目的 通过年龄、性别等多方面研究各亚型注意缺陷多动障碍（ADHD）儿童的智力结构分布特征的临床研究，为ADHD的个体化干预提供科学依据。方法 实验组纳入ADHD儿童754例，其中注意缺陷型（ADHD-I）280例（37.13%）、多动-冲动型（ADHD-HI）212例（28.12%）、混合型（ADHD-C）262例（34.75%），按年龄分为三组：低龄组（6~8岁）、中龄组（9~11岁）及高龄组（12~14岁）；对照组为正常儿童412例，为同期选择的性别、年龄相匹配的儿童。选择采用韦氏智力评估等方法分别对两组儿童进行评估等，对评估结果进行比较和综合分析。结果 ADHD儿童的智力评估结果低于对照组（P＜0.01），且在言语智商方面表现更为明显，在各分测验中以A因子（言语理解）和C因子（记忆/注意集中）为主，而B因子（知觉组织能力）方面则无差异。ADHD-HI型及ADHD-C型的总智商及操作智商均高于ADHD-I型，ADHD-C型言语智商和A因子均高于ADHD-I型（P＜0.01），ADHD-HI型的智力水平最高，而ADHD-I型与ADHD-C型的智力水平差异无统计学意义（P＞0.05）。各年龄段ADHD儿童的智力发育均受到不同程度的影响，尤其是中龄组儿童及高龄组女童所受影响更明显；低、中龄组儿童的智力发育水平均高于高龄组儿童，提示ADHD儿童的智力损害随年龄增长而加重；同一年龄段ADHD女童的智力损害较男童更为严重。结论 本地区6~14岁ADHD儿童的智力水平较低，以言语智商低下更为明显，ADHD-HI型在3个亚型中智力损害最小，ADHD儿童的智力损害随年龄增长而加重，同一年龄段ADHD女童的智力损害较男童更为严重。

   Objective To investigate the distribution characteristics of intellectual structure in children with different subtypes of attention deficit hyperactivity disorder（ADHD）by age and gender，providing scientific basis for individualized treatment and intervention of ADHD．Methods The experimental group consisted of 754 children with ADHD，including 280 cases（37.13%）of inattentive type（ADHD-I），212 cases（28.12%）of hyperactivity impulsive type（ADHD-HI），and 262 cases（34.75%）of combined type（ADHD-C）．They were divided into three groups by age：young group（6-8 years old），middle group（9-11 years old），and older group（12-14 years old）．The control group consisted of 412 normal children with matched sex and age recruited during the same period and had similar sex ratio．The specific methods of Wechsler Intelligence Scale were mainly applied to evaluate normal children and children with ADHD，and the evaluation results were subjected to multidimensional analysis and comparison．Results The intelligence assessment results of ADHD children were significantly lower than those of the control group（P＜0.01），with a more pronounced performance in verbal intelligence．In various sub tests，factors A（verbal comprehension）and C（memory and attention concentration）were the main factors，while there was no difference in factor B（perceptual organization ability）．The ADHD-HI and ADHD-C types had higher total intelligence and operational intelligence than the ADHD-I type，and the ADHD-C type had higher verbal intelligence and factor A than the ADHD-I type（P＜0.01）．The intelligence level of the ADHD-HI type is the highest，while there is no statistically significant difference in intelligence level between the ADHD-I type and the ADHD-C type．The intellectual development of children in different age groups was affected to varying degrees，especially in the middle and older groups of girls．This study found that the intellectual development of children in the young and middle group was higher than that of children in the older group，indicating that the intellectual development of ADHD children will be increasingly damaged with age．At the same time，it was also found that ADHD girls in the same age group had more severe intellectual development impairment than boys．Conclusions The intelligence level of children with ADHD aged 6-14 in this region is relatively low，with verbal intelligence quotient being more pronounced．ADHD-HI has the smallest intellectual impairment among the three subtypes，and the intellectual development of ADHD children becomes more severe with age．ADHD girls in the same age group have more severe intellectual development impairment than boys．

焦虑障碍是常见精神疾病之一，临床表现为情绪异常和多系统躯体不适，其身心共病的特点契合中医“形神一体”理念。中医多将本病归属于郁病、脏躁、忧思病等神志疾患范畴进行论治。临床观察发现，肝气疏泄失常，脾胃运化失健是焦虑障碍的主要病机。本文以中医五行学说为基础，结合现代研究成果，从肝脾生理与病理关联为重点，探究焦虑障碍的发病机制与演变规律，将其分为木郁克土、木不疏土、土虚木乘三种证型，并系统阐述相应的治疗原则与方剂，以利于结合临床实际合理遣方用药。导师自拟方“焦虑平方”以肝脾同调为理念，能有效阻断肝气乘脾的病机传变，能使焦虑障碍患者的身心痛苦均得到显著改善，达到确切的治疗效果。

焦虑障碍是常见精神疾病之一，临床表现为情绪异常和多系统躯体不适，其身心共病的特点契合中医“形神一体”理念。中医多将本病归属于郁病、脏躁、忧思病等神志疾患范畴进行论治。临床观察发现，肝气疏泄失常，脾胃运化失健是焦虑障碍的主要病机。本文以中医五行学说为基础，结合现代研究成果，从肝脾生理与病理关联为重点，探究焦虑障碍的发病机制与演变规律，将其分为木郁克土、木不疏土、土虚木乘三种证型，并系统阐述相应的治疗原则与方剂，以利于结合临床实际合理遣方用药。导师自拟方“焦虑平方”以肝脾同调为理念，能有效阻断肝气乘脾的病机传变，能使焦虑障碍患者的身心痛苦均得到显著改善，达到确切的治疗效果。

目的：探讨填髓益精法联合环孢素A治疗再生障碍性贫血（AA）的临床疗效，及其对骨髓造血功能、免疫功能及生活质量的影响。方法：选取2021年1月—2026年1月收治的AA患者65例，随机分为对照组（21例）、中药组（23例）、综合组（21例）。对照组予环孢素A口服；中药组在对照组基础上加用填髓益精方口服；综合组在中药组基础上联合督灸、艾灸、耳针治疗。连续治疗24周，观察三组临床疗效、血常规、免疫指标、生活质量及不良反应。结果：对照组、中药组、综合组总有效率分别为76.19%、86.96%、85.71%，中药组与综合组均显著高于对照组（P<0.05）。治疗后，三组红细胞、血红蛋白、血小板均较治疗前升高（P<0.05），IL?2水平下降，CD3?、CD4?、CD4?/CD8?升高，中药组与综合组改善优于对照组（P<0.05）。生活质量评分综合组改善最优，三组不良反应发生率差异无统计学意义（P>0.05）。结论：填髓益精法联合环孢素A可有效提高AA临床疗效，改善骨髓造血与免疫功能，提升生活质量，安全性良好，值得临床推广。

Objective To investigate the clinical efficacy of traditional Chinese medicine (TCM) method of tonifying marrow and nourishing essence combined with cyclosporine A in the treatment of aplastic anemia (AA)， and its effects on bone marrow hematopoiesis， immune function and quality of life. Methods A total of 65 patients with AA admitted from July 2014 to January 2024 were randomly divided into control group (21 cases)， TCM group (23 cases) and comprehensive group (21 cases). The control group was treated with oral cyclosporine A; the TCM group was additionally given Tonifying Marrow and Nourishing Essence Decoction; the comprehensive group was further combined with governor vessel moxibustion， moxibustion and ear acupuncture on the basis of the TCM group. All patients were treated for 24 weeks. The clinical efficacy， blood routine， immune indexes， quality of life and adverse reactions were observed. Results The total effective rates of the control group， TCM group and comprehensive group were 76.19%， 86.96% and 85.71%， respectively. The TCM group and comprehensive group were significantly higher than the control group (P<0.05). After treatment， red blood cells， hemoglobin and platelets in the three groups were increased compared with those before treatment (P<0.05)， the levels of IL?2 were decreased， and CD3?， CD4? and CD4?/CD8? were increased. The improvements in the TCM group and comprehensive group were better than those in the control group (P<0.05). The quality of life score of the comprehensive group was the best， and there was no significant difference in the incidence of adverse reactions among the three groups (P>0.05). Conclusion TCM method of tonifying marrow and nourishing essence combined with cyclosporine A can effectively improve the clinical efficacy of AA， ameliorate bone marrow hematopoiesis and immune function， and improve quality of life with good safety， which is worthy of clinical promotion.

意识障碍（Disorders of Consciousness, DoC）是颅脑损伤、脑卒中、缺血缺氧性脑病等严重脑损伤后的常见并发症，其康复治疗是神经科学领域的重大挑战。重复经颅磁刺激（Repetitive Transcranial Magnetic Stimulation, rTMS）作为一种无创神经调控技术，通过调节皮层兴奋性、促进神经可塑性及改善脑血流灌注，在DoC治疗中展现出独特优势。本文系统梳理近年研究，从作用机制、临床证据及未来方向等方面进行综述，旨在为临床精准治疗提供理论依据。

目的 探究复方玄驹胶囊与西地那非联合治疗对轻中度勃起功能障碍（ED）的临床疗效及安全性的影响。方法 前瞻性选取2023-04至2025-04我院98例轻中度ED患者，随机分为2组，各49例。对照组予以西地那非治疗，联合组在对照组基础上予以复方玄驹胶囊，治疗时间均为12周。比较2组临床疗效、治疗前与治疗12周后勃起功能指标[国际勃起功能评分表-5（IIEF-5评分）、勃起硬度量表（EHS评分）、勃起质量量表（QEQ评分）]、阴茎血流动力学[收缩期峰值流速（PSV）、舒张末期流速（EDV）、阻力指数（RI）]、血管内皮功能[一氧化氮（NO）、内皮素（ET）、血管内皮生长因子（VEGF）]及安全性。结果 与对照组相比，联合组有效率较高（P＜0.05）；治疗12周后，与对照组相比，联合组IIEF-5、EHS、QEQ评分较高（P＜0.05）；治疗12周后，与对照组相比，联合组PSV、RI较高，EDV较低（P＜0.05）；治疗12周后，与对照组相比，联合组NO、VEGF水平较高，ET水平较低（P＜0.05）；2组治疗期间不良反应无显著差异（P＞0.05）。结论 复方玄驹胶囊联合西地那非治疗能提高轻中度ED患者疗效，改善血管内皮功能与阴茎血流动力学，恢复勃起功能，且具有一定安全性。

      目的   基于决策树构建老年患者吞咽障碍预警模型。方法  采用便利取样法对宁夏银川市宁夏回族自治区人民医院老年科住院的200例老年患者进行调查。结果  200例老年患者中，吞咽障碍发生率为40.5%。依据是否发生吞咽障碍将其患者分为两组，两组患者在性别、年龄、文化程度、职业、医保类型、家庭年收入、日常生活能力、衰弱、抑郁、营养、体质指数（BMI）比较（χ ² 值分别为13.321、4.064、31.944、36.695、18.230、19.681、52.509、10.253、20.456、9.070、9.483），差异均有统计学意义（均P＜0.05）。决策树模型筛选出老年患者吞咽障碍的影响因素主要有自理能力、职业、文化程度和抑郁，决策树模型受试者工作特征曲线下面积为0.862，灵敏度为79.8%，特异度为79.0%，P＜0.001。结论  基于自理能力、职业、文化程度和抑郁构建的决策树模型，能有效预测老年患者吞咽障碍风险。

       Objective  To construct a swallowing disorder warning model for elderly patients based on decision tree．Methods  Convenience  sampling was  used to  study  200  elderly  patients  admitted to the  geriatric  department  of  a tertiary comprehensive hospital in Yinchuan，Ningxia．Results  Among 200 elderly patients，the incidence of swallowing disorders was 40.5%．The two groups of patients were compared in terms of gender，age，education level，occupation，medical insurance type，annual family income，daily living ability，frailty，depression，nutrition，and BMI（χ ²  values were 13.321，4.064，31.944，36.695，18.230，19.681，52.509，10.253，20.456，9.070，9.483，respectively），and the  differences were  statistically significant（all P＜0.05）．The decision tree model identified the main influencing factors of swallowing disorders in elderly patients as self-care ability，occupation，education level，and depression．The Receiver Operating Characteristic curve of the decision tree model had an area under the curve of 0.862，sensitivity of 79.8%，and specificity of 79.0%，P＜0.001．Conclusions  A decision tree model based on self-care ability，occupation，education level，and depression can effectively predict the  risk of swallowing disorders in elderly patients．

       脑卒中后认知障碍（PSCI）是脑卒中患者常见的并发症，严重影响患者的生活质量和社会功能。近年来，随着认知储备理论的发展和早期干预理念的普及，PSCI的早期干预模式逐渐成为研究热点。文章综述了PSCI早期干预模式的研究现状与进展，包括干预的理论基础、具体措施及未来发展方向，以期为临床实践和科研提供参考。

       Post-stroke cognitive impairment（PSCI）is a common complication among stroke patients．It seriously affects the patients’ quality of life and social functions．In recent years，with the development of the cognitive  reserve theory and the popularization of the concept of early intervention，the early intervention model for PSCI has gradually become a research hotspot．This article reviews the current research status and progress of the early intervention model for PSCI，including the theoretical basis of the intervention，specific measures，and future development directions，aiming to provide  references for clinical practice and scientific research．

      目的 探讨重性抑郁障碍（MDD）患者肠道菌群特征与选择性5-羟色胺再摄取抑制剂（SSRIs）疗效的关联性, 筛选可预测SSRIs疗效的肠道菌群生物标志物。方法 选取2024年5月—2025年5月宁夏回族自治区人民医院收治的90例MDD患者, 根据SSRIs治疗8周后疗效分为应答组56例和无应答组34例, 并选择30例健康对照, 采集基线粪便样本进行16S rRNA基因测序, 分析肠道菌群α多样性、菌属相对丰度差异,并通过相关性分析、多因素Logistic回归及ROC曲线评估菌群标志物对SSRIs疗效的预测价值。结果 MDD患者肠道菌群Chao1指数、Shannon指数低于健康对照（P<0.05）, 应答组与无应答组α多样性无差异（P>0.05）。应答组基线Blautia、双歧杆菌属、粪球菌属丰度高于无应答组（P<0.05）, 大肠杆菌-志贺菌属丰度低于无应答组（P<0.05）。基线Blautia、双歧杆菌属、粪球菌属丰度与SSRIs治疗8周HAMD-17减分率呈正相关（r分别为0.390、0.420、0.350,均P<0.05）, 三者联合预测SSRIs疗效的ROC曲线下面积（AUC）为0.910（灵敏度83.9%,特异度85.3%）。结论 MDD患者存在肠道菌群结构异常, 基线Blautia、双歧杆菌属、粪球菌属丰度可作为SSRIs疗效的潜在预测标志物,为MDD个体化治疗提供实验依据。

       Objective To explore the association between gut microbiota characteristics and the efficacy of selective serotonin reuptake inhibitors（SSRIs）in patients with major depressive disorder（MDD）, and to screen gut microbiota biomarkers for predicting SSRIs efficacy．Methods A total of 90 MDD patients（divided into responders[n=56] and non-responders[n=34] based on 8-week SSRIs efficacy）and 30 healthy controls were enrolled from May 2024 to May 2025．Fecal samples were collected for 16S rRNA gene sequencing to analyze gut microbiota α diversity and genus-level relative abundance．Correlation analysis, multivariate logistic regression, and receiver operating characteristic curve were used to evaluate the predictive value of microbiota markers for SSRIs efficacy．Results The Chao1 and Shannon indices of gut microbiota in MDD patients were significantly lower than those in healthy controls（P<0.05）, with no difference between responders and non-responders（P>0.05）．Responders had higher baseline abundances of Blautia,Bifidobacterium, and Coprococcus（P<0.05）, and lower abundance of Escherichia-Shigella compared to non-responders．Baseline abundances of Blautia,Bifidobacterium（P<0.05）, and Coprococcus were positively correlated with 8-week HAMD-17 reduction rate（r=0.390, 0.420, 0.350; all P<0.05）．The combined prediction of these three genera for SSRIs efficacy showed an area under the curve of 0.910（sensitivity 83.9%, specificity 85.3%）．Conclusions MDD patients exhibit abnormal gut microbiota structure．Baseline abundances of Blautia,Bifidobacterium, and Coprococcus may serve as potential predictive biomarkers for SSRIs efficacy, providing experimental basis for personalized treatment of MDD．

       目的  本研究旨在探讨不同俯卧位通气（PPV）时间对重症肺炎合并胃肠功能障碍患者肠内营养耐受性的影响。方法  选择2020年7月—2023年7月在天津市人民医院重症监护病房（MICU）治疗的80例重症肺炎合并胃肠功能障碍患者为研究对象, 按每日PPV时间分为长时组（≥12 h, n=40）和短时组（<12 h, n=40）。比较两组患者一般资料、氧合指数、胃肠功能指标[腹内压、血清促胃液素（GAS）和血管活性肠肽（VIP）]、肠内营养达标率、胃肠并发症率等。结果  短时组治疗后, 1 d、3 d、5 d氧合指数为（189.93±33.72）、（247.53±63.01）、（325.03±58.11）mmHg,高于长时组的（161.63±36.88）、（191.83±57.65）、（267.95±46.25）mmHg,均P<0.05; 胃残留量为（29.00±7.92）、（19.75±4.45）、（11.00±1.87） mL低于长时组的（75.03±23.29）、（53.13±11.99）、（21.70±5.52） mL, 均P<0.05。短时组治疗后腹内压[（8.53±2.05）mmHg vs （9.75±2.05） mmHg]、VIP水平[（61.14±7.63） vs （67.49±4.43） pg/mL]低于长时组,GAS水平[（65.02±8.84） vs （54.22±9.21）pg/mL]升高（均P<0.05）。短时组总胃肠并发症发生率（7.50%）低于长时组（25.00%）, P=0.034。结论  对于重症肺炎合并胃肠功能障碍患者,每日PPV时间≤12 h可改善氧合并降低胃肠并发症风险, 可能与减轻腹压、调节胃肠激素分泌及提升肠内营养耐受性相关。

      Objective To explore the effect of different duration of prone position ventilation（PPV）on enteral nutritional tolerance in patients with severe pneumonia combined with gastrointestinal dysfunction．Methods A total of 80 patients with severe pneumonia complicated by gastrointestinal dysfunction were treated in the Medical Intensive Care Unit（MICU）of a hospital from July 2020 to July 2023, and were selected as the research subjects．They were divided into the long-duration group（≥12 hours, n=40）and the short-duration group（<12 hours, n=40）according to the daily duration of PPV．The general data, oxygenation index, gastrointestinal function indicators（intra-abdominal pressure, serum gastrin[GAS] and vasoactive intestinal peptide[VIP]）, enteral nutrition achievement rate, and gastrointestinal complications of the two groups were compared．Results The oxygenation index of the short-duration group at 1 d, 3 d,a nd 5 d after treatment（[189.93±33.72], [247.53±63.01], and[325.03±58.11] mmHg, respectively）was significantly higher than that of the long-duration group（[161.63±36.88], [191.83±57.65], and[267.95±46.25] mmHg,respectively, all P<0.05）．The gastric residual volume of the short-duration group（[29.00±7.92], [19.75±4.45], and[11.00±1.87] mL, respectively）was significantly lower than that of the long-duration group（[75.03±23.29], [53.13±11.99], and[21.70±5.52] mL, respectively, all P<0.05）．The intra-abdominal pressure（[8.53±2.05] vs [9.75±2.05] mmHg）and VIP level（[61.14±7.63] vs [67.49±4.43] pg/mL）of the short-duration group after treatment were significantly lower than those of the long-duration group, while the GAS level（[65.02±8.84] vs [54.22±9.21] pg/mL）was significantly higher（all P<0.05）．The total incidence of gastrointestinal complications in the short-duration group（7.50%）was significantly lower than that in the long-duration group（25.00%, P=0.034）．Conclusions For patients with severe pneumonia complicated by gastrointestinal dysfunction, a daily duration of PPV within 12 hours can improve oxygenation and reduce the risk of gastrointestinal complications, which may be related to the reduction of intra-abdominal pressure, regulation of gastrointestinal hormone secretion, and improvement of enteral nutrition tolerance．