以问题为基础的教学模式在临床医学教学中的应用分析

目的了解以问题为基础的教学模式（简称PBL）在临床医学教学中的应用。方法通过个例访谈、文献总结来设计调查问卷,在网络平台上,向国内的3所医学院校中曾参与过PBL教学的学生发放调查问卷,并分析调查问卷结果。结果对PBL教学达成以下共识：（1）PBL教学适合在临床医学课程教学中应用,完成每个PBL课题讨论之后需要教师对此进行总结;（2）分组的方式和小组的人数采取随机分配方式,每6～8名学生为一组;（3）学生围坐,教师及学生组长坐在中间;（4）教师引导学生发言;（5）教案以人文内容为主,以病生理为框架对患者可能的诊断进行讨论;（6）病案以常见病为主;（7）配备网络设施。需进一步讨论的问题：（1）是否需要本专业的教师带教;（2）课前是否应提供和讨论内容相关的信息。结论（1）以问题为基础的教学模式适合在临床医学教学中应用;（2）关于对教师的要求、分组和座位安排、教学设施配备、病例选择等问题达成了共识;（3）课前是否提供和具体的考核方式及讨论的相关信息、授课老师的专业是否需要和PBL讨论的病例内容相符等问题仍需采取进一步讨论。     

在法语班心内科教学中实践问题导向学习教学法的探索

目的 探索在临床医学教学中实践问题导向学习(PBL)的教学方法.方法 将每届40名临床医学专业法文班学生在见习阶段分为6个小组,以小组为单位实施PBL教学.以"冠状动脉粥样硬化性心脏病"的教学为载体,在传统课程体系架构的基础上,融入PBL教学方法 的实施方案.选取了1例因不稳定性心绞痛就诊的男性患者作为教学案例,按以下五个步骤进行教学:①教师陈述案例的最基本信息;②激发学生集体参与讨论如何理解及解决问题;③教师介绍可获得更多知识的学习资源;④在经过课外学习后,教师在下一次课上组织学生汇总各自分工获得的新知识及新信息,并应用这些新知识解释并解决原案例的问题;⑤教师进行总结.结果 成功实施了PBL案例的教学过程.结论 PBL教学方法 既可以达到保持学科知识系统性和完整性,又能激发学生学习的主观能动性,在自主学习过程中学会如何学习的教学目的.     

药理学实验教学方法初探

①目的 探讨如何从教师和学生两个层面提高药理学理论与实验教学效果.②方法 学生完成所有实验课程后,通过严密设计调查问卷,随机抽取部分学生,进行问卷调查.③结果 设计性实验对自主学习能力的显著性提高大于验证性实验;PBL教学模式对自主学习能力显著性提高大于传统教学.设计性实验的成功率大于验证性实验.④结论 设计性实验及PBL教学模式有助于提高学生的自主学习能力.     

在法语班心内科教学中实践问题导向学习教学法的探索

目的探索在临床医学教学中实践问题导向学习(PBL)的教学方法。方法将每届40名临床医学专业法文班学生在见习阶段分为6个小组,以小组为单位实施PBL教学。以"冠状动脉粥样硬化性心脏病"的教学为载体,在传统课程体系架构的基础上,融入PBL教学方法的实施方案。选取了1例因不稳定性心绞痛就诊的男性患者作为教学案例,按以下五个步骤进行教学:①教师陈述案例的最基本信息;②激发学生集体参与讨论如何理解及解决问题;③教师介绍可获得更多知识的学习资源;④在经过课外学习后,教师在下一次课上组织学生汇总各自分工获得的新知识及新信息,并应用这些新知识解释并解决原案例的问题;⑤教师进行总结。结果成功实施了PBL案例的教学过程。结论 PBL教学方法既可以达到保持学科知识系统性和完整性,又能激发学生学习的主观能动性,在自主学习过程中学会如何学习的教学目的。     

PBL教学在妇产科教学中的应用

目的:探讨PBL教学在妇产科临床课程中的应用效果.方法:2007级及2008级北京大学医学部学生采用PBL教学,2005及2006级的学生采用传统教学,对两组学生理论成绩、综合能力水平进行分析,调查问卷了解学生对PBL教学的满意度.结果:两组学生的理论成绩无显著性差异,学习兴趣、自主学习能力等方面PBL组优于传统组,学生对PBL教学有很高的满意度.结论:PBL教学法应用于课程学习有助于学生自主学习能力培养,提高综合能力水平,适合当今医学生的特点,作为一种有效的教学模式,值得提倡和推广.     

美国加州大学旧金山分校医学院课程改革对我国医学教育改革的启示

美国加州大学旧金山分校医学院于2001年秋季首次使用新课程计划.本文首先介绍了该课程计划的目标、具体内容、各学科内容整合方针、课程预评估及管理机构;然后论述了加州大学旧金山分校医学院课程改革对我国医学教育改革的四点启示:①在学科内容整合上,应当遵循认知科学、学习理论的基本原理,充分考虑学生毕业后的工作情境和社会情境,面向学生毕业后的实际工作需要.②在教学方法上,提倡以课堂讨论(小组)为主、以问题为基础学习(PBL),兼而采用床边教学、案例教学等方式,充分利用信息技术,提倡师生"互动式教学".③在学生评价方式上,强调能力培养,重视诊断性评价和过程性评价,重视临床实际操作能力,学生在见习期间要通过客观结构化临床考试(OSCE).④课程计划改革要有制度上的保证.     

美国加州大学旧金山分校医学院课程改革对我国医学教育改革的启示

美国加州大学旧金山分校医学院于2001年秋季首次使用新课程计划.本文首先介绍了该课程计划的目标、具体内容、各学科内容整合方针、课程预评估及管理机构;然后论述了加州大学旧金山分校医学院课程改革对我国医学教育改革的四点启示:①在学科内容整合上,应当遵循认知科学、学习理论的基本原理,充分考虑学生毕业后的工作情境和社会情境,面向学生毕业后的实际工作需要.②在教学方法上,提倡以课堂讨论(小组)为主、以问题为基础学习(PBL),兼而采用床边教学、案例教学等方式,充分利用信息技术,提倡师生"互动式教学".③在学生评价方式上,强调能力培养,重视诊断性评价和过程性评价,重视临床实际操作能力,学生在见习期间要通过客观结构化临床考试(OSCE).④课程计划改革要有制度上的保证.     

美国加州大学旧金山分校医学院课程改革对我国医学教育改革的启示

美国加州大学旧金山分校医学院于2001年秋季首次使用新课程计划.本文首先介绍了该课程计划的目标、具体内容、各学科内容整合方针、课程预评估及管理机构;然后论述了加州大学旧金山分校医学院课程改革对我国医学教育改革的四点启示:①在学科内容整合上,应当遵循认知科学、学习理论的基本原理,充分考虑学生毕业后的工作情境和社会情境,面向学生毕业后的实际工作需要.②在教学方法上,提倡以课堂讨论(小组)为主、以问题为基础学习(PBL),兼而采用床边教学、案例教学等方式,充分利用信息技术,提倡师生"互动式教学".③在学生评价方式上,强调能力培养,重视诊断性评价和过程性评价,重视临床实际操作能力,学生在见习期间要通过客观结构化临床考试(OSCE).④课程计划改革要有制度上的保证.     

美国加州大学旧金山分校医学院课程改革对我国医学教育改革的启示

美国加州大学旧金山分校医学院于2001年秋季首次使用新课程计划.本文首先介绍了该课程计划的目标、具体内容、各学科内容整合方针、课程预评估及管理机构;然后论述了加州大学旧金山分校医学院课程改革对我国医学教育改革的四点启示:①在学科内容整合上,应当遵循认知科学、学习理论的基本原理,充分考虑学生毕业后的工作情境和社会情境,面向学生毕业后的实际工作需要.②在教学方法上,提倡以课堂讨论(小组)为主、以问题为基础学习(PBL),兼而采用床边教学、案例教学等方式,充分利用信息技术,提倡师生"互动式教学".③在学生评价方式上,强调能力培养,重视诊断性评价和过程性评价,重视临床实际操作能力,学生在见习期间要通过客观结构化临床考试(OSCE).④课程计划改革要有制度上的保证.     

美国加州大学旧金山分校医学院课程改革对我国医学教育改革的启示

美国加州大学旧金山分校医学院于2001年秋季首次使用新课程计划.本文首先介绍了该课程计划的目标、具体内容、各学科内容整合方针、课程预评估及管理机构;然后论述了加州大学旧金山分校医学院课程改革对我国医学教育改革的四点启示:①在学科内容整合上,应当遵循认知科学、学习理论的基本原理,充分考虑学生毕业后的工作情境和社会情境,面向学生毕业后的实际工作需要.②在教学方法上,提倡以课堂讨论(小组)为主、以问题为基础学习(PBL),兼而采用床边教学、案例教学等方式,充分利用信息技术,提倡师生"互动式教学".③在学生评价方式上,强调能力培养,重视诊断性评价和过程性评价,重视临床实际操作能力,学生在见习期间要通过客观结构化临床考试(OSCE).④课程计划改革要有制度上的保证.     

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.     

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.     

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.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.