药物治疗抵抗在临床实践中成为肿瘤治疗失败的主因。最近的研究指出,肿瘤细胞的耐药性可能源于其内部高度的细胞异质性,而这种异质性的基础则是肿瘤可塑性。肿瘤细胞可塑性可能引发一系列反应,包括对治疗的耐药性发展、免疫系统逃逸以及对周围组织和血管系统的侵袭和转移等。本文简要介绍肿瘤细胞可塑性的表现形式以及其在药物治疗抵抗的非遗传适应性机制与靶向治疗新策略。
Drug therapy resistance has emerged as a primary cause of treatment failure in cancer management．Recent research indicates that the resistance of tumor cells may stem from their high degree of intracellular heterogeneity,with the underlying basis being tumor plasticity．Tumor cell plasticity can trigger a cascade of responses,including the development of resistance to treatment,evasion of the immune system,and invasion and metastasis into surrounding tissues and the vascular system．This article provides a brief overview of the manifestations of tumor cell plasticity and its non-genetic adaptive mechanisms in drug therapy resistance,along with novel strategies for targeted treatment．
胶质瘤是颅内最常见的原发性恶性肿瘤,其分级对患者治疗方式的选择和预后至关重要。尽管目前组织病理学仍是其最为可靠的分级手段,但需通过有创性手术以获取组织样本,存在一定的风险。相较之下,磁共振成像（MRI）作为一种非侵入性影像诊断工具,在胶质瘤分级中发挥着不可或缺的作用。然而,传统MRI评估受限于医师个体主观性强和可重复性差的问题,一定程度上影响了准确的分级结果。近年来,影像组学技术的崭露头角为解决上述难题开辟了新视角,通过高通量提取影像数据特征捕捉并量化肿瘤的影像学表现,避免因主观因素而导致的不确定性,协助医师更准确地评估肿瘤的恶性程度。本文对近五年来MRI影像组学在胶质瘤术前分级预测方面的相关研究进行了简要综述,旨在为相关领域研究者提供有益的参考和借鉴,以推动MRI影像组学在临床实践中的应用。
Glioma is the most common primary malignant brain tumor,and its grading is crucial for treatment decisions and prognosis．Currently,histopathology remains the gold standard for grading,but it requires invasive procedures and carries inherent risks．In contrast,magnetic resonance imaging（MRI）,a non-invasive diagnostic tool,plays an indispensable role in glioma grading．However,traditional MRI assessment is hampered by interobserver subjectivity and limited repeatability,which compromise grading accuracy．In recent years,radiomics,a burgeoning field,has offered a promising solution to address these challenges．By extracting high-dimensional imaging data features,radiomics enables the quantification of tumor radiological characteristics and elimination of subjectivity-related discrepancies．This technology assists clinicians in more precisely assessing the malignancy of gliomas．This article summarizes relevant studies in the past five years on the application of MRI radiomics in preoperative glioma grading,aiming to provide valuable insights and guidance to researchers in the field and promote the clinician implementation of MRI radiomics．
心血管疾病是导致我国居民死亡的首要原因。在2006—2019年间,我国每年因心血管疾病死亡的人数从215万人增加到328万人。斑马鱼因个体小、成本低廉、体外发育、身体透明、基因组与人类高度同源等特点,近年来被广泛应用于医学研究。斑马鱼模型有利于推动心血管疾病领域的基础性研究。该文通过对前期研究进行综述,重点介绍了斑马鱼模型在心血管疾病中基因筛选、心脏再生、药物筛选、毒性评估等方面的研究进展。
Cardiovascular disease is the leading cause of death in China．Between 2006 and 2019,the annual number of deaths due to cardiovascular diseases increased from 2.15 million to 3.28 million．Zebrafish has been widely used in medical research in recent years because of its small individual size,low cost,in vitro development,transparent body and high homology of genome with human．The zebrafish model is conducive to promoting basic research in the field of cardiovascular disease．Based on the review of previous studies,this paper focuses on the research progress of zebrafish model in gene screening,cardiac regeneration,drug screening,toxicity assessment and other aspects of cardiovascular diseases．
阿尔茨海默病（Alzheimer's disease,AD）是一种复杂的、起病隐秘的、病因不明的、缺乏特异性诊断方式的神经退行性病变。面对与日俱增的患病率,却缺乏有效的治疗方式。中医药治疗方式具有多层次、多靶点、多通路的独特优势,中西医结合方式的互补,非药物疗法的辅助,干细胞疗法、新的分子药物、抗体及蛋白疫苗、γ感官刺激等新颖的实验阶段新疗法等方式治疗AD。本文综述近年来的不同治疗方式治疗AD研究新进展,旨在为临床上治疗AD提供新思路、新方法及参考价值。
Alzheimer's disease is a complex,secrectly onset neurodegenerative disease with unknown etiology,and lacking of specific diagnosis．In the face of the increasing prevalence,there is a lack of effective treatment ways．The treatment of traditional Chinese medicine has the unique advantages of multi-level,multi-target,and multi-channel．With the combination of traditional Chinese and Western medicine and supplement to non-drug therapy,stem cell therapy,new molecular drugs,antibodies and protein vaccines,γ sensory stimulation,and other novel experimental stage new therapies are uesd in the treatment of AD．The article focuses on the new progress of different treatment methods in the treatment of AD in recent years,aiming to provide new ideas,new methods,and reference value for the clinical treatment of Alzheimer's disease．
目的 通过公共数据库筛选急性肺损伤（ALI）及急性呼吸窘迫综合征（ARDS）相关分子标志物,并探索其临床意义。方法 利用基因表达综合数据库（GEO）中有关ALI/ARDS基因表达芯片研究的两个数据集GSE76293和GSE10474,通过STRING网站和Cytoscape软件对差异基因进行蛋白互作网络分析并筛选ALI/ARDS相关关键基因。采用A549细胞构建ALI模型,并通过转录组测序验证关键基因在细胞中的表达差异情况。结果 2个GEO数据集中共筛选出共同上调基因27个,共同下调基因26个。主要参与抗原加工和外源抗原递呈、免疫受体活性调节、内质网膜构成等生物学功能,且与抗原加工、细胞分化等信号通路有关。蛋白互作网络分析共筛选出10个ALI/ARDS相关关键基因,分别为CD4、HLA-DQB1、CD74、HLA-DRA、FCGR2B、TOR1A、RELA、NME8、RNF19B、RHOB。细胞转录组测序结果显示,关键基因的上调或下调特征及表达差异情况与GEO数据集分析结果一致。结论 CD4等关键基因可能参与ALI/ARDS发生、发展的生物学过程,是ALI/ARDS临床诊断及预后预测的潜在个体化分子标志物。
Objective To identify molecular biomarkers associated with acute lung injury（ALI）/ acute respiratory distress syndrome（ARDS）and to explore their clinical significance with public databases. Methods Two datasets GSE76293 and GSE10474 in Gene Expression Omnibus（GEO）database for ALI/ARDS gene expression chip study were used to screen genes with significant differences in both datasets．The protein-protein interaction（PPI）analysis of co-expression genes was performed based on the STRING website and Cytoscape software,and then key genes related to ALI/ARDS were identified with cytoHubba method．The ALI model was constructed using A549 cells cultured in vitro,and the expression differences of key genes in the cells were verified by RNA sequencing. Results A total of 27 up-regulated genes and 26 down-regulated genes were screened in both the two GEO datasets with Venn Diagramm．These co-expression genes were mainly involved in biological functions such as antigen processing and presentation of exogenous peptide antigen,immune receptor activity,integral component of lumenal side of endoplasmic reticulum membrane and were related to signal pathways such as antigen processing and cell differentiation．A total of 10 key genes（CD4,HLA-DQB1,CD74,HLA-DRA,FCGR2B,TOR1A,RELA,NME8,RNF19B,RHOB）related to ALI/ARDS were identified． The results of cell RNA sequencing showed that the up-regulated or down-regulated characteristics and expression differences of key genes were consistent with the results of GEO datasets. Conclusions Several key genes identified in this study may be involved in the biological process of ALI/ARDS development,and may be potential individualized molecular markers for clinical diagnosis and prognosis prediction of ALI/ARDS．
目的 探讨影响颈内动脉闭塞（ICAO）患者预后的相关因素,为临床改善ICAO患者预后提供理论依据。方法 回顾性分析2017—2022年广西医科大学附属武鸣医院因ICAO入住神经内科的131例患者,根据ICAO发病时间分为急性颈内动脉闭塞（AICAO）和慢性颈内动脉闭塞（CICAO）,根据预后的不同,分为预后良好和预后不良组,比较两组的基本信息（性别、年龄等）、既往病史（包括高血压、糖尿病、冠心病等）、发病时神经功能损害程度（美国国立卫生研究院卒中神经功能缺损评分NIHSS评分）、侧支循环代偿评分、介入手术开通治疗、出血转化之间的差异,分析影响患者预后的相关因素。结果 CICAO患者总体预后良好,AICAO预后良好组患者发病时NIHSS评分<6分、侧支循环代偿良好比例高于预后不良组,而出血转化率低于预后不良组,组间比较差异均有统计学意义（P<0.05）。二分类Logistic回归分析显示,发病时NIHSS评分、侧支循环代偿评分、介入手术开通治疗、出血转化、次全闭塞对AICAO预后影响有统计学意义（P<0.05）。两组间的基本信息、既往病史、介入手术开通治疗等比较差异无统计学意义（P>0.05）。结论 CIACO较AICAO总体预后良好,发病时NIHSS评分<6分、侧支循环代偿良好、无出血转化是IACO预后良好的相关因素。发病时NIHSS评分高、侧支循环代偿不良、出血转化是ACAO预后不良的危险因素
Objective To evaluate the prognostic significance of a group of clinical indices in the patients with internal carotid artery occlusion（ICAO）. Methods From 2017 to 2022,a total of 131 patients with ICAO were enrolled．All eligible patients were divided into acute ICAO（AICAO）and chronic ICAO groups（CICAO）,which were subdivided into good and poor prognosis groups．A respective analysis was performed to identify a practical profile for the outcome prediction of the patients with ICAO. Results The overall prognosis of CIACO was good．The proportion of NIHSS score < 6 in AICAO group with good prognosis and good collateral circulation compensation was significantly higher than that in poor prognosis group,while bleeding conversion was lower than that in poor prognosis group,with statistical significance（P<0.05）．Dichotomous logistic regression analysis showed that the prognostic effects of NIHSS score,collateral circulatory compensation score,interventional initiation,hemorrhagic transformation,and subtotal occlusion on the prognosis of AICAO were statistically significant．There were no significant differences in basic information,past medical history,interventional operation between the two groups（P>0.05）. Conclusions The patients with CICAO have a better prognosis than those with AICAO．NIHSS score < 6,good collateral circulation and no-hemorrhagic transformation may have strong prognostic relevance to ICAO．High NIHSS score,poor collateral circulation and hemorrhagic transformation at the time of onset are risk factors for poor prognosis of ACAO ．
谨慎处理报告的抗生素过敏是抗生素管理的一个重要方面。荷兰抗生素政策工作组（SWAB）于2023年4月发布了《SWAB指南：疑似抗生素过敏的处理方法》以下简称（指南）,指南依据对疑似抗生素过敏人群的比较和结果问题研究,对每个问题进行系统的文献检索,并通过证据评价系统对现有最佳证据进行审查后制定。指南就疑似抗生素交叉过敏,速发型过敏和迟发型过敏等问题进行阐述,为报告抗生素过敏患者选用抗生素治疗的床旁决策提供基于现有研究的循证建议。本文对指南涉及12个关键问题进行解读,以期为疑似抗生素过敏患者临床治疗提供参考,使患者获益。
Careful handling of reported antibiotic allergies is an important aspect of antibiotic management．In April 2023,the Dutch Working Group on Antibiotic Policy（SWAB）issued the SWAB Guide：“The Dutch Working Party on Antibiotic Policy（SWAB）guideline for the approach to suspected antibiotic allergy”,hereinafter referred to as “the guide”．According to the intervention,comparison and results of people with suspected antibiotic allergy,the guide systematically searched the literature of each question,and was formulated after reviewing the best evidence available through the evidence evaluation system．The guide elaborated on the suspected cross-allergy,quick-onset allergy and delayed-onset allergy,and selected antibiotics for reporting patients with antibiotic allergy．In this paper,12 key issues involved in the guidelines are interpreted in order to provide reference for clinical treatment of patients suspected of antibiotic allergy and benefit patients．
目的 分析我院羊水栓塞患者的临床资料及诊治经过,总结羊水栓塞致弥散性血管内出血（DIC）患者输血治疗救治经验。方法 回顾性分析2016年1月1日—2022年12月31日在广州医科大学附属第二医院番禺院区分娩并发羊水栓塞患者的症状、实验室辅助检查、用药诊治经过及妊娠结局。结果 在6 104次孕晚期分娩记录中,共发生3例羊水栓塞,高龄产妇1例、经产妇2例、多产1例。3例均并发DIC,产后出血1 500~3 000 mL。其中1例行子宫切除术,2例保留子宫,均抢救成功,无患者死亡。结论 根据有限数据推论羊水栓塞罕见、凶险,病情进展快,多继发产后出血、DIC,主要依靠临床表现进行诊断,早期识别诊断和处理,产科快速反应团队及多学科协作,给予高级生命支持,有效止血并科学地成分输血纠正凝血功能障碍及DIC,是改善孕产妇结局的关键。
Objective To analyze the clinical data,diagnosis and treatment of patients with amniotic fluid embolism in our hospital,and to summarize the experience of blood transfusion treatment for disseminated intravascular coagulation（DIC） patients with amniotic fluid embolism. Methods From January 1,2016 to December 31,2022,the symptoms,laboratory tests,drug treatments and pregnancy outcomes of patients with amniotic fluid embolism during delivery in Panyu Hospital,the Second Affiliated Hospital of Guangzhou Medical University were retrospectively analyzed. Results There were 3 cases of amniotic fluid embolism in 6 104 late pregnancy records,accounting for 1/3 of the elderly parturients,2/3 of the multiparas and 1/3 of the prolific parturients．All three cases had DIC and postpartum hemorrhage of 1 500-3 000 mL．Among them,1 case underwent hysterectomy and 2 cases saved the uterus,all of which were successfully rescued without death. Conclusions Amniotic fluid embolism is rare,dangerous disease with rapid progression,often followed by secondary postpartum hemorrhage and DIC,and mainly relies on clinical manifestations for diagnosis．Early identification,diagnosis and treatment,rapid response team in obstetrics and multidisciplinary collaboration,advanced life support,effective hemostasis and scientific component blood transfusion to correct coagulation dysfunction and DIC,are the keys to improve maternal outcomes．
目的 探讨养老机构老年人死亡态度及其影响因素。方法 选取2018年1月—2022年12月广州市养老机构的593名老年人进行问卷调查,统计养老机构老年群体对死亡的态度,并分析其死亡态度发生的影响因素。结果 经过研究发现,对死亡的态度呈自然接受的老年人数量最少,为42例,占比为7.1%,其次从高到低依次为逃离接受老年人308例,占比为51.9%;死亡恐惧老年人83例,占比为14.0%;死亡逃避老年人81例,占比为13.7%;趋近接受老年人79例,占比为13.3%。患者的死亡态度与患者所患的疾病病种有关,影响死亡态度的因素包括：生理心理因素、文化思想因素、社会环境因素,其中发生概率最高的是生理心理因素,占比为50.9,其次从高到低依次为文化思想因素,占比为26.5%;社会环境因素,占比为22.6%。死亡态度中趋近接受维度的分值相对更高,其次依次为死亡恐惧、自然接受、死亡逃避以及逃离接受。单因素分析显示差异有统计学意义的项目包含家庭内讨论死亡、性别、健康自评状况、年龄、患病种数、经济结构。结论 在养老机构中,大多数老年人对死亡是无法自然接受的,大部分老年群体对死亡的态度是逃离接受,部分群体对死亡的态度是恐惧、逃避;而影响老年群体死亡态度的因素主要是生理心理因素。
Objective To explore the death attitudes and its influencing factors among the elderly in nursing institutions. Methods A questionnaire survey on death attitudes was conducted among 593 elderly individuals in nursing institutions in Guangzhou from January 2018 to December 2022,and their possible influencing factors were analyzed. Results There were 51.9% of the elderly individuals whose death attitudes were characterized by escape acceptance,while 7.1% demonstrated natural acceptance．However,the numbers of the elderly individuals with approaching acceptance,fear of death and escape from death showed no significant statistical difference,all being lower than the number of the elderly individuals with escape acceptance．The influencing factors of death attitude included physiological and psychological factors,cultural and ideological factors,and social environment factors．The probability of physiological and psychological factors influencing death attitudes was higher than that of other factors（P<0.05）．The score for the dimension of approaching acceptance in death attitudes was higher than that for other dimensions（P<0.05）. Conclusions In nursing institutions,the majority of elderly individuals cannot naturally accept death．Most elderly individuals exhibit an attitude of escape acceptance towards death,while some exhibit an attitude of fear and escape．However,the factors influencing the elderly's attitudes towards death are mainly physiological and psychological factors．
目的 探讨与分析回旋支急性闭塞的心电图表现及相关临床表现和病变血管特点。方法 选择2018年1月—2023年6月在鹤壁市人民医院诊治的回旋支闭塞引起急性心肌梗死46例,检测与调查患者的心电图表现、相关临床表现、病变血管特点,随访患者的预后情况。结果 在46例患者中,冠状动脉造影检查判断为近中段闭塞23例（近中段组）,远段闭塞23例（远段组）。近中段组与远段组一般资料比较差异无统计学意义（P>0.05）。近中段组的心电图特征中的ST V1~ V3压低、ST Ⅱ、Ⅲ、aVF抬高、ST Ⅱ、Ⅲ、aVF压低、TV2>TV5、ST Ⅰ~aVL压低、ST Ⅰ~aVL 抬高、ST V7~V9抬高等占比分别为60.87%、47.83%、8.70%、43.48%、69.57%、17.39%、60.87%,远段组的占比分别为4.35%、82.61%、0%、17.39%、30.43%、8.70%、60.87%;近中段组与远段组心电图表现有相似处及各自特征。所有患者随访至2023年8月1日,近中段组与远段组的平均随访时间为（32.69±4.20）个月与（32.92±3.28）个月,近中段组与远段组心血管不良事件发生率比较差异无统计学意义（P>0.05）。受试者操作特征（ROC）曲线分析显示心电图对近中段回旋支急性闭塞患者的预测曲线下面积为0.793（95%CI：0.678~0.914,P=0.000）,灵敏度为78.22%,特异度为81.91%。结论 心电图在急性梗死患者的应用能辅助判定梗死相关动脉回旋支状况,可辅助判断患者的梗死部位,对患者的预后评估也具有重要价值。
Objective To explore and analysis the electrocardiogram manifestations,related clinical manifestations and pathological vascular characteristics of acute occlusion of the circumflex branch. Methods A total of 46 cases of acute myocardial infarction caused by circumflex branch occlusion diagnosed and treated in Hebi People's Hospital from January 2018 to June 2023 were selected as the study subjects,and the electrocardiographic manifestations,related clinical manifestations and characteristics of diseased blood vessels of the patients were detected and investigated,and the prognosis of the patients was followed up. Results Among the 46 patients,23 cases were diagnosed with proximal mid-segment occlusion（proximal mid-segment group）and 23 cases were diagnosed with distal segment occlusion（distal segment group）by coronary angiography．There was no significant difference in the comparison of the general data of the two groups（P>0.05）．The ECG features of ST V1- V3 depression,ST Ⅱ,Ⅲ,aVF elevation,ST Ⅱ,Ⅲ,aVF depression,TV2>TV5,ST I-aVL depression,ST I-aVL elevation and ST V7-V9 elevation in the proximal mid-segment group were 60.87%,47.83%,8.70%,43.48%,and 69.57%,17.39%,60.87%,and 4.35%,82.61%,0%,17.39%,30.43%,8.70%,60.87% in the distal segment group;there were similarities in the electrocardiographic manifestations of the proximal mid-segment group and the distal segment group as well as their respective characteristics．All patients were followed up until August 1,2023,and the mean follow-up time of the proximal mid- and distal segment groups was 32.69±4.20 months versus 32.92±3.28 months,and the incidence of adverse cardiovascular events was 26.09% in the proximal mid-group．There was no difference in the incidence of cardiovascular adverse events between the two groups（P>0.05）．ROC curve analysis showed that the area under the prediction curve of electrocardiogram for patients with acute occlusion of the proximal circumflex artery were 0.793（95% CI：0.678-0.914,P<0.001）,sensitivity was 78.22% and specificity was 81.91%．Conclusions Electrocardiogram has important predictive value in diagnosing acute myocardial infarction in which the infarct related artery is a circumflex branch．It can auxiliary determine the infarct site of patients and also auxiliary evaluate the prognosis of acute myocardial infarction patients．
目的 探讨耳内镜下超薄耳屏软骨-软骨膜修补鼓膜大穿孔的效果。方法 回顾性分析31例应用超薄耳屏软骨-软骨膜行耳内镜下夹层法鼓膜修补术的患者资料,随访6个月,分析术后鼓膜愈合率、听力恢复情况。结果 30例鼓膜愈合,成功率96.8％,无移植物外移、内陷、钝角愈合;术前平均气导听阈为（38.3±3.3）dB HL,骨气导差为（23.5±3.1）dB HL,术后平均气导听阈为（22.3±1.6）dB HL,骨气导差为（6.3±2.5）dB HL,听力较术前提高（P<0.001）。结论 超薄耳屏软骨-软骨膜在耳内镜下鼓膜大穿孔修补术中效果较好,并发症少,是可靠的修复材料,值得临床推广应用。
Objective To investigate the clinical efficacy of endoscopic ultrathin tragus cartilage-perichondrium as graft material for treatment of large tympanic membrane perforations. Methods A total of 31 cases（31 ears）which were diagnosed as chronic suppurative otitis with large tympanic membrane perforation were performed endoscopic myringoplasty with ultrathin tragus cartilage-perichondrium by sandwich technique．The pure tone threshold average（PTA）of speech frequency and the air-bone gap were assessed at 6 month safter surgery. Results Successful closure without reperforation was obtained in 30 of 31 patients（96.8%）．There was no graft lateralization,anterior blunting ．Average postoperative air conduction and bone-air conduction gap were（22.3±1.6）dB HL and（6.3±2.5）dBHL compared with（38.3±3.3）dB HL and（23.5±3.1）dB HL preoperatively（P<0.001）. Conclusions The ultrathin tragus cartilage-perichondrium is liable repair material for large tympanic membrane perforation with excellent graft take and significant improvement of hearing,which is worthy of clinical promotion．
目的 探讨脊柱微调手法治疗产后腰椎-骨盆复合体疼痛的临床疗效及对腰椎前凸曲度（LL）和骨盆入射角度（PI）的调整作用,为产后腰椎-骨盆复合体疼痛的治疗提供理论依据。方法 选取2022年7月—2023年7月在上海市杨浦区中医医院推拿科和上海中医药大学附属岳阳中西医结合医院推拿科门诊治疗的产后腰椎-骨盆复合体疼痛患者共82例,随机分为对照组和治疗组,每组41例。对照组采用传统理筋推拿手法,治疗组采用脊柱微调手法治疗,两组疗程均为8周,观察临床疗效,比较两组患者的疼痛数字评分法（NRS）、Oswestry功能障碍指数（ODI）、LL和PI在治疗前后组间与组内的变化。结果 治疗组总有效率为95.12%,对照组总有效率为75.60%,治疗组优于对照组（P<0.05）。治疗后,两组NRS评分、ODI评分较治疗前均有下降,且治疗组优于对照组（P<0.05）。治疗后,两组LL和PI测量较治疗前均无明显变化,治疗组与对照组比较差异无统计学意义（P>0.05）。结论 脊柱微调手法能有效减轻患者疼痛、提升日常活动功能,但对腰椎曲度、骨盆入射角未产生移位影响,安全性高。
Objective To explore the clinical efficacy of spinal fine adjustment manipulation in the treatment of postpartum lumbopelvic pain（PLPP） and its role in adjusting lumbar lordosis and pelvic incidence,and to provide theoretical basis for the treatment of PLPP. Methods A total of 82 patients with PLPP who were treated in the outpatient clinics of the Tuina Department of Yangpu District Hospital of Traditional Chinese Medicine and the Tuina Department of Yueyang Hospital of Integrative Chinese and Western Medicine affiliated to Shanghai University of Traditional Chinese Medicine from July 2022 to July 2023 were selected and randomly divided into the control group and the treatment group,with 41 cases in each group．The control group was treated with the traditional tendon manipulation and the treatment group was treated with spinal fine adjustment manipulation,and the course of treatment for both groups was 8 weeks．Clinical efficacy was observed,and the changes of pain Numerical Rating Scale（NRS）,Oswestry disability index（ODI）,lumbar lordosis（LL）,and pelvic incidence（PI）of the two groups were compared between the two groups and within the two groups before and after the treatment. Results The total effective rate was 95.12% in the treatment group and 75.60% in the control group,and the treatment group was superior to the control group（P<0.05）．After treatment,the NRS and ODI of both groups were lower than before treatment,and the treatment group was better than the control group（P<0.05）． After treatment,there was no significant change in LL and PI in both groups compared to pre-treatment．There was no significant difference between the treatment group and the control group（P>0.05）. Conclusions Spinal fine adjustment manipulation can effectively reduce the pain of patients and improve the function of daily activities,but it has no displacement effect on LL and PI,which is safe and suitable for clinical promotion and application．
目的 观察低浓度布比卡因联合全身麻醉在腹腔镜下直肠癌根治术中的应用及对患者体征及苏醒质量的影响。方法 选择2020年1月—2021年6月在信阳一五四医院实施腹腔镜镜下直肠癌根治术治疗的126例直肠癌患者为研究对象,通过抽签法对患者进行分组,将其中63例列为全麻组,术中单纯实施全身麻醉,其余63例列为联合组,术中采用低浓度布比卡因联合全身麻醉,比较两组患者体征变化情况,苏醒质量,麻醉相关不良反应,并开展为期1.5年的随访,评估两组患者远期生存质量。结果 联合组术中、术后的心率、平均动脉压均低于全麻组（P<0.05）;术后,联合组的Steward麻醉苏醒评分略低于全麻组、麻醉恢复室停留时间略高于全麻组（P>0.05）;但联合组的视觉模拟疼痛评分、镇静评分均低于全麻组（P<0.05）;联合组的麻醉相关不良反应发生率略高于全麻组（P>0.05）;随访期间,联合组的肠癌患者生存质量测定量表各维度评分均高于全麻组（P<0.05）。结论 低浓度布比卡因联合全身麻醉的麻醉效果更加平稳、安全性高。
Objective To observe the application of low concentration bupivacaine combined with general anesthesia in laparoscopic radical resection of rectal cancer and its effect on the physical signs and recovery quality of patients. Methods In this study,126 rectal cancer patients who underwent laparoscopic radical resection of rectal cancer in Xinyang 154th Hospital from January 2020 to June 2021 were selected as the research subjects．The patients were divided into groups by drawing lots．Among them,63 patients were included in general anesthesia group,and the rest 63 patients were included in combined group．Low-concentration bupivacaine combined with general anesthesia was used in combined group during the operation．The changes of physical signs and the quality of recovery were compared between the two groups．Anesthesia related adverse events,and the long-term quality of life of the two groups of patients was evaluated through one-year and a half follow-up. Results The heart rate and mean arterial pressure during and after surgery in the combined group were lower than those in the general anesthesia group（P<0.05）．After surgery,the Steward anesthesia recovery score of the combined group was slightly lower than that of the general anesthesia group,and the PACU stay time was slightly higher than that of the general anesthesia group（P>0.05）．However,the VAS score and Richmond Agitation-Se dation Scale score of the combined group were lower than those of the general anesthesia group（P<0.05）．The incidence of anesthesia related adverse reactions in the combination group was slightly higher than that in the general anesthesia group（P>0.05）．During the follow-up period,the FACT-C scores of all dimensions in the combination group were higher than those in the general anesthesia group（P<0.05）. Conclusions The anesthesia effect of low concentration bupivacaine combined with general anesthesia is significant and safe．
目的 研究注水法内镜下冷圈套器切除术在5~10 mm 无蒂型大肠息肉中的临床疗效。方法 纳入120例阳春市中医院收治的5~10 mm 无蒂型大肠息肉患者,合计246枚息肉,根据结肠息肉切除方式不同分为内镜下注水法冷圈套器切除术（UCSP）与传统内镜下冷圈套器切除术（CCSP）两组,每组分别纳入60例患者。比较两组息肉部位、息肉大小、术后病理诊断、完整息肉切除率、术后病理深度、息肉回收率、手术时间、术中瞬时性出血率、迟发性穿孔率、迟发性出血率以及手术时间、Boston及视觉模拟评分法（VAS）评分。结果 两组息肉部位、息肉大小、术后病理诊断、完整息肉切除率、息肉回收率、术中瞬时性出血率、迟发性穿孔率、迟发性出血率以及Boston评分比较差异均无统计学意义（P>0.05）;UCSP组术后病理深度[（8.80.5）mm]大于CCSP组[（5.90.4）mm]（P<0.01）,CCSP 组手术时间[（21.32.4）min],较UCSP组[（25.71.1）min]缩短（P<0.01）,VAS评分UCSP组[（2.60.7）分]优于CCSP组[（2.90.3）分]（P<0.001）。结论 UCSP能有效、安全5~10 mm无蒂型大肠息肉,术后深度的病理组织学评估获得更高的肌层黏膜切除深度,虽然UCSP手术时间较长,但术后腹痛发生率较低。
Objective To study the clinical efficacy of endoscopic cold snare resection using water injection method in 5-10 mm pedunculated colorectal polyps. Methods A total of 120 patients with 5-10 mm sessile colorectal polyps admitted to Yangchun Traditional Chinese Medicine Hospital were selected as the research subjects．A total of 246 polyps were enrolled,and the patients were divided into two groups based on the different methods of endoscopic resection：underwater cold snare polypectomy（UCSP）and conventional cold snare polypectomy（CCSP）,with 60 patients enrolled in each group．Compare the location,size,postoperative pathological diagnosis,complete polypectomy rate,postoperative pathological depth,polyp recovery rate,surgical time,instantaneous intraoperative bleeding rate,delayed perforation rate,delayed bleeding rate,surgical time,Boston and VAS scores between two groups. Results Two groups of polyp locations,polyp size,postoperative pathological diagnosis,complete polyp resection rate,polyp recovery rate,the instantaneous intraoperative bleeding rate,delayed perforation rate,delayed bleeding rate,and Boston score,all of above were not significant different（P>0.05）;the postoperative pathological depth in the UCSP group[（8.8±0.5）mm] was significantly greater than that in the CCSP group[（5.9±0.4）mm]（P<0.01）,and the surgical time in the CCSP group[（21.3±2.4）min] was shorter than that in the UCSP group[（25.7±1.1）min]（P<0.01）． The VAS score in the UCSP group（2.6±0.7）was significantly better than that in the CCSP group（2.9±0.3）（P<0.001）. Conclusions The underwater cold snare polypectomy can achieve good therapeutic results in patients with 5-10 mm sessile colorectal polyps．Further pathological evaluation of postoperative can obtain deeper of myomucosal resection．Although the UCSP group has a longer surgical time,the incidence of postoperative abdominal pain is lower．
目的 探讨复方脑肽节苷脂注射液联合阿替普酶静脉溶栓治疗急性缺血性脑卒中的疗效。方法 选择2019年6月—2023年1月在河南省许昌中医院诊治的79例缺血性脑卒中患者,按照入院就诊顺序采用奇偶法把患者分为联合组40例与传统组39例。传统组给予阿替普酶静脉溶栓治疗,联合组给予复方脑肽节苷脂注射液联合阿替普酶静脉溶栓治疗,评价与记录联合组与传统组的疗效与安全性及治疗前、治疗14 d后Fugl-Meyer评定量表（FMA）与改良版Banhel评价指数（MBI）、血清β-内啡肽、前列腺素E2（PGE2）水平变化。结果 治疗14 d后联合组的总有效率更高（97.5% vs 82.1%,P<0.05）,并发症发生率更低（5.0% vs 20.5%,P<0.05）。联合组与传统组治疗14 d后的FMA与MBI评分高于治疗前（P<0.05）,联合组治疗14 d后的FMA评分、MBI评分比传统组提高（P<0.05）。联合组与传统组治疗14 d后的血清β-内啡肽、PGE2水平低于治疗前（P<0.05）,联合组治疗14 d后的血清β-内啡肽、PGE2水平低于传统组（P<0.05）。结论 复方脑肽节苷脂注射液联合阿替普酶静脉溶栓治疗急性缺血性脑卒中能提高效果,降低患者的肺部感染、尿路感染、静脉血栓、褥疮等并发症发生率,改善患者的运动与日常生活功能,还可降低患者血清β-内啡肽、PGE2水平。
Objective To explore and analysis the efficacy and safety of compound brain peptide ganglioside injection combined with alteplase intravenous thrombolysis in the treatment of acute ischemic stroke. Methods From June 2019 to January 2023,79 patients with ischemic stroke who were diagnosed and treated at Henan Xuchang Traditional Chinese Medicine Hospital were selected as the research subjects．According to the order of admission,the patients were divided into the combination group of 40 cases and the traditional group of 39 cases．The traditional group received intravenous thrombolytic therapy with alteplase,while the combination group received treatment with compound brain peptide ganglioside injection on the basis of the traditional group．The efficacy and safety and changes of the Fugl-Meyer rating Scale（FMA）and modified Banhel Evaluation Index（MBI）,serum β-endorphin,and PGE 2 levels in the combined and traditional groups were evaluated and recorded. Results After 14 days of treatment,the combined group had a higher overall response rate（97.5% vs 82.1%,P<0.05）and a lower complication rate（5.0% vs 20.5%,P<0.05）．FMA scores and MBI scores of the two groups after 14 days of treatment were higher than those before treatment（P<0.05）,and FMA scores and MBI scores of the combined group after 14 days of treatment were higher than those of the traditional group（P<0.05）．The contents of β-endorphin and prostaglandin E2 in two groups after 14 days of treatment were lower than those before treatment（P<0.05）,and the contents of β-endorphin and prostaglandin E2 in combination group after 14 days of treatment were lower than those in traditional group（P<0.05）. Conclusions The combination of compound brain peptide ganglioside injection and alteplase intravenous thrombolysis in the treatment of acute ischemic stroke can improve the treatment effect,reduce the incidence of complications such as pulmonary infections,urinary tract infections,venous thrombosis and bedsores in patients,improve patients' motor and daily life functions,and also reduce patients' serum levels of β-endorphins and prostaglandin E2．
目的 分析全瓷冠与高嵌体对后牙牙体缺损的修复效果及对牙周炎性反应的影响。方法 用随机抽签法将我科2022年2月—2023年5月接治的50例后牙牙体缺损者分为对照组（签号为奇数,全瓷冠修复）与高嵌体组（签号为偶数,高嵌体修复）,各25例,对比两组修复效果（指标为修复体佩戴时间及总体康复时间）、牙周炎性反应、口腔健康指数及并发症发生率。结果 高嵌体组修复体佩戴时间（14.38±2.51）d、总体康复时间为（59.66±4.47）d,短于对照组的（21.96±2.87）d、（93.84±5.26）d（P<0.001）;高嵌体组牙周正常率（88.00%）高于对照组（64.00%）（P<0.05）;高嵌体组修复后的GI、PLI、SBI分别为（0.81±0.19）分、（0.85±0.16）分、（1.04±0.25）分,低于对照组的（0.97±0.23）分、（1.01±0.22）分、（1.31±0.28）分（P<0.05）;高嵌体组并发症发生率（8.00%）接近于对照组（12.00%）（P>0.05）。结论 修复后牙牙体缺损时选用高嵌体修复法可取得相对更好的修复效果,能够缩短患者佩戴修复体时间,加速其康复进程,对牙周炎性反应的减轻、口腔健康的改善均有积极影响,且并发症风险较小,整体效果更优。
Objective To analyze the effect of all-porcelain crown and onlay on posterior tooth defect repair and periodontitis reaction. Methods Fifty cases of posterior dental defects treated in our department from February 2022 to May 2023 were divided into control group（odd-numbered,all-porcelain crown restoration）and onlay group（even-numbered,onlay restoration）with 25 cases each．The repair effect,periodontitis response,oral health index and complication rate were compared between the two groups. Results The wearing time and overall recovery time of the onlay group were shorter than those of the control group（P<0.001）．The periodontal normal rate in the onlay group was higher than that in the control group （P<0.05）．gingival index,plaque index,sulcus bleeding index of the onlay group after repair were lower than those of the control group（P<0.05）．The complication rate of the high inlays group was close to that of the control group（P>0.05）. Conclusions In the repair of post-dental defects,the use of onlay repair can achieve relatively better repair effects,shorten the time for patients to wear the prosthesis,accelerate the rehabilitation process,have a positive impact on the reduction of periodontitis reaction and the improvement of oral health．The risk of its complications is small,and the overall effect is better．
目的 探讨妊娠期糖尿病（GDM）患者孕24~28周的75 g 口服葡萄糖耐量试验（OGTT）血糖异常项数及妊娠晚期分娩前血糖值与妊娠结局的关系。方法 选择2019年11月—2020年5月在广州医科大学附属妇女儿童医疗中心进行产检并在孕24~28周确诊的167例GDM患者为研究对象,将孕24~28周75 g OGTT结果中仅其中1项时间点血糖异常的孕妇为GDMⅠ组（92例）,2项异常为GDMⅡ组（48例）,3项异常为GDMⅢ组（27例）,比较三组血糖异常项数GDM患者的人口学特点;并分析GDM患者一般人口学特征与妊娠晚期分娩前血糖监测均值的关系,及血糖值对不良妊娠结局的影响。结果 75 g OGTT血糖异常项数与孕前不同的体质指数（BMI）及妊娠晚期的糖化血红蛋白（HbA1c）间比较差异均有统计学意义（P<0.05）。孕前BMI指数水平对妊娠晚期的空腹血糖、餐后1 h血糖、餐后2 h血糖比较差异均有统计学意义（P<0.05）;75 g OGTT血糖异常项数对空腹血糖及餐后2 h血糖比较差异有统计学意义（P<0.05）;③空腹血糖不同水平组在新生儿低血糖、胎膜早破、早产不良结局中比较,差异有统计学意义（P<0.05）。餐后2 h不同血糖水平间组在新生儿低血糖及胎膜早破中比较,差异有统计学意义（P<0.05）。结论 孕前BMI指数与妊娠中期75 g OGTT的血糖筛查结果有关,75 g OGTT试验中血糖异常项数越多不良妊娠结局的发生概率越大,妊娠期进行规范化的运动饮食干预和必要时的药物干预后可改善妊娠晚期的HbA1c水平。
Objective To investigate the relationship between abnormal blood glucose items in the 75 g oral glucose tolerance test（OGTT）at 24-28 weeks of pregnancy and the blood glucose levels before delivery in the third trimester of pregnancy and pregnancy outcomes in gestational disbetes mellitus（GDM）patients. Methods All 167 GDM patients diagnosed at 24-28 weeks of gestation in Women and Children's Medical Center Affiliated to Guangzhou Medical University from November 2019 to May 2020 were enrolled as subjects．The pregnant women with only 1 abnormal blood glucose item among the 75 g OGTT results were classified as GDMⅠ group（92 cases）,with 2 abnormal items were GDMⅡ group（48 cases）,and with 3 abnormal items were GDM Ⅲ group（27 cases）．The demographic characteristics of the three groups of GDM patients were compared．The relationship between the general demographic characteristics of GDM patients and the mean value of blood glucose monitoring before delivery in the third trimester was analyzed,and the influence of blood glucose monitoring on adverse pregnancy outcomes was also analyzed．Results ①With different BMI and HbA1c,there were significant differences in 75 g OGTT blood glucose items（P<0.05）．BMI level had statistically significant effects on fasting blood glucose,1-hour postprandial blood glucose and 2-hour postprandial blood glucose in the third gestational trimester（P<0.05）．②With different number of abnormal blood glucose items,there were significant in fasting blood glucose and 2 hours postprandial blood glucose（P<0.05）．③There were statistically significant differences in the outcomes of neonatal hypoglycemia,premature rupture of membranes and preterm delivery in different fasting blood glucose groups（P<0.05）．There were statistically significant differences in neonatal hypoglycemia and premature rupture of membranes between different 2 hours postprandial blood glucose（P<0.05）. Conclusions BMI can affect the blood glucose screening results of 75g OGTT in the second trimester．The more abnormal blood glucose items in the 75g OGTT test,the greater the probability of adverse pregnancy outcome．Standardized exercise diet intervention and necessary drug intervention during pregnancy can improve the HbA1c level in the third trimester．
目的 探讨子宫内膜异位症（EMT）患者卵泡液来源的外泌体差异微小RNA（miRNA）对卵母细胞质量的影响。方法 收集2021年12月—2022年3月在广州市第一人民医院生殖医学中心进行体外受精-胚胎移植/卵细胞浆内单精子注射助孕的20例不孕症患者的卵泡液,分为EMT组（EMT不孕症患者10例）和对照组（单纯男性因素不孕症患者10例）。采用高通量测序对卵泡液外泌体微小RNA（miRNA）谱进行分析,选出具有组间差异的miRNAs。结果 与单纯男性因素不孕患者相比,EMT组有18个外泌体miRNAs差异有统计学意义,其中上调9个、下调9个。靶基因预测并采用GO和KEGG富集分析发现,这些靶基因主要参与磷脂酰肌醇-3-激酶/蛋白激酶B（ PI3K-Akt）、核苷酸结合寡聚结构域NOD样受体、Ras等信号通路。结论 EMT患者卵泡液来源的外泌体miRNA存在差异,差异的外泌体miRNAs可能通过多个信号通路影响EMT患者卵母细胞质量。
Objective To investigate the effect of differential microRNA（miRNA）derived from follicular fluid exosomes on oocyte quality in patients with endometriosis（EMT）. Methods Follicular fluid was collected from 20 infertile patients undergoing IVF-ET / ICSI in the Reproductive Medicine Center of Guangzhou First People's Hospital from December 2021 to March 2022,including EMT group（10 patients with EMT infertility）and control group（10 patients with simple male factor infertility）．The miRNA spectrum in follicular fluid exosomes was analyzed by high-throughput sequencing and miRNAs with differences between groups were selected. Results Compared with patients with infertility due to simple male factors,there were significant differences in 18 exosomal miRNAs in the EMT group,of which 9 were up-regulated and 9 were down-regulated．GO and KEGG enrichment analysis showed that these target genes were mainly involved in phosphatidylinositol-3-kinase / protein kinase B,Nucleotide binding oligomerization domain-like receptor and other signaling pathways. Conclusions There are differences in follicular fluid-derived exosomal miRNAs in EMT patients．Differential exosomal miRNAs may affect oocyte quality in EMT patients through multiple signaling pathways．
