鼻衄患者的心理护理

随着现代医学模式的转变,心理护理对疾病的发展转归预后的作用日益受到重视,在耳鼻喉科病房做好心理护理则具有特殊的意义,尤其是鼻衄的患者能否针对心理因素进行恰当的处理,及时做好病人的心理护理,使病人情绪稳定、心理平衡、精神愉快,促成病人心理和生理之间的良性循环,直接影响到防治的效果,有助于病人治疗和康复,进一步发挥了药物不可及的独特作用.现将心理护理的体会介绍如下.     

转型期医学伦理评价的相对性

生物技术的发展以人类难以想象的方式改变着未来的世界,人类利用生物技术攻克多种疑难疾病.随着医学领域的转型,除了给人类带来新的希望外,也给人类留下了无端的困惑,热点争议不断,争议的问题促使了医学伦理学的发展.伦理评价在此显示了它的相对性,若是支持现代生物的发展,会引起人类所担忧的弊端出现;若是禁止则会阻碍现代文明的进步,这就是现在生命伦理学面临的难题.     

出版偏倚与医学期刊报道观念的转变

随着循证医学的兴起,以及循证观念在临床医学实践中的逐渐深入,能够寻找、评价和利用文献证据成为了临床医生应该掌握的基本技能之一,也成为医生让患者获得最大诊疗效益和最低成本的有效途径.循证医学以己发表的文献为研究的素材,而文献发表中存在的出版偏倚对循证医学研究结论会产生致命的影响.虽然循证医学研究从方法学上对这种出版偏倚作了纠偏,但是要从根本上解决出版偏倚问题,需要转变传统的医学期刊报道观念,研究者、报道者和编辑出版者共同参与,从报道的各个环节上加以控制,从源头上减少出版偏倚的发生.现结合多年的编辑工作经验,就出版偏倚的基本概念、产生的原因以及控制的途径和方法作一探讨.     

医学生职业道德培养途径初探

医学生是医务人员的后备力量,是医务界的未来和希望,医学生的职业道德素质关系到我国医疗机构的前途命运、人民的生命安危和社会的和谐稳定.国家、社会和人民群众都对医学生职业道德提出了更高、更严的要求并寄予更大的希望.然而,由于市场经济大潮的冲击,医学生的职业道德出现了滑坡现象.尽快扭转这一趋势,加强对医学生的职业道德培养已成为一项紧迫的课题.现紧密联系我国医学生职业道德培养的实际,借鉴国外一些成功的做法,从4个方面论述我国医学生职业道德培养的根本途径、有效途径、关键途径、必要途径,概括阐述了方向问题、基础问题、保障问题.对医学院校搞好医学生职业道德培养工作具有一定的指导意义.     

医学院校学分制实践与思考

实施学分制,是适应科学技术的迅猛发展和社会主义市场经济发展对人才的需求、改革教学管理模式、提高教学质量的必然要求.通过对我国高等学校学分制实施现状以及泰山医学院实践情况的分析,为进一步推进学分制教学管理制度的实施,做一些必要的研究.     

POCT的信息管理

POCT是在医疗条件下,由非实验室的卫生保健人员,在实验室的质控指导下,于病人身边进行的检验。它广泛适用于医院(如外科,儿科)、监护病房、急救单位、保险公司、社区医疗、家庭保健网络等领域。当今,POCT在全球方兴未艾,据调查,现今已有10%的诊断实验是在POCT仪器上完成的,究其原因,无非是POCT兼具医学上的有效性及经济两个方面的优势。当然,随着POCT设备的投放不断增加,使用范围不断拓展,POCT的管理问题也日益凸现,本文将对POCT实施中的信息管理的若干问题进行初步探讨。     

饮料瓶底部藏有可怕的秘密

据有关媒体报道,阿联酋一个12岁的女童,因为连续十六个月使用同一个矿泉水瓶饮水而患了癌症。一般来说,塑料瓶的底部都会有个三角形的图案,中间还有数字。由三个箭头组成的三角形,是可回收的意思。三角形标识里面的数字则代表了制作饮料瓶所用的最主要的材料。如果人们能了解每个数字所代表的意思,就能更加科学地使用塑料制品。     

我院自产文献数据库的开发研制

高等院校聚集了大量科研人才,本院校自产的文献,特别是作为具有独创性、学术性、实用性的学术论文,已成为一种不可忽视的情报源,越来越受到学术界的重视.教师的科研论文可以及时反映出本校的科研水平和研究成果.从本院校的实际情况出发,为便于论文的检索和利用,着手建立起本院校教师的科研论文数据库,无疑是十分必要的.建立教师科研论文数据库,有利于加强论文的有效管理,提高论文的利用率,有效地为科研、教学和生产服务.     

当前部分军地院校信息化教学建设的现状及启示

从6个方面介绍当前部分军地院校信息化教学建设的基本情况,认为进行信息化教学建设时要尽可能了解兄弟院校的现状,掌握目前的发展趋势,借鉴他人的经验,结合自己院校的实际,抓住建设的重点,充分发挥现有设备和条件的作用.     

美国临床检验医学进展的借鉴

临床检验医学是一门极其重要的医学学科。从宏观的角度看,一个国家的临床检验医学水平能够直接反应这个国家的医疗水平。对一个医院来说,临床检验科室的水平对这个医院的医疗水平起着举足轻重的作用。因为在科学技术高度发展的今天,一份准确全面的实验报告是医生作出准确的诊断与制定正确治疗方案必不可少的先决条件。     

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…     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.