目的 分析當前醫患溝通學課程教學中存在的問題，探索提高教學質量的有效途徑。 方法 2011年12月－2012年1月通過收集相關文獻及實際教學中有關醫患溝通的事例，對醫患溝通中存在的問題進行歸類梳理，并針對各結癥提出解決措施及建議。 結果 目前國內醫患溝通學教學中存在以下問題：醫學生對醫患溝通學課程不夠重視；缺乏系統的教學質量考評體系；醫患溝通學課程的理論與實踐課學時比例缺乏科學的設置標準；教學方式、課程開設對象等不統一。 結論 要提高醫患溝通學教學質量，其提高醫學生對溝通能力重要性的認識是前提，建立健全醫患溝通學課程的教學模式和考核體系是關鍵，為學生構建早期接觸臨床實踐的平臺是保障。
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.
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.
目的 探討保留括約肌虛掛線法治療高位肛周膿腫的臨床療效。 方法 2009年10月－2010年10月采用隨機對照試驗，對52例高位肛周膿腫患者施行手術治療，其中保留括約肌虛掛線法（治療組）26例，切開掛線引流法（對照組）26例。對兩組患者術后6個月肛瘺發生率、切口愈合時間、術后1～15 d每晚疼痛視覺模擬評分（VAS）和術后6個月痊愈患者肛門功能后遺癥發生率進行比較。 結果 術后6個月，治療組和對照組肛瘺發生率分別為4.0%和3.8%，差異無統計學意義（P＞0.05）。術后7～15 d治療組VAS評分均低于對照組，差異有統計學意義（P＜0.05）。兩組切口愈合時間分別為（19.05 ± 6.71）d和（21.42 ± 8.40）d，差異有統計學意義（P＜0.05）。術后6個月治療組痊愈患者肛門功能全部正常，對照組后遺癥發生率為12.0%，兩組比較差異有統計學意義（P＜0.05）。 結論 保留括約肌虛掛線治療在術后疼痛、切口愈合時間和保護肛門功能等方面明顯優于切開掛線引流治療，是一種治療高位肛周膿腫較為理想的方法。
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 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.
目的 探討原發性失眠患者日間功能損害及其影響因素。 方法 選取2010年3月－12月符合美國《精神障礙診斷與統計手冊》第4版診斷標準的原發性失眠者62例，另選擇性別、年齡匹配的健康睡眠者53例。失眠組和對照組均采用匹茨堡睡眠質量指數量表（PSQI）評估1個月的主觀睡眠質量，多導睡眠監測（PSG）評估客觀睡眠質量，并通過“主觀睡眠時間/客觀睡眠時間×100%”計算睡眠知覺，PSG監測后受試者完成一系列日間功能評定，包括Epworth嗜睡量表（ESS）評價嗜睡程度、Flinders疲勞量表（FFS）評價疲勞程度、貝克抑郁量表（BDI）和狀態-特質焦慮量表（STAI）評估情緒狀態。 結果 ① 與對照組相比，失眠組主客觀睡眠質量均較差；PSQI分數更高[（14.37 ± 2.44）、（2.74 ± 1.79）分，P＜0.001）]；睡眠知覺差[（49.76 ± 33.29）、（99.36 ± 12.79）分，P＜0.001）]。② 失眠組FSS、BDI、SAI、TAI分數明顯高于對照組，ESS分數低于對照組（P值均＜0.05）。③ PSQI總分與ESS呈負相關（r=?0.17，P＜0.01），與FSS、BDI、SAI、TAI分數呈正相關（r=0.54，r=0.66，r=0.70，r=0.87）（P值均＜0.01）。客觀睡眠時間與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）分數均無明顯相關性。 結論 原發性失眠者主觀睡眠質量與多項日間功能損害相關，這為有效的治療失眠和改善日間癥狀提供理論依據。
With the aging of the Chinese population, the incidence of vascular diseases is increasing year by year. Currently, venous diseases account for a large proportion of vascular surgical diseases. With the rapid development of venous imaging, the rapid progress of endovascular technology and the innovation of vene-related instruments, the diagnosis and treatment of venous diseases are constantly updated. As the development source and foundation of vascular surgeons, venous diseases should be paid attention to by every vascular surgeon. This paper will discuss the current research hotspots of venous surgery.
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.