医学检验专业输血科实习模式建设探讨

输血专业实习是医学检验专业临床实习阶段一项非常重要的任务。对于实习学生而言,毕业实习是完成他们由学生到输血技术人员转变的第一步。因此,在输血科的实习临床实践中,第一次的体会和感受,以及在输血科实习过程的管理模式等所有的实习内容,不仅影响毕业实习的效果,而且有可能影响毕业实习生今后的工作。由于检验专业通常安排实习学生在检验科的时间较长,在生化、微生物、临检和免疫各个专业实习至少5周时间,而在输血科的时间相对较短,通常只有1~2周的时间,又因为输血科工作的特殊性,无法在短时间内对实习学生完全放手。在这种情况下,如果没有严密的安排,实习同学极有可能在短短的实习时间内走马观花。为了提高医学检验专业学生     

微生物检验临床实习存在的问题及对策

微生物检验是感染性疾病诊断必不可少的重要手段,是医学检验专业重要的专业课之一,是一门实践性、经验性极强的学科。临床实习是学生掌握实践技能的必经阶段,对于实习生来说,要在较短的时间内掌握微生物检验技术是一个比较有挑战性的工作。     

如何做好临床微生物检验实习的带教工作

临床微生物学涉及的面较广,为了让实习生在有限的时间内完成临床微生物检验实习,临床微生物教研室在原有多种教学模式的基础上,将实习手册中的学习要求和目前实验室ISO15189认可准则紧密结合,使临床微生物教学规范化、标准化。     

浅谈临床微生物检验的实习教学

重视临床微生物检验的实习教学，应对学生的临床实习进行统筹安排、科学管理和系统培训。     

医院检验科临床微生物实习教学探索与实践

临床微生物检验实习是检验专业学生实习的重要组成部分,不仅要求学生具备扎实的理论知识,而且得掌握规范的检验操作技术。是否经过严格规范的带教实习,会直接影响学生工作能力和工作作风。由于临床微生物检验专业性与严谨性,一直都是检验带教中的难点。为此,我们需与时俱进,不断调整带教的内容,优化带教方式,现将临床微生物检验教学实践中体会与思考总结以下6点:1)明确制度;2)专岗负责;3)合理安排;4)学以致用;5)加强沟通;6)严格考核。     

模块式教学在医学检验技术专业微生物检验实验中的实践

为了适应现代临床检验对医学检验技术从业人员操作能力的要求,我院将医学检验技术专业微生物检验实验课由传统的授课模式修改为模块式教学。在教学过程中统筹实验课和临床实习课时安排,将微生物检验实验课分为五个模块：基本技能、应用、综合训练、扩展和临床实习模块。基本技能模块以学生学会观察微生物形态和掌握基本操作技术为基础,同时培养学生的无菌观念和生物安全观念;应用模块注重学生对各种类型细菌的检测,让学生反复操练;综合训练模块强调培养学生分析问题、解决问题的能力;扩展模块积极引导学生扩散思维进而全面分析问题;最后的临床实习模块巧妙结合临床实践,培养学生的综合能力,提高其职业思维和习惯。五个模块紧密衔接、层层递进,很好地激发了学生的学习兴趣,解决了他们动手能力不足的问题,提高了教学效果,为提高微生物检验实验教学质量提供了改革方法。     

浅谈临床止凝血检验实习教学

临床实习是医学教育的关键时期,既是学校教育的深化,也是学生将理论与实践相结合的学习过程。实习教学的目的是让学生在实际工作中学会运用理论知识,增强操作技能,培养分析问题、解决问题、独立工作的能力。临床止凝血检验原理抽象,参与反应的凝血因子众多,是医学检验专业教学的难点之一。止凝血检验实习,除要求学生系统掌握止凝血基础理论知     

微生物检验专业实习生带教体会

<正>微生物学检验是一门实践性与技能性很强的学科。通短暂的实习,要让学生很快熟悉微生物各种操作程序,对生物新进展、院内感染、生物安全方面以及抗生素等相关识有所了解,要求带教老师不仅要了解各个学校的教材,知实习大纲的要求,还要合理安排实习计划,做好带教课件才能保证带教任务的完满。通过几年的带教实践,对于如做好微生物专业的带教工作积累了一些经验,现就一些体总结如下。     

微生物学检验教学中注重细节的培养探索

目的探索注重细节的培养在加快微生物学检验专业学生掌握微生物检验技术,缩短实习或就业的适应期的作用。方法对78名检验专业的学生在整个教学过程中注重细节的培养,注重学科精神的强化,注重临床知识的强化,注重病例的应用,重视检验前质量控制,注意加强与临床的沟通,关注国内国际最新微生物学动态信息。结果78名学生在实习期间和就业时90％自我感觉能够对临床标本的检验有一个清晰的思路,并且获得临床同行医护人员和本科室人员的好评。结论注重细节的培养可以加快微生物学检验专业学生掌握微生物捡验技术,缩短实习或就业的适应期。     

临床微生物实验室信息系统本科实习带教的探索

实验室信息系统（laboratory information system,LIS）的广泛使用,极大地提高了检验科的服务和管理质量,在给检验工作带来极大方便的同时,也对实习带教提出了新要求。文章针对临床微生物LIS系统特点,结合ISO15189认可中实验室信息系统的要求,适应微生物检验技术的发展需求,从检验科实习岗前培训到进入微生物组系统培训等方面探索推动临床微生物实验室信息系统实习教学工作,不断完善并规范临床微生物医学检验技术专业实习教学体系。     

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.