2014年以来,以"5+3"为主体的临床医学人才培养体系全面实施,出现了临床研究能力培养质量难以保证的现实问题.以问题为导向,提出针对性思路与措施,推动改革不断深入.了解并理解培养要求,提高政策站位,把握正确方向,增强培养工作的主动性与协调性;建立并执行培养制度,做到系统而科学,发挥制度的稳定性、基础性、强制性和引导性作用,增强培养工作的规范性与实效性.聚焦"要求"和"制度",推出措施,将有利于破解临床研究能力培养问题,以保障对临床研究能力的培养质量.

外科手术学是现代医学教学的重要组成部分,是实现培养具备基本操作能力和临床思维的医学人才的关键内容.文章论述了PBL教学法运用于外科手术学教学中的必要性及意义,并从转变教学理念、拓展教学模块、建立教学框架、完善考评模式四个方面着重探讨了PBL教学法在外科手术学教学中的实践.

地方综合性大学要准确把握五大发展理念的本质内涵,以五大发展理念指导医学教育管理体制改革的全过程,全面掌握医学教育管理体制存在的问题,切实抓好以五大发展理念引领地方综合性大学医学教育管理体制各项改革,通过深化改革,理顺体制机制,提高工作效率,激发办学活力,不断提高医学人才培养质量.

According to the innovative requirements of the staged examinations of clinical physician certification,this paper is set to carry out practical research on its first stage,discussing the feasibility of examination designs,organizations & implementations,results analysis and preliminary effects,and then,putting forward several improvement suggestions.The reform of the staged examinations is able to a chieve the goal that successfully evaluating if one,who is applying for the clinical physician certification,possesses the professional knowledge and skills for clinical practice as well as one of the references to the integral reform of clinical-physician-certification evaluation examinations in clinical medicine fields of China's province-affiliated universities.

Aim To observe the effect of ibrolipim on the expresstion of endothelin-1(ET-1) and von Willebrand factor(vWF) in cultured human umbilical vein endothelial cells induced by high glucose,and to investigate its molecular mechanism.Methods Human umbilical vein endothelial cell-12(HUVEC-12) were cultured respectively under normal glucose level(5.5 mmol/L),high glucose level(33.3 mmol/L),and high glucose level with ibrolipim treatment.HUVEC-12 activity or injury was assayed by methyl thiazolyl tetrazolium(MTT).The ET-1 concentrations were evaluated by radioimmunoassay.The expression of vWF in the conditioned media was tested by enzyme-linked immunosorbent assay(ELISA).Endothelial dysfunction was identified by the expression of ET-1 and vWF through reverse transcription polymerase chain reaction(RT-PCR).The protein content of ET-1 and vWF were evaluated by cell immunofluorescence.Results High glucose condition significantly weakened cell viability,and increased the expression of ET-1 and vWF.Ibrolipim treatment significantly attenuated these alterations of endothelial dysfunction.The low er con-cen trations(2,4,8 μmol/L) of ibrolipim improved cell viability,down-regulated the expression of ET-1 and vWF,and attenuated the cytotoxicity,however,higher concentration(16,32 μmol/L) of ibrolipim aggravated the damage of HUVEC-12 cultured under high glucose level.Conclusion Ibrolipim at low concentration can inhibit high glucose-induced endothelial dysfunction of cultured HUVEC-12,which may be related to the alternation of ET-1 and vWF expression.

人体解剖学是医学专业重要的基础课程,该课程教学具有内容多、概念抽象、实践性强等特点,学生难以全面掌握,为改变传统的教学模式,利用人体血管3D可视化,结合医学和计算机科学的最新成果,运用信息技术建立数字化的人体血管各个层次的计算机模型,展示人体微血管与器官周围诸结构相互关系,为解剖学教学提供形象生动的三维立体模型,从而达到提高教学质量和教学效率的目的,推动解剖学教学改革与发展。

Objective To investigate celluar morphous,doubing time and proliferation speed of Daudi cells affected by STGC3 gene over-expression.Methods We adopted the method of electroporation gene transfection method to introduc pCDNA3.1(+) /STGC3 eukaryotic expression plasmid into Daudi cell,which was selected by geneticin,and established the Daudi cell line of STGC3 gene over-expression.Then,we used Western-blotting to detect expression of STGC3 protein in transgenic Daudi cell,and deployed immuocytochemistry,HE staining and cell growth curve methods to observe the locating of STGC3 protein,the celluar doubing time and proliferation speed affected by STGC3 gene over-expression in Daudi cells.Results STGC3 protein over-expressed and located in endochylema and nucelus of transgenic Daudi cell line.The celluar doubing time was extended,and the celluar proliferation speed was stepped down by STGC3 gene over-expression in Daudi cells(n=3,P<0.05) .Conclusion The Daudi cell line of STGC3 gene over-expression was established successfully.

淋巴瘤是人类常见的恶性肿瘤之一,其病因比较复杂,可能与病毒感染、免疫缺陷、电离辐射和基因突变有关.Epstein-Barr病毒(EBV)已确定是引起人类传染性单核细胞增多症的病因,并与人类恶性肿瘤,如鼻咽癌、淋巴瘤、霍奇金病的关系非常密切[1,2],其中Burkitt淋巴瘤和鼻咽癌的密切相关性已被公认[3,4].

Objective: To provide basis for recognition,prevention and treatment of acute and chronic elbow disease in tennis training.Method: To anatomize and analyze generally conformational and structural features around elbow joints,observe outboard rotary angle changes and evaginable rotary angle changes when relative radiocarpus structures and manual inboard paraligaments are severed in order.Result: The fore bindles of manual inboard paraligaments are found to be composed of foreside fibers and rear fibers.Radiocarpus paraligaments are situated between circle-like ligaments and the outward inferior of lower ulna;When elbow joints bend at the angle of 30 to 60,the fore bundles of manual inboard paraligaments are found to be slack inboards and tense outboards.When bending at the angle of 60 to 145,no obvious difference exists inboards and outboards.When bending at the angle of 60 to 145,rear bundles become tense.Radiocarpus paraligaments of elbow joints play 50 percent role in maintaining stability of joints outboards,while extensor and aponeurosis play concerted role.Conclusion: The fore bundles of radiocarpus and manual inboard paraligaments are the main stable structures.Different components of paraligaments play different roles.Structural changes will lead to the loss of function in this part,the research results can serve as a reference for tennis training and the prevention of tennis elbow trauma.

Objective: To study the anatomical basis on sensory tracts of wrist median nerve pedicled with nutrient vessels transferring to join wrist ulnar nerve. Methods: The length, nervous tracts and nutrient arteries of wrist median nerves and wrist ulnar nerves were investigated in 14 Chinese adult cadavers. The operation was imitated, in which sensory tracts of wrist median nerve pedicled with its nutrient vessels was transferred to join the injured gap in wrist ulnar nerve. Results: ①The length of wrist median nerve was 7.8 (7.5-8.1)cm. There was 19 to 27 nerve tract in it and the majority belonged to sensory tracts on the ulnar side, in which non-damage separated length was about 10.0cm to 14.0cm. Motor and mixed tracts on the radial side were much fewer. Its nutrient vessels originated from radial arteries about 6.2 (6.1-6.6) cm above radial styloid process were 1.2 (1.1-1.4) mm in outer diameter.②The length of wrist ulnar nerve were 9.4 (8.9-9.8)cm and the number of nervous tract were 14 to 19, in which sensory tracts on the anterior external side were approximately equal to motor and mixed tracts on the posterior internal side in quantity. Conclusions: The sensory tracts of wrist median nerve pedicled with nutrient vessels can be applied as nervous grafts to join injured gap in wrist ulnar nerve.

根据对膝上外侧动脉及髂胫束的应用解剖学研究,认为以膝上外侧血管为蒂可构成髂胫束-骨瓣,用于移植或转位修复跟、肘、膝、脊柱等部位肌腱及伴有骨质缺损的修复或骨不连的融合.为推广这一组织瓣的临床应用,以及充实教学、科研和实验室建设标本资料,作者设计制作了带膝上外侧血管蒂几种不同类型的髂胫束-骨瓣标本.

临床显微外科组织瓣研究的重点是依据血管的走行、分支分布及吻合情况,寻找有效的区域性血供保障的供区,这就要求临床医生对细微血管走行分支的形态有明确的认识.近年来,为配合显微外科的研究,我们通过探索,采用新鲜材料乳胶灌注、局部防腐、分层解剖、印模复位等技术,成功制作出肘关节周围血管网多层构筑标本,为研究提供了直观的标本.现简介如下,供临床肘关节与显微外科组织瓣应用参考.

目前我国以南京、重庆为代表采用常温条件和间断真空浸渗处理技术[1～2],而以大连、青岛为代表采用低温连续真空渗透技术;但制作技术的复杂性、关键技术未普及以及设备昂贵[3],使应用受限.生物塑化技术的研究国内报道颇多,但是对其详细制作方法、注意事项、塑化标本颜色加深的原因、影响塑化标本固化因素、低温真空技术与常温真空技术的比较等方面的相关研究,作者尚未见报道.为此作者依据自身经验进行相关文献分析和总结,以期为塑化技术实践者提供基础参考,也为解剖生物塑化技术的研究积累资料.

Objective To provide data of anatomy and fabrication of artificial lower jaw bone and to find out their correlation. Methods Sixty adult formalined cadaveric specimens (male 30 and female 30) normal facial bones with were dissected. The breadth between the angle of mandible, the depth of zygomatic arch, the length of zygomatic arch, the depth of mandibular symphysis and the height of mandibular symphysis were measured, and the data were studied with statistics. Results There are not significant difference in the breadth between the angle of mandible, or the depth or height of mandiblar symphysis between male and female ( P 0.05), but there are significant difference in the depth or length of zygomatic arch between male and female ( P ≤ 0. 05). the breadth between the angle of mandible is 98.78±9.60 mm, the depth of mandible symphsis 77.40±10.33 mm and the height of mandible symphsis 35.20±3.37 mm; moreover, there is correlation between each two of the three ( P 0.01), then we check the equation( P 0.01), and create the regression equations. Conclusion It can analyse sex from the depth or length of zygomatic arch; to provide data for fabrication of artificial lower jaw bone, and calculate some missed data through these regression equations.

Objective To provide anatomy data for the split of the constitution in renal pedicle during the operation of live - DN by pentone scopy. Methods and Results We measure the length of left renal pedicle(42.6±8.1 mm) and right renal pedicle (18.1±4.1 mm), and the height of interior tip of left renal pedicle(22.9±5.5 mm), of intermedia of left renal pedicle (19.1±3.2 mm), of lateral of left renal pedicle (26.9±3.5 mm), and the height of interior of right renal pedicle(15.6±3.1 mm), of intermedia of right renal pedicle(14.8±1.6 mm), of lateral of right renal pedicle (23.2±0.7 mm), and the angle between left renal pedicle and abdomial aorta (70.4° ±10.3°), the angle between right renal pedicle and inferior vena cava (79.2°±8.7°) . Conclusion The morphology of kidney pedicle is beneficial to splitting the constitution in renal pedicle during the operation of live - DN.

Objective To study the different characteristics of physical anthropology of Hui nationality and other nationalities in Hunan. Methods 400 adults of Hui nationality aging from 25 to 45 were observed and measured in Hanshou County, Hunan Province. Seven items were observed and twenty - six items were measured. Results The direction of the palpebral fissure was horizontal(99.5% in males and 99% in females). The length - breadth index of the head was classified as mesocephaly and brachycephaly (43.0% and 39.5% in males), as brachyceph-aly and ultrabrachycephaly(59.0% and 20. 5% in females). The stature of the Hui in Hunan was sub - middle type, averaging 1 637.89 mm in males and 1 538.24 mm in females respectively , which is taller than that of other nationaliies in Hunan. Conclusion The result showed that physical characters of Hui in Hunan has both general characters of the Mongoloids and its own special features. Hui nationality has no written language of its own. They both speak and write in Chinese.

Objective : To study the pattern of right ventricle remodeling in hypoxic pulmonary hypertension rats. Methods : Models of hypoxic pulmonary hypertension rat were set up by normobaric intermittent hypoxia and mean pulmonary arterial pressure was measured by right-heart catheterization. The lengths of right ventricular inflow and outflow tract, the wall thickness of right and left ventricle, and the weights of right ventricle and left ventricle plus septum were measured the to assess the pattern of right ventricle remodeling. Results : With the increase (P0.01) of mean pulmonary arterial pressure, right ventricular hypertrophy index (RVHI) and the length of right ventricular outflow tract increased(P 0.01) significantly after hypoxia for 14 d. Weight of free right ventricle significantly increased(P0.01) 21 d after hypoxia. Twenty-one day after hypoxia, the wall thickness of right and left ventricular and the length of right ventricular inflow tract showed no statistic difference between hypoxic and control rats. Conclusion : Eccentric hypertrophy accounts for the early change of right ventricle in hypoxic pulmonary hypertension rats.

目的为探讨一种新的全身腐蚀铸型标本制作方法.方法采用死亡时间3 d以内的新鲜尸体进行灌注填充剂、盐酸腐蚀、修整封装等操作.结果本方法制成的全身腐蚀铸型标本,外观饱满美观,整体感强.结论本方法制成的全身腐蚀铸型标本,结构显示完整,关节串联成功,适用于各层次、各专业的解剖学实验教学以及标本陈列室的展示.

为了使临床医学专业学生更好地掌握椎动脉重建术相关解剖知识,作者设计制作了椎动脉重建手术入路标本,现对该标本的设计与制作方法作一介绍.

目的探讨一种新的内脏淋巴管标本的制作方法.方法以成年活体狗为实验材料,采用墨汁填充剂,分别加压灌注肠、胃、心、肺等内脏器管,制作淋巴管标本,显示淋巴管道的走行、分布情况.结果墨汁沿淋巴管进入淋巴结,各器管淋巴管道均能显示清楚.结论以成年活体狗为实验材料制作成的淋巴管标本能清楚显示结构,可用于各层次、各专业的解剖实验教学.