以临床胜任力为导向的CBL在急危重症护理本科教学中的实践

目的　探讨临床胜任力为导向的病例教学（case-based learning，CBL）在急危重症护理学本科教学中的可行性和有效性。方法　将急危重症护理本科生120人随机分为CBL教学组和传统教学组。根据每次实习学生人数，CBL教学组分为数个小组，每小组固定一个带教教师，并以小组为单位进行临床教学实践；传统教学组采用既往的临床实习教学方式，即一个学生固定跟随一个带教教师。采用理论考试、技能考试以及问卷调查等多种考核方式评价两组的教学效果，采用SPSS 21.0软件行t检验和卡方检验。结果　与传统教学组相比，CBL教学组在理论考试[（92.5±3.0） vs. （85.3±3.3）]和技能考试[（93.1±4.5） vs. （88.1±3.4）]方面均更好，且差异有统计学意义（P<0.05）；在对教学满意度调查方面，CBL教学组优于传统教学组。结论　以临床胜任力为导向的CBL教学应用于急危重症护理本科教学是可行的，能有效培养学生的临床思维和提高实际的临床胜任力。     

Therapeutic apheresis in Asia: An Indonesia single center experience

In developing countries, like Indonesia, apheresis is still a relative new procedure. Nowadays, therapeutic apheresis procedures are performed in the field of hematology and neurology, especially in the teaching hospitals in Indonesia. Therapeutic apheresis procedure, that is, leukocytapheresis, therapeutic plasma exchange (TPE), and thrombocytapheresis are already performed. In the period 2009–2013, 204 apheresis procedures in 137 patients to reduce the leukocytes, 72 TPE procedures in 17 patients, and 14 thrombocyte reductions were performed in the Sardjito hospital, Yogyakarta, Indonesia. In the future, to improve the therapeutic apheresis implementation, it is important to increase the insurance coverage and also should be considered to introduce the apheresis medicine into the curriculum of appropriate physician programs in Indonesia. Especially in Indonesia, a lot of efforts are still being needed to improve implementation of therapeutic apheresis. J. Clin. Apheresis 30:139–140, 2015. © 2014 Wiley Periodicals, Inc.     

复方倍他米松注射液联合泛昔洛韦胶囊、普瑞巴林胶囊治疗带状疱疹的临床疗效观察

目的 对复方倍他米松注射液联合泛昔洛韦胶囊、普瑞巴林胶囊治疗带状疱疹的临床疗效进行观察并探讨。方法 选取2018 年1 月～2019 年12 月我院收治的118 例带状疱疹患者为研究对象，采用随机抽签的方式将患者分为对照组（泛昔洛韦胶囊+普瑞巴林胶囊+甲钴胺片+维生素B1 片）与观察组（联合复方倍他米松注射液），比较两组治疗总有效率、VAS 评分、QS 评分、C 反应蛋白、无新发皮疹时间、结痂时间及疼痛停止时间、随访2 个月后带状疱疹后遗神经痛发生率以及不良反应发生率。结果 观察组与对照组治疗总有效率分别为94.92%及76.27%，组间对比差异有统计学意义（P＜0.05）；治疗后，观察组VAS 评分显著低于对照组；观察组QS 评分低于对照组（P＜0.05）；治疗后，观察组C 反应蛋白显著低于对照组（P＜0.05）；观察组无新发皮疹时间、结痂时间及疼痛停止时间分别显著短于对照组（P＜0.05）；随访2 个月后，发现观察组带状疱疹后遗神经痛发生率显著低于对照组（P＜0.05）；观察组不良反应发生与对照组比较，差异无统计学意义（P＞0.05）。结论 复方倍他米松注射液联合泛昔洛韦胶囊、普瑞巴林胶囊治疗带状疱疹不仅效果好且安全性高，值得使用。     

多原发结直肠癌的临床特征和预后

目的探讨多原发结直肠癌的临床特征和预后。方法回顾性分析南京医科大学第一附属医院2013年1月至2018年12月收治的42例多原发结直肠癌患者的临床资料,对其临床病理特征、诊治及预后进行总结。结果符合多原发结直肠癌诊断的患者42例,占同期收治的所有结直肠癌患者的1.20%(42/3499),病理类型以腺癌为主。其中,同时性多原发癌32例,年龄38~86岁,中位年龄66岁,共发现73处结直肠癌灶,多位于近端结肠、乙状结肠及直肠;共检出淋巴结527枚,阳性10枚(1.9%),淋巴结阳性患者占同时性多原发癌的37.5%(12/32);27例为双原发癌,3例为三原发癌,2例为五原发癌;1、3年总生存率分别为83.75%和74.38%。异时性多原发癌10例,年龄33~86岁,第一癌多位于直肠和乙状结肠区域,第二癌多位于升结肠区域;共检出淋巴结276枚,阳性率12.3%(34枚),1、3年总生存率分别为100.00%和66.67%。结论多原发结直肠癌在临床上不少见,其分布有一定规律。临床中应引起重视,提高早期诊断率。应早期手术治疗以提高患者的生存率。     

Using gas chromatography and mass spectrometry to determine 25-hydroxyvitamin D levels for clinical assessment of vitamin D deficiency

Vitamin D is responsible for multiple metabolic functions in humans. Rickets are the most common disease caused by vitamin D deficiency. It is caused by poor calcium intake resulting in poor serum-ionized calcium. The purpose of this study is to develop a rapid, sensitive, and feasible method to determine the 25-hydroxy-vitamin D3 (25(OH)D3) levels in blood samples for clinical assessment. In this study, gas chromatography coupled mass spectrometry with trimethylsilyl derivatization (TMS-GC-MS) is the most suitable protocol for quantitative analyses of 25(OH)D3. Performance of method was evaluated and compared with liquid chromatography and immunoassay. Method validation has been carried out with plasma specimens. The limit of quantitation of TMS-GC-MS method is 1.5 ppb with good linear correlation. Furthermore, the dietary intake and nutritional status of vegetarian and non-vegetarians in Taiwan were assessed by our validated method. As a result, this vitamin D nutrition survey demonstrates that most Taiwanese people have insufficient vitamin D. Due to dietary habits; the male vegans may have the highest risk of vitamin D deficiency.     

自拟温润方治疗风寒袭肺型急性咳嗽病的临床观察

目的 观察自拟温润方治疗风寒袭肺型急性咳嗽病的临床疗效。方法 64例风寒袭肺型急性咳嗽病患者,随机分为对照组(31例)和治疗组(33例)。对照组患者给予复方甘草口服溶液治疗,治疗组患者给予温润方治疗。比较两组患者治疗前和治疗3、6 d后的中医症状评分以及临床疗效。结果 治疗3、6 d后,两组患者咳嗽、咯痰、恶风、咽痒、鼻塞、流涕、鼻干、口干咽燥症状评分均低于治疗前,差异均具有统计学意义(P<0.05)。治疗组患者治疗3 d后咳嗽、咽痒、鼻干、口干咽燥症状评分分别为(2.18±0.98)、(1.15±0.81)、(0.60±0.61)、(0.81±0.71)分,均低于对照组的(3.04±1.62)、(1.68±0.96)、(0.96±0.67)、(1.37±0.86)分,差异均具有统计学意义(P<0.05);治疗组患者治疗6 d后咳嗽、咽痒、鼻干、口干咽燥症状评分分别为(0.54±0.51)、(0.42±0.48)、(0.40±0.46)、(0.47±0.51)分,均低于对照组的(1.12±0.76)、(1.11±0.98)、(0.88±0.98)、(1.01±0.92)分,差异均具有统计学意义(P<0.05)。两组患者治疗3、6 d后咯痰、恶风、鼻塞、流涕症状评分比较,差异无统计学意义(P>0.05)。治疗3 d后,治疗组治疗总有效率90.9%高于对照组的71.0%,差异具有统计学意义(P<0.05)。治疗6 d后,治疗组患者治疗总有效率93.9%与对照组的90.3%比较,差异无统计学意义(P>0.05)。结论 在风寒袭肺型急性咳嗽病治疗中,温润方在缓解咳嗽以及部分次症方面明显优于复方甘草口服溶液,起效更快。     

钩虫病感染者免疫球蛋白水平、临床特点及胃肠镜下形态分析

目的分析钩虫病感染者血清免疫球蛋白(Ig)A、IgG、IgM和IgE水平,临床特点及胃肠镜下形态。方法分析16例钩虫病感染者的临床资料,观察患者的临床表现、Ig水平、血常规检查结果、胃肠镜检查结果及治疗结果。结果 16例患者的IgE水平明显高于正常参考上限值;IgA、IgG、IgM水平与正常参考上限值比较,差异不明显。经诊断患者的钩虫分布情况:十二指肠降部8例(50.00%),十二指肠球部5例(31.25%),回肠末端3例(18.75%),升结肠1例(6.25%),其中十二指肠及回肠末端均见钩虫者1例(6.25%)。所有患者均予阿苯达唑片驱虫治疗,治疗后1个月复查见贫血得到纠正,消化道症状得以缓解,复查胃肠镜未见虫体,均治愈。结论钩虫病感染者的IgE水平明显升高,胃肠镜检查是确诊钩虫病的重要手段,尤其是要加强对十二指肠降部的检查,并在确诊后及时给予正规治疗措施。     

新冠肺炎疫情下艾灸防治帕金森病的临床应用分析＊

帕金森病（Parkinson''s disease，PD）是仅次于阿尔茨海默病的世界第二大神经系统退行性疾病，随着老龄化社会的到来，PD患病率呈明显上升趋势。全球爆发的新型冠状病毒肺炎（简称新冠肺炎）是一种急性传染性疾病，严重威胁人们的身体健康和生命安全。PD患者大多为老年人且合并有基础疾病，体质普遍较弱，是新冠肺炎的易感人群，一旦染病则发展为重症的风险很高。中医艾灸疗法在治疗PD及防治疫病方面发挥了很好的辅助治疗效果。通督扶阳灸法联合强壮穴艾灸治疗，既可以帮助PD患者改善临床症状，延缓病情进展，又可以提高机体免疫功能，增强抗病能力而防治新冠肺炎。     

Diagnostic sensitivity of electrophysiology and ultrasonography in ulnar neuropathies of different severity

ObjectiveTo assess the diagnostic performance of electrophysiology and nerve ultrasound in ulnar neuropathies of varying clinical severity in 135 consecutive patients.MethodsClinical severity of ulnar neuropathy was graded on a 4 point scale from very mild (symptoms only) to severe (marked atrophy of intrinsic hand muscles). Sensitivity and localization ability of electrophysiology and nerve ultrasound were assessed for each point of the scale.ResultsUltrasound had higher sensitivity than electrophysiology in clinically very mild (20% and 3% for ultrasound and electrophysiology, respectively) and mild (62% and 47% for ultrasound and electrophysiology, respectively) neuropathies, had greater localizing ability in axonal ulnar neuropathies, and identified nerve hypermobility.Ultrasound nerve cross-sectional area had strong positive correlation with both clinical and electrophysiological severity scores, but with significant overlap across the severity groups.ConclusionThe diagnostic work-up of ulnar neuropathies was improved by using both electrophysiology and ultrasound at all levels of clinical severity. Ultrasound increased the diagnostic yield in very mild and mild neuropathies, localized all the ulnar neuropathies with abnormal non-localizing electrophysiology and identified nerve hypermobility.SignificanceThis is the first detailed analysis of the diagnostic performance of electrophysiology and ultrasound in ulnar neuropathies of varying severity.