目的 探究新生儿坏死性小肠结肠炎接受肠腹壁造口术后，对感染指标和免疫指标的影响效果，以及术中、术后不良反应发生情况。方法 选取2016年1月—2024年1月因坏死性小肠结肠炎在潍坊市妇幼保健院接受肠腹壁造口术的56例患儿为A组，另收集同时期因坏死性小肠结肠炎行I期肠切除肠吻合的39例患儿为B组，观察并比较两组患儿术前、术后免疫指标和感染指标的变化情况。另收集同时期40名健康新生儿，对比A组患儿出院前的免疫、感染指标的与健康新生儿差异情况。出院后继续门诊随访，观察术后并发症及不良反应发生情况。结果 A组和B组患儿接受手术后，免疫指标（IgA、IgG、IgM）较术前呈上升趋势，而感染指标（IL-6、PCT、TNF-α）较术前下降。出院前1天A组IgG、IgM水平均高于B组，差异有统计学意义（t=2.312，P=0.023；t=3.214，P=0.002）。B组患儿术后第2天、术后第7天、出院前1天IL-6水平高于A组，差异有统计学意义（t=-4.252，P＜0.001；t=-3.383，P=0.001；t=-2.505，P=0.014）。至出院前1天，A组患儿的免疫指标和感染指标与健康新生儿相比，差异无统计学意义（P＜0.05）。所有手术患儿住院期间至还纳手术前无严重并发症发生。结论 肠腹壁造口术对患有坏死性小肠结肠炎的患儿治疗效果较好，可在一定程度上减轻炎症反应，改善患儿免疫功能。远期效果较好，安全性良好。
Objective To investigate the effect of enterostomy on infection indexes and immune indexes in necrotizing enterocolitis，as well as the occurrence of enterostomy and postoperative adverse reactions．Methods Fifty-six neonates who underwent enterostomy for necrotizing enterocolitis in Weifang Maternal and Child Health Hospital from January 2016 to January 2024 were selected as Group A，and 39 neonates who underwent phase I intestinal resection and anastomosis for necrotizing enterocolitis during the same period were selected as Group B．The changes of preoperative and postoperative immune indicators and infection indicators between the two groups of neonates were observed and compared．In addition，40 healthy neonates were selected during the same period，and the differences in immune and infection indexes between group A and healthy neonates were compared before discharge．Patients were followed up after discharge to observe postoperative complications and adverse reactions．Results After surgery，the immune indexes（IgA，IgG，IgM）of the two groups（A and B） were higher than those before surgery，while the infection indexes（IL-6，PCT，TNF-α）were significantly lower than those before surgery．The levels of IgG and IgM in Group A were higher than those in Group B one day before discharge，and the differences were statistically significant（t=2.312，P=0.023；t=3.214，P=0.002）．In Group B，the levels of IL-6 on postoperative day two，postoperative day seven，and one day before discharge were significantly higher than in Group A．The differences were statistically significant（t=-4.252，P＜0.001；t=-3.383，P=0.001；t=-2.505，P=0.014）．By one day before discharge，the immune indicators and infection indicators of the infants in Group A were not significantly different from those of healthy newborns．No serious complications occurred among all surgical patients during their hospital stay until the enterostomy closure．Conclusions Enterostomy has a good therapeutic effect on neonates with necrotizing enterocolitis，which can reduce the inflammatory response and improve the immune function of children to a certain exten，with better long-term effects and good safety．
目的 探讨营养评估及炎症因子水平对非霍奇金淋巴瘤（NHL）患者化学治疗（化疗）后感染及平均住院日的影响。方法 回顾性分析接受R-CHOP治疗的NHL患者95例。通过受试者工作特征（ROC）曲线确定患者主观整体营养评估（PG-SGA）预测患者化疗后感染的界值。将患者分为PG-SGA＜4组与PG-SGA≥4组，比较两组间营养及炎症相关指标的差异。采用单因素与多因素回归分析NHL患者化疗后感染及平均住院日延长的危险因素。结果 ROC曲线显示PG-SGA为3.5时，约登指数最大，预测NHL患者化疗后感染灵敏度为92%，特异度为11.1%。PG-SGA≥4组患者平均年龄、国际预后指数（IPI）及Ann arbor Ⅲ~Ⅳ期比例均高于PG-SGA＜4组（P＜0.05）。与PG-SGA＜4组相比，PG-SGA≥4组患者白介素6（IL-6）及中性粒细胞与淋巴细胞比值（NLR）明显升高，且化疗后感染率及平均住院日≥5 d比例高于对照组（P＜0.05）；与对照组相比，PG-SGA＜4组患者前白蛋白、白蛋白和血红蛋白水平升高（P均＜0.05）。多因素回归分析显示，PG-SGA≥4及合并糖尿病是NHL患者化疗后感染率的独立危险因素（P均＜0.05）。白蛋白低于35 g/L及合并化疗后感染是NHL患者平均住院日延长的独立危险因素（P均＜0.05）。结论 基于PG-SGA的营养评估及炎症因子分析对NHL患者化疗后感染及平均住院日的预测具有临床指导意义。
Objective To explore the effects of nutritional assessment and inflammatory factor levels on post-chemotherapy infections and length of hospital stay in patients with non-Hodgkin’s lymphoma（NHL）．Methods A total of 95 NHL patients treated with the R-CHOP regimen were retrospectively analyzed．The cut-off value of Patient-Generated Subjective Global Assessment （PG-SGA） for post-chemotherapy infection in NHL patients was evaluated by Receiver Operating Characteristic（ROC）curves．Patients were categorized into PG-SGA＜4 and PG-SGA≥4 groups and compared for differences of nutritional and inflammation-related factors．Univariate and multivariate logistic regression were used to analyze the risk factors for post-chemotherapy infection and length of hospital stay（LHS）．Results The ROC curve showed that the Youden index was largest at PG-SGA of 3.5，which predicted post-chemotherapy infection in NHL patients with a sensitivity of 92% and a specificity of 11.1%．The mean age，International Prognostic Index（IPI），and Ann Arbor stage Ⅲ~IV proportion in patients with PG-SGA≥4 were higher compared with the control（P＜0.05）．Patients with PG-SGA≥4 had significantly higher interleukin-6 and neutrophil-to-lymphocyte ratio（NLR），and the infection rate and the proportion of LHS≥5 days after chemotherapy were higher than those in the control group（P＜0.05）．Patients in the PG-SGA＜4 group had significantly higher prealbumin，albumin，and hemoglobin levels compared to the PG-SGA≥4 group（P＜0.05）．Multifactorial logistic regression analysis revealed that PG-SGA≥4 and combined diabetes mellitus were independent risk factors for post-chemotherapy infection rate in NHL patients（both P＜0.05）．Albumin less than 35 g/L and combined post-chemotherapy infection were independent risk factors for prolonged LHS in NHL patients（both P＜0.05）．Conclusions PG-SGA nutritional assessment and inflammatory factor analysis are clinically instructive in predicting post-chemotherapy infections and LHS in NHL patients．
目的 初步探讨生长因子受体结合蛋白14（GRB14）在肺腺癌患者预后中的具体作用机制。方法 通过TIMER数据库、UALCAN数据库及GEPIA数据库，探讨GRB14 mRNA在肺腺癌及正常肺组织中的表达。运用免疫组织化学通过组织芯片（75例肺腺癌患者和75例癌旁组织）检测其蛋白表达水平，收集国外肿瘤研究团队上传至TCGA数据库229例肺腺癌患者的临床数据，分析评估GRB14在肺腺癌患者的表达及其临床特征及生存预后之间的关系。应用TIMER数据库对GRB14肺腺癌患者进行免疫浸润分析。String数据库探讨GRB14与其他蛋白之间是否存在相互作用。结果 TIMER数据库分析显示，相比正常组织，GRB14 mRNA在多种实体肿瘤和肺腺癌组织中高表达（P＜0.05）。使用UALCAN数据库和GEPIA数据库以正常样本为对照组，肺腺癌患者的GRB14的表达均增加（P＜0.01）。免疫组织化学检测组织芯片结果显示，GRB14蛋白在肺腺癌的表达高于正常肺组织（肺腺癌6.07±1.01 vs 癌旁组织4.80±1.22；P＜0.01）。TCGA数据库分析显示，肺腺癌患者中GRB14高表达组和低表达组的中位总生存期分别为（41.59±5.20）月和（88.67±16.69）月；结合TCGA数据库绘制ROC曲线，发现GRB14的表达对肺腺癌患者具有一定的诊断价值。单因素回归分析结果显示，肿瘤分期（Ⅲ-Ⅳ）（P＜0.01）、肿瘤原发灶的情况（T3-4）（P＜0.01）、淋巴结转移（N1-3）（P＜0.01）和GRB14表达（P＜0.01）是影响肺腺癌中位总生存期的因素；Cox多因素回归分析显示，淋巴结转移（N1-3）（P＜0.05）和GRB14表达（P＜0.01）是影响肺腺癌中位总生存时间的因素。TIMER数据库分析显示，GRB14 mRNA 表达与巨噬细胞（r=-0.164，P＜0.01）、中性粒细胞（r=-0.175，P＜0.01）和树突状细胞（r=-0.148，P＜0.01）具有相关性。通过String数据库分析发现与GRB14相互作用的蛋白质包括EGFR、HRAS、FGFR1、INSR、CNGA1、COBLL1、LYPLAL1、TNKS2、TNKS、PRKCZ。结论 GRB14表达增加与肺腺癌患者预后不良相关。
Objective To assess the specific mechanism of growth factor receptor-bound protein 14（GRB14）in the prognosis of lung adenocarcinoma（LUAD）patients．Methods The expression of GRB14 mRNA in LUAD and normal lung tissue was explored using TIMER database，UALCAN database，and GEPIA database．The expression of GRB14 protein was examined by immunohistochemistry using a tissue microarray．Then，the associations of GRB14 expression with clinicopathological features and clinical outcomes of LUAD were validated by analyzing TCGA database at the mRNA level and statistically evaluating the results．TIMER database was used to analyze immune infiltration of GRB14 in LUAD．Protein-protein interaction of GRB14 were analyzed using the String database．Results Using the TIMER database，we found that GRB14 mRNA was highly expressed in various solid tumors and LUAD tissues compared to normal tissues（P＜0.05）．Comparing with the normal group，the expression of GRB14 was increased in LUAD（P＜0.01）via using UALCAN database and GEPIA database．The expression level of GRB14 protein in the LUAD tissues was significantly higher than that in the noncancerous LUAD tissues（LUAD［6.07±1.01］ vs benign，［4.80±1.22］；P＜0.01）in tissue microarray ．Median overall survival in the high and low GRB14 expression groups in LUAD was（41.59±5.2）and（88.67±16.69）months respectively．We plotted the ROC curves of 3-year survival rate and 5-year survival rate which again suggested that the model had good predictive performance．Univariate analysis revealed that individual cancer stages（Ⅲ-IV）（P＜0.01），tumor（T3-4）（P＜0.01），lymph node metastasis（N1-3）（P＜0.05）and GRB14 expression（P＜0.01）were risk factors affecting the median overall survival time of LUAD．According to Cox multiple regression analysis，we found that lymph node metastasis（N1-3）（P＜0.05）and GRB14 expression（P＜0.01）were risk factors affecting the median overall survival time of LUAD．Using TIMER database analysis，the mRNA level of GRB14 was significantly correlated with macrophages（r=-0.164，P＜0.01），neutrophils（r=-0.175，P＜0.01）and dendritic cells（r=-0.148，P＜0.01）．Through analysis of the String database，it was found that proteins that interacted with GRB14 including EGFR，HRAS，FGFR1，INSR，CNGA1，COBLL1，LYPLAL1，TNKS2，TNKS，PRKCZ．Conclusions The results of the present study suggest that GRB14 may efficiently predict poor survival in LUAD patients．
目的 探讨长链非编码核糖核酸肺腺癌转移相关转录本 1（LncMALAT1）通过竞争性结合微小RNA-506-3p（miR-506-3p）调控Zeste同源物增强子2（EZH2）影响膀胱癌增殖的机制。方法 收集2023年1月—2024年10月的92例外科手术切除的膀胱癌组织及对应的癌旁组织标本, 利用Western blot和定量实时逆转录聚合酶链式反应（qRT-PCR）方法检测LncMALAT1和EZH2的表达情况。根据患者预后分为不良组（n=34）和良好组（n=58）, 收集患者的性别、年龄、肿瘤直径、血管侵袭情况、TNM分期、远处转移情况等临床指标, 结合临床病理指标分析LncMALAT1和EZH2与膀胱癌患者预后的关系。通过体外实验,包括qRT-PCR、Western blot、平板克隆和EdU实验,验证LncMALAT1对EZH2表达和膀胱癌细胞增殖的影响。利用生物信息学技术预测LncMALAT1与miR-506-3p的相互作用,并通过qRT-PCR验证在膀胱癌细胞中上调LncMALAT1表达后miR-506-3p的表达变化。结果 单因素结果显示, 血管侵袭情况、TNM分期、远处转移情况、LncMALAT1及EZH2表达水平均与膀胱癌患者预后不良有关, 差异有统计学意义（均P<0.05）。分析结果发现LncMALAT1与EZH2在膀胱癌组织中的表达呈正相关。体外实验结果显示, 上调LncMALAT1表达后, EZH2的表达显著上调, 且膀胱癌细胞的增殖能力显著提高（均P<0.05）。qRT-PCR验证表明,上调LncMALAT1表达后,miR-506-3p的表达显著下调（P<0.05）, 提示LncMALAT1通过竞争性结合miR-506-3p调控EZH2,进而影响膀胱癌细胞的增殖进展。结论 LncMALAT1通过竞争性结合miR-506-3p调控EZH2促进膀胱癌增殖功能,进而加快膀胱癌细胞的增殖进展, 可为膀胱癌的治疗提供新的潜在靶点。
Objective To explore the mechanism of long non-coding ribonucleic acid metastasis - associated lung adenocarcinoma transcript 1（LncMALAT1）regulating enhancer of Zeste homolog 2（EZH2）through competitive combination with microRNA-506-3p（miR-506-3p）to affect the proliferation of bladder cancer．Methods A total of 92 pairs of bladder cancer tissues and corresponding adjacent normal tissues were collected from surgical resections between January 2023 and October 2024．The expression levels of LncMALAT1 and EZH2 were detected using Western blot and qRT-PCR．The patients were divided into poor group（n=34）and good group（n=58）according to their prognosis．Clinical data, such as gender, age, tumor diameter, vascular invasion, TNM stage, and distant metastasis were collected, and the relationship between LncMALAT1 and EZH2 and the prognosis of bladder cancer patients was analyzed with clinical pathological indicators．Through in vitro experiments, including qRT-PCR Western blot, plate cloning and EdU experiment were conducted to verify the effect of LncMALAT1 on EZH2 expression and bladder cancer cell proliferation．Bioinformatics technology was used to predict the interaction between LncMALAT1 and miR-506-3p, and qRT-PCR was used to verify the change of miR-506-3p expression after up regulating LncMALAT1 expression in bladder cancer cells．Results The univariate results showed that vascular invasion, TNM stage, distant metastasis, LncMALAT1 and EZH2 expression levels were related to the poor prognosis of bladder cancer patients, and the difference was statistically significant（all P<0.05）．The results showed that the expression of LncMALAT1 and EZH2 in bladder cancer was positively correlated．In vitro experiment results showed that after up regulating LncMALAT1 expression, EZH2 expression was significantly up-regulated, and the proliferation ability of bladder cancer cells was significantly improved（all P<0.05）．QRT-PCR validation showed that the expression of miR-506-3p was significantly down regulated after the expression of LncMALAT1 was up-regulated（P<0.05）, suggesting that LncMALAT1 could regulate EZH2 through competitive combination with miR-506-3p, thereby affecting the proliferation and progression of bladder cancer cells．Conclusions LncMALAT1 can promote the proliferation of bladder cancer cells by competitively combining with miR-506-3p to regulate EZH2, and then accelerate the proliferation of bladder cancer cells, which can provide a new potential target for the treatment of bladder cancer．
目的 探讨非编码长链 RNA ANRIL（lncRNA-ANRIL）通过调控miR‐181b 介导磷酸酶及张力蛋白同源物基因（PTEN）对冠状动脉粥样硬化性心脏病（冠心病）心肌损伤影响的机制。方法 纳入2023年10月—2024年6月广州市第一人民医院30例确诊为冠心病的患者为观察组, 另选择同期本院体检中心30名健康者为对照组,检测两组研究者血压指标、血脂指标以及血清 lncRNA-ANRIL、miR-181b、PTEN水平, 并比较检测结果。结果 两组的性别、年龄、BMI、吸烟、高血压一般资料对比差异无统计学意义（P>0.05）; 观察组收缩压、舒张压水平以及总胆固醇、甘油三酯、低密度脂蛋白胆固醇水平均高于对照组,而高密度脂蛋白胆固醇则低于对照组（P<0.05）; 观察组血清 lncRNA ANRIL Exon 1-2、lncRNA ANRIL Exon 17-18相对表达水平以及PTEN水平低于对照组（t=12.623、7.741、8.231, P=0.001）, 而miR-181b水平则高于对照组（t=37.250, P=0.001）。结论 相较于正常人群, 冠心病患者血清lncRNA-ANRIL和PTEN水平明显降低,而miR-181b水平升高,提示lncRNA-ANRIL可通过调控miR-181b来调节PTEN的表达, 从而影响冠心病心肌损伤的过程。
Objective To explore the mechanism of competitive binding of non coding long stranded RNA ANRIL（lncRNA-ANRIL）to miR-181b to mediate phosphatase and tensin homolog gene（PTEN）on myocardial injury in coronary heart disease．Methods Thirty patients diagnosed with coronary heart disease in our hospital from October 2023 to June 2024 were included as the observation group,and another 30 individuals from physical examination center during the same period were selected as the control group．Blood pressure indicators,blood lipid indicators, and serum levels of lncRNA-ANRIL, miR-181b, and PTEN were measured in the two groups of patients, and the test results were compared．Results There was no significant difference between the two groups in terms of gender, age, BMI, smoking and hypertension（P>0.05）．The levels of systolic blood pressure（SBP）, diastolic blood pressure（DBP）, total cholesterol（TC）, triglycerides（TG）, and low-density lipoprotein cholesterol（LDL-C） in the observation group were higher than those in the control group,while high-density lipoprotein cholesterol（HDL-C） was lower than that in the control group（P<0.05）．The relative expression levels of lncRNA-ANRIL Exon 1-2, Exon 17-18, and PTEN levels in the observation group were lower than those in the control group（t=12.623, 7.741, 8.231, P=0.001）, while the level of miR-181b was higher than that in the control group（t=37.250, P=0.001）．Conclusions Compared with healthy individuals, serum levels of lncRNA-ANRIL and PTEN are significantly reduced in patients with coronary heart disease, while miR-181b levels are elevated, indicating that lncRNA ANRIL can regulate PTEN expression by miR-181b, thereby affecting the process of myocardial injury in coronary heart disease．
目的 探讨卵巢癌化学治疗（化疗）耐药与焦孔素E（GSDME）基因的甲基化是否有关, 以及地西他滨是否可以通过去甲基化使GSDME蛋白表达水平升高从而逆转卵巢癌化疗耐药。方法 顺铂逆浓度梯度构建SKOV-3卵巢癌耐顺铂细胞株（SKOV-3/DDP）; CCK8法检测耐药前后细胞株的半抑制浓度（IC50）; 实时荧光定量甲基化特异性PCR法检测两组细胞中GSDME基因的甲基化水平; Wetern Blot检测两组细胞中GSDME的表达水平。将耐药细胞株用不同质量浓度的地西他滨处理,重复上述实验, 检测地西他滨处理前后细胞的IC50、GSDME基因的甲基化水平及GSDME蛋白的表达程度。结果 与SKOV-3细胞相比, SKOV-3/DDP中GSDME基因的甲基化水平升高（P<0.01）, 同时GSDME蛋白的表达水平降低（P<0.001）; 随着地西他滨作用浓度的升高, 耐药细胞中GSDME基因的甲基化程度逐渐降低, 蛋白的表达水平逐渐升高, 细胞的IC50逐渐降低：在用0.5 μg/mL地西他滨处理耐药细胞后GSDME基因的甲基化水平虽然降低（P<0.01）, 但是此时蛋白的表达水平及耐药细胞的IC50均无明显改变（P>0.05）; 当地西他滨的浓度增加到1.0 μg/mL时蛋白的表达水平才明显升高（P<0.05）, 而此时细胞的IC50仍未见明显降低（P>0.05）; 待药物浓度达到1.5 μg/mL时, 细胞的IC50才表现出明显的下降趋势（P<0.05）。结论 GSDME的表达与卵巢癌的化疗耐药密切相关, GSDME的高甲基化水平致使其低表达可促进卵巢癌的化疗耐药。但地西他滨可以通过去甲基化使卵巢癌耐药细胞中GSDME的表达水平升高, 从而增加卵巢癌细胞对化疗药物的敏感性, 进而逆转卵巢癌化疗耐药。
Objective To explore whether drug resistance in ovarian cancer is associated with gasdermin E（GSDME） methylation, and to explore whether decitabine can reverse ovarian cancer chemoresistance by increasing GSDME protein expression levels through demethylation．Methods The cisplatin-resistant cell line（SKOV-3/DDP）was constructed by inverse concentration gradient of cisplatin．Semi-inhibitory concentration（IC50）of cell lines after drug resistance was detected using the CCK8 assay．Real-time fluorescence quantitative methylation-specific PCR was used to detect the methylation level of GSDME gene in the two groups of cells．Wetern Blot was used to detect the expression level of GSDME in the two groups of cells．Drug-resistant cell lines were treated with different concentrations of the demethylating drug decitabine．Experiments above were repeated to detect the methylation degree of IC50 and GSDME genes and the expression level of GSDME protein in drug-resistant cells before and after decitabine treatment．Results Compared with SKOV-3 cells, the methylation level of GSDME gene in SKOV-3/DDP was significantly increased（P<0.01）, while the expression level of GSDME protein was significantly decreased（P<0.001）．With the increase of decitabine concentration, the methylation degree of GSDME gene in drug-resistant cells was gradually decreased, the expression level of protein was gradually increased, and the IC50 of cells was gradually decreased：the methylation level of GSDME gene was decreased after 0.05 μg/mL decitabine treatment（P<0.01）, but there were no significant changes in protein expression level and IC50 of drug-resistant cells（P>0.05）．The protein expression level was significantly increased when the concentration of local citabine was increased to 0.10 μg/mL（P<0.05）, while the IC50 of the cells was not significantly decreased（P>0.05）．When the drug concentration reached 0.15 μg/mL, he IC50 of the cells showed a significant downward trend（P<0.05）．Conclusions The expression of GSDME is closely related to chemoresistance in ovarian cancer, and the low expression of GSDME due to its high methylation level can promote chemoresistance in ovarian cancer．However, decitabine can increase the expression level of GSDME in drug-resistant ovarian cancer cells through demethylation,thereby increasing the sensitivity of ovarian cancer cells to chemotherapeutic drugs, and then reversing the chemoresistance of ovarian cancer．
目的 了解脑出血患者家属参与治疗共享决策满意度现状及其影响因素,为提升脑出血患者的护理质量和家属体验提供参考。方法 采用横断面研究设计,便利抽取2022年1月—2023年7月许昌中医院收治的脑出血患者及其家属进行问卷调查。结果 共回收问卷178份,全部纳入分析。患者家属参与医疗决策的满意度得分为（48.58±6.34）分,其中维度得分最低的为交流协商。多因素分析结果显示,家属教育程度、家属年龄、家庭总年收入以及患者家属对医疗决策知情程度为患者家属参与医疗决策满意度的影响因素（F=30.872,P<0.001）,解释40.3%的变异。结论 脑出血患者家属参与治疗共享决策满意度处于中等水平,患者家属对医疗决策知情程度越高、家属教育程度越高、家属年龄较大以及家庭总年收入越高的脑出血患者家属参与治疗共享决策满意度越高。
肥胖是一种以慢性低度炎症为特征的进展性疾病,与多种代谢性疾病的发生、发展密切相关。脂肪组织作为一种内分泌和免疫器官,可分泌多种生物活性物质及炎症因子,参与肥胖患者体内的代谢过程。减重手术是治疗病态性肥胖及相关代谢性疾病的有效方法之一,能够调节机体内的炎症反应、有效改善代谢状态。但减重手术对于炎症因子的作用如何,目前国内外的文献证据仍有争议。本文将系统阐述肥胖与代谢性炎症的关系以及减重手术对炎症因子的影响,旨在为肥胖代谢外科的诊疗过程提供参考。
Obesity is a progressive disease characterized by chronic low-grade inflammation,which is closely related to the occurrence and development of a variety of metabolic diseases．As an endocrine and immune organ,adipose tissue can secrete a variety of bioactive substances and inflammatory factors,which participate in the metabolic process of obese patients．Bariatric surgery is one of the effective methods for the treatment of morbid obesity and related metabolic diseases,which can regulate the inflammatory response in the machine and effectively improve the metabolic state．However,the effect of bariatric surgery on inflammatory factors is still controversial at home and abroad．This article will systematically explain the relationship between obesity and metabolic inflammation and the effect of bariatric surgery on inflammatory factors,aiming to provide a reference for the diagnosis and treatment process of bariatric surgery．
目的 分析广州某三甲医院脑梗死患者住院费用的变化以及影响因素,为有效减轻患者疾病经济负担提供参考依据。方法 提取广州某三甲医院2015—2022年出院诊断ICD-10前三位编码为I63的病案首页数据,并采用IBM SPSS 20.0软件对费用结构进行描述性统计分析,以多重线性回归分析患者住院费用的影响因素。结果 2015—2022年脑梗死患者的平均住院费用年均增长率为2.86%;费用结构以药品费为主,占比逐年下降,至2022年占比为27.74%,技术劳务性费用占比逐年增加,至2022年占比为47.41%;住院费用主要受医院感染情况、住院天数以及支付方式等因素影响（F=990.10,P<0.001）。结论 脑梗死患者的住院费用结构显著优化,但患者的疾病经济负担仍然较重,且费用受多种因素的综合影响。建议通过提高医疗质量与服务效能,并严格落实临床路径管理,减少不必要的检查以及耗材使用,以期最大程度地减轻患者的负担。
Objective To analyze the structural changes and influencing factors of the hospitalization expenses for patients with cerebral infarction in a tertiary general hospital in Guangzhou,and provide a scientific basis for reducing economic burden of the patients．Methods The front page data of medical records with the main diagnosis of I63 were collected in the sample hospital．Descriptive statistics analysis of hospitalization expenses structure and multiple linear regression analysis of the influencing factors were carried out by SPSS 20.0．Results The annual growth rate of average hospitalization expenses of cerebral infarction patients from 2015 to 2022 in the sample hospital was 2.86% per year．The highest proportion of hospitalization expenses was medicine fee,the proportion of which declined year by year with a minimum 27.74% in 2022．The proportion of technical labor costs accelerated year by year with a maximum 47.41% in 2022．This study revealed the main factors influencing hospitalization expenses were hospital internal infection or not,length of stay,payment method and so on（F=990.10,P<0.001）．Conclusions The structure of hospitalization expenses for cerebral infarction patients was significantly optimized,but the economic burden of patients was still heavy affected by a combination of factors．In order to minimize the burden of patients,hospitals should improve medical quality and service efficiency and implement clinical pathway management strictly,to reduce unnecessary inspections and consumables．
目的 探究改良Miccoli手术治疗单侧甲状腺癌（TC）患者的效果及其对机体创伤应激反应的影响。方法 选取新密市中医院200例单侧TC患者（2021年3月—2023年3月）,按随机数字表法分两组。A组100例接受改良Miccoli手术治疗,B组100例接受开放根治术（OT）治疗。对比两组围术期指标、喉返神经损伤发生情况、美学效果、手术前后肿瘤指标[细胞角蛋白19片段抗原（Cyfra21.1）、半乳糖凝集素3（Gal-3）、可溶性白细胞介素-2受体（sIL-2R）]、创伤应激反应指标[去甲肾上腺素（NE）、肾上腺素（E）、皮质醇（Cor）]水平。结果 A组切口长度为（2.05±0.13）cm,短于B组的（7.11±0.49）cm,住院及手术用时分别为（3.12±0.44）d、（53.48±7.52）min,均短于B组的（5.22±0.81）d、（76.81±11.39）min,术中失血量、引流量分别为（19.24±2.66）mL、（21.47±3.41）mL,均少于B组的（45.08±5.75）mL、（64.82±7.24）mL,组间比较差异有统计学意义（P<0.05）;A组喉返神经损伤总发生率为2.00%（2/100）,低于B组的12.00%（12/100）,组间比较差异有统计学意义（P<0.05）;A组美容总满意度为97.00%（97/100）,高于B组的73.00%（73/100）,差异有统计学意义（P<0.05）;A组术后3个月血清Cyfra21.1、Gal-3水平分别为（1.78±0.26）ng/mL、（6.14±1.64）ng/mL,均高于B组的（1.55±0.21）ng/mL、（5.39±1.28）ng/mL,血清sIL-2R水平为（375.36±20.12）μg/mL,低于B组的（427.13±23.18）μg/mL,组间比较差异有统计学意义（P<0.05）;A组术后1 d血清NE、E、Cor水平分别为（0.73±0.17）mmol/L、（0.49±0.10）mmol/L、（185.46±22.95）μg/L,均低于B组的（0.96±0.19）mmol/L、（0.81±0.22）mmol/L、（272.53±32.41）μg/L,组间比较差异有统计学意义（P<0.05）。结论 相较于OT治疗单侧TC患者,经改良Miccoli手术治疗更有助于提升美学效果,减少喉返神经损伤,优化围术期指标,抑制肿瘤进展,且机体产生的创伤应激反应更轻微。
Objective To investigate the effect of modified Miccoli surgery on patients with unilateral thyroid cancer（TC）and its impact on the body’s traumatic stress response．Methods The data of 200 patients with unilateral TC in Xinmi City Hospital of Traditional Chinese Medicine from March 2021 to March 2023 were retrospectively collected and divided into two groups according to different surgical protocols．A hundred patients treated with modified Miccoli surgery were classified as group A and 100 patients treated with open radical surgery（OT）were classified as group B．The perioperative indicators,incidence of recurrent laryngeal nerve injury,aesthetic effect,as well as tumor indicators [cytokeratin 19 fragment antigen（Cyfra21.1）,galectin-3（Gal-3）,soluble interleukin -2 receptor（sIL-2R）] and trauma stress response indicators [norepinephrine（NE）,epinephrine（E）,and cortisol（Cor）] before and after surgery were compared between the two groups．Results The incision length of group A was（2.05±0.13）cm,which was shorter than that of group B [（7.11±0.49）cm]．The duration of hospitalization and operation of group A were（3.12±0.44）d and（53.48±7.52）min,respectively,which were shorter than those of group B [（5.22±0.81）d and（76.81±11.39）min]．The intraoperative blood loss and drainage volume were（19.24±2.66）mL and（21.47±3.41）mL,respectively,which were lower than those in group B [（45.08±5.75）mL and（64.82±7.24）mL],and the difference was statistically significant（P<0.05）．The total incidence of recurrent laryngeal nerve injury in group A was 2.00%（2/100）,lower than that in group B [12.00%（12/100）],and the difference was statistically significant（P<0.05）．The total satisfaction of group A was 97.00%（97/100）,higher than that of group B [73.00%（73/100）],and the difference was statistically significant（P<0.05）．Serum Cyfra21.1 and Gal-3 levels in group A were（1.78±0.26）ng/mL and（6.14±1.64）ng/mL,respectively,higher than those in group B [（1.55±0.21）ng/mL and（5.39±1.28）ng/mL]．Serum sIL-2R level was（375.36±20.12）μg/mL,lower than that of group B [（427.13±23.18）μg/mL],and the difference was statistically significant（P<0.05）．The serum levels of NE,E and Cor in group A were（0.73±0.17）mmol/L,（0.49±0.10）mmol/L and（185.46±22.95）μg/L,respectively．They were lower than（0.96±0.19）mmol/L,（0.81±0.22）mmol/L and（272.53±32.41）μg/L in group B,and the differences were statistically significant（P<0.05）．Conclusions Compared to OT treatment for unilateral TC patients,the modified Miccoli surgery is more helpful in improving aesthetic effects,reducing damage to the recurrent laryngeal nerve,optimizing perioperative indicators,inhibiting tumor progression,and producing less traumatic stress response to the body．
