目的 了解陕南贫困县镇安县乡村医生(简称乡医)任职现状和对继续教育培训需求情况,为后续的精准扶贫进行针对性培训政策制定、培训方案优化,以及培训课程内容、方法设计和途径安排提供依据.方法 运用自制调查问卷于2019年3月20日至4月10日对陕南镇安县乡医229人进行问卷调查,了解乡医个人情况及任职情况、既往继续教育培训情况和需求.结果 男性乡医偏多,年龄偏长、学历、职称偏低,拥有医师(助理)执业证者偏少、收入偏低.89.1％的乡医都已接受过培训.在培训内容、培训方式、地点和师资等方面,乡医对培训的需求和经历过的培训之间仍有一定的差距.结论 建议政府建立健全乡医培训的法律法规;主管部门指导完善以需求为导向的培训机制、统一培训标准、优化培训方案和方法;加强培训过程管理及考核制度建设;关注培训基地、建立乡医培训师资库;推广远程培训,形成线上、线下融合方式,真正提高培训的效能.

非酒精性脂肪性肝病(NAFLD)是2型糖尿病(T2DM)的常见并发症,可进展为肝硬化甚至相关性肝癌.然而目前尚缺乏有效的药物治疗.钠-葡萄糖协同转运蛋白2抑制剂(SGLT-2i)作为一种新批准的口服降血糖药,可有效降低血糖.同时,SGLT-2i尚可从改善脂质堆积,改善胰岛素抵抗,抗炎、抗氧化应激,延缓肝纤维化程度,延缓肝细胞癌进展等方面改善NAFLD.同时,可在减轻高糖毒性、减轻体质量、改善肝功能障碍、降低血尿酸等方面对NAFLD起到预防作用.从T2 DM合并NAFLD的现状、SGLT-2 i的作用机制、SGLT-2 i对T2 DM合并NAFLD的预防及安全性方面进行了阐述.

成纤维细胞生长因子23(FGF23)是骨细胞和骨原细胞分泌产生的一种激素样调磷因子,在肾脏及甲状旁腺中调节磷酸盐稳态和维生素D代谢.近年来发现FGF23对心血管疾病的发生发展及其预后有重要意义,有望成为心血管疾病防治的新靶点,本文就FGF23在心血管疾病的作用机制做一综述.

Objective To investigate the effects of the increase of intracellular free calcium on afferent discharges of isolated soleus muscle spindle in rats.Methods Twelve rats were randomly divided into three groups:the 2.0ion group,the 5.0ion group,and the dimethyl sulfoxide(DMSO) group.The isolated soleus muscle spindle of rats in 3 groups were separated.After incubation with 2μmol/L ionomycin in 2.0ion group and 5 μmol/L ionomycin in 5.0ion group respectively,the changes of free calcium concentration in soleus muscle spindle were observed by laser scanning confocal microscopy.The air-gap technique was used to observe the afferent discharge activities of rats' isolated soleus muscle spindle,and the changes of the afferent discharge activities in 3 groups were observed after treated with DMSO,2μmol/L,or 5 μmol/L Ionomycin respectively.Results Ionomycin (2 and 5 μmol/L) could significantly increase the level of resting calcium in intrafusal muscle of rats' soleus muscle,and the effect was concentration dependent (P＜0.01).Ionomycin (2 and 5 μmol/L) could significantly reduce the afferent discharges of single muscle spindle of soleus muscle (P＜0.05).5 μmol/L ionomycin could prolong the periodic interval of spontaneous discharge of single muscle spindle (P ＜ 0.05),and there was no significant changes on evoked discharges of muscle spindle after the adding of Succinylcholine chloride(Sch) with concentration of 50 mg/L.Conclusion Increased free calcium concentration in rat soleus muscle spindle can inhibit afferent discharges of muscle spindle.

炎症性肠病(IBD)是一类具有终生复发倾向的肠道慢性炎症性疾病,需要长期用药,且费用昂贵.本文结合最新IBD的治疗与管理研究进展,从几个关键点出发,涉及IBD的5-氨基水杨酸(5-ASA)的优化治疗方案、生物制剂与免疫调节治疗方案、心理治疗方案、肠道菌群治疗方案、以及IBD管理中的5S原则,旨在增强基层医师对IBD的认识,提高基层医师对IBD的治疗与管理水平.

ObjectiveTo investigate whether glucocorticoids, anti-tumor necrosis factor (anti-TNF) drugs, and a past history of surgical treatment of inflammatory bowel disease (IBD) are the risk factors for the coexistence of IBD and nonalcoholic fatty liver disease (NAFLD). MethodsPubMed, Embase, Cochrane Library, Wanfang Data, CNKI, and VIP were searched for clinical trials of the coexistence of IBD and NAFLD published up to October 2018. The articles included were summarized and quality assessment was performed according to inclusion and exclusion criteria. RevMan 5.2 was used for data processing; the random effects model was used for data with heterogeneity, and the fixed effect model was used for data with homogeneity. ResultsA total of 7 articles were included, with 1645 patients. The meta-analysis showed that glucocorticoids might not be a risk factor for the coexistence of IBD and NAFLD (odds ratio (OR)=1.19, 95% confidence interval (CI): 0.90-1.57, P=0.23); anti-TNF drugs were not a risk factor for the coexistence of IBD and NAFLD (OR = 0.86, 95%CI: 0.65-1.13, P=0.27); a past history of surgical treatment of IBD was a risk factor for the coexistence of IBD and NAFLD (OR=1.50, 95%CI: 1.09-2.05, P=0.01). ConclusionGlucocorticoids and anti-TNF drugs for the treatment of IBD may not increase the incidence rate of the coexistence of IBD and NAFLD, while surgical treatment for IBD may increase this incidence rate.

实验观察了后肢制动一周大鼠离体单一比目鱼肌肌梭自发放电和由氯化琥珀胆碱(Succinylcholine chloride,Sch)所致的诱发放电的变化,并观测了三磷酸腺苷对肌梭传入放电的影响.实验采用空气隔绝法记录离体单一肌梭电生理活动,分别给予3种浓度(1、2和3 mg/kg)的三磷酸腺苷灌流肌梭,并记录其自发放电和氯化琥珀胆碱所致的诱发放电的情况.结果显示,后肢制动7 d大鼠比目鱼肌离体单一肌梭自发放电较正常明显减少(P<0.05),氯化琥珀胆碱所致的诱发放电未见明显增多,给予1 mg/kg三磷酸腺苷灌流肌梭后,肌梭自发及诱发放电未见明显改变,给予2和3 mg/kg三磷酸腺苷灌流其自发放电明显增加(P<0.05),诱发放电仅在给予3 mg/kg的三磷酸腺苷灌流肌梭后明显增加(P<0.05).提示三磷酸腺苷可提高后肢制动大鼠离体单一肌梭自发及诱发放电,起到对抗肌萎缩的作用.研究为大鼠肌梭生理的研究及废用性肌萎缩的实验研究提供了有意义的资料.

采用激光扫描共聚焦显微镜技术,观察大鼠后肢制动一周比目鱼肌梭内肌细胞内静息Ca2+的变化,并以Na2 ATP作为对抗措施,观察其对后肢制动大鼠梭内肌细胞Ca2+的影响.结果显示后肢制动一周,大鼠比目鱼肌梭内肌细胞Ca2+浓度明显升高,而经Na2 ATP注射后,大鼠后肢制动一周梭内肌细胞Ca2+浓度升高不明显.提示Na2 ATP可对抗后肢制动所致的梭内肌细胞钙超载.为大鼠肌梭生理的研究及钙离子与废用性肌萎缩的实验研究提供了有意义的资料.

[Objective]To investigate the signing rate and influencing factors of contracted service of family physicians in Xi'an City, provide scientific basis for raising the contract rate. [Methods] A cluster sampling method was used to extract 1 200 residents from five community health service centers in Xi'an City. The questionnaire, self-made "Xi'an family doctor contracted service status questionnaire", was used to investigate the contract rate, and the multi-factor logistic regression analysis was used to analyze the factors affecting the contract rate. [Results] The study results showed that 499 respondents knew the Xi'an family physicians contracted service model, with the awareness rate of 44.32％. The residents over 60 years old (66.96％) and residents of undergraduate and above (78.57％ ) had the highest awareness rate, while residents with chronic disease (66.99％ ) and residents with a closer distance (66.96％) had the higher awareness rate. Multivariate logistic regression analysis showed that the age (OR=1.128), chronic disease (OR=2.231), awareness rate of family physician contracted service (OR=2.109), diagnosis and treatment level of community health service institution (OR=1.973), medical facilities in community health service institution (OR=1.423) and family physician service model diagnosis and treatment process (OR=1.980) were the influencing factors of contract rate of family physician contracted service. The higher the age (the elderly), patients with chronic diseases, higher the awareness rate, higher satisfaction with the level of medical treatment, higher satisfaction with medical facilities, the higher the signing rate. [Conclusion] The signing rate of contracted service of family physician is still relatively low in Xi'an City, mainly due to the low awareness rate of family physician contracted service mode, and low satisfaction with medical treatment level, medical facilities and treatment process. It is suggested that the relevant health departments should increase publicity, improve the level of diagnosis and treatment of community health service personnel, improve the medical facilities of community health service institutions, and improve the diagnosis and treatment process of the family physician service model.

非酒精性脂肪性肝病(NAFLD)是一种影响约1／4普通人群的疾病,已成为我国及西方国家第一大慢性肝病,造成了巨大的医疗和经济负担.炎症性肠病(IBD)患者中,NAFLD的患病率估计高达40%,包括溃疡性结肠炎和克罗恩病.主要介绍IBD患者中合并NAFLD的现状与经济负担、危险因素评估,并对该类疾病进行总结与展望,以期为未来该领域的进一步研究奠定基础.

目的 通过前期的调研及文献检索发现,西安市社区医生乃至全国专科医生对小儿上呼吸道感染(简称“上感”)的诊疗存在认识不足,导致治疗上的盲目性,存在重复用药、不恰当联合用药和过多使用抗病毒、抗生素等诸多问题,使得部分社区医院未能完全承担起小儿上感的首诊之责.现有的小儿上感诊疗流程都是针对儿科专科医生,缺乏完全适宜全科医生使用的规范流程.为了提升全科医生的能力,迫切需要适宜于全科医生使用的小儿上感诊疗流程.本研究目的是总结出适合社区全科医生使用的小儿上感诊疗及管理流程,引导社区全科医生规范诊疗小儿上感.方法 经检索多个数据库及相关文献,共收集、筛选出最新国内外小儿上感诊疗指南、规范或专家共识7个,从全科医生岗位实际出发,就小儿上感诊断标准、鉴别诊断、治疗原则、合理用药4个维度进行逐个对比、分析和归纳.结果 总结出适宜社区全科医生使用的小儿上感诊断和治疗、管理流程各1个.结论 按照该流程社区全科医生应对首诊上感患儿进行全面评估,根据上感不同类型及病情给予适当治疗.如在急性期以病情观察和对症治疗为主,仅在有指征时才能使用抗生素,流感患儿应尽早用抗病毒药物.

Ca2+触发了肌肉的收缩,参与肌细胞活动的调节,钙稳态的维持对肌肉收缩功能具有重要作用.模拟失重条件下肌细胞钙稳态失衡与肌球蛋白表型的转换及骨骼肌收缩功能减弱关系密切.针对钙稳态的维持及模拟失重条件下的钙稳态失衡与肌萎缩的关系及其可能的机制进行了综述.

Objective To clone and construct the plasmid containing human thyroid stimulating hormone receptor(TSHR) gene ectodomain,and then identify the immunoreactivity of the purified recombinant protein.Methods TSHR total RNA was extracted from human thyroid,and cDNA was obtained with RT-PCR technique.Human TSHR ectodomain gene(hETSHR) was cloned into pcDNA3.1(+) vector.The recombined construct was transfected into CHO cells by Lipofectin 2000.The transcript mRNA was detected by RT-PCR,and protein immunoreactivity was assayed by TSHR antibody with immunocytochemistry staining and Western blot.Results DNA sequencing results showed that the recombinant of human thyrotropin receptor ectodomain had confirmed sequence reported in GenBank.The fusion protein had the immunoreactivity.Conclusion Human thyroid stimulating hormone receptor was successfully cloned in eukaryotic expression vector and the constructor was expressed in eukaryotic cells very well.