《职业卫生与职业医学》自主设计性实验教学的实践与探索

在《职业卫生与职业医学》实验课程教学中,如何科学合理地选择有效的教学方式,以激发预防医学专业本科学生学习兴趣,提高学生综合能力素质,备受广大公共卫生教育者关注。现开展的实验多数为陈旧性和验证性实验,学生兴趣不浓且与实际工作相脱节。本研究以预防医学专业学生为受试对象,探讨自主设计性实验教学模式在《职业卫生与职业医学》实验教学中的应用效果。教学效果表明,在初步掌握职业卫生与职业医学基本理论与操作技能的前提下,于学期最后三周开展自主设计性实验,可在一定程度上调动学生学习兴趣,培养学生实践操作、独立思考、分析与解决问题、团队协作等多种能力,对提高《职业卫生与职业医学》实验教学质量具有积极的促进作用。     

在传承中创新:生理自主设计性实验之我看

生理实验教学在生理学课程的教学中起着重要的作用,开设自主设计性实验有助于激发学生的学习兴趣和探索精神,培养其创新和科研能力,但传统实验教学在培养学生的动手能力和基本科研思维方面同样也起着不可忽视的作用。如何将经典实验和自主设计性实验有机的统一起来,在传承中进行创新是生理实验教学改革中值得探索的问题。     

八年制生理学自主设计性实验探索和体会

实验教学在生理学课程的教学中起着重要的作用,开设自主设计性实验有助于激发学生的学习兴趣和探索精神,培养其创新和科研能力。文章对八年制生理学自主设计性实验教学进行了分析探讨,指出了设计性实验存在问题,提出了解决这些问题应采取的一些措施,并提出了关于开展设计性实验的一些体会和思考,期望能对八年制实验课教学的改革提供一些有益的信息。     

医学免疫学实验教学内容的改革

为适应科技发展对人才的要求,提高医学免疫学实验教学效果,以培养学生实验兴趣、能力为出发点,对现有免疫学实验教学内容进行了改革：在优化必不可少的经典验证性实验的基础上,设计开设综合性实验,大力开展设计性实验。实践证明,改革激发了学生的学习热情,培养了学生的创造性思维,锻炼了学生的创新能力、实践能力和解决实际问题的能力,提高了免疫学实验教学的效果。     

学生自主设计实验教学改革的实践与评价

在开设学生自主设计实验讨论课的基础上,北京大学医学部生理与病理生理学系自2004年起让学生自己动手独立完成所设计的实验。作者从自主设计实验课的前期准备,自主设计实验方案讨论会的开展,自主设计实验操作的实施,对自主设计实验的评价和意见等方面介绍了自主设计实验教学改革的实践。指出:这项改革不仅促进了学生整体化知识的学习及多学科知识的交叉与融合,而且培养了学生的创新性思维能力和运用知识解决实际问题的能力,使实验教学上了一个新台阶,为培养高层次医学人才奠定了基础。     

学生自主设计实验教学改革的实践与评价

在开设学生自主设计实验讨论课的基础上,北京大学医学部生理与病理生理学系自2004年起让学生自己动手独立完成所设计的实验.作者从自主设计实验课的前期准备,自主设计实验方案讨论会的开展,自主设计实验操作的实施,对自主设计实验的评价和意见等方面介绍了自主设计实验教学改革的实践.指出这项改革不仅促进了学生整体化知识的学习及多学科知识的交叉与融合,而且培养了学生的创新性思维能力和运用知识解决实际问题的能力,使实验教学上了一个新台阶,为培养高层次医学人才奠定了基础.     

“以学生为中心”的组织学与解剖学实验教学改革及实践

传统组织学与解剖学实验教学以器官模型和组织切片观察为主,缺乏对学生自主学习能力、探究意识、创新精神以及专业技能的培养。针对传统实验教学的不足,教研室开展“以学生为中心”的组织学与解剖学实验教学改革,包括增加综合设计性实验项目、设计“课前预习—小组探讨—模拟授课—教师解疑”4环节经典实验教学方式以及应用过程性评价考核方式。教学改革有效提高了学生学习主动性,促进了学生的发展,对相关实验课程教学改革具有借鉴意义。     

七年制临床医学专业机能学实验教学的实施与体会

为加强对学生创新思维和综合能力的培养,充分调动学生学习的主动性和创造性,不断完善实验教学体系,我校在2005级七年制临床医学专业实验教学中,选拔高水平的教师指导实验,完善了机能学综合实验,增加了学生自主设计性实验。在机能学实验成绩评定中,取消了期末实验操作考试,以自主设计性实验来替代。     

病理生理学自主设计性实验改革初探*病理生理学自主设计性实验改革初探

高等医学院校的病理生理学实验教学定位于验证性和演示性实验,这种实验模式限定了学生的思维,影响了创造力的发挥。为探索提高学生创造力的方法和手段,该校对2013级护理专业学生实施了自主设计性实验改革。结果显示：自主设计性实验巩固了学生理论知识,激发了学生主动学习兴趣,提供了培养创造性思维的机会,提高了学生的科研实验能力和创新意识。     

环境卫生学综合设计性实验教学改革与实践

针对环境卫生学实验教学中存在的问题,在我校2008级预防专业的环境卫生学实验教学中尝试以课题研究方式整合实验教学内容,开展综合设计性实验,激发了学生的学习兴趣,提高了学生发现问题、分析和解决问题的能力,有助于学生生产实习和综合素质培养,强化了教师能力和教学观念的转变.     

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.