目的 探讨加强医学影像学的教育在肝胆外科本科实习教育中的应用效果。方法 选择了2021年3月—2023年12月，在广州市花都区人民医院肝胆胰疝外科实习的80名本科实习生为研究对象，依据随机数字表法将全部实习生随机分为两组，每组各40例，研究组接受强化影像教育，参照组接受传统教学，并对教学效果进行统计分析。结果 两组实习生经过两种不同教学方法后，研究组的总体成绩优于参照组，满意度比例高于参照组，组间差异具有统计学意义。结论 在肝胆外科临床实习教学中，加强影像学教育，可显著提高实习生的总体成绩，获得更高的教学满意度。

      Objective To explore the application effect of strengthening medical imaging education in the undergraduate internship education of hepatobiliary surgery．Methods Eighty undergraduate interns who interned in the Department of Hepatobiliary，Pancreatic and Hernia Surgery of our hospital from March 2021 to December 2023 were selected as research subjects．Using a random number table method，the interns were evenly divided into two groups，with 40 interns in each group．The experimental group received enhanced imaging education，while the control group received traditional teaching．The teaching effects were statistically analyzed．Results After undergoing two different teaching methods，the experimental group had better overall scores than the control group，and a higher satisfaction rate than the control group ，with statistically significant differences between the groups．Conclusions Strengthening imaging education in clinical internship teaching of hepatobiliary surgery can significantly improve interns’ overall scores and achieve higher teaching satisfaction，indicating its value for promotion．

       目的 评价基于成果导向教育（OBE）理念的“赛教一体化”教学模式在健康教育课程实验教学中的应用效果。方法 选取我校2021级预防医学专业的81名学生为研究对象。采用整群随机分组的方法，将其分为观察组（n=29）和对照组（n=52），观察组采用基于OBE理念的“赛教一体化”教学模式，对照组采用传统教学模式。通过对实验教学质量的模糊综合评判以及期末考试成绩进行效果评价。结果 观察组和对照组实验教学质量的模糊综合评判结果均为“优秀”，最大隶属度分别为0.727和0.534，观察组优于对照组。在一级指标层面，观察组所有指标得分均高于对照组，5个一级指标的两组得分差值从大到小依次为潜能激发（0.80）、教师素养（0.77）、学习成效（0.74）、内容设计（0.70）和教学方法（0.59）。观察组和对照组的期末考试成绩差异无统计学意义（P＞0.05）。结论 基于OBE理念的“赛教一体化”教学模式应用于健康教育课程实验教学能够有效改善教学质量，在潜能激发和教师素养方面提升较为明显。

       Objective To evaluate the application effect of the “integration of competition and education” teaching model based on the（outcomes-based education，OBE） concept in the experimental teaching of health education courses．Methods A total of 81 students majoring in preventive medicine from the 2021 grade at our university were selected as the research objects．They were divided into an observation group（n=29）and a control group（n=52）using cluster randomization．The observation group adopted the “integration of competition and education” teaching model based on the OBE concept，while the control group adopted the traditional teaching model．The effectiveness was evaluated using the fuzzy comprehensive evaluation of experimental teaching quality and the final exam scores．Results The fuzzy comprehensive evaluation results of the experimental teaching quality in both the observation group and the control group were “excellent”，with the maximum membership degrees of 0.727 and 0.534，respectively，indicating that the observation group was superior to the control group．At the level of first-level indicators，all indicators of the observation group scored higher than those of the control group．The score differences between the two groups for the five first-level indicators，from largest to smallest，were：potential excitation（0.80），teacher literacy（0.77），learning effectiveness（0.74），content design（0.70），and teaching method（0.59）．No statistically significant difference was found in the final exam scores between the observation group and the control group（P＞0.05）．Conclusions The application of the “integration of competition and education” teaching model based on the OBE concept in the experimental teaching of health education courses can effectively improve teaching quality，with more obvious improvements in potential excitation and teacher literacy．

       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．

       本文概述了传统日间腹腔镜胆囊切除术患者术后早期康复质量存在的问题，IMB模型通过向患者提供科学的疾病知识，改变其疾病认知与态度，最终促使其采纳并维持健康行为。本文还介绍了IMB模型在日间腹腔镜胆囊切除术后患者早期康复质量中应用涉及的相关概念、研究背景和国内外的研究现状以及未来发展趋势与挑战。研究结果显示，IMB模型可显著降低患者术后疼痛发生率，并提高患者参与治疗决策的程度，为后期关于IMB模型在日间腹腔镜胆囊切除术患者术后早期康复质量的相关研究提供借鉴与参考，以便后期实施相关个性化干预措施，并提供相关理论依据。

       This paper summarizes the problems existing in the early postoperative rehabilitation quality of patients undergoing traditional ambulatory laparoscopic cholecystectomy．The IMB model changes patients’ disease cognition and attitude by providing them with scientific disease knowledge，and ultimately promotes their adoption and maintenance of healthy behaviors．It also introduces the relevant concepts involved in the application of the IMB model in the early postoperative rehabilitation quality of patients undergoing ambulatory laparoscopic cholecystectomy，the research background of this study，the current research status at home and abroad，as well as the future development trends and challenges．The research results show that the IMB model can significantly reduce the incidence of postoperative severe pain in patients and the degree of patient participation in treatment decision-making．This provides reference and guidance for subsequent studies on the early rehabilitation quality of patients undergoing ambulatory laparoscopic cholecystectomy using the IMB model，so as to implement relevant personalized intervention measures in the future and provide relevant theoretical basis．

       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 探究综合性口腔护理干预方案在机械通气患儿中的应用效果。方法 将2023年5月—12月泉州市妇幼保健院重症监护科接收的66例机械通气患儿选为研究对象。以密封信封抽签法分为综合干预组（n=33）及常规干预组（n=33）。常规干预组实施常规口腔护理，综合干预组实施综合性口腔护理模式干预。对比两组患儿口腔情况、并发症、静态全唾液流率（UWS）及机械通气时间。结果 干预后综合干预组Beck总分为（6.33±1.05）分，低于常规干预组的（8.55±1.85）分（t=6.069，P＜0.001）。综合干预组出现呼吸机相关肺炎（VAP）发生率较常规干预组更低（3.03% vs 18.18%）（χ²=3.995，P=0.046）。干预后综合干预组UWS为（0.37±0.09）mg/min，高于常规干预组的（0.29±0.09）mg/min（t=3.611，P=0.001）。结论 综合性口腔护理模式能较大程度改进机械通气患儿的口腔卫生问题，对菌斑、口腔异味及牙龈情况均有改善作用；也能减少并发症发生率，提升UWS，维持口腔卫生健康。

      Objective To explore the effect of comprehensive oral nursing intervention in children with mechanical ventilation．Methods A total of 66 mechanically ventilated children admitted to the intensive care department of the hospital from May 2023 to December 2023 were selected as the study objects．They were divided into comprehensive intervention group（n=33）and routine intervention group（n=33）by sealed envelope lottery method．The routine intervention group implemented routine oral care，and the comprehensive intervention group implemented comprehensive oral care mode intervention．Oral conditions，complications，unstimulated whole saliva（UWS）and mechanical ventilation time were compared between the two groups．Results After the intervention，the total Beck score of the comprehensive intervention group was（6.33±1.05），which was lower than that of the conventional intervention group（［8.55±1.85］，t=6.069，P＜0.001）．The incidence of ventilator-associated pneumonia（VAP）in the comprehensive intervention group was lower than that in the conventional intervention group（3.03% vs 18.18%）（χ²=3.995，P=0.046）．After the intervention，the UWS of the comprehensive intervention group was（0.37±0.09）mg/min，which was higher than that of the conventional intervention group（［0.29±0.09］ mg/min，t=3.611，P=0.001）．Conclusions The comprehensive oral care mode can improve the oral health of children with mechanical ventilation to a great extent，and can improve the plaque，oral odor and gingiva condition．It can also reduce the incidence of complications，improve UWS，and maintain oral health．

       目的 探究肺泡灌洗液靶向高通量测序（tNGS）在鹦鹉热衣原体肺炎中应用效果。方法 选取2021年5月—2025年3月我院收治的35例鹦鹉热衣原体肺炎患者进行研究，患者均接受肺泡灌洗液tNGS检测、肺泡灌洗液常规病原检测，以病原学为金标准，分析肺泡灌洗液tNGS对鹦鹉热衣原体肺炎的诊断效能。结果 金标准对鹦鹉热衣原体阳性检出35例，检出率100.00%，肺泡灌洗液tNGS阳性检出率高于传统病原检测，检测结果回报耗时短于肺泡灌洗液传统病原检测（P＜0.05）。结论 鹦鹉热衣原体肺炎临床症状缺乏特异性，容易转为重症肺炎，肺泡灌洗液tNGS可提高鹦鹉热衣原体肺炎检出率且结果回报较快，采用四环素类、喹诺酮类抗生素有助于改善患者预后。

     Objective To investigate the application effect of targeted next-generation sequencing（tNGS）of bronchoalveolar lavage fluid（BALF）in Chlamydia psittaci pneumonia．Methods Thirty-five patients with Chlamydia psittaci pneumonia admitted to our hospital from May 2021 to March 2025 were selected for the study．All patients underwent BALF tNGS and conventional BALF pathogen detection．With etiology as the gold standard，the diagnostic efficacy of BALF tNGS for Chlamydia psittaci pneumonia was analyzed．Results The gold standard detected 35 cases of Chlamydia psittaci positive，with a detection rate of 100.00%．The positive detection rate of tNGS in alveolar lavage fluid was higher than that of traditional pathogen detection，and the results report time of tNGS was shorter than that of traditional pathogen detection（P＜0.05）．Conclusions Chlamydia psittaci pneumonia lacks specificity in clinical symptoms and is easy to turn into severe pneumonia，bronchoalveolar lavage fluid tNGS can improve the detection rate of Chlamydia psittaci pneumonia and the results return quickly，and the use of tetracyclines and quinolones antibiotics can help improve the prognosis of patients．

       目的 验证尿沉渣评分（USS）对肾前性急性肾损伤（AKI）与急性肾小管坏死（ATN）的鉴别价值，评估USS与AKI严重程度及预后的相关性，为优化AKI分层管理提供依据。方法 回顾性分析2021年3月至2022年2月在郑州市中医院治疗的120 AKI患者，根据肾组织活检及改良FENa-UA诊断标准分为肾前性AKI组（n=68）与ATN组（n=52），于入院日检测USS、血清胱抑素C（Cys-C）及尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL），分析USS诊断效能。结果 ATN组USS高于肾前性组（P＜0.001），且评分随AKI分期升高而增加（P＜0.001）。USS诊断肾前性AKI的ROC曲线下面积（AUC）为0.892，联合Cys-C与NGAL后AUC提升至0.941，灵敏度与特异度分别达90.12%和88.51%。结论 USS通过量化肾小管结构性损伤，可早期鉴别肾前性AKI与ATN，其与Cys-C、NGAL的联合应用提高诊断准确性，且对AKI预后具有重要价值，为临床分层管理提供客观依据。

       Objective To validate the discriminative value of urinary sediment score（USS）in differentiating prerenal acute kidney injury（AKI）from acute tubular necrosis（ATN），and to evaluate the correlation between USS and AKI severity/prognosis，providing evidence for optimizing stratified AKI management．Methods A retrospective analysis was conducted on 120 AKI patients treated at Zhengzhou Traditional Chinese Medicine Hospital from March 2021 to February 2022．According to renal tissue biopsy and modified FENa-UA diagnostic criteria，patients were divided into a prerenal AKI group（n=68）and an ATN group（n=52）．On the day of admission，USS，serum cystatin C（Cys-C），and urinary neutrophil gelatinase-associated lipocalin（NGAL）were measured to analyze the diagnostic performance of USS．Results USS was significantly higher in ATN group than prerenal group（P＜0.001），and increased with advancing AKI stages（P＜0.001）．The area under the ROC curve（AUC）of USS for diagnosing prerenal AKI was 0.892，which improved to 0.941 when combined with Cys-C and NGAL，yielding sensitivity and specificity of 90.12% and 88.51%，respectively．Conclusions USS quantifies structural damage to the renal tubules，allowing for early differentiation between prerenal AKI and ATN．Its combined use with Cys-C and NGAL improves diagnostic accuracy and is of significant value in predicting AKI prognosis，providing an objective basis for clinical stratified management．

       目的 探讨瑞马唑仑复合瑞芬太尼在无痛支气管镜检查中的应用。方法 选取2023年1月1日—2024年12月31日我院86例进行无痛支气管镜检查的患者。随机分为两组，对照组给予瑞芬太尼+丙泊酚麻醉，试验组加用瑞马唑仑。比较两组麻醉效果、血流动力学及不良反应。结果 试验组诱导麻醉时间、离室时间短于对照组（t分别为6.052、5.702，P＜0.05）；气管插管时试验组HR水平短于对照组（t分别为2.582，2.601，P＜0.05），试验组SpO2水平高于对照组（t=8.968，P＜0.05）；试验组不良反应总发生率短于对照组（χ²=6.198，P＜0.05）。结论 在无痛支气管镜检查时，瑞马唑仑与瑞芬太尼联合展现出良好效果，能有效提升麻醉质量，并可维持血流动力学的平稳状态，安全性较高。

       Objective To investigate the application of remimazolam combined with remifentanil in sedation for bronchoscopy．Methods Eighty-six patients who underwent painless bronchoscopy in our hospital from January 1，2023，to December 31，2024，were selected．They were randomly divided into two groups．The control group received a combination of remifentanil and propofol for anesthesia，while the experimental group was additionally administered remimazolam．The anesthesia status，hemodynamic parameters，and adverse reactions were compared between the two groups．Results The experimental group demonstrated significantly shorter induction anesthesia durations and recovery times compared to the control group（t=6.052，5.702，P＜0.05）．At tracheal intubation，the experimental group exhibited notably lower HR than the control group（t=2.582，2.601，P＜0.05），while their SpO2 levels were significantly higher（t=8.968，P＜0.05）．The total incidence of adverse reactions in the experimental group was significantly lower than that in the control group（χ²=6.198，P＜0.05）．Conclusions The combination of remimazolam and remifentanil demonstrates favorable outcomes in painless bronchoscopy，effectively improving anesthesia quality，maintaining hemodynamic stability，and with a favorable safety profile．

       嵌合抗原受体（CAR）T细胞疗法在血液系统恶性肿瘤中疗效显著，但在实体瘤应用中面临肿瘤异质性、免疫抑制微环境和在靶脱瘤毒性等挑战。合成Notch受体（synNotch）作为一种模块化的跨膜信号传导工具，通过将抗原识别与定制化的转录激活程序人工耦联，赋予T细胞整合多重信号、执行布尔逻辑运算的能力。将synNotch与CAR等效应模块结合，可构建“与”、“非”、“或”等逻辑门控回路，可实现对肿瘤微环境的精确识别与响应，极大提升CAR-T细胞的靶向特异性。本文系统综述了synNotch受体的结构演进与逻辑门控设计原理；重点阐明了其在提升细胞疗法靶向特异性、克服实体瘤抗原异质性、动态调控肿瘤微环境以及扩展至其他免疫细胞工程化领域的最新应用进展，并探讨了当前该技术在载体系统构建、受体信噪比优化等方面面临的挑战及未来的发展方向。

   Chimeric antigen receptor（CAR）T-cell therapy has demonstrated remarkable efficacy in hematological malignancies；however，its application in solid tumors is confronted with significant challenges，including tumor heterogeneity，the immunosuppressive microenvironment，and on-target off-tumor toxicity．As a highly modular transmembrane signal transduction tool，the synthetic Notch（synNotch）receptor innovatively links antigen recognition with customized transcriptional activation programs，thereby empowering T cells with the capacity to integrate multiple signals and perform Boolean logic operations．By combining synNotch with effector modules such as CARs，logic-gated circuits，including AND，NOT，and OR gates，can be constructed，which enables precise discrimination of and response to the tumor microenvironment，substantially enhancing the targeting specificity of CAR-T cells．This review systematically summarizes the structural evolution of synNotch receptors and the principles of logic-gated design．Furthermore，it highlights recent advances in their application for enhancing the targeting specificity of cell-based therapies，overcoming solid tumor antigen heterogeneity，dynamically regulating the tumor microenvironment，and extending to the engineering of other immune cell types．Finally，we discuss current challenges，such as the construction of vector systems and the optimization of receptor signal-to-noise ratios，as well as future directions for this technology．