目的 基于SEER数据库分析三阴性乳腺癌（TNBC）的预后,并建立Cox回归临床预测模型且进行内部验证。方法 使用SEER*Stat软件（8.4.2版）筛选2010—2015年诊断为TNBC的病例,进行单因素和Cox多因素回归以及向后逐步回归分析,明确与生存相关的独立危险因素,构建预测TNBC患者3年和5年癌症特异生存（CSS）率的Nomogram图,并用受试者工作特征曲线,Harrell’s一致性指数,临床预测模型校准曲线以及决策曲线对该模型进行评估及内部验证,以评估该模型的临床预测效能。结果 共筛选出符合纳入标准的TNBC患者5 564例,按照7∶3的比例随机拆分为训练集（n=3 894）和验证集（n=1 670）。通过单因素,多因素分析显示TNM分期、放射治疗、化学治疗以及手术和其他治疗的先后顺序是与TNBC患者CSS显著相关的独立危险因素（P<0.05）。利用上述预后相关因素建立Nomogram图模型。训练集的C-index为0.731（95%CI：0.712~0.749）,验证集的C-index为0.719（95%CI：0.688~0.749）,训练集和验证集3年和5年生存ROC曲线的曲线下面积均>0.7,区分度较好,且校准曲线拟合良好。结论 TNM分期、放射治疗、化学治疗以及手术和其他治疗的先后顺序是TNBC的独立预后因素,基于此建立的Nomogram图临床预测模型区分度、准确度以及临床适用性较好,能较好地预测TNBC患者的生存预后。

Objective To analyze the prognosis of triple negative breast cancer（TNBC）based on the SEER database,and to establish a Cox regression clinical prediction model with internal validation．Methods Cases diagnosed with TNBC from 2010 to 2015 were screened using SEER*Stat software（version 8.4.2）,and univariate and Cox multifactorial regression as well as backward stepwise regression analyses were performed to identify the independent risk factors associated with survival,and to construct a clinical prediction model for predicting the three- and five-year cancer specific survival（CSV）of TNBC patients．Survival（CSS）rates of TNBC patients at 3 and 5 years,and the model was evaluated and internally validated using the ROC curve,Harrell’s consistency index（C-index）,clinical prediction model calibration curve,and decision-making curve（DCA curve）to assess the predictive efficacy of the model for clinical prediction．Results A total of 5 564 TNBC patients meeting the inclusion criteria were screened and randomly split into a training set（n=3 894）and a validation set（n=1 670）according to a 7∶3 ratio．By univariate,multivariate analysis showed that T-stage,N-stage,M-stage,radiotherapy,chemotherapy,and the sequence of surgery and other treatments were independent risk factors significantly associated with CSS in TNBC patients．The above prognostic-related factors were utilized to build a Nomogram plot model．The C-index was 0.731（95%CI：0.712-0.749）for the training set and 0.719（95%CI：0.688-0.749）for the validation set,and the areas under the curves of the 3- and 5-year survival ROC curves of both the training and validation sets were >0.7,which was a good differentiation,and the calibration curves were well-fitted．Conclusions T-stage,N-stage,M-stage,radiotherapy,chemotherapy,and the sequence of surgery and other treatments are independent prognostic factors for TNBC,and the Nomogram clinical prediction model based on this has good differentiation,accuracy,and clinical utility,and can better predict the survival prognosis of TNBC patients．

目的 评估医院-社区-家庭一体化康复护理模式对慢性创面患者生活质量及创面愈合的潜在影响。方法 选择2023年1月—2024年6月在广州市第一人民医院接受治疗的慢性创面患者80例作为研究对象,所有患者在住院期间均接受基于溃疡面积、深度及是否合并感染等因素的综合治疗,包括彻底清创、创缘处理、负压治疗、感染控制等治疗,并接受常规护理。出院前,通过随机数字表法将患者分为两组,每组40例。两组患者在住院期间均接受常规护理,出院后,对照组接受延续护理并定期复查。干预组40例患者在出院后接受医院-社区-家庭一体化康复护理模式。入组时及护理3个月后,使用生活质量调查表（SF-36）对患者生活质量和创面愈合率进行评估。结果 干预组创面愈合率为（32.61±4.26）%,高于对照组（11.48±1.04）%,差异具有统计学意义（t=19.473,P<0.05）。两组患者在护理3个月后的数字评定量表评分和创面疼痛频率评分均较入组时降低（P<0.05）。其中干预组护理3个月后的创面VAS评分为（1.82±0.17）分,创面疼痛频率评分为（1.28±0.25）分;而对照组分别为（3.91±0.22）分和（2.63±0.37）分,干预组低于对照组（P<0.05）。此外,干预组在护理后3个月的总体健康、生理功能、生理职能、精神健康、情感功能、社会功能评分均高于对照组（P<0.05）。在居家3个月期间,干预组的感染发生率为5.00%,而对照组为17.50%,干预组感染发生率低于对照组（χ²=3.781,P<0.05）。结论 本研究表明,医院-社区-家庭一体化康复护理模式干预能够促进慢性创面患者的创面愈合,降低居家期间感染的风险,并提升患者的生活质量。

Objective To assess the potential impact of the integrated hospital-community-home rehabilitation nursing model on the quality of life and wound healing in patients with chronic wounds．Methods A total of 80 patients with chronic wounds treated at the Guangzhou First People’s Hospital from January 2023 to June 2024 were selected as the study subjects．All patients received comprehensive treatment during their hospital stay,including thorough debridement,edge treatment,vacuum therapy,infection control and routine nursing care．Prior to discharge,the patients were randomly divided into two groups using a random number table,with 40 patients in each group．Both groups received routine nursing care during their hospital stay,and the control group received continuing nursing care and regular follow-up after discharge．Forty patients in the intervention group received the integrated hospital-community-home rehabilitation nursing model after discharge．Quality of life（QoL）and wound healing rates were assessed using the Short Form 36（SF-36）questionnaire at the time of enrollment and 3 months after nursing．Results The wound healing rate in the intervention group was significantly higher than that in the control group （[32.61±4.26]% vs [11.48±1.04]%）,with a statistical difference（t=19.473,P<0.05）．The numerical rating scale（NRS）scores and frequency of wound pain scores decreased in both groups 3 months after nursing compared to the enrollment period（P<0.05）．Specifically,the VAS score for wound pain in the intervention group 3 months after nursing was（1.82±0.17）,and the frequency of wound pain was（1.28±0.25）,in the control group,these scores were（3.91±0.22）and（2.63±0.37）,respectively,with the intervention group scoring significantly lower than the control group（P<0.05）．Furthermore,the scores for overall health,physical function,role physical,mental health,emotional function,and social function in the intervention group were higher than those in the control group 3 months after nursing（P<0.05）．During the 3-month home recovery period,the incidence of infection in the intervention group was 5.00%,whereas it was 17.50% in the control group,with the intervention group showing a lower incidence of infection（χ²=3.781,P<0.05）．Conclusions This study demonstrates that the hospital-community-home integrated rehabilitation care model intervention can promote wound healing in chronic wound patients,reduce the risk of infection during home care,and significantly improve patients’ quality of life．

目的 探讨CT、MRI影像学表现对原发性肝细胞癌（HCC）微血管侵犯（MVI）的诊断价值。方法 选取2018年1月—2024年7月江门市第二人民医院（江门市中心医院蓬江分院）和江门市中心医院120例（共158个病灶）HCC患者,均行上腹部CT、MRI平扫+增强及弥散加权成像（DWI）检查;以术后病理结果为金标准。比较CT、MRI平扫+增强及DWI对HCC MVI诊断效能;分析HCC MVI诊断中CT、MRI平扫+增强及DWI检查与术后病理确诊结果之间的一致性;比较HCC MVI与无HCC MVI患者影像学表现及表观扩散系数（ADC）值。结果 DWI检查对HCC MVI的诊断效能（灵敏度、特异度、准确度、阳性预测值、阴性预测值）均显著性高于CT、MRI平扫+增强（P<0.05）;CT、MRI、DWI对原发性肝细胞癌患者微血管侵犯的诊断效能比较,差异均无统计学意义（P>0.05）。在HCC MVI诊断效能中,CT、MRI影像学表现与术后病理确诊结果之间为中度一致性;DWI与术后病理确诊结果之间为高度一致性。HCC MVI患者的强化方式在非边缘动脉期强化、强化包膜、晕状强化、结中结、门脉分支癌栓占比均显著性高于无HCC MVI患者（P<0.05）。在不同b值（400、800、1 000、1 500 s/mm²）下,HCC MVI患者的ADC值均显著性高于无HCC MVI患者（P<0.05）。结论 CT、MRI平扫+增强及DWI对HCC MVI均具有较好的诊断效能,而MRI诊断结果与病理诊断一致性更佳,尤其DWI图中ADC值可更加精准地判断HCC的患者是否发生微血管侵犯,有助于指导临床医生建立“个体化”精准诊疗策略。

Objective To explore the diagnostic value of CT and MRI imaging manifestations for microvascular invasion（MVI）in primary hepatocellular carcinoma（HCC）．Methods A total of 120 patients（158 lesions in total）with HCC in the Second People’s Hospital of Jiangmen（Pengjiang Branch of Jiangmen Central Hospital）and Jiangmen Central Hospital were selected from January 2018 to July 2024,all underwent CT and MRI plain + enhanced and diffusion-weighted imaging（DWI）of the upper abdomen;postoperative pathology Results was used as the diagnostic gold standard．The diagnostic efficacy of CT,MRI plain + enhanced and DWI for HCC MVI was compared．The concordance among CT,MRI plain + enhanced and DWI examinations with postoperative pathological diagnostic findings in the diagnosis of HCC MVI．Imaging manifestations and apparent diffusion coefficient（ADC）values in patients with and without HCC MVI were compared．Results Diagnostic effectiveness of DWI examination for HCC MVI（sensitivity,specificity,accuracy,positive predictive value,negative predictive value）were all significantly higher than those of CT and MRI plain + enhanced（P<0.05）;none of the differences were statistically significant（P>0.05）in the comparison of diagnostic effectiveness of CT,MRI,and DWI for the diagnosis of MVI in patients with primary HCC．In HCC MVI diagnostic effectiveness,moderate concordance was found among CT,MRI imaging phenotypes and postoperative pathology Results;high concordance was found between DWI and postoperative pathology Results．In HCC MVI patients,the proportion of non-marginal arterial reinforcement,enhanced envelope,halo reinforcement,nodal in nodal and portal branch cancer thrombi was significantly higher than that in patients without HCC MVI（P<0.05）．At different b-values（400,800,1 000,1 500 s/mm²）,ADC values were all significantly higher in patients with HCC MVI than in patients without HCC MVI（P<0.05）．Conclusions CT,MRI plain + enhanced and DWI have good diagnostic effectiveness for HCC MVI,while MRI diagnostic Results are in better concordance with pathologic diagnosis．In particular,ADC values in DWI maps can more accurately determine whether MVI occurs in patients with HCC,which helps to guide clinicians to establish“individualized”and precise diagnosis and treatment strategies．

目的 探讨单克隆免疫球蛋白血症患者M蛋白质量浓度检测的临床意义。方法 选取2018年6月—2023年6月龙岩人民医院收治的88例单克隆免疫球蛋白血症患者为研究对象,其中意义未明单克隆免疫球蛋白血症（MGUS）21例,具有肾脏意义单克隆免疫球蛋白血症（MGRS）50例,血液系统恶性肿瘤17例。对比其M蛋白质量浓度及临床实验室相关指标表达水平,采用Spearman相关分析法分析临床实验室相关指标的与M蛋白的相关性,对所有患者进行半年随访,以预后情况作为因变量,纳入Logistics回归模型分析M蛋白质量浓度对单克隆免疫球蛋白血症预后的预测价值。结果 不同病种M蛋白水平分别为（2.42±0.55）（2.57±0.64）（4.36±0.64）g/L、24 h尿蛋白分别为（1.45±0.16）（2.98±0.68）（2.43±0.44）g/24 h、血清白蛋白质量浓度分别为（31.01±3.06）（35.03±5.04）（39.05±7.08）g/L、总胆固醇水平分别为（3.42±1.25）（3.87±0.64）、（4.16±0.64）mmol/L、血肌酐水平分别为（114.35±23.23）（81.18±12.12）（146.36±21.12）μmol/L、血红蛋白质量浓度分别为（148.12±15.26）（141.69±12.15）（133.34±15.31）g/L,组间对比差异均有统计学意义（F分别为23.890,19.700,12.044,25.767,36.572,10.267,P<0.05）。MGUS患者24h尿蛋白与M蛋白有相关性（r=-0.384,P=0.033）,24 h尿蛋白、血清白蛋白、总胆固醇、血肌酐与MGRS患者M蛋白有相关性（r=-0.586,P=0.006;r=0.431,P=0.018;r=-0.457,P=0.020;r=0.523,P=0.009）,血清白蛋白、总胆固醇、血红蛋白与血液系统恶性肿瘤患者M蛋白有相关性（r=0.374,P=0.029;r=-0.617,P=0.001;r=-0.414,P=0.024）;年龄、M蛋白为单克隆免疫球蛋白血症患者预后的影响因素（P<0.05）。结论 不同单克隆免疫球蛋白血症患者M蛋白水平存在差异,其中血液系统恶性肿瘤患者的M蛋白水平最高,且M蛋白为单克隆免疫球蛋白血症预后的独立影响因素。

Objective To explore the clinical significance of detecting M protein concentration in patients with monoclonal gammopathy．Methods From June 2018 to June 2023,88 patients with monoclonal gammopathy admitted to the hospital were selected as the study subjects．Among them,21 cases of monoclonal gammopathy with undetermined significance（MGUS）,50 cases of monoclonal gammopathy with renal significance（MGRS）,and 17 cases of hematological malignancies were selected． Concentration of M protein and the expression levels of clinical laboratory related indicators were compared,Spearman correlation analysis was used to analyze the correlation between clinical laboratory related indicators and M protein．All patients were followed up for six months,with prognosis as the dependent variable,included in the logistic regression model to analyze the predictive value of M protein concentration on the prognosis of monoclonal gammopathy．Results There were significant differences in the expression levels of M protein（[2.42±0.55],[2.57±0.64],[4.36±0.64]）g/L,24-hour urine protein（[1.45±0.16],[2.98±0.68],[2.43±0.44]）g/24 h,serum albumin（[31.01±3.06],[35.03±5.04],[39.05±7.08]）g/L,total cholesterol（[3.42±1.25],[3.87±0.64],[4.16±0.64]）mmol/L,blood creatinine（[114.35±23.23],[81.18±12.12],[146.36±21.12]）μmol/L,and hemoglobin（[148.12±15.26],[141.69±12.15],[133.34±15.31]）g/L among different diseases（F=23.890,19.700,12.044,25.767,36.572,10.267;P<0.05）．There was a significant correlation between 24 h urinary protein and M protein in MGUS patients（r=-0.384,P=0.033）．Urinary protein,serum albumin,serum cholesterol and blood creatinine were significantly associated with M protein in MGRS patients（r=-0.586,P=0.006;r=0.431,P=0.018;r=-0.457,P=0.020;r=0.523,P=0.009）,Serum albumin,total cholesterol,and hemoglobin were significantly associated with M protein in patients with hematological malignancies（r=0.374,P=0.029;r=- 0.617,P=0.001;r=-0.414,P=0.024;P<0.05）．Age and M protein were independent risk factors for the prognosis of patients with monoclonal gammopathy（P<0.05）．Conclusions There are significant differences in the concentration of M protein among patients with different levels of monoclonal gammopathy,with the highest level observed in patients with hematological malignancies．M protein is an independent prognostic factor for monoclonal gammopathy．

目的本文聚焦DeepSeek这一国产人工智能技术,结合护理临床实践,系统探讨其在护理场景中的应用潜力、现存问题及应对策略。方法检索国内外相关文献,与现有通用人工智能技术对比,进行综述,并提出思考和建议。结果预计DeepSeek在护理文书自动化、个性化护理方案生成、临床决策支持、护理质控及教育培训等提供适配应用路径,针对性的服务和解决方案等。结论DeepSeek可通过多模态技术整合与跨平台互补策略,推动护理服务向智能化、精准化方向发展,为缓解护理人力短缺、优化资源分配提供新思路。

ObjectiveThis study focuses on DeepSeek,a domestic artificial intelligence technology,systematically exploring its application potential,existing issues,and targeted strategies in nursing clinical scenarios through integration with practical nursing care contexts．MethodsRelevant literatures from both domestic and international sources were collected,compared with existing Artificial General Intelligence（AGI）technologies,to conduct a review,and propose reflections and recommendations．ResultsThrough literature review and technical comparisons,the results proposed specific application paths for DeepSeek in scenarios such as automated nursing documentation,personalized care plan generation,clinical decision support,quality control,and education．It further addressed issues including data privacy,ethical risks,and technical limitations．ConclusionsThe findings suggest that DeepSeek can integrate multimodal technologies and cross-platform complementary strategies to promote intelligent and precise nursing services,offering innovative solutions to alleviate nursing shortages and optimize resource allocation．

目的 探讨电子计算机断层扫描（CT）增强碘对比剂急性不良反应发生及影响因素分析。方法 选取天津市肿瘤医院空港医院2020年10月—2023年10月收治的100例行CT增强出现碘对比剂急性不良反应的患者进行回顾性分析,将其分为观察组,另选取同期在我院行CT增强检查未发生不良反应的100例患者作为对照组。分析观察组患者碘对比剂急性不良反应情况,对比两组患者临床资料及碘对比剂注射情况,以急性不良反应作为因变量（发生急性不良反应=1,未发生急性不良反应=0）纳入Logistic回归模型,分析CT增强碘对比剂急性不良反应发生的独立影响因素。结果 100例发生碘对比剂急性不良反应的患者中轻度65例（65.00%）,中度34例（34.00%）,重度1例（1.00%）;观察组与对照组性别、年龄、体质指数（BMI）、高血压史、糖尿病史、心功能不全史、甲状腺功能亢进史、冠状动脉粥样硬化性心脏病史、碘对比剂使用史、食物过敏史对比差异无统计学意义（P>0.05）,观察组与对照组哮喘史（9.00% vs 2.00%）、肾功能不全史（13.00% vs 3.00%）、碘对比剂不良反应发生史（21.00 % vs 2.00%）、花粉过敏史（12.00% vs 4.00%）、药物过敏史（26.00% vs 7.00%）及其他过敏史（10.00 % vs 2.00%）,对比差异有统计学意义（χ²=4.710,P=0.030;χ²=6.790,P=0.009;χ²=17.740,P<0.001;χ²=4.350,P=0.037;χ²=13.100,P<0.001;χ²=5.670,P=0.017）;观察组与对照组碘对比剂剂量对比差异无统计学意义（P>0.05）,观察组与对照组碘对比剂注射速度（<3 mL/min为55.00% vs 69.00%;≥3 mL/min为45.00% vs 31.00%）、碘对比剂类型（碘克沙醇为34.00% vs 34.00%,碘佛醇为47.00% vs 30.00%,碘海醇为19.00% vs 36.00%）对比差异有统计学意义（χ²=4.160,P=0.041;χ²=9.010,P=0.011）;肾功能不全史、碘对比剂不良反应发生史、药物过敏史、其他过敏史、碘对比剂注射速度为发生碘对比剂急性不良反应的影响因素（P<0.05）。结论 CT增强碘对比剂急性不良反应多以轻度为主,且以往合并肾功能不全、碘对比剂不良反应发生史、药物过敏史、其他过敏史、碘对比剂注射速度过高可能为碘对比剂不良反应发生的影响因素。

Objective To explore the occurrence and influencing factors of acute adverse reactions of iodine contrast agents in enhanced computed tomography（CT）. Methods A retrospective analysis was conducted on 100 patients admitted to our hospital from October 2020 to October 2023 who experienced acute adverse reactions to iodine contrast agents during CT enhancement．They were divided into an observation group and another 100 patients who underwent CT enhancement examination in our hospital during the same period without any adverse reactions were selected as the control group．The acute adverse reactions of iodine contrast agent in the observation group of patients were analyzed,the clinical data and injection of iodine contrast agent between the two groups of patients were compared,and include acute adverse reactions as the dependent variable（occurrence of acute adverse reactions=1,absence of acute adverse reactions=0）was used in the Logistic regression model to analyze the independent influencing factors of acute adverse reactions of CT enhanced iodine contrast agent．Results Among the 100 patients who experienced acute adverse reactions to iodine contrast agents,65 were mild reactions,accounting for 65.00%,34 cases had were moderate reactions,accounting for 34.00%,and one cases had severe reactions,accounting for 1.00%．There was no significant difference between the observation group and the control group in gender,age,body mass index（BMI）,history of hypertension,diabetes,heart dysfunction,hyperthyroidism,coronary heart disease,use of iodine contrast agent,and food allergy（P>0.05）．The history of asthma（9.00% vs 2.00%）,renal insufficiency（13.00% vs 3.00%）,adverse reactions of iodine contrast（21.00 % vs 2.00%）,pollen allergy（12.00% vs 4.00%）,drug allergy（26.00% vs 7.00%）and other allergies（10.00 % vs 2.00%）were significantly different（χ²=4.710,P=0.030;χ²=6.790,P=0.009;χ²=17.740,P<0.001;χ²=4.350,P=0.037;χ²=13.100,P<0.001;χ²=5.670,P=0.017）．There was no significant difference in the dosage of iodine contrast agent between the observation group and the control group（P>0.05）．The injection rate of iodine contrast agent between the observation group and the control group（< 3 mL/min was 55.00% vs 69.00%;≥3 mL/min was 45.00% vs 31.00%）,and the types of iodoxanol （iodoxanol[34.00% vs 34.00%],iodoxanol[47.00% vs 30.00%],iodohexanol[19.00% vs 36.00%]） were significantly different（χ²=4.160,P=0.041;χ²=9.010,P=0.011）．History of renal insufficiency,adverse reactions to iodine contrast agents,drug allergies,other allergies,and injection speed of iodine contrast agents were independent risk factors for the occurrence of acute adverse reactions to iodine contrast agents（P<0.05）．Conclusions Acute adverse reactions to iodinated contrast agents in CT enhancement are mostly mild．Previous history of renal insufficiency,history of adverse reactions to iodinated contrast agents,history of drug allergies,other allergic histories,and high injection speed of iodinated contrast agents may be influencing factors for the occurrence of adverse reactions to iodinated contrast agents．

目的 分析贝伐珠单抗与化疗对晚期结直肠癌患者4种错配修复蛋白（MSH2、MLHI、MSH6、PMS2）水平影响。方法 选择2022年1月—2024年1月江苏省宿迁市中医院肿瘤科102例晚期结直肠癌患者,按抽签法分成两组,即化疗组及联合组,各51例。化疗组应用FOLFOX（亚叶酸钙+奥沙利铂+氟尿嘧啶）方案进行化疗,联合组采取贝伐珠单抗联合FOLFOX方案治疗。对比其肿瘤控制效果、免疫功能及MSH2、MLHI、MSH6和PMS2水平变化,并对比组间不良反应发生率。结果 联合组客观缓解率、疾病控制率高于化疗组（P<0.05）;治疗后联合组患者CD4⁺、CD3⁺、CD8⁺、和CD4⁺/CD8⁺数值高于化疗组,且两组治疗后均低于治疗前（P<0.05）;治疗后两组患者MSH2、MLHI、MSH6和PMS2缺失率对比无统计学意义（P>0.05）,但其阳性、阴性表达情况对比差异有统计学意义,联合组MSH2、MLHI、MSH6和PMS2阳性率低于化疗组（P<0.05）;两组不良反应发生率对比差异无统计学意义（P>0.05）。结论 对晚期结直肠癌在化疗基础上增加贝伐珠单抗抗肿瘤效果显著,改善其免疫功能,虽无法改善患者错配修复蛋白缺损,但可辅助降低其阳性率,且不影响安全性。

Objective To analyze the effects of bevacizumab and chemotherapy on the levels of four mismatch repair proteins（MSH2,MLHI,MSH6,PMS2）in patients with advanced colorectal cancer. Methods A total of 102 patients with advanced colorectal cancer from the Oncology Department of Suqian Traditional Chinese Medicine Hospital in Jiangsu Province from January 2022 to January 2024 were selected,and were divided into two groups according to the drawing method,namely the chemotherapy group and the combination group,with 51 patients in each group．The chemotherapy group received FOLFOX（calcium folinate+oxaliplatin+fluorouracil）regimen for chemotherapy,while the combination group received bevacizumab combined with FOLFOX regimen for treatment．Tumor control effect,immune function,and changes in MSH2,MLHI,MSH6,and PMS2 levels,and its incidence of adverse reactions were compared．Results The objective remission rate and disease control rate of the combined group were higher than those of the chemotherapy group（P<0.05）．After treatment,the CD4⁺,CD3⁺,CD8⁺ and CD4⁺/CD8⁺ values in the combination group were higher than those in the chemotherapy group,and those after treatment were lower than those before treatment in both groups（P<0.05）．After treatment,there were no significant differences in the deletion rates of MSH2,MLHI,MSH6,and PMS2 between the two groups of patients（P>0.05）,but there was a significant difference in their positive and negative expression．The positive rates of MSH2,MLHI,MSH6,and PMS2 in the combination group were lower than those in the chemotherapy group（P<0.05）．There was no significant difference in the incidence of adverse reactions between the two groups（P>0.05）．Conclusions Adding bevacizumab on the basis of chemotherapy has a significant anti-tumor effect on advanced colorectal cancer,improving its immune function．Although it cannot improve the mismatch repair protein defect in patients,it can assist in reducing its positivity rate and has high safety．

目的 对比分析钝性分离扩皮法与常规扩皮法对乳腺癌术后患者经外周静脉置入中心静脉导管（PICC）置管应用效果。方法 选取2022年4月—2024年4月在天津肿瘤医院空港医院接受治疗的120例乳腺癌术后PICC置管患者,依据随机数字表法进行分组处理。对照组60例给予常规扩皮法,观察组60例给予钝性分离扩皮法,对比两组患者扩皮结果。结果 观察组患者满意度为96.67%,对照组患者满意度为86.67%（χ²=3.927,P=0.048）;观察组患者的穿刺点血液浸湿面积分别为穿刺后即刻（0.87±0.14）cm²、1 d后（4.89±0.94）cm²以及3 d后（0.21±0.05）cm²,均低于对照组的（2.74±0.63）（9.89±2.04）（0.44±0.12）cm²,对比差异有统计学意义（t=22.444、17.243、13.704,P<0.05）;观察组患者一次性送鞘成功率为98.33%,对照组患者一次性送鞘成功率为88.33%,观察组高于对照组（χ²=4.821,P=0.028）;扩皮前两组患者的VAS评分无差异（P>0.05）,扩皮后两组患者的VAS评分均降低,且观察组（1.75±0.54）分低于对照组（3.89±1.22）分,对比差异有统计学意义（t=12.425,P<0.001）;观察组患者不良事件发生率为5.00%,对照组患者不良事件发生率为16.67%,观察组患者不良事件发生率低于对照组（χ²=4.227,P<0.05）。结论 钝性分离扩皮法能够降低穿刺点血液浸湿面积及不良事件发生率,提高一次性送鞘成功率,减轻患者疼痛感,提高患者满意度。

Objective To analyze the effect of blunt separating skin expansion and conventional skin expansion in PICC catheterization of patients after breast cancer surgery. Methods From April 2022 to April 2024,120 patients with postoperative PICC catheterization for breast cancer were selected and grouped according to the random number table method．Sixty patients in the control group received conventional skin expansion,and 60 patients in the observation group received blunt separation skin expansion,which the results of the two groups were compared．Results The patient satisfaction was 96.67% in the observation group,86.67% in the control group（χ²=3.927,P=0.048,P<0.05）．In the observation group,the blood immersion area after catheterization,after 1 d and 3 d were（0.87±0.14）,（4.89±0.94）,（0.21±0.05）cm²,lower than those of the control group [（2.74±0.63）（9.89±2.04）（0.44±0.12）cm²],the comparative difference was statistically significant（t=22.444,17.243,13.704,P<0.05）．The success rate of disposable sheath delivery in the observation group was 98.33%,which was higher than 88.33% in the control group（χ²=4.821,P=0.028<0.05）．There was no difference in VAS scores between the two groups before the intervention（P>0.05）,VAS scores decreased in both groups after the intervention,the score of the observation group（1.75±0.54）was lower than that of the control group（3.89±1.22）,the difference was statistically significant（t=12.425,P<0.001）．The incidence of adverse events in the observation group was 5.00%,and in the control group was 16.67%,which difference was significant（χ²=4.227,P<0.05）．Conclusions Blunt separating skin expansion can reduce the area of blood immersion and the incidence of adverse events,improve the success rate of disposable sheath delivery,reduce patient pain,improve patient satisfaction,and have significant clinical application value．

目的 探讨免疫治疗联合化学治疗（化疗）对晚期非小细胞肺癌（NSCLC）患者淋巴免疫及生活质量的影响,为临床进一步治疗提供参考。方法 选择2021年6月—2023年6月天津市滨海新区大港医院收治的晚期NSCLC患者120例进行研究,按抽签法分为干预组及对照组,每组60例,对照组采取单纯化疗方案,干预组采取免疫联合化疗方案,对比两组临床疗效、药物不良反应,治疗前后免疫功能（CD3⁺、CD4⁺、CD8⁺）、糖类抗原199（CA199）、糖类抗原 125（CA125）、血清癌胚抗原（CEA）水平及健康状态调查表（QOL）评分。结果 干预组患者治疗总有效率高于对照组（68.33%>41.67%,P<0.05）;治疗后干预组患者CD3⁺、CD4⁺比例高于治疗前及对照组治疗后,CD8⁺比例低于治疗前及对照组治疗后（P<0.05）;治疗后干预组血清CA199、CA125、CEA水平均低于治疗前及对照组治疗后（P<0.05）;干预组药物不良反应发生率为16.67％,对照组为36.67％,干预组低于对照组（P<0.05）;治疗后干预组QOL各维度评分高于对照组及治疗前（P<0.05）。结论 与单纯化疗相比,免疫联合化疗治疗晚期NSCLC患者,能有效降低肿瘤标志物水平,改善患者免疫指标,减轻药物不良反应,提高患者疗效及生活质量。

Objective To explore the effect of immunotherapy combined with chemotherapy on lymphatic immunity and quality of life of patients with advanced non-small cell lung cancer（NSCLC）,and to provide reference for further clinical treatment. Methods A total of 120 patients with NSCLC from June 2021 to June 2023 were selected and divided into observation group and control group evenly according to the method of drawing lots,control group was treated with chemotherapy,the observation group was treated with immunotherapy combined with chemotherapy,and the clinical efficacy and adverse drug reactions were compared between the two groups．Before and after treatment,immune function（CD3⁺,CD4⁺,CD8⁺）,carbohydrate antigen 199（CA199）,carbohydrate antigen 125（CA125）,serum carcinoembryonic antigen（CEA）levels and health status questionnaire（QOL-RRB- scores）were measured．Results The total effective rate in the observation group was significantly higher than that in the control group（68.33%>41.67%,P<0.05）．After treatment,the ratios of CD3⁺ and CD4⁺ in the observation group were significantly higher than those before treatment and control group after treatment,and the ratio of CD8⁺ was significantly lower than that before and after treatment in the control group（P<0.05）．After treatment,the serum levels of CA199,CA125 and CEA in the observation group were lower than those before and after treatment in the control group（P<0.05）．The incidence of adverse drug reactions was 16.67% in the observation group and 36.67% in the control group,which was significantly lower in the observation group than in the control group（P<0.05）．After treatment,the QOL scores in the observation group were significantly higher than those in the control group and before treatment（P<0.05）．Conclusions Compared with chemotherapy alone,immunotherapy combined with chemotherapy can effectively reduce the levels of tumor markers,improve the immune indexes of patients,reduce the adverse drug reactions,and improve the efficacy and quality of life of patients with advanced NSCLC．

目的 探讨谷氨酸对HT22细胞线粒体自噬和细胞凋亡的影响,并评估虾青素预处理的保护作用及其分子机制。方法 用谷氨酸及虾青素处理HT22细胞,通过蛋白印迹及聚合酶联反应等评估其对线粒体自噬的影响。结果 谷氨酸处理显著抑制线粒体初级自噬（PINK1、Parkin、pULK1^ser555和LC3Ⅱ）和次级自噬（LAMP1和Rab7）,上调cleaved Caspase-3的表达（P<0.05）。虾青素预处理减少细胞凋亡,恢复了线粒体自噬,PINK1、Parkin、pULK1^ser555和LC3Ⅱ的表达水平上升（分别为2.3倍、2.6倍、83.3%及81.1%）（P<0.05）,该作用被自噬抑制剂BafA1阻断。此外,谷氨酸抑制Nrf2核内转移和NLRX1表达,而预处理显著促进Nrf2的核内转移并上调NLRX1,分别上调25.8%、33.2%。生物信息学分析显示NLRX1启动子区域含有3个Nrf2结合位点,提示Nrf2通过调控NLRX1转录活性发挥作用。结论 文章首次揭示虾青素通过Nrf2/NLRX1通路激活线粒体自噬,展现神经保护作用。

Objective To explore the effects of glutamate on mitophagy and apoptosis in HT22 cells and evaluate the protective effects and molecular mechanisms of astaxanthin pretreatment．Methods HT22 cells were treated with glutamate and astaxanthin．The effects on mitophagy were assessed using Western Blot and PCR．Results Glutamate treatment significantly inhibited primary mitophagy（PINK1,Parkin,pULK1^ser555 and LC3II）and secondary mitophagy（LAMP1 and Rab7）while upregulating cleaved Caspase-3 expression．Astaxanthin pretreatment notably reduced apoptosis and restored mitophagy,the expression levels of PINK1,Parkin,pULK1^Ser555 and LC3II were significantly upregulated（by 2.3-fold,2.6-fold,83.3% and 81.1% respectively,P<0.05）,but this effect was blocked by the autophagy inhibitor BafA1．Additionally,glutamate suppressed Nrf2 nuclear translocation and NLRX1 expression,whereas astaxanthin promoted Nrf2 nuclear translocation and increased NLRX1 expression by 25.8% and 33.2%,respectively．Bioinformatics analysis revealed three Nrf2 binding sites in the NLRX1 promoter region,suggesting that Nrf2 may regulate NLRX1 transcriptional activity．Conclusions The study demonstrates that astaxanthin exhibited potential neuroprotective effect by activating mitophagy through the Nrf2/NLRX1 pathway．