品管圈在促进会阴伤口愈合中的临床应用

【】目的 探讨品管圈(QCC)活动在促进阴道分娩产妇会阴伤口愈合中的临床效果。方法 成立QCC小组,找出影响阴道分娩产妇会阴伤口愈合的相关因素,针对出现的问题进行分析,找出原因,提出整改措施,制定规范的操作流程,再进行PDCA循环,在临床中检测方法的有效性,从而不断提高助产质量,提高产妇的生活质量。结果 观察组产后会阴伤口愈合不良的发生率明显低于对照组,两组比较,差异有统计学意义(X₂=6.3421, p<0.05)。结论 通过QCC,可有效提高阴道分娩产妇伤口愈合率,减轻产妇的痛苦,提高了产妇的生活质量。     

Historically‐informed nursing: A transnational case study in China

The term ‘nurse’ (hushi—’caring scholar’) did not enter the Chinese language until the early 20th century. Modern nursing—a fundamentally Western notion popularized by Nightingale and introduced to China in 1884—profoundly changed the way care of the sick was practiced. For 65 years, until 1949, nursing developed in China as a transnational project, with Western and Chinese influences shaping the profession of nursing in ways that linger today. Co‐authored by Chinese, Canadian, and American nurses, this paper examines the early stages of nursing in one province of China as an exemplar of the transnational nature of nursing development. By identifying sociopolitical influences on the early development of nursing in Shandong, the authors aimed not only to contribute to the nascent body of knowledge on China nursing history, but also to heighten readers’ sensitivity to the existence of historical echoes, residue, and resonances in their own nursing practices. Tracing current issues, values, or practices back to their roots provides context and helps us to better understand the present. Whether we are aware of the details or not, the gestalt of nursing practice in a particular place has been shaped by its history—including in Shandong province in China.     

Potential diagnostic performance of contrast-enhanced ultrasound and tumor markers in differentiating combined hepatocellular–cholangiocarcinoma from hepatocellular carcinoma and cholangiocarcinoma

Purpose

To evaluate the diagnostic performance of the combination of tumor markers [alpha-fetoprotein (AFP) and carbohydrate antigen 19-9 (CA19-9)] and imaging features in differentiating combined hepatocellular–cholangiocarcinoma (CHC) from hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC).

Methods

Forty consecutive patients with pathologically proven CHC were retrospectively evaluated with contrast-enhanced ultrasound (CEUS). Additionally, 40 HCC and 40 CC patients who were randomly selected from the same period served as a control group. Images were classified as HCC-like or CC-like pattern according to CEUS guidelines recommended by World and European Federation for Ultrasound in Medicine and Biology (WFUMB-EFSUMB). The diagnostic criteria of CHC were defined as follows: (1) both AFP and CA19-9 are simultaneously elevated (AFP > 20 ng/ml and CA19-9 > 100 units/ml); or (2) elevated AFP with a CC-like pattern on CEUS and without elevated CA19-9 level; or (3) elevated CA19-9 with an HCC-like pattern on CEUS and without elevated AFP level. The diagnostic tests were performed with calculation of the sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC).

Results

For the 40 CHC patients, the rates of elevated AFP and CA19-9 serology were 55.0 and 30.0%, respectively. Twenty-three (57.5%) patients exhibited an HCC-like pattern, and 15 (37.5%) showed a CC-like pattern. After applying the above diagnostic criteria of CHC in the 120 patients, the sensitivity, specificity, PPV, NPV, accuracy, and AUC were 32.5, 93.8, 72.2, 73.5, 73.3, and 0.631%, respectively. When the actual prevalence rate (0.4–14.3%) was taken into account, the PPV and NPV were modified from 2.1 to 46.7% and 89.3 to 99.7%, respectively.

Conclusion

The combination of enhancement patterns on CEUS and serum tumor markers (AFP and CA19-9) may be a potentially specific diagnostic method to differentiate CHC from HCC and CC.

     

Complex Regional Pain Syndrome,Current Concepts and Treatment Options

Purpose of Review

Complex regional pain syndrome (CRPS) refers to a chronic pain condition that is characterized by progressively worsening spontaneous regional pain without dermatomal distribution. The symptomatology includes pain out of proportion in time and severity to the inciting event. The purpose of this review is to present the most current information concerning epidemiology, diagnosis, pathophysiology, and therapy for CRPS.

Recent Findings

In recent years, discovery of pathophysiologic mechanisms of CRPS has led to significant strides in the understanding of the disease process.

Summary

Continued elucidation of the underlying pathophysiological mechanisms will allow for the development of more targeted and effective evidence-based therapy protocols. Further large clinical trials are needed to investigate mechanisms and treatment of the disorder.

     

师生对八年制医学教育课堂教学方法改革期望的调查研究

目的　探讨师生对八年制医学教育课堂教学方法改革的相关期望,为课堂教学方法评价及改革提供依据。方法　将在校已经完成医前教育阶段的八年制医学生78人（2008级22人,2009级20人,2010级20人,2011级16人）和相关任课教师32人作为调查对象,运用自制调查问卷,针对“对改革当前课堂教学方法的期望”“最期望应用的课堂教学方法”“对课堂教学方法应用价值的期望”等问题进行了解。运用SPSS 20.0软件进行统计分析。结果　55.8%（43人）的学生和78.1%（25人）的教师期望改革当前课堂教学方法,差异具有统计学意义（ ?字2=4.782,P=0.029）;61.0%（47人）的学生和90.6%（29人）的教师最期望“多种方法结合应用”,包括讲授式结合板书、讲授式结合多媒体、PBL、翻转课堂、自主学习、应试（刷题）等,差异具有统计学意义（?字2=15.464,P=0.017）,对课堂教学方法应用价值的期望（＞60%）多元化,包括能激发学生学习兴趣、能培养发现问题和解决问题的能力、有利于知识的理解和记忆、有利于学习方法的培养、能提高创新和批判性思维能力、有利于加强师生间互动和沟通、能提高学生课堂主体意识、有利于培养团队协作精神、能提高教学效率、能充分运用信息技术手段等。结论　当前八年制医学教育课堂教学方法改革具有较高期望和多样化价值需求,应重视课堂教学方法评价及改革指导。     

面向混合学习的医学院校《信息安全》课程改革与实践

通过分析混合学习的典型特征,构建了由前期分析、学习活动设计和多元评价构成的混合学习组织过程模型。以第四军医大学《信息安全》课程为例开展混合学习案例研究,详细阐述了混合学习目标制定、内容选择、环境构建、活动实施和课程评价的方法。最后,针对混合学习实施效果进行了问卷调查,结果表明,混合学习能够有效调动学生的学习积极性。但要进一步提升学习效果,混合学习应具有良好的灵活性与适配性,并充分体现面授教学与在线学习的有机融合。     

Bioluminescence Imaging for Monitoring miR-200c Expression in Breast Cancer Cells and its Effects on Epithelial-Mesenchymal Transition Progress in Living Animals

Purpose

Dysregulation of microRNAs (miRNAs) are not only involved in the formation of malignant tumors but also in the processes of differentiation and aggressiveness. However, current methods for detecting miRNA expression have major disadvantages, such as being invasive and non-reproducible. The epithelial-mesenchymal transition (EMT) has been implicated as a pivotal event in the metastasis, stemness, and chemoresistance of malignant tumors.

Procedures

In our study, we constructed a new reporter gene, Luc2/tdT_miR200c_3TS, to examine the in vitro and in vivo expression of miR-200c, an EMT-associated miRNA. Quantitative real-time PCR was used to measure the expression levels of miR-200c and EMT-related mRNA, and luciferase assay and bioluminescence imaging were used to measure the luciferase activities in vitro and in vivo, respectively.

Results

We found that the expression level of miR-200c was negatively associated with cell migration and invasion. Luciferase activities were regulated by the differential expression levels of miR-200c and EMT process.

Conclusions

Our results demonstrate that Luc2/tdT_miR200c_3TS may be a useful tool for monitoring the expression level of miR-200c at both the cellular level and in living animals, thereby providing a potential high-throughput approach for anticancer drug screening.

     

基于模型的多因子降维方法在基因-基因/环境交互作用分析中的应用

介绍一种基于模型的多因子降维方法(MB-MDR),并通过实例说明其分析流程及其在基因-基因/环境交互作用分析中的应用。结果显示该方法可用于原始样本量较小的资料研究,同时也能解决许多经典MDR方法的不足;与其他MDR扩展方法相比,在探索交互作用方面具有更高的统计效能,并已成功应用于膀胱癌、湿疹等研究。MB-MDR能够处理二元性状和数量性状,并可在模型中调整因子的边际效应和混杂因子,与其他非参数方法相比具有一定优势。因此MB-MDR在基因-基因/环境交互作用分析中具有较好的应用前景。