人工智能(artificial intelligence，AI)在白内障手术中的应用越来越广泛，二者结合对于白内障手术的术前诊断和分级管理、术中人工晶状体选择、位置预测及术后管理(视力预测、并发症预测及随访)、手术培训和教学方面均起到巨大的促进作用。诚然，AI在与白内障手术相关的管理、分析和研究中还面临着许多问题，但其广泛的应用前景不可忽视。现对AI在白内障手术治疗和教学中的应用做以总结，并对其未来的发展做出展望。
Artificial intelligence (AI) has been widely used in cataract surgery. The combination of the two can play a great role in improving preoperative diagnosis, grading management of cataract surgery, intraoperative intraocular lens selection and location prediction, postoperative management (vision prediction, complication prediction and follow-up), surgical training and teaching. It is true that AI still faces many problems in the management, analysis and research related to cataract surgery, but its broad application prospects cannot be ignored. This review summarizes the application of AI in cataract surgery and teaching, and the future prospects of AI.
目的：建立和验证一个涉及多级临床场景的白内障协作通用的人工智能(artificial intelligence,AI)管理平台，探索基于AI的医疗转诊模式，以提高协作效率和资源覆盖率。方法：训练和验证的数据集来自中国AI医学联盟，涵盖多级医疗机构和采集模式。使用三步策略对数据集进行标记: 1)识别采集模式；2)白内障诊断包括正常晶体眼、白内障眼或白内障术后眼；3)从病因和严重程度检测需转诊的白内障患者。此外，将白内障AI系统与真实世界中的居家自我监测、初级医疗保健机构和专科医院等多级转诊模式相结合。结果：通用AI平台和多级协作模式在三步任务中表现出可靠的诊断性能: 1)识别采集模式的受试者操作特征(receiver operating characteristic curve,ROC)曲线下面积(area under the curve,AUC)为99.28%~99.71%)；2)白内障诊断对正常晶体眼、白内障或术后眼，在散瞳-裂隙灯模式下的AUC分别为99.82%、99.96%和99.93%，其他采集模式的AUC均 > 99%；3)需转诊白内障的检测(在所有测试中AUC >91%)。在真实世界的三级转诊模式中，该系统建议30.3%的人转诊，与传统模式相比，眼科医生与人群服务比率大幅提高了10.2倍。结论：通用AI平台和多级协作模式显示了准确的白内障诊断性能和有效的白内障转诊服务。建议AI的医疗转诊模式扩展应用到其他常见疾病和资源密集型情景当中。
Objective: To establish and validate a universal artificial intelligence (AI) platform for collaborative management of cataracts involving multilevel clinical scenarios and explored an AI-based medical referral pattern to improve collaborative efficiency and resource coverage. Methods: The training and validation datasets were derived from the Chinese Medical Alliance for Artificial Intelligence, covering multilevel healthcare facilities and capture modes. The datasets were labelled using a three step strategy: (1)capture mode recognition; (2) cataract diagnosis as a normal lens, cataract or a postoperative eye and (3) detection of referable cataracts with respect to aetiology and severity. Moreover, we integrated the cataract AI agent with a real-world multilevel referral pattern involving self-monitoring at home, primary healthcare and specialised hospital services. Results: The universal AI platform and multilevel collaborative pattern showed robust diagnostic performance in three-step tasks: (1) capture mode recognition (area under the curve (AUC) 99.28%–99.71%), (2) cataract diagnosis (normal lens, cataract or postoperative eye with AUCs of 99.82%, 99.96% and 99.93% for mydriatic-slit lamp mode and AUCs >99% for other capture modes) and (3)detection of referable cataracts (AUCs >91% in all tests). In the real-world tertiary referral pattern, the agent suggested 30.3% of people be ’referred’, substantially increasing the ophthalmologist-to-population service ratio by 10.2-fold compared with the traditional pattern. Conclusions: The universal AI platform and multilevel collaborative pattern showed robust diagnostic performance and effective service for cataracts. The context of our AI-based medical referral pattern will be extended to other common disease conditions and resource-intensive situations.
目的：了解八年制医学生对全程导师的教学需求与满意度。方法：将中山大学八年制临床医学生分为低年级、高年级两组，均进行匿名线上问卷调查。分析问卷结果，并比较两组间的不同。结果：回收问卷352份。学生对导师个人“比较满意”占比高(低年级45.56% vs 高年级37.79%，P=0.087)，对全程导师制度“比较满意”占比高(低年级 36.67% vs 高年级33.14%，P=0.806)。对全程导师制度“很了解”与“比较了解”的学生在低年级中明显低于高年级的占比(16.67% vs77.91%，P<0.001)。低年级学生期待全程导师在职业规划、临床思维、科研思维、心理健康发挥较大影响的占比均高于高年级的实际评估(构成比4个方面均P<0.001，选择“有很大影响”及“比较有影响”在低、高年级占比分别为83.33% vs 36.63%，92.22% vs 29.07%，91.67% vs 31.39%，62.78% vs 38.37%)。结论：学生对全程导师个人及制度均较满意，但存在低年级对该制度了解少、师生联系少、导师实际作用低于学生预期、科研训练机会不足等问题。亟需完善全程导师制，推动临床医学高水平人才的培养。
Objective: To evaluate the teaching needs and satisfaction of the eight-year program medical students to the whole-course tutors. Methods: An anonymous online questionnaire survey was conducted among the eight-year program medical students at Sun Yat-sen University. All students were divided the junior group and the senior group, and the differences between the two groups were compared. Results: A total of 352 valid questionnaires were collected. The proportion of students who were fairly satisfied with their whole-course tutors was 45.56% in the junior group and 37.79% in the senior group (P=0.087). The proportion of students who were fairly satisfied with the whole-course tutorial system was 36.67% in the junior group and 33.14% in the senior group (P=0.806). The proportion of students who “know well” and “know fairly well” about the whole-course tutorial system in the junior group was significantly lower than that in the senior group (16.67% vs 77.91%, P<0.001). The proportion of students in the junior group expecting their whole-course tutors “having a great impact” or “having some impact” on career planning, clinical thinking, scientific research thinking and mental health was significantly higher than that in the senior group (tests for proportions, all P<0.001, 83.33% vs 36.63%, 92.22% vs 29.07%, 91.67% vs 31.39%, 62.78% vs 38.37%). Conclusion: The eight-year program medical students are satisfied with their whole-course tutors and the whole-course tutorial system. However, some problems still exist, such as lower grade students lack of understanding of the whole-course tutorial system, insufficient contact between tutors and students, the actual influences of tutors failing to meet the students’ expectation, and insufficient opportunity of scientific research and training. It is urgent to improve the whole-course tutorial system and promote the cultivation of qualified medical talents.
八年制医学教育的目的是培养适合我国国情的高素质医学人才。本文回顾了我国八年制医学教育的产生与发展；介绍了八年制医学教育改革中各个方面积极的探索，包括教师改革、教学理念改革、教学方法改革、教学手段变化和特色课程设置等；总结了我国目前八年制医学教育的现状；并探讨了进一步完善这一教育体系，提高八年制医学生素质的策略与方案。
The purpose of the eight-year medical education is to train students for well-qualified medical talents that are in line with our national conditions. This article introduces the establishment and development of the eight-year medical education in China, and various aspects of exploration in its reform which includes the reform of the tutoring system, teaching philosophy, teaching approach, means of teaching, special courses and so on. It also summarizes the current situation of the eight-year medical education and discusses potential strategies to improve the education system and the quality of eight-year medical students.
内源性干细胞在组织的损伤修复过程中组织相容性好、致瘤风险低，相较于外源性干细胞具有不需要体外扩增和培养、疾病传播风险低的优点，在细胞治疗领域具有显著优势。现在已经有多种使用内源性干细胞进行疾病治疗的成熟方式，应用领域包括了全身各种器质性和功能性疾病。在眼组织中，晶状体具有终生生长的能力且便于观察，是实现再生修复的突破点。哺乳动物中晶状体再生的实现有赖于晶状体内源性干细胞的定位和改良手术方式，以保留晶状体干细胞，并创造适合晶状体再生的微环境。对再生后的晶状体蛋白质组成分析，发现其类似成熟晶状体，而非胚胎期的晶状体，提示晶状体再生的调控与胚胎期的诱导发生并不相同；而调控晶状体再生的策略不仅着眼于干细胞的激活和正确分化的诱导，对其上皮间质转化过程也需要进行调控。在未来，为将晶状体再生的经验应用于其他眼组织中，动员内源性干细胞并促进其生长，可以添加细胞有效成分，比如外泌体、线粒体、小分子化合物等，模拟细胞应激；此外，还可以通过手术或生物材料辅助，恢复晶状体结构和环境。
Endogenous stem cells have significant advantages in cell therapy for excellent histocompatibility, low tumorigenicity risk, unnecessity for in vitro expansion and culture, and low disease transmission risk. There have been some applications for endogenous stem cells in treating diseases, targeting some organic and functional diseases throughout the body. In ocular tissue, the lens is a breakthrough for regenerative therapy due to its potential to grow throughout life and observation accessibility. Achieving lens regeneration in adult mammals attributes to some prerequisites. Firstly, the location of endogenous stem cells in the lens has been identified. Then, surgical approaches have been advanced to preserve lens stem cells and create a microenvironment suitable for lens regeneration. Protein compositional analysis of the regenerated lens reveals that it is similar to a mature lens rather than an embryonic lens, suggesting that the regulation of lens regeneration is not the same as the induction of embryonic onset. The strategy for regulating lens regeneration needs to focus not only on the activation and proper differentiation of stem cells but also on regulating the process of epithelial mesenchymal transition (EMT). In the future, in order to apply the experiences of lens regeneration to other ocular tissues, to mobilize endogenous cells and promote their growth, some strategies could be used. These strategies include mimicking cellular stress via the addition of cellular active ingredients, such as exosome, mitochondria, and small molecular compounds. Additionally, we can also try to restore lens tissue structure and microenvironment through surgical or biomaterial assistance.
目的：分析医学人工智能通识课程“眼科人工智能的研发与应用”的开展效果，为相关医学人工智能通识课程的开展提供参考和借鉴。方法：纵向观察性研究。观察分析2020年秋季学期眼科人工智能的研发与应用通识课程学生人群，课程考核结果以及学生对课程的整体评价。结果：共有118名本科生同学参与了课程学习。其中大部分为低年级临床医学专业本科生。期中考核得分为77.21±10.07，有56位同学(47.46%)达到80分以上。期末考核得分为82.24±6.77，有91位同学(77.12%)达到80分以上。同学对课程的评分为98.76±3.55，超过90%的同学表示课程备课认真、授课条理清晰、表达准确。结论：本课程的顺利进展证明医学人工智能联合教学模式的可行性，理论和实践穿插的教学设置帮助同学们更好地掌握知识技术，完成教学目标。
Objective: To analyze the effectiveness of medical education curriculum named “Development and Application of Ophthalmic Artificial Intelligence”, and provide reference for the development of other related curriculums. Methods: Longitudinal observational study method was adopted. During the fall semester of 2020, we conducted an education curriculum named “Development and Application of Ophthalmic Artificial Intelligence” and analyzed the results of mid-term and final examinations, and curriculum evaluation of students. Results: There were 118 undergraduate students taking the course and most of them were junior students majoring in clinical medicine. The score of the mid-term examination was in the range of 77.2±10.07, and 56 students (47.46%) got more than 80 points. The score of the final examination was in the range of 82.24±6.77, and 91 students (77.12%) got more than 80 points. The score of course evaluation of students was in the range of 98.76±3.55, and more than 90% of the students thought that teachers have made full preparations before class, together with clear teaching logic and accurate expressions in class. Conclusion: The smooth progress of our course proved the feasibility of medical artificial intelligence teaching. The teaching setting interspersed with theory and practice could help students to master knowledge and technology better, so as to achieve the teaching objectives.
目的：了解思政元素融入临床医学八年制眼科学整合课程的学生满意度与教学效果。方法：对中山大学临床医学八年制的五年级医学生进行匿名纸质版问卷调查，评估学生对思政教育的满意度与教育效果。对问卷结果进行描述性统计分析，计数资料以频率与百分比的形式表示。结果：共回收有效问卷90份，91%的学生认同在课程中融入思政元素，93%的学生认为思政与课程的融合度为好或者非常好，82%的学生认为思政课程对激发眼科学兴趣有帮助。思政题目的总体正确率高达92.9%，正确率从高到低依次为：医患沟通(100%)、眼科历史(98.9%)、政策要点(83.3%)、研究前沿(82.2%)。结论：临床医学八年制学生对眼科学整合课程的思政元素融合的满意度高。思政教育获得良好效果，学生对思政知识的掌握度高。后续课程在保持学生对医患沟通以及学科历史兴趣的同时，还应加强对于研究前沿和政策要点的教育。
Objective: To investigate the student satisfaction and educational effect of integrating ideological and political elements into the eight-year clinical medicine ophthalmology integrated curriculum. Methods: An anonymous paper questionnaire survey was administered to fifth-grade clinical medicine students ofthe eight-year clinical medicine program of Sun Yat-sen University to assess students’ satisfaction with ideological and political education as well as the educational effectiveness. Descriptive statistical analysis was performed on thequestionnaire results, and the qualitative data were represented by frequency and percentage. Results: Ninety valid surveys were collected. 91% of the students agreed with the incorporation of ideological and political elements into the curriculum, 93% of the students thought the incorporation of ideological and political elements into the curriculum was good or very good, and 82% of the students believed that the ideological and political curricula helped arouse their interest in ophthalmology. The overall correct rate for ideological and political questions reached 92.9%, with the following correct rates from most accurate to least accurate: doctor-patient communication (100%), history of ophthalmology (98.9%), policy (83.3%), and research frontier (82.2%). Conclusion: Eight-year clinical medicine students are highly satisfied with the integration of intellectual and political components into the ophthalmology integration curriculum. Ideological and political education has yielded favorable results, with students demonstrating a thorough grasp of ideological and political facts. Future curricula should expand students’ awareness of research frontiers and policy issues while maintaining their interest in doctor-patient communication and the history of ophthalmology.
