人工智能与医学

超声引导结合机器学习技术的智能针灸精准诊疗系统研究

Study on acupuncture and moxibustion system using ultrasound and machine learning for precision diagnosis and treatment

:599-604
 
      作为中医药文化瑰宝,针灸在疾病治疗中展现出独特价值,但其标准化操作、疗效量化评价及安全风险控制仍是制约现代化转型的关键问题。随着人工智能技术的突破性发展,机器学习在医疗领域引发的技术革命为针灸创新提供了新机遇。超声医学凭借可视化、定量化及动态监测优势,与机器学习算法形成技术协同,推动传统针灸向精准化、智能化方向迈进。通过超声成像实时定位穴位层次结构与针体轨迹,结合机器学习对多维数据的深度分析,显著提升了针刺治疗的精准性与安全性,同时为建立客观疗效评价体系提供了技术支撑。文章旨在全面回顾超声引导下机器学习技术在针灸研究领域的应用状况,深入剖析现有研究中存在的挑战与局限,并前瞻性地探讨未来的研究方向与趋势,旨在为针灸实践与应用研究的深化与发展提供理论指导与实践启示。
      As an invaluable component of traditional Chinese medicine,acupuncture boasts a distinctive value in the 
treatment of diseases.However,the standardization of its practice,the quantitative assessment of its therapeutic efficacy,and the implementation of safety risk control measures remain pivotal challenges hindering its modernization and transformation.The advent of artificial intelligence technology has precipitated a technological revolution in the medical field,thereby generating novel opportunities for innovation in acupuncture.The integration of ultrasound medicine and machine learning algorithms,leveraging their respective strengths in visualization,quantification and dynamic monitoring,has emerged as a technological synergy.This synergy is poised to propel traditional acupuncture towards precision and intelligence.The integration of ultrasound imaging with machine learning algorithms enables real-time localization of acupoints and needle trajectory,enhancing the precision and safety of acupuncture treatment.Additionally,it facilitates the development of objective efficacy evaluation systems.The present article aims to comprehensively  review the application of ultrasound-guided machine learning technology in the field of acupuncture and moxibustion research.It does so by first analyzing the challenges and limitations of existing research and then prospectively exploring future research directions and trends.The article’s ultimate aim is to provide theoretical guidance and practical inspiration for the deepening and development of acupuncture and moxibustion practice.
论著

便携式超声仪 e-FAST 技术在批量伤员军地联合院前救治中的应用研究

The application of portable ultrasound e-FAST technology in pre hospital treatment of batch injured soldiers in military civilian joint hospitals

:537-541
 
          目的   探讨便携式超声仪超声重点评估(e-FAST)技术在批量伤员军地联合院前救治中的应用效果。方法    抽取2021年5月—2023年10月中国人民解放军联勤保障部队第九八八医院中心急诊科收治的80例批量伤员,均开展军地联合院前救治,按照治疗方案不同分为观察组和对照组,每组患者40例,其中对照组在救治现场行基于创伤严重程度(CRAMS)评分,进行常规急救处置,救护车返院后行CT检查并进行相应伤情治疗,观察组救治现场行CRAMS评分,进行常规急救处置,院前接诊医师在现场或救护车上使用便携式超声仪按照e-FAST流程检查相应部位,初步诊断后进行相应伤情治疗,对比两组患者治疗效果,两组患者诊断时间、初次医疗接触—进入手术室时间及入院诊断与出院时确定性诊断的符合率、两组患者治疗前后CRAMS评分及CRAMS≤8分抢救成功率。结果   观察组治疗有效率为95.0%,对照组为85.0%,对比差异无统计学意义(χ 2 =2.222,P=0.136);观察组患者的诊断时间(13.56±2.36)min、初次医疗接触—进入手术室时间(30.42±8.99)min均短于对照组[(23.64±5.69)、(52.27±12.60)min],差异有统计学意义t=10.349、8.928,P<0.05);观察组患者入院诊断与出院时确定性诊断的符合为97.5%,对照组患者入院诊断与出院时确定性诊断的符合为95.0%,差异无统计学意义(χ 2 =0.346,P=0.556);治疗后两组患者的CRAMS评分均升高,且观察组(9.87±2.62)分高于对照组(8.60±2.98)分,差异有统计学意义(t=2.024,P=0.046);观察组患者CRAMS≤8分的抢救成功率为97.50%,对照组CRAMS≤8抢救成功率为85.00%,观察组患者CRAMS≤8分的抢救成功率高于对照组(χ 2 =3.914,P=0.048)。结论    本研究从军地联合救治批量伤员切入,瞄准部队医院军民融合战略发展路线,本文针对便携式超声仪e-FAST应用范围前移,明显地提高急救人员院前救治能力,提高抢救成功率,值得临床参考。
       Objective  To explore the application effect of portable ultrasound e-FAST technology in the pre hospital treatment of batch wounded soldiers in military civilian joint hospitals.Methods  Eighty batch wounded patients admitted to the emergency department of 988 Hospital from May 2021 to October 2023 were selected,all of whom underwent military civilian joint pre hospital treatment.They were divided into an observation group and a control group according to different treatment plans,with 40 patients in each group.The control group received CRAMS scores at the treatment site for routine first aid treatment,CT scans after ambulance return to the hospital for corresponding injury treatment,the observation group  received CRAMS scores at the treatment site for routine first aid treatment,and the pre-hospital attending physician used a portable ultrasound instrument to examine the corresponding parts on site or in the ambulance according to the e-FAST process.After preliminary diagnosis,corresponding injury treatment was carried out.The treatment effects of the two groups of patients were compared,and the diagnosis time and initial diagnosis of the two groups of patients were compared.The time from medical contact to entering the operation room,the compliance rate of discharge and admission diagnoses,the CRAMS score before and after treatment,and the success rate of rescue with CRAMS ≤ 8 for both groups of patients were compared.Results  The effective rate of treatment in the observation group was 95.0%,while in the control group it was 85.0%,which difference was not statistically significant(χ 2 =2.222,P=0.136).The time to diagnosis(13.56±2.36)min,time to the operating room(30.42±8.99)min were shorter than that in the control group[(23.64±5.69),(52.27±12.60)min],with significant difference(t=10.349,8.928,P<0.05).The consistency  between the admission diagnosis and the definitive diagnosis at discharge of the observation group patients was 97.5%,while the consistency of the control group patients was 95.0%.There was no significant difference between the groups(χ 2 =0.346,P=0.556).After treatment,the CRAMS scores of both groups of patients increased,the observation group(9.87±2.62)was higher than that of the control group(8.60±2.98)(t=2.024,P=0.046).The success rate of CRAMS ≤ 8 rescue in the observation group was 97.50%,while the success rate in the control group was 85.00%.The success rate of CRAMS ≤ 8 rescue in the observation group was higher than that in the control group(χ 2 =3.914,P=0.048).Conclusions  This study focuses on the joint treatment of batch wounded soldiers by military and civilian forces,aiming at the development path of military civilian integration strategy in military hospitals.The application scope of portable ultrasound e-FAST has been moved forward,which significantly improves the pre hospital treatment ability of emergency personnel and improves the success rate of rescue.It is worth clinical reference.
论著

达泊西汀联合达克罗宁胶浆治疗早泄的临床研究

Clinical study on the treatment of premature ejaculation with dapoxetine combined with dacronine mucilage

:523-528
 
       目的   探讨盐酸达泊西汀联合达克罗宁胶浆治疗早泄的临床疗效。方法   选取男科门诊146例早泄患者,随机分组,对照组服用达泊西汀片,研究组为达泊西汀片和达克罗宁胶浆联合治疗,再将研究组分为阴茎头敏感度高组和敏感度正常组,记录各组治疗前、治疗8周后早泄相关指标。结果   治疗后对照组阴道内射精潜伏期(IELT)、早泄诊断量表(PEDT)和早泄指数量表(IPE)中Q6+Q7分别为(4.68±2.79)、(9.52±2.14)、(6.48±1.30),研究组IELT、PEDT和Q6+Q7分别为(6.09±3.09)、(7.52±1.92)、(7.85±1.36),各组相关指标均较治疗前改善(P<0.05),研究组各指标改善程度优于对照组(P<0.05);治疗后敏感度高组IELT、PEDT和Q6+Q7分别为(6.76±2.99)、(6.84±1.53)、(8.16±1.10),敏感度正常组IELT、PEDT和Q6+Q7分别为(5.13±3.02)、(8.50±2.03)、(7.40±1.59),敏感度高组各指标改善程度优于敏感度正常组(P<0.05);对照组、研究组总有效率分别为69.86%(51/73)、84.93%(62/73),研究组治疗效果优于对照组(P<0.05);敏感度高组、敏感度正常组总有效率分别为93.02%(40/43)、73.33(22/30),敏感度高组治疗效果优于敏感度正常组(P<0.05)。结论    达泊西汀联合达克罗宁胶浆治疗早泄效果显著,阴茎头敏感患者联合达克罗宁胶浆治疗受益更大。
       Objective  To investigate the clinical efficacy of dapoxetine hydrochloride combined with dclonine mucilage in the treatment of premature ejaculation.Methods  A total of 146 patients from andrology department with premature ejaculation were selected and randomly divided into control group and research group.The control group was treated with dapoxetine alone,while the research group was treated with dapoxetine combined with dacronine mucilage.The  research group was divided into high sensitivity group and normal sensitivity group.The indexes  related to premature ejaculation were  recorded before treatment and 8 weeks after treatment.Results  After treatment,intravaginal ejaculatory latency time(IELT),Premature Ejaculation Diagnosis Tool(PEDT)and Q6+Q7 of the index of premature ejaculation(IPE)in control group were(4.68±2.79),(9.52±2.14)and (6.48±1.30),respectively,while IELT,PEDT and Q6+Q7 in research group were(6.09±3.09),(7.52±1.92) and (7.85±1.36),respectively.The relevant indexes in all groups were significantly improved compared with those before treatment(P<0.05),and the improvement of all indexes in research group was better than that in control group(P<0.05).After treatment,IELT,PEDT and Q6+Q7 in the highly sensitivity group were(6.76±2.99),(6.84±1.53)and(8.16±1.10),respectively,while IELT,PEDT and Q6+Q7 in the normal sensitivity group were(5.13±3.02),(8.50±2.03)and(7.40±1.59),respectively.The improvement of all indexes in the high sensitivity group was better than that in the normal sensitivity group(P<0.05).The total effective rate of the control group and the research group was 69.86%(51/73)and 84.93%(62/73),respectively.The therapeutic effect of the research group was significantly better than that of the control group(P<0.05).The total effective rate of the high sensitivity group and the normal sensitivity group was 93.02%(40/43)and 73.33%(22/30),respectively.The therapeutic effect of the high sensitivity group was significantly better than that of the normal sensitivity group(P<0.05).Conclusions  Dapoxetine combined with dacronine mucilage has significant effect in the treatment of premature ejaculation,and the patients with high sensitivity of penile head will benefit more from combined dacronine mucilage therapy.
论著

宫腔镜病灶切除术与超声监测下吸宫术治疗剖宫产瘢痕部位妊娠的有效性比较

Comparison of effectiveness between hysteroscopic resection surgery and ultrasound-guided uterine aspiration in the treatment of cesarean scar pregnancy

:500-504
 
       目的   比较宫腔镜病灶切除术与超声监测下吸宫术治疗剖宫产瘢痕部位妊娠(CSP)的有效性。   回顾性分析2021年7月—2023年10月在南宁市妇幼保健院确诊为I、Ⅱ型CSP并接受治疗的129例患者,停经时间在38~83 d,中位停经时间48 d。其中42例患者接受了宫腔镜病灶切除术治疗(A组),87例患者接受超声监测下吸宫术治疗(B组),比较两组患者术后1、3、7、14 d的人绒毛膜促性腺激素水平以及手术出血量、手术时间、住院时间、住院花费。结果   两组患者在术后1 d,血清HCG水平下降,下降幅度均超过50%,且A组患者术后1 d血清HCG的下降幅度及下降速率大于B组患者(P<0.05);术后3、7、14 d,两组血清HCG水平仍持续下降。另外,A组患者手术出血量、手术时间、住院时间、住院花费分别为(15.35±14.53)mL、(60.73±53.05)min、(4.33±1.90)d、(6 689.23±2 216.19)元;B组患者手术出血量、手术时间、住院时间、住院费用分别为(26.09±29.24)mL、(51.59±54.46)min、(4.82±1.83)d、(6 270.34±2 547.85)元。A组患者术中出血量低于B组、住院时间短于B组(P<0.05),手术时间及住院费用与B组比较差异无统计学意义(P均>0.05)。结论   宫腔镜病灶切除术与超声监测下吸宫术均能有效治疗CSP,但宫腔镜病灶切除术在术后血清HCG的下降幅度及下降速率、术中出血量、住院时间等方面优于超声监测下吸宫术,而且手术时间和住院费用并没有显著增加。
       Objective  To compare the efficacy between hysteroscopic  resection surgery and ultrasound-guided uterine aspiration in the treatment of cesarean scar pregnancy(CSP).Methods  A  retrospective analysis was performed in 129 patients diagnosed with CSP(type I or Ⅱ)and treated in Nanning Maternal and Child Health Hospital from July 2021 to October 2023.Their duration of amenorrhea was between 38~83 d,with a median of 48 days.Among them,42  patients were treated with hysteroscopic resection surgery therapy(group A),87 patients were treated with ultrasound-guided uterine aspiration therapy and(group B).Then,the levels of human chorionic gonadotropin(HCG),the amount of the intraoperative bleeding volume,surgical time,hospitalization time,and hospitalization expenses were compared between the two groups at one,three,seven and 14 days postoperativey.Results  After one day of surgery,the serum HCG levels of two groups significantly decreased,with a decrease of more than 50%,and the magnitude and  rate of  decrease in  serum HCG levels of group A were  significantly larger than those of group B(P<0.05);After three,seven,and 14 day of surgery,serum HCG levels continued to decrease.Furthermore,the intraoperative bleeding volume,surgical time,hospitalization time,hospitalization expenses in group A were(15.35±14.53)mL,(60.73±53.05)min,(4.33±1.90)d,(6 689.23±2 216.19)yuan,respectively.That in group B were(26.09±29.24)mL,(51.59±54.46)min,(4.82±1.83)d,(6 270.34±2 547.85)yuan,respectively.Compared to group B,the intraoperative bleeding volume of group A was significantly lower(P<0.05),and the hospitalization time is shorter,while there was no significant difference in surgical time and hospitalization expenses.Conclusions  Both of hysteroscopic resection surgery and ultrasound-guided uterine aspiration can treat cesarean scar pregnancy effectively,but the former is superior to the latter in terms of the magnitude and rate of decrease in serum HCG levels after surgery,intraoperative bleeding volume,and hospitalization time,with no significant increase in surgical time and hospitalization expenses.
综述

双硫死亡与其他细胞死亡在卵巢癌治疗中的研究进展

Research progress on disulfideptosis and other cell death pathways in ovarian cancer treatment

:452-456
 
       卵巢癌是导致女性死亡的全球第五大原因,其治疗效果受限于早期诊断和治疗方案的有限性。近年来,随着靶向治疗的不断发展,细胞死亡途径作为治疗靶点受到广泛关注,其中双硫死亡作为一种新发现的程序性细胞死亡形式,为癌症治疗提供了新的思路。文章探讨了双硫死亡及其他主要细胞死亡途径包括自噬、细胞焦亡、坏死性凋亡、铁死亡和铜死亡在卵巢癌治疗中的研究进展,有望为卵巢癌患者提供更有效的治疗选择。
    Ovarian cancer ranks as the fifth deadliest cancer among women worldwide,with treatment efficacy hampered 
by limited early diagnosis and therapeutic options.In recent years,with the continuous development of targeted therapies,cell death pathways have gained widespread attention as therapeutic targets.Among them,disulfideptosis,a newly discovered form of programmed cell death,offers a novel avenue for cancer treatment.This review aims to explore the research progress of disulfideptosis and other major cell death pathways including autophagy,apoptosis,necroptosis,ferroptosis,and cuproptosis in ovarian cancer therapy,with the potential to provide more effective treatment options for ovarian cancer patients.
论著

无管化微创 PCNL 治疗嵌顿性输尿管上段结石的效果

The effect of tubeless minimally invasive PCNL in the treatment of incarcerated upper ureteral calculi

:398-402
 
       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(Vs)以及舒张末期血流速度(Vd)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 groupwere lower than those in the control group(P<0.05);the renal artery systolic blood flow velocity(Vs)and end-diastolic blood flow velocity(Vd)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.
论著

清醒镇静在急性缺血性脑卒中血管内治疗中的应用效果及预后

Effect of conscious sedation in the application of endovascular treatment and prognosis of acute ischemic stroke

:382-386
 
       目的   探讨清醒镇静应用在急性缺血性脑卒中血管内治疗中的效果。方法   选择2020年1月—2023年3月医院接收的急性缺血性脑卒中患者82例进行研究,按随机数表法分为2组,每组各41例,两组采取溶栓与取栓治疗,对照组采取全身麻醉方式,观察组采取清醒镇静方式,记录两组治疗相关参数,比较两组近期疗效、并发症发生情况及预后。结果   观察组入院到腹股沟穿刺时间(95.52±3.63)min、穿刺至血管再通时间(72.25±5.58)min低于对照组(112.25±4.18)min、(102.45±10.63)min(t=19.349,P<0.05);观察组ICU时间(7.81±2.63)d、住院时间(13.75±3.64)d,与对照组(8.05±2.81)d、(14.52±4.07)d比较差异无统计学意义(t分别为0.524、0.399、0.902,P分别为0.601、0.690、0.369)。观察组近期总有效39例(95.12%)与对照组37例(90.24%)比较差异无统计学意义χ 2 =0.719,P=0.396)。观察组症状性颅内出血3例(7.32%)与对照组6例(14.63%)比较差异无统计学意义(χ 2 =1.123,P=0.289);观察组脑水肿4例(9.76%)、坠积性肺炎12例(29.27%),低于对照组7例(17.07%)、18例(43.90%)(χ 2分别为4.969、6.962,P分别为0.025、0.008)。观察组预后良好21例(51.22%)高于对照组10例(24.39%)(χ 2 =6.275,P=0.012)。结论   急性缺血性脑卒中患者溶栓与取栓治疗中采取清醒镇静方式可获得与全身麻醉相近的疗效,而且可进一步缩短治疗时间,促进血管快速再通,减少相关并发症,使患者获得更好的预后。
       Objective  To investigate the conscious sedation effect of endovascular treatment in acute ischemic stroke.Methods  A total of 82 patients with acute ischemic stroke admitted to the hospital from January 2020 to March 2023 were selected and divided into two groups according to the random number table method,with 41 cases in each group.The two groups were treated with thrombolysis and thrombectomy,the control group was treated with general anesthesia,and the observation group was treated with conscious sedation.The short-term efficacy,complications and prognosis were compared between the two groups.Results  The time from admission to groin puncture [(95.52±3.63)min] and time from puncture to vascular  recanalization [(72.25±5.58)min] in the observation group were significantly lower than those in the control group [(112.25±4.18)min,(102.45±10.63)min](t=19.349,P<0.05).Observation group ICU time,length of hospital stay(7.81+2.63)d(13.75+3.64)d,and the control group(8.05+2.81)d,(14.52-4.07)d  had  no  statistically  significant  difference in comparison(t were 0.524,0.399,0.902,P were 0.601,0.690,0.369).Recent total effective cases observation in group was 39(95.12%)and control group was 37(90.24%),there was no statistically significant difference comparing(χ 2 =0.719,P=0.396).Observation group had symptomatic intracranial hemorrhage in three patients(7.32%)and control group had six cases(14.63%),there was no statistically significant difference(χ 2 =1.123,P=0.289).There were four cases(9.76%)of brain edema and 12 cases(29.27%)of hypostatic pneumonia in the observation group,which were significantly lower than seven cases(17.07%)and 18 cases(43.90%)in the control group(χ 2 =4.969,6.962,P=0.025,0.008).The number of patients with good prognosis in the observation group(21 cases,51.22%)was significantly higher than that in the control group(10 cases,24.39%)χ 2 =6.275,P=0.012).Conclusions In the treatment of acute ischemic stroke patients with thrombolysis and thrombectomy,conscious sedation can achieve the same efficacy as general anesthesia,and can further shorten the treatment time,promote  rapid recanalization of blood vessels and reduce related complications,so that patients can get a better prognosis.
论著

基于 BCVA 和角膜水肿程度探讨改良与常规小梁切除术治疗急性闭角型青光眼的临床价值

Based on BCVA and modified with conventional corneal edema degree to explore the clinical value of treatment of acute angle-closure glaucoma trabeculectomy

:366-371
 
       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%(χ 2 =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%(χ 2 =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%)(χ 2 =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%)(χ 2 =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.
综述

2 型糖尿病合并骨质疏松的药物治疗进展

Advances in the pharmacologic treatment of type 2 diabetes mellitus combined with osteoporosis

:316-322
 
       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.
专家述评

结直肠癌肝转移的分子机制及临床治疗的研究进展

Advances in the emerging mechanisms and treatment progress on liver metastasis of colorectal cancer

:288-299
 
       结直肠癌(CRC)是全球第三大最常见的癌症,也是癌症相关死亡的第二大常见原因。结直肠癌肝转移(CRLM)是导致CRC患者死亡的主要原因,根治性肝切除术是目前有望治愈CRLM的唯一途径,但大部分患者不能进行根治性肝切除术。通过早期发现并进行针对性干预,能够改善患者的治疗效果及预后。文章通过综述CRLM的发病机制、诊疗现状及最新纳米诊疗方法,为深入探索高效诊疗方法提供思路。
      Colorectal cancer(CRC)is the third most common cancer and the second most common cause of cancer-related death worldwide.Colorectal cancer liver metastases(CRLM)are the leading cause of death in patients with CRC.Radical hepatectomy is the only way to cure CRLM so far,while most patients cannot undergo radical hepatectomy.CRLM treatment efficacy and prognosis can be improved by early diagnosis and specialized intervention.This paper reviews the pathogenesis,diagnosis,and treatment status of CRLM and the latest nano-diagnosis and treatment methods so as to provide ideas for in-depth exploration of efficient diagnosis and treatment methods.
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