产科学临床实习教学面临的困难与对策

本文分析了目前产科学临床实习教学中存在的问题:患者隐私权与医学生实习的矛盾,产科临床特点与医学生实习的矛盾,学生沟通技巧方面的缺乏,医学生临床思维能力的缺乏;提出了解决问题的方法:加强患者权利保护的教育,加强产科实习基地的建设,改进实习教学方法,实施以问题为基础的教学方法,培养医学生的情感智力,加强医学生的临床思维培养。     

加强临床实习医学生的素质教育

医学生临床实习是医学理论联系实际的过程，要把所学的医学理论知识运用到患者的临床诊疗中。在新的医疗环境里，患者维权意识增强，医学院校教学医院在完成实习医学生的教学任务与维护患者利益之间难免会出现一定程度的矛盾，加强临床实习医学生的素质教育对圆满完成实习任务、传承医学知识和处理好医患矛盾具有重要的意义。实习医学生的素质教育包括业务素质教育和职业道德素质教育两个方面。     

双主体互动教学模式在乳腺科临床实习教学中的应用探讨

在医学生到医生角色转变的过程中,临床实习教学至关重要。乳腺科临床实习教学过程中存在着患者隐私权与医学生实习相矛盾,医学生医患沟通技巧、临床思维能力及科研能力的缺乏等问题。本文旨在探讨在乳腺科临床实习教学过程中引入双主体互动模式,以充分发挥教师和学生作为主体的能动性,以提升临床医学生的综合素质,培养更全面和优秀的医学人才。     

乳腺外科临床实习面临的问题与对策

临床实习是高等医学院校教育的重要内容。通过临床实习,实习医生逐步完成从医学生到医生的角色转变,为毕业后独立从事临床医疗工作打下坚实的基础。本文分析了目前乳腺外科临床教学中存在的问题:患者隐私权与医学生实习的矛盾,学生沟通技巧方面的缺乏,医学生临床思维能力及科研能力的缺乏等,提出了解决问题的方法。     

医德教育在产科实习医学生临床教学中的实践

通过提高产科医师医德修养,使产科医师在传授专业技能的同时加强实习医学生医德教育,培养既有高超临床专业技能又有高尚医德修养、能够承载患者生命重任的新一代临床医务工作者。     

临床实习中医学生人文精神的培养

临床实习是对医学生人文精神培养有着承前启后作用的重要阶段。目前在临床实习中的医学生人文精神培养方面,管理上缺少过渡环节,带教医生缺乏培养意识和能力,医学生对人文精神培养轻视的同时存在理论与实践脱节现象。通过加强培训,重视带教医生的培养、选拔和奖惩,修订实习手册,将有助于问题的解决。     

眼科临床教学实践与探索

临床实习是医学生向临床医师过渡的关键时期。分析当前眼科临床实习所面临的问题，探索眼科临床教学的方法。加强教师队伍的建设，激发学生的学习兴趣和主动性，实施PBL教学方法，将诊疗最优化原则和循证医学贯彻到教学实践中，加强医学生的法律意识和培养构建和谐医患关系的能力，从而提高临床教学质量。     

临床实习中加强图像教学与培养学生交流能力的探索

临床实习是医学生增加知识、增长技能、培养临床思维的一个重要阶段。医学生临床实习的质量与提高临床科室的教学质量有着密切的关系。我们在妇产科学临床实习中应用图像手段培养医学生的临床思维能力，实习前应用图像手段获得全面认识；实习中应用图解加强疾病的整体观念；实习结束后应用图像加强理论与实践结合。同时，结合妇产科临床工作，培养医学生的交流技巧，进行成功的医患沟通与交流，提高了临床实习的质量。     

医学生临床实习的主要问题及对策

医学生实习态度不够端正、本末倒置，临床教学重视不够以及实习管理制度落后，是当前医学生临床实习存在的主要问题。实习教学矛盾的解决应侧重强化工作作风，提高基本素质，培养正确的临床思维和科研思维能力，以提高实习质量，为医学生逐步向合格医师过渡奠定基础。     

产科临床实习教学存在的问题及对策

临床实习是高等医学院校教育的重要内容。通过临床实习，实习医生逐步完成从学生到医生的角色转变．为毕业后独立从事临床医疗工作打下坚实的基础。在此期间，实习医生将大学四年理论课学习内容与具体的临床实践有机结合起来，实际接触病人，实现从理论到实践质的飞跃。因此，高等医学院校搞好医学生临床实习教学甚为重要。产科临床实习是医学生临床实习的重要组成部分，如何适应新形势发展，搞好产科临床实习教学工作，是摆在产科带教老师面前的重要课题。本文对产科临床实习教学中存在的问题进行了探讨，并提出提高产科临床实习教学质量的对策，现总结报道如下。     

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.