浅谈新时期检验医学本科生实习教学中的思想政治教育

当前，对各级各类医务人员（包括回聘人员、地方聘用人员、医科大学实习生和军地进修生等）进行的思想政治教育是一项长期工作。在检验医学本科生实习教学中有目的地对其施加意识形态方面的教育、进而指导其行为，是检验医学教学工作的重要内容面临新时期，要求检验医学本科生在实习教学过程中，须巩固坚定的政治信念、树立为民服务和为兵服务思想、具备高度的组织纪律和良好的科学作风。因此，军队大型综合性医院检验科在检验医学本科生实习教学工作中开展思想政治教育时，应强化以下几个方面。     

影响军队医院门诊检验能力的因素及对策

当前，随着国家大卫生政策的逐步实施，军队综合性医院在竞争中求生存、在竞争中求发展的意识也逐步增强。面对新形势新局面，如何利用自身优势技术、提高竞争能力是医院管理者和决策者必须思考的问题，就军队综合性医院检验科而言，提高门诊检验数质量也是一个值得探讨的问题。本文结合军队综合性医院检验科门诊化验室面临的现状，从“影响门诊检验数质量的因素、提高门诊检验数质量的措施”两个方面进行了探讨，谈一些看法。     

科室管理须理顺的4个关系

检验科是军队综合性医院的重要医技科室,其科室管理的好坏和管理质量的高低,将直接或间接地影响到军队综合性医院的全面建设。经过长期观察与分析,我们认为:理顺检验科内部的一些管理关系,将直接决定着检验工作的全面落实。1医疗工作与科研、教学工作的关系医疗工作与科研教学工作的关系是检验科科室管理中最难平衡的关系之一,也是最重要的关系之一。当前,少数检验科负责人仅仅重视医疗工作的前沿作用而忽视科研教学工作的后备作用,认为科研教学工作是软性指标,而医疗工作决定了医疗单位的收入,是硬性指标。“重医轻科教”现象比较明显。在…     

加强对医学检验专业实习生实习指导的举措

临床检验科不但承担着繁重的临床检测工作,还承担着培养医学生的理论教学和检验专业学生的实习任务。为进一步提高专业教学质量,加强对实习生的管理及指导,我们采取了以下具体措施。     

医学检验专业办学模式探索

高等医学检验教育的主要任务是为医院检验科培养高级专门人才，医院检验科的学科发展带动着医学检验教育的发展．二者相辅相成，不可分割．因此，发挥两者的积极性对提高我国医学检验的整体水平无疑是极为重要的．我院在1989年开始办医学检验系时，便把该系挂靠在附一院检验科．实行以附一院检验科为主体，附二院检验科参与办学的模式．学院编制检验科教学人员全部归属该系管理，参与二个附院的教学和日常工作．这种办学模式使教学与临床能紧密相结合，能充分调动附属医院和教学基地教师积极性，使学生学到的理论与临床实践紧密结合起来，克…     

加强检验专业实习生职业意识的培养

培养实习生的职业意识,对实现培养目标、学生毕业后适应新环境的挑战,将起到重要的影响。笔者就此问题谈几点看法。１加强职业道德教育学生由学校到医院,是接触社会的开始,是走向社会、从事医学检验的前奏。进入临床后,应强化职业道德教育,打好预防针,增强免疫力,以抵御行业之中不正之风的侵袭和影响。可请医院检验科领导、优秀带教老师组织学习医务人员职业道德规范、岗位职责,讲述检验科良好的医德医风,医学检验在临床诊治的重要性,献身检验工作的体会及成就,介绍优秀实习生,通过潜移默化、现身说法促使实习生树立正确的职业…     

对我省26所县(区)级综合性医院检验科调查报告

为响应国家教育部、共青团中央关于大学生暑期三下乡进行社会实践活动的号召，根据学校的安排，2003年暑假期间我们医学检验班同学随机对泰安、淄博、临沂、枣庄、德州等地市26所县(区)级综合性医院检验科的情况进行了调查。通过这次调查，我们深深体会到了我们未来所从事的医学检验工作的职责和重要性。现将26所县(区)级综合性医院检验科的基本情况总结报道如下。     

临床医学检验实习带教的体会和思考

临床检验是一门介于基础医学和临床医学之间的不完全独立的技术专业,具有实践性强、涉及面广的专业特点。临床检验科是为临床医生对疾病的准确诊断提供服务的专业技术科室。临床医学检验专业的实习阶段是巩固理论和掌握基本技能的重要环节,是专业教育的重要组成部分。因此,学生在实习期间,医院检验科对实习生的带教和管理,是教学中最关键也是最重要的教学环节,直接影响到实习生实习质量的优劣,影响到学生今后的工作和作风。     

加强科室管理是提高检验质量的关键

随着现代科学技术的发展，医学检验工作总是走在临床诊断和治疗的前面，素有临床医师的耳目、侦察兵之称。因此，检验质量的好坏，都会直接或间接地影响到诊疗质量甚至患者的生命，同时也是衡量检验科室服务水平的重要标准。现代医院检验科已远不是吸管和显微镜的时代了，取而代之的是电子仪器自动化、微量化、快速化的新时代。人员少，门类复杂，技术要求高，工作量大，是医院检验科室的普遍现象。因此，检验科在繁重和复杂的工作任务中，如何保证和提高检验质量，     

不同层次周目标结合小讲课在带教中的应用——洁净手术室护生带教体会

我院是一所集医疗、教学、科研为一体的综合性"三甲"医院,近年来随着高校扩招,生源增多,临床教学成为一项艰巨、繁重的工作,每年我科都要接收120-150名本科及大、中专的护理和助产专业实习生,教学任务非常繁重.手术室工作专业性强,无菌要求高,突发事件多,故对护生的带教工作也提出了更高、更严的要求.     

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.