综合教学改革措施对诊断学课程建设作用的研究

为进行诊断学课程建设,2年来我院对诊断学课程进行了大力的改革:加强了对教师和学生的管理,更新了诊断学教材,改造了诊断学实验室,建立了多媒体网络教学平台,改革了教学模式和教学内容,调动了学生学习的积极性。结果显示,学生的学习成绩得以明显提高。     

诊断学教学方法改革的初步尝试

诊断学教学方法改革的初步尝试李树青陆红艾丽梅（附属第一医院内科教研室）诊断学是临床各科的基础，是从学习医学基础理论向临床各门课程过渡的桥梁课。所以，学生学好诊断学尤为重要。结合教学实践，我们对提高诊断学教学质量的方法改革进行初步尝试。１努力钻研教学法...     

诊断学教学方式改革的探讨

诊断学教学方式改革的探讨同济医科大学附属同济医院内科，武汉４３００３０欧阳金芝诊断学是临床各门课程的基础，是医学院校学生必须切实掌握的一门课程。本人连续两年从事诊断学教学工作，分别带教九二级及九三级本科学生，在第二年的教学工作中，根据实际情况进行了一...     

实验诊断学教学改革的实践与体会

实验诊断学是基础医学与临床医学的桥梁学科，是即将从事临床医学的医学生的必修课。我校近年对实验诊断学的教学内容、方法、手段等进行了大胆改革，在统一教规观念的基础上，以第五版“诊断学”为蓝本进行教材建设；建立两个诊断学技能综合实验室，实施多媒体网络教学；强化对教师和学生的理论和实习教学管理，创造条件使学生牢固掌握理论知识并尽早介入临床接触病例；实行教改分离，这一系列的改革，促进了教学质量的提高。     

九九级医学本科生诊断学教学的调查与思考

对九九级五年制本科生进行诊断学教学调查。结果表明，70.2%学生认为诊断学内容多、课堂讲授少，42.1%学生对正常体格检查认识不足，78.8%的学生认为安排去病房见习的次数及病例数太少，45.6%的学生对问诊及病历书写存在困难。文章对今后诊断学教学的改革进行了探讨。     

诊断学课程考试方式改革与意义

以考核内容综合化,培养动手能力为中心,突出学习的过程为侧重点,改革诊断学考试内容、方式,提高了学生诊断学课程的总成绩、及格率,提高了学生检体诊断动手能力,促进了教学内容与方法的改革,同时有助于培养学生良好的学习品质和习惯。     

浅谈面向成人医学生的实验诊断学教学改革

实验诊断学是临床医学教育中的一门重要课程，是联系基础医学与临床医学的桥梁。本文针对成人医学教育中学习时间相对较短，内容较多，学生不易理解和掌握，教学难以达到预期效果及成人学员自身的特点，以提高教学质量为目的，对实验诊断学课程的教学内容、考核方法和临床实践模式等方面进行了一些改进和探索，旨在促进成人医学教育实验诊断学课程教学水平的提高。经过几年的教学实践，收到了较好的教学效果。     

临床教学改革与毕业生质量调查

为适应基层妇幼卫生事业发展，我校自1986年开办了妇产科学专业大专班，目前已毕业学生6届121名。为了解毕业生质量状况及采取临床教学改革措施后的效果，对我校八九～九二届毕业生作了一次较全面的调查。现将该专业的临床教学改革及毕业生调查情况加以总结分析。一、临床教学改革要点根据毕业生反馈的信息，我们着重加强三个方面训练及实施三段式教学方式。1．加强诊断学及内、外科学基础训练。诊断学是基础与临床的桥梁课程，也是学习各临床课程的基础。每一个临床医生，必须掌握好诊断学的基本理论和临床思维程序，这是最基本的要求。内…     

诊断学临床技能教学改革的初步探讨

诊断学是临床各科的基础和入门，是过渡到临床学习的桥梁，是实践性、技术性很强的学科，其重要性不容置疑。但近年来由于高校扩招，学生到临床问诊及体格检查的人数增多给临床造成巨大压力，另一方而，随着社会法制化进程的加快，病人自我保护意识增强，见习学生又缺乏沟通技巧，造成学生临床技能教学困难。我院从2000年开始参照国家职业医师资格考试规范化培训的要求，凋整教学入纲，改进教学方法，实施诊断学实验课程改革，取得了一定的成绩。我们在2003年对学生随机分组后进行研究，也说明了改革的必要性，现总结如下。     

面向岗位胜任力的诊断学实习课教学体系的构建与实践

诊断学实习课是临床医学教育过程中的重要课程,是医科学生把理论学习通过实习课向临床实践应用、认识的桥梁和平台。本文以培养学生的岗位胜任力为导向,通过诊断学实习课程教学方法和手段的改革,构建了诊断学实习课教学体系。教学实践表明,新的教学体系可显著提高教学质量,最大限度地发挥实习课教学在培养学生岗位胜任力的作用,起到培养高素质临床型人才的目的。     

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.