为探讨成果导向教育(outcome based education,OBE)联合以案例为基础(case-based learning,CBL)教学模式在医学本科急性胰腺炎临床教学效果,选取160名临床医学专业学生,随机分为试验组和对照组,比较两组学生基础理论考试、临床技能考核...为探讨成果导向教育(outcome based education,OBE)联合以案例为基础(case-based learning,CBL)教学模式在医学本科急性胰腺炎临床教学效果,选取160名临床医学专业学生,随机分为试验组和对照组,比较两组学生基础理论考试、临床技能考核和满意度。数据分析得出OBE理念联合CBL教学模式在临床本科急性胰腺炎教学上有一定优势。展开更多
Objective： To explore the expression and meaning of Toll-like receptor 2/4 in alveolar macrophage during the process of total hepatic ischemia in mice. Methods： BALB/c mice were used in a model of total hepatic isch...Objective： To explore the expression and meaning of Toll-like receptor 2/4 in alveolar macrophage during the process of total hepatic ischemia in mice. Methods： BALB/c mice were used in a model of total hepatic ischemia/reperfusion. Alveolar Macrophage were collected at the time point of lh, 6h and 12h by the means of bronchoalveolar lavage （BAL）, and its TLR2/4 mRNA and protein were detected with Flow Cytometry and Real-time PCR. The level of TNF in BAL fluid were measured. The concentration of MPO, the ratio of wet/dry and lung histological scores were used to assess the degrees of lung injuries. Results： At the three time points of hepatic ischemia reperfusion, the expression of TLR2/4 protein of and mRNA were up-regulated and the level of TLR2 was on the rise continually. TLR4 at the time of 6 h reached the peak value （P〈0.01）. The level of TNF-2 in BAL fluid reached the highest point at the time of 6 h （P〈0.01）. The ratio of wet/dry rose continually during hepatic ischemia reperfusion. After 1 h, the level of MPO increased rapidly. Then it reached the peak value during the period of 6 h to 12 h. Conclusion： TLR2/4 on the mice of alveolar macrophage were activated in the process of hepatic ischemia/reperfusion and involved in the injury of lung.展开更多
多年来,全球肠外肠内营养学界同道们都在寻求营养不良诊断标准的统一,既需要确定营养不良诊断标准,也需要考虑营养不良指标在不同国家、不同种族的正常值和按临床研究得到的切割点(cut-off point)。全球(营养)领导层倡议营养不良(Global...多年来,全球肠外肠内营养学界同道们都在寻求营养不良诊断标准的统一,既需要确定营养不良诊断标准,也需要考虑营养不良指标在不同国家、不同种族的正常值和按临床研究得到的切割点(cut-off point)。全球(营养)领导层倡议营养不良(Global Leadership Initiative on Malnutrition,GLIM)诊断标准于2018年9月在美国肠外肠内营养学会(American Society for Parenteral and Enteral Nutrition,ASPEN)和欧洲临床营养和代谢学会(European Society for Clinical Nutrition and Metabolism,ESPEN)网站发表。2019年初在纸质版杂志《JPEN》及《Clinical Nutrition》发表。GLIM在《全国科学技术名词审定委员会-肠外肠内营养学分名词-2019》有记载。GLIM中的某些阈值可能会随着时间的推移而有演变,但是从主观评定营养不良(如SGA、PG-SGA),发展到用表现型指标、病因型指标诊断营养不良的方向是正确的。高质量的前瞻性临床有效性验证报告和前瞻性多中心临床应用数据分析,将是GLIM改进的基础。2016年《疾病分类与代码》GB/T(中国ICD-10扩充版)及2019年《关于全国三级公立医院绩效考核通知〔2019〕》以及国家医保局信息业务数据库等三个方面文件均收录了营养风险、营养不良、重度(严重)营养不良作为疾病名称。目前临床各学科都在推行个体化医疗,但是临床各科室的实际情况不同。对肠外肠内营养支持疗法的临床应用来说,与对癌症患者的精准医疗、靶向治疗是有很大的距离。2004年12月,中华医学会肠外肠内营养学分会(Chinese Society for Parenteral and Enteral Nutritional,CSPEN)常委会组建营养风险-不足-营养支持-结局-成本效果比(Nutritional risk-undernutrition-support-outcome-cost effectiveness ratio,NUSOC)多中心分享数据库协作组,该协作组的目标是分出哪些患者需要肠外肠内营养支持疗法,合理应用前提下让患者受益。中国的疾病诊断相关分组(Diagnosis Related Groups,DRG)正在用采集大数据办法来完善DRG(初级阶段DIP,即按病种打包)的制定,就需要让大数据收集系统看到有代码的营养风险和营养不良两个疾病名称,需要填写在出院病案的首页。展开更多
In clinical practice,pancreatic neuroendocrine neoplasms(pNENs)with a diameter smaller than 2 cm are commonly referred to as small pNENs.Due to their generally favorable biological characteristics,the diagnosis and tr...In clinical practice,pancreatic neuroendocrine neoplasms(pNENs)with a diameter smaller than 2 cm are commonly referred to as small pNENs.Due to their generally favorable biological characteristics,the diagnosis and treatment of small pNENs differ from other pNENs and are somewhat controversial.In response to this,the Chinese Pancreatic Surgery Association,Chinese Society of Surgery,Chinese Medical Association have developed a consensus on the diagnosis and treatment of small pNENs,which is based on evidence-based medicine and expert opinions.This consensus covers various topics,including concepts,disease assessment,treatment selection,follow-up,and other relevant aspects.展开更多
Kupffer cells,expressing toll-like receptor 4(TLR4),play a central role in hepatic ischemia/reperfusion(I/R)injury.Hyaluronic acid(HA)fragments,degradative products of high-molecular-weight HA(HMW-HA),acquire the abil...Kupffer cells,expressing toll-like receptor 4(TLR4),play a central role in hepatic ischemia/reperfusion(I/R)injury.Hyaluronic acid(HA)fragments,degradative products of high-molecular-weight HA(HMW-HA),acquire the ability to activate immune cells under inflammatory conditions.Here we inves-tigated whether HA fragments could activate Kupffer cells and analyzed the underlying mechanism.Kupffer cells were isolated from wild-type mice(WT,C3H/HeN)and TLR4 mutant mice(C3H/HeJ)and HA fragments were produced by the methods of enzyme digestion and chromatography.Then Kupffer cells were stimulated by HA fragments or other control stimuli.The activation of Kupffer cells was estimated as the release of pro-inflammatory cytokines.The activation of p38 MAPK pathway of Kupffer cells was checked and blocking experiments were done as well.The results indicated that HA fragments acquired the ability to activate Kupffer cells in vitro,which was TLR4 dependent and not due to contamination of lipopolysaccharide.Experiments of p38 MAPK kinase inhibition by SB-203580 verified p38 MAPK was required in HA fragments induced Kupffer cells activation.This suggests that HA fragments,degradative products of one of the major glycosaminoglycans of the extracellular matrix,play critical roles in Kupffer cell activation mediated by TLR4 signaling pathway,which is,at least partially,de-pendent on p38 MAPK activation.展开更多
文摘为探讨成果导向教育(outcome based education,OBE)联合以案例为基础(case-based learning,CBL)教学模式在医学本科急性胰腺炎临床教学效果,选取160名临床医学专业学生,随机分为试验组和对照组,比较两组学生基础理论考试、临床技能考核和满意度。数据分析得出OBE理念联合CBL教学模式在临床本科急性胰腺炎教学上有一定优势。
文摘Objective： To explore the expression and meaning of Toll-like receptor 2/4 in alveolar macrophage during the process of total hepatic ischemia in mice. Methods： BALB/c mice were used in a model of total hepatic ischemia/reperfusion. Alveolar Macrophage were collected at the time point of lh, 6h and 12h by the means of bronchoalveolar lavage （BAL）, and its TLR2/4 mRNA and protein were detected with Flow Cytometry and Real-time PCR. The level of TNF in BAL fluid were measured. The concentration of MPO, the ratio of wet/dry and lung histological scores were used to assess the degrees of lung injuries. Results： At the three time points of hepatic ischemia reperfusion, the expression of TLR2/4 protein of and mRNA were up-regulated and the level of TLR2 was on the rise continually. TLR4 at the time of 6 h reached the peak value （P〈0.01）. The level of TNF-2 in BAL fluid reached the highest point at the time of 6 h （P〈0.01）. The ratio of wet/dry rose continually during hepatic ischemia reperfusion. After 1 h, the level of MPO increased rapidly. Then it reached the peak value during the period of 6 h to 12 h. Conclusion： TLR2/4 on the mice of alveolar macrophage were activated in the process of hepatic ischemia/reperfusion and involved in the injury of lung.
文摘多年来,全球肠外肠内营养学界同道们都在寻求营养不良诊断标准的统一,既需要确定营养不良诊断标准,也需要考虑营养不良指标在不同国家、不同种族的正常值和按临床研究得到的切割点(cut-off point)。全球(营养)领导层倡议营养不良(Global Leadership Initiative on Malnutrition,GLIM)诊断标准于2018年9月在美国肠外肠内营养学会(American Society for Parenteral and Enteral Nutrition,ASPEN)和欧洲临床营养和代谢学会(European Society for Clinical Nutrition and Metabolism,ESPEN)网站发表。2019年初在纸质版杂志《JPEN》及《Clinical Nutrition》发表。GLIM在《全国科学技术名词审定委员会-肠外肠内营养学分名词-2019》有记载。GLIM中的某些阈值可能会随着时间的推移而有演变,但是从主观评定营养不良(如SGA、PG-SGA),发展到用表现型指标、病因型指标诊断营养不良的方向是正确的。高质量的前瞻性临床有效性验证报告和前瞻性多中心临床应用数据分析,将是GLIM改进的基础。2016年《疾病分类与代码》GB/T(中国ICD-10扩充版)及2019年《关于全国三级公立医院绩效考核通知〔2019〕》以及国家医保局信息业务数据库等三个方面文件均收录了营养风险、营养不良、重度(严重)营养不良作为疾病名称。目前临床各学科都在推行个体化医疗,但是临床各科室的实际情况不同。对肠外肠内营养支持疗法的临床应用来说,与对癌症患者的精准医疗、靶向治疗是有很大的距离。2004年12月,中华医学会肠外肠内营养学分会(Chinese Society for Parenteral and Enteral Nutritional,CSPEN)常委会组建营养风险-不足-营养支持-结局-成本效果比(Nutritional risk-undernutrition-support-outcome-cost effectiveness ratio,NUSOC)多中心分享数据库协作组,该协作组的目标是分出哪些患者需要肠外肠内营养支持疗法,合理应用前提下让患者受益。中国的疾病诊断相关分组(Diagnosis Related Groups,DRG)正在用采集大数据办法来完善DRG(初级阶段DIP,即按病种打包)的制定,就需要让大数据收集系统看到有代码的营养风险和营养不良两个疾病名称,需要填写在出院病案的首页。
基金supported by the Chinese Academy of Medical Sciences(CAMS)Innovation Fund for Medical Sciences(CIFMS)2021-I2M-1-002.
文摘In clinical practice,pancreatic neuroendocrine neoplasms(pNENs)with a diameter smaller than 2 cm are commonly referred to as small pNENs.Due to their generally favorable biological characteristics,the diagnosis and treatment of small pNENs differ from other pNENs and are somewhat controversial.In response to this,the Chinese Pancreatic Surgery Association,Chinese Society of Surgery,Chinese Medical Association have developed a consensus on the diagnosis and treatment of small pNENs,which is based on evidence-based medicine and expert opinions.This consensus covers various topics,including concepts,disease assessment,treatment selection,follow-up,and other relevant aspects.
基金Supported by the National Natural Science Foundation of China(Grant No.30500487 and 30700792)
文摘Kupffer cells,expressing toll-like receptor 4(TLR4),play a central role in hepatic ischemia/reperfusion(I/R)injury.Hyaluronic acid(HA)fragments,degradative products of high-molecular-weight HA(HMW-HA),acquire the ability to activate immune cells under inflammatory conditions.Here we inves-tigated whether HA fragments could activate Kupffer cells and analyzed the underlying mechanism.Kupffer cells were isolated from wild-type mice(WT,C3H/HeN)and TLR4 mutant mice(C3H/HeJ)and HA fragments were produced by the methods of enzyme digestion and chromatography.Then Kupffer cells were stimulated by HA fragments or other control stimuli.The activation of Kupffer cells was estimated as the release of pro-inflammatory cytokines.The activation of p38 MAPK pathway of Kupffer cells was checked and blocking experiments were done as well.The results indicated that HA fragments acquired the ability to activate Kupffer cells in vitro,which was TLR4 dependent and not due to contamination of lipopolysaccharide.Experiments of p38 MAPK kinase inhibition by SB-203580 verified p38 MAPK was required in HA fragments induced Kupffer cells activation.This suggests that HA fragments,degradative products of one of the major glycosaminoglycans of the extracellular matrix,play critical roles in Kupffer cell activation mediated by TLR4 signaling pathway,which is,at least partially,de-pendent on p38 MAPK activation.
