目的 对比乏白细胞富血小板血浆（LP-PRP）与富白细胞富血小板血浆（LR-PRP）联合体外冲击波疗法（ESWT）治疗慢性非止点跟腱腱病（NIAT）的临床价值。方法 选取2021年12月—2023年12月赣州市人民医院收治的80例慢性NIAT患者,以随机数表法分为两组,即对照组和观察组各40例,观察组予LP-PRP联合ESWT治疗,对照组予LR-PRP联合ESWT治疗;于治疗前、第一次治疗后1个月、3个月比较两组疼痛度[视觉模拟量表（VAS）评分]、跟腱病变程度[维多利亚体育研究所跟腱评估问卷（VISA-A）]、跟腱功能（Arner-Lindholm跟腱功能评分）,并比较两组并发症的发生率。结果 两组在治疗后1个月、3个月的VAS评分下降,VISA-A评分升高,且观察组治疗后3个月的VAS评分（1.05±0.31）分低于对照组的（1.82±0.45）分,VISA-A评分（83.35±5.58）分高于对照组的（76.28±5.35）分（F组间与时点交互=338.478、106.663,均P<0.05）;治疗后3个月,观察组跟腱功能（优、良、差各有24、13、3例）优于对照组（优、良、差各有14、16、10例）,差异有统计学意义（Z=2.529,P=0.012）。两组治疗后1个月时VAS评分、VISA-A评分及跟腱功能比较差异无统计学意义（均P>0.05）。结论 与LR-PRP比较,LP-PRP联合ESWT治疗慢性NIAT更有利于减轻患者跟腱疼痛度及病变程度,改善患者跟腱功能。

Objective To compare the clinical value of leukocyte-poor platelet rich plasma（LP-PRP）and leukocyte-rich platelet rich plasma（LR-PRP）combined with extracorporeal shock wave therapy（ESWT）in the treatment of chronic non -insertional Achilles tendinopathy（NIAT）．Methods Eighty patients with chronic NIAT admitted to Ganzhou People's Hospital from December 2021 to December 2023 were randomly divided into two groups using a random number table method：a control group and an observation group,with 40 patients in each group．The observation group received LP-PRP combined with ESWT treatment,while the control group received LR-PRP combined with ESWT treatment．The pain level（Visual Analog Scale[VAS]score）,degree of Achilles tendon lesion（Victorian Institute of Sports Assessment-Achilles tendinopathy questionnaire[VISA-A]）,and Achilles tendon function（Arner Lindholm Achilles tendon function score）between the two groups were compared before treatment,one month after the first treatment,and three months after treatment,as well as the incidence of complications between the two groups．Results The VAS scores of both groups decreased and the VISA-A scores increased one and three months after treatment．The VAS score of the observation group（1.05±0.31）was lower than that of the control group（1.82±0.45）three months after treatment,while the VISA-A score of the observation group（83.35±5.58）was higher than that of the control group（76.28±5.35）（interaction between group and time point F=338.478,106.663,both P<0.05）．After three months of treatment,the Achilles tendon function of the observation group（24 cases of excellent,13 cases of good,and three cases of poor）was better than that of the control group（14 cases of excellent,16 cases of good,and 10 cases of poor）,and the difference was statistically significant（Z=2.529,P=0.012）．There was no statistically significant difference in VAS score,VISA-A score,and Achilles tendon function between the two groups one month after treatment（all P>0.05）．Conclusions Compared with LR-PRP,LP-PRP combined with ESWT was more beneficial in reducing the degree of Achilles tendon pain and lesions in patients with chronic NIAT,and improving Achilles tendon function．

目的 探讨支气管镜灌洗用于儿童重症肺部感染合并肺实变的治疗效果及对CT特征、肺功能的影响。方法 选取2022年5月—2024年5月铜仁市人民医院收治的100例重症肺部感染合并肺实变患儿开展前瞻性研究,应用随机数表法分为对照组和观察组,每组各50例。对照组患儿采取常规治疗,观察组则采取常规治疗加支气管镜灌洗治疗。对比其临床疗效,治疗前后炎症因子、CT特征及肺功能变化。结果 观察组治疗总有效率高于对照组（P<0.05）;治疗后观察组患儿白细胞计数（10.36±2.52）×10⁹/L、白细胞介素-6（20.57±5.05）ng/L、C反应蛋白（13.12±2.64）mg/L、降钙素原（101.62±12.16）pg/L均低于对照组白细胞计数（13.25±3.32）×10⁹/L、白细胞介素-6（31.69±4.11）ng/L、C反应蛋白（16.16±4.44）mg/L、降钙素原（113.46±18.11）pg/L（P<0.05）;治疗后两组患儿胸腔积液、支气管壁增厚、空气支气管征、肺部实变、磨玻璃影等相关CT影像特征占比下降,且观察组低于对照组（P<0.05）;治疗后两组患儿呼气流量峰值水平均升高,观察组（90.67±18.45）L/s高于对照组（81.27±17.69）L/s,用力肺活量水平均更高,观察组（3.33±0.68）L高于对照组（2.68±0.25）L（P<0.05）。结论 针对儿童重症肺部感染合并肺实变,在常规治疗基础上增加支气管镜灌洗可提升临床疗效,减轻机体炎症反应,改善胸部CT各种表现及肺功能。

Objective To explore the therapeutic effects of bronchoalveolar lavage in children with severe pulmonary infection complicated by lung consolidation and its impact on CT features and pulmonary function．Methods A prospective study was conducted on 100 children with severe pulmonary infection complicated with pulmonary consolidation in a hospital from May 2022 to May 2024．They were randomly divided into observation group and control group using a random number table method,50 cases in each group．The control group of children received routine treatment,and the observation group received conventional treatment plus bronchoalveolar lavage．Clinical efficacy,inflammatory factors,CT features,and alterations in pulmonary function before and after therapy were compared．Results The total effective rate of the observation group was higher than that of the control group（P<0.05）．After treatment,the white blood cell count（10.36±2.52）×10⁹/L,interleukin-6（20.57±5.05）ng/L,C-reactive protein（13.12±2.64）mg/L,and procalcitonin（101.62±12.16）pg/L in the observation group were all lower than those in the control group（13.25±3.32）×10⁹/L,interleukin-6（31.69±4.11）ng/L,C-reactive protein（16.16±4.44）mg/L,and procalcitonin（113.46±18.11）pg/L（P<0.05）．After treatment,the proportion of CT imaging features such as pleural effusion,bronchial wall thickening,air bronchogram sign,lung consolidation,ground glass opacities,decreased in both groups of children,and the observation group was lower than the control group（P<0.05）．After treatment,the peak levels of expiratory flow in both groups of children increased,with the observation group（90.67±18.45）L/s higher than the control group（81.27±17.69）L/s．The forced vital capacity levels were also higher,with the observation group（3.33±0.68）L higher than the control group（2.68±0.25）L（P<0.05）．Conclusions Adding bronchoalveolar lavage to routine treatment for children with severe pulmonary infection complicated with pulmonary consolidation can improve their clinical efficacy,alleviate inflammatory reactions,and improve various chest CT manifestations and lung function．

目的 探讨肝脏衰弱程度联合肝功能分级预测肝硬化患者肝病复合不良事件的价值,作为识别和干预不良结局的依据。方法 选择2022年12月—2023年12月医院接收的肝硬化患者80例进行研究,随访6个月观察患者不良事件发生情况,将出现2个及以上肝病并发症的肝病复合不良事件患者25例作为观察组,将出现1个肝病并发症或未出现并发症的患者55例作为对照组,比较两组患者的基本资料、实验室指标、营养指标、体力活动水平、肝脏衰弱指数（LFI）、肝功能Child-Turcotte-Pugh（CTP）评分,采用单因素和多因素Cox回归分析评估肝硬化患者肝病复合不良事件的危险因素,使用受试者工作特征（ROC）曲线下面积评估LFI联合CTP评分预测肝硬化患者肝病复合不良事件的价值。结果 观察组年龄、丙氨酸氨基转移酶（ALT）高于对照组,红细胞计数（RBC）、血红蛋白（Hb）、血肌酐（Scr）、总胆红素（TBIL）、步速、小腿围低于对照组（t分别为4.235、6.500、3.826、3.989、4.289、8.878、2.474,均P<0.05）。观察组营养风险48.00%、LFI≥4.5分52.00%、CTP分级B/C级76.00%高于对照组18.18%、14.55%、27.27%（χ²分别为7.664、12.454、16.699,均P<0.05）。单因素Cox回归分析显示年龄、ALT、营养风险、LFI≥4.5分、CTP分级B/C级、RBC、Scr、TBIL、Hb、步速、小腿围为肝硬化患者发生肝病复合不良事件的危险因素（HR分别为2.251、1.578、1.626、1.981、1.715、1.428、1.443、1.419、1.336、1.332、1.254,均P<0.05）。多因素Cox回归分析显示年龄、营养风险、LFI≥4.5分、CTP分级B/C级为肝硬化患者发生肝病复合不良事件的独立危险因素（HR分别为2.275、1.746、2.025、1.895,P均<0.05）。ROC曲线结果显示LFI、CTP、LFI联合CTP预测肝硬化患者肝病复合不良事件的AUC分别为0.82、0.79、0.88（P<0.05）。结论 年龄、肝脏衰弱、CTP分级B/C级、营养风险为肝硬化患者肝病复合不良事件的危险因素,肝脏衰弱程度联合肝功能分级预测肝硬化患者肝病复合不良事件具有更高的效能。

Objective To explore the value of predicting liver disease complex adverse events in patients with liver cirrhosis by combining the degree of liver frailty with liver function grading,as a basis for identifying and intervening in adverse outcomes．Methods A study was conducted on 80 patients with liver cirrhosis admitted to the hospital from December 2022 to December 2023． Patients were followed up for six months to observe the occurrence of adverse events．Twenty-five patients with liver disease complex adverse events with two or more liver disease complications were selected as the observation group,and 55 patients with one or no liver disease complication were selected as the control group．The basic information,laboratory indicators,nutritional indicators,physical activity levels,liver frailty index（LFI）,Child Turcotte Pugh（CTP）scores,univariate and multivariate Cox regression analysis were used to evaluate the risk factors for liver disease complex adverse events in liver cirrhosis patients．The value of combining LFI and CTP score in predicting liver disease complex adverse events in patients with liver cirrhosis was assessed by Receiver Operating Characteristic（ROC）curve area．Results The age,alanine aminotransferase（ALT）,red blood cell count（RBC）,hemoglobin（Hb）,serum creatinine（Scr）,total bilirubin（TBIL）,walking speed,and calf circumference of the observation group were higher than those of the control group（t=4.235,6.500,3.826,3.989,4.289,8.878,2.474,all P<0.05）．The nutritional risk of the observation group was 48.00%,LFI score≥4.5 was 52.00%,CTP grade B/C was 76.00%,which was higher than that of the control group at 18.18%,14.55%,and 27.27%（χ²=7.664,12.454,16.699,all P<0.05）．Univariate Cox regression analysis showed age,ALT,nutritional risk,LFI ≥ 4.5,CTP grade B/C,RBC,Scr,TBIL,Hb,step speed and calf circumference were risk factors for the occurrence of liver disease complex adverse events in patients with liver cirrhosis（HR values=2.251,1.578,1.626,1.981,1.715,1.428,1.443,1.419,1.336,1.332,1.254,all P<0.05）．Multivariate Cox regression analysis showed that age,nutritional risk,LFI ≥ 4.5,and CTP grade B/C were independent risk factors for liver disease complex adverse events in patients with liver cirrhosis（HR values=2.275,1.746,2.025,1.895,all P<0.05）．The ROC curve results showed that the AUC of LFI,CTP,and LFI combined with CTP in predicting liver disease composite adverse events in patients with liver cirrhosis were 0.82,0.79,and 0.88,respectively（P<0.05）．Conclusions Age,liver frailty,CTP grade B/C,and nutritional risk are risk factors for liver disease complex adverse events in patients with liver cirrhosis．The combination of LFI and liver function grade has higher efficacy in predicting liver disease complex adverse events in patients with liver cirrhosis．

目的 调查南宁市2022—2024年食源性疾病的发生情况,并分析该地食源性疾病的流行病学特征,为防控食源性疾病提供依据。方法 在2022年1月—2024年12月统计南宁市多中心上报的食源性疾病发生情况,并分析食源性疾病的分布特征。结果 2022年1月—2024年12月在南宁市共计调查21 712例食源性疾病患者,其中男性占49.25%,女性占50.75%;食源性疾病以18~59岁、4~17岁年龄段占比相对较高,在季节方面2022年以秋季占比较高,2023—2024年以夏季占比较高;散居儿童、学生和农民是食源性疾病的主要人群,混合食品、水果及其制品、粮食类及其制品、肉类及其制品为前四位暴露食品;包装方面以散装占比最高、进食场所则以家庭占比最高;食源性疾病患者3年间不同性别、年龄段、发病季节、人群类型、暴露食品、包装形式及进食场所比较差异均有统计学意义（P<0.05）。症状主要以消化道症状、其他/全身症状为主。结论 南宁市2022—2024年食源性疾病发生例数有所增长,多发于夏秋季节,散居儿童、学生、农民是食源性疾病的高风险群体,同时针对散装食品,尤其混合食品、水果及其制品、粮食类及其制品、肉类及其制品等主要暴露食品应做好重点防控监测,可根据本地食源性疾病发生的流行病学特征进行对应的宣传教育,以确保食品安全。

Objective To explore the occurrence of foodborne diseases in Nanning City from 2022 to 2024,and analyze the epidemiological characteristics of foodborne diseases in the area,providing a basis for the prevention and control of foodborne diseases．Methods From January 2022 to December 2024,the incidence of foodborne diseases reported by multiple centers in Nanning City was statistically analyzed,and the distribution characteristics of foodborne diseases were analyzed．Results From January 2022 to December 2024,a total of 21 712 foodborne disease patients were analyzed in Nanning City,among them,males account for 49.25% and females account for 50.75%．Foodborne diseases had a relatively high proportion in the age groups of 18-59 and 4-17 years old．In terms of seasons,the proportion was higher in autumn 2022 and in summer 2023-2024．Scattered children,students,and farmers were the main populations of foodborne diseases,with mixed foods,fruits and their products,grains and their products,and meat and its products being the top four exposed foods．In terms of packaging,bulk packaging had the highest proportion,while in terms of eating places,household packaging has the highest proportion．There were statistically significant differences in the gender,age group,onset season,population type,exposed food,packaging form,and eating location of foodborne disease patients over a three-year period．Conclusions The number of foodborne diseases in Nanning City has increased from 2022 to 2024,mostly occurring in summer and autumn seasons．Scattered children,students,and farmers are high-risk groups for foodborne diseases．At the same time,key prevention and control monitoring should be carried out for bulk foods,especially mixed foods,fruits and their products,grains and their products,meat and their products,and corresponding publicity and education can be carried out according to the epidemiological characteristics of local foodborne diseases to ensure food safety．

目的 研究慢性非特异性腰痛患者腰椎正侧位X线中腰椎侧弯、L1-5棘突偏歪和椎体滑脱情况,总结规律,为慢性非特异性腰痛患者治疗提供依据。方法 选取164例慢性非特异性腰痛患者,观察并记录每例患者腰椎正侧位X线中腰椎侧弯、L1~L5棘突偏歪和椎体滑脱情况。用统计学软件分析腰椎侧弯、棘突偏歪和椎体滑脱情况。结果 共有59例发生腰椎侧弯,占35.98%,其中Cobb角5°~10 °有47例,占28.66%;Cobb角>10°有12例,占7.32%。腰椎侧弯发病以L4为下端椎为主。以L3为下端椎有12例患者,占20.34%;以L4为下端椎有37例患者,占62.71%;以L5为发椎有10例患者,占16.95%。共119例发生棘突偏歪,占总例数的72.56%。L5棘突偏歪最常见,发生率为57.93%;L4次之,发生率为48.17%。L5棘突偏歪率与L1~L3棘突偏歪率比较差异均有统计学意义（χ²分别为14.580,11.771,7.484,P分别为<0.001,0.001,0.006）,但与L4棘突偏歪率比较差异无统计学意义（χ²=3.124,P=0.077）。共30例患者存在椎体滑脱,占18.29%。L5最常发生滑脱,发生率为8.54%;L4次之,发生率为7.93%。L4与L5椎体滑脱率比较差异无统计学意义（χ²=0.040,P=0.841）;L4分别与L1,L2,L3以及L5分别与L1,L2,L3椎体滑脱率差异均有统计学意义（L5与L1、L2、L3：χ²分别为14.580、11.771、7.484,P分别为<0.001、<0.001、<0.006;L4与L1、L2、L3：χ²分别为13.495、10.712、6.550,P分别为<0.001、<0.001、<0.010）。结论 慢性非特异性腰痛患者较常发生腰椎侧弯,侧弯以L4为下端椎为主;慢性非特异性腰痛患者较常发生棘突偏歪,L5棘突偏歪最常见,L4次之;L5和L4是慢性非特异性腰痛患者最常发生滑脱的椎体。在治疗慢性非特异性腰痛患者时,与L5和L4相关的肌肉、筋膜等软组织损伤以及关节退行性变或紊乱应引起重点关注。

Objective To study the lumbar scoliosis,L1-5 spinous process deviation and spondylolisthesis in spine X-ray of patients with chronic non-specific low back pain（CNLBP）,and summarizing the existing rules,so as to provide imaging theoretical support for the treatment of CNLBP．Methods A total of 164 patients with CNLBP were selected．The lumbar scoliosis,L1-5 spinous process deviation and spondylolisthesis were observed and recorded in the anteroposterior and lateral X-ray films of each patient．The lumbar scoliosis,spinous process deviation and spondylolisthesis were statistically analyzed by statistical software．Results A total of 59 people had lumbar scoliosis,accounting for 35.98%．There were 47 patients with 5°-10°Cobb angle,accounting for 28.66%．There were 12 patients with Cobb angle >10°,accounting for 7.32%．L4 was the main lower apical vertebra of lumbar scoliosis．There were 12 patients with L3 as the lower apical vertebra,accounting for 20.34%;37 patients with L4 as the lower apical vertebra,accounting for 62.71%;10 patients with L5 as the lower apical vertebra,accounting for 16.95%．A total of 119 people appeared spinous process deviation,accounting for 72.56%．L5 spinous process deviation was the most common,with proportion of 57.93%,and L4 was the second,with proportion of 48.17%．The results of chi-square test showed that there were significant differences between L5 and L1-L3 spinous process deviation（χ² were 14.580,11.771,7.484,and P values were <0.001,0.001,0.006 respectively）,but no significant difference between L5 and L4 spinous process（χ²=3.124,P=0.077）．A total of 30 patients had spondylolisthesis,accounting for 18.29%．L5 was the most common of spondylolisthesis,with an occurrence rate of 8.54%．L4 was the second,with an occurrence rate of 7.93%．There was no significant difference in spondylolisthesis rate between L4 and L5（χ²=0.040,P=0.841）．The spondylolisthesis rates of L4 and L5 were significantly different from those of L1,L2 and L3（L5 and L1,L2,L3：χ² were 14.580,11.771,7.484,and P values were <0.001,0.001,0.006 respectively;L4 and L1,L2,L3：χ² was 13.495,10.712,6.550,P values was <0.001,0.001,0.010 respectively）．Conclusions Lumbar scoliosis is more common in patients with CNLBP,and L4 is the main lower apical vertebra of lumbar scoliosis．Patients with CNLBP often have spinous process deviation,and the most common is L5 spinous process deviation,followed by L4．L5 and L4 are the most common vertebrae with spondylolisthesis in patients with CNLBP．The soft injury and joint degeneration or disorder related to L5 and L4 should be paid more attention in the treatment of patients with CNLBP．

目的 对入住重症监护病房（ICU）重症孕产妇患者的病种特征和住院费用进行分析。方法 从医院信息管理系统中搜索2009—2019年广州市某省级重症孕产妇救治中心ICU的重症孕产妇住院病例,对病例资料进行描述性流行病学分析。结果 2009—2019年该救治中心ICU共收治重症孕产妇1 616例,病种排名前五位依次为心血管疾病430例（26.61%）、血液及造血器官疾病310例（19.18%）、妊娠期特定并发疾病287例（17.76%）、消化系统疾病218例（13.49%）、呼吸系统疾病110例（6.81%）。患者经济负担中位数排名前五位依次为肌肉骨骼系统和结缔组织疾病（62 252.60元）、消化系统疾病（61 684.41元）、感染性疾病（42 945.70元）、血液及造血器官疾病（40 403.52元）、神经系统疾病（40 055.93元）。结论 入住ICU内的重症孕产妇以心血管疾病、血液及造血器官疾病为主,经济学分析表明肌肉骨骼系统和结缔组织疾病造成的经济损失较大。

Objective To analyze the disease characteristics and hospitalization expenses of critically ill maternal patients in intensive care unit（ICU）．Methods Hospitalized cases of severe maternal disease in ICU of a provincial critical care center in Guangzhou from 2009 to 2019 were searched from the hospital information management system,and case data was analyzed by descriptive epidemiology．Results From 2009 to 2019,a total of 1616 critically ill maternal patients received intensive care treatment at this center．The predominant diseases observed were cardiovascular disorders（26.61%）,blood and hematopoietic organ diseases（19.18%）,specific pregnancy-related complications（17.76%）,gastrointestinal ailments（13.49%）,and respiratory disorders（6.81%）．Among the top five patient groups,the median economic burden was the highest in musculoskeletal system and connective tissue diseases（62 252.600 yuan）,followed by digestive system diseases（61 684.410 yuan）,infectious diseases（42 945.700 yuan）,blood and hematopoietic organ diseases（40 403.515 yuan）,and nervous system disorders（40 055.930 yuan）．Furthermore,a discernible correlation between hospitalization cost and length of stay was identified．Conclusions Cardiovascular diseases and disorders of blood and hematopoietic organs are the primary causes for maternal admissions to ICU．Economic analysis shows that musculoskeletal system and connective tissues diseases cause bigger economic loss ．

目的 探讨情景模拟式健康教育对飞秒激光小切口角膜基质透镜取出手术（SMILE）患者的应用效果,提高手术患者术中的配合度。方法 随机选取2020年6月—12月于我院拟进行SMILE手术患者200例,随机分为观察组和对照组,各100例,其中对照组采用常规术前健康教育,观察组采用情景模拟宣教视频的方式实施术前健康教育。比较两组患者围术期依从性、焦虑自评量表（SAS）和SMILE手术知识知晓率。结果 观察组患者围术期依从性和SMILE手术围术期知识知晓率得分高于对照组、患者术前焦虑水平低于对照组,差异均有统计学意义（P<0.05）。结论 情景模拟式健康教育能有效提升SMILE手术患者围术期依从性,减轻患者手术紧张的情绪,提升患者SMILE手术围术期健康知识知晓率,提升就医体验及手术成功率。

Objective To explore the application effect of scenario simulation based health education on patients undergoing small incision lenticule extraction（SMILE）,in order to improve the cooperation of surgical patients．Methods From June to December in 2020,200 patients who were scheduled to undergo SMILE in the hospital were randomly selected and divided into an observation group and a control group,with 100 patients in each group．The control group received routine preoperative health education,while the observation group received preoperative health education through scenario simulation educational videos．The perioperative adherence of patients,Self Rating Anxiety Scale（SAS）,and SMILE surgical knowledge awareness rates were compared between patients of two groups．Results The observation group had higher scores in perioperative adherence of patients and perioperative knowledge awareness of SMILE surgery than the control group,and lower preoperative anxiety levels than the control group,with statistically significant differences（P<0.05）．Conclusions Scenario simulation based health education can effectively improve the adherence of SMILE patients,alleviate their surgical anxiety,enhance their awareness of perioperative health knowledge,improve their medical experience,and increase the success rate of the surgery．

目的 探讨基于迷你临床演练评估（Mini-CEX）的可视化思维导图联合案例教学在全科住院医师规范化培训中的应用效果。方法 选取参加全科住院医师规范化培训的52例学员并分为试验组（n=26）和对照组（n=26）。对照组采取以案例讲授为主的传统教学模式,试验组采取基于Mini-CEX的可视化思维导图联合案例教学模式。对比两组Mini-CEX评分、考核成绩及教学满意度。结果 试验组Mini-CEX测评的问诊技巧、体格检查、临床判断、诊治能力、技能操作及整体表现得分均高于对照组（P<0.05）。试验组理论知识[（86.89±4.75）分 vs （82.96±4.87分）]、专业技能[（84.20±3.46）分 vs （70.18±4.93）分]及病历书写成绩[（80.64±5.26）分 vs （75.58±5.94）分]均高于对照组（t分别为2.678、13.685、2.764,P分别为0.009、<0.001、0.007）。试验组住院医师教学满意度高于对照组（P<0.05）。结论 基于Mini-CEX的可视化思维导图联合案例教学模式用于全科住院医师规范化培训,有助于提高教学效果及教学满意度。

Objective To evaluate the effect of visual mind mapping combined with case teaching based on mini-clinical evaluation exercise（Mini-CEX）for standardized training of general practitioners．Methods A total of 52 students who participated the standardized training of general practitioners were selected and divided into an experimental group（n=26）and a control group（n=26）．The control group adopted the traditional teaching mode based on case teaching and the experimental group adopted the visual mind mapping combined with case teaching based on Mini-CEX．The Mini-CEX score,assessment results and teaching satisfaction of two groups were compared．Results The interrogation skills,physical examination,clinical judgment,diagnosis and treatment ability,skill operation and overall performance of Mini-CEX in experimental group were higher than control group（P<0.05）．Theoretical knowledge score（[86.89±4.75] vs [82.96±4.87]）,professional skills score（[84.20±3.46] vs [70.18±4.93]）and medical record writing score（[80.64±5.26] vs [75.58±5.94]）of experimental groups were higher than control group（t=2.678,13.685,2.764,P=0.009,<0.001,0.007）．The teaching satisfaction of residents in experimental group was higher than control group（P<0.05）．Conclusions The visual mind mapping combined with case teaching based on Mini-CEX for standardized training of general practitioners is helpful to improve teaching effect and teaching satisfaction．

目的 构建并验证主动脉夹层B型（TBAD）患者急性期预后的列线图预测模型,帮助临床医生在急性期内更准确地评估TBAD患者的死亡风险,并制定更合适的治疗策略。方法 回顾性分析从重症监护医学信息数据库v2.2 中提取的399例 TBAD患者的人口学资料和临床资料,结局为TBAD患者急性期（≤14 d）内死亡。先采用最小绝对收缩选择算法回归筛选特征变量,再采用多因素分析确定独立预后因素,并据此构建预测模型。通过受试者工作特征曲线、校准曲线、决策曲线分析（DCA）评价列线图预测模型的性能和临床适用性。结果 APS Ⅲ评分、二氧化碳总量、红细胞分布宽度为TBAD患者14 d内死亡的独立预测因素。列线图预测模型在内部验证中的受试者工作特征曲线下面积为0.776（95% CI：0.691 ~ 0.860）,Hosmer-Lemeshow 检验P=0.604,校准曲线和标准曲线高度重合,表明该模型具有良好的区分度和校准度。同时,DCA曲线显示,预测模型在大部分的阈值概率范围内提供了显著的净收益。结论 本研究基于APS Ⅲ评分、二氧化碳总量、红细胞分布宽度构建的列线图预测模型可以较准确地预测TBAD患者14 d内的死亡风险,有助于临床医生制定更合适的个体化治疗策略。

Objective To develop and verify a nomogram for predicting acute phase outcomes in patients with type B aortic dissection（TBAD）,enabling clinicians to more precisely evaluate mortality risk in TBAD patients during the acute stage and to devise better treatment plans．Methods This retrospective study analyzed demographic and clinical data of 399 TBAD patients from the Medical Information Mart for Intensive Care IV v2.2,focusing on mortality within 14 days of the acute phase in TBAD patients． Initially,the Least Absolute Shrinkage and Selection Operator regression was employed for feature variable selection,and then multivariate analysis was used to identify independent prognostic factors for constructing the predictive model．The nomogram predictive model's effectiveness and clinical applicability were assessed via the Receiver Operating Characteristic curve,calibration curve,and Decision Curve Analysis（DCA）．Results Acute Physidogy Score Ⅲ score,total carbon dioxide,and red blood cell distribution width emerged as independent predictors of 14-day mortality in TBAD patients．The internal validation of the nomogram predictive model showed an area under the curve of 0.776（95%CI：0.691-0.860）,with a Hosmer-Lemeshow test P-value of 0.604． The close alignment of the calibration and standard curves suggested the model's strong discriminative power and calibration． Furthermore,the DCA curve revealed that the predictive model offered substantial net benefits within a wide range of threshold probabilities．Conclusions This study's nomogram,developed using APS Ⅲ score,total carbon dioxide,and red blood cell distribution width,accurately predicts the 14-day mortality risk in TBAD patients,assisting clinicians in creating better personalized treatment plans．

目的 评估无托槽隐形矫治应用在正畸拔牙患者中的效果及对牙根吸收、可溶性细胞间黏附分子-1（sICAM-1）的影响。方法 纳入2022年1月—2024年8月的70例正畸拔牙患者,按照治疗方法分组,即对照组（35例,给予固定矫治）、观察组（35例,给予无托槽隐形矫治）,评价组间牙根吸收情况、牙周指标、炎症因子、矫治时间。结果 治疗结束时,两组均出现牙根吸收情况,但是观察组无牙根吸收>3 mm病例,而对照组存在牙根吸收>3 mm、>4 mm病例,P<0.05。治疗前,两组牙周指标[龈沟出血指数（SBI）、牙龈指数（GI）、菌斑指数（PLI）]、炎症因子[白介素-1β（IL-1β）、sICAM-1]比较差异无统计学意义（P>0.05）。治疗后,两组SBI、GI、PLI、IL-1β、sICAM-1升高,且观察组SBI、GI、PLI、IL-1β、sICAM-1低于对照组（P<0.05）。与对照组比较,观察组矫治时间更长（P<0.05）。结论 对正畸拔牙患者进行无托槽隐形矫治,虽然治疗时间长,但是可以抑制牙根吸收,减轻炎症反应,提高牙周健康水平。

Objective To evaluate the effect of clear aligner treatment on orthodontic tooth extraction patients and its impact on root resorption and soluble intercellular adhesion molecule-1（sICAM-1）．Methods Seventy orthodontic extraction patients from January 2022 to August 2024 were included and divided into two groups according to treatment methods：a control group（35 cases,receiving fixed orthodontic treatment）and an observation group（35 cases,receiving clear aligner treatment）． The root resorption,periodontal indicators,inflammatory factors,and orthodontic treatment time between groups were evaluated．Results At the end of treatment,both groups showed root resorption,but there were no cases of root resorption>3 mm in the observation group,while there were cases of root resorption>3 mm and>4 mm in the control group,P<0.05．Before treatment,there was no difference in periodontal indicators（gingival bleeding index[SBI],gingival index[GI],plaque index[PLI]）,inflammatory factors（interleukin-1 β[IL-1 β],sICAM-1） between the groups,P>0.05．After treatment,SBI,GI,PLI,IL-1 β,sICAM-1 increased in both groups,but SBI,GI,PLI,IL-1 β,sICAM-1 were lower in the observation group,P<0.05．Compared with the control group,the observation group had a longer orthodontic treatment time,P<0.05．Conclusions Although the clear aligner treatment time for orthodontic extraction patients is longer,it can inhibit root resorption,reduce inflammatory reactions,and improve periodontal health．