目的 探讨益生菌辅助治疗儿童过敏性哮喘的临床疗效，分析其对Th1/Th2免疫失衡、炎症反应、免疫功能及复发风险的影响。方法 选取2022年1月至2023年12月本院收治的80例过敏性哮喘患儿，按随机数字表法分为对照组和观察组，各40例。对照组接受常规抗哮喘治疗（布地奈德雾化吸入+孟鲁司特钠），观察组结合益生菌进行辅助治疗。比较两组肺功能[第1秒用力呼气容积占预计值百分比（FEV1%）、最大呼气峰流速占预计值百分比（PEF%）]、Th1/Th2细胞因子[干扰素-γ（IFN-γ）、白细胞介素-4（IL-4）、白细胞介素-13（IL-13）]以及治疗总有效率、治疗后6个月内复发率。结果 治疗后，观察组FEV1%、PEF%分别为（87.35±5.21）%、（85.62±4.93）%，高于对照组的（78.44±5.67）%、（76.18±5.20）%（P<0.05）。观察组IFN-γ为（32.58±4.12）pg/mL，高于对照组的（24.36±3.89）pg/mL（P<0.05）；IL-4、IL-13分别为（18.27±3.06）pg/mL、（22.14±3.51）pg/mL，低于对照组的（25.63±3.74）pg/mL、（31.05±4.02）pg/mL（P<0.05）。观察组治疗总有效率为92.50%（37/40），高于对照组的75.00%（30/40）（P<0.05）。随访6个月，观察组哮喘复发率为10.00%（4/40），低于对照组的27.50%（11/40）（P<0.05）。结论 益生菌辅助治疗儿童过敏性哮喘可显著改善肺功能及临床症状，调节Th1/Th2免疫失衡，提高临床疗效，并降低复发风险，值得临床推广。

巨大/破裂型腰椎间盘突出症（G/RLDH）是腰椎间盘突出症的严重类型，可致剧烈根性疼痛及神经功能障碍。推拿作为非药物中医疗法，广泛应用于腰椎间盘突出症，但治疗G/RLDH的疗效与安全性尚存争议。近年发现G/RLDH具有较高的椎间盘自然重吸收率，为推拿干预提供了病理基础。本文系统检索相关文献，从中医病机、现代医学机制、临床应用及安全性争议等方面进行综述，旨在指导临床诊治并为未来研究提供参考。

Giant/ruptured lumbar disc herniation (G/RLDH) is a severe type of lumbar disc herniation that can cause intense radicular pain and neurological dysfunction. As a non-pharmacological therapy in traditional Chinese medicine, tuina is widely used for lumbar disc herniation; however, its efficacy and safety in treating G/RLDH remain controversial. Recent studies have revealed a relatively high rate of spontaneous resorption of herniated discs in G/RLDH, which provides a pathological basis for tuina intervention. This article systematically reviews the relevant literature, summarizing the traditional Chinese medicine pathogenesis, modern medical mechanisms, clinical application, and safety controversies, aiming to guide clinical diagnosis and treatment and to provide a reference for future research.

目的 探讨吗替麦考酚酯联合醋酸泼尼松对视神经脊髓炎（NMO）患者白细胞介素-23（IL-23）/IL-17A轴相关因子、复发的影响。设计 前瞻性设计。研究对象 选取我院90例NMO患者，简单随机化法分组，各30例。方法 所有患者术前均行矫正视力、Kurtzke功能评定量表（EDSS）、实验室指标检查。A组采取吗替麦考酚酯+醋酸泼尼松，B组采取吗替麦考酚酯，C组采取醋酸泼尼松，观察患者治疗3个月后、6个月后矫正视力、Kurtzke功能评定量表（EDSS）、实验室指标变化。主要指标 IL-23/IL-17A轴相关因子、矫正视力、EDSS评分、复发。结果 （1）治疗前，3组ApoE、AQP4、GFAP、IL-23、IL-17A、IL-6、TNF-α及矫正视力、EDSS评分比较差异无统计学意义（P＞0.05）；治疗3个月后、6个月后A组血清ApoE水平高于B组、C组，AQP4、GFAP、IL-23、IL-17A、IL-6、TNF-α水平低于B组、C组（P＜0.05），治疗3个月后、6个月后A组矫正视力、EDSS评分低于B组、C组（P＜0.05）；（2）3组不良反应比较差异无统计学意义（P＞0.05）；（3）3组治疗后随访12个月，A组、B组、C组各有3、3、3例失访，年复发率比较差异无统计学意义（P＞0.05）。结论 免疫抑制剂联合醋酸泼尼松可调节NMO患者神经递质、IL-23/IL-17A轴相关因子表达，改善视力，降低复发率。

【摘要】目的：探究淀粉样蛋白A（serum amyloid?A，SAA）、超敏C反应蛋白（high sensitivity C-reactive protein，hsCRP）、白细胞计数（white blood cell count，WBC）、SAA/hsCRP比值对儿童感染性疾病早期鉴别的临床价值。方法：选取2025年1月--2025年6月我院就诊的感染性疾病患儿296例进行研究，其中细菌感染组86例、病毒感染组180例，另选取同期30例健康体检儿童作为对照组。检测三组SAA、hsCRP、WBC水平，计算SAA/hsCRP比值情况，通过受试者工作特征（receiver operating characteristic curve，ROC）分析各指标单独及联合检测对细菌感染和病毒感染的诊断效能。结果：与对照组比较，细菌感染组和病毒感染组SAA、hsCRP、WBC、SAA/hsCRP比值更高（P<0.05）；与病毒感染组比较，细菌感染组SAA、hsCRP、WBC更高，SAA/hsCRP比值更低（P<0.05）。相关性分析显示，SAA 与 hsCRP、WBC 及 SAA/hsCRP 比值均呈正相关（r=0.417、0.473、0.324，均 P＜0.001）；hsCRP 与 WBC 呈正相关（r=0.408，P＜0.001），与 SAA/hsCRP 比值呈负相关（r=-0.402，P＜0.001）；SAA/hsCRP 比值与 WBC 呈负相关（r=-0.523，P＜0.001）。ROC 曲线分析结果显示，SAA、hsCRP、WBC 及 SAA/hsCRP 比值均可用于儿童细菌感染与病毒感染的鉴别诊断，其 AUC 分别为 0.810、0.879、0.893 和 0.893，联合检测的 AUC 为 0.997，灵敏度为98.80%，特异度为93.89%，诊断效能优于单项指标。结论：SAA、hsCRP、WBC、SAA/hsCRP比值在儿童细菌感染性疾病及病毒感染性疾病鉴别诊断中有一定价值，临床可联合检测上述指标水平以鉴别具体感染类型，为患儿诊断及预后评估提供依据。

虽然高效抗逆转录病毒治疗已经把艾滋病变成了能够长期管理的慢性传染病，可是患者预后的个体差异比较明显。近些年不良环境暴露被发现是影响艾滋病生存质量、免疫重建、疾病进展的重要外源性因素。环境污染物作为广泛存在而且有可预防的外部风险因素，有着低剂量、长时程、多途径暴露的特点，能够通过免疫毒性、氧化应激、慢性炎症激活、代谢紊乱等多种通路，干扰艾滋病患者的免疫重建进程和病毒抑制效果，进而影响其疾病进展、远期生存结局。本文系统综述了大气污染物、重金属、黄曲霉素、多环芳烃等典型环境污染物与艾滋病患者发病进展及预后转归的关联，深入分析人群易感性差异和当前研究存在的局限，可为优化HIV/AIDS患者的健康管理策略、降低环境相关健康风险、改善患者远期预后给予理论参考和实践依据。

Although highly active antiretroviral therapy has turned AIDS into a chronic infectious disease that can be managed for a long time, the individual differences in the prognosis of patients are obvious. In recent years, adverse environmental exposure has been found to be an important exogenous factor affecting the quality of life, immune reconstruction and disease progression of AIDS. As an external risk factor that exists and has potential intervention, environmental pollutants have the characteristics of low-dose, long-term and multi-channel exposure. They can interfere with the immune reconstruction process and virus inhibition effect of AIDS patients through various pathways such as immunotoxicity, oxidative stress, chronic inflammation activation, and metabolic disorders, thereby affecting their disease progression and long-term survival outcomes. This article systematically reviews the association between typical environmental pollutants such as air pollutants, heavy metals, aflatoxins, and polycyclic aromatic hydrocarbons and the progression and prognosis of AIDS patients. In-depth analysis of the differences in population susceptibility and the limitations of current research can provide theoretical reference and practical basis for optimizing the health management strategies of HIV / AIDS patients, reducing environmental-related health risks, and improving the long-term prognosis of patients.

冠心病是临床高发的心血管疾病，其病理核心为动脉粥样硬化，而炎症反应异常激活是推动病变进展的关键驱动力。PI3K/Akt通路通过调控炎症反应等，在CHD进程中发挥双向调节作用。现代研究表明，该通路保护性激活不足可加剧血管内皮损伤与斑块不稳定性，而炎症反应的持续又可进一步抑制PI3K/Akt通路活性，形成恶性循环。当动脉粥样斑块破裂，AMI发生后炎症级联反应放大，该通路异常激活，诱发MIRI。“荣泣卫除”出自《黄帝内经》，指营气耗损（荣泣）、卫气失守（卫除），荣卫失和则气血运行不畅、脉络瘀阻。本团队结合该理论与现代研究，认为CHD中PI3K/Akt通路介导的异常炎症反应的病理机制，与“荣泣卫除”理论内涵存在对应关系。研究发现，通过调控PI3K/Akt通路活性，抑制炎症因子激活与炎症蛋白表达，可抑制CHD发生发展进程。故本文基于“荣泣卫除”理论，系统梳理了PI3K/Akt通路介导的炎症反应在CHD中的作用及与中医病机的内在关联，总结中医药防治的研究进展，为中西医结合防治CHD提供参考依据。

Coronary heart disease is a clinically prevalent cardiovascular disease, with atherosclerosis as its core pathology. Abnormal activation of the inflammatory response is a key driving force for disease progression. The PI3K/Akt pathway exerts bidirectional regulatory effects on the progression of CHD by modulating inflammatory responses, among other functions. Modern studies indicate that insufficient protective activation of this pathway can exacerbate vascular endothelial injury and plaque instability, while persistent inflammation further suppresses PI3K/Akt pathway activity, forming a vicious cycle. Following atherosclerotic plaque rupture and the onset of AMI, the inflammatory cascade is amplified, leading to aberrant activation of this pathway and triggering MIRI. The theory of "depletion of nutritive level and exhaustion of defensive level" originates from the?Yellow Emperor's Inner Classic, referring to the depletion of nutritive level (Rong Qi) and the exhaustion of defensive level (Wei Qi), resulting in disharmony between nutritive and defensive levels, which impedes the smooth flow of Qi and blood and causes stasis in the collaterals. By integrating this theory with modern research, our team proposes a correspondence between the pathological mechanism of abnormal PI3K/Akt pathway-mediated inflammatory response in CHD and the theoretical connotation of "depletion of nutritive level and exhaustion of defensive level". Studies have found that modulating PI3K/Akt pathway activity to inhibit the activation of inflammatory factors and expression of inflammatory proteins can suppress the occurrence and progression of CHD. Therefore, based on the theory of "depletion of nutritive level and exhaustion of defensive level", this paper systematically reviews the role of the PI3K/Akt pathway-mediated inflammatory response in CHD and its intrinsic relationship with traditional Chinese medicine pathogenesis, summarizes research progress in TCM prevention and treatment, and provides a reference for the integrated traditional Chinese and Western medicine management of CHD.

目的: 探讨RNF213基因敲除对hCMEC/D3细胞分泌的外泌体circRNAs表达谱的影响。方法: 采用尺寸排阻法分别从RNF213-/- hCMEC/D3细胞（KO组）和野生型细胞（WT组）培养上清中提取外泌体，用Illumina Novaseq 6000 平台检测外泌体circRNAs表达谱，并用生物信息学方法进行分析。结果: 两组细胞存在134种差异表达的外泌体circRNAs，其中116种上调，18种下调。GO分析结果中，cellular nitrogen compound metabolic process (BP), intracellular anatomical structure (CC), heterocyclic compound binding (MF)和organic cyclic compound binding (MF)是最丰富的术语。Polycomb repressive complex通路是KEGG分析最显著富集的通路。circHIPK3可能通过ceRNA机制和/或与RNA结合蛋白相互作用参与烟雾病的发生发展，并成功构建circRNA-miRNA-mRNA通路。结论: 本研究确定了RNF213-/- hCMEC/D3细胞与野生型细胞外泌体circRNAs的差异表达谱，从外泌体的视角，为烟雾病的发病分子机制提供了新的见解。

目的 比较锝[???Tc]甲氧基异丁基异腈单光子发射计算机断层扫描/计算机断层扫描（???Tc-MIBI SPECT/CT）双时相显像与颈部超声在继发性甲状旁腺功能亢进症（SHPT）患者术前定位中的诊断价值。方法 回顾性纳入2025年5月至2026年4月于黔东南苗族侗族自治州人民医院行两种影像学检查的疑似SHPT患者54例。以手术病理结果为金标准，计算超声与SPECT/CT在区域层面（共216个区域）的敏感性、特异性、准确性，并比较不同解剖区域的病灶检出率。结果 54例中确诊SHPT 45例（83.33%）。超声诊断敏感性、特异性、准确性分别为70.89%（112/158）、86.21%（50/58）、75.00%（162/216）；SPECT/CT分别为92.41%（146/158）、94.83%（55/58）、93.06%（201/216）。SPECT/CT的敏感性和准确性均高于超声（P均<0.001）。SPECT/CT在左上、左下、右上三个区域的检出率均高于超声（P<0.05）。结论 99mTc-MIBI SPECT/CT双时相显像在SHPT术前定位中的敏感性和准确性优于颈部超声，尤其对左上、左下、右上区域病灶检出优势明显，可作为SHPT患者术前定位的重要补充或首选影像学方法。

Objective?To compare the diagnostic value of technetium-99m methoxyisobutylisonitrile single-photon emission computed tomography/computed tomography (99mTc-MIBI SPECT/CT) dual-phase imaging and cervical ultrasound in preoperative localization of secondary hyperparathyroidism (SHPT).?Methods?A total of 54 patients with suspected SHPT who underwent both imaging examinations at Qiandongnan Miao and Dong Autonomous Prefecture People's Hospital from May 2025 to April 2026 were retrospectively enrolled. Using surgical pathology as the gold standard, the sensitivity, specificity, and accuracy of ultrasound and SPECT/CT were calculated at the regional level (216 regions in total), and the detection rates in different anatomical regions were compared.?Results?Among the 54 patients, 45 (83.33%) were confirmed with SHPT. The sensitivity, specificity, and accuracy of ultrasound were 70.89% (112/158), 86.21% (50/58), and 75.00% (162/216), respectively; while those of SPECT/CT were 92.41% (146/158), 94.83% (55/58), and 93.06% (201/216), respectively. The sensitivity and accuracy of SPECT/CT were significantly higher than those of ultrasound (both?P<0.001). The detection rates of SPECT/CT in the upper-left, lower-left, and upper-right regions were significantly higher than those of ultrasound (P<0.05).?Conclusion?99mTc-MIBI SPECT/CT dual-phase imaging demonstrates superior sensitivity and accuracy compared with cervical ultrasound in preoperative localization of SHPT, especially showing significant advantages in detecting lesions in the upper-left, lower-left, and upper-right regions. It can serve as an important supplement or the first-choice imaging modality for preoperative localization in SHPT patients.

目的 比较锝[???Tc]甲氧基异丁基异腈单光子发射计算机断层扫描/计算机断层扫描（???Tc-MIBI SPECT/CT）双时相显像与颈部超声在继发性甲状旁腺功能亢进症（SHPT）患者术前定位中的诊断价值。方法 回顾性纳入2025年5月至2026年4月于黔东南苗族侗族自治州人民医院行两种影像学检查的疑似SHPT患者54例。以手术病理结果为金标准，计算超声与SPECT/CT在区域层面（共216个区域）的敏感性、特异性、准确性，并比较不同解剖区域的病灶检出率。结果 54例中确诊SHPT 45例（83.33%）。超声诊断敏感性、特异性、准确性分别为70.89%（112/158）、86.21%（50/58）、75.00%（162/216）；SPECT/CT分别为92.41%（146/158）、94.83%（55/58）、93.06%（201/216）。SPECT/CT的敏感性和准确性均高于超声（P均<0.001）。SPECT/CT在左上、左下、右上三个区域的检出率均高于超声（P<0.05）。结论 99mTc-MIBI SPECT/CT双时相显像在SHPT术前定位中的敏感性和准确性优于颈部超声，尤其对左上、左下、右上区域病灶检出优势明显，可作为SHPT患者术前定位的重要补充或首选影像学方法。

Objective?To compare the diagnostic value of technetium-99m methoxyisobutylisonitrile single-photon emission computed tomography/computed tomography (99mTc-MIBI SPECT/CT) dual-phase imaging and cervical ultrasound in preoperative localization of secondary hyperparathyroidism (SHPT).?Methods?A total of 54 patients with suspected SHPT who underwent both imaging examinations at Qiandongnan Miao and Dong Autonomous Prefecture People's Hospital from May 2025 to April 2026 were retrospectively enrolled. Using surgical pathology as the gold standard, the sensitivity, specificity, and accuracy of ultrasound and SPECT/CT were calculated at the regional level (216 regions in total), and the detection rates in different anatomical regions were compared.?Results?Among the 54 patients, 45 (83.33%) were confirmed with SHPT. The sensitivity, specificity, and accuracy of ultrasound were 70.89% (112/158), 86.21% (50/58), and 75.00% (162/216), respectively; while those of SPECT/CT were 92.41% (146/158), 94.83% (55/58), and 93.06% (201/216), respectively. The sensitivity and accuracy of SPECT/CT were significantly higher than those of ultrasound (both?P<0.001). The detection rates of SPECT/CT in the upper-left, lower-left, and upper-right regions were significantly higher than those of ultrasound (P<0.05).?Conclusion?99mTc-MIBI SPECT/CT dual-phase imaging demonstrates superior sensitivity and accuracy compared with cervical ultrasound in preoperative localization of SHPT, especially showing significant advantages in detecting lesions in the upper-left, lower-left, and upper-right regions. It can serve as an important supplement or the first-choice imaging modality for preoperative localization in SHPT patients.

目的 比较锝[???Tc]甲氧基异丁基异腈单光子发射计算机断层扫描/计算机断层扫描（???Tc-MIBI SPECT/CT）双时相显像与颈部超声在继发性甲状旁腺功能亢进症（SHPT）患者术前定位中的诊断价值。方法 回顾性纳入2025年5月至2026年4月于黔东南苗族侗族自治州人民医院行两种影像学检查的疑似SHPT患者54例。以手术病理结果为金标准，计算超声与SPECT/CT在区域层面（共216个区域）的敏感性、特异性、准确性，并比较不同解剖区域的病灶检出率。结果 54例中确诊SHPT 45例（83.33%）。超声诊断敏感性、特异性、准确性分别为70.89%（112/158）、86.21%（50/58）、75.00%（162/216）；SPECT/CT分别为92.41%（146/158）、94.83%（55/58）、93.06%（201/216）。SPECT/CT的敏感性和准确性均高于超声（P均<0.001）。SPECT/CT在左上、左下、右上三个区域的检出率均高于超声（P<0.05）。结论 99mTc-MIBI SPECT/CT双时相显像在SHPT术前定位中的敏感性和准确性优于颈部超声，尤其对左上、左下、右上区域病灶检出优势明显，可作为SHPT患者术前定位的重要补充或首选影像学方法。

Objective?To compare the diagnostic value of technetium-99m methoxyisobutylisonitrile single-photon emission computed tomography/computed tomography (99mTc-MIBI SPECT/CT) dual-phase imaging and cervical ultrasound in preoperative localization of secondary hyperparathyroidism (SHPT).?Methods?A total of 54 patients with suspected SHPT who underwent both imaging examinations at Qiandongnan Miao and Dong Autonomous Prefecture People's Hospital from May 2025 to April 2026 were retrospectively enrolled. Using surgical pathology as the gold standard, the sensitivity, specificity, and accuracy of ultrasound and SPECT/CT were calculated at the regional level (216 regions in total), and the detection rates in different anatomical regions were compared.?Results?Among the 54 patients, 45 (83.33%) were confirmed with SHPT. The sensitivity, specificity, and accuracy of ultrasound were 70.89% (112/158), 86.21% (50/58), and 75.00% (162/216), respectively; while those of SPECT/CT were 92.41% (146/158), 94.83% (55/58), and 93.06% (201/216), respectively. The sensitivity and accuracy of SPECT/CT were significantly higher than those of ultrasound (both?P<0.001). The detection rates of SPECT/CT in the upper-left, lower-left, and upper-right regions were significantly higher than those of ultrasound (P<0.05).?Conclusion?99mTc-MIBI SPECT/CT dual-phase imaging demonstrates superior sensitivity and accuracy compared with cervical ultrasound in preoperative localization of SHPT, especially showing significant advantages in detecting lesions in the upper-left, lower-left, and upper-right regions. It can serve as an important supplement or the first-choice imaging modality for preoperative localization in SHPT patients.