Objective To develop an interpretable machine learning model for predicting mortality risk in elderly intensive care unit (ICU) patients with type 2 diabetes mellitus (T2DM) and cerebral infarction,and to identify critical prognostic factors. Methods We extracted data of 514 elderly patients with T2DM and cerebral infarction from the Medical Information Mart for Intensive Care-Ⅳ database.The dataset was partitioned into training and test sets (7∶3 ratio) via scikit-learn.Within the training set,collinearity analysis was conducted,and features with variance inflation factor >5 were excluded.Lasso regression was further adopted to refine the feature selection.Six machine learning models-eXtreme Gradient Boosting (XGBoost),Logistic regression,LightGBM,AdaBoost,decision tree,and gradient boosting decision tree-were constructed and subjected to rigorous five-fold cross-validation.The optimal model was interpreted by SHAP analysis on the test set to determine the hierarchy of mortality-associated predictors and their nonlinear interactions. Results The XGBoost model demonstrated the best training performance and prediction generalization ability.The area under the curve for 30-day and 365-day mortality risk were 0.928 (95%CI=0.853-0.995) and 0.882 (95%CI=0.800-0.963),respectively.SHAP analysis revealed that the Oxford Acute Severity of Illness Score,length of hospital stay,congestive heart failure,length of ICU stay,peripheral capillary oxygen saturation,and heart rate were the top six predictive factors for 30-day mortality risk,while blood urea nitrogen,Oxford Acute Severity of Illness Score,peripheral capillary oxygen saturation,age,heart rate,and respiratory rate were the top six predictive factors for 365-day mortality risk. Conclusion The XGBoost model shows significant potential in predicting mortality risk in elderly ICU patients with T2DM and cerebral infarction,underscoring the importance of key clinical predictors. 目的 针对重症监护病房(ICU)老年2型糖尿病合并脑梗死患者死亡风险预测需求,构建可解释机器学习模型,探索关键预后因素。方法 从重症监护医学信息市场-Ⅳ数据库提取514例患者数据,利用scikit-learn机器学习库将数据集划分为训练集、测试集(7∶3),在训练集内部进行共线性相关分析,并排除方差膨胀因子>5的特征,后使用Lasso回归算法筛选初始特征,以构建极端梯度提升 (XGBoost)、Logistic回归、LightGBM、自适应增强算法、决策树和梯度提升决策树6种机器学习算法,并通过五重交叉验证进行严格验证。使用测试集以SHAP解释最佳模型,确定死亡率相关预测因子的层次及其非线性相互作用。结果 XGBoost模型表现出最好的训练性能和预测泛化能力。30、365 d死亡风险的受试者工作特征曲线下面积分别为0.928(95%CI=0.853~0.995)和0.882(95%CI=0.800~0.963)。SHAP分析显示,牛津急性疾病严重程度评分、住院时间、充血性心力衰竭、入住ICU时间、外周毛细血管血氧饱和度、心率是30 d死亡风险排名前6的预测因子,而血尿素氮、牛津急性疾病严重程度评分、外周毛细血管血氧饱和度、年龄、心率和呼吸频率是365 d死亡风险排名前6的预测因子。结论 XGBoost模型在预测ICU老年2型糖尿病合并脑梗死患者死亡风险方面具有显著潜力,强调了关键临床预测指标的重要性。.
Gastroesophageal reflux disease (GERD) in infants and young children is a common digestive disorder with diverse clinical manifestations that often overlap with physiological reflux and behavioral expressions, creating diagnostic challenges. Comprehensive searches were conducted in English- and Chinese-language databases, including PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang Data, to review the epidemiological characteristics, clinical presentations, and impacts of GERD on children and their families. Particular emphasis is placed on four principal assessment tools [Infant Gastroesophageal Reflux Questionnaire (I-GERQ), GERD Symptom Questionnaire for Infants/Young Children (GSQ-I/YC), I-GERQ Revised (I-GERQ-R), and Gastrointestinal and Gastroesophageal Reflux Scale for Infants and Toddlers (GIGER)], appraising their development background, structural characteristics, reliability, validity, and clinical application value. The aim is to support early identification, standardized assessment, and individualized management of GERD in infants and young children. Evidence indicates that the I-GERQ-R shows high specificity, good reliability and validity, and cross-cultural applicability, and is currently recommended for symptom assessment and treatment-response monitoring in GERD among infants and young children, while the GIGER scale shows potential for comprehensive screening. Future research should prioritize translation and development of Chinese versions of GERD questionnaires for infants and young children, as well as the establishment of a multidimensional assessment system. 婴幼儿胃食管反流病（gastroesophageal reflux disease, GERD）是婴幼儿期常见的消化道疾病，其临床表现多样，常与生理性反流和行为表现重叠，致使诊断存在挑战。该文通过系统检索PubMed、Web of Science、中国知网和万方数据等中英文数据库，系统综述了婴幼儿GERD的流行病学特征、临床表现及其对患儿和家庭的影响，重点评价了4种主要评估工具（I⁃GERQ、GSQ⁃I/YC、I⁃GERQ⁃R和GIGER量表）的开发背景、结构特点、信效度及临床应用价值，旨在为婴幼儿GERD的早期识别、标准化评估及个体化管理提供理论依据与实践参考。该文发现I⁃GERQ⁃R具有较高的特异性、良好的信效度和跨文化适用性，是目前推荐用于婴幼儿GERD症状评估与疗效监测的有效工具，GIGER量表在全面筛查方面展现出潜力;未来研究应致力于汉化及开发中文版本婴幼儿GERD问卷并建立多维度评估体系。.
A 13-year-old boy with Bartonella henselae meningitis is reported. He presented with recurrent fever with no history of cat scratches and no lymphadenopathy. Cerebrospinal fluid analysis showed an elevated white blood cell count, and Bartonella henselae infection was confirmed by metagenomic next-generation sequencing. Bone marrow examination revealed hemophagocytosis predominantly involving nucleated erythrocytes; to our knowledge, this bone marrow morphological abnormality is the first reported worldwide in association with Bartonella henselae infection. Transient bilateral hip pain occurred during the illness and was considered infection-related joint involvement. The patient improved with treatment and had no neurological sequelae. This case expands the spectrum of clinical and bone marrow manifestations of Bartonella henselae infection and warrants vigilance for possible central nervous system and bone marrow involvement in cases of fever of infectious etiology presenting without typical lymphadenopathy. 该文报道1例13岁男性汉赛巴尔通体脑膜炎病例。患儿以反复发热起病，无猫抓伤史，无淋巴结肿大。脑脊液检查提示白细胞数升高，经宏基因组二代测序确诊为汉赛巴尔通体感染。患儿骨髓象可见以吞噬有核红细胞为主的噬血现象，该骨髓形态学改变为全球首次报道的与汉赛巴尔通体感染相关的异常表现。患儿病程中出现一过性双髋关节疼痛，考虑为感染所致关节受累。经治疗后好转，无神经系统后遗症。该病例拓展了汉赛巴尔通体感染的临床与骨髓表现谱，提示临床上对缺乏典型淋巴结肿大的感染性发热，需警惕该病原体侵犯中枢神经系统及骨髓的可能。.
To investigate the effect of intraoperative hypothermia on short-term prognosis in neonates with necrotizing enterocolitis (NEC) undergoing surgery. Clinical data of 150 neonates with NEC who underwent surgery at Children's Hospital of Chongqing Medical University from June 2017 to August 2023 were retrospectively collected. Based on the lowest intraoperative temperature, patients were classified into a normothermia group (≥36.0℃, n=49), a mild hypothermia group (35.0-35.9℃, n=73), a moderate hypothermia group (34.0-34.9℃, n=20), and a severe hypothermia group (<34.0℃, n=8). Postoperative outcomes were analyzed across groups. Intraoperative hypothermia occurred in 101/150 (67.3%) neonates. Mild hypothermia significantly increased the risk of postoperative coagulation disorders (OR=2.170, 95%CI: 1.035-4.552, P<0.05). Postoperative hospital stay was significantly prolonged in the mild (B=12.250, 95%CI: 1.176-23.324, P<0.05) and severe hypothermia groups (B=24.510, 95%CI: 1.645-47.376, P<0.05), while the duration of central venous catheterization was significantly increased in the moderate hypothermia group (B=11.388, 95%CI: 1.625-21.15, P<0.05). Intraoperative hypothermia is common in neonates with NEC undergoing surgery, and different degrees of hypothermia are associated with distinct adverse effects on short-term prognosis. Intraoperative temperature management should be prioritized, and active warming measures should be implemented to improve outcomes. 目的: 探究新生儿坏死性小肠结肠炎（neonatal necrotizing enterocolitis, NEC）术中低体温对近期预后的影响。方法: 回顾性收集2017年6月—2023年8月重庆医科大学附属儿童医院150例NEC手术患儿的资料。按术中最低体温分为正常体温组（≥36.0℃，49例）、轻度低体温组（35.0~35.9℃，73例）、中度低体温组（34.0~34.9℃，20例）和重度低体温组（<34.0℃，8例），分析低体温对预后的影响。结果: 150例患儿中，101例（67.3%）发生术中低体温。轻度低体温显著增加了术后凝血功能障碍的发生风险（OR=2.170，95%CI:1.035~4.552，P<0.05）。轻度低体温（B=12.250，95%CI:1.176~23.324，P<0.05）和重度低体温（B=24.510，95%CI:1.645~47.376，P<0.05）均显著延长了术后住院时长，而中度低体温显著增加了中心静脉置管时长（B=11.388，95%CI:1.625~21.15，P<0.05）。结论: NEC手术患儿术中低体温发生率高，且不同程度低体温对近期预后的影响存在差异。临床需重视术中体温管理，采取主动保温措施改善预后。.
To investigate the effect of Xingnao Kaiqiao acupuncture therapy (for regaining the consciousness and opening the orifices) on cerebral mitochondrial dynamics homeostasis in middle cerebral artery occlusion/reperfusion (MCAO/R) model rats, and to explore the mechanism of this therapy on cerebral ischemia-reperfusion injury (CIRI). A total of 64 healthy male SD rats were randomly divided into a sham-operation group, a model group, an acupuncture group, and an inhibitor group, with 16 rats in each group. Except for the sham-operation group, the MCAO/R model was established in the remaining groups using the modified Longa's method. In the acupuncture group, acupuncture was delivered at bilateral "Neiguan" (PC 6) and "Shuigou" (GV 26), for 30 min per intervention, once daily for 5 consecutive days. In the inhibitor group, the mitochondrial division inhibitor 1 (Mdivi-1) was injected intraperitoneally (2 mg/kg), once daily for 5 consecutive days. Separately, before cerebral ischemia, after ischemia, after ischemia-reperfusion and after intervention completion, using a laser speckle contrast imaging (LSCI) system, the cerebral blood perfusion in the affected cerebral cortex region was monitored. After intervention completion, the neurological deficits were evaluated using the Bederson score; the grip strength was measured with a small animal grip meter; the cerebral infarction volume percentage was quantified via 2,3,5-triphenyltetrazolium chloride (TTC) staining; the mitochondrial ultrastructure in endothelial cells within the ischemic penumbra (IP) region of the cerebral cortex was observed using transmission electron microscopy; the fluorescence co-localization area of optic atrophy 1 (OPA1) and the endothelial cell marker CD31 in the cortical IP region was analyzed by immunofluorescence; the protein expression of mitochondrial fusion protein 2 (MFN2), OPA1, and dynamin-related protein 1 (DRP1) in the cortical IP region was detected using Western blot. Except in the sham-operation group, cerebral blood perfusion in the affected cerebral cortex decreased after cerebral ischemia in the rest groups compared with that before cerebral ischemia (P<0.001). When compared with the time point after cerebral ischemia, cerebral blood perfusion in the affected cerebral cortex was elevated after cerebral ischemia-reperfusion in each group (P<0.001). After intervention completion, in comparison with the model group, the ratios of cerebral blood perfusion were elevated in both the acupuncture group and the inhibitor group (P<0.001); and the ratio of cerebral blood perfusion rose in the acupuncture group compared with that in the inhibitor group (P<0.001). Compared with the sham-operation group, the model group exhibited the increase of neurological deficit score and cerebral infarction volume percentage (P<0.001), and the decline of grip strength (P<0.001). When compared with the model group, both the acupuncture group and the inhibitor group showed the decrease of neurological deficit scores and cerebral infarction volume percentage (P<0.01, P<0.05, P<0.001), and the increase of grip strength (P<0.001). Compared with the inhibitor group, cerebral infarction volume percentage was lower and grip strength was higher in the acupuncture group (P<0.001). In the model group, the endothelial cell mitochondria exhibited severe swelling, exhibiting a spherical morphology predominantly, with extensive cristae fragmentation or even disappearance, and excessive vacuolization. In both the acupuncture group and the inhibitor group, the ultrastructural damage to endothelial cell mitochondria was partially ameliorated; the acupuncture group demonstrated a superior restoration of mitochondrial ultrastructure in comparison with the inhibitor group. When compared with the sham-operation group, the area ratio of co-localization of OPA1 and CD31 decreased in the model group (P<0.001). The area ratio of co-localization of OPA1 and CD31 increased in either the acupuncture group or the inhibitor group in comparison with the model group, respectively (P<0.001). The area ratio of co-localization of OPA1 and CD31 in the acupuncture group was higher than that of the inhibitor group (P<0.001). Compared with the sham-operation group, the model group exhibited the lower protein expression of MFN2 and OPA1 (P<0.001) and protein higher expression of DRP1 (P<0.001). When compared with the model group, the acupuncture group showed the increase of protein expression of MFN2 and OPA1 and the decrease of DRP1 protein expression (P<0.001, P<0.05), while in the inhibitor group, the protein expression of MFN2 was elevated and that of DRP1 declined (P<0.05, P<0.01). When compared with the inhibitor group, the acupuncture group displayed higher MFN2 expression (P<0.01) and lower DRP1 expression (P<0.01). Xingnao Kaiqiao acupuncture therapy mitigates neurological deficits and enhances cerebral blood supply of ischemic region in MCAO/R rats, and the underlying mechanism may be related to regulating mitochondrial dynamics homeostasis of endothelial cells in the IP of cerebral cortex, and attenuating mitochondrial damage. 目的：观察“醒脑开窍”针刺法对大脑中动脉闭塞再灌注（MCAO/R）模型大鼠大脑皮质线粒体动力学平衡的影响，探讨“醒脑开窍”针刺法改善脑缺血再灌注损伤（CIRI）的机制。 方法：将64只健康雄性SD大鼠随机分为假手术组、模型组、针刺组及抑制剂组，每组16只。除假手术组外，其余各组均采用改良Longa线栓法制备MCAO/R模型。针刺组选用双侧“内关”及“水沟”穴进行针刺干预，每次30 min，每日1次，连续5 d；抑制剂组选用线粒体分裂抑制剂（Mdivi-1）进行腹腔注射（2 mg/kg），每日1次，连续5 d。分别于脑缺血前、脑缺血后、缺血再灌注后及干预结束后采用激光散斑血流成像仪监测各组大鼠患侧脑皮质脑血流灌注量。干预结束后，采用Bederson评分法评估大鼠神经功能缺损程度；小动物抓力测试仪评估大鼠爪抓力；TTC染色法测量大鼠脑梗死体积百分比；透射电镜观察大鼠大脑皮质缺血半暗带（IP）区内皮细胞线粒体超微结构；免疫荧光法检测大鼠大脑皮质IP区线粒体视神经萎缩蛋白1（OPA1）与内皮细胞标志物CD31荧光共定位面积，Western blot法检测大脑皮质IP区线粒体融合蛋白2（MFN2）、OPA1及动力相关蛋白1（DRP1）蛋白表达。 结果：除假手术组外，与脑缺血前比较，各组大鼠脑缺血后患侧大脑皮质脑血流灌注量降低（P<0.001）；与脑缺血后比较，各组大鼠脑缺血再灌注后患侧大脑皮质脑血流灌注量升高（P<0.001）。干预结束后，与模型组比较，针刺组及抑制剂组大鼠脑血流灌注量比值升高（P<0.001）；与抑制剂组比较，针刺组大鼠脑血流灌注量比值升高（P<0.001）。与假手术组比较，模型组大鼠神经功能缺损评分、脑梗死体积百分比升高（P<0.001），爪抓力减弱（P<0.001）；与模型组比较，针刺组及抑制剂组大鼠神经功能缺损评分、脑梗死体积百分比降低（P<0.01，P<0.05，P<0.001），爪抓力增强（P<0.001）；与抑制剂组比较，针刺组大鼠脑梗死体积百分比降低、爪抓力增强（P<0.001）。模型组大鼠内皮细胞线粒体重度肿胀，多呈球状形态，嵴大量断裂甚至消失，空泡化严重；针刺组及抑制剂组大鼠内皮细胞线粒体超微结构破坏有所改善；针刺组大鼠内皮细胞线粒体超微结构修复优于抑制剂组。与假手术组比较，模型组大鼠OPA1与CD31荧光共定位面积比减少（P<0.001）；与模型组比较，针刺组和抑制剂组大鼠OPA1与CD31荧光共定位面积比增加（P<0.001）；与抑制剂组比较，针刺组大鼠OPA1与CD31荧光共定位面积比增加（P<0.001）。与假手术组比较，模型组大鼠MFN2、OPA1蛋白表达降低（P<0.001），DRP1蛋白表达升高（P<0.001）；与模型组比较，针刺组大鼠MFN2和OPA1蛋白表达升高、DRP1蛋白表达降低（P<0.001，P<0.05），抑制剂组大鼠MFN2蛋白表达升高、DRP1蛋白表达降低（P<0.05，P<0.01）；与抑制剂组比较，针刺组大鼠MFN2蛋白表达升高（P<0.01），DRP1蛋白表达降低（P<0.01）。 结论：“醒脑开窍”针刺法可减轻MCAO/R大鼠神经功能损伤、改善缺血区脑血流供应，其机制可能为调控大脑皮质IP区内皮细胞线粒体动力学平衡、减轻线粒体损伤。.
Based on the teaching practice of the course of Selected Readings of Acupuncture and Moxibustion Medical Classics, this paper explores the introduction of Huangdi Mingtang Jing Jijiao into the teaching process to assist students in constructing a framework of the early academic origins of acupuncture, deepening their understanding of theories related to acupoints (especially the tracing and differentiation of acupoint indications), training their ability to read classical acupuncture medical texts, and cultivating rigorous academic thinking. Through the combination of guided classroom lectures, group thematic discussions, and textual collation practice, students are able not only to master the core knowledge of the course, but also to experience a research-oriented learning process of "from literature to clinic, from theory to practice" in tasks such as organizing acupoint indications. This approach effectively bridges the theoretical gap between ancient and modern times, and enhances the comprehensive quality of students majoring in acupuncture and tuina. 本文立足于《针灸医籍选读》课程教学实践，探讨将《黄帝明堂经辑校》一书引入教学环节，帮助学生构建早期针灸学术源流框架、深化对腧穴相关理论的理解（尤其是腧穴主治病症的溯源与甄别）、训练针灸古典医籍研读能力以及培养严谨学术思维的具体应用路径与初步成效。通过课堂引导式讲授、分组专题研讨以及文本校勘实践等多种教学方式的结合，学生不仅能够掌握本课程的核心知识，更能在诸如腧穴主治病症的梳理过程中，体验“从文献到临床、从理论到实践”的研究性学习过程，有效弥合了古今理论隔阂，提升针灸推拿学专业学生的综合素养。.
A 10-year-old boy was admitted with facial edema and proteinuria for two months, occurring nine months after hematopoietic stem cell transplantation. He was clinically diagnosed with nephrotic syndrome and showed no remission after four weeks of standard glucocorticoid therapy, suggesting steroid-resistant disease. Renal biopsy was consistent with membranous nephropathy. Mass spectrometry identified granular co-deposition of IgG and semaphorin 3B (Sema3B) along the glomerular basement membrane, establishing the diagnosis of Sema3B-associated membranous nephropathy. Treatment with glucocorticoids combined with tacrolimus led to a marked reduction in proteinuria, resolution of edema, and clinical stabilization over a three-month follow-up, with no recurrence. This case highlights that Sema3B-associated membranous nephropathy may occur after hematopoietic stem cell transplantation in children and underscores the importance of precise diagnostics in pediatric nephropathies. Future multicenter studies are needed to clarify disease course and genetic susceptibility, develop specific biomarkers and therapies, promote individualized treatment, and improve prognosis. 患儿，男，10岁，因造血干细胞移植后9个月，出现颜面水肿、蛋白尿2个月入院。临床诊断肾病综合征，经规范糖皮质激素治疗4周，尿蛋白未转阴，考虑激素耐药。行肾穿刺活检术，肾脏病理提示膜性肾病，质谱分析肾小球基底膜颗粒状IgG和信号蛋白 3B（semaphorin 3B, Sema 3B）共沉积，诊断为Sema 3B膜性肾病。给予糖皮质激素联合他克莫司治疗后，随访3个月，患儿尿蛋白明显减少，水肿消退，病情稳定，未出现复发。该病例提示儿童造血干细胞移植后可能出现Sema 3B膜性肾病，提示精准诊断在儿科肾病中的重要性，未来需多中心研究明确其病程和遗传易感性，开发特异性标志物和疗法，推动个体化治疗，改善患儿预后。.
To observe the synergistic analgesia and intestinal motility antagonism of electroacupuncture (EA) combined with morphine, and explore the mechanism of the "effect-enhancing and toxicity-reducing" of the combined therapy with acupuncture and medication. Sixty SPF-grade male C57BL/6J mice were randomly divided into a blank group, a model group, a sham-EA+normal saline (NS) group, a morphine+sham-EA group, an EA+NS group, and a morphine+EA group, with 10 mice in each group. Except in the blank group, the mice in the other groups were prepared to be inflammatory pain models induced by complete Freund's adjuvant. After successful modeling, the interventions were administered with EA, morphine, or morphine+EA, respectively. EA was delivered at "Zusanli" (ST36) bilaterally, with continuous wave, at a frequency of 2 Hz and a current of 2 mA, for 30 min, once daily and for 7 consecutive days. Intragastric administration with diluted morphine hydrochloride solution (24 mg/kg) was operated, twice daily and for 7 consecutive days. Sham-EA was obtained by no access to needle puncture and electric stimulation. The thermal pain threshold was measured using the hot plate method from day 0 to day 8. Intestinal motility was evaluated by time to first passage of melena, 2-hour fecal output and small intestinal transit rate. Immunofluorescence was used to detect the positive expression of μ-opioid receptor (MOR) and 5-hydroxytryptamine 1A receptor (5-HT1AR) in the hypothalamus, and that of MOR and purinergic receptor P2Y1 (P2Y1R) in the small intestine. ELISA was employed to measure the contents of β-endorphin (β-EP) and serotonin (5-HT) in the hypothalamus, and those of β-EP and adenosine triphosphate (ATP) in the small intestine. Compared with the blank group, the thermal pain threshold of mice decreased (P<0.05), the positive expression of MOR and 5-HT1AR and the content of 5-HT in the hypothalamus were reduced (P<0.05), the contents of β-EP in the hypothalamus and small intestine increased (P<0.05) in the model group. When compared with the model group, in the morphine+sham-EA group, the thermal pain threshold increased (P<0.05), the time to first passage of melena was prolonged (P<0.05), and the 2-hour fecal output and small intestinal transit rate decreased (P<0.05), and the positive expression of MOR in the hypothalamus and small intestine increased (P<0.05), while the positive expression of P2Y1R and the content of ATP in the small intestine decreased (P<0.05); in the EA+NS group, the thermal pain threshold was higher (P<0.05), the positive expression of MOR and 5-HT1AR in the hypothalamus and that of P2Y1R in the small intestine increased (P<0.05), and the contents of β-EP and 5-HT in the hypothalamus, and the content of ATP in the small intestine were elevated (P<0.05), the positive expression of MOR and the content of β-EP in the small intestine were reduced (P<0.05); in the morphine+EA group, the thermal pain threshold was higher (P<0.05), the time to first passage of melena was prolonged (P<0.05), the 2-hour fecal output and small intestinal transit rate were declined (P<0.05), and the positive expression of MOR and 5-HT1AR and the contents of β-EP and 5-HT in the hypothalamus increased (P<0.05), while the content of β-EP in the small intestine decreased (P<0.05). In comparison with the morphine+sham-EA group, the morphine+EA group showed the decrease in the time to first passage of melena (P<0.05), the increase in the 2-hour fecal output and small intestinal transit rate (P<0.05), and the increase in the positive expression of MOR and 5-HT1AR and the contents of β-EP and 5-HT in the hypothalamus (P<0.05), the decrease in the positive expression of MOR and the content of β-EP in the small intestine (P<0.05), and the increase in the positive expression of P2Y1R and the content of ATP in the small intestine (P<0.05). Compared with the EA+NS group, the morphine+EA group demonstrated the increase in the time to first passage of melena (P<0.05), the decrease in the 2-hour fecal output (P<0.05), and the increase in the positive expression of MOR in the hypothalamus and the small intestine and the content of β-EP in the hypothalamus (P<0.05), and the decrease in the positive expression of P2Y1R and the content of ATP in the small intestine (P<0.05). MOR and P2Y1R were co-located and the positive expression of them in the small intestine showed a significant negative correlation (r=-0.868, P<0.000 1). Electroacupuncture combined with morphine exerts synergistic analgesia by agonizing MOR and 5-HT1AR in the brain, and improves intestinal motility by inhibiting MOR and agonizing P2Y1R in the intestine, demonstrating the characteristic of "effect-enhancing and toxicity-reducing" in the combined therapy with acupuncture and medication. 目的：观察电针联合吗啡的协同镇痛效应和肠动力拮抗效应，探讨针药结合“增效减毒”效应机制。 方法：将60只SPF级雄性C57BL/6J小鼠随机分为空白组、模型组、假电针+生理盐水组、吗啡+假电针组、电针+生理盐水组、吗啡+电针组，每组10只。除空白组外，其余组小鼠以完全弗氏佐剂诱导炎性痛模型。造模成功后采用电针、吗啡及吗啡+电针分别对小鼠进行干预。电针穴取双侧“足三里”，连续波，频率2 Hz，电流2 mA，每次30 min，每天1次，连续7 d；吗啡干预每次给予24 mg/kg吗啡稀释液灌胃，每日2次，连续7 d。假电针不刺入、不接电。第0~8天运用热板法对小鼠热痛阈值进行测定。干预结束后，采用首粒黑便排出时间、2 h排便量及小肠推进率评估小鼠肠动力情况；采用免疫荧光法检测小鼠下丘脑μ阿片受体（MOR）、5-羟色胺1A受体（5-HT1AR）及小肠MOR、嘌呤能受体P2Y1（P2Y1R）阳性表达；ELISA法测定小鼠下丘脑β-内啡肽（β-EP）、5-羟色胺（5-HT）及小肠β-EP、三磷酸腺苷（ATP）含量。 结果：与空白组比较，模型组小鼠热痛阈值降低（P<0.05），下丘脑MOR、5-HT1AR阳性表达及5-HT含量降低（P<0.05），下丘脑、小肠β-EP含量升高（P<0.05）。与模型组比较，吗啡+假电针组热痛阈值升高（P<0.05），首粒黑便排出时间增加（P<0.05），2 h排便量、小肠推进率降低（P<0.05），下丘脑、小肠MOR阳性表达增加（P<0.05），小肠P2Y1R阳性表达、ATP含量降低（P<0.05）；电针+生理盐水组热痛阈值升高（P<0.05），下丘脑MOR、5-HT1AR及小肠P2Y1R阳性表达增加（P<0.05），下丘脑β-EP、5-HT及小肠ATP含量增加（P<0.05），小肠MOR阳性表达及β-EP含量降低（P<0.05）；吗啡+电针组热痛阈值升高（P<0.05），首粒黑便排出时间增加（P<0.05），2 h排便量、小肠推进率降低（P<0.05），下丘脑MOR、5-HT1AR阳性表达及β-EP、5-HT含量增加（P<0.05），小肠β-EP含量降低（P<0.05）。与吗啡+假电针组比较，吗啡+电针组首粒黑便排出时间缩短（P<0.05），2 h排便量、小肠推进率增加（P<0.05），下丘脑MOR、5-HT1AR阳性表达及β-EP、5-HT含量增加（P<0.05），小肠MOR阳性表达及β-EP含量降低（P<0.05），小肠P2Y1R阳性表达及ATP含量增加（P<0.05）。与电针+生理盐水组比较，吗啡+电针组首粒黑便排出时间增加（P<0.05），2 h排便量降低（P<0.05），下丘脑、小肠MOR阳性表达及下丘脑β-EP含量增加（P<0.05），小肠P2Y1R阳性表达、ATP含量降低（P<0.05）。小肠MOR与P2Y1R存在共定位且阳性表达呈显著负相关（r=-0.868，P<0.000 1）。 结论：电针联合吗啡通过激动脑内MOR、5-HT1AR协同镇痛，通过抑制肠内MOR并激动P2Y1R改善肠动力，体现出针药结合“增效减毒”的特征。.
Objective To quantitatively evaluate China's core research integrity policies by constructing an evaluation index system specific to the medical field and reveal the applicability and structural shortcomings of these policies,thereby providing empirical evidence and optimization pathways for enhancing the scientific rigor and practical effectiveness of research integrity governance in China. Methods Eighteen research integrity policy documents issued at the national level by the central government and ministries from January 2010 to January 2025 were collected.An evaluation framework based on the policy modeling consistency index model was constructed via text mining and keyword analysis to quantitatively assess the consistency and effectiveness of these policies.According to their scores,the policies were rated as excellent,good,medium,or bad grade. Results The 18 policies showed the average policy modeling consistency index of 6.27 and the sag index of 2.73,which indicated good overall performance but with clear disparities.Among them,3 policies were rated as excellent,6 as good,and 9 as medium.Analysis of the dimensional averages revealed that while the policies performed robustly in terms of policy function and policy timeliness,they exhibited significant shortcomings in the dimensions of policy target and policy scope,with average scores of 0.59 and 0.44,respectively. Conclusions While China's medical research integrity policy framework is generally effective,it exhibits clear structural shortcomings,including a lack of international perspective,monolithic policy targets,insufficient enforcement rigidity,and low operability.Accordingly,it is recommended that measures such as aligning with global standards,establishing a multi-stakeholder collaborative governance network,strengthening policy enforcement,and improving policy operability should be adopted.These measures will help to systematically optimize China's medical research integrity policy system,thereby enhancing the overall governance level in this domain. 目的 通过构建医学领域科研诚信政策评价指标体系,对我国主要科研诚信政策进行量化评估,旨在揭示科研诚信政策在医学领域的适用性水平与结构性短板,从而为提升我国医学领域科研诚信治理的科学性与实践效能提供实证依据与优化路径。方法 收集2010年1月至2025年1月国家及部委层面发布的18项科研诚信政策文件,通过文本挖掘和关键词分析构建基于政策一致性指数模型的评价指标体系,量化评估政策的一致性与有效性,并依据得分范围将政策分为优秀、良好、中等、不良4个等级。结果 18项政策一致性指数均值为6.27,整体呈现良好水平,凹陷指数均值为2.73,但存在明显参差,其中优秀级3项、良好级6项、中等级9项。从各维度均值看,政策功能与政策时效维度表现稳固,但在政策客体与政策作用范围维度上存在显著不足,其均值分别为0.59和0.44。结论 我国医学领域科研诚信政策整体表现良好,但存在缺乏国际化视野、政策客体单一、政策执行刚性和实操性不足等短板,建议采取与全球标准对接、构建多元主体协同治理网络、增强政策执行刚性、提升内容可操作性等措施,系统性地优化我国医学领域科研诚信政策体系,以整体提升我国医学领域科研诚信治理水平。.
Based on Professor ZHANG Jin's research on acupuncture manipulation techniques, this paper systematically reviews the historical origin and theoretical connotation of the techniques "Green Dragon Wags Tail" and "White Tiger Shakes Head". In combination with classical medical texts such as Jinzhen Fu, Zhenjiu Wendui, Yixue Rumen, and Zhenjiu Dacheng, the key points of the complete operational system of the "flying through meridians and conducting qi" techniques, including the two methods of "Green Dragon Wags Tail" and "White Tiger Shakes Head", are clarified. Specifically, during treatment, after the needle is inserted into the acupoint and arrival of qi is obtained, the needle is directed toward the diseased area, and "Green Dragon Wags Tail" (shallow needling) or "White Tiger Shakes Head" (deep needling) is performed, and supplemented with the pressing along the meridian. 基于张缙教授对针刺手法的研究，系统梳理青龙摆尾、白虎摇头手法的历史源流与理论内涵，结合《金针赋》《针灸问对》《医学入门》《针灸大成》等古典医籍记载，明确包括青龙摆尾、白虎摇头二法在内飞经走气手法完整操作体系的要点，即操作时，针刺入腧穴得气，针向病所，押手闭气，施青龙摆尾（刺浅）或白虎摇头（刺深），辅以循摄手法。.
Abnormalities in growth and development in children with methylmalonic acidemia (MMA) have become a central challenge affecting prognosis. As a relatively common disorder of organic acid metabolism, MMA has a complex etiology and exhibits highly heterogeneous clinical manifestations. Among these, neurodevelopmental delay and impaired somatic growth are particularly prominent and are key determinants of poor long-term outcomes. Accordingly, early identification, refined assessment, and individualized intervention for these growth and developmental problems are focal points of current MMA clinical management. This review focuses on the occurrence status, potential mechanisms, and intervention strategies for growth and developmental abnormalities in MMA, aiming to provide a reference for optimizing patient management and improving long-term outcomes. 甲基丙二酸血症（methylmalonic acidemia, MMA）患儿的生长发育异常已成为影响预后的核心挑战。作为一种相对常见的有机酸代谢障碍，MMA病因复杂，临床表现高度异质。其中，神经发育迟缓与体格发育障碍尤为突出，是导致患儿长期预后不佳的关键因素。因此，对这些生长发育问题的早期识别、精细化评估及个体化干预，是当前MMA临床管理的重点。该文聚焦MMA生长发育异常的发生现状、潜在机制及干预策略，旨在为优化患儿管理、改善长期结局提供参考。.
Trastuzumab deruxtecan is a newly developed antibody-drug conjugate (ADC) designed to overcome human epidermal growth factor receptor 2 (HER2) aberrations. Studies have confirmed that Trastuzumab deruxtecan yields promising efficacy with a manageable safety profile in previously treated non-small cell lung cancer (NSCLC) patients harboring HER2 mutations. However, data on efficacy of Trastuzumab deruxtecan for acquired HER2-amplified NSCLC are limited. Here, we report a case of a patient with metastatic lung adenocarcinoma who developed acquired high-level HER2 amplification (20 copies) after 2nd-line Osimertinib. A partial response (PR) was achieved with reduced-dose Trastuzumab deruxtecan. Plasma next-generation sequencing (NGS) further confirmed successful inhibition of HER2 amplification. 
. 【中文题目：德曲妥珠单抗治疗获得性HER2高水平扩增的EGFR突变肺腺癌：病例报道】 【中文摘要：德曲妥珠单抗是新近研发的抗体偶联药物（antibody-drug conjugate, ADC），用于克服人生长因子受体2（human epidermal growth factor receptor 2, HER2）异常改变。研究已证实其用于既往接受过治疗的HER2突变型非小细胞肺癌（non-small cell lung cancer, NSCLC）患者，疗效可观且安全性可控。然而，该药用于治疗获得性HER2扩增的NSCLC的疗效数据较为有限。本文报道1例转移性肺腺癌患者，在二线奥希替尼治疗后出现获得性HER2的高水平扩增（扩增倍数达20拷贝），经减量德曲妥珠单抗治疗后达到部分缓解（partial response, PR）。血浆二代测序（next-generation sequencing, NGS）结果进一步证实HER2扩增被成功抑制。
】 【中文关键词：肺肿瘤；德曲妥珠单抗；HER2扩增；获得性耐药；病例报道】.
Objective To systematically evaluate the effects of acute and long-term exercise interventions on the physical health of children with Prader-Willi syndrome (PWS). Methods A systematic review was conducted following the preferred reporting items for systematic reviews and meta-analyses of non-randomized studies of interventions guidelines.Relevant studies from 1987 to 2023 were retrieved from PubMed,Web of Science,and EBSCO databases.Eligible studies were primarily non-randomized controlled trials focusing on acute or long-term exercise interventions in the children with PWS.Outcome measures included cardiorespiratory function,muscle strength,body composition,metabolism,and inflammation. Results A total of 19 studies were included.Studies of acute exercise showed that the children with PWS had lower cardiorespiratory function and muscle strength than normal or obese children,but similar metabolic responses.Long-term exercise interventions resulted in significant body mass index reduction,increased muscle mass,improved cardiorespiratory function,and regulation of inflammation markers such as interleukin-8.In addition,exercise improved the quality of life in the children with PWS. Conclusions Exercise interventions positively impact the health of children with PWS by reducing the body mass index,increasing the muscle strength,improving the cardiorespiratory function,and regulating inflammation.Exercise intervention combined with hormone therapy and nutritional intervention can serve as an effective rehabilitation regimen for the health management of children with PWS.Future research should explore optimal exercise prescriptions and long-term effects and mechanisms. 目的 系统评估急性及长期运动干预对普拉德-威利综合征(PWS)儿童体质健康的影响。方法 遵循非随机干预研究的系统综述和Meta分析报告规范,通过检索PubMed、Web of Science、EBSCO等数据库,收集1987至2023年发表的关于运动干预PWS儿童体质健康影响的文献。纳入的文献主要为非随机对照试验,研究对象为PWS儿童,干预措施为急性或长期运动训练,结局指标包括心肺功能、肌肉力量、体成分、代谢指标及炎症反应等。对纳入的研究进行偏倚风险评估,并汇总分析运动干预的效果。结果 共纳入19篇研究,急性运动干预研究显示PWS儿童的心肺功能和肌肉力量均显著低于正常儿童或肥胖对照组,但其代谢反应与对照组相似。长期运动干预结果显示,PWS儿童的体重指数显著下降,肌肉质量增加,心肺功能和身体协调性均显著改善,且长期运动调节部分炎症标志物如白细胞介素-8的水平。此外,部分研究表明运动干预提升了PWS儿童的生活质量。结论 运动干预对PWS儿童的体质健康具有多方面的积极影响,尤其在控制体重、提高肌肉力量、改善心肺功能及调节炎症反应方面具有重要作用。结合激素治疗和营养干预,运动干预可为PWS儿童的健康管理提供有效的康复方案,未来应进一步优化运动处方,探索长期干预的效果和机制。.
Objective To analyze the accuracy of intraoperative frozen section diagnosis of thyroid lesions in Xizang and explore the methods and measures to improve the diagnosis accuracy. Methods The clinicopathological data of 371 patients with thyroid lesions surgically resected by four hospitals in Xizang from January 2020 to December 2024 were collected.With the paraffin section diagnosis after surgery as the standard,the accuracy,missed diagnosis rate,misdiagnosis rate,and delayed diagnosis rate of frozen section diagnosis were analyzed. Results The intraoperative frozen section diagnosis in 371 cases of thyroid lesions showed the accuracy of 95.42% (354/371),the missed diagnosis rate of 0.27% (1/371),the misdiagnosis rate of 0.54% (2/371),and the delayed diagnosis rate of 3.77% (14/371).One case was subjected to missed diagnosis,which was a papillary carcinoma of the thyroid gland.Two cases were misdiagnosed.One of them was diagnosed as malignant tumor during surgery but nodular goiter with atypical hyperplasia of follicular epithelium after surgery.The other case was diagnosed as medullary carcinoma during surgery but subacute thyroiditis after surgery. Conclusions Frozen section diagnosis is an important method for determining the benign or malignant nature of thyroid lesions during surgery.The diagnosis rates of follicular tumors and small lesions are low during surgery.Standardized sampling,improving the quality of frozen sections,and mastering the microscopic morphological characteristics and diagnostic criteria of frozen sections of thyroid lesions during surgery can improve the accuracy of intraoperative frozen section diagnosis. 目的 分析西藏地区甲状腺病变术中冰冻诊断的准确性,探讨提高准确性的方法和措施。方法 收集2020年1月至2024年12月西藏地区4家医院手术切除的371例甲状腺病变患者的临床病理资料,术后以石蜡诊断为标准,分析冰冻诊断准确率、漏诊率、误诊率和延迟诊断率。结果 371例甲状腺病变的术中冰冻切片病理诊断确诊率为95.42%(354/371),漏诊率为0.27%(1/371),误诊率为0.54%(2/371),延迟诊断率为3.77%(14/371)。漏诊1例,为甲状腺微小乳头状癌,冰冻漏取材。误诊2例,其中1例术中考虑恶性肿瘤,术后为结节性甲状腺肿,伴滤泡上皮非典型增生;1例术中考虑髓样癌,术后诊断亚急性甲状腺炎。结论 冰冻病理诊断是手术中确定甲状腺病变良恶性的重要方法,滤泡性肿瘤、微小病变术中确诊率较低,规范取材、提高冰冻切片质量、熟练掌握甲状腺病变术中冰冻病理的显微镜下形态学特点及诊断标准,可以提高术中冰冻病理诊断准确率。.
This paper reported a case of giant renal hamartoma complicated with renal venous tumor thrombus.MRI was used for diagnosis and renal function evaluation on the affected side before surgery,and the patient underwent robot-assisted laparoscopic radical resection of the left kidney and left renal venous tumor thrombus embolectomy.The operation was successfully completed,and there were no complication or tumor recurrence during the 20-month follow-up after surgery.This case,combined with the literature review,suggests that MRI has important guiding significance in the preoperative evaluation and surgical modality selection of giant renal hamartoma. 分析1例巨大肾错构瘤合并肾静脉瘤栓的病例,术前应用MRI进行诊断及患侧肾功能评估,予该患者行机器人辅助腹腔镜下左肾根治性切除术+左肾静脉瘤栓取出术。手术顺利完成,术后20个月随访期间未见并发症发生及肿瘤复发。结合文献综述,MRI在诊治巨大肾错构瘤的术前评估及手术选择上具有重要的指导意义。.
Objective This study aims to systematically analyze the current status of downward referral among rehabilitation physicians in secondary and tertiary hospitals and investigate its influencing factors.By identifying key bottlenecks in the rehabilitation referral process,this study seeks to provide recommendations for optimizing the hierarchical medical system. Methods A multi-stage stratified cluster sampling method was employed to recruit 203 rehabilitation physicians from 33 secondary and tertiary medical institutions across 18 cities in eastern,central,and western China.Data were collected via self-administered online questionnaires,covering demographic characteristics,professional background,and hierarchical medical system-related factors.An ordered multinomial logistic regression model was used to analyze the factors influencing rehabilitation physicians' downward referral behavior. Results After controlling for confounding factors,the nature of the institution in which the doctor worked (OR=0.475, 95%CI=0.245-0.923, P=0.028),downward referral based on the doctor's own clinical experience (OR=0.423, 95%CI=0.217-0.824, P=0.011),the number of outpatient (emergency) visits received in the last week (OR=1.006, 95%CI=1.001-1.011, P=0.018),knowledge of two-way referrals (OR=1.646, 95%CI=1.042-2.601, P=0.033),confidence in correctly judging the timing of patient referrals (OR=1.556, 95%CI=1.013-2.391, P=0.043),and willingness to refer patients downward (OR=1.901, 95%CI=1.366-2.646, P<0.001) were all independent factors influencing rehabilitation physicians' downward referral behavior. Conclusions Rehabilitation physicians' downward referral behavior is influenced by institutional nature,clinical experience,patient volume,referral system awareness,confidence in referral decisions,and referral intention.To enhance referral efficiency and promote the balanced development of rehabilitation services within the hierarchical medical system,this paper proposes the following recommendations:improving bidirectional referral policies,optimizing medical insurance payment structures,strengthening rehabilitation physician training,and encouraging public-private collaboration. 目的 系统分析二、三级医院康复医生向下转诊行为的现状,并探究其影响因素,以揭示当前康复转诊环节的关键瓶颈,为完善分级诊疗体系中的康复转诊流程提供策略建议。方法 采用多阶段分层整群抽样方法,从我国东、中、西部18个城市的33家二、三级医疗机构中抽取203名康复医生作为研究对象。通过网络自填问卷的方式收集数据,问卷内容包括医生的社会人口学特征、职业概况及分级诊疗相关情况。采用有序多分类Logistic回归模型分析康复医生向下转诊行为的影响因素。结果 在控制其他混杂因素后,公立机构的医生(OR=0.475,95%CI=0.245~0.923,P=0.028)、根据本人临床经验办理下转(OR=0.423,95%CI=0.217~0.824,P=0.011)、上周门(急)诊接诊人次越多(OR=1.006,95%CI=1.001~1.011,P=0.018)、对双向转诊的了解程度越高(OR=1.646,95%CI=1.042~2.601,P=0.033)、正确判断患者转诊时机的信心越强(OR=1.556,95%CI=1.013~2.391,P=0.043)、向下转诊患者的意愿越强(OR=1.901,95%CI=1.366~2.646,P<0.001),康复医生向下转诊患者的可能性越高。结论 康复医生的下转行为受医院性质、临床经验、接诊量、转诊认知、判断信心及转诊意愿的影响。建议通过完善双向转诊政策、优化医保支付、加强康复医生培训、鼓励公私协作,提升转诊便利性,促进康复服务的均衡化和分级诊疗体系落地。.
To study the efficacy and safety of upadacitinib in children with refractory inflammatory bowel disease (IBD). Clinical data of eight children with refractory IBD treated with upadacitinib at the Children's Hospital, Zhejiang University School of Medicine, from December 1, 2023 to May 20, 2025 were retrospectively collected to evaluate efficacy and safety. Eight children were included [Crohn's disease (CD), n=5; ulcerative colitis (UC), n=3]; seven were male and one was female. At baseline, six patients had mild disease activity (CD, n=4; UC, n=2) and two had severe activity (CD, n=1; UC, n=1). In UC, all three patients achieved clinical remission by week 2; the week-8 steroid-free clinical remission rate was 67% (2/3). In CD, after 4 weeks of upadacitinib, one patient achieved a clinical response and two switched to other drugs due to persistent activity; the week-12 clinical response rate was 20% (1/5). After 12 weeks, one additional patient switched therapy due to disease activity, and two received combination therapy with thalidomide and exclusive enteral nutrition, respectively. The median follow-up duration was 28 weeks. Overall, five patients achieved clinical remission; among CD, two achieved clinical remission at weeks 14 and 20, respectively. Among eight patients, one episode of norovirus infection occurred, complicated by hypovolemic shock. Upadacitinib can induce a rapid response in children with refractory UC. In refractory CD, combining upadacitinib with agents of different mechanisms may increase the clinical remission rate. Multicenter studies with larger samples are required for confirmation, and vigilance for infection during treatment is warranted. 目的: 分析乌帕替尼治疗难治性炎症性肠病（inflammatory bowel disease, IBD）患儿的有效性及安全性。方法: 回顾性收集2023年12月1日—2025年5月20日在浙江大学医学院附属儿童医院接受乌帕替尼治疗的8例难治性炎症性肠病（inflammatory bowel disease, IBD）患儿的临床资料，评估乌帕替尼对难治性IBD患儿的有效性及安全性。结果: 8例患儿中，克罗恩病（Crohn's disease, CD）5例，溃疡性结肠炎（ulcerative colitis, UC）3例。男7例，女1例。在基线水平，疾病轻度活动期6例（CD 4例，UC 2例），重度活动期2例（CD 1例，UC 1例）。3例UC患儿经乌帕替尼治疗2周均获得临床缓解，8周无激素临床缓解率67%（2/3）;5例CD患儿经乌帕替尼治疗4周后，1例获得临床应答，2例因疾病活动更换为其他药物，12周临床应答率为20%（1/5），12周后1例因疾病活动更换药物，另2例分别联合沙利度胺及全肠内营养治疗。随访时长中位数为28周。最终5例患儿获得临床缓解，2例CD患儿分别于第14周及第20周获临床缓解。8例患儿共发生1例次诺如病毒感染，合并低血容量性休克。结论: 乌帕替尼对难治性UC患儿可快速起效，对难治性CD患儿，乌帕替尼联合不同作用机制的药物治疗可增加临床缓解率，仍需要多中心、大样本的研究进一步证实，治疗过程中需警惕感染的风险。.
To investigate predictors of non-invasive positive pressure ventilation (NIPPV) failure in children with severe pneumonia using propensity score matching. A retrospective case-control study included 79 children with severe pneumonia who experienced NIPPV failure at the Children's Hospital of Chongqing Medical University from January 2021 to December 2023 and 118 contemporaneous children who had successful NIPPV. Propensity score matching was used for 1∶1 matching on baseline variables. Multivariable logistic regression analysis was performed to identify predictors of NIPPV failure, and receiver operating characteristic (ROC) curves were used to evaluate the predictive performance of selected variables. After matching, 77 patients were included in each group, with no statistically significant differences in baseline characteristics (P>0.05). Multivariable logistic regression showed that respiratory rate (OR=1.109) and heart rate (OR=1.064) at 12-24 hours after NIPPV, Pediatric Early Warning Score (PEWS) score before NIPPV (OR=2.809), and lung consolidation on chest imaging before NIPPV (OR=16.144) were positive predictors of NIPPV failure (all P<0.05). Pulse oxygen saturation (SpO2) at 12-24 hours after NIPPV was a negative predictor of NIPPV failure (OR=0.414, P<0.05). ROC analysis showed that SpO2 at 12-24 hours after NIPPV predicted NIPPV failure with an area under the curve (AUC) of 0.906, sensitivity of 70.1%, specificity of 98.7%, and an optimal cutoff of 92%. The PEWS score before NIPPV predicted NIPPV failure with an AUC of 0.784, sensitivity of 64.9%, specificity of 84.4%, and an optimal cutoff of 3.5 points. In children with severe pneumonia receiving NIPPV, close monitoring of respiratory rate, heart rate, and SpO2 is essential, and risk stratification for treatment failure should incorporate pre-treatment chest imaging findings (consolidation area) and PEWS score. 目的: 基于倾向性评分匹配法探究儿童重症肺炎无创正压通气（non-invasive positive pressure ventilation, NIPPV）失败的预测因素。方法: 采用回顾性病例对照研究方法，选取2021年1月—2023年12月重庆医科大学附属儿童医院79例重症肺炎NIPPV失败患儿作为病例组，并抽取同期118例NIPPV成功患儿作为对照组。采用倾向性评分匹配法对两组的基线资料进行1∶1匹配。采用多因素logistic回归分析探究NIPPV失败的预测因素，并绘制受试者操作特征曲线评估部分因素的预测效能。结果: 匹配后两组均包括77例患儿，基线资料比较差异均无统计学意义（P>0.05）。多因素logistic回归分析显示，NIPPV 12~24 h后呼吸频率（OR=1.109）和心率（OR=1.064），以及NIPPV前儿童早期预警评分（Pediatric Early Warning Score, PEWS）得分（OR=2.809）和肺部影像学显示肺实变（OR=16.144）是NIPPV失败的正向预测因素（均P<0.05），而NIPPV 12~24 h后脉搏血氧饱和度（pulse oxygen saturation, SpO2）是NIPPV失败的负向预测因素（OR=0.414，P<0.05）。受试者操作特征曲线分析显示，NIPPV 12~24 h后SpO2预测重症肺炎NIPPV失败的曲线下面积为0.906，灵敏度和特异度分别为70.1%和98.7%，最佳截断值为92%;NIPPV前PEWS得分预测重症肺炎NIPPV失败的曲线下面积为0.784，灵敏度和特异度分别为64.9%和84.4%，最佳截断值为3.5分。结论: 重症肺炎患儿NIPPV治疗中应密切监测呼吸、心率、SpO2等基础生命体征变化，并结合治疗前肺部影像学表现（肺实变面积）、PEWS得分进行NIPPV失败的风险分层。.
Objective To understand the demand of parents in Xichang city for the sexuality education training of young children,analyze its influencing factors,and then put forward corresponding health education strategies. Methods Through cluster random sampling,8 kindergartens were selected in Xichang city,Sichuan province.The knowledge,attitude and practice scale for sexuality education of young children was used to conduct a questionnaire survey among parents of young children.The chi-square test and the multivariate Logistic regression model were used for data analysis. Results Among the 1 496 parents,the demand rates for kindergarten teacher training and expert training were 53.5% and 46.3%,respectively,and the total demand rate for training was 65.4%.The results of the multivariate Logistic regression analysis showed that higher paternal educational level (OR=1.42,95%CI=1.11-1.82,P=0.006),female parenthood (OR=1.71,95%CI=1.28-2.28,P<0.001),positive attitude (OR=1.64,95%CI=1.24-2.15,P<0.001),willingness to participate in school-based early childhood sex education with children (OR=2.44,95%CI=1.67-3.49,P<0.001),and more diverse sources of knowledge (OR=15.32,95%CI=5.49-42.79,P<0.001) were positive predictors of parents' overall demand for training.Conversely,children's prior participation in sex education-related courses at school (OR=0.57,95%CI=0.38-0.85,P=0.006) was a negative predictor of such demand. Conclusions The parents in Xichang city have high demand for the sexuality education training of young children but limited ways to knowledge sources.It is recommended that sexuality education training courses both online and offline should be developed according to the characteristics of parents' needs,and the contents,methods,and ways of health education should be optimized.Special attention should be paid to the health education for male parents,parents with low educational attainment,parents with a passive attitude,and parents who have cognitive misunderstandings about or lack knowledge of children's sexuality education.Efforts should be made to popularize sexuality education knowledge,enhance parents' ability to conduct sexuality education for young children,and improve the quality of family sexuality education through home-school cooperation,thus creating a healthy growth environment for young children. 目的 了解西昌市家长对幼儿性教育培训的需求情况,并分析其影响因素,进而提出相应的健康教育策略。方法 采用整群随机抽样方法在四川省西昌市抽取8所幼儿园,对幼儿家长使用《幼儿性教育知信行量表》进行问卷调查,采用χ2检验和多因素Logistic回归模型进行数据分析。结果 1 496名家长的幼儿园教师培训需求率为53.5%,专家培训需求率为46.3%,培训总需求率为65.4%。多因素Logistic回归分析显示,父亲文化程度高(OR=1.42,95%CI=1.11~1.82,P=0.006)、女性家长(OR=1.71,95%CI=1.28~2.28,P<0.001)、态度积极(OR=1.64,95%CI=1.24~2.15,P<0.001)、愿意和孩子一起参加学校的幼儿性教育(OR=2.44,95%CI=1.67~3.49,P<0.001)、知识来源途径数量多(OR=15.32,95%CI=5.49~42.79,P<0.001)是家长培训总需求的促进因素,孩子在学校参加过性教育相关课程情况(OR=0.57,95%CI=0.38~0.85,P=0.006)是家长培训总需求的抑制因素。结论 西昌市家长幼儿性教育培训需求较高,获取知识来源途径较少。建议针对家长需求特点结合线上线下开展性教育培训课程,优化并完善健康教育内容、方式和途径。重点加强男性家长、文化程度相对较低、态度不积极以及对幼儿性教育存在认知误区或缺乏了解的家长的健康教育,普及性教育知识,提升家长的幼儿性教育能力,通过家校合作的方式提高家庭性教育质量,为幼儿营造健康的成长环境。.
Distinguishing lung cancer from pulmonary infection and interstitial lung disease (ILD) remains challenging. This study aimed to evaluate the diagnostic value of T lymphocyte subsets and neutrophil CD64 (nCD64) index in bronchoalveolar lavage fluid (BALF), alone and in combination, to address this challenge. BALF was collected between October 2021 and October 2022 from 70 patients admitted to West China Hospital, Sichuan University. Based on final diagnosis, the patients were divided into the lung cancer group (21 cases, including 14 with pure lung cancer and 7 with lung cancer and infection) and the non‑lung cancer group (49 cases, including 39 with pulmonary infection and 10 with ILD). Flow cytometry was used to detect T lymphocyte subsets and CD64 expression in BALF, and the CD4+/CD8+ ratio and nCD64 index were calculated. Receiver operating characteristic (ROC) curves were used to evaluate the performance of both indicators in differentiating lung cancer from pulmonary infection and from ILD, and the area under the curve (AUC) and 95% confidence interval (CI) were calculated. The diagnostic efficacy of combining the CD4+/CD8+ ratio and nCD64 index for differentiating lung cancer from pulmonary infection was further analyzed. Firth's logistic regression was performed to adjust for age and to assess the independent differential diagnosis value of the two indicators between lung cancer and pulmonary infection. Compared with the non-lung cancer group, the lung cancer group showed significantly lower CD4+ T cell proportion, CD4+/CD8+ ratio, and nCD64 index (all P<0.05). Further analysis revealed that the lung cancer group also had significantly lower values of the above indicators compared with the pulmonary infection group (P<0.05), but no significant differences were observed compared with the ILD group (P>0.05). ROC curve analysis showed that the CD4+/CD8+ ratio had an AUC of 0.712 (95%CI: 0.575‑0.849, P=0.008) for differentiating lung cancer from pulmonary infection, with a sensitivity of 56.76% and a specificity of 85.00%; the nCD64 index had an AUC of 0.677 (95%CI: 0.539‑0.814, P=0.026), with a sensitivity of 44.74% and a specificity of 95.24%. When the two indicators were combined, the parallel test increased the sensitivity to 78.38%, while the serial test achieved 100.00% specificity and positive predictive value. After adjusting for age, Firth's logistic regression demonstrated that both the CD4+/CD8+ ratio and nCD64 index retained independent differential diagnosis value for differentiating lung cancer from pulmonary infection (both P<0.05). The combined detection of the CD4+/CD8+ ratio and nCD64 index in BALF improves the diagnostic efficacy for differentiating lung cancer from pulmonary infection. 【中文题目：支气管肺泡灌洗液CD4+/CD8+联合
nCD64指数对肺癌与非肺癌疾病的鉴别诊断价值】 【中文摘要：背景与目的 肺癌与肺感染性疾病、间质性肺疾病（interstitial lung disease, ILD）的临床鉴别尚存在困难，本研究旨在探讨支气管肺泡灌洗液（bronchoalveolar lavage fluid, BALF）中T淋巴细胞亚群及中性粒细胞CD64（neutrophil CD64, nCD64）指数单独及联合检测在上述疾病中的鉴别诊断价值。方法 收集2021年10月至2022年10月于四川大学华西医院就诊的70例患者BALF标本，根据诊断分为肺癌组（21例，含单纯肺癌14例、肺癌合并感染7例）和非肺癌组（49例，含肺感染性疾病39例、ILD 10例）。采用流式细胞术检测BALF中T淋巴细胞亚群及CD64表达，计算CD4+/CD8+比值及nCD64指数。采用受试者工作特征（receiver operating characteristic, ROC）曲线评估各指标鉴别肺癌与肺感染性疾病、肺癌与ILD的价值，计算曲线下面积（area under the curve, AUC）及其95%置信区间（confidence interval, CI），并分析CD4+/CD8+比值及nCD64指数联合对肺癌与肺感染性疾病的鉴别诊断效能。采用Firth's logistic回归进行多因素分析，探讨两指标对肺癌与肺感染的独立鉴别价值。结果 与非肺癌组相比，肺癌组CD4+ T细胞比例、CD4+/CD8+比值及nCD64指数均显著降低（均P<0.05）。进一步分析发现，与肺感染性疾病组相比，肺癌组上述指标亦显著下降（P<0.05），但与ILD组相比无显著差异（P>0.05）。ROC曲线显示，CD4+/CD8+比值鉴别肺癌和肺感染性疾病的AUC为0.712（95%CI: 0.575-0.849, P=0.008），灵敏度为56.76%，特异度为85.00%；nCD64指数鉴别肺癌与肺感染性疾病的AUC为0.677（95%CI: 0.539-0.814, P=0.026），灵敏度为44.74%，特异度为95.24%。联合应用CD4+/CD8+比值及nCD64指数时，并联试验的灵敏度提升至78.38%，串联试验的特异度及阳性预测值均达100.00%。校正年龄后，Firth's logistic回归显示CD4+/CD8+比值和nCD64指数仍对肺癌与肺感染性疾病的鉴别具有独立价值（均P<0.05）。结论 BALF中CD4+/CD8+比值与nCD64指数联合检测可提高肺癌与肺感染性疾病的鉴别诊断效能。
】 【中文关键词：支气管肺泡灌洗液；T淋巴细胞亚群；CD4+/CD8+比值；nCD64指数；肺肿瘤；肺感染性疾病；鉴别诊断】.