对医学生《肿瘤学》课程设置建议的调查研究——以华中科技大学为例

恶性肿瘤是一种常见病、多发病,对人类健康的危害极大,其发病率和致死率日趋增高,我国的抗癌形势面临着严峻的挑战,迫切需要加强对临床肿瘤学的教育。但是当前本科生临床肿瘤学教学效果不甚理想,这或许与缺乏统一的教学大纲和教材,教学内容重复,缺乏特色,定位为选修课,缺少见习等诸多因素密切相关,而医学生是未来抗癌斗争的生力军,加强医本科生对肿瘤学科的学习和认识意义重大。基于此,现就目前医学生肿瘤教学现状,经采用问卷调查、统计分析等方法,对医学高年级本科生选修《肿瘤学》的动机、对课程设置的需求进行分析,提出肿瘤学教学的几点建议。     

Risk Factors of Complications after CT-guided Percutaneous Needle Biopsy of Lumps Near Pulmonary Hilum

The factors influencing the incidence of common complications(pneumothorax and pulmonary hemorrhage) of CT-guided percutaneous needle biopsy of lumps near pulmonary hilum were investigated. CT-guided percutaneous needle biopsy of lumps near pulmonary hilum was performed on 48 patients. The complications of pneumothorax and pneumorrhagia as well as the contributing factors were analyzed statistically. The major complications associated with CT-guided needle biopsy included pneumothorax(13 cases, 27.1%) and pulmonary hemorrhage(14 cases, 20.24%). ?2 test revealed that pneumothorax was associated with the lesion size and depth of needle penetration, and pulmonary hemorrhage with the depth of needle penetration and needle retention time with a significant P value. Pneumothorax was observed in 7 cases(17.5%) out of 40 cases with diameter of mass greater than 3 cm, and in 6 cases(60%) out of 10 cases with depth of needle penetration greater than 4 cm. Additionally, pulmonary hemorrhage was identified in 12 cases(41.4%) out of 29 cases with needle retention time longer than 15 min, and pulmonary hemorrhage in 7 cases(70%) out of 10 cases with depth of needle penetration greater than 4 cm. CT-guided percutaneous needle biopsy of lumps near pulmonary hilum is safe and effective. The key factors to prevent the complications include correct evaluation of lesion size, depth of needle penetration and the needle retention time before the operation. Key words: biopsy, CT-guided; hilum; pneumothorax; pulmonary hemorrhage     

自身冷抗体伴IgG抗-E 1例

临床资料患者 ,男 ,5 0岁 ,肺癌 ,中度贫血 ,曾输血 3次 ,再次输血时 ,配血主管发生凝集 ,送至本实验室。血型血清学检查1　血型　患者血型为 A,CCDee。2　直接抗人球蛋白试验　抗 Ig G阳性 ,C3 阴性。3　抗体检测3.1　抗体筛选 :选用上海血液中心血型参比室谱细胞 ( 2 0 0 2 0 1 0 8) ,结果见表 1。患者血清与谱细胞、自身细胞均显凝集 ,怀疑患者有自身抗体。将患者红细胞用 37℃生理盐水洗涤 3次 ,加自身血清 ,放置 4℃冰箱 2 4 h,吸收后的血清与洗涤后自身细胞不凝集 ,与含 E抗原的红细胞呈凝集反应。表 1　患者血清抗体检测结果试验…     

电离辐射抑制海马区神经发生与放射性脑损伤认知损害的关系

目的 研究放疗后海马区神经发生与小鼠放射性脑损伤认知损害的关系.方法 10 d龄C57BL/6J小鼠24只给予10 Gy 6MV X射线全脑照射,Morris水迷宫实验检测放射性脑损伤模型的建立.在照射后不同时间点(0.5、3、6、12、24、48、72 h,1、2、4、8、16、24周),取脑组织标本进行HE染色,观察海马区神经细胞的病理变化.免疫组织化学染色双皮质蛋白(DCX)、增殖细胞核抗原(PCNA)标记海马区神经发生水平,ED1标记小胶质细胞激活情况,TUNEL标记海马区神经细胞凋亡情况.采用Real-time PCR法检测脑组织TNF-α、IL-1β表达水平的变化;酶联免疫吸附法(ELISA)检测照射后不同时间点血浆TNF-α水平的变化.结果 照射后急性期表现为间质水肿,炎性细胞浸润,海马区齿状回神经细胞逐渐出现变性、坏死、凋亡,慢性期间质水肿消退,炎性细胞减少,海马齿状回出现细胞再生呈极性分布.受照后各时间点,DCX阳性细胞和PCNA阳性细胞较对照组均有不同程度减少(F =4.9 ～12.5,5.2～15.7,P＜0.05),受照后ED1阳性细胞较对照组增多(F=20.8,P＜0.05).TUNEL标记凋亡神经元在放疗后6h可见,于48 h达到峰值(F=15.1,P＜0.05);照射后0.5h,γ-H2AX焦点形成达到高峰(F=18.4,P＜0.05),后逐渐减少.照射后脑组织TNF-α和IL-1β表达较对照组均有所增加(t=16.3、12.7,P＜0.05);血浆TNF-α照射后3h开始升高,至1周达到峰值(F=10.5,P＜0.05),随后逐渐降低.Morris水迷宫实验照射组和对照组相比,照后1、2、3d两者差异无统计学意义,但随着时间的延长,4、5、6d照射组躲避潜伏期较对照组延长(F=7.01、8.17、4.22,P＜0.05).结论 10 Gy全脑照射后,建立放射性脑损伤模型,发现海马区神经发生受到抑制和小胶质细胞激活可能是小鼠放射性脑损伤认知损害产生的原因之一.     

The association between RASSF1 gene polymorphisms and lung cancer susceptibility among people in Hubei Province of China

The relationship between Ala/Ser polymorphism in 133 codon of exon 3 region of the RASSF1 gene and genetic susceptibility of lung cancer in Hubei province Han population was investigated by a case-control study. Polymerase chain reaction-restriction fragment length polymorphism （PCR-RFLP） technique was adopted to analyze the polymorphism of codon 133 of exon 3 in the RASSF1 gene of 100 pathologically diagnosed lung cancer patients, and 100 healthy controls. The relationship between different genotypes and the susceptibility of lung cancer was analyzed. Among 200 blood samples from Han people in Hubei Province, including 100 from lung cancer patients and 100 from healthy controls, the frequencies of Ala/Ala, Ala/Ser, Ser/Ser genotype of the RASSF1 in lung cancer patients were 83%, 16%, 1%, and those in healthy controls was 93%, 7%, 0% respectively, with the difference being statistically significant between two groups （P〈0.05）. The individuals with Ala/Ser genotype had higher risk of suffering from lung cancer, with an OR of 2.341, and 95% CI of 1.009-6.393 respectively. It was concluded that RASSF1Ala133Ser was a susceptible genetic factor of lung cancer. Ala/Ser genotype increased the risk of lung cancer.     

Association between CHRNA3 rs1051730 genotype and lung cancer risk in Chinese Han population: A case-control study

Recent population-based genome wide association studies have revealed potential suscepti- bility loci of lung cancer at the region of chromosome 15q25.1 containing nicotinic acetylcholine re- ceptor genes. The loci increasing lung cancer risk has been widely identified in Caucasians, but whether this association also exists in Asians and whether this association is a direct role or mediated via tobacco smoking indirectly has not been fully established. We conducted a case-control study comprising of 210 histologically confirmed lung cancer cases and 200 healthy controls to examine rsl051730 genotyping, a single nucleotide polymorphism receiving much attention recently, and its influence on lung cancer risk as well as nicotine dependence in a Chinese Han population. Our results showed that the heterozy- gous C/T genotype and minor allele T conferred a significant higher risk of lung cancer than the CC homozygotes and allele C （adjusted OR=2.25, 95% CI=1.0~4.89, P=-0.040 and OR=2.18, 95% CI=1.02~4.67, P=0.045 respectively）. However, no association between the smoking habit and the CHRNA3 rs1051730 polymorphism was observed in this study. The results suggested that the rs1051730 polymorphism may modify susceptibility to lung cancer via a smoking-independent manner among Chinese Han population. Additional studies in vitro and in vivo are warranted to further elucidate the impact ofrsl051730 on lung cancer susceptibility.     

原发性颅内生殖细胞瘤治疗进展

颅内原发性生殖细胞瘤是一种相对少见的颅内胚胎性肿瘤,随着诊断水平的提高以及对原发于中枢神经系统的生殖细胞肿瘤的生物学行为认识的深入,绝大多数孤立性的颅内生殖细胞瘤治疗模式已发生转变。全文对原发性颅内生殖细胞肿瘤的治疗争议和治疗进展作一评析。     

CR与屏(铜)-片成像在头颈部肿瘤放疗射野影像验证中的比较应用

目的 评价计算机X线摄影(CR)与屏(铜)-片成像在头颈部肿瘤放疗射野影像验证中的应用价值.资料与方法 40张验证片中,20张采用传统屏(铜)-片摄影,20张采用CR摄影.由4名观察者分别对其进行评价,评价标准参照欧共体提供的影像标准,分"可见"、"再现"及"清晰再现"三级,取其平均百分比.采用SPSS 11.0统计软件包对观察者之间的一致性作方差分析.结果 CR的"可见"率为18.75%,"再现"率为71.25%,"清晰再现"率为10%;屏(铜)-片的"可见"率为71.25%,"再现"率为28.75%,"清晰再现"率为0.对比分析有意义的"再现"率与"清晰再现"率之和,CR组为81.25%,而屏(铜)-片组仅为28.75%.单因素方差分析结果显示观察者之间的一致性无统计学意义(P＞0.05).结论 CR成像在头颈部肿瘤放疗射野影像验证中较屏(铜)-片成像具有更好的显示效果.     

环磷酰胺致大鼠性腺损伤自由基机制的实验研究

大量临床资料表明,环磷酰胺(CTX)是治疗小儿难治性肾病最有效的药物之一.由于其对性腺的毒性作用,尤其对男性精原细胞的影响,而限制了该药在临床上的有效应用.因CTX致性腺损伤的机理不明,故迄今尚无有效的预防方法.为此,本文研究了CTX致性腺损伤的自由基机制,现将结果报告如下.     

肝素治疗小儿肾病综合征的远期效应

采用无抗凝作用剂量肝素皮下注射治疗小儿肾病综合征２５例，观察了近期疗效与１２～２４月后对皮质激素或环磷酰胺（ＣＴＸ）治疗反应的关系．结果表明，近期对肝素治疗显效但复发以及有效者，今后用激素或ＣＴＸ治疗均可达完全缓解，无效者则效果较差．本文结果表明，肝素治疗的近期疗效可用于预测肾病患儿的远期预后．