OBJECTIVE:To systematically review and analyze the effects of Internet-based cognitive behavioral therapy (ICBT) on physical, psychological, and daily life outcomes in patients with breast cancer. METHODS:Relevant studies were retrieved from Wanfang, CBM, CNKI, CINAHL, PsycINFO, Web of Science, The Cochrane Central Register of Controlled Trials, Embase and PubMed from inception to December 2023. Two independent authors conducted the literature search and data extraction. The Cochrane bias risk assessment tool was used to evaluate the included studies for methodological quality, and the data analysis was performed using Stata (Version 15.0). RESULTS:Among 700 records, 11 randomized controlled trials were identified in this study. The meta-analysis showed statistically significant effects of ICBT on depression (standardized mean difference (SMD) = -0.38, 95% confidence interval (CI): -0.70 to -0.06, P = .019) and insomnia severity (SMD = -0.71, 95% CI: -1.24 to -0.19, P = .008). However, there were no statistically significant effects on anxiety, fatigue, sleep quality and quality of life. CONCLUSIONS:ICBT appears to be effective for improving depression and reducing insomnia severity in patients with breast cancer, but the effects on anxiety, fatigue, sleep quality and quality of life are non-significant. This low-cost treatment needs to be further investigated. More randomized controlled trials with a larger sample size, strict study design and multiple follow-ups are required to determine the effects of ICBT on patients with breast cancer.

目的 评价终止高血压膳食疗法(dietary approaches to stop hypertension,DASH)对糖尿病患者代谢结局水平的影响.方法 检索中英文共 10 个数据库中关于DASH饮食干预糖尿病的随机对照试验及队列研究,检索时限为建库至 2022 年12 月.2 名研究者独立进行文献筛选、资料提取、文献质量评价.运用RevMan 5.4 软件对RCT进行Meta分析,对队列研究进行描述性分析.结果 纳入9 项研究(8 项RCT、1 项队列研究),共990 名患者.Meta分析结果显示,与对照组相比,DASH饮食在空腹血糖水平、空腹胰岛素水平、胰岛素抵抗稳态模型水平、总谷胱甘肽水平、总抗氧化能力水平方面有统计学差异(P<0.05).在糖化血红蛋白、超敏C-反应蛋白方面,两组差异无统计学意义.同时,队列研究结果表明,DASH饮食在改善空腹胰岛素、胰岛素抵抗稳态模型水平方面,差异无统计学意义(P=0.89,P=0.55).结论 DASH饮食可改善糖尿病患者多项代谢指标,但仍需更多高质量的大样本研究予以验证.

目的 探讨基于"学习通"平台的BOPPPS教学模式在中医护理学基础课程中的应用效果.方法以某高校2021 级护理学专业50 名学生为观察对象,开展基于"学习通"平台的BOPPPS教学.以学习成绩、自主学习能力、学生满意度评估教学质量,并与采用传统教学模式的2020 级护理本科生进行比较.结果 试验组学生对BOPPPS教学模式满意度较高,期末考试结果与形成性评价成绩、自主学习能力均优于对照组,差异有统计学意义(P＜0.05).结论 基于"学习通"平台的BOPPPS教学模式可以激发学生学习兴趣,提升学生的自主学习能力.同时,强化了学生批判意识和中医临床思维.

目的 在中医护理学基础课程中开展基于BOPPPS教学模式的教育实证研究.方法 以某高校2022 级471 名学生为研究对象,采用抽签法选定1、2、4、7 班233 名学生为试验组,3、5、6、8 班 238 名学生为对照组.对照组接受传统规范教学,试验组开展基于BOPPPS教学模式的精准教学.课程结束后比较 2 组学生的课程成绩、学习投入、学习适应水平.结果 试验组课程成绩、学习投入、学习适应水平显著高于对照组(P<0.05).结论 基于BOPPPS教学模式的精准教学通过对学习者特征的把控与学习数据的追踪,精准动态调整教学活动,提高了课程学习成绩,对促进学生学习投入,提升学习适应水平有积极影响.

BACKGROUND Neutrophil-lymphocyte ratio (NLR) is related to increased mortality risk in many diseases. However, there is limited research on critically ill patients with chronic obstructive pulmonary disease (COPD). A retrospective cohort study was performed to investigate whether NLR can be used as a biomarker to predict the mortality of critically ill COPD patients. MATERIAL AND METHODS In the research, the data were gathered from the database of the Medical Information Mart for Intensive Care-IV. The 28-day mortality was defined as the primary outcome, while the secondary outcomes were in-hospital and 90-day mortality. Through the application of the Kaplan-Meier curves and the multivariate Cox regression analysis, the potential association between NLR and mortality for critically ill patients with COPD was evaluated. For subgroup analysis, age, sex, ethnicity, mean blood pressure, and comorbidities were considered. RESULTS We extracted data on 2650 patients, of which 53.7% were male. A higher level of NLR was correlated with higher 28-day mortality risk. Compared to the lower quartile (NLR<4.56), HR (95% CI) of the upper quartile (NLR>16.86) was 1.75 (1.21-2.52) in the multivariate Cox regression model when adjusted for confounders (P=0.003). A similar tendency was found in the 90-day mortality (HR=1.59, 95% CI=1.16-2.19, P=0.004) and the in-hospital mortality (HR=1.71, 95% CI=1.22-2.42, P=0.002). Subgroup analyses showed that the correlation between NLR and 28-day mortality was stable. CONCLUSIONS The higher level of NLR is likely to be correlated with the increase of the all-cause mortality risk in critically ill patients with COPD, but this needs to be validated in future prospective research.

目的 观察基于信息化环境服务性学习在中医护理学课程实践教学改革中的应用效果.方法 将2019级护理本科的两个平行班分为实验组(57人)和对照组(56人).对照组沿袭传统教学方式,实验组采用服务性学习教学方法.教学结束后,对两组学生的理论和实践技能知识进行考核,对实践操作得分进行比较,并对实验组的服务性学习实践教学效果进行评价.结果 实验组理论、技能知识及实践操作成绩均高于对照组(P＜0.05).实验组82％以上的学生认为实践教学改革有助于端正学习态度,提高知识掌握能力、综合能力和文化认知能力.结论 基于信息化环境的服务性学习是适合中医学科特点的中医课程实践教学的新模式.

目的:观察耳部全息铜砭刮痧联合"认知-建构主义"心理干预对老年慢性便秘患者生活质量的影响.方法:将71例老年慢性便秘患者随机分为观察组(36例)和对照组(35例).对照组给予常规治疗和护理干预,观察组在对照组的基础上给予耳部全息铜砭刮痧联合"认知-建构主义"心理干预.连续干预4周后比较2组患者睡眠质量、心理状态、生活质量、便秘程度评分.结果:2组患者的睡眠质量、心理状态、生活质量、便秘程度评分均优于干预前,且观察组评分改善较对照组更显著(P＜0.01).结论:耳部全息铜砭刮痧联合"认知-建构主义"心理干预能有效改善老年慢性便秘患者的生活质量.

2020年上学期新冠肺炎疫情期间,利用现代数据化网络教学形式,通过"浅谈《伤寒论》疫病思想指导下中医护治新冠肺炎"专题教学,尝试将经典《伤寒论》中关于中医药防治外感疫病的学术思想和治疗方法,与课程教学有关章节的教学内容相结合,改变注入式灌输教学和以知识为向导的记忆性学习,开展高等中医院校中医课程"经典引导启发式"教育教学(Classic guidance heuristic education,CGHE)改革的研究.教学效果说明:《伤寒论》"经典引导启发式"教育教学,可以培养中医思辨能力,提高学生的综合素质,是构建中医疫病学科及培养中西医并重高素质卫生人才的有效模式和必然选择.

目的:从文献计量学角度探析我国中医护理核心能力研究进展,为提升我国中医护理人才质量和中医护理队伍建设提供思路和指导.方法:检索中国知网(CNKI)、万方(Wan Fang)、维普(VIP)和中国生物医学文献数据库(CBM)自建库至2020年7月有关我国中医护理核心能力的相关研究,运用文献计量学方法对其进行统计分析.结果:共纳入58篇有效文献,包含42项研究,分布16个省、市、自治区,发表在31种期刊上;时间跨度为2006-2020年;发文地域主要集中在江苏、广东、湖北;研究机构以高层级单位为主;文献合作度为3.24,合著率为70.69％;研究内容主要涉及中医护理核心能力培养现状、需求调查,以及中医护理核心能力培训效果.结论:我国中医护理核心能力研究整体呈波动上升态势,跨区域、跨机构、跨团队协作水平亟待加强,有必要发挥高层级单位辐射带动作用,重视高素质中医护理人才培养,推动中医护理学科趋向专科化发展.

目的 探讨并发症体验式教育在0级糖尿病足患者中的应用效果.方法 选取2020年7—12月在合肥市某三甲专科医院就诊的60例0级糖尿病足患者,运用随机数字表法分为体验组和对照组,各30例.对照组进行常规教育,体验组在对照组基础上加以并发症体验式教育.比较2组患者体验前、体验后及3个月后血糖(空腹及早餐后2h血糖)、自我管理效能及足部护理行为.结果 干预后体验组患者空腹及早餐后2h血糖均低于对照组,差异均有统计学意义(P<0.05).体验组体验后、体验3个月后自我管理效能、足部护理行为得分均高于对照组,差异均有统计学意义(P<0.05).结论 并发症体验式教育提高了患者的自我管理效能及足部护理行为,改善了血糖水平.

自《关于促进中医药传承创新发展的意见》提出中医药事业发展蓝图后,中医药发展始终是当今时代的高频词,2021年两会新华社评论中医药发展"正逢其时".中医药文化是中华文化的精粹,中医药院校肩负着培育中医药后继人才的大任,而中医药院校辅导员又是大学生思想政治教育工作的重要力量,因此,只有不断提高辅导员自身的综合素质,才能有效发挥辅导员的引导和培育作用.本文以中医药文化对中医院校辅导员综合素质的提升为切入口,探索如何让辅导员运用中医思维引导高校学生成长成才,促进高校辅导员将中医药文化与高校思政教育有机结合的路径.

OBJECTIVE:To observe the therapeutic effect of moxibustion combined with Guifu Yuhe decoction on allergic acne and the influence on immunologic function in the patients.METHODS:A total of 60 patients with allergic acne were rando-mized into an observation group (30 cases) and a control group (30 cases).Thirty healthy employees were in the healthy group. In the control group, Guifu Yuhe decoction was prescribed for oral administration, while in the observation group, on the base of the treatment as the control group, moxibustion was exerted at Dazhui (GV14) and Shenque (GV8). The treatment duration was 8 weeks. Before and after treatment, serum IgE, blood EOS, CD4+T cell, CD8+ T cell and CD4+T/CD8+T, as well as the conversion score of idiopathic constitution and the symptom score were compared in the patients of two groups. The clinical therapeutic effect was observed in the two groups.RESULTS:Before treatment, compared with the healthy group, IgE and EOS, CD4+T cell and CD8+T cell all increased (P<0.05), and CD4+T/CD8+T decreased in the two groups (P<0.05). After treatment, IgE, EOS and CD4+T cell and CD8+T cell decreased (P<0.05), and CD4+T/CD8+T increased (P<0.05) in the intra-group comparison in the patients. The changes of IgE, EOS, CD4+T cell and CD8+T cell in the observation group were more larger than those in the control group (P<0.05). After treatment, the conversion score of body constitution and symptom score all decreased in either group (P<0.05) and the scores in the observation group were lower than those of the control group (P< 0.05). The total effective rate of the observation group (29/30, 96.7%) was higher than that of the control group (22/30, 73.3%, P<0.05).CONCLUSION:Moxibustion combined with Guifu Yuhe decoction can significantly improve immune function and body constitution of the patients with allergic acne, which may be related to rectifying idiopathic constitution, improving in lymphocyte subsets dysfunction and inhibiting allergic reaction.

2020年,为了有效阻断新冠肺炎疫情在校园蔓延,教育部要求延迟春季开学,同时倡导高校有效利用慕课和优质在线课程中的教学资源,依托在线课程平台及校内网络学习空间等,积极开展线上教学[1].

目的 整合相关质性研究、系统评价糖尿病患者自我管理过程中的体验和感受.方法 检索PubMed、Embase、Web of science、The cochrane library(CENTRAL)、CINAHL5个英文数据库及中国生物医学文献数据库、中国知网、万方、维普4个中文数据库中本领域的质性研究,检索时间均为建库至2019年11月30日.采用"澳大利亚JBI循证卫生保健中心(2017)质性研究质量评价标准"进行质量评价,采用汇集性整合的方法进行结果整合.结果 共纳入8项研究,提炼32个完整的研究结果,将相似的结果进行归纳,得出6个新类别,并综合为2个整合结果.整合结果1:糖尿病患者在自我管理过程中会产生诸多压力和负性情绪,但随着对自我管理认知的不断深入,患者能采取各种措施,予以积极应对;整合结果2:糖尿病患者在自我管理过程中有足够的动力,但仍存在诸多困惑及障碍,渴望得到家庭、社会的支持.结论 政府、医疗卫生机构、社会公众及患者家庭应充分重视糖尿病患者在自我管理过程中的感受和体验,针对患者自我管理过程中的薄弱环节,给予指导和支持,帮助其更好地管理疾病.

目的 通过Meta分析评价迷你临床演练评量(Mini-clinical evaluation exercise,Mini-CEX)在中医教育中的应用效果.方法 计算机检索CBM中国生物医学文献数据库、CNKI、维普、万方、PubMed、Cochrane图书馆等国内外数据库中有关Mini-CEX在中医教育中应用的随机对照试验(Randomized controlled trial,RCT),检索时限从建库至2020年1月15日,由两名研究者根据Cochrane协作网的系统评价方法独立筛选文献,评价文献质量,并使用Revman 5.3软件统计分析.结果 最终共纳入9项RCT,合计466名受试者.Meta分析结果显示Mini-CEX较之于传统教学评价法对提高学员病史采集能力[SMD=0.79,95％CI(0.39,1.19),P=0.0001]、体格检查能力[SMD=1.64,95％CI(0.75,2.53),P=0.0003]、沟通能力[SMD=1.24,95％CI(0.94,1.53),P<0.001]、考核成绩[SMD=1.76,95％CI(0.75,2.77),P=0.0007]及教学满意度[RR=1.33,95％CI(1.14,1.56),P=0.0004]均有显著作用.结论 Mini-CEX能有效提高学员临床综合能力、考核成绩及教学满意度,有助于培养卓越中医人才.

Objective. The purpose of this study was to assess the effects of glucose fluctuation targeted intervention on neurologic function, independent living skills, and quality of life in type 2 diabetes patients following the first episode of cerebral infarction (CI). Methods. This was a randomized control trial. Following confirmed cerebral infarction, 75 patients with type 2 diabetes were randomized into 2 groups: control group (n=37) with usual care, focused on hemoglobin A1c (HbA1c) control, targeting A1c<7%, and intervention group (n=38), targeting both A1c<7%and daily glycemic fluctuation (largest amplitude of glycemic excursions (LAGE<80 mg/dL)). Results. After 6 months, data from 63 patients were analyzed (30 in the control group, 33 in the intervention group). There was no difference (P>0.05) in the reduction of A1c between the 2 groups, but the reductions of LAGE (P=0.030), 1,5-anhydroglucitol (1,5-AG) (P=0.023), 2-hour postprandial blood glucose (2hPG) (P=0.041), and low-density lipoprotein cholesterol (LDL-c) (P=0.046) were significantly different. The National Institutes of Health Stroke Scale (NIHSS) score of the intervention group was better than the control group (2.35±0.81 vs. 3.50±2.24, P=0.047). In terms of quality of life, there was no significant between-group difference in total Stroke Impact Scale (SIS) score, but in the intervention group, scores in the strength, hand function, and participation dimensions were higher than those in the control group (P=0.041, P=0.049, and P=0.048, respectively). Conclusion. Glucose fluctuation targeted intervention can improve nerve function for patients with T2DM following the first CI episode. This trial is registered with NCT03932084.

目的 元认知策略是一种典型的学习策略,针对学生及中医护理学基础课程的特点,通过元认知策略培训,促使学生有效的管理学习,提高学习成绩.方法 选择2018级护理本科专业两个班学生共119人作为研究对象,随机分成实验班(61人)和对照班(58人).两个班级的教学均由项目研究主持者担任,实验班增加元认知策略的培训.结果 课程结束时实验班元认知监控策略、元认知调控策略比对照班有明显提高(P<0.05);实验班在课程结束的期末考试成绩明显优于对照班(P<0.05).结论 通过元认知策略培训,提高了学生元认知策略水平及学生的学习成绩.

中医护理学基础是高等中医药院校护生重要的中医基础课程,将慕课(MOOC)视域下微课结合翻转课堂引入到中医护理学的教学中,改变了传统形式下教师授课、学生被动学习局面,增强课程的针对性和灵活性,促进了学生课前独立思考及对中医护理学习的自主性,增加了师生互动,培养护生在以后的临床工作中能够中西贯通、自我解决问题以及思维创新的能力.

为了能够合理、公正地考核教师的教学水平和学生的学习效果,建立试题库是有效方法之一.本文主要介绍了适用于生物学相关专业的生物化学试题库的建设,以期在试题库的基础上建立一个基于校园网络的课程学习系统.

Objective To investigate the role of hexokinase inhibitor 2-deoxy-D-glucose ( 2-DG) in enhancing antitumor effect of metformin on human colon cancer cells and its mechanism. Methods HT-29 human colon cancer cells were treated with different dosages of 2-DG and metformin alone or jointly. The cell viability and proliferation rate were determined by trypan blue staining and MTT assay, respectively. The apoptotic rate was recorded by a double staining with Annexin V/PI followed by FACS analysis. Western blotting was used to detect the protein levels of several key components involved in AKT/mTOR signaling pathway and autophagy, including AKT, phosphorylated AKT ( p-AKT) , ribosomal p70S6 kinase ( p70S6K) , phosphorylated ribosomal p70S6 kinase ( p-p70S6K) , and p62. Results After combined treatment of 2-DG ( 1, 5, and 10 mmol/L) and metformin ( 5 and 10 mmol/L) for 24 h, the cell mortality rates of HT-29 cells were much higher than those of cells receiving single drug treatment ( all P < 0. 05) , with the highest mortality rate at 10mmol/L of both drugs ( P < 0. 01) . The combined treatment of 10 mmol/L 2-DG and various amount of metformin ( 0, 1, 5, 10, 15, and 20 mmol/L) for 48 h inhibited the cell proliferation as compared with the corresponding single drug treatment when the metformin was ≥ 5 mmol/L ( all P < 0. 05) and the cell viability was the lowest at 10 mmol/L metformin ( P < 0. 01) , however, when the concentration was 20 mmmol/L, the survival rate of HT-29 cells did not continue to decrease significantly. HT-29 cells were treated with different dosages of 2-DG ( 5 and 10 mmol/L) and 10 mmol/L of metformin for 24 h, but only under the combined treatment of 10 mmol/L 2-DG and metformin, the apoptosis rate of HT-29 cells was higher than that under the single drug treatment ( all P < 0. 05) , as well as the expression of p-AKT, p-p70S6 K and p62 proteins. Conclusion 2-DG enhances the efficacy of metformin in inhibiting the viability and proliferation of HT-29 cells and induces the apoptosis, with maximum effect at the dosage of 10 mmol/L, and the mechanism may be related to their synergistic inhibition of AKT/mTOR pathway and autophagy in tumor cells.