目的 分析当前医患沟通学课程教学中存在的问题，探索提高教学质量的有效途径。 方法 2011年12月－2012年1月通过收集相关文献及实际教学中有关医患沟通的事例，对医患沟通中存在的问题进行归类梳理，并针对各结症提出解决措施及建议。 结果 目前国内医患沟通学教学中存在以下问题：医学生对医患沟通学课程不够重视；缺乏系统的教学质量考评体系；医患沟通学课程的理论与实践课学时比例缺乏科学的设置标准；教学方式、课程开设对象等不统一。 结论 要提高医患沟通学教学质量，其提高医学生对沟通能力重要性的认识是前提，建立健全医患沟通学课程的教学模式和考核体系是关键，为学生构建早期接触临床实践的平台是保障。
Objective To investigate the possible role of ulinastatin(UTI) in f lipopolysacccharide (LPS)-induced acute lung injury(ALI).Methods Thirty male SD rats were randomly divided into three groups，ie.a normal control group，a LPS group and a LPS plus UTI group.The rats were injected with 1 mL of normal saline via caudal vein in the control group，with LPS 5 mg/kg via caudal vein in the LPS group，and with UTI 100000 U/kg shortly after injection with LPS in the LPS plus UTI group.The rats were sacrificed 4 h after the injection.Lung wet/dry weight ratio was measured.IL-18 level in serum and lung tissue was determined by ELISA and the expression of NF-κB in lung tissue was determined by immunohistochemistry.Pathological changes of rats’ lung were observed by optical and electron microscope.Results Compared with the control group，IL-18 level in serum and NF-κB expression in lung tissue were significantly higher in the LPS group(Plt;0.01).The IL-8 level was somewhat elevated in the LPS+UTI group but with no significant difference from that in control group was found (Pgt;0.05).The lung inflammation in the LPS+UTI group was milder than that in the LPS rats.Conclusion UTI can alleviate LPS-induced inflammatory reaction and lung injury in rat model.
Objective To investigate the changes in terms of knowledge, attitudes, behavior, and mental status in hospital outpatients after the Wenchuan earthquake so as to provide more convenient and efficient outpatient services for patients from the disaster areas. Method A self- designed questionnaire was used to survey the outpatients in West China Hospital. Data analysis was performed with SPSS 13.0 software. Result The duration of earthquake feeling was correlated with age, gender, family address, disaster experience, and casualties of relatives and friends. Sleep quality after the earthquake was also significantly correlated with age, gender, family address, disaster experience, casualties of relatives and friends, and the duration of eartqhauke feeling. Seeking medical treatment after the earthquake was associated with the availability of medical insurance. Knowledge about post-quake epidemics was correlated with the responders’ educational background. Conclusion Stress response is related to age and disaster experience. Many factors may effect the development, extent, and duration of people’s stress response. People became more aware of risk after the quake and had a b demand for post-disaster psychological counseling.
目的 探讨原发性失眠患者日间功能损害及其影响因素。 方法 选取2010年3月－12月符合美国《精神障碍诊断与统计手册》第4版诊断标准的原发性失眠者62例，另选择性别、年龄匹配的健康睡眠者53例。失眠组和对照组均采用匹茨堡睡眠质量指数量表（PSQI）评估1个月的主观睡眠质量，多导睡眠监测（PSG）评估客观睡眠质量，并通过“主观睡眠时间/客观睡眠时间×100%”计算睡眠知觉，PSG监测后受试者完成一系列日间功能评定，包括Epworth嗜睡量表（ESS）评价嗜睡程度、Flinders疲劳量表（FFS）评价疲劳程度、贝克抑郁量表（BDI）和状态-特质焦虑量表（STAI）评估情绪状态。 结果 ① 与对照组相比，失眠组主客观睡眠质量均较差；PSQI分数更高[（14.37 ± 2.44）、（2.74 ± 1.79）分，P＜0.001）]；睡眠知觉差[（49.76 ± 33.29）、（99.36 ± 12.79）分，P＜0.001）]。② 失眠组FSS、BDI、SAI、TAI分数明显高于对照组，ESS分数低于对照组（P值均＜0.05）。③ PSQI总分与ESS呈负相关（r=−0.17，P＜0.01），与FSS、BDI、SAI、TAI分数呈正相关（r=0.54，r=0.66，r=0.70，r=0.87）（P值均＜0.01）。客观睡眠时间与ESS（r=−0.01，P=0.138）、FSS（r=−0.02，P=0.019）、BDI（r=−0.03，P=0.022）、SAI（r=−0.03，P=0.086）、TAI（r=−0.04，P=0.015）分数均无明显相关性。 结论 原发性失眠者主观睡眠质量与多项日间功能损害相关，这为有效的治疗失眠和改善日间症状提供理论依据。
目的 探讨保留括约肌虚挂线法治疗高位肛周脓肿的临床疗效。 方法 2009年10月－2010年10月采用随机对照试验，对52例高位肛周脓肿患者施行手术治疗，其中保留括约肌虚挂线法（治疗组）26例，切开挂线引流法（对照组）26例。对两组患者术后6个月肛瘘发生率、切口愈合时间、术后1～15 d每晚疼痛视觉模拟评分（VAS）和术后6个月痊愈患者肛门功能后遗症发生率进行比较。 结果 术后6个月，治疗组和对照组肛瘘发生率分别为4.0%和3.8%，差异无统计学意义（P＞0.05）。术后7～15 d治疗组VAS评分均低于对照组，差异有统计学意义（P＜0.05）。两组切口愈合时间分别为（19.05 ± 6.71）d和（21.42 ± 8.40）d，差异有统计学意义（P＜0.05）。术后6个月治疗组痊愈患者肛门功能全部正常，对照组后遗症发生率为12.0%，两组比较差异有统计学意义（P＜0.05）。 结论 保留括约肌虚挂线治疗在术后疼痛、切口愈合时间和保护肛门功能等方面明显优于切开挂线引流治疗，是一种治疗高位肛周脓肿较为理想的方法。
【摘要】 目的 评估吉非替尼治疗终末期（PS评分≥3分）非小细胞肺癌（NSCLC）的临床效果和生活质量改善情况。 方法 2008年5月-2010年6月共收治终末期NSCLC患者40例，其中19例患者采用吉非替尼治疗（治疗组），21例采用支持治疗+中药治疗（对照组）。 结果 治疗6个月后，治疗组19例患者中，CR 1例，PR 5例，SD 10例，PD 3例。治疗组有效率为31.5%（6/19），临床受益率为84.2%（16/19）。对照组21例中，SD 5例，PD 16例，无CR。对照组有效率为23.8%（5/21），临床受益率为 23.8%（5/21）。两组间有效率和临床受益率比较，差异均有统计学意义（Plt;0.05）。治疗组中位生存期为13.2个月，对照组中位生存期为4.5个月。 结论 吉非替尼可延长NSCLC患者的生存期，改善其生活质量。【Abstract】 Objective To evaluate the curative effect and life improvement of gefitinib on non-small cell lung cancer (NSCLC) which in the end stage. Methods Forty patients with end-stage NSCLC were treated from May 2008 to June 2010. Nineteen patients of them were treated with gefitinib (treatment group), 21 patients were treated with supportive care and traditional Chinese medicine treatment (control group). Results Six months after treatment, there are one patient with CR, five patients with PR, 10 patients with SD and three patients with PD in the treatment group. The effective rate of treatment group was 31.5% (6/19), clinical benefit rate was 84.2% (16/19). There are five patients with SD, 16 patients with PD, and no one with CR in the control group. The effective rate of the control group was 23.8% (5/21), clinical benefit rate was 23.8% (5/21). The differences of effective rate and clinical benefit rate between two groups were statistically significant (Plt;0.05). The median survival period of the treatment group and control group were 13.2 and 4.5 months respectively. Conclusion Gefitinib can extend the lifetime of NSCLC patients and improve their quality of life.
Objective To investigate and explore the clinical effect of preoperative exercise intervention on total hip arthroplasty. Methods Seventy-three patients who underwent primary unilateral total hip replacement (THR) in the Orthopedics Department, the Second Hospital of Jilin University between March 2017 and January 2018 were divided into 2 groups: treatment group (n=37) and control group (n=36). Patients in treatment group received exercise intervention and routine education since 4 weeks before surgery; the control group just received routine education before surgery and both groups underwent the same routine rehabilitation training. The Visual Analogue Scale (VAS) was evaluated and compared separately between the two groups at 4 weeks before surgery (T0), 1 day before surgery (T1), before discharge (T2), 1 month after discharge (T3), and 3 months after discharge (T4). The results of Hip Harris score and Time Up and Go test (TUG) were evaluated and compared separately between the two groups at T0, T1, T3 and T4. Results Time of TUG of the treatment group and the control group at T1, T3 and T4 were (14.59±3.15) vs. (16.31±3.31) s, (13.61±2.76)vs. (15.25±3.08) s, (12.49±2.37)vs. (14.22±2.65) s, respectively, and the differences between the two groups at T1, T3 and T4 were all statistically significant (P<0.05). In terms of VAS and Harris scores, both groups showed significant improvement after surgery at different time nodes (P<0.05), but the differences between the two groups was not statistically significant (P>0.05). Conclusion Preoperative exercise intervention can effectively improve the walking ability of THR patients and reduce the risk of falls after discharge, but it did not reduce postoperative pain or improve postoperative hip Harris score after discharge.
ObjectiveTo understand the application of vacuum assisted rotary cutting technique in benign and malignant breast diseases.MethodThe related literatures about the application of vacuum assisted rotary cutting technique in the breast benign and malignant diseases were reviewed.ResultsThe technique of vacuum assisted rotary cutting had been applied to the treatment of intraductal and phyllodes tumors. The non-lactation mastitis lesions could all be removed by this technique, and as a minimally invasive treatment for gynecomastia. It could guided by the color Doppler ultrasound, mammography and MRI, which could obtain enough tissue specimens for the screening and biopsy of early breast cancer. The indication of vacuum assisted rotary cutting technique should be further discussed in the breast conserving treatment of breast cancer.ConclusionsVacuum assisted rotary cutting technique has been widely used in treatment of various benign diseases of the breast and diagnosis and treatment of breast cancer. The best indication for operation should be determined based on clinical manifestations and auxiliary examination results.
ObjectiveTo investigate the application scope and effects of pancreatic duct stent in common pancreas diseases.MethodThe literatures on application of pancreatic duct stent in common pancreas diseases at domestic and foreign were reviewed.ResultsPancreatic duct stent had been used in acute and chronic pancreatitis and pancreatic tumor, which could the relieve symptoms, reduce the complications of pancreatitis, improve the prognosis, shorten the hospital stay, and reduce the hospitalization costs. Meanwhile it had also been used in pancreatic tumor surgery, palliative treatment, and brachytherapy that some achievements had been made.ConclusionAlthough application of pancreatic duct stent in some common pancreatic diseases is still controversial, effect is better and has some advantages with small trauma and low incidence of complications, which also provides a new treatment option for some common pancreatic diseases.
Objective To explore the difference between the hemorheology levels and the expression of hypoxia inducible factor 1α/2α (HIF-1α/2α) in the peripheral blood mononuclear cells of the Tibetan and Han patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods This research recruited 30 high-risk Tibetan and Han patients with OSAHS, and 30 Tibetan and Han healthy volunteers at the same period. The whole blood viscometer was used to detect the high shear rate of whole blood viscosity, low shear rate of whole blood viscosity, plasma viscosity ratio, red blood cell aggregation index, and hematocrit in each group. RT-qPCR and Western blot assays were used to detect the mRNA and protein levels of phosphoinositide 3-kinase (PI3K), serine/threonine kinase (AKT), nuclear factor-κB (NF-κB) p65, HIF-1α and HIF-2α in peripheral blood mononuclear cells. Results The hemorheology level of Tibetan OSAHS patients was significantly higher than that of healthy Tibetans and Han OSAHS patients (P<0.05), and the hemorheology level of Han OSAHS patients was significantly higher than that of Han healthy people (P<0.05) . The mRNA and protein levels of PI3K, AKT, NF-κB p65 and HIF-1α in the peripheral blood mononuclear cells of Tibetan OSAHS patients were significantly higher than those of the healthy Tibetans or Han people, and these indexes of the Han OSAHS patients were significantly higher than those of the Han healthy people (all P<0.05), while HIF-2α mRNA and protein levels were significantly lower than those of healthy Han people (all P<0.05). Conclusion The upregulation of HIF-1α level and downregulation of HIF-2α expression in peripheral blood mononuclear cells of OSAHS patients depend on the activation of the PI3K/AKT/NF-κB p65 signaling pathway, and the hemorheological level of Tibetan OSAHS patients is higher than that of Han OSAHS patients.