以框架为基础的教学／自学模式实施效果的初步评估

北京协和医学院医学微生物教学中,采用以框架为基础的教学／自学模式,82名学生参与其中。本文对以框架为基础的教学／自学模式在微生物学教学中的实施效果进行了评估,主要从8个方面评估了学生组织自学后的自我展示情况,同时学生也从10个方面对该教学／自学模式的实施效果进行了匿名评估。结果显示,学生自我展示情况各项得分（满分为5分）为（4．30±0．33）分～（4．66±0．21）分;学生匿名评估的各项得分（满分为4分）为（3．13±0．75）分～（2．33±0．79）分。实践证明,学生在以框架为基础的自学训练中表现良好,大部分学生对此教学／自学模式持正面和积极的看法,此教学／自学模式比较适用于现阶段本学院的医学微生物学教学。     

改良翼点入路治疗颅底脑挫伤及血肿78例分析

目的:总结改良翼点入路治疗颅底脑挫伤及血肿的方法及经验。方法:运用改良翼点入路对78例颅脑损伤患者进行手术治疗。结果:本组67例术后存活,病死率14.1%,骨瓣回植率65%。结论:该入路暴露彻底,减压充分,便于手术操作和减轻术后脑肿胀,病死率低。     

Acid–base physiology: new concepts

The traditional approach to acid–base physiology is based on the Henderson–Hasselbalch equation which is derived from the ${\text{CO}}_2/{{\text{HCO}}_3}^{?}$ buffer system. However, it is becoming increasingly recognized that this is an incomplete analysis as it focuses on only one of the six reactions involving H⁺ and can lead to the incorrect assumption that CO₂ and ${{\text{HCO}}_3}^{?}$ are independently adjusted factors that ultimately determine pH. In 1983, Stewart, a Canadian physiologist, proposed that a fuller understanding of acid–base physiology required consideration of biological fluids as a complex dynamic system, taking into account the interactions of all the chemical species involved. He showed that the true independent variables controlling the pH of any given fluid compartment are: the difference in the concentration of ‘strong ions’; the total concentration of ‘weak acid’; and the PCO₂. Importantly, H⁺ and ${{\text{HCO}}_3}^{?}$ are dependent variables and it is incorrect to think of them as being specifically regulated to manipulate pH. This review will discuss the importance of pH homeostasis and highlight the implications of the Stewart approach in our understanding of acid–base control mechanisms and disorders. In particular, the true mechanisms by which the kidney regulates plasma pH will be discussed, emphasizing key misconceptions that have been propagated as a result of the traditional approach.     

Combining a digital design-mediated surgery-first approach and clear aligners to treat a skeletal Class III defect for aesthetic purposes: a case report

This case report introduces digital surgery-first approach orthognathic surgery assisted by three-dimensional virtual planning and combined with invisible orthodontic treatment for a 21-year-old female patient with a skeletal Class III high-angle gummy smile malocclusion. We explored the clinical significance of the widespread application of digital technology for rapid development of the orthodontic/orthognathic field. The regional acceleratory phenomenon and clear aligners were used to achieve fast and aesthetic tooth movement after surgery. The treatment lasted only 8 months, and the patient was satisfied with the aesthetic results. The results remained stable after 1 year of follow-up. This case report highlights the advantages of combining a digital design and a surgery-first approach to produce accurate, rapid, safe, stable, and fulfilling cosmetic results. The combination of the surgery-first approach and clear aligners can facilitate patient-oriented surgical orthodontic treatment.     

经不同手术径路治疗胸中下段食管鳞癌的比较研究

目的比较经左胸与右胸手术径路治疗胸中下段食管鳞癌的疗效,探讨合理的胸中下段食管鳞癌手术径路。方法回顾性分析2004年1月到2007年12月间上海交通大学附属胸科医院行手术治疗的120例食管中下段鳞癌患者的临床资料．其中左胸径路和右胸径路各60例．比较两组患者手术切除率、淋巴结清扫情况、术后并发症发生率、复发情况以及生存率。结果左胸径路组和右胸径路组患者手术切除率分别为91．7％（55／60）和95．0％（57／60）,差异无统计学意义（P〉0.05）。左胸径路组平均每例淋巴结清扫数和转移淋巴结数分别为4．60枚和0．57枚,显著低于右胸径路组的8．32枚和1．33枚（均P〈0.01）。两组术后并发症发生率分别为26．7％（16／60）和31．7％（19／60）,差异无统计学意义（P〉0.05）。两组术后局部复发率分别为43．3％（26／60）和23．3％（14／60）．差异有统计学意义（P〈0.05）：但远处转移率的差异无统计学意义[68.3％（41／60）比56．7％（34／60）,P〉0.05]。左胸径路组术后5年生存率为21．7％,明显低于右胸径路组（36．7％,P〈0.05）。结论右胸径路与左胸径路对胸中下段食管鳞癌的手术切除率相似．但右胸径路更易于进行系统性的纵隔淋巴结清扫．有助于减少局部复发、提高长期生存。     

Natural orifice transluminal endoscopic surgery: The transvaginal route moving forward from cholecystectomy

The advent of minimally invasive surgery and the advances in endoluminal flexible endoscopy have converged to generate a new concept in digestive surgery, whose acronym natural orifice transluminal endoscopic surgery (NOTES), has become a familiar term in the surgical community. NOTES has been performed through the mouth, the bladder, the rectum and the vagina. Of these four approaches, the vagina has gained most popularity for several reasons. It is not only readily accessible and easy to decontaminate but it also provides safe entry and simple closure. The transvaginal approach has been described in the experimental and the clinical setting as an option for cholecystectomy, nephrectomy, splenectomy, segmental gastrectomy, retroperitoneal exploration and bariatric surgery. However, larger series are needed to delineate the exact risks of this approach, and to transcend cultural barriers that impede its wider introduction. Prospective randomized trials will shed light on the definitive role of the vaginal approach in minimal invasive surgery of the future.     

应用循证医学探讨福利院中老年骨折的特点

目的：应用循证医学探讨福利院中老年骨折的特点（原因、好发部位、骨折时骨骼的状态）。方法：在循证医学指导下对福利院369名老年人中3年间发生骨折的病人进行X线摄片和骨密度、骨生化代谢指标测定。结果：369人中有73人骨折，其中50人患中度以上骨质疏松症；骨生化测定仅骨钙素与骨密度呈正相关；骨折常见于髋、腕和脊柱等部位。结论：骨质疏松为老年骨折的主要原因，骨密度下降提示骨折的可能性增高；髋、腕和脊柱是老年骨折好发部位。     

An Agent Based Model for Simulating the Spread of Sexually Transmitted Infections

This work uses agent-based modelling (ABM) to simulate sexually transmitted infection (STIs) spread within a population of 1000 agents over a 10-year period, as a preliminary investigation of the suitability of ABM methodology to simulate STI spread. The work contrasts compartmentalized mathematical models that fail to account for individual agents, and ABMs commonly applied to simulate the spread of respiratory infections. The model was developed in C++ using the Boost 1.47.0 libraries for the normal distribution and OpenGL for visualization. Sixteen agent parameters interact individually and in combination to govern agent profiles and behaviours relative to infection probabilities. The simulation results provide qualitative comparisons of STI mitigation strategies, including the impact of condom use, promiscuity, the form of the friend network, and mandatory STI testing. Individual and population-wide impacts were explored, with individual risk being impacted much more dramatically by population-level behaviour changes as compared to individual behaviour changes.