目的 探讨标准化沟通（SBAR）模式交接班联合护理质量指标管理在胆管结石患者中的应用效果及护理质量、不良事件及并发症影响。方法 选取天津市人民医院2021年1月—2022年12月收治的80例胆管结石患者,应用抽签法分为观察组与对照组,每组各40例。所有患者均采取手术治疗,其中对照组患者实施常规护理,观察组患者在对照组基础上增加SBAR沟通模式交接班联合护理质量指标管理。对比两组患者的护理质量、护理不良事件发生率、护理满意度及术后并发症发生率。结果 观察组基础护理、护理态度、护理责任心、风险识别能力、风险防范能力护理质量评分高于对照组（P<0.05）;两组注射、口服给药差错、换药、抽血差错、病例书写错误以及执行医嘱不及时等护理不良事件发生率对比差异无统计学意义（P>0.05）,观察组患者护理满意度高于对照组（P<0.05）;观察组患者压疮、感染、静脉血栓等并发症发生率均低于对照组（P<0.05）。结论 SBAR沟通模式交接班联合护理质量指标管理针对胆管结石患者应用效果显著,可改善临床护理质量,同时患者护理满意度较高,进一步降低患者术后并发症发生率。

Objective To investigate the application effect of SBAR communication mode shift combined with the management of care quality indicators on patients with bile duct stones and their influence on postoperative complications. Methods Eighty patients with bile duct stones admitted to our hospital from January 2021 to December 2022 were selected,and divided into observation group and control group by drawing lots,40 cases each．All the patients were treated by surgery,and the control group patients received routine care,and the observation group patients added the SBAR communication mode．The quality of care,incidence of adverse events,satisfaction with care and incidence of postoperative complications of the two groups were compared. Results The quality of care values of basic care,nursing care,nursing responsibility,risk identification and risk prevention in the observation group were significantly higher than in the control group（P<0.05）．There was no difference in the incidence of nursing side effects such as injection and oral administration errors,dressing changes,blood sampling errors,case clerk errors and delayed execution of medical orders between the two groups（P>0.05）．Patient satisfaction in the observation group was significantly higher than that in the control group（P<0.05）．The incidence of complications such as pressure ulcers,infections and venous thrombosis in the observation group was significantly lower than that in the control group（P<0.05）. Conclusions SBAR communication mode and combined nursing quality index management for patients with bile duct stones,which can improve the quality of clinical nursing and patient nursing satisfaction,and further reduce the incidence of postoperative complications in patients．

目的 观察雌二醇片/雌二醇地屈孕酮片对早发性卵巢功能不全（POI）患者卵巢储备功能及血清免疫指标的影响。方法 选取2022年2月—2023年8月福建中医药大学附属第三人民医院妇科收治的早发性卵巢功能不全患者60例,按随机数字表法分为对照组和研究组,对照组（30例）予常规激素替代疗法,研究组（30例）予雌二醇片/雌二醇地屈孕酮片。比较两组血清抗缪勒管激素（AMH）、卵泡刺激素（FSH）、雌二醇（E₂）、抗心磷脂抗体（ACA）、抗卵巢抗体（AOA）、抗β2糖蛋白1 IgM抗体（β2GP1-IgM）水平。结果 研究组治疗总有效率高于对照组,治疗后两组患者血清AMH、E₂水平均升高,血清FSH、ACA、AOA和β2GP1-IgM水平均降低（均P<0.05）,研究组临床疗效优于对照组,且不良反应发生率较低（P<0.05）。结论 雌二醇片/雌二醇地屈孕酮片可改善POI患者的卵巢储备功能,纠正机体自身免疫紊乱,其作用机制可能与免疫调节有关。

Objective To observe the effects of Complex Packing Estradiol Tablets/Estradiol and Dydrogesterone Tablets on ovarian reserve function and serum immune indicators in patients with premature ovarian insufficiency. Methods Sixty patients with early-onset ovarian insufficiency admitted to the gynecology department of the Third People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine from February 2022 to August 2023 were selected and randomly divided into a control group（CG）and a study group（SG）using a random number table method．The CG（30 cases）received Complex Packing Estradiol Tablets/Estradiol and Dydrogesterone Tablets．while the SG（30 cases）received Femoston．Compare two groups of serum anti-Müllerian hormone（AMH）,follicle stimulating hormone（FSH）,estradiol（E₂）,anticardiolipin antibody（ACA）,anti ovarian antibody（AOA）,and anti β2 Glycoprotein 1 IgM antibody（β2GP1 IgM）level. Results The total effective rate of the SG was higher than that of the control group（P<0.05）;Compared with before treatment,the serum levels of AMH and E₂ increased in both groups of patients after treatment,while serum levels of FSH,ACA,AOA and β The level of 2GP1 IgM decreased（P<0.05）,and the clinical efficacy of the SG was better than that of the CG,with a lower incidence of adverse reactions. Conclusions Complex Packing Estradiol Tablets/Estradiol and Dydrogesterone Tablets can regulate the levels of sex hormones in patients with premature ovarian insufficiency,improve ovarian reserve function,correct autoimmune disorders in the body,and its mechanism of action may be related to immune regulation．

目的 分析神经系统副肿瘤综合征（PNS）的临床特点以提高对该病的早期诊断和治疗效果。方法 回顾性分析惠州市第一人民医院和惠州市中心人民医院神经内科2019年10月—2022年10月收治的21例PNS患者的临床表现、实验室检查结果和治疗效果,并作文献回顾。结果 21例患者中出现了10种副肿瘤综合征,其中经典综合征占比28.6%（6/21）,最多见的是边缘叶脑炎;20例在血液或脑脊液中发现检测到抗神经元抗体,非特征性抗体阳性率最高（12/20）,其中以半定量脑组织切片TBA检测阳性率最高（7/20）;有特征性抗体的8例以抗Yo抗体阳性率最高（6/8）。21例患者均随访至2023年3月,8例发现原发肿瘤,其中4例在神经系统病变之后。69.25%（9/13）的患者使用糖皮质激素治疗和（或）丙种球蛋白治疗有效。结论 21例PNS患者中以非经典综合征占比较多,经典与非经典副肿瘤综合征均应进行肿瘤筛查,未发现肿瘤者应密切随访。非特征性抗体阳性率最高,提示PNS可能仍有许多相关抗体未明确,临床工作中也应对非特征性抗体阳性予以重视。

Objective To analyze the clinical features of paraneoplastic neurological syndrome（PNS）to improve the early diagnosis and treatment of this disease. Methods The clinical manifestations,laboratory results and treatment effects of 21 patients with PNS admitted to Huizhou First People's Hospital and Huizhou Central People's Hospital from October 2019 to October 2022 were retrospectively analyzed,and literature review was performed. Results There were 10 paraneoplastic syndromes in 21 patients,of which classical syndrome accounted for 28.6%（6/21）,the most common was limbic lobe encephalitis．Anti-neuronal antibodies were detected in blood or cerebrospinal fluid in 20 cases,with the highest positive rate of non-characteristic antibodies（12/20）,among which the positive rate of TBA detection by semi-quantitative brain tissue sections was the highest（7/20）;Eight cases with characteristic antibodies had the highest positive rate of anti-Yo antibody（6/8）．All 21 patients have been followed up so far,and 8 cases have found primary tumors,4 of which were after neurological lesions．There was 69.25%（9/13）of patients responded to hormone therapy or（and）gamma globulin therapy. Conclusions Non-classical syndrome accounts for more patients with PNS,and both classical and non-classical paraneoplastic syndromes should be screened for tumors,and those who have not found tumors should be closely followed．The positive rate of non-characteristic antibodies is the highest,indicating that there may still be many related antibodies in PNS that are not clear,and the positive of non-characteristic antibodies should also be paid attention to in clinical work．

目的 探讨Nolla分期对青少年拔牙正畸患者下颌第三磨牙倾斜角的影响。方法 选择2018年10月—2022年10月收治的100例拔牙正畸青少年患者。100例患者均拔除了4颗前磨牙,共有100颗下颌第三磨牙,通过Nolla分期,可将100例患者分成四组,每组25例。Ⅰ组：牙冠正在形成,Ⅱ组：牙冠基本形成,Ⅲ组：牙根形成在1/2以下,Ⅳ组：牙根形成在1/2以上。在治疗前后,测量下颌第三磨牙倾斜角,对角度α的变化进行分析。结果 第三磨牙牙胚倾斜角、MP-SN、MP-FH在不同组间比较差异无统计学意义（F=0.256,P=0.857;F=0.033,P=0.992;F=0.028,P=0.994）;治疗前组间下颌第三磨牙角度比较差异无统计学意义（P>0.05）,治疗后不同组间下颌第三磨牙角比较差异有统计学意义（F=13.376,P<0.001）,治疗前后Ⅰ组、Ⅱ组、Ⅳ组第三磨牙的角度无差异（t=0.757,P=0.453;t=0.224,P=0.824;t=0.852,P=0.399）,Ⅲ组治疗后角度变化减少（t=3.697,P<0.001）。结论 青少年正畸拔牙后,下颌第三磨牙处于牙根形成阶段的一半以下可能会导致第三磨牙近中倾斜加重。当下颌第三磨牙处于牙冠形成阶段,牙冠形成超过一半时,第三磨牙角度变化较小。在治疗前应根据Nolla分期评估下颌第三磨牙的预后情况,并及时制定相应的干预策略。

Objective To explore the effect of Nolla staging on the inclination angle of mandibular third molars in adolescent orthodontic patients undergoing tooth extraction. Methods A total of 100 adolescent patients who underwent tooth extraction orthodontic treatment from October 2018 to October 2022 were included．All 100 patients had 4 premolars extracted,with a total of 100 mandibular third molars．According to Nolla staging,the 100 patients can be divided into 4 groups,with 25 cases in each group．Group I：The crown was forming,Group II：The crown was basically formed,Group III：The root formation was below 1/2,Group IV：The root formation was above 1/2．The inclination angle of the mandibular third molar was measured before and after treatment,and the angle α changes will be analyzed. Results There was no difference in the inclination angle,MP-SN,and MP-FH of the third molar tooth germ among different groups（F=0.256,P=0.857;F=0.033,P=0.992;F=0.028,P=0.994）．There was no difference in the angle of mandibular third molar teeth between groups before treatment（P>0.05）,the contrast of mandibular third molar angles between different groups after treatment was signifiant（F=13.376,P<0.001）,while the angles in Group I,Group and Group Ⅳ were not slgnificantly different（t=0.757,P=0.453;t=0.224,P=0.824;t=0.852,P=0.399）,and the angle change decreased after treatment in Group Ⅲ（t=3.697,P<0.001）. Conclusions After orthodontic extraction in adolescents,if the mandibular third molar is less than half of the root formation stage,it may lead to increased mesial inclination of the third molar．However,when the mandibular third molar is in the stage of crown formation and the crown is more than half formed,the angle change of the third molar is relatively small．Therefore,in clinical practice,Nolla staging should be evaluated in the prognosis of mandibular third molars before treatment and develop corresponding intervention strategies in a timely manner．

目的 探讨福莫特罗联合格隆溴铵对慢性阻塞性肺疾病急性加重期（AECOPD）患者的疗效。方法 选择2021年1月—2023年6月廉江市人民医院收治的97例AECOPD患者进行研究,在双方知情基础上,通过单双号抽签方式分组,抽取单号纳入对照组（n=48,予以福莫特罗治疗）,抽取双号纳入观察组（n=48,予以福莫特罗联合格隆溴铵治疗）,对比两组肺功能指标、血气指标、症状改善情况及出现的不良反应。结果 治疗后两组的肺功能指标均高于治疗前,而观察组各指标高于对照组（P<0.05）;治疗后两组PaO₂高于治疗前,PaCO₂低于治疗前,且观察组上述血气指标与对照组比较差异有统计学意义（P<0.05）;治疗后两组的CAT及SGRQ评分均低于治疗前,其中观察组评分低于对照组（P<0.05）;观察组（8.33%）与对照组（12.24%）不良反应率比较,差异不显著（P>0.05）。结论 采用福莫特罗联合格隆溴铵治疗AECOPD患者,有助于改善患者肺功能,使其血气指标得到改善,还可有效缓解其呼吸道症状,且安全性得到保障。

Objective To explore the curative effect of formoterol combined with glycopyrronium bromide on patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）. Methods The research cut-off period was from January 2021 to June 2023．A total of 97 patients with AECOPD were selected from Lianjiang People's Hospital for research．On the basis of mutual knowledge,they were divided into groups by odd and even numbers．The odd numbers were drawn into the control group（n=48,treated with formoterol）and the odd numbers were drawn into the observation group（n=48,treated with formoterol+glycopyrronium bromide）,the pulmonary function index,blood gas index,symptom improvement and adverse reactions were compared between the two groups. Results After treatment,the lung function indexes of the two groups were higher than those before treatment,while the indexes of the observation group were higher than those of the control group（P<0.05）．PaO₂ was higher and PaCO₂ was lower in the two groups after treatment,and the blood gas indexes in the observation group were different from those in the control group（P<0.05）．The scores of COPD assessment test and St. George's Respiratory Questionaire in the two groups after treatment were lower than those before treatment,while the scores in the observation group were lower than those in the control group（P<0.05）;There was no significant difference between the observation group（8.33%）and the control group（12.24%）（P>0.05）. Conclusions The choice of formoterol and qualified ammonium bromide for AECOPD is helpful to improve the lung function,blood gas index and respiratory symptoms,And the security is guaranteed．

目的 探讨终末期肾病患者血液透析中实施基于依从性曲线变化规律的阶段性护理的效果。方法 选择2022年1月—2023年10月濮阳市人民医院收治的接受血液透析治疗的86例终末期肾病患者,将其通过单双号抽签的方式分组,即对照组与观察组,各43例,前者实施常规护理,后者在此基础上实施基于依从性曲线变化规律的阶段性护理,对比两组患者护理前后心理状态评分情况、生活质量评分情况及治疗依从性。结果 两组患者护理前后正性负性情绪量表（PANAS评分有一定差距,其中负性情绪显著降低,正性情绪显著提升,而护理后观察组负性情绪评分为（11.67±2.55）分,低于对照组的（16.11±3.02）分,正性情绪为（25.07±5.28）,高于对照组的（20.11±5.23）分（t=7.366、4.376,P<0.05）;护理后观察组生活质量综合评定量表（GQOLI-74）躯体、心理、社会及物质生活等维度评分分别为（82.17±7.11）分、（82.02±7.45）分、（81.11±7.78）分及（81.11±7.42）分,高于对照组的（71.22±7.23）分、（72.12±7.56）分、（71.23±7.45）分及（70.23±7.33）分（t=7.081、6.116、6.015、6.840,P<0.05）;观察组（95.35%）与对照组（76.74%）的治疗依从性比较,前者更高（χ²=6.198,P<0.05）。结论 基于依从性曲线变化规律的阶段性护理对于接受血液透析治疗的终末期肾病患者,不仅有助于调整其心理状态,还有助于提高其治疗依从性,使其生活质量也得以全面提高。

Objective To explore the effect of implementing phased nursing based on compliance curve changes in hemodialysis for end-stage renal disease patients. Methods The research deadline was from January,2022 to October,2023．The research object was 86 patients with end-stage renal disease who received hemodialysis treatment in Puyang People's Hospital,and they were divided into control group and observation group with 43 patients in each group by odd and even numbers．The former was given routine care,while the latter was given stage nursing based on the change of compliance curve．The psychological state score,quality of life score and treatment compliance of the two groups were compared before and after care. Results There was a certain difference in the Positive and Negative Affect Scale（PANAS）scores between the two groups before and after nursing,in which the negative emotion was significantly reduced and the positive emotion was significantly improved．After nursing,the negative emotion score of the observation group was（11.67±2.55）,which was significantly lower than that of the control group（16.11±3.02）,and the positive emotion score was（25.07±5.28）,which was significantly higher than that of the control group（20.11±5.23）（t=7.366,4.376,P<0.05）．After nursing,the scores of Generic Quality of Life Inventory-74（GQOLI-74）in the observation group were（82.17±7.11）,（82.02±7.45）,（81.11±7.78）and（81.11±7.42）,which were significantly higher than those in the control group（71.22±7.23）,（72.12±7.56）,（71.23±7.45）and（70.23±7.33）（t=7.081,6.116,6.015,6.840,P<0.05）．The treatment compliance of the observation group（95.35%）was higher than that of the control group（76.74%）（χ²=6.198,P<0.05）. Conclusions Choosing stage nursing based on the variation pattern of compliance curve for end-stage renal disease patients undergoing hemodialysis not only helps to adjust their psychological state,but also improves their treatment compliance,leading to a comprehensive improvement in their quality of life．

目的 探讨复方甘草口服液联合泼尼松治疗特发性肺间质纤维化急性加重期患者的疗效。方法 选取张掖市第二人民医院2020年1月—2023年10月收治的128例特发性肺间质纤维化急性加重期患者,应用随机数字表法分为两组,每组各64例。对照组采取泼尼松治疗,观察组采取复方甘草口服液联合泼尼松治疗。对比其临床疗效,治疗前后血清肺纤维化指标及炎症因子水平,最后对比其不良反应发生率。结果 观察组总有效率93.75%,高于对照组的79.69%（χ²=5.490,P=0.019）;治疗前两组层黏连蛋白（LN）、Ⅲ型前胶原肽（PC-Ⅲ）、透明质酸（HA）对比差异无统计学意义（P>0.05）,治疗后两组患者LN、PC-Ⅲ、HA均降低,观察组[（89.25±7.61）μg/L;（68.33±7.68）mg/L;（81.53±8.54）μg/L]低于对照组[（96.17±8.34）μg/L;（75.68±8.25）mg/L;（95.68±9.25）μg/L],对比差异有统计学意义（t₁=4.903,P₁<0.001;t₂=5.217,P₂<0.001;t₃=8.992,P₃<0.001）;治疗前两组患者肿瘤坏死因子-α（TNF-α）、白细胞介素-4（IL-4）、IL-10、转化生长因子（TGF-β1）对比差异无统计学意义（P>0.05）,治疗后两组TNF-α、IL-4、IL-10、TGF-β1水平降低,观察组[（61.94±8.24）ng/L;（4.43±1.17）ng/mL;（65.49±13.24）g/L;（114.73±13.12）pg/mL]低于对照组[（75.52±9.43）ng/L;（6.31±1.28）ng/mL;（79.27±9.38）g/L;（147.76±15.46）pg/mL],对比差异有统计学意义（t₁=8.675,P₁<0.001;t₂=8.673,P₂<0.001;t₃=6.794,P₃<0.001;t₄=13.032,P₄<0.001）;两组不良反应发生率对比差异无统计学意义（7.81% vs 6.25%,χ²=0.120,P=0.730）。结论 复方甘草口服液联合泼尼松治疗特发性肺间质纤维化急性加重期疗效显著,可辅助延缓患者肺纤维化发展进程,减轻机体炎症反应,安全性较高。

Objective To investigate the efficacy of compound licorice oral liquid combined with prednisone in patients with acute exacerbations of idiopathic pulmonary interstitial fibrosis. Methods A total of 128 patients with acute exacerbation of idiopathic pulmonary interstitial fibrosis admitted to Zhangye Second People's Hospital from January 2020 to October 2023 were divided into two groups by random number table method,with 64 patients in each group．The control group received prednisone treatment,while the observation group received compound licorice oral liquid combined with prednisone treatment．Compare its clinical efficacy,serum pulmonary fibrosis indicators and inflammatory factor levels before and after treatment,and finally compare its incidence of adverse reactions. Results The total response rate in the observation group was 93.75%,which was higher than the 79.69% in the control group（χ²=5.490,P=0.019）．There was no difference between the two groups of LN,PC-III,and HA（P>0.05）,LN,PC-III and HA were decreased in both groups,while the observation group[（89.25±7.61）μg/L;（68.33±7.68）mg/L;（81.53±8.54）μg/L] was lower than the control group[（96.17±8.34）μg/L;（75.68±8.25）mg/L;（95.68±9.25）μg/L],the contrast difference was statistically significant（t₁=4.903,P₁<0.001;t₂=5.217,P₂<0.001;t₃=8.992,P₃<0.001）．There was no difference in TNF-α,IL-4,IL-10,and TGF-β1 between the two groups before treatment（P>0.05）,lower levels of TNF-α,IL-4,IL-10,and TGF-β1 in the two patient groups after treatment,the observation group[（61.94±8.24）ng/L;（4.43±1.17）ng/mL;（65.49±13.24）g/L;（114.73±13.12）pg/mL] was lower than the control group[（75.52±9.43）ng/L;（6.31±1.28）ng/mL;（79.27±9.38）g/L;（147.76±15.46）pg/mL],the contrast difference was statistically significant（t₁=8.675,P₁<0.001;t₂=8.673,P₂<0.001;t₃=6.794,P₃<0.001;t₄=13.032,P₄<0.001）．There was no difference in the incidence of adverse effects between the two groups（7.81% vs 6.25%,χ²=120,P=0.730）. Conclusions The combination of compound licorice oral liquid and prednisone has a significant therapeutic effect on the acute exacerbation of idiopathic pulmonary interstitial fibrosis．It can assist in delaying the progression of pulmonary fibrosis in patients,reducing the body's inflammatory response,and has high safety．

目的 探讨复方甘草酸苷联合卡泊三醇乳膏治疗寻常型银屑病的效果观察。方法 选取辽健集团阜新矿总医院2019年12月—2022年12月收治的96例寻常型银屑病患者,分为联合组与对照组,每组48例。对照组使用卡泊三醇乳膏治疗,联合组在对照组基础上联用复方甘草酸苷治疗,对比临床疗效,以皮质含量、经表皮水分流失（TEWL）、角质层水含量变化评价患者的皮肤屏障功能,并对比两组患者治疗前后T细胞相关炎症因子表达水平。结果 联合组治疗总有效率较对照组高[93.75% vs 77.08%,χ²=5.352,P=0.021];治疗后两组皮质含量、角质层水含量升高,联合组高于对照组,TEWL降低,联合组低于对照组[皮质含量：（73.59±7.24）μg/cm² vs（110.12±13.64）μg/cm²,t=16.389,P<0.001;角质层水含量：（25.28±3.25）% vs（16.24±2.14）%,t=16.095,P<0.001;TEWL：（8.06±1.44）g/（h·m²）vs（11.71±2.68）g/（h·m²）,t=8.312,P<0.001];治疗后两组患者白细胞介素-2（IL-2）、白细胞介素-6（IL-6）、γ干扰素（IFN-γ）表达水平均降低,且联合组低于对照组[IL-2：（22.25±3.32）vs（26.62±3.24）pg/mL,t=6.661,P<0.001;IL-6：（80.46±5.11）vs（112.62±12.16）pg/mL,t=16.892,P<0.001;IFN-γ：（68.62±10.73）vs（51.26±6.37）ng/L,t=9.639,P<0.001]。结论 复方甘草酸苷联合卡泊三醇乳膏可改善寻常型银屑病皮肤屏障功能,降低炎症因子,改善Th1/Th2细胞因子失衡情况。

Objective To investigate the effect of compound glycyrrhizin and caspotriol cream in psoriasis vulgaris. Methods The 96 psoriasis patients admitted to Fuxin Mine General Hospital from December 2019 to December 2022 were selected and divided into combined group and control group,with 48 patients in each group．The control group was treated with caspotriol cream,the combined group treated with compound glycyrrhizin treatment,the clinical efficacy was compared,and the skin barrier function of patients was evaluated by cortical content,transepidermal water loss（TEWL）,and changes in stratum corneum water content．The expression levels of T cell related inflammatory factors before and after treatment were compared between the two groups. Results The overall effective treatment rate in the combined group was higher than in the control group[93.75% vs 77.08%,χ²=5.352,P=0.021]．After treatment,cortical and stratum corneum water levels increased in both groups,with the combined group being higher than the control group．TEWL decreased and the combined group was lower than the control group[cortical content：（73.59±7.24）μg/cm² vs（110.12±13.64）μg/cm²,t=16.389,P<0.001;water content in the stratum corneum：（25.28±3.25）% vs（16.24±2.14）%,t=16.095,P<0.001;TEWL：（8.06±1.44）g/（h·m²）vs（11.71±2.68）g/（h·m²）,t=8.312,P<0.001]．After treatment,two groups of patients were treated with interleukin-2（IL-2）,interleukin-6（IL-6） and interferon（IFN）-γ,and the combined group was lower than the control group[IL-2：（22.25±3.32）pg/mL vs（26.62±3.24）pg/mL,t=6.661,P<0.001;IL-6：（80.46±5.11）pg/mL vs（112.62±12.16）pg/mL,t=16.892,P<0.001;IFN-γ：（68.62±10.73）ng/L vs（51.26±6.37）ng/L,t=9.639,P<0.001]. Conclusions The combination of compound glycyrrhizin and carpotriol cream can improve the skin barrier function of psoriasis vulgaris,reduce inflammatory factors,and improve the imbalance of Th1/Th2 cytokines．

目的 探讨血浆置换联合泼尼松（PDN）联合环磷酰胺（CTX）治疗抗黑色素瘤分化相关基因5（MDA5）抗体阳性皮肌炎（DM）伴肺间质纤维化（ILD）患者疗效及安全性。方法 回顾性分析2014年6月—2023年6月普洱市人民医院诊断的MDA5阳性DM伴ILD患者40例,其中治疗组20例,采用血浆置换联合PDN 1 mg/kg每日1次口服,4周后减量,每周减总量10%,CTX 1 g每月1次静脉滴注,共6次治疗;另20例设为对照组,采用PDN 1 mg/kg每日1次口服,4周后减量,每周减总量10%,CTX 1 g每月1次静脉滴注,共6次治疗,分别于治疗后3月、6月检测一氧化碳弥散量（DLCO）、第1秒用力呼气量（FEV₁）,血清铁蛋白（SF）、C-反应蛋白（CRP）、涎液化糖链抗原（KL-6）、MDA5转阴率行疗效评估。结果 在治疗3个月和6个月时,两组患者的DLCO、FEV1、SF、CRP、KL-6、MDA5转阴率等指标的完全缓解率不一致。其中,3个月时,治疗组上述指标的完全缓解率依次为95%、85%、90%、90%、90%、85%,对照组依次为15%、20%、20%、15%、0%、0%。两组患者在治疗3个月的DLCO、FEV1、SF、CRP、KL-6水平和MDA5转阴数均有所不同。其中治疗组的DLCO、KL-6、CRP水平均较对照组降低（P<0.01）,治疗组FEV₁水平较对照组升高（P<0.01）,治疗组SF水平较对照组降低（P<0.05）,两组治疗6个月时,治疗组上述指标缓解率依次为95%、85%、90%、90%、90%、85%,对照组依次为20%、25%、20%、20%、20%、5%。两组患者在DLCO、FEV₁、SF、CRP、KL-6水平以及MDA5转阴数和死亡例数方面比较差异均有统计学意义,其中治疗组的DLCO、KL-6和CRP水平均较对照组降低（P<0.01）,治疗组FEV₁水平较对照组升高（P<0.01）,SF水平治疗组较对照组降低（P<0.05）。结论 在MDA5抗体阳性DM伴ILD患者治疗中,给予血浆置换联合PDN、CTX治疗,可以提高疗效,降低病死率。

Objective To explore the effect of plasmapheresis combined with prednisone（PDN）plus cytoxan（CTX）on patients with anti-melanoma differentiation-associated gene 5（MDA 5）antibody-positive dermatomyositis（DM）with interstitial lung disease（ILD）. Methods The data of 40 patients with MDA 5 positive DM and ILD diagnosed in the People's Hospital of Pu'er City from June 2014 to June 2023 were retrospectively was analyzed．Twenty patients of the treatment group were treated with plasmapheresis combined with PDN 1mg / kg once daily,which was reduced by 10% per week after 4 weeks．The other 20 patients of the control group were treated with PDN 1mg / kg once daily,which was reduced after 4 weeks by 10% per week,and CTX 1g once per month．diffusing capacity of the lungs for carbon monoxide（DLCO）,forced expiratory volume in the first second（FEV₁）,serum ferritin（SF）,C-reactive protein（CRP）,Krebs Von den Lungen-6（KL-6）and MDA5 negative conversion rate were measured at 3 and 6 months after treatment,respectively. Results At 3 and 6 months of treatment,complete remission rates of DLCO,FEV₁,SF,CRP,KL-6,MDA 5 conversion and other indicators were inconsistent．Among them,at 3 months,the complete response rate of the above indicators in the treatment group was successively：95%,85%,90%,90%,90% and 85%．The control group was 15%,20%,20%,15%,and 0%,0%．Statistical analysis showed that the levels of DLCO,FEV₁,SF,CRP,KL-6 and MDA 5 significantly varied at 3 months of treatment．Pairwise comparison of LSD found that the DLCO,KL-6 and CRP levels in the treatment group were significantly lower than the control group（P<0.01）,the FEV₁ level in the treatment group was significantly higher（P<0.01）,and the SF level in the treatment group was significantly lower（P<0.05）．After 6 month of treatment,the complete response rate of the above indicators in the treatment group were 95%,85%,90%,90%,90% and 85%,and the complete response rate of the above indicators in the control group was 20%,25%,20%,20%,20% and 5%．Statistical analysis showed the levels of DLCO,FEV₁,SF,CRP,KL-6 for the amount of MDA 5 and the number of deaths between two groups were significantly different．Further pairwise comparison of LSD showed that the DLCO,KL-6 and CRP levels in the treatment group were significantly lower compared with the control group（P<0.01）,the FEV₁ level was significantly increased compared with the control group（P<0.01）,and the SF treatment group was significantly decreased compared with the control group（P<0.05）. Conclusions In the treatment of patients with MDA 5 antibody positive DM with ILD,the treatment of plasmapheresis combined with PDN and CTX can significantly improve the efficacy and reduce the mortality rate．

目的 探索干预因素对4~12岁孤独症谱系障碍（ASD）患儿社交反应的影响,为开展ASD患儿的早期干预提供参考。方法 选取于2020年1月—2023年3月在清远市妇幼保健院儿童神经与发育中心康复干预的ASD患儿,采用社交反应量表（SRS）对患儿进行社交行为评估,采用自编一般情况问卷对家长进行问卷调查,调查内容包括患儿的基本情况（性别、共患病情况、干预时长、上学情况等）。结果 202例ASD患儿中,男性患儿162例（80.2%）,女性40例（19.8%）,性别对社交反应的影响比较差异无统计学意义（t=2.969,P>0.05）。共患病方面,无共患病的ASD患儿与共患智力发育障碍及注意缺陷多动障碍的患儿相比,其SRS得分差异有统计学意义（F=6.920,P<0.05）。在上学情况方面,普通学校就读的患儿与特殊学校及未上学的患儿相比,其SRS得分差异有统计学意义（F=3.823,P<0.05）,但在特殊学校就读的患儿与未上学的患儿相比,差异无统计学意义（P>0.05）。在干预时长方面,干预≥1年与干预<1年及未干预的患儿比较,其SRS得分更低,差异有统计学意义（F=4.477,P<0.05）,但干预<1年与未干预患儿相比,两者差异无统计学意义（P>0.05）。结论 ASD患儿中,是否患有其他无共患病、上学情况、干预时长会影响其社交反应;存在共患疾病的ASD患儿社交反应表现更差;相较于就读特殊教育机构和未上学的患儿,就读于普通学校的ASD患儿社交障碍程度更轻;干预时间越长,其社交障碍程度也越轻。

Objective To explore the impact of intervention factors on social response in children with autism spectrum disorder（ASD）aged 4—12,and to provide reference for early intervention in children with ASD. Methods Children with ASD who underwent rehabilitation intervention at the Children's Neurology and Development Center of Qingyuan Maternal and Child Health Hospital from January 2020 to March 2023 were selected．The social behavior of the children was evaluated using the Social Response Scale（SRS）,and the parents were surveyed using a self-made general situation questionnaire．The survey content included the basic information of the children（gender,comorbidity,intervention duration,and school attendance,etc．）. Results Among the 202 cases of ASD,162 were male（80.2%）and 40 were female（19.8%）．There was no statistically significant difference in the impact of gender on social response（t=2.969,P>0.05）．In terms of comorbidities,there was a statistically significant difference in SRS scores between ASD children without comorbidities and those with comorbidities such as intellectual development disorder and attention deficit hyperactivity disorder（F=6.920,P<0.05）．In terms of school attendance,there was a statistically significant difference in SRS scores between children enrolled in regular schools and those who attended special schools and those who did not attend school（F=3.823,P<0.05）,but there was no statistically significant difference between children enrolled in special schools and those who did not attend school（P>0.05）．In terms of intervention duration,compared with children with intervention≥1 year and those with intervention<1 year and no intervention,the SRS score was lower and the difference was statistically significant（F=4.477,P<0.05）．However,compared with children with intervention<1 year and those without intervention,the difference was not statistically significant（P>0.05）. Conclusions No comorbidities,attending regular schools,and intervention duration≥1 year are positive factors that affect social response．Children with ASD who have comorbidities have poorer social response performance;compared to children who attend special education institutions and those who do not attend school,children with ASD who attend regular schools have lower levels of social impairment;the longer the intervention time,the lighter the degree of social impairment．