Microsim医学模拟培训系统在实习学员临床思维培训中的应用

目的　评估Microsim 医学模拟培训系统在实习学员临床思维培训中的价值及可行性。方法　以2009级、2010级临床医学五年制96名学员为研究对象,随机分组为两组,每组48人。A组在呼吸内科临床实习3周后通过Microsim医学模拟培训系统进行病例学习1周,B组在呼吸内科临床实习4周。观察两组学员实习结束后临床思维考核成绩及教学满意度,数据应用SPSS 17.0进行统计分析,计量资料进行配对t 检验,计数资料采用χ2检验。结果　Microsim医学模拟培训系统评估报告得分[（89.37±7.18） vs. （61.95±15.34）],组间差异有统计学意义。学员临床思维能力考核中得分,分析问题能力[（89.95±4.02） vs. （75.51±6.34）]、处理问题能力[（78.81±8.09） vs. （59.67±9.33）]、处理流程[（86.74±6.59） vs. （70.39±7.05）]和处理效果[（88.61±8.16） vs. （63.54±11.48）]方面,２组间差异有统计学意义。但沟通交流得分[（82.47±5.23） vs. （84.09±3.72）],组间无统计学差异。89.6%（43人）的学员认为Microsim医学模拟培训系统能明显提高临床思维能力,但只有58.3%（28人）的学员认为能巩固基本理论知识。结论　Microsim医学模拟培训系统可提高学员临床思维能力及临床综合处置能力,可作为临床实习教学的有效补充。     

CT、ECT在脊柱关节病诊断中的价值

目的 探讨CT、ECT核素骨显像对脊柱关节病（SpA)的诊断价值。方法 对临床诊断为SpA患者63例（其中强直性脊柱炎26例，未分化脊柱关节病37例）同时进行骶髂关节CT扫描和ECT全身及骶髂关节局部显像。结果 CT对未分化脊柱关节病检查阳性率为24.3%(9/37)。远低ECT检查阳性率64.9%(24/37)；ECT对强直性脊柱炎的诊断阳性率为53.8%(14/26)。结论 ECT核素骨显像早期诊断SpA较CT敏感，具有重要价值。     

Bone growth patterns in Chinese children and adolescents: a 6-year follow-up study provides evidence for sexual dimorphism and tracking

Summary We prospectively examined bone growth patterns in 894 children aged 6–17 years at the baseline visit, with a 6-year follow-up. Results show bone “tracking” over a six-year interval and sexual dimorphism of bone attained levels and timing of peak bone growth. Our findings underscore childhood and adolescence as critical periods for building bone and developing gender differences. Introduction Bone growth patterns were prospectively examined in 894 Chinese children (496 males), aged 6–17 yrs, from a population-based twin cohort. Whole-body bone area (BA), bone mineral content (BMC), and bone mineral density (BMD) were measured by DEXA at baseline and a 6-yr follow-up. Methods Graphic smoothing plots and generalized estimating equations were used to model bone attained levels, growth, and “tracking”. Results Attained levels of BMC and BA increased curvilinearly with age. Male attained levels were higher than females after age ∼15 yr, but BMD was lower between 13–17 yrs (Tanner stage I to IV). In both genders, peak BMC and BMD growth lagged ∼2 yrs behind peak BA growth, which lagged 2 yrs behind peak height growth. Peak bone growth occurred 1–3 yrs later in males. Over the 6-yr follow-up, all bone measurements “tracked”, but “shifting” across ranks also occurred, and baseline tertile ranking influenced bone growth. Females with early menarche had higher attained levels than females with late menarche at age 12–13 yrs. Conclusion Our findings confirm and expand previous studies on peak bone growth conducted in Caucasian cohorts, particularly sexually dimorphic and maturational effects. The significant “tracking” of bone measurements in this 6-yr follow-up study underscores the importance that osteoporosis prevention should begin in childhood and adolescence. Fengxiu Ouyang and Binyan Wang contributed equally to this article. Source(s) of support: This study is supported in part by grant R01 HD049059, R01 HL0864619 and R01 AR045651 from the National Institute of Health and by the Food Allergy Project.     

Requirement of MyD88 for macrophage-mediated islet xenograft rejection after adoptive transfer

BACKGROUND: Porcine antigen primed and CD4+ T-cell activated macrophages are able to migrate to and destroy porcine xenografts. However, the specific signaling mechanisms involved remain to be identified. METHODS: In this study macrophages which lack the universal toll-like receptor (TLR) adaptor MyD88 were used to investigate the role of TLR in the recognition and activation of macrophages in islet xenograft rejection. Macrophages were isolated from rejecting MyD88(-/-) and wild-type C57BL/6 mice that were recipients of neonatal porcine pancreatic cell cluster (NPCC) xenografts, and were transferred to NPCC recipient NOD-SCID mice. RESULTS: Both wild-type C57BL/6 and MyD88(-/-) mice rejected NPCC xenografts 8 and 10 days, respectively after transplantation, and the grafts were heavily infiltrated with CD4+ T cells and macrophages. However, graft infiltrating macrophages from rejecting MyD88(-/-) recipients demonstrated impaired up-regulation of TLR expression and impaired activation phenotype, when compared to those from rejecting C57BL/6 recipients. Transfer of NOD-SCID recipients with macrophages from rejecting C57BL/6 mice resulted in NPCC xenograft rejection along with massively infiltrated macrophages 8 days after transfer, whereas NPCC xenografts in NOD-SCID mice transferred with macrophages from rejecting MyD88(-/-) mice remained intact until the end of this study, 90 days after transfer, with insulin-positive islets and no infiltration by macrophages. CONCLUSION: This study demonstrates that deletion of MyD88 causes impaired macrophage activation after pig islet xenotransplantation. However, graft survival is not prolonged and xenografts are rejected rapidly by alternate mechanisms.     

严重脓毒症患者外周血单个核细胞Toll样受体2、4和髓样分化因子88在胸腺肽α1治疗过程中的基因表达变化

目的 观察严重脓毒症患者外周血单个核细胞Toll样受体（TLR）2、4基因及其信号传导通路上的髓样分化因子88（MyD88）基因表达水平在胸腺肽α1治疗过程中的变化。方法 54例严重脓毒症患者被随机分为对照组（常规治疗,28例）和治疗组（胸腺肽α1治疗,26例）,采用实时荧光定量PCR监测两组患者入院时及治疗后第3、7天外周血单个核细胞TLR2、TLR4和MyD88基因表达水平变化,并观察两组的28 d病死率。结果 治疗组的28 d病死率虽低于对照组,但差异无统计学意义（23.1%vs 35.7%,P=0.310）。治疗组的患者单核细胞TLR2、TLR4和MyD88基因表达水平逐渐上升,而对照组未见该规律,与对照组相比,治疗后第3天时治疗组的TLR2（2.31±0.79 vs 1.83±0.51）、TLR4基因表达增高（7.31±0.79 vs 6.55±0.92）;第7天时治疗组TLR2（2.75±1.17 vs 1.63±0.36）、TLR4（7.75±1.03 vs 6.39±0.72）和MyD88（4.26±0.77 vs 3.77±0.68）水平明显增高,均P〈0.05。结论 胸腺肽α1在治疗严重脓毒症患者过程中可以上调患者单核细胞的TLR2、4和MyD88基因的表达水平。     

Please quote: Tian Y, Liu GE, Zhao WJ, Peng YY, Song SM, Li L. Review of Chinese Journal of Traumatology in the year 2018. Chin J Traumatol. 2019;22(1):21–23. doi:10.1016/j.cjtee.2019.01.001

Li Y, Li PY, Sun SJ, et al. Chinese Trauma Surgeon Association for management guidelines of vacuum sealing drainage application in abdominal surgeries-Update and systematic review. Chin J Traumatol. 2019;22(1):1–11. doi:10.1016/j.cjtee.2018.10.005     

改良关节镜双袢法Latarjet手术治疗癫痫患者复发性肩关节前脱位的疗效观察

目的研究改良关节镜双袢法Latarjet手术治疗癫痫患者伴复发性肩关节前脱位的临床疗效。 方法自2014年10月至2016年10月,共有9例伴发严重骨缺损的肩关节前脱位癫痫患者在深圳大学第一附属医院接受了改良关节镜双袢法Latarjet手术,患者平均年龄为（26.3±3.1）岁,术前均进行超过半年的抗癫痫治疗,术后继续进行抗癫痫治疗1年。术后立刻行CT检查观察骨块位置,分别于术后3、6、12、24个月随访行CT检查观察骨块吸收、愈合情况;并记录患者的美国肩与肘协会评分系统（American shoulder and elbow surgeon’form,ASES）评分、Rowe评分以及Walch-Duplay评分并进行肩关节功能评估。 结果共8例患者得到全程随访,平均随访（20.1±4.2）个月,3例患者术后再发癫痫（未按时服药）,分别为术后2、6、8个月,其中1例（术后6个月癫痫复发）失访,其余2例复发者CT显示骨块明显移位,随后经保守治疗后再次愈合。全部随访患者骨块愈合良好,6例恢复对抗运动,2例恢复正常生活,无肩关节不稳感,CT检查显示移植骨块最终塑形差异较大,其中4例吸收5%~75%,3例较原始状态面积扩大,1例无变化。术前及末次随访时平均ASES评分为（76.75±7.41）分和（94.68±5.02）分（P<0.05）,Rowe评分为（43.75±5.82）分和（93.13±5.30）分（P<0.05）,Walch-Duplay评分为（76.13±6.98）分和（93.00±2.00）分（P<0.05）。 结论改良关节镜双袢法Latarjet技术对于癫痫患者合并肩关节前脱位具有良好的短期临床疗效,且复发后有再次愈合的可能。但更应注意癫痫患者的术后病情控制,尽可能防止癫痫再发作导致手术失败,肩关节复发脱位。     

微信结合情景模拟在有效沟通课程教学的应用

目的探讨微信结合情景模拟用于《有效沟通》课程教学的效果。方法整群抽取37名2016级护理本科生作为对照组,《有效沟通》课程采取情景模拟教学模式;38名2017级护理本科生作为研究组,采取微信结合情景模拟的课程教学模式。结果课程教学结束后,研究组和对照组沟通能力评分分别为86.66±8.29和69.35±8.98,差异有统计学意义(P0.01);研究组课程期末考试成绩显著高于对照组,对课程教学效果评价显著优于对照组(P0.05,P0.01)。结论微信线上互动与线下情景模拟相结合,有利于提高《有效沟通》课程的教学效果,提高护生沟通能力。