浅谈长学制医学教育中的人文素质教育

随着医学模式的转换和卫生需求的不断增长,社会对医务工作者的人文素养要求越来越高。本文就加强医学生人文素质教育的重要性进行了探讨,总结了北京协和医学院90年办学历史中在医学生人文素质培养中进行的探索,同时对未来长学制医学教育中人文素质教育存在的问题提出了思考。     

加强医学生的人文教育

医学生是未来医学科研和临床工作的主力军，社会的进步要求医学生不仅需要精湛的专业技能还应从医学、社会、道德和伦理等不同角度去思考问题，树立以人为本以病人为中心的高尚医德，具备良好的与人沟通的能力，深入的了解服务对象的需求，以帮助患者走出身心困境。要达到这一目标，单纯的专业教育是远远不够的，必须同时加强人文教育，这是社会发     

临床医学专业强化人文教育的可行性分析

为适应医学科学和医学教育的发展,在中国协和医科大学的八年制临床医学专业的预科阶段适当增加和强化了人文科学的教育。本文对1997年至2001年共五届学生所选修的人文学科课程门类,选修学分对预科总成绩的影响等作了分析。分析结果表明,医学生对选修此类课程有兴趣,而且并未因此增加整个预科阶段的学习负担。     

医学人文教育的缺失与回归

医学研究和医疗实践渗透着大量的人文知识和人文精神.不过,长期以来我国医学人文研究力量有待加强,教学内容及方法需要更新,医学生人文素养有待提高.作者建议:加强师资队伍建设,借助“以问题为导向”的教学方法,培养医学生的批判思维能力,弘扬科学精神,重塑医学职业理想.     

论加强当代医学生人文关怀精神的教育

医学是一门自然科学与人文社会科学高度结合的综合性学科,其本质特点是人文关怀。本文分析了当前医学教育中人文关怀精神的缺失问题,并阐述了通过转变医学教育观念、强化医学生的人文关怀意识及营造良好的校园文化氛围等方式,来加强对医学生人文关怀精神的教育。     

加强素质创新教育促进医学教育发展

我国教育事业近几年飞速发展 ,有了新的突破 ,特别是面向未来 ,面向世界 ,实施素质教育 ,提高全民族的素质 ,这是关键性举措。这既是针对中小学应试教育 ,也是针对大学教育 ,尤其是医学教育 ,存在的种种弊端 ,同时更是从战略高度针对科技发展 ,打破陈旧教学观念体系 ,培养创新型高素质全新医学人才 ,攻占新世纪制高点的科学布署。因此 ,加强医学教学理论 ,特别是当今教学新理论进展的学习和研究 ,是提高教学质量的必然要求。当前医学教育的发展 ,要求我们从实际情况出发 ,改革研究 ,创造新的教学方式方法 ,加强素质创新教育 ,才能促进医学教…     

与人体解剖学相融合的医学人文教育实践与体会

人文教育是当今医学生全面发展不可或缺的内容.而传统的基础医学教育多重视学生专业知识的掌握,忽视学生的人文素质教育.若能在解剖教学中融人人文教育,也许能使学生学会从社会和道德等角度去看待医学,有利于提高教学效果,提升医学生综合素质.     

因特网医学教育资源及对现代医学教育的影响

作为现代科学重要组成部分的现代医学,因特网必将对它的发展产生深远的影响,医学教育的传统行为模式必将受到来自这一新生事物的冲击.研究因特网对现代医学教育的影响以及如何利用因特网更好地为医学教育服务,是目前医学界迫切需要解决的问题.     

人文素质教育与生理学教学的结合

本文介绍了人文素质教育与医学教育的关系,探讨了融人文素质教育于生理学教学的方法和途径．以期培养出具有良好的综合素质和完善的人格品质的医学生。体、评价内容、评价方式等方面进行了新的尝试,力图提高学生职业核心能力,使其更适应未来职业岗位的不断发展需要。     

Biomechanical analysis of the effects of medial meniscectomy on degenerative osteoarthritis

To investigate the effects of meniscectomy on degenerative osteoarthritis, a three-dimensional (3D) finite element (FE) model of the human lower limb is constructed from a combination of magnetic resonance (MR) images and computed tomographic (CT) images that can provide anatomically suitable boundary conditions for a knee joint. Four cases, i.e., the intact meniscus, and the partial, sub-total, and total meniscectomy of the medial meniscus are modeled and simulated. We consider that the cartilage-to-cartilage contact area and the peak contact pressure in the meniscus may be significant parameters in evaluating degenerative osteoarthritis. Partial meniscectomy can be regarded as a better treatment than sub-total/total meniscectomy, and a high possibility of degenerative osteoarthritis is anticipated after total meniscectomy. Moreover, medial meniscectomy has the potential to bring about degenerative osteoarthritis in both the medial compartment and the lateral compartment of a knee joint.     

Substance P-immunoreactivity in the dorsal medial region of the medulla in the cat: effects of nodosectomy

The distribution of substance P in the vagal system of the cat was studied by immunohistochemistry. Substance P-immunoreactive cell bodies and fibres were observed in the nodose ganglion. Numerous substance P-immunoreactive terminals and fibres were localized in their bulbar projection area, i.e. throughout the caudo-rostral extent of the nucleus of the solitary tract. Four subnuclei, among the nine forming the nucleus of the solitary tract, were strongly labelled: interstitial, gelatinosus, dorsal and commissural. The dorsal motor nucleus of the vagus nerve also exhibited numerous substance P-immunoreactive terminals, sometimes closely apposed on the somata of preganglionic neurons. To determine the substance P component of the vagal afferent system a nodose ganglion was removed on one side. The ablation triggered ipsilaterally a large decrease of substance P immunoreactivity in the four subnuclei strongly labelled on normal cats. These results suggest the involvement of substance P-containing vagal fibres in integrative processes of the central regulation of cardiovascular, digestive and respiratory systems, viscerotopically organized throughout these four subnuclei. The nodose ablation also resulted in a decrease of substance P immunoreactivity in the ipsilateral dorsal motor nucleus of the vagus nerve, suggesting monosynaptic vago-vagal interactions.     

Behavioral effects of large and small lesions of the rat medial frontal cortex

Summary Rats with either sham operations, small medial frontal cortex lesions (SMF), or large medial frontal cortex lesions (LMF) were tested in the open field, for spatial alternation and for 8-arm maze learning. The behaviors of sham-operated and SMF rats were similar on the spatial learning tasks, while the LMF group performed poorly in relation to these two groups. In contrast, the two lesion groups differed from the sham group, but not from each other, on locomotor activity in the open field. The differences in performance between the SMF and LMF groups on the spatial learning measures suggest that medial frontal cortex lesion size and locus may be important factors underlying the variable results of previous studies evaluating spatially-oriented behaviors of rats with varying degrees of medial frontal cortex damage.This project was supported in part by BRSG SO7 BRO754-19 awarded by the Biomedical Research Support Grant Program, Division of Research Resources, National Institutes of Health     

Systemic morphine and local opioid effects on neuronal activity in the medial prefrontal cortex

Behavioral studies support the importance of the medial prefrontal cortex in the circuitry of drug-reinforced behavior, yet the neurophysiological correlates of this phenomenon remain unclear. The present study evaluates opioid neuropharmacology in the medial prefrontal cortex of the anesthetized rat. The effects of both systemic and local application of mu agonists on individual neurons in the medial prefrontal cortex were examined. Systemic morphine was found to inhibit (63%), excite (4%) or have no effect on (33%) spontaneous firing. The inhibitory response was reversed by systemic naloxone in 77% of the cases. Electrophoretic application of a mu-selective agonist, ]d-Ala², N-Me-Phe⁴,Gly-ol⁵]enkephalin, had mixed effects on cell activity. While most cells exhibited no change in firing rate (53%), 38% showed inhibition of spontaneous activity. The ]d-Ala²,N-Me-Phe⁴,Gly-ol⁵]enkephalin-evoked inhibitory responses were antagonized by electrophoresis of naloxone (86%).

These results indicate that the medial prefrontal cortex might directly mediate some portion of the overall response to opiates in reinforcement or self-administration paradigms. The naloxone-reversible inhibition of firing seen following both systemic and local application of predominantly mu-selective agonists argues for a direct involvement of medial prefrontal cortical neurons in opiate-induced effects. However, the smaller percentage of cells inhibited by local versus systemic application of mu agonists also supports an influence of other brain circuitry in this response.     

The effects of morphine on basal neuronal activities in the lateral and medial pain pathways

Numerous studies indicate that morphine suppresses pain-evoked activities in both spinal and supraspinal regions. However, little is known about the effect of morphine on the basal brain activity in the absence of pain. The present study was designed to assess the effects of single-dose morphine on the spontaneous discharge of many simultaneously recorded single units, as well as their functional connections, in the lateral pain pathway, including the primary somatosensory cortex (SI) and ventral posterolateral thalamus (VPL), and medial pain pathway, including the anterior cingulate cortex (ACC) and medial dorsal thalamus (MD), in awake rats. Morphine (5 mg/kg) was administered intraperitoneally before the recording. Naloxone plus morphine and normal saline injections were performed respectively as controls. The results showed that morphine administration produced significant changes in the spontaneous neuronal activity in more than one third of the total recorded neurons, with primary activation in the lateral pathway while both inhibition and activation in the medial pathway. Naloxone pretreatment completely blocked the effects induced by morphine. In addition, the correlated activities between and within both pain pathways was exclusively suppressed after morphine injection. These results suggest that morphine may play different roles in modulating neural activity in normal vs. pain states. Taken together, this is the first study investigating the morphine modulation of spontaneous neuronal activity within parallel pain pathways. It can be helpful for revealing neuronal population coding for the morphine action in the absence of pain, and shed light on the supraspinal mechanisms for preemptive analgesia.     

The effects of morphine on basal neuronal activities in the lateral and medial pain pathways

Interferon-α (IFN-α)-induced "depressive-like" behavior is a major limitation for the treatment of hepatitis C virus (HCV), especially for patients with psychiatric disorders. Recently, serotonin 1A (5-HT(1A)) receptor and cellular apoptosis are involved in mechanism(s) contributing to depression. To gain insight into this mechanism(s), we used C57BL/6J mice to examine the impact of IFN-α on the modulation of 5-HT(1A) receptor and cellular apoptosis and their relationship. Our results showed that repeated administration of IFN-α (6 MIU/kg, s.c.) induced "depressive-like" behavior of mice in the forced swim test, tail suspension test and sucrose preference test. Besides, the depressive mice exhibited a notable downregulation of 5-HT(1A) receptor and upregulation of cleaved caspase-3 and Bax/Bcl-2 ratio. These changes could be blocked by the 5-HT(1A) receptor agonist 8-OH-DPAT (0.5 mg/kg, i.p., 30 min before IFN-α administration), but not by the standard antidepressant imipramine (10 mg/kg, i.p., 30 min before IFN-α administration) although both of them could ameliorate the depressive-like behavior of mice. These findings indicated that repeated injection with IFN-α provoked "depressive-like" behavior through cellular apoptosis, which could be ameliorated by the activation of 5-HT(1A) receptor.     

Differential effects of GDF5 on the medial and lateral rat ventral mesencephalon

Growth/differentiation factor 5 (GDF5) is a member of the transforming growth factor-beta (TGF-beta) superfamily that has potent neurotrophic and protective effects on dopaminergic neurones and is expressed in the developing rat substantia nigra (the ventral mesencephalon; VM). GDF5 has the potential to be used in the treatment of Parkinson's disease (PD), a neurodegenerative disorder characterised by the selective degeneration of nigrostriatal dopaminergic neurones. One therapy being explored for PD involves transplantation of fetal VM tissue into the striatum in order to replace lost dopaminergic neurones. The majority of transplantation studies have used transplants incorporating the whole VM. The principal location of dopaminergic neurones in the E14 rat VM is in the medial VM. In the present study, the effects of GDF5 on cultures prepared from medial, lateral and whole E14 rat VM tissue were compared. GDF5 treatment increased the number of dopaminergic neurones in whole and lateral, but not in medial, VM cultures, whereas it increased total cell number in medial, but not in whole or lateral, VM cultures. RT-PCR studies showed that the receptors for GDF5 were differentially expressed in E14 VM; the expression of BMPR-IB and Ror2 was low in medial but high in lateral VM tissue. This study suggests that GDF5 increases the number of dopaminergic neurones in whole VM cultures by acting on BMPR-IB and Ror2-expressing cells in the lateral VM.     

锁定钢板结合重建肱骨近端内侧支撑治疗成人肱骨近端骨折

目的探讨锁定钢板结合重建肱骨近端内侧支撑治疗成人肱骨近端骨折的疗效。方法回顾性分析自2007年1月~2014年6月我院采用肱骨近端锁定钢板治疗肱骨近端骨折70病例。术后X线片,按是否重建肱骨近端内侧柱分为重建组(50例)和非重建组(20例)。重建组:男21例,女29例,年龄40~84岁,平均年龄67.8岁。Neer分型:二部分骨折32例,三部分骨折14例,四部分骨折4例。其中三部分骨折1例、四部分骨折2例予内侧植骨。未重建组:男8例,女12例,年龄56~90岁,平均年龄72.2岁。Neer分型:二部分骨折10例,三部分骨折7例,四部分骨折3例。其中三部分骨折2例予内侧植骨。两组患者在术后1周内(T1)、骨折愈合后功能锻炼时(T2)摄片测量肱骨头高度及颈干角,并计算T1~T2期间高度变化及内翻角度;功能锻炼后按Neer百分法对肩关节功能进行评定。结果两组患者随访时间12~24个月,平均16个月。发生并发症:重建组Neer四部分骨折1例予内侧植骨患者发生螺钉穿出,术后3月取出螺钉。未重建组:内翻畸形、近端退钉2例(Neer三、四部分骨折各1例),螺钉穿出1例(Neer三部分骨折),肩峰撞击综合征2例(Neer二部分骨折),延迟愈合1例(Neer四部分骨折),肱骨头坏死2例(Neer三、四部分骨折各1例)。2例内翻畸形、近端退钉患者予早期二次手术重新内固定,螺钉穿出1例及2例肩峰撞击综合征患者予取出内固定后症状缓解,2例肱骨头坏死患者予人工关节置换术。两组间年龄(P=0.088)、骨折类型(P=0.080)和植骨(P=0.564)在本课题分析中差异无统计学意义。两组术后并发症例数按独立样本检验(P=0.008),卡方检验(X~2=3.92,P0.01)差异有统计学意义。两组患者在肩关节Neer百分法评分、术后肱骨头丢失高度、内翻角度方面,均存在显著性差异(P0.01)。结论肱骨近端骨折术中重建肱骨近端内侧柱支撑不仅能使肱骨头得到有效的支撑,还能明显减少术后并发症发生,提高肩关节功能满意度。     

Spreading of fatigue-related effects from active to inactive parts in the medial gastrocnemius muscle of the cat

In the medial gastrocnemius muscle of the decerebrate cat, the spatial spread of fatigue between active and inactive muscle parts was studied. Conditioning fatiguing stimulation (CFS) was applied to a part of the muscle to test whether it had an effect on the contraction efficiency in an unstimulated part. To exclude somato-sympathetic reflexes during CFS, a full rhizotomy of the lumbo-sacral spinal cord was performed. The same ipsilateral ventral root, either L7 or S1, was divided into seven filaments, one of which was used for the test stimulation, and four or five for CFS. The CFS consisted of 12 s sessions of distributed stimulation of five (or four) filaments at a rate of 40 s^–1, the sessions were repeated, every 40 s, 15 or more times. The test consisted of 12 s of regular stimulation at a rate of 10 s^–1, preceded and followed by a single stimulus. The tests applied just after CFS showed a strong decline of both tension and electromyogram (EMG), amounting to only [mean (SD)] 0.45 (0.18) and 0.51 (0.19) (n=15), respectively, of the corresponding values in the tests before CFS. It thus turned out that depressive fatigue-related effects could spread within the muscle. At the same time, control reactions recorded in the lateral gastrocnemius during stimulation of its cut nerve did not change. Subsequent repetitions of the tests usually revealed a tendency towards restoration. The EMG reactions recovered more quickly than tension. The depression of EMG after CFS was accompanied by a slowing of the constituent M-waves; their latencies decreased during restoration. Distinct changes in the systemic blood pressure were observed during CFS. These changes were usually correlated well with muscle tension changes. The factors possibly underlying the observed effects may include diffusion of metabolites from active to inactive muscle fibres, lowering of the efficiency of neuro-muscular transmission due to squeezing of efferent motor terminals and changes in outer metabolite content, as well as local hypoxia due to increases in intramuscular pressure. Electronic Publication     

Characteristics of spatiotemporal integration in the priming and rewarding effects of medial forebrain bundle stimulation.

Only the function relating the required pulse frequency to the interburst interval discriminates between the priming effect and the rewarding effect: Separating two short bursts of pulses has no effect on their combined rewarding effect, but it enhances their priming effect. There are significant nonscalar differences between animals in the number-current and charge-duration functions for priming and reward, but there are no significant differences in these functions between effects within animals. Substantially more electrical-stimulation is required to produce good priming than to produce a reward that sustains maximum possible levels of performance. These findings suggest that the priming effect is a transient excitement generated by the receipt of one or more very large rewards. The discussion elaborates a model that reconciles this hypothesis with the earlier finding that the rewarding effect may be blocked pharmacologically without blocking priming.