目的 探讨针对小儿外科实习学生临床教育的新模式,提高教学效果. 方法 将临床实习学生分为两组,对照组使用传统的教学方法,实验组在传统教学方法基础上加用腹腔镜技术课程.比较两组出科理论考核和四项腹腔镜技能考核成绩,并以调查问卷的形式对两组学生在提高学习积极性、提高腹腔镜操作技术、提高理论知识水平方面的满意度进行调查分析. 结果 出科理论考核成绩、四项腔镜技能考核成绩比较,实验组均优于对照组,差异有统计学意义(P＜0.05);实验组学生在提高学习积极性、提高腔镜操作技术的满意度高于对照组,差异有统计学意义(P＜0.05). 结论 将腹腔镜技术课程引入小儿外科临床实习中可进一步提高教学效果.

Objective:To evaluate the changes of agrin expression in the myocardium of viral myocarditis (VMC) mice induced by coxsackievirus B3 (CVB3),and to explore the role of agrin in the pathology of VMC.Methods:A total of 80 male BALB/c mice were randomly divided into a control group (phosphate-buffered saline,PBS) and an experimental group (PBS containing CVB3).Mice in each group were divided into four subgroups according to various time points (1,2,4,and 6 wks) after injection,and the hearts of the mice were harvested at these time points.Hematoxylin-eosin (HE) staining was used to examine the pathological changes in the myocardium,and immunohistochemistry was used to investigate the agrin expression in myocardial tissue.In addition,semi-quantitative reverse transcription polymerase chain reaction and western blotting were used to detect the expression of agrin mRNA and agrin protein,respectively.Results:HE staining indicated that the VMC mouse model was established successfully.In the experimental group,the expression of agrin,agrin mRNA,and agrin protein began to decrease in the subgroup at week 1,slightly increased at week 2,and then gradually decreased at weeks 4 and 6.The expression of agrin in all experimental subgroups was significantly lower than that in the corresponding control subgroups (P＜0.05).Conclusion:The expression of agrin is diminished in VMC mice,suggesting that agrin may be involved in the pathogenesis of VMC.

Objective:To explore the operation management mode and socioeconomic benefits of pediatric day surgery at a general hospital.Methods:A retrospective analysis was conducted for 939 cases of day surgery from January 2017 to December 2018. According to different treatment methods, they were divided into experimental and control groups. Five specific diseases included hernia, hydrocele, cryptorchidism, varicocele and concealed penis. The experimental group underwent day surgery mode of going through fast, reasonable and optimized service procedures, incorporating the concept of enhanced postoperative recovery during perioperative period and applying single-hole laparoscopy. For control group, general hospitalization mode and conventional laparoscopy were employed.Results:As for postoperative fever, hernia, hydrocele and cryptorchidism, there were inter-group statistical differences ( P<0.05). And experimental group was better than control group. Regarding postoperative nausea/vomiting, hernia, hydrocele, cryptorchidism and concealed penis, there were inter-group statistical differences ( P<0.05). And experimental group was better than control group; length of hospital stay and total expenditure of hospitalization were statistically different between two groups ( P<0.05). And experimental group was better than control group. The inter-group expenditure of surgery was statistically different ( P<0.05) and experimental group was higher than control group. As for cryptorchidism and varicocele, the expenditure of medical consumables was significantly different between two groups ( P<0.05). And experimental group was more expensive than control group. Conclusions:Reasonable management of pediatric day surgery may shorten the length of hospitalization, lower the expenditure of hospitalization and boost parental satisfaction.

Wilms＇tumor is a common malignant tumor in children. most patients have a good prognosis,but its pathogenesis is not yet clear. In recent years,some non_coding RNAs have been found to have a close relationship with the development of this tumor. Some non_coding RNAs may serve as biomarkers for the diagnosis,predictors indica_tors,or targets for gene therapy. This paper studied the relationship between some non_coding RNAs associated with nephroblastoma is now available.

Objective To explore the clinical and genetic characteristics,protein expression of Wiskott-Aldrich syndrome (WAS).Methods 1.Clinical data of a Chinese sick boy patient who was treated in the First Affiliated Hospital of Guangxi Medical University was collected,and DNA samples were obtained from the patient and his mother,12 WAS gene exons were amplified by polymerase chain reaction (PCR) followed by direct sequencing,and then the protein expression was analyzed by Western blot.2.China National Knowledge Infrastructure (CNKI) was searched to identify the clinical data and clear genetic diagnosis of WAS literature from Jan.1991 to Oet.2013,combined with the case of WAS patient treated in this hospital,and a retrospective relationship analysis was made among WAS phenotype,genotype and protein phenotype in China.Results 1.The boy had a classical WAS phenotype,his clinical scores were 4.Sequencing revealed a nonsense mutation in exon 1,c.71C ＞ T (p.R13X).Western blot analysis revealed WASP-.The patient's mother was normal It's a de novo mutation in the patient.2.Other 53 cases of WAS patients had been reported,and they were all are male children,onset age from 1 day to 3 years.Forty-nine cases of typical WAS views,4 cases of X-linked thrombocytopenia (XLT).Immunological tests lack of specificity,mutant gene distribute in each exons except 4,5,6,9,12 and 1,3,6,7,8,9,11 introns.Protein detection was mostly negative.Conclusions Affected males who presented recurrent infections,persistent thrombocytopenia and eczema,should be considered to have the possibility of suffering from the WAS.Genetic diagnosis is the golden standard to diagnose the disease.And detection of protein expression can help define the relationship amone phenotype,genotype and protein phenotype.

Objective To investigate the clinical relationship between villus cells chromosome abnormality and spontaneous a-bortion in early pregnancy.Methods Villus cells from 112 women who just had spontaneous abortion in early pregnancy were cul-tured and prepared for karyotype analysis.Results 105 specimens were anaIyzed successfully which accounted for 93.75%(105/112).Among them 50 specimens were normal karyotype which accounted for 47.62%(50/105),55 cases were abnormal karyotype accounted for 52.38%(55/105).Abnormal number was the major type of abnormal karyotype.Among them there were 33 cases of trisomy which were most common,6 cases of triploid,1 case of tetraploid and 1 case of compound,2 cases of chimera,1 case of sex-ual chromatids and 6 cases of structural abnormalities.In the specimens with normal karyotype,20 cases were from male,30 cases were from female.Conclusion Embryo chromosome abnormality is one of the factors causing early pregnancy spontaneous abor-tion.Conduct villus chromosome examination in clinical treatment is useful to determine the reasons of abortion and to guide the next pregnancy.

Objective To analyze karyotype and clinical characteristic features of Turner syndrome.Methods Prospective genetic counseling and cytogenetic analysis was performed.Results In sixty-four patients with Turner syndrome,karyotype could be divided into five major categories,namely simple type,chimeric,X chromosome structural abnormalities,X-trisomy and containing the Y chromosome.Abnormal karyotype was present in 27 of 64 patients with Turner syndrome(42%).Simple type was more prevalent among patients with Turner syndrome(36%).Conclusion The clinical characteristic features could include short stature,webbed neck,primary amenorrhea,gonadal dysgenesis and so on.The clinical manifestations of chimeras might depend on the proportion of abnormal karyotype with normal karyotype cell lines.Cases containing the Y chromosome could have sex abnormality mostly.

<正>猫叫综合征(catcry syndrome)是5号染色体短臂缺失中最常见的一种,属染色体结构异常综合征。其发病率在常染色体结构异常中占首位,约为1/15000～1/50000,占小儿染色体病的1.3%,由法国科学家于1963年首先报道,患儿因猫叫样啼哭而命名。现就3例猫叫综合征的临床表现,检验结果报

Objective To study the karyotype distribution characteristics and clinical manifestations of the robertsonian translocation carriers. Methods Samples were cultured for 72 hours by peripheral blood lymphocyte, followed by giemsa staining. Then 30 split-phase were counted under microscope and 3～5 karyotype chromosomes were analyzed. Results In the 18 cases, the karyotype of robertsonian translocation were not randomly distributed, including 9 cases of rob (13q;14q), accounting for 50%, and 4 cases of rob (14q; 21q), accounting for 22.2%. In this group, there were 13 females and five males, with the male to female ratio of 0.38:1. Thirteen of the 18 carriers were adults, while 5 were children. In the 13 adult carriers, 11 had history of habitual abortion in one of the spouses, with the average abortion rate of 84.6%, for 1～6 times, 2.4 times in average. The other two carriers manifested as infertility. In clinical practice, Robertsonian translocation carriers tended to have habitual abortion, infertility, amenorrhea, azoospermia or abnormal sperm. Conclusion Robertsonian translocation was the main cause for habitual abortion, infertility, male oligospermia, azoospermia or abnormal sperm, and 21 three-body syndrome. Carriers with different types of Robertsonian translocation may have manifestations vary significantly. In day-to-day genetic counseling, the carriers should be informed the reproductive risks based on different situations, and that assisted reproductive technology or prenatal diagnosis can be applied to reduce the chance of birth of baby carrying robertsonian translocation.

目的研究新生儿先天性畸形的临床与染色体异常核型特征,为提高产前诊断提供依据。方法采用常规外周血培养及制备染色体,G显带核型分析。结果 56例先天性畸形中,染色体异常以21-三体最为多见（40例占71.43%）,其次有18-三体及13-三体,同时还发现一些罕见的染色体异常。临床上,常以特殊面容表现最为突出,同时先心、唇腭裂等较严重畸形在三体型中较为常见。结论染色体异常所致胎儿特殊异常表现,重点心血管,唇腭裂检查是提高产前诊断检出染色体异常的重要依据。

Objectives:To determine the relationship between abnormal karyotype of X and Y bisexual chromosome mosaic and the clinical manifestation.Methods:Eight socially male patients with bisexual karyotype were reviewed.The karyotype and clinical manifestations were analyzed.Results:Five cases(children) showed hypospadias and cryptorchidism,among whom 3 cases received abdominal exploration and testiculus,ovarian duct and ovaries were found.Three adults showed aciesis after marriage and agenesia.of testiculus and secondary sex characters.Conclusion:Individuals with abnormal bisexual chromosome mosaic karyotypes may have both female and male reproductive organs.Real androgyneity can be confirmed by abdominal exploration.For the children with uncertain sex development,especially of hypospadias and cryptorchidism,chromosome karyotype analysis can offer important theory for further treatment.

Objective To observe the expressions of myocardial pri-miRNA-1 and connexin43(Cx43) in murine myocardium with viral myocarditis(VMC) induced by coxsackievirus B3(CVB3),and explore the mechanism of VMC ventricular arrhythmia.Methods Seventy Balb/c male mice (4 weeks old) were divided randomly into VMC group (n=40) and control group (n=30).VMC group mice were peritoneally injected with CVB3.Control group were injected with RPMI 1640 excluding virus.Mice were sacrificed at 14 days and 28 days,respectively after injection,and the ventricular myocardium were obtained.The expressions of pri-miRNA-1 and dicer1 mRNA were measured by reverse transcriptase-polymerase chain reaction(RT-PCR).Cx43 were determined by immunohistochemistry.Results 1.Compared with control group,the expressions of pri-miRNA-1 on days 14 and 28 were significantly increased than those in VMC group (0.82±0.04 vs 0.63±0.07,0.79±0.03 vs 0.62±0.01 Pa0.01);2.The expressions of dicer1 mRNA at 14 days and 28 days were significantly increased than those in VMC group (0.91±0.03 vs 0.72±0.02,0.87±0.02 vs 0.71 ± 0.02 Pa0.01);3.The expressions of Cx43 at 14 days and 28 days were decreased remarkably than those in VMC group (0.27±0.01 vs 0.42±0.02,0.22±0.02 vs 0.44±0.02 Pa0.01).The decreased expression of Cx43 was located in the part of degenerative myocardium;4.Myocardial pri-miRNA-1 was negatively correlated with Cx43 protein (r=-0.798 P0.01),and positively correlated with dicer1 mRNA (r=0.828 P0.01).Conclusions pri-miRNA-1 and dicer1 play roles in the mechanism of VMC caused by CVB3.dicer1 might approve ventricular arrhythmia by promoting the production of miRNA-1 and inhibiting the expression of Cx43.

lso.This result suggested that Th17 subset is differentiated in chronic stage of viral myocarditis.

OBJECTIVETo explore the role of interleukin-17 (IL-17) in the evolution of viral myocarditis (VMC) into dilated cardiomyopathy (DCM).METHODSA mouse model of VMC was established in 100 male Balb/c mice by intraperitoneal injection of coxsackievirus B3. The expression of IL-17 protein in the cardiac tissue of the mice was detected immunohistochemically, and IL-17 mRNA in the splenocytes was examined by reverse transcription-polymerase chain reaction (RT-PCR). IL-17 levels in the plasma, peripheral blood mononuclear cell (PBMC) culture supernatants, and phytohemagglutinin (PHA)-stimulated PBMC culture supernatants were measured in 30 DCM patients, 26 non-DCM patients and 20 normal adults using enzyme-linked immunosorbent assay (ELISA), and IL-17 mRNA expression in the PBMCs was detected using RT-PCR.RESULTSThe levels of IL-17 mRNA in the splenocytes of the mice with VMC were significantly higher at 4 and 6 weeks than those at 8 weeks (P<0.01), but not detected at 2 weeks. No IL-17 expression was found in the ventricular tissue of the mice at 2 weeks, but peaked at 4 weeks followed by gradual decrease (P<0.01). IL-17 level in PHA-stimulated PBMC culture supernatants but not the plasma, and its mRNA level in PHA-stimulated PBMCs but not the PBMC culture supernatants, were significantly elevated in DCM patients as compared with those in non-DCM patients and normal control subjects.CONCLUSIONSThe mouse model of VMC in the chronic phase and DCM patients express high levels of IL-17, which may contribute to the transition from VMC to DCM.

目的 研究人血清可溶性CD14(sCD14)水平变化与不稳定型心绞痛(UA)患者进展成急性心肌梗死(AMI)危险性的关系及其预测意义.方法 UA患者158例,其中21例进展成AMI,同时选取50例健康体检患者作为对照.使用ELISA方法 测定患者血清sCD14水平.结果 UA患者血清sCD14水平显著高于健康对照组;UA患者发生AMI后血清sCD14明显增高,但发生AMI前血清水平sCD14水平与未发生AMI的UA患者比较差异无统计学意义;AMI稳定后,sCD14仍持续在较高水平.结论 UA患者血清sCD14水平与AMI发生相关,有一定预测意义.