冠心病是世界上主要的死亡原因,心肌纤维化是冠心病发展的必经阶段,继之发生心室重塑、心肌僵硬度增加、心律失常、心力衰竭等恶性心血管事件,是导致冠心病死亡率增加的重要因素.早期诊断心肌纤维化对冠心病的治疗、预后具有重要意义.目前国内外许多关于心肌纤维化的新锐研究结果表明,心脏影像学检查可无创评估心肌纤维化,避免了患者心肌活检的痛苦,在临床诊断和治疗中具有重要意义,现本文对近年来缺血性心肌纤维化的超声、核磁共振、计算机断层扫描以及分子成像的研究成果作一综述,讨论了心血管磁共振延迟钆增强的应用、心血管磁共振的量化方法、斑点追踪技术(STE)的应用、2D和3D STE优势对比、多种CT成像的应用、新型放射性示踪剂成像评估心肌纤维化.旨在为心肌纤维化的影像学评估提供理论和实践基础,推动国内相关技术的发展,解决心肌纤维化未满足的关键临床诊断需求.

发展全科医学成为大势所趋,但目前仍存在问题,如职业吸引力不足,人才流失严重.解决该问题的关键点在于医学教育改革.将课程思政融入全科医学教学,转变教师教育理念,明确人才培养目标;深化教学体制改革,加强师资队伍建设;优化课堂设计;实践思政内涵,挖掘思政元素,加强全科医学文化建设、人文素质教育,构建新的教学模式,在传授知识的同时进行价值引领.

该院收治了1例胡桃夹现象患者,患者存在左肾静脉受压,但尚无蛋白尿、血尿、精索静脉曲张等临床表现,考虑系胡桃夹现象,如合并上述临床表现则考虑为胡桃夹综合征.体型瘦长的儿童及青少年人群系胡桃夹现象的主要患者群,早发现、早预防能尽可能减少胡桃夹综合征的发生.

目的 分析数据库中相关临床数据,明确治疗体位性低血压药物疗效.方法 检索万方数据库、中国知网数据库、PubMed、Embase数据库和https://clinicaltrials.gov/网站中关于口服药物治疗低血压的实验研究,使用R软件中的gemtc,rjags程序包,最后检索日期为2020年10月10日,绘制网状关系图呈现不同干预措施间直接比较的情况并分析相关数据.结果 共检索到4012篇关于屈昔多巴、米多君和溴比斯的明的文章,筛选后共8个临床研究符合入选标准,共837名患者;共纳入8个临床研究,包括6个研究组,涉及3种升血压药物;屈昔多巴组、米多君10 mg组与安慰剂比较,均可升高患者立位血压,米多君10mg组与米多君2.5 mg组、米多君5 mg组、屈昔多巴组比较,可升高立位收缩压,差异有统计学意义(<0.05);米多君10mg组卧位高血压风险高于对照组,差异有统计学意义(:26.00,1.80～1500.00,<0.05),屈昔多巴与对照组发生卧位高血压的风险比较,差异无统计学意义(:1.30,0.25～6.70,>0.05).结论 米多君10 mg组升高体位性低血压效果最佳,但导致的卧位风险也增加.

该文报道了1例Becker型肌营养不良性心肌病(BMDC)的临床表现和诊疗经过.患者体检发现心脏扩大、双肺底细湿啰音、双下肢凹陷性水肿,通过心脏彩色多普勒超声、心脏增强M RI、肌酶谱、B型钠尿肽前体等检查,诊断为肌营养不良性心肌病、扩张型心肌病、全心力衰竭.予以比索洛尔、螺内酯、托拉塞米、沙库巴曲缬沙坦等治疗,患者喘累、脚肿症状减轻.BM-DC的治疗目标是早发现,延缓心肌损害进展,控制心力衰竭和心律失常,预防猝死,提高患者的生活质量和生存率.

目的 分析妊娠急性脂肪肝(AFLP)并发急性肝衰竭(ALF)孕妇的临床特点及实验室相关指标.方法 选取2006-2018年达州市中心医院和重庆医科大学附属第二医院收治的57例AFLP孕妇为研究对象,根据是否并发ALF分为并发组(n=23)和未并发组(n=34),回顾性分析两组临床特点、治疗预后及实验室指标等资料.结果 并发组平均发病孕周(35.8±2.1)周,入院时以黄疸、纳差、恶心呕吐等消化道症状最为常见.与未并发组比较,并发组总胆红素(TBil)、丙氨酸氨基转移酶(ALT)、尿素氮(BUN)、血肌酐(SCR)、血氨、凝血酶原时间(PT)、白细胞计数(WBC)水平更高,清蛋白(ALB)、血糖(GLU)、纤维蛋白原(FIB)和血小板计数(PLT)水平更低,差异有统计学意义(P<0.05).并发组易发生凝血功能障碍、低蛋白血症、急性肾损伤及低血糖等并发症,其中4例死于多脏器衰竭.结论 早期诊治及控制ALF相关并发症是改善AFLP并发ALF孕妇预后的关键措施.

在当前经济发展快速、大力推进城镇一体化以及人口老龄化日趋严重的时代背景下,深化医学教育布局、发展现代卫生职业教育是必然趋势.深化医学教育布局的途径有:适当调整专业培养结构,发展现代卫生职业教育,挖掘、调整和发挥医学教育存量资源,内涵式发展,重视人文,协同发展健康产业,结合现代教育技术等.发展现 代卫生职业教育的有益探索包括:制定适合当今社会经济需求的卫生职业教育发展规划和质量监控机制、探索卫生职业教育的具体抓点.

发热待查是指临床诊疗工作中经过常规检查和治疗后仍不能使体温恢复正常的一类疾病 ,其病因繁多 ,除常见的感染性发热外 ,还需注意一类非感染性病因. 1 临床资料 患者,女,37 岁 ,因"发热伴四肢皮疹 1 周"于2017年8月21日入本院.入院前1周 ,患者于劳累后出现发热、四肢皮疹 ,自测最高体温38 .8 ℃ ,自诉发热常于中午、下午5 :00-6 :00及夜间2 :00-3 :00 ,发热过程中伴有咽痛、畏寒、四肢肌肉酸痛乏力、皮疹 ,其中皮疹以四肢为主(图1) ,初为点状淡红色皮疹伴皮温升高、瘙痒难忍 ,之后皮疹面积逐渐扩大呈红色斑片状 ,无水疱、脱屑 ,偶有咳白色泡沫痰 ,无咯血、胸痛 ,无盗汗、呼吸困难.于当地诊所使用马来酸氯苯那敏、地塞米松、中药等治疗.

目的:调查重庆市社区老年教育的现状、存在问题、发展前景,探索社区老年教育的优化战略,为社区老年教育的发展出谋划策.方法:通过问卷调查、队列研究、定性和定量研究相结合的方法,建立重庆主城、“一圈”和“两翼”3个队列,从3个队列中各抽取2个社区(合计6个社区).对入选社区的596名社区居民进行了问卷调查,开展了3次现场调研、访谈和分组讨论,对重庆市社区老年教育的内容、需求及前景等问题进行分析.结果:重庆各地对社区老年教育的知晓率存在差异,主城略高(67.5％).居民喜好的课程主要为生活技能类(烹饪、养生保健)等,占82.72％;社区老年教育有着方便快捷、利于邻里交流等优势,但劣势在于活动场地、资金、师资有限;政策细化、资金师资丰富、社区实地联合远程教育更有利于社区老年教育的发展.结论:重庆地区社区老年教育有着广大的社会需求,细化社区老年教育章程规划、优化课程、多元化师资,社区实地融合线上远程教育,将更好地促进社区老年教育发展.

多年来 ,心肌梗死长期占据我国居民死亡病因前列 ,严重威胁人民健康[1] . 目前 ,心脏疾病的治疗手段以药物 、介入及手术治疗为主 ,因此期待有更多的措施改善患者预后 . 间歇性低氧训练(IHT)是通过采用恰当方式将受试者反复暴露于合适的低氧或低压低氧环境中 ,使其机体通过一系列的自身调节达到心脏保护的目的 . IHT主要包括间歇性低压低氧 (IHHT)和间歇性常压低氧 .IHHT 是指模拟类似高原环境 ,海拔越高 ,吸入氧浓度(FiO2 )越低 ,压力越小 . 间歇性常压低氧则仅是改变 FiO2 .

心肌梗死等缺血性疾病均可导致心肌纤维化.干细胞疗法可用于修复受损的心脏组织,促进微血管形成,减少瘢痕形成,抑制心肌纤维化.但干细胞归巢、存活、移植效率尚待提升.现总结了系列增效措施:优化干细胞(干预基因重组、预处理干细胞等)、提高靶向性、改善归巢微环境等.干细胞疗法可从"种子""播种""土壤"等环节提高干细胞的归巢、移植效率.

The department of general medicine is receiving more and more attention with the development of three-tier medical treatment system in China.It is an inevitable trend to set up a department of general medicine in tertiary hospitals in the development of general medicine.It is an important development strategy that meets our national conditions.In this article, we analyzed the current situation of general practice in China,and proposed that the department of general medicine in tertiary hospitals can provide support for developing general medicine in medical universities and a platform for continuing education and personnel training of general practitioners,and offer favorable resources for conducting general practice research.The government and hospitals should invest more in general medicine,establish a digital coverage network,improve training of general medical staff,strengthen the incentive mechanism for general practitioners,and enhance the publicity of general medical services,so as to improve the building of general practice medicine.

城乡一体化背景下,医学生兼具创新能力与应用能力是时代的需求.应用型创新人才的培养途径包括:强化临床实践教学,注重默会知识的传授,建立模拟中心,兼顾“应用”与“创新”,建设“懂创新、精应用”的教师队伍.构建质量评价体系和第三方量化评估模式是衡量应用型创新医学人才的可行万式.

Objective: To explore the relationship between serum level of high-sensitivity cardiac troponin T (hs-cTnT) and atrial ifbrillation (AF) occurrence in patients with stable coronary artery disease (CAD). <br> Methods: A total of 1011 patients with stable CAD treated in our hospital from 2013-01 to 2015-09 were retrospectively studied. According to quartiles of hs-cTnT, the patients were divided into 4 groups: Group① the patients with hs-cTnT≤7ng/L, n=283, Group② hs-cTnT 7-10ng/L,n=238, Group③ hs-cTnT 10-15ng/L,n=272 and Group④ hs-cTnT>15ng/L,n=218. The relationship between hs-cTnT level and AF occurrence rate was studied; the risk factors for AF occurrence were explored by multi stepwise Logistic regression analysis. <br> Results: There were 127/1011 (12.6%) patients combining AF and 884 (87.4%) with simple type stable CAD. AF patients had the higher serum level of hs-cTnT than non-AF patients 17.0 (12.0, 25.0) ng/L vs 10.0 (7.0, 13.0) ng/L,P<0.01. With baseline hs-cTnT level increasing, AF occurrence rates were elevated from group① to Group④ as 4.6% (13/283), 4.6% (11/238), 11.0% (30/272) and 33.5% (73/218), Ptrend<0.05. Multi stepwise Logistic regression analysis revealed that with adjusted common risk factors of age and gender, the risk for stable CAD patients suffering from AF in Group④ was 5.324&nbsp;times higher than group① (95% CI 2.285-12.405,P<0.01). <br> Conclusion: Increased serum level of hs-cTnT was closely related to AF occurrence in patients with stable CAD.

目的 设计、合成天蚕素AD(CAD)基因序列,与内含肽(Intein)融合表达后通过重组蛋白自剪切作用获得C端酰胺化的CAD,并与抗生素配伍使用. 方法 根据大肠埃希菌密码子偏好性对CAD基因序列进行改造,人工合成目的基因,构建重组质粒pCold-SUMO-CAD-Intein,转化大肠埃希菌,诱导表达重组蛋白,经镍柱亲和层析纯化,后用DTT及肠激酶切割,利用分子筛纯化获得酰胺化CAD,并进行电泳及质谱鉴定.采用微量肉汤法检测重组CAD抑菌活性及其与不同抗生素按不同比例配伍使用的抑菌活性. 结果 PCR扩增目的基因片段为132 bp,与预期一致.质谱显示表达的CAD分子质量单位为3.949 ku,与理论值相符.所得CAD抗菌肽对常见革兰阴性菌抗菌力强,配伍抗生素使用能发挥协同抑菌作用. 结论 成功构建CAD基因重组质粒pCold-SUMO-CAD-Intein,通过与内含肽(Intein)融合表达,经分子内的自剪切作用直接获得C末端酰胺化的抗菌肽,与抗生素配伍使用,能显著降低抗生素用量,具有作为抗生素替代物的应用潜力.

Objective: To explore the relationship between lower extremity atherosclerosis disease (LEAD) and cardiovascular risk factors in elder people. <br> Methods: A total of 700 consecutive patients receive lower extremity Color Doppler ultrasound in our hospital from 2013-05 to 2014-11 were investigated. The patients were divided into 3 age groups: Young and middle group, n=83, Elder group, n=377 and Senile group, n=240. Based on ultrasound scoring system, the patients were divided into 4 groups: Normal group, n=112, Mild atherosclerosis (Mild) group, n=81, Moderate group, n=466 and Severe group, n=41. The cardiovascular risk factors among different groups were compared. <br> Results: Multivariate unconditional logistic regression analysis showed that age, smoking, history of diabetes, uric acid (UA), ankle-brachial index (ABI) were the independent risk factors for LEAD (B=0.144, 1.496, 0.963, 0.004, -2.510; 95% CI: 1.120-1.190, 2.257-8.824, 1.456-4.716, 1.001-1.007, 0.012-0.534;P=0.000, 0.000, 0.001, 0.006, 0.009 respectively. Ordinal logistic regression analysis indicated that age, male gender, smoking, ABI, UA, history of hypertension were related to the severity of atherosclerosis (B=0.130, 0.737, 0.592, -3.365, 0.003, 0.735; 95% CI: 0.097-0.162, 0.222-1.252, 0.052-1.132, -4.674 to -2.055, 0.001-0.005, 0.313-1.157;P=0.000, 0.005, 0.032, 0.000, 0.005, 0.001 respectively. Compared with Young and Middle groups, Elder and Senile groups had increased rates of moderate and&nbsp;severe arteriosclerotic lesions; compared with Elder group, Senile group presented the higher incidence of moderate and severe lesions, allP<0.01. With elevated age, the severity score of LEAD increased accordingly,P<0.01. <br> Conclusion: Lower extremity atherosclerosis lesions were more severe in elder patient, and it was particularly severe in senile patients.

UNLABELLED:This study was initiated to investigate the efficacy of myocardial fibrosis intervention via signal transducer and activators of transcription (STAT) signaling using bone marrow (BM) mesenchymal stromal cells (MSC) in which being over-expressed with the aid of bispecific antibody (BiAb) and ultrasound-mediated microbubbles (MB). BiAb was prepared and combined with isolated MSC with CD47 overexpression from male mice and trans-fused into female mice with isoproterenol-induced myocardial fibrosis via the tail vein, followed by MB. This study included five groups. Five weeks after treatment, expression levels of the sex-determining region of Y-chromosome (SRY), matrix metalloproteinases (MMP)-9, tissue inhibitor of metalloproteinase (TIMP)-1 and vascular endothelial growth factor (VEGF) in myocardium were detected by fluorescent quantitative real-time polymerase chain reaction (qRT-PCR). The protein expression of signal transducer and activators of transcription (STAT) 1 and STAT 3 was detected by Western blot.RESULTS:The highest homing number of MSC was in the CD47 + MSC + BiAb + MB group, second highest in the CD47 + MSC + BiAb group, and lowest in MSC alone. Compared with the Control group, CD47 + MSC + BiAb + MB, CD47 + MSC + BiAb, CD47 + MSC and MSC groups had decreased levels of MMP-9, TIMP-1, STAT 1 and collagen deposition, and increased levels of STAT 3. Up regulated STAT 3 and down regulated TIMP-1 were significantly different in CD47 + MSC + BiAb + MB compared with CD47 + MSC or CD47 + MSC + BiAb.CONCLUSION:CD47 can enhance the homing rate and repairing efficacy of MSC. MSC can improve MMP-TIMP expression in injured myocardium and interfere with myocardial fibrosis after homing, a mechanism that may be related to the STAT-mediated signaling pathway.

目的:构建CD47重组质粒并将其转染至大鼠骨髓间充质干细胞(Bone marrow mesenchymal stem cells,BMMSCs),建立稳定过表达CD47的BMMSCs,为研究干细胞治疗中逃避免疫监视的有关机制提供实验模型.方法:构建过表达CD47基因的质粒载体,转染至分离培养的大鼠BMMSCs,RT-PCR、Western blot分别检测干细胞CD47 mRNA、蛋白水平的表达,并完成功能检测.结果:成功构建了pYr-ads-4-ratCD47质粒,经酶切、测序结果表明pYr-ads-4-ratCD47重组质粒构建成功;RT-PCR、Western blot显示实验组转染至大鼠BMMSCs后CD47的mRNA和蛋白水平表达明显增高(P＜0.05);功能检测提示过表达CD47分子的BMMSCs成功逃避巨噬细胞吞噬.结论:经质粒介导可成功将大鼠CD47目的基因片段转染至大鼠BMMSCs,并能够在体外有效的过表达.

从老年病科所收治患者的特点,探讨培养老年病科实习医师医患沟通的重要性和如何提高老年病科实习医师医患沟通技巧。让医生用爱心、耐心、责任心去理解、关爱、帮助老年患者,体现医疗服务的人文精神,促进医患关系和谐。

Objective To investigate the effects of bone marrow mesenchymal stem cells(BMSC) transplantation on angiogenesis and proliferation-apoptosis in ischemic myocardium.Methods BMSC isolated from male mice were transfused into female mice with isoproterenol-induced myocardial ischaemia via tail vein.This study included three groups: BMSC,untreated,and control groups.Five weeks after treatment,expression levels of sex-determining region of Y-chromosome(SRY) and vascular endothelial growth factor(VEGF) in myocardium were detected by fluorescent qRT-PCR.Collagen distribution was observed using sirius red staining.The protein expression of VEGF,proliferating cell nuclear antigen(PCNA) and caspase-3 was detected by immunohistochemistry.Results BMSC group had significantly higher expression of SRY(11.22±0.90 vs 1.05±0.47,P0.05).Compared with the untreated group,BMSC group had decreased levels of collagen content(3.44±0.84 vs 8.44±1.09,P0.05) and caspase-3(0.46±0.11 vs 3.12±0.28,P0.05),and increased level of VEGF(14.19±0.37 vs 11.88±0.28,P0.05) and PCNA(4.08±0.18 vs 0.64±0.05,P0.05).Conclusions BMSC can home to ischemic myocardium.BMSC transplantation improve microvascular angiogenesis and regulate the proliferation and apoptosis in ischemic myocardium.