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目的探究肺癌患者合并肺部感染的风险因素，构建和验证一个风险预测模型，使用现有的临床数据来预测肺癌患者的肺部真菌感染风险。方法这是一项回顾性研究，收集了2021年1月至2023年3月在中山市人民医院接受治疗的390例肺癌患者的信息，利用合并和不合并肺部真菌感染的肺癌患者人口统计学和临床特征来构建预测发生肺部真菌感染的列线图。所有患者按7：3的比例随机分为训练集和内部验证集两组，应用LASSO回归方法筛选变量和选择预测因子，并使用训练集的多元logistic回归方法构建列线图模型。通过计算受试者工作特征曲线下面积（AUC）确定模型的判断能力，此外，还对模型进行了校正分析和决策曲线分析（DCA）评价预测效果。结果LASSO回归筛选出14个潜在的预测因素，进一步的Logistic回归分析结果显示肝损伤、手术、贫血、低蛋白血症、疾病历程、侵入性操作、住院时间大于2周、全身糖皮质激素应用大于2周是肺癌患者发生肺部真菌感染的独立预测因素。根据这些变量建立了一个预测模型，该模型对训练集的AUC95%CI=0.980（0.973，0.896）和内部验证的AUC95%CI=0.956 （0.795，1.000），显示具有很高的区分度。训练集和验证集的校准曲线均基本沿45°线分布，DCA 曲线显示在阈概率为大于0.03时存在净获益。结论肺癌患者合并肺部真菌感染风险预测模型的构建和验证有助于临床确定高危人群，及早进行干预或调整治疗决策。

上平焊接球节点是一种新型的空间结构用节点型式,综合了焊接球和鼓形节点的优点。节点刚度不对称,现行规范中未有相应的承载力计算公式。通过足尺节点试验结果与节点有限元模拟结果对比,验证了有限元模型参数设置的有效性和合理性。研究了焊接球直径、加劲肋数量、高度、加载管径和球壁厚度5个因素对节点受压极限承载力的影响,分析了不同因素作用下普通焊接球节点与上平焊接球节点极限承载力的比值关系,为该类节点的设计提供了参考。

【摘要】 基质金属蛋白酶9（matrix metalloproteinases 9，MMP9）被证明在缺血性卒中患者梗死灶及梗死灶周围脑组织，梗死灶血管周围及外周血中性粒细胞中均高表达。聚合酶δ-相互作用蛋白2、白细胞介素17（interleukin17，IL-17）、肿瘤坏死因子α、IL-1β、心血管活性肽、血管内皮生长因子等可通过p38丝裂原活化蛋白激酶（mitogen activated protein kinases，MAPK）、细胞外调节蛋白激酶1/2依赖的核因子κB（nuclear factor κB，NF-κB）和活化蛋白-1、p42/p44MAPK、c-Jun氨基末端激酶、p65-NF-κB等不同途径促进MMP9的表达。MMP9的高表达与缺血性卒中出血转化关系密切，且外周血MMP9水平变化与rt-PA溶栓患者死亡或症状性颅内出血独立相关，与缺血性卒中严重程度及不良功能结局相关。MMP9 rs3918242位点基因多态性与缺血性卒中的风险及疾病严重程度可能相关，但目前研究的结果和结论尚不一致。 【Abstract】 When ischemic stroke occurs, matrix metalloproteinases 9 (MMP9) has been shown to be highly expressed in infarct lesion and surrounding cerebral tissue, and neutrophils will be highly expressed in perivascular around infarct focus and peripheral blood. Polymerase δ-interacting protein 2, interleukin17 (IL-17), tumor necrosis factor alpha, IL-1β, cardiovascular active peptide, vascular endothelial growth factor may promote the expression of MMP9 through p38 mitogen activated protein kinases (MAPK), extracellular regulated protein kinases 1/2-dependent nuclear factor κB (NF-κB) and activated protein 1, p42/p44MAPK, c-Jun N-terminal kinase, p65-NF-κB and other pathways. The high expression of MMP 9 is closely related to hemorrhagic transformation in ischemic stroke. The MMP9 level in peripheral blood is closely correlated with ischemic stroke severity, and is an independent risk factor for death and symptomatic intracranial hemorrhage in patients with rt-PA thrombolysis, and related to poor outcome of ischemic stroke patients. The gene locus polymorphism of MMP9 rs3918242 may be associated with the risk of ischemic stroke and the disease severity, but current research results are still inconsistent.

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Objective Methods A purposive sampling strategy was used to choose patients with delayed resolution after microvascular decompression for hemifacial spasm. The qualitative phenomenological study was conducted and two trained research nurses used semi-structured interview on 10 patients. Each interview was recorded on audiotape and later transcribed verbatim , and was stopped when the information reached a saturated level. The Colaizzi s 7-step analysis method was used to analyze the recording materials. Results There are four main themes: Treatment of disease and cognition; Psychological issues such as excessive negative expectation, expectation bias, autosuggestion of surgery failure and positive coping style; Physical issuers such as headache, nausea and vomiting dizziness; incomprehension and support of social relations. Conclusion Patients with delayed resolution after microvascular decompression for hemifacial spasm suffered physical, mental and social stress. Medical staff should take a comprehensive dynamic evaluation on disease awareness, physical issues, psychological issues and social support system, try to understand the symptoms and psychological experience of patients, and provide professional guidance and individualized nursing intervention, in order to relieve discomfort, improve the mental health, and improve the satisfaction and therapeutic experience of patients. To investigate the symptoms and psychological experience of patients with delayed resolution after microvascular decompression for hemifacial spasm, in order to improve the medical staff awareness of patients ‘symptoms and psychological experience after surgery, and provide reference for improving nursing procedures of symptoms management and psychological care. (目的 本研究旨在探讨面肌痉挛行微血管减压术后延迟治愈患者真实的症状体验和心理感受, 以期为医护人员全面掌握患者术后的症状表现及心理状态, 并为完善术后护理程序症状管理及心理护理干预提供依据。方法 采用目的抽样法, 选取符合要求的江苏省南京市某三甲医院神经外科 2021 年 1 月—5 月面肌痉挛行微血管减压术后延迟治愈患者, 采用现象学研究方法, 由 2 名接受过访谈技巧培训的护士采用质性研究方法进行半结构访谈。现场进行笔录和录音, 信息饱和时终止访谈, 本研究共纳入10例面肌痉挛行微血管减压术后延迟治愈患者, 并运用Colaizzi7 步分析法分析访谈资料。结果 访谈内容最终归纳为 4 个主题, 疾病的治疗与认知方面; 心理方面: 过度负性预期、与心理预期的偏差、自我暗示手术失败、积极面对; 生理方面: 头痛、恶心呕吐、头晕; 社会支持系统: 社会关系的不理解、社会关系的支持。结论 面肌痉挛行微血管减压术后延迟治愈的患者承受着生理、心理、社会支持系统多方面压力, 医护人员应对患者的疾病认知水平、生理方面、心理方面、社会支持系统进行全面动态评估, 了解患者最真实的症状体验和心理感受, 给予专业的指导和个性化护理干预, 减轻患者术后不适症状, 促进心理健康, 提高患者满意度, 改善患者治疗体验。)