摘要:The review presents the epidemiology of leishmaniasis in the Eastern Africa region. We searched PUB MED and MEDLINE with several key words-namely,“leishmaniasis”;“cutaneous”,“diffuse cutaneous”,“mucosal”, and“visceral leishmaniasis”; “kala azar”and “post kala azar dermal leishmaniasis”-for recent clinical and basic science articles related to leishmaniasis in countries in the Eastern Africa region. Poverty, wars, conflicts and migration have significantly aggravated leishmaniases in Eastern Africa. Of particular concern is the increasing incidence of Leishmania-HIV co-infection in Ethiopia where 20~40% of the persons affected by visceral leishmaniasis are HIV-co-infected. Sudan has the highest prevalence rate of post kala-azar dermal leishmaniasis(PKDL) in the world, a skin complication of visceral leishmaniasis(VL) that mainly afflicts children below age ten. In view of its spread to previously non-endemic areas and an increase in imported cases, leishmaniasis in Eastern Africa should be considered a health emergency.

摘要:Biliary complications(BC) are a major cause of morbidity in liver transplant recipients with an incidence of 10~30% following orthotopic liver transplantation(OLT), and a mortality rate of up to 10%. The most common biliary complications are bile leaks, biliary strictures, ampullary dysfunction, and stones. Leaks predominate in the early posttransplant period; while stricture formation typically develops gradually over time. Risk factors for biliary complications comprise technical failure, T-tube-related complications, hepatic artery thrombosis, bleeding, ischemia/reperfusion injury, primary diseases, and other immunological, non-immunological, and infectious complications. Cholangiography, such as endoscopic retrograde cholangiopancreatography(ERCP) or percutaneous transhepatic cholangiogram(PTC), is considered the gold standard for identifying post-transplant BC. The management of biliary complications after OLT requires a multidisciplinary approach, in which interventional radiology and endoscopic techniques are emerging as the preferred treatment option, but in a selected majority of patients, surgery is still necessary.

摘要:我国新医改方案经过四个多月的公开征求意见和修订,已对外公布-这是一项涉及面广-难度大-争议多的重大改革-而在诸多难点中,最主要体现在两个方面,一是公立医院改革难;二是基本药物制度改革难-文章试图从改革国家补偿机制-医师制度-转变政府职能和创新定价机制等几个方面来探讨如何有差别地逐步推进医疗体制改革-

摘要:新医改方案出台,明确了改革的指导思想-基本原则-总体目标和近期要抓好的重点工作,不仅利国-利民,而且有利于卫生事业发展-但是,医改新政再好,如不狠抓落实,就会失去一次卫生大发展的机遇-

摘要:Objective:To investigate the association between the X-ray repair cross complementing(XRCC) group 5, XRCC6 and XRCC7 polymorphisms and risk of acute myeloid leukemia(AML). Methods:This hospital-based case-control study included 120 AML patients and 210 cancer-free controls in a Chinese population. Three polymorphisms of XRCC5, XRCC6 and XRCC7 were genotyped using the polymerase chain reaction(PCR) or polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP) method. Results: We found that there was a significant decrease in risk of AML associated with the XRCC6 -61 CG/GG genotype(adjusted odd ratio(OR) = 0.55; 95% confident interval(CI) = 0.34-0.89) compared with the -61CC genotype. For the novel tandem repeat polymorphism (VNTR) in the XRCC5 promoter, we found when the XRCC5 six genotypes were dichotomized(i.e., 2R/2R, 2R/1R versus 2R/0R, 1R/1R, 1R/0R and 0R/0R), the latter group was associated with increased risk of AML(adjusted OR = 1.67; 95% CI = 1.00~2.79) compared to 2R/2R+2R/1R genotype. However, the XRCC7 6721G>T polymorphism had no effect on risk of AML. Conclusion:The XRCC6 -61C > G and XRCC5 2R/1R/0R polymorphisms, but not XRCC7 6721G > T polymorphism, could play an important role in the development of AML. Larger scale studies with more detailed data on environment exposure are needed to verify these findings.

摘要:健康权是人权的一个重要组成部分,政府必须承担起保障的责任-作为国家主体医疗卫生事业,从其固有的特性及担负的社会重任出发,应当毫不动摇地坚持其“公益性福利事业”的根本属性,通过强有力的政府行为促进自身的发展与改革,坚定恪守非市场化原则,始终把社会效益放在首位,国家必须着手建立民众基本医疗卫生服务的免费享受制度,公立非营利性医疗卫生服务机构定位为行政主体,其从业人员为国家公职人员-公立非营利性医疗卫生服务机构在法定服务领域形成的医患关系的法律属性明确定位为行政法律关系,其侵权损害赔偿适用国家赔偿法-重构和改造基本医疗保障制度,诸险合一-建立统一全民医保体系

摘要:如何解决中国老百姓“看病难”-“看病贵”的问题,早已引起全国人民和中央政府的高度关注-新的医改方案已经出台,能否解决“看病难”-“看病贵”的问题面临考验-

摘要:Objective:To investigate the relation between hepatitis B virus(HBV) genotypes and the double mutation of A-to-T nucleotide(nt) 1762 and G-to-A nt 1764 in basic core promoter(BCP T1762/A1764) in patients of the Li nationality. Methods:Subjects were 125 HBV DNA positive patients that belong to the Li nationality on Hainan Island. HBV DNA genotype was determined by real time fluorimetry polymerase chain reaction. BCP T1762/A1764 mutation was performed using the direct sequencing method. Results:The prevalence rates of genotype B, genotype C, genotype D, genotype C and D mixed infection(genotype C＋D) and genotype B and D mixed infection (genotype B＋C) were 31.20%, 53.60%, 12.00%, 2.40% and 0.80% respectively. Mutation frequencies in patients infected with HBV genotype C(58.21%) were significantly higher than in those infected with other genotypes (P ＜0.01). The serum viral load of the patients with genotype C(5.74±1.21) was also higher than that of those with genotype B(P ＜0.01). Conclusion:The major genotypes in the Li nationality were genotype C and genotype B. The infection of genotype D and mixed infection also occurred in the Li nationality. Genotype C HBV has a higher replication rate, and the different degrees of pathogenecity among HBV genotypes may be related to BCP T1762/A1764 mutation frequency.

摘要:自20世纪80年代,艾滋病在全球流行开来-在防治艾滋病的过程中,无论何种政治-经济和文化体系的国家都有责任去保护艾滋病患者人权和自由-保障艾滋病患者人权既是我国宪法中保障公民人权之所必须,也是我国承担的国际公约义务-二十多年的实践证明,歧视或遗弃艾滋病患者不仅不能解决艾滋病问题,反而会把问题弄得更糟-只有保障其生存权,使其免受歧视,保障其就业及受教育等基本人权才是明智之举-

摘要:Objective:To identify the in vitro effects of sodium hyaluronate(HA) on the proliferation and the apoptosis of chondrocytes from patients with Kashin-Beck disease(KBD) and osteoarthritis(OA). Methods:Samples of articular cartilages from KBD and OA patients, as well as healthy volunteers(6 subjects in each of the 3 groups) were dissected, digested with collagenase and the cells cultured in monolayers. Chondrocytes from each sample were assigned to an untreated group and two HA-treated groups: H0(no HA), H100(HA, 0.1 g/L) and H500(HA, 0.5 g/L). The first passage chondrocytes were used to observe proliferation using the MTT assay, and apoptosis by flow cytometry through Annexin V/PI staining. Results:HA promoted proliferation of chondrocytes in all the three groups, and in KBD and OA groups, for cells cultured for 4 and 6 days, H500 significantly promoted the cell proliferation. The apoptotic rates of both KBD and OA group chondrocytes were in the order H500 < HA100 < H0. Conclusion:Sodium hyaluronate administration has a dose-dependent in vitro effect to promote proliferation and inhibit apoptosis of chondrocytes from patients with KBD and OA.

摘要:

摘要:Objective:The role of methylseleninic acid (MSeA), a selenium compound, has been documented in cancer chemoprevention. However, the therapeutic effect of MSeA in combination with paclitaxel, a chemotherapeutic agent used to treat ovarian cancer, is unknown. In this study, we investigated the effect of combination treatment of MSeA and paclitaxel against ovarian cancer cells. Methods:Ovarian cancer cells(A2780) were treated with different concentrations of MSeA, paclitaxel alone or in combination. The individual and combined concentrations of drugs that achieved certain cells growth/death were determined using a sulforhodamine B(SRB) assay. Drug effects on cell viability were further confirmed using floating cell count and trypan blue exclusion assay. The mean values±standard deviation were calculated and compared between treatment groups using unpaired t test. Results: The concentration of paclitaxel alone that inhibited 50% of cell growth(IC50) was 0.5μmol/L. This concentration increased to 1.2μmol/L when paclitaxel was given in sequential combination with MSeA. The number of dead cells after the combination treatment did not show a significance increase when compared with drug alone. Conclusion:Pretreatment with MSeA did not enhance the paclitaxel effect against A2780 ovarian cancer cells.

摘要:汶川地震时隔一年,不能忘却的有许多,最值得纪念和传承的是汶川抗震救灾伟大精神-这一精神是由无数可歌可泣的人和事所铸就,彰显了社会主义核心价值体系的现实要求,体现了现实社会和新时代的崇高追求,这一精神作为推进科学发展,构建和谐社会的内在灵魂,值得深入发掘和发扬光大-

摘要:解放思想不仅是探索客观真理的过程,同时也是实践主体价值实现的过程-改革开放以来,中国共产党人坚持解放思想,中国社会主义既冲破了传统社会主义的束缚,实现了生产力和经济社会的巨大进步,同时又使这种进步成为巩固和发展社会主义制度的保证-面对新形势新任务,中国共产党人只有自觉地将解放思想真理尺度和价值尺度结合起来,才能完成历史赋予的任务-

摘要:Objective:To investigate the effect of the gap junction blocker 1-heptanol on the in vitro chondrogenic differentiation of mouse bone marrow mesenchymal stem cells(MSCs) following induction by GDF-5. Methods:MSCs were isolated from mouse bone marrow and cultured in vitro. After 3 passages cells were induced to undergo chondrogenic differentiation with recombinant human GDF-5(100 ng/ml), with or without 1-heptanol(2.5μmol/L). The effect of 1-heptanol on MSCs proliferation was investigated using the MTT assay. TypeⅡ collagen mRNA and protein were examined by RT-PCR and immunocytochemistry respectively, and the sulfate glycosaminoglycan was assessed by Alcian blue dye staining. Connexin43(Cx43) protein was examined by western blotting. Results:GDF-5 induced proliferation and chondrogenic differentiation of MSCs. While 1-heptanol treatment had no effect on this proliferation, it inhibited the expression of both typeⅡ collagen mRNA and protein. The Alcian blue staining revealed that 1-heptanol also inhibited the deposition of the typical cartilage extracellular matrix promoted by recombinant GDF-5. Western blotting demonstrated that 1-heptanol had no effect on the expression of Cx43. Conclusion:These results suggest that mouse bone marrow MSCs can be differentiated into a chondrogenic phenotype by GDF-5 administration in vitro. While the gap junction blocker, 1-heptanol, did not reduce gap junction Cx43, these intercellular communication pathways clearly played an important functional role in GDF-5-induced cartilage differentiation.

摘要:介绍了预防医学教育的教学质量评价中的随机过程模型的基本原理,基于预防医学学科的教学过程带有诸多随机因素的特点,运用随机过程中的马尔可夫链建立相应的动态模型进行教学质量评价和分析-通过两所医学院校预防医学专业的《流行病学》与《医学统计学》教学质量评价的比较检验,证明了将随机过程模型应用到预防医学学科教学质量评价中的科学性和可行性-最后总结了预防医学教学质量评价中的诸多问题并提出了对本方法进行改进的思路-

摘要:Objective:To record Calcium, Potassium and Sodium currents in acutely isolated hippocampal pyramidal neurons. Methods:Hip-pocampal CA3 neurons were freshly isolated by 1 mg protease /3 ml SES and mechanical trituration with polished pipettes of progressively smaller tip diameters. Patch clamp technique in whole-cell mode was employed to record voltage-gated channel currents. Results:The procedure dissociated hippocampal neurons, preserving apical dendrites and several basal dendrites, without impairing the electrical characteristics of the neurons. Whole-cell patch clamp configuration was successfully used to record voltage-gated Ca2+ currents, delayed rectifier K+ current and voltage-gated Na+ currents. Conclusion:Protease combined with mechanical trituration may be used for the dissociation of neurons from rat hippocampus. Voltage-gated channels currents could be recorded using a patch clamp technique.

摘要:在省级公共卫生信息系统建设的总体框架要求下,依据《职业病防治法》及相关规范-标准,基于j2ee开发环境,采用oracal数据库-b/s多层体系架构的应用平台,并与采用delphi 7.0开发工具-c/s多层体系架构专项信息系统相整合,采用虚拟专网(vpn)的隧道技术-认证技术和加密技术等网络安全技术,构建了适合地级市各级卫生部门-安全生产监督管理部门-工会和用人单位等职业病防治工作需要的信息网络管理平台-通过试点应用,实现了不同职业病防治管理与服务机构-用人单位之间的信息共享-沟通与合作,实现了对职业病危害企业的分级分类管理模式,辅助各机构建立了完善的职业病防治档案,规范和提高各项职业病防治工作的质量,促进了地区职业病防治综合管理与服务的程序化-规范化-信息化和现代化进程-

摘要:Objective:To investigate the effects of siRNA of ADAM17 gene and genistein on apoptosis and the inhibition of proliferation in HepG2 cells in an attempt to seek an effective therapy for hepatocellular carinoma. Methods:Cells were divided into control groups and experimental groups and siRNA was used to silence the ADAM17 gene, alone and in combination with genistein. Cells were harvested at several time periods and assessed for proliferation and apoptosis. Proliferation was assayed by MTT at 24, 48, 72 and 96 hours following treatment and apoptosis was assessed by flow cytometric analysis at 48 hours. Results:In siRNA groups, proliferation of cells was significantly inhibited compared to the control groups at 24, 48 and 72 hours(P < 0.05), and apoptosis was significantly increased at 48 hours(P < 0.01); In genistein groups, proliferation was inhibited at 24, 48, 72 and 96 hours, and the apoptosis ratio was significantly increased at 48 hours(P < 0.01); while in the groups that received the combination of siRNA transfection and genistein treatment, there was a further significant decrease of proliferation and increase in apoptosis compared with either treatment alone. Conclusion:The ADAM17 gene could be an effective target, and genistein could be a useful agent, in the treatment of hepatocellular carcinoma. siRNA of ADAM17 gene and genistein both inhibited HepG2 cells proliferation and promoted apoptosis, and further, the combination of these treatments had a greater effect than either treatment alone.

摘要:目的:评估危重病人比重的引入对综合评估的影响-方法:采用主成分分析法,对医疗质量指标-效率指标和效益指标进行综合评估-结果:危重病人比重对传统主成分分析的结果产生影响-结论:在不同医院之间-同一医院不同时期的质量评估引入危重病人比重具有一定意义-

摘要:Objective:To investigate the silencing effects of recombinant adenovirus Ad-shRNA-MK on midkine(MK) gene in pancreatic cancer cells. Methods:Ad-shRNA-MK was used to infect pancreatic cancer BxPC-3 cells. Assays were conducted for knockdown of the MK gene on the day of infection and on the 1st, 3rd, 5th, 7th, and 9th days post-infection by using immunocytochemistry, real-time RT-PCR, and Western blot analysis. Results:The adenoviral Ad-shRNA-PTN was constructed successfully, and infection was confirmed by electron microscopic observation. By using real-time RT-PCR, the inhibition rates of MK mRNA expression in the BxPC-3 cells were 20%, 80%, 55%, and 23% on the 1st, 3rd, 5th, and 7th days post-infection. Immunocytochemistry and Western blot analysis confirmed this effect at the gene product level. Conclusion:Efficient and specific knockdown of MK in pancreatic cancer cells by adenoviral Ad-shRNA-PTN is a potentially powerful tool for the study of gene therapy of pancreatic cancer nerve infiltration.

摘要:目的:了解民营乡镇医院卫生人力资源发展情况及其影响-方法:以整群抽样的方式,调查了南通市3个县(市)所有改制乡镇卫生院-结果:民营乡镇医院卫生技术人员数量不足,专业素质提高缓慢,卫生人才队伍不稳定-结论:民营乡镇医院卫生人力资源发展落后,影响农村基本医疗卫生保障;乡镇卫生技术人员素质亟待提高;强化农村卫生的政府责任,保障农村居民公平享有基本医疗卫生服务-

摘要:Objective:To investigate the effect of hepatic ischemia-reperfusion(I/R) on bile canalicular F-actin microfilaments in rats. Methods:A rat model of hepatic ischemia-reperfusion was employed and the ischemia time was 35 min. The activity of serum alanine aminotransferase(ALT), aspartate aminotransferase(AST),γ-glutamyl transferase(GGT) and the level of total bilirubin(TBIL) were measured. Changes in the bile canaliculi were observed by transmission electron microscope. The modification of F-actin microfilaments was quantified by using FITC-Phalloidin and analyzed by confocal laser scanning microscopy imaging. Results:Modifications of F-actin staining were consistent with the observations made by transmission electron microscopy. The staining of F-actin was normal in hepatocytes before reperfusion but decreased significantly after reperfusion, and there was a marked loss of canalicular microvilli after reperfusion, which coincided with abnormal serum GGT and TBIL levels. Conclusion:Reperfusion, not short-term ischemia, induced a disruption of F-actin microfilaments and a loss of microvilli. These modifications could lead to the impaired bile secretion by damaging canalicular contraction, and could be the main mechanisms of cholestasis after hepatic ischemia-reperfusion in rats.

摘要:探讨药物经济学在现代医院药事管理中现状与实际应用,实现药物经济学与医院药事管理的有机结合,应用决策树方法制定标准化诊疗规范,编制医院基本用药目录及标准处方集,对临床医生实行教育性行为监督,目的在于有效控制药物成本-降低医疗费用,使医院用药规范-合理-经济,减轻患者及社会负担-

摘要:目的:研究氧化锌(ZnO)纳米颗粒对雌性小鼠的在体毒性作用,着重观察其对雌性小鼠生殖系统的影响-方法:成年雌性小鼠隔日腹腔注射ZnO纳米(200-500 mg/kg),对照组注射等体积生理盐水,共给药5次-停药1周后,测量各重要脏器的脏器系数,血清生化指标-雌二醇和孕激素的水平,主要脏器作病理切片和HE染色-结果:与对照组相比,给药ZnO纳米(200 mg/kg-500 mg/kg)的小鼠,肝脏-肾脏和卵巢的脏器系数均显著增加,200 mg/kg组的心脏脏器系数显著增加(P均 < 0.05);给药200 mg/kg和500 mg/kg组小鼠血生化指标中,尿酸(UA)显示增高,且有统计学意义(P < 0.05),提示在200~500 mg/kg ZnO纳米作用下肾功能有异常;此外,给药200 mg/kg和500 mg/kg组小鼠的乳酸脱氢酶(LDH)增高明显,提示心肌也有轻度的损伤-给药200 mg小鼠的雌二醇-孕酮水平没有统计学差异(P > 0.05),生殖系统脏器组织病理也未发现明显异常-结论:200~500 mg/kg ZnO纳米对雌性小鼠肝-肾和心功能有轻度影响,对小鼠的雌孕激素的分泌及卵巢组织无明显影响-因此,200~500 mg/kg ZnO纳米对小剂量ZnO纳米有一定的毒性,而对雌性小鼠生殖系统功能是安全的-

摘要:健康权是公民的一项基本人权,国家对乡村医生培训有利于实现-保护公民的健康权-本文从健康权的国家义务角度探析乡村医生培训的理论依据,得出如下结论:乡村医生培训是法律赋予乡村医生的权利和义务,是卫生法保护公民健康原则的体现,符合生命伦理学对医生职业规范的要求,是我国现阶段卫生工作方针和现代医学模式对医学教育影响的必然结果-

摘要:Objective:To explore the antibacterial effect of Chinese crude drugs against clinical strains of Ureaplasma urealyticum(UU), including eight pure herbs and three compound herbs, and determine their minimal inhibitory concentrations(MICs). Methods:Isolates were collected from clinical patients with UU infection, and cultured in UU broth. In order to test the different effects on clinical strains of UU, the assays were performed by microdilution inhibition tests, and MICs of the herbs against the clinical strains of UU were calculated. Results:The MICs of eight pure herbs against clinical strains of UU were as follows: Galla Chinensis:0.313~1.25 g/L; Fructus Forsythiae: 1.25~5.00 g/L; Cortex Phellodendri:1.25~5.00 g/L; Radix Paeoniae Rubra:1.25~2.50 g/L; Semen Plantaginis:2.50~10.00 g/L; Herba Lysimachiae: 5.00~20.00 g/L; Rhizoma Coptidis: 5.00~20.00g/L, Herba Houttuyniae: 10.00~20.00 g/L. The MICs of compound herbs were: Liuheji: 0.625~2.50 g/L; Bazhengsan: 5.00~20.00 g/L; Wulinsan:2.50~20.0 g/L.Conclusion:Galla Chinensis, Fructus Forsythiae, Cortex Phellodendrim, Radix Paeoniae Rubra, and Semen Plantaginis, exerted the stronger antibacterial effect against clinical strains of UU, whereas Herba Lysimachiae, Rhizoma Coptidis and Herba Houttuyniae, had relatively weaker activity against UU. Compound herbs, Bazhengsan and Wulinsan, and particularly Liuheji, also had antibacterial effects against UU. Further studies of the effects and mechanisms of action of Chinese crude drugs against UU infections are worthwhile.

摘要:以照护为主的思想在东西方国家里有悠久的历史,现代意义的临终关怀起源欧洲-由于传统文化-伦理观念等因素影响,临终关怀在我国本土化发展过程中,陷入了伦理困境-文章从探讨临终关怀的源起-发展以及内涵开始,对临终关怀本土化的伦理困境做出分析,从宏观-微观层面建构临终关怀伦理,以解决临终关怀本土化的伦理困境,促进临终关怀本土化-

摘要:A 67-year-old woman with chronic cholecystitis was scheduled to have laparoscopic cholecystectomy under general anesthesia. About 5~10 min after the CO2 intraperitoneal insufflation, the peak airway pressure gradually increased from 15 cmH2O to 27 cmH2O, the end-tidal CO2(EtCO2) from 32 mmHg to 56 mmHg. The SpO2 decreased from 100% to 96%, and blood pressure from 135/80 mmHg to 80/52 mmHg. A right side tension pneumothorax was confirmed and a drainage tube was placed in the right pleural cavity. As the continuous gas leakage from the drainage tube was noted, even as ventilation was withheld, the diaphragm was carefully examined and a porous diaphragm was found. These defects were then patched with biomedical materials. The operation was finished uneventfully. It was concluded that in a patient with a tension pneumothorax during laparoscopic surgery, a diaphragm defect should be taken into consideration.

摘要:目的:研究东亚钳蝎毒素Bukatoxin对大鼠背根神经节(dorsal root ganglion,DRG)神经元河豚毒素不敏感型(tetrodotoxin- resistant,TTX-R)钠离子通道电流(INa)的影响-方法:在急性分离的大鼠DRG神经元上,应用全细胞膜片钳技术,观察Bukatoxin对DRG神经元TTX-R INa的影响-结果:Bukatoxin浓度依赖性地抑制TTX-R INa-在刺激电压为-10 mV时,20-40-80 μg/ml的Bukatoxin对TTX-R INa峰值的抑制率分别为(18.72 ± 1.27)%-(27.40 ± 4.97)%和(59.02 ± 4.71)%-半数抑制浓度(IC50)为66.28 μg/ml,Hill系数(h)为1.48;80 μg/ml 的Bukatoxin可以使TTX-R INa激活曲线向去极化方向移动约3 mV,稳态失活曲线向超极化方向移动6 mV-结论:Bukatoxin可以浓度依赖性的抑制DRG神经元上TTX-R INa,并改变TTX-R INa的激活和稳态失活特性,这可能是其降低外周伤害性信息传入,参与伤害性信息调制的机制之一-

摘要:从会议记录员应加强文字语言能力修养着手,认为会议记录员的文字语言能力包括基础性和提升性两个方面,基础性是需要具备基本的文字语言能力,是做好一份会议记录需要具备的基本文字语言素质,而提升性是在文字组织方面,对会议记录的可读性方面进行提升-本文综合医院工作的特性试图对这两方面能力的培养途径进行探讨-

摘要:校训是一所大学独特精神的体现-“博学至精,明德至善”作为南京医科大学的校训,其本身有着温柔敦厚的文化内涵和乐观崇高的道德审美-在校训精神的指引下,南京医科大学注重医学与人文的融通,培养至精至善的精诚大医-

摘要:目的:检测1例凝血因子Ⅹ(FⅩ)缺陷患者的基因突变-方法:用活化部分凝血活酶时间(APTT)-凝血酶原时间(PT)及FⅩ促凝活性(FX:C)等测定进行表型诊断;用PCR法对其F10基因8个外显子及其侧翼序列和5′端非翻译区(5′UTR) 序列进行扩增,PCR产物纯化后直接测序,检测其基因突变-突变位点经限制性内切酶分析排除多态性-结果:患者APTT 100.0 s-PT 46.6 s-FX:C 2.4%-位于F10基因Exon2内杂合性G8394A错义突变导致Gla(GAG)26Lys(AAG);位于Exon8内的杂合性T28262C错义突变导致Ser(UCC)425Pro(CCC)-限制性内切酶分析排除Ser425Pro为多态性-结论:复合杂合性错义突变Gla26Lys和Ser425Pro可能是导致该例患者FⅩ缺陷症的原因-这是2个新的导致FX缺陷症的F10基因突变-

摘要:目的:探讨Atf3在大鼠妊娠期胰岛β细胞中的表达及其对体外催乳素作用下INS-1细胞增殖的影响-方法:运用RT-PCR,Real-time PCR和Western blotting检测大鼠妊娠期Atf3 mRNA及蛋白的表达;MTT法测定不同浓度催乳素作用下INS-1细胞的增殖情况;RT-PCR检测催乳素作用不同时间后INS-1细胞Atf3 mRNA的表达;Western blotting检测相应蛋白表达-结果:与正常未孕组相比,孕10.5天组Atf3 mRNA表达明显增强,孕14.5天时降至正常未孕组水平-Atf3蛋白在孕期表达亦呈一过性增强,于孕10.5天达高峰-体外不同浓度催乳素(50~1 000 ng/ml)作用24 h后,INS-1细胞增殖显著增加,且呈浓度依赖性-200 ng/ml催乳素作用3 h,Atf3 mRNA表达开始增加,6 h达高峰,其后又复降低;蛋白表达则从6 h开始上调,12 h显著增加,一直持续至24 h-结论:转录因子Atf3在大鼠妊娠期表达一过性增强,且时相上早于胰岛增殖的高峰(孕14.5天),提示它可能与胰岛再生相关-另外,催乳素可促进INS-1细胞增殖,并伴随Atf3表达的相应增加,提示Atf3在催乳素介导的细胞增殖效应中发挥重要作用,且于早期即启动-

摘要:中国高等医学教育正在借鉴国际标准,建立自己的《中国本科医学教育标准》和《中国本科医学教育认证办法》,实施人才培养模式改革,实现与国际医学教育的接轨-而要实现人才培养模式的改革就必须从课程体系-教学方法和实践环节等方面进行综合改革,不断增强学生的实践能力和创新精神-

摘要:当前,我国高校的人才培养模式还存在着与社会需求不相适应的问题,人才培养的针对性不强-为此,高校要以就业为导向,积极探索人才培养方案的改革,以提高高校毕业生的就业能力-

摘要:目的:研究大黄酸(rhein,Rh)对人前体脂肪细胞增殖与分化的影响,并进一步探讨其作用机制-方法:采用噻唑蓝(MTT)比色法测定RH对人前体脂肪细胞增殖的影响;通过形态学观察脂肪细胞的分化程度及形态学变化;并用油红O染色法,检测脂肪细胞内甘油三酯积聚量的变化;应用RT-PCR检测RH干预后分化抑制基因CHOP mRNA的表达-结果:各浓度组RH(0.1-1-2.5-5-10 ug/ml)抑制人前体脂肪细胞增殖,作用呈剂量依赖性;RH对脂肪细胞分化的抑制作用亦呈剂量依赖性;1 ug/ml的RH使CHOP mRNA表达增加-结论:RH可抑制人前体脂肪细胞增殖与分化,该作用可能与CHOP表达上调有关-

摘要:建立教师质量保障体系,完善教师资格制度,全面提高教师素质是保证教育质量的必由之路-本文分析了我国现阶段的教师资格制度,指出我国的教师资格制度未能充分考虑普通高等医学院校学科及专业特点,使医学院校部分临床带教人员教师资格认定困难,结合医学院校临床教学基地建设,就医学院校临床带教人员在申请高校教师资格认定过程中面临的问题进行了分析并提出相应对策-

摘要:对于医学院校而言,《思想道德修养与法律基础》既是政治理论课的重要组成部分,也应当是医学人文教育体系的基础平台-一方面,在现有改革内容的基础之上,思想-道德-法律三大部分适当融入医学人文思想-医学道德-医学法学等医学人文学的相关内容,另一方面,应采用灵活多样的教学方法,课内教学与课外教学相结合,隐性课程与显性课程相融通,促进医学人文教育在医学院校教育过程中得到体系化的贯彻-

摘要:目的:探讨胃动素对膈下迷走神经传入自发放电和扩胃诱发放电的影响及其相应的机制-方法:实验在SD大鼠身上进行,记录膈下迷走神经传入自发和扩胃诱发的放电变化,静脉注射不同剂量胃动素,以及先用昂丹司琼-阿托品处理再给胃动素观察其变化-结果:小剂量胃动素(1 μg/kg)自发和诱发均无无显著变化;中剂量(5 μg/kg)和大剂量(40 μg/kg)胃动素注射后,自发放电和诱发放电均显著增加;昂丹司琼能够完全阻断大剂量的作用;阿托品对大剂量胃动素作用有改变,但无统计学意义-昂丹司琼能够单独阻断迷走传入神经放电,阿托品对迷走传入放电有抑制作用,前者有统计意义而后者无-结论:胃动素引起迷走传入自发和诱发放电增加,迷走传入神经参与了胃动素对胃肠感觉影响后的传递,而5-HT3受体也可能与这种传递有关-

摘要:双语教学在我国由来已久,使双语教学“形神兼备”-体现其独特优势却是一个极大的挑战-神经生物学是一门新兴学科,合理科学地应用双语教学对于完善和发展神经生物学的本科教学十分必要,需要从教师队伍建设-专业教材选用和教学方法改革等几方面同时着手,在推动双语教学开展的同时确保神经生物学的本科教学质量-

摘要:探讨中医术语翻译的现状和存在问题,针对目前中医术语翻译缺乏规范性和标准的现象,分析严复的翻译理论“信-达-雅”的具体含义,进而提出和分析严复的“信-达-雅”翻译标准用于指导中医术语翻译的可行性-

摘要:目的:研究PPAR-γ增殖物激动剂(罗格列酮)对ANP及合并肺损伤大鼠是否有保护作用-方法:50只健康雄性SD大鼠随机分为5组,正常对照组-假手术组-ANP组-罗格列酮预防组,罗格列酮治疗组-正常对照组,未做任何处理;假手术组,腹腔内注射同等剂量生理盐水;采用大剂量精氨酸腹腔注射诱导ANP模型,预防组于造模前60 min给予罗格列酮 10 mg/kg,2次,每次间隔30 min,治疗组于造模后60 min给予罗格列酮 10 mg/kg,2次,每次间隔30 min-各组于造模后24 h处死大鼠,观察大鼠血清AMY-TNF-α和IL-1β水平变化,同时检测胰腺和肺的组织病理变化和肺组织髓过氧化物酶(MPO)的变化-结果:ANP组AMY-TNF-α-IL-1β和MPO均较对照组和假手术组明显升高(P < 0.001);罗格列酮预防和治疗组血清AMY-TNF-α-IL-1β-肺组织中MPO水平较ANP组明显下降,且胰腺和肺的病理损伤也明显减轻(P < 0.001)-结论:罗格列酮能明显降低ANP的炎症,能明显减少TNF-α-IL-1β的产生,能降低肺组织中MPO含量,对ANP及合并的肺损伤具有保护和治疗作用-

摘要:目的:运用RNAi技术下调平衡型核苷转运蛋白1(hENT1)的表达,观察hENT1下调后5-氟尿嘧啶(5-FU)对胰腺癌Panc-1细胞周期阻滞作用的改变情况-方法:设计并构建能表达特异性针对hENT1的shRNA的重组质粒pSilence-hENT1 4.1-CMV neo,用脂质体Lipofectamin 2000将重组质粒转染胰腺癌Panc-1细胞,并以含G418(600 -滋g/ml)的培养液筛选阳性转染细胞(pSilence-hENT1 Panc-1)-RT-PCR检测下调hENT1 mRNA表达的效果及稳定性-用流式细胞仪检测hENT1下调前后Panc-1细胞在相同浓度5-FU(20 μmol/L)中24 h后的细胞周期-结果:测序显示重组质粒pSilence-hENT1 4.1-CMV neo中插入片段序列正确-RT-PCR结果显示pSilence-hENT1 Panc-1细胞hENT1 mRNA表达水平下调,并在2个月内(共传代15次)保持相对稳定-细胞周期检测结果显示在相同浓度5-FU的作用下,hENT1下调组胰腺癌细胞的G0/G1期百分比为未下调组的1.20倍(P < 0.01),S期百分比则是未下调组的66.76%(P < 0.01)-结论:抑制hENT1的表达可以增强5-FU对胰腺癌细胞的G0/G1期阻滞作用,从而可提高其抗癌效果-

摘要:目的:观察脂多糖(LPS)对γ-丁内酯(GBL)诱导大鼠失神发作皮层脑电图棘慢波(SWDs)的影响,并推测其可能的机制-方法:40只SD大鼠随机分为4组:实验1-2-3组及对照组,每组10只-分别腹腔注射LPS 50 μg/kg-100 μg/kg-200 μg/kg及 NS 1 ml,1 h后每组随机取5只大鼠处死取海马用RT-PCR方法检测IL-1βmRNA表达的变化;另外5只大鼠腹腔注射GBL 200 mg/kg诱发失神发作,观察皮层脑电图(ECoG)SWDs潜伏时间-持续时间的改变-结果:LPS腹腔注射后1 h大鼠海马组织IL-1βmRNA表达:50 μg/kg组0.196 ± 0.04-100 μg/kg组0.285 ± 0.057-200 μg/kg组0.404 ± 0.072,与对照组(0.131 ± 0.034)比较均有显著差异(P < 0.05);另外,LPS不同剂量组大鼠失神发作SWDs放电潜伏时间均较对照组缩短-持续时间延长,两者有显著差异(P < 0.05)-其中实验2-3组SWDs潜伏时间与持续时间较实验1组潜伏时间更为缩短,持续时间更为延长(P < 0.05);但实验3组SWDs潜伏时间和持续时间与实验2组比较没有差异(P > 0.05)-结论:LPS能影响GBL诱导大鼠失神发作的SWDs发放,缩短其潜伏时间-延长持续时间,并且有剂量依赖性及饱和性,其机制可能与LPS刺激机体引起的免疫异常有关-

摘要:目的:探讨血浆谷胱甘肽过氧化酶(Plasma Glutathione Peroxidase, GPX-3)启动子rs8177412位点基因多态性与脑梗死的相关性-方法:采用聚合酶链反应-连接酶检测方法(PCR-LDR)对94例脑梗死患者和80例健康对照者进行GPX-3启动子基因多态性分析-结果:脑梗死患者组中rs8177412位点TC+CC基因型频率分别高于对照组(P < 0.05),其C等位基因频率亦高于对照组(P < 0.05)-经多项非条件logistic回归分析提示GPX-3启动子rs8177412携带C等位基因可能为脑梗死的独立危险因素-结论:GPX-3启动子rs8177412基因多态性与脑梗死的发生有关,可能是脑梗死的一个重要危险因素-

摘要:目的:比较经门静脉及肝动脉两种途径肝内植入海藻酸钠微囊对肝纤维化影响的差别,探求一种更安全-更简便的胰岛植入途径-方法:实验犬30只随机分为A-V 2组,每组15只,分别作为经肝动脉植入组及经门静脉植入组,A-V两组各随机分为3个小组,每小组5只,分别植入海藻酸钠微囊8 000个/kg-16 000个/kg-32 000个/kg,观察植入前后血清肝纤维化标志物Ⅳ型胶原(CIV)的变化,并对肝脏进行病理组织学检查-结果:血清纤维化指标:V组:血清CIV值在植入后逐渐升高,植入前后有明显差别(P < 0.01);且各植入量组间存在显著性差异(P < 0.01)-A组:血清CIV值在植入后轻度升高,但植入前后无显著差异(P > 0.05),且各植入量组间的差异无统计学意义(P > 0.05)-相同植入量Vn及 An组间血清CIV值的比较差异有显著性(P < 0.01)-肝脏病理组织学检查:植入术后12周时,V3组肝脏组织学检查发现汇管区少量胶原纤维沉积,肝细胞浊肿,间质见炎性细胞浸润;而A组肝脏组织学检查未见明显异常-结论:植入量达到32 000个/Kg时,经门静脉植入可造成中远期肝损伤,导致肝纤维化;而经肝动脉植入对肝脏损伤小,将有望成为一种相对简单-安全的植入途径-

摘要:目的:通过研究抑抗汤对不明原因不孕症患者子宫内膜白血病抑制因子(leukemia inhibitory factor,LIF)表达的影响,了解抑抗汤治疗不明原因不孕症的作用机制-方法:不明原因不孕症患者20例,口服标准量抑抗汤2个月,首先应用RT-PCR初步了解不孕症患者服药前-后黄体晚期子宫内膜表达LIFmRNA水平的差异,然后采用实时荧光定量PCR对服药前后LIF基因转录水平定量验证,并以免疫组化鉴定其在服药前后子宫内膜蛋白水平的表达情况-结果:不孕症患者治疗前-后子宫内膜LIF 荧光定量PCR的Ct值分别为9.79 ± 0.91和4.60 ± 1.24,两者相比差异有显著性(P < 0.01),表明治疗后LIF的转录水平高于治疗前-免疫组化结果显示LIF表达在子宫内膜腺上皮细胞的细胞浆内,且治疗后蛋白水平的表达较治疗前明显增强(P < 0.05)-结论:抑抗汤治疗不明原因不孕症可能是通过促进子宫内膜LIF的表达来实现的-

摘要:目的:建立颐和春口服液中人参皂苷Rg1-Re-Rb1高效液相色谱法含量测定方法-方法:在Shim-pack VP-ODS(150 × 4.6 mm)色谱柱上,以流动相A:乙腈-甲醇-0.3%磷酸(10 ∶5 ∶ 85),流动相B:乙腈-甲醇-0.3%磷酸(50 ∶ 5 ∶ 45)梯度洗脱,波长203 nm进行检测-结果:人参皂苷Rg1-Re-Rb1在0.04~0.4 mg/ml范围内线性良好,加样回收率分别为96.0 ± 3.2%-94.1 ± 1.6%-96.2 ± 3.3%,稳定性实验RSD分别为1.19%-2.85%-3.17%,重现性实验RSD分别为1.56%-1.97%-3.29%-结论:本法可用于颐和春口服液的质量控制-

摘要:目的:观察牙龈卟啉单胞菌(Porphyromonas gingivalis, Pg)对人脐静脉内皮细胞(human umbilical vein endothelial cells,HUVEC)一氧化氮(NO)生成的影响,探讨Pg对内皮细胞功能损伤的途径,以期为牙周病在动脉粥样硬化发病机制中的作用提供依据-方法:用感染复数(multiplicity of infection, MOI) 1 ∶ 10-1 ∶ 100Pg干预HUVEC,未受Pg干预的HUVEC作为阴性对照组,分别于4-8-12-24 h时收集细胞上清液,利用硝酸还原酶法测定细胞上清液中NO的浓度;Western-blot检测诱导型一氧化氮合酶(iNOS)和内皮型一氧化氮合酶(eNOS)蛋白表达水平;透射电镜观察Pg对HUVEC的黏附和入侵方式-结果:在24 h内,Pg MOI 1 ∶ 10-1 ∶ 100能促进HUVEC NO的生成,与阴性对照组相比差异有统计学意义(P < 0.05),PgMOI1 ∶ 10,MOI1 ∶ 100可以诱导HUVEC iNOS 的蛋白表达,抑制eNOS 的蛋白表达,与阴性对照组相比差异均有统计学意义(P < 0.05),透射电镜观察Pg能够利用其菌毛黏附于HUVEC细胞表面并入侵到HUVEC细胞胞质内,定植于细胞内-结论:Pg能够黏附于HUVEC并入侵到细胞胞质内,诱导iNOS蛋白表达,抑制eNOS 的蛋白表达,最终促进HUVEC NO的生成-过量的NO可能发挥细胞毒性作用,导致内皮功能失调-

摘要:目的:建立微种植体正畸支抗的三维有限元模型,分析不同倾斜角度下植入微种植体时,不同载荷对种植体-骨界面的生物力学变化,为微种植体正畸支抗的临床应用提供理论依据-方法:利用计算机辅助设计和有限元软件处理,建立倾斜角度分别为30°,45°,60°,90°的4组微种植体支抗模型,分析在0.98 N(100 g力)-1.96 N(200 g力)-2.94 N(300 g力)-3.92 N (400 g力)水平力作用下,微种植体-骨界面应力及位移的分布情况-结果:不同角度不同载荷下微种植体颈部为应力集中区,Von-Mises应力及位移峰值随倾斜角度的增大而增大-微种植体90°植入,在3.92 N(400 g力)水平力作用下最大Von-Mises应力峰值为19.263 MPa,最大位移峰值为1.234 4 μm-结论:微种植体可在90°内载荷3.92 N(400 g力)以内的水平向正畸力-减小微种植体的倾斜角度,可以提高其载荷水平向正畸力的能力,提示临床应选择尽量倾斜于颊侧牙槽骨的方向植入微支抗种植体-

摘要:目的:探讨高血压病及高血压合并心律失常患者血清脂联素水平,及其与脑钠肽(BNP)-C-反应蛋白(CRP)的相关性-方法:选取原发性高血压病患者71例,分为单纯高血压组(36例)及合并心律失常组(35例)-测定血清脂联素-BNP-CRP水平,并进行相关性分析-结果:合并心律失常组[(0.977 ± 0.340)mg/L]及单纯高血压病组[(1.977 ± 0.990)mg/L]脂联素浓度显著低于正常对照组[(6.451 ± 1.972)mg/L](P < 0.01),合并心律失常组脂联素浓度显著低于单纯高血压组(P < 0.01)-合并心律失常组及单纯高血压组BNP-CRP浓度高于正常对照组,合并心律失常组BNP-CRP浓度显著高于单纯高血压组(P < 0.01)-单纯高血压组及合并心律失常组血清脂联素与BNP-CRP均呈负相关-结论:高血压病患者,血清脂联素降低-CRP及BNP水平升高,合并心律失常的高血压患者上述指标改变更为显著-血清脂联素与血清BNP-CRP呈负相关-脂联素可能与高血压病发生-发展有关-

摘要:目的:探讨不同抗栓药物对阵发性非瓣膜性心房颤动(Paroxysmal nonvalvular atrial fibrillation,PAF)心-脑及外周血管疾病血栓的预防作用-方法:选取PAF病例807例,其中80例因各种原因失访,有效病例727例,分别使用华法林和阿司匹林进行抗栓治疗,随访心脑血管疾病发生情况,比较二者预防主要终点-次要终点事件-主要出血事件及次要出血事件发生率-结果:高危PAF组,使用华法林治疗主要终点事件及次要终点事件均较阿司匹林组低(P﹤0.05),出血事件二者间无差异(P > 0.05);中危PAF组,使用华法林及阿司匹林治疗,二者在主要终点事件及出血事件发生率间无差异(P > 0.05),而应用华法林抗凝较应用阿司匹林抗栓能降低次要终点事件-及次要事件(P﹤0.05)-结论:对高危PAF病例,应用华法林抗凝较优于应用阿司匹林抗栓;对中危PAF病例,主要事件二者疗效相当,但应用华法林抗凝能减低次要事件发生率-

摘要:目的:通过对22例致心律失常性右室心肌病(ARVC)患者的远期随访观察,探讨ARVC的临床特征和远期预后-方法:对1996~2006年于南京医科大学第一附属医院确诊为ARVC的22例患者进行回顾性分析并随访,随访内容包括治疗经过-症状-有无猝死以及心电图-超声心动图-动态心电图等-结果:22例ARVC患者平均随访时间(6.1 ± 2.9)年(2.2~12年)-共有2例患者猝死,年平均病死率1.5%-心电图随访中新出现Epsilon波3例-肢体导联低电压2例-完全性右束支传导阻滞1例,完全性左束支传导阻滞1例,T波倒置1例,T波倒置导联数增加2例;比较随访前后肢体导联电压的绝对值和有明显降低(P < 0.01)-心脏超声示左室结构和功能在随访前后无明显变化(P > 0.05)-10例射频消融成功的患者经随访有7例室速复发,均为新形态的室速;2例安装ICD患者,ICD有效工作并存活;10例单纯口服抗心律失常药物治疗患者,6例室速复发,其中3例患者出现新形态的室速,2例猝死-结论:①ARVC患者发病年龄以中青年为主,随访期间心电图肢导电压绝对值和降低,超声心动图较少发现左心结构-功能有明显变化;②以药物或射频消融治疗ARVC复发率均较高,目前ICD使用率较低-

摘要:目的:探讨小剂量尿激酶联合银杏叶提取物治疗急性脑梗死的临床疗效及治疗前后血液流变学指标的变化-方法:将发病72 h内的入选患者随机分为治疗组及对照组,治疗组采用尿激酶每天20万U联合银杏叶提取物20 ml(70 mg)静脉滴注,连用10日,后改为阿斯匹林100 mg/天;对照组采用血塞通400 mg静脉滴注同时口服阿斯匹林200 mg/天,10天后改为阿斯匹林100 mg/天-两组患者均同时应用钾镁液及对症支持治疗-结果:治疗组自治疗后7天起其神经功能缺损程度评分即显著低于对照组(P < 0.05);临床总有效率91.7%,与对照组73.3% 相比有显著性差异(P < 0.05);治疗后血液流变学各项指标均有所下降,尤以血液粘稠度和纤维蛋白原下降明显,与对照组相比差异显著(均P < 0.05)-结论:小剂量尿激酶联合银杏叶提取物静脉滴注治疗发病72 h内的急性脑梗死患者简便-安全-有效-

摘要:目的:探讨急性脑梗死患者外周血sE-选择素-sL-选择素表达水平的变化-临床意义-方法:对30例急性脑梗死患者采用酶联免疫吸附技术(ELISA)定量测定发病 < 72 h-7天时外周血血清sE-选择素-sL-选择素的表达水平,并与20例健康者作对照-结果:发病 < 72 h-7天时外周血sE-选择素的表达水平分别为(10.49 ± 8.70)ng/ml-(5.74 ± 4.40)ng/ml,均显著高于对照组(均P < 0.01);且与发病 < 72 h相比,发病7天时下降明显,其差异有显著性(P < 0.01)-发病 < 72 h-7天时外周血sL-选择素的表达水平分别为(4.29 ± 2.22)ng/ml-(4.27 ± 2.11)ng/ml,均显著低于对照组(均P < 0.01);7天与 < 72 h相比其表达水平差异无显著性(P > 0.05)-结论:急性脑梗死时患者外周血 sE-选择素表达上调而sL-选择素表达下调;它们可能参与了急性脑梗死的病理过程,对临床治疗有参考价值-

摘要:目的:研究缺血性脑卒中患者急性期和恢复期血液流变学变化-方法:使用全自动血液粘度分析仪分别对20名缺血性脑卒中急性期患者,20名缺血性脑卒中恢复期患者及20名健康人的血液流变学进行检测-结果:缺血性脑卒中患者急性期,全血黏度明显增高(P < 0.01),相对血液黏度在部分切变率上高于对照组(P < 0.05);恢复期的全血粘度变化不明显,而相对血液粘度在各切变率上均低于对照组(P < 0.05);急性期与恢复期的血浆黏度和纤维蛋白原含量均明显增高(P < 0.01)-结论:缺血性脑卒中急性期是一个高粘滞状态,通过治疗或机体自身的反馈机制,恢复期患者的血液相对粘度降低,血液循环得到改善-

摘要:目的:探讨HA或DA联合治疗慢性粒细胞白血病的效果-方法:HA或DA联合治疗慢性粒细胞白血病,HA方案:三尖杉酯碱(H)(4~6)mg/d,阿糖胞苷(A)200 mg/d,加入液体静滴,第1~7天-DA方案:柔红霉素(D)(40~60)mg/d,加入液体静滴,第1~3天,阿糖胞苷(A)剂量用法同上,均为每7天 1个疗程-2个疗程间歇7~14天-结果:完全缓解(CR)56例(66.7%),其中HA方案1个疗程达CR24例,2个疗程达CR10例,HA和DA方案交替3个疗程达CR22例;部分缓解(PR)22例,(26.2%);总有效率92.9%;无效6例(7.1%)-26例做了染色体检查,发现10例Ph1染色体阳性,其中12例达CR,而CR患者有4例转阴-结论:HA或DA联合治疗效果明显-

摘要:目的:探讨多西他赛为主的DCF方案治疗进展期胃癌的疗效和毒副反应-方法:63例经病理确诊的进展期胃癌患者随机分为DCF组(治疗组)和FOLFOX4组(对照组)治疗,2周期后评价疗效-结果:治疗组(31例)有效率(RR)为51.6%,中位疾病进展时间(mTTP)为5.5个月,中位生存期(MST)为9.0个月,1年生存率为41.9%;对照组(32例)RR为46.9%,mTTP为5.3个月,MST为8.8个月,1年生存率为40.6%,两组比较无显著性差异(P > 0.05)-毒副反应:治疗组中性粒细胞减少发生率为87.1%,没有Ⅳ度中性粒细胞减少和治疗相关性死亡-对照组中性粒细胞减少发生率为50.0%,没有Ⅲ/Ⅳ度中性粒细胞减少,差异有非常显著性意义(P < 0.005),治疗组周围神经毒性发生率为3.2%,对照组为40.6%,差异有非常显著性意义(P < 0.001)-结论:DCF方案治疗进展期胃癌疗效较好, 毒副反应可耐受,值得临床上推广应用-

摘要:目的:通过对腰椎后路融合术后患者邻近节段影像学指标的测量,探讨邻近节段退变的发生-发展情况-方法:随访组为本院脊柱中心2004年~2007年间21位行腰椎后路融合术的患者,对照组A为本院门诊行腹部CT扫描的患者,对照组B为本院门诊行腰椎侧位片的患者-随访组患者术后无邻近节段病(Adjacent Segment Degeneration,ASD)的发生,亦无渐进的神经症状-测量患者邻近节段黄韧带厚度-小关节间隙宽度-侧隐窝宽度-小关节极性-椎板角并与对照组进行比较-结果:和对照组相比,随访组部分节段黄韧带明显增厚(P < 0.05),但尚未达到黄韧带肥厚的诊断标准-小关节极性:部分节段随访组大于对照组,有显著的统计学差异(P < 0.05)-小关节间隙宽度:和对照组相比数据无显著的统计学差异(P > 0.05)-椎板角:和对照组相比数据无显著的统计学差异(P > 0.05)-侧隐窝宽度:和对照组相比无显著的统计学差异(P > 0.05)-结论:腰椎后路融合术后,由于力学分布的变化,邻近节段出现渐进式的改变,这些改变包括韧带增生,小关节退变等-连续-动态地观察腰椎后路融合术后患者黄韧带的厚度-小关节极性等数据,可为评估邻近节段退变的进展和防治邻近节段退变的发生提供重要的依据-

摘要:目的:探讨Lichtenstein平片式疝修补术与疝环充填式无张力疝修补术的优缺点-方法:采用美国Bard公司的疝环充填物及网状补片,德国B.Braun公司网状补片对各类型腹股沟疝行无张力修补122例,其中疝环充填式62例,单纯补平片法(Lichtenstein手术)60例-结果:平均手术时间疝环充填式疝修补术(49.5 ± 10.7)min,Lichtenstein手术(44.6 ± 10.9)min-术后并发尿潴留疝环充填式疝修补术17例,Lichtenstein手术8例,疝环充填式疝修补术复发1例,切口感染Lichtenstein手术和疝环充填式疝修补术各1例-结论:两术式治疗成人腹股沟疝在手术时间-术后早期疼痛-导尿率-并发症-平均住院日及术后复发率等主要方面无明显差异,总的治疗效果相近,并发症较少-

摘要:目的:探讨辅助性回肠造口在超低位直肠前切除术中应用临床价值-方法:对2000~2008年行超低位直肠前切除术140例患者随机分成施行或未施行辅助性回肠造口两组,分析两组间肠道功能恢复-住院时间及吻合口瘘发生率的差异-结果:70例行辅助性单腔回肠造口术患者术后恢复肠道时间和住院时间明显短于未行辅助性回肠造口患者-70 例未行造口的患者中发生吻合口瘘5 例(7.1%),而行辅助性回肠造口的70 例未发生1 例吻合口瘘-结论:在超低位直肠前切除术中,应常规使用辅助性回肠造口术-

摘要:目的:探讨小儿梅克尔憩室并发出血的诊断和外科处理-方法:回顾分析1997年1月至2007年12月收治的12例梅克尔憩室并发出血的病历,数据采用t检验,经SPSS 10.0系统处理-结果:男11例,女1例,首次下消化道出血年龄(1~8■)岁,平均(5.50 ± 3.16)岁,手术时年龄(1■ ~ 11)岁,平均(6.70 ± 3.19)岁-Hb(48~98)g/L,平均(68.54 ± 14.72)g/L,RBC(2.0~3.7) × 1012/L,平均(2.62 ± 0.65) × 1012/L-1例上消化道造影显示憩室-11例99mTc扫描,其中9例阳性,另2例阴性者腹腔镜检查证实为梅克尔憩室-9例经腹手术,其中楔形梅克尔憩室切除6例,肠切除-肠吻合3例;另3例腹腔镜辅助梅克尔憩室切除-梅克尔憩室距回盲襻距离范围50~100 cm,平均(76.25 ± 20.12)cm,憩室长度2~5 cm,平均(3.4 ± 0.9)cm,憩室基部直径0.5~3.0 cm,平均(1.94 ± 0.63)cm,11例切除憩室病理检查有异位胃黏膜-术后无并发症-随访1年无再出血-结论:小儿下消化道出血Hb(48~98)g/L,平均(68.54 ± 14.72)g/L者首选99mTc扫描,阴性者行腹腔镜检查-腹腔镜辅助梅克尔憩室切除是简单-安全的方法-

摘要:目的:探讨手术治疗结直肠癌合并结直肠息肉的方法和效果-方法:回顾性分析91例结直肠癌合并结直肠息肉的病例,对其结果进行随访-结果:2004年1月至2007年10月共收治的393例结直肠癌中共发现携带结直肠息肉91例,45例行术前息肉摘除手术,无并发症发生,38例行术中结肠切除,8例在术后进行结肠息肉摘除,其中1例结肠息肉发生癌变而且无法内镜切除行再次剖腹手术,1例息肉无法息肉内镜下切除而行再次剖腹切除-结论:对于结直肠癌合并结直肠息肉的患者,尽量应用内镜进行切除,对于不能进行扩大切除的患者,进行内镜定位下的区段切除或局部扩大切除-

摘要:目的:探讨乳腺癌术后放射治疗后横行腹直肌肌皮瓣(TRAM)乳房再造的手术效果-方法:5例患者接受TRAM乳房再造术-结果:除1例受区皮瓣边缘延迟愈合外,均获得满意效果-结论:TRAM具有丰富组织量-恒定的血管-质地与乳房相近,操作安全等优点,是乳腺癌术后乳房再造的理想皮瓣之一-

摘要:目的:探讨新生儿窒息早期尿视黄醇结合蛋白(尿RBP)-尿N-乙酰-β葡萄糖酐酶(尿NAG)与尿肌酐(Cr)比值(尿RBP/Cr,尿NAG/Cr)的变化与新生儿肾脏损害情况的关系-方法:选取2007年6月至2008年4月间本院新生儿科收治的窒息新生儿35例和对照组35例,在出生后24~72 h内留取新鲜尿标本5~10 ml送检,比较两组尿RBP/Cr-尿NAG/Cr并进行相关性分析,同时比较同期血尿肌酐和尿素氮-结果:窒息组病例尿RBP/Cr-pH值-明显高于对照组,P < 0.001,有显著统计学意义;窒息组尿NAG/Cr高于对照组,P < 0.005,有统计学意义;窒息组病例35例血肌酐高于对照组,P < 0.001,有显著统计学意义-血尿素氮与对照组35例比较,P > 0.05,无明显统计学差异-结论:窒息早期可以通过监测尿RBP/Cr和NAG/Cr值了解肾功能状况以评价窒息新生儿的肾损害情况,尤其是尿RBP/Cr较其他数据更灵敏,且简便易行-

摘要:目的:探讨小儿无痛胃镜检查的实用价值及其临床意义-方法:回顾性分析168例0~14岁因消化道出血-异物及腹痛呕吐患儿,采用丙泊酚加小剂量氯胺酮方法的无痛胃镜检查及临床资料-结果:168例不同年龄患儿,均顺利安全完成胃镜检查及治疗,无不适反应-结论:采用无痛技术,任何年龄患儿均可行胃镜检查;同时无痛胃镜的广泛使用将大大提高儿童消化疾病诊断的正确率-

摘要:目的:观察丝裂霉素(mitomycin C,MMC)联合Ahmed减压阀植入术治疗难治性青光眼的疗效-方法:应用Ahmed青光眼减压阀植入手术治疗32例35眼难治性青光眼,术后随访一年,观察其临床疗效及其手术并发症-结果:本组成功率为80.0%; 眼压由术前的(47.28 ± 13.14)mmHg 降至术后的(17. 62 ± 6. 42)mmHg-采用配对t检验差异有统计学意义(P < 0.01)-术后并发症为:引流盘周纤维包裹2眼(5.7%),浅前房2眼(5.7%),引流管口堵塞2眼(5.7%),脉络膜脱离1眼 (2.8%)-结论:应用丝裂霉素联合Ahmed减压阀植入手术治疗难治性青光眼是一种相对有效-安全的治疗方法-

摘要:目的:比较氯诺昔康和曲马多患者自控镇痛(patient-controlled-analgesia,PCA)用于妇科术后镇痛的效应及不良反应-方法:64例择期行子宫(次)全切术以及附件手术的患者随机分为2组,分别接受静脉氯诺昔康(L组)或曲马多(Q组)行手术后镇痛治疗,以开始镇痛后1-2-4-8-10-20-24 h的VAS评分作为主要镇痛效应指标,记录镇痛观察期间补救药物的使用情况-不良反应的发生情况-患者睡眠质量-以及镇痛结束后患者总体满意度,统计因镇痛不全或不良反应而退出的患者比例-结果:开始镇痛后2-4-8-10-24 h时间点,L组VAS评分均数均低于Q组(P < 0.05);未经历疼痛患者的比例L组高于Q组(P < 0.05)-L组恶心-呕吐的发生率明显低于Q组(P < 0.05)-L组镇痛总体满意度为Ⅰ级的患者数明显高于Q组(P < 0.05),镇痛优良率两组(分别为82.1%和76.0%)比较差异无统计学意义(P > 0.05)-结论:氯诺昔康静脉PCA用于妇科手术后镇痛效果确切-不良反应发生率低-

摘要:目的:了解南京医科大学第一附属医院2007年 ICU病原菌分布及细菌耐药情况,为临床防治提供依据-方法:采用API鉴定系统鉴定细菌及真菌;纸片扩散法测定细菌药物敏感性,Rosco纸片法测定真菌药物敏感性;WHONET 5.4软件进行统计分析-结果:2007年该院总标本数为4 431份,ICU标本数为343份,阳性率为7.7%,病原菌以G-为主,占70.7%,其中非发酵菌占46.9%,肠杆菌科细菌占23.8%-非发酵菌以铜绿假单胞菌(37.3%)和不动杆菌(7.6%)多见,肠杆菌科细菌以克雷伯菌(10.5%)-大肠埃希菌(6.1%)为多;G+菌以金黄色葡萄球菌(金葡菌)为主-从耐药性分析来看,葡萄球菌属未发现万古霉素耐药株,但对其他多种抗菌药物耐药;肠杆菌科细菌对亚胺培南-美洛培南-头孢哌酮/舒巴坦和阿米卡星较敏感;非发酵菌中,铜绿假单胞菌对大部分抗菌药物耐药,而不动杆菌则对美洛培南-亚胺培南和头孢哌酮/舒巴坦较敏感-结论:该院ICU感染病原菌对多种抗菌药物耐药率较高,应合理选择抗菌药物-

摘要:目的:通过技术流程管理和感染控制方法探索,以减少丙型肝炎HCV新感染病例-方法:将132例血液透析患者分为3组,A组27例为血液透析≤1年者;B组71例为血液透析1~5年者;C组34例为血液透析 > 5年者-检测血液透析患者抗HCV抗体及HCV-RNA滴度,分析与血液透析时间-方式-使用血液制品几率-是否采用复用透析器等因素的关系-结果:剔除输血和复用透析器的影响,HCV感染几率与透析时间长短呈正相关即当透析时间每增加一个等级时,抗HCV转阳率将平均增加2.99倍-HCV-RNA滴度提高一个几何级数的可能性将平均增加1.29倍-结论:制订一系列感染控制措施和规章制度,特别是透析器复用环节RC接头的使用,复用机设计新观点,以及血液透析区域中间清场制等有效对策,可控制HCV新感染病例-

摘要:目的:探讨肺肉瘤样癌的CT影像特点及其诊断价值-方法:回顾性分析22例肺肉瘤样癌的临床资料和CT影像特点-结果:22例肺肉瘤样癌中,周围型19例(86.3%),中央型3例(13.7%);均表现为肺内肿块或结节,密度大部分不均匀,1例(4.5%)钙化,5例(22.7%)空洞-17例(77.3%)呈类圆形,3例(13.7%)呈楔形,1例(4.5%)呈葫芦状,1例(4.5%)呈条状-19例(86.3%)有分叶,7例(31.8%)有毛刺,3例(13.7%)有胸膜凹陷征-3例(13.7%)支气管狭窄伴阻塞性肺不张,1例(4.5%)纵隔大血管被侵犯,12例(54.5%)侵犯邻近胸膜或胸壁,15例(68.1%)肺门淋巴结增大,14例(63.6%)纵隔淋巴结增大-转移到同侧肺2例(9.1%%),骨1例(4.5%)-结论:肺肉瘤样癌以周围型为主,肿块较大,密度不均匀,易侵犯邻近胸膜或胸壁,伴肺门-纵隔淋巴结转移-

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