目的 建立针对炎症性肠病患者的运动锻炼方案。方法 通过系统检索Web of Science、Embase、Cochrane Library等数据库,综合相关文献并由两名研究者独立提取信息,制定出指导患者运动锻炼的方案。检索时间从建库截至2023年9月1日。结果 共筛选出12篇文献,包括指南、专家共识、Meta分析以及RCT试验。最终总结出运动的必要性、作用、适合人群、评估及筛选、运动方式选择、监测以及限制因素等7个方面,共计37条证据。结论 这些证据为轻中度炎症性肠病患者提供了有氧运动联合抗阻运动的最佳实践依据,可指导临床实践,规范运动训练,从而延缓疾病进展。

Objective To establish an exercise program for patients with inflammatory bowel disease（IBD）．Methods A systematic search was conducted in databases such as Web of Science,Cochrane Library,and Embase,with relevant literature being comprehensively reviewed．Information was independently extracted by two researchers to develop a program guiding patients' exercise．Searching terms included both Chinese and English keywords,with the searching period covering from the inception of the databases to September 1,2023．Results A total of 12 articles were screened,including guidelines,expert consensuses,Meta-analyses,and randomized controlled trials．Ultimately,37 pieces of evidence were summarized across seven aspects：the importance of exercise,suitable populations,assessment and screening,choice of exercise modes,monitoring and limiting factors．Conclusions These evidences provide the best practice basis for aerobic and resistance exercises in patients with mild to moderate IBD,guiding clinical practice,standardizing exercise training,and thus delaying disease progression．

目的 探讨Yes1相关蛋白（YAP）及p65在弥漫大B细胞淋巴瘤（DLBCL）中与临床特征的相关性及对DLBCL治疗和预后的意义。方法 收集65例DLBCL和10例反应性增生淋巴结患者组织进行免疫组织化学染色,分析两组差异;对多种临床特征与YAP、p65的相关性进行统计学和生存差异性分析。结果 YAP、p65染色评分在两组间比较差异有统计学意义（P<0.05）;YAP评分与疗效分组呈正相关,与治疗前乳酸脱氢酶（LDH）、Ann-Arbor分期、国际预后指数（IPI）呈负相关（P<0.05）;p65表达与疗效分组呈负相关,与治疗前LDH水平、Ann-Arbor分组、美国东部肿瘤协作组活动状态评分（ECOG）ECOG分组、结外侵犯、IPI评分、巨大包块呈正相关（P<0.05）。IPI及p65评分是DLBCL患者总生存期（OS）的独立危险因素（P<0.05）。共表达分层中YAP-/p65⁺组患者OS均值最低。结论 对于DLBCL,YAP低表达或p65高表达提示患者瘤荷较大、较差的疗效和预后。

Objective To investigate the correlation of YAP and p65 with clinical features in diffuse large B-cell lymphoma（DLBCL）and the significance for treatment and prognosis．Methods Tissues from 65 patients with DLBCL and 10 patients with reactive hyperplasia lymph node were collected for immunohistochemistry staining to analyze the differences between the two groups;statistical analysis and survival difference analysis of the correlation between various clinical features and YAP,p65 were performed．Results YAP and p65 staining scores were significantly different between the two groups（P<0.05）．YAP scores were positively correlated with efficacy subgroups,and negatively correlated with LDH levels before treatment,Ann-Arbor staging,and International Prognostic Index（IPI）scores before treatment（P<0.05）;p65 expression was negatively correlated with efficacy subgroups,and positively correlated with pretreatment LDH levels,Ann-Arbor subgroup,ECOG subgroup,extra-nodal invasion,IPI scores,and huge mass（P<0.05）．IPI and p65 score were independent prognostic risk factors for overall survival（OS） in DLBCL patients（P<0.05）．The mean value of OS was the lowest in patients in the YAP-/p65⁺ group in the co-expression stratification．Conclusions Low expression of YAP or high expression of p65 suggests larger tumor load and poorer outcome and prognosis in patients for DLBCL．

乳腺癌是女性最常见的原发恶性肿瘤之一。目前,通过采用综合治疗手段,包括手术、新辅助治疗、辅助放化疗等多种手段,乳腺癌已成为疗效最佳的实体肿瘤之一。其中,新辅助治疗（NAT）包括新辅助化疗、靶向治疗和内分泌治疗,目的是使肿瘤降期、保乳、保腋窝,并可观察药物敏感性,是当前乳腺癌综合治疗中非常重要的组成部分,其治疗疗效对患者手术方式的选择和预后至关重要。尽管病理学评价在评估NAT疗效方面被公认为金标准,但其局限性在于只能通过有创手段在治疗后进行,无法在治疗前对患者做出准确预测。磁共振成像（MRI）作为一项广泛使用的乳腺成像技术,在评估NAT疗效中扮演着关键角色。近年来,人工智能技术,尤其是影像组学（Radiomics）和深度学习（Deep Learning）,在医学影像分析领域取得了显著进展。这些技术能够从医学图像中提取大量肉眼难以识别的特征,揭示病变内部的微观结构和生物学行为,全面反映肿瘤的异质性,这不仅有助于临床医生更准确地区分良、恶性肿瘤,还能对恶性肿瘤的预后进行更为精确的评估。本文系统综述了近年来基于MRI的人工智能技术在乳腺癌新辅助治疗疗效评估中的应用研究,旨在促进人工智能在NAT临床实践中的应用和发展,为乳腺癌NAT治疗策略的优化和个性化医疗的实现提供科学依据。

Breast cancer is one of the most common primary malignant tumors in women．Currently,breast cancer has become one of the most effective solid tumors by using comprehensive treatment methods,including surgery,neoadjuvant therapy,adjuvant radiotherapy and chemotherapy．Among them,neoadjuvant therapy（NAT）,including neoadjuvant chemotherapy,targeted therapy and endocrine therapy,is a very important part of the current comprehensive treatment of breast cancer．It aims to reduce the tumor stage,preserve the breast,preserve the armpit,and observe the drug sensitivity．Its therapeutic effect is crucial to the choice of surgical methods and prognosis of patients．Although pathological evaluation is recognized as the gold standard in evaluating the response to NAT,its limitation is that it can only be performed after treatment by invasive means,and cannot accurately predict response before treatment．As a widely used breast imaging technology,magnetic resonance imaging（MRI）plays a key role in evaluating the response to NAT．However,traditional MRI evaluation methods are limited by the individual differences of interobserver and the low repeatability of evaluation results,which affects the accuracy of efficacy evaluation to a certain extent．In recent years,artificial intelligence technology,especially radiomics and deep learning,has made significant progress in the field of medical image analysis．These techniques can extract a large number of features that are difficult to be recognized by the naked eye from medical images,reveal the internal microstructure and biological behavior of the lesion,and fully reflect the heterogeneity of the tumor．This not only helps clinicians to distinguish benign and malignant tumors more accurately,but also makes a more accurate assessment of the prognosis of malignant tumors．This article reviews the application and progress of MRI-based artificial intelligence technology in evaluating the response to neoadjuvant therapy for breast cancer in the past five years,aiming to promote the application and development of artificial intelligence in NAT clinical practice,and provide a scientific basis for the optimization of NAT treatment strategy and the realization of personalized medicine for breast cancer．

蒜氨酸为大蒜氨基酸成分,对机体无毒副作用,在体内代谢酶作用下分解成大蒜素,具有多种药理作用和广阔的临床应用前景。本文就蒜氨酸的分离提取、制剂及生物活性研究现状进行综述,以供参考。

Alliin is an amino acid component of garlic, no toxic side effects to the body. It breaks down into allicin by metabolic enzymes in the body, has a variety of pharmacological effects and broad clinical application prospects. In this paper, the isolation, extraction, preparation and biological activity of alliin were reviewed for reference.

缺牙区水平骨量不足一直是口腔种植的重要难题。骨劈开术是常用于解决此难题的手术方式之一,目前临床常用术式是采用超声骨刀沿牙槽嵴顶矢状劈开后,用骨凿将唇(颊)侧骨板向唇(颊)侧移位后增加牙槽骨水平宽度,达到同期种植的目的。骨劈开并同期植入种植体降低了困难病例的手术难度和风险,减少了患者就诊次数,降低患者成本。但若劈开后种植体周围的间隙大于1 mm或唇侧骨板分离,则需要同期进行植骨。但骨劈开术的使用也具有一定的适应症,要求缺牙区垂直骨高度足够,水平骨宽度不足(3～5 mm),骨质为Ⅲ ～ Ⅳ类骨,患者无种植手术的局部和全身禁忌证。近年来的研究表明骨劈开术具有创伤小、手术安全有效、不用开辟第二创口即可获得较好的骨增量效果等优点,一定程度上扩大了种植手术适应证。现本文对骨劈开术的翻瓣术式、非翻瓣术式及术后效果的进展进行综述。

The insufficient horizontal bone mass in the missing tooth area has always been an important problem of dental implant. Bone splitting is one of the surgical methods commonly used to solve this problem. At present, the commonly used surgical method is to use ultrasonic bone knife to sagittal splitting along the crest of the alveolar ridge, and then use bone chisel to shift the lateral bone plate of the lip (buccal) to the lip (buccal) to increase the horizontal width of the alveolar bone, so as to achieve the purpose of simultaneous implantation. Bone splitting and implantation of implants in the same period reduced the surgical difficulty and risk of difficult cases, reduced the number of patient visits, and reduced the cost of patients. However, if the gap around the implant was more than 1 mm or the labial bone plate was separated after splitting, bone grafting should be performed simultaneously. But the use of bone splitting technique also has a certain indications, demanding sufficient vertical bone height in the missing area, inadequate width of horizontal bone (3 mm to 5 mm), Ⅲ~Ⅳ class bone, without local and systemic contraindicated of planting surgery. In recent years, the research shows that bone splitting surgery has the advantages of small trauma, safe and effective operation, and better bone increment effect obtained without opening the second wound. This article reviewed the progress of flap operation, flapless operation and postoperative effect of bone splitting.

目的 通过分析2019—2021年广州地区保密性弃血工作情况,完善献血者献血后回告受理和保密性弃血管理。方法 通过分析广州市血液中心2019年1月—2021年12月期间受理的无偿献血者献血后保密性弃血回告记录,统计分析无偿献血者要求保密性弃血的各种原因,以及保密性弃血施行程序中出现的新情况。结果 2019年、2020年、2021年保密性弃血人数分别占当年献血人数的0.156‰,0.090‰,0.091‰。2020年之后出现接触或疑似接触新型冠状病毒患者的回告案例;在这3年间,87.6%的保密性弃血在72小时内完成回告。结论 无偿献血者保密性弃血回告以及血液屏蔽是保障血液用血安全的重要举措之一,目前广州市回告率相对较低,提示要强化血液保密性弃血回告及方法途径指引宣传,注意对新回告原因的收集以有针对性开展献血前征询工作,从源头筛选出合格、低风险的无偿献血者,同时完善长时间(72小时以上)才回告的血液保密性弃血处理程序。

目的 分析上颌唇侧倒置埋伏中切牙患者正畸矫治后埋伏牙牙根吸收影响因素。方法 选取2017年8月—2021年5月我院正畸科上颌唇侧倒置埋伏中切牙患者1 542例,统计上颌唇侧倒置埋伏中切牙患者正畸矫治后埋伏牙及牙根吸收发生情况,并进行单因素多因素分析。结果 1 542例上颌唇侧倒置埋伏中切牙患者正畸矫治后共出现埋伏牙186例,其中男102例、女84例,出现埋伏牙1颗最多,占比65.05%,年龄以12～18岁居多,单侧埋伏牙157例(84.41%),双侧埋伏牙29例(15.59%),埋伏牙位置为斜位81例(43.55%),倒置47例25.27%,平行42例(22.58%),水平16例(8.60%);186例正畸矫治后出现埋伏牙的患者中,发生牙根吸收患者75例,发生率为40.32%;出现牙根吸收的患者埋伏牙位置为颌骨中间占比高于未发生牙根吸收患者,近远中分区0～1区占比、年龄均小于未发生牙根吸收患者(P＜0.05);埋伏牙位置(颌骨中间)、近远中分区(0～1区)、年龄(低)是上颌唇侧倒置埋伏中切牙患者正畸矫治后埋伏牙牙根吸收的独立危险因素(P＜0.05)。结论 上颌唇侧倒置埋伏中切牙患者正畸矫治后埋伏牙发生情况不容乐观,主要为12～18岁的患者为主,且多为单发,牙根吸收发生率较高,主要影响因素包括埋伏牙位置、近远中分区、年龄,临床应根据患者实际情况合理选择治疗方案。

目的 观察镇肝熄风汤加减在椎-基底动脉供血不足(VBI)性眩晕患者辅助治疗中的应用。方法 选取2019年5月—2021年2月我院收治的124例VBI性眩晕患者,按照随机数字表法1:1配对原则分为观察组(n=62)、对照组(n=62),其中对照组给予长春西汀+天麻素,观察组在对照组基础上辅以镇肝熄风汤加减,对比2组疗效、经颅多普勒检查结果[基底动脉、椎动脉平均血流速度(MV)与血管搏动指数(PI)]、眩晕评估量表(DARS)、眩晕障碍调查表(DHI)评分及血液流变学指标(纤维蛋白原、红细胞积压、全血粘度)。结果 观察组总有效率95.16%(59/62)高于对照组82.26%(51/62)(P＜0.05);治疗14 d后观察组椎动脉、基底动脉PI低于对照组,MV高于对照组(P＜0.05);治疗14 d后观察组DHI评分、DARS评分低于对照组(P＜0.05);治疗14 d后观察组纤维蛋白原、红细胞积压、全血粘度低于对照组(P＜0.05)。结论 镇肝熄风汤加减辅助治疗VBI性眩晕患者疗效显著,可有效减轻眩晕症状,调节血液粘度,改善椎-基底动脉血流,促进脑部供血恢复。

目的 探讨胎儿颈部软组织(NT)超声检查联合血清甲胎蛋白(AFP)水平检测对产前胎儿神经管畸形诊断中的应用价值。方法 选取684例我院2018年4月—2021年4月接受产前检查的孕妇,所有孕妇分别采用NT超声检查、血清AFP水平检查,以引产结果为“金标准”,比较NT超声、血清AFP水平及联合检查诊断结果、诊断效能及对不同类型神经管畸形诊断符合率的影响。结果 经引产结果显示共48例神经管畸形胎儿;经NT超声检查共36例神经管畸形胎儿;经血清AFP水平检查共34例神经管畸形胎儿;经联合检查共47例神经管畸形胎儿;与NT超声、血清AFP水平单独检查相比,联合检查灵敏度89.58%、准确率98.68%、阴性预测值99.22%较高,漏诊率10.42%较低(P＜0.05);与NT超声、血清AFP水平单独检查相比,联合检查对于脑膨出、隐形脊柱裂胎儿检出率较高(P＜0.05)。结论 NT超声检查、血清AFP联合诊断准确率显著高于单独检查,可有效提高诊断效能,为临床筛查胎儿神经管畸形提供有效手段。

目的 探讨频发室性早搏与四级非心脏手术术后心衰发生率的相关性。方法 回顾性分析2020年7月—2021年6月于我院治疗的201例四级非心脏手术患者,根据术后是否发生心衰,将其分为心衰组和非心衰组,其中出现心衰者20例,未心衰者181例。分析2组患者临床资料、频发室性早搏次数,随后经单因素分析及Logistic回归分析术后心衰发生率的相关性。结果 心衰组临床资料中性别、糖尿病史、饮酒史、吸烟史、手术危险性分级、BMI、血红蛋白、红细胞宽度、左室舒张末径、左室射血分数值与非心衰组比较,差异无统计学意义(P>0.05);心衰组年龄大于非心衰组,胆固醇值、甘油三酯、室性早搏次数、术前肌酐水平均高于非心衰组(P<0.05);经多因素Logistic回归分析,分析结果显示年龄(OR=1.400,95%CI:1.060~1.848)、胆固醇值(OR=4.318,95%CI:1.122~16.622)、甘油三酯(OR=12.889,95%CI:1.232~134.808)、室性早搏次数(OR=1.010,95% CI:1.001~1.020)、术前肌酐(OR=34.071,95% CI:1.186~978.753)为四级非心脏手术术后发生心衰的危险因素(P<0.05)。结论 频发室性早搏为四级非心脏手术术后心衰发生的危险因素,其中年龄、胆固醇值、甘油三酯、术前肌酐也为术后心衰发生的危险因素。