TBL 结合情境教学在预选卫生士官常见疾病教学中的应用

目的　研究以团队为基础的学习（team-based learning, TBL）结合情境教学在预选卫生士官常见疾病教学中的应用成效。方法　将200名学员随机等分为两组（每组100名学员）,教学内容均为高原病和高血压两个章节,对照组（LBL组）学员按照传统方法教学;实验组（TBL组）学员则采用小组学习讨论结合情境教学,由教师提前拟定预习提纲及思考题,学员在课堂上以小组为单位开展讨论,并应用典型病例进行情境模拟。教学完成后,两组学员均采用成绩考核和问卷调查两种方式评估教学效果。结果　TBL组与LBL组相比,学员理论考核分数明显提高（88.90±5.28 vs. 76.10±5.12,P＜0.05）,教师对学员的满意度评分也较高（8.63±0.85 vs. 7.18±0.72,P＜0.05）。结论　TBL成效好,有助于提高学生学习兴趣和自学能力,培养其分析解决问题的能力,加强其沟通能力和团队协作精神。     

Lifetime and baseline alcohol intakes and risk of pancreatic cancer in the European Prospective Investigation into Cancer and Nutrition study

Recent evidence suggested a weak relationship between alcohol consumption and pancreatic cancer (PC) risk. In our study, the association between lifetime and baseline alcohol intakes and the risk of PC was evaluated, including the type of alcoholic beverages and potential interaction with smoking. Within the European Prospective Investigation into Cancer and Nutrition (EPIC) study, 1,283 incident PC (57% women) were diagnosed from 476,106 cancer‐free participants, followed up for 14 years. Amounts of lifetime and baseline alcohol were estimated through lifestyle and dietary questionnaires, respectively. Cox proportional hazard models with age as primary time variable were used to estimate PC hazard ratios (HR) and their 95% confidence interval (CI). Alcohol intake was positively associated with PC risk in men. Associations were mainly driven by extreme alcohol levels, with HRs comparing heavy drinkers (>60 g/day) to the reference category (0.1–4.9 g/day) equal to 1.77 (95% CI: 1.06, 2.95) and 1.63 (95% CI: 1.16, 2.29) for lifetime and baseline alcohol, respectively. Baseline alcohol intakes from beer (>40 g/day) and spirits/liquors (>10 g/day) showed HRs equal to 1.58 (95% CI: 1.07, 2.34) and 1.41 (95% CI: 1.03, 1.94), respectively, compared to the reference category (0.1–2.9 g/day). In women, HR estimates did not reach statistically significance. The alcohol and PC risk association was not modified by smoking status. Findings from a large prospective study suggest that baseline and lifetime alcohol intakes were positively associated with PC risk, with more apparent risk estimates for beer and spirits/liquors than wine intake.     

A comparison of six methods for genomic DNA extraction suitable for PCR-based genotyping applications using ovine milk samples

Isolation of amplifiable genomic DNA is a prerequisite for the genetic assessment of diseases and disease susceptibility in farm animals. Milk somatic cells are a practical, animal friendly and cost-effective source of genomic DNA in milking ruminants. In this study, six different DNA extraction methods were optimized, evaluated and compared for the isolation of DNA from ovine milk samples. Methods 1 and 2 were direct applications of two commercial kits, Nucleospin^® Blood and Nucleospin^® Tissue, respectively. Methods 3 and 4 were based on modified protocols of methods 1 and 2, respectively, aiming at increasing DNA recovery and integrity, and eliminating PCR inhibitors. Method 5 was a standard Phenol–Chloroform protocol application and method 6 was based on an in-house developed protocol using silica as the affinity matrix. Spectrophotometer, gel electrophoresis and real-time PCR measurements were used as criteria for evaluating quantity and quality of the extracted DNA. Processing time, intensity of labor and cost for each method were also evaluated. Results suggested that methods 1–4 were considered suitable for molecular downstream applications and performed better than methods 5 and 6. Modifications of protocols 3 and 4 increased the quantity and quality of the extracted DNA from ovine milk samples. Method 3 was proved to be highly efficient and robust for large scale use as demonstrated by its successful application to 1000 individual ovine milk and 50 bulk milk samples.     

3例肝移植术后罕见高热患者的护理

对3例肝移植术后高热患者进行生命体征监测，并结合实验室检查结果分析，认为肝移植术后高热除了排斥反应和感染等原因外，可能存在疟原虫感染。细致的护理对查找高热原因和促进患者康复具有重要的意义。     

Sputum carcinoembryonic antigen, neuron-specific enolase and cytokeratin fragment 19 levels in lung cancer diagnosis

OBJECTIVE: The aim of the present study was to examine the impact of sputum carcinoembryonic antigen (CEA), neuron-specific enolase (NSE) and cytokeratin fragment 19 (CYFRA 21-1) levels in lung cancer diagnosis and to compare the diagnostic usefulness of sputum assays with that of serum assays. METHODOLOGY: Forty-seven patients with lung cancer and 62 with benign lung disease were studied. Tumour marker levels in sputum (sp.) and serum (ser) were measured by immunoradiometric assays. RESULTS: Sputum and serum tumour marker levels were significantly higher in lung cancer than in benign disease. When the specificity was 95%, the sensitivity was 57%, 43%, 36%, 30%, 28% and 19%, for spCEA, serCYFRA 21-1, spCYFRA 21-1, serCEA, serNSE, and spNSE, respectively. Bayesian analysis showed that the best predictive values correspond to spCEA and serCYFRA 21-1. The maximum overall gain was obtained in pretest probability of 0.35 for both spCEA and serCYFRA 21-1, with predictive values of 84% and 80% for spCEA and serCYFRA 21-1, respectively. CONCLUSION: Sputum tumour marker levels were no more useful than the serum levels in lung cancer diagnosis. SpCEA offered the best predictive values but these were still not sufficiently satisfactory for spCEA to be proposed for routine use.     

Cumulative incidence of coronary lesions with vulnerable characteristics in patients with stable angina pectoris: an intravascular ultrasound and angiographic study

BACKGROUND: The impact of allograft vasculopathy on the coronary circulation and consequently on cardiac outcome may be expressed by coronary flow reserve (CFR) impairment. Therefore, we aimed to evaluate CFR and its relation to cardiac events in heart transplant patients. METHODS: Twenty-three patients, 2 female, with left ventricular ejection fraction >45% were studied 76+/-30 months after heart transplantation. They were divided into 2 groups according to coronary angiography: Group A, 10 patients with significant coronary artery disease (stenosis> or =50%) and group B, 13 patients without significant stenosis. Twenty healthy subjects, 13 female, served as controls. Coronary flow velocity reserve (CFVR) was assessed by transesophageal echocardiography and calculated as the ratio of maximal (i.v. adenosine, 140 microg/kg/min) to baseline coronary velocities. Patients were followed for a mean of 25 months for cardiac events. RESULTS: Compared to controls, heart transplant groups showed significantly higher baseline coronary flow velocities (51+/-27, 38+/-12 and 32+/-12 cm/s, respectively) and lower maximal coronary velocities (90+/-52, 112+/-33 and 118+/-24 cm/s), resulting in a reduced CFVR (1.9+/-1.0, 3.0+/-0.5 and 3.8+/-1.2). Multivariate analysis identified heart transplantation and epicardial coronary artery disease as the only variables independently related to CFVR. Hypertension was positively related to baseline while diabetes inversely related to maximal coronary flow velocities. A CFVR <2.3 was a marker for cardiac events (4 deaths, 1 heart failure). CONCLUSION: CFVR impairment, particularly in the presence of epicardial coronary artery disease, follows heart transplantation and is associated with a worse outcome.     

Perioperative use of iloprost in cardiac surgery patients diagnosed with heparin‐induced thrombocytopenia‐reactive antibodies or with true HIT (HIT‐reactive antibodies plus thrombocytopenia): An 11‐year experience

Thrombocytopenia and thromboembolism(s) may develop in heparin immune‐mediated thrombocytopenia (HIT) patients after reexposure to heparin. At the Onassis Cardiac Surgery Center, 530 out of 17,000 patients requiring heart surgery over an 11‐year period underwent preoperative HIT assessment by ELISA and a three‐point heparin‐induced platelet aggregation assay (HIPAG). The screening identified 110 patients with HIT‐reactive antibodies, out of which 46 were also thrombocytopenic (true HIT). Cardiac surgery was performed in HIT‐positive patients under heparin anticoagulation and iloprost infusion. A control group of 118 HIT‐negative patients received heparin but no iloprost during surgery. For the first 20 patients, the dose of iloprost diminishing the HIPAG test to ≤5% was determined prior to surgery by in vitro titration using the patients’ own plasma and donor platelets. In parallel, the iloprost “target dose” was also established for each patient intraoperatively, but before heparin administration. Iloprost was infused initially at 3 ng/kg/mL and further adjusted intraoperatively, until ex vivo aggregation reached ≤5%. As a close correlation was observed between the “target dose” identified before surgery and that established intraoperatively, the remaining 90 patients were administered iloprost starting at the presurgery identified “target dose.” This process significantly reduced the number of intraoperative HIPAG reassessments needed to determine the iloprost target dose, and reduced surgical time, while maintaining similar primary clinical outcomes to controls. Therefore, infusion of iloprost throughout surgery, under continuous titration, allows cardiac surgery to be undertaken safely using heparin, while avoiding life‐threatening iloprost‐induced hypotension in patients diagnosed with HIT‐reactive antibodies or true HIT. Am. J. Hematol. 90:608–617, 2015. © 2015 Wiley Periodicals, Inc.     

Skeletal myopathy associated with concomitant use of statin and cyclosporin in a heart transplant patient - case report

62-year-old woman after heart transplantation due to congestive heart failure of ischemic origin with history of hyperlipidemia was treated with cyclosporin and statin. Concomitant use of these agents caused clinical and biochemical symptoms of skeletal myopathy. After statin withdrawal the symptoms of myopathy disappeared.     

Analysis of epidemiology, clinical features and management of erysipelas

Background Erysipelas is a superficial form of cellulitis affecting the upper dermis and superficial lymphatics. The widespread use of antibiotics may affect clinical findings and response to therapy of infectious disorders. The purpose of the study was to investigate the epidemiological, clinical, and laboratory features of erysipelas and to compare the results of treatment with penicillin vs. other antibiotic regimens. Methods All charts of erysipelas patients treated at the University Hospital of Heraklion, Crete, Greece from 1994 to 2002 were retrospectively studied. Results Median age of the 99 patients was 54.5 years; 59% were females. The most frequent site involved was the lower extremity (76%), followed by the face (17%) and upper extremity (6%). In 61 patients (62%), a possible entry portal was identified. The most common manifestation of erysipelas was local symptoms and signs (pain, erythema, and swelling) in all patients, together with elevated erythrocyte sedimentation rate (ESR) (60%). Fever was present in 25% of patients. The most commonly used antibiotic was intravenous penicillin G (64%). In the penicillin group, mean duration of fever after treatment initiation was shorter than in the nonpenicillin group (1.7 vs. 4.5 days, P = 0.002). Both treatment failures and recurrences were the same between the two groups. Discussion The diagnosis of erysipelas can be based on careful examination for local signs and symptoms. The role of ESR in primary diagnosis needs further investigation. Penicillin seems to preserve its fundamental role in the treatment of disease.