目的 观察镇肝熄风汤加减在椎-基底动脉供血不足(VBI)性眩晕患者辅助治疗中的应用。方法 选取2019年5月—2021年2月我院收治的124例VBI性眩晕患者,按照随机数字表法1:1配对原则分为观察组(n=62)、对照组(n=62),其中对照组给予长春西汀+天麻素,观察组在对照组基础上辅以镇肝熄风汤加减,对比2组疗效、经颅多普勒检查结果[基底动脉、椎动脉平均血流速度(MV)与血管搏动指数(PI)]、眩晕评估量表(DARS)、眩晕障碍调查表(DHI)评分及血液流变学指标(纤维蛋白原、红细胞积压、全血粘度)。结果 观察组总有效率95.16%(59/62)高于对照组82.26%(51/62)(P＜0.05);治疗14 d后观察组椎动脉、基底动脉PI低于对照组,MV高于对照组(P＜0.05);治疗14 d后观察组DHI评分、DARS评分低于对照组(P＜0.05);治疗14 d后观察组纤维蛋白原、红细胞积压、全血粘度低于对照组(P＜0.05)。结论 镇肝熄风汤加减辅助治疗VBI性眩晕患者疗效显著,可有效减轻眩晕症状,调节血液粘度,改善椎-基底动脉血流,促进脑部供血恢复。

目的 探讨频发室性早搏与四级非心脏手术术后心衰发生率的相关性。方法 回顾性分析2020年7月—2021年6月于我院治疗的201例四级非心脏手术患者,根据术后是否发生心衰,将其分为心衰组和非心衰组,其中出现心衰者20例,未心衰者181例。分析2组患者临床资料、频发室性早搏次数,随后经单因素分析及Logistic回归分析术后心衰发生率的相关性。结果 心衰组临床资料中性别、糖尿病史、饮酒史、吸烟史、手术危险性分级、BMI、血红蛋白、红细胞宽度、左室舒张末径、左室射血分数值与非心衰组比较,差异无统计学意义(P>0.05);心衰组年龄大于非心衰组,胆固醇值、甘油三酯、室性早搏次数、术前肌酐水平均高于非心衰组(P<0.05);经多因素Logistic回归分析,分析结果显示年龄(OR=1.400,95%CI:1.060~1.848)、胆固醇值(OR=4.318,95%CI:1.122~16.622)、甘油三酯(OR=12.889,95%CI:1.232~134.808)、室性早搏次数(OR=1.010,95% CI:1.001~1.020)、术前肌酐(OR=34.071,95% CI:1.186~978.753)为四级非心脏手术术后发生心衰的危险因素(P<0.05)。结论 频发室性早搏为四级非心脏手术术后心衰发生的危险因素,其中年龄、胆固醇值、甘油三酯、术前肌酐也为术后心衰发生的危险因素。

目的 研究氨溴索静脉用药联合不同通气方式治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效。方法 选取2019年2月—2021年1月我院收治的98例NRDS患儿,根据治疗方案不同分为对照组(49例)和观察组(49例)。2组均给予常规治疗,对照组采用氨溴索静脉用药、常规机械通气治疗,观察组采用氨溴索静脉用药、高频振荡通气(HFOV)治疗。比较2组临床疗效、胸部X线评分、新生儿评分(Apgar评分)、不同时间点(治疗前、治疗后2 h、治疗后12 h)动脉血气指标[氧合指数(OI)、动脉氧分压(PaO₂)、动脉血二氧化碳分压(PaCO₂)]、呼吸力学指标[呼吸指数(RI)、呼吸道阻力(R)、肺动态顺应性(Crs)]、并发症发生率、死亡率。结果 2组治疗后总有效率比较,观察组93.88%高于对照组77.55%(P＜0.05);治疗后,观察组胸部X线评分、Apgar评分均高于对照组(P＜0.05);治疗后2 h、治疗后12 h时观察组OI、PaCO₂均低于对照组,PaO₂高于对照组(P＜0.05);治疗后,观察组RI、AR水平低于对照组,Crs水平高于对照组(P＜0.05);观察组死亡率2.04%低于对照组14.29%(P＜0.05)。结论 氨溴索静脉用药联合HFOV治疗NRDS的临床疗效显著,可有效促进患儿呼吸功能、动脉血气改善,降低新生儿死亡率。

目的 探究益气活血汤剂联合热敏灸在脊髓损伤(SCI)后尿潴留患者中的应用效果。方法 选取2019年7月—2021年7月我院SCI后尿潴留患者80例,根据治疗方案不同分为观察组、对照组,各40例。对照组给予益气活血汤剂,观察组在此基础上进行热敏灸治疗。观察2组疗效、治疗前后排尿情况、膀胱功能、尿动力学指标[膀胱容量(VH₂O)、膀胱顺应(BC)、逼尿肌压力(Pdet)、膀胱压力(Pves)、平均尿流速(Qave)]及不良事件发生率。结果 观察组总有效率92.50%高于对照组70.73%(P＜0.05);治疗后观察组膀胱功能积分、平均排尿次数、平均漏尿次数、平均尿量、残余尿量均低于对照组(P＜0.05);治疗后与对照组相比,观察组Pves较低,VH₂O、Pdet、Qave、BC较高(P＜0.05);观察组不良事件率2.50%与对照组5.00%相比,无差异(P＞0.05)。结论 热敏灸联合益气活血汤剂治疗SCI尿潴留患者效果确切,可改善患者排尿异常症状,促进膀胱功能恢复,且安全可靠。

Objective To explore the effect of Yiqi Huoxue Decoction combined with heat sensitive moxibustion in patients with urinary retention after spinal cord injury (SCI). Methods From July 2019 to July 2021, 80 patients with urinary retention after SCI in our hospital were selected and divided into observation group and control group according to different treatment plans, 40 cases in each group. The control group was given Yiqi Huoxue decoction, and the observation group was treated with heat sensitive moxibustion additionally. Efficacy, urination before and after treatment, bladder function, urodynamic indexes [bladder volume (VH₂O), bladder compliance (BC), pressure of detrusor (Pdet), pressure of vesical (Pves), average flow rate (Qave)] and incidence of adverse events in 2 groups were observed. Results The total effective rate of observation group was 92.50%, higher than that of control group (70.73%, P<0.05). After treatment, bladder function score, average times of urination, average times of urine leakage, average urine volume and residual urine volume in the observation group were lower than those in the control group (P<0.05). After treatment, compared with the control group, the observation group had lower Pves, higher VH₂O, Pdet, Qave and BC (P<0.05). The adverse event rate of the observation group (2.50%) was not significantly different from control group (5.00%, P>0.05). Conclusions Heat sensitive moxibustion combined with Yiqi Huoxue decoction is effective in the treatment of SCI patients with urinary retention, which can improve the symptoms of abnormal urination and promote the recovery of bladder function, and is safe and reliable.

目的 探讨分析利用坐式DR轮椅辅助精神发育迟滞患儿胸部DR体检的图像质量。方法 2020年7月—2021年2月,共80例精神发育迟滞患儿纳入本研究。根据协助拍片的方式不同,分为坐式DR轮椅协助组(实验组)和医护人员抓扶协助组(对照组)。采用SPSS 20.0秩和检验分析2组图像质量的差异。结果 2组摄片图像差异有统计学意义(P<0.001)。坐式DR轮椅协助精神发育迟滞患者的胸部DR体检图片质量较高,废片率低。结论 坐式DR轮椅协助精神发育迟滞患儿胸部DR摄片图片的质量高,避免重复拍片的几率,为精神发育迟滞患儿及家属减少不必要的辐射风险提供了可靠方案。

Objective To explore and analyze the image quality of chest DR examination of children with mental retardation using DR wheelchair. Methods From July 2020 to February 2021, a total of 80 children with mental retardation were included in this study.According to different ways of assistance in examination, they were divided into seated DR wheelchair assisting group (experimental group) and medical staff assisting group (control group).The SPSS 20.0 rank sum test was used to analyze the difference in image quality between the two groups. Results The difference of radiographic images between the two groups was statistically significant (P<0.001).Seated DR wheelchairs assisted patients with mental retardation were with high quality and low rejection rate in their chest DR examination pictures. Conclusions DR wheelchair could help children with mental retardation to take chest DR pictures with high quality, avoid the probability of repeated examination, and provide a reliable method for children with mental retardation and their families to reduce the risk of unnecessary radiation.

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 通过多种生物信息学方法分析MAML1在GC患者中的表达及与临床特征、预后和免疫治疗疗效的相关性。方法 利用TCGA数据库分析胃癌组织与正常胃黏膜组织中的MAML1表达水平;Kaplan-Meier在线工具对胃癌数据集GSE15459进行分析,阐明MAML1与患者临床特征及分期、治疗疗效的相关性;STRING软件预测与MAML1表达相关的基因,并用FUNRICH软件评估其富集的分子生物学功能和信号通路;TIMER和GEPIA数据库探索MAML1表达水平与肿瘤浸润免疫细胞及其相应基因标记集之间的关系。结果 MAML1在GC组织中的表达水平高于正常组织(P<0.001),且其表达水平与III期、有淋巴结转移、无远处转移的患者生存期相关(P<0.05),而与I、II和IV期、无淋巴结转移和有远处转移的患者生存期无相关性(P>0.05)。MAML1的相关作用基因主要分布在细胞核、参与转录调控,并且主要富集在雄激素受体、C-MYB转录因子和HIF-2α转录调控等相关的信号通路。MAML1表达水平与B细胞、CD4⁺ T细胞、巨噬细胞的表达水平存在正相关关系(P<0.05),但与肿瘤纯度、CD8⁺ T细胞、中性粒细胞、树突状细胞无相关性(P>0.05)。结论 MAML1有可能成为GC患者较差的临床预后标志物之一,其潜在分子机制可能与转录调控调节肿瘤微环境有关。

Objective To investigate the expression of MAML1 and its relationship with clinical characteristics, prognosis and the efficiency of immunotherapy in patients with GC. Methods MAML1 expression profile was observed by TCGA database. Kaplan-Meier survival analysis was applied to evaluate the correlation between the expression of MAML1 and clinical characteristics, prognosis and treatment efficiency of patients in GSE15459 dataset. MAML1-associated genes were predicted by STRING and were enriched in GO and KEGG by FUNRICH software. The relationship between MAML1 expression and markers of tumor infiltrated cells were explored by TIMER and GEPIA database. Results MAML1 was abnormally upregulated in GC tissues compared to normal gastric tissues (P<0.001). MAML1 expression was significantly associated with the overall survival of patients in stage III, with lymph node metastasis and without distant metastasis (P<0.001). There was no significant difference between MAML1 expression and the overall survival of patients in stage I, II, IV, without lymph node metastasis and with distant metastasis (P>0.05). MAML1-assoicated genes were mainly located at the nucleus, mediating transcriptional regulation and mainly enriching in androgen receptor, C-MYB transcription factor and HIF-2α transcription regulation and other related signaling pathways. MAML1 expression was positively related with the expression of B cell, CD4⁺ T cell and macrophages (P<0.05), but without significant difference with tumor purity, CD8⁺ T cell, neutrophils and dendritic cells (P>0.05). Conclusions MAML1 could be used as a marker of clinical prognosis of patients with GC. The potential molecular mechanism might be associated with its function in transcriptional regulation and changes in tumor microenvironment.

目的 探究数字乳腺三维断层融合摄影技术(DBT)联合MR波谱在乳腺高危病灶诊断中的应用。方法 选取2020年6月—2021年6月来我院进行乳腺钼靶X线摄影并诊断为BI-RADS 4级及以上的100例乳腺高危病灶患者为研究对象,对入选患者行MR波谱及DBT检查,分析MR波谱征象及DBT乳腺病变摄影特征,以病理结果为标准,评价MR波谱与DBT及两者联用对乳腺高危病灶的诊断疗效。结果 DBT敏感度、特异度、阳性预测值、阴性预测值均高于MR波谱;DBT漏诊率、误诊率均低于MR波谱漏诊率、误诊率,2组诊断方法比较(P<0.05)。MR波谱及DBT对≥2 cm恶性病变的病理诊断结果符合率比较,差异均无统计学意义(P＞0.05)。MR波谱及DBT对乳腺良性病变、恶性病变＜2 cm诊断结果符合率比较,DBT对乳腺高危患者的病理诊断结果符合率高于MR波谱(P＜0.05)。结论 乳腺高危病灶诊断中选择DBT可对乳腺高危病灶诊断中做出准确的分析和判断,对乳腺高危病灶诊断更具有应用价值,值得临床采纳。

Objective To explore the application of digital breast tomosynthesis (DBT) combined with MR wave in the diagnosis of high-risk breast lesions. Methods A total of 100 patients with breast high-risk lesions diagnosed as BI-RADS 4 or above by mammography in our hospital from June 2020 to June 2021 were selected as the research objects. The selected patients were examined by MR spectrum and DBT. The signs of MR spectrum and the photographic characteristics of DBT breast lesions were analyzed. Based on the pathological results, the diagnostic efficacy of MR spectrum, DBT and their combination in the diagnosis of breast high-risk lesions was evaluated. Results The sensitivity, specificity, positive predictive value and negative predictive value of DBT were higher than those of MR spectrum; the missed diagnosis rate and misdiagnosis rate of DBT were lower than those of MR spectrum (P<0.05). There was no significant difference in the coincidence rate of MR spectrum and DBT in the pathological diagnosis of malignant lesions ≥ 2 cm (P>0.05). The coincidence rate of MR spectrum and DBT in the diagnosis of benign and malignant breast lesions<2 cm was higher than that of MR spectrum (P<0.05). Conclusions Selecting DBT in the diagnosis of breast high-risk lesions can make accurate analysis and judgment in the diagnosis of breast high-risk lesions. It has higher application value in the diagnosis of breast high-risk lesions and is worthy of clinical adoption.

目的 探究脐动脉血流动力学指标、血脂、促甲状腺激素(TSH)对妊娠期糖尿病患者分娩结局的影响研究。方法 选取我院2021年1月—2021年11月收治的妊娠期糖尿病患者138例,采用随机数字表法分为对照组和研究组,每组各69例。比较2组患者体内脐动脉血流动力学指标、血脂指标及TSH相关指标表达水平差异及妊娠结局,并通过多元线性回归分析探究脐动脉血流动力学指标、血脂指标、TSH等相关指标与妊娠期糖尿病患者不良妊娠结局的相关性。结果 研究组孕妇脐动脉峰值流速/舒张末期流速(S/D)、阻力指数(RI)、三酰甘油(TG)、低密度脂蛋白(LDL)、TSH水平高于对照组,游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平低于对照组(P<0.05);研究组孕妇巨大儿、剖宫产、新生儿低血糖发生率及新生儿体质量均高于对照组(P<0.05);多元线性回归方程显示:S/D、RI、TG、LDL、TSH水平变化均与不良妊娠结局存在相关性(R²=0.224,调整R²=0.201;F=9.504,P<0. 05),且影响顺序由大到小依次为 TG、TSH、RI、S/D、LDL。结论 妊娠期糖尿病孕妇体内的S/D、RI、TG、LDL、TSH水平异常可能会影响妊娠结局,临床可通过监测上述指标的变化,及时采取干预措施。

Objective To investigate the effects of umbilical artery hemodynamic indexes, blood lipids and thyroid stimulating hormone (TSH) on delivery outcomes in patients with gestational diabetes mellitus. Methods A total of 138 patients with gestational diabetes mellitus who were admitted to our hospital from January 2021 to November 2021 were selected and divided into a control group and a study group by random digital table, with 69 cases in each group. The differences in umbilical artery hemodynamic indexes, blood lipid indexes and TSH-related indexes and pregnancy outcomes were compared between the two groups, and multiple linear regression analysis was used to explore the relationship between umbilical artery hemodynamic indexes, blood lipid indexes, TSH, other related indexes and adverse pregnancy outcomes in patients with gestational diabetes mellitus. Results The systolic and diastolic peak volume ratio (S/D), resistive index (RI) of umbilical artery, triglyceride (TG), low density lipoprotein (LDL) and TSH in the study group were higher than those in the control group, while the levels of free triiodothyronine (FT3) and free thyroxine (FT4) were lower than those in the control group (P<0.05). The incidences of macrosomia, cesarean section, neonatal hypoglycemia and neonatal weight in study group were significantly higher than those in the control group (P<0.05). The multiple linear regression equation showed that the adverse pregnancy outcomes were correlated with changes of TG, TSH, RI, S/D, LDL levels (R²=0.224, adjusted R²=0.201; F=9.504, P<0.05), in descending order. Conclusions Abnormal levels of S/D, RI, TG, LDL, TSH and FT4 in pregnant women with gestational diabetes mellitus may affect the pregnancy outcomes. Clinical intervention measures can be taken by monitoring the changes of the above indicators.

目的 探讨透明质酸钠注射联合富含血小板的血浆治疗膝骨关节炎患者的效果。方法 收集2019年7月—2021年7月在本院就诊的膝骨关节炎患者120例,采用随机数字表法分组,即对照组、观察组,均60例。对照组患者注入富含血小板的血浆(4 mL),观察组患者注射透明质酸钠(2 mL)联合富含血小板的血浆(3.5 mL),1次/周,3次为1个疗程,共2～3疗程。统计2组患者膝关节功能、临床疗效及并发症发生率。结果 ①组内比较:治疗后2月、3月及6月平均Lysholm膝关节评分均升高,P<0.05;②组间比较:治疗前及治疗后2月,2组患者平均Lysholm膝关节评分比较,P>0.05,治疗后3月、6月,2组平均Lysholm膝关节评分比较,P<0.05。2组患者Lysholm膝关节评分均较治疗前有所改善,P<0.05;观察组疼痛评分(18.92±4.11、17.61±3.83)分、肿胀度评分(10.64±2.82、9.66±1.21)分均高于对照组疼痛评分(14.02±3.52、13.54±3.21)分、肿胀度评分(9.62±2.63、8.71±1.93)分(P<0.05)。观察组临床总有效率98.33%高于对照组临床总有效率88.33%(χ²=4.821,P=0.028)。经过6个月的随访后,2组均1例出现局部肿胀,未发生其他并发症。结论 透明质酸钠注射联合富含血小板的血浆治疗膝骨关节炎患者,可以有效改善患者膝关节功能,减轻患者疼痛及肿胀程度等,安全性高,值得推广应用。

Objective To investigate the effect of sodium hyaluronate injection combined with platelet-rich plasma in the treatment of patients with knee osteoarthritis. Methods A total of 120 patients with knee osteoarthritis who were treated in our hospital from July 2019 to July 2021 were collected and randomly divided into control group and observation group,60 cases each.The patients in the control group were injected with platelet-rich plasma(4 mL),and the patients in the observation group were injected with sodium hyaluronate(2 mL)combined with platelet-rich plasma(3.5 mL),once a week,3 times as a course of treatment,total 2-3 courses of treatment.The knee joint function,clinical efficacy and complication rates of the two groups were compared. Results ①Intra-group comparison:the average Lysholm knee joint scores were significantly increased in 2 months,3 months and 6 months after treatment,P<0.05. ②Comparison between groups:before and 2 months after treatment,the average Lysholm knee joint scores of the two groups were significantly increased (P<0.05). After 3 months and 6 months treatment,the comparison of the average Lysholm knee score between the two groups were statistic significant (P<0.05).The Lysholm knee joint scores in both groups were improved compared with those before treatment (P<0.05). Three months after treatment,the pain score(18.92±4.11, 17.61±3.83)and swelling score(10.64±2.82, 9.66±1.21)in the observation group were significantly higher than those in the control group(14.02±3.52, 13.54±3.21, 9.62±2.63, 8.71±1.93, P<0.05).The total clinical effective rate of the observation group was 98.33%,which was significantly higher than that of the control group (88.33%, χ²=4.821,P=0.028).After 6-month follow-up,local swelling occurred in 1 case in both groups,and no other complications occurred. Conclusions Sodium hyaluronate injection combined with platelet-rich plasma in the treatment of patients with knee osteoarthritis can effectively improve the knee joint function and reduce the pain and swelling of the patients.It is safe and worthy of popularization and application.