新生儿期的免疫系统发育阶段对维持新生儿健康至关重要,具有独特的免疫调节机制。近年来,人们越来越关注髓源性抑制细胞（MDSCs）在新生儿免疫调节中的作用。MDSCs是一类免疫抑制功能强大的异质性细胞群体,它们能够通过多种机制调节免疫应答。MDSCs在新生儿中的调节作用对防止过度免疫反应和促进免疫耐受至关重要,有助于预防新生儿期炎症性疾病,并对其后续健康产生积极影响。近期研究文献分析展示了MDSCs在新生儿免疫调节中的多种作用机制,包括在特定病理条件下的保护作用、与新生儿期炎症反应的相互作用,以及对长期免疫发展的潜在影响。因此,深入理解MDSCs在新生儿免疫中的角色,不仅有助于揭示其复杂的调节机制,也为制定新的预防和治疗新生儿炎症性疾病的策略提供了新的思路。

The developmental stage of the immune system during the neonatal period is crucial for maintaining neonatal health,characterized by unique immunoregulatory mechanisms．In recent years,increasing attention has been drawn to the role of myeloid-derived suppressor cells（MDSCs）in neonatal immune regulation．MDSCs represents a heterogeneous population of cells with potent immunosuppressive functions,capable of modulating immune responses through various mechanisms．The regulatory role of MDSCs in neonates is vital for preventing excessive immune reactions and promoting immune tolerance,thereby aiding in the prevention of neonatal inflammatory diseases and positively influencing subsequent health outcomes．Analysis of recent research literature reveals multiple mechanisms through which MDSCs contribute to neonatal immune regulation,including protective effects under specific pathological conditions,interactions with neonatal inflammatory responses,and potential impacts on long-term immune development．Therefore,a comprehensive understanding of the role of MDSCs in neonatal immunity not only helps elucidate their intricate regulatory mechanisms but also provides novel insights for developing strategies for the prevention and treatment of neonatal inflammatory diseases．

目的 分析以信息-动机-行为技巧（IMB）模型为基础延续护理平台在帕金森病患者中的应用效果。方法 纳入河南省人民医院在2019年1月至2022年1月期收治的帕金森病患者96例进行研究,将其依据随机数表法分为对照组和观察组,均为48例,对照组均给予常规护理干预,观察组均给予以IMB模型为基础延续护理平台干预。比较两组主要照顾者干预前24 h（T0）和完成干预24 h（T1）内的心理状态评分、自我效能、希望水平、运动能力、肌张力、认知功能,并评估T1时刻的Barthel指数。结果 观察组患者T1时的汉密尔顿焦虑量表（HAMA）（16.64±2.57）分、汉密尔顿抑郁量表（HAMD）（16.38±1.69）分均低于对照组（20.65±1.68）（19.57±2.65）分（t=10.116、5.407,P<0.001）,观察组患者T1时的自我效能（7.24±1.48）分、希望水平（44.51±4.07分）均高于对照组（6.02±1.74）（38.95±4.54）分（t=3.357、3.311,P<0.001）,观察组患者T1时的运动能力评分（43.62±4.01）分高于对照组（39.17±5.25）分（t=4.715,P<0.001）,肌张力评分（0.72±0.21）分低于对照组（1.13±0.52）分（t=5.118,P<0.001）,观察组患者T1时刻的Barthel指数评估依靠帮助完成率（6.25%）、部分完成率（10.42%）低于对照组（25.00%）、（27.08%）（χ²=6.353、5.263,P<0.05）,观察组患者T1时刻的命名能力（3.46±0.51）、延迟回忆（3.78±0.21）分、语言能力（3.29±0.48）分、注意力评分（3.95±0.10）分均高于对照组（2.91±0.98 ）（3.21±0.96）（2.87±0.82）（3.76±0.05）分（t=3.698、3.675、3.846、4.305,P<0.001）。结论 以IMB模型为基础延续护理平台干预能够改善帕金森病患者的负性情绪,提升自我效能、希望水平,改善运动能力、肌张力、日常生活能力、认知水平。

Objective To analyze the application effect of the information motivation behavioral skills（IMB）model as a continuous care platform in Parkinson's patients. Methods A study was conducted on 96 Parkinson's patients enrolled in our hospital from January 2019 to January 2022．They were divided into a control group and an observation group based on a random number table method,with 48 patients in each group．The control group received routine nursing intervention,while the observation group received continuous nursing platform intervention based on the IMB model．The psychological state scores,self-efficacy,hope level,motor ability,muscle tone,cognitive function of the two main caregivers 24 hours before intervention（T0）and 24 hours after completion of intervention（T1）,and evaluate the Barthel index at T1 time were compared. Results The Hamilton Anxiety Scale（HAMA）[（16.64±2.57）points] and Hamilton Depression Scale（HAMD）[（16.38±1.69 points）scores] of patients in the observation group at T1 were lower than those in the control group [（20.65±1.68）points,（19.57±2.65）points]（t=10.116,5.407,P<0.001）．The self-efficacy of patients in the observation group at T1 was（7.24±1.48）points．The hope level [（44.51±4.07）points] was higher than that of the control group [（6.02±1.74）points,（38.95±4.54）points]（t=3.357,3.311,P<0.001）．The motor ability score at T1 time in the observation group [（43.62±4.01）points] was higher than that in the control group [（39.17±5.25）points]（t=4.715,P<0.001）,and the muscle tone score [（0.72±0.21）points] was lower than that in the control group [（1.13±0.52）points]（t=5.118,P<0.001）．The Barthel index evaluation of patients in the observation group at T1 time relied on help completion rate（6.25%）and partial completion rate（10.42%）,which were lower than those in the control group（25.00%）and（27.08%）（χ²=6.353,5.263,P=0.012,0.022）．The naming ability [（3.46±0.51）points],delayed recall [（3.78±0.21）points],language ability [（3.29±0.48）points],attention scores [（3.95±0.10）points] were higher than the control group [（2.91±0.98）points,（3.21±0.96）points,（2.87±0.82）points,（3.76±0.05）points]（t=3.698,3.675,3.846,4.305,P=<0.001,<0.001,<0.001）. Conclusions Continuing nursing platform intervention based on the IMB model can improve the negative emotions,self-efficacy,hope level,motor ability,muscle tone,daily living ability,and cognitive level of Parkinson's patients．

目的 评价早产儿经胃管喂养后采用空气冲管的应用效果。方法 选择2021年1月–2021年12月广州市第一人民医院收治的经胃管喂养后采用温水冲管的60例早产儿为对照组,选择2022年1月–2022年12月收治的经胃管喂养后采用空气冲管的57例早产儿为研究组。喂养1周后,比较两组患儿体质量增加量、血清白蛋白浓度增加量、大便量、喂养不耐受发生率、胃管堵塞率等指标的差异。结果 无患儿发生胃管堵塞。研究组的血清白蛋白浓度增加量[（2.86±5.61）g/L]高于对照组[（0.84±5.27）g/L]（P<0.05）,而两组患儿在体质量增加量、大便量、喂养不耐受发生率等方面比较差异无统计学意义（P>0.05）。多元线性回归分析结果显示空气冲管为血清白蛋白浓度增加量的影响因素（P<0.05）。结论 采用空气进行胃管冲管的方法可改善早产儿的营养状态。

Objective To evaluate the effects of flushing gastric tube by air after feeding in premature infants．Methods A total of 60 premature infants admitted to Guangzhou First People's Hospital from January 2021 to December 2021 whose gastric tube were flushed with water after feeding were selected as the control group,while 57 admitted from January 2022 to December 2022 whose gastric tube were flushed with air after feeding were selected as the study group．After 1 week of feeding,the differences of weight increase,serum albumin concentration increase,stool volume,feeding intolerance incidence and gastric tube blockage rate were compared between the 2 groups．Results No gastric tube blockage occurred．The increase of serum albumin concentration in the study group[（2.86±5.61）g/L] was significantly higher than that in the control group[（0.84±5.27）g/L]（P<0.05）,but there were no significant differences in weight increase,stool volume and feeding intolerance incidence between the 2 groups．Multiple linear regression analysis showed that the flushing gastric tube with air was an independent influencing factor for the increase of serum albumin（P<0.05）．Conclusions Flushing gastric tube with air can improve the nutritional status of premature infants,which is worthy of clinical application．

目的 分析单核细胞-淋巴细胞比率（MLR）联合游离三碘甲腺原氨酸（FT₃）对乙型肝炎病毒（HBV）相关慢加急性肝衰竭（ACLF）患者生存状况的预测效果。方法 纳入我院在2019年1月—2022年1月期间收治的HBV-ACLF患者共187例进行研究,随访患者90 d的生存状况,其中69例死亡患者设为死亡组,其余118存活患者设为存活组。对2组患者的各项资料进行单因素分析,对差异有统计学意义的因素行Logistic多因素分析,分析HBV-ACLF患者死亡的危险因素,并分析MLR联合FT3对HBV-ACLF死亡的预测效果。结果 死亡组患者的年龄、肝硬化发生率、原发性腹膜炎发生率、肝肾综合征发生率、电解质紊乱发生率、终末期肝病模型、MLR、中性粒细胞与淋巴细胞计数比值、国际标准化比值、肌酐、白细胞计数、总胆红素水平均高于B组,血钠、FT₃、总血清胆固醇水平均低于存活组,差异有统计学意义（P<0.05）。MLR≥0.60、FT₃≤2.50 pmol/L均为HBV-ACLF患者死亡的危险因素（P<0.05）。MLR、FT₃、MLR+FT₃对HBV-ACLF患者死亡均有一定的预测价值,但MLR+FT3的预测价值高于其他单项预测。结论 MLR≥0.60、FT₃≤2.50 pmol/L均为HBV-ACLF患者死亡的危险因素（P<0.05）,且二者联合应用对HBV-ACLF患者死亡有较佳的预测价值。

Objective To analyze the predictive effect of mononuclear-lymphocyte ratio（MLR）combined with free triiodothyronine（FT₃）on the survival of patients with hepatitis B virus-related acute-on-chronic liver failure（HBV-ACLF）．Methods In the study,187 patients with HBV-ACLF from January 2019 to January 2022 in our hospital were included,and the survival status of the patients was followed up for 90 days．Among them,69 patients were included in the death group and the rest 118 patients were included in the survival group．The data of the two groups of patients were analyzed by univariate analysis,and the statistically significant factors were analyzed by Logistic multifactor analysis．The risk factors of death in patients with HBV-ACLF were analyzed,and the predictive effect of MLR combined with FT₃ on the death of HBV-ACLF was analyzed．Results The age,incidence of cirrhosis,primary peritonitis,hepatorenal syndrome,electrolyte disturbance,ratio of neutrophil to lymphocyte count,international standardized ratio,model for end stage liver disease,MLR,creatinine,white blood cell count and total bilirubin of the patients in the death group were higher than those in survival group,and the levels of serum sodium,FT₃ and total cholesterol were lower than those in survival group,the differences were significant（P<0.05）．The results showed that MLR≥0.60,FT₃≤2.50 pmol/L were risk factors for death of HBV-ACLF patients（P<0.05）．MLR,FT₃,MLR+FT₃ had certain predictive value for the death of HBV-ACLF patients,but the predictive value of MLR+FT₃ was higher than other single prediction．Conclusions MLR≥0.60 and FT₃≤2.50 pmol/L are risk factors for death of patients with HBV-ACLF（P<0.05）,and the combination of the two has a better predictive value for death of patients with HBV-ACLF．

目的 观察低出生体重早产儿应用抗生素后肠道菌群的动态变化。方法 选取2018年6月—2019年7月在广州市第一人民医院住院的10名低出生体重早产儿,在出生时、出生后1~2周、出生后2~3周、出生后3~4周、出生后4~5周、出生后5~6周时分别收集粪便样本,通过16s高通量测序检测患儿粪便菌群变化并统计分析。结果 应用抗生素后的低出生体重早产儿肠道菌群α多样性(Shannon指数、Simpson指数、ACE指数和PD_whole_tree指数)下降(P均<0.05),肠道菌群结构在门、科、属水平均发生改变,其中Alistipes、Bacteroides、Lactobacillus、unidentified_Lachnospiraceae、unidentified_Ruminococcaceae、Alloprevotella、unidentified_Cyanobacteria、Bacillus、Stenotrophomonas和Acinetobacter菌属相对丰度减少(P均<0.05)。结论 低出生体重早产儿应用抗生素后肠道菌群多样性下降,肠道菌群结构发生改变,并在抗生素停用后仍持续,针对性补充益生菌或益生元可能有助于肠道菌群恢复稳态。

Objective To observe the dynamic changes of gut microbiota in premature infants with low birth weight after antibiotics therapy. Methods 10 low birth weight premature infants hospitalized in Guangzhou First People's Hospital from June 2018 to July 2019 were included. Fecal samples were collected at birth, 1~2 weeks after birth, 2~3 weeks after birth, 3~4 weeks after birth, 4~5 weeks after birth and 5~6 weeks after birth, respectively. The changes of fecal microbiota were detected and analyzed by 16s high-throughput sequencing. Results The α-diversity of gut microbiota (Shannon index, Simpson index, ACE index and PD_whole_tree index) in low birth weight preterm infants treated with antibiotics decreased (P<0.05). The structure of gut microbiota changed at phylum, family and genus levels, among which Alistipes, Bacteroides, Lactobacillus, unidentified_Lachnospiraceae, unidentified_Ruminococcaceae, Alloprevotella, unidentified_Cyanobacteria, Bacillus, Stenotrophomonas and Acinetobacter decreased (P<0.05). Conclusion The diversity of gut microbiota in low birth weight preterm infants decreased and the structure of gut microbiota changed after antibiotic therapy. Targeted supplementation of probiotics or prebiotics may contribute to the recovery of gut microbial homeostasis.

目的 分析平板运动试验阳性患者行冠脉造影检查后结果阳性者与冠心病的高危因素的关联性,从而预警冠心病。方法 选取浙江大学医学院附属第二医院2016年3月—2019年3月行平板运动试验的阳性患者经冠脉造影结果为阳性,且资料完整者280例患者为研究对象,筛选出影响冠心病的独立危险因素。结果 性别、体质量指数(BMI)、高甘油三酯、平板恢复1、2 min心率是影响冠心病的独立危险因素。结论 对于男性、BMI>24、高甘油三酯、平板恢复1、2 min心率异常的患者,当其平板运动试验为阳性时,应建议其进一步行冠脉造影检查。

Objective To analyze the correlation between coronary angiography and the risk factors of coronary heart disease in patients with positive treadmill exercise test, so as to give early warning of coronary heart disease. Methods A total of 280 patients who underwent treadmill exercise tests from March 2016 to March 2019 in the Second Affiliated Hospital of Medical College of Zhejiang University were selected as the study subjects with positive coronary angiography results and complete data to screen out independent risk factors for coronary heart disease. Results Gender, body mass index, high triglycerides, high cholesterol, heart rate after 1 or 2 minutes of tablet recovery were the risk factors for positive coronary angiography. Conclusion For men, patients with BMI>24, high triglycerides, and abnormal heart rate after 1 or 2 minutes of tablet recovery, when the treadmill exercise test is positive, further coronary angiography should be recommended.

目的 检测外周血循环肿瘤细胞(circulating tumor cell, CTC)在原发性肝癌患者中的表达情况,并探讨CTC动态变化及其相对于甲胎蛋白(Alpha fetoprotein AFP)对原发性癌患者术后复发转移的预测作用。方法 收集原发性肝癌患者134例,肝脏良性病变患者72例,检测外周血 CTC 数目,同时检测AFP的表达水平,分析 CTC 与 AFP 的相关性。然后在134名原发性肝癌患者中筛选出成功行肝癌根治术的患者,共86例,检测这86名患者术前、术后外周血CTC和AFP,分析CTC和AFP对原发性肝癌术后复发转移的评估价值。结果 原发性肝癌患者外周血CTC阳性率高于肝脏良性病变患者,差异有统计学意义(P＜0.05);原发性肝癌患者CTC水平与AFP水平、淋巴结转移、肿瘤结节多少有关,与年龄、性别、肿瘤直径、分化程度、肝硬化有无、TNM分期无关;原发性肝癌患者CTC和AFP生存分析显示,原发性肝癌根治术后早期复发转移与CTC和AFP密切相关;CTC较阳性对术后复发转移具有更好的诊断价值,二者联合对复发转移预测价值最高。结论 CTC可以做为一个比传统肿瘤标志物更好的对原发性肝癌术后复发转移进行监测的指标,与肿瘤标志物联合检测预测价值更高。

Objective To detect the expression of peripheral blood circulating tumor cells CTC in patients with primary liver cancer and to explore the dynamic changes of CTC and its predictive effect on postoperative recurrence and metastasis of primary cancer. Methods The number of CTC in peripheral blood was measured in 134 patients with primary liver cancer and 72 patients with benign liver disease, the expression of AFP was detected, and the correlation between CTC and AFP was analyzed. Then 86 patients with primary liver cancer were selected from 134 patients with primary liver cancer who underwent radical hepatectomy. The values of CTC and AFP in evaluating recurrence and metastasis of primary liver cancer before and after operation were analyzed by CTC and AFP, in peripheral blood of these 86 patients. Results The positive rates of CTC in peripheral blood of patients with primary liver cancer were higher than that of patients with benign liver disease(P< 0.05). The levels of CTC in patients with primary liver cancer were related to AFP level, lymph node metastasis and the number of tumor nodules, but not to age, sex, tumor diameter, differentiation degree, liver cirrhosis and TNM stage. The survival analysis of CTC and AFP in patients with primary liver cancer showed that the early recurrence and metastasis of primary liver cancer after radical resection were closely related to the positive rate of CTC and AFP, and the positive rate of CTC was more effective than that of AFP positive in the diagnosis of recurrence and metastasis after operation, and the combination of the two had the highest predictive value for recurrence and metastasis. Conclusion CTC may be used as a better index to monitor postoperative recurrence and metastasis of primary liver cancer than traditional tumor markers. The combined detection prediction value of tumor markers is higher.

目的 评价SAMe-TT₂R₂评分对非瓣膜性房颤使用华法林的患者中的抗凝疗效的评估作用,探讨SAMe-TT₂R₂评分与缺血性卒中事件、出血事件的相关性。方法 以石河子大学医学院第一附属医院2018年1月—2019年1月住院治疗,确诊为非瓣膜性房颤并口服华法林抗凝的患者作为观察对象,进行为期10月的随访。通过患者的国际标准化比值(INR),计算患者的抗凝治疗范围内时间百分比(Time in Therapeutic Range, TTR),并对所有患者进行SAMe-TT₂R₂评分。运用χ²检验、Spearman秩相关、ROC曲线分析评估SAMe-TT₂R₂评分对患者抗凝疗效的预测能力。随访期内收集缺血性卒中和出血事件的发生情况,分析上述事件与SAMe-TT₂R₂评分的相关性。结果 190例患者平均TTR为(46.76±21.99)％,SAMe-TT₂R₂分数与患者的TTR呈负相关(P=0.001),ROC曲线下面积为0.661,P=0.001,约登指数0.203对应的临界值取整数为4分,敏感度和特异度分别为72.6％和47.7％,提示SAMe-TT₂R₂对预测TTR<65％有一定的价值。随访期间共有5例患者发生缺血性卒中事件,25例患者发生不同程度出血事件,11例患者发生全因死亡事件,上述事件在各个SAMe-TT₂R₂分值的发生分布差异无统计学意义(P＞0.05)。结论 在非瓣膜性房颤并使用华法林抗凝治疗的患者中,SAMe-TT₂R₂评分对使用华法林抗凝治疗患者的抗凝有效性具有一定的预测能力,可将SAMe-TT₂R₂评分作为预测华法林抗凝疗效的预测的指标。

Objective To evaluate the anticoagulant effect of SAMe-TT₂R₂ in patients with non-valvular atrial fibrillation treated with warfarin, and to explore the correlation between SAMe-TT₂R₂ and ischemic stroke events and bleeding events. Methods Patients who were diagnosed as non-valvular atrial fibrillation and with oral warfarin were enrolled in the First Affiliated Hospital of Shihezi University School of Medical College in January 2018-January 2019, and for 10 months of follow-up. Collecting patients' International normalization ratio(INR), calculating the Time in therapeutic range(TTR), and the SAMe-TT2 R2 score. And χ² test, Spearman rank correlation and ROC curve analysis were used to evaluate the predictive ability of SAMe-TT2 R2 score on anticoagulant efficacy in patients. Follow-up was conducted to investigate the incidence of ischemic stroke or hemorrhagic events and explore the relationship with the SAMe-TT2 R2 score. Results The mean TTR of 190 patients was 46.76%±21.99%, and the score of SAMe-TT_{2 R2} was negatively correlated with the TTR of the patients(P=0.001), the area under the ROC curve was 0.661, P=0.001, The critical value corresponding was 4 points, and the sensitivity and specificity were 72.6% and 47.7%, respectively suggesting that SAMe-TT₂R₂ had certain value in predicting TTR< 65%. During follow-up, a total of 5 patients had ischemic stroke, 25 patients had different degrees of bleeding, and 11 patients had all-cause death, different SAMe-TT₂R₂ scores showed no statistical significance(P>0.05). Conclusion In patients with non-valvular atrial fibrillation treated with warfarin anticoagulant, the SAMe-TT₂R₂ score has a certain predictive ability for the anticoagulant efficacy of patients treated with warfarin anticoagulant, and the SAMe-TT₂R₂ score could be used as an indicator for predicting the anticoagulant efficacy of warfarin.

目的 探讨Stanford B型胸主动脉夹层腔内修复(TEVAR)术后不同类型内漏的产生机制及处理措施。方法 收集整理2008年9月—2017年2月间在我院诊断为Stanford B型胸主动脉夹层并接受TEVAR术治疗的105例患者的临床及影像资料,分析术中及术后出现内漏的原因,根据内漏来源及渗漏量给予不同处理,观察处理后内漏的变化情况。结果 术中出现急性内漏11例,包括Ⅰ型内漏8例(7.6%)和Ⅱ型内漏3例(2.8%);迟发内漏3例,包括Ⅰ型内漏1例(1.0%)和Ⅱ型内漏2例(1.9%),内漏总发生率为13.3%。术后患者未出现支架移位、截瘫、肾动脉缺血等严重并发症。结论 根据内漏产生的原因不同,内漏分为5型,其中Ⅰ型及Ⅱ型内漏较为常见,不同类型内漏处理方式不同,正确判断内漏类型是合理、有效处理内漏的前提。

Objective To investigate the causes of different types of endoleak after thoracic endovascular aortic repair(TEVAR)for Stanford type B aortic dissection, and to discuss its management. Methods The clinical data and imaging data of 105 patients with Stanford type B aortic dissection, who were admitted to authors' hospital during the period from September 2008 to February 2017 to receive TEVAR, were collected and reviewed. Reasons of intraoperative endoleak or after operation were analyzed, different treatments for the source of endoleak and leakage were taken and the conversions followed were observed. Results Acute endoleak was occurred in 11 patients during operation, including endoleak typeⅠ (n=8,7.6%)and endoleak type Ⅱ (n=3,2.8%). Delayed endoleak was seen in 3 patients, including endoleak typeⅠ (n=1,1.0%)and endoleak type Ⅱ (n=2,1.9%). Both in-operative and postoperative endoleak occurred in 14 patients (13.3%). After TEVAR, no serious complications such as displacement of stent, paraplegia or renal artery ischemia occurred. Conclusion According to the different reasons, endoleak can be divided into five types, among them, type Ⅰ and type Ⅱ are most common. Different endoleak should be handle in different ways.Correct judgment of endoleak type is the premise of reasonable and effective treatment for endoleak.

目的 了解老年冠脉支架植入患者的临床特征及治疗疗效。方法 按照纳入、排除标准入选2015年10月—2017年10月于我院住院并接受冠状动脉支架治疗的患者372例,分为女性组和男性组,收集临床资料并随访预后。结果 女性组157例,男性组215例,2组冠脉病变支数、发生心血管不良事件比例无统计学意义(P>0.05),女性组不稳定性心绞痛、合并糖尿病、高血压比例及胆固醇、甘油三酯、低密度脂蛋白、脂蛋白a、TSH水平均高于男性组(P<0.05),急性心肌梗死、吸烟比例及年龄、血肌酐均低于男性组(P<0.05)。结论 老年患者合并可控制的危险因素较多,女性要强调血糖、血脂的控制,男性要强调戒烟。冠脉病变支数、术后1年发生不良心血管事件比例无性别差异。