直肠癌全直肠系膜切除术后直肠阴道瘘原因与防治

本文通过分析近5年来我院18例女性直肠癌全直肠系膜切除术后直肠阴道痿的临床资料。发现直肠阴道痿多发生于中低位直肠癌行全直肠系膜切除保肛手术的患者。痿的发生与肿瘤的位置、肿瘤的分期、肿瘤距肛门口的距离．以及手术技巧、手术难度、引流方法有关。而与是否进行预防性造口，以及是否采用腹腔镜手术无关。预防上强调应重视术中直肠前壁的锐性分离、结肠直肠吻合以及术后盆腔的负压引流。治疗上应首先进行保守治疗，即肠内营养，阴道冲洗。早期配合肠外营养、及全身或局部抗炎治疗，大部分直肠阴道痿通过保守治疗可以治愈。保守治疗无效时考虑结肠或回肠末端造口。若长期不愈应考虑吻合口肿瘤复发的可能。     

床边检查仪与自动化凝血仪在肝素治疗时凝血功能检验的差异

目的确定床边检查（POCT）仪与全自动凝血仪在肝素治疗时凝血常规检验和监测肝素治疗中的差异。方法以接受肝素抗凝治疗的老年心血管病患者为研究对象,分别使用Hemachron Jr Ⅱ和CG02两种POCT仪器与全自动凝血仪STA-R对比检测血浆凝血酶原时间（PT）,国际标准化比值（INR）,活化部分凝血活酶时间（APTT）和纤维蛋白原含量（Fbg）,并将不同肝素水平的血浆凝血指标进行统计分析。结果干化学法床边检查仪和自动化凝血仪对凝血参数PT、INR、APTT、Fbg的检测具有较好的相关性（r分别为0．945、0．966、0．662和0．977,均P〈0．05）;监测肝素治疗时,Hemachron Jr Ⅱ与自动化凝血仪检测APTT结果差异有统计学意义（P〈0．01）。结论干化学法床边设备不适于与自动化凝血仪同时报告凝血检验结果。     

医学机能实验学教学改革与思考

广州医科大学通过以综合性实验为主体,以学生自主设计性实验、大学生课余创新性实验为支撑,以虚拟仿真实验与实体操作实验相结合的混合式教学模式为重要教学手段,同时结合基于智能模拟人系统开设的"模拟机能实验学"选修课和青少年医学科普教育活动,对机能实验学进行了改革。问卷调查显示,改革对培养学生的综合运用能力、科研素养以及临床和...     

Apoptotic study on the effect of fluorine and selenium on the human hair follicle in vitro

Objective To investigate the methods of isolating and identifying human adipose derived EPCs.Methods The cells obtained from human lipoaspirates were plated on culture dishes coated with human fibronectin and were cultured in DMEM containing 2% FBS.Cells of passage 2 cultured in EGM-2 （2% FBS） served as the induced cells （experimental group）,with cells cultured in DMEM （2% FBS） as the noninduced cells （control group）.     

金红石型钛白粉表面包覆氧化铝的形态及机理

探讨了以H2SO4和CH2OHCH2Cl为酸解介质时,氯化法金红石型钛白粉表面包铝的行为及形态特征。利用正交实验研究了包膜过程中,熟化pH、熟化时间以及温度对包铝钛白粉白度的影响。氯化法金红石型钛白粉浆在pH为10时,Zeta电位最大,在水中达到最佳分散,利用H2OHCH2Cl作为酸解介质时,浆液中的均相成核得到显著抑制,钛白粉表面的包膜质量得到明显改善。以稀硫酸作为酸解介质时,随熟化温度升高和熟化时间的延长,钛白粉包覆效果明显改善,白度值明显升高。     

The clinical and pathological characteristics of Chinese patients with pauci-immune crescent golmerulonephritis

Objective　To investigate the clinical and pathological characteristics of pauci-immune crescent glomerulo～nephritis (PICGN) in Chinese patients. Methods　During 13 years (1985-1998), 6400 patients underwent non-transplanting renal biopsy. Twenty-four patients were diagnosed as PICGN. All clinical and laboratory data of these patients were collected from the patients’ records and used for detailed analysis. The diagnosis is based on clinico-pathologic findings. Results　Of the 24 patients, 16 were females and 8 were males, with median age of 33 years (ranged 10-76 years). Microscopic polyarteritis (MPA) (33.3%) and systemic vasculitis (8.3%) were the secondary diseases. The incidence of PICGN was 0.38% in renal biopsies and 22.9% in crescentic glomerulonephritis. Clinically, most patients (75.0%) showed rapidly progressive nephritis with enlarged kidneys. At onset, gross hematuria was noted in 58.3% of patients, hypertension in 45.8%, nephrotic syndrome in 41.7%, and oliguria in 25.0%. However, systemic symptoms were rare except for anemia. Pathologically, necrosis of glomerular capillaries (62.5%), infiltration of monocytes and neutrophil cells in glomeruli (66.7%), and vasculitis in the interstitium (53.3%) were observed. In addition, glomerulosclerosis was noted in 45.8%, severe tubular atrophy in 83.3% and interstitial fibrosis in 75.0%. Anti-neutrophil cytoplasmic antibodies (ANCAs) were positive in 52.2%. All patients except two received intensively immunosuppressive therapy. Sixteen patients were available for long-term follow up (median 29.8 months, range 8-92 months). Twelve of them had life-sustaining renal function, four had normal serum creatinine (<124?μmol/L) and only 4 patients were dialysis-dependent. Conclusion　PICGN is not rare in China. Early diagnosis and administration of immunosuppressive therapy, particularly in patients with rapidly progressive glomerulonephritis (RPGN), are important for good prognosis.     

Problems for clinical judgement: 4. Surviving in the report card era

HEALTH CARE REPORT CARDS INVOLVE COMPARISONS of health care systems, hospitals or clinicians on performance measures. They are going to be an important feature of medical care in Canada in the new millennium as patients demand more information about their medical care. Although many clinicians are aware of this growing trend, they may not be prepared for all of its implications. In this article, we provide some historical background on health care report cards and describe a number of strategies to help clinicians survive and thrive in the report card era. We offer a number of tips ranging from knowing your outcomes first to proactively getting involved in developing report cards.     

MAP4K4在胰腺癌中的表达及增殖功能的研究

目的：检测丝裂原激活蛋白激酶4（MAP4K4）在胰腺癌中的表达及意义,并研究其对胰腺癌细胞增殖功能的影响。方法：检索GEPIA和Oncomine数据库,分析MAP4K4在胰腺癌以及正常胰腺组织中的表达;检索GEPIA和OncoLnc数据库,分析MAP4K4的表达量与胰腺癌患者生存期之间的关系。免疫组化检测MAP4K4在人胰腺癌及癌旁组织中的表达并分析其与胰腺癌患者临床病理参数的相关性以及生存分析。qRT?PCR和Western blot检测MAP4K4在人胰腺癌细胞株中的表达。慢病毒感染人胰腺癌细胞株CFPAC?1和MIA PaCa?2构建MAP4K4过表达及干扰细胞株,CCK?8和克隆形成实验研究其增殖能力变化。结果：GEPIA和Oncomine数据库显示MAP4K4在人胰腺癌中的表达显著高于正常胰腺组织（P＜0.01）。GEPIA和OncoLnc数据库表明胰腺癌中高表达MAP4K4组患者的总体和无病生存期显著低于低表达组患者（P＜0.01）。免疫组化表明MAP4K4在人胰腺癌组织中的表达高于癌旁组织并与肿瘤大小、肿瘤分化相关（P＜0.05）,生存分析提示MAP4K4高表达的胰腺癌患者生存时间显著低于MAP4K4低表达的患者（P＜0.05）。MAP4K4过表达及干扰胰腺癌细胞株构建成功,过表达后胰腺癌细胞株增殖能力明显增加而干扰后显著降低（P＜0.05）。结论：MAP4K4在胰腺癌中表达增高并与预后负相关,且促进胰腺癌细胞增殖。     

双导师制教学在心血管内科住院医师规范化培训中的应用

目的　探讨双导师制教学在心血管内科住院医师规范化培训中的应用效果。方法　分别选取我院心血管内科在2016年1至12月和2017年1至12月期间接收的规培医师各40人作为对照组和观察组。对照组采用传统的带教模式;观察组采用双导师制培养模式,即给每名规培医师指派一名理论导师和一名技能导师,按照教学组制定的教学计划展开带教培养,轮转结束后对培训效果进行问卷调查,并与往年传统带教模式的培训效果进行对比分析。采用SPSS 20.0进行非参数Mann-Whitney检验。结果　双导师制培养模式下,规培医师对心内科常见疾病的理论知识和临床技能的掌握情况明显改善,观察组医师的理论知识完全掌握率达42.5%、临床技能完全掌握率达35.0%,均明显优于对照组医师的15.0%和12.5%,差异有统计学意义（均P＜0.05）;观察组医师的医患沟通能力提高效果（明显提高+有一定提高）显著优于对照组（92.5% vs. 77.5%,P<0.05）、对培训的满意度（非常满意+比较满意）显著高于对照组（82.5% vs. 60.0%,P<0.05）;82.5%的观察组医师认为培训安排合理,明显高于对照组的52.5%（P＜0.05）。结论　双导师制教学在心血管内科住院医师规范化培训中的应用效果确切,有助于提高规培医师对专业知识和技能的掌握程度,提高医患沟通能力,对规培带教教师和规培教学安排更满意,值得推广应用。     

老年晚期非小细胞肺癌外周血RRM1 表达与吉西他滨疗效及预后的相关性研究

目的 探讨老年晚期非小细胞肺癌（non-small cell lung cancer,NSCLC）外周血中核苷酸还原M1（RRM1）的表达水平与吉西他滨化疗疗效及预后的相关性。方法 通过实时荧光定量聚合酶链反应方法（qRT-PCR）检测40 例老年晚期NSCLC 患者外周血中RRM1 的表达水平,并对临床特征、吉西他滨化疗的疗效及预后的关系进行分析。结果 外周血RRM1 的表达水平与性别、组织学类型及分期差异均无统计学意义（P >0.05）。低表达组的外周血RRM1 化疗有效率（35%）及疾病控制率（60%）均高于高表达组（10%,20%）（P <0.05）。生存分析显示：低表达组的外周血RRM1 生存期（14.8 个月）及无疾病进展期（4.4个月）均长于高表达组（11.6 个月,3.2 个月）（P <0.05）;低表达组的1 年生存率（76.7%）及2 年生存率（9.3%）均高于高表达组（53.3%,0%）（P <0.05）。结论 老年晚期非小细胞肺癌外周血中RRM1 低表达的患者对吉西他滨化疗反应率更高,生存期更长,是独立的预后因素。这为无法获取组织进行化疗药物筛选的老年晚期NSCLC 患者提供了一种新的选择。