OBJECTIVES:To investigate the protective effect and mechanism of total flavonoids from Citrus paradise cv. Changshan-huyou extracts (TFC) on oxygen-glucose deprivation (OGD) of primary neurons and chronic ischemia-induced cerebral injury in mice.METHODS:Primary hippocampal neurons of 18-day fetal rats were isolated and cultured for 1 week, then treated with 0.25, 0.50 and 1.00 mg/mL TFC. After oxygen-glucose deprivation for 1 h, cells were reperfused for 6 and 24 h, respectively. The cytoskeleton was observed by phalloidin staining. In animal study, 6-week ICR male mice were randomly divided into sham operation group, model group, low-dose (10 mg/kg), medium-dose (25 mg/kg) and high-dose (50 mg/kg) TFC treatment groups, with 20 mice in each group. After 3 weeks, chronic cerebral ischemia was induced by unilateral common carotid artery ligation in all groups except sham operation group. Mice were treated with different concentrations of TFC in the three TFC treatment groups for 4 weeks. Open field test, novel object recognition test and Morris water maze test were used to evaluate anxiety, learning and memory of these mice. Nissl, HE and Golgi stainings were used to detect neuronal degeneration and dendritic spine changes in the cortex and the hippocampus. The expression levels of Rho-associated kinase (ROCK) 2, LIM kinase (LIMK) 1, cofilin and its phosphorylation, as well as the expression of globular actin (G-actin) and filamentous actin (F-actin) protein in hippocampus of mice were detected by Western blotting.RESULTS:Neurons subjected to OGD showed that neurites displayed shortening and breakage; while treatment with TFC reversed OGD-induced neurite injury, especially in the 0.50 mg/mL TFC group. Compared with the sham operation group, the mice in the model group showed a significant decline in anxiety and cognitive ability (P<0.01), whereas treatment with TFC significantly reversed anxiety and cognitive deficits (P<0.05). Improvement in the medium-dose TFC group was the most obvious. Histopathological analysis indicated that the number of Nissl bodies and dendritic spines in hippocampus and cortex were decreased in the model group (all P<0.01). However, after treatment with medium dose of TFC, the number of Nissl bodies and dendritic spines (all P<0.05) was significantly recovered. Compared with the sham operation group, the phosphorylation level of ROCK2 in the brain tissue of the model group was significantly increased (P<0.05), while the phosphorylation levels of LIMK1 and cofilin were significantly decreased (P<0.05), and the relative content ratio of G-actin/F-actin was significantly increased (P<0.05). After administration of TFC, the phosphorylation level of ROCK2 in brain tissue of each group was significantly decreased (P<0.05), while the phosphorylation levels of LIMK1 and cofilin were significantly up-regulated (P<0.05) and the relative content ratio of G-actin/F-actin was significantly decreased (P<0.05).CONCLUSIONS:TFC protects from ischemia-induced cytoskeletal damage, reduces neuronal dendritic spine injury and protects mice against chronic cerebral ischemia through RhoA-ROCK2 signaling pathway, indicating that TFC might be a potential candidate for treatment of chronic ischemic cerebral injury.

基于政策文件指引、社会需求导向,坚持面向基层培养高素质医学人才的办学定位,杭州医学院将健康素养提升与全科医学基础教育相互结合,探索形成了具有"医防融合、医护结合"特色的全科医学素养教育体系.本文围绕全科医学素养提升,介绍杭州医学院全科医学素养教育的改革历程及培养方案,以期为我国医学素养教育发展提供参考.

目的:新型冠状病毒肺炎疫情期间,应用虚拟仿真技术辅助临床技能操作线上教学,以提升教学效果.方法:制定"理论讲解操作重点+虚拟仿真平台辅助教学+课堂互动练习"的教学方案,选取2018级临床医学专业(专科)全体学生为研究对象,以社区适宜技能课程为研究课程,在实施一月后对学生进行问卷调查,用返校后的OSCE(客观结构化临床技能考试)成绩来评价教学效果.结果:91.72％ 的学生认为虚拟仿真实验的优势在于教学不受时间空间限制,75.16％ 的学生认为其劣势在于不利于动手能力和观察能力的培养.OSCE成绩与上届学生相比无差异.结论:虚拟仿真技术作为临床技能操作的辅助教学工具,在新型冠状病毒肺炎疫情期间的线上教学中显示出较好的教学效果,值得推广.

目的:探讨情景模拟结合TBL教学法在外科学实验教学中的应用.方法:以2017级临床医学专业学生为研究对象,对照组(55人),采用传统教学法;实验组(55人),采用情景模拟结合TBL教学法.通过成绩分析和问卷调查进行教学效果评价.结果:实验组综合成绩明显高于对照组,差异有统计学意义(P<0.05);调查问卷表明实验组对教学效果评价更高.结论:情景模拟结合TBL教学法在外科学实验教学中的应用效果较理想.

目的 :探索我国老年人的抑郁情绪异质性轨迹.方法 :基于"中国健康与养老追踪调查"数据,通过增长混合模型拟合轨迹.结果 :本研究构建了我国老年人抑郁情绪的5条异质性轨迹,分别是"高水平症状"、"症状缓解"、"症状复发"、"症状恶化"、"低水平症状".结论 :我国老年人的抑郁情绪存在不同类型的轨迹,并非所有老年人都遵循相似的发展历程.近25％ 的老年人表现出恶化、复发或持续高水平的抑郁情绪,应引起重视.

探讨非虚构写作技巧在医学教学案例中应用.通过对其在案例编写群体的确定、案例结构的建立、写作伦理的处理三方面的应用解析,归纳出优秀医学教学案例的五大特征,为医学教学案例编写提供依据与指导,也为教学案例在医学教育中的应用推广奠定基础.

目前医学院校的临床技能操作教学采用模型教学,存在场地、时间等诸多限制,学生在真实病人身上操作的机会也很少.运用PDCA循环指导教学改革,引入“虚拟医院”虚拟实训系统辅助传统教学模式,通过课程满意度问卷和OSCE成绩对比,发现该系统受到学生的欢迎,并能提高学生临床技能操作成绩.接下去的PDCA循环将进行不断改进,探索传统教学模式与新兴技术相结合的新篇章.

目的:开发一个运行在“云”端的临床技能实训系统,让学生能在课外通过任意一台联网的终端预习和复习临床操作,获得一种接近现实操作的体验,从而提高技能操作教学的效果.方法:运用“互联网+”思路及虚拟互动动画开发软件开发“虚拟医院”临床技能虚拟云实训系统.选取2014级临床医学专业学生287人为观察组,2013级临床医学专业学生289人为对照组,观察组在传统实验课基础上使用虚拟云实训系统,对照组仅采用传统的实验课授课模式.比较2组学生OSCE技能考试成绩,进行问卷调查.结果:观察组学生OSCE技能考试成绩优于对照组(P＜0.05),超过九成学生认为本系统能激发其学习兴趣.结论:在传统实验课基础上使用虚拟云实训系统进行教学,教学效果良好.

The exact mechanism associated with inflammation and atrial fibrillation (AF) remains unknown. The aim of the present study was to investigate the roles of connexin 43 (Cx43) and a1‑adrenergic receptor (α1‑AR) activation in the pathogenesis of system inflammation‑induced AF. A canine model of chronic low‑grade system inflammation was established by administrating a low dose of lipopolysaccharide (LPS; 0.1 µg/kg) for 2 weeks. Programmed stimulation was applied on the right atrial appendage to determine the effective refractory periods (ERP) and the window of vulnerability (WOV). Tumor necrosis factor α (TNF‑α) and interleukin 6 (IL‑6) levels in plasma and atrial tissue were measured by ELISA. Cx43, Toll‑like receptor 4 (TLR4) and nuclear factor κB (NF‑κB) proteins were analyzed using western blotting or immunohistochemistry. Administration of LPS for 2 weeks increased the concentration of TNF‑α and IL‑6 in the plasma and right atrium. ERP was markedly shortened and cumulative WOV was significantly widened in the LPS group. Following treatment with LPS, the amount of Cx43 protein in the area of intercalated disk increased. In addition, a high‑density of Cx43 in the lateral connection was identified. LPS also induced the activation of NF‑κB in the canine atrium. Administration with the α1‑AR blocker doxazosin prevented the production of LPS‑induced inflammatory cytokine and reversed the enhanced vulnerability to atrial fibrillation. Doxazosin inhibited the LPS‑induced increase in Cx43 protein and heterogeneous distribution, and prevented the activation of NF‑κB. These results indicated that chronic low‑grade system inflammation may increase the inducibility of AF in a canine model. The underlying mechanism may be involved in the LPS‑induced activation of NF‑κB, and the increase in Cx43 expression and lateral distribution via an α1-AR-dependent pathway.

Objectives:To analyze the influencing factors of adverse pregnancy outcomes of pregnant women complicated with syphilis,in order to provide reference for the clinical treatment.Methods:A retrospective analysis of 324 pregnant women complicated with syphilis admitted in our hospital from December 2010 to October 2015 was conducted.The incidence of adverse pregnancy outcomes was surveyed and the clinical data of the two groups having different pregnancy outcomes was compared to analyze the influencing factors of adverse pregnancy outcomes.Then Logistic multivariate regression analysis was conducted for further analysis of risk factors,to explore measures to prevent the incidence of adverse pregnancy outcomes.Results:Among the 324 patients,24 ones (7.41％) had adverse pregnancy outcomes.According to the analysis of the clinical data,times of labor,age,syphilis stage,other infectious diseases,anti-syphilitic treatment and the implementation of follow-up treatment were all influencing factors of adverse pregnancy outcomes.According to multivariate logistic regression analysis,late syphilitic stage,other infectious diseases,completed anti-syphilitic course ≤ 1 and lenient implementation of follow-up treatment were all risk factors of adverse pregnancy outcomes.Conclusion:The incidence of adverse pregnancy outcomes is high among pregnant women complicated with syphilis,with many influencing factors.Therefore,timely screening,treatment and follow-up treatment and management should be provided to reduce the incidence of adverse pregnancy outcomes.

Aims: To investigate the effect of lipopolysaccharide (LPS) on the migration of cardiac stem cells (CSCs) and whether beta-catenin is involved in its underlying mechanism.Main methods: CSCs were isolated from neonatal Sprague-Dawley rat hearts. Migration was detected using 24-well transwell system in vitro cultured CSCs and using carboxyfluorescein diacetate (CFDA)-labelled method in myocardial infarction rat model. The expression of toll like receptor 4 (TLR4), beta-catenin, heat shock protein 90 (HSP90) was analyzed using western blotting.Key findings: Exposure of CSCs to higher LPS (1 mu g/mL) for 24 h inhibited the cell migration. However, LPS (0.01, 0.1 mu g/mL) significantly increased the number of migrated CSCs, which reached a peak at 0.01 mu g/mL. LPS (0.01 mu g/mL) pretreatment promoted the migration of CFDA-labeled CSCs into the risk area in ischemia-reperfusion rat heart. And injection of LPS-pretreated CSCs also caused a significant decrease in infarct size when compared with LPS-untreated CSCs group. Lower dose of LPS did not influence the expression of TLR4 and total beta-catenin protein. However, it enhanced the levels of active beta-catenin, nuclear beta-catenin, and HSP90 protein. Comparedwith LPS group, after preincubated with HSP90 inhibitor 17-AAG, the LPS-induced enhancement of active beta-catenin protein and nuclear beta-catenin protein was abolished. In addition, 17-AAG also prevented the lower dose of LPS-induced cell migration.Significance: The results suggested that low dose of LPS pretreatmemt induced increased CSC migration, reduced the infarct size of ischemia-reperfusion heart. The mechanismmight be due to the activation and translocation of beta-catenin via HSP90-dependent manner. (C) 2016 Elsevier Inc. All rights reserved.

医学实践教学是专科层次农村社区高素质应用型全科医学人才培养的关键环节,随着第三代医学教育的倡导与实施,开展以满足基层全科医疗岗位需求为目标的实践课程教学改革,形成以提升岗位胜任力为导向的农村社区全科医生医学实践教学体系.

In the present study, the alterations in uncoupling protein 2 (UCP2) expression following hypothermic preservation in rat hearts were investigated. Isolated rat hearts were preserved in Celsior solution for 3‑12 h followed by 60 min of reperfusion. The cardiac function was evaluated using the Langendorff perfusion system. UCP2 and silent mating type information regulation 2 homolog 1 (SIRT1) proteins were detected by western blot analysis. The ATP production and mitochondrial reactive oxygen species (ROS) levels were assessed. Subsequent to preservation in ice‑cold Celsior solution for 3‑12 h, the UCP2 protein expression in rat hearts was observed to increase in a time‑dependent manner. The UCP2 inhibitor genipin inhibited the hypothermic preservation‑induced cardiac dysfunction, prevented a decline in ATP production induced by 9 h of preservation, however had no effect on the hypothermic preservation‑induced increase in mitochondrial ROS levels. Compared with the control group, the SIRT1 protein expression in rat hearts reduced following hypothermic preservation. Compared with the 9‑h preservation group, Celsior solution supplemented with the SIRT1 activator resveratrol (20 or 40 µmol/l) inhibited UCP2 protein overexpression, prevented the decline in ATP production and resulted in an improvement cardiac function. The SIRT1 inhibitor EX‑527 abolished the resveratrol‑induced inhibition of UCP2 overexpression and cardiac protection in the hypothermic preserved rat heart. These observations suggest that downregulation of UCP2 expression in the hypothermic preserved rat heart in part initiated the protective mechanism via the SIRT1 pathway.

本文针对医学高职高专急救医学教学中存在的主要问题进行深入探讨，通过对急救医学课程的教学大纲、教学内容、教学方法、教学评价等各方面进行一系列的改革，来达到提高学生实际工作能力，培养合格的面向农村/社区卫生机构的实用型人才的教学目的。

Sepsis is a complex syndrome characterized by the development of progressive dysfunction in multiple organs. The aim of the present study was to investigate the protective effect of curcumin against lipopolysaccharide (LPS)-induced vasoconstrictive dysfunction, and to investigate the possible underlying mechanism. Male Sprague-Dawley rats were randomly divided into the following groups: Control, sepsis and curcumin. A sepsis model was established by an intraperitoneal (i.p.) injection of 5 mg/kg LPS. Thoracic aortic rings obtained from the rats were mounted in an organ bath and the vasoconstriction of the rings was recorded. In addition, the serum E-selectin levels were determined by an enzyme-linked immunosorbent assay. The expression levels of thrombospondin (TSP)-1 and transforming growth factor (TGF)-β1 in the aortic tissue were detected by immunohistochemistry. Vasoconstriction of the aortic rings was found to significantly decrease in the sepsis rats when compared with the control group. However, curcumin (10 or 20 mg/kg, i.p.) prevented the vasoconstrictive dysfunction induced by LPS. The serum level of E-selectin and the expression levels of TSP-1 and TGF-β1 significantly increased in the sepsis rats when compared with the control group rats; however, the levels decreased significantly following treatment with curcumin (10 or 20 mg/kg). Furthermore, hematoxylin and eosin staining revealed that curcumin alleviated the LPS-induced damage in the aortic tunica intima and tunica media. Therefore, the results indicated that curcumin alleviates LPS-induced vasoconstrictive dysfunction in the thoracic aorta of rats. In addition, the inhibition of TSP-1 and TGF-β1 expression may be involved in the mechanism underlying this protective effect.

为了完善临床医学(大专)专业急救培养模式,课题组对浙江省192个农村社区医疗机构急救现状作了调查.结果显示农村社区医生常用急救技能包括:创伤急救技术、心肺复苏等,他们获取相关知识和技能的途径主要是参加各种培训班和学术会议,缺乏针对性.作者认为在调查基础上对医学生进行急救培养模式探索具有一定的现实意义.

高职高专医学教育的目标是培养高技能应用型医学人才，这就需要有一支“双师型”教师队伍。本文在分析“双师型”教师的内涵及临床医学专业“双师型”教师队伍建设中存在的主要问题的基础上，提出了“双师型”教师的培养途径。

只有加强临床医学研究生的临床实践能力、科研能力和理论知识的培养,抓好导师队伍建设,才能提高研究生的培养质量,为我国医学事业的发展做出贡献。

培养大学生科研能力是高等学校提高人才培养质量的重要途径。本文分析了科研能力的内涵、重要性、必要性及培养大学生科研能力过程中存在的主要问题,并针对问题提出了解决措施。

After studying on medical contest for university students of Zhejiang Province,the paper thinks that contest cultivates medical students’team cooperative spirit,improves professional knowledge and skill,psychological and medical humane quality,and ability in analysis and solution of problem,strengthens construction of double-qualified teacher team,and cooperation between hospital and medical college,and promotes reform in teaching,improvement in practice and training conditions, and exchange between medical colleges.