医学整合课程神经科学教学实践的探讨

借鉴芝加哥大学医学院的课程设置,武汉大学医学部将神经解剖、神经生理、神经药理、神经病学、行为医学、精神病学等整合为神经科学新课程。通过对149名临床五年制教改班学生的问卷调查表明:新课程有效整合了多门学科,有利于学生系统学习神经科学知识,并提高了学生的整合学习能力。     

神经科学基础教学中PBL教学模式应用的初步尝试（摘要）

近年来,随着PBL(problem-based learning)这一全新教学模式的提出,越来越多的学科已经开始尝试将其应用于课堂教学中.在中国医科大学五年制整合班开设的神经科学基础课程是将组成神经科学学科的两方面重要内容,即神经解剖学和神经生物学融合后对学生进行讲授,使学生能全面系统地掌握从神经科学的整体水平到分子生物学水平的相关知识.这种整合课虽然较好地体现了学科的横向融合和纵向延伸,但是缺乏对学生综合能力的培养.     

五年制临床医学专业开设神经解剖学的重要性

神经解剖学是神经科学的基础,而神经科学已成为生命科学发展的基础。自20世纪90年代国际上提出“脑的十年”后,我国将脑的研究纳入“863”攀登计划,至今神经科学各方面的知识日新月异。1995年国际脑研究组织在第四届世界神经科学大会上提议把21世纪称为“脑的世纪”。在这种背景下,医学院校学生学好神经解剖学对其后续课程的学习与将来的工作尤为重要。     

神经科学基础课程教学模式的分析与思考

加拿大麦吉尔大学综合神经科学研究生项目(integrated program in neuroscience, IPN)培养神经科学领域的理学硕士和博士,有近270位专业导师,是北美最大的硕博项目。2020年9月,电子科技大学与加拿大麦吉尔大学生物医学工程-神经科学双硕士学位教育项目招收了第一届学生。学生已顺利完成麦吉尔大学IPN的所有课程学习。文章将详细介绍IPN主干课程：神经科学基础I和神经科学基础II的教学内容、教材使用、授课模式、考核方式等,最后结合学生的学习体会,提出神经科学相关课程研究生教学的三点思考和启示,为国内研究生课程教学提供重要参考。     

神经科学基础整合课程教学改革的总结与思考

神经科学基础整合课题体系的建立是中国医科大学基础医学课程整合的重要组成部分.通过10余年的整合教学,与传统的医学课程教学方法相比较,从组织实施、师资力量建设和课程效果评价等方面总结了有利于整合课程教学的经验和成果,并应用于其它传统课程教学中,旨在促进整个医学基础教育的发展.     

医学八年制课程整合神经科学模块教学的探索与实践

文章介绍了医学八年制课程整合神经科学教学模块教学的探索和实践,介绍了课程整合的实施具体过程：（1）制定课程负责人制,组织联合教学团队;（2）以结果为导向整合课程;（3）采取循证医学和PBL相结合的教学方法;（4）探索多样的考核评价机制。     

以旧金山加州大学为例浅谈神经科学博士生培养

目的初步探讨如何培养具有强烈内在驱动力的"专而全"的神经科学博士。方法分析当代神经科学的发展对神经科学博士的要求,我国神经科学博士培养存在的问题,及美国旧金山加州大学的神经科学培养制度。结果我国目前大多数神经科学博士存在内在驱动力不足和知识结构偏窄的缺憾。旧金山加州大学神经科学博士培养中的课程设置、实验室轮转、资格考试和高强度的科学研究等制度有利于上述两点的培养。结论 "以学生为本"和"以学术为本",培养学生对学术的强烈追求感和"专而全"的知识结构,是神经科学博士培养的一个重要方向。     

系统整合教学法在口腔正畸学本科教学中的应用

目的研究"系统整合课程"教学法在口腔正畸学本科生理论课程教学中应用的效果;方法在2016及2017学年分别选取中山大学光华口腔医学院口腔医学专业大四本科生各30人为研究对象,2016学年对大四本科生采用传统三段式教学法(对照组)、2017学年采用系统整合课程教学法进行口腔正畸学理论课程进行授课(实验组),最后分别进行阶段性考核及期末综合测评,比较系统整合课程教学组与传统三段式教学组的学生理论课程的成绩差异;同时在教学任务完成后采用问卷调查的形式,了解学生对两种教学方法的反馈。结果分析对比两组学生理论课程成绩,系统整合课程教学组学生的口腔正畸学成绩较传统三段式教学组有了一定程度的提高;且在课后的问卷反馈结果中系统整合教学法在提升学生学习积极性、对临床病例处理能力等方面与对照组相比得到了较高的认可,差异有统计学意义。结论系统整合课程教学方式在一定程度上有助于提高现阶段的口腔正畸学本科理论课程教学效果、完善现有的教学手段,提高学生学习积极性和主动性,为后期培养高质量的口腔正畸学人才奠定基础。     

针对工程专业学生的神经生物学课程教学探讨（摘要）

在当代生命科学中,神经科学研究新成果层出不穷,作为神经科学主体的神经生物学已成为生命科学中发展最迅速和最活跃的前沿科学之一.为了适应生命科学发展的需要,全国一些综合性大学生命科学学院相继开设了神经生物学课程,我校也在近年分别为研究生和本科生开设了该课程,同时该课程还面向自动化、通讯、计算机等专业的学生.     

针推专业神经解剖学教学思路与方法探讨

神经解剖学是人体解剖学的重要组成部分,是神经科学的基础,是一些相关医学专业的重要课程,与针推专业具有明显的联系,能提高学生对神经走向的深入了解及加强临床应用,因此要求教师和学生在教与学过程中对其有充分的认识,并掌握一些适合其专业特点的教学的思路和方法.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.