大剂量甲基强的松龙联合阿糖胞苷、阿霉素治疗成人难治性急性白血病5例探讨

对于难治性急性白血病目前尚无有效治疗方案.国外有学者报告,大剂量甲基强的松龙(HDMP)合并阿糖胞苷(Ara—C)、阿霉素(ADR)(简称MAA方案)治疗儿童急性非淋巴细胞性白血病有一定疗效,为此,本文用MAA方案治疗5例成人难治性急性白血病,现报告如下:     

普鲁卡因辅佐治疗毛细支气管炎60例疗效观察

目的 探讨普鲁卡因辅佐治疗毛细支气管炎临床疗效。方法 将120例毛细支气管炎患儿随机分为治疗组、对照组各60例，对照组给予常规治疗，治疗组在常规治疗基础上加用普鲁卡因静滴治疗，对治疗前后症状、体征、持续时间、病情治愈好转率进行比较。结果 治疗组治愈率、缓解喘憋及缩短哮鸣音持续时间明显优于对照组（P〈0．05）。结论 普鲁卡因静滴副作用小，能提高毛细支气管炎的治愈率及缩短病程。     

分组单项质控在病区护理质量管理中的应用效果探讨

目的:探讨分组单项质控在病区护理质量管理中的应用效果。方法:将病区护理质量项目分为6～8个单项质量控制小组,每组设置组长1名及组员1～2名,经过统一培训,并制定相应的岗位职责及工作流程,按PDCA循环法开展质量控制。结果:实施分组单项质控后,各单项质量指标、病人满意度、年护理缺陷发生率与实施前比较,差异均有统计学意义(P<0.05)。结论:实施分组单项质控管理,加强了病区一级护理质控力量,提高了护理人员参与质量管理的积极性,减轻了护士长的工作压力,能有效防范护理缺陷的发生,促进护理质量持续改进与稳步提高。     

核苷(酸)类耐药患者中乙型肝炎病毒逆转录酶区基因变异类型及其特点

目的 了解核苷(酸)类药物治疗慢性乙型肝炎过程中HBV耐药变异模式特点以及是否有新的变异位点产生. 方法对2005年9月-2007年6月送检的227份慢性乙型肝炎患者血清标本,应用Trugene试剂盒抽提、扩增HBV基因组聚合酶逆转录酶区,PCR产物经过CLIP反应后加到MicroCel 500电泳胶板中电泳,应用GeneObjects软件获得样本的序列,分析其突变,并应用SPSS15.0软件进行统计分析.结果 在227份标本中有111份(48.9%)发现已知耐药位点(M204V/I,L180M,V173L,V207I,N236T,A18lV/T等)变异,其中有明确用药史的共75例.在拉米夫定和阿德福韦序贯治疗的患者中出现多重耐药变异的概率较高,为25.0%(4/16),而在先用拉米夫定后联合阿德福韦治疗的16例患者中未发现后续阿德福韦耐药变异.在其他位点的变异中,以A222T、L229V和S256C频率较高.数据采用SPSS15.0软件分析,组间比较用Kruskal-Wallis和SNK方法检验. 结论在核苷(酸)类药物治疗慢性乙型肝炎过程中,出现的变异模式复杂,对拉米夫定耐药的患者,换用阿德福韦可导致多重耐药变异.     

慢性乙型肝炎恩替卡韦治疗过程中病毒动力学特点分析

Objective To analyze the viral dynamics and clinical significance during the antiviral treatment by a mathematical model.Methods Six chronic hepatitis B patients were evaluated with a kinetic model(Neumann model)during dose of 0.5 mg/d oral entecavir.Blood samples were drawn for HBV DNA measurement at week 0,2,4,12,24.Non-linear modeling was used to fit individual patient data.Results The median effectiveness in blocking viral production was 99.970%(n=6).The median half-life of viral turn-over was 1.6 d(n=6).The median half-life of infected hepatocytes was 21.3 d(n=5).Compared with the other patients,the c(virions are cleared at a rate)、ε(effectiveness)、δ(infected cell are lost at a rate)value of one patient(eg.6)were all lower and the half-life of virus and infected cells were higher,and eg.6 developed viral break-through after 38 weeks of follow-up.Conclusions Viral load decay showed a biphasic pattern during entecavir therapy which can be described with a mathematical model.The model relates processes of viral infection and replication as well as drug efficacy to model parameters.It indicates the prediction of bio-mathematical model during antiviral treatment.     

中西药结合外用治疗老年褥疮30例体会

笔者自2005年10月至2008年6月对30例老年褥疮患者采用西药结合自制的褥疮膏外用治疗,取得了满意疗效.     

临床医学专业学位硕士研究生临床能力考核评估体系的建立与应用

根据临床医学专业学位硕士研究生临床能力培养的特点和规律,以科学、客观、全面、完整、可测量为原则,将Mini-CEX和OSCE应用于临床医学专业学位硕士研究生临床能力考核评估,建立了科学性、实践性和操作性较强的全程考核评估体系,在提高研究生培养质量方面取得了较好的效果.     

Interaction of Human Genes WT1 and CML28 in Leukemic Cells

The molecular pathogenesis of leukemia is poorly understood. Earlier studies have shown both Wilms’ tumor 1 suppressor gene (WT1) and CML28 abnormally expressed in malignant diseases of the hematopoietic system and WT1 played an important role in leukemogenesis. However, the rela- tionship between molecular CML28 and WT1 has not been reported. Here we described the use of small interfering RNA (siRNA) against WT1 and CML28 in leukemic cell line K562 to examine the interac- tion between CML28 and WT1. WT1 and CML28 gene expression in transfected K562 cells was de- tected by using RQ-PCR and Western blotting. K562 cells transfected with WT1-siRNA could greatly decrease both mRNA and protein expression levels of WT1 and CML28. In contrast, CML28-siRNA did not exert effect on WT1. Further, subcellular co-localization assay showed that the two proteins could co-localize in the cytoplasm of K562 cells, but WT1/CML28 complexes were not detected by us- ing immunoprecipitation. It was suggested that there exists the relationship between CML28 and WT1. CML28 may be a downstream target molecule of WT1 and regulated by WT1, which will provide im- portant clues for further study on the role of CML28 and WT1 in leukemic cells.     

儿科临床实习教学方法初探

随着医学水平的迅速发展和医学模式的转变,对儿科实习教学也提出新的要求。通过对儿科实习教学进行改革和探索,包括实习角色的转换、加强基本功的训练、教学措施多样化。通过改革,培养学生正确的临床思维方法、临床操作和解决实际问题的能力,这样才能提高教学效果。