目的 探讨白细胞介素-1β(IL-1β)和胰岛素样生长因子-1(IGF-1)在发育性髋脱位(DDH)髋臼软骨细胞增殖和凋亡中的作用及意义.方法 选取4周龄实验幼兔32只,采用左侧后肢伸膝屈髋位管型石膏固定方法制作DDH动物模型,右侧后肢不做特殊处理作为对照侧,将幼兔平均分为4组(A、B、C、D组),分别在石膏固定8、12、16、20周后处死,采用免疫组织化学法和Western blot法检测双侧髋臼外缘软骨块及细胞中IL-1β和IGF-1的表达情况和蛋白水平,结果进行统计学分析.结果 IL-1β和IGF-1在双侧髋臼软骨细胞中均有不同程度的阳性表达;D组实验侧髋臼软骨中IL-1β的阳性率和蛋白水平最高,B、C、D组实验侧和对照侧比较,差异有统计学意义(P＜0.05).C组实验侧髋臼软骨中IGF-1的阳性率最高,B组实验侧髋臼软骨中IGF-1的蛋白水平最高,B、C组实验侧和对照侧比较,差异有统计学意义(P＜0.05).结论 IL-1β与IGF-1在DDH髋臼软骨细胞中的表达异常,导致软骨细胞增殖和凋亡之间失衡,可能是DDH发生髋关节退行性变的原因之一.

目的 探索以Mini-CEX量表联合DOPS量表作为工具,对泌尿内科住院规培医师进行形成性评价的效果及可行性.方法 以遵义医科大学附属医院内科规培基地进行住院医师规范化培训的2016～2018级规培医师医师为研究对象,包括研究生规培医师及本科规培医师,共76人.以Mini-CEX量表联合DOPS量表对其进行形成性评价,每月考核一次.对比出科末次考核及入科首次考核成绩.结果 住院医师Mini-CEX量表末次考核成绩(63.96±2.22)分与首次考核成绩(32.64±3.26)分,差异具有统计学意义(P<0.05).住院医师DOPS量表末次考核成绩(89.48±2.80)分与首次考核成绩(52.87±7.84)分,差异具有统计学意义(P<0.05).结论 Mini-CEX联合DOPS作为泌尿内科住院规培医师形成性评价工具效果良好.

Objective To compare and study the effect of two practice models on clinical practice teaching in pediatric orthopedic surgery.Methods A total of 60 5-year undergraduate interns were selected and assigned randomly separately into control group (n=30) and experimental group (disease-based internship group,n=30).The control group took bed-based internship model,that is,interns managed patients with fixed beds.The experimental group took disease-based internship model,that is,interns managed the same disease patients and rotated regularly.Both groups used the same teaching method,namely the PBL+ LBL teaching.At the end of the internship,SPSS 18.0 was used to analyze the data,the independent sample t test and Chi-square test were used to compare the results of the two groups.Results In the dimensions of theoretical knowledge,medical records written and consolidated results,the score of the experimental group were higher than the control group,and the differences were statistically significant (P＜0.05).The score of practical skill in two groups had no statistically significant difference (P＞0.05).The satisfaction survey showed that the experimental group had higher satisfaction than the control group,and the difference was statistically significant (P＜0.05).Conclusion The disease-based internship model is better than the bedbased internship model in clinical practice teaching in pediatric orthopedic surgery,and can improve the quality of clinical teaching practice.

Objective To investigate the drug resistance and its changes of Staphylococcus aureus (SA) in children with bone and joint infection caused by hematogenous dissemination in Zunyi area.Methods A retrospective study was performed on the clinical data of 95 cases with bone and joint infections caused by SA from January 2008 to December 2016 in the Affiliated Hospital of Zunyi Medical College,in which there were 53 boys and 42 girls with a mean age of 5.6 years (ranging from 10 days to 14 years),including 39 cases of acute osteomyelitis,31 cases of acute suppurative arthritis,19 cases of chronic osteomyelitis,and 6 cases of acute osteomyelitis and arthritis.According to the results of drug sensitivity,the drug resistance of SA was analyzed,and the detection rates of Methicillin resistant Staphylococcus aureus (MRSA) were compared in different genders and timeframes,and the drug resistance of SA to other antibiotics were also analyzed.Results The detection rate of MRSA was 50.53％ (48 cases) in 95 cases,the resistance rate to Penicillin was 92.63％ (88 cases),and to Lincomycin,Erythromycin,Tetracycline and Cefoxitin were 64.21％ (61 cases),57.90％ (55 cases),55.79％ (53 cases) and 53.68％ (51 cases) respectively,but to Sulfamethoxazole Co.,Gentamicin and Rifampicin it was relatively low[25.26％ (24 cases),11.58％ (11 cases),6.32％ (6 cases) respectively],while the resistance to Moxifloxacin,Linezolid,Tigecycline,Vancomycin and Nitrofurantoin was not found.The detection rate of MRSA in boys (52.83 ％,28/53 cases) was slightly higher than that of girls (47.62％,20/42 cases),but the difference was not statistically significant (x2 =0.255,P ＞0.05).The detection rates of MRSA in 2008-2010,2011-2013 and 2014-2016 were 27.78％ (5/18 cases),51.61％ (16/31 cases) and 58.70％ (27/46 cases) respectively,and it was obviously higher in 2014-2016 than in 2008-2010,and the difference was statistically significant (x2 =4.95,P ＜ 0.05).The drug resistance rate of SA to Lincomycin,Erythromycin and Cefoxitinis was obviously higher in 2014-2016 than in 2008-2010,and the differences were all statistically significant (all P ＜ 0.05).Conclusions The drug resistance of SA is high with the bone and joint infection caused by hematogenous dissemination in children,and the detection rate of MRSA and the drug resistance of SA to a variety of antimicrobial agents are gradually increasing.

目的 探讨典型病例教学法在临床本科生外科见习教学中的应用价值,探寻外科见习医师临床带教方法 .方法 选取2016年5—11月在我科见习的5年制临床医学专业本科生40例为研究对象,随机分成实验组和对照组,每组20例,两组在性别、年龄、基础医学考试成绩及外科学考试成绩上比较,差异无统计学意义(P>0.05),实验组采用典型病例教学法进行教学,对照组采用普通教学法进行教学,见习2周后对两组见习生进行理论考试和问诊考试,比较两组考试成绩,结果 进行统计学分析.结果实验组的理论考试成绩好于对照组,差异有统计学意义(P<0.05),实验组在问诊考试成绩和总成绩上也优于对照组,两组比较差异有统计学意义(P<0.05).结论 采用典型病例教学法可提高临床本科外科见习医生的临床实践能力,能更好的理论结合实践,培养见习生在工作中养成良好自觉性和主动性;典型病例教学法是一种较好的临床见习医师教学方法.

目的 研究病例教学法在临床实习生医患沟通能力培养中的应用价值,探寻医患沟通技能培训的临床教学方法.方法 选取2016年2—10月在我科学习的实习生60名作为研究对象,将其随机分为实验组和对照组,每组各30名.实验组采用病例教学法,对照组采用传统教学法,实习时间为4周.实验结束后采用SEGUE问卷调查方法,对实习生、患者或家属进行问卷式调查和评分,评价其医患沟通效果,结果进行统计学分析.结果 实验组实习生SEGUE问卷调查评分高于对照组,两组比较,差异有统计学意义(P<0.05);实验组患者或家属SEGUE问卷调查评分均高于对照组,两组比较,差异有统计学意义(P<0.05).结论 采用病例教学法能提高临床实习生医患沟通能力,可增加医患之间的信任,建立和谐医患关系,是一种较好的临床教学方法.

儿童股骨头缺血性坏死是临床上小儿骨科较常见和重要的髋关节疾病之一,多发于4~10岁儿童,男性多于女性,单侧占90%。目前其发病机制及病理过程尚未完全明确,早期临床症状不明显,中后期可出现跛行或疼痛等表现,可通过影像学检查结合临床表现进行诊断。目前临床上对该病有多种治疗方法,均围绕改善血供与修复坏死组织展开,因为该病属于自愈性疾病,股骨头压力消失后可自行恢复,但其后遗的股骨头畸形,可导致髋关节负重和活动功能的障碍,甚至致残致畸,对儿童的身心健康与正常发育影响较大。

Objective To evaluate the expression of Caspase-8 and Fas after treatment by interferon-α and to study the mechanism of interferon-α for the treatment of hemangioma.Methods Hemangioma vascular endothelial cells were obtained from freshly excised sterile hemangioma and cultured by tissue culture method.Factor Ⅷ related antigen which only exists on the endothelial cells was used to confirm hemangioma vascular endothelial cells by indirect immunofluorescence technique.After the cells were treated with interferon-α,cell apoptosis and Caspase-8 protein were detected by the flow cytometry.Immunofluorescence and immunohistochemistry were used to detect Fas antigen.Results There was significant difference in the percentage of Fas expression in the intervention group (90％) when compared to the control group ( 15％ ).When the cells were managed with interferon-a for 6 h,24 h and 48 h,the mean values of Caspase-8 fluorescence were 148.99 ± 12.72,87.06 ± 6.81,55.17 ± 9.06,and these were higher than the control group,which was 25.82 ± 3.59 (P＜0.01 or P＜0.05).The apoptosis rate for various treatment groups were:11.89 ± 0.56 in the group of 1 × 104μ interferon-α,18.88 ± 3.04 in the group of 1 × 10s μ and 31.92 ± 1.92 in the group of 1 × 106μ They were higher than the control group which was 3.25 ± 0.23 (P＜0.01 ).Conclusions Interferon-α might promote apoptosis of hemangioma endothelial cells by upregulating the expression of Fas and Caspase-8.