情景教学在中医院住培医师急救技能培训中的应用

目的 对中医院住院医师规范化培训学员进行情景模拟教学在急诊技能培训的应用进行研究。方法 选择本院进行住院医师规范化培训的学员180名,随机分为观察组与对照组各90名。对照组采用常规培训方法进行急救技能的基础知识和临床实践知识教授,包括如何识别危重患者、心肺复苏术、气管插管术、电除颤等。观察组采取情景模拟教学方法,以临床实际案例为依托,针对前述常用急救技能,选择适宜疾病和典型病例制作相关临床模拟材料,让学员主动思考,结合案例进行具体抢救方案的实施。引导学员解析病例,以及实施救治中的思维方向。每次培训将学员分成5人1组,分角色演练。设置患者心脏骤停等临床场景,住院医师进行心肺复苏和气管插管等急救操作。对教师及学员用时、学员理论及技能考核成绩、满意度、工作能力评估等方面进行评分。结果 观察组教师用时明显低于对照组,学员活跃度较对照组高(P <0.05)。两组学员的基础知识、单项技能的考核中,观察组均显著高于对照组(P <0.05)。观察组对情景模拟教学方式的技能培训满意度显著高于对照组,在基础知识培训、技能培训、课题活跃度、师生互动方面均有显著差异(P <0.05)。观察组在病情评估、诊治思维、应急能力、团队配合评分等方面均显著高于对照组(P <0.05)。结论 情景模拟教学法适用于住院医师规范化培训的技能培训,能帮助住院医师进一步巩固理论知识,学习并掌握临床知识和技能,激发其学习兴趣,提高病情评估、诊治思维、应急能力、团队配合等综合能力,教学效果好。

IL-37b suppresses epithelial mesenchymal transition in hepatocellular carcinoma by inhibiting IL-6/STAT3 signaling

Background: Interleukin-37 b(IL-37 b), a vital negative regulator of the innate immune system, has been reported to be a tumor inhibitor in different type of cancers. However, little is known about the relationship between IL-37 b and hepatocellular carcinoma(HCC). The present study aimed to investigate the potential roles of IL-37 b in HCC progression. Methods: Subjects( n = 237) were recruited, and serum IL-37 b was measured using ELISA. The tumorsuppressive capacity and underlying mechanisms of IL-37 b in HCC were investigated in vitro and in vivo. Results: Compared to healthy controls, serum IL-37 b levels were elevated in chronic hepatitis B(CHB) patients but decreased significantly in HBV-HCC patients, especially for those with portal venous tumor thrombus. Low level serum IL-37 b in HBV-HCC patients correlated with high HCC stage and poor overall survival and disease-free survival. In vitro and in vivo, recombinant human IL-37 b inhibited proliferation and metastasis in HCC cells. Furthermore, IL-37 b inhibited epithelial mesenchymal transition in HCC cells in vitro by downregulating IL-6, pSTAT3(Y705), N-cadherin, and vimentin expression and by upregulating E-cadherin expression. These effects were partially reversed by transfection of adenovirus encoding human IL-6. Conclusions: IL-37 b inhibits HCC growth, metastasis and epithelial mesenchymal transition by regulating IL-6/STAT3 signaling. Serum IL-37 b may be a biomarker for HBV-HCC and its staging.

Everolimus in de novo liver transplant recipients: a systematic review

BACKGROUND： Everolimus has no nephrotoxicity and is used to treat patients with post-liver transplant chronic renal insufficiency. The present systematic review was to evaluate the efficacy and safety of everolimus in de novo liver transplant patients.DATA SOURCES： Randomized controlled trials comparing everolimus for de novo liver transplant in Pub Med, the Cochrane Library, and Science Direct published up to March 31, 2014 were searched by two independent reviewers. Mean differences and 95% confidence interval（95% CI） for renal function, relative risk（RR） and 95% CI for treated biopsy-proven acute rejection（t BPAR）, graft loss, death, neoplasms/tumor recurrence, and adverse events were collected. Meta-analyses were performed with Rev Man version 5.10.RESULTS： A total of four randomized controlled trials covering 1119 cases were included. The meta-analyses revealed that compared with standard exposure of calcineurin inhibitors（CNIs）, everolimus combined with reduced CNIs improved creatinine clearance（calculated with the Cockcroft-Gault formula） by 5.13 m L/min at one year（95% CI： 0.42-9.84; P=0.03）, and decreased t BPAR（RR： 0.56; 95% CI： 0.35-0.90; P=0.02）. Everolimus initiation with CNIs elimination improved glomerular filtration rate（GFR, measured with the modification of diet in renal disease formula） of 10.42 m L/min/1.73 m2（95% CI： 3.44-17.41; P〈0.01） one year after treatment, but in-creased t BPAR（RR： 1.71; 95% CI： 1.15-2.53; P〈0.01）. Everolimus decreased the risk of neoplasms/tumor recurrence after liver transplant（RR： 0.60; 95% CI： 0.34-1.03; P=0.06）, but was associated with greater risk of adverse events which resulted in drug discontinuation（RR： 1.98; 95% CI： 1.49-2.64; P〈0.01）. CONCLUSIONS： Early introduction of everolimus combined with low-dose or no CNI in de novo liver transplant significantly improves renal function one year post treatment. Everolimus combined with low-dose CNI decreases the risk of t BPAR one year after liver transplant, but everolimus administered without CNIs increases t BPAR.

Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

The prognosis of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is very poor although sorafenib is recommended as the first-line treatment. Therefore, an effective treatment regime is needed for treating HCC with PVTT. This review summarized seven potential treatment regimes which including transarterial chemoembolization (TACE), TACE combined with sorafenib, TACE combined with radiotherapy (RT), hepatectomy, hepatic arterial infusion chemotherapy (HAIC), HAIC combined with sorafenib and HAIC combined with RT in the treatment of HCC with PVTT. In conclusion, hepatectomy or the combination of HAIC and sorafenib may be a more effective modality in the treatment of HCC patients with type I - II PVTT. HAIC combined with or without sorafenib/RT or the combination of RT and TACE is an alternative treatment choice for HCC patients with type III - IV PVTT. Further randomized controlled studies are warranted.

Carbon Nanoparticles for Identifying Lymph Nodes during Surgery in Colorectal Cancer: A Meta-Analysis

Aim: To investigative the efficacy of carbon nanoparticles (CNs) to identify the lymph nodes during radical surgery in colorectal cancer. Method: The MEDLINE, EMBASE and Cochrane Library databases were searched electronically to identify the studies that compared the use of CNs (CN group) with control group in patients undergoing colorectal cancer radical surgery (from January 2009 to November 2018). The primary outcome was the number of retrieved central lymph nodes. Results: This meta-analysis identified 2 randomized controlled trials and 5 non-randomized controlled trials. Compared with the control group, the CN group resulted in an average of 7.16 more lymph nodes removed per patient (WMD = 7.16, 95% CI = 3.76 to 10.57, p < 0.01), 7.26 minutes less required for retrieving lymph nodes (WMD = -7.26, 95% CI = -13.43 to -1.09, p = 0.02), and 15.1 ml less blood loss during operation (WMD = -15.11, 95% CI = -23.15 to -7.06, p < 0.01). Although there was no significant difference in the metastatic lymph nodes between the two groups (OR = 1.02, 95% CI = 0.79 to 1.31, p = 0.87), there was 1.45 times more metastatic lymph of the stained nodes in CN group than in the control group (OR = 1.45, 95% CI = 1.13 to 1.85, p < 0.01). In addition, lymph nodes less than 5 mm were detected significantly more in the CN group than in the control group (OR = 2.15, 95% CI = 1.77 to 2.63, p < 0.01). Conclusions: The technique of CNs labeled lymph node staining in curative colorectal carcinoma is easy and effective, which can improve the retrieved number of lymph nodes, especially for nodes < 5 mm. The black stained lymph node indicates higher risk of metastasis. Further high quality RCT is needed to verify these conclusions.

Identification of Hub Genes Associated with Hepatocellular Carcinoma Prognosis by Bioinformatics Analysis

Objective: This study aimed to identify hub genes that are associated with hepatocellular carcinoma (HCC) prognosis by bioinformatics analysis. Methods: Data were collected from the Gene Expression Omnibus (GEO) and The Cancer Genome Atlas (TCGA) liver HCC datasets. The robust rank aggregation algorithm was used in integrating the data on differentially expressed genes (DEGs). Online databases DAVID 6.8 and REACTOME were used for gene ontology and pathway enrichment analysis. R software version 3.5.1, Cytoscape, and Kaplan-Meier plotter were used to identify hub genes. Results: Six GEO datasets and the TCGA liver HCC dataset were included in this analysis. A total of 151 upregulated and 245 downregulated DEGs were identified. The upregulated DEGs most significantly enriched in the functional categories of cell division, chromosomes, centromeric regions, and protein binding, whereas the downregulated DEGs most significantly enriched in the epoxygenase P450 pathway, extracellular region, and heme binding, with respect to biological process, cellular component, and molecular function analysis, respectively. Upregulated DEGS most significantly enriched the cell cycle pathway, whereas downregulated DEGs most significantly enriched the metabolism pathway. Finally, 88 upregulated and 40 downregulated genes were identified as hub genes. The top 10 upregulated hub DEGs were CDK1, CCNB1, CCNB2, CDC20, CCNA2, AURKA, MAD2L1, TOP2A, BUB1B and BUB1. The top 10 downregulated hub DEGs were ESR1, IGF1, FTCD, CYP3A4, SPP2, C8A, CYP2E1, TAT, F9 and CYP2C9. Conclusions: This study identified several upregulated and downregulated hub genes that are associated with the prognosis of HCC patients. Verification of these results using in vitro and in vivo studies is warranted.

中药防治心肌缺血再灌注损伤研究进展

中药防治心肌缺血再灌注损伤的临床效果已经得到广泛肯定。大量文献表明,心肌缺血再灌注损伤与氧自由基生成、钙超载、能量代谢障碍、炎症反应、细胞凋亡等因素密切相关,而丹参、红景天、葛根、黄芪、玉郞伞、牡丹皮、当归、川芎、姜黄、五味子、白蒺藜、淫羊藿、黄连、银杏叶等中药皆具有抗心肌缺血再灌注损伤的作用,主要是通过提高内源抗氧化性,抑制Ca2+超载,改善心肌能量代谢,防治炎症反应以及增加抑制细胞凋亡的基因等途径发挥作用。目前,对中药有效成分抑制心肌缺血再灌注损伤的作用机制研究仍存在一些问题,如动物实验样本量较少,说服力不够;临床研究病例数较少,证据尚不充足;缺少规范的动物模型评价体系;研究多针对某单味中药,对复方的研究较少;结合西医机制研究较多,但结合中医理论进行机制研究较少;中医病机、辨证分型尚缺乏统一标准等。以后的研究中,应扩大动物实验样本量,结合中医系统的整体研究及中医理论机制研究,制作更符合研究需要的动物模型,从分子、细胞、生物等不同层面出发,以期为临床应用提供更多有力的支持。