Objective:To observe the regulatory effect of microRNA (miR)-221 on phosphatase and tensin homologue deleted on chromosome 10 (PTEN) gene in thyroid cancer (TC) cells and its influence on the invasion ability of TC cells.Methods:A total of 30 cases of TC papillary carcinoma tissue specimens were collected from April 2018 to December 2019 in the General Surgery Department of the Second Hospital of Hebei Medical University. The expression of miR-221 and PTEN gene was detected in TC and adjacent tissues by Real-time PCR. After transfecting miR-221 mimic into human TC cell line TPC-1, dual luciferase reporter gene assay was used to observe the regulation of miR-221 on PTEN gene. After TPC-1 cells were transfected with PTEN overexpression plasmids combined with miR-221 mimics, the effects of miR-221 and PTEN expression on the invasion of TC cells were examined by Transwell assay. T test was used for comparison between two groups. Results:Real-time PCR results indicated that miR-221 expression (4.12±0.09) was significantly higher in TC tissues than that in adjacent tissues (1.32±0.06, t=18.320, P<0.01). miR-221 was negatively correlated with PTEN mRNA expression in TC ( r=-0.429, P<0.05). The relative luciferase activity of PTEN in the miR-221 mimic transfection group (0.35±0.04) was significantly lower than that in the control group (1.05±0.03, t=12.120, P<0.05). Moreover, the number of invasive cells in the miR-221 mimic group (352.1±37.2) was significantly higher than that in the control group (189.7±23.1, t=3.135, P<0.01). In addition, after co-transfection with PTEN overexpression plasmids, compared with the negative control group (168.7±17.6), the number of invasive cells in TC (165.0±16.2) had no significant difference ( t=1.060, P>0.05). Conclusion:MiR-221 can promote the invasion ability of TC cells, and its mechanism may be related to the targeted inhibition of PTEN expression.

目的 探讨乳腺癌保乳术式采用连续集中护理对患者生存质量的影响.方法 选取2018年1月至2019年1月接受乳腺癌保乳手术治疗的84例患者,随机分为对照组和观察组,每组42例.对照组保乳术后常规护理,观察组保乳术后连续集中护理.对比2组患者治疗依从性、生存质量、护理满意度以及并发症发生状况.结果 观察组患者在复诊、用药、饮食、锻炼方面的依从性优于对照组(P<0.05);护理前,2组患者生存质量差异无统计学意义(P>0.05),护理后生存质量方面观察组优于对照组(P<0.05);观察组患者的护理满意度高于对照组(P<0.05);观察组患者并发症发生率低于对照组(P<0.05).结论 对乳腺癌保乳手术患者进行连续集中护理,可有效改善患者治疗的依从性,提升生存质量,护理满意度也得到提高,有效避免并发症的发生,同时还可以改善患者心理,护理效果满意,值得推广应用.

Objective:To observe the effect of sorafenib on ferroptosis in thyroid cancer TPC-1 cells, and to provide a new strategy for the treatment of thyroid cancer.Methods:Thyroid cancer TPC-1 cells were cultured in vitro, treated and divided into sorafenib group and negative control group, and cell counting kit-8 (CCK-8) assay was used to detect cell viability; Dichlorofluorescein (DCFH-DA) probe was used to detect reactive oxygen species (ROS) production; Western blotting experiment was used to detect the protein expression levels of ACSL4, SLC7A11 and GPX4; Malondialdehyde (MDA) kit was used to detect the content of MDA in thyroid cancer cells. Analysis of variance was used for the mean comparison between multiple groups, and t-test was used for the comparison between the two groups. Results:The cell absorbance value of sorafenib intervention group (1.29±0.17) was significantly lower than that of control group (1.86±0.23, t=2.695, P<0.05); The fluorescence intensity of ROS in TPC-1 cells treated with sorafenib (1.833±0.293) was significantly higher than that in the control group (0.825±0.186, t=2.801, P<0.05); Western blotting experiments showed that the expression level of ACSl4 protein (0.954±0.091) after sorafenib intervention was higher than that in the control group (0.442±0.132, t=5.314, P<0.05), and the protein expression level of SLC7A11 (0.293±0.087) was significantly lower than that in the control group (0.897±0.098, t=7.916, P<0.05), the protein expression level of GPx4 (0.325±0.051) was also lower than that of control cells (0.893±0.069, t=9.325, P<0.05). The results of MDA detection showed that the expression level of MDA in sorafenib intervention group (30.661±3.192) was significantly higher than that in control group (19.285±1.406, t=5.901, P<0.05). Conclusion:Sorafenib can promote the ferroptosis process of thyroid cancer cells and accelerate the death of thyroid cancer cells.

目的 探讨可视化思维导图结合案例教学对护生思维过程的影响.方法 采用便利抽样法抽取44名于2017年7月-2018年6月在河北医科大学第二医院普外科实习的同班级本科护生,采用随机数字表法将其分为对照组22名,观察组22名,分配在普外一区和普外二区,研究过程中观察组有2名护生脱落.对照组采用传统教学模式,观察组在对照组基础上采用可视化思维导图结合案例分析教学法,比较两组护生评判性思维能力和病例分析入科及出科考核成绩.结果 观察组护生在寻找真相、求知欲、系统化能力、开放思想、分析能力及评判性思维自信心方面得分均高于对照组,差异有统计学意义(P<0.05).观察组护生出科病例分析考核成绩,高于对照组,差异有统计学意义(P<0.01).结论 可视化思维导图结合案例教学法能够发现护生思维过程中存在的问题,对培养护生评判性思维能力具有良好效果.

Objective? To expLore the effects of mind mapping teaching based on case anaLysis on nursing students practicing in the Department of GeneraL Surgery. Methods? TotaLLy 42 nursing students from the same cLass who practiced in the Department of GeneraL Surgery from JuLy 2017 to June 2018 were seLected using convenient sampLing and divided into the controL group (n=22) and the observation group (n=20) according to the random number tabLe. The nursing students were dispatched to No.1 Ward and No.2 Ward respectiveLy. Nursing students in the controL group received traditionaL teaching, whiLe nursing students in the observation group received mind mapping teaching based on case anaLysis on the basis of traditionaL teaching. The seLf-Learning abiLity, satisfaction with nursing teaching and examination performance were compared between the two groups. ResuLts? The observation group scored (36.50±4.69), (19.55±3.72), (31.65±5.75) and (13.05±1.64) respectiveLy in seLf-motivation, task anaLysis, seLf-monitoring and adjustment and seLf-evaLuation in terms of seLf-Learning abiLity, higher than those of the controL group (P＜0.05), which were (31.73±9.15), (16.68±3.40), (26.41±8.93) and (11.32±2.89). The observation group scored (36.70±6.17), (59.95±7.43), (50.95±9.66) and (12.55±1.90) respectiveLy in teaching attitude, teaching LeveL, teaching pLan and teaching management, higher than those of the controL group (P＜ 0.05), which were (32.05±7.57), (53.95±10.97), (45.82±5.91) and (10.91±2.09). Comparing the performance of case anaLysis in theoreticaL examination between the two groups, the observation group scored (79.80±6.97), higher than that of the controL group (P＜0.05), which was (73.73±6.50). ConcLusions? Mind mapping teaching based on case anaLysis shows good effects on fostering nursing students' abiLity to acquire, process and appLy knowLedge and enhances their seLf-Learning abiLity and satisfaction with nursing teaching.

目的:对语前聋儿童人工耳蜗术后的言语康复效果进行跟踪性评价,旨在研究人工耳蜗术后语前聋儿童言语康复的发展情况.方法:选取语前聋儿童为研究对象,1~3岁患儿30例,3~5岁患儿30例.在人工耳蜗术后开机第1、3、6、12、24个月时间点,随访熟悉患儿的监护人或教师,完成言语能力测试的问卷,并进行评估.结果:患儿在人工耳蜗术后开机的MUSS和SIR评分均随康复时间的增加而增大,且1~3岁组患儿在两年间的增大幅度大于3~5岁组患儿;3~5岁组患儿在各康复时间的MUSS评分和SIR评分均小于1~3岁组;3~5岁组患儿人工耳蜗术后开机24个月的MUSS评分和SIR评分与1~3岁组的差异有统计学意义(P<0.05).结论:语前聋儿童言语能力随康复时间增加而逐渐提高;患儿接受人工耳蜗植入术越早,其言语能力提高幅度越大,言语康复效果越好.

Objective To study expression and significance of Wnt inhibitory factor-1(WIF-1),β-catenin and chclin D1 in Wnt/β-catenin signal transduction pathway in papillary thyroid cancer(PTC).Methods Sixty cases of PTC were selected and the specimens of cancerous foci and adjacent tissues were taken.The expression of WIF-1,β-catenin and cyclin D1 mRNA and protein were detected,and the correlation between WIF-1 mRNA and β-catenin,cyclin D1 mRNA was analyzed.Results The expression levels of WIF-1 mRNA and positive rates of WIF-1 protein expression in PTC tissues were significantly lower than those in paracancerous tissues(P<0.05),while expression levels of β-catenin,cyclin D1 mRNA and protein in PTC tissues were on the contrary(P<0.05).And the expression levels of WIF-1 mRNA and protein in PTC lymph node metastasis group was lower than those without lymph node metastasis,but the expression levels of β-catenin,cyclin D1 mRNA and protein in PTC lymph node metastasis group were on the contrary(P<0.05).There were no statistically significant differences in the expression levels of WIF-1,β-catenin,cyclin D1 mRNA and positive rates of protein in PTC tissues in different sex,age,tumor diameter,number of lesions and whether or not the capsule was invaded(P>0.05).Expression levels of β-catenin,cyclin D1 mRNA were negatively correlated with those of WIF-1 mRNA(P<0.05).Conclusion The down regulation mechanism of WIF-1 gene in PTC tissues promoted the accumulation of β-catenin protein in the cytoplasm,which resulted in over activation of target gene cyclin D1.The WIF-1 down regulation or β-catenin and cyclin D1 up regulation mechanism may play an auxo-action role in the occurrence and metastasis in PTC.

Objective To study acoustic parameters of children's vocal nodules,to analyze the acoustic characteristics and differences of children's vocal nodules before and after treatment and to provide theoretical basis for the quantitative evaluation of voice improvement in children with vocal nodules after treatment by using voice parameters.Methods Forty-five cases of vocal nodules diagnosed by stroboscopic laryngoscope were selected as the treatment group,and 45 normal children as control group.Multidimensional speech analysis was carried out by computer speech station 4150B type speech analysis system.Results Among children with vocal nodules after 2 weeks' non-surgical treatment,26 cases were cured,11 cases got better,8 patients were improved.In treatment group before and after treatment,fundamental frequency(Fo),highest fundamental frequency(Fhi),Jita,Jitter,Shimmer,amplitude perturbation quotient (APQ),noise to harmonic ratio(NHR) were higher than that in the cortrol group.In treatment group after treatment,Jita,Jitter,Shimmer,APQ,NHR were lower than the group before treatment,the difference was statistically significant (P＜0.05).Conclusion The acoustic parameters of vocal nodules in children can be evaluated objectively by computer voice acoustic testing,which can be used to evaluate the therapeutic effect of vocal nodules in children.The voice acoustic parameters of children with vocal nodules are significantly different from those of normal children.Children with vocal nodules of vocal training and voice rehabilitation is of great significance to improve children's voice quality,training and drug treatment combined with voice can improve the patient's pronunciation function,which is worthy of promotion.

目的:探讨多灶甲状腺微小乳头状癌(PTMC)的临床病理特征.方法:回顾性分析2013年5月-2016年4月297例手术治疗并经病理证实的PTMC患者临床资料.结果:297例PTMC患者中,多灶PTMC 70例(23.6％).与单灶PTMC患者比较,多灶PTMC患者肿瘤直径小(0.54 cm vs.0.69 cm)、包膜侵犯率高(18.6％vs.8.8％)、行甲状腺全切比例高(87.1％vs.41.4％),差异均有统计学意义(均P＜0.05).癌灶数≥3多灶PTMC患者与癌灶数=2的PTMC患者比较,前者合并双侧癌的比例增高(88.2％vs.44.4％)、中央区淋巴结转移的比例增高(47.1％vs.22.2％),差异均有统计学意义(均P＜0.05).结论:多灶PTMC的病灶更为微小且更易出现包膜侵犯;多灶PTMC的病灶数越多合并双侧癌和中央区淋巴结转移的风险就越大;多灶PTMC应常规行预防性中央区淋巴结清扫.

Objective To investigate the risk factors of central lymph node metastasis in papillary thyroid microcarcinoma (PTMC) patients.Methods We retrospectively reviewed 203 PTMC patients who underwent prophylactic central lymph node dissection.Results Sixty-six of 203 (32.5％) patients had central lymph node metastasis,among which there were 48 patients (72.7％) in tumor size ≥7 mm,14 patients (21.2％) in capsular invasion,21 patients (31.8％) in multifocal and 16 patients (24.2％) in bilateral.There was significant difference in tumor size ≥7 mm,capsular invasion,multifocal and bilateral lesions between the two groups (P ＜ 0.05).Non-conditional logistic regression analysis revealed that tumor size ≥7 mm was significantly correlated with central lymph node metastasis (P ＜ 0.05).The central lymph node dissection didn' t increase the rate of hypocalcemia and recurrent laryngeal nerve injury.Conclusion Tumor size ≥7 mm was the main influencing factor contributing to central lymph node metastasis.Capsular invasion,multifocal and bilateral lesions were secondary factors contributing to the central lymph node metastasis.PTMC has high central lymph transfer rate and routine prophylactic central lymph node dissection is necessary.

Objective To explore the application effect of"Five-Stage" cycle in combination with CP teaching mode on nursing students′ clinical practice at earlier practice stage. Methods Selected 54 nursing students into our department from July 2012 to July 2014 and adopted random number table to divide them into control group and observa-tion group randomly. Adopted the traditional teaching mode to teach the control group and"Five-Stage" cycle in combi-nation with teaching approaches to teach the observation group, then compared the two groups′evaluation results of theo-ries and practical skills as well as satisfaction from clinical practice teaching. Results The observation group′s evalua-tion results of theories and clinical nursing skills were both higher than those of the control group, the difference from comparison was of statistical significance ( P<0. 05 ) . The nursing students′satisfaction degree of the observation group was obviously higher than that of the control group, the difference from comparison was of statistical significance ( P<0. 05 ) . Conclusion The teaching mode of"Five-Stage" cycle in combination with CP not only standardizes the teach-ing method, but also helps to improve the students′ability to combine theories and practice.

Objective To evaluate the effects of teaching mode of “5-stage”cycle combined with teaching pathway on improving clinical practice ability of nursing students and patients′satisfaction.Methods A total of 54 practice nursing undergraduates in Oncology Department from September 201 3 to November 201 3 were divided into observation group (28 cases,teaching mode of “5-stage”cycle combined with teaching pathway)and control group (26 cases,teaching mode of “one-to-one”).Clinical practice ability of nursing students and patients′satisfaction were compared between two groups.Results The comprehensive score of theoretical examination (85.89 ±7.1 9)and examination of practical ability (86.57 ±5.34)of nursing students in observation group were higher than those in control group with a statistically significant difference (P <0.05).The satisfaction of patients in basic nursing,technical operation,health education,service attitude were 78.5%,67.0%,73.5%,63.0%in observation group,which were higher than those in control group (P <0.05).Conclusions The teaching mode of “5-stage”cycle combined with teaching pathway can improve clinical practice ability of nursing students and patients′satisfaction.

Objective: The present study aimed to examine the therapeutic mechanism of shen qi fu zheng zhu she ye toward the adrenal cortex ultrastructure in cancer-related fatigue(CRF).Methods: BALB/C nude mice(n=130) were used to establish animal models for the CRF.The nude mice were categorized into control(n=10),model(n=30),and treatment(n=90) groups.We injected 0.2 ml of the cell culture(cell density of human stomach cancer BGC-823 cell line = 2.5×106/mL) into the nude mice.During cancer transplantation,5-fluorine uracil and shen qi fu zheng zhu she ye were used in making treatment comparisons of the injected and untreated mice.Water maze,tail hanging,and swimming capability experiments,as well as open field test,were conducted to determine the behavior of the animal models.The ultrastructure of the adrenal cortex was observed by an electron microscope.High-performance liquid chromatography was employed to determine the cortisol levels.Results: The cortisol levels in the mild,moderate,and severe fatigue groups were significantly lower than the control group.The change in the adrenal cortex ultrastructure was nonsignificant.Conclusion: The adrenal cortex ultrastructure plays a role in the CRF,especially when the body was tired.Shen qi fu zheng zhu she ye exhibited therapeutic action toward the adrenal cortex ultrastructure in CRF.

目的 探讨嗓音障碍指数(voice handicap index,VHI)用于嗓音障碍性疾病患者自我评估的临床意义及与声学参数间的相关性.方法 对嗓音障碍性患者114例(患者组) 及嗓音正常者40例(对照组)采用多维嗓音软件(multi dimensional voice program,MDVP)进行嗓音声学分析和VHI调查,嗓音声学分析指标包括基频、基频微扰、振幅微扰、噪声/谐和比(noise to harmonic ratio,NHR),VHI 调查包括功能(function,F) 、生理(physiology,P) 、情感(emotion,E) 3个范畴,记录3方面得分及总分(total scores of the VHI,TVH ) 分值.结果 患者组的基频微扰、振幅微扰、NHR 均高于正常组,差异有统计学意义(P<0.01);患者组与对照组间VHI差异有统计学意义(P<0 01).VHI中P与E之间(r=0.863),F与TVH之间(r=0.818)、P与TVH之间(r=0.929)、E与TVH之间(r=0.910)均有良好相关性(P<0.01);VHI各范畴与嗓音各参数之间无显著相关性(P＞0.05).结论 临床上不能以嗓音声学分析为标准来预测主观评估结果;VHI可用于主观反映患者的嗓音障碍程度.

Objective To analysis the voice characteristics and differences between genders and ages of mutation period. Methods The voice samples were collected from 1 028 subjects that during the mutation period without voice disorders.They were divided into three groups according to the age:127 male and 132 female aged between 10~12 years in the premutation group,234 male and 233 female aged between 13~16 years in the mutation group,122 male and 180 female aged between 17~20 years in the post mutation group.The objective parameters,including fundamental frequency(F0),jitter,shimmer,amplitude perturbation quotient(APQ) and noise to harmonic ratio(NHR) were measured mainly on a sustained vowel / ɑ:/ were recorded on a windows software named Kay. Results The values of F0 were different significantly between male and female.The normal reference values of F0: the premutation period: male 270.90±27.39,、female 287.54±25.51;group A of mutation period: male 197.74±43.09,female 259.54±25.99;group B: male 178.38±46.75,female 254.91±22.24;postmutation period: male 148.97±25.08,female 255.45±25.01.Jitt had obvious difference(P<0.05) between male and female of the same age in addition to the group A.The values of female were greater than that of male.NHR had obvious difference(P<0.01) between the group A and the group B of the same sex in the mutation period.The values of the group A were greater than that of the group B. Conclusion From the premutation period F0 had a significant difference between male and female.Although NHR showed no gender differenes,it was an important parameter to judge the vioce feature.

癌性发热是中晚期恶性肿瘤常见的并发症之一,通常是指癌症患者出现的直接与恶性肿瘤有关的非感染性发热. 1 病因及发病机制

<正>癌性发热是恶性肿瘤晚期常见症状之一,病程长,有时可达数周或数月,大剂量长时间应用抗生素难以凑效。长期发热不仅消耗病人的体力,还会使病人产生焦虑、烦躁的情绪,严重影响病人的生活质量。临床常采用的降温方法有药物降温、酒精或温水擦浴等。本试验采用中药擦浴降温,以寻求一种更加安全、有效的降温方法。