Creating an effective PBL case in oral and maxillofacial surgery at a Chinese dental school: a dental education primer

Problem-based learning (PBL) is a widely accepted educational method centered on the discussion and learning that emerge from a clinically based problem; however, little has been reported on the details of PBL case-writing in the dental education literature. This article outlines some principles of writing a PBL case as it is practiced at a Chinese dental school and presents, as an example, an actual case based on a clinical problem (ameloblastoma of the jaw) intended to provide a learning focus for predoctoral dental students. A good PBL case should allow for progressive, interdependent actions to be taken in the evaluation and overall management of the patient in context and should trigger inquiry and discussion among students in both the basic sciences (anatomy, physiology, biochemistry, pharmacology, pathophysiology, etc.) and related clinical sciences. The epidemiological, sociological, and ethical considerations related to each problem should also be emphasized as an essential component of effective health care provision.     

两种纳米晶羟基磷灰石的细胞相容性比较

目的 比较两种不同形态纳米晶羟基磷灰石的细胞相容性。方法 采用化学湿法合成的两种纳米晶形态羟基磷灰石。采用原代培养的成骨细胞检测两者的细胞相容性。采用MTT法观察成骨细胞在几种材料表面3d后的增殖情况，细胞培养第5d时对碱性磷酸酶活性进行检测，并用SEM观察第3d时细胞在材料表面的附着形态。结果 成骨细胞在球形纳米晶羟基磷灰石表面的细胞增殖数显著高于同直径的棒状纳米晶羟基磷灰石，并具有更好的细胞伸展形态；而碱性磷酸酶表达没有明显差别。结论 羟基磷灰石球形纳米晶较棒状纳米晶更能促进成骨细胞生长。     

Inverted U-Shaped Associations between Glycemic Indices and Serum Uric Acid Levels in the General Chinese Population: Findings from the China Cardiometabolic Disease and Cancer Cohort (4C) Study

Objective The relationship between serum uric acid(SUA)levels and glycemic indices,including plasma glucose(FPG),2-hour postload glucose(2 h-PG),and glycated hemoglobin(HbA1 c),remains inconclusive.We aimed to explore the associations between glycemic indices and SUA levels in the general Chinese population.Methods The current study was a cross-sectional analysis using the first follow-up survey data from The China Cardiometabolic Disease and Cancer Cohort Study.A total of 105,922 community-dwelling adults aged≥40 years underwent the oral glucose tolerance test and uric acid assessment.The nonlinear relationships between glycemic indices and SUA levels were explored using generalized additive models.Results A total of 30,941 men and 62,361 women were eligible for the current analysis.Generalized additive models verified the inverted U-shaped association between glycemic indices and SUA levels,but with different inflection points in men and women.The thresholds for FPG,2 h-PG,and HbA1 c for men and women were 6.5/8.0 mmol/L,11.0/14.0 mmol/L,and 6.1/6.5,respectively(SUA levels increased with increasing glycemic indices before the inflection points and then eventually decreased with further increases in the glycemic indices).Conclusion An inverted U-shaped association was observed between major glycemic indices and uric acid levels in both sexes,while the inflection points were reached earlier in men than in women.     

非外伤性皮质凸面蛛网膜下腔出血237例汇集分析

目的探讨非外伤性大脑皮质凸面蛛网膜下腔出血(cSAH)的临床特征,以提高对该病的认识。方法以PubMed和"中国生物医学文献数据库"为主要检索数据库,对2004至2014年发表的中、英文文献26篇中237例CSAH的临床特征进行汇集分析,内容包括病因、临床表现、影像学特征、治疗及预后。结果 cSAH各年龄段均有发病,绝大多数急性起病。脑淀粉样血管病、可逆性脑血管收缩综合征、脑静脉血栓形成、颈内动脉狭窄/闭塞、可逆性后部脑病综合征占全部病因66.67%。常见症状为不同程度的头痛、类似短暂性脑缺血发作的神经功能缺损症状、局限性神经功能缺损以及癫发作。头颅CT阳性检出率87.91%,主要表现大脑皮质凸面条索状出血。大多数cSAH患者预后良好,再出血发生率低。结论 cSAH是蛛网膜下腔出血(SAH)的少见类型,其病因、临床表现及影像学特点与动脉瘤破裂导致SAH不同。对于初次发病的cSAH,要进行全面的脑血管筛查。     

污泥焚烧灰渣中重金属的检测和毒性分析

采用ICP-OES和原子荧光光度计分析了污泥及其焚烧灰渣中重金属的种类和浓度,并对灰渣中重金属的浸出毒性进行分析。结果表明污泥焚烧灰渣中重金属种类多、浓度高,可依据不同重金属的挥发性大小将污泥中重金属划分为极易挥发重金属、易挥发重金属、中等挥发重金属和难挥发重金属四大类,实际污染控制中应重点关注重金属Hg、As、Cd、Pb四种重金属的控制;同时,毒性浸出实验结果表明污泥焚烧之后灰渣中重金属稳定性得到极大提高,可直接进行填埋处理,但做建材使用时仍存在很大的浸出风险。     

Resolution of concomitant Achromobacter xylosoxidans burn wound infection without adjustment of antimicrobial therapy

Achromobacter xylosoxidans is part of an emerging group of Gram negative bacterial infections with potentially severe sequelae, especially in the immunocompromised population such as burn patients. While antimicrobial therapy for patients with A. xylosoxidans bacteremia has been reported, the literature is scarce with regard to treatment in patients with positive tissue cultures only. Herein, we report our institution''s experience with such a case and a brief review of the current literature on this micro-organism in the setting of non-bacteremic infection.KEY WORDS: Achromobacter xylosoxidans, alcaligenes xylosoxidans, burn, tissue culture     

PICC维护网络的建立与管理

目的探讨PICC置管患者携管出院期间的维护方法。方法静脉治疗团队将进修护士、肿瘤专科护士、静疗专科护士及静疗学习班学员纳入网络维护人员,逐步建立PICC维护网点并不断扩大规模,通过建立维护花名册、QQ群、专科护士返基地活动等措施进行管理。结果 PICC维护网络已覆盖到江苏省126所二、三级医院及安徽省3个市县的3所二、三级医院,参与PICC维护网点维护的护士达195人。携管出院患者导管相关并发症(静脉炎、导管堵塞、皮肤湿疹、渗液、非计划拔管)的总发生率由2008年的17.9%下降至2013年的3.5%;借助QQ群解决了近600例置管及维护疑难问题。结论 PICC维护网络的建立,满足了携管出院患者治疗间歇期间的导管维护需求,既增加了维护点医院的经济效益又提升了社会效益。     

老年术后患者全静脉营养治疗中预防心力衰竭的输液管理

目的探讨老年患者术后全静脉营养治疗过程出现急性心力衰竭的预防护理措施与效果。方法将65岁以上术后静脉营养治疗的患者460例,按住院时间顺序分为常规组(240例)和干预组(220例)。常规组给予输液管调节器控制输液速度(40~65gtt/min)、监测CVP并准确记录24h出入液量及输液常规健康教育;干预组在此基础上采取使用输液泵、阶梯式输液速度控制、合理安排输液次序、制定昼夜输液要求、缩短CVP监测间隔时间等措施。结果常规组出现急性心力衰竭8例(3.3%),干预组未发生,两组比较,差异有统计学意义(P0.05)。结论老年患者术后全静脉营养治疗过程中,采取积极的护理干预措施,可有效预防静脉输液诱发的心力衰竭。