血栓栓塞性疾病的栓塞和出血风险并存已成为临床困境.疾病的多元化与药物更迭使抗栓治疗日益复杂和专业化,单一学科已不能胜任疑难病例的抗栓治疗.为更好地整合医疗资源,确保患者从规范化抗栓治疗中获益,北京大学第三医院突破学科间壁垒,组建了以心内科为主体,联合药剂科、检验科、神经内科、急诊科、消化科、心脏外科、呼吸科、介入血管外科、神经外科、风湿免疫科和血液科等12个科室参与的抗栓诊治专业团队,致力于制定合理的抗栓策略,着力解决临床血栓性疾病抗凝、抗血小板治疗中的关键问题,旨在探索一个"以心房颤动患者为中心"的多学科联合诊疗和精细化管理模式.

学生是学习的主体,通常主动学习的学习效果更佳.在主动学习过程中学生发挥其主观能动性,能从自身角度积极主动的学习.而针对医学大学生自主性学习的研究发现,通常医学生受到对其学科性质不了解、自我观念未更新以及高中与大学知识未衔接恰当这三个因素影响.由于这些因素不具有特殊性,导致大部分人普遍忽视,转而关注更加深层次的影响因素,未能抓住其问题的重点.所以对于如何提高医学大学生自主性学习技能的培养,本文针对以下几个方面来进行探讨与分析,并提出部分建议.

基于互联网的在线学习是现代信息化社会教育发展的主流方向.生物学实验课程如何建设适合于自身课程特点的网络学习平台是亟待解决的问题.北京大学生物学国家级实验教学示范中心结合自身的教学特点,以及借鉴国外其他高校生物实验教学信息化建设的经验,开发出实验原始数据及实验报告管理系统,建设了虚拟仿真实验和多门生物学实验类慕课,并开发出实验室安全考试系统.以上三方面对传统实验教学模式进行的优化,可为其他高校生物学实验类课程的信息化建设提供借鉴.

中药鉴定学是中药学专业学生的大学必修课程,也是执业中药师考试的内容之一[1].本课程以中医药理论为基础,主要研究目标为考证和整理中药品种、鉴定和研究中药品种与质量、建立和完善中药质量标准以及寻找和扩大新药源[2,3].

目的 观察分析水针疗法联合清热祛毒汤治疗寻常型银屑病(血热证)的疗效及其作用机制.方法 选择2018年8月-2019年7月在我院接收治疗的112例寻常型银屑病患者作为分析对象,采取随机分组的办法将其分为对照组56例和研究组56例,对照组患者采取水针疗法治疗,研究组在对照组的基础上联合清热祛毒汤治疗.比较分析2组患者的疗效;治疗前后的中医证候评分、皮肤病生活质量指数(DLQI)评分;治疗前后皮损面积、浸润、鳞屑、红斑等评分;治疗前后肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、血管内皮生长因子(VEGF)水平变化情况.结果 研究组患者治疗总有效率89.29%明显高于对照组73.21%(P<0.05);治疗前,2组患者的中医证候评分、DLQI评分、皮损面积、浸润、鳞屑、红斑等评分及TNF-α、IL-6、VEGF等水平比较(P>0.05);研究组患者治疗后的中医证候评分与DLQI评分明显低于治疗前(P<0.05);研究组患者治疗后的皮损面积、浸润、鳞屑、红斑等评分明显低于对照组(P<0.05);研究组患者治疗后的TNF-α、IL-6、VEGF等水平明显低于对照组(P<0.05).结论 对寻常型银屑病患者采取水针疗法联合清热祛毒汤治疗的疗效显著,能有效改善中医证候表现,提高生活质量,减轻皮损程度,降低炎症反应,其作用机制可能与炎症因子水平、皮损血管增生相关.

目的:通过对川麦冬药材多种质控指标的检测和分析,探索该药材性状与内在质量之间的关联性,为川麦冬药材等级标准的制定提供参考.方法:对28批不同等级川麦冬药材(一等品、二等品、三等品和统货)开展性状检查、显微和薄层鉴别、水分、灰分、酸不溶性灰分、二氧化硫残留量、重金属和有害元素残留量、多效唑残留量、水溶性浸出物、总皂苷含量及3种主要成分(麦冬皂苷D,甲基麦冬黄烷酮A,甲基麦冬黄烷酮B)含量测定,分析各项指标与川麦冬药材等级之间的相关性.结果:川麦冬药材在性状、显微特征和薄层色谱方面均具有专属性特征,川麦冬药材的杂质、水分、灰分、酸不溶性灰分和水溶性浸出物在不同等级之间存在一定差异性.川麦冬一等品每50 g药材含80 ～ 120粒,水分11.1％～14.9％,灰分1.6％ ～2.1％,酸不溶性灰分0.03％～0.14％,水溶性浸出物77.0％～86.5％;二等品每50 g药材含120～160粒,水分13.1％ ～14.2％,灰分1.3％ ～2.2％,酸不溶性灰分0.06％～0.22％,水溶性浸出物75.9％ ～83.3％;三等品每50 g药材含160～300粒,杂质0.2％～8.4％,水分12.6％～14.0％,灰分1.2％～1.5％,酸不溶性灰分0.06％～0.22％,水溶性浸出物74.0％～86.5％;统货每50 g药材含80～300粒,杂质1.2％～22.6％,水分13.0％～15.4％,灰分1.4％～2.0％,酸不溶性灰分0.03％ ～0.15％,水溶性浸出物79.8％～85.2％.结论:川麦冬药材以每50 g所含粒数等外观性状并结合杂质、浸出物等内在指标进行等级划分具有一定合理性和可行性,可作为川麦冬药材等级标准的参考.

Objective: To explore the practice patterns and the related factors of oral antiarrhythmic drug (AAD) treatment in Chinese patients with atrial fibrillation (AF), and to evaluate the compliance of AAD application to atrial fibrillation management guidelines. Methods: From August 2011 to August 2016, medical records from 18 014 patients with AF were analyzed based on data from the Chinese Atrial Fibrillation Registry trial. Patients were divided into AAD group (7 788 cases, 43.23%) and non-AAD group (10 226 cases, 56.77%) according to whether AAD was used at baseline or at the time of first use during follow-up. Amiodarone (4 129 cases, 53.02%) and propafenone (3 211 cases, 41.23%) were the mostly prescribed AAD and subgroup analysis was performed accordingly. Medical records were analyzed by random forest regression to evaluate the use of AAD and related factors in patients with AF, and the rationality of AAD was analyzed according to the guidelines for the management of atrial fibrillation. Result: A total of 18 014 patients were included in this study, of which 60.48% (10 895/18 014) were male patients, 22.65% (4 081/18 014) were elderly patients(≥75 years old), there were 7 788 patients (43.23%) in AAD group, and 10 226 patients(56.77%) in non-AAD group. Compared with the non-AAD group, the elderly patients (≥75 years old, 13.74%(1 070/7 788) vs. 29.44%(3 011/10 226)), persistent AF (28.95% (2 250/7 788) 45.80% (4 683/10 226)), heart failure(8.29% (646/7 788) vs. 21.95% (2 245/10 226)), stroke and (or) TIA(12.15% (946/7 788) vs. 19.95% (2 040/10 226)), renal dysfunction(16.36%(1 274/7 788) vs. 29.37% (3 003/10 226)), and high thromboembolism risk(60.17% (4 748/7 788) vs. 76.40% (7 813/10 226)) were less prevalent in the AAD subgroup (P<0.001). Multivariate analysis showed that patients in tertiary hospitals (OR=3.72, 95%CI 3.17-4.37) were more likely to use AAD, elderly patients (≥75 years old, OR=0.47, 95%CI 0.39-0.55), persistent atrial fibrillation (OR=0.66, 95%CI 0.60-0.72), and patients with heart failure (OR=0.54, 95%CI 0.47-0.63), stroke and (or) TIA (OR=0.77, 95%CI 0.68-0.87), renal dysfunction (OR=0.75, 95%CI 0.59-0.95) and high thromboembolism risk(OR=0.7, 95%CI 0.58-0.84) were more likely not to use AAD(P<0.05). In the AAD group, amiodarone and propafenone were the most commonly used AAD, accounting for 53.02% (4 129/7 788) and 41.23% (3 211/7 788), respectively. Multivariate analysis showed that patients with persistent atrial fibrillation (OR=4.57, 95%CI 3.94-5.29) and coronary heart disease (OR=4.14, 95%CI 3.03-5.64), heart failure (OR=2.07, 95%CI 1.48-2.89), non-ischemic cardiomyopathy (OR=4.84, 95%CI 2.41-9.73) were more likely to use amiodarone, and those with normal left ventricular ejection fraction (OR=0.31, 95%CI 0.15-0.65) and low thromboembolism risk (OR=0.78, 95%CI 0.63-0.97) were more likely to use propafenone (P<0.001). The overall incidence of AAD treatment, which was not indicated by the guidelines was 6.5% (480/7 340); 5.1% (212/4 129) in the amiodarone group and 8.3% (268/3 211) in the propafenone group, respectively. Compared with the rational AAD use group, the proportion of irrational drug use was higher in the elderly (≥75 years old) (20.4% (98/480) vs. 12.9% (887/6 860)), patients of high thromboembolism risk (77.1% (379/480) vs. 59.0% (4 047/6 860)), and in non-tertiary hospitals (7.1% (34/480) vs. 3.3% (299/6 860)), but lower in men(50.8% (244/480) vs. 64.5% (4 427/6 860)), P<0.001. Conclusions: The patients with paroxysmal atrial fibrillation, who were treated with AAD, were mostly patients with fewer complications, and the patients who were treated with amiodarone were mostly patients with persistent atrial fibrillation, patients were more likely to complicate with organic heart disease. The incidence of AAD that do not comply with the guidelines was low, and it was more common in non-tertiary hospitals and the elder patients with high thromboembolism risk.

目的 分析九味镇心颗粒联合柴胡加龙骨牡蛎汤在更年期女性心悸气阴两虚型的临床效果.方法 选择更年期女性心悸气阴两虚型患者80例,按照随机分组法,两组各40例,对照组采用参松养心胶囊治疗,实验组采用九味镇心颗粒联合柴胡加龙骨牡蛎汤服用治疗,对比两组的治疗效果、不良反应情况,进行分析.结果 实验组患者的治疗有效率显著高于对照组,且实验组患者治疗后的不良反应概率远远低于对照组患者,差异有统计学意义(P<0.05).结论 九味镇心颗粒联合柴胡加龙骨牡蛎汤治疗心悸气阴两虚型疗效显著,能够有效缓解患者的心悸汗出、心情烦躁、睡眠症状,出现不良反应的几率较低,能够有效改善患者的生活质量,值得临床推广.

心房颤动(AF)增加卒中和死亡的风险.心脏植入式电子装置(CIED)对高频心房事件(AHRE)的记录为发现AF提供了诊断依据.研究表明AHRE与卒中风险增高有关.但对于AHRE患者是否需要抗凝治疗尚缺乏证据.由于栓塞风险不仅与A H RE有关,还需关注患者的其它临床情况,因此专家建议抗凝治疗应个体化,将AHRE负荷与CHA2DS2-VASC评分相结合是一种恰当的卒中危险分层的方法.目前正在进行的临床研究将为AHRE患者的抗凝治疗决策提供循证依据.

患者男性,81岁,病窦综合征,起搏器植入术后心悸.起搏器程控显示阵发性房性心动过速和心房颤动频繁发生.开启起搏器治疗房性心动过速/心房颤动的特殊功能后,患者临床症状明显改善,起搏器程控显示房性心动过速和心房颤动的发生明显减少.

The qualitative analysis of flavonoids in Coreopsis tinctoria was carried out by a combination of 2 D-TLC and HPLC-IT-TOF-MS. The separation was conducted on 2 D-TLC and a Phenomenex Kinetex Evo C_(18) column(2.1 mm×100 mm, 2.6 μm) with methanol-0.05% aqueous formic acid by gradient elution. Electrospray ionization-(ESI) source was applied and operated in both positive and negative ionization modes. Eighteen flavonoids including three flavonoids, one flavonol, nine flavonones, one flavanonol and four chalcones, were putatively identified from the flavone-enriched fraction of C. tinctoria. 2 D-TLC could separate the flavonoids from C. tinctoria. HPLC-IT-TOF-MS was able to quickly and accurately analyze the flavonoids in C. tinctoria. The results would provide experimental information for the efficacy material basis clarification of C. tinctoria.

穴位敷贴是一种典型的中医技术,属于中医外治法的范畴,在临床医学上还有重要意义.慢性心力衰竭患者对穴位敷贴的依赖性较高,在疾病治愈中具有显著成效,成为越来越多医院甚至患者的选择.本文从中药对慢性心力衰竭的认识与治疗入手,分析现代医学对慢性心力衰竭的认识与治疗研究,梳理结合穴位敷贴治疗心力衰竭患者的研究进展.

患者男性,22岁,主因"发作性心悸伴黑矇12年"入院.患者自12年前开始经常发作心动过速,突发突止,7年前确诊为心肌致密化不全并发预激综合征、室上性心动过速,7年来先后出现5个部位的右侧房室旁道,均行射频消融术成功.

目的:探究缺血性脑卒中大鼠向卒中后抑郁、焦虑、痴呆演变过程中宏观表征动态变化情况以及中药颐脑解郁方的干预作用.方法:选取雄性wistar大鼠100只,随机分为卒中模型组、卒中观察组、卒中假手术组、PSD模型组、PSD观察组、PSD假手术组、PSA模型组、PSA观察组、PSA假手术组、VaD模型组、VaD观察组、正常组.除正常组及假手术组外,均进行MCAO手术建立缺血性脑卒中模型,术后分别复合CUMS建立PSD模型、复合不确定性空瓶饮水刺激建立PSA模型,VaD模型为术后正常喂养28 d后通过水迷宫实验筛选而出.卒中组术后药物干预2周,其余各组应激结束后药物干预4周.观察组灌胃颐脑解郁方,余各组灌胃蒸馏水.连续采集各组大鼠宏观表征信息,并比较卒中组治疗1、2周及PSD、PSA、VaD组治疗1、2、4周体重变化情况.结果:卒中大鼠向PSD演变过程中,以先出现易激惹表现,而后活动度、精神状态、反应性逐渐下降,口鼻黯淡,舌色紫暗,舌下脉络发绀为特征;卒中大鼠向PSA演变过程中表征变化为攻击性、探究性增加,梳理行为减少,口鼻黯淡,舌红少津等;向VaD演化过程中,具有活动度、精神状态、反应性逐渐下降趋势,口鼻色稍暗,舌润泽,舌色淡红.各模型大鼠体重均较正常组明显下降.应用颐脑解郁方干预后,观察组大鼠宏观表征改善,体重显著增加.结论:PSD、PSA、VaD在其演变过程中具有肾虚肝郁的共同病机,益肾调气方药颐脑解郁方对缺血性脑卒中及卒中后精神疾病具有一定疗效.

目的:探索P16在宫颈上皮内瘤变Ⅱ级(CINⅡ)组织中的表达状态及其作为生物标记物对CINⅡ患者进行分流管理和预后判断的临床意义.方法:选取中日友好医院2008年1月～2017年12月宫颈锥切术后病理诊断为CINⅡ的组织学标本158例,应用免疫组织化学法检测P16的表达,取正常宫颈组织40例进行对照研究,并对CINⅡ患者进行术后随访统计.结果:CINⅡ患者宫颈组织中P16阳性表达率为55.7％,显著高于正常宫颈组织中P16阳性表达率(7.5％,P＜0.01).在CINⅡ患者中随机选取37例进行术后随访,P16阳性患者超薄细胞检测(LCT)阳性率72.72％,显著高于P16阴性患者LCT阳性率(15.79％,P＜0.05).P16阳性表达患者的HPV阳性率为75％,显著高于P16阴性表达患者的HPV阳性率(18％,P＜0.05).结论:P16在CINⅡ患者阳性表达提示病情进展风险更高,建议积极进行宫颈锥切诊断治疗,并加强术后随访;P16阴性患者建议暂时观察,避免不必要的手术创伤.

Objective: To systematically assess the curative effect and safety of acupoint catgut embedding on epilepsy. Methods: The domestic and overseas databases were retrieved until April 15, 2017. The randomized controlled trials (RCT) about the comparison in the treatment of epilepsy among acupoint catgut embedding, placebo or AEDs were identified and included. The quality of included RCT, such as randomization, allocation concealment, blinding, quitting and lost to follow-up, was assessed according to internationally recognized criterions, and then the curative effect was analyzed systematically and comprehensively. Results: There were totally 13 RCT included (involving 1 291 patients). There were 8 studies reported the comparison of acupoint catgut embedding with AEDs and AEDs, and 5 studies reported the comparison of acupoint catgut embedding and AEDs. There were 3 RCT showed that acupoint catgut embedding combined with AEDs had advantages in seizure frenquency, 11 studies showed that acupoint catgut embedding had advantage in improving effective rate, only 2 reported the adverse reactions evaluation, so the safety of acupoint catgut embedding was not obtained affirmation. Conclusion: Compared with AEDs, acupoint catgut embedding combined with AEDs have advantages in epilepsy treatment, but more rigorous designed large-sample clinical trials are needed for further confirmation.

根据《国家信息化发展战略纲要》中“大力增强信息化发展能力,加强信息资源规划、建设和管理”的要求,实践“推动重点信息资源国家统筹规划和分类管理,增强关键信息资源掌控能力,完善基础信息资源动态更新和共享应用机制”指引高校实验室管理信息化建设的工作方向.根据纲要要求,我校基于当前实验室信息化相关系统整合实验室管理信息资源,创新性地通过引入实验室房间管理单元连接实验室人员、地点、资产、安全等各维度实验室管理数据信息,通过跨系统、跨部门的实验室信息共享增强了实验室的信息互联互通能力,提高了实验室信息的更新效率,促进了实验室管理水平的提高,进而保证了实验教学以及科研工作质量的提高.

目的 通过总结磁共振波谱(MRS)在卒中后精神障碍脑代谢中的应用现状,评价MRS对卒中后精神障碍的鉴别诊断作用和中医药治疗对脑代谢的MRS干预作用.方法 主要检索PubMed和CNKI数据库.在检索术语方面,以卒中和磁共振波谱为基础,分别检索精神障碍的相关词语,并从中挑选出中医类研究.结果 卒中后精神障碍会造成神经元损伤,其标志物氮-乙酰天冬氨酸(NAA)含量也会随之降低.肌醇(mI)、含胆碱化合物(Cho)以及谷氨酸(Glx)、谷氨酰胺复合物(Glu)在卒中后抑郁、血管性痴呆和广泛性焦虑中具有一定特异性.中医治疗方面常采用补肾填精、疏肝理气、清热化痰、活血化瘀法.中药和针灸治疗可以调节脑代谢,使降低的NAA恢复正常水平.另外,血管性认知功能障碍的不同中医证型具有不同的脑代谢变化.结论 卒中后精神障碍患者有脑代谢异常,MRS作为一种反映脑代谢的无创手段,有望完善卒中后精神障碍的鉴别诊断.中医药及针灸治疗可以改善患者的脑代谢,修复受损的神经元.

Objective To conduct a pharamacognosical study on snow chrysanthemum (coreopsis tinctoria nutt.),and lay a theoretical foundation for its origin identification. Methods The properties, structure,and micro-characters of snow chrysanthemum powder were observed and described; the main components were analyzed, and finger-print was built with HPLC, aiming at analyzing snow chrysanthemum from property,microscopic,and physicochemical aspects. Results The macro-character and micro-characters of snow chrysanthemum are described as follows: the capitula of snow chrysanthemum is consistent with that of asteraceae species with two colors of the ray floret,yellow on the upper part,and purple brown in the middle of basal part. Powder under the microscope presents yellow spine spheroidal pollen grains, light yellow to brown red secretary canal scrap, papilla with simple cellular hair,basal part cell,and inner wall cells of pollen sac. The HPLC fingerprint was determined. Conclusion Snow chrysanthemum shares the common features with asteraceae species, and is different from Coreopsis lanceolate L,and Coreopsis grandiflora Hogg in the same genus. This study supplemented the gap in the pharacognosical study of snow chrysanthemum for origin identification.

Objective To investigate the chemical constituents from the herbs of Corydalis edulis. Methods The compounds were isolated and purified by various column chromatographies, and their structures were identified by physiochemical properties and spectroscopic data. Results Fifteen compounds were isolated from the n-BuOH layer of EtOH extract of the herbs of C. edulis. and identified as 6,7-methylenedioxydihydroisocoumarin (1), oxohydrastinine (2), 6,7-dimethoyisoquinolin-1 (2H)-one (3), 6,7-methylenedioxy-1 (2H)-isoquinolinone (4), (+)-syringaresinol (5), (+)-medioresinol (6), salidroside (7), isosalicin (8), icariside D2 (9), salicin (10), icariside F2(11), icariside B2(12), nicotinamide (13), pyrocatechol (14), and 5-hydroxyl-2-hydroxymethylpyridine (15), respectively. Conclusion Compound 1 is a new natural product. Compounds 3, 5—12, 14, and 15 were isolated from Corydalis species for the first time. Compounds 2, 4, and 13 were firstly obtained from C. edulis.