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 探讨低浓度罗哌卡因行超声引导下髋关节囊周围神经（PENG）阻滞联合椎管内麻醉对衰弱患者髋关节手术的应用优势。方法 选择行髋关节手术的衰弱患者76例，随机分为两组，A 组（38例）行PENG阻滞联合椎管内麻醉，C 组（38例）行椎管内麻醉。比较两组入室（T0）、摆放体位时（T1）、术后6 h（T2）、术后12 h（T3）、术后24 h（T4）静息和活动状态的数字等级评定量表（NRS）疼痛评分；术后非甾体抗炎药及阿片类药物补救次数；术后 6 h、24 h患侧股四头肌徒手肌力分级（MMT）；首次下床活动时间、住院时间。结果 A组T1～T4时刻静息状态NRS疼痛评分分别为2（1，3）分、1（1，2）分、2（1，2）分、3（2，4）分均低于C组的5（4，7）分、4（3，5）分、5（3，6）分、4（2，6）分，比较差异有统计学意义（均P＜0.001）；A组T1～T4时刻活动状态NRS疼痛评分分别为5（4，7）分、3（2，4）分、4（3，5）分、6（4，7）分均低于C组的10（9，10）分、8（6，9）分、8（7，9）分、9（8，10）分，比较差异有统计学意义（均P＜0.001）。A组在T1～T4时的静息状态NRS疼痛评分低于T0时的（均P＜0.01）；C组在T1～T4时的静息状态NRS疼痛评分低于T0时的（均P＜0.05）；A组在T1～T4时的活动状态NRS疼痛评分均低于T0时的（均P＜0.001）；C组在T1、T2时的活动状态NRS疼痛评分均低于T0时的（均P＜0.01）。A组术后非甾体抗炎药及额外阿片类药物补救次数为4（0，8）、2（0，3）次，均低于C组的15（7，19）、5（3，7）次，比较差异有统计学意义（均P＜0.001）。两组术后 6 h和24 h患侧股四头肌MMT分级、首次下床活动时间和住院时间比较差异无统计学意义（P＞0.05）。结论 低浓度罗哌卡因PENG阻滞可以有效减轻衰弱患者髋关节手术术后疼痛，不影响其术后下肢肌力。

   Objective To explore the application advantages of low-concentration ropivacaine for ultrasound-guided pericapsular nerve group（PENG）block combined with spinal-epidural anesthesia in hip joint surgery for frail patients．Methods Seventy-six frail patients undergoing hip surgery were randomly divided into two groups：Group A（38 cases）received PENG block combined with intraspinal anesthesia，while Group C（38 cases）received only intraspinal anesthesia．The numerical rating scale（NRS）pain scores of resting and active states were compared between the two groups at the time of entering the room（T0），placing the position（T1），6 hours after surgery（T2），12 hours after surgery（T3），and 24 hours after surgery（T4）．Postoperative non-steroidal drugs and opioids remedy times，muscle strength grading（MMT）of quadriceps femoris at 6 hours and 24 hours after operation，and the first time out of bed activity time，hospitalization time were also compared．Results The resting NRS pain scores at T1-T4 in Group A were 2（1，3），1（1，2），2（1，2）and 3（2，4），respectively，which were lower than 5（4，7），4（3，5），5（3，6）and 4（2，6）in Group C，and the difference was statistically significant（all P＜0.001）．The NRS pain scores at T1-T4 in Group A were 5（4，7），3（2，4），4（3，5）and 6（4，7），respectively，which were lower than 10（9，10），8（6，9），8（7，9）and 9（8，10）in Group C，and the difference was statistically significant（all P＜0.001）．The resting NRS pain score of Group A at T1-T4 was lower than that at T0（all P＜0.01）；the resting NRS pain score of Group C at T1-T4 was lower than that at T0（all P＜0.05）．The NRS pain scores at T1-T4 in Group A were lower than those at T0（all P＜0.001）；the NRS pain scores at T1 and T2 in Group C were lower than those at T0（all P＜0.01）．The number of postoperative non-steroidal drugs and additional opioids in group A（4［0，8］，2［0，3］）was lower than that in Group C（15［7，19］，5［3，7］），and the difference was statistically significant（all P＞0.001）．There was no significant difference in the MMT grade of the affected quadriceps femoris at 6 h and 24 h after operation，the first time of getting out of bed and the number of days of hospitalization between the two groups（P＞0.05）．Conclusions Low concentration ropivacaine PENG block can effectively reduce the postoperative pain of hip joint surgery in frail patients without affecting the postoperative lower extremity muscle strength．

       目的 调查重型β地中海贫血患儿照顾者的负担现状，并分析其影响因素，为医护人员制定干预方案提供依据。方法 采用便利抽样法，于2024年1月—12月选取华南地区5家医院就诊的重型β地中海贫血患儿的主要照顾者作为调查对象，采用一般资料调查表、Zarit照顾者负担量表、中文简化版家庭弹性量表和社会支持评定量表进行调查，并采用单因素分析、相关性分析及多重线性回归探究其影响因素。结果 共发放问卷242份，回收232份，回收率为95.87%。重型β地中海贫血患儿主要照顾者照顾负担的总体平均得分为（36.67±18.63）分。多重线性回归分析结果显示，患儿输血频率、输血相关性皮肤过敏和社会支持是患儿照顾负担的影响因素（P＜0.001），可解释总变异的23.9%。结论 重型β地中海贫血患儿照顾者负担程度以中重度为主。患儿曾出现输血不良反应、输血频率更高，其照顾者负担更重；而主要照顾者具有良好的社会支持水平有助于降低其照顾者负担。医护人员应针对以上因素制定干预方案，以减轻重型β地中海贫血患儿照顾者负担水平。

      Objective To investigate the current burden in caregivers of children with β thalassemia major and analyze its influencing factors，so as to provide a basis for medical staff to formulate intervention plans．Methods By using the convenience sampling method，primary caregivers of children with β thalassemia major from five hospitals in South China from January to December 2024 were selected as the survey subjects．The general information questionnaire，Zarit Caregiver Burden Scale，Simplified Chinese Family Resilience Scale and Social Support Rating Scale were used for the survey．And univariate analysis，correlation analysis and multiple linear regression were adopted to explore its influencing factors．Results A total of 242 questionnaires were distributed and 232 were retrieved，with a recovery rate of 95.87%．The overall average score of care burden for primary caregivers of children with β thalassemia major was（36.67±18.63）．The results of multiple linear regression analysis showed that the frequency of blood transfusion in children，transfusion-related skin allergy and social support were the influencing factors of the care burden（P＜0.001），which could explain 23.9% of the total variation．Conclusions The burden level in caregivers of children with β thalassemia major is mainly moderate to severe．The children with adverse reactions to blood transfusion and higher frequency of blood transfusion impose a heavier burden on its caregivers．The primary caregivers who have good social support can help reduce the burden．Medical staff should formulate intervention plans based on the above factors to reduce the burden level of caregivers of children with β thalassemia major．

      目的 调查消化系统恶性肿瘤患者营养风险、营养知识-态度-行为（知信行）水平的现状，探究各因素是否对患者的营养风险、营养知信行水平具有影响，并分析两者之间的相关性。方法 选取中山大学附属第八医院（深圳福田）2024年2月—10月的244例消化系统恶性肿瘤患者为研究对象，采用一般资料调查表、营养风险筛查NRS2002量表以及消化系统肿瘤患者营养知信行问卷进行调查，数据收集后进行统计分析，从而研究消化系统恶性肿瘤患者营养筛查风险与营养知信行水平的现状、影响因素及两者间的相关性。结果 69.3%的消化系统恶性肿瘤患者存在营养风险，营养风险评分为（2.72±1.42）分。消化系统恶性肿瘤患者营养知识水平得分为（12.30±5.26）分、营养态度水平得分为（14.80±2.68）分、营养行为水平得分为（22.82±4.55）分、营养知信行水平总分为（49.96±9.50）分。家庭经济收入是患者营养风险水平的核心影响因素（P＜0.05），学历水平是患者营养知信行水平的核心影响因素（P＜0.05）。消化系统恶性肿瘤患者营养风险水平与营养知信行的总体水平呈负相关（r=-0.143，P＜0.05）。结论 消化系统恶性肿瘤患者的营养知信行水平总体处于中等水平，但普遍存在营养风险较高的情况。在患者治疗期间实施个性化营养健康宣教至关重要，这将有助于提升患者的营养知识水平，从而整体性改善其营养知信行素养并降低其营养风险，但在进行营养宣教和制定个性化营养方案时应充分考虑患者的家庭经济收入及学历水平。

    Objective To explore the nutritional risk and nutritional knowledge-attitude-behavior status of patients with digestive system malignant tumors，to analyze the influencing factors of nutritional risk，nutritional knowledge-attitude-behavior，and explore the correlation between them．Methods From February 2024 to October 2024，244 patients with digestive system malignant tumors at the Eighth Affiliated Hospital of Sun Yat-sen University were selected as the research subjects．A general information questionnaire，Nutritional Risk Screening 2002，and digestive system tumor patient nutrition knowledge-attitude-behavior questionnaire were used to study the influencing factors and correlations between the nutritional screening risk and nutritional knowledge-attitude-behavior in patients with digestive system malignant tumors．Results There were 69.3% of the patients with digestive system malignant tumors had nutritional risk score ≥3，and the overall score was（2.72±1.42）．The scores of nutritional knowledge，attitude，behavior and total score of digestive system malignant tumors patients were（12.30±5.26），（14.80±2.68），（22.82±4.55）and（49.96±9.50），respectively．Family economic income was the core influencing factors of nutritional risk in patients with digestive system malignant tumors，while educational level was the core influencing factor of nutritional knowledge-attitude-behavior in patients with digestive system malignant tumors．The nutritional risk level of patients with malignant tumors of the digestive system was significantly negatively correlated with the overall level of nutritional knowledge-attitude-behavior．Conclusions The nutritional knowledge-attitude-behavior level of patients with malignant tumors of the digestive system is generally at a medium level，but there is a widespread situation of relatively high nutritional risk．It is extremely important and necessary to conduct personalized nutrition knowledge education for patients during their treatment period，which will help enhance patients’ nutritional knowledge level，thereby comprehensively improving their nutritional knowledge-attitude-behavior literacy and reducing their nutritional risks．However，when conducting nutrition education and formulating personalized nutrition plans，the patient’s family economic income，medical payment methods and educational level should be fully considered．

       目的 通过年龄、性别等多方面研究各亚型注意缺陷多动障碍（ADHD）儿童的智力结构分布特征的临床研究，为ADHD的个体化干预提供科学依据。方法 实验组纳入ADHD儿童754例，其中注意缺陷型（ADHD-I）280例（37.13%）、多动-冲动型（ADHD-HI）212例（28.12%）、混合型（ADHD-C）262例（34.75%），按年龄分为三组：低龄组（6~8岁）、中龄组（9~11岁）及高龄组（12~14岁）；对照组为正常儿童412例，为同期选择的性别、年龄相匹配的儿童。选择采用韦氏智力评估等方法分别对两组儿童进行评估等，对评估结果进行比较和综合分析。结果 ADHD儿童的智力评估结果低于对照组（P＜0.01），且在言语智商方面表现更为明显，在各分测验中以A因子（言语理解）和C因子（记忆/注意集中）为主，而B因子（知觉组织能力）方面则无差异。ADHD-HI型及ADHD-C型的总智商及操作智商均高于ADHD-I型，ADHD-C型言语智商和A因子均高于ADHD-I型（P＜0.01），ADHD-HI型的智力水平最高，而ADHD-I型与ADHD-C型的智力水平差异无统计学意义（P＞0.05）。各年龄段ADHD儿童的智力发育均受到不同程度的影响，尤其是中龄组儿童及高龄组女童所受影响更明显；低、中龄组儿童的智力发育水平均高于高龄组儿童，提示ADHD儿童的智力损害随年龄增长而加重；同一年龄段ADHD女童的智力损害较男童更为严重。结论 本地区6~14岁ADHD儿童的智力水平较低，以言语智商低下更为明显，ADHD-HI型在3个亚型中智力损害最小，ADHD儿童的智力损害随年龄增长而加重，同一年龄段ADHD女童的智力损害较男童更为严重。

   Objective To investigate the distribution characteristics of intellectual structure in children with different subtypes of attention deficit hyperactivity disorder（ADHD）by age and gender，providing scientific basis for individualized treatment and intervention of ADHD．Methods The experimental group consisted of 754 children with ADHD，including 280 cases（37.13%）of inattentive type（ADHD-I），212 cases（28.12%）of hyperactivity impulsive type（ADHD-HI），and 262 cases（34.75%）of combined type（ADHD-C）．They were divided into three groups by age：young group（6-8 years old），middle group（9-11 years old），and older group（12-14 years old）．The control group consisted of 412 normal children with matched sex and age recruited during the same period and had similar sex ratio．The specific methods of Wechsler Intelligence Scale were mainly applied to evaluate normal children and children with ADHD，and the evaluation results were subjected to multidimensional analysis and comparison．Results The intelligence assessment results of ADHD children were significantly lower than those of the control group（P＜0.01），with a more pronounced performance in verbal intelligence．In various sub tests，factors A（verbal comprehension）and C（memory and attention concentration）were the main factors，while there was no difference in factor B（perceptual organization ability）．The ADHD-HI and ADHD-C types had higher total intelligence and operational intelligence than the ADHD-I type，and the ADHD-C type had higher verbal intelligence and factor A than the ADHD-I type（P＜0.01）．The intelligence level of the ADHD-HI type is the highest，while there is no statistically significant difference in intelligence level between the ADHD-I type and the ADHD-C type．The intellectual development of children in different age groups was affected to varying degrees，especially in the middle and older groups of girls．This study found that the intellectual development of children in the young and middle group was higher than that of children in the older group，indicating that the intellectual development of ADHD children will be increasingly damaged with age．At the same time，it was also found that ADHD girls in the same age group had more severe intellectual development impairment than boys．Conclusions The intelligence level of children with ADHD aged 6-14 in this region is relatively low，with verbal intelligence quotient being more pronounced．ADHD-HI has the smallest intellectual impairment among the three subtypes，and the intellectual development of ADHD children becomes more severe with age．ADHD girls in the same age group have more severe intellectual development impairment than boys．

       目的 分析药品集中带量采购（集采）政策下医院药品供应保障实况，提出优化政策及保障的对策建议。方法 通过提取重庆市渝北区人民医院2023年1月—2024年12月集采药品供应采购数据，描述性统计分析集采药品供应情况。结果 采购的416个中标药品中，69个在购销合同期内短缺，短缺率16.59%。短缺原因与企业生产能力、季节性需求波动相关，季节性强，以慢性病药和抗感染药为主。结论 建议建立监测平台、完善报告制度、制定应急预案、评估供货能力，保障供应。

   Objective To analyzes the current situation of hospital drug supply guarantee under the policy of centralized and volume-based procurement（hereinafter referred to as “central procurement”），and proposes optimization strategies and suggestions for the policy and guarantee．Methods By extracting the procurement data of drugs supplied through centralized procurement at Yubei District People’s Hospital in Chongqing from January 2023 to December 2024，descriptive statistical analysis of the drug supply situation through centralized procurement was conducted．Results Among the 416 selected drugs purchased，69 were in short supply during the contract period，with a shortage rate of 16.59%．The reasons for the shortage were related to the production capacity of the enterprise，seasonal demand fluctuations，strong seasonality，and mainly chronic diseases and anti-infective．Conclusions It is suggested to build a monitoring platform，improve the reporting system，formulate emergency plans，and evaluate the supply capacity to ensure supply．

      目的  探讨精子DNA碎片指数（DFI）对体外受精-胚胎移植（IVF-ET）胚胎发育及妊娠结局的影响，为优化男性生育力评估及辅助生殖治疗策略提供依据。方法  回顾性分析2023年1月—2024年1月于徐州市妇幼保健院接受IVF-ET治疗的126对不孕夫妇，根据男方DFI检测结果分为低碎片组（DFI≤15%，n=42）、临界组（15%＜DFI＜30%，n=45）和高碎片组（DFI≥30%，n=39）。比较三组患者受精相关指标、胚胎发育指标及妊娠结局指标的差异，并分析DFI与各指标的相关性。结果  低碎片组双原核率（2PN）率、优质胚胎率及囊胚形成率均高于临界组和高碎片组（P＜0.001），低碎片组1PN率、多PN率均低于临界组和高碎片组（P＜0.001）；三组种植率、临床妊娠率、早期流产率比较差异无统计学意义（P＞0.05），但高碎片组活产率低于低碎片组（P＜0.05）。相关性分析结果表明，DFI与优质胚胎率（r=-0.412，P＜0.001）、囊胚形成率（r=-0.387，P＜0.001）、活产率（r=-0.287，P=0.012）呈负相关，与早期流产率（r=0.206，P=0.059）、种植率（r=-0.215，P=0.058）、临床妊娠率（r=-0.203，P=0.072）无显著相关性。结论  精子DNA碎片指数是影响IVF-ET胚胎发育及妊娠结局的重要因素，高DFI主要通过降低胚胎发育潜能及增加流产风险导致活产率下降，临床需对高DFI患者进行干预以改善治疗结局。

       Objective  To investigate the impact of sperm DNA fragmentation index（DFI）on embryo development and pregnancy outcomes of in vitro fertilization-embryo transfer（IVF-ET），and to provide a basis for optimizing male fertility assessment and assisted reproductive treatment strategies．Methods  A retrospective analysis was performed on 126 infertile couples undergoing IVF-ET treatment at the Reproductive Medicine Center of Xuzhou Maternal and Child Health Hospital from January 2023 to January 2024．According to the male DFI test results，they were divided into three groups：low fragmentation group（DFI≤15%，n=42），critical group（15% ＜ DFI ＜ 30%，n=45），and high fragmentation group（DFI≥30%，n=39）．Differences in fertilization-related indicators，embryo development indicators，and pregnancy outcome indicators were compared among the three groups，and the correlation between DFI and each indicator was analyzed．Results  The 2 pronuclei rate（PN）rate，high-quality embryo rate，and blastocyst formation rate in the low fragmentation group were significantly higher than those in the critical and high fragmentation groups（P＜0.001）．The 1PN  rate and multi-PN  rate in the low fragmentation group were significantly lower than those in the critical and high fragmentation groups（P＜0.001）．There was no significant difference in the three groups of implantation rate，clinical pregnancy rate and early abortion rate（P＞0.05），but the live birth rate of high fragment group was significantly lower than that of low fragment group（P＜0.05）．The results of correlation analysis showed that DFI was significantly negatively correlated with the rate of high quality embryos（r=-0.412，P＜0.001），blastocyst formation rate（r=-0.387，P＜0.001）and live birth rate（r=-0.287，P=0.012），but not with the rate of early abortion（r=0.206，P=0.059），implantation rate（r=-0.215，P=0.058）and clinical pregnancy rate（r=-0.203，P=0.072）．Conclusions  Sperm DFI is an important factor affecting embryo development and pregnancy maintenance in IVF-ET．High DFI leads to a decrease in live birth rate mainly by reducing embryo developmental potential and increasing the risk of early abortion．Clinically，early intervention is needed for patients with high DFI to improve treatment outcomes．

       目的  分析改良经脊柱内椎间孔镜系统技术（TESSYS）对腰椎间盘突出症患者疼痛及功能的影响，以期分析该术式优劣，丰富该研究领域。方法  回顾性选取2022年10月—2024年10月医院治疗的80例腰椎间盘突出症患者作为研究对象，根据治疗方式的不同划分为观察组（TESSYS技术治疗）和对照组（经皮椎间孔镜髓核摘除术治疗），每组各40例。观察两组患者疗效、手术时间、术中出血量、住院时间、透视次数、切口长度等情况。比较两组患者术前、术后6 h、术后1天、术后1周、术后1个月VAS评分情况，比较两组患者术前及术后1个月腰椎功能情况，包括Oswestry功能障碍指数（ODI）、腰椎曲度、腰背肌后伸活动度。比较两组患者术前及术后24 h的血清超敏C-反应蛋白（hs-CRP）、白细胞介素-6（IL-6）水平。结果   观察组患者疗效优于对照组（Z=-3.737，P＜0.001）。交互效应下，两组疼痛因不同术式而随着时间增加而有所不同（P＜0.05）；时点效应下，观察组、对照组各组均随着时点增加疼痛随之减少（P＜0.05）；组间效应下，干预前、干预后1个月两组差异不明显，但是观察组疼痛干预后6 h（Z=-2.831，P=0.005）、干预后1天（Z=-3.253，P=0.001）低于对照组。术后1个月，观察组患者的ODI（Z=-4.804，P＜0.001）低于对照组，而腰椎曲度（Z=-6.218，P＜0.001）、腰背肌后伸活动度（Z=-7.014，P=0.001）高于对照组。术后24 h后，观察组患者的hs-CRP（Z=-5.671，P＜0.001）、IL-6（Z=-3.262，P＜0.001）低于对照组。结论  TESSYS相较于经皮椎间孔镜髓核摘除术在治疗腰椎间盘突出症时具有显著优势，可提高疗效，减少出血量，减轻疼痛，减少炎症反应，加快腰椎功能康复，缩短住院时间。

       Objective  The effect of modified transforaminal endoscopic spine system（TESSYS） on pain and function in patients with lumbar disc herniation was analyzed，so as to analyze the advantages and disadvantages of this procedure and enrich the research field．Methods  Retrospectively，80 patients with lumbar disc herniation treated in the hospital from October 2022 to October 2024 were selected as the study subjects．These patients were divided into two groups based on their treatment methods：the observation group（treated with TESSYS technology）and the control group（treated with percutaneous endoscopic discectomy）．Each group consisted of 40 patients．The study evaluated the treatment efficacy，surgical duration，intraoperative bleeding volume，hospital stay fluoroscopy frequency，and incision length for both groups．Additionally，we compared the VAS  scores of  both groups before surgery，six hours post-surgery，one day post-surgery，one week post-surgery，and one month post-surgery．We also compared the lumbar function of both groups before surgery and 1 month post-surgery，including the Oswestry Functional Index（ODI），lumbar lordosis，and lumbar back muscle extension activity．Furthermore，we compared the serum levels of high-sensitivity C-reactive protein（hs-CRP）and interleukin-6（IL-6）in both groups before and 24 hours after surgery．Results  The therapeutic effect of the observation group was better than that of the control group（Z=-3.737，P＜0.001）．Under the interaction effect，the pain of the two groups varied with time due to different surgical procedures（P＜0.05）．Under the time effect，both the observation group and the control group showed a decrease trend in pain as the time to treatment increased（P＜0.05）．Under the inter group effect，there was no significant difference between the two groups before and 1 month after intervention，but the pain in the observation group was less than that in the control group at 6 hours after intervention（Z=-2.831，P=0.005）and 1 day after intervention（Z=-3.253，P=0.001）．One month after surgery，the ODI（Z=-4.804，P＜0.001）of the observation group patients was lower than that of the control group，while the lumbar curvature（Z=-6.218，P＜0.001）and lumbar back muscle extension activity（Z=-7.014，P=0.001）were higher than those of the control group．Twenty-four hours after surgery，the hs-CRP（Z=-5.671，P＜0.001）and IL-6（Z=-3.262，P＜0.001）levels in the observation group were lower than those in the control group．Conclusions  The improved  percutaneous transforaminal endoscopic technique  has  significant advantages over  percutaneous transforaminal discectomy in the treatment of lumbar disc herniation．It can improve efficacy，reduce bleeding，alleviate pain，reduce inflammatory reactions，accelerate lumbar functional recovery，and shorten hospitalization time．

       目的  探讨结肠镜下息肉切除术后复发的危险因素，并基于机器学习算法构建复发风险预警模型，为防治对策提供依据。方法  回顾性收集2018年9月—2023年9月六安市人民医院1 058例初次行无痛结肠镜下息肉切除术患者的临床资料，使用单因素和多因素Logistic回归分析筛选复发危险因素。采用7∶3随机抽样分为训练集和验证集，分别通过决策树、贝叶斯及Logistic回归算法构建预测模型，并以受试者工作特征曲线（ROC）曲线下面积（AUC）、灵敏度、特异度等指标来评估模型效能。结果  单因素分析显示，性别、吸烟、代谢综合征、息肉数量、息肉位置、山田分型、组织病理学类型、切除方式、复查时间、肠息肉直径、手术时间是复发的危险因素（P＜0.05）。多因素分析显示，性别、代谢综合征、息肉数量、息肉直径、肠息肉位置、山田分型、组织学病理类型、切除方式、手术时间均是结肠息肉内镜下切除术后复发的危险因素。模型评估显示，决策树算法、贝叶斯算法、Logistic回归算法的ROC曲线下面积（AUC）分别为0.849、0.818、0.811；灵敏度分别为85.14%、81.62%、79.43%；特异度分别为81.69%、79.45%、74.18%；约登指数分别为0.534、0.551、0.573；95%CI分别为0.810~0.876、0.794~0.860、0.782~0.850；决策树算法模型效能最佳，Logistic回归算法的性能最差。结论  性别、代谢综合征、肠息肉特征（数量、直径、位置等）是术后复发的关键危险因素。决策树模型在风险预测中表现最优，可为临床制定个体化随访策略提供参考。

       Objective  To explore the  risk factors for  recurrence after painless colonoscopic polypectomy and construct a recurrence risk warning model based on machine learning algorithms to provide evidence for prevention and treatment strategies．Methods  A retrospective analysis was conducted on clinical data from 1 058 patients who underwent their first painless colonoscopy-guided polypectomy at our hospital between September 2018 and September 2023．Univariate and multivariate Logistic  regression analyses were performed to identify recurrence risk factors．The dataset was randomly divided into training and validation sets using a 7∶3 ratio．Prediction models were constructed using decision tree，Bayesian，and Logistic regression algorithms，and their performance was evaluated using metrics such as the area under the receiver operating characteristic curve（AUC），sensitivity，specificity，and others．Results  Univariate analysis revealed that gender，smoking，metabolic syndrome，number of polyps，polyp location，Yamada classification，histopathological type，resection method，follow-up time，polyp diameter，and operation duration were risk factors for recurrence（P＜0.05）．Multivariate analysis identified gender，metabolic syndrome，number of polyps，polyp diameter，polyp location，Yamada classification，histopathological type，resection method，and operation duration as independent risk factors for recurrence after endoscopic polypectomy．Model evaluation showed AUC values of 0.849，0.818，and 0.811 for the decision tree，Bayesian，and Logistic regression algorithms，respectively．Sensitivity values were 85.14%，81.62%，and 79.43%；specificity values were 81.69%，79.45%，and 74.18%；Youden’s indices were 0.534，0.551，and 0.573；and 95% confidence intervals（CIs）were 0.810–0.876，0.794–0.860，and 0.782–0.850，respectively．The  decision tree algorithm demonstrated the best predictive performance，while the Logistic regression algorithm performed the least favorably．Conclusions  Gender，metabolic syndrome，and polyp characteristics（number，diameter，location，etc．）are key  risk factors for recurrence after polypectomy．The decision tree algorithm exhibited optimal predictive efficacy，offering valuable insights for developing individualized follow-up strategies in clinical practice．

    目的   探讨放血疗法对小儿发热的疗效。方法   检索包括中国生物医学文献数据库（CBM）、CNKI、万方、维普、PubMed、Embase、Web of Science、Cochrane Library等8个中、英文数据库自建库至2025年5月所发表的放血疗法治疗小儿发热的随机对照试验研究（RCT），2名研究人员根据Cochrane系统评价手册（5.1.0版）推荐的偏倚风险评估表对所纳入文献进行质量评估，采用RevMan 5.4软件对纳入文献质量进行系统分析。结果  纳入19项RCT，共2 224例患儿，其中观察组1 118例、对照组1 106例。放血疗法能够提高小儿发热的临床疗效［OR=4.18，95% CI（3.00，5.38），P＜0.001］；降低患儿24 h内高热复发率［OR=0.12，95% CI（0.05，0.34），P＜0.001］；缩短平均退热时间［MD=-1.78，95% CI（-2.56，-1.00），P＜0.001］。结论  放血疗法能够提高小儿发热的临床疗效，降低复发率，缩短退热时间，可作为小儿发热的辅助治疗方法。

       Objective  To explore the efficacy of bloodletting therapy treatment on pediatric fever by meta-analysis．Methods  The randomised controlled trials（RCTs）examining bloodletting therapy for paediatric fever were  retrieved from eight Chinese and English databases—China Biomedical Literature Database（CBM），CNKI，Wanfang，VIP，PubMed，Embase，Web of Science，and Cochrane Library—covering publications from the establishment of each database up to May 2025．Two researchers assessed study quality using the risk of bias assessment tool recommended in the Cochrane Handbook for Systematic Reviews（version 5.1.0）．RevMan 5.4 software was employed for systematic analysis of included studies．Results  Nineteen RCTs involving 2 224 patients were ultimately included，comprising 1 118 patients in the observation group and 1 106 in the control group．Results indicated that bloodletting therapy significantly improved clinical efficacy in paediatric fever（OR=4.18，95% CI［3.00，5.38］，P＜0.001），reduced the recurrence rate of high fever within 24 hours（OR=0.12，95% CI［0.05，0.34］，P＜0.001），and shortened the average time to fever resolution（MD=-1.78，95% CI［-2.56，-1.00］，P＜0.001）．Conclusions  Bloodletting therapy can improve the clinical efficacy of pediatric fever，reduce the recurrence rate and shorten the time of fever reduction，and can be used as an adjunctive treatment for pediatric fever．