循证医学在肾内科临床教学中的应用

循证医学是一种新的医学模式,为临床教学提供了新的思路,循证医学提倡在临床实践中发现问题,寻找现有的最好证据、评价和综合分析所得证据并正确应用证据以指导疾病的诊断、治疗和预后.将循证医学的理念应用于肾内科临床教学过程可以培养医学生树立正确的学习观,提高医学生分析和解决问题的能力,从而进一步提高临床教学质量.     

循证医学在风湿免疫内科临床教学中的应用

循证医学是一种新的临床医学模式,核心思想是把临床医师的专业技能与当前系统研究所获得的最佳结果有机结合,以病人为对象查找证据,严格评价,综合分析,将最好的证据用于临床实践。其理念和方法已经扩展到整个医学教育领域,代表了现代医学教育的发展方向,是21世纪医学生教育的重要内容。风湿病学是一门专科性强的学科,也是与别的专业联系紧密的学科。临床实习是培养合格临床医师的关键阶段。本文介绍了循证医学在风湿免疫内科临床教学中的应用,分别就其必要性、重要性、教学方法及具体案例进行探讨。实践表明在风湿免疫病临床教学中培养循证医学思维,使教学内容与时代接轨,同时也使教学方法得以丰富,有助于学生提高临床技能、熟练掌握疾病的诊治原则以及培养科研创新能力。     

以团队为基础学习结合循证医学导入病例教学在2型糖尿病临床教学中的应用及探讨

以2型糖尿病为代表的内分泌代谢性疾病是一门专业性强、知识体系繁多复杂，临床指南证据多的学科。由于其发病机制复杂且涉及较多环节，在实际教学过程中传统教学模式难以达到满意教学效果。我们将以团队为基础学习结合循证医学导入病例的教学应用于2型糖尿病的临床教学，将班级分为若干团队，通过指导教师导向下的组内讨论和共同学习，并结合循证医学导入病例教学，发现有助于培养学员的团队协作及自主学习能力，全面加强学员的循证医学思维，有效提高了解决临床实际问题的能力。     

循证医学在传染病学临床教学中的应用

以循证医学为基础的教育模式不同于传统的医学教育模式。循证医学提倡在临床实践中发现问题、寻找现有的最好证据、评价和综合分析所得证据并正确应用证据以指导疾病的诊断、治疗和预后。将循证医学的理念应用到传染病学临床教学过程中,有利于培养医学生发现问题、寻求证据、分析资料、解决问题等方面的能力,有利于教学质量的提高和学生综合素质的培养。     

心内科临床教学新模式的探讨

我国医学临床教学受到新医疗法规与传统医学教育相冲突的影响,不断出现新的问题,使临床教学处于徘徊的境地.根据在心血管内科临床教学方面所作的尝试,通过在心内科临床的教学中应用循证医学、病例式教学、多媒体教学、专题讲座、双语教学、医疗纠纷案例讨论会等多种教学方法探讨临床教学的经验与技巧,培养学生的学习兴趣、综合学习能力和分析问题、解决问题的能力.     

心血管内科PBL教学中循证医学思维的培养

以问题为基础的教学方法（PBL）有利于学生积极主动学习及临床思维能力的培养。循证医学以病人为中心,从解决临床实际问题出发,寻找并评价证据,综合分析后指导疾病的诊断、治疗。在心血管内科临床教学中,以PBL教学方法为基础,辅以循证医学思维的培养,有助于学生主动掌握和评价临床疾病的诊断和治疗。     

循证医学在神经内科学教学中的应用

循证医学是近年来迅速兴起的一门新学科,它的出现使临床医学研究和临床教学实践发生了巨大的转变.在医学教育中引入循证医学的理念、原则和方法 ,帮助医学生和医务工作者学会掌握自我更新医学知识和临床技能的方法 和技巧.在临床医疗决策中将现有的最好的临床研究证据融入临床治疗中,将极大地提高疾病的诊治水平.本文阐述了循证医学产生的背景及其发展、循证医学引入神经内科学教学中的重要意义及其实际应用.     

加强临床教学基地建设 提高临床教学质量

随着医学教学改革的深入和新课程体系的实施,对临床教学基地提出了更高的要求。实践结果表明,完善临床教学基地管理规章制度,有利于临床教学基地的规范化管理;专家深入基层指导教学查房,举办教学方法学习班和开展教学研究,名师示范讲课,有利于强化教师的教学能力与临床能力;构建综合的评价体系,有利于临床教学质量的客观评价。切实做好各个方面的工作,对于提高医学教育质量,培养高素质医学人才具有积极的促进作用。     

加强临床教学基地建设提高临床教学质量

随着医学教学改革的深入和新课程体系的实施，对临床教学基地提出了更高的要求。实践结果表明，完善临床教学基地管理规章制度，有利于临床教学基地的规范化管理；专家深入基层指导教学查房，举办教学方法学习班和开展教学研究，名师示范讲课，有利于强化教师的教学能力与临床能力；构建综合的评价体系，有利于临床教学质量的客观评价。切实做好各个方面的工作，对于提高医学教育质量，培养高素质医学人才具有积极的促进作用。     

CBL与seminar二联教学方法在脑血管疾病实习中的应用

脑血管疾病是神经系统疾病中常见疾病之一,临床症状及体征表现多样,诊断及鉴别诊断不易掌握.同时在这类疾病的诊治过程中需要医生有较好的医患沟通能力和较高的人文素质.目前实习中多采取传统的LBL教学或联合PBL的教学方法,学生在临床教学中参与度低,导致学生对临床教学兴趣下降[1].将CBL与seminar二联教学方法引入脑血管疾病实习过程中,提高了学生的临床实践能力,同时有助于医学人文素质的培养.     

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

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.     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.     

Possible Spread of adenovirus type 3 from poultry to humans ：indirect evidence from an outbreak in China

Objective:To explore the epidemiology and etiology for an outbreak of acute respiratory tract infection that occurred in one county of Jiangsu Province, China 2004. Methods: Only cases meeting the case definition were included in the study. We reviewed the medical records of the cases who were admitted to the local hospitals, interviewed cases by a standard questionnaire, and then described the epidemiotogic features and analyzed risk factors by means of a case-control study. We collected pharyngeal swab specimens and sent them to different laboratories for isolation and culture. The laboratory used different detection methods such as DIP, PCR, electron microscope examination and microneutralization assay, to identify and then type the positive specimens. Results:A total of 871 cases were reported during the period from April 18 to July 4,2004. The distribution of onset times presented two peaks, one in late May and another in middle June. The epidemic occurred mainly in the elementary and junior high schools in ten townships of one county, and the mean age of the cases was 12 years (range 7 months to 18 years). The course of the disease was acute, and was characterized by fever accompanied with sore throat and tonsillitis. The WBC count of cases was normal or elevated. The mean duration of illness was 5 days (range 2 to 12 days). No fatalities from illness were reported. A case-control study indicated that the possible risk factors were close contact with a case and/or poultry before onset and sharing of towels among members of the family. The typical CPE was observed through inoculating pharyngeal swab specimens into the HEP-2 cell cultures in different laboratories. An infection of adenovirus type 3 was verified by detecting positive specimens in different methods. Conclusion:This investigation demonstrated that the acute respiratory infection in cases was caused by adenovirus type 3. Cases occurred in over 70 schools in ten townships in 2004, and the route of transmission was possibly close contact with cases or droplet transmission.