In recent years, progress has been made in general practice education research with the integration of narrative medicine and general practice. The narrative medicine is conducive to upgrading the abilities of general practice residents in doctor-patient communication, disease management and clinical decision makings; it also conducive to improvement of their humanistic quality and doctor-patient relationship. This article reviews the application of narrative medicine in the general practice residency training, and discusses relevant problems and countermeasures.

针对学校教育、教学改革中新启用的中医专业五年制本科教学大纲,西医内科学的学习从教学目的、教学科室的选择、实习教学的实施、教学效果的评价等方面均需重新制定方案,本文对实施过程及问题的解决进行了探讨。

Objective: To establish a visual three-dimensional model of human coronary artery and discuss the three-dimensional visual model of cardiovascular teaching in cardiology.Methods: Consecutive patients with normal and abnormal coronary artery cross-sectional images were selected,and computer software and RadioDexter software were used to reconstruct three-dimensional of the stereoscopic display and applied to the teaching of cardiovascular disease.Results: The normal and abnormal coronary artery visualization model has been reconstructed.The model can be arbitrarily scaled and rotated at any angle,and can display adjacent to the relations between different vessels and conformation,and three-dimensional measurement of the distance and angle.Good result has been received in the application of RadioDexter system in students' probation of cardiovascular disease teaching.Conclusion:Three-dimensional visualization of coronary vascular structure model can promote understanding and mastering coronary artery anatomy for students,and increase interest in learning more with the obstructive lesion.

目的:研究Dextroscope系统对乳腺浸润性导管癌的三维重建方法,探讨其临床应用价值.方法:对浸润性导管癌10例患者采用Dextroscope系统软件生成虚拟图像,从任意角度观察肿瘤与乳腺的解剖关系,确定保乳手术方案并进行模拟操作.10例均行乳腺癌保乳手术.结果:Dextroscope系统对乳腺浸润性导管癌的三维重建图像清晰,可以精确定位肿瘤.10例患者病理切缘均为阴性.术后病理大体标本与术前模拟图像测量数值,差异无统计学意义(P＞0.05).结论:通过Dextroscope系统,术者提前预演手术,为精确手术创造了条件,对乳腺癌保乳手术的实施有指导意义.

Dextroscope workstation is an advanced equipment developed in recent years and is used to make virtual reality model.We not only used it in surgical planning of thyroid disease,but also applied it in clinic teaching.Application of Dextroscope virtual reality system can help to improve students'capabilities of clinical thoughts and clinical techniques,stimulate their learning interest,enlarge the knowledge,shorten learning curve and release the conflict in practice.Dextroscope system will push forward the progress of education reform,so it is worth spreading.

By taking thoracic dropsy puncture as an example,this paper introduces the reconstruction of three-dimensional model by using RadioDexter system and its application in basic clinical skill teaching.The three-dimensional model can make up for the insufficiency of traditional teaching mode because of its realness and repeatability,help students master basic clinical skills,and stimulate their interest in making further exploration.

According to the clinical characteristics of breast diseases,we apply Dextroscope virtual reality system in clinical teaching of breast diseases.It can obviously improve the efficiency of education and relieve students' difficulty in finding practice opportunities.

The use of a volume-and pressure-limited mechanical ventilation strategy improves clinical outcomes of patients with acute lung injury and acute respiratory distress syndrome (ALI/ARDS). We reviewed the results of five randomized clinical trials of lung-protective mechanical ventilation strategies. Found mortality and Pplat are relative. We could adjust tide volume when inspiratory plateau pressures less than 30 cm H2O, We could not identify a safe upper limit for plateau pressures in patients with ALI/ARDS. There are some problems in RCT itself. Tide volume and plateau pressures are both important.

急性呼吸窘迫综合征(ARDS)常见病因为:全身严重感染、胃内容物误吸、肺挫伤、肺炎、溺水等.其中病因直接作用于肺的称为肺源性ARDS(ARDSp),如重症肺炎;病因间接作用于肺的称为肺外源性ARDS(ARDSexp),如重症坏死性胰腺炎等.