标准化病人结合CBL教学模式在眼科学专业硕士临床实践教学中的应用

目的:探讨标准化病人(SP)与以病例为基础的学习(CBL)模式相结合的教学模式应用在眼科学专业硕士研究生临床实践教学中的效果。方法:于2017-07/2019-07选取南昌大学第一附属医院眼科病区2017、2018、2019级专业硕士研究生40名为研究对象,随机进行分组,研究组20名采取SP+CBL案例式相结合的教学模式;对照组20名采取传统课堂带教学习(LBL)教学模式。两组教学师资、内容与时间(12mo)无差别,观察并比较两组学生学习能力、理论知识和临床技能操作考核成绩,并针对学生对教学效果的评价进行统计学分析。结果:两组学生入学成绩无明显差异,教学后研究组学生学习积极性、记忆效率、临床操作技能及医患沟通能力均更具优势(P<0.05),理论知识和临床技能操作考核成绩均优于对照组(87.95±6.78分vs 78.95±6.28分,82.20±4.53分vs 75.95±4.05分,均P<0.05),且研究组学生对实行SP+CBL案例式教学模式的评价显著高于实行LBL教学模式的对照组(P<0.05)。结论:SP与CBL案例式教学相结合的教学模式对眼科学专业硕士研究生的临床实践教学有显著优势。     

吉西他滨固定剂量率输注联合奥沙利铂一线治疗晚期胰腺癌的Meta分析

背景与目的:有研究提示吉西他滨(Gemcitabine,GEM)固定剂量率(Fixed-dose rate,FDR)输注治疗晚期胰腺癌似有较好的疗效,Meta分析也显示含铂类联合化疗优于GEM单药化疗,本文试图通过Meta分析,探讨GEM FDR输注联合奥沙利铂(GEMOX)一线治疗晚期胰腺癌的地位和价值.方法:通过MEDLINE、EMBASE、ASCO等数据库及论文集检索国内外的相关文献.选择治疗组为GEMOX方案化疗,对照组为标准GEM单药化疗的晚期胰腺癌随机对照试验.由2位评价者分别按上述检索策略收集资料,按纳入标准入选,主要对总生存率及主要不良反应进行Meta分析.结果:从182篇文献中筛选出符合纳入标准的2个随机对照试验,共涉及869例患者.与GEM单药组比较,GEMOX组半年生存率提高9%(95%CI 0.03～0.16,P=0.005),1年生存率提高5%(95%CI-0.01～0.11,P=0.08),客观有效率提高6%(95%CI 0.02～0.10,P=0.006);WHO Ⅲ/Ⅳ度贫血发生率下降5%(95%CI-0.08～-0.01,P=0.01),恶心/呕吐提高13%(95%CI 0.08～0.18,P＜0.001),神经毒性增加14%(95%CI 0.04～0.24,P=0.009),粒细胞减少症、血小板减少症两组相似,差异无统计学意义.结论:现有的证据提示,GEM固定剂量率输注联合奥沙利铂组成的GEMOX方案一线治疗晚期胰腺癌可能有较好的应用前景,值得进行进一步的临床试验.     

吉西他滨联合化疗一线治疗晚期胰腺癌生存结果的亚组meta分析

 【目的】Meta分析提示吉西他滨（GEM）联合化疗一线治疗晚期胰腺癌优于标准的GEM单药化疗,在此基础上进行亚组生存结果的meta分析及资料更新,旨在寻找确切有效的化疗方案。【方法】通过MEDLINE、EMBASE、ASCO、ECCO等数据库及论文集检索相关文献。按纳入标准筛选新增文献并进行资料更新。主要对各亚组进行半年生存率、其次是1年生存率的meta分析。【结果】17个随机对照临床试验（RCT）共3 821例患者纳入分析,按化疗方案分为GEM联合顺铂（GEMDDP）、GEM固定剂量率输注联合奥沙利铂（GEMOX）、联合5FU（GEMFU）、联合卡培他滨（GEMCAP）以及联合伊立替康（GEMIRI）等5个亚组,各亚组半年生存率的治疗优势（RD）分别为5%（P=0.24）、9%（P=0.005）、2%（P=0.46）、7%（P=0.03）和-1%（P=0.88）;1年生存率RD为6%（P=0.11）、5%（P=0.07）、4%（P=0.19）、5%（P=0.08）和0（P=0.97）。【结论】现有的证据提示GEMOX、GEMCAP联合化疗方案一线治疗晚期胰腺癌,有较好的应用前景,值得进一步的临床试验。     

牛至超临界CO2萃取物的GC指纹图谱

目的采用GC法测定牛至CO2萃取物的指纹图谱.方法 采用超临界CO2萃取技术提取牛至挥发油.GC色谱条件DB-17石英毛细管柱(30 m×0.25 mm,膜厚0.25 μm),载气为氮气,流速1.5 mL·min-1,分流比201, 程序升温 80℃(2 min)4℃/min270℃(2min).结果指纹图谱中标示了17个共有峰并采用GC-MS进行了鉴别,其峰面积之和大于总峰面积的90%,方法精密度、稳定性、重现性均符合指纹图谱有关规定.结论本方法为牛至药材的质量控制提供了依据.     

晚期妊娠与围绝经期盆底松弛患者子宫主骶韧带Ⅲ型胶原含量的变化

目的:探讨妊娠晚期和围绝经期盆底松弛患者子宫主骶韧带的组织学改变及胶原含量变化与盆底松弛发生的关系。方法:以10例妊娠晚期因产科严重并发症而行全子宫切除术者为晚孕组,14例行全子宫切除术为围绝经期盆底松弛组,14例无盆底松弛因妇科疾病而行全子宫切除术者为同龄对照组。每例取主韧带及骶韧带组织经病理切片,经Masson染色,观察其组织学特征,并用免疫组化方法检测其Ⅲ型胶原含量。结果:晚孕组、围绝经期盆底松弛组主韧带Ⅲ型胶原阳性单位分别为10.29±1.56、9.62±2.43,与对照组的17.68±3.95比较,P<0.01,差异有意义。骶韧带Ⅲ型胶原阳性单位分别为12.88±3.21、10.34±3.62,与对照组的19.29±4.57比较,P<0.01,差异有意义。结论:①晚期妊娠所致盆底松弛与围绝经期盆底松弛的共同特征之一是Ⅲ型胶原含量减少;②妊娠所致盆底损伤、胶原结构代谢改变和胶原排列稀疏,提示胶原的分解增强可能是妊娠晚期盆底松弛发生的原因,也是导致产后盆底松弛及尿失禁的因素之一。     

妊娠晚期妇女与同龄妇女盆底胶原组织的对比研究

目的:探讨妊娠晚期年轻孕妇子宫韧带组织胶原含量改变与盆底结构障碍的关系。方法:收集晚期妊娠组(n=10)及同龄对照组(n=12)需行全子宫切除共22例,每例取双侧主韧带及骶韧带组织,经病理切片,行Masson染色,观察其组织学特征。用免疫组化方法检测Ⅰ、Ⅲ型胶原含量。结果:免疫组化和图像分析切片中可见浅棕色至深褐色的胶原阳性区域。作对比研究,晚期妊娠组胶原阳性反应区域、阳性单位均小于对照组,灰度大于对照组(P<0.01),差异有统计学意义。结论:妊娠晚期妇女盆底组织Ⅰ、Ⅲ型胶原含量减少,提示妊娠引起盆底结构松弛是产后尿失禁易发因素之一。     

Common Neurological Disorders Involving Inpatient Liaisons at a Secondary Referral Hospital in Taiwan: A Retrospective Cross-Sectional Study

MethodsThis was a retrospective cross-sectional study of NILs in a secondary referral hospital over a 12-month period.ResultsThere were 853 neurological consultations with a liaison rate of 3% per admission case. Chest medicine, gastroenterology, and infectious disease were the three most frequent specialties requesting liaison, and altered consciousness, seizure, and stroke were the three most frequent disorders for which a NIL was requested. Infection was the most common cause of altered consciousness. Epilepsy, infection, and previous stroke were common causes of seizure disorders. Acute stroke accounted for 44% of all stroke disorders. Electroencephalography was the most recommended study, and was also the most frequently performed. Ninety-five percent of emergency consultations were completed within 2 hours, and 85% of regular consultations were completed within 24 hours. The consult-to-visit times for emergency and regular consultations were 44±47 minutes (mean±standard deviation) and 730±768 minutes, respectively, and were shorter for regular consultations at intensive care units (p=0.0151) and for seizure and stroke disorders (p=0.0032).ConclusionsAltered consciousness, seizure, and stroke were the most common reasons for NILs. Half of the patients had acute neurological diseases warranting immediate diagnosis and treatment by the consulting neurologists. Balancing increasing neurologist workloads and appropriate health-care resources remains a challenge.     

Inhaled Corticosteroids Increase the Risk of Pneumonia in Patients With Chronic Obstructive Pulmonary Disease: A Nationwide Cohort Study

The association of inhaled corticosteroids (ICS) and pneumonia in patients with chronic obstructive pulmonary disease (COPD) is still controversial.From the National Health Insurance Database of Taiwan, COPD cases with history of acute exacerbation (AE) were identified (COPD cohort). Time-dependent Cox regression analysis was applied to investigate the risk factors for pneumonia with COPD severity controlled by surrogate variables. Among the COPD cohort, those who continuously used ICS for more than 360 days without interruption were selected (ICS cohort). The incidence rate of pneumonia during ICS use was compared with those before ICS use and after ICS discontinuation by using pair t test.A total of 6034 and 842 cases were identified as the COPD and ICS cohorts, respectively. In the COPD cohort, recent ICS use was independently associated with pneumonia (hazard ratio: 1.06 [1.02–1.11] for per 80 mg of budesonide). Other independent risk factors included age, male, diabetes mellitus, malignancy, low income, baseline pneumonia event, and recent use of oral corticosteroids and aminophylline. In the ICS cohort, while AE rate gradually decreased, the incidence rate of pneumonia significantly increased after ICS use (from 0.10 to 0.21 event/person-year, P = 0.001).This study demonstrates the association between ICS use and pneumonia in patients with COPD and history of AE. ICS should be judiciously used in indicated COPD patients.