Objective:To investigate the effects of different levels of ophthalmic surgical stimulation on blood glucose in patients with type 2 diabetes mellitus(T2DM).Methods:From Mar to Oct 2021,236 patients with T2DM who underwent ophthalmic surgery in our hospital were enrolled,including 71 cases of secondary surgery,89 cases of tertiary surgery,and 76 cases of quaternary surgery.According to the operation time,the 236 patients were divided into groups A(＜60 min),B(60-120 min)and C(＞120 min).The preoperative and postoperative blood glucose levels were compared in patients with different levels of surgery,and in groups A,B and C.Results:The postoperative blood glucose level was lower than that before surgery in secondary and tertiary surgery,and it was higher than that before surgery in quaternary surgery(P＜0.05).The fluctuation value of blood glucose in secondary and tertiary surgery was higher than that in quaternary surgery(P＜0.05).In groups A,B and C,the postoperative blood glucose level was lower than that before surgery in secondary and tertiary surgery(P＜0.05).In group A,there was no significant difference in the blood glucose before and after surgery in quaternary surgery(P＞0.05),and in groups B and C,the postoperative blood glucose was higher than that before surgery in quaternary surgery(P＜0.05).In group A,there was no difference in the fluctuation value of blood glucose at different levels of surgery(P＞0.05).In group B,the fluctuation value of blood glucose in patients with secondary and tertiary surgery was higher than that in quaternary surgery(P＜0.05).In group C,the fluctuation value of blood glucose in patients with tertiary and quaternary surgery was higher than that in patients with secondary surgery(P＜0.05).Conclusions:For ophthalmic surgery patients with T2DM,the postoperative blood glucose values of patients undergoing secondary and tertiary surgery generally show a downward trend,while the postoperative blood glucose value of patients undergoing quaternary surgery generally shows an upward trend.It is suggested that clinical workers should actively manage the perioperative blood glucose of patients with high-level surgery.

Objective To observe the correlations of conventional ultrasound and contrast-enhanced ultrasound(CEUS)features with expression level of Ki-67 of intrahepatic cholangiocarcinoma(ICC).Methods A total of 77 patients with pathologically confirmed ICC were retrospectively enrolled.According to the expression level of Ki-67 of target lesions,the patients were divided into high expression group(Ki-67≥20%,n=53)and low expression group(Ki-67＜20%,n=24).The features showed on conventional ultrasound and CEUS were compared between groups,and the variables being significantly different were analyzed with multivariate logistic regression to select ultrasonic features being correlated with Ki-67 expression level of ICC.Results The mean maximum diameter of ICC in high expression group was larger than that in low expression group([6.2±2.0]cm vs.[5.2±1.9]cm,P=0.041),and the percentage of ICC with maximum diameter>5 cm in high expression group was higher than that in low expression group(66.04%vs.33.33%,P=0.007).No significant difference of the lesions shape,border nor the internal echogenicity showed on conventional ultrasound was found between groups(all P＞0.05).The percentage of ICC with peripheral rim enhancement and enlargement after enhancement in high expression group were both higher than those in low expression group(both P＜0.05),but no significant difference of the enhancement pattern,the presence or absence of non-enhance area within the lesion nor the peak intensity of lesions was found between groups(all P＞0.05).The maximum diameter larger than 5 cm(OR=5.612,P=0.004)and peripheral rim enhancement(OR=3.880,P=0.025)were both independent factors for predicting high Ki-67 expression level of ICC.Conclusion ICC with the maximum diameter larger than 5 cm and peripheral rim enhancement on CEUS might indicate high expression level of Ki-67,which was helpful for clinical treatment decisions.

The pathogenesis of ankylosing spondylitis （AS） is usually insidious and has not been fully elucidated. Non-steroidal anti-inflammatory drugs （NSAIDs） and anti-rheumatic drugs （ARDs） are usually given to improve the condition. however, some patients still have poor results or adverse reactions from conventional treatments. Biological agents have significantly changed therapeutic strategies in the field of rheumatology since their clinical application was initiated and are gradually becoming the main therapeutic option for patients with AS. The current research progress on biologics in the treatment of AS in terms of the current treatment status, clinical problems, and solution strategies were reviewed, which could provide theoretical basis and reference with clinical value, and promote the precise treatment of AS in the future.

Direct acid hydrolysis of Dioscorea zingiberensis rhizomes for preparation of diosgenin is wildly used in the traditional industry， which uses a large amount of inorganic acid catalysts， with high wastewater discharge and serious environmental pollution. Therefore， exploring clean and efficient preparation methods and processes has become an inevitable choice to realize the sustainable development of industrial production of diosgenin. Herein， the author reviewed and analyzed the research progress and problems of enzymatic hydrolysis， microbial transformation and modified acid hydrolysis in the preparation of diosgenin from D. zingiberensis rhizomes during the last ten years， and their application prospects are analyzed. Enzymatic hydrolysis has mild reaction conditions， but the yield of diosgenin is low， the economic cost is high， and the purification process of active enzyme is complicated. Microorganism shows specific activity to the substrate and high efficiency for diosgenin production， and microbial transformation is clean and environmentally friendly， but microbial transformation is time-consuming and the metabolic intermediates are complicated. For the modified acid hydrolysis， two-phase acid hydrolysis can reduce the amount of acid catalyst， and sulfonic acid-functionalized ionic liquid displays good recyclable performance by replacing the traditional inorganic acid， however， the wastewater discharge should still be considered. Solid acid catalysts are non-corrosive and easy to be recycled， but the need to use ethanol as the reaction solvent has certain safety hazards， and the catalyst preparation process is cumbersome. In conclusion， exploring clean and efficient conversion methods is an important research trend for preparation of diosgenin from D. zingiberensis rhizomes. For the enzymatic hydrolysis， the key glycoside hydrolases in the bioconversion process should be explored in depth， the conversion pathway of enzymatic saponins and enzyme specificity should be fully elucidated， and efforts should be made to improve the efficiency of enzymatic hydrolysis. For the microbial transformation， we should accelerate its industrial application process based on selecting and breeding efficient transformation strains， and optimizing stable transformation systems and processes， and in-depth investigation of the mechanism of microbial transformation， fully elucidating the specific key hydrolases and its catalytic properties， and striving to improve the efficiency of microbial transformation. For the modified acid hydrolysis， novel acid catalytic system with simple structure， stable performance and good biodegradability should be explored and applied， which can effectively solve the problems of environmental pollution and production safety.