目的 分析儿童大环内酯类耐药重症肺炎支原体肺炎（SMPP）的危险因素,构建列线图预测模型。 方法 回顾性收集2023年1月—2024年9月在广州医科大学附属番禺中心医院儿科住院治疗的1 121例大环内酯类耐药肺炎支原体肺炎患儿入院初期的临床资料。按7∶3比例将患儿资料随机分为训练集（784例）和验证集（337例）。采用R4.4.1软件使用10重交叉验证最小绝对收缩与选择算法（LASSO）回归分析进行单因素变量筛选,采用Logistics回归分析建立预测模型, 绘制可视化列线图。使用受试者操作特征曲线（ROC）, 校准曲线、Hosmer-Lemeshow（HL）检验及临床决策曲线（DCA）分别评估模型的区分度、校准度和临床使用价值。 结果 在训练集中, LASSO回归结合Logistics回归分析结果显示,院前发热时间>5.5 d、谷丙转氨酶>14.5 U/L、乳酸脱氢酶>287.5 U/L、C反应蛋白>18.65 mg/L、肺实变、合并病毒感染是大环内酯类耐药SMPP发生的危险因素（P<0.05）, 根据上述危险因素构建列线图预测模型。训练集和验证集ROC曲线下面积分别为0.847和0.822; 校准曲线和HL检验显示模型具有良好的校准度; DCA显示预测模型在风险阈值为0.05~0.95时预测性能最优。 结论 院前发热时间、谷丙转氨酶、乳酸脱氢酶、C反应蛋白、肺实变、合并病毒感染是大环内酯类耐药SMPP发生的影响因素, 基于以上因素构建的列线图模型具有较好的预测效能, 有利于早期识别耐药重症病例, 及早采取有效干预,改善患者预后。

      Objective To explore the risk factors and to construct a nomogram prediction model for severe macrolide-resistant Mycoplasma pneumoniae pneumonia（MPP）in children．Methods The clinical data during the initial admission period of 1 121 children with macrolide-resistant MPP who were hospitalized in the Department of Pediatrics of the Affiliated Panyu Central Hospital of Guangzhou Medical University from January 2023 to September 2024 were retrospectively collected．The children data were randomly divided into a training set（n=784）and a validation set（n=337）at a ratio of 7∶3．With R language software（version 4.4.1）, least absolute shrinkage and selection operator（LASSO）regression analysis with tenfold cross-validation was used to screen risk factors, Logistics regression analysis was used to establish prediction model, and a visualization of the risk variables was created using a nomogram．The receiver operating characteristic（ROC）curves, calibration curves, Hosmer-Lemeshow（HL）test and clinical decision curve analysis（DCA）were used to evaluate the discrimination, calibration and clinical application value of the model．Results In the training set, LASSO regression analysis combined with Logistics regression analysis showed that prehospital fever duration > 5.5 days, alanine aminotransferase level> 14.5 U/L, lactate dehydrogenase level> 287.5 U/L, C-reactive protein > 18.65 mg/L, lung consolidation, and co-infection with virus were risk factors for severe macrolide-resistant MPP（P<0.05）．A nomogram prediction model was constructed based on the above risk factors．The area under the ROC curves of the training set and the validation set were 0.847 and 0.822, respectively．The calibration curves and HL test showed that the model had good calibration． The DCA curves showed that the prediction model had the best prediction performance when the risk threshold was between 0.05-0.95．Conclusions Prehospital fever duration, alanine aminotransferase level, lactate dehydrogenase level, C-reactive protein level, lung consolidation and co-infection with virus were risk factors for prediction of severe macrolide-resistant MPP．The nomogram model based on the above factors had a good prediction efficiency, which was conducive to early identification of severe cases with macrolide-resistant, and taking early effective interventions to improve the prognosis．

目的 探讨行动导向法在原位新膀胱患者康复中的应用效果。方法 选取36例新膀胱术后回归社区的患者,自出院当天起按“提出任务、计划制订、计划实施、自我反馈”4个完整的行动进行健康教育,6个月后评价患者尿失禁或尿潴留的发生率、新膀胱控尿效果、健康知识知晓率。结果 干预后患者尿失禁的发生率为2.78%、尿潴留为8.33%,新膀胱控尿效果和健康知识知晓率均为100%,与干预前比较差异均有统计学意义(P<0.05 )。结论 行动导向法对原位新膀胱患者进行健康教育,有利于提高患者学习积极性和依从性,促进理想自主排尿早日恢复。

Objective To explore the effect of action oriented method in the rehabilitation of patients with orthotopic neobladder. Methods Select 36 cases of patients who return to the community after the new bladder surgery, from the day of discharge, according to“ the objective, plan making, plan implementation, self feedback” these 4 complete actions to implement health education. After 6 months the evaluation for the patients with urinary incontinence or urinary retention including the incidence of new bladder continence, awareness of health knowledge were taken. Results The incidence of urinary incontinence was 2.78% and urinary retention was about 8.33%. The awareness rate of urinary continence and health knowledge was 100%, and the difference was statistically significant (P<0.05). Conclusion It is helpful to improve the learning interesting and compliance of the patients with bladder cancer, and to promote the early recovery of the ideal autonomous urination.

目的 探讨逍遥散治疗首发抑郁症的疗效与5-HT2A受体基因多态性的关联。方法 采用病例对照研究方法,以120例首发抑郁症患者(研究组)和120例正常人(对照组)为研究对象,研究组予逍遥散治疗,疗程8周。于治疗前后采用汉密顿抑郁量表评定。采用高温连接酶检测反应法(LDR)检测5-HT2A受体基因,分析其与抗抑郁药物疗效的关系。结果 5-HT2A受体基因(T102C)T／C基因型、C／C基因型频率及等位基因频率与对照组相比差异无统计学意义(P﹥0.05)。不同基因型的疗效无差异(P﹥0.05)。结论 5-HT2A受体基因(T102C)多态性与逍遥散治疗抑郁症的疗效无关联。

目的 观察单唾液酸四己糖神经节苷脂联合复方丹参片在治疗难治性癫痫的脑保护作用。方法 选取2010年1月—2015年10月于我院进行治疗的80例难治性癫痫患者为研究对象,随机分为对照组和治疗组。对照组患者给予常规抗癫痫药物治疗,而治疗组患者在对照组治疗基础上给予单唾液酸四己糖神经节苷脂联合复方丹参片治疗。治疗一疗程后,对两组患者进行疗效判定;并分别在治疗前后使用韦氏成人智力量表(WAIS-RC)和韦氏记忆量表(WMS-RC)对两组患者的智商和记忆商进行测评,并比较分析。结果 ①观察组患者的治疗总有效率为97.5%高于对照组的87.5%(P<0.05)。②治疗后,观察组患者的语言智商、操作智商、总智商和记忆商得分分别为(95.4±8.5)分、(94.8±12.5)分、(92.8±7.5)分和(93.5±8.2)分,均高于治疗前的(89.5±7.2)分、(91.5±10.1)分、(88.5±6.9)分和(82.5±10.0)分,且也均高于对照组治疗后的(75.4±6.8)分、(80.6±9.8)分、(80.1±5.9)分和(76.9±8.2)分,以上差异均有统计学意义(P<0.05)。治疗后,对照组患者的智商和记忆商均见的下降,均低于治疗前各分数,以上差异有统计学意义(P<0.05)。结论 神经节苷脂联合复方丹参片治疗难治性癫痫临床效果显著,且具有一定的脑保护效果,可为以后临床治疗难治性癫痫患者提供参考依据。

Objective To observe the cerebral protective effects of monomial four hexose ganglioside combined with compound salvia miltrorrhiza tablets (CSMT) in patients with refractory epilepsy. Methods 80 patients with refractory epilepsy patients treated in our hospital between January 2010 and October 2015 were randomly divided into control group and treatment group. The control group patients were treated with conventional antiepileptic drug therapy, and the treatment group patients were treated with monomial four hexose ganglioside, CSMT and conventional antiepileptic drug therapy. The efficacy in two groups' patients was determined after a course of treatment. The IQ and memory quotient in two groups' patients before and after treatment were evaluated by the Wechsler Adult Intelligence Scale (WAIS-RC) and the Wechsler Memory Scale (WMS-RC) respectively and comparative analysed. Results ①The total effective rate in the treatment group (97.5%) was significantly higher than that in the control group (87.5%) (P<0.05). ②The verbal IQ (95.4±8.5), performance IQ (94.8 ± 12.5), total IQ (92.8 ± 7.5) and memory quotient (93.5 ± 8.2) scores in the treatment group after treatment were significantly higher than those before treatment (89.5 ± 7.2), (91.5 ± 10.1), (88.5 ± 6.9), (82.5 ± 10.0) respectively, and also were significantly higher than those in the control group after treatment (75.4 ± 6.8), (80.6 ± 9.8), (80.1 ± 5.9) and (76.9 ± 8.2) respectively (P<0.05). The IQ and memory quotient in the control groups' patients after treatment were significantly decline and lower than before treatment, which had a statistically significant difference (P<0.05). Conclusion Ganglioside combined with CSMT in the treatment of refractory epilepsy can receive significant clinical effect and own a certain brain protective effect, which provide reference to the future clinical treatment of refractory epilepsy patients.

目的 “看病难”这个与社会民生密切相关的难题,长期困扰广大民众。主要表现在看病流程复杂,挂号、候诊排队时间长,就诊指引不清晰,服务水平低。移动互联网时代,各个传统行业都在转变运营模式,医院应如何因势利导,寻求“破冰”良策。本文结合佛山市中医院的应用案例,对利用微信公众号^[1]改造现有业务流程,有效解决“看病难”问题进行讨论分析。

The problem “proper health care is difficult to get” is closely related to the people's livelihood,which has plagued the people for a long period of time.The difficulties mainly focused on the complex process,long-time waiting,unclear instruction and the low level of service.In the time of mobile internet,each traditional industry is shifting the operation mode.What the hospital should do to is to make the best use of the advantages to solve the problems.The purpose of the research is to optimize the current processes and to solve the problem of “Proper health care is difficult to get” by using Wechat public number combined with the cases in Foshan hospital of traditional Chinese medicine.