1994年中国引进患者自控镇痛（PCA）,经过国人改造升级如今已取得了令人瞩目的成绩：2007年《术后患者自控镇痛临床研究与推广应用》获教育部科学技术进步奖二等奖和中华医学科技奖三等奖;2011年具有中国自主专利产权和创新数字医疗的智能化患者自控镇痛（Ai-PCA）诞生,2019年《智能化术后患者自控镇痛管理关键技术及其临床应用》获得中国抗癌协会科技奖二等奖;2023年《中国分娩镇痛规范及推广应用》获得华夏医学科技奖二等奖。笔者撰写述评,提出努力推进Ai-PCA高水平高质量发展的措施,呼吁国内学者重视引领数智镇痛医疗规范化,于2024年在《中华疼痛学杂志》刊出由余守章教授牵头制定的《患者自控镇痛临床应用规范专家共识》,助力中国数智镇痛医疗技术向智慧化前行,为人民群众切实享受到舒适镇痛提供更优质的服务。

Since the introduction of Patient-Controlled Analgesia（PCA）in China in 1994,the domain has witnessed its substantial advancements．The project,Clinical Research and Promotion of Postoperative Patient-Controlled Analgesia,achieved the Ministry of Education’s Second Prize for Scientific and Technological Progress and the Chinese Medical Association’s Third Prize in 2007．The innovation continued in 2011 with the development of an intelligent PCA system（Ai-PCA）endowed with Chinese independent patent rights and innovative digital medical technology．In 2019,the Key Technologies and Clinical Application of Intelligent Postoperative Patient-Controlled Analgesia Management was honored with the second-class Science and Technology Award by the Chinese Anti-Cancer Association．Furthering this trend．In 2023,the Standards and Promotion of Labor Analgesia in China secured the second-class prize in Medical Science and Technology from Huaxia Medical Science and Technology．This commentary suggest strategies for the qualitative enhancement of Ai-PCA and urge domestic scholars to spearhead the standardization of Ai-PCA．Expert Consensus on Clinical Application Standards for Patient-Controlled Analgesia leaded and edited by Pro．She has published,in 2024,which fervently supports the advancement of China’s Ai-PCA technology towards a more intelligent future,to provide the public with higher quality and more comfortable pain management services．

长链非编码RNA（lncRNA）是一类长度大于200个核苷酸转录本,通过调控DNA、RNA及蛋白质的表达和功能,参与肿瘤发生、发展并发挥重要作用的RNA,近年来lncRNA成为恶性肿瘤早期诊断和预后标志物研究新的关注方向。Linc-UBC1作为一种新发现的lncRNA,在多种恶性肿瘤如肺癌、胃癌、结直肠癌、宫颈癌、卵巢癌、食管鳞癌等中异常高表达,可通过作为竞争性RNA（ceRNA）、参与信号通路等促进肿瘤细胞的增殖、迁移、侵袭、细胞周期进展、细胞凋亡和上皮间充质转化（EMT）等过程;高表达的linc-UBC1能够增加恶性肿瘤的耐药性,其表达水平与肿瘤分期、淋巴结转移和原发肿瘤远处转移呈正相关;linc-UBC1有望成为许多恶性肿瘤的新型的生物标志物、预后预测因子和治疗靶点,但其具体的调控机制仍处于研究的早期阶段,有待进一步深入研究。文章就目前linc-UBC1在恶性肿瘤发生和发展中的作用研究进展进行综述。

Long non-coding RNA（lncRNA）is a class of transcripts with a length of more than 200 nucleotides．It is involved in the occurrence and development of tumors and plays an important role by regulating the expression and function of DNA,RNA and protein．In recent years,lncRNA has become a new research direction for early diagnosis and prognosis of malignant tumors．As a newly discovered lncRNA,linc-UBC1 is abnormally highly expressed in a variety of malignant tumors such as lung cancer,gastric cancer,colorectal cancer,cervical cancer,ovarian cancer,and esophageal squamous cell carcinoma．It can promote the proliferation,migration,invasion,cell cycle progression,cell apoptosis and EMT of tumor cells by acting as a competing endogenous RNA（ceRNA）and participating in signaling pathways．High expression of linc-UBC1 can increase the drug resistance of malignant tumors,and its expression level is positively correlated with tumor stage,lymph node metastasis and distant metastasis of primary tumors．linc-UBC1 is expected to become a new biomarker,prognostic predictor and therapeutic target for many malignant tumors,while its specific regulatory mechanism is still in the early stage of research and needs further in-depth study．This article reviews the current research progress of linc-UBC1 in the occurrence and development of malignant tumors．

目的 构建并验证主动脉夹层B型（TBAD）患者急性期预后的列线图预测模型,帮助临床医生在急性期内更准确地评估TBAD患者的死亡风险,并制定更合适的治疗策略。方法 回顾性分析从重症监护医学信息数据库v2.2 中提取的399例 TBAD患者的人口学资料和临床资料,结局为TBAD患者急性期（≤14 d）内死亡。先采用最小绝对收缩选择算法回归筛选特征变量,再采用多因素分析确定独立预后因素,并据此构建预测模型。通过受试者工作特征曲线、校准曲线、决策曲线分析（DCA）评价列线图预测模型的性能和临床适用性。结果 APS Ⅲ评分、二氧化碳总量、红细胞分布宽度为TBAD患者14 d内死亡的独立预测因素。列线图预测模型在内部验证中的受试者工作特征曲线下面积为0.776（95% CI：0.691 ~ 0.860）,Hosmer-Lemeshow 检验P=0.604,校准曲线和标准曲线高度重合,表明该模型具有良好的区分度和校准度。同时,DCA曲线显示,预测模型在大部分的阈值概率范围内提供了显著的净收益。结论 本研究基于APS Ⅲ评分、二氧化碳总量、红细胞分布宽度构建的列线图预测模型可以较准确地预测TBAD患者14 d内的死亡风险,有助于临床医生制定更合适的个体化治疗策略。

Objective To develop and verify a nomogram for predicting acute phase outcomes in patients with type B aortic dissection（TBAD）,enabling clinicians to more precisely evaluate mortality risk in TBAD patients during the acute stage and to devise better treatment plans．Methods This retrospective study analyzed demographic and clinical data of 399 TBAD patients from the Medical Information Mart for Intensive Care IV v2.2,focusing on mortality within 14 days of the acute phase in TBAD patients． Initially,the Least Absolute Shrinkage and Selection Operator regression was employed for feature variable selection,and then multivariate analysis was used to identify independent prognostic factors for constructing the predictive model．The nomogram predictive model's effectiveness and clinical applicability were assessed via the Receiver Operating Characteristic curve,calibration curve,and Decision Curve Analysis（DCA）．Results Acute Physidogy Score Ⅲ score,total carbon dioxide,and red blood cell distribution width emerged as independent predictors of 14-day mortality in TBAD patients．The internal validation of the nomogram predictive model showed an area under the curve of 0.776（95%CI：0.691-0.860）,with a Hosmer-Lemeshow test P-value of 0.604． The close alignment of the calibration and standard curves suggested the model's strong discriminative power and calibration． Furthermore,the DCA curve revealed that the predictive model offered substantial net benefits within a wide range of threshold probabilities．Conclusions This study's nomogram,developed using APS Ⅲ score,total carbon dioxide,and red blood cell distribution width,accurately predicts the 14-day mortality risk in TBAD patients,assisting clinicians in creating better personalized treatment plans．

目的 探讨早产儿语言-社会行为情况及其影响因素,研究语言-社会行为发育与智能发育之间的关系,为早产儿保健提供指导。方法 采用自制的一般情况问卷对125例早产儿开展随访、追踪,直至2岁时,采用盖泽尔发展量表（GDS）进行语言-社会行为及智能发育评估。结果 早产儿语言发育正常43例（34.4%）,社会行为发育正常40例（32%）。早产儿语言发育商平均为（67.99±25.75）,社会行为发育商平均为（67.75±23.98）,处于发育低下水平。性别、脑出血病史、定期随访史、康复干预史、家庭干预史在语言、社会行为方面比较差异均无统计学意义（P>0.05）。不同胎儿期安胎史、胎龄、出生体质量在语言、社会行为方面比较差异有统计学意义（P<0.05）;且胎儿期反复安胎,胎龄小,出生体质量低,语言及社会行为发育较差。与出生时无中-重度窒息史的患儿相比,出生时有中-重度窒息的患儿存在更多的语言发育异常,比较差异有统计学意义（P<0.05）;但在社会行为发育方面比较差异无统计学意义（P>0.05）。语言-社交行为发育落后的同时,早产儿的大运动、精细动作、适应性行为也存在落后,五大能区比较差异并均有统计学意义（P<0.05）。结论 多数早产儿存在语言-社会行为发育落后,其同时可能伴有更多的运动和适应行为发育问题;语言-社交行为发育落后的患儿在胎儿期存在反复安胎且胎龄较小、出生体质量更低或有中-重度窒息史。对早产儿的语言-社会行为要及时给予关注,早期发现并早期干预,改善预后。

Objective To explore the language-social behavior of preterm infants and its influencing factors,to study the relationship between language-social behavior development and intellectual development,and to provide guidance for preterm infants' health care．Methods A self-administered general questionnaire was used to follow up 125 preterm infants until the age of 2 years,and Gesell development scale（GDS）was used to assess their language-social behavior and intellectual development．Results Preterm infants had normal language development in 43 cases（34.4%）and normal social behavioral development in 40 cases（32%）．The mean language development quotient of preterm infants was（67.99±25.75）and the mean social behavioral development quotient was（67.75±23.98）,which was at the low developmental level．There were no significant differences in gender,history of cerebral hemorrhage,regular follow-up,rehabilitation intervention,family intervention and language or social behavior（P>0.05）．Infants with different fetal age history,gestational age,and birth weight varied significantly in language and social behavior（P<0.05）;and with repeated miscarriage,small gestational age,low birth weight,showed poor language and social behavior development．Compared the children with and without moderate to severe asphyxia at birth,there was statistically significant differences in language development（P<0.05）,but in social behavior there was no significant difference（P>0.05）．The backward development of language-social behavior was accompanied by backwardness in gross motor,fine motor,and adaptive behavior in preterm infants,and the differences in the five major domains were all present and statistically significant（P<0.05）．Conclusions A major of preterm infants have poor language-social behavior development,which may be accompanied by more motor and adaptive behavior development problems;children with poor language-social behavior development have repeated miscarriage prevention at younger gestational ages,lower birth weights,or a history of moderate-to-severe asphyxia during the fetal period．It is important to give timely attention to language-social behavior in preterm infants for early detection and early intervention to improve prognosis．

融合基因是指两个独立基因的编码区首尾相连所形成的且置于同一套调控序列控制的产物,研究表明许多癌症的发生与融合基因存在密切的联系。融合基因可作为癌症治疗的靶点,在癌症诊断及治疗领域中融合基因的研究具有重要意义。部分融合基因驱动癌症的机制已被初步揭示,但是有些真实存在的在肿瘤发生发展过程中有重要意义的融合基因由于工具和实验技术限制还未被发现。因此,对融合基因的分析预测研究方法逐渐成为关注的热点之一。本文探讨了目前常用的关于融合基因的分析工具及方法,为融合基因在癌症中的研究提供思路。

Fusion genes are the products of two independent genes whose coding regions are linked and controlled by the same set of regulatory sequences．Studies have shown that many cancers are closely linked to gene fusions．Fusion genes can be used as targets for cancer therapy,and the study of fusion genes is of great importance in cancer diagnosis and treatment．Some of the mechanisms of fusion genes driving cancer have been initially revealed,but there are more fusion genes which are important in the process of tumor development have not been discovered due to the limitation of tools and experimental techniques．Therefore,the analysis and prediction methods of fusion genes are becoming a hot topic of interest．In this paper,we discuss the commonly used analytical tools and methods on fusion genes to provide ideas for the study of fusion genes in cancer．

目的 探讨家庭医生契约式服务对婴儿生长发育及肺炎发生率的影响。方法 选取2019年7月—2020年2月龙凤社区出生的婴儿200例作为研究对象,随机分为签约组与未签约组,每组100例。其中,签约组婴儿接受家庭医生契约式服务,未签约组婴儿则接受社区常规儿童保健服务。记录两组婴儿出生后第1、3、6、9、12个月时的生长发育指标(身长、体质量)、神经心理发育指标(大动作、精细动作、个人-社会、语言、适应性)以及肺炎发生率,进行对比分析。结果 出生后第1个月和第3个月,两组婴幼儿身高与体质量差异无统计学意义(P＞0.05)。自出生后第6个月开始,签约组婴幼儿的身高与体质量水平均高于未签约组婴幼儿(P＜0.05)。两组中出生后1月龄的婴幼儿在发育商5项指标中差异均无统计学意义(P＞0.05)。在12月龄时,签约组婴幼儿的大动作、精细动作、个人-社会、语言、适应性5项指标评分均高于未签约组婴幼儿(P＜0.05)。截止出生后第12个月,签约组共发生2例肺炎患儿,肺炎发生率2%;未签约组发生10例肺炎患儿,肺炎发生率10%,高于签约组肺炎发生率。所有肺炎患儿均给予积极对症治疗后痊愈。结论 家庭医生契约式服务能够促进婴幼儿出生后第1年内身心发育水平,同时还能有效降低肺炎的发生风险,有利于婴幼儿身心全面、健康地发育和生长,具有比较显著的卫生和社会学价值,值得推广应用。

Objective To explore the effect of family doctor contract service on infant growth and development and incidence of pneumonia. Methods From July 2019 to February 2020, 200 infants in Longfeng community were selected as the research objects and randomly divided into contract group and non contract group, with 100 cases in each group. Among them, the infants in the contract group received the family doctor contract service, while the infants in the non signing group received the community routine child health care services. The growth and development indexes (body length, body weight), neuropsychological development indexes (big movements, fine movements, personal society, language, adaptability) and the incidence of pneumonia were recorded and analyzed in the first, third, sixth, ninth and twelfth months after birth. Results There were no significant differences in height and weight between the two groups at the first and third month after birth (P>0.05). From the 6th month after birth, the height and weight of infants in the signing group were higher than those in the non signing group (P<0.05). There were no significant differences in the 5 indexes of development quotient between the two groups (P>0.05). At the age of 12 months, the scores of big movement, fine movement, personal society, language and adaptability of infants in contract group were higher than those in non contract group (P<0.05). By the end of the 12th month after birth, there were 2 cases of pneumonia in the signing group, the incidence of pneumonia was 2%; in the non signing group, there were 10 cases of pneumonia, the incidence of pneumonia was 10%, which was higher than that of the signing group. All children with pneumonia were cured after active symptomatic treatment. Conclusion Family doctor contract service can promote the physical and mental development level of infants and young children in the first year after birth, at the same time, it can effectively reduce the risk of pneumonia, which is conducive to the comprehensive and healthy development and growth of infants and young children. It has significant health and sociological value and is worthy of promotion and application.

目的 分析某院中期早产儿体格发育及肠外营养状况,为中期早产儿制定合理的肠外营养方案提供参考。方法 收集某院2017年10月—2018年12月50例(32～33⁺⁶)周早产儿的病例进行回顾分析。结果 50例患儿出生平均体质量、身长、头围各为(1.84±0.24) kg、(42.92±2.16) cm、(29.77±1.20) cm,生后 1周和生后2周的平均体质量、身长、头围分别为(1.83±0.24) kg、(43.28±1.95) cm、(29.97±1.32) cm和(2.07±0.23) kg、(43.91±1.79) cm、(30.62±1.13) cm。营养素的起始剂量各为:氨基酸(1.11±0.37)g·kg^-1·d ^-1,脂肪乳(0.78±0.22)g·kg^-1·d ^-1,葡萄糖(5.86±1.51)mg·kg^-1·min^-1,肠外营养平均天数(22.8±6.46)天,体质量平均下降幅度(7.22±3.82)%,恢复至出生体质量平均天数(8.3±2.72)天。结论 该院中期早产儿肠外营养设计需完善,以控制生理性体质量下降程度及持续时间,更适于体格发育。

Objective To analyze the physical development and parenteral nutrition status of preterm infant in a hospital in order to provide reference for the formulation of reasonable parenteral nutrition treatment plan for medium preterm infants. Methods The clinical data of 50 preterm infants aged 32～33⁺⁶ weeks from October 2017 to December 2018 were collected and analyzed retrospectively. Results The average birth weight, body length and head circumference of the child patients were (1.84±0.24) kg, (42.92 ±2.16) cm, (29.77±1.20) cm respectively. After one week and After two weeks,the average birth weight, body length and head circumference were(1.83±0.24) kg, (43.28±1.95) cm, (29.97±1.32) cm respectively and (2.07±0.23) kg, (43.91±1.79) cm, (30.62±1.13) cm respectively. The initial dose of amino acid(1.11±0.37)g·kg^-1·d^-1, fat emulsion(0.78±0.22)g·kg^-1·d^-1, glucose(5.86±1.51)mg·kg^-1·min^-1. The average days of parenteral nutrition treatment were(22.8±6.46)d, the average weight loss was(7.22±3.82)% and the average days of recovery to birth weight were (8.3±2.72)d. Conclusion The design of parenteral nutrition for preterm infants still needs to be improved in order to control the degree and duration of physiological weight loss of preterm infants in the mid-term, which is conducive to the physical development of preterm infants in the mid-term.

目的 探讨Graf法超声在6个月以内婴儿发育性髋关节异常筛查及随访中的应用价值。方法 选取我院2014年1月—2017年6月2 000例0～6个月婴儿(4 000个髋关节)为标本,采用Graf法超声检查进行筛查,检测发病率,并对部分髋关节异常的婴儿进行随访。结果 Ⅰ型髋关节3 572例(89.3%),Ⅱ型336例(8.4%),Ⅲ型92例(2.3%)。随访的272例发育性髋关节异常婴儿中,86例Ⅱ型转化为Ⅰ型,42例Ⅲ型转化为Ⅰ型,46例Ⅱa型转化为Ⅱb型,98例Ⅱ型无转化。结论 Graf法超声检查在婴儿髋关节异常筛查以及随访中有较高的使用价值。Graf法超声检查安全性好、有效率高,有助于发育性髋关节异常疾病的早期诊断及早期治疗。

目的 探讨孕母甲状腺疾病的新生儿第一个月生长速率和甲状腺功能与2岁时神经发育结局之间的相关性。方法 2013年1月—2014年12月在我院出生的156例孕母甲状腺疾病的新生儿为实验组,观察其第1个月体质量、身长及头围生长的速率,生后当天、第7天、第28天的总甲状腺素(TT4)及促甲状腺素(TSH)的水平;妊娠期无高危因素的母亲分娩的正常新生儿中随机抽取150例为正常对照组,观察生后新生儿第1个月体质量、身长及头围生长的速率,2组均在2岁内分别每3个月均接受随访评估,2岁时行贝利婴幼儿发展量表进行Bailey智力发育指数(MDI)、精神运动发育指数(PDI)的评分。采用回归分析检验新生儿生后第一个月体质量、身长及头围生长的速率,新生儿生后当天、第7天、第28天的TT4及TSH水平与中位数的差值与2岁时MDI、PDI之间的关联性。结果 ①实验组生后第1个月体质量(29.5±4.2 g/d)、身长(1.18±0.67 cm/周)及头围(0.79±0.39 cm/周)生长的速率慢于正常对照组的体质量(35.4±6.3 g/d)、身长(1.69±0.85 cm/周)及头围(1.10±0.42 cm/周)生长的速率,2组差异有统计学意义(t值分别为9.672、5.882、6.768,P均<0.05);②实验组2岁时MDI(108±15)、PDI评分(109±16)低于正常对照组MDI(115±14)、PDI评分(118±11),2组差异有统计学意义(t值分别为16.129、21.279,P均<0.05);③实验组孕母甲状腺疾病的新生儿生后第1个月体质量、身长及头围生长的速率与2岁时MDI、PDI呈正相关(相关系数分别为:0.874,0.842,0.890,0.857,0.871,0.845,t值分别为22.584,59.296,65.441,61.214,62.662,59.507,P均<0.05);④实验组孕母甲状腺疾病的新生儿生后当天、第7天及第28天的TT4及TSH水平与中位数的差值与2岁时MDI、PDI呈负相关(相关系数分别为:-0.878,-0.894,-0.890,-0.690,-0.654,-0.702,t值分别为73.167,81.273,74.166,11.523,10.548,12.103,P均<0.05)。结论 母亲妊娠期患有甲状腺疾病会影响新生儿生后第1个月体质量、身长、头围生长的速率及2岁时的精神运动、智力发育,落后于母亲妊娠期无高危疾病的正常新生儿。另外孕母甲状腺疾病的新生儿第1个月体质量、身长及头围生长的速率和生后当天、生后第7天 及第28天的T4及TSH的水平与2岁时MDI、PDI密切相关。

Objective To investigate the correlation between the growth rate, thyroid function in the first month and neurodevelopmental outcome at the age of 2 in the infants of the maternal thyroid disease. Methods We chose 156 infants of maternal thyroid disease from January 2013 to December 2014 born in our hospital as the experimental group and 150 normal infants of their mothers without high risk factors during pregnancy as the control group. We observed the rate of weight, length and head circumference growth in the first month and TT4 、TSH level at the 1^st day, 7^th day, and 28^th day after birth. We followed up two groups every 3 months up to the age of 2. We assessed Bailey mental development index (MDI) and psychomotor development index (PDI) at the age of 2. Regression analysis was used to test the correlation between the growth rate, TT4,TSH level in the 1^st month and MDI, PDI at the age of 2. Results ① The rate of growth rate in the 1^st month of the experimental group was slower than the control group. It was statistically significant difference between the two groups (P<0.05); ②MDI, PDI at the age of 2 in the experimental group were lower than those of the control group. It was statistically significant difference between the two groups (P<0.05); ③The rate of growth rate in the first month of the experimental group was positively related to MDI and PDI at the age of 2.④The difference between the level of TT4,TSH at the 1^st day, 7thday, and 28^th day and the median after birth was negatively related to MDI and PDI at the age of 2. Conclusion The maternal thyroid disease will affect the first month growth rate and neurodevelopmental outcome at the age of 2 of their infants. Their infants will grow behind than the normal newborns on pregnancy without high-risk disease.The growth rate of the first month and the level of T4 and TSH on the 1^st day, 7^th day, and 28^th day in maternal thyroid disease are closely related MDI and PDI at the age of 2.

目的 观察家庭式康复教育结合模式对脑瘫儿童发育情况的影响。方法 采用随机数字表法将38例脑瘫患儿分为实验组及对照组。2组患儿均给予常规日常康复,康复治疗师、引导式教师、特殊教育教师组成的团队共同对实验组内儿童功能情况进行评估,设计引导式教育课程,对无康复教育知识背景的专职护理人员进行课程培训,完成培训的护理员具体执行引导式教育课程,每天2次,每次60min,每周介入6日,持续半年。于治疗前、治疗后采用Gesell发展量表进行评测。结果 治疗前,两组患儿适应性行为、大运动、精细动作、语言、个人-社会行为5个领域指标组间差异无统计学意义（P>0.05）;经介入半年后,两组患儿的适应性行为、大运动、精细动作、语言、个人-社会行为5个领域评分均优于组内治疗前水平（P <0.05）,且实验组优于对照组（P <0.05）。结论 家庭式康复教育结合模式,对改善脑瘫患儿的多方面功能发展有重要意义,值得在专业人才资源缺乏的机构和社会中推广、应用。

Objective To observe the effect of the model of family rehabilitation education on the development of children with cerebral palsy. Methods 38 children with cerebral palsy were divided into experimental group and control group by random digital table method. Two groups of children were given routine daily rehabilitation. A team of rehabilitation therapists,guided teachers and special education teachers assessed the children's function in the experimental group,and designed guiding education course. The team offered curriculum training for full-time nurses without background knowledge of rehabilitation education,and the trained nurses implemented the guiding education course twice each day,60 minutes each time,6 days per week. The training lasted for six months. The Gesell development scale was used for evaluation before and after treatment. Results Before treatment,there was no statistically difference between 2 groups of children in 5 areas of adaptive behavior,exercise,fine motor,language and personal social behavior （P >0.05）. After six months' intervention,2 groups of children were better than the pre-treatment level （P <0.05）. The experimental group was superior to the control group （P <0.05）. Conclusion The model of family rehabilitation education is of great significance to the improvement of the multifaceted function of children with cerebral palsy. It is worthy of popularization and application in institutions and societies which are lack of professional talent resources.