新加坡眼科医疗机构科技创新经验及其启示

介绍了新加坡国立眼科中心和新加坡眼科研究院在医疗、科研和教学等方面取得的成功经验,特别是在人才培养、科学研究和国际合作上的重要举措,以期对我国大型眼科医疗机构学科建设、转化医学发展及复合型人才培养等有一定的启示和借鉴.     

认真走好青春期的每一步——试论《爱弥儿》中的性教育

法国著名启蒙思想家卢梭,是西方教育史上第一个精辟论述性教育的教育家。在他的巨著《爱弥儿》中,他深刻批判了当时扼杀人性的旧教育,以"遵循自然"为指导原则,以爱弥儿为载体,详细论述了他的性教育思想,成为西方性教育史上的里程碑式的人物。他的性教育思想为在我国家庭教育中实施性教育提供了诸多启示。     

协同教学对制药化工原理课程教学组织的启示

教学组织形式是教学论中的一个重要问题,一直以来,在教学组织形式研究上,主要关注学生的组织形式,而对教师的组织形式有所忽略。本文从教师组织形态变革着手,详细介绍协同教学的基本情况及其在制药化工原理课程教学中的实施构想,以期对当前教学组织形式的变革有所启发。     

美国NN/LM医学图书馆网的分析和启示

从背景、宗旨、任务、现状、信息服务等方面全面分析美国NN/LM,并提出对我国医学图书馆发展的启示和建议。     

“罗森塔尔效应”对大学生教育的启示

“罗森塔尔效应”启示教育者,要取得良好的教育效果,应该对学生抱有积极的期待,要热爱所有学生。赏识所有学生,因为老师的赏识和期待,将成为激发学生潜能、唤起学生自信的力量之源。     

Relationship among cardiac index, inspiration/expiration ratio, and perfluorocarbon dose during partial liquid ventilation in an oleic acid model of acute lung injury in sheep

Background

The aim of this study was to demonstrate the influence of different inspiration/expiration (I/E) ratios on cardiac index (CI) and hemodynamics during partial liquid ventilation (PLV) using a large animal model of acute respiratory failure in a prospective, randomized controlled animal laboratory trial.

Methods

After induction of respiratory failure by right atrial injection of 0.09 mL/kg oleic acid, (1) determination of agreement between reversed Fick and pulmonary artery thermodilution (Q_TD) techniques with progressive doses of perflubron (LiquiVent, Alliance Pharmaceutical Corp, San Diego, Calif) (n = 7 sheep) and (2) comparison of 4 groups with I/E ratios of 3.4:1, 2:1, 1:1, and 1:2 were performed, applying identical ventilatory patterns in all I/E groups (n = 28 sheep). PLV was established with intratracheal instillation of 25 mL/kg perflubron. Cardiac index was assessed at 15-minute intervals for a 120-minute experimental period by Q_TD.

Results

During progressive doses of PLV, the correlation (r) between Fick and Q_TD techniques was 0.82. Thermodilution deteriorated after induction of lung injury and recovered after PLV start. Regarding Q_TD, no significant changes after PLV onset (within-group comparison) and between I/E groups were observed (P < .05).

Conclusion

The QTD technique is a satisfactory reflector of CI during PLV, and I/E ratio has no significant influence on CI, even using extreme inverse ratio ventilation.     

台湾全民健保制度基本情况及启示

本文通过对台湾全民健康保险制度的背景、给付范围、自付设计、经费来源、支付设计等方面情况的阐述,对两岸医保制度进行了对比分析,提出台湾全民健保制度对推进我国医疗保险制度改革整体进程的几点启示。认为应从建立统一的医疗保险体系,尝试多样化经费渠道,设计科学灵活的自付方式,推进多元支付制度这四个方面入手。     

加拿大McMaster大学医学院基于问题学习教学模式及其启示

基于问题学习(problem-based learning,PBL)是一种以学习者为中心,通过合作学习完成解决问题的全新教学模式。本文介绍了加拿大McMaster大学医学院PBL教学模式的具体安排和评估方式,探讨了其对我国推进PBL教学带来的启示:根据医学生教育背景选择切合实际的具体教学方式和教案;选择合适的PBL导师并保证教师角色的顺利转变;强化以学生为中心的理念,积极发挥教学评估的促进作用;引导学生充分使用多媒体、互联网等资源,发挥其对PBL的推动作用。     

Developmental effects of ketamine on inspiratory hypoglossal nerve activity studied in vivo and in vitro

The effects of the anesthetic ketamine on properties of inspiratory bursts (I-bursts) in mouse hypoglossal nerve activity were studied in vivo and in vitro. In urethane anesthetized mice we observed rhythmic I-phase activity in only one of eight pups at P9 days. In contrast in older mice rhythmic I-phase hypoglossal activity was almost always observed. Ketamine caused a reduction in I-burst frequency and an increase in peak integrated hypoglossal nerve activity in all three age groups studied (P10-P13, P15-P20 and adult mice). In these mice I-phase oscillations, due to hypoglossal motoneurons firing clusters of action potentials at a particular frequency, were observed in control and after ketamine. Ketamine did not change the frequency of the dominant spectral peak determined from power spectra examined from 0 to 200 Hz. The effects of ketamine were also studied in vitro in the mouse rhythmic medullary slice preparation. Ketamine reduced hypoglossal I-burst frequency and I-burst peak integrated amplitude. Oscillations were observed in I-phase activity, and as in the in vivo studies ketamine did not shift the dominant spectral peak frequency. These results demonstrate that in vivo and in vitro ketamine results in significant changes in I-burst frequency and peak integrated hypoglossal nerve activity, but changes in the oscillation frequency are minimal.     

肺复张对急性呼吸窘迫综合征的疗效观察

目的 观察肺复张对急性呼吸窘迫综合征(ARDS)患者的治疗效果.方法 观察7例符合美国/欧洲危重症学会诊断标准ARDS早期患者,应用压力控制型呼吸机,在吸氧体积分数为100％条件下,监测血流动力学参数及血管外肺水指数(EVLWI).肺复张开始时将呼吸机模式调整为压力控制,吸气压力(Pi) =24 cm H2O(1cmH2O=0.0981 kPa),呼气末正压(PEEP)10cm H2O,f=50,吸呼比为5∶1.此后,先将PEEP上调至24 cm H2O,Pi上调至45 cm H2O,维持3次吸气再将Pi下调至30 cm H2O,立即查动脉血气.如果PaO2＜450mmHg (1mmHg=0.133kPa),在上次压力的基础上增加5 cm H2O,直到PaO2＞ 450 mm Hg,认为复张成功.随后,逐渐以2 cm H2O下调PEEP,每次下调后再重复上述步骤,直到PEEP到达某数值时PaO2＜ 350 mm Hg,在此PEEP上增加2 cm H2O则认为是最佳PEEP.保持气道压力不少于4h,监测复张前后血气指标以及血液动力学指标并进行比较.如果复张过程中血液动力学不稳定则立即停止复张.结果 方差分析结果表明:6位患者复张后4 h PaO2较基础明显增加(P＜0.01),PEEP比基础状态明显升高(P＜0.01),EVLWI则显著降低(P＜0.01).1位患者因血液动力学不稳而终止复张.7位患者均未出现复张相关并发症,并且6位患者治愈.结论 应用肺复张治疗ARDS是安全有效的.