PBL与CBL教学法在留学生实验诊断教学的应用探讨

目的探讨PBL与CBL教学法在留学生实验诊断教学的应用效果。方法将PBL联合案例教学法(CBL)应用于临床医学本科留学生实验诊断教学,与大班传统讲授教学方法(对照组)相比较,通过问卷调查和成绩分析学习效果。结果试验组在激发学习兴趣和培养临床思维能力方面均高于对照组,理论知识的成绩和实习的成绩也是试验组优于对照组,P<0.05。结论PBL与CBL教学联合应用于实验诊断教学中能够有效提高教学质量,并受到学生的认可和喜爱。     

CD40靶向小干扰RNA抑制大鼠异体肢体移植急性排斥反应后细胞凋亡及P53、P21表达

目的探讨CD40靶向小干扰RNA（即短发夹RNA，shRNA）对大鼠异体肢体移植急性排斥反应及细胞凋亡的影响。方法以纯系SD大鼠为供体，纯系Wistar大鼠为受体，行同种异体右后肢移植。27只大鼠肢体移植后随机分为3组：实验组．注射梭华一Sofast（15μl）-siCD40—2，pSilencer（100μg）载体复合物600μl；空载体对照组，在肢体移植后，即注射Sofast（15μl）-pSilencer4．1-CMVneo（100μg）空载体复合物600μl；生理盐水对照组，在肢体移植注射生理盐水600μl。观察移植物排斥反应征象及存活情况，并于第7天对产生免疫耐受大鼠进行混合淋巴细胞反应（MLR），同时进行组织学检查。结果与其他组相比．实验组移植物发生排斥反应的时间及存活时间均显著延长（P〈0．01）（〉13d），未见排斥反应征象，其他组均于术后近期发生排斥反应；实验组大鼠对供体的淋巴细胞呈现低反应性，移植的供体同系大鼠的肢体得以存活。实验组移植物细胞凋亡率低于其他组。结论在术后不应用免疫抑制剂的情况下，CD40靶向的shRNA干扰可以抗大鼠异体肢体移植急性排斥反应。     

Study of electroacupuncture with different frequencies for the treatment of headache and anxiety-depression symptoms in patients with migraine: A randomized clinical trial: 不同频率电针改善偏头痛患者头痛及焦虑抑郁症状的差异性研究-随机临床试验

ObjectiveTo observe the effects of electroacupuncture (EA) with varied frequencies on headache and anxiety-depression symptoms in patients with migraine and to screen optimal frequency of EA for patients with such conditions.DesignSingle-center, randomized, controlled clinical trial was designed, and the outcome assessors and statisticians were blinded. The patients with migraine were randomized into 2 Hz EA group, 100 Hz EA group and sham-stimulation group. In each group, the changes in migraine attacks, days with headache, the scores of visual analogy scale (VAS), self-rating anxiety scale (SAS), self-rating depression scale (SDS) and migraine-specific quality-of-life questionnaire (MSQ), as well as the dosage of analgesics were observed at the baseline, during treatment, in 1, 2 and 3 months of follow-up separately.SettingPatients were enrolled in the Third Affiliated Hospital of Zhejiang Chinese Medical University, between 1^st August 2018 and 31^st July 2021.ParticipantsSixty-five migraine patients with or without aura.InterventionsIn the EA groups, the acupoints were bilateral Fengchi (GB20), Gongxue (Extra), Sizhukong (TE23), Taiyang (EX-HN5), Shuaigu (GB8), Waiguan (TE5) and Yanglingquan (GB34). Electric stimulation was exerted at GB20 and Gongxue (Extra), with 2 Hz and 100 Hz separately. In the sham-stimulation group, the shallow acupuncture was operated at the sites 1 cm lateral to GB20 and Gongxue (Extra), and on the radial side of TE5 and GB34. The output wires were cut off after attached to the acupoints. The patients in each group received the treatment 3 times weekly, once every two days, for consecutive 4 weeks. The complete intervention was composed of 12 treatments.Main outcome measuresChanges in numbers of migraine attacks at treatment phase (week 1 to week 4) from the baseline(week -4 to week 0) in patients of each groupResults(1) Changes in migraine attacks and days with headache: In the 2 Hz EA and 100 Hz EA groups, the changes for migraine attacks and days of headache were higher significantly when compared with that in the sham-stimulation group at the same time stage (P < 0.05). There was no statistical difference between two EA groups. (2) Changes of VAS score: In the 2 Hz EA and 100 Hz EA groups, the changes of VAS score were significantly higher when compared with that in the sham-stimulation group at the same time stage (P < 0.05). There was no statistical difference between two EA groups. (3) Assessment of anxiety and depression: The differences in the changes of SAS and SDS scores had no statistical significance in patients of each group at each assessment stage (P > 0.05). (4) Assessment on the quality of life: Compared with the sham-stimulation group at the same time stage, the improvement in MSQ score was increased significantly during treatment in patients of the 2 Hz EA and 100 Hz groups (P < 0.05). There was no statistical difference between two EA groups. (5) Assessment on safety and compliance: The patients of each group had sound compliance. There was no adverse events during trial, suggesting promising safety of treatment.ConclusionEA may effectively reduce the migraine attacks, and the days and intensity of headache, presenting promising safety. However, there was no significant improvement on anxiety-depression symptoms, and no significant difference between high and low frequencies of EA treatment in relieving headache and anxiety/depression symptoms in the patients with migraine.Trial registrationChiCTR1800017259     

Late arrhythmias in patients with new-onset persistent left bundle branch block after transcatheter aortic valve replacement using a balloon-expandable valve

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The critical role of therapeutic plasma exchange in ABO-incompatible liver transplantation

BackgroundThe shortage of donor liver restricts liver transplantation (LT). Nowadays, donor liver with ABO blood group incompatibility between donor and recipient has become an option to expand the source of donor liver. Although it is now possible to perform ABO-incompatible (ABO-I) LT, antibody-mediated rejection (AMR) has been recognized as the primary cause of desperate outcomes after ABO-I LT. Anti-A/B antibody is the trigger of immune response to ABO-I LT graft injury. Therapeutic plasma exchange (TPE) can quickly reduce the titer of plasma antibodies and effectively inhibit humoral immunity.Data sourcesWe searched PubMed and CNKI databases using search terms “therapeutic plasma exchange”, “ABO-incompatible liver transplantation”, “ABO-I LT”, “liver transplantation”, “LT”, “antibody-mediated rejection”, and “AMR”. Additional publications were identified by a manual search of references from key articles. The relevant publications published before September 30, 2020 were included in this review.ResultsDifferent centers have made different attempts on whether to use TPE, when to use TPE and how often to use TPE. However, the control standard of lectin revision level is always controversial, the target titer varies significantly from center to center, and the standard target titer has not yet been established. TPE has several schemes to reduce antibody titers, but there is a lack of clinical trials that provide standardized procedures.ConclusionsTPE is essential for ABO-I LT. Hence, further research and clinical trials should be conducted to determine the best regimen for TPE to remove ABO antibodies and prevent AMR.     

复方维生素E口腔药膜含量测定方法研究

目的改进复方维生素E口腔药膜现有质量标准。方法将药膜放入少量纯化水中,水浴加热,溶解后,滴加适量无水乙醇,上清液加甲醇稀释。色谱柱为Sinochrom ODS-BP柱(200 mm×4. 6 mm,5μm),流动相为甲醇-异丙醇(88∶12,V/V),流速为1. 0 m L/min,检测波长为284 nm,柱温为40℃,进样量为10μL。结果维生素E质量浓度在50~800μg/m L范围内与峰面积线性关系良好(r=0. 999 9);精密度和稳定性均良好,RSD分别为1. 13%和0. 71%;平均加样回收率为95. 55%和100. 56%,RSD为2. 66%和1. 46%(n=3);6批药膜中维生素E的含量分别为标示量的98. 10%~101. 70%。结论热溶法将膜剂中有效物质的提取回收率大于95. 00%,显著高于超声波的提取率。该方法操作简便、结果准确、专属性强、重复性好,可用于复方维生素E口腔药膜中维生素E含量的快速测定。     

人工髋关节置换术后早期活动的近期疗效分析

目的评价人工髋关节置换术(THR)术后患者康复情况及其疗效。方法选择84例行人工THR治疗患者,其中男性48例,女性36例;年龄32~89岁,平均年龄60.7岁。行人工THR。术后进行近期康复情况随访,应用髋关节Harris功能评分法与视觉模拟评分法(VAS)对疗效进行分析。同时对比分析单侧及双侧人工THR后疗效差异。结果 84例病例均获访,平均随访时间12~18个月。其中股骨头缺血坏死、髋关节骨性关节炎、先天性髋关节发育不良的随访患者Harris评分由术前的39.81±8.73提高到术后的79.05±5.13。病因为股骨粗隆间骨折、股骨颈骨折的随访患者VAS由术前6.42±0.89降低到术后1.28±0.50。行同期双侧人工THR治疗的随访患者与行单侧THR治疗患者术后Harris评分比较,差异无显著统计学意义。结论单侧、同期双侧THR后早期活动有助于患者术后髋关节功能的改善,提高日常功能。同期双侧THR治疗对髋关节疾病患者的近期预后疗效可靠,不会因一期遭受双侧同时手术,受手术时间长、出血多、创伤大等因素影响近期预后恢复。     

特发性室性心律失常的发生基质研究进展

心律失常的发生基质是目前电生理领域研究的热点问题。近期研究提示:心肌组织、心肌细胞间的缝隙连接、心脏传导系统以及自主神经系统等在特发性室性心律失常的发生和维持中起着重要作用。深入研究特发性室性心律失常的发生基质将会为一些难治性室性心律失常提供新的治疗方法,有助于从根源上治疗特发性室性心律失常。     

我院医务人员对高危药品认知现状的调查分析

目的:评估我院医务人员对高危药品相关知识的掌握情况,为加强高危药品规范化管理、保障患者用药安全提供参考。方法:采用随机抽样法选取我院部分医务人员作为研究对象,采用自行设计的问卷对其进行高危药品相关知识调查并就调查结果进行分析。结果:共发放问卷245份,回收有效问卷225份,有效回收率为91.84%。结果显示,受访医务人员中有69.61%的医师、72.62%的护士和71.79%的药师明确高危药品的概念;对高危药品的品种能够准确辨别的医师仅为4.90%,护士为20.24%,药师为15.38%;约20%的受访医务人员对于科室建立的高危药品风险防范措施不清楚;用药差错报告的意愿率为88.44%;对高危药品知识的需求途径主要是专题讲座,占受访医务人员的88.00%;最易发生风险的前5类高危药品分别为高渗电解质注射液、胰岛素制剂、肾上腺素受体激动药、抗凝血药、抗心律失常药。结论:我院医务人员对高危药品的认识存在一定不足,对高危药品风险防范意识相对薄弱。建议医疗卫生机构加强医务人员高危药品相关知识的培训,提高医务人员对高危药品的认知程度和警惕性,使其牢记风险防范措施,减少或杜绝由此引起的严重不良事件的发生。     

我院2年间骨科髋关节置换术预防性应用抗菌药物的临床评价

目的:评价我院骨科髋关节置换术预防性应用抗菌药物整治活动的效果,以期逐步扩大抗菌药物专项整治成效,建立长效管理机制。方法:随机抽取我院骨科行髋关节置换术患者182例,其中2010年4月-2011年4月(整治活动前组)90例,2011年11月-2012年11月(整治活动后组)92例。对患者的自然情况、抗菌药物使用品种、使用时机、使用疗程等进行汇总及评价,并将结果应用SPSS 18.0软件进行统计分析,比较两组患者预防性应用抗菌药物的合理性。结果:开展抗菌药物专项整治后,抗菌药物预防性应用主要药物由第3代头孢菌素(31.11%)变为第1代头孢菌素(54.35%),其他各类药物的使用率均有显著下降(P<0.01);预防用药时机由大于术前2 h(58.89%)变为切皮前0.5² h(88.04%);用药疗程由平均(11.91±3.87)d变为(4.07±2.32)d;抗菌药物平均总费用下降71.06%。经过整治活动后药物选择不合理、术前用药不合理、更换药物不合理以及联合用药不合理的情况均有显著下降(P<0.01)。结论:抗菌药物专项整治活动后,我院骨科髋关节置换术预防性应用抗菌药物合理性得到明显改善,抗菌药物合理应用的长效管理机制已逐步建立。