Cervical lesions pose a significant threat to women’s health worldwide. Colposcopy is essential for screening and treating cervical lesions, but its effectiveness depends on the doctor’s experience. Artificial intelligence-based solutions via colposcopy images have shown great potential in cervical lesions screening. However, some challenges still need to be addressed, such as low algorithm performance and lack of high-quality multi-modal datasets. Here, we established a multi-modal colposcopy dataset of 2,273 HPV+ patients, comprising original colposcopy images, acetic acid reactions at 60s and 120s, iodine staining, diagnostic reports, and pathological results. Utilizing this dataset, we developed CerviFusionNet, a hybrid architecture that merges convolutional neural networks and vision transformers to learn robust representations. We designed a temporal module to capture dynamic changes in acetic acid sequences, which can boost the model performance without sacrificing inference speed. Compared with several existing methods, CerviFusionNet demonstrated excellent accuracy and efficiency.

围绝经期是女性必经的生理阶段,此期由于肾气衰,天癸竭,冲任亏虚,脏腑失于濡养极易发展为绝经前后诸证.文章从《金匮要略》入手,选取酸枣仁汤、甘麦大枣汤、百合知母汤、桂枝加龙骨牡蛎汤深入分析绝经前后诸证病因病机,总结归纳辨治绝经前后诸证的深层规律,通过"从心论治""注重五脏生克制化关系""以后天养先天"探讨治疗绝经前后诸证策略,以期为临床诊治绝经前后诸证提供新的思路.

自《伤寒论》始,在汗牛充栋的中医典籍之中,"血室"一词并不常见.历代医家对"热入血室"之证异说纷纭,大多集中在"冲脉说""胞宫说""肝脏说",三者皆为诠释"热入血室"的不同趋向奠定基础,然都尚存疑虑.随着诠释学理论风发泉涌,通过结合诠释学的研究方法对其进行探讨,分析各种诠释方法对"热入血室"解释的合理性,进一步阐明各类说法均是一种趋于综合的解读,中医经典的诠释需要方法学的反思意识.

月经病是妇科最常见的疾病,病症复杂,治疗上颇有难度.哈孝廉教授继承哈氏妇科学术思想,临证治疗月经病见解独特,疗效甚佳.他认为月经病的产生与肝、脾、肾关系密切,脏腑功能失衡,冲任失调,经血失常.临证辨证时多从妇人多虚、多瘀、多郁的特点出发,治疗上以补肾为本,调肝为先,扶脾为要,三脏同调.用药独具匠心,重在恢复脏腑平衡,调和气血,冲任通畅,月事顺时而下.

目的 探讨消渴康颗粒联合聚乙二醇洛塞那肽注射液治疗2型糖尿病的临床疗效.方法 选取2020年2月—2022年1月在天津医科大学第二医院就诊的104例2型糖尿病患者,按照随机数字表法将所有患者分为对照组和治疗组,每组52例.对照组皮下注射聚乙二醇洛塞那肽注射液,0.1 mg/次,1次/周.治疗组在对照组基础上口服消渴康颗粒,1袋/次,3次/d.两组在治疗30 d后统计疗效.观察两组的临床疗效,比较两组血糖指标、血糖波动指标以及脂肪型脂肪酸结合蛋白(A-FABP)、趋化素(chemerin)、白细胞介素-17(IL-17)水平.结果 治疗后,治疗组的总有效率为96.15％,高于对照组的总有效率82.69％,组间比较差异显著(P<0.05).治疗后,两组患者的空腹血糖(FPG)、糖化血红蛋白(HbA1c)、餐后2 h血糖(2 h BG)显著降低(P<0.05),治疗组FPG、HbA1c、2 h BG比对照组更低(P<0.05).治疗后,两组的平均血糖波动幅度(MAGE)、日间血糖平均绝对差(MODD)、血糖水平标准差(SDBG)水平均明显降低(P<0.05),治疗组MAGE、MODD、SDBG水平明显低于对照组,组间差异有显著意义(P<0.05).治疗后,两组的血清A-FABP、chemerin、IL-17水平均明显低于治疗前(P<0.05);治疗组患者的血清A-FABP、chemerin、IL-17水平低于对照组,差异有统计学意义(P<0.05).结论 消渴康颗粒联合聚乙二醇洛塞那肽注射液治疗2型糖尿病的疗效确切,可提高降糖疗效,降低血糖波动,调节A-FABP、chemerin、IL-17水平,值得临床推广运用.

目的 研究维生素D辅助胰岛素泵强化对重症妊娠期糖尿病患者糖代谢紊乱的改善作用.方法 选取2018年3月-2020年4月在天津医科大学第二医院就诊的重症妊娠期糖尿病患者196例,按照随机数字分配法分为胰岛素泵强化治疗组和联合治疗组各98例,胰岛素泵强化治疗组采用胰岛素泵经导管皮下注射基础量和餐前追加量胰岛素进行治疗,联合治疗组在胰岛素泵强化治疗组的基础上给予维生素D进行治疗,直到分娩前.采用葡萄糖氧化酶法检测空腹血糖(FPG)、饭后1h血糖(1 hPG)及糖化血红蛋白(HbA1c)水平,体质指数(BMI)评估患者的身体质量,E160电化学发光分析仪检测空腹胰岛素(FINS)、饭后1h胰岛素(1 hINS),胰岛素抵抗指数(HO-MA-IR)评估患者的胰岛素抵抗水平,酶联免疫吸附法检测纤溶酶原激活物抑制剂-1(PAI-1)、基质细胞趋化因子-1α(SDF-1α)、内脏脂肪素(Visfatin)、成纤维细胞生长因子-21(FGF-21)水平,统计患者的临床治疗总有效率和妊娠结局.结果 两组患者治疗后FPG、1hPG、HbA1c水平、BMI、FINS、1hINS、HO-MA-IR、SDF-1α、ViSfatin及FGF-21水平低于治疗前,PAI-1水平高于治疗前;治疗后联合治疗组FPG、1hPG、HbA1c水平、BMI、FINS、1hINS、HO-MA-IR、SDF-1α、ViSfatin及FGF-21水平低于胰岛素泵强化治疗组,PAI-1水平高于胰岛素泵强化治疗组,差异均有统计学意义(均P＜0.05).联合治疗组临床治疗总有效率高于胰岛素泵强化治疗组,差异有统计学意义(P＜0.05).结论 维生素D辅助胰岛素泵强化对重症妊娠期糖尿病患者的治疗效果较好,可有效改善患者的糖代谢水平.

目的 探讨天芪降糖胶囊联合达格列净片治疗2型糖尿病的临床疗效.方法 回顾性分析2019年8月—2020年9月天津医科大学第二医院收治的134例2型糖尿病患者临床资料,采用随机数字表分成对照组和治疗组,每组各67例.对照组口服达格列净片,10 mg/次,1次/d;治疗组在对照组基础上口服天芪降糖胶囊,5粒/次,3次/d.两组患者治疗8周.观察两组患者临床疗效,比较治疗前后两组患者血糖指标空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbAlc)、胰岛素(FINS)、血糖标准差(SDBG)、平均血糖波动幅度(MAGE)、日内血糖波动次数(NGE)及日间血糖平均绝对差(MODD)水平,及血清肿瘤坏死因子相关蛋白6(CTRP6)、1-磷酸鞘氨醇(SIP)、白细胞介素-18(IL-18)、C1补体肿瘤坏死因子相关蛋白12(CTRP12)和血清脂蛋白-α(LP)水平.结果 治疗后,在总有效率上治疗组显著高于对照组(98.51％vs 83.58％,P<0.05).治疗后,两组FPG、2 h PG、HbAlc、FINS水平均显著降低(P<0.05),且治疗组最显著(P<0.05).治疗后,两组血清CTRP6、SIP、IL-18、LP水平均显著降低,而CTRP12水平显著升高(P<0.05),且以治疗组改善最明显(P<0.05).治疗后,两组SDBG、MAGE、NGE和MODD均显著下降(P<0.05),且以治疗组降低最明显(P<0.05).结论 天芪降糖胶囊联合达格列净片治疗2型糖尿病可显著控制患者血糖,具有一定的临床推广应用价值.

目的 探讨基于CBL与PBL结合床旁教学模式在妇科临床教学中的应用效果.方法 将2017年1—12月到我院妇科实习的学生随机分为实验组(84例)和对照组(84例),实验组采用CBL与PBL结合床旁教学法,对照组采用传统床旁教学法;实验结束后两组同时进行理论测试、Mini-CEX量表测评及问卷调查.结果 实验组在理论成绩、Mini-CEX评测和提高学生的学习兴趣、提高学生的医患沟通能力等方面均优于对照组,两组比较差异有统计学意义(P<0.05).结论 CBL与PBL结合床旁教学模式可提升学生临床技能及综合诊疗能力,达到临床教学目的.

目的 研究牙痛停滴丸对大鼠口腔溃疡的治疗效果,并设计小鼠耳肿胀实验验证其抗炎作用.方法 SD大鼠随机分为对照组、模型组、牙痛停滴丸组(86.4 mg/kg,4倍临床等效剂量)、甲硝唑组(16.2 mg/kg,临床等效剂量,阳性药),每组10只.除对照组外,以80％冰醋酸溶液灼烧颊侧口腔黏膜的方法建立口腔溃疡模型,造模24h开始给药,连续ig给药10d,模型组和对照组给予等量蒸馏水.观察溃疡大体形态;于造模1d和给药4、10d,利用游标卡尺测量大鼠口腔溃疡的直径大小,进行口腔溃疡评分;于给药第4天,取每组2只大鼠溃疡处口腔黏膜做病理组织学观察.ICR小鼠随机分为模型组、阿司匹林(195 mg/kg,临床等效剂量,阳性药)组、牙痛停滴丸(124.8 mg/kg,4倍临床等效剂量)组,每天给药1次,连续ig3 d.于末次给药1h后,以二甲苯致小鼠耳肿胀为炎症模型,考察小鼠耳片的肿胀度.结果 大体观察显示,给药10d,模型组溃疡表面仍存在假膜,牙痛停滴丸组基本愈合,甲硝唑组溃疡面积减小并伴有假膜;与模型组比较,给药4、10d时,牙痛停滴丸和甲硝唑组溃疡直径显著减小(P＜0.05),口腔溃疡评分显著降低(P＜0.05);HE染色显示,牙痛停滴丸组假膜较模型组小,且鳞状上皮细胞坏死程度较低.与模型组比较,牙痛停滴丸及阿司匹林组的小鼠耳片肿胀度均显著降低(P＜0.05、0.01).结论 牙痛停滴丸可以治疗炎症、促进口腔溃疡的愈合,缓解溃疡表面的红肿情况,对口腔溃疡有一定的治疗作用.

2型糖尿病(T2DM)作为临床常见慢性病,患者发病机制复杂,多以血糖升高作为主要表现.达格列净作为SGLT-2抑制剂中的一种,既能有效控制患者血糖,肥胖者还能达到减重效果,并对其肾脏保护、心血管改善有一定疗效.本次研究现阐述达格列净药理机制,总结其用于治疗T2DM的作用和可能会存在的不良反应,为临床用药治疗提供参考.

Background: Cognitive dysfunction is increasingly recognized as an important complication of diabetes mellitus (DM). Accumulating evidence indicates that the abnormality of cerebrovascular structure and function plays an essential role in diabetic cognitive impairment (DCI), however, changes in cerebrovascular factors have been blurred during the development of diabetes. Objective: To evaluate the changes in the structure and function of cerebrovascular in DCI mice and to investigate the changes of cerebral angiogenesis and stability factors during the development of DM. Methods: Diabetes was induced by feeding with high-fat diet combined with intraperitoneal injection of streptozotocin (STZ,120 mg/kg). Cognitive function was evaluated at different stages of DM, cerebral neovascularization, blood-brain barrier (BBB) permeability and hippocampal neurons were measured of DCI mice, and the expression of vascular endothelial growth factor (VEGF) and platelet-derived growth factor receptor beta (PDGERB) in hippocampus was detected during the development of DM. Results: With the progress of diabetes, the learning and memory ability of mice gradually decreased, and DCI mice showed neuronal degeneration, increased BBB permeability and pathological cerebral neovascularization. Moreover, the expression of VEGF in the hippocampus increased first and then decreased at DM+8week, PDGFR beta decreased continuously with the development of diabetes. Conclusions: Our results demonstrate that DCI may be attributed to the dynamic expression of VEGF/PDGFR beta in diabetic hippocampus, and pathological cerebral neovascularization, increased BBB permeability and neuronal degeneration are the key links.

目的:探讨支气管扩张症患者抗感染、止血等治疗方案中的药学监护.方法:通过参与3例支气管扩张症患者的药物治疗实践,临床药师从用药指征、给药剂量、给药速度与疗程、药物调整、相互作用、不良反应监测等方面,结合患者具体情况,协助临床医师为患者制订个体化治疗方案,提供个体化药学服务.结果:临床药师积极参与药学监护,及时发现支气管扩张症患者治疗方案中实际存在的用药问题,并提出解决办法,提高了临床治愈率,减少了药物不良反应的发生.结论:临床药师通过临床实践,探索出了支气管扩张症的药学监护方法,将该方法用于开展药学服务,可以协助临床医师优化治疗方案,提高临床治疗效果,提高患者用药依从性.

当岁月带走了青春,女人到了更年,"老"就扑面而来.老,不可避免,但我们可以老得慢一点、美一点、健康一点. "绝经,一个新的开始"……这不仅是2020年在澳大利亚墨尔本举行的世界绝经大会的主题,更是一种在全球范围内引起共鸣的说法. 中年是她们崭新的开始,但是"新的开始"却被它阻挡住了脚步,那就是更年期综合征. 不知不觉,人生页码已近"五"字头,更年期的各种不适,此起彼伏,让有些女性在更年期期间,备感骄傲.

目的:探究丹白颗粒联合阿奇霉素对慢性盆腔炎的治疗效果.方法:选取2018年12月至2019年2月山东省日照市人民医院收治的支原体感染导致的慢性盆腔炎患者110例作为研究对象,按照随机数字表法分为对照组和观察组,每组55例.对照组患者单纯给予阿奇霉素治疗,观察组患者在对照组基础上加用丹白颗粒治疗.观察2组患者治疗期间的显效时间、临床疗效、不良反应和复发率发生情况.治疗前、治疗后子宫低切全血黏度、高切全血黏度、血浆黏度、红细胞聚集指数、红细胞压积(％)、红细胞沉降率和纤维蛋白原血流动力学指标的变化情况以及TNF-α、IL-8和IL-10的水平变化情况.结果观察组显效时间显著低于对照组;观察组总有效率为98.2％,显著高于对照组的90.9％;观察组的不良反应的复发率发生情况同样显著低于对照组;2组患者血流动力学各项指标与组内治疗前比较,差异均有统计学意义(P均<0.05);治疗后观察组患者血流变学各项指标与对照组比较,差异均有统计学意义(P均<0.05);2组患者治疗后TNF-α、IL-8和IL-10水平均比组内治疗前显著降低;与对照组比较,观察组TNF-α、IL-8和IL-10水平下降更明显,差异均有统计学意义(P均<0.05).结论:丹白颗粒联阿奇霉素治疗慢性盆腔炎可能是通过影响患者血液中TNF-α、IL-8和IL-10表达水平来改善其子宫血流动力学指标,最终提高治疗,降低复发率和不良反应发生率.

Ovarian cancer is one of the most common gynecological malignancies leading to female deaths, and its early diagnosis and prevention are very complicated. Therefore, biomarkers for this disease prediction and prognosis are urgently needed for early diagnosis and individualized treatment. miRNAs are short-chain, highly conserved non-coding RNA molecules that mainly degrade or inhibit target genes at the post-transcriptional level to regulate cell growth, proliferation, differentiation, metabolism, and apoptosis. Existing studies have confirmed that miRNAs can be used as potential biomarkers for clinical diagnosis and treatment of cancer. Moreover, tumor-related miRNAs play an important role in the occurrence, invasion and metastasis of ovarian cancer by regulating the expression of multiple oncogenes and tumor suppressor genes. In this paper, the roles of miRNAs as biomarkers for early prevention or detection of ovarian cancer, prognostic diagnosis and treatment targets were reviewed, and the future clinical application of miRNA in patients with ovarian cancer was proposed.

Although it is feared that diabetes-induced cognitive impairment (DCI) will become a major clinical problem worldwide in the future, its detailed pathological mechanism is not well known. Because patients with diabetes have various complications of vascular disease, vascular disorders in the brain are considered to be one of the main mechanisms of DCI. Mounting evidence suggests that the vascular endothelial growth factor (VEGF) family plays a crucial role in the development of DCI. In this review, we summarized the changes and functions of VEGF during the development of DCI, and speculated that it was characterized by spatiotemporal variations in DCI progression. Considering the complexity of DCI pathogenesis and the diversity of VEGF function, we focused on the interrelationship of DCI and VEGF spatiotemporal variations during DCI development. During the progression of DCI, hyperglycemia, abnormal brain insulin signals, advanced glycation end products (AGEs) and consequently hypoxia, oxidative stress, and inflammation are the main pathophysiological changes; hypoxia-inducible factor (HIF), reactive oxygen species (ROS), and nuclear factor kappa beta (NF-κB) play major roles in DCI-related VEGF spatiotemporal regulation. Furthermore, spatiotemporal variations in VEGF-mediated pathological cerebral neovascularization, repair and regeneration of dural lymphatic vessels, increased blood-brain barrier (BBB) permeability and slight neuroprotection are increasing emphasized as potential targets in the treatment of DCI.

目的 利用实时细胞分析(RTCA) Cardio系统,通过体外细胞实验及整体动物实验评价速效救心丸抗心律失常作用.方法 培养原代大鼠乳鼠心肌细胞,接种于E-Plate Cardio 96,分析3 600/孔、20 000/孔以及90 000/孔接种浓度心肌细胞的细胞指数(CI)和搏动图形;MTT法检测速效救心丸(10、20、40、80、160 μg/mL)对原代心肌细胞活力的影响;考察速效救心丸(160 μg/mL)对乌头碱(8μmol/L)诱发心律失常的心肌细胞搏动频率、搏动幅度的影响;舌下iv乌头碱50 μg/kg制备大鼠心律失常模型,利用八导生理记录仪观察速效救心丸(54、270 mg/kg)对Ⅱ导联心电图的影响.结果 20 000/孔为最佳接种浓度,CI值在观察时间内成对数生长,细胞形成同步搏动,波形正常且持续时间长;在10～160μg/mL浓度范围内,速效救心丸对心肌细胞活力均没有明显影响.RTCA Cardio系统检测结果显示,与模型组比较,速效救心丸能显著降低心肌细胞搏动速率(P＜0.01)、显著增加心肌细胞的搏动幅度(P＜0.01).动物实验发现,速效救心丸能有效对抗乌头碱诱导的心律失常、改善乌头碱对实验动物RR间期的抑制作用和对心率的促进作用、降低乌头碱诱导的室颤发生率(P＜0.01、0.001).结论 RTCA Cardio系统能实现对心肌细胞的实时监测,可以检测心肌细胞的搏动情况;速效救心丸能有效对抗乌头碱诱导的心律失常.

Ethnopharmacological relevance: Eucommia ulmoides Oliv., a Chinese medicinal herb called "Duzhong" from the bark of Eucommia ulmoides Oliv., has been shown to possess significant protective effects in Parkinson's disease (PD). However, the molecular mechanism remains unclear. Aim of the study: In this study, we explored the anti-neuroinflammatory mechanisms of Duzhong on the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced PD mouse model to elucidate the traditional medical theories with modern pharmacological methods and to provide a reference for further clarifying its mechanisms of action. Materials and methods: The representative components in Duzhong extract were identified by UPLC-Q-TOF/MS. Male C57BL/6J mice were intraperitoneally injected with MPTP to establish an in vivo PD model. The pole, rotarod, and grip strength tests were performed to evaluate the motor coordination ability of the PD mice. HPLC-ECD was used to detect the striatal levels of dopamine (DA), 3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA). The expression of tyrosine hydroxylase (TH) was studied by immunohistochemistry (IHC) and Western blot assays. ELISA and Q-PCR were used examined the levels of proinflammatory cytokines in the serum and midbrain, respectively. Whole-transcriptome analysis of the midbrain was performed to explore the therapeutic effect of Duzhong on PD mice, and Q-PCR was then used to validate the differential gene expression changes in the PD mice treated with Duzhong. Results: Ten compounds were identified from Duzhong extract. Duzhong significantly alleviated the behavioral impairments and dopaminergic neuron degeneration of PD mice, and inhibited the expression of proinflammatory cytokines. Whole-transcriptome analysis revealed nine oppositely regulated genes, and the Fosl2 gene was consistent with the trend of observed by RNA-seq. Furthermore, Duzhong downregulated mRNA expression of p38 and JNK, which are key upstream genes of Fosl2. Conclusions: Duzhong has promising therapeutic potential in PD mice, and its molecular mechanism is mediated by downregulating p38/JNK-Fosl2 gene expression to alleviate neuroinflammation.

介绍金季玲教授运用补肾调周法治疗月经过少的临床经验.金教授认为,月经过少有虚实之分,虚多因肾精匮乏,导致冲任气血不足,经血无以为生;实多因痰湿、寒凝等阻滞冲任,使气血运行不畅,血海不能满溢.其治疗上重视月经周期中肾阴、肾阳的相互转化,以补肾调周为治疗方法,将月经周期分为经后期、排卵期、经前期、行经期,分别采用滋阴补肾汤加减、补肾促排卵汤加减、健脾温肾汤或毓麟珠、四物汤加减治疗,临床效果较佳.