Identification of differentially expressed miRNAs and key genes involved in the progression of alcoholic fatty liver disease using rat models

BackgroundAlcoholic fatty liver disease (AFLD) is a liver disease caused by prolonged heavy drinking and has a poor prognosis in the clinic. This study aimed to explore the differential miRNAs expression profiles in the AFLD rat model.MethodsThe rat model of AFLD was established by ethanol intragastric administration and was used to explore the differential miRNAs expression profiles. We further analyzed the potential target mRNAs using the bioinformatics technique. GO and KEGG pathway enrichment analyses were carried out to better understand the biological function of differential expression genes (DEGs). We used the human Gene Expression Omnibus (GEO) dataset GSE28619 to further screen the key differentially expressed genes. The integration between the differentially expressed genes from the AFLD model and GEO was conducted and the key genes were identified.ResultsThe serum ALT, AST, TG, and TC levels in the AFLD model group were significantly higher than those in the normal control group. There are 45 miRNAs with significant changes including 26 upregulated and 19 down-regulated miRNAs. GO and KEGG enrichment showed various metabolic processes and signaling pathways were enriched in the progression of AFLD. After integrating the results of GSE28619 and DEGs, we observed that there are 12 genes with significant changes in two data sets, including PSAT1, TKFC, PTTG1, LCN2, CXCL1, NR4A1, RGS1, VCAN, FOS, CXCL10, ATF3, and CYP1A1.ConclusionAFLD showed differentially expressed miRNAs, which may be involved in the occurrence and progression of AFLD. Meanwhile, some signal metabolic pathways may be related to the pathogenesis of AFLD.     

A randomized controlled trial: Comparison of one-per-mil tumescent technique and tourniquet in surgery for burn hand contracture in creating clear operative field and assessment of functional outcome

BackgroundThis study aims to compare the use of one-per-mil tumescent solution (a mixture of epinephrine and 0.2% lidocaine in a ratio of 1:1,000,000 in normal saline solution) and tourniquet to create clear operative fields and to evaluate the functional outcomes after post burn hand contracture surgery.MethodsThe subjects of this randomized controlled trial were divided into one-permil tumescent technique and tourniquet group for a similar surgical procedure. Three independent assessors evaluated the clarity of the operative fields through recorded videos for the first 15 min and the first 10-minute of each hour of the surgery. Functional outcome was evaluated at least three months postoperatively using total active and passive motion (TAM and TPM) of each digit. Malondialdehyde (MDA) and tumor necrosis factor alpha (TNF-α) were tested during baseline (5 min before the procedures), ischemia phase, and reperfusion phase (a phase when the blood flow returned to the tissue).Results35 subjects were included in this study: 17 in the tumescent group and 18 in the tourniquet group. We found a significant difference in the clarity of operative field between tumescent and tourniquet groups, 5 vs 35 bloodless operative fields, respectively (p < 0.05). TAM and TPM of each digit before surgery and 3 months postoperatively showed no significant difference between both groups (p > 0.05). Furthermore, we found no difference in MDA and TNF-α levels between both groups at their respective phases.ConclusionsThe use of one-per-mil tumescent technique does not replace tourniquet use to create bloodless operative fields in burned hand contracture surgery. However, the postoperative functional results were similar in both groups showing that tumescent technique can be used as an alternative to tourniquet without compromising outcomes. The MDA and TNF-α examinations do not provide conclusive outcomes regarding ischemia and reperfusion injury.     

过伸性颈椎颈髓损伤的手术入路疗效比较

目的探讨过伸性颈椎颈髓损伤后三种手术入路疗效的比较。方法我们对2000年9月～2004年10月间收治的47例过伸性颈椎颈髓损伤并接受手术治疗的患者进行回顾性分析，根据手术方式不同分成三组：前路入路组、后路入路组、前后联合入路组，比较其疗效。结果所有患者经6～12个月随访，比较三组间手术前、后的Frankel的分级变化和ASIA评分改变。三组术后神经功能均较术前有明显改善；前路减压、植骨内固定和前后联合入路减压、植骨内固定均较后路减压、植骨内固定术后神经功能恢复好，两两间差异有显著性意义（P〈0．05）；前后联合入路减压最彻底，但其预后与单纯前路减压内固定差异无显著性意义（P〉0.05）。结论前路减压内固定是过伸性颈椎颈髓损伤首选的手术方式，后路是辅助的手术方法，而前后联合入路应谨慎选用。     

后路寰椎螺钉固定的研究进展

后路寰椎螺钉固定包括寰椎侧块螺钉和寰椎后弓侧块螺钉固定。它们在解剖上是可行的,但需注意椎动脉沟底骨质最薄处的后弓厚度,避免损伤椎动脉及颈内动脉,术前必须常规行寰椎侧位X线及CT扫描帮助确定进钉点及进钉方向。螺钉有较好的拔出力(即使使用单皮质螺钉),并且寰椎侧块螺钉和枢椎关节突间螺钉以及棒连接的结构与经关节螺钉后路钢丝植骨块结构一样稳定。目前较为常用的进钉技术有3种:Harms、Xia、Gupta等的侧块螺钉技术,以及Tan和马向阳等的后弓侧块螺钉技术。临床结果显示:后路寰椎螺钉固定技术能即刻解除脊髓神经压迫、缓解症状,有较好的即刻稳定性,保留枕颈间的运动功能,并且有融合率极高,断钉率、疾病复发以及术后并发症极少等优越性。     

Anaesthesia for abdominal vascular surgery

Abdominal vascular surgery is required for aneurysmal and symptomatic occlusive disease of the aorta. Abdominal aortic aneurysms account for more than 8,500 deaths per year in England and Wales. Most deaths occur as a result of rupture of the abdominal aortic aneurysm, which has an overall mortality of 80%. These deaths are potentially preventable because elective repair of the abdominal aorta can be performed with an operative mortality of less than 7%. This article reviews the current indications and anaesthetic practices for open and endovascular abdominal aortic aneurysm repair.     

临床护理带教教师多层次岗前培训现状与需求分析

目的　调查临床护理带教教师多层次岗前培训的培训现状并分析其培训需求,为进一步完善临床护理带教教师岗前培训的方案设计提供参考。方法　采用横断面调查法,利用自行设计的调查问卷,于2020年4月至2020年6月对采用多层次岗前培训模式的哈尔滨市某三级综合医院的172名临床护理带教教师进行调查,分析其岗前培训的现状与教师的培训需求。通过SPSS 17.0统计软件对所有原始数据进行统计学处理。结果　172名调查对象中,138名（80.2%）教师年龄在35岁以下,133名（77.3%）教师第一学历在本科以下;89名（51.7%）教师明确医院或科室会有计划、有组织地开展岗前培训,10名（5.8%）教师表示医院或科室从未组织过培训,41名（23.8%）教师从未参加过岗前培训,80名（46.5%）教师参加岗前培训的次数为1~3次。院内培训和科内培训的前8项培训内容有5项重复,分别是科室常见病疾病知识、护理程序、沟通技能、医院规章制度、带教方法。培训需求总得分为（154.51±40.35）分,总体需求率为81.3%,处于高等水平;得分率最高的维度是法制和人文素养,得分率为83.0 %;得分率最低的维度是教学管理,得分率为74.9%。培训需求得分率最高的9个条目分别为对学生基本素质（慎独、乐学、敬业品质等）的培养（84.7%）、法律知识（84.4%）、科室常用药物配伍禁忌（84.3%）、护士礼仪（83.3%）、护理风险防范（83.1%）、对学生的教育评价方法（83.1 %）、护患沟通技巧（83.0%）、科室常用药物的用药观察要点（83.0%）、科室常用药物作用（82.9%）。序位前3的培训形式分别为网络学习84名（48.8%）、医院内部有经验的教师讲授74名（43.0%）、经验交流与分享讨论会72名（41.9%）。结论　该院临床护理带教教师队伍人才结构相对年轻,第一学历偏低,应大力加强临床护理带教教师岗前培训工作;岗前培训开展的知晓率与参与度均一般,应加强各渠道培训信息的发布,提高培训活动的知晓率,明确参与岗前培训活动的鼓励或奖励措施,提高培训活动的参与度;各层次岗前培训内容存在重复,且与临床护理带教教师的培训需求存在差距,建议各教学医院结合自身培训对象的培训需求,采用线上线下混合的培训模式,合理统筹各层次的培训内容,避免培训内容重复,避免师资浪费,并可适时组织带教教师开展经验交流分享会。     

Car-R/Ceph-S的铜绿假单胞菌OprD基因突变分析

  目的  研究对碳青霉烯类耐药而对头孢菌素敏感（carbapenem-resistant but cephalosporin-susceptible ,Car-R/Ceph-S）的铜绿假单胞菌（Pseudomonas aeruginosa）中OprD基因的突变类型。  方法   对2021年1月至2021年3月昆明医科大学第一附属医院临床分离的10株对碳青霉烯类耐药而对头孢菌素敏感的铜绿假单胞菌进行分离培养;使用聚合酶链式反应（polymerase chain reaction,PCR）检测该表型铜绿假单胞菌中OprD基因的携带情况,并测序分析OprD基因的突变类型。  结果   10株菌株均显示出明显的OprD扩增条带,测序分析显示有以下突变类型,分别是移码突变2株、氨基酸替代突变8株、提前终止密码子2株、大片段缺失4株。  结论   对碳青霉烯类耐药而对头孢菌素敏感（Car-R/Ceph-S）的铜绿假单胞菌中OprD基因的突变类型呈多样化,点突变频率最高,还有大片段的缺失以及提前终止密码子。这些突变导致OprD结构发生改变,从而使得耐药现象的发生。