基于雨课堂的临床流行病学教学改革与实践

目的探讨雨课堂在临床流行病学教学中的作用和效果。方法采用随机对照法在本科阶段无流行病学学习经历的临床专业硕士研究生中,使用雨课堂线上课前预习及课后随堂练习的功能,用于评价雨课堂线上功能的辅助教学效果。结果应用雨课堂线上功能干预组与对照组在基线、阶段小测和末考卷面成绩均无统计学差异;但对于主动学习,雨课堂参与度较高的学生成绩提高明显。结论雨课堂有利于理论性较强课程的学习,但是仍不能忽略课堂教学师生互动过程。     

Decreased blood riboflavin levels are correlated with defective expression of RFT2 gene in gastric cancer

AIM: To investigate the relationship between blood riboflavin levels and riboflavin transporter 2 (RFT2) gene expression in gastric carcinoma (GC) development.METHODS: High-performance liquid chromatography was used to detect blood riboflavin levels in patients with GC. Real-time fluorogenic quantitative polymerase chain reaction and immunohistochemistry were used to analyze the expression of RFT2 mRNA and protein in samples from 60 GC patients consisting of both tumor and normal tissue.RESULTS: A significant decrease in the RFT2 mRNA levels was detected in GC samples compared with those in the normal mucous membrane (0.398 ± 0.149 vs 1.479 ± 0.587; P = 0.040). Tumors exhibited low RFT2 protein expression (75%, 16.7%, 8.3% and 0% for no RFT2 staining, weak staining, medium staining and strong staining, respectively), which was significantly lower than that in the normal mucous membrane (10%, 16.7%, 26.7% and 46.7% for no RFT2 staining, weak staining, medium staining and strong staining, respectively; P < 0.05). Tumors with low RFT2 expression were significantly associated with tumor stage and histological grade. Moreover, a significantly decrease in Uyghur patients was observed compared with Han patients. However, other parameters-gender, tumor location and lymph node metastasis-showed no significant relationship with RFT2 expression. Blood riboflavin levels were reverse correlated with development of GC (1.2000 ± 0.97 569 ng/mL in high tumor stage patients vs 2.5980 ± 1.31 129 ng/mL in low tumor stage patients; P < 0.05). A positive correlation of plasma riboflavin levels with defective expression of RFT2 protein was found in GC patients (χ² = 2.619; P = 0.019).CONCLUSION: Defective expression of RFT2 is associated with the development of GC and this may represent a mechanism underlying the decreased plasma riboflavin levels in GC.     

胃食管反流病合并房颤患者采用盐酸胺碘酮联合艾司奥美拉唑治疗效果及对炎症因子的影响

目的探讨胃食管反流病（GERD）合并心房颤动（房颤）患者采用盐酸胺碘酮联合艾司奥美拉唑治疗后的临床疗效及其对炎症因子水平的影响。 方法回顾性分析2018年1月至2019年12月在新疆维吾尔自治区人民医院住院收治的87例GERD合并房颤患者,根据治疗方式的不同,分为对照组（常规治疗的基础上给予盐酸胺碘酮治疗）和研究组（在对照组基础上联合给予艾司奥美拉唑治疗）;2组均接收治疗1个月。采用GERD症状评分、胃食管24 h pH监测、高分辨率食管测压监测来分析2组治疗前后抑酸,胃食管动力及房颤发生的影响及疗效;收集2组患者治疗前后的血液标本,并采用ELISA法检测炎症因子（白细胞介素-6、C反应蛋白及肿瘤坏死因子-α）的变化水平。 结果经食管24 h pH监测发现,研究组在GERD症状评分,食管近端弱酸反流（%）、食管近端酸反流（%）及DeMeester评分等指标,与其治疗前和对照组治疗后比较显著降低（P＜0.05）;高分辨率食管测压分析显示,与治疗前和对照组治疗后相比,研究组治疗后显著改善食管上段括约肌（UES）静息压、食管下段括约肌（LES）静息压及食管远端收缩积分（DCI）等指标（P＜0.05）;2组患者治疗后心率以及QT离散度（QTd）水平均显著小于治疗前（P＜0.05）,且研究组治疗后心率水平显著小于对照组治疗后的水平（P＜0.05）;2组患者治疗后动脉血压（收缩压、舒张压）水平均显著低于治疗前（P＜0.05）;治疗后2组炎症因子水平均明显低于治疗前（P＜0.01）,而研究组治疗后炎症因子水平明显低于对照组（P＜0.05）;研究组治疗后疗效明显高于对照组（P＜0.05）;而其无效率为显著低于对照组（P＜0.05）;研究组总有效率显著高于对照组（P＜0.05）。 结论该联合治疗在GERD合并房颤患者的疗效较好,降低炎性因子水平,显著改善症状及房颤的发生。     

新疆地区70例艾滋病相关型卡波西肉瘤患者临床特征及预后分析

目的 分析新疆艾滋病相关型卡波西肉瘤(AIDS-KS)患者的临床特征,探讨抗反转录病毒治疗(HAART)及系统性化疗等对患者预后的影响.方法 连续收集2008年1月至2013年6月新疆维吾尔自治区第六人民医院收治的70例AIDS-KS患者的临床资料,采用回顾性研究的方法对人群特点、KS进展情况、病变部位及范围、治疗及预后等进行总结分析,并采用t检验和x2检验比较不同治疗组的疗效及预后.结果 70例AIDS-KS患者的平均年龄为(40±10)岁,男女比例2.5∶1,其中66例(94.29％)为维吾尔族,23例(32.9％)疾病进展评分为快速.KS临床症状主要有斑片、结节等,且头颈、躯干、四肢和内脏均有累及.治疗组总病死率为7.7％ (4/52),而未治疗组的12例患者中4例死亡,与治疗组比较差异有统计学意义(x2=5.861,P＜0.05).单纯HAART组和HAART序贯化疗组治疗半年后CD4+T淋巴细胞计数较治疗前明显上升(t=35.258和42.528,P＜0.01),而采用其他治疗方案的患者和未治疗的患者CD4+T淋巴细胞计数较治疗前无显著变化或下降.HAART序贯化疗组、化疗序贯HAART组和单纯化疗组中的所有患者对KS治疗均有效,而单纯HAART组的治疗有效率为86.4％ (19/22),且45.5％ (10/22)的患者在HAART后出现免疫重建炎症反应综合征(IRIS),KS症状加重.结论 AIDS-KS多发生于中青年,以维吾尔族男性多见,病灶部位多样化,部分呈快速进展.HAART联合系统性化疗疗效较好,且可降低IRIS的发生率,值得临床推广应用.     

体外构建新型骨组织工程三维复合体

体外实现兔脂肪干细胞(rADSCs)、利福喷丁聚乳酸缓释微球及羟基磷灰石/β-磷酸三钙(HA/β-TCP)的三维复合,构建既能抗结核又能填补、促进骨缺损的新型骨组织工程复合体。以HA/β-TCP为支架材料,通过缓慢滴加细胞型方式,将复乳溶媒挥发法制备的利福喷丁聚乳和定性分化诱导的rADSCs(茜红染色表征)体外制得新型骨组织工程三维复合体,并对其进行显微结构及药物缓释表征。结果表明,载药利福喷丁聚乳酸缓释微球大部分分布在18~28 μm,载药利福喷丁聚乳酸缓释微球在一定浓度下不影响rADSCs的分化诱导,层状膜形分布的成骨诱导后rADSCs牢固包绕利福喷丁聚乳酸缓释微球,分布在HA/β-TCP上,载药支架材料有着良好的药物缓释,体外维持最低抑菌浓度长达46 d。新型骨组织工程的三维骨组织工程复合体具有缓慢、持续的释药特性,且具有具有成骨活性。     

Combination of Clavicular Hook Plate with Coracoacromial Ligament Transposition in Treatment of Acromioclavicular Joint Dislocation

ObjectiveTo evaluate the clinical efficacy of Arbeitsgemeinschaft für Osteosynthesefragen (AO) clavicular hook plate (CHP) combined with coracoacromial ligament transposition for Rockwood III‐V dislocation of AC joint, providing an alternative choice for AC joint dislocation treatment.MethodsTwenty‐five patients diagnosed with Rockwood III‐V dislocation of acromioclavicular (AC) joint, including 18 males and seven females, aged 43.5 ± 2.4 years old on average, who had undergone open reduction and AO CHP in combination with coracoacromial (CC) ligament transposition between January 2010 and December 2015, were retrospectively analyzed. Among them, 17 cases were diagnosed as type III, five cases were type IV, and three cases were type V. The surgery mainly included three main steps: bone flap incision, drilling in the clavicle, and hook plate fixation and AC joint reposition. The treatment efficacy was evaluated through clinical examinations and imaging studies for the shoulder joint, including gross observation and measuring coracoid clavicle distance (CC‐Dist) using orthophoria X‐ray before and 1 year after the surgery, and University of California (UCLA) shoulder rating scale.ResultsAll the patients were followed up three to four times in 18 months (12–24 months) on average, and the UCLA rating results showed that there were 17 excellent cases (68%), five good cases (20%), and three fair cases (12%). The CC‐Dist values after the surgery reduced to 9.7 ± 0.7 mm, which was significantly (P < 0.05) lower compared to that before the surgery (15.8 ± 1.6 mm). Most (88%) of the cases showed almost normal joint function and good anatomical arrangement of the acromioclavicular joint, without any secondary dislocation, and for them, 12 ± 2 weeks on average were needed to regain the normal function of shoulder joint movement.ConclusionDue to the stable fixation, fewer complications, and satisfactory therapeutic effect with great clinical value, the combination of AO CHP and CC ligament transposition is expected to be used for treating Rockwood III‐V dislocation of AC joint.     

肥胖与早期动脉粥样硬化性心血管疾病识别的关系

目的 评价人体脂肪测量指标[体质指数(BMI)、腰围(WC)、腰臀比(WHR)和体脂量(BFM)]与早期动脉粥样硬化性心血管疾病识别的关系.方法 共分析649名研究对象,平均年龄(55±11)岁,均行人体脂肪测量4个指标的评价.同时进行形态学和血生化两个方面的早期动脉粥样硬化性心血管疾病识别的评价.结果 脂肪测量的4个评价指标与收缩压、舒张压、血糖、甘油三酯和载脂蛋白B呈正相关(r＞0),与高密度脂蛋白胆同醇和载脂蛋白A1呈负相关(r＜0),与早期动脉粥样硬化性心血管疾病的发生均为正相关(OR＞1).在与颈动脉内膜中层厚度的相关性分析中,BFM的作用最强(OR值和95%CI分别为1.98和1.44～2.57).在与轻度炎症的相关性中,WHR的作用最强(OR和95%CI分别为1.74和1.43～2.10).结论 BFM与早期动脉粥样硬化的关系最为密切.提示BFM可以作为预测成人心血管事件的参考指标.     

维吾尔医药治疗膝骨性关节炎回顾性研究

目的：维吾尔医药治疗102例膝关节骨性关节炎回顾性研究。方法：针对临床上最多见的涩味黏液质、石膏状黏液质患者以Balham Hilit（黏液质）的基础方药辨Mizaj进行,浯床疗效观察。结果：疗效均具有可比性,即涩味黏液质相对石膏状黏液质疗程短,见效快,不易复发,而石膏状黏液质变异的患者顽固。结论：雏吾尔医药祛寒、祛湿功效较强对渗出物的变异对抗能力较强,减缓关节内环境的失调,从而抑制骨质的异常增生。     

玫瑰花口服液的红外指纹图谱及化学模式识别

目的:采用红外光谱和化学模式识别相结合建立了玫瑰花口服液质量评价的方法。方法:以11批玫瑰花口服液和4种伪品作红外光谱分析,对主要吸收峰进行指认,获得红外指纹图谱,并按不同特征吸收峰位下的透射比进行相似度计算,通过相似度分析对11批玫瑰花口服液及4种伪品的红外图谱一致性进行了考察,并把获得的指纹图谱采用系统聚类分析和主成分分析进行化学模式识别。结果:11批玫瑰花口服液红外指纹图谱一致性良好,玫瑰花口服液及伪品通过相似度分析和化学模式识别均能够很好地区分开来,相似度和聚类分析、主成分分析结果相一致,2种化学计量方法具有良好的相关性。结论:结果表明该方法是鉴别玫瑰花口服液真伪的有效方法。     

甲状腺肿瘤中突变型 p16 表达的免疫组织化学研究

应用免疫组织化学技术对２２例甲状腺癌包括１８例乳头状腺癌和４例滤泡性腺癌及２０例甲状腺腺瘤的突变型ｐ１６表达进行研究。结果发现，突变型ｐ１６在甲状腺癌和甲状腺腺瘤表达于细胞核，甲状腺癌阳性表达率为４５％，甲状腺腺瘤阳性表达率为１０％。两者表达率有显著性差异（Ｐ＜０．０１）。乳头状腺癌及滤泡性腺癌表达率分别为４４．４％及５０％，两者之间无显著性差异（Ｐ＞０．０５）。提示ｐ１６基因突变在甲状腺恶性肿瘤发生发展中具有重要作用。