Distinct Recurrence Pattern and Outcome of Adenocarcinoma of the Gastric Cardia in Comparison with Carcinoma of Other Regions of the Stomach

Background Carcinoma arising in the cardioesophageal junction is a distinct clinical entity compared with tumors located in other regions of the stomach. The prognosis for adenocarcinoma of the upper stomach is considered to be relatively poorer than carcinomas of the more distal stomach. We have therefore investigated patients with carcinoma of the gastric cardia in order to evaluate the underlying cause of this poor prognosis. Materials and Methods Clinicopathologic features and postoperative prognosis of 101 patients with carcinoma of the cardia were evaluated and compared with findings on 1884 patients with tumors in other regions of the stomach. Results Tumors of the cardia had a mean size of 6.8 cm, which was significantly larger than the mean size of 5.9 cm for tumors found in the middle- and lower third of the stomach. The incidence of serosal invasion, lymph node metastasis, and lymphatic and blood vessel invasion was higher in association with adenocarcinoma of the cardia than with adenocarcinoma in remaining parts of the stomach. In the analysis of patients who had undergone curative resection, the 5-year survival rates were 61.6, 79.1, and 82.6% in patients with carcinoma of the cardia, upper one-third, and remaining middle- and lower one-third of the stomach, respectively, and the differences were statistically significant. Multivariate analysis indicated that adenocarcinoma of the gastric cardia is an independent prognostic factor. With regard to the site of recurrence, both lymph node and hematogenous recurrence were observed more frequently in the cardia than in the remaining parts of the stomach. Conclusions Our data indicate that the prognosis of patients with adenocarcinoma of the gastric cardia is extremely poor. To improve their prognosis, new treatments in addition to gastrectomy with extensive lymph node dissection are needed.     

白细胞介素6在狼疮性肾炎患者小管间质的表达及其意义

探讨白细胞介素6(IL-6)在狼疮性小管间质病变中的作用。方法 采用ELISA方法与原位分子杂交技术(后者结合IBAS计算机图像分析系统),分别检测42例活动期狼疮性肾炎(LN)患者尿IL-6浓度与其中的15例肾小管间质IL-6mRNA水平。结果 42例活动期LN患者有36例尿IL-6>5pg/mg·cr,其增高程度与尿β_2-m及NAG活性水平呈显著正相关;其中15例肾组织切片中,肾小管间质均有IL-6mRNA表达,并且小管间质病变愈严重,其表达量愈高,而健康肾组织小管间质几无IL-6mRNA表达。结论 LN患者活动期尿IL-6浓度异常增高与肾小管间质IL-6mRNA异常表达有关,提示IL-6在狼疮性小管间质损害过程中可能具有重要作用。     

肿瘤坏死因子及化疗联合治疗晚期妇科恶性肿瘤的探索

肿瘤坏死因子是近年来研究较多的细胞因子，但大多数为实验研究。本研究将肿瘤坏死因子与化疗联合治疗晚期妇科恶性肿瘤，其结果显示近期疗效显著，但远期疗效尚难确定，还需进一步对其进行探索。     

置信职业行为在以胜任力为导向的院校医学教育中的应用与研究进展

本文通过检索国内外置信职业行为评价在院校教育中的应用研究文献,从置信职业行为评价概念、评价项目构建、临床应用成效与需要完善的问题、研究展望等方面进行综合梳理,以期为我国以胜任力为导向的医学教育改革与评价研究和可复制可推广的置信职业行为评价在临床教学中的应用提供有益借鉴。     

Incidence and distribution of stress fractures in recruits during basic training

Stress fracture(SF)in military recruits in China was investigated using~(99m)Tc-MDP bone scintigraphy in a randomized sample of 432 injured who wereclinically screened from 1060 recruits during basic training.The relationship between SFand training intensity was discussed.It was shown that the total incidence was 32.5%.There were two peaks during 9 training-weeks:one was in the 2nd week,and the otherin the 7th.Infantry soldiers had a more intensive training and,therefore a higher inci-dence than in artillery and service troops.Although SF was found in most ofweight-bearing bones,tibia was most commonly fractured(67%).The findings suggestthat SF is a major training-related injury in military recruits and improperly strengthenedtraining can increase the incidence.     

A case－control study on risk factors of stress fractures in military recruits during basic training

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Cluster like headache in a patient with the Maffucci's syndrome]

Maffucci's syndrome is a rare congenital, nonhereditary mesodermal dysplasia characterized by soft tissue hemangiomas and multiple enchondromas. A 52 years old man was diagnosised as Maffucci's syndrome in his childhood. He complained of mild paraesthesia which gradually progressed to intolerable pain lasting one to two houres with rhinorrhea (cluster like headache). Magnetic resonance imaging showed a pituitary adenoma which invaded into right cavernous sinus. Serum hormone level was almost normal, therefore we diagnosed nonfunctional pituitary adenoma. The pharmacological preventive treatments for headache, such as loxoprofen, sumatriptan, lomerizine had no effect. On the other hand, verapamil showed moderate improvement of his headache, then the symptons was gradually getting better and finally he felt no pain. This case demonstrated occurence mechanism of cluster headache and preventive effect of verapamil associated with cavernous sinus.     

成人原发性肾病综合征治疗的探讨

报告成人原发性肾病综合征（ＰＮＳ）１００例，采用８周大剂量强的松治疗后，病情未获显著缓解者，至小剂量强的松（０．５ｍｇ·ｋｇ￣－１／ｄ）治疗时，维持８个月或更长一些时间，总疗程在１年或更长一些时间，病情往往获得显著缓解。与过去常规大剂量激素治疗成人ＰＮＳ１００例比较，两者有效率分别为７１％和５４％，有显著性差异（Ｐ＜０．０５）。本文还观察了各种病理类型的激素疗效。     

病毒性肝炎病例对照调查中二类对照的对比性研究

本文报告了医院与普通人群甲、乙型病毒性肝炎病例对照研究中同时使用普通对照与易感者对照进行平行研究的初步结果.医院中甲肝(病例60例,普通对照200例,易感者对照37例)乙肝(病例64例,普通对照200例,易感者对照65例)主要发病因素,人群中甲肝(普通对照时1∶3配比37对,易感者对照时1∶1配比11对)爆发因素,用两种对照方式获得的OR值均无显著差异;除个别因素外,分析效果基本一致.本文对此及其有关因素进行了讨论,初步提示在病毒性肝炎病例对照研究中使用普通对照与易感者对照都是可以的.     

肝炎病例对照调查中两种对照免疫水平与暴露率及优势比比较

本文报告了医院与普通人群甲、乙型病毒性肝炎病例对照研究中同时使用普通对照与易感者对照时,两种对照的免疫水平与暴露率对OR值的影响作用.结果表明:从免疫水平看,抗HAV阳性率在80.5%或92.3%、HBV感染在47.5%的情况下,普通对照和易感者对照的OR值,除个别发病因素(甲肝的不洁饮食史)外,基本无显著差异.再从暴露率来看,两种对照除个别因素外暴露率均无显著差异(x~2<3.84,P>0.05),OR值的95%CI也相互交叉.从而可初步认为在病毒性肝炎病例对照研究中使用普通对照与易感者对照都是合理的.