目的 探讨翻转课堂结合CBL+TBL教学模式在留学生中医妇科学网络教学中的应用效果.方法 选取北京中医药大学新冠疫情期间参与中医妇科学线上学习的2018 级中医班留学生实施该教学法,通过期末综合成绩评定和问卷调查综合评价教学效果.结果 应用线上翻转课堂结合CBL+TBL教学模式的2018 级学生的期末综合成绩优于常规线上教学的 2016 级和 2017 级学生的成绩,具有统计学意义(P＜0.05);调查问卷显示该教学法在提高学生临床思维能力、自主学习能力、学习兴趣、综合素质和教学满意度方面有积极作用.结论 新冠疫情期间实施翻转课堂结合CBL+TBL教学模式可以提高中医妇科学网络教学的教学效果.

教学查房是中医院校临床教学工作中最重要的教学活动之一,以学生为中心的教学理念应贯穿教学查房过程中,不断挖掘和培养中医院校学生的临床思维能力.基于OBE理念的教学查房以实现预期教学成果为依据,以学生课后反馈为驱动,以启发式及引导式教学为主,注重学情分析和总结,可根据学生的实际情况调整教学方案,过程可持续改进,真正体现了以学生为中心,应得到推广应用.

Hedysari Radix Praeparata Cum Melle (HRPCM) and Astragali Radix Praeparata Cum Melle (ARPCM) are used interchangeably in clinics to treat spleen-qi deficiency (SQD) symptom mainly including gastrointestinal dysfunction and decreased immunity, which has unknown differences in efficacy. To investigate the differences between HRPCM and ARPCM on intervening gastrointestinal- and immune-function with SQD syndrome. After the SQD model was established, the Sprague–Dawley (SD) rats were randomly divided into nine groups (n = 10): normal; model; Bu-Zhong-Yi-Qi Pills; 18.9, 12.6 and 6.3 g/kg dose groups of HRPCM and ARPCM. Gastrointestinal function including d-xylose, gastrin, amylase vasoactive intestinal peptide, motilin, pepsin, H+/K+-ATPase, Na+/K+-ATPase, sodium-glucose cotransporter 1 (SGLT1), glucose transporter 2 (GLUT2) and immune function including spleen and thymus index, blood routine, interleukin (IL)-2, IL-6, interferon-γ (IFN-γ), tumour necrosis factor-α (TNF-α), immunoglobulin (Ig) M, IgA, IgG and delayed-type hypersensitivity (DTH) were detected. Finally, the efficacy differences were analysed comprehensively by the fuzzy matter-element method. In regulating immune, the doses differences in efficacy between HRPCM and ARPCM showed in the high-dose (18.9 g/kg), but there were no differences in the middle- and low- dose (12.6 and 6.3 g/kg); the efficacy differences were primarily reflected in levels of IL-6, IFN-γ, TNF-α and IgM in serum, and the mRNA expression of IL-6 and IFN-γ in the spleen. In regulating gastrointestinal, the efficacy differences were primarily reflected in the levels of D-xylose, MTL, and GAS in serum, and the mRNA and protein expression of SGLT1 and GLUT2 in jejunum and ileum. HRPCM is more effective than ARPCM on regulating gastrointestinal function and immune function with SQD syndrome. Therefore, we propose that HRPCM should be mainly used to treat SQD syndrome in the future.

目的 观察补肾活血通络法治疗薄型子宫内膜肾虚血瘀证的临床疗效.方法 选取68例薄型子宫内膜患者,采用随机数字表法将入组患者随机分为治疗组34例、对照组34例.剔除脱落病例后,治疗组30例、对照组30例.治疗组予补肾活血通络方加减治疗,对照组予口服戊酸雌二醇加黄体酮胶囊治疗.观察子宫内膜厚度、子宫内膜类型、子宫内膜血流类型、子宫内膜血流阻力指数(RI)和搏动指数(PI)值、子宫动脉RI和PI值、中医症状评分.结果 治疗后2组子宫内膜厚度均较治疗前增厚,差异均有统计学意义(P＜0.05).治疗后治疗组A型内膜比例高于对照组、C型内膜比例低于对照组,差异均有统计学意义(P＜0.05),治疗组优于对照组.治疗后2组子宫内膜血流类型均较治疗前改善(P＜0.05),治疗组优于对照组,差异均有统计学意义(P＜0.05).治疗后,治疗组患者子宫内膜血流RI,PI较治疗前降低(P＜0.05),治疗后2组患者子宫动脉血流RI,PI较治疗前降低(P＜0.05).治疗后2组月经量、行经时间评分较本组治疗前均降低,差异均有统计学意义(P＜0.05).治疗后,治疗组月经色质、腰膝酸软、头晕耳鸣、行经腹痛评分较本组治疗前均降低,差异均有统计学意义(P＜0.05).治疗后,治疗组各症状及总积分较对照组降低明显,治疗前后症状评分差值比较,差异均有统计学意义(P＜0.05).结论 补肾活血通络法治疗薄型子宫内膜肾虚血瘀证具有较好的临床效果.

胞络为络脉之一,胞络为病亦分虚实.薄型子宫内膜的发生分为胞络虚损和胞络不通两方面.因胞络空虚,无血可充,导致胞宫失养为病者当属虚;因寒、热、湿、毒外邪入侵及金刃等不内外因导致胞络气血运行不畅、瘀血内阻、络脉不通而无法将气血输送至胞宫者当属实.薄型子宫内膜的治疗应以通络为主,根据虚实不同,可分为扶正通络和祛邪通络.扶正通络重视补肾,治疗时阴阳同补,使肾中阴阳互根互用,消长平衡,常选用熟地、骨碎补、续断、川牛膝、巴戟天等;祛邪通络以活血贯穿始终,在应用当归、鸡血藤等活血中药的同时,应用川芎等行气类药物以助活血之力,调理络中气血,同时选用路路通、桂枝等辛温通络之品标本兼治,共奏行气活血通络之功.

Purpose: To explore the therapeutic role of amber powder in endometriosis by investigating its effect on endometrial ultrastructure, ERK1/2, p38MAPK, and NF-κB mRNA pathways and CSRC/EFR/ERK1/2 proteins. Methods: Sprague Dawley (SD) rats were randomly divided into blank group, disease model group (untreated), amber powder high-dose group, amber powder medium-dose group, amber powder lowdose group and danazol group. Morphological changes in endometrial cells were studied using transmission electron microscopy. The expression of ERK1/2, p38MAPK, and NF-κB mRNA in endometrial tissues of each group was determined using quantitative real-time polymerase chain reaction (qRT-PCR). Immunohistochemistry was utilized for the measurement of C-SRC/EFR/ERK1/2 pathway protein expression. Results: The endometriosis rats treated with a high-, mediumand low-dose amber powder showed a decrease in the volume of ectopic lesions, compared with the untreated disease model group. The expressions of ERK1/2, p38MAPK, NF-κB mRNA, and C-SRC/EFR/ERK1/2 protein were higher in the eutopic and ectopic endometrial tissues in untreated disease group than those in normal control group. Moreover, treatment of endometriosis rats with amber powder revealed a reduction in the expressions of ERK1/2, p38MAPK, NF-κB mRNA and C-SRC/EFR/ERK1/2 proteins in eutopic and ectopic endometrium tissues. Conclusion: Amber powder reduces ectopic lesions and slows down the development of endometriosis, probably via inhibition of MAPK pathway genes in eutopic and ectopic endometrial tissues.

目的:探索围着床期小鼠子宫内膜自噬情况.方法:选择36只ICR妊娠小鼠随机分为空白组、胚胎着床障碍模型组,每组小鼠18只.模型组采用米非司酮制备,每组每日予以生理盐水灌胃,分别于妊娠第4、5、6天脱颈处死小鼠各6只.观察子宫形态,计算各组平均胚胎着床位点数,检测自噬标志物微管相关轻链蛋白3-Ⅱ(LC3-Ⅱ),透射电镜观察子宫内膜细胞中自噬小体的表达.结果:空白组妊娠第4天(pd4)子宫无明显串珠样改变,妊娠第5天(pd5)、妊娠第6天(pd6)子宫串珠样改变明显且分布均匀.模型组pd4、pd5未见明显串珠样改变,pd6可见少量串珠稀疏分布.空白组pd6的胚胎着床位点数较pd4增多,差异有统计学意义(P<0.05);而pd5的胚胎着床位点数与pd4比较有增多,但差异无统计学意义(P>0.05).模型组pd5、pd6平均胚胎着床位点数分别低于空白组pd5、pd6(P<0.05,P<0.01).2组LC3-Ⅱ蛋白水平差异无统计学意义(P>0.05).透射电镜下空白组小鼠子宫内膜细胞完整,pd5自噬小体数量较pd4减少,pd6又增多.模型组部分细胞损伤、坏死,pd4自噬小体表达较空白组多,亦较模型组pd5、pd6多.结论:自噬参与并调控胚胎着床过程,自噬异常可能破坏子宫内膜细胞活性和功能,影响胚胎着床.

By summarizing the recent literatures on brain mechanisms with acupuncture intervention based on blood oxygenation level-dependent (BOLD)-functional magnetic resonance imaging (fMRI), the BOLD-fMRI examination and analysis methods, the points to be acupunctured, the corresponding meridian activation regions, the specific intensity range, functions and indications of the acupoints, the manifestation of 'bi-directional regulation' characteristics, fMRI performance of chronergy, laterality and needling qi of acupuncture were reviewed to provide the ideas for future research in this area.

目的 观察补肾活血通络方联合人工周期治疗促进宫腔粘连术后内膜恢复的效果.方法 选取2018年1月—2019年12月就诊于北京中医药大学第三附属医院妇科门诊的宫腔粘连分离术后恢复期患者60例,随机分为对照组和观察组各30例,对照组患者给予人工周期治疗,观察组则在对照组治疗基础上联合应用补肾活血通络方治疗,2组均治疗3个周期.比较2组患者治疗前后子宫内膜厚度以及子宫内膜血流搏动指数、阻力指数,中医症状及粘连程度评分、月经状况(月经量、月经周期、月经色质)评分,评价2组临床疗效.结果 治疗后2组子宫内膜厚度均明显增加(P均<0.05),子宫内膜血流搏动指数、阻力指数均明显下降(P均<0.05),观察组各检测指标变化幅度均明显高于对照组(P均<0.05);治疗后2组中医症状及粘连程度评分均明显下降(P均<0.05),观察组各项评分均明显低于对照组(P均<0.05);治疗后2组月经量、月经周期和月经色质评分均较治疗前明显下降(P均<0.05),观察组下降幅度明显高于对照组(P均<0.05);观察组治疗总有效率为93.3％(28/30),对照组为83.3％(25/30),观察组明显高于对照组(P<0.05).结论 补肾活血通络方联合人工周期应用于宫腔粘连术后可有效促进子宫内膜功能恢复,改善粘连状态及中医症状,疗效确切.

薄型子宫内膜发病率逐年升高,严重困扰育龄女性生殖健康,该病的治疗也一直是临床上的棘手问题.西医并无统一治疗方案,且治疗效果并不确切.中医治疗该病具有显著优势,笔者潜心研究,临床不断摸索,运用补肾活血通络法治疗该病.笔者补肾重视阴阳同补,兼顾先天与后天之精,活血采用补肾活血、养血活血、行气活血为主,将络病理论应用到该病的治疗,同时注重补心血、安心神、通心阳,临床取得了较好疗效.

目的:系统评价保妇康栓治疗宫颈人乳头瘤病毒(HPV)感染的临床疗效,为宫颈HPV感染患者的临床治疗决策提供依据.方法:计算机检索CNKI、VIP、CBM、Wanfang、EMCC、PubMed、EMBASE、SPRINGER(从建库至2015年5月),纳入以宫颈感染HPV患者为研究对象的随机对照临床试验,使用Cochrane手册评价纳入研究的方法学质量,用Revman 5.0进行统计分析.结果:共15篇文献,2437例患者被纳入本研究,Meta分析结果显示保妇康栓治疗宫颈HPV感染的总有效率[RR=1.72,95％CI(1.5,1.96),P<0.00001],转阴率[RR=2.05,95％CI(1.79,2.35),P<0.00001].结论:保妇康栓治疗宫颈HPV感染临床有效,由于纳入研究质量不高,需要更多高质量、低偏倚风险的随机对照试验加以证实.

王庆国教授为当代名医刘渡舟教授的大弟子,其在继承刘渡舟伤寒学术思想的基础上,结合自身临床经验及现代医学知识,在妇科病方面见解独特.王师非常重视辨证论治,并主张辨证与辨病相结合.现举其辨治痛经三则,以馈同仁.

Primary breast diffuse large B‐cell lymphoma (PB‐DLBCL) is a rare subtype of DLBCL with limited data on patterns of failure. This multicenter study aimed to define the optimum treatment strategy and patterns of failure for PB‐DLBCL patients. We retrospectively reviewed data on 108 PB‐DLBCL patients from 21 Chinese medical centers. Only patients with localized disease (involvement of breast and localized lymph nodes) were included. After a median follow‐up of 3.2 years, 32% of patients developed progression or relapse. A continuous pattern of relapse was observed, characterized by frequent late relapses in the contralateral breast and central nervous system (CNS). Although rituximab significantly reduced the overall cumulative risk of progression or relapse (5‐year cumulative risk 57% vs 24%, P = .029), it had limited effect on the reduction of breast relapse (P = .46). Consolidative radiotherapy significantly decreased the risk of breast relapse, even in the subgroup of patients treated with rituximab (5‐year cumulative risk 21.2% vs 0%, P = .012). A continuous risk of CNS progression or relapse up to 8.2 years from diagnosis was observed (10‐year cumulative risk 28.3%), with a median time to CNS relapse of 3.1 years. Neither rituximab nor prophylactic intrathecal chemotherapy significantly decreased the risk of CNS relapse. In summary, our study indicates that PB‐DLBCL has a continuous pattern of relapse, especially with frequent late relapses in the CNS and contralateral breast. Rituximab and RT confer complementary benefit in the reduction of relapse. However, neither the addition of rituximab nor prophylactic intrathecal chemotherapy could effectively prevent CNS relapse for PB‐DLBCL patients.

目的 分析加味琥珀散治疗50例肾虚血瘀型子宫内膜异位症患者的疗效.方法 对50例肾虚血瘀型子宫内膜异位症患者治疗前后的中医症候评分、血清CA125水平、痛经症状积分、卵巢子宫内膜异位囊肿大小进行统计分析.结果 采用加味琥珀散治疗子宫内膜异位症治愈3例(6％),显效25例(50％),有效21例(42％),无效1例(2％).治疗后3个月受孕率为10％.治疗后中医症候积分、CA125水平、痛经程度、卵巢囊肿大小都较治疗前显著下降(P<0.05).结论 加味琥珀散治疗子宫内膜异位症具有显著性疗效.

随着中医药逐渐被世界认可,来华学习中医的留学生与日俱增,但由于留学生在语言能力、文化背景、学习经历、个人素质等方面的差异和中医药学本身的特点及中国教育体制的因素,导致留学生在学习中医妇科学过程中普遍存在对中医理论的理解不够深入、难以学以致用的问题.为了提高中医留学生的教学质量,笔者在日常中医妇科学课堂教学过程中运用隐性分层教学法、形象教学法、混合式教学法等多种教学方法及手段,取得较好效果.

功能失调性子宫出血为妇科临床多发病,且随现代女性生活和工作压力的增加,发病率明显上升,众多医家多从肝、脾、肾论治,然笔者以心的生理功能为基本理论基础,结合文献和临床经验提出从心论治功血,在辨证论治基础上准确应用解心郁、补心血、清心火、安心神的方法,适当加入入心经药物,往往收到事半功倍的效果.

The menopausal period, an inevitable physiological process for women, is frequently associated with physiological and psychological dysfunction attributable to substantial fluctuation and gradual decrease in female hormones induced by ovarian failure, leading to corresponding symptoms and diseases that impact multiple systems in the body to varying degrees. As prior studies have focused primarily on menopausal syndrome-related pathophysiological changes and hormone replacement therapy effects, here we approached menopausal disease incidence risk and pathogenesis through systemic plasma proteomics analysis. Female Sprague-Dawley rats were randomly divided into sham, ovariectomized, and estrogen treatment after ovariectomy groups (n=9 per group). Tandem Mass Tag quantitative proteomics analysis of their plasma identified over 900 proteins by MS. Between group fold change of >1.2 and p<0.05 (Student's t-test) identified 121 (including 36 up-regulated and 85 down-regulated), 117 (69 up-regulated and 48 down-regulated), and 109 (41 up-regulated and 68 down-regulated) differentially expressed proteins between groups, respectively. Of these, 5 (GHR, LIFR, apoA IV, RTN, and Lin28b) were verified by parallel reaction monitoring to be reliable. Further application of optimized screening criteria and performance of a series of bioinformatics analyses allowed the selection of 35 optimal differentially expressed proteins. Gene ontology annotation results suggested that the differentially expressed proteins are mainly annotated as protein binding, cell, and single organism process in terms of molecular function, cell composition, and biological process, respectively. KEGG pathway analysis indicated that the PI3-Akt pathway has the highest aggregation degree of differentially expressed proteins. Protein-protein interaction analysis noted GLUT4 as an important node protein. This research is the first to comprehensively analyze plasma protein changes, together with estrogen efficacy, in ovariectomized rats. The findings facilitate our understanding of the molecular mechanism of systemic menopausal changes and provide valuable clues for developing diagnostic biomarkers for menopausal dysfunctions and selecting clinical therapeutic strategies.

Cerebral palsy (CP) is the most common childhood disability worldwide, yet biomarkers for predicting CP are lacking. By subjecting peripheral blood samples from 62 CP patients and 30 healthy controls to Affymetrix GeneChip® PrimeView™ HumanGene Expression Microarray analysis, we identified the novel biomarker B-cell lymphoma 6 (BCL6) as the most upregulated gene in the CP samples. Gastrodin is a traditional Chinese medicine and bioactive compound that promotes adductor angle release, as well as gross and fine motor performance by increasing Gross Motor Function Measure-66 and Fine Motor Function Measure-45 scores. Gastrodin upregulates the mRNA expression of Mgl2 and Mrc1, M2 macrophage markers, and arginase activity, an M2 polarization indicator, in murine RAW264.7 macrophages. Moreover, these effects were blocked by BCL6 siRNA, which also abrogated the protective effects of Gastrodin against hydrogen peroxide-induced apoptosis and death in RAW264.7 cells. Our work identified BCL6 as a novel biomarker for early prediction of CP. Moreover, we demonstrated that Gastrodin not only stimulated polarization toward M2-like macrophages, which promote tissue repair, but also rescued macrophages from oxidative stress, apoptosis and death by inducing BCL6 expression. BCL6-targeted therapeutic strategies have promise for improving motor performance in CP patients.

Extranodal natural killer (NK)/T cell lymphoma-associated hemophagocytic syndrome (HPS) (NK/T-LAHS) is a heterogeneous and life-threatening disease, which warrants investigation of its risk factors and clinical features. We retrospectively analyzed the clinical records of 202 patients with extranodal NK/T cell lymphoma and compared the characteristics and survival of extranodal NK/T cell lymphoma patients with and without HPS. The cumulative incidence of NK/T-LAHS was 11.4 % (23/202). In a multivariate logistic regression model, younger age (p = 0.012), bone marrow involvement (p = 0.012), and reduced serum albumin (p < 0.001) were independent risk factors for developing HPS in patients with extranodal NK/T cell lymphoma. The survival of extranodal NK/T cell lymphoma patients was aggravated when complicated with HPS, with an overall 2-year survival of 72.1 and 30.4 %, respectively (p < 0.001). Six patients with HPS onset at lymphoma diagnosis tended to have a poor performance status (p = 0.040), while the rate of elevated bilirubin was significantly higher in 17 patients with HPS onset at lymphoma relapse (p = 0.045). After HPS onset, treatment response was poor (response rate, 17.4 %) and survival was dismal with a median of 26 days. Univariate analysis showed that patients with lactate dehydrogenase >1000 U/L (p = 0.048) and disseminated intravascular coagulation (p = 0.004) had shorter survival time. Extranodal NK/T cell lymphoma was frequently complicated with HPS, and survival was discouraging in this circumstance. Intensive chemotherapy regimens including l-asparaginase or pegaspargase and allogeneic stem cell transplantation should be investigated.