目的   探讨淋巴细胞亚群在鉴别低增生性骨髓增生异常综合征（hypo-MDS）和再生障碍性贫血（AA）中的价值。方法   选取2020年7月—2023年6月在平顶山市第一人民医院治疗的80例hypo-MDS或和AA患者进行回顾性分析，其中hypo-MDS 48例、AA 32例，分析两组患者各类淋巴细胞（CD3⁺ 、CD4⁺ 、CD8⁺ 、CD4⁺ /CD8⁺ 、CD3⁺ CD57⁺ T-大颗粒淋巴细胞、CD3^- CD16/CD56⁺ 自然杀伤细胞、CD19⁺ B淋巴细胞）的差异。结果   hypo-MDS组的CD3⁺ （78.42±8.02）%与AA组的（75.65±8.44）%对比差异无统计学意义（P＞0.05）；hypo-MDS组的CD4⁺ （47.54±6.88）%、CD4⁺ /CD8⁺（2.16±0.61）%高于AA组的CD4⁺ （40.11±5.71）%、CD4⁺ /CD8⁺ （1.49±0.48）%，CD8⁺ （23.12±6.42）%低于AA组CD8⁺ （31.77±6.79）%（P＜0.05）；hypo-MDS患者CD3⁺ CD57⁺ T-大颗粒淋巴细胞（13.45±3.77）%、CD3^- CD16/CD56⁺自然杀伤细胞（12.32±3.97）%高于AA组CD3⁺ CD57⁺ T-大颗粒淋巴细胞（9.77±2.15）%、CD3^- CD16/CD56⁺ 自然杀伤细胞（8.84±2.11）%，CD19⁺ B淋巴细胞（9.75±2.08）%低于AA组（12.65±3.35）%（P＜0.05）。结论   淋巴亚群变化情况可用于AA和hypo-MDS的鉴别诊断。

       Objective  To explore the value of lymphocyte subsets in differentiation between hypoplastic myelodysplastic syndrome（hypo MDS）and aplastic anemia（AA）．Methods  A  retrospective analysis was conducted on 80 patients with hypo MDS and AA who underwent treatment in the First People’s Hospital of Pingdingshan City from July 2020 to June 2023．Among them，there were 48 cases of hypo MDS and 32 cases of AA．The differences in lymphocytes（CD3⁺ ，CD4⁺ ，CD8⁺ ，CD4⁺ /CD8⁺ ，CD3⁺ CD57⁺  T-large granular lymphocytes，CD3^- CD16/CD56⁺  natural killer cells，and CD19⁺  B lymphocytes）between the two groups of patients were analyzed．Results  There was no statistically significant difference in CD3⁺ （78.42±8.02）% between the hypo MDS group and the AA group（75.65±8.44）%（P＞0.05）．The CD4⁺ （47.54±6.88）% and CD4⁺ /CD8⁺ （2.16±0.61）% in the hypo MDS group were higher than those in the AA group（40.11±5.71）% and （1.49±0.48）%，respectively．The CD8⁺（23.12±6.42）% was lower than that in the AA group（31.77±6.79）%（P＜0.05）．The levels of CD3⁺ CD57⁺  T-large granular lymphocytes（13.45±3.77）% and CD3^- CD16/CD56⁺  natural killer cells（12.32±3.97）% in hypo MDS patients were higher than those in the AA group（［9.77±2.15］%，［8.84±2.11］%），and CD19⁺  B lymphoid cells（9.75±2.08）% were lower than that in the AA group（［12.65±3.35］%，P＜0.05）．Conclusions  The changes in lymphatic subpopulations can be used for the differential diagnosis of AA or hypo MDS．

       目的   探讨CT、MRI影像学表现对原发性肝细胞癌（HCC）微血管侵犯（MVI）的诊断价值。方法   选取2018年1月—2024年7月江门市第二人民医院（江门市中心医院蓬江分院）和江门市中心医院120例（共158个病灶）HCC患者，均行上腹部CT、MRI平扫+增强及弥散加权成像（DWI）检查；以术后病理结果为金标准。比较CT、MRI平扫+增强及DWI对HCC MVI诊断效能；分析HCC MVI诊断中CT、MRI平扫+增强及DWI检查与术后病理确诊结果之间的一致性；比较HCC MVI与无HCC MVI患者影像学表现及表观扩散系数（ADC）值。结果    DWI检查对HCC MVI的诊断效能（灵敏度、特异度、准确度、阳性预测值、阴性预测值）均显著性高于CT、MRI平扫+增强（P＜0.05）；CT、MRI、DWI对原发性肝细胞癌患者微血管侵犯的诊断效能比较，差异均无统计学意义（P＞0.05）。在HCC MVI诊断效能中，CT、MRI影像学表现与术后病理确诊结果之间为中度一致性；DWI与术后病理确诊结果之间为高度一致性。HCC MVI患者的强化方式在非边缘动脉期强化、强化包膜、晕状强化、结中结、门脉分支癌栓占比均显著性高于无HCC MVI患者（P＜0.05）。在不同b值（400、800、1 000、1 500 s/mm² ）下，HCC MVI患者的ADC值均显著性高于无HCC MVI患者（P＜0.05）。结论    CT、MRI平扫+增强及DWI对HCC MVI均具有较好的诊断效能，而MRI诊断结果与病理诊断一致性更佳，尤其DWI图中ADC值可更加精准地判断HCC的患者是否发生微血管侵犯，有助于指导临床医生建立“个体化”精准诊疗策略。

       Objective  To explore the diagnostic value of CT and MRI imaging manifestations for microvascular invasion（MVI）in primary hepatocellular carcinoma（HCC）．Methods  A total of 120 patients（158 lesions in total）with HCC in the Second People’s Hospital of Jiangmen（Pengjiang Branch of Jiangmen Central Hospital）and Jiangmen Central Hospital were selected from January 2018 to July 2024，all underwent CT and MRI plain + enhanced and diffusion-weighted imaging（DWI）of the upper abdomen；postoperative pathology results was used as the diagnostic gold standard．The diagnostic efficacy of CT，MRI plain + enhanced and DWI for HCC MVI was compared．The concordance among CT，MRI plain + enhanced and DWI examinations with postoperative pathological diagnostic findings in the diagnosis of HCC MVI．Imaging manifestations and apparent diffusion coefficient（ADC）values in patients with and without HCC MVI were compared．Results  Diagnostic effectiveness of DWI examination for HCC MVI（sensitivity，specificity，accuracy，positive predictive value，negative predictive value）were all significantly higher than those of CT and MRI plain + enhanced（P＜0.05）；none of the differences were statistically significant（P＞0.05）in the comparison of diagnostic effectiveness of CT，MRI，and DWI for the diagnosis of MVI in patients with primary HCC．In HCC MVI diagnostic effectiveness，moderate concordance was found among CT，MRI imaging phenotypes and postoperative pathology results；high concordance was found between DWI and postoperative pathology results．In HCC MVI patients，the proportion of non-marginal arterial reinforcement，enhanced envelope，halo reinforcement，nodal in nodal and portal branch cancer thrombi was significantly higher than that in patients without HCC MVI（P＜0.05）．At different b-values（400，800，1 000，1 500 s/mm² ），ADC values were all significantly higher in patients with HCC MVI than in patients without HCC MVI（P＜0.05）．Conclusions  CT，MRI plain + enhanced and DWI have good diagnostic effectiveness for HCC MVI，while MRI diagnostic results are in better concordance with pathologic diagnosis．In particular，ADC values in DWI maps can more accurately determine whether MVI occurs in patients with HCC，which helps to guide clinicians to establish“individualized”and precise diagnosis and treatment strategies．

       目的   探讨免疫及靶向药物联合肝动脉灌注化学治疗（化疗）治疗晚期肝癌的临床疗效。方法   选取甘肃省武威市人民医院2021年1月—2024年1月收治的78例晚期肝癌患者进行回顾性分析，其中20例患者采取单纯肝动脉灌注化疗（HAIC）治疗为单化疗组，30例患者采取HAIC联合程序性细胞死亡受体-1（PD-1）抗体治疗为免疫组，28例患者采取HAIC联合PD-1抗体免疫治疗与甲磺酸仑伐替尼胶囊靶向治疗为联合组。对比三组临床疗效、治疗前后胚抗原（CEA）、糖类抗原125（CA125）、甲胎蛋白（AFP）表达水平，不良反应发生率，并采用Piper疲乏修正量表（PFS-R）、世界卫生组织生存质量量表简表（WHOQOL-BREF）对两组癌因性疲乏程度及生存质量进行评价。结果   单纯化疗组、免疫组、联合组客观缓解率分别为15.00%、40.00%、64.29%，疾病控制率为30.00%、66.67%、82.14%，联合组高于单纯化疗组与免疫组（χ ² =11.720，P=0.003；χ ² =13.890，P＜0.001）；治疗后三组患者CEA、CA125、AFP水平均降低，且联合组［CEA：（13.62±4.24）ng/mL、CA125：（31.62±13.66）U/mL、AFP：（35.21±5.93）ng/mL］低于免疫组［（17.85±3.32）ng/mL、（59.26±9.35）U/mL、（42.12±4.12）ng/mL］及单纯化疗组［（23.73±4.79）ng/mL、（64.57±5.23）U/mL、（47.46±5.32）ng/mL］，对比差异有统计学意义（F=7.698，P＜0.001；F=11.480，P＜0.001；F=14.952，P＜0.001；P＜0.05）；所有患者均无5级不良反应及严重肝功能损害出现，且三组血小板减少、白细胞减少、腹痛、呕吐、消化道出血、厌食等不良反应发生率对比差异无统计学意义（P＞0.05）；治疗后三组患者PFS-R评分均降低，联合组（3.85±1.13）分低于免疫组（5.39±1.25）分及单纯化疗组（6.33±1.26）分，WHOQOL-BREF评分均升高，联合组（348.58±66.12）分高于免疫组（297.24±72.21）分及单纯化疗组（256.35±41.67）分，对比差异有统计学意义（F=2.526，P=0.014；F=2.167，P=0.033）。结论   免疫及靶向药物联合肝动脉灌注化疗治疗晚期肝癌疗效显著，可有效控制疾病进展的同时，降低机体肿瘤标志物水平，安全性可控，同时可改善患者生存质量，减轻癌因性疲乏程度。

       Objective  To explore the clinical efficacy of immune and targeted drugs combined with hepatic artery infusion chemotherapy（HAIC）in the treatment of advanced liver cancer．Methods  A retrospective analysis was conducted on 78 patients with advanced liver cancer admitted to our hospital from January 2021 to January 2024．Among them，20 patients were treated with simple HAIC and divided into a single chemotherapy group．Thirty patients were treated with HAIC combined with PD-1 antibody，and divided into an immune group．Twenty-eight patients were treated with HAIC combined with PD-1 antibody immunotherapy and lenvatinib mesylate capsule targeted therapy，and divided into a combination group．The clinical efficacy of three groups，the expressionlevels of CEA，CA125，AFP，and incidence of adverse reactions before and after treatment were compared．Piper Fatigue Correction Scale（PFS-R）and the WHO QOL-BREF were used to assess cancer-related fatigue in both groups．The degree of fatigue and quality of life were assessed．Results  The objective response rates of the simple chemotherapy group，the immune group，and the combination group were 15.00%，40.00% and 64.29%，respectively．The disease control  rates were 30.00%，66.67% and 82.14%，respectively．The indicators above of the combination group was significantly higher than those in the simple chemotherapy group and the immune group（χ ² =11.720，P=0.003；χ ² =13.890，P＜0.001；P＜0.05）．After treatment，the levels of CEA，CA125 and AFP were all decreased in the three groups，and those in the combined group （CEA［13.62±4.24］ng/mL，CA125［31.62±13.66］U/mL，AFP：Ng/mL［35.21±5.93］）were lower than those in the immune group（17.85±3.32 ng/mL，59.26±9.35 U/mL，/ 42.12±4.12 ng/mL）and single chemotherapy group（23.73±4.79 ng/mL，64.57±5.23 U/mL47.46±5.32］ng/mL），the differences were statistically significant（F=7.698，P＜0.001；F=11.480，P＜0.001；F=14.952，P＜0.001；P＜0.05）．All patients had no grade 5 adverse reactions or severe liver function damage，and there was no statistically significant difference in the incidence adverse reactions such as thrombocytopenia，leukopenia，abdominal pain，vomiting，gastrointestinal bleeding，and anorexia among the three groups（P＞0.05）．After treatment，the PFS-R score of the three groups was decreased，and the combined group（3.85±1.13）score was lower than that of the immune group（5.39±1.25）and the chemotherapy group（6.33±1.26）．While the WHOQOL-BREF score was increased，the score of combination group（348.58±66.12）was higher than that of immune group（297.24±72.21）and chemotherapy group（256.35±41.67），and the difference was statistically significant（F=2.526，P=0.014；F=2.167，P=0.033；P＜0.05）．Conclusions  The combination of immune and targeted drugs with hepatic artery infusion chemotherapy has a significant therapeutic effect on advanced liver cancer．It can effectively control disease progression，reduce tumor marker levels in the body，improve patient quality of life，and alleviate cancer-related fatigue，with controllable safety

       目的   探讨与分析实时图像引导系统对乳腺癌保乳术后放射治疗（放疗）摆位误差的影响。方法   选取安阳市肿瘤医院2021年9月—2023年12月收治的乳腺癌保乳术后108例患者为研究对象，按照随机信封抽签法把108例患者分为实时组54例与对照组54例。两组的放疗观察时间均为3个月，对照组给予热塑体模定位，实时组给予实时图像引导系统定位，记录两组的摆位误差与放疗不良反应发生情况。结果   实时组X轴、Y轴、Z轴方向的配准结果误差发生率分别为1.85%、7.41%、1.85%，均低于对照组的14.81%、22.22%、16.67%（χ ² =5.939，P=0.015；χ ² =4.696，P=0.030；χ ² =7.053，P=0.008）。实时组摆位纠正前X轴、Y轴、Z轴误差大于对照组（t分别为38.888、28.106、50.102，P＜0.05），摆位纠正后两组摆位误差对比差异无统计学意义（P＞0.05）。实时组放疗3个月期间的心脏平均受量、肺脏平均受量均少于对照组（t分别为49.942、13.996，P＜0.001）。实时组放疗3个月期间的急性放射性皮肤反应发生率为3.70%，对照组为16.67%，实时组低于对照组（χ ² =4.960，P＜0.05）。结论   实时图像引导系统在乳腺癌保乳术后放疗的应用可减少摆位误差，也能减少患者的心脏平均受量、肺脏平均受量，降低急性放射性皮肤反应发生率。

       Objective  To investigate and analysis the effects of image-guided radiation therapy on the positioning error of radiotherapy after breast conserving surgery for breast cancer．Methods  from September 2021 to December 2023，108 patients with breast cancer after breast conserving surgery in Anyang Cancer Hospital were selected as the study subjects．According to the principle of random envelope drawing，108 patients were divided into the real-time group of 54 patients and the control group of 54 patients．The observation time for radiotherapy in both groups was 3 months．The control group was given thermoplastic phantom positioning，while the real-time group was given image-guided radiation therapy positioning．The positioning errors and incidence of radiotherapy adverse reactions were recorded in both groups．Results  The error rates of registration results in the X-axis，Y-axis，and Z-axis directions of the real-time group were 1.85%，7.41% and 1.85%，respectively，which were significantly lower than the control group（14.81%，22.22% and 16.67%；χ ² =5.939，P=0.015；χ ² =4.696，P=0.030；χ ² =7.053，P=0.008）．The errors in the X-axis，Y-axis and Z-axis before the pendulum correction were greater than that in the control group（t=38.888，28.106，50.102，P＜0.05），and there were no statistically significant difference in positioning errors compared between the two groups after positioning correction（P＞0.05）．The average cardiac and lung uptake during the 3-month period of real-time radiotherapy in the group were significantly lower than those in the control group（t=49.942，13.996，P＜0.001）．The incidence of acute radiation-induced skin reactions during the 3-month period of real-time group radiotherapy was 3.70%，compared to 16.67% in the control group，the real-time group showed a significant decrease（χ ² =4.960，P=0.026＜0.05）．Conclusions  The application of image-guided  radiation therapy in radiotherapy after breast conserving surgery for breast cancer can reduce the positioning error，the average cardiac and pulmonary dose，and the incidence of acute radiation skin reaction．

       目的   探讨NXT629改善肝胆结石形成的相关机制。方法   对C57BL/6J小鼠分别采用常规饮食或成石饮食（LD）喂养，并在LD组小鼠注射PPAR-α拮抗剂NXT629。通过苏木精-伊红染色法染色分析肝脂肪病变，油红O染色检测肝脏脂质的积累，分光光度法检测胆汁或血清中总胆固醇、甘油三酯、磷脂、总胆汁酸、胆固醇饱和指数、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇指标；qPCR法检测小鼠肝组织中ABCG5/8、CYP7A1、CYP7B1、PPAR-α和ABCB11 mRNA的表达情况。结果  NXT629通过靶向PPAR-α降低LD组小鼠肝脏中的ABCG5、ABCG8、ABCB11 mRNA水平以及增加CYP7A1、CYP7B1 mRNA水平，进而减少LD诱导的肝胆结石形成并改善脂质代谢紊乱。结论  NXT629可能通过影响脂代谢相关基因表达改善肝胆结石。

       Objective  To explore the mechanism on NXT629 improves hepatolithiasis formation．Methods  C57BL/6J mice were fed either a regular diet or a lithogenic diet（LD），with the LD group receiving injections of PPAR-α inhibitor NXT629．Liver steatosis was analyzed via HE staining，hepatic lipid accumulation was detected by Oil Red O staining，and total cholesterol，triglycerides，phospholipids，total bile acids，cholesterol saturation index，low density lipoprotein cholesterol，and high density lipoprotein cholesterol levels in bile or serum were measured using assay kits．RT-qPCR was employed to determine the mRNA expression of ABCG5/8，CYP7A1，CYP7B1，PPAR-α，and ABCB11 in mouse liver tissues．Results  The results showed that NXT629 target PPAR-α to down-regulate the mRNA levels of ABCG5，ABCG8，and ABCB11 in the livers of LD-fed mice，while increasing the mRNA levels of CYP7A1 and CYP7B1，thereby  reducing LD-induced hepatolithiasis formation and improving lipid metabolism disorders．Conclusions  NXT629 can improve cholesterol gallstones by affecting the expression of genes related to lipid metabolism．

       目的   探讨影响急性脑梗死患者接受重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗决策延迟的因素，并提出减少溶栓决策时间的建议。方法   采用回顾性分析方法，对泉州市第一医院2023年通过急诊收治的120例急性脑梗死患者及其家属的资料进行分析。根据溶栓决策时间，以5 min为界限，将患者分为非延迟组（62例）和延迟组（58例），并对两组资料进行比较分析。采用SPSS 23.0统计软件分析数据，运用t检验（针对连续变量）和χ ² 检验（针对分类变量）比较组间的差异。此外，通过Logistic回归分析，确定影响急性脑梗死患者静脉溶栓治疗决策的危险因素。结果   对比两组患者数据后发现，籍贯地区、冠心病史、外院转入、发病到入院时间以及决策家属数量比较差异具有统计学意义（P＜0.05）。多因素Logistic回归分析进一步揭示，非泉州籍贯地区［OR（95%CI）：9.29（2.21~38.97），P=0.002］、决策家属人数≥2人［OR（95%CI）：18.73（5.96~58.80），P＜0.001］、从外院转入［OR（95%CI）：10.26（2.09~50.42），P=0.004］以及发病到入院时间3.0~4.5 h［OR（95%CI）：4.09（1.45~11.48），P=0.008］是导致治疗决策延迟的独立危险因素。结论   患者非泉州籍贯地区、外院转入、溶栓决策家属人员≥2个、发病到入院时间3~4.5 h是溶栓决策延误的影响因素，提出优化卒中急诊抢救流程以及通过卒中宣教以缩短溶栓决策时间的建议。

       Objective  To investigate the factors influencing delays in decision-making for intravenous thrombolysis with recombinant tissue plasminogen activator（rt-PA）in patients with acute cerebral infarction and to propose  recommendations for reducing thrombolysis decision-making time．Methods  A  retrospective analysis was conducted on data from 120 patients with acute cerebral infarction admitted to the emergency department at Quanzhou First Hospital in 2023，including information from their families．Patients were divided into non-delay group （62 cases） and delay group （58 cases） based on a 5-minute threshold for thrombolysis decision-making time．Comparative analysis between the two groups was performed using SPSS 23.0 statistical software，with t-tests for continuous variables and χ ²  tests for categorical variables．Logistic  regression analysis was employed to identify  risk factors affecting decision-making for intravenous thrombolysis in these patients．Results  Statistical analysis  revealed significant differences between the two groups in terms of native region，history of coronary heart disease，transfer from other hospitals，time from onset to hospital admission，and number of family members involved in decision-making（P＜0.05）．Multivariate Logistic regression identified independent risk factors for delayed treatment decisions：non-Quanzhou native region （OR［95%CI］：9.29［2.21-38.97］，P=0.002），having two or more decision-making family members （OR［95%CI］：18.73［5.96-58.80］，P＜0.001），transfer from other hospitals （OR［95%CI］：10.26［2.09-50.42］，P=0.004），and a time from onset to hospital admission of 3-4.5 hours （OR［95%CI］：4.09［1.45-11.48］，P=0.008）．Conclusions  Factors  such as non-Quanzhou native region，transfer from other hospitals，having two or more family members involved in decision-making，and a time from onset to hospital admission of 3-4.5 hours are associated with delays in thrombolysis decision-making．Optimizing the emergency  rescue process for stroke and shortening the thrombolytic decision-making time through stroke education are suggested．

       目的     探讨CT增强延迟扫描技术在非小细胞肺癌术前诊断中的应用价值。方法    对2021年5月—2024年5月商丘市第一人民医院收治的82例非小细胞肺癌手术治疗患者进行回顾性分析，将其分为观察组，另选取82例肺部良性肿瘤患者作为对照组，收集其术前CT增强延迟扫描结果，以术后病理诊断结果为金标准，分析CT增强延迟扫描技术在非小细胞肺癌术前诊断中的应用价值。并对比不同临床病理特征非小细胞肺癌患者CT增强延迟扫描的CT增强值，采用Spearman相关性分析法分析CT增强值与非小细胞肺癌病理特征的关系。结果  CT增强延迟扫描显示观察组患者分叶征（12.50% vs 53.57%）、内部空泡征数量（6.25% vs 39.29%）低于对照组（χ ² =26.560、24.680，P＜0.05），观察组患者边缘毛刺（56.25% vs 17.86%）、胸部凹陷征（59.38% vs 14.29%）、高于对照组（χ ² =43.330、64.600，P＜0.05）；82例非小细胞肺癌通过CT增强延迟扫描共确诊79例，CT增强延迟扫描诊断对非小细胞肺癌的准确率为96.34%（79/82），与病理诊断结果100.00%对比差异无统计学意义（χ ² =3.060，P=0.080）；82例非小细胞肺癌平均CT增强值为（39.14±7.31），不同性别、年龄、肿瘤最大直径、淋巴结浸润情况患者CT增强值对比差异无统计学意义（P＞0.05），不同病理类型［腺癌（43.75±7.15）vs 鳞癌（34.74±6.12）］、细胞分化程度［中、低分化（45.71±7.21）vs 高分化（32.81±5.11）］、临床分期［Ⅰ期（31.03±2.12）vs Ⅱ期（36.61±3.13）vs Ⅲa期（46.32±6.83）］患者、淋巴结转移［是（42.75±4.21）vs 否（35.77±8.13）］CT增强值对比差异有统计学意义（t/F=5.243、8.804、84.828、4.378，P＜0.05）；Spearman相关分析结果显示：病理类型、细胞分化程度、临床分期、淋巴结转移与非小细胞肺癌患者CT增强值呈正相关（r=0.431，P=0.021；r=0.511，P=0.009；r=0.586，P=0.005；r=0.579，P=0.008，P＜0.05）。结论  CT增强延迟扫描技术对非小细胞肺癌术前确诊具有重要价值，其诊断准确率与病理诊断并无显著差异，且可通过CT增强延迟扫描技术确定患者CT增强值，从而为非小细胞肺癌患者术后病理特征判断提供参考。

      Objective  To explore the application value of CT enhanced  delayed  scanning in  preoperative  diagnosis of non-small cell lung cancer（NSCLC）．Methods  A retrospective analysis was conducted on 82 patients with NSCLCwho underwent surgical treatment in a hospital from May 2021 to May 2024．They were included into  an  observation  group and another 82 patients with benign lung tumors were included in the control group．The  preoperative CT enhanced  delayed scanning results were collected，and the postoperative pathological diagnosis was used as the “gold standard” to analyze the application value of CT enhanced delayed scanning in the preoperative diagnosis of NSCLC．And the CT enhancement values of delayed CT scans in NSCLC patients with different clinical and pathological features were compared，and Spearman correlation analysis was used to analyze the relationship between CT enhancement values and pathological features of NSCLC．Results  CT enhanced delayed scanning showed that the number of lobular（12.50% vs 53.57%）and internal vacuolar signs（6.25% vs39.29%）in the observation group was significantly lower than that in the control group（χ ² =26.560，24.680，P＜0.05），while the edge spicules（56.25% vs 17.86%）and chest depression signs（59.38% vs 14.29%）in the observation group were significantly higher than that in the control group（χ ² =43.330，64.600，P＜0.05）．A total of 79 cases of 82 NSCLC were diagnosed by CT-enhanced delayed scan，and the accuracy of CT-enhanced delayed scan diagnosis for NSCLC was 96.34%（79/82），with no significant difference from the pathological diagnosis result of 100.00%（χ ² =3.060，P=0.080）．The average CT enhancement value of 82 NSCLC cases was（39.14±7.31）．There was no significant difference in CT enhancement values among patients of different genders，ages，maximum tumor diameter，and lymph node infiltration（P＞0.05）．Patients with different pathological types ［adenocarcinoma（43.75±7.15）vs squamous cell carcinoma（34.74±6.12）］，degree of cell differentiation ［moderate，and low differentiation（45.7±7.21）vs high differentiation（32.81±5.11）］，clinical stage ［I（31.03±2.12）vs II（36.61±3.13）vs IIIa（46.32±6.83）］ and lymph node metastasis ［yes（42.75±4.21），vs no（35.77±8.13）］ CT enhancement had significant difference（t/F=5.243，8.804，84.828，4.378，P＜0.05）．The Spearman correlation analysis results showed that pathological type，degree of cell differentiation，clinical stage，lymph node metastasis were positively correlated with CT enhancement values in NSCLC patients（r=0.431，P=0.021；r=0.511，P=0.009；r=0.586，P=0.005；r=0.579，P=0.008）．Conclusions  CT enhanced delayed scanning has important value in preoperative diagnosis of NSCLC．Its diagnostic accuracy is not significantly different from pathological diagnosis，and the CT enhanced value of patients can be determined through CT enhanced delayed scanning，providing reference for postoperative pathological feature judgment of NSCLC patients．

       目的     探讨内镜下黏膜切除术患者肠道准备教育程序的优化方法及改善效果。方法    选择2022年12月—2023年12月广州市中西医结合医院接收的内镜下黏膜切除术患者180例进行研究，电脑随机编号按奇偶数分为两组各90例，对照组采取常规肠道准备教育工作，观察组实施基于优化的教育程序展开教育工作，比较两组依从性、肠道准备质量、满意度、不适症状发生情况。结果    观察组饮食依从率96.88%、服药依从率98.44%、运动依从率93.75%，均高于对照组的78.13%、79.69%、71.88%（χ ² 分别为6.172、7.745、7.120，P分别为0.012、0.005、0.007）。观察组左侧、横结肠、右侧等评分及肠道准备质量总分高于对照组（t分别为7.175、6.442、5.971、8.234，均P＜0.001）。观察组肠道准备满意度为98.89%，高于对照组的88.89%（χ ² =7.842，P=0.005）。观察组恶心11.11%、呕吐4.44%、腹胀5.56%、腹痛0.00%，低于对照组的22.22%、13.33%、14.44%、6.67%（χ ² 分别为4.000、4.390、3.950、4.310，P分别为0.045、0.036、0.046、0.037）。结论    对内镜下黏膜切除术患者实施基于优化的教育程序展开肠道准备教育工作可提高患者肠道准备依从性，保证良好的肠道准备质量和肠道清洁度，提高患者的满意度，有助减少肠道不适症状。

       Objective  To explore the optimization method and improvement effect of bowel preparation education program in patients undergoing endoscopic mucosal resection．Methods  A total of 180 patients with endoscopic mucosal resection admitted to the hospital from December 2022 to December 2023 were selected for the study．They were randomly divided into two groups with 90 cases in each group．The control group was given routine bowel preparation education，and the observation group was given education based on optimized education procedures．The compliance，quality of bowel preparation，satisfaction and discomfort symptoms were compared between the two groups．Results  The diet compliance rate 96.88%，medication compliance rate 98.44%，exercise compliance rate 93.75% in the observation group were significantly higher than 78.13%，79.69%，71.88% in the control group（χ ² =6.172，7.745，7.120，P=0.012，0.005，0.007）．The scores of left colon，transverse colon and  right colon and the total score of bowel preparation quality in the observation group were significantly higher than those in the control group（t=7.175，6.442，5.971，8.234，all P＜0.001）．The satisfaction of bowel preparation in the observation group（98.89%）was significantly higher than that in the control group（88.89%）（χ ² =7.842，P=0.005）．Nausea 11.11%，vomiting 4.44%，abdominal distension 5.56%，abdominal pain 0.00% in the observation group were significantly lower than 22.22%，13.33%，14.44%，6.67% in the control group（χ ² =4.000，4.390，3.950，4.310，P=0.045，0.036，0.046，0.037）．Conclusions  The implementation of bowel preparation education based on optimized education program in patients undergoing endoscopic mucosal  resection can improve the compliance of bowel preparation，ensure good quality of bowel preparation and bowel cleanliness，improve patient satisfaction，and reduce the occurrence of intestinal discomfort symptoms，which is worthy of promotion．

          目的   探讨便携式超声仪超声重点评估（e-FAST）技术在批量伤员军地联合院前救治中的应用效果。方法    抽取2021年5月—2023年10月中国人民解放军联勤保障部队第九八八医院中心急诊科收治的80例批量伤员，均开展军地联合院前救治，按照治疗方案不同分为观察组和对照组，每组患者40例，其中对照组在救治现场行基于创伤严重程度（CRAMS）评分，进行常规急救处置，救护车返院后行CT检查并进行相应伤情治疗，观察组救治现场行CRAMS评分，进行常规急救处置，院前接诊医师在现场或救护车上使用便携式超声仪按照e-FAST流程检查相应部位，初步诊断后进行相应伤情治疗，对比两组患者治疗效果，两组患者诊断时间、初次医疗接触—进入手术室时间及入院诊断与出院时确定性诊断的符合率、两组患者治疗前后CRAMS评分及CRAMS≤8分抢救成功率。结果   观察组治疗有效率为95.0%，对照组为85.0%，对比差异无统计学意义（χ ² =2.222，P=0.136）；观察组患者的诊断时间（13.56±2.36）min、初次医疗接触—进入手术室时间（30.42±8.99）min均短于对照组［（23.64±5.69）、（52.27±12.60）min］，差异有统计学意义（t=10.349、8.928，P＜0.05）；观察组患者入院诊断与出院时确定性诊断的符合为97.5%，对照组患者入院诊断与出院时确定性诊断的符合为95.0%，差异无统计学意义（χ ² =0.346，P=0.556）；治疗后两组患者的CRAMS评分均升高，且观察组（9.87±2.62）分高于对照组（8.60±2.98）分，差异有统计学意义（t=2.024，P=0.046）；观察组患者CRAMS≤8分的抢救成功率为97.50%，对照组CRAMS≤8抢救成功率为85.00%，观察组患者CRAMS≤8分的抢救成功率高于对照组（χ ² =3.914，P=0.048）。结论    本研究从军地联合救治批量伤员切入，瞄准部队医院军民融合战略发展路线，本文针对便携式超声仪e-FAST应用范围前移，明显地提高急救人员院前救治能力，提高抢救成功率，值得临床参考。

       Objective  To explore the application effect of portable ultrasound e-FAST technology in the pre hospital treatment of batch wounded soldiers in military civilian joint hospitals．Methods  Eighty batch wounded patients admitted to the emergency department of 988 Hospital from May 2021 to October 2023 were selected，all of whom underwent military civilian joint pre hospital treatment．They were divided into an observation group and a control group according to different treatment plans，with 40 patients in each group．The control group received CRAMS scores at the treatment site for routine first aid treatment，CT scans after ambulance return to the hospital for corresponding injury treatment，the observation group  received CRAMS scores at the treatment site for routine first aid treatment，and the pre-hospital attending physician used a portable ultrasound instrument to examine the corresponding parts on site or in the ambulance according to the e-FAST process．After preliminary diagnosis，corresponding injury treatment was carried out．The treatment effects of the two groups of patients were compared，and the diagnosis time and initial diagnosis of the two groups of patients were compared．The time from medical contact to entering the operation room，the compliance rate of discharge and admission diagnoses，the CRAMS score before and after treatment，and the success rate of rescue with CRAMS ≤ 8 for both groups of patients were compared．Results  The effective rate of treatment in the observation group was 95.0%，while in the control group it was 85.0%，which difference was not statistically significant（χ ² =2.222，P=0.136）．The time to diagnosis（13.56±2.36）min，time to the operating room（30.42±8.99）min were shorter than that in the control group［（23.64±5.69），（52.27±12.60）min］，with significant difference（t=10.349，8.928，P＜0.05）．The consistency  between the admission diagnosis and the definitive diagnosis at discharge of the observation group patients was 97.5%，while the consistency of the control group patients was 95.0%．There was no significant difference between the groups（χ ² =0.346，P=0.556）．After treatment，the CRAMS scores of both groups of patients increased，the observation group（9.87±2.62）was higher than that of the control group（8.60±2.98）（t=2.024，P=0.046）．The success rate of CRAMS ≤ 8 rescue in the observation group was 97.50%，while the success rate in the control group was 85.00%．The success rate of CRAMS ≤ 8 rescue in the observation group was higher than that in the control group（χ ² =3.914，P=0.048）．Conclusions  This study focuses on the joint treatment of batch wounded soldiers by military and civilian forces，aiming at the development path of military civilian integration strategy in military hospitals．The application scope of portable ultrasound e-FAST has been moved forward，which significantly improves the pre hospital treatment ability of emergency personnel and improves the success rate of rescue．It is worth clinical reference．

       目的    探究经鼻间歇正压通气（NIPPV）和经鼻持续正压通气（NCPAP）作为早产儿呼吸窘迫综合征气管插管机械通气拔管后无创呼吸支持过渡的临床效果的差异。方法   纳入2021年1月—2023年6月在广东省吴川市妇幼保健计划生育服务中心治疗的新生儿呼吸窘迫综合征早产儿66例，用随机数字表法将患儿分为NIPPV组（33例）和NCPAP组（33例）。NIPPV组患儿予经鼻间歇正压通气作为过渡期无创呼吸支持，NCPAP组患儿则予以经鼻持续正压通气作为过渡期无创呼吸支持。对比两组患儿治疗前后血气分析结果、脱机失败率、无创呼吸支持时间、无创后吸氧时间、总给氧时间等指标。结果  接受无创呼吸支持12 h后，NIPPV组患儿的PaO₂升至（76.46±1.10）mmHg，高于NCPAP组患儿的（75.51±2.15）mmHg（t=2.249，P=0.028）。此外，NIPPV组患儿的SaO₂升至（96.36±0.52）%，也高于NCPAP组患儿的（96.07±0.59）%（t=2.138，P=0.034）。而NIPPV组患儿的PaCO₂则降至（41.39±0.74）mmHg，较NCPAP组患儿的（41.87±0.95 ）mmHg低（t=-2.230，P=0.025）。NIPPV组无创呼吸支持时间为（3.09±0.52）d，短于NCPAP组的（3.45±0.62）d，且该差异有统计学意义（t=2.584，P=0.012）。同样的，NIPPV组总给氧时间（9.52±0.76）天较NCPAP组的（10.00±0.79）天短，且该差异有统计学意义（t=-2.548，P=0.013）。而两组在脱机失败率、无创呼吸支持后吸氧时间、不良反应发生率等方面比较差异无统计学意义（均P＞0.05）。结论   与NCPAP模式相比，早产儿拔管后应用NIPPV模式进行无创呼吸支持取得的临床效果更优。

      Objective  To explore the difference of clinical effect of nasal intermittent positive pressure ventilation（NIPPV）and nasal continuous positive pressure ventilation（NCPAP）as non-invasive respiratory support mode after extubation in preterm infants with endotracheal intubation．Methods   Sixty-six cases of preterm infants with neonatal respiratory distress syndrome treated in our hospital from January 2021 to June 2023 were included．All the subjects were randomly divided into NIPPV group（n=33）and NCPAP group（n=33）．The blood gas analysis results，weaning failure rate，non-invasive respiratory support time，oxygen inhalation time after noninvasive ventilation，total oxygen administration time．were compared between the two groups．Results   After 12 hours of noninvasive respiratory support，PaO₂ in the NIPPV group increased to（76.46±1.10）mmHg，which was significantly higher than that（75.51±2.15）mmHg in the NCPAP group（t=2.249，P=0.028）．In addition，SaO₂ in the NIPPV group increased to （96.36±0.52）%，which was also significantly higher than that（96.07±0.59）% in the NCPAP group（t=2.138，P=0.034）．The PaCO₂ in the NIPPV group decreased to （41.39±0.74）mmHg，which was lower than that（41.87±0.95）mmHg in the NCPAP group（t=-2.230，P=0.025）．The  duration of  non-invasive  respiratory  support in the NIPPV group（3.09±0.52） days was shorter than that（3.45±0.62）days in the NCPAP group，and the difference was statistically significant（t=2.584，P=0.012）．Similarly，the total duration of oxygen administration in the NIPPV group（9.52±0.76）days was shorter than that（10.00±0.79）days in the NCPAP group，and the difference was statistically significant（t=-2.548，P=0.013）．There were no significant differences in weaning failure rate，oxygen inhalation time after noninvasive respiratory support，and incidence of adverse reactions between the two groups（P＞0.05）．Conclusions   Compared with NCPAP mode，NIPPV mode for non-invasive respiratory support in preterm infants after extubating has better clinical effect，and it is worthy of clinical application．