目的 探讨中青年医护人员血尿酸(UA)水平与心血管危险因素的关系。方法 利用国人缺血性心血管疾病发病危险的评估方法及简易评估工具“心血管危险积分”评价982名中青年医护人员的心血管危险因素,计算其危险评分积分值,用四分位法根据UA值将研究对象分为四组,比较不同分组间的临床资料,分析UA水平与心血管危险因素的关系。结果 UA水平与心血管危险因素存在正相关(P＜0.01);Ⅲ、Ⅳ组心血管危险积分均高于Ⅰ、Ⅱ组,差异有统计学意义(P＜0.01)。结论 UA增高是心血管疾病的一个重要危险因素,重视高尿酸血症的防治,对预防中青年医护人员的心血管疾病的发生具有重要意义。

Objective To study the relationship between serum uric acid levels and risk factor of cardiovascular disease in young and middle-aged medical staff. Methods Using of risk assessment method and simple assessment tools of cardiovascular risk score of Chinese ischemic cardiovascular disease, the study appraised risk factors of cardiovascular disease about 982 young and middle-aged medical staffs, calculated the risk score integral value. The study divided objects of study into four groups with quartile's method according to serum uric acid levels, compared clinical data between different groups, analyzed the correlation between uric acid level and cardiovascular risk factors. Results Serum uric acid level and cardiovascular risk factors had positive correlation(P<0.01); Ⅲ,Ⅳ group's cardiovascular risk score were higher than Ⅰ, Ⅱ group; the difference had statistics significance(P<0.01). Conclusion Hyperuricemia is an important risk factors in cardiovascular disease. Paying attention to hyperuricemia prevention has important significance to prevention of cardiovascular disease in young and middle-aged medical staff.

目的 探讨经皮微创技术应用股骨近端解剖锁定钢板治疗高龄骨质疏松粗隆间骨折的治疗。方法 我院自2009年12月—2013年6月共收治高龄骨质疏松粗隆间骨折56例,男35例,女21例;年龄76～94岁,平均81岁。所有患者应用股骨近端解剖锁定钢板通过经皮微创置入技术治疗。根据Harris髋关节功能评分对治疗效果进行评定。结果 56例手术时间30～90 min,平均45 min;术中失血量70～250 mL,平均110 mL。全部患者获随访,时间6～13.5个月,平均9.5个月。X线骨折愈合时间3～6个月,平均3.5个月。其中优41例,良12例。结论 对于高龄骨质疏松患者粗隆间骨折,采用经皮微创置入股骨近端解剖锁定钢板内固定治疗,具有手术创伤小、出血少、安全可靠等优点,有良好的临床应用价值。

Objective To study the application of proximal femur anatomic locking plate with minimally invasive percutaneous plate osteosynthesis (MIPPO) techniques in the treatment of senile osteoporosis curative effect of intertrochanteric fractures in elderly patients. Methods We have treated 56 elderly patients of senile osteoporosis intertrochanteric fractures in December 2009 to June 2013, including 35 male and 21 female cases, aged 76~94, the average of 81. All patients were applied in the proximal femur anatomic locking plate with minimally invasive percutaneous plate osteosynthesis technology according to Harris hip joint function scale curative effect. Results 56 cases of operation time 30~90 min, an average of 45 min. Intraoperative blood loss was 70~250 ml, an average of 110 ml. All patients received follow-up from 6 to 13.5 months, an average of 9.5 months. The X-ray fracture healing time was from 3~6 months, 3.5 months on average. According to the Harris hip joint function scale: 41 cases was excellent, 12 cases was good. Conclusion For the senile osteoporosis intertrochanteric fracture, using the proximal femur anatomic locking plate with minimally invasive percutaneous plate osteosynthesis technology can make minimal trauma, less bleeding reliable fixation,and has good clinical application value.

       无创正压通气的使用是患者发生鼻面部压力性损伤的重要原因之一，随着我国防控政策的放开，新增老年新冠感染患者急剧增加。文章对使用无创正压通气发生相关压力性损伤现状进行综述，介绍老年患者使用无创正压通气发生鼻面部压力性损伤的主要影响因素、评估方法以及预防措施现状，旨在为临床医务人员预防其相关压力性损伤提供参考。

       The use of non-invasive positive pressure ventilation is one of the important reasons for nasal and facial pressure injuries in patients．With the release of China's epidemic prevention policy，the number of new elderly patients with COVID-19 has increased dramatically．This paper summarizes the current situation of stress injuries caused by noninvasive positive pressure ventilation，introduces the main influencing factors，evaluation methods and prevention measures of nasal and facial stress injuries in elderly patients with noninvasive positive pressure ventilation，aiming to provide a reference for clinical medical personnel to prevent their related stress injuries．

       运动可以调节机体代谢，预防和治疗由糖脂代谢紊乱所引发的心血管疾病。运动因子是在运动过程中，由肌肉、脂肪以及肝脏等多个组织合成和分泌的一系列生物活性物质，包括蛋白质和多肽类分子、小分子代谢物以及核酸等。诸多研究证实，运动因子是运动调节机体代谢的重要因素之一，也是机体从运动中获益的关键分子机制。近年来，随着蛋白质组学、代谢组学以及高通量测序等相关技术的飞速发展，越来越多的运动因子被陆续发现和证实。这不仅拓宽了人们对机体从运动中获益相关机制的认知，还激发了人们对运动因子在健康领域应用前景的浓厚兴趣。文章系统地阐述了运动因子对机体心血管系统的影响，旨在揭示运动因子在促进心血管健康以及治疗心血管疾病等方面的积极效用。

       Exercise can prevent and treat cardiovascular diseases resulting from the metabolic disorders of glucose and lipid．Exerkines are defined as a series of bioactive substances in response to exercise including proteins，peptides，small molecular metabolites and nucleic acids．Multiple tissues can produce exerkines，such as skeletal muscle，adipose tissue，and liver．Many studies indicate that exerkines play essential roles in improving glucose and lipid metabolism，which are crucial to harness the health-related benefits mediated by exercise．In recent years，with the progression of proteomics，metabolomics and high-throughput sequencings，an increasing number of exerkines are discovered．These findings expand the research on beneficial effects of exercise and draw attention to the clinical implications of exerkines．This review aims to explore the influence of exerkines on cardiovascular system and reveal their potential roles in the prevention and treatment of cardiovascular disease．

       目的   探讨CT、MRI影像学表现对原发性肝细胞癌（HCC）微血管侵犯（MVI）的诊断价值。方法   选取2018年1月—2024年7月江门市第二人民医院（江门市中心医院蓬江分院）和江门市中心医院120例（共158个病灶）HCC患者，均行上腹部CT、MRI平扫+增强及弥散加权成像（DWI）检查；以术后病理结果为金标准。比较CT、MRI平扫+增强及DWI对HCC MVI诊断效能；分析HCC MVI诊断中CT、MRI平扫+增强及DWI检查与术后病理确诊结果之间的一致性；比较HCC MVI与无HCC MVI患者影像学表现及表观扩散系数（ADC）值。结果    DWI检查对HCC MVI的诊断效能（灵敏度、特异度、准确度、阳性预测值、阴性预测值）均显著性高于CT、MRI平扫+增强（P＜0.05）；CT、MRI、DWI对原发性肝细胞癌患者微血管侵犯的诊断效能比较，差异均无统计学意义（P＞0.05）。在HCC MVI诊断效能中，CT、MRI影像学表现与术后病理确诊结果之间为中度一致性；DWI与术后病理确诊结果之间为高度一致性。HCC MVI患者的强化方式在非边缘动脉期强化、强化包膜、晕状强化、结中结、门脉分支癌栓占比均显著性高于无HCC MVI患者（P＜0.05）。在不同b值（400、800、1 000、1 500 s/mm² ）下，HCC MVI患者的ADC值均显著性高于无HCC MVI患者（P＜0.05）。结论    CT、MRI平扫+增强及DWI对HCC MVI均具有较好的诊断效能，而MRI诊断结果与病理诊断一致性更佳，尤其DWI图中ADC值可更加精准地判断HCC的患者是否发生微血管侵犯，有助于指导临床医生建立“个体化”精准诊疗策略。

       Objective  To explore the diagnostic value of CT and MRI imaging manifestations for microvascular invasion（MVI）in primary hepatocellular carcinoma（HCC）．Methods  A total of 120 patients（158 lesions in total）with HCC in the Second People’s Hospital of Jiangmen（Pengjiang Branch of Jiangmen Central Hospital）and Jiangmen Central Hospital were selected from January 2018 to July 2024，all underwent CT and MRI plain + enhanced and diffusion-weighted imaging（DWI）of the upper abdomen；postoperative pathology results was used as the diagnostic gold standard．The diagnostic efficacy of CT，MRI plain + enhanced and DWI for HCC MVI was compared．The concordance among CT，MRI plain + enhanced and DWI examinations with postoperative pathological diagnostic findings in the diagnosis of HCC MVI．Imaging manifestations and apparent diffusion coefficient（ADC）values in patients with and without HCC MVI were compared．Results  Diagnostic effectiveness of DWI examination for HCC MVI（sensitivity，specificity，accuracy，positive predictive value，negative predictive value）were all significantly higher than those of CT and MRI plain + enhanced（P＜0.05）；none of the differences were statistically significant（P＞0.05）in the comparison of diagnostic effectiveness of CT，MRI，and DWI for the diagnosis of MVI in patients with primary HCC．In HCC MVI diagnostic effectiveness，moderate concordance was found among CT，MRI imaging phenotypes and postoperative pathology results；high concordance was found between DWI and postoperative pathology results．In HCC MVI patients，the proportion of non-marginal arterial reinforcement，enhanced envelope，halo reinforcement，nodal in nodal and portal branch cancer thrombi was significantly higher than that in patients without HCC MVI（P＜0.05）．At different b-values（400，800，1 000，1 500 s/mm² ），ADC values were all significantly higher in patients with HCC MVI than in patients without HCC MVI（P＜0.05）．Conclusions  CT，MRI plain + enhanced and DWI have good diagnostic effectiveness for HCC MVI，while MRI diagnostic results are in better concordance with pathologic diagnosis．In particular，ADC values in DWI maps can more accurately determine whether MVI occurs in patients with HCC，which helps to guide clinicians to establish“individualized”and precise diagnosis and treatment strategies．

       目的    探究经鼻间歇正压通气（NIPPV）和经鼻持续正压通气（NCPAP）作为早产儿呼吸窘迫综合征气管插管机械通气拔管后无创呼吸支持过渡的临床效果的差异。方法   纳入2021年1月—2023年6月在广东省吴川市妇幼保健计划生育服务中心治疗的新生儿呼吸窘迫综合征早产儿66例，用随机数字表法将患儿分为NIPPV组（33例）和NCPAP组（33例）。NIPPV组患儿予经鼻间歇正压通气作为过渡期无创呼吸支持，NCPAP组患儿则予以经鼻持续正压通气作为过渡期无创呼吸支持。对比两组患儿治疗前后血气分析结果、脱机失败率、无创呼吸支持时间、无创后吸氧时间、总给氧时间等指标。结果  接受无创呼吸支持12 h后，NIPPV组患儿的PaO₂升至（76.46±1.10）mmHg，高于NCPAP组患儿的（75.51±2.15）mmHg（t=2.249，P=0.028）。此外，NIPPV组患儿的SaO₂升至（96.36±0.52）%，也高于NCPAP组患儿的（96.07±0.59）%（t=2.138，P=0.034）。而NIPPV组患儿的PaCO₂则降至（41.39±0.74）mmHg，较NCPAP组患儿的（41.87±0.95 ）mmHg低（t=-2.230，P=0.025）。NIPPV组无创呼吸支持时间为（3.09±0.52）d，短于NCPAP组的（3.45±0.62）d，且该差异有统计学意义（t=2.584，P=0.012）。同样的，NIPPV组总给氧时间（9.52±0.76）天较NCPAP组的（10.00±0.79）天短，且该差异有统计学意义（t=-2.548，P=0.013）。而两组在脱机失败率、无创呼吸支持后吸氧时间、不良反应发生率等方面比较差异无统计学意义（均P＞0.05）。结论   与NCPAP模式相比，早产儿拔管后应用NIPPV模式进行无创呼吸支持取得的临床效果更优。

      Objective  To explore the difference of clinical effect of nasal intermittent positive pressure ventilation（NIPPV）and nasal continuous positive pressure ventilation（NCPAP）as non-invasive respiratory support mode after extubation in preterm infants with endotracheal intubation．Methods   Sixty-six cases of preterm infants with neonatal respiratory distress syndrome treated in our hospital from January 2021 to June 2023 were included．All the subjects were randomly divided into NIPPV group（n=33）and NCPAP group（n=33）．The blood gas analysis results，weaning failure rate，non-invasive respiratory support time，oxygen inhalation time after noninvasive ventilation，total oxygen administration time．were compared between the two groups．Results   After 12 hours of noninvasive respiratory support，PaO₂ in the NIPPV group increased to（76.46±1.10）mmHg，which was significantly higher than that（75.51±2.15）mmHg in the NCPAP group（t=2.249，P=0.028）．In addition，SaO₂ in the NIPPV group increased to （96.36±0.52）%，which was also significantly higher than that（96.07±0.59）% in the NCPAP group（t=2.138，P=0.034）．The PaCO₂ in the NIPPV group decreased to （41.39±0.74）mmHg，which was lower than that（41.87±0.95）mmHg in the NCPAP group（t=-2.230，P=0.025）．The  duration of  non-invasive  respiratory  support in the NIPPV group（3.09±0.52） days was shorter than that（3.45±0.62）days in the NCPAP group，and the difference was statistically significant（t=2.584，P=0.012）．Similarly，the total duration of oxygen administration in the NIPPV group（9.52±0.76）days was shorter than that（10.00±0.79）days in the NCPAP group，and the difference was statistically significant（t=-2.548，P=0.013）．There were no significant differences in weaning failure rate，oxygen inhalation time after noninvasive respiratory support，and incidence of adverse reactions between the two groups（P＞0.05）．Conclusions   Compared with NCPAP mode，NIPPV mode for non-invasive respiratory support in preterm infants after extubating has better clinical effect，and it is worthy of clinical application．

       目的   探讨预防性风险管理在肌层浸润性膀胱癌根治术后的应用效果及对术后生活质量影响。方法   选取2020年6月—2023年10月安阳市肿瘤医院收治的66例肌层浸润性膀胱癌患者，应用抽签法分为观察组（n=33）与对照组（n=33）。所有患者均采取根治性全膀胱切除术与淋巴清扫术治疗，对照组患者术后实施常规护理，观察组在对照组基础上增加预防性风险管理。对比两组术后尿量、胃肠功能恢复时间、术后住院时间，干预前后病耻感及负面情绪、术后并发症发生率，最后对比两组干预前后生活质量变化。结果   两组患者术后尿量对比差异无统计学意义（P＞0.05），观察组术后胃肠功能恢复时间为（5.27±0.82）d，术后住院时间为（18.31±3.27）d，短于对照组的（7.25±1.12）（23.27±4.18）d，对比差异有统计学意义（t分别为8.194、5.369，P＜0.05）；干预后两组患者病耻感量表（SSCI）、抑郁自评量表（SDS）和焦虑自评量表（SAS）评分均降低，观察组分别为（35.67±7.45）（40.02±2.43）（45.36±4.17）分，低于对照组的（48.27±10.69）（54.54±3.54）（51.37±4.38）分，对比差异有统计学意义（t分别为5.555、19.426、5.709，P＜0.05）；观察组术后并发症发生率为9.09%，低于对照组的30.30%（χ ² =4.690，P=0.030）；干预后两组膀胱癌特异性模块、功能状况、精神状况、家庭/社会状况及躯体状况相关维度膀胱癌患者生活质量量表（FACT-BL）评分均升高，观察组分别为（34.27±3.26）（25.11±4.23）（21.51±4.23）（25.02±4.43）（20.56±3.11）分，高于对照组的（27.00±4.34）（21.11±3.24）（16.12±2.12）（21.54±5.54）（15.87±4.13）分，对比差异有统计学意义（t分别为7.694、4.313、6.544、2.818、5.211，P＜0.05）。结论   预防性风险管理在肌层浸润性膀胱癌根治术后的应用效果显著，可缩短患者术后胃肠功能恢复时间及住院时间，改善患者负面情绪，有助减少术后并发症，提升患者生活质量。

       Objective  To explore the effect of preventive risk management on postoperative application and quality of life of myometrial invasive bladder cancer patients after radical surgery．Methods  A total of 66 patients with myometrial invasive bladder cancer admitted to Anyang Cancer Hospital from June 2020 to October 2023 were selected as research objects，and were divided into observation group（n=33）and control group（n=33）by lot drawing．All patients were treated with  radical total cystectomy and lymph node dissection．The control group received routine nursing care after surgery，while the observation group received preventive risk management in addition to the control group．The postoperative urine output，recovery time of gastrointestinal function，and hospitalization time between two groups were compared，as well as the shame and negative emotions before and after intervention，the incidence of postoperative complications，and the changes in quality of life between the two groups before and after intervention．Results  There was no significant difference in postoperative urine volume between the two groups of patients（P＞0.05），and the postoperative gastrointestinal function recovery time（5.27±0.82）d，postoperative hospitalization time（18.31±3.27）d were shorter than the control group［（7.25±1.12）d，（23.27±4.18）d］，with statistical significantce（t=8.194，5.369，P＜0.05）．After intervention，the Stigma Scale of Chronic Illness（SSCI），Self Rating Depression Scale（SDS），and Self-Rating Anxiety Scale（SAS）in both groups of patients decreased，and the observation group［（35.67±7.45），（40.02±2.43），（45.36±4.17）］scored lower than the control group［（48.27±10.69），（54.54±3.54），（51.37±4.38）］，statistically significant（t=5.555，19.426，5.709，P＜0.05）．The incidence of postoperative complications in the observation group was significantly lower at 9.09% compared to the control group at 30.30%（χ ² =4.690，P=0.030，P＜0.05）．After intervention，the scores of bladder cancer specific module，functional status，mental status，family/social status and physical status  related dimensions of bladder cancer patients’ quality of life scale for bladder cancer patients（FACT-BL）in both groups increased，and the observation group［（34.27±3.26），（25.11±4.23），（21.51±4.23），（25.02±4.43），（20.56±3.11）］ scored higher than the control group［（27.00±4.34），（21.11±3.24），（16.12±2.12），（21.54±5.54），（15.87±4.13）］，the comparison was statistically significant（t=7.694，4.313，6.544，2.818，5.211，P＜0.05）．Conclusions  Preventive  risk management has a significant effect on the application of myometrial invasive bladder cancer after radical surgery，which can shorten the recovery time of gastrointestinal function and hospital stay，improve patients’ negative emotions，assist in preventing postoperative complications，and improve patients’ quality of life．

      嗜酸性粒细胞（EOS）作为过敏反应中关键的先天免疫细胞，在心血管疾病的发生与发展进程中也扮演着至关重要的角色。大量证据显示，血液EOS计数与诸多心血管疾病之间存在紧密联系，但临床研究得出的结论不尽相同。基础研究发现，EOS一方面可通过释放白细胞介素-4（IL-4）、IL-13及阳离子蛋白等细胞因子，对心肌梗死、心肌肥厚、心力衰竭或腹主动脉瘤发挥保护作用；另一方面，EOS表达的阳离子蛋白和血小板活化因子会促进平滑肌细胞增殖和钙化，进而加速动脉粥样硬化的形成。因此，EOS在不同心血管疾病中所发挥的作用存在差异，这与疾病的演变进程、EOS的数量均密切相关。本文对现有的临床和基础研究成果进行汇总，阐述EOS在各类心血管疾病中的不同作用。

       Eosinophils（EOS），as key innate immune cells in allergic reactions，play a crucial role in the occurrence and development of cardiovascular diseases．Ample evidence shows that the count of blood EOS is closely related to many cardiovascular diseases．However，the conclusions drawn from clinical studies are inconsistent，and these contradictory observational  results still cannot be reasonably explained so far．Basic research has found that，on the one hand，EOS can exert protective effects on myocardial infarction，myocardial hypertrophy，heart failure，or abdominal aortic aneurysm by releasing cytokines such as interleukin-4（IL-4），IL-13，and cationic proteins；on the other hand，the cationic proteins and platelet activating factors expressed by EOS can promote the proliferation and calcification of smooth muscle cells，thereby accelerating the formation of atherosclerosis．Therefore，the roles played by EOS in different cardiovascular diseases vary，which is closely related to the evolution process of the disease and the number of EOS．This article will summarize the existing clinical and basic research results to elaborate the different roles of EOS in various cardiovascular diseases．

       目的   探讨无管化微创PCNL（经皮肾镜取石术）治疗嵌顿性输尿管上段结石的效果。方法   将中山大学附属第一医院惠亚医院2019年12月—2021年12月收治的95例嵌顿性输尿管上段结石患者按照随机数字表法分组，给予对照组47例患者经尿道输尿管镜碎石术（TURL）治疗、观察组48例患者无管化微创PCNL治疗，观察两组手术一般状况、血清学指标、肾脏血流动力学以及并发症发生情况。结果   观察组手术时间、术后血尿以及住院时间均短于对照组，观察组术中出血量少于对照组，观察组结石清除率高于对照组（P＜0.05）；术后1 d观察组肾损伤分子-1（KIM-1）、中性粒细胞明胶相关脂脂质运载蛋白（NGAL）以及胱抑素C（Cys-C）水平低于对照组（P＜0.05）；两组肾动脉收缩期血流速度（Vs）以及舒张末期血流速度（Vd）对比差异无统计学意义（P＞0.05）；观察组并发症发生率（4.16%）低于对照组（19.15%）（P＜0.05）。结论   无管化微创PCNL可改善嵌顿性输尿管上段结石手术一般状况，减轻患者肾脏损伤，提高结石清除率，不影响肾脏血流，且并发症更少。

       Objective  To explore the effect of tubeless minimally invasive（percutaneous nephrolithotomy，PCNL）in the treatment of impacted upper ureteral stones．Methods  A total of 95 patients with impacted upper ureteral stones admitted to our hospital from December 2019 to December 2021 were grouped according to the random number table method．Control group of 47 cases were treated with transurethral ureteroscopy lithotripsy（TURL），48 patients in the observation group were given tubeless minimally invasive PCNL treatment．The general surgical conditions，serological indicators，renal hemodynamics and complications of the two groups were observed．Results  The operation time，postoperative hematuria and hospitalization time of the observation group were shorter than those of the control group，the intraoperative bleeding volume of the observation group was less than that of the control group，and the stone free rate of the observation group was higher than that of the control group（P＜0.05）．One day after surgery，the levels of kidney injury molecule-1（KIM-1），lipocalin（NGAL）and cystatin C（Cys-C）in the observation groupwere lower than those in the control group（P＜0.05）；the renal artery systolic blood flow velocity（Vs）and end-diastolic blood flow velocity（Vd）had no statistical significance（P＞0.05）；the incidence of complications in the observation group（4.16%）was lower than that in the control group（19.15%）（P＜0.05）．Conclusions  Tubeless minimally invasive PCNL can improve the general conditions of surgery，reduce kidney damage，increase stone free rate，does not affect renal blood flow，and has fewer complications．