对高职生诊断教学的几点思考

诊断学是论述诊断疾病的基本理论、基本技能和临床思雏方法的一门学科。现存的高职诊断学教学中存在培养目标不明确、课程设王不舍理、教学模式陈旧单一、实习基地建设不足、考试评估体系不完善等问题。为此，我们可以采取明确培养目标；调整课程设置，增加实践教学；采用多种教学模式；加强实习基地的建设；改进测评手段。强化技能训练等措施加以改进。     

酸相关性疾病与幽门螺杆菌感染

酸相关性疾病是指一类与胃酸攻击作用密切相关的上胃肠道疾病,包括器质性疾病和功能性疾病。根据病理生理机制的不同,酸相关性疾病主要分为胃食管反流病(GERD)、消化性溃疡病(PUD)和功能性消化不良(FD)三类。尽管目前对酸相关性疾病的发病机制已有了较深入的了解,但幽门螺杆菌(Hp)与其症状之间的关系仍不明确。现简要介绍幽门螺杆菌(Hp)感染在酸相关性疾病发生机制中的作用。     

Target-dependent axonal sprouting following vagal-hypoglossal nerve anastomosis in cats

Purpose: To investigate the relationships between the axonal sprouting and target neurotization by central neurons after nerve heterocon-nection. Methods: Unilateral (right) vagal-hypoglossal nerve anastomosis (VHA) was performed in adult cats. Following 3-315 days postoperation (dpo), quantitative analyses and ultrastructural changes in the proximal portion of the vagal-hypoglossal heteroconnected nerve as well as the time course of neuronal regeneration were studied. Along with this, horseradish peroxidase (HRP) retrograde tracing technique was used to label the neurons of dorsal motor vagal nucleus (DMV) and nucleus ambiguus (NA) to ascertain if target neurotization was established. Results: The contralateral (left) intact vagus nerve proximal to the level of ansa cervicalis showed an average of 33 +/- 1 myelinated and 74 +/- 4 unmyelinated axons in 727 &mgr;m(2) sectional area of the nerve. In the heteroconnected nerve at the corresponding level just proximal to the anastomosis site, there was a marked increase in the number of small axons sprouting from the unmyelinated nerve fibers between 18 and 25 dpo. The number of these axonal sprouts appeared to decline at 32 dpo but its increase of 131 % was sustained until the late regeneration stage at 315 dpo when compared with the contralateral nerve serving as a control. The mean number of myelinated axons per area unit (727 &mgr;m(2)) was reduced to 18 at 3 dpo but was immediately restored to the normal range at 7 dpo. The retrograde labelling of neurons in both the DMV and NA was first detected at 22 dpo and was progressively increased peaking by about 67 dpo. Conclusions: We conclude that compared with the unmyelinated axons, the myelinated axons may acquire a superior interaction with the new target. Furthermore, the postoperative neurotization of tongue muscles may initiate and facilitate the retraction of the redundant axonal sprouts.     

BDNF is involved in sympathetic sprouting in the dorsal root ganglia following peripheral nerve injury in rats

Peripheral nerve injury results in sympathetic sprouting around large diameter sensory neurons in the dorsal root ganglia (DRG). The mechanism underlying this pathological phenomenon is not known. Brain-derived neurotrophic factor (BDNF) is up-regulated in large sensory neurons and ensheathing satellite cells following a sciatic nerve injury. In the present study, we investigated the effects of BDNF on the sympathetic sprouting in the DRG, by delivering BDNF antibody or antisense oligodeoxynucleotide to injured DRGs, or by delivering exogenous BDNF to intact DRGs. The sheep antibody to BDNF, characterized by bioassays and dot blots, specifically reacted with BDNF but not other neurotrophins. Noradrenergic fibers were visualized by immunostaining of tyrosine hydroxylase (TH) and quantified by an NIH Imaging program. Two weeks following L5 spinal nerve lesion, a dramatic increase in TH-immunoreactive (-ir) fibres was observed in both ipsi- and contralateral DRGs in normal sheep IgG treated rats. BDNF antibody significantly reduced the sprouting of sympathetic nerves in both ipsi- and contra-lateral DRGs by 67% and 42% respectively. BDNF antisense oligodeoxynucleotide, by inhibiting BDNF synthesis in DRGs, also significantly suppressed the sprouting by 67% and 60% respectively in the ipsi- and contra-lateral DRGs. Delivery of exogenous BDNF into an intact L5 DRGs resulted in an increase in the sprouting by 4.2-fold. Our results clearly indicate that BDNF, synthesized in and secreted from the DRGs, is involved in the sympathetic sprouting in the DRG following the peripheral nerve injury.     

逍遥散加减在皮肤科的应用

逍遥散由当归、白芍、白术、茯苓、炙甘草、柴胡、生姜、薄荷组成,有疏肝解郁,健脾和营之功[1].后世医家在原方基础上加减化裁,广泛应用于临床各科.凡邪在半表半里者,出现肝郁脾虚之证,均可采用,以调其偏胜,扶其不足,使病去人安.笔者临床应用逍遥散治疗肝郁不舒、克伐脾土、脾失健运、气血失和而产生的各种皮肤疾患,收到较好的疗效.     

白鲜皮质量标准研究

目的：为中药白鲜皮制定2005年版药典标准。方法：采用TLC法鉴别、反相高效液相色谱法测定白鲜皮中活性成分末梣酮含量，并对各地产白鲜皮药材的水分、总灰分、酸不溶性灰分、浸出物含量进行测定。结论：本方法操作简单，重现性好，可用于白鲜皮药材的质量控制。     

金瓷修复体制作中的问题分析

目的 研究金属烤瓷修复体制作过程中经常出现的问题及如何补救，探讨提高金瓷修复体修复工艺方面的问题。方法 收集并分析临床近5年制作的580例、共650件金属烤瓷修复体，归纳其在制作中出现的问题。结果 瓷裂及崩瓷18件，占2．76％：气泡15件，占2．31％；铸造缺陷11件，占1．69％；色泽不协调12件，占1．85％。结论 金瓷修复体的加工制作是一个复杂而细致的过程，与技工室制作、临床设计及牙体制备都有密切关系，其中任何一个环节的操作不当都可能导致修复体的失败。     

两种术式在缓解恶性输尿管梗阻疗效中的对比研究

目的 探讨恶性输尿管梗阻（malignant ureteral obstruction,MUO）现有的临床治疗方案和经验,讨论恶性输尿管梗阻时使用经皮肾脏穿刺引流（percutaneous nephrostomy,PN）或输尿管支架置入术（ureteral stenting,US）的临床适用范围,明确2种术式在缓解恶性输尿管梗阻时肾功能损伤的有效性。方法 回顾性纳入重庆医科大学附属第一医院泌尿外科2021年1月至2023年5月诊断为恶性输尿管梗阻的患者,严格筛选纳入及排除标准后共有76例患者入组并随机分为PN组（n=22）与US组（n=54）,对患者基本特征及围术期、术后半年随访数据进行病例对照研究以反映肾功能在2组中的差异,采用SPSS 21.0版本对数据进行处理分析。结果 2组患者在性别（P=0.017）、手术侧肾积水程度（P=0.000）的比较,差异有统计学意义。2组患者术前3 d比较尿素氮（P=0.002）、血肌酐（P=0.003）,术后1 d尿素氮（P=0.017）、血肌酐（P=0.005）,差异有统计学意义。术后3 d与术后6个月2组患者在肾功能比较中差异均无统计学意义。结论 恶性输尿管梗阻以宫颈癌多发,其次为位膀胱癌、结直肠癌等。US可选择梗阻或积水较轻、慢性输尿管梗阻、肾功能损伤较轻的患者,可作为缓解输尿管梗阻的首选治疗方案。PN临床常对中至重度肾积水、肾功能损伤较重或者急性肾功能不全的恶性输尿管梗阻患者进行治疗,可作为US失败的替代方案。     

Ferric citrate for the treatment of hyperphosphatemia and anemia in patients with chronic kidney disease: a meta-analysis of randomized clinical trials

BackgroundHyperphosphatemia and anemia, which are common complications of chronic kidney disease (CKD), can independently contribute to cardiovascular events. Several previous studies have found that the iron-based phosphate binder, ferric citrate (FC), could be beneficial to both hyperphosphatemia and anemia.MethodsRelevant literature from PUBMED, EMBASE, the Cochrane Central Register of Controlled Trials (CCRCT) and MEDLINE databases were searched up to 21 February 2022, in order to conduct a meta-analysis to investigate the efficacy, safety and economic benefits of ferric citrate treatment in CKD patients with hyperphosphatemia and anemia. The meta-analysis was conducted independently by two reviewers using the RevMan software (version 5.3).ResultsIn total, this study included 16 randomized clinical trials (RCT) involving 1754 participants. The meta-analysis showed that ferric citrate could significantly reduce the serum phosphorus in CKD patients compared to the placebo control groups (MD −1.76 mg/dL, 95% CI (−2.78, −0.75); p = 0.0007). In contrast, the difference between ferric citrate treatment and active controls, such as non-iron-based phosphate binders, sevelamer, calcium carbonate, lanthanum carbonate and sodium ferrous citrate, was not statistically significant (MD − 0.09 mg/dL, 95% CI (−0.35, 0.17); p = 0.51). However, ferric citrate could effectively improve hemoglobin levels when compared to the active drug (MD 0.43 g/dL, 95% CI (0.04, 0.82); p = 0.03) and placebo groups (MD 0.39 g/dL, 95% CI (0.04, 0.73); p = 0.03). According to eight studies, ferric citrate was found to be cost-effective treatment in comparison to control drugs. Most of the adverse events (AE) following ferric citrate treatment were mild at most.ConclusionCollectively, our review suggests that iron-based phosphate binder, ferric citrate is an effective and safe treatment option for CKD patients with hyperphosphatemia and anemia. More importantly, this alternative treatment may also less expensive. Nevertheless, more scientific studies are warranted to validate our findings.