衡阳地区STD患者病原体检测结果分析

目的了解衡阳地区性传播疾病(STD)患者病原体感染情况及特征。方法淋病奈瑟菌(NG)、解脲脲原体(UU)、人型支原体(MH)采用培养法;沙眼衣原体(CT)、人乳头瘤病毒(HPV)、单纯疱疹病毒(HSV)核酸采用PCR法;梅毒螺旋体(TP)采用RPR、TPPA法,对2 420例可疑STD患者进行检测分析。结果确诊STD 922例,各种病原体阳性检出率为UU(29.6%)>CT(20.8%)>HPV(17.8%)>NG(17.4%)>MH(6.3%)>HSV(4.2%)>TP(3.9%)。结论本组STD患者中UU感染率最高,CT、HPV感染率次之,TP感染率最低。     

SAPHO综合征1例

SAPHO综合征是以滑膜炎(synovitis)、痤疮(acne)、脓疱病(pustulosis)、骨肥厚(hyperostosis)和骨炎(osteitis)为特征的一组疾病综合群,与脊柱关节病及关节病型银屑病(psoriatic arthritis,PsA)     

前列腺癌内分泌治疗患者性心理调查与护理干预

目的:探讨护理干预应用在前列腺癌内分泌治疗患者中的护理效果及心理状态分析。方法:对我院开展内分泌治疗的前列腺癌患者104例采用随机数字表法分为观察组和对照组,每组各52例,对照组给予内分泌治疗,观察组联合综合护理干预,对比两组治疗情况。结果:观察组干预后焦虑量表评分(48.76±2.41)分,抑郁量表评分(51.81±3.17)分;对照组干预后焦虑量表评分(58.33±6.88)分,抑郁量表评分(64.77±7.28)分,组间对比差异有统计学意义(t=9.4666、11.7699,P0.05)。观察组干预后尿路症状(22.43±3.82)分,肠道症状(11.88±2.65)分,其他症状(21.37±4.08)分,性功能量表中性兴趣(7.21±3.13)分,性愉悦(5.81±2.72)分,性质量(76.51±10.38)分,其中症状量表评分优于对照组,组间对比差异有统计学意义(t=5.9260、7.5247、7.6762,P0.05)。对照组躯体功能(60.43±5.87)分,角色功能(62.54±5.39)分,认知功能(56.24±3.86)分,情绪功能(58.27±4.32)分,社会功能(62.18±5.41)分;观察组躯体功能(71.83±11.32)分,角色功能(73.44±12.15)分,认知功能(74.65±9.87)分,情绪功能(70.16±10.85)分,社会功能(72.51±13.22)分,组间对比差异有统计学意义(t=6.6648、5.9135、12.5266、7.3418、5.2149,P0.05)。结论:应用综合护理干预在前列腺癌内分泌治疗患者中能够改善患者焦虑和抑郁状态,提升治疗后生活质量,值得在临床上推广应用。     

女性闭经后萎缩性尿道炎患者血清FSH、LH、PRL检验的临床意义分析

目的:分析并探讨女性闭经后萎缩性尿道炎患者血清卵泡刺激素(FSH)、促黄体生成素(LH)、泌乳素(PRL)检验指标的意义。方法:选取2012年1月至2016年1月我院收治的女性闭经后萎缩性尿道炎患者80例为观察组,选取同期体检健康女性80例为对照组,检测两组FSH、LH、PRL水平。结果:观察组FSH水平为(11.73±6.31)mU/mL,LH水平为(12.31±7.34)mU/mL,PRL水平为(38.13±12.14)ng/mL。对照组FSH水平为(6.57±2.45)mU/mL,LH水平为(4.49±3.12)mU/mL,PRL水平为(15.24±5.35)ng/mL。观察组FSH、LH以及PRL水平明显高于对照组(P0.05)。观察组雌二醇(E_2)水平为(41.24±16.53)pg/mL,孕酮(P)水平为(0.51±0.34)pg/mL,睾酮(T)水平为(0.33±0.14)ng/mL。对照组E_2水平为(51.42±9.43)pg/mL,P水平为(0.52±0.32)pg/mL,T水平为(0.34±0.15)ng/mL。观察组E_2水平明显低于对照组(P0.05),两组P、T检测无显著差异(P0.05)。结论:女性闭经后萎缩性尿道炎患者血清FSH、LH、PRL明显升高,临床上可作为闭经后萎缩性尿道炎诊断进行参考,提前做好防治措施。     

全子宫和次全子宫切除术对子宫肌瘤患者盆底功能及生活质量的影响

目的:探讨全子宫与次全子宫切除术对患者盆底功能和生活质量的影响。方法:选择我院子宫切除手术治疗的子宫肌瘤患者130例采用随机数字表法分为观察组和对照组,对照组给予全子宫切除,观察组采用次全子宫切除,记录两组治疗情况。结果:观察组手术时间(70.83±10.31)min,术中出血量(108.74±14.58)m L,术后肛门排气时间(1.13±0.31)d,住院时间(5.66±1.11)d;对照组手术时间(92.38±16.37)min,术中出血量(142.97±27.15)m L,术后肛门排气时间(1.87±0.94)d,住院时间(8.96±2.24)d,组间对比差异具有统计学意义(P0.05)。观察组性欲(188.37±17.32)分,性唤起(180.45±19.94)分,性高潮(176.98±19.13)分,性心理(178.85±17.69)分,性行为(140.28±12.77)分,综合评分(176.79±15.77)分;对照组性欲(165.28±10.33)分,性唤起(161.31±11.04)分,性高潮(160.38±9.97)分,性心理(163.46±10.05)分,性行为(121.39±6.76)分,综合评分(160.09±8.87)分,组间对比差异具有统计学意义(P0.05)。观察组术后3个月E2(98.37±8.96)pg/m L,FSH(14.57±1.14)m IU/m L,LH(24.59±2.47)m IU/m L;对照组术后3个月E2(70.04±4.55)pg/m L,FSH(19.81±1.88)m IU/m L,LH(34.57±3.76)m IU/m L,组间对比差异具有统计学意义(P0.05)。结论:采用次全子宫切除手术应用在子宫肌瘤患者中可以缩短手术时间,减少手术出血,缩短术后肛门排气时间和住院时间,提升患者术后性功能评分,对患者性激素水平影响更小,值得在临床上推广应用。     

51例麻风患者临床及皮肤病理分析

回顾性分析2013年1月至2020年6月我科收治的51例麻风患者临床资料,其中男34例,女17例;35例首诊考虑麻风,16例误诊。皮损主要位于面颈部、躯干、四肢,表现为弥漫性浸润性斑片、斑块,其中伴眉毛脱落(21例)、尺神经粗大(1例)、感觉异常(13例)、畸形(1例),皮疹处瘙痒(2例)。临床分型:结核样型(TT)2例、界线类偏结核样型(BT)2例、中间界线类(BB)2例、界线类偏瘤型(BL)10例、瘤型(LL)34例、未定类麻风(I)1例。I型麻风反应5例(9.8%)、II型麻风反应12例(23.52%)。组织病理示表皮萎缩、变薄33例(64.70%)、有无浸润带30例(58.82%),病变累及真皮全层8例(15.60%);抗酸染色(Wade-Fite染色)阳性率49例(96%)。     

阻塞性睡眠呼吸暂停低通气综合征与勃起功能障碍的相关性研究

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者与勃起功能障碍(ED)之间的相关性。方法:OSAHS患者60例,纳入观察组;门诊体检健康志愿者60例,纳入对照组,采用PSG睡眠监测仪和NPT同步监测两组患者睡眠状态及阴茎勃起情况,包括呼吸暂停低通气指数(AHI)、最低动脉血氧饱和度(min Sa O2)和阴茎血容积变化率(%)。硝酸还原酶法、比色法分别检测NO、i NOS浓度,ECLIA法检测血清睾酮(T)、游离睾酮(FT)、卵泡刺激素(FSH)、黄体生成激素(LH)、催乳素(PRL)水平,国际勃起功能指数评分5项(IIEF-5)评估男性OSAHS患者ED的发病率,并对数据进行相关分析。结果:OSAHS组T(2.10±2.42)、FT(9.76±2.33)、NO(72.51±11.74)、iN OS(25.32±11.57)、minS aO 2(71.23±5.71)、阴茎血容积变化率(158.36±32.87),与对照组相比,差异有非常显著的统计学意义(P0.01),OSAHS组AHI(45.75±11.92)显著高于对照组(P0.05)。OSAHS患者ED的发生率显著高于对照组(P0.01),重度ED患者NO(32.57±6.33)、iN OS(8.06±1.01)、阴茎血容积变化率(135.56±16.92)及IIEF-5总分(5.3±2.3)明显低于轻中度ED患者(P0.01)。结论:OSAHS与ED有明显的相关性,NO升高、低氧血症、T降低可能是OSAHS患者导致ED的机制。     

Bcl-2、CD10、CD34、CK15表达在基底细胞癌和毛发上皮瘤鉴别诊断中的意义

目的:观察Bcl-2、CD10、CD34、CK15在基底细胞癌(BCC)和毛发上皮瘤(TE)中的表达,探讨其在两种肿瘤诊断和鉴别中的作用。方法:对确诊的36例BCC和16例TE石蜡包埋标本行Bcl-2、CD10、CD34、CK15免疫组化染色,观察其在肿瘤细胞及其周围间质中的表达。结果:在BCC和TE中表达的阳性率分别为Bcl-2(栅栏状模式):0、68.75%;CD10(肿瘤细胞染色):72.22%、12.50%;CD10(间质染色)2.78%、62.50%;CD34:0、12.5%;CK15:5.56%、56.25%,其中Bcl-2、CD10、CK15表达差异有统计学意义(P值均<0.01),而CD34表达差异无统计学意义(P>0.05)。灵敏度:CD10(肿瘤细胞染色)72.22%>Bcl-2(68.75%)>CD10(间质染色)62.50%>CK15(56.25%)。特异性:Bcl-2(100%)>CD10(间质染色)97.22%>CK15(94.44%)>CD10(肿瘤细胞染色)87.50%。准确度:Bcl-2(90.38%)>CD10(间质染色)86.54%>CK15(82.69%)>CD10(肿瘤细胞染色)65.38%。阳性预测值:Bcl-2(100%)>CD10(肿瘤细胞染色)92.86%>CD10(间质染色)90.91%>CK15(81.82%)。阴性预测值:Bcl-2(87.80%)>CD10(间质染色)85.37%>CK15(82.92%)>CD10(肿瘤细胞染色)58.33%。结论:Bcl-2、CD10在BCC和TE中表达模式的差异,以及CK15在TE中高表达,有助于这两种肿瘤的鉴别诊断,CD34对于鉴别BCC和TE意义不大。     

丹益片联合低频脉冲治疗仪治疗Ⅲ型前列腺炎伴早泄的临床观察

目的:探讨口服丹益片联合低频脉冲治疗Ⅲ型前列腺炎合并早泄的临床疗效。方法:选取240例符合Ⅲ型前列腺炎合并早泄诊断标准患者为研究对象,随机分为口服丹益片联合低频脉冲治疗组(研究组)、丹益片药物治疗组(对照1组)和低频脉冲治疗组(对照2组),每组80例,治疗4周,记录各组治疗前后美国国立卫生研究院慢性前列腺炎症状指数(NIH-CPSI)评分及阴道内射精潜伏期(IELT)。对比分析三组患者治疗前后的NIH-CPSI评分及IELT,比较三组治疗的显效率。结果:研究组、对照1组、对照2组治疗前NIH-CPSI评分分别为(28.6±5.3)、(27.6±5.1)、(28.5±4.9)分,治疗后分别减低为(11.4±2.3)、(18.5±3.1)、(19.4±3.3)分(P0.05)。三组治疗前的IELT分别为(0.81±0.16)、(0.74±0.15)、(0.82±0.17)min,治疗后分别延长为(5.81±0.96)、(3.74±0.85)、(3.12±0.87)min(P0.05)。显效率分别为80%、60%、45%(P0.05)。结论:口服丹益片联合低频脉冲对于Ⅲ型前列腺炎合并早泄取得较好疗效,且比单独丹益片药物治疗或单独使用低频脉冲治疗所取得的临床疗效更好。     

46例斑秃患者经络生物共振检测结果病因分析

目的斑秃病因未明,利用经络生物共振检测技术开展大范围斑秃患者病因检测与分析。方法采用德国MORA-Supe经络生物共振仪,通过人体体表经络穴位广泛开展人体内不耐受物质和器官检测。结果环境化学物质作为首要病因39例(84.78%)、植物类26例(56.52%)、电磁辐射19例(41.30%)、动物蛋白15例(32.61%)、寄生虫12例(26.09%)、动物脂肪6例(13.04%)、微生物7例(15.22%)、酒类4例(8.70%)、精神因素3例(6.52%)、食用真菌2例(0.04%)。结论斑秃病因检测结果,以环境化学物质因素(87.78%)远远高于其他因素,需要引起注意。     

Community based rehabilitation programmes: monitoring and evaluation in order to measure results

Although Community Based Rehabilitation has now formally existed for almost 30 years, few papers have been written about the results of this approach. The authors hope to contribute with this paper towards methodologies that will help to measure results of Community Based Rehabilitation programmes. The importance of establishing--prior to the development of Community Based Rehabilitation--an extensive baseline has not been extensively covered as the importance of it is almost self-evident; yet the lack of baseline data often severely hampers the possibility of being able to measure the effects of Community Based Rehabilitation. The article places considerable importance on management information systems and monitoring, since it is believed that evaluation will greatly benefit from both the existence of baseline data as well as a well-developed and well-implemented information system. The present article emphasises the need for participatory processes in the development of baseline data and information systems. Four key areas for measuring CBR are highlighted: people, power, public society and partnerships. Finally, a tool is presented in order to evaluate (or monitoring and evaluation) systematically. What gets measured gets done; If you don't measure results, you can't tell success from failure; If you can't see success, you can't reward it; If you can't reward success, you're probably rewarding failure; If you can't see success, you can't learn from it; If you can't recognize failure, you can't correct it; If you can demonstrate results, you can win public support.     

全自动化学发光免疫分析仪在梅毒螺旋体抗体检测中的临床应用

目的探讨CHEMCLIN(600型全自动化学发光免疫分析仪(下称CLIA法)在梅毒螺旋体抗体检测中的临床应用价值。方法通过测定CLIA法在梅毒螺旋体抗体检测中的精密度、携带污染现象、灵敏度、干扰试验及对比试验。并进行统计分析1484份临床血清标本用CLIA法、甲苯胺红不加热血清试验(TRUST)和梅毒螺旋体明胶凝集试验(TPPA)三种方法的平行检测的结果。结果 CHEMCLIN(600型系统对高、中、低度3个浓度梅毒螺旋体抗体阳性标本检测的重复性结果显示,其批内、批间的变异系数均低于10%。通过比较强阳性混合血清混合前后及阴性混合血清,系统吸样针无携带污染,差异无显著性(P0.05)。用CLIA法和TPPA法同时检测弱阳性标本,CLIA法1∶16稀释检测结果为阴性,TPPA法1∶4稀释检测为阴性。三酰甘油浓度高达20.0mmol/L、血红蛋白浓度高达30.0g/L、胆红素高达95mol/L时对测定结果的发光值影响度3.5%,且前后判断结果不变。比较CLIA法与进口仪器I2000两种方法 ,差异无统计学意义P0.05。TPPA法与CLIA法两种方法检测结果比较,差异也无显著性(P0.05)。CLIA的敏感度为98.4%,特异度为99.8%。结论 CHEMCLIN(600型全自动化学发光免疫分析仪系统作为国内新开发的梅毒血清学特异性抗体检测方法 ,其检测精密度较好,无携带污染现象,检测灵敏度高于TPPA法,抗干扰能力强。其敏感性和特异性都很高,自动化程度高,值得在临床推广应用。     

Patient satisfaction and high-reliability organizations: what's the connection?

Patients' perceptions of their care is extremely varied based on their expectations and of the actual variability of the care provided to them. The signature experience is the concept by which we can clearly develop the vision of the ideal experience for patients and staff. Patients can't heal effectively when their environment does not support an atmosphere where the signature experience is foremost in everyone's mind and activity.     

尖锐湿疣患者郎格罕细胞观察

用ＯＫＴ６单抗及ＡＢＣ法观察了１８例尖锐湿疣患者包皮病损中郎格罕细胞（ＬＣ）的数量、分布及形态，并与正常对照组及疣旁“正常”皮肤中的ＬＣ进行了比较。结果表明，皮损表皮中ＬＣ密度明。减少，与对照组和疣旁“正常”皮肤相比，Ｐ＜０．００１，并有胞突缩短、减少或消失等改变。ＬＣ减少可能使ＨＰＶ抗原不易提是给真皮中的免疫活性细胞，以致病损长期存在，不易消退。     

Compliance leadership: the 17th century model that doesn't work

The world of health care has changed. We can't operate on 17th century models and be successful. We don't have to argue for the movement to committed, inspired leadership models, and the death of compliance leadership. There is abundant research to document this is the way we must go. In reality, we have a moral obligation to provide the kind of work environment that provides the meaningful work that Maslow (1998) tells us makes life meaningful. No one has the right to make people miserable at work because we have failed to create the cultures that create commitment, inspiration, and transformation for our patients, their families, and our staff. It is unfortunate that in times of staff shortages, this message is heard louder. We should be equally committed no matter what the situation, because it is the right thing to do. We do not have the right to be abusive to others in any context.     

雌、孕激素及促性腺激素水平测定对于绝经后妇女子宫内膜异常病变筛查的临床研究

目的探讨性激素水平测定对于筛查绝经后妇女子宫内膜病变的意义.方法选取我院门诊有充分手术指征的绝经后流血的患者,空腹时采肘静脉血3ml采用放射免疫RIA法测定性激素水平,并行分段诊刮,任何程度的子宫内膜增殖或增生均视为异常子宫内膜.结果绝经后妇女子宫内膜异常病变患者的雌激素水平明显高于正常绝经妇女(P＜0.05),尤其子宫内膜癌患者及子宫内膜不典型增生患者体内雌激素水平较正常绝经妇女显著增高,P＜0.01,且前两者之间亦有明显差异(P＜0.05).结论绝经后妇女阴道流血不能作为子宫内膜异常病变筛查的单一指标,对绝经后妇女常规进行性激素检测可作为子宫内膜异常病变的筛查方法之一.     

Unusual clinical features of cutaneous tuberculosis in an immune compromised patient

We report a case of an unusual form of cutaneous tuberculosis in an 82-year-old woman. She visited our hospital because of an intractable ulcer on the fifth finger of her right hand. While examining the ulcer surrounding half of her right fifth finger and covered with necrotic tissue, we also perceived a nodule with crust on the forearm, multiple subcutaneous nodules on the right forearm and upper arm, and a hen's-egg-sized agglomerative nodule on the axilla. All the lesions were located on her right arm. Skin biopsy specimens showed granulomatous tissue with necrosis in the lesions. Mycobacterium tuberculosis was identified by culture of a biopsied specimen, so the diagnosis was confirmed. Further examination revealed that she also had pulmonary tuberculosis. Cutaneous tuberculoses are classified morphologically with reference to host immune status, but no satisfactory classification exists. The present case can't be classified into any of the types which have been proposed so far. She is elderly and suffers from liver cirrhosis, hepatocellular carcinoma and myelodysplastic syndrome. The resulting acquired immunosuppression may have caused a unique form of cutaneous tuberculosis.     

Über pericapilläre Lipidablagerungen in pathologisch veränderter Haut

Zusammenfassung Es wurden 257 histologische Präparate von verschiedenen Dermatosen auf pericapilläre Lipidablagerungen (pcL.) untersucht. Derartige Veränderungen fanden sich besonders häufig beim Pemphigus vulgaris, Pemphigoid, Erythematodes chronicus, Granuloma anulare und bei der Dermatitis herpetiformis Duhring. Als Genese kommen Lipidinsudationen aus den Gefäßen, Fettphanerose aus dem Gewebe und Lipidfreisetzungen aus eosinophilen Leukocyten in Betracht. In den meisten Fällen dürfte ein Gefäßschaden mit Austritt von Lipoproteinen aus dem Blutplasma die Ursache sein. Der diagnostische Wert der pcL. wird erörtert. Diese sind wahrscheinlich kein spezifisches Zeichen für einen allergischen Prozeß im Hautgewebe, wie dies Prunieras angenommen hat.

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Summary In this study a total of 257 histological slights of different dermatosis have been investigated in search for the presence of depots of pericapillar lipids (pcl.) Such findings could be made mainly in slights of Pemphigus vulgaris, Pemphigoid, Erythematodes chronicus, Granuloma anulare, and in those of Dermatitis herpetiformis Duhring. It is considered to be imaginable that lipids originate by insudations from vessels, by phanerose in tissue and lastly a liberation from the eosinophilic leucocyts may take place. In the majority of the cases it is supposes to be possible that the reason for the presence of pcl. are lesions of the vessels in connection with exsudation of lipoproteins from bloodplasma. The diagnostic value of pcl. is discussed. Prunieras believes pcl. to be characteristic features of allergic processes in tissue, a suggestion, which can't be proved by our investigations.

     

系统性硬皮病的治疗进展

系统性硬皮病是一种以皮肤及各系统胶原纤维硬化为特征的结缔组织疾病,本病目前尚无特殊疗法,获取良好的治疗效果,是临床医师期待解决的实际问题。为此,本文简要综述并分析当前国内外缓解该病的治疗方法(如血管活性剂,结缔组织抑制剂。免疫抑制剂的应用)并介绍新的治疗手段,如自体干细胞移植等。