随着社会的发展,教育方法也在不断地改革与进步.实验诊断学涉及内容非常广泛,是一门极其重要的基础医学与临床医学的桥梁性学科.把新式TBL教学法与传统LBL教学法相互结合应用于实验诊断学的教学课堂中去,不仅可以起到激发学生们上课的积极性作用,还可以帮助学生对课堂知识的理解与吸收.

目的:探讨Sandwich教学法在实验诊断学病例分析教学中的应用效果.方法:选择济宁医学院2012级临床本科班100人为研究对象,根据随机数字表法分成对照组和实验组.每组均为50人.对照组采用传统教学法,实验组则应用Sandwich教学法.结果:实验组学生理论考试成绩和实践操作成绩为(81.38±8.69)分和(84.39±8.79)分,显著高于对照组的(75.34±7.06)分和(72.63±7.76)分,差异具有统计学意义(P＜0.05);多数学生对Sandwich教学法表示满意.结论:Sandwich教学法在实验诊断学病例分析教学中的应用,提升了学生的学习质量和教师综合素质,培养了学生临床思维能力.

运用回顾性研究方法,分析实施与未实施病例引导式教学法的两级临床本科医学生在课程满意度调查、期末考试试卷病例分析试题的平均分值之间的统计学差异,探索实验诊断学病例引导式教学法的效果.结果表明,临床医学生对病例引导式教学法在实验诊断教学的应用高度认可,病例引导式教学法有助于提高临床医学生分析、解决临床病例问题的能力,是改革传统实验诊断学教学的有效方法.

目的 探索理论与病例分析结合式教学法在临床专升本实验诊断学教学改革中的成效.方法 从两级临床专升本医学生对课程满意度的调查、病例分析试题得分方面分析实施与未实施该教学法的统计学差异.结果 实施理论与病例分析结合式教学法的2011级临床专升本学生对实验诊断教学的满意度及病例分析试题平均分值均明显高于未实施该教学法的2010级临床专升本学生.结论 理论与病例分析结合式教学法是临床专升本实验诊断教学改革的可行和有效方法.

目的:探讨急性主动脉夹层并心包填塞患者的急诊护理。方法:对12例急性主动脉夹层并心包填塞患者进行回顾性分析。结果:12例患者通过稳定血压、控制心率及急诊心包穿刺等治疗和一系列观察护理后,病情稳定收住入院或转上级医院10例,死亡2例。结论:对急性主动脉夹层并心包填塞患者,通过严密的观察护理及合理的治疗,可以在急性期控制夹层的进一步扩展。

Objective: To explore the effect of case-analysis lesson in teaching reform of laboratory diagnostic experiments.Methods: Statistic differences of course satisfaction survey between case-analysis lesson and traditional teaching was analyzed,meanwhile case-analysis test score was compared before and after case-analysis lesson in clinical medical students of grade 2007 in laboratory diagnostic experiments.Results: Clinical medical students approved the case-analysis lesson mostly,and their abilities to deal with clinical cases were elevated significantly due to case-analysis lesson.Conclusion: Case-analysis lesson is effective and practicable method in teaching reform of laboratory diagnostic experiments.

Objective To investigate the pathway of lymphatic drainage of proteins from cerebral parenchyma in subarachnoid hemorrhage rat models. Methods Healthy adult male Wistar rats were divided into Saline group, Evans blue-labeled albumin (EBA) group, and SAH + EBA group. SAH models were produced by double injection of autologous arterial blood into cisterna magna. Using a modified microinjection method, EBA was injected into left candate-putamen of the EBA group and EBA + SAH group rats. In Saline control group, saline was injected. After injection, at 12 hours, 1 day, 2 days, 3 days and 5 days, the animals were sacrificed and the fluorescence signals of EBA were imagined and analyzed along the possible lymphatic drainage pathway, e.g. the brain tissue, the wall of common carotid artery, and cervical lymphatic nodes. Results One day after injection, in EBA group, the fluorescence of EBA initially appeared on the left of the brain, the wall of common carotid artery, left lateral cerebral ventricle, and the perivascular spaces of cerebral vessels. The fluorescence signals gradually expanded to the opposite side.Large amount of fluorescence granules accumulated in the outer layer of common carotid artery. Fluorescence was also found in cervical lymphatic nodes. Two days after injection in this group, the density of fluorescencein the brain became weaker while the density of fluorescence in rhinencephalon became stronger. The fluorescence of EBA was found in lymphatic nodes adjacent to abdominal aorta. In SAH + EBA group,reduced amount and velocity of the drainage of EBA from left caudate-putamen to rhinencephalon, cervical lymphatic nodes, and lymphatic nodes adjacent to abdominal aorta were observed. From 12 hours to 5 days after injection, fluorescence intensity of EBA in deep cervical lymphatic nodes in SAH + EBA group(8.9 ±2. 0, 11.9 ± 2. 5, 17.4 ± 3.7, 26.7 ± 4. 5 and 59.0 ± 8. 1 ) were lower than those in EBA group ( 14. 5 ±3.2, 27.5 ±7.4, 60.3 ±12.3, 138.0±12.0 and 108. 1 ±13.4, F=13. 17, 24.04, 66.81, 302.77 and 59.36, P ＜ 0. 01 ). From 2 to 5 days, fluorescence intensity of EBA in lymphatic nodes adjacent to abdominal aorta was also lower in SAH + EBA group( 11.0 ± 1.5, 12. 5 ±2. 8, 23.6 ±3. 2) than those in EBA group(26. 3 ±5.9, 47.5 ±9.6, 41.0 ±9.3; F =38. 17, 72.52, 19.01, P ＜0.01). Conclusion SAH can result in reduced drainage of macromolecular substances, e.g. protein, from the brain via lymphatic pathway.

Cerebral vasospasm caused by subarachnoid hemorrhage is a major cause of poor prognosis, but the pathogenesis has not been understood completely until now. Therefore, to found an ideal animal model of cerebral vasospasm following subarachnoid hemorrhage will have an enormous advanced effect on research of pathogenesis, clinical prevention and cure of cerebral vasospasm. The author reviewed various establishment methods of animal models of cerebral vasospasm following subarachnoid hemorrhage, and their advantages, disadvantages and application. However, there is still not a model used for studying symptomatic cerebral vasospasm following subarachnoid hemorrhage

Cerebral vasospasm caused by subarachnoid hemorrhage is a major cause of poor prognosis, but the pathogenesy has not been understood completely until now.Therefore, establishing an ideal animal model of cerebral vasospasm following subarachnoid hemorrhage will have an enormous advanced effect on research of pathogenesy, clinical prevention and cure of cerebral vasospasm.However, there is still not an ideal model used for studying symptomatic cerebral vasospasm following subarachnoid hemorrhage.The author reviewed the advancement of different animal models of cerebral vasospasm.

[编者按] 美国心脏病学会/美国卒中学会于2009年发布了动脉瘤性蛛网膜下腔出血处理指南,本文编译了指南中的建议部分.

临床资料:患者,男,44岁,因头痛、发热半月余,加重1天于2008年1月1日入院.患者于半月前无明显诱因出现持续性头痛,阵发性加重,以右侧额顶部胀痛为主,伴发热,体温多在38℃左右波动,伴恶心、无呕吐,偶咳嗽、无痰,咳嗽时伴左胸壁疼痛、气促.既往有原发性血小板减少性紫癜、脾切除术、肺曲菌病、脑真菌病、胸壁脓肿病史.患者自2008年8月20日以来,曾因"肺真菌感染、呼吸衰竭、脑真菌病、胸壁脓肿"多次在我院呼吸内科、山东省立医院住院治疗,给予"伏立康唑"抗真菌治疗,现院外一直坚持服用"伏立康唑、复方新诺明、激素"治疗,但疗效不佳.

近年来,我国乳腺癌的发病率以及病死率呈明显升高趋势.我院对不能明确诊断而又高度怀疑为恶性者先行手术切除包块,术中快速冰冻病理检查,确诊后再行乳腺癌根治术,因为病理检查是乳腺疾病确诊的金标准[1].在围术中等待快速冰冻病理结果时段至少1～2小时,当患者确诊为乳腺癌时,病人往往会出现情感上和心理上的剧变,短时间产生悲观绝望的情绪,甚至拒绝手术.2007年1月～2008年7月,我们对120例术中病理后行乳腺癌根治术患者进行了术前心理干预取得了良好的效果,现报道如下.

Objective:To investigate influential factors and status of reproductive tract infections(RTIs) of married women of reproductive age in Taian city communities and to explore an new-style service model of reproductive health.Methods: A total of 1982 married women of reproductive age in Tai'an city community were investigated through questionnaire,on-the-spot inquiry,gynecological examination,lab examination,B-ultrasonography.Statistical analysis was performed using PEMS 3.0 for windows and SPSS 13.0 statistical software.Results: The prevalence rate of RTIs in the women was 50.10%,and the prevalence rate of cervicitis was the highest(10.39%) among RTIs.And few women had knowledge on RTIs or how to prevent it.Conclusion: It is important to enhance reproductive health care services,to establish new style reproductive health service model,to take the advantage of family planning organizations and to take various measures of providing information and education about the prevention and harmfulness of RTIs for the improvement of the consciousness of health care and the level of reproductive health.

口腔颌面部恶性肿瘤扩大根治术后,创腔难以关闭,器官(如:舌)的形态难以恢复,影响患者的生存质量,因此需要用组织瓣来整复术后创腔和恢复器官(如:舌)的形态.

肾移植已成为终未期肾脏疾病的唯一治疗方法,腹膜后腹腔镜下活体供肾切除术,对腹腔干扰小,不易造成腹腔脏器损伤,术后胃肠功能恢复快,同时供肾者创伤小,住院时间短,康复快.供体的热缺血时间可以缩至最短,费用低.我院2006年12月至2007年1月,通过腹膜后腹腔镜下活体取肾6例,现将手术配合报告如下.

Objective To discuss injection methods that macromolecular tracer entered rat caudate-putamen(CPu)in order to find a better way to study the drainage pathway from the parenchyma of the brain.Methods Adult Sprague-Dawley rats were randomly divided into cutting needle group,non-cutting needle 4ul group and non-cutting needle 1ul group.Evans Blue-labeled albumin(EBA)solution was injected into the rat CPu with microsyringe under stereotaxic apparatus' control.Frozen sections of rat brain samples were made and observed by naked eye and fluorescence microscope respectively.Results The cutting needle way by which tracer's dose is injected into CPu was inaccurate and unstable,however,non-cutting needle way was accurate and stable.Conclusion Non cutting needle wethod by which tracers were injected into rat CPu was economical,accurate,stable and suitable for researching drainage of macromolecules from the parenchyma of the brain.

目的 探讨腹腔镜精密器械有效的清洗方法.方法 将1200件可拆卸式和不可拆卸式腹腔镜手术器械(各600件)均分为A、B、C三组,分别采用3种不同清洗方法各200件,即单纯手工清洗法(手洗法)、单纯清洗机清洗法(机洗法)和手工清洗与清洗机联合清洗的方法(手洗加机洗法).并对器械进行了洁净度目测检查和实验室潜血实验(OB).结果 C组两类器械的目测检查不合格率和OB实验阳性率显著少于A、B两组(P＜0.05,P＜0.01).结论 采用手洗加机洗法清洗可拆卸式和不可拆卸式腹腔镜手术器械,能够将器械清洗得更彻底,确保其灭菌效果.

传统解剖学观念认为,中枢神经系统(central nervous system,CNS)内不存在衬附内皮细胞的淋巴管及淋巴引流,脑脊液(cerebrospinal fluid,CSF)主要经蛛网膜绒毛回流到血液中, 该观点延续了一个多世纪.直到20世纪60年代,动物实验和临床研究发现颈部淋巴回流障碍可导致脑组织形态学、生理功能及行为异常后[1],CNS淋巴引流的重要性始为人们所关注.随后有更多定量研究的结果显示颅外淋巴管在CSF引流中所起的作用可能比蛛网膜绒毛更为重要[2].近年来,CNS淋巴引流的研究成为国内外研究的热点课题之一,许多学者对CNS淋巴引流途径、引流的量、生理和病理意义等方面进行了广泛深入的研究,并取得了突破性进展.现就该领域的最新研究进展作一综述.

传统解剖学观念认为,中枢神经系统(central nervous system,CNS)不存在衬附内皮细胞的淋巴管及淋巴引流,脑脊液(cerebrospinal fluid,CSF)主要经蛛网膜绒毛回流到血液中,该观点延续了一个多世纪.直到20世纪60年代,动物实验和临床研究发现颈部淋巴回流障碍可导致脑组织形态学、生理功能及行为异常后[1],CNS淋巴引流的重要性始为人们所关注.随后的定量研究显示颅外淋巴管在CSF引流中所起的作用可能比蛛网膜绒毛更为重要[2].近年来,许多学者对CNS淋巴引流途径、引流量、生理和病理意义等方面进行了广泛深入的研究,并取得了突破性进展.现就该领域的研究进展综述如下:

Objective: To prove methods which are not easier to be polluted through observing the growth of the colony in culture dish when aseptic container being opened,with the inside of the lid being kept up or down in hand.Methods: Taking the culture dish as aseptic container and the culture medium as the lid.When we opened the culture dish,the inside of the lid was uncovered up in control group while it was uncovered down in experiment group.Results: 160 culture dishes were used in each group.The colony of 78 was found grown in 54 dishes in the control group and the colony of 17 was grown 15 culture dishes in the experiment group.There are significant differences between the two groups in rate of infecting bacteria and the colony amount(P<0.01).Conclusion: When aseptic container opened,the lid is not easier to be polluted when its inside is kept down than up.The lid whose inside is kept up is easy to be polluted with exposed time lengthening and colony growing.But the change is not obvious when its inside is down.