模拟教学在继续医学教育中的应用探讨

目前,模拟技术在院校医学教育和毕业后医学教育以及其他医疗卫生专业人员的个人训练和评估中有广泛的应用,模拟技术能给各种技术水平的医疗卫生专业人员提供安全、有效的实践机会,帮助他们学会治疗患者所需的临床技能.有越来越多的研究证实了模拟技术对于医疗卫生专业人员的培训效果.然而,在继续医学教育领域,模拟技术还未得到广泛的应用.     

Specific identification of fibrin polymers, fibrinogen degradation products, and crosslinked fibrin degradation products in plasma and serum with a new sensitive technique

A new method is described for identifying low concentrations of circulating derivatives of fibrinogen and fibrin, even when present in heterogeneous mixtures. This technique is applicable to plasma and serum and uses electrophoresis in 2% agarose in the presence of sodium dodecyl sulfate (SDS) followed by immunological identification of separated derivatives, using radiolabeled antifibrinogen antiserum and autoradiography. Unique electrophoretic patterns distinguish plasmic derivatives of crosslinked fibrin from those of fibrinogen and also identify crosslinked fibrin polymers produced by the combined action of thrombin and factor XIII on fibrinogen. The assay is sensitive to a concentration of 0.1 micrograms/mL of fibrinogen in serum or plasma. Fibrin polymers, plasmic degradation products of fibrinogen, and plasmic degradation products of crosslinked fibrin were detected in the plasma or serum of a patient with disseminated intravascular coagulation. Plasmic derivatives of both fibrinogen and crosslinked fibrin appeared in serum in the course of fibrinolytic therapy for pulmonary embolism, whereas during acute myocardial infarction a marked increase in the proportion of fibrin polymers in plasma was found in comparison with normal controls. Thus, the procedure can distinguish between the simultaneous processes of fibrin polymer formation, fibrinogenolysis, and fibrinolysis, and is sufficiently sensitive to detect relevant quantities of derivatives in pathologic conditions.     

The frequency of fungal infection in biopsies of oral mucosal lesions

To determine the frequency of fungal infection in biopsies of oral mucosal lesions. MATERIALS AND METHODS: Histopathology reports issued between 1991–1995 inclusive were reviewed. During this period, a single section of each mucosal biopsy had been stained using the periodic acid-Schiff (PAS) technique. RESULTS: A total of 223 (4.7%) biopsies contained PAS-positive fungi: 191 individuals were affected, 124 (64.9%) of whom were male. There was a significant (P < 0.01) positive association of fungal infection with moderate and severe epithelial dysplasia, median rhomboid glossitis and squamous papillomas. Where a subsequent biopsy was available, 21.9% dysplasias which were infected with fungi worsened in histological severity, as compared with 7.6% of dysplasias which were not infected at any stage. There was a significant negative association of fungal infection with benign fibrous overgrowths (P < 0.01), benign hyperkeratoses, lichenoid reactions and pyogenic granulomas (P < 0.05). The difference in frequency of infection between the tongue and other sites was also significantly higher (P < 0.01). CONCLUSIONS: There is a statistically significant association between histologically-determined fungal infection and epithelial dysplasia, and we recommend that a PAS stain be performed whenever oral epithelial dysplasia is diagnosed, especially in male patients. On histological confirmation of dysplasia, anti-fungal therapy should be considered in the management of these lesions.     

Abdominal and hepatic uptake of 99mTc-pyrophosphate in neonatal necrotizing enterocolitis

Abdominal 99mTc-pyrophosphate (99mTc-PYP) scans were obtained in 15 neonates: 12 with neonatal necrotizing enterocolitis (NEC), two with osteomyelitis, and one with myocarditis. Ten of the babies with NEC had at least one positive scan; of these 10 studies, seven (Group A) showed both diffuse abdominal uptake and localized hepatic activity, two (Group B) showed abdominal uptake and questionable hepatic uptake, and one (Group C) demonstrated diffuse abdominal uptake only. The other two babies with NEC had normal scans (Group D). Pneumatosis intestinalis was unquestionably present in two patients from Group A and one from Group B. Upon resolution of the clinical findings, all NEC patients had normal scans. A patient with myocarditis had hepatic uptake of 99mTC-PYP while the abdominal scan in the two infants with osteomyelitis was normal. These preliminary observations suggest that further study of a relationship between abdominal scan findings and the course of NEC is warranted.