基于PBL的情景模拟教学在重症医学科住院医师规范化培训中的应用

目的 探讨基于以问题为基础的学习（problem-based learning,PBL）的情景模拟教学在重症医学科住院医师规范化培训中的作用和效果。方法 选取2019年3月至2019年12月在苏州大学附属第一医院重症医学科规范化培训的住院医师48人,分为试验组和对照组,每组各24人。试验组采用基于PBL的情景模拟教学,对照组采用传统教学。教学任务结束后比较两组规培学员成绩,对比和分析调查问卷结果差异。应用SPSS 17.0进行t 检验。结果 试验组的理论考核成绩（85.50±5.15）分和技能考核成绩（82.38±5.64）分均高于对照组[（77.04±8.69）分、（70.92±5.65）分],差异有统计学意义（P<0.05）。试验组在提升学习兴趣和效率、提高临床工作能力、强化临床思维能力、提高团队协作能力和提高医患沟通能力等5个方面均高于对照组,差异有统计学意义（P<0.05）。结论 基于PBL的情景模拟与传统教学相比优势明显,值得推广。     

以信息技术构建系统解剖学网络课程体系的实践和思考

为推动医学教育的信息化建设,进一步提升教师的信息化的认知,遵义医科大学积极推广数字化教学工具,创新教育教学管理,促进信息技术与教育的深度融合。为此选择临床专业系统解剖学进行网络课程体系的建立,利用Camtasia studio 9、Adobe After Effects CS6及格式工厂等视频软件制作系统解剖学的网络课程,并在超星学习通平台上打造专属的系统解剖学网络课程体系,进行线上教学模式的探索。通过对线上、线下教学的评估得知,此次线上教学改革达到了预期的教学效果,激发了学生学习的自主性,实现了系统解剖学的教学要求;但还有许多问题,如何将线上线下更好地融合,还有待进一步探索。     

脂质体转染AFP基因构建树突状细胞肝癌瘤苗及体外活性检测

目的：探讨以ＡＦＰ为靶点，构建ＡＦＰ－ＤＣ肝癌瘤苗及其抗肝癌免疫治疗的可能性。方法：应用脂质体将ＡＦＰ基因转染体外培养的未成熟 ＢＭＤＣ，构建 ＡＦＰ－ＤＣ肝癌瘤苗，以流式细胞术、Ｗｅｓｔｅｒｎ ｂｌｏｔ、３Ｈ－ＴｄＲ法和 ＭＴＴ法等检测其免疫活性。结果：ＡＦＰ－ＤＣ瘤苗不仅能产生和分泌ＡＦＰ，而且能上调自身的Ｂ７分子和ＭＨＣ分子，明显刺激Ｔ细胞增殖及提高ＣＴＬ的杀伤作用。结论：提示肝癌相关基因ＡＦＰ可作为抗肝癌基因治疗的切入点。     

与眶下神经相关的初级传入纤维终末的溃变、非突触部位胞吐及突触联系

切断眶下神经的各组大鼠存活2～30天后分别杀死,于其三叉神经尾侧脊束核胶状质亚核内观察了一级传入纤维轴突终末的溃变过程.非突触部位胞吐及突触联系.结果发现:(1)眶下神经的跨节溃变、以突触小泡聚集、融合、空泡形成为主要特征,无微丝增生现象:(2)部分溃变终末内的线粒体明显肿胀变暗.呈球形改变:(3)大致密核心小泡的溃变时间远滞后于突触小泡.两者并不同步进行;(4)轴突终未在溃变过程中,其内的大致密核心小泡仍然进行非突触部位胞吐;(5)溃变纤维终末于胶状质内分别形成轴一树、轴一体、轴一轴三种类型的突触、并参与了突触复合体的形成.     

携带hIL-2cDNA的逆转录病毒载体的构建及其在人肝癌细胞中的特异表达研究

将人白细胞介素２（ｈＩＬ-２）ｃＤＮＡ克隆到逆转录病毒载体ＭＮＳＭ的ＰＬ位点　，分别构建了转录受ＳＶ４０早期启动子和人甲胎蛋白增强子调控的重组逆转录病毒载体ＭＮＳＩ和ＭＮＳＩＡ。用脂质体转染法将ＭＮＳＩ和ＭＮＳＩＡ分别转导ＰＡ３１７包装细胞，测质粒转染率为（５～２０）×１０~(－３)克隆／μｇＤＮＡ·１０~６细胞，病毒感染率为（５．４～４５０）×１０~４ＣＦＵ／ｍｌ。重组病毒在４μｇ／ｍｌ ｐｏｌｙｂｒｅｎｅ存在条件下感染人肝癌细胞、肾癌细胞和黑色素瘤细胞，Ｎｅｏ~Ｒ克隆经Ｓｏｕｔｈｅｒｎｂｌｏｔ分析证明ｈＩＬ－２ｃＤＮＡ转入人肿瘤细胞并整合，　Ｒ　ＮＡ斑点杂交及ＩＬ－２活性表达分析证明，人甲胎蛋白增强子可促进异源启动子启动ｈＩＬ－２ｃＤ－ＮＡ在合成甲胎蛋白的人肝癌细胞中高效特异转录和表达。该研究对肝癌特异性免疫增强基因治疗有重要意义。     

pcDNA3.1/hIL-18真核表达载体的构建及表达

目的 :构建重组真核表达质粒pcDNA3.1/IL 18,并在哺乳动物细胞COS 7和Rlc310中进行瞬时和稳定性表达。方法 :从含hIL 18基因的中介载体 pGEM TEasy( pGEM T/hIL 18)中 ,以限制性内切酶酶切方法获得目的片段 ,克隆入真核表达质粒 pcDNA3.1( )中。以脂质体法转染COS 7和Rlc310细胞 ,用RT PCR检测IL 18mRNA的水平 ,免疫组化染色法检测蛋白表达。结果 :构建了hIL 18基因的重组真核表达质粒pcDNA3.1/IL 18,并可在哺乳动物细胞中瞬时、稳定表达 ,获得了可稳定表达hIL 18基因的Rlc310细胞株。结论 :pcDNA3.1/IL 18的构建及表达 ,为IL 18抗肿瘤作用的研究奠定了基础     

Inhibition of skin xenograft rejection by depleting T-cell receptor alpha beta-bearing cells without T-cell receptor gamma delta-bearing cells or natural killer cells by monoclonal antibody.

We compared the effects of in vivo administration of the anti-T-cell receptor (TCR) alpha beta monoclonal antibody (mAb) (H57-597) to those of the anti-CD3 mAb (145-2C11), with or without anti-NK1.1 mAb (PK136), on xenogeneic skin graft survival in mice. In anti-TCR alpha beta mAb-treated B6 mice, F344 rat skin grafts survived for about 54 days, whereas in anti-CD3 mAb-treated B6 mice with or without anti-NK1.1 mAb treatment grafts survived about 25 days. In anti-TCR alpha beta mAb-treated B6 mice, TCR alpha beta-bearing T-lymphocyte function was completely abrogated, although TCR gamma delta-bearing T-lymphocyte function was still intact on day 9. In the anti-CD3 mAb-treated mice, the functions of both types of T lymphocytes were completely abrogated. On day 32, when most of the skin xenografts had been rejected in the anti-CD3 mAb-treated mice, the functions of both T lymphocytes had recovered considerably, and could actually respond to F344 antigens. In contrast, the function of TCR alpha beta-bearing cells had only partially recovered in the anti-TCR alpha beta mAb-treated mice. Finally, natural killer (NK) activity in the anti-TCR alpha beta mAb-treated mice was intact on day 32, when rat skin grafts still survived. In contrast, NK activity in the anti-CD3 mAb plus anti-NK1.1 mAb-treated mice did not recover on day 32, when skin xenografts had already been rejected. These results suggest that TCR gamma delta-bearing T cells and NK cells by themselves, at least in the absence of TCR alpha beta-bearing T cells, do not mediate xenogeneic skin graft rejection in mouse/rat combinations.     

促肝细胞生长素诱导人肝癌细胞（BEL－7402）凋亡

本文从细胞学、ＤＮＡ凝胶电泳、流式细胞术三方面研究促肝细胞生长素（ｐＨＧＦ）在体外对肝癌细胞增殖活性的影响。结果表明：ｐＨＧＦ对肝癌ＢＥＬ－７４０２细胞增殖有抑制作用，并存在剂量和时间相关性。其４８ｈ的半数抑制浓度（ＩＤ５０）为０．３７ｍｇ／ｍｌ±０．０４ｍｇ／ｍｌ。而３７℃灭活的ｐＨＧＦ对ＢＥＬ－７４０２细胞增殖在１５ｈ无抑制作用，在２４和４８ｈ抑制作用很弱（ＩＤ５０＞１．５ｍｇ／ｍｌ）。ＤＮＡ凝胶电泳结果表明，ｐＨＧＦ可诱导ＢＥＬ７４０２细胞产生细胞凋亡（Ａｐｏｐｔｏｓｉｓ）。流式细胞术（ＦＣＭ）结果显示：ｐＨＧＦ抑制ＢＥＬ－７４０２细胞增殖过程是先使细胞停留在Ｇ０／Ｇ１期，继而诱导细胞产生凋亡。后两项结果均显示ｐＨＧＦ对人肝癌细胞凋亡的诱导里时间和剂量相关性。     

Discordant quantitative detection of putative biomarkers in nodal micrometastases of colorectal cancer: biological and clinical implications

AIMS: Nodal expression of the carcinoembryonic antigen (CEA), cytokeratin 20 (CK20), and guanylyl cyclase C (GCC) genes was measured in tandem in patients with colorectal cancer (CRC) to assess whether there would be sufficient agreement between these markers in their ability to detect micrometastasis to qualify one of them as a universal marker, and whether frozen and paraffin wax embedded tissues would yield similar results. METHODS: One hundred and seventy five frozen lymph nodes (FT) and 158 formalin fixed, paraffin wax embedded lymph nodes (PET) from 28 CRC cases were analysed using gene specific quantitative real time polymerase chain reaction, carried out on the LightCycler system with SYBR Green chemistry. RESULTS: There was significant disparity in positive detection of the three biomarkers in FT versus PET, with notable agreement achieved only for CEA (66.6%) in FT versus PET in Dukes' B disease, and between CK20 and GCC (44.6%) in FT, also in Dukes' B disease. One patient with full concordance in all three tumour markers with both tissue types suffered a relapse and died within two years of follow up. CONCLUSIONS: There was considerable discordance in the positive detection of the three tumour markers in both tissue types (FT versus PET). This brings into question whether using a single tumour marker to detect micrometastasis in one tissue type (FT or PET) is adequately representative, and challenges the concept of universal markers for molecular CRC metastatic detection. Multiple tumour markers would predict more accurately the metastatic potential of Dukes' B CRCs.     

青少年归因方式与人际信任的关系

目的探求青少年归因方式与人际信任的关系。方法运用一般情况调查表、I—E量表、信任量表对413名青少年进行测查。结果①青少年的归因方式在性别、是否留守上均存在显著差异；②青少年的人际信任在性别、是否留守上均不存在显著差异；③青少年的归因方式对人际信任有极其显著的影响。结论青少年的归因方式极其显著地影响其人际信任。