增强《影像解剖学》实验课教学效果的方法

《影像解剖学》这门课程是当今医学影像专业学生必修的一门专业基础课程,它是建立在《影像成像技术》和《人体解剖学》这两门课程之上的一门科学。本门课程主要学习X线片、CT、MRI等一些影像检查技术及其正常的影像学表现。通过学习本门课程,使学生对一些常见的影像检查技术有所了解,更主要的是理论联系了临床,减少课程的枯燥性,增加了学生的学习兴趣,为以后学习《影像诊断学》和进入临床学习工作打下坚实基础。为了讲好本门课程,我教研室开展以下内容,尤其是实验教学。     

多媒体技术在影像解剖学教学中的应用

影像解剖学尤其是断层解剖学对医学生来讲是一门十分棘手的课程。结合多年的教学实践，初步探讨多媒体技术在影像解剖学教学中的应用，深入加强学生对影像解剖学知识的理解和掌握，为进一步提高多媒体技术在影像解剖学教学中的应用水平和提高影像解剖学的教学质量提供有益的尝试。     

浅谈断层解剖学教学体会

20世纪70年代以来，随着医学科学技术的飞速发展，超声成像（USG）、X线计算机断层成像（CT）、核磁共振成像（MRI）、发射型计算机断层扫描（ECT）、单光子发射体层成像（SPECT）和正电子发射体层成像（PET）等现代影像技术相继崛起并迅速普及。这些影像技术赖以诊断和介入治疗的形态学基础是断层解剖学。断层解剖学是研究正常人体不同方位断面上的器官结构的形态、位置以及其相互关系的科学，是一门相对独立的学科，它是在系统解剖学和局部解剖学基础上发展起来的。为适应社会需求，我院于2002年设立了医学影像专业，断层解剖学作为医学影像专业的主干课程之一，却缺乏完整的理论体系。笔者从事断层解剖学的教学工作时间虽短，但也有些工作体会，在此简单谈谈断层解剖学的教学体会。     

在断层影像解剖学教学中的几点体会

断层影像解剖学是局部解剖学和断层影像学相结合的边缘学科。随着医学影像学的发展，断层解剖学已经成为继系统解剖学和局部解剖学之后的又一门人体解剖学课程。在为3年制医学影像专业开展断层解剖教学中，初步建立了断层影像解剖学教学体系及计算机辅助教学模式，就此略谈几点体会。     

影像解剖学教学要立足培养实用型医学影像人材

影像解剖学是随着现代医学影像技术发展而兴起的一门新兴学科。近年来，现代医学成像技术飞速发展，大量利用现代放射学、微电子学、电子计算机图修处理等手段，诊断治疗疾病，B超、CT、MRI已相当普及，为了适应这一需要，我国一些高等医学院校相继开办“医学影像学专业”。我院于1979年正式开办该专业，1993年开设影像解剖学。在几年的影像解剖学教学过程中，我们分析了国内医学影像技术水平和普及现状，参照兄弟院校的经验，确定了我们学院影像解剖学教学思路，以培养实用型医学影像专业人材为目的。1制定温学计划，g立足培养目标“培…     

在影像解剖学教学中注重学生能力的培养

影像解剖学是医学影像学与人体解剖学之间的边缘学科，它为医学生及广大医务工作者提供了认识人体解剖结构和功能的新途径。同时亦为医学生在今后的临床工作中诊疗疾病奠定了良好的基础。我校自1986年开始招收医学影像专业学生，影像解剖学这门课一直由我们影像教研组承担教学任务，在这些年的教学实践中，我们克服了种种困难。较好地完成了教学任务，为社会输送了大量合格的影像专业人才。在教学中我们注萤从以下几方面培养学毕的能力．     

试论《影像解剖学》课程改革环境下教师角色创新

医学影像成像技术正以人们意料不到的速度发展，但是，不论那一类新的成像技术，它们都有一个共同的基础，就是要有坚实的解剖知识，才能掌握好这些新的诊断技术。医学影像学的成像技术各有特点，传统的人体解剖学知识远不能满足这门新兴学科的需要，近几年来，开设医学影像专业的各高等医学院校，为了提高教学质量，先后开设了《影像解剖学》这门起桥梁作用的课程，我校从1997年开设此门课程至今已有9a了。随着我校主编的《影像解剖学》新版教材的出版，《影像解剖学》课程改革这项系统工程便紧迫地摆在了我们面前，作为承担这项系统工程的主要角色——教师，面临新课程体系和新教材学习的挑战。教师要适应新教材新课程体系的要求，必须要以新理念为主帅，以新素质为先锋，以新方法为利器，从根本上完成系列角色的创新与转换。     

改革局部解剖学实验课教学的探索

局部解剖学是介于基础医学与临床医学之间的一门桥梁课程,是临床医学特别是外科学、妇产科学等手术学科和影像诊断学科的重要基础学科,具有很强的实际应用意义[1].随着手术学科的迅猛发展和影像技术的日新月异变化,局部解剖学的重要性越发显现出来.由于局部解剖学的实践很强,所以实验课在局解教学中占有重要位置.     

把多媒体技术应用于断层解剖教学中

随着医学科技的飞速发展,医学影像诊断技术在临床诊断中也日益被广泛应用,断层影像解剖学作为一门新的形态学科,在临床医学类的教学中得以开展。而传统的断层解剖学的教学是运用简陋的幻灯机进行教学,教学效果不尽人意。作者在近几年的断层解剖学的教学中,把自制的简易多媒体课     

适应现代医学发展趋势，加快断层解剖学课程建设

随着临床影像诊断和治疗技术飞速发展,高新技术在影像治疗技术中日益深入和广泛渗透,临床各科对影像诊断和治疗的依赖性越来越强。医学影像学教学对基础课程断层解剖学的理论知识需求程度也越来越高,从而激励从事解剖学教学的教师在断层解剖学教学和科研方向上作出快速反应,以适应现代医学影像学发展需要,     

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.