异牡荆素对非小细胞性肺癌细胞自我更新和凋亡的影响

目的研究异牡荆素(ISO)对非小细胞性肺癌(NSCLC)细胞的影响和潜在的机制。方法将A549和H1650细胞分别分为空白组、低剂量实验组(4μmol·L^-1 ISO)和高剂量实验组(16μmol·L^-1 ISO)。用噻唑蓝法检测NSCLC细胞活性,用肿瘤球形成实验检测NSCLC细胞的细胞球形成率,用Western blot法检测NSCLC细胞凋亡、自我更新、无翅型MMTV整合位点家族/β-连环蛋白(Wnt/β-catenin)信号通路相关蛋白的表达水平。结果与空白组比较,低、高剂量实验组中A549和H1650细胞在24,48和72 h的细胞活性均显著降低。低、高剂量实验组和空白组中A549细胞的细胞球形成率分别为(4.18±0.45)%,(2.01±0.67)%和(6.02±0.57)%,切割的半胱氨酸蛋白酶-3相对表达量分别为0.24±0.08,1.25±0.13和0.06±0.07,SRY相关高迁移率族盒蛋白-2相对表达量分别为0.49±0.04,0.25±0.03和1.00±0.09,Kruppel样因子4相对表达量分别为0.68±0.04,0.44±0.03和1.01±0.06,Wnt1相对表达量分别为0.63±0.06,0.28±0.04和1.00±0.06,β-catenin相对表达量分别为0.41±0.05,0.22±0.03和1.01±0.09;与空白组比较,低、高剂量实验组中A549细胞的上述指标的差异均有统计学意义(P<0.05,P<0.01)。上述3组中H1650细胞的上述指标也呈现一致的现象。结论ISO可能通过抑制Wnt/β-catenin信号通路来抑制NSCLC细胞活性和自我更新,并促进其凋亡。     

Navigating nursing curriculum change during COVID-19 pandemic: A systematic review and meta-synthesis

AimTo consolidate the evidence around the experiences of nursing undergraduates and faculty members navigating through remote and online education during the COVID-19 pandemic.BackgroundThe Coronavirus disease 2019 caused by the SARS-CoV-2 Virus (COVID-19) has placed massive pressure on healthcare, economic and education systems globally. Restrictive social distancing policies and public health measures necessitated educational institutions to switch from face-to-face to remote and online education to sustain the learning process. These changes have created an uncertain path and undue stress for healthcare learners and faculty, especially for professional roles that traditionally require more hands-on and access to clinical practice particularly pre-licensure nursing students. As such, there is an urgent need to consolidate evidence on the experiences of nursing undergraduates and faculty members as they navigate the rapid transition from face-to-face to remote and online education to ensure continuity of learning in achieving optimal learning outcomes and to support them during current and future public health crises.DesignA systematic review and meta-synthesis of the qualitative literature was undertaken using Sandelowski and Barroso’s approach.MethodsSix electronic databases, CINAHL, Embase, ERIC, PsycINFO, PubMed and Scopus, were searched systematically using the eligibility criteria from December 2019 to September 2022. The Critical Appraisal Skills Program checklist for qualitative studies was used to conduct the critical appraisal of the selected articles.ResultsForty-seven studies were included in this review, which encapsulates the experiences of 3052 undergraduates and 241 faculty members. An overarching meta-theme ‘Remote and online education: a rollercoaster ride’, emerged along with three main meta-themes: (1) Transition to remote and online education: A turbulent road, (2) Acceptance of the untravelled road, (3) Hopes and recommendations for the road ahead.ConclusionTo improve nursing undergraduates’ and faculty member’s navigation of remote and online education, more institutions should move towards establishing hybrid education as the new ‘normal’ and exercise prudence in the organisation and delivery of curriculum, teaching, well-being and clinical attachment contingencies of their healthcare courses.     

产学研合作模式下长三角生物医药产业一体化协同创新发展研究——基于专利合作及基金项目合作

长三角一体化上升并发展为国家战略后，国内鲜有探讨长三角地区生物医药产业一体化协同发展的研究，长三角作为我国生物医药产业的重要地区，已初步形成产业集群的发展模式。本研究基于专利及基金项目合作的产学研模式，利用社会网络分析方法（SNA）对长三角地区生物医药产业中专利和国家自然科学基金重大项目合作进行分析研究。研究表明，长三角地区生物医药领域的产学研合作还处于发展阶段，一体化程度也有待提高；高校及科研院所更倾向于与企业合作开展发明专利，与高校合作开展基金项目研究。长三角地区三省一市间的生物医药产业发展也存在一定差距，建议长三角地区采取产学研深度融合模式，相关龙头科研机构建立开放式创新平台，医药类高校借助学科优势培养创新型人才，采取“揭榜挂帅”等方式进行关键核心技术攻关。     

Cabozantinib in Renal Cell Carcinoma With Brain Metastases: Safety and Efficacy in a Real-World Population

BackgroundCabozantinib showed efficacy and manageable toxicity in patients with metastatic renal cell carcinoma (mRCC). In this study we aimed to describe the safety and to collect evidence on the potential efficacy of cabozantinib in mRCC patients with brain metastases (BM) in a real-world experience.Materials and MethodsWe retrospectively collected data of patients treated with cabozantinib within the Italian Managed Access Program. Patients were selected for the presence of BM before the start of treatment and for at least 1 previous tyrosine kinase inhibitor (TKI) treatment regimen for metastatic disease. Safety data were reported, and overall response rate (ORR), brain-specific response, progression-free survival (PFS), and median overall survival (OS) were analyzed.ResultsOverall, 12 patients treated with cabozantinib were evaluated. Any grade adverse events (AEs) accounted for 92%, Grade 3/4 AEs rated at 36% with no major neurological side effects. The most common AEs included hypertension (33%), fatigue (24%), aminotransferase elevation (25%), hypothyroidism (16%), and gastrointestinal toxicity (16%). The ORR was 50% with a disease control rate of 75%. All 5 patients treated with a combined systemic and brain-directed approach obtained intracranial disease control, without increased toxicity. Median PFS and median OS were 5.8 and 8.8 months, respectively. Comparable safety and tolerability results for other TKI regimens were reported from the literature.ConclusionCabozantinib showed safety, acceptable tolerability, and promising antitumor activity in a population of mRCC patients with BM from a real-world experience. A combined modality approach for renal cell carcinoma with BM, whenever feasible, could be recommended to improve oncological outcomes.     

基于核心能力的临床医学专业研究生课程体系建设研究

临床医学专业研究生课程体系是培养研究生过程中极为重要的环节，课程是实现教育教学目标的关键载体和平台。目前，我国对于临床医学教育提出了创新改革课程体系的具体要求。2019年我国教育部发布了《教育部卫生部关于加强医学教育工作提高医学教育质量的若干意见》，表示各大医学高校要“积极全面开展课程体系革新，使得医学知识与自然科学和人文科学知识的融合”。突出学生的教学主体性，创建学生为中心的专业教学模式，大力促进教学方法的创新和实践，强化学生综合知识能力、创新意识以及批判性思维的培养和锻炼。本文对基于核心能力的临床医学专业研究生课程体系建设进行研究，并提出具体的建设策略，以期为我国临床医学专业研究生培养提供有价值的参考建议。     

＊ 补充基金信息（立项部门，项目类型，课题名称，负责人信息）

病机是认识疾病病变的关键，抓住核心病机演变发展的规律，是中医临床诊疗的主旨和核心。病机兼化理论由中国中医科学院胡镜清研究员提出，用以从病机层面理解疑难复杂疾病病证关系和把握其演变规律，在明确疾病基本矛盾的同时，兼顾疾病的复杂性和多变性。文章通过构建新型冠状病毒肺炎病机兼化框架，揭示其病机演化规律，认为新冠肺炎属于“湿毒疫”范畴，湿毒始终是本病的病变核心，初期寒化，进展期热化，恢复期虚化是本病病机的传变方式。知本病之机，可未病先防，知病机传变，可截断扭转，有利于临床上增强对疾病发生发展趋势的预见性。     

首发精神障碍家庭照顾者经历的系统评价

目的：系统评价首发精神障碍家庭照顾者的经历，为患者早期康复及照顾者心理健康问题的干预提供循证依据。方法：计算机检索The Cochrane Library、Ovid 、PubMed、Embase、Web of Science、CBM、CNKI、VIP和WANFANG DATE 数据库，检索时限均从建库至2021年7月31日，使用“JBI循证卫生保健中心质性研究质量评价标准”评价符合纳入标准的文献，并采用汇集性整合法对研究结果进行整合。结果：纳入12篇文献，提炼出60个研究结果，整理成8个类别，得出3个整合结果。分别是多维度的挑战、成长或缺如的角色结局、急需的社会支持。结论：亟需提高全民心理健康素质及去精神障碍疾病污名化，营造患者及家属无障碍化就医环境；关注家庭照顾者早期心理健康的干预，满足其社会支持的需要，提高该类人群应激应对能力，促进照顾者心理康复。     

脑卒中幸存者运动依从性影响因素质性研究的Meta整合

目的 系统整合脑卒中幸存者运动依从性的影响因素。方法 计算机检索PubMed、Web of Science、Cochrane library、Embase、CINAHL、PsycINFO、百度、Google、中国期刊全文数据库、万方数据库、中国生物医学数据库和维普中文期刊数据库中有关脑卒中运动依从性影响因素的相关研究,检索时间自建库至2021年11月15日。2名研究员独立筛选、提取、评价文献,遇到分歧小组协商讨论。结果 纳入符合标准的文献13篇,共提炼出完整的研究主题62个,归纳组合形成6个新的类别,2个综合的整合结果。整合结果1： 影响脑卒中患者运动依从性的个人因素;包括个人动机因素,个人能力因素及个人心理因素;整合结果2：影响脑卒中患者运动依从性的外在因素;包括人际关系因素、康复团队因素及社会系统因素。结论 深入理解影响卒中患者康复运动依从性的驱动和阻碍因素,找准提高康复运动依从性的突破口,进而提高患者的运动积极性,提高其生活质量。