在人体解剖学教学中如何开展启发式教学

<正>启发式教学法是以激发学生的积极性和主动性为出发点,按照思维发展的规律阐述书本知识,科学地引导学生开动脑筋,积极思考,融会贯通地掌握知识,增强技能,发展智力。其教学效果明显优于传统的灌注式教学法。很多人认为解剖学是对人体形态的客观描述,它的内容较"死板",讲授时难以进行启发和诱导。实际上人体是物质运动发展的高级形式,它的形态结构亦是活生生的,具有深刻的内涵。它的教学不仅可以而且必须     

A hierarchy of effective teaching and learning to acquire competence in evidenced-based medicine

Background  

A variety of methods exists for teaching and learning evidence-based medicine (EBM). However, there is much debate about the effectiveness of various EBM teaching and learning activities, resulting in a lack of consensus as to what methods constitute the best educational practice. There is a need for a clear hierarchy of educational activities to effectively impart and acquire competence in EBM skills. This paper develops such a hierarchy based on current empirical and theoretical evidence.     

Effective preexposure tuberculosis vaccines fail to protect when they are given in an immunotherapeutic mode

Two vaccine formulations previously shown to induce protective immunity in mice and prevention of long-term necrosis in guinea pigs were tested as potential immunotherapeutic vaccines in mice earlier infected by aerosol with Mycobacterium tuberculosis. Neither vaccine had any effect on the course of the infection in the lungs, but both reduced the bacterial load in the spleen. Similarly, inoculation with Mycobacterium bovis BCG had no effect whatsoever and, if given more than once, appeared to induce an increasingly severe pyogranulomatous response in the lungs of these mice.     

联系思维在人体解剖学教与学中的应用

人体解剖学是一门研究人体形态和结构的科学,是医学生最先接触而又很重要的医学启蒙学科之一。解剖学名词、术语之丰富,人体结构之复杂,需要记忆内容之多,且难于记忆为本学科的重要特点。作者根据多年学习和教学实践,结合解剖学特点及联系思维,总结一些实用的教与学技巧,以期在有限的学习时间内达到事半功倍的学习效果。1理论联系活体学习人体解剖学不仅仅是为了研究尸体,而是通过对尸体标本的器官、结构的认证,更好的了解正常活体情况下各器官结构的位置和形态,以便为学习其它临床各科打下坚实基础。我们每个人自己就是活生生的标本,因而教…     

浅析如何在人体生理学教学过程中提升学生的创新思维能力

新形势下的高校,培养大学生的创新思维能力非常重要,而这种能力培养的主要途径之一是科研,也就是目前很多高校都主张教学与科研并重。教学是高校的基本任务,科研是高校的重要任务。在两者的关系上,要求教学必须能推动高校科研的发展,而科研也必须要促进高校教学质量的提升。本着这样一个原则,在医学生理学的授课过程中,也务必要做到科研促进教学,或者至少是科研应该渗透到教学中去,使二者实现一个有机的结合,进而实现在理论知识的学习过程中达到提升学生创新思维能力的目的。     

Moving from theory to research to practice. Implementing an effective dyadic intervention to improve antiretroviral adherence for clinic patients

There is a dearth of evidence on the relative efficacy of intervention modalities to improve and maintain patient adherence to antiretroviral medications. Although empiric findings from research on HIV/AIDS, other diseases, and chronic medical conditions consistently demonstrate that social support plays an important role in facilitating adherence, few HIV/AIDS interventions have directly targeted this factor. Ewart's social action theory emphasizes the role of social relationships in behavior change and provides a comprehensive and useful guide to the development of interventions for adherence. We describe the development, content, and testing of SMART Couples, an effective antiretroviral adherence intervention that is grounded in social action theory and designed to enhance social support for ART adherence. Finally, we discuss some of the challenges of translating findings from the randomized clinical trial of this intervention into clinical practice and offer recommendations for integration of lessons learned into ongoing clinical care.     

Streptolysin-O reversible permeabilisation is an effective method to transfect siRNAs into myeloma cells

RNA interference (RNAi) has been shown to be a valuable tool to specifically target gene expression in a number of organisms becoming an indispensable weapon in the arsenal in functional genomics. In this study, we demonstrate that streptolysin-O (SLO) reversible permeabilisation is an efficient method to deliver small interfering RNAs (siRNAs) to hard-to-transfect human myeloma cell lines. We used published, pre-validated siRNAs for ERK2 and non-silencing siRNA control. We transfected siRNAs into human myeloma cell lines using SLO reversible permeabilisation method. Flow cytometry and western blot analysis were performed to assess the effect of SLO on transfection efficiency and ERK2 knockdown. These experiments demonstrate that SLO reversible permeabilisation method is an efficient and easy-to-use method to deliver siRNAs into human myeloma cell lines. Optimised SLO permeabilisation method showed to transfect >80% of JIM-3, H929, RPMI8226 and U266 cells, with minimal effect on cell viability (<10%) and cell cycle. Equally important, SLO permeabilisation induced a substantial knockdown of ERK2 at the protein level. These studies demonstrate that reversible SLO permeabilisation can successfully be applied to hard-to-transfect human myeloma cell lines to effectively silence genes.     

Responses of human frontal cortex to surprising events are predicted by formal associative learning theory

Learning depends on surprise and is not engendered by predictable occurrences. In this functional magnetic resonance imaging (fMRI) study of causal associative learning, we show that dorsolateral prefrontal cortex (DLPFC) is associated specifically with the adjustment of inferential learning on the basis of unpredictability. At the outset, when all associations were unpredictable, DLPFC activation was maximal. This response attenuated with learning but, subsequently, activation here was evoked by surprise violations of the learned association. Furthermore, the magnitude of DLPFC response to a surprise event was sensitive to the relationship that had been learned and was predictive of subsequent behavioral change. In short, the physiological response properties of right DLPFC satisfied specific predictions made by associative learning theory.     

Development of multimedia learning modules for teaching human anatomy: application to osteology and functional anatomy

Computer-assisted learning (CAL) is growing quickly within academic programs. Although the anatomical commercial packages that are available for this learning have attractive advantages, they also have drawbacks: they are frequently not in the local language of the students, they do not perfectly answer the needs of the local academic program, and their cost is frequently more than students can afford. This study describes a relatively inexpensive method to create CAL tutorials, whose content can be fully customized to local academic needs in terms of both program and language. The study describes its use in creating multimedia learning modules (MLMs) about Osteology and joint kinematics. The pedagogical content in these modules was collected from objective experiments to give students the opportunity to access new scientific knowledge during their education. It can be replaced, as desired, by almost any content due to the flexibility of the production method. Each MLM consists of two complementary subelements: a multimedia theoretical lecture and a three-dimensional interactive laboratory. Such MLMs are in use at both the University of Brussels (ULB) and the National University of Rwanda (NUR). The development of this work was part of the VAKHUM project, and the pedagogical validation is currently being performed as part of the MULTIMOD project.     

Early cleavage of human embryos: an effective method for predicting successful IVF/ICSI outcome.

BACKGROUND: The need for effective parameters for selecting the best embryos is paramount when a large number of them are available for transfer. Other studies have reported that transfer of pre-selected embryos, based on cleavage to the 2-cell stage at 25 h and 27 h post-insemination/intracytoplasmic sperm injection (ICSI), increases implantation and pregnancy rates. We investigated whether extending the time for selection of cleaved embryos to 29 h post-insemination/ICSI had a similar effect on pregnancy and implantation rates. METHODS: Cleavage to the 2-cell stage was assessed at 25, 27 and 29 h post-insemination/ICSI. Embryos that had cleaved at any of these time points were designated as 'early cleavage' (EC), while others were designated as 'non-early cleavage' (NEC). EC embryos were selected and preferentially transferred. RESULTS: EC occurred in 57% of the cycles (61% IVF; 51% ICSI). Significantly (P = 0.02) more clinical pregnancies occurred in the EC group (23/42, 55%) compared with the group that had no embryo undergoing first cleavage up to 29 h post-insemination/ICSI (8/32, 25%). The EC group of patients was significantly younger than the NEC. CONCLUSION: Transfer of selected embryos that reached the 2-cell stage between 25 and 29 h post-insemination/ICSI is a reliable prognostic tool for patients undergoing assisted reproduction techniques.     

A method to improve visual similarity of breast masses for an interactive computer-aided diagnosis environment

The purpose of this study was to develop and test a method for selecting "visually similar" regions of interest depicting breast masses from a reference library to be used in an interactive computer-aided diagnosis (CAD) environment. A reference library including 1000 malignant mass regions and 2000 benign and CAD-generated false-positive regions was established. When a suspicious mass region is identified, the scheme segments the region and searches for similar regions from the reference library using a multifeature based k-nearest neighbor (KNN) algorithm. To improve selection of reference images, we added an interactive step. All actual masses in the reference library were subjectively rated on a scale from 1 to 9 as to their "visual margins speculations". When an observer identifies a suspected mass region during a case interpretation he/she first rates the margins and the computerized search is then limited only to regions rated as having similar levels of spiculation (within +/-1 scale difference). In an observer preference study including 85 test regions, two sets of the six "similar" reference regions selected by the KNN with and without the interactive step were displayed side by side with each test region. Four radiologists and five nonclinician observers selected the more appropriate ("similar") reference set in a two alternative forced choice preference experiment. All four radiologists and five nonclinician observers preferred the sets of regions selected by the interactive method with an average frequency of 76.8% and 74.6%, respectively. The overall preference for the interactive method was highly significant (p < 0.001). The study demonstrated that a simple interactive approach that includes subjectively perceived ratings of one feature alone namely, a rating of margin "spiculation," could substantially improve the selection of "visually similar" reference images.     

Surface modification of poly-L-lactic acid (PLLA) membrane by grafting acrylamide: an effective way to improve cytocompatibility for chondrocytes

Poly-L-lactic acid (PLLA) membranes were photo-oxidized in hydrogen peroxide solution under ultraviolet light (UV) to introduce hydroperoxide groups onto the PLLA membrane surfaces. The photo-oxidized membranes were then immersed in acrylamide (AAm) solution containing Fe2+ to graft polyacrylamide (PAAm) onto the PLLA membrane surfaces. The density of the hydroperoxide groups introduced on the PLLA membrane surfaces varied with the temperature and the photo-oxidization time. The occurrence of grafting was verified by X-ray photoelectron spectroscopy (XPS). The degree of grafting increased with the monomer concentration and the polymerization time. Water contact angle measurements showed that the wettability of the modified PLLA membranes had improved. Chondrocytes proliferated more rapidly and were more spread out on the modified membrane than on the control PLLA membrane, indicating that the PAAm-grafted PLLA membrane has better cytocompatibility for chondrocytes.     

Individualized cancer chemotherapy integrating drug sensitivity tests, pathological profile analysis and computational coordination - an effective strategy to improve clinical treatment

BACKGROUND: Most current cancer chemotherapy is unsatisfactory. There is a trend towards changing the norm for drug selection; one approach is to seek individualized cancer chemotherapy (ICC). METHODS AND RESULTS: ICC is an approach to maximizing the efficacy of chemotherapy and reducing its adverse effects to a minimum. It involves choosing anticancer drugs through the following critical steps: (i) performing drug sensitivity tests in vivo and/or in vitro; (ii) analyzing pathogenic information from morphology, histology and bioinformatics, so that targeted therapy can be offered to disrupt the escalating tumorigenic molecules and pathways; (iii) introducing mathematical and computational systems to assist in improving the quality of decision-making. CONCLUSION: Increasing clinical evidence indicates that drug sensitivity tests, pathological profile analyses and computational coordination are ways to improve therapeutic quality. In future, each patient should have his own unique chemotherapy protocol.     

Protamine sulfate as an effective alternative to polybrene in retroviral-mediated gene-transfer: implications for human gene therapy

The polycation protamine sulfate was compared to polybrene, the usual agent employed, for its ability to increase the efficiency of retroviral infection. The murine retroviral vector SAX, which contains the neoR gene and the human adenosine deaminase (ADA) cDNA, was used as a marker of cell infection. SAX viral supernate was titered on NIH 3T3 cells in varying concentrations of polycation. The highest infection efficiency for protamine was seen at 5 micrograms/ml and was 7-fold greater than infections performed in the absence of polycation. Infection efficiency using protamine averaged 92% +/- 11 (SEM) of the highest efficiency obtained with polybrene. Total ADA activity attained when human-ADA deficient T cells were exposed to SAX supernate in the presence of protamine was 83% of that attained with polybrene. The infection rate of mouse bone marrow early progenitor cells (CFU-S) was similar with each polycation. In summary, for supernate infections, concentrations of 5-10 micrograms/ml of protamine provided essentially the same infection efficiency as polybrene with low toxicity on a range of cell types. Since protamine is approved for human use by the U.S. Food and Drug Administration it provides an effective alternative to polybrene when developing human gene therapy protocols.     

一种高效的人精子核原位杂交前处理技术

目的建立高效的荧光原位杂交（fluorescence in situ hybridization,FISH）前人精子核去凝集方法和监测手段。方法精子标本经10mmol/L二硫代苏糖醇（dithiothreitol,DTT）处理,使人精子核去凝集,倒置相差显微镜监测精子核膨胀度。标本固定后制片,变性后行FISH分析。结果倒置相差显微镜下,人精子核膨大程度清晰可见,膨大精子细胞边缘清楚并完整。荧光显微镜下,可见精子头部染成蓝色,边缘清楚,背景清晰,精子杂交信号清晰,非特异性杂交少。结论本方法具有简便、高效的特点,精子核解聚程度可控性和可见性强,杂交后荧光信号强、易分辨和非特异性性杂交率低,可用于人精子核FISH前处理。     

Antibodies to an epitope from the Cha human autoantigen are markers of Chagas' disease.

Chagas' disease is a prevalent disease in South America that is thought to have an autoimmune etiology. We previously identified human Cha as a new autoantigen recognized by chagasic sera. Those sera recognized an epitope spanning amino acids 120 to 129 of Cha, named R3. In the present study we have used the synthetic R3 peptide for the detection of serum immunoglobulin G antibodies from patients at different stages of Chagas' disease, including a therapeutically treated group. The immunoreactivity with R3 by enzyme-linked immunosorbent assay (ELISA) showed 92.4% sensitivity and 100% specificity for Chagas' disease sera. This sensitivity and specificity were higher than for any other autoantigen described to date. No anti-R3 antibodies were detected in sera from Leishmania-infected or idiopathic dilated cardiomyopathy patients or healthy controls from the same areas. Moreover, anti-R3 antibody reactivity detected by ELISA correlated with conventional serological tests as indirect immunofluorescence and ELISA assays with Trypanosoma cruzi extracts and other diagnostic tests as indirect hemagglutination. The levels of anti-R3 antibodies increased with progression and symptomatology of Chagas' disease. More interestingly, a statistically significant fall in anti-R3 antibody titer was observed in patients treated with antiparasitic drugs. Those results suggest that the presence of anti-R3 antibodies is a highly specific marker of Chagas' disease and that R3 ELISA could be helpful in the diagnosis and monitoring of this disease.