ABSTRACT:Background: The dysregulation of circular RNAs (circRNAs) is involved in various human diseases, including sepsis-induced acute lung injury (ALI). We aimed to investigate the role of circTDRD9 in the development of sepsis-induced ALI. Methods: Cell models of sepsis-induced ALI were established by treating A549 cells with LPS. The expression of circTDRD9, miR-223-3p, and RAB10 mRNA was measured by quantitative real-time PCR (qPCR). The levels of inflammatory factors were measured by ELISA. Oxidative stress-related indicators were monitored by using commercial detection kits. The expression of fibrosis-related proteins was detected by Western blot assay. Cell proliferation was assessed by EdU assay. The predicted binding relationship between miR-223-3p and circTDRD9 or RAB10 was verified by dual-luciferase reporter assay, RIP assay or pull-down assay. Results: CircTDRD9 was highly expressed in LPS-treated A549 cells. CircTDRD9 downregulation prevented LPS-induced inflammation, oxidative stress, cell proliferation inhibition, and cell fibrosis in A549 cells, whereas these effects were reversed by the inhibition of miR-223-3p, a target of circTDRD9. In addition, RAB10 was verified as a target of miR-223-3p, and RAB10 overexpression recovered LPS-induced inflammation, oxidative stress, cell proliferation inhibition, and cell fibrosis in A549 cells that were ameliorated by miR-223-3p restoration. Importantly, circTDRD9 positively regulated RAB10 expression by binding to miR-223-3p. Conclusion: CircTDRD9 overexpression was closely associated with LPS-induced ALI. CircTDRD9 contributed to LPS-induced ALI partly by upregulating RAB10 via binding to miR-223-3p.

目的 探讨优化教学法联合以案例为基础的教学法(case-based learning,CBL)在急诊规培医师教学中的应用效果.方法 随机选取2021年7-12月于西安交通大学第二附属医院急诊科接受常规教学法的50名规培医师,设为对照组,随机选取2022年1-6月于本院急诊科接受优化教学法联合CBL的50名规培医师,设为研究组.对比两组教学成绩、学习主动性及教学方法满意率.结果 研究组理论知识、案例分析、实践操作成绩均高于对照组,差异有统计学意义(P<0.05).两组教学前ALS评分比较,差异无统计学意义(P>0.05),两组教学后ALS评分均高于教学前,且研究组高于对照组,差异有统计学意义(P<0.05).研究组教学总满意率高于对照组,差异有统计学意义(P<0.05).结论 优化教学法联合CBL应用于规培医师的急诊教学,能够提高教学成绩与学习主动性,促使教学满意率提升.

Myocardial injury is a frequently occurring complication of sepsis. This study aims to investigate the molecular mechanism of long noncoding RNA (lncRNA) small nucleolar RNA host gene 1 (SNHG1)‐mediated DNA methyltransferase 1/B‐cell lymphoma‐2 (DNMT1/Bcl‐2) axis in sepsis‐induced myocardial injury. Mice and HL‐1 cells were treated with lipopolysaccharide (LPS) to establish animal and cellular models simulating sepsis and inflammation. LncRNA SNHG1 was screened out as a differentially expressed lncRNA in sepsis samples through microarray profiling, and the upregulated expression of lncRNA SNHG1 was confirmed in myocardial tissues of LPS‐induced septic mice and HL‐1 cells. Further experiments suggested that silencing of lncRNA SNHG1 reduced the inflammation and apoptotic rate of LPS‐induced HL‐1 cells. LncRNA SNHG1 inhibited Bcl‐2 expression by recruiting DNMT1 to Bcl‐2 promoter region to cause methylation. Inhibition of Bcl‐2 promoter methylation reduced the inflammation and apoptotic rate of LPS‐induced HL‐1 cells. In vivo experiments substantiated that lncRNA SNHG1 silencing alleviated sepsis‐induced myocardial injury in mice. Taken together, lncRNA SNHG1 promotes LPS‐induced myocardial injury in septic mice by downregulating Bcl‐2 through DNMT1‐mediated Bcl‐2 methylation.

Atherosclerosis (AS) is one of the significant chronic inflammatory pathology considering public health impact. Up-regulation of HDAC1 has been proved to be related with endothelial dysfunction which is correlated intimately with AS. Our research aims to investigate how histone deacetylase 1 (HDAC1)/miR-182-5p/vav guanine nucleotide exchange factor 3 (VAV3)/AKT axis participates in AS in terms of molecular mechanism. We detected miR-181-5p in human umbilical vein endothelial cells after treatment with aorta and ox-LDL in AS model mice. Dual luciferase reporter assay was employed to verify interaction of miR-182-5p and VAV3. ChIP was performed to determine the relationship between HDAC1 and promoter of miR-182-5p. Protein levels of HADC1, VAV3, AKT, p-AKT, vascular cell adhesion molecule-1 (VCAM-1), intercellular cell adhesion molecule-1 (ICAM-1), and monocyte chemotactic protein 1 (MCP-1) were detected by western blot analysis. CCK8 and flow cytometry were used to detect cell viability and apoptosis, respectively. After different treatments, the ability of cells to form monoclonal cells was detected, and AS was evaluated by detecting arterial injury and inflammation-related factors. Overexpression of HDAC1 could inhibit HUVECs proliferation and promote AS in mouse model. It was verified by dual luciferase assay that miR-182-5p could bind to VAV3 3'UTR mRNA. Meanwhile, HDAC1 repressed miR-182-5p expression through binding to miR-182-5p promoter and then inhibit VAV3 expression further. In summary, HDAC1 promoted AS through AKT pathway, which was improved by VAV3 activation mediated by miR-182-5p. Our results demonstrated that HDAC1 repressed miR-182-5p and activating AKT pathway via improving VAV3 to promote AS progression.

Tripartite motif 8 (TRIM8) is a member of the TRIM protein family that has been found to be implicated in cardiovascular disease. However, the role of TRIM8 in myocardial ischemia/reperfusion (I/R) has not been investigated. We aimed to explore the effect of TRIM8 on cardiomyocyte H9c2 cells exposed to hypoxia/reoxygenation (H/R). We found that TRIM8 expression was markedly upregulated in H9c2 cells after stimulation with H/R. Gain- and loss-of-function assays proved that TRIM8 knockdown improved cell viability of H/R-stimulated H9c2 cells. In addition, TRIM8 knockdown suppressed reactive oxygen species production and elevated the levels of superoxide dismutase and glutathione peroxidase. Knockdown of TRIM8 suppressed the caspase-3 activity, as well as caused significant increase in bcl-2 expression and decrease in bax expression. Furthermore, TRIM8 overexpression exhibited apposite effects with knockdown of TRIM8. Finally, knockdown of TRIM8 enhanced the activation of PI3K/Akt signaling pathway in H/R-stimulated H9c2 cells. Inhibition of PI3K/Akt by LY294002 reversed the effects of TRIM8 knockdown on cell viability, oxidative stress, and apoptosis of H9c2 cells. These present findings defined TRIM8 as a therapeutic target for attenuating and preventing myocardial I/R injury.

背景 脓毒症患者易并发静脉血栓栓塞症(VTE),而该类患者是否需接受预防性抗凝及其风险、获益目前国内外均无定论,且针对脓毒症患者并发VTE的风险评估方法尚缺乏共识且研究较少.目的 探讨Caprini血栓风险评估量表对脓毒症伴VTE高危患者预防性抗凝的指导价值.方法 回顾性选取2017—2019年西安交通大学第二附属医院急诊重症监护室(EICU)收治的脓毒症患者65例,均经Caprini血栓风险评估量表评估为VTE高危.根据不同的治疗措施将所有患者分为对照组35例和观察组30例;另根据VTE发生情况将所有患者分为VTE组10例和无VTE组55例.比较观察组、对照组患者治疗期间VTE、出血发生情况及EICU住院时间、总住院时间;比较VTE组、无VTE组临床资料.采用多因素Logistic回归分析探讨脓毒症患者并发VTE的影响因素.结果 观察组患者VTE发生率低于对照组,EICU住院时间、总住院时间短于对照组(P<0.05);两组患者出血发生率比较,差异无统计学意义(P>0.05).VTE组患者年龄大于无VTE组,急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭估计评分(SOFA)及Caprini血栓风险评估量表评分高于无VTE组,预防性抗凝治疗率低于无VTE组(P<0.05).多因素Logistic回归分析结果显示,Caprini血栓风险评估量表评分〔OR=16.639,95％CI(2.173,127.440)〕、预防性抗凝〔OR=0.005,95％CI(0,0.380)〕是脓毒症患者并发VTE的影响因素(P<0.05).结论 Caprini血栓风险评估量表评分越高,脓毒症患者VTE发生风险越高;对于Caprini血栓风险评估量表评估为VTE高危的脓毒症患者实施预防性抗凝可降低VTE发生率,并可缩短患者住院时间且不增加出血风险,故该量表可用于评估并指导脓毒症伴VTE高危患者的预防性抗凝.

背景 针对高度可疑急性肺栓塞(APE)后至确诊APE患者,由低分子肝素(LMWH)过渡到利伐沙班的序贯治疗方法各不相同,目前临床关于其对APE患者的短期疗效也鲜有报道.目的 比较LMWH序贯利伐沙班与华法林治疗APE的短期疗效.方法 回顾性选取2018—2019年西安交通大学第二附属医院收治的APE患者65例,根据患者和/或家属自主意愿分为华法林组34例和利伐沙班组31例.华法林组患者给予LMWH序贯华法林治疗,利伐沙班组患者采用LMWH序贯利伐沙班治疗,两组患者均持续治疗3个月及以上.比较两组患者的临床疗效及治疗前、治疗后1个月炎性因子、凝血功能指标及血管内皮功能指标,并观察两组患者治疗期间不良反应发生情况.结果 利伐沙班组患者临床疗效优于华法林组(P<0.05).两组患者治疗前C反应蛋白(CRP)、白介素6(IL-6)、肿瘤坏死因子α(TNF-α)、D-二聚体(D-D)、蛋白C(PC)、蛋白S(PS)、内皮素1(ET-1)、血栓素B2(TXB2)、一氧化氮(NO)水平及治疗前后D-D水平的差值比较,差异无统计学意义(P>0.05);利伐沙班组患者治疗后1个月CRP、IL-6、TNF-α、D-D、ET-1、TXB2水平低于华法林组,PC、PS、NO水平高于华法林组(P<0.05).利伐沙班组患者治疗前后CRP、IL-6、TNF-α、PC、PS、ET-1、TXB2、NO水平的差值大于华法林组(P<0.05).两组患者治疗期间不良反应发生率比较,差异无统计学意义(P>0.05).结论 LMWH序贯利伐沙班治疗APE患者的短期疗效优于华法林,其可更有效地减轻患者的炎性反应,改善凝血功能及血管内皮功能,且安全性高.

背景广藿香酮(POG)具有抗癌、抗炎、抗菌等多重药理作用,但目前关于其治疗脑卒中的研究报道较少.目的 探讨POG对脑卒中大鼠的影响及其作用机制.方法 本实验于2018年12月—2019年4月完成.选取7～8周龄SPF级雄性Sprague-Dawley大鼠36只,随机分为空白对照组(未经模型诱导,n=6)、对照组(建模后未经治疗,n=6)、低剂量组(建模24 h后给予POG 5 mg/kg,n=6)、中剂量组(建模24 h后给予POG 15 mg/kg,n=6)、高剂量组(建模24 h后给予POG 45 mg/kg,n=6)和LY294002组(建模24 h后给予0.1％～0.3％二甲亚砜溶解浓度为0.1％,n=6).比较六组大鼠磷酸化PI3K(p-PI3K)、磷酸化AKT(p-AKT)、磷酸化内皮型一氧化氮合酶(p-eNOS)蛋白相对表达量,血管内皮生长因子(VEGF)、B细胞淋巴瘤2(Bcl-2)、Bcl-2相关X蛋白(Bax)蛋白及mRNA相对表达量,大脑皮质和外周血中的超氧化物歧化酶(SOD)、丙二醛(MDA)和一氧化氮(NO)水平.结果 (1)高剂量组大鼠p-PI3K、p-AKT、p-eNOS蛋白相对表达量低于对照组,p-AKT和p-eNOS蛋白相对表达量高于LY294002组(P<0.05).(2)高剂量组大鼠Bcl-2蛋白相对表达量高于对照组,Bax、VEGF蛋白相对表达量低于对照组(P<0.05);高剂量组大鼠Bcl-2、VEGF mRNA相对表达量高于对照组,Bax mRNA相对表达量低于对照组(P<0.05).(3)高剂量组大鼠大脑皮质和外周血NO、SOD水平高于对照组,大脑皮质和外周血MDA水平低于对照组(P<0.05);高剂量组大鼠大脑皮质和外周血MDA水平高于LY294002组,大脑皮质和外周血SOD水平低于LY294002组(P<0.05).结论 POG可通过抑制PI3K/AKT-eNOS信号通路及脂质过氧化而减轻脑卒中大鼠脑组织损伤,且无剂量依赖性.

目的 探究老老年复发脑卒中合并重症肺炎患者的病原菌分布情况和抗生素应用分析.方法 选择西安交通大学第二附属医院老老年复发脑卒中合并重症肺炎患者共168例,统计分析感染菌群类型和比例,敏感抗生素类型和比例,分析患者预后与感染菌群类型、菌群耐药数量以及培养时间的关系.结果 初检阳性率46.3％,经多次送检阳性率为79.8％,多次送检可提高阳性率(P＜0.05);革兰氏阴性菌(G-)感染率高于革兰氏阳性菌(G+)和真菌(P＜0.05);2种菌群感染患者比例最高(P＜0.05).患者应用抗生素类型以头孢类最多,其次为青霉素类和喹诺酮类(P＜0.05);2种抗生素联合应用比例最多(P＜0.05).预后较差患者感染G-菌比例高于预后较好患者,联合感染比例升高,联合应用抗生素种类增多,降阶梯治疗次数增加(P＜0.05).多因素logistic回归分析可知,病原菌分布、抗生素种类、菌群培养时间是影响预后的独立危险因素(P＜0.05).结论 菌群感染是导致老老年复发脑卒中合并重症肺炎患者预后不佳的重要因素,早期多次送检和药敏试验可显著改善临床效果.

目的 分析目标导向液体治疗重症胸部创伤并创伤性休克的临床效果.方法 70例重症胸部创伤并创伤性休克患者,按随机数字表法分为观察组与对照组,每组35例.观察组采用目标导向液体复苏治疗方案,对照组采用开放式液体复苏治疗方案.观察2组在不同液体复苏治疗后的平均动脉压(MAP)、心脏指数(CI)和每搏变异度(SVV)及补液量,并观察急诊手术后2组凝血功能指标凝血酶原时间(PT)及活化部分凝血酶时间(APTT)、核心体温、pH值,比较2组治疗总效率、并发症发生率及伤口恢复时间.结果 2组患者经过不同液体复苏治疗后,两组MAP比较差异无统计学意义(P>0.05),而观察组SVV和补液量低于、CI高于对照组(P<0.05).观察组患者凝血功能指标PT及APTT优于对照组(P<0.05),但2组核心体温及pH值比较差异无统计学意义(P>0.05).观察组总有效率为85.71％,高于对照组的60.00％(P<0.05);术后观察组并发症发生率为17.14％(其中2例炎症反应,1例ARDS,3例术口渗血),对照组并发症发生率为45.71％(其中4例炎症反应,2例MODS,3例ARDS,7例术口渗血),观察组并发症发生率低于对照组(P<0.05).术后伤口恢复时间观察组短于对照组(P<0.05).结论 通过对重症胸部创伤并创伤性休克患者采取目标导向液体复苏治疗措施,可有效增强临床治疗效率,改善凝血功能,缩短伤口恢复时间,减少并发症,为患者预后恢复创造良好条件,具有临床意义.

Myocardial infarction (MI) is one of the most serious cardiovascular diseases associated with myocardial ischemia/reperfusion (I/R) injury. Glaucocalyxin A (GLA) is a biologically active ent-kauranoid diterpenoid that has been found to ameliorate myocardial I/R injury in mice. However, the mechanism has not been fully investigated. In the present study, we aimed to investigate the effect of GLA on rat cardiomyocytes H9c2 cells exposed to hypoxia/reoxygenation (H/R). The results showed that GLA treatment improved cell viability of H/R-stimulated H9c2 cells. Administration with GLA suppressed the H/R-stimulated reactive oxygen species (ROS) production in H9c2 cells. GLA also elevated the activities of antioxidant enzymes, including superoxide dismutase and glutathione peroxidase in H/R-stimulated H9c2 cells. Moreover, GLA prevented H/R-stimulated cell apoptosis in H9c2 cells, as evidenced by increased bcl-2 expression, decreased bax expression, as well as reduced caspase-3 activity. Furthermore, GLA enhanced the activation of protein kinase B (Akt)/nuclear factor erythroid 2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1) signaling pathway in H9c2 cells exposed to H/R. Additionally, treatment with LY294002 reserved the protective effects of GLA on H/R-stimulated oxidative injury in H9c2 cells. In conclusion, these findings suggested that GLA protected H9c2 cells from H/R-stimulated oxidative damage, which was mediated by the Akt/Nrf2/HO-1 signaling pathway. Thus, GLA might be a promising therapeutic agent for the prevention and treatment of myocardial I/R.

目的 探讨影像归档和通信系统(PACS)多窗联合阅片在急诊空腔脏器穿孔诊断中的应用效果.方法 回顾性分析的58例空腔脏器穿孔患者的腹部X线和CT影像资料.通过PACS阅片,比较单独X线、单独常规CT(仅包括腹窗)、联合阅片(X线、CT腹窗、CT纵隔窗)诊断空腔脏器穿孔的准确性.结果 立位腹部X线诊断空腔脏器穿孔准确率为41.38％(24/58),常规CT诊断空腔脏器穿孔准确率为65.52％(38/58),联合阅片诊断空腔脏器穿孔准确率为86.21％(50/58);联合阅片诊断准确率高于单独X线或常规CT检查,而常规CT诊断准确率高于X线(均P<0.05).结论 PACS系统多窗联合阅片有助于提高急诊空腔脏器穿孔的诊断准确率.

目的 分析肺癌患者术后呼吸功能衰竭的影响因素.方法 选取行手术治疗的100例肺癌患者,根据患者术后有无呼吸功能衰竭分为观察组(30例,术后出现呼吸功能衰竭)与对照组(70例,术后无呼吸功能衰竭).分析肺癌患者术后呼吸功能衰竭的影响因素.结果 观察组年龄>65岁、有吸烟史、术前合并慢性疾病及肺功能不全、术后肺部感染及术中输液输入量≤2500 mL的患者占比高于对照组(P<0.05);多因素Logistic回归分析结果显示,年龄、吸烟史、术前合并慢性疾病、术前合并肺功能不全、术后肺部感染及术中输液输入量均为肺癌患者术后呼吸功能衰竭的独立危险因素(P<0.05).结论 年龄、吸烟史、术前合并慢性疾病、术前合并肺功能不全、、术后肺部感染及术中输液输入量均为肺癌患者术后呼吸功能衰竭的独立危险因素,需要引起医务人员的重视.

目的 探讨可视化技术在急诊医学规范培训化教学过程中应用.方法 选取2017年9月～2018年9月在我院急诊科进行规范培训化的医师72人,随机分为实验组及对照组,每组36人,对照组采用传统模式进行教学,实验组采用可视化技术进行教学,出科前由教学考核小组对每位医师进行理论及操作考核,记录考试成绩.给72位规培医师发放教学形式及教学效果满意调查表,统计分数.结果 应用统计学软件对结果进行分析,实验组医师的理论考试成绩为(89.3±0.54)分,对照组医师理论考试成绩为(88.1±0.98)分,其差异没有统计学意义(P＞0.05).实验组医师操作气管插管、纤维支气管镜、深静脉穿刺置管成功率及考核时间均高于对照组医师[91.8％ vs 59.6％;(2.8±1.1)min vs(5.1±2.7)min;80.7％ vs 42.1％;(9.8±1.9)min vs(15.2±2.8)min;85.9％ vs 52.5％;(7.5±2.8) min vs(10.5±3.3)min],其差异有统计学意义(P＜0.05).实验组规培医师对教学形式和教学效果的满意度评分均高于对照组[(91.2±1.3)分vs (80.5±1.6)分],差异有统计学意义(P＜0.05).结论 在急诊医学的教学过程中,可视化技术可以有效提高规培医师的学习效率及操作兴趣,值得在临床教学中推广.

Homeodomain interacting protein kinase-2 (HIPK2) has emerged as a crucial stress-responsive kinase that plays a critical role in regulating cell survival and apoptosis. However, whether HIPK2 participates in regulating cardiomyocyte survival during myocardial ischemia/reperfusion injury remains unclear. Here, we investigated the regulatory effect of HIPK2 on hypoxia/reoxygenation (H/R)-induced cardiomyocyte injury and its potential underlying molecular mechanism. We found that HIPK2 expression was induced in response to H/R exposure. HIPK2 depletion by small interfering RNA (siRNA)-mediated gene silencing significantly decreased the viability and exacerbated H/R-induced apoptosis and reactive oxygen species (ROS) production in cardiomyocytes. Comparatively, HIPK2 overexpression effectively rescued H/R-impaired viability and repressed H/R-induced apoptosis and ROS production in cardiomyocytes. HIPK2 overexpression significantly increased the nuclear expression of nuclear factor (erythroid-derived 2)-like 2 (Nrf2) and enhanced Nrf2-mediated transcriptional activity. Moreover, HIPK2 overexpression significantly increased the transcription of Nrf2/ARE target genes. Additionally, Nrf2 inhibition partially reversed the HIPK2-mediated protective effect. Overall, these results demonstrate that HIPK2 overexpression protects cardiomyocytes from H/R-induced injury by enhancing Nrf2/ARE antioxidant signaling, data that suggest HIPK2 is a potential target for cardioprotection.

Objective To investigate changes and significances of intercellular adhesion molecule-1( ICAM-1),procalcitonin( PCT) and C reaction protein( CRP) in severe acute pancreatitis patients with secondary infectious pancreatic necrosis. Methods A total of 98 patients with severe acute pancreatitis admitted during March 2015 and March2017 were divided into infection group( n = 46) and non-infection group( n = 52) according to whether or not having secondary infectious pancreatic necrosis. Changes and diagnostic values of ICAM-1,PCT and CRP in pancreatitis patients with secondary infected pancreatic necrosis were analyzed. Results ICAM-1,PCT and CRP levels and Ranson scores in infection group were significantly higher than those in non-infection group( P < 0. 05). Pearson correlation analysis showed that ICAM-1,PCT and CRP expressions were positively correlated with Ranson score( r = 0. 251,0. 223,0. 270,P < 0. 05). Efficacy by combined diagnosis was significantly higher than those by ICAM-1,PCT and CRP diagnosis only( P < 0. 05),and values of specificity and accuracy of ICAM-1,PCT and CRP combined detection were significantly higher than those by ICAM-1,PCT and CRP detection only( P < 0. 05). Conclusion ICAM-1,PCT and CRP in patients with secondary infectious pancreatic necrosis have increased expressions,and they are closely related to Ranson level,and combined detection may have significantly higher accuracy,and therefore it can be used as one of important indexes in diagnosis of severe acute pancreatitis patients with secondary infectious pancreatic necrosis.

Objective To investigate the feasibility and effect of visualization teaching method using HC visual laryngoscope for the standardized training of endotracheal intubation in emergency department.Methods Forty standard-trainee doctors were divided into two groups randomly.20 standard-trainee doctors in team N were taught using the conventional teaching method of emergency medicine for the standardized training of endotracheal intubation,and the other 20 standard-trainee doctors in team HC were taught by visualization teaching method using HC visual laryngoscope.After 1 month training,comparisons of the success rate of tracheal intubation in airway management simulator,the time consumed for intubation and the number of attempt on successful intubation cases,and the satisfaction score with the teaching mode scored by standard-trainee doctors between the two groups were done.Results The one-attempt success rate and the success rate of tracheal intubation in airway management simulator by the standard-trainee doctors in group HC were significantly higher than those in group N (40％ vs.10％,85％ vs.55％),while the number of attempt and the time consumed for successful intubation were significantly less than those in group N[(1.65±0.61) vs.(2.27±0.66),(79.00±8.35) s vs.(89.36±12.03) s).The satisfaction score with this teaching mode and teaching effect of standard-trainee doctors in group HC were significantly higher than those in group N (8.10±0.74 vs.6.55±1.05,8.15±0.80 vs.6.85±0.91).Conclusions The visualization teaching method with application of HC visual laryngoscope for standardized training of endotracheal intubation in emergency department could improve the success rate and efficiency of tracheal intubation in airway management simulator for standard-trainee doctors,and this teaching method may be better than the conventional teaching method on teaching mode presenting some feasibility.

Objective: To study the effect of edaravone combined with cinepazide maleate on patients with acute cerebral infarction serum MMP-3, MMP-9, TIMP-1, EPCs. Methods: 114 cases with acute cerebral infarction were researched, according to the random number table they were divided into combined treatment group(n=57) and the single treatment group(n=57). The single treatment group was only treated with edaravone, and the combined treatment group was treated with edaravone and cinepazide malete. They were compared with clinical treatment effect, NIHSS score change, laboratory index level change, blood lipid level change and adverse reactions. Results: After treatment, combined treatment group cured and significantly improved patients reached 49 cases, the total effective rate was 85.96％, and the single treatment group cured and significant progress in patients with only 39 cases, the total effective rate was 68.42％, there was significant difference between two groups (P＜0.05). After the treatment of 14 d and 28 d, the scores of patients were significantly lower than those before treatment, while the level of decrease in the combined treatment group was better than that in the single treatment group (P＜0.05). Two groups of patients with MMP3 and MMP9 levels decreased significantly, while TIMP-1 and EPCs levels increased significantly, and the combined treatment group MMP3 and MMP9 decreased and TIMP-1 and EPCs levels were significantly better than the single treatment group (P＜0.05). After treatment of 14 d and 28 d, the indexes of blood lipid in patients decreased significantly compared with the previous measurement, and the decrease in the individual treatment group was more obvious than that in the combined treatment group (P＜0.05). The adverse reaction rate was 5.26％ in the combined treatment group, the adverse reaction rate in the single treatment group was 10.53％, and the adverse reaction rate was not statistically significant(P＞0.05). Conclusion: Edaravone combined with cinepazide maleate used in the treatment of patients with acute cerebral infarction is effective, effectively improve the serum levels of MMP-3, MMP-9, TIMP-1, EPCs and blood lipid abnormalities, promote angiogenesis, protect the brain tissue of patients.

Objective To investigate the feasibility and effect of scene simulation combined with multiple-station mini-CEX evaluation used for the teaching of standardized training of emergency medicine. Methods Sixty standard-trained doctors were randomly(random number) divided into two groups. Thirty standard-trained doctors in team A were taught using the traditional teaching modality of emergency medicine, and the rest in team B were trained using the method of scene simulation combined with multiple-station mini-CEX evaluation. At the end of standardized training, comparisons of the examination results of mini-CEX evaluation and the satisfaction of standard-trained doctors with the teaching mode were done between two groups. Results The scores of team B on medical interviewing skills, clinical judgment, counseling skills, proper presentation/efficiency and overall clinical competence were significantly higher than those of team A[(7.26±0.36),(7.63±0.39),(7.22±0.34),(7.26±0.45), (7.75±0.24) vs. (6.81±0.42),(7.24±0.39),(6.90±0.44),(6.97±0.50),(7.21±0.32)],while there were no significant differences in scores on physical examination skills and humanistic qualities/professionalism between two teams [(7.60±0.36),(7.92±0.35) vs. (7.42±0.30),(7.98±0.32)]. The satisfaction with the mini-CEX evaluation of both teachers and standard-trained doctors in team B were significantly higher than those in team A [(7.40±0.30), (7.46±0.28) vs. (7.06±0.38), (6.91±0.38)]. The satisfaction of standard-trained doctors in team B with the teaching mode and teaching effect were significantly higher than those in team A[(8.17±0.78),(8.59±0.66) (6.67±0.73), (6.80±0.72)]. Conclusions The scene simulation combined with multiple-station mini-CEX evaluation used for the teaching of standardized training of emergency medicine may improve some of the clinical skills of standard-trained doctors, and thus this teaching reform was feasible.