对2018级和2019级全体共48名全科住院医师进行为期6个月的基于基层常见疾病诊疗指南解读的学员临床小讲课培训,整群抽样,采用教师现场考核和学员自评进行培训效果评价.实践表明,基于基层常见疾病诊疗指南解读的学员临床小讲课能有效提升全科住院医师的理论知识水平、循证思维能力和教育能力,值得进一步推广和应用.

目的 研究不同程度老年痴呆病人的睡眠障碍特征.方法 纳入2016～2019年于重庆医科大学附属第一医院老年病科住院的老年痴呆病人752例,根据MMSE得分及文化程度分为认知正常组411例、认知障碍组341例,认知障碍组进一步被分为轻度痴呆组133例(21～26分)、中度痴呆组167例(10～20分)、重度痴呆组41例(＜10分).比较4组的匹兹堡睡眠质量指数(PSQI)总分及各因子得分情况.结果 认知障碍组PSQI总分高于正常组(P＜0.05),其中前者入睡潜伏时间、睡眠效率及日间功能障碍得分高于后者(P＜0.05).轻、中、重度痴呆组PSQI总分依次递增.中、重度痴呆组的日间功能障碍得分均高于轻度痴呆组(P＜0.05).重度痴呆组的入睡潜伏时间、睡眠效率、日间功能障碍得分均高于轻度和中度痴呆组(P＜0.05).结论 认知障碍病人睡眠障碍问题更加严重,且随着痴呆程度的加深,睡眠障碍也随之加重;痴呆程度对睡眠障碍特征的影响由以日间功能障碍为主,逐渐进展到入睡潜伏时间、睡眠效率、日间功能障碍均受累.

目的 评估肺炎严重程度评分(PSI)和CURB-65评分对65～79岁及≥80岁的老年社区获得性肺炎(CAP)严重程度和预后评估的价值.方法 采用回顾性分析方法选取2018年9月-10月重庆医科大学附属第一医院收治住院的98例老年CAP患者作为研究对象,根据患者年龄分为低年龄组(65 ～79岁)及高年龄组(≥80岁),其中低年龄组54例,高年龄组44例,分析其一般临床资料,统计每例患者的PSI评分和CURB-65评分,以28 d预后为临床观察终点,比较两个评分系统不同危险分层的患者间病死率的差异,通过受试者工作特征曲线(ROC)比较两个评分系统对老年CAP严重程度的预测效能.结果 共纳入老年CAP患者98例,其中低年龄组(65 ～79岁)54例,高年龄组(≥80岁)44例.低年龄组28 d病死率为13.0％,高年龄组28 d病死率为15.9％.低年龄组CURB-65和PSI评分的曲线下面积分别为0.843 (95％ CI: 0.700～0.987)、0.775(95％ CI:0.618～0.932),高年龄组CURB-65和PSI评分的曲线下面积分别为0.653(95％ CI:0.418～0.887)、0.651(95％口:0.451～0.850).结论 2种评分系统对老年CAP患者病死率的预测效能随着年龄的增长而降低.在低龄老年患者中由于CURB-65评分特异性高,有利于筛选出高危患者进行加强治疗和监护,且评分系统相对简单,更适合于临床使用.在高龄老年患者中两种评分系统均显示出较差的预后预测价值.

[提要]分级诊疗可实现医疗资源的合理分配及充分应用,近年来成为医改条件下的一种医疗制度.在这种形势下,培养全科医生既可使得医疗卫生资源优化配置,又可为群众提供便利的医疗卫生服务.因此,在分级诊疗发展过程中,全科医生的培养显得尤为关键.全科医生可提供优质的初级卫生保健,其是社区健康保健系统的重要守卫者.只有着重培养全科医生的临床技能并提高其整体素质,才能提供良好的全科医疗服务,更好地落实并实现分级诊疗.

我国已进入老龄化社会,发展现代老年医学教育势在必行.老年医学专业研究生实践能力培养,是老年医学高等人才培养、发展我国老年医疗保健事业亟待解决的关键问题.本文从老年医学专业研究生实践能力培养的重要性、方法及内容等方面进行阐述,就老年医学专业研究生实践能力培养提出一些建议与思考.

Objective To investigate the effects of ciliary neurotrophic factor ( CNTF) on the expression of choline acetyltransferase ( ChAT) in hippocampus and cognitive function of diabetic mellitus ( DM) , and explore its possible mechanism .Methods 50 SD male rats were meanly divided into normal , DM, DM+DMSO, DM+CNTF, DM+CNTF+AG490 groups randomly .Streptozotocin-diabetic rats model were established , diabetic rats with depression were screened by open-field test.Escape latency and frequency of entrance into the target zone were measured by Morris water maze .The mRNA and protein levels of ChAT were examined with RT-PCR,Western blot and immuno-histochemistry.Results Compared to that of normal group ,escape latency was increased and frequency of entrance into the target zone was decreased significantly in DM,DM+DMSO and DM+CNTF+AG490 groups(P<0.05),the mRNA and protein levels of ChAT in hippocampal were decreased significantly (P<0.05) .The scores of escape latency and frequency of entrance into the target zone were highly improved in DM+CNTF group,the mRNA and protein expressions of ChAT in hippocampal were increased markedly than those of DM group (P<0.05) . Conclusions CNTF could improve cognitive ability of DM rats by increasing the mRNA and protein expressions of ChAT through the JAK 2/STAT3 pathway .

Insulin-like growth factor-1 (IGF-1) is a kind of protein polypeptide which widely exists in the body tissue and its structure and functions are similar to insulin.IGF-1 involves in many pathological and physiological process.Through a variety of ways,IGF-1 affects the occurrence and development of heart,brain,kidney,nerves and other chronic complications of diabetes.Exploring the mechanism of IGF-1 provides new ideas for the treatment of diabetic chronic complications.

In recent years,the impact of diabetes on cognitive function in a cross-disciplinary research is a central point.Recent studies have confirmed that the core of diabetic cognitive impairment are neuronal damage,loss and functional down-regulation.The underlying mechanisms are cerebrovascular disorders,metabolism disorders,the lack of neurotrophic factors,the abnormal expression of the brain rennin-angiotensin system,the hypothalamic-pituitary-adrenal (HPA) axis hyperfunction,etc.

Objective:To investigate the correlation between serum CA19-9 levels and type 2 diabetes mellitus(T2DM),and to analyze the relationship between blood glucose(BG),T2DM correlation factors and CA19-9 levels.Methods:This was a retrospective observation.120 inpatients with T2DM(group A)were recruited into this study,and 108 non-T2DM inpatient(group B)were used as controls.Routine tests were examined in both of two groups to exclude other diseases,which might be responsible for increased CA19-9.Patients with T2DM were classified as two subgroups according to HbA1c level.A1 subgroup was considered as BG controlled group(HbA1c≤7.0%),and A2 subgroup was considered as BG uncontrolled group(HbA1c7.0%).CA19-9 concentration was measured with the electro-chemiluminescence immunoassay.Data were analyzed by SPSS17.0 software packet,and independent samples t-test was used for simple correlation analysis and stepwise linear regression analysis.Results:The independent samples t-test analysis showed the CA19-9 level of A was higher than that of B(P0.01);that of A1 was lower than that of A2(P0.01).Correlation analysis showed positive correlation between HbA1c,duration of T2DM and CA19-9.Stepwise regression analysis showed a positive linear correlation between HbA1c and CA19-9.Conclusion:The positive rate of CA19-9 is correlated with T2DM.There is a significant linear correlation between CA19-9 and HbA1c.This study suggests that CA19-9 is one of reference marker for BG control.

Objective To explore the cut-off value of CA19-9 for differentiating type 2 diabetes mellitus(T2DM) and the alimentary canal malignancy.Methods Serum CA19-9 concentration was determined in diabetes group(n=120) and in gastrointestinal malignancy group(n=403)using chemiluminescence.Statistical analysis was performed by SPSS17.0.Statistical significance was taken at the 5% level.A receiver-operating characteristic(ROC) curve was constructed to determine the cut-off value of CA19-9 for differentiating T2DM and gastrointestinal malignant diseases.Results There was significant difference in CA19-9 level between T2DM and cancer groups.The cut-off value of CA19-9 for differentiating T2DM and the alimentary canal malignancy was 40.0 U/ml.Conclusions 40.0 U/ml is ideal for differentiating T2DM from alimentary canal malignancy.

Objective:To investigate the influence of transplantation with MSCs to hippocampus on PSA-NCAM in DM rats.Methods:30 SD rats were divided into the normal control group,diabetic model group,and stem cells transplanted group.Streptozotocin-diabetic rat model was established.MSCs were separated from bone marrow of rats.After purified,they were transplanted to hippocampus of DM rats.Then,the rats were Secrificed,to get the hippocampus for detect in of the expression of PSA-NCAM by immunofluorescence and RT-PCR.the data of the three groups were Compared.Results:Compared with diabetic model group,the transplanted group showed a significant increase in the expression of PSA-NCAMprotein and mRNA in hippocampus(P <0.05),butthey were significantly lower than those in normal control group(P<0.05).Conclusion:Transplantation with stem cells could increase the expression of PSA-NCAM in hippocampus of DMrats.

OBJECTIVE To observe the effect of BMSCs on the cardiac function in diabetes mellitus (DM) rats through injecting BMSCs into the ventricular wall of the diabetic rats and investigate its mechanism. METHODS BMSCs isolated from male SD rats (3-4 months old) were cultured in vitro, and the cells at passage 5 underwent DAPI labeling. Thirty clean grade SD inbred strain male rats weighing about 250 g were randomized into the normal control group (group A), the DM group (group B), and the cell transplantation group (group C). The rats in groups B and C received high fat forage for 4 weeks and the intraperitoneal injection of 30 mg/kg streptozotocin to made the experimental model of type II DM. PBS and DAPI-labeled passage 5 BMSCs (1 x 10(5)/microL, 160 microL) were injected into the ventricular wall of the rats in groups B and C, respectively. After feeding those rats with high fat forage for another 8 weeks, the apoptosis of myocardial cells was detected by TUNEL, the cardiac function was evaluated with multi-channel physiology recorder, the myocardium APPL1 protein expression was detected by Western blot and immunohistochemistry test, and the NO content was detected by nitrate reductase method. Group C underwent all those tests 16 weeks after taking basic forage. RESULTS In group A, the apoptosis rate was 6.14% +/- 0.02%, the AAPL1 level was 2.79 +/- 0.32, left ventricular -dP/dt (LV-dP/dt) was (613.27 +/- 125.36) mm Hg/s (1 mm Hg = 0.133 kPa), the left ventricular end-diastolic pressure (LVEDP) was (10.06 +/- 3.24) mm Hg, and the NO content was (91.54 +/- 6.15) nmol/mL. In group B, the apoptosis rate was 45.71% +/- 0.04%, the AAPL1 level 1.08 +/- 0.24 decreased significantly when compared with group A, the LV-dP/dt was (437.58 +/- 117.58) mm Hg/s, the LVEDP was (17.89 +/- 2.35) mm Hg, and the NO content was (38.91+/-8.67) nmol/mL. In group C, the apoptosis rate was 27.43% +/- 0.03%, the APPL1 expression level was 2.03 +/- 0.22, the LV -dP/dt was (559.38 +/- 97.37) mm Hg/s, the LVEDP was (12.55 +/- 2.87) mm Hg, and the NO content was (138.79 +/- 7.23) nmol/mL. For the above mentioned parameters, there was significant difference between group A and group B (P < 0.05), and between group B and group C (P < 0.05). CONCLUSION BMSCs transplantation can improve the cardiac function of diabetic rats. Its possible mechanism may be related to the activation of APPL1 signaling pathway and the increase of NO content.

甲胎蛋白(AFP)是一种特异性癌标志物,已经广泛用于肝细胞肝癌和卵黄囊肿瘤的诊断,研究亦发现其他内胚层肿瘤也有AFP产生,如胃肠癌、胰腺癌、胆囊癌、乳腺癌,其中胃癌相对常见,被称为产甲胎蛋白胃癌(AFP-producing gastric carcinoma,AFPGC).我们近期也遇到1例该病人,现报道如下.

Objective:To investigate the effects of common inhibitors of the antioxidation system and vitamin C on the measurement of hemoglobin (Hb).Methods:Hemolyzed rabbit red blood cell was used as the sample.The interferences of common inhibitors of the antioxidation system on assay of Hb by its absorbance at 540nm,alkalinized Hb by absorbance at 575nm,the azide-Hb complex by absorbance at 542nm were compared.Results:Vitamin C and the inhibitors of superoxide dismutase,catalase exhibited larger interferences with direct assay of Hb by absorbance at 540 nm and the assay of azide-Hb,and inhibitor of GSH and GSH peroxidase showed smaller effects.The assay of alkalinized Hb exhibited the strongest resistance to all these chemicals.Conclusion:The assay of alkalinized Hb shows the strongest resistance to common chemicals used to investigate the mechanism of peroxidative damage and can be applicable to the study of the mechanism of vitamin C-induced hemolysis.

通过相关文献资料分析老年人小细胞肺癌化疗的必要性,介绍第3代抗肿瘤药物和不同化疗方案的疗效,以及分子靶向治疗药物(如gefitinib)在老年人中的研究进展,为老年人肺癌化疗方案的选择提供参考.

目的:探讨老年人疾病终末期败血症的临床规律,提高诊治水平,减少病死率.方法:对我科收治的16例老年住院病人发生的终末期败血症进行分析总结.结果:本组16例老年人败血症发生于各种疾病的终末期,主要包括恶性肿瘤、糖尿病、脑血管意外以及心、肺肾等疾病终末期的病人.临床症状、体征不典型,主要表现为意识障碍、精神萎靡等神经精神症状;发热,热型不规则,常被基础疾病掩盖.本组16例老年人终末期败血症中铜绿假单胞菌败血症4例、金黄色葡萄球菌败血症3例、白色念珠菌败血症2例、口腔链球菌败血症2例,粪链球菌败血症2例,表面葡萄球菌败血症2例及大肠杆菌败血症1例.16例病人中15例在2周内死亡,其中6例在1周内死亡.结论:老年人疾病终末期败血症死亡率高,早期诊断和早期应用有效抗生素及加强支持治疗是减少病死率的关键.