目的 研究母代不同孕期巨细胞病毒（CMV）感染对自身精神及行为的影响。方法 72只BALB/c雌鼠随机分为12组（A1、A2、A3、B1、B2、B3、C1、C2、C3、D1、D2、D3,每组6只）,A为孕期再感染、B为既往感染、C为孕期原发感染、D为空白对照,1为孕早期、2为孕中期、3为孕晚期。母鼠腹腔注射小鼠CMV（murine CMV,MCMV）Smith株建立播散性感染模型,或注射无菌生理盐水建立对照模型。母鼠产仔后同笼合养,产后22 d分笼;母鼠做行为学试验。试验结束,每组随机处死3只母鼠;测量子宫、肝、脑脏器重量系数及唾液腺中MCMV含量。结果 A、B、C组母鼠产后次日体质量均低于D组（均P<0.05）,其中C2、C3组母鼠低体质量情况持续至产后22日（均P<0.05）。A、B、C组母鼠唾液腺组织均测出MCMV。与D组母鼠相比,A1、C1组母鼠活胎率降低（均P<0.05）,A、C组母鼠的子宫、肝、脑脏器系数升高（均P<0.05）且脑组织有病损表现。产后6天时,A3、B3、C组母鼠水平运动总距离和直立次数减少（均P<0.05）,糖水偏好量降低（均P<0.05）,悬尾不动时间延长（P<0.05）;其中,C2、C3组母鼠以上行为退缩情况至产后22天仍存在,且有逃避潜伏时间延长（均P<0.01）,穿越原平台位置次数减少（均P<0.01）情况。结论 孕期CMV感染损害母代身心健康,有可能增加子代不良抚养的风险。

Objective To investigate the effects of cytomegalovirus（CMV）infection in different stages of maternal pregnancy on its own spirit and behavior．Methods A total of 72 female BALB/c mice were randomly divided into 12 groups（each group had 6 mice）：A1-A3,B1-B3,C1-C3,D1-D3（group A had re-infection,group B had previous infection,group C had primary infection,group D was blank control,group 1 was in early pregnancy,group 2 was in middle pregnancy,group 3 was in late pregnancy）．The disseminative infection model was established by intraperitoneal inoculation of murine CMV（MCMV）Smith strain,and the blank control model was established by intraperitoneal inoculation of 0.9% sterile saline（NaCl）．After 21 days of parturition,the mothers and offspring were reared in separate cages,mothers were selected for the behavior experiments．At the end of all the behavior tests,3 mothers in each group were killed randomly．Weighed and calculated the organ coefficients of the uteri,livers and brains,and detected the expression levels of MCMV in salivary gland．Results On the first day after delivery,the weights of mothers in groups A,B and C were lower than those in group D（all P<0.05）,the low body weight of mice in C2 and C3 groups lasted to the 22th day（all P<0.05）．The MCMV in salivary gland tissue were found in groups A,B and C,but not in group D．The live fetus rates of groups A1 and C1 were significantly lower than that of group D．The organ coefficients of uteri,livers and brains in groups A and C were higher than those in group D（all P<0.05）．And the lesions of brain tissues in groups A and C were more serious than in the other groups．On the 6th day,compared with the other groups,the mothers of groups A3,B3 and C were significantly abnormal in the open field test,the tail suspension test and the sugar preference test（all P<0.05）．But on 22th day,only the mothers of groups C2 and C3 were significantly abnormal in those tests（all P<0.01）,and even in the water maze test（all P<0.01）．Conclusions Maternal CMV infection in different stages pregnancy have impacts on mother mice's physical and mental health．Those bad situations may bring poor parenting to the offspring．

本文综述近10年中医传统疗法中通过穴位刺激预防与治疗老年患者骨折术后谵妄的研究概况。术后谵妄是老年患者骨折术后常见的并发症,不仅延长患者住院时间、增加经济负担,同时与骨折术后死亡并发症的发生密切相关。但是本病机制尚未明确,在临床治疗上难以达成共识。针灸等穴位刺激是中医药治疗脑病的独具特色的疗法,近年来有关穴位刺激防治老年骨折术后谵妄的报道越来越多,本文主要探讨不同的穴位刺激方法干预对骨折术后谵妄发生率的影响,包括传统刺激方式如毫针、电针、穴位注射、穴位敷贴和新针疗法如耳针、头针等,认为穴位刺激能够较好预防骨折术后谵妄发生,在治疗上也有较好疗效。以期为进一步临床研究与应用提供参考。

This article summarized the research of acupoint stimulation in preventing delirium after fracture surgery in elderly patients in recent 10 years．Postoperative delirium is a common complication in elderly patients after fracture surgery, which affects life extremely and increases economic burden．However, the mechanism of this disease haven't been revealed, and it is difficult to reach consensus on clinical treatment．Acupoint stimulation, like acupuncture, is a unique treatment of encephalopathy with traditional Chinese medicine．In recent years, there are more and more reports on acupoint stimulation therapy to prevent and treat delirium after fracture surgery in the elderly．This article mainly study the influence of different acupoint stimulation therapy on treatment of delirium after fracture surgery, including electroacupuncture, auriculotherapy, scalp acupuncture, acupoint injection and acupoint application, etc．It is believed that acupoint stimulation can prevent delirium after fracture surgery, so as to provide reference for further clinical research and application．

我国结直肠癌的发病率与死亡率逐年增加,约10%~30%新发结直肠癌患者可表现为急性肠梗阻,其中梗阻发生率较高的主要部位是左半结肠。急性梗阻性左半结肠癌患者的主要治疗方式仍是急诊手术（ES）,但术后并发症发生率及围手术期死亡率较高,自膨式金属支架（SEMS）被一些指南推荐为梗阻性结肠癌的初始治疗选择,SEMS可将部分ES转变为择期手术,支架置入后择期手术（SBTS）与ES相比不仅可改善患者的短期生存结局,且支架置入后新辅助化疗为梗阻性结肠癌的治疗提供了新的途径;就长期生存结果而言,选择SBTS还是ES存在一定的争议。对于支架置入后手术时机的选择尚未达成共识,有指南表明大约两周的短桥接间隔可使患者最大程度获益,因而可有效指导临床工作。肠道支架置入术目前看来是一种简单、有效的临时性或永久性的治疗手段。

In recent years, the incidence and mortality of colorectal cancer in our country have been increasing year by year．Around 10% to 30% of newly diagnosed colorectal cancer patients showed acute intestinal obstruction, which the left colon cancer has higher incidence．Emergency surgery（ES）is still the main treatment for patients with acute obstructive left colon cancer, but the incidence of postoperative complications and perioperative mortality are high．Self-expanding metallic stents（SEMS）can convert some emergency procedures into stent as bridge to surgery（SBTS）, which is recommended by some guidelines as the initial treatment option for obstructive colon cancer．SBTS can not only improve the short-term survival outcome of patients compared with ES, but also provide a new approach for the treatment of obstructive colon cancer with neoadjuvant chemotherapy after intestinal obstruction stent placement．The choice of SBTS versus ES is somewhat controversial in terms of long-term survival outcomes．There is no consensus on the timing of surgery after stenting, and current guidelines suggest that bridging intervals of approximately two weeks strike a balance between potential adverse events and long-term outcomes．At present, intestinal stenting is still a simple, feasible and effective temporary or palliative permanent treatment with few complications．

目的 分析安氏Ⅲ类错牙合正畸治疗牙合患者中切牙牙根及牙槽骨形态变化的影响。方法 分析2020年1月—2021年12月于我院口腔科进行正畸治疗的23例安氏Ⅲ类错牙合患者基本资料,对患者予以治疗前后的对锥形束CT测量,记录并对比相关数据,分析正畸治疗对于患者中切牙牙根及牙槽骨的影响。结果 （1）治疗后牙体及牙根长度较治疗前明显减小;（2）患者在治疗后唇、舌侧牙槽骨宽度呈下降趋势,与其他位点相比,上下颌舌侧中牙槽骨更易出现牙根吸收;下颌唇侧中牙槽骨宽度增加明显;（3）治疗后唇、舌侧牙槽骨缺损高度上有所增加,骨开窗、骨开裂位点增多。结论 安氏Ⅲ类错牙合有一定概率会出现牙根吸收等损伤,定期对患者实施锥形束CT检查能够为医生提供清晰准确图像资料支持,帮助医生更好判断患者状况并及时调整和优化治疗方法,以此进一步改善患者预后。

目的 探讨与观察思维导图教育模式对肠造口患者生活质量与心理情绪的影响。方法 选择2021年5月—2022年4月本院胃肠外科收治的低位直肠癌术后患者80例为研究对象,按入院顺序随机编号,对应随机数字为偶数的分到思维导图组（n=40）,奇数的分到传统组（n=40）。传统组给予常规健康教育干预,思维导图组在传统组护理的基础上给予思维导图教育模式干预,思维导图组与传统组护理观察时间为3个月。结果 思维导图组护理期间的造口感染、坏死、水肿、出血、旁疝等并发症发生率与传统组相比都降低（P<0.05）。思维导图组与传统组护理后的焦虑与抑郁评分与护理前相比降低（P<0.05）,护理后思维导图组评分与传统组相比降低（P<0.05）。思维导图组的术后住院时间、术后排气时间、术后下床活动时间与传统组相比均减少（P<0.05）。思维导图组护理后的副作用、共性症状、尿路症状、特异躯体症状、特异心理、性功能、尿袋问题等生活质量评分与传统组相比都减少（P<0.05）。结论 思维导图教育模式在肠造口患者的应用能促进缓解心理负面情绪,促进患者康复,提高患者的生活质量,减少术后造口并发症的发生。

Objective To explore and observe the effects of mind map education mode on the quality of life and psychological emotions of patients with enterostomy．Methods From May 2021 to April 2022, 80 cases of patients with postoperative low rectal cancer who were admitted to the Gastrointestinal Surgery Department of our hospital were selected as the research subjects, and all the cases were numbered according to the random admission sequence, and those with even random numbers were assigned to the mind map group（n=40）, and odd numbers were assigned to the traditional group（n=40）．The traditional group was given routine health education intervention, the mind map group was given mind map education mode intervention additionally, and the nursing observation time of both groups was 3 months．Results The incidences of complications such as stoma bleeding, parastomal hernia, stoma necrosis, stoma edema and stoma infection during nursing in the mind map group were lower than that in the traditional group（P<0.05）．The anxiety and depression scores in both groups after nursing were significantly lower than those before nursing（P<0.05）, and the scores in the mind map group after nursing were also significantly lower than those in the traditional group（P<0.05）．The postoperative hospital stay, postoperative exhaust time, and postoperative ambulation time of the mind map group were significantly shorter than those of the traditional group（P<0.05）．The quality of life scores of common symptoms, side effects, urinary tract symptoms, specific somatic symptoms, specific psychology, urine bag problems and sexual function in the mind map group after nursing were significantly lower than those in the traditional group（P<0.05）．Conclusions The application of mind map education model in patients with enterostomy can promote the relief of psychological negative emotions, promote the recovery of patients, reduce the occurrence of postoperative complications, and improve the quality of life of patients．

目的 探索基于患者居家护理服务需求且以三甲医院为实施主体的“互联网+护理服务”模式,以期为“互联网+护理服务”的开展提供借鉴。方法 成立“互联网+护理服务”小组,基于患者需求进行平台建设,组建“互联网+护理服务”团队,经过同质化培训持证上岗,提供专科护理、母婴护理以及基础护理共25项服务内容。服务结束后,调查患者对“互联网+护理服务”的满意度。结果 截至2022年10月,该平台注册护士438名,注册患者1 000人。共开展“互联网+护理服务”居家护理服务841人次,排名前三位的服务项目是母婴护理、留置/更换鼻饲管护理、留置/更换尿管护理。患者居家服务好评率为100％,对护理服务的整体满意度为（4.86±0.22）分。患者对护士指导居家护理知识的满意度最高,为（4.89±0.33）分,对平台收费的满意度最低,为（4.12±0.78）分。结论 “互联网+护理服务”为居家护理提供了更加方便快捷的渠道,使资源利用更有效,患者认可度高。

Objective To explore the“Internet + Nursing Service”model based on the needs of patients' home care, which the grade A class 3 hospital hospital was the main institution of implementation, and to provide the reference for implementing “Internet + Nursing Service”．Methods We set up a working group, built a platform according to needs, and set up the “Internet + Nursing service”team, who worked with the certificate after homogenization training．The program provided 25 kinds of services, including specialist nursing, maternal and child care, basic nursing, provides high-quality and convenient home care services．After the service, the patients' satisfaction was investigated．Results By October 2021, the platform had 438 registered nurses and 1000 registered patients．A total of 841 people were provided with “Internet + Nursing service”home care services, and the top three services were maternal and infant care, nasal feeding tube care with indentation/replacement, and urinary tube care with indentation/replacement．The favorable rate of home service was 100%, and the overall satisfaction with nursing services was（4.86±0.22）points．Patients had the highest level of satisfaction with nurses' guidance on home nursing knowledge, which was（4.89±0.33）points, and the lowest level of satisfaction with platform fees, which was（4.12±0.78）points．Conclusions “Internet + Nursing Service”provides a more convenient and fast access for home nursing, making resource utilization more effective and with high patient recognition．

目的 探讨苏黄止咳胶囊联合多索茶碱对慢性持续期支气管哮喘的疗效及对肺功能、呼出气一氧化氮（FeNO）的影响。方法 选择2020年3月—2022年3月70例慢性持续期支气管哮喘患者,随机分为2组各35例,对照组仅予以多索茶碱治疗,研究组在对照组基础上加服苏黄止咳胶囊治疗。治疗3个月,采用哮喘控制测试（ACT）对患者进行评估,记录哮喘急性加重、急救药物使用情况及急诊入院情况,测定肺功能和呼出FeNO。结果 2组治疗1月的ACT评分比较无统计学意义（P>0.05）,治疗2、3个月时研究组的ACT评分高于对照组（P<0.05）。研究组哮喘急性加重次数、急救药物使用次数均少于对照组（P<0.05）,而2组急诊入院次数比较差异无统计学意义（P>0.05）。与基线值相比,2组治疗3个月时的肺功能指标无改变（P>0.05）且组间比较差异亦无统计学意义（P>0.05）;2组治疗3个月时的FeNO无改变（P>0.05）,而研究组的FeNO低于对照组（P<0.05）。结论 苏黄止咳胶囊联合多索茶碱治疗慢性持续期支气管哮喘可降低FeNO,提高哮喘控制水平。

Objective To investigate the effect of Suhuang Zhike capsule combined with doxofylline on chronic persistent bronchial asthma, pulmonary function and exhaled nitric oxide（FeNO）．Methods Seventy patients with chronic persistent bronchial asthma from March 2020 to March 2022 were randomly divided into two groups, 35 cases in each group．The control group was only treated with doxofylline, and the study group was treated with Suhuang Zhike capsule additionally．After 3 months of treatment, the patients were evaluated by asthma control test（ACT）, the acute exacerbation of asthma was recorded, and the pulmonary function and exhaled FeNO were measured．Results There was no statistical significance in the ACT score of the two groups after one month of treatment（P>0.05）．The ACT scores of the study group after two months and three months of treatment were significantly higher than those of the control group（P<0.05）．The times of acute exacerbation of asthma and the use of emergency drugs in the study group were less than those in the control group（P<0.05）, but there was no significant difference in the number of emergency hospitalizations between the two groups（P>0.05）．Compared with the baseline value, there was no significant change in lung function indexes in the two groups after 3 months of treatment（P>0.05）．Compared with the baseline value, there was no significant change in FeNO in the two groups after 3 months of treatment（P<0.05）, while FeNO in the study group was lower than that in the control group（P<0.05）．Conclusions Suhuang Zhike capsule combined with doxofylline in the treatment of chronic persistent bronchial asthma can reduce FeNO and improve the level of asthma control．

目的 探讨与分析推拿联合补肾祛瘀针刺法治疗慢性腰肌劳损恢复期患者对腰部疼痛及表面肌电图的影响。方法 选择2019年9月—2022年4月我院收治的72例慢性腰肌劳损恢复期患者为研究对象,根据随机1∶1数字表法,分为联合组与对照组各36例。对照组给予推拿治疗,联合组在此基础上,给予补肾祛瘀针刺法治疗,2组均治疗并观察4周,评价腰部疼痛及表面肌电图变化情况。结果 治疗后联合组与对照组的总有效率分别为97.2%和75%,联合组高于对照组（P<0.05）;治疗前,2组患者的视觉类比疼痛评分法（VAPS）和下腰痛失能问卷（OPDG）评分比较差异无统计学意义,治疗后,2组患者的VAPS和OPDG评分均降低,且联合组低于对照组（P<0.05）;2组治疗后的腰椎前屈力度都高于治疗前（P<0.05）,且联合组更高（P<0.05）;2组治疗后的表面肌电图神经根振幅和潜伏期均低于治疗前（P<0.05）,且联合组更低（P<0.05）。联合组与对照组治疗后的血清5-HT含量均高于治疗前（P<0.05）,联合组更高（P<0.05）。结论 推拿联合补肾祛瘀针刺法在慢性腰肌劳损恢复期患者中的应用具有良好的安全性,有效改善患者的腰椎功能,缓解患者疼痛,提高整体治疗效果,也能改善患者的表面肌电图状况,促进血清5-HT的释放。

Objective To explore and analyze the effects of massage combined with kidney tonifying and blood stasis removing acupuncture on lumbar pain and surface electromyography in patients with chronic lumbar muscle strain in the recovery period．Methods From September 2019 to April 2022, 72 cases of patients in the recovery period of chronic lumbar muscle strain treated in our hospital were selected as the research objects, and were divided into the combined group and the control group with 36 cases in each group by the random 1∶1 number table method．The control group were given massage therapy, and the combination group were given kidney tonifying and stasis removing acupuncture additionally．Results After treatment, the total effective rates of combined group and control group were 97.2% and 75%, respectively, and the combined group was significantly higher than the control group（P<0.05）．Before treatment, there was no significant difference in the visual analogue pain scale（VAPS）and Oswestry low pain & disability questionnaire（OPDG）scores between the two groups, but after treatment, the scores of the two groups were significantly decreased, and the combined group was significantly lower than the control group（P<0.05）．The lumbar flexion intensity after treatment was significantly higher in both groups than before treatment（P<0.05）, and higher in combination group（P<0.05）．The amplitude and latency of surface electromyogram nerve roots after treatment were significantly lower in both groups than before treatment（P<0.05）, and even lower in combination group（P<0.05）．The serum 5-HT content in combination group and control group after treatment was significantly higher than that before treatment（P<0.05）, and that in combination group was higher（P<0.05）．Conclusions The application of massage combined with kidney tonifying and blood stasis removing acupuncture in patients recovering from chronic lumbar muscle strain has good safety, which can improve the lumbar function of patients, relieve the pain of patients, improve the overall therapeutic effect, improve the surface electromyography of patients and promote the release of serum 5-HT．

目的 比较单纯康复训练和在此基础上结合苍龟探穴针法对脑卒中后肩手综合征I期的临床疗效差异。方法 选择响水县人民医院疼痛康复科收治的卒中后出现肩手综合征I期患者60例,按随机数字表法分为治疗组（n=30）和对照组（n=30）。治疗组患者行与苍龟探穴中医针法结合康复训练,先由具备针灸专业主治资格的临床医师对所选取的部分穴位使用苍龟探穴中医传统针法实施治疗后,再由具有5年以上工作经历的康复治疗师实施治疗,而其他患者则单纯接受康复训练,并观察2组患者在治疗前和治疗后的视觉模拟评分（VAS）、肿胀程度、简式上肢运动功能（Fugl-Meyer）评估以及临床疗效。结果 本次研究临床治疗进程中,2组无不良反应情况出现,因疫情和不能配合治疗而出现5例脱落病例（治疗组2例,对照组3例）。①治疗后,2组患者的VAS和肿胀程度评分低于治疗前（P<0.01）,治疗组患者2项评分高于治疗前（P<0.05）;②治疗后,2组患者的Fugl-Meyer评分高于治疗前（P<0.01）,治疗组患者评分高于对照组（P<0.01）;③治疗组的有效率高于对照组,组间比较差异有统计学意义（P<0.05）。结论 苍龟探穴中医传统针法结合康复训练可减少患者水肿和酸痛情况,明显改善患者上肢运动能力,有良好的临床效果。

Objective To compare the clinical efficacy of rehabilitation training alone and the combination of Cangguitanxue acupuncture on post-stroke stage I shoulder-hand syndrome．Methods A total of 60 patients from the Department of Rehabilitation Medicine of Xiangshui County People's Hospital who met the diagnosis（stroke followed by stage I shoulder-hand syndrome）were selected, and they were randomly divided into treatment group（n=30）and control group（n=30）according to the random number table method．Patients in the treatment group underwent a combination of rehabilitation training with the Cangguitanxue acupuncture Chinese medicine acupuncture method, and were first treated by a clinician qualified in acupuncture using the Cangguitanxue acupuncture Chinese medicine traditional acupuncture method on selected acupoints, and then by a rehabilitation therapist with more than five years of experience, while other patients received rehabilitation treatment alone．Results In the clinical treatment process of this study, there were no adverse reactions in the two groups, but there were five cases of dropout due to the epidemic and the inability to cooperate with the treatment（two cases in the treatment group and three cases in the control group）．After treatment, the visual analogue scale（VAS）and swelling degree scores of the two groups were significantly lower than those before treatment（P<0.01）, and the performance of the patients in the treatment group was better than that before treatment（P<0.05）．After treatment, the score of simplified upper limb motor control function（Fugl-Meyer）score in the two groups was significantly higher than that before treatment（P<0.01）, and the score of patients in the treatment group was higher than that of the control group（P<0.01）．The effective rate of the control group was inferior to that of the treatment group, and the difference was statistically significant（P<0.05）．Conclusions The traditional acupuncture method combined with rehabilitation training can significantly reduce edema and soreness in patients, significantly improve upper limb motor ability, and have good clinical effects．

目的 基于随机森林方法构建甲状腺功能减退（简称甲减）患病风险预测模型。方法 从MIMIC-IV数据库纳入5 735名甲减患者为病例组,4 803名非甲减患者为对照组,基于随机森林模型进行建模。同时利用逻辑回归、贝叶斯正则化神经网络、XGBoost作为比较模型。最后用准确率、F1分数、精确率、召回率、特异性以及AUC值评价四个机器学习模型性能。结果 随机森林模型准确率为0.85,F1分数为0.84,精确率为0.84,召回率为0.84,特异性为0.86,AUC值为0.91。在该模型中,促甲状腺激素、年龄、绝对淋巴细胞计数、血液中红细胞数、中性白细胞、性别、碱性磷酸酶、丙氨酸氨基转移酶、嗜酸性粒细胞绝对计数、尿素氮为甲减患者诊断重要性排前10的指标。结论 采用随机森林方法构建的甲减患病预测模型为甲减的早期诊断有潜在应用价值。

Objective To construct a risk prediction model for hypothyroidism based on the random forest model．Methods A total of 5 735 hypothyroidism patients were included from the MIMIC-IV database as the case group, and 4 803 non-hypothyroidism patients were included as the control group．Random forest models were constructed for both groups, and logistic regression, Bayesian regularized neural network, and XGBoost were used as comparative models．The performance of the four machine learning models was evaluated using accuracy, F1 score, precision, recall, specificity, and AUC value．Results The random forest model had an accuracy of 0.85, an F1 score of 0.84, a precision of 0.84, a recall of 0.84, a specificity of 0.86, and an AUC value of 0.91．In this model, thyroid-stimulating hormone, age, absolute lymphocyte count, red blood cell count in blood, neutrophil, gender, alkaline phosphatase, aspartate aminotransferase, absolute eosinophil count, and blood urea nitrogen were the top 10 indicators for diagnosing hypothyroidism patients．Conclusions The hypothyroidism disease prediction model constructed using the random forest method has potential application value for the early diagnosis of hypothyroidism．