目的 探讨64层螺旋CT三维重建技术在主动脉夹层介入术前评估中的价值。方法 选择2023年7月—2024年5月在潜江市中心医院诊治的主动脉夹层疑似患者96例为研究对象,所有患者均进行64层螺旋CT三维重建技术检查, 记录成像参数。所有患者在64层螺旋CT三维重建后进行介入治疗, 以介入检查结果为金标准, 判断64层螺旋CT三维重建技术在主动脉夹层介入术前评估中的价值。结果 在96例患者中, 64层螺旋CT三维重建联合判断为主动脉夹层60例, 其中Ⅰ型32例、Ⅱ型20例、Ⅲ型8例,其中再现（VR）、最大密度投影（MIP）及多平面重建（MPR）分别判断为主动脉夹层56例、54例、56例。在96例患者中, 64层螺旋CT三维重建检查的破口层面主动脉平均直径（3.08±0.25）cm、破口至左锁骨下平均距离（4.05±0.26）cm, 与介入治疗检查（3.05±0.36）cm、（4.06±0.14）cm, 对比差异无统计学意义（t=0.671, P=0.503; t=0.332, P=0.740）。64层螺旋CT三维重建联合、VR、MIP、MPR对主动脉夹层的诊断灵敏度分别为98.33%、93.22%、89.83%、94.92%, 特异度分别为97.30%、97.30%、97.30%、100.00%, 准确率分别为98.96%、94.79%、92.71%、96.88%。结论 64层螺旋CT三维重建技术在主动脉夹层介入术前评估中具有很高的灵敏度、特异度与准确率。

Objective To explore and analyze the value of 64-slice spiral CT three-dimensional reconstruction technology in the preoperative assessment of aortic dissection（AD）intervention．Methods From July 2023 to May 2024, 96 cases of patients suspected of aortic dissection treated in our hospital were selected as the research subjects．All patients underwent 64-slice spiral CT three-dimensional reconstruction technology examination, and imaging parameters were recorded．After the 64-slice spiral CT three-dimensional reconstruction, all patients were given interventional treatment, and the results of the interventional examination were used as the “gold standard” to evaluate the value of 64-slice spiral CT three-dimensional reconstruction technology in the preoperative assessment of aortic dissection intervention．Results Among the 96 patients,64-slice spiral CT three-dimensional reconstruction combined diagnosis identified 60 cases of aortic dissection,including 32 type I, 20 type II, and 8 type III cases．volume rendering（VR）, maximum intensity projection（MIP）, and muhiplanar reconstrudion（MPR） identified 56, 54, and 56 cases of aortic dissection,respectively．In 96 patients, the mean aortic diameter at the lacerated level and the mean distance from the lacerated to the left subclavicular level were（3.08±0.25）cm and（4.05±0.26）cm respectively in 64-slice spiral CT three-dimensional reconstruction examination, compared with（3.05±0.36）cm and（4.06±0.14）cm in interventional examination．There was no difference in comparison（t=0.671, P=0.503; t=0.332, P=0.740）．The sensitivity, specificity, and accuracy of the 64-slice spiral CT three-dimensional reconstruction combined, VR, MIP, and MPR for the diagnosis of aortic dissection were 98.33%, 93.22%, 89.83%, 94.92%, specificity were 97.30%, 97.30%, 97.30%, 100%, accuracy were 98.96%, 94.79%, 92.71%, 96.88%．Conclusions Technology of 64-slice spiral CT three-dimensional reconstruction has high sensitivity, specificity, and accuracy in the preoperative assessment of aortic dissection intervention and is worth promoting and applying clinically．

目的 探讨降钙素原（PCT）联合营养指标对肝硬化营养状况的评定价值。方法 选取2021年2月—2022年3月在右江民族医学院附属医院感染科住院的140例肝硬化患者,根据营养风险筛查2002（NRS 2002）将其分为有营养风险组和无营养风险组。比较两组肝硬化患者中营养指标体质指数（BMI）、血红蛋白（HGB）、前白蛋白（PA）、白蛋白（ALB）、视黄醇结合蛋白（RBP）水平, 并分析它们与PCT的相关性。结果 BMI、HGB、ALB、PA及RBP水平低于低营养风险组（P<0.05）; 营养指标（BMI、HGB、ALB、PA、RBP）与PCT呈负相关（P<0.05）。二元Logistics回归分析发现ALB、PCT是肝硬化患者营养风险的危险因素（P<0.05）。ROC结果显示PCT与ALB的联合营养指标评定肝硬化营养不良的曲线下面积为0.984,（95%CI：0.964~1.000）, 灵敏度98.8%, 特异度93.3%, 约登指数0.921; ALB、PCT的AUC分别为0.919、0.974。结论 肝硬化患者PCT水平与其营养状况密切相关, 对营养状况的评定有一定的价值, 联合评定能有效提高其评定价值。

Objective To explore the value of procalcitonin（PCT）combined with nutritional indexes in evaluating the nutritional status of liver cirrhosis．Methods A total of 140 patients with cirrhosis admitted to the Department of Infection of the Affiliated Hospital of Youjiang Medical College for Nationalities from February 2021 to March 2022, they were selected and divided into with and without nutritional risk group according to nutritional risk screening 2002（NRS 2002）．The levels of body mass index（BMI）, hemoglobin（HGB）, prealbumin（PA）, albumin（ALB）and retinol binding protein（RBP）in two groups of patients with cirrhosis were compared, and the correlation between them and PCT was analyzed．Results The levels of BMI, HGB, ALB, PA and RBP were lower than those of low nutritional risk group（P<0.05）．The nutritional indices（BMI, HGB, ALB, PA, RBP）were negatively correlated with PCT（P<0.05）．Binary Logistics regression analysis showed that ALB and PCT were risk factors affecting nutritional risk in patients with cirrhosis（P<0.05）．ROC results showed that the area under the curve was 0.984（95% confidence interval：0.964 ~ 1.000）, sensitivity 98.8%, specificity 93.3%, and Yoden index 0.921 for the combined PCT and ALB indexes predicting malnutrition in cirrhosis．The AUC of ALB and PCT were 0.919 and 0.974, respectively．Conclusions The level of PCT in patients with cirrhosis is closely related to their nutritional status, which has certain value in the evaluation of nutritional status, and combined prediction can effectively improve the evaluation value．

目的 探讨非编码长链 RNA ANRIL（lncRNA-ANRIL）通过调控miR‐181b 介导磷酸酶及张力蛋白同源物基因（PTEN）对冠状动脉粥样硬化性心脏病（冠心病）心肌损伤影响的机制。方法 纳入2023年10月—2024年6月广州市第一人民医院30例确诊为冠心病的患者为观察组, 另选择同期本院体检中心30名健康者为对照组,检测两组研究者血压指标、血脂指标以及血清 lncRNA-ANRIL、miR-181b、PTEN水平, 并比较检测结果。结果 两组的性别、年龄、BMI、吸烟、高血压一般资料对比差异无统计学意义（P>0.05）; 观察组收缩压、舒张压水平以及总胆固醇、甘油三酯、低密度脂蛋白胆固醇水平均高于对照组,而高密度脂蛋白胆固醇则低于对照组（P<0.05）; 观察组血清 lncRNA ANRIL Exon 1-2、lncRNA ANRIL Exon 17-18相对表达水平以及PTEN水平低于对照组（t=12.623、7.741、8.231, P=0.001）, 而miR-181b水平则高于对照组（t=37.250, P=0.001）。结论 相较于正常人群, 冠心病患者血清lncRNA-ANRIL和PTEN水平明显降低,而miR-181b水平升高,提示lncRNA-ANRIL可通过调控miR-181b来调节PTEN的表达, 从而影响冠心病心肌损伤的过程。

Objective To explore the mechanism of competitive binding of non coding long stranded RNA ANRIL（lncRNA-ANRIL）to miR-181b to mediate phosphatase and tensin homolog gene（PTEN）on myocardial injury in coronary heart disease．Methods Thirty patients diagnosed with coronary heart disease in our hospital from October 2023 to June 2024 were included as the observation group,and another 30 individuals from physical examination center during the same period were selected as the control group．Blood pressure indicators,blood lipid indicators, and serum levels of lncRNA-ANRIL, miR-181b, and PTEN were measured in the two groups of patients, and the test results were compared．Results There was no significant difference between the two groups in terms of gender, age, BMI, smoking and hypertension（P>0.05）．The levels of systolic blood pressure（SBP）, diastolic blood pressure（DBP）, total cholesterol（TC）, triglycerides（TG）, and low-density lipoprotein cholesterol（LDL-C） in the observation group were higher than those in the control group,while high-density lipoprotein cholesterol（HDL-C） was lower than that in the control group（P<0.05）．The relative expression levels of lncRNA-ANRIL Exon 1-2, Exon 17-18, and PTEN levels in the observation group were lower than those in the control group（t=12.623, 7.741, 8.231, P=0.001）, while the level of miR-181b was higher than that in the control group（t=37.250, P=0.001）．Conclusions Compared with healthy individuals, serum levels of lncRNA-ANRIL and PTEN are significantly reduced in patients with coronary heart disease, while miR-181b levels are elevated, indicating that lncRNA ANRIL can regulate PTEN expression by miR-181b, thereby affecting the process of myocardial injury in coronary heart disease．

背景 虚拟标准化患者作为医学教育中的新型教学工具, 已广泛用于提升学生的临床问诊能力。随着生成式人工智能的快速发展, 基于大语言模型（LLMs）构建的VSP系统成为研究热点。然而, 目前尚缺乏对不同LLM在模拟患者角色方面表现的系统比较。目的 比较ChatGPT-4o与DeepSeek两种主流LLM在VSP模拟中的适用性, 评估其在病史采集、语言自然度、线索引导能力及教学辅助效果等方面的表现差异。方法 采用类实验研究,参与者为某医学院校临床医学专业本科四年级学生, 所有参与者均已修完《诊断学》课程, 具备基础问诊技能, 研究对象共60人, 按学号尾数单双分为两组, 分别与ChatGPT-4o或DeepSeek驱动的VSP系统进行交互。进行模拟急性阑尾炎问诊, 并在完成病史采集后提交诊断判断与体验问卷。结果 ChatGPT-4o在结构化信息整合、线索引导及技术稳定性方面更为优越, 而DeepSeek则在语言亲和力与情感回应方面表现更具人文关怀色彩。结论 不同LLM在VSP中的优势方向不同, 可根据教学目标进行有针对性地系统选择与设计。未来研究可进一步拓展至不同病种、交互方式及评估维度,以全面评估LLM驱动VSP在医学教育场景下的适应性与教学成效。

Background Virtual standardized patients（VSPs）have emerged as a novel tool in medical education, widely adopted to enhance students’ clinical interview skills．With the rapid development of generative artificial intelligence, VSP systems powered by large language models（LLMs）have become a new focus of research．However, few studies have systematically compared the performance of different LLMs in simulating patient roles．Objective This study aims to compare the applicability of two mainstream LLMs, ChatGPT-4o and DeepSeek, in VSP-based medical interview simulations, focusing on their differences in history-taking performance,linguistic naturalness, clue guidance,and educational support．Methods A quasi-experimental study was conducted involving 60 fourth-year clinical medicine undergraduates from a medical school．All participants had completed a diagnostics course and possessed basic interviewing skills．Students were assigned to either the ChatGPT-4o or DeepSeek group based on the parity of their student ID numbers．Each participant conducted a text-based simulated interview with a VSP presenting with acute appendicitis, then submitted both a preliminary diagnosis and a structured satisfaction questionnaire．Results ChatGPT-4o demonstrated superior performance in structured information integration, clue-based prompting, and system stability．In contrast, DeepSeek showed more natural language affinity and emotional responsiveness,reflecting stronger humanistic communication traits．The two models displayed divergent strengths within the VSP framework, suggesting that system selection and integration should be tailored to specific teaching objectives．Conclusions Future research should expand the scope to include diverse disease scenarios, interaction modalities, and evaluation dimensions, to comprehensively assess the educational utility and adaptability of LLM-driven VSP systems in medical training．

心肌梗死是由冠状动脉阻塞所引起的心肌缺氧坏死,其发病率和病死率居高不下。近年研究发现,利用组织工程手段仿生构建心肌微环境能有效改善心肌梗死区微环境,对心肌的再生能力有着重要的调控作用,能在一定程度上促进心肌再生,有望成为将来治疗心肌梗死的新方向。然而,由于对仿生心肌微环境和机体微环境交互作用、引发的生物学效应及作用机制不清楚,直接影响心肌损伤修复的过程和质量。因此,阐明仿生心肌微环境在心肌损伤修复过程中的交互作用过程及其介导的生物学效应迫在眉睫。该文系统性综述了仿生心肌微环境的构建策略及植入体内后介导的生物学效应,包括免疫调控效应、促血管再生效应以及再生协同效应等,为新型心肌补片的仿生设计和临床应用提供理论支持。

Myocardial infarction（MI）,arising from coronary artery obstruction resulting in hypoxic necrosis of myocardium,remains high morbidity and mortality．Recent studies have revealed that constructing myocardial microenvironment bionically through tissue engineering methods can effectively ameliorate the microenvironment in the infarcted area and exert a crucial regulatory role in myocardial regeneration,which promotes myocardial regeneration to a certain extent and holds promise for the treatment of MI．However,the interaction between biomimetic myocardial microenvironment and host microenvironment,as well as the triggered biological effects and mechanisms are not clear,which directly affects the process and quality of myocardial repair．Therefore,it is urgent to clarify the interaction process and biological effects mediated by the biomimetic myocardial microenvironment during myocardial repair．This review systematically summarizes the construction strategies of biomimetic myocardial microenvironment and their mediated biological effects after implantation,including immunomodulatory effects,pro-vascular regenerative effects,and regenerative synergistic effects,which provides theoretical support for the biomimetic design and clinical application of novel cardiac patches．

目的 研究基于儿童早期预警评分（PEWS）的分级干预模式促进重症肺炎患儿康复进程及对呼吸功能的影响。方法 回顾性分析2021年4月—2023年4月我院收治的100例重症肺炎患儿临床资料。将其按照干预方式的差异分为研究组（n=50）及对照组（n=50）。对照组选用常规干预,研究组则于对照组基础上增加基于PEWS的分级干预。对比两组康复进程（相关指标涵盖症状持续时长及住院天数）、呼吸功能（涵盖通气流速、每分钟最大通气量、肺活量、用力肺活量及深吸气量）、并发症发生情况（涵盖呼吸机相关性肺炎、肺大疱及胸膜炎）、患儿家属满意度。结果 研究组各项症状持续时长及住院天数均短于对照组（均P<0.05）。研究组各项呼吸功能指标水平均高于对照组（均P<0.05）。两组各项并发症发生率对比差异无统计学意义（P>0.05）。研究组患儿家属满意度高于对照组（96.00% vs 82.00%,P<0.05）。结论 基于PEWS的分级干预模式促进重症肺炎患儿康复进程的效果较佳,且能改善呼吸功能,提高患儿家属满意度。

Objective To study the effect of graded intervention mode based on Pediatric Early Warning Score（PEWS）on the recovery process and respiratory function of children with severe pneumonia．Methods The clinical data of 100 children with severe pneumonia treated in our hospital from April 2021 to April 2023 were retrospectively analyzed．Those children were divided into study group（n=50）and control group（n=50）according to the difference of intervention methods．Conventional intervention was used in the two groups,and PEWS-based graded intervention was added to the study group．The two groups were compared with each other in terms of recovery process（including duration of symptoms and length of stay）,respiratory function（including ventilation velocity,maximum volume per minute,vital capacity,forced vital capacity and deep inspiratory capacity）,complications（including ventilators associated pneumonia,bullosa and pleurisy）,and family member satisfaction．Results The duration of symptoms and hospitalization days in the study group were shorter than those in the control group（all P<0.05）．The levels of respiratory function indexes in study group were higher than those in control group（all P<0.05）．There was no significant difference in the incidence of complications between the two groups（P>0.05）．The satisfaction of family member in the study group was higher than that in the control group（96.00% vs 82.00%）（P<0.05）．Conclusions The PEWS based graded intervention model has a good effect on promoting the rehabilitation process of children with severe pneumonia,and can improve respiratory function,and increase the satisfaction of family member of children with severe pneumonia．

目的 分析产后出血预测评分与产妇凝血指标的相关性,以及出血预测评分对阴道分娩产后出血的预测效能。方法 采用回顾性研究,纳入2021年1月—2022年12月河南科技大学第二附属医院收治的136例阴道分娩产妇,根据产后出血情况,将合并产后出血的36例患者列为病例组,其余100例列为对照组,比较两组患者的产后出血预测评分及凝血指标,经Spearman相关性系数验证产后出血预测评分结果与凝血指标的相关性,依据实际出血情况,验证产后出血预测评分、各凝血指标对产后出血的预测效能。结果 病例组患者的产后出血预测评分为（7.33±2.46）分,D-二聚体（D-D）为（2.62±0.41）mg/L,均高于对照组[（6.14±2.06）分、（2.17±0.45）mg/L],纤维蛋白原（FIB）为（4.42±1.25）g/L,低于对照组（5.23±1.16）g/L;活化部分凝血活酶时间（APTT）为（37.44±10.25）s,凝血酶原时间（PT）为（15.45±4.12）s,凝血酶时间（TT）为（16.77±4.25）s,均高于对照组[（30.11±10.12）s、（12.49±4.11）s、（13.34±4.18）s],差异具有统计学意义（P<0.05）。经Spearman相关性系数分析,产后出血预测评分与经阴道分娩产妇的D-D、APTT、PT、TT呈正相关,与FIB呈负相关。通过绘制受试者工作特征曲线（ROC）后得知,产后出血预测评分及凝血指标对产后出血均有一定预测价值,但产后出血预测评分的AUC值大于各凝血指标。结论 产后出血预测评分与产妇凝血功能指标呈正相关,将产后出血预测评分与凝血指标检测相结合能实现对产后出血的早期识别及诊断。

Objective To analyze the correlation between postpartum bleeding prediction score and maternal blood coagulation index and the prediction efficiency of postpartum bleeding in vaginal delivery．Methods This is a retrospective study．The cases were included from January 2021 to December 2022．The subjects of the study were 136 vaginal delivery mothers． According to the delivery situation,36 patients with postpartum bleeding were included in the case group,and the rest 100 patients were included in the control group．The postpartum bleeding prediction score and coagulation indicators of the two groups were compared．The correlation between postpartum bleeding prediction score and coagulation indicators was verified by Spearman correlation coefficient．According to the actual bleeding situation,verify the predictive score for postpartum bleeding and the diagnostic efficacy of various coagulation indicators on postpartum bleeding．Results According to the test,the predictive score for postpartum bleeding in the case group was（7.33±2.46）,D-dimer（D-D）was（2.62±0.41）mg/L,which were higher than those in the control group [（6.14±2.06）,（2.17±0.45）mg/L]．Fibrinogen（FIB）was（4.42±1.25）g/L,lower than the control group（5.23±1.16）g/L,activated partial thromboplastin time（APTT）was（37.44±10.25）s,prothrombin time（PT）was（15.45±4.12）s,and thrombin time（TT）was（16.77±4.25）s．Compared with the control group [（30.11±10.12）s,（12.49±4.11）s,and（13.34±4.18）s）],the above indicators were all higher（P<0.05）．Through Spearman correlation coefficient analysis,the predictive score of postpartum bleeding was positively correlated with the D-D,APTT,PT,TT,negatively correlated with the FIB of the parturient who delivered through vagina．After drawing the ROC curve,it was found that both the postpartum hemorrhage prediction score and coagulation indicators had certain predictive value for postpartum hemorrhage,but the AUC value of the postpartum hemorrhage prediction score was greater than each coagulation indicator．Conclusions The prediction score of postpartum bleeding is positively correlated with the coagulation function indicators of the parturient,combining the score and indicators can achieve early identification and diagnosis of postpartum bleeding．

目的 分析阿莫西林克拉维酸钾与第三代头孢类抗菌药联合应用于新生儿肺炎患儿的应用效果及其对患儿肠道菌群的影响。方法 选择在2021年2月—2022年11月期间于我院新生儿科接受相关治疗的100例新生儿肺炎患儿,依照简单随机化法将患儿分为研究组（n=50）及参照组（n=50）。给予参照组常规新生儿肺炎治疗,在此基础上给予研究组患者阿莫西林克拉维酸钾与第三代头孢类抗菌药的联合治疗。治疗结束后对比两组患儿的血清因子水平、肠道菌落情况、临床疗效以及不良反应发生情况。结果 治疗前,两组患儿的血清因子水平、肠道内菌群数量比较差异无统计学意义（P>0.05）,治疗后两组患儿的降钙素原（procalcitonin,PCT）、C-反应蛋白（C-reactive protein,CRP）、白细胞计数（white blood cell count,WBC）、肠球菌、肠杆菌、双歧杆菌以及乳酸杆菌水平均有改善（P<0.05）,其中研究组的PCT、CRP、WBC、肠球菌、双歧杆菌以及乳酸杆菌数量低于参照组,而研究组的肠杆菌数量高于参照组;同时研究组的临床有效率（94.00%）与参照组的临床有效率（86.00%）比较差异无统计学意义（P>0.05）;两组患儿的不良反应发生率比较差异无统计学意义（P>0.05）,但其中研究组腹泻的发生率高于参照组（P<0.05）。结论 在对新生儿肺炎患儿进行治疗时采取阿莫西林克拉维酸钾单纯治疗与阿莫西林克拉维酸钾+第三代头孢类抗菌药（头孢他啶）的临床疗效相当,联合用药虽能更为显著地减少患儿机体的细菌数量,改善血清因子水平,但更易发生腹泻的并发症,且为了减少耐药性,应适当采用单独用药。

Objective To analyze the application effect of amoxicillin clavulanate potassium combined with third-generation cephalosporin antibiotics in children with neonatal pneumonia and its impact on the intestinal microbiota．Methods From February 2021 to November 2022,100 newborns with pneumonia who received relevant treatment in the Department of Neonatology at the First People’s Hospital of Shangqiu City were randomly divided into a study group（n=50）and a reference group（n=50）using a simple randomization method．Routine treatment was provided for neonatal pneumonia in the reference group,and on this basis,a combination treatment of amoxicillin,clavulanate potassium,and third-generation cephalosporin antibiotics was applied on the study group patients．After treatment,the serum factor levels,intestinal colony status,clinical efficacy,and incidence of adverse reactions were compared between the two groups of children．Results Before treatment,there were no statistically significant differences in serum factor levels and intestinal microbiota between the two groups of children（P>0.05）．After treatment,the levels of procalcitonin（PCT）,C-reactive protein（CRP）,white blood cell count（WBC）,Enterococcus,Enterobacter,Bifidobacterium,and Lactobacillus in the two groups of children improved（P<0.05）,with the levels of PCT,CRP,WBC,the number of Enterococcus,Bifidobacterium,and Lactobacillus in the study group was lower than that in the reference group,while the number of Enterobacter in the study group was higher．There was no statistically significant difference（P>0.05）in the clinical response rate between the study group（94.00%）and the reference group（86.00%）．There was no statistically significant difference in the incidence of adverse reactions between the two groups of children（P>0.05）,but the incidence of diarrhea in the study group was higher than that in the reference group（P<0.05）．Conclusions The clinical efficacy of amoxicillin clavulanate potassium alone and amoxicillin clavulanate potassium+third-generation cephalosporin antibiotics（ceftazidime）in the treatment of newborns with pneumonia is comparable．Although the combination therapy can significantly reduce the number of bacteria in the body of children and improve serum factor levels,it is more prone to complications of diarrhea．In order to reduce drug resistance,separate medication should be appropriately used．

目的 探讨计划-实施-检查-处理（PDCA）循环法及根本原因分析法在持续正压通气治疗重症肺炎患儿中的应用效果。方法 选取2021年1月—2023年1月医院收治并接受鼻塞式持续正压通气治疗的重症肺炎患儿80例,基于随机数字表法分为两组,每组各40例。对照组接受常规护理,观察组采用PDCA循环法联合根本原因分析法护理干预。比较两组临床症状改善时间、血气指标[动脉血氧分压（PaO₂）、动脉血氧饱和度（SaO₂）、动脉血二氧化碳分压（PaCO₂）]、肺功能指标[第1秒用力呼气容积（FEV₁）、潮气量（VT）]、炎症免疫指标[单核细胞趋化蛋白-1（MCP-1）、可溶性髓系细胞触发受体-1（sTREM-1）、可溶性细胞间黏附分子-1（sICAM-1）]水平变化,比较两组患儿家属满意度情况。结果 观察组患儿咳嗽、气促、哮鸣音、心率恢复及紫绀等症状改善用时均低于对照组,比较差异有统计学意义（P<0.05）。干预前,两组患儿PaO₂、SaO₂、PaCO₂、FEV₁、VT、MCP-1、sTREM-1、sICAM-1水平比较差异均无统计学意义（P>0.05）;干预后,两组患儿上述指标水平均有不同程度变化（P<0.05）,观察组PaO₂（97.18±7.90 mmHg vs 90.30±7.12 mmHg）、SaO₂（93.58±3.82% vs 86.30±4.21%）、FEV₁（2.66±0.46 L vs 1.97±0.34 L）、VT（11.92±1.89% vs 9.83±1.10%）水平均高于对照组,观察组PaCO₂（36.70±3.97 mmHg vs 40.65±3.79 mmHg）、MCP-1（58.45±11.94 ng/L vs 74.46±16.69 ng/L）、sTREM-1（36.25±8.30 ng/L vs 51.57±9.51 ng/L）、sICAM-1（187.52±31.22 mg/L vs 243.73±46.79 mg/L）水平低于对照组,差异均有统计学意义（P<0.05）。观察组患儿家属满意度整体优于对照组（P<0.05）;观察组总满意率（97.5% vs 77.5%）高于对照组,差异有统计学意义（P<0.05）。结论 PDCA循环法及根本原因分析法应用于接受持续正压通气治疗的重症肺炎患儿,能够有效促进患儿临床症状改善,有利于血气及肺功能恢复,且可降低炎症反应,患儿家属满意度较高。

Objective To explore the application effect of Plan-Do-Check-Action（PDCA）circulation method and root cause analysis method in the treatment of children with severe pneumonia with continuous positive pressure ventilation．Methods From January 2021 to January 2023,80 children with severe pneumonia who were admitted to hospital and received nasal plug continuous positive pressure ventilation treatment were enrolled in this study．Based on the random number table method,they were divided into two groups,with 40 cases in each group．The control group received routine nursing,while the observation group received PDCA circulation method combined with root cause analysis nursing intervention．The improvement time of clinical symptoms,changes in blood gas indicators[arterial partial oxygen pressure（PaO₂）,arterial oxygen saturation（SaO₂）,arterial partial pressure of carbon dioxide（PaCO₂）],lung function indicators [（forced expiratory volume in 1 second,FEV₁）,tidal volume（VT）],and inflammatory immune indicators [monocyte chemotactic protein-1（MCP-1）,soluble myeloid cell trigger receptor-1（sTREM-1）,soluble intercellular adhesion molecule-1（sICAM-1）] levels between the two groups were compared,and the family members’ satisfaction of the two groups was also compared．Results The improvement time for symptoms such as cough,shortness of breath,wheezing,heart rate recovery and cyanosis in the observation group was lower than that in the control group,and the difference was statistically significant（P<0.05）．Before intervention,there was no statistically significant difference in the levels of PaO₂,SaO₂,PaCO₂,FEV₁,VT,MCP-1,sTREM-1 and sICAM-1 between the two groups of children（P>0.05）．After intervention,the levels of the above indicators in both groups of children showed varying degrees of change（P<0.05）．The levels of PaO₂（97.18±7.90 mmHg vs 90.30±7.12 mmHg）,SaO₂（93.58±3.82% vs 86.30±4.21%）,FEV₁（2.66±0.46 L vs 1.97±0.34 L）,VT（11.92±1.89% vs 9.83±1.10%）in the observation group were higher than those in the control group．The levels of PaCO₂（36.70±3.97 mmHg vs 40.65±3.79 mmHg）,MCP-1（58.45±11.94 ng/L vs 74.46±16.69 ng/L）,sTREM-1（36.25±8.30 ng/L vs 51.57±9.51 ng/L）and sICAM-1（187.52±31.22 mg/L vs 243.73±46.79 mg/L）in the observation group were lower than those of the control group,with statistically significant differences（P<0.05）．The overall satisfaction of the observation group was better than that of the control group（P<0.05）,the total family members’ satisfaction rate of the observation group was higher than that of the control group（97.5% vs 77.5%）,with a statistically significant difference（P<0.05）．Conclusions PDCA circulation method and root cause analysis method applied to children with severe pneumonia who receive continuous positive pressure ventilation treatment,can effectively promote the improvement of clinical symptoms,be conducive to the recovery of blood gas and lung function,and reduce inflammatory reaction,with high family members’ satisfaction．

目的 探讨子宫内膜异位症（EMT）患者卵泡液来源的外泌体差异微小RNA（miRNA）对卵母细胞质量的影响。方法 收集2021年12月—2022年3月在广州市第一人民医院生殖医学中心进行体外受精-胚胎移植/卵细胞浆内单精子注射助孕的20例不孕症患者的卵泡液,分为EMT组（EMT不孕症患者10例）和对照组（单纯男性因素不孕症患者10例）。采用高通量测序对卵泡液外泌体微小RNA（miRNA）谱进行分析,选出具有组间差异的miRNAs。结果 与单纯男性因素不孕患者相比,EMT组有18个外泌体miRNAs差异有统计学意义,其中上调9个、下调9个。靶基因预测并采用GO和KEGG富集分析发现,这些靶基因主要参与磷脂酰肌醇-3-激酶/蛋白激酶B（ PI3K-Akt）、核苷酸结合寡聚结构域NOD样受体、Ras等信号通路。结论 EMT患者卵泡液来源的外泌体miRNA存在差异,差异的外泌体miRNAs可能通过多个信号通路影响EMT患者卵母细胞质量。

Objective To investigate the effect of differential microRNA（miRNA）derived from follicular fluid exosomes on oocyte quality in patients with endometriosis（EMT）. Methods Follicular fluid was collected from 20 infertile patients undergoing IVF-ET / ICSI in the Reproductive Medicine Center of Guangzhou First People's Hospital from December 2021 to March 2022,including EMT group（10 patients with EMT infertility）and control group（10 patients with simple male factor infertility）．The miRNA spectrum in follicular fluid exosomes was analyzed by high-throughput sequencing and miRNAs with differences between groups were selected. Results Compared with patients with infertility due to simple male factors,there were significant differences in 18 exosomal miRNAs in the EMT group,of which 9 were up-regulated and 9 were down-regulated．GO and KEGG enrichment analysis showed that these target genes were mainly involved in phosphatidylinositol-3-kinase / protein kinase B,Nucleotide binding oligomerization domain-like receptor and other signaling pathways. Conclusions There are differences in follicular fluid-derived exosomal miRNAs in EMT patients．Differential exosomal miRNAs may affect oocyte quality in EMT patients through multiple signaling pathways．