慢性胰腺炎并发门静脉高压症

目的：探讨慢性胰腺炎并发门静脉高压症的诊断和治疗。方法：回顾性分析我院1990年3月至2005年10月收治的慢性胰腺炎所致的胰源性门静脉高压症21例，其中左侧门静脉高压症16例，肝前型门静脉高压症5例。其诊断依据主要依靠多普勒超声．CT和MR等影象学检查和上消化道内镜检查．肝前性门静脉高压症有时须行MRA或肠系膜上动脉血管造影。治疗左侧门静脉高压症可行脾切除术，肝前型门静脉高压症有出血史者可行肠系膜上静脉、下腔静脉分流术．必要时加行脾切除术。结果：21例均获随访，随访时间1～5年．患者恢复良好．脾亢纠正，15例行上消化道内镜复查，曲张静脉？肖失或仅有轻度曲张。10例有出血史者未再发性出血。结论：注意慢性胰腺炎所致的胰源性左侧门静脉高压症的诊断治疗的同时应注意SMV—PV阻塞所致的肝前性门静脉高压症的诊治。     

大学英语词汇教学探索

本文着重强调词汇在大学英语教学中的重要性,探讨了大学英语词汇教学的内容及核心,并且根据自己的教学实践,阐述了有效的词汇教学方法不仅能极大促进学生对词汇的记忆和掌握,同时还有助于提高学生其他方面的能力.     

The early risk stratification of the patients with acute chest pain

Objective: This investigation was designed to stratify patients with acute chest pain based on their symptoms, electrocardiogram (ECG), cardiac injury markers and the number of accompanying traditional risk factors(smoking, obesity, hyperlipemia, hypertension, diabetes), and to assess the effect of the above factors to obtain a risk stratification for patients with chest pain. Methods: We identified 139 patients with acute chest pain, including 45 myocardiac infarction patients, 65 unstable angina patients and 29 chest pain patients without identified acute coronary syndrome(ACS) admitted to our Coronary Heart Center during December 2004 to February 2005. All patients accepted coronary angiography. All data was collected using questionnaires. Based on reported symptom, electrocardiogram (ECG), cardiac injury markers and the number of the accompanying traditional risk factors, we stratified all patients into four groups: Group 1, patients with acute chest pain, ECG changes and abnormal cardiac injury biomarkers. Group 2, patients with acute chest pain and ECG changes(without abnormal cardiac injury biomarkers). Group 3, patients with acute chest pain, normal ECG, normal cardiac injury biomarkers and >2 traditional risk factors. Group 4, patients with acute chest pain, normal ECG and normal cardiac injury biomarkers, but only≤2 traditional risk factors. From this data we examined the difference of ACS incidence in the four groups. Results:After stratification the ACS incidence of the grouped patients in turn was 100%, 84%, 69.6% and 53.3%. The combination of early phase ECG and cardiac injury markers identified 70.9% patients with ACS(the specificity being 90.7%). The mortality of group 3 was higher compared with group 4(69.6% vs 53.3%), however the P value was more than 0.05 and didn’t show significant statistical difference. The correlation analysis found the number of the traditional risk factors had a significant positive correlation (r = 0.202, P = 0.044) with the number of stenosis being more than 50% of the artery diameter. Multiple linear regression showed the hypertension had a significant correlation with the number of the diseased regions(P = 0.014). Conclusions:The risk stratification based on the symptom, ECG, cardiac injury markers and accompanying traditional risk factors is both important and available in practice. It is unsuitable for patients with a normal ECG and cardiac injury markers to differentiate ACS from non-cardiac chest pain relying only on the number of the accompanying traditional risk factors. However we found the number of the risk factors can indicate the disease severity.     

Detection of pim-1 mRNA in prostate cancer diagnosis

Background Pim-1 plays an important role in the apoptosis, proliferation, differentiation of cancer cells and progression of cancer. In this study we detected the expression of pim-1 mRNA in normal prostate, benign prostatic hyperplasia (BPH), and prostate cancer (PCa) and explored its diagnostic value for PCa.Methods The prostate tissues were collected from 23 patients with PCa, 37 patients with BPH, and 3 healthy volunteers. Pim-1 mRNA expression levels in these samples were determined by the quantitative real-time PCR (QRT-PCR). The differences of expression were calculated based on a standard curve.Results The ratio of pim-1 mRNA to β-actin in the normal prostate, BPH, and PCa were 1.05±0.04, 2.57±0.74 and 4.45±0.63, respectively. The differences among PCa, BPH and NT were significant (P<0.05, respectively).Conclusion Detecting pim-1 mRNA expression by QRT-PCR provides a reliable metric for the diagnosis of PCa.     

粒细胞-巨噬细胞集落刺激因子联合乙肝疫苗增加抗HBs应答率研究

目的 研究粒细胞-巨噬细胞集落刺激因子联合乙肝疫苗能否提高抗-HBs应答率.方法 对61例乙肝疫苗初次接种失败病例增加乙肝疫苗剂量,并对其中28例接种前24h注射GM-CSF作为研究观察组.结果 研究组和对照组的抗-HBs阳性率分别为82.1%和27.3%,两者差异有显著性,x2=18.12,P＜0.005.结论 乙肝疫苗接种前注射GM-CSF可以提高抗-HBs的应答.     

高盐饮食对海岛地区胃食管反流病患病率的影响

目的调查了解舟山市胃食管反流病(GERD)的患病率和高盐饮食对患病率的影响。方法2004年6月~2005年6月采用随机抽取门诊患者的方法,对舟山市18岁以上的常住城乡居民1578例,进行反流性疾病问卷(reflux diagnostic questionnaire,RDQ,又称耐信量表)调查。我们以RDQ评分>12分作为GERD的诊断标准,将RDQ评分≤12分设定为非GERD病人,以这段时间内有反流症状人群的检出率代表患病率。结果共1578例完成筛查,以上RDQ评分>12分共148例,占总调查人数的9.41%,RDQ评分≤12分1430例,占91.58%。胃食管反流相关因素的研究Logistic多元回归分析显示,饮食特别是经常进食高盐饮食(OR=2.781)与GERD的患病关系较大。结论对海岛地区与GERED调查的结果显示,高盐饮食和GERED密切相关。     

心肺联合移植治疗艾森曼格综合征二例

目的总结心肺联合移植术治疗艾森曼格综合征的围术期经验。方法对2例先天性心脏病合并艾森曼格氏综合征患者施行同种异体原位心肺联合移植术。采用改良St．Thomas心脏停搏液和改良LPD液保护供体心肺。小心去除患者心、肺,胸腔及纵隔彻底止血后,置入供体心肺,采用双腔静脉术式,依次吻合气管,上、下腔静脉和主动脉。术后对患者进行密切监护,积极防治排斥反应和感染,及时处理并发症。结果手术均获成功。气管吻合口狭窄,经气管袖式切除后改善。目前2名患者均恢复正常工作生活。结论良好的心肺保护,精细的手术操作和正确的术后处理是心肺联合移植成功的关键。     

乳腺癌钼靶X线表现与c-erbB-2,ER,PR蛋白表达的相关性

目的:探讨乳腺癌患者钼靶X线表现与癌基因蛋白表达之间的相关性.方法:收集术前行钼靶X线检查且临床资料完整的乳腺癌患者83例,用链霉菌抗生物蛋白-过氧化酶免疫组织化学法(S-P法)检测c-erbB-2,ER,PR基因的表达,分析钙化、结构扭曲、肿块征的影像表现与c-erbB-2,雌激素受体(ER),孕激素受体(PR)的关系.结果:钼靶X线表现:单纯肿块39例(47.0%),单纯钙化17例(20.5%),结构扭曲13例(15.7%),肿块 钙化9例(10.8%),扭曲 钙化5例(6.0%).病变有钙化组c-erbB-2基因的阳性表达率71.0%(22/31),无钙化组的阳性表达率42.3%(22/52),二者之间的差别有统计学意义(χ2=6.040,P=0.01).结构扭曲组ER的阳性表达率28.6%(4/18),低于非结构扭曲组ER的阳性表达率47.7%(31/65),二者的差别有统计学意义(Fisher's精确检验,P=0.045).肿块组PR阳性表达率27.1%(13/48)低于非肿块组PR的阳性表达率48.6%(17/35),二者的差别有统计学意义(χ2=4.049,P=0.044).结论:乳腺癌钼靶X线征象与基因蛋白的异常表达有一定的相关性.     

CDIO结合集束化培训应用于临床心肺复苏教学的研究

目的　探讨构思（conceive）、设计（design）、实现（implement）和运作（operate）（CDIO）结合集束化培训模式应用于临床心肺复苏教学的价值研究。方法　将南部战区总医院2019年1月至2020年11月108例实习生纳入研究对象,按照简单随机数字表法分为对照组（n=54）和观察组（n=54）。对照组采用集束化培训模式进行心肺复苏教学,观察组采用CDIO结合集束化培训模式进行心肺复苏教学。比较两组实习生的理论成绩、操作成绩、综合能力、胸外按压质量及心肺复苏时间,并评估两组实习生岗位胜任力得分情况及满意度。采用SPSS 22.0软件进行t检验和卡方检验。结果　观察组理论成绩、操作成绩、综合能力得分均高于对照组;与培训前比较,观察组按压深度、按压频率、胸廓回弹速率均高于对照组;观察组发现患者无意识到判断无脉时间、出现室颤至启动自动体外除颤器（automated external defibrillator,AED）时间、完成AED时间均低于对照组;观察组实践能力、评判性思维能力、协调能力、职业发展能力、心理特质5个维度评分及岗位胜任力总分均高于对照组（P<0.05）;观察组对带教教师、实习内容、实习形式、实习效果等满意度均高于对照组（P<0.05）。结论　CDIO结合集束化培训应用于临床心肺复苏教学可提高实习生的理论成绩、操作成绩以及综合能力,改善胸外按压质量、心肺复苏时间,使实习生具备良好的沟通能力和岗位胜任力,提升实习生的满意度。     

回馈教学法对老年2型糖尿病患者胰岛素注射依从性的应用效果评价

目的将回馈教学应用到老年2型糖尿病离退休老干部患者胰岛素注射教育中,探讨回馈教学法对其胰岛素注射依从性的影响。方法 2019年4月1日-2020年7月31日在北京市某医院干部门诊采用随机数字表法选取2型糖尿病的离退休老干部200例,分为观察组100例和对照组100例。对照组给予常规的胰岛素注射教育,观察组在对照组基础上增加回馈教学法,2组患者均于健康教育后第12周门诊复查时采用自行设计的胰岛素注射依从性问卷测评胰岛素注射依从性,同时收集其血糖控制达标率,采用2样本均数t检验对其胰岛素注射依从性及血糖水平进行对比。结果 2组胰岛素注射依从性比较,对照组依从性高者占73%,依从性中者占18%,依从性低者占9%,观察组依从性高者占87%,依从性中者占9%,依从性低者占4%,对照组胰岛素注射依从性低于于观察组,差异有统计学意义(P<0.05);2组血糖控制比较,对照组空腹血糖8.24±2.13,餐后2h血糖12.15±2.83,糖化血红蛋白9.18±2.14,观察组空腹血糖6.81±1.21,餐后2h血糖9.55±2.25,糖化血红蛋白7.12±1.36,观察组血糖控制达标率高于对照组,...