目的 探究维持性血液透析（MHD）患者的病耻感现状,并对其影响因素进行分析。方法 根据便利抽样法,选取2020年2月—2022月10月在河南省郑州市第三人民医院血液净化中心进行MHD治疗的236例患者作为研究对象,并采用一般资料调查问卷、领悟社会支持量表（PSSS）以及社会影响量表（SIS）进行调查。根据SIS得分情况进行分组,采用Logistic回归分析行MHD患者病耻感的影响因素。结果 MHD患者病耻感得分为（65.03±10.68）分,其中病程较短、社会支持度低、家庭平均收入低、文化水平较低以及未参加肾友会的患者病耻感得分较高,病程较长、家庭平均收入高、社会支持度高、参加肾友会以及文化水平较高者病耻感得分较低（P<0.05）。多因素Logistic回归分析结果显示,患者文化水平、家庭平均收入、是否参加肾友会、病程以及社会支持情况是患者病耻感的影响因素（P<0.05）。结论 MHD患者病耻感得分处于中高等水平。指导患者正确认识疾病,多关注家庭收入较低患者,鼓励患者积极参与肾友会,为患者提供良好的社会支持,均有助于降低其病耻感程度。

Objective To explore the current status of shame in maintenance hemodialysis（MHD）patients and analyze its influencing factors．Methods Based on the convenience sampling method,236 patients who underwent MHD treatment at the Blood Purification Center of the Third People’s Hospital of Zhengzhou City,Henan Province from February 2020 to October 2022 were selected as the research subjects．A general information survey questionnaire,Perceived Social Support Scale（PSSS）,and Social Impact Scale（SIS）were used for the survey．Grouping based on SIS scores,logistic regression analysis was used to analyze the influencing factors of shame in MHD patients．Results MHD patients had a shame score of（65.03±10.68）,among which patients with shorter disease course,lower social support,lower average family income,lower education level,and those who did not participate in kidney friend associations had higher shame scores．Patients with longer disease course,higher average family income,higher social support,participation in kidney self-help group,and higher education level had lower shame scores（P<0.05）．The results of multivariate logistic regression analysis showed that the patient’s educational level,average family income,participation in a kidney self-help group,course of illness,and social support were the influencing factors for the patient’s sense of shame（P<0.05）．Conclusions The shame score of MHD patients is at a moderate high level．Guiding patients to have a correct understanding of the disease,paying more attention to patients with lower family income,encouraging them to actively participate in kidney self-help group,and providing good social support to patients can all help reduce their sense of shame．

肿瘤相关巨噬细胞（TAMs）是肿瘤微环境中最丰富的免疫细胞之一,M2-TAMs在肿瘤发生、发展、转移和治疗过程中发挥重要作用,被认为是肿瘤治疗中的重要靶点。已有的研究表明,通过将促肿瘤的M2-TAMs重编程为促炎的M1-TAMs可实现抑制肿瘤生长和转移。本综述在介绍TAMs与肿瘤治疗相关背景的基础上,重点关注纳米药物重编程TAMs增强抗肿瘤的研究进展。本文将从TAMs靶向递送各种活性物质进行重编程TAMs和纳米药物介导的异常肿瘤微环境调节的间接重编程TAMs两种方式,综述近年来基于纳米药物递送系统的调控策略及典型例子。

Tumor associated macrophages（TAMs）is one of the most abundant immune cells in the tumor microenvironment．M2-TAMs play an important role in tumor genesis,progression,metastasis and treatment,and is additionally a very important target in tumor therapy．Previous studies have shown that inhibition of tumor growth and metastasis can be achieved by reprogramming M2-TAMs to M1-TAMs．On the basis,this review focuses on the analysis progress of nano-drug reprogramming TAMs to boost anti-tumor．In this paper,we reviewed two methods of reprogramming TAMs for targeted delivery of various active substances and indirect reprogramming TAMs for abnormal tumor microenvironment regulation mediated by nanomedicine．The regulatory strategies and typical samples of nanomedicine delivery systems in recent years were summarized.

目的 探究精神分裂症患者应用帕利哌酮后剂量校正浓度（C/D）的影响因素,旨在为精神分裂症患者的临床用药提供参考。方法 选择2021年9月–2022年5月在我院择期接受帕利哌酮治疗的122例精神分裂症患者作为研究对象,收集患者的年龄、性别、给药剂量、给药频次以及合并用药等状况。结果 不同性别间帕利哌酮C/D存在差异,其中女性的C/D明显比男性的C/D更高。在关于年龄、性别、给药剂量、给药频次以及合并用药对帕利哌酮C/D的影响分析中,合并用药阿立哌唑、性别对帕利哌酮C/D有影响。结论 帕利哌酮应用在精神分裂症患者治疗中,性别、合并应用阿立哌唑会对帕利哌酮C/D产生显著影响。

Objective To explore the influencing factors of dose-corrected through concentration（C / D）of paliperidone in patients with schizophrenia,in order to provide reference for clinical medication of patients with schizophrenia．Methods A total of 122 patients with schizophrenia treated with paliperidone in our hospital from September 2021 to May 2022 were selected as the research objects．The patient's age,gender,dosage,frequency of administration and combined medication were collected．Results There were differences in the C / D of paliperidone between different genders,and the C / D of women was significantly higher than that of men．In the analysis of the effects of age,gender,dosage,frequency of administration and combined medication on the C / D of paliperidone,the combined medication of aripiprazole and gender had effect on the C / D．Conclusions The application of paliperidone in the treatment of patients with schizophrenia,gender and combined application of aripiprazole can have significant impact on C / D．

目的 分析CT肺动脉栓塞指数(PAOI)与急性肺栓塞(APE)患者右心功能与预后的相关性。方法 以收治的86例疑似患者为研究对象,均行CT肺动脉成像(CTPA)检查,共60例APE患者,依据患者病情严重程度分为轻度、中度与重度,而无APE患者26例(对照组),分析左右心室最大短轴内径(RVd/LVd)、左右心室最大截面积比(RVA/LVA)、右心室短轴最大直径(RVMSA)、左心室短轴最大内径(LVMSA)、主肺动脉直径(MPAd)、上腔静脉直径(SVCd)、奇静脉直径(AZd)、动脉血氧分压(PaO₂)、动脉血二氧化碳分压(PaCO₂)以及动脉血氧饱和度(SaO₂)与PAOI的相关性,并分析患者预后情况。结果 经比较,中、重度患者RVd/LVd、RVA/LVA、RVMSA、MPAd与AZd水平高于轻度患者,而LVMSA低于轻度患者(P<0.05);且重度患者RVd/LVd、RVMSA水平高于中度,而RVA/LVA、LVMSA、MPAd与AZd水平比较无意义(P>0.05);3组SVCd水平比较P>0.05,其他参数指标比较差异明显(P<0.05);APE患者的PaO₂、PaCO₂以及SaO₂水平随着患者病情的加重呈现出逐渐下降趋势,且3组患者的PaO₂对比差异有统计学意义(P<0.05);PaO₂、PaCO₂和SaO₂与PAOI均呈负相关,且仅有PaO₂的差异存在统计学意义(P<0.05);POAI对APE患者的死亡有着一定的预测价值(P<0.05),最佳切点值58.91%,敏感度为85.29%,特异度为89.93%,其他数据未见明显诊断预测价值(P>0.05)。故RVd/LVd、RVA/LVA、RVMSA、MPAd与AZd水平与PAOI成正相关,而LVMSA水平与PAOI成负相关,与SCVd无关。结论 PAOI与APE患者的右心功能各参数以及动脉血气各参数均有密切关联性,可将其作为患者预后评估的有效指标。

目的 探讨复方丹参滴丸联合阿托伐他汀治疗对伴有颈动脉粥样硬化短暂性脑缺血发作患者脑循环动力的影响。方法 将2017年12月—2018年12我院收治入院的98例伴有颈动脉粥样硬化短暂性脑缺血发作患者为研究对象,随机分为观察组(49例,给予复方丹参滴丸联合阿托伐他汀治疗)和对照组(49例,给予阿托伐他汀治疗)。观察对比治疗前及治疗后2组患者每日短暂性脑缺血发作频率及持续时间,血脂水平、血流变指标、粥样硬化斑块及斑块面积。结果 治疗前,两组患者每日短暂性脑缺血发作频率、持续时间、各项血脂水平、脑循环动力学指标IMT 及斑块面积相比,差异无统计学意义(P>0.05);治疗后,2组患者每日短暂性脑缺血发作频率、持续时间、各项血脂水平、脑循环动力学指标IMT 及斑块面积相比均有所改善,其中观察组患者每日短暂性脑缺血发作频率、持续时间、各项血脂水平、脑循环动力学指标IMT 及斑块面积相比优于对照组,差异有统计学意义(P<0.05)。结论 在伴有颈动脉粥样硬化短暂性脑缺血发作患者中采用复方丹参滴丸联合阿托伐他汀治疗效果确切,可有效降低伴有颈动脉粥样硬化的短暂性脑缺血发作患者发作频率及持续时间,同时可有效调节患者血脂水平,改善对脑循环动力学指标,值得临床推广普及。

Objective To investigate the effect of compound Danshen dripping pills combined with atorvastatin on cerebral circulation dynamics in patients with transient ischemic attack accompanied by carotid atherosclerosis. Methods A total of 98 patients with transient ischemic attack with carotid atherosclerosis admitted to our hospital from December 2017 to December 2018 were randomly divided into observation group (49 cases, receiving compound danshen drop pill combined with atorvastatin) and control group (49 cases, receiving atorvastatin), to observe and compare the frequency and duration of transient ischemic attack, blood lipid level, hemorheological indexes, atherosclerotic plaque and plaque area of the two groups before and after treatment. Results Before treatment, there was no significant difference in frequency, duration, blood lipid levels, IMT and plaque area between the two groups (P>0.05). After treatment, 2 groups of patients with transient ischemic attack daily frequency, duration, the lipid levels and cerebral circulation dynamics index IMT and plaque area were improved. Compared with observation group of patients with transient ischemic attack daily frequency, duration, the lipid levels and cerebral circulation dynamics index IMT and plaque area were better than control group, the differences were statistical significance (P<0.05). Conclusion Patients in associated with carotid atherosclerosis with transient ischemic attack using compound danshen dropping pill with atorvastatin therapy have good effects. This may effectively reduce frequency and duration in patients with transient ischemic attack associated with carotid atherosclerosis, regulate blood lipid levels at the same time, and improve the dynamics of cerebral circulation index. It is worthy of clinical popularization.

目的 分析社区综合干预对小儿反复呼吸道感染的影响,为社区临床治疗小儿反复呼吸道感染性疾病提供理论依据。方法 采用随机抽签方式,从我社区2012年10月—2014年10月期间收治的小儿反复呼吸道感染患儿中,随机抽取60例纳入本项研究,依据就诊单双顺序,分为研究组30例(社区综合干预方式)和对照组30例(常规性治疗和常规措施进行干预),对两组患儿干预结果进行对比分析。结果 研究组治疗总疗效高于对照组(93.33% vs 76.67%),差异有统计学意义(P<0.05)。对比治疗干预过程中疾病发作次数、就诊次数状况,研究组优于对照组,差异有统计学意义(P<0.05)。干预后研究组小儿呼吸道感染致病因素改善情况(除滥用抗生素外)优于对照组,差异有统计学意义(P<0.05)。结论 针对小儿反复呼吸道感染疾病可采用社区综合干预方式,可显著提升治疗有效率,缓解病情,降低反复感染发生率,效果突出,具有广阔应用前景。

目的 探讨超声引导下经皮肺穿刺活检术在艾滋病周围型肺部病变中的应用价值。方法 我院52例经皮肺穿刺活检的病例,术前均采用高效抗逆转录病毒治疗,依据CD4⁺T淋巴细胞确定是否手术,术中规范手术方式,做好防护措施,27例行超声引导穿刺,25例行CT引导穿刺,术后应用抗生素预防机会性感染等。结果 所有患者穿刺成功率100%,超声组肺结核13例,真菌感染67例,细菌感染4例,肺腺样囊性癌2例、卡波西肉瘤1例。CT组肺结核11例,真菌感染7例,细菌感染5例,肺腺样囊性癌1例。术后并发症:超声组5例病灶少量气胸,2例周围少量出血,咯血4例;CT组8例病灶少量气胸,4例周围少量出血,咯血7例。结论 经过术前控制患者计数及预防感染治疗,超声引导下经皮肺穿刺活检术在艾滋病周围型肺部病变中应用更为安全、有效、可行的,值得临床应用及推广。

Objective Objective to investigate the value of ultrasound-guided percutaneous lung biopsy in the diagnosis of peripheral lung lesions in AIDS patients. Methods 52 cases in our hospital of percutaneous pulmonary biopsy cases, preoperative highly active antiretroviral therapy was used, basis of CD4⁺T lymphocytes count determined whether the operation were performed, standard operation mode in the operation. It must to take good protective measures. 27 cases underwent ultrasound guided puncture, 25 cases underwent CT guided puncture and had postoperative application of antibiotics to prevent opportunistic infections. Results The successful rate of puncture was 100% in all patients. Tuberculosis in the ultrasound group was 13 cases, fungal infection was 67 cases, bacterial infection was 4 cases, pulmonary adenoid cystic carcinoma was 2 cases, and Posey's sarcoma was 1 cases. There were 11 cases of pulmonary tuberculosis in CT group, 7 cases in fungal infection, 5 cases in bacterial infection, and 1 cases in adenoid cystic carcinoma of the lung. Postoperative complications included: 5 cases of small pneumothorax in the ultrasound group, a small amount of bleeding around the surrounding, hemoptysis in 4 cases, CT group of patients with 8 cases of a small amount of pneumothorax in the lesions, 4 cases of a small amount of bleeding around the case, 7 cases of hemoptysis. Conclusion After preoperative control count and prevention of infection in patients with treatment, ultrasound guided percutaneous lung biopsy in peripheral pulmonary lesions of AIDS is more safe and effective, worthy of clinical application and promotion.