大鼠冠状动脉微栓塞模型的建立

目的建立大鼠冠状动脉微栓塞（Coronary Microembolization，CME）模型。方法S-D雄性大鼠随机分为假手术组（S0组），微栓塞组（CME组）；CME组再按微球数目不同分为1000、2000、3000、4000个微球亚组（分别计为CME1、CME2、CME3、CME4组，各组存活大鼠均n=10）；大鼠麻醉后开胸，夹闭升主动脉10s，从左心室注射微栓塞球到达冠状动脉记为CME组，以注射生理盐水为假手术组；分别于术后6h心脏超声检测左室射血分数（LVEF）、HBFP检测心肌微梗死面积和TUNEL检测心肌细胞凋亡卒。结果①与s。组比较，CME，组LVEF下降，但没有统计学意义；与S0组比较，CME2、CME3、CME4组LVEF均显著下降（均P〈0．05）；CME组均出现心肌微梗死灶与心肌细胞凋亡。②不同微栓塞亚组之间比较，LVEF与微栓塞球数目成负相关（γ=0．78，P〈0．05）、心肌微梗死面积和心肌细胞凋亡率均与微栓塞数目成正相关（γ分别为0．85、0．80，均P〈0．05）。③3000个微球是较理想的建立大鼠CME模型所需的微球数日。结论开胸大鼠，从左室注入微栓塞球3000个，可成功建立大鼠CME模型。     

浅谈医院数字化学习平台的建设

数字信息时代的革命深刻地改变着医院图书馆的发展方向，医院图书馆面对这样的挑战应采取何种应对措施，本文重点论述了数字化图书馆的典型特征，医院图书馆的现状及医院数字化图书馆建设中的对策。     

电子图书馆在创建现代化医院中的作用

文章阐述了电子图书馆的建立是创建现代化医院的重要组成部分，电子图书馆信息服务的方式是对医院图书馆传统服务方式的创新，电子图书馆在现代化医院创建中发挥了的作用。     

试论医院图书馆发展的构想

本人是一个热爱医学事业的工作人员，结合十余年实际工作经验，并进行了大量的调查研究，分析了医院图书馆的发展现状及优势：借鉴先进图书馆的发展经验，本文提出了医院图书馆发展的几点建议，旨在促进医学信息事业的发展，充分发挥医院图书馆的作用。     

我院图书馆信息服务新模式的实践

本文介绍了信息时代医院图书馆在信息服务模式创新实践的主要做法：实践表明，新的信息服务模式既满足了读者各种不同的需求．又奠定了医院图书馆在医院建设中的地位，为医院图书馆的生存探索出了新路子。     

新形势下医院图书馆的生存与发展

本文分析了我国医院图书馆的现状，阐明医院图书馆为求得生存与发展，必须适应新形势，在各个方面都得到发展，建成现代化的图书馆。     

浅析医院图书馆的特点与建设

医院图书馆不同于公共图书馆，也不同于其他医学图书馆，医院图书馆是医院整体结构的重要组成部分，是医院文献信息中心，它根据医院的性质、任务，以其特有的形式和内容，为临床医疗、科研、教学、管理发挥应有的职能。办好医院图书馆，加强医学信息管理，是现代医院管理的一项重要内容。医院图书馆作为医院的图书情报中心，在服务对象及藏书方面有其如下特点。     

中国医院知识仓库(CHKD)在医院信息保障中的作用

本文重点介绍了《中国医院知识仓库(CHKD)》数字期刊数据库的特点及在医院图书馆的应用，CHKD的应用对加强医院信息资源建设，对医院学术研究、医疗服务质量提高的推动作用，为医院图书馆向网络化、数字化、虚拟化发展提供了一个良好的契机，也为未来医院图书馆的数字化发展指明了方向。     

网络环境下医院图书馆的信息服务

随着全球信息化网络进程的加快，医院图书馆也步入了管理自动化，资源数字化，信息传递网络化的新阶段。在网络环境下，医院图书馆应当抓住机遇，充分利用计算机网络技术，全方位为读者服务，满足读者的个性化需求，推动医院图书馆事业向前发展。     

杭白菊乙酸乙酯提取物的舒血管作用及相关机制

目的：研究杭白菊乙酸乙酯提取物（CME）的舒血管作用及机制。方法： 大鼠胸主动脉环张力测定法。结果： CME可以浓度依赖性地降低主动脉环由苯肾上腺素（PE）及高钾预收缩的血管张力，其对内皮完整血管的作用显著大于去内皮血管（P＜0.05）。L-N-硝基精氨酸甲酯（L-NAME）、亚甲蓝可以显著降低CME的舒血管作用（P＜0.01）；将主动脉与CME共孵育后，血管NOS活力呈现浓度依赖地增高（P＜0.01）；吲哚美辛对CME的作用无显著影响；SKF-525A与L-NAME合用，与单用L-NAME无显著差异。CME的舒血管作用不受普萘洛尔、四乙氨、氯化钡、4-氨基吡啶、5-羟基癸酸的影响；但却可被格列苯脲显著削弱（P＜0.01）。无钙环境下CME对PE引起的收缩无显著影响；无钾环境下以及无钙环境下渐加钙，CME对PE引起的收缩有显著影响（P＜0.05）。结论： CME具有显著的舒血管作用，其机制既与NO介导的途径有关，也与抑制电压依从性钙通道和受体操纵性钙通道以及激活ATP敏感钾通道有关。     

全结肠系膜切除在腹腔镜结肠癌根治术中的应用

目的探讨全结肠系膜切除(CME)在腹腔镜结肠癌根治术中的应用。方法 102例腹腔镜手术患者按手术方法分为2组,68例行CME为CME组,34例行传统手术为传统手术组,对2组进行回顾性分析。结果 CME组与传统腹腔镜手术组相比,手术时间、肛门排气时间、住院时间稍增加,术后引流量减少,术中出血量减少,差异具有统计学意义;而且,CME组清扫淋巴结个数增多,与传统腹腔镜手术组比较差异具有统计学意义,P0.05;但术后并发症发生率2组比较无显著差异,P0.05。结论在腹腔镜下结肠癌根治术中应用CME技术具有减少肿瘤播散、淋巴结清扫更彻底的优势。     

Domains-based outcomes assessment of continuing medical education: the VA's model.

Demonstrating outcomes of continuing medical education (CME) efforts has become increasingly important to CME providers, accrediting organizations, and licensing bodies. Many CME providers have difficulty defining the nature of the outcomes, much less documenting the outcomes for which they are responsible. The vague nature of the terms "outcome," "impact," or "result" in the complexity of health care and medical education environments is a particular obstacle to many education providers. To overcome these barriers, the VA's Employee Education System (EES), a large CME provider, created a model identifying five major domains of possible outcomes for CME interventions; these are the domains of individual participants, employee teams, the larger organization, patients, and the community. These domains are useful in either assessing a single CME activity's outcomes or comprehensively assessing a CME provider's outcomes-assessment strategy. The use of such a domains-based outcomes-management strategy links organizational mission, needs assessment, specific activity assessment, and assessment of the overall education program. This approach may be useful to CME providers, accrediting and licensing bodies, or others interested in the relationship of CME outcomes to the activities of CME providers.     

Continuing medical education for pathologists: an evaluation of the Royal College of Pathologists' Wessex pilot scheme.

AIM: To discover the attitudes to continuing medical education (CME) of the Wessex pathologists who participated in the Wessex CME pilot scheme and to identify their preferences and difficulties in pursuing CME activities. METHOD: The views of pathologists in the scheme were collected during a period of one year using workshops and discussions. A confidential, anonymous postal questionnaire based on these issues was sent to the 103 pathologists in Wessex who participated in the pilot scheme. RESULTS: A 64% response rate was obtained. The respondents identified lack of time and funded study leave as major barriers to CME and highlighted the gap between CME activity and its recognition and funding by employers. They wanted a wide variety of locally based CME activities to be recognised, and they valued local activities that linked theory with practice. They believed that the college scheme tended to favour academic activities over more practical and locally based ones. They found the paired peer review process time consuming but valuable for identifying their learning needs in some cases, but demonstrated that they have mixed preferences about the way they do their CME. CONCLUSIONS: The Wessex pathologists believe that CME is important and have positive attitudes to it. Their attitudes to CME echo the current literature about what makes CME effective. Unless individuals' preferences and difficulties are taken into account, CME programmes in which they participate are not likely to succeed.     

数字化医院建设和数字读者培养

数字化医院建设是当前医院发展的热点，数字图书馆是数字化医院的重要组成部分，数字读者是伴随数字图书馆的发展而产生的现代化的读者群体，他们是有效使用数字图书馆的读者群。我们必须搞好数字化医院建设，大力培养数字读者，促进医学科学的发展。     

Effects of a CME program on physicians' transfusion practices

A two-stage project was designed to assess physicians' transfusion practices and to evaluate the effectiveness of a continuing medical education (CME) lecture to change these practices. The hospital charts of 44 patients who were autologous blood donors undergoing elective orthopedic surgery and a matched group of 44 patients who were not autologous blood donors were analyzed to determine their physicians' transfusion practices. The groups were matched for age and sex distribution and for procedure. The results suggested that the physicians accepted lower hematocrit levels for autologous-donor patients, did not request adequate amounts of autologous blood, overtransfused some patients with their own blood, and did not schedule the elective procedures far enough in advance to allow patients to deposit the requested amounts of autologous blood. A CME program developed to address the latter three problems was given to seven subspecialty groups in a grand rounds lecture format. Follow-up comparisons of the orthopedic surgeons' blood transfusion practices indicate that after the CME program they did significantly less underordering of autologous blood but still did not increase the time for patients to donate the requested amounts of blood.     

An audit to estimate the quality of practices followed during bedside blood transfusion in a tertiary care hospital and role of continuous medical education in it

Blood transfusion is an integral component of the health Service system and it becomes imperative that its benefits, risks as well as prospective and viable alternatives of this common medical intervention are explained explicitly to the patients. Appropriate compliance to bedside blood transfusion practices can also help in avoiding adverse transfusion outcomes. At the same time, it is also crucial to document a patient's valid consent based on their decision after evaluation of the risk to benefit ratio. This audit aims to assess the compliance and adherence to bedside blood transfusion practices in a tertiary care hospital and role of Continuous Medical education (CME) on it. The study involved collection of data for blood transfusion services and practices in two periods, for adults and children, who received transfusion from the month of June 2021 to October 2021 and a re-audit beginning from November 2021 to February 2022 following few CMEs in between involving doctors and nurses. A total of 3240 transfusion procedures were assessed in this duration. In them 1500 (46.3%) took place before CME and remaining 1740 (53.7%) procedures took place after CME. There were statistically significant differences between pre-CME and post-CME bedside transfusion practices. During CME/training session, pre-training and post training knowledge has been evaluated by test which also showed statistically significant difference in knowledge of transfusion medicine & bedside transfusion practices. Our study recommends that there is a need of frequent audit on bedside transfusion practices to check the quality and standards associated with it and also points out the need of continuous medical education on this issue.     

A bi-national perspective on continuing medical education

This paper presents a review and comparison of qualitative improvements in the organization, needs assessment, educational methodology, evaluation, and research in continuing medical education (CME) in the United States and Canada. Although accreditation now establishes minimal standards for CME and reduces the chances of irresponsible programs, some organizational issues (such as commercial sponsorship) and educational issues (how to "accredit" journal reading) remain unresolved. There are many examples of excellent, innovative CME programs offered by medical schools, and specialty societies have been instrumental in upgrading CME by serving as sponsors of accreditation and special projects. There is some evidence that the national health system of Canada has influenced the organization and content of Canadian CME, and these changes may soon affect U.S. programs as well. CME research has grown, with two types of research evident: the biomedical model, which assesses the efficacy of CME interventions by quantitative methods; and a model that uses grounded, ethnographic, methods to assess physician learning and performance change. Given the improvements of the past 20 years, the criticisms that focus exclusively on the lack of ideal educational planning for all CME programs are not so much wrong as dated and perhaps irrelevant. In developing their programs, CME leaders can begin to emphasize the physician learner and the clinical and social environment in which learning occurs.     

Cloning, characterisation, and heterologous expression of the Candida utilis malic enzyme gene

The Candida utilis malic enzyme gene, CME1, was isolated from a cDNA library and characterised on a molecular and biochemical level. Sequence analysis revealed an open reading frame of 1,926 bp, encoding a 641 amino acid polypeptide with a predicted molecular weight of approximately 70.2 kDa. The inferred amino acid sequence suggested a cytosolic localisation for the malic enzyme, as well as 37 and 68% homologies with the malic enzymes of Schizosaccharomyces pombe and Saccharomyces cerevisiae, respectively. Expression of the CME1 gene was subject to carbon catabolite repression and substrate induction, similar to the regulatory mechanisms observed for the C. utilis dicarboxylic acid permease. The CME1 gene was successfully expressed in S. cerevisiae under control of the S. cerevisiae PGK1 promoter and terminator. When coexpressed with the S. pombe malate permease gene (mae1), it resulted in a recombinant S. cerevisiae strain able to completely degrade 90% of the extracellular L-malate within 24 h. Nucleotide sequence data reported are available in the DDBJ/EMBL/Genbank databases under the accession number DQ173437.     

Continuing Medical Education: an international reality

We are all aware today of the growing interest in continuing medical education (CME) programmes in many European Countries and it is important to understand why and how CME could become an international reality. It is obvious that patients need a good doctor--the best possible--as far as medical knowledge, attention to the patient's quality of life and cost-control is concerned. All European health care systems have to take into consideration everything that causes patient dissatisfaction, risk management and unjustified expenses. An example is the increase of claims and complaints against doctors and the strong attention of patients to medical procedures. In other words, medicine worldwide is becoming a service industry and has to consider quality and quantity of performances as well as to pay attention to personal responsibility. The object of our work is to evaluate the CME systems present in Europe, to show the work done on CME by the CME Committee of the European Academy of Allergology and Clinical Immunology and to highlight the Consensus Report on CME approved by an international panel of CME experts.