目的 推动3D打印技术在医药学高等教育中的应用.方法 总结3D打印技术发展现状及其应用于医药学教育的优势.结果与结论 3D打印技术的飞速发展拓宽了医学和药学研究的领域,促进了其发展和进步.结合3D打印技术的医学高等教育模式是对传统模式的创新和发展,可提升学生学习的积极性和效果,未来随着技术的发展和教学方法的改进,由3D打印技术创建的教学环境将更逼真及个体化,学生将更易理解和掌握相关知识.但仍存在许多挑战和问题,还需建立全面的伦理体系以保证其合规性.

文章结合卫生连卫勤演练的经历,深入探讨卫生连卫勤演练模式.对比以前卫生队卫勤演练情况,分析卫生连演练中面临的问题,并结合未来战争卫勤保障需求,提出实战化训练的方法 与思路.

Objective To analyze the imaging features of cardiogenic pulmonary congestion and pulmonary edema for more reliable clinical diagnosis.Methods One hundred patients with cardiogenic pulmonary congestion and pulmonary edema admitted to our hospital were enrolled in this study and their imaging features were retrospectively analyzed.Results From the images,cardiac enlargement was found in 96cases (96.0％),pulmonary blood bypass in 40 cases (40.0％),pulmonary congestion in 44 cases (44.0％),and interstitial pulmonary edema in 53 cases (53.0％),including bronchial sleeve sign in 22 cases (22.0％)and Kelery B,A,and C line in 31 cases (31.0％),which were shown as thickening and blurring of the pulmonary texture and the portopulmonary blood vessels,occurrence of pulmonary interlobular septum line and subpleura line,thickening and increasing of bronchial vascular bundles,occurrence of bronchial sleeve sign,and thickening of the interlobular septum in a smooth type.Alveolar edema occurred in 40 cases (40.0％),showing as gradually increasing density of thin gauzes and cloud-like or cloud-white flake exudation.The typical manifestation was increased pterygoid density centering on the hilar of the lungs.Among them,19 cases (19.0％) had ground glass shadow/cavity consolidation and blurring edge and 21 cases (21.0％) had butterfly wing sign.Pleural effusions occurred in 75 cases (75.0％).Conclusion The imaging changes of pulmonary congestion and pulmonary edema are earlier than the clinical changes,which are rapidly developed and complexly changed.Through analyzing the chest edema images,more reliable bases can be found for the doctor's clinical diagnosis and for improving the clinical treatment outcome.

目的:调查了解特种兵部队军事训练伤发生情况,为科学施训提供依据.方法:在巡诊和巡讲工作基础上,采用自制调查表对某部特种兵281例进行问卷调查,由某军医大学研究人员进行分析.结果:281例的问卷全部同收.报告军事训练伤者142例,占被调查人群的50.5％.训练伤损伤部位排前3位分别是:膝、腰、足踝;损伤类型居前3位的疾病分别是:半月板损伤、腰肌劳损、关节积液.发生军事训练伤142例中,受伤后就诊者仅81例,占57.0％.女性官兵军事训练伤发生率83.3％,显著高于男性官兵的49.8％ (P＜0.05).结论:具有较好身体素质的某部特战队员军事训练伤发生率仍较高,尤其是女性官兵,且有较多伤员未及时就诊而带伤训练,这一现象应引起相关人员的重视.

Objective To analyze the characteristics of multilayer spiral CT (MSCT) images of pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma for improving the diagnostic accuracy.Methods The MSCT findings of 16 patients with lung MALT lymphoma pathologically confirmed were analyzed retrospectively.Results Among the 16 patients,6 patients suffered from single lung MALT lymphoma and 10 from multiple ones.According to the MSCT morphology,MALT lymphomas were divided into three types:nodular/mass pattern in 7 cases,exudate/consolidation pattern in 6 cases and mixed pattern in 3 cases.Fourteen cases showed thickened vascular bronchial bundle around the lesions,and 8 cases showed calcification within the lesions.And 11 cases had air bronchial sign,including 9 cases of bronchiectasis.Four cases of nodular/mass pattern showed drilled-like growth.Among the 16 patients,13 patients received enhanced scanning,including 11 patients receiving uniform enhancement,and as a result,11 patients showed angiogram sign.Three cases had enlarged mediastinal lymph nodes and 8 cases had pleural effusion.Conclusion The MSCT of lung MALT lymphoma has certain characteristics,therefore,the lung MALT lymphoma can be diagnosed combined with the clinical manifestation of inert growth.

目的:采用工作坊模式以静脉穿刺为例进行护理程序的培训,了解临床护士对护理工作坊的满意程度、实用性、教学性等方面的评价及反馈.方法:以陆军军医大学大坪医院临床护士为培训对象,将其均分为四组,每组由一名组长带领,在一名教员的组织下实施静脉穿刺工作坊,结束后发放问卷并回收,了解参与护士对工作坊模式的看法、满意度、评价及反馈.结果:培训过程中,护士参与度较高.问卷结果分析显示67.35％的护士认为工作坊具有实用性,30.61％认为对工作有帮助.满意度方面95.38％的护士表示满意,其中表示非常满意的占47.83％.结论:护理程序培训采用工作坊模式进行,受到了护士广泛的欢迎,且对护理工作具有实用性,提示工作坊模式对临床护理工作及教学具有适用性和有效性.

With the development of mobile internet, mobile learning based on smart mobile terminals and mobile APP is getting more and more popular, which also plays an increasingly important role in medical higher education. The purpose of this paper is to analyze the status of mobile APP in medical higher education in China, to explain the advantages and challenges of mobile APP and to provide a reference for mobile APP to better serve medical higher education in the future.

Objective:To study the value of 1H-magnetic resonance spectroscopy (1H-MRS) in the diagnosis of invasive pituitary adenoma.Methods:1 H-MRS data of 56 patients with pathology proven pituitary adenoma were retrospectively analyzed,which were divided into invasive group (36 cases) and non-invasive group (20 cases).Cho/Cr,NAA/Cr,MI/Cr,LL/Cr and Cho/NAA of the lesions were measured and calculated,statistical analyses were performed.Results:The ratio of Cho/Cr,LL/Cr,MI/Cr,NAA/Cr and Cho/NAA in invasive group was 3.913 ±2.091,2.435 ± 1.645,1.466 ± 1.319,1.169±0.781 and 3.865±1.890,respectively,in non-invasive group was 1.796±0.612,3.552±2.716,1.340±1.010,1.069±0.774 and 1.799 ± 0.581,respectively.Only the values of Cho/NAA and Cho/Cr of invasive pituitary adenoma were significantly higher than that of non-invasive pituitary adenoma,with statistical differences (P＜0.05).Receiver operating characteristic (ROC) curve showed that when Cho/NAA ratio was greater than 2.045,the diagnosis sensitivity,specificity and accuracy for invasive pituitary adenoma was 89.9 ％,80.0％ and 88.5 ％,respectively.When Cho/Cr ratio was greater than 1.900,the diagnosis sensitivity,specificity and accuracy for invasive pituitary adenoma was 86.1 ％,65.0 ％ and 83.6％ respectively.Conclusion:1H-MRS has certain reference value for the diagnosis of invasive pituitary adenoma.

Objective:To study the value of combination of multiple MRI findings in the diagnosis of placenta accreta.Methods:MR scanning was performed in 20 pregnant women with placenta previa and clinically highly suspected placenta accreta.Independent analysis was performed with the signs including heterogeneous signal intensity within the placenta,discontinuous of myometrium, focal protrusion of placenta, thinning myometrium and blurring structure and placental tissue invaded outside of uterus.Taking whether placenta accrete was existed after cesarean section as standard, the sensitivity, specificity,positive predictive value (PPV) and negative predictive value (NPV) of the MRI findings independently as well as in combination was analyzed.Results:Thinning myometrium and blurring structure had the highest sensitivity as 92.9％,discontinuous myometrium and placental tissue invaded outside of uterus had the highest specificity as 100％ respectively,The sensitivity, specificity, PPV and NPV was 85.7 ％, 66.7 ％, 85.7 ％, 66.7 ％ respectively in heterogeneous signal intensity within the placenta, and 71.4 ％, 83.3 ％,90.9 ％, 55.6 ％ respectively in focal protrusion of placenta.As for the combination of the two,the sensitivity and NPV was 100％ respectively,the specificity was 83.3％,and the PPV was 93.3％.Conclusion:MRI could show the placenta accreta accurately, and should be routinely performed in the patient with suspected placenta accrete.MRI findings of heterogeneous signal intensity within the placenta in combination with focal protrusion of placenta showed high sensitivity and specificity in the diagnosis of placenta accrata.

目的 探讨球后静脉注射在裸小鼠纳米粒静脉给药中的可行性.方法 成年裸小鼠8只,随机分成2组,每组4只,分别通过尾静脉及球后静脉注射超顺磁性氧化铁(superparamagnetic iron oxide,SPIO)纳米粒,行裸小鼠肝脏磁共振(magnetic resonance,MR)快速自旋回波(fast spin echo,FSE) T2WI扫描,测量同一层面、同一区域肝实质及邻近肌肉在增强前后的信号强度,计算信号强度变化率.结果 8只裸小鼠全部穿刺成功.尾静脉穿刺平均耗时8 min 30 s,平均穿刺次数为3.7次;球后静脉窦穿刺平均耗时约3 min 50 s,平均穿刺次数为2.3次.球后静脉及尾静脉两种方法注射纳米粒后肝脏的信号强度变化规律一致,纳米粒注射后即刻、5 min、10 min、30 min、1h及2h的信号强度变化率分别为:尾静脉注射66.78％±5.62％,72.92％±8.41％,73.08％±7.68％,74.06％±7.44％,74.61％±6.28％,73.66％±4.52％;球后静脉注射:69.29％±7.53％,74.86％士5.84％,77.54％士6.47％,78.85％±8.23％,79.05％±4.65％,77.99％±7.73％,两者差异无显著性(P＞0.05).结论 裸小鼠球后静脉穿刺简单、可靠,可以作为尾静脉穿刺以外纳米粒注射的途径.

Objective To explore the diagnostic value of MRI in placenta accrete with placenta previa by comparative magnetic resonance imaging (MRI) with ultrasonography (US). Methods US and MRI were performed in 20 pregnancy with placenta previa in 1 week. The sensitivity, specificity, positive predictive value and negative pre-dictive value of MRI and US were comparative studied by the standard of postoperative clinical data. The advantage of MRI in the placenta accreta was evaluated according to comparative analysis of the muscle-invasive of placenta on MRI and US. Results The sensitivities, specificities, positive predictive values and the negative predictive values were respectively, 93%, 83%, 93%and 83%in US, and 93%, 100%, 100%and 86%in MRI. MRI was more sensi-tive than US in the terms of muscle-invasive display with diagnostic accuracy rate of 75% and 50% respectively. Conclusion MRI could show the placenta accreta accurately, and should be routinely performed in the patient with placenta previa. MRI is more accurate than US in evaluation of the depth of placenta accreta.

Objective To explore the feasibility of constructing tissue engineered cartilage by using the cartilage particle as seed ceils and collagen Ⅱ-hyaluronic acid-chondroitin sulfate (COL Ⅱ-HA-CS) bionic matrix sol.Methods Cartilage particles were acquired from 5 months old Guizhou minipig knee joint;particles with different diameters were acquired by sieve filtration.The proliferation and adhesion of chondrocytes were evaluated at day 1,3,and 7.The bionic sol matrix at final concentration of 10 g/L was prepared by dissolving COL Ⅱ-HA-CS (mass ratio:8.0∶1.5∶0.5) in 0.15 mol/L HCl;The quality of prepared gel was examined.The cartilage particles with the diameter of strongest proliferation rate was seeded into COL Ⅱ/HA/CS sol mix at 5 × 107/L the in vitro results were evaluated by Living cell immunofluorescence and histological observation after 1 week.Results Cartilage particles with different sizes all developed visible chondrocytes adherence and proliferation,and particle size less than 120 μm showed strongest chondrocytes proliferation ability,the difference is statistically significant (P ＜ 0.05).Neutralized COL Ⅱ/HA/CS bionic sol matrix showed good flowability at low temperature;and transferred to gel at 37 ℃ for 6 min.After 1 week the cultured cartilage particles/gel complex showed transparent chondroid appearance,smooth surface and certain level of flexibility;Immunofluorescence observation showed good chondrocytes activity;Histological observation demonstrated chondrocytes were evenly distributed with good viability.Conclusion It reached the best proliferation of chondrocytes when particle size was less than 120 μm;Cartilage particles and COL Ⅱ/HA/CS bionic matrix sol are feasible to culture and construct bionic cartilage in vitro.

目的：探讨后路椎间盘镜下髓核摘除术护理要点。方法：对我院200例后路椎间盘镜下髓核摘除术患者采用术前、术中、术后及出院后进行全程护理干预。结果：均取得满意的临床效果。结论：全程护理干预可提高患者满意度、提高护理质量、减少并发症的发生。

成熟的关节软骨无血液供应、神经支配及淋巴同流,故软骨的自身修复能力非常有限.全厚软骨损伤在某些情况下可发牛自发性修复反应,但新形成的组织是纤维性软骨组织,不具有天然透明软骨的生物化学和生物力学特征,通常会在生理负荷下发生退变[1].组织工程的提出及应用为关节软骨缺损的再生修复带来了希望.水凝胶是一种以水为分散介质的高分子网络体系,性质柔软,能保持一定的形状和吸收大量的水.凡是水溶性或亲水性的高分子,通过一定的化学交联或物理交联,都可以形成水凝胶.水凝胶应用丁软骨组织工程,克服了以往支架材料的许多缺陷,本文就水凝胶的部分基础研究及其在软骨组织工程中的应用做一综述.

Objective To test the biocompatibility of type I collagen and polyvinyl alcohol(Col-Ⅰ/PVA) co-polymerizing filature.Methods Mouse fibroblast L-929 cells were cultured in the medium contain-ing 100% or 50% consistency Col-Ⅰ/PVA co-polymerizing filature leaching liquor.Those cells cultured in normal medium or in the medium contain 0.5% phenol solution served as blank control and positive control,respectively.MTT assay was used to test absorbance value of the cells on the 1st,2nd,3rd,4th,5th,6th,and 7th day.Thus,relative growth rate(RGR) of the cells was calculated,and their cytotoxicity was graded.Direct contact method was used to culture L-929 cells directly on Col-Ⅰ/PVA co-polymerizing filature.The cell growth was observed by inverted microscopy and scanning electron microscopy.Col-Ⅰ/PVA co-polymerizing filature and polyethylene terephthalate(PET) fiber were respectively implanted subcutaneously into KM mice.Specimens were harvested at 1st,3rd and 9th postoperative week for gross observation,and histological changes through HE and Mallory triple staining.Results Relative growth rate of the cells in 100% and 50% consistency Col-Ⅰ/PVA co-polymerizing filature leaching liquor varied from 90% to 123.61% at different time points.Cytotoxicity of Col-Ⅰ/PVA co-polymerizing filature was graded at 0 to Ⅰ.The cells were cultured together with Col-Ⅰ/PVA co-polymerizing filature by means of direct contact.The growth of these cells was in good condition,with normal shapes and attaching to Col-Ⅰ/PVA co-polymerizing filature.Capsules were formed around both subcutaneously implanted Col-Ⅰ/PVA co-polymerizing filature and PET fiber at 1st,3rd and 9th week,with their transparency increasing with the elapse of time.The inflammatory cells around the capsule were mainly neutrophilic granulocytes,macrophages and lymphocytes,whose amounts were obviously decreased with the extension of time.Conclusion Col-Ⅰ/PVA co-polymerizing filature has good biocompatibility.Its cytotoxicity and histocompatibility are within the permission of clinical application.

Objective To construct a sponge scaffold for cell adhesion,proliferation and differentiation in cartilage tissue engineering.Methods Collagen Ⅱ was extracted from hyaline cartilage,and was then subjected to high-speed centrifugation and vacuum freeze-drying to obtain a sponge scaffold.The sponge scaffold was soaked in 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide(EDC)/N-hydroxysuccinimide(NHS) for cross-linking.The sponge scaffold was evaluated by scanning electron microscopy,immunohistochemistry,degradation test and cell adhesion and culture.Results The sponge scaffold had a good pore structure,with pore sizes of 40-130 μm and porosity above 90%.Good cell proliferation and differentiation were found on the scaffold.Conclusion The sponge scaffold constructed from high-concentration collagenⅡ has excellent biocompatibility,and shows great promise in the treatment of articular cartilage defect.

Objective To construct the scaffold for cartilage tissue engineering according to the bionics principles. Methods 3-dimensional scaffolds were prepared with type-Ⅱ collagen (CoⅡ),hyaluronan (HA) and chondroitin sulfate (CS) using the freeze-dry technology. Polyvinyl alcohol (PVA) was added to enhance their mechanical strength. The scaffolds were evaluated by SME,mechanical test and immunohistochemistry. Then 293 cells were seeded in scaffolds and cultured for 7 d in vitro. Data were analyzed by SPSS13.0. Results The pores of scaffold were uniform with a porosity rate of 93%-95%. The maximum tension of CoⅡ-CS-HA-PVA scaffold and CoⅡ-CS-HA scaffold was 1.19 N and 0.55 N,respectively (t=4.985,P=0.002). The distribution of cells was even in scaffolds. Conclusion The CoⅡ-CS-HA-PVA scaffold can provide a suitable environment for cell proliferation and differentiation,thus having a very good prospect in clinical application.

法国是世界上第一个通过国家法律确立了医学终身教育和继续教育的国家.法国国家立法规定:正在从事医疗工作的全科或专科医师,为更新知识和提高诊疗水平,必须主动接受医学新知识和新技术的培训、进修和自学[1].近10年来,根据欧盟制定的有关医学教育框架原则性规定,由国家制定和监控医学再教育培训,使法国医师资质在欧盟各成员国中得到进一步的认可.

在解决关节镜技术应用上缺乏规范的问题而倡导规范化培训的背景下,探讨关节镜培训基地的建立和实施方法,旨在使其合理、有序、规范,以期提高关节镜水平.

患者男性,40岁,长期饮酒,饮食无规律,四肢关节反复肿痛10年,被诊断为痛风,后全身多处形成痛风结节.未正规降血尿酸等治疗,而自行采用针灸治疗膝关节肿痛,3 d后右膝关节症状加重,皮肤红胀,伴全身高热,随后在当地医院行膝关节穿刺,抽出脓性分泌物,培养提示金黄色葡萄球菌,诊断为右膝关节化脓性感染,采用切开引流与局部灌洗,结合全身广谱抗菌素治疗。