关于临床医学专业学位硕士研究生科研能力培养的探讨

目的：探究山东省省内临床医学专业学位研究生科研能力培养现状以及培养过程中的问题。方法：选取山东省省内六所医学高校的临床医学专业学位研究生、导师和管理人员进行了问卷调查，并对有效问卷进行统计分析。结果：36.63%的研究生对自身的科研能力表示不太满意，81.90%的导师表示研究生的科研能力不够优秀。结论：山东省省内临床医学专业学位研究生科研能力培养现状不容乐观并在培养过程中存在诸多问题，本文就培养过程中存在的问题进行了详述并结合问卷调查结果提出了相关建议。     

基于核心能力培养的临床医学硕士研究生课程改革研究

目的:以临床医学研究生核心能力培养为重点,根据培养模式的差异,对课程体系进行研究,以期构建出临床医学研究生知识、能力、素质协调发展,具备符合度更高的岗位胜任力的新型课程体系。方法:对临床医学硕士研究生核心能力分类培养可行性深入探讨,采取完善培养方案、优化课程体系、加强课程改革、完善考核制度、建立质量保障机制以及提高教师教学能力和水平等措施,并通过广泛调研进行改革成果满意度的检验。结果:学生对课程满意度较高,导师对学生核心能力评价优良率达90%以上;课程体系改革实现了满足学术学位研究生核心能力注重科研创新能力培养,专业学位研究生核心能力注重临床能力培养的需求。结论:基于核心能力培养的临床医学硕士研究生课程改革凸显了临床医学硕士研究生分类培养的目标需求,构建了满足社会对临床医学专业人才的多元化需求的新型课程体系。     

专业型学位医学硕士研究生创新能力培养的探讨

创新能力的培养,是贯穿在整个医学硕士研究生培养中的核心目标[1].如何创造条件,在临床实践中引导临床医学专业型研究生积极主动探索,采取多种创新性手段培养临床医学专业学位研究生的良好的临床思维和动手能力、临床科研创新能力和团队合作意识,是现代高等医学研究生教育的培养要求和面临的课题.本文从临床专业学位研究生的目标,对研究生和导师必备的素质要求进行探讨,并提出相应的措施和手段,对于加强临床医学专业型硕士研究生的创新能力的培养,具有重要的意义和实践价值.     

临床医学专业学位在读硕士研究生满意度调查

目的　调查临床医学专业学位在读硕士研究生对课程培养、实践培养、科研培养、导师培养、管理服务方面的满意度,发现问题并提出对策建议。方法　采用问卷对广西某高等医学院校1 585名临床专硕进行满意度调查。使用SPSS 20.0软件对相关数据进行统计分析。定量资料统一采用（均数±标准差）进行统计描述,组间比较采用方差分析。结果　临床医学专业学位在读研究生在导师培养方面满意度最高,均值超过4分;在课程培养、管理服务方面总体为满意,但在实践培养、科研培养两方面的满意度评价呈现两极分化;其中补助津贴、科研工作的参与度、科研工作的强度均为不满意。结论　对于临床医学专业学位硕士研究生的培养,应该提高补助津贴待遇,提升学校管理服务能力;开拓科研培养平台,提升科研工作参与度;协同制订培养标准,适度提升科研强度。     

浅析临床医学硕士研究生导师的有效指导

临床医学硕士专业研究生是一代名医的重要摇篮,导师的有效指导是保证其培养质量的基本保证。本文围绕临床专业研究生培养的难点,浅析了临床硕士专业研究生导师的指导核心和有效的方法,以期把临床医学专业学位的研究生培养成既具有良好的临床专业能力,又具有科研意识、创新能力和人文关怀的高级医学人才。     

临床医学“专硕+学硕”科研能力培养模式的构建

当前,我国临床医学硕士研究生教育类别主要包括以住院医师规范化培训制度为依托、注重临床实践能力培养的专业学位硕士和以培养医学科研创新能力为导向的学术学位硕士两大类。这两类硕士研究生的培养侧重点有所不同,目前较为单一的导师制培养模式可能导致研究生科研能力和科学素养不高。基于此,提出以联合导师组共同指导为基础、以“专硕+学硕”联合课题小组为特色的临床医学硕士研究生新型科研能力培养模式。在这种培养模式中,研究生可共享不同类型导师的专业优势和学术经验,根据自身特点进行分工合作,实现优势互补,共享科研成果,以期培养临床医学硕士研究生较为完整的医学科研理论体系和思维方法,并推进医学院校研究生教育的改革发展和学科建设。     

提高临床医学专业学位培养质量的思考

设置临床医学专业学位是医学学位与研究生教育领域的一项重大举措 ,它可以改变过去只将医学高级人才培养成科研型的医学硕士和博士的单一模式。对于临床专业学位 ,它侧重于临床技能的考核 ,因此要处理好课程学习、临床能力培养与科研训练三者的关系 ,特别是如何贯彻以临床能力培养为重点的全面素质培养 ,如何评判它的培养质量 ,如何保证培养质量 ,是临床医学专业学位实施的核心。尽快建立适合临床医学专业学位的课程体系 ,提高研究生临床能力培养及保证科研论文质量 ,是确保临床专业学位质量的关键问题。     

医学硕士科学与专业学位研究生培养现状调查与分析

目的了解医学硕士科学与专业学位研究生的培养现状,为医学硕士研究生培养质量评价提供参考依据。方法以河南某大学医学院2015届即将毕业的396名医学硕士研究生为研究对象,通过问卷对医学硕士科学与专业学位研究的培养质量进行调查。结果除社会实践参加情况和导师培养计划未见统计学差异外(P>0.05),医学硕士科学学位研究生在课程设置、教学规章制度建设与执行、教学质量、教学质量监控、学位论文选题等级、学位毕业论文完成质量及第一作者发表中文核心/SCI文章等方面均优于专业学位研究生(P<0.05),但在毕业后出国留学/攻读博士意愿方面,专业学位研究生高于科学学位研究生(P<0.05);自主选择学位类型与所在学位类型一致性方面,医学硕士研究生的总一致率为72.0%,但临床医学专业一致性仅为69.9%,较其他医学专业低,且倾向于选择专业学位。结论医学科学学位硕士研究生培养质量优于专业学位研究生,临床医学硕士研究生倾向于选择专业学位类型。     

上海市临床医学专业学位硕士研究生（住院医师）教学现状与需求分析

目的 了解上海市“临床医学硕士专业学位教育与住院医师规范化培训并轨”改革实施现状,分析学生需求.方法 自行设计问卷,对上海市4所高等医学院校的122名2011年入学的专业学位硕士研究生（住院医师）进行相关调查.结果 88.5％的被调查者认为有必要设置公共基础课;80.3％的被调查者对网络化的教学模式表示认可;47.5％的被调查者认为医院没有提供足够的机会让住院医师参与临床科研和学术活动.对毕业后择业情况的调查显示：39.3％的被调查者的就业去向是三级医院;22.1％的被调查者选择二级医院;28.7％的被调查者选择继续深造或从事非医疗行业;9.9％的被调查者选择一级或社区医院.对于导师指导方式,64.7％的被调查者认为集体指导方式有待完善,84.4％的被调查者更倾向选择传统单一导师的指导方式.结论 公共基础课程可以采用网络化的教学方式进行授课,单一导师指导仍然是目前更可取的导师指导模式,应加强对医学毕业生的就业指导.     

提升“双轨合一”模式下临床医学专业学位硕士研究生科研创新能力的探索

目的 探讨“双轨合一”模式下临床医学专业学位硕士研究生科研创新能力提升的策略和方法,以期培养具有科研创新意识的复合型高素质型医学人才,满足时代的要求。方法 选取滨州医学院2017和2018两个年级医学专业学位硕士研究生共42名,随机分为对照组(20人)和实验组(22人)。对照组给予常规教学管理,实验组通过建立双导师联合培养机制、优化课程设置、打造网上课程平台、完善考核监督机制、组建学术型和专业型研究生帮扶小组六个方面解决科研时间不足的问题,增强临床医学专业学位研究生的科研意识、提升他们的科研能力。统计至毕业前发表的文章数量和质量,由相关专业高级职称人员对硕士研究生的毕业论文进行审核评分。结果 实验组研究生毕业前发表的文章数量和质量、硕士学位论文得分均优于对照组,差异均具有统计学意义,P＜0.05。实验组SCI论文发表数量、中文核心期刊论文发表数量以及发表文章总数量三项均高于对照组,差异有统计学意义,P＜0.05。结论 新培养方法能有效激发专业学位硕士研究生对科研的学习兴趣,增强了学习的积极性以及导师和学生的互动性,提高了学生科研创新能力。     

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.