临床医学专业基础医学课堂问题设计的策略研究

课堂学习在临床专业的学习中占据重要地位,问题设计的水平影响着课堂教学的效率,但当前教师的问题设计存在诸多缺陷。针对临床医学专业的培养目标和学习特点,立足于基础医学课堂的角度,首先从知识、技能、综合素质三方面阐述了高效的问题设计对实现临床专业培养目标的重要意义,接着研究了当前问题设计存在的不足之处,最后从构建合理知识架构,模拟临床诊断,留疑独立思考,学生发问教师这四方面为提高临床专业基础医学课堂问题设计的高效性提出切实可行的建议。     

Real evaporative cooling efficiency of one‐layer tight‐fitting sportswear in a hot environment

Real evaporative cooling efficiency, the ratio of real evaporative heat loss to evaporative cooling potential, is an important parameter to characterize the real cooling benefit for the human body. Previous studies on protective clothing showed that the cooling efficiency decreases with increasing distance between the evaporation locations and the human skin. However, it is still unclear how evaporative cooling efficiency decreases as the moisture is transported from the skin to the clothing layer. In this study, we performed experiments with a sweating torso manikin to mimic three different phases of moisture absorption in one‐layer tight‐fitting sportswear. Clothing materials Coolmax^® (CM; INVISTA, Wichita, Kansas, USA; 100%, profiled cross‐section polyester fiber), merino wool (MW; 100%), sports wool (SW; 50% wool, 50% polyester), and cotton (CO; 100%) were selected for the study. The results demonstrated that, for the sportswear materials tested, the real evaporative cooling efficiency linearly decreases with the increasing ratio of moisture being transported away from skin surface to clothing layer (adjusted R² >0.97). In addition, clothing fabric thickness has a negative effect on the real evaporative cooling efficiency. Clothing CM and SW showed a good ability in maintaining evaporative cooling efficiency. In contrast, clothing MW made from thicker fabric had the worst performance in maintaining evaporative cooling efficiency. It is thus suggested that thin fabric materials such as CM and SW should be used to manufacture one‐layer tight‐fitting sportswear.     

移动输液管理系统应用的效果观察

目的 探讨移动输液管理系统对于护士工作效率的影响.方法 选取海军总医院急诊科2014年1月～2月引进“移动输液管理系统”后300名输液患者为试验组.2013年11月～12月未引进“移动输液管理系统”前的300名输液患者为对照组.统计两组患者的从接单到输液完成各环节耗时.结果 对两组患者各环节耗时进行统计,试验组接单耗时（24.38±3.11）s、配液核对前耗时（7.11±1.31）s、输液前核对耗时（6.53±1.34）s、呼叫相应耗时（6.40± 1.30）s均短于对照组,P＜0.05,差异有统计学意义.结论 引进“移动输液管理系统”能减少患者输液等候时间和呼叫相应时间、从而提高护士的工作效率.     

miR-20a对NSCLC细胞增殖、迁移、侵袭、凋亡的影响及与血清肿瘤标志物联合检测的诊断效能

目的探讨miR-20a对非小细胞肺癌(NSCLC)细胞增殖、迁移、侵袭、凋亡的影响及血清肿瘤标志物联合miR-20a检测在NSCLC诊断中的价值。方法选取该院2013年1月至2015年1月收治的NSCLC患者112例,肺部良性疾病患者94例,采用电化学发光法检测血清癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)、糖类抗原(CA)125的表达水平;采用实时荧光定量PCR法检测患者血浆miR-20a的表达水平;对血清肿瘤标志物和miR-20a单独及联合检测在NSCLC诊断中的效能进行分析。结果miR-20a高表达于NSCLC组织,且A594细胞中过表达miR-20a可显著促进细胞增殖、迁移与侵袭(P<0.05)。NSCLC患者血清CEA、NSE、CA125及血浆miR-20a的表达水平明显高于肺部良性疾病患者(P<0.05)。CEA、NSE、CA125及miR-20a联合检测诊断NSCLC的特异度和灵敏度明显高于各肿瘤标志物及miR-20a单独检测(P<0.05)。结论血清肿瘤标志物与miR-20a联合检测对NSCLC具有较高的诊断效能,有较高的临床应用价值。     

基于部分药效和毒副作用探索中药汤剂抑苦掩味伴侣剂的影响：以黄连解毒汤为例

目的 基于黄连解毒汤（Huanglian Jiedu Decoction,HJD）部分药效和毒副作用评价抑苦掩味伴侣剂[纽甜、单甲氧基聚乙二醇-左旋聚乳酸（m PEG2000-PLLA2000）、γ-环糊精（γ-CD）、HJD药液（以生药量计0.2 g/mL）质量比0.028∶0.15∶1.5∶100]对中药汤剂疗效和安全性的影响。方法 以HJD为例,采用体外抗氧化（1,1-二苯基-2-苦基肼基自由基清除率、超氧阴离子清除率和羟自由基清除率）、抗二甲苯致小鼠耳肿胀和解内毒素致小鼠高热试验研究抑苦掩味伴侣剂对中药汤剂疗效的影响,以小鼠急性毒性试验研究该伴侣剂对汤剂安全性（毒性）的影响,最后采用16S rDNA测序技术探索抑苦掩味伴侣剂对中药汤剂作用（可能的不良反应）的影响。结果 抑苦掩味伴侣剂既不影响HJD体外抗氧化（1,1-二苯基-2-苦基肼基自由基、超氧阴离子和羟自由基清除率）作用,也不影响HJD抗二甲苯致小鼠耳肿胀效果和抗内毒素致热作用。同时,在实验剂量范围内,抑苦掩味伴侣剂和HJD对小鼠均无急性毒性。此外,抑苦掩味伴侣剂对小鼠肠道菌群的干扰与HJD并无显著性差异。结论 抑苦掩味伴...     

基于Triangle理论的华法林抗凝患者分级管理模式的建立与实践

目的 建立基于Triangle理论的华法林抗凝患者分级管理模式(hierarchical warfarin anticoagulation management mode, HWAMM),并评价其实践成效。方法 采用文献计量学方法建立HWAMM。纳入2020年5月至2020年9月于南京大学医学院附属鼓楼医院住院的华法林抗凝患者。临床药师对试验组患者进行分级管理,对照组患者进行无差别监护管理,比较两组的抗凝管理质量和药师工作情况等。结果 共计纳入使用华法林抗凝的住院患者237例。相较于对照组,试验组中患者凝血检测次数与术后住院天数的比值显著降低,且在住院期间国际标准化比值(international normalized ratio, INR)达标率、出院时INR达标人数(65.0% vs 47.9%, P=0.008)等方面显著更优,而单位患者每日管理时间显著减少。在不良事件发生率、服药依从性和抗凝知识评分等方面无显著性差异。结论 临床药师建立的HWAMM,能够帮助临床药师识别抗凝治疗高风险患者,使临床药师减负增效,最终提升抗凝管理质量。     

基于肿瘤微环境增强抗肿瘤治疗效果的纳米递药系统设计及应用

纳米递送系统是当前解决抗肿瘤药物靶向性差、毒副作用大及生物利用度低等关键问题的有效手段之一。与正常组织相比,肿瘤微环境具有一些独特的性质,如血管异常、缺氧和酸性pH等,这些复杂的性质极大的影响药物在肿瘤部位的递送。基于肿瘤微环境来设计纳米递药系统可以改善递送效率以增强抗肿瘤治疗效果。本文综述了肿瘤微环境的组成、特征及基于肿瘤微环境所设计的纳米递药系统的应用研究,并讨论了其中存在的挑战和机遇,旨在为促进纳米递送系统在临床上的实际应用提供参考。     

上海某区儿童血清轮状病毒LLR型疫苗株的免疫水平

[目的]了解2012年上海部分0～5周岁儿童的血清轮状病毒LLR型中和抗体水平及不同年龄段儿童轮状病毒感染的情况,为疫苗的研究提供科学数据。[方法]在2012年6—8月上海市静安区儿保门诊部就诊的儿童中,筛选无发热、无轮状病毒感染疑似症状的健康儿童血清标本210份,采用微量中和试验方法检测儿童血清对轮状病毒LLR型疫苗株的中和抗体水平,并对检测结果进行统计学分析。[结果]210份0～5周岁儿童血清中,轮状病毒LLR型中和抗体阳性率为27.1%,中和抗体几何平均滴度（GMT）为1∶35.36;0～6个月婴儿血清中和抗体阳性率为16.0%,GMT为1∶28.72;7～11个月儿童血清中和抗体阳性率为2.5%,GMT为1∶25.88。1～2周岁儿童的中和抗体阳性率为20.0%,GMT为1∶30.78,2～3周岁儿童的中和抗体阳性率为20.0%,GMT为1∶32.99,该两年龄组（段）间差异无统计学意义。3～4周岁儿童的中和抗体阳性率为56.67%,GMT为1∶54.84,4～5周岁儿童的中和抗体阳性率为63.33%,GMT为1∶44.55,此两年龄组（段）儿童的阳性率和GMT均显著高于3周岁以下各年龄组,此两组间阳性率差异无统计学意义。[结论]0～3周岁儿童中和抗体水平较低,特别是7～11个月年龄组为最低,提示可能为轮状病毒感染的高危儿童群体。     

Effects of electrolysis time and electric potential on chlorine generation of electrolyzed deep ocean water

Electrolyzed water is a sustainable disinfectant, which can comply with food safety regulations and is environmentally friendly. A two-factor central composite design was adopted for studying the effects of electrolysis time and electric potential on the chlorine generation efficiency of electrolyzed deep ocean water (DOW). DOW was electrolyzed in a glass electrolyzing cell equipped with platinum–plated titanium anode and cathode. The results showed that chlorine concentration reached maximal level in the batch process. Prolonged electrolysis reduced chlorine concentration in the electrolyte and was detrimental to electrolysis efficiency, especially under high electric potential conditions. Therefore, the optimal choice of electrolysis time depends on the electrolyzable chloride in DOW and cell potential adopted for electrolysis. The higher the electric potential, the faster the chlorine level reaches its maximum, but the lower the electric efficiency will be.     

The investigation and the use of high flow column-switching LC/MS/MS as a high-throughput approach for direct plasma sample analysis of single and multiple components in pharmacokinetic studies

Recently direct plasma injection LC/MS/MS technique has been increasingly used in pharmaceutical research and development due to the demand for higher throughput of sample analyses. In this work, two on-line extraction methods including high flow LC/MS/MS and high flow column switching LC/MS/MS were investigated. The evaluations were conducted and focused on their performances with respect to peak responses, separation efficiency, and signal to-noise ratio in a multiple-component LC/MS/MS assay. Two HPLC pumps were used-with one for high flow delivery and one for gradient elution. A CTC autosampler was used to inject plasma samples. High flow LC was achieved by the use of 4 ml/min flow rate on a 1×50 mm Waters Oasis column. A 2×100 mm YMC column was coupled via a column-switching valve. The extracted analytes were analyzed in multiple-reaction-monitoring (MRM) mode using a triple quadrupole MS/MS. As a rapid and simple procedure, vortex-mixing plasma and internal standard directly in sample vials completed sample preparation. The high flow column switching method (two-column system) provided sharper peak shape than the conventional high flow method. This effect increased analyte signal-to-noise ratio and sensitivity. Narrower peak width resulted in much better separation efficiency, which was required for multiple compound (N-in-1) analysis. A 2 mm I.D. column resulted in better peak shape and resolution than using a smaller I.D. column. The selected method achieved acceptable recoveries for most of the compounds tested, and it was successfully applied to a 10-in-1 pharmacokinetic (PK) study. The results showed that the dynamic range, lower limit of quantitation, assay accuracy and precision were acceptable for all compounds. Rapid sample preparation eliminated labor intensive and time consuming processes and improved productivity. This high throughput on-line extraction high flow column switching method has been proven particularly useful for multiple component analysis in PK studies.