目的 回顾性分析乙型肝炎肝硬化失代偿期并发自发性腹膜炎(SBP)患者腹水培养病原菌分布、药敏状况及临床真实抗生素选择应用情况,为合理选择抗菌药物提供参考.方法 收集并分析乙型肝炎肝硬化失代偿期并发SBP患者的腹水病原菌培养、药敏试验,并针对抗生素的选择及依据药敏结果的调整应用情况,对6 个临床科室 30 名医师行问卷调查,使用SPSS 26.0 行统计学分析.结果 49 名患者腹水标本中,分离出病原菌60 株,41 例患者为单一菌感染,8 例患者为复合菌感染.其中革兰阴性菌 36 株、革兰阳性菌 22 株和真菌 2 株.革兰阴性菌中主要致病菌以大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌的肠杆菌目为主.药敏结果显示,革兰氏阴性菌对美罗培南、替加环素、哌拉西林/舒巴坦、阿米卡星敏感,对复方新诺明、氨苄西林和氨苄西林/舒巴坦,头孢唑林、妥布霉素、左氧氟沙星耐药率较高.革兰阳性菌中主要致病菌为缓症链球菌、金黄色葡萄球菌、人葡萄球菌.革兰阳性菌对万古霉素、利奈唑胺、氯霉素、利福平敏感,对青霉素、氨苄西林、红霉素耐药率较高.抗菌药物使用情况临床问卷调查显示,医师初期会选择使用广谱抗生素(29/30,96.67%),但在药敏结果回示后,仅有 1 名会调整为窄谱抗生素(3.3%).结论 乙肝肝硬化失代偿期并发SBP患者腹水培养的病原菌以革兰阴性菌居多,同时混合菌感染比例增加,尤其是低毒力的条件致病菌.在临床实践过程中仍存在抗生素应用不合理情况,应依据药敏结果及时调整抗菌药物,减少耐药菌的产生.

《全科医学概论》是医学生认识全科医学和启蒙全科医疗思维的一门专业基础课程,能够帮助医学生树立以健康为中心、持续性、基础性、预防性、综合性等服务的理念,培养良好的社会主义核心价值观.然而在教育及实践中,全科医学常存在归类为非主流专业、职业认同感低、重理论轻实践、"难下基层""难留基层"等问题,忽略了对全科医学生课程思想政治的教育.以成果为导向教育的理念正在为我国工程教育认证所推荐,教育者需"以职业需求为导向,以创新和实践能力为主线,构建学生的知识、能力和素质结构体系".文章根据《全科医学概论》课程特点,基于成果导向教育理念,深入挖掘、提炼课程中的隐性思政教育元素,探索《全科医学概论》课程思政教学目标、体系和方案,激发其对全科医生的职业认同感,鼓励更多的医学生毕业后选择全科医生作为终身职业,培养适用于新社会形势下扎根基层的全科医学人才.

对全科住院医师进行规范化培训,通过构建整合课程体系、形成普适性培养模式、采用教学组织方式、明确临床思维能力评价标准开展临床思维能力培养的新模式,可使全科住院医师的临床思维能力得到提升,并在一定程度上提高其专业技能与岗位胜任能力,继而减轻其职业压力.以培训临床思维能力为基本,对全科住院医师进行规范化培训,还能将临床思维能力培养理念渗入到培训中,有助于提高全科住院医师的临床技能,使其成为一名合格的临床医师,对提高医院的医疗服务水平有意义.

结合疫情期间线上教学经验,从加强课程思政、更新教学模式、建设教学资源和提升教师能力等方面着手,通过线上和线下教学有机结合,实现导学互动,将BOPPPS教学模式引入诊断学大班理论授课,以期提高教学效果.

Preeclampsia is the main cause of poor maternal-fetal outcomes. A series of cell and animal experiments, and a small number of clinical studies have shown that pravastatin can prevent and treat preeclampsia by regulating angiogenesis, increasing the expression of heme oxygenase, and stimulating the production of nitric oxide without any reported adverse effects during pregnancy. We review the latest progress on the mechanism, effect, and safety of pravastatin in the prevention and treatment of preeclampsia.

Objective To investigate the protective effects of astragalosides Ⅳ (ASI) on high glucose-induced renal proximal tubular epithelial cells (NRK-52E).Methods NRK-52E were cultured and divided randomly into three groups:control group,high glucose group (HG in short),ASI groups (with various doses).Cells were treated with increasing concentrations of ASI (20,40,80 and 100 μg/ml) for 24 h in high glucose and we also stimulated cells in ASI 100 μg/ml with high glucose for various lengths of time.The apoptosis rate was detected by flow cytometric analysis.The mRNA and protein expression of transforming growth factor-β1 (TGF-β1),a-smooth muscle actin (α-SMA),Smad2,Smad3 and their phosphorylated forms were detected by real-time polymerase chain reaction (PCR) and Western blot,respectively.Results Compared with the control group,apoptosis was increased in the high glucose group (P ＜ 0.01).However,ASI inhibited high glucose-induced cell apoptosis in a dose-dependent manner,with a maximal inhibitory effect achieved at 100 μg/ml (P ＜ 0.05).The significant inhibition caused by ASI was observed at 8h after the start of pretreatment (P ＜ 0.05) and increased in a time-dependent manner.ASI can inhibit the expression of TGF-β1,α-SMA,Smad2,Smad3 both at mRNA and protein level.Conclusions ASI inhibited NRK-52E cells apoptosis induced by high glucose and reduced expression of TGF-β1,α-SMA,Smad2,Smad3 both at the mRNA and protein level in NRK-52E cells,thus delayed epithelial-to-mesenchymal transition progress.

目的 观察不同浓度葡萄糖腹膜透析液(dextrose)、艾考糊精腹膜透析液(icodextrin)对大鼠腹膜间皮细胞血管内皮生长因子(VEGF)及其受体VEGFR1、VEGFR2、sFlt-1合成的影响.方法 分离、培养SD雄性大鼠腹膜间皮细胞(RPMCs),第二代细胞用于实验研究.实验分为5组,分别以不同腹膜透析液〔1.50％dextrose(低糖组)、2.50％dextrose(中糖组)、4.25％dextrose(高糖组)、7.50％icodextrin组(糊精组)〕进行刺激培养,无血清DMEM为阴性对照(对照组).RT-PCR法检测VEGF及其受体VEGFR1、VEGFR2、sFlt-1 mRNA表达,Western印迹法检测RPMCs的VEGFR1、VEGFR2蛋白表达;酶联免疫吸附试验(ELISA)检测细胞培养上清中VEGF及sFlt-1表达.结果 各组均见VEGFR1、VEGFR2、sFlt-1 mRNA和蛋白表达.在核酸和蛋白水平,中糖组、高糖组VEGFR1表达明显高于低糖组、糊精组及对照组(P<0.01,P<0.05);中糖组、高糖组VEGFR2表达显著低于低糖组、糊精组及对照组(均P<0.01);低糖组VEGFR2蛋白表达显著低于对照组(P<0.01).在核酸水平,中糖组、高糖组VEGF、sFlt-1表达明显高于对照组(P<0.01);RPMCs培养上清液中,VEGF、sFlt-1蛋白表达强弱趋势与RT-PCR一致.结论 正常培养的RPMCs表达VEGFR1、VEGFR2及sFlt-1.腹膜透析液,尤其是高浓度dextrose,能明显上调VEGF、VEGFR1及sFlt-1的表达,但下调VEGFR2的表达,提示其可通过调节VEGF受体从而调节VEGF系统,这可能是导致长期腹膜透析过程中腹膜血管增生的机制之一.icodextrin的生物相容性可能优于高浓度dextrose.

Hypoxia-inducible factor1-alpha (HIF-1 alpha) and vascular endothelial growth factor (VEGF) are associated with the occurrence and development of diabetic nephropathy (DN) and the process of angiogenesis. This research adopts the streptozotocin (STZ) to create animal models with DN, detect the levels of HIF-1 alpha and VEGF and analyze the impact of HIF-1 alpha expression on VEGF and microvessel density (MVD) in rats with DN. STZ was adopted to create the rat models with DN and retinal venous blood and renal tissues of rats were selected. Enzyme linked immunosorbent assay (ELISA) and immunohistochemical (IHC) method were used to detect the expressions of HIF-1 alpha and VEGF in serum and tissues, observe the MVD and analyze the relations between HIF-1 alpha and VEGF, MVD. Levels of HIF-1 alpha and VEGF of rat serum in experimental group were higher than that in control group (P<0.05). The positive rate of HIF-1 alpha in experimental group had reached to 80%, VEGF reached to 70% and MVD reached to (33.9 +/- 15.2)/200 visual fields, which were higher than that in control group (P<0.05). HIF-1 alpha stayed positive correlation with VEGF and MVD (P<0.05). HIF-1 alpha, VEGF and MVD in DN were increased and the HIF-1 alpha stayed positive correlation with VEGF and MVD.

目的 研究维生素E抑制环磷酰胺所致肾小管上皮细胞毒性作用的影响.方法 通过MTT和中性彗星实验,分别观察环磷酰胺单独或与维生素E联合应用时对肾小管上皮细胞生存率及DNA损伤的作用.结果 与对照组相比,1、3mol/L环磷酰胺处理肾小管上皮细胞12h后可显著降低细胞生存率,并可造成细胞的DNA损伤(P<0.05);与环磷酰胺处理组相比,1mmol/L维生素E显著降低了环磷酰胺致肾小管上皮细胞DNA损伤的作用(P<0.05),但对环磷酰胺降低肾小管上皮细胞生存率的作用无明显影响(P>0.05).结论 维生素E对抗环磷酰胺致肾小管上皮细胞DNA损伤的作用.

目的 探讨维持性血液透析(MHD)患者血清白细胞介素-35(IL-35)与心脑血管疾病的关系.方法 选取稳定的MHD患者72例,体检健康人30例为对照组.酶联免疫吸附法测定血清IL-35.Spearman相关分析IL-35与其它指标的相关性.结果 MHD患者IL-35水平显著低于健康对照组.心脑血管疾病患者IL-35水平明显低于无心脑血管疾病者.IL-35与左室射血分数呈正相关,与高敏C反应蛋白、氨基末端脑钠肽前体、颈动脉内膜中层厚度呈负相关.结论 MHD患者血清IL-35水平与心脑血管疾病相关,血清IL-35可能成为MHD患者心脑血管疾病新的标志物.

1临床资料患者男性，57岁，因“双下肢水肿1年半，加重伴胸闷、憋气15 d”于2015‐11‐14入院。在此前1年半前曾因“多饮多尿12年，水肿半年，加重15 d”入院，诊断为：①慢性肾功能衰竭尿毒症期合并肾性贫血；②2型糖尿病（糖尿病肾病，糖尿病视网膜病变）；③高血压（3级，很高危）；④冠状动脉粥样硬化性心脏病。给予腹膜透析治疗（初浓度为1.5％透析液8000 m l ，3个月前自行改为浓度2.5％透析液6000 m l ），并规律服用药物治疗，病情控制欠佳，1年来持续双下肢水肿。患者15 d前无明显诱因出现水肿加重，水肿为全身性、凹陷性，晨轻暮重，伴胸闷、憋喘，夜间可憋醒，尿量200 m L／d ，伴恶心，无呕吐，伴乏力、纳差，无其他不适，自行将腹膜透析改为浓度2.5％腹膜透析液8000 m l／d ，疗效欠佳，遂入我科。既往史：高血压病史20年，血压最高可达190／100 m m H g ，糖尿病病史13年，冠心病病史2年。2年前因“消化道出血”输注浓红及白蛋白治疗。个人史、家族史无特殊。入院查体：T 36.4℃， P 102次／min ，R 22次／min ，BP 225／105 mmHg ，神志清，精神可，端坐位呼吸，慢性病容，皮肤及黏膜苍白，结膜苍白，颜面浮肿，双肺呼吸音粗，可闻及少量干湿性啰音。心音有力，心律齐，心率102次／min ，未闻病理性杂音。胸背部水肿，腹部膨隆，移动性浊音阳性，肠鸣音4次／min ，双下肢重度凹陷性水肿。

AIM:Our study was aimed to study the distributional characteristics of fibronectin (Fn) Msp iv polymorphism in Chinese Han Population and investigate its association with susceptibility and clinicopathologic features of diabetic nephropathy (DN).METHODS:Polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) were applied to testify Fn Msp iv genotypes among 108 patients with DN and 86 healthy individuals. Odds ratio (OR) with 95% confidence interval (CI) were used to evaluate the association of Fn Msp iv polymorphism and onset risk and clinicopathologic stages of DN.RESULTS:The comparison of genotype and allele distribution in normal, micro and massive proteinuria groups showed that genotype and allele distribution in massive proteinuria group showed great differences, compared with those of control group (P=0.006, P=0.004). Further analysis on the association of Fn Msp iv polymorphism and occurrence of abnormal proteinuria suggested that DD genotype and D allele appeared to be a risk factor for abnormal proteinuria (OR=3.553, 95% CI=1.278-9.875; OR=2.442, 95% CI=1.378-4.327). Then, we analyzed the effects of Fn Msp iv polymorphism on the clinicopathologic stages of DN, the result showed that DD genotype showed great effect on the occurrence of early-onset DN (OR=7.500, 95% CI=1.691-33.272). For the DN patients with D allele, the risk for early-onset DN was increased 3.445 folds (OR=4.445, 95% CI=1.869-33.10.574).CONCLUSION:Fn Msp iv polymorphism appeared to be associated with DN susceptibility.

Objective To investigate the effects of puerarin on the activity of isolated intestinal smooth muscle of rats and to explore its mechanism.Methods PowerLab Signal Processing Instrument was used to observe the effects of puerarin on the activity of isolated intestinal smooth muscle of rats.Nitric oxide(NO) kits were used to detect the content of NO in isolated intestinal smooth muscle.Western blot was used to measure the expression of inducible nitric oxide synthase(iNOS) upregulated by puerarin.Results Puerarin(0.12,0.24,0.48 g/L) had significantly inhibited isolated intestinal smooth muscle of rats in a dose-dependent manner.Pretreatment of S-methylisothioure(SMT),a specific iNOS inhibitor,the inhibitory effects of puerarin were attenuated.Following puerarin(0.12,0.24,0.48 g/L) administration,the amounts of NO and iNOS were decreased.Conclusions Puerarin could inhibit the contraction of isolated intestinal smooth muscle of rats mainly through the upregulation of iNOS expression and increasing NO release in intestine.

Objective To investigate the reversal effect of puerarin on mediated multidrug resistance in renal cell carcinoma line GRC-1. Methods GRC-1 cells were cultivated in vitro, and four groups were designed in this experiment: control group, adriamycin treatment group with 10 mg·L -1 ADM, puerarin control group with 0.48 g·L -1 Pur, combined treatment group in which 10 mg·L -1 ADM+0.24 g·L -1 Pur or 10 mg·L -1 ADM+0.48 g·L -1 Pur respectively. After treatment with drugs for 24 h,MTT assay was employed to measure cell viability. Flow cytometry with Annexin-V/PI double-labeled) and TUNEL method were used for detecting cell apoptosis. Results Compared with the control group in which the GRC-1 cell viability was 100%, cell viability in ADM group significantly decreased to (69.7±0.04)% (P<0.05). In the combined treatment group, in which 10 mg ·L -1 ADM, combined with 0.12,0.24 and 0.48 g·L -1 Pur was administered to GRC-1cells, the cell viabilities were (70.1±0.03)%, (63.2±0.02)% and (42.1±0.04)% respectively, which were obviously lower than that in the control group (P<0.05), The cells viabilities of two subgroups, in which 10 mg ·L -1 ADM was combined with 0.24 or 0.48 g·L -1 Pur, were much lower than that in the ADM group(P<0.05). The cell viabilities of the only 0.12 g ·L -1 or 0.24 g·L -1 Pur treated group were respectively (97.4±0.02)% and (90.1±0.01)%, having no significant difference from the control group (P>0.05). But after treated by 0.48 g ·L -1 Pur alone, the cell viability was (75.0±0.03)%, much lower than that in the control group (P<0.05). Compared with the control group, the apoptotic rates of GRC-1cells in 0.24 and 0.48 g ·L -1 puerarin groups significantly increased in a dose-dependent manner (P<0.05). The apoptotic rates of 10 mg ·L -1 adriamycin plus 0.24 g·L -1 puerarin or 0.48 g·L -1 puerarin groups were remarkablely higher than that of the ADM group (P<0.05). Conclusion Puerarin may effectively promote the apoptosis of GRC-1 cells and increase the anticarcinogenic effect of adriamycin by reversing multidrug resistance in GRC-1 cells.

目的:检测IgA肾病肾小球内α-平滑肌肌动蛋白(α-SMA)及波形蛋白等细胞骨架蛋白表达,探讨IgA肾病系膜细胞肌成纤维细胞表型转化与病理分级、肾功能关系.方法:对63例肾穿刺病理诊断为IgA肾病患者,回顾其临床资料及病理改变,通过免疫组织化学显色检测α-SMA及波形蛋白在肾小球的表达.参考Cockcroft-Gault公式计算肾小球滤过率(GFR).结果:α-SMA、波形蛋白在IgA肾病标本中均100％阳性表达,α-SMA及波形蛋白在肾小球内的表达呈正相关关系.α-SMA、波形蛋白表达与WHO分级、Katafuchi氏肾病积分及GFR均呈正相关关系.在与GFR相关性方面,α-SMA高于波形蛋白.结论:α-SMA可作为评估IgA肾病患者肾病变严重程度的分子生物学指标.

<正>肾源性血尿是指血尿来源于肾小球,临床上表现为单纯性血尿或血尿伴蛋白尿,多见于原发性肾小球疾病,如IgA肾病、系膜增生性肾炎、局灶性肾小球硬化症、肾囊肿、多囊肾,也可见于继发性肾小球疾病,如紫癜性肾炎、狼疮性肾炎。如果治疗不彻

【Objective】To observe the antitumor effects of dendritic cell(DC) and recombinant adenovirus harbouring the murine Mig gene(Ad-Mig) on murine lymphadenoma in vivo.【Methods】C57BL/6 mice were inoculated subcutaneously with EG7 cells to establish the murine lymphadenoma model.The tumor-bearing mice were injected intratumorally with DC or DC combined with Ad-Mig respectively.Tumor growth was observed.The change of tumor mass was revealed by histological examination.The CTL and NK activity was measured in vitro by lactate dehydrogenase(LDH) release assay.【Results】DC could significantly inhibit the tumor growth,increase the number of inflammatory cells,and decrease the number of tumor cells.CTL and NK activity of the mice was also enhanced after treatment with DC.In contrast,co-delivery of DC and Ad-Mig led to stronger antitumor effects than DC alone.【Conclusion】Intratumoral injection of DC and Ad-Mig has significantly therapeutic effects on mice lymphadenoma.

Objective To investigate the clinical efficacy of multiglycosidorum tripterygii combined with dipyridamole in children with anaphylactoid purpura nephritis.Methods 128 children with anaphylactoid purpura nephritis were randomly divided into treatment group and control group.Two groups were treated with conventional medical treatment,and the treatment group was given multiglycosidorum tripterygii combined with dipyridamole additionally on the basis of conventional therapy.Results The total effective rate was 82.7% in the treatment group and 72.0% in the control group,there was a significant difference between the two groups(P0.05).Conclusion Multiglycosidorum tripterygii combined with dipyridamole has significant therapeutic effect on children anaphylactoid purpura nephritis

Objective:To investigate the laxative effect of Puerarin on constipation in mice, and to explore the involved mechanism. Methods: Constipation model was established by diphenoxylate. After the constipation model were treated with Puerarin, several factors were observed after Puerarin treated constipation model, including the first defecation time. And the effects of Puerarin on water contents of large intestine and activity of isolated large intestinal smooth muscle were studied by weighing the intestine and Powerlab signal processing system respectively. Results: ① Compared with the model group, Puerarin could shorten the first defecation time and enhance two other factors such as the amount of feces within 12 hours, the weight of feces ( P0. 05). ② Compared with model group, low and medium dose of Puerarin could significantly increase the water content in large intestine ( P0. 05). And the above factor in high dose Puerarin group is higher than the control and model group ( P0.05). ③ Puerarin could further enhance the inhibitory effect of diphenoxylate on the scope , frequency and curve of activities of intestine smooth muscle contraction. Conclusion:Puerarin can defecate feces excretion, whose possible mechanism is that the stimulatory effect by increasing water in intestine is stronger than the direct inhibitory effect on the intestinal activities.

Objective To investigate whether γH2AX is a sensitive,rapid and simple technique in detecting formaldehyde induced DNA damage.Methods After V79 lung cells were treated with formaldehyde,γH2AX foci formation was detected by immune-fluorescent microscopy.Single cell gel electrophoresis was employed to detect DNA damage.Results Increase of the formation of γH2AX foci could be induced by treating V79 lung cells in 20 μmol/L formaldehyde for 10 min,however,the increase of comet tail length would increase only 2 h later.When the cells were treated with 1 μmol/L formaldehyde for 8 h,the mean value of foci per cell and the percentage of γH2AX foci cells increased significantly compared with the control(P0.05),however,this dosage could not increase comet tail length at any time duration.Conclusions γH2AX could detect formaldehyde induced DNA damage at early stage,moreover,DNA damage induced by low concentration formaldehyde could also be detected.It is more sensitive than single cell gel electrophoresis.