创建中医基础理论精品课程的思路与举措

通过加强师资培养,建设合理梯队;加强教材建设,选用精品教材;深化教学改革,重在方法创新;加强效果评价,注重总结分析;加强网络建设,开创自学平台5个方面,阐述了创建中医基础理论精品课程建设的思路,并强调了精品课程建设的重要性和长期性.     

食管上皮癌变过程中DNA 含量及细胞周期调控因子表达的定量检测

 目的 探讨食管上皮癌变过程中DNA含量、细胞周期分布的变化及多个相关的细胞周期调控因子的表达状况及其意义. 方法 应用碘化丙啶染色和间接免疫荧光标记方法,采用流式细胞仪对30例食管癌组织及相应的癌旁组织进行定量检测. 结果 与正常黏膜和非典型增生组织相比,癌组织中DNA含量明显增高,异倍体细胞显著增加;G0/G1期细胞明显减少,而S期和G2/M期细胞显著增多,增殖指数（PI）高于癌旁组织;cyclinE、cdk2、p53、E2F基因蛋白过表达,两两之间皆有显著性正相关关系,抑癌基因p21^WAF1基因蛋白表达水平明显降低,与其余基因蛋白之间有明显的负相关. 结论 食管上皮癌变过程中,DNA含量及异倍体率增加,细胞周期分布发生了明显的改变,细胞周期相关基因蛋白表达异常.     

后程加速超分割放射治疗晚期鼻咽癌的疗效观察

目的探讨后程加速超分割放射治疗晚期鼻咽癌的临床疗效,同时观察急性放疗反应和后遗症。方法92例Ⅲ、Ⅳa期鼻咽癌患者随机分为常规分割放射治疗组(常规组)46例和后程加速超分割放射治疗组(后超组)46例,常规组2.0G y/次,1次/d,5次/周,总剂量(74￣78)G y/(7.4￣7.8)周,后超组前3.5￣4周照射同常规组,放疗至36￣40G y后改为1.5G y/次,2次/d,间隔6￣8h,5d/周,总剂量(72￣78)G y/(7.2￣7.8)周。结果两组病例3年鼻咽原发灶控制率分别为69.6%和87.0%,差异有显著性意义(P<0.05),3年生存率分别为67.4%、76.1%,差异无显著性意义(P>0.05),3年累积远处转移发生率分别为32.6%和26.1%,差异无显著性意义(P>0.05)。两组颈淋巴结控制率相仿;两组急性黏膜放射反应和正常组织后期放射反应相仿。结论后程加速超分割放射治疗较常规分割放射治疗提高了Ⅲ、Ⅳa期鼻咽癌3年鼻咽原发灶控制率,不能提高3年生存率,两组急性放射反应相似,后期放射反应相仿,有必要扩大病例并作长期随访研究。     

The Natural Course of Serum D-Dimer,C-Reactive Protein,and Erythrocyte Sedimentation Rate Levels After Uneventful Primary Total Joint Arthroplasty

BackgroundThis study aimed to assess the baseline levels of D-dimer, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) and monitor the natural course of these serum markers after uneventful primary total joint arthroplasty.MethodsThis prospective study enrolled 81 patients undergoing primary total knee arthroplasty or total hip arthroplasty. The level of serum D-dimer, CRP, and ESR was measured preoperatively and on postoperative days 1, 3, 5, 15, and 45. Mean peak values, peak times, and distribution were compared between D-Dimer, CRP, and ESR.ResultsThe mean preoperative serum D-dimer, CRP, and ESR level was 412 ± 260 (range 200-980) ng/mL, 2.93 ± 2.1 (range 1-18) mg/L, and 22.88 ± 17.5 (range 3-102) mm/h, respectively. The highest mean peak for D-dimer, CRP, and ESR was at postoperative day 1, 3, and 5, respectively.ConclusionD-dimer levels reached peak levels on postoperative day 1 and then declined rapidly to a plateau level by postoperative day 3. A second, albeit small, peak in the level of D-dimer occurred on postoperative day 15. The level of CRP and ESR remained elevated for much longer with CRP returning to baseline on postoperative day 45 and the level of ESR had not returned back to normal on postoperative day 45.     

Treating the N0 neck in early stage oral cancer: a pause for re-assessment?

The incidence of metastases following neck dissection in the apparent lymph node negative neck in oral cancer is between 7% and 33%; early resection of cervical metastases may well increase survival. Modern imaging techniques can reduce the yield of previously undiagnosed metastatic nodes in elective neck dissection (END). An audit of 112 consecutive cases was conducted to determine the proportion of undiagnosed nodal metastases, after END. There were neck metastases in 10 cases (9%), which were mainly (but not all) micrometastic. The 20% likelihood of nodal metastases was only apparent in primary tumours greater than 6 mm thick. The length of inpatient stay was increased from 3.7 to 16.5 days with free vascularised transfer. There were complications including cranial nerve damage. There were two peri-operative deaths. No ipsilateral neck failures occurred, median follow up was 937 days. To reduce unnecessary END, resection can be undertaken as a prior procedure, subsequently only carrying out END on tumours greater than 6 mm, or with unfavourable tumour characteristics.     

Correlation between symptoms and course duration of upper aerodigestive tract cancer at early and advanced stages

There still are many clinical and biological aspects of the natural history of cancer of the upper aerodigestive tract to be unveiled; which in Brazil is a direct consequence of the failure of systematic prevention and early diagnosis campaigns.ObjectiveTo analyze the signs and symptoms presented by patients with the disease at initial and advanced stages. Other variables such as disease duration, general and nutritional status were considered.MethodA historical cohort study with a cross-section involving 895 subjects with cancer of the upper aerodigestive tract.ResultsClinical findings were not statistically correlated with disease progression, nor with the disease in early stages, but it showed rapid disease development.ConclusionThe results suggest a disease of insidious onset in the early stages and fast course afterwards. The long disease duration - greater than three months, was associated with worsening in general and nutritional states of patients.     

The effect of appendectomy on the course of ulcerative colitis: a systematic review

Aim Previous studies have shown significantly lower appendectomy rates in ulcerative colitis (UC) patients compared with healthy controls. Evidence indicating that the appendix has an immunomodulatory role in UC has been accumulating. To examine the latest evidence on the effect of appendectomy on the disease course of UC. Method PubMed, The Cochrane Library and EMBASE were searched. Primary end‐points were number of relapses, use of steroids, number of hospital admissions and number of colectomies. Results The search resulted in six observational studies (five case–control studies and one cohort study) totalling 2532 patients. Owing to clinical heterogeneity, no meta‐analysis could be conducted. One study found lower relapse rates in patients appendectomized before the onset of UC [absolute risk reduction (ARR) = 21.5%; 95% CI: 1.71–45.92%]. Another two studies found a reduced requirement for immunosuppression in appendectomized patients (ARR = 20.2%; 95% CI: 9.67–30.46% in the first study and ARR = 21.4%; 95% CI: 10.32–32.97% in the second study). In addition, one study found lower colectomy rates in nonappendectomized patients (ARR = 8.7%; 95% CI: 1.29–18.66%) and two studies found lower colectomy rates in appendectomized patients (ARR = 21.4%; 95% CI: 13.17–28.79% in the first study and ARR = 18.7%; 95% CI: 7.50–29.97% in the second study). Conclusion There are limited and conflicting data available regarding the effect of appendectomy on the disease course of UC. Most studies suggest a beneficial effect and the minority find no, or a negative, effect.     

An Elective Course on Dermatological Topics and Cosmeceutical Compounding

Objective. To implement and assess a pharmacy dermatology and cosmeceutical compounding elective course and its impact on graduates’ careers.Design. A 3-credit elective course that incorporated classroom lectures on ambulatory dermatologic diseases and cosmeceutical products with case studies, weekly quizzes, and a comprehensive business plan project was implemented in a doctor of pharmacy (PharmD) program in 2010.Assessment. Assessment instruments including weekly quizzes, a business plan project, and pre- and post-course tests were used to evaluate course content. Across 3 offerings of the course (2010, 2011, 2012), pre- and post-course test scores improved. Results of a postgraduate survey showed that 54% of respondents worked at a pharmacy offering compounding services, and 57% felt that the course played a significant or very significant role in their counseling on dermatologic conditions.Conclusions. Assessment methods revealed student learning of course content and the course appeared moderately beneficial to graduates’ early careers. A more longitudinal analysis is needed to assess the course’s impact on long-term career choices, particularly those dealing with compounding of cosmeceutical products.