目的 分析医学虚拟仿真实验教学平台在普通外科学教学中的应用效果.方法 采取随机数表法选取本校在2020年9月—2021年1月期间学习医学专业的2017级五年制本科生有120名,根据其教学措施将其均分为两组,采取常规外科学教学措施与采取医学模拟仿真实验教学措施,对比分析通过不同的教学模式后两组学生的教学效果.结果 与传统教学组相比,虚拟仿真教学组的本科学生普通外科学考核成绩、学生对不同教学模式的评分及教学满意度均明显更高(P<0.05).结论 通过将医学虚拟仿真实验教学平台使用于普通外科教学过程中展开教学活动,可以明显的增加教学工作的整体质量以及效果,对于本科学生个人对学习的主动性与兴趣度均可以发生提高作用,此外就学生个人具体医学实践操作过程中的技能与技巧水平可以起到良好的锻炼左右,同时还可以增加学生对教学工作的满意程度.

目的:观察乳宁颗粒治疗肿块期肝郁痰凝型乳腺导管扩张症的临床疗效。方法:前瞻性选取2015年5月至2019年4月北京中医药大学东直门医院收治的80例肿块期肝郁痰凝型乳腺导管扩张症患者，按随机数字表法分为观察组和对照组各40例，两组均外敷如意金黄膏7 d，观察组加服乳宁颗粒，3个月为一疗程，经期停用。比较两组临床疗效及治疗前后的肿块长径、乳导管直径、VAS评分和肝郁痰凝证中医症候积分，记录不良反应和肿块复发情况。结果:观察组临床总有效率为92.5%(37/40)，明显高于对照组的75.0%(30/40， P<0.05)。治疗后，两组肿块长径、乳导管直径、VAS评分及肝郁痰凝证中医症候积分均明显下降( P<0.05)，且观察组低于对照组( P<0.05)。观察组肿块复发率和手术引流率分别为7.5%(3/40)和0，均低于对照组的25.0%(10/40)和12.5%(5/40)( P<0.05)。 结论:乳宁颗粒联合如意金黄膏外敷对肿块期肝郁痰凝型乳腺导管扩张症有良好治疗作用。

哺乳期乳腺炎的发病率在逐年升高,因此在哺乳期乳腺炎的早期控制病情,避免发展为化脓性乳腺炎就尤为重要.李乃卿教授认为早期哺乳期乳腺炎的病机以肝郁气滞为主,加之产后肝血不足,因此治疗应当从肝出发,以疏肝、柔肝为主;中医在治疗哺乳期乳腺炎上应当充分发挥中医外治法的特色,将特色药物直接作用于局部,使药效直达其所,能够获得明显的临床疗效.

Objective: To explore the effects of allitridi on insulin resistance and adipokines of the rats with streptozotocin (STZ) -induced diabetes mellitus (DM). Methods: DM rat models were prepared by high fat and high sugar diet and abdominal injection of STZ, they were given different concentrations of allitridi[5, 10 and 20 mg/ (kg·d) ] and deltamine[200 mg/ (kg·d) ], once each day, the course was four weeks, the model group and normal control group were set up. The levels of fasting blood glucose (FBG) and fasting serum insulin (FINS) of the rats were detected before medicating, at the seventh, 14 th, 21 st and 28 th day after medicating; insulin sensitivity index (ISI) and HOMA-IR were calculated in four weeks, the levels of th indexes of blood lipid and adipokines were detected. Results: Compared with the model group, the levels of FBG decreased while the levels of FINS rose in the allitridi group; HOMA-IR and ISI lowered; the contents of TC, TG and LDL-C lowered while the contents of HDL-C increased; the levels of leptin, TNF-α and IL-6 lowered while the level of adiponectin raised, which were in a dose-dependent manner, and the effects of allitridi in the concentrations of 20 mg/ (kg·d) ] were the most obvious. Conclusion: Allitridi could improve insulin resistance and regulate the contents of adipokines of the rats with STZ-induced DM in a dose-dependent manner, and its effects are superior to these of deltamine.

目的:通过临床实践研究,提出急性阑尾炎的中医临床证型诊疗标准.方法:查阅近50年以来的全国高等中医药院校统编或自编的外科教材,以及临床相关的文献资料,总结出急性阑尾炎的辨证分型和用药规律.结果:共识是中医将急性阑尾炎分为四型:瘀滞型、蕴热型、毒热型、脓肿型,并提出各型阑尾炎的治疗原则和方药.结论:西医急性阑尾炎病理演变规律是:单纯性阑尾炎→化脓性阑尾炎→坏疽穿孔性阑尾炎→阑尾周围脓肿,分别与中医辨证分型的瘀滞型→蕴热型→毒热型→脓肿型相对应,这是一个典型的中西医临床结合点,对指导临床治疗意义重大.

Background and Purpose: Laparoscopic appendectomy for acute appendicitis is gold standard for adult patients in the world. The incidence of appendicitis in the elderly has risen. The aim of this study was to compare post-operatory outcomes in old patients with acute appendicitis approached by laparoscopy versus open surgery. Methods: We retrospectively analysed the data of elderly patients who underwent appendectomy for acute appendicitis from 1st of January 2010 to the 1st of August 2017. We analysed 286 appendectomies in elderly patients: 214 patients were operated by laparoscopic appendectomy (LA) and 72 patient were underwent Open Appendectomy (OA). Results: The operation time was slightly longer in the LA group (P<0.001), but the time of recovery inflammatory response, time for diet and hospital stay were significantly shorter in LA group than that in OA group. Complications: The rate of surgical site infection in LA group was less than that in OA group, and the rate of pneumonia between LA group and OA group was similar. Conclusions: Laparoscopic appendectomy can be recommended as first choice for old patients with appendicitis.

目的 观察空肠内注入通腑汤对重症急性胰腺炎患者胃肠功能的影响及机制研究.方法 选择45例重症急性胰腺炎患者,随机分为对照组和治疗组.对照组给予常规治疗,治疗组在常规治疗的基础上同时给予经鼻空肠管注入通腑汤.观察比较两组患者肠鸣音恢复时间、肛门排气时间和排便时间.观察比较两组患者血清胃动素和血管活性肠肽浓度.结果 治疗组的肠鸣音出现时间、肛门排气时间、排便时间与对照组相比均显著缩短.治疗组的血清胃动素浓度高于对照组,治疗组的血管活性肠肽浓度低于对照组.结论 空肠内注入通腑汤有助于重症急性胰腺炎患者胃肠功能的恢复,其作用机制可能与调节血清胃动素和血管活性肠肽浓度有关.

Abstract Rheumatoid arthritis (RA) is polygenic autoimmune disease with unclear etiology. MicroRNAs (miRNAs) play a critical role in the pathogenesis of RA. The objective of this study was to evaluate the role of miR-146a in patients with RA receiving Tripterygium wilfordii Hook F (TwHF) treatment. In total, 69 patients with RA and 69 healthy controls (HC) were included in the study, and patients with RA received TwHF treatment for 24 weeks. Blood samples were collected from RA patients and HC, and peripheral blood mononuclear cells (PBMCs) were isolated. Expression of miR-146a was analyzed in RA patients (baseline, 12 weeks and 24 weeks) and HC. Circulating miR-146a expression was markedly increased in patients with RA compared with healthy controls (P < .001), ROC analysis of miR-146a for diagnosis for RA showed that the AUC was 0.908 (95% CI: 0.862–0.955) with a sensitivity of 87.0% and a specificity of 82.6% at best cutoff. And miR-146a expression was positively associated with the DAS28 score and CRP level (P = .002 and P = .019). Moreover, miR-146a expression was markedly reduced after TwHF therapy (P < .001), and baseline miR-146a level was observed to present an increased tendency in responders compared with non-responders at 24 weeks (P = .066). Our study presented that circulating miR-146a level was correlated with risk and disease activity of RA patients by TwHF treatment, which could strikingly decrease expression of miR-146a in RA patients, and miR-146a may have a value in predicting clinical response of TwHF treatment. It indicates that circulating miR-146a plays a prominent role in RA patients treated by TwHF.

Objective To investigate the effects of ursolic acid (UA) on liver fibrosis and portal hypertension of CCl4-induced cirrhosis rats.Methods One hundred and twenty experimental rats were randomly assigned into six groups:normal control group,model control group,UA (10,20,40 mg·kg-1) groups and colchicine 0.1 mg·kg-1group (positive control group).Except the normal control group,all of the model rats were made by injecting CCl4.The drugs were given by intraperitoneal injection at the same time,once a day.The contents of ALT,AST,TBIL in serum were determined;the contents of CⅣ,PCⅢ,LN,HA in serum and the level of HYP in hepatic tissue were determined;the PVP,PVF,MAP,HR were detected;the histopathological changes of the hepatic tissue were observed by HE staining;the contents of NO and cGMP in hepatic tissue were determined;the activities of SOD,GSH-Px,CAT and the content of MDA in hepatic tissue were determined.Results Compared with the model control group,the contents of ALT,AST,TBIL in serum of UA 20,40 mg·kg-1groups were significantly decreased (P<0.05,P<0.01);the contents of CⅣ,PCⅢ,HA,HYP in serum were significantly decreased and LN in 40 mg·kg-1 group was significantly decreased (P<0.05,P<0.01);the PVP,PVF in UA 20,40 mg·kg-1 groups were significantly decreased (P<0.05),and the MAP in 40 mg·kg-1 group was significantly increased and HR was significantly decreased (P<0.05);the histopathological changes in hepatic tissue of UA treatment groups were significantly improved,especially the UA 40 mg·kg-1 group;the content of NO in hepatic tissue and the activities of SOD and CAT of UA 20,40 mg·kg-1 groups were significantly increased,and the content of cGMP in UA 40 mg·kg-1 group and the activity of GSH-Px were significantly increased (P<0.05,P<0.01).Conclusions UA had inhibitory effects on liver fibrosis and portal hypertension in CCl4 induced cirrhosis rats,the function of which is likely related to its effects of protecting hepatic tissue and inhibiting enzyme activity,inhibiting the damage of oxidative stress,upregulating eNOS expression,and enhancing the content of NO.

Objective:To investigate the effect of Tongfu decoction injected into the jejunum on gastrointesti-nal function of patients with severe acute pancreatitis. Methods:Totally 49 patients were randomly divided into two groups:control group and treated group. Patients in the control group were given regular therapy, and patients in the treatment group were given both regular therapy and Tongfu decoction injected into the jejunum. The recovery time of gurgling sound,anus exhaust time,defecation time and time for relieving ab-dominal pain were compared between two groups. Result:The recovery time of gurgling sound,anus exhaust time,defecation time and time for relieving abdominal pain in the treatment group was obviously shorter than that in the control group(P<0.05). Conclusion:Tongfu decoction injected into the jejunum can improve the recovery of gastrointestinal function of patients with severe acute pancreatitis.

参芪扶正注射液是中医临床常用的扶正药物，在临床上与抗消化道肿瘤药物相配伍治疗消化道肿瘤疗效明显提高[1-2]，保护血象，改善患者免疫功能，减轻化疗药物的不良反应，保证化疗药物疗程的完成。参芪扶正注射液被广东省经济委员会评为优秀新产品二等奖。为了提高临床疗效，方便临床用药，对参芪扶正注射液与临床常用抗肿瘤药相配伍理化性质及一般药理的变化规律进行了研究，结果如下。

Objective To investigate the effect of Dachengqi Decoction injected into the jejunum on cytokines and pancreatic acinar cell apoptosis in rats with acute pancreatitis.Methods 90 rats were randomly divided into three groups: sham-operated group,untreated group and treated group.The concentration of IL-1β,IL-18 and TNF-αwere detected 24 hours after established acute pancreatitis modal.Both the pathological scores of pancreatic tissues and the pancreatic acinar cell apoptosis indexes were determined.Results Both the concentration of IL-1β,IL-18,TNF-α and the pathological scores of pancreatic tissues were lower in treated group rats.The pancreatic acinar cell apoptosis indexes were higher in treated group rats.Conclusion Dachengqi Decoction injected into the jejunum can decrease the inflammatory reaction and promote pancreatic acinar cell apoptosis in rats with acute pancreatitis.

目的观察通腑汤在急性单纯性肠梗阻中的临床应用效果。方法选取34例急性单纯性肠梗阻患者在常规治疗的基础上加用通腑汤免煎颗粒治疗,观察其疗效并与对照组进行比较。结果通腑汤免煎颗粒治疗组的治愈率及总有效率优于对照组。结论通腑汤免煎颗粒配伍灵活,使用方便,对于治疗急性单纯性肠梗阻有效,其作用机制值得进一步研究探讨。

<正>1病例资料患者男性,57岁,三轮车工人,三天来上腹饱胀不适,呃逆频繁,不能进食,两日来阵发性右胸疼痛,气急,气短,不能平卧,无排便矢气,上腹微胀,他院按心绞痛治疗无效。门诊胸透,疑胸内肠梗阻收住入院。查体:体温正常,呼吸急迫,脉搏弦数。口唇绛紫,气管左移,右胸膨隆,无呼吸音。可闻及高调肠鸣音,左肺呼吸音正常,无干湿啰音,心尖搏动左偏,腹部平软,右上腹压痛,肝脾未及,肝浊音界

Objective To observe the clinical effect of Wuweixiaoduyin gauze topical treatment for pressure ulcers.Methods 90 cases of patients with pressure ulcers were treated in the First Department of Surgery in Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine from January 2011 to January 2013,they were divided into the observation group and control group according to the treatment methods,46 patients of the observation group were given Wuweixiaoduyin gauze topical treatment,44 patients of the control group were given iodophor gauze topical treatment.According to wound healing,after treatment for 1 month,the clinical efficacy of two groups were assessed,and the healing time of two groups were compared.Results The cure rate and total effective rate of control group were 18.18%,72.27%,significantly lower than 65.22%,97.83% of the observation group;the total cure time was(11.02 ± 1.21) d in the control group,and(6.05±1.05) d in the observation group,the difference was statistically significant(t = 6.28,P < 0.05).Conclusion The curative effect of Wuweixiaoduyin gauze topical treatment for pressure ulcers is bet ter,it is worthy of further clinical research.

<正>为了适应稳、准、轻、快、手术操作的需要,我们对阑尾手术的术式进行了简化改革,简化后的阑尾术式有如下几方面的优点:①切口小:一般长约2cm。②组织损伤少:腹壁全层缝合一针即可。③减少了针麻中三关影响,提高了针麻优良率。④缩短了手术时间,手术全程15~20min可以完成。手术操作步骤:①切口:一般选用麦氏斜切口,但要根据腹壁叩痛点,调节切口的位置,原则上选在叩痛点最明显处为宜。切口长约2cm,如果采用针刺麻醉,切口要皮内注射0.5%普鲁卡因

By more than thirty years' experience of western medicine surgery in traditional Chinese medicine colleges,the author has realized that the training of medical interns in professional ethics and humanity spirit is equally important as in medical knowledge and skills.Attention should be paid to the training of basic surgical skills by guiding interns to actively participate in the clinical treatment,teaching ward-round,surgical seminars.Interns should be encouraged to broaden their horizon and to strengthen their creative thinking by grasping the new surgical technology and new therapies.They are also encouraged to participate in surgery clinical research and solve new problems encountered in medical practice.Interns should often read related monograph and medical literature,master and take advantage of multimedia,network-based, virtualization theories and technology.All the above training methods are to avoid the surgical students in institutions of Chinese medicine becoming high score and low capacity doctors after entering into the society,and to help them become a real modern surgeon in clinical practice.

Objective To investigate the effect of ω-3 polyunsaturated fatty acids injected into the jejunum on immune function in rats with acute pancreatitis(AP).Methods 80 rats were randomly divided into four groups: no-AP group,AP-commen enteral nutrition group,AP-corn oil group and AP-fish oil group.Both the value of IL-10/TNF-α and the concentration of IL-1β,IL-18,IL-10 and TNF-α were detected at the 7th day after established acute pancreatitis model.Results Both the value of IL-10/TNF-α and the concentration of IL-1β,IL-18,IL-10 and TNF-α were lower in AP-fish oil group rats.Conclusion ω-3 polyunsaturated fatty acids injected into the jejunum can decrease the inflammatory reaction and modulate the immune function in rats with acute pancreatitis.

目的:探讨通腑汤在术后早期炎性肠梗阻中的临床应用效果。方法:对30例术后早期炎性肠梗阻患者在常规治疗的基础上加用通腑汤,观察其疗效并与对照组进行比较。结果:通腑汤治疗组的肠鸣音恢复时间明显快于对照组[(58.8+15.6)hvs(83.6+24.0)h],治疗组的总有效率也明显优于对照组(93.3%vs83.3%)。结论:通腑汤对于术后早期炎性肠梗阻有明显疗效,其作用机制值得进一步研究。

Objective:To study the effect of Shenqi Fuzheng Injection on the balance of Th1/Th2 in S 180-bearing mice with chemotherapy. Methods:45 of 57 tumor-bearing mice were given cyclophosphamide twice by intraperitoneal injection,and then randomly divided into four groups:the model group、the high dose group (8 g·kg-1 )、the clinical equivalent dose group(4 g·kg-1 ) and the low dose group (2 g·kg-1 ) of Shenqi Fuzheng Injection. The model group and the 12 tumor-bearing mice without cyclophosphamide injection were given physiological saline by intraperitoneal injection once a day,while the others were given Shenqi Fuzheng Injection in the same way. 9 days later,the eyes and 0.5 mL blood were obtained before each mouse was sacrificed.The blood was for cytometric bead aray(CAB)test.The tumors were weighed,and the tumor index was calculated.Results:Shenqi Fuzheng Injection,in the clinical equivalent dose,could significantly depress the weights of tumors and the tumor indexes(P0.01),and elevate the contents of TNF-α and IL-2 (P0.01～0.05) in S 180-bearing mice with chemotherapy. Conclusion:In clinical equivalent dose(4 g·kg-1 ),Shenqi Fuzheng Injection could make Th1 cells to be predominant to Th2 cells in S 180-bearing Mice with chemotherapy.