在新的时代背景下,以"立德树人"为目标的课程思政作为一种新的教育理念已经成为加强高校人才培养和思想政治教育的重要手段.八年制医学教育在培养拔尖创新医学人才方面,承担着重要的历史使命和责任,也对其思政教学提出了更高、更新的要求.医学免疫学作为中医学专业的一门重要专业基础课,教学内容中蕴含丰富的课程思政元素.而中医学根植于中国古代文化土壤之中,具有浓厚的文化底蕴和丰富的德育资源.在中医八年制医学免疫学课程中深入挖掘具有中医药优秀文化特色的思政元素,找准理论知识与思政元素的"连接点",巧妙融入思想政治教育,从多角度探索实施免疫学课程思政的有效路径.通过调查问卷形式评价课程思政教学效果并进行分析,为今后进一步优化做准备,以期为国家培养厚德精术、启古纳今的复合型卓越中医学人才奠定坚实基础.

Objective:To evaluate the safety and efficacy of modified percutaneous transhepatic portal vein islet cell transplantation.Methods:Clinical data of 46 patients undergoing percutaneous transhepatic portal vein islet cell transplantation in Shanghai Changzheng Hospital Affiliated to Naval Medical University from December 2016 to June 2020 were retrospectively analyzed. Among them, 34 patients were male and 12 female, aged from 13 to 74 years, with a median age of 49 years. The informed consents of all patients were obtained and the local ethical committee approval was received. According to different surgical methods, all patients were divided into the conventional intervention group (conventional group, n=25) and modified intervention group (modified group, n=27). In the conventional group, infusion of islet cells was performed with F single-curved arteriographic catheter under real-time pressure monitoring, and the puncture channel was blocked up with steel ring and gelfoam particles. In the modified group, PTCD catheter infusion with manually-cutted inner core was performed under intermittent pressure monitoring, and the puncture channel was blocked up with gelfoam particles. The operation time and portal pressure between two groups were compared by using t test and the rate comparison was analyzed by Chi-square test.Results:46 patients successfully completed 52 times of islet cell transplantation, with a success rate of 100%. Among them, 2 recipients received twice transplantation in the conventional group and 4 in the modified group. The operation time in the conventional and modified group was (124±14) and (110±17) min, respectively, where no significant difference was observed (t=1.35,P>0.05). In the conventional group, the portal vein pressure before and after transplantation were (13±4) and (12±3) mmHg (1 mmHg=0.133 kPa), and (16±3) and (14±5) mmHg in the modified group, where no significant difference was observed between portal vein pressures before and after operation (t=0.34, 0.87;P>0.05). 1 case developed postoperative thoracic hemorrhage in the conventional group and 1 case of intrahepatic hematoma in the modified group, and both were healed after conservative treatments. The incidence of bleeding was 4%(1/25) and 4%(1/27) respectively in the conventional and modified groups, with no significant difference (χ2=0.45,P>0.05). The insulin-free rate in the recipients undergoing initial islet cell transplantation within 6 months was 60%(15/25) and 66%(18/27) respectively in the conventional and modified groups, with no significant difference (χ2=5.32,P>0.05). In the conventional and modified groups, the fasting C-peptide increment was (0.22±0.07) and (0.19±0.06) nmol/L, respectively, and the 2 h postprandial C-peptide increment was (0.67±0.20) and (0.53±0.17) nmol/L, respectively, with no significant differences (t=1.362, 1.722;P>0.05).Conclusions:Compared with the conventional surgery, the modified percutaneous transhepatic portal vein islet cell transplantation is equally safe and efficacious, which possess multiples advantages of less use of intrahepatic steel ring and no artifacts in the postoperative imaging examination.

目的 探讨过继性回输调节性T细胞(Treg)对同种胰岛移植术后胰岛功能恢复及移植物存活时间的影响.方法 以C57BL/6小鼠为受体建立糖尿病模型,以Balb/c小鼠为供体进行肾包膜下同种小鼠胰岛移植.根据处理方法不同将受体小鼠分为3组:Treg实验组(Treg组,术前1 d经尾静脉注射1×106个Treg细胞)、阳性对照组[西罗莫司(SRL)组,术前1 d开始给予300μg/(kg·d)SRL灌胃]和空白对照组(对照组,术前1 d开始每日给予等体积生理盐水灌胃),每组3只.采用酶联免疫吸附试验(ELISA)检测小鼠术后14 d内血糖、C肽变化情况;通过活体成像技术动态监测小鼠移植物术后14 d内存活情况.结果 与移植术前比较,术后3 d各组小鼠血糖水平均显著降低(均为P<0.001).术后1 d各组小鼠C肽水平均出现不同程度的爆发性回升,术后3 d各组小鼠C肽水平较术前明显升高(均为P<0.001).在术后14 d观察期结束时,与对照组比较,SRL组与Treg组C肽水平仍相对较高[(427±50)、(833±57)pmol/L];而两组的血糖水平[(14.5±0.5)、12.1±0.6)mmol/L]均显著低于对照组(均为P<0.001).与SRL组比较,Treg组C肽爆发性释放量更低,下降趋势明显更加平缓,观察期结束时C肽水平较高(均为P<0.001).术后14 d对照组的移植物几乎完全凋亡,SRL组有>50％ 的移植物存活,Treg组有>80％ 的移植物存活.结论 过继性回输Treg能有效保护胰岛移植物,延长移植物存活时间,维持移植小鼠血糖以及C肽的正常水平.

目的 研究同种异体胰岛移植治疗1型糖尿病与肾移植后糖尿病的临床效果.方法 对27位(其中5位行二次移植术)1型糖尿病患者或糖尿病肾病肾移植后患者施行同种异体胰岛移植.胰腺供体来自于公民死亡捐献,经消化、纯化后获得纯度≥50％、活力≥80％的胰岛,重悬于CMRL1066液体后,采用经皮肝门静脉穿刺,将胰岛悬液重力输注与肝内.术前采用巴利昔单抗诱导,术后采用口服他克莫司+吗替麦考酚酯诱导免疫耐受.定期检测移植受者血糖、C肽和糖化血红蛋白水平等指标.结果 移植后平均随访7.6个月.随访期内,其中16例完全停用胰岛素,9例胰岛素用量减少50％～90％,2例效果不明显,术后C肽无显著增加.25例有效移植受者空腹血糖从移植前的(8.8±13.7)mmol/L降至(5.1±4.3)mmol/L,控制更加平稳;糖化血红蛋白A1从(7.63±4.53)％降至(5.30±1.43)％.平均C肽增量为1.34nmol/L.常见并发症为术后短暂的恶心、呕吐和转氨酶上升,无严重并发症发生.结论 经肝门静脉胰岛移植是治疗1型糖尿病与肾移植后糖尿病的有效手段,短期临床疗效较好,远期疗效尚需进一步观察.

目前中国的糖尿病病人数量已居世界第一.根据2017年的流行病学数据[1],中国成人糖尿病患病率达10.9％,约1.2亿人,而糖尿病前期的人群达到35.7％.糖尿病病人由于胰岛β细胞大量破坏,导致胰岛素分泌严重缺乏,引起1型糖尿病,或由于胰岛素抵抗和β细胞分泌缺陷,引起2型糖尿病,最终均会引起糖代谢紊乱,导致血管病变、神经损伤等一系列并发症.严重者肢体坏死、失明、肾功能衰竭等,甚至危及生命[1-4].虽然采用胰岛素强化治疗方案或使用胰岛素泵,在一定程度上有助于稳定血糖,但对于部分中、晚期糖尿病病人,特别是已发展到脆性糖尿病阶段的病人,这些干预手段效果有限,不能有效阻止并发症的发生、发展[2,5-6].寻找新的治疗手段是当前糖尿病治疗的前沿课题.

Super enhancers (SEs) are composed by consecutive regulatory elemcnts in series,which is actually an extraordinary long cluster of transcriptional enhancers.SEs manipulate the expressions of relevant genes,and hundreds of SEs control the cellular destiny by regulating key genes.Recent studies showed that the expression of pathogenic genes were highly related to the aberrant activation of SEs,in malignancies,Alzheimer's disease,diabetes and many autoimmune diseases.In this paper,we reviewed the discovery of SEs,the method to identify SEs,and databases related to SEs.We also summarizd the recent progress of SEs involving in embryonic stem cells,malignancies tumor and immune-related diseases,as well as the potential application in gynecological diseases.

Objective To evaluate the animal model of traumatic skull base artery injury (TSBAI) established by the high-pressure intraarterial injection method.Methods Fifty New Zealand rabbits were submitted to high-pressure carotid artery injection (experiment group,n =20),tension-free carotid artery injection (sham group,n =20) and simple carotid artery exposure (control group,n =10),according to the random number table.Animal survival was observed.Diameters of carotid artery were measured using the CT angiography (CTA).Pathological changes of the involved carotid artery were monitored under microscope.Results There were three deaths in experiment group,with the success rate of modeling of 85％.There were two deaths in sham group.All animals in control group survived.Diameter of right carotid artery at postoperative one week was (1.62 ±0.10)mm in experiment group,reduced compared to (2.25 ± 0.08) mm in sham group and (2.43 ± 0.15) mm in control group (P ＜0.05).For experiment group,intimal tear,loss of normal continuity,and local platelet thrombus formation attaching to the vascular intimal tear were observed in the injured right carotid artery,medial elastic fibers showed structural disorder complicated with discontinuous fibers,and deposition of red blood cells,lymphocytes and macrophages were observed.Conclusions High-pressure intraarterial injection for induction of the TSBAI model is associated with maneuverable operation,low risk,few complications and morphological results conforming to the actual damage.The model can survive for a long time that is suitable for investigating the pathological and physiological mechanism of traumatic skull base artery fullthickness injury and the legacy effect.