This paper focuses on the practical necessity of discipline-integrated PBL curriculum in cultivating clinical thinking ability of college students majoring in clinical medicine. Through the teaching process of group discussion of some real and complete cases, this paper explains in detail how to cultivate medical students' clinical thinking ability by discipline-integrated PBL curriculum, discusses the implementation of ideological and political education associated with clinical medicine by heuristic teaching from close touching with clinical case and implicitly infiltration of the socialist core values such as dedication and integrity, and elaborates the humanistic quality and psychological comfort levels of medical students by being close to clinical patients. After five years of teaching practice, the teaching effect of discipline-integrated PBL curriculum has been approved by the national clinical medicine professional certification experts and praised by students. We believes that the development of discipline integrated PBL curriculum in medical college can strengthen students' problem-based autonomous learning ability, significantly improve the two-way integration ability between basic medical courses and basic medicine, and significantly build students' clinical thinking and clinical decision-making ability.

OBJECTIVE To determine the effect of activation of lambda-opioid receptor with U50, 488H, a selective kappa-opioid receptor agonist, on the changes in electrical coupling during prolonged ischemia and to explore the possible mechanism. METHODS The isolated rat heart was perfused in a Langendorff apparatus. The effect of U50, 488H on electrical coupling parameters including onset of uncoupling, plateau time, slope and fold increase in r(t) was observed in isolated perfused rat heart subjected to global no-flow ischemia. The effect of U50, 488H on connexin 43 (Cx43) expression of ventricular muscle during ischemia was determined by immunohistochemistry. RESULTS In the prolonged ischemia model, U50, 488H concentration dependently delayed the onset of uncoupling, increased time to plateau, and decreased the maximal rate of uncoupling during ischemia. The effect of U50, 488H on electrical uncoupling parameters during ischemia was abolished by a selective kappa-opioid receptor antagonist nor-BNI or a PKC inhibitor chelerythrine. The amount of Cx43 immunoreactive signal in ventricular muscle was greatly reduced after ischemia. U50, 488H markedly increased Cx43 expression during ischemia and its effect was also attenuated by nor-BNI or chelerythrine. CONCLUSION These results demonstrated that U50, 488H delayed the onset of uncoupling and plateau time, decreased the maximal rate of uncoupling and increased Cx43 expression of ventricular muscle during ischemia, and these effects of U50, 488H were mediated by kappa-opioid receptor, in which activation of PKC was involved. The effect of U50, 488H on electrical coupling during ischemia was probably correlated with preservation of Cx43 in cardiac muscle.

高等职业教育的目的是为社会培养生产、服务和管理的实用人才.必须更新课堂教学观念,改革当前的教学方法,着重提高高职学生的实践操作技能、自主学习和创新能力;大力培养学生的综合素质.

近年来青年胃癌呈上升趋势[1,2].我院1994年1月～2001年12月经胃镜、病理活检确诊16～40岁胃癌患者65例,现就其临床特点分析如下.

雷贝拉唑作为新一代的质子泵抑制剂,85%通过非酶代谢.该药是目前唯一不完全依赖细胞色素P2C19酶基因型的质子泵抑制剂,因而它在所有PPI中,是唯一对各种基因型患者都能提供稳定,相同的抑酸效果的药物[3].

炎症性肠病是一组病因未明的慢性肠道炎症性疾病,多以腹痛与腹泻为主要肠道症状.近年来人们发现其病因包括多种因素,其中与机体的免疫系统有明显关系.患者的HLA-DR1、HLA-DQw5明显增高;肠粘膜免疫细胞数量增多,肠局部体液或细胞免疫活性增强、多数UC患者P-ANCA阳性;TH1/TH2失衡;以及在IBD初期,内皮细胞表达ICAM-1明显增加.

目的分析甲亢误诊为消化系统疾病的原因和防止方法.方法将我院就诊的8例误诊的甲亢患者分别进行甲状腺激素测定和详细的局部检查,并加以分析.结果误诊病人甲状腺激素测定和局部检查后,给予抗甲状腺药物治疗后症状均消失或好转.结论甲亢的临床表现具有多样性和全身性,极易误诊,应及时进行甲状腺功能检查,对甲状腺等组织进行详细的局部检查,防止误诊.