目的 探究本体感觉神经肌肉促进疗法（PNF）技术与居家远程康复治疗对缺血性脑卒中患者凝血功能、平衡状态的影响。方法 选择2023年1月—2024年1月在宁乡市中医医院择期治疗的60例缺血性脑卒中患者为研究对象。按照患者选择的治疗方案进行分组, 观察组接受PNF技术联合居家远程康复指导治疗, 对照组接受常规居家远程康复指导治疗。记录疗效、凝血功能、神经功能缺损症状。结果 凝血功能方面,观察组治疗后活化部分凝血酶时间（APTT）、凝血酶原时间（PT）高于治疗前, 二聚体（D-D）、纤维蛋白原（FIB）低于治疗前,组间比较差异有统计学意义（P<0.05）。与对照组相比, 观察组的APTT、PT、D-D、FIB指标相近,组间比较差异无统计意义（P>0.05）。治疗后, 观察组平衡功能（BBS）评分比治疗前高, 组间比较差异有统计学意义（P<0.05）。观察组BBS评分、FMA评分、肌力等级更高, 组间比较差异有统计学意义（P<0.05）。结论 PNF技术+居家远程康复指导治疗可作为缺血性脑卒中患者治疗的有效手段。联合治疗后凝血功能、平衡状态、肢体功能状况、肌力明显改善, 可见联合治疗对于减轻患者病情尤为明显。

Objective To explore the effects of proprioceptive neuromuscular facilitation（PNF）and home-based remote rehabilitation on coagulation function and balance function in patients with ischemic stroke．Methods From January 2023 to January 2024, 60 patients with ischemic stroke were selected from our hospital．The patients were divided into two groups according to the treatment plan chosen by themselves．The patients in the observation group received PNF technology combined with home-based remote rehabilitation guidance, while the patients in the control group received routine home-based remote rehabilitation guidance．The curative effect, coagulation function and neurological deficit were recorded．Results After treatment, activated partial thrombin time（APTT）and prothrombin time（PT）were significantly higher, D-dimer（D-D）and fibrinogen（FIB）were significantly lower in the observation group than those before treatment（P<0.05）．Compared with the control group, the APTT, PT, D-D and FIB of the observation group were similar, and there was no significant difference between the two groups（P>0.05）．After treatment, the Berg Balance Scale score of the observation group was higher than that before treatment, and there was significant difference between the two groups（P<0.05）．The Berg Balance Scale score, Fugl-Meyer Assessment score and muscle strength grade of observation group were higher than those of control group（P<0.05）．Conclusions PNF combined with home-based remote rehabilitation can be used as an effective method for the treatment of patients with ischemic stroke．The coagulation function, balance, extremity function and muscle strength were significantly improved after combined treatment, which indicated that the combined treatment was especially effective in relieving the patients’ symptoms．

目的 探讨不同类型尿结石患者肠道菌群结构与尿酸代谢的相关性研究。方法 随机选取2022年5月—2023年5月广州市第一人民医院泌尿外科住院的尿结石患者60例为研究组, 选取同期体检中心健康体检人群30名为对照组,按照结石成分将研究组患者分为尿酸组和非尿酸组, 每组各30例, 所有入选患者均接受结石样本、尿样本、大便样本、血样本的采集, 所有样本经光谱、质谱、基因测序、尿常规及血生化检测 , 比较入选对象的肠道菌群及血尿生化指标变化。结果 尿酸组和非尿酸组患者的血磷（SNK-q=7.970、3.542）、血BUN（SNK-q=5.647、4.756）、血SUA（SNK-q=8.178、3.623）、血SCr（SNK-q=7.300、5.553）、血LPS（SNK-q=13.101、9.705）及24h尿酸（SNK-q=4.462、6.426）水平均高于对照组, 具有统计学意义（P<0.05）, 尿酸组和非尿酸组患者的血钙水平低于对照组（SNK-q=3.918/3.047, P<0.05）。非尿酸组患者的血磷、血SUA、血LPS均低于尿酸组, 均有统计学意义（SNK-q=4.428、4.555、3.397, P<0.05）。尿酸组和非尿酸组患者肠道中双歧杆菌数量低于对照组, 差异具有统计学意义（SNK-q=3.754、3.143, P<0.05）。非尿酸组患者肠道中乳酸杆菌数量高于对照组和尿酸组（SNK-q=4.105、3.463, P<0.05）, 尿酸组及非尿酸组患者的血尿酸及24 h尿尿酸水平与肠道双歧杆菌数量呈负相关（P<0.05）。结论 肠道双歧杆菌数量对结石患者血尿酸代谢及尿结石形成具有相关性。

Objective To explore the relationship of intestinal flora and uric acid metabolism in different urinary stones patients．Methods From May 2022 to May 2023, 60 patients with urinary stones patients in Guangzhou First People’s Hospital were selected as the study group, and 30 health check-up people in the same period of the medical examination center were selected as the control group．Study group was divided into the uric acid group and the non-uric acid group, 30 cases each group, all patients received stone samples, urine samples, stool samples,blood samples collection, mass spectrometry, gene sequencing, urine routine, blood biochemical detection were performed．Intestinal flora and blood urinary biochemical indicators of the patients were compared．Results The levels of blood phosphorus（SNK-q=7.970, 3.542）, blood BUN（SNK-q=5.647, 4.756）, blood SUA （SNK-q=8.178, 3.623）, blood SCr（SNK-q=7.300, 5.553）, blood LPS（SNK-q=13.101, 9.705）, and 24-hour urine uric acid （SNK-q=4.462, 6.426）in the uric acid group and the non-uric acid group were all higher than those in the control group,and were statistically significant（P<0.05）．The blood calcium levels of the patients in the uric acid group and the non-uric acid group were lower than those in the control group（SNK-q=3.918/3.047, P<0.05）．The blood phosphorus, blood SUA and blood LPS levels of the non-uric acid group were all lower than those of the uric acid group, and the differences were statistically significant （SNK-q=4.428, 4.555, 3.397, P<0.05）．The number of bifidobacteria in the intestines of patients in the uric acid group and the non-uric acid group was lower than that of the control group,and the differences were statistically significant（SNK-q=3.754, 3.143, P<0.05）．The number of lactobacilli in the intestines of patients in the non-uric acid group was higher than that of the control group and the uric acid group（SNK-q=4.105, 3.463, P<0.05）．The levels of blood uric acid and 24-hour urine uric acid in the uric acid group and the non-uric acid group were negatively correlated with the number of Bifidobacterium in the intestines（P<0.05）．Conclusions The number of intestinal bisidobacteria has a significant correlation with the metabolism of blood uric acid and urinary stones in patients with stones．

目的 明确亚甲基四氢叶酸还原酶（MTHFR）C677T、A1298C基因多态性与成人患者使用大剂量甲氨蝶呤（MTX）治疗急性淋巴细胞白血病（ALL）毒性反应和24、48、72 h MTX血药浓度关系。方法 收集2014年6月—2020年6月就诊于新疆医科大学第一附属医院成人急性淋巴细胞白血病75例患者血样检测MTHFR C677T及A1298C基因多态性, 根据抗癌药物常见毒性反应分级标准对毒性反应进行分级,采用非条件Logistic回归分析MTHFR C677T、A1298C基因多态性与HD-MTX毒性反应及血药浓度的关系。结果 MTHFR 677TT型发生贫血风险显著高于CC型（P=0.027, OR=4.694, 95%CI：1.195~18.438）; 未发现MTHFR C677T与白细胞减少、血小板计数减少、中性粒细胞计数减少、淋巴粒细胞计数减少、骨髓抑制、谷丙转氨酶升高、谷草转氨酶升高、肝功能损伤、急性肾损伤及黏膜损伤、24 h、48 h及72 h MTX血药浓度有相关性（P>0.05）; 未发现MTHFR A1298C与HD-MTX毒性反应及血药浓度有相关性（P>0.05）。结论 MTHFR C677T基因多态性与成人急性淋巴细胞白血病患者大剂量MTX化学治疗后血液毒性存在相关性。

Objective To determine the relationship among C677T and A1298C gene polymorphisms of methyltetrahydrofolate reductase（MTHFR）and adult acute lymphocytic leukemia（ALL）, the relationship between the toxicity of high-dose methotrexate（HD-MTX）after chemotherapy and the MTX blood concentration of 24 h, 48 h and 72 h in patients with ALL．Methods Blood samples were collected from 75 adult patients with ALL who were treated at the First Affiliated Hospital of Xinjiang Medical University from June 2014 to June 2020．The samples were used to detect the genetic polymorphisms of MTHFR C677T and A1298C, and the toxic reactions were graded according to the common toxic reaction classification criteria of anti-cancer drugs．Unconditional Logistic regression was used to analyze the relationship between MTHFR C677T and A1298C gene polymorphisms and HD-MTX toxic reactions and blood drug concentration．Results The risk of anemia in MTHFR 677TT was significantly higher than that in CC type（P=0.027, OR=4.694, 95% CI：1.195-18.438）．No correlation was found between MTHFR C677T and leukopenia, thrombocytopenia, neutropenia, lymphogranulocytopenia, bone marrow suppression, elevated alanine aminotransferase, elevated aspartate aminotransferase, liver function injury, acute kidney injury and mucosal injury, 24 h, 48 h and 72 h MTX plasma concentrations（>0.05）．No correlation was found among MTHFR A1298C and HD-MTX toxicity and blood concentration（P>0.05）．Conclusions MTHFR C677T gene polymorphism is associated with hematotoxicity after HD-MTX chemotherapy in adult patients with ALL．

目的 探讨降钙素原（PCT）联合营养指标对肝硬化营养状况的评定价值。方法 选取2021年2月—2022年3月在右江民族医学院附属医院感染科住院的140例肝硬化患者,根据营养风险筛查2002（NRS 2002）将其分为有营养风险组和无营养风险组。比较两组肝硬化患者中营养指标体质指数（BMI）、血红蛋白（HGB）、前白蛋白（PA）、白蛋白（ALB）、视黄醇结合蛋白（RBP）水平, 并分析它们与PCT的相关性。结果 BMI、HGB、ALB、PA及RBP水平低于低营养风险组（P<0.05）; 营养指标（BMI、HGB、ALB、PA、RBP）与PCT呈负相关（P<0.05）。二元Logistics回归分析发现ALB、PCT是肝硬化患者营养风险的危险因素（P<0.05）。ROC结果显示PCT与ALB的联合营养指标评定肝硬化营养不良的曲线下面积为0.984,（95%CI：0.964~1.000）, 灵敏度98.8%, 特异度93.3%, 约登指数0.921; ALB、PCT的AUC分别为0.919、0.974。结论 肝硬化患者PCT水平与其营养状况密切相关, 对营养状况的评定有一定的价值, 联合评定能有效提高其评定价值。

Objective To explore the value of procalcitonin（PCT）combined with nutritional indexes in evaluating the nutritional status of liver cirrhosis．Methods A total of 140 patients with cirrhosis admitted to the Department of Infection of the Affiliated Hospital of Youjiang Medical College for Nationalities from February 2021 to March 2022, they were selected and divided into with and without nutritional risk group according to nutritional risk screening 2002（NRS 2002）．The levels of body mass index（BMI）, hemoglobin（HGB）, prealbumin（PA）, albumin（ALB）and retinol binding protein（RBP）in two groups of patients with cirrhosis were compared, and the correlation between them and PCT was analyzed．Results The levels of BMI, HGB, ALB, PA and RBP were lower than those of low nutritional risk group（P<0.05）．The nutritional indices（BMI, HGB, ALB, PA, RBP）were negatively correlated with PCT（P<0.05）．Binary Logistics regression analysis showed that ALB and PCT were risk factors affecting nutritional risk in patients with cirrhosis（P<0.05）．ROC results showed that the area under the curve was 0.984（95% confidence interval：0.964 ~ 1.000）, sensitivity 98.8%, specificity 93.3%, and Yoden index 0.921 for the combined PCT and ALB indexes predicting malnutrition in cirrhosis．The AUC of ALB and PCT were 0.919 and 0.974, respectively．Conclusions The level of PCT in patients with cirrhosis is closely related to their nutritional status, which has certain value in the evaluation of nutritional status, and combined prediction can effectively improve the evaluation value．

目的 探讨非编码长链 RNA ANRIL（lncRNA-ANRIL）通过调控miR‐181b 介导磷酸酶及张力蛋白同源物基因（PTEN）对冠状动脉粥样硬化性心脏病（冠心病）心肌损伤影响的机制。方法 纳入2023年10月—2024年6月广州市第一人民医院30例确诊为冠心病的患者为观察组, 另选择同期本院体检中心30名健康者为对照组,检测两组研究者血压指标、血脂指标以及血清 lncRNA-ANRIL、miR-181b、PTEN水平, 并比较检测结果。结果 两组的性别、年龄、BMI、吸烟、高血压一般资料对比差异无统计学意义（P>0.05）; 观察组收缩压、舒张压水平以及总胆固醇、甘油三酯、低密度脂蛋白胆固醇水平均高于对照组,而高密度脂蛋白胆固醇则低于对照组（P<0.05）; 观察组血清 lncRNA ANRIL Exon 1-2、lncRNA ANRIL Exon 17-18相对表达水平以及PTEN水平低于对照组（t=12.623、7.741、8.231, P=0.001）, 而miR-181b水平则高于对照组（t=37.250, P=0.001）。结论 相较于正常人群, 冠心病患者血清lncRNA-ANRIL和PTEN水平明显降低,而miR-181b水平升高,提示lncRNA-ANRIL可通过调控miR-181b来调节PTEN的表达, 从而影响冠心病心肌损伤的过程。

Objective To explore the mechanism of competitive binding of non coding long stranded RNA ANRIL（lncRNA-ANRIL）to miR-181b to mediate phosphatase and tensin homolog gene（PTEN）on myocardial injury in coronary heart disease．Methods Thirty patients diagnosed with coronary heart disease in our hospital from October 2023 to June 2024 were included as the observation group,and another 30 individuals from physical examination center during the same period were selected as the control group．Blood pressure indicators,blood lipid indicators, and serum levels of lncRNA-ANRIL, miR-181b, and PTEN were measured in the two groups of patients, and the test results were compared．Results There was no significant difference between the two groups in terms of gender, age, BMI, smoking and hypertension（P>0.05）．The levels of systolic blood pressure（SBP）, diastolic blood pressure（DBP）, total cholesterol（TC）, triglycerides（TG）, and low-density lipoprotein cholesterol（LDL-C） in the observation group were higher than those in the control group,while high-density lipoprotein cholesterol（HDL-C） was lower than that in the control group（P<0.05）．The relative expression levels of lncRNA-ANRIL Exon 1-2, Exon 17-18, and PTEN levels in the observation group were lower than those in the control group（t=12.623, 7.741, 8.231, P=0.001）, while the level of miR-181b was higher than that in the control group（t=37.250, P=0.001）．Conclusions Compared with healthy individuals, serum levels of lncRNA-ANRIL and PTEN are significantly reduced in patients with coronary heart disease, while miR-181b levels are elevated, indicating that lncRNA ANRIL can regulate PTEN expression by miR-181b, thereby affecting the process of myocardial injury in coronary heart disease．

目的 观察辅助性T17细胞（Th17）与调节性T细胞（Treg）比值与2型糖尿病（T2DM）患者胰岛素抵抗及胰岛β细胞功能的关系。方法 纳入2022年4月—2023年4月在贵州医科大学第二附属医院内分泌科住院及健康体检人群各100例, 分为糖耐量正常组（NGT组, n=100）和T2DM组（n=100）, 分别测定糖化血红蛋白（HbA1c）、空腹血糖（FPG）、甘油三酯（TG）等生化指标, 电化学发光法测定空腹胰岛素（FINS）, 稳态模型计算胰岛β细胞功能指数（HOMA-β）、胰岛素抵抗指数（HOMA-IR）及胰岛素敏感指数（HOMA-ISI）。流式细胞术检测Th17、Treg水平。HOMA-IR、HOMA-β和HOMA-ISI的影响因素采用多元线性回归分析。结果 与NGT组相比, T2DM组BMI、FPG、HbA1c、LDL-C 、TG、TC、FINS、HOMA-IR、Th17及Th17/Treg水平均升高（P<0.01）, HDL-C、HOMA-β、HOMA-ISI、Treg水平均降低, 且差异有统计学意义（P<0.01）。Th17与BMI（r=0.251, P<0.001）及HOMA-IR（r=0.305, P<0.001）呈正相关; 与HOMA-β（r=-0.204, P<0.001）及HOMA-ISI（r=-0.359, P<0.001）呈负相关。Treg与HOMA-ISI之间呈正相关（r=0.170, P=0.008）, 而与HOMA-IR呈负相关（r=-0.153, P=0.017）; Th17/Treg与BMI（r=0.332, P<0.001）及HOMA-IR（r=0.374, P<0.001）;与HOMA-β（r=-0.249, P<0.001）及HOMA-ISI（r=-0.427, P<0.001）呈负相关。多元线性回归分析显示, Th17/Treg是HOMA-IR（β=5.915）升高及HOMA-ISI（β=-2.557）下降的影响因素（P<0.01）。结论 Th17/Treg可能通过影响胰岛素抵抗、降低胰岛素敏感性参与T2DM的发生。

Objective To explore the relationship among the proportion of helper T17 cells（Th17）to regulatory T cells（Treg）, insulin resistance, and the function of islet beta cells．Methods One hundred cases of hospitalized patients and 100 cases of health check-ups people in the Department of Endocrinology of the Second Affiliated Hospital of Guizhou Medical University from April 2022 to April 2023 were included．Patients were divided into normal glucose tolerance group（NGT group, n=100）and type 2 diabetes mellitus group（T2DM group, n=100）．The biochemical indexes of HbA1c, fasting blood glucose（FPG）, triglyceride（TG）and fasting insulin（FINS）were determined by electrochemiluminescence．Islet beta cell function index（HOMA-β）, insulin resistance index（HOMA-IR）and insulin sensitivity index（HOMA-ISI）were calculated in homeostasis model．The levels of Th17 and Treg were detected by flow cytometry．Spearman was used to analyze the correlation between indicators, and multiple linear regression analysis was used to analyze the influencing factors of HOMA-IR, HOMA-β and HOMA-ISI．Results In contrast to the NGT group, the T2DM group exhibited elevated levels of BMI, FPG, HbA1c, LDL-C, TG, TC, FINS, HOMA-IR, Th17 and Th17/Treg, with these variances being signifincantly different（P<0.01）．There was a notable reduction in the levels of HDL-C,HOMA-β,HOMA-ISI,Treg,with those changes being significantly different（P<0.01）．Th17 was positively correlated with BMI（r=0.251, P<0.001）and HOMA-IR（r=0.305, P<0.001）, it was negatively correlated with HOMA-β（r=-0.204, P<0.001）and HOMA-ISI（r=-0.359, P<0.001）．Treg was positively correlated with HOMA-ISI（r=0.170, P=0.008）, while it was negatively correlated with HOMA-IR（r=-0.153, P=0.017）．The ratio of Th17/Treg was positively correlated with BMI（r=0.332, P<0.001）and HOMA-IR（r=0.374, P<0.001）, it was negatively correlated with HOMA-β（r=-0.249, P<0.001）and HOMA-ISI（r=-0.427, P<0.001）．Multiple linear regression analysis showed that Th17/Treg was an influential factor in the increase of HOMA-IR（β=5.915）and the decrease of HOMA-ISI（β=-2.557）（P<0.01）．Conclusions Th17/Treg may be involved in the development of T2DM by affecting insulin resistance and reducing insulin sensitivity．

目的 探讨卵巢癌化学治疗（化疗）耐药与焦孔素E（GSDME）基因的甲基化是否有关, 以及地西他滨是否可以通过去甲基化使GSDME蛋白表达水平升高从而逆转卵巢癌化疗耐药。方法 顺铂逆浓度梯度构建SKOV-3卵巢癌耐顺铂细胞株（SKOV-3/DDP）; CCK8法检测耐药前后细胞株的半抑制浓度（IC₅₀）; 实时荧光定量甲基化特异性PCR法检测两组细胞中GSDME基因的甲基化水平; Wetern Blot检测两组细胞中GSDME的表达水平。将耐药细胞株用不同质量浓度的地西他滨处理,重复上述实验, 检测地西他滨处理前后细胞的IC₅₀、GSDME基因的甲基化水平及GSDME蛋白的表达程度。结果 与SKOV-3细胞相比, SKOV-3/DDP中GSDME基因的甲基化水平升高（P<0.01）, 同时GSDME蛋白的表达水平降低（P<0.001）; 随着地西他滨作用浓度的升高, 耐药细胞中GSDME基因的甲基化程度逐渐降低, 蛋白的表达水平逐渐升高, 细胞的IC₅₀逐渐降低：在用0.5 μg/mL地西他滨处理耐药细胞后GSDME基因的甲基化水平虽然降低（P<0.01）, 但是此时蛋白的表达水平及耐药细胞的IC₅₀均无明显改变（P>0.05）; 当地西他滨的浓度增加到1.0 μg/mL时蛋白的表达水平才明显升高（P<0.05）, 而此时细胞的IC₅₀仍未见明显降低（P>0.05）; 待药物浓度达到1.5 μg/mL时, 细胞的IC₅₀才表现出明显的下降趋势（P<0.05）。结论 GSDME的表达与卵巢癌的化疗耐药密切相关, GSDME的高甲基化水平致使其低表达可促进卵巢癌的化疗耐药。但地西他滨可以通过去甲基化使卵巢癌耐药细胞中GSDME的表达水平升高, 从而增加卵巢癌细胞对化疗药物的敏感性, 进而逆转卵巢癌化疗耐药。

Objective To explore whether drug resistance in ovarian cancer is associated with gasdermin E（GSDME） methylation, and to explore whether decitabine can reverse ovarian cancer chemoresistance by increasing GSDME protein expression levels through demethylation．Methods The cisplatin-resistant cell line（SKOV-3/DDP）was constructed by inverse concentration gradient of cisplatin．Semi-inhibitory concentration（IC₅₀）of cell lines after drug resistance was detected using the CCK8 assay．Real-time fluorescence quantitative methylation-specific PCR was used to detect the methylation level of GSDME gene in the two groups of cells．Wetern Blot was used to detect the expression level of GSDME in the two groups of cells．Drug-resistant cell lines were treated with different concentrations of the demethylating drug decitabine．Experiments above were repeated to detect the methylation degree of IC₅₀ and GSDME genes and the expression level of GSDME protein in drug-resistant cells before and after decitabine treatment．Results Compared with SKOV-3 cells, the methylation level of GSDME gene in SKOV-3/DDP was significantly increased（P<0.01）, while the expression level of GSDME protein was significantly decreased（P<0.001）．With the increase of decitabine concentration, the methylation degree of GSDME gene in drug-resistant cells was gradually decreased, the expression level of protein was gradually increased, and the IC₅₀ of cells was gradually decreased：the methylation level of GSDME gene was decreased after 0.05 μg/mL decitabine treatment（P<0.01）, but there were no significant changes in protein expression level and IC₅₀ of drug-resistant cells（P>0.05）．The protein expression level was significantly increased when the concentration of local citabine was increased to 0.10 μg/mL（P<0.05）, while the IC50 of the cells was not significantly decreased（P>0.05）．When the drug concentration reached 0.15 μg/mL, he IC₅₀ of the cells showed a significant downward trend（P<0.05）．Conclusions The expression of GSDME is closely related to chemoresistance in ovarian cancer, and the low expression of GSDME due to its high methylation level can promote chemoresistance in ovarian cancer．However, decitabine can increase the expression level of GSDME in drug-resistant ovarian cancer cells through demethylation,thereby increasing the sensitivity of ovarian cancer cells to chemotherapeutic drugs, and then reversing the chemoresistance of ovarian cancer．

目的 基于Donabedian环节模型构建急诊脑出血患者护理质量评价体系, 并应用于临床,为急诊脑出血患者护理质量管理、监测与评价提供客观、科学的参考依据。方法 通过文献查阅、筛查与评价, 提取可行性资料, 基于Donabedian环节模型构建急诊脑出血患者护理质量评价体系的框架, 并采用德尔菲法完成两轮专家函询,确定最终的指标体系。选择2021年1月—2024年1月本院收治的230例急诊脑出血患者为研究对象, 将2021年1月—2022年6月作为干预前监测节点,该阶段的165例患者为传统组, 实施常规的护理质量管理;将2022年7月—2024年1月作为干预后监测节点,该阶段的165例患者为观察组, 实施以急诊脑出血患者护理质量评价指标进行护理质量监测管理。结果 两轮函询中专家积极系数分别为95%和100%, 意见提出率分别为56.25%和35.54%; 两轮函询专家权威系数为0.945、0.893; 第1轮函询中各项指标变异系数（CV）均值为0~0.136, Kendall’s W协调系数为0.065; 第2轮函询中变异系数（CV）均值为0~0.110, Kendall’s W协调系数为0.186。最终形成的急诊脑出血患者护理质量评价体系共涵盖一级指标3个、二级指标11个、三级指标55个。观察组入院-用药时间合格率、吞咽障碍患者动态评估率、气道管理合格率、早期被动/主动活动落实率高于传统组,差异具有统计学意义（χ²=14.850、12.261、8.183、37.420, P<0.05）, 观察组患者满意度明显高于传统组（χ²=14.049, P<0.001）。结论 本研究构建的急诊脑出血患者护理质量评价体系具有一定的科学性、可靠性和实用性, 可作为临床实现护理质量持续改进的重要评价工具。

Objective Based on the Donabedian model,the nursing quality evaluation system of emergency cerebral hemorrhage patients was constructed, and applied to clinical practice, providing an objective and scientific reference basis for realizing the nursing quality management, monitoring and evaluation of emergency cerebral hemorrhage patients．Methods Through literature review, screening and evaluation, the feasibility data was extracted, and the framework of the nursing quality evaluation system for patients with emergency cerebral hemorrhage was constructed based on the Donabedian model, and the Delphi method was adopted to complete two rounds of expert letter inquiry to determine the final index system．The study selected 230 patients with acute cerebral hemorrhage admitted to our hospital from January 2021 to January 2024 as the research subjects．The period from January 2021 to June 2022 was used as the pre-intervention monitoring period, during which 165 patients were in the traditional group, receiving routine nursing quality management．The period from July 2022 to January 2024 was used as the post-intervention monitoring period, during which 165 patients were in the observation group,implementing nursing quality monitoring and management based on evaluation indicators for the care of patients with acute cerebral hemorrhage．Results In the two rounds of letter inquiry, the positive coefficient of experts was 95% and 100%, respectively, and the rate of suggestions was 56.25% and 35.54%, respectively; the authority coefficient of experts in the two rounds of letter inquiry was 0.945 and 0.893．In the first round the mean value of coefficient of variation（CV）of each index was 0~0.136, and the coordination coefficient of Kendall’s W was 0.065; in the second round the mean value of variation coefficient（CV）was 0-0.110, and the coordination coefficient of Kendall's W was 0.186．The final nursing quality evaluation system for emergency cerebral hemorrhage patients covers 11 first-level indicators, 11 second-level indicators and 55 third-level indicators．The results showed that the pass rate of admission-medication time, dynamic assessment rate of dysphagia patients, airway management rate, and early passive / active activity implementation rate of the observation group were statistically significant different from those in the traditional group（χ²=14.850,12.261, 8.183, 37.420, P<0.05）, and the patient satisfaction in the observation group was significantly higher than that in the traditional group（χ²=14.049, P<0.001）．Conclusions The nursing quality evaluation system for emergency cerebral hemorrhage patients constructed in this study is scientific,reliable and practical, and can be used as an important evaluation tool to achieve continuous improvement of nursing quality in clinical practice．

背景 虚拟标准化患者作为医学教育中的新型教学工具, 已广泛用于提升学生的临床问诊能力。随着生成式人工智能的快速发展, 基于大语言模型（LLMs）构建的VSP系统成为研究热点。然而, 目前尚缺乏对不同LLM在模拟患者角色方面表现的系统比较。目的 比较ChatGPT-4o与DeepSeek两种主流LLM在VSP模拟中的适用性, 评估其在病史采集、语言自然度、线索引导能力及教学辅助效果等方面的表现差异。方法 采用类实验研究,参与者为某医学院校临床医学专业本科四年级学生, 所有参与者均已修完《诊断学》课程, 具备基础问诊技能, 研究对象共60人, 按学号尾数单双分为两组, 分别与ChatGPT-4o或DeepSeek驱动的VSP系统进行交互。进行模拟急性阑尾炎问诊, 并在完成病史采集后提交诊断判断与体验问卷。结果 ChatGPT-4o在结构化信息整合、线索引导及技术稳定性方面更为优越, 而DeepSeek则在语言亲和力与情感回应方面表现更具人文关怀色彩。结论 不同LLM在VSP中的优势方向不同, 可根据教学目标进行有针对性地系统选择与设计。未来研究可进一步拓展至不同病种、交互方式及评估维度,以全面评估LLM驱动VSP在医学教育场景下的适应性与教学成效。

Background Virtual standardized patients（VSPs）have emerged as a novel tool in medical education, widely adopted to enhance students’ clinical interview skills．With the rapid development of generative artificial intelligence, VSP systems powered by large language models（LLMs）have become a new focus of research．However, few studies have systematically compared the performance of different LLMs in simulating patient roles．Objective This study aims to compare the applicability of two mainstream LLMs, ChatGPT-4o and DeepSeek, in VSP-based medical interview simulations, focusing on their differences in history-taking performance,linguistic naturalness, clue guidance,and educational support．Methods A quasi-experimental study was conducted involving 60 fourth-year clinical medicine undergraduates from a medical school．All participants had completed a diagnostics course and possessed basic interviewing skills．Students were assigned to either the ChatGPT-4o or DeepSeek group based on the parity of their student ID numbers．Each participant conducted a text-based simulated interview with a VSP presenting with acute appendicitis, then submitted both a preliminary diagnosis and a structured satisfaction questionnaire．Results ChatGPT-4o demonstrated superior performance in structured information integration, clue-based prompting, and system stability．In contrast, DeepSeek showed more natural language affinity and emotional responsiveness,reflecting stronger humanistic communication traits．The two models displayed divergent strengths within the VSP framework, suggesting that system selection and integration should be tailored to specific teaching objectives．Conclusions Future research should expand the scope to include diverse disease scenarios, interaction modalities, and evaluation dimensions, to comprehensively assess the educational utility and adaptability of LLM-driven VSP systems in medical training．

脓毒症当前仍然是全球范围内重要的医疗卫生问题,其对世界公共卫生及患者安全带来重大威胁。脓毒症是指宿主对感染反应失调引起的危及生命的器官功能障碍, 其发病率和病死率均极高,是临床重症医学中的重大挑战。在脓毒症病情的进展过程中, 可出现组织灌注不足、血流动力学不稳定等变化, 从而导致多器官功能受损,而心脏是常见的被累及的重要靶器官之一, 这种由脓毒症所导致的不同程度的心肌损伤, 被称为“脓毒性心肌病”, 其发生和发展机制复杂多样, 涉及循环心肌抑制因素、心肌自身因素及自主神经失调等多个方面。文章综述了脓毒症患者发生心肌损伤的高危因素, 以期为临床治疗和预防提供参考。

Sepsis currently remains an important global healthcare issue, and a major threat to world public health and patient safety．Sepsis is a life-threatening organ dysfunction caused by dysregulation of the host response to infection, with extremely high morbidity and mortality,which is a major challenge in clinical critical care medicine．During the progression of sepsis, changes such as inadequate tissue perfusion and haemodynamic instability may occur, leading to impairment of multiple organ functions, while the heart is one of the commonly involved vital target organs, and the varying degree of myocardial damage caused by sepsis is known as “septic cardiomyopathy”．The mechanisms of its occurrence and development are complex and diverse, involving circulating myocardial inhibitory factors, myocardial auto-factors, and autonomic dysregulation．In this paper, we review the high-risk factors for myocardial injury in septic patients, providing a reference for clinical treatment and prevention.