"肾脑相济"电针对阿尔茨海默病模型小鼠行为学及IL-1β、TNF-α表达的影响

目的观察"肾脑相济"电针对阿尔茨海默病(AD)模型小鼠行为学和大脑皮质炎性因子白细胞介素-1β(IL-1b)和肿瘤坏死因子-α(TNF-α)表达的影响,探究"肾脑相济"电针疗法治疗阿尔茨海默病的作用机理。方法将7月龄雄性SAMP8小鼠随机分成模型组、西药组和电针组,每组6只;将SAMR1小鼠作为对照组。西药组给予盐酸多?哌齐灌胃,电针组电针百会、肾俞和三阴交。采用Morris水迷宫观察小鼠行为学,应用免疫组化法、Western Blot法测定大脑皮质区IL-1b、TNF-α的阳性细胞数和蛋白表达。结果与对照组比较,模型组小鼠学习记忆能力明显下降,IL-1b、TNF-α的表达升高,差异有统计学意义(P<0.05);与模型组比较,西药组和电针组小鼠学习记忆能力增强,IL-1b、TNF-α的表达降低,差异有统计学意义(P<0.05);与西药组比较,电针组小鼠学习记忆能力及IL-1b、TNF-α的表达变化不明显,差异无统计学意义(P>0.05)。结论"肾脑相济"电针疗法可以改善SAMP8模型小鼠的学习和记忆能力,降低大脑皮质区IL-1b、TNF-α的含量,从而对阿尔茨海默病达到治疗效果。     

DPD、MTHFR和TS表达水平与氟尿嘧啶类药物治疗消化道肿瘤疗效及预后关系的研究进展

消化道恶性肿瘤包括结直肠癌、胃癌和食管癌等。尽管使用了各种治疗方式，癌症患者仍然有复发和转移。绝大多数患者确诊时即为中晚期，因而化疗在癌症患者中发挥重要作用。作为5-FU抗癌活性中的三个关键酶，二氢嘧啶脱氢酶（DPD）、5,10-亚甲基四氢叶酸还原酶（MTHFR）、胸苷酸合成酶（TS）与消化道肿瘤的疗效、对化疗药物的敏感性及患者的预后有密切关系。     

生理学教学核心理念变革的探讨

医学教育改革更多的是热衷于授课形式和方法的改革，而忽视了真正能够渗透到教学各方面的教学理念的改革。结合对生理学教学目标的反思和“岗位胜任力”培养的需求，将生理学教学的核心理念总结为四个方面：“三观”要正，帮助学生树立平衡观、辩证观和整体观；“三基”要牢，培养学生掌握基本的知识架构体系、基本的知识获取能力、基本的操作技能；重视学以致用和强化人文素养。上述核心理念在教学实践中得到学生的广泛认可，临床医学专业学生对核心理念的评价明显高于护理专业。下一步教学改革的方向是在教学理念的指导下如何细化授课内容，以适应专业设置越来越细化的现状。     

Hepatitis B virus infection and the risk of cancer among the Chinese population

The relationship between hepatitis B virus (HBV) and nonhepatocellular cancers remains inconclusive. This large case-control study aimed to assess the associations between HBV infection status and multiple cancers. Cases (n = 50 392) and controls (n = 11 361) were consecutively recruited from 2008 to 2016 at the First Affiliated Hospital of Nanjing Medical University. Multivariable adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were estimated using logistic regression by adjusting age and gender. A meta-analysis based on published studies was also performed to verify the associations. Of these, 12.1% of cases and 5.5% of controls were hepatitis B surface antigen (HBsAg) seropositive. We observed significant associations between HBsAg seropositivity and esophagus cancer (aOR [95% CI] = 1.32 [1.13-1.54]), stomach cancer (1.46 [1.30-1.65]), hepatocellular carcinoma (HCC; 39.11 [35.08-43.59]), intrahepatic and extrahepatic bile duct carcinoma (ICC and ECC; 3.83 [2.58-5.67] and 1.72 [1.28-2.31]), pancreatic cancer (PaC; 1.37 [1.13-1.65]), non-Hodgkin lymphoma (NHL; 1.88 [1.61-2.20]) and leukemia (11.48 [4.05-32.56]). Additionally, compared to participants with HBsAg−/anti-HBs−/anti-HBc−, participants with HBsAg−/anti-HBs−/anti-HBc+, indicating past HBV-infected, had an increased risk of esophagus cancer (aOR [95% CI] = 1.46 [1.24-1.73]), stomach cancer (1.20 [1.04-1.39]), HCC (4.80 [3.95-5.84]) and leukemia (15.62 [2.05-119.17]). Then the overall meta-analysis also verified that HBsAg seropositivity was significantly associated with stomach cancer (OR [95% CI] = 1.23 [1.14-1.33]), ICC (4.05 [2.78-5.90]), ECC (1.73 [1.30-2.30]), PaC (1.26 [1.09-1.46]), NHL (1.95 [1.55-2.44]) and leukemia (1.54 [1.26-1.88]). In conclusion, both our case-control study and meta-analysis confirmed the significant association of HBsAg seropositivity with stomach cancer, ICC, ECC, PaC, NHL and leukemia. Of note, our findings also suggested that the risk of stomach cancer elevated for people whoever exposed to HBV.     

“两阶段三部曲”在结直肠癌辅助化疗期的应用＊

辅助化疗有助于改善高危II/III期结直肠癌患者的生存。然而，辅助化疗的不良反应影响患者的生活质量，严重的不良反应甚至可能导致化疗的延期或终止，使得患者不能从辅助化疗中获益。中国中医科学院西苑医院杨宇飞教授根据多年临床经验，创新性提出辅助化疗期的“两阶段三部曲”，即补肾健脾序贯疗法，第1阶段应用自拟六君安胃方健脾和胃，针对化疗导致的胃肠道反应；第2阶段运用芪菟二至方健脾益肾，针对化疗导致的骨髓抑制；以及辛凉解表感冒方，针对化疗期间的外感。临床应用取得了显著的疗效。文章详细阐述“两阶段三部曲”提出的背景及其主要内容。     

The association between body mass index and in-hospital outcome among patients with acute myocardial infarction—Insights from China Acute Myocardial Infarction (CAMI) registry

BackgroundThe relationship between body mass index (BMI) and in-hospital mortality risk among patients with acute myocardial infarction (AMI) remains controversial.Methods and ResultsWe included 35,964 patients diagnosed with AMI in China Acute Myocardial Infarction registry between January 2013 and December 2016. Patients were categorized into 4 groups according to BMI level: BMI <18.5, 18.5–24.9, 25–30, and ≥30 kg/m² for underweight, normal, overweight, and obese groups, respectively. Clinical data were extracted for each patient, and multivariable logistic regression analysis was used to examine the association between BMI level and in-hospital mortality. Compared with normal-weight patients, obese patients were younger, more often current smokers, and more likely to have hypertension, hyperlipidemia, and diabetes. Multivariable regression analysis results demonstrated that compared with normal group, underweight group had significantly higher in-hospital mortality (odds ratio [OR]: 1.34; 95% confidence interval [CI]: 1.06–1.69; p = 0.016), while overweight group (OR: 0.86; 95% CI: 0.77–0.97; p = 0.011) and obese group (OR: 0.65; 95% CI: 0.46–0.91; p = 0.013) had lower mortality. All subgroups showed a trend toward lower in-hospital mortality risk as BMI increased.ConclusionsOur study provided robust evidence supporting “obesity paradox” in a contemporary large-scale cohort of patients with AMI and demonstrated that increased BMI was independently associated with lower in-hospital mortality.     

Severe lumbar spinal stenosis combined with Guillain-Barré syndrome: A case report

BACKGROUNDGuillain-Barré syndrome (GBS) is a rare disorder that typically presents with ascending weakness, pain, paraesthesias, and numbness, which mimic the findings in lumbar spinal stenosis. Here, we report a case of severe lumbar spinal stenosis combined with GBS.CASE SUMMARYA 70-year-old man with a history of lumbar spinal stenosis presented to our emergency department with severe lower back pain and lower extremity numbness. Magnetic resonance imaging confirmed the diagnosis of severe lumbar spinal stenosis. However, his symptoms did not improve postoperatively and he developed dysphagia and upper extremity numbness. An electromyogram was performed. Based on his symptoms, physical examination, and electromyogram, he was diagnosed with GBS. After 5 d of intravenous immunoglobulin (0.4 g/kg/d for 5 d) therapy, he gained 4/5 of strength in his upper and lower extremities and denied paraesthesias. He had regained 5/5 of strength in his extremities when he was discharged and had no symptoms during follow-up.CONCLUSIONGBS should be considered in the differential diagnosis of spinal disorder, even though magnetic resonance imaging shows severe lumbar spinal stenosis. This case highlights the importance of a careful diagnosis when a patient has a history of a disease and comes to the hospital with the same or similar symptoms.