以实验室为依托的医学院校本科生科研模块式教学探讨

科研模块式教学是一种针对医学院校本科生的开放式教学方法。在学生自主选择的前提之下,以实验室为依托,实施15个教学周的训练,开展3个模块化的科研课程;同时,以一系列科研讲座、文献汇报、实验结果讨论等活动为辅助,教师指导学生开展模块式科研训练并在实验教学中讲授相应的理论知识。科研模块式教学有利于强化医学院校本科生生命科学和基础医学知识,培养学生基本的实验能力;让学生为进入临床研究或研究生阶段学习,做好充分准备。     

Reverse engineering techniques applied to a human skull,for CAD 3D reconstruction and physical replication by rapid prototyping

The production of a copy of an existing object of complex shape is one of the typical applications of the integration between two modern computer-based technologies, reverse engineering (RE) and rapid prototyping (RP). The method is extremely versatile and can be used in various applicative domains (e.g. replacement of anatomical parts with artificial prostheses, replication of skeletal remains). Two different acquisition techniques of images of a skull, by laser and by CT scan, were compared to ascertain which enabled more accurate reproduction of the original specimen. The skull was chosen due to it being the body part most often used in medico-legal investigations (for personal identification, skull-photo superimposition techniques, forensic art, etc). Comparison between the copy and the original yielded satisfactory results for both techniques. However, CT scanning demonstrated some advantages over the laser technique, as it provided a cleaner point cloud, enabling shorter pre-reproduction processing times, as well as data on the internal parts, which resulted in the reproduction of a more faithful copy.     

Late fracture of an old-generation modular neck in a titanium alloy femoral stem of a cementless total hip arthroplasty

Neck-stem modularity gained recent popularity in hip arthroplasty for clinical advantages, and few complications have been reported. We describe an unusual two-stage failure of the bimodular neck of a cementless forged titanium alloy stem implanted 12 years before. The retrieved neck was forwarded to the manufacturer for metallurgic evaluation and failure analysis. Lengthening and bending of the superolateral aspect of the neck and double depression of the medial part prove that the prosthetic neck underwent a medial displacement and a varus rotation. The crack initiated from the superolateral corner of the fracture section, and the neck probably underwent two subsequent unstable configurations. The first horizontal part of the fracture occurred in the external surface as a result of physiological load carried on abnormal conditions of frictions. Due to increased oscillations, the end of the fracture section knocked against the inner aspect of the proximal hole of the stem, preventing further valgus displacement of the neck, which was moved forward. Consequently, the neck achieved a second unstable configuration, and the fracture propagated in the weaker direction creating a bent track. Finally, the neck broke unexpectedly as a result of the traumatic event. An incorrect placement into the femoral component during surgery was the initiation of the failure of the bimodular neck. The transitory but repeated interface motion between the neck and the stem induced a local surface irregularity acting as a starting point for crack propagation of fatigue fracture. Final failure followed a direct trauma.     

抗阻运动结合模块化营养指导对糖尿病周围神经病变患者神经传导功能的影响

目的探讨抗阻运动结合模块化营养指导对糖尿病周围神经病变患者神经传导功能的影响。方法选择2018年9月—2020年7月收治的86例糖尿病周围神经病变患者为研究对象,随机数字表法分为对照组与观察组,各43例,对照组接受常规护理,观察组在对照组基础上实施抗阻运动结合模块化营养指导,对两组血糖控制情况及神经传导功能、生活质量评分进行比较。结果两组干预前血糖控制达标率差异无统计学意义(P>0.05),观察组干预后患者血糖控制达标率为95.35%,明显较对照组79.07%高,差异有统计学意义(P<0.05);两组干预前的腓总神经和正中神经的运动神经传导速度(MNCV)、感觉神经传导速度(SNCV)差异无统计学意义(P>0.05),观察组干预后的MNCV、SNCV明显优于对照组,差异有统计学意义(P<0.05);两组干预前的生活质量评分差异无统计学意义(P>0.05),观察组干预后生活质量评分明显较对照组高,差异有统计学意义(P<0.05)。结论抗阻运动结合模块化营养指导可提高糖尿病周围神经病变患者血糖控制达标率,也能提高神经传导功能及生活质量,值得推广。     

医疗美容技术专业《临床医学概论》模块化课程体系的构建与探讨

针对医疗美容技术专业《临床医学概论》教学不能满足能力本位的职业教育要求,笔者对《临床医学概论》进行了模块化课程体系的构建,并从构建的必要性、原则、思路、步骤及应用前景等方面进行较为深入的探讨。     

Clinical and Radiographic Results for the Richards Modular Hip System Prosthesis in Total Hip Arthroplasty : Average 10-Year Follow-Up

The clinical results of total hip arthroplasty using the Richards Modular Hip System prosthesis were evaluated in 41 patients (44 joints). The mean Harris hip score improved from 42 points before surgery to 82 after 1 year, 85 at 5 years, and 79 at the final examination. The average polyethylene wear rate was 0.09 ± 0.07 mm/y. Forty joints (90.9%) achieved press fit in either of the proximal or the distal stem portion, and only 4 joints (9.1%) failed to achieve press fit in both the proximal and distal stem portions. Although the 10-year survival of the stem was 94.5% and no revisions of the stem were performed, osteolysis was found at high frequency at a distal stem. The high incidence of osteolysis has been the limiting factor in the long-term success of Richards Modular Hip System. Achievement of good canal fill in both the proximal and distal stem portions did not contribute to the good long-term result of the stem.     

The ProDisc-L lumbar prosthesis

Degenerative disc disease at some stage requires surgical treatment to improve the pain situation. As opposed to fusion technologies, which bring immediate pain relief but that will again develop over the next years due to adjacent level disease, motion-sparing devices appear to avoid this condition. The ProDisc-L is a ball and socket design with a semi-constrained biomechanical concept implanted to replace the intervertebral disc. The surgical procedure has a minimal learning curve and a low complication rate, in treatment of low back pain. Long-term results in terms of radiological data, clinical data, and subjective scores like VAS, ODI, SF-36 show high patient satisfaction and indicate an equal or sometimes superior treatment option over fusion procedures.     

Evaluation of the turnaround time of an integrated preanalytical and analytical automated modular system in a medium-sized laboratory

OBJECTIVES: Evaluation of an integrated Modular Preanalytics (MPA) and Modular Analytics SWA (MA) system (Roche Diagnostics) during continuous batch processing. DESIGN AND METHODS: A total of 1000 blood specimen tubes was processed and tested in a batch-wise fashion, according to two different specimen input conditions (Study 1 and Study 2). The resulting turnaround time of the system was assessed. RESULTS: Study 1 tubes were centrifuged in the MPA. The preanalytical time rose steadily from 14 to 28 min, and after sample 315, it showed minimal variation. The analytical time remained almost constant. In Study 2, tubes were centrifuged before being processed in the MPA. The preanalytical time increased from 4 to 19 min, and the analytical time increased similarly. The turnaround time in Study 1 was 132 min and in Study 2 was 108 min. CONCLUSION: Centrifugation in the MPA slightly increased the turnaround time. Nevertheless, the labor associated with specimen processing was reduced and the efficiency of the laboratory was improved.     

组配式人工髋关节系统假体治疗CroweⅣ型髋关节发育不良25例疗效分析

目的探讨组配式人工髋关节系统（S-ROM,DePuy）治疗重度髋关节发育不良（CroweⅣ型）的外科技术及疗效。方法2004年6月～2008年12月,对25例（27髋）因重度髋关节发育不良引起严重骨性关节炎的患者应用组配式（S-ROM,DePuy）假体行全髋关节置换治疗,患者全部为女性。随访12～66个月,平均37个月,观察疗效。结果随访时Harris评分由术前37分提高至86分,除外1例Harris评分小于70分,为长期骨盆倾斜导致腰椎病变,引起慢性下腰痛以及下肢疼痛与功能障碍,其余患者评分均达良好。术后半年所有患者均能下地行走,并恢复日常活动。结论应用组配式（S-ROM,DePuy）人工髋关节系统行人工全髋关节置换术治疗重度髋关节发育不良,尤其是处理股骨近端严重畸形,术中操作方便,术后中短期随访临床以及影像学结果令人满意。