器官捐献与器官移植是一项大爱工程,在挽救患者生命的同时也传递了社会的真善美.浙江大学本科通识课"器官捐献与器官移植——生命的接力与延续",深度融合医学教育和思政教育,注重科学性和人文性的融合平衡.本研究通过对参与本课程学生问卷调查,显示通过本课程的学习,学生对器官捐献及器官移植的认知有了大幅提升,能更深切体会医学、社会与伦理之间的密切联系,有助于培养学生大爱情怀、公益心和国民意识,塑造正确的价值观.

提升全球竞争力、培养国际化人才已经成为新时代人才培养的重大命题.浙江大学药学院以培养"兼具创新精神和全球竞争力的药学拔尖人才"为目标,围绕关键原则、关键内容、关键支撑、关键载体和关键保障五个维度,将国际化建设贯穿于药学人才培养的全过程,构建了"三三式"国际化药学拔尖人才培育体系,取得良好成效.文章简要介绍了浙江大学药学院关于国际化建设在人才培养过程中的实现路径和主要成效,以期为国内药学院校开展相关工作提供思路和借鉴.

创新人才培养是新形势下高校的一项迫切任务,本文以浙江大学深化教育教学改革,创新教育教学方法,探索多元化人才培养模式为例,从人才培养的顶层设计、课程体系的优化、教育教学方法的革新等方面,探索新形势下本科高素质创新型人才培养的新途径.

本文通过对浙江大学海外教师主导全英文课程建设进行有益的探索,结合项目实践过程中的亮点与成效、存在的问题等方面加以综合阐释与分析,从而深化认识、明确目标、启发思考.

教师的聘任与晋升政策是建立一流师资队伍的关键.UCLA是国际一流的研究型大学,其医学院在美国亦居于领先地位,它拥有一支高素质、高水平的师资队伍.与国内大学在晋升中重科研、轻教学不同,它对教学异常重视,将教学作为聘任晋升的必备条件之一.通过对UCLA医学院教授聘任晋升中教学工作要求的浅析,为建立一套合理的评聘体系提供借鉴.

>病历摘要患者女,48岁。因"反复腹泻2年半,再发伴恶心、纳呆、消瘦1个月"入院。患者2年半前无明显诱因出现腹泻,3～4次/d,大便稀烂,无黏液脓血,可自行缓解或经用双歧杆菌、嗜酸乳杆菌和匹维溴铵等治疗后好转。1个月前上述症状再发并伴有恶心、纳呆和消瘦等,经地衣芽孢杆菌胶囊和米曲菌胰酶片等治疗无效。胃镜检查发现胃体黏膜不规则隆起(图1),活检病理:胃体黏膜中度浅表活动性炎伴固

Celiac disease (CD) is a type of intestinal malabsorption syndrome, in which the patients are intolerant to the gliadin in dietary gluten, resulting in chronic diarrhea and secondary malnutrition. The disease is common in Europe and the United States, but only sporadic reports are found in East Asia including China. Is CD really rare in China? We examined 62 patients by capsule endoscopy for chronic diarrhea from June 2003 to March 2008. Four patients with chronic diarrhea and weight loss were diagnosed to have CD. Under the capsule endoscopy, we observed that the villi of the proximal small bowel became short, and that the mucous membrane became atrophied in these four patients. Duodenal biopsies were performed during gastroscopy and the pathological changes of mucosa were confirmed to be Marsh 3 stage of CD. A gluten free diet significantly improved the conditions of the four patients. We suspect that in China, especially in the northern area where wheat is the main food, CD might not be uncommon, and its under-diagnosis could be caused by its clinical manifestations that could be easily covered by the symptoms from other clinical situations, particularly when it came to subclinical patients without obvious symptom or to patients with extraintestinal symptoms as the initial manifestations.

Takayasu’s arteritis (TA), also known as the “pulseless disease,” is a chronic vasculitis of the aorta and aortic branches. TA with Crohn’s disease is rare and has not been documented in China before. In this paper we report on a case of Takayasu’s arteritis associated with concurrent Crohn’s disease. A 17-year-old Chinese male developed upper limb sourness and a sensation of fatigue, and his upper limb pulses were absent. He was diagnosed with TA and underwent an axillary artery bypass with autologous great saphenous vein on the left subclavian artery. After the surgery, he regained the normal blood pressure. This patient also had years of diarrhea and developed an anal canal ulcer, and was diagnosed with inflammatory bowel disease and ulcerative colitis before. Five months after the TA surgery, he was hospitalized for severe stomachache and diarrhea and was finally diagnosed with Crohn’s disease. The possible pathophysiological mechanisms responsible for concurrent existence of TA and Crohn’s disease may be associated with immune disorders, especially autoimmunity.

As evidence-based strategies to the clinical management of Barrett's esophagus (BE) are lacking, we have carried out a systematic review and meta-analysis of all published randomized controlled trials with the aim of evaluating the value of different approaches in the treatment of BE. Searches were conducted in the databases PUBMED, EMBASE, and Cochrane Library. Thirteen randomized clinical trials that fulfilled the inclusion criteria and addressed the clinical questions of this analysis were assessed in more detail. Based on our search, neither the pharmacological nor surgical therapies currently available for reflux appear to achieve complete regression of BE and the elimination of the cancer risk associated with it. In contrast, endoscopic ablative techniques are capable of achieving endoscopic and histological reversal of BE, with ablation by argon plasma coagulation (APC) appearing to be more effective than treatment with photodynamic therapy (PDT) [odds ratio (OR) 3.46, 95% confidence interval (CI) 1.67-7.81, P = 0.0008]. There was no statistically significant difference between APC and multipolar electrocoagulation (MPEC) in terms of the efficacy to achieve regression of BE (OR 2.01, 95% CI 0.77-5.23, P = 0.15). In conclusion, there have been only a limited number of randomized controlled trials that compare treatments for BE. The pharmacological therapy, antireflux surgery, and endoscopic ablative techniques are promising in terms of treating BE, but the studies carried out to date have had no adequate power to assess the effect of treatment on reducing and preventing progression to adenocarcinoma.

酗酒相关各种疾病已构成较严重的公共卫生问题.西方国家饮酒人群中酒精性肝病(ALD)的患病率高达84%,且嗜酒者中约有20%～30%可发展为酒精性肝硬化[1].近10余年来,酒精相关性疾病在我国日益受到重视.酒精性肝病在此类疾病中较为突出,受到临床关注.同时,酒精性肝损伤可增加肌体对HBV和HCV的易感性.HBV感染在我国人群中较常见,但尚无有关ALD伴HBV感染率的确切数据.我们对浙江省酒精性肝病合并乙肝病毒感染人群进行调查,现将结果报告如下.

OBJECTIVE:  The aim of this study was to obtain a comprehensive survey on the expression of p 53, p 16 and cyclooxygenase-2 (COX-2) in esophageal cancer progression and their clinical significance. METHODS:  A tissue microarray containing 86 specimens from esophageal cancer and 40 specimens from adjacent non-cancer tissue was constructed to survey the expression of p 53, p 16 and COX-2 by immunohistochemistry. The influence of each biomarker on the histotype of esophageal lesion was assessed by logistic regression analysis. RESULTS:  The expression of p 53 and COX-2 was significantly higher in tumorous tissue than in non-tumorous tissue. As to p 16, no significant difference was detected between tumorous and non-tumorous tissue. A significant correlation was observed among p 53, COX-2 and p 16 expression. Logistic regression analysis revealed that the risk factors of a tumorous histotype were the positive expression of p 53 (odds ratio [ OR ] = 18.214) or COX-2 ( OR  = 42.703), and no reciprocal relationship to neoplastic progression was recognized with p 53, p 16 and COX-2. CONCLUSIONS:  p 53 and COX-2 were independent predictors in esophageal carcinogenesis. Esophageal tissue with a positive expression of p 53 or COX-2 was more likely to develop esophageal cancer.

OBJECTIVE:The aim of this study was to obtain a comprehensive survey on the expression of p53, p16 and cyclooxygenase-2 (COX-2) in esophageal cancer progression and their clinical significance. METHODS:A tissue microarray containing 86 specimens from esophageal cancer and 40 specimens from adjacent non-cancer tissue was constructed to survey the expression of p53, p16 and COX-2 by immunohistochemistry. The influence of each biomarker on the histotype of esophageal lesion was assessed by logistic regression analysis. RESULTS:The expression of p53 and COX-2 was significantly higher in tumorous tissue than in non-tumorous tissue. As to p16, no significant difference was detected between tumorous and non-tumorous tissue. A significant correlation was observed among p53, COX-2 and p16 expression. Logistic regression analysis revealed that the risk factors of a tumorous histotype were the positive expression of p53 (odds ratio [OR] = 18.214) or COX-2 (OR = 42.703), and no reciprocal relationship to neoplastic progression was recognized with p53, p16 and COX-2. CONCLUSIONS:p53 and COX-2 were independent predictors in esophageal carcinogenesis. Esophageal tissue with a positive expression of p53 or COX-2 was more likely to develop esophageal cancer.

BACKGROUND:Pancreatic cancer development and progression is driven by the accumulation of genetic changes. In this study we constructed tissue microarray containing specimens from pancreatic cancer, adjacent non-cancer tissue and normal tissue to survey the expression of p53, p16 and cyclooxygenase-2 (COX-2).METHODS:Tissue microarray containing 337 specimens from different stages of pancreatic cancer, adjacent non-cancer tissue and normal tissues was constructed, and the expression of p53, p16 and COX-2 was assayed by immunohistochemistry to consecutive formalin-fixed tissue microarray sections.RESULTS:The expression of p53, p16 and COX-2 was significantly higher in tumorous tissues than in non-tumorous ones. A significant relationship was observed between p53 and COX-2, or p16 and COX-2. But no obvious correlation was seen between p53 and p16 expressions. Logistic regression analysis showed p53 and COX-2 as dependent predictors in pancreatic carcinogenesis, and a reciprocal relationship to neoplastic progression between p53 and COX-2.CONCLUSION:Combination analysis of p53 and COX-2 may be useful in predicting pancreatic carcinogenesis.

消化性溃疡是全球性常见病、多发病,主要包括胃溃疡(GU)、十二指肠溃疡(DU)和复合溃疡(CU),大约10%的人一生中患过此病.近年来随着社会的发展,内镜检查的普及,以及人们对幽门螺杆菌(HP)的认识,在青年人中发病率有一定的变化.我们对12年来浙江大学学生在我院行胃镜检查的所有资料,进行回顾性分析,以期发现其中发病及变化趋势.

OBJECTIVE:To investigate the diagnosis and treatment of sinusoidal obstruction syndrome (SOS).METHODS:The data of 8 patients with SOS, including clinical manifestations, laboratory results, imaging, pathology, and the course of diagnosis and treatment were reviewed. All cases were followed up.RESULTS:The main clinical manifestations included abdominal distention, hepatalgia and signs of ascites and hepatomegaly. There were mild or moderate hepatocellular injury in 6 patients and heavy injury in 2. All patients' serum-ascites albumin gradient exceeded 11.1 g/L. The levels of CA125 in both serum and ascites elevated significantly. All patients' ultrasonography showed hepatomegaly, appearance of portal hypertension and attenuated hepatic veins. Reverse blood flow in portal vein was observed in 5 cases. Magnetic resonance imaging showed that contrast agent accumulated unevenly in liver in both portal period and lag period, but filled poorly in hepatic veins. Per cutsem liver biopsy showed that all patients' hepatic sinusoids were congested, but venular occlusion was observed in only 3 cases. Five cases had been misdiagnosed. One patient healed after liver transplantation, 4 patients recovered gradually by treatment with heparin and so on and 3 patients died.CONCLUSIONS:Signs of outstanding portal hypertension with mild hepatocellular injury is the main clinical feature of SOS. Both serum and ascites CA125 levels in SOS patients are elevated significantly. The misdiagnosis rate of SOS is quite high, ultrasonography and magnetic resonance imaging have significant value in diagnosis and differential diagnosis, while the value of per cutsem liver biopsy is limited. Combination of imaging and pathology should contribute to correct diagnosis of SOS. Application of anticoagulant in early course is vital, liver transplantation should be considered in severe cases.

BACKGROUND:Alcoholic liver disease (ALD) is a serious and potentially fetal consequence of alcohol use. The diagnosis of ALD is based on alcohol consumption, physical signs and symptoms, and laboratory tests. The aim of the present study was to assess the reliability of carbohydrate-deficient transferrin (CDT) in the diagnosis of ALD.METHODS:According to the diagnostic criteria for ALD by the Chinese Medical Association in 1995, 76 patients with ALD, 55 patients with alcoholism, 32 patients with nonalcoholic liver disease (NALD), and 27 healthy subjects (controls) were studied. Serum CDT was assayed by isoelectric focusing immunofixation and Comassie blue staining. The levels of alamine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma glutamyltransferase (GGT) were also examined.RESULTS:The positive rate of CDT in the patients with ALD was 93.4%(71/76), which was higher than that in those with alcoholism (52.7%, 29/55, P<0.001), in those with NALD(9.4%, 3/32, P<0.001), and in healthy controls, respectively. The sensitivity and specificity of CDT for ALD was 93.4% and 71.9%, respectively.CONCLUSION:CDT may help diagnose alcoholic liver disease.

BACKGROUND Interleukin-1 receptor antagonist (IL-1ra) can inhibit the pro-inflammatory effects of IL-1, which recently has been thought to involve the pathogenesis of alcoholic liver disease (ALD). This study was undertaken to determine whether there is any association between IL-1ra gene polymorphism and ALD in a Chinese population. METHODS The polymorphism of IL-1ra gene intron 2 (VNTR) was assessed in 165 alcoholics (43 alcohol-dependent subjects without liver diseases, 30 patients with alcoholic fatty liver, 61 patients with alcoholic hepatitis and 31 patients with alcoholic cirrhosis) and 65 healthy control subjects by PCR with DNA of peripheral blood mononuclear cells. RESULTS The rate of IL-1RN*1 carriage was statistically higher in the alcoholics than in the control group (98.79% vs 93.85%, chi2=4.48, P<0.050). And the IL-1RN*1 allele frequency was more common in the alcoholics than in the control group (86.67% vs 76.92%, chi2=6.56, P<0.025). IL-1RN*1 heterozygote was significantly more frequent in the patients with alcoholic hepatitis or those with cirrhosis than in the alcohol-dependent subjects without liver diseases (32.79%, 29.03% vs 9.30%; chi2=7.84, chi2=4.84; P<0.010, P<0.050). The IL-1RN*2 allele frequency in the patients with alcoholic hepatitis and the patients with cirrhosis was also significantly higher than in those alcoholics without liver diseases (13.93%, 17.74% vs 4.65%; chi2=4.79, chi2=6.78; P<0.050, P<0.010). But the frequencies of IL-1RN*1 heterozygote and IL-1RN*2 allele appear to be not different between the patients with alcoholic fatty liver and the alcoholics without liver diseases. CONCLUSIONS IL-1ra gene polymorphism is closely associated with race. IL-1RN*2 allele doesn't influence the susceptibility to ALD, but the gene carriers with ALD have additional risk for aggravation of the illness.

患者,男,65岁.因持续腹部胀痛、大便次数增多伴嗜酸粒细胞增多10个月,于2000年10月10日收住我院消化内科.患者发病初大便每日2-3次,劳累或进食油腻食物后可达5次.大便多呈糊状,含白色粘液,有里急后重感,后大便次数逐渐增加到每日8～10次,呈水样便或粘液便.