汕头大学医学院“医者之心”（HEART）医学人文教育模式与实践——以“医学生公益种子培育计划”为视角

目的  医学人文教育是医学生教育的必然要求，然而长期以来存在重理论、轻实践的弊端，导致医学生在医学人文教育的培养方面受限。汕头大学医学院发展出基于“医者之心”（HEART）社会实践课程及其课程外可选修的扩展性内容，并取得了一定成效。在“医者之心”（HEART）课程中，作为该课程的扩展性选修内容，汕头大学医学院学生参加“广东省医学生公益种子培育计划”，开展医疗公益实践活动。方法  对875名参与公益种子活动的医学生进行完成医疗公益实践活动后的问卷调查，并以描述性分析、对比分析等方式进行分析。结果  医学生对实践性医学教育模式有较大的认同感，并在活动中提升社会责任感和医德感知水平，同时服务到社区居民。结论  基于“医者之心”（HEART）教育模式与教育理念，通过医疗公益服务学习来进行医学人文教育，取得一定成效。     

Prospective case‐control study of enterovirus detection differences in children’s cerebrospinal fluid between multiplex PCR and real‐time RT‐PCR assay

BackgroundViral encephalitis is common in childhood. It is an acute brain parenchymal inflammation caused by a variety of viral infection, and enterovirus accounts for the majority. Due to atypical clinical manifestations, pathogenic testing is important for assisting clinical diagnosis. The purpose of this study was to evaluate the performance of the multiplex PCR assay compared with quantitative real‐time PCR for enterovirus detection.MethodsA prospective case‐control study was performed involving 103 pediatric patients suspected for viral encephalitis and cerebrospinal fluid (CSF) samples were collected and tested for 9 pathogens using multiplex PCR assay during April to November in 2018. In parallel, an aliquot of samples was tested for enterovirus infection by real‐time PCR assay.ResultsThere were 85.4% children were confirmed as viral encephalitis on discharge, the remaining ones were diagnosed as other CNS diseases, such as epilepsy. The specificity of the two methods was the same as that of the clinical diagnosis, but the sensitivity and consistency with clinical diagnosis of multiplex PCR were both higher than the real‐time PCR. Besides of enterovirus, multiplex PCR could also detect coinfection of enterovirus with Epstein‐Barr virus and mumps virus.ConclusionResults of multiplex PCR method are more consistent with the clinical diagnosis and are superior to real‐time PCR for detecting enterovirus in CSF.     

基于网络药理学中药复方“三药三方”治疗新冠肺炎的分期治疗分析＊

目的 本研究探究中药复方“三药三方”在新冠肺炎治疗发挥药理作用的多成分、多靶点和多通路的分子机理以及复方药味归经的中医联系，探究“三药三方”药理作用的异同。方法 通过ETCM数据库获取“三药三方”的成分、靶点、药味归经，用STRING数据库进行蛋白互作网络构建，用DAVID和Metascape数据库进行靶标功能富集分析，利用Cytoscape软件构建和分析可视化网络图。结果 “三药三方”多重点作用于脾经和肺经，初期和中期复方重点作用于肺经和胃经，重症期复方重点作用于肝经和心经，通用方的温性药比例最大，初期和中期复方寒性药比例最大，“三药三方”药味均以苦味、辛味、甘味为主。共同化合物中Alexandrin（胡萝卜甙）与Nsp（N7-MTase）（非结构蛋白C端鸟嘌呤-N7甲基转移酶），Oleanolic Acid（齐墩果酸）与E protein（ion channel）（包膜小膜蛋白）有良好结合力。复方调控共同之处：包含共同子模块γ-氨基丁酸受体亚基相互作用以及细胞色素、ATP依赖转位酶和核受体的相互作用，参与调控16条生物通路涉及①神经保护作用；②免疫调节以及抗炎症风暴调节；③内分泌调节以及性激素调控；④能量代谢调控；⑤药物代谢；⑥其他通路。不同之处：“三药三方”也存在各自特异调控的通路，金花清感颗粒和莲花清瘟胶囊参与ACE2相关通路Renin-angiotensin system（肾素-血管紧张素系统）的调节，同时6种复方有各自的子模块相互作用蛋白。结论 “三药三方”在治疗新冠病毒体现辨证论治、治病求因、正气存内、已病防变的中医治疗原则，并且通过网络药理学初步揭示“三药三方”功能调控以及异同之处，阐述“三药三方”通过多成分-多靶点-多通路的综合调控之间的异同关系。     

重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白联合糖皮质激素治疗急性泛发性发疹性脓疱病一例

患者女，64岁，因全身红斑脓疱半月余于2017年10月20日至我科就诊。患者3个月前于外院诊断为抗中性粒细胞胞质抗体相关性血管炎，口服泼尼松片40 mg/d治疗。1个月前因四肢关节疼痛口服硫酸羟氯喹片0.2 g/d，治疗10 d后前胸、后背出现散在分布的红色斑疹，伴剧烈瘙痒……     

Impact of the COVID-19 pandemic on the hospital attendance of patients with primary cervical cancer in Heilongjiang,China

Information regarding the impact of the coronavirus disease 2019 (COVID-19) pandemic on cervical cancer in mainland China is lacking. We explored its impact on the hospital attendance of patients with primary cervical cancer. We included 1918 patients with primary cervical cancer who initially attended Harbin Medical University Cancer Hospital between January 23, 2019, and January 23, 2021. Attendance decreased by 31%, from 1135 in 2019 to 783 in 2020, mainly from January to June (𝜒² = 73.362, P < .001). The percentage of patients detected by screening decreased from 12.1% in January-June 2019 to 5.8% in January-June 2020 (𝜒² = 7.187, P = .007). Patients with stage I accounted for 28.4% in 2020 significantly lower than 36.6% in 2019 (𝜒² = 14.085, P < .001), and patients with stage III accounted for 27.1% in 2020 significantly higher than 20.5% in 2019 (𝜒² = 11.145, P < .001). Waiting time for treatment was extended from 8 days (median) in January-June and July-December 2019 to 16 days in January-June (𝜒² = 74.674, P < .001) and 12 days in July-December 2020 (𝜒² = 37.916, P < .001). Of the 179 patients who delayed treatment, 164 (91.6%) were for the reasons of the healthcare providers. Compared to 2019, the number of patients in Harbin or non-Harbin in Heilongjiang Province and outside the province decreased, and cross-regional medical treatment has been hindered. The COVID-19 pandemic has negatively impacted cervical cancer patient attendance at the initial phase. These results are solid evidence that a strategy and mechanism for the effective attendance of cervical cancer patients in response to public health emergencies is urgently needed.     

非梗阻性无精子症患者的生育生活质量及影响因素调查

目的 了解非梗阻性无精子症患者的生育生活质量现状及其影响因素。 方法 选取生殖中心就诊的311例非梗阻性无精子症患者，采用一般情况问卷、简明中文版生育生活质量量表及社会支持评定量表进行横断面问卷调查。 结果 非梗阻性无精子症患者生育生活质量得分为（65.55±13.52）分。回归分析显示，不育年限、家庭年收入、接受辅助生殖技术治疗次数和社会支持为非梗阻性无精子症患者生育生活质量的影响因素，可解释总变异的35.4%。 结论 非梗阻性无精子症患者生育生活质量较低，医护人员应重点关注不育年限长、家庭收入低、接受辅助生殖技术治疗次数多及社会支持水平低者，采取针对性干预措施提高其生活质量。     

激素敏感型原发性肾病综合征患儿激素治疗巩固维持阶段不同减量方案比较

目的探讨激素敏感型原发性肾病综合征(PNS)患儿激素治疗巩固维持阶段不同减量方案对疾病复发率的影响。 方法选择2017年6月至2020年6月，在中山大学附属第一医院确诊的41例初治PNS患儿为研究对象，均对激素治疗敏感。根据激素治疗巩固维持阶段采用的不同减量方案，将其分为每日顿服组(n＝22)和隔日顿服组(n＝19)。本研究41例激素敏感型PNS患儿中，男性患儿为29例，女性为12例，男、女比例为2.4∶1，确诊时年龄为1.3~14.6岁。采取回顾性分析法对2组患儿一般临床资料、实验室检查结果进行分析。同时分析2组患儿PNS首次治疗复发时间、复发率、频复发率、加用免疫抑制剂治疗率，以及激素相关不良反应发生情况。本研究遵循的程序符合中山大学附属第一医院伦理委员会规定，通过该伦理委员会审查，并获得批准(审批文号：伦审〔2022〕334号)。 结果①2组患儿发病年龄、性别构成比、PNS临床分型构成比比较，差异均无统计学意义(P>0.05)。②2组患儿初治时24 h尿蛋白定量、血清白蛋白、血清胆固醇、血清肌酐、估算的肾小球过滤率(eGFR)、免疫球蛋白(Ig)G、补体C3水平，以及足量激素疗程及变态反应性疾病占比、肾功能不全占比比较，差异均无统计学意义(P>0.05)。2组患儿初治时血清IgE水平比较，差异有统计学意义(χ²＝－2.153，P＝0.031)。③本研究41例PNS患儿中，距初始治疗3、6、12个月时复发率分别为12.2%(5/41)、31.7%(13/41)、53.7%(22/41)。与隔日顿服组相比，距初始治疗时12个月内，每日顿服组患儿首次复发时间明显延长(χ²＝4.973，P＝0.026)。距初始治疗3、6个月时，每日顿服组患儿的复发率明显低于隔日顿服组，并且差异均有统计学意义(P<0.05)；距初始治疗12个月时复发率，也低于隔日顿服组[40.9%(9/22) vs 68.4%(13/19)]，但是2组比较，差异无统计学意义(P>0.05)。这41例PNS患儿中，60.7%患儿复发有明确诱因(感染或激素减量/停药)，对其采取控制感染和(或)激素加量/再次使用足量激素治疗后，尿蛋白检查结果均在4周内转阴。每日顿服组患儿激素相关性眼损害发生率高于隔日顿服组，但是差异无统计学意义(22.7% vs 5.3%，P＝0.257)。 结论激素敏感型PNS患儿预后良好，复发率高，巩固维持阶段采用每日顿服方案可延长复发时间，降低中期复发率。治疗期间需定期监测患儿眼压，早发现、早治疗糖皮质激素相关性眼损害。     

Prevalence of human papillomavirus in esophageal carcinoma in Tangshan,China

AIM:to study the prevalence of human papillomavirus(HPV) in esophageal carcinoma in tangshan,China,a high-incidence area.METHODS:Formalin-fixed,paraffin-embedded tissue specimens from 198 patients who were pathologically diagnosed with esophageal squamous cell carcinoma from 2011 to 2013 were obtained from a pathology department in Tangshan.DNA was extracted from all198 specimens to detect HPV by polymerase chain reaction(PCR).β-globin PCR was performed to check the quality of the DNA extraction procedure.PCR was performed to detect a wide range of HPV types,and type-specific PCR was performed to detect HPV types16 and 18.Negative and positive controls were used for HPV 16 and 18 detection.RESULTS:the DNA extraction method in this study appeared to be more effective than other previously reported methods.After DNA extraction,more than98%of the tissue specimens had an acceptable result in the DNA qualification test(β-globin PCR).the overall prevalence of HPV in tumor tissues by GP6+/GP5+PCR was 79.79%,and the prevalence of HPV types16 and 18 was 40.40%and 47.47%,respectively.PCR demonstrated the presence of HPV,and direct sequencing confirmed the HPV genotypes.All HPVpositive PCR products were checked by DNA sequence analysis using DNAman and compared with the known HPV sequences listed in the basic Local Alignment Search tool database to evaluate the HPV types.this analysis confirmed the presence of HPV types 16 and18.CONCLUSION:DNA of high-risk HPV types 16 and 18is present in esophageal tumors,implicating HPV as a possible etiologic factor for esophageal squamous cell carcinoma.