目的 系统评估阻塞性睡眠呼吸暂停（OSA）与脑小血管病（CSVD）影像特征的关系，以期深入探索OSA在CSVD发生、发展中的潜在机制，并为优化临床管理策略提供新的科学依据。方法 收集自2021年5月—2023年10月期间入院的首发缺血性脑卒中合并CSVD的患者。完善头部MRI，评估CSVD影像学特征，并完善睡眠呼吸检测，计算OSA的特异性指标“低氧负荷（HB）”，并与传统指标对比，采用多因素Logistic回归分析研究这些缺氧指标与CSVD之间的关系，并绘制ROC曲线以比较缺氧指标与结局指标的相关性。结果 共纳入243例首发急性缺血性脑卒中患者，男性155例（63.8%），女性88例。多因素Logistic回归分析发现HB（OR=1.037，95%CI 1.020~1.055，P<0.001）和呼吸暂停低通气指数（AHI）（OR=1.044，95%CI 1.020~1.070，P<0.001）均与脑白质高信号（WMH）呈显著正相关。绘制ROC曲线结果显示，HB（AUC=0.722）与WMH的相关性优于AHI（AUC=0.670）。而睡眠期间血氧饱和度低于90%的时间总和（T90）、血氧饱和度下降指数（ODI）与WMH无关。OSA与扩大的血管周围间隙（EPVS）、脑微出血（CMB）、腔隙性脑梗死（LI）无相关性。结论 相较于传统评估指标，HB与WMH关联性更强，可作为OSA患者风险评估的更有效指标，为个体化干预提供精准依据。 Abstract Objective To systematically evaluate the association between obstructive sleep apnea （OSA） and the radiological features of cerebral small vessel disease （CSVD）， to investigate the potential mechanism of OSA in the development and progression of cerebrovascular diseases， and to provide a new scientific basis for optimizing clinical management strategies. Methods The patients with first-episode ischemic stroke and CSVD who were admitted from May 2021 to October 2023 were enrolled according to the inclusion and exclusion criteria. Cranial MRI was performed to evaluate the radiological features of CSVD， and sleep respiration testing was conducted to calculate hypoxic burden （HB）， a specific indicator for OSA， which was compared with traditional indicators. The multivariate logistic regression analysis was used to investigate the association between these hypoxic indicators and CSVD， and the receiver operating characteristic （ROC） curve was plotted to compare the correlation between hypoxic indicators and outcome measures. Results A total of 243 patients with first-episode acute ischemic stroke were enrolled in this study， among whom there were 155 male patients （63.8%） and 88 female patients. The multivariate logistic regression analysis showed that both HB OR=1.037， 95%CI 1.020-1.055， P<0.001） and apnea-hypopnea index （AHI）（OR=1.044， 95% CI 1.020-1.070， P<0.001） were significantly positively correlated with white matter hyperintensities （WMH）.The ROC curve analysis showed that the correlation between HB and WMH （AUC=0.722） was better than that between HB and AHI（AUC=0.670）. However， sleep time with oxygen saturation below 90% and oxygen desaturation index were not associated with WMH. OSA was not associated with enlarged perivascular spaces， cerebral microbleeds， or lacunar infarction. Conclusion Compared with traditional indicators， HB has a stronger correlation with WMH and can be used as a more effective indicator for risk assessment in OSA patients， thereby providing a precise basis for individualized intervention.

Objective:To analyze the medication law of external application of TCM in the treatment of psoriasis vulgaris (PV) by using data mining method.Methods:Clinical controlled trial literature about external application of TCM in the treatment of PV was retrieved from CNKI, VIP, WanFang, SinoMed, PubMed and Cochrane Library from the establishment of the databases to May 23, 2022. Prescriptions were extracted after screening. TCM inheritance computing platform V3.0 was used to analyze the property, taste, meridian, efficacy, use frequency, common medicinal pairs and the core combinations.Results:A total 186 prescriptions were included, involving 190 kinds of Chinese materia medica. The medicines were mostly bitter and cold in property and taste, mainly belonging to the liver and heart meridians. Heat-clearing drugs were mainly used, followed by blood circulation-activating and stasis-eliminating medicines, and tonic medicines. The ten most frequently used medicines were Sophorae Flavescentis Radix, Dictamni Cortex, Phellodendri Chinensis Cortex, Kochiae Fructus, Angelicae Sinensis Radix, Salviea Miltiorrhizae Radix et Rhizoma, Poria, Rehmannine Radix, and Arnebiae Radix; the 3 commonly used medicinal pairs were Sophorae Flavescentis Radix- Dictamni Cortex, Sophorae Flavescentis Radix- Cnidii Fructus, and Sophorae Flavescentis Radix- Kochiae Fructus; 4 combinations were obtained through evolution. Conclusions:External application of TCM for the treatment of PV is around the core pathogenesis of "heat toxin", mainly treating from the blood, including cooling blood and detoxifcation, activating blood circulation and removing stasis, nourishing the blood and moistening dryness. Clearing heat and drying dampness, dispelling wind and relieving itching are also valued. The treating thoughts can provide some references for clinical treatment.

Objective To establish Brucella peptide mass fingerprint database by MicroflexTMLT MALDI-TOF mass spectrometer ,and evaluate its application value in the identification of clinical isolates of Brucella. Methods In October 2013 ,a suspected Brucella strain was isolated in the microbiology laboratory of the hos-pital.It was confirmed as Brucella meltensis by VITEK ? 2 Compact automatic microbial analysis system and 16S rDNA gene sequencing.Brucella peptide mass fingerprint database was established with this strain ac-cording to the manufacturer's recommended method.Two suspected Brucella strains isolated in the laboratory in April 2015 and June 2016 were tested for Gram stain ,Kozlowski stain and biochemical reactions such as oxi-dase ,catalase and rapid urease activity.MicroflexTM LT mass spectrometer was used to collect the mass spec-trums of these two strains and three suspected Brucella strains isolated from other hospitals.When these spectrums were comparatively analyzed ,self-built database was added on the basis of the MALDI Biotyper da-tabase.The 16S rDNA gene sequencing was also used to identify the above-mentioned bacteria.Results Ac-cording to the recommended self-built database construction process ,Brucella peptide mass fingerprint data-base based on BRUxh1 was obtained successfully.The suspected Brucella strains isolated in April 2015 and June 2016 showed small Gram-negative coccobacillus under microscopic examination of stained smear ,and were positive for oxidase ,catalase ,urease activity (within 5 min).The identification results of mass spectrom- etry for the 5 suspected strains were all Brucella (mass spectrometry score :2.407 ,2.475 ,2.436 ,2.466 and 2.397).The 5 strains were confirmed as Brucella by 16S rDNA gene sequencing.Two strains among bacteria from other hospitals were falsely identified as Roseomonas gilardii by the VITEK?2 Compact system.Conclu-sion The combination of MALDI Biotyper database and self-built Brucella database can be used to compara-tively analyze the mass spectrometry of clinical isolates.Accurate identification of Brucella can be achieved by this means.The method which is fast and sensitive has high application value for rapid clinical diagnosis of Brucellosis.

Objective·To directly detect the bacteria in positive blood culture specimens by the separation gel tube combined with MicroflexTM matrixassisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS),perform direct antimicrobial susceptibility test based on the results of mass spectrometry,and preliminary explore the redesign of conventional positive blood culture specimen processing flow.Methods·449 positive-alarm blood culture specimens of monobacterial infections in clinical microbiology laboratory of Xirhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine from September 1,2015 to August 31,2016 were collected and prepared according to the new positive blood culture specimens processing flow.The new redesigned processing flow included smear staining and microscopy,separation gel/mass spectrometry direct identification,bacteria film/mass spectrometry identification,pure colony/mass spectrometry identification,direct antimicrobial susceptibility test,and conventional antimicrobial susceptibility test,etc.According to the results of microscopic examination,identification test,and antimicrobial susceptibility test,level Ⅰ direct microscopic examination report,positive blood culture level Ⅱ (direct identification/bacteria film identification or direct antimicrobial susceptibility) report,and level Ⅲ final report were provided sequentially.Results·With the new redesigned processing flow,bacterial specieslevel identification reports for 82.2％,95.8％,and 100％ of positive blood samples could be obtain at 10 am and 17 pm on the current day and 10 am in the next morning,respectively,and be sent to clinical departments.Initial antimicrobial susceptibility reports for the bacteria that were considered as clinical significant pathogens by preliminary assessment could be provided in the next day of blood culture positive alarm with a higher coincidence rate as compared to the results of traditional antimicrobial susceptibility tests.Conclusion·The time from blood culture positive alarm to the provision of initial identification and antimicrobial susceptibility reports is shorter by 1-2 d for the redesigned processing flow than for the traditional one,which can provide fast and accurate etiologic diagnosis evidence for bloodstream infections for clinicians and is important for improving early diagnosis and treatment of clinical bloodstream infections.