PBL教学法在消化内科住院医师规范化培训中的应用

目的评价PBL教学法在消化内科住院医师规范化培训中的应用效果。方法选择在川北医学院附属医院消化内科进行住院医师规范化培训的住院医师(包括专业学位硕士研究生)56人。随机分为实验组(采用PBL教学法)及对照组(采用传统教学法),每组各28人。采用出科成绩及问卷调查进行应用效果的评估。结果 PBL教学组规培医师的总成绩和病例分析成绩均高于传统教学组,两组间差异有统计学意义(P0.05)。两组规培医师理论知识成绩和基本技能成绩比较,差异无统计学意义(P0.05)。PBL教学组规培医师在提高学习主动性、自学能力、归纳分析能力、提高沟通和团队协作能力等方面的评价较传统教学组高(P0.05)。结论在消化内科住院医师规范化培训中PBL教学法有助于促进规培医师临床思维能力的形成,提高其学习主动性和自学能力,提高教学质量。     

PBL+CBL+CP教学法在肝胆外科住院医师规范化培训中的初步探索

目的 探讨以问题为基础的教学方法(problem based learning,PBL)、病案教学方法(case based learning,CBL)和临床路径(clinical pathway,CP)相结合的教学法应用于肝胆外科住院医师规范化培训中的效果。方法 以2019年1月至2019年7月在陕西省人民医院肝胆外科接受规范化培训的64名住院医师为研究对象,随机分为观察组和对照组,其中对照组运用PBL+CBL教学法,观察组运用PBL+CBL+CP教学法,对比两组住培医师出科考试成绩和教学认可度评分。结果 观察组住培医师出科考试成绩和对教学认可度评分均高于对照组(P < 0. 05)。结论: PBL+CBL+CP教学法有利于住培医师全面、系统的掌握知识,并快速建立科学的临床思维,具有很强的科学性和系统性,值得推广。     

CBL联合PBL教学法在普外科住院医师规范化培训中的应用

目的 探讨基于案例的学习(case-based learning,CBL)联合基于问题的学习(problem-based learning,PBL)教学法与传统教学法(lecture-based learning,LBL)在普外科住院医师规范化培训中的应用。 方法 选取2016年9月—2018年9月在皖南医学院弋矶山医院普外科(共5个病区)36名接受本院普外科规范化培训的住院医师为研究对象,采用随机数字表分为实验组(CBL+PBL组,18名)和对照组(LBL组,18名)。比较2组教学效果和教学满意度之间的差异。 结果 2组在平均年龄、性别、入院考核成绩、学员原单位等方面差异无统计学意义(均P>0.05);在基础理论考试方面,联合教学组的住培学员平均成绩[(47.1±1.4)分]明显优于LBL组[(42.2±1.2)分],差异有统计学意义(P<0.05);技能操作考核方面,联合教学组学员平均成绩[(45.5±1.3)分]明显优于LBL组[(40.6±1.5)分],差异有统计学意义(P<0.05)。联合教学组学员在学习兴趣、自主学习能力、临床操作技能、团队协作能力、文献查阅能力、临床思维能力等6个方面评价均高于LBL组,差异有统计学意义(均P<0.05)。 结论 CBL结合PBL教学法有利于加深住培医师对普外科理论知识的理解,培养自主学习和解决问题的能力,明显优于LBL教学法,可以有效提升普外科住培医师的规范化培训效果。      

PBL结合CBL教学法在心内科住培教学中的应用研究

目的 探究在心血管内科住院医师规范化培训教学工作中联合使用PBL教学法和CBL教学法的教学实践效果。方法 选取2022年1月至2023年1月在内蒙古巴彦淖尔市医院心血管内科接受住院医师规范化培训的56名住培医师,随机分为观察组(n=28)和对照组(n=28)。对照组采用传统的教学法即讲授式教学法(lecture-based learning, LBL)对医师进行规范化培训,观察采用PBL结合CBL教学法对医师进行规范化培训。比较两组住培医师理论知识、技能操作、综合能力的成绩及其对教学方法的满意度,分别从主动参与感、是否提高语言能力、临床思维能力、团队协作能力、自主学习能力、是否提高专业知识、是否增强人际关系、案例分析能力、师生互动情况、教学效果10个方面评价此次教学工作。结果 接受规范化培训后,观察组的理论知识、技能操作、综合能力成绩以及在教学结束后对教学方法的满意度评价均高于对照组,差异有统计学意义(P<0.05)。结论 联合使用PBL教学法与CBL教学法有助于提高心内科住院医师规范化培训的教学效果,能够提升其综合能力,住培医师在培训结束后对这一教学方法的满意度评价较高。     

以多学科协作诊疗为基础的CBL联合PBL教学模式在妇产科住院医师规范化培训中的应用

目的 探讨以多学科协作诊疗（MDT）为基础的案例教学法（CBL）联合以问题为导向的教学法（PBL）教学模式在妇产科住院医师规范化培训中的应用价值。方法 将2020年6月至2021年6月在徐州医科大学附属医院妇产科参加住院医师规范化培训的规培生随机分为传统教学组（30人）和改革教学组（30人）,以妊娠合并内外科疾病为相关病例,比较两组实施不同教学模式后的考试成绩及教学满意度。结果 传统教学组的理论考试成绩及技能操作考核成绩均明显低于改革教学组（P<0.05）,教学满意度也明显低于改革教学组（P<0.05）。结论 以MDT为基础的CBL联合PBL教学模式在妇产科住院医师规范化培训中表现出明显优势。     

SimMan模拟人联合PBL教学在麻醉科住院医师规培中的应用

目的评价SimMan模拟人联合以问题为基础(PBL)教学法用于麻醉科住院医师规范化培训中的效果。方法将80名在河南大学淮河临床学院麻醉科参加规范化培训的住院医师按随机数表法分为两组,即PBL联合单项操作组(C组)和PBL联合SimMan模拟人教学法组(S组),各40名。教学结束后评价住院医师理论考试成绩、实际操作技能水平、教学质量、教学满意度情况及对麻醉学的兴趣。结果 S组住培医师考试总分、临床应用题、综合分析题的分值高于C组,差异有统计学意义(均P<0.05)。S组胸外按压、人工呼吸操作得分高于C组,复苏成功比例高于C组(均P<0.05)。S组住培医师增强急救意识、提高急救能力、增强队伍配合意识、提高主动学习积极性及理论结合实践能力高于C组住培医师(均P<0.05)。S组医师住培后对教学满意度较住培前提高(P<0.05);两组医师住培后对麻醉学的兴趣较住培前提高,差异有统计学意义(均P<0.05);S组医师在住培后教学满意度调查及对麻醉学的兴趣均高于C组(均P<0.05)。结论 SimMan模拟人联合PBL教学法可提高麻醉科住院医师规范化培训的规培教学质量,可应用于麻醉科住院医师规培教学。     

PBL+CBL+CP教学在肝胆外科住院医师规范化培训中的应用

目的 探讨以问题为基础的学习（problem-based learning,PBL）、以案例为基础的学习（case-based learning,CBL）和临床路径（clinical pathway,CP）相结合应用于肝胆外科住院医师规范化培训中的效果。方法 以2018年7月至2019年7月在陕西省人民医院肝胆外科接受规范化培训的64名住院医师为研究对象,分为观察组和对照组。其中对照组运用PBL+CBL教学,观察组运用PBL+CBL+CP教学。对比两组住培医师出科考试成绩和教学认可度评分。采用SPSS 15.0进行t检验和卡方检验。结果 对比两组住培医师的出科考试成绩,在专业理论、病例分析、操作技能方面,观察组均高于对照组,差异有统计学意义（t=6.98、7.85、7.01,P<0.05）。在对教学的认可度方面,观察组高于对照组,差异有统计学意义（t=9.14,P<0.05）。结论 PBL+CBL+CP教学有利于住培医师全面、系统地掌握知识,并快速建立科学的临床思维,具有很强的科学性和系统性,值得推广。     

EBM-PBL-CBL整合教学法在血液内科住院医师规范化培训中的应用研究

目的 探讨循证医学(EBM)-问题教学(PBL)-案例教学(CBL)整合教学法在血液内科住院医师规范化培训(简称规培)中的应用效果.方法 将血液内科轮转的90名内科规培学员按1:1随机分为试验组(采用EBM-PBL-CBL整合教学法)和对照组(采用CBL).对比两组规培医师出科时的理论考试、技能考核、病历书写和教学能力的成绩,并结合调查问卷评估教学效果.结果 试验组的理论成绩和技能考核成绩明显高于对照组(P=0.001、0.033),教学能力评优或者优+良的规培医师明显多于对照组(P=0.034、0.035).试验组在激发学习兴趣、提高自学能力、培养临床思维、提升解决问题能力及提高团队合作能力方面明显优于对照组(P=0.017、0.007、0.004、0.008和0.015).试验组规培医师对EBM-PBL-CBL整合教学模式的评价明显优于对照组对CBL的评价(P<0.001).结论 EBM-PBL-CBL整合教学法的整体教学效果优于CBL,能够达到规培目标,有助于提高血液内科规培医师的综合素质,可以在血液内科规培教学中推广.     

PBL联合CBL教学模式在住院医师规范化培训中的应用

目的探讨PBL联合CBL教学模式在住院医师规范化培训中的应用效果。方法此次依不同教学模式将2015年1月至2017年1月我院参与规范化培训住院医师20名分组为:对照组以传统LBL教学模式授课,观察组用PBL+CBL教学模式授课;详细记录两组住院医师各项实验数据,并将所获相关数据作对比分析,探讨PBL+CBL教学模式在住院医师规范化培训中的应用效果。结果两组住院医师理论客观题、实践操作成绩比较,差异无统计学意义(P0.05);观察组住院医师主观题、病例分析成绩优于对照组,差异有统计学意义(P0.05)。结论 PBL+CBL教学模式可充分提高住院医师规范化培训教学效果,可经此教学模式更好的激发住院医师的学习兴趣及其主动性,并可有效培养住院医师的团队协作能力,值得广泛应用。     

PBL联合CBL教学法在泌尿外科住院医师规范化培训中的应用

目的 探讨以问题为基础的教学法（problem-based learning,PBL）联合以案例为基础的教学法（case-based learning,CBL）应用于泌尿外科住院医师规范化培训中的教学效果。方法 选择2019年9月至2021年8月在浙江大学医学院附属第一医院泌尿外科参与住院医师规范化培训的学员180名,随机分为实验组和对照组,每组各90名,对照组学生接受传统教学模式带教,实验组采用PBL联合CBL教学法,住培结束后进行出科成绩测试和教学方法满意度评价。结果 实验组学员的基础理论知识测评、临床病例分析以及操作实践考核的成绩均优于对照组学员,两组差异有统计学意义（P <0.001）。实验组学员对于教学方法的总体满意度较高,与对照组相比,差异有统计学意义（P=0.040）。结论 在泌尿外科住院医师规范化培训中充分采用PBL联合CBL教学法有助于增强住培医师的临床学习热情,提升其对专科知识的掌握和应用,以及提高临床实践操作和解决临床具体问题的能力。     

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.