中医诊断学教学方法新探讨

中医诊断学是中医基础与临床各科之间的桥梁课程.针对传统中医诊断教学中存在的一些弊端,从对比教学、启发式教学、场景教学、多媒体教学、学生参与教学、奖励式教学、复式组合教学和实验教学8个方面对中医诊断教学方法做了一些新的探讨,以拓宽学术视野,开阔教学思路,并希望能为中医高等教育教学改革提供有益的借鉴.     

检体诊断的多媒体教学

检体诊断学对于培养医学生＂三基＂至关重要。然而,传统的检体诊断学教学只是在书本的基础上提供了有限的临床操作,尚缺少对重要理论知识细致而全面的实践应用,而多媒体在检体诊断学上的应用可以很好地解决这个问题。     

Profiling protein expression and interactions: proximity ligation as a tool for personalized medicine

Abstract. Blokzijl A, Friedman M, Pontén F, Landegren U (From the Department of Genetics and Pathology, Uppsala University, Uppsala, Sweden). Profiling protein expression and interactions: proximity ligation as a tool for personalized medicine. (Review) J Intern Med 2010; 268 : 232–245. The ability to detect very low levels of expressed proteins has enormous potential for early diagnostics and intervention at curable stages of disease. An extended range of targets such as interacting or post‐translationally modified proteins can further improve the potential for diagnostics and patient stratification, and for monitoring response to treatment. These are critical building blocks for personalized treatment strategies to manage disease. The past few decades have seen a remarkably improved understanding of the molecular basis of disease in general, and of tumour formation and progression in particular. This accumulated knowledge creates opportunities to develop drugs that specifically target molecules or molecular complexes critical for survival and expansion of tumour cells. However, tumours are highly variable between patients, necessitating the development of diagnostic tools to individualize treatment through parallel analysis of sets of biomarkers. The proximity ligation assay (PLA) can address many of the requirements for advanced molecular analysis. The method builds on the principle that recognition of target proteins by two, three or more antibodies can bring in proximity DNA strands attached to the antibodies. The DNA strands can then participate in ligation reactions, giving rise to molecules that are amplified for highly sensitive detection. PLA is particularly well suited for sensitive, specific and multiplexed analysis of protein expression, post‐translational modifications and protein–protein interactions. The analysis of this extended range of biomarkers will prove critical for the development and implementation of personalized medicine.     

Direct determination of carbapenem-resistant Enterobacteriaceae and Pseudomonas aeruginosa from positive blood cultures using laser scattering technology

Delays in appropriate antimicrobial treatment contribute to increased mortality of septic patients. We aimed to develop a methodology for detection of carbapenem resistance in Gram-negative bacteria directly from positive blood cultures (BCs). Initially, meropenem-resistant Enterobacteriaceae (n?=?13) and Pseudomonas aeruginosa (n?=?32) isolates as well as the same numbers of meropenem-susceptible isolates were used to establish the detection of carbapenem resistance from agar cultures. Growth-based phenotypic detection of meropenem resistance was performed by a laser scattering (LS) method using a BacterioScan?216R instrument. A subset of the strain collection consisting of meropenem-susceptible and -resistant isolates (each comprising seven P. aeruginosa and three Klebsiella pneumoniae) was used for determination of carbapenem resistance directly from positive BCs. Lysis/centrifugation and filtration/dilution methods were investigated for processing of positive BCs. Four different statistical approaches to discriminate between susceptible and resistant bacteria in real-time were applied and were compared regarding their sensitivity and specificity. After 3?h and 4?h of incubation, respectively, detection of carbapenem resistance in Enterobacteriaceae (sensitivity, 100%; specificity, 100%) and P. aeruginosa (sensitivity, 100%; specificity, ≥90%) agar cultures was attainable. Detection of carbapenem resistance directly from positive BCs was achievable with 100% sensitivity and 100% specificity after 4?h and 5?h, respectively, applying lysis/centrifugation and filtration/dilution methods. In conclusion, LS technology combined with lysis/centrifugation and appropriate statistical real-time analyses represents a promising option for rapid detection of carbapenem resistance in Gram-negative rods directly from positive BCs.     

Engineered NS1 for Sensitive,Specific Zika Virus Diagnosis from Patient Serology

Dengue virus (DENV) and Zika virus (ZIKV) belong to the Flaviviridae family of viruses spread by Aedes aegypti mosquitoes in tropical and subtropical areas. Accurate diagnostic tests to differentiate the 2 infections are necessary for patient management and disease control. Using characterized ZIKV and DENV patient plasma in a blind manner, we validated an ELISA and a rapid immunochromatographic test for ZIKV detection. We engineered the ZIKV nonstructural protein 1 (NS1) for sensitive serologic detection with low cross reactivity against dengue and developed monoclonal antibodies specific for the ZIKV NS1 antigen. As expected, the serologic assays performed better with convalescent than acute plasma samples; the sensitivity ranged from 71% to 88%, depending on the performance of individual tests (IgM/IgG/NS1). Although serologic tests were generally less sensitive with acute samples, our ZIKV NS1 antibodies were able to complement the serologic tests to achieve greater sensitivity for detecting early infections.     

中医四诊信息数字化研究现状评析

本综述客观评析了中医望、闻、问、切四诊研究现状及存在问题，提出在探索四诊信息数字化研究中建立中医四诊信息规范化采集和分析的方法，完善中医四诊检测系统，建立中医四诊特征信息数据库，以及建立计算机判读量化分类方法，同时利用数据库平台对中医四诊信息进行融合分析，综合判断等构想，以获取有关中医病性、病位的客观诊断依据。     

Clostridium Perfringens Enterotoxin (CPE) and CPE-Binding Domain (c-CPE) for the Detection and Treatment of Gynecologic Cancers

Clostridium perfringens enterotoxin (CPE) is a three-domain polypeptide, which binds to Claudin-3 and Claudin-4 with high affinity. Because these receptors are highly differentially expressed in many human tumors, claudin-3 and claudin-4 may provide an efficient molecular tool to specifically identify and target biologically aggressive human cancer cells for CPE-specific binding and cytolysis. In this review we will discuss these surface proteins as targets for the detection and treatment of chemotherapy-resistant gynecologic malignancies overexpressing claudin-3 and -4 using CPE-based theranostic agents. We will also discuss the use of fluorescent c-CPE peptide in the operative setting for real time detection of micro-metastatic tumors during surgery and review the potential role of CPE in other medical applications.     

超声诊断临床实习带教体会

在临床实习教学中,强调多学科结合,多媒体及临床实践的应用。运用多种教学方法,注重培养学生归纳分析图像的能力,注重临床实践操作和报告的规范书写等基本功。     

互动式与传统式教学在中医诊断学教学中的比较

将互动式教学方法引入中医诊断学教学实践中.并分别采用互动式教学法和传统式教学法,对两个班的中医诊断学进行教学实践,通过对两班期终综合成绩进行统计分析及对中医学习兴趣的调查,判明两种教学方法教学效果的差异.