医学机能实验室建设的思考

医学机能实验学是随着高校机能实验室的建立而迅速发展起来的一门新兴学科,已成为基础医学实验教学的重要组成部分。本文中笔者从实验室管理、实验内容优化、实验人才培养三个方面出发,对机能实验室的建设进行了思考。通过对机能实验室的建设和改革,构建一种新的实验教学体系,以提高实验教学的效果,培养高素质的医学人才。     

中医药院校基础医学实验教学改革探索

目的:以建立一种新的实验教学课程体系为目标,对基础医学机能、形态实验教学课程体系进行了综合改革。方法:以对学生的素质教育和能力培养为主线,来构建新型机能、形态实验教学体系和课程教材建设。结果:新型实验课程体系的建立与实践,在巩固、运用、补充理论知识,培养学生创新精神和实践能力,提高综合素质等方面取得了良好的效果。结论:新型实验课程体系的建立,不仅改变基础医学实验课程单科设置的教学模式,适应了全方位、多学科相互渗透、相互融合的医学发展新趋势,为培养中医药高级复合型人才创造了良好条件。     

机能实验学设计性实验的实践与体会

设计性实验又称探索性实验,是机能实验学中主要实施内容之一。通过近几年机能实验学设计性实验教学,该文详细地提出了机能设计性实验的实践过程,实践的体会和存在的问题,突出机能学科为医学服务的特点,尽快培养具有开拓精神和创新能力的新型医学人才。     

生理学设计性实验方案及实验教学改革设想

本文详细地提出生理学设计性实验的尝试方案和实验教学改革的一些设想,旨在加快包括生理学在内的医学基础机能学科实验教学的改革步伐,突出机能学科为临床医学服务的特点,尽快培养出大批具有开拓精神和创新能力的新型医学人才。     

开放式医学机能学实验教学体系的探索与实践

机能学实验是基础医学实验教学的重要组成部分，是培养学生实践能力和创新精神的重要环节。近年来我校以构建新型实验教学体系为目标，积极探索机能实验室的开放式管理。并对开放式实验教学体系进行了试点改革。实践证明，建立在开放实验室基础上的开放式实验教学体系，有利于培养学生学习的主体意识，进一步提高其实践能力和创新意识，是培养高素质专业医学人才的有效途径之一。     

开放式医学机能学实验教学体系的探索与实践

机能学实验是基础医学实验教学的重要组成部分，是培养学生实践能力和创新精神的重要环节。近年来我校以构建新型实验教学体系为目标，积极探索机能实验室的开放式管理，并对开放式实验教学体系进行了试点改革。实践证明，建立在开放实验室基础上的开放式实验教学体系，有利于培养学生学习的主体意识，进一步提高其实践能力和创新意识，是培养高素质专业医学人才的有效途径之一。     

谈机能实验课程建设

实验教学是医学人才培养过程中的重要环节,我们引入机能实验课程改革理念,将实验教学内容进行整合改革,本文从机能实验课的组成、教学模式、和实验评价方式等方面进行了概述。经过几年的改革探索,机能实验课程建设取得了良好的效果,促进了学生综合能力的培养。     

以培养创新型人才为目标的机能实验学教学改革

实验教学是高等医学教育的重要组成部分，是培养医学生实践能力、创新意识、科学思维方法与严谨科学态度的有效途径。我校以提高教学质量与实验教学投资效益，培养融知识、能力与素质为一体的医学科技创新型人才为目的，于十年前建立了综合性医学机能中心，开设了独立设置的《机能实验学》这门课程，并不断开展机能实验教学改革研究与实践，创立了新型医学机能实验教学与管理模式并完善了师资培养措施。本文就医学机能学科实验教学多年来改革经验，尤其在推行创新教育的探索与实践情况作一小结，以期得到同行们的指教。     

机能设计性实验模式与医学生创新能力培养的探索

医学机能学实验主干课程中设计性实验模块已成为培养本科生创新思维与创新能力的重要方式。首都医科大学在本科临床与基础医学专业的机能实验教学中开展了课堂设计实验、命题式设计性实验与开放式设计实验等方式,通过上述实验增强了本科生创新思维与创新能力的培养,对今后机能实验教学改革提供了新的思路。     

医学微生物学实验教学平台的建设

目的:通过加强医学微生物学实验平台建设来培养学生的创新意识和科研思维,从而增强学生学习医学微生物学的积极性和主动性。方法:通过加强基础实验平台建设、选修实验平台建设、开放实验平台建设和临床实践平台建设对实验教学进行改革,为学生提供一个良好的实验环境,着力培养学生的创新能力、综合分析问题和解决问题的能力。结果:通过实验平台的建设提高了实验教学质量和效果,促进了学生学习医学微生物学的兴趣,也提高了学生的创新意识和科研意识。结论:医学微生物学实验平台建设在提高医学微生物学实验教学质量和培养学生创新能力、科研能力方面具有重要作用。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.