肿瘤相关巨噬细胞（TAMs）是肿瘤微环境中最丰富的免疫细胞之一,M2-TAMs在肿瘤发生、发展、转移和治疗过程中发挥重要作用,被认为是肿瘤治疗中的重要靶点。已有的研究表明,通过将促肿瘤的M2-TAMs重编程为促炎的M1-TAMs可实现抑制肿瘤生长和转移。本综述在介绍TAMs与肿瘤治疗相关背景的基础上,重点关注纳米药物重编程TAMs增强抗肿瘤的研究进展。本文将从TAMs靶向递送各种活性物质进行重编程TAMs和纳米药物介导的异常肿瘤微环境调节的间接重编程TAMs两种方式,综述近年来基于纳米药物递送系统的调控策略及典型例子。

Tumor associated macrophages（TAMs）is one of the most abundant immune cells in the tumor microenvironment．M2-TAMs play an important role in tumor genesis,progression,metastasis and treatment,and is additionally a very important target in tumor therapy．Previous studies have shown that inhibition of tumor growth and metastasis can be achieved by reprogramming M2-TAMs to M1-TAMs．On the basis,this review focuses on the analysis progress of nano-drug reprogramming TAMs to boost anti-tumor．In this paper,we reviewed two methods of reprogramming TAMs for targeted delivery of various active substances and indirect reprogramming TAMs for abnormal tumor microenvironment regulation mediated by nanomedicine．The regulatory strategies and typical samples of nanomedicine delivery systems in recent years were summarized.

目的 探讨进食时机对尿毒症血液透析患者的影响,为临床上此类研究提供参考依据。方法 选取2018年5月—2020年5月于我院进行血液透析的患者42例,根据自身随机对照法分为A组（n=21）和B组（n=21）。A组患者前六次在血液透析1.5 h时进食,后六次在血液透析2.5 h时进食;B组患者前六次在血液透析2.5 h时进食,后六次在血液透析1.5 h时进食。观察比较1.5 h和2.5 h进食的患者在血液透析前以及血液透析中不同时间点的血压和血糖。结果 2组患者在不同时间点的血压值和低血压发生率比较差异无统计学意义（P>0.05）;血液透析1.5 h进食患者在透析2 h和3 h时血糖值明显高于2.5 h进食患者,比较差异具有统计学意义（P<0.05）;血液透析1.5 h进食的患者在透析2 h时低血糖的发生率显著低于2.5 h进食患者,差异具有统计学意义（P<0.05）。结论 对尿毒症血液透析患者来说,于血液透析1.5 h进食能够有效降低患者低血压和低血糖的发生几率。

Objective To discuss the influence of eating timing on uremic hemodialysis patients,and to provide a reference for this kind of clinical research．Methods A total of 42 patients undergoing hemodialysis were selected in our hospital from May 2018 to May 2020 and were divided into group A（n=21）and group B（n=21）according to self randomized control method．Patients in group A ate at 1.5 hour of hemodialysis for the first six times,and at 2.5 hour of hemodialysis for the last six times;patients in group B ate at 2.5 hour of hemodialysis for the first six times,and at 1.5 hour of hemodialysis for the last six times．Observed and compared the blood pressure and blood sugar of patients who eat at 1.5 hour and 2.5 hour before hemodialysis and at different time points during hemodialysis．Results There were no significant differences in blood pressure and the incidence of hypotension between the two groups of patients at different time points（P>0.05）;the blood glucose levels at 2 and 3 hour of the patients who ate at 1.5 hour of hemodialysis was significantly higher than that of the patients who ate at 2.5 hour,and the difference was statistically significant（P<0.05）;the incidence of hypoglycemia at 2 hour of hemodialysis in patients who ate at 1.5 hour was significantly lower than that of patients who ate at 2.5 hour,and the difference was statistically significant（P<0.05）．Conclusions For uremic hemodialysis patients,eating at 1.5 hour of hemodialysis could effectively reduce the incidence of hypotension and hypoglycemia．

目的 调查眼科患者对荧光素眼底血管造影认知情况及健康教育需求,为眼底造影医护人员实施高效、个性化健康教育提供依据。方法 采用自制眼底造影认知及健康教育需求问卷,对本院2021年6月—8月的123例眼底血管造影患者进行问卷调查,使用Spearman相关性分析、非参数秩和检验及多元线性逐步回归分析患者眼底血管造影认知的影响因素。结果 患者荧光素眼底血管造影认知得分为（33.77±8.09）分,其中,患者对于检查中的相关知识认知最低,相对得分为0.59;患者健康教育需求的得分为（43.95±7.63）分,其中,检查后的相关知识需求度最高,相对得分为0.77;不同年龄、文化程度、主要照顾者、眼造影检查次数及是否合并全身病的患者的认知水平差异有统计学意义（P<0.05）。多元线性逐步回归分析表明,眼造影检查史是患者眼底血管造影认知的独立影响因素。结论 眼科患者对荧光素眼底血管造影认知水平较低,健康教育需求高,医护人员应重视健康教育的实施,结合FFA操作流程及患者特点,制定标准化健康教育流程,探索有效的线上+线下的健康教育模式,以提高造影患者认知水平,保障患者安全。

Objective To investigate fundus fluorescein angiography（FFA）cognition and health education needs in ophthalmic patients,and to provide basis for efficient and personalized health education for FFA medical staff．Methods A self-made questionnaire was used in a survey of 123 patients from June to August 2021．The influencing factors of FFA cognition were analyzed by Spearman correlation analysis,non parametric rank sum test and multiple linear stepwise regression．Results The score of FFA cognition was（33.77 ± 8.09）．Patients had the lowest cognition of relevant knowledge during the examination,with a relative score of 0.59．The score of patient's health education needs was（43.95 ± 7.63）,while the score of relevant knowledge needs after examination was the highest,with a relative score of 0.77．There were significant differences in cognitive level among patients with different ages,educational levels,main caregivers,angiographic times,and complication of systemic diseases（P<0.05）．Multiple linear stepwise regression analysis showed that the number of ocular angiography was an independent factor affecting the cognition of FFA．Conclusions Patients with FFA have low cognitive level and high demand for health education．Medical staff should pay attention to the implementation of health education,formulate a standardized health education process with the combination of operation process and patient characteristics,and explore an effective online-to-offline health education mode,so as to improve the cognitive level of angiography patients and ensure the safety of patients．

目的 基于影像组学方法,探讨多层螺旋CT（MSCT）四期增强扫描单一/不同期相及不同容积感兴趣区（VOI）的选择,在术前预测原发性肝细胞癌（HCC）微血管侵犯（MVI）中的价值。方法 回顾性收集88例经手术病理证实为HCC并行术前MSCT四期增强扫描的患者,其中包括47例MVI阳性患者和41例MVI阴性患者。在MSCT增强扫描的动脉早期、动脉晚期、门静脉期及延迟期图像中手动逐层勾画肿瘤ROI,获得瘤体容积感兴趣区VOI（Vt）,然后基于计算机自动膨胀算法将Vt外扩10 mm获得瘤体及瘤周VOI（Vt+Vp）。使用Pyradiomics软件分别从Vt和Vt+Vp中提取影像组学特征,随后采用15种特征选择方法和10种分类器构建150个预测模型,并通过十折交叉检验以验证模型的效能。使用准确度、敏感度、特异度、受试者工作特性曲线下面积（AUC）评估模型的效能,并比较性能最优的前三个预测模型。结果 MSCT四期增强扫描图像中预测HCC MVI状态的影像组学模型在门静脉期的表现优于其它期相及各期相的不同组合,其中最大的AUC值在Vt和Vt+Vp两种ROI中分别为0.768和0.782。此外,基于Vt+Vp的影像组学模型对MVI的预测效能优于基于Vt的影像组学模型,基于Vt+Vp性能最优的预测模型的AUC值、准确度、敏感度和特异度分别0.782、0.728、0.745和0.705。结论 采用影像组学方法术前无创性预测HCC MVI状态首选增强扫描的门静脉期,ROI首选瘤体联合瘤周10 mm区域。

Objective To investigate the value of single or different phases of contrast-enhanced multi-slice spiral CT（MSCT）in different volumetric regions of interest（ROI）to preoperatively predict the state of microvascular invasion in primary hepatocellular carcinoma（HCC）based on radiomics methods．Methods A total of 88 patients with HCC confirmed by surgical pathology who underwent preoperative MSCT quadruple-enhanced scan were retrospectively recruited,including 47 MVI-positive patients and 41 MVI-negative patients．The ROI was manually delineated slice-by-slice in the early arterial phase,late arterial phase,portal venous phase,and equilibrium phase of enhanced MSCT images to obtain the volume of tumor VOI（Vt）,and then Vt was expanded by 10 mm through the computer expansion algorithm automatically to obtain the volume of tumor and peritumor（Vt+Vp）．Pyradiomics software was used to extract radiomic features from Vt and Vt+Vp,followed by 150 discriminant models constructed with 150 feature selection methods and 10 classifiers,and then 10-fold cross-validation was used to evaluate the performance of these models．Using accuracy,sensitivity,specificity,area under the receiver operating characteristic curve（AUC）to assess model performance．The top three predictive models with the best performance were also compared．Results The radiomics model for predicting HCC MVI status in portal venous phase among quadruple-enhanced MSCT images outperformed other phases and different combinations of phases,achieving the highest AUC values of 0.768 and 0.782 in Vt and Vt+Vp respectively．In addition,the prediction performance of the radiomics model based on Vt+Vp was superior to models based on Vt．AUC value,accuracy,sensitivity,and specificity of the model with the best performance based on Vt+Vp were 0.782,0.728,0.745 and 0.705 respectively．Conclusions Radiomics models based on the portal venous phase of contrast-enhanced MSCT and tumor combined with the 10mm peritumoral area were more recommended to be employed to preoperative non-invasively predict the state of HCC MVI．

消化系统疾病诊治与组织病理诊断密切相关,高效、规范获取组织样本是关键,对此2021年欧洲胃肠内镜学会制定了消化道及肝胰腺胆道的内镜下组织活检的指南,分为上消化道（含肝、胰腺、胆道）和下消化道两部分,提供了规范活检的指导及建议。笔者对指南就上消化道内镜下组织活检的部分内容进行解读,解读内容为个人观点。

The diagnosis and treatment of digestive system diseases are closely related to histopathological diagnosis．Efficient and standardized acquisition of tissue samples plays a key role．In 2021,European Society of Gastrointestinal Endoscopy（ESGE）had developed guidelines for endoscopic tissue biopsy of the digestive tract and hepatopancreatic biliary tract,which divided into upper gastrointestinal tract（including liver,pancreas,biliary tract）and lower gastrointestinal tract．This guideline provided guidance and recommendations for standardizing biopsies．We interprets some of the contents of the guideline on tissue biopsy under endoscopy of the upper gastrointestinal tract,which are personal opinions．

吞咽障碍是慢性阻塞性肺疾病（COPD）的常见并发症之一,并且是COPD急性加重的危险因素之一,对患者预后造成不良影响。对COPD患者吞咽障碍的发生及严重程度进行准确的评估,是进行科学管理的首要前提。本文对COPD吞咽障碍评估工具的基本特点、应用现状及发展现状进行综述,为临床医务人员选择评估工具提供借鉴。

Dysphagia is one of the common complications of chronic obstructive pulmonary disease（COPD）,and is one of the risk factors of acute exacerbation of COPD,which has adverse effects on the prognosis of patients．Accurate assessment of the occurrence and severity of dysphagia in COPD patients is the first step for scientific management．In this paper,the basic characteristics,application status and development status of assessment tools for COPD patients with dysphagia are reviewed,which can provide reference for the selection of assessment tools for clinical medical staff．

目的 探讨柳州市老年骨质疏松性骨折（OPF）现状及其发生的危险因素。方法 回顾性分析2018年1月—2020年12月柳州市工人医院创伤中心收治的5 235例60周岁及以上老年OPF患者的临床资料,并从中随机抽取300例老年OPF患者临床资料作为研究组;选取同时期接诊的老年骨质疏松未骨折的300例患者临床资料作为对照组,通过医院病案管理系统,详细收集2组患者各项临床资料,分析柳州市老年OPF现状及危险因素。结果 5 235例老年OPF患者中,以胸腰椎压缩性骨折占比最高58.19%、其次为股骨颈骨折15.42%;60~74岁年龄段患者以胸腰椎压缩性骨折占比最高77.03%,75~89年龄段患者股骨颈骨折、粗隆间骨折占比均较高分别为43.36%、41.34%,≥90岁患者粗隆间骨折占比最高49.25%;男性、女性均以胸腰椎压缩性骨折占比较高,分别为46.34%、62.47%。经单因素/多因素分析显示,年龄、性别、体质量指数（BMI）、跌倒史、骨折史、骨密度（BMD）、糖尿病、不良生活习惯为老年OPF发生的独立危险因素（P<0.05）。结论 胸腰椎压缩性骨折是柳州市老年OP患者骨折的主要类型;老年OPF的发生与年龄、性别、BMI、跌倒史、骨折史、BMD 、糖尿病、不良生活习惯等因素有关,应采取积极预防措施,降低OPF的发生风险。

目的 评价银杏二萜内酯葡胺注射液（DGMI）联合依达拉奉右崁对急性缺血性脑卒中（AIS）的治疗效果。方法 回顾性分析我院2021年3月—2022年6月收治的86例AIS患者,根据治疗方法不同,分为单药组和联合组,每组43例,2组均予以DGMI治疗,联合组加用依达拉奉右崁醇。对比2组的治疗效果。结果 治疗后,联合组美国国立卫生研究院卒中量表（NIHSS）评分低于单药组（P<0.05）,简易智能精神状态检查量表（MMSE）和Barthel指数（BI）得分高于单药组（P<0.05）;联合组治疗后脑血流动力学指标（Q_min和V_min）高于单药组（P<0.05）,而全血还原黏度、血浆黏度和血小板聚集指数低于单药组（P<0.05）;联合组治疗后血清丙二醛（MDA）、超敏C-反应蛋白（hsCRP）和白细胞介素-6（IL-6）低于单药组（P<0.05）,而超氧化物歧化酶（SOD）高于单药组（P<0.05）;联合组治疗总有效率88.37%,高于单药组的67.44%（P<0.05）,且2组不良反应总发生率比较差异无统计学意义（P>0.05）。结论 DGMI联合依达拉奉右崁醇可有效提高AIS患者的神经功能、认知功能及日常生活能力,降低血液高凝状态,改善脑部血流,缓解机体氧化应激及炎症反应,且不良反应发生率较低,安全性良好。

Objective To evaluate the clinical efficacy of diterpene ginkgolides meglumine injection（DGMI）combined with edaravone dextracanthol in the treatment of acute ischemic stroke（AIS）．Methods A total of 86 patients with AIS admitted to our hospital from March 2021 to June 2022 were divided into single drug group and combination group according to different treatment methods,with 43 patients in each group．Both groups were treated with DGMI,and the combination group was added with edaravone dextracanthol．The therapeutic effect,neurological function and adverse reactions of the two groups were compared．Results After treatment,compared with the single drug group,the NIH Stroke Scale（NIHSS）score of the combination group was significantly lower（P<0.05）,and the Mini-Mental State Examination（MMSE）and Barthel index（BI）scores were significantly higher（P<0.05）．After treatment,the cerebral hemodynamic indexes（Q_min and V_min）in the combination group were significantly higher（P<0.05）,while the whole blood reducing viscosity,plasma viscosity and platelet aggregation index were significantly lower（P<0.05）．After treatment,compared with the single drug group,the serum malondialdehyde（MDA）,high sensitive C-reactive protein（hsCRP）and interleukin- 6（IL-6）levels in the combination group were significantly lower（P<0.05）,while the level of superoxide dismutase（SOD）was significantly higher（P<0.05）．The total effective rate of the combination group was 88.37%,which was significantly higher than 67.44% of the single drug group（P<0.05）．The incidence of adverse reaction between two groups was not significant（P>0.05）．Conclusions DGMI combined with edaravone dextracanthol can effectively improve the neurological function,cognitive function and daily living ability of patients with AIS,reduce blood hypercoagulability,improve cerebral blood flow,alleviate oxidative stress and inflammatory reaction,improve the therapeutic effect,without increasing the incidence of adverse reactions,which has good safety．

目的 分析子宫癌肉瘤的临床诊疗过程及其特征,以期提高对该病的认识。方法 回顾性分析我院收治的1例藏族女性子宫癌肉瘤患者的临床资料。并检索中国万方、中华医学期刊、PubMed等数据库,对相关文献进行系统性分析,归纳其临床、病理特点。结果 本例患者术后一般情况良好,切口痊愈出院,电话随访了解到患者术后9月均未按期进行复查,亦未行术后辅助治疗,无法获得辅助治疗和随访复诊的情况。结论 子宫癌肉瘤在临床上较为少见,无特异性临床表现,确诊依靠病理,病理上有特殊性,含有癌和肉瘤两种组织成分,治疗上参考子宫内膜癌的高危特殊组织类型处理,但缺少有效的治疗手段,需要采用各种综合治疗,预后较差。

Objective To analyze the clinical diagnosis and treatment of uterine carcinosarcoma and its characteristics,in order to improve the understanding of the disease．Methods The clinical data of a Tibetan woman with uterine carcinosarcoma treated in our hospital was analyzed retrospectively．The databases of China Wanfang,Chinese Medical Journal and PubMed were searched,and the relevant literatures were systematically analyzed to summarize the clinical and pathological characteristics．Results This patient was generally in good condition after operation．The incision was healed and she was discharged．The telephone follow-up found that the patient did not receive re-examination as scheduled in 9 months after the operation,and did not receive postoperative adjuvant treatment．The follow-up situation was unable to obtain．Conclusions Uterine carcinosarcoma is relatively rare in clinic and has no specific clinical manifestations．The diagnosis depends on pathology．It has particularity in pathology and contains two kinds of tissue components：cancer and sarcoma．Treatment refers to high-risk special tissue types of endometrial cancer,but there is a lack of effective treatment means,a variety of comprehensive treatment is needed,and the prognosis is poor．

目的 探讨非小细胞肺癌（NSCLC）组织中转化生长因子β激活激酶1（TAK-1）与T细胞因子-4（TCF-4）在 mRNA以及蛋白水平的表达情况及其相关性,并分析两者与NSCLC患者临床病理因素的关系。方法 收集NSCLC手术标本51例,每例均包含肺癌组织及配对癌旁组织,所有患者的术后诊断均经病理结果证实,通过RT-PCR以及Western blot法检测TAK1、TCF-4在癌组织及配对癌旁组织中的表达情况,并通过SPSS进一步分析两者的相关性及其与临床病理因素的关系。结果 TAK1与TCF-4 mRNA以及蛋白水平在NSCLC患者癌组织中均高表达,其中TAK1蛋白的表达与NSCLC的TNM分期（P=0.022）、淋巴结转移（P=0.014）相关,TCF-4蛋白的表达与NSCLC的TNM分期相关（P=0.045）。TAK1在NSCLC组织中的表达与TCF-4呈正相关（r=0.427,P=0.002）。结论 TAK1 mRNA及蛋白水平在NSCLC组织中均高表达,并与TCF-4呈正相关,TAK1有可能成为NSCLC诊断及预后的一个潜在靶标,并且TAK1与TCF-4的联合应用有可能成为一种更为理想的NSCLC辅助诊断及临床治疗方法。

Objective To investigate the mRNA and protein expressions of transforming growth factor β-activated kinase 1（TAK1）and T cell factor-4（TCF-4）in non-small cell lung cancer（NSCLC）tissues and their correlation,and to analyze the relationship between TAK1/TCF-4 and clinicopathological factors in NSCLC patients．Methods Cancer tissues and matched adjacent tissues of 51 NSCLC patients in our hospital were collected．The postoperative diagnosis of all patients was confirmed by pathological results．The expression of TAK1 and TCF-4 in cancer tissues and paired adjacent tissues were detected by RT-PCR and Western blot,then SPSS was used to further analyze the correlation between TAK1 and TCF-4 and clinicopathological factors．Results TAK1 and TCF-4 mRNA and protein were highly expressed in NSCLC tissues,and TAK1 protein expression was significantly correlated with TNM stage of NSCLC（P=0.022）and lymph node metastasis（P=0.014）;TCF-4 protein expression was significantly correlated with TNM stage of NSCLC（P=0.045）．TAK1 expression in NSCLC tissues was positively correlated with TCF-4（r=0.427,P=0.002）．Conclusions TAK1 mRNA and protein were highly expressed in NSCLC tissues and positively correlated with TCF-4．TAK1 may become a potential target for the diagnosis and prognosis of NSCLC,and the combined application of TAK1 and TCF-4 may become a more ideal method for the auxiliary diagnosis and clinical treatment of NSCLC．