关于医学硕士研究生科研写作能力的培养思考

随着国家社会经济的高速发展,各领域都需要更多高层次拔尖创新性人才。我国医药卫生事业的快速、稳定发展将会直接关系国民生命的健康,这就需要培养大量硕士研究生及以上的医学高层次人才。目前,医学硕士研究生还存在着科研能力不足的现状,而科研写作是科研水平和科研质量的呈现,是增强沟通、提高创新性的必然媒介。就如何培养提高医学硕士研究生写作能力内外部影响因素进行了阐述,并提出了改善方法。     

缺血性脑卒中后癫痫的影响因素分析

目的 分析缺血性脑卒中后癫痫的影响因素。方法 选取华中科技大学同济医学院附属梨园医院2019年3月至2021年3月收治的146例缺血性脑卒中病人和149例健康体检者,分别记为疾病组（n=146）和健康组（n=149）。疾病组治疗前抽取外周血、健康组采用体检剩余外周血测定血清微RNA-181a(miR-181a)表达并比较;疾病组随访1年比较癫痫组与无癫痫组血清miR-181a表达;以logistic多元回归分析探讨缺血性脑卒中后癫痫的影响因素。结果 疾病组血清miR-181a表达高于健康组（P<0.001）;疾病组癫痫发生率为26.71%,其中早发型癫痫、迟发型癫痫、单次发作、反复发作、癫痫大发作、小发作、局灶性发作、精神运动性发作构成比分别为38.46%、61.54%、43.59%、56.41%、64.10%、10.26%、20.51%、5.13%;癫痫组血清miR-181a表达高于无癫痫组[（1.84±0.40）比（1.58±0.35）](P<0.001);癫痫组入院NIHSS评分高于无癫痫组[（15.22±2.38）分比（9.88±2.07）分]（P<0.001...     

Effectiveness and safety of herbal medicines in the treatment of irritable bowel syndrome： A systematic review

AIM： To explore the efficacy and safety of herba medicines （HM） in the treatment of irritable bowe syndrome （IBS）. METHODS： A computer-based as well as manual literature search was performed. We reviewed randomized controlled trials on the treatment of IBS with and without HM. RESULTS： A total of 22 studies with 25 HMs met the inclusion criteria. Four of these studies were of good quality, while the remaining 18 studies involving 17 Chinese herbal medicine （CHM） formulas were of poor quality. Eight of these reports using 9 HMs showed global improvement of IBS symptoms, 4 studies with 3 HMs were efficacious in diarrhea-predominant IBS, and 2 studies with 2 HMs showed improvement in constipation- predominant IBS. Out of a total of 1279 patients, 15 adverse events in 47 subjects were reported with HM. No serious adverse events or abnormal laboratory tests were observed. The incidence of the adverse events was low （2.97%; 95% CI： 2.04%-3.90%）. CONCLUSION： Herbal medicines have therapeutic benefit in IBS, and adverse events are seldom reported in literature. Nevertheless, herbal medicines should be used with caution. It is necessary to conduct rigorous, well-designed clinical trials to evaluate their effectiveness and safety in the treatment of IBS.     

MicroRNA-145增强非小细胞肺癌细胞对吉非替尼敏感性及其机制探讨

目的:探讨微小RNA-145（microRNA-145，miR-145）对非小细胞肺癌细胞系吉非替尼耐药的作用及其可能的潜在机制。方法:实时荧光定量PCR（Q-PCR）方法检测正常细胞及非小细胞肺癌细胞中miR-145的表达差异；不同时间5 μmol/L吉非替尼干预肺癌细胞SPC-A-1和A549后，Q-PCR检测miR-145表达变化；miR-145 mimics和miR-145 inhibitors分别转染SPC-A-1和A549肺癌细胞后，CCK8检测细胞活力变化;双荧光素酶报告系统检测miR-145与ADAM19的靶向结合；miR-145 mimics转染SPC-A-1和A549肺癌细胞，Western blot检测ADAM19蛋白表达；Western blot检测5 μmol/L吉非替尼干预后，SPC-A-1和A549肺癌细胞中ADAM19蛋白的表达；miR-145 mimics转染SPC-A-1和A549肺癌细胞，再用5 μmol/L吉非替尼干预，Western blot检测ADAM19蛋白的表达；采用siRNA抑制ADAM19表达，再用5 μmol/L吉非替尼干预，CCK8检测细胞活力；采用BALB/C雌性裸鼠皮下接种肿瘤细胞的方法，观察上述效应。结果:Q-PCR结果显示，与正常肺上皮细胞系BEAS-2B相比较，肺癌细胞SPC-A-1和A549中miR-145表达明显降低；5 μmol/L吉非替尼干预SPC-A-1和A549细胞后，miR-145表达显著上调；转染miR-145 mimics后,CCK8结果显示两种细胞细胞活力下降；双荧光素酶报告系统结果显示，miR-145靶向结合ADAM19基因的3'-UTR区；Western blot结果显示，5 μmol/L吉非替尼诱导SPC-A-1和 A549细胞后，两种细胞中ADAM19蛋白表达均降低；miR-145 mimics转染SPC-A-1和A549细胞，之后给予5 μmol/L吉非替尼治疗，ADAM19蛋白表达下调；siRNA抑制SPC-A-1和A549细胞中ADAM19表达，再给予5 μmol/L吉非替尼治疗，CCK8结果显示，两种细胞的细胞活力显著降低；过表达BALB/C雌性裸鼠的miR-145后，显著抑制皮下肿瘤生长，并且增强吉非替尼的抗肿瘤效果。结论:miR-145显著增强肺癌细胞SPC-A-1和A549对吉非替尼的敏感性，其机制可能是通过靶向结合AMDM19基因的3'-UTR区域，从而抑制其表达。miR-145有可能成为治疗非小细胞肺癌吉非替尼耐药的有效靶点。     

血浆NT-ProBNP及D-Dimer检测在老年慢性肺源性心脏病患者中的应用价值

目的探讨血浆氨基末端脑钠肽前体（NT—ProBNP）、D-二聚体（D-Dimer）在老年慢性肺源性心脏病患者中的应用价值。方法选取25例老年慢性肺源性心脏病急性加重期患者，分别检测治疗前（A组）、治疗后2周（B组）血浆NT—ProBNP、D—Dimer水平、动脉血二氧化碳分压及氧分压。并以30例老年单纯COPD急性加重患者（c组）做对照。结果A组较B组及C组比较，血浆NT-Pro BNP及D-Dimer水平显著增高，差异具有统计学意义（P〈0．05）。结论血浆NT-ProBNP及D-Dimer可作为评估老年慢性肺源性心脏病患者右心室功能不全严重程度的敏感指标。     

定制式和患者匹配增材制造医疗器械医工交互全过程构成要素与控制方法研究

目的：在现阶段生产和临床应用经验的基础上,以保障定制式和患者匹配增材制造医疗器械的安全性和有效性为目的,围绕医工交互环节,寻找并提炼其关键环节及其构成要素,提出要素控制的重要性并探讨相关控制方法。方法：通过检索和研究现阶段文献,深入临床机构和企业调研。对使用定制式和患者匹配增材制造医疗器械的临床机构、生产企业和患者的沟通流程进行研究,梳理每个环节和关键要素。基于现阶段法规,提炼各关键要素的控制方法,结合中国医疗器械行业协会3D打印医疗器械专委会组织制定的团体标准,形成本文。结果与结论：现阶段,定制式和患者匹配增材制造医疗器械的生产和临床应用仍缺乏足够的实践经验,所以出于安全有效应用和质量控制的考虑,有必要通过对医工交互全过程的监控,实现定制式和患者匹配医疗器械全过程的严密控制,使其设计开发、生产加工和临床应用得到保障。     

大蒜素对肺纤维化大鼠肺组织α-SMA和TGF- β1表达的影响

目的 观察大蒜素对肺纤维化大鼠肺组织α-平滑肌肌动蛋白(α -SMA)及转化生长因子-β1(TGF-β1)表达的影响,并初步探讨大蒜素对大鼠肺纤维化抑制作用的机制.方法 通过气管内注射博莱霉素复制大鼠肺纤维化模型,空白对照组大鼠用生理盐水代替.造模后的Wistar大鼠随机分成4组:空白对照组(气管内注入生理盐水+生理盐水灌胃)、大蒜素组(博莱霉素造模+大蒜素灌胃)、秋水仙碱组(博莱霉素造模+秋水仙碱灌胃)和模型组(博莱霉素造模+生理盐水灌胃),分别于第7天和第28天处死大鼠后取肺组织,行HE染色和Masson染色,观察大鼠肺组织肺纤维化程度,碱水解法检测大鼠肺组织内羟脯氨酸的浓度,免疫组织化学染色检测大鼠肺组织α -SMA及TGF-β1的表达.结果 在HE染色和Masson染色中,大蒜素组及秋水仙碱组肺炎分级和肺纤维化分级较模型组降低.与模型组相比,大蒜素组大鼠肺组织内羟脯氨酸的浓度降低,肺组织内α-SMA及TGF-β1的表达均明显减少,与秋水仙碱组相似.结论 大蒜素对大鼠肺纤维化的干预作用可能与下调TGF-β1的表达,从而减少成纤维细胞α-SMA基因的表达有关.     

HLA-DRB1 allele polymorphisms in genetic susceptibility to esophageal carcinoma

AIM: To probe into the genetic susceptibility of HLA-DRB1 alleles to esophageal carcinoma in Han Chinese in Hubei Province. METHODS: HLA-DRB1 allele polymorphisms were typed by polymerase chain reaction with sequence-specific primers(PCR-SSP) in 42 unrelated patients with esophageal cancer and 136 unrelated normal control subjects and the associated HLA-DRB1 allele was measured by nucleotide sequence analysis with PCR.SAS software was used in statistics. RESULTS: Allele frequency (AF) of HLA-DRB1*0901 was significantly higher in esophageal carcinoma patients than that in the normal controls (0.2500 vs 0.1397, P=0.028, the odds ratio 2.053, etiologic fraction 0.1282). After analyzed the allele nucleotide sequence of HLA-DRB1*0901 which approachs to the corresponded exon 2 sequence of the allele in genebank. There was no association between patients and controls in the rested HLA-DRB1 alleles. CONCLUSION: HLA-DRB1*0901 allele is more common in the patients with esophageal carcinoma than in the healthy controls, which is positively associated with the patients of Hubei Han Chinese. Individuals carrying HLA-DRB1*0901 may be susceptible to esophageal carcinoma.