Sedimentary record of a late Holocene storm event in Laizhou Bay,Bohai Sea,China

The Bohai Sea is influenced by numerous extreme oceanic wave events in history.However,it is often difficult to determine the types of these events due to the lack of detailed historical records,causing uncertainty in the reconstruction of historical coastal disasters.We investigated an anomalous sand layer in the Xiliyu Village by the coast of Laizhou Bay,Shandong,from which an extreme event deposit was identified using a multi-proxy approach including grain size distribution,geochemistry,and magnetic susceptibility.This event was dated 2700–3100 a bp,and caused inundation of a large coastal area of Laizhou Bay.By comparing historical records with instrumental data,we believe that the event deposit was generated by a severe storm surge with wind speed of>34.9 m/s.

Tuning Structural and Electronic Configuration of FeN_(4) via External S for Enhanced Oxygen Reduction Reaction

The Fe-N-C material represents an attractive oxygen reduction reaction electrocatalyst,and the FeN_(4)moiety has been identified as a very competitive catalytic active site.Fine tuning of the coordination structure of FeN_(4)has an essential impact on the catalytic performance.Herein,we construct a sulfur-modified Fe-N-C catalyst with controllable local coordination environment,where the Fe is coordinated with four in-plane N and an axial external S.The external S atom affects not only the electron distribution but also the spin state of Fe in the FeN_(4)active site.The appearance of higher valence states and spin states for Fe demonstrates the increase in unpaired electrons.With the above characteristics,the adsorption and desorption of the reactants at FeN_(4)active sites are optimized,thus promoting the oxygen reduction reaction activity.This work explores the key point in electronic configuration and coordination environment tuning of FeN_(4)through S doping and provides new insight into the construction of M-N-C-based oxygen reduction reaction catalysts.

Flexible ureteroscopic treatment of kidney stones: How do the new laser systems change our concepts?

Objective: Flexible ureteroscopy (fURS) has become a widely accepted and effective technique for treating kidney stones. With the development of new laser systems, the fURS approach has evolved significantly. This literature review aims to examine the current state of knowledge on fURS treatment of kidney stones, with a particular focus on the impact of the latest laser technologies on clinical outcomes and patient safety.Methods: We conducted a search of the PubMed/PMC, Web of Science Core Collection, Scopus, Embase (Ovid), and Cochrane Databases for all randomized controlled trial articles on laser lithotripsy in September 2023 without time restriction.Results: We found a total of 22 relevant pieces of literature. Holmium laser has been used for intracavitary laser lithotripsy for nearly 30 years and has become the golden standard for the treatment of urinary stones. However, the existing holmium laser cannot completely powder the stone, and the retropulsion of the stone after the laser emission and the thermal damage to the tissue have caused many problems for clinicians. The introduction of thulium fiber laser and Moses technology brings highly efficient dusting lithotripsy effect through laser innovation, limiting pulse energy and broadening pulse frequency.Conclusion: While the holmium:yttrium-aluminum-garnet laser remains the primary choice for endoscopic laser lithotripsy, recent technological advancements hint at a potential new gold standard. Parameter range, retropulsion effect, laser fiber adaptability, and overall system performance demand comprehensive attention. The ablation efficacy of high-pulse-frequency devices relies on precise targeting, which may pose practical challenges.

Influencing factors and solution strategies of chimeric antigen receptor T-cell therapy(CAR–T)cell immunotherapy

Chimeric antigen receptor T-cesll therapy(CAR–T)has achieved groundbreaking advancements in clinical application,ushering in a new era for innovative cancer treatment.However,the challenges associated with implementing this novel targeted cell therapy are increasingly significant.Particularly in the clinical management of solid tumors,obstacles such as the immunosuppressive effects of the tumor microenvironment,limited local tumor infiltration capability of CAR–T cells,heterogeneity of tumor targeting antigens,uncertainties surrounding CAR–T quality,control,and clinical adverse reactions have contributed to increased drug resistance and decreased compliance in tumor therapy.These factors have significantly impeded the widespread adoption and utilization of this therapeutic approach.In this paper,we comprehensively analyze recent preclinical and clinical reports on CAR–T therapy while summarizing crucial factors influencing its efficacy.Furthermore,we aim to identify existing solution strategies and explore their current research status.Through this review article,our objective is to broaden perspectives for further exploration into CAR–T therapy strategies and their clinical applications.

血清高迁移率族蛋白B1、人β防御素2与腺病毒肺炎患儿闭塞性细支气管炎发生的关系

目的探讨血清高迁移率族蛋白B1(HMGB1)、人β防御素2(hBD-2)与腺病毒肺炎(AP)患儿闭塞性细支气管炎(BO)发生的关系。方法选取193例AP患儿,根据出院3个月后是否发生BO将AP患儿分为BO组58例和非BO组135例。收集两组临床资料并用酶联免疫吸附试验检测血清HMGB1、hBD-2,用单因素及多因素Logistic回归分析AP患儿发生BO的影响因素,以受试者工作特征(ROC)曲线分析血清HMGB1、hBD-2对AP患儿发生BO的预测价值。结果BO组月龄小于非BO组,热程长于非BO组,低氧血症、机械通气发生比例及血液白细胞计数、血小板计数、C反应蛋白、降钙素原、HMGB1、hBD-2高于非BO组(P均<0.05)。多因素Logistic回归分析显示,低氧血症、机械通气和HMGB1、hBD-2升高为AP患儿发生BO的独立危险因素(P均<0.05)。ROC曲线分析显示,血清HMGB1、hBD-2联合应用预测AP患儿发生BO的曲线下面积为0.818,与血清HMGB1、hBD-2单独预测的曲线下面积(0.739、0.726)比较差异有统计学意义(P均<0.05)。结论血清HMGB1、hBD-2水平升高是AP患儿发生BO的危险因素,二者联合检测对AP患儿发生BO的预测价值较高。

基于网络药理学和分子对接技术探讨冬虫夏草治疗肺纤维化的作用机制

目的采用网络药理学方法和分子对接技术探讨冬虫夏草防治肺纤维化的作用机制。方法通过网络药理学方法筛选出冬虫夏草抗肺纤维化的主要化学成分、靶点及潜在作用肺纤维化的信号通路,并对关键的化合物和靶点进行分子对接。结果冬虫夏草共有22个化合物和91个靶点参与治疗肺纤维化,蛋白互作(PPI)分析出EGFR、IL6、MDM2、RELA、CDK1和JAK2等关键靶点,KEGG通路富集筛选得到73条通路信号通路,分子对接结果显示冬虫夏草活性成分与关键靶点PI3K、AKT、RELA、IL6、EGFR、JAK2、MAP2K1和MDM2具有良好的结合性能。结论冬虫夏草能通过多成分、多靶点、多通路抗肺纤维化。

3D打印技术辅助陈旧性骨盆髋臼骨折的手术治疗

目的探讨3D打印技术在手术治疗陈旧性骨盆髋臼骨折中的临床意义。方法回顾性分析2019年5月至2022年2月使用3D打印技术辅助治疗的13例陈旧性骨盆髋臼骨折病人的临床资料,其中男9例、女4例。术前应用3D打印技术,按1∶1比例制作病人全骨盆模型,根据模型进行术前决策,模拟骨折复位、截骨、减压,指导术前选择及预弯内固定物。记录手术时间、出血量及术后复位效果。术后复位质量根据Matta评分标准进行评估。末次随访时,采用Merle D’Aubigne和Postel评分、Majeed评分评估疗效。结果13例病人均顺利完成手术,手术时间为(194.38±79.82)min,术中出血量为(534.62±268.46)mL。按Matta标准,骨折复位优3例,良7例,优良率为76.92%。所有病人均获得随访,按照Merle D’Aubigne和Postel评分标准,髋关节功能优1例,良2例,优良率为75%,Majeed评分为(93.00±4.37)分。结论3D打印技术辅助治疗陈旧性骨盆髋臼骨折,有助于了解骨折形态、制定合理的手术方案、提高内固定物植入的精度、减少手术时间及术中出血量。

开发和验证一种预后的列线图来指导肺大细胞神经内分泌癌的决策

背景与目的肺大细胞神经内分泌癌(lung large cell neuroendocrine carcinoma,LCNEC)是一种罕见且预后极差的肺恶性肿瘤。目前对LCNEC的研究大多基于回顾性研究,缺乏现实世界的验证。本研究旨在识别独立的危险因素,建立并验证LCNEC预后的预测模型。方法从2010至2015年监测、流行病学和结果数据库(Surveillance,Epidemiology,and End Results,SEER)和我科2016至2020年住院患者中提取患者资料。采用Kaplan-Meier法评估总生存期(overall survival,OS)。OS被定义为患者从确诊到死亡或最后一次随访时间。单因素Cov回归分析和多因素Cox回归分析确定显著的预后因素。从而构建预测LCNEC预后的Nomogram。结果共纳入1892例LCNEC患者,分为训练队列(n=1288)和两个验证队列(n=552,n=52)。单因素Cox回归分析显示年龄、性别、肿瘤原发部位、偏侧、肿瘤原发灶-淋巴结-转移(tumor-node-metastasis,TNM)各分期、手术、放疗可影响LCNEC的预后(P<0.05),多因素Cox分析显示年龄、性别、肿瘤原发部位、T分期、N分期、M分期、手术、放疗是LCNEC患者预后的独立危险因素(P<0.05)。校准曲线和一致性指数(内部:0.744±0.015;外部:0.763±0.020、0.832±0.055)显示模型预测性能良好。结论年龄≥65岁、男性、TNM分期晚、未经过手术或放疗的患者预后不佳。列线图可以对患者的个性化临床决策提供一定的参考。

ICU机械通气并发呼吸机相关性肺炎患者预后不良的影响因素

目的:探讨重症监护室(ICU)机械通气并发呼吸机相关性肺炎(VAP)患者预后不良的影响因素。方法:选取2020年10月至2022年10月昌江黎族自治县人民医院收治的96例ICU机械通气并发VAP患者进行前瞻性研究,进行28 d院内随访和电话随访,将死亡患者纳入预后不良组,其余患者纳入预后良好组,比较两组临床资料,分析ICU机械通气并发VAP患者预后不良的影响因素。结果:96例ICU机械通气并发VAP患者中,16例预后不良,80例预后良好,预后不良发生率为16.67%(16/96);两组性别、合并高脂血症、合并高血压、合并糖尿病、病原菌类型、体质量指数、白细胞计数占比比较,差异均无统计学意义(P>0.05);两组年龄、机械通气类型、住院时间、降钙素原(PCT)、超敏C反应蛋白(hs-CRP)占比比较,差异均有统计学意义(P<0.05);Logistic回归分析结果显示,PCT>2.5 ng/mL、hs-CRP>40 mg/L均为影响ICU机械通气并发VAP患者预后不良的危险因素(P<0.05)。结论:PCT>2.5 ng/mL、hs-CRP>40 mg/L均为影响ICU机械通气并发VAP患者预后不良的危险因素。

Measurement of^(134)Xe(n,2n)^(133m),gXe reaction cross sections in 14‑MeV region with detailed uncertainty quantification

A lead-shielded HPGe detector and offlineγ-ray spectra of the residual product were used to measure the cross section(CS)and ratios of isomeric CS(σm/σg)in^(134)Xe(n,2n)^(133m),gXe reactions at different energies(13.5 MeV,13.8 MeV,14.1 MeV,14.4 MeV,14.8 MeV)relative to the^(93)Nb(n,2n)^(92)mNb reaction CS.The target was high-purity natural Xe gas under high pressure.The T(d,n)4He reaction produces neutrons.TALYS code(version 1.95)for nuclear reactions was used for calculations,with default parameters and nuclear level density models.The uncertainties in the measured CS data were thoroughly analyzed using the covariance analysis method.The results were compared with theoretical values,evaluation data,and previous experimental findings.CS data of the 134Xe(n,2n)133mXe and 134Xe(n,2n)133gXe reactions and the corresponding isomeric CS ratios at 13.5 MeV,13.8 MeV,and 14.1 MeV neutron energies are reported for the first time.This research advances our knowledge of pre-equilibrium emission in the(n,2n)reaction channel by resolving inconsistencies in the Xe data.

Quality-Aware Massive Content Delivery in Digital Twin-Enabled Edge Networks

Massive content delivery will become one of the most prominent tasks of future B5G/6G communication.However,various multimedia applications possess huge differences in terms of object oriented(i.e.,machine or user)and corresponding quality evaluation metric,which will significantly impact the design of encoding or decoding within content delivery strategy.To get over this dilemma,we firstly integrate the digital twin into the edge networks to accurately and timely capture Quality-of-Decision(QoD)or Quality-of-Experience(QoE)for the guidance of content delivery.Then,in terms of machinecentric communication,a QoD-driven compression mechanism is designed for video analytics via temporally lightweight frame classification and spatially uneven quality assignment,which can achieve a balance among decision-making,delivered content,and encoding latency.Finally,in terms of user-centric communication,by fully leveraging haptic physical properties and semantic correlations of heterogeneous streams,we develop a QoE-driven video enhancement scheme to supply high data fidelity.Numerical results demonstrate the remarkable performance improvement of massive content delivery.

A small-spot deformation camouflage design algorithm based on background texture matching

In order to solve the problem of poor fusion between the spots of deformation camouflage and the background,a small-spot deformation camouflage design algorithm based on background texture matching is proposed in this research.The combination of spots and textures improved the fusion of the spot pattern and the background.An adversarial autoencoder convolutional network was designed to extract background texture features.The image adversarial loss was added and the reconstruction loss was improved to improve the clarity of the generated texture pattern and the generalization ability of the model.The digital camouflage was formed by obtaining the mean value of the square area and replacing the main color.At the same time,the spots in the square area with a side length of 2 s were subjected to simple linear iterative clustering to form irregular small-spot camouflage.A dataset with a scale of 1050 was established in the experiment.The training results of three different loss functions were investigated.The results showed that the proposed loss function could enhance the generalization of the model and improve the quality of the generated texture image.A variety of digital camouflages with main colors and irregular small-spot camouflage were generated,and their efficiency was tested.On the one hand,intuitive evaluation was given by personnel observing the camouflage pattern embedded in the background and its contour map calculated by the canny operator.On the other hand,objective comparison result was formed by calculating the 4 evaluation indexes between the camouflage pattern and the background.Both results showed that the generated pattern had a high degree of fusion with the background.This model could balance the relationship between the spot size,the number of main colors and the actual effect according to actual needs.

ZIF-Mediated Anchoring of Co species on N-doped Carbon Nanorods as an Efficient Cathode Catalyst for Zn-Air Batteries

Developing efficient oxygen reduction reaction(ORR)catalyst is essential for the practical application of Zn-air batteries(ZABs).In this contribution,we develop a novel zeolitic imidazolate framework(ZIF)-mediated strategy to anchor Co species on N-doped carbon nanorods for efficient ORR.Featuring ultrahigh N-doping(10.29 at.%),monodisperse Co nanocrystal decoration,and well-dispersed Co-N_(x)functionalization,the obtained Co-decorated N-doped carbon nanorods(Co@NCNR)exhibit a decent ORR performance comparable to commercial Pt/C in alkaline media.Aqueous ZABs have been assembled using Co@NCNR as the cathode catalyst.The assembled ZABs manifest high initial open-circuit voltage as well as high energy density.In addition,the Co@NCNR also demonstrates ideal ORR performance in quasi-solid-state ZABs.

Chiral Dirac Fermion in a Collinear Antiferromagnet

In a Dirac semimetal, the massless Dirac fermion has zero chirality, leading to surface states connected adiabatically to a topologically trivial surface state as well as vanishing anomalous Hall effect. Recently, it is predicted that in the nonrelativistic limit of certain collinear antiferromagnets, there exists a type of chiral“Dirac-like” fermion, whose dispersion manifests four-fold degenerate crossing points formed by spin-degenerate linear bands, with topologically protected Fermi arcs. Such an unconventional chiral fermion, protected by a hidden SU(2) symmetry in the hierarchy of an enhanced crystallographic group, namely spin space group, is not experimentally verified yet. Here, by angle-resolved photoemission spectroscopy measurements, we reveal the surface origin of the electron pocket at the Fermi surface in collinear antiferromagnet CoNb3S6. Combining with neutron diffraction and first-principles calculations, we suggest a multidomain collinear antiferromagnetic configuration, rendering the the existence of the Fermi-arc surface states induced by chiral Dirac-like fermions.Our work provides spectral evidence of the chiral Dirac-like fermion caused by particular spin symmetry in CoNb_(3)S_(6), paving an avenue for exploring new emergent phenomena in antiferromagnets with unconventional quasiparticle excitations.

Single-Atom Lithiophilic Sites Confined within Ordered Porous Carbon for Ultrastable Lithium Metal Anodes

Attributing to the high specific capacity and low electrochemical reduction potential,lithium(Li)metal is regarded as the most promising anode for high-energy Li batteries.However,the growth of lithium dendrites and huge volume change seriously limit the development of lithium metal batteries.To overcome these challenges,an ordered mesoporous N-doped carbon with lithiophilic single atoms is proposed to induce uniform nucleation and deposition of Li metal.Benefiting from the synergistic effects of interconnected three-dimensional ordered mesoporous structures and abundant lithiophilic single-atom sites,regulated local current density and rapid mass transfer can be achieved,leading to the uniform Li deposition with inhibition of dendrites and buffered volume expansion.As a result,the as-fabricated anode exhibits a high CE of 99.8%for 200 cycles.A stable voltage hysteresis of 14 mV at 5 mA cm^(−2)could be maintained for more than 1330 h in the symmetric cell.Furthermore,the full cell coupled with commercial LiFePO_(4)exhibits high reversible capacity of 108 mAh g^(−1)and average Coulombic efficiency of 99.8%from 5th to 350th cycles at 1 C.The ordered mesoporous carbon host with abundant lithiophilic single-atom sites delivers new inspirations into rational design of high-performance Li metal anodes.

Experimental Investigation of Regular or Wavy Two-Phase Flow in a Manifold

An experimental study was conducted to investigate the properties of stratified regular or wavy two-phase flow in two parallel separators located after a manifold.A total of 103 experiments with various gas and liquid velocity combinations in three inlet pipes were conducted,including 77 groups of outlet pipe resistance symmetry and 26 groups of outlet pipe resistance asymmetry trials.The experimental results have revealed that when the gas-liquid flow rate is low,the degree of uneven splitting is high,and“extreme”conditions are attained.When the superficial gas velocity is greater than that established in the extreme case,the direction of the liquid-phase displacement is reversed,while that of the gas remains unchanged.Thus,the degree of gas phase bias tends to be mitigated with an increase in the gas velocity,while the uneven splitting degree of liquid approaches 10%.Finally,varying the gas-phase outlet pipe resistance is shown to effectively change the gas-liquid two-phase flow distribution.

具有高效界面电荷转移的0D/2D Bi_(4)V_(2)O_(11)/g-C_(3)N_(4)梯形异质结的设计合成及抗生素降解性能研究

随着工业技术的飞速发展,大量有机污染物被应用于生活的各个领域,由此带来了严重的环境问题。众所周知,半导体光催化技术是一种有效且环境友好的降解去除典型污染物的方法,而光催化剂在该技术的应用中起着关键作用。因此,在光催化污染物降解领域,人们已经尝试研究了各种半导体材料。其中石墨相氮化碳(g-C_(3)N_(4))是近年来公认的“明星”材料之一。因其独特的二维层状结构和良好的可见光响应而引起了人们的极大兴趣。由于带隙较窄(~2.7 eV)、能带结构可调以及良好的物理化学稳定性,g-C_(3)N_(4)对太阳光谱的吸收可达450 nm,具有一定的可见光光催化性能。然而,g-C_(3)N_(4)在去除抗生素和染料方面的降解效率仍然存在不足,例如光生电荷的快速复合以及空穴的氧化能力弱等。为了优化这种有前景的光催化材料,人们尝试了多种方法来改善g-C_(3)N_(4)的电子能带结构,例如金属/非金属元素掺杂、形貌调控和官能团修饰等。最近,人们提出了由两种N型半导体光催化剂组成的梯形异质结理念,它可以利用半导体材料更正的价带和更负的导带。相关结果表明,构筑梯形异质结是提高g-C_(3)N_(4)光催化活性的最有效方法之一。因此,本文通过简单的原位溶剂热生长法制备了新型0D/2D Bi_(4)V_(2)O_(11)/g-C_(3)N_(4)梯形异质结光催化剂。Bi_(4)V_(2)O_(11)/g-C_(3)N_(4)复合材料对去除土霉素(OTC)和活性红染料展示出了优异的光催化活性。尤其是BVCN-50复合材料对OTC和活性红的降解效率高达74.1%和84.2%,该过程的主要活性物种为∙O_(2)^(−)。大幅增强的光催化性能归因于Bi_(4)V_(2)O_(11)和g-C_(3)N_(4)之间形成的梯形异质结保持了光催化体系的强氧化还原能力(Bi_(4)V_(2)O_(11)的强氧化能力和g-C_(3)N_(4)的强还原能力),并促进了光生电荷的空间分离。此外,金属Bi0的表面等离子共振效应可以拓宽异质结系统的光吸收范围。此外,基于高效液相色谱-质谱联用(LC-MS)分析,我们研究了OTC降解过程中可能的中间体和降解路径。这项工作为设计和制备g-C_(3)N_(4)基梯形异质结用于抗生素和活性染料降解提供了一种新的策略。

羊膜移植联合冷冻术与板层角膜移植术治疗蚕食性角膜溃疡的近中期疗效比较

目的分析羊膜移植联合冷冻术与板层角膜移植术治疗蚕食性角膜溃疡的近中期效果。方法选取2017年12月—2019年12月郴州市第一人民医院收治的88例蚕食性角膜溃疡患者为研究对象,根据随机数字表法分为A组和B组,每组44例。A组采用羊膜移植联合冷冻术,B组采用板层角膜移植术。比较两组患者的临床疗效、术后视力、术后恢复情况、疼痛感、并发症、近中期预后。结果两组治疗总有效率比较,差异有统计学意义(P<0.05),B组治疗总有效率比A组高。A组与B组术后1个月、术后6个月、术后12个月视力比较,采用重复测量设计的方差分析,结果:①不同时间点的视力有差异(P<0.05);②A组与B组视力有差异(P<0.05),A组与B组术后视力相比术前视力好,相对恢复效果好;③A组与B组视力变化趋势有差异(P<0.05)。A组角膜上皮愈合时间为(13.26±2.47)d,B组角膜上皮愈合时间为(10.05±1.45)d,B组角膜上皮愈合时间比A组短(P<0.05)。A组羊膜溶解脱落时间为(8.78±1.03)d。两组角膜/角膜植片透明度分级、溃疡愈合率比较,差异有统计学意义(P<0.05),B组角膜植片透明度分级轻于A组,溃疡愈合率高于A组。两组可见角膜新生血管率比较,差异无统计学意义(P>0.05)。A组与B组术后3 d、术后1个月、术后6个月VAS评分比较,采用重复测量设计的方差分析,结果:①不同时间点的VAS评分有差异(P<0.05);②A组与B组VAS评分有差异(P<0.05),A组与B组视力相比术前VAS评分比较低,缓解疼痛效果较好;③A组与B组视力变化趋势有差异(P<0.05)。两组治疗并发症发生率、术后1年及3年原病复发率比较,差异有统计学意义(P<0.05),B组并发症发生率比A组低,术后1年及3年原病复发率比A组高。结论板层角膜移植术治疗蚕食性角膜溃疡更利于提高疗效、促进术后溃疡愈合、提高视力、缓解患者疼痛、降低并发症发生率,但羊膜移植联合冷冻术近中期复发率更低。

加替沙星和左氧氟沙星对急性细菌性结膜炎有效性与安全性的Meta分析

目的:运用Meta分析系统评价加替沙星滴眼液和左氧氟沙星滴眼液对急性细菌性结膜炎的临床疗效及安全性。方法:按Cochrane系统评价方法,以“加替沙星”“左氧氟沙星”“急性细菌性结膜炎”为关键词,检索Embase、Cochrane library、Pubmed、Medline、中国知网数据库、万方数据库、维普中文科技期刊数据库、中国生物医学文献数据库,从建库开始时间检索至2021-03-01。纳入比较加替沙星滴眼液和左氧氟沙星滴眼液治疗急性细菌性结膜炎的随机对照研究。采用Cochrane偏倚风险评估工具对纳入研究进行质量评价,使用RevMan5.3统计软件进行Meta分析,运用Stata12中Egger检验分析发表性偏倚,并按照GRADE系统评估证据水平。结果:共纳入10项随机对照研究,合计1149例患者。对照组采用左氧氟沙星滴眼液治疗,试验组采用加替沙星滴眼液滴眼液治疗。Meta分析结果表明加替沙星滴眼液组对于急性细菌性结膜炎临床有效率优于左氧氟沙星滴眼液组(OR=3.75,95%CI:2.52~5.58,P<0.00001),Egger检验提示存在发表偏倚,且GRADE评价结果显示该证据水平为“很低”;加替沙星滴眼液组药物不良反应发生率低于左氧氟沙星滴眼液组(OR=0.37,95%CI:0.19~0.71,P=0.003);Egger检验提示不存在发表偏倚,且根据GRADE方法评价,该证据水平为“低”。结论:加替沙星滴眼液对于急性细菌性结膜炎的疗效优于左氧氟沙星滴眼液,且不良反应发生率较低;但由于纳入的研究证据水平较低,需要更多的多中心、随机双盲临床试验,从而提高加替沙星滴眼液治疗急性细菌性结膜炎临床疗效的证据强度。

骨肉瘤的精准外科治疗进展

当前,医学已开始步入精准医学时代,其实质是利用现代遗传技术、分子成像技术和生物信息学技术,并整合患者的生活环境和临床信息,实现疾病的个体化诊断及治疗。目前,骨肉瘤的标准治疗方法是新辅助化疗联合手术治疗,手术治疗仍然是骨肉瘤综合治疗的关键环节之一。在传统手术中,外科医师通常根据术前二维影像资料制定手术方案,并根据临床经验和空间思维进行手术,这很难保证骨肉瘤获得精确的截骨和周围软组织的精确切除,从而影响肿瘤的复发、术后解剖重建和功能恢复。3D打印技术、计算机导航和机器人等新技术的出现,使外科医师能够在术前了解肿瘤及其毗邻解剖关系,可以进行术前模拟手术和术中指导实施手术,从而使骨肉瘤的精准外科治疗得以实现。