目的 探讨高频经颅磁刺激治疗对 PSD 伴失眠患者的抑郁情绪及睡眠质量的疗效。方法 对63例PSD患者随机分为联合组32例(10Hz高频rTMS+艾司西酞普兰)及药物组31例(艾司西酞普兰+假刺激),每周5次,共治疗4周。于治疗前及治疗后4周末分别对两组患者进行HAMD、PSQI评分及多导睡眠监测。。结果 rTMS 治疗前,2组HAMD、PSQI评分及睡眠参数比较均无差异;治疗后第4周末,两组HAMD评分、PSQI评分、总睡眠时间、睡眠效率及快眼动睡眠期比例均较治疗前改善;研究组HAMD评分下降幅度较对照组明显,而PSQI评分下降幅度及相关睡眠参数改善无差异。结论 高频rTMS治疗对PSD的抑郁症状疗效更明显,而对睡眠质量及睡眠结构的改善则与药物治疗疗效相当。

Objective To investigate the effect of high frequency transcranial magnetic stimulation on depression and sleep quality in poststroke depression patients with insomnia. Methods 63 patients with PSD were randomly divided into observation group (n=32)and control group (n=31). Both groups were treated by 10~20 mg escitalopram citalopram for 4 weeks. The patients in observation group also accepted 10 Hz rTMS 10 times (i.e., as a course), while the patients in control group were treated by sham stimulation. At the baseline and 4th week, the 17-item Hamilton depression scale (17-HAMD), Pittsburgh Sleep Quality Index (PSQI)and polysomnography (PSG)were evaluated. Results The sleep parameters, PSQI scores and HAMD scores among two groups had no significant difference at baseline. After 4 weeks treatment, the HAMD score, PSQI score, total sleep duration, sleep efficiency and proportion of rapid eye movement sleep in both groups were improved compared with those before treatment. The descend range of HAMD score in observation group was larger than that in control group (t=2.590,P=0.012), while the descend range of PSQI scores(t=0.897,P=0.373)and the change of the sleep parameters in the two group had no obvious difference. Conclusion High frequency rTMS has better curative effect than antidepressant therapy on depressive symptoms of PSD,while there was no difference on the effect to improve the sleep quality and sleep structure of PSD between these two treatments.

目的 探讨二氢丹参酮Ⅰ在胃癌细胞中的抗癌作用。方法 采用 3-(4,5-二甲基噻唑-2)-2,5-二苯基四氮唑溴盐法(MTT法)测定细胞活力。流式细胞术检测细胞内活性氧(ROS)水平。荧光法测定Caspase活性。裸鼠胃癌模型验证DHTS的抗癌活性。结果 MTT实验结果表明,DHTS对HCG27和AGS细胞活力具有明显的剂量依赖性和时间依赖性。在DHTS处理的HCG27和AGS细胞中,细胞内ROS水平升高,凋亡细胞增多。 在DHTS处理的HCG27和AGS细胞中发现caspase-3和caspase-8活性增高,caspase-9活性不变。用N -乙酰半胱氨酸阻断ROS生成可显著逆转DHTS诱导的细胞凋亡。DHTS显著抑制小鼠肿瘤瘤体体积的增加。结论 所有的研究结果都有力的说明,DHTS可以在HCG27和AGS人胃癌细胞中启动活性氧生成,诱导氧化应激和细胞凋亡,值得作为抗癌药物进一步开发。

Objective To evaluate the anticancer actions of dihydrotanshinone Ⅰ(DHTS)in gastric cancer cells. Methods Cell viability was determined using 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT)assay. Intracellular reactive oxygen species (ROS)levels were determined using flow cytometry. Caspase activities were measured with fluorometric assay. The anticancer activity of DHTS in nude mouse gastric cancer model was verified. Results MTT assay showed that DHTS greatly inhibited HCG27 or AGS cell viability in dose- and time-dependent manners. Elevated intracellular ROS levels and increased apoptotic cells were observed in DHTS-treated HCG27 or AGS cells. In addition, activation of caspase-3 and caspase-8, rather than caspase-9, were noticed in DHTS-treated HCG27 or AGS cells. Furthermore, blocking ROS generation with N-acetylcysteine markedly reversed DHTS-induced cell apoptosis. DHTS inhibited the increase of tumor volume in mice. Conclusion All the findings strongly suggest that DHTS may initiate ROS generation and induce oxidative stress and cell apoptosis in HCG27 or AGS human gastric cancer cells, which deserves to be further developed as an anticancer agent.

目的 应用iTRAQ联合质谱技术筛选COPD大鼠肺组织差异表达蛋白。方法 20只雄性SD大鼠(200~220 g),随机分为对照组和模型组,每组10只,采用熏烟法建立COPD大鼠模型。观察大鼠肺组织病理学改变,测定肺功能,BALF白细胞数,肺组织总蛋白iTRAQ标记后质谱鉴定,用生物信息学方法分析蛋白表达变化。结果 与对照组相比,模型组大鼠支气管黏膜下肌层增厚,肺内可见大量炎性细胞浸润,肺功能降低,BALF白细胞数升高(均P<0.05)。质谱鉴定出4 916种蛋白,筛选出468个差异表达蛋白,其中285个表达上调,183个表达下调。筛选了上皮细胞粘着连接蛋白、fMLP、整合素等与COPD相关蛋白。结论 基于iTRAQ技术的蛋白质组学方法筛选出COPD大鼠差异表达蛋白,为进一步研究COPD的发生机制奠定了基础。

Objective iTRAQ and mass spectrometry were used to screen the differentially expressed proteins in the lung of COPD rats. Methods 20 male SD rats (200-220g)were randomly divided into control group and treatment group, with 10 rats in each group. COPD rat model was established by smoking. The lung function, the number of BALF leukocytes, the total protein iTRAQ in lung tissue were measured and identified by mass spectrometry. The differentially expressed proteins were identified by bioinformatic analysis. Results Compared with the control group, the submucous layer of bronchus in the model group was thickened, a large number of inflammatory cells were seen in the lung, the lung function was reduced, and the number of BALF leukocytes was increased. 4 916 proteins were identified by mass spectrometry, 468 differentially expressed proteins were screened, 285 of which were up-regulated and 183 down regulated. Among them, the important COPD related proteins were epithelial adhesion connexin, fMLP and integrins. Conclusion iTRAQ technology screened out the differentially expressed proteins of COPD rats, which laid the foundation for the further study of COPD mechanism

目的 探讨高脂血症大鼠模型前后血液中氨基酸代谢谱的变化,寻找高脂血症大鼠血液中氨基酸代谢标志物。方法 将SD大鼠随机分为正常对照组、模型组,连续灌胃给药4周后收集大鼠血液,测定各组大鼠血清中TG、TC、HDL-C、LDL-C含量,并运用超高效液相色谱-四极杆-飞行时间质谱(UPLC-Q-TOF-MS/MS)法测定血清中氨基酸代谢谱,利用统计学分析研究不同组动物间的氨基酸代谢的差异。结果 与正常对照组比较,模型组TG、TC、LDL-C含量升高,HDL-C含量降低,高脂血症大鼠模型建模成功;与正常对照组比较,模型组蛋氨酸、苯丙氨酸、脯氨酸、苏氨酸、缬氨酸、甘氨酸等6种氨基酸发生明显改变(P<0.05)。结论 高脂血症大鼠存在氨基酸代谢的紊乱,其中蛋氨酸、苯丙氨酸、脯氨酸、苏氨酸、缬氨酸、甘氨酸等6种氨基酸为其潜在的生物标志物。

Objective To investigate the amino acid metabolism profiles changes in the serum of SD rats, and identify the potential biomarkers. Methods SD rats were divided into normal group and model group. The contents of TG, TC, HDL-C, and LDL-C in the serum of each group were measured, after 4 weeks of continuous intragastric administration. Ultra performance liquid chromatography coupled with electrospray time-of-flight tandem mass spectrometry (UPLC-Q-TOF-MS/MS)was used to determine amino acid metabolism profile in serum, and statistical analysis was applied to determine metabolic differences among different groups of rats. Results As compared with normal group, TG, TC, LDL-C were increased and HDL-C was decreased in model group, hyperlipidemia rat model successfully modeled. As compared with normal group, methionine, phenylalanine, proline, threonine, valine, glycine in the amino acid metabolic profiling were decreased in model group (P＜0.05). Conclusion Hyperlipidemia rats have disorders of amino acid metabolism, of which methionine, phenylalanine, proline, threonine, valine, and glycine are potential biomarkers.

目的 调查临床医学生医患沟通能力的现状,分析其影响因素。方法 采用《医患沟通技能评价表（SEGUE量表）》对广州市某三甲医院的155名临床医学生进行调查。结果 临床医学生沟通技能总成绩得分率只有58.9%,在5个维度中,沟通结束方面得分率最高,为82.9%,而理解病人方面得分率最低,只有45.5%。性别、接受医患沟通相关培训次数不同的临床医学生,其沟通能力差异有统计学意义（P﹤0.05）。结论 临床医学生的医患沟通能力总体水平有待提高,特别是在理解病人方面。性别和参加医患沟通培训次数是临床医学生沟通能力的影响因素,应加强对医学生在共情能力、情感支持、移情等方面能力的培训,以提高医患沟通能力。

Objective To investigate the status of medical students' doctor-patient communication skill and analyze the influencing factors. Methods An investigation on 155 clinical medical students in a level 3 hospital in Guangzhou was conducted using the Doctor-patient Communication Skills Evaluation Scale （also called SEGUE Scale）. Results The clinical medical students’ scoring rate of communication skill was only 58.9%. Among the five dimensions, the scoring rate of communication skill end was the highest, which was 82.9%, while the scoring rate of understanding patients was the lowest, which was only 45.5%. The difference in communication skill between clinical medical students with different gender and the training times related to doctor-patient communication was statistically significant （P<0.005）. Conclusion The overall level of doctor-patient communication skill among clinical medical students was needed to be improved, especially on understanding patients. Gender and training times on doctor-patient communication training were the influencing factors of communication skills of medical students. Medical students’skills include empathy and doctor-patient communication skills, etc.

目的 探讨替罗非班联合丁苯酞应用于进展性脑梗死的疗效与安全性。方法 选取2016年1月—2018年1月广州医科大学附属第三医院神经内科收治的进展性脑梗死患者98例。对照组采用硫酸氢氯吡格雷加阿司匹林（双抗）治疗,观察组采用替罗非班（静脉治疗48 h）联合丁苯酞序贯双抗治疗。结果 替罗非班联合丁苯酞序贯双抗治疗组的神经功能缺损（NIHSS）评分、日常生活能力评定量表（Barthel指数）、改良 Rankin 量表评分优于对照组,血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）与凝血酶时间（TT）水平高于对照组,两组有差异。两组患者药物不良反应发生率无差异。结论 替罗非班联合丁苯酞序贯双抗治疗可明显改善进展性脑梗死的神经功能,为时间窗外的进展性脑梗死提供了治疗方法,疗效显著。

Objective To observe the effect and safety of triofiban combined with butylphthalide in treatment of progressive cerebral infarction. Methods A total of 98 patients with progressive cerebral infarction in the department of neurology from January 2016 to January 2018.The control group was treated with clopidogrel hydrogen sulfate plus aspirin（dual antiplatelet）. The observer group was treated with Tirofiban（48 h intravenous treatment） combined with butylphthalide on the basis of the treatment of the control group. Results The score of National Institutes of Health Stroke、 Barthel Index and mRS in the triofiban combined with butylphthalide group were better than that of the control group. There were statistical differences between the two groups. PT,APTT and TT were higher than that in the control group .There was no significant difference in drug adverse reactions between the two groups. Conclusion Triofiban combined with butylphthalide may improve the neurologic function of progressive cerebral infarction and provide treatment for progressive cerebral infarction outside the time window.

目的 探讨二维斑点追踪成像技术（Two-dimensional speckle tracking imaging,2D-STI）检测心肌肥厚患者左心室短轴收缩功能变化的效果。方法 选择2016年1月—2018年6月我院接诊的心肌肥厚100例为观察组,选取同期在我院行健康体检的健康者100例,均接受2D-STI检查,比较两组左心室短轴收缩期圆周应变与最大径向应变参数。结果 观察组前侧壁、前壁、下壁、后侧壁、前间隔、后间隔左心室短轴收缩期最大圆周应变均低于对照组,差异有统计学意义（P<0.05）;观察组前侧壁、前壁、下壁、后侧壁、前间隔、后间隔左心室短轴收缩期最大径向应变均低于对照组,差异有统计学意义（P<0.05）。结论 2D-STI可测量心机肥厚患者左心室短轴收缩功能,准确评价其心室局部运动,值得临床推广。

Objective To investigate the effect of two-dimensional speckle tracking imaging （2D-STI） on the changes of left ventricular short-axis systolic function in patients with cardiac hypertrophy. Methods 100 cases of cardiac hypertrophy received from our hospital from January 2016 to June 2018 were selected as observation group. 100 healthy subjects who underwent physical examination in our hospital during the same period were examined by 2D-STI. The left ventricle was compared between the two groups. Short-axis systolic circumferential strain and maximum radial strain parameters were compared . Results The maximum circumferential strain of the anterior wall of the anterior wall, anterior wall, inferior wall, posterior wall, anterior septum and posterior septum of the left ventricle was lower than that of the control group, and the difference was statistically significant （P<0.05）. The maximum radial strain of the anterior wall, anterior wall, inferior wall, posterior wall, anterior septum and posterior septal left ventricle was lower than the control group, and the difference was statistically significant （P<0.05）. Conclusion 2D-STI can measure the left ventricular short-axis systolic function in patients with cardiac hypertrophy and accurately evaluate the local ventricular motion, which is worthy of clinical promotion.

目的 探讨哮喘患者的气道炎症表型分布及肺功能指标情况。方法 选择226 例哮喘患者为研究对象,其中50 例为重症哮喘,76 例为普通哮喘,对比哮喘患者的气道炎症表型分布情况及患者肺功能指标情况。结果 226 例哮喘患者中,嗜酸性粒细胞型最为常见,占36.73%,之后为中性粒细胞型（31.86%）、混合细胞型（22.12%）、寡细胞型（9.29%）;重度哮喘患者中,中性粒细胞型患者肺功能相关指标均低于其它类型的重症患者（P<0.05）。结论 在哮喘气道炎症表型中,最常见的表型为嗜酸性粒细胞型,其中中性粒细胞型的哮喘患者的肺功能最差。

Objective To explore the phenotype distribution and lung function indicators of airway inflammation in asthmatic patients. Methods 226 cases of asthma patients were chosen as the research objects,in which 50 cases of severe asthma,76 cases of asthma,to compare asthma airway inflammation phenotype distribution and lung function index. Results Among 226 asthma patients,eosinophilic granulocytes were the most common,accounting for 36.73%,followed by neutrophilic granulocytes （31.86%）,mixed cell types （22.12%） and oligocytes （9.29%）. Among patients with severe asthma, the lung function of neutrophil patients was lower than that of other severe patients（P < 0.05）. Conclusion Among asthmatic airway inflammatory phenotypes, the most common phenotype is eosinophilic granulocyte type, among which neutrophil asthmatic patients have the worst lung function.

目的 探讨高龄患者（≥65岁）腹股沟嵌顿疝术后肺部感染的相关因素。方法 以我院手术治疗的60例腹股沟嵌顿疝术后肺部感染的高龄患者为观察组,行1∶1匹配病例对照研究,应用单因素及多因素条件Logistic回归对相关因素进行分析,计算各因素与肺部感染的OR值及其95%可信区间。结果 研究提示术前血清白蛋白≤35 g/L（P=0.013）、术前血红蛋白≤100 g/L（P=0.029）、既往慢性阻塞性肺气肿病史（P=0.014）及抽烟（P=0.008）、手术时间≥2 h（P=0.021）、手术切除部分肠管（P=0.032）、气管插管（P=0.024）、手术季节为冬季（P=0.030）为危险因素;预防性使用抗生素（P=0.018）、术后雾化（P=0.023）、良好睡眠（P=0.048）为保护因素。结论 高龄患者腹股沟嵌顿疝术后肺部感染的发生与相关生化指标、既往史、治疗过程、环境因素等密切相关。

Objective To investigate the correlation factors of elderly patients with inguinal incarcerated hernia surgery related lung infection. Methods A hospital-based 1∶1 matched case-control study was conducted among elderly patients with inguinal incarcerated hernia surgery related lung infection,calculated the factors associated with the extent of lung infection,and the 95% confidence interval. Results The analysis showed that pre-ALB≤35g/L（P=0.013）,pre-Hb≤100g/L（P=0.029）,COPD（P=0.014）,smoking（P=0.008）,operation time（P=0.021）,bowel resection（P=0.032）,endotracheal intubation（P=0.024） and operation in winter（P=0.030） were the risk factors of lung infection,while the prophylactic use of antibiotics（P=0.018）,aerosol inhalation（P=0.023） and good sleep（P=0.048） were the protective factors. Conclusion Some biochemical indicators,past history,therapeutic process and environmental factors were closely related to inguinal incarcerated hernia surgery related lung infection in elderly patients.

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.