实施实习前强化训练以提高外科基本操作技能

目的探讨实习前强化训练对提高外科基本操作技能的影响。方法对2005级临床医学专业本科生156人进行实习前强化训练,训练内容包括无菌技术和外科基本操作,强化训练前后进行考核。结果学生强化训练后,外科基本操作技能考核成绩较强化训练前有明显提高。结论开展实习前的强化训练,有助于提高实习生外科基本操作技能,增强动手能力,缩短进入临床实习的适应期。     

临床医学专业本科实习生护理基本操作技能培训的实践与思考

目的探讨临床医学专业本科实习生护理基本操作技能培训的最佳途径及效果。方法对我院2001、2002、2003级临床医学专业本科实习生在毕业实习不同时期进行护理基本操作技能培训,比较各年级学生毕业考试中基本操作技能考核成绩并调查学生对护理基本操作技能培训的满意度。结果毕业考试中,护理基本操作技能考核成绩与内科、外科基本操作技能考核成绩比较,除2002级学生护理基本操作技能考核成绩与内科基本操作技能考核成绩有显著性差异外,其余均无显著性差异（P〉0．05）。结论临床医学专业本科实习生护理基本操作技能培训能取得与内、外科临床技能培训同样的效果。值得推广,但还需进一步完善。     

实习前集中训练临床基本操作的体会

笔者通过临床实践教学体会到，实区医学专业实习前集中训练临床基本操作，能够使学生很快适应临床，养成基本的临床思维程序，提高临床基本诊断技能。     

卫生学校计算机专业实习前强化训练的实施

卫生学校计算机专业实习前强化训练是对即将开始实习的学生所进行的计算机基本操作技能的训练,目的是使学生更加熟练地掌握各项常用计算机技术,促使学生较快地适应计算机实习的工作。我校开展实习前强化训练多年,效果显著,获得各级实习单位及学生的好评。     

外科手术学教学问题探讨

外科手术学在医学教育教学中具有重要作用，学生通过外科手术学的教学实习，以开展动物手术来促进外科基本操作技能的训练和提高，为将来临床实习和工作打好坚实基础．因此，应提高外科手术学的教学地位和质量．     

病理生理学实验教材的建设及效果

为了体现病理生理学是桥梁学科以及理论性和实践性都较强的特点，我们扩充了实习指导的内容，包括概述、实验、自学及复习等部分。因而，实习指导既能指导学生完成实验又能有针对性训练学生基本操作等技能；既是实验教材又是培养学生临床思维及理论复习的辅导材料。四年的实践，效果显著。     

医院制剂实习带教体会

学生实习是学生由学校走向社会,由从单纯的基础理论学习转化成实践过程中的特殊阶段。我院药剂科作为医院的一个重要科室,每年都肩负着学生实习带教工作的重要任务。医院制剂是学生在药剂科实习的必修内容。怎样保证完成学生的实习任务，如何抓好实习学生的学习管理，提高学生实习质量，使学生的后期毕业实习与前期理论学习有机地结合起来，尽快掌握基本操作技能、达到实习的目的已成为当前的新课题。笔者就近几年的制剂带教工作中总结的一些经验报道如下：     

培养卓越医师的教学路径管理

为加强培养卓越医师的教学路径管理,以提高学生临床技能,达到医学院校满足社会需求,输送合格实用人才的教育目标。将所有学生在校成绩、实习前后成绩均进行登记,取在校期间技能教学考核成绩,作为实习成绩。采用实习前后自身对照的方法,通过理论知识、基本操作技能、医患沟通技能、危重病应急能力四个方面评定比较,进行统计分析。结果发现,卓越医师的教学实用人才培训理念下的学生的理论知识加强,基本操作技能熟练,医患沟通技能提高,危重病应急能力反应敏捷。因此,通过培养卓越医师的教学路径管理,完善教学质控,取得了满意的教学评估效果,受到用人单位的欢迎,为今后培养卓越医师的教学路径探索到更好的方法。     

医学本科生临床实习教学改革探讨

为探讨医学本科生实习教学管理难点，提高教学质量，通过对我院1999级本科实习生考核成绩分析发现，由于诸多因素的影响，学生的临床基本操作技能及综合分析能力、动手能力明显偏低。要想保证医学本科生教学质量及临床实习效果，必须改革现有的医学教育管理体制、教学模式及教学大纲。     

儿科临床实习教学改革的探讨

目的通过儿科教学改革,培养学生临床分析思维能力和实践技能,提高临床实习教学质量。方法自1997年至今,我科对临床实习学生加强教学管理,端正学习态度,培养爱伤观念,增加学生对临床儿科实习的兴趣;着重培养学生临床分析思维能力和基本操作技能,增加专题讲座和教学查房,活跃思维、扩大知识面;临床实习考核实行出科多站考试,对出科成绩进行量化评价。结果临床实习教学改革后,不仅注重学生理论知识的教授,更注重学生临床技能和综合素质的培养,出科成绩有了量化的考核指标。结论经过一系列临床实习教学改革,取得了良好的教学效果。     

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

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.