杜茎山属植物三萜皂苷的研究进展

杜茎山属植物皂苷系该属植物富含的特性成分,其结构特点是以齐墩果烷型五环三萜为苷元基本骨架,苷元上连有各种酰基等多种取代基,且均为3β位单糖链分支四糖苷或五糖苷,具有抗病毒、抗菌、抗突变诱导、灭螺等多种生物活性和较好的潜在开发利用前景.现按化学结构、结构解析与NMR特征、生物活性等内容对杜茎山属植物三萜皂苷的研究进展进行总结.     

三唑类抗真菌药的研发进展与临床评价

目的 :介绍三唑类抗真菌药的进展和临床应用评价。方法 :通过查阅国内、外近期有关文献进行评述。结果与结论 :近年来 ,三唑类抗真菌药进展十分迅速 ,其抗菌谱广 ,杀菌活性强大 ,成为目前有关抗真菌药研究和开发的重要领域之一。     

补肾活血中药治疗血栓前状态复发性流产的研究进展

对补肾活血中药治疗血栓前状态复发性流产进行了概述,分别从调节激素水平、改善子宫内膜容受性、改善胎盘微循环、调节免疫及炎症因子水平四个方面探讨了补肾活血中药治疗血栓前状态复发性流产的作用机制,为补肾活血中药治疗复发性流产的研究进一步提供依据。      

非感染性葡萄膜炎的系统治疗进展

葡萄膜炎是发生于眼内组织的炎症反应。其中,非感染性葡萄膜炎是T细胞介导的自身免疫性炎症反应。尽管非感染性葡萄膜炎的系统治疗方案多种多样,但主要原理都是抑制自身免疫反应。在本综述中,我们回顾了非感染性葡萄膜炎系统治疗的历史,详细叙述了系统治疗的现状,总结了各治疗方案的利弊,同时对非感染性葡萄膜炎的系统治疗进行一定的展望。     

核转运蛋白KPNA2 与肿瘤关系的研究进展

KPNA2 作为核转运蛋白家族成员之一，通过核浆运输功能调节多种蛋白的核转位，而参与细胞分化、增殖凋亡、转录调节、免疫反应和病毒感染等多种生命活动。近年来研究表明KPNA2 在多种肿瘤组织中表达上调，并且KPNA2 的异常表达与患者预后差相关，提示KPNA2 在肿瘤形成和进展过程中扮演重要角色。经细胞学研究证实，KPNA2 亦参与细胞的恶性转化。因此，本文对KPNA2 的功能及在肿瘤中的研究进展进行综述。      

逍遥散治疗抑郁症的研究进展

逍遥散出自《太平惠民和剂局方》，全方由柴胡、当归、白芍、白术、茯苓、煨姜、薄荷、炙甘草组成。逍遥散作为中医调治情志活动异常的经典名方，临床实践及实验研究均证实其可用于抑郁、焦虑症及多种躯体疾病继发的抑郁状态，如逍遥散加减联合西药或其他疗法治疗妇科疾病、内科疾病、消化系统疾病等基础上伴随抑郁症发病，可明显改善患者汉密尔顿抑郁量表、抑郁自评量表等评分，疗效良好，患者依从性较高，无明显不良反应。目前逍遥散治疗抑郁症的发病机制主要集中于单胺神经递质5-羟色胺（5-HT）、去甲肾上腺素（NE）、多巴胺（DA）等，下丘脑-垂体-肾上腺轴促肾上腺皮质激素（ACTH）、皮质酮（CORT）等，免疫炎症因子水平白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）等，肠道微生态及脑肠轴食欲素、胃饥饿素、瘦素等，进而调节机体神经生化机制、内分泌机制、免疫机制和脑区结构异常等达到防治抑郁症的目的，但逍遥散抗抑郁的作用机制研究尚待进一步深入探讨。该文通过整理相关文献，对逍遥散治疗抑郁症的临床应用和基础作用机制进行了综合分析，以期为逍遥散临床防治抑郁症，提高患者生存质量提供有益的指导；同时也为逍遥散抗抑郁作用机制的深入研究，提供参考。     

Incremental Development of an Integrated Assessment Method for the Professional Curriculum

Objective. To incrementally create and embed biannual integrated knowledge and skills examinations into final examinations of the pharmacy practice courses offered in the first 3 years of the pharmacy curriculum that would account for 10% of each course’s final course grade.Design. An ad hoc integrated examination committee was formed and tasked with addressing 4 key questions. Integrated examination committees for the first, second, and third years of the curriculum were established and tasked with identifying the most pertinent skills and knowledge-based content from each required course in the curriculum, developing measurable objectives addressing the pertinent content, and creating or revising multiple-choice and performance-based questions derived from integrated examination objectives. An Integrated Examination Review Committee evaluated all test questions, objectives, and student performance on each question, and revised the objectives and questions as needed for the following year’s iteration. Eight performance objectives for the examinations were measured.Assessment. All 8 performance objectives were achieved. Sixty-four percent of the college’s faculty members participated in the integrated examination process, improving the quality of the examination. The incremental development and implementation of the examinations over a 3-year period minimized the burden on faculty time while engaging them in the process. Student understanding of expectations for knowledge and skill retention in the curriculum also improved.Conclusions. Development of biannual integrated examinations in the first 3 years of the classroom curriculum enhanced the college’s culture of assessment and addressed accreditation guidelines for formative and summative assessment of students’ knowledge and skills. The course will continue to be refined each year.     

补阳还五汤抗器官纤维化作用机制的研究进展

纤维化可发生于多种器官，是多种慢性疾病的最终结局。由于炎症导致器官实质细胞发生坏死，器官组织内成纤维细胞过度增殖，细胞外基质（ECM）过度沉积，持续进展可致器官结构破坏和功能丧失。中医药治疗纤维化具有较好疗效，临床常用益气活血类方药。补阳还五汤是益气活血的代表方剂，临床和实验研究表明补阳还五汤能够延缓肺、心、肝、肾等多器官纤维化的发展进程，作用机制包括改善脏器功能、减少ECM沉积、抗氧化应激、抗炎症反应、调节基质金属蛋白酶（MMPs）/基质金属酶组织抑制因子（TIMPs）失衡、调控转化生长因子-β（TGF-β）/Smad通路等。中医学认为，正气亏虚是纤维化发生的内在原因，瘀血是纤维化形成的重要病理因素，虚和瘀贯穿纤维化始终，纤维化器官组织微环境的改变符合气虚血瘀的病理表现，故益气活血法是治疗纤维化的基本法则。该文通过综述补阳还五汤治疗多器官纤维化的作用机制，为阐明其治疗多器官纤维化的科学内涵提供文献支持，也为进一步的临床研究奠定基础。     

腹腔镜直肠癌根治原则与保肛手术的临床研究进展

随着社会的发展与进步,公众接触理化不良因素的机会也在增加,随之产生的是消化道恶性肿瘤发病率的提高。临床上最常见的消化道恶性肿瘤包括大肠癌,其中低位直肠癌发病率在50%以上。低位直肠癌的判断依据是与肛缘有8 cm的距离;与肛缘相距5 cm的为超低位直肠癌。直肠癌研究与治疗的最终目的是提高患者生存率和部分控制恶性肿瘤。在现代医学技术不断发展的今天,人们对直肠癌也有了更加深刻的了解,主要包括生理和解剖方面以及病理学和生理学方面。由此,更加科学的治疗方式也随之产生。新兴的治疗方式主要有腹腔镜与保肛手术治疗术。     

Promoting Responsible Electronic Documentation: Validity Evidence for a Checklist to Assess Progress Notes in the Electronic Health Record

Construct: We aimed to develop an instrument to measure the quality of inpatient electronic health record– (EHR–) generated progress notes without requiring raters to review the detailed chart or know the patient. Background: Notes written in EHRs have generated criticism for being unnecessarily long and redundant, perpetuating inaccuracy and obscuring providers' clinical reasoning. Available assessment tools either focus on outpatient progress notes or require chart review by raters to develop familiarity with the patient. Approach: We used medical literature, local expert review, and attending focus groups to develop and refine an instrument to evaluate inpatient progress notes. We measured interrater reliability and scored the selected-response elements of the checklist for a sample of 100 progress notes written by PGY-1 trainees on the general medicine service. Results: We developed an instrument with 18 selected-response items and four open-ended items to measure the quality of inpatient progress notes written in the EHR. The mean Cohen's kappa coefficient demonstrated good agreement at .67. The mean note score was 66.9% of maximum possible points (SD = 10.6, range = 34.4%–93.3%). Conclusions: We present validity evidence in the domains of content, internal structure, and response process for a new checklist for rating inpatient progress notes. The scored checklist can be completed in approximately 7 minutes by a rater who is not familiar with the patient and can be done without extensive chart review. We further demonstrate that trainee notes show substantial room for improvement.