小柴胡汤是《伤寒杂病论》中的一首经典方剂，是和解法的基础方，后世将其广泛用于治疗妇科疾病。本研究旨在通过文献检索，探讨小柴胡汤在治疗妇科疾病方面的有效性及其应用的最新进展。文章综述了小柴胡汤在治疗妇科痛证、血证、带下证、块证等相关疾病方面的临床研究和实践经验。小柴胡汤通过其疏肝利胆、健运脾胃、和解枢机的作用，有效改善了女性痛经、盆腔炎性疾病、月经不调、妇科肿瘤、围绝经期综合征等妇科疾病症状。作为临床常用的妇科学方剂，小柴胡汤亟需进一步的发扬与创新，以期更有效地应用于未来的临床实践。

    Xiaochaihu Decoction，as a classic prescription in the Treatise on Cold Pathogenic and Miscellaneous Diseases，laid the foundation for reconciliation．It has a wide range of applications in the treatment of gynecological diseases．Through a literature search，this study aimed to explore the effectiveness of Xiaochaihu Decoction in the treatment of gynecological diseases and the latest progress of its application．This article reviews the clinical research and practical experience of Xiaochaihu Decoction in the treatment of gynecological pain，bleeding，leucorrhea disease，tumors and other related diseases．Xiaochaihu Decoction has effectively improved the symptoms of gynecological diseases such as dysmenorrhea，pelvic inflammatory disease，menstrual irregularities，gynecological tumors，and perimenopausal syndrome through its role of soothing the liver and promoting bile flow，strengthening the spleen and stomach，and harmonizing and releasing the pivot．As a commonly used gynecological prescription in clinical practice，Xiaochaihu Decoction urgently needs to be further developed and innovated to be more effectively applied to clinical practice in the future．

       目的 验证尿沉渣评分（USS）对肾前性急性肾损伤（AKI）与急性肾小管坏死（ATN）的鉴别价值，评估USS与AKI严重程度及预后的相关性，为优化AKI分层管理提供依据。方法 回顾性分析2021年3月至2022年2月在郑州市中医院治疗的120 AKI患者，根据肾组织活检及改良FENa-UA诊断标准分为肾前性AKI组（n=68）与ATN组（n=52），于入院日检测USS、血清胱抑素C（Cys-C）及尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL），分析USS诊断效能。结果 ATN组USS高于肾前性组（P＜0.001），且评分随AKI分期升高而增加（P＜0.001）。USS诊断肾前性AKI的ROC曲线下面积（AUC）为0.892，联合Cys-C与NGAL后AUC提升至0.941，灵敏度与特异度分别达90.12%和88.51%。结论 USS通过量化肾小管结构性损伤，可早期鉴别肾前性AKI与ATN，其与Cys-C、NGAL的联合应用提高诊断准确性，且对AKI预后具有重要价值，为临床分层管理提供客观依据。

       Objective To validate the discriminative value of urinary sediment score（USS）in differentiating prerenal acute kidney injury（AKI）from acute tubular necrosis（ATN），and to evaluate the correlation between USS and AKI severity/prognosis，providing evidence for optimizing stratified AKI management．Methods A retrospective analysis was conducted on 120 AKI patients treated at Zhengzhou Traditional Chinese Medicine Hospital from March 2021 to February 2022．According to renal tissue biopsy and modified FENa-UA diagnostic criteria，patients were divided into a prerenal AKI group（n=68）and an ATN group（n=52）．On the day of admission，USS，serum cystatin C（Cys-C），and urinary neutrophil gelatinase-associated lipocalin（NGAL）were measured to analyze the diagnostic performance of USS．Results USS was significantly higher in ATN group than prerenal group（P＜0.001），and increased with advancing AKI stages（P＜0.001）．The area under the ROC curve（AUC）of USS for diagnosing prerenal AKI was 0.892，which improved to 0.941 when combined with Cys-C and NGAL，yielding sensitivity and specificity of 90.12% and 88.51%，respectively．Conclusions USS quantifies structural damage to the renal tubules，allowing for early differentiation between prerenal AKI and ATN．Its combined use with Cys-C and NGAL improves diagnostic accuracy and is of significant value in predicting AKI prognosis，providing an objective basis for clinical stratified management．

目的 优化纸质版脊髓损伤神经功能评估系统, 探讨其在脊柱脊髓损伤患者临床管理中的实际应用效果。方法 广泛检索国内外关于脊柱脊髓损伤患者神经运动功能评估的文献, 结合课题组成员的临床经验, 初步筛选出神经运动功能评估的关键项目。通过两轮德尔菲专家函询, 确定评估项目内容, 对纸质版脊髓损伤神经功能评估系统进行优化, 并进行临床应用验证。选取2021年8月1日—2023年5月31日在广州市第一人民医院脊柱外科住院的120例脊柱脊髓疾病患者作为研究对象, 随机分为观察组和对照组。对比两组在应用优化前后评估系统的神经功能评估准确性、评估所需时间以及临床应用便捷性等方面的差异。结果 观察组的评估准确性显著高于对照组,错评率由20.3%降至4.7%,漏评率由32.0%降至5.0%; 此外,优化后的评估系统显著缩短了评估时间,平均减少6.0 min, 有效提升了评估效率。结论 优化后的脊髓损伤神经功能评估系统显著提高了评估的准确性和效率, 有效减少了主观误差。

Objective To refine and optimize the paper-based assessment tool for evaluating neurological function in spinal cord injury patients, and to explore its impact on clinical practice．Methods A comprehensive review of existing literature on neuromotor function assessment in spinal cord injury patients was conducted, complemented by discussions among members of this study．This led to the integration of a preliminary evaluation framework．Subsequently, a two-round Delphi consensus process involving experts was undertaken to finalize the content of the assessment project．Based on this, a paper-based evaluation system was developed and converted into an electronic format by computer professionals．This system was then tested in a clinical setting, where it was administered to 120 spinal cord injury patients at the Spine Surgery Department of Guangzhou First People’s Hospital between 1 August 2021 and 31 May 2023．Patients were randomly assigned to either an experimental group or a control group, allowing for a comparison of accuracy, efficiency, and convenience in clinical application．Results The experimental group demonstrated a notable improvement in assessment accuracy over the control group, with a significant reduction in error rate from 20.3% to 4.7% and a decrease in omission rate from 32.0% to 5.0%．Furthermore, the average assessment time was shortened by 6.0 minutes, markedly enhancing the efficiency of the evaluation process．Conclusions The optimized neurological function assessment system for spinal cord injury patients has proven effective in enhancing both the accuracy and efficiency of assessments, while significantly minimizing subjective errors．This system holds considerable potential for widespread clinical adoption and application．

目的 检验婴儿孤独症观察量表中文版（AOSI）临床应用的灵敏度与特异度,评价其临床应用效果。方法 随机抽取1岁时曾在清远市妇幼保健院行AOSI评估,于2~3岁时诊断为孤独症谱系障碍（ASD）的48例患儿为ASD组,诊断为正常发展的46例幼儿作为对照组。比较两组患儿的18个条目得分和总分,采用受试者操作特征（ROC）曲线计算AOSI的特异度、灵敏度、阳性预测值与阴性预测值,并判断AOSI的最佳诊断（阳性）分界值;分析AOSI评估结果与《精神障碍诊断与统计手册（第5版）》（DSM-5）中ASD诊断标准的一致性。结果 两组研究对象性别、年龄比较差异无统计学意义（P>0.05）。ASD组各条目得分和总分均高于对照组,且差异具有统计学意义（P<0.01）。AOSI的曲线下面积（AUC）为1.00（P<0.01）,95%置信区间为（1.00,1.00）。不同阳性分界线的灵敏度、特异度、阳性预测值、阴性预测值及一致性相比较,当约登指数等于1.00时AOSI的最佳诊断（阳性截断值）界线为9分时,其上述值均为1.00。AOSI评估结果与DSM-5中ASD的诊断标准完全相一致（Kappa=1,P<0.01）。结论 AOSI应用于评估1岁的婴儿,当取9分为诊断界值时,具有高度的灵敏度与特异度,能较好地预测该婴儿在2~3岁时是否患ASD;AOSI是婴儿期ASD筛查的重要工具,其评估结果可作为ASD高危儿早期干预的证据和ASD的辅助诊断工具,适合于临床推广应用。

Objective To test the sensitivity and specificity of the Chinese version of the Autism Observation Scale for Infants（AOSI）in clinical application and evaluate its clinical application effect．Methods Forty-eight children with autism spectrum disorder（ASD）diagnosed at the age of 2 to 3 years who had undergone AOSI evaluation in Qingyuan Maternal and Child Health Hospital at the age of 1 year（2021）were randomly selected as the ASD group,and 46 children with normal development were randomly selected as the control group．The scores of 18 items and total scores of the two groups of subjects were compared．The specificity,sensitivity,positive predictive value and negative predictive value of AOSI were calculated using the receiver operating characteristic curve（ROC）,and the best diagnostic（positive）cut-off value of AOSI was confirmed．The consistency of AOSI evaluation results with the ASD diagnostic criteria in DSM-5 were compared．Results There was no statistically significant difference in genders or age between two groups（P>0.05）．The scores of each item and total scores in the ASD group were significantly higher than those in the control group,and the difference was statistically significant（P<0.01）．The area under the curve of AOSI（AUC=1.00,P<0.01）had a 95% confidence interval of（1.00,1.00）．Comparing the sensitivity,specificity,positive predictive value,negative predictive value and consistency of different positive boundary points,when the Youden index was equal to 1.00,the optimal diagnostic（positive cut-off value）boundary for AOSI was 9 points,and all of the above values were 1.00． The AOSI evaluation results were completely consistent with the diagnostic criteria for ASD in DSM-5（Kappa=1,P<0.01）．Conclusions AOSI has high sensitivity and specificity when it is used to evaluate the 1-year-old infant．When “9 points” is taken as the diagnostic threshold,it can better predict whether the infant has ASD at the age of 2~3 years．AOSI is an important tool for screening ASD in infancy．Its evaluation results can be used as evidence for early intervention of high-risk infants with ASD and as a assisting tool to diagnosis ASD,which is suitable for clinical application．

前人总结的用药禁忌十八反未必是绝对禁忌,笔者从广东省名中医陈国成主任独创星夏止痛膏外治中得到反药“乌头-半夏”的配伍启示。本文简要叙述反药配伍的源流及应用,重点对陈国成使用乌头配半夏外用的经验及思路进行论述,认为乌头与半夏配伍可通过多种方式减毒增效,为临床安全使用该配伍药物提供新的思路。

The eighteen antagonisms summarized by predecessors may not be absolute contraindications．The author obtained the inspiration of the antagonism medicinals “aconite-pinellia” from the external treatment of Xingxia painkiller ointment created by Chen Guocheng．The present paper provides a concise overview of the origin and application of anti-drug compatibility,with a specific focus on Chen Guocheng's expertise and insights regarding the external use of aconite combined with pinellia．It is postulated that diverse approaches can be employed to modulate the compatibility between aconite and pinellia,thereby offering novel perspectives for ensuring the safe utilization of this drug combination in clinical practice．

缺牙区水平骨量不足一直是口腔种植的重要难题。骨劈开术是常用于解决此难题的手术方式之一,目前临床常用术式是采用超声骨刀沿牙槽嵴顶矢状劈开后,用骨凿将唇(颊)侧骨板向唇(颊)侧移位后增加牙槽骨水平宽度,达到同期种植的目的。骨劈开并同期植入种植体降低了困难病例的手术难度和风险,减少了患者就诊次数,降低患者成本。但若劈开后种植体周围的间隙大于1 mm或唇侧骨板分离,则需要同期进行植骨。但骨劈开术的使用也具有一定的适应症,要求缺牙区垂直骨高度足够,水平骨宽度不足(3～5 mm),骨质为Ⅲ ～ Ⅳ类骨,患者无种植手术的局部和全身禁忌证。近年来的研究表明骨劈开术具有创伤小、手术安全有效、不用开辟第二创口即可获得较好的骨增量效果等优点,一定程度上扩大了种植手术适应证。现本文对骨劈开术的翻瓣术式、非翻瓣术式及术后效果的进展进行综述。

The insufficient horizontal bone mass in the missing tooth area has always been an important problem of dental implant. Bone splitting is one of the surgical methods commonly used to solve this problem. At present, the commonly used surgical method is to use ultrasonic bone knife to sagittal splitting along the crest of the alveolar ridge, and then use bone chisel to shift the lateral bone plate of the lip (buccal) to the lip (buccal) to increase the horizontal width of the alveolar bone, so as to achieve the purpose of simultaneous implantation. Bone splitting and implantation of implants in the same period reduced the surgical difficulty and risk of difficult cases, reduced the number of patient visits, and reduced the cost of patients. However, if the gap around the implant was more than 1 mm or the labial bone plate was separated after splitting, bone grafting should be performed simultaneously. But the use of bone splitting technique also has a certain indications, demanding sufficient vertical bone height in the missing area, inadequate width of horizontal bone (3 mm to 5 mm), Ⅲ~Ⅳ class bone, without local and systemic contraindicated of planting surgery. In recent years, the research shows that bone splitting surgery has the advantages of small trauma, safe and effective operation, and better bone increment effect obtained without opening the second wound. This article reviewed the progress of flap operation, flapless operation and postoperative effect of bone splitting.

目的 探索整体针联合运动处方应用于伴骨质疏松症（OP）的膝骨关节炎（KOA）患者全膝关节置换术（TKA）术前预康复的可行性、有效性及其对Wnt/β-catenin通路的影响。方法 2021年5月—2022年4月在广州市第一人民医院南沙医院骨科住院治疗的伴OP的KOA患者随机入组,分3组：A组予常规术前宣教和准备;B组在A组基础上,术前应用标准化运动处方3周;C组在A组基础上,术前联合应用整体针和运动处方3周。比较术前3周、术前1天、术后8周视觉模拟疼痛评分（VAS）、关节活动度（ROM）、膝关节功能评分（HSS）的组间差异,并比较术中关节液β连环蛋白（β-catenin）、基质金属蛋白酶-13（MMP-13）、重组人Dickkopf相关蛋白-1（DKK-1）含量的组间差异。结果 共纳入50例受试者,A组15例,B组18例,C组17例。术前1天组间方差分析显示：B、C组VAS均低于A组（P<0.05）,C组VAS低于B组（P<0.05）;B、C组ROM均高于A组（P<0.05）,B、C组ROM比较差异无统计学意义（P>0.05）;B、C组HSS均高于A组（P<0.05）,C组HSS高于B组（P<0.05）。术后8周组间方差分析显示：B、C组VAS均低于A组（P<0.05）,C组VAS低于B组（P<0.05）;B、C组ROM均高于A组（P<0.05）,B、C组ROM比较差异无统计学意义（P>0.05）;B、C组HSS均高于A组（P<0.05）,C组HSS高于B组（P<0.05）。术中关节液标志物含量组间方差分析显示：B、C组β-catenin、MMP-13含量均低于A组（P<0.05）,C组β-catenin、MMP-13含量均低于B组（均P<0.05）;B、C组DKK-1含量均高于A组（均P<0.05）,C组DKK-1含量高于B组（P<0.05）。结论 整体针联合运动处方在OP患者TKA术前应用切实可行,可有效缓解疼痛、改善功能。整体针可增强运动处方的正向预康复作用,其作用机制可能与Wnt/β-catenin通路调节有关。

Objective To explore the feasibility,effectiveness and impact on the Wnt/β-catenin pathway of combined holistic acupuncture and exercise prescription for preoperative rehabilitation in knee osteoarthritis（KOA）patients with osteoporosis（OP）undergoing total knee arthroplasty（TKA）．Methods KOA patients with OP were divided into three groups randomly：Group A received conventional preoperative education and preparation,Group B received standardized exercise prescription for three weeks additionally,Group C received combined holistic acupuncture and exercise prescription for three weeks additionally．Between-group differences in visual analogue scale（VAS）pain scores,range of motion（ROM）and knee joint function scores（HSS）were compared at 3 weeks preoperatively,1 day preoperatively and 8 weeks postoperatively．Differences in intraoperative joint fluid levels of β-catenin,MMP-13 and DKK-1 were also compared．Results A total of 50 participants were included,with 15 in Group A,18 in Group B and 17 in Group C．Baseline conditions were comparable among the three groups．One-day preoperative analysis showed that VAS scores were lower in both Groups B and C compared to Group A（P<0.05）,and VAS score was lower in Group C compared to Group B（P<0.05）．ROM was higher in Groups B and C compared to Group A（P<0.05）,with no statistically significant between-group difference between Groups B and C．HSS scores were higher in Groups B and C compared to Group A（P<0.05）,and HSS score was higher in Group C compared to Group B（P<0.05）．Eight-week postoperative analysis revealed that VAS scores were lower in both Groups B and C compared to Group A（P<0.05）,and VAS score was lower in Group C compared to Group B（P<0.05）．ROM were higher in Groups B and C compared to Group A（P<0.05）,with no statistically significant between-group difference between Group B and C．HSS scores were higher in Groups B and C compared to Group A（P<0.05）,and HSS score was higher in Group C compared to Group B（P<0.05）．Intraoperative joint fluid biomarker analysis showed that β-catenin and MMP-13 levels were lower in Groups B and C compared to Group A（P<0.05）,and β-catenin and MMP-13 levels were lower in Group C compared to Group B（P<0.05）．DKK-1 levels were higher in Groups B and C compared to Group A（P<0.05）,and DKK-1 level was higher in Group C compared to Group B（P<0.05）．Conclusions Combined holistic acupuncture and exercise prescription is feasible and effective for preoperative rehabilitation in TKA for KOA patients with OP．Holistic acupuncture enhances the positive pre-rehabilitation effect of exercise prescription,and its mechanism may be related to the regulation of the Wnt/β-catenin pathway．

目的 探讨右美托咪定与咪达唑仑在儿童牙科患者术前镇静中的作用及安全性。方法 选取2020年6月—2021年1月需行择期全麻牙科治疗的60例患儿作为研究资料,将其根据数字法随机分为对照组(采取咪达唑仑)与观察组(采取右美托咪定)各30例,比较2组患儿的镇静效果。结果 2组患儿经麻醉后,观察组患儿的自主呼吸恢复时间、苏醒时间以及拔管时间低于对照组,经统计学分析有差异(P＜0.05);患儿在给药前Ramsay镇静评分中比较无差异;在给药10 min、20 min、30 min时Ramsay镇静评分均能达到2分以上,但经统计学比较无差异;血氧饱和度未发现异常,而且在给药观察期间患儿的血氧饱和度也在95%以上;但经统计学分析,患儿在给药前和给药10 min、20 min、30 min时心率、呼吸以及血氧饱和度均无差异(P＞0.05)。结论 右美托咪定与咪达唑仑均能成功用于儿童牙科患者术前镇静中,但经本文研究发现右美托咪定其效果更为显著些,而且绝大多数患儿能够配合与父母分离、配合麻醉面罩,降低患儿术后躁动发生率。

目的 探讨性别、年龄、日剂量、合并用药、药物厂家等因素对使用阿立哌唑患者稳态血药浓度的影响,为临床合理用药提供依据。方法 收集深圳市康宁医院2019年1月—2021年2月使用阿立哌唑住院患者血药浓度监测数据样本229份,包括患者性别、年龄、日剂量、合并用药、药物厂家等基本信息,使用SPSS 25.0统计学软件对数据进行回顾性分析。结果 经多元线性回归分析,本研究仅性别、日剂量能解释阿立哌唑血药浓度的变化。使用阿立哌唑患者血药浓度剂量比值(C/D)女性组高于男性组(P＜0.01),阿立哌唑合用丙戊酸盐组高于无合用组(P＜0.05),年龄、其他合并、药物厂家用药对阿立哌唑(C/D)值的影响无统计学差异。结论 阿立哌唑C/D值与性别有关,合并用药对其有一定影响,不同药物厂家的阿立哌唑C/D值无统计学差异,临床应加强治疗药物监测,根据血药浓度及临床诊疗效果,结合药物经济学因素优化给药方案。

Objective To provide the reference for clinical rational use of aripiprazole,to investigate the effects of gender, age, daily dose, concurrent medication, drug manufacturer and other factors on the steady-state serum concentration in aripiprazole patients. Methods Serum concentration monitoring data of 229 inpatients using aripiprazole in Shenzhen Kangning Hospital from January 2019 to February 2021 was collected, including patients' gender, age, daily dose, concurrent medication, drug manufacturer and other basic information, which were retrospectively analyzed by SPSS 25.0 statistical software. Results In this study, only gender and daily dose could explain the significant changes of aripiprazole serum concentration after multiple linear regression analysis. The serum concentration/dose ratio (C/D) was significantly higher in female patients than in male patients (P＜0.01), and the group of aripiprazole combined with valproate was markedly higher than the non-combined group (P＜0.05). Nevertheless, there were no statistically significant differences in the effects of age, concurrent medication and drug manufacturer on aripiprazole C/D values. Conclusions The C/D value of aripiprazole was closely related to gender, and concurrent medication had a certain effect on it. There was no statistical difference in the aripiprazole C/D value among different drug manufacturers. This study suggested that clinical monitoring of therapeutic drugs should be strengthened, and the prescription should be optimized based on serum concentration and therapeutic efficacy, combined with pharmacoeconomic factors.

目的 粪菌移植(fecal microbiota transplantation,FMT)是治疗疾病的新途径,本文总结我院408例(1 085例次)FMT的临床疗效和安全性。FMT治疗艰难梭菌感染有效率达80%,抗生素相关性腹泻68%,炎症性肠病52%,功能性肠病65%,代谢性疾病50%,其他疾病57%,安全性良好,未见严重不良事件发生,结果和多数文献相符。还需更多随机对照试验才能明确FMT的临床价值。