PBL＋EBM教学模式引入肝胆外科研究生临床培养阶段中的尝试与探讨

PBL教学模式与EBM的教学理念具有一致性,两者的基础都是从最初的问题开始进行延伸。通过总结PBL＋EBM教学模式在我院既往三届肝胆外科研究生临床培养阶段中的实施经验及具体措施,认为该教学模式对于研究生临床学习阶段具有可行性,在提高研究生临床思维考核、理论知识及基本操作方面优势明显,值得提倡与推广。     

Plexiform fibrohistiocytic tumour with novel phenotypic features

Plexiform fibrohistiocytic tumour is a recently described type of fibrohistiocytic tumour, the differentiation pattern of which is poorly understood. A case representing the predominantly fibrohistiocytic type of the tumour is reported. Immunohistochemical analysis supports the histiocytic origin of this entity. The expression of EBM/11 and tissue transglutaminase both in fibroblast-like and histiocyte-like cells indicate that a single cell line produces the dual morphological features. It is proposed that a non-phagocytic epithelioid pattern of histiocytic differentiation characterizes this tumour.     

Evidence-based resources and search strategies for orthopaedic surgeons

Identification of information on a specific topic of interest can be a difficult and time-consuming task. The key to successful and time-efficient article identification is to use easily accessible, complete, and most up-to-date information sources and to perform a focused search that minimises hits without missing relevant articles. Pre-appraised articles and databases allowing "pre-filtering" techniques for high level evidence are useful for a quick search for the best available evidence. For a more comprehensive review, a combination of MEDLINE, EMBASE and meeting abstract databases is usually more than sufficient. Full-text publications can be obtained from the Cochrane library and from OVID.     

中西医结合治疗单纯疱疹性角膜炎的循证医学分析

目的评价国内中西医结合治疗单纯疱疹性角膜炎的研究质量及其有效性。方法通过检索中国知网（CNKI），获得研究方案为随机对照试验（RCT），研究对象为中西医结合治疗单纯疱疹性角膜炎的论著，以循证医学方法对其进行分析。结果共检索到文献101篇，符合纳入标准的共29篇。对入选文献进行逐篇分析，内容包括随机方法、基线资料、纳入和排除标准、盲法、失访说明、统计学处理等。结论RCT论著研究质量不高，无法进行Meta分析。目前没有充分证据表明中西医结合是治疗单纯疱疹性角膜炎的最好方法。     

JPN Guidelines for the management of acute pancreatitis: cutting-edge information

The JPN Guidelines for the Management of Acute Pancreatitis are organized under the subject headings: epidemiology, diagnosis, management strategy, severity assessment and transfer criteria, management of gallstone pancreatitis, nonsurgical management, and surgical management. The Guidelines contain cutting-edge information on each of these subjects, as well as a section on the Japanese medical insurance system which provides information that should prove useful to physicians in other countries. The quality of the evidence was evaluated by the evidence-based classification method used at the Cochrane Library. The levels of recommendation of the individual management methods contained in the Guidelines were determined on the basis of the evaluation of evidence by the consensus of the members of the Working Group (see below). The Japanese Society for Abdominal Emergency Medicine, the Japan Pancreas Society, and the Research Group for Intractable Diseases and Refractory Pancreatic Diseases (which is sponsored by the Japanese Ministry of Health, Labour, and Welfare) were commissioned to produce the JPN Guidelines for the Management of Acute Pancreatitis. A Working Group of 20 physicians specializing in pancreatic diseases and emergency medicine investigated and analyzed 14821 cases retrieved by means of a Medline (1960–2004) search and discussed the available literature on acute pancreatitis (limited to human pancreatitis). The Working Group held many general discussions in order to reach a consensus on the content of the Guidelines. After producing a draft, the Publishing Committee of the JPN Guidelines for the Management of Acute Pancreatitis posted it on a website and asked for comments and criticisms. Subsequently, a final version of the Guidelines was published in Japanese in 2003. The Publishing Committee is now making the Guidelines available to a much wider readership by bringing out an English version.     

PBL结合循证医学培训体系在神经外科临床见习中的建立及探讨

神经外科是一门专业性较强的学科,在神经外科临床教学中,开展传统的以问题为基础的教学法结合循证医学教育模式,全方位加强对医学生循证医学思维培养,有助于学生在临床实践中学会应用循证医学思维和手段解决临床实际问题。     

循证医学模式在临床教学中的探索

目的：在临床教学中探索循证医学模式的作用。方法：对120名进入临床内科实习的临床医学专业本科学生开展循证医学教学模式的探索和实践。入选学生随机分为试验组和对照组,试验组采用以小组为单位的循证医学教学法,对照组采用传统教学方法。结果：试验组理论和临床技能考核成绩、病历书写、病案分析能力、“三基”掌握情况、学生及教师满意度均优于对照组,在临床教学改革中引入循证医学思维,在提高学生学习积极性和医学创造性方面具有重要性。     

Effect of Scanning Strategy on Thermal Stresses and Strains during Electron Beam Melting of Inconel 625: Experiment and Simulation

This paper develops a hybrid experimental/simulation method for the first time to assess the thermal stresses generated during electron beam melting (EBM) at high temperatures. The bending and rupture of trusses supporting Inconel 625 alloy panels at ~1050 °C are experimentally measured for various scanning strategies. The generated thermal stresses and strains are thereafter simulated using the Finite-Element Method (FEM). It is shown that the thermal stresses on the trusses may reach the material UTS without causing failure. Failure is only reached after the part experiences a certain magnitude of plastic strain (~0.33 ± 0.01 here). As the most influential factor, the plastic strain increases with the scanning length. In addition, it is shown that continuous scanning is necessary since the interrupted chessboard strategy induces cracking at the overlapping regions. Therefore, the associated thermal deformation is to be minimized using a proper layer rotation according to the part length. Although this is similar to the literature reported for selective laser melting (SLM), the effect of scanning pattern is found to differ, as no significant difference in thermal stresses/strains is observed between bidirectional and unidirectional patterns from EBM.     

Patellar tendon autograft versus hamstring tendon autograft in arthroscopic anterior cruciate ligament reconstruction: appraisal of the evidence

Arthroscopy–assisted reconstruction of a torn anterior cruciate ligament (ACL) is a commonly performed surgical procedure. The type of graft used for ACL reconstruction has traditionally been an autograft; the more commonly used grafts are the bonepatellar tendon–bone (BPTP) and hamstring tendons, namely the gracilis and semitendinosus tendons (GST). We surveyed the evidence concerning the outcome of patients treated by arthroscopic reconstruction of the ACL with either BPTP or GST. On basis of several welldesigned studes, specifically 5 meta–analyses and one systematic review, we critically discuss the best evidence available today regarding ACL reconstruction. This evidence suggests that BPTP may be considered for patients performing high–demand activities not involving repetitive kneeling.     

Software review

RagTime®: Computer Design for Poster Presentation. MacVonk, 1100,940 Sixth Avenue SW, Calgary, Alberta, T2P 3T1, Canada, Version 3.1 for Macintosh? Hex and higher, U.S. $599 (discount available), available in 12 European languages; versions available for Macintosh classic and other models; ancillary materials in this application—Radius II monochrome monitor with 32‐bit graphic board, LaserWriter II NT, Apple Macintosh flatbed scanner (300‐dpi resolution), AppleScan, and standard word processing, spreadsheet, and graphics software.