目的:观察长期负性情绪积累对化疗后三阴性乳腺癌患者认知功能、尿8-羟化脱氧鸟苷(8-hydroxylated deox-yguanosine,8-OHdG)及血浆超氧化物歧化酶(superoxide dismutase,SOD)、过氧化脂质(lipid peroxidation,LPO)的影响.方法:采用艾森克人格问卷(EPQ)N维度量表评估河南中医药大学第一附属医院血液肿瘤科门诊以及病房就诊的化疗后三阴性乳腺癌患者,筛选情绪稳定与不稳定患者,并按照同性别、同年龄段、同文化程度进行1:1匹配,分为情绪稳定组和情绪不稳定组.采用蒙特利尔量表(Montreal cognitive assessment,MoCA)评估两组患者的认知功能,采用肝气郁结量表观察两组患者的肝气郁结程度,采用酶联免疫吸附法检测两组患者的尿8-OHdG及血浆SOD和LPO水平.结果:情绪不稳定组患者认知功能明显下降,与情绪稳定组比较,差异有统计学意义(P＜0.05).情绪不稳定组视空间与执行、注意、语言、延迟回忆、定向得分明显下降,与情绪稳定组比较,差异有统计学意义(P＜0.05).情绪不稳定组肝气郁结证症状程度评分高于情绪稳定患者,差异有统计学意义(P＜0.05).情绪不稳定组尿8-OHdG、血浆LPO水平高于情绪稳定组,而情绪不稳定组的血浆SOD水平低于情绪稳定组,差异均有统计学意义(P＜0.05).结论:长期负性情绪积累是导致化疗后三阴性乳腺癌患者功能衰退的主要原因.

传统的中医师承教育与现代的高等院校教育均为目前中医学中的教育方式，相较于现代的高等院校教育而言，传统的中医师承教育具有更长久的历史文化，传承了中医传道受业解惑的教学方式，促进了中医药的文化发展。但由于其教学模式较小，老师所教授学生人数有限，并且在学习过程中在基础理论知识方面未有系统教学，存在一定的弊端，而现在高等院校教育采用多种方式教学，丰富学生知识面，但学生在校期间较少接触临床，学习实践性较为缺乏，两种教学方式存在互补性，将两者进行结合，提供新的教学方式，力争为中医药培养更多的人才，传承中医文化。

肿瘤的多学科诊疗模式(MDT)是目前临床上新兴的治疗模式,对于恶性肿瘤患者的诊疗是一种进步.目前我国各大教学医院已经尝试开展了肿瘤MDT的教学模式.该教学模式较大幅度的提高了临床实习医师的综合素质,激发了学生的自主学习能力,科研创新能力以及人文修养,并加深了对肿瘤学理论知识的理解,但是肿瘤MDT的教学模式仍有一些不足.本文就MDT在肿瘤教学中的必要性展开论述,诠释MDT诊疗模式在肿瘤治疗中的重要性.

中医学“中和”思想是对中国传统文化的继承和延伸,是儒家修身治世的核心思想.是中医学生命观、疾病观、治疗观、养生观建立的基础.所以在中医学临床带教中应注重“中和”思想,将医患“和”、师生“和”以及中西医和谐发展的理念贯穿于临床教学中.

诊断学是基础医学与临床医学之间的重要桥梁课程,它是临床各科的基础.该课程具有理论知识点多 、实践操作性强,部分内容抽象 、涉及内容面广等特点,在教学中可有效培养学生的临床实践与思维能力,为今后临床工作打下坚实的基础.为了有效提高诊断学课程的教学质量,为临床工作培养更多的人才,积极开展微课与PBL教学法的有机结合,通过这种教学改革最终让学生提高了自主学习能力,增强了临床思维能力;让教师自身成长.

甲状腺癌(TC)是最常见的内分泌系统恶性肿瘤,其发病率近年明显上升,目前分化型甲状腺癌(DTC)术后最佳综合治疗方案是"放射性碘(RAI)治疗+促甲状腺激素(TSH)抑制治疗",靶向治疗也日渐成熟,对DTC术后的生命质量日益关注.DTC术后预后较好,但对于术后并发症缺乏有效手段,中医治疗可改善患者的临床症状及并发症,降低复发率,提高生命质量,本人通过复习相关文献,对DTC术后的研究进展进行综述.

背景:研究表明,白血病患者需要及早行化疗延缓病情进展,中草药对该病治疗效果甚微,还有研究持相反意见,认为中草药联合化疗可以一定程度提高患者的治愈率.由于中草药成分复杂,治疗的机制尚不明确.目的:探究解毒化瘀中药对急性淋巴细胞白血病模型小鼠的影响.方法:将白血病细胞株L1210和白血病耐药细胞分别从小鼠尾静脉注入体内制备急性淋巴细胞白血病模型,随机分为白血病模型组、解毒化瘀中药低浓度组、解毒化瘀中药高浓度组,另设正常对照组.造模成功后第2天按照10,50 mg/kg给药,连续7 d,于每周一早晨7点取尾静脉血,连续5周,采用MTT检测白血病耐药细胞生存率,分析血细胞种类及血象;Western blot法检测小鼠骨髓中NF-κB/P65、NF-κB/P50、IκBα、PTEN、Akt、Bcl-2及p-Akt蛋白的表达.结果与结论:①与白血病模型组比较,解毒化瘀中药低、高浓度组白血病耐药细胞存活率显著降低,差异有显著性意义(P<0.01);②与模型组比较,解毒化瘀中药低、高浓度组小鼠骨髓中NF-κB/P65、NF-κB/P50、IκBα、Bcl-2、Akt、p-Akt蛋白表达量显著降低,PTEN蛋白表达量显著升高,差异有显著性意义(P<0.01);③与模型组相比,解毒化瘀中药低、高浓度组白细胞、淋巴细胞、L1210细胞显著降低,中性粒细胞显著升高,差异有显著性意义(P<0.01);④结果表明,解毒化瘀中药通过阻断PI3K/Akt及NF-κB信号通路实现抑制L1210细胞增殖效应,从而缓解和治疗急性淋巴细胞白血病.

近年来,受生活生存压力增加、饮食快餐化、环境质量下降、人口老龄化等因素综合影响,甲状腺癌的发病率逐年快速增高且发病年龄范围不断扩大.甲状腺癌患者手术治疗或碘131治疗后出现诸多亟待解决的问题,如术后诸多不适症状及不同程度的心理问题.本文从病因病机分析、辨证治法分析、临床治疗机制研究等方面对甲状腺癌术后的中医药治疗进行详细论述.

目的:探讨滋髓生血汤治疗慢性再生障碍性贫血(CAA)临床疗效的倾向指数及对患者骨髓微血管密度(MVD)、血管内皮生长因子(VEGF)及成纤维细胞生长因子(FGF)-1水平的影响.方法:选取2015年1月-2018年1月医院收治的118例CAA患者,根据治疗方法分成两组,对照组(n=59,仅给予常规西药治疗)和观察组(n=59,在西药治疗基础上联合滋髓生血汤内服治疗).应用倾向指数匹配法对两组基线资料进行匹配,经处理后共有92例患者入选,其中观察组与对照组各46例,匹配比例为77.97％,基线资料匹配后达到均衡.对匹配后两组的临床疗效、药物不良反应及治疗前后中医症状总积分、骨髓MVD值和骨髓VEGF、FGF-1水平变化等情况进行统计分析.结果:观察组总有效率为86.96％(40/46),与对照组的67.39％(31/46)相比显著升高(P＜0.05).两组治疗后中医证候总积分均较治疗前显著降低(P＜0.05),而观察组减少更显著(P＜0.05).两组治疗后骨髓MVD值及骨髓VEGF、FGF-1含量均较治疗前显著增高(P＜0.05),且观察组上升更显著(P＜0.05).观察组肝功能异常、痤疮、多毛症、牙龈增生发生率依次为4.35％、4.35％、4.35％、2.17％,均显著低于对照组(21.74％、23.91％、19.57％、15.22％,P＜0.05).结论:滋髓生血汤治疗CAA能有效增加患者骨髓MVD,调控骨髓中VEGF、FGF-1表达水平,改善造血微环境,提高治疗效果,且呈现出明显的减毒优势.

Objective To investigate the effect of the serum containing Banxia-Danggui-Chixi-aodou decoction on the proliferation, invasion and migration of lung cancer cells A549 and underly-ing mechanisms.Methods Lung cancer cells A549 were divided into control, Banxia-Danggui-Chixiaodou decoction low-dosage ( LD ) , middle-dosage ( MD ) and high-dosage ( HD ) groups.After treatment of the cells with different doses of drug-containing serum, cell proliferation was detected by using CCK8 kit; apoptosis by Hoechst staining, cell invasion by Transwell assay, cell migration by scratch test and the expressions of PCNA, BCL-2, BAX, VEGF, MMP-2, MMP-9, TGF-β, SMAD2 and SMAD3 by Western blotting.The transplanted tumor model was es-tablished by subcutaneous injection of lung cancer A549 cells into nude mice, and rats were divided into Control, LD, MD and HD groups.After aforementioned treatments, the survival of nude mice in each group was observed; the volume of subcutaneous tumors in each group was measured; the apoptosis of tumor tissues was detected by TUNEL; the expression of Ki67 and VEGF in tumor tis-sues was immunohistochemically detected.Results Compared with the control group, the cell pro-liferation rate and PCNA expression in Banxia-Danggui-Chixiaodou decoction groups were significant- ly decreased; the percentage of apoptotic cells and BAX expression were significantly increased;the expression of BCL-2 was significantly decreased; the cell scratch closure rate and the number of invasive cells were significantly decreased and the expression of VEGF, MMP-2, MMP-9, TGF-β, SMAD2 and SMAD3 was significantly reduced.Compared with the control group, the survival rate of nude mice fed with Banxia-Danggui-Chixiaodou decoction was significantly increased; the volume of subcutaneous tumor tissue was significantly decreased; the percentage of apoptotic cells was signifi-cantly increased, and the proportion of Ki67 and VEGF positive cells was significantly de-creased.The effect was increase with the dosage of administration.Conclusion The serum contai-ning Banxia-Danggui-Chixiaodou Decoction can significantly reduce the proliferation, invasion and migration of lung cancer A549 cells, and inhibited the activation of TGF-β /SMAD signaling path-way in the cells.

目的:观察藤梨根提取物与第三代铂类奥沙利铂(L-OHP)对人食管癌Ec9706细胞株增殖的影响.方法:分别应用藤梨根正丁醇提取物与L-OHP单独应用以及联合应用于人食管癌Ec9706细胞株,并应用MTT法检测食管癌Ec9706细胞的抑制率,并且应用显微镜在镜下观察食管癌细胞株的形态变化;并且对细胞的凋亡率和细胞周期使用流式技术进行检测,且对食管癌细胞Ec9706株应用免疫细胞化学技术检测中细胞株内Bcl-2和Survivin蛋白的表达水平.结果:藤梨根提取物单用、奥沙利铂单用、以及联合应用均可对食管癌细胞Ec9706的增殖起到抑制作用.通过显微镜下观察食管癌细胞株发现Ec9706细胞的形态发生了改变,并且凋亡比率也显著增加;且藤梨根提取物与L-OHP连用后能起到协同增效的作用.而应用藤梨根提取物后食管癌细胞Ec9706中Bcl-2和Survivin蛋白的表达水平均受到了抑制.连用L-OHP后两种蛋白的阳性率表达均进一步降低.结论:藤梨根正丁醇提取物能显著抑制人食管癌细胞Ec9706细胞的增殖并且与L-OHP联用可有协同增效的作用,抑制作用明显增强,可能机制与Bcl-2和Survivin蛋白的下调有关.

Objective To observe the inhibitory effect of Rattan pear root extract on gastric cancer SGC7901 cells and its mecha-nism. Methods MTT was used to detect different doses of Rattan pear root extract inhibition on proliferation of human gastric cancer SGC7901 cells. Cell cycle and apoptosis were detected. Results In the concentration range from 25 to 200μg/ml,different concentrations of Rattan pear root extract had inhibitory effect on gastric cancer cells SGC7901 with concentration dependence. Treated with 53,86 μg/ml and 142 μg/ml Rattan pear root extract for 48 h,the SGC7901 in S phase ratio was increased,the apoptosis rate was increased significantly. Con-clusions Rattan pear root extract might inhibit gastric cancer SGC7901 cells proliferation by intervening in the cell cycle and apoptosis,at the same time drug concentration has certain dependence.

目的翻转课堂结合技能考核教学模式在诊断学检体诊断教学中的应用效果.方法随机选择2013级中西医临床本科2班102名学生为观察对象,将其分为对照组和实验组,实验组采用翻转课堂结合技能考核的方法进行教学,对照组采用传统教学方法,通过技能考核成绩及问卷调查进行效果评估.结果实验组学生技能考核成绩明显高于对照组(P＜0.05),且绝大部分实验组学生对在检体诊断教学中开展翻转课堂结合技能考核教学模式评价较好.结论翻转课堂结合技能考核教学模式可明显提高诊断学检体诊断的教学效果,优于传统教学模式.

随着生物—心理—社会医学模式的形成,作为一名优秀的医生除具有扎实的医学理论功底和丰富的临床经验外,还需要广博的人文社会学知识与高尚的道德修养.只有在医学教育中渗透人文素质教育,才有可能培养出时代需要的合格医学人才.诊断学是连接基础医学与临床医学的桥梁,是人文素质教育的重要途径.利用灵活的教学方法在教学各环节渗透医德意识、医患沟通方法、法律意识、文化修养等人文素质教育内容,不仅可提高学生学习兴趣与学习效率,还可全面提升医学人文素质,促使其成长为优秀的临床医生.

OBJECTIVE To analyze the effects of linezolid on treatment of myeloid leukemia in elderly patients with gram‐positive bacteria ,so as to provide the basis for clinical prevention and treatment .METHODS A total of 20 patients with myeloid leukemia associated with gram‐positive bacterial infections in the hospital from Sep .2010 to Sep .2015 were randomly selected for the study ,and divided into observation group and control group according to the methods of treatment ,with 10 cases in each group .Two groups of patients were treated with cefoperazone/sulbactam ,and observation group were treated with linezolid on this basis .The effects of linezolid on treatment of myeloid leukemia in elderly patients with gram‐positive bacteria were analyzed .RESULTS There was no significant difference in infection sites between the two groups .Totally 30 strains of pathogenic bacteria were detected from 20 patients ,including 22 strains of gram‐positive bacteria ,accounting for 73 .33% ,8 strains of gram‐negative bac‐teria ,accounting for 26 .67% ,and 10 patients with dual infections .The average treatment time and body tempera‐ture recovery time of observation group were significantly shorter than those of control group ,(P<0 .05) .The therapeutical effective rate of observation group was 90 .00% ,which was significantly higher than 80 .00% of con‐trol group .There were no drug‐related heart and liver function abnormalities of the two groups during treatment . CONCLUSION Linezolid has good therapeutical effect on treatment of myeloid leukemia in elderly patients with gram‐positive bacteria ,it can effectively shorten the treatment time and body temperature recovery time ,has low adverse events ,so it is clinically worthy of promoting .

高萍教授治疗慢性再生障碍性贫血重视中西医结合,病证结合,认为其病因常常由于外感所伤,病机以脾肾两虚,阴阳不和为本,气血两亏、瘀血为标,临床上往往呈现出虚实夹杂之证.用药重视益肾补脾、活血化瘀兼以补气养血,临床上往往取得满意疗效.

目的 研究在高等中医院校诊断学中进行检体诊断实践教学改革对学生体格检查操作技能培养的促进作用.方法 将2012级中西医临床医学本科4班学生随机分成实验组(40人)和对照组(40人),采用技能考核的方法进行教学效果评估.结果 实验组学生的技能考核成绩明显高于对照组的学生(P＜0.05),且绝大部分实验组学生对在实训过程中开展强化技能考核评价较好.结论 在诊断学实践教学中进行技能考核,在体格检查操作技能方面的培养效果显著优于传统教学模式.

肝脾各自的生理功能和病理特点,决定了两者密不可分的联系,结合晚期乳腺癌的疾病特点,提出治疗思路上重视"肝脾同治",强调调整脏腑功能,配合化痰行瘀等攻邪之法,是晚期乳腺癌中医治疗策略之一。

目的探讨扶正固本法联合NP方案化疗治疗晚期乳腺癌的疗效。方法将60例晚期乳腺癌患者随机分为中药加化疗组及单纯化疗组,观察生存质量、瘤体改变及毒副作用比较。结果中药加化疗组与化疗组患者生存质量,毒副作用比较有显著性差异,有效率分别为56.7%与53.3%,两组比较有显著性差异。结论扶正固本法联合NP方案化疗治疗晚期乳腺癌能改善患者的生存质量,降低毒副作用。

《诊断学基础》是高等中医院校学生学习的一门重要临床课程,但由于教学模式落后,教学目标单一等原因,学生在学完本课程后却不会实际应用。为此,我们在以"培养学生能力为重心"的教学指导思想下,借助信息技术环境,对教学模式和教学方法进行创新研究,以便更好地完成教学使命。