目的:研究心内科临床见习教学中微信平台的应用效果.方法:观察对象为2020年于我院心内科实习的60例临床见习学生,参考随机数字表法分为研究组(30例)与对照组(30例),对照组选取传统教学模式,研究组基于传统教学行微信公众平台教学模式,比较两组专业技能(仪器、用具、诊治、沟通)评分与理论知识评分、临床技能评分、批判性思维能力评分、综合能力评分、满意度.结果:研究组专业技能评分与理论知识评分、临床技能评分、批判性思维能力评分、综合能力评分、满意度较对照组更高,差异有显著性(P ＜ 0.05).结论:心内科临

1 基本情况 患者,男,17岁.1年前体检时发现血压升高,当时血压为 170/120 mm Hg(1 mm Hg=0.133 kPa),偶有头晕、胸闷,无头痛,无气促.夜间无打鼾及呼吸暂停,无阵发性颜面潮红,无心悸,无夜尿增多,无四肢麻木,无恶心、呕吐,未服药,未规律监测血压.为查明高血压病因入住我科.既往史:既往体健.否认特殊个人史.反复仔细询问患者家族史,但均否认家庭成员中有类似疾病患者.

Objective:To investigate the effects of poly adenosine diphosphate ribose polymerase-1(PARP-1) inhibitor fluzoparib on proliferation, apoptosis and migration of pancreatic cancer PANC1 cells.Methods:PANC1 cells cultured in conventional culture medium were used as control group, and PANC1 cells cultured in the medium containing fluzoparib were used as fluzoparib group. The effects of fluzoparib with different concentrations on the proliferation of PANC1 cells were detected by CCK8 method, and the half inhibitory concentration (IC 50) of fluzoparib on PANC1 cells was calculated. The effect of fluzoparib on apoptosis and cell cycle of PANC1 cells was detected by flow cytometry, and the migration ability of PANC1 cells was detected by cell scratch test and Transwell chamber. Results:Compared with control group, with the increase of fluzoparib concentration and the prolongation of the action time, the cell proliferation activity of PANC1 in fluzoparib group was significantly decreased, and the differences were statistically significant (all P values <0.05). IC 50 of fluzoparib on PANC1 cells cultured for 24 h was 0.03 mmol/L. After 24 h culture, the IC 50 apoptosis rate of fluzoparib group was (32.19±2.48)%, and the apoptosis rate of control group was (21.99±6.30)%. The former was greatly higher than the latter, and the difference was statistically significant ( P<0.05). The proportion of cells in G 2/M phase was (16.28±0.62)% in the fluzoparib group and (11.64±0.88)% in the control group, and the difference between the two groups was statistically significant ( P<0.05). The migration rates of PANC1 cells in IC 50 fluzoparib group in 12 h and 24 h culture were (2.59±1.46)% and (19.76±7.84)%; and those in control group were (27.08±2.17)% and (45.92±3.61)%, respectively. The number of transmembrane cells was (348±19) cells/10 visual field in the fluzoparib group and (587±14) cells/10 visual field in the control group. The migration ability of PANC1 cells in fluzoparib group was significantly lower than that in control group ( P<0.05). Conclusions:Fluzoparib can inhibit the proliferation and migration of PANC1 cells and promote the apoptosis of PANC1 in vitro, which may be an effective drug for the treatment of pancreatic cancer.

炎症学说认为动脉粥样硬化(As)是由修饰的脂质颗粒与单核细胞、巨噬细胞共同参与的免疫炎症反应.补体系统作为先天性免疫的一部分,是As发生发展的重要参与者.部分补体成分在As发生发展过程中的作用有新的进展,例如,补体蛋白C1q在As中具有双重作用,即致As作用和抗As作用;补体成分C3通过与其受体结合或形成非蛋白水解中间体,参与As及晚期血栓形成;补体成分C3a与C3a受体、C5a与CSa受体1或C5a受体2结合后,通过不同途径促进核苷酸结合寡聚化结构域样受体热蛋白结构域亚家族成员3炎症小体活化、白细胞介素1β分泌,促进As发生;C5b-9补体复合物通过致动脉内皮功能障碍,从而发挥致As作用,且补体应答基因32是其关键效应因子.

目的:制备黄芩苷(BAI)聚乙二醇衍生化磷脂酰乙醇胺(BAI@PEG-PE)纳米胶束,并对其进行表征和细胞毒性研究.方法:采用薄膜水化法制备BAI@PEG-PE纳米胶束,观察其外观特征,检测其粒径、多分散系数(PDI)、Zeta电位、载药量、包封率.比较BAI原料药和BAI@PEG-PE纳米胶束在pH 7.4磷酸盐缓冲液中1～84 h内的释药情况.以香豆素6为荧光探针,观察PEG-PE纳米胶束在H9c2心肌细胞中的分布.将H9c2心肌细胞分为模型组、BAI原料药组和BAI@PEG-PE纳米胶束组,用不含药或含相应药物的无血清DMEM培养液培养0.5 h后,用异丙肾上腺素诱导心肌细胞凋亡,比较3组细胞的细胞核形态变化、细胞凋亡率和凋亡相关蛋白B淋巴细胞瘤2(Bcl-2)及其X蛋白(Bax)的蛋白表达水平.结果:所制备的BAI@PEG-PE纳米胶束呈现大小比较均一的圆球形,其粒径为(16.7±0.8)nm,PDI为0.11±0.01,Zeta电位为(-18.4±0.6)mV,载药量为(7.84±0.65)％,包封率为(85.7±4.9)％(n=3),84 h的累积释放度为76.5％,而BAI原料药在24 h内已基本释放完全.PEG-PE纳米胶束可增强H9c2心肌细胞对香豆素6的摄取,且主要聚集在线粒体周围.与模型组比较,BAI原料药组和BAI@PEG-PE纳米胶束组细胞的凋亡形态明显改善,凋亡率明显降低,Bcl-2蛋白表达明显增强,Bax蛋白表达水平明显降低,差异均有统计学意义(P<0.05或P<0.01),其中BAI@PEG-PE纳米胶束组的上述效果更明显(P<0.05或P<0.01).结论.成功制得BAI@PEG-PE纳米胶束,其具有明显的缓释作用、心肌靶向性,可预防心肌细胞的凋亡.

目的 探讨急性冠状动脉综合征患者中性粒细胞/淋巴细胞比值(NLR)与冠状动脉病变程度的相关性,以及与经皮冠状动脉介入治疗(PCI)术后心血管终点事件的相关性.方法 回顾分析302例首次在我院住院并行PCI术的急性冠状动脉综合征患者,其中男性218名,女性84名,年龄62.18±10.18岁.依据冠状动脉造影结果进行Gensini评分并将其分为低分组(≤46.5分)和高分组(＞46.5分);检测外周血白细胞分类计数并计算NLR,Logistic回归分析探讨NLR与Gensini评分的相关性.PCI术后平均随访15个月,再依据随访是否发生心血管终点事件将急性冠状动脉综合征患者分为事件组和非事件组.应用受试者工作特征曲线(ROC曲线)来分析NLR对急性冠状动脉综合征患者PCI术后心血管终点事件的预测价值.结果 高分组患者合并高血压及NLR值明显高于低分组,而高密度脂蛋白胆固醇(HDLC)水平明显低于低分组(P＜0.05);Logistic回归分析显示NLR值、高密度脂蛋白胆固醇水平均为急性冠状动脉综合征患者高Gensini评分的独立危险因素.302例急性冠状动脉综合征患者PCI术后有49例发生心血管终点事件,事件组老年患者(≥60岁)、高血压、糖尿病、低高密度脂蛋白胆固醇水平及NLR值均显著高于非事件组(P＜0.05);ROC曲线分析显示,NLR预测急性冠状动脉综合征患者PCI术后发生心血管终点事件的曲线下面积为0.710(95％CI为0.632～ 0.788,P＜0.05),当NLR切点值取3.985时,其诊断效率最高,敏感性为67.3％,特异性为70.4％.Kaplan-Meier曲线分析显示,NLR值＞3.985的患者心血管终点事件发生率明显高于NLR值＜3.985者(P＜0.05);多因素COX回归分析显示NLR值、老年、高血压与糖尿病均为急性冠状动脉综合征患者PCI术后心血管终点事件发生的独立预测因子.结论 高NLR值可作为急性冠状动脉综合征患者冠状动脉病变程度及PCI术后心血管终点事件的独立预测因子.

目的 探究血液灌流(HP)联合血液滤过(HF)治疗百草枯中毒的可行性及安全性.方法 将50例百草枯中毒患者随机分为两组,各25例.对照组入院后行常规治疗,观察组在对照组基础上实施HP联合HF治疗.比较两组患者的百草枯血药浓度、血肌酐水平、临床疗效、病死率以及多器官功能障碍综合征(MODS)、急性呼吸窘迫综合征(ARDS)和急性肾功能衰竭(ARF)发生率.结果 治疗后,观察组患者百草枯血药浓度和血肌酐均低于对照组(P<0.01);观察组患者MODS、ARDS和ARF的发生率均低于对照组(P<0.05);观察组治疗效果高于对照组,病死率低于对照组,差异均具有统计学意义(P<0.05).结论 HP联合HF治疗百草枯中毒,能有效降低百草枯血药浓度和血肌酐水平,提高治疗有效率,降低并发症发生率和病死率.

目的 探讨白细胞介素4(IL-4)对人类单核细胞株THP-1巨噬细胞源性泡沫细胞三磷酸腺苷结合盒转运体A1(ABCA1)表达及细胞内胆固醇流出的影响及机制.方法 THP-1巨噬细胞源性泡沫细胞加入不同浓度的IL-4,处理不同时间,以及加入肝X受体α(LXRα)激动剂T0901317处理后,采用半定量RT-PCR和Western blot分别检测细胞ABCA1及LXRα mRNA和蛋白质的表达,采用油红O染色观察细胞内脂质蓄积情况,使用液体闪烁计法检测细胞内胆固醇流出,采用高效液相色谱法检测细胞内总胆固醇、游离胆固醇和胆固醇酯的量.结果 IL-4能呈浓度和时间依赖性地降低THP-1巨噬细胞源性泡沫细胞ABCA1表达(P＜0.05),并减少细胞内胆固醇流出.加入T0901317后能使IL-4对ABCA1的抑制作用减弱(P＜0.05).结论 IL-4能抑制THP-1巨噬细胞源性泡沫细胞ABCA1的表达及胆固醇的流出.LXRα激活能逆转IL-4对ABCA1的抑制作用.

Plasma cholesterol levels are the major risk factor for atherosclerosis (AS) and coronary heart disease (CHD). Biliary pathway to reverse cholesterol transport (RCT) is the process that cholesterol in peripheral tissue and macrophages is transported to liver by lipoprotion, then secreted into the bile and finally excreted through feces. According to a large number of studies, there is nonbiliary pathway to RCT to clear excess cholesterol in the body, apart from the biliary pathway to RCT. This review focuses on the current views on the different pathways to RCT, and the regulation on the RCT of the relevant transports, lipoprotion, receptor and so on, aiming at providing new theoretical evidence and acting targets for the treatment of cholelithiasis and AS related disease.

目的 通过心内科临床实习教学及考核中应用“模拟诊疗”,培养学生临床诊疗思维及独立工作能力.方法 100名学生随机分成两组,对照组采取常规心内科临床实习教学和考核；观察组采取“模拟诊疗”实习教学和考核,分析学生满意及兴趣度,比较两组学生临床诊疗能力,评价“模拟诊疗”考核不同环节的优缺点.结果 观察组学生实习满意度及兴趣度、医患沟通能力、病例分析技能、临床诊疗能力成绩明显优于对照组,差异有统计学意义(P＜0.05),“模拟诊疗”3环节各有优势特点,其中第2环节客观全面.结论 模拟诊疗考核激发学生学习兴趣,使技能考核的结果更加客观公正,使学生更明确实习的目的及学习的积极性；培养学生独立临床工作能力.

Objective To study the effect of 3T3-L1 adipocyte fatty acid-binding protein(A-FABP) gene on secretion of adipocyte-synthesized triglyceride and adiponectin by constructing its micro RNA expression vector using RNAi technology.Methods A microRNA expression vector for A-FABP gene was constructed and transfected into 3T3-L1 adipocytes.Expression of A-FABP mRNA and protein was detected by RT-PCR and Western blot,respectively.A model of silent A-FABP gene was established.Free fatty acid(FFA) cells(0.5 mmol/L) and mature adpocytes were incubated for 24 h and divided into control group,FFA group,RNAi group,and RNAi + FFA group.Triglyceride and adiponectin levels were measured by ELISA.Expression of A-FABP and adiponectin mRNA was detected by RT-PCR.Results The microRNA expression vector after transfected into 3T3-L1 adipocytes could significantly inhibit the expression of A-FABP mRNA and protein.The synthesis of triglyceride increased significantly while the secretion of adiponectin decreased significantly with the increasing fatty acid concentration in adipocytes(P<0.05).The triglyceride level was significantly lower while the adiponectin secretion level and the adiponectin mRNA expression level were significantly higher in RNAi and RNAi+ groups than in control and fatty acid groups(P<0.05).Conclusion Silent A-FABP gene may become a new target for preventing and treating atherosclerosis and diabetes mellitus.

脂肪细胞型脂肪酸结合蛋白(adipocyte fatty acid-binding protein,A-FABP)是脂肪酸结合蛋白家族的成员,与饱和/不饱和长链脂肪酸、类花生四烯酸和其他脂质有高度亲和力,参与脂肪酸的吸收、转运和代谢,在糖脂代谢、炎性反应中起重要作用。A-FABP已成为近年研究的热点,该文就A-FABP的分布、性质、作用及其与各类疾病的关系作简述。

<正>脂肪组织不仅能调节能量储存与营养平衡,而且还是活跃的内分泌器官,可分泌多种脂肪细胞因子,如瘦素、抵抗素、脂联素、网膜素等,这些脂肪因子具有广泛的内分泌及心血管活性作用。肥胖时随着脂肪的堆积以及脂肪细胞体积的增大,脂肪因子分泌失调,可引起多种代谢紊乱,如高脂血症、胰岛素抵抗、糖尿病、代谢综合征等。内脂素(visfatin)是新近发现的主要由内脏脂肪组织

Objective To explore the relationship smoking index and coronary artery disease degree and cardiovascular disease prognosis.Methods Retrospective analysis of collection patients with coronary heart disease(CHD) and it' suspected in the Digital Subtraction Angiography(DSA) of the first affiliated hospital of the university of south china in January 2010 to August 2011,1203 cases of coronary angiography were entered in.according to the international standards of CHD and smoking index Coronary artery pathological damage through the Gensini quantitative evaluation scoring system,divided into 5 groups.Results With smoking index increased coronary artery disease severity and disease extent increase significantly,the relationship has the remarkable concentration-response smoking is independent risk factors of coronary heart disease;It also found that age and men is also the risk factors of coronary heart disease.Conclusion Smoking index and coronary artery pathological changes has a significant relationship between the degree,a serious threat to human health and life safety,quit smoking and tobacco control is urgently needed.

凝血系统和纤溶系统的动态平衡是血液正常流动的关键,纤溶酶原激活物抑制物是纤溶系统调节活性的主要因子,它的主要作用是促进血栓的形成,很多研究证实,纤溶酶原激活物抑制物与冠状动脉粥样硬化发生密切相关,可作为心血管疾病的独立危险因素,因此,该研究主要从纤溶酶原激活物抑制物的基本特性、生物学特性、与冠状动脉粥样硬化的关系以及其致病机制几个方面进行综述,以便进一步探讨纤溶酶原激活物抑制物与冠状动脉粥样硬化两者的相关性研究的进展情况。

Objective:Through summarizing the methods of diagnosis and treatment for 48 cases of acute myocardial infarction patients,providing reference for diagnosis and treatment of acute myocardial infarction patients.Methods:Review 48 cases of acute myocardial infarction patients in Department of Cardiology on the first affiliated hospital of University of South China from 2011 June to 2012 January,specification of the diagnosis and treatment.Results:8 patients died,40 patients had recovered.Conclusion:With acute myocardial infarction medical care level standard and rise,with good drug continuous introduction and with disease prevention knowledge propaganda,myocardial infarction cure rate will be greatly improved.7refs.

Vascular endothelial cell injury or dysfunction has been implicated in the onset and progression of cardiovascular diseases including atherosclerosis.Numerous studies have indicated that endothelial cells oxidative and inflammation play an important role in initiation and progress of atherosclerosis.More and more studies have demonstrated that interleukin-4 can increase oxidative stress by inflammatory mediators such as cytokines,chemokines and endothelial cell adhesion molecule.Interleukin-4 can accelerate apoptosis and promote endothelial cell updates through a variety of signaling pathway,which can lead to vascular endothelial dysfunction.These studies will most likely provide new targets or direction for the prevention and treatment of vascular inflammatory diseases such as atherosclerosis.

Aim To explore the influence of adipocyte's triglyceride anabolism and visfatin secretion after silence adipocyte fatty acid binding protein(A-FABP) genes by RNA interference. Methods 3T3-L1 preadipocytes were cultured in vitro and were induced to differentiate into adipocytes,then the adipocytes were cultured with concentration from 0 to 1 mmol/L fatty acid,adipocyte's triglyceride production and visfatin secretion were measured.The micro RNA(miRNA) expression vector plasmid about A-FABP genes was constructed and then transfected with the 3T3-L1 mature adipocytes.A-FABP mRNA expression and A-FABP protein expression were measured by reverse transcription polymerase chain reaction(RT-PCR) and Western blot.After and before slience A-FABP,the adipocytes were cultured with concentration of 0.5 mmol/L fatty acid,visfatin mRNA expression in adipocyte were measured by RT-PCR,adipocyte's triglyceride anabolism and visfatin secretion were detected. Results With the concentration of fatty acid risen in adipocytes,the concentration of triglyceride in adipocyte were raised(P0.05),the concentration of visfatin in adipocyte were raised too(P0.05).Constructing the miRNA expression vector plasmid about A-FABP genes,then transfecting the 3T3-L1 mature adipocytes,the expression of mRNA and protein about A-FABP genes were obviously restrained(P0.05).After silence AFABP genes,the concentration of adipocyte's triglyceride was obviously lower than before(P0.05),the concentration of visfatin secretion was obviously lower than before(P0.05). Conclusion After silence A-FABP genes by RNA interference,the concentration of adipocyte's triglyceride anabolism and visfatin secretion were lower than before.

Adipocyte fatty acid binding proteins(AFABP),as one of the members of the fatty acid binding proteins family,is widely expressed in all normal tissues,involving in fatty acid storage,transport and degradation processes.In recent years,adipocyte fatty acid binding protein has become a hot spot.This paper is aiming at discussing the main characteristics and the relationship among various diseases.

Adipose tissue not only can store energy,but also secrete some hormone actively.Most kinds of adipocytokines can promote variety cardiovascular diseases,such as coronary heart disease(CHD).However,the adiponectin may protect the CHD patient by effecting the risk factors,reducing the risk degree of CHD,and improving prognosis for CHD patient.