目的 研究母代不同孕期巨细胞病毒（CMV）感染对自身精神及行为的影响。方法 72只BALB/c雌鼠随机分为12组（A1、A2、A3、B1、B2、B3、C1、C2、C3、D1、D2、D3,每组6只）,A为孕期再感染、B为既往感染、C为孕期原发感染、D为空白对照,1为孕早期、2为孕中期、3为孕晚期。母鼠腹腔注射小鼠CMV（murine CMV,MCMV）Smith株建立播散性感染模型,或注射无菌生理盐水建立对照模型。母鼠产仔后同笼合养,产后22 d分笼;母鼠做行为学试验。试验结束,每组随机处死3只母鼠;测量子宫、肝、脑脏器重量系数及唾液腺中MCMV含量。结果 A、B、C组母鼠产后次日体质量均低于D组（均P<0.05）,其中C2、C3组母鼠低体质量情况持续至产后22日（均P<0.05）。A、B、C组母鼠唾液腺组织均测出MCMV。与D组母鼠相比,A1、C1组母鼠活胎率降低（均P<0.05）,A、C组母鼠的子宫、肝、脑脏器系数升高（均P<0.05）且脑组织有病损表现。产后6天时,A3、B3、C组母鼠水平运动总距离和直立次数减少（均P<0.05）,糖水偏好量降低（均P<0.05）,悬尾不动时间延长（P<0.05）;其中,C2、C3组母鼠以上行为退缩情况至产后22天仍存在,且有逃避潜伏时间延长（均P<0.01）,穿越原平台位置次数减少（均P<0.01）情况。结论 孕期CMV感染损害母代身心健康,有可能增加子代不良抚养的风险。

Objective To investigate the effects of cytomegalovirus（CMV）infection in different stages of maternal pregnancy on its own spirit and behavior．Methods A total of 72 female BALB/c mice were randomly divided into 12 groups（each group had 6 mice）：A1-A3,B1-B3,C1-C3,D1-D3（group A had re-infection,group B had previous infection,group C had primary infection,group D was blank control,group 1 was in early pregnancy,group 2 was in middle pregnancy,group 3 was in late pregnancy）．The disseminative infection model was established by intraperitoneal inoculation of murine CMV（MCMV）Smith strain,and the blank control model was established by intraperitoneal inoculation of 0.9% sterile saline（NaCl）．After 21 days of parturition,the mothers and offspring were reared in separate cages,mothers were selected for the behavior experiments．At the end of all the behavior tests,3 mothers in each group were killed randomly．Weighed and calculated the organ coefficients of the uteri,livers and brains,and detected the expression levels of MCMV in salivary gland．Results On the first day after delivery,the weights of mothers in groups A,B and C were lower than those in group D（all P<0.05）,the low body weight of mice in C2 and C3 groups lasted to the 22th day（all P<0.05）．The MCMV in salivary gland tissue were found in groups A,B and C,but not in group D．The live fetus rates of groups A1 and C1 were significantly lower than that of group D．The organ coefficients of uteri,livers and brains in groups A and C were higher than those in group D（all P<0.05）．And the lesions of brain tissues in groups A and C were more serious than in the other groups．On the 6th day,compared with the other groups,the mothers of groups A3,B3 and C were significantly abnormal in the open field test,the tail suspension test and the sugar preference test（all P<0.05）．But on 22th day,only the mothers of groups C2 and C3 were significantly abnormal in those tests（all P<0.01）,and even in the water maze test（all P<0.01）．Conclusions Maternal CMV infection in different stages pregnancy have impacts on mother mice's physical and mental health．Those bad situations may bring poor parenting to the offspring．

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．

我国结直肠癌的发病率与死亡率逐年增加,约10%~30%新发结直肠癌患者可表现为急性肠梗阻,其中梗阻发生率较高的主要部位是左半结肠。急性梗阻性左半结肠癌患者的主要治疗方式仍是急诊手术（ES）,但术后并发症发生率及围手术期死亡率较高,自膨式金属支架（SEMS）被一些指南推荐为梗阻性结肠癌的初始治疗选择,SEMS可将部分ES转变为择期手术,支架置入后择期手术（SBTS）与ES相比不仅可改善患者的短期生存结局,且支架置入后新辅助化疗为梗阻性结肠癌的治疗提供了新的途径;就长期生存结果而言,选择SBTS还是ES存在一定的争议。对于支架置入后手术时机的选择尚未达成共识,有指南表明大约两周的短桥接间隔可使患者最大程度获益,因而可有效指导临床工作。肠道支架置入术目前看来是一种简单、有效的临时性或永久性的治疗手段。

In recent years, the incidence and mortality of colorectal cancer in our country have been increasing year by year．Around 10% to 30% of newly diagnosed colorectal cancer patients showed acute intestinal obstruction, which the left colon cancer has higher incidence．Emergency surgery（ES）is still the main treatment for patients with acute obstructive left colon cancer, but the incidence of postoperative complications and perioperative mortality are high．Self-expanding metallic stents（SEMS）can convert some emergency procedures into stent as bridge to surgery（SBTS）, which is recommended by some guidelines as the initial treatment option for obstructive colon cancer．SBTS can not only improve the short-term survival outcome of patients compared with ES, but also provide a new approach for the treatment of obstructive colon cancer with neoadjuvant chemotherapy after intestinal obstruction stent placement．The choice of SBTS versus ES is somewhat controversial in terms of long-term survival outcomes．There is no consensus on the timing of surgery after stenting, and current guidelines suggest that bridging intervals of approximately two weeks strike a balance between potential adverse events and long-term outcomes．At present, intestinal stenting is still a simple, feasible and effective temporary or palliative permanent treatment with few complications．

目的 研究以尼尔·诺丁斯关怀理论为基础的全程护理在病毒性脑炎（VE）患儿中的干预效果。方法 选取我院2020年4月—2022年4月收治的VE患儿88例,以随机抽签法分为对照组（44例）、观察组（44例）,对照组采用常规护理,观察组在此基础上实施以尼尔·诺丁斯关怀理论为基础的全程护理。比较2组治疗依从性、恢复情况、儿童抑郁障碍自评量表（DSRSC）、儿童焦虑性情绪障碍筛查表（SCARED）、生存质量[儿童生存质量普适性核心量表（PedsQLTM4.0）]及家属护理满意度。结果 观察组治疗依从性100.00%（44/44）高于对照组86.36%（38/44）（P<0.05）;干预后,观察组DSRSC、SCARED评分低于对照组,PedsQLTM4.0评分高于对照组（P<0.05）;干预后,观察组FMA、MMSE评分较对照组升高（P<0.05）;观察组家属护理满意度97.93%（43/44）高于对照组81.82%（36/44）（P<0.05）。结论 以尼尔·诺丁斯关怀理论为基础的全程护理可改善VE患儿心理状态,提高治疗依从性,促进身体康复,进而提高患儿生存质量及家属护理满意度。

目的 探讨与观察思维导图教育模式对肠造口患者生活质量与心理情绪的影响。方法 选择2021年5月—2022年4月本院胃肠外科收治的低位直肠癌术后患者80例为研究对象,按入院顺序随机编号,对应随机数字为偶数的分到思维导图组（n=40）,奇数的分到传统组（n=40）。传统组给予常规健康教育干预,思维导图组在传统组护理的基础上给予思维导图教育模式干预,思维导图组与传统组护理观察时间为3个月。结果 思维导图组护理期间的造口感染、坏死、水肿、出血、旁疝等并发症发生率与传统组相比都降低（P<0.05）。思维导图组与传统组护理后的焦虑与抑郁评分与护理前相比降低（P<0.05）,护理后思维导图组评分与传统组相比降低（P<0.05）。思维导图组的术后住院时间、术后排气时间、术后下床活动时间与传统组相比均减少（P<0.05）。思维导图组护理后的副作用、共性症状、尿路症状、特异躯体症状、特异心理、性功能、尿袋问题等生活质量评分与传统组相比都减少（P<0.05）。结论 思维导图教育模式在肠造口患者的应用能促进缓解心理负面情绪,促进患者康复,提高患者的生活质量,减少术后造口并发症的发生。

Objective To explore and observe the effects of mind map education mode on the quality of life and psychological emotions of patients with enterostomy．Methods From May 2021 to April 2022, 80 cases of patients with postoperative low rectal cancer who were admitted to the Gastrointestinal Surgery Department of our hospital were selected as the research subjects, and all the cases were numbered according to the random admission sequence, and those with even random numbers were assigned to the mind map group（n=40）, and odd numbers were assigned to the traditional group（n=40）．The traditional group was given routine health education intervention, the mind map group was given mind map education mode intervention additionally, and the nursing observation time of both groups was 3 months．Results The incidences of complications such as stoma bleeding, parastomal hernia, stoma necrosis, stoma edema and stoma infection during nursing in the mind map group were lower than that in the traditional group（P<0.05）．The anxiety and depression scores in both groups after nursing were significantly lower than those before nursing（P<0.05）, and the scores in the mind map group after nursing were also significantly lower than those in the traditional group（P<0.05）．The postoperative hospital stay, postoperative exhaust time, and postoperative ambulation time of the mind map group were significantly shorter than those of the traditional group（P<0.05）．The quality of life scores of common symptoms, side effects, urinary tract symptoms, specific somatic symptoms, specific psychology, urine bag problems and sexual function in the mind map group after nursing were significantly lower than those in the traditional group（P<0.05）．Conclusions The application of mind map education model in patients with enterostomy can promote the relief of psychological negative emotions, promote the recovery of patients, reduce the occurrence of postoperative complications, and improve the quality of life of patients．

目的 基于随机森林方法构建甲状腺功能减退（简称甲减）患病风险预测模型。方法 从MIMIC-IV数据库纳入5 735名甲减患者为病例组,4 803名非甲减患者为对照组,基于随机森林模型进行建模。同时利用逻辑回归、贝叶斯正则化神经网络、XGBoost作为比较模型。最后用准确率、F1分数、精确率、召回率、特异性以及AUC值评价四个机器学习模型性能。结果 随机森林模型准确率为0.85,F1分数为0.84,精确率为0.84,召回率为0.84,特异性为0.86,AUC值为0.91。在该模型中,促甲状腺激素、年龄、绝对淋巴细胞计数、血液中红细胞数、中性白细胞、性别、碱性磷酸酶、丙氨酸氨基转移酶、嗜酸性粒细胞绝对计数、尿素氮为甲减患者诊断重要性排前10的指标。结论 采用随机森林方法构建的甲减患病预测模型为甲减的早期诊断有潜在应用价值。

Objective To construct a risk prediction model for hypothyroidism based on the random forest model．Methods A total of 5 735 hypothyroidism patients were included from the MIMIC-IV database as the case group, and 4 803 non-hypothyroidism patients were included as the control group．Random forest models were constructed for both groups, and logistic regression, Bayesian regularized neural network, and XGBoost were used as comparative models．The performance of the four machine learning models was evaluated using accuracy, F1 score, precision, recall, specificity, and AUC value．Results The random forest model had an accuracy of 0.85, an F1 score of 0.84, a precision of 0.84, a recall of 0.84, a specificity of 0.86, and an AUC value of 0.91．In this model, thyroid-stimulating hormone, age, absolute lymphocyte count, red blood cell count in blood, neutrophil, gender, alkaline phosphatase, aspartate aminotransferase, absolute eosinophil count, and blood urea nitrogen were the top 10 indicators for diagnosing hypothyroidism patients．Conclusions The hypothyroidism disease prediction model constructed using the random forest method has potential application value for the early diagnosis of hypothyroidism．

融合基因是指两个独立基因的编码区首尾相连所形成的且置于同一套调控序列控制的产物,研究表明许多癌症的发生与融合基因存在密切的联系。融合基因可作为癌症治疗的靶点,在癌症诊断及治疗领域中融合基因的研究具有重要意义。部分融合基因驱动癌症的机制已被初步揭示,但是有些真实存在的在肿瘤发生发展过程中有重要意义的融合基因由于工具和实验技术限制还未被发现。因此,对融合基因的分析预测研究方法逐渐成为关注的热点之一。本文探讨了目前常用的关于融合基因的分析工具及方法,为融合基因在癌症中的研究提供思路。

Fusion genes are the products of two independent genes whose coding regions are linked and controlled by the same set of regulatory sequences．Studies have shown that many cancers are closely linked to gene fusions．Fusion genes can be used as targets for cancer therapy,and the study of fusion genes is of great importance in cancer diagnosis and treatment．Some of the mechanisms of fusion genes driving cancer have been initially revealed,but there are more fusion genes which are important in the process of tumor development have not been discovered due to the limitation of tools and experimental techniques．Therefore,the analysis and prediction methods of fusion genes are becoming a hot topic of interest．In this paper,we discuss the commonly used analytical tools and methods on fusion genes to provide ideas for the study of fusion genes in cancer．

目的 探讨腹主动脉瘤腔内修复术后瘤体直径和瘤体体积的转归以及与术后内漏的关系。方法 回顾性分析2015年—2020年在我院行腹主动脉瘤腔内修复术的83例患者的临床及影像学资料。测量术前和术后各随访时间点瘤体最大直径及体积。CT评价术后内漏发生情况。定义瘤体（直径/体积）扩张/回缩及瘤体（直径/体积）稳定。以术前瘤体最大直径大小和术后内漏发生情况将患者分组,比较组间各随访时点的瘤体直径和体积转归情况。结果 患者术后平均随访时间24（10~62）个月。以瘤体直径<50 mm及≥50 mm分组,术后各随访时间点2组间瘤体体积及瘤体直径比较均无统计学差异。以术后有无内漏分组,术后各随访时间点组间比较瘤体体积变化比较差异均有统计学意义（P<0.05）,但瘤体直径变化组间比较差异均无统计学意义。结论 主动脉瘤瘤体体积与直径变化并不存在一致性,监测瘤体体积可以发现那些直径变化不明显的瘤体变化;腹主动脉瘤腔内修复术后内漏可能是导致瘤体增大的因素之一。

Objective To evaluate the outcome of aneurysm diameter and volume,and the role of endoleak after endovascular aneurysm repair of abdominal aortic aneurysm．Methods The clinical and imaging data from 83 patients who underwent endovascular repair of abdominal aortic aneurysm in our hospital from 2015 to 2020 were retrospectively analyzed．The maximum aneurysm diameter and volume were measured at the preoperative and postoperative follow-up time points．CT was used to evaluate the incidence of postoperative leakage．The aneurysm（diameter/volume）expansion/shrinkage and aneurysm（diameter/volume）stability were defined．Patients were divided into different groups according to the maximum preoperative aneurysm diameter and the incidence of postoperative endoleak,and the outcomes of aneurysm diameter and volume were compared at established follow-up points．Results The mean follow-up time was 24（10-62）months．There were no statistically significant differences in postoperative aneurysm volume and diameter at follow-up points between the patients with aneurysm diameter <50 mm and patients with aneurysm≥50 mm．There were statistically significant differences in postoperative aneurysm volume between the patients with postoperative endoleak and patients without postoperative endoleak（P<0.05）．However,there were no statistically significant differences in postoperative diameter between the two groups．Conclusions The changes of aneurysm volume and diameter were not closely related,and the detection of aneurysm volume can help to find the aneurysm changes with no obvious diameter changes．The postoperative endoleak after endovascular aneurysm repair may be one of the factors leading to aneurysm enlargement．

代谢综合征属于中医学“肥胖”“消渴”“脾瘅”等范畴,是以多种代谢异常在同一个体集结出现,包括肥胖、高血糖、血脂异常、高血压以及高尿酸血症等为表现的临床综合征。“浊毒”是由于脏腑功能失常,导致机体产生的生理、病理产物不能及时排出,蕴积体内而化生的致病因素。浊毒致病机体多有面色晦浊、腹胀满、小便浑浊、大便黏腻不爽、黄腻苔、滑数脉等表现。浊毒与代谢综合征的发病机制,在微观和宏观上具有对应性。文章从浊毒与代谢综合征的发病机制出发,对其临床治疗的共同点进行了综述。

Metabolic syndrome falls into the categories of obesity,diabetes and spleen disease in traditional Chinese medicine,and is manifested by various metabolic abnormalities in an individual,including obesity,hyperglycemia,dyslipidemia,hypertension and hyperuricemia. The turbid toxin is a pathogenic factor caused by visceral dysfunction,which leads to the accumulation of physiological and pathological wastes that fail to be eliminated from the body in time. People with turbid toxin are manifested by dull and cloudy complexion,abdominal distension,turbid urine,sticky stool,yellow greasy coating,slippery pulse,etc. The turbid toxin corresponds to the pathogenesis of metabolic syndrome at both micro and macro levels. This paper intends to explore the correlations between the turbid toxin and the pathogenesis of metabolic syndrome and make a review with relevant clinical treatment.

目的 分析早、中期肝细胞癌（HCC）切除术后早期（≤2年）复发的危险因素并探讨术前系统免疫炎症指数（SII）对早、中期HCC术后早期复发的预测价值。方法 回顾性研究2017年10月—2020年10月于我院接受肝癌根治性切除术的238例早中期HCC患者,收集基线资料,通过1∶1倾向性评分匹配（PSM）均衡组间协变量获取早期复发组及未复发组各69例;单因素和多因素Logistic回归分析影响术后早期HCC复发的相关因素,构建列线图模型,临床决策曲线（DCA）评估列线图预测模型在临床的应用效果;受试者操作特征（ROC）曲线评价预测效能,根据最高约登指数确定截断点。结果 单因素及多因素Logistic回归分析结果均提示微血管侵犯（MVI）及术前系统免疫炎症指数（SII）高水平是术后早期复发的独立危险因素;列线图模型有较好的预测效能;ROC曲线计算出SII最佳临界值为696.85×10⁹／L。结论 术前高水平SII可能对预测HCC患者术后早期复发具有潜在价值。