TBL联合CBL在军人积极心理学教学中的应用

目的探讨以团队为基础的教学(team-based learning,TBL)联合以案例为基础的教学(case-based learning,CBL)在军人积极心理学教学中的应用效果。方法选取陆军军医大学校2017级临床医学专业100名本科生作为教学对象,随机分为TBL联合CBL教学组(n=50)和传统教学组(n=50)。通过基础理论知识及案例分析考核、问卷调查和心理测评等方式评估两种教学方法的教学效果。运用SPSS 19.0对结果进行t检验。结果TBL联合CBL教学组在理论知识得分(54.87±4.98)高于传统教学组(48.65±3.51);案例分析考核得分(36.84±2.73)也高于传统教学组(32.37±2.34);在心理测评结果中,TBL联合CBL教学组在SCL-90后测得分(143.31±43.62)低于传统教学组(149.89±46.96);ERC、GWB后测得分(48.76±5.37)、(107.87±15.56)均高于传统教学组(43.58±5.79)、(102.32±12.13)。此外,TBL联合CBL教学组学生对该教学满意率达95.83%(46/50)。结论TBL联合CBL教学在军人积极心理学教学中能取得良好的教学效果,提高学员的知识应用水平和心理调适能力,具有较好的可行性和适用性。     

Susceptibility-weighted MR imaging of radiation therapy-induced cerebral microbleeds in patients with glioma: a comparison between 3T and 7T

Introduction

Cerebral microbleeds have been observed in normal-appearing brain tissue of patients with glioma years after receiving radiation therapy. The contrast of these paramagnetic lesions varies with field strength due to differences in the effects of susceptibility. The purpose of this study was to compare 3T and 7T MRI as platforms for detecting cerebral microbleeds in patients treated with radiotherapy using susceptibility-weighted imaging (SWI).

Methods

SWI was performed with both 3T and 7T MR scanners on ten patients with glioma who had received prior radiotherapy. Imaging sequences were optimized to obtain data within a clinically acceptable scan time. Both T2*-weighted magnitude images and SWI data were reconstructed, minimum intensity projection was implemented, and microbleeds were manually identified. The number of microbleeds was counted and compared among datasets.

Results

Significantly more microbleeds were identified on SWI than magnitude images at both 7T (p?=?0.002) and 3T (p?=?0.023). Seven-tesla SWI detected significantly more microbleeds than 3T SWI for seven out of ten patients who had tumors located remote from deep brain regions (p?=?0.016), but when the additional three patients with more inferior tumors were included, the difference was not significant.

Conclusion

SWI is more sensitive for detecting microbleeds than magnitude images at both 3T and 7T. For areas without heightened susceptibility artifacts, 7T SWI is more sensitive to detecting radiation therapy-induced microbleeds than 3T SWI. Tumor location should be considered in conjunction with field strength when selecting the most appropriate strategy for imaging microbleeds.     

Digital Breast Tomosynthesis: A New Diagnostic Method for Mass‐Like Lesions in Dense Breasts

To compare the rates and accuracy of digital breast tomosynthesis (DBT) and 2D digital mammography (DM) for detecting and diagnosing mass‐like lesions in dense breasts. Mediolateral and craniocaudal images taken with DBT (affected breast) and DM (both breasts) of the dense breasts of 631 women were assessed independently using Breast Imaging Reporting and Data System (BI‐RADS) scores. Images were compared for detection and diagnostic accuracy for masses; sensitivity and specificity of diagnosis; false‐negative and recall rates; and clarity of display, particularly of margins and spicules. Histopathology was conducted via surgical biopsies of all patients. The detection and diagnostic accuracy rates of DBT images (84.3% and 82.3%, respectively) were significantly higher than that of DM (77.3% and 73.4%; p < 0.01, both). The sensitivity and specificity of DBT (68.1% and 95.2%) were higher than that of DM (58.8% and 86.7%), whereas the recall rate of DBT was lower (3.6% cf. 9.8%). The number of cases of benign circumscribed masses and malignant spiculated masses detected by DBT (172 and 182) was significantly higher than the number detected through DM (75 and 115; p < 0.01, both). Radiologists assigned higher BI‐RADS scores for probability of malignancy to DBT images than DM, to lesions proved malignant (p = 0.025); for benign cases, the methods were comparable (p = 0.065). Compared with DM, DBT yielded significantly higher rates of detection and diagnostic accuracy for benign and malignant masses, with greater sensitivity and specificity and lower recall rates. In addition, DBT images facilitated analysis of margins, and the rate of accuracy for judgments of malignancy probability was higher, as proved on biopsy.     

应用化学发光法检测男性不育人群精液活性氧水平

目的 探讨化学发光法检测男性不育人群中精液ROS水平的意义.方法 使用化学发光法检测1018例不育男性和50例已育志愿者精液活性氧水平.不育男性精液分为弱精子组(400例)、少精子组(19例)、少弱精子组(21 2例),少弱畸精子组(3 5例),精液指标正常组(3 52例).结果 男性不育人群精液活性氧水平旱偏峰分布,中位数为40 RLU/s;男性不育各组与志愿者ROS水平差异有统计学意义,不育组各组之间差异也有统计学意义.结论 用化学发光法检测精液ROS水平能够较好地评价男性生育功能,ROS能够作为一个独立的指标指导男性不育的诊断.     

Hypoxia and HIF-1α expression in the epiphyseal cartilage following ischemic injury to the immature femoral head

HIF-1α has been shown to be a central mediator of cellular response to hypoxia. The role it plays after ischemic injury to the immature femoral head is unknown. The purpose of this study was to determine the region of the femoral head affected by hypoxia following ischemic injury to the immature femoral head and to determine the site of HIF-1α activation and revascularization. We hypothesize that the epiphyseal cartilage, rather than the bony epiphysis, is the site of HIF-1α activation following ischemic osteonecrosis and that the epiphyseal cartilage plays an important role in the revascularization process.Materials and methodsFemoral head osteonecrosis was surgically induced in 56 immature pigs. Hypoxyprobe staining, cell viability assay, HIF-1α western blot, RT-qPCR of HIF-1α, VEGF, VEGFR2, and PECAM, and micro-CT assessments of microfil-infused femoral heads were performed.ResultsSevere hypoxia was present in the bony epiphysis and the lower part of the epiphyseal cartilage following ischemia. In the bony epiphysis, extensive cell death and tissue necrosis was observed with degradation of proteins and RNAs which precluded further analysis. In the epiphyseal cartilage, the loss of cell viability was limited to its deep layer with the remainder of the cartilage remaining viable. Furthermore, the cartilage from the ischemic side showed a significant increase in HIF-1α protein level and HIF-1α expression. VEGF expression in the cartilage was dramatically and significantly increased at 24 h, 2 and 4 weeks (p < 0.05 for all) with 5 to 10 fold increase being observed on the ischemic side compared to the normal side. PECAM and VEGFR2 expressions in the cartilage were both significantly decreased at 24 h but returned to the normal levels by 2 and 4 weeks, respectively. Micro-CT showed revascularization of the cartilage on the ischemic side with the vessel volume/total volume equaling the normal side by 4 weeks.ConclusionsAcute ischemic injury to the immature femoral head induced severe hypoxia and cell death in the bony epiphysis and the deep layer of the epiphyseal cartilage. Viable chondrocytes in the superficial layer of the epiphyseal cartilage showed HIF-1α activation and VEGF upregulation with subsequent revascularization occurring in the cartilage.     

原发性开角型青光眼患者决策辅助方案的构建及应用

目的 探讨决策辅助方案在原发性开角型青光眼患者中的应用效果。方法 将100例原发性开角型青光眼患者按住院时间分为对照组与观察组各50例;对照组行常规护理,观察组在常规护理基础上实施决策辅助方案。分别于干预后（出院前）、出院后1、3个月评价干预效果。结果 干预后观察组决策困境得分显著低于对照组,决策准备得分显著高于对照组,出院后1、3个月药物依从性得分显著高于对照组,出院后3个月目标眼压达标率显著高于对照组（均P＜0.05）。结论 决策辅助方案的应用可有效降低原发性开角型青光眼患者决策困境水平,提高决策准备度,增强用药依从性,从而提高目标眼压达标率。     

养老机构预立医疗照护计划研究进展

介绍预立医疗照护计划的概念内涵,综述养老机构开展预立医疗照护计划的必要性、实践现状（包括介入预立医疗照护计划讨论的时机、讨论牵涉人员及内容、干预策略及效果）、影响因素,以期为今后在我国养老机构中开展预立医疗照护计划提供参考。     

腹腔镜全子宫切除术中结扎束血管闭合系统的应用研究

目的评估结扎束血管闭合系统(LF1537 Blunt Tip)在腹腔镜全子宫切除术中应用的临床疗效,探讨其临床价值。 方法选取解放军总医院2014年1月至2016年1月期间收治并行腹腔镜全子宫切除术患者,根据术中是否使用结扎束血管闭合系统分为观察组(使用结扎束血管闭合系统)和对照组(常规手术),记录并比较两组的一般资料和手术相关指标。 结果两组的年龄、体质量指数、腹部手术史符合正态分布且差异无统计学意义(P＝0.625、0.287、0.664);两组的疾病构成差异无统计学意义(P＝0.808)。观察组的手术时间[(46.6 ± 19.1)min vs (65.8 ± 29.2)min]和术中出血量[(51.0 ± 21.9)ml vs (118.4 ± 50.7)ml]均少于对照组,差异有统计学意义(P< 0.001);两组的输血(2例 vs 6例)、住院时间[(6.3 ± 2.2)d vs (6.7 ± 2.8) d]、中转开腹(0例 vs 2例)、并发症发生(4例 vs 7例)比较,差异无统计学意义(P＝0.204、0.391、0.182、0.472)。 结论本研究中将结扎束血管闭合系统(LF1537 Blunt Tip)应用于腹腔镜全子宫切除术,能够更加安全有效的对血管和组织进行闭合和切割,缩短了手术时间,减少了出血量,使手术更加可靠、快捷,具有重要临床应用价值。     

Mammotome微创旋切系统在乳腺外科中的应用(附132例分析)

目的探讨B超引导下Mammotome微创旋切系统对乳腺肿块诊断与治疗的应用价值.方法132例221处乳腺肿块在B超引导下进行Mammotome微创旋切术.其中一侧单发肿块79例,单侧或双侧多发肿块53例,直径0.5～5.2cm,平均1.4 cm,149处肿块临床可扪及.结果所有肿块均完成Mammotome微创旋切切除,平均旋切24次,平均36 min (10～40 min).无一例操作失败.所有肿块均获得明确病理诊断,良性病变129例,乳腺浸润性导管癌3例均行乳腺癌改良根治术.皮肤伤口小,除10例有轻度皮下瘀血外无其它并发症.结论B超引导Mammotome微创旋切系统进行乳腺肿块切除,操作简易,切除彻底,创伤小.