在本科生的人才培养计划中，专业理论课是人才培养的重要环节，是学生创新创业能力培养的主要抓手。依托半导 体物理课程的教学，“以学生为本，教师为基”，构建了学生-学生助教-任课教师的学习共同体，让学生参与到教 学的各个环节，调动了同学们学习专业理论课的热情。

重症急性胰腺炎(severe acute pancreatitis,SAP)是指急性胰腺炎伴有器官功能障碍,或胰腺出现坏死、脓肿、假性囊肿等局部并发症,具有起病急骤、进展迅速、病情危重复杂、病死率高等特点,可引起全身炎症反应,导致急性肾衰竭、急性呼吸窘迫综合征、肺栓塞等并发症[1].血液净化能有效降低患者的炎症水平和血脂,改善脏器功能和体液平衡,在SAP治疗中得到广泛的应用[2].本文报道2例SAP合并急性肺动脉栓塞(pulmonary thromboembolism,PTE)的病例,采取不同的治疗策略后,取得良好的疗效,并进行文献复习,供临床参考.

Objective To explore the application of SPOC flipped classroom based on WeChat platform in clinical pharmacology teaching. Methods The undergraduates, who took the course in the same grade majored in clinical medicine from the first clinical college of Wuhan University, were divided into the control group using traditional teaching methods and the experimental group adopting the SPOC flip classroom teaching method based on the WeChat platform. Results The theoretical test score(83.39±9.17) of the experimental group, which was significantly higher than the control group (76.91±9.70) (P＜0.05). For the examination of abbreviated question and case analysis with a score of 40 points, the score of experimental group (31.61±3.69) was higher than the control group (26.68±5.15) (P＜0.001). Conclusions The application of the SPOC flip classroom based on WeChat platform in teaching clinical pharmacology for the undergraduate students can improve their performance, especially the capacity to use the theoretical knowledge to solve clinical problems.

随着测序技术发展,越来越多真菌的基因组、转录组序列被测定.目前,已有17个真菌来源的抗微生物多肽相继被发现,其氨基酸序列及空间结构呈现出多样性(主要包括线性多肽和含分子内二硫键多肽).本文从多肽的氨基酸序列、多肽性质、结构特点、抗微生物活性等方面对真菌来源的抗微生物多肽进行综述.

Objective To express the new Delhi metallo-beta-lactamase-4 (NDM-4) by using bioengineering techniques,determine the kinetic parameters of enzyme reaction with its hydrolyzed substrate,and to study the effects of pH and temperature on NDM-4 activity.Methods Clinically separated blaNDM-4 gene was amplified by polymerase chain reaction (PCR) and cloned into pET30a vector to construct a recombinant prokaryotic expression plasmid.The latter was transformed into E.coli BL21 (DE3).The engineered bacteria strain [E.coli BL21 (DE3)-pET30a-NDM-4] was measured for resistance to various β-lactam antibiotics,and then used to induce NDM-4 expression.The overexpressed recombinant enzyme was purified by Ni2+-NTA column,identified by SDS-PAGE and mass spectrometry,and determined for the kinetic parameters,optimum pH and temperature of enzyme reaction with its hydrolyzed substrates.Results The recombinant plasmid pET30a-NDM-4 was verified by sequencing.The engineered bacteria strains harboring blaNDM-4 gene were resistant to β-lactam antibiotics.The relative molecular mass of the over-expressed recombinant enzyme was about 28 400.After purification,the NDM-4 protein was at a concentration of 0.4 g/L,presenting high hydrolysis activity against almost all β-lactam antibiotics including Carbapenems,particularly at the optimum pH of 7.5,and the optimum temperature of 35 ℃.Conclusion NMD-4 with high hydrolysis activity against β-lactam ring was successfully overexpressed and obtained by using a prokaryotic expression system.This provides a material basis for further study of the action mechanisms and enzymatic properties of NMD-4.

Objective To explore the curative effects and influences of the serum cytokines level in patients with UC after the medication treatment combined salad oxazine with Chang weining. Methods Selecting forty-four patients with UC who came to Renmin Hospital of Wuhan University and accepted medication treatment. Twenty patients were only treated with salad oxazine and other twenty-four patients were treated with salad oxazine and Chang weining, then clinical efficacy was compared between the two groups. In addition, sixteen healthy people were chosen as normal control group, and the serum cytokine level of TGF-β and IGF-1 in two groups were measured before and after treatment with medications. Results After treatments, the total efficiency of combination group (79.17%) was higher than that of single drug treatment group (50.00%), and the difference presented statistically significant (χ2=4.13, P=0.04). The levels of TGF-β1 and IGF-1 in the normal control group were (108.50±18.99) ng/L and (255.25±17.41) ng/L, respectively. After treatment, the combined drug treatment group [(92.46±16.76) ng/L, (221.25±11.56) ng/L] presented more significant changes than single drug treatment group [(79.45±14.44) ng/L, (181.80±12.12) ng/L]. Compared with the of serum cytokine level before treatment, both TGF-β and IGF-1 levels in two groups were increased, and the difference was statistically significant (single drug treatment group: t=-4.16, P=0.001; t=-14.22, P=0.000) (combined drug treatment group: t=-8.49, P=0.000; t=-26.7, P=0.000). Compared with the single drug treatment group, the level of cytokine in patients with combined drug treatment group was significantly higher, and the difference was statistically significant (t=2.02, P=0.01; t=2.02, P<0.001). Conclusions The total effective rate was increased by the combination of salad oxazine and Chang weining, and the serum cytokine level of TGF-β1 and IGF-1 of combination group were closer to the normal control group. Key words: Ulcerative colitis; TGF-β1; IGF-1; Drugs used in combination; Curative effect

Objective To explore the distribution of pathogenic fungus,drug resistance,and influence factors of fungal infection after colorectal cancer operation.Methods 46 cases of fungal infection patients in Department of Gastrointestinal Surgery after colorectal cancer operation from January 2014 to June 2016 were selected.The identification,distribution,drug resistance and influence factors of pathogenic fungus isolated form patients' blood,urine,sputum and secretions in the surgical site were analyzed.Results Pathogenic fungus isolated mainly from the secretion of surgical site and blood.The isolation rates of Candida albicans,Candida parapsilosis,Candida glabrata and Candida krusei were high,the isolation rate was 28.3％,21.7％,13.0％ and 10.9％ respectively.The results of antifungal-drug sensitive experiment showed that the pathogenic fungus displayed different degrees of resistance against antifungal drugs.Pathogenic fungus presented higher resistant rates against Fluconazole,Ketoconazole and Econazole (resistant rate more than 20％),but sensitive against 5-fluorine cytosine,Amphotericin B and Voriconazole (sensitive rate more than 90％).The results of single factor x2 test showed that operation time,age,and basal metabolic disorder were the important influence factors of fungal infection after colorectal cancer operation (P ＜ 0.05).Conclusion Clinical medical staff should pay much more attention to patients with related influence factors and prevent fungal infection after colorectal cancer operation.If fungal infection has occurred,appropriate antifungal drugs should be selected according to the results of drug sensitive experiment.

Objective To investigate the changes of the serum cytokines levels of interleukin (IL)-1β, IL-6, IL-18 and tumor necrosis factor-α (TNF-α) in patients with herpes zoster before and after the treatment of antiviral medication. Methods According to the inclusion criteria, total of 18 patients with herpes zoster in our hospital were selected. The levels of serum cytokines IL-1β, IL-6, IL-18 and TNF-α were detected before and after the treatment of antiviral drug therapy, respectively. Results After the treatment, the statistical results showed the levels of serum cytokines IL-1β (t = 18.46), IL-6 (t = 6.15), IL-18 (t = 21.50) and TNF-α(t = 10.95) of the 18 patients significantly decreased (all P < 0.001). The levels of serum cytokine IL-6 of 3 cases increased compared with the levels before treatment. The levels of serum cytokine TNF-α of 2 cases displayed no significantly change after treatment. Follow-up visits after one month, the patient with high level of IL-6 after the treatment of antiviral drug therapy felt neuropathic pain, which the symptom remit without any treatment. But one patient with high level of both IL-6 and TNF-α emerged post-herpetic neuralgia. Conclusions After the treatment of antiviral medication, the inflammatory condition had improved in all patients. But the status of sustained high levels of serum IL-6 and TNF-α may lead post-herpetic neuralgia.

Helicobacter pylori infection is an important factor which is related to gastritis, gastric ulcer, gastric cancer and other gastrointestinal diseases. In the process of infection, it can produce many cytokines. In recent years, many researches have proved that the interleukin-17 (IL-17) plays an important role in pathophysiology of infection and immune mediated gastrointestinal diseases. IL-17 increased in H. pylori infected patients with gastric mucosa. The activa-tion of MAPK/ERK 1/2 signaling pathway may lead to the expression of IL-8, which is a chemotactic factor of neutro-phils and promote inflammation. Regulatory T cells (Tregs) can suppress the inflammatory response. At present, the mechanism of H. pylori induced inflammation has not yet been fully understood, and host and pathogen can both pro-mote inflammation, such as cytotoxin associated gene A (cagA) and vac uolating cytotoxin A (vacA). IL-1β, IL-6, TNF-α, TGF-β1, IL-17, IL-18, IL-21 and IL-22 are related with gastric mucosal inflammation induced by H. pylori, but many details and different models of inflammatory response are still not clear. A large number of studies have shown that IL-17 has important function in the process of acute and chronic inflammation. In this paper, the relationship between IL-17 and gastrointestinal diseases, such as gastritis, gastric ulcer and gastric cancer, has been reviewed.

肝小静脉闭塞病（ hepaticveno－occlusive disease， HVOD），是某些原因导致非血栓性肝小静脉闭塞，以急性肝肿大、黄疸、腹水为主要表现，病死率高。由于该病在临床上较少见，本文报道我院2004年至2009年收治的6例中药土三七导致HVOD的病例并结合文献复习，旨在探讨HVOD的临床特点，为疾病预防和早期诊治提供依据，以期改善患者的预后。

Objective To study the distribution, drug resistance and risk factors of pathogenic bacteria of hospital acquired infection in Department of Gastroenterology in Renmin Hospital of Wuhan University.MethodsInpatients (64 cases) with hospital acquired infection in Department of Gastroenterology in Renmin Hospital of Wuhan University from August 2012 to February 2015 were selected. The distribution, drug resistance and risk factors of pathogenic bacteria were analyzed.Results The specimens were mainly obtained from urine and sputum. There were 20 strains of Gram-positive bacteria, and 44 strains of Gram-negative bacteria. Gram positive bacteria were sensitive to linezolid, while they were variously resistant to other antibiotic drugs. The resistance of Gram-negative bacteria was serious. The main risk factors of hospital acquired drug resistance bacteria infection was age, surgery and urine tube.Conclusion Clinical medical staff should pay much more attention to related risk factors of pathogenic bacteria of hospital acquired infection, to prevent the happening of bacterial infection, and rationally use antibiotic drugs.

目的 研究肝脏炎性肌纤维母细胞瘤(hepatic inflammatory myofibroblastic tumor,hepatic IMT)的临床特点,以提高对该病的认识和诊疗水平.方法 收集5例患者的临床资料,分析和总结其主要的临床病理特点.结果 肝脏单发者4例,多部位受累者1例.临床症状包括发热、乏力、纳差、肿块局部疼痛等.可伴有贫血、纤维蛋白原和肝酶增高.病理检查示梭形肿瘤细胞排列成束状或编织状分布于胶原性基质中,伴淋巴细胞、浆细胞浸润,肿瘤细胞表达波形蛋白Vim (5/5)、平滑肌肌动蛋白SMA(5/5)和肌特异性蛋白MSA (5/5).全部患者行肿瘤完整切除.随访11 ～65个月,无复发、转移、死亡.结论 肝脏IMT的临床表现无特异性,病理学检查和免疫组化对诊断意义较大,手术完整切除是其有效的治疗方法.

By studying the sequence of key protein(AcrA protein) and conserved/non-conserved amino acid residue in AcrAB-TolC efflux pump,a phylogenetic tree was obtained.After collecting known sequence of AcrA protein in different bacteria,removing redundancy,the results of aligning sequences were used to research the similarity,conservative property of amino acid residue and evolution characteristics of AcrA protein.Part of the amino acid residue of AcrA protein from different bacteria is highly conservative,which is related to the biological function.Nonconserved area is relevant to evolution.This study can provide reference for the evolution of different strains.Relevant data is presented for new drug research of which AcrAB-TolC type effluent pump is as drug target.

目的 通过分析急性肺栓塞的临床资料,提高诊断水平.方法 回顾性分析30例急性肺栓塞的诱发危险因素、症状、体征、实验室检查、心电图、心脏彩超、肺部CT和肺核素扫描特点.结果 急性肺栓塞以中老年人多见.主要表现为急性呼吸功能衰竭和右心功能不全的表现.可有D-D二聚体和血肌钙蛋白水平增高.心电图表现包括Ⅱ、Ⅲ、avF导联q 波,Ⅱ、Ⅲ、avF导联T波倒置,窦性心动过速,SⅠQⅢTⅢ征,胸前导联T波倒置.心脏彩超可见右心室功能不全的征象.肺螺CT检查和放射性核素肺通气和灌注显像是确诊肺栓塞的主要手段.结论 急性肺栓塞的临床表现结合实验室检查可协助确立初步诊断,确诊需行肺螺CT检查和放射性核素显像.

Multiple myeloma commonly has cardiac involvement which presents as congestive heart failure,angina pectoris,acute myocardial infarction,arrhythmia and pericardial effusion.The use of the electrocardiogram,echocardiogram,radionuclide scan,or magnetic resonance image can help to diagnose the disease.The gold standard for diagnosis is a myocardial biopsy.The prognosis for patients with cardiac impairment is very poor,but some novel treatments are giving hope.

Objective To summarize the clinical features of abdominal inflammatory myofibroblastic tumor(IMT).MethodsThe clinical data of 15 cases of abdominal IMT,and the clinicopathologic features were analyzed.Results The patients included 8 men and 7 women,with age ranging from 4 to 63 years old.The tumor located in the liver(5 cases),gallbladder(3 cases),mesentery(2 cases),stomach(1 case),spleen(1 case),rectum(1 case),adrenal gland(1 case),and abdominal cavity(1 case).In 2 cases,tumor grew in multiple locations.Symptoms included fever,fatigue,anorexia,pain in the focal area,etc.Anemia and high fibrinogenemia were common.Histologically,spindle-shaped cells proliferated in a bunch manner in collagenous stroma with inflammatory infiltration primarily composed of plasma cells and lymphocytes.Immunohistochemically,spindle-shaped cells showed strong positive staining for Vim(15/15),SMA(15/15)and MSA(15/15),partial positive staining for ALK(6/15),Calponin(6/15),Desmin(5/15)and CK(4/15).In 13 cases,tumors were completely resected.In one case,tumor was partly resected.One case just underwent biopsy.After follow-up for 11-65 months,13 patients were alive without recurrence after the surgery.Conclusion Abdominal IMT,a rare kind of tumor,origins from mesenchymal tissue.Symptoms vary according to the different locations of tumor.Diagnosis mainly depends on the pathological and histological examinations.Complete surgical resection is an effective therapeutic method for most IMT patients.

目的:探讨血CA125测定在肠结核和克罗恩病中的鉴别诊断价值。方法:选取肠结核患者32例、克罗恩病患者15例,抽取静脉血测定血CA125的浓度,以CA125>35μ/mL为阳性。结果:肠结核和克罗恩病患者的血CA125阳性率和绝对值存在很大差异[78.1%vs.26.7%,(245.3±306.3)μ/mL vs.(23.8±14.4)μ/mL,P=0.000]。其中,肠结核合并肺结核或结核性胸、腹膜炎者血CA125阳性率和绝对值与克罗恩病相比统计学意义[95.0%vs.26.7%,(388.1±335.4)μ/mL vs.(23.8±14.4)μ/mL,P=0.000],而单纯肠结核(不合并肠外结核)与克罗恩病无统计学意义[58.3%vs.26.7%,(47.5±47.2)μ/mL vs.(23.8±14.4)μ/mL,P>0.05]。CA125用于鉴别两者的敏感性、特异性、阳性预测值和阴性预测值分别为78.1%、73.3%、86.2%和61.1%。结论:血CA125在肠结核合并肺结核或结核性胸、腹膜炎患者中显著升高,在单纯肠结核者呈轻度增高,在克罗恩病者中增高不明显。测定血CA125有助于鉴别诊断肠结核和克罗恩病。

急性心包填塞表现为动脉压急剧下降,脉压差变小,静脉压明显上升,心动过速.本文2例急性心包填塞患者的心率非但不增快,反而减慢,报道如下.例1 患者,女,4|5岁.因颜面浮肿,双下肢无力2年入院.

Atrial fibrillation is one of the most common arrhythmia.Some different pacing sites have recently been introduced in atrial fibrillation pacing therapy.The present review refers to Bachmann's bundle pacing in atrial fibrillation treatment.

Store-operated calcium channel(SOC),which was found in recent years,is located on the cell membrane.It is the main channel regulating the Ca2+ influx in non-excitable cells.The channel activation is aroused by the Ca2+ store depletion.However,the process of SOC opening after the calcium store depletion is still unclear.The article reviews the latest progress in the research on the regulating mechanisms of store-operated calcium channel.