目的 探索"慕课"背景下适时教学模式在肾内科医学临床实践教学中应用的效果.方法 肾内科五年制临床医学专业实习学生随机分为两组,每组40人,一组实施传统的临床带教方法,另外一组应用"慕课"背景下适时教学模式管理带教方法,在肾内科轮转学习一个月后进行出科前理论考核及临床带教满意度调查表进行比较及分析.结果 "慕课"背景下适时教学组出科考核成绩(82.22±1.52)明显高于传统的临床带教组(74.80±1.29),差异有统计学意义(P<0.05);大多数学员认为适时教学方法新颖、更个体化、更适合临床教学,满意度较高,同时可提高专业外语学习能力及提高学习积极性.结论 "慕课"背景下适时教学法可有效改善临床教学效果.

目的 WTX基因转染结肠癌Lovo细胞株,分析WTX基因对结肠癌细胞增殖和凋亡的影响.方法 将结肠癌Lovo细胞株分为WTX基因转染组和对照组,WTX基因转染组给予WTX质粒转染,对照组给予空载质粒转染.观察WTX基因转染组和对照组WTX基因的表达情况,两组Lovo细胞株结肠癌细胞的增殖情况、凋亡情况及细胞周期变化.结果 WTX基因转染组结肠癌细胞WTX蛋白表达明显高于对照组(P＜0.05);WTX基因转染组结肠癌转染后4、7d光密度值均明显低于对照组(P＜0.05);WTX基因转染组G1期细胞比例明显高于对照组(P＜0.05),WTX基因转染组G2期和S期细胞比例明显低于对照组(P＜0.05).结论 WTX基因抑制结肠癌细胞的增殖,影响结肠癌细胞周期,对结肠癌细胞凋亡没有影响.

目的 观察丁苯酞对急性脑血栓形成患者血浆溶血磷脂酸(LPA)水平及临床疗效的影响.方法 急性脑血栓形成患者96例,随机分为添加丁苯酞治疗组(丁苯酞组48例)和不添加丁苯酞治疗组(常规治疗组48例);同时选择门诊体检者为正常对照组(48例).分别测定入院时和治疗后3 d,7 d,14 d血浆LPA水平,采用美国国立卫生研究所脑卒中量表进行评估临床病情严重程度和治疗效果,治疗前及治疗14 d后采用Bar-thel指数(BI)、焦虑量表(SAS)和抑郁量表(SDS)等测试.结果 两组急性脑血栓形成患者血浆LPA水平均较正常对照组明显增高(P<0.01);丁苯酞组和常规治疗组血浆LPA水平在治疗后3 d和7 d逐渐下降,14 d基本降至正常水平,两组治疗后神经功能缺损程度均有改善,日常生活能力均有提高,但丁苯酞组优于常规治疗组(P<0.01).与治疗前及与常规治疗比较,丁苯酞组治疗14 d后SAS、SDS评分明显降低(P<0.05).结论 在急性脑血栓形成患者治疗中添加丁苯酞可显著降低血浆LPA水平,降低神经功能缺损评分,提高日常生活能力,减轻焦虑、抑郁症状,有效提高患者生存质量.

Objective To study a-synuclein(SNCA)rs356200 and rs356165 loci polymorphism in the patients with Parkin son's disease(PD)and to investigate the correlation between SNCA gene polymorphism and PD cognitive impairment.Methods One hundred and twenty cases of PD in our hospital from June 2014 to December 2015 and 120 heaalthy people were selected as the research subjects.The PD cases served as the PD group and 120 healthy subjects as control group.The PD cases were also divided into the cognitive impairment group and non-cognitive impairment group according to the cognitive impairment.The rs356200 and rs356165 allele frequencies and genotype in each group were studied.Results The rs356200 allele frequency had statistical difference between the PD group and control group(P＜0.05),the rs356200 G/G,A/A and A/G genotype had statistical difference between the PD group and control group(P＜0.05).The rs356165 allele frequency had no statistical difference between the PD group and the control group(P＞0.05),the rs356165 G/G,A/A and A/G genotype had statistical difference between the PD group and control group(P＜0.05).The rs356200 and rs356165 allele frequencies and genotype had no statistical difference between the cognitive impairmentgroup and non-cognitive impairment group(P＞0.05).Conclusion The morbidity of PD is related to SNCA gene rs356200 and rs356165 sites polymorphism.PD cognitive dysfunction has no significant correlation with SNCA gene rs356200 and rs356165 loci polymorphism.

急性门静脉血栓形成（acute portal vein thrombosis，APVT）是一种少见且临床表现复杂的急腹症，约占肠道血管性疾病的5％～15％［1］。急性广泛门静脉血栓形成（acute extensive por-tal vein thrombosis，AEPVT）是指门静脉、脾静脉、肠系膜上静脉、肠系膜下静脉中有2条或2条以上血管急性血栓形成［2］，在临床更为罕见，治疗上也更为棘手。本文报道2例肠系膜上动脉置管溶栓联合全身抗凝治疗AEPVT的病例。

目的：探讨同型半胱氨酸（ Hcy）及代谢酶基因遗传多态性、叶酸和维生素B12与溃疡性结肠炎（ UC）的相关性。方法选择UC患者60例为观察组，选取同期健康体检人员60例作为对照组。观察两组Hcy、亚甲基四氢叶酸还原酶（ MTHFR）及甲硫氨酸合成酶（ MS）的基因多态性及叶酸和维生素B12水平。结果观察组Hcy为（14.74±1.69） mol/L，高于对照组〔（10.26±1.48） mol/L，P＜0.05〕。观察组叶酸和维生素 B12分别为（5.10±0.43） ng/ml和（241.63±10.51） pg/ml，均低于对照组〔（6.28±0.75）ng/ml和（376.52±11.38） pg/ml，P＜0.05〕。两组 MTHFR 和MS基因型频率及等位基因频率比较，差异具有显著性（P＜0.05）；观察组治疗后Hcy为（11.33±1.50） mol/L，低于对照组（P＜0.05）；观察组治疗后叶酸和维生素B12分别为（6.04±0.58） ng/ml和（312.75±11.49） pg/ml，均高于对照组（P＜0.05）。结论 UC患者中 Hcy升高，叶酸和维生素 B12浓度降低， Hcy及代谢酶基因遗传多态性、叶酸和维生素B12可能与UC密切相关。

大约2／3以上的脑卒中病患者发生不同程度的焦虑症〔1〕。而且，焦虑症将导致患者起居失常、心理障碍等，容易诱发再次发病或加重原有病情。因此，有效控制脑卒中后焦虑症对于脑卒中的恢复至关重要。国内外多采用口服阿普唑仑等药物改善焦虑症状，临床疗效不理想且疗效难持久。本研究拟观察西药疗法和针药结合疗法治疗脑卒中后焦虑症的临床疗效。

目的探讨同型半胱氨酸（Hcy）及代谢酶基因遗传多态性、叶酸和维生素B12与溃疡性结肠炎（UC）的相关性。方法选择UC患者60例为观察组,选取同期健康体检人员60例作为对照组。观察两组Hcy、亚甲基四氢叶酸还原酶（MTHFR）及甲硫氨酸合成酶（MS）的基因多态性及叶酸和维生素B12水平。结果观察组Hcy为（14.74±1.69）mol/L,高于对照组〔（10.26±1.48）mol/L,P＜0.05〕。观察组叶酸和维生素B12分别为（5.10±0.43）ng/ml和（241.63±10.51）pg/ml,均低于对照组〔（6.28±0.75）ng/ml和（376.52±11.38）pg/ml,P＜0.05〕。两组MTHFR和MS基因型频率及等位基因频率比较,差异具有显著性（P＜0.05）;观察组治疗后Hcy为（11.33±1.50）mol/L,低于对照组（P＜0.05）;观察组治疗后叶酸和维生素B12分别为（6.04±0.58）ng/ml和（312.75±11.49）pg/ml,均高于对照组（P＜0.05）。结论 UC患者中Hcy升高,叶酸和维生素B12浓度降低,Hcy及代谢酶基因遗传多态性、叶酸和维生素B12可能与UC密切相关。

Objective To explore the suitable human albumin infusion speed in the liver cirrhosis patients with portal hypertension .Methods Fifty-eight portal hypertension patients need to infusion human albumin(50 ml,20%) were chosen and divided into the control group (n =30) and the experimental group ( n=28) by using the coin toss method .The control group received the infusion speed of 25 gtt/min for 45 min, and the experimental group received the infusion speed of 33 gtt/min for 30 min.The portal vein inside diameter (Dpv), mean blood flow velocity (Vpv), blood flow volume (Qpv) and the portal vein pressure measured by the color doppler ultrasound diagnostic instrument were compared at different times between two groups .Results At the end of the infusion, the Dpv,Vpv,Qpv and the portal vein pressure in the control group were (13.03 ± 2.01)mm,(9.40 ±2.06)cm/s,(782.29 ±313.02)ml/min and (2.747 ±0.348)kPa respectively, compared with the experimental group, and the differences were not statistically significant (t=-0.04,0.81,0.46,0.55, respectively;P>0.05).Conclusions It is feasible to input 10 g human albumin (50 ml,20%) during 30 min for the portal hypertension patients .

目的 探讨卡托普利预处理对急性心肌损伤大鼠心肌细胞凋亡及凋亡相关基因表达的影响.方法 将Wistar雄性大白鼠随机分为3组:对照组、异丙基肾上腺素损伤组(Iso损伤组)、卡托普利预处理组(Cap预处理组).用TUNEL方法检测心肌细胞凋亡,用免疫组化方法检测Fas、FasL、Bcl-2和Bax蛋白表达.结果 Cap预处理组与Iso损伤组比较,心肌细胞凋亡指数减少,Fas、FasL和Bax蛋白表达降低,Bcl-2蛋白表达增高(P＜0.01或P＜0.05).结论 卡托普利可通过减少心肌细胞凋亡及降低凋亡相关基因的表达发挥心肌保护作用.

Objective To value stability of carotid atherosclerotic plaque. Method Forty-four symptomic patients in our hospital from June 2011 to June 2012 were selected as candidates. Intraplaque neovascularization of their plaques were studied on contrast-enhanced ultrasonic( CEUS) imaging. All these patients were monitered on Transcranial Doppler to find micro embolus signal( MES),in order to confirm whether there is micro embolus dropping. Those patients who were positive on both CEUS and MES,were reviewed their previous results of the CT or MRI scanning to find whether there were some fresh infarcts. Then those patients with fresh infarcts were verified with unstable plaques. Twenty-four patients with hyperecho plaque were matched group. In addition,the TCD results had been reviewed to exclude middle cerebral artery stenosis. Results( 1) Among the 44 patients on ECUS,34 patients imaging showed neovascularization,including 20( 58. 8%)neovasculariztion patients showing hypoecho or isoecho plaque,and 16( 47. 1%) neovasculariztion patients showing mixed echo with dominant hypoecho or isoecho plaque,while matched group showed negative. The results of CEUS in two groups were significantly different. The matched group were negative.( 2) Sixteen cases among 44 cases were positive on MES,including 2 cases of CEUS imaging were negative.( 3) Those patients with intraplaque neovascularization were grade 2 and grade 3 on ECUS,whose MES positive rate were higher than else groups.( 4) These patients MRI results were reviewed to confirm fresh infarction. And their TCD results were also reviewed to excluded middle cerebral artery stenosis. Conclusion Intraplaque neovascularization grade 2 and grade 3 on CEUS may indicate vulnerable plaque.

目的 探讨缺血后处理对大鼠脑缺血再灌注后星形胶质细胞(AS)的影响.方法 54只Wistar雄性大鼠随机分为假手术(Sham)组、缺血后处理(I/R)组、缺血后处理(IP)组.采用线栓法建立大鼠大脑中动脉缺血模型,脑缺血2h后,IP组给予缺血后处理.于脑缺血再灌注后24 h行TrC染色观察脑梗死体积,免疫组化法观察AS中胶质纤维酸性蛋白(GFAP)的表达情况,应用透射电镜观察AS的超微结构变化.结果 IP组脑梗死体积明显小于I/R组,IP组AS损伤均轻于I/R组,IP组AS GFAP阳性细胞数明显多于I/R组.结论 缺血后处理可减小脑梗死体积,减轻AS损伤,增加细胞活化程度,对AS具有保护作用.

目的探讨Gadd45a在人脑胶质瘤细胞中的表达及其与细胞凋亡及增殖的关系。方法采用RT-PCR方法检测正常人脑组织和胶质瘤细胞系U251中的Gadd45a mRNA的表达水平。流式细胞仪检测细胞凋亡率及细胞周期。MTT法检测细胞增殖率。结果正常人脑组织Gadd45a mRNA表达水平明显高于U251细胞(P<0.05)。U251细胞在S期比例明显高于正常人脑神经细胞,G2-M期比率明显降低(P<0.05)。U251细胞凋亡率明显低于正常人脑细胞(P<0.05),增殖率明显高于正常人脑神经细胞(P<0.05)。结论 Gadd45a基因低表达导致细胞多处于S期,降低细胞凋亡率从而促进人脑胶质瘤的发生发展。

老年性皮肤瘙痒症患者可感觉全身或局部瘙痒,严重的影响生活质量[1,2].因其发病原因复杂,故老年瘙痒症治疗方法多种多样,但疗效大多不够理想.本文观察依巴斯汀联合卡介菌多糖核酸治疗老年瘙痒症的临床疗效、不良反应及对血浆组胺水平的影响.

目的 探讨经阴道能量多普勒显像(PDI)评价高强度聚焦超声(HIFU)治疗子宫肌瘤近期疗效的应用价值.方法 15例子宫肌瘤患者(共23个肌瘤)经HIFU治疗后,分别于治疗前、治疗后1、3、6个月行经阴道PDI检查,利用Photoshop软件测量肌瘤内彩色面积像素值占肌瘤总面积像素值的百分比(BCR),并进行分级判定.分级标准: BCR=0为Ⅰ级, 0＜BCR＜5%为Ⅱ级, 5%≤BCR＜20% 为Ⅲ级, BCR≥20%为Ⅳ级.Ⅰ、Ⅱ级为治疗有效,Ⅲ级为治疗好转,Ⅳ级为无效.结果 治疗后子宫肌瘤内回声增强,肌瘤体积逐渐变小(P<0.01),BCR定量分析显示治疗后1、3、6个月有效率分别为100%(15/15)、93.3%(14/15)、86.7%(13/15).结论 经阴道PDI以其价廉、便捷、敏感、准确等优势,为HIFU治疗子宫肌瘤的近期疗效观察及评价提供了一种方便有效的方法.

目前国内外多数研究认为幽门螺杆菌(Hp)感染与动脉粥样硬化(AS)相关(1),而Pasceri等进一步研究发现冠心病(CHD)患者细胞毒素相关蛋白(CagA)阳性Hp感染率高于健康对照组,而CagA阴性的Hp感染率在两组间无明显差异[2].因此,进一步研究Hp的毒力因子CagA在冠心病发病中的作用尤为重要.本研究采用酶联免疫吸附法(ELISA)检测150例CHD患者的Hp感染状况以及CagA的阳性率,并在此基础上分析CagA阳性的Hp感染者血清高敏C反应蛋白(hs-CRP)、热休克蛋白60(HSP60)及细胞间黏附因子-1(ICAM-1)的含量变化，为深入探讨CHD的发生、发展提供科学依据.