支气管镜检查模拟教学是涵盖认知、知识、技能、情感多个纬度的操作性培训.自2001年第一个模拟器用于支气管镜培训以来,不断有研究证明,支气管镜模拟教学可行且非常重要.模拟训练提供给住院医师安全的环境,通过重复的刻意练习使得住院医师在临床接触真实病人前获取技能.支气管镜模拟教学是以能力为导向的医学教育(competency-based medical education,CBME),它以能力培养为基准,已由既往数量的认证转向标准的技能获得;依靠基于能力的经验证的结构化评估工具来实现支气管镜检查能力的评估.标准化、结构化的支气管镜模拟教学,可明显促进住院医师技能的提升,内容主要包含标准和灵活的课程、基于模拟的培训、持续的测量和持续的能力技能评估.具体实施可分为课前学习、课中模拟和课后评估3个部分.

Currently, osimertinib (AZD9291) is the only third-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor approved by the Food and Drug Administration for the treatment of non-small cell lung cancer (NSCLC) with EGFR T790M mutations. However, acquired resistance is an inevitable clinical challenge. Although placenta-specific 8 (PLAC8) has been proven to serve an important role in tumor progression and resistance, its effect in AZD9291 resistance in NSCLC remains largely unknown. The aim of the present study was to investigate the functional role of PLAC8 in AZD9291 resistance in NSCLC. The results revealed that the level of PLAC8 was significantly upregulated in AZD9291-resistant cells compared with that in parent cells. Overexpression of PLAC8 in parent cells markedly decreased drug sensitivity, and enhanced cell proliferation, colony formation and migration. Furthermore, the levels of aldehyde dehydrogenase 1 family member A1 (ALDH1A1) were observed to be upregulated in resistant cells and PLAC8-overexpressing parent cells, suggesting that ALDH1A1 may be involved in the association between the overexpression of PLAC8 and AZD9291 resistance in NSCLC. Overall, PLAC8 overexpression promoted NSCLC resistance to AZD9291, and PLAC8 may be a potential target for the reversal of AZD9291 resistance.

目的 探讨血清血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)水平与慢性阻塞性肺疾病(COPD)患者肺动脉高压(PAH)的关系.方法 选取2015年6月～2018年12月上海交通大学附属第六人民医院(以下简称“我院”)收治的COPD患者,共143例.根据PAH诊断标准将患者分为对照组A(COPD未并发PAH)61例和观察组(COPD并发PAH)82例.另选取同期来我院健康体检的40名肺功能正常者作为对照组B.根据COPD患者病情严重程度分为急性期(69例)、缓解期(49例)、稳定期(25例).根据肺动脉收缩压(PASP)升高程度将观察组分为轻度PAH组(32例)、中度PAH组(27例)、重度PAH组(23例).结果 对照组A、观察组血清bFGF、VEGF水平与PASP均显著高于对照组B,观察组明显高于对照组A,差异有统计学意义(P＜0.05).COPD患者急性期、缓解期血清VEGF、bFGF水平与PASP均显著高于稳定期,急性期明显高于缓解期,差异有统计学意义(P＜0.05).中度PAH组、重度PAH组血清VEGF、bFGF水平均显著低于轻度PAH组,重度PAH组明显低于中度PAH组,差异有统计学意义(P＜0.05).COPD未并发PAH患者血清VEGF、bFGF水平与PASP呈正相关(r=0.346、0.438,P=0.011、0.006).COPD并发PAH患者血清VEGF、bFGF水平与PASP呈负相关(r=-0.421、-0.339,P=0.008、0.012).结论 COPD患者中血清VEGF、bFGF水平存在异常表达,其表达水平与PASP存在密切联系.

Circular RNAs (circRNAs) are a novel type of endogenous RNAs and increasing evidence have uncovered the important role of circRNA in tumor progression; however, the function of circRNAs in non-small cell lung cancer (NSCLC) remains largely unclear. In the present study, it was demonstrated that the expression level of hsa_circ_0033155 was significantly downregulated in NSCLC tissue and the expression of hsa_circ_0033155 correlated with lymphatic metastasis. In order to further investigate the possible role of hsa_circ_0033155 in NSCLC progression, circRNA was overexpressed in NSCLC cells and it was observed that the overexpression of hsa_circ_0033155 significantly decreased cell proliferation, colony formation and migration, and elevated the level of phosphatase and tensin homolog deleted on chromosome 10, a tumor suppressor in many types of tumor. In conclusion, hsa_circ_0033155 may serve as a prospective biomarker for detection and a promising therapeutic target for NSCLC.

目的：分析并评价噻托溴铵与沙美特罗替卡松及二者联合吸入治疗中重度稳定期慢性阻塞性肺疾病的临床疗效。方法随机将2011年10月至2013年10月期间收治的165例慢性阻塞性肺疾病患者分成单药A组与单药B组及联合用药组，各组均为55例，单药A组患者给予沙美特罗替卡松粉吸入剂；单药B组患者给予噻托溴胺粉吸入剂；联合用药组给予吸入沙美特罗替卡松粉吸入剂与噻托溴胺粉吸入剂，全部患者均治疗3个月。对比分析三组治疗前及治疗后的临床症状、肺功能以及生活质量。结果本研究中165例患者最终按要求实施治疗者共163例。治疗后各组临床症状、日常生活、社会生活以及精神生活各项指标、FEV1、FEV1/FVC以及FEV1/预计值均显著优于治疗前，差异具有统计学意义（ P均﹤0.05）；联合用药组上述各指标改善程度明显优于单用药A组与单用药B组，差异具有统计学意义（ P均﹤0.05）。结论噻托溴铵与沙美特罗替卡松二者联合吸入对中重度稳定期慢性阻塞性肺疾病的疗效确切，明显优于单独用药，提倡临床推广应用。

目的:探讨雾化激素是否可作为全身激素的替代方法用于慢性阻塞性肺疾病急性加重期(AECOPD)的治疗。方法:因AECOPD住院的患者随机分为常规治疗组、雾化激素组、静脉激素组3组,后两组分别在常规治疗组的基础上加用布地奈德雾化或甲基强的松龙静滴,疗程10d。结果:(1)常规治疗组于入组后10dPaO2、FEV1改善(P<0.05)。雾化激素组于入组后24hPaO2改善,3d时FEV1、FVC改善,10d时FEF50改善(P<0.05)。静脉激素组于入组后24hPaO2改善,3d时FEV1、FVC、FEF50改善(P<0.05)。与雾化激素组比,静脉激素组3d时FEV1、FVC改善更明显(P<0.05),10d时两组改善值相似(P>0.05)。(2)治疗后静脉激素组痰IL-6下降幅度高于常规治疗组(P<0.05),与雾化激素组比无差异(P>0.05)。仅静脉激素组痰TNF-α降低(P<0.05)。(3)静脉激素组高血糖发生率(20.0%)高于常规治疗组(P<0.05),与雾化激素组(3.3%)比无差异(P>0.05),雾化激素组与常规治疗组比无差异(P>0.05)。结论:雾化激素治疗AECOPD疗效与静脉激素相似,可作为AECOPD的一种替代治疗方案。