胰源性门脉高压症临床诊治分析

目的 探讨胰源性门脉高压症的诊断和治疗方法,总结手术治疗经验,尤其是复杂病例和合并症的处理.方法 总结1990年1月至2006年11月收治的26例病例,行脾切除、胃底贲门周围血管离断术,并对复杂病例的术中应对措施和方法进行回顾性总结.其中7例合并胰腺囊肿者,因囊肿巨大、且不规则无法完整切除而行囊肿空肠Roux-en-Y 吻合;3例因胰腺炎后脾脏与膈肌粘连严重、界限不清,脾脏切除时首先行膈肌局部切开,解剖显露清晰后切除脾脏;2例胰腺肿瘤同时行胰腺体尾部肿瘤切除.结果 除1例术后5 d死于急性心肌梗死,25例获得临床治愈,随访2～15年(平均8年)无复发,无消化道出血.结论 脾脏切除、胃底贲门周围血管离断是治疗胰源性门脉高压症可靠的手术方法,正确诊断、同时处理胰腺原发性疾病及其并发症是治愈胰源性门脉高压的关键.     

现代医学发展趋势下的口腔医学教学改革探索

随着社会经济、科技的进步,我国医学科学迅速发展,使得医学教育模式发生了巨大改变。在现代医学大发展的新形势下,我们应该推进口腔临床医学的教学工作与人才培养模式的改革,处理好医学基础知识教育与临床技能训练的关系,培养学生的创新意识及提高专业英语水平。     

血液透析带教中的审美化教育

在血液透析带教中,要强调审美化教育,培养学生在血液透析工作中寻找美、发现美,塑造美的心灵,加强对血液透析工作的认同,从而在实践中掌握更多的血透知识,更好地为患者服务。对医学生进行医学审美化教育对未来医疗团队的建设、医疗质量的提高及医学科学的发展十分重要。     

吡格列酮对胰岛素抵抗大鼠认知功能及脑组织AGE-RAGE损伤途径的影响

目的探讨吡格列酮（PIO）对高果糖诱发的胰岛素抵抗（IR）大鼠认知功能及脑组织糖基化终末产物（AGEs）-AGEs受体（RAGE）损伤途径的影响。方法45只6～8周龄Wistar大鼠分为正常对照组（NC组）、胰岛素抵抗组（IR组）、吡格列酮组（PIO组）,后两组给予饮用10%的果糖水建立胰岛素抵抗模型,模型成功的PIO组给予吡格列酮干预12周后,采用Morris水迷宫试验检测逃避潜伏期;免疫荧光技术检测脑组织AGEs表达;Western blotting检测脑组织过氧化物酶体增殖物激活受体γ（PPARγ）、RAGE、磷酸化核转录因子-κB(Phospho NF κB)的蛋白表达。结果① IR组与PIO组逃避潜伏期较NC组明显延长,差异有统计学意义(P＜0.01或P＜0.05);PIO组逃避潜伏期较IR组明显缩短,差异有统计学意义(P＜0.01)。②　免疫荧光检测结果显示,PIO组、IR组AGEs表达较NC组明显增强;与IR组相比,PIO组AGEs的表达较弱。③ 与NC组相比,IR组和PIO组磷酸化NF κB、RAGE的蛋白表达升高(P＜0.01),PPARγ表达降低（P＜0.05）;与IR组相比,PIO组磷酸化NF κB、RAGE的蛋白表达明显下降(P＜0.01);PPARγ表达增加（P＜0.05）。结论胰岛素抵抗大鼠脑组织AGEs RAGE系统活性增强可能是脑损害机制之一,吡格列酮能改善胰岛素抵抗大鼠的认知功能,抑制AGEs RAGE通路活性,发挥脑保护作用。     

仙连颗粒治疗特发性血小板减少性紫癜的临床研究

对特发性血小板减少性紫癜(ITP)患者60例子口服仙连颗粒,观测其血小板计教、骨髓巨核细胞及中医不同证型的疗效比较.结果发现,仙连颗粒能够提高血小板数量,改善巨核细胞成熟障碍,对阴虚血热型疗效较好,对血热妄行型疗效较差,对气虚不摄型的作用介于二型之间.     

自尊研究进展

自尊作为个体人格的核心和基础变量而倍受国内外心理学家们的关注。本文在总结以往自尊心理研究的基础上,在自尊的本质、类型及心理机能等方面进行了理论综述;从目前我国自尊研究存在的问题出发,提出今后我国的自尊研究要注重对自尊本质的深入探讨、进一步完善研究方法、拓展自尊应用研究的领域和重视跨文化研究。     

舒血宁注射液治疗老年急性脑梗死44例临床观察

目的通过临床观察，对舒血宁注射液治疗老年性脑梗死的疗效及安全性进行评价。方法选择发病48h内、年龄〉60岁的急性脑梗死病例88例，随机分为治疗组和对照组，治疗组44例，给予舒血宁注射液20ml加入生理盐水250ml中静脉滴注，1次／d，14d为1个疗程。对照组44例，给予复方丹参注射液20ml加入生理盐水250ml中静脉滴注，1次／d，14d为1个疗程。其余常规治疗相同。结果治疗组疗效明显优于对照组。治疗后治疗组血液流变学指标有显著性改变。结论舒血宁注射液治疗老年性脑梗死安全有效。     

胃癌患者外周血EGFRmRNA的研究

目的检测胃癌患者外周血中EGFR并分析其临床病理联系。方法应用RT-PCR检测57例胃癌患者及30例健康人外周血EGFRmRNA。结果30例健康对照组外周血EGFR均为阴性。胃癌患者组EGFRmRNA表达24例。EGFRmRNA表达阳性在TNM分期中为Ⅰ期3例,Ⅱ期3例,Ⅲ期13例及Ⅳ期5例(P<0.05,Ⅰ,ⅡvsⅢ,Ⅳ)。胃癌病理上在低未分化及中高分化癌间经χ2检验有显著差异。结论RT-PCR方法检测胃癌患者外周血中EGFRmRNA表达与其临床及病理分期相关。此项指标检测可作为胃癌治疗及预后的参考指标。     

Reliability and validity of addiction severity index in drug users with methadone maintenance treatment in Guizhou province, China

Objective To evaluate the reliability and validity of the Chinese version of addiction severity index （ASI）-5th version （ASI-C-5）, in illegal drug users receiving methadone maintenance treatment （MMT） in China. Methods One hundred and eighty-six heroin addicts （144 men and 42 women） receivihg MMT at three clinics in Guizhou province, southwest China, were recmited. They were all interviewed with a questionnaire of ASI-C-5 and 35 were re-interviewed at an interval of seven days to assess its test-retest reliability. Results Cronbach＇s alpha for internal consistency of CSs varied from 0.60 to 0.81 in all domains. Test-retest reliability of composite scores （CSs） of ASI-C-5 were satisfactory （r=0.38-0.97）. Based on item analysis and expert＇s suggestions, five items were deleted and one item was modified in ASI-C-5. Criterion validity of ASI-C-5 was found acceptable, as compared to addicts＇ self-rating anxiety scale （SAS） and self-rating depression scale （SDS） （r=0.59 and 0.45） except for social support rating scale （SSRS）. Conclusions ASI-C-5 can be used for heroin addicts receiving MMT with acceptable reliability and validity.     

Modulation of TLR9 on anti-tumor immune responses of peripheral blood mononuclear cells from patients with non-small-cell lung cancer

OBJECTIVE: To assess the modulation of TLR9 on anti-tumor immune responses in peripheral blood mononuclear cells (PBMC) from patients with non-small-cell lung cancer (NSCLC). METHODS: PBMCs were isolated from 36 NSCLC patients. Lung cancer cells were isolated from these patients and further enriched. PBMCs were cultured in RPMI-1640 medium (blank control group), and medium with cytosine guanine oligodeoxynucleotide (CpG ODN, an TLR9 agonist) or control ODN for 72 h; and then flow cytometry was used to examine the expression of CD69 antigen on the surface of CD3 cells, [3H]-thymidine incorporation method was used to examine the cell proliferation, and the IFN-alpha level in the supernatant was measured. Another PBMCs were cultured in medium with interleukin (IL)-1 and then CpG ODN, control ODN, and CpG ODN + chloroquine or inhibitory ODN were added respectively for 24-48 h. Then the IFN-alpha in the supernatant was measured. Subsets were assessed by flow cytometry and the expression of TLR9-mRNA in freshly isolated PBMC was detected by RT-PCR. The production of interferon (IFN)-alpha in the PBMCs was measured by ELISA. The proliferation of the PBMCs was determined by [3H]-thymidine incorporation. The PBMCs co-cultured with CpG ODN and autologous lung tumor cells treated with mitomycin C were used as effector cells, and K562 cells and autologous tumor cells were used as target cells flow cytometry was used to detect the capacity of PBMCs to kill autologous lung tumor cells and K562 cells. Meanwhile we investigated the intracellular expression of IFN-gamma and IL-4 in CD8+ T. RESULTS: The expression level of TLR9 of the PBMCs from patients was not significantly different from that of the PBMCs from the healthy donors. The proportion of CD69 antigen expressing CD3+ T cells of the CpG ODN group was (39.5 +/- 8.9)%, significantly higher than those of the blank control group [(8.8 +/- 1.2)%, t = 40.30, P = 0.00] ands control ODN group [(10.6 +/- 1.0)%, t = 41.85, P = 0.00]. Examination with beta liquid scintillation counter showed that the cpm value of the CpG ODN group was (1.61 +/- 0.20) x 10(4), significantly higher than those of the blank control group [(0.27 +/- 0.14) x 10(4), t = 20.43, P = 0.00] and control ODN group [(0.34 +/- 0.13) x 10(4), t =20.20, P = 0.00]. Chloroquine and inhibitory ODN dose-dependently inhibited the IFN-alpha levels in the supernatant. The CD4 + T/CD8 + T of the CpG ODN group was (3.44 +/- 0.20), significantly higher than those of the control ODN group (1.73 +/- 0.27, t = 19.85, P = 0.00) and blank control group (1.69 +/- 0.13, t = 29.32, P = 0.00). The IFN-gamma positive CD8 + T cells of the CpG ODN group was (18.5 +/- 4.2)%, significantly higher than those of the control ODN group [(4.2 +/- 1.0)%, t = 24.12, P = 0.00] and blank control group [(3.1 +/- 1.2)%, t = 25.1, P = 0.00]. There was no significant differences in the proportion of IL-4 positive CD8 + T cells among different groups. When the E/T was 40:1 the killing capacity of PBMCs against the K562 cells was (19.5 +/- 1.0), significantly higher than those of the control ODN group (7.9 +/- 1.1, t = 19.9, P = 0.00) and blank control group (5.1 +/- 1.6, t = 21.9, P = 0.00), and the killing capacity of PBMCs against the autologous lung tumor cells was (29.8 +/- 2.1), significantly higher than those of the control ODN group (8.1 +/- 0.9, t = 36.9, P = 0.00) and blank control group (5.7 +/- 1.6, t = 35.7, P = 0.00). CONCLUSION: TLR9 signal takes part in the immunomodulation of PBMCs. The activation of TLR9 results in enhanced anti-tumor response in the PBMCs against autologous lung cancer cells and K562 cells.