临床教学阶段医学英语系列课程设置及学生评价

通过3年来的尝试,我院初步建立了临床教学阶段医学英语系列课程。医学英语课程授课教师主要由医学部专业英语教师、我院临床医师及外籍医师组成。课程贯穿于临床教学的全过程(七年制教学的第四年、第五年)。我们就学生对该系列课程的评价进行了认真的分析,就如何完善系列课程提出了一些建议。     

把医学人文精神融入临床医学教育

临床医学在长期的医疗实践过程中积累了大量的人文教育素材，富含人文精神。医学生进入临床课程学习阶段，首次接触病人，临床教师应该将医学科学中的人文精神贯彻到医疗工作和临床教学中，从医学的人文精神培育、感化医学生。本文以妇产科学临床教学为例，论述医学人文精神与临床教学的整合。     

实习医师病案缺陷分析与对策

我院是一所省级三级甲等综合性教学医院，每年承担130多名大学本科实习医师的临床教学任务。1998年通过省高等医学院临床教学评审，被评为优秀教学医院。近几年我院针对实习教学中的薄弱环节，对实习医师的病案缺陷进行了分析，并采取相应措施。     

检验专业学生临床实习教学现状及改进措施思考

目前医学检验的临床实习教学现状与培养合格检验医师的要求还不够协调,主要表现在课程设置、实习条件、学生及带教教师素质等方面。要建立有效的医学检验临床实习教学模式,必须合理设置临床教学内容、采取有效的教学手段,这对全面提高实习生的素质具有重要意义。     

如何做好临床教学查房

临床教学查房是教学医院的临床教师利用临床现场，通过临床现实材料，结合临床工作而开展的重要的临床教学工作，是临床教师实施技术指导、培训各级临床医师，加强学科专业建设、提高专业技术水平，完成医学教学任务的重要的经常性的业务活动方式。临床教学查房可以培养学生如何观察和诊疗病人、学习处理医患关系、逐步适应从医学生向临床医生的角色转变，也能培养实习学生的临床思维、提高其临床操作技能。因此，搞好临床教学查房工作对提高医学教学水平、培养新时代高质量的临床医务工作者来说，至关重要。     

加强临床教学基地建设,确保医学人才培养质量

建设临床教学基地(非直管附属医院、教学医院、实习医院)是我院解决临床教学资源不足,保证临床教学质量的有效手段。我院把临床教学基地建设作为临床教学工作的重点,积极探索和实践,采取多种措施加强指导和管理。指导临床教学基地开展教学活动,从教学理念、教学方法、教学技巧等方面加强临床教学基地师资培训,强化临床教学基地教师的教学意识,不断丰富高水平的临床教学基地建设的内涵,为培养合格医学人才搭建了良好的平台。在2007年和2008年重庆医科大学两次组织对临床教学基地评估检查中,我院指导的临床教学基地取得了优异成绩。     

医学临床教学中应注意的法律问题

目前我国与医学临床教学活动相关的法律问题日益受到关注。加强实习医师综合素质的培养、增加临床教师的法律意识已迫在眉睫。建立与临床医疗教学工作相关的法律法规，完善有法可依的医疗临床教学模式，在保障患者合法权益和遵守医疗常规的前提下，保证临床教学工作合理合法的进行，应当是我们今后的工作重点。     

七年制诊断学教学改革的实践

从1988年开始，我校试办七年制临床医学专业，培养具有医学硕士水平的高级临床医师。我教研室承担了第一届（八八级）和第三届（九○级）七年制诊断学及内科学教学任务。在教学实践中，我们大胆实施一系列教学改革措施，积极探索七年制临床教学模式，取得了较好的成绩。一、实行大课教授负责制，小课教师一贯制第一届七年制临床课采用单科独进、分科循环模式。以往几门课齐头并进，现在集中在短时间内完成某门课程。因而诊断学课时密度猛增，五年制周学时为8，七年制则为14，课程进度很快，七年制要求11周结束诊断学，五年制则为21周。面对…     

如何加强临床基本技能培训

目前，临床教学普遍面临由于学生多、病人自我保护意识增强等原因使床边教学阻力增大、临床教学资源相对匮乏的问题。因此，应加强对学生临床基本技能的训练，而且按照国家对执业医师实践技能的要求，强调临床医师必须掌握基本技能，注重学生通科技能和临床素质的培养。临床基本技能既是沟通基础课程和临床课程的桥梁，又是培养具有优秀动手能力的医学接班人的根本保障。通过临床技能训练，使学生尽快进入临床角色，树立全面的临床观念，强化医师素质的培养，更快、更好地适应临床学习和实践，进一步提高临床基本技能。     

提高外科临床实习教学质量的探讨

医学是一门实践性很强的科学 ,在医学教育中 ,临床实习是从理论到实践的过程 ,是出人才、出产品的最后阶段 ,是至关重要的环节。所以 ,临床实习的教学质量直接影响到学生的临床工作能力。特别是执业医师考试制度的建立 ,对临床教学质量提出了新的要求。在临床实习中 ,外科实习除具有其他科的共性外 ,更具有自己的特点 ,那就是基本技能的训练 ,它直接反映出一个学生的素质。如何提高外科临床实习教学质量 ,笔者根据自己的教学经验 ,结合我院具体情况 ,提出以下看法。1　加强师资培养与规范在外科临床教学工作中 ,要提高教学质量 ,教师是关键。在我院的外科临床教学中 ,主要由住院医师及进修医师直接指导学生完成临床实习任务 ,但有些住院医师及进修医师的教学意识不强 ,临床经验少 ,业务水平有限 ,特别在基本技能方面缺乏规范。要提高教师的教学素质 ,以下几方面是重要的。1.1　强化教师的教学意识 :教学意识淡薄是临床教学中存在的主要问题。部分年轻教师不能正确认识临床教学的重要性 ,把临床教学任务当成负担。作为附属和教学医院 ,其职能不同于其他单纯医疗型的医院 ,教学是其根本任务之一 ,而教学也促进了医院学科发展和学术地位提高 ,培...     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.     

Possible Spread of adenovirus type 3 from poultry to humans ：indirect evidence from an outbreak in China

Objective:To explore the epidemiology and etiology for an outbreak of acute respiratory tract infection that occurred in one county of Jiangsu Province, China 2004. Methods: Only cases meeting the case definition were included in the study. We reviewed the medical records of the cases who were admitted to the local hospitals, interviewed cases by a standard questionnaire, and then described the epidemiotogic features and analyzed risk factors by means of a case-control study. We collected pharyngeal swab specimens and sent them to different laboratories for isolation and culture. The laboratory used different detection methods such as DIP, PCR, electron microscope examination and microneutralization assay, to identify and then type the positive specimens. Results:A total of 871 cases were reported during the period from April 18 to July 4,2004. The distribution of onset times presented two peaks, one in late May and another in middle June. The epidemic occurred mainly in the elementary and junior high schools in ten townships of one county, and the mean age of the cases was 12 years (range 7 months to 18 years). The course of the disease was acute, and was characterized by fever accompanied with sore throat and tonsillitis. The WBC count of cases was normal or elevated. The mean duration of illness was 5 days (range 2 to 12 days). No fatalities from illness were reported. A case-control study indicated that the possible risk factors were close contact with a case and/or poultry before onset and sharing of towels among members of the family. The typical CPE was observed through inoculating pharyngeal swab specimens into the HEP-2 cell cultures in different laboratories. An infection of adenovirus type 3 was verified by detecting positive specimens in different methods. Conclusion:This investigation demonstrated that the acute respiratory infection in cases was caused by adenovirus type 3. Cases occurred in over 70 schools in ten townships in 2004, and the route of transmission was possibly close contact with cases or droplet transmission.