临床诊断学教学中实施以问题为基础学习教学方法的探索

目的 探索在医学桥梁课程中实施以问题为基础学习(problem-based learning,PBL)教学方法的可行性和实施方式.方法 选择华中科技大学2004级八年制临床医学专业50名学生、2007级七年制临床医学专业70名学生作为研究对象,分为实验组和对照组.实验组在临床诊断学课程中实施PBL教学方法,对照组实施传统教学方法.教学结束后通过比较两组学生的考试成绩了解学生知识运用和综合能力的提高情况,并对实验组学生进行问卷调查以了解其对PBL教学认同度.结果 实验组学生在理论考试与病例分析成绩、知识运用与综合能力均高于对照组学生,差异具有统计学意义.问卷调查结果显示,实验组学生对PBL教学方法持肯定态度.结论 PBL教学方法有利于提高学生的学习积极性,可以促进医学生临床技能的提高,在对知识的应用能力及发挥学习主体作用等方面明显优于传统教学方法.     

医学病毒学实验课PBL教学改革

目的：探讨以问题为基础的学习（problem-based learning, PBL）在医学病毒学实验教学中的应用。方法将2011级临床医学专业学生随机分为2组,实验组45人（含五年制20人、七年制25人）采用PBL教学,对照组63人（含五年制38人、七年制25人）采用传统教学。对比两组学生的实验成绩、医学病毒学理论成绩和期末理论成绩,并对实验组学生行问卷调查;考试成绩采用t检验,用SPSS统计软件包进行分析。结果实验组七年制学生的医学病毒学理论成绩明显高于对照组七年制学生（P＆lt;0.05）,其他成绩2组差异无统计学意义。问卷显示,实验组学生对PBL可激发兴趣、锻炼病案分析与实验设计能力、促进知识理解和掌握方面满意度高;七年制学生对PBL可提高循证和归纳总结能力、五年制学生对PBL可提高自主学习能力和演绎素材能力满意度略低。结论联系公共卫生事件的医学病毒学实验课PBL教学能够激发学生学习兴趣,促进学生掌握知识,培养其良好的公共卫生意识。但需根据五年制和七年制学生学习能力对PBL教学流程作适当调整。     

影响妇产科临床技能教学效果的相关因素分析

目的：分析八年制临床医学专业的妇产科实习临床技能考试成绩,评估妇产科临床教学质量。方法：选择2001级、2002级八年制临床医学专业的妇产科实习临床技能考试试卷,共134份,对考试成绩及其失分项进行分析。结果：妇产科临床技能考试成绩为87．69±7．24。病史采集、诊断和回答问题方面失分较多;病史采集、查体、辅助检查、诊断和回答问题是造成学生成绩低于85分的主要原因。结论：八年制临床医学生临床技能掌握较好,但是痛史采集、诊断和回答问题方面尚有不足,以后的教学工作中应加强这方面的训练。     

医学微生物学教学中以问题为基础学习与以授课为基础学习教学法的比较研究

目的 探讨以问题为基础学习与以授课为基础学习教学法在医学微生物学教学中的应用效果.方法 选择河南大学医学院2006级和2007级临床医学专业各100名本科学生,分别采用以问题为基础学习和以授课为基础学习教学法进行医学微生物学理论教学.结果 学生的考试成绩表明,以问题为基础学习教学班学生"细菌学"的平均成绩明显高于以授课为基础学习教学班学生,而"病毒学"的平均成绩却明显低于以授课为基础学习教学班学生.结论 两种教学法各有所长,在具体的医学微生物学教学中,只有灵活运用才会获得较好的教学效果.     

医学微生物学教学中以问题为基础学习与以授课为基础学习教学法的比较研究

目的 探讨以问题为基础学习与以授课为基础学习教学法在医学微生物学教学中的应用效果.方法 选择河南大学医学院2006级和2007级临床医学专业各100名本科学生,分别采用以问题为基础学习和以授课为基础学习教学法进行医学微生物学理论教学.结果 学生的考试成绩表明,以问题为基础学习教学班学生"细菌学"的平均成绩明显高于以授课为基础学习教学班学生,而"病毒学"的平均成绩却明显低于以授课为基础学习教学班学生.结论 两种教学法各有所长,在具体的医学微生物学教学中,只有灵活运用才会获得较好的教学效果.     

学制互通优胜劣汰教学管理机制的实践与探索

1988年以来,华中科技大学同济医学院实施了五年制与七年制学制互通、优胜劣汰的教学管理制度,成绩优异的五年制医学类各专业学生经过德、智、体全面考核,可以升入七年制临床医学专业学习,而达到淘汰标准的七年制临床医学专业学生则降至五年制医学类专业学习,始终使七年制临床医学专业学生处于动态的变化过程之中。近20年的七年制临床医学专业办学实践表明,五年制、七年制学制互通优胜劣汰的教学管理机制对培养学生的竞争意识,形成良好的学风,培养高质量的医学人才发挥了重要作用。     

不同专业动物外科操作考试成绩分析及差异原因探讨

目的分析我校2005级四个不同专业学生期末动物外科操作考试成绩,探讨出现差别的原因及改进方法。方法选取我校2005级临床医学五年制,救援医学,七年制和麻醉医学四个专业的学生（共383人）在2009年期末动物外科的操作考试成绩进行统计分析。结果按样本间两两比较的秩和检验（Nemenyi法）,七年制组与麻醉医学组、救援医学组之间差别有统计学意义（P〈0.05）,其余各组之间差别没有统计学意义。结论 本学期大多数学生能认真完成动物外科的学习、成绩相近,但麻醉医学及救援医学的学生需克服偏科思想,加强动手能力训练,才能更好地掌握外科学操作知识。     

对我校临床医学七年制学生生理学考试成绩的分析

研究目的:以西安交通大学医学院2002、2003、2004级568名临床医学七年制学生为对象,分析其生理学考试成绩的差异.研究方法:定量与定性分析相结合,并以定量为主.研究结果:(1)各年级学生的生理学成绩分布合理,难度和区分度适宜;(2)不同性别学生成绩有显著差别.思考与建议:(1)建立规范的成绩分析和教学评估指标体系;(2)利用现代化的教学手段增强学生学习的主动性和积极性.     

病理学教学中以问题为基础学习教学方法的应用

目的 通过与传统教学方法的比较,探讨以问题为基础学习(problem-based learning,PBL)教学方法在病理学教学中的应用效果.方法 以中国医科大学2008级、2009级和2010级五年制、七年制临床医学专业1班～4班学生为实验组,以2008级、2009级和2010级五年制临床医学专业13班～16班、七年制临床医学专业5班～8班学生为对照组进行比较研究.实验组采用PBL教学方法,对照组采用传统教学方法.结果 实验组多数学生对于PBL教学方法给予肯定的评价;实验组学生的病理学病例分析题考试成绩高于对照组学生,其差异具有统计学意义.结论 病理学教学中采用PBL教学方法的教学效果优于传统教学方法,有利于达到教学目标,能够更好地实现对学生能力的培养.     

七年制临床医学专业人体寄生虫学教学探讨

在飞速发展的现代科技的渗透下,结合七年制临床医学专业的教学要求和特点,针对传统教学模式中的薄弱环节,从双语教学、计算机辅助教学、实验教学的革新以及考核措施的多样性四个方面对七年制临床医学专业人体寄生虫学进行了初步探索,旨在激发学生的学习兴趣,提高学习效率,启发学生思维,从而更好地掌握这门学科。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.