医学生循证医学知识、态度、行为和技能的调查分析

目的了解高年级医学本科生的循证医学知识、态度、行为和技能(KABP)的现况。方法整群抽样,横断面调查。结果对北京大学医学部285名高年级医学本科生的KABP情况调查结果显示,目前大部分高年级医学生对循证医学不了解,多数医学生在临床实践中不具备自我学习的主动性,循证医学知识运用情况和检索医学专业信息的技能水平较低。调查显示,专业是影响KABP的主要因素。结论大部分高年级医学本科生循证医学知识的掌握程度、临床实践行为、知识运用技能和信息检索技能均处于较低的水平,开展系统、有效的循证医学教育势在必行。     

医学生循证医学认知现状调查

目的：了解目前医学生对循证医学的认知情况现状以及实践循证医学遇到的困难与障碍,为进一步开展循证临床实践和循证医学教学提供参考依据。方法：对2008年春季滨州医学院必修循证医学的608名三年级医学生进行了问卷调查,并采用SPSS13．0统计软件对结果进行分析。结果：修完循证医学后,医学生对循证医学知识、态度有所提高,但实践循证医学的行为几乎没有变化;医学生认为实践循证医学的主要三大障碍是医生时间有限、文献检索能力差和病人不支持。结论：循证医学的实践教学必须加强,尤其应该注意学生的技能获取。     

高年级医学本科生老年医学知识现况问卷调查分析

医学本科生是将来提供老年医学服务的重要人力资源,他们对老年医学知识掌握的程度将直接关系到未来老年医学的服务水平。本研究通过自行设计的高年级医学本科生老年医学知识调查问卷,随机抽取我校1998级-2000级部分5年级医学本科生进行老年医学知识现况调查。发现高年级医学本科生仍然对老年医学基础知识知道的较少;参加调查的高年级医学本科生90%以上对老年医学感兴趣和很感兴趣。提示现有的本科医学教育架构使医学本科生掌握的老年医学知识十分有限,因此有必要在医学本科生中开设专门的老年医学课程。     

某医学院3年级临床专业本科生循证医学知识、态度、行为情况调查

目的了解某医学院临床专业本科生循证医学相关知识、态度、循证行为的基本情况,探讨其影响因素,为循证医学教学改革提供科学依据。方法对某医学院3年级临床专业本科生以自填调查问卷的方式进行普查。结果 10%左右的同学知道循证医学,7个流行病学及卫生统计学相关题目答对4个及以上的不到20%;约20%的同学认为杂志文章都真实可信,约80%的同学认为临床经验最重要、应该遵循患者意愿、许多治疗措施缺乏有力证据;约90%的同学没选修过循证医学相关课程,约90%的同学没检索过PubMed,在遇到实际问题时约70%的同学倾向于查阅教科书及咨询老师。结论约90%的同学缺乏循证医学知识及信息检索技能,约80%的同学缺乏循证的观念,系统、有效的循证医学教育势在必行。     

地方高校临床医学专业本科生循证医学认知及态度调查

目的：解地方高校临床医学专业本科生对循证医学的认知及态度,为提高本科生循证医学教学水平提供依据。方法采用自制问卷,对大学三年级314名临床医学专业学生在涉及循证医学知识的相关课程开课前后进行两次调查。结果发放问628卷份,有效问卷596份。学生获取循证医学知识的途径主要通过课程,学术讲座和医学杂志;49.6%的学生学对认为循证医学是最佳证据和临床经验及患者价值的结合,学习循证医学可以指导临床科研和提高业务水平,但77.5%的比例认为循证医学有助于发文章。学习循证医学的困难主要集中在英语水平和文献检索方面。结论地方高校临床医学专业本科生对循证医学的认知程度较低,但对循证医学有较高的学习积极性。应针对学生的背景和需求开展循证医学教学。     

南昌某高校不同层次医学生对循证医学的认知、需求和评价

目的通过对南昌某高校2011年下半年所有开设循证医学课程的医学生进行现况调查,以了解不同层次医学生对循证医学的认知、需求和评价,为进一步促进循证医学课程的教学改革提供理论依据。方法在参考有关文献的基础上,自行设计调查问卷,在循证医学课程结束后一周,采用现场填写并回收的方式,收集不同层次医学生（博士生、硕士生和本科生）对循证医学的认知、需求和评价等方面的信息。并进行统计学分析。结果不同层次医学生在学习前对循证医学的认知存在显著性差异（P〈0.001）,学习后认知情况均有较大改善（P〈0．01或P〈0．05）。在课程需求、课程学习的影响因素评价和学习后的收获等方面,研究生与本科生比较,均有显著性差异（P〈0．001或P〈0．05）。结论不同层次医学生在对循证医学的认知、需求和评价等方面存在一定差异。应围绕不同层次医学生的需求和相关制约因素,加强教学方法和教学模式改革。     

浅谈循证医学在传染病学实习中的应用

循证医学（EBM）是研究证据与医师的l临床实践和病人价值三者之间关系的最佳手段，能够为病人的诊治提供最佳决策。循证医学教育已经深入到临床教学和继续医学教育之中。EBM是一种新的医学模式，也是一种新的医学教育模式，本文探讨如何在医学本科生的传染病学实习中，引入循证医学的理念、原则和方法，形成以问题为中心、变学生被动学习为主动学习的教学模式，帮助医学生掌握自我更新医学知识和临床技能的方法和技巧。     

对医学本科生实施循证医学讨论课后知识与技能的改变

用2套包含20个问题的试卷评价三年级医学本科生参加循证医学必修讨论课前后的知识和技能水平,并要求学生在课后以匿名方式对课程进行评价,结果表明本科生循证医学必修讨论课能全面提高医学生的知识水平,并具有很好的接受程度。     

在本科生与硕士研究生中实施循证医学教学的比较研究

目的明确在本科生和硕士研究生循证医学教学中应该实施的不同教学重点和培养目标。方法选择上海交通大学医学院2008年度选修循证医学课程的硕士研究生（151名）和本科生（55名）,采用问卷调查方法,从其对循证医学知晓、态度、实践及其难点四个方面进行调查。结果对循证医学的知晓和实践难点调查显示本科生和硕士研究生间差异无统计学意义,两者均对循证医学的了解程度较低并且均认为实践有困难;但两者在对循证医学态度及实践现状方面差异有统计学意义（P〈0.05）,硕士研究生对循证医学反映出较高的兴趣和学习需要性。结论循证医学的教育应该分阶段、循序渐进地进行,各阶段教学重点应有所区别。     

在本科生与硕士研究生中实施循证医学教学的比较研究

目的 明确在本科生和硕士研究生循证医学教学中应该实施的不同教学重点和培养目标.方法 选择上海交通大学医学院2008年度选修循证医学课程的硕士研究生(151名)和本科生(55名),采用问卷调查方法,从其对循证医学知晓、态度、实践及其难点四个方面进行调查.结果 对循证医学的知晓和实践难点调查显示本科生和硕士研究生间差异无统计学意义,两者均对循证医学的了解程度较低并且均认为实践有困难;但两者在对循证医学态度及实践现状方面差异有统计学意义(P<0.05),硕士研究生对循证医学反映出较高的兴趣和学习需要性.结论 循证医学的教育应该分阶段、循序渐进地进行,各阶段教学重点应有所区别.     

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.     

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.     

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.