The development of medical education is rapidly evolving, with innovative teaching methods such as problem-based learning (PBL) and multidisciplinary treatment (MDT) combined with flipped classroom approaches gaining increasing attention in clinical medical education. However, the actual effectiveness of PBL combined with MDT and flipped classroom methods in the teaching of cardiovascular diseases has not been well studied. Considering that these which includedteaching methods can complement each other, this study explores the application and effectiveness of PBL combined with MDT and flipped classroom teaching method in the case-based teaching of acute coronary syndrome. A total of 100 undergraduate clinical medicine students aged 20–21 years from Guangzhou Medical University were selected as research participants. They were randomly divided into two groups via a random number table: the experimental group (PBL combined with MDT and flipped classroom teaching), which included 50 students, and the control group (traditional teaching methods), which also included 50 students. After the clinical training, the theoretical examination scores and skill assessment results of the two groups were compared, and a questionnaire survey was conducted to evaluate teaching effectiveness. The theoretical examination scores and skill assessment results of the experimental group were significantly better than those of the control group (P < 0.05). The questionnaire survey revealed that the students in the experimental group outperformed those in the traditional teaching group in terms of learning motivation, theoretical learning outcomes, clinical thinking ability, literature retrieval skills, self-directed learning ability, practical ability, and classroom satisfaction, with statistically significant differences (P < 0.05). The findings of this study suggest that the integration of PBL, MDT, and the flipped classroom teaching method may have a positive impact on the theoretical knowledge and clinical skills of undergraduate medical students in the context of acute coronary syndrome (ACS). However, due to the study’s limited sample size, short-term assessment period, and reliance on self-reported data, these results should be interpreted with caution.

Background: The development of medical education is rapidly evolving, with innovative teaching methods such as problem-based learning (PBL) and multidisciplinary treatment (MDT) combined with flipped classroom approaches gaining increasing attention in clinical medical education. However, the actual effectiveness of PBL combined with MDT and flipped classroom methods in the teaching of cardiovascular diseases has not been well studied. Considering that these two teaching methods can complement each other, this study explores the application and effectiveness of PBL combined with MDT and flipped classroom teaching method in the case-based teaching of acute coronary syndrome. Methods: A total of 100 undergraduate clinical medicine students aged 20--21 years from Guangzhou Medical University were selected as research subjects. They were randomly divided into two groups via a random number table: the experimental group (PBL combined with MDT and flipped classroom teaching), which included 50 students, and the control group (traditional teaching methods), which included 50 students. After the clinical training, the theoretical examination scores and skill assessment results of the two groups were compared, and a questionnaire survey was conducted to evaluate teaching effectiveness. Results: The theoretical examination scores and skill assessment results of the experimental group were significantly better than those of the control group (P < 0.05). The questionnaire survey revealed that the students in the experimental group outperformed those in the traditional teaching group in terms of learning motivation, theoretical learning outcomes, clinical thinking ability, literature retrieval skills, self-directed learning ability, practical ability, and classroom satisfaction, with statistically significant differences (P < 0.05). Conclusion: PBL combined with MDT and the flipped classroom teaching method is effective in the clinical training of acute coronary syndrome patients, offers better teaching outcomes than traditional methods do and is worthy of further promotion and application.

BACKGROUND:M1 macrophages are closely associated with cardiac injury after myocardial infarction (MI). Increasing evidence shows that exosomes play a key role in pathophysiological regulation after MI, but the role of M1 macrophage-derived exosomes (M1-Exos) in myocardial regeneration remains unclear. In this study, we explored the impact of M1 macrophage-derived exosomes on cardiomyocytes regeneration in vitro and in vivo. METHODS:M0 macrophages were induced to differentiate into M1 macrophages with GM-CSF (50 ng/mL) and IFN-γ (20 ng/mL). Then M1-Exos were isolated and co-incubated with cardiomyocytes. Cardiomyocyte proliferation was detected by pH3 or ki67 staining. Quantitative real-time PCR (qPCR) was used to test the level of miR-155 in macrophages, macrophage-derived exosomes and exosome-treated cardiomyocytes. MI model was constructed and LV-miR-155 was injected around the infarct area, the proliferation of cardiomyocytes was counted by pH3 or ki67 staining. The downstream gene and pathway of miR-155 were predicted and verified by dual-luciferase reporter gene assay, qPCR and immunoblotting analysis. IL-6 (50 ng/mL) was added to cardiomyocytes transfected with miR-155 mimics, and the proliferation of cardiomyocytes was calculated by immunofluorescence. The protein expressions of IL-6R, p-JAK2 and p-STAT3 were detected by Western blot. RESULTS:The results showed that M1-Exos suppressed cardiomyocytes proliferation. Meanwhile, miR-155 was highly expressed in M1-Exos and transferred to cardiomyocytes. miR-155 inhibited the proliferation of cardiomyocytes and antagonized the pro-proliferation effect of interleukin 6 (IL-6). Furthermore, miR-155 targeted gene IL-6 receptor (IL-6R) and inhibited the Janus kinase 2(JAK)/Signal transducer and activator of transcription (STAT3) signaling pathway. CONCLUSION:M1-Exos inhibited cardiomyocyte proliferation by delivering miR-155 and inhibiting the IL-6R/JAK/STAT3 signaling pathway. This study provided new insight and potential treatment strategy for the regulation of myocardial regeneration and cardiac repair by macrophages.

Objective To explore the effect of problem-based learning（PBL） combined with scenario simulation teaching on language expression and communication ability of medical students. Methods A total of 80 clinical medical undergraduates from Guangzhou Medical University were divided into experimental group and control group.The control group adopted conventional teaching method,while the experimental group adopted PBL combined with situational simulation method.The language expression and communication ability of the two groups of medical students were compared.Results The scores of language expression in the experimental group were higher than those in terms of the control group in the consciousness of active expression,confidence of expression,accuracy and clarity of expression,the use of non-linguistic factors,listening and empathy,and the differences were statistically significant（t=5.29,4.30,5.44,3.04,4.31,P＜0.05）.The scores of self-evaluation,environmental perception,communication performance,tendency to communicate with friends and tendency to communicate with strangers in the experimental group were higher than those in the control group,and the differences were statistically significant（t=4.21,4.94,3.30,5.74,3.17,P＜0.05）. Conclusion PBL combined with scenario simulation teaching can effectively improve the language expression and communication ability of medical students.

目的:探讨对非小细胞肺癌(NSCLC)患者,临床治疗上应用贝伐珠单抗联合放化疗治疗方式对患者炎性因子、血管内皮生长因子(VEGF)以及Let-7的影响.方法:采取回顾性分析方法,将97例NSCLC患者分成两组,即试验组47例,对照组50例,对照组应用常规放疗序贯化疗治疗12周,试验组采取贝伐珠单抗联合放疗序贯化疗治疗12周,比较各组临床疗效、治疗前后炎性因子[白细胞介素-2(IL-2)、IL-12、干扰素-γ(INF-γ)]、VEGF及Let-7水平变化.结果:试验组患者治疗总有效率80.00％显著高于对照组52.00％,差异有统计学意义(P<0.05);治疗后两组患者IL-2、IL-12、INF-γ、Let-7水平均较治疗前提高,VEGF水平较治疗前降低,而试验组指标变化幅度明显比对照组更显著,差异有统计学意义(P<0.05).结论:应用贝伐珠单抗联合放化疗治疗NSCLC的效果显著,降低炎性因子水平及VEGF水平,提高Let-7水平.

Abstract M1 macrophages inhibit cardiac repair, but their role in myocardial regeneration remains unclear. In this study, the underlying mechanisms of M1 macrophage-derived exosomes (M1-Exos) in cardiomyocyte proliferation was investigated. Mouse RAW264.7 macrophages were cultured and induced into M1 macrophages. The exosomes from the culture media of M1 macrophages were isolated, and results showed that M1-Exos could inhibit the proliferation of cardiomyocytes. During M1-Exos, miR-155 was highly expressed and delivered to the cardiomyocytes. Furthermore, miR-155 inhibited the proliferation of cardiomyocytes and antagonized the pro-proliferation effect of IL-6 via inhibition of its novel target gene IL-6R. M1-Exos inhibited cardiomyocyte proliferation and cardiac repair by delivering miR-155, which targeted IL-6R, and inhibiting the IL-6R/Jak/Stat signaling pathway. This study provides new insights and potential treatment strategies for the regulation of myocardial regeneration and cardiac repair by M1-Exos.

This study aimed to evaluate the value of neutrophil-to-platelet ratio (NPR) in predicting all-cause mortality in patients with ST-elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI). We enrolled 186 patients with STEMI who underwent primary PCI in the Third Affiliated Hospital of Guangzhou Medical University between January 2017 and December 2018. Based on the NPR values, the patients were divided into two groups: the NPR >0.035 group (n = 82) and the NPR ≤0.035 group (n = 104). All-cause mortality of the patients was followed up for 3 years. By the end of 3 years, 109 (58.6%) patients survived, 53 (28.5%) died, and 24 (12.9%) were lost to follow-up. Univariate analyses found that NPR was associated with all-cause mortality (p < 0.05). In COX regression analyses, patients in the high NPR group had a higher risk of all-cause death than those in the low NPR group (HR = 2.296, 95% CI: 1.150–4.582). These results indicate that NPR could predict all-cause death in 3 years after primary PCI in patients STEMI. NPR values may be useful in risk stratification and in specifying individualized treatment in patients with STEMI. In addition, NPR is a low-cost and easily accessible indicator, if its strong predictive value is confirmed in further studies of other large populations, it can be introduced into clinical practice for effective application.

目的:探讨PBL教学对临床医学本科生自主学习和学习投入的影响.方法:选取广州医科大学临床医学专业本科(2017级)大二学生共80名,随机分为对照组和实验组.对照组采用传统课程方法教学,实验组在传统课程基础上开设PBL课程.通过自主学习能力量表和学习投入量表评估学生的自主学习和学习投入情况.结果:实验组的自主学习和学习投入情况均显著优于对照组(P<0.05).结论:PBL教学能显著提高医学生自主学习和学习投入.

目的:探讨葛根素对人源肥大心肌细胞脑钠肽(BNP)表达的影响.方法:内皮素-1(ET-1)诱导人源心肌细胞肥大,200μg/mL葛根素对肥大心肌细胞进行预处理及后处理,高内涵仪器MD ImageXpress Nano检测分析肥大心肌细胞BNP的表达量.结果:与对照组相比,肥大心肌细胞BNP表达量增加(P<0.05);与肥大心肌细胞组相比,葛根素预处理及后处理均可降低BNP表达量(P<0.05),其中葛根素预处理降低BNP表达量更为显著(P<0.05).结论:葛根素对肥大心肌细胞可起到一定的保护作用,为葛根素在心肌肥大治疗方面提供了理论基础.

目的:探究压力负荷型心肌肥大中NPY受体的双向调节作用.方法:选择12只Wistar雄性大鼠并对其进行随机分组,6只为假手术组,另外6只为手术组,同时选择腹主动脉部分缩窄法,以构建压力超负荷的动物模型.对Wistar大鼠在术后2、7、14天分别进行动态观察.检测Y1、Y2、Y5受体蛋白含量和mRNA表达、心肌细胞横截面积、全心重量/体质量、血压.结果:假手术组和手术组的收缩压在术后2、7、14天对比,差异显著(P<0.05);两组的全心重量/体质量在术后14天对比差异显著(P<0.05);在术后14天的心肌细胞横截面积上,两组对比差异显著(P<0.05);在术后2、7天的NPY受体Y5、Y2、Y1 mRNA表达量上,手术组高于假手术组,对比差异有统计学意义(P<0.05),在术后14天,手术组低于假手术组,对比差异有统计学意义(P<0.05);在术后2、7天的NPY受体Y5、Y2、Y1蛋白表达量上,手术组高于假手术组,对比差异有统计学意义(P<0.05),在术后14天,手术组低于假手术组,对比差异有统计学意义(P<0.05).结论:在大鼠压力负荷型心肌肥大中,手术组术后2、7天为压力超负荷初期,压力超负荷心肌肥大代偿期出现于第14天.压力超负荷大鼠心肌NPY受体Y1、Y2、Y5呈动态表达,初期上升,而在心肌肥大代偿阶段降低.

目的 观察并探讨替格瑞洛治疗非ST段抬高型急性冠脉综合征(NSTE-ACS)患者,血清内皮细胞微粒(EMPs)和可溶性细胞间黏附分子-1(sICAM-1)的水平变化及预后.方法 选取2019年1—6月广州医科大学附属第三医院收治的NSTE-ACS患者146例,根据随机数字表法分为两组,每组73例,氯吡格雷组给予氯吡格雷治疗,替格瑞洛组给予替格瑞洛治疗.观察两组经皮冠状动脉介入术(PCI)前、术后24 h、术后7 d和术后30 d的EMPs和sICAM-1的水平变化.随访比较两组术后6个月主要不良心脏事件(MACE)和不良反应的差异.结果 两组患者EMPs和sICAM-1水平在术后24 h较PCI前均明显上升,在术后7 d较术后24 h均显著下降,在术后30 d较术后7 d均显著下降,差异有统计学意义(P<0.05).替格瑞洛组EMPs和sICAM-1水平在术后7 d均低于氯吡格雷组、在术后30 d均低于氯吡格雷组,差异有统计学意义(P<0.05).与氯吡格雷组比较,替格瑞洛组总体MACE事件降低,差异有统计学意义(P<0.05);两组出血事件发生率比较,差异无统计学意义(P>0.05).结论 替格瑞洛治疗NSTE-ACS患者,能够更加迅速改善血管内皮功能并降低炎症反应,从而稳定动脉粥样硬化斑块,不增加出血风险.

OBJECTIVE:To study the effect of puerarin on electrophysiology using a hypertrophic cardiomyocyte (HC) model.MATERIALS AND METHODS:Human urine epithelial cells were used to generate the HC model (hiPSC-CM). Cardiomyocyte hypertrophy was induced by applying 10 nM endothelin-1 (ET-1). Effects of puerarin pre-treatment (PPr) and post-treatment (PPo) on action potential, sodium current (INa) activation and inactivation, and recovery following INa inactivation were tested using patch clamp electrophysiology.RESULTS:Depolarization to repolarization 50% time (APD50) and repolarization 30% time (APD30) were significantly prolonged in the PPo and PPr groups compared with the controls. However, there were no significant differences in the action potential depolarization amplitude (APA) or the maximum depolarization velocity (Vmax) in phase 0. The PPr group had a slightly shortened APD90, and an extended APD50 and APD30, but did not exhibit any significant changes in stage A of APA and Vmax. The PPo group did not exhibit any significant changes in INa, while 12 h of PPr improved INa. However, puerarin did not significantly affect the activation, inactivation, or recovery of the sodium channel.CONCLUSIONS:Cardiomyocyte hypertrophy significantly decreased the Vmax of the action potential and the peak density of INa. PPr inhibited the decrease in Vmax and increased the peak density of INa. Thus, puerarin could be used to stabilize the electrophysiological properties of hypertrophic cardiomyocytes and reduce arrhythmias.

内科教学作为医学中较为重要的一个分支,在医学的应用中十分广泛,因此在教学中更应该对内科教学进行重视,让内科的学生们对知识更好的掌握,在此过程中教师也可以通过改善教学模式以及教学理念使得内科教学的目的进一步得到实现.传统的医学教育过程中更加重视老师的讲解和学生的吸收,该教学模式较为死板,不能很好地激发学生的积极性,对学生的理解也有着一定的影响,本研究对基于工作过程的情景教学方法在内科学教学中产生的作用和影响展开了探究,旨在找出最为有效的教学方法.

目的 探讨情景式PBL教学法联合形成性评价对心血管内科规培医生的教学效果.方法 将2018年1月—2019年6月在广州医科大学附属第三医院心血管内科进行规培的医生80名作为研究对象,将其分为对照组及试验组,比较两组规培医生的临床实践能力、三基考试和综合能力.结果 试验组临床实践能力的医疗面谈、体格检查、操作技能、临床思维、组织协调均优于对照组(P<0.05);试验组三基考试成绩优于对照组(P<0.05);试验组综合能力的自主学习、解决问题、运用知识、逻辑推理、查阅文献、职业素养均优于对照组(P<0.05).结论 情景式PBL教学法联合形成性评价能够明显提升规培医生的临床实践能力、理论考试成绩和综合能力.

胸痛是许多致命性疾病如急性心肌梗死、心绞痛、主动脉夹层、急性肺梗死等的常见症状,其中急性心肌梗死的病死率及并发症发生率极高.如何快速诊断、及时抢救和治疗、提高生存率至关重要.为进一步提高广州市荔湾区急性心肌梗死的救治水平,荔湾区医联体探索新模式,笔者所在的广州医科大学附属第三医院(以下简称广医三院)胸痛中心牵头,联合荔湾区多家社区卫生服务中心联合成立了荔湾区胸痛医联体,这也是广州市第一个区域性胸痛中心医联体.

Objective To investigate the level changes and clinical value of serum H-FABP,hs-CRP and Hcy in patients with atrial fibrillation(AF)and chronic heart failure(CHF).Methods 120 patients with AF and CHF were chosen as the observation group,100 patients with sinus rhythm were chosen as the control.The levels of H-FABP,hs-CRP and Hcy of the two groups were compared.H-FABP,hs-CRP and Hcy levels were also compared in the different subgroups divided according to the cardiac function.Risults Compared with the control group,the levels of H-FABP,hs-CRP and Hcy in patients with atrial fibrillation were significantly higher(P<0.05).The lev-els of H-FABP,hs-CRP and Hcy in the observation group were higher than those in the control group in the same cardiac function subgroup(P < 0.05). Conclusion The elevation of the level of H-FABP,hs-CRP and Hcy are closely related to the occurrence and maintenance of atrial fibrillation and the damage of myocardial cells,and it was related with the severity of cardiac function.

The aim of the present study was to investigate the cardioprotective effects of anisodamine against myocardial ischemia/reperfusion (I/R) injury and the molecular mechanisms involved. The present results demonstrated that anisodamine attenuated myocardial infarct sizes, decreased the levels of creatine kinase and lactate dehydrogenase, whereas it increased the left ventricular (LV) systolic pressure, the LV end‑diastolic pressure, and the LV pressure maximum rising and falling rates in a myocardial I/R rat model. In addition, anisodamine was revealed to suppress oxidative stress, inflammatory factor production and myocardial cell apoptosis, as demonstrated by the downregulation of caspase‑3 and apoptosis regulator BAX protein expression. The production of reactive oxygen species was decreased and the protein expression of inducible nitric oxide synthase (iNOS) was downregulated, whereas the expression of endothelial NOS was enhanced. In addition, the activity of nicotinamide‑adenine dinucleotide phosphate oxidase (Nox) was suppressed and the expression of Nox4 was downregulated in rats with myocardial I/R injury. In conclusion, the results of the present study suggested that anisodamine exerted a cardioprotective effect against myocardial I/R injury in rats, through the inhibition of oxidative stress, the suppression of inflammatory processes and the inhibition of myocardial cell apoptosis.

Objective To explore the effect of mild hypothermia on cardiac output of patients with acute myocardial infarction (AMI) complicated with cardiac shock after percutaneous coronary intervention (PCI). Methods Seventy patients with AMI complicated with cardiac shock were divided into the observation group and the control group according to the order of admission ,and all patients underwent emergency PCI. The observation group was treated with mild hypothermia combined with emergency PCI under IABP support ,while the control group was treated with emergency PCI under IABP support alone. The changes of cardiac index(CI),creatinine(Cr)and left ventricular ejection fraction(LVEF)before and after treatment were compared between the two groups. The dose of norepinephrine ,complications and 28 d survival rate were recorded. Results After treatment,CI,urine volume,SvO2 and LVEF were significantly increased,while Cr was significantly decreased (P<0.05),and the above indexes in the observation group were significantly better than those in control group(P<0.05);After operation,the dose of norepinephrine in the observation group was significantly lower than that in control group (P<0.05). There were no significant differences in the incidence rates of severe arrhythmia ,heart failure,hypopiesia and shock and 28 d survival rates between the two groups (P>0.05). Conclusion Survival rate of patients with AMI complicated with cardiac shock treated by mild hypothermia combined with IABP assisted emergency PCI is high,with few complications. It can significantly improve postoperative circulatory function and cardiac function ,and reduce the dose of norepinephrine.

目的 探讨卡维地洛用于扩张型心肌病心力衰竭临床治疗的效果.方法 86例扩张型心肌病心力衰竭患者, 随机分为对照组与观察组, 每组43例.对照组采用常规治疗, 观察组在常规治疗基础上加用卡维地洛治疗.比较两组患者的临床疗效、左心功能、不良反应.结果 观察组治疗总有效率为93.02%, 明显高于对照组的76.74%, 差异具有统计学意义(P<0.05).治疗后观察组左室舒张期内径(LVIDd)、左室收缩期内径(LVIDs)、左室射血分数(LVEF)、左房内径(LAD)、6 min步行距离均优于对照组,差异均具有统计学意义(P<0.05).治疗后两组均无明显不良反应发生.结论 卡维地洛用于扩张型心肌病心力衰竭临床治疗效果良好, 能有效改善左心功能, 使用安全性高, 具有积极的临床意义.

目的 探讨曲美他嗪用于肥厚型心肌病心力衰竭临床治疗的效果观察.方法 选取我院2016年3月～2017年3月收治的肥厚型心肌病心力衰竭患者80例随机分为两组,对照组采用常规治疗,在此基础上观察组给予曲美他嗪治疗,比较两组患者的临床疗效、心功能变化、不良反应.结果 观察组治疗有效率为95％,明显高于对照组的82.5％,两组间比较,差异有统计学意义(P<0.05);观察组治疗后LVIDd、LVIDs、LVEF、CO较对照组明显改善,两组间有统计学差异,差异有统计学意义(P<0.05);两组均无明显不良反应发生,差异无统计学意义(P>0.05).结论 曲美他嗪用于肥厚型心肌病心力衰竭临床治疗效果良好,有利于左心功能的提高,抑制病情进展,且使用安全性高,具有积极的临床意义.