目的 探讨医德认知专项教育对医学生专业素养的影响.方法 选择 2021 年 11 月至 2022 年 5 月在牡丹江医学院附属红旗医院实习的 68 名学生为教学对象.采取随机数表法,将学生分为对照组和观察组两组,每组学生各 34 名.对照组采取常规教学,观察组开展医德认知专项教育.教学后,从实习生对医生工作岗位的认知评分、实习生医德认知评分和各个科室实习成绩平均分等方面,比较教学效果.结果 在实习生对医生工作岗位的认知评分方面,观察组技术能力认知评分大于对照组;观察组实习生医德认知评分和各个科室实习成绩平均分均大于对照组,差异有统计学意义(P＜0.05).结论 医学生医德认知专项教育模式的构建,有效改善了实习生对医德的认知,同时也提高了医学生专业素养.

传统骨水泥的主要成分是聚甲基丙烯酸甲酯,是一种广泛运用于骨科手术中的骨粘固剂.生物骨水泥在发展过程中主要分为两大体系:生物相容性较差的PMMA骨水泥和生物相容性良好的磷酸钙骨水泥.但其临床运用中的利弊仍然是一个在持续讨论中的话题.理想的骨水泥应该具有生物相容性好,固化过程放热少,组成、结构、性能与人体骨组织相近等相关的生物活性特点.硫酸钙骨水泥( CSC)作为一种新型骨植入物材料的运用已经有相当长的一段历史,它本身不仅具备优良的骨传导及可吸收的特点,而且还具有较为理想的力学性能,包括较好的初始力学强度、耐压及耐疲劳性.现已较为广泛的运用于临床对于其在作为骨缺损的填充以及骨科用药的负载材料的相关研究中,展现出良好的应用前景.同时近年来也有文献提及以硫酸钙作为基础的复合骨水泥效能的诸多优势,但单纯性注射型或复合型琉酸钙骨移植替代材料的质地较脆、机械强度依然有限.硫酸钙骨水泥( CSC)的出现与运用,在力学强度、生物相容性、孔隙率等方面相于前两类骨水泥,均有较为全面的弥补与突破.由于硫酸钙骨水泥( CSC)拥有上述优良的接近于理想骨水泥的特性,故其作为某些骨科用药的负载材料以及复合骨水泥在临床中运用就显得愈加迫切与重要.现就此研究综述如下.

目的 系统评价Dynesys腰椎动态稳定系统与经后路腰椎椎间融合术PLIF对手术相邻节段退变的不同影响.方法 计算机检索中国知网、万方数据库、重庆维普、PubMed等数据库,搜集比较Dynesys与PLIF两种术式对手术相邻节段腰椎退变影响的文献,检索文献为近6年国内外公开发表的文章,具体时间为2015年1月1日至2020年10月9日.结果 本研究共纳入中文研究14个及英文研究3个,共计17个.描述两种术式对手术节段上位椎间隙高度H影响的研究共9项,描述两种术式对手术节段上位椎间活动度ROM影响的研究共15项,描述两种术式对手术节段下位椎间隙高度H影响的研究共4项,描述两种术式对手术节段下位椎间活动度ROM影响的研究共7项.结论 Meta分析结果显示,两种术式对手术相近节段椎间隙高度的影响及对手术下节段椎间活动度的影响比较,差异均无统计学意义(P>0.05);与Dynesys术相比,PLIF术可以更好地保留手术上节段椎间活动度,而Dynesys术并不能延缓手术相邻节段的退变.

Abnormal expression of miR-409-3p has been found in several neurodevelopmental disorders, but whether it is dysregulated in the patients with acute cerebral infarction (ACI) has not been evaluated. The current study mainly focused on the clinical significance and the underlying mechanism of plasma miR-409-3p in the progression of ACI. The level of plasma miR-409-3p was determined in ACI patients (n = 80) and healthy controls (n = 30). Pearson correlation assay was performed to evaluate the association and cardiovascular risk factors. A receiver operating characteristic curve (ROC) was used to evaluate the diagnostic value of plasma miR-409-3p levels in patients with ACI. Dual luciferase reporter assay and western blot were performed to determine the possible target gene of miR-409-3p. Our data showed that the expression of plasma miR-409-3p in the ACI group was higher than that in the healthy controls. Furthermore, Pearson correlation analysis indicated a positive correlation between plasma miR-409-3p and the NIHSS score. ROC analysis indicated that plasma miR-409-3p could differentiate plasma miR-409-3p in ACI patients from healthy controls. Then, we explored the possible target genes of miR-409-3p. Interestingly, C1q and TNF-related 3 (CTRP3), a novel adipose tissue-derived secreted factor, was found to be a target gene of miR-409-3p. We found that knockdown of CTRP3 significantly induced PC12 cell apoptosis, even in PC12 cells transfected with miR-409-3p inhibitor. These data suggested that miR-409-3p induced PC12 cell apoptosis by targeting CTRP3. Altogether, elevated plasma miR-409-3p is correlated with disease severity and may be efficient for the early diagnosis of ACI.

目的 探讨扩散张量成像对早期糖尿病肾病肾脏异常灌注及弥散水平评价价值.方法 选取2017年2月～2019年2月我院收治的104例早期糖尿病肾病患者,依据是否含微量白蛋白,分为早期糖尿病肾病组(40例)和糖尿病组(64例),另选取同期来我院接受体检的40例健康人群作为对照组,分别对以上三组进行MRI扫描,获取IVIM参数,分析三组临床资料、体素内不相干运动成像相关参数、扩张量成像有关参数,对比肾脏髓质FA值及皮髓质f、D值对糖尿病及糖尿病肾病诊断价值.结果 三组年龄、BMI差别没有明显差别(P＞0.05),糖尿病组eGFR及空腹血糖均高于对照组(P＜0.05);糖尿病肾病组空腹血糖高于对照组,eGFR低于糖尿病组(P＜0.05);三组肾皮质D、灌溉分数值均高于髓质,D*值低于髓质.糖尿病肾病组皮髓质灌溉分数、D值低于对照组和糖尿病组,三组存在明显差别(P＜0.05);三组肾皮质FA值低于髓质(P＜0.05),糖尿病肾病组和对照组肾皮质γ1低于髓质(P＜0.05),三组皮质γ3、ADC、γ2值高于髓质(P＜0.05).糖尿病肾病组和糖尿病组γ1皮、髓质、ADC、γ2值没有明显区别(P＞0.05).糖尿病组肾髓质FA值低于对照组,糖尿病组及糖尿病肾病组髓质γ3值均高于对照组(P＜0.05);对糖尿病及糖尿病肾病鉴别,皮质f值诊断效能最好,敏感度和特异度均高于肾皮质D、肾髓质D、肾髓质f、肾髓质FA(P＜0.05).结论 糖尿病肾病弥散变化和早期肾脏灌注及通过弥散水平评价可通过扩散张量成像反映,在早期糖尿病肾病患者肾功能异常评价中发挥重要作用.

目的 探讨负压封闭引流(vacuum sealing drainage,VSD)技术联合深部冲洗治疗深层软组织创面感染的应用效果.方法 选取本院2017年9月～2019年9月收治的40例深层软组织创面感染患者为考察对象,其中20例为改良组,采用负压封闭引流技术联合深部冲洗,另20例为传统组,采用传统的VSD技术;观察和比较两组的堵管率、第一次敷料拆除时创面感染率、创面愈合时间、手术治疗的费用等.数据采用SPSS统计学软件进行分析.结果 改良组的堵管率、创面感染率、创面愈合时间、手术治疗费用显著低于传统组(P<0.05).结论 改良的VSD技术在治疗深层软组织感染患者上,可显著降低堵管率、创面感染率、手术治疗费用,缩短创面愈合时间,提高临床疗效.

负压封闭引流技术在临床上是用来促进组织愈合、加快外形及功能恢复的重要治疗方法,随着医疗水平不断提高,负压封闭引流技术不断地优化改进,在四肢的创面感染、皮肤移植修复、骨髓炎、骨筋膜室综合征的治疗上取得了显著的效果.目前该技术已日臻完善,治疗的覆盖面和适应证在不断地扩大,但在深层软组织感染上,传统负压封闭引流技术的疗效却有很大的局限性,因此急需临床一线医生结合患者的实际情况,不断地推陈出新,以寻求最佳的改良方案.本文通过对负压封闭引流技术相关文献进行回顾,以及联合深部冲洗治疗深层创面感染等改良方案的展望,旨在为临床提供更有效、更适合患者的治疗方式.

目的 探讨临床医学专业学生在实习阶段最佳的学习效果评价方法.方法 选取2013年7月～2018年6月牡丹江医学院临床医学专业的92名学生作为教学对象,采取随机数字表法分为对照组和观察组,每组各46名.对照组采取传统的教学效果评价方法,观察组采取综合性、衔接式学习效果评价模型,对实习效果加以评价.实习完成后,从学生理论知识学习情况自评、综合能力自评和教师评价3方面对教学效果评价.结果 在理论知识学习情况自评方面,观察组扩展知识自评结果高于对照组(P＜0.05);在综合能力自评方面,观察组分析问题能力等各项评分结果均高于对照组(P＜0.05);在教师评价方面,在实习期后半程阶段,观察组评价良好率高于对照组,差异有统计学意义(P＜0.05).结论 在实习阶段,采用综合性、衔接式学习效果评价模型对实习生实习效果加以评价,有效提高了教学效果.

负压封闭引流(VSD)技术最初于1994年被裘华德教授从德国引进中国,在当时该技术仅应用于治疗开放性骨折和软组织的损伤.随着医疗水平和人民生活水平的不断提高,负压封闭引流技术不断地优化改进,现已广泛应用于骨外科、普外科、妇产科、周围血管科、烧伤科等多个临床科室中,并已取得了良好的效果.但对于一些深层感染较严重的病例,单一负压封闭引流技术的治疗效果不尽如人意,因此我们在应用单一负压封闭引流技术的基础上,联合深部冲洗来治疗深层创面感染,以此不仅减轻患者的痛苦、降低临床物资损耗,而且为患者减少住院费用、缩短住院的时间.本文通过对负压封闭引流技术联合深部冲洗治疗深层创面感染的临床治疗的展望,为临床提供更经济、有效的深部软组织感染的治疗方式.

Objective To compare the efficacy of hip arthroplasty and PFNA internal fixation for the treatment of femoral trochanteric fractures in the elderly. Methods Pub Med, CNKI, Wanfang full-text database were used to search the related literatures of hip joint replacement and PFNA for the treatment of femoral trochanteric fractures in the elderly from 2013 to 2018. Meta-analysis was performed using Rev Man 5.3. Results This study included 7 articles in the literature, 659 patients with senile intertrochanteric fractures, 365 of whom underwent PFNA internal fixation and 294 underwent hip replacement. The difference in data between the two different procedures was statistical. Meaningful (WMD = -13.36; 95% CI (-17.40, -9.33); P<0.00001); mean intraoperative mean bleeding was statistically significant (WMD = -109.59; 95% CI (-169.51) , -49.67); P=0.0003); both were statistically significant at bed-loading time (WMD = 6.95; 95% CI (5.38, 8.52); P<0.00001); both hip joints 12 months after surgery The Harris functional score was statistically significant (WMD = 6.35; 95% CI (1.90, 10.79); P<0.00001); there was no statistical difference in terms of related complications, mean hospital stay, etc. Conclusion PFNA internal fixation has advantages in minimally invasive treatment and postoperative recovery. Hip replacement has an advantage in postoperative functional recovery. There is no statistical difference in postoperative complications and mean hospital stay.

The traditional methods of identifying biomarkers in rheumatoid arthritis (RA) have focussed on the differentially expressed pathways or individual pathways, which however, neglect the interactions between pathways. To better understand the pathogenesis of RA, we aimed to identify dysregulated pathway sets using a pathway interaction network (PIN), which considered interactions among pathways. Firstly, RA-related gene expression profile data, protein–protein interactions (PPI) data and pathway data were taken up from the corresponding databases. Secondly, principal component analysis method was used to calculate the pathway activity of each of the pathway, and then a seed pathway was identified using data gleaned from the pathway activity. A PIN was then constructed based on the gene expression profile, pathway data, and PPI information. Finally, the dysregulated pathways were extracted from the PIN based on the seed pathway using the method of support vector machines and an area under the curve (AUC) index. The PIN comprised of a total of 854 pathways and 1064 pathway interactions. The greatest change in the activity score between RA and control samples was observed in the pathway of epigenetic regulation of gene expression, which was extracted and regarded as the seed pathway. Starting with this seed pathway, one maximum pathway set containing 10 dysregulated pathways was extracted from the PIN, having an AUC of 0.8249, and the result indicated that this pathway set could distinguish RA from the controls. These 10 dysregulated pathways might be potential biomarkers for RA diagnosis and treatment in the future.

目的 :比较股骨近端锁定钢板及加长型PFNA治疗股骨粗隆下骨折的临床效果.方法 :选取牡丹江医学院附属红旗医院2017年12月 ～2018年7月间收治60例股骨粗隆下骨折患者进行实验研究,采用随机数字法将患者分为实验组和对照组,每组30例,实验组采用非骨科牵引床闭合复位PFNA内固定,对照组采用骨科牵引床闭合复位PFNA内固定,比较两组患者手术时间 、 出血量 、 麻醉费用 、C臂机次数 · 骨折复位情况.结果 :实验组患者手术时间 、 出血量 、 麻醉费用 、C臂机次数 · 骨折复位情况均由于对照组,差异具有统计学意义(P<0.05).结论 :利用非骨科牵引床闭合复位PFNA内固定治疗股骨粗隆下骨折临床效果良好,值得推广应用.

目的 探讨氟比洛芬酯对下肢骨折术后镇痛及血栓素B2(TXB2)和6-酮-前列腺素F1α(6-k-PG F1α)水平变化及意义.方法 将2015年12月-2017年9月牡丹江医学院附属红旗医院骨科收治的下肢骨折手术患者60例随机均分为两组,各30例,术后应用氟比洛芬酯为实验组(FB组)、术后应用曲马多为对照组(Q组).术后6、12、24、48 h采用VAS评分法评价两组患者的镇痛效果;并于术前2 h(T0)、术后24 h(T1)、术后48 h(T2)采用ELISA法检测血浆中的TXB2、6-K-PGF1α;记录分析血浆TXB2、6-K-PGF1α水平变化及意义.结果 运动状态下,各时间点Q组VAS评分分别为(5.43±1.22)分、(5.07±1.17)分、(5.60±1.10)分、(4.47±1.01)分,FB组分别为:(4.47±1.01)分、(3.40±0.86)分、(4.00±0.95)分、(3.10±0.76)分,各时间点Q组VAS评分均大于FB组,差异有统计学意义(P<0.05).在T1、T2时刻,Q组TXB2值分别为(271.5±42.82)、(248.68±61.15)ng/L,FB组TXB2值分别为(302.3±60.11)、(299.76±50.70)ng/L,Q组TXB2明显低于FB组,两组差异有统计学意义(P<0.05);在T1、T2时刻,Q组6-K-PGF1a值分别为(24.97±4.75)、(30.10±5.31)pg/mL,FB组6-K-PGF1a值分别为(22.31±3.82)、(23.52±3.59)pg/mL,Q组6-K-PGF1a明显高于FB组,两组差异有统计学意义(P<0.05).结论 下肢骨折手术患者应用氟比洛芬酯能够有效减轻术后疼痛及抑制TXB2的含量,促进6-k-PG F1α含量增加.对下肢骨折患者术后降低下肢静脉血栓有积极作用.

The current study mainly aims to evaluate the expression pattern and underlying mechanism of upstream stimulating factor 1 (USF1) in the muscle tissues of knee osteoarthritis (KOA) patients. In accordance with previous findings, our data showed that muscle strength was significantly decreased in KOA patients compared with controls. Furthermore, several inflammatory factors, including tumor necrosis factor α (TNFα), IL-8, IL-6 and MCP-1, were associated with reduced muscle strength in KOA patients. Not surprisingly, NF-κB signaling was significantly activated in the muscle tissues of KOA patients compared with control individuals. Furthermore, we showed that USF1 was increased in the muscles of KOA patients compared with controls. More importantly, overexpression of USF1 in primary human skeletal muscle cells significantly increased the activation of NF-κB signaling as well as the levels of pro-inflammatory factors. In summary, we showed novel data that the upregulation of USF1 promoted NF-κB activation-induced inflammatory responses in muscle tissues of KOA patients.

临床实习教学是临床医学教学工作的重要组成部分.传统本科实习生的临床带教模式,面对现今高校不断扩招、师资日益紧张以及应用型人才的市场需求等形势,逐渐显得力不从心.因此,针对人才培养模式的创新,提出复合阶梯式导师团队这样一种导师队伍的建构模式,进行整体优化设计,具有明显的效果和优势,是贯彻落实应用型人才的培养理念、提高实习效果的行之有效的方式.

Increasing evidence has suggested that microRNAs (miRNAs; miRs) are extensively involved in the progression of chondrosarcoma (CHS). However, few studies have investigated the functional role of miR-525 in CHS tissues and cells. In the present study, it was discovered that miR-525 levels were decreased in CHS tissues and cells. Dual luciferase assays indicated that F-spondin 1 (SPON1) is a target gene of microRNA (miR)-525. In addition, miR-525 overexpression suppressed SW1353 cell migration and invasion and enhanced SW1353 cell apoptosis. Increased SPON1 expression levels were identified in CHS tissues and cell lines. Furthermore, miR-525 overexpression significantly suppressed the activation of focal adhesion kinase (FAK)/Src/phosphatidylinositol-4,5-bisphosphate 3-kinase (PI3K)/protein kinase B (Akt) signaling in CHS cells; this suppression led to SPON1 silencing. In comparison, the SPON1 knockdown-mediated inactivation of FAK/Src/PI3K/Akt signaling was inhibited by inhibiting miR-525. In summary, the present study revealed that decreased miR-525 levels could enhance CHS malignancy as decreased miR-525 binding to the 3' untranslated region of SPON1 activates FAK/Src/PI3K/Akt signaling.

负压封闭引流(VSD)技术是临床上用来加速组织愈合、恢复外形及功能的重要治疗方法,最初应用于治疗软组织损伤和开放性骨折,在不断地优化后,现运用于各种类型疾病中,并取得了良好效果.随着对VSD技术在软组织损伤、创面感染和术后切口感染、骨筋膜室综合征、皮肤移植修复、骨髓炎的疗效及作用机制的深入研究,VSD技术已然变成近几年研究的热门之一.目前该技术已日臻完善,覆盖骨科疾病治疗的范围也逐年扩大,在临床疗效上获得了广泛认可,当然,这其中也存在美中不足的部分,需要各方人员不断推陈出新,共克难关.本文就负压封闭引流技术在骨科的临床应用进展作一综述,以利于VSD技术在临床中推广和进一步发展应用.

目的 探讨NLRP3炎性体与类风湿关节炎的相关性.方法 选取2015年1～12月我院收治的类风湿关节炎患者(RA)40例为研究组,同时选取同期健康体检人员40例为对照组,比较两组研究对象外周血NLRP3、半胱天冬酶-1(CASP1)以及凋亡斑点样蛋白(PYCARD)mRNA表达水平.结果 研究组的NLRP3表达显著低于对照组,同时CASP1以及PYCARD表达显著高于对照组,差异均有统计学意义(P＜0.05).结论 NLRP3炎性体各个基因mRNA表达在类风湿关节炎患者当中表达异常,表明NLRP3炎性体在炎症反应中有重要影响.

目的 评价质子磁共振波谱分析对脑多发性硬化的诊断价值.方法 选取我院2015年4月～2016年1 1月收治的20例脑多发性硬化患者作为实验组,选取同期我院正常健康人群作为对照组.两组均进行质子磁共振波谱检查,采用SPSS 20.0统计学软件对两组研究对象脑部代谢产物氮乙酰天门冬氨酸/肌酸浓度比、胆碱/肌酸浓度比肌酸浓度值等参数指标进行统计分析.结果 实验组脑部代谢产物氮乙酰天门冬氨酸/肌酸浓度值、胆碱/肌酸浓度值分别为(1.39±0.44)、(1.98±0.83),正常对照组脑部代谢产物氮乙酰天门冬氨酸/肌酸浓度值、胆碱/肌酸浓度值分别为(1.90±0.50)、(1.47±o.35),实验组脑部代谢产物氮乙酰天门冬氨酸/肌酸浓度值显著低于对照组(P＜0.05),胆碱/肌酸浓度值显著高于对照组(P＜0.05).结论 质子磁共振波谱分析对脑多发性硬化的诊断价值较高.

Recent studies suggest that cytokines and microRNAs play a key role in the destruction of cartilage matrix in osteoarthritis (OA) tissues. In the current study, we focused on miR-204, which has never been explored in OA. We found that the level of miR-204 was markedly reduced in the OA cartilage tissues compared with that of normal control. Real time PCR analysis demonstrated that the level of miR-204 was markedly decreased after IL-1β treatment for 3, 6, 12 h in the normal chondrocytes and OA chondrocytes, respectively. Furthermore, overexpression of miR-204 markedly suppressed the protein levels of IL-1β, COX-2 and IL6 in human OA chondrocytes and chondrogenic SW1353 cells. Dual luciferase reporter assay demonstrated that miR-204 significantly suppressed the relative luciferase activity of pmirGLO-IL-1β-3'UTR, indicating that IL-1β was a target gene of miR-204. More importantly, treatment with IL-1β significantly enhanced the protein levels of IL-1β, COX-2 and IL6. However, overexpression of miR-204 could partially abolish such effects. In conclusion, our data demonstrate that reduced miR-204 expression enhances the destruction of the cartilage tissues among OA patients mainly through targeting IL-1β.