珠蛋白是一类结构保守的血红素蛋白家族,大部分生命中均有表达[1].它们具有紧凑的螺旋构象和附着血红素的能力,允许气态双原子分子可逆结合,包括氧(oxygen,O2)、一氧化氮(nitric oxide,NO)和一氧化碳(carbonic oxide,CO)等[1],在机体中主要承担氧的储存和运输功能.已知的珠蛋白主要有红细胞特异性血红蛋白(hemoglobin,Hb)、肌肉中的肌红蛋白(myoglobin,Mb)、神经元和神经内分泌组织中的脑红蛋白(neuroglobin,Ngb),以及各种器官中普遍存在的胞红蛋白(cytoglobin,Cygb).4种珠蛋白具有相似的结构,因此也具有相近的生物学活性,其中氧化还原酶活性是珠蛋白生物学活性研究中的重要内容.

现代信息技术运用于医学教育教学已逐渐成为医学教育改革的重要发展趋势.在当前医疗环境下,医患矛盾呈现易变性和复杂性的特点,需要医学人文素质教育更具针对性与时效性,促进教学目标、课程体系、教学内容、方式方法、资源环境不断优化."医患矛盾"大数据的充分挖掘与全面深入分析将为医学人文素质教育提供新的改革方向.文章拟通过对大数据与医学人文素质教育交融的时代背景进行分析,探讨"医患矛盾"大数据与医学人文素质教育的交融机制,为医学人文素质教育改革向数字化、信息化、多学科交叉融合改造升级提供新的研究方向.

数据和知识的转化与重组使大数据逐渐成为促进医学和人类健康卫生事业发展的重要手段和方向.该文通过分析大数据与医学人文素质教育的研究现状,思考大数据对医学人文素质教育研究的重要意义,为深化医学人文素质教育改革、优化教育体系、提升实效提供研究途径,为健康中国建设输送一流医学人才提供研究支撑.

肺癌是当今世界最常见的恶性肿瘤之一,其新发率和死亡率多年来都居于各类癌症之首,其中85％的肺癌都是非小细胞癌,而腺癌又是最常见的非小细胞癌.肺癌的高隐匿性是造成其高死亡率的最主要原因,因此为肺癌的早期诊断和病理分期寻求高效可靠的方法是十分必要的.代谢组学揭示了小分子代谢物的一系列变化,反映了生命活动的最终状态,因此也能直接反映疾病不同发展阶段的病理生理变化.本研究利用核磁共振氢谱(1H-NMR),对在我院就诊的27例不同病理分期的肺腺癌患者和13例健康志愿者进行了血清代谢物分析,运用正交偏最小二乘判别分析(OPLS-DA)对1H-NMR数据进行建模,单变量统计分析对模型进行评价.结果 表明肺腺癌患者组的血清中有14种代谢物出现明显差异,其中丙酮酸、丙氨酸、NAC1、乳酸、GPC和甘氨酸比起对照组来有显著上升,而葡萄糖、谷氨酰胺、亮氨酸、异亮氨酸、缬氨酸、丙酮、乙酰乙酸和苏氨酸则显著下降.而在不同分期肺腺癌患者间进行比较后发现,异亮氨酸、乙酰乙酸、NAC1和乳酸的变化与肺腺癌的发展有相关性,可能是肺腺癌早期诊断和分期的潜在生物标志物.

新型冠状病毒肺炎(以下简称新冠肺炎)疫情对医学教育带来了挑战,同时也带来新的机遇.具有针对性与时效性的医学人文素质教育对于提高医学生人文素养,促进医学生养成良好的医患沟通能力,减少因沟通不畅诱发医患矛盾冲突,保障医疗安全,构建和谐医患关系有着及其重要的作用.通过对构建基于医患纠纷案例大数据的医学人文素质教育优化体系的实施策略进行探讨,以期为医学人文素质教育改革提供参考.

目的:研究长链非编码RNA(LncRNA)RNU12 siRNA转染对食管癌EC9706细胞生物学特性的影响.方法:采用qRT-PCR检测EC9706细胞和人食管上皮细胞HEEC中RNU12的表达水平.将RNU12 siRNA转染EC9706细胞,同时设阴性对照组(转染随机序列)和空白对照组(未转染),采用qRT-PCR检测RNU12的表达,采用MTT法检测细胞增殖,Annexin V-FITC和PI双染法检测细胞凋亡,Transwell实验检测细胞侵袭和迁移能力.结果:EC9706细胞中RNU12的表达水平高于HEEC细胞(P<0.05).与空白对照组和阴性对照组比较,RNU12 siR-NA组细胞中RNU12的表达水平降低,细胞增殖能力受抑,凋亡率升高,侵袭和迁移细胞数减少(P<0.05).结论:RNU12在EC9706细胞中高表达,干扰RNU12的表达能够抑制EC9706细胞增殖,促进细胞凋亡,阻碍细胞侵袭和迁移.

目的 观察胸腔镜下改良膈肌折叠术治疗膈肌膨升症的近期效果及体会.方法 对2017年1月-2017年12月收住该院胸外科行胸腔镜下改良膈肌折叠术治疗膈肌膨升症的患者进行影像学观察.结果 术前术后患者影像学观察比较显示:通过胸腔镜改良膈肌折叠术治疗膈肌膨升症状明显改善,恢复快.结论 膈肌膨升症容易误诊,可采用影像学手段进行确诊.胸腔镜下改良膈肌折叠术治疗膈肌膨升症可获得满意的治疗效果.

报告单孔胸腔镜联合锁骨上入路切除颈胸交界处纵隔肿瘤的可行性及安全性.通过对1例颈胸交界处纵隔肿瘤患者行单孔胸腔镜联合锁骨上入路切除术.报告手术切除肿瘤的完整性,手术时间、出血情况及术后并发症,术后随访情况.患者围手术期无死亡,完整切除肿瘤.手术时间为120 min.术中出血量为100 mL.住院时间为10天.术后患者未出现臂丛损伤等严重并发症.所以单孔胸腔镜联合锁骨上入路行颈胸交界处纵隔肿瘤切除损伤小,切除完整.

Objective To evaluate the security and effectiveness of emerging sternal rigid plate by comparing with wires closure. Methods 60 patients who undergoing median sternotomy from two centers were enrolled in this study, 30 received wire cerclage( control group) and the other 30 received rigid plate fixation( experimental group) . Patients' sternal were closed with wires or rigid plates, and the painness, sternal union and status of wires or rigid plates were followed up and assessed one week, three months and six months after procedures. Results All patients survived and were followed up. 117 rigid plates were implanted. There was no significant difference in pre-operative data, post-operative painness, sternal union and status of wires and plates between control and experimental group. No patient reached the standard of clinical sternal union one week post-operation, but all patients reached the standard of clinical sternal six months post-operation. One patient in control group suffered sternal nonunion, movement and wound infection after sternotomy. Conclusion Compared to wire closure, sternal closure with rigid plates is the same safe and effective.

信息技术的飞速发展,使网络课程与学生自主学习的模式成为医学教育发展的必由之路.临床医学教学中医学生的参与至关重要,微课与翻转课堂的有机融合可以更好地促进医学生主动性地学习,充分调动学生学习的积极性及热情,整合各种优质资源,更新学生思想观念,提高医学生的综合素质.

临床技能学是从临床技能实践教学的整体出发,以基本临床技能操作与综合临床技能为主要教学内容的实践性课程.及时了解、跟进临床技能学领域的最新理论、最新方法与技术是临床技能学教学中不可或缺的重要组成部分.临床技能学双语网络教学平台的构建对于培养全面发展创新型医学人才有着重要的意义.

目的：探讨特发性脊柱侧凸合并漏斗胸畸形的手术治疗和临床矫形策略。方法我科从2002年2月~2015年11月共收治特发性脊柱侧凸合并漏斗胸畸形的患者6例,采用一期头盆环牵引＋二期后路脊柱侧凸矫形＋二期或三期前路漏斗胸畸形矫正术治疗；观察术前术后患者脊柱侧凸Cobb角、后凸角、双肩平衡、身高、漏斗胸畸形程度的改善,并进行统计学分析。结果6例患者均顺利完成手术,其中5例分三期手术治疗,1例分二期手术治疗。患者年龄介于11~15岁之间,平均13.2岁；住院时间31~52天,平均40.4天；1例患者在脊柱侧凸矫形术后出现左下肢麻木、肌力减退,经保守治疗4周后缓解；1例患者在三期漏斗胸矫形术后出现胸部切口渗液并感染,经换药及抗生素治疗后痊愈。6例患者均获得随访,随访时间2~130月,平均60.5月；术后末次随访时,脊柱侧凸矫平均正率78.1％,身高平均增高4.6cm,漏斗胸平均矫正率65.5％。结论对于特发性脊柱侧凸合并漏斗胸畸形的患者,针对性的制定个体化的手术方案,先行脊柱侧凸矫形术后再行漏斗胸畸形矫正,能获得满意的矫形效果及胸廓容积,临床疗效优良。

目的：探讨重症肌无力( MG)并胸腺瘤患者的临床特点、治疗及预后等情况。方法回顾性分析经手术病理证实的55例重症肌无力并胸腺瘤患者的发病年龄、临床表现、手术合并症及预后。结果术后患者治愈15例,占27.27%(15/55)；术后好转30例,占54.54%(30/55)；术后恶化6例,占10.90%(6/55)；1例死亡,3例失访。本组患者整体治疗效果明显,有效率达81.81%。结论手术治疗重症肌无力并胸腺瘤疗效明显,是目前治疗重症肌无力的有效办法。

目的 观察白杨素是否抑制人肺癌H1299细胞系干细胞样细胞肿瘤球形成能力,并探讨其作用机制是否涉及CK2α表达和Notch1信号.方法 干细胞条件培养基悬浮培养与扩增H1299细胞系球形成细胞作为肺癌干细胞样细胞.不同浓度白杨素处理,肿瘤球形成法检测H1299球形成细胞的肿瘤球形成率;Western blot分析CK2α、Notch1和CD44蛋白表达.CK2α siRNA转染探讨白杨素作用机制.结果 白杨素(5、10和20μM)处理H1299球形成细胞72 h,肿瘤球形成率以浓度依赖方式降低;CK2α、Notch1和CD44蛋白表达下调.CK2 αsiRNA转染H1299球形成细胞导致Notch1信号抑制,并协同白杨素抑制肿瘤球形成.结论 白杨素具有抑制肺癌干细胞样细胞肿瘤球形成作用,其作用机制涉及下调CK2 α表达抑制Notch1信号传导.

目的:研究白杨素(chrysin,ChR)抑制肺癌A549细胞系球形成细胞自我更新作用.方法:不同浓度ChR处理体外培养A549细胞系球形成细胞.肿瘤球形成法测定自我更新.Western blot分析CK2α和Gli1蛋白表达.pcDNA3.1-CK2α转染探讨作用机制.结果:ChR(10、20和40 μM)处理24小时显著降低A549细胞系肿瘤球形成率(P＜0.05),并伴随着CK2α和Gli1蛋白表达下调.与pcDNA3.1-LacZ转染细胞相比,pcDNA3.1-CK2α转染A549细胞系球形成细胞CK2α和Gli1蛋白表达显著上调,并增高肿瘤球形成率和减弱ChR的作用.结论:下调CK2α和Gli1表达参与ChR抑制A549细胞系球形成细胞自我更新作用.

目的通过对血管内皮细胞生长因子-D（VEGF-D）及基质金属蛋白酶-12（MMP-12）在非小细胞肺癌（NSCLC）组织及癌旁组织中的表达特点进行检测,探讨VEGF-D及MMP-12 2种蛋白的表达与NSCLC纵隔淋巴结转移的相关性。方法采集60例NSCLC组织及其癌旁组织,应用免疫组织化学方法检测VEGF-D及MMP-12蛋白在这2种组织中的表达情况,分析其与临床病理因素之间的关系,以及与纵隔淋巴结转移的相关性。结果 VEGF-D及MMP-12蛋白在NSCLC组织中呈高表达[均为93.3%（56/60）],显著高于癌旁组织[51.7%（31/60）,63.3%（38/60）]（P＜0.01）。在有纵隔淋巴结转移的癌组织中的表达显著高于无纵隔淋巴结转移的癌组织（P＜0.05）。在NSCLC组织中,2种蛋白的高表达与性别、年龄、分化程度以及组织学类型无关（P＞0.05）,但与肿瘤病理学分期有关（P＜0.05）。在有纵隔淋巴结转移的癌组织中,VEGF-D与MMP-12蛋白的表达存在相关性（c=0.274,P=0.041）。结论 VEGF-D及MMP-12蛋白在NSCLC组织及癌旁组织中的高表达现象与NSCLC的淋巴结转移密切相关,抑制VEGF-D及MMP-12蛋白的表达有可能为NSCLC的治疗提供新的治疗靶点。

BACKGROUND: Researches have showed that the selection of trachea and bronchi anastomotic materials has different effects in the healing quality.OBJECTIVE: To establish the rabbit tracheal reconstruction model with three different suture materials and to detect the relationship between biomechanical property and tracheal remodeling during the different phases of the rabbit wound healing.METHODS: Eighteen New Zealand white rabbits were divided into three groups randomly, and the silk thread,dacron thread and synthetic absorption suture were used to establish tracheal reconstruction model.RESULTS AND CONCLUSION: Tensile strength of anastomosis trachea: The tracheas anastomosed by three sutures were fractured close to the anastomotie stoma under external forces after 2 weeks; otherwise, the sutures were not torn. After 4 and 8 weeks, the tracheas were fractured in the part far away from anastomotie stoma, and no trachea was fractured on the anastomotie stoma. Bursting strength of anastomosis trachea: After 2, 4 and 8 weeks,three anastomotie stomas were burst from tracheal membranous. Collagen Ⅰ concentration: the collagen Ⅰconcentration in dacron thread group was lower than that in the other two groups (P < 0.05). There was no significant difference of collagen Ⅰ concentration after 4 and 8 weeks among three groups. It shows that the stability of the tracheal anastomosis will not be influenced by the suture material, but tracheal stenosis has certain differences after suture with different suture materials at various periods.

Objective To investigate the relationship between the levels of serum intercellular adhesion molecules-1(ICAM-1) and the formation of coronary collateral circulation in patients with severe coronary artery stenosis.Method Total 108 patients with at least the stenosis of one vessel ≥95% among three main vessels of coronary artery were consecutively enrolled in the study according to angiographic estimation.Development of collaterals was classified by Rentrop′s method.According to the collateral degree,patients were divided into two groups(a non-CCC formation group:47 patients with grade 0;a CCC formation group:61 patients with grade 2-3).The serum levels of ICAM-1 were also measured.Results Compared with the CCC formation group(243.08±70.90) ng/ml,the levels of serum ICAM-1 with non-CCC formation group(286.38±56.27) ng/ml were increased significantly(P=0.001,P<0.01).Conclusion In patients with severe coronary artery stenosis,the serum levels of ICAM-1 are negatively correlated with CCC formation.

Objective To investigate the effects of diabetes mellitus on coronary collateral circulation and the relationship between serum levels of ADMA and degrees of coronary collateral circulation in diabetes mellitus patients.Methods 112 patients at least with the stenosis of one vessel >95% among coronary artery were consecutively enrolled.The 112 patients were divided into two groups:DM group and NDM group.Development of collaterals was classified by Rentrops method.The levels of ADMA were also determined.Results Compared with NDM group,poor CCC was higher in the DM group(P=0.043,P<0.05),the serum ADMA concentration is also significantly higher than NDM group(P=0.000,P<0.01);Compared with NDM group in poorly developed collateral,the serum levels of ADMA in DM group were significantly increased(P=0.001,P<0.01).Conclusions Diabetes mellitus inhibits the development of coronary collateral circulation in patients with severe coronary artery stenosis,which is related to the serum levels of ADMA.

Objective Through detecting the expressions of VEGF-C,VEGF-D and MMP-12 in the tissues of Nonsmall cell lung cancer and peritumoral,to investigate their correlations with lymph node metastasis of NSCLC.Methods Expressions of VEGF-C,VEGF-D and MMP-12 in 60 cases of tissues of Non-small cell lung cancer and peritumoral were detected by immunohistochemistry,and their correlations with clinical-pathological findings were analysed in patients. Results The positive rates of VEGF-C,VEGF-D andMMP-12 were 96.7%%,93.3%,91.7%respectively,which were significantly higher than those of the tissues of peritumoral(P 0.01).The expression of VEGF-C,VEGF-D and MMP-12 protein in lymph node metastasis was significantly higher than the cases without lymph node metastasis(x~2 =13.237,x~2 = 6.960,x~2 = 9.870;P = 0.000,P = 0.000,P = 0.000).The expressions of VEGF-C,VEGF-D and mmp-12 protein in NSCLC were not correlated with gender,age,degree of differentiation and histological types(x~2 = 0.472;P = 0.244),but correlated significantly with PTNM stage(P =0.01 ).Significant correlations between VEGF-C and VEGF-D(r =0.929, P =0.000),VEGF-C and MMP-12(r =0.787,P =0.000),VEGF-D and MMP-12(r =0.914,P =0.000) expression were observed in LNM.Conclusions There was significant correlation between the high expression of VEGF-C,VEGF-D and MMP-12 and lymph node metastasis in tissues of NSCLC.