基于OBE质量控制理念探讨在线教学中的教学督导

在线教学中的教学督导对保证“线上”“线下”教学实质等效有着重要意义，而相较于常规线下督导其又具有其特殊性。上海交通大学医学院依托在长期实践中不断完善的督导体系，基于以提高学生学习效果为目标成果导向教学理念（outcomes-based education，OBE）的质量控制，制定在线教学督导方案。该方案包括专家督导全覆盖、学生反馈渠道畅通、管理督导沟通解决等内容，并在实践中检验在线教学督导对学生学习效果的作用。通过对督导专家和学生的问卷调查，反映在线教学的效果，结果表明在线教学专家督导满意度较高，学生学习效果较好，说明在线教学督导方案在教学中发挥了积极作用。     

医教协同背景下临床教学改革中教师团队激励发展的探索与实践

在医教协同背景下统筹推进医学教育改革，教师队伍的可持续发展是关键。上海交通大学医学院在上海市骨干教师教学激励计划支持下，建立与医学整合课程相对应的跨学科、跨院系的本科教学团队，在全国率先打通器官系统整合式教学改革成果全面落实的“最后一公里”。同时，改革按学时计酬的绩效制度，出台与各环节相对应的规章制度，健全督导机制，夯实医教协同机制，促进了教师共同体发展，全面提升了医学教育质量。     

溃疡性结肠炎患者中肿瘤坏死因子相关凋亡诱导配体基因多态性及单倍型分析

目的 探讨肿瘤坏死因子相关凋亡诱导配体(Trail)基因多态性及单倍型与溃疡性结肠炎(UC)的关系.方法 收集UC患者331例,健康对照者832名,PCR扩增Trail目的基因后,直接测序检测Trail基因3非编码区(G1525A/G1588A/C1595T)三种单核苷酸多态性,并分析Trail单倍型与UC的关系.结果 与对照组相比较,Trail G1525A突变等位基因A和基因型GA+ AA的频率在UC组中明显降低(P值均＜0.01);UC组Trail G1588A和C1595T两位点突变等位基因A和T的频率明显低于对照组,且差异有统计学意义(P值均＜0.01).轻和中度UC患者Trail C1595T突变等位基因T和CT+ TT基因型频率为49.15％和64.51％,重度UC患者分别为72.37％和84.21％,两组比较差异均有统计学意义(OR值分别=2.710和2.935,95％CI:1.598～4.596和1.188～7.249,P值均＜0.05).重度UC患者Trail G1525A突变等位基因A的频率为48.69％,较轻和中度UC患者(35.16％)增加(OR=1.750,95％CI:1.082～2.830,P=0.021).UC组中AAT单倍型频率显著低于对照组(43.09％比58.41％,95％CI:1.549～2.229,P＜0.01);GAT单倍型频率在UC组中明显增高(10.15％比0.18％,95％CI:0.005～0.051,P＜0.01).结论 Trail基因多态性及单倍型与UC易感性密切相关.     

SEC1基因敲除对实验性结肠炎小鼠严重程度和肠道菌群的影响

目的 探讨一种小鼠α-(1,2)-岩藻糖基转移酶SEC1基因敲除(SEC1-/-)对葡聚糖硫酸钠(dextran sulphate sodium,DSS)诱导的结肠炎小鼠中结肠炎症和肠道菌群的影响。方法 采用CRISPR/Cas9技术构建SEC1-/-C57BL/6小鼠,通过连续口服3%葡聚糖硫酸钠5天构建实验性结肠炎模型,设置SEC1-/-结肠炎组(14只)、野生型结肠炎组(15只)和野生型对照组(6只)共3组。通过疾病活动度评分和体质量变化评估结肠炎严重程度,收集小鼠升结肠内粪便样本,采用高通量16s-rDNA测序技术检测粪便菌群组分,通过生物信息分析比较肠道菌群组分的差异。组间比较采用方差分析、独立样本t检验或秩和检验。结果饮用DSS第7天,与野生型结肠炎组比较,SEC1-/-结肠炎小鼠体质量显著下降(77.9%±4.7% vs 87.0%±6.2%,P<0.05),而疾病活动指数显著升高(7.3±2.8 vs 9.4±2.6,P <0.05)。野生型结肠炎小鼠Simpson指数显著低于对照组小鼠(0.83 vs 0.91,P<0.05),但两组小鼠肠道菌群OTU个数、Shannon和chao1指数比较,差异均无统计学意义(P均>0.05)。与野生型结肠炎组比较,SEC1-/-结肠炎组肠道菌群的OTU个数显著增多(305 vs 194,P<0.05),Shannon和chao1指数均显著增加(4.71 vs 4.09;332 vs 207;P均<0.05),乳酸杆菌属(28.95 vs 2.23)、梭菌属(0.13 vs 0.01)和糖单胞菌属(1.82 vs 0.09)的丰度均显著增多(P均<0.05)。结论 SEC1基因敲除使葡聚糖硫酸钠诱导的结肠炎小鼠模型严重程度加重,并影响结肠炎小鼠的肠道菌群组成。     

谷胱甘肽转硫酶M1基因型与汉族溃疡性结肠炎及大肠癌易感性的关系

谷胱甘肽转硫酶（GST）能促进毒性物质从机体排出，其基因多态性与人体对毒性物质的解毒能力相关，因此影响个体对疾病尤其是肿瘤的易感性。本研究通过探索谷胱甘肽转硫酶M1基因型（GSTM1）在正常汉族人群、溃疡性结肠炎（UC）及散发性大肠癌（SCRAC）患者中的分布差异，旨在阐明UC和SCRAC的遗传易感性。     

医学基础教育中PBL和CBL两种教学模式的实践与体会

以PBL和CBL为主的讨论式教学模式已成为推进医学教育质量的重要教学改革内容之一,文章分析了这两种教学模式在实践应用中的特殊性和区别性。PBL教学模式通常作为一门独立课程设置。在医学基础教育阶段,PBL以激发学生主动学习、团队合作和批判性思维建立为主要目的,因此较适宜于尚未接触医学桥梁课程的学生。而CBL教学模式常依附于学科的课程之内,以引导学生探索问题、发现问题、解决问题和增强思辩能力为目标,授教对象以完成医学桥梁课程学习的学生为主。两种教学模式中,PBL的教师更像是一位旁听者或辅导员,而CBL的教师则如主持人或顾问的角色。分清PBL和CBL两者的教学特点,有利于其达到预期的教学效果与目标。     

白细胞介素-10和肿瘤坏死因子基因多态性与湖北汉族人群胃十二指肠疾病及幽门螺杆菌感染的相关性

Objective To study the distribution of IL-10 and TNF gene polymorphisms in patients with gastroduodenal diseases in Hubei Han ethnic and their association with Helicobacter pylori (Hp) infection. Methods Six hundred and five patients with gastroduedenal diseases (196 chronic gastritis, 189 gastroduodenal ulcer and 220 gastric cancer) as well as 624 healthy controls were genotyped with PCR-RFLP method for IL-10-1082,-819,-592 and TNFα-308, lymphotoxin-α (LTα) Nco Ⅰ and AspH Ⅰ gene polymorphisms. Hp infection status was determined with ELLS& Results (1) There was significant difference of IL-10-1082 AG + GG genotype among the gastric cancer group with the non-malignant gastric diseases groups and healthy control group (P <0. 05). There was no significant difference of IL-10-592 and -819 gene polymorphisms among gastric cancer patients,non-malignant gastric disease patients and healthy controls (P>0. 05). The genotype frequencies of IL-10-819 were the same as those of IL-10-592. (2) Frequency of IL-10-1082 AG + GG genotype in gastric cancer patients with positive Hp was significantly higher than that in the other three groups (P < 0. 05). (3) Frequency of LTα Nco I AG genotype in gastric cancer patients with Hp infection was signiilcandy higher than that in Hp positive healthy controls (P < 0. 05). There were no other associations between TNFα-308, LTα Nco Ⅰ and AspH Ⅰ gene polymorphisms and Hp infection in gastroduodenal diseases. Conclusions (1) Allele AG + GG of IL-10-1082 was associated with gastric cancer in Han nationality of Hubei province. (2) IL-10-1082 AG + GG,LTct Nco ⅠAG heterozygous genotype may be associated with Hp infection in patients with gastric cancer in Han nationality of Hubei province.     

白细胞介素-10和肿瘤坏死因子基因多态性与湖北汉族人群胃十二指肠疾病及幽门螺杆菌感染的相关性

Objective To study the distribution of IL-10 and TNF gene polymorphisms in patients with gastroduodenal diseases in Hubei Han ethnic and their association with Helicobacter pylori (Hp) infection. Methods Six hundred and five patients with gastroduedenal diseases (196 chronic gastritis, 189 gastroduodenal ulcer and 220 gastric cancer) as well as 624 healthy controls were genotyped with PCR-RFLP method for IL-10-1082,-819,-592 and TNFα-308, lymphotoxin-α (LTα) Nco Ⅰ and AspH Ⅰ gene polymorphisms. Hp infection status was determined with ELLS& Results (1) There was significant difference of IL-10-1082 AG + GG genotype among the gastric cancer group with the non-malignant gastric diseases groups and healthy control group (P <0. 05). There was no significant difference of IL-10-592 and -819 gene polymorphisms among gastric cancer patients,non-malignant gastric disease patients and healthy controls (P>0. 05). The genotype frequencies of IL-10-819 were the same as those of IL-10-592. (2) Frequency of IL-10-1082 AG + GG genotype in gastric cancer patients with positive Hp was significantly higher than that in the other three groups (P < 0. 05). (3) Frequency of LTα Nco I AG genotype in gastric cancer patients with Hp infection was signiilcandy higher than that in Hp positive healthy controls (P < 0. 05). There were no other associations between TNFα-308, LTα Nco Ⅰ and AspH Ⅰ gene polymorphisms and Hp infection in gastroduodenal diseases. Conclusions (1) Allele AG + GG of IL-10-1082 was associated with gastric cancer in Han nationality of Hubei province. (2) IL-10-1082 AG + GG,LTct Nco ⅠAG heterozygous genotype may be associated with Hp infection in patients with gastric cancer in Han nationality of Hubei province.     

白细胞介素-10和肿瘤坏死因子基因多态性与湖北汉族人群胃十二指肠疾病及幽门螺杆菌感染的相关性

Objective To study the distribution of IL-10 and TNF gene polymorphisms in patients with gastroduodenal diseases in Hubei Han ethnic and their association with Helicobacter pylori (Hp) infection. Methods Six hundred and five patients with gastroduedenal diseases (196 chronic gastritis, 189 gastroduodenal ulcer and 220 gastric cancer) as well as 624 healthy controls were genotyped with PCR-RFLP method for IL-10-1082,-819,-592 and TNFα-308, lymphotoxin-α (LTα) Nco Ⅰ and AspH Ⅰ gene polymorphisms. Hp infection status was determined with ELLS& Results (1) There was significant difference of IL-10-1082 AG + GG genotype among the gastric cancer group with the non-malignant gastric diseases groups and healthy control group (P <0. 05). There was no significant difference of IL-10-592 and -819 gene polymorphisms among gastric cancer patients,non-malignant gastric disease patients and healthy controls (P>0. 05). The genotype frequencies of IL-10-819 were the same as those of IL-10-592. (2) Frequency of IL-10-1082 AG + GG genotype in gastric cancer patients with positive Hp was significantly higher than that in the other three groups (P < 0. 05). (3) Frequency of LTα Nco I AG genotype in gastric cancer patients with Hp infection was signiilcandy higher than that in Hp positive healthy controls (P < 0. 05). There were no other associations between TNFα-308, LTα Nco Ⅰ and AspH Ⅰ gene polymorphisms and Hp infection in gastroduodenal diseases. Conclusions (1) Allele AG + GG of IL-10-1082 was associated with gastric cancer in Han nationality of Hubei province. (2) IL-10-1082 AG + GG,LTct Nco ⅠAG heterozygous genotype may be associated with Hp infection in patients with gastric cancer in Han nationality of Hubei province.     

CTLA-4基因启动子区-1661和-318位点多态性与胃癌的关系

细胞毒性T淋巴细胞相关抗原4（CTLA-4）是一种免疫调节分子,可通过降低T细胞活性,抑制机体的抗肿瘤免疫反应。目的：探讨CTLA-4基因启动子区-1661和-318位点多态性与胃癌的关系。方法：121例无血缘关系的胃癌患者和236名正常对照者纳入研究,分别采用聚合酶链反应一限制性片段长度多态性（PCR—RFLP）和扩增不应突变系统（ARMS）。PCR检测CTLA-4基因启动子区-1661和．318位点多态性。结果：胃癌组．1661位点AA基因型和A等位基因频率显著低于正常对照组（73．6％对83．9％,P=0．024;85．1％对91．1％,P=0．022）;而-318位点CC基因型和C等位基因频率与正常对照组相比无明显差异。管状腺癌患者CTLA-4基因启动子区-1661位点AA基因型和．318位点CC基因型频率显著低于正常对照组（64．1％对83．9％,P=0．001;76．6％对87．3％,P=0．047）。结论：CTLA-4基因启动子区-1661位点基因多态性与胃癌呈显著负相关,-1661和-318位点多态性与管状腺癌呈显著负相关。