一个医学生眼里的医学伦理学教育

主要通过医学生的视角，从教学内容、教学方法等方面谈了对医学伦理学教育的感受和一些建议，并通过医学生的声音反映医学伦理学教育的成果以及存在的一些问题。     

Diabetes Education: Whose Priorities Are Met?

Two hundred Type 2 diabetic patients newly referred to the diabetes centre at a large university teaching hospital were studied over an 8-month period. Patients completed a diabetes knowledge questionnaire, and specified their educational priorities by selecting six diabetes-related topics from a list of 14. After giving 1 h of individual education and using the same list, the educators selected six topics which they considered to be most important for that particular patient to know. Choice of educational priorities differed between the patients and the corresponding educator (p less than 0.001). In only 38% of cases did the educators' first three priorities coincide with those of the patients. The major discrepancies were in the selection of 'sick day management' and 'complications', especially favoured by patients, as against 'oral hypoglycaemic agents' and other therapy-related topics, especially favoured by educators. Diabetes knowledge was a determinant of educational priority for patients (p less than 0.001) but not educators. In contrast, only the educators' overall choices were affected by duration of diabetes (p less than 0.001). Diabetes treatment type influenced both patients' and educators' selection of priorities (p less than 0.001). We conclude that an educational strategy which relies on health professionals' perceptions to determine what diabetic patients need to know may be inadequate.     

Studies on monoclonal anti-isotypic and anti-idiotypic antibodies against leukemia and myeloma: IV modulation of membrane fluidity of leukemic cell lines and tonsillar cell stimulated with McAbs

Summary In this study the technique of labelling the cell membrane with DPH fluorescence polarization was used to observe the membrane fluidity of B lymphocytic cell lines and tonsillar cells from healthy persons; the modulation effect on membrane-fluidity induced by McAbs against isotypic and idiotypic determinants of IgM from patients with leukemia was studied as well. The expression of the corresponding isotypic and idiotypic determinants of IgM on the cell membrane was determined. The results show that the membrane fluidity of leukemic cell lines is remarkably higher than that of tonsillar cells from healthy persons, and McAbs against isotypic determinants of leukemic IgM can enhance the membrane fluidity of all kinds of cells mentioned above. However, the anti-idiotypic monoclonal antibody increased only the membrane fluidity of leukemic cell lines. These results indicated that there was a close relationship between the effect of McAbs on cell membrane fluidity and the expression of corresponding isotypic and idiotypic determinants of IgM on the cell membrane.     

Chemical constituents of Hedysarum polybotrys Hand.-Mazz]

Butanedioic acid was isolated from the ethyl alcohol extract of Hedysarum polybotrys. The methylated carboxylic acid was identified by GC-MS method.     

胶体金免疫层析法检测尿hCG的质量控制方法探讨

目的通过对胶体金免疫层析法（GICA）试纸条评价,建立该方法的检测尿hCG的室内质控.方法利用hCG不同浓度的标准品评价试纸条的敏感性、重复性、稳定性、检测范围,检测温度及时间对试纸条检测尿hCG结果的影响等.结果GICA的检测范围25-100万mlU/ml,最低检出限达25mIU/ml,大于200万mIU/ml时存在后带现象.试纸条反应5分钟后呈色均一,最佳检测温度为4-30℃.结论灵敏度检测可作为GICA室内质控的主要指标,它能保证检测结果的准确性.     

胸部X线与CT诊断支气管结核的临床价值

目的分析胸部X线及CT影像征象在支气管结核临床诊断中的价值和意义。方法收集本院经病理及电子支气管镜证实为支气管结核105例，对照其胸部X线与CT表现进行回顾性分析。结果105例患者中，胸部X线显示伴有肺内结核灶77例，气管狭窄、肺叶不张分别为51例和49例，未见异常表现17例。胸部CT扫描对气管狭窄及肺叶不张检出率明显提高，分别为72例和61例，且能观察到气管内壁情况及狭窄或阻塞后肺野情况，伴肺内结核灶79例，无异常改变只有8例。结论提高对支气管结核的影像学认识，能有效地提高临床诊断准确率。     

Twinblock矫治器早期治疗安氏Ⅱ^1的软硬组织变化

目的研究早期应用Twinblock治疗安氏Ⅱ1前后牙面软硬组织的变化并探讨相互关系。方法对16例应用Twinblock治疗前后的912岁安氏Ⅱ1病例X线头颅侧位定位片进行分析,共测量18项硬组织和15项软组织项目,分析治疗前后软硬组织的变化。结果矫治后的硬组织改变主要为SNB角的增大和ANB角的减小,提示下颌骨的生长,面角增加和颌突角减小,上前牙轻度内收和下前牙少量唇倾。软组织面凸角减小,软组织面角和Z角增加,反映出软组织侧貌突度的减小。结论对安氏Ⅱ1病例早期应用Twinblock能够产生下颌骨的骨骼改变,并达到相应的软组织侧貌美观改善。     

肝病患者血清中总胆汁酸测定的意义

采用全自动酶法分析法 ,测定 32 1例各种肝病患者血清总胆汁酸 (TBA)。结果表明 :血清总胆汁酸是一种较灵敏的肝功能指标。在各类肝病中 ,尤其是急性肝炎、肝硬化、肝癌患者的总胆汁酸 (TBA)浓度均明显高于正常对照组 (P<0 .0 1) ,并在肝功能常规指标改变不明显时对肝脏疾病的诊断有一定的价值     

甲状腺部分切除术后甲状腺功能减退的相关原因分析

目的　探讨继发于部分甲状腺 ( 5 0 %～ 70 % )切除术后甲状腺功能减退 (甲减 )的发病率和相关原因。方法　回顾性分析 1988～ 2 0 0 0年行部分甲状腺切除术 12 10例患者的临床资料 ,包括年龄、性别、血清TSH水平、甲状腺球蛋白抗体 (TGA )、甲状腺过氧化物酶抗体 (TPO )、切除甲状腺组织重量等 ,以确定外科术后甲减的发生率和相关原因。结果　 12 10例中有 41例 ( 3 .4% )诊断为甲减 ,其中亚临床甲减 2 8例 ,临床甲减 13例。术后TSH平均水平为 ( 9.2 2± 3 .3 6)mU /L。与甲状腺功能正常患者的术前TSH水平 [( 1.0 7± 0 .72 )mU /L]相比 ,甲减者术前TSH平均水平 [( 3 .14±1.0 5 )mU /L ]明显升高 (P 0 .0 5 ) ;术前、术后的TGA及TPO水平比术后功能正常者明显升高 (P 0 .0 5 )。在年龄、性别或切除甲状腺组织重量上无显著性差异。平均甲状腺片的有效治疗剂量为1mg/ (kg·d) [范围 0 .3～ 1.3mg/ (kg·d) ]。 结论　继发于部分甲状腺切除术后的甲减常见于术前TSH和甲状腺自身抗体水平较高的病例 ,而与年龄、性别或切除甲状腺组织重量等因素无关 ,通常是症状轻微或无症状者 ,且用小剂量的甲状腺激素治疗效果良好。     

1例成人Still病的临床观察与护理

成人Still病(AOSD)又称变应性亚败血症,病因及发病机制不明,临床表现复杂多样,主要以弛张热、一过性多形性皮疹、关节痛为主要临床表现,并伴有周围血粒细胞增生,严重者可出现多脏器功能损害[1],激素治疗有效。该病临床较少见,早期临床表现缺乏特异性,所以极易误诊。我科2006年2月9日收治1例AOSD病人,现报告如下。1临床资料病人,男,18岁。于2006年1月3日无明显诱因出现咽痛、发热,体温最高达39.3℃,鼻塞,伴周身酸痛、关节疼痛,2006年1月7日晨起排血尿1次,门诊血常规检查:白细胞14.2×109/L,中性粒细胞0.918,淋巴细胞0.053,单核细胞0.029,…