行气散外敷治疗结核性肠梗阻的疗效观察

目的:探讨中西医结合治疗结核性腹膜炎伴粘连性肠梗阻的疗效。方法:96例结核性腹膜炎合并肠梗阻患者随机分为治疗组及对照组,每组各48例,治疗组及对照组均在抗痨治疗的基础上给予常规禁食、持续胃肠减压、抗感染、补液支持等治疗,治疗组则在此基础上加用中药行气散外敷治疗。结果:治疗组疗效有效率为91.67%,优于对照组的64.60%(P<0.05);且治疗组的住院时间与对照组相比明显缩短,优于对照组(P<0.05)。结论:西医常规治疗的基础上结合中药行气散外敷治疗,具有良好的临床效果,在抗痨治疗的基础上能有效缓解肠梗阻,同时缩短住院时间,值得在临床上推广应用。     

临床医学专业学位硕士研究生开展叙事医学课程的初步研究

目的　建立一套科学合理的临床医学专业学位研究生叙事医学课程标准,提高临床医学专业学位研究生的医学人文素养。方法　在查阅文献、小组讨论的基础上初步构建临床医学专业学位研究生叙事医学课程标准,采用Delphi法对指标进行评价筛选,然后拟定专家咨询问卷,对选取的40名专家进行专家咨询,最终确定叙事医学的课程标准。对重庆市西南医院肝胆外科在读研究生进行小范围教学实践,并收集了教学实施过程出现的各种问题。结果　经过2轮咨询后,专家的意见趋于一致。最终确定由叙事医学导论理论课、叙事医学相关书籍的阅读、医学叙事影视作品的观摩、叙事医学病历的书写4个部分组成的理论和实践相结合的课程。通过小范围的教学实践,收集了教学实施过程中出现的各种问题,对问题进行整理与分析,并提出了改进方案。结论　临床医学专业学位研究生叙事医学课程设置的构建合理,可为提升临床医学专业学位研究生的人文素养和医患沟通能力奠定基础,加快叙事医学理念在我国的普及进程。     

医学院校研究生学术英语写作教材编写研究

医学全球化背景下,运用学术英语（English for academic purposes,EAP）撰写论文成为我国医学研究生面临的挑战。而自编教材的缺乏是制约EAP教学效果的一大瓶颈。研究基于复合型人才团队,以EAP理论为指导,对医学院校研究生开展深度需求分析,结合体裁分析理论设计教材框架,根据自建语料库确定材料筛选原则,最后编写完成适用于医学院校研究生的EAP写作教材。教材编写研究过程及教材本身有望为其他学科EAP教材编写提供借鉴,从而促进我国研究生教育的全面发展。     

NLR及PLR对晚期尿路上皮癌免疫治疗疗效和预后的预测价值

目的：探讨外周血中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio,NLR）和血小板与淋巴细胞比值（platelet to lymphocyte ratio,PLR）对晚期尿路上皮癌免疫治疗疗效和预后的预测价值。方法：回顾性分析2019年9月至2022年7月接受过免疫检查点抑制剂治疗的晚期尿路上皮癌患者的临床资料,绘制受试者工作特征曲线,根据曲线下面积（area under the curve,AUC）筛选的最佳截断值分组,应用Kaplan-Meier生存分析比较组间生存差异,运用Cox模型进行多因素分析筛选出独立预测因素。结果：共纳入57例患者,经3周期免疫治疗后NLR较治疗前显著下降（P<0.001）,分别为2.40±1.08和3.05±1.07;而治疗前后PLR无明显变化（P=0.402）,分别为226.41±111.70和246.97±113.17;外周血中治疗前后NLR、PLR及NLR变化幅度的AUC分别为0.829 1(P=0.004)、0.889 6(P<0.001)、0.743 6(P=0.003)、0.740 4(P&l...     

高泌乳素血症诊治若干临床问题探讨

高泌乳素血症是继发性性腺功能减退的常见原因,影响男性及女性的生殖功能,目前高泌乳素血症的诊治存在较多挑战。在激素测定方面存在低估激素真实水平的“钩状效应”,无症状或与症状不相符的高泌乳素水平为特点的巨泌乳素血症;在诊断时应注意鉴别生理性、病理性或药物性这三大常见原因从而减少误诊、漏诊;多巴胺受体激动剂是一线治疗,但对于耐药的高泌乳素血症应在全面评估病情后选择外科手术、放疗及其他药物的试验性治疗（如替莫唑胺）等;妊娠阶段是泌乳素生理性分泌增加的时期,不建议孕期应用泌乳素测定评价病情,主要通过有无肿瘤占位效应及病情危急情况决定是否需要启动药物或手术治疗。对于耐药/难治性高泌乳素血症及妊娠期高泌乳素血症的诊疗建议在有经验的多学科诊疗团队支持下进行。     

Transnasal Endoscopic and Transoral Approaches in the Biopsies of Ventral Atlas and Axis Vertebrae: A Comprehensive Retrospective Study for Preprocedural Scheme,Biopsy Procedure,Core Technique Analysis,Diagnostic Yield and Clinical Outcome

ObjectiveThis study aims to describe and analyze the transoral and transnasal approaches for pathologies of the ventral atlas and axis vertebrae, which are considered technically challenging regions for diagnostic biopsy.MethodsA series of transnasal endoscopic approach (TNA) and transoral approach (TOA) biopsies for the pathologies of the first and second cervical vertebrae were conducted and retrospectively analyzed from July 2014 to May 2021. The depth of the biopsy trajectory was measured on computed tomography images for all nine patients (eight males and one female with an average age of 58.11 ± 11.60 years), as were the coronal, sagittal, and vertical biopsy safe ranges. The characteristics of each lesion, including radiographic features, blood supply, and destruction of anterior or posterior vertebral body edges, were evaluated to guide the biopsy. Four biopsy core techniques (BCTs), including “lesion perforating”, “aspiration”, “cutting‐and‐scraping” and “biopsy forceps utilization” were elaborated in this study. The biopsy procedures and periprocedural precautions were demonstrated. Patient demographics, clinical data, lesion characteristics, diagnostic yield, and complications were recorded for each case.ResultsEight TOA biopsies for the axis vertebral body and one TNA biopsy for the atlas anterior arch were successfully performed and yielded adequate pathologies. All biopsies were organized based on the preprocedural radiographic measurements, which showed that the average length of biopsy trajectory and coronal, sagittal, and vertical safe biopsy ranges were 85.00 ± 5.88, 20.63 ± 4.75, 16.25 ± 1.49, and 24.63 ± 2.26 mm, respectively, and these corresponding data were 95, 36, 9, and 26 mm in the TNA patient. Six osteolytic lesions (66.7%), one osteoblastic lesion (11.1%), and two mixed lesions (22.2%) were observed, among which seven lesions had a rich blood supply. Biopsy forceps and core needles were utilized to obtain samples in six and three patients, respectively. All the TNA and TOA biopsies were performed with cooperative application of multiple BCTs under compound anatomic and stereotactic navigations. Intraprocedural or postprocedural complications occurred in no patients who underwent the biopsy in the follow‐up period (1–39 months). No significant differences were found between the preprocedural and postprocedural blood indexes and visual analogue scale scores.ConclusionWith a sophisticated preprocedural arrangement, cooperative application of BCTs, and careful periprocedural precautions, transnasal endoscopic and transoral biopsies are two feasible, efficient, and well‐tolerated procedures that achieve satisfactory diagnostic yield, complication rate, and clinical outcome.     

内侧颞叶癫痫患者丘脑核团表面形状改变的结构MRI研究

目的:探讨内侧颞叶癫痫(mTLE)患者丘脑体积与丘脑局部形态学改变,并分析其与病程的相关性。方法:采用回顾性研究方法。纳入2009年7月—2019年2月东部战区总医院80例mTLE患者以及同期进行健康体检的60例年龄、性别与之相匹配的志愿者(正常对照组),对所有受试者进行全脑高分辨率MR T 1加权成像(T...     

结直肠癌中辅酶Q10的功能及分子机制探讨

目的：探索辅酶Q₁₀(coenzyme Q₁₀,CoQ₁₀)对结直肠癌细胞增殖和迁移能力的影响及潜在分子机制。方法：使用CoQ₁₀分别处理SW480细胞和RKO细胞后,采用细胞计数和细胞划痕实验探究CoQ₁₀对结直肠癌细胞增殖和迁移能力的影响;采用流式细胞术探究CoQ₁₀对结直肠癌SW480细胞周期和细胞凋亡的影响;采用RNA-seq测序分析CoQ₁₀对结直肠癌RKO细胞系基因表达谱的影响,将差异表达基因进行GO和KEGG通路分析,最后采用定量RT-PCR验证RNA-seq结果。结果：(1)CoQ₁₀对结直肠癌细胞系SW480的细胞增殖、细胞周期、细胞凋亡和细胞迁移均无明显影响,对结直肠癌细胞系RKO的细胞增殖也无明显影响,但可抑制RKO细胞迁移。(2)CoQ₁₀处理结直肠癌RKO细胞后的RNA-seq结果表明,差异表达基因明显富集于细胞黏附分子信号通路、细胞外基质受体信号通路和胆固醇信号通...     

遵循医学人才成长规律 将质量价值观落实到人才培养各环节

探讨医学教育的质量价值观,是为了服务健康中国战略、培养一流医学人才;本文提出医学人才成长七个规律。只有遵循医学人才成长规律,才能将医学教育质量价值观落实到医学人才培养各环节中,才能使医学教育改革真正达到提升医学人才培养质量的目的。     

Altereporenes A–E,five epoxy octa-hydronaphthalene polyketides produced by an endophytic fungus Alternaria sp. YUD20002

Five previously undescribed epoxy octa-hydronaphthalene polyketides, altereporenes A–E (1–5) were isolated from rice culture of the endophytic fungus Alternaria sp. YUD20002 derived from the tubers of Solanum tuberosum. Their structures were determined on the basis of comprehensive spectroscopic analyses, while the absolute configurations were elucidated by the comparison of experimental and calculated specific rotations. Meanwhile, the antimicrobial, cytotoxic, anti-inflammatory and acetylcholinesterase inhibitory activities of compounds 1–5 were also investigated.

Five previously undescribed epoxy octa-hydronaphthalene polyketides, altereporenes A–E (1–5) were isolated from rice culture of the endophytic fungus Alternaria sp. YUD20002 derived from the tubers of Solanum tuberosum.