目的 分析促红细胞生成素（EPO）及促红细胞生成素受体（EPOR）在肝细胞癌（NCC）以及正常组织中的表达规律,以及它们和肝细胞癌微血管密度（MVD）之间的关系。方法 选取我院手术切除的肝细胞肝癌的标本30例,取肿瘤边缘2.0 cm的肝组织作为对照,同时取正常肝脏组织10例做为阴性对照。利用酶联免疫吸附实验（ELISA）检测各组织中EPO及EPOR表达水平,利用免疫组织化学方法染色检测微血管密度（MVD）。对比癌组织和癌旁组织EPO、EPOR及MVD差异,分析NCC中EPO、EPOR、MVD与肿瘤病理特征的关系,分析EPO、EPOR表达水平与MVD之间的关系。结果 HCC组织中,EPR、EPOR、MVD均高于癌旁组织和正常组织,差异有统计学意义（P<0.001）,EPR、EPOR、MVD在癌旁组织和正常组织中,差异无统计学意义（P>0.05）。肿瘤大小>5 cm、存在包膜侵犯、存在远处转移以及高中分化的HCC中,EPR、EPOR、MVD水平高于肿瘤大小≤5 cm、无包膜侵犯、无远处转移以及低分化的水平,差异有统计学意义（P<0.05）。Person相关分析结果显示,EPO表达水平与MVD的相关系数r=0.651（P<0.001）,EPOR表达水平与MVD的相关系数r=0.620（P<0.001）。结论 EPO、EPOR、MVD在HCC中呈现高水平,且与肿瘤大小、局部侵犯、远处转移及分化程度有关,其机制可能与EPO、EPOR增加MVD有关。

Objective To analyze the expression of erythropoietin （EPO） and erythropoietin receptor （EPOR） in hepatocellular carcinoma （NCC） and normal tissues,and their relationship with hepatocyte microvessel density （MVD）. Methods Thirty specimens of hepatocellular carcinoma hepatectomy were selected from our hospital. The liver tissue at the edge of the tumor was taken as a control,and 10 cases of normal liver tissue were used as a negative control. The expression levels of EPO and EPOR in each tissues were detected by enzyme-linked immunosorbent assay （ELISA）,and microvessel density （MVD） was detected by immunohistochemistry. The differences of EPO,EPOR and MVD between each tissues were compared. The relationship between EPO,EPOR,MVD and tumor pathological features in NCC was analyzed. The relationship between EPO and EPOR expression levels and MVD was analyzed. Results In HCC tissues,EPR,EPOR and MVD were higher than those in adjacent tissues and normal tissues. The difference was statistical difference （P<0.001）. EPR,EPOR and MVD were not statistically significant in adjacent tissues and normal tissues. P>0.05）. The levels of EPR,EPOR,and MVD in tumors with tumor size >5 cm,invasion of the capsule,distant metastasis,and high-differentiation were higher than those of tumor size ≤ 5 cm,no capsule invasion,no distant metastasis,and poor differentiation. The difference was statistical difference （P < 0.05）. Person correlation analysis showed that the correlation coefficient between EPO expression level and MVD was r=0.651 （P<0.001）,and the correlation coefficient between EPOR expression level and MVD was r=0.620 （P<0.001）. Conclusion EPO,EPOR and MVD are highly expressed in HCC,and are related to tumor size,local invasion,distant metastasis and differentiation. The mechanism may be related to EPO and EPOR increasing MVD.

目的 探讨恙虫病患者血清乳酸脱氢酶（LDH）水平在检查中的临床价值及LDH与血小板数目、丙氨酸氨基转移酶和天冬氨酸氨基转移酶的相关性。方法 选取2016年3月—2018年2月在我院就诊的60例恙虫病患者,其中男25例,女35例。记录患者的基本情况,血常规、肝肾功能等实验室检测指标;并检测患者血清中乳酸脱氢酶水平。并分析患者乳酸脱氢酶与小板数目、丙氨酸氨基转移酶和天冬氨酸氨基转移酶的相关性。结果 多数患者出现发烧、头痛、腹痛、咳嗽咳痰等症状,少数患者出现腰痛、意识障碍、皮肤黏膜出血等症状;60例恙虫病患者中,52名患者血清乳酸脱氢酶含量高于正常值,15例患者血小板数量低于正常值;55名患者丙氨酸氨基转移酶高于正常值,53名患者天冬氨酸氨基转移酶高于正常值;患者血清LDH与血小板数目（r=-0.929,P<0.01）呈负相关,与丙氨酸氨基转移酶（r=0.957,P<0.01）,天冬氨酸氨基转移酶（r=0.947,P<0.01）呈正相关。结论 乳酸脱氢酶水平可以作为患者恙虫病的早期诊断标志。

Objective To investigate the clinical value of serum LDH levels in tsutsugamushi patients. Methods We selected 60 patients with tsutsugamushi disease who were enrolled in our hospital from September 2016 to February 2018,including 25 males and 35 females. We recorded the patients' basic conditions,blood tests,liver and kidney function and other laboratory testing indicators;and we detected serum lactate dehydrogenase levels in patients. The correlations in lactate dehydrogenase and platelet number,alanine aminotransferase,and aspartate aminotransferase were analyzed. Results Most patients developed fever,headache,abdominal pain,cough,sputum,and other symptoms. A small number of patients suffered low back pain,disturbance of consciousness,skin mucosal bleeding,and other symptoms;among the 60 patients with tsutsugamushi disease,the contents of serum amblytic dehydrogenase were higher than normal in 52 patients,and the numbers of platelets in 15 patients were lower than normal. The value of alanine aminotransferase was higher than normal in 55 patients,and the value of aspartate aminotransferase was higher than normal in 53 patients;serum LDH and platelet counts （r=-0.929,P<0.01）,alanine aminotransferase （r=0.957,P<0.01） and aspartate aminotransferase （r=0.947,P<0.01） showed positive correlation. Conclusion Lactate dehydrogenase level may be used as an early diagnostic marker for patients with tsutsugamushi disease.

目的 研究加减香砂六君子汤联合三联疗法治疗慢性萎缩性胃炎的临床疗效。方法 将100例慢性萎缩性胃炎患者随机分为对照组和观察组各50例,对照组患者给予三联疗法而观察组在对照组基础上辨证使用加减香砂六君子汤加减进行治疗。对临床疗效进行评估,观察两组患者临床症状并测定血清中超氧化物歧化酶（SOD）、丙二醛（MDA）水平的变化,统计两组的幽门螺杆菌（Hp）转阴率及复发率、根除率。结果 治疗以后统计有效率,观察组为92%,而对照组仅有76%,胃胀、胃痛、痞满、反酸、饮食减少等症状均缓解,各症状的积分治疗后均降低,两组相比其差异有统计学意义,观察组的Hp转阴率为92.0%,对照组Hp转阴率为68.0% ,两组Hp转阴率比较,差异有统计学意义。两组SOD水平均较治疗前上升,MDA水平均较治疗前下降,SOD水平高于对照组,MDA水平低于对照组,差异均有统计学意义（P<0.05）。结论 加减香砂六君子汤联合三联疗法治疗慢性萎缩性胃炎可显著改善患者的临床症状,有良好的应用前景。

Objective To observe the clinical effect of Jiajianxiangshaliujunzi decoction combined with triple therapy for chronic atrophic gastritis. Methods We selected 100 cases of patients with chronic atrophic gastritis of intertwined,and divided them into the control group and the observation group randomly with 50 cases in each group. The control group was given triple therapy for treatment,while the observation group was additionally given Jiajianxiangshaliujunzi decoction based on the syndrome differentiation for treatment. We observed the changes of clinical symptoms and levels of superoxide dismutase（SOD） and malondialdehyde（MDA） in serum of both groups. The negative conversion rate,recurrence rate and eradication rate of Helicobacter pylori （Hp） in 2 groups were statistically analyzed,in both groups and the clinical effect. Results After treatment,the total effective rates were counted: the observation group was 92%,and the control group was only 76%. The symptoms such as stomach distention,stomachache,distention and fullness,acid reflux,and diet reduction were reduced after the treatment. The difference between the two groups had statistical significance. In the two groups of stomachache,fullness and boredom,low appetite and acid regurgitation scores were all lower than those before treatment,and the differences were statistically significant. The negative rate of Hp in the observation group was 92%,while the negative rate of Hp in the control group was 68%. There was difference between the two groups in the negative rate of Hp. The levels of SOD in both groups were higher than those before treatment,and the levels of MDA were lower than those before treatment,differences being significant（P< 0.05）;the level of SOD in the observation group was higher than that in the control group,and the level of MDA was lower than that in the control group. Difference was statistically significant. （P< 0.05）. Conclusion Jiajianxiangshaliujunzi decoction combined with triple therapy for chronic atrophic gastritis may improve clinical symptoms of patients,and promote the negative rate of Hp as well as the clinical effect.

目的 观察肺保护性通气策略对肺功能不全胃肠手术患者术后转归影响。方法 选取2016年4月—2017年3月期间我院收治的90例肺功能不全胃肠手术患者作为研究对象,根据随机数字表将患者随机分为观察组和对照组,每组各45例。对照组采用传统机械通气方式,观察组采用肺保护性通气方式。观察两组患者动脉血气指标、自主呼吸恢复时间、清醒时间、拔管时间、PACU观察时间及住院期间术后肺部并发症发生情况。结果 两组患者麻醉时间、手术时间、晶胶液输入情况、麻醉药物用量差异无统计学意义（P>0.05）。观察组患者术后PaO₂高于对照组,差异有统计学意义（P<0.05）。两组患者自主呼吸恢复时间、清醒时间、拔管时间、PACU观察时间比较,差异均无统计学意义（P>0.05）。观察组患者住院期间PPCs发生率低于对照组,差异有统计学意义（P<0.05）。结论 肺保护性通气策略可有效改善肺功能不全胃肠手术患者术后氧合,降低患者住院期间PPCs发生率,对于患者术后转归具有积极的作用。

Objective To observe the effect of lung protective ventilation strategy on postoperative outcome of patients with pulmonary insufficiency of gastrointestinal surgery. Methods 90 patients with pulmonary insufficiency gastrointestinal surgery in our hospital from April 2016 to March 2017 were selected as study subjects. According to the random number table,patients were randomly divided into observation group and control group,with 45 cases in each group. The control group used traditional mechanical ventilation,and the observation group used lung protective ventilation. Arterial blood gas parameters,spontaneous breathing recovery time,awakening time,extubation time,PACU observation time and postoperative pulmonary complications in both groups were observed. Results There was no significant difference in anesthesia time,operation time,crystal glue fluid input,and anesthetic drug dosage between the two groups （P>0.05）. The postoperative PaO₂ was higher in the observation group than in the control group （P<0.05）. There was no significant difference between the two groups in spontaneous breathing recovery time,awakening time,extubation time,and PACU observation time （P>0.05）. The incidence of PPCs was lower in the observation group than that in the control group,and the difference was statistical difference （P<0.05）. Conclusion Lung protective ventilation strategy may effectively improve postoperative oxygenation in patients with pulmonary insufficiency and gastrointestinal surgery,reduce the incidence of PPCs during hospitalization,and have a positive effect on postoperative outcome.

目的 观察并比较注射用重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白（益塞普）剂量递减方案与标准剂量维持方案治疗强直性脊柱炎（AS）的疗效及安全性。方法 选择2015年1月—2016年6月共18个月在我院治疗的80例AS患者为研究对象,随机分为两组,A组40例,给予益塞普递减方案治疗,B组40例,给予益塞普标准剂量维持方案治疗,比较两组的用药疗效及安全性。结果 治疗后,两组的BASDAI、BASFI评分,腰背痛VAS评分,血清CRP、ESR水平均低于治疗前（P<0.05）,但两组组间比较未见统计学意义（P>0.05）;在治疗期间,A组与B组的不良反应发生率（32.50%、55.00%）及复发率（27.50%、22.50%）比较均无统计学意义（P>0.05）;经统计,A组的年平均药物费用为（47 391±4 830）元,少于B组（82 038±5 127）元（P<0.05）。结论 采用益塞普剂量递减方案治疗AS安全有效,能在短时间内控制疾病活动及改善临床症状,且花费更低,患者接受度更高。

Objective To observe and compare the clinical effect and safety of dose reduction scheme for recombinant human tumor necrosis factor receptor antibody fusion protein （hTNFR：Fc,etanercept） for injection and standard dose maintenance scheme in treatment of ankylosing spondylitis （AS）. Methods 80 cases of patients with AS and who were treated in our hospital from January 2015 to June 2016 for 18 months were selected as the research objects,and were randomly divided into two groups.The group A of 40 cases were treated with etanercept of degressive scheme therapy,while the group B of 40 cases were treated with etanercept of standard dose maintenance therapy. Then,the clinical effect and safety of drug use of two groups were compared. Results The BASDAI,BASFI score,VAS score of low back pain,serum CRP and ESR levels of two groups after treatment were lower than those before the treatment （P < 0.05）,but there was no statistical significance between the two groups （P > 0.05）. During the treatment,there was no significant difference in the incidence of adverse reactions （32.50%,55%） and recurrence rate （27.50%,22.50%） between group A and group B （P > 0.05）. By statistics,the average annual drug cost in group A was RMB （47 391±4 830） yuan,which was less than that in group B of RMB （82 038±5 127） yuan （P < 0.05）. Conclusion The etanercept of degressive scheme therapy in treatment of AS are safe and effective,which may control disease activity and improve clinical symptoms in a short time,and low costs. The patient will receive higher degree of acceptance.

目的 探讨生物电抗无创心排监测（bioreactance noninvasive cardiac output monitoring,NICOM）心指数（cardiac index,CI）和总外周阻力指数（total peripheral resistance index TPRI）对呼吸困难病因诊断的临床价值。方法 采用前瞻性观察性研究的方法 ,纳入急性呼吸困难或慢性呼吸困难急性加重的患者共113例,临床医师根据2010年中华医学会心血管病学分会编委会组织编写的《急性心力衰竭诊断和治疗指南》为金标准分为心力衰竭组（n=55）和非心力衰竭组（n=58）,通过NICOM监测CI、TPRI,构建受试者工作特征曲线（receiver operating characteristic curve,ROC曲线）,分析CI和TPRI对心力衰竭的诊断价值。结果 心力衰竭组患者的CI低于非心力衰竭组（P<0.001）;心力衰竭组患者TPRI高于非心力衰竭组（P<0.001）;利用ROC曲线进行分析,CI曲线下面积（area under the curve,AUC）为0.792（95%CI：0.708~0.875,P=0.000）,当CI截断值取2.65L/（min·m²）时,诊断心力衰竭的敏感度为63.6%,特异度为87.9%;TPRI的AUC为0.733（95%CI：0.641~0.825,P=0.000）,当TPRI截断值取2 353dynes.sec/（cm⁵·m²）时,诊断心力衰竭的敏感度为72.7%,特异度为67.2%;CI联合TPRI诊断心力衰竭的敏感度为80%,特异度为65.5%。结论 NICOM监测CI对心力衰竭所致的呼吸困难特异度高,联合TPRI监测可提高敏感度。

Objective To investigate the clinical values of etiological diagnosis by testing cardiac index CI and total peripheral resistance index TPRI using bioreactance noninvasive cardiac output monitoring NICOM in patients with dyspnea. Methods Prospective,observational study was taken in 113 adult patients admitted with dyspnea or acute exacerbation of dyspnea in stable disease. The patients were divided into two groups namely heart failure group （n=55）and non-heart failure group（n=58） according to the guidelines on the diagnosis and treatment of acute heart failure（2010） as the standard criterion. All patients underwent CI and TPRI test by using NICOM. Receiver operating characteristic curve（ROC curve） was plotted to evaluate the diagnostic value of CI and TPRI. Results Compared with non-heart failure group,the CI was worse（P<0.001）,and the TPRI was elevated（P<0.001）. ROC curve showed that the area under the curve（AUC） of CI was 0.792（95%CI：0.708~0.875,P=0.000）. The cut-off of CI was 2.65L/min/m²,the sensitivity was 63.6%,and specificity was 87.9%. The AUC of TPRI was 0.733（95%CI：0.641~0.825,P=0.000）. The cut-off of CI was 2 353dynes.sec/cm⁵/m²,the sensitivity was 72.7%,and specificity was 67.2%. The sensitivity of CI combined TPRI was 80%,and specificity was 65.5%. Conclusion NICOM monitoring CI have high specificity,and combined TPRI monitored may improve sensitivity for dyspnea caused by heart failure.

目的 筛选结直肠癌（CRC）差异性表达的长链非编码RNA（lncRNA）,并进行临床标本验证,研究其对结肠癌细胞HCT116功能的作用。方法 利用lncRNA PCR芯片对3对CRC组织和癌旁对照组织筛选差异性表达的lncRNA,确定候选研究lncRNA GAPLINC,RT-qPCR对21例临床样本进行验证其表达的差异性;同时构建GAPLINC表达质粒及其沉默体siRNA转染HCT116细胞,研究其对细胞凋亡、迁移及侵袭能力的影响。结果 lncRNA芯片实验结果提示CRC组织中存在大量的差异性表达的lncRNA,其中GAPLINC在CRC组织表达稳定增加,21例临床样本进一步验证了其在肿瘤组织中表达增加（P<0.05）;转染GAPLINC表达质粒后,HCT116细胞凋亡被抑制,同时其迁移及侵袭能力增强,转染siRNA抑制GAPLINC的表达后,则出现相反的结果。结论 利用lncRNA芯片可对CRC差异性表达lncRNA进行批量筛选,GAPLINC在CRC组织中表达稳定增加,具有促癌作用,在CRC发生发展中可能起着重要作用。

Objective To screen the differentiational expression of lncRNA in CRC tissue,confirm it in large simple of clinical specimens,and study its effects on human colorectal cells HCT116 cell line. Methods We screened the lncRNA which expressed differently in 3 CRC tissues and their pair-non carcinour tissues by lncRNA arrays;chose the over expressed lncRNA which played the potential role of oncogene for further researching,and tested the difference in 21 clinical specimens by RT-qPCR. We cultured the HCT166 cells,and then constructed expressed plasmids pcCDNA3.1-GAPLINC and synthesized GAPLINC siRNA,transfected the plasmids and siRNA into HCT116 cells;to study the changes of HCT116 cells behavior,the transwell assays were carried on;the changes of apoptosis of HCT116 cells were tested by flow cytometry. Results There existed many lncRNA which expressed differently between CRC tissues and normal control tissues by lncRNA arrays,there were 21 lncRNA down expressed,and 3 lncRNA up expressed;among these lncRNA,GAPLINC over expressed stably,and its high level of expression was approved in 21 clinical specimens by the test of RT-qPCR. We constructed the expressed plasmids pcCDNA3.1-GAPLINC and synthesizing GAPLINC siRNA successfully;after transfecting pcCDNA3.1-GAPLINC into HCT116 cells,the over expression of GAPLINC increased the migration and invasion of the HCT166 cells （P<0.05）,decreased the proportion of cell apoptosis （P <0.05）;by contraries,knocked down the expression of GAPLINC inhibited invasion and migration of HCT116 cells （P<0.05）,and promoted the apoptosis of the HCT116 cells （P <0.05）. Conclusion It could screen the different expression of lncRNA in large quantities by lncRNA arrays,and GAPLINC expressed highly and stably in CRC tissues. GAPLINC played a role of oncogene,which promoted the proliferation and invasion of CRC cells,and inhibited the apoptosis of CRC cells,which meant playing an important role in the carcinoma and development of CRC.

目的 探讨TBL教学法在物理治疗学教学资源库建设中的应用效果。方法 选取我校康复治疗学专业2013级和2014级各60名学生为研究对象,分别作为传统教学组和试验教学组,传统教学组采用传统教学方法,试验教学组在传统教学方法的基础上,采用TBL教学法参与教学资源库建设的方式来完成教学。学期结束对学生进行实践技能、理论考试及问卷调查评估。结果 在牵引疗法的考核中,两组实践技能成绩无差异(P＞0.05),其它项目试验教学组实践技能成绩均高于传统教学组(p＜0.05)。试验教学组理论考试成绩高于传统教学组,对教学的满意度也更高。结论 采用TBL教学法建设物理治疗学教学资源库,不仅能提高教学效果,而且有助于加快实践教学资源库的建设。

Objective To explore the application effect of TBL teaching method in the construction of physiotherapy teaching resources library. Methods We selected 60 students from the 2013 and 2014 grades of rehabilitation therapy in our school respectively, who were used the traditional teaching method group and the experimental teaching method group. The traditional teaching method group adopted the traditional teaching method. The experimental teaching method group was based on the traditional teaching methods, and used TBL to participate in the construction of a teaching resource library. At the end of the semester, students will be assessed on practical skills, theoretical examinations, and questionnaire surveys. Results In the assessment of traction therapy, there was no significant difference in the performance of the two groups (P>0.05). The other experimental skills of the experimental teaching group were better than those of the traditional teaching group (p<0.05). Theoretical test scores of experimental teaching group are higher than the traditional one, and satisfaction with teaching is also higher than the latter. Conclusion Using TBL teaching method to build a library of physiotherapy teaching resources may not only improve the teaching effect, but also help to speed up the construction of practical teaching resources.

目的 探讨TBL(Team-Based Learning)教学在临床实践教学中的应用效果。方法 将2015年外科实习学生分为应用传统教学的对照组与应用TBL教学的实验组,教学效果采用出科考核成绩、实习效果调查和TBL教学法可行性调查问卷进行评估。结果 两组学生出科考核成绩无明显差异, TBL有助于提高学生解决临床问题的综合能力、课堂参与度、自觉知识掌握度、实习满意度。结论 TBL可以增强学生主动思考学习、团队协作能力,在临床实践教学中切实可行。

Objective To explore the application effect of TBL (Teaching Team-Based Learning) in clinical practice teaching. Methods The surgical internship students of the year 2015 were divided into the control group with traditional teaching and the experimental group with TBL teaching. The teaching effect was evaluated by the examination results, the internship effect survey and the TBL pedagogical feasibility questionnaire. Results There was no significant difference between the two groups in their test scores. TBL helped to improve students' comprehensive ability to solve clinical problems, classroom participation, degree of self-knowledge and internship satisfaction. Conclusion TBL may enhance students' ability of active thinking and learning, teamwork and practicing in clinical practice teaching.

目的 探究不同类型职业病危害因素对暴露工人生命质量的影响。方法 在某市电子制造业、灯饰制造业、金属冶炼业等能够接触到粉尘、铅、苯以及噪声的6家企业中,采用整群随机抽样法,共计抽取742人为研究对象,对上述企业2015—2017年的职业病危害因素检测报告进行回顾性分析,主要对各企业的职业病危害因素以及暴露水平实施分析,并对企业员工的生命质量情况实施调查。结果 三种不同行业之间的有机溶剂检测合格率比较差异均有统计学意义(P＜0.05),其中有机溶剂检测合格率最低的是金属冶炼业;三种不同行业的粉尘检测合格率差异以及噪声检测合格率比较差异无统计学意义(P＞0.05),其中灯饰制造业的噪声及粉尘检测合格率最低;各行业工作人员的生理、社会功能,心理、情感职能,精神健康,身体疼痛、活力以及总计健康评分差异有统计学意义(P＜0.05),电子制造企业的各项评分均高于金属冶炼业以及灯饰制造业。多重线性回归分析结果发现,电子制造企业的生理与心理健康维度得分均高于灯饰制造业、金属冶炼业,差异有统计学意义(P＜0.05),且主要与运动锻炼以及所从事的行业有较大关联。结论 不同类型的职业病危害因素暴露水平存在一定差异,企业职工的生命质量也会因此受到不同程度的影响,应对存在噪声、粉尘以及大量使用有机溶剂等职业病危害因素企业作为健康监护的重点。