微课联合模块化教学在内科与基础护理实验教学中的应用

目的　探究微课联合模块化教学在内科与基础护理实验教学中的应用效果。方法　采用抽签法选取某校2016级4个班专科护理生为研究对象。用随机字母表法将148名护理本科生分为两组,联合教学组采用微课联合模块化教学,模块化教学组采用模块化教学方式。对比两组考试成绩、自主学习准备度量表（self-directed learning readiness scale for nursing education,SDLRS）评分、医学教育环境及教学满意度。采用SPSS 22.0统计软件对数据进行卡方检验和t检验。结果　联合教学组学生内科护理学、基础护理学、操作技能分值均高于传统教学组（P<0.05）;学期末,联合教学组学生自我管理、热爱学习、自我控制维度评分及SDLRS总分均高于模块化教学组（P<0.05）;联合教学组学生学习知觉、教师知觉、环境知觉评分及总分均高于模块化教学组（P<0.05）;联合教学组学生在提高学习兴趣、提高学习效率、提高学习主动性、更好掌握重点内容等方面的教学满意度高于模块化教学组（P<0.05）。结论　微课联合模块化教学能够提高护理专业学生考试成绩与自主学习准备度,改善医学教育内环境,且学生的教学满意度较高。     

来华留学生数字化系统解剖学双语试题库的建设与应用

目的　探讨数字化系统解剖学双语试题库对临床医学专业留学生教学资源创新与教学质量提升的作用。方法　组建试题库并用于2018级留学生（实验组）教学。通过对比2017级留学生（对照组）平时测试、期末理论和实验考试成绩验证试题库应用价值。利用调查问卷获得留学生使用反馈,进一步评价试题库的开发可行性和教学改革推动作用。采用SPSS 20.0统计学软件进行数据分析,两组考核成绩进行独立样本t检验,计量资料以（均数±标准差）表示。结果　两组学生平时测试成绩差异无统计学意义（P>0.05）,但实验组数字化标本考试与期末理论考试成绩均高于对照组（P<0.05）。问卷结果显示,89.55%（155人）以上的留学生在学习资源、试题质量、考试模式和使用评价等方面对试题库给予了高度评价,但仅有52.02%（90人）的留学生认可试题的双语体现形式。结论　数字化系统解剖学双语试题库有效拓展了教学资源,推动了留学生教学改革。     

混合式教学在医学影像诊断专业大学生临床实习中的应用

目的　探讨混合式教学在医学影像诊断专业大学本科生临床实习中的应用效果。方法　选取2017至2019年在中国科学院大学重庆医院放射科实习的医学影像诊断专业60名大学本科生作为研究对象，分为试验组和对照组，各30名学生。试验组在实习期间采用混合式教学（根据不同的教学场景运用授课教学法、案例教学、问题教学、团队教学），对照组采用传统教学。实习结束时，比较两组实习学生的出科考试成绩，并采取问卷调查了解学生对教学的满意度。采用SPSS 19.0进行t检验和卡方检验。结果　出科理论知识考试成绩方面，试验组为（90.27±5.38）分，对照组为（83.13±7.57）分，差异有统计学意义（t=4.21，P<0.001）；出科读片分析考试成绩方面，试验组为（90.07±4.80）分，对照组为（82.13±8.71）分，差异有统计学意义（t=4.37，P<0.001）。满意度调查显示，对教学总体满意度中试验组"非常满意"为76.7%（23/30），对照组"非常满意"为50.0%（15/30），差异有统计学意义（χ²=6.57，P=0.037）。结论　混合式教学在医学影像诊断专业大学本科实习生的教学中具有很好的效果。     

基于SPOC与交互工具相融合的混合教学模式在护理双语教学中的运用

目的　探讨基于小规模限制性在线课程（small private online course,SPOC）与交互工具相融合的混合教学模式在妇产科护理学双语教学改革中的应用效果。方法　便利选取重庆医科大学2018级护理本科生作为研究对象,试验组336名、对照组332名。试验组采用基于SPOC与交互工具相融合的混合教学模式,对照组采用传统的线上线下教学方法进行教学。采用学习成绩、在线学习及课堂表现等形成性评价指标,比较两组学生的教学效果。采用SPSS 26.0统计学软件进行t检验和卡方检验。结果　试验组期末考试成绩为（67.84±8.65）分、对照组为（66.50±7.29）分,试验组双语章节试题得分为（5.32±1.90）分、对照组为（4.95±1.92）分,两组比较差异有统计学意义（P<0.05）。试验组在线学习表现及课堂表现均高于对照组,差异有统计学意义（P<0.05）。试验组大部分学生认为采用基于SPOC与交互工具相融合的混合教学模式可培养其自主学习能力、提高其专业知识掌握程度和英语水平。结论　基于SPOC与交互工具相融合的混合教学模式可有效培养学生自主学习能力,提升教学效果。     

基于微信的PBL联合微课堂用于住培学员胃超声造影的教学实践

目的　探讨基于微信的以问题为基础的学习（problem-based learning,PBL）联合微课堂用于住院医师规范化培训学员胃超声造影教学中的应用价值。方法　选取2019年1月至2021年6月在重庆医科大学附属第一医院超声科进行住院医师规范化培训的40名学员为研究对象。将其分为试验组（基于微信的PBL联合微课堂教学）和对照组（传统教学）。教学内容均为胃超声造影诊断。理论课和实习操作课结束后对两组学生进行胃超声造影理论考试和操作考试。采用SPSS 22.0进行t检验和秩和检验。结果　胃超声造影教学结束后,试验组的理论考试成绩高于对照组[（93.09±2.31）vs.（90.63±2.26）],差异有统计学意义（P<0.05）。但两组学员中操作成绩各等级的人数分布差异无统计学意义（P>0.05）。结论　基于微信的PBL联合微课堂用于住培学员胃超声造影的教学效果良好,可尝试推广应用。     

基于自制动态心血管3D模型的CBL教学在心脏瓣膜病临床见习中的应用

目的　探讨自制动态心血管3D模型辅助案例导向学习（case-based learning,CBL）教学法在心脏瓣膜病临床见习中的应用效果。方法　选择南京医科大学2016级五年制临床医学专业2个班共60名见习学生作为研究对象,将其平均分为试验组和对照组。试验组接受自制动态心血管3D模型辅助的CBL教学,对照组接受传统教学模型辅助的CBL教学。学习结束后,通过对两组学生进行考核成绩比较和问卷调查评分比较,评价两种教学方法的教学效果。采用SPSS 19.0统计软件进行独立样本t检验和卡方检验。结果　两种教学方法下,试验组学生的基础理论知识和临床思维考试成绩均高于对照组学生[（43.10±3.51）vs.（40.87±3.19）,（42.20±3.15）vs.（40.20±3.81）],差异有统计学意义（P<0.05）。问卷调查结果显示,试验组学生在学习主动性和积极性、理论知识掌握度、临床思维能力、课堂学习兴趣、课堂活跃度及知识讲授清晰度方面的评分均高于对照组学生,差异均有统计学意义（P<0.05）。结论　自制动态心血管3D模型辅助CBL教学法应用在心脏瓣膜病临床见习中,可以培养学生临床诊断思维能力,提高教学质量。     

移动增强现实技术在神经解剖教学中的应用效果研究

目的　探索将移动增强现实（mobile augmented reality,mAR）技术应用到神经解剖学教学中,观察其对学生学习成绩及认知负荷的影响。方法　通过收集并设计各种神经解剖学的多媒体教学资源（图形、动画和视频）,运用AR基于标记的图像识别技术,将多媒体资源放置在传统书页中的标记处,使书籍具有交互性;并且通过移动设备将各种多媒体资源与传统印刷书结合在一起。40名学生被分配至试验组或对照组,试验组采取mAR多媒体资源教学,对照组采取传统方式教学。6学时课程完成后,全部学生进行统一测试,使用学业成绩测验和PAAS（platform-as-a-service）认知负荷量表进行数据收集和分析。采用SPSS 18.0进行方差（MANOVA和ANOVA）分析。结果　单向MANOVA检验用于确定通过mAR学习对学习成绩和认知负荷的影响,结果表明试验组和对照组之间差异有统计学意义（P<0.05）。单变量ANOVA检验发现通过mAR学习神经解剖的试验组学生在测试成绩上比对照组学生更高。此外,与对照组学生相比,试验组学生的认知负荷明显降低了,差异有统计学意义（P<0.05）。结论　通过教学实践发现,使用mAR学习神经解剖学有助于学生在减轻认知负荷的情况下提高学习成绩。     

基于案例和临床实践教学在护理学专升本《临床营养护理》教学中的运用

目的　探索以临床案例分析和实践为导向的教学在《临床营养护理》教学中的运用。方法　2018级上海中医药大学护理学专业专升本学生（A班）采用传统教学;2019级上海中医药大学护理学专业专升本学生（B班）采用临床案例教学、案例分析汇报和实践等多种形式相结合的教学。教学结束后,通过课程考核和问卷调查进行教学效果评价。采用SPSS 18.0进行t检验。结果　学员自评显示,B班学员对教学效果评价高于A班学员,差异有统计学意义（P<0.05）。A班学生考试成绩（83.34±4.27）分,B班学生考试成绩（85.07±4.22）分,差异有统计学意义（P<0.05）。结论　以临床案例分析和实践为导向的教学在《临床营养护理》教学中取得了良好的教学效果,值得在护理学专业专升本教学中推广。     

病例教学联合思维导图在病理生理学教学中的应用

目的　评价病例教学联合思维导图在病理生理学教学中的应用效果,为提高病理生理学教学质量提供依据。方法　选取首都医科大学燕京医学院2017级本科生124名学生作为研究对象,分为试验组60人和对照组64人。其中,对照组采用传统教学,试验组采用课上病例教学联合课后思维导图的教学方式。课程结束后通过云班课平时成绩和试卷成绩对教学效果进行评价。采用SPSS 17.0进行Wilcoxon秩和检验和Welch’s correction t检验。结果　试验组学习的积极性得到了有效的调动（P<0.001）、知识的理解力也优于对照组（P=0.020）。试验组的平均理论成绩优于对照组（P=0.036）,主要表现为客观题成绩高于对照组（P<0.001）及简答和论述题成绩高于对照组（P=0.006）,名词解释成绩差异无统计学意义（P=0.302）。结论　病例教学联合思维导图可显著提高病理生理学的教学质量。     

支架式教育在后疫情时代传染病护理教学中的应用

目的　探讨将支架式教学应用于传染病教学中的效果。方法　选取2017级护理本科259名学生为研究对象,根据学号单双数分为试验组（126人）和对照组（133人）。试验组开展支架式教学,对照组采用传统教学。教学结束后对两组学生进行传染病理论考核及情景演练,通过问卷调查评估两组的教学满意度。采用SPSS 23.0进行t检验和卡方检验。结果　试验组理论考核、情景模拟均高于对照组,差异有统计学意义（P<0.05）;问卷调查结果显示,试验组学生对于支架式教学满意度较好[80.2%（101/126）],高于对照组[（54.1%（72/133）],差异有统计学意义（P<0.001）。结论　支架式教学应用在传染病教学中,有助于提升教学质量和满意度,值得在教育实践中进一步推广和应用。     

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.