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小柴胡汤是《伤寒杂病论》中的一首经典方剂,是和解法的基础方,后世将其广泛用于治疗妇科疾病。本研究旨在通过文献检索,探讨小柴胡汤在治疗妇科疾病方面的有效性及其应用的最新进展。文章综述了小柴胡汤在治疗妇科痛证、血证、带下证、块证等相关疾病方面的临床研究和实践经验。小柴胡汤通过其疏肝利胆、健运脾胃、和解枢机的作用,有效改善了女性痛经、盆腔炎性疾病、月经不调、妇科肿瘤、围绝经期综合征等妇科疾病症状。作为临床常用的妇科学方剂,小柴胡汤亟需进一步的发扬与创新,以期更有效地应用于未来的临床实践。
Xiaochaihu Decoction,as a classic prescription in the Treatise on Cold Pathogenic and Miscellaneous Diseases,laid the foundation for reconciliation.It has a wide range of applications in the treatment of gynecological diseases.Through a literature search,this study aimed to explore the effectiveness of Xiaochaihu Decoction in the treatment of gynecological diseases and the latest progress of its application.This article reviews the clinical research and practical experience of Xiaochaihu Decoction in the treatment of gynecological pain,bleeding,leucorrhea disease,tumors and other related diseases.Xiaochaihu Decoction has effectively improved the symptoms of gynecological diseases such as dysmenorrhea,pelvic inflammatory disease,menstrual irregularities,gynecological tumors,and perimenopausal syndrome through its role of soothing the liver and promoting bile flow,strengthening the spleen and stomach,and harmonizing and releasing the pivot.As a commonly used gynecological prescription in clinical practice,Xiaochaihu Decoction urgently needs to be further developed and innovated to be more effectively applied to clinical practice in the future.
本文概述了传统日间腹腔镜胆囊切除术患者术后早期康复质量存在的问题,IMB模型通过向患者提供科学的疾病知识,改变其疾病认知与态度,最终促使其采纳并维持健康行为。本文还介绍了IMB模型在日间腹腔镜胆囊切除术后患者早期康复质量中应用涉及的相关概念、研究背景和国内外的研究现状以及未来发展趋势与挑战。研究结果显示,IMB模型可显著降低患者术后疼痛发生率,并提高患者参与治疗决策的程度,为后期关于IMB模型在日间腹腔镜胆囊切除术患者术后早期康复质量的相关研究提供借鉴与参考,以便后期实施相关个性化干预措施,并提供相关理论依据。
This paper summarizes the problems existing in the early postoperative rehabilitation quality of patients undergoing traditional ambulatory laparoscopic cholecystectomy.The IMB model changes patients’ disease cognition and attitude by providing them with scientific disease knowledge,and ultimately promotes their adoption and maintenance of healthy behaviors.It also introduces the relevant concepts involved in the application of the IMB model in the early postoperative rehabilitation quality of patients undergoing ambulatory laparoscopic cholecystectomy,the research background of this study,the current research status at home and abroad,as well as the future development trends and challenges.The research results show that the IMB model can significantly reduce the incidence of postoperative severe pain in patients and the degree of patient participation in treatment decision-making.This provides reference and guidance for subsequent studies on the early rehabilitation quality of patients undergoing ambulatory laparoscopic cholecystectomy using the IMB model,so as to implement relevant personalized intervention measures in the future and provide relevant theoretical basis.
目的 探讨血浆细胞周期依赖性激酶9(CDK9)水平与大动脉粥样硬化(LAA)型脑梗死病情进展及预后的相关性,评估其作为疾病风险分层及预后评估生物标志物的临床价值。方法 选取2020年1月—2024年12月期间于本院就诊的400例急性LAA型脑梗死患者作为观察组,并同期纳入100名健康体检者作为对照组。发病90 d后,采用改良Rankin量表(mRS)对所有患者进行预后评估。根据评估结果,将观察组进一步划分为预后不良组(152例)与预后良好组(248例)。检测患者血浆CDK9水平并收集临床资料。分析CDK9水平与美国国立卫生研究院卒中量表(NIHSS)评分、梗死灶体积的相关性;分析预后不良的影响因素。结果 观察组CDK9水平高于对照组[(185.6±42.3) pg/mL vs (62.4±18.5) pg/mL,P<0.001],且与梗死体积(r=0.586)、NIHSS评分(r=0.628)、高敏C反应蛋白(r=0.452)及白介素6(r=0.418)呈正相关(均P<0.001)。多因素Logistic回归分析显示,CDK9升高是90天预后不良的独立危险因素。受试者工作特征曲线(ROC)曲线分析显示,CDK9预测预后不良的曲线下面积(AUC)为0.854(最佳截断值为198.6 pg/mL,灵敏度为78.3%,特异度为82.5%),联合NIHSS评分及梗死体积后AUC提升至0.912(P<0.001)。结论 血浆CDK9水平可作为急性LAA型脑梗死病情进展及预后的独立预测标志物,联合传统指标可提高预后评估效能。
Objective To investigate the correlation between plasma cyclin-dependent kinase 9(CDK9)level and disease progression and prognosis in patients with acute large artery atherosclerosis(LAA)cerebral infarction,and to evaluate its clinical value as a biomarker for disease risk stratification and prognostic assessment.Methods This study enrolled 400 patients with acute LAA-type cerebral infarction who visited our hospital between January 2020 and December 2024 as the observation group,along with 100 healthy individuals as the control group during the same period.After 90 days of symptom onset,all patients were assessed using the modified Rankin Scale(mRS)for prognostic evaluation.Based on the assessment results,the observation group was further divided into two subgroups:the poor prognosis group(152 cases)and the good prognosis group(248 cases).Plasma CDK9 levels were measured,and clinical data were collected.The correlation between CDK9 level and National Institutes of Health Stroke Scale(NIHSS)score and infarct volume,and the factors affecting poor prognosis were analyzed.Results Plasma CDK9 levels in the observation group were higher than those in the control group([185.6±42.3] pg/mL vs [62.4±18.5] pg/mL,P<0.001),and were positively correlated with infarct volume(r=0.586),NIHSS score(r=0.628),high-sensitivity C-reactive protein(r=0.452),and interleukin-6(r=0.418)(all P<0.001).Multivariate Logistic regression analysis showed that elevated CDK9 level was an independent risk factor for poor prognosis at 90 d.Receiver Operating Characteristic(ROC)curve analysis revealed that the area under the curve(AUC)of CDK9 for predicting poor prognosis was 0.854(optimal cut-off value:198.6 pg/mL,sensitivity:78.3%,specificity:82.5%),and the AUC increased to 0.912 when combined with NIHSS score and infarct volume(P<0.001).Conclusions Plasma CDK9 level may serve as an independent predictive biomarker for disease progression and prognosis in acute LAA cerebral infarction,and combining it with traditional indicators can improve the efficacy of prognostic assessment.
自闭症谱系障碍(ASD)是一类神经发育障碍性疾病,其核心临床表现为社交行为障碍、语言沟通困难以及重复刻板行为。早期诊断并进行早期行为干预,是目前能改善患者临床症状且减少终身残疾的主要措施。但早期诊断困难,因为目前所采用的行为量表,比如ABC(异常行为检查表)等,在儿童生命早期阶段,如2岁左右,很难准确地反应出被试者的社交行为或者语言交流能力;而且,其判断也非常依赖于医生的经验,具有一定的主观性。近年来,随着脑影像技术,比如核磁共振(MRI),特别是功能性核磁共振(fMRI),以及人工智能技术(AI)的飞速发展,为ASD的早期诊断,从无创、客观、以及神经活动异常-行为异常偶联的角度,展示了一种新的机遇。本文比较系统地介绍了ASD的临床基础与诊断挑战,并详细阐述了AI在ASD早期诊断中的数据来源、核心算法和典型研究案例。通过分析当前技术面临的挑战与局限性,提出未来研究方向与临床转化路径,以期进一步加强AI在ASD早期诊断中的临床使用研究,使之最终能高效的服务于临床。
Autism spectrum disorder(ASD)is a group of neurodevelopmental disorders clinically characterized by deficits in social interaction and verbal communication,along with repetitive behaviors.Early diagnoses,followed by early behavioral interventions,are currently effective strategies to attenuate clinical symptoms and improve patient outcomes in ASD; however,early diagnosis remains challenging at present.Current diagnostic tools,such as the Aberrant Behavior Checklist(ABC),have difficulty in accurately evaluating social engagement and verbal communication in early childhood(e.g. ,at 2 years of age).Furthermore,such evaluations may be somewhat subjective,as they rely,at least partially,on clinicians’ experience.Recently,with the rapid development of brain imaging techniques(e.g. ,MRI,especially fMRI)and artificial intelligence(AI),a significant opportunity has emerged to develop novel early-diagnostic tools for ASD.These tools exhibit clear advantages,including being non-invasive,more objective,and focusing on the coupling of abnormalities in both neuronal activity and behavioral responses.Here,we systematically introduce the clinical features of ASD,discuss the challenges in early diagnosis,and review the current status of AI-driven diagnostic tool development in detail,including data acquisition methods,computational architectures,and typical clinical applications.Through a detailed analysis of the technical challenges,advantages,and limitations of these tools,we propose future research directions,aiming to eventually establish highly valuable AI-based diagnostic approaches for clinical use in ASD care.
作为胃肠道的常见疾病,慢传输型便秘近年来患病率逐年上升。关于该病的具体病因和病理机制目前仍未完全明确,部分患者保守治疗效果欠佳,症状难以彻底缓解。随着病程的延长,患者的生活质量受到显著影响。若长期治疗无效,还可能诱发胃肠道肿瘤、心脑血管疾病等疾病,进一步加重患者的经济与心理负担。在此背景下,外科手术为慢传输型便秘缓解症状提供了新的选择。多数就诊于外科门诊的患者已有数年的便秘病史,曾尝试口服泻药、开塞露刺激或灌肠等常规治疗,但效果均不理想,最终转向手术干预。目前的标准术式以全结肠切除或次全结肠切除为主。近年来,次全结肠切除联合盲乙状结肠吻合术的应用取得了良好疗效,而针对混合型便秘设计的金陵术式也展现出独特的优势。文章通过系统梳理近年来的相关文献,从病因学、发病机制、诊断方法、治疗现状及手术疗效等方面,对慢传输型便秘进行了全面阐述,旨在增进对该疾病的深入理解,从而为临床诊疗策略提供新的理论思路。
As a prevalent gastrointestinal disorder,slow transit constipation(STC) has demonstrated a steadily increasing incidence in recent years.The precise etiology and underlying pathological mechanisms of STC remain incompletely elucidated,with conservative management often proving inadequate for achieving complete symptom resolution in a subset of patients.Chronic disease progression significantly compromises patients’ quality of life,and prolonged ineffective treatment may predispose individuals to serious complications including gastrointestinal neoplasms and cardiovascular disorders,thereby imposing substantial economic and psychological burdens.Within this clinical context,surgical intervention has emerged as a viable therapeutic alternative for refractory STC.The majority of surgical candidates typically present with a multi-year history of constipation refractory to conventional therapies such as oral laxatives,rectal stimulants,and enema administration.Current standard surgical approaches predominantly involve total or subtotal colectomy.Notably,subtotal colectomy with cecosigmoid anastomosis has demonstrated particularly favorable outcomes in recent clinical practice,while the Jinling procedure,a novel surgical technique specifically designed for mixed-type constipation,has shown distinctive therapeutic advantages.This comprehensive review systematically evaluates contemporary literature to provide an integrated perspective on STC,encompassing its etiological factors,pathogenic mechanisms,diagnostic modalities,current treatment paradigms,and surgical outcomes.Through this scholarly synthesis,we aim to deepen the clinical understanding of this condition and propose innovative theoretical frameworks to inform future therapeutic strategies.
肺癌作为全球恶性肿瘤中发病率和死亡率较高的一种,手术是其主要治疗手段。然而,肺切除手术常引起肺功能下降,影响患者术后功能恢复及生活质量。准确预测术后肺功能对制定个体化手术方案、降低并发症风险及改善患者预后具有重要意义。目前,研究者已开发出多种结合临床指标、影像学参数及生物标志物的预测模型,用于评估肺癌患者术后肺功能变化。然而,现有模型在准确性、特异性、标准化及临床推广方面仍存在诸多挑战。本文系统综述肺癌术后肺功能的影响因素,并对现有预测模型进行总结与评价,以期为患者术前评估、手术方案选择及术后管理提供参考,进而为改善治疗效果与患者生活质量提供理论依据。
Lung cancer is a kind of malignant tumor with high morbidity and mortality in the world,and surgery is the main treatment.However,pneumonectomy is often accompanied by the loss of lung function,which seriously affects the recovery of lung function and the quality of life.Accurate prediction of postoperative pulmonary function is of great significance for formulating individualized surgical plans,reducing the risk of complications and improving the prognosis of patients.At present,researchers have developed a variety of predictive models that combine clinical indicators,imaging parameters,and biomarkers to evaluate postoperative lung function changes in patients with lung cancer.However,there are still many challenges in the accuracy,specificity,standardization and clinical promotion of existing models.This paper systematically reviews the influencing factors of lung function after lung cancer surgery,and summarizes and evaluates the existing prediction models,in order to provide a reference for preoperative evaluation,surgical plan selection and postoperative management of patients,and then provide theoretical basis for improving treatment effect and quality of life of patients.
目的 探讨肌少症性肥胖(SO)诊断标准的演进及其在中国老年人群中的本土化综合干预路径。方法 评述ESPEN/EASO最新共识,结合我国老年人代谢特征,系统分析“筛查-诊断-分期”流程及运动营养协同干预的临床效能。结果 SO诊断核心在于识别“隐性肥胖”,建议在AWGS2019标准基础上,叠加中国特异性腰围切点(男≥90 cm,女≥85 cm)或体脂率指标,并应用ALM/BMI校正肌肉质量。研究证实,以渐进式抗阻训练联合高蛋白营养(1.2~1.5 g·kg-1·d-1)为核心的协同模式,通过激活mTOR通路可显著逆转肌肉流失并改善胰岛素抵抗。融入八段锦等传统功法及乳清蛋白补充,能有效重塑中国患者“高碳水、低蛋白”的膳食习惯,提升依从性。结论 构建护士主导、社区依托的多学科管理模式,并借助远程健康工具实现闭环监测,是提升我国SO精准诊疗水平的关键路径。
Objective To explore the evolution of diagnostic criteria for sarcopenic obesity(SO)and its localized comprehensive intervention pathways tailored to the metabolic characteristics of the Chinese elderly population.Methods The latest ESPEN/EASO consensus was reviewed.Combined with the metabolic profile of Chinese older adults,the “screening-diagnosis-staging” workflow and the clinical efficacy of synergistic exercise and nutrition interventions were systematically analyzed.Results The core of SO diagnosis lies in identifying “hidden obesity.”It is recommended to incorporate Chinese-specific waist circumference cut-offs(male≥90 cm,female≥85 cm)or body fat percentage into the AWGS2019 framework,utilizing ALM/BMI for muscle mass calibration.Evidence suggests that a synergistic model,centered on progressive resistance training(PRT)and high-protein nutrition(1.2~1.5 g·kg-1·d-1),can significantly reverse muscle loss and improve insulin resistance by activating the mTOR pathway.Integrating traditional Chinese exercises(e. g. ,Baduanjin)and whey protein supplementation effectively reshapes the “high-carbohydrate,low-protein” dietary habits of Chinese patients,thereby enhancing intervention adherence.Conclusions Establishing a nurse-led,community-based multidisciplinary management model,integrated with digital health tools for closed-loop monitoring,is a pivotal strategy for enhancing the precision of SO diagnosis and treatment in China.
葛根芩连汤作为一种传统中药复方,在治疗代谢性疾病方面展现出显著的疗效。随着中草药现代研究方法的进步,逐渐揭示了葛根芩连汤在代谢性疾病中的治疗作用及其分子机制,包括葛根素、黄芩苷、小檗碱等活性成分的抗炎作用。然而,中草药研究领域的新理论和新机制被不断发现,如影响肠道菌群、产生植物外囊泡、中药汤剂成分自组装等,使得对葛根芩连汤作用机制的理解亟待更新。本文旨在综述葛根芩连汤在代谢性疾病中的作用及机制,并结合最新的研究成果,重点分析其在肠道菌群、植物外囊泡和中药自组装领域的相关发现,探讨其潜在的治疗靶点和未来研究方向,为临床应用和基础研究提供指导。
Gegen Qinlian decoction(GQD),as a traditional Chinese herbal formula,has demonstrated significant efficacy in treating metabolic diseases.With advancements in modern research methodologies for Chinese herbal medicine,the therapeutic effects and molecular mechanisms of GQD in metabolic diseases have been progressively uncovered,including the anti-inflammatory properties of its active components such as puerarin,baicalin,and berberine.However,emerging theories and mechanisms in the field of herbal research,such as modulation of gut microbiota,production of plant-derived extracellular vesicles,and self-assembly of components in herbal decoctions,continuously refine our understanding,highlighting the need to update insights into GQD’s mechanisms of action.This review aims to summarize the roles and mechanisms of GQD in metabolic diseases,integrating the latest research progress with a focus on findings related to gut microbiota,plant-derived extracellular vesicles,and self-assembly phenomena.It further seeks to explore potential therapeutic targets and future research directions,thereby providing guidance for clinical applications and fundamental studies.
脑卒中后认知障碍(PSCI)是脑卒中患者常见的并发症,严重影响患者的生活质量和社会功能。近年来,随着认知储备理论的发展和早期干预理念的普及,PSCI的早期干预模式逐渐成为研究热点。文章综述了PSCI早期干预模式的研究现状与进展,包括干预的理论基础、具体措施及未来发展方向,以期为临床实践和科研提供参考。
Post-stroke cognitive impairment(PSCI)is a common complication among stroke patients.It seriously affects the patients’ quality of life and social functions.In recent years,with the development of the cognitive reserve theory and the popularization of the concept of early intervention,the early intervention model for PSCI has gradually become a research hotspot.This article reviews the current research status and progress of the early intervention model for PSCI,including the theoretical basis of the intervention,specific measures,and future development directions,aiming to provide references for clinical practice and scientific research.
目的 分析广东省卒中中心建设现状及存在的问题,提出切实可行的改善建议。方法 基于广泛的文献调研, 通过问卷对广东省护士协会卒中中心建设与管理分会相关单位开展问卷调查, 统计分析其在医院管理制度、医护人员卒中救治水平及健康宣教等方面的现状与问题。结果 广东省卒中中心建设与管理委员会相关单位在卒中救治中基本实现跨学科合作, 院前评估制度基本满足卒中判断需求, 在提高卒中救治效率方面已基本形成共识, 卒中健康宣教基本满足患者需求, 但方式有待改进, 卒中随访制度和个案管理制度基本符合要求; 存在的问题包括卒中中心一线救治人员外出交流学习机会较少; 院前评估数据采集的便利性有待提高; 卒中康复需求仍难以满足; 健康宣教工作仍需加强。结论 广东省卒中中心建设与管理委员会相关单位在卒中院前评估、院内救治、出院随访和健康宣教方面能够满足患者需求, 但仍存在不足。建议相关单位为一线工作人员提供更多外出交流学习机会, 充分应用互联网和物联网技术提高院前卒中数据采集共享便利性; 加强多种形式的科普宣教, 继续完善拓展卒中康复治疗和护理服务并完善相关制度。
Objective To understand the current situation of construction and existing problems of Stroke Center in Guangdong Province.Put forward feasible suggestions for improvement.Methods Based on extensive literature research, a questionnaire was designed to investigate the relevant organizations of Stroke Center Construction and Management Branch of Guangdong Nurses Association.The status quo and existing problems in hospital management system, stroke treatment level of medical staff, health education and other aspects were statistically analyzed.Results The relevant organizations of the Guangdong Stroke Center Construction and Management Committee could basically achieve interdisciplinary cooperation in stroke treatment, the pre-hospital assessment system basically met the needs of stroke judgment, and a consensus was basically reached on how to improve the efficiency of stroke treatment.Stroke health education basically met the needs of patients but the methods need to be improved.The stroke follow-up system and case management system basically met the requirements,but there were not many opportunities for first-line treatment personnel in stroke centers to exchange and study abroad.The convenience of data collection for pre-hospital assessment needed to be improved.Stroke rehabilitation needs were still difficult to meet.Health education still needs to be strengthened.Conclusions The relevant units of Guangdong Stroke Center Construction and Management Committee can meet the needs of patients in the aspects of pre-hospital assessment, in-hospital treatment,discharge follow-up and health education, but there are still shortcomings.It is suggested that relevant organizations provide more opportunities for front-line staff to exchange and study abroad, make full use of Internet and Internet of Things technology to improve the convenience of pre-hospital stroke data collection and sharing.Strengthen various forms of science popularization and education, and continue to improve and expand stroke rehabilitation treatment and nursing services, improve relevant systems.