目的 探讨接受冠状动脉造影患者的中性粒细胞-淋巴细胞比值（NLR）、血小板-淋巴细胞比值（PLR）和单核细胞-淋巴细胞比值（MLR）与冠状动脉疾病（CAD）严重程度的关系。方法 收集2021年1月—2021年12月在六安市人民医院接受冠状动脉造影的150例急性冠脉综合征（ACS）患者。CAD的严重程度通过Gensini评分进行评估,150例ACS患者根据评分被分为轻度病变组（≤14分,41例）、中度病变组（15~47分,69例）和重度病变组（≥48分,40例）。比较3组的临床指标,采用相关统计学分析NLR、PLR、MLR与CAD严重性（Gensini评分）的相关性。结果 纳入研究的150例患者的平均年龄为（66.49±11.43）岁,男性占67.3%。在重度病变组,NLR和PLR值高于其他两组。在Pearson相关性检验中,Gensini评分与NLR呈正相关（r=0.319,P<0.001）,然而,Gensini评分与MLR、PLR之间无相关性（P>0.05）。在Logistic回归分析中,NLR（OR：1.306,95%CI：0.107~0.427）是CAD的独立危险因素。在ROC曲线分析中,发现NLR的曲线下面积最高,为0.723（95%CI：0.629~0.817,P<0.001）,NLR≥0.25为识别CAD存在的最佳临界值,灵敏度为78.49%,特异度为60.26%。结论 根据Gensini评分,NLR与CAD的严重程度呈正相关,而研究中未观察到MLR、PLR与CAD严重程度之间的关联。

Objective To explore the correlation of neutrophil-to-lymphocyte ratio（NLR）,platelet-to-lymphocyte ratio（PLR）,monocyte-to-lymphocyte ratio（MLR）with coronary artery disease（CAD）severity in patients undergoing coronary angiography．Methods A total of 150 patients with acute coronary syndrome（ACS）who underwent coronary angiography in Lu'an People's Hospital from January 2021 to December 2021 were enrolled．The severity of CAD was assessed by Gensini score,according to the score,150 patients with ACS were divided into mild disease group（≤14 points,41 cases）,moderate disease group（15-47 points,69 cases）and severe disease group（≥48 points,40 cases）．Clinical indicators of the three groups were compared,and related statistics were used to analyze the correlation between NLR,PLR,MLR and the severity of coronary artery lesions（Gensini score）．Results The average age of selected 150 patients was（66.49±11.43）,67.3% were male．In the severe disease group,NLR,PLR values were higher than the other two groups．A positive significant correlation was found between Gensini score and NLR（r=0.319,P<0.001）by Pearson's correlation test．However,no correlation was found between Gensini score and MLR and PLR（P>0.05）．In the Logistic regression analysis,NLR（OR：1.306,95% CI：0.107-0.427）was the independent risk factor of CAD．In receiver operating characteristic curve analysis,NLR was found to have highest area under the curve at 0.723（95% CI：0.629-0.817,P<0.001）,with an optimal cut-off value of 0.25,predicting the severe coronary lesion with a sensitivity of 60.26% and specificity of 78.49%．Conclusions The NLR is positively correlated with the severity of CAD．No correlation between MLR,PLR and severity of CAD in the cohort were observed．

目的 探讨与分析高频超声联合超微血流成像对肱三头肌肌腱断裂伴骨化性肌炎的诊断价值。方法 选择2020年7月—2022年5月在本院诊治的84例肱三头肌肌腱断裂患者作为研究对象,所有患者均行关节镜及超声检查,超声检查包括高频超声、超微血流成像,记录超声特征并判断诊断价值,根据关节镜检查结果分为骨化性肌炎组和非骨化性肌炎组。结果 84例患者中,经关节镜检查判断为合并骨化性肌炎24例（骨化性肌炎组）,占比28.6%。骨化性肌炎组超声表现为肱三头肌肌腱纤维呈连续性中断,含稍强回声的非均质等回声,近侧断端肌腱有回缩并增厚。非骨化性肌炎组（60例）超声表现为肱三头肌肌腱纤维呈连续性中断,局限性边界清晰非均质性稍低回声,两断端中间呈不均质低回声。骨化性肌炎组的骨质破坏、软组织肿胀与关节积液等占比分别为75.0%、79.2%、79.2%,均高于非骨化性肌炎组的20.0%、25.0%、35.0%（P<0.05）。骨化性肌炎组的肌腱面积、肌腱厚度、血管条数均比非骨化性肌炎组更高（P<0.05）。84例患者中,高频超声、超微血流成像与两者联合诊断为肱三头肌肌腱断裂伴骨化性肌炎分别为18例、23例、24例,高频超声、超微血流成像与两者联合诊断肱三头肌肌腱断裂伴骨化性肌炎的灵敏度为70.8%（17/24）、91.7%（22/24）、100.0%（24/24）,特异度为98.3%（59/60）、98.3%（59/60）、100.0%（60/60）。结论 肱三头肌肌腱断裂伴骨化性肌炎比较常见,高频超声联合超微血流成像在肱三头肌肌腱断裂伴骨化性肌炎的应用可有效反映病灶形态特征与血流特征,在诊断上具有很高的灵敏度与特异度。

Objective To explore and analyze the diagnostic values of high-frequency ultrasound combined with superb microvascular imaging（SMI）in triceps brachii tendon rupture with ossifying myositis．Methods From July 2020 to May 2022,84 cases of patients with triceps brachii tendon rupture who were diagnosed and treated in our hospital were selected as research subjects．All patients underwent arthroscopy and ultrasonography,ultrasonography including high-frequency ultrasound and SMI,to record ultrasound characteristics and determine diagnostic value,and patients were divided into ossifying myositis group and non-ossifying myositis group according to the results of the arthroscopic examination．Results In 84 patients,there were 24 patients（28.6%）diagnosed as ossifying myositis by arthroscopy（ossifying myositis group）．The ultrasound findings of the ossifying myositis group were interruption of the triceps brachii muscle tendon fibers with slightly strong echogenicity and heterogeneous isoechogenicity．The proximal severed tendon had retraction and thickening．In the non-ossifying myositis group（n=60）,the ultrasound findings showed a interruption of the triceps brachii muscle tendon fibers,with clear localized boundaries and slightly heterogeneous hypoechogenicity,and there was an uneven hypoechogenicity between the two broken ends．The proportions of bone destruction,soft tissue swelling and joint effusion in the myositis group were 75.0%,79.2% and 79.2%,which were significantly increased compared to 20.0%,25.0% and 35.0% in the non-ossifying myositis group（P<0.05）．The tendon area,tendon thickness and vascular number in the ossifying myositis group were significantly higher than those in the non-ossifying myositis group（P<0.05）．In the 84 patients,there were 18 cases,23 cases and 24 cases diagnosed of triceps tendon rupture with ossifying myositis by high-frequency ultrasound,SMI and their combination．The sensitivity of high-frequency ultrasound,SMI and their combination in the diagnosis of triceps tendon rupture with ossifying myositis were 70.8%（17/24）,91.7%（22/24） and 100.0%（24/24）,with specificity of 98.3%（59/60）,98.3%（59/60） and 100.0%（60/60）．Conclusions Triceps brachii tendon rupture with ossifying myositis is relatively common．The application of high-frequency ultrasound combined with SMI in triceps brachii tendon rupture with ossifying myositis can effectively reflect the morphological and blood flow characteristics of the lesion,with high sensitivity and specificity in diagnosis．

目的 探讨多参数磁共振成像对T₁高信号间隔与非T₁高信号间隔的原发性鼻腔鼻窦黑色素瘤（PSM）的鉴别价值。方法 回顾性分析经病理证实的 PSM 44例,术前均接受常规,DWI 和DCE-MRI检查。通过单因素和多因素Logistic分析评估T₁高信号间隔与非T₁高信号间隔PSM各MRI参数的差异。结果 44例PSMs 中,T₁高信号间隔PSMs 25例,非T₁高信号间隔PSMs 19例。两者在多参数MRI中,仅T₂低信号间隔,ADC值、达峰时间（Tp）及最大相对增强率（MRER）在单变量分析中差异存在统计学意义（均P<0.05）,在多因素Logistic分析中差异均无统计学意义（P均>0.05）。结论 多参数MRI对区分T₁高信号间隔与非T₁高信号间隔的PSM具有一定的指导价值,但并不能作为区分两者的独立预测指标。

Objective To evaluate the diagnostic value of multi-parameter MRI in differential diagnosis of primary sinonasal melanoma（PSM）with high- and non-high-T₁ signal septa．Methods Forty-four patients pathologically confirmed with PSMs underwent conventional,DWI and DCE-MRI examinations before operation．Univariate and multivariate Logistic analyses were used to evaluate the differences of MRI parameters between high- and non-high-T₁ signal septa in PSMs．Results Among 44 PSMs,25 cases had high T₁ signal septa and 19 cases had non-T₁ high signal septa．In multi-parameter MRI,only T₂ low signal septa,the value of ADC,peak time（TP）and maximum relative enhancement rate（MRER）were significantly different in univariate analysis（P<0.05）,but not in multivariate Logistic analysis（P>0.05）．Conclusions Multi-parameter MRI has some value in differentiating PSM with high-T₁ and non-high-T₁ signal septa,but it can not be used as an independent predictor to distinguish them．

受试者招募工作关乎临床研究质量与进度。无法按计划招募到合适的受试者,一直是研究者发起的临床研究（IIT）开展过程中面临的主要挑战之一。本文分析影响IIT项目受试者招募进度的常见因素,并借鉴国内外经验,从提高受试者认知度与信任度、拓宽招募渠道、加强人文关怀、建立多中心伦理协作审查机制等方面探讨推进受试者招募的具体措施,以期为IIT研究者及科研管理部门提供参考。

Recruitment of subjects is crucial to the quality and progress of clinical research．However,the inability to recruit suitable subjects according to the plan has been one of the major challenges faced by investigators in the process of conducting investigator-initiated trial（IIT）．This article analyzes the common factors that affect the recruitment progress of IIT projects,draws on domestic and international experiences,and explores specific measures to promote subject recruitment,including improving subject awareness and trust,expanding recruitment channels,enhancing humanistic care and establishing a multi-center ethical collaboration review mechanism,in order to provide reference for IIT researchers and research management departments．

嵌合基因是指由两个或多个原本不连续的基因片段重组而成的新基因,它们可以通过基因组重排、转录诱导等机制产生。嵌合基因在正常生理和发育过程中具有重要的功能和调控作用。嵌合基因可以改变原有基因的表达水平、编码蛋白质的结构和功能、信号通路的激活和抑制等,从而促进肿瘤细胞的增殖、侵袭、转移和耐药性。近年来,随着高通量测序技术的发展和应用,越来越多的嵌合基因被发现和鉴定,它们在不同类型的肿瘤中具有不同的表达模式和功能作用,为肿瘤的分子诊断、预后评估和靶向治疗提供了新的机会和挑战。本文旨在对嵌合基因产生的机制、检测方法和在肿瘤中的功能和应用等方面进行综述,为进一步认识嵌合基因在肿瘤进展中的功能机制及其精准化治疗提供参考。

Chimeric genes refer to novel genes formed by the recombination of two or more originally non-contiguous gene fragments through mechanisms like genomic rearrangement and transcriptional induction．They play important roles in physiological and developmental regulation．Chimeric genes can alter the expression,structure and function of original genes,modulate signaling pathway activation and inhibition,and thereby promote tumor cell proliferation,invasion,metastasis and drug resistance．In recent years,with the development and application of high-throughput sequencing technologies,increasing numbers of chimeric genes have been discovered and identified．They demonstrate different expression patterns and functional roles in various tumor types,providing new opportunities and challenges for molecular diagnosis,prognostic assessment and targeted therapy of cancers．This review summarizes the mechanisms of chimeric gene formation,detection methods and their functions and applications in tumors,to provide insights into the functional mechanisms of chimeric genes in tumor progression and their implications for precision treatment．

目的 研究高胆红素血症新生儿溶血三项及抗体效价的相关影响因素。方法 采用回顾性分析,选取我院2022年7月—2023年3月期间收治的新生儿高胆红素血症85例,所有患儿均接受溶血三项检查及母亲IgG 抗体效价检测,其中溶血三项包括直接抗人球蛋白试验、抗体释放试验、血清游离抗体试验。记录患儿出生孕周、性别、日龄、母亲怀孕次数、母亲分娩方式、母亲IgG 抗体效价及血红蛋白水平、总胆红素水平指标,观察上述因素对溶血三项检测阳性有无影响,并开展影响溶血三项检测阳性的多因素Logistic回归分析。结果 85例高胆红素血症患儿中,高胆红素血症阳性63例（74.12%）;其中男婴32例（50.79%）、女婴31例（49.21%）,A型30例（47.62%）、B型31例（49.21%）、O型2例（3.17%）、AB型0例（0.00%）。不同血型高胆红素血症患儿溶血三项阳性率比较差异无统计学意义（χ²=0.857,P=0.652）,不同母亲IgG 抗体效价高胆红素血症患儿溶血三项阳性率比较差异有统计学意义（χ²=19.807,P<0.001）。结论 新生儿溶血阳性可能与母体中血型抗体效价密切相关,可随其升高而升高,应针对特定人群开展针对性干预,改善新生儿结局。

目的 对比磁敏感加权成像（SWI）、磁共振成像（MRI）、第3代双源电子计算机断层扫描（CT）三种方式在急性缺血性脑卒中（AIS）患者血管内治疗后诊断出血灶以及碘对比剂外渗中的临床价值。方法 选取2022年1月—2023年2月在新乡医学院第一附属医院接受血管内治疗的80例AIS患者作为研究对象,所有患者均接受MRI、SWI、第3代双源CT检查,经综合分析后确定诊断结果,对比三种检查方法对治疗后早期出血灶的鉴别效能,同时以治疗72 h后的常规CT结果作为诊断金标准,评价三种检查方法诊断早期出血灶与碘对比剂外渗的效能。结果 MRI的阳性预测价值为90.32%、阴性预测价值为88.00%,SWI的阳性预测价值为93.55%、阴性预测价值为92.00%,第3代双源CT的阳性预测价值为93.75%、阴性预测价值为95.83%,其中第3代双源CT与金标准的一致性更高（Kappa=0.891）。与治疗72 h后的常规CT结果对比,MRI的曲线下面积（AUC）为0.907,诊断灵敏度为90.32%、特异度为88.00%、准确度为89.29%;SWI的AUC为0.937,诊断灵敏度为93.55%、特异度为92.00%、准确度为92.86%;第3代双源CT的AUC为0.971,诊断灵敏度为96.77%、特异度为92.00%、准确度为94.64%,第3代双源CT的诊断效能最高。结论 AIS血管内治疗后,采用SWI、MRI、第3代双源CT三种检查方式均能有效区分出血灶与碘对比剂外渗情况,且临床诊断价值较好。

目的 探讨烧伤后瘢痕整形患者康复期创伤后成长及情绪调节策略及干预效果。方法 选择2021年10月—2023年6月期间我院接收的55例烧伤后瘢痕整形患者作为研究对象,采用随机数字表法分为2组,对照组27例采取常规康复护理干预,观察组28例实施针对性评估及护理干预,评价2组创伤后成长特征、情绪调节策略、应对方式。结果 干预后,观察组自我转变、个人力量、人生感悟、新的可能性和与他人关系等评分均高于对照组（均P<0.05）。护理干预后观察组情绪调节评分（ERQ）优于对照组,其中认知重评评分更高、表达抑制评分更低,组间比较差异有统计学意义（均P<0.05）。护理干预后应对方式评分优于对照组,其中回避、屈服评分更低,面对评分更高（均P<0.05）。结论 基于康复期创伤后成长及情绪调节现状实施针对性护理干预可促进烧伤后瘢痕整形患者减轻创伤感受,能够以积极的情绪应对康复期,改善情绪状态。

李俊,广东省名中医,从事中医临床工作30年,尤擅长经方“峻剂轻投”治疗疑难杂症,主张根据病情需要,从小剂量用起;根据脾胃功能,以小剂量取效;根据慢性病的特点,以小剂量调治;根据个体差异,以小剂量获效;并注重杂合以治疗。

目的 探讨脑卒中患者多重耐药菌（MDROs）医院感染风险因素,并进行病原学特点分析。方法 选择2020年1月—2022年12月福建中医药大学附属福鼎医院神经内科病房收治的160例脑卒中患者为研究对象,评估患者的MDROs医院感染发生状况,调查患者的一般资料并进行多因素分析。结果 在160例患者中,发生医院感染20例,分离到病原体26株,其中8例样本为MDROs（研究组,其他归为对照组）,来源于8例患者,占比5.00%,包括耐甲氧西林金黄色葡萄球菌（MRSA）3株,耐碳青霉烯大肠埃希菌（E.coli）2株、耐碳青霉烯肺炎克雷伯菌（KP）1株、全耐药KP1株、耐碳青霉烯PA1株。研究组的美国国立卫生院神经功能缺损（NIHSS）评分、急性生理学和慢性健康状况评价Ⅱ（APACHEⅡ）评分、糖尿病、低蛋白血症、置管留置时间、住院时间等与对照组对比差异有统计学意义（P<0.05）。二分类Logistic回归分析显示,上述指标均为导致MDROs医院感染发生的重要因素（P<0.05）。结论 脑卒中患者MDROs医院感染的发生率依然比较高,病原菌多为耐甲氧西林MRSA、耐碳青霉烯E.coli,患者的NIHSS评分、APACHEⅡ评分、糖尿病、低蛋白血症、置管留置时间、住院时间为主要的MDROs感染风险因素。