医学模式的逻辑解析

在医学模式转变过程中,人文精神是医学发展的旗帜,对医学概念的深入理解是医学发展的学理根本.医学模式的转变表明,医学的发展不仅要同科技与社会发展的客观因素相结合,而且要尝试主体(人是所有发展因素的主体)思维方式的革新;医学的发展不仅要注重临床经验的积累,而且要注重主体实践与认识过程的统一.     

关于医学人文学学科设置的思考与建议

我国医学人文学学科发展存在的主要问题有:医学人文学学科与医学学科门类其他一级学科的关系问题,医学人文学内部各学科群之间的关系问题,医学人文学学科设置的规范化问题,医学人文学学科发展理念问题.提出学科设置和发展的建议:在医学学科门类下、增设医学人文学一级学科,明确医学人文学培养目标,务实医学人文学学科建设基础.     

循证和转化医学背景下的医学图书馆

概述当前医学科学发展的时代背景,指出循证医学和转化医学是当今医学发展的趋势,从学科建设、硬件、软件、人员、制度标准5方面讨论在循证和转化医学背景下医学图书馆应如何面对挑战,为医学图书馆制定发展策略提供参考.     

急诊医学的特征与建设之路

本文简要回顾急诊医学的发展历史,透析急诊医学之现状,明确急诊医学之任务,解读急诊医学之特征,查找急诊医学之不足,探索急诊医学的发展与建设之路,积蛙步以至千里,不断健全、壮大急诊队伍,从而促进急诊医学的发展与急诊医学学科的完善,既彰显急诊医学的特征,更体现急诊医学的人文关怀价值.     

大力发展转化医学 促进高等医学院校跨越式发展

目的转化医学是当代医学发展的一场变革,发展转化医学将会大大促进我国高等医科学校的改革发展。本文从管理及促进转化医学发展的角度对转化医学及其意义、作用进行了初步探讨,并由此提出,我们一定要抓住当前医学发展的这一重大机遇,审时度势,顺势而为,采取切实措施大力发展转化医学,抢占学科发展的战略制高点,实现高等医学院校跨越式发展。     

医学模式转变中的道德继承

医学是关乎道德的科学,医学道德以潜能的形式存在于医学的灵魂之中.医学的发展伴随着医学道德的进步,医学模式的转变过程体现了医学道德的继承,医学道德在医学模式转变中的继承和发扬,又将推动医学事业的发展.     

论医学人文精神在实践医学新模式中的地位与作用

随着经济的发展、社会的进步,医学人文精神的地位与作用越来越重要。本文在分析了医学人文精神的发展与内涵以及医学模式转变的基础上,提出医学人文精神是实践医学新模式的必备条件之一,在实践医学新模式中倡导医学人文精神有利于促进现代生命伦理学的发展,推动医学人文教育的发展,并为人们营造了良好的心理社会环境。充分发挥医学人文精神在实践医学新模式中的地位与作用,才能培养出适应现代医学模式要求的、具有医学人文精神的合格医学人才,才能推进以人为本、努力构建社会主义和谐医患关系的伟大实践。     

医学学报开设理论医学专栏的必要性和可能性

本文概要介绍了理论医学及其发展,分析了高等医学院校学报开设理论医学专栏的必要性和可能性。医学研究要想得到突飞猛进的发展,必须重视理论医学的研究。要使以医学方法论为主体内容的理论医学受到医学界的重视,做为医学综合性学术期刊的医学院校学报,必须率先开设理论医学专栏,这是医学学报随医学发展而改革的重要内容。我院学报开设理论医学专栏一年来收到了良好效果。     

开展循证检验医学的创新价值

循证医学(EBM)近年在医学领域中的迅速兴起,为以个人经验为主的临床医学注入了新的活力.循证医学理论基础上形成的循证检验医学,是检验医学发展过程中的一次飞跃,是21世纪检验医学发展的必然趋势.循证检验医学的发展将改变检验医学的现状,面对循证医学检验带来的挑战,检验人员应积极开展循证实验室医学的应用研究,探索循证检验医学实践的途径,提供以患者为中心的最佳实验医学技术及实验医学服务.     

分子医学及其技术

分子医学是涵盖医学分子生物学基础理论、医学分子生物学常用实验技术及其在医学研究中的应用等的综合性学科。分子医学与传统医学最根本的区别在于前者可在基因水平上对疾病进行操作 ,所以分子医学技术已成为推动分子医学发展的重要工具。本文较全面阐述分子医学和分子医学技术的主体内容 ,并指出其在医学发展中的重要性。分子医学的发展将逐渐改变目前以经验医学为主导的局面 ,分子医学技术将成医学工作者必须掌握的基本技能 ,使基础研究和临床应用更紧密地相互联系 ,使科研成果更快速地向临床转化 ,使实验医学和经验医学有机地融合起来 ,这将是未来医学发展的方向。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.