PBL-CBL整合教学在内分泌科轮转临床医学专业学位研究生培养中的应用

目的 探讨以问题为基础的学习（problem-based learning,PBL）-以案例为基础的学习（case-based learning,CBL） 整合教学在内分泌科轮转临床医学专业学位研究生培养的效果。方法 将80名在内分泌科轮转的临床医学专业学位研究生随机分为试验组（采用PBL-CBL整合教学）和对照组（采用传统教学）,每组40人,轮转期为3个月。记录两组学生入科和出科时专业考试成绩,并通过问卷调查分析自信心、学习主动性和人际交往能力。采用SPSS 20.0进行t检验、卡方检验。结果 两组学生基线情况一致,经过3个月的转轮期后,与入科前相比,试验组学生的出科考试成绩、自信心、学习主动性和人际交往能力明显提升,差异均有统计学意义（P<0.001）。结论 PBL-CBL整合教学效果优于传统教学,有助于提高临床医学专业学位研究生在内分泌轮转的学习能力和成绩,值得推广。     

肥胖相关性肾病诊疗研究进展

肥胖相关性肾病已呈流行发展趋势,已成为终末期肾病的主要原因之一。目前认为其发病机制主要与肥胖所致肾小球血流动力学改变和脂质异位沉积等相关,但其机制仍未完全阐明。减轻体重是治疗肥胖相关性肾病的重要方法,但常因环境、个人执行情况的影响而收效甚微,且有部分患者体重控制后肾病仍持续进展。综合应用有效的肥胖相关性肾病治疗方法,对控制其进展十分重要。该文综述肥胖相关性肾病的致病机制和诊疗进展,探讨中药在肥胖相关性肾病治疗中的价值,旨在为临床提供参考,提高肥胖相关性肾病一体化管理水平。     

胎儿筛骨的形态学研究

本文从组织学角度,研究胎儿筛骨的形态学变化以及水平板、纸板和筛凹的发育特点。结果表明:筛骨整体(在冠状位)呈等腰梯形,即纸板为梯形的两边;胎儿期的纸板在水平切面上呈向外凹的骨板,至出生时呈轻微的“S”形弯曲;胚胎第24周后,水平板的外侧部分逐渐形成筛凹,并随筛窦的气化而变薄,形成筛窦的顶部。上述结果提示:出生时其眶内侧壁(主要为纸板)结构不呈矢状平面,且与水平板间的角度(斜度)随胎龄增长而增大(P<0.01);筛骨水平板则由内侧部分的筛板和外侧部分的筛凹组成。     

Preparation and characterization of porous beta-tricalcium phosphate/collagen composites with an integrated structure

Porous beta-tricalcium phosphate (TCP)/collagen composites with different beta-TCP/collagen weight ratio were prepared. The influences of the preparation conditions on the microstructure of porous composite and the joint status of beta-TCP particles with collagen fibrils were characterized by X-ray diffractometer, scanning electron microscopy and transmission electron microscopy. The results showed: (1) an acid treatment could effectively disassemble collagen fibrils; (2) in the resulting porous composites, beta-TCP particles homogenously existed on the skeleton of the collagen fibril network and bonded tightly to both the fibrils and themselves. The tight bonding formation could be due to the reaction between Ca ions in the particles and carboxyl groups in collagen polypeptide chains and due to the reprecipitation of partially dissolved beta-TCP during synthesis. The tight bonding between beta-TCP particles and collagen fibrils in the composites demonstrated an integrated structure, which was reproducible when beta-TCP/collagen ratio ranged from 2 to 4. Such integrated structure would make significant contributions in reliably tailoring properties of the porous composites by varying beta-TCP content. In addition, the porous composites had large porosity (approximately 95%) and appropriate pore size (approximately 100 microm), showed no negative impact in cytotoxicity assay and complete bone tissue regeneration after 12 weeks in animal test.     

雷诺氏综合征患者的微循环特点和中西结合治疗

对40例雷诺氏综合征（RDS）患者应用益气通阳活血化瘀中药与西药倍他乐克联合治疗，同时观察RDS患者治疗前后的甲襞微循环（NFM）、血液流变性和彩色多普勒血流显像（CDFI）变化。结果显示RDS患者经治疗后NFM明显改善，细动脉增宽、血流加快（P＜0．05），全血粘度、血浆粘度、纤维蛋白原及体外血栓重量与长度明显减轻缩小（P＜0．01）；CDFI表现动脉痉挛消失，血流阻力下降以及血流量增加。提示：益气通阳活血化瘀中药和倍他乐克西药合用有明显的降粘、解聚、抗栓、改善微循环的作用，治疗RDS有较好的疗效。     

Survey of the Distribution of a Newly Characterized Receptor for Advanced Glycation End Products in Tissues

Advanced glycation end products (AGEs), the final products of nonenzymatic glycation and oxidation of proteins, are found in the plasma and accumulate in the tissues during aging and at an accelerated rate in diabetes. A novel integral membrane protein, termed receptor for AGE (RAGE), forms a central part of the cell surface binding site for AGEs. Using monospecific, polyclonal antibody raised to human recombinant and bovine RAGE, immunostaining of bovine tissues showed RAGE in the vasculature, endothelium, and smooth muscle cells and in mononuclear cells in the tissues. Consistent with these data, RAGE antigen and mRNA were identified in cultured bovine endothelium, vascular smooth muscle, and monocyte-derived macrophages. RAGE antigen was also visualized in bovine cardiac myocytes as well as in cultures of neonatal rat cardiac myocytes and in neural tissue where motor neurons, peripheral nerves, and a population of cortical neurons were positive. In situ hybridization confirmed the presence of RAGE mRNA in the tissues, and studies with rat PC12 pheochromocytes indicated that they provide a neuronal-related cell culture model for examining RAGE expression. Pathological studies of human atherosclerotic plaques showed infiltration of RAGE-expressing cells in the expanded intima. These results indicate that RAGE is present in multiple tissues and suggest the potential relevance of AGE-RAGE interactions for modulating properties of the vasculature as well as neural and cardiac function, prominent areas of involvement in diabetes and in the normal aging process.     

Ryk-mediated Wnt repulsion regulates posterior-directed growth of corticospinal tract

Guidance cues along the longitudinal axis of the CNS are poorly understood. Wnt proteins attract ascending somatosensory axons to project from the spinal cord to the brain. Here we show that Wnt proteins repel corticospinal tract (CST) axons in the opposite direction. Several Wnt genes were found to be expressed in the mouse spinal cord gray matter, cupping the dorsal funiculus, in an anterior-to-posterior decreasing gradient along the cervical and thoracic cord. Wnts repelled CST axons in collagen gel assays through a conserved high-affinity receptor, Ryk, which is expressed in CST axons. Neonatal spinal cord secretes diffusible repellent(s) in an anterior-posterior graded fashion, with anterior cord being stronger, and the repulsive activity was blocked by antibodies to Ryk (anti-Ryk). Intrathecal injection of anti-Ryk blocked the posterior growth of CST axons. Therefore, Wnt proteins may have a general role in anterior-posterior guidance of multiple classes of axons.     

脊髓损伤后神经修复过程中的细胞微环境北大核心

背景:以往的研究显示单一改变脊髓损伤区域某一基因表达或者某一细胞的状态,对脊髓损伤后功能恢复无显著影响,而大量证据表明调控脊髓损伤后紊乱的细胞微环境是神经功能恢复的关键因素。目的:对脊髓损伤前后细胞微环境的生物学特性,包括多种细胞之间的相互调控以及细胞外组分对损伤神经修复的作用和机制进行综述。方法:由第一作者检索PubMed及Web of Science数据库,英文检索词为“spinal cord injury,glial cell,neuron,immune cell,neural stem cell,extracellular matrix,cytokine,extracellular vesicle,regeneration”。文献检索的时间范围为2000年1月至2021年12月,最终筛选出64篇文献进行分析。结果与结论:①脊髓损伤后,在细胞微环境的细胞组分中,占比最高的胶质细胞间的相互作用,以及与神经元的相互调控作用最为关键。②在脊髓损伤后的细胞外组分中,利用生物相容性良好的水凝胶模仿天然细胞外基质,可有效模拟和重建损伤区域内的细胞微环境,促进轴突伸长。③在脊髓损伤后的细胞外调节因子中,促炎因子如肿瘤坏死因子α和白细胞介素1β等加剧了细胞微环境的炎症反应,应用受体抑制剂或阻断相关通路抑制上述促炎因子的表达是一种有效的治疗方法,同时在脊髓微环境中增加白细胞介素10等抗炎因子的表达,抑制损伤区域炎症发展的研究也陆续出现。④最近被重视起来的细胞外囊泡作为传递信息的载体在细胞微环境中也发挥了重要作用。⑤文章揭示了脊髓损伤后细胞微环境中的包括细胞组分和细胞外组分之间的多组相互调控关系,证实了细胞微环境中各组分之间所发挥的神经修复作用并不是孤立的。     

镉对培养大鼠睾丸支持细胞的损伤及黄芪的拮抗作用

目的:探讨镉对培养大鼠睾丸支持细胞的损伤及黄芪的保护作用.方法:对照组和经镉、镉加黄苠处理的原代培养大鼠睾丸支持细胞用于波形蛋白、E-钙黏蛋白免疫组织化学检测、细胞内钙离子浓度测定及电镜观察.结果:镉处理后2种蛋白阳性产物表达较对照组减弱.镉加黄芪组阳性产物较对照组减弱但明显强于镉组.对照组、镉和镉加黄苠组细胞内钙离子浓度分别为(81.773±3.711)、(161.6024±1.978)和(104.278±1.963).镉处理后支持细胞超微结构受损明显,部分细胞核异染色质凝聚或核碎裂,胞质空泡化.镉加黄芪组细胞破坏较轻.结论:镉对培养支持细胞具有明显的毒性作用,而黄苠可以拮抗镉对支持细胞的损伤.     

Wg3h细胞系转染PSV_2-neo质粒前后生长特性及表面超微结构改变的研究

本文对转染PSV_2-neo质粒后的Wg3h细胞系(Wg3h-neo)在长期传代中的生长特性和表面超微结构与母系Wg3h细胞进行了比较研究。结果发现:转染后Wg3h细胞的DNA合成及生长速度明显高于母系Wg3h细胞,生长饱和密度增大。在软琼脂培养中不形成集落,接种在裸鼠不长肿瘤。在扫描电镜下,细胞表面的微绒毛较母系Wg3h细胞丰富。Southern印迹杂交实验证明PSV_2-neo质粒已整合到宿主细胞的基因组中。转染后Wg3h细胞的生长特性和表面超微结构均发生了某些转化特征。