目的 本研究通过检测吸入布地奈德治疗支气管哮喘患儿前、后气道重塑、肺功能及外周血TGF-β浓度的变化,探讨布地奈德在哮喘患儿气道重塑早期干预的作用。方法 将2013年1月—2014年10月在我院确诊为支气管哮喘患儿18例,给予规律吸入布地奈德治疗6个月,分别于治疗前、后检测肺功能、外周血TGF-β浓度以及通过高分辨CT(HRCT)测量支气管管壁厚度(T)并计算管壁面积(WA)、支气管管壁厚度与气管外径之比(WT%)、气道壁横截面面积占气道总截面积的的百分比(WA%)。结果 吸入布地奈德治疗治疗6个月后,哮喘患儿WT%、WA%、肺功能以及TGF-β浓度均明显改善,与治疗前比较差异有统计学意义(P<0.05)。结论 规律吸入布地奈德治疗能减轻支气管哮喘患儿早期气道重塑,改善肺功能,可能通过下调细胞因子TGF-β的表达有关。

Objective We detected the changes of Airway remodeling,lung function and peripheral blood concentrations of TGF-β in asthmatic children before and after inhaled budesonide, and explored the role of budesonide in airway remodeling before early intervention in asthmatic children. Methods 32 cases of children were diagnosed asthma in our hospital,and given treatment of inhaled budesonide for 6 months, and to detect lung function,pheral blood TGF-β concentration as well as measuring the bronchial wall thickness (T) and calculate the wall area (WA), the outer diameter of the trachea and bronchial wall thickness ratio (WT%), the cross-sectional area of the airway wall accounted for airway percentage (WA%) of the total cross-sectional area by high-resolution CT (HRCT) before and after treatment. Results After treatment with inhaled budesonide in six months, the asthma WT%, WA%, lung function, and TGF-β concentrations were significantly improved, the differences compared with that before treatment were statistically significant(P<0.05). Conclusion The treatment of inhaled budesonide can alleviate asthmatic airway remodeling in early, improve lung function,possibly related to down the expression TGF-β.

目的 对出生缺陷知信行健康教育模式效果进行策略分析与探讨,为进一步完善围产期保健服务及健康教育工作提供合理化建议。方法 采用《孕期妇女出生缺陷基本知识知晓率专题测评问卷》并结合实际情况设定有关信念、行为方面的7个问题,对2011年1月—2013年6月期间在中心孕妇学校参加健康教育活动课堂的孕妇进行调查,并应用决策树模型对中心现有的出生缺陷知信行健康教育模式效果进行探讨。结果 预防出生缺陷知识方面,对初高中及中专文化程度的孕期妇女加强出生缺陷预防知识健康教育的预期收益合计达到51.2%,可作为重点目标人群;预防出生缺陷信念方面,主要决定因素是户籍类型和年龄,加大对本地户籍及25岁以上流动妇女人群的健康教育,促进孕期妇女树立预防出生缺陷信念的预期收益累计达95.9%;预防出生缺陷行为方面,主要影响因素是产检医生的嘱咐,受到嘱咐的孕期妇女预期收益为62.3%。结论 为了达到出生缺陷防治目标与健康教育整体效果的提高,应将预防出生缺陷的健康教育工作重点放在初高中及中专文化程度人群,本地户籍孕期妇女和25岁以上流动性孕期妇女又是需要树立预防出生缺陷信念的重点人群,强化产检医生的嘱托义务是提高孕期妇女出生缺陷知信行健康教育模式效果的有力保证。

Objective To identify factors related to the knowledge, attitude and practice KAP of birth defects prevention among pregnant women, and provide reasonable suggestions to improve perinatal health services and health education. Methods Using cluster sampling method, 5500 participants from pregnant women school were enrolled. Information on “awareness of basic knowledge of birth defects” and 7 questions about attitudes and practice to participant actual situation was gathered through personal interviews using a structured questionnaire. The related factors were analyzed by classification tree model of SPSS 19.0. Results As to birth defects related knowledge, prospective return was more than 50% in the pregnant women with junior, senior high school and technical secondary school education level. As to birth defects prevention faith, the main determinant was census register types; prospective return of pregnant women who were local permanent residents and floating population aged ≥25 years was 95.9%. The main influencing factor of practice was prenatal doctor's education; prospected return was 62.3% after strengthening the health education of prenatal doctor. Conclusion In order to improve birth defects education effect, pregnant women who have junior, senior high school and technical secondary school education level and are local permanent residents or floating population aged ≥25 years should be key targeted population. Prenatal doctor's health education will be a powerful guarantee.

目的 通过建立大鼠泛耐药铜绿假单胞菌肺炎模型,对其进行联合用药,观察疗效,以便为治疗泛耐株引起的感染提供理论基础。方法 选择体外药敏实验中各药物组合同时有效的一株铜绿假单胞菌建立小鼠肺炎模型,于感染后6小时给药,对照组腹腔注射0.5 mL生理盐水,治疗组分别用头孢他啶+阿米卡星+环丙沙星以及头孢他啶+阿米卡星+环丙沙星+氨氯地平两组用药方案连续治疗三天后,根据肺组织匀浆细菌计数及病理结果评价疗效。结果 体内药敏试验显示用药组不管有无氨氯地平干预,对细菌的清除作用与对照组比较差异有统计学意义(P﹤0.05),而两用药组之间比较,差异无统计学意义。结论 对泛耐药铜绿假单胞菌感染后肺炎模型,联合应用体外单药药敏试验耐药的抗菌药后对细菌仍有一定的清除作用,但加入氨氯地平干预未显示有明显的治疗效应。

目的 水解乳清蛋白对炎症性肠病大鼠的抗炎作用及机制。方法 将40只雄性大鼠随机分为实验组和对照组,并建立炎症性肠病动物模型,分别喂食添加了水解乳清蛋白及普通蛋白的饲料,喂养4周后处死大鼠,每周检测体重,血清ALB、TNF-α、IL-2、IL-6等。结果 二组间体重及血清白蛋白无区别(P>0.05),实验组与对照组的TNF-α、IL-2及IL-6无区别(P>0.05),从第二周到第四周,实验组的炎症因子水平低于对照组(P<0.05)。结论 水解乳清蛋白具有抗炎作用,能够减少炎症性肠病大鼠动物模型的炎症因子的释放,并改善其营养状况。

Objective To evaluate the anti-inflammatory effects of whey protein on SD rats model of inflammatory bowel disease. Methods 40 SD rats model of inflammatory bowel disease were established and randomly divided into experimental and control groups equally. Experimental and control groups were fed whey protein and ordinary protein respectively. After 4 weeks, TNF-α, IL-2 and IL-6 were detected. Results There were no significant difference between the two groups of weights and the level of ALB. The level of TNF-α, IL-2 and IL-6 between groups were not significantly different in the first week(P>0.05). However, thelevels of TNF-α, IL-2 and IL-6 in experimental group were significantly lower than those of the control group in the follow weeks. Conclusion The whey protein could reduce the production of inflammatory cytokines.

目的 通过构建结构方程模型,分析某三级甲等综合医院腹股沟疝患者住院费用的影响因素,旨在为合理控制腹股沟疝单病种费用提供依据。方法 收集4 328份高州市人民医院2016—2022年主要诊断疾病名称为腹股沟疝且行腹股沟疝手术的患者的病历资料,预分析单个影响因素,采用AMOS28.0拟合构建模型。结果 结构方程模型拟合达到标准。性别、年龄、费别、住院次数、入院途径、伴随病、单双侧疝对总费用所产生的总效应数值分别为0.008、-0.044、0.062、0.014、-0.119、0.106、0.236;性别、年龄、费别、住院次数、入院途径、伴随病、单双侧疝通过住院时间间接对住院费用产生影响。结论 对住院费用产生的影响因素有性别、年龄、费别、住院次数、入院途径、伴随病、单双侧疝、住院时间,建议推行患者预住院模式及日间手术,在正式住院前完成相关检查,优化医疗服务流程,从而合理有效控制单病种住院费用。

Objective By utilizing a structural equation model, to analyze determinants that affect the hospitalization costs for individuals with inguinal hernia at a tertiary-level comprehensive medical center, offering insights for the potential management of costs associated with this specific ailment. Methods This study entailed the compilation of 4 328 patient files from individuals who received surgical treatment for inguinal hernia at a third-level general hospital over the period spanning 2016 to 2022. Preliminary analysis was conducted on isolated variables, followed by the development of a model using AMOS 28. 0 for fit assessment. Results The fitting of structural equation model reached the standard. The total effect values of gender, age, cost, number of hospitalizations, admission route, concomitant disease, unilateral and bilateral hernia on the total cost were 0. 008, -0. 044, 0. 062, 0. 014, -0. 119, 0. 106, 0. 236, respectively. Gender, age, cost, number of hospitalizations, admission route, concomitant disease, unilateral and bilateral hernia indirectly affected hospitalization expenses through hospitalization days. Conclusions Gender, age, cost, number of hospitalizations, of admission, concomitant diseases, unilateral and bilateral hernia, and length of hospital stay have an impact on hospitalization costs. It is suggested to implement the pre-hospitalization mode and day surgery, complete relevant examinations before formal hospitalization, and optimize the medical service process, so as to reasonably and effectively control the hospitalization cost of single disease.

目的 通过建立急性心力衰竭（AHF）患者服药依从性预测模型,提高AHF患者的服药依从性和临床管理效果。方法 纳入2021年1月—2023年12月在广州市番禺区何贤纪念医院住院治疗的580例AHF患者,通过收集患者的一般人口学资料、疾病相关资料及出院后6个月的服药依从性数据,应用Logistic回归模型分析患者服药依从性的影响因素,并基于影响因素建立预测模型。结果 患者服药依从性总体良好（75%）。依从性良好组与依从性差组的年龄、独居情况、合并基础病、服药种类、疾病了解评分、治疗信心评分和自我控制信心评分比较差异有统计学意义（P<0.05）。Logistic 回归分析显示危险因素包括年龄≥60岁（OR=1.774）、独居（OR=1.871）、合并基础病≥2种（OR=1.719）和服药种类≥7种（OR=1.456）。而疾病了解评分（OR=0.923）、治疗信心评分（OR=0.946）和自我控制信心评分（OR=0.901）是保护因素（P<0.05）。基于上述因素建立的预测模型,通过ROC曲线验证,曲线下面积为0.815（95%CI：0.780~0.850）,提示所构建的模型具有良好的区分度。对该模型的校准度进行评价,P=0.528,提示该预测模型拟合度良好。此外,该预测模型的一致性指数为0.738,说明模型的预测性能良好。绘制的决策曲线中,曲线位于极端线之上,当阈概率取值在9%~59%时,对应的净获益率为0~27%,提示建立的模型具有优秀的临床有效性。结论 AHF患者的服药依从性受到多种因素的影响,包括年龄、居住状态、合并基础病种类及服药种类等。

Objective To establish a predictive model for medication compliance among acute heart failure（AHF）patients in order to enhance their therapeutic compliance and optimize clinical outcomes. Methods A total of 580 AHF inpatients at He Xian Memorial Hospital in Panyu District, Guangzhou between January 2021 and December 2023 were enrolled. Demographic information, disease-specific data,as well as post-discharge medication compliance records within six-month were collected by investigators. Utilizing logistic regression analysis revealed several influential determinants affecting medication compliance which formed the basis for constructing our predictive model. Results Generally,patient compliance was good（75%）. The comparison between the good compliance group and the poor compliance group showed that there were significant differences in age, living alone,combined with underlying diseases, types of medication, disease understanding score, treatment confidence score and self-control confidence score（P<0. 05）. Logistic regression analysis showed that independent risk indicators including individuals aged ≥60 years（odds ratio[OR]=1. 774）, those living alone（OR=1. 871）, presence of two or more underlying diseases（OR=1. 719）, along with consumption of seven or more medications daily（OR=1. 456）. Conversely,disease awareness score（OR=0. 923）, treatment confidence score（OR=0. 946）, and self-control confidence score（OR=0. 901）were identified as independent protective factors. Validation using receiver operating characteristic curves demonstrated robust predictive performance with an area under curve value of 0. 815（95%CI：0. 780-0. 850）, affirming its efficacy. The calibration of the model was evaluated, with a P-value of 0. 528, indicating good fit of the predictive model. Additionally, the concordance index（C-index）of the model was 0. 738, suggesting its excellent predictive performance. The decision curve analysis revealed that the curve was above the extreme lines, with a net benefit rate ranging from 0 to 27% when the threshold probability falls between. Conclusions The medication compliance of AHF patients is influenced by various factors, including age, living arrangement, the number of underlying diseases, and the number of medications taken. Targeted interventions such as enhancing patient education, simplifying treatment regimens, and improving social support can effectively improve the medication compliance of AHF patients. The predictive model established in this study provides a scientific basis for clinicians to develop more precise and effective individualized intervention measures,thereby improving the prognosis and quality of life.

目的 建立大鼠急性心肌梗死缺血再灌注后无复流模型,并初步验证细胞焦亡在其中的发生情况。方法 选用20只标准成年雄性Sprague Dawley大鼠（体质量260~320 g）,随机分为对照组（n=5）和手术组（n=15）。对照组仅穿线冠状动脉,未行结扎;手术组结扎左前降支0.5 h后解除,进行再灌注4 h,以建立无复流模型。通过Evens blue和硫磺素S染色,评估心肌的正常供血区、再灌注区及无复流区,并对两组大鼠心肌组织进行病理分析。结果 对照组大鼠全部存活,未出现无复流现象,心肌组织中未见细胞焦亡。手术组存活13只,形成明确的正常供血区（n=13）、再灌注区（n=13）和无复流区（n=10）。在无复流区的心肌细胞中均观察到细胞焦亡（n=10）,而正常供血区未见（n=0）,再灌注区部分出现（n=4）,差异具有统计学意义（P<0.05）。结论 细胞焦亡现象主要存在于大鼠急性心肌梗死缺血再灌注后无复流区域中,细胞焦亡可能作为一种区域特异性程序性死亡方式,在心肌无复流的发生与发展中发挥重要作用。

Objective To establish a rat model of myocardial no-reflow after acute myocardial infarction with ischemia-reperfusion injury and to preliminarily explore the occurrence of pyroptosis in the affected myocardium. Methods Twenty adult male Sprague-Dawley rats（260-320 g）were randomly divided into a control group（n=5）and a surgical group（n=15）. In the control group,the coronary artery was encircled with suture but not ligated. In the surgical group,the left anterior descending artery was ligated for 30 minutes, followed by 4 hours of reperfusion to induce the no-reflow model. Evans blue and thioflavin S staining were used to evaluate the normal perfusion area,reperfusion area,and no-reflow area of the myocardium. Histopathological analysis was conducted on myocardial tissues from both groups. Results All rats in the control group survived without evidence of no-reflow or pyroptosis in myocardial tissue. In the surgical group, 13 rats survived and showed distinct regions of normal perfusion, 13 with reperfusion, and 10 with no-reflow. Pyroptosis was observed in all no-reflow areas（n=10）, absent in the normal perfusion zones（n=0）, and partially present in the reperfusion zones（n=4）. The differences were statistically significant（P<0. 05）. Conclusions Pyroptosis predominantly occurs in the no-reflow zones following acute myocardial infarction and ischemia-reperfusion injury in rats. As a region-specific form of programmed cell death, pyroptosis may play an important role in the development of myocardial no-reflow.

目的 探讨基于品管圈活动构建健康体检重要异常结果的追踪管理模式对提高电话随访率的影响。方法 选取2022年5月—2023年4月在中山大学孙逸仙纪念医院健康管理中心体检重要异常结果的328例受检者作为研究对象。成立品管圈活动小组,实施追踪管理模式。干预后时间段为2022年11月—2023年4月,期间针对不同样本分别实施了干预措施一至四及全面实施措施,分析随访1个月后成功随访人数。比较干预前后圈员综合能力变化及患者对健康管理中心的满意度。结果 电话随访率在干预措施一实施后为85.02%,干预措施二实施后为88.59%,干预措施三实施后为90.23%,干预措施四实施后为95.27%,全面实施干预措施一至干预措施四后为95.80%,均较干预措施实施前电话随访率（75.91%）有所增长;干预成功随访人数中,复诊率为84.34%（210/249）,全面实施措施后成功随访人数中复诊率为94.74%（216/228）。相较于干预前,干预后,圈员解决问题能力、责任心、沟通协调、团队凝聚力、积极性、品管手法、自信心、和谐感分值均升高（P<0.05）。干预前患者满意度为85.37%,干预后患者满意度为87.80%,干预后满意度有所升高,差异具有统计学意义（P<0.05）。结论 通过开展品管圈活动,使重要异常结果电话随访率明显提高,有利于提升体检机构的服务质量和服务能力,有利于疾病的早发现、早干预。

Objective Exploring the impact of establishing a tracking and management model for important abnormal results of health check ups based on quality control circle activities on improving telephone follow-up rates. Methods A total of 328 subjects with important abnormal results in Health Management Center of Sun Yat-sen Memorial Hospital of Sun Yat sen University from May 2022 to April 2023 were selected. The quality control circle activity group was set and the tracking management mode was carried out. The post intervention period was from November 2022 to April 2023, during which intervention measures 1-4 and comprehensive implementation measures were implemented for different samples. The number of successful follow-up after 1 month of follow-up was analyzed. Changes in the comprehensive ability of the circle staff before and after the intervention and the patients’ satisfaction with the health management center were compared. Results The telephone follow-up rate after intervention 1 was 85. 02%, 88. 59% after intervention 2,90. 23% after intervention 3,95. 27% after intervention 4 and 95. 80% after all intervention,which was higher than 75. 91% before intervention implementation. Among the single intervention individuals, the re-visit rate was 84. 34%（210/249）, and after the comprehensive implementation of measures, the re-visit rate among the successfully intervened individuals was 94. 74%（216/228）. After the intervention,the problem solving ability,responsibility, communication and coordination,team cohesion, enthusiasm,quality control techniques,self-confidence,and sense of harmony all significantly increased（P<0. 05）. The patient satisfaction rate before intervention was 85. 37%, and after intervention it was 87. 80%. The satisfaction rate increased after intervention, and the difference was statistically significant（P<0. 05）. Conclusions Through the quality control circle activities, the telephone follow-up rate of important abnormal results is significantly improved,which is conducive to improving the service quality and service capacity of physical examination institutions,is conducive to the early detection and early intervention of diseases.

       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   本研究以脑卒中患者为研究对象，通过二代Illumina高通量测序平台对患者的粪便标本进行微生物群落多样性测序。选择物种丰度≥30%的24个门类（Phylum）作为肠道菌群的研究指标，进而研究肠道菌群与脑卒后抑郁（PSD）之间的相关关系。方法   以40位脑卒中患者的24个门类作为特征变量，抑郁组和对照组为二分类目标变量，建立以Logistic回归、随机森林、支持向量机和AdaBoost为基模型的Stacking分类模型。主成分分析方法作为该模型的特征选择方法选择恰当的主成分进行模型训练，通过二分类评价报告（precision、recall、f1-score）、ROC曲线和混淆矩阵等评价指标对其性能进行评价。结果   （1）通过差异性检验分析了两组（抑郁组和对照组）的基线一致（P＜0.05）；（2）从Stacking模型融合的角度定量分析了影响脑卒中后抑郁情绪的具体肠道菌群。研究结果可知，放线菌门、拟杆菌门、变形菌门和酸杆菌门在PSD患者中均增加（P＜0.001）；厚壁菌门，疣微菌门，绿弯菌门和软壁菌门在PSD患者中降低（P＜0.001）。结论   以上菌群是影响脑卒中后抑郁患者情绪的主要影响因素，因此，在临床上通过恰当干预肠道菌群的变化来调节脑卒中后抑郁患者的抑郁水平，这为脑卒中后抑郁情绪的诊断和治疗方案提供科学依据。

        Objective  In this study，patients with stroke were selected as the research object，and the microbial community diversity of patients’ stool samples was sequenced by the second-generation Illumina high-throughput sequencing platform．Twenty four phylum species with 30% species abundance were selected as indicators for the study of gut microbiota，and then the correlation between gut microbiota and post-stroke depression（PSD） was studied．Methods  Taking 24 categories of 40 stroke patients as characteristic variables，depression group and control group as dichotomous target variables，a stacking classification model based on Logistic regression，random forest，support vector machine and AdaBoost was established．As the feature selection method of the model，principal component analysis selects the appropriate principal components for model training，and evaluates its performance through dichotomous evaluation reports（precision，recall，f1 score），ROC curve and confusion matrix．Results  The baseline of the two groups（depression group and control group）was consistent（P＜0.05）through the difference test．From the perspective of stacking model fusion，the specific intestinal flora affecting post-stroke depression was quantitatively analyzed．The results showed that Actinobacteria，Bacteroidetes，Proteobacteria and Acidobacteria were significantly increased in PSD patients（P＜0.001），while Firmicutes，Verrucomicrobia，Chloroflexi and Tenericutes were significantly decreased in PSD patients（P＜0.001）．Conclusions  The above microbiota are the main factors affecting the mood of patients with post-stroke depression．Therefore，in clinical practice，we can adjust the depression level of patients with post-stroke depression by properly intervening the changes of intestinal microbiota，which provides a scientific basis for the diagnosis and treatment of PSD．