心肌梗死是由冠状动脉阻塞所引起的心肌缺氧坏死,其发病率和病死率居高不下。近年研究发现,利用组织工程手段仿生构建心肌微环境能有效改善心肌梗死区微环境,对心肌的再生能力有着重要的调控作用,能在一定程度上促进心肌再生,有望成为将来治疗心肌梗死的新方向。然而,由于对仿生心肌微环境和机体微环境交互作用、引发的生物学效应及作用机制不清楚,直接影响心肌损伤修复的过程和质量。因此,阐明仿生心肌微环境在心肌损伤修复过程中的交互作用过程及其介导的生物学效应迫在眉睫。该文系统性综述了仿生心肌微环境的构建策略及植入体内后介导的生物学效应,包括免疫调控效应、促血管再生效应以及再生协同效应等,为新型心肌补片的仿生设计和临床应用提供理论支持。
Myocardial infarction（MI）,arising from coronary artery obstruction resulting in hypoxic necrosis of myocardium,remains high morbidity and mortality．Recent studies have revealed that constructing myocardial microenvironment bionically through tissue engineering methods can effectively ameliorate the microenvironment in the infarcted area and exert a crucial regulatory role in myocardial regeneration,which promotes myocardial regeneration to a certain extent and holds promise for the treatment of MI．However,the interaction between biomimetic myocardial microenvironment and host microenvironment,as well as the triggered biological effects and mechanisms are not clear,which directly affects the process and quality of myocardial repair．Therefore,it is urgent to clarify the interaction process and biological effects mediated by the biomimetic myocardial microenvironment during myocardial repair．This review systematically summarizes the construction strategies of biomimetic myocardial microenvironment and their mediated biological effects after implantation,including immunomodulatory effects,pro-vascular regenerative effects,and regenerative synergistic effects,which provides theoretical support for the biomimetic design and clinical application of novel cardiac patches．
新生儿期的免疫系统发育阶段对维持新生儿健康至关重要,具有独特的免疫调节机制。近年来,人们越来越关注髓源性抑制细胞（MDSCs）在新生儿免疫调节中的作用。MDSCs是一类免疫抑制功能强大的异质性细胞群体,它们能够通过多种机制调节免疫应答。MDSCs在新生儿中的调节作用对防止过度免疫反应和促进免疫耐受至关重要,有助于预防新生儿期炎症性疾病,并对其后续健康产生积极影响。近期研究文献分析展示了MDSCs在新生儿免疫调节中的多种作用机制,包括在特定病理条件下的保护作用、与新生儿期炎症反应的相互作用,以及对长期免疫发展的潜在影响。因此,深入理解MDSCs在新生儿免疫中的角色,不仅有助于揭示其复杂的调节机制,也为制定新的预防和治疗新生儿炎症性疾病的策略提供了新的思路。
The developmental stage of the immune system during the neonatal period is crucial for maintaining neonatal health,characterized by unique immunoregulatory mechanisms．In recent years,increasing attention has been drawn to the role of myeloid-derived suppressor cells（MDSCs）in neonatal immune regulation．MDSCs represents a heterogeneous population of cells with potent immunosuppressive functions,capable of modulating immune responses through various mechanisms．The regulatory role of MDSCs in neonates is vital for preventing excessive immune reactions and promoting immune tolerance,thereby aiding in the prevention of neonatal inflammatory diseases and positively influencing subsequent health outcomes．Analysis of recent research literature reveals multiple mechanisms through which MDSCs contribute to neonatal immune regulation,including protective effects under specific pathological conditions,interactions with neonatal inflammatory responses,and potential impacts on long-term immune development．Therefore,a comprehensive understanding of the role of MDSCs in neonatal immunity not only helps elucidate their intricate regulatory mechanisms but also provides novel insights for developing strategies for the prevention and treatment of neonatal inflammatory diseases．
肥胖是一种以慢性低度炎症为特征的进展性疾病,与多种代谢性疾病的发生、发展密切相关。脂肪组织作为一种内分泌和免疫器官,可分泌多种生物活性物质及炎症因子,参与肥胖患者体内的代谢过程。减重手术是治疗病态性肥胖及相关代谢性疾病的有效方法之一,能够调节机体内的炎症反应、有效改善代谢状态。但减重手术对于炎症因子的作用如何,目前国内外的文献证据仍有争议。本文将系统阐述肥胖与代谢性炎症的关系以及减重手术对炎症因子的影响,旨在为肥胖代谢外科的诊疗过程提供参考。
Obesity is a progressive disease characterized by chronic low-grade inflammation,which is closely related to the occurrence and development of a variety of metabolic diseases．As an endocrine and immune organ,adipose tissue can secrete a variety of bioactive substances and inflammatory factors,which participate in the metabolic process of obese patients．Bariatric surgery is one of the effective methods for the treatment of morbid obesity and related metabolic diseases,which can regulate the inflammatory response in the machine and effectively improve the metabolic state．However,the effect of bariatric surgery on inflammatory factors is still controversial at home and abroad．This article will systematically explain the relationship between obesity and metabolic inflammation and the effect of bariatric surgery on inflammatory factors,aiming to provide a reference for the diagnosis and treatment process of bariatric surgery．
大蒜为百合科葱属植物的地下鳞茎,具有药食两用的价值,其含有大蒜素、二烯丙基硫醚、二烯丙基二硫醚、二烯丙基三硫醚、 硫-烯丙基半胱氨酸等多种生物活性成分,具有抗氧化、抗感染、免疫调节、心血管保护、抗癌等作用。不仅如此,大蒜在糖脂代谢的调节中功效显著,且相关机制日益明晰,主要包括保护胰岛β细胞功能、改善胰岛素抵抗、阻止脂肪细胞生长、抑制脂合成代谢及调节肠道菌群分布等。不同的提取工艺可影响大蒜的功效,其提取手段及药效关系值得进一步研究。
Garlic has values of both medicine and food,with rich allicin,diallyl disulfide（DADS）,diallyl trisulfide（DATS）and other garlic sulfur contents,which have been found to have multiple effets such as antioxidant,anti-infection,immunomodulatory,cardiovascular protection,anti-cancer,etc．Moreover,numerous studies have demonstrated that garlic plays an important role in the regulation of glycose and lipid metabolism,and the relevant mechanisms are becoming better understood,including protecting pancreatic β cells,improving insulin resistance,preventing the growth of fat cells,inhibiting lipid anabolism and adjusting the distribution of intestinal microflora．Different extraction processes can affect the efficacy of garlic,and further investigations are needed to elucidate the relationship between effective extraction methods and pharmacodynamic properties．
目的 运用数据挖掘的方法检测奥马珠单抗上市后的不良反应信号,为临床安全合理用药提供参考。方法 本研究采用报告比值比法（ROR）和贝叶斯判别可信区间递进神经网络法（BCPNN）对美国FDA不良事件报告系统（FAERS）中2004年第1季度至2023年第2季度的奥马珠单抗相关不良事件（ADE）报告进行数据挖掘和信号检测。结果 通过数据挖掘和信号检测,涉及奥马珠单抗的ADE报告中提取了186,353份报告,涉及45,383例患者。在这些报告中,女性（65.31%）比例远高于男性（24.97%）。主要报告国家为美国（64.93%）和加拿大（11.96%）。报告者中以消费者（41.35%）和医师（36.97%）为主要群体。研究发现了621个ADE阳性信号,涉及25个系统器官分类（SOC）,主要包括呼吸系统、胸部和纵隔疾病（21.29%）以及感染和侵染类疾病（10.91%）。其中,183个信号被评定为高风险信号,其中包括57个新的高风险信号,如血压升高、易醒型失眠和心律失常等。这些发现有助于更全面地了解奥马珠单抗的安全性和潜在风险。结论 在奥马珠单抗的临床应用过程中,除了要注意药品说明中提到的已知不良反应外,还需特别警惕潜在的不良药物事件,如血压升高、心率升高、中间易醒型失眠、体位性心动过速综合征等。
Objective To use data mining method to detect the adverse reaction signal of omalizumab after marketing,and to provide reference for clinical safety and rational drug use．Methods In this study,the report odds ratio method（ROR）and Bayesian confidence propagation neural network（BCPNN）were used to conduct data mining and signal detection for omalizumab-related adverse event（ADE）reports from the FDA Adverse Event Reporting System（FAERS）from the first quarter of 2004 to the second quarter of 2023．Results Through data mining and signal detection,186,353 reports of ADE involving omalizumab were extracted,involving 45,383 patients．Among these reports,the proportion of women（65.31%）was much higher than that of men（24.97%）．The main reporting countries were the United States（64.93%）and Canada（11.96%）．consumers（41.35%）and doctors（36.97%）were the main groups of reporters．The study identified 621 ADE positive signals across 25 system organ classes（SOCs）,including respiratory,chest,and mediastinal diseases（21.29%）and infectious and infectious diseases（10.91%）．Of these,183 signals were assessed as high risk,including 57 new high-risk signals．These findings contribute to a more complete understanding of the safety and potential risks of omalizumab．Conclusions In the clinical application of omalizumab,in addition to the known adverse reactions mentioned in the drug description,special attention should be paid to potential adverse drug events,such as elevated blood pressure,elevated heart rate,intermediate insomnia,and postatic tachycardia syndrome．
目的 探究伏诺拉生三联疗法根除幽门螺杆菌（Hp）的疗效。方法 入组2022年5月—12月经13C尿素呼气试验确诊的Hp现症感染者200例,分为观察组和对照组,每组100例。观察组方案为阿莫西林、呋喃唑酮、伏诺拉生三联疗法,对照组方案为阿莫西林、呋喃唑酮、艾司奥美拉唑镁、枸橼酸铋钾四联疗法;疗程均为14 d。在治疗停药后1个月复查13C尿素呼气试验判定是否Hp根除成功,并观察药物不良反应发生率。结果 观察组Hp根除率为96.97%,高于对照组的89.80%,差异有统计学意义（P<0.05）;观察组不良反应发生率和对照组比较差异无统计学意义（P>0.05）。结论 伏诺拉生、阿莫西林、呋喃唑酮三联疗法的Hp根除率较高且安全性良好,可作为Hp感染的治疗方案之一。
Objective To explore the effect of vonoprazan triple therapy on Helicobacter pylori（Hp）．Methods A total of 200 patients with Hp infection confirmed by 13C urea breath test from May-December 2022 were selected and divided into observation group and control group with 100 patients in each group．The observation group was treated with triple therapy of amoxicillin,furazolidone and vonoprazan,while the control group was treated with quadruple therapy of amoxicillin,furazolidone,esomeprazole magnesium and bismuth potassium citrate．The treatment course was 14 days．The 13C urea breath test was reviewed one month after treatment withdrawal to determine whether Hp eradication was successful,and the incidence of adverse drug reactions was observed．Results The eradication rate of Hp in the observation group was 96.97%,higher than 89.80% in the control group,and the difference was statistically significant（P<0.05）．There was no significant difference in the incidence of adverse reactions between the observation group and the control group（P>0.05）．Conclusions The triple therapy of vonoprazan,amoxicillin and furazolidone has a very high eradication rate and good safety,which can be used as one of the treatment options for Hp．
目的 研究颈源性头痛患者颈椎X线中C2~C7棘突偏歪和椎体滑脱情况,总结其中存在的规律,为治疗颈源性头痛提供影像学理论支持。方法 选取颈源性头痛患者96例,观察并记录每位患者颈椎X线片中C2~C7棘突偏歪和椎体滑脱情况。用统计软件分别对棘突偏歪和椎体滑脱数据进行分析。结果 颈源性头痛患者较常出现棘突偏歪,右侧偏歪明显多于左侧偏歪。其中C2棘突偏歪最常见,出现比例为66.7%。C2棘突偏歪率与C3~C7分别进行χ2检验,其中C5、C6与C2均有显著差异。C3、C4、C7与C2均无显著差异。椎体滑脱亦常出现于颈源性头痛患者,其中C7椎体向前Ⅰ度滑脱最常见,出现比例为50.0%。C7椎体向前Ⅰ度滑脱率与C2~C6分别进行χ2检验,其结果均有显著差异。结论 C2棘突偏歪和C7椎体向前Ⅰ度滑脱较常出现于颈源性头痛患者。在治疗颈源性头痛患者时,与C2和C7相关的软组织损伤和关节紊乱应引起重点关注。
Objective To study the skew of C2~C7 spinous process deviation and spondylolisthesis in cervical spine X-ray of patients with cervical headache,and summarize the existing rules,so as to provide imaging theoretical support for the treatment of cervical headache．Methods The C2~C7 spinous process distortion and spondylolisthesis in cervical radiographs of 96 patients with cervical headache were observed,recorded and analyzed．Results Skew of spinous process was more common in patients with cervicogenic headache,and skew of right side was more obvious than skew of left side．C2 spinous process was the most common,and the proportion of occurrence was 66.7%．The skew rate of C2 spinous process were compared with that of C3~C7 by χ2 test．There were significant differences between C5,C6 and C2．There were no significant difference between C3,C4,C7 and C2．Spondylolisthesis was commonly seen in patients with cervicogenous headache,and I degree spondylolisthesis was most commonly seen in C7,and the proportion of occurrence was 50.0%．There were significant differences between the anterior Ⅰ degree slip rate of C7 vertebrae and that of C2~C6 vertebrae by χ2 test．Conclusions C2 spinous process and C7 spondylolisthesis I are more commonly seen in patients with cervicogenic headache．Soft tissue injuries and joint disorders associated with C2 and C7 should be paid more attention in the treatment of patients with cervicogenic headache．
目的 运用数据挖掘、网络药理学和分子对接的方法,探讨中药复方治疗中枢性性早熟（CPP）的用药规律和作用机制,为其临床治疗提供更多依据。方法 在中国知网（CNKI）、万方数据（Wanfang）、维普中文期刊（VIP）等数据库中检索从建库至2022年10月发表的中药复方治疗CPP的文献,用Excel 2021 收集整理临床治疗CPP的常用中药复方,并通过Excel 2021、SPSS Modeler 18.0、SPSS Statistics 25.0等软件对其进行频次、关联规律等分析,研究CPP治疗的用药规律。在上述基础上采用网络药理学的研究方法,筛选出高频药对的活性成分、作用靶点以及疾病的相关靶点,构建蛋白互作网络,并通过基因本体和京都基因 基因组百科全书通路富集分析来阐明药物的作用机制。最后运用 Autodock Vina 软件进行分子对接对结果验证。结果 共筛选出224篇文献,包含方剂133首,中药188味。发现18味使用超过25次的高频药物;清热类、补虚类的药物应用较多;药物性味以寒及苦为主;归经之中以肝经占比最高;进一步关联分析得到高频药对14个;核心处方4个。网络药理学结果显示,共得到44个活性成分、200个药物靶点、1 287个疾病靶点、70个共有靶点、573条GO富集条目及136条KEGG通路,药物主要成分槲皮素、山奈酚、β-谷甾醇作用于雌激素受体、黄体酮受体等核心靶点,通过内分泌抵抗、雌激素等信号通路发挥治疗作用。分子对接结果显示药物主要活性成分与相应核心靶点具有较好的结合能力。结论 中药复方治疗CPP多为滋阴清热、补虚类药物,与药性寒,药味苦、甘,归肝、肾经的药物配伍使用。其中高频药对“知母-黄柏”通过多成分、多靶点调控内分泌抵抗、雌激素信号通路发挥治疗作用。
Objective To explore the prescription rules and mechanism of traditional Chinese medicine（TCM） in the treatment of central precocious puberty（CPP）by using data mining,network pharmacology and molecular docking,so as to provide more evidence for clinical treatment．Methods Using the literature on the treatment of CPP with TCM compounds,which was retrieved from the databases of CNKI,Wanfang,VIP and other databases from the establishment of the database to October 2022 as the data sources．Excel 2021 was used to collect and summarize the commonly used TCM prescriptions for CPP,and conducted frequency analysis and association rules analysis of CPP by Excel 2021,SPSS Modeler 18.0,SPSS Statistics 25.0 and other software,so as to study the composition rule of prescriptions for CPP．On the basis of these results,network pharmacology method was used to screen out the active ingredients and action targets of high-frequency drugs,and then screen out the disease related targets to construct PPI network．Mechanism of drugs was clarified through GO and KEGG pathway enrichment analysis．Finally,the molecular docking of autodock Vina（Vina）platform was used to verify the results．Results A total of 244 documents met the search criteria,including 133 prescriptions and 188 traditional Chinese medicines．It had been found that 18 high-frequency Chinese medicines were used more than 25 times．The drugs mainly focused on clearing heat and supplementing deficiency．The medicinal flavors were mainly cold and bitter,which belonged to the liver channel．Further correlation analysis yielded 14 high-frequency drug pairs and 4 core prescriptions．The results of network pharmacological analysis showed that 44 active components,200 drug targets,1 287 disease corresponding targets,70 common targets,573 GO enrichment entries and 136 KEGG pathways targets were obtained．It has been found that the main components of the drugs,such as quercetin,kaempferol and β-sitosterol,act on the core targets of ESR1,PGR and play a therapeutic role through endocrine resistance and estrogen signaling pathways．Finally,molecular docking results showed that the main active ingredients of the drug had good binding ability with the corresponding core targets．Conclusions In the treatment of CPP,traditional Chinese medicine is mainly used types of nourish Yin,clear heat and replenish deficiency,which is compatible with the drugs with cold properties,bitter and pliant taste,and the liver and spleen channels．Among them,high-frequency drug pair “ZhiMu-HuangBai” play a therapeutic role in the regulation of endocrine resistance and estrogen signaling pathways through multi-components and multi-targets．
目的 探讨振幅整合脑电图（aEEG）联合头颅磁共振成像（cMRI）对早产儿矫正12月龄时神经发育的预测价值。方法 选取110例早产儿为研究对象,并在矫正12月龄时采用Gesell 发育量表评估发育商（DQ）,依据DQ分为Gesell 正常组（DQ≥85,n=83）、Gesell 异常组（DQ<85,n=27）。采集早产儿及母亲临床资料,对比两组出生后72 h内aEEG、矫正胎龄37周时cMRI检查指标差异。结果 两组早产儿及母亲基线资料比较差异无统计学意义（P>0.05）。相较于Gesell 正常组,Gesell 异常组双顶径（BPW）降低[（70.68±5.32）mm vs（66.54±3.69）mm],睡眠-觉醒周期（SWC）不成熟率（20.48% vs 85.19%）、aEEG异常率（30.12% vs 70.37%）、两半球间距（IHD）增高[（2.95±0.83） mm vs（3.56±0.72）mm]（P<0.05）。Pearson相关分析结果显示,DQ值与IHD呈负相关,DQ值与BPW呈正相关（r=-0.361、0.598,P<0.05）。二元Logistic回归分析结果显示,BPW增高是Gesell 异常的独立保护因素（P<0.05）,IHD增高、SWC不成熟及aEEG异常是Gesell 异常的独立危险因素（P<0.05）。结论 早产儿出生后72 h内aEEG异常、矫正胎龄37周时cMRI异常可能提示矫正12月龄时不良神经发育结局。
Objective To evaluate the predictive value of amplitude-integrated electroencephalogram combined with cranial magnetic resonance on neurodevelopment for preterm infants at corrected age of 12 months．Methods A total of 110 preterm infants were selected as study subjects,and Gesell developmental scale was used to evaluate developmental quotient（DQ）at corrected age of 12 months．According to DQ,they were divided into normal Gesell group（DQ≥85,n=83）and abnormal Gesell group（DQ<85,n=27）．Clinical data of preterm infants and their mothers were collected,and the differences of amplitude-integrated electroencephalogram and cranial MRI（cMRI）were compared between two groups．Results There was no significant difference in baseline data between two groups（P>0.05）．Compared with the normal Gesell group,the biparirtal width（BPW）in the abnormal Gesell group was decreased（70.68±5.32mm vs 66.54±3.69mm）,the immaturity rate of sleep-wake cycle（SWC）（20.48% vs 85.19%）,the abnormal rate of aEEG（30.12% vs 70.37%）,and（IHD）（2.95±0.83mm vs 3.56±0.72mm）were increased（P<0.05）．The results of Pearson correlation analysis showed that DQ was negatively correlated with IHD,and DQ was positively correlated with BPW（r=-0.361、0.598,P<0.05）．Binary Logistic regression analysis showed that increased BPW was an independent protective factor for abnormal Gesell（P<0.05）,and increased IHD,immature SWC and abnormal aEEG were independent risk factors for abnormal Gesell（P<0.05）．Conclusions Abnormal aEEG within 72h after birth and abnormal cMRI at corrected age of 37 weeks may lead to adverse neurodevelopmental outcomes at corrected age of 12 months．
目的 研究并分析星状神经节阻滞联合银杏叶提取物治疗颈源性头晕的临床效果。方法 选取周口骨科医院100例颈源性头晕的住院患者作为研究对象,于2022年6月—2023年6月期间内收治,根据入院顺序奇偶号将其分为对照组与观察组,各50例,对照组实行星状神经节阻滞治疗,观察组在对照组基础上联合使用银杏叶提取物治疗,对比两组患者的临床症状（头痛、眩晕、耳鸣、视物模糊）改善程度、颈部疼痛量表、临床效果和不良反应发生率。结果 治疗30 d后,观察组临床症状评分低于对照组（P<0.05）。两组治疗前的数字分级法评分差异无统计学意义（P>0.05）,治疗15 d与30 d时,观察组数字分级法评分评分均低于对照组（P<0.05）。观察组患者的治疗总有效率高于对照组（P<0.05）;治疗期间,观察组的并发症发生率低于对照组,比较差异有统计学意义（P<0.05）。结论 颈源性头晕患者使用星状神经节阻滞联合银杏叶提取物治疗,能够明显改善疾病症状,缓解颈部疼痛感,有效提高临床效果,同时降低不良反应发生率。
Objective To analyze the clinical study of stellate ganglion block combined with Ginkgo biloba extract to treat cervical dizziness．Methods A total of 100 hospitalized patients with cervical dizziness at Zhoukou Orthopedic Hospital were selected as the study subjects,who were admitted between June 2022 and June 2023．They were divided into a control group and an observation group based on the odd and even numbers of admission,with 50 cases in each group．The control group received stellate ganglion block treatment,while the observation group received a combination of Ginkgo biloba extract treatment on the basis of the control group,The degree of improvement in clinical symptoms（headache,dizziness,tinnitus,blurred vision）,neck pain scale,clinical efficacy,and incidence of adverse reactions were compared between two groups of patients．Results After 30 days of treatment,the clinical symptom score of the observation group was lower than that of the control group（P<0.05）．There was no statistically significant difference in the numerical grading scores between the two groups before treatment（P>0.05）．On the 15th and 30th day of treatment,the observation group had lower numerical grading scores than the control group（P<0.05）．The total effective rate of treatment in the observation group was higher than that in the control group（P<0.05）．During the treatment period,the incidence of complications in the observation group was lower than that in the control group,and the difference was statistically significant（P<0.05）．Conclusions The use of stellate ganglion block combined with Ginkgo biloba extract in the treatment of patients with cervicogenic dizziness can significantly improve their disease symptoms,significantly alleviate their neck pain,effectively improve the clinical effect,while reducing the incidence of adverse reactions．
目的 探讨作业疗法结合经皮神经电刺激对脑卒中后肩痛的疗效。方法 选取2020年6月—2023年6月在肇庆市第一人民医院治疗的60例脑卒中后肩痛患者为研究对象,随机分为观察组和对照组各30例。其中,观察组进行作业疗法结合经皮神经电刺激;对照组单纯进行作业疗法。记录患者治疗前及治疗4周后的视觉模拟疼痛评分（VAS）,改良Barthel指数（MBI）和汉密顿抑郁量表评分（HAMD）,并对记录进行检验和t检验。结果 观察组和对照组的治疗效果比较差异有统计学意义（P=0.019）,观察组治疗有效率（93.33%）高于对照组（63.33%）;治疗前两组患者的VAS（P=0.536）和HAMD（P=0.558）分值比较差异无统计学意义,治疗后其VAS（P=0.049）及HAMD（P=0.023）分值均较治疗前下降,且观察组下降幅度分别为（2.23±1.14）分和（4.47±3.06）分,均高于对照组的（1.27±0.98）和（1.33±1.35）,组间比较差异有统计学意义;治疗前两组患者的MBI分值比较差异无统计学意义（P=0.216）,治疗后其MBI分值均较治疗前提高,且观察组提高幅度（21.87±10.25）较对照组（12.00±13.58）更显著,组间比较差异有统计学意义（P=0.003）。结论 作业疗法结合经皮神经电刺激可缓解脑卒中肩痛,改善患者日常生活能力和心理精神状态,减少抑郁的发生。
Objective To explore the therapeutic effect of occupational therapy combined with transcutaneous electrical nerve stimulation（TENS） on shoulder pain after stroke．Methods Sixty patients with post-stroke shoulder pain who were treated in the First People’s Hospital of Zhaoqing from June 2020 to June 2023 were selected as the study subjects and randomly divided into an observation group and a control group,with 30 cases in each group．Among them,the observation group received occupational therapy combined with TENS,while the control group received occupational therapy alone．This study recorded the Visual Analogue Scale（VAS）,modified Barthel Index（MBI）,and Hamilton Depression Rating Scale（HAMD）of patients before and after 4 weeks of treatment,and conducted the and t-test analysis．Results The test analysis showed a significant difference in treatment effectiveness between the observation group and the control group（P=0.019）,with the observation group having a significantly higher treatment effectiveness rate（93.33%）than the control group（63.33%）;t-test analysis showed that there was no statistically significant difference in VAS（P=0.536）and HAMD（P=0.558）indicators between the two groups of patients before treatment．However,after treatment,the VAS（P=0.049）and HAMD（P=0.023）indicators decreased compared to before treatment．The observation group had decreased（2.23±1.14）and（4.47±3.06）,respectively,which were significantly higher than the control group’s（1.27±0.98）and（1.33±1.35）,and the inter group differences were statistically significant;before treatment,there was no statistically significant difference in MBI indicators between the two groups of patients（P=0.216）．After treatment,their MBI indicators increased compared to before treatment,and the observation group（21.87±10.25）showed a more significant improvement compared to the control group（12.00±13.58）．The difference between the groups was statistically significant（P=0.003）．Conclusions Occupational therapy combined with TENS can significantly alleviate shoulder pain after stroke,improve daily living ability and psychological state of patients,and reduce the occurrence of depression．
目的 调查儿童川崎病（KD）冠状动脉损伤发生情况,并进行危险因素分析。方法 选择2018年1月—2022年12月在泉州市妇幼保健院儿童医院诊治的KD儿童782例为研究对象,所有患儿在入院时均给予超声检查,判定冠状动脉损伤情况,调查所有患儿的一般资料,进行危险因素分析。结果 782例患儿中,超声判断为冠状动脉损伤171例,占比21.9%（冠脉损伤组）,无冠状动脉损伤611例（无冠脉损伤组）。冠脉损伤组的皮疹、肢端硬性红肿、球结膜充血、杨梅舌等临床表现占比分别为83.6%、67.8%、86.0%、81.9%,高于无冠脉损伤组的63.5%、49.7%、62.5%、65.3%（P<0.05）。冠脉损伤组与无冠脉损伤组的性别、年龄、血红蛋白、血红细胞沉降率（ESR）等比较差异无统计学意义（P>0.05）,冠脉损伤组的丙氨酸氨基转移酶、白细胞计数（WBC）、D-二聚体（D-D）、C-反应蛋白（CRP）、降钙素原（PCT）、血小板计数（PLT）、发热时间与无冠脉损伤组比较差异有统计学意义（P<0.05）。多因素Logistic逐步回归分析显示,WBC、D-D、CRP、PCT、PLT、发热时间均为川崎病患儿发生冠状动脉损伤的影响因素（P<0.05）。结论 KD儿童中,冠状动脉损伤发生率较高,可导致患儿临床特征多样化,加重患儿的病情,WBC、D-D、CRP、PCT、PLT、发热时间为导致冠状动脉损伤发生的影响因素。
Objective To investigate the incidence of coronary artery injury in children with Kawasaki disease（KD）and analyze the risk factors．Methods From January 2018 to December 2022,782 children with KD diagnosed and treated in Quanzhou Women’s and Children’s Hospital were selected as the study subjects．All the children were given ultrasound examination on admission to determine the coronary artery injury level．The general information of all the children was investigated and the risk factors were analyzed．Results Among the 782 children,171 cases（21.9%）were diagnosed as the“coronary artery injury group”．The remaining 611 patients did not exhibit any coronary artery injury and were thus categorized as the“no coronary artery injury group”．The clinical manifestations incidences of rashes,hard red swelling of extremity,bulbar conjunctival congestion and bayberry tongue in the coronary injury group were 83.6%,67.8%,86.0% and 81.9%,respectively,which were significantly higher than those in the non-coronary injury group（63.5%,49.7%,62.5% and 65.3%,P<0.05）．There were no significant differences in gender,age,hemoglobin and erythrocyte sedimentation rate between the coronary injury group and the no coronary injury group（P>0.05）．There were significant differences in alanine aminotransferase,white blood cell count（WBC）,D-dimer（D-D）,C-reactive protein（CRP）,procalcitonin（PCT）,platelet count（PLT）and fever duration between the two groups（P<0.05）．Multivariate Logistic stepwise regression analysis showed that WBC,D-D,CRP,PCT and PLT were all important factors leading to coronary artery injury（P<0.05）．Conclusions The incidence of coronary artery injury in children with KD is relatively high,which can lead to the diversification of clinical features and disease aggravation of children．WBC,D-D,CRP,PCT,PLT and fever duration are important risk factors for the occurrence of coronary artery injury．
目的 了解脑出血患者家属参与治疗共享决策满意度现状及其影响因素,为提升脑出血患者的护理质量和家属体验提供参考。方法 采用横断面研究设计,便利抽取2022年1月—2023年7月许昌中医院收治的脑出血患者及其家属进行问卷调查。结果 共回收问卷178份,全部纳入分析。患者家属参与医疗决策的满意度得分为（48.58±6.34）分,其中维度得分最低的为交流协商。多因素分析结果显示,家属教育程度、家属年龄、家庭总年收入以及患者家属对医疗决策知情程度为患者家属参与医疗决策满意度的影响因素（F=30.872,P<0.001）,解释40.3%的变异。结论 脑出血患者家属参与治疗共享决策满意度处于中等水平,患者家属对医疗决策知情程度越高、家属教育程度越高、家属年龄较大以及家庭总年收入越高的脑出血患者家属参与治疗共享决策满意度越高。
目的 探讨广州市越秀区青少年近视特点和危险因素,为降低青少年近视发病率提供参考依据。方法 本项目采用分层随机整群抽样的研究方法,抽取分布于广州市越秀区2 774名青少年作为研究对象,根据近视检查情况将其分为近视组（n=1 657）与非近视组（n=1 117）,通过问卷调查的方式,分析青少年近视整体现况、流行病学特征以及影响青少年近视发生、发展的相关行为和因素。结果 2 774名青少年中,1 657名近视,检出率为59.73%;其中女生为872名,多于男生的785名;幼儿园、小学生、初中生、高中生近视人数分别为20名、446名、484名、707名,呈升高趋势。学段、校内用眼环境、校外用眼环境、读写姿势、电子屏幕使用情况、近距离用眼情况、户外活动及睡眠情况、近视检查及矫治情况是广州市越秀区青少年近视的影响因素（P<0.05）。广州市越秀区青少年近视程度均与学段、校外用眼环境、电子屏幕使用情况、户外活动及睡眠情况、近距离用眼情况呈正相关（P<0.05）,与校内用眼环境、读写姿势、近视检查及矫治情况呈负相关（P<0.05）。对不同预后组间存在统计学差异的因素进行Logistic多因素分析后得到,学段、校内用眼环境、校外用眼环境、读写姿势、电子屏幕使用情况、近距离用眼情况、户外活动及睡眠情况、近视检查及矫治情况是广州市越秀区青少年近视的相关影响因素（P<0.05）。结论 广州市越秀区青少年近视发生人群呈现高龄化,学段、校内用眼环境、校外用眼环境、读写姿势、电子屏幕使用情况、近距离用眼情况、户外活动及睡眠情况、近视检查及矫治情况是青少年近视的相关影响因素,建议加强组织学生到户外进行多种课间户外体育活动,同时鼓励家长在校外从自身做起,树立爱眼护眼好榜样,与学校共同保护孩子的视力。
Objective To explore the characteristics and risk factors of myopia among adolescents in Yuexiu District,Guangzhou,and to provide reference for reducing the incidence of myopia among adolescents．Methods This project adopted stratified random cluster sampling to select 2 774 adolescents distributed in Yuexu District,Guangzhou as the research objects,which were divided into myopia group（n=1 657）and non-myopia group（n=1 117）according to the myopic examination．Through questionnaire survey,the overall situation and epidemiological characteristics of myopia among adolescents in our district were comprehensively known,in order to explore the related behaviors and factors affecting the occurrence and development of myopia among adolescents in our district,explore reasonable intervention measures,and put forward scientific and effective myopia prevention and control technical means and strategies．Results Among 2 774 adolescents,1 657 were nearsighted（59.73%）．Among them,872 were female and 785 were male．The number of myopia in kindergarten,primary school,middle school and high school students were 20,446,484 and 707 respectively,showing an increasing trend．School period,eyes use environment in school and outside school,reading and writing posture,situations of electronic screen use,close distance eye use,outdoor activities and sleep,myopia examination and correction were the relevant influencing factors on myopia of adolescents in Yuexui District of Guangzhou（P<0.05）．The myopia degree of adolescents in Yuexiu District of Guangzhou was positively correlated with school period,out-of-school eyes use environment,electronic screen use,outdoor activities and sleep conditions,and close distance eyes use（P<0.05）,and negatively correlated with in-school eyes use environment,reading and writing posture,myopia examination and correction conditions（P<0.05）．After Logistic multivariate analysis of the factors with statistical difference between different prognostic groups,school period,eyes use environment in school and outside school,reading and writing posture,electronic screen use,close distance eyes use,outdoor activities and sleep conditions,myopia examination and correction were the relevant influencing factors on myopia of adolescents in Yuexui District of Guangzhou（P<0.05）．Conclusions In Yuexiu District,Guangzhou,the population with myopia is gradually moving to a younger age．School period,eyes use environment in school and outside school,reading and writing posture,electronic screen use,close distance eyes use,outdoor activities and sleep condition,myopia examination and correction are the relevant influencing factors．It is recommended to strengthen the organization of students to go outdoors for a variety of outdoor sports activities between classes,while encouraging parents to set a good example of eye care outside the school and work with the school to protect their children’s eyesight．
目的 分析超早期阶梯式协同营养管理在改善重症急性胰腺炎患者喂养中的应用效果。方法 抽取2020年1月—2022年1月南阳市中心医院收治的80例重症急性胰腺炎患者为研究对象,随机数字表法分为观察组和参照组,各40例,两组患者均给予常规营养干预措施,其中观察组患者在以上基础上给予超早期阶梯式协同营养管理,对比两组患者的临床症状消退时间、营养状况、喂养相关并发症、喂养不耐受发生率。结果 与参照组相比,观察组患者的临床症状消退时间更短（P<0.05）,观察组患者的体质量指数、上臂肌围、肱三头肌皮褶厚度及血清清蛋白水平更高（P<0.05）;两组患者的喂养相关并发症主要包括恶心呕吐、误吸、腹泻、感染,观察组患者的喂养相关并发症发生率为7.50%,参照组患者的喂养相关并发症发生率为25.00%,观察组患者的喂养相关并发症发生率低于参照组（P<0.05）;观察组患者喂养不耐受发生2例（5.00%）,参照组患者喂养不耐受发生9例（22.50%）,观察组患者喂养不耐受发生率低于参照组（P<0.05）。结论 重症急性胰腺炎患者实施超早期阶梯式协同营养管理可降低喂养不耐受发生率及喂养相关并发症发生率,改善患者营养水平。
Objective To analyze the application effect of ultra early stepped collaborative nutrition management on improving feeding in patients with severe acute pancreatitis．Methods Eighty patients with severe acute pancreatitis admitted to our hospital from January 2020 to January 2022 were selected as research subjects and randomly divided into observation group and reference group,with 40 cases in each group．Patients in both groups were given conventional nutritional intervention measures,among which patients in the observation group were given super-early stepped collaborative nutritional management on the basis of the above．Clinical symptom resolution time,nutritional status,feeding related complications and feeding intolerance rate were compared between the two groups．Results Compared with the reference group,the time of clinical symptoms resolution in the observation group was shorter（P<0.05）,and the body mass index,upper arm muscle circumference,triceps skin fold thickness and serum albumin level in the observation group were higher（P<0.05）．The feeding-related complications of the two groups mainly included nausea and vomiting,aspiration,diarrhea and infection．The incidence of feeding-related complications in the observation group was 7.50%,and that in the reference group was 25.00%．The incidence of feeding-related complications in the observation group was lower（P<0.05）．There were 2 cases of feeding intolerance in the observation group,the feeding intolerance rate was 5.00%,and 9 cases of feeding intolerance in the reference group,the feeding intolerance rate was 22.50%,the feeding intolerance rate in the observation group was lower（P<0.05）．Conclusions Implementing ultra early stepped collaborative nutritional management in patients with severe acute pancreatitis can reduce the incidence of feeding intolerance and feeding related complications,and improve nutritional levels．
目的 探讨与分析全面护理联合细节干预在创伤骨科手术质量及康复中应用价值。方法 选择2022年1月—2023年1月在福建省立医院骨科进行创伤骨科手术患者120例为研究对象,用随机数字表法分组,分为常规组、联合组,各纳入60例患者。前者进行常规护理,后者在前者基础上开展全面护理联合细节干预,对两组患者术后恢复情况进行观察比较。结果 在围术期指标方面,联合组手术时间、术中出血量、术后首次下床活动时间、术后住院时间与常规组相比减少（P<0.05）。联合组术后1 d、术后3 d、术后7 d、术后14 d的疼痛VAS评分与常规组相比减少（P<0.05）。联合组术后14 d的护理总满意度为100.00%,常规组为83.33%,联合组与常规组相比明显提高（P<0.05）。联合组术后14 d的社会关系、心理关系、生理关系等生活质量评分均高于常规组（P<0.05）。结论 全面护理联合细节干预在创伤骨科手术患者的应用促进患者康复,能持续缓解患者的疼痛状况,提高患者的护理满意度与生活质量。
Objective To explore and analyze the application value of comprehensive nursing combined with detailed intervention in the quality and rehabilitation of orthopedic trauma surgery．Methods From January 2022 to January 2023,120 cases of patients who underwent trauma orthopedic surgery in the Department of Orthopedic Surgery of Fujian Provincial Hospital were selected as the research subjects．And the randomized numerical table method was taken to operate in groups,which were divided into the conventional group and the combined group,and 60 patients were included in each group．The former group recieved conventional nursing care,and the latter group recieved comprehensive nursing care combined with detail intervention on its basis to observe and compare the postoperative recovery of patients in the two groups．Results In terms of perioperative indicators,the operation time,intraoperative bleeding,time to first postoperative bed movement and postoperative hospitalization time were significantly reduced in the combined group compared with the conventional group（P<0.05）．The pain VAS scores of the combination group were significantly reduced compared to the conventional group at 1 day,3 days,7 days and 14 days after surgery（P<0.05）．The total satisfaction rate of postoperative care in the combination group at 14 days was 100.00%,while in the conventional group it was 83.33%．The combination group showed there were significant improvements compared to the conventional group（P<0.05）．The social,psychological and physiological quality of life scores of the combination group were significantly higher than those of the conventional group 14 days after surgery（P<0.05）．Conclusions The application of comprehensive nursing combined with detailed intervention in orthopedic trauma surgery patients can promote their recovery,continuously alleviate their pain status and improve their nursing satisfaction and quality of life．
目的 探讨基于健康意识理论（HEC）的健康管理联合早期活动护理干预应用于急性胰腺炎（AP）患者的效果。方法 将南阳市第一人民医院2020年1月—2023年1月期间收治的80例AP患者作为研究对象,按照随机数字表法分为对照组（n=40）和观察组（n=40）。两组患者均按照AP护理常规进行护理,对照组予早期活动护理干预,观察组予早期活动护理和基于HEC的健康管理,观察两组健康行为能力、健康促进行为和并发症发生情况。结果 干预后,两组患者健康行为能力自评量表得分均高于干预前,且观察组得分高于对照组（P<0.05）;两组患者健康促进生活方式量表Ⅱ得分均高于干预前,且观察组得分高于对照组（P<0.05）;观察组并发症发生率（5.00%）低于对照组（20.00%）。结论 基于HEC的健康管理联合早期活动护理可以有效改善AP患者的健康行为能力、健康促进行为减少并发症的发生。
Objective To explore the effect of health management combined with early activity nursing intervention based on health as expanding consciousness（HEC）on patients with acute pancreatitis（AP）．Methods Eighty patients with AP admitted to the First People’s Hospital of Nanyang City from January 2020 to January 2023 were selected as the study subjects．They were randomly divided into a control group（n=40）and an observation group（n=40）using a random number table method．Both groups of patients received routine AP nursing care．The control group received early activity nursing intervention,while the observation group received early activity nursing and HEC based health management．The health behavior ability,health promotion behavior,and incidence of complications were observed in both groups．Results After the intervention,both groups of patients had higher scores on the Self Rating Health Behavioral Ability Scale than before the intervention,and the observation group had higher scores than the control group（P<0.05）．The scores of the Health Promotion Lifestyle Scale II for both groups of patients were higher than before intervention,and the scores of the observation group were higher than those of the control group（P<0.05）．The incidence of complications in the observation group（5.00%）was lower than that in the control group（20.00%）．Conclusions Health management based on HEC combined with early activity nursing can effectively improve the health behavior ability of AP patients,promote health behavior,and reduce the occurrence of complications．
目的 分析“侧俯卧位”MRI引导腰脊神经后根神经节脉冲射频治疗腰椎间盘突出症的手术体位护理效果。方法 对2018年9月—2020年12月在广州市荔湾中心医院住院接受经MRI引导腰脊神经后根神经节脉冲射频的腰椎间盘突出症患者62例随机分为两组：侧俯卧位组和俯卧位组,每组各31例。侧俯卧位组采用患侧抬高约30 °的侧俯卧位手术,俯卧位组采用标准俯卧位手术。记录两组手术时间、手术并发症、手术体位相关并发症及术者对术野显露的满意度评价。结果 所有患者均顺利完成手术,未见出血、感染、下肢麻痹加重神经损伤、脏器损伤等手术并发症,无患者发生眼压增高、臂丛损伤、压疮等体位相关并发症。侧俯卧位组手术时间（60.65±12.45）min,俯卧位组手术时间（70.58±10.25） min,组间比较差异有统计学意义（t=3.429,P=0.001）。术者对侧俯卧位组和俯卧位组术野侧显露总满意度分别为93.55%和77.42%,组间比较差异有统计学意义（χ2=4.292,P=0.038）。结论 侧俯卧位MRI引导腰脊神经后根神经节脉冲射频治疗腰椎间盘突出症安全、有效,做好手术体位护理可有效防止并发症。
Objective To analyze the effect of surgical position nursing for radiofrequency ablation in posterior root ganglion in lumbar spinal nerve guided by MRI in lateral prone position．Methods Sixty-two patients with lumbar disc herniation hospitalized in Liwan Central Hospital of Guangzhou from September 2018 to December 2020 were randomly divided into two groups（the lateral prone position group and the prone position group,31 patients in each group）．The lateral prone position group used the lateral prone position with about 30 degrees elevation of the affected side,and the prone position group used the standard prone position for operation．Operating time,surgical complications,surgical position related complications,and operator satisfaction evaluation of surgical field exposure were recorded in both groups．Results All patients completed the operation successfully．No surgical complications such as bleeding,infection,lower limb paralysis,aggravated nerve injury or organ injury were found in the two groups．No surgical position related complications such as intraocular pressure raising,brachial plexus injury or pressure ulcers in both the groups either．The operation time was（60.65±12.45）min in the lateral prone position group and（70.58±10.25）min in the standard prone position group,respectively,and the difference was statistically significant（t=3.429,P=0.001）．The surgeon’s satisfaction evaluation of the surgical field exposure was much higher in the lateral prone position group（93.55%）compared with the standard prone position group（77.42%）,and the difference was statistically significant（χ2=4.29,P=0.038）．Conclusions Radiofrequency ablation in posterior root ganglion of lumbar spinal nerve guided by MRI in lateral prone position is safe and effective．Good surgical position nursing can effectively prevent complications．
值班和交接班制度是医疗质量安全管理核心制度之一,是医院 “8 h”以外医疗质量安全连续性的重要保障。华西天府医院以往依托纸质排班进行医师值班工作管理,容易造成值班信息不透明、手工报送信息繁琐等弊端。利用值班排班系统对医师值班工作进行科学管理,不仅使值班排班及值班费报送工作便捷、及时、规范,还有利于提升临床医师和行政管理人员的工作效率和满意度。
The doctor duty arrangements system is one of the core systems of medical quality and safety management．It is an important guarantee for the continuity of medical quality and safety beyond “eight hours”．In the past,a tertiary hospital relied on paper scheduling to manage doctors’ on-duty work,which was easy to cause defects such as opaque on-duty information and complicated manual information submission．The scientific management of doctors’ on-duty work by using the on-duty scheduling system not only makes the on-duty scheduling and on-duty fee reporting to be convenient,timely and standard,but also helps to improve the work efficiency and satisfaction of clinicians and administrative staffs．
医联体是分级诊疗制度建设的重要抓手,对“健康中国”战略目标的实现具有重要作用。在当前医疗改革背景下,探究医联体建设模式具有重要意义。文章介绍了广州市属A医院和区属B医院探索的非托管紧密型医联体实践举措、成效、创新与不足,总结了该模式对我国医联体建设的启示：一是政府层面要做好顶层设计,给与政策支持;二是网顶医院要下沉优质资源,因地制宜帮扶;三是成员单位要主动参与建设,抓住发展机遇。
The establishment of medical unions is a crucial step in the development of a hierarchical diagnosis and treatment system and plays a significant role in achieving the strategic goal of “Healthy China．”Given the current context of healthcare reform,it is highly important to explore effective models for constructing medical unions．This paper introduces the practical measures taken by Guangzhou Hospital A and Hospital B to establish a non-trustee-close medical commonwealth．It discusses the effects achieved as well as innovations made through this approach while also highlighting its limitations．Furthermore,this study summarizes key insights that can be drawn from this model for building medical commonwealths in China：firstly,governments should focus on top-level design and provide policy support;secondly,leading hospitals should allocate high-quality resources based on local conditions;thirdly,member units should actively participate in construction efforts and seize development opportunities．
