目的:探究肺癌细胞外泌体miR-24-3p调控CD8+T细胞抗肿瘤的功能及机制.方法:将 16HBE exo、A549 exo、H522 exo、H460 exo、miR-NC exo、miR-24-3p exo与CD8+T细胞共孵育(16HBE exo组、A549 exo组、H522 exo组、H460 exo组、miR-NC exo组、miR-24-3p exo组),与PBS共孵育组(PBS组)作为对照,CD8+T与miR-24-3p exo共孵育后转染FGF11 质粒(miR-24-3p exo+FGF11 组).CCK8 法检测CD8+T细胞的增殖能力.双荧光素酶报告基因实验验证miR-24-3p和FGF11 的靶向关系.将各组CD8+T细胞与A549 细胞以20∶1的比例共孵育 4 h(16HBE exo/CD8+T组、A549 exo/CD8+T组、H522 exo/CD8+T组、H460 exo/CD8+T组、miR-NC exo/CD8+T组、miR-24-3p exo/CD8+T组、PBS/CD8+T组、miR-24-3p exo+FGF11/CD8+T组),Elisa检测共孵育后细胞上清中INF-γ和IL-2 的浓度,LDH法检测CD8+T细胞对A549 细胞的杀伤能力.结果:相比于PBS组,A549 exo组、H522 exo组、H460 exo组CD8+T细胞增殖能力显著降低(P<0.05).A549 exo/CD8+T组、H522 exo/CD8+T组、H460 exo/CD8+T组细胞上清中INF-γ和IL-2 的浓度显著下降(P<0.001),CD8+T细胞杀伤能力亦显著下降(P<0.001).双荧光素报告基因检测结果显示FGF11 为miR-24-3p的靶基因.miR-24-3p exo组CD8+T细胞增殖能力显著低于miR-NC exo组,miR-24-3p exo+FGF11 组CD8+T细胞增殖能力显著高于miR-24-3p exo组(P<0.05).miR-24-3p exo/CD8+T组细胞上清中INF-γ和IL-2 浓度及CD8+T细胞杀伤能力均显著低于miR-NC exo/CD8+T组(P<0.001),miR-24-3p exo+FGF11/CD8+T组细胞上清中INF-γ和IL-2 浓度及CD8+T细胞杀伤能力显著高于miR-24-3p exo/CD8+T组(P<0.001).结论:肺癌细胞外泌体miR-24-3p可通过靶向抑制FGF11 而抑制CD8+T细胞的抗肿瘤功能.

Objective To investigate the changes and clinical significance of the expression of neutrophil gelatinase-associated li-pocalin(NGAL)and autophagy during different time of renal ischemia/reperfusion(I/R)injury in rats.Methods The rat renal I/R in-jury model was established,thirty male Wistar rats were divided by random number table method into sham operation group(Sham group)and I/R group,according to the different time of reperfusion after I/R injury,the I/R group was divided into 4subgroups:2h group,6h group,24h group,48h group.Blood,urine and renal tissue samples were collected at different time points,NGAL levels of blood and u-rineweredetectedbyenzyme-linkedimmunoadsordentassay(ELISA)method.Bloodureanitrogen(BU)and serum creatinine(SCr)were detected by automatic biochemical analyzer.Hematoxylin-eosin staining was used to detect the degree of histopathological injury and score the degree of injury.TdT-mediated dUTP nick end labeling(TUNEL)method was used to detect the apoptosis of renal tubular ep-ithelial cells;the expression of autophagy related genes LC3 and Beclin-1gene was detected by real-time quantitative polymerase chain reaction(RT-qPCR)method.Results The expression levels of NGAL in blood and urine were elevated in the 2h after I/R injury,and peaked at 6h of reperfusion,and showed a downward trend at 24h.BU and Scr values began to increase after the 6h reperfusion of I/R in-jury and peaked at 24h of reperfusion.TUNEL positive cells began to increase at 6h after I/R injury,the number of the highest was at 24h reperfusion of I/R injury.Hematoxylin-eosin staining showed that there were different degrees of swelling and necrosis of renal tubular epithelial tissue in all groups after I/R injury.The expression of LC3 and Beclin-1 gene began to increased after the 6h reperfusion of I/R injury and peaked at 24h of reperfusion.Conclusion The expression level of NGAL increased at the early stage of renal I/R injury in rats,which was earlier than the changes of BU and SCr levels,and could be used as a molecular indicator for early diagnosis of renal I/R injury.During the aggravation of renal I/R injury,the expression of NGAL was increased and autophagy was activated,which indica-ted that NGAL and autophagy played a certain role in the process of renal I/R injury.

目的 评价交互式医学图像控制系统(MIMICS)软件行三维重建联合胸腔镜在肺腺癌复杂肺段切除术中的应用价值.方法 以2016年1月—2017年6月在河北医科大学第四医院进行单纯胸腔镜肺段切除术的42例患者为对照组,以2017年7月—2018年7月期间行MIMICS软件三维重建联合胸腔镜肺段切除术的48例患者为观察组.比较2组围手术期临床指标、手术并发症;比较术前和拔除胸腔引流管后2组肺功能指标,包括1 s用力呼气容积(FEV1)、用力肺活量(FVC)、每分钟最大通气量(MVV).结果 2组患者病灶数量、结节性质差异无统计学意义(均P＞0.05),观察组并发症发生率(10.42％,5/48)显著低于对照组(28.57％,12/42,P＜0.05).观察组手术时间、术中出血量、术后胸管留置时间、术后住院时间显著短于对照组(均P＜0.05).2组术前FEV1、FVC、MVV差异无统计学意义(均P＞0.05);拔除胸腔引流管后,2组患者肺功能均显著低于术前,但观察组FEV1、FVC、MVV 显著高于对照组[(1.67±0.52)L vs.(1.38±0.69)L,(1.73±0.64)L vs.(1.48±0.51)L,(54.27±7.14)L/min vs.(50.36±6.08)L/min,均P＜0.05].结论 对于行复杂肺段切除术的肺腺癌患者,采用MIMICS软件在术前进行三维重建有利于在术中分辨肺部解剖结构,确定结节位置,有利于提高手术准确性,缩短手术时间,减少并发症,减轻手术对肺功能的损伤,利于术后康复.

Objective:To investigate the status quo and training needs of general practitioner (GP) job-transfer training program in Hebei Province.Methods:An online survey with self-designed questionnaire was conducted on May 2019 through WeChat among 165 trainees in the General Practice Training Center of Hebei Province. A total of 165 questionnaires were distributed and 149 were valid with an effective rate of 90.3%. The contents of the questionnaire included the basic information of the trainees, the evaluation of the current training, and the needs of the GPs′ job-transfer training.Results:Among 149 participants, there were 131 (87.9%)from the secondary hospitals or above, 146(98.0%)with bachelor′s degree or above, and 128 (85.9%)with intermediate or above professional titles. The survey showed that 72.0%(67/93)thought the main reasons affecting participation in the training were busy work load and insufficient personnel, the main problems of training were too short training duration(45.2%, 42/93), the not focused training contents(38.7%, 36/93) and lack of practice(37.6%, 35/93). In the 149 trainees, 136(91.3%) thought that the most important contents should be standardized diagnosis and treatment of common diseases; 104(69.8%), 118(79.2%), 115(77.2%) and 98(65.8%) considered that the knowledge of prevention and health-protection, first aid, latest progress and chronic disease management were needed for training; 110(73.8%)and 80(53.7%)thought the mastery of clinical practice and basic theory were needed. And 57.7% (86/149)of the trainees believed that research training was needed, and there was significant difference in the demand for research training among participants from different work units and with different professional titles (χ 2=15.371,10.625,all P<0.05). The accepted training methods were case study(53.7%, 81/149) and practical work(37.6%, 56/149). For training duration, 43.6% (65/149) thought it should not exceed 6 months and 56.4% (84/149) preferred more than 1 year; there was a significant difference in demanded training duration among trainees from different work units, with different education background and professional titles (χ 2=16.225,6.243,25.966, all P<0.05). Conclusion:We need a multi-channel and multi-level training model to establish a better job-transfer training system for general practitioners, in order to meet different training needs and to improve the effectiveness of the training.

The organ system-based teaching model integrates the morphology and function of various organ and system of human body, breaks the boundaries of disciplines, and avoids the duplication and disjunction between disciplines. With this model general practitioners can effectively and efficiently learn basic knowledge and clinical skills in the training. This article introduces the organ system-based teaching model and its application in general practice job-transfer training in China.

Objective To survey the current status and training requirement of rural doctors in Hebei province.Methods A questionnaire survey was conducted among1 200 rural doctors selected from 11 cities of Hebei province by stratified sampling from October to December 2017.The self-designed questionnaire included general condition,job satisfaction,impact of medical reform policies,training needs of rural doctors.Results A total of 1 200 questionnaires were distributed and 1 170 valid ones were retrieved with a recovery rate of 97.5％.Among the 1 170 responders,there were 726 males(62.1％) and 444 females (37.9％);748 (63.9％) were aged more than 40 years;612 (52.3％) hold secondary school degree;826 (70.6％) had been working in the village for more than 10 years,and the overall job satisfaction rate was 30.8％ (360/1 170).Among all responders,73.8％ (864/1 170) worked in the standardized village clinics,and 72.0％ (842/1 170) were contracted with local residents as family doctors;52.8％ (618/1 170) responders believed that the reform policy improved the health care for villagers.In all responders,98％ (1 147/1 170)thought they needed training,93.6％ (1 095/1 170) had received training.The training contents they most needed werethe management of common diseases (904,77.3％),followed by medical humanities(650,55.6％)and first aid knowledge (492,42.1％).The influencing factors for training were lack of time,no energy (656,54.3％),lack of appropriate training forms (510,43.6％),economic reasons (476,40.3％) and so on.Conclusion The working status of rural doctors need to befurther improvedand the training need to be strengthened to increase their job satisfaction.

目的:分析三阴性乳腺癌(triple negative-breast carcinoma,TNBC)临床病理特征及预后影响因素。方法:收集2005年1月至2008年12月就诊于河北医科大学第四医院乳腺癌手术患者的临床资料。回顾分析TNBC与非TNBC的临床、病理特征差异及TNBC预后影响因素。结果:TNBC在初诊时肿块较大、淋巴结转移阳性者较多,临床分期以Ⅱ、Ⅲ期为主,有乳腺癌家族史者较多,肺、肝转移率高。Cox回归分析显示,淋巴结状况、原发肿瘤大小是影响TNBC患者OS及DFS的两个主要因素。结论:TNBC与非TNBC在临床、病理特征上存在的差异较多,35岁以上TNBC患者预后更差。N、T为TNBC独立预后因素。

三阴性(ER、PR、HER-2均阴性)乳腺癌是具有特殊生物学行为及临床病理特征的一个乳腺癌亚型,与基底细胞样乳腺癌和BRCA1相关性乳腺癌有一定相关性。对三阴性乳腺癌的分子病理特征、治疗现状及潜在药物靶点等方面的研究,将有助于设计更佳的治疗方案,改善预后。