智慧课堂融合任务驱动教学法在《医学影像学》教学中的应用

目的 探讨智慧课堂融合任务驱动教学法在《医学影像学》教学中的应用效果。方法 选取2018 年9 －12 月大连医科大学2015 级本科临床专业4 个班的学生，分为研究组64 名学生（接受智慧课堂融合任务驱动教学法教学），对照组64 名学生（接受传统授予式教学法教学）。教学结束后，通过随堂测试评价教学效果，内容包括学生客观考核与主观考评。应用SPSS 19.0 软件对数据进行统计分析。结果 研究组学生客观考核成绩（82.39±9.59）高于对照组（70±11.55），差异具有统计学意义（P ＜ 0.05）；研究组学生在激发学习兴趣（82.9% 比10.6%）、培养影像诊断思维能力及阅片技能（91.3% 比5.6%）、培养独立思考与解决问题能力（88.5% 比7.8%）、培养自主学习与科研创新思维（86.7% 比9.2%）均高于对照组学生，具有统计学意义（P ＜ 0.01）；两组学生对智慧课堂融合任务驱动教学法改革的认同感或对教学改革的期待（93.3% 比85.4%）无统计学意义。结论 智慧课堂融合任务驱动教学法，提高《医学影像学》教学质量显著，有助于激发学生的学习兴趣，培养学生的影像学诊断思维模式、良好的阅片习惯及技能。     

糖尿病足溃疡复发因素及预防策略的研究进展

综述糖尿病足溃疡复发的影响因素包括足底压力、周围神经病变、周围血管病变、足部外伤、血糖控制不佳及其他(吸烟、日常活动负重、C-反应蛋白水平升高),预防复发的措施包括识别和筛查高危因素、卸载足部压力、选择合适的治疗鞋和鞋垫、手术卸载、自我护理、健康教育、信息化管理、依从性管理等,提出采取多种预防措施的综合性护理干预有助于减少糖尿病足溃疡的复发率。     

Quality of life in caregivers of a family member with serious mental illness: Evidence from China

Purpose

To evaluate the quality of life (QoL) and social support among family caregivers of a family member with a mental illness and to identify factors associated with the QoL.

Laparoendoscopic Single-site Surgery for Comprehensive Staging of Early Ovarian Cancer

Study ObjectiveTo demonstrate the procedure and suspension skills of laparoendoscopic single-site (LESS) staging surgery with infrarenal para-aortic lymphadenectomy for early-stage ovarian cancer.DesignA presentation of the surgery through this technical video.SettingA hospital.Patient and InterventionsA 45-year-old woman presented with a pelvic mass on gynecologic examination and a serum cancer antigen 125 level of 5910 U/mL (normal = <35 U/mL). A computed tomographic scan revealed a mixture of solid and cystic components (70 × 77 × 71 mm) arising from the right ovary and characterized by the “ovarian vascular pelvic” sign. Clinically early-stage ovarian cancer was suspected. Subsequently, LESS staging surgery was performed by an experienced surgeon in our department.ResultsThe surgery lasted 280 minutes, and the volume of blood loss was 50 mL; there were no intra- or postoperative complications. We “hid” the incision perfectly for cosmetic purposes. The histopathologic findings supported high-grade serous ovarian cancer of the right ovary with the left fallopian tube involved as well. In addition, a total of 34 negative pelvic and 18 negative para-aortic lymph nodes were identified, and a stage of IIA was diagnosed as a result.ConclusionWe performed an LESS staging surgery for early-stage ovarian cancer successfully. Our video shows that the LESS approach provided feasible, cosmetic, and safe access among the selected malignant gynecologic surgery. Therefore, we have experienced that the effective suspension was an auxiliary measure for LESS lymphadenectomy. In addition, compared with multiport laparoscopy, the LESS approach could provide easier access to infrarenal para-aortic regions; furthermore, it was safe and quick to extract an unknown sample.     

餐后不同时间点运动对2型糖尿病患者血糖的影响

目的探讨早餐后不同时间点运动对2型糖尿病患者血糖的影响。方法将120例2型糖尿病患者,按随机数字法分为A组(早餐后90 min运动组)、B组(早餐后120 min运动组)、C组(早餐后150 min运动组),每组各40例。三组患者运动方式均采取2.0 km的快走运动,速度为4.0～5.0 km/h。检测空腹、运动前、运动后即刻、11:00(中餐前)血糖值。结果三组患者空腹血糖和运动前血糖比较,差异无统计学意义(均P0.05);三组运动后即刻、11:00血糖值比较,差异有统计学意义(P0.05,P0.01)。B、C组运动后即刻血糖及11:00血糖与A组比较,差异有统计学意义(P0.05,P0.01)。C组11:00发生低血糖5例。结论 2型糖尿病患者在早餐后120 min和餐后150 min运动降低血糖效果明显优于早餐后90 min,但早餐后150 min运动低血糖发生的风险较高,选择早餐后120 min运动较好,但仍需进一步研究验证。     

Pathological classification and prognosis of renal damage caused by antineutrophil cytoplasmic antibody associated vasculitis

Objective To analyze the pathological characteristics and prognostic factors of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Methods A retrospective analysis of AAV patients with renal biopsy results admitted to Kidney Disease Center of the First Affiliated Hospital from January 2004 to February 2017 was performed. The patients were divided into 4 types according to Berden classification, and their clinical, pathological characteristics and prognosis were compared. The survival curves of each type of patients were plotted by Kaplan-Meier method, and the difference of survival curves was compared using Log-rank test. With entering the maintenance dialysis as the endpoint, Cox regression was used to analyze the prognostic factors. Results A total of 175 patients with AAV, including 59 cases (33.7%) of focal type, 39 cases (22.3%) of crescent type, 32 cases (18.3%) of sclerosis type, 45 cases (25.7%) of mixed type. The basal serum creatinine levels in crescent type group and sclerosis type group were significantly higher than those in the focal type group or mixed type group (all P＜0.05), and loop necrosis rate in sclerosis type group was significantly lower than chat in the focal type group or crescent type group (both P＜0.05). The median follow-up period was 11.8 (0.5-86.7) months. The event-free survival rates were 83.1%, 77.8%, 64.1% and 50.0% in the focal type, mixed type, crescent type and sclerotic type groups (Log-rank χ2=11.537, P=0.009). Cox regression analysis showed higher parathyroid hormone (HR=1.013, 95%CI 1.007-1.019, P＜0.001), glomerular sclerosis ≥50% (HR=10.532, 95%CI 2.903-38.203, P＜0.001) were independent risk factors for AAV patients entering maintenance dialysis, and higher estimated glomerular filtration rate (HR=0.943, 95%CI 0.896-0.993, P=0.025) was protective factor. Conclusion The prognosis of AAV renal damage is worsened according to focal, mixed, crescent and sclerosis types. Lower estimated glomerular filtration rate, higher parathyroid hormone and glomerular sclerosis ≥50% are independent risk factors for AAV patients entering maintenance dialysis.     

三七粉质量标志物研究＊

三七为常用中药材，具有散瘀、止血，消肿定痛的功效。三七粉作为三七市场应用的主要形式之一，市场逐年增大。现行标准难以评价和控制三七粉“多重功效”的质量特点。本课题组在系统辨识三七粉化学物质组及其传递规律的基础上，采用网络药理学和体内、体外模型，研究并阐明了三七粉的活血、心肌与血管保护、止血以及消肿定痛的药效物质基础；进一步结合成分的特有性分析，确定了三七粉的质量标志物；在此基础上，建立了基于质量标志物的三七粉的指纹图谱及“一测多评”的多指标含量测定方法，为建立三七粉整体质量控制方法提供了理论与实验证据。