内镜仿真模拟系统用于内镜医师初学者胃镜培训的研究

目的评价内镜仿真模拟系统用于内镜医师初学者胃镜培训的可行性。方法将胃镜初学者分为2组,A组4名学员,接受内镜仿真模拟系统培训,B组4名学员,接受传统的内镜培训。培训结束后,比较2组学员在最初10名查体者胃镜检查中的独立完成率、辅助完成率和不能完成率。结果2组在性别、年龄、学历以及工作年限上差异无统计学意义。模拟系统培训组的独立完成检查率以及辅助完成检查率显著高于传统组,而不能完成检查率明显低于传统组。结论内镜仿真模拟系统可用于胃镜培训,减少学习弯路,降低学习费用,值得推广。     

基于EBME模式的呼吸内科临床教学研究

目的探讨EBME(循证医学教育)模式在规范化培训呼吸内科查房教学中应用价值。方法选择自2013-2016年在安徽医科大学第二附属医院呼吸内科进行传统教学规范化培训住院医师30人进行分析,依据是否给予EBME模式分为试验组和对照组,对两组培训后考核、评价、与传统方法进行对比。结果EBME教学模式下学员的考核成绩优于传统模式下学员的成绩,差异有统计学意义。结论 EBME模式有利于培养学生临床实践应对能力,可持续改进规范化培训的教学质量,为住院医师规范化培训开拓新的教学思路和方法。     

专题探究式教学模式在心肾综合征教学中的应用

目的 比较专题探究式教学模式与传统教学方法在心肾综合征临床教学中的应用优势。方法 纳入2020年9月至2021年12月于解放军总医院海南医院肾脏病科接受住院医师规范化培训的2019级轮转学生30名,随机分为观察组(接受专题探究式教学模式)和对照组(接受传统教学模式),比较两组学生的出科理论、操作考核成绩,通过调查问卷方式比较教学效果和学生满意度,运用SPSS 20.0进行统计学分析。结果 观察组学生的出科理论、操作考核成绩明显优于对照组(理论考核P=0.006,操作考核P=0.003),两种教学方式在加深理论知识理解、促进理论与临床结合方面无统计学差异,但观察组学生在提高问题分析能力、提高思维拓展能力、提升科研能力和培养创新能力等方面更有帮助(P<0.05)。结论 专题探究式教学模式应用于心肾综合征的临床教学过程,能有效提高成绩,对于培养学生主动学习能力、锻炼临床思维、探寻前沿进展等方面较传统教学方法具有显著优势,值得在临床规培教学中推广。     

浅析任务式教学对心血管内科实习生学习能力和满意度的影响

目的观察在心血管内科中,采取任务式教学对实习生学习能力和满意度的影响。方法选取2013年11月~2014年10月在我院心血管内科的实习生50名,将其随机分两组,各25名,对照组使用传统教学模式,观察组采取任务式教学模式,观察两组实习生的学习能力,测评其对教学模式的满意程度。结果观察组实习生的学习能力提高情况、对教学模式的满意程度均高于对照组,差异有统计学意义(P0.05)。结论在心血管内科中,采取任务式教学,能够有效提高实习生的学习能力,还能获得实习生对教学较高的满意程度评价。     

TBL结合翻转课堂教学模式在心跳起源分析实验教学中的应用

目的评价团队导向式教学(TBL)联合翻转课堂在心跳起源分析实验课程教学中的应用效果。方法第四军医大学2015级五年制临床医学本科学员共60人,随机分为两组,分别给予传统讲授教学法(LBL)及TBL、翻转课堂联合教学法进行教学。课程结束后,通过调查问卷、理论及实践能力考核的方式来评价教学效果。结果与传统的LBL相比,TBL、翻转课堂联合教学组学员的综合个人成绩为[(84.3±10.4)分vs.(73.2±13.5)分],差异具有统计学意义(P0.01)。问卷调查结果显示,TBL、翻转课堂联合教学法有利于培养学员的综合学习能力,总体满意度达93.3%。结论 TBL、翻转课堂联合教学模式可以提高生理学心跳起源分析实验课程的教学效果,不仅提高学生的学习兴趣,并且有利于培养学生团队协作、独立思考和解决问题的学习能力。     

实施分层培训(进阶模式下)提高护士专业能力

目的对实施分层培训(进阶模式下)提高护士专业能力的成效予以分析和探讨。方法自2014年3月-2015年8月从我院选取60名护士随机均分为两组,分别为对照组和观察组,每组各30名。为对照组护士人员采用常规的护理模式培训,为观察组护士采用分层护理管理的模式进行培训。对两种不同培训模式下的两组护士所护理病人的护理满意度及综合能力的考核情况进行比较。结果观察组护理人员在分层培训(进阶模式下)的综合能力的考核情况明显优于对照组,且经观察组护理人员护理的患者护理满意度明显高于对照组,且P0.05,差异具有统计学意义。结论实施分层培训(进阶模式下)对于提高护士专业能力具有较高的应用价值,能够促进护理人员的工作积极性,从而有效的提高临床护理质量及护理满意率。     

消化科专科医师早期胃癌诊治培训模式探讨与教学效果评估

目的 通过对早期胃癌诊治培训模式建立和教学效果的评估,探讨消化专科医师专题继续教育的方式。方法 纳入2019年9月—2020年1月参加北京协和医院早期胃癌培训班的共3期48名学员,通过问卷调查和现场测试的形式,对6种不同培训方法的教学效果进行主观和客观评估。结果 通过早期胃癌培训班学习,学员对早期胃癌的诊断意识（100.0%,48/48）、基础理论水平（97.9%,47/48）、内镜下识别能力（95.8%,46/48）和内镜操作技术（87.5%,42/48）均有了明显提高。效果较好的培训模式包括内镜图片识别培训、理论知识讲座、临床病例讨论和手把手操作培训。学员培训后的理论知识测试成绩为（79.38±8.10）分,较培训前的（48.33±9.96）分显著提高（t=-21.176,P<0.001）,培训后的图片识别测试成绩为（81.50±8.32）分,也较培训前的（49.58±13.48）分显著提高（t=-15.408,P<0.001）。结论 包含多种培训方法的早期胃癌系统培训模式效果显著,应在消化专科医师的专题继续教育中广泛推广。     

互动式数字化教学在内科循环系统中的应用

目的 互动式数字化教学深层次应用到内科循环系统理论及实践教学的模式探索。方法 纳入本校临床医学专业五年制本科生60名作为研究对象随机分为两组,试验组采用互动式数字化教学模式进行循环系统疾病的理论及实践教学,对照组应用传统学习模式。于两组学员循环系统教学结束后进行情景模拟病例分析考核,并采用问卷调查收集学生对教学模式的效果评价及统计分析。结果 试验组病例分析考核成绩显著高于对照组,教学评价问卷分数优于对照组,差异有统计学意义（P<0.05）。试验组学员对于互动式数字化教学模式的循环课学习反馈优于对照组。结论 互动式数字化教学模式能显著提高学生的课堂专注力及知识掌握力,适用于内科循环系统学习。     

社区医生急救技术培训模式与效果评价研究

目的探索一套便捷、高效的社区医生急救技术培训模式,同时对我街道所属社区医生进行规范化培训以提高其院前急救能力。方法将容桂街道所属13个社区卫生服务站每站点选取2名医生作为培训对象,随机抽取1名作为A组学员,另一名作为B组学员,每组共13名学员。A组学员采用传统教学方法即＂理论讲授-实践技能操作-考核＂三步骤进行;B组采用＂逆向补充教学法＂进行培训,A、B两组总培训时间均为2周。学习期满进行考核及1年后随访两组学员在1年内使用急救技术实施急救的能力和效果。结果学习期满实践考核成绩B组较A组好,考核达标培训所需时间B组较A组少,1年内急救技术应用能力二者无显著差异。结论＂逆向补充教学法＂在实施急救技术培训中省时省力,针对性强,学员学习效果好。     

LPR教学模式在八年制心力衰竭案例教学中的应用

目的评价LPR[课堂讲授(LBL)+基于问题的学习(PBL)+基于研究的学习(RBL)]教学模式在八年制心力衰竭案例教学中的应用效果。方法选取空军军医大学2014级八年制学生32名,随机分为两组,分别采取LP(LBL+PBL)和LPR模式进行教学。课程结束后,通过理论考试和调查问卷的方式来评价教学效果。结果 LPR教学模式组学员平均成绩明显高于LP教学模式组(P 0. 05)。问卷调查结果显示,LPR教学模式组学生对于知识的掌握与应用、学习主观能动性、分析解决问题能力以及临床和科研思维的认可程度明显提高。结论 LPR教学模式可提高八年制心力衰竭案例的教学效果,不仅提高学生学习主观能动性,还有利于提升学生的科研思维。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.