医学生胸腔穿刺模拟训练学习曲线的研究

Objectiye The purpose of this study is to document the learning curve of simulation based thoracentesis training and to evaluate its long term outcome. Methods Forty-eight medical students were enrolled in this study. Each participant performed 5 supervised but unmentored thoracentesis on the simulator. Participant's performance was assessed by performance errors (PE), procedure time (PT) and participant's confidence (PC) by the supervisors for every operator on each test trial. Learning curves for each variable were generated. Long term outcomes of the training were measured by the re-test on half year later. Results An obvious improvement was noted in PE, PT and PC when comparing the subjects 1st and4th test trial (P ＜ 0.01 ). A plateau for PE, PT and PC in the learning curve occurred in 4th test trial. The results of re-test on half year later were similar with that in the test trial 5 (P ＞ 0.05). Conclusions This study demonstrated simulation based thoracentesis training can significantly improve the individual's skill.The full effect of learning from the modular can be achieved by four times of practices.     

高仿真模拟人在心肺复苏教学中的应用研究

Objective To evaluate the application effect of high-fidelity human patient simulation in cardiopulmonary resuscitation (CPR) training in emergency medicine course. Method All of the 84medical freshmen in the academic year of 2008, who studied emergency medicine course, were chosen as the study object. The students were randomly divided into high-fidelity simulator (SimMan) training group(EG) and ordinary training group (CG), when they finished the course. Two groups accepted training for the same time, and then examined the CPR performing by the system of advanced cardiovascular life support (ACLS) simulator, and make data-analysis with the software of SPSS 11.5. Result The students in EG group have higher total mean score than CG ( P ＜ 0.05). However, in the aspects of survival ratio,performing time and chest compression quality, EG has higher score than CG, but there is no significant statistical difference ( P ＞ 0.05 ). Conclusion This study demonstrates that high-fidelity human patient simulation can simulate many common symptoms of emergency patients, it has great effect on helping medical students to improve the quality of doing CPR, but the training results is not as good as the author expected compared with the ordinary training. So the training method in the application of high-fidelity human patient simulation should be improved.     

Effect of behavior training on learning,memory and the expression of NR2B,GluR1 in hippocampus of rats offspring with fetal growth restriction

Objective： To study effects of behavior training on learning, memory and the expression of NR2B, GluR1 in hippocampus of rat＇ s offspring with fetal growth restriction（FGR）. Methods： The rat model of FGR was established by passive smoking method. The rats offspring were divided into the FGR group and the control group, then randomly divided into the trained and untrained group, respectively. Morris water maze test was proceeded on postnatal month（PM2/4） as a behavior training method, then the learning-memory of rats was detected through dark-avoidance and step-down tests. The expressions of NR2B and GluR1 subunits in hippocampal CA1 and CA3 areas were detected by immunohistochemical method. Results： In the dark-avoidance and step-down tests, the performance record of rats with FGR was worse than that of control rats, and the behavior-trained rats was better than the untrained rats, when the FGR model and training factors were analyzed singly. The model factor and training factor had significant interaction（P 〈 0.05）. The expressions of NR2B and GluR1 subunits in hippocampal CA1 and CA3 areas of rats with FGR reduced. In contrast, the expressions of GluR1 and NR2B subunits in CA1 area of behavior-trained rats increased, when the FGR model and training factors were analyzed singly. Conclusion： These findings suggested that the effect of behavior training on the expressions of NR2B and GluR1 subunits in CA1 area should be the mechanistic basis for the training-induced improvement in learning-memory abilities.     

Study of Qingre Liyan Decoction (清热利咽汤) in treating and preventing acute radioactive oral mucositis

Objective:To study the effect of Qingre Liyan Decoction(清热利咽汤,QRLYD)in the prevention and treatment of acute radiative oral mucositis(AROM),and to explore the mechanism of QRLYD by detecting epidermal growth factor(EGF)and T lymphocytes(CD3,CD4,and CD8). Methods:Sixty patients conforming with the standard were randomly assigned to two groups,30 patients in each group.Patients in the trial group were treated with QRLYD,and those in the control group were treated with Dobell's solution,both groups receiving conventional radiation treatment.The treatment course for both groups was 6 weeks on average.Blood routine test,CD3,CD4,and CD8 in the peripheral blood and EGF in the saliva were detected one day before and on the 14th and 28th day of radio-therapy.Results:Patients in the trial group were in good condition with normal spirits and intake of food and drinks.The incidence of AROM is lower and the effect in preventing AROM is higher in the trial group than those in the control group(P<0.05).The EGF in saliva,and CD4 and CD8 in the blood of patients in the trial group were higher than those in the control group(P<0.05). Conclusion:QRLYD can cure and prevent AROM.The mechanism may be related with its effects in enhancing body immunity and promoting salivary EGF.     

Effect of behavior training on learning,memory and the expression of NR2B,GluR1 in hippocampus of rats offspring with fetal growth restriction

Objective:To study effects of behavior training on learning,memory and the expression of NR2B,GluR1 in hippocampus of rat's offspring with fetal growth restriction(FGR).Methods:The rat model of FGR was established by passive smoking method.The rats offspring were divided into the FGR group and the control group,then randomly divided into the trained and untrained group,respectively. Morris water maze test was proceeded on postnatal month(PM2/4)as a behavior training method,then the learning-memory of rats was detected through dark-avoidance and step-down tests.The expressions of NR2B and GluR1 subunits in hippocampal CA1 and CA3 areas were detected by immunohistochemical method.Results:In the dark-avoidance and step-down tests,the performance record of rats with FGR was worse than that of control rats,and the behavior-trained rats was better than the untrained rats,when the FGR model and training factors were analyzed singly.The model factor and training factor had significant interaction(P<0.05).The expressions of NR2B and GluR1 subunits in hippocampal CA1 and CA3 areas of rats with FGR reduced.In contrast,the expressions of GluR1 and NR2B subunits in CA1 area of behavior-trained rats increased,when the FGR model and training factors were analyzed singly. Conclusion:These findings suggested that the effect of behavior training on the expressions of NR2B and GluR1 subunits in CA1 area should be the mechanistic basis for the training-induced improvement in learning-memory abilities.     

Efficacy of rabdosia rubescens in the treatment of gingivitis

This study evaluated the efficacy ofrabdosia rubescens against gingivitis and compared the therapeutic efficacy of different dosage forms of rabdosia rubescens. A multi-center, randomized, double-blind, double-simulation, positive-controlled and parallel trial was conducted. A total of 136 patients exhibiting clinical symptoms of gingivitis were enrolled. The subjects were randomly assigned to two groups： test group （n=67）, in which rabdosia rubescens drop pill （960 mg） and 4 tablets of simulation agent of rabdosia rubescen were orally given to the subjects three times a day for 5 days; and control group （n=69）, in which the subjects were administered the tablets of rabdosia rubescens （1000 mg） and 24 drop pills of simulation agent of rabdosia rubescens thrice daily for 5 days. The experimental protocols and diagnostic criteria were established by expert panel prior to the experiment. The clinical symptoms were graded according to the severity of the disease and quantified. The total scores and scores for each clinical symptom of gingivitis were assessed at baseline and on the 6th day post-treatment. The therapeutic efficacy was compared between the two groups and in each group itself before and after the treatment. The results showed that in the two groups, the subjects who were given rabdosia rubescens, drop pill or tablet, had a decrease in total scores and scores for each clinical symptom when compared with those before treatment （P〈0.01）. There was significant difference in the therapeutic efficacy between the test group and the control group with the efficacy rate being 92.54% and 79.71% respectively （P〈0.05）. It was concluded that rabdosia rubescens showed great promise in treating gingivitis. And rabdosia rubescens drop pill was more efficacious than rabdosia rubescens tablet.     

The Undergraduate Medical Students＇ Approach to Learning in University of Latvia

Learning approach of medical students has been pointed out as one of the most important long term success factors for medical career. There are two major differences how students learn. One group of students use deep approach learning that is characterised by understanding of matter of studies. Other part of students using surface approach of learning that is based on memorisation of facts and knowledge. It has been recognised that deep approach learning is more used in modern medical schools but surface learning in traditional medical schools. The purpose of this study was to evaluate, describe and compare the learning approach of students at the University of Latvia in the academic year of 2009/2010. University of Latvia represents traditional medical school, which uses traditional curriculum. The assessment was done using Entwistle＇s Short Inventory of Approaches to Learning consisting of 30 items. The inventory was answered by a total of 345 students. Findings show that learning approach has trend towards surface approach of learning in six groups studied in the University of Latvia in year 2009/2010. It has been recognised that reproduction and learning pathology were found increased in all study years. Results might suggest that modernisation of undergraduate curriculum including assessment with target to improve the way how medical students learn could be topic of discussion in senior management of University of Latvia. Study allows compare findings of this study to similar studies where the same instrument is used for evaluation of learning approaches in longitudinal prospective. It gives opportunity to compare results within findings of medical schools of Europe.     

A new plastic model of endoscopic technique training for endonasal transsphenoidal pituitary surgery

Background Endoscopic transsphenoidal approach is a minimally invasive surgical technique for the removal of sellar and parasellar lesions, which has been progressively accepted by neurosurgeons. However, frustration is often expressed by neurosurgeons when first attempting endoscopic endonasal pituitary surgery. To overcome the learning curve from microscope to endoscope in a smooth way, a new human nasal model has been developed. The present study assessed this new model of the human paranasal sinuses for endonasal surgery training, particularly for endonasal pituitary surgery training. Methods The procedure for endonasat transsphenoidal endoscopy was performed using this model. Three approaches were used to observe the endonasal structures and sphenoidal sinus： paraseptal; middle turbinectomy; and middle meatal. Attempts were made to identify anatomical landmarks in the nasal cavity and sphenoidal sinus. Model landmarks were compared with those in a cadaver and a real patient. Results This model precisely reproduced nasal bone structure. Compared with cadavers and living bodies, intranasal structures displayed very good color and texture, providing a close facsimile of the operative environment, and good morphology, with similar hardness and tactile feel on resection. All intranasal anatomical landmarks were easily identified, including choanae, inferior, middle and superior turbinates, and even the natural ostium of the sphenoidal sinus. Conclusion This human nasal model is very useful for training neurosurgeons in endoscopic endonasal transsphenoidal pituitary surgery, but typical anatomical landmarks in the posterior wall of the sphenoidal sinus in this model should be improved.     

Development and Validation of a Model for Predicting Diabetic Nephropathy in Chinese People

Objective To develop a risk model for predicting later development of diabetic nephropathy(DN)in Chinese people with type 2 diabetes mellitus(T2DM)and evaluate its performance with independent validation.Methods We used data collected from the project‘Comprehensive Research on the Prevention and Control of Diabetes’,which was a community-based study conducted by the Jiangsu Center for Disease Control and Prevention in 2013.A total of 11,771 eligible participants were included in our study.The endpoint was a clear diagnosis of DN.Data was divided into two components:a training set for model development and a test set for validation.The Cox proportional hazard regression was used for survival analysis in men and women.The model’s performance was evaluated by discrimination and calibration.Results The incidence(cases per 10,000 person-years)of DN was 9.95(95%CI;8.66-11.43)in women and 11.28(95%CI;9.77-13.03)in men.Factors including diagnosis age,location,body mass index,high-density-lipoprotein cholesterol,creatinine,hypertension,dyslipidemia,retinopathy,diet control,and physical activity were significant in the final model.The model showed high discrimination and good calibration.Conclusion The risk model for predicting DN in people with T2DM can be used in clinical practice for improving the quality of risk management and intervention.     

Reproducibility and Validity of a Chinese Food Frequency Questionnaire

Objectives This study was design to develop a semi-quantitative Chinese Food Frequency Questionnaire (FFQ) and to conduct a validation study for the questionnaire. Methods Based on the survey experience in recent years, a new Chinese food frequency questionnaire (FFQ) with 149 items in 17 food categories was developed. A validation study on this new FFQ was conducted in Jiangsu and Beijing of China between 1999 and 2001. The period of study covered 1 year and the FFQ was validated by comparing with data obtained by a six repeated 24-hour recalls for 3 consecutive days, or a totally 18-day 24- hour recall throughout the year. A total of 271 healthy adult subjects were enrolled in the study. Food and nutrient intakes measured by the 18-day dietary recalls and food frequency questionnaires (FFQs) were computed in the National Institute for Nutrition and Food Safety, China CDC using the existing nutrition database. The average daily intake of foods and nutrients over the 18-day recall was used to compare with FFQ1 and FFQ2, which was conducted at the beginning and the end of the year, respectively. All statistical analyses were carried out using SAS software version 6.12.     

非手术定向模拟腹腔镜训练在八年制医学生临床教学中的应用

目的探讨八年制临床医学专业学生第4至第5学年非手术定向腹腔镜模拟训练的可行性。方法选取我校八年制临床医学专业9名学生为学生组,40岁以上的5名志愿者为高龄组、18岁以下的5名志愿者为低龄组,进行非手术定向模拟腹腔镜训练操作,每人训练5轮,对完成时间、准确率及水平持镜时间比三种主要参数进行记录和统计分析。结果培训前,三组人员在准确率及水平持镜时间比两个参数间差异无统计学意义。完成时间高龄组最长、低龄组最短,三组之间差异有统计学意义。培训后,低龄组完成时间最短,学生组及低龄组很快达到学习曲线的平台期。结论腹腔镜模拟训练可以提高具有不同临床经验参与者的腹腔镜操作技巧,在八年制临床医学专业学生的实习阶段进行非手术定向模拟腹腔镜训练是可行的。     

白三烯受体拮抗剂对乙酰甲胆碱支气管激发试验剂量-反应曲线参数的影响

目的　探讨白三烯受体拮抗剂扎鲁斯特对乙酰甲胆碱支气管激发试验剂量 -反应曲线参数的影响。方法　对 2 0例咳嗽变异型哮喘 (CVA)、2 0例哮喘患者进行白三烯受体拮抗剂的临床研究 ,以 4例 CVA,10例哮喘患者为对照。对治疗前后乙酰甲胆碱支气管激发试验剂量 -反应曲线各参数 ,包括反应阈值 (PC35 s Gaw )、剂量 -反应曲线斜率 (DRS)、曲线下面积与最末浓度对数之比 (AUC/ lg[Cm ax])、最大反应平台进行了测定。结果　白三烯受体拮抗剂显著增加 CVA组与哮喘组的 PC35 s Gaw,显著降低 CVA组的 DRS与 AUC/ lg[Cm ax];但对哮喘组 DRS与 AU C/ lg[Cmax]无影响 ,对 CVA组和哮喘组的平台有无及平台高度均无影响。结论　短期应用白三烯受体拮抗剂可改善哮喘患者乙酰甲胆碱支气管激发试验剂量 -反应曲线参数。     

本科临床实习岗前急救技能培训中模拟人系统的应用及效果分析

目的研究模拟人系统在本科生临床实习岗前急救技能培训中的应用。方法在本科生临床实习岗前培训中引入模拟人系统,采用四段式教学互动的学导式教学法,在培训结束和实习半年后通过学生考核成绩和满意度调查评价教学效果。结果岗前培训结束后,所有学生在理论和操作考试中均能顺利通过,合格率达100%;两组学生对所采取的教学方式较为接受,对教学效果比较满意,满意率均达100%;在实习半年后对部分学生的调查表明学生的满意程度均有所下降,分别为89.6%和86.1%;带教教师对部分学生的总体评价表明两组学生掌握急救理论知识和实际操作能力、配合能力较高,合格率分别为89.6%和88.9%。结论应用模拟人系统有利于增加教学的直观性,提高学生的主动性,值得在教学中进一步推广。     

小儿脓胸的外科治疗

目的 总结小儿脓胸的外科治疗经验,探讨小儿脓胸不同治疗方法的应用时机.方法 对1993年6月～2006年1月期间我院收治的98例小儿脓胸进行回顾性研究分析.根据病程病情选择不同的治疗方法,其中行单纯胸腔穿刺治疗10例,行胸腔闭式引流术38例,行肋床引流术43例,行胸膜纤维板剥脱7例.结果 所有病例均治愈出院,其中10例单纯行胸腔穿刺患儿中3例效果不佳再次行肋床引流,4例患儿胸腔闭式引流效果不佳改行肋床引流,2例患儿肋床引流后3个月再次行胸膜纤维板剥脱术.各组患者远期疗效良好.结论 小儿脓胸一经诊断,尽早选择有效的方法充分引流脓液是提高治愈率的关键,不同治疗方法应用时机不同,只要病例选择合适,各种方法均能取得满意的治疗效果.     

大豆磷脂联合维生素E预防大鼠肺出血和水肿的研究

本实验应用雄性大鼠静脉注射肾上腺素造成肺出血、水肿（ＰＨ、ＰＥ）模型，以及应用静脉注大豆磷脂（ＰＣ）联合维生素Ｅ（ＶＥ）进行预防的研究，结果显示：ＰＣ＋ＶＥ能降低死亡率，降低血清脂质过氧化物（ＬＰＯ），支气管肺泡灌洗液（ＢＡＬＬ）中蛋白质及磷脂，肺指数烽；肺组织切片中肺水肿、出血明显改善，其效果优于应用ＰＣ。     

表象训练对临床医学生微创外科抓持动作技能学习的影响

目的 通过表象训练进行微创外科抓持技能教学并对考核结果进行量化评价,分析应用表象训练后微创外科抓持动作技能学习的影响.方法 36名研究对象随机分为3组:表现训练组(n=12)、常规教学组(n=12)、对照组(n=11),按照不同的教学方法进行微创外科抓持技能的培训,在统一的考核标准及条件下进行考核,得出数据并进行统计分析.结果 表象训练组培训前考核成绩[(16.18±5.73)分]和培训后考核成绩[(79.47±22.05)分]有明显差异(P＜0.001),培训后考核和2周后考核成绩[(89.32±31.56)分]无明显差异(P=0.283);常规教学组培训前考核成绩[(17.47±8.33)分]和培训后考核成绩[(57.18±21.83)分]有明显差异(P＜0.001),培训后考核和2周后考核成绩[(42.27±24.64)分]有明显差异(P=0.048);对照组培训前考核成绩[(18.19±4.74)分]和培训后考核成绩[(38.04±19.13)分]有明显差异(P=0.003),培训后考核和2周后考核成绩[(23.71±15.71)分]有明显差异(P=0.034).运用ONE WAY ANOVA进行组间两两比较,与表现训练组相比较,培训前考核,常规教学组(P=0.632)和对照组(P=0.464)均无明显差异;培训后考核,常规教学组(P=0.014)与对照组(P＜0.001)均有明显差异;2周后考核,常规教学组及对照组均存在明显差异(两者均P＜0.01).结论 表现训练能明显提高微创外科抓持技能培训效果,改良学习曲线,且有较好的持久性,在教学中易于实施,学员易于掌握,是未来微创外科技能培训的新方法.     

动机性访谈在糖尿病患者自我效能及自我管理中的应用研究

目的探讨动机性访谈在提升糖尿病患者自我效能及自我管理中的应用效果。方法运用类实验研究方法,将104例糖尿病患者采用随机数字表法将研究对象分为对照组和实验组各52例,对照组给予常规护理教育,实验组在常规护理教育的基础上给予以动机性访谈为基础的护理干预。两组患者出院随访半年,观察动机性访谈在糖尿病患者自我效能及自我管理中的长期效应。结果出院前一天对照组和实验组在自我效能方面饮食控制和预防高低血糖两个维度具有统计学意义（P〈0.05）,而两组在自我管理方面无统计学差异（P〉0.05）。随访半年后自我效能,自我管理及糖化血红蛋白几个方面都不存在统计学差异,并且患者对糖化血红蛋白监测的依从性缺乏,这与国内外大多研究不同。结论动机性访谈可在提高糖尿病患者自我效能方面具有短期效应。     

虚拟现实模拟培训在青年医师腹腔镜技能培训中的作用

目的 通过分析郑州大学附属郑州中心医院参加过腹腔镜技能培训的普外科青年医师的腹腔镜胆囊切除术学习曲线,探讨腹腔镜虚拟现实模拟培训的意义。方法 将青年外科医师50人分为两组,干预组参加虚拟现实模拟培训,对照组参加传统腹腔镜临床培训。培训完成后,在高年资拥有丰富腹腔镜手术经验医师的监督下完成30例腹腔镜胆囊切除术。应用CUSUM分析法,根据完成率、手术评分和手术时间绘制学员的手术学习曲线。x为手术例数,k为斜率。计算k=0时的x值,比较两组学员的手术学习曲线和术中评分。采用SPSS 23.00进行t检验和卡方检验。结果 干预组与对照组分别在x=19.24±0.39、x=21.72±0.73时跨过手术学习曲线,差异有统计学意义（P<0.01）;干预组与对照组显露胆囊部分得分分别为（10.82±2.73）、（9.71±2.69）（t=4.61,P<0.01）;解剖胆囊三角得分分别为（12.59±3.12）、（8.87±2.99）（t=6.21,P<0.01）;剥离胆囊得分分别为（10.69±3.38）、（8.80±3.55）（t=3.10,P<0.01）。结论 虚拟现实模拟培训可以促进腹腔镜培训的基本技能转化为临床操作技能,可促进普外科青年医师成长。     

Plasma-metabolite-based machine learning is a promising diagnostic approach for esophageal squamous cell carcinoma investigation

The aim of this study was to develop a diagnostic strategy for esophageal squamous cell carcinoma (ESCC) that combines plasma metabolomics with machine learning algorithms. Plasma-based untargeted metabolomics analysis was performed with samples derived from 88 ESCC patients and 52 healthy controls. The dataset was split into a training set and a test set. After identification of differential metabolites in training set, single-metabolite-based receiver operating characteristic (ROC) curves and multiple-metabolite-based machine learning models were used to distinguish between ESCC patients and healthy controls. Kaplan-Meier survival analysis and Cox proportional hazards regression analysis were performed to investigate the prognostic significance of the plasma metabolites. Finally, twelve differential plasma metabolites (six up-regulated and six down-regulated) were annotated. The predictive performance of the six most prevalent diagnostic metabolites through the diagnostic models in the test set were as follows: arachidonic acid (accuracy: 0.887), sebacic acid (accuracy: 0.867), indoxyl sulfate (accuracy: 0.850), phosphatidylcholine (PC) (14:0/0:0) (accuracy: 0.825), deoxycholic acid (accuracy: 0.773), and trimethylamine N-oxide (accuracy: 0.653). The prediction accuracies of the machine learning models in the test set were partial least-square (accuracy: 0.947), random forest (accuracy: 0.947), gradient boosting machine (accuracy: 0.960), and support vector machine (accuracy: 0.980). Additionally, survival analysis demonstrated that acetoacetic acid was an unfavorable prognostic factor (hazard ratio (HR): 1.752), while PC (14:0/0:0) (HR: 0.577) was a favorable prognostic factor for ESCC. This study devised an innovative strategy for ESCC diagnosis by combining plasma metabolomics with machine learning algorithms and revealed its potential to become a novel screening test for ESCC.     

西安市社区老年人记忆障碍的干预研究

目的:明确记忆学习干预对西安市社区轻度认知功能障碍老年人群记忆功能的作用效果,为开展有效地社区健康教育和制定相应地干预模式提供依据。方法:对西安市6家社区老年人群按照随机整群抽样的方法,从140位轻度认知障碍患者中随机选取70位作为干预对象,通过视觉记忆训练、手指保健操、地图作业训练、彩色卡片拼图训练、照片记忆训练、复述短小故事等方法进行为期半年的学习训练干预,同时鼓励老人采取健康的生活方式。应用英国Rivermead康复中心设计的Rivermead行为记忆测验量表(RBMT)分别在干预前和干预后进行评估,然后用SPSS 16.0统计软件包进行统计分析。结果:针对性的记忆学习训练干预和健康的生活方式可以明显的提高西安市社区老年轻度认知功能障碍人群的记忆功能,RBMT总分、立即回忆故事、回忆预约、立即回忆路线、图片再认、回忆信件、定向、面部再认、故事延迟回忆、日期、回忆姓名等10项得分均明显提高,差异有统计学意义(P<0.05)。结论:健康工作者应关注社区轻度认知功能障碍的老年人群,给予其提供针对性的记忆功能学习训练,以提高记忆能力,鼓励老年人群采取健康的生活方式,以阻止或延缓轻度认知功能障碍的发生,提高社区老年人群的生活质量。