乳腺叶状肿瘤超声特征及与病理对照分析

目的:研究乳腺叶状肿瘤的超声声像图特征,并与病理结果相对照,以期从超声角度提高对本病的认识。方法:分析经病理证实的16例乳腺叶状肿瘤的二维及彩色多普勒超声表现,并与病理结果对照分析。结果:二维图像肿块体积大小范围变化大,形态不规则可分叶,可有包膜,内部多为不均匀弱回声,可有液性暗区。CDFI良性血流0~Ⅰ级,恶性Ⅱ~Ⅲ级,阻力指数偏高。结论:乳腺叶状肿瘤的二维声像图具有一定特点,但无明显特异性,肿块的大小与良恶性之间无明显联系,结合肿块内部囊性变、彩色多普勒超声显示丰富的血流及高速高阻频谱,对提示恶性有意义。     

失血性大鼠休克后肠、肝、肺组织中细胞因子表达、释放时相及其伴随的病理变化

目的：探讨休克后促炎细胞因子的表达、释放时相及伴随的肠、肝、肺组织病理变化。方法：80只SD大鼠随机均分为失血性休克组和对照组。采用RT-PCR、ELISA方法检测失血性休克后30、60、90min及复苏后30、90min肠、肝、肺组织内TNF-α、IL-6 mRNA表达及血清中TNF-α、IL-6含量；HE和IHC染色检测伴随的组织病理变化。结果：①休克30min时，肠、肝、肺内的促炎细胞因子表达未见升高；60min时肠道先出现TNF-αmRNA表达升高（P〈0．05）：而肝脏在90min开始表达升高（P〈0．05），肺脏则在复苏后30min开始表达升高（P〈0．05）。复苏后90min肠、肝、肺的细胞因子表达都继续显著升高（P〈0．01）。②TNF-α 在肠、肝、肺的表达升高最早，其后为IL-6 mRNA。③30min时门静脉和外周血中TNF-α、IM的含量与对照组相比无显著差异，而60min时门静脉血中含量显著升高（P〈0．01）。④休克后肠黏膜坏死脱落；肝组织结构紊乱、肝窦增宽、肝细胞变性坏死；肺脏间质水肿、炎症细胞浸润。结论：失血性休克时细胞因子的释放顺序是肠道、肝脏和肺脏，推测存在“肠-肝-肺”细胞因子释放轴的可能，有待进一步确定。     

Candidaemia: a 10-year study in an Indian teaching hospital

Retrospective evaluation of candidaemia patients was performed in an Indian teaching hospital over a 10-year period. The incidence of patients with candidaemia increased eleven-fold in the second half of the study period (55 patients) compared with the first half (5 patients). Haematological malignancies (11 patients), neonatal septicaemia (9), cardiac abnormalities and cardiac surgery (9) were the commonest underlying diseases in these patients. Candida albicans (50%), C. guilliermondii (17%), C. tropicalis (15%) and C. parapsilosis (8%) were the most common fungal pathogens isolated from blood culture. Therapy with two or more antibiotics (92%), corticosteroid administration (25%), intravascular catheter use for over 24 h (78%) and neutropenia (48%) were the accountable predisposing factors. Prolonged hospitalization (mean average 22.2 days as compared with 11.2 days in other patients) was an added risk factor in these patients.     

House officers in general medicine: their perception of educational value of rotation components

Summary: As curriculum planners in general medicine residency training programmes we were concerned about house officers' anecdotal reports that hospital work requirements often overshadow individual learning goals. After each of five rotations, we asked residents to identify the educational 'usefulness' of certain rotation components which can be included in three categories; team members, work-related activities and educational events. Of 165 surveys distributed, 127 (77%) were returned. Data were analysed by residency year and by all years combined. The mean overall perception of learning was 3.9 out of a possible 5 points suggesting that residents do find some learning value. Results suggest that different residency years vary as to the significance of specific educational components. The importance of faculty/resident relationships to residents' perceptions of learning value was highlighted in particular.     

护理学基础课程技术操作教学改革与实践

目的培养高素质实用型护理人才，塑造护生良好形象，使之更加适应现代护理工作需要。方法教师在护理学基础课程技术操作教学过程中，注意通过课前引导学生预习操作内容、精心设计教案、规范操作流程、善于灵活运用示教和多媒体、演练情景剧、开放实验室、强化训练、开展技能考核与比赛等方式培养学生动手操作能力。结果2001年以来，已先后有3届学生进入临床实习。通过问卷调查，学生、带教教师、病人满意度分别达到98．5％、98．2％、97．0％。     

流行性出血热流产婴儿与胎盘的病理变化及巨噬细胞内抗原定位

妊娠6~ 个月孕妇感染流行性出血热(EHF),临床有典型的EHF的发病过程。第23病日血清学检测孕妇外周血EHF-IgG(卅)、IgM(-),第24病日流产一女婴,抽取脐带血检测EHF-IgG(卅),流产女婴心血检测EHF-IgG(卅),IgM(-)。病理:肾小球上皮细胞肿胀,上皮细胞足突融合、坏死,毛细血管基底膜皱缩,肾小管上皮细胞线粒体肥大,间质内大单核细胞浸润。肺间质细胞增生、水肿、毛细血管基底膜不规则增厚,肺泡壁Ⅱ型细胞增多。肝细胞肿胀,胞浆内查见包涵体样物质,有多核肝巨细胞,地依红染色阴性。胎盘母体面、脐带、肺、肝间质内大单核细胞、中性粒细胞浸润。EHF-MCAb荧光直接法染色、PAP、ABC等免疫组化染色,在巨噬细胞浆内均为阳性反应,从而证实母体感染EHF可以经胎盘感染给胎儿,其传播方式可能是通过巨噬细胞系统。     

基础医学教师课堂教学质量评价

为了了解本科教师的教学质量和教学效果 ,教学专家和学生评价了 14 7位基础医学教师。结果显示 ,讲师以上职称教师的教学质量明显好于初级职称教师 (P<0 .0 5 ) ,高级职称教师教学的科学性、艺术性和思想性明显好于讲师和助教 (P<0 .0 5 )。文章还对教学中存在的问题和对策进行了讨论。     

Education in family and community health: the challenge faced by a new medical school

This paper describes the efforts of the Department of Family and Community Health at Sultan Qaboos University in providing opportunities for the development of 'hands-on' problem-solving skills appropriate for Oman. The curriculum of the Department is discussed, highlighting the unusual emphasis of this discipline in both the preclinical and clinical curriculum of the College of Medicine. The importance of continuous assessment and supervision of students is discussed. Course-work in the preclinical curriculum of the Department is kept to a minimum. Field-work forms an important part of preclinical training, where application and problem-based learning are emphasized. During the clinical years the students are exposed to an integrated series of lectures and practicals covering core knowledge in clinical medicine. Practical clinical training, over a total period of 15 weeks, takes place at a variety of sites where common problems in primary health care in Oman are handled by students under supervision.