Refractory prolactinoma is the most common pituitary neuroendocrine tumor.Dopamine receptor agonists(DA)are the primary choice for drug treatment.Most patients with prolactinomas respond well to DA.However,a minority of prolactinomas patients still show resistance to DA.Although drug-resistant and refractory prolactinomas are rare in clinical practice,their treatment is extremely challenging.Even a combination of drug therapy,multiple surgeries,and radiotherapy may not yield satisfactory outcomes.Therefore,standardizing the diagnosis and treatment process and pathway for refractory prolactionmas and exploring more effective multidisciplinary collaborative treatment strategies are urgent problems to be solved.In the clinical management of refractory prolactinomas,it is often necessary to consider the patient's condition comprehensively,replace other types of DA,or consider surgery,radiotherapy,and immunotherapy,which requires multidisciplinary diagnosis and treatment.This review synthesizes the latest literature at home and abroad to systematically discuss the latest advances in drug therapy,surgery,and radiotherapy treatments for refractory prolactionmas,aiming to provide new ideas for basic research,clinical diagnosis and treatment.

Optical coherence tomography angiography(OCTA)is a non-invasive imaging technique that provides three-dimensional,informative vascular images.Numerous studies have shown that OCTA technology has unique advantages in biomarker quantification,diagnosis and monitoring,and has therefore been rapidly applied in experiments and clinical stud-ies.Image analysis tools can quickly and accurately quantify vascular and pathological features,greatly improving the value of OCTA imaging.In recent years,artificial intelligence(AI)has become the most powerful image analysis method,espe-cially deep learning-based image analysis,which can provide accurate measurements in various situations,including differ-ent diseases and eye regions.The Ophthalmic Imaging and Intelligent Medicine Branch of Chinese Medicine Education Asso-ciation and the Ophthalmology Committee of International Association of Translational Medicine designated experts to sum-marize the application of AI in OCTA image analysis and disease diagnosis at home and abroad,including accurate detection of choroidal neovascularization and other lesions,accurate quantification of retinal perfusion,and reliable disease diagno-sis.They also analyzed the current challenges and development directions.After multiple rounds of discussion and revi-sions,they drafted the guidelines for the application of AI in OCTA image analysis and ocular disease diagnosis,aiming to provide new insights and references for clinical practice.

The accuracy of ultrasound examination and measurement is of great significance to diagnosing ocular disea-ses.The commonly used ocular ultrasonography includes amplitude(A)-mode ultrasound,brightness(B)-mode ultra-sound,ultrasound biomicroscopy(UBM),and color Doppler flow imaging(CDFI).A-mode ultrasound is mainly used to measure the distance between tissues with different echo intensities.B-mode ultrasound can visualize the two-dimensional structure of the eye and make quantitative measurements of the target point.UBM is an ultra-high-frequency two-dimen-sional imaging method,which can clearly display the structural characteristics of the anterior segment and measure the rele-vant parameters.It can also help quantitatively analyze the morphological changes of the angle and the anterior segment be-fore and after implantable collamer lens surgery.CDFI can quantitatively measure the parameters of blood vessels by apply-ing the Doppler effect on the basis of two-dimensional ultrasound,reflecting the changes of blood flow in the eye.To standardize the operations of different ultrasound examination methods,this guideline is formulated.This guideline mainly focuses on the standardized operation of ocular ultrasound instruments and their clinical application in ocular diseases,so as to provide guidance for the diagnosis and treatment of related ocular diseases.

Senile macular degeneration(SMD)is a complex,highly heritable,and multifactorial disease that leads to the aging-related change in the macular region,characterized by progressive retinal degeneration and progressive loss of vi-sion.About 200 million people worldwide suffer from SMD,and the incidence is increasing as the population ages.Artifi-cial intelligence(AI)technology has developed rapidly in recent years,and its application in the medical field has brought new possibilities for the development of the medical industry.AI-based qualitative and quantitative evaluation of retinal fluid can not only facilitate the diagnosis of neovascular SMD but also help adjust the treatment plan timely according to the effect,so as to provide more targeted treatment for patients.This guide summarizes the application of AI in the treatment of SMD,including the application progress,clinical application and future development of AI in retinal fluid monitoring,to pro-vide sufficient support for ophthalmologists to evaluate patient's conditions,design treatment plans and estimate prognosis.

Objective To develop an expert consensus on subcutaneous injection nursing for allergic asthma in children,standardize nursing practice to reduce the occurrence of related adverse reactions.Methods The clinical guideline,expert consensus,systematic review,evidence summary and original research on subcutaneous injection of monoclonal antibody drug for children with allergic asthma were comprehensively searched in domestic and foreign databases.The time limit for retrieval was from the establishment of databases until August 2023.Combined with clinical practice experience,the first draft of the consensus was formed.From December 2023 to February 2024,27 experts were invited to conduct 2 rounds of expert letter consultation,revise and improve the contents of the first draft,and expert demonstration was conducted,and finally a consensus final draft was formed.Results The effective recovery rate of the 2 rounds of letter consultation questionnaires was 100％;the authority coefficient of experts was 0.88;the judging basis coefficient was 0.93;the familiarity coefficient was 0.83.In the 2 rounds of correspondence,the Kendall concordant coefficients of expert opinions were 0.241 and 0.252,respectively(P＜0.001 for both).The consensus includes 6 parts,including personnel management,environmental layout,indications and contraindications,subcutaneous injection operation norms,identification and treatment of adverse reactions,and health education.Conclusion The consensus is strongly scientific and practical,and can provide guidance for nursing practice of subcutaneous injection of monoclonal antibodies in children with allergic asthma.

Humans ; Diabetes Mellitus, Type 2/therapy* ; Self Care ; Renal Insufficiency, Chronic/complications*

The lungs are one of the most common extra-articular organs involved in rheumatoid arthritis (RA), which is reported to occur in up to 60% to 80% of RA patients. Respiratory complications are the second leading cause of death due to RA. Although there is a wide spectrum of RA-associated respiratory diseases, interstitial lung disease is the most common manifestation and it impacts the prognosis of RA. There has been progress in understanding the management and progression of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) and RA-associated respiratory diseases recently, for example, opportunistic pulmonary infectious diseases and toxicity from RA therapies. From a chest physicians' perspective, we will update the diagnosis and treatment of RA-associated ILD, methotrexate-associated lung disease, and the complication of Pneumocystis jiroveci pneumonia in RA in this review.
Humans ; Arthritis, Rheumatoid/complications* ; Methotrexate/therapeutic use* ; Lung Diseases, Interstitial/complications* ; Prognosis ; Lung

Background: To compare risk of diabetic retinopathy (DR) between patients taking sodium-glucose cotransporter-2 inhibitors (SGLT2is) and those taking glucagon-like peptide-1 receptor agonists (GLP1-RAs) in routine care. Methods: This retrospective cohort study emulating a target trial included patient data from the multi-institutional Chang Gung Research Database in Taiwan. Totally, 33,021 patients with type 2 diabetes mellitus using SGLT2is and GLP1-RAs between 2016 and 2019 were identified. 3,249 patients were excluded due to missing demographics, age <40 years, prior use of any study drug, a diagnosis of retinal disorders, a history of receiving vitreoretinal procedure, no baseline glycosylated hemoglobin, or no follow-up data. Baseline characteristics were balanced using inverse probability of treatment weighting with propensity scores. DR diagnoses and vitreoretinal interventions served as the primary outcomes. Occurrence of proliferative DR and DR receiving vitreoretinal interventions were regarded as vision-threatening DR. Results: There were 21,491 SGLT2i and 1,887 GLP1-RA users included for the analysis. Patients receiving SGLT2is and GLP-1 RAs exhibited comparable rate of any DR (subdistribution hazard ratio [SHR], 0.90; 95% confidence interval [CI], 0.79 to 1.03), whereas the rate of proliferative DR (SHR, 0.53; 95% CI, 0.42 to 0.68) was significantly lower in the SGLT2i group. Also, SGLT2i users showed significantly reduced risk of composite surgical outcome (SHR, 0.58; 95% CI, 0.48 to 0.70). Conclusion Compared to those taking GLP1-RAs, patients receiving SGLT2is had a lower risk of proliferative DR and vitreoretinal interventions, although the rate of any DR was comparable between the SGLT2i and GLP1-RA groups. Thus, SGLT2is may be associated with a lower risk of vision-threatening DR but not DR development.

Humans ; Female ; Deep Learning ; Ovarian Neoplasms/genetics* ; Carcinoma, Ovarian Epithelial/genetics* ; Neural Networks, Computer ; RNA