目的:探讨以器官系统为中心的教学模式在卓越医生培养中的效果.方法:在新组建的卓越医生试点班中开展以器官系统为中心的教学模式,总结分析培养成效.结果:通过8年改革和实践,以器官系统为中心的教学模式在卓越医生培养中取得较好的成效,同时推动了教学团队、课程和教材等建设.结论:以器官系统为中心的教学模式有效地提升了医学生的临床思维能力、执业医师考试通过率、考研率、科研及岗位胜任能力.

目的:整合临床医学专业课程,建立以器官系统为中心的课程体系.方法:通过总结和借鉴国内外相关经验,建设我校以器官系统为中心的临床医学专业新课程体系.结果:通过8年实践和不断完善,初步建立的以器官系统为中心的临床医学本科课程体系,在教学团队建设、课程建设、PBL教学和教材建设等方面取得较好的效果.结论:通过集体备课、强化形成性考核、PBL教学、教材建设、教学团队建设等方式能有效地推动以器官系统为中心的课程体系建设.

目的 探讨应用揭盖术对治疗鼻底部巨大囊肿的临床效果及预后疗效.方法 选择我科近期收治的1例鼻底部巨大囊肿患者为对象,对其行视频鼻内镜下鼻底巨大囊肿揭盖术,分析观察患者的术后症状改善、并发症、术腔恢复及术后复发情况.结果 该患者术后症状明显改善、无并发症、术腔粘膜恢复良好、无术后复发.结论 鼻内镜下鼻囊肿揭盖术治疗鼻底巨大囊肿对患者鼻腔创伤小,切口愈合快、术后肿胀不明显,疼痛较轻,并发症及复发率较低,值得临床推广应用.

儿童变应性鼻炎主要症状为打喷嚏、流清鼻涕、鼻塞等,严重影响患儿的生活质量,了解其致病因素、临床表现以及治疗方法,对提高变应性鼻炎的诊断及治愈率尤为重要.

食管癌在全球各地区的发病率存在差异,我国河南省林州市、山东省肥城市为高发地区,大多数患者就诊时已属晚期.食管癌早期症状无特异性,中晚期出现进行性吞咽困难,但以声嘶为首发症状的食管癌病例很少见.为加深对该病的认识,现将我院收治的1例以声嘶为首发症状的食管癌进行现报道.

梭形细胞瘤发生在鼻腔、鼻窦极其罕见,2016 年 10 月我院收治了一例鼻腔鼻窦梭形细胞瘤的患者,报告如下. 临床资料 患者,女,28 岁,因"渐进性左侧鼻阻 3 月余"入院,鼻阻夜间显著,无流脓涕、头痛,无喷嚏、流清涕,未感嗅觉明显减退,无涕中带血、面部麻木等症状,无眼球运动障碍.患者无烟酒不良嗜好,家族无类似疾病史.

过敏性鼻炎(Allergic Rhinitis,AR)又称变应性鼻炎,是由具有过敏体质的人接触过敏原后由免疫球蛋E(ImmunoglobulinE,IgE)介导的以炎性介质(组胺)释放为开始的、有免疫活性细胞和促炎细胞以及细胞因子参与的鼻黏膜变态反应性疾病.随着工业化进展,现代生活方式和人类生态环境的急剧变化,过敏性鼻炎有逐年增高趋势,全球发病率达到10％-25％,世界卫生组织已将变应性疾病列为21世纪重点研究和防治疾病.本文主要介绍了过敏性鼻炎的定义及目前国内外对过敏性鼻炎治疗方法的新进展.

目的:探讨气管及支气管异物的临床特征,总结诊疗经验.方法:回顾性分析2014年1月至2015年1月一年间秦皇岛人民医院耳鼻咽喉科诊治的气管及支气管异物98例的临床资料.支气管镜检查发现异物位于右主支气管者55例,位于左主支气管者30例,位于双侧支气管者10例,位于气管者3例.结果:常见的异物有花生米、瓜子、核桃仁、豆类等干果.结论:对患气管及支气管异物的病人,应详细询问病史重视胸部X线检查结果,以免延误病情,尤其对病人及其家庭成员进行相关的教育是预防该病的关键.

目的:探讨大理地区妇女宫颈人乳头瘤病毒(HPV)感染亚型与宫颈病变及其流行病学特征的关系.方法:收集2011年7月至2014年9月在大理大学附属医院妇产科门诊病例,共2053例,平均年龄为39.46岁,应用基因扩增及导流杂交技术进行基因亚型检测.TCT及病理检查方法对其进行病变类型检测.收集整理HPV阳性患者的年龄、民族、职业.结果:2053例病例中阳性例数为308例,阳性率为15.00%.共检测出14种高危:HPV16(28.90%)、HPV52(21.75%)、HPV58(12.99%)、HPV18(10.39%)、HPV68(4.22%)、HPV31(2.27%)、HPV66(3.25%)、HPV33(5.19%)、HPV39(5.52%)、HPV53(4.55%)、HPV59(1.62%)、HPV56(0.65%)、HPV35(1.62%)、HPV51(2.60%);5种低危型:HPV45、HPV42、HPV6、HPV11、81(cp8304).HPV单一感染宫颈病变阳性率为21.95%(TBS)、50%(病理),多重感染宫颈病变阳性率为4.88%(TBS)、9.38%(病理).阳性病例中有122例记录了民族,其中白族81例(66.39%),汉族27例,彝族6例,傈僳族4例,藏族2例,回族1例,纳西族1例.白族妇女中共检出8种基因亚型.职业主要分为务农人员(52.70%),非务农人员(职员、公务员及自由职业者等)(47.30%).结论:大理地区HPV感染高危型以16型、52型、58型、18型最常见,多重感染并不增加宫颈癌的发生.HPV病例构成比较高的年龄段为30~52岁,阳性率较高的年龄段为≥62岁.白族妇女中较常见的HPV基因亚型为HPV52型、16型、58型、18型.HPV感染亚型分布具有一定的地域、年龄及民族特点.

目的：探讨慢性鼻－鼻窦炎伴鼻息肉（ CRSwNP ）患者鼻窦内微生物感染对鼻内窥镜手术近期疗效的影响。方法对收治的101例行鼻内镜下Messerklinger术的CRSwNP患者进行回顾性研究。取上颌窦分泌物行微生物培养并鉴定，术后口服克拉霉素及局部应用糖皮质激素等常规治疗。术前及术后第12个月采用视觉模拟量表（ VAS）、Lund－Kennedy内镜评分及Lund－Mackay CT 评分对所有患者进行主观及客观病情评估。结果微生物培养阴性（MCN组）22例，细菌培养阳性（BCP组）54例，真菌培养阳性（FCP组）25例。随访12个月，MCN组、BCP组和FCP组有效率分别为90.9％、85.2％、64.0％，MCP组与FCP组相比，FCP组与BCP组相比差异均有统计学意义（P＜0.05），MCN组与BCP组相比差异无统计学意义（P＞0.05）；术后MCN组的VAS评分、Lund－Kennedy内镜评分和Lund－Mackay CT 评分最低，FCP组最高，MCN组与FCP组相比，FCP组与BCP组相比差异均有统计学意义（ P＜0.05）。结论 CRSwNP患者鼻窦内微生物感染可能对鼻内镜手术的疗效产生影响，有微生物感染患者的疗效不佳，特别是真菌感染患者的疗效更差，应用敏感抗生素是否可以改善CRSwNP患者鼻内镜手术的术后疗效有待进一步研究。

Objective: To explore the feasibility of Draf frontal sinus drainage surgery in the treatment of frontal recess lesions. Methods:Draf frontal sinus drainage surgery was undergone in 12 patients with frontal recess lesions. Results: All patients' frontal sinuses were opened completely in the surgery and followed up for more than 6 months and no postoperative primary diseases occurred, only one case with frontal recess blocking. Conclusion: Draf frontal sinus drainage surgery could open frontal sinus safely and effectively.

Nasopharyngeal carcinoma is one of the common malignant tumor in southern China,that 5-year survival rate is in the range of 50%- 60% and the prognosis is poor. Vascular endothelial growth factor(VEGF)belongs to the family of platelet-derived growth factors and so far as the only known specific factor acts to vascular endothelial cells. It expresses lower in most tissues of the human with nonspecific manner and higher abnormally in most tumor tissues. The fact that it is related closely to tumor's occurrence,development,treatment and prognosis suggests that VEGF is a potentially valuable tumor marker and also expected to become an ideal new target for targeted cancer therapy. Some studies found that the phenomenon of high expression of VEGF is also occurs in nasopharyngeal carcinoma and gene silence with VEGF siRNA can inhibit the proliferation of nasopharyngeal carcinoma cell lines. Hence,the treatment using VEGF as the target may open new avenues for the clinical treatment of nasopharyngeal carcinoma. In this paper,it is reviewed about the research status of VEGF and nasopharyngeal carcinoma.

Basal cell carcinoma has much difference with trichoblastoma in therapy and prognosis. In the past years, due to the lack of definite classification and distinctions of basal cell carcinoma and trichoblastoma, misdiagnosis and mismanagement were often encountered and the patients underwent inappropriate treatment. So we must differentiate basal cell carcinoma from trichoblastoma early and accurately. It is difficult to distinguish them distinctly only by clinical presentation and pathologic features. In recent years, with the development of molecular biology, research in immunohistochemisty and genetics have increased, and provide us some new identification. This review article mainly describes the recent development of molecular biological markers AR, CD10, Ln5γ2, Nestin, PHLDAl and CK20 for the differential diagnosis of basal cell carcinoma and trichoblastoma.

Recent years,Non-institution personnel has became an important force in the development of hospital. Culture construction is a vital means of hospital sustainable development strategy. Under the circumstance of the“institution”and“non-institution”employment system,non-institution personnel may have different views of hospital culture identity and inheritance,so we must attach importance to the status and role of non-institution personnel in the hospital culture construction. In turn,cultural identity,cultural orientation,cultural incentive is an important means to strengthen the non-institution personnel management. Therefore culture management of non-institution personnel is important and positive for a hospital.

临床医学本科毕业综合考试是对毕业实习过程中的临床操作技能、疾病诊治能力、医疗文书及医学论文的书写能力等的掌握情况进行有效评价和考核，同时又能反映实习医院教学质量，充分发挥毕业考试对临床实习的导向、评价作用，引导学生在临床实践中积极主动地学习［1-3］。近年来，本校对毕业考试的内容、方法进行了改革，结合执业医师考试大纲要求，变原来的一次性理论考试为多站点综合性考试。现将近几年来改革结果报道如下。

EZH2 is a human gene, homologous with Drosophila zeste gene enhancer. It belongs to PcG (Polycomb group) protein family, and becomes the important epigenetic research object in recent years. EZH2 expresses highly in a variety of tumors such as breast cancer, prostate cancer, and glioma, and has been frequent studied currently as a transcription factor suppressor gene. Numerous studies have demonstrated that relationship between EZH2 and the occurrence, development of cancer, and EZH2 may become a new target for treating the glioma. Glioma is a cancer occurring in neuroectodermal tumor and originates from nerve stromal cells, with characteristics including high morbidity, high recurrence rate, high mortality and low cure. So the effect is not satisfactory. Many findings suggest that EZH2 is highly express in glioma, using EZH2 gene silencing technology can inhibit the proliferation of glioma cells at cell level, and therefore EZH2 as a target for clinical treatment methods may open new avenues for the treatment of glioma. In this paper, the researches status of EZH2 and glioma were reviewed.

<正>微转移、过渡转移、转移灶形成是恶性肿瘤转移的三个阶段。肿瘤微转移又称隐性转移,是指直径不大于1mm的微小转移灶。具体是指非血液系统的恶性肿瘤发生播散且存活于淋巴系统、骨髓或血循环等组织器官中的微小肿瘤,一般未出现任何临床表现[1],一般很难用常规检查方法如CT、MRI、单抗放射显影等技术发现。目前研究头颈部恶性肿瘤一个重要热点就是如何早期预防与发现恶性肿瘤的微转移。本文就鳞癌(头颈部)淋巴结微转移的研究现状作一简要概述。

本科专业建设与管理是高等学校一个十分重要的内容,各级教育行政管理部门和各个高校都十分重视专业建设及其与之相关的各种教育教学改革问题.<'[1-6]>专业建设与管理改革涉及的内容比较复杂,如课程体系建设、<'[1,6]>特色专业建设臣<'[2,5]>和专业设置<'[3]>等.大理学院的临床医学、医学检验和医学影像3个专业是该校招生规模较大、生源和就业状况都比较好的本科专业,2010年这3个专业招生人数达到630余人,其中临床医学专业是具有30多年办学历史的老牌专业,2010年该专业首次在云南省实行"一本"批次招生且生源很好.

To design performance evaluation indicator system of clinical departments in the DL hospital,through organizing experts to discuss time and again,a general study idea is designed,based on the literature review.It is important to create performance environment during establishing clinical department performance evaluation system;and the evaluation result will be accredited by experts generally.