目的 探讨依奇珠单抗对中重度斑块型银屑病的治疗效果。方法 选取厦门大学附属第一医院2022年1月—2023年8月收治的75例中重度斑块型银屑病患者,应用抽签法进行分组,分为试验组（n=35）与对照组（n=40）。对照组采取常规外用药物治疗,试验组采取依奇珠单抗治疗。对比两组临床疗效,治疗前后外周血调节性T细胞（Treg）和辅助性T细胞17（Th17/Treg）细胞水平变化,并对所有患者进行6个月门诊复查随访,对比复发率及不良反应。结果 试验组总有效率88.57%,高于对照组的67.50%（χ²=4.730,P=0.028）;治疗后两组患者Treg细胞升高,试验组（5.59±1.24）%高于对照组（4.12±1.13）%,对比差异有统计学意义（t=5.371,P<0.001）,Th17细胞、Th17/Treg细胞降低,试验组[（1.06±0.14）%、0.19±0.05]低于对照组[（1.71±0.28）%、0.42±0.14],对比差异有统计学意义（t=12.434、9.212,P<0.001）;试验组停药后6个月复发率低于对照组（5.71% vs 27.50%,χ²=6.180,P=0.013）;试验组不良反应发生率略高于对照组,组间对比差异无统计学意义（14.29% vs 5.00%,χ²=1.900,P=0.168）。结论 依奇珠单抗治疗中重度斑块型银屑病疗效显著,可调节Th17/Treg平衡,降低停药后复发率,且安全性较高。

Objective To explore the therapeutic effect of Ixekizumab on moderate to severe plaque psoriasis. Methods Seventy-five patients with moderate to severe plaque psoriasis who were admitted to the First Affiliated Hospital of Xiamen University from January 2022 to August 2023 were selected and allocated by lottery into an experimental group（n=35）and a control group（n=40）．The control group received routine external medication while the experimental group received Ixekizumab treatment．The clinical efficacy of two groups,changes in Th17/Treg cell values before and after treatment were compared,and a 6-month outpatient follow-up for all patients was conducted to compare recurrence rates and incidence of adverse reactions. Results The total response rate in the experimental group was 88.57%,which was higher than the 67.50% in the control group（χ²=4.730,P=0.028）．After treatment,the level of Treg cell in the two groups was significantly higher,and the level of Treg cell experimental in the group was higher than that in the control group[（5.59±1.24）% vs （4.12±1.13）%,t=5.371,P<0.001]．After treatment,the level of Th17 and Th17/Treg cell in the two groups were lower,and the level of Th17 cell and Th17/Treg in the experimental group[（1.06±0.14）%,0.19±0.05] were significantly lower than those in the control group[（1.71±0.28）%,0.42±0.14],which was statistically significant（t=12.434、9.212,P<0.001）．The relapse rate at 6 months after drug withdrawal in the experimental group was significantly lower than that in the control group（5.71% vs 27.50,χ²=6.180,P=0.013）．The incidence of adverse reactions in the experimental group was higher than that in the control group,but with no statistical significance（14.29% vs 5.00%,χ²=1.900,P=0.168）. Conclusions Ixekizumab has a significant therapeutic effect on moderate to severe plaque psoriasis．It can regulate the Th17/Treg balance and reduce the recurrence rate after discontinuation,and with high safety．

肉芽肿性小叶性乳腺炎（GLM）是一种临床较为难治的、慢性、炎症性的疾病,虽不会影响患者的生命,但是对患者的生理、心理造成了一定程度的影响,近年来该病的发病率有逐年上升的趋势。“治未病”是中医的基本思想之一,在疾病的预防、诊治方面具有重要意义。该文尝试将中医“治未病”思想应用于GLM的预防和治疗中,试图构建独特的中医预防GLM质量管理模式,以期为GLM防治提供新的思路。

Granulomatous lobular mastitis（GLM）is a chronic,inflammatory disease that is difficult to treat．Although it does not affect the patient's life,it has a certain degree of physiological and psychological impact on the patient,and in recent years the incidence of this disease has been increasing year by year．“Treating Disease Before Its Onset” is one of the basic ideas of Chinese medicine,which is of great significance in the prevention,diagnosis and treatment of diseases．In this paper,we try to apply the idea of “Treating Disease Before Its Onset” in Chinese medicine to the prevention and treatment of GLM,and attempt to construct a unique quality management model of Chinese medicine for the prevention of GLM,with a view to providing new ideas for the prevention and treatment of GLM．

目的 探讨基于失效模式与效应分析法（FMEA）风险管理模式的在消化内镜诊疗护理中的应用价值。方法 选取2021年7月—2022年12月在河南省人民医院接受无痛消化内镜诊疗的368例患者为研究对象,根据入组时间顺序,2022年3月及其之前入组患者为对照组（n=171）,实施常规护理管理;2022年3月之后入组的患者为观察组（n=197）,在对照组基础上,增加基于FMEA的护理风险管理模式,对比两组患者的护理质量。结果 观察组各环节风险优先级（RPN）值较干预前明显好转,RPN总分由1 044分降至336分,观察组不良事件发生率低于对照组（17.3% vs 33.3%,P<0.05）,观察组患者对医护人员满意度高于对照组（92.9% vs 85.4%,P<0.05）,观察组患者所需的等待时间低于对照组[（35.68±7.29）min vs （44.27±8.65）分min,P<0.05]。结论 FMEA风险管理模式能有效提高无痛消化内镜诊疗中的护理质量。

Objective To explore the application analysis of failure mode and effect analysis（FMEA）risk management model in digestive endoscopy diagnosis treatment and nursing．Methods A total of 368 patients who underwent painless endoscopic diagnosis and treatment at Henan Provincial People’s Hospital from July 2021 to December 2022 were selected．According to the order of enrollment,patients enrolled in March 2022 and before were selected as the control group（n=171）,and routine nursing management was implemented．The patients enrolled after March 2022 were in the observation group（n=197）．In addition to the control group,a nursing risk management model based on FMEA was added to compare the nursing quality of the two groups of patients．Results The risk priority number（RPN）values of each link in the observation group showed a significant improvement compared to that before intervention．The total RPN score decreased from 1 044 points to 336 points,and the incidence of adverse events in the observation group was lower than that in the control group（17.3% vs 33.3%,P<0.05）．The satisfaction of the observation group with medical staff was higher than that in the control group（92.9% vs 85.4%,P<0.05）．The waiting time required by the observation group was lower than that in the control group[（35.68±7.29）min vs（44.27±8.65）min,P<0.05]．Conclusion sThe FMEA risk management model can effectively improve the nursing quality in painless endoscopic diagnosis and treatment．

目的 探讨关节镜下外侧韧带增强固定修复术治疗慢性踝关节不稳定的护理和康复方案。方法 回顾性分析2023年1月–2023年8月广州市正骨医院收治的31例采用关节镜下外侧韧带增强固定修复术治疗的慢性踝关节不稳定患者的围术期护理措施和康复指导措施。结果 31例患者均随访无脱落,于术后3、6、12个月返院复查随访,患者手术后患足美国矫形外科足踝协会（AOFAS）踝-后足评分均较前次随访评分提高（均P<0.05）。患者术后3个月Zung焦虑评分和Zung抑郁评分较术前均明显下降（均P<0.05）。31例患者术后无1例发生踝关节不稳定复发、腓肠神经损伤和感染等并发症。结论 关节镜下外侧韧带增强固定修复术的方法治疗慢性踝关节不稳定患者,加强术前术后的护理措施、康复指导,对恢复踝关节稳定性和灵活性有重要作用,有利于提高患者生活质量和满意度。

Objective To investigate the nursing and rehabilitation of chronic ankle instability with reinforcement fixation and repair of lateral ligament under arthroscopy．Methods The perioperative nursing measures and rehabilitation guidance of 31 patients with chronic ankle instability treated with lateral ligament reinforcement fixation under arthroscopy from January 2023 to August 2023 were analyzed retrospectively．Results None of the 31 patients was disassociated during follow-up．The American Orthopaedic Foot and Ankle Society（AOFAS）scores of the patients were significantly higher and higher at 3,6 and 12 months after surgery（all P<0.05）．The Zung anxiety score and Zung depression score at 3 months after operation were significantly lower than those before operation（all P<0.05）．None of the 31 patients had postoperative complications such as ankle instability recurrence,sural nerve injury,peroneal tendinitis and infection．Conclusions In arthroscopic reinforcement fixation of lateral ligament in the treatment of patients with chronic ankle instability,strengthening the perioperative nursing measures and rehabilitation guidance,plays an important role in restoring the stability and flexibility of the ankle,and is conducive to improving the quality of life and satisfaction of patients．

目的 探究对神经根型颈椎病(CSR)患者开展悬吊运动疗法+推拿的临床价值。方法 选择2020年1月—2021年7月100例神经根型颈椎病患者,参考“数字双盲法”,分为对照组和观察组(均n=50);对照组患者为推拿治疗,观察组基于对照组基础+悬吊运动疗法;对比治疗结果。结果 观察组临床总有效率94.00%较对照组80.00%高(P＜0.05)。2组治疗后VAS疼痛评分较治疗前均下降,且观察组较对照组更低(P＜0.05)。治疗前120°/s的等速度运动状态下2组峰力距(PT)、平均功率(AP)、屈肌峰力距/伸肌峰力距(F/E)比较(P＞0.05),经治疗后2组均显著改善,且观察组PT、AP、F/E指标较对照组均更优(P＜0.05)。2组治疗后颈椎功能障碍指数(NDI)评分、颈椎病临床评价量表(CASCS)评分较同组治疗前均改善,且观察组较对照组NDI评分更低,CASCS评分更高。结论 针对CSR患者开展悬吊运动疗法+推拿治疗,有利于调节患者颈部肌群协调能力,减轻疼痛感,改善临床症状,促进颈椎功能恢复,实现理想的治疗效果。

Objective To explore the clinical value of sling exercise therapy (SET) and massage in patients with cervical spondylotic radiculopathy (CSR). Methods From January 2020 to July 2021, 100 patients with CSR were selected and divided into control group and observation group (both n=50). The patients in the control group were treated with massage, and the observation group was treated with massage+SET, the treatment results were compared. Results The total clinical effective rate of 94.00% in the observation group was significantly higher than 80.00% in the control group (P<0.05). The VAS pain scores of the two groups after treatment were lower than those before treatment, and the VAS pain score of the observation group was lower than that of the control group (P<0.05). The peak torque (PT), average power (AP) and flexor peak force distance/extensor peak force distance (F/E) of the two groups were significantly improved after treatment, and the PT, AP and F/E indexes of the observation group were better than those of the control group (P<0.05). After treatment, the neck disability index (NDI) score and clinical assessment scale of cervical spondylosis (CASCS) score of the two groups were significantly improved compared with those before treatment, and the NDI score of the observation group was lower and the CASCS score was higher in the observation group. Conclusions SET+massage therapy for patients with CSR is helpful to adjust the coordination ability of cervical muscle group, reduce pain, improve clinical symptoms, promote the recovery of cervical function and achieve ideal therapeutic effect.

目的 探讨低强度体外冲击波联合本体感觉训练治疗双侧颞下颌关节紊乱病的临床疗效。方法 给予1例双侧颞下颌关节紊乱病半年余患者低强度体外冲击波联合本体感觉训练治疗2周,比较治疗前、治疗2周后的最大张口度(MIO)、疼痛压力阈值(PPT)和Fricton颞下颌关节紊乱指数量表 (CMI),并于2个月后随访。结果 经过2周治疗,MIO、PPT和CMI均出现明显改善,2个月后随访未出现反弹,持续改善。结论 低强度体外冲击波联合本体感觉训练治疗颞下颌关节关节紊乱病临床疗效显著。

Objective To investigate the clinical efficacy of low intensity extracorporeal shock wave combined with proprioceptive training in the treatment of bilateral temporomandibular disorders (TMD). Methods A patient with bilateral TMD was treated with low intensity extracorporeal shock wave combined with proprioceptive training for 2 weeks.The maximal interincisal opening (MIO)、pain pressure thresholds (PPT), and Fricton's craniomandibular index (CMI) were compared before and after treatment,and followed up for 2 months. Results After 2 weeks of treatment, MIO, PPT and CMI were significantly improved, and there was no relapse after 2 months of follow-up. Conclusions Low intensity extracorporeal shock wave combined with proprioceptive training was effective in treating TMD.

目的 观察百令胶囊辅助缬沙坦治疗IgA肾病效果及对患者肾功能、细胞免疫调节、尿足细胞标志蛋白的影响。方法 选取2019年5月—2021年5月西部战区总医院肾内科收治经肾活检确诊为IgA肾病,筛选治疗方案中尚未使用激素及免疫抑制剂的80例患者,按住院先后顺序随机分为观察组和对照组,每组各40例。对照组给予缬沙坦治疗,观察组给予百令胶囊辅助缬沙坦治疗,治疗12周后,比较2组的疗效、治疗前后肾功能指标[24 h蛋白尿(24 h Upro)、尿素氮(BUN)、血肌酐(SCr)、尿红细胞(RBC)计数]、1型/2型辅助性T细胞(Th1/Th2)代表细胞因子[γ-干扰素(IFN-γ)、白介素-4(IL-4)]、尿足细胞标志蛋白[尿足萼糖蛋白(PCX)、尿足细胞B7-1分子(B7-1)]水平。结果 治疗12周后,观察组的治疗总有效率为95.0%,高于对照组的82.5%;观察组的24 h Upro、BUN、SCr、尿RBC计数低于对照组,IFN-γ、Th1/Th2低于对照组、IL-4高于对照组,尿PCX、B7-1水平低于对照组;差异均有统计学意义(P<0.05)。结论 百令胶囊辅助缬沙坦治疗IgA肾病患者,可以提高临床疗效,有效保护患者肾功能,调节其免疫状态,减轻肾损伤。

Objective To observe the effects of Bailing capsules assisting valsartan in the treatment of IgA nephropathy and its influence on renal function, cellular immune regulation and urine prodocytes marker protein. Methods From May 2019 to May 2021, 80 patients with IgA nephropathy confirmed by renal biopsy in the Nephrology Department of Western Theatre Command General Hospital, who had not used hormones or immunosuppressants in the treatment were selected.Patients were divided into observation group and control group according to the order of hospitalization, 40 cases in each group.The control group was given valsartan, and the observation group was given Bailing capsules and valsartan.After 12 weeks of treatment, the efficacy, the levels of renal function indexes [24 h proteinuria (24 h Upro), urea nitrogen (BUN), serum creatinine (SCr), urinary red blood cell (RBC) count], type 1/type 2 helper T cells (Th1/Th2) represent cytokines [interferon-γ (IFN-γ), interleukin-4 (IL-4)], urine prodocytes marker protein [urine podocalyxin (PCX), urinary podocyte B7-1 molecule (B7-1)] before and after treatment were compared between the two groups. Results After treatment, the total effective rate in observation group was higher than that in control group (95.0% vs 82.5%).The 24 h Upro, BUN, SCr levels and urine RBC count in observation group were lower than those in control group, IFN-γ and Th1/Th2 levels were lower than those in control group, the IL-4 level was higher than that in control group, and the levels of urine PCX and B7-1 were lower than those in control group.Those differences were statistically significant (P<0.05). Conclusions Bailing capsules assisting valsartan in the treatment of IgA nephropathy can improve clinical efficacy, effectively protect the renal function of patients, regulate the immune status, and alleviate renal injury.

分泌性中耳炎（SOM）的临床特征表现为听力下降和中耳积液,与中耳化脓性炎症常伴随耳部急性感染不同,SOM常伴随耳部闷胀、轻微耳痛等,致使听力出现障碍。SOM发病机制较为复杂,可能与感染、免疫、咽鼓管功能障碍等多种因素相关,治疗方法也因此呈现出多样化的特点。本文就SOM的病因病机及其治疗方式展开综述,以期为临床及早诊断和治疗SOM提供理论依据。

The clinical characteristics of secretory otitis media（SOM）are hearing loss and effusion in the middle ear．Different from acute ear infection of suppurative inflammation in the middle ear,SOM is often accompanied by ear tightness and mild earache,resulting in hearing impairment．The pathogenesis of SOM is complex,which may be related to infection,immunity,eustachian tube dysfunction and other factors．Therefore,the treatment methods are diversified．This paper reviews the etiology,pathogenesis and treatment of SOM,in order to provide theoretical basis for clinical early diagnosis and treatment of SOM.

目的 探析化疗联合调强放疗（IMRT）治疗老年（≥65岁）局部晚期鼻咽癌的临床效果。方法 选取2018年1月—2019年1月我院诊治的90例老年局部晚期鼻咽癌患者为研究对象,使用随机数表法将此90例患者分为观察组及对照组,各45例。观察组行IMRT,对照组行化疗联合IMRT,对比2组的效果。结果 2组的治疗总有效率均为100%,组间差异不显著（P<0.05）。观察组的生活质量改善率（93.33%）高于对照组（77.78%）（P<0.05）。对照组出现3~4级白细胞减少、呕吐、黏膜炎人数明显高于观察组（P<0.05）,两者其他毒副反应比较无显著差异（P>0.05）。观察组的1年总体生存率（91.11%）及3年总体生存率（75.56%）均高于对照组（86.67%、68.89%）（P<0.05）。结论 对于老年局部晚期鼻咽癌,化疗联合IMRT相比单纯IMRT降低了远期生存率,增加了毒副反应并影响疗后生活质量的改善,不宜常规应用,单纯IMRT可能是更合适的治疗选择。

Objective To explore the clinical effect of chemotherapy combined with intensity modulated radiation therapy（IMRT）in the treatment of elderly（≥65 years old）locally advanced nasopharyngeal carcinoma．Methods The study was carried out from January 2018 to January 2019．During this period,90 elderly patients with locally advanced nasopharyngeal carcinoma who were diagnosed and treated in our hospital were selected as the research objects．The random number table method was used to divide the 90 patients into observation groups,and the control group,each with 45 cases．The observation group was treated with IMRT,and the control group was treated with chemotherapy combined with IMRT．The effects of the two groups were compared．Results The total effective rate of the two groups was 100%,and there was no significant difference between the two groups（P<0.05）．The improvement rate of quality of life in the observation group（93.33%）was higher than that in the control group（77.78%,P<0.05）．The number of grade 3-4 leukopenia,vomiting and mucositis in the control group was significantly higher than that in the observation group（P<0.05）,and there was no significant difference in other side effects between the two groups（P>0.05）．The 1-year overall survival rate（91.11%）and 3-year overall survival rate（75.56%）of the observation group were higher than those of the control group（86.67%,68.89%,P<0.05）．Conclusions For locally advanced nasopharyngeal carcinoma in the elderly,chemotherapy combined with IMRT reduces the long-term survival rate,increases the toxic and side effects and affects the improvement of the quality of life after treatment．It is not suitable for routine application,and IMRT alone may be a more appropriate treatment choice.

目的 为寻找治疗盆腔炎性疾病（PID）的有效治疗方案,对比分析头孢哌酮舒巴坦钠+吗啉硝唑、康妇炎胶囊联合头孢哌酮舒巴坦钠及吗啉硝唑两种用药方案治疗PID的效果差异,期望为今后临床中合理选择PID药物治疗方案提供参考依据。方法 选取2019年1月—12月期间在我院接受治疗的104例急性PID患者（湿毒壅盛证）作为研究对象,用随机信封分为参照组、研究组,各52例。予以参照组患者头孢哌酮舒巴坦钠+吗啉硝唑静脉滴注治疗,研究组患者在参照组基础上口服康妇炎胶囊,均持续治疗14 d。观察2组患者近期疗效、炎性因子、盆腔炎性疾病包块、远期复发率（6个月、1年）、远期生活质量,综合评价两种用药方案应用效果。结果 治疗14 d后,研究组总有效率96.00%,高于参照组的80.39%,差异显著（P<0.05）;WBC、CRP、IL-2、TNF-α四项炎性因子水平均低于参照组,差异显著（P<0.05）;腔包块直径、疼痛评分均低于参照组,差异显著（P<0.05）。随访6个月、1年,研究组患者PID复发率分别为4.00%、10.00%,均低于参照组的15.69%、29.41%,差异显著（P<0.05）。结论 以康妇炎胶囊联合头孢哌酮舒巴坦钠及吗啉硝唑治疗PID,能够提升患者的近期治疗效果,改善炎性反应、盆腔炎性疾病包块,降低远期复发风险,改善远期生活质量,而且能够保证用药安全性,具有推广使用价值。

Objective To find an effective treatment for pelvic inflammatory disease（PID）,and to compare and analyze the difference of efficacy of cefoperazone and sulbactam sodium + molinidazole,Kangfuyan capsule combined with cefoperazone and sulbactam sodium + molinidazole in the treatment of PID,in order to provide reference for rational selection of PID drug treatment in future clinical practice．Methods A total of 104 patients with acute PID（excessive wet toxin accumulation syndrome）who received treatment in our hospital from January to December 2019 were selected as the research objects．They were randomly divided into the control group and the research group with 52 cases in each group．Patients in the control group were given intravenous infusion of cefoperazone and sulbactam sodium + morinidazole,and patients in the research group were given Kangfuyan capsule orally on the basis of the control group,all treated for 14 days．The short-term efficacy,inflammatory factors,pelvic inflammatory mass and pain improvement,adverse reactions,long-term recurrence rate（6 months,1 year）,long-term quality of life in two groups were observed,and the application effect of the two drug regimens was comprehensively evaluated．Results After 14 days of treatment,the total effective rate of the research group was 96.00%,which was higher than that of the control group（80.39%）,with significant difference（P<0.05）．After treatment,the levels of WBC,CRP,IL-2 and TNF-α were lower than those of the control group,and the differences were significant（P<0.05）．After treatment,lumen mass diameter and pain score were lower than the control group,the differences were significant（P<0.05）．After 6 months and 1 year follow-up,the PID recurrence rate of the research group was 4.00% and 10.00% respectively,both lower than that of the control group（15.69% and 29.41%）,with significant difference（P<0.05）．Conclusions Using Kangfuyan capsule combined with cefoperazone and sulbactam sodium + molinidazole in the treatment of PID,can improve the patient's recent treatment effect,improve the inflammatory reaction,pelvic inflammation mass, lower long-term risk of recurrence,improve the long-term quality of life,and can ensure medication safety,with promotion value.