合格的医学人才,除了要具备专业技能,还应该是一个良好的沟通者、合作者、领导者、健康倡导者.国际医学教育专门委员会制定的"全球医学教育最低基本要求"中,沟通技能、信息管理、批判性思维与研究是"基本要求"所规定的核心能力[1].医学教育是一个包括在校教育、毕业后教育和继续职业发展的连续过程.本科医学教育阶段,除了专业知识的学习外,更要关注能力的培养,才能为医学生毕业后继续深造和在各类卫生保健机构执业奠定必要的基础[2-3].

Objective:To investigate the relationship between the origin of vertebral artery and the height of transverse foramen of cervical vertebra using three-dimensional CT angiography (CTA).Methods:The clinical data of 480 patients who underwent head, neck and upper chest CTA examinations from March 2017 to March 2019 at Department of Neurosurgery, the Second Hospital of Hebei Medical University were retrospectively analyzed. The images were transferred to the image post-processing workstation for bone and vascular reconstruction, and the origin and course of bilateral vertebral arteries and the height of the vertebral arteries entering the cervical vertebrae transverse foramen were documented. Patients with normal origin of the right vertebral artery were divided into groups C 4, C 5, and C 6 according to the height of vertebral artery entering transverse foramen of cervical vertebra. Ten cases were randomly selected from each group to measure the distance from the origin of right vertebral artery to the origin of right common carotid artery (L 1) and to the right thyroid cervical trunk (L 2). We calculated the relative position of the origin of vertebral artery with L1/(L 1+ L 2)×100%. Results:Among 480 patients, 457 cases (95.2%) had normal origins of bilateral vertebral arteries which were from the subclavian artery, and the other 23 cases (4.8%) had abnormal origins. Among them, the left vertebral artery originated from the aortic arch in 19 cases, and left vertebral artery originated from the left external carotid artery in 1 case; the right vertebral artery originated from the right common carotid artery in 3 cases, all of which were complicated with aberrant right subclavian artery. Among the 480 patients, 405 cases (84.4%) had bilateral vertebral arteries entering the C 6 transverse foramen. The remaining 75 (15.6%) had vertebral arteries entering the cervical transverse foramen with abnormal height, which was observed on the left side in 34 cases (left vertebral arteries entering transverse foramen of C 3, C 4, C 5, C 7 in 1 case, 4 cases, 24 cases and 4 cases respectively, and directly entering the foramen magnum in 1 case) and on the right side in 41 cases (right vertebral artery entering C 3, C 4 and C 5 in 1 case, 14 cases, 26 cases respectively). The height of vertebral artery entering transverse foramen of cervical vertebra was mostly abnormal when the origin of left vertebral artery was abnormal. In patients with abnormal vertebral artery origin, the left vertebral artery originating from the aortic arch accounted for the highest proportion (19/20), and most of the vertebral arteries entered the transverse foramen of cervical vertebra with abnormal height (18/19). The right vertebral artery originating from the right common carotid artery were complicated with aberrant right subclavian artery (3/3), and the height of vertebral artery entering transverse foramen of cervical vertebra was abnormal (3/3). In patients with normal vertebral artery origin, 96.7% (445/460) of left vertebral artery entered transverse foramen of cervical vertebra with normal height, and 92.0% (439/477) of the right vertebral artery entered transverse foramen of cervical vertebra with normal height. Comparison of patients with normal right vertebral artery origin in the 3 groups showed statistically significant differences in the relative position of the vertebral artery origin (C 4 group: 24.3±2.1 %, C 5 group: 47.9±6.6 %, and C 6 group: 77.7±1.7 %, H=20.178, P<0.001). Conclusions:In case of abnormal origins of vertebral arteries, the heights of vertebral arteries at the transverse foramen of cervical vertebra are mostly abnormal. When the relative position of origin of right vertebral artery is closer to the right common carotid artery, the height of right vertebral artery at the transverse foramen of cervical vertebra seems higher. When the relative origin of right vertebral artery is closer to the right thyroid cervical trunk, the height of right vertebral artery at the transverse foramen of cervical vertebra seems lower.

目的 探讨3D打印导向模板辅助技术在髋部骨折治疗中的应用价值.方法 前瞻性随机研究2017年2月—2019年2月武警河北省总队医院及河北医科大学附属医院手术治疗的髋部骨折患者60例,男性34例,女性26例;年龄35～65岁,平均52.5岁.按照随机数字表法分为3D组和常规组,各30例,3D组患者术前首先进行3D数字化重建,虚拟复位及内固定,设计导航模板等;常规组采取常规的手术方法 实施治疗.比较两组患者手术时间、手术出血量、术后引流量、术后下床活动时间、复位效果、术后不同时间髋关节功能、手术并发症.结果 3D组手术时间(73.9±8.1)min、手术出血量(230.8±30.5)mL均低于常规组(81.0±11.5)min、(285.7±46.2)mL(P<0.05);3D组和常规组术后引流量、术后下床活动时间比较差异无统计学意义(P>0.05);术后复查3D组手术复位效果优80.00％、良20.00％,常规组优56.67％、良40.00％、差3.33％,3D组优于常规组,差异有统计学意义(P<0.05);术后3个月3D组髋关节功能Harris功能评分高于常规组(P<0.05);术后6个月两组患者Harris功能评分比较差异无统计学意义(P>0.05);3D组并发症发生率6.67％(切口感染和肺部感染各1例),常规组并发症率16.67％(切口感染2例、肺部感染2例、内固定松动1例),差异无统计学意义(P>0.05).结论 3D打印导向模板手术内固定在髋部骨折治疗中可减少手术时间和出血量、提高复位效果,促进早期关节功能恢复.

对计算机断层扫描(CT)医学影像技术在我国体育科学领域的研究进行回顾,总结CT医学影像技术在体育科学研究中的作用.发现,在运动解剖学方面,CT影像技术不仅可准确评估运动员骨、关节、骨骼肌运动损伤种类与程度,且通过横截面积、体积、密度等形态学指标可以从解剖学角度,为运动选材、训练监控、运动损伤防治提供科学借鉴;在运动生物力学方面,CT法测量的人体惯性参数已十分成熟,但与运动项目相关联的研究还较少;CT影像数据建立的运动员骨、关节、骨骼肌等三维有限元模型,可分析各运动项目训练器材特征、训练动作生物力学机理等.

目的:探讨表皮生长因子(EGF)对中年大鼠运动活性以及纹状体多巴胺含量的影响.方法:经皮给予健康18月龄大鼠不同剂量EGF(0.01,0.05,0.1,0.15,0.3 mg/ml),通过旷场实验检测大鼠运动行为的改变,通过液相色谱-串联质谱分析多巴胺的含量变化.结果:与对照组相比,小剂量EGF组大鼠(0.01,0.05 mg/ml)旷场实验中各行为参数没有变化;中等剂量EGF组大鼠(0.1,0.15 mg/ml)旷场实验中闻嗅行为、探索行为、趋触性行为、运动行为和理毛行为改善;大剂量EGF(0.3 mg/ml)组大鼠旷场实验中各行为参数下降.纹状体多巴胺及其代谢产物DOPAC和HVA的含量与对照组相比,小剂量EGF(0.01 mg/ml)组开始上升,中等剂量EGF(0.1 mg/ml)组达到峰值,大剂量EGF(0.3 mg/ml)组下降.结论:EGF对中年大鼠运动活性以及纹状体多巴胺的含量均有影响.

[目的]利用3D打印骨折模型设计最佳手术方式及步骤,利用3D打印手术导向模板进行辅助定位,为临床手术治疗提供一种新的方法和有效的辅助手段.[方法]选取1例复杂股骨转子下骨折患者进行双侧股骨螺旋CT扫描,将数据导入Mimics软件生成骨折数字三维模型.虚拟复位确定手术方案.应用3D打印机打印出骨折模型,进行模拟手术,并对选定的公版内置物进行预塑形.测量内置物详细参数,在Creo Parametric 2.0软件中得到内置物数字模型,导入3-matic 9.0中,安放在符合AO固定标准的位置,验证并确定进针点,在软件中建立与进针点周围骨皮质解剖形状一致的导向模板并打印出导板.另选取1份骨折模型,通过手术导向模板安装内置物来验证其可行性.[结果]建立了复杂股骨转子下骨折模型以及制作个体化手术导板的方法,制备出的导向模板具有较好的匹配性,适用于动力髁螺钉的固定.[结论]该方法缩短了手术的学习曲线,增加了手术固定的准确性和安全性.为手术医生术中快速、准确定位提供了一种新的方法,具有一定的临床应用价值.

垂体的漏斗部是连接垂体和下丘脑的重要部分.大鼠垂体的漏斗柄纤细,在取材中极易断裂,因此国内外有关这一研究少见报道.为探索大鼠垂体带下丘脑标本的取材方法,同时提供大鼠垂体的完整形态学资料,选取成年雄性SD大鼠,经多聚甲醛液灌注固定后取材.对取材手法进行了探索,总结出了确保取材成功率达40％以上的取材经验.观察其石蜡切片发现,腺垂体的中间部和神经垂体是紧密融合的;腺垂体远侧部和中间部之间有多处结合,提示拉司克囊可能是由多个大小不等的潜在间隙组成.

BACKGROUND:In recent years,with the wide application of finite element analysis in the field of biomechanics,studies on the ankle joint from domestic and abroad scholars have been increased.However,the study is mainly on static states,searching the literature of the past few years,reports about ankle injury in non-mid-stance have seldom been found.OBJECTIVE:To make finite element biomechanical analysis of the ankle three-dimensional digital model;to observe the changes of displacement distribution,shear stress and stress of every part of the ankle joint from different perspective;and to discuss the ankle injury mechanism under the condition of inversion.METHODS:The three-dimensional digital model of ankle that processed in Mimics and Geomagic surfale was imported into Ansys,and then made a finite element analysis of the obtained model at different inversion angles after constraining conditions,loading pressure and solving.RESULTS AND CONCLUSION:In this article,10 different inversion angles of the ankle joint model were simulated successfully,that were 10°,15°,20°,25°,30°,45°,60°,70°,80° and 85°.At each inversion angle,we made finite element mechanical analysis,and obtained the distribution of displacement,shear stress,and stress of every part of the ankle joint from different spatial dimensional.After studying the datum,we draw a conclusion that the x(y,z)-displacement,xy(yz,xz)-shear stress,x(y,z)-stress were increased gradually with the increasing of the inversion angle,the maximum stress located on the lateral malleolus and the lateral part of trochlea tali,where was the most fragile part of the ankle joint to be broken.In addition,the x-displacement of talus was increased with the increasing of inversion angle,which influenced the distribution of stress on the whole ankle joint model.

Objective: To examine the three dimensional shape and position relation of the hypothalamus and the pituitary in a 14.5 embryonic day rat by using true color reconstruction. Methods: After obtaining the image database of serial sections of a rat embryo and mixing color channels with luminance channel in the software, we observed the reconstruction result of the region of hypothalamus and pituitary. Results: The structure position relation in this region was freely observed in the true color reconstruction result due to the real HE stain color and transparence of no tissue region. Conclusion: For the structures with complicated spatial position, the true color volume rendering may faciliate the recognization and be consistent with the observing custom.

BACKGROUND:With the development of computer technology,blood vessels virtual reality becomes possible.OBJECTIVE:To construct a digital finite element model of the lower limb artery based on the CT sectional images for fluid dynamics simulation.METHODS:DICOM images were harvested from patients with narrow artery CTA to build a three-dimensional model in MIMICS14.0.Then,the finite element model was obtained in ANSYS11.0,for analysis of the real conditions of fluid flow.RESULTS AND CONCLUSION:A three-dimensional model of local stenosis vessel in MIMICS14.0 software.Then,the finite element model of blood vessels was obtained in ANSYS workbench,with 7 335 model nodes and 43 415 units.Finite element analysis was applied to obtain a series of visualized computational fluid data.We could the visual graphic of the flow velocity variations,pressure variations,blood flow path and Wall shear,and establish the required three-dimensional finite element model.

Objective: To establish the image database of the digital virtual Chinese children craniofacial structure anterior to growth peak time with 0.1mm intervals. Methods: An 8-year-old anterior to growth peak time, middle growth and no deformity boy skull was selected to establish the visible chinese boy craniofacial structure image database. After 30 days of embedding, fixing and freezing, the slice-cutting of the skull was performed using a machine in - 13°C homothermic cryogenic laboratory in Research Center for Sectional and Imaging Anatomy, Shandong University School of Medicine. The milling was perfomed with 0.1mm at intervals. The Canon EOS-IDS MarkII camera was used to produce all the images. Results: All original image data were saved as RAW format, which was transferred to PSD and JPG format for sharing and commumication more generally. The digital virtual chinese children craniofacial structure dataset gained a total of 2 150 images. An image size with RAW format was approximate of 20.4MB and the whole craniofacial structure images researched 42.87GB. We saved 3 versions for variously oriented studies about boy craniofacial structure. Conclusion: We established the serial anatomical cross-sectional image data of the craniofacial structure of the children anterior to growth peak time in succeeded. Compared to other available data, the dataset with at intervals 0.1mm were demonstrated to be of more efficient anatomical information to provide for various related studies of the children craniofacial structures.

Objective: To observe the 3-dimentional structural relationship between the components of a whole tissue block in rat pancreas and describe the morphological figures of Langerhans islet. Methods: After the processes of HE staining, digitalization, assembling and alignment, the digitalized image database of long serial sections from normal rat pancreatic paraffin-embedded tissues were made, with which the vascular system, ductal system and islets were segmented and reconstructed. The spacial figure of islets was also measured. Results: The image database reappeared structural pattern of the tissue with high resolution and accurate alignment, and the reconstructed results was displayed freely in a 3-dimentional space. Based on the reconstructed results, some morphological features were measured. The largest composition of rat pancreas was gland alveolus and connective tissue, and the pancreatic islets account to 1.125%. Conclusion: In the rat pancreas, the vascular vessels diverged perpendicularly from the trunk lined tissue superficially and then branched to the inner lobule. Anastomoses were found in the pancreatic ducts. Occasionally the duct parallels with vascular vessel nearby, which forms the triad pattern. The close relationship between pancreatic islets and ductal system was found in this study.

目的 观察胰岛的超微结构特点,探讨胰岛细胞多肽激素分泌颗粒的释放形式和转运途径及其功能意义.方法 对小鼠胰组织超薄切片,进行透射电镜观察.结果 小鼠胰岛散在分布于胰腺小叶之间,主要由A、B两类内分泌细胞组成.胰岛内部和周围存在丰富的有孔型(50 nm)毛细血管;毛细淋巴管内皮为开放连接型(0.5～1.5 μm),只存在于胰岛周围.胰岛细胞内含大量电子致密的分泌颗粒(200～500 nm),常见许多分泌颗粒靠近细胞膜或突出于细胞表面.在胰岛细胞周围的组织间隙内,也常见到与胰岛细胞内相似的分泌颗粒.结论 小鼠胰岛细胞多肽激素分泌颗粒连同颗粒被膜整体释放;释放入胰组织液中的多肽激素或分泌颗粒,更易通过淋巴管随淋巴转运,间接进入血液循环而发挥作用.

目的 评价酶组织化学双重染色法在肿瘤组织脉管新生研究中的作用.方法 对人结直肠腺瘤、结直肠癌、胃癌、喉癌、结直肠癌细胞系Colon-21和鳞状上皮癌Vx2细胞系种植瘤标本,通过5'-核苷酸酶-碱性磷酸酶组织化学双重染色,相邻切片的HE染色,进行了光镜观察.结果 在所用病理类型的肿瘤组织中,均可观察到5'-核苷酸酶阳性管道结构,HE染色切片观察显示其为淋巴管;肿瘤周围组织和血管平滑肌,也呈5'-核苷酸酶强阳性反应;在同一组织切片上,碱性磷酸酶阳性管道为血管,某些炎性细胞也呈现碱性磷酸酶阳性反应.结论 肿瘤组织与正常组织相似,5'-核苷酸酶阳性管道为淋巴管,碱性磷酸酶阳性管道为血管,5'-核苷酸酶-碱性磷酸酶组织化学双重染色法,在研究肿瘤组织脉管新生现象中,可用于血管和淋巴管的区分.

哺乳动物松果体除了分泌胺类激素(如褪黑素)外,在松果体内也发现了多种肽类物质,如生长抑素等[1-4].但是,关于生长抑素是存在于有突起的松果体细胞内,还是位于支配松果体的神经纤维内,以及数量的多少,不同研究者间的报道差异较大[5-6].因此,本研究对大鼠松果体进行生长抑素的免疫组织化学显色观察,以探讨松果体合成与分泌生长抑素的情况.

目的 探讨乳腺癌组织内淋巴管密度(lymphatic vessel density,LVD)及其与腋窝淋巴结癌细胞转移的相关性.方法 采用5-核苷酸酶和碱性磷酸酶组织化学双霞染色法,对50例乳腺组织标本(包括乳腺癌组织标本40例,乳腺纤维瘤组织标本5例,正常乳腺组织标本5例)中的LVD进行光镜观察和图像分析.结果 乳腺癌组织中的LVD值16.10±1.51,明显大于乳腺纤维瘤组织中的LVD值12.45±0.47,也大于正常乳腺组织中的LVD值12.37±0.45.在腋窝淋巴结出现癌转移组,其乳腺癌组织中的LVD值17.74±0.48,明显大于无腋窝淋巴结癌转移组的LVD值为14.88±0.49.结论 乳腺癌组织中的LVD与腋窝淋巴结癌转移状态密切相关,是预测乳腺癌腋窝淋巴结转移状态的有价值指标之一.

Objective: To study the expression of somatostatin in primary cultured pineal cells in rats.Methods: The pineal glands of neonatal rats were removed by microsurgical technique.The pineal cells were then isolated by digesting with trypsin and EDTA and cultured in DMEM/F12medium containing 10% newborn bovine serum.Morphological appearances of the cultured pineal cells were observed under phase contrast microscope,transmission electron microscopy.5-HT and somatostatin were detected by immunocytochemical staining.Results: The obvious proliferation of cultured pineal cells was not found until the cells were cultured for 5 to 6 days,and the vigorous capability of proliferative cells was observed during 8 to 12 days after seeding.The typical cell nest was displayed at 7 to 8 days and lost its typical features at 12 to 15 days.5-HT-immunoreactive positive cells and somatostatin-immunoreactive positive cells with two or three processes emerging from the cell body were observed in vitro after being cultured for 12 days.The transmission electron microscope image showed that the cultured pinealocytes after 15 days in vitro had more prominent rough endoplasmic reticulum,free ribosomes,and many spherical clear vesicles.Conclusion: The primary cultured rat pineal cells could synthesize somatostatin.

<正>为探索喉癌颈淋巴结转移与微淋巴管形成的关系,我们采用5'-核苷酸酶和碱性磷酸酶(5'-Nase-ALPase)双重组织化学染色方法检测喉癌中微淋巴管密度(lymphatic microvessel density,LMVD),采用免疫组化法检测血管内皮生长因子-D(endothelial vascular growth factor-D,VEGF-D)的表达。

目的研究胃癌组织中血管内皮生长因子-D(vascular endothelial growth factor-D,VEGF-D)表达与淋巴管生成和淋巴结转移的关系,探讨其在胃癌淋巴转移中的作用和意义。方法采用免疫组化方法检测胃癌及癌旁正常胃组织中VEGF-D的表达,酶组织化学方法行胃癌组织淋巴管染色并计数,分析胃癌淋巴结转移及其它临床病理特征。结果胃癌组织VEGF-D表达阳性率(46.6%)显著高于癌旁正常胃组织(22.4%)(P<0.01)。VEGF-D阳性表达的胃癌组织淋巴管计数(28.86±6.32)显著高于阴性表达的胃癌组织(21.27±5.66)(P<0.01)。VEGF-D表达与胃癌患者性别、年龄及肿瘤大小、浸润深度无关(P>0.05),但其表达在低分化组(53.3%)、有淋巴结转移组(54.5%)、+期组(56.1%)显著高于高、中分化组(39.3%)、无淋巴结转移组(31.3%)和+期组(41.2%),差异有显著性(P<0.05)。结论VEGF-D与胃癌的发生、发展有关,VEGF-D可刺激胃癌组织淋巴管生成,促进淋巴道转移。

Objective To explore the structural foundation of transport pathway of pineal secretions from the pineal body to the cerebrospinal fluid of subarachnoid space. Methods The pineal capsule of the superficial pineal body of 1.5-month and 12-month old rats was observed under scanning electron microscope(SEM).Results Cribriform and trumpet-shaped epithelial stomata were scattered on the pineal capsule.Cribriform epithelial stomata were seen mostly in 1.5-month old rats.They were composed of many round pores which pierced through the full-thickness of the periphery of the capsule endothelium.The pores were dense and ranged from 200-500 nm in diameter;trumpet-shaped epithelial stomata were seen in both 1.5-month and 12-month old rats.Trumpet-shaped epithelial stomata were located among epithelial cells of the pineal capsule.They were round or elliptic in shape and ranged from 1-4 μm in diameter.On the surface of the pineal capsule,many secretory granules were observed.They were spherule and 8001 000 nm in diameter.Conclusion The releasing pattern of secretory granules of the pineal body could include a releasing of the whole membrane;the pineal secretions may be transported directly from the pineal body to the cerebrospinal fluid of subarachnoid space through the epithelial stomata of the pineal capsule.