基于行动学习方法的住院医师规范化培训中高阶思维能力培养研究

住院医师规范化培训旨在培养能独立、规范承担常见多发疾病诊疗工作的临床医师,是医学教育培养体系的重要一环.为推进医学教育改革,大力发展住院医师高阶思维能力,才能更好地医疗卫生服务.笔者立足心内科住院医师规范化培训,运用行动学习方法,围绕心内科的临床实践教学设计、组织和效果评价,探索了如何有效地提升住院医师的高阶思维能力,...     

浅谈妇科恶性肿瘤患者化疗护理干预

目的：探讨护理对妇科恶性肿瘤患者化疗干预的效果.方法：选取2008年1月至2010年4月在我院的收治进行化疗的妇科恶性肿瘤患者46例,其中,宫颈癌患者为12例,子宫内膜癌患者为3例,卵巢癌患者为22例,恶性葡萄胎患者为9例,所有患者均无其他疾病史.化疗方法按照国家标准化疗方案进行化疗.结果：通过一系列的护理措施,减轻了患者的痛苦,增加了治疗的效果.结论：通过对化疗的妇科恶性肿瘤患者进行护理干预,减轻了患者的化疗痛苦,增强了患者的治疗信心,提高了患者的生活质量.     

泊马度胺治疗复发/难治性多发性骨髓瘤的疗效、安全性研究

多发性骨髓瘤(MM)是好发于老年患者的恶性浆细胞疾病。近10余年靶向新药(包括硼替佐米、来那度胺等)、造血干细胞移植及嵌合抗原受体T(CAR-T)细胞免疫治疗的应用, 使骨髓瘤患者的疗效和预后取得了革命性进步[1], 但MM至今仍无法治愈, 患者终将面临疾病复发进展, 进而难治[2]。如何为复发/难治性MM(RRMM)患者选择治疗方案仍然是临床面临的难题。泊马度胺是第三代免疫调节剂, 具有多重抗骨髓瘤机制, 通过与Cereblon结合激活E3泛素连接酶复合物活性, 促进底物蛋白Ikaros和Aiolos泛素化和蛋白水解, 抑制MM细胞增殖[3-5], 并发挥免疫调节和抗血管生成作用, 对既往硼替佐米及来那度胺等靶向药物耐药的MM患者有显著疗效。2013年泊马度胺被美国食品药品监督管理局(FDA)批准用于治疗RRMM, 2020年11月泊马度胺在我国获批上市。目前泊马度胺在国内应用时间较短, 其治疗RRMM的疗效、安全性数据较少。因此本研究回顾性分析50例应用泊马度胺治疗的RRMM患者的疗效及安全性, 旨在为RRMM患者的治疗选择提供借鉴和参考。     

头孢氨苄缓释片的研制

目的:制备头孢氨苄缓释片,通过溶出度试验研究其生物利用度和药代动力学。方法:EudragitⅡ和HPMC作为缓释材料制备头孢氨苄缓释片,并与日本进口头孢氨苄缓释片(Syncl SR tablets)进行了体外释放度比较。结果:本制备品与进口片溶出结果相似,经人体生物利用度研究表明,头孢氨苄缓释片比普通胶囊口服后能明显推迟达峰时间,并降低峰浓度(P<0.01),缓释片与普通胶囊的AUC_(0→24)之间没有显著性差异(P>0.05)。缓释片相对于普通胶囊生物利用度为(104.90±8.35)％。结论:体内和体外实验结果表明本品达到预期效果。     

达格列净在IgA肾病中的临床应用1例

<正>本文报道1例应用SGLT2抑制剂（SGLT2i）达格列净治疗IgA肾病的病例，该患者诊断为IgA肾病、慢性肾脏病3a期A3、肾性高血压、高甘油三酯血症、耳源性眩晕、高尿酸血症和骨质疏松，在接受达格列净治疗后，患者24 h尿蛋白得到明显改善，估算肾小球滤过率（eGFR）保持在稳定水平，血压控制良好。现报告如下。1病例资料患者女性，66岁，于1969年感冒后出现颜面部水肿，诊断为“急性肾小球肾炎”，治疗后好转（具体治疗不详），后反复出现双下肢水肿，予中药等治疗，复查尿蛋白在2+～3+左右。1999年开始患者出现血压偏高，最高血压180/90 mmHg(1 mmHg=0.133 kPa)。2005年北大深圳医院行肾脏穿刺活检提示IgA免疫荧光染色IgA（+），病理报告诊断结果为IgA肾病。2012年以来患者长期口服氨氯地平阿托伐他汀、缬沙坦、骨化三醇，降压、降脂及利尿对症治疗。2015年6月5日复查24 h尿蛋白定量1379.22 mg/24 h，血肌酐101μmol/L，拟进一步肾脏穿刺活检，7月14日以“颜面部及下肢水肿40余年”入香港大学深圳医院。既往史：否认糖尿病、...     

The role of mother-child relationship in the association between maternal parenting stress and emotional and behavioral problems in preschool children北大核心CSCD

Objective To study the moderating effect of mother-child relationship in the association between maternal parenting stress and emotional and behavioral problems in preschool children, and to provide reference for the prevention and control of emotional and behavioral problems in preschool children. Methods Using a stratified cluster sampling method, 2 049 preschool children were surveyed from November to December 2021, who sampled from 12 kindergartens in Wuhu City, Anhui Province. The emotional and behavioral problems of preschool children were assessed with the Strength and Difficulties Questionnaire. Pearson correlation analysis was used to evaluate the relationship of maternal parenting stress and mother-child relationship with children's emotional and behavioral problems. The PROCESS Macro was used to analyze the moderating effect of conflicted and dependent mother-child relationships in the association between maternal parenting stress and emotional and behavioral problems in these preschool children. Results Among these preschool children, maternal parenting stress was positively correlated with the scores of emotional symptoms, conduct problems, hyperactivity, and peer problems subscales and total difficulty scores (P<0.001); intimate mother-child relationships were negatively correlated with the scores of conduct problems, hyperactivity, and peer problems subscales and total difficulty scores (P<0.001); conflicted and dependent mother-child relationships were positively correlated with the scores of emotional symptoms, conduct problems, hyperactivity, and peer problems subscales and total difficulty scores (P<0.001). After controlling for relevant confounding factors, conflicted mother-child relationship (β=0.05, P=0.001) and dependent mother-child relationship (β=0.04, P=0.012) were found to have a moderating effect on the association between maternal parenting stress and total difficulty scores in these preschool children. Conclusions Negative mother-child relationships play a moderating role in the association between maternal parenting stress and emotional and behavioral problems in preschool children. Prevention of emotional and behavioral problems in preschool children should focus on reducing maternal parenting stress and improving negative mother-child relationships. © 2023 Xiangya Hospital of CSU. All rights reserved.     

周期性张应力作用下Hippo-YAP信号通路调控人牙周膜细胞自噬

目的 探究周期性张应力（CTS）作用下人牙周膜细胞（hPDLCs）自噬激活的分子机制。方法 分离培养正常牙周组织的hPDLCs，利用Forcel四点弯曲细胞加力仪对hPDLCs加载张应力模拟正畸牙移动过程中正畸力诱导的张力侧hPDLCs自噬，利用XMU-MP-1抑制Hippo信号通路探究Hippo-YAP信号通路在张应力激活hPDLCs自噬中的作用。采用实时荧光定量聚合酶链反应（RT-qPCR）检测hPDLCs自噬相关基因（Beclin-1、LC3、p62）的表达；采用蛋白免疫印迹（Western blot）检测hPDLCs自噬相关蛋白（Beclin-1、LC3-Ⅱ/LC3-Ⅰ、p62）及Hippo-YAP通路相关蛋白（active-YAP、p-YAP）的表达；采用免疫荧光染色定位hPDLCs自噬相关蛋白（LC3-Ⅱ、p62）及Hippo-YAP通路相关蛋白（active-YAP）。结果 CTS激活hPDLCs的自噬，自噬相关因子表达随加力时间的延长呈先升高后降低的趋势，30 min自噬开始，3 h达到高峰，随后出现下调（P<0.05）;CTS促进active-YAP蛋白表达增加...