现代人面临更大的工作与生活压力,每天的生活节奏较快,因此经常出现饮食不规律、饮食结构不合理等现象,这样就增加了肠胃疾病的发生率。胃肠道间质瘤（GIST）以人体胃肠道最为常见的肿瘤疾病,该病患者占全部胃肠道间叶性肿瘤患者人数的80%以上。GIST根据疾病进展、间质瘤体积等不同因素又能够分为不同的疾病类型,需采取对应的诊断措施与治疗措施。本文将针对胃小间质瘤的流行病学、临床症状、临床诊断以及治疗措施等进行研究与分析,以供参考。

Modern people are facing greater pressure in work and life,and the pace of daily life is fast．Therefore,irregular diet and unreasonable diet structure often occur,which increases the incidence of gastrointestinal diseases．Gastrointestinal stromal tumor（GIST）is the most common tumor disease in human gastrointestinal tract,accounting for over 80% of all patients with gastrointestinal mesenchymal tumors．GIST can be divided into different types according to different factors such as disease progression and stromal tumor volume,thus corresponding diagnostic and therapeutic measures should be taken．This paper studied and analyzed the epidemiology,clinical symptoms,clinical diagnosis and treatment of gastric small stromal tumors for reference．

目的 探讨消肿化瘀膏治疗骨性关节炎的临床疗效。方法 选择2017年5月—2022年1月在本院诊治的骨性关节炎患者124例作为研究对象,根据简单分配原则把患者分为消肿化瘀膏组与传统药物组各62例。传统药物组给予传统药物治疗,消肿化瘀膏组给予消肿化瘀膏治疗,判定2组患者治疗总显效率、疼痛评分、关节评分、血清中炎症因子水平变化。结果 消肿化瘀膏组治疗后的总显效率为98.4%,高于传统药物组的83.9%（P<0.05）。治疗后,2组的疼痛评分都低于治疗前（P<0.05）,且消肿化瘀膏组低于传统药物组（P<0.05）。2组治疗后的关节评分都高于治疗前（P<0.05）,且消肿化瘀膏组与传统药物组相比升高（P<0.05）。2组治疗后的血清白介素-1β、白介素-6水平都低于治疗前（P<0.05）,且消肿化瘀膏组较传统药物组降低更多（P<0.05）。结论 消肿化瘀膏治疗骨性关节炎能有效抑制血清炎症因子的表达,缓解疼痛,改善关节功能,提高患者的总体治疗效果。

Objective To explore the clinical efficacy of Xiaozhonghuayu ointment in the treatment of osteoarthritis．Methods From May 2017 to January 2022,124 patients with osteoarthritis who diagnosed and treated in our hospital were selected as the research subjects．According to the simple allocation principle,the patients were divided into the Xiaozhonghuayu ointment group and the traditional medicine group with 62 cases each．The traditional medicine group was treated with traditional medicine,and the Xiaozhonghuayu ointment group was treated with Xiaozhonghuayu ointment．The total therapeutic efficiency,pain score,joint score,and the changes of serum inflammatory factors were compared in the two groups．Results The total efficiency of Xiaozhonghuayu ointment group after treatment were 98.4%,which were higher than 83.9% in the traditional medicine group（P<0.05）．The pain scores in both groups after treatment were lower than those before treatment（P<0.05）,and that in the Xiaozhonghuayu ointment group were lower than the traditional medicine group（P<0.05）．The joint scores of the two groups after treatment were higher than those before treatment（P<0.05）,and that in the Xiaozhonghuayu ointment group were higher than the traditional medicine group（P<0.05）．After treatment,the levels of serum interleukin-1β and interleukin-6 in the two groups were significantly lower than those before treatment（P<0.05）,compared with the traditional medicine group,those levels in the Xiaozhonghuayu ointment group also decreased significantly after treatment（P<0.05）．Conclusions Xiaozhonghuayu ointment in the treatment of osteoarthritis can effectively inhibit the expressions of serum inflammatory factors,promote pain relief,improve joint function,and improve the overall therapeutic effect of patients．

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

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

目的 探讨乙酰半胱氨酸泡腾片联合布地格福气雾剂治疗慢性阻塞性肺疾病疗效及对患者肺功能的影响。方法 以2020年4月—2022月4月在本院诊治的84例慢性阻塞性肺疾病患者作为研究对象,根据1∶1简单分配原则把患者分为联合组与对照组各42例。对照组行传统治疗,联合组在对照组治疗的基础上,再给予乙酰半胱氨酸泡腾片联合布地格福气雾剂治疗,联合组与对照组都治疗观察4周。检测患者的疗效、肺功能与血清超敏C反应蛋白（hs-CRP）与降钙素原（PCT）含量变化情况。结果 联合组治疗后的总有效率与对照组相比有提高（P<0.05）。治疗后,联合组与对照组的第一秒用力呼气容积占用力肺活量百分比（FEV₁/FVC）、第一秒用力呼气容积占预计值百分比（FEV₁%）更高（P<0.05）,且联合组与对照组对比有提高（P<0.05）。联合组治疗后的疾病影响、活动能力、症状部分等SGRQ生活质量评分与对照组相比降低（P<0.05）。联合组与对照组治疗后的血清 hs-CRP与 PCT含量低于治疗前（P<0.05）,联合组与对照组相比也降低（P<0.05）。结论 乙酰半胱氨酸泡腾片联合布地格福气雾剂治疗慢性阻塞性肺疾病能有效抑制hs-CRP、PCT的表达,能促进改善患者的肺功能,提高治疗效果与生活质量。

Objective To investigate the efficacy of acetylcysteine effervescent tablets combined with budigraf aerosol in the treatment of chronic obstructive pulmonary disease（COPD）and its effect on the pulmonary function of patients．Methods From April 2020 to April 2022,a total of 84 patients with COPD diagnosed and treated in our hospital were selected as the research objects,and the patients were divided into the combination group and the control group with 42 cases in each group,according to the 1∶1 simple allocation principle．The control group were given traditional treatment,and the combination group were given acetylcysteine effervescent tablets combined with budigraf aerosol additionally．Both the combined group and the control group were observed for 4 weeks．The efficacy of patients,lung function and serum hypersensitive C-reactive protein（hs-CRP）and procalcitonin（PCT）levels were detected．Results The total effective rates after treatment in the combination group were higher than the control group（P<0.05）．After treatment,The forced expiratory volume in 1 second/forced vital capacity（FEV₁/FVC）,FEV₁% value of the two groups were higher（P<0.05）,and the combination group had greater improvement（P<0.05）．The SGRQ quality of life scores,such as disease impact,activity ability,and symptom in the combination group were lower（P<0.05）．After treatment,the serum high-sensitivity C-reactive protein（hs-CRP）and procalcitonin（PCT）levels in the two groups were significantly lower（P<0.05）,and the combined group decreased more（P<0.05）．Conclusions Acetylcysteine effervescent tablets combined with budigraf aerosol in the treatment of COPD can effectively inhibit the expression of hs-CRP,PCT,promote the improvement of lung function,improve the treatment effect and quality of life．

目的 探讨良肢位训练联合风险预控急救应用于重症脑卒中的效果。方法 采用回顾性分析,纳入我院2020年3月—2021年3月期间收治的41例重症脑卒中患者为对照组,救治方式为常规救治联合良肢位训练。同时纳入我院2021年4月—2022年4月期间收治的41例重症脑卒中患者为观察组,救治方式为良肢位训练联合风险预控急救。对比2组抢救情况、抢救效果、运动功能。结果 观察组院外吸氧率（46.34%）、院外插管率（34.15%）均高于对照组（17.07%、9.76%）,转入专科治疗时间、发病至入院时间均短于对照组（P<0.05）;干预3 d后,观察组格拉斯哥昏迷量表分值高于对照组,APACHEⅡ评分分值低于对照组（P<0.05）;观察组Fugl-Meyer运动评估、Berg平衡量表分值均高于对照组,NIHSS量表分值低于对照组（P<0.05）。结论 良肢位训练联合风险预控急救应用于重症脑卒中可有效改善抢救情况、提升抢救效果,从而增强运动功能。

Objective To explore the effect of normal extremity position training combined with risk pre-control emergency treatment in severe stroke．Methods Forty-one severe stroke patients from March 2020 to March 2021 included in the control group were retrospective studied,and the treatment method was conventional treatment combined with normal extremity position training．At the same time,41 severe stroke patients from April 2021 to April 2022 were included in the observation group,which the treatment method was the risk pre-control and emergency treatment．The rescue situation,rescue effect and sports function of the two groups were compared．Results Incidences of oxygen inhalation（46.34%）and intubation（34.15%）outside the hospital in observation group were higher than that in control group（17.07%,9.76%）;specialist treatment,onset to admission time were longer in control group（P<0.05）．Glasgow coma scale score in observation group was higher than that in control group,while APACHE Ⅱ score was lower in observation group（P<0.05）,Fugl-Meyer assessment and Berg Balance Scale score were higher,and NIHSS score was lower than control group（P<0.05）．Conclusions Combination of normal extremity position training and risk pre-control emergency treatment in severe stroke treatment can effectively improve the rescue effect,thus enhance the motor function．

目的 探讨影响宫腔修复的因素,为不全流产妇女选择期待治疗提供理论依据。方法 2021年1月—12月在香港大学深圳医院招募早孕药流不全的患者534例,记录其人口学特征以及从排胎到流产后3周到月经复潮后的相关情况,通过多因素Logistic回归分析影响不全流产者宫腔修复的因素。结果 534例药流不全患者中,月经复潮后宫腔残留240例,残留率为44.9%;多因素Logistic回归分析显示,BMI（OR=0.888,95%CI：0.808~0.975）、子宫位置（OR=1.836,95%CI：1.139~2.958）、人工流产次数（OR=2.258,95%CI：1.078~4.728）、阴道流血时长（OR=0.344,95%CI：0.141~0.837）、残留物最大径线（OR=1.061,95%CI：1.031~1.092）、残留物血流信号2级/3级（OR=3.636,95%CI：1.790~7.394;OR=4.001,95%CI：1.561~10.256）是宫腔残留的影响因素。结论 宫腔残留的高危因素有子宫后位、残留物最大径线、1次以上的人工流产、2级及以上的残留物血流信号,且血流信号等级影响最大。BMI和阴道流血时长>3周是宫腔残留的保护因素。

Objective To investigate the factors affecting uterine cavity repair and to provide a theoretical basis for the choice of expectant treatment for women with incomplete abortion．Methods From January to December 2021,534 patients with incomplete abortions were recruited at University of Hong Kong-Shenzhen Hospital,and their demographic characteristics and correlations from expulsion of the gestational sac to 3 weeks after medication abortion and after menstrual resumption were recorded,and the factors affecting uterine cavity repair in incomplete abortions were analyzed by multifactorial logistic regression．Results In 534 women,there were 240 cases of uterine cavity remnants after menstrual return,with a remnant rate of 44.9%;the results of multifactorial logistic regression analysis showed that BMI（OR=0.888,95% CI：0.808-0.975）,uterine position（OR=1.836,95% CI：1.139-2.958）,number of abortions（OR=2.258,95% CI：1.078-4.728）,length of vaginal bleeding（OR=0.344,95% CI：0.141-0.837）,maximum diameter of residuals（OR=1.061,95% CI：1.031-1.092）,and residual blood flow signal grade 2/3（OR=3.636,95% CI：1.790-7.394;OR=4.001,95%CI：1.561-10.256）were influential factors for uterine residuals．Conclusions High-risk factors for uterine residuals are posterior uterus,the maximum diameter of residuals,more than one abortion,grade 2 or higher residual blood flow signal,and the grade of blood flow signal had the greatest effect．BMI and duration of vaginal bleeding >3 weeks are protective factors for uterine residuals．

自身免疫性肝炎（AIH）是由不明原因免疫异常引起的急性或慢性肝脏炎症性疾病,不分年龄或性别,影响所有种族群体。AIH如果没有得到及时的治疗,可能会发展为肝硬化、肝衰竭,甚至导致死亡。目前一些诊断评分系统和肝活组织病理检查已成为诊断的标准,然而由于疾病表现的高度异质性,AIH诊断仍很有挑战性。大多数患者最初对一线治疗（糖皮质激素与硫唑嘌呤的联合治疗）有应答,然而,应答欠佳和因不良反应引起的不耐受也不少见,需要二线和（或）三线治疗。本文总结阐述诊断困难、一线药物治疗应答欠佳或不耐受的疑难AIH诊断和管理的最新进展,并归纳了目前国内外关于AIH治疗的新方法,为AIH的临床诊疗提供参考。

Autoimmune hepatitis（AIH）is an acute or chronic inflammatory disease of liver caused by unclear immune response that affects people from all ethnic groups irrespective of age or sex．If left untreated,AIH will lead to cirrhosis,liver failure,or death．A number of diagnostic scoring systems and histopathological examination of liver biopsies are now the standard for diagnosis．However,due to the high heterogeneity of the disease presentation,AIH diagnosing remains challenging．Most patients initially respond to first-line treatment,which is corticosteroids combined with azathioprine．However,insufficient response and intolerance due to side effects are also common,so some patients requires second-and/or third-line therapies．Here we summarized the latest progress in diagnosis and management of AIH with difficult diagnosis,poor response to first-line drug treatment or intolerance,as well as the new methods of AIH treatment worldwide,to provide reference for the clinical diagnosis and treatment of AIH．

我国结直肠癌的发病率与死亡率逐年增加,约10%~30%新发结直肠癌患者可表现为急性肠梗阻,其中梗阻发生率较高的主要部位是左半结肠。急性梗阻性左半结肠癌患者的主要治疗方式仍是急诊手术（ES）,但术后并发症发生率及围手术期死亡率较高,自膨式金属支架（SEMS）被一些指南推荐为梗阻性结肠癌的初始治疗选择,SEMS可将部分ES转变为择期手术,支架置入后择期手术（SBTS）与ES相比不仅可改善患者的短期生存结局,且支架置入后新辅助化疗为梗阻性结肠癌的治疗提供了新的途径;就长期生存结果而言,选择SBTS还是ES存在一定的争议。对于支架置入后手术时机的选择尚未达成共识,有指南表明大约两周的短桥接间隔可使患者最大程度获益,因而可有效指导临床工作。肠道支架置入术目前看来是一种简单、有效的临时性或永久性的治疗手段。

In recent years, the incidence and mortality of colorectal cancer in our country have been increasing year by year．Around 10% to 30% of newly diagnosed colorectal cancer patients showed acute intestinal obstruction, which the left colon cancer has higher incidence．Emergency surgery（ES）is still the main treatment for patients with acute obstructive left colon cancer, but the incidence of postoperative complications and perioperative mortality are high．Self-expanding metallic stents（SEMS）can convert some emergency procedures into stent as bridge to surgery（SBTS）, which is recommended by some guidelines as the initial treatment option for obstructive colon cancer．SBTS can not only improve the short-term survival outcome of patients compared with ES, but also provide a new approach for the treatment of obstructive colon cancer with neoadjuvant chemotherapy after intestinal obstruction stent placement．The choice of SBTS versus ES is somewhat controversial in terms of long-term survival outcomes．There is no consensus on the timing of surgery after stenting, and current guidelines suggest that bridging intervals of approximately two weeks strike a balance between potential adverse events and long-term outcomes．At present, intestinal stenting is still a simple, feasible and effective temporary or palliative permanent treatment with few complications．

目的 观察经鼻高流量氧疗治疗慢性阻塞性肺疾病急性加重期（AECOPD）伴Ⅱ型呼吸衰竭对患者肺功能、血气分析指标的影响。方法 收集2020年3月—2022年3月我院收治的AECOPD伴Ⅱ型呼吸衰竭患者92例,随机分为常规通气组（46例,无创正压通气）、经鼻氧疗组（46例,经鼻高流量氧疗）,测量记录治疗前及治疗后2组患者心率及呼吸频率、血气分析指标、肺功能指标,评估患者舒适度及呼吸困难情况,记录治疗期间并发症。结果 治疗后经鼻氧疗组心率、呼吸频率低于常规通气组（P<0.05）;治疗后经鼻氧疗组二氧化碳分压（PaCO₂）低于常规通气组,动脉血氧分压（PaO₂）高于常规通气组（P<0.05）;治疗后经鼻氧疗组第1秒用力呼出气容积（FEV₁）、用力呼气容积（FVC）高于常规通气组（P<0.05）;治疗后经鼻氧疗组Borg评分低于常规通气组,舒适率高于常规通气组（P<0.05）;经鼻氧疗组并发症发生率低于常规通气组（P<0.05）。结论 给予AECOPD伴Ⅱ型呼吸衰竭患者经鼻高流量氧疗可改善患者肺功能、血气分析指标,促进呼吸困难症状缓解,且可提高患者舒适度,降低并发症发生率。

Objective To observe the effect of nasal high-flow oxygen therapy on pulmonary function and blood gas analysis indexes in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）with type Ⅱ respiratory failure．Methods From March 2020 to March 2022,92 patients with AECOPD complicated with type Ⅱ respiratory failure who were treated in our hospital were enrolled and randomly divided into conventional ventilation group（46 cases,non-invasive positive pressure ventilation）and nasal oxygen therapy group（46 cases,nasal high-flow oxygen therapy）．The heart rate and respiratory rate,blood gas analysis indexes,pulmonary function indexes of the two groups of patients before and after treatment were measured and recorded,the comfort level and dyspnea situation of the patients were evaluated,and the complications during the treatment were recorded．Results After treatment,the heart rate and respiratory rate in the nasal oxygen therapy group were significantly lower than those in the conventional ventilation group（P<0.05）．The partial pressure of carbon dioxide（PaCO₂）in the nasal oxygen therapy group was significantly lower than that in the conventional ventilation group,partial pressure of oxygen（PaO₂）was significantly higher than the conventional ventilation group（P<0.05）．The nasal oxygen therapy group forced expiratory volume in one second,（FEV₁）,forced vital capacity（FVC）were significantly higher than the conventional ventilation group（P<0.05）．The Borg score of nasal oxygen therapy group was significantly lower than the conventional ventilation group,the comfort level was significantly higher than the conventional ventilation group（P<0.05）．The incidence of complications in the nasal oxygen therapy group was significantly lower than that in the conventional ventilation group（P<0.05）．Conclusions Nasal high-flow oxygen therapy for AECOPD patients with type Ⅱ respiratory failure can significantly improve the pulmonary function and blood gas analysis indicators,promote the relief of dyspnea symptoms,improve the comfort level of patients,and reduce the incidence of complications．

代谢综合征属于中医学“肥胖”“消渴”“脾瘅”等范畴,是以多种代谢异常在同一个体集结出现,包括肥胖、高血糖、血脂异常、高血压以及高尿酸血症等为表现的临床综合征。“浊毒”是由于脏腑功能失常,导致机体产生的生理、病理产物不能及时排出,蕴积体内而化生的致病因素。浊毒致病机体多有面色晦浊、腹胀满、小便浑浊、大便黏腻不爽、黄腻苔、滑数脉等表现。浊毒与代谢综合征的发病机制,在微观和宏观上具有对应性。文章从浊毒与代谢综合征的发病机制出发,对其临床治疗的共同点进行了综述。

Metabolic syndrome falls into the categories of obesity,diabetes and spleen disease in traditional Chinese medicine,and is manifested by various metabolic abnormalities in an individual,including obesity,hyperglycemia,dyslipidemia,hypertension and hyperuricemia. The turbid toxin is a pathogenic factor caused by visceral dysfunction,which leads to the accumulation of physiological and pathological wastes that fail to be eliminated from the body in time. People with turbid toxin are manifested by dull and cloudy complexion,abdominal distension,turbid urine,sticky stool,yellow greasy coating,slippery pulse,etc. The turbid toxin corresponds to the pathogenesis of metabolic syndrome at both micro and macro levels. This paper intends to explore the correlations between the turbid toxin and the pathogenesis of metabolic syndrome and make a review with relevant clinical treatment.