TBL对医学本科基础医学课程教学影响的Meta分析

目的　系统评价以团队为基础的学习（team-based learning,TBL）相对于以讲授为基础的学习（lecture-based learning,LBL）在国内医学本科教育基础医学课程中的应用效果。方法　计算机检索中国知网、维普中文科技期刊数据库和万方医药数据库,搜索关于TBL教学在我国医学本科基础医学课程中应用效果的随机对照试验研究,其中实验组采用TBL教学,对照组采用LBL教学,课程考核以成绩分数评价。按照纳入与排除标准筛选文献,对所纳入的文献提取数据、质量评价后采用RevMan 5.3软件进行Meta分析。结果　最终纳入12篇文献的研究,研究方法学质量评级均为C。Meta分析显示,TBL教学的课程成绩分数总体优于传统LBL教学,差异具有统计学意义[WMD=9.33,95%CI（5.67,13.00）,P=0.000]。结论　相比LBL教学,医学本科基础医学课程中应用TBL教学对教学效果有促进作用,但需更多设计严谨的随机对照试验来验证。     

国内康复专业课程教学中PBL应用效果的Meta分析

目的　评价以问题为基础的学习（problem-based learning,PBL）在康复专业课程中的应用效果,并比较PBL与传统的以授课为基础的学习（lecture-based learning,LBL）的效果差异。方法　计算机检索CNKI、CBMdisc、中文科技期刊全文数据库、维普中文科技期刊数据库、万方数据以及Google学术搜索中有关康复专业课程PBL与LBL教学效果比较的对照性研究;检索时间截至2017年10月。选择教学对象为康复治疗专业学生或实习生,实验组采用PBL、对照组采用LBL的对照研究文献;提取文献基本信息、教学方法、课程内容、评估指标等有效数据,采用Cochrance质量评价标准评价文献质量,采用卡方检验并结合I2判断进行异质性分析,采用RevMan 5.3进行Meta分析。结果　共纳入研究文献18篇,研究对象1 943人,其中PBL组964人、LBL组979人。Meta分析结果显示,针对康复治疗专业学生,在专业理论成绩（MD=9.26,95%CI=5.24~13.29）、实践技能成绩（MD=12.11,95%CI=5.17~19.06）、综合成绩优秀率（RR=3.90,95%CI=2.10~7.26）、学生主观满意率（RR=8.98,95%CI=4.23~19.07）以及问卷调查结果方面,PBL教学效果评估结果均优于LBL,且差异有统计学意义（P<0.01）。结论　PBL在康复专业课程教学中的应用效果优于LBL,有助于提高学生的学习主动性和满意度。实践中可将PBL与其他教学方法相结合,以充分发挥PBL优势。     

冠心病PCI术后实施延续性护理对预后影响的Meta分析

目的 定量评价延续性护理对冠心病经皮冠状动脉介入治疗术后患者的预后影响。方法 计算机检索中国知网、万方、维普、中华医学期刊、PubMed及Web of Science数据库中有关冠心病患者经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）术后以常规护理为对照组实施延续性护理的随机对照试验（randomized controlled trial,RCT）的文献,由2名研究员依据纳入和排除标准筛选文献,采用Jadad文献质量标准对纳入的RCT文献质量进行评估,使用RevMan5.4软件进行Meta分析。结果 最终纳入RTC文献13篇,共1 519例患者（760/759）。Meta分析结果显示,与常规护理相比,延续性护理可提高患者的自我护理能力[WMD=9.60,95%CI(7.22,11.98),P<0.001]、提高生活质量[WMD=12.16,95%CI(10.26,14.05),P<0.001]、[WMD=7.42,95%CI(5.00,9.83),P<0.001]、增强对医嘱的依从性[OR=3.93,95%CI(3...     

PBL+CBL与LBL在临床医学生外科实习教学中的效果系统评价

目的 系统评价以问题为基础的学习（problem-based learning，PBL）+以案例为基础的学习（case-based learning，CBL）与传统授课（lecture-based learning，LBL）在中国临床医学生外科实习教学中的效果。方法 计算机检索PubMed、The Cochrane Library、Embase、CNKI、VIP、万方数据库中PBL+CBL教学与LBL教学在中国医学生外科实习中随机对照研究，检索时间从建库至2019年6月。采用RevMan 5.2软件进行数据分析。结果 纳入17篇随机对照试验，共计1 161名学生，其中PBL+CBL组581名，LBL组580名。Meta 分析结果显示：PBL+CBL组的学生理论成绩高于对照组（MD=6.15，95%CI=4.14~8.15，P<0.001），技能操作成绩高于对照组（MD=7.67，95%CI=3.66~11.69，P<0.001），病例分析成绩高于对照组（MD=6.06，95%CI=2.89~9.23，P=0.000 2），并且PBL+CBL组学生对教学效果表示满意的高于LBL组（OR=2.98，95%CI=1.88~4.73，P<0.001）。结论 PBL＋CBL教学在临床医学生外科实习教学中效果优于LBL教学。受纳入研究数量及质量的影响，上述结论需要更多、更高质量的研究予以验证。     

国内本科超声医学PBL教学效果的Meta分析

目的系统评价PBL在超声医学教学中的应用效果。方法使用计算机检索知网、万方、维普等中文数据库,收集从数据库建库至2018年1月国内有关PBL教学在超声医学教学中应用效果的对比实验。对纳入文献进行质量评价,提取数据后进行Meta分析。结果最终纳入8篇文献,共897名学生,其中PBL组440人,LBL组457人。Meta分析后得出:与LBL教学法相比,PBL教学法不仅能够提高本科生超声医学理论考试成绩(SMD=1.42,95%CI=0.44～2.40)、操作考试成绩(SMD=2.26,95%CI=0.67～3.85),而且能提高自学能力(RR=3.15,95%CI=2.13～4.66)、诊断思维能力(RR=2.70,95%CI=1.90～3.84)和综合满意度(R R=1.50,95%CI=1.35～1.67),加深知识理解(R R=1.70,95%CI=1.26～2.30),差异均有显著性(P<0.05)。结论 PBL教学能够提升本科超声医学教学效果。     

中西医结合治疗原发免疫性血小板减少症的系统评价及Meta分析

[目的]系统评价中西医结合治疗原发免疫性血小板减少症（ITP）的临床疗效及安全性。[方法]检索知网（CNKI）、万方、Pubmed和Embase等中英文数据库,筛选中西医结合治疗ITP的随机对照试验（RCT）。依据Cochrane系统评价方法对纳入文献进行质量评价,提取文献基本资料,运用RevMan 5.3软件进行Meta分析。[结果]经严格筛选评价,最终纳入20篇文献,共1 538例受试者（观察组782例,对照组756例）。Meta分析结果显示,中西医结合治疗ITP在提高临床疗效[OR=3.42,95%CI(2.55,4.58),P<0.000 01]、外周血小板计数[WMD=22.88,95%CI (17.48,28.28),P<0.000 01]、中医证候疗效[OR=5.32,95%CI (2.19,12.89),P=0.000 2]、Treg细胞水平[WMD=0.59,95%CI(0.06,1.12),P=0.03]、CD4+T细胞水平[WMD=4.39,95%CI(2.72,6.06),P <0.000 01]、远期疗效[OR=3.37,95%CI(1.74...     

国内医学统计学PBL教学效果的系统评价与Meta分析

目的　评价以问题为基础的学习（problem-based learning, PBL）相对于传统教学在医学统计学教学中的应用效果。方法　采用Meta分析方法,通过计算机检索国内有关2种教学法的对照研究。在严格质量评价的基础上,使用RevMan 5.0软件进行分析。结果　共初检出39篇文献,经筛选最终纳入7篇进行Meta分析。结果显示：PBL教学与传统教学相比,两者的教学效果在综合考核及格率上差异无统计学意义[RR=1.09,95%CI（0.98,1.23）,P=0.12>0.05];在考核成绩分数上差异也无统计学意义[WMD=0.30,95%CI（-0.06, 0.67）, P=0.10>0.05]。结论　尚不能认为PBL教学在医学统计学教学目标的实现上优于传统教学。     

3D打印联合PBL教学促进骨科教学效果的系统综述

目的旨在通过系统性Meta分析来证实3D打印联合PBL教学可以有效改进骨科学教学质量。方法系统检索中国生物医学文献服务系统、万方数据知识服务平台、维普中文期刊服务平台、中国知网等数据库中关于3D打印联合PBL应用于骨科教学的文献,用Meta分析来评价3D打印联合PBL在骨科学教学中的效果。结果共检出53篇文献,通过筛选共有6篇文献纳入研究,共计纳入390例教学对象。结果提示,3D打印联合PBL教学法与传统教学法对理论成绩[SMD=1.35,95%CI(1.11-1.59),P<0.01]、临床操作[SMD=1.61,95%CI(1.32,1.89),P<0.01]、学习兴趣[SMD=1.17,95%CI(0.85,1.49),P=0.02]等指标的差异具有统计学意义。结论3D打印联合PBL教学可以提高学生骨科学成绩。     

基于案例教学法的多元化教学模式在康复护理课程中应用效果的Meta分析

目的 Meta分析基于CBL的多元化教学模式在康复护理课程中的应用效果,为基于CBL的多元化教学模式在康复护理教学中的应用提供循证依据。方法 计算机检索PubMed、Cochrane Library、EMBase、Web of Science、中国期刊全文数据库(CNKI)、万方数字化期刊全文数据库(WanFangData)、中国科技期刊全文数据库(VIP)、中国生物医学文献数据库(CBM),检索建库至2022年5月公开发表应用基于CBL的多元化教学模式进行康复护理课程教学的随机对照试验。按照纳入和排除标准筛选文献,应用偏倚风险评估工具评价纳入文献的质量,提取文献数据并运用RevMan5.3软件进行分析。结果 纳入12项研究,共1591名学生。Meta分析结果显示：在提高学生理论成绩[WMD=11.60,95%CI=(8.08,15.13),P<0.00001]、操作成绩[WMD=9.58,95%CI=(5.82,13.35),P<0.00001]和分析、解决问题能力[RR=1.31,95%CI=(1.15,1.51),P<0.0001]方面,试验组优于对照组;在理解...     

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.