目的 探讨真武汤联合八段锦在老年冠状动脉粥样硬化性心脏病（冠心病）患者中的应用效果。方法 将96例75岁以上冠心病患者按照随机数字表法分为对照组与干预组,每组各48例。在12周的临床研究期间,对照组用规范的冠心病二级预防药物治疗;干预组在规范的冠心病二级预防药物治疗基础上,增加真武汤以及八段锦运动处方。结果 治疗后干预组中医临床疗效（P=0.023）和中医证候积分（P<0.001）均优于对照组。两组患者的心肺运动试验指标均有改善,且干预组在升高峰值摄氧量（Peak VO₂,P=0.005）、最大摄氧量（VO₂max,P=0.001）、氧脉搏（VO₂/HR,P=0.002）和无氧阈值时最大代谢当量（MET,P=0.001）,以及降低无氧阈值（AT,P<0.001）和二氧化碳通气当量（VE/VCO₂,P=0.020）方面比对照组更明显。两组患者在36项简明健康状态调查表（SF-36）评分的8个维度中评分均有所升高,其中在生理机能（P=0.001）、生理职能（P<0.001）、一般健康状况（P=0.018）、精力（P=0.007）、社会职能（P=0.010）、精神健康（P=0.004）方面,干预组效果优于对照组;而在躯体疼痛、情感职能维度改善方面,两组间结果相近,差异无统计学意义（P>0.05）。两组患者的匹兹堡睡眠质量指数（PSQI）均有所改善,且干预组效果优于对照组（P<0.001）。结论 真武汤联合八段锦能够进一步增强老年冠心病患者中医证候疗效,改善心肺运动试验Peak VO₂、VO₂max、VO₂/HR、MET、AT、VE/VCO₂等指标,并提高SF-36评分多个维度的生活质量及睡眠质量。

Objective To explore the therapeutic effects of Zhenwu Decoction combined with Baduanjin Qigong in older adults with coronary heart disease（CHD）．Methods Ninety-six patients with CHD aged ≥75 years were randomly divided into a treatment group and a control group,with 48 patients in each group．Within the 12-week period,the control group received standard secondary prevention therapy for CHD,while the treatment group received Zhenwu Decoction and Baduanjin Qigong prescription,in addition to the standard treatment．Results After treatment,both groups showed improvement in the traditional Chinese medicine（TCM）clinical efficacy,TCM syndrome,SF-36 scores and Pittsburgh Sleep Quality Index（PSQI）scores;increase in Peak VO₂,VO₂max,VO₂/HR,and metabolic equivalent（MET）;and decrease in AT and VE/VCO₂．However,the treatment group had a more pronounced improvement in the TCM clinical efficacy（P=0.023）,TCM syndrome（P<0.001）,PSQI scores（P<0.001）,and cardiopulmonary exercise testing（CPET）indicators including Peak VO₂（P=0.005）,VO₂max（P=0.001）,VO₂/HR（P=0.002）,MET（P=0.001）,AT（P<0.001）and VE/VCO₂（P=0.020）,compared to their control counterparts． For the SF-36 scores,in comparison to the control group,the treatment group presented better outcomes in enhancing physical functioning（P=0.001）,role limitations due to physical health（P<0.001）,general health（P=0.018）,vitality（P=0.007）,social functioning（P=0.010）and mental health（P=0.004）,but not in pain or role limitations due to emotional problems．Conclusions The Zhenwu Decoction combined with Baduanjin Qigong can enhance the TCM syndrome,improve various CPET indicators such as Peak VO₂、VO₂max、VO₂/HR、MET、AT and VE/VCO₂,and elevate both quality of life and sleep quality among older adults with CHD．

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 利用靶向二代测序技术探究天津市发热呼吸道症候群病原特征,分析病原流行特征,总结规律,为发热伴呼吸道症候群患者治疗策略提供指导。方法 收集2023年1月—2023年12月天津地区某四家医院初诊为发热伴呼吸道症候群的4 039例病例,通过tNGS技术检测,分析鉴定病原微生物,研究不同标本类型病原微生物分布、年龄分布、性别分布、不同时间季节感染分布、微生物类型分布趋势等。结果 4 039例经tNGS技术检测,共检测出90种潜在病原体,总阳性率为94.80%（3 829/4 039）。包括36种细菌、29种病毒、5种非典型病原体和20种真菌。不同种类病原体检出频次排序：革兰阴性细菌（G-细菌）>RNA病毒>DNA病毒>革兰阳性细菌（G+细菌）>真菌>非典型病原体。男女性别阳性检出率比较差异无统计学意义（χ²=0.249,P=0.618）;不同年龄段人群病原体谱有异质性,且阳性患者多分布在0~10岁和>60岁,阳性也集中在该两类人群,阳性率分别为47.90%（1 834/3 829）和31.24%（1 196/3 829）。在单一感染中,肺炎支原体占比最高,为4.91%,其次为新型冠状病毒,占1.59%,再次为呼吸道合胞病毒,占1.23%。不同季节不同感染类型具有差异,整体呈现夏冬季混合感染率高的特点,即夏季新冠病毒合并细菌（鲍曼不动杆菌、肺炎链球菌）,冬季肺炎支原体合并甲型、乙型流感病毒多见。肺炎支原体对大环内酯类药物耐药率随月份呈现增加趋势。结论 tNGS 技术在天津市发热呼吸道症候群样本中获得了较高的病原体检出率,病原体覆盖面广,通过提供更多的病原体信息,可以有效辅助鉴别混合感染和耐药信息。

Objective Using targeted next-generation sequencing technology to explore the composition of the pathogenic spectrum of febrile respiratory syndrome ,analyze the epidemic characteristics of the pathogen,summarize the rules,and provide accurate guidance for the treatment strategy of patients with febrile respiratory syndrome．Methods By tNGS detection of 4039 cases with fever with respiratory diseases in four hospitals in Tianjin in 2023,pathogenic microorganisms were analyzed and identified,and the distribution of pathogenic microorganisms,age distribution,gender distribution,infection distribution in different times and seasons,and distribution trend of microbial types in different specimen types were studied．Results In 4039 cases,90 potential pathogens were detected,the total positive rate was 94.80%（3 829/4 039）,including 36 kinds of bacteria,29 kinds of viruses,5 kinds of atypical pathogen and 6 kinds of fungi．The order of detection frequency of different types of pathogens：G-bacteria > RNA virus > DNA virus > G+ bacteria > fungi > atypical pathogens．There was no significant difference in the positive rate of male and female between the two groups（χ²=0.249,P=0.618）．The pathogen spectrum of different age groups was heterogeneous． The positive patients were mostly distributed in 0-10 years old [47.90%（1 834/3 829）] and >60 years old [31.23%（1 196/3 829）]．Among the single infection,Mycoplasma pneumoniae accounted for the highest proportion,4.91%（188/3829）,followed by 2019-nCoV,1.59%（61/3 829）,and respiratory syncytial virus,1.23%（47/3 829）．There were differences in different infection types in different seasons,and the overall characteristics of mixed infection rate in summer and winter were high． In summer,the new coronavirus was combined with bacteria（Acinetobacter baumannii,Streptococcus pneumoniae）,and in winter,Mycoplasma pneumoniae was combined with influenza A and B viruses．The resistance rate of Mycoplasma pneumoniae to macrolides showed an increasing trend with the time．Conclusions The tNGS technology had obtained a high pathogen detection rate in the samples of febrile respiratory syndrome in Tianjin．By providing more pathogen information,it can be effectively applied to the etiological diagnosis of respiratory infectious diseases and assist in the identification of mixed infections and drug resistance information．

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 探讨人外周血中炎症因子的表达与炎性衰老的相关性。方法 通过招募年轻和老年志愿者,检测外周血中炎症因子IL-6、IL-8、TNF-α和IL-1β的mRNA表达水平和蛋白水平。结果 显示老年个体组中IL-6,IL-8和TNF-α的mRNA表达水平高于年轻组,且蛋白水平呈现相同的趋势,比较差异均有统计学意义（P<0.05）。此外,通过热图分析了炎症因子mRNA和蛋白水平的相对表达谱,也发现相同的结果。结论 当年龄超过65岁以后,随着年龄的增长,体内的炎症因子表达水平会升高,这一结果具有成为炎性衰老生物标志物的潜力,对评估老年人的健康状况和疾病风险具有重要意义。

Objective To explore the correlation between the expression of inflammatory factors in human peripheral blood and inflamm-aging．Methods In this experiment,the young and old volunteers were recruited to detect mRNA and protein levels of IL-6,IL-8,TNF-α and IL-1β in peripheral blood．Results The results indicated that mRNA expression levels of IL-6,TNF-α and IL-8 in the old individuals were higher than the young individuals,and the protein concentration followed the same trend,with acceptable P value suggesting a great statistically significant difference．In addition,the relative expression profiles of mRNA and protein concentrations of inflammatory cytokines were analyzed by heat map,and the same results were found．Conclusions It shows that the expression level of inflammatory cytokines up-regulates along with age goes on over 65,which has the potential of inflammatory biomarkers of aging．