心肌梗死是由冠状动脉阻塞所引起的心肌缺氧坏死,其发病率和病死率居高不下。近年研究发现,利用组织工程手段仿生构建心肌微环境能有效改善心肌梗死区微环境,对心肌的再生能力有着重要的调控作用,能在一定程度上促进心肌再生,有望成为将来治疗心肌梗死的新方向。然而,由于对仿生心肌微环境和机体微环境交互作用、引发的生物学效应及作用机制不清楚,直接影响心肌损伤修复的过程和质量。因此,阐明仿生心肌微环境在心肌损伤修复过程中的交互作用过程及其介导的生物学效应迫在眉睫。该文系统性综述了仿生心肌微环境的构建策略及植入体内后介导的生物学效应,包括免疫调控效应、促血管再生效应以及再生协同效应等,为新型心肌补片的仿生设计和临床应用提供理论支持。

Myocardial infarction（MI）,arising from coronary artery obstruction resulting in hypoxic necrosis of myocardium,remains high morbidity and mortality．Recent studies have revealed that constructing myocardial microenvironment bionically through tissue engineering methods can effectively ameliorate the microenvironment in the infarcted area and exert a crucial regulatory role in myocardial regeneration,which promotes myocardial regeneration to a certain extent and holds promise for the treatment of MI．However,the interaction between biomimetic myocardial microenvironment and host microenvironment,as well as the triggered biological effects and mechanisms are not clear,which directly affects the process and quality of myocardial repair．Therefore,it is urgent to clarify the interaction process and biological effects mediated by the biomimetic myocardial microenvironment during myocardial repair．This review systematically summarizes the construction strategies of biomimetic myocardial microenvironment and their mediated biological effects after implantation,including immunomodulatory effects,pro-vascular regenerative effects,and regenerative synergistic effects,which provides theoretical support for the biomimetic design and clinical application of novel cardiac patches．

目的 研究基于儿童早期预警评分（PEWS）的分级干预模式促进重症肺炎患儿康复进程及对呼吸功能的影响。方法 回顾性分析2021年4月—2023年4月我院收治的100例重症肺炎患儿临床资料。将其按照干预方式的差异分为研究组（n=50）及对照组（n=50）。对照组选用常规干预,研究组则于对照组基础上增加基于PEWS的分级干预。对比两组康复进程（相关指标涵盖症状持续时长及住院天数）、呼吸功能（涵盖通气流速、每分钟最大通气量、肺活量、用力肺活量及深吸气量）、并发症发生情况（涵盖呼吸机相关性肺炎、肺大疱及胸膜炎）、患儿家属满意度。结果 研究组各项症状持续时长及住院天数均短于对照组（均P<0.05）。研究组各项呼吸功能指标水平均高于对照组（均P<0.05）。两组各项并发症发生率对比差异无统计学意义（P>0.05）。研究组患儿家属满意度高于对照组（96.00% vs 82.00%,P<0.05）。结论 基于PEWS的分级干预模式促进重症肺炎患儿康复进程的效果较佳,且能改善呼吸功能,提高患儿家属满意度。

Objective To study the effect of graded intervention mode based on Pediatric Early Warning Score（PEWS）on the recovery process and respiratory function of children with severe pneumonia．Methods The clinical data of 100 children with severe pneumonia treated in our hospital from April 2021 to April 2023 were retrospectively analyzed．Those children were divided into study group（n=50）and control group（n=50）according to the difference of intervention methods．Conventional intervention was used in the two groups,and PEWS-based graded intervention was added to the study group．The two groups were compared with each other in terms of recovery process（including duration of symptoms and length of stay）,respiratory function（including ventilation velocity,maximum volume per minute,vital capacity,forced vital capacity and deep inspiratory capacity）,complications（including ventilators associated pneumonia,bullosa and pleurisy）,and family member satisfaction．Results The duration of symptoms and hospitalization days in the study group were shorter than those in the control group（all P<0.05）．The levels of respiratory function indexes in study group were higher than those in control group（all P<0.05）．There was no significant difference in the incidence of complications between the two groups（P>0.05）．The satisfaction of family member in the study group was higher than that in the control group（96.00% vs 82.00%）（P<0.05）．Conclusions The PEWS based graded intervention model has a good effect on promoting the rehabilitation process of children with severe pneumonia,and can improve respiratory function,and increase the satisfaction of family member of children with severe pneumonia．

目的 分析谷草转氨酶（AST）、胆碱酯酶（CHE）、糖类抗原125（CA125）以及甲胎蛋白（AFP）对肝硬化患者的诊断效能。方法 选择70例肝硬化患者为观察组研究对象,另取70例同期健康体检者为对照组。两组研究对象均接受生化检验、肿瘤标志物检验。对比两组研究对象的AST、CHE、CA125、AFP检测结果,分析上述指标对肝硬化患者的诊断效能。结果 观察组肝硬化患者的CHE低于对照组,AST、CA125与AFP高于对照组（P<0.05）;AST与CHE在肝硬化诊断中具有良好的灵敏度、特异度;CA125联合AFP的灵敏度、特异度、符合率均高于CA125或AFP单独检验（P<0.05）。结论 AST、CHE、CA125、AFP在肝硬化患者临床诊断中具有良好的应用表现,是反映患者肝硬化病情进展的重要参考指标。

Objective To analyze the diagnostic efficacy of aspartate aminotransferase（AST）,cholinesterase（CHE）,carbohydrate antigen 125（CA125）,and alpha fetoprotein（AFP）in patients with liver cirrhosis．Methods A total of 70 patients with liver cirrhosis were included in the observation group as the study subjects,and 70 healthy individuals who underwent physical examinations during the same period were selected as the control group．Both groups of research subjects underwent biochemical testing and tumor marker testing．The AST,CHE,CA125,and AFP detection results of two groups of research subjects were compared,and the diagnostic effect of the above indicators on patients with liver cirrhosis were analyzed．Results The CHE test results of patients with liver cirrhosis in the observation group were significantly lower than those of healthy individuals undergoing physical examination,and the AST,CA125,and AFP test results were higher（P<0.05）．AST and CHE had good sensitivity and specificity in the diagnosis of liver cirrhosis．The sensitivity,specificity and coincidence rate of CA125 combined with AFP were higher than those of CA125 or AFP alone．Conclusions AST,CHE,CA125,and AFP have good clinical application performance in the diagnosis of liver cirrhosis patients,and are important reference indicators reflecting the progression of liver cirrhosis in patients．

目的 挖掘使用美托洛尔后的药物不良事件（ADE）,为临床合理用药提供参考意见。方法 对美国食品药品管理局（FDA）FDA药物ADE报告系统（FAERS）数据库进行信号挖掘,采用报告比值比法和比例报告比值法,分析FAERS数据库中2004年第1季度至2023年第2季度关于美托洛尔的ADE报告。结果 在FAERS数据库中收集到美托洛尔相关ADE共24 184例、667个阳性信号,共涉及27个系统器官分类。ADE严重报告共16 766（占69.33%）,ADE报告频次排名前3的分别是头晕、心动过缓、呼吸困难。结论 美托洛尔的不良反应主要集中在全身性疾病及给药部位各种反应、心脏器官疾病和各类损伤。在使用美托洛尔过程中发生ADE时,应该及时采取相应的干预措施。

Objective To explore the adverse drug events（ADEs）after the use of metoprolol and provide reference opinions for clinical rational drug use．Methods Signal mining was conducted on the FDA Adverse Event Reporting System（FAERS）database in the United States．The reporting ratio method and proportional reporting ratio method were used to analyze ADEs reports related to metoprolol in the FAERS database from the first quarter of 2019 to the second quarter of 2023．Results A total of 24 184 cases of metoprolol related ADEs were collected in the FAERS database,with 667 positive signals and a total of 27 system organ class involved．Conclusions The adverse reactions of metoprolol mainly focus on systemic diseases,various reactions at the administration site,heart organ diseases,and various injuries．It is recommended that timely intervention measures should be taken when ADE occurs during the use of metoprolol．

目的 评估多种气道湿化方法对喉癌患者术后气道湿化的效果。方法 检索PubMed、Cochrane、Embase、Web of Science、Ovid、中国知网、万方、CBM、Google Scholar等数据库和网站,检索时限为建库至2023年2月。搜集关于喉癌患者术后不同气道湿化方法的随机对照试验,采用JBI2016年随机对照试验RCT评价标准评价文献质量。使用ADDIS1.16.5软件进行网状Meta分析。结果 纳入18篇研究,共1 596例患者。结果显示,镇痛泵持续泵入与注射器间断滴入、喷雾瓶间断喷雾在痰痂形成方面比较差异有统计学意义[OR（95%CI）=537.70（4.18,124 511.88）、0（0,0.52）,P<0.05];湿化满意度方面,注射器间断滴入与喷雾瓶间断喷雾比较差异有统计学意义[OR（95%CI）=8.55（1.40,73.35）,P<0.05];其余比较差异无统计学意义（P>0.05）。概率排序显示,降低肺部感染、黏膜出血和痰痂形成、痰液黏稠度、咳嗽和湿化不满意的发生,最优方法分别为湿化泵持续泵入、镇痛泵持续泵入、MR400湿化器和输液器持续泵入。结论 综合网状Meta分析及概率排序结果,考虑到喉癌患者术后早期下床活动,推荐便携式持续湿化方法。

Objective To access the effects of multiple airway humidification methods for postoperative patients with laryngeal cancer．Methods PubMed,Cochrane Library,EMbase,Web of Science,Ovid,China National Knowledge Infrastructure,Wanfang database,CBM and Google Scholar were searched systematically from establishment to February 2023,respectively．Related randomized controlled trials on airway humidification for postoperative patients with laryngeal cancer was analyzed and the quality of the literature was assessed using the JBI 2016 RCT evaluation．The network Meta analysis was performed using ADDIS 1.16.5 softwares．Results A total of 18 articles and 1596 patients were inciuded．The results showed that the analgesia pump continued to pump into the airway compared with the syringe intermittently drip and the spray bottle intermittent spray was statistically different in the formation of sputum[OR（95%CI）=537.70（4.18,124 511.88）,0（0,0.52）,P<0.05]．In terms of satisfaction of wetness,the difference between the intermittent drop of the syringe and the intermittent spray of the spray bottle was statistically different[OR（95%CI）=8.55（1.40,73.35）,P<0.05],the others were not statistically different（P>0.05）．Probability ranking table shows that the optimal methods were the humidification pump continues to pump into the airway,the analgesia pump continued to pump into the airway,the MR400 humidifier and the infusion set continuously pumped into the airway,which were beneficial to the reduction in pulmonary infection,tracheal mucosal hemorrhage and formation of phlegm callus,the degree of sputum viscosity,cough and unsatisfactory wetness．Conclusions Based on the comprehensive mesh meta-analysis and probability ranking results,a portable continuous humidification method is recommended considering the early post-operative activities of laryngeal cancer patients．

目的 探讨Ki-67、微小染色体维持蛋白2（MCM2）、p16在宫颈鳞状上皮内病变中的表达及其临床意义。方法 采用免疫组化检测Ki-67、MCM2、p16在宫颈炎症组14例、低级别鳞状上皮内病变（LSIL）组47例、高级别鳞状上皮内病变（HSIL）组49例中的表达情况,以病理结果作为金标准,对结果进行统计分析。结果 HSIL组中Ki-67、MCM2、p16阳性率均高于炎症组和LSIL组（均P<0.017）。HSIL组中Ki-67、MCM2过表达率均显著高于炎症组和LSIL组（均P<0.017）。随着宫颈病变级别增加,Ki-67及MCM2阳性范围从基底层至表层逐渐扩大。MCM2及Ki-67在LSIL组中表达模式多为基底层的非过表达模式,HSIL组多为中层及以上的过表达模式。Spearman相关性分析显示,MCM2和Ki-67在宫颈鳞状上皮内病变中的表达强度之间呈正相关（r=0.801,P<0.05）;p16与MCM2在宫颈鳞状上皮内病变中的表达呈正相关（r=0.559,P<0.05）;p16与Ki-67在宫颈鳞状上皮内病变中的表达呈正相关（r=0.478,P<0.05）。结论 p16阳性提示宫颈高级别鳞状上皮内病变。MCM2与Ki-67在宫颈鳞状上皮内病变中的表达具有较高一致性,MCM2可作为宫颈鳞状上皮内病变新的增殖标志物。

Objective To investigate the expression and significance of Ki-67,MCM2 and p16 in cervical intraepithelial lesions．Methods The expressions of Ki-67,MCM2 and p16 in cervicitis group（14 cases）,low-grade squamous intraepithelial lesion（LSIL） group（47 cases）and high-grade squamous intraepithelial lesion（HSIL） group（49 cases）were detected by immunohistochemistry．The pathological results were used as the gold standard for statistical analysis．Results The positive rates of Ki-67,MCM2 and p16 in HSIL group were significantly higher than those in cervicitis group and LSIL group（P<0.017）．The over-expression rates of Ki-67,MCM2 in HSIL group were significantly higher than those in cervicitis group and LSIL group（P<0.017）．With the increase of cervical lesion grade,the positive range of Ki-67 and MCM2 gradually expanded from basal layer to surface layer．The expression patterns of MCM2 and Ki-67 in LSIL group were mostly non-overexpressed in the basal layers,while those in HSIL group were mostly overexpressed in the middle layer and above．Spearman correlation analysis showed that the expression intensity of MCM2 and Ki-67 in cervical squamous intraepithelial lesions was positively correlated（r=0.801,P<0.05）．There was a positive correlation between the expression of p16 and MCM2 in cervical squamous intraepithelial lesions（r=0.559,P<0.05）．There was a positive correlation between the expression of p16 and Ki-67 in cervical squamous intraepithelial lesions（r=0.478,P<0.05）．Conclusions Positive p16 indicates high-grade squamous intraepithelial lesion．The expression of MCM2 and Ki-67 in cervical intraepithelial lesions is highly consistent．MCM2 can be used as a new proliferative marker for cervical intraepithelial lesions．

目的 开发适合中国肾癌患者的生命质量测定量表的特异模块。方法 采用议题小组和核心小组的程序化决策方式,提出条目池,形成初步量表,采用医生及患者重要性评分法、相关系数法、变异度法、因子分析法和克朗巴赫系数α对20例肾癌患者和20名医护人员进行的数据进行统计分析。结果 经过上述方法进行筛检,结合专家小组的建议,最终得到含有11个条目的肾癌生命质量测定量表的特异模块。结论 肾癌的生命质量测定量表特异模块严格按照程序执行,具有较好的内容效度。

Objective To develop the specific module of the quality of life instruments for patients with renal cancer（QLICP-RE）．Methods With the structured group（nominal group and focus group）methods,the item pool was put forward and a preliminary instrument was formed．The data from 20 renal cancer patients and 20 doctors/nurses were analyzed by statistical procedures．Doctors and patients' importance rating procedure,correlation analysis,method of coefficient of variation,factor analysis,and Cronbach's α．Results By above statistical procedures and advises of expert panel,11-items of the specific module were formed finally．Conclusions The specific module of QLICP-RE developed on the strict procedures has good content validity and representativeness．

目的 探究血清多配体蛋白聚糖-1（SCD-1）与可溶性血管内皮生长因子受体-2（sVEGFR-2）表达水平在老年慢性心力衰竭患者预后评估的判定价值。方法 选取2023年1月—2024年3月珠海市第五人民医院检验科收治的110例老年慢性心力衰竭患者,检测其血清SCD-1和sVEGFR-2水平,对患者进行随访调查,了解其再次由于心力衰竭住院、心源性死亡的情况。运用多因素Logistic回归分析,探究老年慢性心力衰竭患者预后影响因素。结果 Logistic回归分析显示,心功能分级（OR=3.433,95%CI：0.934~6.431）、B型脑钠肽升高（OR=2.462,95%CI：0.861~4.765）、血清SCD-1升高（OR=3.795,95%CI：0.972~6.894）、血清sVEGFR-2升高（OR=3.842,95%CI：0.942~6.912）为影响老年慢性心力衰竭患者预后不良的重要因素（P<0.05）;联合血清SCD-1和sVEGFR-2曲线下面积0.962与B型脑肽钠曲线下面积0.844,相较于单一SCD-1曲线下面积0.658、sVEGFR-2曲线下面积0.712明显偏高（P<0.05）。结论 经研究证实,老年慢性心力衰竭患者预后效果不理想,其血清SCD-1和sVEGFR-2监测水平异常升高,和老年慢性心力衰竭预后不佳存在关联性,可视为老年慢性心力衰竭患者判定预后效果的主要标志物。

Objective To investigate the prognostic value of serum syndecan-1（SCD-1）and soluble vascular endothelial growth factor receptor-2（sVEGFR-2）expression levels in elderly patients with chronic heart failure. Methods A total of 110 elderly patients with chronic heart failure admitted to our hospital were selected,with a time interval of January 2023 to March 2024．Serum SCD-1 and sVEGFR-2 levels were detected and follow-up investigations were conducted to understand their re hospitalization and cardiogenic death due to heart failure．Multiple logistic regression analysis was used to explore the prognostic factors affecting elderly patients with chronic heart failure. Results According to logistic retrospective analysis,heart function grading（OR=3.433,95%CI：0.934-6.431）,elevated B-type brain natriuretic peptide（OR=2.462,95%CI：0.861-4.765）,elevated serum SCD-1（OR=3.795,95%CI：0.972-6.894）,and elevated serum sVEGFR-2（OR=3.842,95%CI：0.942-6.912）were important factors affecting the poor prognosis of elderly patients with chronic heart failure,with differences P<0.05．The area under the curve of combined serum SCD-1 and sVEGFR-2 was 0.962,and the area under the curve of B-type brain peptide sodium was 0.844,which was significantly higher than that of a single SCD-1 curve of 0.658 and sVEGFR-2 curve of 0.712,with a difference of P<0.05. Conclusions Research has confirmed that the prognosis of elderly patients with chronic heart failure is not satisfied,and their serum SCD-1 and sVEGFR-2 monitoring levels are abnormally elevated,which is related to the poor prognosis of elderly patients with chronic heart failure．It can be regarded as the main biomarker for defining the prognosis of elderly patients with chronic heart failure．

目的 探讨BOPPPS[（导引（B）,目标（O）,课前测试（P）,参与式学习（P）,课后测试（P）,总结（S）]模式下模块化教学结合模拟演练在创伤急救培训中的应用效果。方法 选取福建省泉州市正骨医院急诊科2022年8月—2024年2月90名护士,随机分为对照组和干预组,每组45名护士。对照组采用传统授课模式进行教学培训;干预组采用BOPPPS模式下模块化教学结合模拟演练进行教学培训。培训结束对两组学员的创伤急救综合理论及单项技能、创伤急救救护综合能力、培训效果满意度进行统计分析。结果 干预组的综合理论成绩为（80.74±6.87）分、单项技能成绩为（92.13±2.26）分,相较于对照组均提高（P<0.05）。干预组对创伤急救课程的总体满意度：非常同意23例、同意20例,比例均高于对照组（P<0.05）。干预组的创伤急救救护综合能力如病情评估预判能力,优秀26例、良好15例;护理计划分析实施能力,优秀25例、良好13例;团队协作与资源管理能力,优秀27例、良好15例;情景感知与应变能力,优秀30例、良好11例;综合救护能力,优秀36例、良好5例。显著优于对照组（P<0.05）。结论 BOPPPS模式下模块化教学结合模拟演练能够提高急诊科护士的综合创伤救护能力,且取得了较高的满意度,值得进一步推广应用。

Objective To explore the application effect of modular teaching combined with simulation exercise in trauma first aid training under BOPPPS model．Methods A total of 90 nurses in the emergency department from August 2022 to February 2024 were randomly divided into control group（n=45） and intervention group（n=45）．The control group was trained by traditional teaching mode．The intervention group was trained by BOPPPS modular teaching combined with simulation exercise．After the training,the comprehensive theory of trauma first aid,individual skills,comprehensive ability of trauma first aid and satisfaction degree of training effect of the two groups of nurses were statistically analyzed．Results The comprehensive theoretical scores and single skill scores of the intervention group were significantly improved compared with the control group（P<0.05）．The satisfaction degree of trauma first aid training in the intervention group was significantly higher than that in the control group（P<0.05）．The comprehensive ability of trauma first aid in the intervention group was significantly better than that in the control group（P<0.05）．Conclusions The combination of modular teaching and simulation exercise in BOPPPS model can improve the comprehensive trauma rescue ability of nurses in emergency department,and has obtained a high degree of satisfaction,which is worthy of further popularization and application．

目的 探讨白蛋白-胆红素（ALBI）联合中性粒细胞与淋巴细胞比值（NLR）预测肝硬化合并食管胃底静脉曲张破裂出血（EGVB）的临床价值。方法 回顾性分析2021年1月—2022年12月肇庆市第一人民医院消化内科收治的80例肝硬化合并EGVB患者的临床资料,通过电话及门诊、再入院对其进行为期1年的随访,根据随访结果,将其分为2组,即存活组（n=69）与死亡组（n=11）,分析导致患者死亡的危险因素,并评估ALBI联合NLR预测肝硬化合并EGVB患者死亡的临床价值。结果 死亡组的年龄60岁以上、腹水和肝性脑病者占比,总胆红素（TBiL）、NLR、凝血酶原时间（PT）、谷丙转氨酶（ALT）水平及ALBI评分均高于存活组（均P<0.05）,而血红蛋白（HGB）、白蛋白（ALB）及血钠水平均低于存活组（均P<0.05）;Logtisic回归分析显示,年龄60岁以上、腹水、肝性脑病和TBiL、NLR水平升高及ALBI分级为3级是肝硬化合并EGVB患者死亡的危险因素（均P<0.05）;ALBI联合NLR预测肝硬化合并EGVB患者预后的准确率及灵敏度高于单一诊断,漏诊率低于单一诊断（P<0.05）。结论 肝硬化合并EGVB患者可见ALBI评分及NLR水平升高,而以上两种指标是患者死亡的危险因素,将其联合检测可评估患者预后,预测其死亡风险。

Objective To investigate the clinical value of albumin-bilirubin（ALBI）combined with neutrophil lymphocyte ratio（NLR）in predicting liver cirrhosis complicated with esophageal and gastric varices bleeding（EGVB）．Methods The clinical data of 80 patients with liver cirrhosis complicated with EGVB admitted to the Department of Gastroenterology of the First People's Hospital of Zhaoqing from January 2021 to December 2022 were retrospectively analyzed．They were followed up for one year by telephone,outpatient service and readmission．According to the follow-up results,they were divided into the survival group（n=69）and the death group（n=11）．The risk factors leading to the death of patients were analyzed and evaluated．Results The proportion of age over 60,ascites and hepatic encephalopathy,the levels of TBiL,NLR,PT,ALT and ALBI in the death group were higher（P<0.05）,while the levels of HGB,ALB and blood sodium were lower（P<0.05）．Logistics analysis showed that age over 60,ascites,hepatic encephalopathy,NLR and ALBI grade 3 were independent risk factors for the death（P<0.05）．The accuracy and sensitivity of ALBI combined with NLR in predicting their prognosis were significantly higher than that of single diagnosis,and the missed diagnosis rate was lower（P<0.05）．Conclusions ALBI scores and NLR levels significantly increase in patients with liver cirrhosis complicated with EGVB,and the above two indexes are risk factors for the death,and the combination of them can evaluate the prognosis of patients and predict the death risk．