综述

脑卒中后认知障碍患者早期干预模式的研究现状与进展

Research status and progress of early intervention methods for patients with cognitive impairment after stroke

:286-292
 
       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.
综述

肝硬化患者消化道出血风险预测模型的系统综述

Systematic review of prediction models for gastrointestinal bleeding risk in cirrhosis patients

:277-285
 
       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.
论著

孕中晚期口腔二维轴向切面超声诊断唇腭裂类型的价值研究

The value of two-dimensional axial sectional ultrasonography in the diagnosis of cleft lip and palate in the second and third trimesters of pregnancy

:83-87
 
       目的   探讨孕中晚期口腔二维轴向切面超声在产前诊断胎儿唇腭裂中的应用价值,评估其对唇裂、唇腭裂及继发腭裂的检出率和准确性。方法   本研究为前瞻性研究,共纳入2020年3月—2023年12月在我院超声科行产前超声诊断的3 666例孕中晚期胎儿,其中经超声检查诊断出111例唇腭裂,这些病例归为唇腭裂组,其余3 555例归入正常对照组。所有受试者均通过口腔二维轴向切面超声进行评估,诊断结果经产后随访确认。结果   在正常对照组中,上唇及上牙槽突的评估成功率为100%,软硬腭分界线显示率为99%,软腭显示率为85%。在唇腭裂组中,超声对唇裂、唇腭裂及继发腭裂的检出率分别为45%、48%和7%,且超声诊断的灵敏度、特异度和预测值均超过98%。结论   孕中晚期口腔二维轴向切面超声在产前诊断胎儿唇腭裂中具有较高的准确性和可靠性,为早期干预和临床管理提供了重要的影像学依据。
       Objective  To explore the application value of two-dimensional axial section ultrasound in prenatal diagnosis of fetal cleft lip and palate in the second and third trimesters of pregnancy,and to evaluate its detection rate and accuracy for cleft lip,cleft lip and palate,and secondary cleft palate.Methods  This study is a prospective study that included 3 666 fetuses in the second and third trimesters of pregnancy.Among them,111 cases of cleft lip and palate were diagnosed by ultrasound examination.These cases were classified as the cleft lip and palate group,and the remaining 3 555 cases were classified as the normal control group.All subjects were evaluated by oral two-dimensional axial section ultrasound,and the diagnostic  results were confirmed by postpartum follow-up.Results  In the normal control group,the success rates of evaluating the upper lip and upper alveolar process were 100%.The present rate of the soft hard palate boundary was 99%,and the present rate of the soft palate was 85%.In the cleft lip and palate group,the detection rates of cleft lip,cleft lip and palate,and secondary cleft palate by ultrasound were 45%,48% and 7% respectively,and the sensitivity,specificity,and predictive value of ultrasound diagnosis exceeded 98%.Conclusions  Two dimensional axial section ultrasound of the oral cavity in second and third trimesters of pregnancy has high accuracy and reliability in prenatal diagnosis of fetal cleft lip and palate,providing strong imaging evidence for early intervention and clinical management.
论著

基于机器学习的脓毒症谵妄患者死亡预测模型的构建与评估

Machine learning prediction model for sepsis-associated delirium mortality

:1501-1510
 
       目的   通过机器学习方法构建脓毒症谵妄患者30 d死亡的预测模型,并识别关键预测因子。方法   采用基于医疗信息集成重症监护数据库(Medical Information Mart for Intensive Care IV)的回顾性队列研究方法,boruta筛选重要特征,并通过决策树,K近邻,LightGBM,随机森林,支持向量机,XGBoost构建模型进行分析,通过ROC曲线下面积进行评估,利用F1分数、召回率、精确率、特异度、灵敏度和阳性预测值比较模型表现。结果  XGBoost模型在训练集和验证集中的ROC曲线下面积分别为0.906和0.762,表明该模型具有良好的预测能力,入院年龄、红细胞分布宽度和白细胞计数是最重要的预测因子。结论   基于机器学习的脓毒症谵妄患者预后预测模型展现出良好的预测效能,为临床早期干预提供了重要参考依据。
       Objective  To construct a  30-day mortality  prediction model for  patients with  sepsis-associated  delirium using machine learning methods and identify key predictive factors.Methods  A  retrospective cohort study was conducted based on the Medical Information Mart for Intensive Care IV database.Important features were selected using the Boruta algorithm,and models including Decision Tree,K-Nearest Neighbors,LightGBM,Random Forest,Support Vector Machine,and XGBoost were constructed and analyzed.Model performance was evaluated using the area under the reciver operater characteristic(ROC)curve(AUC),along with F1 score,recall,precision,specificity,sensitivity,and positive predictive value.Results  The XGBoost model demonstrated strong predictive performance,with AUC values of 0.906 in the training set and 0.762 in the test set.Key predictors identified included admission age,red blood cell distribution width,and white blood cell count.Conclusions  The machine learning-based prediction model for sepsis-associated delirium prognosis exhibits robust predictive efficacy,providing a valuable tool for early clinical intervention.
论著

LncMALAT1通过竞争性结合miR-506-3p调控EZH2影响膀胱癌增殖的机制研究

The mechanism of LncMALAT1 regulating EZH2 by competitively combining with miR-506-3p to affect the proliferation of bladder cancer

:1440-1447
 
目的 探讨长链非编码核糖核酸肺腺癌转移相关转录本 1(LncMALAT1)通过竞争性结合微小RNA-506-3p(miR-506-3p)调控Zeste同源物增强子2(EZH2)影响膀胱癌增殖的机制。方法 收集2023年1月—2024年10月的92例外科手术切除的膀胱癌组织及对应的癌旁组织标本, 利用Western blot和定量实时逆转录聚合酶链式反应(qRT-PCR)方法检测LncMALAT1和EZH2的表达情况。根据患者预后分为不良组(n=34)和良好组(n=58), 收集患者的性别、年龄、肿瘤直径、血管侵袭情况、TNM分期、远处转移情况等临床指标, 结合临床病理指标分析LncMALAT1和EZH2与膀胱癌患者预后的关系。通过体外实验,包括qRT-PCR、Western blot、平板克隆和EdU实验,验证LncMALAT1对EZH2表达和膀胱癌细胞增殖的影响。利用生物信息学技术预测LncMALAT1与miR-506-3p的相互作用,并通过qRT-PCR验证在膀胱癌细胞中上调LncMALAT1表达后miR-506-3p的表达变化。结果 单因素结果显示, 血管侵袭情况、TNM分期、远处转移情况、LncMALAT1及EZH2表达水平均与膀胱癌患者预后不良有关, 差异有统计学意义(均P<0.05)。分析结果发现LncMALAT1与EZH2在膀胱癌组织中的表达呈正相关。体外实验结果显示, 上调LncMALAT1表达后, EZH2的表达显著上调, 且膀胱癌细胞的增殖能力显著提高(均P<0.05)。qRT-PCR验证表明,上调LncMALAT1表达后,miR-506-3p的表达显著下调(P<0.05), 提示LncMALAT1通过竞争性结合miR-506-3p调控EZH2,进而影响膀胱癌细胞的增殖进展。结论 LncMALAT1通过竞争性结合miR-506-3p调控EZH2促进膀胱癌增殖功能,进而加快膀胱癌细胞的增殖进展, 可为膀胱癌的治疗提供新的潜在靶点。
Objective To explore the mechanism of long non-coding ribonucleic acid metastasis - associated lung adenocarcinoma transcript 1(LncMALAT1)regulating enhancer of Zeste homolog 2(EZH2)through competitive combination with microRNA-506-3p(miR-506-3p)to affect the proliferation of bladder cancer.Methods A total of 92 pairs of bladder cancer tissues and corresponding adjacent normal tissues were collected from surgical resections between January 2023 and October 2024.The expression levels of LncMALAT1 and EZH2 were detected using Western blot and qRT-PCR.The patients were divided into poor group(n=34)and good group(n=58)according to their prognosis.Clinical data, such as gender, age, tumor diameter, vascular invasion, TNM stage, and distant metastasis were collected, and the relationship between LncMALAT1 and EZH2 and the prognosis of bladder cancer patients was analyzed with clinical pathological indicators.Through in vitro experiments, including qRT-PCR Western blot, plate cloning and EdU experiment were conducted to verify the effect of LncMALAT1 on EZH2 expression and bladder cancer cell proliferation.Bioinformatics technology was used to predict the interaction between LncMALAT1 and miR-506-3p, and qRT-PCR was used to verify the change of miR-506-3p expression after up regulating LncMALAT1 expression in bladder cancer cells.Results The univariate results showed that vascular invasion, TNM stage, distant metastasis, LncMALAT1 and EZH2 expression levels were related to the poor prognosis of bladder cancer patients, and the difference was statistically significant(all P<0.05).The results showed that the expression of LncMALAT1 and EZH2 in bladder cancer was positively correlated.In vitro experiment results showed that after up regulating LncMALAT1 expression, EZH2 expression was significantly up-regulated, and the proliferation ability of bladder cancer cells was significantly improved(all P<0.05).QRT-PCR validation showed that the expression of miR-506-3p was significantly down regulated after the expression of LncMALAT1 was up-regulated(P<0.05), suggesting that LncMALAT1 could regulate EZH2 through competitive combination with miR-506-3p, thereby affecting the proliferation and progression of bladder cancer cells.Conclusions LncMALAT1 can promote the proliferation of bladder cancer cells by competitively combining with miR-506-3p to regulate EZH2, and then accelerate the proliferation of bladder cancer cells, which can provide a new potential target for the treatment of bladder cancer.
论著

64层螺旋CT三维重建技术在主动脉夹层介入术前评估中的价值

The value of 64-slice spiral CT three-dimensional reconstruction technology in the preoperative assessment of aortic dissection intervention

:1409-1414
 
目的 探讨64层螺旋CT三维重建技术在主动脉夹层介入术前评估中的价值。方法 选择2023年7月—2024年5月在潜江市中心医院诊治的主动脉夹层疑似患者96例为研究对象,所有患者均进行64层螺旋CT三维重建技术检查, 记录成像参数。所有患者在64层螺旋CT三维重建后进行介入治疗, 以介入检查结果为金标准, 判断64层螺旋CT三维重建技术在主动脉夹层介入术前评估中的价值。结果 在96例患者中, 64层螺旋CT三维重建联合判断为主动脉夹层60例, 其中Ⅰ型32例、Ⅱ型20例、Ⅲ型8例,其中再现(VR)、最大密度投影(MIP)及多平面重建(MPR)分别判断为主动脉夹层56例、54例、56例。在96例患者中, 64层螺旋CT三维重建检查的破口层面主动脉平均直径(3.08±0.25)cm、破口至左锁骨下平均距离(4.05±0.26)cm, 与介入治疗检查(3.05±0.36)cm、(4.06±0.14)cm, 对比差异无统计学意义(t=0.671, P=0.503; t=0.332, P=0.740)。64层螺旋CT三维重建联合、VR、MIP、MPR对主动脉夹层的诊断灵敏度分别为98.33%、93.22%、89.83%、94.92%, 特异度分别为97.30%、97.30%、97.30%、100.00%, 准确率分别为98.96%、94.79%、92.71%、96.88%。结论 64层螺旋CT三维重建技术在主动脉夹层介入术前评估中具有很高的灵敏度、特异度与准确率。
Objective To explore and analyze the value of 64-slice spiral CT three-dimensional reconstruction technology in the preoperative assessment of aortic dissection(AD)intervention.Methods From July 2023 to May 2024, 96 cases of patients suspected of aortic dissection treated in our hospital were selected as the research subjects.All patients underwent 64-slice spiral CT three-dimensional reconstruction technology examination, and imaging parameters were recorded.After the 64-slice spiral CT three-dimensional reconstruction, all patients were given interventional treatment, and the results of the interventional examination were used as the “gold standard” to evaluate the value of 64-slice spiral CT three-dimensional reconstruction technology in the preoperative assessment of aortic dissection intervention.Results Among the 96 patients,64-slice spiral CT three-dimensional reconstruction combined diagnosis identified 60 cases of aortic dissection,including 32 type I, 20 type II, and 8 type III cases.volume rendering(VR), maximum intensity projection(MIP), and muhiplanar reconstrudion(MPR) identified 56, 54, and 56 cases of aortic dissection,respectively.In 96 patients, the mean aortic diameter at the lacerated level and the mean distance from the lacerated to the left subclavicular level were(3.08±0.25)cm and(4.05±0.26)cm respectively in 64-slice spiral CT three-dimensional reconstruction examination, compared with(3.05±0.36)cm and(4.06±0.14)cm in interventional examination.There was no difference in comparison(t=0.671, P=0.503; t=0.332, P=0.740).The sensitivity, specificity, and accuracy of the 64-slice spiral CT three-dimensional reconstruction combined, VR, MIP, and MPR for the diagnosis of aortic dissection were 98.33%, 93.22%, 89.83%, 94.92%, specificity were 97.30%, 97.30%, 97.30%, 100%, accuracy were 98.96%, 94.79%, 92.71%, 96.88%.Conclusions Technology of 64-slice spiral CT three-dimensional reconstruction has high sensitivity, specificity, and accuracy in the preoperative assessment of aortic dissection intervention and is worth promoting and applying clinically.
论著

血清降钙素原联合营养指标对肝硬化营养状况评定价值的研究

Value of serum procalcitonin combined with nutritional indicators in assessing the nutritional status of liver cirrhosis

:1384-1389
 
目的 探讨降钙素原(PCT)联合营养指标对肝硬化营养状况的评定价值。方法 选取2021年2月—2022年3月在右江民族医学院附属医院感染科住院的140例肝硬化患者,根据营养风险筛查2002(NRS 2002)将其分为有营养风险组和无营养风险组。比较两组肝硬化患者中营养指标体质指数(BMI)、血红蛋白(HGB)、前白蛋白(PA)、白蛋白(ALB)、视黄醇结合蛋白(RBP)水平, 并分析它们与PCT的相关性。结果 BMI、HGB、ALB、PA及RBP水平低于低营养风险组(P<0.05); 营养指标(BMI、HGB、ALB、PA、RBP)与PCT呈负相关(P<0.05)。二元Logistics回归分析发现ALB、PCT是肝硬化患者营养风险的危险因素(P<0.05)。ROC结果显示PCT与ALB的联合营养指标评定肝硬化营养不良的曲线下面积为0.984,(95%CI:0.964~1.000), 灵敏度98.8%, 特异度93.3%, 约登指数0.921; ALB、PCT的AUC分别为0.919、0.974。结论 肝硬化患者PCT水平与其营养状况密切相关, 对营养状况的评定有一定的价值, 联合评定能有效提高其评定价值。
Objective To explore the value of procalcitonin(PCT)combined with nutritional indexes in evaluating the nutritional status of liver cirrhosis.Methods A total of 140 patients with cirrhosis admitted to the Department of Infection of the Affiliated Hospital of Youjiang Medical College for Nationalities from February 2021 to March 2022, they were selected and divided into with and without nutritional risk group according to nutritional risk screening 2002(NRS 2002).The levels of body mass index(BMI), hemoglobin(HGB), prealbumin(PA), albumin(ALB)and retinol binding protein(RBP)in two groups of patients with cirrhosis were compared, and the correlation between them and PCT was analyzed.Results The levels of BMI, HGB, ALB, PA and RBP were lower than those of low nutritional risk group(P<0.05).The nutritional indices(BMI, HGB, ALB, PA, RBP)were negatively correlated with PCT(P<0.05).Binary Logistics regression analysis showed that ALB and PCT were risk factors affecting nutritional risk in patients with cirrhosis(P<0.05).ROC results showed that the area under the curve was 0.984(95% confidence interval:0.964 ~ 1.000), sensitivity 98.8%, specificity 93.3%, and Yoden index 0.921 for the combined PCT and ALB indexes predicting malnutrition in cirrhosis.The AUC of ALB and PCT were 0.919 and 0.974, respectively.Conclusions The level of PCT in patients with cirrhosis is closely related to their nutritional status, which has certain value in the evaluation of nutritional status, and combined prediction can effectively improve the evaluation value.
论著

LncRNA-ANRIL通过调控miR‐181b介导PTEN对冠心病心肌损伤影响的机制研究

Mechanism of LncRNA ANRIL mediated PTEN induced myocardial injury in coronary heart disease by miR-181b

:1378-1383
 
目的 探讨非编码长链 RNA ANRIL(lncRNA-ANRIL)通过调控miR‐181b 介导磷酸酶及张力蛋白同源物基因(PTEN)对冠状动脉粥样硬化性心脏病(冠心病)心肌损伤影响的机制。方法 纳入2023年10月—2024年6月广州市第一人民医院30例确诊为冠心病的患者为观察组, 另选择同期本院体检中心30名健康者为对照组,检测两组研究者血压指标、血脂指标以及血清 lncRNA-ANRIL、miR-181b、PTEN水平, 并比较检测结果。结果 两组的性别、年龄、BMI、吸烟、高血压一般资料对比差异无统计学意义(P>0.05); 观察组收缩压、舒张压水平以及总胆固醇、甘油三酯、低密度脂蛋白胆固醇水平均高于对照组,而高密度脂蛋白胆固醇则低于对照组(P<0.05); 观察组血清 lncRNA ANRIL Exon 1-2、lncRNA ANRIL Exon 17-18相对表达水平以及PTEN水平低于对照组(t=12.623、7.741、8.231, P=0.001), 而miR-181b水平则高于对照组(t=37.250, P=0.001)。结论 相较于正常人群, 冠心病患者血清lncRNA-ANRIL和PTEN水平明显降低,而miR-181b水平升高,提示lncRNA-ANRIL可通过调控miR-181b来调节PTEN的表达, 从而影响冠心病心肌损伤的过程。
Objective To explore the mechanism of competitive binding of non coding long stranded RNA ANRIL(lncRNA-ANRIL)to miR-181b to mediate phosphatase and tensin homolog gene(PTEN)on myocardial injury in coronary heart disease.Methods Thirty patients diagnosed with coronary heart disease in our hospital from October 2023 to June 2024 were included as the observation group,and another 30 individuals from physical examination center during the same period were selected as the control group.Blood pressure indicators,blood lipid indicators, and serum levels of lncRNA-ANRIL, miR-181b, and PTEN were measured in the two groups of patients, and the test results were compared.Results There was no significant difference between the two groups in terms of gender, age, BMI, smoking and hypertension(P>0.05).The levels of systolic blood pressure(SBP), diastolic blood pressure(DBP), total cholesterol(TC), triglycerides(TG), and low-density lipoprotein cholesterol(LDL-C) in the observation group were higher than those in the control group,while high-density lipoprotein cholesterol(HDL-C) was lower than that in the control group(P<0.05).The relative expression levels of lncRNA-ANRIL Exon 1-2, Exon 17-18, and PTEN levels in the observation group were lower than those in the control group(t=12.623, 7.741, 8.231, P=0.001), while the level of miR-181b was higher than that in the control group(t=37.250, P=0.001).Conclusions Compared with healthy individuals, serum levels of lncRNA-ANRIL and PTEN are significantly reduced in patients with coronary heart disease, while miR-181b levels are elevated, indicating that lncRNA ANRIL can regulate PTEN expression by miR-181b, thereby affecting the process of myocardial injury in coronary heart disease.
人工智能与医学

基于ChatGPT-4o与DeepSeek的虚拟标准化患者系统在医学问诊教学中的比较研究

A comparative study of ChatGPT-4o and DeepSeek-based virtual standardized patient systems in medical interview training

:1346-1352
 
背景 虚拟标准化患者作为医学教育中的新型教学工具, 已广泛用于提升学生的临床问诊能力。随着生成式人工智能的快速发展, 基于大语言模型(LLMs)构建的VSP系统成为研究热点。然而, 目前尚缺乏对不同LLM在模拟患者角色方面表现的系统比较。目的 比较ChatGPT-4o与DeepSeek两种主流LLM在VSP模拟中的适用性, 评估其在病史采集、语言自然度、线索引导能力及教学辅助效果等方面的表现差异。方法 采用类实验研究,参与者为某医学院校临床医学专业本科四年级学生, 所有参与者均已修完《诊断学》课程, 具备基础问诊技能, 研究对象共60人, 按学号尾数单双分为两组, 分别与ChatGPT-4o或DeepSeek驱动的VSP系统进行交互。进行模拟急性阑尾炎问诊, 并在完成病史采集后提交诊断判断与体验问卷。结果 ChatGPT-4o在结构化信息整合、线索引导及技术稳定性方面更为优越, 而DeepSeek则在语言亲和力与情感回应方面表现更具人文关怀色彩。结论 不同LLM在VSP中的优势方向不同, 可根据教学目标进行有针对性地系统选择与设计。未来研究可进一步拓展至不同病种、交互方式及评估维度,以全面评估LLM驱动VSP在医学教育场景下的适应性与教学成效。
Background Virtual standardized patients(VSPs)have emerged as a novel tool in medical education, widely adopted to enhance students’ clinical interview skills.With the rapid development of generative artificial intelligence, VSP systems powered by large language models(LLMs)have become a new focus of research.However, few studies have systematically compared the performance of different LLMs in simulating patient roles.Objective This study aims to compare the applicability of two mainstream LLMs, ChatGPT-4o and DeepSeek, in VSP-based medical interview simulations, focusing on their differences in history-taking performance,linguistic naturalness, clue guidance,and educational support.Methods A quasi-experimental study was conducted involving 60 fourth-year clinical medicine undergraduates from a medical school.All participants had completed a diagnostics course and possessed basic interviewing skills.Students were assigned to either the ChatGPT-4o or DeepSeek group based on the parity of their student ID numbers.Each participant conducted a text-based simulated interview with a VSP presenting with acute appendicitis, then submitted both a preliminary diagnosis and a structured satisfaction questionnaire.Results ChatGPT-4o demonstrated superior performance in structured information integration, clue-based prompting, and system stability.In contrast, DeepSeek showed more natural language affinity and emotional responsiveness,reflecting stronger humanistic communication traits.The two models displayed divergent strengths within the VSP framework, suggesting that system selection and integration should be tailored to specific teaching objectives.Conclusions Future research should expand the scope to include diverse disease scenarios, interaction modalities, and evaluation dimensions, to comprehensively assess the educational utility and adaptability of LLM-driven VSP systems in medical training.
护理研究

侧俯卧位MRI引导腰脊神经后根神经节射频消融术的手术体位护理

Surgical position nursing for radiofrequency ablation in posterior root ganglion of lumbar spinal nerve guided by MRI in lateral prone position

:562-566
 
目的 分析“侧俯卧位”MRI引导腰脊神经后根神经节脉冲射频治疗腰椎间盘突出症的手术体位护理效果。方法 对2018年9月—2020年12月在广州市荔湾中心医院住院接受经MRI引导腰脊神经后根神经节脉冲射频的腰椎间盘突出症患者62例随机分为两组:侧俯卧位组和俯卧位组,每组各31例。侧俯卧位组采用患侧抬高约30 °的侧俯卧位手术,俯卧位组采用标准俯卧位手术。记录两组手术时间、手术并发症、手术体位相关并发症及术者对术野显露的满意度评价。结果 所有患者均顺利完成手术,未见出血、感染、下肢麻痹加重神经损伤、脏器损伤等手术并发症,无患者发生眼压增高、臂丛损伤、压疮等体位相关并发症。侧俯卧位组手术时间(60.65±12.45)min,俯卧位组手术时间(70.58±10.25) min,组间比较差异有统计学意义(t=3.429,P=0.001)。术者对侧俯卧位组和俯卧位组术野侧显露总满意度分别为93.55%和77.42%,组间比较差异有统计学意义(χ2=4.292,P=0.038)。结论 侧俯卧位MRI引导腰脊神经后根神经节脉冲射频治疗腰椎间盘突出症安全、有效,做好手术体位护理可有效防止并发症。
Objective To analyze the effect of surgical position nursing for radiofrequency ablation in posterior root ganglion in lumbar spinal nerve guided by MRI in lateral prone position.Methods Sixty-two patients with lumbar disc herniation hospitalized in Liwan Central Hospital of Guangzhou from September 2018 to December 2020 were randomly divided into two groups(the lateral prone position group and the prone position group,31 patients in each group).The lateral prone position group used the lateral prone position with about 30 degrees elevation of the affected side,and the prone position group used the standard prone position for operation.Operating time,surgical complications,surgical position related complications,and operator satisfaction evaluation of surgical field exposure were recorded in both groups.Results All patients completed the operation successfully.No surgical complications such as bleeding,infection,lower limb paralysis,aggravated nerve injury or organ injury were found in the two groups.No surgical position related complications such as intraocular pressure raising,brachial plexus injury or pressure ulcers in both the groups either.The operation time was(60.65±12.45)min in the lateral prone position group and(70.58±10.25)min in the standard prone position group,respectively,and the difference was statistically significant(t=3.429,P=0.001).The surgeon’s satisfaction evaluation of the surgical field exposure was much higher in the lateral prone position group(93.55%)compared with the standard prone position group(77.42%),and the difference was statistically significant(χ2=4.29,P=0.038).Conclusions Radiofrequency ablation in posterior root ganglion of lumbar spinal nerve guided by MRI in lateral prone position is safe and effective.Good surgical position nursing can effectively prevent complications.
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