“课堂理论教学与临床实践教学相结合”的两步教学法理论与实践

阐述了山东大学医学院医学伦理学课程“课程理论教学与临床实践教学相结合”教学模式改革的设想提出过程,具体实施办法和实施效果。实践证明,这一教学法,对于培养医学生的医德信念和医学伦理决策能力是切实有效的,值得在实践中进一步完善和推广。     

产前精神因素对分娩方式及乳汁分泌的影响

目的：探讨产妇产前精神状态与分娩方式、乳汁分泌的关系。方法：用汉密顿焦虑量表（ＨＡＳ）和抑郁量表（ＨＤＳ）评定１０４例在我院分娩健康初产妇的精神状态,全部产妇均以产科常规分娩而不进行干预,观察其分娩方式及产后７ｄ内乳汁分泌情况;按分娩方式不同分为剖宫产组、儿吸产组及顺产组;按产后乳汁分必不同分为纯母乳喂养组和母乳加代乳品喂养组。结果：１０４例产妇出现焦虑２５例,发生率２４．０４％;出现抑郁２０例,     

急性坏死型胰腺炎的B超与CT诊断比较(附38例分析)

目的 评价超声及ＣＴ诊断急性坏死型胰腺炎（ＡＮＰ）的价值。方法 将３８例急性胰腺炎患者手术前的超声及ＣＴ诊断资料与手术病理诊断进行对照,分析超声及ＣＴ诊断ＡＮＰ的敏感性、特异性、预测精确性。结果 ３８例患者,按手术病理诊断,３０例为ＡＮＰ,７例为急性水肿型胰腺炎,１例化脓性胆囊炎胰腺未见异常。ＣＴ诊断ＡＮＰ的敏感性９５．８％,特异性８０．０％,阳性预测值９５．８％,阴笥预测值８０．０％,预测精确性     

病毒唑雾化吸入治疗上呼吸道感染40例

目的　探讨病毒唑雾化吸入在上呼吸道感染中的疗效。方法　治疗组 4 0例 ,应用病毒唑 15mg/kg雾化吸入 ,15min吸完 ;。对照组 4 0例静脉滴注病毒唑。 结果　治疗组治愈率为 95% ,对照组为 6 3.2 % ,两组差异明显 (P <0 .0 5)。结论　静脉滴注到达呼吸道剂量较少 ,超声雾化可使吸入 70 %药物直接分布于呼吸道表面 ,且无副作用。     

医学模式的转变促进健康观念的更新

健康是人类追求的永恒目标。随着社会的发展,生物医学模式向生物心理社会医学模式转变,“没有疾病就是健康”的观念已过于陈腐,人们对健康的理解已从“没有疾病”发展到包括生理、心理、社会的完满状态,健康的涵义更为深化,健康观念得到更新。     

羊水过少围产儿345例预后及分娩方式探讨

目的：探讨改善羊水过少围产儿预后,降低死亡率的终止妊娠方法。方法：抽取１９８８年３月～１９６６年１月间住院分娩产妇９４７２例,其中羊水过少３４５例,发生率３．６５％。对３４５例羊水过少围产儿预后及分娩方式进行探讨。结果：３４５例羊水过少,经阴分娩１５３例,剖宫产１９２例,剖宫产率为５５．６５％。胎儿窘迫１４３例（４１．２％）,新生儿窒息１８５例（５３．６％）,新生儿死亡１４例（４．１％）。对照组５００例,肥儿窘迫３４例（６．８％）,新生儿窒息３４例（６．８％）,新生儿死亡４例（０．８％）,两组相比羊水过少围产儿发病率显著升高（Ｐ〈０．０５,Ｐ〈０．０１）。结论：羊水过少胎儿窘迫,新生儿窒息及死亡率均高,适时剖宫产能改善围产儿预后。     

Evaluation of serum type III procollagen peptide as an exposure marker in retired coal workers

Serum type III procollagen peptide (PIIIP), a degradation product of the type III collagen precursor, has been put forward as an exposure marker for mineral dust. We evaluated PIIIP levels as a marker of exposure to and effects of coal dust in retired coal miners (n = 104). To this end: (a) the individual cumulative dust exposure was calculated from job-exposure matrices, and (b) in addition to routine chest radiography (CR) of all miners according to the criteria of the International Labour Organisation (ILO), a subgroup (n = 46) was screened by high-resolution computed tomography (HRCT). Profusion score (CR and HRCT) tended to increase with cumulative dust exposure, even in the absence of CR evidence for pneumoconiosis (i.e. CR , 0/1, n = 35). In contrast to our previous findings in active miners, PIIIP levels were not increased in miners as compared with non-dust-exposed controls (n = 29), and no differences were observed between miners without (ILO = 0/0) and miners with coal workers' pneumoconiosis (CWP; ILO 0/1). No trend in PIIIP versus pneumoconiosis stage was present, either by CR or by the more sensitive HRCT score. PIIIP was also unrelated to any lung function parameter (FEV₁, FVC, impedance, diffusion capacity). Age, medication, medical history and smoking habits had no significant effect on PIIIP levels. In the miners with CWP (i.e. ILO > 0/0, n = 28) a significant negative correlation was present between PIIIP values and (log) cumulative dust exposure. This decrease in serum PIIIP levels with increasing cumulative exposure may be due to chronic adaptive changes in type III collagen deposition and/or breakdown. Other relations between exposure and PIIIP were not observed. In conclusion, the present findings do not support the use of serum type III procollagen peptide as a marker of exposure to and (early) interstitial or respiratory effects of coal dust.     

ROC曲线在评价铅中毒指标中的应用

目的评价几种铅中毒指标筛选不同水平职业性铅接触的准确性。方法连续性收集１５７名铅接触工人的血标本,同时测定血铅、红细胞游离原卟啉（ＦＥＰ）、锌原卟啉（ＺＰＰ）、尿铅、尿δ氨基酮戊酸（δＡＬＡ）,以血铅≥４０、≥６０μｇ／ｄｌ的铅接触水平为金标准,用ＲｅｃｅｉｖｅｒＯｐｅｒａｔｉｎｇＣｈａｒａｃｔｅｒｉｓｔｉｃ（ＲＯＣ受试者工作特征）曲线分析软件评价所测定指标筛选血铅≥４０、≥６０μｇ／ｄｌ职业性铅接触的价值,在ＲＯＣ曲线上制定各测定指标筛选上述２个铅接触水平的最佳临界点,用ＥＰＩＮＦＯＲ统计软件比较筛选血铅≥４０、≥６０μｇ／ｄｌ的平行试验的敏感度。结果筛选血铅≥４０、≥６０μｇ／ｄｌ的铅接触水平,ＲＯＣ曲线下的面积（ＡＵＣＲＯＣ）最大的是ＺＰＰ,其他依次为ＦＥＰ、尿铅、尿δＡＬＡ;联合ＺＰＰ与ＦＥＰ的平行试验的敏感度高于联合尿铅与尿δＡＬＡ的平行试验。结论筛选血铅≥４０、≥６０μｇ／ｄｌ水平的职业性铅接触,ＺＰＰ的准确性最高,并且联合ＺＰＰ与ＦＥＰ的平行试验的敏感度高于联合尿铅与尿δＡＬＡ的平行试验。     

B超图像纹理的复杂性分析

本文提出一种复杂性度量法对肝脏Ｂ超图像纹理的分类进行了研究,图像的灰度值复杂性作为纹理特征。     

The epidemiology of occupational contact dermatitis

Occupational contact dermatitis (OCD) ranks first of all occupational diseases in many countries. The incidence rate is believed to be around 0.5–1.9 cases per 1000 full-time workers per year. Epidemiological studies play an important role in observing disease trends, analysing risk factors, and monitoring the effect of preventive measures. In this review article the lack of truly epidemiologic data on OCD and the difficulties of those studies are illustrated. The following issues are highlighted: case ascertainment and bias, the distribution of allergic and irritant contact dermatitis in the working population, the interrelationship between exogenous (allergens, irritants) and endogenous factors, the prognosis, the social and economic impact, and the need for intervention studies. Received: 26 January 1999 / Accepted: 24 April 1999