目的 探索基于常规教学+"雨课堂+翻转课堂"的混合式教学在医学本科生《血压测量》实践课程中的应用和效果.方法 以《血压测量》课程为例,针对2018级五年制临床、航医、医学心理学专业159名学员采取常规教学模式上课(对照组),2019级五年制口腔、基础医学专业50名学员,采取常规教学+"雨课堂"模式上课(实验1组),2019级五年制临床、航医、医学心理学专业53名学员,采用常规教学+"雨课堂+翻转课堂"混合教学授课(实验2组).通过随堂测验得分、教学效果和学员评价等三项维度开展课堂调查分析,综合比较不同教学模式的有效性.结果 与常规教学比较,采用常规教学+"雨课堂+翻转课堂"混合教学授课学生在随堂测验得分、课堂教学评价和学生评价三个方面均明显更高(P＜0.05,P＜0.01).结论 使用基于常规教学+"雨课堂+翻转课堂"的混合教学模式不仅能提高学生血压测量技能,而且加强了学生对临床医学知识的掌握和学习的主动性,有效提高教学质量.

目的 本研究旨在探讨巨噬细胞亚型在类风湿关节炎相关间质性肺疾病(RA-ILD)患者外周血中的意义.方法 选取2017年1月至2021年12月在医院随访的158例RA-ILD患者入组本研究.RA-ILD患者分为活动组(n=63)和非活动组(n=65).活动组中,包括新诊断的RA-ILD和未治疗的受试者;非活动组中,符合缓解期的RA-ILD患者.30例单纯类风湿关节炎(RA)作为对照组.所有患者均采集外周血.流式细胞术检测巨噬细胞亚型:M1(CD14+CD86+CD80+)、M2a(CD14+CD206+CD301+)、M2b(CD14+CD206+CD86+)和 M2c(CD14+CD206+CD163+),还检测了细胞因子淋巴细胞亚群含量,包括白细胞介素(IL)(IL-1 β、IL-2、IL-4、IL-5、IL-6、IL-8、IL-10和IL-17)、干扰素(IFN)-α、IFN-γ和肿瘤坏死因子(TNF)-α.结果 M1标记CD80和M2标记CD163、CD301在活动性RA-ILD患者中高表达.活动组巨噬细胞以M1和M2a为主(P＜0.05).在非活动组中,M2倾向于极化为M2b和M2c(P＜0.05).与对照组相比,活动组IL-6显著升高(P＜0.05),非活动组IL-10、IL-4和IL-17显著升高(P＜0.05).结论 在活动的RA-ILD中,M1激活促进炎症,而M2a快速反应抑制炎症;在非活动组RA-ILD中,M2b和M2c在抑制炎症中起主要作用.

Objective To observe the protection effect of T-614 on bleomycin ( BLM) -induced pulmonary fibrosis mice. Methods After successful induction of the disease, forty female C57BL/6 mice were randomly divided into control group ( n=20) and T-614 treatment group ( n=20) . Mice in control group were treated with phosphate buffered saline (PBS);while the mice in the treatment group were treated with T-614 intragastrically. On the first day after induction, the control group and the treatment group were subjected to PBS and T-614 once a day for 28 days. The pathological changes of the lung were observed by Hematoxylineosin ( HE) staining and Masson trichrome staining on day 7, 14, 21, and 28. Results HE staining showed that a large number of inflammatory cells accumulated in the interstitial lung tissue of the control group. In the treated group, the lung interstitium inflammatory lesions were significantly reduced. The Ashcroft fibrosis scores showed a significant difference between the treatment group and the control group on the day 21 (4. 96±0. 06 vs. 0. 70±0. 17) and day 28 (4. 92±0. 10 vs. 0. 75±0. 55, P<0. 001). Conclusion T-614 can effectively protect the BLM-induced pulmonary fibrosis of mice against pulmonary damage and alleviate clinical condition of pulmonary fibrosis mice.

Objective To set up ankylosing spondylitis BALB/c mice experimental animal model and discuss the Aggrecan G1 purified protein in the role of spondylitis and sacroiliitis.Methods Human-purified Aggrecan G1 domain and FCA were injected into BALB/c mice to induce spondylitis and sacroiliitis.Spondylitis and sacro iliitis were determined by pathological examination and radiology.Results It was shown that immunity to human-purified Aggrecan G1 domain resulted in spondylitis in the lumbar spine and sacroiliitis in 46％ and 9％ mice respectively.Accumulation of chondrocytes was observed in spinal intervertebral disc and the rodent sacroiliac joints.Conclusion We successfully established and identified Aggrecan G1 area with purified protein induced spondylitis experimental animal model of mice,which will help to probe the further research on the pathogenesis ankylosing spondylitis.

Objective To investigate the diagnostic value of SPECT/CT in early Ankylosing Spondylitis (AS).Methods 482 patients with low back pain and hip pain in our hospital from September 2013 to April 2016 received SPECT/CT detection.All patients were fulfilled the standard 2009 ASAS-SPA criteria.Among them,334 patients fulfilled the revised AS New York criteria.The correlation of SPECT/CT and clinical indicators were analyzed.Results CRP had correlation with SPECT/CT markers (r=0.279,P=0.279).The ESR had correlation with SPECT/CT markers (r=0.372,P=0.002).The ESR has correlation with bone erosion (r=0.279,P=0.045).Patients pain VAS had correlation with SPECT/CT markers (r=0.418,P ＜ 0.01).Patients pain VAS had correlation with bone erosion (r=0.335,P=0.005).Conclusion Early AS with SPECT/CT examination can effectively detect the early pathological changes and provide imaging basis for early diagnosis and treatment.

Objective To evaluate the efficacy and safety of biological agent for ankylosing spondylitis with hip joint involvement .Methods 178 patients with confirmed AS complicated with hip joint involve-ment met the criteria for candidates receiving biological agents were divided into the control group ( n=52) and the observation group ( n=126) .The control group received oral methotrexate plus sulfasalazine while the observation group received oral methotrexate in combination with biological agent .The curative efficacy in the two groups after 24 weeks treatment , and the clinical and laboratory parameters as well as adverse drug reactions at 12 and 24 week were evaluated .Results After 24 weeks of treatment , the response rate of the observation group was significantly better than the control group ( P<0.01);after treatment of 12 and 24 weeks, the observation group showed significant better improvement in ASDAS , BASFI, Harris score, CRP, ESR, and other indicators, the differences were statistically significant (P<0.01).In the control group as compared with before treatment , the control group was significantly different in BASDAI , BASFI, CRP and ESR at week 24 ( P<0.05) .Comparative evaluation of the observation group and the thalidomide control group, the ASAS20 remission rate at week 24 was 51.7％vs.38.6％(P=0.135), and the ASAS40 remission rate was 40.0％vs.22.9％(P=0.035), the ASAS partial remission rate was 33.3％vs.12.8％(P=0.005).No significant adverse drug reactions were noted in either group .Conclusion Biological agent treatment of AS complicated with hip joint involvement may result in early induction and remission and it is safe and effective .

Objective To analyze the clinical features of connective tissue disease associated interstitial lung disease (CTD-ILD). Methods The clinical manifestation of 305 patients diagnosed CTD-ILD and chest high resolu-tion computed tomography features of rheumatoid arthritis associated interstitial lung disease ( RA-ILD) and Sjogren's syndrome associated interstitial lung disease ( pSS-ILD) were retrospectively analyzed. Results The total incidence of ILD in CTD was 11. 78%. The highest incidence of ILD was polymyositis ( 53. 13%) , then was anti-neutrophil cytoplasmic antibody associated vasculitis (40. 74%), mixed connective tissue disease (35. 14%) and scleroderma (29. 73%). pSS-ILD and RA-ILD were the major part of the total CTD-ILD with the proportion of 24. 92% and 23. 61% respectively and almost occupied the half of all CTD-ILD patients. Conclusion The incidence of CTD-ILD is very high. pSS-ILD and RA-ILD are the main diseases of CTD-ILD, and the early screening and treatment is very important.

Objective To evaluate the interactive relationship between inflammation detected by single photon emission computed tomography combined with computed tomography (SPECT/CT) and magnetic resonance imaging (MRI) detection of synovitis,bone marrow edema (BME) in the early rheumatoid arthritis (RA) patients.Methods Twenty patients with early RA were included into this study.All patients were diagnosed based on the 2010 ACR/EULAR classification criterion.Patients' unilateral hands (MCP 2-5 and PIP 2-5 joints) were inspected by SPECT/CT (label:99Tcm-MDP) and MRI (3.0 T).SPECT/CT and MRI images were analyzed by two reviewers blinded to other clinical information.Increased bone metabolism of the regional area of interest (ROI) was analyzed and the uptake ratio was calculated.MRI quantitative evaluation was completed by RAMRIS score system.Statistical analysis was performed using SPSS 17.0 software.Student's t-test,analysis of variance (ANOVA),x2 test and post-hoc analysis (Scheffe) were used for comparison of datas,correlation analysis was carried out with Spearman rank correlation test.Results Twent ypatients with a total of 160 joints were examined.MRI examination revealed synovitis (39,24.4％),or BME (24,15.0％) in 63(39.4％) joints.99Tcm-MDP uptake increased in 79(49.4％) joints,and the uptake ratio was higher than normal joints (1.59±0.26 vs 1.15±0.09,t=6.408,P＜0.01).The uptake ratio between the graded synovitis level and RAMRIS synovitis score had a moderate correlation (r=0.535,P=0.001).The uptake ratio of BME level and BME score was well correlated (r=0.765,P=0.001).Conclusion In early RA patients,MRI is sensitive for synovitis and BME.SPECT/CT can detect early abnormal bone metabolism associated with inflammation,which is more sensitive than MRI.SPECT/CT can be used to detect changes of RA at the molecular level.Compared with synovitis,BME is more closely related to bone metabolism changes,which may suggest that BME may play a major role in the bone destruction in RA.However,further studies are needed to verify this hypothesis.

Objective This study is aimed to assess the accuracy of clinical measurement of remission and investigate the association between clinical remission and the ultrasound imaging assessment of synovitis and infla'mation and to explore the value of ultrasound imaging in the evaluation of disease activity in the tight control of rheumatoid arthritis (RA).Methods RA patients with a disease activity score in 28 joints (DAS28-ESR) ≤2.6 for at least 3 months were stratified-using a standard and more stringent DAS28 and simplified disease activity index (SDAI) remission thresholds and the corresponding clinical and ultrasound imaging measures of synovitis were recorded.In addition,a retrospective analysis of disease activity in patients was carried out.Mann-Whitney U test,x2 test and multi-factor analysis of variance of repeated measurements were used for statistical analysis.Results A total of 48 cases were recruited.Thirty-seven cases (77％) met the ACR remission criteria,29 cases (60％) fulfilled the SDAI remission criteria,and 32 (67％) cases reached 2010 ACR/EULAR Boolean-based definition of remission criteria.There was no significant differences on imaging disease activity between SDAI remission patients and those who were not in remission (GS score,P=0.38; PD score,P=0.32).Seventy-nine percent patients in SDAI remission had GS and/or PD activity,but the difference was not statistically different when compared with patients who did not reach SDAI remission (P=0.29).Sustainable remission obtained in patients who also had achieved image remission could have longer remission time (P＜0.01) Conclusion Using more stringent clinical remission criteria could help in reducing residual inflammatory activity of,but ultrasound PD activities may not be significantly reduced.Integrated clinical indicators such as physical examination and imaging tools such as ultrasound can provide more accurate assessment of disease activity and could be used to guide treatment to achieve "true"remission.

目的:了解强直性脊柱炎(AS)患者的一般流行病学特征,同时以两种诊断标准通过现有病例的统计分析进行比较。方法:收集622例强直性脊柱炎患者的临床资料,进行回顾性分析,并进行新旧两种诊断标准的比较。结果:622例患者中,男470例,女152例,男女患者比例为3.09︰1。患者平均发病年龄为(23.01±9.83)岁,其中男性平均发病年龄为(19.67±4.36)岁,女性为(28.89±11.30)岁,男性平均发病年龄小于女性,差异有统计学意义。髋关节受累患者的平均发病年龄为(20.05±9.69)岁,发病年龄较小。使用新标准,622例患者中有42例被诊断为SpA(即早期AS)。结论:新标准更重视早期患者的发现,对于SpA患者的早期防治起到很重要的作用,可以有效地减少此类患者的高致残率。