整合-混合式临床应用型解剖学教学模式的探索与展望

人体解剖学作为一门医学生的专业基础课,课程设置和教学方法在不断改进。本文总结了国外医学院校人体解剖学最前沿的教学模式,结合我校解剖学教学改革现状,提出整合-混合式临床应用型解剖学教学模式,旨在简化学习难度,提高教学效果,努力培养应用型和创新型医学人才。

病理学硕士研究生临床应用型培养模式探讨

通过不断调整研究生培养方案,促进临床病理诊断能力及科学研究能力有效结合,培养从事临床病理诊断、科研和教学能力的高层次综合性专门人才。

临床应用型中医人才的培养与改革探讨

目前我国中医药教育事业仍存在发展不平衡的问题,作为培养中医人才的主要阵地,进行教育改革是高等中医院校的使命。文章从中医人才培养存在的问题入手,结合实际综合选用PBL、CBL、RBL等方法,同时根据医学的特殊性采取注重经典,跟师名医,培养医德医风等措施,加强医学生临床思维的培养,帮助尽快完成从医学生到医生的转变。

应用型临床医学人才培养中预防医学教学模式的改革与实践

针对现代医学模式下应用型临床医学本科人才的特点,论述了在应用型临床医学人才培养中预防医学的教学思想和对策,探索了预防医学的教学内容、教学方式、实践教学体系以及素质教育的改革,提出了用大卫生观念培养学生宏观视野、强调行为因素对健康和疾病的作用、正视经济发展对健康的负面影响的教学对策;并采用了案例讨论和参与式教学相结合、及时更新知识调整教学内容与现代化教学手段相结合、教学实践与社会实践相结合、传染病和突发公共卫生事件法律和法规教学与素质教育相结合等教学方式,阐明了预防医学教学在培养适合社区和基层的应用型临床医学人才中的作用.

新医改背景下应用型临床医学专业人才培养模式的创新与实践

随着新医改的推进,人们越来越关注医疗事业发展,对医学人才的培养也成为人们重点关注问题。为了满足人们对医学人才的需求,应用型临床医学专业在新医改背景下也构建了新型人才培养模式,并在此基础上不断创新与实践。以便为社会培养更多人才,满足社会发展需求。本文从培养应用型临床医学专业人才的重要意义入手,结合应用临床医学专业人才培养现状,重点研究新医改背景下应用型临床医学专业人才培养模式的创新与实践,以便为医学人才培养提供方向。

基于循证医学实践的应用型研究生人才培养模式探讨

随着新疆医疗卫生事业的快速发展,培养高素质、高能力的医学人才对新疆医疗卫生事业的发展尤为重要。应用型的医学研究生是即将进入临床一线的医务工作者,必须使其通过各种途径得到证据,进行临床决策,并能正确评价专家意见,符合循证医学实践的要求。如何做好以上工作也对循证医学实践提出了新的挑战。文章提出从教学方式、考试制度、全方位普及循证医学知识、搭好医学信息平台工作等方面进行改革,引导研究生正确提出患者的临床问题,查找最佳证据,系统评价证据,慎重、准确和明智地应用所获得的最好研究证据确定患者的治疗措施,取得最好的治疗效果,构建和谐的医患关系,提高实践循证能力并进行后效评价。

中西医临床专业实施小班化病理教学的探讨

目的:探讨在中西医临床本科专业学生中实施小班化病理学理论教学的实践效果。方法:选择湖北民族学院医学院2008级、2009级中西医临床本科学生为研究对象,随机分为实验组和对照组。实验组利用显微数码互动多媒体教学系统进行理论课讲授。对照组采用传统方法进行授课;以测试成绩、综合能力、问卷调查、跟踪调查等形式作为评价指标。结果:实验组成绩考核优良率均明显高于对照组(P<0.05);在教学目标达到、激发学习兴趣、师生互动及提高综合能力方面,实验组效果均好于对照组。结论:大部分同学认为小班化理论教学能调动学习的主动性和积极性,提高分析问题和解决问题的能力,并且在临床应用型和创新型人才培养上,小班化理论教学取得了明显的效果。

Cost-effective method of siRNA preparation and its application to inhibit hepatitis B virus replication in HepG2 cells

AIM: To find a cost-effective method of preparation of short interfering RNAs based on cloning, fermentation, digestion and purification (CFDP) and test its feasibility to inhibit hepatitis B virus replication in cell culture. METHODS: We constructed an expression vector containing T7 and tac promoter in a head-to-head orientation. cDNA fragment of interest was cloned into this vector between the opposing promoters. dsRNAs were expressed with this vector in Escherichia coli, and purified by affinity chromatography using CF 11 column. They were digested by RNase III in a buffer containing manganese ions, then separated on 15% non-denaturing PAGE, and the siRNAs about 25 bp in length were recovered. siRNAs prepared with CFDP were co-transfected with target gene expression plasmid into human cell lines with lipofectamine 2 000 to test their inhibition efficiency. RESULTS: siRNAs corresponding to part of the hepatitis B virus polymerase gene (siHBVP) prepared by CFDP specifically and dramatically suppressed the virus protein expression. The HBsAg expression level was reduced to 10% that of the control by co-transfection of 60 nmol/L siHBVP in SMMC7721 cells. Dose-dependent effect on suppression of HBsAg and HBeAg expression was observed in HepG2 cells. The highest inhibition rate was kept at 70% during the six days after transfection of 7.5 nmol/L siHBVP. CONCLUSION: We show CFDP is a very promising method to prepare therapeutic agents in anti-virus applications.

CLINICAL APPLICATION OF BOTULINUM TOXIN TYPE B IN MOVEMENT DISORDERS AND AUTONOMIC SYMPTOMS

Objective To evaluate efficacy and safety of botulinum toxin type B (BTX-B) in treatment of movement disorders including blepharospasm, oromandibular dystonia, hemifacial spasm, tremor, tics, and hypersecretory disorders such as sia-lorrhea and hyperhidrosis. Methods A retrospective study of BTX-B injections in treatment of 58 patients with various neurological disorders was performed. The mean follow-up time was 0.9 ± 0.8 years. Results of the first and last treatment of patients with at least 3 injection sessions were compared. Results The response of 58 patients to a total of 157 BTX-B treatment sessions was analyzed. Of the 157 treatment sessions, 120 sessions (76.4%) resulted in moderate or marked improvement while 17 sessions (10.8%) had no response. The clinical benefits after BTX-B treatment lasted an average of 14 weeks. Of the 41 patients with at least 3 injection ses-sions (mean 10 ± 8.6), most patients needed increased dosage upon the last session compared to the first session. Nineteen patients (32.8%) with 27 sessions (17.2%) reported adverse effects with BTX-B treatment. Conclusions Though most patients require increased dosage to maintain effective response after repeated injections, BTX-B is an effective and safe treatment drug for a variety of movement disorders, as well as drooling and hyperhidrosis.

Do statins reduce hepatitis C RNA titers during routine clinical use?

AIM: To compare hepatitis C virus (HCV) titers in patients with chronic hepatitis C with and without exposure to 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins).METHODS: Medical records were reviewed for 6463 patients with documented HCV infection at a single center between March 2004 and September 2006. Patients with confi rmed viremia and meeting inclusion criteria were assigned to one of three groups: Group A (n = 50), dyslipidemic patients with statin usage during HCV RNA polymerase chain reaction (PCR) determination; Group B (n = 49), dyslipidemic patients with prior or future statin usage but not at the time of HCV RNA PCR determination; and Group C (n = 102), patients without statin usage during the study period. The primary analysis explored the effect of statin therapy on HCV viremia. Secondary analyses assessed class effect, dose response, and effect of other lipid-lowering therapies on HCV viral titers.RESULTS: Median HCV RNA titers did not signif icantly differ among the three groups (Group A: 4 550 000 IU/mL, Group B: 2 850 000 IU/mL, Group C: 3 055 000 IU/mL).For those subjects with longitudinal assessment of HCV viremia prior to and while on statins, there were no signif icant differences between pre- and post-HCV viral titers. Additionally, no differences in HCV titers were observed at any dose level of the most prescribed statin, simvastatin. However, hypertriglyceridemia independently correlated with HCV titers, and niacin exposure was associated with signif icantly lower viral titers (P < 0.05).CONCLUSION: There was no apparent effect of statins on HCV viral replication in this analysis. Further investigation is warranted to explore the possible antiviral properties of triglyceride-lowering agents and their potential role as adjuncts to standard HCV therapy.

Clinical results and histological changes following preoperative interventional treatment of the aggressive subtype of endometrial cancer

Objective: The aim of the study was to evaluate the clinical value of preoperative intra-arterial infusion chemotherapy and embolization in treating the aggressive subtype of endometrial carcinoma with hysterectomy. Methods: Fifteen cases of endometrial carcinoma were performed intra-arterial chemotherapy and embolization before operation with carboplatin or cisplatin, epirubicin or ADM, and all the cases were performed the arterial chemoembolization with KMG or gel-foam particles mixed with 1/3 total drug dose after 2/3 total drug dose perfusion through the bilateral feeding arteries. Of 15 cases, there were 5 cases with uterine papillary serous carcinoma, 3 cases with endometrial clear cell carcinoma, and 7 cases with endometrial adenosquamous carcinoma. Results: Fifteen cases of endometrial carcinoma were performed operations after 3–4 weeks of intra-arterial chemotherapy and embolization. In these cases, 3 were found mass necrosis and lymphocyte cells infiltration in the tumor tissues but no carcinoma cells, which was noted as histological complete remission (HCR). After intra-arterial chemotherapy and embolization 3–4 weeks, the expression of proliferating cell nuclear antigen (PCNA) was obviously reduced (P < 0.001). Conclusion: The preoperative intra-arterial chemotherapy and embolization can improve the operability of resection in patients with aggressive subtype of endometrial carcinoma, reduce the expression of PCNA, adjust malignancy of endometrial carcinoma, and improve prognosis.

Clinical application of full automatic animal experimental cabin of normobaric/hypobaric hypoxia and high carbon dioxide

To explore the feasibility of the full automatic animal experimental cabin to establish the animal models in normobaric/hypobaric hypoxic and high carbon dioxide environment. Methods： Sixty SPF-class male DS rats were divided into 2 groups, 20 for normobaric, hypoxic conditions and the other 40 for hypobaric, hypoxic conditions. For each group, the pulmonary arterial pressure and carotid arterial pressure indicators of rats were examined by using the physiological multi-detector, and the pulmonary vascular changes in the structure were observed. Results： The normobaric/hypobaric hypoxic with high carbon dioxide environment can promote the formation of pulmonary hypertension and accelerate changes in pulmonary vascular remodeling, and promote the right ventricular hypertrophy. Conclusion： Clinical applications showed that the animal experimental cabin has observed and controlled accurately. The result was safe, reliable and reproducible. The cabin can successfully establish the pulmonary hypertension model in normobaric/hypobaric hypoxic with high carbon dioxide environment, and in order to study the physiological mechanism of a variety of circulation and respiratory diseases caused by lack of oxygen, which provided an experimental technology platform for clinical research.

Application of Computed Tomographic Colonography in Diagnosis of Colonic Polyps

Objective To assess the clinical values of computed tomographic colonography （CTC） in diagnosis of colonic polyps. Methods Forty-two patients who were clinically suspicious of colonic polyps or underwent colonic polyps screening received examinations with both CTC and conventional colonoscopy. Sixteen- or 64-slice spiral computed tomography and professional imaging processing techniques were used for evaluation. Per-polyp and per-patient results were analyzed. Those by per-polyp were subsequently divided into ≥10 mm group, 5-10 mm group, and ≤5 mm group. Sensitivity, positive predictive value （PPV）, specificity, negative predictive value （NPV）, and accuracy were calculated using statistical method for diagnostic studies, with conventional colonoscopy as a gold standard. Results Ninety and 61 polyps were found by CTC and conventional colonoscopy, respectively. The per-polyp sensitivity/PPV were 80.3%/55.6% in total, and 100%/92.9%, 93.8%/65.2%, and 68.8%/ 41.5% in the ≥10 mm group, 5-10 mm group, and ≤5 turn group, respectively. The per-patient sensitivity, PPV, specificity, NPV, and accuracy were 97.1%, 89.5%, 42.9%, 75.0%, and 88.1%, respectively. Conclusion CTC can clearly reveal the morphology of colonic polyps and be used as a routine monitoring method for the clinical diagnosis of polyps.

Analysis and clinical applications of metabolic syndrome risk factors for cardiovascular

Metabolic syndrome had many different names, including syndrome X, insulin resistance syndrome. At present the cause of metabolic syndrome is unclear, it may come from two aspects： First, acquired, including being overweight or obese, reduced physical activity and excessive carbohydrate diet; Second, genetic factors, involving multiple genes, not yet fully elucidated. The syndrome is generally believed to be the collection of a variety of cardiovascular risk factors caused by poor lifestyle under the genetic background, including hypertension, dyslipidemia, abdominal obesity, hyperinsulinemia, microalbuminuria, hypercoagulable state, hyperhomocysteinemia and so on. Hyperinsulinemia and insulin resistance is the central link, which is closely related to dyslipidemia, impaired glucose tolerance, and abdominal obesity. Metabolic syndrome may eventually lead to atherosclerosis： coronary artery disease, myocardial infarction, stroke, peripheral vascular disease and endothelial dysfunction. In 1999, the working definition of World Health Organization （WHO） to the metabolic syndrome is： glucose regulation impairment or diabetes, and / or insulin resistance, accompanied by the other two items or more ingredients, such as hypertension, high triglycerides esters hyperlipidemia and / or low HDL cholesterol, central obesity or microalbuminuria.

A Meta-analysis of Ginsenoside Rg3 for Non-small Cell Lung Cancer

OBJECTIVE Ginsenoside Rg3 （Rg3） has shown anti-tumor effects on various tumor cells. It has been widely used in China for non-small cell lung cancer （NSCLC）. However, there are only a few clinical trials to study the effectiveness of Rg3 on NSCLC, and almost them are small- samples, so we performed a meta-analysis on the results of the studies we collected in order to investigate the effectiveness of Rg3 on NSCLC. METHODS A meta-analysis was conducted in all the selected randomized controlled trials evaluating the effectiveness of Rg3 on NSCLC patients. All on-line databases regarding Rg3 from 1950 to 2011 were searched. Supplemental hand searching of the references of retrieved articles was performed. RESULTS Six trials met the inclusion criteria. Four of them compared chemotherapy plus Rg3 with chemotherapy alone, and the other 2 compared chemotherapy plus Rg3 with chemotherapy plus placebo. These trials are homogeneous. Two of the trials report overall survival, but the data are not suitable for a meta-analysis. After meta-analysis was conducted in the included studies comparing the effects of chemotherapy plus Rg3 with that of chemotherapy alone or chemotherapy plus placebo, it was suggested that chemotherapy plus Rg3 increased the response rate [odds ratio： 2.64 （95% Ch 1.70-4.11）, fixed effects model] and disease control rate [odds ratio： 3.34 （95% CI： 1.92-5.81）; fixed effects model] of the patients at stage II-IV, especially for the patients at stage Ill-IV. CONCLUSION Meta-analysis of the available evidence suggests that Rg3 plus chemotherapy improves the response rate of NSCLC patients, and well-designed RCTs with large sample size are needed.

Comparsion analysis of data mining models applied to clinical research in Traditional Chinese Medicine

OBJECTIVE: To help researchers selecting appropriate data mining models to provide better evidence for the clinical practice of Traditional Chinese Medicine(TCM) diagnosis and therapy.METHODS: Clinical issues based on data mining models were comprehensively summarized from four significant elements of the clinical studies:symptoms, symptom patterns, herbs, and efficacy.Existing problems were further generalized to determine the relevant factors of the performance of data mining models, e.g. data type, samples, parameters, variable labels. Combining these relevant factors, the TCM clinical data features were compared with regards to statistical characters and informatics properties. Data models were compared simultaneously from the view of applied conditions and suitable scopes.RESULTS: The main application problems were the inconsistent data type and the small samples for the used data mining models, which caused the inappropriate results, even the mistake results. These features, i.e. advantages, disadvantages, satisfied data types, tasks of data mining, and the TCM issues, were summarized and compared.CONCLUSION: By aiming at the special features of different data mining models, the clinical doctors could select the suitable data mining models to resolve the TCM problem.