目的 调查眼科患者对荧光素眼底血管造影认知情况及健康教育需求,为眼底造影医护人员实施高效、个性化健康教育提供依据。方法 采用自制眼底造影认知及健康教育需求问卷,对本院2021年6月—8月的123例眼底血管造影患者进行问卷调查,使用Spearman相关性分析、非参数秩和检验及多元线性逐步回归分析患者眼底血管造影认知的影响因素。结果 患者荧光素眼底血管造影认知得分为（33.77±8.09）分,其中,患者对于检查中的相关知识认知最低,相对得分为0.59;患者健康教育需求的得分为（43.95±7.63）分,其中,检查后的相关知识需求度最高,相对得分为0.77;不同年龄、文化程度、主要照顾者、眼造影检查次数及是否合并全身病的患者的认知水平差异有统计学意义（P<0.05）。多元线性逐步回归分析表明,眼造影检查史是患者眼底血管造影认知的独立影响因素。结论 眼科患者对荧光素眼底血管造影认知水平较低,健康教育需求高,医护人员应重视健康教育的实施,结合FFA操作流程及患者特点,制定标准化健康教育流程,探索有效的线上+线下的健康教育模式,以提高造影患者认知水平,保障患者安全。

Objective To investigate fundus fluorescein angiography（FFA）cognition and health education needs in ophthalmic patients,and to provide basis for efficient and personalized health education for FFA medical staff．Methods A self-made questionnaire was used in a survey of 123 patients from June to August 2021．The influencing factors of FFA cognition were analyzed by Spearman correlation analysis,non parametric rank sum test and multiple linear stepwise regression．Results The score of FFA cognition was（33.77 ± 8.09）．Patients had the lowest cognition of relevant knowledge during the examination,with a relative score of 0.59．The score of patient's health education needs was（43.95 ± 7.63）,while the score of relevant knowledge needs after examination was the highest,with a relative score of 0.77．There were significant differences in cognitive level among patients with different ages,educational levels,main caregivers,angiographic times,and complication of systemic diseases（P<0.05）．Multiple linear stepwise regression analysis showed that the number of ocular angiography was an independent factor affecting the cognition of FFA．Conclusions Patients with FFA have low cognitive level and high demand for health education．Medical staff should pay attention to the implementation of health education,formulate a standardized health education process with the combination of operation process and patient characteristics,and explore an effective online-to-offline health education mode,so as to improve the cognitive level of angiography patients and ensure the safety of patients．

目的 基于影像组学方法,探讨多层螺旋CT（MSCT）四期增强扫描单一/不同期相及不同容积感兴趣区（VOI）的选择,在术前预测原发性肝细胞癌（HCC）微血管侵犯（MVI）中的价值。方法 回顾性收集88例经手术病理证实为HCC并行术前MSCT四期增强扫描的患者,其中包括47例MVI阳性患者和41例MVI阴性患者。在MSCT增强扫描的动脉早期、动脉晚期、门静脉期及延迟期图像中手动逐层勾画肿瘤ROI,获得瘤体容积感兴趣区VOI（Vt）,然后基于计算机自动膨胀算法将Vt外扩10 mm获得瘤体及瘤周VOI（Vt+Vp）。使用Pyradiomics软件分别从Vt和Vt+Vp中提取影像组学特征,随后采用15种特征选择方法和10种分类器构建150个预测模型,并通过十折交叉检验以验证模型的效能。使用准确度、敏感度、特异度、受试者工作特性曲线下面积（AUC）评估模型的效能,并比较性能最优的前三个预测模型。结果 MSCT四期增强扫描图像中预测HCC MVI状态的影像组学模型在门静脉期的表现优于其它期相及各期相的不同组合,其中最大的AUC值在Vt和Vt+Vp两种ROI中分别为0.768和0.782。此外,基于Vt+Vp的影像组学模型对MVI的预测效能优于基于Vt的影像组学模型,基于Vt+Vp性能最优的预测模型的AUC值、准确度、敏感度和特异度分别0.782、0.728、0.745和0.705。结论 采用影像组学方法术前无创性预测HCC MVI状态首选增强扫描的门静脉期,ROI首选瘤体联合瘤周10 mm区域。

Objective To investigate the value of single or different phases of contrast-enhanced multi-slice spiral CT（MSCT）in different volumetric regions of interest（ROI）to preoperatively predict the state of microvascular invasion in primary hepatocellular carcinoma（HCC）based on radiomics methods．Methods A total of 88 patients with HCC confirmed by surgical pathology who underwent preoperative MSCT quadruple-enhanced scan were retrospectively recruited,including 47 MVI-positive patients and 41 MVI-negative patients．The ROI was manually delineated slice-by-slice in the early arterial phase,late arterial phase,portal venous phase,and equilibrium phase of enhanced MSCT images to obtain the volume of tumor VOI（Vt）,and then Vt was expanded by 10 mm through the computer expansion algorithm automatically to obtain the volume of tumor and peritumor（Vt+Vp）．Pyradiomics software was used to extract radiomic features from Vt and Vt+Vp,followed by 150 discriminant models constructed with 150 feature selection methods and 10 classifiers,and then 10-fold cross-validation was used to evaluate the performance of these models．Using accuracy,sensitivity,specificity,area under the receiver operating characteristic curve（AUC）to assess model performance．The top three predictive models with the best performance were also compared．Results The radiomics model for predicting HCC MVI status in portal venous phase among quadruple-enhanced MSCT images outperformed other phases and different combinations of phases,achieving the highest AUC values of 0.768 and 0.782 in Vt and Vt+Vp respectively．In addition,the prediction performance of the radiomics model based on Vt+Vp was superior to models based on Vt．AUC value,accuracy,sensitivity,and specificity of the model with the best performance based on Vt+Vp were 0.782,0.728,0.745 and 0.705 respectively．Conclusions Radiomics models based on the portal venous phase of contrast-enhanced MSCT and tumor combined with the 10mm peritumoral area were more recommended to be employed to preoperative non-invasively predict the state of HCC MVI．

目的 探讨术前控制营养状态评分在老年胃癌患者术后短期并发症中的应用价值。方法 回顾分析统计2015年1月—2020年12月在江苏大学附属医院接受治疗的确诊胃癌患者,根据纳入标准和排除标准,选择入组患者,收集纳入研究患者一般资料、术前实验室检测数据和术后并发症情况,计算控制营养状况（CONUT）评分,统计分析CONUT营养评分在老年胃癌患者接受胃癌D2根治术术后短期并发症的价值。结果 共223例患者纳入研究,CONUT评分的截断值为2.5,肿瘤直径的截断值为2.75 cm。CONUT评分>2.5组的平均年龄高于CONUT评分<2.5组（P=0.005 3）,且2组性别构成存在差异,男性患者多于女性（P=0.037 0）。CONUT评分>2.5组患者的肿瘤直径较大（P=0.039 4）。在术后并发症方面,CONUT评分>2.5组的术后并发症多于CONUT评分<2.5组（P=0.008 3）。单因素Logistic回归分析,年龄（OR=1.127;95%CI：1.028~1.236;P=0.011）、CONUT评分（OR=0.339;95%CI：0.151~0.764;P=0.009）是患者发生短期并发症的危险因素。多因素Logistic回归分析显示年龄（OR=1.115;95%CI：1.008~1.233;P=0.035）、CONUT评分（OR=0.414;95%CI：0.175~0.982;P=0.045）是患者发生短期并发症的危险因素。结论 CONUT评分作为老年胃癌患者术前营养评估项目可以有效预测患者术后短期并发症,进而提前进行营养干预,降低术后并发症发生率。

Objective To explore the value of controlling nutritional status score in short-term postoperative complications of elderly patients with gastric cancer．Methods The data of patients who confirmed gastric cancer and treated in the Affiliated Hospital of Jiangsu University from January 2015 to December 2020 were reviewed and analyzed．Patients were selected according to the inclusion criteria and exclusion criteria,the general data,preoperative laboratory test data and postoperative complications of the included patients were collected,and the controlling nutritional status（CONUT）score was calculated．The value of CONUT score in the short-term complications of elderly gastric cancer patients undergoing D2 radical gastrectomy for gastric cancer was evaluated．Results A total of 223 patients were included in this study．The cut-off value of CONUT score was 2.5 and the cut-off value of tumor diameter was 2.75 centimeter．The average age of the group with CONUT score > 2.5 was significantly higher than that of the group with CONUT score < 2.5（P=0.005 3）．Moreover,there was significant difference between the sex ratio of the two groups,with male more than female（P=0.037 0）．The tumor diameter was significantly larger in the group with CONUT score > 2.5（P=0.039 4）．In terms of postoperative complications,there was significantly more postoperative complications in the group with CONUT score > 2.5 than in the group with CONUT score < 2.5（P=0.008 3）．Univariate logistic regression analysis showed that age（OR=1.127;95% CI：1.028-1.236;P=0.011）and CONUT score（OR=0.339;95% CI：0.151-0.764;P=0.009）were the risk factors for short-term complications．Multivariate logistic regression analysis showed that age（OR=1.115;95% CI：1.008-1.233;P=0.035）and CONUT score（OR=0.414;95% CI：0.175-0.982;P=0.045）were the risk factors for short-term complications．Conclusions As a preoperative nutritional evaluation item for elderly patients with gastric cancer,CONUT score can effectively predict the short-term postoperative complications of patients,and then carry out nutritional intervention in advance to reduce the incidence of postoperative complications．

目的 研究核因子-κB激活剂1（Act1）对高糖诱导肾小管上皮细胞炎症反应及细胞外基质表达的调控作用。方法 培养肾小管上皮细胞MK2,设置对照组和高糖组,处理12 h、24 h、48 h、72 h后检测细胞中Act1的mRNA和蛋白表达水平;设置si-NC组（5.5 mmol/L葡萄糖培养基中转染NC siRNA）、si-NC+高糖组（30 mmol/L葡萄糖培养基中转染NC siRNA）、si-Act1+高糖组（30 mmol/L葡萄糖培养基中转染Act1 siRNA）,48 h后检测细胞中Act1、E-钙黏蛋白（E-cadherin）、N-钙黏蛋白（N-cadherin）、I型胶原（Col-I）、III型胶原（Col-III）的mRNA和蛋白表达水平以及培养基中肿瘤坏死因子-α（TNF-α）、白介素-1β（IL-1β）、干扰素-γ（IFN-γ）的含量。结果 高糖组处理12 h、24 h、48 h、72 h时细胞中Act1的mRNA和蛋白表达水平均高于对照组（P<0.05）;si-NC+高糖组处理48h时细胞中Act1、N-cadherin、Col-I、Col-III的mRNA和蛋白表达水平以及培养基中TNF-α、IL-1β、IFN-γ的含量均高于si-NC组,细胞中E-cadherin的mRNA和蛋白表达水平均低于si-NC组（P<0.05）;si-Act1+高糖组处理48h时细胞中Act1、N-cadherin、Col-I、Col-III的mRNA和蛋白表达水平以及培养基中TNF-α、IL-1β、IFN-γ的含量均低于si-NC+高糖组,细胞中E-cadherin的mRNA和蛋白表达水平均高于si-NC+高糖组（P<0.05）。结论 Act1表达增加对高糖诱导肾小管上皮细胞炎症反应激活和细胞外基质增多具有促进作用。

Objective To study the regulation effect of nuclear factors-κB activator 1（NF-κB activator 1,Act1）on high glucose induced inflammatory response and extracellular matrix expression in renal tubular epithelial cells．Methods Renal tubular epithelial cells MK2 were cultured and control group and high glucose group were set．The mRNA and protein expression of Act1 were detected after treatment for 12,24,48 and 72 hours．MK2 were divided into si-NC group（transfected with NC siRNA in 5.5 mmol/L glucose medium）,si-NC+high glucose group（transfected with NC siRNA in 30 mmol/L glucose medium）and si-Act1+high glucose group（transfected with Act1 siRNA in 30 mmol/L glucose medium）．The mRNA and protein expression of Act1,E-cadherin,N-cadherin,type I collagen（Col-I）,and type III collagen（Col-III）and the contents of tumor necrosis factor-α（TNF-α）,interleukin-1β（IL-1β）,interferon-γ（IFN-γ）in culture medium were detected．Results The mRNA and protein expression levels of Act1 in cells of high glucose group were higher than those of control group at 12 h,24 h,48 h and 72 h（P<0.05）．The mRNA and protein expression levels of Act1,N-cadherin,CoL-I,Col-III in cells and the contents of TNF-α,IL-1β,IFN-γ in culture medium of si-NC+high glucose group were higher than those of si-NC group,the mRNA and protein expression levels of E-cadherin in cells were lower than those of si-NC group at 48 h（P<0.05）．The mRNA and protein expression levels of Act1,N-cadherin,CoL-I,Col-III in cells and the contents of TNF-α,IL-1β,IFN-γ in culture medium of si-Act1+high glucose group were lower than those of si-NC+high glucose group,the mRNA and protein expression levels of E-cadherin in cells were higher than those of si-NC+high glucose group at 48 h（P<0.05）．Conclusions The increased expression of Act1 promotes the activation of inflammatory response and the increase of extracellular matrix in renal tubular epithelial cells induced by high glucose．

消化系统疾病诊治与组织病理诊断密切相关,高效、规范获取组织样本是关键,对此2021年欧洲胃肠内镜学会制定了消化道及肝胰腺胆道的内镜下组织活检的指南,分为上消化道（含肝、胰腺、胆道）和下消化道两部分,提供了规范活检的指导及建议。笔者对指南就上消化道内镜下组织活检的部分内容进行解读,解读内容为个人观点。

The diagnosis and treatment of digestive system diseases are closely related to histopathological diagnosis．Efficient and standardized acquisition of tissue samples plays a key role．In 2021,European Society of Gastrointestinal Endoscopy（ESGE）had developed guidelines for endoscopic tissue biopsy of the digestive tract and hepatopancreatic biliary tract,which divided into upper gastrointestinal tract（including liver,pancreas,biliary tract）and lower gastrointestinal tract．This guideline provided guidance and recommendations for standardizing biopsies．We interprets some of the contents of the guideline on tissue biopsy under endoscopy of the upper gastrointestinal tract,which are personal opinions．

目的 观察2型糖尿病大鼠肝脏组织中circRNA-0003340的表达,并探讨与糖尿病的关系。方法 选取健康雄性SD大鼠30只,随机分为2组,正常对照组（NC组,n=10）与2型糖尿病组（T2DM组,n=20）,检测FPG、FINs、HbA1c、TC、TG、HDL-C、LDL-C、AST、ALT;行腹腔注射糖耐量实验和胰岛素耐量实验,计算胰岛素抵抗指数（HOMA-IR）;HE染色观察胰岛细胞形态;RT-PCR检测大鼠肝脏组织circRNA-000334的表达量。结果 与NC组比较,T2DM组的AST、ALT、FPG、HAb1c、FINs、HOMA-IR、TG、TC、LDL-C均升高（P<0.05）,HDL-C降低（P<0.05）。circRNA-0003340在T2DM组肝脏组织中的表达较NC组肝脏组织中的表达是下调的,差异有统计学意义（P<0.05）。Sperman相关分析示大鼠肝脏组织中circRNA-0003340表达水平与FPG、TG及TC呈负相关（P<0.05）。结论 circRNA-003340的表达水平可能与T2DM大鼠的糖脂代谢密切相关,circRNA-003340在肝脏组织中的表达水平下调可能参与T2DM的发生发展。

Objective To observe the expression of circRNA-0003340 in the liver tissue of type 2 diabetes mellitus （T2DM）rats and to explore its relationship with diabetes．Methods A total of 30 healthy male SD rats were randomly divided into two groups,normal control group（NC group,n=10）and T2DM group（n=20）,and fasting plasma glucose（FPG）,fasting insulins（FINS）,glycated hemoglobin（HbA1c）,total cholesterol（TC）,triglyceride (TG）,high-density lipoprotein cholesterol（HDL-C）,low-density lipoprotein cholesterol（LDL-C）,aspartate aminotransferase（AST）,alanine aminotransferase（ALT）levels were detected．Intraperitoneal glucose tolerance test and insulin tolerance test were performed to calculate the insulin resistance index（HOMA-IR）,HE staining was used to observe islet cell morphology,the expression of circRNA-000334 in rat liver tissue was detected by RT-PCR．Results Compared with the NC group,the T2DM group had increased AST,ALT,FPG,HAb1c,FINs,HOMA-IR,TG,TC,LDL-C（P<0.05）and decreased HDL-C（P<0.05）．The expression of circRNA-0003340 in liver tissue in T2DM group was down-regulated compared with that in NC group,with statistically significant difference（P<0.05）．Sperman correlation analysis showed that the expression level of circ-0003340 in rat liver tissue was negatively correlated with FPG,TG and TC（P<0.05）．Conclusions The expression level of circRNA-003340 may be closely related to the glycolipid metabolism of T2DM rats,and the downward regulation of the circRNA-003340 expression level in liver tissues may be involved in the occurrence and development of T2DM．

吞咽障碍是慢性阻塞性肺疾病（COPD）的常见并发症之一,并且是COPD急性加重的危险因素之一,对患者预后造成不良影响。对COPD患者吞咽障碍的发生及严重程度进行准确的评估,是进行科学管理的首要前提。本文对COPD吞咽障碍评估工具的基本特点、应用现状及发展现状进行综述,为临床医务人员选择评估工具提供借鉴。

Dysphagia is one of the common complications of chronic obstructive pulmonary disease（COPD）,and is one of the risk factors of acute exacerbation of COPD,which has adverse effects on the prognosis of patients．Accurate assessment of the occurrence and severity of dysphagia in COPD patients is the first step for scientific management．In this paper,the basic characteristics,application status and development status of assessment tools for COPD patients with dysphagia are reviewed,which can provide reference for the selection of assessment tools for clinical medical staff．

肝内胆管细胞癌（ICC）是发病率仅次于肝细胞癌的肝脏恶性肿瘤,它的恶性程度高、术后易复发,且早期无典型症状,大多数患者在确诊时已处于晚期。诊断主要依赖于增强CT、MRI和实验室检查。肝切除术是ICC首选的治疗方法,完整的切缘阴性切除和保留足够残留肝是影响手术预后的重要因素。淋巴结清扫、卡培他滨辅助化疗已被证实对患者有益。局部治疗、分子靶向治疗、免疫治疗等新疗法发展迅速,为晚期ICC患者带来了希望。传统疗法与新疗法的结合为ICC提供新的诊疗思路。

Intrahepatic cholangiocarcinoma（ICC）is the second most common liver malignancy after hepatocellular carcinoma．It is highly malignant,easy to recur after surgery,and has no typical symptoms in the early stage,and most patients are in the late stage when diagnosed．Diagnosis relies on enhanced CT,MRI and laboratory tests．Hepatectomy is the preferred treatment for intrahepatic cholangiocarcinoma．Complete resection with negative margin and adequate residual liver preservation are important factors affecting the prognosis of the operation．Lymph node dissection and adjuvant chemotherapy with capecitabine have been shown to be beneficial for patients．The rapid development of new therapies such as local therapy,molecular targeted therapy and immunotherapy has brought hope to patients with advanced intrahepatic cholangiocarcinoma．The combination of traditional therapy and new therapy provide a new idea for diagnosis and treatment of intrahepatic cholangiocarcinoma．

目的 探讨柳州市老年骨质疏松性骨折（OPF）现状及其发生的危险因素。方法 回顾性分析2018年1月—2020年12月柳州市工人医院创伤中心收治的5 235例60周岁及以上老年OPF患者的临床资料,并从中随机抽取300例老年OPF患者临床资料作为研究组;选取同时期接诊的老年骨质疏松未骨折的300例患者临床资料作为对照组,通过医院病案管理系统,详细收集2组患者各项临床资料,分析柳州市老年OPF现状及危险因素。结果 5 235例老年OPF患者中,以胸腰椎压缩性骨折占比最高58.19%、其次为股骨颈骨折15.42%;60~74岁年龄段患者以胸腰椎压缩性骨折占比最高77.03%,75~89年龄段患者股骨颈骨折、粗隆间骨折占比均较高分别为43.36%、41.34%,≥90岁患者粗隆间骨折占比最高49.25%;男性、女性均以胸腰椎压缩性骨折占比较高,分别为46.34%、62.47%。经单因素/多因素分析显示,年龄、性别、体质量指数（BMI）、跌倒史、骨折史、骨密度（BMD）、糖尿病、不良生活习惯为老年OPF发生的独立危险因素（P<0.05）。结论 胸腰椎压缩性骨折是柳州市老年OP患者骨折的主要类型;老年OPF的发生与年龄、性别、BMI、跌倒史、骨折史、BMD 、糖尿病、不良生活习惯等因素有关,应采取积极预防措施,降低OPF的发生风险。

目的 利用品管圈工具提高某三甲医院住院病案首页主要诊断编码正确率。方法 成立品管圈小组,选取2022年11月出院日期前200份住院病案首页作为开展品管圈前的对照组,按照出院科室分层抽取2021年8月1日—2022年3月31日的2 007份首页作为开展品管圈后的研究对象,对上述首页的主要诊断填写及疾病分类编码进行核对、检查、汇总统计。针对主要诊断编码错误率高的现象,从人、法、测3个维度进行分析,根据找出的原因制定对策并执行。根据具体情况使用χ²检验或者四格表资料的Fisher确切概率法检验比较品管圈前后主要诊断编码正确、错误份数的差异。结果 开展一系列改进措施后医生主要诊断填写正确率从95.00%上升到98.01%,编码员主要诊断编码正确率从97.50%上升至99.55%,住院病案首页主要诊断编码正确率从93.50%提高到97.56%,临床医师的书写质量、编码员的编码质量均有改善。品管圈开展前后主要诊断编码正确、错误份数差异有统计学意义。通过开展品管圈,标准化了一个院级规范、多个院级编码共识、两个科级工作工具和机制以及一个科级绩效分配方案。结论 品管圈质量改进工具能有效提高病案首页主要诊断编码正确率,后期应持续开展。

Objective To improve the accuracy of main diagnostic codes on the home page of inpatient medical records in a Class III Grade A Hospital by using the quality control circle．Methods The Medical Record Department set up a quality control circle group．A total of 200 inpatient medical records' home pages were selected as the control group before the quality control circle carried out,which patients were discharged in November 2022．Home pages of 2 007 inpatient medical records from August 1,2021 to March 31,2022 were selected according the discharge department as the research objects after the quality control circle carried out．The main diagnosis filling and disease classification codes on those home pages of the above medical records were checked and summarized．We analyzed the reason of the high error rate of the main diagnostic codes from three dimensions of people,law and test．Countermeasures were formulated and implemented according to the identified causes．Fisher exact probability method of four grid data or χ² test were used to compare the correct copies of main diagnostic codes before and after the quality control circle according to the specific situation．Results The writing quality of clinicians and the coding quality of coders were improved after a series of improvement measures were carried out．The correct rate of doctors' main diagnostic codes increased from 95.00% to 98.01%,the correct rate of coders' main diagnostic codes increased from 97.50% to 99.55%,and the correct rate of main diagnostic codes on the home page of inpatient medical records increased from 93.50% to 97.56%．The number of correct copies of main diagnostic codes before and after the development of the quality control circle was statistically significant．Through the development of the quality control circle,one institute level specification,multiple institute level coding consensus,two department level work tools and mechanisms,and one department level performance allocation scheme have been standardized．Conclusions The application of the quality control circle tool can effectively improve the accuracy of the main diagnostic codes on the home page of the inpatient medical record,which should be continued in the later period．