随着糖尿病患者的增加,因肺炎住院的糖尿病患者数也呈现出明显上升趋势。由于糖代谢紊乱及机体免疫功能下降等因素,细菌在高血糖的机体环境中快速繁殖并分泌大量毒素,增加了抗菌药物使用的时间跨度和细菌清除难度,对患者预后造成了极大的威胁。文章主要对糖尿病合并细菌性肺炎患者的病原学特征、耐药情况及药物治疗等进行阐述,旨在进一步为临床预防和治疗提供参考依据。
With the increasing incidence in diabetes, the number of hospitalized diabetes patients with pneumonia is also increasing. Due to factors such as glucose metabolism disorders and decreased immune function in the body, bacteria rapidly multiply and secrete a large amount of toxins in the hyperglycemic environment,increasing the duration of antibiotic use and the difficulty of bacterial clearance, posing a great threat to patient prognosis. This article mainly elaborates on the pathogenic characteristics, drug resistance, and drug treatment of diabetes patients with bacterial pneumonia, aiming to provide reference for the clinical prevention and treatment.
股骨转子间骨折是最常见的髋部骨折,内固定手术为其目前治疗的首选方式。头颈钉位置是评估手术效果和判断治疗预后的重要因素,合适的置钉位置有利于稳定骨折、加速康复以及改善预后。目前头颈钉位置最经典的评估方式为尖顶距（TAD）,但TAD至今仍存在较多争议。近年来提出的轴刀角、尖颈距离比、偏心距（ED）以及标准化TAD（STAD）为临床实践拓展了新视野。文章通过对上述头颈钉位置的评估方法及局限性进行文献综述,旨在为临床手术置钉时提供相应的参考。ED和STAD的提出,为未来人工智能评估头颈钉位置提供了可能。
Femoral intertrochanteric fracture is one of the most common hip fractures, and the internal fixation is the preferred treatment. The position of cephalic fixator is an important factor to evaluate the effect of operation and the prognosis of treatment. Tip-apex-distance（TAD）is the most classical method to evaluate the position of cephalic fixator, but it is still controversial. In recent years, the axis-blade angle,tip-neck distance ratio, eccentric distance（ED）and standardized TAD（STAD）have been proposed,though with limitations, they also provide a new perspective for clinical practice. In this study, we reviewed the literature on the evaluation of the position of cephalic fixator in order to provide the corresponding references and guidance for the clinical operation of internal fixation. Both STAD and ED may be the theoretical possibility of artificial intelligence evaluation of the position of cephalic fixator in the future.
目的 探讨帕金森病（PD）患者执行功能障碍与脑小血管病（CSVD）总负荷的关系。方法 回顾性分析2020年1月1日—2024年6月30日在佛山市第一人民医院住院的156例PD患者收集患者的临床资料，包括性别、年龄、教育年限、高血压病史等，采用简易精神状态量表（MMSE）、蒙特利尔认知评估量表（MoCA）评估认知功能以及采用额叶功能评定表（FAB）评估执行功能。根据患者的认知功能和执行功能评定结果，将156例患者分为PD认知功能正常（PD-NC）组、PD执行功能异常组（PD-EF）和PD非执行功能异常组（PD-NEF）。所有研究对象均行头颅磁共振检查，行CSVD总负荷的评分。比较3组患者一般临床资料、CSVD及其标志物的差异。结果 PD-EF组的年龄、病程、H-Y分期、脑室周围白质高信号（PVWMH）、皮层下白质高信号（DWMH）、腔隙性脑梗死（LI）、CSVD 总负荷评分高于PD-NEF组、PD-NC组，差异均有统计学意义（均P＜0.05）。Spearman相关性分析结果显示，PD患者FAB评分与PWMH评分、DWMH评分、LI数目、CSVD总负荷评分均呈负相关（均P＜0.05）。多元线性回归分析显示，PD患者FAB评分越低，DWMH评分、LI数目、CSVD总负荷评分均越高（均P＜0.05）。结论 PD患者执行功能障碍和CSVD总负荷相关。
Objective To explore whether total burden of cerebaral small vessel disease（CSVD）detected with MRI was associated with the executive functions in patients with Parkinson's disease（PD）．Methods In total，156 patients with PD in First People’s Hospital of Foshan from January 2020 to June 2024 were retrospectively enrolled．Detailed clinical data were obtained．The clinical data of all the patients such as age，gender，years of education，hypertension history were collected．The MiniMental State Examination（MMSE）and the Montreal Cognitive Assessment Scale（MoCA）were used to assess cognitive function，the Frontal Assessment Battery（FAB）was used to assess executive function．According to the function levels，all cases were divided into PD with normal cognition（PD-NC）group，PD with executive function（PD-EF）and PD with non-executive function（PD-NEF）．All the patients underwent brain MRI to determine the presence and burden of CSVD，scoring between 0 and 4．Results The age，course of disease，Hoehn-Yahr staging，the scores of periventricular white matter hyperintensities（PWMH），the scores of deep subcortical white matter hyperintensities（DWMH），the numbers of lacunar infarcts（LI），the CSVD scores were significantly higher in the patients of PD-EF group than PD-NC group and PD-NEF group（P＜0.05）．Spearman’s correlation analysis showed that FAB scores had a significant correlation with scores of PWMH，the scores of DWMH，the numbers of LI，and the CSVD burden scores（P＜0.05）．Multivariable analysis showed that there was a significant negative correlation between FAB scores and the scores of DWMH，the numbers of LI，the CSVD scores．Conclusions The total MRI CSVD burden was associated with the executive functions in patients with PD in this study．
目的 本研究以脑卒中患者为研究对象，通过二代Illumina高通量测序平台对患者的粪便标本进行微生物群落多样性测序。选择物种丰度≥30%的24个门类（Phylum）作为肠道菌群的研究指标，进而研究肠道菌群与脑卒后抑郁（PSD）之间的相关关系。方法 以40位脑卒中患者的24个门类作为特征变量，抑郁组和对照组为二分类目标变量，建立以Logistic回归、随机森林、支持向量机和AdaBoost为基模型的Stacking分类模型。主成分分析方法作为该模型的特征选择方法选择恰当的主成分进行模型训练，通过二分类评价报告（precision、recall、f1-score）、ROC曲线和混淆矩阵等评价指标对其性能进行评价。结果 （1）通过差异性检验分析了两组（抑郁组和对照组）的基线一致（P＜0.05）；（2）从Stacking模型融合的角度定量分析了影响脑卒中后抑郁情绪的具体肠道菌群。研究结果可知，放线菌门、拟杆菌门、变形菌门和酸杆菌门在PSD患者中均增加（P＜0.001）；厚壁菌门，疣微菌门，绿弯菌门和软壁菌门在PSD患者中降低（P＜0.001）。结论 以上菌群是影响脑卒中后抑郁患者情绪的主要影响因素，因此，在临床上通过恰当干预肠道菌群的变化来调节脑卒中后抑郁患者的抑郁水平，这为脑卒中后抑郁情绪的诊断和治疗方案提供科学依据。
Objective In this study，patients with stroke were selected as the research object，and the microbial community diversity of patients’ stool samples was sequenced by the second-generation Illumina high-throughput sequencing platform．Twenty four phylum species with 30% species abundance were selected as indicators for the study of gut microbiota，and then the correlation between gut microbiota and post-stroke depression（PSD） was studied．Methods Taking 24 categories of 40 stroke patients as characteristic variables，depression group and control group as dichotomous target variables，a stacking classification model based on Logistic regression，random forest，support vector machine and AdaBoost was established．As the feature selection method of the model，principal component analysis selects the appropriate principal components for model training，and evaluates its performance through dichotomous evaluation reports（precision，recall，f1 score），ROC curve and confusion matrix．Results The baseline of the two groups（depression group and control group）was consistent（P＜0.05）through the difference test．From the perspective of stacking model fusion，the specific intestinal flora affecting post-stroke depression was quantitatively analyzed．The results showed that Actinobacteria，Bacteroidetes，Proteobacteria and Acidobacteria were significantly increased in PSD patients（P＜0.001），while Firmicutes，Verrucomicrobia，Chloroflexi and Tenericutes were significantly decreased in PSD patients（P＜0.001）．Conclusions The above microbiota are the main factors affecting the mood of patients with post-stroke depression．Therefore，in clinical practice，we can adjust the depression level of patients with post-stroke depression by properly intervening the changes of intestinal microbiota，which provides a scientific basis for the diagnosis and treatment of PSD．
目的 探讨长病程2型糖尿病（T2DM）患者体质指数（BMI）与胰岛β细胞功能间的相关关系。方法 选取2023年12月—2024年3月于承德市中心医院内分泌风湿免疫科住院的260例长病程（病程≥10年）T2DM患者作为研究对象，依据BMI将其分成正常组、超重组和肥胖组，比较三组间一般资料、检验学指标及检查的差异，分析胰岛β细胞功能与各指标间的相关性。结果 三组研究对象在空腹静脉血糖（FPG）、空腹C肽（FCP）、胰岛素抵抗指数（HOMA-IR）、尿酸（UA）、甘油三酯（TG）等上差异有统计学意义（P＜0.05），在胰岛β细胞功能指数（HOMA-β）比较差异无统计学意义（P＞0.05）；肥胖组的FPG、FCP、HOMA-IR、UA、TG均高于正常组（P＜0.05），超重组的UA、TG均高于正常组（P＜0.05），肥胖组的FPG、HOMA-IR、UA高于超重组（P＜0.05），Spearman相关分析结果显示HOMA-β与体质量指数（BMI）无相关性（r=0.046，P=0.461），HOMA-β与UA（r=0.226，P＜0.001）、TG（r=0.148，P=0.017）呈正相关，HOMA-IR与BMI（r=0.279，P＜0.001）与、UA相关（r=0.284，P＜0.001）及TG（r=0.349，P＜0.001）呈正相关，多元线性回归分析显示UA是HOMA-β的影响因素（P＜0.05），BMI、UA、TG是HOMA-IR的影响因素（P＜0.05）。结论 长病程的T2DM患者，其胰岛素抵抗水平随着BMI的增加逐渐升高，而胰岛β细胞功能指数与BMI的相关性不显著。同时，UA和TG也是长病程T2DM患者胰岛β细胞功能的影响因素。
Objective To explore the correlation between body mass index（BMI）and islet β cell function in patients with long course type 2 diabetes mellitus（T2DM）．Methods A total of 260 patients with T2DM with a long course of disease（course≥10 years）admitted to the Department of Endocrinology and Rheumatology of Chengde Central Hospital from December 2023 to March 2024 were selected as the study objects，and were divided into normal group，overweight group and obese group according to BMI．Comparison among the three groups in general data，inspection index and and the difference of the islet β cell function were performed，and the correlation among the indexes was analyzed．Results There were statistically significant differences in fasting plasma glucose（FPG），fasting C peptide（FCP），homeostasis model assessment-insulin resistance（HOMA-IR），uric acid（UA）and triglycerides（TG）among the three groups（P＜0.05），but no statistically significant differences in homeostatic model assessment of β-cell function（HOMA-β）（P＞0.05）．The levels of FPG，FCP，HOMA-IR，UA and TG in the obese group were higher than those in the normal group（P＜0.05）；the levels of UA and TG in the overweight group were higher than those inthe normal group（P＜0.05）；the levels of FPG，HOMA-IR and UA in the obese group were higher than those in the overweight group（P＜0.05）．Spearman correlation analysis showed that HOMA-β was not correlated with BMI（r=0.046，P=0.461），but was positively correlated with UA and TG（r=0.226，P＜0.001；r=0.148，P=0.017），HOMA-IR was positively correlated with BMI，UA and TG（r=0.279，P＜0.001；r=0.284，P＜0.001；r=0.349，P＜0.001）．Multiple linear regression analysis showed that UA was the influencing factor of HOMA-β（P＜0.05），BMI，UA and TG were the influencing factors of HOMA-IR（P＜0.05）．Conclusions In T2DM patients with long disease course，the level of insulin resistance increased gradually with the increase of BMI，but the correlation between β-cell function index and BMI was not significant．At the same time，UA and TG are also factors affecting the function of islet β cells in patients with long-course T2DM．
胃食管反流病是一种以烧心和反流为主要症状的胃食管动力障碍性疾病，现有的常规治疗存在药物依赖，手术风险高且易复发等局限性，而经皮电刺激作为一种新兴疗法，在治疗动力障碍性疾病时具有非侵入性、可逆性及调节生理功能的优势。因此本研究为了探讨经皮电刺激治疗胃食管反流病的进展，现从胃食管反流病的神经调控生理、不同经皮电刺激对治疗胃食管反流病的研究以及应用效果等方面进行综述，以期为胃食管反流病提供新的诊断思路和方法。
In order to discuss the progress of transcutaneous electrical stimulation for the treatment of gastroesophageal reflux disease（GERD），the physiology of neuromodulation of GERD，the research on different transcutaneous electrical stimulation for the treatment of GERD，and the application effect were reviewed，with the aim of providing new diagnostic ideas and methods for GERD．
先天性血管瘤（CH）是一种较为罕见的良性血管肿瘤，出生前瘤体已经存在，按照出生后瘤体的生长特征可分为4类：不消退型CH、部分消退型CH、快速消退型CH以及迟发性扩张型CH。不同类型的CH其临床特征及治疗方式不同。结合近年CH的研究进展报道，文章对CH的发病机制、临床特征、诊断及治疗着重进行综述，以期更好地为临床诊治提供指导。
Congenital hemangioma（CH）is a relatively rare benign vascular tumor that is present before birth．Based on the growth characteristics of CH after birth，CH can be classified into four types：non-involuting congenital hemangioma，partially involuting congenital hemangioma，rapidly involuting congenital hemangioma，and delayed expanding congenital hemangioma．Different types of CH exhibit distinct clinical features and require different treatment approaches．This review focuses on recent research advances in CH，including its pathogenesis，clinical characteristics，diagnosis，and treatment，aiming to provide better guidance for clinical practice．
糖尿病肾病（DN）是指由糖尿病所致的慢性肾脏疾病，是目前我国和全球范围内慢性肾脏疾病和终末期肾脏疾病的首位病因。DN发病率逐年攀升，且预后不良，已成为我国重大的公共卫生问题之一。DN不仅明显降低了患者的生活质量，还增加了心血管疾病的风险。随着对DN发病机制的深入研究，近十余年来在DN治疗手段方面取得了显著进展，包括新型药物的研发、生活方式的干预及各种新兴疗法的探索。本文旨在系统性综述近年来DN领域的重要治疗进展，阐明这些进展在临床应用中的有效性和适用性，并展望未来的研究方向，以期为临床实践提供参考和指导。
Diabetic nephropathy（DN）is a form of chronic kidney disease（CKD）induced by diabetes．Diabetic nephropathy represents the leading cause of CKD and end-stage renal disease both in China and globally．The incidence of DN has been steadily increasing and its prognosis remains unfavorable．Diabetic nephropathy has become a major public health concern．Diabetic nephropathy not only significantly affects patients’ quality of life but also increases the risk of cardiovascular diseases．Recent advancements in our understanding of the pathogenesis of DN have facilitated significant progress in treatment options over the past decade．These developments include the introduction of novel pharmacological agents，the implementation of lifestyle modifications，and the exploration of various emerging therapeutic approaches．This review aims to systematically expound the significant therapeutic advancements in the field of DN in recent years，evaluate the efficacy and applicability of these advancements in clinical practice，and explore potential future research directions，thereby providing valuable insights andguidance for clinical practice．
目的 观察急性期脑卒中患者早期针刺结合康复训练的临床疗效。方法 采用单盲、分层、区组随机设计分组，随机分成针康组与康复组。针康组35例，康复组35例，按5 d为一个疗程，共4个疗程。采用Fug-Meyer运动功能评分法（FMA）、巴氏指数（BI）、脑卒中专用生活质量量表（SS-QOL）对治疗前及治疗后4周末、出院后8周末及随访期3个月、6个月末的死亡率、残疾率、复发率评估，比较两组的疗效。结果 两组基线比较差异无统计学意义（P＞0.05）。组间比较：4周末 FMA、BI评分两组相比差异均无统计学意义（P＞0.05），8周末则具有统计学意义（P＜0.01）。SS-QOL评分在第4周末和第8周末相比差异无统计学意义（P＞0.05）。随访3个月、6个月末的死亡率、致残率和复发率差异均无统计学意义（P＞0.05）。组间多重比较，两组4、8周末 FMA、 BI和SS-QOL评分较治疗前比较差异有统计学意义（P＜0.01）。针刺康复组8周末疗效优于4周末（P＜0.01），康复组8周末与4周末相比差异无统计学意义（P＞0.05）。针刺康复组4、8周末SS-QOL评分显著高于治疗前（P＜0.01），8周末与4周末相比差异无统计学意义（P＞0.05），康复组各时间点SS-QOL评分两两比较差异有统计学意义（P＜0.01）。结论 对急性脑卒中患者进行早期针刺结合康复训练，可明显改善其肢体运动功能和日常生活活动能力。
Objective To observe the clinical efficacy of early acupuncture combined with rehabilitation training in acute-phase stroke patients．Methods Single-blind，stratified，zone group randomized design grouping was adopted，and randomly divided into acupuncture rehabilitation group and rehabilitation group．There were 35 cases in the acupuncture rehabilitation group and 35 cases in the rehabilitation group，received 4 courses，5 days in each course．Fugl-Meyer Assessment（FMA），Barthel Index（BI），Stroke Specific Quality of Life Scale（SS-QOL） scores and mortality，disability and recurrence rates at the end of 3 and 6 months of follow-up were used to compare the efficacy of the two groups．Results Comparing the basic conditions of the two groups，the difference was not significant（P＞0.05）．Comparison between groups：differences FMA and BI scores between two groups at the end of 4 weekends were not significant（P＞0.05），while differences were significant（P＜0.01）at the end of 8 weekends．SS-QOL scores at the end of 4 weekends and the end of 8 weekends were not significant different between two groups（P＞0.05）．Mortality，disability and recurrence rates at the end of 3 and 6 months of follow-up were not significantly different（P＞0.05）．Multiple comparisons between groups：there were significant differences in FMA，BI and SS-QOL scores at the end of 4 and 8 weeks between the two groups compared with the pre-treatment period（P＜0.01）．The efficacy of the acupuncture rehabilitation group at the end of 8 weekends was significantly better than that at the end of 4 weekends（P＜0.01），and there was no statistically significant difference between the rehabilitation group at the end of 8 weekends and that at the end of 4 weekends（P＞0.05）．The SS-QOL scores at the end of 4 and 8 weekends in the acupuncture rehabilitation group were significantly higher than those before treatment（P＜0.01），and there was no statistically significant difference at the end of 8 weekends compared with that at the end of 4 weekends（P＞0.05），and there was a statistically significant difference in the two-by-two comparisons of SS-QOL scores at each time point in the rehabilitation group（P＜0.01）．Conclusions Early acupuncture combined with rehabilitation training for acute stroke patients can significantly improve their extremities motor function and daily vitality．
目的 对比乏白细胞富血小板血浆（LP-PRP）与富白细胞富血小板血浆（LR-PRP）联合体外冲击波疗法（ESWT）治疗慢性非止点跟腱腱病（NIAT）的临床价值。方法 选取2021年12月—2023年12月赣州市人民医院收治的80例慢性NIAT患者，以随机数表法分为两组，即对照组和观察组各40例，观察组予LP-PRP联合ESWT治疗，对照组予LR-PRP联合ESWT治疗；于治疗前、第一次治疗后1个月、3个月比较两组疼痛度［视觉模拟量表（VAS）评分］、跟腱病变程度［维多利亚体育研究所跟腱评估问卷（VISA-A）］、跟腱功能（Arner-Lindholm跟腱功能评分），并比较两组并发症的发生率。结果 两组在治疗后1个月、3个月的VAS评分下降，VISA-A评分升高，且观察组治疗后3个月的VAS评分（1.05±0.31）分低于对照组的（1.82±0.45）分，VISA-A评分（83.35±5.58）分高于对照组的（76.28±5.35）分（F组间与时点交互=338.478、106.663，均P＜0.05）；治疗后3个月，观察组跟腱功能（优、良、差各有24、13、3例）优于对照组（优、良、差各有14、16、10例），差异有统计学意义（Z=2.529，P=0.012）。两组治疗后1个月时VAS评分、VISA-A评分及跟腱功能比较差异无统计学意义（均P＞0.05）。结论 与LR-PRP比较，LP-PRP联合ESWT治疗慢性NIAT更有利于减轻患者跟腱疼痛度及病变程度，改善患者跟腱功能。
Objective To compare the clinical value of leukocyte-poor platelet rich plasma（LP-PRP）and leukocyte-rich platelet rich plasma（LR-PRP）combined with extracorporeal shock wave therapy（ESWT）in the treatment of chronic non insertional Achilles tendinopathy（NIAT）．MethodsEighty patients with chronic NIAT admitted to Ganzhou People’s Hospital from December 2021 to December 2023 were randomly divided into two groups using a random number table method：a control group and an observation group，with 40 patients in each group．The observation group received LP-PRP combined with ESWT treatment，while the control group received LR-PRP combined with ESWT treatment．The pain level（Visual Analog Scale［VAS］score），degree of Achilles tendon lesion（Victorian Institute of Sports Assessment-Achilles tendinopathy questionnaire［VISA-A］），and Achilles tendon function（Arner Lindholm Achilles tendon function score）between the two groups were compared before treatment，one month after the first treatment，and three months after treatment，as well as the incidence of complications between the two groups．Results The VAS scores of both groups decreased and the VISA-A scores increased at one and three months after treatment．The VAS score of the observation group（1.05±0.31）was lower than that of the control group（1.82±0.45）at three months after treatment，while the VISA-A score of the observation group（83.35±5.58）was higher than that of the control group（76.28±5.35）（interaction between group and time point F=338.478，106.663，both P＜0.05）．After three months of treatment，the Achilles tendon function of the observation group（24 cases of excellent，13 cases of good，and three cases of poor）was better than that of the control group（14 cases of excellent，16 cases of good，and 10 cases ofpoor），and the difference was statistically significant（Z=2.529，P=0.012）．There was no statistically significant difference in VAS score，VISA-A score，and Achilles tendon function between the two groups one month after treatment（all P＞0.05）．Conclusions Compared with LR-PRP，LP-PRP combined with ESWT was more beneficial in reducing the degree of Achilles tendon pain and lesions in patients with chronic NIAT，and improving Achilles tendon function．
