马克思主义幸福观指出追求个人幸福需要从物质满足、精神满足两个方面入手,针对目前物质因素、工作氛围、心理因素、个人追求、社会舆论等因素对临床医生职业幸福感造成的影响,可以通过提高临床医生的薪资待遇、优化医生职业发展框架、建立定期心理检测机制、优化临床医生工作时长、提高社会大众对临床医生工作的认知等方式提高临床医生职业幸福感.提高临床医生职业幸福感不仅能够提高临床医生在参与社会劳动过程中的幸福感,还能够有效提高其工作积极性,对于推动我国医疗体系的健康发展有重要意义.通过对临床医生职业幸福感提升的研究分析,可以看出我国目前仍处于社会主义初级阶段,广大人民群众对幸福生活的追求仍是相关部门工作的重点.

医疗队伍的职业幸福感直接关系着医疗卫生队伍建设进度的推进与医疗改革的深化.本文从医院医生职业幸福感的重要性出发,结合工作压力、收入差距、医患关系、管理体系、个人能力与人际关系等影响医院医生职业幸福感的常见因素,深入探讨强化人事保障、落实文化建设、重视环境建设、改革管理模式、关注文化建设与营造和谐环境等提升医院医生职业幸福感的改善手段,以期从社会、医院与医生个人三个角度提供行之有效的强化策略,继而为医生个人价值的自我实现与行业的可持续发展提供助力.

目的 探讨鹿茸多肽(VAP)在阿尔茨海默病(AD)模型中抗氧化应激的作用机制.方法 选用8月龄雄性淀粉样前体蛋白(APP)/早老素1(PS1)双转基因小鼠随机分为模型组、VAP组,另以同窝阴性小鼠设立为对照组,每组12只.连续灌胃给药6个月后进行行为学、形态学和氧化应激相关指标检测.Western blotting检测小鼠海马组织中APP及β-分泌酶1(BACE1)蛋白的表达水平.另外以β-淀粉样蛋(Aβ)25～35(25 μmol/L)诱导SH-SY5Y细胞损伤建立AD细胞模型组,VAP组(VAP 500 mg/L+Aβ25～35 2 5 μmol/L)和对照组.检测细胞凋亡、膜电位、活性氧簇(ROS)水平和氧化应激相关指标.结果 动物实验发现,与模型组比较,VAP组小鼠逃避潜伏期缩短(P＜0.05).模型组小鼠海马CA1区神经元减少且排列紊乱,VAP组排列较规则,形态有明显改善.与模型组比较,VAP组老年斑数量减少;与模型组比较,VAP组丙二醛(MDA)含量下降,超氧化物歧化酶(SOD)和谷胱甘肽过氧化物酶(GSH-Px)含量上升,差异有统计学意义(P＜0.05).与对照组比较,模型组APP和BACE1含量上升,与模型组比较,VAP组APP和BACE1含量下降,差异有统计学意义(P＜0.05).细胞培养实验发现,VAP组细胞凋亡率下降.与模型组比较,VAP组线粒体膜电位上升,ROS含量明显下降,MDA含量下降,SOD和GSH-Px含量上升,差异有统计学意义(P＜0.05).结论 VAP对AD模型动物和细胞的氧化应激损伤具有保护作用,可能是通过降低ROS产生,且提高抗氧化酶系活性,减少Aβ的沉积而实现的.

Clinical teachers' teaching ability and teaching research ability are the key factors affecting the quality of medical education personnel training. Scientifically designed clinical teachers' teaching development will directly improve their teaching and research ability.In December 2017, Qiqihar Medical College started clinical teacher training and designed a learning-research-practice teacher community (referred to as learning-research-practice community).After 4 periods of training, 332 clinical teachers completed the training. Among them, 21.4%(71/332) of clinical teachers have their own college and provincial teaching and research projects; 74.7%(248/332) of the clinical teachers' grasp of the evaluation methods of clinical skills and the norms of clinical teaching; 97.4%(323/332) of clinical teachers were satisfied with the training results. Therefore, the teaching development of learning-research-practice community is conducive to improving the teaching ability and teaching research ability of clinical teachers, which can be further promoted.

目的 探讨鹿茸多肽(VAP)32对Aβ25～35诱导的SH-SY5Y细胞阿尔茨海默病(AD)模型的建立及对其治疗作用.方法 以Aβ25～35诱导SH-SY5Y细胞,构建AD模型,分为正常(NOR)组,诱导(MOD)组和VAP32组.应用酶联免疫吸附试验(ELISA)检测丙二醛(MDA)水平及超氧化物歧化酶(SOD)酶活性.Western印迹测定BACE1与ADAM10的蛋白表达水平,RT-聚合酶链反应(PCR)检测p-JNK的基因表达水平.结果 0、50、100、200μg/ml VAP32加入后,随着培养时间的延长,细胞的活力差异无统计学意义(P>0.05).3组细胞凋亡率随时间的延长,均显著升高(均P<0.05).同一时间点,MOD组细胞凋亡率均显著高于NOR组和VAP32组(均P<0.05).与NOR组比较,MOD组SOD水平显著下降,而MDA水平显著上升(均P<0.05).与MOD组比较,VAP32组SOD水平显著上升,而MDA水平显著下降(均P<0.05).与NOR组p-JNK基因、BACE1表达水平比较,MOD组均显著升高(P<0.05),与MOD组比较,VAP32组均显著下降(P<0.05).与NOR组BACE1表达水平比较,MOD组显著升高,与MOD组BACE1表达水平比较,VAP32组显著下降(P<0.05).与NOR组ADAM10表达水平比较,NOD组显著下降,与MOD组ADAM10表达水平比较,VAP32组显著升高(P<0.05).结论 VAP32可治疗Aβ25～35诱导的AD.

This prospective study investigated the relationship between the lipoprotein-associated phospholipase A2 (Lp-PLA2) level and cognitive impairment (CI) in type II diabetes mellitus (TIIDM) patients with white matter hyperintensity (WMH). A total of 87 TIIDM patients diagnosed with WMH were included in this study. They were grouped into CI group and noncognitive impairment (NCI) group based on the MoCA scales. The serum Lp⁃PLA2 levels and MoCA scores of the patients with WMH were compared with those of control (Ctl). Logistic regression was used to analyze the risk factors affecting CI and diagnostic value of serum Lp⁃PLA2 for CI. The WMH group had significantly higher serum level of Lp⁃PLA2 and significantly lower MoCA score than Ctl group. There were significant differences in serum levels of homocysteine, high-density lipoprotein cholesterol (HDL-C) and Lp⁃PLA2 (P < 0.05) between the groups. Logistic regression showed that HDL-C, homocysteine and Lp⁃PLA2 were the risk factors for CI in the patients (P < 0.05); receiver operating characteristic curve analysis showed that HDL-C and Lp⁃PLA2 had significant diagnostic value for CI in WMH patients. Therefore, Lp⁃PLA2 can be assessed in the elderly as a screening to identify putative CI patents for preventive treatment and management.

目的 探讨鹿茸多肽(VAP)对APP/PS1双转基因小鼠Rho/ROCK通路的影响.方法 APP/PS1双转基因小鼠随机分为模型组和鹿茸多肽组,每组20只,另以同窝同性别阴性小鼠20只设立为对照组.鹿茸多肽组小鼠鹿茸多肽100 mg/kg灌胃给药,每天1次,连续28 d.治疗后水迷宫实验检测并记录小鼠逃避潜伏期和穿越平台次数;透射电子显微镜观察突触的超微结构;免疫荧光切片观察海马CA1区Ras同源基因家族成员A(RhoA)和Rho相关卷曲螺旋形成蛋白激酶Ⅱ(ROCK Ⅱ)的表达;Western blotting法检测海马内RhoA和ROCK Ⅱ蛋白相对表达量;ELISA法测定海马β-淀粉样蛋白(Aβ)1～42含量.结果 与模型组比较,对照组和鹿茸多肽组逃避潜伏期均缩短,跨越平台次数增多.与模型组比较,对照组和鹿茸多肽组小鼠海马区突触计数增多,突触间隙宽度减小,突触后致密物厚度增加,差异有统计学意义(P＜0.05).与模型组相比,对照组和鹿茸多肽组CA1区RhoA和ROCK Ⅱ表达量减少,Western blotting检测海马内RhoA和ROCK Ⅱ蛋白表达水平也减少(P＜0.05).与模型组比较,对照组和鹿茸多肽组海马Aβ1～42含量均下降(P＜0.05).结论 鹿茸多肽对阿尔茨海默病模型小鼠神经损伤有保护作用,其机制可能通过抑制Rho/ROCK通路中RhoA和ROCKⅡ的表达,促进突触结构的改变和Aβ1～42含量减少,减轻神经损伤,改善认知功能.

In the current study, two new Co(II)-bearing coordination polymers (CPs) with solvent induced structural diversity have been successfully prepared via reaction of Co(NO3)(2)center dot 6H(2)O with the 5-methylisophthalic acid (5-H(2)mipa) in the presence of a N-donor co-ligand 1,2-bis(4-pyridyl)ethylene (bpe), and the chemical formulae for the as-prepared CPs are {[Co(5-mipa)(bpe)]center dot 0.4IPA}(n) (1) and [Co(5-mipa)(bpe)](n) (2). Their application values on the Alzheimer's disease treatment were evaluated and the related mechanism was explored at the same time. Firstly, the western blotting assay was performed in this present research for the A beta detection after CP exposure. Besides, the ELISA (enzyme linked immunosorbent assay) detection kit was used to detect the content of the TNF-alpha (tumor necrosis factor-alpha) in the cerebrospinal fluid under CP treatment. Above all, the compound 1 was much better than the compound on Alzheimer's disease.

目的:研究瑞舒伐他汀钙联合多奈哌齐对阿尔茨海默病模型小鼠炎性因子表达的影响.方法:APP/PS1双转基因小鼠随机分为模型组、多奈哌齐组、瑞舒伐他汀钙组和联合治疗组,每组10只.多奈哌齐组剂量为1.3 mg/(kg?d),瑞舒伐他汀钙组剂量为1 mg/(kg?d),联合治疗组采用瑞舒伐他汀钙和盐酸多奈哌齐联合给药,剂量分别为1 mg/(kg?d)和1.3 mg/(kg?d),3组均采用灌胃给药.模型组不予治疗.Morris水迷宫实验测试各组小鼠逃避潜伏期,亚甲蓝染色观察各组小鼠海马神经元损伤的形态改变,免疫组化法检测小鼠海马白细胞介素-1β(interleukin-1β,IL-1β)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)和p38丝裂原活化蛋白激酶(p38 mitogen-activated protein kinases,p38MAPK)表达,Western blot检测小鼠海马IL-1β、TNF-α和p38MAPK含量.结果:治疗后多奈哌齐组、瑞舒伐他汀钙组和联合治疗组逃避潜伏期缩短,但联合治疗组好于多奈哌齐组、瑞舒伐他汀钙组.免疫组化显示,与模型组比较,联合治疗组IL-1β(0.37 ±0.05 vs.0.52±0.09,P=0.001),TNF-α(0.42 ±0.08 vs.0.69±0.11,P=0.002)和p38MAPK(0.39± 0.06 vs.0.61 ± 0.10,P=0.001)平均光密度的表达明显降低.Western blot检测结果再次验证,与模型组比较,多奈哌齐组、瑞舒伐他汀钙组和联合治疗组IL-1β、TNF-o和p38MAPK蛋白表达水平降低.结论:瑞舒伐他汀钙联合多奈哌齐对APP/PS1转基因小鼠的空间学习记忆和神经元损伤有明显的改善作用,可能通过抑制p38MAPK通路,共同降低海马中的炎性因子产生.

目的 观察表没食子儿茶素没食子酸酯(EGCG)对淀粉样前体蛋白(APP)/早老素1(PS1)双转基因小鼠空间学习记忆能力、海马CA1区突触超微结构和神经细胞黏附分子表达的影响.方法 选用8周龄雄性APP/PS1双转基因小鼠随机分为模型组、EGCG组、盐酸多奈哌齐组,另以同窝阴性小鼠设立正常组,每组12只.连续灌胃给药6个月后进行相关指标检测.采用Morris水迷宫实验观测APP/PSI转基因小鼠空间学习记忆能力;透射电子显微镜观察小鼠海马CA1区突触超微结构;分别采用免疫荧光法及免疫印迹法检测APP/PS1转基因小鼠海马CA1区神经细胞黏附分子(NCAM)和唾液酸转移酶(ST8Sia Ⅱ)的蛋白表达.结果 与正常组比较,模型组逃避潜伏期延长;与模型组比较,EGCG组、盐酸多奈哌齐组小鼠逃避潜伏期下降(P＜0.05).电子显微镜结果显示,与模型组比较,EGCG组和盐酸多奈哌齐组突触界面曲率变化不明显;突触间隙宽度变窄,突触后致密物厚度增加(P＜0.05).免疫荧光结果显示,海马CA1区NCAM、ST8SiaⅡ蛋白表达在神经元的胞体内,EGCG组和盐酸多奈哌齐组NCAM、ST8Sia Ⅱ蛋白表达明显增加(P＜0.05),免疫印迹实验发现其含量亦呈高表达水平(P＜0.05).结论 EGCG对APP/PS1转基因小鼠的空间学习记忆功能具有改善作用,其机制可能与影响小鼠海马突触结构,提高小鼠海马神经黏附分子表达有关.

Alzheimer’s disease (AD) is the most common cause of dementia among older people in worldwide. miR-29c-3p was reported to play a role in AD development. However, the detail function of miR-29c-3p in AD remains unclear. The aim of this research is to analyze the functional mechanism of miR-29c-3p in AD. The RNA levels of miR-29c-3p and Tumor necrosis factor-α-inducible protein-1 (TNFAIP1) were detected by Quantitative real time polymerase chain (qRT-PCR) reaction. Western blot assay was carried out to examine the protein levels of TNFAIP1, Bax, B-cell lymphoma-2 (Bcl-2), Cleaved caspase 3, and Nuclear factor-k-gene binding (NF-κB). The interaction between miR-29c-3p and TNFAIP1 was predicted by online tool TargrtScan and verified using the dual luciferase reporter assay and RNA immunoprecipitation RIP (RIP) assay. Besides, cell proliferation and apoptosis rate were determined by 3-(4, 5-dimethyl-2-thiazolyl)-2, 5-diphenyl-2-H-tetrazolium bromide (MTT) assay and flow cytometry analysis, respectively. Aβ treatment decreased miR-29c-3p expression and increased TNFAIP1 expression. Overexpression of miR-29c-3p mitigated the effects of Aβ on proliferation and apoptosis. Similarly, knockdown of TNFAIP1 also reversed the effects of Aβ on cell progression. Interestingly, miR-29c-3p suppressed the expression of TNFAIP1 via binding to 3′UTR of TNFAIP1 mRNA. As expected, overexpression of TNFAIP1 reversed the effects of miR-29c-3p on Aβ-mediated cell progression. Besides, we also confirmed that miR-29c-3p affected Aβ-mediated cell progression by regulating TNFAIP1/NF-κB signaling pathway. In conclusion, our findings confirmed that miR-29c-3p attenuated Aβ-induced neurotoxicity through regulation of NF-κB signaling pathway by directly targeting TNFAIP1, providing the potential value for the treatment of AD patients.

Objective To investigate the training process of clinical practice ability in medical undergraduates in the context of tutorial system,as well as new clinical training models and evaluation methods.Methods A total of 40 medical undergraduates who entered the stage of clinical practice were randomly divided into tutorial group and control group,with 20 undergraduates in each group.A diversified evaluation system was used to perform a comprehensive evaluation of clinical practice ability of medical undergraduates at different stages,with a combination of professional theory examination,Mini-Clinical Evaluation Exercise,Direct Observation of Procedural Skills,and clinical case report.All the data were analyzed by SPSS 23.0,t test was used for statistical analysis.Results Compared with the control group after the internship ended,the tutorial group had significantly higher scores of clinical professional theory (86.24 ± 2.93),clinical practice ability (7.53 ± 0.48),clinical operation skills (4.35 ± 0.47),and clinical thinking ability (6.31 ± 0.52) (all P＜0.05).Conclusion The application of the tutorial training mode during the internship of medical undergraduates can improve their comprehensive qualities such as professional quality,medical theory,and practical skills.The diversified evaluation system can evaluate the teaching effect and reflect the cultivation of comprehensive quality among students.

临床实习对于医学生临床专业知识、实践技能和职业道德的形成都是一个重要的时期.在教学医院实施导师制培养模式,有助于提高医学生的培养质量和临床执业能力.本文从全科医学实习生临床实习中实施导师制的背景、必要性及实施策略等方面进行探讨.

目的 探讨迷你临床演练评估(Mini-CEX)在神经内科临床实习评估的效果,验证Mini-CEX在临床实习评估的有效性.方法 选取2016年9月—2017年7月在齐齐哈尔医学院附属第一医院实习的2012级全科专业学生作为研究对象.在神经内科实习期间使用Mini-CEX测量表进行测评并反馈,每位学生实习初始和实习结束接受2次测评.结果 实习初始测评时检测各项成绩分数均较低,实习结束时学生的各项测评合格率均显著提高,差异具有统计学意义(P<0.01).结论 应用Mini-CEX在神经内科实习中,有利于学生不断夯实自己的基础知识,提高查体技能,培养学生临床思维能力及职业素养.

目的:研究表没食子儿茶素没食子酸酯(epi-gallocatechin-3-gallate,EGCG)对APP/PS1双转基因小鼠中神经突触损伤的保护作用及其可能机制.方法:实验采用APP/PS1双转基因小鼠,随机分为模型组(0.1 mL/10 g,生理盐水灌胃)、EGCG组[20 mg/(kg·d),EGCG灌胃],每组10只,另以同窝同性别阴性小鼠10只设立正常组(0.1 mL/10 g,生理盐水灌胃),共3组.Morris水迷宫实验测试各组小鼠逃避潜伏期和跨越平台变化,电镜观察各组小鼠海马神经元损伤情况,免疫组化法检测小鼠海马PSD95、GAP43表达,RT-PCR检测小鼠海马PSD95 mRNA、GAP43 mRNA含量.结果:模型组逃避潜伏期明显延长,海马神经元损伤严重,PSD95表达下降、GAP43表达增高.免疫组化结果表示,EGCG组PSD95平均光密度高于模型组[(0.11±0.03) vs.(0.05±0.02),P=0.001],EGCG组GAP43平均光密度低于模型组[(0.10±0.03) vs.(0.16±0.04),P=0.002].RT-PCR检测结果再次验证,EGCG组PSD95 mRNA表达高于模型组[(0.82±0.11) vs.(0.50±0.06),P=0.000],EGCG组GAP43 mRNA表达低于模型组[(1.12±0.11) vs.(1.56±0.16),P=0.000].结论:EGCG对APP/PS1转基因小鼠的空间学习记忆和突触损伤具有明显的改善作用,其机制可能与影响小鼠海马突触结构,提高PSD95表达、下调GAP43表达有关.

Alzheimer's disease (AD) treatment is not effective. Statins are lipid-lowering drugs. However, the role and mechanism of statins for treating AD remains unclear. SD rats were separated into sham operation group; AD group and rosuvastatin calcium group followed by analysis of cognitive function and neuronal morphology. ELISA was to measure the level of TNF-α and IL-1; SOD activity and ROS levels were measured,. Real-time quantitative PCR was to analyze Bcl-2 and Bax level. The expression of Nuclear Erythroid 2-Related Factor 2/Antioxidant Responsive Element (NRF2/ARE) signaling pathway was analyzed by Western blot. Compared with sham operation group, the cognitive ability of the AD group was significantly decreased; with elevated secretion of TNF-α and IL-1, decreased SOD activity, increased ROS generation, decreased Bcl-2 expression as well as increased Bax expression (P < 0.05). In addition, AD group rats showed neuronal damage in the hippocampus and decreased expression of NRF2 and ARE. However, rosuvastatin calcium treatment improved cognitive ability, decreased TNF-α and IL-1 secretion, increased SOD activity, decreased ROS content, increased Bcl-2 expression and decreased Bax expression as well as ameliorated neuronal damage, increased number of nerve cells, and increased expression of NRF2 and ARE. Rosuvastatin calcium can inhibit the oxidative stress and inflammation, inhibit the apoptosis of hippocampus cells and improve the cognitive ability of AD rats by regulating NRF2/ARE signaling pathway.

目的 观察内皮素(ET)-1在红藻氨酸(KA)致癫痫大鼠海马的表达及依达拉奉对其影响.方法 50只雄性 Wistar大鼠被随机分成5组,每组10只.正常组、磷酸盐缓冲液(PBS)组、癫痫组,治疗组1(地西泮治疗),治疗组2(地西泮+依达拉奉治疗).癫痫组在大鼠右侧海马以每公斤体重注射 1.5 μg/μl KA,PBS组采取同样的方法在相同部位注入等量PBS,治疗组1在癫痫模型成立后给予10 mg/kg地西泮终止癫痫,治疗组2在治疗组1的基础上1 h后再给予依达拉奉30 mg,1次/12 h,正常组不注射任何药物.结果 激光共聚焦显微镜观察,癫痫组ET-1的表达密度显著高于PBS组及正常组(P<0.05),治疗组较正常组、PBS组及癫痫组表达显著下降(P<0.05),治疗组1较治疗组2表达显著增高(P<0.05).十二烷基硫酸钠、聚丙烯酰胺凝胶电泳(SDS-PAGE)分析显示ET-1的相对分子质量为2 492 D,其在癫痫组的表达较正常组及PBS组显著增加,治疗组较癫痫组显著降低(均P<0.05),与激光共聚焦的结果相一致.结论 ET-1表达增加对癫痫后大鼠海马的神经元损伤具有细胞保护作用.

Objective: To make a study of the effects of EGCG on learning and memory abilities in mice with Alzeimer's disease. Methods: The mice were divided into normal control group, model control group, brain repair group, low EGCG dose group, middle EGCG dose group and high EGCG dose group. We use the evaluation method of Morris water to study the learning and memory acquisition and the SOD activity and MDA content. Results: Compared with the model group, the incubation period of EGCG high dose group mice was significantly shorten; quadrant dwell time of high dose group and middle dose group were prolonged; the activity of SOD increased obviously in high dose of EGCG in serum of mice and the content of MDA in the high dose group in mice serum decreased obviously. Conclusion: EGCG can obviously prevent and improve the learning and memory dysfunction in mice.

Based on the particularity of the following medical disciplines, "Three orientation" is the higher medical personnel training mode which orients in the future development of medical students, and makes scientific allocation and combination to medicine curriculum system , personnel training system , management mode and evaluation system and so on. The clinical practice ability of medical students is the core of the professional quality training in the "three orientation". In this article, the ability of professional quality, clinical practice ability and the ability to operate are clinical practice ability training goals and the training methods and evaluation system are divided into 2 stages, the fourth year and the fifth year, as well as three aspects such as professional quality ability training, clinical practice ability training and skills training.