PBL教学法在胸外科学教学中的优势探讨

目的：探讨PBL教学法在胸外科学教学中的优势。方法：将我院胸外科84例实习学生随机分为PBL教学和传统教学效果,比较两组的教学效果。结果：传统教学组理论成绩、技能成绩均显著低于PBL教学组、技能成绩。PBL教学组学生的学习气氛、学习兴趣等均高于常规教学组。结论：PBL教学法在胸外科实施取得了良好的效果,对于培养学生独立、积极的学习,增强学习兴趣有重要的意义。     

PBL教学法在医学生物化学实验中的应用

目的:探讨以问题为基础的学习法(PBL)在生物化学实验教学中的效果.方法:选取200名2年级临床医学专业本科学生为研究对象,其中100名学生为PBL组,另100名学生为传统教学组;对PBL组学生发放问卷调查了解学生对PBL教学的认同度,学期结束时分析比较两组学生的考试成绩.结果:PBL组90％以上的学生能接受PBL教学法,认为PBL教学法能提高学习兴趣及综合分析能力,培养独立思考和解决问题的能力,提高参与意识;PBL教学组期末理论考试成绩优秀的学生(80分以上)多于传统教学组.结论:PBL教学法优于传统讲授法,可在生物化学实验教学中推广.     

PBL教学法在口腔修复学实习教学中的应用

目的探索口腔修复学临床实习教学的新模式。方法将30名学生随机分为PBL教学组和传统教学组,两组教学效果通过开展试卷考核和问卷调查进行评估。结果PBL教学组试卷考核两项成绩均高于传统教学组(P<0.05);问卷调查结果显示学生对PBL教学法的认可程度更高,PBL教学组学生的学习效果优于传统教学组。结论 PBL教学法能够提高学生的学习兴趣并增强其发现问题、解决问题的综合能力,值得在修复学临床实习教学中推广应用。     

尝试PBL与肿瘤MDT及个体化治疗相结合的教学模式

目的：尝试建立以问题为基础的学习（PBL）与肿瘤多学科综合治疗（MDT）及个体化治疗相结合的创新型教学模式。方法：选取100名临床医学系八年制学生,进行PBL教学,与传统教学（LBL）进行对比,探讨PBL教学在肿瘤MDT及个体化治疗模式中的作用。结果：PBL教学组理论知识成绩与LBL教学组差异无统计学意义,但MDT及个体化病例分析及临床应用成绩显著优于LBL教学组（P<0.05）。问卷调查发现,90%学生青睐PBL教学。结论：在肿瘤MDT及个体化治疗模式中实施PBL教学法,能培养学生循证医学和创新思维,提高学生自主学习和临床知识运用能力。     

CBS结合PBL教学法在呼吸内科临床教学中的应用

目的探讨CBS结合PBL教学法在呼吸内科临床教学中的应用效果。方法将2012年5月至2013年4月在上海中医药大学附属岳阳中西医结合医院呼吸内科临床实习的50名学生随机分为CBS结合PBL教学组和J孵乏法教学组。分别进行教学,教学结束后进行问卷调查和出科考试。结果出科考试结果显示,CBS结合PBL教学组的平均成绩显著高于阶段法教学组（P〈O．01）。调查问卷结果显示,多数学生认为CBS结合PBL教学法能加深临床教学印象,活跃教学气氛,激发探索问题的兴趣,有助于建立良好的医学思维方式。结论CBS结合PBL教学法对提高呼吸内科临床教学质量和学生综合素质具有积极意义。     

在研究生心血管药理学教学中应用PBL的实践与思考

PBL是国际上较流行的一种教学方法,它可以挖掘学生的潜力,对未来的学习提供更好的帮助。为了寻求适合我国医学研究生基础课程教学的方法,近三年,西安交通大学药理学系在研究生心血管药理学的教学中应用了PBL教学法,并加以改良。问卷调查显示,参加试教的研究生对PBL教学的满意度达到93.5%,同学们一致认为PBL教学方式优于传统的教学方式,不仅能够调动学生主动学习,而且可以培养创新思维。     

肿瘤科实施PBL教学培养学生循证医学思维模式的探索

目的建立适合肿瘤科教学特点的PBL教学体系,培养学生循证医学临床思维模式。方法在肿瘤科临床教学中,选取40名临床医学系七年制学生,进行"以问题为基础的学习(PBL)",与传统教学方法进行对比研究,探讨PBL启发式教学在培养学生循证医学临床思维模式方面的作用。结果 PBL教学组理论学习成绩中基础知识部分成绩与传统教学组无明显差异,但是临床问题分析及处理能力考核成绩显著优于传统教学组(P<0.001)。结论在肿瘤科临床教学中的运用和实施PBL教学法,能够使得学生的循证医学思维得到良好的建立,临床能力得到更好的提高,该方法值得进一步实践推广。     

双语 PBL 教学法在病理生理学教学中的应用

目的：探讨双语 PBL 教学法在病理生理学教学中的应用效果。方法病理生理学教学过程中实施双语 PBL 教学法,课程结束后建立综合评估体系对教学效果进行评估。结果双语教学中使用 PBL 教学法充分激发了学生的双语学习兴趣和主动性,提高了其专业英语沟通表达能力和英文文献查阅能力。结论联合 PBL 教学显著提高了病理生理学双语教学的效果。     

PBL教学法在口腔临床护理带教中的应用

目的:探讨PBL教学法在口腔临床护理带教中的应用效果。方法:将2010年7月-2011年7月在我科实习的98名护生随机分为对照组和观察组,对照组采用传统常规教学法,观察组采用PBL教学法,比较两组护生在本科实习结束时理论考试、操作考试成绩的差异.两组护生间的理论与操作技能考试成绩差异有统计学意义(P<0.05),PBL教学组成绩显著优于传统教学法组。结论:PBL与常规教学法相比PBL教学法有利于调动学生学习积极性和结论与常规教学法相比,有利于帮助学生掌握知识要点有利于提高学生多方面的能力,PBL教学法更能提高带教质量,有助于培养护生的职业综合能力。     

PBL应用于口腔颌面外科临床教学的对照研究

目的研究PBL（Problem-based learning）口腕颌面外科临床教学中的适用性。方法本教学小组在2007年4月-2008年3月间在牙槽外科教学中采用了PBL教学法,参加教学的学生为2003级本科实习医生38人,另有40位2002级本科实习医生参加传统教学法教学。在教学前后,两组学生接受客观题考核和临床口试。同时,给出主观问卷对两组学生的主观能动性、学习时间进行自我评价。结果客观考核表明,两组学生成绩均获得一定程度的提高。PBL教学组的口试成绩优于传统教学组,有显著性差异。PBL教学组在＂病例分析能力＂和＂操作能力＂上得分较高,其他方面没有显著性差异。两组学生在课堂所用时间相同,但总体学习时间PBL教学组明显长于传统教学组。PBL教学组学生的学习能动性明显强于传统教学组。结论 PBL教学法对口腔颌面外科教学有一定帮助,但需要更多的证据及对学生长期发展的观察才能明确PBL教学是否适合目前中国教育实际。     

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.