3D打印技术结合CBL教学模式在骨科临床教学中的应用

目的 以案例为基础的教学法(case-based learning,CBL)是一种以案例为导向提高学生学习效率的教学模式,3D打印技术作为新兴的科学技术越来越多的应用在现代医学应用之中。本研究为提高骨科的临床教学效率,故尝试采用3D打印技术集合CBL教学模式的新型教学方法,探究新型教学模式效果。 方法 选取蚌埠医学院2017级临床本科班二班的50名同学作为实验对象,并根据学号后2位数的奇偶性分为研究组(新教学法组)和对照组(传统教学法组),每组25名。新教学法组采用3D打印结合CBL教学模式进行临床教学,传统教学法组采用传统教学方式。在完成授课以后,进行统一的考核测试和评价量表调查,分析2组学生学习成绩分数及自我评定程度有无差异以评估新型教学模式的应用效果。 结果 在回收的50份有效问卷里,对照组理论平均成绩为(69.84±12.52)分、临床技能平均成绩为(68.96±12.65)分;研究组理论平均成绩为(83.16±10.46)分、临床技能平均成绩为(83.48±8.89)分。经过分析,采用新教学法学习的学生得分及其自我评定明显高于传统教学法组(均P<0.05)。 结论 相比传统的教学模式,3D打印技术结合CBL教学模式在骨科临床教学应用使抽象的知识具体化,增加了学生对骨科学习的兴趣,加深了学生对理论和实验知识的理解能力,提高了教学效率。      

过伸牵引弹性按压联合经皮椎弓根螺钉治疗单节段胸腰椎骨折疗效分析

目的：分析过伸牵引弹性按压联合经皮椎弓根螺钉与传统后路椎弓根螺钉内固定治疗单节段胸腰椎骨折的手术创伤与临床疗效。方法：回顾性分析46例胸腰椎骨折病人的资料,按照治疗方式不同分为过伸牵引弹性按压联合经皮置钉组(经皮置钉组)24例和传统切开组22例,观察指标包括：椎体前缘高度变化、Cobb角变化、切口长度、术中出血量、手术时间、术后住院时间及术前术后疼痛等级评分法(VAS)评分、术后日本骨科协会评估治疗分数(JOA)评分、Oswestry功能障碍指数(ODI)评分。结果：经皮置钉组病人与传统切开组病人相比,其切口长度、手术时间、术中出血量、术后住院时间均相对减少(P<0.05);2组病人术后的矢状面后凸Cobb角均较术前降低(P<0.05);伤椎椎体前缘高度较术前均升高(P<0.05);术后1周、6个月VAS评分较术前均降低(P<0.05)。但术后6个月,经皮置钉组VAS评分、ODI评分均较传统切开组低(P<0.05),术后JOA评分较传统切开组高(P<0.05)。结论：过伸牵引弹性按压联合经皮椎弓根螺钉内固定治疗胸腰椎骨折临床疗效肯定,具有创伤小、出血...     

Vasculogenic mimicry and aberrant expression of HIF-lα/E-cad are associated with worse prognosis of esophageal squamous cell carcinoma

This study aims to find good markers for predicting the prognosis of patients with esophageal squamous cell carcinoma (ESCC). Vasculogenic mimicry (VM) and the expression of hypoxia inducible factor-lα (HIF-lα)/E-cad protein in ESCC were investigated by immunostaining. The association between VM, HIF-lα/E-cad and clinicopathologic characteristics and 5-year-survival rate of patients with ESCC was analyzed. A total of 160 ESCC specimens were involved in this study and 28 specimens of normal esophageal mucosa served as controls. VM channels were identified in 78 (48.75%) of the 160 ESCC specimens and none of the normal esophageal mucosa was found to have VM. The rates of high-expression of HIF-lα and E-cad in ESCC were 43.75% and 38.75%, while the rates in control were 17.86% and 71.43%, respectively (P<0.05 for all). VM and the expression levels of HIF-lα and E-cad were significantly related to lymph node metastasis, serosa infiltration, PTNM staging and 5-year-survival rates of patients with ESCC (P<0.05 for all). VM was positively correlated with HIF-lα but negatively with E-cad, and HIF-lα was negatively correlated with E-cad (P<0.001 for all). The 5-year-survival rate of patients with ESCC was 6.41% (5/78) in VM group and 65% (52/82) in non-VM group, 7.14% (5/70) in high HIF-lα expression group and 57.78% (52/90) in low HIF-lα expression group. Oppositely, the 5-year-survival rate in high E-cad expression group was 80.65% (50/62) and that in low E-cad expression group was 7.37% (7/98) (P<0.05 for all). Cox multifactor regression analysis indicated that lymph node metastasis, PTNM stage, VM and expression levels of HIF-lα and E-cad were independent risk factors of patients with ESCC (P<0.05 for all). Combined detection of VM, HIF-lα and E-cad plays an important role in predicting the invasion, metastasis and prognosis of patients with ESCC.     

喉鳞状细胞癌中细胞周期蛋白E和p27异常表达的临床意义

目的：探讨喉鳞状细胞癌（LSCC）中细胞周期蛋白E（CyclinE）和p27蛋白的表达情况及其临床意义,旨在寻找影响LSCC患者预后的新指标。方法：采用免疫组织化学ElivisionTM法检测160例LSCC和20例正常喉黏膜组织（NLT）中CyclinE和p27的表达情况;统计分析CyclinE和p27蛋白之间及其二者与LSCC患者临床病理因素和总体生存期之间的关系。结果：LSCC组织中CyclinE和p27阳性率分别为62．50％（100／160）和41．25％（66／160）,NLT中CyclinE和p27阳性率分别为35％（7／20）和70％（14／20）（P〈0．05）;CyclinE和p27与LSCC患者淋巴结转移和PTNM分期有关（P〈0．05）,与年龄、性别及肿瘤直径、部位和分化程度无关（P〉0．05）;CyclinE和p27呈显著负相关,r=-0．767（P％0．05）;Cox多因素分析显示淋巴结转移、PTNM分期、CyclinE和p27是影响LSCC患者预后的独立危险因素。Kaplan-Meier生存分析显示LSCC患者的总体生存率为36．9％（P〈0．05）;CyclinE阳性组患者5年生存率为8％,阴性组为80％（P〈O．05）;而p27蛋白阳性组患者5年生存率为77．27％,阴性组为5．32％（P〈O．05）。结论：CyclinE基因的激活同时伴有p27基因的失活可能是LSCC发生发展和侵袭转移的分子基础,联合检测CyclinE和p27对判断LSCC患者预后有重要意义。     

电子病案应用对教学医院的影响

本文以电子病案及教学医院为切入点,以医学生及医护人员为中心,探讨教学医院实施电子病案的必要性、现状及对医学生及医患双方的优点及不足。提出在教学医院实施电子病案应以双轨制为过渡态,最终完全实施电子病案,这样有利于提高医学生及医护人员的规范化意识,提高教学医院的教学质量,更好地为医学院校及社会各方服务。