目的 探讨以教学微视频结合教学平台"讨论区"互动为基础的在线教学在病理生理学教学中的应用,以评价该教学模式在疫情期间的教学效果,探索后疫情时代深化病理生理学教学改革的可行性.方法 本实验以山东第一医科大学2018级医学影像1、2班和3、4班本科生为实验组和对照组,分别开展以教学微视频结合教学平台"讨论区"互动为基础的在线教学和以直播为基础的在线教学模式.通过分析教学平台数据和问卷星APP问卷调查结果,评价学生理论知识掌握程度和综合能力提高情况.结果 与以直播为基础的在线教学模式比较,以教学微视频结合教学平台"讨论区"互动为基础的在线教学不但加深了学生对所学理论知识的理解和掌握,而且提高了其归纳总结、自主学习能力,分析、解决实际问题和临床思维能力.结论 以教学微视频结合教学平台"讨论区"互动为基础的在线教学优于以直播为基础的在线教学模式,在新冠疫情期间实现了"以学生为中心"的理念,提高了病理生理学教学质量,而且可为后疫情时代开展线上线下混合式教学奠定基础.

学生对教学的满意度是教学质量的重要反映,也是学生学习效果以及持续学习意愿的重要影响因素.通过问卷星平台收集在疫情期间医学遗传学课程翻转课堂+慕课线上教学方法的教学满意度情况,发现学生对翻转课堂+慕课的线上教学方法满意度总体情况高于单纯用录播+QQ或微信答疑教学方法.文章讨论了该教学方法的优势,为后疫情时代促进教学改革提供理论参考.

从小规模限制性在线课程(small private online course,SPOC)建设、教学实施方案和考核评价体系的优化等方面,探讨线上线下混合式教学模式在病理生理学教学中的应用,以评价其对教学质量的提升作用,为高校混合式教学改革提供参考.以山东第一医科大学2018级临床医学本科12个班631人为教学对象,基于SPOC开展线上-线下混合式教学,每一章内容的教学分为课前、课中和课后三个阶段.通过教学平台数据分析、问卷星App问卷调查以及期末考试成绩分析评价学生理论知识掌握和综合能力提高情况.结果显示,该教学模式不仅加深了学生对所学理论知识的理解和掌握,而且提高了其归纳总结、自主学习能力和分析、解决实际问题和临床思维以及团队合作、语言表达等方面的能力,且在期末时学生对该混合式教学模式的认可度比期中时显著升高(P＜0.01).全部章节开展混合式教学的2018级期末考试成绩高于部分章节开展混合式教学的2017级成绩,且高于开展传统课堂授课的2016级成绩(P＜0.05),差异有显著性.本研究结果表明以高质量教学微视频为核心、临床病例和问题为基础,以线上-线下"零时空"讨论为主要沟通方式,以行之有效的教学实施方案和形成性评价为保障,全程开展的线上-线下混合式教学可将线上知识传授与线下能力提升有机结合,真正实现了"学生为中心"的教育理念.

Objective:To analyze the amino acid differences in the B-cell epitope within the structural proteins of D3a and D3b branch of coxsackievirus A6 (CVA6) D3 sub-genotype circulating in China, so as to optimize the design of virus-like particle (VLP) vaccine of CVA6.Methods:The nucleotide CVA6 sequence containing P1 region were downloaded from GenBank. The phylogenetic tree of VP1 sequence was constructed by MEGA.11.0 software using the maximum likelihood method and was used for genotype and sub-genotype identification. The online tool, WebLogo and the relevant literature on CVA6 B-cell epitopes were used to analyze the amino acid differences in the VP1-VP3 region of the B cell epitope of D3a and D3b branch, so as to screen vaccine candidate strains for the preparation of CVA6 VLP.Results:For D3a and D3b branches, the P27 in the N-terminal of VP1 were asparagine (96.2%) and serine (92.9%), respectively and the P60 in the N-terminal of VP3 were glycine (98.8%) and serine (60.0%), respectively. Based on the above differences, the virus strain (GenBank accession number: MN845862) containing the common B-cell epitope (D3a-JX2018) in the two branches of D3a (VP3-N-P60) and D3b (VP1-N-P27) was selected as a vaccine candidate strain, and CVA6 VLP was successfully prepared.Conclusions:This study provided a new idea for the selection of vaccine candidate strain and a basis for the development of CVA6 VLPs vaccine and immuno-diagnostic reagents in the future.

目的 探讨高等医学院校线上教学的现状及存在的问题,为应对新冠肺炎疫情等突发事件及深化教学改革提供依据.方法 采用自制电子调查问卷,利用问卷星平台对山东省多所医学院校共计7000余名医学生进行网络问卷调查,并对问卷进行分析.结果 大部分学生对疫情下的线上教学资源和教学模式表示满意,以各校教师自行录制的SPOC视频资源为基础的教学方式取得的教学效果相对好于以直播和MOOC为基础的教学方式,但是总的教学效果不如传统课堂教学,其原因可能与教师准备不充分,学生压力过大、困难多及网络拥堵、卡顿等因素有关.结论 各高等医学院校有必要从转变教学观念和提升教学能力、优化线上教学资源和教学实施方案、培养学生综合素质和能力等方面深化医学院校教学改革.

以山东第一医科大学2000余名医学生为研究对象,通过问卷星APP平台问卷调查学生对线上教学、线上—线下混合式教学以及传统课堂教学方式的选择意愿,并分析其影响因素,为探寻后疫情时代医学教育改革的方向和策略提供依据.

目的 了解山东省布鲁氏菌病的流行病学特征及临床特点.方法 收集2018年布病临床诊断病例和实验室确诊病例的个案调查资料2683例,运用回顾性分析的方法,使用SPSS 24.0软件进行统计分析.结果 2018年有2683例患者,年发病率为2.67/10万;患者平均年龄为(49.11±15.37)岁,不同年龄分布差异有统计学意义(P＜0.01),其中40～69岁病例最多,占病例总数的67.02％;患者以男性农民为主,临床症状主要以发热(81.59％)、乏力(76.89％)、肌肉关节酸痛(73.95％)等.布病发病季节性明显,发病高峰期在3～6月(554例、占51.47％),8月份以后病例低于全年平均水平;在30 d之内诊断的布病患者占68.65％.结果 山东省布鲁氏菌病发病以男性农民为主,春夏为发病高峰,患者以发热、乏力、肌肉关节酸痛为主要症状.

本研究旨在了解医学类本科生自主学习能力现状,分析相关影响因素的作用.研究结果显示,学习目标、课外活动频率、兼职情况及对所学专业态度直接影响大学生自主学习能力;学习动机、教师教学模式及性别可通过直接和间接作用共同影响学生自主学习能力.

新冠肺炎疫情防控期间高校医学专业在线教学面临巨大挑战.利用问卷星APP平台对山东第一医科大学2700余名医学生进行问卷调查与分析,从学习资源和方式、教学效果和面临的困难等方面了解在线教学现状,并提出疫情期间及后疫情时代在线教学的应对策略.

目的 研究40岁及以上男性脑卒中的危险因素,探讨其风险等级与相关因素的路径关系,为此类人群的疾病预防提供科学的建议和措施.方法 采用随机抽样的方法,由培训合格的调查人员进行问卷调查,应用广义最小二乘-结构方程模型(GLS-SEM)进行统计分析.结果 共调查401人,年龄分布为(57.78±12.085)岁;结构方程模型的拟合效果较好,其中各路径系数均为正相关关系,生活方式对40岁及以上男性脑卒中风险等级的路径系数最大(1.631);相关疾病和既往病史对生活方式的路径系数为0.420和0.908,并且相关疾病和既往病史与40岁及以上男性脑卒中风险等级之间存在着中介作用,即前者通过影响生活方式来影响后者;明显超重或肥胖对生活方式的影响最小(0.030);脑卒中家族史对疾病史的影响最小(0.083).结论 所有危险因素中,高血压病史、血脂异常或未知、吸烟和既往脑卒中病史对40岁及以上男性脑卒中风险等级影响最大,此结果对社区40岁及以上男性居民脑卒中的防控,具有重要参考价值.

Objective To explore the expression and clinical significance of microRNA (miR)-155 and miR -222 in plasma of patients with ventricular septal defect(VSD),and to analyze the possible mechanism.Methods A total of 20 children with VSD who received treatment at the Department of Cardiovascular Surgery from August 2012 to June 2013 were enrolled (the VSD group)and 15 patients with fracture (the control group).The plasma miR -155 and miR -222 expression levels were measured by real -time quantitative reverse transcription -polymerase chain reaction (RT -qPCR).The potential target genes of miR -155 and miR -222 were predicted by using 3 current-ly available prediction programs,including TargetScan,mirbase and Miranda,and the signaling pathway of miRNA was predicted by Pathway -express analysis.Results Compared with the control group,the expression levels of miR -155 (P =0.033)and miR -222(P <0.001)in the VSD group decreased significantly;miR -155 and miR -222 predic-ted target genes included 74 and 50,respectively.The Pathway -express analysis indicated that 7 signaling pathways played important roles in the occurrence of fetal VSD,including signaling pathways for heart development,such as:mito-gen -activated protein kinase(MAPK)signaling pathway.Conclusions The expression levels of plasma miR -155 and miR -222 in VSD were significantly decreased.The target genes were related to signaling pathways for heart deve-lopment (MAPK signaling pathway),which indicates that miR -155 and miR -222 may be involved in the pathological process of VSD,and may serve as an independent evaluation indicator for the diagnosis of VSD.

[ 3 ] 赵非一.解析“路怒症”心理[J].上海中医药报ꎬ2013ꎬ11:1 -3. [ 4 ] 吴超仲ꎬ雷虎. 汽车驾驶愤怒情绪研究现状与展望[ J] . 中国 安全科学学报ꎬ2010ꎬ20(7):3 8. [ 5 ] 雷虎. 愤怒情绪下的汽车驾驶行为特征及其对交通安全的影 响研究[D] . 湖北:武汉理工大学. 2011. [ 6 ] 孙龙ꎬ杨程程ꎬ常若松. 多维度驾驶风格量表的修订及初步应 用[J] . 人类工效学ꎬ2014ꎬ20(2):6 9. [ 7 ] 骆勇. 道路交通中攻击性驾驶行为分析与研究[D] . 西南交通 大学ꎬ2009. [ 8 ] 李凤芝ꎬ李昌吉.龙云芳ꎬ等. 汽车驾驶员攻击性驾驶行为的心理 因素分析[J].四川大学学报:医学版ꎬ2004ꎬ35(4):568 -570. [ 9 ] 胡江碧. 道路交通事故肇事驾驶员特征分析[ J] . 中国公路学 报ꎬ2009ꎬ22(6): 106 110. [10] 冯忠祥. 攻击性驾驶行为选择模型及影响因素敏感度分 析[J] . 中国公路学报ꎬ2012ꎬ25(2):106 112. [11] 李艳春. 大货车驾驶员交通心理与交通安全的研究[ J] . 中国 安全科学学报ꎬ2006ꎬ16(10):15 20. [12] 黎娜ꎬ单秋实ꎬ韩淇卉ꎬ等. 吉林省居民不安全驾驶行为影响 因素分析[J] . 中国公共卫生ꎬ2013ꎬ29(7):1064 1066. [13] 孙龙. 驾驶员人格特质研究述评[ J] . 社会心理科学ꎬ2013ꎬ28 (1):16 20. [14] 孙龙ꎬ常若松. 营运驾驶员驾驶风格研究[ J] . 人类工效学ꎬ 2014ꎬ20(3):10 12. [15] 吴蔚ꎬ张永青ꎬ黄明豪ꎬ等. 机动车驾驶员道路交通伤害危险 因素分析[J] . 中国公共卫生ꎬ2008ꎬ24(6):723 724. [16] 马苏ꎬ冯铁男ꎬ接潇ꎬ等. 中国驾驶员道路交通伤害危险因素 Meta 分析[J] . 中国公共卫生ꎬ2015ꎬ31(4):518 521.

以2011级临床医学本科生为对象,探讨其专业课学习策略使用现状,不同性别和生源地对学习策略使用的影响及其与学习成绩的相关性.结果显示:临床医学生学习策略的使用处于中等水平;不同性别和生源地学生学习策略使用有统计学差异;学习策略的选择、使用与学习成绩呈正相关,提示加强学习策略运用有助于提高学习效率和质量.

Objective To study pension pattern and its influencing factors among urban and rural elderly people in Shandong province and to provide a basis for improving pension services in the province. Methods A total of 2 932 urban and rural elders aged ≥60 years were selected from Jiu0027nan,Taiu0027an,Linyi,Heze,Liaocheng,Dezhou,and Zaozhuang municipality with multi-stage cluster random sampling and investigated through a self-designed questionnaire and Activity of Daily Living Scale( ADL). Results Among the elder residents,98% chose family pension and only 2% chose agency pension. The results of unconditioned logistic regression analysis showed that,compared with the healthy elders,the elder residents suffering from 1- 3 chronic diseases were more likely to select family pension pattern; the elders with at least one child and living in their own houses were more likely to select family pension pattern compared to the elders without child and without private house. Conclusion Family pension is the main pension pattern among urban and rural elders in Shandong province and housing situation,number of children and heath status are major factors influencing the selection preference of pension pattern in the elders.

Objective Through the comprehensive analysis on 2 716 inpatients staying over 30 days, some useful advices to reduce the average hospitalization days and rationally use medical resource were proposed. Methods The clinical data of 2 716 inpatients staying over 30 days in some third-grade class-A comprehensive hospital were analyzed retrospectively. Results Most inpatients staying over 30 days belonged to anterior three departments:department of orthopedics, the number of inpatients was 408 cases (15.02%);followed by the department of neurosurgery with 371 cases (13.66%), the department of rehabilitation with 246 cases (9.06%). From the composition of the inpatients’ diseases, the first disease was tumor, there were 627 (23.09%) inpatients staying over 30 days suffered tumor, followed by injury and poisoning with 514 cases (18.92%), diseases of the circulatory system with 466 cases (17.16%) etc. From the cause of diseases, there were 2 065 inpatients staying over 30 days (76.03%) because of diseases itself cause, so this was the main cause of inpatients staying over 30 days. Conclusion Inpatients of the department of orthopedics and tumor inpatients became the main part of staying over 30 days, and the diseases itself cause was the main reason for staying over 30 days.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的应用叉生分析法分析先天性心脏病（CHD）基因与环境因素的交互作用,为CHD的病因研究提供新的分析方法。方法采用以医院为基础的病例对照研究方法,对2012年7月—2013年10月在山东省4家医院胸外科住院的137例CHD患儿及同期住院的132例无CHD及其他畸形的其他疾病患儿母亲进行问卷调查,并采集患儿空腹外周静脉血进行DNA提取和基因检测;应用叉生分析方法分析CHD致病基因（MTHFRC677T位点突变）与环境因素（孕期患病情况）的交互作用。结果病例组和对照组患儿CC、CT、TT基因型分别占20.44%和36.36%、38.69%和40.91%、40.87%和22.73%,C、T等位基因分别占39.78%和57.58%、60.22%和42.42%,2组患儿全基因型、等位基因频率比较,差异均有统计意义（P&lt;0.010）;叉生分析显示,CHD致病MTHFR基因C677T位点突变与环境因素（孕期患病情况）基于相加模型的交互作用差异有统计学意义（U=2.060,P=0.020）,各评价指标:SI=4.85,AP=70%,AP*=79%,RERI=5.64;基于相乘模型交互作用差异无统计学意义（P&gt;0.05）。结论 MTHFR基因C677T位点突变与孕期患病对CHD具有相加交互作用。</span>

Objective To study the characteristics of Th17 cells frequency and the relationship with clinical characters in paediatric patients with chronic hepatitis B.Methods Forty-five paediatric patients with chronic hepatitis B within 16-year old from December 2010 to February 2014 in Maternal and Child Health-Care Hospital were enrolled in present study,and 11 age-matched healthy children were enrolled as control group.Hepatitis B virus markers(HBV-M),HBV-DNA loads and alanine amino shift enzyme(ALT) levels in serum were detected in the two groups.The frequencies of Thl7 cells in peripheral blood were measured by flow cytometry.Tumor grade was classed in Children with liver tissue.Results Compared with the control group ((1.61 ± 0.56) ％),the Th17 cells frequencies in peripheral blood ((3.03 ± 1.08) ％) were significantly increased in chronic hepatitis B paediatric patients(t=-0.52,P＜0.01).There was no correlations between Th17 cells frequencies with HBV DNA quantity(lg(HBV-DNA)6.49±3.25) and ALT level((40.5±11.3) U/L) (P ＞0.05).The patients with higher HAI scores (G2-G3) had a greater proportion of Th17 cells ((5.95 ±2.05)％) than those with lower HAI scores(G0-G1) ((1.31±0.19)％),and the difference was significant(t =-1.51,P＜0.01).Conclusion Th17 cells frequencies in peripheral blood were associated closely with liver injury in paediatric patients with CHB.

Objective: Anxiety status survey data of 1282 college students in Shandong Province Based on Taishan Medical University to study the influences of the anxiety of college students and to provide measures for college student's anxiety factor.Methods: By cluster sampling methods, self-rating Anxiety Scale for evaluation of Shandong Province, Taishan Medical University students, and statistical analysis.Results:The anxiety rate was 23.48%.The mean SAS score was (42.58 ±11.286), self-rating Anxiety Scale 20 entries can be extracted 4 common factors, respectively, spirit of psychological disorders affective disorder, somatic symptoms, mental disorder and anxiety; the mental disorder so-matic symptoms and anxiety.Conclusion:Anxiety among college students are common and cannot be ignored, treat anxiety intervention measures should be to change the psychological disorder somatic symptoms and anxiety .

Objective To monitor the levels of seven bone growth factors in humeral shortness patients and normal controls.Methods Peripheral blood of 12 humeral shortness patients and 16 normal controls were collected in Nujiang basin of Tibet.The levels of bone morphogenetic protein-2(BMP-2),bone morphogenetic protein-4(BMP-4),bone morphogenetic protein-7(BMP-7),transforming growth factor-β 2(TGF-β2),fibroblast growth factor receptor-3(FGFR3),growth differentiation factor-5( GDF-5),and fibroblast growth factor-23( FGF23) were measured with enzyme-linked immunosorbent assay(ELISA).Results The content of BMP-2,BMP-4,BMP-7,TGF-β2,FGFR3,GDF-5,and FGF23 in humeral shortness patients were 3.35,3.14,568.24,625.09,3.01,3.26 ng /mL,and 161.33 pg /mL,respectively,and those in normal controls were 4.61,3.25,2 300.35,1849.47,5.99,8.09 ng /mL,and 373.47 pg /mL.The contents of BMP-7,FGFR3 and GDF-5 in humeral shortness patients were lower than those of normal controls,and there were significant differences between the two groups.The results of Pearson correlation analysis showed that the seven growth factors were highly correlated in the patient group,while in the normal control group,BMP-2,BMP-4,and TGF-β2 were highly correlated,but the correlations of BMP-7,GDF-5,FGFR3 and FGF23 were weak.Conclusion The causative factor of humeral shortness may be the changes of BMP-7,FGFR3 and GDF-5 and the interactions of various growth factors may affect the mcidence of the disease.

Objective: To understand the present menstruation condition of girl students,and to explore specific measures and strategies for effective prevention of primary dysmenorrhea,in order to take timely measures to improve university women students' quality of life. Methods: Questionnaires were used to conduct a questionnaire survey of 600 female students of different specialties and different departments. Results: The prevalence rate of primary dysmenorrhea in female college students was 69. 78%. The single factor analysis and multivariate Logistic regression analysis found that factors like mother with dysmenorrhea history,dietary and fear in menstrual period were the influencing factors of primary dysmenorrhea( P <0. 05). Primary dysmenorrhea had little relation to age,menstrual quantity or other factors( P > 0. 05). Medical students and non-medical students had some differences in drinking cold drink habits,having a breakfast habits,menstruation diet and regular eating( P < 0. 01). Senior and junior students had some differences in getting regular meals and having sports during menstruation. Conclusion: Students with primary dysmenorrhea should avoid drinking herbal tea,increase exercise,live a regular,better nutrition,reduce psychological burden and these measures can effectively reduce or alleviate dysmenorrhea. We should strengthen health education for college students on adolescent health of female university students in schools.