从"开放的复杂巨系统"角度分析医者的诊疗思维构象

中医诊疗活动是一个动态、连续的复杂认知过程,也是医者针对患者所患疾病的多次构象过程.不同的医者,由于其知识积累、临床经验和阅历的不同,即他们对同一个疾病的构象不同,导致最终做出的判断也不完全相同,这种认知差异直接影响临床疗效.在中医诊疗过程中起关键作用的是医者.文章从医者的思维构象入手,应用系统科学的理论,分析医者诊疗思维构象特点的形成过程,提出应用定性与定量相结合的方法在计算机上进行系统建模,能为医者诊疗经验从隐性知识转化为显性知识提供可行的技术平台,是在更大范围内对医者诊疗思维的拓展与明晰.     

Course of the hepatic inferior vena cava in a Kenyan population

The course of the hepatic inferior vena cava (HIVC) has a wide range of variations which are relevant in hepato‐vascular surgery and liver transplantation. Eighty livers were studied for hepatic course and axial orientation of the HIVC. The HIVC was found to run in an incomplete tunnel in 43.8% of the cases (n = 35), complete tunnel in 32.5% of the cases (n = 26) while in the rest, it was contained in a shallow groove on the retrohepatic surface. It assumed an oblique course in relation to the longitudinal axis of the liver in 60% of the cases (n = 48). The findings of this study vary to a wide range from those reported previously, and call for extra caution during surgical operations involving the HIVC region. Clin. Anat. 22:610–613, 2009. © 2009 Wiley‐Liss, Inc.     

148例溃疡性结肠炎临床分析

目的：探讨溃疡性结肠炎（ＵＣ）临床特征，提高对本病的认识及诊治水平。方法：回顾性分析我院１９９５年￣１９９７年收治的经纤维结肠镜确诊的１４８例ＵＣ患者的临床特征。结果：发现ＵＣ的住院病例较前有增高趋势，男女发病率无明显差异，发病平均年龄为４０．３７岁，３０￣４９岁多发。临床特征有腹泻（８０．４１％），脓血便（６３．５１％），腹痛（６８．９２％）及发热，这些表现的发生率随病变范围加大而增高，病变范围     

后程超分割放射治疗食管癌的临床分析

目的评价后程超分割放射治疗食管癌的疗效及放射反应.方法对96例食管癌随机分为后程超分割组(后超组)和常规组,每组48例.经病理证实76例,后超组39例,常规组37例,均为鳞癌.男性65例,女性31例.年龄41～70岁,中位年龄57.1岁.病变部位胸上段21例,胸中段63例,胸下段12例.病变长度<5.0cm29例,5.0～7.0cm57例,>7.0cm10例.全部采用60Co外照射,常规组1次/d,2.0Gy/次,5次/周,总剂量64Gy,32分次,44d完成.后超组放射治疗前2/3疗程同常规组,照射到40Gy后改为1.15～1.25Gy/次,2次/d,间隔6～8h,使总剂量达到68～70Gy,44～45d完成.结果随访率为96.9%.1、3、5年生存率后超组为81.1%、44.1%、26.8%,常规组为61.7%、25.1%、16.9%.后超组1、3年生存率高于常规组(u值为2.97及2.64,P<0.01),5年生存率无显著性意义(u=1.71,P>0.05).后超组和常规组放射性食管炎的发生率分别为27.1%及16.7%(χ2=1.52,P=0.20);放射性支气管炎的发生率后超组为18.8%,常规组为12.5%(χ2=0.71,P=0.40).结论食管癌后程超分割治疗1、3生存率高于常规组,患者对后程超分割所引起的副作用能够耐受不影响治疗.     

对高师体育院系足球普修课教学的思考

随着教育改革的不断深入，高校体育教学的内涵已经在本质上发生了重大变革，运动参与、运动技能、身体健康、心理健康与社会适应5个学习领域的教育理念应得到充分的体现和强化，因此根据体育院系足球普修课实际情况，体育教学、训练原理和足球运动的规律，运用系统化、程序化的教学模式和手段，在有限的授课时间内，充分利用科学的教学措施、发挥教师的主导作用和培养学生能力，以及建立健全考核制度等，提高足球普修课教学质量。     

Significant change in ZAP‐70 expression during the course of chronic lymphocytic leukemia

Introduction: It is widely accepted that expression of ZAP‐70 in chronic lymphocytic leukemia (CLL) remains stable in time. However, data supporting this notion are surprisingly scarce. Therefore, we assessed expression of ZAP‐70 in serial samples taken during the course of the disease. Patients and Methods: We studied 44 patients with CLL diagnosed according to NCI‐WG criteria (34 men, 10 women, median age 62, range, 36–81). A total of 104 samples were examined; all patients had at least two measurements. Median interval between the first and the second sample was 13 months (range, 2–36). ZAP‐70 expression was detected by flow cytometry using phycoerythrin‐conjugated monoclonal antibody clone 1E7.2 and negative isotype control. Twenty percent of positive cells were considered as the threshold of positivity. Results: Significant change in ZAP‐70 expression (i.e. from positivity to negativity and vice versa) was detected in 15/44 patients (34%). Interestingly, 7/8 patients whose ZAP‐70 expression converted to positivity had unmutated IgVH genes. In addition, the conversion was accompanied by clinical progression or relapse in all but one patient. On the other hand, 5/7 patients with loss of ZAP‐70 had stable clinical course. One patient became ZAP‐70‐negative during treatment with prednisone for autoimmune hemolytic anemia. Conclusions: In contrast to commonly accepted opinion, significant change in ZAP‐70 expression in time was detected in a substantial proportion of our patients with CLL. While the conversion to ZAP‐70 negativity was found predominantly in patients with stable disease, change to positivity was typical in patients with unmutated IgVH genes at the time of progression or relapse. Based on our pilot results, repeated assessment of ZAP‐70 expression might be especially useful at the time of progression or relapse in patients who were initially ZAP‐70‐negative.     

中医对周围血管病治疗效果展望

周围血管疾病是一种危害性极强的高发病种，本文通过对中医周围血管病学科的发展回顾，展望了中医诊疗周围血管病的优势。