类风湿关节炎与骨质疏松症都属于临床常见疾病,骨质破坏是类风湿关节炎的一项重要表现,类风湿关节炎患者常见于继发性骨质疏松症.类风湿关节炎引起骨质疏松症的发病机制目前尚未清晰,其中主要包括破骨细胞分化因子 κB受体活化因子配体(RANK)、细胞核刺激因子受体(RANKL)、护骨素(OPG)信号转导通路系统、炎症因子及治疗类风湿关节炎的药物如糖皮质激素等,均会导致骨质疏松症.主要对OPG/RANKL/RANK系统及炎症因子如白细胞介素(IL)-1β、IL-6、IL-17、IL-4与类风湿关节炎合并骨质疏松症发病中的潜在作用进行综述,以期为类风湿关节炎合并骨质疏松症患者提供可能的、有前景的治疗途径.

痛风是一种尿酸盐沉积机体相应部位而导致的晶体相关性关节炎,与嘌呤代谢紊乱以及尿酸排泄减少而形成的高尿酸血症直接相关[1].临床上可分为原发性和继发性两大类:原发性多由于天性嘌呤代谢异常而引起,常伴有代谢综合征;继发性主要因某些疾病或应用某些药物而引起[2-3].临床上常表现为血尿酸升高、反复发作的痛风性关节炎、关节畸形以及晚期痛风性肾病的发生[4].痛风目前无法根治,常并发有高血脂、高血压、糖尿病等代谢紊乱,严重威胁着人类的健康.中医学将其归为“痹证”范畴,因其走注关节、痛势甚剧,故又名“白虎历节”,此外亦称“白虎风”“痛风”“风痹”“痛痹”等[5].在长期的临床实践及众多的科学研究中发现,大黄治疗痛风疗效确切,现笔者就大黄治疗痛风的作用机制研究进展进行综述.

Objective To investigate the levels of serum bone metabolic markers and inflammatory factors in patients with rheumatoid arthritis. Methods A total of 60 RA patients and 20 healthy controls were enrolled into this study. According to whether associated with osteoporosis, a total of 60 rheumatoid arthritis patients were divided into OP group (n＝32) and NOP group (n＝28). Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry. The level of IL-1β, IL-6, IL-17, PINP, CTX, OPG and IL-6 were detected by ELISA. Relevant clinical and laboratory data were also recorded. T-test was used for data analysis, and Pearson's test was adopted for correlation analysis. Results ①Compared with the controls, the levels of BMD and PINP in RA patients decreased significantly, whereas the levels of CTX, IL-1β, IL-17 and IL-6 increased significantly ( P＜0. 05). ②Compared with the NOP group, the levels of IL-1β, IL-17 and IL-6 increased significantly in the OP group (P＜0. 05). The levels of CTX and PINP in the OP group were higher than those in the non-OP group but there was no statistical difference between two groups. ③The level of IL-1β was positively correlated with ESR (r ＝0. 423, P＜0. 05). The level of IL-6 was positively correlated with CRP, ESR and DAS28 ( r ＝0. 473, 0. 370, 0. 481, P＜0. 05). The level of IL-17 was positively correlated with CRP, ESR and DAS28 (r＝0. 411, 0. 367, 0. 468, P＜0. 05). The level of CTX was positively correlated with CRP, ESR and DAS28 (r＝0. 536, 0. 488, 0. 466, P＜0. 05), but negatively correlated with the course of disease (r＝ -0. 268, P＜0. 05). PINP was not statistically different between two groups (P＞0. 05). Conclusion RA patients had a higher incidence of OP, and the levels of IL-1β, IL-17 and IL-6 were higher in OP patients than NOP patients. The levels of CTX, as well as PINP ratio correlated with disease activity and secondary osteoporosis in RA. These two bone metabolic markers can be used to understand the extent of bone destruction in patients with RA.

痛风性肾病发病率呈逐年上升趋势,是痛风致死的首要原因.痛风性肾病病情复杂,现代医学认为高尿酸血症是本病的独立危险因素,治疗主要是以抑制尿酸合成和促进尿酸排泄为主,长期服用此类药物毒副作用较大,会加重肝肾功能损害.近年来,中医药治疗本病展现了广阔的发展前景,已逐渐成为目前的研究热点与趋势之一.就中医辨治痛风性肾病加以综述,为临床合理治疗提供参考.

Rheumatoid arthritis (RA) and osteoporosis (OP) are common clinical diseases.RA is one of the major causes of secondary osteoporosis.RA induced osteoporosis is associated with increased bone fragility,increased fractures incidence,reduced healing rate and increased burden to families and the society.The pathogenesis of osteoporosis induced by RA is not very clear,but the RANKL/OPG/RANK signal transduction pathway system and inflammatory factors are correlated with the occurrence of osteoporosis.The occurrence of osteoporosis with RA was related to the following factors:the length of the course of RA,the degree of disease activity,and the use of glucocorticoids.There is a consensus on the use of glucocorticoids as a risk factor for osteoporosis,however,there are still some different views on whether the use of low dose glucocorticoids could cause osteoporosis.There were no significant correlations between the use of slow acting anti-rheumatic drugs and biological agents and the occurrence of osteoporosis.Controlling joint inflammation in time can reduce the damage to joint structure and reduce the loss of bone mass.Early non-specific symptoms osteoporosis can be detected using traditional assessment tools,and the latest software also can be used to assess the risk of fracture.With further research on the molecular biology of bone cells,some new drugs have been discovered,which provide a new choice for the treatment of osteoporosis.This paper reviewed from three aspects of RA related osteoporosis,including current progress in epidemiological studies,pathophysiological mechanism,and prevention and treatment of osteoporosis,in order to improve the knowledge and understanding of clinic workers in RA associated osteoporosis.

The chronic pelvic inflammation is characterized with the lower abdominal swelling,pain and lumbosacral pain,leucorrhea quantity increased,and a side or both sides uterine attachment thickening or abscess.The weak viscera function and qi stagnation and blood stasis are important causes of the disease.Learning from the tutor in clinic,the meaning of treating this disease from blood stasis and deficiency was understood,and the disease can be cured by supplementing the deficiency,removing the blood stasis and benefiting Qi and activating blood circulation.

科教科作为附属医院和医学院的科研教学管理部门,如何强化内部管理,优化人员组成,明确职责分工,加强成员间团结协作,以实现工作效率最大化,是确保各项科研教学工作得以及时有效落实的基础和前提。本文结合浙江中医药大学附属第三医院(第三临床医学院)科教科在"院系合一"及"合并重组"后"两岸三地"的新形势下,探索适合附属医院、医学院医疗教学科研协调统筹发展需要的内部管理模式。

课间见习是临床医学教学的重要环节之一,是课堂理论教学与临床实践相结合的桥梁。见习对于学生加深和巩固理论知识的理解具有不可替代的作用,也是临床教师教学能力培养的重要途径。主要目的是理论联系实际,使医学生通过接触临床实际,进一步学习、巩固课堂理论知识,初步了解、熟悉和掌握临床各科基本技能操作;培养科学、严谨、认真、扎实的医疗工作作风和良好的医德医风;为毕业实习打下良好基础。

The paper introduces the connotation and development status of PBL in acupuncture science teaching and analyses the feasibility application of PBL used in acupuncture science teaching.Based on the previous teaching practice we introduce some understanding on application of PBL in acupuncture science teaching from the following aspects such as distributing the PBL in acupuncture science teaching rationally,focusing on the shift of teacher and student roles.Carrying out the PBL teaching can help to deepen the teaching reform and enhance the level and teaching quality of acupuncture science.