目的 探究血清多配体蛋白聚糖-1（SCD-1）与可溶性血管内皮生长因子受体-2（sVEGFR-2）表达水平在老年慢性心力衰竭患者预后评估的判定价值。方法 选取2023年1月—2024年3月珠海市第五人民医院检验科收治的110例老年慢性心力衰竭患者，检测其血清SCD-1和sVEGFR-2水平，对患者进行随访调查，了解其再次由于心力衰竭住院、心源性死亡的情况。运用多因素Logistic回归分析，探究老年慢性心力衰竭患者预后影响因素。结果 Logistic回归分析显示，心功能分级（OR=3.433，95%CI：0.934~6.431）、B型脑钠肽升高（OR=2.462，95%CI：0.861~4.765）、血清SCD-1升高（OR=3.795，95%CI：0.972~6.894）、血清sVEGFR-2升高（OR=3.842，95%CI：0.942~6.912）为影响老年慢性心力衰竭患者预后不良的重要因素（P＜0.05）；联合血清SCD-1和sVEGFR-2曲线下面积0.962与B型脑肽钠曲线下面积0.844，相较于单一SCD-1曲线下面积0.658、sVEGFR-2曲线下面积0.712明显偏高（P＜0.05）。结论 经研究证实，老年慢性心力衰竭患者预后效果不理想，其血清SCD-1和sVEGFR-2监测水平异常升高，和老年慢性心力衰竭预后不佳存在关联性，可视为老年慢性心力衰竭患者判定预后效果的主要标志物。
Objective To investigate the prognostic value of serum syndecan-1（SCD-1）and soluble vascular endothelial growth factor receptor-2（sVEGFR-2）expression levels in elderly patients with chronic heart failure．Methods A total of 110 elderly patients with chronic heart failure admitted to our hospital were selected，with a time interval of January 2023 to March 2024．Serum SCD-1 and sVEGFR-2 levels were detected and follow-up investigations were conducted to understand their re hospitalization and cardiogenic death due to heart failure．Multiple logistic regression analysis was used to explore the prognostic factors affecting elderly patients with chronic heart failure．Results According to logistic retrospective analysis，heart function grading（OR=3.433，95%CI：0.934-6.431），elevated B-type brain natriuretic peptide（OR=2.462，95%CI：0.861-4.765），elevated serum SCD-1（OR=3.795，95%CI：0.972-6.894），and elevated serum sVEGFR-2（OR=3.842，95%CI：0.942-6.912）were important factors affecting the poor prognosis of elderly patients with chronic heart failure，with differences P＜0.05．The area under the curve of combined serum SCD-1 and sVEGFR-2 was 0.962，and the area under the curve of B-type brain peptide sodium was 0.844，which was significantly higher than that of a single SCD-1 curve of 0.658 and sVEGFR-2 curve of 0.712，with a difference of P＜0.05．Conclusions Research has confirmed that the prognosis of elderly patients with chronic heart failure is not satisfied，and their serum SCD-1 and sVEGFR-2 monitoring levels are abnormally elevated，which is related to the poor prognosis of elderly patients with chronic heart failure．It can be regarded as the main biomarker for defining the prognosis of elderly patients with chronic heart failure．
目的 分析以信息-动机-行为技巧（IMB）模型为基础延续护理平台在帕金森病患者中的应用效果。方法 纳入河南省人民医院在2019年1月至2022年1月期收治的帕金森病患者96例进行研究，将其依据随机数表法分为对照组和观察组，均为48例，对照组均给予常规护理干预，观察组均给予以IMB模型为基础延续护理平台干预。比较两组主要照顾者干预前24 h（T0）和完成干预24 h（T1）内的心理状态评分、自我效能、希望水平、运动能力、肌张力、认知功能，并评估T1时刻的Barthel指数。结果 观察组患者T1时的汉密尔顿焦虑量表（HAMA）（16.64±2.57）分、汉密尔顿抑郁量表（HAMD）（16.38±1.69）分均低于对照组（20.65±1.68）（19.57±2.65）分（t=10.116、5.407，P＜0.001），观察组患者T1时的自我效能（7.24±1.48）分、希望水平（44.51±4.07分）均高于对照组（6.02±1.74）（38.95±4.54）分（t=3.357、3.311，P＜0.001），观察组患者T1时的运动能力评分（43.62±4.01）分高于对照组（39.17±5.25）分（t=4.715，P＜0.001），肌张力评分（0.72±0.21）分低于对照组（1.13±0.52）分（t=5.118，P＜0.001），观察组患者T1时刻的Barthel指数评估依靠帮助完成率（6.25%）、部分完成率（10.42%）低于对照组（25.00%）、（27.08%）（χ 2 =6.353、5.263，P＜0.05），观察组患者T1时刻的命名能力（3.46±0.51）、延迟回忆（3.78±0.21）分、语言能力（3.29±0.48）分、注意力评分（3.95±0.10）分均高于对照组（2.91±0.98 ）（3.21±0.96）（2.87±0.82）（3.76±0.05）分（t=3.698、3.675、3.846、4.305，P＜0.001）。结论 以IMB模型为基础延续护理平台干预能够改善帕金森病患者的负性情绪，提升自我效能、希望水平，改善运动能力、肌张力、日常生活能力、认知水平。
Objective To analyze the application effect of the information motivation behavioral skills（IMB）model as a continuous care platform in Parkinson’s patients．Methods A study was conducted on 96 Parkinson’s patients enrolled in our hospital from January 2019 to January 2022．They were divided into a control group and an observation group based on a random number table method，with 48 patients in each group．The control group received routine nursing intervention，while the observation group received continuous nursing platform intervention based on the IMB model．The psychological state scores，self-efficacy，hope level，motor ability，muscle tone，cognitive function of the two main caregivers 24 hours before intervention（T0）and 24 hours after completion of intervention（T1），and evaluate the Barthel index at T1 time were compared．Results The Hamilton Anxiety Scale（HAMA）［（16.64±2.57）points］ and Hamilton Depression Scale（HAMD）［（16.38±1.69 points）scores］of patients in the observation group at T1 were lower than those in the control group ［（20.65±1.68）points，（19.57±2.65）points］（t=10.116，5.407，P＜0.001）．The self-efficacy of patients in the observation group at T1 was（7.24±1.48）points．The hope level ［（44.51±4.07）points］ was higher than that of the control group ［（6.02±1.74）points，（38.95±4.54）points］（t=3.357，3.311，P＜0.001）．The motor ability score at T1 time in the observation group ［（43.62±4.01）points］ was higher than that in the control group ［（39.17±5.25）points］（t=4.715，P＜0.001），and the muscle tone score ［（0.72±0.21）points］ was lower than that in the control group ［（1.13±0.52）points］（t=5.118，P＜0.001）．The Barthel index evaluation of patients in the observation group at T1 time relied on help completion rate（6.25%）and partial completion rate（10.42%），which were lower than those in the control group（25.00%）and（27.08%）（χ 2 =6.353，5.263，P=0.012，0.022）．The naming ability ［（3.46±0.51）points］，delayed recall ［（3.78±0.21）points］，language ability ［（3.29±0.48）points］，attention scores ［（3.95±0.10）points］ were higher than the control group ［（2.91±0.98）points，（3.21±0.96）points，（2.87±0.82）points，（3.76±0.05）points］（t=3.698，3.675，3.846，4.305，P=＜0.001，＜0.001，＜0.001）．Conclusions Continuing nursing platform intervention based on the IMB model can improve the negative emotions，self-efficacy，hope level，motor ability，muscle tone，daily living ability，and cognitive level of Parkinson’s patients．
目的 探讨转录因子E盒结合锌指蛋白1（ZEB1）、溶酶体相关膜蛋白5（LAMP5）在结直肠癌组织中的表达水平分析及预后预测价值。方法 选取驻马店市中心医院2018年1月—2020年1月收治的120例结直肠癌患者，分别采取所有患者的结直肠癌组织及癌旁组织进行免疫组化染色，对比ZEB1、LAMP5阳性率。对比不同病理特征结直肠癌患者ZEB1、LAMP5表达水平差异。对所有患者进行4年随访，依照随访结果将患者分为2个亚组，即预后不良组（n=35）和预后良好组（n=85），对比两组患者一般临床特征及ZEB1、LAMP5表达水平，应用Logistic回归分析ZEB1、LAMP5对结直肠癌预后的预测价值。结果 结直肠癌组织ZEB1、LAMP5相对表达量（38.26±5.49、26.77±3.85）与ZEB1、LAMP5阳性率（86.67%、72.22%）高于癌旁组织（15.46±2.54、8.04±1.59、23.33%、15.56%］，对比差异有统计学意义（t=41.280，χ2=25.437；t=49.255，χ 2 =16.071；P＜0.05）。不同TNM分期［Ⅰ~Ⅱ期（35.55±4.13）、Ⅲ~Ⅳ期（42.32±4.75）］、淋巴结转移患者［是（44.37±4.28）、否（35.84±3.77）］、肿瘤分化程度［低分化（35.27±4.57）、中高分化（41.34±4.60）］ZEB1相对表达量对比差异有统计学意义（t=-8.281，P＜0.001；t=10.746，P＜0.001；t=-7.253，P＜0.001）；不同TNM分期［Ⅱ期（24.88±3.37）、Ⅲ~Ⅳ期（29.61±2.57）］、淋巴结转移［是（30.72±2.19）、否（25.21±3.19）］、肿瘤分化程度［低分化（24.57±3.62）、中高分化（29.04±2.55）］患者LAMP5相对表达量对比差异有统计学意义（t=-8.254，P＜0.001；t=9.227，P＜0.001；t=-7.797，P＜0.001）；预后良好组与预后不良组患者性别、年龄、大体类型、肿瘤大小对比差异无统计学意义（P＞0.05），预后良好组与预后不良组患者TNM分期、淋巴结转移、肿瘤分化程度、ZEB1、LAMP5阳性比例对比差异有统计学意义（P＜0.05）；Logistic回归分析显示：淋巴结转移、ZEB1阳性、LAMP5阳性为结直肠癌预后不良独立预测因素（P＜0.05）。结论 ZEB1、LAMP5在结直肠癌组织中呈现高表达状态，且与结直肠癌的发生有关，同时ZEB1、LAMP5是结直肠癌预后的独立预测因素，两者有希望成为结直肠癌的治疗靶点。
Objective To investigate the expression levels and prognostic value of transcription factor E-box binding to zinc finger protein 1（ZEB1）and lysosomal associated membrane protein 5（LAMP5）in colorectal cancer tissues．Methods A total of 120 colorectal cancer patients admitted to a hospital from January 2018 to January 2020 were selected．Immunohistochemical staining was performed on the colorectal cancer tissues and adjacent tissues of all patients，and the positivity rates of ZEB1 and LAMP5 were compared．The expression levels of ZEB1 and LAMP5 in colorectal cancer patients with different pathological characteristics were compared．All patients were followed up for 4 years and divided into two subgroups based on the follow-up results，namely the poor prognosis group（n=35）and the good prognosis group（n=85）．The general clinical characteristics and expression levels of ZEB1 and LAMP5 were compared between the two groups．Logistic regression analysis was used to evaluate the predictive value of ZEB1 and LAMP5 for the prognosis of colorectal cancer．Results The relative expression level of ZEB 1 and LAMP 5 in colorectal cancer tissues ［（38.26±5.49），（26.77±3.85）］ and the positive rate of ZEB 1 and LAMP 5（86.67%，72.22%）were significantly higher than that of adjacent tissues ［（15.46±2.54），（8.04±1.59），23.33%，15.56%］，the contrast difference was statistically significant（t=41.280，χ2=25.437；t=49.255，χ 2 =16.071；P＜0.05）．Relative ZEBI expression levels in different TNM stages ［I-Ⅱstage（35.55±4.13），Ⅲ-Ⅳstage（42.32±4.75）］，lymph node metastasis［Yes（44.37±4.28），No（35.84±3.77）］，degree of tumor differentiation ［hypodifferentiated（35.27±4.57），and middle or high differentiated （29.04±2.55）］，those differences were statistically significant（t=-8.254，P＜0.001；t=9.227，P＜0.001；t=-7.797，P＜0.001）．The relative expression of LAMP 5 between different TNM stages ［I-Ⅱstage（24.88±3.37），Ⅲ-Ⅳstage（29.61±2.57）］，lymph node metastasis ［yes（30.72±2.19），no（25.21±3.19）］，degree of tumor differentiation ［hypodifferentiated（24.57±3.62），and middle or high differentiated（29.04±2.55）］，the contrast was statistically significant（t=-8.254，P＜0.001；t=9.227，P＜0.001；t=-7.797，P＜0.001）．There were no differences in gender，age，gross type，and tumor size between the good prognosis group and the poor prognosis group（P＞0.05），while there were differences in TNM stages，lymph node metastasis，tumor differentiation degrees，ratio of ZEB 1 and LAMP 5（P＜0.05）．Logistic regression analysis showed that TNM stage，lymph node metastasis，ZEB 1 positive，and LAMP 5 positive were independent predictive factors of poor prognosis in colorectal cancer（P＜0.05）．Conclusions ZEB1 and LAMP5 are highly expressed in colorectal cancer tissues and closely related to the occurrence and development of colorectal cancer．ZEB1 and LAMP5 are independent prognostic factors for colorectal cancer，and they have the potential to become therapeutic targets for colorectal cancer．
目的 采用网络药理学方法与分子对接技术分析白头翁汤治疗细菌性痢疾（BD）的潜在活性成分与作用机制。方法 借助中药系统药理学数据库与分析平台（TCMSP）及PubChem数据库检索筛选白头翁汤方的化学成分和作用靶点，通过Uniprot数据库校正基因名，同时通过比较毒物基因组学数据库（CTD）、药物靶标数据库（TTD）、GeneCards数据库和药物和药物靶标数据库（DRUGBANK）获得BD相关疾病靶点。经在线绘图平台微生信分析“活性成分-疾病”交集靶点，使用Cyoscape 3.7.2软件构建可视化的中药-活性成分-靶点网络、蛋白质互作网络，筛选潜在的关键活性成分与核心靶点；通过Metascape数据库对进行靶点的基因本体（GO）功能分析和京都百科全书基因和基因组通路数据库（KEGG）通路富集分析，同时使用Cyoscape 3.7.2软件构建基因-通路网络，筛选潜在的通路及其作用机制。同时采用分子对接技术对白头翁汤中关键活性成分和BD核心靶点进行分析。结果 白头翁汤共筛选出266个潜在活性成分，其中，槲皮素、β-谷甾醇、异鼠李素、异延胡索单酚碱、小檗红碱、豆甾醇等66个关键活性成分可通过肿瘤坏死因子（TNF）、白细胞介素-6（IL-6）、前列腺素内过氧化物合酶2（PTGS2）、丝氨酸/苏氨酸蛋白激酶1（AKT1）、血管内皮生长因子A（VEGFA）、V-rel网状内皮细胞病毒癌基因同源物A（RELA）、半胱氨酸天冬氨酸蛋白酶3（CASP3）、白细胞介素-8（CXCL8）、白细胞介素-1B（IL-1B）、丝裂原活化蛋白激酶1（MAPK1）、白细胞介素-10（IL-10）等33个潜在交集靶点作用于BD。GO基因功能分析共得到生物过程（BP）条目20个、细胞组成（CC）条目6个、分子功能（MF）条目9个（P＜0.01），主要涉及外部凋亡过程、细胞迁移正向调控、细胞因子受体结合、蛋白同源二聚活性、TNF受体超家族结合等生物进程。KEGG通路富集分析确定13条信号通路（P＜0.01），主要涉及癌症信号通路、白细胞介素-17（IL-17）信号通路等关键通路。分子对接结果显示槲皮素、β-谷甾醇、异鼠李素、异延胡索单酚碱等核心活性成分与TNF、IL-6、PTGS2核心靶点具有良好的结合效应（结合能＜-5 kJ/mol）。结论 白头翁汤主要通过槲皮素、β-谷甾醇等潜在的多种活性成分作用于TNF、IL-6、IL-1B、PTGS2、AKT1、VEGFA等潜在的关键靶点调控IL-17等信号通路，从而发挥治疗细菌性痢疾的作用，符合中药复方多成分、多靶标、多途径起效的显著特征。
Objective To analyze the potential active ingredients and mechanism of Baitouweng Decoction in the treatment of bacillary dysentery（BD）by means of network pharmacology and molecular docking technology．Methods With the help of the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform（Traditional Chinese Medicine Systems Pharmacology Database，TCMSP）and PubChem database to search and screen the chemical composition and target of Baitouweng Decoction，the gene name was corrected through the Uniprot database，and the CTD database，TTD database，GeneCards database and DRUGBANK database obtain BD-related disease targets．The intersection target was obtained through the online drawing platform，and Cytoscape 3.7.2 was used to construct a network of Pulsatilla active ingredient-component disease intersection target．The protein-protein interaction analysis of the intersection target was performed through the String database，and the Cytoscape 3.7.2 software was used for visualization．The Metascape database platform performed GO function analysis and KEGG pathway enrichment analysis on the target to predict its mechanism of action．The key active ingredient compounds in Baitouweng Decoction were molecularly docked with the core protein in the intersection target．Results A total of 266 potential active ingredients in Baitouweng Decoction were screened，of which 66 key active ingredients such as quercetin，β-sitosterol，isorhamnetin，Isocorypalmine，berberine，stigmasterol，etc．It acts on BD through 33 potential intersection targets such as TNF，IL-6，PTGS2，AKT1，VEGFA，RELA，CASP3，CXCL8，IL-1B，MAPK1，IL-10．GO gene function analysis yielded a total of 20 biological process（BP）entries，6 cell composition（CC）entries，and 9 molecular function（MF）entries（P＜0.01），which mainly involve external apoptosis process and positive regulation of cell migration，Cytokine receptor binding，protein homodimerization activity，tumor necrosis factor receptor superfamily binding and other biological processes．KEGG pathway enrichment analysis identified 13 signal pathways（P＜0.01），mainly related to key pathways such as cancer signal pathway and IL-17 signal pathway．The results of molecular docking showed that the core active ingredients such as quercetin，β-sitosterol，isorhamnetin，Isocorypalmine and TNF，IL-6，PTGS2 core targets have good binding effects（binding energy ＜-5 KJ /mol）．Conclusions Baitouweng Decoction modulated signaling pathways involving IL-17 through its active constituents like quercetin and β-sitosterol，targeting key molecules such as TNF，IL-6，IL-1β，PTGS2，AKT1，and VEGFA，reflecting the multi-target therapeutic approach of traditional Chinese medicine．
目的 探讨阴道分娩后尿失禁患者疾病应对方式的影响因素。方法 选取2022年1月—2023年1月医院收治的阴道分娩后尿失禁患者78例，评估所有患者的应对方式，根据结果分为积极应对组与消极应对组，设计基线资料调查表，详细统计两组患者的基线资料并比较，重点分析阴道分娩后尿失禁患者疾病应对方式的影响因素。结果 经评估，78例阴道分娩后尿失禁患者疾病消极应对有40例，占比51.28%；积极应对组与消极应对组患者的产次（χ 2 =4.110，P=0.043）、文化水平（Z=2.094，P=0.036）、家庭关怀度（Z=2.069，P=0.040）与自我效能（Z=2.249，P=0.025）比较差异有统计学意义，组间年龄（t=0.096，P=0.924）、孕次（t=1.257，P=0.212）、体质指数（BMI）（t=0.125，P=0.901）、工作（χ 2 =0.778，P=0.378）、家庭月人均收入（χ 2 =0.044，P=0.834）、漏尿（χ 2 =0.040，P=0.842）比较差异无统计学意义；经回归分析发现，家庭关怀度低（OR=1.799，P=0.041）、自我效能低（OR=1.942，P=0.026）、经产妇（OR=2.554，P=0.045）及文化水平低（OR=1.837，P=0.038）均是阴道分娩后尿失禁患者疾病应对方式的影响因素。结论 阴道分娩后尿失禁患者疾病消极应对风险高，可能与产次、文化水平、家庭关怀度及自我效能有关。
Objective To explore the influencing factors of disease coping strategies in patients with urinary incontinence after vaginal delivery．Methods A total of 78 patients with urinary incontinence after vaginal delivery admitted to the hospital from January 2022 to January 2023 were selected．The coping strategies of all patients were evaluated，and they were divided into a positive coping group and a negative coping group based on the results．A baseline data questionnaire was designed，and the baseline data of the two groups of patients were compared in detail．The focus was on analyzing the factors influencing the disease coping strategies of patients with urinary incontinence after vaginal delivery．Results After evaluation，40 out of 78 patients with urinary incontinence after vaginal delivery had negative coping strategies，accounting for 51.28%．The parity of patients in the positive and negative coping groups（χ 2 =4.110，P=0.043），educational level（Z=2.094，P=0.036），family care（Z=2.069，P=0.040），and self-efficacy（Z=2.249，P=0.025）among the groups were different．Age between groups（t=0.096，P=0.924），gestational age（t=1.257，P=0.212），body mass index（t=0.125，P=0.901），and work experience（χ 2 =0.778，P=0.378），monthly per capita income of households（χ 2 =0.044，P=0.834），urinary leakage（χ 2 =0.040，P=0.842）had no statistically significant difference in comparison．Through regression analysis，it was found that low family care（OR=1.799，P=0.041），low self-efficacy（OR=1.942，P=0.026），postpartum women（OR=2.554，P=0.045），and low educational level（OR=1.837，P=0.038）were all influencing factors on the disease coping strategies of patients with urinary incontinence after vaginal delivery．Conclusions Patients with urinary incontinence after vaginal delivery have a higher risk of negative coping with the disease，which may be related to parity，educational level，family care and self-efficacy．
目的 评价人工晶状体（IOL）集中带量采购政策对于白内障摘除术中人工晶状体选择的影响。方法 回顾性分析2020年6月—2022年5月在广州市第一人民医院眼科完成白内障超声乳化摘除联合IOL植入术的患者，根据医院开始集采的时间（2021年5月）将患者分为集采前组与集采后组。比较两组患者的一般资料、IOL类别、IOL价格、手术费用、国产IOL占比等。结果 集采前组（2020年6月—2021年5月）与集采后组（2021年6月—2022年5月）的白内障手术量分别为1 188例及1 099例（双眼手术者仅纳入一眼），两组患者的年龄及性别比例比较差异均无统计学意义（P＞0.05）。集采前IOL价格为3 770（3 162~7 950）元，高于集采后的1 613（1 079~4 994）元（P＜0.001）。两组患者中非球面单焦点IOL所占比例均为最高，集采后多焦点及散光IOL的数量较集采前增加（集采前vs.集采后：多焦IOL：1.9% vs15.0%；散光IOL：0.2% vs 1.3%，均P＜0.05），球面IOL的数量减少（集采前后：7.7% vs 0.6%，P＜0.05）。集采后国产IOL的使用率由0.5%增加至3.5%（P＜0.001）。并且集采后选择多焦点IOL的患者年龄更大［集采前（62.3±12.4）岁，集采后（66.1±10.5）岁，P=0.02］。结论 IOL集中带量采购政策减轻了白内障患者的经济负担，增加了高端IOL的使用量，同时减少了国家医疗保险的支出，并且促进国产医用耗材的使用。
Objective To evaluate the influence of intraocular lens（IOLs）purchasing policy in a centralized volume-based manner on patients’ selection of cataract extraction surgery．Methods The patients who completed cataract phacoemulsification combined with IOLs implantation in the ophthalmology department of Guangzhou First People’s Hospital from June 2020 to May 2022 were retrospectively analyzed．According to the time of centralized IOLs procurement policy implemented in our hospital（May 2021），the patients were divided into before centralized purchase group（from June 2020 to May 2021）and centralized purchase group（from June 2021 to May 2022）．The demographics of study population，IOLs category，IOLs cost，operation cost and the proportion of Chinese-made IOLs were compared between the two groups．Results The total numbers of operations in the before centralized purchase group and centralized purchase group were 1 188 and 1 099 eyes（only one eye was included in the binocular surgery），respectively．There was no significant difference in the age and sex between the two groups（P＞0.05）．The median cost of IOLs in the before centralized purchase group was 3 770（3 162，7 950），which was higher than that of centralized purchase group ［1 613（1 079，4 994），P＜0.001］．The proportion of aspherical IOLs was the highest in both groups．The number of multifocal and astigmatic IOLs in the centralized purchase group increased significantly compared with those of before centralized purchase group（multifocal IOLs：1.9% and 15.0%；astigmatic IOLs：0.2% and 1.3%，all P＜0.05）．The number of spherical IOLs decreased significantly（7.7% and 0.6%，P＜0.05）．The utilization rate of domestic IOLs increased from 0.5% to 3.5%（P＜0.001）．The patients who chose multifocal IOLs in centralized purchase group were older than patients in before centralized purchase group ［（62.3±12.4）vs（66.1±10.5），P=0.02］．Conclusions The centralized volume-based procurement policy of IOLs reduces the economic burden of patients and increase the use of high-end IOLs．At the same time，it reduces the expenditure of national medical insurance and promotes the use of domestic medical consumables．
目的 分析重症烧伤患者血培养标本中检测出念珠菌的临床分布，探究重症烧伤患者血流念珠菌感染的病原学特征。方法 选取2012—2023年在广州市红十字会医院住院治疗的重症烧伤患者血培养标本1 148份，分析分离出念珠菌的非重复患者病死率、菌种分布、同时送检的其他类型标本念珠菌培养结果及患者念珠菌血流感染的检出时间与季节分布、抗菌药物使用情况及对常用抗真菌药物的耐药情况。结果 1 148份血培养标本中77份检出真菌，阳性率为6.71%。检出念珠菌感染的非重复患者27例，其中近平滑念珠菌13例，构成比为48.15%、白念珠菌8株，构成比为29.63%。血与静脉导管培养均检出念珠菌的有22例（81.48%）；血与伤口分泌物培养圴检出念珠菌的有10例（37.04%）；血、静脉导管、伤口分泌物培养圴检出念珠菌的有4例（14.81%）。静脉导管检出念珠菌高于其他类型标本。27例重症烧伤患者血流感染检出念珠菌的时间主要分布在入院后第2~3周、季节主要分布在春夏季。近平滑念珠菌、白念珠菌、热带念珠菌对氟康唑敏感率分别为83.33%、87.50%和75.00%。结论 重症烧伤患者血流近平滑念珠菌检出率最高，发生血流感染时间主要在春夏季及烧伤入院后第2~3周，静脉导管留置是增加重症烧伤患者念珠菌血流感染的因素。我院念珠菌对抗真菌药物具有较高敏感性。
Objective To retrospective analyze the clinical distribution of Candida species detected in blood cultures of patients with severe burns and to investigate the etiological characteristics of Candida bloodstream infections in these patients．Methods A total of 1 148 blood culture specimens were collected from patients with severe burns hospitalized at an institution between 2012 and 2023．Patients data with Candida bloodstream infections isolated from 1 148 blood culture specimens were analyzed，including mortality rates，species distribution，Candida culture results from other simultaneously collected specimen types，and the timing and seasonal distribution of Candida bloodstream infections，the use of antibiotics and resistance to commonly-used antifungal drugs．Results A total of 1 148 blood culture samples，77 fungi were separated，resulting in a positive rate of 6.71%．Among the 27 patients with Candida infections，13 cases（48.15%）were caused by Candida parapsilosis and 8 cases（29.63%）by Candida albicans．Candida was isolated from both blood and intravenous catheter cultures in 22 cases，with a positivity rate of 81.48%．Candida was isolated from both blood and wound secretion cultures in 10 cases（positivity rate of 37.04%），and 4 cases from blood，intravenous catheter and wound secretion cultures（positivity rate of 14.81%）．The detection rate of Candidafrom intravenous catheters was higher than that from other specimen types．Candida bloodstream infections were most commonly observed during the 2nd and 3rd week after admission，with a seasonal peak in spring and summer．The susceptibility rates of Candida parapsilosis、Candida albicans and Candida tropicalis to fluconazole were 83.33%、87.50% and 75.00%，respectively．Conclusions The detection rate of Candida parapsilosis in bloodstream infections among patients with severe burns was the highest．These infections predominantly occur during the spring and summer and in the 2nd and 3rd week post-admission．The presence of intravenous catheters significantly contributes to Candida infections．The Candida in the hospital has high sensitivity to antifungal drugs．
目的 探讨老年营养风险指数（GNRI）与慢性阻塞性肺疾病者急性加重期患者预后的相关性。方法 选择贵州省六盘水水旷医院2019年1月—2022年1月收治的COPD急性加重期患者，根据GNRI值，分为正常营养组（GNRI＞98）和营养不良组（GNRI≤98），应用生存曲线和Cox比例风险回归评估营养状况与死亡率之间的关联。结果 共纳入198例COPD急性加重期患者，正常营养组90例，营养不良组108例，营养不良发生率为54.5%；Kaplan-Meier曲线表明，营养不良组的全因累积死亡率更高（58.3% vs 35.0%，P＜0.001）。Cox比例风险回归分析显示在未校正模型中，HR为2.31（1.25~4.28），P＜0.001。在完全校正模型中，HR为2.48（1.37~4.51），P=0.005，提示与正常营养状况相比，营养不良与全因死亡风险升高相关。结论 GNRI低是COPD患者急性加重期全因死亡的独立危险因素。
Objective To investigate the correlation between elderly nutritional risk index（GNRI）and prognosis of patients with AECOPD．Methods Patients with AECOPD admitted to our hospital from January 2019 to January 2022 were selected and divided into normal nutrition group（GNRI＞98）and malnutrition group（GNRI≤98）according to GNRI value．Survival curve and Cox regression were used to evaluate the association between nutritional status and mortality．Results A total of 198 patients with AECOPD were included in this study．According to GNRI scores，90 patients were in the normal nutrition group and 108 were in the malnutrition group，with malnutrition incidence of 54.5%．The Kaplan-Meier curve showed that the cumulative all-cause mortality was higher in the malnutrition group（58.3% vs 35%，P＜0.001）．Cox proportional hazard regression analysis showed that HR in the uncorrected model was 2.31（1.25-4.28），P＜0.001．In the fully corrected model，HR was 2.4（1.37-4.51）and P=0.005，suggesting that malnutrition was associated with a significantly higher risk of all-cause mortalitycompared with normal nutritional status．Conclusions Low GNRI is an independent risk factor for all-cause death in AECOPD patients．
目的 探讨2型糖尿病（T2DM）睡眠障碍患者使用经颅微电流刺激（CES）联合自我穴位按摩干预的效果。方法 使用随机数表法将南昌大学第二附属医院2022年6月—2023年1月收治的T2DM合并睡眠障碍患者100例分为两组，每组各50例。对照组采用CES干预，基于此，观察组加用自我穴位按摩，比较两组临床疗效、睡眠质量及血糖水平。结果 与对照组干预总有效率80.00%（40/50）比较，观察组干预总有效率96.00%（48/50）更高（χ 2 =6.061，P=0.014）；两组干预后匹兹堡睡眠质量指数（PSQI）中入睡时间、睡眠效率、催眠药物、睡眠障碍、睡眠时间、主观睡眠质量、日间功能障碍及总分均降低，且观察组［（0.95±0.28）分、（1.05±0.24）分、（0.55±0.14）分、（0.67±0.20）分、（0.92±0.21）分、（0.82±0.20）分、（0.65±0.18）分、（5.61±1.10）分］均低于对照组［（1.42±0.33）分、（1.30±0.33）分、（1.40±0.26）分、（1.14±0.27）分、（1.31±0.30）分、（1.32±0.37）分、（1.22±0.27）分、（9.11±1.26）分］（t=7.679、4.332、20.354、9.891、7.531、8.406、12.421、14.797，均P＜0.001）；两组干预后餐后2 h血糖（2 hPG）、糖化血红蛋白（HbA1c）及空腹血糖（FBG）水平均降低，且观察组2 hPG［（6.14±0.68）mmol/L］、HbA1c［（3.45±0.37）%］、FBG［（5.52±0.48）mmol/L］低于对照组［（7.12±1.25）mmol/L、（4.30±0.34）%、（6.58±0.67）mmol/L］（t=4.870、11.961、9.094，均P＜0.001）。结论 对T2DM合并睡眠障碍患者使用CES联合自我穴位按摩干预效果满意，可有效提高患者的睡眠质量，调节血糖水平。
目的 基于Nomogram初步构建膝骨关节炎（KOA）患者术前衰弱的风险预测模型。方法 便利选取172例于2021年12月—2022年8月在广州市某三甲医院关节外科接受择期膝关节置换术的KOA患者为研究对象，依据衰弱的发生与否分为衰弱组（n=111）和非衰弱组（n=61），通过单因素分析筛选变量，纳入Logistic回归分析，并构建列线图模型。结果 单因素分析结果显示年龄、BMI、膝关节疼痛年限、合并症、抑郁、焦虑、疼痛、睡眠障碍、营养状况等在不同组间比较差异存在统计学的意义（P＜0.05）。多因素Logistic回归分析表明，BMI异常（OR=3.360）、膝关节疼痛年限＞5年（OR=14.188）、抑郁（OR=5.608）、睡眠障碍（OR=25.480）是KOA患者术前衰弱的独立危险因素（P＜0.05）。基于此，建立了预测膝骨关节炎患者术前衰弱风险的列线图预测模型。结果显示C-index为0.915，校正曲线接近理想曲线，ROC曲线下面积（AUC）为0.919（95%CI：0.878~0.961），可见该预测模型具有较好的区分度和准确度。结论 根据BMI、膝关节疼痛年限、抑郁以及睡眠障碍这四个独立危险因素，可以准确地预测膝骨关节炎患者术前衰弱的风险。
Objective To develop a nomogram for predicting the risk of preoperative frailty in knee osteoarthritis patients．Methods A convenience sample of 172 patients who underwent elective knee arthroplasty at a Grade-A hospital in Guangzhou from December 2021 to August 2022 was selected．The patients were divided into two groups based on the presence of preoperative frailty：frailty group（n=111）and non-frailty group（n=61）．The variables with statistical differences were screened by univariate analysis for multivariate logistic regression analysis，and the nomogram prediction model was established．Results Univariate analysis identified significant differences between the groups in age，BMI，years of knee pain，complications，depression，anxiety，pain，sleep disturbance，and nutrition（P＜0.05）．Multivariate logistic regression showed that abnormal BMI（OR=3.360），years of knee pain ＞ 5（OR=14.188），depression（OR=5.608），and sleep disorders（OR=25.480）were independent risk factors for preoperative frailty in knee osteoarthritis patients（P＜0.05）．Based on these findings，a nomogram prediction model was established．Model verification results demonstrated that the nomogram had good differentiation and accuracy in predicting the risk of preoperative frailty，with a C-index of 0.915，an area under the ROC curve of 0.919（95% CI：0.878~0.961），and a calibration curve slope close to 1．Conclusions The nomogram，based on four independent risk factors（BMI，years of knee pain，depression，and sleep disturbance），effectively predicts the risk of preoperative frailty in knee osteoarthritis patients．
