目的 分析當前醫患溝通學課程教學中存在的問題，探索提高教學質量的有效途徑。 方法 2011年12月－2012年1月通過收集相關文獻及實際教學中有關醫患溝通的事例，對醫患溝通中存在的問題進行歸類梳理，并針對各結癥提出解決措施及建議。 結果 目前國內醫患溝通學教學中存在以下問題：醫學生對醫患溝通學課程不夠重視；缺乏系統的教學質量考評體系；醫患溝通學課程的理論與實踐課學時比例缺乏科學的設置標準；教學方式、課程開設對象等不統一。 結論 要提高醫患溝通學教學質量，其提高醫學生對溝通能力重要性的認識是前提，建立健全醫患溝通學課程的教學模式和考核體系是關鍵，為學生構建早期接觸臨床實踐的平臺是保障。
ObjectiveTo investigate the application scope and effects of pancreatic duct stent in common pancreas diseases.MethodThe literatures on application of pancreatic duct stent in common pancreas diseases at domestic and foreign were reviewed.ResultsPancreatic duct stent had been used in acute and chronic pancreatitis and pancreatic tumor, which could the relieve symptoms, reduce the complications of pancreatitis, improve the prognosis, shorten the hospital stay, and reduce the hospitalization costs. Meanwhile it had also been used in pancreatic tumor surgery, palliative treatment, and brachytherapy that some achievements had been made.ConclusionAlthough application of pancreatic duct stent in some common pancreatic diseases is still controversial, effect is better and has some advantages with small trauma and low incidence of complications, which also provides a new treatment option for some common pancreatic diseases.
目的 探討保留括約肌虛掛線法治療高位肛周膿腫的臨床療效。 方法 2009年10月－2010年10月采用隨機對照試驗，對52例高位肛周膿腫患者施行手術治療，其中保留括約肌虛掛線法（治療組）26例，切開掛線引流法（對照組）26例。對兩組患者術后6個月肛瘺發生率、切口愈合時間、術后1～15 d每晚疼痛視覺模擬評分（VAS）和術后6個月痊愈患者肛門功能后遺癥發生率進行比較。 結果 術后6個月，治療組和對照組肛瘺發生率分別為4.0%和3.8%，差異無統計學意義（P＞0.05）。術后7～15 d治療組VAS評分均低于對照組，差異有統計學意義（P＜0.05）。兩組切口愈合時間分別為（19.05 ± 6.71）d和（21.42 ± 8.40）d，差異有統計學意義（P＜0.05）。術后6個月治療組痊愈患者肛門功能全部正常，對照組后遺癥發生率為12.0%，兩組比較差異有統計學意義（P＜0.05）。 結論 保留括約肌虛掛線治療在術后疼痛、切口愈合時間和保護肛門功能等方面明顯優于切開掛線引流治療，是一種治療高位肛周膿腫較為理想的方法。
ObjectiveTo understand the application of vacuum assisted rotary cutting technique in benign and malignant breast diseases.MethodThe related literatures about the application of vacuum assisted rotary cutting technique in the breast benign and malignant diseases were reviewed.ResultsThe technique of vacuum assisted rotary cutting had been applied to the treatment of intraductal and phyllodes tumors. The non-lactation mastitis lesions could all be removed by this technique, and as a minimally invasive treatment for gynecomastia. It could guided by the color Doppler ultrasound, mammography and MRI, which could obtain enough tissue specimens for the screening and biopsy of early breast cancer. The indication of vacuum assisted rotary cutting technique should be further discussed in the breast conserving treatment of breast cancer.ConclusionsVacuum assisted rotary cutting technique has been widely used in treatment of various benign diseases of the breast and diagnosis and treatment of breast cancer. The best indication for operation should be determined based on clinical manifestations and auxiliary examination results.
Objective To explore the difference between the hemorheology levels and the expression of hypoxia inducible factor 1α/2α (HIF-1α/2α) in the peripheral blood mononuclear cells of the Tibetan and Han patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods This research recruited 30 high-risk Tibetan and Han patients with OSAHS, and 30 Tibetan and Han healthy volunteers at the same period. The whole blood viscometer was used to detect the high shear rate of whole blood viscosity, low shear rate of whole blood viscosity, plasma viscosity ratio, red blood cell aggregation index, and hematocrit in each group. RT-qPCR and Western blot assays were used to detect the mRNA and protein levels of phosphoinositide 3-kinase (PI3K), serine/threonine kinase (AKT), nuclear factor-κB (NF-κB) p65, HIF-1α and HIF-2α in peripheral blood mononuclear cells. Results The hemorheology level of Tibetan OSAHS patients was significantly higher than that of healthy Tibetans and Han OSAHS patients (P<0.05), and the hemorheology level of Han OSAHS patients was significantly higher than that of Han healthy people (P<0.05) . The mRNA and protein levels of PI3K, AKT, NF-κB p65 and HIF-1α in the peripheral blood mononuclear cells of Tibetan OSAHS patients were significantly higher than those of the healthy Tibetans or Han people, and these indexes of the Han OSAHS patients were significantly higher than those of the Han healthy people (all P<0.05), while HIF-2α mRNA and protein levels were significantly lower than those of healthy Han people (all P<0.05). Conclusion The upregulation of HIF-1α level and downregulation of HIF-2α expression in peripheral blood mononuclear cells of OSAHS patients depend on the activation of the PI3K/AKT/NF-κB p65 signaling pathway, and the hemorheological level of Tibetan OSAHS patients is higher than that of Han OSAHS patients.
With the aging of the Chinese population, the incidence of vascular diseases is increasing year by year. Currently, venous diseases account for a large proportion of vascular surgical diseases. With the rapid development of venous imaging, the rapid progress of endovascular technology and the innovation of vene-related instruments, the diagnosis and treatment of venous diseases are constantly updated. As the development source and foundation of vascular surgeons, venous diseases should be paid attention to by every vascular surgeon. This paper will discuss the current research hotspots of venous surgery.
Objective To investigate the changes in terms of knowledge, attitudes, behavior, and mental status in hospital outpatients after the Wenchuan earthquake so as to provide more convenient and efficient outpatient services for patients from the disaster areas. Method A self- designed questionnaire was used to survey the outpatients in West China Hospital. Data analysis was performed with SPSS 13.0 software. Result The duration of earthquake feeling was correlated with age, gender, family address, disaster experience, and casualties of relatives and friends. Sleep quality after the earthquake was also significantly correlated with age, gender, family address, disaster experience, casualties of relatives and friends, and the duration of eartqhauke feeling. Seeking medical treatment after the earthquake was associated with the availability of medical insurance. Knowledge about post-quake epidemics was correlated with the responders’ educational background. Conclusion Stress response is related to age and disaster experience. Many factors may effect the development, extent, and duration of people’s stress response. People became more aware of risk after the quake and had a b demand for post-disaster psychological counseling.
Objective To summarize and evaluate the significance of tumor necrosis factor (TNF) tolerance, and to understand the general characteristics and known molecular mechanisms of different forms of tolerance, including the roles of transcription factors, signaling systems and receptors. Method The relevant literatures at home and abroad in recent years were collected and readed, and the content related to TNF tolerance was summarized. ResultsTNF tolerance could be produced after TNF pretreatment, and be divided into absolute tolerance and induced tolerance. TNF tolerance was related to a variety of interrelated and interdependent intracellular signal transduction. There was cross tolerance between TNF and lipopolysaccharide. Conclusions TNF tolerance may represent a protective mechanism, participating in the termination of inflammation and preventing excessive or persistent inflammation. TNF tolerance may also trigger immune paralysis, leading to severe inflammatory diseases, such as sepsis. The understanding of TNF tolerance can promote the diagnosis of inflammation related diseases or the implementation of treatment methods, so as to achieve more accurate evaluation and treatment.
【摘要】 目的 評估吉非替尼治療終末期（PS評分≥3分）非小細胞肺癌（NSCLC）的臨床效果和生活質量改善情況。 方法 2008年5月-2010年6月共收治終末期NSCLC患者40例，其中19例患者采用吉非替尼治療（治療組），21例采用支持治療+中藥治療（對照組）。 結果 治療6個月后，治療組19例患者中，CR 1例，PR 5例，SD 10例，PD 3例。治療組有效率為31.5%（6/19），臨床受益率為84.2%（16/19）。對照組21例中，SD 5例，PD 16例，無CR。對照組有效率為23.8%（5/21），臨床受益率為 23.8%（5/21）。兩組間有效率和臨床受益率比較，差異均有統計學意義（Plt;0.05）。治療組中位生存期為13.2個月，對照組中位生存期為4.5個月。 結論 吉非替尼可延長NSCLC患者的生存期，改善其生活質量。【Abstract】 Objective To evaluate the curative effect and life improvement of gefitinib on non-small cell lung cancer (NSCLC) which in the end stage. Methods Forty patients with end-stage NSCLC were treated from May 2008 to June 2010. Nineteen patients of them were treated with gefitinib (treatment group), 21 patients were treated with supportive care and traditional Chinese medicine treatment (control group). Results Six months after treatment, there are one patient with CR, five patients with PR, 10 patients with SD and three patients with PD in the treatment group. The effective rate of treatment group was 31.5% (6/19), clinical benefit rate was 84.2% (16/19). There are five patients with SD, 16 patients with PD, and no one with CR in the control group. The effective rate of the control group was 23.8% (5/21), clinical benefit rate was 23.8% (5/21). The differences of effective rate and clinical benefit rate between two groups were statistically significant (Plt;0.05). The median survival period of the treatment group and control group were 13.2 and 4.5 months respectively. Conclusion Gefitinib can extend the lifetime of NSCLC patients and improve their quality of life.
Objective To investigate the possible role of ulinastatin(UTI) in f lipopolysacccharide (LPS)-induced acute lung injury(ALI).Methods Thirty male SD rats were randomly divided into three groups，ie.a normal control group，a LPS group and a LPS plus UTI group.The rats were injected with 1 mL of normal saline via caudal vein in the control group，with LPS 5 mg/kg via caudal vein in the LPS group，and with UTI 100000 U/kg shortly after injection with LPS in the LPS plus UTI group.The rats were sacrificed 4 h after the injection.Lung wet/dry weight ratio was measured.IL-18 level in serum and lung tissue was determined by ELISA and the expression of NF-κB in lung tissue was determined by immunohistochemistry.Pathological changes of rats’ lung were observed by optical and electron microscope.Results Compared with the control group，IL-18 level in serum and NF-κB expression in lung tissue were significantly higher in the LPS group(Plt;0.01).The IL-8 level was somewhat elevated in the LPS+UTI group but with no significant difference from that in control group was found (Pgt;0.05).The lung inflammation in the LPS+UTI group was milder than that in the LPS rats.Conclusion UTI can alleviate LPS-induced inflammatory reaction and lung injury in rat model.