Objective To investigate the protective effect of human amniotic mesenchymal stem cells(hAMSCs)on pulmonary microvascular endothelial cell(PMVECs)through observing the effects of prolifer-ation,apoptosis and inflammatory response after PMVECs injury induced by pine sawdust smoke solution.Methods HAMSCs and rat PMVECs were isolated and cultured.The flow cytometry and immunofluores-cence were used to identify hAMSCs and PMVECs respectively.The experimental grouping:control group(normal cultured PMVECs),smoke group(PMVECs injury induced by pine sawdust smoke solution),smoke+hAMSCs group(after PMVECs was injured by smoke solution,hAMSCs and PMVECs were co-cul-tured in Transwell culture system).The proliferative activity of PMVECs after co-culture for 12,24 h was measured by cell counting kit-8(CCK-8),the apoptosis of PMVECs was measured by flow cytometry,and the ex-pression levels of TNF-α and IL-6 were detected by enzyme-linked immunosorbent assay(ELISA).Results hAMSCs and PMVECs were successfully isolated and cultured,and the hAMSCs surface markers CD105(95.4％),CD73(99.8％)and CD90(99.8％)were identified as strongly positive expression,while CD34,CD45,CD14,CD19 and HLA-DR were weakly expressed(1.96％in total).The vascular endothelial cell mark-er CD34 in PMVECs was positively expressed,moreover its combination with aggulutinin BSI was also posi-tive.At the observation time point of 12,24 h co-culture,compared with the Control group,the proliferation activity of PMVECs in the Smoke group was inhibited(P＜0.05),and the cellular apoptosis was increased(P＜0.05),the TNF-α and IL-6 expression levels were up-regulated(P＜0.05);the phenomena of PMVECs proliferation activity inhibition,apoptosis increase and inflammatory factor expression level up-regulation in the Smoke+hAMSCs group were reversed compared with the Smoke group(P＜0.05).Conclusion After PMVECs are injured by smoke solution,hAMSCs could decrease the PMVECs inflammatory factors expres-sion,promote its proliferation activity and inhibit its apoptosis,thus play the protective effect on PMVECs.

Objective:To explore the application value of online and offline interactive teaching combined with three-dimensional quality theory mutual evaluation in the standardized residency training of general practitioners.Methods:Twenty-four general practitioners who were trained in The Second Hospital of Tianjin Medical University from January 2019 to December 2019 were selected as the control group, receiving traditional teaching; another 22 residents who were trained from March 2020 to February 2021 were selected as the observation group, taking online and offline interactive teaching combined with mutual evaluation of three-dimensional quality theory. After the training, the theoretical knowledge, skill operation and case analysis assessment scores, clinical ability and teaching satisfaction were compared between the two groups. SPSS 25.0 software was used for t test and rank sum test. Results:There was no significant difference in the scores of theoretical knowledge assessment, operation skills assessment, and case analysis assessment between the two groups before the training. After the training, the scores of the two groups were all increased, and the observation group had higher scores than the control group ( P<0.05). There was no significant difference in the scores of each dimension in the Direct Observation of Procedural Skills (DOPS) scale between the two groups before training, while after training, the scores of each dimension in the DOPS scale of the two groups were increased ( P<0.05), and the scores in the observation group were higher than those in the control group. The difference of mutual evaluation results after the training between the two groups was statistically significant, and the results of the observation group were higher than those of the control group ( P<0.05). Conclusion:The application of online and offline interactive teaching combined with mutual evaluation of three-dimensional quality theory in the standardized residency training of general practitioners can help improve the theory, skill practice, case analysis assessment performance and clinical ability of residents, and also obtain higher teaching satisfaction.

Objective:To investigate the change and clinical significance of serum alkaline phosphatase (ALP) level in patients with acute spontaneous intracerebral hemorrhage(AICH).Methods:81 patients with AICH admitted to the Neurosurgery Department of Tianjin Third Central Hospital from January 2019 to October 2020 were retrospectively analyzed. 81 patients with non cerebral hemorrhage who came from the health examination center or complained of dizziness and had no hepatobiliary and skeletal diseases were selected as the control group. The clinical data of all the patients were recorded, including gender, age, Glasgow Coma Scale (GCS) score, hemorrhage location, liver function indexes, the history of hypertension, diabetes, heart disease, smoking, drinking, and so on. The differences in clinical data between the two groups were compared. Pearson correlation was used to analyze the correlation between liver function indexes and GCS score. The independent risk factors for AICH were screened by binary logistic regression, and the receiver operating characteristic (ROC) curve was used to evaluate the value of serum ALP in predicting intracerebral hemorrhage.Results:Serum ALP level in AICH group was significantly higher than that in the control group [85.0(70.0, 103.0) U/L vs 65.0(54.5, 71.5)U/L, Z=6.740, P<0.001]. Pearson correlation analysis showed that serum ALP had a negative correlation with GCS score ( r=0.255, P=0.022). Binary logistic regression analysis showed that hypertension ( OR=20.440, 95% CI 8.572-48.737) and ALP ( OR=1.077, 95% CI 1.049-1.105) were risk factors for intracerebral hemorrhage. Serum ALP level was an independent risk factor ( OR=1.069, 95% CI 1.038-1.101) for AICH after adjusting for confounding variables including age, AST, history of hypertension. ROC curve showed that the area under the curve (AUC) of serum ALP in predicting intracerebral hemorrhage was 0.807 (95% CI 0.740-0.873, P<0.001), with sensitivity of 67.9% and specificity of 81.5%. Conclusions:Serum ALP level may be related to the occurrence and severity of AICH. Therefore, serum ALP level can be used as a reference index to evaluate the occurrence, severity of patients with AICH.