Objective Through the analysis of medical data, this paper compares the change of treatment ability between the independent routine mode and the managed together special mode of emergency department and department of infectious diseases of a Grade three A hospital in Beijing, so as to provide a scientific basis for integrating and optimizing medical resources when similar major infectious disease outbreaks occur again, resulting in the imbalance of medical resources.Methods The total reception volume, total infusion volume, and severe patients volume of three periods were collected from the information system. The combined group was the medical data of the emergency department and infectious disease department receiving patients with novel coronavirus in the peak period of 2022-12-20 to 2023-1-18 for a total of 30 days, and the opening period of emergency department and infectious disease department in the previous year was the same group. And the medical data in the first 30 days of the same year were in the sequential group for statistical analysis.Results There were statistically significant differences in the total number of consultations, total infusion volume and severe patients volume between the emergency department and the department of infectious diseases compared to the same period last year（P＜ 0.05）.Conclusions In the case of the imbalance between the supply and demand of medical resources in the early stage of the outbreak of the novel coronavirus, the overall arrangement of the emergency and infectious diseases departments in manpower and regions and the combination of opening medical services can optimize the medical resources and improve the reception capacity.

目的 对三种急危症24小时诊疗数据与临床路径标准进行对比,分析实际诊疗与路径标准的差异,探讨临床路径合理性及实用可行性仍存在的问题.方法 收集、统计解放军总医院第一医学中心急诊科2020年1月到2020年12月全年救治的符合纳入标准的320例急性消化道出血、134例急性心肌梗死和117例脑出血患者急诊24小时内的实际诊疗数据,根据疾病诊疗指南,与相关临床路径标准进行对比,查找实际诊疗数据与临床路径标准之间的差异,分析差异出现的原因,并提出优化建议.结果 三种急危症的临床路径标准检查实际应用比率分别为:急性消化道出血与脑出血均为100％,急性心肌梗死为82.35％.符合率50％以上的检查项目在三种急危症的构成比分别为:急性消化道出血84.62％,急性心肌梗死47.06％,脑出血71.43％.超出路径标准的检查分别为:急性消化道出血9项,急性心肌梗死7项,脑出血4项.实际治疗与路径标准基本相符.结论 三种急危症诊疗状况与现行临床路径标准基本符合,但仍存在未能按临床路径标准规范实施和超标准诊疗的情况,应在实际应用中不断规范和优化急危症临床路径标准.

目的 探讨影响急诊患者长时间滞留的因素,启示解决急诊拥挤问题.方法 回顾性分析2019年1月5日—4月5日在解放军总医院海南医院急诊科抢救间留观患者的资料,计算患者急诊滞留时间,序贯器官功能衰竭评分(SOFA),查尔森合并症指数(CWIC),并分析相关因素对于急诊滞留时间的影响.结果 3个月时间内,共有798名患者在急诊抢救间滞留,外地患者(候鸟患者)占82.6％,133例(16.7％)在急诊滞留超过3 d时间.心血管疾病(149例(18.7％)、呼吸134例(16.8％)、消化116例(14.5％)以及神经内科107例(13.4％)等是急诊就诊的主要疾病类型.与海南本地相比,外地患者年龄偏大,基础疾病更多,呼吸道疾病患者更多.所有患者在急诊平均滞留时间为41.1(75.6)h,与年龄,基础疾病和SOFA评分明显相关(r=0.163,P<0.001;r=0.192,P<0.001;r=0.200,P<0.001).呼吸、消化、神经内科等内科疾病患者在留观时间较长,需要急诊PCI手术者能够很快收入院.COX生存分析提示,CWIC评分、SOFA评分以及呼吸、PCI和神经内科疾病是影响患者滞留时间长短的独立因素.结论 候鸟人群是急诊滞留患者的主要来源,年龄大,基础疾病多,病情重的患者滞留急诊时间长,尤其是因呼吸、神经内科等疾病就诊的患者容易长时间滞留急诊抢救间.

目的 探讨损伤控制式急救模式结合全面干预在海水淹溺伤伴吸入性肺损伤患者急救中的应用效果.方法 选取2008年1月至2020年12月由北戴河康复疗养中心收治的130例海水淹溺伤伴吸入性肺损伤患者作为研究对象进行研究,按照急救和护理干预方法的不同将其分为对照组和研究组,每组65例.对照组患者给予传统急救方法及常规护理干预,研究组患者则给予损伤控制式急救模式联合全面护理干预.比较两组患者的急救效果、生活质量评分和护理服务满意度等指标.结果 ①研究组患者急救成功率显著高于对照组,肺部并发症发生率显著低于对照组,住院时间显著短于对照组,急性肺损伤评分显著低于对照组,比较差异均有统计学意义(P＜0.05).②干预后两组患者血气分析动脉血氧分压[p(O2)]较干预前明显升高,动脉血二氧化碳分压[p(CO2)]较干预前明显降低,且研究组与对照组比较差异有统计学意义(P＜0.05).③研究组患者及家属对整体救治水平和护理干预满意度较对照组显著升高,比较差异有统计学意义(P＜0.05).④干预后两组患者圣乔治呼吸问卷(SGRQ)各维度评分及总评分较干预前均显著降低,且干预后研究组患者的评分均显著低于对照组(P＜0.05).结论 损伤控制式急救模式结合全面干预能提高海水淹溺伤伴吸入性肺损伤患者急救成功率,降低肺部并发症发生率,改善患者血气状况,缩短住院时间,改善其预后和生活质量,同时提升患者对护理质量的满意度.

目的 研究不同靶目标低温治疗对心肺复苏后大鼠循环功能及预后的影响.方法 选取健康成年雄性清洁级SD大鼠44只,电刺激诱导大鼠室颤8 min后开始心肺复苏,复苏8 min后给予电除颤.共有28只大鼠心肺复苏成功,恢复自主循环后,将大鼠随机分入4组:37℃常温组、35℃低温组、33℃低温组及28℃低温组,每组7只.立即采用物理降温方式降温至靶目标温度,低温治疗4 h后开始复温至(37.0±0.2)℃,继续观察72 h.低温治疗期间及复温后监测心肺复苏大鼠平均主动脉压(MAP)、心率、射血分数(EF),颊黏膜微循环血流(MBF)、血乳酸(Lac)、生存时间、生存率及神经系统缺陷评分(NDS)等指标并进行组间比较.结果 在复苏过程中,大鼠冠脉灌注压、电除颤次数、室颤-自主循环恢复时间差异均无统计学意义(P>0.05).低温治疗期间,28℃组大鼠心率最低,37℃组心率最高;低温组MAP及EF值高于常温组,其中33℃组及28℃组EF值(％)明显高于35℃组(63.8±6.1,67.8±8.4 vs.54.0±5.2,P<0.05];33℃组及35℃组Lac值明显低于37℃组及28℃组(P<0.05);低温组MBF值低于常温组,3个低温组间MBF值差异无统计学意义(P>0.05).复温后,35℃组大鼠EF值(％)明显高于其他组(52.9±3.3 vs.46.9±6.2,38.5±7.5,35.8±7.3,P<0.05);33℃组及35℃组MBF值与28℃组比较明显恢复(2.8±0.4,2.4±0.5 vs.1.6±0.6,P<0.05),33℃组与35℃组MBF值无明显差异(P>0.05).35℃组及33℃组生存时间、生存率、NDS评分明显优于37℃组及28℃组(P<0.05),35℃组与33℃组比较差异无统计学意义(P>0.05).结论 靶目标温度为33℃及35℃的低温治疗可以保护心肺复苏后大鼠循环功能,减轻神经功能损伤,改善预后.35℃低温治疗可能是临床心跳骤停患者复苏后治疗的一个新选择.

Background:Huangkui capsule (HKC) comprises the total flavonoid extract of flowers of Abelmoschus manihot (L.) Medicus. This study aimed to explore the effects of HKC on lipopolysaccharide- (LPS-) induced acute lung injury (ALI) in mice and LPS-stimulated RAW 264.7 cells.Methods:Enzyme-linked immunosorbent assay, histopathology, spectrophotometry, and quantitative real-time polymerase chain reaction were used for the assessments. Statistical analysis was performed using a one-way analysis of variance.Results:LPS significantly increased lung inflammation, neutrophil infiltration, and oxidative stress and downregulated lung miR-451 expression. Treatment with HKC dramatically, reduced the total cell count in the bronchoalveolar lavage fluid (BALF), and inhibited myeloperoxidase activity in the lung tissues 24 h after LPS challenge. Histopathological analysis demonstrated that HKC attenuated LPS-induced tissue oedema and neutrophil infiltration in the lung tissues. Additionally, the concentrations of tumour necrosis factor- (TNF-) α and interleukin- (IL-) 6 in BALF and IL-6 in the plasma reduced after HKC administration. Moreover, HKC could enhance glutathione peroxidase and catalase activities and upregulate the expression of miR-451 in the lung tissues. In vitro experiments revealed that HKC inhibited the production of nitric oxide, TNF-α, and IL-6 in LPS-induced RAW 264.7 cells and mouse primary peritoneal macrophages. Additionally, HKC downregulated LPS-induced transcription of TNF-α and IL-6 in RAW 264.7 cells.Conclusions:These findings suggest that HKC has anti-inflammatory and antioxidative effects that may protect mice against LPS-induced ALI and macrophage activation.

目的 分析新型冠状病毒肺炎防控期间发热门诊留观重症患者的临床特点,提高发热门诊重症患者的诊治水平.方法 采用回顾性病例分析方法,采集2020年2-3月在解放军总医院第一医学中心发热门诊重症区收治的80例患者的临床资料,所有患者间隔24 h采集咽拭子标本行2次新型冠状病毒核酸检测.同时行甲、乙型流感病毒核酸联合测定,肺部计算机断层扫描(CT)检查.比较不同血白细胞计数组别患者的临床数据差异.结果 所有患者新型冠状病毒核酸检测结果均为阴性,2例患者甲流病毒核酸检测为阳性.1例患者乙流病毒核酸检测为阳性.年龄>65岁患者有60例(75.00％),存在两种以上的基础性内科疾病患者47例(58.75％),肺部CT提示存在病变的患者70例(87.50％),出现急性肾损伤的患者30例(37.50％),与白细胞计数<10×109/L组的患者比较,白细胞计数≥10×109/L组的患者糖尿病比例升高(P=0.024),两组患者筛查留观时间、体温、氧合指数、急性肾损伤发生率差异无统计学意义.结论 医院发热门诊的重症患者年龄大、基础疾病多、肺部普遍存在病变、留观筛查期间容易出现急性肾损伤,核酸检测是新型冠状病毒感染筛查最重要的鉴别诊断依据.

目的 通过文献分析,对近二十年来国内外地震医学救援相关研究趋势、热点进行总结.方法 选取科学网(Web of Science)为数据来源,对2000—2019年全球发表的地震医学救援相关的研究论文进行分析,利用CiteSpace可视化分析软件从整体发文趋势、国家分布、机构分布、高被引文献等方面进行文献计量学分析.结果 2000—2019年Web of Science收录相关研究文献共962篇,全球发文量整体呈现上升趋势,排名前3的分别为美国(258篇)、日本(251篇)、中国(149篇),排名前10的发文机构中,日本有4个,美国和中国各2个.高被引排名前10的文献主要集中在灾害应急预案、应急管理方向的研究.地震医学救援研究领域关键文献主要为各大型地震救援实践中的医学分析报告及经验总结,近年来主要研究内容集中在灾害预案、灾害医学、尼泊尔地震及心理方向.结论 国际地震医学救援研究主要受重大地震灾害事件牵引,涉及多学科交叉发展.中国地震医学救援研究与国际同类研究相比尚存在较大差距.

患者为老年女性,以发热21天为主诉就诊,外院尿培养提示泌尿系统感染,既往糖尿病病史,规律服用二甲双胍,入院后给予抗感染及对症治疗,但来诊后血气分析提示持续高乳酸血症,给予停用二甲双胍及行血液滤过治疗,但乳酸无明显下降.结合患者全身浅表淋巴结肿大,给予腹股沟淋巴结切除,病理提示弥漫性大B细胞淋巴瘤,给予骨髓穿刺提示淋巴瘤骨髓受累可能.通过此例病例分析,对于发热、持续高乳酸血症、全身淋巴结肿大的可能原因进行诊疗鉴别,最后明确诊断,并进行相关文献复习.

目的 通过调查重症监护室(ICU)一起疑似泛耐药鲍氏不动杆菌(PDR-AB)感染暴发的情况,研究泛耐药鲍氏不动杆菌医院感染防控的集束化策略,指导医院感染防控措施实施.方法 通过分子流行病学分析与环境卫生学监测相结合的方法,对2018年2月-2018年4月ICU住院患者鲍氏不动杆菌分离与感染情况展开调查,对疑似污染的环境与物品进行微生物学采样、鉴定和药敏试验.患者和环境中PDR-AB克隆菌株采用脉冲场凝胶电泳(Pulsed Field Gel Electrophoresis,PFGE)技术进行同源性分析.结果 2018年3月ICU PDR-AB院内定植或感染患者7例,患者新发感染率10.14％;PDR-AB定植或感染患者的头部垫巾,病床床尾板、床栏,护士站台面及医务人员护理服和清洗消毒后的纤支镜中分离出PDR-AB存在;ICU患者与环境分离的27株PDR-AB耐药谱基本一致;PFGE结果显示患者、环境、纤支镜PDR-AB克隆菌株来自于同一亚型.结论 PDR-AB克隆菌株在患者、环境及纤支镜之间具有高度同源性的克隆传播,通过强化医务人员无菌观念,患者隔离,环境及医疗器械的严格清洁消毒,暴发流行情况得到有效控制.

Background: We describe a case of Guillain-Barre syndrome (GBS) associated with hemorrhagic fever with renal syndrome. To our knowledge, only five cases of GBS associated with Hantavirus infection have been reported so far. Case presentations: A 62-year-old man presented intermittent fever, chill and oliguria. According to remarkable leukocytosis, atypical lymphocytes, thrombocytopenia and former dwelling in hemorrhagic fever-endemic area, he was suspected as hemorrhagic fever with renal syndromeand certified with positive Hantavirus IgG. Later, the patient had symmetrical flaccid paralysis of all extremities. Electromyography showed peripheral nerve injury (mainly in axon). The patient was diagnosed as having acute motor sensory axonal neuropathy (AMSAN). After immunoglobulin infusion, patient showed progressive recovery and was transferred 3 weeks after his first admission to a rehabilitation center. Conclusions: Our case was the 6th reported case of GBS associated with hemorrhagic fever with renal syndrome. Moreover, we for the first time classified the subtype of GBS (AMSAN) based on the electrophysiology characteristics. GBS should be suspected in patients who are already diagnosed as hemorrhagic fever with renal syndrome when delayed symmetrical limb paralysis occurs. Until recent now, GBS was only reported in hemorrhagic fever patients in Europe and Asia, which termed as hemorrhagic fever with renal syndrome.

The number of retracted articles with Chinese authors has raised much attention, but no systematic study has specifically explored the retraction of academic publications by researchers from mainland China. Here, we determined the characteristics of retracted publications from mainland China in the biomedical literature. We searched the Medline database through PubMed and Web of Science to identify retracted publications with first authors from mainland China. Data for 825 retracted studies were included in the analysis. The number and rate of retractions have increased since 1999. We found that 651 retractions were for articles published in journals with relatively low impact factors (< 5). Commonest reasons for retraction were plagiarism (192), errors (159), duplicate publication (143), and invalid peer review (137). Authors of retracted articles were from 28 of the 31 provinces in mainland China. The number of retracted articles from mainland China has shown an increasing trend. Misconduct was the primary reason for retraction. Retracted articles originated from most provinces in China and were published in numerous journals. These findings indicate that misconduct issues are widespread in China. Results of this study highlight the need to take measures to prevent misconduct among Chinese researchers.

Objective: Observe the effect of anisodamine on functions of myocardial and brain tissues of rats suffering from cardiac arrest. Methods: The cardiac arrest model of rats were induced by alternating current (AC) via pacing electrode placed in esophagus. Five minutes after onset of cardiac arrest, cardiopulmonary resuscitation (CPR) was initiated. A total of 65 SD rats were randomly divided into five groups as follows: physical group (n = 5), physiological saline group (n = 15), epinephrine (Epi) group (n = 15), anisodamine (Ani) group (n = 15), anisodamine and epinephrine combination group (n = 15). We injected 0.6 mL FDG before the stimulation. Medicine was given in blind way. The hearts and brain of the rats were removed for radiocounting, and the plasma A-type natriuretic peptide (ANP), and the rate of restored of self circulation (ROSC) and success resuscitation were also detected. Results: The success rate of resuscitation in Ani and Epi combination group was 70%, that was higher than other groups, the difference was significant statistically (P < 0.01). The myocardium and the cerebrum radiocounting of the Epi recovery group were lower than those of the Ani and Epi combination recovery group, which of the myocardium were (25.71 ± 2.83 vs 38.3 ± 7.2, P < 0.05) and the cerebrum were (16.06 ± 2.93 vs 31.02 ± 2.72, P < 0.05), respectively. The plasma ANP level of the recovery in the Ani and Epi combination group and the Ani group were lower than that of the Epi group (P < 0.05), but all of these groups were higher than that of the physical group, the difference was significant statistically (P < 0.05). Conclusion: The early recovery of anisodamine combined with epinephrine may improve the success rate of resuscitation, improve the metabolism of myocardium and brain tissue, and has protective effects on cardiopulmonary resuscitation in rats.

目的 探讨慢性心力衰竭(CHF)患者血清糖类抗原 125(CA125)与脑钠尿肽(BNP)水平、左室射血分数(LVEF)、左室舒张末内径(LVEDd)、左心房内径(LA)的相关性.方法 选取CHF 患者110例,按照心功能状态分为Ⅰ/Ⅱ、Ⅲ、Ⅳ级三组.随机抽取心功能正常的心血管病患者为对照组,对比各组间血清CA125、BNP水平及LVEF、LVEDd、LA变化,分析CA125与BNP、LVEF、LVEDd及LA的相关性.结果 与对照组相比,CHF患者血清CA125、BNP明显升高(P均<0.05).Ⅰ/Ⅱ、Ⅲ、Ⅳ级组两两对比,血清CA125、BNP水平差异有统计学意义(P均<0.05).Ⅰ/Ⅱ、Ⅲ、Ⅳ级组LVEDd、LA随心衰等级增高而增高,LVEF随心衰等级增高而降低,且差异具有统计学意义(P均<0.05).Pearson直线相关分析结果显示,CA125与BNP、LA、LVEDd呈正相关(r分别为0.636、0.279、0.320,P均<0.05),与LVEF呈负相关(r=-0.65,P<0.05).结论 CHF患者血清CA125水平与BNP水平及心功能相关,联合检测血清CA125、BNP水平对CHF患者的预后判断价值更大.

Objective To investigate the clinical value of early lactate clearance in predicting prognosis of patients with acute upper gastrointestinal bleeding (UIGB).Methods One hundred and sixty-eight patients with UIGB admitted to the emergency department of Chinese PLA General Hospital from January to May in 2016 were enrolled in this study.The patients' demographic data,including past history,drug history,vital signs on admission and laboratory test and early lactate clearance were analyzed.All patients were followed up for 3 months,and the relationships between early lactate clearance with mortality and re-bleeding were assessed using univariate and multivariate analysis.Results Mortality and re-bleeding rates of 168 patients were 23.2％ and 34.5％,respectively.Univariate analysis found that early lactate clearance of patients within 3 months death was significantly lower than that of survival patients (13％ vs 28％,P ＜ 0.01).During follow-up period,early lactate clearance of re-bleeding patients was significantly lower than that of non-bleeding patients (12％ vs 28％,P ＜ 0.01).Early lactate clearance was explored to be an independent risk factor of patients' survival (OR:0.15;95％ CI:0.04-0.51;P ＜ 0.01) and re-bleeding (OR:0.26;95％ CI:0.08-1.04;P ＜ 0.01) by multivariate logistic regression.Conclusion Lactate clearance may be associated with prognosis in critically ill patients with UGIB,and it can be used as a predicting indicator for mortality and recurrent bleeding.

Background: The purpose of this study was to comprehensively evaluate the role of PCT (procalcitonin) in diagnosis and prognosis of community acquired pneumonia (CAP) by a meta-analysis. Methods: Two researchers independently performed a retrieve on the databases of PubMed, Embase and Cochrane published in English up to July 2015. The search strategy was("community acquired pneumonia" OR CAP) AND procalcitonin. The risk ratio (RR) with 95% CI (confidence interval) was used for the analysis of dichotomous data. Standardized mean differences (SMD) and 95% CI were used to perform the analysis for continuous outcomes. All statistical analyses were performed by using RevMan (Review Manager) 5.3 software and Stata 12.0 statistical software package. Heterogeneity was analyzed with the Cochran Q test and I-2 test. Stata 12.0 was used to perform sensitivity analysis. Results: A total of 15 studies (6401 adult patients diagnosed with CAP) were selected in this meta-analysis. The number of patient mortality in PCT >= 0.5 ng/ml was twice that of PCT<0.5 ng/ml (RR = 0.50 (95% CI: 0.40, 0.62)). The number of patients that pathogen could be detected was 1.31 times that of could not be detected (RR = 1.31 (95% CI: 1.11, 1.55)). PCT levels of death cases were significantly higher than those of survival cases (SMD = -0.31 (95% CI: -0.50, -0.13)). The sensitivity analysis showed that this meta-analysis result was stable. Conclusions: Serum PCT levels are significantly related with detection of CAP pathogen and severity of CAP cases.

Background This study aimed to identify the potential key long non-coding RNAs (lncRNAs) and target genes associated with pneumonia using lncRNA sequencing (lncRNA-seq). Material/Methods A total of 9 peripheral blood samples from patients with mild pneumonia (n=3) and severe pneumonia (n=3), as well as volunteers without pneumonia (n=3), were received for lncRNA-seq. Based on the sequencing data, differentially expressed lncRNAs (DE-lncRNAs) were identified by the limma package. After the functional enrichment analysis, target genes of DE-lncRNAs were predicted, and the regulatory network was constructed. Results In total, 99 DE-lncRNAs (14 upregulated and 85 downregulated ones) were identified in the mild pneumonia group and 85 (72 upregulated and 13 downregulated ones) in the severe pneumonia group, compared with the control group. Among these DE-lncRNAs, 9 lncRNAs were upregulated in both the mild and severe pneumonia groups. A set of 868 genes were predicted to be targeted by these 9 DE-lncRNAs. In the network, RP11-248E9.5 and RP11-456D7.1 targeted the majority of genes. RP11-248E9.5 regulated several genes together with CTD-2300H10.2, such as QRFP and EPS8. Both upregulated RP11-456D7.1 and RP11-96C23.9 regulated several genes, such as PDK2. RP11-456D7.1 also positively regulated CCL21. Conclusions These novel lncRNAs and their target genes may be closely associated with the progression of pneumonia.

Objective To assess medical emergency in elderly patients by using the modified early warning score (MEWS)and the national early warning score(NEWS)and compare their application values in order to find out which scoring method is more suitable for elderly patients. Methods We enrolled 361 elderly patients(≥60 years old)who were admitted by the Department of Emergency,Chinese PLA General Hospital from October 2013 to March 2014. According to the emergency outcomes,the subjects were divided into general ward group and intensive care unit group;according to the conditions on day 30,the subjects were also divided into death group and survival group. NEWS and MEWS assessments were employed on the subjects. ROC curves were also used to compare the two scoring methods in predicting emergency outcomes and prognosis. Results The general ward group consisted of 239 patients and the intensive care unit group consisted of 122 patients. The intensive care unit group was higher(P < 0. 01)than the general ward group in NEWS,MEWS,respiratory rate and heart rate and was lower( P < 0. 01) in oxyhemoglobin saturation. The areas under ROC curves of NEWS and MEWS that predicted emergency outcomes were(0. 970 ± 0. 011)and(0. 831 ± 0. 025)respectively,with significant difference(Z = 6. 950,P <0. 010)between them. 30 days later,323 subjects who survived were assigned into the survival group and 38 subjects who died were assigned into the death group. The death group was higher( P < 0. 05) than the survival group in NEWS,MEWS,&nbsp;respiratory rate and heart rate and was lower(P < 0. 05) in oxyhemoglobin saturation. ROC curves of NEWS and MEWS that predicted the 30 d prognosis were(0. 861 ± 0. 039) and(0. 789 ± 0. 045) respectively,with significant difference( Z =2. 250,P = 0. 023) between them. Conclusion The NEWS is more accurate and effective in assessing the respiratory and heart rate conditions in elderly patients and is more suitable for the condition assessment of elderly patients with emergent and critical illness.

网络教学是运用计算机、网络、多媒体等技术手段实施的一种全新的、开放式的教学手段.与传统教学模式相比,网络教学打破了时间和空间的限制,营造出开放式的教学环境,改变了老师授课方式及在教学中的绝对支配地位,提高了学生学习的自由性和主动性.随着信息化技术的迅猛发展,网络教学是实现教育国际化、现代化、社会化和终身化的一种创新教学模式,是信息时代下医学教育发展的新趋势.