一种培养评判性思维能力的护理教学方法--实践反思讨论法的研究及应用

介绍了实践反思讨论法在护理教学中的具体应用和效果，阐述了该法对于培养学生评判性思维能力的作用主要体现在四个方面：（１）使学生分享彼此的临床经验，增加实践的丰富性和多样性；（２）提高护士自信和环境适应能力；（３）养成对自己的认知和思维活动过程自觉反思、调控的能力和习惯；（４）了解病人的情感和需要，反省自己的情感和态度，逐步确立正确的学科价值观     

大鼠骨髓基质干细胞在成骨诱导剂条件下的成骨能力

目的:观察在有成骨诱导剂存在的条件下,大鼠骨髓基质干细胞向成骨细胞转化的能力。方法:实验于2005-07/12在锦州医学院中心实验室完成。选取清洁级2月龄SD大鼠6只,无菌条件下取双侧股骨,制备单细胞悬液。采用贴壁培养与传代结合方法分离纯化大鼠骨髓基质干细胞,将2代细胞置于含有1×10-7mol/L地塞米松、10mol/Lβ-甘油磷酸钠、50mg/L抗坏血酸成骨诱导剂的培养基中,培养21～30d。应用倒置显微镜观察骨髓基质干细胞与诱导后细胞形态,描绘生长曲线,流式细胞仪检测细胞周期,并用碱性磷酸酶染色和VON-KOSSA法检测成骨能力。结果:6只大鼠均进入结果分析。①骨髓基质干细胞形态学观察结果:在成骨诱导剂里细胞增殖变缓慢,呈长梭形、成纤维细胞样或不规则形。②细胞生长曲线:1～2d为潜伏期,细胞增殖不明显;3d后细胞增殖明显加快,进入对数生长期;6d后增殖变慢为平台期。经计算细胞群体倍增时间为38h。③细胞增殖周期检测结果:G0/G1期为(82.12±4.60)%,S期为(14.35±2.32)%,G2/M期为(0.87±0.30)%。④成骨能力检测结果:细胞碱性磷酸酶染色阳性率为86%,VON-KOSSA染色提示有钙结节形成。结论:大鼠骨髓基质干细胞在有成骨诱导剂存在的情况下成骨能力较高。     

pfcrt Allelic types with two novel amino acid mutations in chloroquine-resistant Plasmodium falciparum isolates from the Philippines

Mutations in the pfcrt and pfmdr1 genes have been associated with chloroquine resistance in Plasmodium falciparum. Ten and five mutations, respectively, have been identified in these genes from chloroquine-resistant parasites worldwide. Mutation patterns in pfcrt revealed that chloroquine resistance evolved independently in southeast Asia, South America, and Papua New Guinea. However, the evolution of chloroquine resistance in the rest of the Pacific region is unclear. In this study, we examined sequence polymorphisms in these genes in isolates from Morong, Philippines, and compared them to known chloroquine resistance sequences. Two novel mutations, A144T and L160Y, were identified outside of the 10 known mutations in pfcrt in Morong isolates. These novel mutations were identified only in parasites with K76T and N326D but without the common A220S mutation found in most chloroquine-resistant isolates. This represents a unique chloroquine resistance allelic type (K76T/A144T/L160Y/N326D) not previously found elsewhere in the world. One Morong isolate also had an additional C72S mutation, whereas only one isolate possessed an allelic type typical of chloroquine resistance in Asia. Parasites with the novel pfcrt allelic types were resistant to chloroquine in vitro and were unresponsive to verapamil (0.9 microM) chemosensitization, similar to chloroquine-resistant parasites from South America and Papua New Guinea. These results suggest that chloroquine resistance evolved independently in the Philippines and represents a second chloroquine resistance founder event in the South Pacific.     

肿瘤标志物可溶性CD44拼接变异体6和血管内皮生长因子在癌性腹水初筛中的临床意义

目的 探讨检测可溶性CD44拼接变异体6（sCD44v6）和血管内皮生长因子（VEGF）的水平在癌性腹水初筛诊断中的临床意义。方法 应用双抗体夹心酶联免疫吸附法检测185例腹水标本中sCD44v6、VEGF的水平，应用受试者工作特征（ROC）曲线，评价该肿瘤标志物在癌性腹水诊断中的临床价值。结果 癌性腹水组的sCD44v6、VEGF水平显著高于良性肿瘤组（P〈0．01），诊断癌性腹水以sCD44v6值78.97μg/L为临界值时，其灵敏度为71．1％、特异度94．7％；以VEGF值213．90ng／L为临界值时，灵敏度为85.6％、特异度92．6％。比较ROC曲线下面积，发现VEGF优于sCD44v6。联合检测准确率更高。结论 sCD44v6和VEGF可作为初筛诊断癌性腹水的良性肿瘤标志物，联合应用意义更大。     

金属框架打包植皮法在面部植皮中的应用

背景:颜面部打包植皮是传统的皮片固定方法,但在皮片的固定、成活质量、术后皮片挛缩及外观上存在不足,应不断完善.目的:试验拟观察应用改进的金属框架打包植皮法对提高颜面植皮成活质量的影响.设计、时间及地点:观察性试验,于2003-01/2007-12在北京积水潭医院烧伤科完成.对象及材料:选择本科收治的颜面部烧伤和烧伤后瘢痕畸形的患者23例,男16例,女7例,平均年龄(37±18)岁.手术植皮部位32处,面颊部8处,跟睑部20处、口周部4处.手术中应用的金属框架材料为医用不锈钢材质的1.0～1.5号克氏针,消毒后术中根据植皮创面形状用钳子弯制而成;术中应用的橡皮筋和回形针为普通文具用品,经环氧乙烷消毒后应用.方法:所有患者均应用金属框架打包植皮法于32处面部进行植皮,最大植皮面积为18 cm×10 cm.常规植皮缝合后周边应用1.0～1.5号克氏针按创面形状制成环形金属框架,随后打包固定移植皮片,三四周拆除金属框架.主要观察指标:于术后拆除打包包扎时,观察记录皮片成活情况,包括皮片成活率、植皮边缘是否有边缘突起中央凹陷的"火山口现象";术后三四周拆除金属框架时,观察皮片是否有小于框架的早期挛缩现象,并照相记录.对有可能进行长期随访的病例观察皮片长期的挛缩情况.结果:23例患者32处创面,除1处因基底扩创不彻底部分皮片坏死外,其余31处创面植皮均成活良好,皮片平整,未出现边缘突起中央凹陷的"火山口现象",至术后三四周拆除金属框架时,移植皮片面积与手术时维持一致,未出现早期挛缩.随访1年以上的病例皮片挛缩轻,外观满意.结论:改进的金属框架打包植皮法可提高颜面植皮的成活质量,减轻皮片挛缩.     

深静脉留置管行胸腔闭式引流的护理

胸腔积液是内科常见的临床征象，其中恶性胸腔积液较为常见。胸腔闭式引流对缓解症状、减轻痛苦、延长寿命、提高生命质量具有重要意义。近年来，深静脉留置管行胸腔闭式引流术已在我院广泛应用，尤其对于病情危重，需维持时间较长，宜适当活动者。由于其具有良好的弹性且管腔直径较细，提高了病人的舒适度，避免了反复胸腔穿刺给病人带来的痛苦和产生气胸的危险。现将我院2004年8月-2006年12月86例病人采用深静脉留置管行胸腔闭式引流情况报告如下。     

Application of CT perfusion imaging to the histological differentiation of adrenal gland tumors

Background

CT perfusion imaging has been used in diagnosis and classification of tumors widely and in assess tumor angiogenesis in some organs. However, there are few reports describing CT perfusion imaging of adrenal gland tumors.

Objective

This study aimed to evaluate the application of CT perfusion imaging in analysis of angiogenesis in adrenal tumors and in diagnosis of adrenal tumors.

Patients and methods

Forty four patients with adrenal gland tumors (26 with adenomas and 18 with nonadenomas) were enrolled in this study. CT scan of adrenal glands was performed with the perfusion of non-ionic contrast medium Ultravist. The obtained images were processed with deconvolution algorithms-based perfusion software and then perfusion parameter maps and values (blood flow, blood volume, mean transit time, and permeability surface-area production) were generated and analyzed respectively.

Results

Univariate multivariate logistic regression indicated that blood volume (OR: 1.261, 95% CI: 1.056, 1.505, P = 0.010) was associated with the likelihood of adrenal adenoma. Receiver operating characteristic analysis showed that the blood volume value of ≥9.325 ml min⁻¹ 100 g⁻¹ predicted adrenal adenoma with sensitivity of 76.9% and specificity of 73.2%. In addition, permeability surface-area production in adenoma was higher than in non-adenoma (27.11 ± 15.45 vs. 16.76 ± 14.44 ml min⁻¹ 100 g⁻¹, P < 0.05). The other parameters had no clear prognostic significance.

Conclusions

CT perfusion imaging can quantitatively distinguish adrenal gland tumors with different histological characteristics. Especially, blood volume can be used in differentiating adrenal adenomas from nonadenomas.     

Primary fourth ventricular meningioma: a case report of an adult male

Primary fourth ventricular meningiomas are extremely rare and often misdiagnosed as other tumors. They have no characteristic imaging appearance on computed tomography and magnetic resonance imaging. Therefore, differentiating the lesion from common lesions in the fourth ventricle can be diagnostically challenging. In this report, we present a 25-year-old man with fourth ventricular meningioma and refer to the usefulness of diffusion-weighted imaging and apparent diffusion coefficient measurements for the differential diagnosis of fourth ventricular tumors.     

Stress-induced reduction in reward-related prefrontal cortex function

Acute psychological stress can trigger normal and abnormal motivated behaviors such as reward seeking, habitual behavior, and drug craving. Animal research suggests that such effects may result from actions of catecholamines and glucocorticoids that converge in brain regions that regulate motivated behaviors and incentive processing. At present, however, little is known about the acute effects of stress on these circuits in humans. During functional magnetic resonance imaging (fMRI), twenty-seven healthy young women performed a modified version of the monetary incentive delay (MID) task, which is known to robustly engage ventral striatal and medial prefrontal regions. To induce psychological stress, strongly aversive movie clips (versus neutral movie clips) were shown with the instruction to imagine being an eyewitness. Physiological (cortisol levels, heart rate frequency, and heart rate variability) and subjective measurements confirmed successful induction of moderate levels of acute psychological stress. Brain imaging data revealed that stress induction resulted in a significant decrease in reward-related responses in the medial prefrontal cortex (PFC) without affecting ventral striatal responses. Our results thus show that acute psychological stress induces regionally specific changes in functioning of incentive processing circuits. This regional specificity is in line with animal data showing inverted U-shaped relations between levels of stress-related neuromodulators and functioning of the PFC, a structure that is believed to be critical for coordinating behavior in accordance with higher order internal goals. Our findings thus suggest that stress-related increases in habitual and reward-seeking behaviors may be triggered primarily by an impairment of such PFC-dependent cognitive control mechanisms.