基于医者精神的人体解剖学课程思政教学资源库建设及融入路径探索

立德树人是我国教育事业的根本任务,医学院校应该大力弘扬“敬佑生命、救死扶伤、甘于奉献、大爱无疆”的医者精神,强化医学生职业素养与医者仁心教育。人体解剖学是医学生入学后所学的首门医学课程,蕴含着丰富的思想价值和精神内涵。充分挖掘课程思政元素,建设相关教学资源库并探索其融入路径,有利于激发学生的学习热情,提升医德医风教育效果。

清燥救肺汤抗气阴两虚型肺癌现代药理机制浅析

清燥救肺汤主要功用为清燥润肺、益气养阴,应用于外感燥热伤肺。现代研究发现,该方适用于气阴两虚型肺癌,可有效抑制肺癌生长,并改善肺癌及放疗、放化疗后出现身热,干咳少痰,口干乏力等症状。现综合清燥救肺汤抗肺癌研究成果,阐释该方发挥清燥润肺、益气养阴抗肺癌功用现代药理机制,为临床应用提供参考。

Anti-vascular endothelial growth factor drugs combined with laser photocoagulation maintain retinal ganglion cell integrity in patients with diabetic macular edema: study protocol for a prospective, non-randomized, controlled clinical trial

The integrity of retinal ganglion cells is tightly associated with diabetic macular degeneration that leads to damage and death of retinal ganglion cells,affecting vision.The major clinical treatments for diabetic macular edema are anti-vascular endothelial growth factor drugs and laser photocoagulation.However,although the macular thickness can be normalized with each of these two therapies used alone,the vision does not improve in many patients.This might result from the incomplete recovery of retinal ganglion cell injury.Therefore,a prospective,non-randomized,controlled clinical trial was designed to investigate the effect of anti-vascular endothelial growth factor drugs combined with laser photocoagulation on the integrity of retinal ganglion cells in patients with diabetic macular edema and its relationship with vision recovery.In this trial,150 patients with diabetic macular edema will be equally divided into three groups according to therapeutic methods,followed by treatment with anti-vascular endothelial growth factor drugs,laser photocoagulation therapy,and their combination.All patients will be followed up for 12 months.The primary outcome measure is retinal ganglion cell-inner plexiform layer thickness at 12 months after treatment.The secondary outcome measures include retinal ganglion cell-inner plexiform layer thickness before and 1,3,6,and 9 months after treatment,retinal nerve fiber layer thickness,best-corrected visual acuity,macular area thickness,and choroidal thickness before and 1,3,6,9,and 12 months after treatment.Safety measure is the incidence of adverse events at 1,3,6,9,and 12 months after treatment.The study protocol hopes to validate the better efficacy and safety of the combined treatment in patients with diabetic macula compared with the other two monotherapies alone during the 12-month follow-up period.The trial is designed to focus on clarifying the time-effect relationship between imaging measures related to the integrity of retinal ganglion cells and best-corrected visual acuity.The trial protocol was approved by the Medical Ethics Committee of the Affiliated Hospital of Beihua University with approval No.(2023)(26)on April 25,2023,and was registered with the Chinese Clinical Trial Registry(registration number:ChiCTR2300072478,June 14,2023,protocol version:2.0).

An early scoring system to predict mechanical ventilation for botulism: a single-center-based study

BACKGROUND:Early identifi cation of patients requiring ventilator support will be benefi cial for the outcomes of botulism.The present study aimed to establish a new scoring system to predict mechanical ventilation(MV)for botulism patients.METHODS:A single-center retrospective study was conducted to identify risk factors associated with MV in botulism patients from 2007 to 2022.Univariate analysis and multivariate logistic regression analysis were used to screen out risk factors for constructing a prognostic scoring system.The area under the receiver operating characteristic(ROC)curve was calculated.RESULTS:A total of 153 patients with botulism(66 males and 87 females,with an average age of 43 years)were included.Of these,49 patients(32.0%)required MV,including 21(13.7%)with invasive ventilation and 28(18.3%)with non-invasive ventilation.Multivariate analysis revealed that botulinum toxin type,pneumonia,incubation period,degree of hypoxia,and severity of muscle involvement were independent risk factors for MV.These risk factors were incorporated into a multivariate logistic regression analysis to establish a prognostic scoring system.Each risk factor was scored by allocating a weight based on its regression coeffi cient and rounded to whole numbers for practical utilization([botulinum toxin type A:1],[pneumonia:2],[incubation period≤1 day:2],[hypoxia<90%:2],[severity of muscle involvement:grade II,3;grade III,7;grade IV,11]).The scoring system achieved an area under the ROC curve of 0.82(95%CI 0.75-0.89,P<0.001).At the optimal threshold of 9,the scoring system achieved a sensitivity of 83.7%and a specifi city of 70.2%.CONCLUSION:Our study identified botulinum toxin type,pneumonia,incubation period,degree of hypoxia,and severity of muscle involvement as independent risk factors for MV in botulism patients.A score≥9 in our scoring system is associated with a higher likelihood of requiring MV in botulism patients.This scoring system needs to be validated externally before it can be applied in clinical settings.

Ground-Based Radar Reflectivity Mosaic of Mei-yu Precipitation Systems over the Yangtze River–Huaihe River Basins

The 3D radar reflectivity produced by a mosaic software system, with measurements from 29 operational weather radars in the Yangtze River–Huaihe River Basins（YRHRB） during the mei-yu season of 2007, is compared to coincident TRMM PR observations in order to evaluate the value of the ground-based radar reflectivity mosaic in characterizing the 3D structures of mei-yu precipitation. Results show reasonable agreement in the composite radar reflectivity between the two datasets,with a correlation coefficient of 0.8 and a mean bias of -1 dB. The radar mosaic data at constant altitudes are reasonably consistent with the TRMM PR observations in the height range of 2–5 km, revealing essentially the same spatial distribution of radar echo and nearly identical histograms of reflectivity. However, at altitudes above 5 km, the mosaic data overestimate reflectivity and have slower decreasing rates with height compared to the TRMM PR observations. The areas of convective and stratiform precipitation, based on the mosaic reflectivity distribution at 3-km altitude, are highly correlated with the corresponding regions in the TRMM products, with correlation coefficients of 0.92 and 0.97 and mean relative differences of -7.9% and -2.5%, respectively. Finally, the usefulness of the mosaic reflectivity at 3-km altitude at 6-min intervals is illustrated using a mesoscale convective system that occurred over the YRHRB.

清燥救肺汤调控AMPK通路诱导Lewis荷瘤小鼠肺癌细胞自噬体膜及溶酶体形成的机制探讨

目的基于腺苷酸活化蛋白激酶(AMPK)通路探讨清燥救肺汤诱导Lewis荷瘤小鼠肺癌细胞自噬体膜及溶酶体形成的机制。方法将50只雄性C57BL/6J小鼠随机分为模型组、环磷酰胺(CTX)组(50 mg·kg^(-1))、清燥救肺汤组(11 g·kg^(-1))、AMPK抑制剂组(Compound C,10 mg·kg^(-1))及清燥救肺汤+AMPK抑制剂组(11 g·kg^(-1)清燥救肺汤+10 mg·kg^(-1)Compound C)。各组小鼠均右腋皮下注射Lewis肺癌细胞构建肺癌荷瘤模型。清燥救肺汤组和清燥救肺汤+AMPK抑制剂组需造模前14 d开始灌胃清燥救肺汤(11 g·kg^(-1)·d^(-1))。造模24 h后,CTX组以50 mg·kg^(-1)CTX隔日腹腔注射1次,共7次;AMPK抑制剂组和清燥救肺汤+AMPK抑制剂组均腹腔注射Compound C(10 mg·kg^(-1)·d^(-1)),清燥救肺汤组和清燥救肺汤+AMPK抑制剂组继续按照设定剂量灌胃清燥救肺汤(11 g·kg^(-1)·d^(-1)),连续14 d。采用Western Blot法检测肺癌组织自噬体膜形成相关蛋白[自噬关键分子酵母ATG6同系物(Beclin-1)、磷酸化自噬关键分子酵母ATG6同系物(p-Beclin-1)、Ⅲ型磷脂酰肌醇3-激酶(VPS34)、磷酸化Ⅲ型磷脂酰肌醇3-激酶(p-VPS34)]的表达水平;RT-q PCR法检测肺癌组织中自噬相关蛋白9A(ATG9A)、乙酰辅酶A合成酶2(ACSS2)、转录因子增强子3(TFE3)m RNA表达水平;免疫荧光双重染色法检测肺癌组织中自噬蛋白微管相关蛋白轻链3B(LC3B)及P62蛋白表达情况。结果与模型组比较,清燥救肺汤组和CTX组小鼠肺癌组织中Beclin-1、p-Beclin-1蛋白表达水平及p-Beclin-1/Beclin-1比值显著升高(P<0.05,P<0.01),VPS34、p-VPS34蛋白表达水平及p-VPS34/VPS34比值均显著升高(P<0.05,P<0.01),ATG9A、ACSS2 m RNA表达水平显著升高(P<0.05,P<0.01),TFE3 m RNA表达水平显著降低(P<0.01),LC3B蛋白荧光强度表达水平显著升高(P<0.01),P62蛋白荧光强度表达水平显著降低(P<0.01)。与清燥救肺汤组比较,清燥救肺汤+AMPK抑制剂组小鼠肺癌组织中p-Beclin-1蛋白表达水平及p-Beclin-1/Beclin-1比值显著降低(P<0.05,P<0.01),VPS34、p-VPS34蛋白表达水平及p-VPS34/VPS34比值均显著降低(P<0.05,P<0.01),ATG9A、ACSS2 m RNA表达水平显著降低(P<0.05,P<0.01),TFE3 m RNA表达水平显著上升(P<0.01),LC3B蛋白荧光强度表达水平显著降低(P<0.01),P62蛋白荧光强度表达水平明显升高(P<0.05)。与AMPK抑制剂组比较,清燥救肺汤+AMPK抑制剂组小鼠肺癌组织中Beclin-1、p-Beclin-1蛋白表达水平显著升高(P<0.01);VPS34、p-VPS34蛋白表达水平及p-VPS34/VPS34比值均显著升高(P<0.01);ATG9A、ACSS2 m RNA表达水平显著升高(P<0.05,P<0.01)。结论清燥救肺汤诱导肺癌细胞自噬体膜及溶酶体形成的机制可能是通过激活Beclin-1、VPS34蛋白,上调ATG9A、ACSS2 m RNA表达,抑制TFE3 mRNA表达实现的。

基于在线课程建设的翻转课堂实践——以复合材料力学课程为例

在信息化大爆炸的背景下,以复合材料力学课程教学为主要对象,基于其教学现状以及存在的困难和问题,分析了在线课程建设的重要性和必要性;提出和探讨了基于在线课程(MOOC)的翻转课堂教学实践的教学模式,旨在提高复合材料力学的授课效率,具有现实意义。

A progressive surrogate gradient learning for memristive spiking neural network

In recent years, spiking neural networks(SNNs) have received increasing attention of research in the field of artificial intelligence due to their high biological plausibility, low energy consumption, and abundant spatio-temporal information.However, the non-differential spike activity makes SNNs more difficult to train in supervised training. Most existing methods focusing on introducing an approximated derivative to replace it, while they are often based on static surrogate functions. In this paper, we propose a progressive surrogate gradient learning for backpropagation of SNNs, which is able to approximate the step function gradually and to reduce information loss. Furthermore, memristor cross arrays are used for speeding up calculation and reducing system energy consumption for their hardware advantage. The proposed algorithm is evaluated on both static and neuromorphic datasets using fully connected and convolutional network architecture, and the experimental results indicate that our approach has a high performance compared with previous research.

Pregnancy-related spontaneous coronary artery dissection after intravenous ritodrine infusion: a case report

Ritodrine hydrochloride(ritodrine)is a β2-adrenoceptor stimulant that has been effectively prescribed for the prevention of premature labor.[1]In clinical practice,one of the biggest drawbacks ofβ-mimetics is their adverse eff ects,including arrhythmias,myocardial ischemia,and pulmonary edema,due to theirβ-sympathomimetic effects.[2]Here,we report a rare pregnant case of spontaneous coronary artery dissection(SCAD)after intravenous infusion of ritodrine.

Bone marrow mesenchymal stem cell-induced autophagy ameliorates TNBS-induced experimental colitis by downregulating the NLRP3 inflammasome

This study aimed to elucidate the potential mechanisms through which bone marrow-derived mesenchymal stem cells(BM-MSCs)may be effective in alleviating experimental colitis induced by treatment with 2,4,6-trinitrobenzene-sulfonate acid(TNBS),specifically through autophagy modulation.Methods:BM-MSCs were collected from BALB/c mice for subsequent experiments.The study employed cell counting kits(CCK-8)to investigate the impact of the MSC-conditioned medium(M medium)on the proliferation of RAW264.7 macrophages.The GFP-mRFP-LC3 adenovirus was transfected into RAW264.7 to detect autophagic flux.The gene expression of cytokines was assessed through quantitative reverse transcription polymerase chain reaction(qRT-PCR).Western blot analysis was employed to determine the presence of a binding interaction between NOD-like receptor protein 3(NLRP3)and autophagy.Furthermore,a colitis mouse model was established by TNBS induction.Clinical disease activity score was assessed regularly,and histological and morphometric analyses were performed on colonic tissues.Inflammatory serum cytokines were identified using an enzyme-linked immunosorbent assay.Results:BM-MSCs significantly promoted the proliferation of RAW264.7.In vitro lipopolysaccharide(LPS)-stimulated RAW264.7 cells,treated with BM-MSCs,triggered autophagy and inhibited cytokine mRNA expression.Additionally,in LPS-induced RAW264.7,BM-MSCs enhanced the Beclin1 protein expression and the microtubule-associated protein 1 light chain 3(LC3)-II to LC3-I ratio while suppressing the protein levels of NLRP3 and apoptosis-associated speck-like protein(ASC).Nevertheless,3-methyladenine(3-MA),an inhibitor of autophagy,prevented the impact of BM-MSCs by reducing the levels of NLRP3 and ASC proteins,suggesting that autophagy triggered the inhibition of the NLRP3 inflammasome.In comparison to the mice in the TNBS group,the mice in the TNBS+MSC group displayed a more acute form of colitis,and the IL1βand IL18 cytokines in their serum were lowered as well.In the meantime,3-MA raised IL1βand IL18 cytokine levels and worsened TNBS-induced experimental colitis.Conclusions:BM-MSCs can suppress inflammation in TNBS-induced experimental mice by inhibiting the NLRP3 inflammasome,thereby enhancing autophagy.

清燥救肺汤对荷Lewis小鼠肺癌细胞中ACO1与ACL和FFA及CHO的影响

目的观察清燥救肺汤对荷Lewis小鼠肺癌细胞顺乌头酸酶(Aconitase closing odor,ACO1)、三磷酸腺苷柠檬酸裂解酶(ATP citrate lyase,ACL)、游离脂肪酸(Free fatty acids,FFA)、胆固醇(Cholesterol,CHO)含量的影响。方法C57BL/6J雄性小鼠,随机分为5组,分别为清燥救肺汤高剂量组、中剂量组、低剂量组,模型组,环磷酰胺(Cyclophosphamide,CTX)组,每组10只,共50只。于小鼠右腋下注射Lewis肺癌细胞建立肺癌荷瘤模型,清燥救肺汤低、中、高剂量组剂量分别为2.75、5.5、11 g·kg-1·d-1,先灌胃给药2周后造模,CTX组以50 mg·kg-1·(2d)-1进行腹腔注射给药,模型组用等体积的生理盐水进行灌胃给药,接种后继续灌胃给药2周,处死小鼠取瘤组织。酶联免疫吸附测定检测FFA、CHO的含量;实时荧光定量聚合酶链式反应(Real-time PCR)检测ACL mRNA的表达;蛋白质免疫印记法(Western blot)检测ACO1蛋白表达。结果与模型组比较,CTX组及清燥救肺汤高、中、低剂量组中肺癌细胞ACO1蛋白表达,ACL mRNA的表达及FFA、CHO含量显著降低(P<0.05,P<0.01)。结论清燥救肺汤可有效抑制荷Lewis肺癌细胞增殖,减少肺癌细胞能量生成,ACO1、ACL、FFA、CHO可能是其药效作用靶点。

肺癌的病机分析及方剂应用探索

通过分析肺癌临床症状、病因病机、放化疗后病变特点,提出燥热伤肺是肺癌的重要病机,缓解燥热是提高其生存质量的关键环节。通过配伍分析认为清燥救肺汤集宣、清、润、养于一体,既可清热又能润燥,无论理论文献和实验研究,还是临床应用,均显示了较好的疗效,值得深入研究及推广应用。

基于《素问·阴阳应象大论篇》探讨清燥救肺汤对肺癌癌性发热的影响

基于《素问·阴阳应象大论篇》阳病治阴、阴病治阳的治疗原则,分析肺癌癌性发热的阴阳病机,探讨清燥救肺汤对肺癌癌性发热的作用机制,为该中药药方的临床运用提供理论支撑。

大豆E2泛素结合酶基因GmUBC1的克隆及在拟南芥中的异源表达

E2泛素结合酶(ubiquitin-conjugating enzyme)参与植物的抗逆、生长发育等多种生物途径的调控,其功能研究在拟南芥(Arabidopsis thaliana)中的报道较多,但在重要经济作物大豆(Glycine max)中鲜有报道。本研究从大豆“南农94-16”中克隆了1个与大豆子叶折叠突变体可能相关的基因Glyma.12G161200,序列分析结果表明该基因编码一个E2泛素结合酶,因此将其命名为GmUBC1。该基因编码区全长为462 bp,编码一个含153个氨基酸的蛋白,预测其分子量为17.25 kDa,等电点为6.74。利用qRT-PCR技术对GmUBC1在大豆不同组织中的表达模式及其对不同非生物胁迫和激素处理的响应模式进行分析,发现该基因在开花后40 d种子中表达量最高,在PEG、低温、JA和ABA处理下表达下调。亚细胞定位分析发现GmUBC1蛋白在整个细胞内都有表达。进一步在拟南芥中异源表达GmUBC1,发现转基因株系的千粒重和总氨基酸含量显著提高,表明异源过表达GmUBC1可以调控种子重量和氨基酸含量,为大豆品质改良提供了基因资源。

浅析方剂配伍中反佐的应用

探讨"反佐"在方剂配伍中的应用,在阐明"反佐"涵义及历史发展的基础上,举例论述了寒热反佐、补泻反佐、散收反佐、润燥反佐、行止反佐及以升佐降等配伍方法,探讨其相关配伍规律,为探索研究中医药理论和临床处方用药提供依据。

一贯煎中川楝子佐制配伍对荷H22肝癌小鼠胃肠消化吸收功能的影响

目的:观察一贯煎中川楝子佐制配伍对荷H22肝癌小鼠胃肠消化吸收的影响。方法:雄性KM小鼠50只,随机分为模型组,环磷酰胺(cyclophosphamide,CTX)组,一贯煎组、川楝子组、一贯煎不含川楝子组,每组12只,右腋下注射H22肝癌细胞建立肝癌荷瘤模型。一贯煎组、川楝子组、一贯煎不含川楝子组,造模前2周开始以23 mg/kg灌胃给药,CTX组以50 mg/(kg·2d)腹腔注射给药,模型组以等体积生理盐水灌胃给药,接种后继续给药2周后,采集小鼠眼眶静脉血,然后处死取瘤组织、胃与小肠组织。以酶联免疫吸附测定法(ELISA)检测胃黏膜上皮细胞中胃泌素(GAS)、胆囊收缩素(CCK)、胃动素(MLT)的含量,间苯三酚法检测血清D木糖的含量。结果:与模型组比较,一贯煎组、川楝子组、一贯煎不含川楝子组瘤重降低(P<0.01);与模型组比较,一贯煎组、川楝子组血清D木糖含量升高(P<0.01);与模型组比较,一贯煎组血清CCK含量升高(P<0.05);与模型组比较,一贯煎组血清胃动素含量升高(P<0.01);与模型组比较,一贯煎组血清胃泌素含量升高(P<0.01)。结论:一贯煎能升高荷H22小鼠血清D木糖、CCK、MLT、GAS含量,可明显促进荷H22肝癌小鼠胃肠消化吸收功能,可能与该方中川楝子佐制配伍有关。

肺癌干咳病机分析

基于《黄帝内经》"燥者濡之"和"燥胜则干"理论,分析肺癌干咳和燥证的发病特点及病机,提出肺癌干咳属于燥证范畴,燥热伤肺是其重要病机。

Tumor suppressor role of mi R-133a in gastric cancer by repressing IGF1R

AIM:To investigate the function and mechanism of mi R-133a in gastric cancer(GC)and its relationship with clinicopathological characteristics of GC.METHODS:A total of 105 GC patients who underwent surgical resection as primary treatment were selected for this study.Real-time quantitative reverse transcriptase polymerase chain(q RT-PCR)was used to examine the expression levels of mi R-133a in human GC and adjacent non-tumor tissues,as well as in GC cell lines(SGC-7901,BGC-823,MGC-803,and AGS)and a human gastric mucosal epithelial cell line(GES-1).The biological role of mi RNA(mi R)-133a was assessed in the GC cell lines using MTT,apoptosis,migration and invasion,and colony formation assays,and xenograft tumorigenesis.q RT-PCR and western blot analyses were used to evaluate the potential target gene expression of mi R-133a.Pearson’s correlation was calculated to evaluate the correlation between mi R-133a and insulinlike growth factor 1 receptor(IGF1R)expression.The regulation of IGF1R by mi R-133a was verified using the luciferase reporter assay.RESULTS:In 80%of the 105 GC patients,the mean expression of mi R-133a was significantly downregulated in tumor tissues compared with adjacent normal tissues(1.215±0.1477 vs 3.093±0.4104,P<0.0001).Downregulation of mi R-133a was significantly correlated with the degree of differentiation(P=0.01),local invasion(P=0.001)and TNM stage(P=0.02)in GC patients.Compared with a control construct,forced expression of mi R-133a in GC cell lines inhibited proliferation(0.4787±0.0219 vs 0.7050±0.0147,P=0.0013 in SGC-7901 cells;and 0.5448±0.0085vs 0.7270±0.0084,P=0.001 in MGC-803 cells);migration(0.6333±0.0233 vs 1.037±0.0584,P=0.003 in SGC-7901 cells;0.6126±0.0311 vs 1.024±0.0456,P=0.0017 in MGC-803 cells);and invasion(0.613±0.0399 vs 1.033±0.0278,P=0.0013 in SGC-7901 cells;0.7433±0.0221 vs 1.017±0.0311,P=0.002 in MGC-803 cells).It also induced apoptosis(18.19%±0.2483%vs 5.887%±0.3837%,P<0.0001 in SGC-7901 cells;22.69%±0.7846%vs9.347%±0.3012%,P<0.0001 in MGC-803 cells).Furthermore,mi R-133a inhibited tumor growth and xenograft tumorigenesis of SGC-7901 cells in vivo.In addition,we identified IGF1R as a regulatory target of mi R-133a in GC.CONCLUSION:This study suggests that mi R-133a is downregulated in GC and functions as a tumor suppressor in vitro and in vivo partly by repressing IGF1R.

Advanced Analysis of HVDC Electrodes Interference on Neighboring Pipelines

This paper focuses on advanced analysis techniques and design considerations of DC interference generated by HVDC electrodes during normal bipolar and temporary monopolar operations on neighboring metallic utilities, with a special emphasis on buried gas and oil pipelines. This study examines the level of pipeline corrosion, the safety status in the vicinity of exposed appurtenances and the impact of DC interference on the integrity of insulating flanges and impressed current cathodic protection (ICCP) systems. Computation results obtained for different soil models show that different soils can lead to completely different DC interference effects. The results and conclusions presented here can be used as a reference to analyze the severity of DC interference on pipelines due to proximate HVDC electrodes.

Phase transitions in bismuth under rapid compression

The structural phase transitions of bismuth under rapid compression has been investigated in a dynamic diamond anvil cell using time-resolved synchrotron x-ray diffraction. As the pressure increases, the transformations from phase I,to phase II, to phase III, and then to phase V have been observed under different compression rates at 300 K. Compared with static compression results, no new phase transition sequence appears under rapid compression at compression rate from 0.20 GPa/s to 183.8 GPa/s. However, during the process across the transition from phase III to phase V, the volume fraction of product phase as a function of pressure can be well fitted by a compression-rate-dependent sigmoidal curve.The resulting parameters indicate that the activation energy related to this phase transition, as well as the onset transition pressure, shows a compression-rate-dependent performance. A strong dependence of over-pressurization on compression rate occurs under rapid compression. A formula for over-pressure has been proposed, which can be used to quantify the over-pressurization.