目的 分析新生儿无乳链球菌（B族链球菌,GBS）败血症的临床特点、围产期高危因素及预后,提高临床对GBS败血症的认识。方法 选择21例GBS败血症新生儿（收集病例时间为2018年2月—2021年11月）,采用回顾性调查法分析临床资料;对新生儿临床资料、实验室检查、影像学资料进行统计和对比,分析临床特征,同时比较患儿合并症情况及评估治疗预后结果等。结果 GBS败血症新生儿中早发型（90.48%）明显高于迟发型（9.52%）,P<0.05;GBS败血症新生儿主要症状表现为发热、发绀、气促、呻吟、抽搐等,以气促、呻吟为主;通过实验室检查,发现患儿普遍存在C反应蛋白、降钙素原、白细胞计数等指标异常情况;经头颅MRI检查提示蛛网膜下腔出血6例;X线提示新生儿吸入性综合征6例、双肺新生儿肺炎4例;部分患儿存在合并症,其中1例合并脑膜炎、3例合并蛛网膜下腔出血、4例合并黄疸、2例合并新生儿低血糖;所有患儿接受抗菌药物治疗,以青霉素、头孢他啶为主,平均住院时间（14.86±2.33）d,治愈19例（占比90.48%）、1例患儿好转后家属要求签字出院,1例家属要求转上级儿童医院。结论 新生儿无乳链球菌败血症有早发型和迟发型之分,两者的临床表现及特征有明显差异,该病病情较凶险,临床需高度重视本病的防治工作,早期诊断及时治疗干预,以提高新生儿预后。

Objective To analyze the clinical characteristics,perinatal high-risk factors and prognosis of neonatal Streptococcus agalactiae（group B Streptococcus,GBS）sepsis,and to improve the clinical understanding of Streptococcus agalactiae sepsis．Methods Twenty-one newborns with GES sepsis were selected（the cases were collected from February 2018 to November 2021）,and the clinical data were analyzed by retrospective investigation．The clinical data,laboratory examination and imaging data of newborns were summarized and compared,and the clinical characteristics were analyzed．At the same time,the complications of children were compared and the prognosis of treatment was evaluated．Results In newborns with GBS sepsis,the early-onset rate（90.48%）was significantly higher than the late-onset（9.52%）,P < 0.05．The main symptoms of newborns with GBS sepsis were shortness of breath,moaning,fever,cyanosis,convulsions,etc．Through laboratory examination,it was found that there were common abnormalities in C-reactive protein,procalcitonin,leukocyte count and other indicators in children．Transcranial MRI results showed 6 cases with subarachnoid hemorrhage;X-ray showed 6 cases with neonatal aspiration syndrome and 4 cases with both lungs neonatal pneumonia．Some children had complications,including 1 case with meningitis,3 cases with subarachnoid hemorrhage,4 cases with jaundice,and 2 cases with neonatal hypoglycemia．All children were treated with antibiotics,mainly penicillin and ceftazidime．The average hospital stay was（14.86 ± 2.33）days,and 19 cases were cured（accounting for 90.48%）．One case of the child's family member asked to sign and leave the hospital after improvement,and one case of the family member asked to be transferred to a superior children's hospital．Conclusions Neonatal Streptococcus agalactiae sepsis can be divided into early-onset and late-onset type．There are significant differences in clinical manifestations and characteristics between them．The disease is dangerous,clinical attention should be paid to the prevention and treatment of the disease,early diagnosis and timely treatment and intervention,so as to improve the prognosis of newborns．

目的 分析对比肺部受累的惠普尔病与初治菌阴肺结核患者的临床特征,提高对肺部受累的惠普尔病的认识、诊断及鉴别水平。方法 回顾性收集20例肺部受累的惠普尔病为病例组,并随机选取同期56例初治菌阴肺结核患者为对照组进行对比,探讨肺部受累的惠普尔病的临床特征。结果 病例组中老年（>37岁）、急性或亚急性的病程比例高于对照组（P<0.05）。CT影像学中,从病灶分布来看,病例组的病灶分布在下叶的病例比例高于对照组（P<0.05）,病灶分布在上叶的病例比例低于对照组（P<0.05）;从形态上看,病例组中表现为网状病灶、间质性肺炎的比例高于对照组（P<0.05）,病例组中表现为空洞、纤维条索、实性影、结节影、树芽征、肺门淋巴结肿大的比例低于对照组（P<0.05）,而性别、合并免疫力低下疾病、咳嗽、咳痰、发热、咳血、关节痛、腹泻等在组间比较差异均无统计学意义。病例组全部病例的肺泡灌洗液宏基因测序结果显示：惠普尔养障体是唯一菌19例（95.0%）或主要菌1例（5.00%,合并结核菌1序列）,而对照组肺泡灌洗液宏基因测序结果显示：21例（37.5%）检测出结核分枝杆菌（TB）复合群是唯一菌或主要致病菌,18例TB-RNA（+）,15例TB-LAMP（+）。结论 惠普尔病在临床可表现为急性或亚急性病程,好发中老年男性,以发热和（或）呼吸道症状为主,可伴或不伴有腹泻、关节痛;肺部影像学以下肺网状、间质性肺炎改变为主,可以单独累及肺部;与初治菌阴肺结核患者临床症状极其相似。应尽快完善支气管镜检查,肺泡灌洗液的宏基因检测对早期、快速诊断此病尤为重要。

Objective To analyze and compare the clinical features of patients with pulmonary involvement of Whipple disease and primary treated bacteriological negative pulmonary tuberculosis,so as to improve the recognition,diagnosis and differentiation ability of pulmonary involvement of Whipple disease．Methods Clinical features of Whipple disease with pulmonary involvement were investigated by retrospectively collecting 20 cases as a case group,comparing with 56 randomly selected patients with primary treated bacteriological negative pulmonary tuberculosis as a control group during the same period．Results The case group had a significantly higher proportion of older patients（>37 years）,acute or subacute disease courses than the control group （P<0.05）．On CT imaging,in terms of lesion distribution,the proportion of cases with lesions in the lower lobe was significantly more in the case group than in the control group（P<0.05）,and the ratio of cases with lesions in the upper lobe was considerably less than in the control group（P<0.05）．Regarding morphology,significantly more of the case group showed reticular lesions and interstitial pneumonia than the control group（P<0.05）．Significantly fewer of the case group showed cavities,fibrous bands,solid shadows,nodular shadows,tree-bud signs,and enlarged hilar lymph nodes than the control group（P<0.05）．No statistically significant differences existed between the two groups in gender,combined immunocompromising diseases,cough,sputum,fever,coughing up blood,arthralgia or diarrhea. At the same time,the differences of gender,combined immunocompromised disease,cough,sputum,fever,coughing up blood,arthralgia,and diarrhea were not statistically significant．The metagenomic sequencing of alveolar lavage fluid in the case group revealed Tropheryma whipplei as the sole pathogenic bacteria in 19 cases（95%）or the primary pathogenic bacteria in 1 case（5.00%,combined TB 1 sequence）．In contrast,metagenomic sequencing of alveolar lavage fluid in the control group detected Mycobacterium tuberculosis complex as the sole or primary pathogenic bacteria in 21 cases（37.5%）,TB-RNA（+）in 18 cases and TB-LAMP（+）in 15 cases．Conclusions Clinical presentation in Whipple disease can be of an acute or subacute course,preferably in middle-aged and older men,with fever or/and respiratory symptoms,either with or without diarrhea and arthralgia．Its pulmonary imaging dominates with reticular,interstitial pneumonia changes in the lower lungs,which can involve the lungs alone in the disease．At the same time,the clinical symptoms are highly similar to those patients with primary treated bacteriological negative pulmonary tuberculosis．Therefore,it is vital to complete bronchoscopy and metagenomic sequencing of alveolar lavage fluid as soon as possible for early and rapid diagnosis of this Whipple disease．Treatment with sensitive antibacterial drugs can result in significant improvement and save patients' lives．

目的 探讨慢性淋巴细胞白血病（CLL）合并第二肿瘤临床特征和预后。方法 回顾性分析2015年8月—2021年10月我院收治的58例CLL患者,其中有11例合并第二肿瘤,47例无合并第二肿瘤,分析两组病例的临床特征及其对预后的影响。结果 CLL合并第二肿瘤和无合并第二肿瘤患者在年龄、性别、白细胞计数、血红蛋白水平、淋巴细胞计数、血小板计数、乳酸脱氢酶（LDH）、β₂-微球蛋白（β₂-MG）水平、分期、单个基因缺失类型之间比较差异无统计学意义,但CLL合并第二肿瘤患者基因缺失个数较无合并第二肿瘤CLL患者组高（χ²=11.17,P=0.03）,且总生存期较短。结论 CLL合并第二肿瘤患者常伴有多个基因缺失,且预后差,当CLL患者伴有多个基因缺失时,在诊治过程中需警惕有无合并第二肿瘤。

Objective To investigate the prognosis and clinical characteristics of chronic lymphocytic leukemia（CLL）patients with second tumor．Methods A retrospective analysis was performed on 58 cases of CLL patients who were diagnosed in our hospital from August 2015 to October 2021．The clinical data of 11 CLL patients with second cancer and 47 CLL patients without second cancer were compared and analyzed．Results There were no significant differences in age,sex,white blood cell count,lymphocyte count,platelet count,the level of serum β₂-microglobulin and lactate dehydrogenase between two groups．However,in CLL patients with second cancer,the incidence of multiple genetic deletions was higher than those without second cancer（χ² =11.17,P =0.03）．The overall survival time was shorter in CLL patients with second primary cancer．Conclusions CLL patients with second tumor have a frequent multiple gene deletions and poor prognosis．Physicians should pay attention to second cancers when diagnosing the CLL patients with multiple gene deletions．

本文综述近10年中医传统疗法中通过穴位刺激预防与治疗老年患者骨折术后谵妄的研究概况。术后谵妄是老年患者骨折术后常见的并发症,不仅延长患者住院时间、增加经济负担,同时与骨折术后死亡并发症的发生密切相关。但是本病机制尚未明确,在临床治疗上难以达成共识。针灸等穴位刺激是中医药治疗脑病的独具特色的疗法,近年来有关穴位刺激防治老年骨折术后谵妄的报道越来越多,本文主要探讨不同的穴位刺激方法干预对骨折术后谵妄发生率的影响,包括传统刺激方式如毫针、电针、穴位注射、穴位敷贴和新针疗法如耳针、头针等,认为穴位刺激能够较好预防骨折术后谵妄发生,在治疗上也有较好疗效。以期为进一步临床研究与应用提供参考。

This article summarized the research of acupoint stimulation in preventing delirium after fracture surgery in elderly patients in recent 10 years．Postoperative delirium is a common complication in elderly patients after fracture surgery, which affects life extremely and increases economic burden．However, the mechanism of this disease haven't been revealed, and it is difficult to reach consensus on clinical treatment．Acupoint stimulation, like acupuncture, is a unique treatment of encephalopathy with traditional Chinese medicine．In recent years, there are more and more reports on acupoint stimulation therapy to prevent and treat delirium after fracture surgery in the elderly．This article mainly study the influence of different acupoint stimulation therapy on treatment of delirium after fracture surgery, including electroacupuncture, auriculotherapy, scalp acupuncture, acupoint injection and acupoint application, etc．It is believed that acupoint stimulation can prevent delirium after fracture surgery, so as to provide reference for further clinical research and application．

目的 分析儿童肺炎支原体肺炎（MPP）合并EB病毒（EBV）感染的临床表现及危险因素,以期进一步提升疾病预防及治疗有效率。方法 分析2020年4月—2022年4月间于我院进行入院治疗的MPP合并EBV感染患儿基本资料,选择84例进行研究,另选择单一EBV感染患儿作为对照组,对比两组患儿临床表现差异及各项指标,分析合并感染的危险因素。结果 一般资料上,研究组患儿低体质量、免疫力低下、流行病接触史占比均高于对照组,数据差异存在统计学意义（P<0.05）;临床表现上,研究组患儿高热、发热时间≥10 d、呼吸困难、胸腔积液、侵犯多肺叶占比及白细胞、淋巴细胞指标均高于对照组,血小板、Hb低于对照组,数据差异存在统计学意义（P<0.05）;经多因素分析发现,低体质量、免疫力低下、流行病接触史、高热、发热时间≥10 d、呼吸困难、胸腔积液、侵犯多肺叶、白细胞、血小板、Hb、淋巴细胞是MPP合并EBV感染的重要危险因素（P<0.05）。结论 儿童MPP合并EBV感染临床病症表现明显,且相较于单一EBV感染症状更为严重,医务人员需要根据患儿表现及相关危险因素及时予以准确诊断,对患儿实施针对性有效治疗,提升疾病治疗有效率。

目的 分析在胃癌诊断中应用人表皮生长因子受体2（HER-2）结合肿瘤标志物检测的意义。方法 回顾性选取2019年6月—2021年6月我院收治的100例胃癌患者作为胃癌组,另选同期收治的60例胃良性肿瘤患者作为胃良性肿瘤组。比较HER-2与多项肿瘤标志物检测的诊断效能等。结果 胃癌组HER-2、糖类抗原（CA）125、CA72-4及CA19-9浓度与阳性表达率高于胃良性肿瘤组（P<0.05）。对于胃癌诊断,免疫组化指标HER-2检测的敏感度为72.00%,正确率为77.00%;多项肿瘤标志物检测的敏感度为77.00%,正确率为80.00%;二者联合检测的敏感度为89.00%,正确率为90.00%;相较于多项肿瘤标志物与HER-2单一检测,二者联合检验的正确率、敏感度更高（P<0.05）。结论 HER-2结合血清肿瘤标志物检验对胃癌的诊断价值较高。

Objective To analyze the significance of human epidermal growth factor receptor 2（HER-2）combined with tumor marker in the diagnosis of gastric cancer．Methods A total of 100 patients with gastric cancer admitted to our hospital from June 2019 to June 2021 were retrospectively selected as the gastric cancer group, and 60 cases of gastric benign tumor admitted to our hospital during the same period were also selected．The diagnostic efficacy of HER-2 was compared with those of multiple tumor markers．Results The concentration and positive expression rate of HER-2, carbohydrate antigen（CA）125, CA72-4 and CA19-9 in gastric cancer group were higher than those in gastric benign tumor group（P<0.05）．For the diagnosis of gastric cancer, the sensitivity of the immunohistochemical indicator HER-2 detection was 72.00%, and the accuracy rate was 77.00%．The sensitivity and accuracy of detecting multiple tumor markers were 77.00% and 80.00%, respectively．The sensitivity of the combined detection of the two was 89.00%, and the accuracy was 90.00%．Compared to multiple tumor markers and HER-2 single detection, the combined test of the two had a higher accuracy and sensitivity（P<0.05）．Conclusions The detection of HER-2 combined with serum tumor markers has high diagnostic value for gastric cancer．

目的 比较单纯康复训练和在此基础上结合苍龟探穴针法对脑卒中后肩手综合征I期的临床疗效差异。方法 选择响水县人民医院疼痛康复科收治的卒中后出现肩手综合征I期患者60例,按随机数字表法分为治疗组（n=30）和对照组（n=30）。治疗组患者行与苍龟探穴中医针法结合康复训练,先由具备针灸专业主治资格的临床医师对所选取的部分穴位使用苍龟探穴中医传统针法实施治疗后,再由具有5年以上工作经历的康复治疗师实施治疗,而其他患者则单纯接受康复训练,并观察2组患者在治疗前和治疗后的视觉模拟评分（VAS）、肿胀程度、简式上肢运动功能（Fugl-Meyer）评估以及临床疗效。结果 本次研究临床治疗进程中,2组无不良反应情况出现,因疫情和不能配合治疗而出现5例脱落病例（治疗组2例,对照组3例）。①治疗后,2组患者的VAS和肿胀程度评分低于治疗前（P<0.01）,治疗组患者2项评分高于治疗前（P<0.05）;②治疗后,2组患者的Fugl-Meyer评分高于治疗前（P<0.01）,治疗组患者评分高于对照组（P<0.01）;③治疗组的有效率高于对照组,组间比较差异有统计学意义（P<0.05）。结论 苍龟探穴中医传统针法结合康复训练可减少患者水肿和酸痛情况,明显改善患者上肢运动能力,有良好的临床效果。

Objective To compare the clinical efficacy of rehabilitation training alone and the combination of Cangguitanxue acupuncture on post-stroke stage I shoulder-hand syndrome．Methods A total of 60 patients from the Department of Rehabilitation Medicine of Xiangshui County People's Hospital who met the diagnosis（stroke followed by stage I shoulder-hand syndrome）were selected, and they were randomly divided into treatment group（n=30）and control group（n=30）according to the random number table method．Patients in the treatment group underwent a combination of rehabilitation training with the Cangguitanxue acupuncture Chinese medicine acupuncture method, and were first treated by a clinician qualified in acupuncture using the Cangguitanxue acupuncture Chinese medicine traditional acupuncture method on selected acupoints, and then by a rehabilitation therapist with more than five years of experience, while other patients received rehabilitation treatment alone．Results In the clinical treatment process of this study, there were no adverse reactions in the two groups, but there were five cases of dropout due to the epidemic and the inability to cooperate with the treatment（two cases in the treatment group and three cases in the control group）．After treatment, the visual analogue scale（VAS）and swelling degree scores of the two groups were significantly lower than those before treatment（P<0.01）, and the performance of the patients in the treatment group was better than that before treatment（P<0.05）．After treatment, the score of simplified upper limb motor control function（Fugl-Meyer）score in the two groups was significantly higher than that before treatment（P<0.01）, and the score of patients in the treatment group was higher than that of the control group（P<0.01）．The effective rate of the control group was inferior to that of the treatment group, and the difference was statistically significant（P<0.05）．Conclusions The traditional acupuncture method combined with rehabilitation training can significantly reduce edema and soreness in patients, significantly improve upper limb motor ability, and have good clinical effects．

目的 分析医院急诊患者24小时诊疗数据与临床路径标准的差异,以此探讨现行诊疗路径存在的问题及提升策略。方法 统计和分析本院2021年1月—2021年12月间收治的218例急性消化道出血和82例急性脑出血患者急诊治疗相关诊疗数据,并与相关疾病诊疗指南进行对比,分析实际诊疗数据与临床路径标准的差异,探究问题出现的原因并探讨针对性改良方案。结果 急性消化道出血临床路径诊疗标准规定检查项目为13项,急性消化道出血患者的应用率为100%,其中有11项符合率>50%,占比84.62%;急性脑出血临床路径诊疗标准规定检查项目为14项,急性脑出血患者的应用率为100%,其中有10项符合率>50%,占比71.43%;急性消化道出血患者中,超出临床路径检查标准项目9项,且检查率均在50%以上;急性脑出血患者中,超出临床路径检查标准项目4项,其中2项检查率在50%以上;在治疗措施方面,急性消化道出血、急性脑出血的实际治疗与临床路径标准基本相符,在针对不同病情时会采用不同治疗方法,会存在一定差异。结论 医院临床实际疾病诊疗情况与临床路径诊疗标准间尚存在一定差异,医院必须对问题进行分析,不断优化诊疗路径,进一步提升临床路径实用性、可行性、规范性以及科学性,为居民提供更优质的医疗服务,同时减轻患者医疗经济负担。

目的 总结以双下肢乏力为主要表现的、合并低叶酸血症的患者的临床特征。方法 选择自2017年1月—2020年12月在我院神经内科住院的患者,分为3组：双下肢乏力伴叶酸缺乏组,共23例;叶酸缺乏合并脑血管病组,共129例;叶酸缺乏的健康体检者,为来我院行健康体检、无意中发现叶酸水平降低者,共42例,比较3组患者特征。结果 双下肢乏力伴叶酸缺乏组患者的发病年龄在19~88岁之间,平均（63.82±20.24）岁,男女比为2.3∶1。起病时间（13.34±17.88）d。与叶酸缺乏合并脑血管病组以及与叶酸缺乏的健康体检者相比,双下肢乏力伴叶酸缺乏组患者脑叶缺血灶数量较少,差异有统计学意义,P分别=0.001和0.008;与叶酸缺乏的健康体检者相比,双下肢乏力伴叶酸缺乏组患者放射冠和侧脑室缺血灶数量无变化,差异无统计学意义,P>0.05;与叶酸缺乏合并脑血管病组以及与叶酸缺乏的健康体检者相比,双下肢乏力伴叶酸缺乏组患者整体脑组织缺血灶总数较少,差异有统计学意义,P分别<0.01和0.05。结论 临床上遇到双下肢乏力患者,尤其是发病年龄在63岁左右,男性,起病时间在13 d左右,颅内整体缺血灶、尤其脑叶缺血灶较少的患者,需要警惕低叶酸血症所致双下肢乏力的可能。

Objective To summarize the clinical characteristics of patients with lower extremity weakness as the main manifestation and hypofolicemia．Methods Patients admitted in our neurology inpatient center from January 2017 to December 2020 were selected and divided into 3 groups．Group A consisted of 23 cases of bilateral lower extremity weakness combined with folic acid deficiency．Group B consisted of 129 cases of folic acid deficiency combined with cerebrovascular disease．Group C consisted of 42 healthy people with folic acid deficiency who came to our hospital for health check-up and found that the level of folic acid was decreased accidentally．The clinical characteristics of the three groups of patients were compared．Results The age of onset in group A was between 19 and 88 years old,with an average of（63.82±20.24）years old,and the male to female ratio was 2.3∶1．The onset time was（13.34±17.88）days．Compared with the group B and group C,the number of cerebral lobe ischemic area in group A was lesser,and the difference was statistically significant,P=0.001 and 0.008,respectively．Compared with group C,the number of corona radiata and lateral ventricle ischemic lesions in group A did not change,and the difference was not statistically significant,P>0.05．Compared with group B and group C,the total number of ischemic lesions in the overall brain tissue of group A was lesser,and the difference was statistically significant,P<0.01 and P=0.05 respectively．Conclusions When we encounter patients with bilateral lower extremity weakness in clinical practice,especially the average age of onset is around 63 years old,male,the onset time is about 13 days,and the overall intracranial ischemic lesions,especially the lobar ischemic lesions are less,we need to think of the possibility of bilateral lower extremity weakness caused by hypofolate．

目的 探讨血清脂联素（ADPN）、糖类抗原125（CA125）及抗苗勒管激素（AMH）水平检测在多囊卵巢综合征（PCOS）中的临床诊断价值。方法 选取2022年1月—2022年9月在东莞市中医院经鹿特丹诊断标准确诊的100例PCOS患者作为PCOS组;PCOS组通过测定患者体质量指数（BMI）是否大于28 kg/m²分为肥胖组和非肥胖组;测定患者的睾酮水平的高低是否大于80 ng/dL分为高雄激素组和非高雄激素组。另选身体健康、年龄与PCOS组相近的100名健康女性作为对照组。分别测定PCOS组和对照组的ADPN、CA125以及AMH,分析血清ADPN、CA125、AMH在PCOS患者中的检测价值。结果 POCS组的BMI、AMH、CA125、睾酮、ADPN与健康组比较差异均有统计学意义（P<0.05）。与对照组比较,PCOS组的BMI、AMH、CA125、睾酮水平升高、ADPN水平降低。PCOS患者的CA125与AMH水平呈正相关（P<0.05）,ADPN与AMH无关（P>0.05）。结论 PCOS 患者血清CA125和AMH水平升高,ADPN水平降低。

Objective To explore the clinical diagnostic value of serum adiponectin（ADPN）,carbohydrate antigen 125（CA125）and anti-Mullerian hormone（AMH）levels in polycystic ovary syndrome（PCOS）．Method A total of 100 patients confirmed with PCOS in Dongguan Traditional Chinese Medicine Hospital from January 2022 to September 2022 were selected as the study subjects．All patients were diagnosed with PCOS according to the 2003 Rotterdam diagnostic criteria,and served as the PCOS group．The PCOS group was divided into obese and non obese group by measuring the patient’s body mass index（BMI）whether was greater than 28 kg/m²．A high androgen group and a non high androgen group were determined by whether the patient’s testosterone level is greater than 80 ng/dL．A hundred healthy women of similar age were selected as the healthy control group．The levels of ADPN,CA125 and AMH were measured in the experimental and control group,and their detection value were analyzed．Results BMI,AMH,CA125,testosterone and ADPN in the POCS group were statistically different compared to the healthy group（P<0.05）．Compared with the PCOS group,the control group showed a significant increase in BMI,AMH,CA125 and testosterone levels,while the PCOS group showed a decrease in ADPN level．There was a positive correlation between CA125 and AMH in patients with PCOS,while there was no correlation between ADPN and AMH．Conclusions The levels of serum CA125 and AMH in PCOS patients significantly increased,while the level of ADPN decreased．The three indicators have good diagnostic value in PCOS and are worth promoting．