肾功能与心血管疾病危险需要更精确的肾功能测定方法以识别那些存在危险的个体

若干研究已揭示，肾功能受损者的心血管疾病及死亡危险是增高的，但其原因尚未明确。在一项相关研究（doi：10．1136／bmj．b2392，见本期第286页）中，Kurth等对入组妇女健康研究（WHS）的≥45岁女性医务人员的资料进行了分析，以评价肾功能与心血管疾病及死亡危险之间的关系。。     

美国哈佛大学BWH医院神经外科专科医师培养过程及借鉴

以美国哈佛大学附属布列根与女子医院神经外科专科培训为例,介绍美国神经外科专科培训体系,阐释其逐年递增的临床知识、技能、决策、人文关怀、职业规范、沟通技巧等培训措施,以及注重神经科学科研思维与产出的培养模式,以期为促进我国神经外科专科培养提供借鉴。     

Cardiovascular risk and prevalence of metabolic syndrome by differing criteria

Background The prevalence of metabolic syndrome （MetS） in hypertensive population in Chinese countryside is unknown. Firstly, this study compared the prevalence of MetS according to National Cholesterol Education Program （NCEP） ATPIII, revised NCEP and International Diabetes Federation （IDF） definitions. Secondly, it investigated the association between MetS, coronary heart disease （CHD） and stroke in patients with hypertension. Methods In this cross sectional study, the cluster sampling method was used. Three MetS definitions were applied to 1418 normal subjects and 5348 hypertensive patients aged 40-75 years in rural areas in China. The agreement between different MetS definitions was estimated by K statistics. Logistic regression analyses determined the association between MetS defined by the three MetS definitions and CHD and stroke. Results In subjects without hypertension, the prevalence of Mets was 4.1% by NCEP definition, 8.3% revised NCEP definition and 7.8% IDF definition. In hypertensive individuals, the prevalence was 14.0%, 32.9%, and 27.4% in men; 35.6%, 53.1%, and 50.2% in women by the same definitions, respectively. In hypertensive individuals, the agreement was 94.4% in men and 97.0% in women between revised NCEP and IDF definitions. The IDF defined MetS was more strongly associated with CHD than the NCEP or revised NCEP defined MetS （adjusted odds ratio： 1.92 compared with 1.85 and 1.69 in men; 1.64 compared with 1.48 and 1.60 in women）. Conclusions In the patients with hypertension, the revised NCEP and IDF definitions identified more individuals than NCEP definition and their agreement is very high. The IDF defined MetS is more strongly associated with CHD than the NCEP or revised NCEP defined MetS, but weakly or not associated with stroke.     

策略训练的评价标准及模式

本文以阅读策略训练为切入点，从四个方面来分析学习者经过策略训练后自身的变化，探讨策略训练的评价标准及模式。这四个方面为：（1）学习者外部行为的变化；（2）学习者内部认知过程的改变；（3）学习者自身策略体系的形成和发展；（4）学习者成绩的提高和对外语学习总的态度的转变。     

Triad of markers for identifying children at high risk of developing insulin-dependent diabetes mellitus

A longitudinal investigation was conducted from 1977 to 1984 on 178 families in which one or more of the children had insulin-dependent diabetes mellitus. Of 351 nondiabetic sibs followed up for an average of 54 months, ten have, thus far, become diabetic. Eight sibs were HLA identical to their diabetic proband and nine had HLA-DR3 and/or HLA-DR4. Islet cell surface antibody and islet cell cytoplasmic antibody were found from two to 74 months before the onset of clinical diabetes in 100% and 90%, respectively, of the children. A decrease in insulin secretion was observed in all of these children on entry into the study and was detected in the absence of elevated plasma glucose concentrations. The data suggest that the triad of HLA identity, pancreatic islet cell antibodies, and depressed insulin secretion identifies those sibs who are at high risk of developing insulin-dependent diabetes mellitus.     

关注县医院建设

县医院是农村三级医疗预防保健网的龙头,是全县医疗技术指导中心,加强县医院建设对完善农村卫生服务体系,改善农村医疗卫生状况,提高广大农民的健康水平有着十分重要的作用,对解决好“三农”问题,促进我国农村经济建设和社会发展,实现全面建设小康社会的奋斗目标更有着重大影响。当前县医院建设在各级政府的领导关怀下,有关部门的支持、帮助以及县医院广大职工的共同努力下取得了长足进展,但也存在不少尚待解决的问题,为了交流经验、分析讨论问题,共商对策,使县医院建设更好适应新形势发展的需求,我刊特设立了“县医院管理”专栏,并在本期作…     

开展大学生探索性实验项目优化创新性人才培养模式

高等教育的任务是培养具有创新精神和实践能力的高级专门人才。目前全国多数医学院校正建立多种渠道、多种机制鼓励大学生参与科研。扬州大学医学院基础医学实验教学中心通过开展大学生探索性实验项目,培养学生的创新意识、创新思维,提高学生分析问题、解决问题的能力,从而积极探索创新性人才实践教学改革,优化创新性人才培养模式。     

住院医师培训实践与体会

我国住院医师培训制度是医学生毕业后教育的重要组成部分.从发展趋势看,我国住院医师培训制度正向专科医师培训制度发展.本文介绍了我院目前在住院医师规范化培训制度取得的经验,面临的困难和存在的问题,并对此提出积极的建议.