目的 探讨经会阴盆底超声参数对压力性尿失禁患者康复训练效果的评估.方法 选取2019年6月至2021年6月常州市第一人民医院和徐州市中心医院收治的48例产后压力性尿失禁患者作为观察组,另选取同时期产后无压力性尿失禁患者48例作为对照组,比较两组患者一般资料;分析并比较观察组患者康复治疗前、后及其与对照组之间盆底超声参数变化.结果 观察组患者康复治疗前静息状态与Valsalva动作后的盆膈裂孔面积(LHA)、膀胱尿道后角(RA)均显著高于康复治疗后和对照组,而膀胱颈至耻骨联合后下缘的垂直距离(BSD)均显著低于康复治疗后和对照组(P＜0.05);观察组康复治疗后静息状态和Valsalva动作后的LHA、RA、BSD与对照组比较,差异无统计学意义(P＞0.05).结论 盆底超声参数能有效反映不同动作下压力性尿失禁患者盆底结构的变化并能有效评估患者康复训练效果.

Objective:To assess the value of conventional sonographic characteristics of thyroid nodules combined with internal coarse calcification in differentiating benign and malignant thyroid nodules.Methods:The ultrasonographic data of 217 patients with 229 thyroid nodules confirmed by pathology at Changzhou First People's Hospital from January 2018 to July 2020 were retrospectively analyzed. Ultrasonography of the included nodules showed that there were coarse calcifications in the nodules. According to the gold standard of pathological results, the nodules were divided into either a benign (n=110) or a malignant (n=119) group. The conventional sonographic characteristics of nodules including maximum diameter, anteroposterior/transverse diameter ratio, echo intensity, growth pattern, composition, margin, and color Doppler flow imaging, and sonographic characteristics of coarse calcification including thickness, calcification interruption, morphology, margin of soft tissue outside the calcification, echo consistency, and location were analyzed retrospectively. Univariate analysis was used to compare the conventional sonographic characteristics of nodules and coarse calcification in nodules between the two groups. Binary logistic regression was used to establish prediction models of conventional nodule characteristics (model 1) and the comprehensive characteristics of nodules and coarse calcification (model 2). The diagnostic performance of each parameter and the combined model was compared by receiver operating characteristic curve (ROC) analysis and Z-test.Results:The maximum diameter of thyroid nodules ≤1.25 cm, anteroposterior/transverse diameter ratio >0.78, being solid, vertical growth, irregular margin or extra-thyroidal extension, as well as irregular thickness, interruption, echo inconsistency, soft tissue edge ,and central type of coarse calcification were significantly more common in the malignant group than in the benign group (P＜0.05). Model 1 included the maximum diameter, anteroposterior/transverse diameter ratio, and margin of the nodule. In model 2, the maximum diameter of nodule, anteroposterior/transverse diameter ratio, and calcification thickness, interruption, and location were included. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of model 2 were 81.85%, 82.73%, 82.29%, 80.18%, and 81.22%, respectively. The area under the curve was 0.877, which was significantly higher than that of model 1 (0.753; Z=4.197, P＜0.001).Conclusion:Sonographic characteristics such as irregular thickness, interruption, and central calcification in nodules are helpful for the diagnosis of malignant nodules. While observing the sonographic characteristics of thyroid nodules, it is important to evaluate the characteristics of internal coarse calcification in order to better distinguish benign and malignant thyroid nodules.

医患沟通是临床医师与患者之间最重要的互动项目,沟通情况不仅关系到患者诊疗效果,也可能成为医患纠纷的起因,加强医生医患沟通能力培训,对临床工作开展意义重大.文章主要分析当前医院全科医生医患沟通能力培训现状,探讨培训工作存在的不足与缺陷,提出相应的管理对策,期待能为临床全科医生医患沟通培训工作做出贡献.

全科医师的教育和培养是保障国家全科医学事业可持续发展的关键.目前中国全科医生培养已经取得了一定成果,教育成绩显著,但同时也发现了一些问题,其中不乏有棘手的难题,制约了中国全科医学教育培养工作进展.调查分析全科医生培养现状,发现问题并制定对策,合理利用医疗资源,对中国医疗卫生事业发展有重要意义.文章主要从中国全科医生培养现状、全科医生培养存在的问题和解决对策与措施三个方面做一综述.

目的:对台州市全科医师的科研能力现状进行调研与分析,并针对现状提出相应的管理对策.方法:随机选取台州市12家社区卫生服务中心的86名全科医师作为研究对象,通过问卷的方式对台州市全科医师的科研能力现状进行调查与分析.结果:在参与科研意愿调查中发现愿意参加科研的有49名,认为需要开展科研活动的有64名,认为开展科研存在困难的有57名,认为进行科研的目的主要是为了晋升职称的有58名,经常阅读医学期刊有17名,主动了解学科前沿研究进展的有21名,经常主动使用医学数据库的有14名.在参与科研工作调查中发现未发表过论文有33名,未主持过课题的有65名,未参与过科研培训的有33名.调查对象在2012～2016年期间总共发表论文为296篇,其中核心期刊有135篇,非核心期刊有161篇,论文研究方向中关于疾病和健康相关的研究的数量最多,其次是社区卫生服务管理,且论文发表数量呈现逐年上升趋势,不同机构在发表数量上有着明显的差异(P＜0.05).结论:台州市全科医师论文发表数量不断增加,但不同机构科研水平层次不齐,研究方向相对单一,整体科研实力偏弱,且全科医师参与科研意愿不高,多数医师进行科研的目的为了晋升职称,缺乏对科研的主动精神.应该在全科医师教育和科研能力培养上进行主动探索,注重营造良好科研氛围,加强科研技能培训.

目的:探究盆底实时进行三维超声技术检测以及尿道内口漏斗在女性压力性尿失禁中的诊断价值.方法:抽取2019年1月至2020年1月在我院进行诊断的30例压力性尿失禁(SUI)女性患者,30例正常女性,其中将30例SUI患者作为实验组,30例正常女性作为对照组,分别进行盆底实时三维超声检测,观察记录两组最大程度Valsalva动作时尿道内口漏斗情况,进行比较分析.结果:实验组中诊断出尿道内口为漏斗型的患者多于对照组,并且尿道内口漏斗深度和宽度测量值较大,组间差异具有统计学意义(P<0.05).结论:应用盆底实时三维超声检测尿道内口漏斗诊断SUI,诊断较为准确,应用价值较高.

目的:研究不同类型乳腺黏液癌超声声像图与病理学特征.方法:回顾性分析97例乳腺黏液癌的超声声像图表现,总结分析其与手术后的病理结果间的关系.结果:97例患者中术前诊断为乳腺癌或可疑乳腺癌的患者60例,97例患者中,单纯型51例,混合型46例.乳腺黏液癌的声像图相应特征为:单纯型黏液癌多为中等回声、边界清楚、形状规则、后方回声增强,混合型粘液癌则多表现为低回声、边界不清、形状不规则、后方回声衰减.混合型黏液癌患者有5例出现淋巴结转移,单纯型黏液癌患者没有出现淋巴结转移.其他声像图表现如血流、钙化无明显差异.结论:乳腺黏液癌的病理组成决定了它的超声声像图特征,单纯型乳腺粘液癌多呈膨胀性生长,似纤维瘤,不易鉴别.

女性盆底功能障碍性疾病（female pelvic floor dysfunction,FPFD）对产后妇女及中老年女性健康和生活产生较大的影响,中盆腔缺陷重建手术越来越多地运用于治疗FPFD。盆底超声是一种实时、安全、无创的检查方式,为中盆腔缺陷重建手术提供了术前评估和术后随访的可靠依据。本文就盆底三维超声运用于中盆腔缺陷重建手术的研究进展作一综述。

目的:探讨延龄草总皂苷(TST)对脑缺血再灌注大鼠肺组织的影响及其可能机制.方法:选取80只雄性大鼠随机分为8组:假手术组、模型组、阳性对照组(尼莫地平,200 mg·kg-1)、TST低(50 mg·kg-1)、中(100 mg·kg-1)、高(200 mg·kg-1)剂量组、腺苷酸活化蛋白激酶(AMPK)/沉默信息调节因子1(Sirt1)通路抑制剂组(1 mg·kg-1)、TST+AMPK/Sirt1通路抑制剂组(200 mg·kg-1+1 mg·kg-1),每组10只.苏木精-伊红(HE)染色检测大鼠肺组织病理变化;检测各组大鼠氧分压(PaO2);酶联免疫吸附(ELISA)法检测各组大鼠支气管肺泡灌洗液中炎性因子水平;检测各组大鼠肺组织氧化应激水平.蛋白免疫印迹(Western blot)法检测肺组织AMPK、磷酸化AMPK(p-AMPK)、Sirt1蛋白表达水平.结果:模型组大鼠肺损伤评分较假手术组高,而阳性对照组与TST不同剂量组均较模型组低(P<0.05);模型组大鼠PaO2、氧合指数(OI)、超氧化物歧化酶(SOD)、p-AMPK及Sirt1蛋白表达水平均较假手术组低,而阳性对照组与TST组(高剂量)较模型组高,AMPK/Sirt1通路抑制剂组与TST+AMPK/Sirt1通路抑制剂组较TST组低,AMPK/Sirt1通路抑制剂组较TST+AMPK/Sirt1通路抑制剂组低(P<0.05);模型组IL-18、IL-1β、TNF-α、IL-6、肺组织湿干质量比、MDA、ROS、Ac-NF-κB p65蛋白表达水平均较假手术组高,而阳性对照组与TST组(高剂量组)较模型组低,AMPK/Sirt1通路抑制剂组与TST+AMPK/Sirt1通路抑制剂组较TST组高,AMPK/Sirt1通路抑制剂组较TST+AMPK/Sirt1通路抑制剂组高(P<0.05);阳性对照组与TST组比较差异均无统计学意义(P>0.05).结论:TST可通过激活AMPK/Sirt1通路并减轻肺组织炎性反应及氧化应激反应进而减缓脑缺血再灌注继发肺损伤.