医学伦理学教学的体会

我从事医学教育工作已经十五个春秋 ,教医学伦理学课也有十二年了。积本人之教训 ,学他人之经验 ,颇有感触 ,故写了“医学伦理学教学的体会”,抛砖引玉 ,以求前辈、同道指教。1　开宗明义大凡绪论课 ,往往被一些老师所忽视 ,三言两语 ,匆匆而过 ,我以为此乃大谬。是否可以讲 ,绪论好比游览风景名胜的“导游图”,又好比上台人物的“施政演说”,大有文章可做。尤其是 ,此刻是任课教师在学生面前首次亮相 ,不可小视。我一般先介绍医学伦理学的发展简史 ,突出讲授祖国医学道德的优良传统、古代苍生大医对祖国医学道德发展的贡献及我国医学伦理学…     

医学实验技术专业医学免疫学绪论教学探讨

医学免疫学作为医学实验技术专业本科生的重要专业基础课程,其具有难讲和难学的特点。医学免疫学的绪论课是该门课程的缩影和开端,教师重视绪论课的教学对学生以后的学习可能起到事半功倍的效果。文章结合医学免疫学学科特点及医学实验技术专业本科生的特点,对医学实验技术专业的医学免疫学绪论的教学方法进行了探讨,以及教学效果进行了分析。教师重视和讲授好医学实验技术专业的医学免疫学绪论课,能充分调动学生的学习热情及主动性,为以后该课程的学习奠定良好的基础。此外,医学实验技术专业本科生尚未建立职业认同感且正值青春期后期,将课程思政教学融入绪论课的教学中,能培养学生的职业认同感及提高个人道德修养,并培养学生的爱国精神,增强民族自信。笔者就如何上好医学实验技术专业本科生的医学免疫学绪论课发表了自己的看法。     

医学生物化学绪论教学的探讨

通过分析医学生物化学绪论的教学中存在的问题,强调讲好绪论对于学生全面了解医学生物化学作为临床医学的奠基课程的重要性,以及如何解决存在的问题,并通过绪论的教学有效激发学生学习生物化学的兴趣和主观能动性,最大程度地提高教学效果.     

上好解剖学绪论课的几点体会

绪论是第一节人体解剖课，是学生迈向医学殿堂的第一步。上好绪论课将对本门课程的后期学习效果起决定性的影响。结合多年来的教学经验，就如何增强教师的亲和力；科学运用导入法，激发学生的学习兴趣；丰富教学手段，变抽象为具体；引导学生运用科学方法学习等方面谈几点体会。     

提高医学伦理学教学质量亟待解决的几个问题

近20年来,经过广大教学和科研人员的不断探索,医学伦理学在我国得到了较快的发展。但是,进一步加强医学伦理学的教学,全面提高教学质量,仍有许多问题亟待解决。一、医学伦理学的重要地位亟待摆正自古以来,人们一直都强调“无德不从医”。以培养高尚的医学职业道德为目的的医学伦理学课程,在医学教育中占有重要位置,是培养德才兼备的医学人才的一门不可缺少的重要课程。目前高等医学院校虽已普遍开设了这门课程,但许多院校对开设医学伦理学这门课程的重要性没有得到应有的重视,医学专业课与医学伦理学课存在“一硬一软”的现象。医学伦理学课…     

把实践课引入医学伦理学教学的研究

为了提高医学伦理学的教学效果,提高学生发现问题、解决实际问题的能力,把实践课引入医学伦理学教学中.实践表明:在医学伦理学教学中,设置实践课的教学方法可提高学生学习医学伦理学的兴趣,加深学生对医学伦理学理论的理解和记忆,利于学生实践能力的提高.     

不同年级医学生对医学伦理学教学认知的调查分析

目的：了解不同年级医学对医学伦理学教学的认知差异，为医学伦理学教学改革提供参考资料。方法：在已完成医学伦理学课程学习的三个年级中各随机抽查100名学生，对答卷结果进行对比研究。内容：对医学伦理学学科性质的认知；对医学伦理学教学内容及方式的认知；对医学伦理学教学效果的认知。结果：三组（三个年级）学生对大多数问题的认知非常接近。结论：目前的医学伦理学教学环境和质量相对稳定，教学方式和手段有待改进。     

我院医学伦理学教学现状及思考

目的调查我院医学伦理学教学现状及存在的问题,探讨解决问题的策略。方法随机选取临床医学、医学影像、检验医学、口腔医学、预防医学等5个专业272名学生进行问卷调查,建立数据库,进行统计分析。结果调查显示,我院学生重视医学伦理学课却轻视课程学习;对医学伦理学理论知识掌握较好,但对具体问题的态度却不乐观;师资结构、教学模式和方法有待调整和改进。结论必须采取多种举措改进伦理学教学,以提高医学伦理学教学效果。     

检验医学伦理认知的调查报告

目的了解医学检验专业学生对检验医学伦理学知识的现状,探讨医学检验专业是否有必要开设检验医学伦理学课程。方法采用抽样调查方法,对243名医学检验专业大学生进行了检验医学伦理认知的调查。结果高达90．9％的学生不知道检验医学伦理学的基本知识;25．7％的学生认为“在今后的医疗工作实践中不会遇到医疗纠纷的困扰”;45．5％的学生认为“检验医学伦理学知识对今后工作没有用处”;72．7％的学生“不知道检验医学的道德标准”。结论随着现代检验医学涉及领域的扩展,有必要将检验医学伦理学作为医学检验专业的基础课程,尽快组织编写系统的相应教材,重点采用案例教学法,培养学生的伦理思维。     

重视绪论教学,上好入门第一课

绪论课是课程教学中不可缺少的教学环节,对全课程的教学起着非常重要的作用,应当引起高度的重视。绪论教学应着力突出绪论的引导性,使学生了解本课程将要学习的基本内容,懂得本门课程与其他已学课程和后续课程之间的关系,建立起课程的整体概念;同时,绪论教学应注重激发学生学习热情、指导学习方法,启发和培养学生浓厚的学习兴趣,帮助学生解决学习中的实际困难,达到师生感情交流,创造出学习本课程的良好心理环境,以保证今后教学的顺利进行。     

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.