南京医科大学七年制临床医学专业人才培养效果评价

通过对毕业生及其培养或用人单位的问卷调查,本文分析了南京医科大学七年制临床医学专业人才培养的成效,以及江苏省医疗卫生事业发展对高层次医学人才的需求.结果 显示,临床实践能力和科研创新能力是医疗卫生事业发展所需要的高层次医学人才的重要能力;在三级甲等医院工作,具有硕士/博士学位、在专业技术岗位的被调查者更加看重医学生的科研创新能力;而在"1年通识教育、4年医学专业教育(含1年临床课程及见习、1年临床通科实习)、2年二级学科轮转"模式下培养的七年制临床医学专业毕业生的临床实践能力较强,但是科研创新能力不足,且学业负担偏重.因此,应当加强对七年制临床医学专业学生科研创新能力的培养和临床实践能力的通科训练.

Abstract：

An evaluation of 7-year medical education program in Nanjing Medical University was performed via questionnaire survey to the graduates and the staff of hospitals in which the graduates work,and the demand for advanced quality of medical graduates in the field of medical health care in Jiangsu Province is further analyzed. The results showed that the capacity for clinical practice and the capacity for research and innovation are the most important, which can meet the demands of health service development for high-level medical talents. The staff working in advanced hospitals, possessing master or doctor degree,or working as medical experts put more emphasis on the ability of the graduates to do innovative scientific research. Through the completed procedure of the 7-year program includes college general education for 1 year, medical education for 4 years ( containing senior clinical clerkship for 1 year and internship for 1 year) and alternation for medical and surgery subspecialties for 2 years, the graduates showed higher ability to do clinical practice, but not showed the growth of capacity for research and innovation. The most staff investigated proposed an enhancement in training for the capacity for innovative research and general clinical practice.     

Advances in nutrition care of children with neoplastic diseases: a review of treatment, research, and application

Within the last decade, significant advances have been made both in treating children with cancer and in providing proper nutrition support. Oncologic treatment and nutrition research and their application to the nutrition care of children with cancer are reviewed. Quality nutrition care is now possible because of an improved understanding of (a) the prevalence and significance of protein-energy malnutrition (PEM) in high-risk groups, (b) the staging and assessment of nutritional status, and (c) the efficacy and limitations of nutrition support options. Nutrition staging, assessment, and support should be integrated into treatment protocols for children with neoplastic diseases. Common risk factors for the development of PEM have been identified from serial monitoring of newly diagnosed children with a variety of tumors. Certain tumor types and their treatment can be classified within either low or high nutritional risk groups. A comprehensive nutrition program (intense nutrition counseling, favorite nutritious foods) is preferred for low nutritional risk groups but is ineffective in preventing or reversing PEM in high-risk groups. For high-risk patients, central parenteral nutrition (CPN) is the method of choice as a relatively short-term but important support measure that allows children to withstand long intervals of intense treatment during periods of growth and development. Current data suggest that bone marrow suppression may be attenuated and treatment tolerance improved with the use of CPN in selected children with advanced cancer (e.g., acute nonlymphocytic leukemia or advanced neuroblastoma).     

Primary Ewing sarcoma: follow-up with Ga-67 scintigraphy

While avid accumulation of gallium-67 citrate and technetium-99m methylene diphosphonate (MDP) occurs initially in most cases of primary Ewing sarcoma, uptake after therapy is less well defined. Thirty patients with Ewing sarcoma who underwent Ga-67 and bone scintigraphy at diagnosis, at completion of therapy, and at relapse from 1978 to 1988 were evaluated. All 30 patients showed less primary site Ga-67 activity following therapy. Twenty-three of 28 patients who underwent corresponding bone scintigraphy showed less uptake, but residual activity was usually more intense than with Ga-67. Avid reaccumulation of Ga-67 occurred in four of five patients with primary site relapse, while patients who underwent bone scintigraphy showed less change. It was concluded that a greater decrease in Ga-67 than in Tc-99m MDP uptake often occurs in patients successfully treated for primary Ewing sarcoma. Information obtained at Ga-67 scintigraphy is most likely to be helpful if results of bone scintigraphy remain abnormal or if occult relapse is suspected.     

紫草剂量与用药时间对药物流产临床效果的影响

本文对药物流产时在不同时间加用不同剂量的紫草对药物流产效果的影响进行探索。紫草的加用时间为米索前列醇 (简称米索 )应用前 3d、后 3d及前后共 6 d,剂量分别为 5 0 g、75 g和 1 0 0 g。 1 35 0例早孕妇女分成 9个研究组进行观察。结果表明 :在米索应用前 3d和前后 6 d加用紫草效果较米索应用后 3d加用紫草在完全流产率和出血时间两方面效果明显改善 (P均 <0 .0 5 )。紫草用量 5 0～ 1 0 0 g时流产效果与紫草剂量无明显相关。因此我们认为药物流产时在应用米索前紫草与米非司酮同时应用效果较好 ,剂量以5 0 g较为合理     

脾切除对结直肠癌切除术后的影响：一项多中心、嵌入式、配对队列研究

目的探讨医源性脾脏损伤脾切除对结直肠癌切除患者术后长期生存的影响。方法对1990年1月1日至1999年12月31日10年间行结直肠癌手术切除并附带脾切除患者进行病例配对回顾研究。分析患者年龄、性别、依据美国麻醉学医师协会（ASA）标准评估的身体状况、疾病分期、手术类型及预后等资料。配对病例来自同一医疗中心，性别、年龄、疾病分期及手术类型完全相同。手术附带脾切除患者为试验组，未切脾者为对照组。结果55例患者行医源性脾切除术，对照组在年龄、性别、身体状况、疾病分期及手术类型上与之匹配。随访时间（从手术开始到患者死亡或者最后一次随访1为2～205个月（中位随访时间为43个月）。Cox比例危险度模型进行Kaplan-Meier法生存分析发现两组间差异有显著性意义，不切除脾脏对患者生存有利（危险度1．8，95％可信区间为1-3．3，P=0．0399），未切脾组与切脾组5年生存率分别为70％和47％，10年生存率分别为55％和38％。结论结直肠癌患者在行结肠或直肠切除时，因医源性脾脏损伤而切除脾脏者，预后较差。     

The comparative responses of human polymorphonuclear leukocytes obtained by counterflow centrifugal elutriation and Ficoll-Hypaque density centrifugation. I. Resting volume, stimulus-induced superoxide production, and primary and specific granule release

Standard isolation techniques for the human polymorphonuclear leukocyte (PMN) involve sequential exposure of cells to the nonphysiologic environments of dextran, Ficoll-Hypaque (FH) gradient centrifugation, and hypotonic conditions. It has been suggested that these may be harmful to the recovered PMN. Counterflow centrifugal elutriation (CCE) allows separation of human PMNs while the cells are continuously bathed in a physiologic and isotonic buffer. To investigate whether preparative technique may alter PMN activation, we compared PMNs obtained by these two methods for stimulus-induced superoxide production and release of primary and specific granule contents. Resting PMN volume was also evaluated. We observed that PMNs obtained using the CCE method were larger and released significantly more superoxide and specific granule contents than PMNs obtained by the standard FH technique. The possible origins for these differences are discussed.     

The alteration of superoxide dismutase, catalase, glutathione peroxidase, and NAD(P)H cytochrome c reductase in guinea pig polymorphonuclear leukocytes and alveolar macrophages during hyperoxia.

Superoxide dismutase, catalase, glutathione peroxidase and NAD(P)H cytochrome c reductase were quantitated in polymorphonuclear leukocytes (PMN) and alveolar macrophages (AM) obtained from guinea pigs exposed up to 90 h to 85% oxygen. PMN and AM were sonicated and separated into a 16,000-g pellet, a 100,000-g pellet, and a 100,00-g supernate. Superoxide dismutase activity increased in both cells within 18 h, persisted for 66 h and decreased by 90 h. The highest rate of increase was in the 100,000-g pellet containing 3.4% of total enzyme activity in PMN but 28% in AM. The enzyme induction in PMN and AM was partially inhibited by daily intracardiac injections of 50 mg/kg actinomycin D. During oxygen exposure, catalase activity in PMN and AM decreased to 60% of its original activity, and gluthathione peroxidase was reduced in PMN to 60% and in AM to 20% of control values. Although NAD(P)H cytochrome c reductase decreased to 50% in PMN, no change was noted in AM. Upon exposure to superoxide anion, purified catalase, the glutathione peroxidase of the 100,000-g supernate, NADH, and NADPH cytochrome c reductases of the 16,000-g pellet decreased to 66+/-5%, 72+/-4%, 52+/-8%, and 40+/-9%, respectively, of their original activity. This inactivation was prevented by 0.1 mg superoxide dismutase. These in vitro observations could explain the decreased catalase and glutathione peroxidase activity demonstrated in vivo that may lead to an intracellular accumulation of hydrogen peroxide. Increased hydrogen peroxide concentrations have been found to inactivate superoxide dismutase thus impairing the first defense mechanism against superoxide anion.     

H-FABP与GPBB早期诊断AMI的价值研究

目的:探讨H-FABP(心肌型脂肪酸结合蛋白)与GPBB(糖原磷酸化酶同工酶)在临床早期诊断急性心肌梗死(AMI)的应用指标及实用价值.方法:选取48例正常人与42例急性心肌梗死病人采用用双抗体夹心ELISA法对急性胸痛的病人在0～1h、1～3h、3～6h内快速检测H- FABP与GPBB.结果:本实验研究结果表明H-...     

SA/hIL21双功能融合蛋白的表达、纯化及生物学活性检测

目的 制备链亲和素(SA)标记的人白细胞介素21融合蛋白(SA-hIL-21),检测其生物学活性.方法 构建hIL21-SA-pET21及pET24a-SA-hIL21质粒,利用大肠杆菌BL21(DE3)表达两种双功能融合蛋白,并利用镍金属螯合层析柱(Ni-NTA)纯化,之后透析复性,Western blotting进行鉴定,最后利用MTT法检测hIL21-SA及SA-hIL21融合蛋白与抗CD3单克隆抗体(anti-CD3)共刺激人外周血淋巴细胞的增殖活性,流式细胞仪分析两种融合蛋白对生物素化的MB49肿瘤细胞的锚定修饰效率.结果 hIL21-SA及SA-hIL21重组融合蛋白在大肠杆菌中实现了高效表达,约占菌体蛋白的30%,经复性后hIL21-SA及SA-hlL21具有了双重活性,即不仅可以与抗CD3单抗共刺激淋巴细胞的增殖,而且具有了SA介导的高效结合已生物素化的MB49肿瘤细胞表面的功能(表面修饰效率95.18%,96.91%).结论 本实验成功研制了具有双重活性的hIL21-SA及SA-hlL21融合蛋白,两种融合蛋白的双功能活性无显著性差异,该项研究为SA/hIL21双功能融合蛋白应用于肿瘤疫苗以及肿瘤局部治疗奠定了基础.