目的 探索机械通气患者发生呼吸机相关性肺炎（VAP）的危险因素,为医疗机构降低VAP的发生率提供参考依据。方法 采用回顾性病例对照的方法,收集2020年1月—2021年4月入住重症医学科（ICU）接受机械通气>48 h、年龄>18岁的患者资料。根据诊断标准确定20例VAP患者作为病例组,在同期住院患者筛选性别、年龄与病例匹配的20例未发生VAP患者为对照组,并对两组间各项临床指标进行统计分析。结果 两组患者在接受机械通气前入院诊断情况、是否手术和合并慢性阻塞性肺炎、APACHEⅡ评分、置管地点比较差异均无统计学意义（P>0.05）;机械通气时白细胞、C反应蛋白、降钙素原比较差异无统计学意义（P>0.05）。与对照组相比,病例组住院总日数、住ICU天数、机械通气时间、吸痰护理次数、抗生素使用天数明显增加（均P<0.05）。其中ICU中VAP以耐碳青霉烯类鲍曼不动杆菌（占比70%）感染为主;环境卫生学监测发现,患者周围环境、护士站及使用后的消毒物品均检出鲍曼不动杆菌,说明医务人员手卫生依从性差及环境消毒不彻底也是导致院内VAP发生的原因之一。病例组住院总费用中位数为145 207元,对照组为60 745.48元,VAP造成的平均经济损失为84 461.52元/例。病例组各项医疗费用均高于对照组,比较差异有统计学意义（P<0.05）。结论 机械通气期间不适当的诊治、环境消毒不到位、手卫生依从性差可能是造成医疗机构VAP发生的主要原因。

Objective To explore the risk factors of ventilator-associated pneumonia（VAP）in patients with mechanical ventilation,and provide a reference basis for medical institutions to reduce the occurrence of VAP．Methods A retrospective case-control method was used to collect data of patients who hospitalized in intensive care unit（ICU）from January 2020 to April 2021,received mechanical ventilation > 48 h and were >18 years old．According to the diagnostic criteria,20 patients with VAP infection were enrolled as the case group．During the same period,20 non-infected patients who matched sex,age with case group patients were enrolled as the control group,and the clinical indicators between the two groups were statistically analyzed．Results There were no significant differences between the two groups in terms of admission diagnosis,surgery and chronic obstructive pulmonary disease,APACHEII score and place of intubation before mechanical ventilation（P>0.05）．There were no significant differences in white blood cell,C-reactive protein and procalctionin,CRP and PCT during the mechanical ventilation period（P>0.05）．Compared with the control group,the length of stay in hospital,the length of stay in ICU,the time of mechanical ventilation,number of sputum suction nursing,and the days of antibiotic use increased significantly（all P<0.05）．Among them,Acinetobacter baumannii resistant to carbapenem in ICU（accounting for 70%）was the main cause of VAP infection．The environmental hygiene monitoring found that Acinetobacter baumannii was detected in the patient’s surrounding environment,the nurse station and the disinfected items after use,indicating that the low hand hygiene compliance of medical staff and the incomplete disinfection of the environment were also the causes of VAP infection in the hospital．The median of total cost of hospitalization in the case group was 145 207 yuan,while that in the control group was 60 745.48 yuan．The average economic loss caused by VAP infection was 84 461.52 yuan each case．The medical expenses of the case group were higher than those of the control group,with a statistically significant difference（P<0.05）．Conclusions Improper diagnosis and treatment during the mechanical ventilation period,poor environmental disinfection,low hand hygiene compliance of medical staff are probably the main reasons for the occurrence of VAP in this institution．

腺苷至肌苷RNA编辑（AIRE）是指转录前体RNA在腺苷酸脱氨酶的作用下,某些位点的腺苷发生脱氨反应转变成肌苷的过程,在碱基配对时,肌苷被识别作鸟苷,导致转录组重编写。随着高通量测序技术的不断进步,大量异常的AIRE被发现可导致氨基酸编码改变、RNA剪切异常以及microRNA-mRNA重定向等过程,从而参与肿瘤的发生发展。绝大部分的AIRE位点均位于基因非编码区,解析它们的生物学功能仍存在一定的挑战。本综述旨在描述AIRE的生物学机制和AIRE位点在不同肿瘤发生发展作用的进展,为AIRE与肿瘤的研究提供思路。

Adenosine-to-inosine RNA editing（AIRE）is catalysed by adenosine deaminases acting on RNA（ADARs）,which converts adenosine to inosine in nascent RNA．Since inosine is recognized as guanosine in post-transcriptional process,AIRE is functionally approximate to an A-to-G mutation and results in transcriptome recoding．With the continuous advancement of high-throughput sequencing technology,a large number of abnormal AIRE events have been found to exert different biological mechanisms such as amino acid changes,RNA splicing abnormalities and microRNA-mRNA redirection,which plays an important role in the development of human tumorigenesis．Most of AIRE sites are located in non-coding region,which brings challenges in analyzing their biological functions．This review aims to describe the biological mechanisms of AIRE and the relationship between AIRE sites and the development of different tumor types,providing ideas for the study of AIRE and tumors．

目的 探讨子宫内膜异位症（EMT）患者卵泡液来源的外泌体差异微小RNA（miRNA）对卵母细胞质量的影响。方法 收集2021年12月—2022年3月在广州市第一人民医院生殖医学中心进行体外受精-胚胎移植/卵细胞浆内单精子注射助孕的20例不孕症患者的卵泡液,分为EMT组（EMT不孕症患者10例）和对照组（单纯男性因素不孕症患者10例）。采用高通量测序对卵泡液外泌体微小RNA（miRNA）谱进行分析,选出具有组间差异的miRNAs。结果 与单纯男性因素不孕患者相比,EMT组有18个外泌体miRNAs差异有统计学意义,其中上调9个、下调9个。靶基因预测并采用GO和KEGG富集分析发现,这些靶基因主要参与磷脂酰肌醇-3-激酶/蛋白激酶B（ PI3K-Akt）、核苷酸结合寡聚结构域NOD样受体、Ras等信号通路。结论 EMT患者卵泡液来源的外泌体miRNA存在差异,差异的外泌体miRNAs可能通过多个信号通路影响EMT患者卵母细胞质量。

Objective To investigate the effect of differential microRNA（miRNA）derived from follicular fluid exosomes on oocyte quality in patients with endometriosis（EMT）. Methods Follicular fluid was collected from 20 infertile patients undergoing IVF-ET / ICSI in the Reproductive Medicine Center of Guangzhou First People's Hospital from December 2021 to March 2022,including EMT group（10 patients with EMT infertility）and control group（10 patients with simple male factor infertility）．The miRNA spectrum in follicular fluid exosomes was analyzed by high-throughput sequencing and miRNAs with differences between groups were selected. Results Compared with patients with infertility due to simple male factors,there were significant differences in 18 exosomal miRNAs in the EMT group,of which 9 were up-regulated and 9 were down-regulated．GO and KEGG enrichment analysis showed that these target genes were mainly involved in phosphatidylinositol-3-kinase / protein kinase B,Nucleotide binding oligomerization domain-like receptor and other signaling pathways. Conclusions There are differences in follicular fluid-derived exosomal miRNAs in EMT patients．Differential exosomal miRNAs may affect oocyte quality in EMT patients through multiple signaling pathways．

目的 探讨妊娠期糖尿病（GDM）患者孕24~28周的75 g 口服葡萄糖耐量试验（OGTT）血糖异常项数及妊娠晚期分娩前血糖值与妊娠结局的关系。方法 选择2019年11月—2020年5月在广州医科大学附属妇女儿童医疗中心进行产检并在孕24~28周确诊的167例GDM患者为研究对象,将孕24~28周75 g OGTT结果中仅其中1项时间点血糖异常的孕妇为GDMⅠ组（92例）,2项异常为GDMⅡ组（48例）,3项异常为GDMⅢ组（27例）,比较三组血糖异常项数GDM患者的人口学特点;并分析GDM患者一般人口学特征与妊娠晚期分娩前血糖监测均值的关系,及血糖值对不良妊娠结局的影响。结果 75 g OGTT血糖异常项数与孕前不同的体质指数（BMI）及妊娠晚期的糖化血红蛋白（HbA_1c）间比较差异均有统计学意义（P<0.05）。孕前BMI指数水平对妊娠晚期的空腹血糖、餐后1 h血糖、餐后2 h血糖比较差异均有统计学意义（P<0.05）;75 g OGTT血糖异常项数对空腹血糖及餐后2 h血糖比较差异有统计学意义（P<0.05）;③空腹血糖不同水平组在新生儿低血糖、胎膜早破、早产不良结局中比较,差异有统计学意义（P<0.05）。餐后2 h不同血糖水平间组在新生儿低血糖及胎膜早破中比较,差异有统计学意义（P<0.05）。结论 孕前BMI指数与妊娠中期75 g OGTT的血糖筛查结果有关,75 g OGTT试验中血糖异常项数越多不良妊娠结局的发生概率越大,妊娠期进行规范化的运动饮食干预和必要时的药物干预后可改善妊娠晚期的HbA_1c水平。

Objective To investigate the relationship between abnormal blood glucose items in the 75 g oral glucose tolerance test（OGTT）at 24-28 weeks of pregnancy and the blood glucose levels before delivery in the third trimester of pregnancy and pregnancy outcomes in gestational disbetes mellitus（GDM）patients. Methods All 167 GDM patients diagnosed at 24-28 weeks of gestation in Women and Children's Medical Center Affiliated to Guangzhou Medical University from November 2019 to May 2020 were enrolled as subjects．The pregnant women with only 1 abnormal blood glucose item among the 75 g OGTT results were classified as GDMⅠ group（92 cases）,with 2 abnormal items were GDMⅡ group（48 cases）,and with 3 abnormal items were GDM Ⅲ group（27 cases）．The demographic characteristics of the three groups of GDM patients were compared．The relationship between the general demographic characteristics of GDM patients and the mean value of blood glucose monitoring before delivery in the third trimester was analyzed,and the influence of blood glucose monitoring on adverse pregnancy outcomes was also analyzed．Results ①With different BMI and HbA_1c,there were significant differences in 75 g OGTT blood glucose items（P<0.05）．BMI level had statistically significant effects on fasting blood glucose,1-hour postprandial blood glucose and 2-hour postprandial blood glucose in the third gestational trimester（P<0.05）．②With different number of abnormal blood glucose items,there were significant in fasting blood glucose and 2 hours postprandial blood glucose（P<0.05）．③There were statistically significant differences in the outcomes of neonatal hypoglycemia,premature rupture of membranes and preterm delivery in different fasting blood glucose groups（P<0.05）．There were statistically significant differences in neonatal hypoglycemia and premature rupture of membranes between different 2 hours postprandial blood glucose（P<0.05）. Conclusions BMI can affect the blood glucose screening results of 75g OGTT in the second trimester．The more abnormal blood glucose items in the 75g OGTT test,the greater the probability of adverse pregnancy outcome．Standardized exercise diet intervention and necessary drug intervention during pregnancy can improve the HbA_1c level in the third trimester．

目的 分析全瓷冠与高嵌体对后牙牙体缺损的修复效果及对牙周炎性反应的影响。方法 用随机抽签法将我科2022年2月—2023年5月接治的50例后牙牙体缺损者分为对照组（签号为奇数,全瓷冠修复）与高嵌体组（签号为偶数,高嵌体修复）,各25例,对比两组修复效果（指标为修复体佩戴时间及总体康复时间）、牙周炎性反应、口腔健康指数及并发症发生率。结果 高嵌体组修复体佩戴时间（14.38±2.51）d、总体康复时间为（59.66±4.47）d,短于对照组的（21.96±2.87）d、（93.84±5.26）d（P<0.001）;高嵌体组牙周正常率（88.00%）高于对照组（64.00%）（P<0.05）;高嵌体组修复后的GI、PLI、SBI分别为（0.81±0.19）分、（0.85±0.16）分、（1.04±0.25）分,低于对照组的（0.97±0.23）分、（1.01±0.22）分、（1.31±0.28）分（P<0.05）;高嵌体组并发症发生率（8.00%）接近于对照组（12.00%）（P>0.05）。结论 修复后牙牙体缺损时选用高嵌体修复法可取得相对更好的修复效果,能够缩短患者佩戴修复体时间,加速其康复进程,对牙周炎性反应的减轻、口腔健康的改善均有积极影响,且并发症风险较小,整体效果更优。

Objective To analyze the effect of all-porcelain crown and onlay on posterior tooth defect repair and periodontitis reaction. Methods Fifty cases of posterior dental defects treated in our department from February 2022 to May 2023 were divided into control group（odd-numbered,all-porcelain crown restoration）and onlay group（even-numbered,onlay restoration）with 25 cases each．The repair effect,periodontitis response,oral health index and complication rate were compared between the two groups. Results The wearing time and overall recovery time of the onlay group were shorter than those of the control group（P<0.001）．The periodontal normal rate in the onlay group was higher than that in the control group （P<0.05）．gingival index,plaque index,sulcus bleeding index of the onlay group after repair were lower than those of the control group（P<0.05）．The complication rate of the high inlays group was close to that of the control group（P>0.05）. Conclusions In the repair of post-dental defects,the use of onlay repair can achieve relatively better repair effects,shorten the time for patients to wear the prosthesis,accelerate the rehabilitation process,have a positive impact on the reduction of periodontitis reaction and the improvement of oral health．The risk of its complications is small,and the overall effect is better．

目的 探讨复方脑肽节苷脂注射液联合阿替普酶静脉溶栓治疗急性缺血性脑卒中的疗效。方法 选择2019年6月—2023年1月在河南省许昌中医院诊治的79例缺血性脑卒中患者,按照入院就诊顺序采用奇偶法把患者分为联合组40例与传统组39例。传统组给予阿替普酶静脉溶栓治疗,联合组给予复方脑肽节苷脂注射液联合阿替普酶静脉溶栓治疗,评价与记录联合组与传统组的疗效与安全性及治疗前、治疗14 d后Fugl-Meyer评定量表（FMA）与改良版Banhel评价指数（MBI）、血清β-内啡肽、前列腺素E2（PGE2）水平变化。结果 治疗14 d后联合组的总有效率更高（97.5% vs 82.1%,P<0.05）,并发症发生率更低（5.0% vs 20.5%,P<0.05）。联合组与传统组治疗14 d后的FMA与MBI评分高于治疗前（P<0.05）,联合组治疗14 d后的FMA评分、MBI评分比传统组提高（P<0.05）。联合组与传统组治疗14 d后的血清β-内啡肽、PGE2水平低于治疗前（P<0.05）,联合组治疗14 d后的血清β-内啡肽、PGE2水平低于传统组（P<0.05）。结论 复方脑肽节苷脂注射液联合阿替普酶静脉溶栓治疗急性缺血性脑卒中能提高效果,降低患者的肺部感染、尿路感染、静脉血栓、褥疮等并发症发生率,改善患者的运动与日常生活功能,还可降低患者血清β-内啡肽、PGE2水平。

Objective To explore and analysis the efficacy and safety of compound brain peptide ganglioside injection combined with alteplase intravenous thrombolysis in the treatment of acute ischemic stroke. Methods From June 2019 to January 2023,79 patients with ischemic stroke who were diagnosed and treated at Henan Xuchang Traditional Chinese Medicine Hospital were selected as the research subjects．According to the order of admission,the patients were divided into the combination group of 40 cases and the traditional group of 39 cases．The traditional group received intravenous thrombolytic therapy with alteplase,while the combination group received treatment with compound brain peptide ganglioside injection on the basis of the traditional group．The efficacy and safety and changes of the Fugl-Meyer rating Scale（FMA）and modified Banhel Evaluation Index（MBI）,serum β-endorphin,and PGE 2 levels in the combined and traditional groups were evaluated and recorded. Results After 14 days of treatment,the combined group had a higher overall response rate（97.5% vs 82.1%,P<0.05）and a lower complication rate（5.0% vs 20.5%,P<0.05）．FMA scores and MBI scores of the two groups after 14 days of treatment were higher than those before treatment（P<0.05）,and FMA scores and MBI scores of the combined group after 14 days of treatment were higher than those of the traditional group（P<0.05）．The contents of β-endorphin and prostaglandin E2 in two groups after 14 days of treatment were lower than those before treatment（P<0.05）,and the contents of β-endorphin and prostaglandin E2 in combination group after 14 days of treatment were lower than those in traditional group（P<0.05）. Conclusions The combination of compound brain peptide ganglioside injection and alteplase intravenous thrombolysis in the treatment of acute ischemic stroke can improve the treatment effect,reduce the incidence of complications such as pulmonary infections,urinary tract infections,venous thrombosis and bedsores in patients,improve patients' motor and daily life functions,and also reduce patients' serum levels of β-endorphins and prostaglandin E2．

目的 研究注水法内镜下冷圈套器切除术在5~10 mm 无蒂型大肠息肉中的临床疗效。方法 纳入120例阳春市中医院收治的5~10 mm 无蒂型大肠息肉患者,合计246枚息肉,根据结肠息肉切除方式不同分为内镜下注水法冷圈套器切除术（UCSP）与传统内镜下冷圈套器切除术（CCSP）两组,每组分别纳入60例患者。比较两组息肉部位、息肉大小、术后病理诊断、完整息肉切除率、术后病理深度、息肉回收率、手术时间、术中瞬时性出血率、迟发性穿孔率、迟发性出血率以及手术时间、Boston及视觉模拟评分法（VAS）评分。结果 两组息肉部位、息肉大小、术后病理诊断、完整息肉切除率、息肉回收率、术中瞬时性出血率、迟发性穿孔率、迟发性出血率以及Boston评分比较差异均无统计学意义（P>0.05）;UCSP组术后病理深度[（8.80.5）mm]大于CCSP组[（5.90.4）mm]（P<0.01）,CCSP 组手术时间[（21.32.4）min],较UCSP组[（25.71.1）min]缩短（P<0.01）,VAS评分UCSP组[（2.60.7）分]优于CCSP组[（2.90.3）分]（P<0.001）。结论 UCSP能有效、安全5~10 mm无蒂型大肠息肉,术后深度的病理组织学评估获得更高的肌层黏膜切除深度,虽然UCSP手术时间较长,但术后腹痛发生率较低。

Objective To study the clinical efficacy of endoscopic cold snare resection using water injection method in 5-10 mm pedunculated colorectal polyps. Methods A total of 120 patients with 5-10 mm sessile colorectal polyps admitted to Yangchun Traditional Chinese Medicine Hospital were selected as the research subjects．A total of 246 polyps were enrolled,and the patients were divided into two groups based on the different methods of endoscopic resection：underwater cold snare polypectomy（UCSP）and conventional cold snare polypectomy（CCSP）,with 60 patients enrolled in each group．Compare the location,size,postoperative pathological diagnosis,complete polypectomy rate,postoperative pathological depth,polyp recovery rate,surgical time,instantaneous intraoperative bleeding rate,delayed perforation rate,delayed bleeding rate,surgical time,Boston and VAS scores between two groups. Results Two groups of polyp locations,polyp size,postoperative pathological diagnosis,complete polyp resection rate,polyp recovery rate,the instantaneous intraoperative bleeding rate,delayed perforation rate,delayed bleeding rate,and Boston score,all of above were not significant different（P>0.05）;the postoperative pathological depth in the UCSP group[（8.8±0.5）mm] was significantly greater than that in the CCSP group[（5.9±0.4）mm]（P<0.01）,and the surgical time in the CCSP group[（21.3±2.4）min] was shorter than that in the UCSP group[（25.7±1.1）min]（P<0.01）． The VAS score in the UCSP group（2.6±0.7）was significantly better than that in the CCSP group（2.9±0.3）（P<0.001）. Conclusions The underwater cold snare polypectomy can achieve good therapeutic results in patients with 5-10 mm sessile colorectal polyps．Further pathological evaluation of postoperative can obtain deeper of myomucosal resection．Although the UCSP group has a longer surgical time,the incidence of postoperative abdominal pain is lower．

目的 观察低浓度布比卡因联合全身麻醉在腹腔镜下直肠癌根治术中的应用及对患者体征及苏醒质量的影响。方法 选择2020年1月—2021年6月在信阳一五四医院实施腹腔镜镜下直肠癌根治术治疗的126例直肠癌患者为研究对象,通过抽签法对患者进行分组,将其中63例列为全麻组,术中单纯实施全身麻醉,其余63例列为联合组,术中采用低浓度布比卡因联合全身麻醉,比较两组患者体征变化情况,苏醒质量,麻醉相关不良反应,并开展为期1.5年的随访,评估两组患者远期生存质量。结果 联合组术中、术后的心率、平均动脉压均低于全麻组（P<0.05）;术后,联合组的Steward麻醉苏醒评分略低于全麻组、麻醉恢复室停留时间略高于全麻组（P>0.05）;但联合组的视觉模拟疼痛评分、镇静评分均低于全麻组（P<0.05）;联合组的麻醉相关不良反应发生率略高于全麻组（P>0.05）;随访期间,联合组的肠癌患者生存质量测定量表各维度评分均高于全麻组（P<0.05）。结论 低浓度布比卡因联合全身麻醉的麻醉效果更加平稳、安全性高。

Objective To observe the application of low concentration bupivacaine combined with general anesthesia in laparoscopic radical resection of rectal cancer and its effect on the physical signs and recovery quality of patients. Methods In this study,126 rectal cancer patients who underwent laparoscopic radical resection of rectal cancer in Xinyang 154th Hospital from January 2020 to June 2021 were selected as the research subjects．The patients were divided into groups by drawing lots．Among them,63 patients were included in general anesthesia group,and the rest 63 patients were included in combined group．Low-concentration bupivacaine combined with general anesthesia was used in combined group during the operation．The changes of physical signs and the quality of recovery were compared between the two groups．Anesthesia related adverse events,and the long-term quality of life of the two groups of patients was evaluated through one-year and a half follow-up. Results The heart rate and mean arterial pressure during and after surgery in the combined group were lower than those in the general anesthesia group（P<0.05）．After surgery,the Steward anesthesia recovery score of the combined group was slightly lower than that of the general anesthesia group,and the PACU stay time was slightly higher than that of the general anesthesia group（P>0.05）．However,the VAS score and Richmond Agitation-Se dation Scale score of the combined group were lower than those of the general anesthesia group（P<0.05）．The incidence of anesthesia related adverse reactions in the combination group was slightly higher than that in the general anesthesia group（P>0.05）．During the follow-up period,the FACT-C scores of all dimensions in the combination group were higher than those in the general anesthesia group（P<0.05）. Conclusions The anesthesia effect of low concentration bupivacaine combined with general anesthesia is significant and safe．

目的 探讨脊柱微调手法治疗产后腰椎-骨盆复合体疼痛的临床疗效及对腰椎前凸曲度（LL）和骨盆入射角度（PI）的调整作用,为产后腰椎-骨盆复合体疼痛的治疗提供理论依据。方法 选取2022年7月—2023年7月在上海市杨浦区中医医院推拿科和上海中医药大学附属岳阳中西医结合医院推拿科门诊治疗的产后腰椎-骨盆复合体疼痛患者共82例,随机分为对照组和治疗组,每组41例。对照组采用传统理筋推拿手法,治疗组采用脊柱微调手法治疗,两组疗程均为8周,观察临床疗效,比较两组患者的疼痛数字评分法（NRS）、Oswestry功能障碍指数（ODI）、LL和PI在治疗前后组间与组内的变化。结果 治疗组总有效率为95.12%,对照组总有效率为75.60%,治疗组优于对照组（P<0.05）。治疗后,两组NRS评分、ODI评分较治疗前均有下降,且治疗组优于对照组（P<0.05）。治疗后,两组LL和PI测量较治疗前均无明显变化,治疗组与对照组比较差异无统计学意义（P>0.05）。结论 脊柱微调手法能有效减轻患者疼痛、提升日常活动功能,但对腰椎曲度、骨盆入射角未产生移位影响,安全性高。

Objective To explore the clinical efficacy of spinal fine adjustment manipulation in the treatment of postpartum lumbopelvic pain（PLPP） and its role in adjusting lumbar lordosis and pelvic incidence,and to provide theoretical basis for the treatment of PLPP. Methods A total of 82 patients with PLPP who were treated in the outpatient clinics of the Tuina Department of Yangpu District Hospital of Traditional Chinese Medicine and the Tuina Department of Yueyang Hospital of Integrative Chinese and Western Medicine affiliated to Shanghai University of Traditional Chinese Medicine from July 2022 to July 2023 were selected and randomly divided into the control group and the treatment group,with 41 cases in each group．The control group was treated with the traditional tendon manipulation and the treatment group was treated with spinal fine adjustment manipulation,and the course of treatment for both groups was 8 weeks．Clinical efficacy was observed,and the changes of pain Numerical Rating Scale（NRS）,Oswestry disability index（ODI）,lumbar lordosis（LL）,and pelvic incidence（PI）of the two groups were compared between the two groups and within the two groups before and after the treatment. Results The total effective rate was 95.12% in the treatment group and 75.60% in the control group,and the treatment group was superior to the control group（P<0.05）．After treatment,the NRS and ODI of both groups were lower than before treatment,and the treatment group was better than the control group（P<0.05）． After treatment,there was no significant change in LL and PI in both groups compared to pre-treatment．There was no significant difference between the treatment group and the control group（P>0.05）. Conclusions Spinal fine adjustment manipulation can effectively reduce the pain of patients and improve the function of daily activities,but it has no displacement effect on LL and PI,which is safe and suitable for clinical promotion and application．

目的 探讨耳内镜下超薄耳屏软骨-软骨膜修补鼓膜大穿孔的效果。方法 回顾性分析31例应用超薄耳屏软骨-软骨膜行耳内镜下夹层法鼓膜修补术的患者资料,随访6个月,分析术后鼓膜愈合率、听力恢复情况。结果 30例鼓膜愈合,成功率96.8％,无移植物外移、内陷、钝角愈合;术前平均气导听阈为（38.3±3.3）dB HL,骨气导差为（23.5±3.1）dB HL,术后平均气导听阈为（22.3±1.6）dB HL,骨气导差为（6.3±2.5）dB HL,听力较术前提高（P<0.001）。结论 超薄耳屏软骨-软骨膜在耳内镜下鼓膜大穿孔修补术中效果较好,并发症少,是可靠的修复材料,值得临床推广应用。

Objective To investigate the clinical efficacy of endoscopic ultrathin tragus cartilage-perichondrium as graft material for treatment of large tympanic membrane perforations. Methods A total of 31 cases（31 ears）which were diagnosed as chronic suppurative otitis with large tympanic membrane perforation were performed endoscopic myringoplasty with ultrathin tragus cartilage-perichondrium by sandwich technique．The pure tone threshold average（PTA）of speech frequency and the air-bone gap were assessed at 6 month safter surgery. Results Successful closure without reperforation was obtained in 30 of 31 patients（96.8%）．There was no graft lateralization,anterior blunting ．Average postoperative air conduction and bone-air conduction gap were（22.3±1.6）dB HL and（6.3±2.5）dBHL compared with（38.3±3.3）dB HL and（23.5±3.1）dB HL preoperatively（P<0.001）. Conclusions The ultrathin tragus cartilage-perichondrium is liable repair material for large tympanic membrane perforation with excellent graft take and significant improvement of hearing,which is worthy of clinical promotion．