晚期癌痛所带来的疼痛症状是持久且严重的，这十分影响患者的生活质量与身心健康，并阻碍肿瘤治疗方案的顺利实施，进而影响患者治疗效果。阿片类药物是治疗中重度癌痛的主要方式，具有明确的镇痛效果，但是，吗啡、芬太尼等具有代表性的传统阿片类药物也存在一定的应用局限性，其主要通过激活μ-阿片受体下游的G蛋白信号通路以发挥镇痛作用，这会在一定程度上激活β-arrestin通路，进而增加呼吸抑制、严重便秘、过度镇静等副作用的发生情况，因此，该类药物不具有临床广泛应用性[1-2]。在此背景下，奥赛利定作为新型阿片类药物应运而生，其可选择性激活G蛋白通路，且不会显著激动β-arrestin通路效应，能够在实现强效镇痛的同时，还可降低由β-arrestin通路激活所介导的不良反应发生率，这十分适合应用在无法耐受传统阿片镇痛药物副作用的患者群体之中[3-4]。基于此，本研究进一步探究奥赛利定注射液治疗晚期癌痛的临床疗效与安全性，如下。

目的：探究阻塞性冠心病患者中舌象纹理特征与冠周脂肪影像组学的相关性。 方法：收集辽宁中医药大学附属医院131例就诊的疑似冠心病患者，其中阻塞性冠心病63例、非阻塞性冠心病68例，提取临床常规指标、舌象纹理特征及右冠状动脉影像组学参数。独立样本t检验、曼-惠特尼U检验、卡方检验、错误发现率校正用于比较组间差异。使用斯皮尔曼相关性分析舌象纹理特征与冠周脂肪影像组学的相关性。采用弹性网络进行特征筛选,按照7：3的比例随机抽样划分为训练集和测试集，使用BP神经网络模型构建冠周脂肪及冠周脂肪与舌象纹理特征联合模型，使用ROC曲线、准确性、精度、召回率、特异度、F1分数、Kappa系数评估模型。 结果：在疑似冠心病患者中，舌象纹理与冠周脂肪影像组学共检出22组弱负相关、1组中等正相关及23组弱正相关；阻塞性冠心病患者中检出4组中等负相关、4组弱负相关、2组中等正相关及6组弱正相关；非阻塞性冠心病患者中检出1组中等负相关、6组弱负相关、1组中等正相关及10组弱正相关。基于BP神经网络构建诊断模型，联合舌象纹理特征后较单一冠周脂肪影像组学模型测试集AUC有所提升。 结论：舌象纹理特征与冠周脂肪影像组学参数在阻塞性冠心病中存在一定的相关性；舌象纹理信息对冠周脂肪诊断阻塞性冠心病具有增量价值。

Abstract:Objective: To investigate the correlation between tongue image texture features and pericoronary adipose tissue (PCAT) radiomics in patients with obstructive coronary heart disease. Methods: A total of 131 patients with suspected coronary heart disease admitted to the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine were enrolled, including 63 cases of obstructive coronary heart disease and 68 cases of non-obstructive coronary heart disease. Clinical routine indicators, tongue image texture features, and right coronary artery radiomics parameters were extracted. Independent sample t-test, Mann-Whitney U test, Chi-square test, and false discovery rate correction were used to compare intergroup differences. Spearman correlation analysis was employed to examine the correlation between tongue image texture features and PCAT radiomics. Elastic net was applied for feature selection. The dataset was randomly split into training and test sets at a 7:3 ratio. BP neural network models were constructed using PCAT features alone and in combination with tongue image texture features. Model performance was evaluated using receiver operating characteristic (ROC) curves, accuracy, precision, recall, specificity, F1 score, and Kappa coefficient. Results: In patients with suspected coronary heart disease, 22 weak negative correlations, 1 moderate positive correlation, and 23 weak positive correlations were identified between tongue image texture features and PCAT radiomics. In patients with obstructive coronary heart disease, 4 moderate negative correlations, 4 weak negative correlations, 2 moderate positive correlations, and 6 weak positive correlations were detected. In patients with non-obstructive coronary heart disease, 1 moderate negative correlation, 6 weak negative correlations, 1 moderate positive correlation, and 10 weak positive correlations were observed. The BP neural network diagnostic model combining tongue image texture features with PCAT radiomics demonstrated improved performance on the test set compared with the PCAT radiomics model alone. Conclusion: Tongue image texture features exhibit certain correlations with PCAT radiomics parameters in obstructive coronary heart disease, and tongue texture information provides incremental value for the diagnosis of obstructive coronary heart disease when combined with PCAT radiomics.

目的：分析急性有机磷农药中毒（AOPP）引发缺血缺氧性脑病预后相关因素，建立相关的预后预测模型。方法：回顾性分析90例（33例预后不良、57例预后良好）AOPP致HIE患者（2022年3月～2025年8月）的临床资料、中毒指标和血清学指标，独立危险因素用Logistic回顾分析筛选，并构建预后不良预测模型，采用ROC工具对模型效能进行验证。结果：Logistic 回归分析显示，年龄≥60岁、重度中毒、中毒至就诊时间、LAC水平、CHE水平、CRP水平及NSE水平均为患者预后不良的独立危险因素（P＜0.05）；AUC、灵敏度、特异度为0.943、90.91%、87.72%。结论：高龄、中毒程度高及中毒至就诊时间长等因素可导致AOPP致HIE患者出现不良结局，据此构建风险预测模型可有效预测预后不良的发生风险。

To determine the key impacting factors for hypoxic ischemic encephalopathy (HIE) caused by acute organophosphorus pesticide poisoning (AOPP) and build a prediction model. Methods: The clinical data, poisoning indicators and serological indicators of 90 patients (33 cases with poor prognosis and 57 cases with good prognosis) with HIE caused by AOPP (from March 2022 to Aug 2025) were analyzed. Independent risk factors were screened using logistic retrospective analysis, and a poor prognosis prediction model was constructed. The model efficiency was verified by the receiver operating curve (ROC). Results: Logistic regression analysis showed that age ≥ 60 years, severe poisoning, time from poisoning to treatment, LAC level, CHE level, CRP level, and NSE level were all risk factors for the prognosis in patients (P < 0.05). The AUC, sensitivity, and specificity were 0.943, 90.91%, and 87.72%.Conclusion: Factors such as advanced age, high degree of poisoning, and long time from poisoning to treatment can lead to adverse outcomes in patients with HIE caused by AOPP. Based on this, building a risk prediction model can effectively predict the risk of poor prognosis.

2-8℃低温干预结合金银花口腔喷雾在甲状腺术后气管拔管患者中的应用研究

目的 探讨改良后本科生临床医学课堂教学评价量表在时效性、有效性和易用性方面的变化。方法 2018年9月-2019年9月选取四川大学华西医院2017级临床医学和口腔医学五年制本科生共30名，以及3名授课教师作为研究对象，将既往版、现行版以及改良版教学质量评价量表应用课堂，并采用问卷调查方法对其进行分析评估。评估经改良后的教学质量评价表在及时性、有效性和易用性方面的变化差异。结果 共计向研究对象发放99份教学质量评价量表和33份调查问卷，回收率为100%。针对授课教师能及时获取教学质量反馈，教师认为课后评教工具的最佳评价时机为课后当天晚上12点前（33.3%）或课后24小时内（66.7%），高于课后立即评价（0%）和期末评价（0%）。对三个版本教学评价表问卷调查结果显示，改良版教学评价量表的时效性、有效性和易用性为优的比例分别为86.67%，60%和76.67%，均高于现行版的43.33%，60%和46.67%，同时均高于既往版的23.33%，23.33%和36.67%，差异有统计学意义（P＜0.05）。结论 改良后的本科生临床医学课堂教学评价量表在时效性、有效性和易用性方面均得以显著提高。通过不断优化量表设计和评价指标，可以提高教学质量评价的科学性和准确性。

Objective: To investigate the changes in timeliness, validity, and usability of the modified classroom teaching evaluation scale for undergraduate clinical medical education. Methods: From September 2018 to September 2019, a cohort comprising 30 fifth-year undergraduate students majoring in clinical medicine and stomatology from West China Hospital, Sichuan University, along with three faculty instructors, was enrolled. Three versions of teaching evaluation scales (historical, current, and modified) were implemented in classroom settings, followed by questionnaire-based comparative analyses. The revised scale was systematically assessed for improvements in feedback timeliness, measurement validity, and operational usability. Results: A total of 99 evaluation forms and 33 questionnaires were distributed, with a 100% response rate. Regarding timely feedback acquisition, faculty preferred receiving evaluations by midnight on the teaching day (33.3%) or within 24 hours post-class (66.7%), outperforming immediate

虽然高效抗逆转录病毒治疗已经把艾滋病变成了能够长期管理的慢性传染病，可是患者预后的个体差异比较明显。近些年不良环境暴露被发现是影响艾滋病生存质量、免疫重建、疾病进展的重要外源性因素。环境污染物作为广泛存在而且有可预防的外部风险因素，有着低剂量、长时程、多途径暴露的特点，能够通过免疫毒性、氧化应激、慢性炎症激活、代谢紊乱等多种通路，干扰艾滋病患者的免疫重建进程和病毒抑制效果，进而影响其疾病进展、远期生存结局。本文系统综述了大气污染物、重金属、黄曲霉素、多环芳烃等典型环境污染物与艾滋病患者发病进展及预后转归的关联，深入分析人群易感性差异和当前研究存在的局限，可为优化HIV/AIDS患者的健康管理策略、降低环境相关健康风险、改善患者远期预后给予理论参考和实践依据。

Although highly active antiretroviral therapy has turned AIDS into a chronic infectious disease that can be managed for a long time, the individual differences in the prognosis of patients are obvious. In recent years, adverse environmental exposure has been found to be an important exogenous factor affecting the quality of life, immune reconstruction and disease progression of AIDS. As an external risk factor that exists and has potential intervention, environmental pollutants have the characteristics of low-dose, long-term and multi-channel exposure. They can interfere with the immune reconstruction process and virus inhibition effect of AIDS patients through various pathways such as immunotoxicity, oxidative stress, chronic inflammation activation, and metabolic disorders, thereby affecting their disease progression and long-term survival outcomes. This article systematically reviews the association between typical environmental pollutants such as air pollutants, heavy metals, aflatoxins, and polycyclic aromatic hydrocarbons and the progression and prognosis of AIDS patients. In-depth analysis of the differences in population susceptibility and the limitations of current research can provide theoretical reference and practical basis for optimizing the health management strategies of HIV / AIDS patients, reducing environmental-related health risks, and improving the long-term prognosis of patients.

目的 分析2016—2024年宜春市5岁以下儿童死亡水平、死因构成、县区分布特征及变化趋势，为制定儿童健康干预策略提供依据。方法 回顾性收集2016—2024年宜春市5岁以下儿童死亡监测资料，统计各年度新生儿、婴儿及5岁以下儿童死亡率，分析死因构成比、顺位变化及县区分布特征，采用线性趋势χ2检验分析死亡率年度变化趋势。结果 2016—2024年宜春市各年龄段儿童死亡率均呈下降趋势（均P＜0.05），新生儿、婴儿、5岁以下儿童9年平均死亡率分别为1.35‰、2.62‰、5.02‰，较2016年分别下降26.79%、43.55%、43.06%。死因顺位整体呈现小幅变迁，肺炎占比逐步下降，溺水、意外窒息等意外伤害相关死因顺位持续前移。各县区死亡率存在差异，高死亡率县区集中在袁州区、奉新县，低死亡率县区以铜鼓县为主。结论 2016—2024年宜春市5岁以下儿童死亡率呈下降趋势，但意外伤害已成为主要死因，县区差异客观存在。应重点加强意外伤害预防工作，针对高死亡率县区实施差异化干预。

目的：探讨不同时机宫腔镜检查对反复胚胎移植未孕患者后续体外受精-胚胎移植（IVF-ET）临床妊娠结局的影响。方法：回顾性分析2025年1月至2025年10月于东莞康华医院生殖医学科就诊的206例行IVF-ET助孕研究对象的临床资料。根据宫腔镜检查时机分为三组：A组（胚胎移植前检查，n=82）、B组（胚胎移植1次失败后检查，n=70）、C组（胚胎移植2次失败后检查，n=54）。比较三组研究对象后续IVF-ET周期的临床妊娠率。结果：三组研究对象基线年龄、不孕年限、BMI、AMH等指标差异无统计学意义（P>0.05）。总人群临床妊娠率为53.59%（97/206），其中A组妊娠率为72.0%（59/82），B组为35.7%（25/70），C组为24.1%（13/54），组间差异有统计学意义（P<0.001）。免疫双染阳性研究对象占86.27%（176/206），其在组间分布均衡，未改变主要结论。结论：对于IVF-ET助孕研究对象，胚胎移植前进行宫腔镜检查并处理异常，可能与后续临床妊娠率升高相关；延迟至1次或2次胚胎移植失败后再检查，妊娠获益可能大幅降低。提示胚胎移植前常规行宫腔镜评估的必要性。

Objective: To investigate the impact of different timing of hysteroscopy on the subsequent clinical pregnancy outcomes of patients with recurrent embryo transfer failure undergoing in vitro fertilization - embryo transfer (IVF-ET). Methods: The clinical data of 206 patients who underwent IVF-ET assisted pregnancy treatment at the Reproductive Medicine Department of Dongguan Kanghua Hospital from January 2025 to October 2025 were retrospectively analyzed. The patients were divided into three groups based on the timing of hysteroscopy: Group A (examined before embryo transfer, n = 82), Group B (examined after one failed embryo transfer, n = 70), and Group C (examined after two failed embryo transfers, n = 54). The clinical pregnancy rates of the subsequent IVF-ET cycles of the three groups were compared. Results: There were no statistically significant differences in baseline age, duration of infertility, BMI, AMH, etc. among the three groups (P > 0.05). The overall clinical pregnancy rate of the population was 53.59% (97/206), with the pregnancy rates in Group A being 72.0% (59/82), in Group B 35.7% (25/70), and in Group C 24.1% (13/54). The differences among the groups were statistically significant (P < 0.001). Immunobright staining positive study subjects accounted for 86.27% (176/206), and their distribution among the groups was balanced, without changing the main conclusion. Conclusion: For patients undergoing IVF-ET assisted pregnancy treatment, performing hysteroscopy and treating abnormalities before embryo transfer may be associated with an increased subsequent clinical pregnancy rate; delaying the examination until one or two failed embryo transfers may significantly reduce the pregnancy benefit. It suggests the necessity of routine hysteroscopy assessment before embryo transfer.

【摘要】目的：探讨HEART五步沟通模式对突发性耳聋（SSHL）患者心理状态及恢复情况的影响。方法：将2024年3月~2025年9月就诊于本院的110例SSHL患者作为研究对象，经抛币法将入组患者随机列为常规组、试验组，55例为一组。常规组实施常规临床护理，试验组在常规组的护理基础上联合实施HEART五步沟通模式，比较两组患者的心理状态，治疗依从性，护理结束后开展为期3个月短期随访，比较两组患者的听力改善情况及生活质量。结果：护理后，试验组的医院焦虑抑郁量表（HADS）、疾病不确定感（MUIS）评分分别为（8.25±1.39）分、（20.34±5.49）分，均低于常规组[（10.28±2.46）分、（25.52±6.67）分]（t=5.328，4.447；P＜0.05）。护理后，试验组的用药依从性、康复依从性、随访依从性均高于常规组（x2=9.429，11.733，11.282；P＜0.05）。试验组随访1个月、随访3个月时气导1kHz下平均听阈（PTA）及2kHz下PTA分别为（25.62±5.41）dB HL、（18.35±3.69）dB HL、（28.52±5.44）dB HL、（20.18±5.24）dB HL，均低于常规组[（30.67±6.35）dB HL、（21.33±4.25）dB HL、（33.69±6.37）dB HL、（25.49±6.33）dB HL]（t=4.490，3.927，4.577，4.792；P＜0.05）。截至随访结束时，试验组的成人听力障碍量表（HHIA）中社交维度、情绪维度、躯体维度评分均低于常规组（t=3.787，5.562，12.132；P＜0.05）。结论：HEART五步沟通模式可改善SSHL患者的不良心理状态并提升治疗依从性，对促进患者听力水平恢复及生活质量提升均有积极影响

[Abstract]Objective:To explore the impact of the HEART five step communication model on the psychological state and recovery of patients with sudden sensorineural hearing loss (SSHL).Methods:110 patients with SSHL who visited our hospital from March 2024 to September 2025 were selected as the research subjects. The enrolled patients were randomly divided into a control group and an experimental group using a coin toss method, with 55 patients in each group. The routine group received routine clinical nursing care, while the experimental group received the HEART five step communication model in addition to the routine nursing care. The psychological status and treatment compliance of the two groups of patients were compared. After the nursing was completed, a 3-month short-term follow-up was conducted to compare the hearing improvement and quality of life of the two groups of patients.Results:After nursing, the HADS and MUIS scores of the experimental group were (8.25 ± 1.39) points and (20.34 ± 5.49) points, respectively, which were lower than those of the control group [(10.28 ± 2.46) points and (25.52 ± 6.67) points] (t=5.328，4.447; P<0.05). After nursing, the medication compliance, rehabilitation compliance, and follow-up compliance of the experimental group were higher than those of the conventional group (x2=9.429，11.733，11.282; P<0.05). The PTA of the experimental group at 1kHz and 2kHz were (25.62 ± 5.41) dB HL, (18.35 ± 3.69) dB HL, (28.52 ± 5.44) dB HL, and (20.18 ± 5.24) dB HL, respectively, during a 1-month and 3-month follow-up, which were lower than those of the control group [(30.67 ± 6.35) dB HL, (21.33 ± 4.25) dB HL, (33.69 ± 6.37) dB HL, and (25.49 ± 6.33) dB HL] (t=4.490，3.927，4.577，4.792; P<0.05). As of the end of the follow-up, the scores of social, emotional, and physical dimensions in the HHIA of the experimental group were lower than those of the control group (t=3.787，5.562，12.132; P<0.05).Conclusion:The HEART five step communication model can improve the adverse psychological state of SSHL patients and enhance treatment compliance, which has a positive impact on promoting the recovery of patients' hearing level and improving their quality of life.

目的 比较白内障超声乳化吸除术（Phaco）+房角分离术与Phaco+小梁切除术治疗急性原发性闭角型青光眼（APACG）合并白内障的临床价值。方法 回顾性分析2022年1月至2025年1月我院200例APACG合并白内障患者临床资料，根据手术方式分为小梁切除组（Phaco+小梁切除术）与房角分离组（Phaco+房角分离术），每组100例（200眼）。比较两组眼压、视力[最佳矫正视力（BCVA）]、中央前房深度、视盘血流密度[整体视盘血流密度（wiVD）、视盘内血流密度（diVD）]、生活质量[视功能相关生活质量量表-25（NEI-VFQ-25）]及并发症情况。结论 术后1周、1个月、3个月，房角分离组眼压低于小梁切除组，BCVA、中央前房深度大于小梁切除组，wiVD、diVD高于小梁切除组（P＜0.05）；术后1个月，房角分离组NEI-VFQ-25评分高于小梁切除组（P＜0.05），术后3月两组NEI-VFQ-25评分比较无显著差异（P＞0.05）；房角分离组并发症总发生率（6.50%）低于小梁切除组（13.00%）（P＜0.05）。结论 与Phaco+小梁切除术相比，Phaco+房角分离术治疗APACG合并白内障患者能有效控制眼压，增加前房深度，改善视盘血流循环，恢复患者视力，提高生活质量，减少并发症发生率。

Objective To compare the clinical efficacy of phacoemulsification (Phaco) combined with goniosynechialysis and phacoemulsification combined with trabeculectomy in the treatment of acute primary angle-closure glaucoma (APACG) complicated with cataract. Methods The clinical data of 200 patients with APACG complicated with cataract treated in our hospital from January 2022 to January 2025 were retrospectively analyzed. According to surgical procedures, the patients were divided into trabeculectomy group (Phaco combined with trabeculectomy) and goniosynechialysis group (Phaco combined with goniosynechialysis), with 100 patients (200 eyes) in each group. Intraocular pressure, visual acuity [best corrected visual acuity (BCVA)], central anterior chamber depth, optic disc vessel density [whole-image optic disc vessel density (wiVD), disc-inside vessel density (diVD)], quality of life [25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25)] and complications were compared between the two groups. Results At 1 week, 1 month and 3 months after surgery, the goniosynechialysis group had lower intraocular pressure, better BCVA, deeper central anterior chamber depth, and higher wiVD and diVD than the trabeculectomy group (P<0.05). One month postoperatively, the NEI-VFQ-25 score of the goniosynechialysis group was significantly higher than that of the trabeculectomy group (P<0.05), while no significant difference was observed between the two groups at 3 months after surgery (P>0.05). The overall incidence of complications in the goniosynechialysis group was 6.50%, which was lower than 13.00% in the trabeculectomy group (P<0.05). Conclusion Compared with phacoemulsification combined with trabeculectomy, phacoemulsification combined with goniosynechialysis can effectively control intraocular pressure, increase anterior chamber depth, improve optic disc blood circulation, restore visual acuity, enhance quality of life and reduce the incidence of complications in patients with APACG complicated with cataract.