从“名老中医工作室”建设探讨中医传承人才的培养模式

在现代社会,中医人才是中医药宝贵经验得以继承发展的载体。优化中医人才培养模式、加快中医人才培养速度、提高中医人才培养质量是振兴中医事业的重要内容。作为综合医院内的中医科,我科结合自身特色,围绕 “宗修英名老中医工作室”建设创新开展了一系列中医传承人才的培养工作,积极探索、总结经验,取得了良好效果。     

陕西省018例HIV/AIDS病人HBV、HCV及TP合并感染情况

目的 分析陕西省艾滋病病毒（HIV）感染者/艾滋病（AIDS）病人（简称HIV/AIDS病人）中,乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）及梅毒螺旋体（TP）共感染情况,为陕西省HIV防控提供科学依据。方法 对陕西省HIV/AIDS病人进行横断面调查,采用酶联免疫吸附试验（ELISA）进行乙肝五项、抗-HCV及抗-TP检测。结果 018例HIV/AIDS病人中,112例（11.0%）乙肝表面抗原（HBsAg）阳性,共发现19种血清模式,其中以HBsAb单阳最高,446例（43.8%）,其次为HBV标志物全阴,307例（30.2%）,乙肝“大三阳”（HBsAg+、HBsAb-、HBeAg+、HBeAb-、HBcAb+）16例（1.6%）;抗-HCV阳性119例（11.1%）;抗-TP阳性265例（26.0%）;抗-HCV+抗-TP阳性22例（2.2%）,抗-HCV+HBsAg阳性17例（1.7%）,抗-TP+HBsAg阳性26例（2.6%）,抗-HCV+HBsAg+抗-TP阳性1例（0.1%）。结论 陕西省HIV/AIDS人群中HBV、HCV、TP合并感染率高于普通人群,应加强HIV/AIDS人群宣传教育及乙肝疫苗接种工作。     

Controllable release of pirfenidone by polyvinyl alcohol film embedded soft contact lenses in vitro and in vivo

To increase the amount of pirfenidone (PFD) loaded in polyvinyl alcohol (PVA) film embedded soft contact lens (SCL), and evaluate its function of sustaining delivery of drug in vitro and in vivo. Drug loading efficiency within PVA film and SCLs, drug release from SCLs in vitro, and the effects of parameters of SCLs and external environment on drug release in vitro were evaluated by ultraviolet–visible spectrophotometer at 312 nm. Safety of SCLs was evaluated in vitro by transformed human corneal epithelial cell. Safety in vivo was determined by optical coherence tomography and histology of anterior segment of rabbits. Drug release study in tear fluid and aqueous humor were measured by ultra-performance liquid chromatography. SCLs had smooth surface and were fit for experimental rabbits. Amount of PFD in PVA film and SCLs were 153.515 μg ± 12.508 and 127.438 μg ± 19.674, respectively, PFD in PVA film was significantly higher than SCLs (p=.006) and closed to 150 μg (targeting amount of PFD to be loaded). Thickness of SCLs, molecular weight of PVA, and amount of PVA used in SCLs affected drug release in vitro significantly. Thickness of PVA film and amount of drug in SCLs had no effect on drug release rate in vitro. SCLs were safe in vitro and in vivo, PFD released from SCLs could be detected around 12 hours in tears and aqueous humor, and the concentration of drug was higher than eye drop at all detected time points while amount of PFD in SCLs was lower than eye drop. Drug loaded PVA film embedded SCLs may be a promising ocular drug delivery system.     

选择性激光小梁成形术体外激光效应模型的建立

背景选择性激光小梁成形术（SLT）是利用532nmNd：YAG激光选择性地作用于小梁网含有色素的小梁细胞而发挥降眼压作用,但其对细胞的具体作用机制尚不完全清楚。目的建立小梁细胞激光效应模型,观察色素化小梁细胞经不同能量激光照射后的形态变化。方法采用人小梁细胞体外实验的方法,将永生化人小梁细胞与色素颗粒混悬液隔夜孵育培养16h制备色素化小梁细胞,并用苏木精一伊红染色法鉴定色素化小梁细胞模型。用改良的激光镜模拟激光斑大小（400μm）和激发时间（3ns）,设置标准能量（0．2mJ）和低能量（0．1mJ）激光分别照射色素化小梁细胞,激光照射后1、4、8、12、24h分别用光学显微镜和透射电子显微镜观察色素化小梁细胞的形态变化;分别用锥虫蓝染色和TUNEL荧光染色法评估不同能量激光照射后小梁细胞的死亡数和凋亡数。结果人小梁细胞用DMEM／F12培养基与色素颗粒共培养16h后,细胞质内可见棕褐色色素颗粒。光学显微镜下可见,激光照射无色素化小梁细胞后,细胞形态无明显变化,但照射色素化小梁细胞后,培养皿内可形成直径约400μm的类圆形激光斑。透射电子显微镜下显示,激光照射后小梁细胞崩解,色素颗粒释放。标准能量激光照射培养皿中的细胞后,激光斑内中央均出现细胞缺失区,可见锥虫蓝阳性染色细胞、TUNEL阳性染色细胞及排列和形态正常的细胞区,低能量激光照射后上述改变较轻微。激光照射后24h可见新生小梁细胞增生并移行至激光斑中央区;激光照射后的量化分析表明,各时间点低能量照射后锥虫蓝阳性细胞和TUNEL阳性细胞明显少于标准能量照射后,差异均有统计学意义（P〈0．001）,2个组照射后各时间点间锥虫蓝阳性细胞和TUNEL阳性细胞逐渐减少,差异均有统计学意义（P〈0．01）。结论通过模型激光镜照射色素化培养的小梁细胞可以成功地建立激光效应模型。激光照射色素化小梁细胞后细胞可出现气化、死亡或凋亡,但随着时间的延长,激光破坏的细胞由增生和移行的小梁细胞替代。与标准能量的激光照射相比,低能量激光照射对色素化小梁细胞形态改变的影响相似,但损伤的细胞数量明显减少。     

TBL教学法在呼吸系统病理教学实践中的应用

<正>病理学是研究人体疾病发生的原因、发生机制、发展规律以及疾病过程中机体的形态结构、功能代谢变化和病变转归的一门基础医学科学。疾病的发生于进展是一个极其复杂的过程:在致病因子与机体反应功能的相互制约与平衡之的作用下,患病机体内部相应的形态结构、代谢及功能均会发生各种变化,这些都是研究和认识疾病的重要依据,而病理学的任务就是运用各种方法研究疾病的原因(病因学)、在病因作用下疾病发生发展的过程(发病学)以及机体在疾病过程中的功能、代谢和形态结构的改变,阐明其本质,从而为认识和掌握疾病发生发展的规律,为防治疾病,提供必要的理论基础。病理学既是医学基础学科,同时又是一门实践性     

miR-206靶向MAPK-1通路增强胶质瘤细胞放射敏感性

目的 研究miR-206对胶质瘤细胞放射敏感可能作用的信号通路,为深入研究其调控机理奠定基础。方法 将miR-206模拟剂或miR-206抑制剂转染到胶质瘤U87细胞中,使用抑制剂PD98059抑制MAPK通路活性并照射处理细胞,MTT和克隆形成实验检测细胞放射敏感性变化。分别用qRT-PCR和蛋白印迹法检测miR-206和MAPK1的表达变化,TargetScan软件预测和双荧光素酶报告实验验证miR-206和MAPK1的相互作用。结果 胶质瘤细胞放射处理后miR-206表达下调,MAPK1表达上调。miR-206模拟剂过表达miR-206,细胞增殖和克隆形成能力下降,放射敏感性增高;转染抑制剂抑制miR-206表达,细胞增殖和克隆形成能力加强,放射敏感性降低。使用TargetScan软件查找发现MAPK1可能是miR-206的靶基因,双荧光素酶报告实验进一步验证了miR-206和MAPK1具有相互作用。过表达或降低miR-206表达,MAPK1与miR-206呈相反变化趋势。使用抑制剂抑制MAPK信号通路,胶质瘤细胞放射敏感性升高。结论 miR-206可能靶向MAPK1,通过抑制MAPK信号通路活性调节胶质瘤细胞的放射敏感性。     

Putative digenic inheritance of heterozygous RP1L1 and C2orf71 null mutations in syndromic retinal dystrophy

Background: Retinitis pigmentosa (RP) is the most common cause of inherited retinal degeneration and can occur in non-syndromic and syndromic forms. Syndromic RP is accompanied by other symptoms such as intellectual disability, hearing loss, or congenital abnormalities. Both forms are known to exhibit complex genetic interactions that can modulate the penetrance and expressivity of the phenotype.

Materials and methods: In an individual with atypical RP, hearing loss, ataxia and cerebellar atrophy, whole exome sequencing was performed. The candidate pathogenic variants were tested by developing an in vivo zebrafish model and assaying for retinal and cerebellar integrity.

Results: Exome sequencing revealed a complex heterozygous protein-truncating mutation in RP1L1, p.[(Lys111Glnfs*27; Gln2373*)], and a heterozygous nonsense mutation in C2orf71, p.(Ser512*). Mutations in both genes have previously been implicated in autosomal recessive non-syndromic RP, raising the possibility of a digenic model in this family. Functional testing in a zebrafish model for two key phenotypes of the affected person showed that the combinatorial suppression of rp1l1 and c2orf71l induced discrete pathology in terms of reduction of eye size with concomitant loss of rhodopsin in the photoreceptors, and disorganization of the cerebellum.

Conclusions: We propose that the combination of heterozygous loss-of-function mutations in these genes drives syndromic retinal dystrophy, likely through the genetic interaction of at least two loci. Haploinsufficiency at each of these loci is insufficient to induce overt pathology.     

焦炉逸散物暴露对焦炉工人肺功能影响的队列研究

目的 通过对比研究同一批焦炉工人焦炉逸散物暴露5年前后肺通气功能的损伤情况,进一步探讨焦炉逸散物与焦炉工人肺通气功能损伤的关系.方法 选取山西某焦化厂焦炉作业工人165人(暴露组)和辅助工人52人(对照组)为研究对象,使用统一调查表收集工人个人信息.定点定期采集工作场所中空气样本,高压液相色谱仪测定空气样本中苯并(a)芘浓度.分别于2009和2013年使用便携式肺功能仪测定研究对象肺通气功能,并进行对比分析.结果 2009至2013年同一区域B(a)P浓度的差异无计学意意义(P＞0.05).与2009年比较,2013年对照组工人各肺功能测定值及异常率差异无统计学意义(P＞0.05),而暴露组工人用力肺活量(FVC％)、第1秒用力呼气容积(FEV10％)、最大通气量(MVV％)、肺活量(VC％)、25％肺活量时呼气流速(FEF.％)均显著降低,FVC％、FEV10％和VC％异常率显著升高,差异有统计学意义(P＜0.05).新出现肺功能异常的工人主要分布在炉顶和炉侧,炉顶组FVC％、FEV1.0％、VC％新增异常人数(率)明显高于对照组和炉底组,炉侧组明显高于对照组,差异有统计学意义(P＜0.05).多因素logistic回归分析结果显示,继续暴露5年后,炉顶作业工人FVC％、FEV1.0％和VC％新出现肺功能异常的调整OR分别为7.939、5.966和4.956;接焦工龄为暴露组工人FVC％、FEV1.0％、MVV％、VC％异常的危险因素.接焦工龄与炉顶作业存在正向交互作用,差异有统计学意义(P＜0.05).结论 焦炉工人肺功能损伤与焦炉逸散物暴露有关,焦炉逸散物暴露水平和暴露时间是焦炉工人肺功能损伤的主要影响因素,二者存在正交互作崩.