关键词： 内科学   血管紧张素Ⅱ   外膜成纤维细胞   骨桥蛋白   氯沙坦   血管重塑  

摘要： 目的研究血管紧张素Ⅱ对培养的大鼠胸主动脉外膜成纤维细胞骨桥蛋白表达的影响。方法大鼠外膜成纤维细胞被随机分为对照组、血管紧张素Ⅱ不同浓度(10-8、10-7、10-6和10-5mol/L)和时间(6h、12h和24h)干预组及血管紧张素Ⅱ加AT1受体拮抗剂氯沙坦和/或AT2受体拮抗剂PD123319干预组,用RT-PCR及Western blotting技术结合光密度扫描分析,观察血管紧张素Ⅱ对培养的大鼠胸主动脉外膜成纤维细胞骨桥蛋白表达的影响。结果血管紧张素Ⅱ10-6mol/L明显刺激外膜成纤维细胞骨桥蛋白的表达,6h、12h和24h桥蛋白较对照组分别升高65.43%、97.03%和105.11%(P<0.05);而24h阴性对照无明显变化。不同浓度的血管紧张素Ⅱ均可诱导骨桥蛋白表达,10-8、10-7、10-6和10-5mol/L管紧张素Ⅱ孵育后分别升高了70.46%、97.37%、123.10%和147.59%(P<0.01)。在血管紧张素Ⅱ刺激前1h分别加入氯沙坦(10-5mol/L)、PD123319(10mmol/L)、氯沙坦(10-5mol/L)+PD123319(10mmol/L),共同孵育12h后,其抑制率分别为58.9%、0.92%和59.7%。Western blotting分析,12h不同剂量血管紧张素Ⅱ干预组(10-8、10-7、10-6和10-5mol/L)骨桥蛋白量较对照组分别提高了50.68%、63.03%和69.86%(P<0.05),氯沙坦明显抑制血管紧张素Ⅱ刺激的骨桥蛋白表达,抑制率达到61.7%(P<0.05),而PD123319作用后抑制作用不明显,抑制率仅为0.85%(P>0.05)。结论血管紧张素Ⅱ能在基因和蛋白水平上刺激大鼠外膜成纤维细胞骨桥蛋白的表达,此作用可能是通过AT1受体介导。

关键词： 治疗应用   科学杂志   并发症   并发病   疾病   病理生理学   淋巴细胞   白细胞   药理学   药物学   病理学   基础医学   疾病学   病因学   病原学   药物作用   药物效应   药物疗法   主题索引   目录   检索工具  

关键词： 临床见习   中医内科   模式  

摘要： 临床见习是指医学生在临床学科理论阶段为巩固所学的理论知识而进行的初步实践,它是医学院校教学的重要组成部分。中医内科学教学一般分为三个阶段:①中医内科学总论与各论的理论教学;②临床见习;③临床实习。这三个阶段具有有机的内在联系,组成了统一的教学整体。在临床教学中,临床见习是扩大学生视野、保证课堂教学效果、让学生更好地理论结合临床实践、提高综合分析能力及培养临床思维能力的一个重要组成环节,[第一段]

关键词： 内科学   多种教学方法   课堂效率  

摘要： 阐述教学的内涵,分析内科学的教学现状,提出提高内科学教学质量的意义。加深了解多种内科学教学方法,提出合理化建议,更好的应用多种教学方法提高课堂效率。

关键词： 内科学   扩张型心肌病   冠状动脉狭窄  

摘要： 扩张型心肌病(dilated cardiomyopathy,DCM)患者若同时合并冠状动脉临床有意义狭窄病变,在临床上极有可能被误诊为缺血性心肌病。为此,我们报道1例在我院随访4年继发严重冠状动脉病变的扩张型心肌病患者,旨在为临床医生提供诊断参考资料。1病例报告文某,男,60岁,2004年5月开始出现活动后心悸、气促,但无劳累后胸痛及胸闷;无咳嗽及咳痰。既往无高血压、糖尿病、冠心病、风湿性心脏病、先天性心脏病和慢性肺源性心脏病等病史。2004年9月首次入院时:十二导联心电图示T波普遍低平或双向;血糖及血脂正常;超声心动图示左、右房室内径均普遍增大,室壁运动普遍减弱(其中左心室内径71.0mm,左心房内径43.0mm,左心室射血分数26.8%),无瓣膜狭窄及关闭不全;运动平板试验阴性;冠状动脉造影未发现临床有意义狭窄病变(仅见右冠状动脉开口处及冠状动脉前降支中段存在25%的非临床有意义狭窄病变)。当时入院体查:一般情况可,高枕卧位,血压90/60mmHg,无桶状胸,双肺呼吸音清晰,心界扩大,心率86次/min,律齐,心音稍低,心前区可闻及收缩期2/6级杂音。当时诊断为“扩张型心肌病,心脏扩大,心功能Ⅲ级”。[第一段]

关键词： 中医医结合内科学   教学   临床思维   培养  

摘要： 《中西医结合内科学》是中西医结合医学中最重要的临床学科之一。由于《中西医结合内科学》目前仍处在中医内科学与西医内科学二者进一步相互兼容、相互渗透、优势互补、相互结合的过程,因而在教授本门课程中,应分析中西医结合内科学的学科特点与发展现状,合理设计教学内容,以有利于学生掌握学习内容。[第一段]

关键词： 牙体硬组织非龋性疾病   口腔内科学   牙本质粘接剂   临床观察   龋病   疗效观察   磨牙缺损   嵌体修复  

摘要： 70例隐裂牙临床疗效观察;复合树脂嵌体修复磨牙缺损的临床疗效观察;老年人牙隐裂治疗临床疗效分析;32例乳牙牙本质光密度的测定与分析;

关键词： Albumin   Nutritional status   Onco-hematological diseases  

摘要： Background: Serum albumin is commonly measured in hospitalized patients. It has habitually been included among the parameters used for nutritional assessment, and recently its use has become even more widespread. Yet, no data are available in the literature about the prevalence and clinical significance of hypoalbuminemia in patients hospitalized in an internal medicine ward. The aim of this study was to investigate the prevalence and clinical significance of hypoalbuminemia in in-hospital internal medicine patients. Methods: We retrospectively evaluated the albumin level of patients admitted to the Department of Internal Medicine and Biomedical Sciences of the University of Parma during the year 2000. We then evaluated sex, age, nutritional status, some laboratory parameters, associated diseases, and length of hospitalization in hypoalbuminemic patients in comparison with a group of patients without hypoalbuminemia. Results: Hypoalbuminemics (46.5% of patients) were older, more frequently anemic, and had a higher erythrocyte sedimentation rate (ESR) and longer hospitalization;they were mostly normal weight or overweight. These patients also had chronic liver (18.6% vs. 4.5%), oncohematological (33.8% vs. 12%), and infectious diseases (13.4% vs. 2.3%) and nephropathies (6.3% vs. 2%) more often than patients without hypoalbuminemia. The presence of onco-hematological diseases was related to anemia (O.R.=5.73;95% CI: 3.184-10.310), lymphopenia (O.R.=2.76;95% CI: 1.584-4.801), and hypoalbuminemia (O.R.=2.5;95% CI: 1.178-5.307). Conclusions: Hypoalbuminemia is very frequent in an internal medicine ward. In this setting, serum albumin is related to the length of hospitalization and to other parameters with a well-known prognostic value (age, hemoglobin) and clinical usefulness (ESR). It may also play a role in the evaluation of the possible association of onco-hematological diseases. (C) 2008 European Federation of Internal Medicine. Published by Elsevier B.V. All rights

关键词： pain management   resident education   hospital standards   opioid conversion   opiophobia  

摘要： We aimed to improve internal medicine residents' deficiencies in pain management and evaluate the effectiveness of our intervention, which included an interactive conference series, e-mail vignettes, and didactic sessions. All anonymous survey was administered at the beginning and at the end of an academic year, before and after the intervention, respectively. We analyzed 65 preintervention and 63 postintervention surveys. Self-perception of competency in pain management increased From 40% to 60% (P =.02). Perception of adequacy of training increased From 35.5% to 55.6% (P =.05). Opioid conversion skills improved by 25% (P =.02). Overall, knowledge did not change significantly, except in the subgroup of residents who had completed the oncology rotation from 0.60 to 0.72 (P =.003). "Opiophobia" improved by 20% (P =.05). Documentation of pain improved (rank correlation =21;P =.02). We concluded that educational and institutional interventions administered over an academic year improved pain management skills and documentation and reduced "opiophobia" among residents.