PBL、CBL联合教学在中药临床药师培训带教中的实践研究

目的 探讨以问题为基础的学习（problem-based learning,PBL）联合以案例为基础的学习（case-based learning,CBL）在中药临床药师规范化培训中的应用效果。方法 选取2020年8月至2021年7月在重庆市中医院进行中药临床药学规范化培训的40名中药临床药师作为研究对象,将其分为研究组（PBL、CBL联合教学）及对照组（传统教学）。比较两组理论知识、实践技能、培训满意度问卷调查等。采用SPSS 23.0进行t检验和卡方检验。结果 研究组理论知识和实践技能考核结果成绩分别为（49.45±5.52）分及（48.65±5.23）分,高于对照组的（40.54±5.65）分及（41.53±4.41）分,组间比较差异有统计学意义（P<0.05）。培训满意度问卷结果显示,研究组在临床问题的分析能力及解决能力强、学习主动性及积极性强、教师乐于与学员互动、教学相长、满意此种考核方式方面高于对照组（P<0.05）。结论 PBL、CBL联合教学有利于提高中药临床药师规范化培训的教学质量,可培养药师良好学习习惯、独立思考能力、临床思维能力,有益于培养高质量的中药临床药师。     

兔视网膜在不同阈值激光作用后MMP-9表达的变化

目的:观察兔视网膜在不同阈值577nm激光作用后MMP-9的表达变化.方法:将色素兔26只采用抽签法随机分为正常对照组2只、常规光凝组6只和阈下微脉冲光凝组18只.正常对照组不做任何处理,常规光凝组行577nm激光光凝,阈下微脉冲光凝组又亚分为三个亚组,分别行9%、12%、15%工作负载率的577nm阈下微脉冲激光光凝.采用免疫组织化学法检测各组兔眼视网膜上MMP-9的表达情况.结果:常规光凝组:RPE层及视细胞层MMP-9呈强阳性表达,较阈下微脉冲组明显增多,差异有统计学意义(P<0.05);阈下微脉冲组:9%工作负载率见RPE层及视细胞层MMP-9少许阳性表达,12%工作负载率见RPE层及视细胞层阳性表达增多、胞核也出现少许阳性表达,15%工作负载率RPE层及视细胞层中度阳性表达,三个亚组间差异无统计学意义(P>0.05).结论:577nm阈下微脉冲光凝在9%、12%、15%工作负载率下对视网膜色素上皮层具有高度选择性,对视网膜神经纤维层无明显损伤,较常规577nm激光光凝更加安全.     

全数字化野战伤员搜救与信息管理系统

介绍一套无线野战伤员搜救与信息管理系统.通过蓝牙信息卡、个人数据助理PDA、GPS卫星定位系统以及CDMA无线网络,实现战场上伤员精确定位、快速搜救和伤员电子伤票生成管理,为各级救治机构提供伤员信息,实现信息共享.     

亚健康抑郁倾向人群的中医辨识及影响因素分析

目的了解亚健康抑郁倾向人群的基本特征,明确其体质类型、心理状态、应对方式、应激事件发生等。方法采用《个人身心健康调查量表》进行横断面调查,利用EPI软件建立数据库,以SAS8.1软件进行统计分析。结果抑郁倾向女性易发生,20～40岁人群发生率最高,大专以上学历最多见,职业以党政机关办事人员及专业技术人员为主,并与家庭不和、人际关系不协调、生活环境改变等应激事件有关;抑郁倾向人群以虚性体质(阳虚、阴虚)为主,SCL-90量表各因子阳性结果发生率高于健康人群(P<0.01),社会应对方式以消极应对为主,生活质量评分低于健康人群水平(P<0.05)。结论亚健康抑郁倾向人群女性多见,以虚性体质的高学历、脑力劳动者为主,同时与家庭不和、人际关系不协调、生活环境改变等特定应激事件有关。     

VSD联合邮票植皮治疗跟腱断裂后皮肤软组织缺损

目的:探讨应用持续封闭负压引流联合邮票植皮术治疗跟腱断裂后皮肤软组织缺损的治疗方法及临床疗效。方法:采用持续封闭负压引流联合邮票植皮治疗跟腱断裂后皮肤软组织缺损9例,跟腱功能恢复疗效评价按Arner-Lindholm标准进行评定。结果:本组均获6～13月随访,平均随访(7±3.5)个月,植皮成活率100%,足跟部外形良好。疗效优5例,良3例,差1例,优良率为88.9%。结论:应用持续封闭负压引流联合邮票植皮治疗跟腱断裂后皮肤软组织缺损,操作简单,能够较好地修复跟腱区皮肤软组织缺损、缩短治疗时间,有利于踝关节的功能恢复,是一种治疗跟腱断裂后皮肤软组织缺损的较好方法。     

丙泊酚联合地佐辛对人工流产术后血流动力学的影响

目的 观察丙泊酚联合地佐辛用于人工流产术对血流动力学的影响.方法 随机选取拟行无痛人流术的成年女性120例.分别测定地佐辛注药前（T0）,注药后5 min（T1）、注射丙泊酚后5 min（T2）、手术结束时（T3）平均动脉压（MAP）、心率（HR）、心率变异性功率谱（HRV）.结果 静脉注射地佐辛5 min（T1）MAP、HR较T0升高,差异有统计学意义（P＜0.05）,注射丙泊酚5 min（T2）后MAP、HR、HRV低频带、高频带/低频带较T1显著降低,差异有显著统计学意义（P＜0.01）,T3有所回升,但较T1仍显著降低,差异有统计学意义（P＜0.05）,T2、T3较T0差异无统计学意义（P＞0.05）.结论 丙泊酚联合地佐辛可安全用于人工流产术,静脉注射丙泊酚2 mg/kg联合地佐辛0.1 mg/kg对血流动力学无明显抑制或兴奋,且镇静镇痛效果较好.     

Lisfranc损伤围手术期的中医护理

目的探讨Lisfranc损伤围手术期中医护理临床效果。方法选择住院患者30例,男性26例,女性4例;年龄45～26岁,平均28．4岁;车祸伤13例,落伤12例,压砸伤5例。Lisfranc损伤按照Myerson分型,1型10例,2型17例。3型3例。软组织损伤按照Tscheme分级,0级10例,1级8例,2级8例,3级4例。结果所有病例获得完整随访。随访时间5～20个月,平均14个月;本组病例伤口1期愈合,骨折愈合时间5—7个月平均愈合时间6个月。Maryland足部评分优良率90．00％。结论Lisfranc损伤围手术期的中医护理十分重要,不仅要注意观察患肢血液循环和皮肤张力情况进行常规护理,而且还要对患者进行心理护理,加强患肢功能锻炼,预防深静脉栓塞,发挥中医药治疗本病的优势,积极预防术后并发症,才能使患者尽快康复。．     

Clinical curative effect of electric acupuncture on acute cerebral in- farction： a randomized controlled multicenter trial

OBJECTIVE： To examine whether electric acupuncture can improve the daily life of patients with ischemic cerebral apoplexy at acute stage.METHODS： A stratified-block randomized controlled multicenter trial was designed for this study.Totally 340 patients with acute ischemic cerebral apoplexy were randomly divided into an electric acupuncture group and a control group. In the electric acupuncture group, 170 patients were treated with electric acupuncture and routine therapy, and170 patients in the control group with routine therapy alone. Major indexes for judging curative effect were Barthel index at 3- and 6- months follow-up visits and number of re-hospitalized patients. Mi-nor indexes for judging curative effect were change in the score for nervous dysfunction at 4and 12 weeks follow-up visits and number of patients persisting in rehabilitation treatment with acupuncture during follow-up visit.RESULTS： Baseline data at the time of case selection between the two groups were similar. The odds ratio（OR） was 0.92, and the 95% confidence interval（CI） was 0.49-1.73 in disabled rate and 0.73 and 0.51-1.05 in the number of re-hospitalized patients in the electric acupuncture group at 6-month follow up visit compared with the control group.There was no difference in the score for nervous dysfunction at the end of 12-week follow-up visit between the two groups. The score for nervous dysfunction at the end of 4-week treatment in the electric acupuncture group was significantly higher than that in the control group（P〈0.05）. The number of patients discharged from hospital who persisted in rehabilitation treatment with acupuncture in the acupuncture group was significantly higher than that in the control group.CONCLUSION： Using electric acupuncture to treat patients with acute ischemic cerebral apoplexy can effectively improve the nervous dysfunction scores after 4-week treatment and their ability to deal with daily life after 6-month follow-up visit. Systematic treatment with acupuncture may also reduc     

MnFe2O4纳米胶束合成及其应用于磁共振分子影像的可行性

BACKGROUND: Studies have shown that the saturation magnetization of nanoparticles can be increased by increasing of particle size of nanoparticles or cluster-like aggregation of multiple nanoparticles. But the increased particle size can reduce the cycle time of nanoparticles in the body. OBJECTIVE: To synthesize MnFe₂O₄  nanomicelles and explore the feasibility of its application in magnetic resonance molecular imaging. METHODS: MnFe₂O₄  nanoparticles were synthesized using thermal decomposition method and self-assembled with polyethylene glycol-polycaprolactone amphiphilic diblock copolymers (PEG-PCL) to construct PEG-PCL-MnFe₂O₄  nanomicelles. The characteristics of the MnFe₂O₄ nanoparticles and nanomicelles were tested. Then, MnFe₂O₄  nanoparticles and nanomicelles at different iron concentrations (0, 0.01, 0.02, 0.03, 0.04, 0.06, 0.08, 0.1, 0.2, 0.4, 0.6, 0.8 mmol/L) were placed into EP tubes. Relaxation rate of the nanomicelles were measured using magnetic resonance scanner. RESULTS AND CONCLUSION: (1) MnFe₂O₄  nanoparticles appeared as round under transmission electron microscopy. The size of nanoparticles was 11 nm with good monodispersion. The Zeta-particle size was (11.18±1.72) nm. The molar ratio of Fe/Mn was 2.13:1. The size of PEG-PCL-MnFe₂O₄  nanomicelles ranged from 52 to 86 nm, with a mean Zeta-particle size of (78.8±12.4) nm. (2) The signal intensity (SI) change of PEG-PCL-MnFe₂O₄  nanomicelles and PEG-PCL-Fe₃O₄ nanomicelles shared similar trend according to iron concentration. With the increasing of iron concentration, SI first increased and then decreased in T1WI, and it gradually decreased in T2WI and T2*WI. The SI changes in T2*WI were significantly stronger than that in T2WI and T1WI. Taken together, our results show that PEG-PCL-MnFe₂O₄ nanomicelles are expected to perform as a sensitive contrast agent used in T2WI as their moderate particle size, good monodisperse and strong T₂ relaxation.     

市场经济体制下医院管理新思维

讨论了市场经济体制下,医院管理层如何转变观念,解放思想,主动掌握市场经济动态,加速人才培养,提高医院管理水平和医疗质量,从而增强医院竞争能力,促进医院的发展。