疫情之下医学人文慕课建设的现状分析与思考

分析当前我国医学人文类慕课的建设现状,促进医学人文慕课优质课程资源共享,为课程设计规划提供信息参考。采用数理统计法、思维导图分析法对疫情期间17个在线课程平台上的42门医学人文慕课进行分析,结果显示：①医学人文慕课规模和数量有待扩增;②慕课建设存在地域不均衡性,华东地区建设最多;③慕课师资以团队授课为主,高级职称教师为团队主力,且部分教师团队为多学科背景;④课程内容中人文知识和能力相关教学内容丰富,但需适当增加医学人文精神认知相关内容。根据以上分析结果,建议医学人文慕课建设注重系统性和规范性,配备多学科专业背景师资团队,注意做好课程设计和规划,充分关注学习者的反馈与评价,以发现不足之处。     

应用比较基因组杂交技术对卵巢癌耐药机制的研究

目的探讨卵巢癌化疗耐药患者组织中染色体的变化特征,寻找或定位与卵巢癌化疗耐药密切相关的基因,以便对其耐药机制进一步研究。方法采用比较基因组杂交技术分析卵巢癌化疗耐药组（浆液性卵巢癌6例、黏液性卵巢癌3例、子宫内膜样卵巢癌2例、透明细胞癌1例,共12例）和化疗敏感组（浆液性卵巢癌5例、黏液性卵巢癌3例、子宫内膜样卵巢癌2例、透明细胞癌2例,共12例）两组癌细胞基因组的不平衡,即DNA丢失或扩增。结果化疗耐药患者组织中最常见的染色体DNA拷贝数增加的部位是3q,8q,20q,11q,17q,2p,1q;常见的染色体DNA拷贝数缺失的部位是9p,5q,10q,3p。其中17q的增加,耐药组为66．7％,敏感组为16．7％;1q的增加,耐药组为66、7％,敏感组为16．7％;3p的丢失,耐药组为50．0％,敏感组为8．3％,在化疗耐药患者组织中表现更加明显。结论卵巢癌耐药患者组织中细胞染色体基因组最明显的改变为17q,1q的增加以及3p的丢失,这些部位可能存在与卵巢癌化疗耐药密切相关的癌基因及抑癌基因。     

异丙酚对人脐静脉内皮细胞凋亡相关基因Bcl-2及Bax表达的影响

目的 :观察异丙酚 (Propofol)及肿瘤坏死因子 α(TNF α)对培养的人脐静脉内皮细胞 (HUVECs)凋亡相关基因Bcl 2及Bax表达的影响 ,探讨异丙酚抑制凋亡的机理。方法 :将培养的人脐静脉内皮细胞 3～ 4代于融合状态 ,随机分为 7组 :对照组 (P0 ) ,2 5 μmol/L异丙酚组 (P2 5) ,TNF α组 (P0 +TNF α) ,12 .5 μmol/L异丙酚和TNF α组 (P12 .5+TNF α) ,2 5 μmol/L异丙酚和TNF α组 (P2 5+TNF α) ,5 0 μmol/L异丙酚和TNF α组 (P50 +TNF α) ,10 0 μmol/L异丙酚和TNF α组 (P10 0 +TNF α)。各组加入相应药物培养 2 4h后收获细胞 ,采用免疫细胞化学染色方法测定Bcl 2及Bax蛋白表达。结果 :与对照组 (P0 )相比 ,异丙酚 2 5 μmol/L组 (P2 5)Bcl 2及Bax蛋白表达无明显变化 (P >0 .0 5 ) ;TNF α(P0 +TNF α)组Bcl 2蛋白表达降低 ,Bax蛋白表达升高 (P <0 .0 0 1) ;而不同浓度的异丙酚预处理后再加入肿瘤坏死因子的各组 (P12 .5+TNF α、P2 5+TNF α、P50 +TNF α、P10 0 +TNF α)Bcl 2蛋白表达增加 ,Bax蛋白表达降低 (P <0 .0 5或P <0 .0 1)。结论 :临床相关浓度的异丙酚可通过调节Bcl 2及Bax蛋白表达抑制TNF α诱导的内皮细胞凋亡     

肿瘤疫苗的作用机制及研究进展

0 引言 一直以来,对于肿瘤的治疗多采用手术,放疗和化疗三大常规方法.一百多年前,Caley用细菌疫苗免疫机体时,观察到肿瘤缩小.     

浅议生命伦理学中的民主自由

目前的生命伦理学正处于一种“缺乏最终根据”的危机之中，道德直觉的缺失实际上源于最高的伦理原则——如自由、人权、民主和正义等绝对的普遍价值的缺位和忽略；从灵魂深处启发、唤醒国民的自由民主意识和愿望，构建尊人和自尊的人文环境，乃是生命伦理学的必然诉求。     

Relationship between rosacea and sleep

Rosacea is a chronic facial skin disease involved in neurovascular dysregulation and neurogenic inflammation. Behavioral factors such as stress, anxiety, depression and sleep were identified to be associated with other inflammatory skin diseases. Few studies have reported sleep status in rosacea. Aiming to investigate the relationship between rosacea and sleep, a case–control survey was conducted, enrolling 608 rosacea patients and 608 sex- and age-matched healthy controls. Sleep quality was assessed through the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Diagnosis and severity grading of rosacea were evaluated under the standard guidelines of the National Rosacea Society. More rosacea patients (52.3%, n = 318) suffered poor sleep quality (PSQI, >5) than the healthy controls (24.0%, n = 146), displaying a much higher PSQI score (rosacea vs control, 6.20 vs 3.95). There was a strong association between sleep quality and rosacea (odds ratio [OR], 3.525; 95% confidence interval [CI], 2.759–4.519). Moreover, the severity of rosacea was also associated with sleep quality (OR, 1.847; 95% CI, 1.332–2.570). Single nucleotide polymorphisms in hydroxytryptamine receptor 2A and adrenoceptor-β1 genes, which are associated with sleep behaviour, were detected and revealed to be associated with rosacea. Furthermore, the LL-37-induced rosacea-like phenotype and sleep-deprivation mice models were applied, revealing that sleep deprivation aggravated the rosacea-like phenotype in mice, with higher expression of matrix metallopeptidase 9, Toll-like receptor 2, cathelicidin antimicrobial peptide and vascular endothelial growth factor. In conclusion, rosacea patients presented poorer sleep quality, as well as a higher propability of genetic background with sleep disturbance. In addition, poor sleep might aggravate rosacea through regulating inflammatory factors, contributing to a vicious cycle in the progression of disease.     

后路钉棒内固定治疗胸腰椎骨折的临床疗效分析

目的 探讨应用后路钉棒内固定系统治疗胸腰椎骨折的临床效果。方法 自2009年1月至2010年12月,我科采用后路钉棒内固定系统联合或不联合椎管减压植骨融合治疗胸腰椎骨折33例,其中,男21例,女12例,年龄21～57岁,平均37.5岁。根据术前脊髓神经损伤Frankel评定分级：A级1例,B级2例,C级2例,D级10例,E级18例,术前Cobb角为23.40±1.64°,椎体平均高度前缘32.02±2.99% 和后缘78.27±1.65%。结果 本组平均手术时间为3.9h（3～5h）,平均出血量为495mL（200～800mL）,术后发生未伤口感染、血肿或其他严重并发症。经术后X线照片检查,未发现内固定材料断裂、松动以及胸腰椎骨折、移位。随访6～24个月,术后Cobb角为3.15±1.64°,椎体平均高度恢复到术后的前缘（90.15±1.72）%和后缘（98.09±1.14）%。神经功能恢复：A级1例,B级0例,C级1例,D级2例,E级29例。结论 后路钉棒系统手术相对简单、操作方便、固定可靠,是胸腰椎骨折的一种有效治疗方法。     

自发性高血压大鼠中医证候及其理化指标相关性研究

目的：探寻自发性高血压大鼠（SHR）稳定的证候时间窗及与理化指标的相关性,为深入研究高血压证候生物学机制奠定基础。方法：动态采集SHR和Wistar大鼠宏观表征、血压及行为学试验,Elisa和免疫组化法测定血清NE、NO及脑内NE含量。基于临床证候诊断标准进行动物表征等效转化判别证候属性。结果：SHR14～18周龄表现为肝火亢盛证,与10～12周龄SHR及同周龄wistar大鼠相比,血清NE升高、NO减少和脑内NE升高（P〈0.01）。结论：SHR稳定的肝火亢盛证为14～18周龄,与血清NE、NO和脑内NE含量变化密切相关。     

当归(Angelica sinesis)及其成分阿魏酸钠对小鼠吞噬功能的影响

当归为中医常用的补血活血药之一。设想当归的补血活血可能和增强机体免疫功能有关,故进行本项研究。实验分两部分:(1)给小鼠静脉注射当归16g/kg或阿魏酸钠100～200mg/kg均能显著地促进单核吞噬细胞系统对刚果红的廓清率。(2)给小鼠灌胃阿魏酸钠0.3g/kg或皮下给0.2g/kg能增强腹腔巨噬细胞吞噬鸡红细胞的能力。皮下给当归20g/kg也有增强作用。     

Ethanol-wet bonding may improve root dentine bonding performance of hydrophobic adhesive

Objectives

The current study aimed to assess ethanol-wet dentine surfaces by atomic force microscopy (AFM), and to evaluate the efficacy of ethanol-wet bonding on root dentine by determining the shear bond strength (SBS) and interfacial nanoleakage expression.

Methods

Flat dentine slices from human premolar roots were randomly grouped into five. All specimens were acid-etched, rinsed, and left moist. They were then treated with 100% ethanol for 0 s (control group), 20 s (Group 1), 60 s (Group 2), three 60 s periods (Group 3), or stepwise ethanol application (Group 4). After treatment, each group was bonded either with Adper™ Scotchbond™ Multi-Purpose (Scotchbond) or experimental hydrophobic adhesive. Nano-scale adhesion forces (Fad) were probed by AFM and analysed using one-way ANOVA. The SBS results were analysed using two-way ANOVA. Tukey's test was employed for multiple comparisons.

Results

Ethanol-wet protocols significantly decreased the value of Fad (p < 0.001). When bonded with Scotchbond, ethanol treatment did not affect the bond strength (p > 0.05), but decreased the interfacial nanoleakage. The SBS values of the groups bonded with hydrophobic adhesive varied with different ethanol-wet protocols (p < 0.05). Decreased nanoleakage was manifested in all experimental groups, except Group 1. Compared with the classical water-wet bonding with Scotchbond in the control group, Group 4 bonded with hydrophobic adhesive exhibited a significantly higher bond strength (p < 0.05).

Conclusions

Ethanol-wet bonding using a stepwise ethanol application protocol may have potential benefits in the root dentine bonding of hydrophobic adhesive.