目的 评价不同间变性淋巴瘤激酶（ALK）抑制剂联合安罗替尼治疗非小细胞肺癌（NSCLC）的疗效。方法 收集ALK突变阳性NSCLC患者的临床资料,筛选服用ALK抑制剂疗效不佳再加用安罗替尼的病例。根据不同的用药方案分为阿来替尼+安罗替尼,塞瑞替尼+安罗替尼和克唑替尼+安罗替尼三个组别。记录患者联合用药前最近一次的影像学检查结果,并以此为基线按Recist1.1评价疗效,以病情进展、患者死亡、停药、改变治疗方案为终点计算各组患者的无事件生存期（EFS）,收集肿瘤标志物、血常规和肝功、心功能、肾功能生化检测等指标数据,统计分析患者联合用药前后各项指标的变化。结果 经筛选,共纳入49例患者的临床数据。阿来替尼+安罗替尼组有23例,疾病控制率（DCR）为86.96%;平均EFS为（10.8±3.6）个月,中位EFS为8.3个月;塞瑞替尼+安罗替尼组有14例,DCR为71.43%;平均EFS为（6.5±2.9）个月,中位EFS为5.6个月;克唑替尼+安罗替尼组有12列,DCR为66.67%;平均EFS为（7.7±3.2）个月,中位EFS为7.2个月。阿来替尼+安罗替尼组的平均EFS长于另外两组（P<0.05）。各研究组肿瘤标志物仅有CyFra21-1在克唑替尼+安罗替尼组在联合用药后升高（P<0.05）,生化检测和血常规指标在用药前后差异无统计学意义（P>0.05）。结论 ALK抑制剂与安罗替尼联用,疗效最好为阿来替尼,其次为塞瑞替尼,最后为克唑替尼。三种ALK抑制剂与安罗替尼联用后,均未导致心、肝、肾功能和血细胞损害。

Objective To evaluate the efficacy of different anaplastic lymphoma kinase（ALK）inhibitors combined with anlotinib in the treatment of non-small cell lung cancer（NSCLC）. Methods Clinical data of drug resistant NSCLC patients with ALK positive mutation was collected who were treated with ALK inhibitors and anlotinib synchronously．According to different regimens,three groups were set,alectinib+anlotinib,ceritinib+anlotinib,and crizotinib+anlotinib．The latest imageological examination results of the patient before the synchronous therapy was set as the baseline to evaluate the therapeutic effect according to Recist1.1．The event free survival（EFS）of each group was calculated with disease progression,patient death,treatment discontinuation and changing regimen as endpoints．Data of tumor markers,hematology test,liver function,cardiac function,renal function biochemical examination was collected and analyzed statistically before and after the combination therapy,with P<0.05 as the statistically significant difference. Results After screening,clinical data of 49 patients were collected．Twenty-three patients in the alectinib+anlotinib group,with a disease control rate（DCR） of 86.96%;mean EFS was（10.8±3.6）months,median EFS of 8.3 months;14 patients in the ceritinib+anlotinib group,with a DCR of 71.43%,mean EFS was（6.5±2.9）months,median EFS was 5.6 months;12 patients in the crizotinib+anlotinib group,with a DCR of 66.67%,mean EFS was（7.7±3.2）months,median EFS was 7.2 months．EFS of alectinib+anlotinib group was longer significantly than the other two groups（P<0.05）．Only CyFra21-1,increased significantly after the combination of crizotinib and anlotinib（P<0.05）．No statistically significant difference in biochemical test and hematology test before and after the treatment（P>0.05）． Conclusions The therapeutic effect of ALK inhibitors with anlotinib was ordered,alectinib being the most effective,followed by ceritinib and finally crizotinib．The combination of ALK inhibitors with anlotinib did not cause any abnormal results in the examination of heart,liver,kidney and blood cells．

实体瘤对免疫治疗应答非常有限,因此,如何有效提升肿瘤免疫治疗的疗效,已成为当前肿瘤免疫治疗领域亟待解决的关键难题与挑战。髓系来源抑制性细胞（MDSCs）的趋化募集及其所介导的肿瘤免疫逃逸机制,是制约实体瘤免疫治疗效果的核心因素之一。文章深入探讨了MDSCs的起源、表型特征、其介导肿瘤免疫逃逸的具体机制,以及当前针对MDSCs的靶向治疗策略与将MDSCs靶向疗法与肿瘤免疫治疗相结合的最新研究进展。此外,文章还系统性地分析了靶向MDSCs联合免疫治疗策略所面临的关键挑战,并据此提出了MDSCs的精准靶向策略。这一策略旨在精确激活抗肿瘤免疫反应,为癌症患者提供更为个性化、高效的治疗方案,从而开启肿瘤免疫治疗领域的新纪元,为癌症治疗策略的创新与发展贡献力量。

Solid tumors exhibit a very limited response to immunotherapy．Consequently,effectively enhancing the therapeutic efficacy of tumor immunotherapy has emerged as a critical challenge and problem that urgently needs to be addressed in tumor immunotherapy．The chemotaxis and recruitment of myeloid-derived suppressor cells（MDSCs）and the tumor immune evasion mechanisms mediated by them are one of the core factors that significantly restrict the efficacy of immunotherapy for solid tumors．In this review,we discuss the origins and phenotypic characteristics of MDSCs,the specific mechanisms by which they mediate tumor immune evasion,as well as current targeted therapeutic strategies for MDSCs and the latest research progress in combining MDSC-targeted therapy with tumor immunotherapy．Furthermore,we have systematically analyzed the key challenges faced by the combination of MDSC-targeted and immunotherapy strategies,and accordingly proposed a precise targeting strategy for MDSCs．This strategy aims to precisely activate anti-tumor immune responses,providing more personalized and efficient treatment options for cancer patients,thereby opening a new era in tumor immunotherapy and contributing to the innovation and development of cancer treatment strategies．

目的 探讨无管化微创PCNL（经皮肾镜取石术）治疗嵌顿性输尿管上段结石的效果。方法 将中山大学附属第一医院惠亚医院2019年12月—2021年12月收治的95例嵌顿性输尿管上段结石患者按照随机数字表法分组,给予对照组47例患者经尿道输尿管镜碎石术（TURL）治疗、观察组48例患者无管化微创PCNL治疗,观察两组手术一般状况、血清学指标、肾脏血流动力学以及并发症发生情况。结果 观察组手术时间、术后血尿以及住院时间均短于对照组,观察组术中出血量少于对照组,观察组结石清除率高于对照组（P<0.05）;术后1 d观察组肾损伤分子-1（KIM-1）、中性粒细胞明胶相关脂脂质运载蛋白（NGAL）以及胱抑素C（Cys-C）水平低于对照组（P<0.05）;两组肾动脉收缩期血流速度（V_s）以及舒张末期血流速度（V_d）对比差异无统计学意义（P>0.05）;观察组并发症发生率（4.16%）低于对照组（19.15%）（P<0.05）。结论 无管化微创PCNL可改善嵌顿性输尿管上段结石手术一般状况,减轻患者肾脏损伤,提高结石清除率,不影响肾脏血流,且并发症更少。

Objective To explore the effect of tubeless minimally invasive（percutaneous nephrolithotomy,PCNL）in the treatment of impacted upper ureteral stones．Methods A total of 95 patients with impacted upper ureteral stones admitted to our hospital from December 2019 to December 2021 were grouped according to the random number table method．Control group of 47 cases were treated with transurethral ureteroscopy lithotripsy（TURL）,48 patients in the observation group were given tubeless minimally invasive PCNL treatment．The general surgical conditions,serological indicators,renal hemodynamics and complications of the two groups were observed．Results The operation time,postoperative hematuria and hospitalization time of the observation group were shorter than those of the control group,the intraoperative bleeding volume of the observation group was less than that of the control group,and the stone free rate of the observation group was higher than that of the control group（P<0.05）．One day after surgery,the levels of kidney injury molecule-1（KIM-1）,lipocalin（NGAL）and cystatin C（Cys-C）in the observation group were lower than those in the control group（P<0.05）;the renal artery systolic blood flow velocity（V_s）and end-diastolic blood flow velocity（V_d）had no statistical significance（P>0.05）;the incidence of complications in the observation group（4.16%）was lower than that in the control group（19.15%）（P<0.05）．Conclusions Tubeless minimally invasive PCNL can improve the general conditions of surgery,reduce kidney damage,increase stone free rate,does not affect renal blood flow,and has fewer complications．

目的 基于最佳矫正视力（BCVA）、角膜水肿程度对比改良与常规小梁切除术治疗急性闭角型青光眼（AACG）的疗效。方法 回顾性收集2021年12月—2023年6月期间信阳爱尔眼科医院收治的112例AACG患者作为研究对象,依据1∶1匹配原则,将接受常规小梁切除术的56例患者作为对照组,接受改良小梁切除术的56例患者作为观察组,统计两组围术期BCVA、眼压、术后浅前房形成状况、角膜水肿程度以及并发症状况。结果 术后3个月,观察组视力为（0.63±0.04）logMAR,高于对照组（0.50±0.03）logMAR,眼压为（16.22±2.28）mmHg,低于对照组（19.95±2.31）mmHg（t=19.457、8.600,均P<0.05）;观察组浅前房发生率为8.93%,低于对照组的26.79%（χ²=6.087,P=0.014）;观察组角膜水肿状况优于对照组（Z=2.737,P=0.006）;观察组脉络膜脱离率、滤道阻塞率、前房积血率、虹膜炎症率依次为1.79%、5.36%、16.07%、10.71%,均低于对照组17.86%、23.21%、32.14%、35.71%（χ²=8.166、7.292、3.953、9.818,均P<0.05）。结论 较常规小梁切除术,改良小梁切除术治疗AACG患者,有助于改善视力、降低眼压、减轻角膜水肿、减少浅前房发生,且安全性较高。

Objective To compare the efficacy of modified and conventional trabeculectomy in the treatment of acute angle-closure glaucoma（AACG）based on best-corrected visual acuity（BCVA）and degree of corneal edema．Methods A total of 112 patients with AACG admitted to the hospital during December 2021 to June 2023 were retrospectively selected as study objects． According to the 1∶1 matching principle,56 patients receiving conventional trabeculectomy were selected as control group,and 56 patients receiving modified trabeculectomy were selected as observation group．Perioperative BCVA,intraocular pressure,postoperative shallow anterior chamber formation,degree of corneal edema and complications were analyzed．Results At three months postoperatively,visual acuity in the observation group was（0.63±0.04）logMAR,which was higher than that in the control group（0.50±0.03）logMAR,and intraocular pressure was（16.22±2.28）mmHg,which was lower than that in the control group（19.95±2.31）mmHg（t=19.457,8.600,P<0.05）;the incidence of shallow anterior chamber in the observation group was 8.93%,which was lower than that of the control group（26.79%）（χ²=6.087,P=0.014）;the corneal edema status in the observation group was better than that of the control group（Z=2.737,P=0.006）;the rates of choroidal detachment,filtering channel obstruction,hyphema,and iris inflammation in the observation group were 1.79%,5.36%,16.07%,and 10.71%,respectively,which were lower than those of the control group（17.86%,23.21%,32.14%,and 35.71%）（χ²=8.166,7.292,3.953,and 9.818,P<0.05）．Conclusions Compared with conventional trabeculectomy,modified trabeculectomy can improve visual acuity,reduce intraocular pressure,relieve corneal edema,and reduce the occurrence of shallow anterior chamber in patients with AACG,with higher safety．

随着糖尿病发病率不断攀升,人们逐渐聚焦于糖尿病合并骨质疏松。围绕此疾病,国内外学者开展了广泛而深入的研究,临床实践聚焦于两点：糖尿病的精准治疗和骨质疏松的有效干预。在确保血糖稳定的基础上,致力于抑制骨吸收、促进骨形成。在此治疗理念指导下,临床医生应当更加全面了解血糖管理与抗骨质疏松药物的作用机制并合理应用,更大程度改善患者的临床症状及预后。然而,药物作用机制复杂,联合应用存在潜在药物相互作用问题。未来研究方向包括探索更安全有效的联合治疗方案,更加精确化地治疗以提高临床疗效。文章分析了降糖药物及抗骨质疏松药物对疾病的疗效,并展望未来的研究方向,旨在为临床实践提供更为深刻与全面的指导。

As the incidence of diabetes mellitus continues to rise,people are also gradually focusing on diabetes mellitus combined with osteoporosis,which puts patients at a higher risk of fragility fracture．Scholars at home and abroad have conducted extensive and in-depth research around this condition,and clinical practice has focused on two points：first,the precise treatment of diabetes,and second,the effective intervention of osteoporosis．On the basis of ensuring blood glucose stabilization,we are committed to inhibiting bone resorption and promoting bone formation．Under the guidance of this therapeutic concept,we should have a more comprehensive understanding of the mechanism of action of blood glucose management and anti-osteoporosis drugs and apply them rationally,aiming to improve the clinical symptoms and prognosis of patients to a greater extent through dual intervention． However,the mechanism of action of different drugs is complex,and there are potential drug-drug interactions and safety issues associated with their combined use．Future research directions should include exploring safer and more effective combination therapies,developing novel drugs,and more precise and individualized treatments to improve clinical efficacy．This article analyzes the efficacy of glucose-lowering drugs and anti-osteoporosis drugs on the disease and looks forward to future research directions,aiming to provide more profound and comprehensive guidance for clinical practice．

目的 评价现有关于干预组仅涉及不同针具针刺或联合常规针刺治疗腰椎间盘突出症系统评价的方法学质量,以比较不同针具针刺治疗腰椎间盘突出症的治疗效果。方法 通过CNKI（中国知网）、万方数据库、VIP（维普）、PubMed、Web of Science等数据库以及其他相关电子资源,对诊断、治疗腰椎间盘突出症的多种针灸技术进行全面的研究。使用AMSTAR2软件,对所有参与的系统性评估结果进行地分析,并根据不同的检测结果,确定文献筛选标准。通过Revman5.4和Cochrance风险偏倚工具,以及Stata16.0的网格Meta分析,挑选了3 381个满足纳入排除要求的随机对照试验。结果 以Stata 16.0统计软件制作排序图可知,杵针+电针的临床有效率SUCRA=81.6%排名第一;目测类比评分显示,银质针SUCRA（用于评估疗效的指标）=95%,排名第一。结论 根据现有的研究证据,杵针+电针以及银质针优于其他9种干预措施,但确切的结果仍需要大量的随机对照试验来证明。

Objective To evaluate the methodological quality of the existing systematic evaluation of the intervention group involving only different needle sets of acupuncture or combined with conventional acupuncture in the treatment of lumbar disc herniation,in order to compare the therapeutic effect of different needle sets of acupuncture in the treatment of lumbar disc herniation．Methods Through CNKI,Wanfang database,VIP,PubMed,web of science and other databases as well as other relevant resources,a variety of acupuncture techniques for the diagnosis and treatment of lumbar disc herniation were comprehensively studied．Through the use of AMSTAR2 software,all participating systematic evaluation results were effectively analyzed,and according to different test results,which literature meets the requirements were determined．Through revman5.4,Cochrane risk bias tool,and grid meta-analysis of stata16.0,3 381 RCTs meeting the inclusion and exclusion requirements were selected．Results According to the ranking chart made by stata16.0 statistical software,the clinical effective rate of pestle needle + electroacupuncture ranked first with sucra=81.6%．According to the visual analogy score,the silver needle sucra=95%,ranking first．Conclusions According to the existing research evidence,pestle needle + electroacupuncture and silver needle are better than the other nine interventions,but the exact results still need a large number of randomized controlled trials to prove．

目的 对比乏白细胞富血小板血浆（LP-PRP）与富白细胞富血小板血浆（LR-PRP）联合体外冲击波疗法（ESWT）治疗慢性非止点跟腱腱病（NIAT）的临床价值。方法 选取2021年12月—2023年12月赣州市人民医院收治的80例慢性NIAT患者,以随机数表法分为两组,即对照组和观察组各40例,观察组予LP-PRP联合ESWT治疗,对照组予LR-PRP联合ESWT治疗;于治疗前、第一次治疗后1个月、3个月比较两组疼痛度[视觉模拟量表（VAS）评分]、跟腱病变程度[维多利亚体育研究所跟腱评估问卷（VISA-A）]、跟腱功能（Arner-Lindholm跟腱功能评分）,并比较两组并发症的发生率。结果 两组在治疗后1个月、3个月的VAS评分下降,VISA-A评分升高,且观察组治疗后3个月的VAS评分（1.05±0.31）分低于对照组的（1.82±0.45）分,VISA-A评分（83.35±5.58）分高于对照组的（76.28±5.35）分（F组间与时点交互=338.478、106.663,均P<0.05）;治疗后3个月,观察组跟腱功能（优、良、差各有24、13、3例）优于对照组（优、良、差各有14、16、10例）,差异有统计学意义（Z=2.529,P=0.012）。两组治疗后1个月时VAS评分、VISA-A评分及跟腱功能比较差异无统计学意义（均P>0.05）。结论 与LR-PRP比较,LP-PRP联合ESWT治疗慢性NIAT更有利于减轻患者跟腱疼痛度及病变程度,改善患者跟腱功能。

Objective To compare the clinical value of leukocyte-poor platelet rich plasma（LP-PRP）and leukocyte-rich platelet rich plasma（LR-PRP）combined with extracorporeal shock wave therapy（ESWT）in the treatment of chronic non -insertional Achilles tendinopathy（NIAT）．Methods Eighty patients with chronic NIAT admitted to Ganzhou People's Hospital from December 2021 to December 2023 were randomly divided into two groups using a random number table method：a control group and an observation group,with 40 patients in each group．The observation group received LP-PRP combined with ESWT treatment,while the control group received LR-PRP combined with ESWT treatment．The pain level（Visual Analog Scale[VAS]score）,degree of Achilles tendon lesion（Victorian Institute of Sports Assessment-Achilles tendinopathy questionnaire[VISA-A]）,and Achilles tendon function（Arner Lindholm Achilles tendon function score）between the two groups were compared before treatment,one month after the first treatment,and three months after treatment,as well as the incidence of complications between the two groups．Results The VAS scores of both groups decreased and the VISA-A scores increased one and three months after treatment．The VAS score of the observation group（1.05±0.31）was lower than that of the control group（1.82±0.45）three months after treatment,while the VISA-A score of the observation group（83.35±5.58）was higher than that of the control group（76.28±5.35）（interaction between group and time point F=338.478,106.663,both P<0.05）．After three months of treatment,the Achilles tendon function of the observation group（24 cases of excellent,13 cases of good,and three cases of poor）was better than that of the control group（14 cases of excellent,16 cases of good,and 10 cases of poor）,and the difference was statistically significant（Z=2.529,P=0.012）．There was no statistically significant difference in VAS score,VISA-A score,and Achilles tendon function between the two groups one month after treatment（all P>0.05）．Conclusions Compared with LR-PRP,LP-PRP combined with ESWT was more beneficial in reducing the degree of Achilles tendon pain and lesions in patients with chronic NIAT,and improving Achilles tendon function．

目的 探讨中医药治疗小儿腺样体肥大（AH）的研究现状、研究热点及趋势,为本领域研究者提供借鉴。方法 检索中国知网（CNKI）数据库从2005年1月1日至2024年1月31日中医药治疗小儿腺样体肥大的相关文献。运用Excel 2019分析其发文量,运用CiteSpace 6.2.R6软件分析其作者、机构、关键词。结果 共纳入文献395篇,年发文量整体呈现波动上升的趋势;发文量最多的作者为姜之炎;发文量最多的研究机构为山东中医药大学。初步形成了以姜之炎、俞景茂、阎兆君为核心的研究团队;研究机构以中医类院校及其附属医院为主。高频关键词提示当前研究热点前三位为中医药治疗方法、临床疗效。结论 AH领域研究内容主要以内治法、外治法、作用机制为主;研究热点逐渐从临床研究转向作用机制等实验研究;应用“数据挖掘”“网络药理学”等计算机技术研究AH会成为趋势。

Objective To explore the research status,research hotspots,and trends of traditional Chinese medicine in the treatment of adenoid hypertrophy in children,to provide a reference for researchers in this field．Methods The relevant literature on the treatment of adenoid hypertrophy in children with traditional Chinese medicine was searched in the CNKI database from January 1,2005,to January 31,2024．Excel 2019 was applied to analyze the number of published papers,and CiteSpace 6.2.R6 software was applied to analyze its authors,institutions,and keywords．Results A total of 395 papers were included,and the annual number of papers showed a fluctuating upward trend．The author with the largest number of papers was JIANG Zhiyan．Shandong University of Traditional Chinese Medicine was the research institution with the largest number of papers．The core research teams including JIANG Zhiyan,YU Jingmao,and YAN Zhaojun were initially formed．The research institutions were mainly Chinese medicine colleges and their affiliated hospitals．High-frequency keywords suggest that the current top three research hotspots were traditional Chinese medicine treatment methods,clinical efficacy．Conclusions The research content in this field is mainly based on internal treatment,external treatment,and mechanism．The focus has gradually shifted from clinical research to experimental research such as mechanism．The application of computer technologies such as “data mining” and “network pharmacology” for this disease will become a trend．

腹腔镜手术后除躯体创伤疼痛,部分患者还可能经历痛苦的术后内脏痛,不仅使患者术后体验不佳,疼痛应激甚至可能加重机体的内环境紊乱,不利于患者的术后康复。内脏痛是来源于内脏器官和组织的疼痛,其产生与脏器的平滑肌痉挛、扩张、缺血、化学炎症刺激等密切相关。在这个过程中,许多离子通道和受体在调节内脏伤害性刺激信号的传导上发挥作用。目前,临床上术后镇痛治疗方案多样,但如何针对性地控制术后内脏痛是临床医生需要面对和解决的问题。为此,该文对腹腔镜术后内脏痛发生的相关机制、内脏感觉的神经传导及临床特征、治疗进展进行综述。

In addition to physical trauma,patients undergoing laparoscopic surgery may also experience postoperative visceral pain．This pain not only impacts the patient's postoperative experience,but can also worsen the body's internal environment and hinder recovery．Visceral pain originates from internal organs and tissues．It is closely related to smooth muscle spasms,dilations,ischemia,and chemical inflammatory stimulation of organs．In this process,numerous ion channels and receptors regulate the transmission of visceral nociceptive stimulus signals．At present,there are multiple clinical treatment options available for postoperative pain management．However,clinicians must overcome the challenge of controlling postoperative visceral pain．This article provides a review of the relevant mechanisms of visceral pain following laparoscopic surgery,the neural conduction of visceral sensation,clinical characteristics and treatment advancements．

目的 探讨软组织重建治疗儿童蟹钳指畸形的临床效果。方法 2019年1月—2022年12月对25例蟹钳指畸形或蟹钳指畸形术后出现“Z”形畸形患儿进行软组织重建治疗,观察术后1年Tada评分、并发症发生情况。结果 术后1年,25例患儿的Tada评分优16例（64%）,良8例（32%）,差1例（4%）。术后1年Peds QL评分（92.74±9.52）高于术前（79.25±7.43）,比较差异有统计学意义（P<0.001）。指间关节伸直障碍、骨折愈合延迟各发生1例,并发症总发生率8%。结论 软组织重建治疗儿童蟹钳指畸形,患儿无需经历一期切除重复拇指,二期行截骨矫形手术或者切除多指的多次手术,只需一次手术就完成蟹钳指截骨矫形,具有治疗周期短、患儿痛苦少、家庭经济成本低,且能显著提升患儿生存质量,临床效果满意等优点。

Objective To investigate the clinical effect of soft tissue reconstruction in the treatment of crab-claw finger deformity in children．Methods From January 2019 to December 2022,soft tissue reconstruction was performed in 25 patients with crab-claw finger deformity or “Z-shaped” deformity after surgery,and Tada score and complications were observed one year after surgery．Results One year after surgery,16 of 25 children had excellent Tada scores（64%）,8 of 25 had good scores（32%）,and 1 had poor score（4%）．The Peds QL score 1 year after operation（92.74±9.52）was significantly higher than that before operation（79.25±7.43）,and the difference was statistically significant（P<0.001）．Dysextension of interphalangeal joint and delayed fracture healing occurred in 1 case,the total complication rate was 8%．Conclusions In the treatment of crab-claw finger deformity and soft tissue reconstruction,children do not need to undergo one-stage resection of the repetitive thumb,second-stage osteotomy and orthopedic surgery or multiple operations to remove extra fingers,and just only one operation is needed to complete the osteotomy and orthopedic surgery of crab-claw finger,which has the advantages of short treatment cycle,less pain for children and low economic cost for families．It significantly improves the quality of life of children and has satisfactory clinical effects．