4+4临床医学人才培养美国模式与交医模式的比较及思考

上海交通大学医学院借鉴北美医学院校的培养模式，从2002年起在国内率先开展临床医学专业"4+4"培养项目，招收优秀非医学应届本科毕业生攻读4年医学课程。经过20年的实践，交大医学院已积累了一系列具有中国特色且行之有效的办学经验，同时也面临问题和困惑。本研究对比分析交大医学院和美国一流医学院校哈佛医学院、斯坦福大学医学院的"4+4"人才培养模式，并从培养目标、招生方式与规模、课程设置、学位授予标准等方面展开深入探讨。研究表明，未来交大医学院还需通过凸显特色人才培养目标，完善招生标准与流程，优化课程体系，平衡临床和科研能力培养等举措加大教育教学改革力度，助力推进"4+4"临床医学人才培养模式从优秀迈向卓越。     

针药联合克罗米芬治疗多囊卵巢综合征导致不孕症:随机对照研究

目的:探寻治疗多囊卵巢综合征导致不孕症的较佳疗法。方法:将120例患者随机分为3组:克罗米芬(CC)组(A组)、针灸+中药组(B组)、CC+针灸+中药组(C组),每组40例。A组在月经第5天开始口服克罗米芬,B组在月经第5天于腹部中极、关元、归来等穴位行温针灸,并配合补肾活血中药治疗;C组在A组治疗基础上,联合B组治疗,连续治疗3个月经周期。观察3组患者人绒毛膜促性腺激素(HCG)日子宫内膜厚度、内膜类型、宫颈黏液评分,及治疗后排卵周期率、临床妊娠率以及流产率。结果:1HCG日宫颈黏液评分、子宫内膜厚度、子宫内膜形态(A型率):C组优于A组(均P<0.01),B组优于A组(均P<0.05);而C组与B组比较内膜厚度差异无统计学意义(P>0.05),宫颈黏液评分、子宫内膜形态(A型率)C组均优于B组(均P<0.05)。2A、C组排卵周期率高于B组(均P<0.05);C组妊娠率高于其他两组(均P<0.05),C组早期流产率低于A、B组(均P<0.01)。3卵泡直径18~20mm、子宫内膜厚度:正常妊娠与早期流产患者比较差异均无统计学意义(均P>0.05);正常妊娠患者子宫内膜形态A型率高于早期流产患者(P<0.05)。结论:针药联合克罗米芬通过有效改善HCG日宫颈黏液、子宫内膜厚度、子宫内膜形态,从而提高妊娠率和降低早期流产率,其疗效明显优于单纯用克罗米芬及针药联合者。     

Optical coherence tomography angiography for marginal corneal vascular remodelling after pterygium surgery with limbal-conjunctival autograft

PurposeTo demonstrate the marginal corneal vascular remodelling using optical coherence tomography angiography (OCTA) after pterygium surgery.MethodsTwenty-two eyes of 19 patients (8 males, 11 females; age, 58.68 ± 0.34 years) with primary grade-T3 nasal pterygium were enroled in this study. The eyes underwent excision of the pterygium followed by a free limbal-conjunctival autograft. OCTA was performed in the nasal limbal area before surgery and at 10 days, 1 month, and 3 months after surgery. The scans were analyzed in terms of postoperative vascular remodelling of the autograft and marginal corneal vascular arcades (MCAs).ResultsPreoperatively, the pterygium presented as abnormal centripetal vascular growth in OCTA scans. The conjunctival vessel density in the nasal quadrant was 29.26% ± 1.00%, 15.80% ± 0.83%, 19.80% ± 0.88%, and 20.26% ± 0.89% before and 10 days, 1 month, and 3 months, respectively, after surgery (F = 1.55, P < 0.01). The vessel density of MCAs was 28.33% ± 0.88%, 42.09% ± 0.41%, and 42.46% ± 0.31% 10 days, 1 month, and 3 months, respectively, after surgery (F = 188.2, P < 0.01).ConclusionsWe describe a new application of OCTA for MCA vasculature imaging. Vascular remodelling of the graft and MCAs appeared at 1 month and continued for 3 months after surgery.Subject terms: Conjunctival diseases, Corneal diseases     

新医科背景下医学专业设置的思考

国家教育、医疗行业需求及外部环境都提出了培养"医+X"复合型医学人才的诉求，近年来"医+X"取得的发展为本科阶段设置相关专业提供了基础。本文通过分析国内外医学交叉学科发展现状，总结了现有的本科阶段"医+X"培养模式，论证了要从优化制度设计和聚焦交叉前沿两方面来为"医+X"新专业设置做好支撑，同时提出"医+X"新专业设置也要关注民生、师资、就业3个特征要素。     

Vitrified collagen-based conjunctival equivalent for ocular surface reconstruction

The main functions of the conjunctiva, an essential part of the ocular surface, are to maintain the equilibrium of the tear film and to protect the eye. Upon injuries, the prerequisite to successful ocular surface repair is conjunctival reconstruction. Tissue engineering techniques, including transplantation of autografts, amniotic membranes and numerous synthetic/natural materials, have been developed. However, none of these strategies is completely satisfactory due to lack of goblet cell repopulation, poor mechanical properties or non-standardized preparation procedure. Here, we cultured conjunctival epithelial cells on vitrified collagen membranes and developed a tissue equivalent for repairing damaged conjunctiva. Optimized vitrified collagen has superior mechanical and optical properties to previous biomaterials for ocular surface application, and its unique fibrillar structure significantly benefited conjunctival epithelial cell growth and the phenotypic development in vitro. In a rabbit model, vitrified collagen greatly promoted conjunctival regeneration with rapid re-epithelization, sufficient repopulation of goblet cells and minimized fibrosis and wound contracture, proved by gene expression analyses and histological staining. In conclusion, we have demonstrated the potential suitability of utilizing vitrified collagen-based tissue equivalent in ocular surface reconstruction.     

Diplopia of Pediatric Orbital Blowout Fractures: A Retrospective Study of 83 Patients Classified by Age Groups

Orbital blowout fractures are relatively rare in patients under 18 years of age, but may lead to serious complications. We conducted this retrospective study to evaluate diplopia, clinical characteristics, and postoperative results in cases of orbital blowout fractures in the pediatric population.Eighty-three patients, all less than 18 years old, with orbital blowout fractures, were divided into 3 groups by age: 0 to 6 years old, 7 to 12 years old, and 13 to 18 years old. The cause of injury, fracture locations, diplopia grades, ocular motility restrictions, enophthalmos, and postoperative results were reviewed from their records. Chi-square tests, Fisher''s exact analyses, analyses of variance, and logistic regressions were performed to determine characteristics associated with diplopia, and to identify factors related to residual diplopia in pediatric patients.The most common causes of injuries were traffic accidents in the 0 to 6 years old group, normal daily activities in the 7 to 12 years old group, and assaults in the 13 to 18 years old group. Floor fractures were the most common location in both the 0 to 6- and 7 to 12 years old groups, and medial-floor fractures were the most common location in the 13 to 18 years old group. The occurrence of preoperative diplopia was related to ocular motility restriction and enophthalmos, but not with the age group, the gender, the cause of injury, or the fracture locations. The time interval from injury to surgery was significant in the outcome of postoperative diplopia (P < 0.01). A statistical difference was also found in the recovery time from diplopia among the 3 age groups (P < 0.01).The characteristics of orbital blowout fracture varied among the different age groups. It was related to 2 factors, the cause of injury and fracture locations, which probably resulted from structural growth changes and differences in daily habits. Children had a slower recovery from orbital fractures, and the younger the patient, the longer it took for recovery from diplopia after surgery.