Exploration and practice of collaborative teaching in anesthesia nursing / 中华医学教育探索杂志

Objective:To explore the effect of collaborative teaching on anesthesia nursing.Methods:A total of 50 anesthesiology nursing undergraduates were randomly selected from the Batch 2018 of Harbin Medical University as experimental group and control group respectively. The two groups completed the teaching tasks in the same teaching hours. The control group was taught by traditional teaching method. The experimental group was jointly taught by the teaching team composed of anesthesia nursing teachers, humanistic medicine teachers and ideological and political teachers. After the completion of teaching, the two groups of students were surveyed by questionnaire to evaluate the teaching effect. SPSS 22.0 was used Fisher's exact probability test.Results:The questionnaire results showed that in the evaluation of collaborative teaching, the evaluation of expanded ideological, political and humanistic knowledge (96.00%, 48/50), strengthened the understanding of theoretical knowledge (88.00%, 44/50), improved doctor-patient communication ability (90.00%, 45/50), improved clinical strain ability (94.00%, 47/50), and improved professional identity (86.00%, 43/50) of the experimental group was significantly higher than that of the control group ( P<0.05). Conclusion:The collaborative teaching method in anesthesiology nursing course can not only strengthen students' mastery of clinical skills, but also cultivate lofty sense of mission and professional spirit, strengthen doctors' benevolent belief, improve medical students' comprehensive quality in an all-round way, and promote the development of new medical education.

Proliferation, migration and apoptosis of acute myeloid leukemia cells regulated by mir-23a-3p targeting SMC1A and the mechanism / 中华肿瘤杂志

Objective@#To investigate the effects of miR-23a-3p on proliferation, migration and apoptosis on human acute myeloid leukemia (AML) cells by targeting SMC1A.@*Methods@#Microarray analysis was used to screen differentially expressed microRNAs and mRNAs in human AML cells. Real-time fluorescence quantitative PCR (RT-qRCR) was used to detect the expressions of miR-23a-3p and SMCA in human AML cell line U937. TargetScan database was used to analyze the correlation between miR-23a-3p and SMC1A. Double luciferase reporter gene was used to detect the interaction between miR-23a-3p and SMC1A. The effect of miR-23a-3p expression on the proliferation of U937 cells was detected by clonal assay. The migration, apoptosis, cell cycle and caspase-3 activity of U937 cells regulated by miR-23a-3p were detected by cell scratch assay and flow cytometry, respectively. Western blot was used to detect the expressions of Bax and Bcl-2 in U937 cells.@*Results@#Compared with human normal monocyte SC group (1.00), the expression of miR-23a-3p in U937 cells was up-regulated (2.56±0.78) (P<0.01), while the expression of SMC1A was down-regulated (0.48±0.56, P<0.01). miR-23a-3p specifically bond to SMC1A 3′UTR and regulated the expression activity of SMC1A. Overexpression of miR-23a-3p promoted the proliferation and migration of U937 cells and inhibited the apoptosis of U937 cells, while up-regulation of SMC1A inhibited the proliferation and migration of U937 cells and promoted the apoptosis of U937 cells. The percentages of G0/G1 phase, G2/M phase and S phase cells in the negative control group were (37.48±0.21)%, (16.78±0.18)% and (45.74±0.15)% respectively, and those in the miR-23a-3p mimics group were (19.96±0.11)%, (41.69±0.24)% and (38.24±0.34)%, respectively. The difference was statistically significant (all P<0.05). The proportions of G0/G1 phase, G2/M phase and S phase cells in the group of miR-23a-3p mimics+ pcDNA3.1-SMC1A were (36.88±0.21)%, (30.44±0.33)% and (32.88±0.16)%, respectively, without significant difference when compared with those of the miR-23a-3p mimics group (P>0.05). The relative expression levels of Bax and Bcl-2 protein in the negative control group were 0.55±0.45 and 0.31±0.54, respectively. Overexpression of miR-23a-3p inhibited the expression of Bax protein in U937 cells (0.23±0.13, P<0.001), promoted the expression of Bcl-2 protein (0.50±0.23, P<0.01), while SMC1A increased the expression of Bax protein in U937 cells (0.40±0.11, P<0.01), and inhibited the expression of Bcl-2 protein (0.37±0.15). In the negative control group, caspase-3 activity was (25.82±0.89)%. Overexpression of miR-23a-3p inhibited caspase-3 activity in U937 cells (3.64±0.56)%, P<0.01, while up-regulation of SMC1A promoted caspase-3 activity in U937 cells (15.29±0.85)%, P<0.01.@*Conclusion@#miR-23a-3p can inhibit the proliferation and migration and promote apoptosis of human AML cells by targeting SMC1A.

Comparison of clinical efficacy between first-generation and second-generation tyrosine kinase inhibitors based regimen in the treatment of patients with BCR-ABL positive acute lymphoblastic leukemia / 中华血液学杂志

Objective@#To explore the clinical efficacy and prognostic factors of first-generation and second-generation tyrosine kinase inhibitors (TKI) based regimen in the treatment of patients with BCR-ABL positive acute lymphoblastic leukemia (ALL) .@*Methods@#Retrospectively analyze the clinical characteristics and prognostic factors of 89 patients with BCR-ABL positive ALL from April 2012 to June 2018 in our hospital, the clinical efficacy of first-generation and second-generation TKI was compared.@*Results@#60 patients were classified into the first-generation TKI (imatinib) group, and 29 patients were in the second-generation TKI (dasatinib) group. There were no significant differences in gender, age, WBC, hemoglobin concentration, PLT, chromosomal karyotype, the types of fusion genes, allogeneic hematopoietic stem cell transplantation (allo-HSCT) and TKI initiation time between the two groups. The first-generation and second-generation TKI groups, for which the complete remission (CR) rate at the fourth week of induction therapy was 83.3% and 89.7% (P=0.637) , respectively, and the complete molecular remission (CMR) was 48.3%and 58.6% (P=0.363) , respectively, the difference was not statistically significant. The 2-year overall survival (OS) rate of first-generation and second-generation TKI group was 34.9% and 64.0% (χ2=4.743, P=0.029) , the 2-year relapse free survival (RFS) rate was 17.2% and 55.0% (χ2=8.801, P=0.003) , respectively. Multivariate analysis showed that complete molecular remission (HR=0.281, 95%CI 0.151-0.523, P<0.001) was independent favorable prognostic factor for overall survival (OS) , complete molecular remission (HR=0.209, 95%CI 0.112-0.390, P<0.001) and second-generation TKI (HR=0.318, 95%CI 0.158-0.641, P=0.001) were independent favorable prognostic factors for RFS.@*Conclusion@#For TKI-based regimen of BCR-ABL positive ALL, second-generation TKI is superior to first-generation TKI in OS and RFS time.

Treatment of pediatric patients with refractory acute lymphoblastic leukemia with IHDA regimen / 中华实用儿科临床杂志

Objective To observe the efficacy and adverse effect of IHDA [Idarubicin(IDA) + high-dose Cytarabine(HD-Ara-C)] as a remedy regimen in the treatment of pediatric patients with refractory acute lymphoblastic leukemia(ALL).Methods Twelve children with refractory ALL were treated by IHDA regimen as follows:IDA,10 mg/(m2·d),d1-3;Ara-C,1.0g/m2,q12h,d1-3.The children who achieved complete remission(CR)could get into the following sequential regimens or allogeneic hematopoietic stem cell transplantation (allo-HSCT).The same regimen was given to the children who didn't achieve CR when WBC ＞2.0×109/L.The efficacy and hematology or non-hematology adverse effect were evaluated.Results CR/partial remission (PR)/non-remission (NR) were respectively 4/3/5 cases after giving the first regimen,and CR/PR/NR were 5/3/4 cases after giving the second regimen,respectively.The overall remission was 66.7％ (8/12 cases),of which 5 cases(41.7％) achieved CR,3 cases (25.0％) reached PR and 4 cases(33.3％) reached NR.Grade Ⅳ myelosuppression occurred in all patients,but no severe infection and hemorrhage happened after the application of granulocyte colony stimulating factor (G-CSF),platelet transfusion and anti-infection treatment.Some reversible side effects like liver toxicity,myocardial damage and nerve injury were observed in some patients.There was no chemotherapy related mortality in all the patients.Two cases relapsed again followed up to October 2015.One achieved CR after applying chimeric antigen receptor T-cell immunotherapy and was receiving allo-HSCT now.Another was dead after applying FLAG (Prednisone+Fludarabine+Ara-C+G-CSF) save regimen.The time of the other 3 cases achieving CR was 26,10,4 months,respectively.Among the remaining 7 cases,3 cases were forced to receive hematopoietic stem cell transplantation,2 cases abandoned treatment and 2 cases failed to follow up.Conclusions The IHDA regimen is a well-effective and tolerated treatment for pediatric patients with refractory ALL,and could create an opportunity for the application of allo-HSCT.

Anticoagulation intensity with warfarin for patients after heart valve replacement / 中国医师进修杂志

Objective To analyze warfarin anticoagulation therapy for patients after heart valve replacement,and to explore an optimal intensity of warfarin anticoagulation.Methods The administration method,international normalized ratio (INR) monitoring of 265 patients who received warfarin anticoagulation therapy after heart valve replacement were analyzed retrospectively.The patients were divided into three groups according to different valve prostheses:aortic valve replacement (AVR) group (37 cases),mitral valve replacement (MVR) group (165 cases) and double valve replacement (DVR) group (63 cases).Each group was divided into two subgroups according to their INR levels (INR 1.5-2.0,INR 2.1-2.5).The occurrence of bleeding and thromboembolic events in these subgroups were compared.Results A total of 265 cases were visited,and followed up for 4 months to 6 years.The dose of warfarin was 0.625-7.500 (2.5 ± 1.4) mg/d.The incidence of anticoagulation adverse events was 23 cases.The incidence of bleeding events was 6.79％ (18/265),which was higher than that of thromboembolic events (1.89％,5/265),and there was significant difference (P ＜ 0.05).Four cases of the hemiplegia sequelae occurred and 2 cases died.The incidence of bleeing events in patients with INR1.5-2.0 in AVR group,MVR group and DVR group were 0 (0/20),3.57％ (3/84),2.70％ (1/37),in patients with INR 2.1-2.5 were 1/17,11.11％ (9/81),15.38％ (4/26),and there were significant differences (P ＜ 0.05).There were no significant differences in the incidence of thromboembolic events between INR 1.5-2.0 and INR 2.1-2.5 in AVR group,MVR group and DVR group (P ＞ 0.05).Conclusions After heart valve replacement,the anticoagulation therapy with warfarin is effective and safe to maintain the low intensity anticoagulation (INR1.5-2.0).AVR and MVR/DVR may benefit from a treatment strategy with levels ranging from 1.5-1.8 and 1.8-2.0,and the anticoagulation therapy of individuation should be formulated according to different conditions.

The levels of insulin-like growth factors in children with acute leukemia / 临床儿科杂志

Objective To detect the levels of insulin-like growth factors in children with acute leukemia (AL). Methods A total of 50 previously untreated AL patients were selected, meanwhile 30 healthy children were selected as normal controls. AL children were given regular chemotherapy. All cases were not given the brain radiotherapy. The levels of insulin-like growth factor-1 (IGF-1), free insulin-like growth factor-1 (fIGF-1), insulin-like growth factor binding protein 3 (IGFBP-3) in AL patients before treatment and 6 months after complete remission were measured by enzyme-linked immunosorbent assay (ELISA), and were compared with those in normal controls. Results Before treatment, compared with normal controls, the serum levels of IGF-1, IGFBP-3 in AL patients were lower while the level of fIGF-1 was higher, and the differences were signiifcant (P<0.01). At six months after complete remission, the levels of IGF-1 and fIGF-1 in AL patients were similar to those before treatment, but were signiifcantly different from those in control group (P<0.05);the level of IGFBP-3 was signiifcantly higher than that before treatment (P<0.01), but was similar to that in control group. Before treatment, the level of IGFBP-3 in AL patients was positively correlated with the level of IGF-1 (r=0.777, P<0.01), and negatively correlated with the level of fIGF-1 (r=-0.714, P<0.01). Conclusion Insuline-like growth factors were involved in the pathophysiological process in children with AL.

Research and progress of cartilage tissue-engineering vector materials / 中国组织工程研究

With the emergence of tissue engineering techniques, using tissue engineering methods and tools to repair cartilage defects become a new treatment model, while looking for a suitable carrier of chondrocytes is the current focus of the study in cartilage tissue engineering. In this paper, synthetic biodegradable polymers and natural extracellular matrix substitutes (natural polymers) make progress in two areas reviewed.

Expression and Clinical Significance of PCNA, p53 and Bcl-2 Protein in Bone Marrow Cells in Children with Acute Leukemia / 中国医师杂志

Objective To investigate the relationship between the expressions of proliferating cell nuclear antigen (PCNA), p53 and Bcl-2 protein and clinical chemothreapy, prognosis in bone marrow cells in children with acute leukemia (AL). Methods Immunohistochemical SP method was used to detect the expressions of PCNA, p53 and Bcl-2 in specimens of bone marrow puncture of 59 children with AL and 15 healthy children as control. Results There was a significant difference in the expressions of PCNA, p53 and Bcl-2 proteins between the initially treated patients and healthy subjects, and between the remission patients and non remission ones. There was not a significnat difference in PCNA expression between the refractory patients and healthy subjects, and PCNA expression was related to the chemotherapeutic sensitivity. There was a significant difference in the 6-week remission rate between the patients with and without PCNA expression, but there was no significant difference in the over 3 years survival rate without illness. The expression levels of Bcl-2 and p53 were significantly higher in the refractory patients than those in healthy subjects. The patients with the high expression of p53 and Bcl-2 were resistant to chemotherapy, low in the remission rate and poor in prognosis. Conclusion The AL patients with PCNA expression were higher in remission rate, and PCNA expression was not associated with long-term prognosis. The AL patients with the expression of p53 and Bcl-2 were lower in remission rate, and their expression was associated with long-term prognosis. Both p53 and Bcl-2 protein may serve as a molecular marker to predict chemotherapeutic sensitivity and prognosis. PCNA, p53 and Bcl-2 may be involved in the pathogenesis of child AL by various ways. It is more valuable for predicting prognosis to simultaneously detect the expression of PCNA, p53 and Bcl-2 proteins.