合并门静脉高压症的原发性肝细胞癌发生上消化道出血的风险因素分析

目的 探讨合并门静脉高压症(portal hypertension,PH)的肝细胞癌(hepatocellular carcinoma,HCC)发生上消化道出血的风险因素.方法 回顾性分析2005年1月1日至2009年8月1日收治的231例HCC-PH临床资料.二分类Logistic回归模型行上消化道出血的风险多因素分析.Kaplan-Meier法计算总体生存时间,作Log-rank检验.ROC曲线评估风险因素预测能力.结果 在231例HCC-PH治疗随访共有28例发生上消化道出血,发生后中位生存时间0.8个月(0.10～2.40个月).发生上消化道出血与无上消化道出血者1、2、3年生存率分别为3.57%(1/28)、0%(0/28)、0%(0/28)和21.18%(43/203)、14.29%(29/203)、4.43%(9/203)(P=0.022,0.031,0.605).多因素分析显示AFP界值(P=0.026)和AST≥2N(P=0.004)是HCC-PH发生上消化道出血的风险因素.ROC曲线显示PI≥7.242时,预测HCC-PH发生上消化道的出血灵敏度为81.0%,特异度81.0%,曲线下面积(Area Under the ROC Curve,AUC)为0.828(95%CI,0.698～0.957).不同风险等级病例之间上消化道出血的发生率差异明显(4/151比24/80,P=0.000).结论 上消化道出血是HCC-PH的终末期事件之一,预后不良.AFP界值和AST≥2N是HCC-PH发生上消化道出血的风险因素.风险因素等级划分有助于针对性的筛查和治疗.

Abstract：

Objective To explore the risk factors for upper gastrointestinal haemorrhage (UGH) in hepatocellular carcinoma (HCC) with portal hypertension (PH). Methods We retrospectively reviewed the medical records of 231 patients with HCC-PH treated in our Department from 1st January 2005 to 1st August 2009. The clinicopathologic factors were evaluated for their possible association with UGH in univariate analysis followed by multivariate analysis using Logistic regression model. The overall survival (OS) was calculated by the Kaplan-Meier method. Receiver operating characteristics (ROC) analysis with calculation of the area under the curve (AUC), sensitivity, and specificity were carried out to assess the predictive ability of the independent risk factors. Results Among 247 patients diagnosed with HCC-PH, 231 patients met the inclusion criteria and were entered into this study. UGH occurred in 28 patients (12.12 %, 28/231). Patients suffering from UGH had a higher 30-and 60-d mortality when compared with the non UGH group (53.57% vs. 4.43%, 96.43%vs. 10.34%, P＜0. 001, 0. 001). The 1-,2-and 3-year overall survival (OS) rates in the non-UGH and the UGH groups were 3. 57% (1/28), 0% (0/28), 0% (0/28) and 21.18% (43/203), 14.29% (29/203), 4.43% (9/203), respectively. There was a trend towards a non-significantly statistical difference in long-term (≥3 yr) survival (P=0. 605). UGH had a dismal prognosis with a median OS of 0. 8 months (0. 10-2. 40 months). Multivariate analysis of the risk factors showed elevated alpha-fetoprotein (AFP) (P = 0. 026) and aspartate aminotransferase (AST) more than twice normal (2N)(P=0. 004) were predictive factors, in particular, AST≥2N. A cutoff value (PI≥7. 242) predicted UGH with an AUC of 0.828 (95%CI, 0.698-0.957), sensitivity of 81.0% and a specificity of 81.0%, as calculated from the ROC. Risk score stratification predicted UGH to show a statistically significant difference (P＜0. 001). Conclusions UGH, as one of the end-stage incidents of HCC-PH,had a dismal prognosis. Patients with elevated AFP levels and AST levels above 2N were associated with high risks for UGH and should be monitored carefully or offered prophylactic treatments. Risk score stratification was useful for prediction of UGH.     

烧伤后疤痕增生挛缩畸形21例临床观察

目的：探讨治疗颈部烧伤后疤痕增生挛缩畸形临床效果。方法：回顾性分析我院自2002年6月～2008年6月分别采用了游离植皮和皮瓣修复手术治疗颈部烧伤后疤痕挛缩畸形患者的临床资料。结果：本组游离植皮修复术后14天拆线,皮瓣修复术后7～8天拆线,皮瓣及皮片全部成活。术后6～12月随访皮瓣修复病例颏颈角恢复、功能活动正常。结论：根据患者病情应用游离植皮和皮瓣修复方法治疗颈部疤痕挛缩畸形各有优点,效果确切。     

运用科学发展观构建医学生职业生涯规划教育体系的探讨

科学发展观是坚持以人为本,全面、协调、可持续的发展观.运用科学发展观的理念帮助医学生合理地设计自己的职业生涯规划,是使他们迈向成功人生的重要一步.它可以使医学生正确、科学地认识自我,客观地分析环境;帮助医学生进一步了解社会,树立职业目标;增强医学生的自信心,促成医学生自我目标的实现.本文分析了我国高等医学院校职业生涯规划教育体系建设的现状,并结合辽宁医学院开展职业生涯规划教育工作的经验和发现的问题,提出了运用科学发展观构建医学生职业生涯规划教育体系的建议和措施.

Abstract：

The scientific development ideas insists people-oriented, comprehensive, harmonious and sustainable development. It is the key for medical students to be guided on their career programming according to the scientific development ideas. Through reasonable career programming, medical students can understand themselves and situations so impersonally as to boost up self-confidence, build up career target and achieve it. The author analyses the status on the career programming education of medical universities and colleges in China, and combining the practice of the career programming education in Liaoning Medical University, makes suggestions on building the educational system of medical students' career programming according to the scientific development ideas.     

宫腔镜、腹腔镜在辅助生殖领域中的应用

自首例试管婴儿1978年诞生以来,人类辅助生殖技术(assisted reproductive technology,ART)已经走过了30年的发展历程,现已成为治疗不孕不育症的理想治疗措施之一.随着实验室技术的成熟和临床经验的积累,ART的妊娠率逐年提高,如何进一步提高成功率仍是生殖医学领域积极探讨的主要问题.     

医学教育学硕士研究生课程设置改革与实践

课程是教育最微观、最普通的问题,但它要解决的却是教育中最根本的问题——培养人.在医学教育学硕士研究生培养中,课程设置是关键环节之一,其设计的科学性、合理性直接关系到人才培养质量的高低.本文介绍了目前我国医学院校研究生课程设置的内容,分析了医学教育学硕士研究生课程设置中存在的问题,并结合锦州医科大学的相关实践,提出了医学...     

大学生自卑心理研究现状

综述了近年来大学生自卑心理的多种表现、产生原因、危害.提出了补偿法、领悟法、暗示法、成功性格训练法等对策.     

临床教学基地学生管理工作的现状与思考

高等医学教育担负着培养高级医学人才的重任，临床实习是医学教育的重要组成部分，直接关系到医学生的培养质量。本文通过对我院2002级实习生的实习状况进行抽样问卷调查，分析了临床教学基地的学生管理工作的现状，并针对存在的问题提出了切实可行的对策和建议。     

一种新型单糖类声学造影剂及实验研究

一种新型单糖类声学造影剂及实验研究天津医学院附院心脏科姚翠红，王佩显，丛洪良，王小飞本声学造影剂是在一定条件下，用７５％乙醇重结晶的半乳糖（晶体）和支持液（２０％半乳糖或５％葡萄糖或生理盐水）组成两种物质以一定比例（０．６０一０．７５）混匀后，于镜下...     

地高辛标记探针在斑点杂交检测HBV DNA中的初步应用

应用核酸分子杂交检测血清HBV DNA已成为诊断乙肝病毒(HBV),感染及判断其复制状态的重要手段。由于同位素标记探针的半衰期短及放射性污染等缺陷,限制了该技术的推广应用。生物索标记探针的灵敏度和特异性都不十分理想。本文制备地高辛际记的HBV DNA探针,初步应用于血清斑点杂交,是一种适合临床应用的探针检测技术。     

保护动机干预模式在老年骨质疏松性脊柱骨折患者中的应用观察

目的 探讨保护动机干预模式在老年骨质疏松性脊柱骨折患者中的应用价值.方法 将我院收治的老年骨质疏松性脊柱骨折患者78例随机分为2组各39例,对照组采用常规护理模式,观察组实施保护动机干预模式.比较2组干预前后骨质疏松知识、跌倒风险、自我效能及健康行为评分.结果 2组干预前各项评分差异无统计学意义(P>0.05);干预后,观察组跌倒风险评分明显低于对照组,余下三项评分均明显高于对照组,差异有统计学意义(P<0.05).结论 保护动机干预模式可显著改善老年骨质疏松性脊柱骨折患者的自我效能,增强其对疾病的认知,降低骨折再发风险,值得推广.