目的 探讨病历点评式晨交班在心血管内科住院医师规范化培训中的作用效果.方法 选择2019年1—6月在郑州大学第一附属医院心内科参加住院医师规范化培训的68名医师为研究对象,将其随机分为研究组(34名)和对照组(34名),研究组参加晨交班后病历点评,对照组只参加常规晨交班,出科时所有规培学员均接受理论考核,填写1份调查问卷,带教老师填写1份调查问卷,对两组出科考试成绩和调查问卷进行对比分析.结果 研究组学员出科成绩总分、多项选择及病例分析得分均高于对照组,差异具有统计学意义(P<0.05);学员问卷调查表分析显示,研究组学员对晨交班后的病历点评形式较为认可,能提高自身业务水平;带教老师问卷调查表分析显示,病历点评式晨交班形式较新颖,有助于提高规培学员对心内科常见病及危急重症的处理能力,增加其自身的主观能动性.结论 病历点评式晨交班可显著提高规培学员的学习主观能动性,有助于提高学员的临床思维能力和实践能力.

Objective:To explore the effect of phillyrin on the proliferation, migration, invasion and apoptosis of hepatoma cells and its regulatory effect on circ_0054537/miR-409-3p.Methods:Hep3B liver cancer cells were cultured in vitro, and Hep3B cells were treated with phillyrin at different doses (5, 10, 20 μmol/L). Cell counting kit-8 (CCK-8) method was used to detect cell proliferation. Flow cytometry was used to detect the apoptosis rate. Transwell cell test was used to detect cell migration and invasion ability. The expression levels of circ_0054537 and miR-409-3p were detected by real-time quantitative reverse transcriptase-polymerase chain reaction (RT-qPCR) method. The dual luciferase report experiment detected the targeting relationship of circ_0054537 and miR-409-3p. Hep3B cells were transfected with si-circ_0054537, pcDNA-circ_0054537, respectively, and cell proliferation, apoptosis, migration and invasion were detected by the above methods. SPSS 21.0 statistical software was used to analyze the data. The measurement data were expressed as ( Mean± SD) and all accorded with normal distribution. The comparison between the two groups was performed by independent sample t test. The comparison between groups was performed by one-way analysis of variance, with P<0.05 The difference was statistically significant. Results:Phillyrin could significantly reduce cell viability [(1.276±0.110) vs. (1.031±0.090), (0.637±0.050), (0.507±0.040), F=244.841, P<0.05], increased apoptosis rate [(7.34±0.62)% vs. (12.44±1.03)%, (22.86±2.12)%, (28.16±2.71)%, F=244.841, P<0.05], reduce the number of migrating cells [(154.15±12.76) vs. (124.06±10.04), (78.05±7.25), (61.13±5.83)] and the number of invasive cells [(112.04±10.08) vs. (89.43±8.13), (57.11±5.12), (43.08±4.05), F=186.018, 166.514, P<0.05], inhibit the expression of circ_0054537 [(1.00±0.10) vs. (0.40±0.04), t=16.713, P<0.05], promote the expression of miR-409-3p [(1.02±0.11) vs. (3.42±0.31), t=21.889, P<0.05]. Transfection of si-circ_0054537 could significantly inhibit cell viability [(1.264±0.10) vs. (0.686±0.06)], migration [(151.96±11.17) vs. (79.03±7.21)] and invasion ability[(115.28±11.05) vs. (68.14±6.43), t=14.869, 16.457, 11.062, P<0.05], increase the apoptosis rate [(7.26±0.71)% vs. (23.79±2.06)%, t=22.759, P<0.05]. The dual luciferase report experiment confirmed that circ_0054537 could target and bind to miR-409-3p. Transfection of pcDNA-circ_0054537 could significantly reverse the regulatory effect of phillyrin on proliferation, apoptosis, migration, invasion of Hep3B cells. Conclusion:Phillyrin could down-regulate the expression of circ_0054537 and up-regulate the expression of miR-409-3p to inhibit hepatocellular carcinoma cell proliferation, migration, invasion and promote apoptosis.

Objective To investigate the effect of transplantation of bone marrow mononuclear cells (BMMNCs) on neuron-like cell differentiation and glial cell-derived neurotrophie factor (GDNF) expression in rats with intracerebral hemorrhage (ICH).Methods ICH was induced by stereotactic injection of type Ⅳ collagenase into the striatum of rats,and the successful models were randomly divided into model group (ICH group) and BMMNCs transplantation group (BMMNCs group); BMMNCs group was injected with 1 mL cell suspension containing 3 ×107 cells marked with 5-Bromo-2-deoxyuridine (Brdu).The neurological functions of the rats were observed by modified neurological severity scale (mNSS) test 1,7,14 and 28 days after the injection; the GDNF expression in cerebral tissue was observed by Western blotting 1,7,14 days after the injection; double immunofluorescent labeling was utilized to trace the differentiation of BMMNCs in the rat brains 28 days after the injection.Results As compared with those in the ICH group,the mNSS scores in the BMMNCs group were significantly lower (P＜0.05) and the GDNF expression was significantly increased at all time points (P＜0.05); Brdu and neuron specific nuclear protein (NeuN) double-labeled positive cells were found in the hemorrhage focus in the BMMNCs group 28 d after injection.Conclusion BMMNCs transplantation can improve the neural behavioral function,increase the GDNF expression,and induce BMMNCs differentiating into neuron-like cells.

近年来,随着社会工业化的发展,交通伤和高处坠落伤等各类创伤明显增多,严重胸部损伤合并颅脑损伤的发生率也逐年增加.严重胸部损伤合并颅脑损伤患者病情危重且复杂,病死率高,其症状和体征相互影响,相互掩盖,导致临床救治比较棘手[1].如果对严重胸部损伤合并颅脑损伤的认识不足,救治过程中疏于对颅脑损伤病情变化的观察、监测,以至病情恶化甚至出现脑疝及死亡[2].现就我院2006年1月-2011年1月收治的严重胸部损伤合并颅脑损伤92例患者的救治及疗效进行回顾性分析.

随着成人腹股沟疝采用无张力修补术方法治疗的逐渐开展和普及,其术后并发症也越来越受到人们的关注.切口感染就是成人腹股沟疝无张力修补术后常见的并发症之一.该类切口感染的治疗与一般的切口感染不同,具有其特殊性.总结我院2005年6月至2009年6月来收治的12例成人腹股沟疝无张力修补术后切口感染的治疗经验,报告如下.