移动互联网的全面普及标志着信息时代的来临,网络多媒体技术和数字通信与教育、科研、医疗等领域相结合,形成了数字化、信息化产业模式.基于移动互联网技术背景,国家提出了"互联网+"的发展战略,移动互联网与其他产业的深度结合已成为产业结构优化与调整的必然趋势.当移动互联网在现代临床中推广后,移动医疗的理念产生、发展并成熟,医疗大数据平台的诊断与治疗技术将把个性化医疗推向一个前所未有的空间,传统的诊疗模式将发生变化.由陈金雄主编,电子工业出版社出版的《互联网+医疗健康——迈向5P医学时代》一书,主要就"互联网+"战略下现代医疗建设与发展的相关问题进行了论述.该书着重对互联网对现代医疗的影响,以及移动互联网背景下临床工作格局的变迁进行了论述和分析.并以互联网技术背景切入,从临床工作变化开始分析互联网技术对医疗领域的影响,最后从医疗发展和社会需求两个层次分析了互联网时代移动医疗的发展机遇与发展方向.

在我们国家日益繁荣昌盛的今天,我国高职医学教育事业获得良好的发展,而医学实践教学是医学教育的重要组成部分,是深化理论知识、强化专业知识,培养学生实践操作能力和创新能力的关键环节,是提高学生专业素质和增强就业竞争力的重要途径.

目的 探讨基于职教云平台学生个性化学习模式在《成人护理学》教学中的实践效果.方法 在2017级护理专业学生中选取两个班级分别设为干预组和对照组,对照组采用传统教学模式,干预组采用基于职教云学生个性化学习模式,比较两组学生的考核成绩、教学满意度及自主学习能力.结果 干预组学生的考核成绩和教学满意度均高于对照组(P<0.05),干预组学生自主学习能力高于教学前(P<0.05),对照组学生教学前后自主学习能力差异无统计学意义(P>0.05).结论 基于职教云学生个性化学习模式有助于提高学生的知识掌握度、教学满意度,同时还可以提高学生的自主学习能力.

在医学教学的过程中,必须要注重理论和实际的结合,提高学生的思维和动手能力,以便能根据实际需要提升应变能力.所以在本文之中将会对于医学教学中注重培养学的临床思维能力做出分析.

目的 了解女性狼疮患者家庭婚姻功能与生活质量现状及其相关性,为针对性干预提供参考.方法 对223例门诊就诊的女性狼疮患者,采用狼疮生活质量量表、家庭婚姻功能量表进行调查分析.结果 生活质量总分504.46±153.05,得分率63.06％;家庭婚姻功能总分36.04±6.57,得分率70.67％;家庭婚姻功能与生活质量呈正相关(P＜0.01).结论 女性狼疮患者的生活质量与家庭婚姻功能水平均偏低,医护人员应重视家庭婚姻功能的评估并进行针对性干预,以提高其水平从而改善患者的生活质量.

随着21世纪医学模式的不断更新,临床医疗工作发生着本质性改变,因此,临床医学生在实习阶段面临着前所未有的新要求和新挑战,医德医风教育尤其突出.本文在分析当前临床实习阶段医学生面临的处境的基础上,阐述加强医德教育工作的必要性,并提出相应的教育对策,对临床专业的未来发展进行展望.

Objective To study the rule of Apaf-1 in wnt/β-catenin signaling pathway and its regulatory expression mechanism in hepatocellular carcinoma cells.Methods The regulatory mechanism of Apaf-1 gene in Wnt/β-catenin signaling pathway was verified by the TOPflash experiment;real-time PCR was used to detect the expression amounts of Apaf-1 in various hepatoma cell lines (HepG2,H HCC,HB611) and normal liver cell line(LO2);the RNAi interference plasmid of Apaf-1 was constructed and transfected into the HepG2 cell line.Then the transfection efficiency and expression of related genes and proteins were detected.Results The TOPFlash experiment found that Apaf-1 gene could inhibit the wnt/β-catenin signal pathway in a dose dependent manner;the Apaf-1 expression level in hepatoma cells was decreased compared with the normal liver cells,moreover its expression level was lowest in HepG2 cell line;RNA interfering Apaf-1 gene in HepG2 cell line,the expression level of Apaf-1 gene was significantly decreased,and the expression levels of downstream genes and protein(β-catenin,Cyclin A,CDK2,wnt5a,STAT3,EGFR,APC) in wnt signal pathway were significantly increased or decreased,the difference was statistically significant(P＜0.05).Conclusion Apaf-1 gene plays an important role in the formation process of hepatocarcinoma cells by wnt/β-catenin signaling pathway.

This paper reviews the application status quo of microteaching method in nursing teaching in China and abroad, and describes the feature and implementation of microteaching. It gives reflection on urgent problems for microteaching in domestic nursing teaching. Moreover, it also put forward some development suggestions from the perspective of teacher training, preparation of teaching subjects and evaluation criteria.

Objective To learn the experiences of higher vocational nursing students on lfipping classroom, and to provide the basis for further optimization of teaching.Methods It used phenomenological research methods of qualitative research, and used open questionnaire and semi-structured interviews on higher vocational nursing students. Data analysis was carried out using Colaizzi seven step analysis method.Results The experiences and feelings of higher vocational nursing students on lfipping classroom mainly concentrated in four areas: learning enthusiasm and initiative, communication skills, team work, Internalization of knowledge. Conclusion Higher vocational nursing students generally recognized flipped classroom teaching mode, and their learning efficiency improved signiifcantly. But we also need to take into account of students' individual development, and to further optimization of curriculum design.

目的：观察表没食子儿茶素没食子酸酯（ EGCG）对细菌脂多糖（ LPS）所致大鼠神经胶质细胞炎症的保护作用。方法取新生乳鼠原代神经胶质细胞培养，利用LPS激活小胶质细胞引起炎症反应。荧光探针检测细胞内超氧化自由基的水平；酶联免疫吸附试验（ ELISA）和Western印迹检测肿瘤坏死因子（ TNF）-α、白细胞介素（ IL）-1β、IL-8、诱导型一氧化氮合酶（ iNOS）、炎性因子蛋白含量的变化。结果 LPS激活神经小胶质细胞，促进其释放超氧化自由基，诱导炎症因子的过度表达，大幅上调TNF-α、IL-1β、IL-8炎性因子和升高iNOS蛋白质水平（ P＜0.05），EGCG明显抑制超氧化自由基及上述炎症因子的过度产生，减轻LPS对神经胶质细胞的毒性。结论 EGCG能减弱LPS引起的体外培养神经胶质细胞的炎症反应。

Objective To investigate the effect and mechanism of human type 1 cannabinoid receptor (hCB1R) on the apoptosis of cervical cancer HeLa cell by constructing the gene eukaryotic expression vector .Methods The GV230‐hCB1R plasmid was con‐structed and identified by the double enzyme digestion and DNA sequencing .Then it was transfected into HeLa cells .The expres‐sion and cellular localization(ECL) of hCB1R was detected by Western blot and immunofluorescence cellular chemical staining com‐bined with laser scanning confocal microscope;the apoptosis rate was tested by flow cytometry ;the mRNA and protein expression of hCB1R ,Bcl‐2 ,Bax and Bad was examined by real‐time fluorescent quantitative PCR(qRT‐PCR) .Results After transfection into HeLa cells ,hCB1R protein with the relative molecular mass of 40 000 was expressed in both cytoplasm and cellular membrane of cells .The over expression of hCB1R could up‐regulate the apoptosis of Bax and Bad ,and inhibited the Bcl‐2 expression .The flow cytometry results displayed that HeLa cell line showed apoptosis ,hCBIR had obvious inhibiting effect on the growth of cervical cancer HeLa cell line and promoted apoptosis .Conclusion Up‐regulating expression of hCB1R in Hela cells could enhance the ex‐pression of Bax and Bad inhibit the expression of Bcl‐2 ,thus inducing the cellular apoptosis .

目的 探讨翻转课堂教学模式对高职护理专业学生自主学习能力的影响.方法 从2013级护理专业学生中随机抽取3个班作为试验组,采用翻转课堂教学法授课;另外3个班作为对照组,采用传统教学法授课.课程结束后,比较两组学生自主学习能力有无差异.结果 课程结束后试验组学生学习动机、自我管理能力、学习合作能力及学习能力总得分均高于干预前,且均高于同期对照组学生得分,差异均有统计学意义(P＜0.05).课程结束后,试验组学生理论考核成绩和操作考核成绩均高于对照组学生,差异有统计学意义(P＜0.05).结论 翻转课堂教学模式可有效提高高职护理专业学生的自主学习能力.

Objective To construct the eukaryotic expression plasmid of human cannabinoid receptor 2 ( hCB2) gene GV230 and to detect the expression of hCB2 gene in the HEK293 cells.Methods Full length of hCB2 cDNA was obtained by RT-PCR with total RNA isolated from human T lymphocytes, and then we inserted the target fragment into eukaryotic ex-pression vector GV230 to construct the recombinant expression plasmid GV230-hCB2 after enzyme digestion, connection and sequencing.We used the liposome to transiently transfect HEK293 cells.The expression of hCB2 gene expression products was detected by Western blotting and confocal laser scanning microscope (CLSM).Results The hCB2 gene fragments were amplified, and we successfully constructed the recombinant expression plasmid, detected the target protein expressing in the transfected cells, and observed the distribution and expression of hCB2 receptor in the cell membrane. Conclusion We successfully contrast the GV230-hCB2 plasmid expressing hCB2 protein in the HEK293 cells, which lays the experimental foundation for further research of hCB2 biology function.

Human colon cancer is one of the most common malignant tumors. The current treatment of chemical drugs still has serious side effects and toxicity, therefore, it is very urgent to develop drugs with low side effects and toxicity for colon cancer patients. Enriched with active ingredients, Chinese herbal medicine becomes an important resource to screen anti-cancer drugs. Compounds of polyphenols, glycoside, organic sulfide and isoprenoids from natural plants are mark-edly characterized by their antitumor activities in vitro for human SW480 colon cancer cells, by killing tumor cells directly, blocking the cell cycle, affecting the gene expression and apoptosis signal pathways and induction of cell differentiation. This article makes a brief summary of monomers in anti-activity of SW480 cells from natural plant.

目的:观察表没食子儿茶素没食子酸酯(EGCG)对野百合碱(MCT)所致大鼠右心室肥厚的影响并探讨其可能的机制.方法:40只雄性SD大鼠随机分为正常组,模型组,EGCG(40 mg·kg-1)组和阳性药卡托普利(25 mg· kg-1)组,每组10只.除正常组外,采用野百合碱诱导制备右心肥厚大鼠模型,24 h后各组分别ig给药,正常组和模型组ig等体积生理盐水,每天1次,连续21d,观察EGCG对模型大鼠右室肥厚指数(RVHI),右心室质量指数(RVMI),右心室心肌细胞超微结构的变化的影响;对右室心肌组织一氧化氮(NO),诱导性一氧化氮合酶(iNOS),白细胞介素-1β(IL-1β)及IL-6含量的影响.结果:与正常组比较,模型组RVHI,RVMI明显增高(P＜0.05),其右心室组织NO,iNOS,IL-1β及IL-6水平明显升高(P＜0.05);与模型组比较,EGCG(40 mg· kg-1)组RVHI,RVMI明显降低(P＜0.05),右室心肌组织的NO,iNOS,IL-1β及IL-6水平明显降低(P＜0.05).结论:EGCG能有效抑制MCT诱导的大鼠右心室肥厚,其作用途径与其降低右心室心肌组织iNOS表达和NO过多产生及降低IL-1β及IL-6水平有关.

目的 探讨大麻系统(ECS)药物CB1拮抗剂利莫那班联合CB2激动剂JWH133预处理对大鼠脑缺血再灌注损伤的神经保护作用机制.方法 将健康成年雄性SD大鼠随机分为假手术组、模型组、JWH133组和LHGY组(利莫那班+JWH133).造模前1h用二甲基亚砜(DMSO)溶解药物,预处理腹腔注射给药;其他两组注射等体积生理盐水,改良ZEA-LONGA线栓法建立大鼠右脑中动脉缺血再灌注模型.采用Longa评分法进行神经功能评分,TTC染色测量脑梗死体积,测定缺血侧脑组织及周围血清中和白细胞介素-6(IL-6)和白细胞介素-10(IL-10)含量,比色法检测诱导型一氧化氮合酶(iNOS)活性的表达.结果 模型组、WH133组和LHGY组均出现不同程度的神经行为功能异常,两组神经行为功能恢复明显好于其他两组(P＜0.05),LHGY组表现略优于WH133组(P＞0.05).其中,脑切片TTC染色显示WH133组和LHGY组均较模型组白色梗死灶缩小(P＜0.05),后者梗死面积程度小于前者(P＞0.05).模型组大鼠脑组织及血清中IL-6含量比假手术组合量有较显著的升高,IL-10则相反;而JWH133组和LHGY组治疗后两种炎性因子呈现不同程度的反相变化(P＜0.05).与假手术组相比,模型组脑组织中iNOS活性明显升高;JWH133组和LHGY组脑组织中iNOS活力均明显降低(P＜0.05).结论 JWH133组和LHGY组预处理后通过抑制脑缺血再灌注损伤过程中的炎性反应而发挥神经保护作用,其机制可能与调节IL-6、IL-10和iNOS等因子水平有关.而CB1拮抗剂利莫那班联合CB2激动剂JWH133给药方案产生一定程度的叠加效果,这也提示ECS对脑缺血再灌注损伤产生神经保护作用机制尚待进一步探讨.

目的:观察表没食子儿茶素没食子酸酯[(-)Epigallocatechin-3 gallate,EGCG]对细菌脂多糖(LPS)所致原代神经胶质细胞炎性反应的保护作用.方法:取新生乳鼠原代神经胶质细胞培养,利用LPS引起其炎症反应.用酶联免疫吸附试验(ELISA)测定炎性因子肿瘤坏死因子(TNF-α)、白介素-1β(IL-1β)、白介素-1β(IL-8)表达情况和蛋白免疫印记法(Western blot)检测炎症因子(诱导型一氧化氮合酶)iNOS蛋白含量变化.结果:LPS激活神经胶质细胞后诱导炎症因子过度表达,大幅上调TNF-α、IL-1β、IL 8炎性因子(P＜0.05),iNOS蛋白质水平显著升高(P＜0.05),不同浓度EGCG干预组均可明显抑制炎症因子的过度产生,一定程度上减轻LPS诱导神经胶质细胞的炎性反应.结论:一定浓度范围内,EGCG能减弱LPS引起的体外培养神经胶质细胞的炎症反应.

Objective To determine the effects of EGCG on lipopolysaccharide ( LPS)-induced neuroinflamma-tion and investigate the role of neuroprotection mediated by EGCG .Methods Primary cultures of rat gliacyte were used as an in vitro model to examine the effects of EGCG on LPS-induced neuronal damage .The intracellu-lar Glu andγ-GABA were quantified via HPLC .Then the protein level of TNF-α,IL-1βand IL-8 was determined by ELISA and Western blot assay .Results Compared with the control group , LPS apparently induced the pro-duction of intracellular ROS ( P<0.05 ) and released the TNF-α, IL-1βand IL-8 in the primary cultures super-natant (P<0.05).Compared with the LPS group,EGCG significantly attenuated the release of TNF-α, IL-1βand IL-8 ( P<0.05 ) and the level of iNOS protein ( P<0.05 ) .LPS apparently induced the production of intra-cellular ROS( P<0.05 ) and released the TNF-α, IL-1βand IL-8 in the primary cultures supernatant ( P <0.05 ) .EGCG significantly attenuated the release of TNF-α, IL-1βand IL-8 ( P<0.05 ) and the level of iNOS protein(P<0.05), and rugulated the concentration of Glu/γ-GABA(P<0.05).Conclusions EGCG is effective&nbsp;in protecting hosts against LPS-induced neuroinflammation through anti-inflammatory effects and regulating extracel-lular Amino acid levels .

目的:运用本课程的教学资源库辅助教学,并与传统授课方式相比较.方法:在试验班教师指导学生利用教学资源库的学习单元进行学习,对照班教师采用传统的课堂教学法进行讲授,课程结束后对学生进行问卷调查及闭卷知识考核.结果:试验班对课程教学效果的评价及考核成绩明显高于对照班,差异有显著性意义P ＜0.05.结论:运用教学资源库内容辅助教学有利于提高学生对知识吸收率,激发学生学习兴趣.

移动性浊音检查为诊断腹腔有无大量积液的检查方法,但在学习过程中的频繁反复练习又不可能完全通过医疗临床在患者病体上实现.本教学模型有效地解决了医护教学中检查人体腹部移动性浊音的实践练习问题,并可达到清楚理解腹腔大量积液诊断原理、正确掌握诊断操作方法的效果.