口腔精准医学：现状与挑战

精准医学是人类基因组计划的延续,是医学发展的必然产物,是一种考虑人群基因、环境及生活方式个体差异的促进健康和治疗疾病的新兴医学模式。本文首次提出口腔精准医学的概念,以口腔典型疾病为例,结合近期的研究成果与学者观点,阐述口腔精准医学对口腔学科发展的指导意义及实现口腔精准医学将面对的机遇与挑战。     

细胞凋亡与胃癌

胃癌是我国最常见的恶性肿瘤之一 ,死亡率占恶性肿瘤的第一位。胃癌的发生与胃粘膜上皮细胞和胃癌细胞凋亡、增殖调控失衡有关。现综述细胞凋亡及凋亡相关基因在胃癌的发生、发展、转归和治疗中的地位及其应用前景     

老年非心脏手术患者术前高敏C反应蛋白与术后心脏不良事件相关性的研究

Objective To investigate the relevance between level of preoperative high-sensitivity C-reactive protein(hsCRP) and the occurrence of postoperative adverse cardiac events in elderly patients underwent noncardiac surgery. Methods 49 patients of more than 65 years that had undergone elective noncardiac surgery were enrolled in the study. And all patients were conformed to the standards of "classification of risk factors for clinical history", content of "Guidelines on Preoperative Cardiovascular Evaluation for Noncardiac Surgery" established by the ACC/AHA .The patients were divided into two groups based on the preoperative hsCRP level:A group:hsCRP ≤ 3mg/L group (n=21) and B group: hsCRP>3mg/L group (n=28). General clinical characteristics of patients were recorded before operation, and 24 hours dynamic ECG was monitored a week prior to and after the operation. All patients taken measures of analgesia after surgery. The incidence of postoperative adverse cardiac events and the hospitalized days was recorded. The distinctions between two groups were analyzed regarding the occurrence of adverse cardiac events and hospitalized days after operation. Results 19 patients had postoperative myocardial ischemia; 4 cases in A group and 15 cases in B group. 7 patients suffered other postoperative adverse cardiac events, including 1 case in A group and the others in B group. There was statistically significant difference considering morbidity of myocardial ischemia in postoperation between the two groups, but there was no statistically significant difference about incidence of other adverse cardiac events and the length of stay in postoperation. Indexes about serious degree of myocardial ischemia:total depression time is(43.5±5.82 )min in A group, is( 135.0±81.2)min in B group. The depression times is(5.2±2.5 )in A group, is( 8.8±3.0)in B group.The longest depression time is( 23.7±9.2)min in A group, is( 84.3±54.1 )min in B group.Total ischemia burden is( 170.1 ±88.8 )mm· min-1 ·24h-1 in A group, is (311.3± 118.8 )mm· min-1 ·24h-1 in B group.There was statistically significant difference between the two groups. Conclusion Level of preoperative hsCRP>3 mg/L was relevant to the incidence of the most common postoperative adverse cardiac events--myocardial ischemia in elderly patients and level of preoperative hsCRP >3 mg/L was one of the risk factors of postoperative myocardial ischemia;Determination of preoperative hsCRP level may improve cardiovascular risk scoring system.     

螺旋CT和MMP-3联合诊断胃癌的浸润和转移

目的 探讨联合应用螺旋CT及患者胃癌组织中MMP-3的表达水平以提高胃癌的浸润和转移的诊断率.方法 应用螺旋CT对患者进行术前诊断;应用免疫组织化学法对胃癌患者MMP-3的表达进行检测.结果 SCT与MMP-3联合诊断胃癌的检出率为(92.31%),明显高于SCT(71.79%)及MMP-3(74.36%)单个指标的检出率.结论 应用SCT与MMP-3联合诊断,诊出率较高,可用于临床判断胃癌的浸润和转移的重要参考指标.     

螺旋CT和MMP-3联合诊断胃癌的浸润和转移

目的探讨联合应用螺旋CT及患者胃癌组织中MMP-3的表达水平以提高胃癌的浸润和转移的诊断率。方法应用螺旋CT对患者进行术前诊断;应用免疫组织化学法对胃癌患者MMP-3的表达进行检测。结果 SCT与MMP-3联合诊断胃癌的检出率为（92.31%）,明显高于SCT（71.79%）及MMP-3（74.36%）单个指标的检出率。结论应用SCT与MMP-3联合诊断,诊出率较高,可用于临床判断胃癌的浸润和转移的重要参考指标。     

自然出版集团纯网络刊办刊模式的研究

本文简述了英国自然出版集团旗下纯网络刊的办刊模式及其现状,对其特点进行了分析,提出了对中国纯网络刊发展值得借鉴的建议。     

影响村卫生室医务人员报告法定传染病因素分析

目的找出村医漏报传染病的原因,为制定相关政策提供依据。方法采用分阶段整群抽样法,从河南省报告水平中等县随机抽出一个平原县和一个山区县作为样本县,每个样本县随机抽4个乡镇作为样本乡,对样本全体村医进行调查,统计分析采用非条件logistic归因分析。结果"接诊过传染病人"、"有乡村医师资格"、"掌握传染病诊断标准数"、"传染病相关知识得分"、"有传染病报告卡"以及"报告传染病没有报酬"均与被调查人是否报告传染病有关。结论诊断传染病的技术水平低,从事防保工作没有报酬以及缺乏必要的报告工具是影响河南省村医报告法定传染病的主要因素。     

实脾散治疗脾肾阳虚型癌性腹水的机理初探

癌性腹水常见于恶性肿瘤的中晚期,易反复,预后差,严重影响肿瘤患者的生活质量,病程日久可出现脾肾阳虚的证型,使用实脾散治疗癌性腹水可起到温阳利水的作用,同时实脾散中的很多药物兼具有抗肿瘤的作用。     

游离皮瓣修复头颈部肿瘤术后组织缺损△

目的 探讨不同游离皮瓣在头颈部肿瘤术后组织缺损修复应用中的优缺点。方法 回顾分析46例经游离皮瓣修复的头颈部恶性肿瘤病例临床资料,其中扁桃体癌11例、下咽癌17例、舌根会厌癌4例、鼻腔鼻窦癌术后放疗后复发14例。根据肿瘤切除术后缺损部位和大小,分别采用前臂桡侧皮瓣、股前外侧瓣和背阔肌皮瓣修复术后组织缺损。结果 46例恶性肿瘤患者,应用前臂皮瓣修复20例,应用股前外侧瓣修复20例,采用背阔肌修复6例。46例游离皮瓣成活42例(91.3%)。修复扁桃体癌术后缺损的11例患者,综合治疗后3年总生存率为72.7%(8/11);修复下咽缺损的17例患者,综合治疗后3年总生存率为64.7%(11/17);全舌加全喉切除术后缺损修复的4例患者,综合治疗后3年总生存率为50%(2/4);14例复发性鼻腔鼻窦癌患者,再次手术后总生存率为21.4%(随访2~5年)。结论 游离前臂皮瓣和股前外侧瓣能满足头颈部肿瘤术后不同大小缺损修复的需求。