目的 探讨超声监测导向下早期肠内营养（EEN）在重症脓毒血症（SS）有创通气（IV）患者中的应用效果。方法 选取2021年2月—2023年11月连州市人民医院收入的115例SS-IV患者,依据随机数字表法分为对照组（n=57）、超声监测组（n=58）。所有患者均予重症监护病房（ICU）综合治疗,在此基础上对照组实施临床经验的传统肠内营养（EN）干预,超声监测组实施超声监测导向下EEN干预,均监测至治疗结束。统计两组IV时间、ICU停留时间、EN达标时间、EN不耐受发生率、相关并发症发生率,比较干预前、EN结束时营养状况[白蛋白（ALB）、总蛋白（TP）、前白蛋白（PA）]、序贯器官衰竭评分（SOFA）、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分。结果 对照组剔除放弃治疗1例,死亡2例,纳入54例;超声监测组剔除放弃治疗1例,死亡1例,纳入56例。超声监测组EN达标时间[（40.18±8.46）h]、IV时间[（7.12±1.44）d]、ICU停留时间[（9.21±1.63）d]短于对照组[（46.03±10.15）h、（8.02±1.62）d、（10.18±1.54）d]（t=3.288、3.082、3.206,均P<0.05）。EN结束时超声监测组SS-IV患者血清ALB[（32.05±3.13）g/L]、TP[（65.36±3.62）g/L]、PA[（0.24±0.06）g/L]高于对照组[（30.28±2.24）g/L、（63.28±4.24）g/L、（0.21±0.05）g/L]（t=3.400、2.770、2.843,均P<0.05）。EN结束时超声监测组APACHEⅡ评分[（15.85±1.93）分]、SOFA评分[（7.42±1.64）分]低于对照组[（17.02±2.04）分、（8.35±2.03）分]（t=3.091、2.648,均P<0.05）。超声监测组EN不耐受发生率[12.50%（7/56）]低于对照组[29.63%（16/54）],超声监测组相关并发症发生率[8.93%（5/56）]低于对照组[24.07%（13/54）]（χ²=4.878、4.608,均P<0.05）。结论 超声监测导向下EEN干预应用于SS-IV患者,可改善患者病情与营养状况,降低EN不耐受及相关并发症发生风险,缩短恢复时间。

Objective To investigate the effect of ultrasound monitoring guided early enteral nutrition（EEN）in patients with severe sepsis（SS）and invasive mechanical ventilation（IV）．Methods A total of 115 SS-IV patients admitted to Lianzhou People's Hospital from February 2021 to November 2023 were randomly divided into control group（n=57）and ultrasound monitoring group（n=58）．All patients were given comprehensive treatment in intensive care unit（ICU）．On this basis,traditional enteral nutrition（EN）intervention with clinical experience was implemented in control group,and EEN intervention guided by ultrasonic monitoring was implemented in ultrasound monitoring group．All patients were monitored until the end of treatment．IV time,ICU stay time,EN compliance time,incidence of EN intolerance,and incidence of related complications were analyzed in the 2 groups．Nutritional status [albumin（ALB）,total protein（TP）,prealbumin（PA）],sequential organ failure assessment（SOFA）,acute physiology and chronic health evaluation Ⅱ（APACHEⅡ）were compared before intervention and at the end of EN．Results In control group,1 cases gave up,2 cases died,and 54 cases were included．In ultrasound monitoring group,1 case gave up,1 case died,and 56 cases were included．The EN compliance time [（40.18±8.46）h],IV time [（7.12±1.44）d] and ICU stay time [（9.21±1.63）d] of ultrasound monitoring group were shorter than those of control group [（46.03±10.15）h,（8.02±1.62）d,（10.18±1.54）d]（t=3.288,3.082,3.206,all P<0.05）．At the end of EN,serum ALB[（32.05±3.13）g/L],TP[（65.36±3.62）g/L],PA[（0.24±0.06）g/L] of SS-IV patients in ultrasound monitoring group were higher than those in control group [（30.28±2.24）g/L,（63.28±4.24）g/L,（0.21±0.05）g/L]（t=3.400,2.770,2.843,all P<0.05）．At the end of EN,APACHEⅡ scores [（15.85±1.93）points] and SOFA scores [（7.42±1.64）points] of ultrasound monitoring group were lower than those of control group [（17.02±2.04）points and（8.35±2.03）points]（t=3.091,2.648,all P<0.05）．The incidence of EN intolerance in ultrasound monitoring group [12.50%（7/56）] was lower than that in control group [29.63%（16/54）],and the incidence of related complications in ultrasound monitoring group [8.93%（5/56）] was lower than that in control group [24.07%（13/54）]（χ²=4.878,4.608,all P<0.05）．Conclusions EEN intervention guided by ultrasonic monitoring in SS-IV patients can improve the nutritional status of patients,reduce the risk of EN intolerance and related complications,shorten the recovery time,and reduce the progression of patients' disease．

目的 探讨脊柱外科围术期康复指导方案的临床疗效。方法 选取毕节市第三人民医院脊柱外科184例行择期手术治疗的患者,对照组继续脊柱外科原康复方案行术前及术后管理,观察组使用新的康复行为规范方案,即系统行术前预康复指导和术后规范管理。对患者的术后起床活动、在院时间、住院费用、疼痛恢复情况、满意调查情况进行对比。结果 术前,患者的性别、年龄、病种分布对比差异无统计学意义（P>0.05）。术后,观察组的术后下床活动时间（3.09±1.02）d、住院时间（10.73±3.96）d、住院费用（17 388±5 217）元、术后2天VAS评分（3.04±1.19）分、出院时VAS评分（2.36±1.25）分、住院患者满意度（89.80±8.20）分,均优于对照组的术后起床活动时间（4.44±1.58）d、住院时间（13.38±2.73）d、住院费用（23 242±7 971）元、术后2天VAS评分（4.01±1.44）分、出院时VAS评分（3.39±1.38）分、住院满意度（80.27±11.45）分。新的康复指导方案在脊柱外科患者中较对照组减轻术后疼痛、减少患者卧床时间及缩短住院时间（P<0.05）。结论 围手术期加快患者术后康复及提高术后恢复优良率,提高患者就医满意度,使医患关系更加融洽。

Objective To investigate the clinical effect of the rehabilitation guidance protocol of spinal surgery in perioperative period．Methods A total of 184 patients undergoing selective surgery in the spine surgery department of the Third People's Hospital of Bijie City were selected．The conventional rehabilitation group was the control group,which preoperative and postoperative management was continued with the original rehabilitation program of spine surgery;the rehabilitation guidance group was the observation group：the new rehabilitation behavior code program was used to provide systematic preoperative pre-rehabilitation guidance and postoperative standardized management．The patients' activities of getting up after surgery,days in hospital,economic use,pain recovery and satisfaction survey were compared．Results Before surgical treatment,the gender,age and disease distribution of patients were compared（P>0.05）．After surgical treatment,observation group：Postoperative time of getting out of bed（3.09±1.02）d,length of hospitalization（10.73±3.96）d,hospitalization expenses（17 388±5 217）yuan,VAS score of 2 days after surgery（3.04±1.19）,VAS score of discharge（2.36±1.25）,inpatient satisfaction（89.80±8.12）,were significantly better than the control group：Postoperative activity time（4.44±1.58）d,length of hospitalization（13.38±2.73）d,hospitalization expenses（23 242±7 971）yuan,VAS score（4.01±1.44）,VAS score at discharge（3.39±1.38）,hospitalization satisfaction（80.27±11.45）．Compared with the control group,the new rehabilitation guidelines significantly reduced postoperative pain,bed time and hospital days in spinal surgery patients（P<0.05）．Conclusions Speeding up the postoperative rehabilitation of patients and improving the rate of postoperative recovery,improving patients' sense of access to medical treatment,can make the doctor-patient relationship more harmonious．

目的 了解广州市某净水公司职工脂肪肝检出情况,并分析影响因素。方法 选取2023年广州市某净水公司参加职业健康检查的职工为研究对象,收集研究对象的一般情况、个人史、职业史、身体质量指数（BMI）、血压、血生化指标、肝脏彩超等资料。对该人群脂肪肝的患病情况进行描述性分析,对脂肪肝的影响因素进行单因素及多因素Logistic回归分析。结果 共收集研究对象1 217人,检出脂肪肝543例,检出率为44.62%。单因素分析结果表明,脂肪肝的发生与性别、年龄、体质量指数、高血压相关（P<0.05）。接触硫化氢、氨的职工脂肪肝检出率高于非接触者（P<0.05）,且职工工龄越长,脂肪肝检出率越高（P<0.05）。患脂肪肝职工的肝功能、脂代谢、血糖及尿酸水平高于非脂肪肝者（P<0.05）。多因素Logistic回归分析提示,年龄、体质量指数、肝功能异常、脂代谢异常、高血糖、高尿酸是脂肪肝的影响因素（P<0.05）。结论 广州市某净水公司职工的脂肪肝检出率较高,脂肪肝的发生主要与年龄、体质量指数、肝功能异常、脂代谢异常、高血糖、高尿酸等因素相关。

Objective To investigate the prevalence of fatty liver disease and influencing factors among employees of a water purification company in Guangzhou．Methods Employees of a water purification company in Guangzhou who participated in occupational health examinations in 2023 were selected as the study subjects．The subjects' general conditions,personal history,occupational history,BMI,blood pressure,blood biochemical indicators,and liver ultrasound images were collected．Descriptive analysis was used to analyze the prevalence of fatty liver disease in this population．The influencing factors of fatty liver were analyzed by single factor and multiple factor Logistic regression．Results A total of 1 217 subjects were included in this study,and 543 were diagnosed as fatty liver disease,with a detection rate of 44.62%．The results of single factor analysis showed that the occurrence of fatty liver was closely related to gender,age,BMI and hypertension（P<0.05）．The analysis of occupational hazard factors showed that,the detection rate of fatty liver disease was higher in people exposed to hydrogen sulfide and ammonia compared to non-exposed individuals（P<0.05）．The longer the working years,the higher the detection rate of fatty liver（P<0.05）．The levels of liver function,lipid metabolism,blood glucose and uric acid in workers with fatty liver were higher than those in workers without fatty liver（P<0.05）．Multivariate Logistic regression analysis showed that age,BMI,abnormal liver function,abnormal lipid metabolism,high blood glucose levels and hyperuricemia were independent influencing factors for fatty liver disease（P<0.05）．Conclusions The detection rate of fatty liver disease among employees of a water purification company in Guangzhou is high,and the occurrence of fatty liver disease is mainly related to factors such as age,BMI,abnormal liver function,abnormal lipid metabolism,high sugar levels and hyperuricemia．

目的 探讨动态对比增强磁共振成像（DCE-MRI）多参数定量特征对乳腺癌腋窝淋巴结转移（ALNM）风险的预测价值。方法 回顾性收集2020年3月—2022年11月在佛山市高明区人民医院经手术病理确诊的155例乳腺癌患者临床资料,根据患者是否发生ALNM分为ALNM 组（n=39）和无ALNM 组（n=116）。采用单因素分析和多因素Logistic回归分析乳腺癌发生ALNM的影响因素。结果 ALNM组和无ALNM 组患者的肿块质地、肿块直径、肿块部位、肿块形状、肿块内部强化特征等指标比较差异无统计学意义（t/χ²=2.249、0.977、1.369、0.524、2.158,P>0.05）。两组患者肿块表观扩散系数（ADC）值、腋窝淋巴结（ALN）短径、肿块边缘、动态增强时间-信号强度曲线（TIC）曲线等指标比较,差异有统计学意义（t/χ²=6.573、9.873、29.441、2.031,P<0.05）。二元Logistic回归模型结果显示,肿块ADC值、ALN 短径（≥5 mm）、TIC曲线（流出型）为乳腺癌ALNM发生的危险因素（OR=0.251、0.106、0.002,P<0.05）。结论 DCE-MRI多参数定量特征中,乳腺癌患者的肿块ADC值低、ALN 短径（≥5 mm）、TIC曲线（流出型）为乳腺癌ALNM发生的危险因素。

Objective To investigate the predictive value of multi-parameter quantitative features of dynamic contrast-enhanced magnetic resonance imaging（DCE-MRI）in the risk of axillary lymph node metastasis（ALNM）in breast cancer．Methods Clinical data of 155 patients with breast cancer diagnosed by surgery and pathology in Foshan Gaoming District People's hospital from March 2020 to November 2022 were retrospectively collected．According to whether the patients had ALNM,they were divided into ALNM group（n=39）and non-ALNM group（n=116）．Univariate analysis and multiple Logistic regression models were used to explore the influencing factors of ALNM in breast cancer．Results There was no significant difference in mass texture,mass diameter,mass location,mass shape and internal enhancement between the ALNM group and the non-ALNM group（t/χ²=2.249,0.977,1.369,0.524,2.158,P>0.05）．There were significant differences in ADC value,ALN short diameter,tumor margin and TIC curve between the two groups（t/χ²=6.573,9.873,29.441,2.031,P<0.05）．Binary Logistic regression model showed that ADC value,ALN short diameter（≥5 mm）and tumor margin（blur）were risk factors for the occurrence of breast cancer ALNM（OR=0.251,0.106,0.002,P<0.05）．Conclusions Among the multi-parameter quantitative features of DCE-MRI,the ADC value of breast cancer,the short diameter of ALN（≥5 mm）,and the edge of the tumor（blur）are the risk factors for the occurrence of ALNM in breast cancer．

目的 探讨高频超声对小儿梅克尔憩室所致肠梗阻的诊断价值。方法 选取广州市妇女儿童医疗中心2018年1月—2023年12月经手术证实的由梅克尔憩室引起的肠梗阻患儿41例作为研究对象,回顾性分析患儿临床资料及超声表现,并与术中所见和病理结果进行对照。结果 41例患儿,发病平均年龄为（3.97±3.69）岁,其中男32例、女9例。术前超声诊断肠梗阻38例,诊断符合率为92.7%;诊断梅克尔憩室所致肠梗阻9例,诊断符合率为21.9%。术中诊断梅克尔憩室索带卡压肠管24例,腹内疝8例,肠扭转1例;肠套叠10例;梅克尔憩室炎症、粘连6例,粘连穿孔1例;憩室内异物并穿孔1例。结论 高频超声对小儿肠梗阻有重要的诊断价值,仔细探查可以明显提高梅克尔憩室所致肠梗阻的临床诊断率,为临床尽早手术提供重要依据。

Objective To investigate the diagnostic value of high frequency ultrasound for intestinal obstruction caused by Meckel's diverticulum in children．Methods From January 2018 to December 2023,41 children with intestinal obstruction caused by Meckel's diverticulum were selected as the study objects．The clinical data and ultrasound images of the children were analyzed retrospectively,and compared with the intraoperative and pathological results．Results In 41 patients,the average age of onset was（3.97±3.69）years ,including 32 males and 9 females．Preoperative ultrasonic diagnosis of intestinal obstruction in 38 cases,diagnosis coincidence rate was 92.7%．Intestinal obstruction caused by Meckel's diverticulum was diagnosed in 9 cases,the diagnosis coincidence rate was 21.9%．During the operation,24 cases of Meckel's diverticulum intestinal compression were diagnosed,8 cases of abdominal hernia,1 case of intestinal torsion,and intussusception of 10 cases．Meckel's diverticulum had inflammation and adhesion in 6 cases and adhesion perforation in 1 case．A case of foreign body in diverticulum with perforation．Conclusions High-frequency ultrasound has an important diagnostic value for intestinal obstruction in children．Careful exploration can significantly improve the clinical diagnosis rate of intestinal obstruction caused by Meckel's diverticulum,and provide an important basis for early clinical operation．

目的 探讨表皮生长因子受体酪氨酸酶抑制剂（EGFR-TKIs）一线治疗耐药后,二线化学治疗（化疗）联合程序性死亡蛋白1及其配体（PD-1/L1）免疫检查点抑制剂方案对晚期非小细胞肺癌（NSCLC）的疗效。方法 选取2018年 6月—2022年10月期间就诊于南通大学附属肿瘤医院院的80例有完整临床资料、应用EGFR-TKIs耐药后晚期NSCLC患者进行回顾性分析,依照不同治疗方式将患者分为观察组与对照组,均为40例。对照组一线EGFR-TKIs治疗耐药后进行二线化疗,观察组一线EGFR-TKIs治疗耐药后进行二线化疗联合PD-1/L1免疫检查点抑制剂治疗。对比两组临床疗效及无进展生存期（PFS）,化疗前后血清中人细胞角蛋白21-1片段（Cyfra21-1）、糖类抗原125（CA125）、碱性成纤维细胞生长因子（bFGF）、血管内皮生长因子（VEGF）水平变化,不良反应发生率及生存质量。结果 观察组客观缓解率与疾病控制率高于对照组（P<0.05）,对照组PFS为10（2.38,24.13）个月,观察组PFS为14（5.27~,5.27）个月,观察组高于对照组（χ²=4.536,P=0.041）;化疗后两组bFGF、VEGF,CA125、Cyfra21-1肿瘤标志物水平均比化疗前降低,且观察组[（17.85±3.32）ng/L、（310.51±88.37）ng/L、（51.62±13.66）U/mL、（10.26±3.37）ng/mL]低于对照组[（19.62±3.24）ng/L、（366.26±49.42）ng/L、（59.26±9.35）U/mL、（12.62±2.73）ng/mL],对比差异有统计学意义（t₁=2.413,P₁=0.018;t₂=3.482,P₂<0.001;t₃=2.919,P₃=0.005;t₄=3.442,P₄<0.001）;两组不良反应发生率对比差异无统计学意义（P>0.05）;化疗后两组世界卫生组织生存质量量表简表评分均升高,观察组[（98.62±8.24）、（101.53±12.62）、（95.28±11.15）、（97.79±10.47）分]高于对照组[（84.25±7.32）、（93.58±15.75）、（82.24±9.34）、（83.47±8.38）]分,对比差异有统计学意义（t₁=8.246,P₁<0.001;t₂=2.491,P₂=0.015;t₃=5.670,P₃<0.001;t₄=6.753,P₄<0.001）。结论 对EGFR-TKIs耐药后晚期非小细胞肺癌患者采取二线化疗联合PD-1/L1免疫检查点抑制剂可提升其临床疗效及生存期,改善血清相关肿瘤标志物表达水平,提升患者生存质量。

Objective To explore the therapeutic effect of second-line chemotherapy combined with PD-1/L1 immune checkpoint inhibitor regimen on advanced non-small cell lung cancer（NSCLC） after epidermal growth factor receptor-tyrosine kinase inhibitors（EGFR-TKIs）resistance in first-line chemotherapy．Methods Retrospectively selected 80 patients with advanced NSCLC EGFR TKIs resistance,who were admitted to the Affiliated Cancer Hospital of Nantong University from June 2018 to October 2022．Patients were divided into an observation group and a control group according to different treatment methods,with 40 cases in each group．The control group received second-line chemotherapy after first-line EGFR-TKIs therapy resistance,while the observation group received second-line chemotherapy and PD-1/L1 inhibitor after first-line EGFR-TKIs therapy reactions and quality of live．Clinical efficacy and PFS,changes in serum levels of human Cyfra21-1,CA125,bFGF,VEGF,incidence of adverse chemotherapy of two groups were compared．Results The ORR and DCR of the observation group were significantly higher than those of the control group（P<0.05）．The mean PFS of the control group was 10（2.38-24.13）months,while the mean PFS of the observation group was 14（5.27-35.27）months．The observation group was higher than the control group（χ²=4.536,P=0.041）．After chemotherapy,levels of bFGF,VEGF,CA125 and Cyfra21-1 tumor markers decreased in both groups,and the observation group [（17.85±3.32）ng/L,（310.51±88.37）ng/L,（51.62±13.66）U/mL,（10.26±3.37）ng/mL] was lower than the control group [（19.62±3.24）ng/L,（366.26±49.42）ng/L,（59.26±9.35）U/mL,（12.62±2.73）ng/mL],which showed statistically significant difference in the comparison（t₁=2.413,P₁=0.018;t₂=3.482,P₂<0.001;t₃=2.919,P₃=0.005;t₄=3.442,P₄<0.001）．There was no significant difference in the incidence of adverse reactions between the two groups（P>0.05）．After treatment,the WHO QOL-BREF scores increased in both patient groups and the observation group scores[（98.62±8.24）,（101.53±12.62）,（95.28±11.15）,（97.79±10.47）] were higher than the control group scores[（84.25±7.32）,（93.58±15.75）,（82.24±9.34）,（83.47±8.38）],which showed statistically significant difference．（t₁=8.246,P₁<0.001;t₂=2.491,P₂=0.015;t₃=5.670,P₃<0.001;t₄=6.753,P₄<0.001）．Conclusions The combination of second-line chemotherapy with PD-1/L1 immune checkpoint inhibitors can improve the clinical efficacy and survival of advanced NSCLC patients who are resistant to EGFR-TKIs,improve the expression levels of serum related tumor markers,and enhance the quality of life of patients．

目的 应用高频超声观察眼轮匝肌的解剖信息和动态特征,探究肉毒毒素注射前超声评估的可行性,为个体化、精准化的治疗提供可能,以实现更加安全、更加高效的治疗效果。方法 采用高频超声获取40名20~30岁健康志愿者的双侧80条眼轮匝肌的长轴、短轴切面声像图,观察其全程形态、内部回声,并测量外眦水平眼轮匝肌最外侧缘与外眦之间的距离、外眦水平眼轮匝肌最厚处的前后径、外眦水平眼轮匝肌最厚处与表皮之间的距离,并对数据进行统计学分析。结果 高频超声可以清晰地显示眼轮匝肌全程的走形和整体肌束结构。微笑时可见外眦外侧的眼轮匝肌向内收缩,并出现不同程度的增厚。男性和女性外眦水平眼轮匝肌最外侧缘与外眦之间的距离分别为左侧（27.50±2.58）（25.32±2.17）mm,右侧（27.35±2.15）（25.11±2.08）mm;外眦水平眼轮匝肌最厚处的前后径分别为左侧（1.055±0.209）（0.770±0.172）mm,右侧（1.010±0.171）（0.775±0.162）mm;外眦水平眼轮匝肌最厚处与表皮之间的距离分别为左侧（2.450±0.274）（2.860±0.375）mm,右侧（2.430±0.252）（2.825±0.424）mm。上述3种指标在左右侧对比差异无统计学意义（P>0.05）。与男性对比,女性外眦水平皮下组织较厚、眼轮匝肌较薄,其最外侧缘与外眦之间的距离较短（P<0.05）。结论 高频超声为观察青年人群眼轮匝肌结构的有效影像学工具,可用于肉毒毒素注射前的面部评估。

Objective To observe the anatomical information and dynamic characteristics of the orbicularis oculi muscle by high-frequency ultrasound,to explor the feasibility of ultrasound evaluation before botulinum toxin injection,and to provide the possibility for personalized and precise treatment to achieve safer and more efficient therapeutic effects．Methods High frequency ultrasound was used to obtain long axis and short axis sectional ultrasound images of 80 bilateral orbicularis oculi muscles from 40 healthy volunteers aged 20-30．The overall morphology and internal echoes were observed,and the distance between the outermost edge of the orbicularis oculi muscle and the outer canthus,the anterior posterior diameter of the thickest part of the orbicularis oculi muscle at the outer canthus level,and the distance between the thickest part of the orbicularis oculi muscle and the epidermis at the outer canthus level were measured．Statistical analysis was performed on the data．Results High frequency ultrasound can clearly display the entire course of the orbicularis oculi muscle and the overall muscle bundle structure．When smiling,the orbicularis oculi muscle on the outer side of the outer canthus can be seen to contract inward and show varying degrees of thickening．The distance between the outermost edge of the orbicularis oculi muscle and the outer canthus of males and females were（27.50±2.58）（25.32±2.17）mm on the left side and（27.35±2.15）（25.11±2.08）mm on the right side,respectively．The anterior posterior diameters of the thickest part of the orbicularis oculi muscle at the level of the outer canthus were left（1.055±0.209）（0.770±0.172）mm and right（1.010±0.171）（0.775±0.162）mm,respectively．The distance between the thickest part of the orbicularis oculi muscle at the level of the outer canthus and the epidermis were（2.450±0.274）（2.860±0.375）mm on the left side and（2.430±0.252）（2.825±0.424）mm on the right side．There was no statistically significant difference in the comparison of the above three indicators on the left and right sides（P>0.05）,while there was a statistically significant difference in the mean values of both males and females（P<0.05）．Compared with males aged 20-30,females had thicker subcutaneous tissue at the level of the outer canthus and thinner orbicularis oculi muscle,with a shorter distance between the outermost edge and the outer canthus． Conclusions High frequency ultrasound is an effective imaging tool for observing the structure of the orbicularis oculi muscle in young population,and can be used for facial assessment before botulinum toxin injection．

目的 调查护理人员对预防跌倒知识掌握的情况,以提高其对防跌倒相关知识的认知水平,减少住院患者跌倒的发生。方法 用自编住院患者跌倒相关知识掌握量表对护理人员进行问卷调查。结果 护理人员对跌倒知识的掌握正确率最高为跌倒分级64.04%、最低为跌倒后干预措施17.10%。外科护理人员对患者跌倒风险评估时机的把握为88.69%,妇儿科护理人员的正确率（71.11%）高（χ²=21.319,P=0.003）,住院患者发生跌倒后的处理正确率急诊为76.67%,高于门诊的42.67%（χ²=27.651,P<0.001）;在把握患者跌倒风险评估的时机方面工作年限<5年的护理人员为 89.81%,比工作年限>20年的护理人员（64.15%）更容易把握患者跌倒风险评估的时机（χ²=18.921,P<0.001）,工作年限11~20年的护理人员对住院患者预防跌倒的干预措施正确率为24.66%,比工作年限<5年的护理人员（11.46%）高（χ²=9.678,P=0.022）;工作年限>20年的护理人员对住院患者发生跌倒后的处理正确率为58.49%比工作年限<20年以下的护理人员（34.25%）高（χ²=12.787,P=0.005）。结论 护理人员跌倒预防相关知识掌握度总体较低,应加强对护理人员关于患者跌倒预防知识的系统培训,减少住院患者跌倒的发生。

Objective To investigate the mastery of falls prevention knowledge among nursing staffs,in order to improve their cognitive level of falls prevention related knowledge and reduce the occurrence of falls in hospitalized patients．Methods A questionnaire survey was conducted among nursing staffs with a self-designed questionnaire on the mastery of falls related knowledge among hospitalized patients．Results The highest accuracy rate of nursing staffs' mastery of falls knowledge was 64.04% for falling classification,and the lowest was 17.10% for falls intervention measures．Nursing staffs' accuracy of the timing of patient fall risk assessment was 88.69% in surgery,which was higher than 71.11% in nursing staff in obstetrics,gynecology,and pediatrics（χ²=21.319,P=0.003）．The accuracy of emergency treatment for hospitalized patients after falls was 76.67%,which was higher than 42.67% in outpatient treatment（χ²=27.651,P<0.001）．The accuracy of the timing of patient fall risk assessment in nursing staffs with less than 5 years of work experience was 89.81%,which was better than nursing staff with more than 20 years of work experience（64.15%）（χ²=18.921,P<0.001）．Nursing staff with 11-20 years of work experience had a correct intervention rate for preventing falls in hospitalized patients of 24.66%,which was higher than nursing staffs with less than 5 years of work experience（11.46%）（χ²=9.678,P=0.022）．The accuracy rate of handling falls in hospitalized patients by nursing staffs with more than 20 years of work experience was 58.49%,which was higher than that of nursing staff with less than 20 years of work experience,which is 34.25%（χ²=12.787,P=0.005）．Conclusions Overall,nursing staff had a low level of falls prevention knowledge,and systematic training on patient fall prevention should be strengthened to reduce the occurrence of falls in hospitalized patients．

目的 建立针对炎症性肠病患者的运动锻炼方案。方法 通过系统检索Web of Science、Embase、Cochrane Library等数据库,综合相关文献并由两名研究者独立提取信息,制定出指导患者运动锻炼的方案。检索时间从建库截至2023年9月1日。结果 共筛选出12篇文献,包括指南、专家共识、Meta分析以及RCT试验。最终总结出运动的必要性、作用、适合人群、评估及筛选、运动方式选择、监测以及限制因素等7个方面,共计37条证据。结论 这些证据为轻中度炎症性肠病患者提供了有氧运动联合抗阻运动的最佳实践依据,可指导临床实践,规范运动训练,从而延缓疾病进展。

Objective To establish an exercise program for patients with inflammatory bowel disease（IBD）．Methods A systematic search was conducted in databases such as Web of Science,Cochrane Library,and Embase,with relevant literature being comprehensively reviewed．Information was independently extracted by two researchers to develop a program guiding patients' exercise．Searching terms included both Chinese and English keywords,with the searching period covering from the inception of the databases to September 1,2023．Results A total of 12 articles were screened,including guidelines,expert consensuses,Meta-analyses,and randomized controlled trials．Ultimately,37 pieces of evidence were summarized across seven aspects：the importance of exercise,suitable populations,assessment and screening,choice of exercise modes,monitoring and limiting factors．Conclusions These evidences provide the best practice basis for aerobic and resistance exercises in patients with mild to moderate IBD,guiding clinical practice,standardizing exercise training,and thus delaying disease progression．

乳腺癌是女性最常见的原发恶性肿瘤之一。目前,通过采用综合治疗手段,包括手术、新辅助治疗、辅助放化疗等多种手段,乳腺癌已成为疗效最佳的实体肿瘤之一。其中,新辅助治疗（NAT）包括新辅助化疗、靶向治疗和内分泌治疗,目的是使肿瘤降期、保乳、保腋窝,并可观察药物敏感性,是当前乳腺癌综合治疗中非常重要的组成部分,其治疗疗效对患者手术方式的选择和预后至关重要。尽管病理学评价在评估NAT疗效方面被公认为金标准,但其局限性在于只能通过有创手段在治疗后进行,无法在治疗前对患者做出准确预测。磁共振成像（MRI）作为一项广泛使用的乳腺成像技术,在评估NAT疗效中扮演着关键角色。近年来,人工智能技术,尤其是影像组学（Radiomics）和深度学习（Deep Learning）,在医学影像分析领域取得了显著进展。这些技术能够从医学图像中提取大量肉眼难以识别的特征,揭示病变内部的微观结构和生物学行为,全面反映肿瘤的异质性,这不仅有助于临床医生更准确地区分良、恶性肿瘤,还能对恶性肿瘤的预后进行更为精确的评估。本文系统综述了近年来基于MRI的人工智能技术在乳腺癌新辅助治疗疗效评估中的应用研究,旨在促进人工智能在NAT临床实践中的应用和发展,为乳腺癌NAT治疗策略的优化和个性化医疗的实现提供科学依据。

Breast cancer is one of the most common primary malignant tumors in women．Currently,breast cancer has become one of the most effective solid tumors by using comprehensive treatment methods,including surgery,neoadjuvant therapy,adjuvant radiotherapy and chemotherapy．Among them,neoadjuvant therapy（NAT）,including neoadjuvant chemotherapy,targeted therapy and endocrine therapy,is a very important part of the current comprehensive treatment of breast cancer．It aims to reduce the tumor stage,preserve the breast,preserve the armpit,and observe the drug sensitivity．Its therapeutic effect is crucial to the choice of surgical methods and prognosis of patients．Although pathological evaluation is recognized as the gold standard in evaluating the response to NAT,its limitation is that it can only be performed after treatment by invasive means,and cannot accurately predict response before treatment．As a widely used breast imaging technology,magnetic resonance imaging（MRI）plays a key role in evaluating the response to NAT．However,traditional MRI evaluation methods are limited by the individual differences of interobserver and the low repeatability of evaluation results,which affects the accuracy of efficacy evaluation to a certain extent．In recent years,artificial intelligence technology,especially radiomics and deep learning,has made significant progress in the field of medical image analysis．These techniques can extract a large number of features that are difficult to be recognized by the naked eye from medical images,reveal the internal microstructure and biological behavior of the lesion,and fully reflect the heterogeneity of the tumor．This not only helps clinicians to distinguish benign and malignant tumors more accurately,but also makes a more accurate assessment of the prognosis of malignant tumors．This article reviews the application and progress of MRI-based artificial intelligence technology in evaluating the response to neoadjuvant therapy for breast cancer in the past five years,aiming to promote the application and development of artificial intelligence in NAT clinical practice,and provide a scientific basis for the optimization of NAT treatment strategy and the realization of personalized medicine for breast cancer．