孕前超重及肥胖女性孕中期子宫-胎盘血流动力学的变化

目的探讨孕前超重及肥胖女性孕中期子宫-胎盘血流动力学及胎儿生长发育指标的变化。 方法回顾性选取2019年6月至2020年9月在唐都医院进行产前检查并行胎儿超声心动图检查的孕妇127例。依据孕前体质量指数（BMI）将孕妇分为正常对照组55例、超重组45例和肥胖组27例。对3组孕妇的一般资料、子宫-胎盘血流、胎儿生物学测量指标和大脑中动脉、脐动脉血流进行比较分析。 结果与正常组孕妇相比，超重组及肥胖组孕妇双侧子宫动脉收缩期峰值血流速度（Vs）、舒张期峰值血流速度（Vd）及搏动指数（PI）均升高，3组比较差异均有统计学意义（P均＜0.05），其中肥胖组孕妇双侧子宫动脉PI较超重组升高（P均＜0.05）。与正常组比较，肥胖组和超重组胎儿脐动脉游离段血流速度不同程度减低，3组比较差异均有统计学意义（Vs：F值=4.41，P=0.01；Vd：F值=4.03，P=0.02）；进一步两两比较，超重组与正常组Vd比较，差异有统计学意义（P＜0.05）；肥胖组与正常组Vs比较，差异有统计学意义（P＜0.05）。 结论孕前超重及肥胖女性孕中期子宫-胎盘循环血流动力学已经出现明显改变，应用超声实时监测这些参数变化对指导临床合理控制孕期体重，避免或减少相关并发症有潜在价值。     

基于网络药理学和生物信息学研究苍附导痰丸治疗多囊卵巢综合征的分子机制＊

目的 探讨苍附导痰丸治疗多囊卵巢综合征（Polycystic ovary syndrome，PCOS）的潜在机制。方法 通过检索中药系统药理学数据库和分析平台（Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform，TCMSP）中苍附导痰丸组成药物的成分数据，筛选其有效成分和作用靶点；检索Drug Bank、GeneCards、OMIM、PharmGKB及Uniprot疾病数据库中PCOS相关靶点；检索GEO数据库，选择多囊卵巢综合征的差异表达基因。构建苍附导痰丸和PCOS成分、靶点间的相互关系网络，利用筛选出的关键靶点，构建蛋白互作（Protein-protein interaction，PPI）网络；在GO功能和KEGG信号通路富集的基础上，得出苍附导痰丸治疗PCOS的作用机制，进一步用分子对接技术验证靶点之间结合的可靠性。结果 共筛选出活性成分单体46个，159个苍附导痰丸治疗PCOS的共同靶点。结论 苍附导痰丸治疗PCOS具有多成分、多靶点、多通路的特点，推测苍附导痰丸可能通过调节炎症微环境从而改善肥胖型PCOS患者胰岛素抵抗，通过调节雌激素信号通路改善卵巢功能，因而可以改善肥胖及卵巢排卵的临床症状，为后期研究苍附导痰丸治疗PCOS的作用机制提供了新的理论支撑。     

Establishment of nomograms for the prediction of useful hearing loss in patients with neurofibromatosis type 2

Journal of Neuro-Oncology - Treatment for vestibular schwannoma (VS) in patients with neurofibromatosis type 2 (NF2) is extremely challenging due to the high risk of hearing loss. The aim of this...     

Electroacupuncture improves learning and memory functions in a rat cerebral ischemia/reperfusion injury model through PI3K/Akt signaling pathway activation

Electroacupuncture has been widely used to treat cognitive impairment after cerebral ischemia, but the underlying mechanism has not yet been fully elucidated. Studies have shown that autophagy plays an important role in the formation and development of cognitive impairment, and the phosphoinositide 3-kinase(PI3 K)/Akt signaling pathway plays an important role in autophagy regulation. To investigate the role played by the PI3 K/Akt signaling pathway in the electroacupuncture treatment of cerebral ischemia/reperfusion rat models, we first established a rat model of cerebral ischemia/reperfusion through the occlusion of the middle cerebral artery using the suture method. Starting at 2 hours after modeling, electroacupuncture was delivered at the Shenting(GV24) and Baihui(GV20) acupoints, with a dilatational wave(1–20 Hz frequency, 2 mA intensity, 6 V peak voltage), for 30 minutes/day over 8 consecutive days. Our results showed that electroacupuncture reduced the infarct volume in a rat model of cerebral ischemia/reperfusion injury, increased the mRNA expression levels of the PI3 K/Akt signaling pathwayrelated factors Beclin-1, mammalian target of rapamycin(mTOR), and PI3 K, increased the protein expression levels of phosphorylated Akt, Beclin-1, PI3 K, and mTOR in the ischemic cerebral cortex, and simultaneously reduced p53 mRNA and protein expression levels. In the Morris water maze test, the latency to find the hidden platform was significantly shortened among rats subjected to electroacupuncture stimulation compared with rats without electroacupuncture stimulation. In the spatial probe test, the number of times that a rat crossed the target quadrant was increased in rats subjected to electroacupuncture stimulation compared with rats without electroacupuncture stimulation. Electroacupuncture stimulation applied to the Shenting(GV24) and Baihui(GV20) acupoints activated the PI3 K/Akt signaling pathway and improved rat learning and memory impairment. This study was approved by the Animal Ethics Committee of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, China(approval No. 8150150901) on March 10, 2016.     

我国高等医学院校医学人才培养体制现状调查与分析

目的  为了遵循医学人才培养规律，规范医学人才培养体制，提高医学人才培养质量，探索符合我国实际需求的医学人才培养模式。方法  采用问卷调查法对全国140所高等医学院校进行调查，并对相关调查结果进行分析。结果  ①86.96%的高校对统一规范为“5+3”一体化为主体，同时参加住院医师规范化培训，毕业合格者授予医学博士（MD）学位表示赞成。②76.80%的高校对将“5+3”一体化作为培养全科医生主要渠道的医学博士培养体系表示赞成。③90.40%的高校对通过“5+3+X”一贯制培养授予MD+PhD项目，培养复合型高水平临床医学人才表示赞成。④84.80%的高校对医学学位授予与专科医师规范化培训相脱离，后者应纳入职业培训范畴表示赞成。结论  全面推进落实“5+3”为主体的高素质临床医学相关人才培养模式，将培养目标定位为以满足社会需求的高水平全科医生为主体，加快高层次复合型医学人才的培养体系建设。     

课程思政视域下医学人文教育的途径与尝试

“课程思政”作为新时代背景下的综合教育理念和德育工作指导方针，为立德树人指引了正确方向。中国医学教育是为党和国家培育合格医学人才，为人民群众培养健康守护者，如此的国家社会需求离不开对医学生人文思政素质的着力培养。因此，从课程思政视野出发，以深圳大学医学部为具体案例，在专业课程设计、特色社会实践两个维度上探析融入思想政治元素的医学人文教育的路径选择与现实尝试。     

Medial sustainable nail versus proximal femoral nail antirotation in treating AO/OTA 31-A2.3 fractures: Finite element analysis and biomechanical evaluation

Objectives

Using finite element analysis and biomechanical tests, the biomechanical behaviors of Medial Sustainable Nail (MSN) and Proximal Femoral Nail Antirotation (PFNA) were compared for the fixation of fracture type of AO/OTA 31-A2.3.