医用物理学教学中培养学生创新能力探究

培养高素质创新型医学人才是高等医学院校当前面临的一项现实而紧迫的任务。医用物理学是物理学和医学相结合形成的一门交叉学科,是高等医学院校开设的一门必修的基础课。培养学生创新能力是医用物理学课程教学的重要内容。本文从重视学生思维训练,培养学生个性发展,构造学生创新平台和机制三方面探讨医用物理学课程教学中培养学生创新能力的方法和途径。     

Teaching evidence-based medicine: should we be teaching information management instead?

To encourage high-quality patient care guided by the best evidence, many medical schools and residencies are teaching techniques for critically evaluating the medical literature. While a large step forward, these skills of evidence-based medicine are necessary but not sufficient for the practice of contemporary medicine. Incorporating the best evidence into the real world of busy clinical practice requires the applied science of information management. Clinicians must learn the techniques and skills to focus on finding, evaluating, and using information at the point of care. This information must be both relevant to themselves and their patients as well as being valid. The authors discuss the need to teach the applied science of information management along with, or perhaps even instead of, teaching the basic science of evidence-based medicine. All students, residents, and practicing physicians need three skills to practice the best medicine: the ability to select foraging--"keeping up"--tools that filter information for relevance and validity, the skill to select and use a hunting--"just in time"--information tool that presents prefiltered information easily and in a quickly accessible form at the point of care, and the ability to make decisions by combining the best patient-oriented evidence with patient-centered care, placing the evidence in perspective with the needs and desires of the patient. This teaching of information management skills will prepare students and residents for a practice of medicine that requires lifelong learning.     

Remitted depression studies as tests of the cognitive vulnerability hypotheses of depression onset: a critique and conceptual analysis

Investigations of cognitive patterns among individuals who have recovered from a depressive episode (i.e., remitted depressives) have figured importantly in evaluations of the validity of the vulnerability hypotheses of the cognitive theories of depression. However, we suggest that remitted depression studies as typically conducted and interpreted are inadequate tests of the cognitive vulnerability hypotheses of depression onset for four reasons: (1) remitted depression studies are based on the erroneous assumption that cognitive vulnerability should be an immutable trait; (2) remitted depression studies use a logically "backward" participant selection strategy in which participants are selected on the basis of the "dependent" variable (depression) and then compared on the "independent" variable (cognitive vulnerability), which is likely to result in heterogeneity of cognitive vulnerability among both the remitted depressed as well as the nondepressed groups given the causal relations specified in the cognitive theories of depression; (3) many remitted depression studies have ignored the possible activating role of stress in the cognitive vulnerability-stress theories, particularly Beck's theory, and thus, may attempt to assess cognitive vulnerability at a time when it is not operative (i.e., priming hypothesis); and (4) remitted depression studies inappropriately use postmorbid participants to test causal hypotheses, and therefore, are ambiguous about whether negative cognitive styles observed in remitted depressed persons are vulnerabilities as opposed to consequences of depression (i.e., scar hypothesis). As a remedy, we advocate the use of a theory-guided behavioral high-risk strategy to more adequately test the cognitive vulnerability hypotheses of depression onset.     

Physics and engineering: milestones in medicine.

The history of the development of the applications of physics and engineering in medicine provides an insight into contemporary practice and can help to mould the future. Physics and engineering form a continuum, and, in the present context, engineering is indistinguishable from applied physics. The modern scientific era, which extends over 500 years, is characterised by numerous significant developments: for example, the Nobel prizes which most closely relate to physics and engineering in medicine were for X-rays and radioactivity, the electrocardiogram, the scattering of radiation, the cyclotron, nuclear magnetic resonance, the transistor, radioimmunoassay and computed tomography; and a medical physicist has received the Peace Prize. The origins and development of nuclear medicine, magnetic resonance and ultrasonic imaging are representative of the whole field. Physics and engineering rank alongside other medical sciences and underpin many of their applications. In what is now the developed world, human life expectancy has increased dramatically, but the costs and risks of modern medicine have meanwhile become a huge problem. The growing divergence of rich and poor is now arguably the greatest challenge. The future cannot be predicted, but the potential of physics and engineering to improve medicine has never been greater.     

Why there should be more science Nobel prizes and laureates - And why proportionate credit should be awarded to institutions

The four science Nobel prizes (physics, chemistry, medicine/physiology and economics) have performed extremely well as a method of recognizing the highest level of achievement. The prizes exist primarily to honour individuals but also have a very important function in science generally. In particular, the institutions and nations which have educated, nurtured or supported many Nobel laureates can be identified as elite in world science. However, the limited range of subjects and a maximum of 12 laureates per year mean that many major scientific achievements remain un-recognized; and relatively few universities can gather sufficient Nobel-credits to enable a precise estimate of their different levels of quality. I advocate that the Nobel committee should expand the number of Nobel laureates and Prize categories as a service to world science. (1) There is a large surplus of high quality prize candidates deserving of recognition. (2) There has been a vast expansion of research with a proliferation of major sub-disciplines in the existing categories. (3) Especially, the massive growth of the bio-medical sciences has created a shortage of Nobel recognition in this area. (4) Whole new fields of major science have emerged. I therefore suggest that the maximum of three laureates per year should always be awarded in the categories of physics, chemistry and economics, even when these prizes are for diverse and un-related achievements; that the number of laureates in the 'biology' category of physiology or medicine should be increased to six or preferably nine per year; and that two new Prize categories should be introduced to recognize achievements in mathematics and computing science. Together, these measures could increase the science laureates from a maximum of 12 to a minimum of 24, and increase the range of scientific coverage. In future, the Nobel committee should also officially allocate proportionate credit to institutions for each laureate, and a historical task force could also award institutional credit for past prizes.     

Humans cannot consciously generate random numbers sequences: Polemic study

It is widely believed, that randomness exists in Nature. In fact such an assumption underlies many scientific theories and is embedded in the foundations of quantum mechanics. Assuming that this hypothesis is valid one can use natural phenomena, like radioactive decay, to generate random numbers. Today, computers are capable of generating the so-called pseudorandom numbers. Such series of numbers are only seemingly random (bias in the randomness quality can be observed). Question whether people can produce random numbers, has been investigated by many scientists in the recent years. The paper "Humans can consciously generate random numbers sequences..." published recently in Medical Hypotheses made claims that were in many ways contrary to state of art; it also stated far-reaching hypotheses. So, we decided to repeat the experiments reported, with special care being taken of proper laboratory procedures. Here, we present the results and discuss possible implications in computer and other sciences.     

人类遗传智商的高低与优生科学的混沌现状

本文介绍基因与优生专家及其权威人士,对当前世界优生科学的评论。通过30～40年社会调查发现,国内的教育改革与学生智商及其培养世界创新人才这一宗旨产生了许多矛盾,而创新人才从哪里来？实质上要从优生科学中来。然而,当代人们的生活水平有了极大的提高,但人们的素质下降了,人口的出生缺陷却增加了一倍多,为什么？这是由多种社会自然混沌现象形成的。本文的目的是应用混沌理论宏观与微观地研究优生科学。     

Issues of research in medicine

Research in medicine is liable to all rules and standards that apply to research in other natural sciences, since medicine as a science and service fully meets the general definition of science: it is a common, integrated, organized and systematized knowledge of mankind, whereby physician--being more or less aware of doing so-- in his daily activities applies scientific thinking and scientific methods. The procedure of problem solving in scientific work and in medical practice is characterized by many similarities as well as variation. In scientific research, the observation of some phenomenon that cannot be explained by the known facts and theories is followed by making a hypothesis, planning and carrying out experimental investigation resulting in some data. Interpretation of these data then provides evidence to confirm or reject the hypothesis. In medical practice, quite a similar procedure is followed; the initial examination of a patient, when his condition cannot be explained by the data thus obtained, is identical to the observation of a phenomenon which cannot be explained by the known facts; working diagnosis would correspond to making the hypothesis; and experimental investigation would compare to laboratory and other diagnostic studies. The working diagnosis is accepted or rejected depending on these results. Of course, there also are differences in the problem solving procedure between scientific research and daily medical practice. For example, in research a single hypothesis is posed, a single experiment with successive testing and/or repeats is performed, whereas in medical practice several hypotheses are made, multiple studies are concurrently performed to reject current hypotheses and to make new ones. Scientific investigation produces an abundance of systematic data, whereas in medical practice target data are being generated, yet not systematically. Definitive decision making also differs greatly, as in scientific research it only ensues from conclusive evidence, whereas in medical practice definitive decision is made and therapeutic procedures are performed even before reaching final evidence. The general strategy of work and research in medicine can be briefly described by four principles, i.e. good knowledge of one's own work; continuing upgrading of one's own work in collaboration with respective institutions (laboratories, university, and research institutes); implementation of standard, up-to-date and scientific methods most of the time; and publishing work results on a regular basis. This strategy ensures constant progress and treatment quality improvement while allowing due validation and evaluation of the work by the society. Scientific research is based on the pre-existing knowledge of the problem under study, and should be supervised, systematic and planned. Research produces data that may represent some new concepts, or such concepts are developed by further data processing. In research, scientific procedure includes a number of steps that have to be made to reach a new scientific result. This procedure includes (a) thinking about a scientific issue; (b) making a scientific hypothesis, i.e. the main objective of the study; (c) research ethics; (d) determination of sources and mode of data collection; (e) research performance; (f) collection and analysis of all research data; (g) interpretation of results and evidence; and (h) publications. The next section of this chapter brings an example of scientific research in the field of medicine, where the procedures carried out during the research are briefly described; other chapters of this supplement deal with statistical methodology used on processing the data obtained in the study, which is most frequently employed in scientific work in the field of medicine.     

"Complementary and alternative" medicine--a measure of crisis in academic medicine

Academic medicine integrates three of the most honorable human activities: treating the ill, teaching, and research. The quality that all three share is persistent quest for truth. However, there is reluctance of academic medicine today to openly defend scientific truth by challenging the arguments and the very existence of "complementary and alternative medicine" (CAM). There is no sound proof of CAM effectiveness, no hypotheses on the mechanisms of their action, nor scientific reports testing them. The fact that patients are charged for these "healing" activities makes CAM a plain fraud. With these facts in mind, the name "complementary and alternative medicine" is undeserved and misleading. CAM advocates maintain that CAM should be recognized precisely because it is widely practiced and very promising, that it has a special holistic/human approach, and works at least as a placebo in situations where medicine can do nothing more. As it seems that the public interest in paramedicine will only grow stronger before it grows weaker, scientists must raise their voice and question the truthfulness of CAM more openly. N of 1 randomized controlled trials (RCTs) should be used to test effectiveness of CAM, just as they are used to test any other treatment. Irrespectively of the noble principles of human rights and political correctness, academic medicine must discuss paramedicine equally openly and on the basis of the same criteria as it discusses its own activities, results, and plans.     

Integrative Medicine in Allergy and Immunology

Integrative medicine is a relatively new discipline which attempts to combine allopathic medicine with alternative or complementary medicine, to reap the benefits of both forms of medicine in optimizing the care of patients. Integrative medicine concentrates on treating the patient as a whole, both in body and mind. While the scientific method and “evidence-based” clinical research drives the management and treatment of diseases in conventional Western medicine, alternative or complementary medicine is based on unproven yet potentially beneficial techniques that have been developed throughout history, dating back to the ancient cultures in the Middle East, Africa, and China. In spite of the lack of evidence of most alternative medicine techniques, these methodologies have been practiced for centuries with great acceptance in many countries. It is in the Western world, where “modern” medicine is dictated by the scientific method, that the most controversy in the use of these alternative modes of therapy exists. Since the science behind alternative medicine is incomplete or non-existent, it is difficult for those trained in Western medicine to accept or adopt this approach. But perhaps it is the failure of Western medicine to adequately guarantee our well being and good health that have led to the ongoing debate between the medical profession and the general public as to the benefits of these alternative treatments. In one sense, integrative medicine may be a futile attempt to coin a new term in the hope of legitimizing alternative medicine. On the other hand, there is a wealth of historical experience in the use of the techniques. Studies to evaluate the scientific basis behind ancient medical techniques are ongoing, and it is to be expected that the results will neither be uniformly positive nor negative. Of particular interest is the effect of traditional medicine, herbal formulations, and manipulative techniques on the immune system, and its application in the treatment of autoimmune and allergic diseases. Studies are being designed or conducted to investigate immune effects of herbal formulations or their components. Herbal plants or medicines may lead to skewing of the Th1/Th2 balance in either direction, thus may offer potential application in the treatment of allergic or autoimmune diseases.     

Zombie science: a sinister consequence of evaluating scientific theories purely on the basis of enlightened self-interest

Although the classical ideal is that scientific theories are evaluated by a careful teasing-out of their internal logic and external implications, and checking whether these deductions and predictions are in-line-with old and new observations; the fact that so many vague, dumb or incoherent scientific theories are apparently believed by so many scientists for so many years is suggestive that this ideal does not necessarily reflect real world practice. In the real world it looks more like most scientists are quite willing to pursue wrong ideas for so long as they are rewarded with a better chance of achieving more grants, publications and status. The classic account has it that bogus theories should readily be demolished by sceptical (or jealous) competitor scientists. However, in practice even the most conclusive 'hatchet jobs' may fail to kill, or even weaken, phoney hypotheses when they are backed-up with sufficient economic muscle in the form of lavish and sustained funding. And when a branch of science based on phoney theories serves a useful but non-scientific purpose, it may be kept-going indefinitely by continuous transfusions of cash from those whose interests it serves. If this happens, real science expires and a 'zombie science' evolves. Zombie science is science that is dead but will not lie down. It keeps twitching and lumbering around so that (from a distance, and with your eyes half-closed) zombie science looks much like the real thing. But in fact the zombie has no life of its own; it is animated and moved only by the incessant pumping of funds. If zombie science is not scientifically-useable--what is its function? In a nutshell, zombie science is supported because it is useful propaganda to be deployed in arenas such as political rhetoric, public administration, management, public relations, marketing and the mass media generally. It persuades, it constructs taboos, it buttresses some kind of rhetorical attempt to shape mass opinion. Indeed, zombie science often comes across in the mass media as being more plausible than real science; and it is precisely the superficial face-plausibility which is the sole and sufficient purpose of zombie science.     

Measuring revolutionary biomedical science 1992-2006 using Nobel prizes, Lasker (clinical medicine) awards and Gairdner awards (NLG metric)

The Nobel prize for medicine or physiology, the Lasker award for clinical medicine, and the Gairdner international award are given to individuals for their role in developing theories, technologies and discoveries which have changed the direction of biomedical science. These distinctions have been used to develop an NLG metric to measure research performance and trends in 'revolutionary' biomedical science with the aim of identifying the premier revolutionary science research institutions and nations from 1992-2006. I have previously argued that the number of Nobel laureates in the biomedical field should be expanded to about nine per year and the NLG metric attempts to predict the possible results of such an expansion. One hundred and nineteen NLG prizes and awards were made during the past fifteen years (about eight per year) when overlapping awards had been removed. Eighty-five were won by the USA, revealing a massive domination in revolutionary biomedical science by this nation; the UK was second with sixteen awards; Canada had five, Australia four and Germany three. The USA had twelve elite centres of revolutionary biomedical science, with University of Washington at Seattle and MIT in first position with six awards and prizes each; Rockefeller University and Caltech were jointly second placed with five. Surprisingly, Harvard University--which many people rank as the premier world research centre--failed to reach the threshold of three prizes and awards, and was not included in the elite list. The University of Oxford, UK, was the only institution outside of the USA which featured as a significant centre of revolutionary biomedical science. Long-term success at the highest level of revolutionary biomedical science (and probably other sciences) probably requires a sufficiently large number of individually-successful large institutions in open competition with one another--as in the USA. If this model cannot be replicated within smaller nations, then it implies that such arrangements need to be encouraged and facilitated in multi-national units.     

The mind-body dichotomy

The mind-body problem has been pondered by philosophers and physicians since antiquity, yet remains unsolved despite frequent appeals for a holistic approach. The perpetuation of Cartesian dualism has been attributed to many factors ranging from the limitations of Indo-European languages to the founding of scientific medicine on Newtonian physics instead of the more modern quantum and relativity theories. Liaison psychiatry is described as the latest attempt to eradicate mind-body dualism and to treat the patient and his illness as one.     

Medical errors as a result of specialization

Errors in medicine result in over 44,000 preventable deaths annually. Some of these errors are made by specialized physicians at the time of diagnosis. Building on error frameworks proposed in the literature, we tested the experimental hypothesis that physicians within a given specialty have a bias in diagnosing cases outside their own domain as being within that domain. Thirty-two board-certified physicians from four internal medicine subspecialties worked four patient cases each. Verbal protocol analysis and general linear modeling of the numerical data seem to confirm the experimental hypothesis, indicating that specialists try to "pull" cases toward their specialty. Specialists generate more diagnostic hypotheses within their domain than outside, and assign higher probabilities to diagnoses within that domain.     

Confirmation of the "protein-traffic-hypothesis" and the "protein-localization-hypothesis" using the diabetes-mellitus-type-1-knock-in and transgenic-murine-models and the trepitope sequences

As possible mechanisms to explain the emergence of autoimmune diseases, the current author has suggested in earlier papers two new pathways: the "protein localization hypothesis" and the "protein traffic hypothesis". The "protein localization hypothesis" states that an autoimmune disease develops if a protein accumulates in a previously unoccupied compartment, that did not previously contain that protein. Similarly, the "protein traffic hypothesis" states that a sudden error within the transport of a certain protein leads to the emergence of an autoimmune disease. The current article discusses the usefulness of the different commercially available transgenic murine models of diabetes mellitus type 1 to confirm the aforementioned hypotheses. This discussion shows that several transgenic murine models of diabetes mellitus type 1 are in-line and confirm the aforementioned hypotheses. Furthermore, these hypotheses are additionally inline with the occurrence of several newly discovered protein sequences, the so-called trepitope sequences. These sequences modulate the immune response to certain proteins. The current study analyzed to what extent the hypotheses are supported by the occurrence of these new sequences. Thereby the occurrence of the trepitope sequences provides additional evidence supporting the aforementioned hypotheses. Both the "protein localization hypothesis" and the "protein traffic hypothesis" have the potential to lead to new causal therapy concepts. The "protein localization hypothesis" and the "protein traffic hypothesis" provide conceptional explanations for the diabetes mouse models as well as for the newly discovered trepitope sequences.     

大气压低温等离子体在口腔医学中应用进展

等离子体医学是一门结合物理、化学、生命科学以及临床医学等相关学科的一门综合性的交叉学科,其在医学领域中具有非常广泛的应用前景。近年来,等离子体在口腔医学领域中的应用越来越广泛。本文首先阐述了等离子体用于杀毒和灭菌等方面的研究,另外等离子体还可以对口腔中常用的材料通过接枝或引入新的化学官能团,在不破坏材料本身结构和形态的前提下进行表面改性,而且在使用的过程中对口腔组织没有损伤作用。正是由于等离子体具有这些独特的性能,使其在口腔医学领域中的研究不断扩大,现已将其应用在材料改性、美学修复、抗菌、抗炎症、成骨、抗肿瘤等多方面的研究中。未来随着对等离子不断深入以及细致的研究,等离子体有望成为口腔临床医学中一种常规的辅助治疗手段。     

提高医学物理学教学质量的探索

医学物理学是物理学与医学相结合所形成的交叉学科，该学科中包含大量抽象的概念、复杂模型、烦琐的数学推导，这对医科院校的学生来说，学习和掌握起来比较困难。那么如何在遵循教学规律、贯彻教学原则的基础上．激发学生对医学物理的学习兴趣，提高医学物理学的教学质量，一直是很多物理老师和专家的困惑和难题。作者结合教学经验，浅谈以下几个方面的体会。     

Progress in the study of brain evolution: From speculative theories to testable hypotheses

Darwin's theory of evolution raised the question of how the human brain differs from that of other animals and how it is the same. Early students of brain evolution had constructed rather grand but speculative theories which stated that brains evolved in a linear manner, from fish to man and from simple to complex. These speculations were soundly refuted, however, as contemporary comparative neurobiologists used powerful new techniques and methodologies to discover that complex brains have evolved several times independently among vertebrates (e.g., within teleost fishes and birds) and that brain complexity has actually decreased in the lineages leading to modern salamanders and lungfishes. Moreover, the old idea that brains evolved by the sequential addition of new components has now been replaced by the working hypothesis that brains generally evolve by the divergent modification of preexisting parts. Speculative theories have thus been replaced by testable hypotheses, and current efforts in the field are aimed at making phylogenetic hypotheses even more testable. Particularly promising new directions for comparative neurobiology include (1) the integration of comparative neuroanatomy with comparative embryology and developmental genetics in order to test phylogenetic hypotheses at a mechanistic level, (2) research into how evolutionary changes in the structure of neural circuits are related to evolutionary changes in circuit function and animal behavior, and (3) the analysis of independently evolved similarities to discover general rules about how brains may or may not change during the course of evolution. Anat. Rec. (New Anat.) 253:105–112, 1998. © 1998 Wiley-Liss, Inc.