血液学医学生人文素质教育初探

加强医学生人文素质培养是适应医学教育现状、完成医学模式转变、减少医疗纠纷、提高医学生职业道德的关键。人文课程的设置应贯穿于整个医学教育过程中。着重探讨医学人文素质教育的含义,加强血液学医学生人文素质教育的必要性及加强医学人文教育的举措。     

湖北省某高等医学院校人文素质培养体系探讨

高等医学院校对医学生进行人文素质培养是适应新的医学模式转变的需要,也是为了适应医学教育工作可持续发展的要求和适应医学实践的内在要求。本文针对目前高等医学院校的医学生在人文素质教育培养过程中存在的人文教育理念缺乏、课程设置不合理等问题,并结合湖北某高等医学院校医学生人文素质教育的现状,对建立科学有效的人文素质培养体系进行了探索,旨在推进医学生人文素质与医学教育的进一步融合,从而为我国高等医学院校更加有效的培养优秀医学人才提供理论依据。     

临床实习中医学生人文素质培养的思考

医学人文精神匮乏是当今医患冲突发生的重要原因之一.临床实习中医学生人文素质培养的缺失主要表现在人文知识欠缺、心理素质欠佳、医患沟通协调能力差、医学人文关怀缺乏和责任意识不强等.分析成因,可能与医学生忽视医学人文素质培养,教师对人文素质培养的重要性认识不足,人文教育课程设置不够合理,教学中没有将医学人文教育与医学专业教育渗透与融合等有关.临床实习是培养医学生人文素质的绝佳时期,可以通过提高教师的思想认识及教学能力,开设有针对性的人文科学课程,营造良好的人文教育环境,尤其是在临床医疗实践中渗透医学人文教育,在多种社会实践活动中强化人文素质培养等多种途径,加强医学生的人文素质培养.     

高职院校医学特色人文课程的研究与实施

医学高职院校遵循以“培养医学生的人文素质”为导向、以“突出医学生的人文能力”为核心的整体原则。在医学人文课程设置过程中,探索具有高等职业院校特色的医学人文教育,构建医学特色人文课程新体系,从而缩短与发达国家医学人文教育的差距,全面提升医学高职院校学生的整体人文素养,重建和谐的医患关系。     

医学人文课程历史回顾与经验启示

医学集科学与人文于一身,其本质内在规约医学教育中人文精神的培育与专业知识的传授地位并重。医学人文精神培育之目的立足于使医学生在观念的、精神的与哲学的层面自觉形成科学与人文相融合的认识方式、思维方法与知识结构;有效途径是医学人文课程的适时复归与合理设置。探索与时俱进、符合医学发展规律的医学人文课程体系,提高医学生人文知识水平及其综合素质,是当前医学教育改革的重要课题,也是医学院校社会科学工作者义不容辞的职责。西方发达国家的切身经历与实践探索为中国医学人文教育提供了丰富的经验借鉴与有益的价值启示。     

高等医学院校大学英语教学与医学人文教育的融合

人文素质的培养是高等医学教育的组成部分和重要任务之一.大学英语因其人文学科性质和高校必修公共课程的独特优势,成为实施人文教育的良好平台.本文在分析了医学人文教育的必要性和人文素质培养与大学英语教学关联性的基础上,探讨了大学英语教学与高等医学人文教育融合的基本策略,旨在对提高医学生的人文素质、培养合格的现代医学人才有所启示.     

医学生人文素质教育探研

医学院校的人文教育的核心目标应当是增强医学生对人、对生命、对病人的尊重与关爱，遵循和维护医学增进人民健康的内在精髓和神圣宗旨。所以，在高等医学教育中充分重视医学人文教育十分重要。医学院校的人文素质教育应适应医学教育培养目标和医学生综合素质的提升，在学科建设、课程设置、内容更新上进行改革创新。     

深化课程设置和教学内容改革加强医学生人文素质教育

由于传统生物医学模式的作用以及唯科技主义、唯物质主义、唯功利主义的冲击与影响,在医学教育中,存在着不重视人文素质教育的情况,导致了医学生人文关怀精神的缺失.为了改变这种现状,以适应现代社会对医学人才综合素质的要求,我们应当在医学教育实践中确立对学生全面发展的培养模式,积极进行医学院校人文社会科学课程设置的研究和教学内容的改革,提高人文社会科学课程的教学质量,以提高医学生的人文素养和培养医学生的人文关怀精神.     

外科学教学中医学生人文素质培养的探索

人文教育与医学教育的整合可以使医学生的医疗技术、社会责任感和人道主义精神同时得到培养.对于外科学教学来说,人文素质培养与医学科学教育的结合非常重要,而实施人文素质教育的方法仍然处于探索阶段.北京大学第一医院根据外科学教学的实际情况,参照国外医学教育的经验,进行了医学生人文素质培养的探索和实践.通过授白大衣仪式、珍爱实验动物教育、手术观摩等一系列多样化的方式,对医学生进行人文素质的培养,取得了较好的效果.     

外科学教学中医学生人文素质培养的探索

人文教育与医学教育的整合可以使医学生的医疗技术、社会责任感和人道主义精神同时得到培养.对于外科学教学来说,人文素质培养与医学科学教育的结合非常重要,而实施人文素质教育的方法仍然处于探索阶段.北京大学第一医院根据外科学教学的实际情况,参照国外医学教育的经验,进行了医学生人文素质培养的探索和实践.通过授白大衣仪式、珍爱实验动物教育、手术观摩等一系列多样化的方式,对医学生进行人文素质的培养,取得了较好的效果.     

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.