心肌纤维化是心力衰竭等心血管疾病演化过程中的关键性病理改变，该病的进展机制依赖巨噬细胞与成纤维细胞的相互调控。现有现代医学研究证实巨噬细胞可凭借M1、M2表型极化行为介导炎症反应与组织修复过程，成纤维细胞能够分化形成肌成纤维细胞并推动细胞外基质异常沉积，两类细胞可依托TGF-β/Smad、CSF-1/CSF-1R等信号通路构建相互调控的作用网络并介导心肌纤维化恶化。中医痰瘀互结病机理论指出痰浊与瘀血可相互滋生、交织阻滞，是各类慢性迁延性疾病的关键发病基础。本文以中医痰瘀互结理论为研究切入点，剖析该病机理论与巨噬细胞、成纤维细胞交互作用的内在关联，整合现代医学关于两种细胞交互作用的现有研究成果，深入分析细胞互作在心肌纤维化发病过程中的协同机制与病理关联，旨在为心肌纤维化的中西医协同防治提供理论依据，为相关动物实验及临床应用研究筑牢研究基础。

Myocardial fibrosis is a key pathological change in the progression of cardiovascular diseases such as heart failure. The progression mechanism of this disease relies on the reciprocal regulation between macrophages and fibroblasts. Current modern medical research has confirmed that macrophages can mediate inflammatory responses and tissue repair processes through M1 and M2 phenotypic polarization behaviors, and fibroblasts can differentiate into myofibroblasts and promote abnormal extracellular matrix deposition. The two types of cells can construct a reciprocal regulatory network through signaling pathways such as TGF-β/Smad and CSF-1/CSF-1R, thereby mediating the deterioration of myocardial fibrosis. The theory of phlegm and blood stasis intermingling in traditional Chinese medicine suggests that phlegm turbidity and blood stasis can mutually generate and interweave to cause obstruction, serving as a key pathological basis for various chronic and persistent diseases. This article takes the traditional Chinese medicine theory of phlegmblood stasis intermingling as a research entry point, analyzes the intrinsic relationship between this pathological theory and the interaction of macrophages and fibroblasts, integrates existing modern medical research findings on the interaction between the two cell types, and deeply analyzes the synergistic mechanisms and pathological correlations of cellcell interactions in the pathogenesis of myocardial fibrosis. The aim is to provide a theoretical basis for the integrated traditional Chinese and Western medicine prevention and treatment of myocardial fibrosis, and also to lay a solid research foundation for related animal experiments and clinical application studies.

心肌纤维化是心力衰竭等心血管疾病演化过程中的关键性病理改变，该病的进展机制依赖巨噬细胞与成纤维细胞的相互调控。现有现代医学研究证实巨噬细胞可凭借M1、M2表型极化行为介导炎症反应与组织修复过程，成纤维细胞能够分化形成肌成纤维细胞并推动细胞外基质异常沉积，两类细胞可依托TGF-β/Smad、CSF-1/CSF-1R等信号通路构建相互调控的作用网络并介导心肌纤维化恶化。中医痰瘀互结病机理论指出痰浊与瘀血可相互滋生、交织阻滞，是各类慢性迁延性疾病的关键发病基础。本文以中医痰瘀互结理论为研究切入点，剖析该病机理论与巨噬细胞、成纤维细胞交互作用的内在关联，整合现代医学关于两种细胞交互作用的现有研究成果，深入分析细胞互作在心肌纤维化发病过程中的协同机制与病理关联，旨在为心肌纤维化的中西医协同防治提供理论依据，为相关动物实验及临床应用研究筑牢研究基础。

Myocardial fibrosis is a key pathological change in the progression of cardiovascular diseases such as heart failure. The progression mechanism of this disease relies on the reciprocal regulation between macrophages and fibroblasts. Current modern medical research has confirmed that macrophages can mediate inflammatory responses and tissue repair processes through M1 and M2 phenotypic polarization behaviors, and fibroblasts can differentiate into myofibroblasts and promote abnormal extracellular matrix deposition. The two types of cells can construct a reciprocal regulatory network through signaling pathways such as TGF-β/Smad and CSF-1/CSF-1R, thereby mediating the deterioration of myocardial fibrosis. The theory of phlegm and blood stasis intermingling in traditional Chinese medicine suggests that phlegm turbidity and blood stasis can mutually generate and interweave to cause obstruction, serving as a key pathological basis for various chronic and persistent diseases. This article takes the traditional Chinese medicine theory of phlegmblood stasis intermingling as a research entry point, analyzes the intrinsic relationship between this pathological theory and the interaction of macrophages and fibroblasts, integrates existing modern medical research findings on the interaction between the two cell types, and deeply analyzes the synergistic mechanisms and pathological correlations of cellcell interactions in the pathogenesis of myocardial fibrosis. The aim is to provide a theoretical basis for the integrated traditional Chinese and Western medicine prevention and treatment of myocardial fibrosis, and also to lay a solid research foundation for related animal experiments and clinical application studies.

摘要 目的 分析固定（FB）和活动平台（MB）单髁置换术（UKA）在膝关节内侧间室骨关节炎早期阶段的临床效果与影像学差异，以指导临床假体选择。 方法 本研究回顾性纳入41例确诊为单侧膝关节内侧间室骨关节炎的患者，按照假体类型分为两组：FB组（20例，使用春立XG假体）和MB组（21例，使用春立XK假体）。分别在术前、术后及随访终点统计膝关节屈伸活动范围（ROM）、VAS 疼痛评分、美国特种外科医院膝关节评分（HSS ）；测量并比较股胫角（FTA）、胫骨假体内外翻角（TCVA）、胫骨假体后倾角（TCPSA）；记录围手术期指标及并发症情况。 结果 两组患者术后ROM、VAS、HSS 评分均较术前显著改善（P均<0.0001）；末次随访时固定平台组 VAS 评分显著低于活动平台组（P<0.05），而两组间的ROM、HSS 评分无统计学差异（均 P>0.05）。两组术后 FTA、TCVA、TCPSA 均恢复至理想范围，组间均无统计学差异（均 P>0.05）。固定平台组手术时间更短（P<0.05），两组均无严重并发症，假体生存率均为 100%。 结论 活动平台与固定平台单髁置换术均可显著改善膝关节内侧间室骨关节炎患者疼痛、活动度及功能，下肢力线恢复效果相当；固定平台假体在疼痛控制与手术便捷性方面更具优势，临床可根据患者情况与术者经验个体化选择。 关键词 单髁置换术；活动平台假体；固定平台假体；骨关节炎；并发症

Abstract Objective To investigate the early clinical outcomes and radiological differences between fixed-bearing (FB) and mobile-bearing (MB) unicompartmental knee arthroplasty (UKA) in the treatment of medial compartment knee osteoarthritis (OA), and to provide evidence for clinical prosthesis selection. Methods Clinical data of 41 patients with unilateral medial compartment knee OA were retrospectively analyzed. The FB group comprised 20 patients (using Chunli XG prosthesis), and the MB group comprised 21 patients (using Chunli XK prosthesis). Knee range of motion (ROM), Visual Analogue Scale (VAS) pain score, and Hospital for Special Surgery (HSS) knee score were compared between the two groups preoperatively, postoperatively, and at the final follow-up. Femorotibial angle (FTA), tibial component valgus angle (TCVA), and tibial component posterior slope angle (TCPSA) were measured and compared. Perioperative indicators and complications were recorded. Results Postoperative ROM, VAS, and HSS scores significantly improved compared with preoperative values in both groups (all P < 0.0001). At the final follow-up, the VAS score in the FB group was significantly lower than that in the MB group (P < 0.05), while no significant differences were observed in ROM or HSS scores between the two groups (all P > 0.05). Postoperative FTA, TCVA, and TCPSA values returned to the ideal range in both groups, with no significant intergroup differences (all P > 0.05). The FB group had a significantly shorter operative time (P < 0.05). No severe complications occurred in either group, and the prosthesis survival rate was 100% in both groups. Conclusion Both FB-UKA and MB-UKA significantly improve pain, range of motion, and function in patients with medial compartment knee OA, with comparable efficacy in restoring lower limb alignment. The FB prosthesis offers advantages in pain control and surgical convenience. Clinical selection may be individualized based on patient characteristics and surgeon experience. Keywords Unicompartmental knee arthroplasty; Mobile-bearing prosthesis; Fixed-bearing prosthesis; Osteoarthritis; Complications

目的 探讨固定平台（FB）与活动平台（MB）单髁置换术（UKA）治疗膝关节内侧间室骨关节炎（OA）的早期临床疗效及影像学差异，为临床假体选择提供依据。 方法 回顾性分析41 例单侧膝关节内侧间室骨关节炎患者临床资料，其中 FB 组 20例（采用春立XG假体），MB 组 21 例（采用春立XK假体）。比较两组患者术前、术后和末次随访的膝关节活动度（ROM）、疼痛视觉模拟评分（VAS）、美国特种外科医院膝关节评分（HSS）；测量并比较股胫角（FTA）、胫骨假体内外翻角（TCVA）、胫骨假体后倾角（TCPSA）；记录围手术期指标及并发症情况。 结果 两组患者术后ROM、VAS、HSS 评分均较术前显著改善（P均<0.0001）；末次随访时固定平台组 VAS 评分显著低于活动平台组（P<0.05），ROM、HSS 评分两组差异无统计学意义（均 P>0.05）。两组术后 FTA、TCVA、TCPSA 均恢复至理想范围，组间差异均无统计学意义（均 P>0.05）。固定平台组手术时间更短（P<0.05），两组均无严重并发症，假体生存率均为 100%。 结论 固定平台与活动平台单髁置换术均可显著改善膝关节内侧间室骨关节炎患者疼痛、活动度及功能，下肢力线恢复效果相当；固定平台假体在疼痛控制与手术便捷性方面更具优势，临床可根据患者情况与术者经验个体化选择。 关键词 单髁置换术；活动平台假体；固定平台假体；骨关节炎；并发症

Abstract Objective To investigate the early clinical outcomes and radiological differences between fixed-bearing (FB) and mobile-bearing (MB) unicompartmental knee arthroplasty (UKA) in the treatment of medial compartment knee osteoarthritis (OA), and to provide evidence for clinical prosthesis selection. Methods Clinical data of 41 patients with unilateral medial compartment knee OA were retrospectively analyzed. The FB group comprised 20 patients (using Chunli XG prosthesis), and the MB group comprised 21 patients (using Chunli XK prosthesis). Knee range of motion (ROM), Visual Analogue Scale (VAS) pain score, and Hospital for Special Surgery (HSS) knee score were compared between the two groups preoperatively, postoperatively, and at the final follow-up. Femorotibial angle (FTA), tibial component valgus angle (TCVA), and tibial component posterior slope angle (TCPSA) were measured and compared. Perioperative indicators and complications were recorded. Results Postoperative ROM, VAS, and HSS scores significantly improved compared with preoperative values in both groups (all P < 0.0001). At the final follow-up, the VAS score in the FB group was significantly lower than that in the MB group (P < 0.05), while no significant differences were observed in ROM or HSS scores between the two groups (all P > 0.05). Postoperative FTA, TCVA, and TCPSA values returned to the ideal range in both groups, with no significant intergroup differences (all P > 0.05). The FB group had a significantly shorter operative time (P < 0.05). No severe complications occurred in either group, and the prosthesis survival rate was 100% in both groups. Conclusion Both FB-UKA and MB-UKA significantly improve pain, range of motion, and function in patients with medial compartment knee OA, with comparable efficacy in restoring lower limb alignment. The FB prosthesis offers advantages in pain control and surgical convenience. Clinical selection may be individualized based on patient characteristics and surgeon experience. Keywords Unicompartmental knee arthroplasty; Mobile-bearing prosthesis; Fixed-bearing prosthesis; Osteoarthritis; Complications

目的：探讨闭合复位弹性髓内钉固定术（CR-ESIN）对股骨骨折患儿康复进程及关节功能的影响。方法：回顾性选取2024年4月~2025年6月至我院行内固定术治疗的102例股骨骨折患儿为研究对象，依据手术方案不同，将行CR-ESIN治疗的51例患儿列为CR-ESIN组，将剩余51例行传统切开复位接骨板内固定术（ORIF）治疗的患儿列为ORIF组，比较两组患儿的治疗情况、康复进程，手术并发症发生情况，关节功能恢复情况及内固定物取出阶段负担。结果：在不同手术方案下，CR-ESIN组的手术耗时、术中出血量、术后住院时间、支具使用时间、完全负重时间分别为（60.29±5.44）min、（50.52±5.49）mL、（6.22±1.34）d、（4.15±1.33）周、（6.81±1.34）周，均低于ORIF组[（76.33±8.29）min、（190.48±20.51）mL、（8.17±1.65）d、（6.32±1.48）周、（7.82±2.17）周]（t=11.552，47.076，6.552，8.322，2.828；P＜0.05）。CR-ESIN组的手术并发症发生率5.88%（3/51）低于ORIF组19.61%（10/51）（x2=4.320；P＜0.05）。CR-ESIN组的髋关节前屈活动度、后伸活动度、儿童下肢功能量表（PODCI）评分分别为（132.44±22.52）°、（20.39±4.47）°、（75.14±6.29）分，均高于ORIF组[（120.28±20.37）°、（17.55±3.12）°、（70.31±5.36）分]，术后双侧股骨长度差（1.52±0.39）cm低于ORIF组（3.08±0.44）cm（t=2.860，3.721，4.174，18.948；P＜0.05）。CR-ESIN组的取出手术切口长度、取出手术耗时、取出手术出血量、再骨折率均低于ORIF组（t/x2=31.706，8.298，38.448，4.883；P＜0.05）。结论：CR-ESIN能提高股骨骨折患儿手术效率并降低出血风险，与传统ORIF相比，此术式有利于加快患儿康复进程、降低术后并发症发生率、促进关节功能恢复并减轻内固定物取出阶段负担。

Objective:To explore the effects of closed reduction elastic intramedullary nail fixation (CR-ESIN) on the rehabilitation process and joint function of children with femoral fractures.Methods:A retrospective study was conducted on 102 children with femoral fractures who underwent internal fixation surgery in our hospital from April 2024 to June 2025. Based on different surgical plans, 51 children who underwent CR-ESIN treatment were included in the CR-ESIN group, and the remaining 51 children who underwent traditional open reduction plate internal fixation (ORIF) treatment were included in the ORIF group. The treatment status, rehabilitation process, incidence of surgical complications, joint function recovery, and burden during the removal of internal fixation materials were compared between the two groups of children.Results:Under different surgical plans, the surgical time, intraoperative blood loss, postoperative hospitalization time, brace use time, and complete weight-bearing time of the CR-ESIN group were (60.29 ± 5.44) min, (50.52 ± 5.49) mL, (6.22 ± 1.34) d, (4.15 ± 1.33) weeks, and (6.81 ± 1.34) weeks, lower than the ORIF group [(76.33 ± 8.29) min, (190.48 ± 20.51) mL, (8.17 ± 1.65) d, (6.32 ± 1.48) weeks, and (7.82 ± 2.17) weeks] (t=11.552，47.076，6.552，8.322，2.828; P<0.05). The incidence of surgical complications in the CR-ESIN group was 5.88% (3/51) lower than the ORIF group 19.61% (10/51) (x2=4.320; P<0.05). The hip flexion range of motion, extension range of motion, and PODCI scores of the CR-ESIN group were (132.44 ± 22.52) °, (20.39 ± 4.47) °, and (75.14 ± 6.29) points, higher than the ORIF group [(120.28 ± 20.37) °, (17.55 ± 3.12) °, and (70.31 ± 5.36) points]. The length difference between the bilateral femurs was (1.52 ± 0.39) cm, which was lower than the ORIF group (3.08 ± 0.44) cm (t=2.860，3.721，4.174，18.948; P<0.05). The length of the surgical incision, the duration of the extraction surgery, the amount of bleeding during the extraction surgery, and the rate of re fracture in the CR-ESIN group were all lower than the ORIF group (t/x2=31.706，8.298，38.448，4.883; P<0.05).Conclusion:CR-ESIN can improve the surgical efficiency and reduce the risk of bleeding in children with femoral fractures. Compared with traditional ORIF, this procedure is beneficial for accelerating the recovery process of children, reducing the incidence of postoperative complications, promoting joint function recovery, and reducing the burden of internal fixation removal stage.

       目的  探讨TAP水平与乳腺癌分子亚型及临床病理参数之间的相关性。方法  以2021年3月—2025年1月期间收治的150例乳腺癌病例为样本，采用静脉采血方式测定TAP凝聚物表面积指标，通过免疫组织化学EnVision双步染色技术，对雌激素受体（ER）、雄激素受体（AR）、孕激素受体（PR）、Ki-67及p53等表达水平进行分析，采用荧光原位杂交（FISH）对人表皮生长因子受体2（HER2）基因扩增状态进行检测。结果  150例患者中，TAP强阳性131例，TAP弱阳性15例，TAP阴性4例，TAP阳性率97.33%。免疫表型：ER阴性43例，ER阳性107例；AR阳性133例，AR阴性17例；PR阴性60例，PR阳性90例；p53阳性73例，p53阴性77例；HER2强阳性41例，HER2弱阳性89例，HER2阴性20例；Ki-67增殖指数≥20% 116例，Ki-67增殖指数＜20% 34例。FISH对65例免疫组织化学检测结果为HER2（2+ ）的乳腺癌病例进行基因扩增状态分析，其中阳性7例，阴性58例。Ki-67高增殖组TAP表达水平显著高于低增殖组（P＜0.05）；不同临床分期患者TAP表达水平存在差异（P＜0.05）；三阴型、HER2阳性型、Luminal A型和Luminal B型的患者之间的TAP表达水平存在差异（P＜0.05），各分子分型（HER2阳性型、三阴型、Luminal A型和Luminal B型）与其对应非分型组的TAP表达均无统计学差异（均P＞0.05）。结论  TAP在乳腺癌中广泛表达，且与Ki-67增殖指数、临床分期呈正相关。虽然不同分子分型间TAP表达存在总体差异，但具体亚型对比未显示显著性，后期需扩大样本量验证。

       Objective  To explore the relationship between tumor abnormal protein（TAP）level and molecular typing and clinicopathological features of breast cancer．Methods  A total of 150 breast cancer cases admitted from March 2021 to January 2025 were enrolled in this study．The surface area of TAP condensates was measured using venous blood samples．The expression levels of estrogen receptor（ER），androgen receptor（AR），progesterone receptor（PR），Ki-67，and P53 were analyzed via immunohistochemistry（IHC）using the EnVision two-step staining technique．The amplification status of the human epidermal growth factor receptor 2（HER2+）gene was determined using fluorescence in situ hybridization（FISH）．Results  Among 150 patients，131 cases were strongly positive，15 cases were weakly positive and 4 cases were negative，with a positive rate of 97.33%．Immunophenotype：ER positive in 107 cases and ER negative in 43 cases，133 cases were  positive for AR and  17 cases were negative，PR was positive in 90 cases and negative in 60 cases，73 cases were positive for p53 and 77 cases were negative．HER2 is strongly positive in 41 cases，weakly positive in 89 cases and negative in 20 cases．There were 116 cases with Ki-67 proliferation index ≥ 20% and 34 cases with Ki-67 proliferation index ＜ 20%．Sixty-five cases of breast cancer HER2（2 ）were detected in the later stage．by FISH，of which 7 cases were positive and 58 cases were negative．The expression level of TAP in patients with high Ki-67 proliferation index was higher than that in patients with low Ki-67 proliferation index（P＜0.05）．The expression level of TAP in patients with different clinical stages was different（P＜0.05）．There were differences in TAP expression levels among patients with triple negative type，HER2 positive type，Luminal A type and Luminal B type（P＜0.05）．There was no statistical difference in TAP expression between each molecular type（triple negative type，HER2 positive type，Luminal A type and Luminal B type）and its corresponding non-typing group（all P＞0.05）．Conclusions  TAP is widely expressed in breast cancer，and it is positively correlated with Ki-67 proliferation index and clinical stage．Although there is a general difference in TAP expression among different molecular typing，the comparison of specific subtypes shows no significance，and it needs to be verified by expanding the sample size 

       目的 汇总分析肝硬化患者消化道出血风险预测模型，为今后模型的建立和优化提供参考。方法   系统检索中国知网、维普、PubMed数据库在2025年4月22日前公开发表的所有肝硬化患者消化道出血风险预测模型，按纳入标准筛选文献，对最终纳入文章分析摘录并系统汇总，包括模型特征、危险因素及模型预测评估效果等信息。结果   共检索3 603篇预测模型相关研究论文，最终纳入30篇，其中中国27篇、韩国1篇、印度1篇、埃及1篇。22项研究收集了肝硬化病因，其中病毒性肝病最多（72.94%，2 922/4 006），药物性肝病及非酒精性脂肪性肝病最少（均为0.02%，1/4 006）。在研究类型上，有28篇单中心研究，2篇为多中心研究，其中有12个模型未进行验证，只有1个模型进行了外部验证，其余模型只进行了内部验证，曲线下面积（AUC）范围0.680~0.994。根据模型纳入因素特点，分为血常规指标、凝血指标、生化指标、影像学指标、复合指标、其他指标共6种，其中纳入因素最多为影像学指标，最少为凝血指标。在纳入危险因素中，第1位为门静脉直径，第2位为血小板计数，第3位为血红蛋白水平及脾脏硬度，所有因素中与脾脏相关的指标最多。结论   肝硬化患者消化道出血风险预测模型研究质量有待提升，影像学指标应用最广，脾脏相关指标重要性突出，门静脉直径、血小板计数、血红蛋白水平及脾脏硬度为最常用的危险预测因素。

       Objective  To  summarize and analyze the  prediction models for gastrointestinal  bleeding  risk in  patients with cirrhosis，providing references for the establishment and optimization of future models．Methods  A systematic search was conducted in CNKI，VIP，and PubMed for all published prediction models for gastrointestinal bleeding risk in patients with cirrhosis before April 22，2025．Articles were screened according to the inclusion criteria，and the finally included articles were analyzed and summarized，including model characteristics，risk factors，and model prediction evaluation effects．Results  A total of 3 603 related research papers on prediction models were initially retrieved，and 30 were finally included，with 27 from China，one from South Korea，one from India，and one from Egypt．Among the 22 studies that collected the etiology of cirrhosis，viral hepatitis was the most common（72.94%，2 922/4 006），while drug-induced liver disease and non-alcoholic fatty liver disease were the least common（0.02%，1/4 006）．In terms of study type，28 were single-center studies and two were multicenter studies．Among them，12 models were not validated，only one model was externally validated，and the rest were only internally validated，with an area under the curve range of 0.680-0.994．According to the characteristics of the factors included in the models，they were divided into six types of indicators：blood routine，coagulation，biochemistry，imaging，composite，and others，among which imaging indicators were the most common and coagulation indicators were the least．In the included risk factors，the first was portal vein diameter，the second was platelets count，and the third was hemoglobin level and spleen stiffness，with the most factors related to the spleen．Conclusions  The quality of studies on prediction models for gastrointestinal bleeding risk in cirrhosis patients needs to be improved．Imaging indicators are the most widely used，and spleen-related indicators are of prominent importance，with portal vein diameter，platelets count，hemoglobin level，and spleen stiffness being the most commonly used risk prediction factors．

       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． 

       铁死亡是一种以铁依赖性脂质过氧化为特征的程序性细胞死亡形式。近年来研究表明，铁死亡与缺氧应答的关键调控因子——缺氧诱导因子（HIF）存在密切关联。HIF（包括HIF-1α、HIF-2α、HIF-3α三种亚型）调控的铁死亡在结直肠癌、胃癌、溃疡性结肠炎及其他胃肠黏膜损伤性疾病中发挥作用，影响疾病的发生发展。但目前关于HIF-铁死亡通路在不同胃肠道疾病中的差异化作用及调控机制尚未完全阐明。因此，本文对HIF各亚型调控铁死亡的分子机制及其在胃肠道疾病中的作用进行综述，以期为靶向HIF-铁死亡通路治疗相关疾病提供新的思路。

       Ferroptosis is a form of regulated cell death characterized by iron-dependent lipid peroxidation．Recent 

studies have demonstrated a close association between ferroptosis and hypoxia-inducible factor（HIF），the key  regulator of the hypoxic response．Ferroptosis regulated by HIF（comprising three isoforms：HIF-1α，HIF-2α，and HIF-3α）plays a  role in colorectal cancer，gastric cancer，ulcerative colitis，and other gastrointestinal mucosal injury diseases，impacting their initiation and progression．However，the differential roles and regulatory mechanisms of the HIF-ferroptosis pathway in various gastrointestinal diseases remain incompletely elucidated．Therefore，this  review  summarizes the molecular mechanism networks through which individual HIF isoforms regulate ferroptosis and their roles in gastrointestinal diseases，with the aim of providing new perspectives for targeting the HIF-ferroptosis pathway to treat relevant diseases．

       目的   通过总结分析我国华东五省市紧密型城市医疗集团的实践经验，为全面推进紧密型城市医疗集团建设，促进区域内医疗资源的优化整合和高效利用提供借鉴和参考。方法   采用内容分析法从责权协同、资源协同、业务协同和机制协同四个维度对上海闵行、浙江湖州、江苏淮安、安徽铜陵、山东青岛五个紧密型医疗集团建设的实践经验进行梳理和对比分析。结果   各地区医疗集团建设总体具备政府主导，集团共建，一体化管理、同质化服务等紧密型医疗集团特点，但存在权责归属失配、利益分配机制缺失、信息化建设不均衡、基层服务能力不足、一体化管理不全面、机制协同有待加强等问题。结论   建议通过完善治理体系、均衡利益分配、强化数字赋能、推进强基提能、落实配套政策等措施，切实推动紧密型城市医疗集团高质量发展。

       Objective  To  summarize  and  analyze the  practical  experience  of  compact  city medical  groups in five provinces and cities in East China，for reference of promoting the construction of compact city medical groups，and promoting the optimization，integration and efficient utilization of medical resources in the region．Methods  The content analysis method was used to sort out and compare the practical experience of building such compact medical groups in Shanghai Minhang，Zhejiang Huzhou，Jiangsu Huai’an，Anhui Tongling and Shandong Qingdao from the four dimensions of responsibility and power synergy，resource synergy，business synergy and mechanism synergy．Results  Such medical groups are characterized by government-led，group co-construction，integrated management，and homogeneous services．However，there are such problems as mismatched ownership of rights and responsibilities，lack of interest distribution mechanism，unbalanced information construction，insufficient primary service capacity，incomplete integrated management，and mechanism coordination to be strengthened．Conclusions  It is recommended to effectively promote the high-quality development of compact city medical groups by improving the governance system，balancing the distribution of interests，strengthening digital empowerment，promoting the strengthening of energy，and implementing supporting policies．