自我效能感培养对温州某医学院医学生临床实习效果的作用

目的:了解自我效能感对医学生临床实习效果的影响,以探索更行之有效的临床实习教学方法。方法:学期开始,采用整群随机抽样方法,抽取200名在温州某医院实习的临床医学本科生,再随机分为对照组和实验组,每组100名。对照组按照传统教学大纲的要求进行实习教学,实验组在传统实习基础上,引入自我效能感培养。学期结束,评价两组在理论知识、操作技能、学习态度方面的差异。结果:试验组在理论知识、操作技能、学习态度方面均明显优于对照组,差异有显著统计学意义(84.65±7.44vs 96.21±6.85,t=-5.440,P<0.01;79.04±6.18vs91.20±5.12,t=-6.872,P<0.01;90.50±4.80vs95.65±4.13,t=-3.645,P<0.01)。结论:培养自我效能感能够提高医学生的临床实习效果,为将其引入医学教学奠定基础。     

拉米夫定治疗四周时HBV-DNA水平对5年后应答反应的早期预测作用

背景和目的：在拉米夫定治疗的早期阶段，预测长期疗效的最佳时间和最佳HBV-DNA水平目前尚不清楚。本研究旨在明确在拉米夫定早期治疗阶段预测5年抗病毒疗效的最佳时间和最佳HBV-DNA水平。方法：研究对象为接受拉米夫定治疗的74位HBeAg阳性的慢性乙型肝炎患者，测定其基线水平及治疗2周、4周、8N、     

肾综合征出血热患者VWF和GMP-140水平临床观察

目的 探讨肾综合征出血热（ＨＦＲＳ）患者抗血管性假血友病因子（ＶＷＦ）,血小板α－颗粒膜蛋白（ＧＭＰ－１４０）在ＨＦＲＳ各病期中的动态变化以及在止血,血小板活化中的意义。方法 应用酶标免疫技术（ＥＬＩＳＡ）对３６例ＨＦＲＳ患者血浆中ＶＷＦ,ＧＭＰ－１４０进行动态检测,并与２４例正常组对照。结果 ＶＷＦ、ＧＭＰ－１４０值在发热期下降,少尿期达到高峰,轻型至危重型逐渐递增。ＶＷＦ与ＧＭＰ－１４０之间各     

肝细胞生长因子与肝再生增强因子重组表达质粒对大鼠肝纤维化的影响

Objective To evaluate the therapeutic effects of recombinant expression plasmid containing hepatocyte growth factor (HGF) and augmenter of liver regeneration (ALR) on rats with hepatic fibrosis. Methods Ninety Sprague-Dawley rats, which had been established into hepatic fibrosis models, were equally divided into 6 groups: blank group, pcDNA3.1 therapy group,pcDNA3.1-HGF therapy group, pcDNA3. 1-ALR therapy group, pcDNA3.1-HGF and pcDNA3. 1-ALR combined therapy group, and pcDNA3. 1-HGF-ALR therapy group. Zero point one μmol of blank or plasmid was injected into model rats in each group by tail vein once a day for 3 days. Model rats in blank group didn't receive any treatment. Additional 10 rats were chosen as control group, which were not given any interference during the experiment. All rats were sacrificed 4 days after end of treatment. Liver tissues were reserved for observing pathologic changes after HE staining and detecting proliferating cell nuclear antigen (PCNA) and c-jun by immunohistochemistry. Measurement data were compared by single-factor analysis of variance. Comparison between groups was done by SNK test. Enumeration data were analyzed by Fisher's exact test. Results In blank group and pcDNA3.1 therapy group, hyperplasia of fibrous connective tissue was very obvious, false lobules were formed. There was no significant difference between these two groups (x2 =0. 317,P= 1. 000).In the 4 remaining groups, hepatic fibrosis all achieved different degree of amelioration, and the therapeutic effect of pcDNA3.1-HGF-ALR was optimal. In control group, the expressions of PCNA and c-jun in liver tissues were low, with absorbance value of 8.6±1.9 and 3.2 ± 1.2, respectively. In blank group and pcDNA3. 1 therapy group, the expressions of PCNA and c-jun were obviously increased, with absorbance value of 24. 1±3.0, 24.5±4.3 and 23.8±3.1, 24.9±4.2, respectively,which were significant different from control group (all P＜0.01). In the 4 remaining groups, the expressions of PCNA were all obviously increased, and expressions of c-jun were all obviously decreased. The maximum change scope was observed in pcDNA3. 1-HGF-ALR therapy group.Conclusions The recombinant expression plasmid pcDNA3. 1-HGF-ALR can effectively ameliorate experimental hepatic fibrosis of rats. The anti-fibrosis effects are achieved probably by up-regulating PCNA expression and down-regulating c-jun expression.     

眼眶占位性病变36例手术分析

目的探讨眼眶占位性病变的临床诊断，手术治疗及其组织病理学分类。方法对2004年1月～2006年5月手术治疗的36例（36眼）眼眶占位性病变的性别、年龄、眼别及病理检查结果进行分析。结果恶性肿瘤3例，良性病变33例。组织病理学检查：恶性肿瘤3例均为非何杰金氏淋巴瘤；良性者中海绵状血管瘤9例，泪腺多形性腺瘤8例，静脉性血管瘤3例，炎性假瘤3例，囊肿3例，皮脂腺囊肿2例，淋巴管瘤、视神经胶质瘤、神经纤维瘤、骨瘤及颗粒细胞瘤各1例。在泪腺多形性腺瘤中浸润性生长3例，恶变1例。结论眼眶占位性病变种类繁多，良性肿瘤中以海绵状血管瘤多见，可采用前路开眶或外侧壁开眶顺利摘除肿瘤，次为泪腺多形性腺瘤，并且容易因手术切除不彻底或术中肿瘤破碎残留肿瘤细胞而改变生长方式，甚至于恶变。炎性假瘤手术完整切除较难，多要进一步作术后治疗。神经源性肿瘤早期就对视力损伤较大。     

血管内皮生长因子在急性肝衰竭大鼠中的变化及其意义

目的探讨血管内皮生长因子（vascular endothelial growth factor,VEGF）在急性肝衰竭（acute liver failure,ALF）大鼠中的变化及其对肝再生的作用。方法SD大鼠分两组：正常组6只,模型组48只。D-氨基半乳糖（D-Gal）诱发大鼠急性肝衰竭模型,造模后分6、12、24、36、48、72、120、168h8个时间点取大鼠血及肝脏标本,动态观察肝功能的变化。采用免疫组织化学法检测肝组织中VEGF、增殖细胞核抗原（proliferating cell nuclear antigen,PCNA）的变化。结果造模后24h,丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、总胆红素（TB）等指标显著升高（均P〈0.05）,以48～72h为著。PCNA在正常组表达很少,造模后6h显著升高（P〈0.01）,48h达最高峰,72h则明显下降（P〈0.01）。VEGF在正常大鼠肝组织中表达量很少或不表达,模型组随着时间的推移,VEGF水平逐渐升高,其变化与PCNA一致,48h达高峰,72h开始下降。结论VEGF在急性肝衰竭大鼠中的表达与肝细胞再生程度密切相关,其对肝再生具有重要作用。这可能为急性肝衰竭提供一种新的治疗途径。     

人工肝支持系统血浆置换治疗重型病毒性肝炎的临床疗效分析

目的 探讨人工肝支持系统（ALSS）血浆置换（PE）治疗重型病毒性肝炎的疗效及影响疗效的主要因素。方法 重型病毒性肝炎169例，设治疗组及对照组，两组均采用重型病毒性肝炎的常规治疗，治疗组同时加用血浆置换治疗。通过观察两组患者治疗前后临床症状及生化指标等的变化。判断人工肝支持系统血浆置换的疗效。结果治疗组患者经血浆置换后，临床症状都得到一定程度的改善，肝功能明显好转，总有效率为58．4％，其中早期重型病毒性肝炎有效率为84．6％。中期为63．4％，与对照组比较差异有统计学意义（P〈0、01或P〈0．05）。结论 血浆置换治疗可提高重型病毒性肝炎的疗效．以早、中期最为适宜，安全性好。     

巢式聚合酶链反应检测血液中恙虫病立克次体56kDa抗原基因

目的通过恙虫病立克次体５６ｋＤａ抗原基因片段检测,探讨早期病原诊断的方法。方法采用巢式聚合酶链反应（ＮＰＣＲ）对１１例确诊及１０例疑诊恙虫病患者血液标本进行检测,并以血清ＩｇＧ抗体间接免疫荧光试验（ＩＦ）对比分析。结果１１份ＩＦ检测阳性的标本,ＮＰＣＲ均阳性;１０份ＩＦ阴性的标本,７例ＮＰＣＲ检测阳性,总阳性率为８５．７％。而作为阴性对照的１０份血标本则无阳性。结论本法用于临床血液标本中恙虫病立克次体ＤＮＡ的快速检测,具有敏感性高、特异性强的优点。