鼻咽部神经内分泌癌的病理特征和临床分析

目的 探讨鼻咽部神经内分泌癌（neuroendocrine carcinoma，NEC）的临床病理特征、免疫组化特点、治疗方法及预后。方法 回顾性分析12例NEC患者的临床和病理资料，并复习相关文献。 结果 12例患者中，男性10例，女性2例，平均年龄49.4岁，病理类型均为小细胞型NEC。光镜下可见较小瘤细胞，呈圆形、卵圆形和梭形，核深染，胞浆少，核浆比例高，伴有较明显的病理性核分裂象，染色质细腻。免疫表型：CgA、Syn、CD56和EBERs阳性或部分阳性者分别有6例、10例、9例和3例。临床分期Ⅰ期1例，Ⅱ期1例，Ⅲ期4例，Ⅳ期5例，分期不详1例。所有患者均接受放疗和（或）化疗，至随访结束存活者9例，死亡3例。结论 鼻咽部神经内分泌癌临床上较少见，好发于中老年男性，病理类型以小细胞型为主，易出现颈部淋巴转移，就诊时大部分已处中晚期，治疗以放化疗为主。     

The Relationship between College Graduate’s Dual Self-Consciousness and Job Search Clarity: The Mediating Role of Perceived Stress

The aim of the study was to explore the relationship between college graduates’ dual self-consciousness, job search clarity and perceived stress, and reveal the mediating role of perceived stress between dual self-consciousness and job search clarity. In this study, 467 college graduates were investigated using the Dual Self-Consciousness Scale, Job Search Clarity Scale, and Perceived Stress Scale. After controlling for gender, age, and region, the results revealed that: (1) private self-consciousness has a significant positive predictive effect on job search clarity; (2) perceived stress has a significant negative predictive effect on job search clarity; (3) perceived stress plays partial mediation effects between private self-consciousness and job search clarity; (4) perceived stress plays complete mediation effects between public self-consciousness and job search clarity; (5) perceived stress has suppressing effects between public self-consciousness and job search clarity.     

Optimizing Prescribing and Deprescribing of Proton Pump Inhibitors

Prescribing of proton pump inhibitors (PPIs) has markedly increased since their inception more than 30 years ago. The increase is related to inappropriate and long-term prescribing of PPIs, associated with a lack of education and unclear prescribing and deprescribing guidelines. The implementation of prescribing stewardship programs influences the reduction and inappropriate use of this medication. The purpose of this review is to address the gaps that exist regarding the use of PPIs along with determining methods for deprescribing. Guidelines and stewardship programs, along with education, are needed to reduce the adverse health effects of long-term PPI therapy.     

针刀配合针灸治疗腰椎间盘突出症的临床疗效观察

目的:分析针刀与针灸配合应用于腰椎间盘突出症患者中的临床治疗效果。方法:在我院针灸康复科2017年12月-2018年12月治疗的腰椎间盘突出症患者中选取64例,并严格按照系统随机分配原则分为对照组和观察组,各32例。其中对照组采用针灸进行治疗,观察组采用针刀与针灸配合治疗,观察对比两组患者治疗后临床效果和治疗前后运动功能评分(Fugl-Meyer)、腰椎日本骨科学会(Japanese Orthopaedic Association,JOA)评分、视觉模拟评分法(Visual Analogue Scale,VAS)评分以及临床症状改善情况。结果:两组患者治疗前Fugl-Meyer、VAS、JOA评分差异无统计学意义(P>0.05),治疗后对照组VAS评分高于观察组,Fugl-Meyer、JOA评分低于观察组,且对照组总有效率低于观察组,对照组腰骶疼痛评分和腿疼痛评分均低于观察组,直腿抬高度高于观察组,差异具有统计学意义(P<0.05)。结论:予以腰椎间盘突出症患者针刀与针灸配合治疗效果显著,效果优于单一使用针灸治疗,可有效缓解患者疼痛感,改善临床症状,值得推广。     

直视医学临床见习难——浅析面临困境及其对策

随着社会发展、医学模式的转变，医疗改革和学校扩招政策的实施，传统的临床见习教学遇到了前所未有的冲击与困惑。本文根据临床见习现状进行分析，力求找到最佳的解决方法。     

痛经的临床因素分析

目的:痛经的发病率逐年增高,重新分析痛经患者的临床因素,提出新的认识。方法:将1 158例痛经患者的临床资料及超声检查结果进行统计学分析。结果:人工流产史与痛经的发生有密切相关性(P<0.001)。结论:人工流产手术是引起痛经的主要原因。该手术所产生的副作用可对女性生理健康造成严重伤害,必须引起全社会的高度关注。     

米索前列醇预防剖宫产后出血344例临床观察

目的:观察米索前列醇预防剖宫产手术后出血的临床效果。方法:随机将有剖宫产手术指征的344例孕妇分为3组,分别为在胎儿娩出后给予米索前列醇200mg舌下含化(A组)、缩宫素静脉滴注及子宫肌层注射(B组)和对照组(C组,不给予任何药物),观察产后不同时间的出血量。结果:产后出血量及出血发生率A、B组均明显少于C组(P<0·05)。结论:米索前列醇对分娩后子宫具有较好的收缩作用,且给药方便、安全性较好。     

脉冲微波治疗前列腺炎的临床疗效观察

目的探讨脉冲微波治疗前列腺炎的效果。方法收治前列腺炎病人532例。用南京亿高ECO—100型电脑微波前列腺炎治疗仪,经肛门途径发射脉冲微波,前列腺部位温度控制在41℃~42℃,每次持续45~60min,共七次。以显效、有效为判断疗效标准。结果17~25岁组显效47.93%,有效52.07%,26~45岁组显效52.06%,有效47.94%,两组有效率100%。结论脉冲微波经肛门途径治疗前列腺炎效果明显,有推广价值。     

Evaluation of Training Course Effects on Integrated Sexual and Reproductive Health Counseling

Since the International Conference on Population and Development held in Cairo in 1994, and the Fourth World Conference on Women held in Beijing in 1995, the international organizations and public health communities have paid more attention to reproductiv…     

CT增强扫描的观察及护理

目的观察CT增强时对静脉选择及对造影剂的不良反应，并制定出相关的护理措施。方法2003年2月-2004年8月间，对460例行CT增强扫描的患者，根据检查部位、病情、体质、年龄，调节注射量及速度、选择不同的注射部位及不同造影剂，并及时了解患者的思想动态，做好心理护理。结果静脉穿刺成功率达95％，对1例重度碘过敏患者的抢救及时，处置恰当。结论做好CT增强扫描的观察及护理工作，是保证增强扫描顺利进行并获得满意结果的必要条件。