目的 分析在妇产科教学中使用多元化教学模式的效果.方法 选择2018年9月—2019年9月期间于本院妇产科学习的学生共30名作为研究对象,按照随机数表法分为对照组和观察组,对照组使用LBL教学法进行教学,共15名学生,观察组使用多元化教学模式,共15名学生.对比两组学生成绩指标(理论成绩、实践成绩和综合成绩)、能力指标(思维能力、胜任能力)、学习兴趣指标(学习主动性、知识接受水平以及团队协作意识).结果 观察组理论成绩、实践成绩和综合成绩均高于对照组,思维和胜任能力均优于对照组,学习主动性、知识接受水平以及团队协作意识均高于对照组,多元化教学模式应用效果较好,差异有统计学意义(P<0.05).结论 多元化教学模式可以改变传统教学模式存在的问题,调动学生学习的积极性,提升学生理论知识水平和实践操作能力,加强学生岗位胜任能力以及思维能力,对于后续学生的就业和工作有着积极影响.

Objective:To investigate the risk factors of short-term poor prognosis of neonatal purulent meningitis.Methods:The clinical data of 76 cases of neonatal purulent meningitis treated in the Neonatology Department of Hebei Provincial People′s Hospital from September 2015 to January 2021 were retrospectively analyzed. According to their outcomes of 6-12 months, they were divided into the good prognosis group (n=46) and the poor prognosis group (n=30). The newborn′s general situation, birth history, clinical features, laboratory examination results and pathogenic species were compared between the two groups. Multivariable logistic regression was used to analyze the factors associated with poor outcome, and the ROC curve to assess the effectiveness of each index in predicting prognosis.Results:In the poor prognosis group, the proportion of male (23/30, 76.67%), the proportion of low gestational age (13/30, 43.33%), the proportion of low birth weight (8/30, 26.67%), the proportion of complicated with consciousness disorder (13/30, 43.33%), and the proportion of electrolyte abnormalities (9/30, 30.00%) were higher than those in the good prognosis group [52.17%(24/46), 2.17%(1/46), 2.17%(1/46), 21.74%(10/46), 2.17%(1/46)], the differences between the two groups were statistically significant (χ2=4.62, 4.01, 9.99, all P<0.05). The CSF white blood cell count [435(165, 875)×106/L] and CSF protein level [1.54(0.90, 2.38)g/L] in the poor prognosis group were higher than those in the good prognosis group [78(32, 305)×106/L, 0.70(0.57, 1.02)g/L)], and the CSF glucose/blood glucose ratio [0.37(0.27, 0.53)] was lower than that in the good prognosis group [0.54(0.46, 0.68)]. The differences between the two groups were statistically significant (Z=-3.78, -4.72, -3.26, all P<0.01). Logistic regression analysis showed that CSF white blood cell count, CSF protein level and CSF glucose/blood glucose ratio were risk factors for poor prognosis (OR=1.002, 2.840, 0.056; all P<0.05). The ROC curve showed that area under the curve (AUC) of CSF white blood cell count, CSF protein level, CSF glucose/blood glucose ratio, and the combined model were 0.800, 0.822, 0.769, and 0.879, respectively.Conclusion:High CSF white blood cell count, low CSF glucose/blood glucose ratio and high CSF protein level are independent risk factors for short-term poor prognosis of neonatal purulent meningitis.

癫痫是儿童神经系统最常见的慢性发作性疾病.癫痫患儿易合并智力障碍、特殊学习障碍、自闭症谱系障碍、注意缺陷多动障碍、抑郁和焦虑障碍等神经精神共患病,逐渐受到儿科临床医师的重视,但目前对其认识尚不充分,可能造成诊断和治疗的不全面.积极探讨癫痫患儿神经精神共患病的临床类型和特点、特殊癫痫综合征患儿的心理行为、癫痫患儿神经精神共患病的潜在危险因素及其内在关系,有助于探索癫痫神经精神共患病的协同诊疗和长程管理原则,并最大限度地提高癫痫的治疗效果,改善癫痫患儿的生活质量.

目的 总结Helsmoortel-Van der Aa综合征的临床特征、分子生物学特点,为该病的早期诊断提供临床依据.方法 分析2017年9月该院儿科收治的1例确诊为Helsmoortel-Van der Aa综合征患儿的病例资料,对该患儿及其父母进行遗传学分析并进行相关文献复习.结果 患儿男,18个月龄,存在运动、语言、智力发育障碍,孤独症谱系障碍,乳牙萌出早,有行为问题,外貌畸形,身材矮小,听力障碍,便秘,反复呼吸道感染等临床表现,基因检测发现定位于20号染色体上的功能活性依赖神经保护蛋白(ADNP)基因存在移码突变.其父母均未携带该突变.结论 该例患儿有Helsmoortel-Van der Aa综合征共同的表现:运动、语言、智力发育障碍和孤独症谱系障碍,典型的外貌特点,标志性的特征乳牙萌出早,同时有以往文献未报道过的胰岛素样生长因子减低.

目的 总结PIGT基因突变相关癫痫的临床特点和诊治.方法 回顾性分析1例我院确诊的PIGT基因突变相关癫痫患儿的临床资料,并复习相关文献.结果 患儿生后3个月时以抽搐起病,同时伴有精神、运动发育落后,经基因检测证实有PIGT基因突变.给予口服左乙拉西坦2个月余控制欠佳,加用丙戊酸钠治疗1个月余后仅表现为右下肢抖动,持续数秒钟,间歇性发作,每日20余次.后加用奥卡西平,上述症状无好转.结论 PIGT基因突变所致癫痫起病年龄早,常合并发育迟缓/智力障碍,多种抗癫痫药物控制不佳.所以,对于难治性癫痫,应尽早完善基因检测,以明确诊断,指导治疗.

目的 探讨炉甘石洗剂混合茶油用于低分子肝素钙腹壁皮下注射后硬结瘙痒安全性及有效性.方法 选取2017年1月至2018年12月本院收治的低分子肝素钙腹壁皮下注射后硬结瘙痒患者120例作为研究对象,随机分为研究组与对照组,每组60例.对照组给予常规治疗,研究组患者给予炉甘石洗剂混合茶油治疗.分析比较两组患者临床效果、瘙痒消失时间、硬结大小及Znug焦虑自评量表(SAS)、Znug抑郁自评量表(SDS)评分.结果 研究组患者总有效率为95.00％,对照组总有效率为76.67％(P<0.05).治疗前,两组患者硬结直径比较差异无统计学意义;治疗后,研究组患者瘙痒消失时间、硬结直径明显低于对照组(P<0.05).治疗前,两组患者SAS、SDS比较差异无统计学意义;治疗后,两组患者SAS、SDS均有所改善(P<0.05),研究组患者SAS、SDS明显低于对照组(P<0.05).结论 炉甘石洗剂混合茶油用于低分子肝素钙腹壁皮下注射后硬结瘙痒临床效果显著,能够有效控制患者临床症状,改善患者负面情绪,缩短病程,有利于患者身心健康恢复,值得推广.

目的 分析穴位按压在减轻肌内注射患者疼痛中的应用价值.方法选取2017年1月至2018年1月需要肌内注射刺激性药物3～5 d的患者64例,按照不同注射方法分为对照组和观察组,各32例.对照组给予常规肌内注射与护理,观察组在对照组基础上护士进行肌内注射时,在给患者臀部皮肤消毒待干的同时联合按压环跳穴和秩边穴,随后再按"两快一慢"进行肌内注射.对比两组注射时的疼痛情况和局部不良反应发生情况.结果观察组注射时的疼痛情况明显轻于对照组,差异有统计学意义(P<0.05).观察组局部不良反应发生率均明显低于对照组,差异有统计学意义(P<0.05).结论对于需要肌内注射刺激性药物3～5 d的患者,采用常规注射护理与穴位按压,操作方便,流程合理,能有效减轻患者的疼痛.

目的 观察和评价分析按揉环跳穴位对苄星青霉素肌内注射成功率的影响.方法 选取2016年10月至2018年1月收治的肌内注射苄星青霉素患者120例,按照双盲法分为观察组和对照组,各60例.对照组采用常规注射与干预,观察组在对照组基础上进行按揉环跳穴位.观察两组苄星青霉素肌内注射一次成功率和护理满意度.结果 观察组一次注射成功率为96.7％(58/60),高于对照组的78.3％(47/60),差异有统计学意义(P<0.05).观察组护理满意度为95.0％(57/60),明显高于对照组的80.0％(48/60),差异有统计学意义(P<0.05).结论 在肌内注射苄星青霉素时先按揉环跳穴2 min,能提高患者的痛阈,增加对疼痛的耐受,从而减轻患者疼痛紧张造成的针头阻塞.

目的 探讨运用品管圈降低门诊注射输液室外周静脉输液重注率的效果.方法 2016年3～9月组建品管圈小组,以“降低门诊注射输液室外周静脉输液重注率”为主题,采用头脑风暴法、鱼骨图、柏拉图等方法分析造成重注率高的主要原因,比较实施品管圈前后门诊注射输液室外周静脉输液重注率变化情况.结果 实施品管圈活动后外周静脉注射重注率为4.2％,显著低于实施前的25.7％,差异有统计学意义(P＜0.05),进步幅度为83.7％;与实施前比较,实施品管圈活动后输液室护士穿刺技术水平、工作积极性、健康教育能力、团队协助能力、解决问题能力、沟通交流能力、品管手法运用均有提高.结论 品管圈有助于降低门诊注射输液室外周静脉输液重注率,提升护理质量,值得推广应用.

目的：探讨产房实施医护合作工作模式作用效果。方法：选取初产妇80例为试验组，实施医护合作工作模式。80例初产妇为对照组，实施常规工作模式。比较两组患者护理质量、医生对护理的满意度、患者对护理满意度、不良事件的发生率。结果：试验组护理质量、医生对护理的满意度、患者对护理满意度高于对照组，不良事件发生率少于对照组，差异有统计学意义（P ﹤0.05）。结论：在产房实施医护合作工作模式，能提高对产妇的护理质量，提高医生对护理的满意度、患者对护理满意度，减少不良事件的发生率，值得推广。

ObjectivesTo explore the neuropathological characteristics of children with temporal intractable epilepsy. MethodsA retrospective analysis of the pathological characteristics was conducted in 38 children who underwent epilepsy surgery from December 2011 to December 2013.ResultsAmong 38 patients, aged 2.5-14 years, 21 boys and 17 girls, 21 cases had focal cortical dysplasia (FCD), 1 case had FCDⅠa, 2 cases had FCDⅠb, 1 case had FCDⅡa, 3 cases had FCDⅡb, 5 cases had CDⅢa, 1 case had FCDⅢb, 1 case had FCDⅢc, 6 cases had FCDⅢd. Three cases had microdysgenesis, 3 cases had simple hippocampal sclerosis, 7 cases had neoplasms, 5 cases had dysembryoplastic neuroepithelial tumor, 2 cases had astroglioma, 2 cases had encephalitis, 2 cases had arachnoid cyst. ConclusionsFCD is the most common form that causes temporal lobe intractable ep-ilepsy in children. FCDIIId is the most common subtype in FCD.

目的:探讨精细化护理模式在门诊输液患者中的应用价值.方法:选取医院门诊输液室实施精细化护理前后各半年时间内患者的平均等候时间、医疗投诉发生率,并采用焦虑自评量表和自拟调查问卷分别对患者的心理状态、护理满意度等进行调查.结果:精细化护理实施前后,患者的输液平均等候时间分别为(15.1±2.3) min和(7.0±1.4) min,医疗投诉发生率分别为3.2％ (16/500)和0;焦虑发生率分别为42.4％和5.6％,护理满意度分别为68.4％ (342/500)和98.4％ (492/500),精细化护理实施后的各项指标的比较均显著优于实施前,差异均有统计学意义(P＜0.05).结论:精细化护理模式在门诊输液过程中的实施与应用可大大缩短患者的等候时间,提高护理人员的服务意识和服务质量,改善患者对护理的满意程度,降低护患纠纷的发生率.

目的 研究STAT3在成人局灶性皮质发育不良(Focal cortical dysplasias,FCD) Ⅲa型颞叶组织中的表达情况,探讨FCDⅢa的发病机制.方法 选取20例FCDⅢa型患者的颞叶皮质组织和5例行颅内减压术患者的颞叶组织为研究对象,分别通过免疫组化和蛋白免疫印迹方法检测各标本中STAT3、P-STAT3(ser727)的表达水平.结果 P-STAT3(ser727)在FCDⅢa患者颞叶皮质中表达较对照组增加,两组差异有统计学意义(P＜0.05).结论 活化的STAT3可能参与成人FCDⅢa型的发病机制,推测是通过介导星形胶质细胞增生途径实现的.

Objectives To detect the expression of STAT3 in children with FCD (focal cortical dysplasias) type IIIa. Methods The expression of STAT3 and P-STAT3 (ser727) were determined in temporal lobe specimens from 26 children with FCD type IIIa and from 5 normal control by immunohistochemistry, immunolfuorescence and Western blot. Results The expression of P-STAT3 (ser727) was obviously higher in FCD type IIIa than in control group. P-STAT3 (ser727) was located mainly in the nucleus of astrocytes. Conclusions Activated STAT3 might contribute to the patholgenesis of FCD type IIIa by mediating proliferation of astrocytes.

提高患者身份辨识操作正确率。 CQI小组活动。患者身份辨识率由原来的88.89%提高到现在的94.44%。

精神分裂症断裂基因1(DISC1)是精神疾病的重要候选基因,是精神分裂症、双相情感障碍、抑郁症、自闭症和阿斯伯格综合征的一个共同的危险因素.许多遗传研究证实,DISC1不只是与精神分裂症有关,而且与各种伴有神经发育异常和细胞内的脑功能障碍信号通路有关.目前对DISC1在中枢神经系统作用的研究主要集中在神经元发生和神经元突触发育方面,如神经元的成熟、增殖、迁移、定位、分化,树突生长和突触可塑性等.DISC1编码DISC1蛋白,DISC1蛋白是一种多功能支架蛋白,它在成人大脑,尤其在海马齿状回的神经发生和神经发育方面具有重要的作用.DISC1有望成为精神疾病和癫(间)的一个治疗靶点.本文就DISC1的生物学特性及主要相关信号通路作一综述.

Objective To discuss the effect of gene transfection of rAAV2/1-NPY-EGFP on KA-induced rat seizures,EEG and the expression of hippocampal phosphorylated Tau protein.Methods Altogether 72 healthy male Wistar adult rats were randomly divided into three groups:control group,KA group and NPY group(n=24).The epileptic models were established by the injection of KA 2 μl (0.4 μg/μl) five times to the right side of the hippocampus CA3 area every three days.rAAV2/1-NPY-EGFP group,in which 10 μl of rAAV2/1-NPY-EGFP (titer 5× 1011 v.g./ml) was injected to the lateral ventricle in successful rats chronic model,while KA group was injected with an equal dose of saline.The control group was injected with an equal dose of saline both in the hippocampal CA3 area and the lateral ventricle.The seizure situation,the onset latency and EEG were observed at 2 weeks and 4 weeks after vector injection.Then the expression of phosphorylated Tau protein in hippocampus were detected with Western blotting.Results (1) Scale and latency of each seizure onset in rats of rAAV2/1-NPY-EGFP group (12.13 ± 8.06) had no significant difference at 2 weeks (P＞ 0.05) compared with KA group (12.10± 8.07).The scale of seizure in rats of rAAV2/1-NPY-EGFP group(6.06±3.78) significantly reduced at 4 weeks(P ＜0.05).Latency of seizure onset (79.06±8.83min) significantly increased at 4 weeks(P＜0.05),EEG epileptic discharge frequency and wave amplitude decreased (P＜ 0.05) at 4 weeks.The control group had no seizures.(2)Compared with the control group,the expression of phosphorylated Tau protein in KA group and NPY group significantly increased(P＜0.05) at 2 weeks and 4 weeks,and the expression of phosphorylated Tau protein in the NPY group (1.15±0.16 RQ value) at 4 weeks significantly decreased (P＜0.05) compared with the KA group(1.87± 0.23 RQ value).Conclusion rAAV2/1-NPY-EGFP gene transfection significantly reduces scale of seizure onset and prolongs latency of seizure onset in KA-induced rat model.rAAV2/1-NPY-EGFP gene transfection may play anti-epileptic and neuroprotective effects through inhibiting the expression of phosphorylated Tau protein in hippocampus of KA-induced epileptic rat model.

目的：观察重组腺相关病毒介导人源性神经肽Y基因（ rAAV2/1-hNPY-EGFP）转染对红藻氨酸（ KA）致痫大鼠海马组织中P35表达的影响，探讨其在癫痫发病机制中的作用以及NPY基因治疗慢性癫痫的可能机制。方法 Wistar健康老年雄性大鼠96只，随机分为四组，A组：海马CA3区间断注射KA 1.5μl（0.4μg/μl）5次制成慢性癫痫大鼠模型；B 组：在 A 组模型基础上，脑室注射 rAAV2/1-empty-EGFP 10μl，滴度为5×1011/ml；C组：在A组模型基础上，脑室注射rAAV2/1-hNPY-EGFP 10μl，滴度为5×1011/ml；D组：注射药物为生理盐水，方法同A组。将四组大鼠分别于基因导入后2 w和4 w，取大脑海马组织，荧光定量PCR技术检测大鼠海马中NPY和P35 mRNA的表达，免疫组织化学技术检测二者蛋白的表达。结果在注射后2 w，A、B、C组大鼠NPY和P35 mRNA及蛋白的表达水平均升高，与 A组相比有明显差异（P＜0.05）；在注射后4 w，rAAV2/1-hNPY-EGFP在癫痫病理状态下的脑组织中实现有效表达，C组大鼠海马组织中NPY的表达明显升高，而P35的表达明显降低，与A组及B组大鼠相比有明显差异（P＜0.05）。结论 rAAV2/1-hNPY-EGFP基因转染可以抑制KA致痫大鼠海马中P35的表达，进而发挥抗癫痫作用，为NPY基因治疗癫痫病提供了有力试验支持。

Objective To enhance the rate of early diagnosis of inherited metabolic disease(IMD) occurring in neonatal period through selective screening. Methods The dry blood filter papers were tested by tandem mass spectrometry(MS/MS) technology in 416 neonates suspected to be with IMD and 1928 neonates without any clinical symptoms. Results Forty-one(9.86%) of the 416 high risk neonates were diagnosed with 11 kinds of IMD and 6(0.31%) of the 1928 normal neonates were diagnosed with 3 kinds of IMD. Conclusion Early diagnosis of IMD in neonatal period by current available screening techniques is helpful for earlier treatment and better prognosis.

目的探讨能全力在老年患者肠内营养支持中的重要性。方法选择30例老年患者,采用能全力肠内营养,观察患者治疗前后的蛋白水平及生命体征的变化。结果治疗3个月后总蛋白、清蛋白、前清蛋白水平叫治疗前均明显升高,差异有统计学意义(P<0.05)。治疗后与治疗前体温、呼吸、心率、血压比较差异无统计学意义(P>0.05)。结论对于老年患者,如果存在进食困难的情况时,选择能全力肠内营养支持是可行的。肠内营养符合生理要求、费用低、并发症少。既能延长老年人的生存时间又能节约患者的治疗费用,可广泛应用。