Objective To evaluate the application of a new clinical teaching model of MOOC based flipped classroom in internal medicine teaching.Methods 100 five-year students majored in clinical medicine of grade 2018 from Bengbu Medical College were enrolled as study subjects, and they were randomly divided into control group and observation group, 50 cases in each group.Students in the control group adopted the traditional teaching mode for teaching, while students in the observation group adopted the new flipped classroom teaching mode based on MOOC.At the end of the teaching course, theoretical assessment, clinical skill operation and questionnaire survey score were conducted respectively.The effects of the two teaching modes were analyzed according to the assessment results.Results In terms of theoretical assessment, clinical skill operation and questionnaire survey score, the observation group was better than the control group（P＜0.05）.In addition, most students in the observation group believe that the new teaching method of flipped classroom based on MOOC can improve students’ enthusiasm of self-study and achieve the expected learning effect.Conclusions The clinical teaching model of MOOC based flipped classroom can not only enhance the ability of teamwork and improve students’ ability of independent thinking, but also improve the quality of clinical teaching of internal medicine.It is expected to further promote and apply this model in internal medicine teaching, and provide new ideas for clinical teaching methods.

患者男性,46岁.2015年1月因"头晕乏力1周"就诊于蚌埠医学院第一附属医院,入院时血常规显示白细胞23 8.3×109/L,血红蛋白95 g/L,血小板计数35×109/L;骨髓细胞学分类见白血病细胞占83.5％;流式细胞学显示:表达CD2、CD3、CD7、CD13、CD34、HLA-DR、TdT、MPO,幼稚细胞占76.14％;融合基因:BCR-ABL(p210、p190 阳性)、CBFβ-MYH11(+);染色体核型:46,XY,t(9;22)(q34;q11).符合混合表型急性白血病(mixed phenotype acute leukemia,MPAL).

BackgroundAdults with relapsed/refractory acute myeloid leukemia (AML) have poor prognosis, very low long-term survival rate and cure rate, and limited chemotherapy regimens.ObjectiveTo investigate the safety and efficacy of venetoclax (VEN) with HAAG 〔homoharringtonine (HHT) , Cytarabine (Ara-C) , aclacinomycin (Acla) , granulocyte stimulating factor (G-CSF) 〕 in relapsed/refractory AML.MethodsThe clinical data of 10 adult patients with relapsed/refractory AML treated in the First Affiliated Hospital of Bengbu Medical College were analyzed retrospectively, including: clinical characteristics (sex, age, diagnosis, chromosome, gene mutation, prognosis) , peripheral blood and bone marrow cytology, and the effect of Ven+Aza+HAAG regimen.ResultsAmong the 10 patients, there were 7 men and 3 women, with an average age of (47.9±11.3) years; 4 cases of M2 and 6 cases of M5 by FAB classification; 3 cases of good prognosis, 2 cases of fair and 5 cases of poor. The median levels of WBC count, hemoglobin content, and platelet count, as well as median percentage of bone marrow blast cells before chemotherapy of the patients were 4.10×109/L, 87.5 g/L, 66.00×109/L, and 63.5%, respectively, and after chemotherapy, the values of these four indicators were 3.28×109/L, 107.0 g/L, 78.00×109/L and 5.5%, respectively. Before VEN+Aza+HAAG regimen combined chemotherapy, the median number of chemotherapy used by the patients was 5. And after the combined therapy, there were 1 case of complete remission (CR) and 4 cases of CR with incomplete count recovery (CRi) , 3 cases of partial remission (PR) , and 2 cases of non-remission (NR) . The objective response rate of 10 patients was 80%, and median survival time was 〔6.5 (3.0, 8.5) 〕months. The toxic and side effects were mainly bone marrow suppression and infection. No patients died of treatment-related complications and other toxic and side effects.ConclusionCompared with traditional chemotherapy regimen, the use of Ven + Aza + HAAG with chemotherapy could significantly improve the objective response rate and remission degree, and prolong the survival in patients with relapsed/refractory AML, which is worthy of further study and has a prospect of clinical application.

目的探讨双头空心加压螺钉加克氏针内固定治疗股骨颈骨折的疗效。方法对76例应用双头空心加压螺钉加克氏针内固定治疗股骨颈骨折进行了观察分析,平均随访6年10个月。结果髋关节功能评价参照Merled-Aubigue评分标准,优28例(36.84%),良39例(51.32%),差9例(11.84%)。结论双头空心加压螺钉治疗股骨颈骨折具有操作简单、安全、创伤小,对骨折断端有加压作用,但抗旋转能力比较差,加用克氏针内固定可有效控制旋转移位,降低骨折不愈合和股骨头坏死率。

目的观察脉络宁口服液对深静脉血栓形成的疗效和安全性.方法将符合纳入标准的患者随机分为2组:治疗组100例,对照组30例,分别用脉络宁口服液和注射液治疗,2周为1疗程,共用2个疗程;观察治疗前后主要症状体征、静脉血流图、甲襞微循环、血凝与抗凝及安全性指标等变化情况.显效病例,停药1个月后随访观察远期疗效.结果经过2个疗程的治疗,总有效率:治疗组为97%,对照组为100%,两组比较无显著性差异(P>0.05).临床显效病例,停药1个月后随访,治疗组保持疗效者占87.5%,复发者占13%;对照组保持疗效者占80%,复发者占20%;两组比较无显著性差异(P>0.05).两组静脉血流图、甲襞微循环及血凝与抗凝情况治疗后均优于治疗前,组间比较则均无显著性差异(P>0.05).治疗过程中两组均未发现明显不良反应.结论脉络宁口服液对深静脉血栓形成具有较好的疗效和较高的安全性,其作用机制可能与改善血液高凝状态及溶栓作用等有关.

目的观察脉络宁口服液与注射液对血栓闭塞性脉管炎的临床疗效和安全性.方法将符合纳入实验标准的患者随机配对分为2组;试验组100例;对照组30例.分别用脉络宁口服液和注射液治疗,2周为1个疗程,治疗2个疗程;观察两组治疗前后主要症状体征、血液流变学、甲襞微循环及安全性指标等变化情况.结果总有效率:试验组为91%,对照组为96.7%;两组间无显著性差异(P>0.05).两组治疗后与治疗前相比:甲襞微循环有明显改善(P<0.01),两组间比较无显著性差异(P>0.05).结论脉络宁口服液与注射液对血栓闭塞性脉管炎均具有较好的疗效和较高的安全性,其作用机制可能与改善血液流变学及微循环有关.

目的评价比较脉络宁口服液与注射液对动脉硬化性闭塞症的临床疗效.方法将130例患者随机分为2组:试验组100例,给予脉络宁口服液治疗;对照组30例,给予脉络宁注射液治疗.2周为1个疗程,治疗两个疗程后统计疗效.观察治疗前后主要症状体征、微循环、血液流变等指标变化.结果总有效率:试验组为91%,对照组为76.7%;两组间无显著性差异(P>0.05).脉络宁口服液与注射液对甲襞微循环均有明显改善(P<0.001),并可降低血沉(P<0.01).结论脉络宁口服液与注射液对动脉硬化性闭塞症均有良好的治疗效果,这一作用可能与其改善微循环有关.

目的探讨聚甲基丙烯酸甲酯(PMMA)和自固化磷酸钙骨水泥(CPC)的不同用量对骨质疏松性椎体强度和硬度的影响,明确恢复椎体强度及硬度所需的最小骨水泥用量.方法取5具老年女性(65～73岁)脊椎标本(T6～L3),分解后压缩并测量其强度和硬度,将3ml,5ml,7mlPMMA和CPC注入压缩后的椎体,再测其强度和硬度,并与原来的强度和硬度进行比较.结果所有椎体注入骨水泥后强度都得到恢复,注入5ml,7ml骨水泥后强度明显增加;注入PMMA后硬度都得到恢复,而注入CPC5ml,7ml才能恢复椎体硬度.结论骨质疏松性椎体骨折后,注入骨水泥可有效恢复椎体的强度和硬度,此结果可有利于指导椎体成形术的临床应用.

目的对青少年脊柱侧弯根据不同情况采用4种手术方法,比较后路固定器械的选择.方法对24例青少年脊柱侧弯采用4种手术方法.单纯Harrington撑开棍固定法,单纯Luque法,联合Harrington-Luque矫正法,C-D矫正法.所有病人术前牵引3～4周,一般做侧卧悬吊牵引,较重者用头颅环-骨盆环牵引.结果 24例患者术前平均侧弯角度54度,术后平均角度18度,矫正率67%.C-D矫正组1例Cobb角45度者,术后矫正到0度.并发症Luque棒钢丝断裂1例,刀口表浅感染1例,无1例发生截瘫或死亡.结论 C-D棒较其它器械固定牢固,多点固定,撑开张力较平均分布,稳定性高,同时能矫正脊柱的旋转,肋骨隆凸及胸椎前凸畸形,极少发生矫正度丧失和并发症.

股骨髁间骨折是一种严重的关节内骨折,尤其是粉碎性骨折治疗困难.自1993年以来,我们应用改变三叶钢板弧度内固定治疗股骨髁间粉碎性骨折37例,疗效满意,现将资料完整的32例报告如下:

To investigate the clinical results of transposition of muscular skeletal flap pedicled with straight head of rectus femoris for treatment of avascular necrosis of adult femoral head.Eight patients with avascular necrosis of femoral head were adopted in this study. There were 6 males and 2 females, the ages were ranged from 24 to 56 years. According to the criteria of Ficat, there were 5 cases in stage II and 3 cases in stage III. The Smith-Peterson incision was used to expose the capsule of the hip. After complete curettage of the necrotic bone from the femoral head, the muscular skeletal flap pedicled with straight head of rectus femoris was resected and transposited into femoral head. Finally, conventional decompression of head was performed.All the cases were followed up for 1 to 3 years. There were excellent results in 5 cases, good in 2 cases and moderate in 1 case. The rate of excellent and good results were 87.5%.Comparing with other pedicled bony flaps, the muscular skeletal flap pedicled with straight head of rectus femoris is characterized by its convenience and efficacy. It is suitable for the treatment of avascular necrosis of femoral head in stage II or III, but the contour of the femoral head should be nearly normal.

目的检测p16、p53基因蛋白及增殖细胞核抗原(PCNA)在骨肉瘤中的存在情况,探讨其与骨肉瘤发生、发展和预后的关系.方法采用改良的免疫组化ABC法,对32例骨肉瘤手术标本和15例正常骨组织标本进行p16、 p53基因蛋白、PCNA的检测.结果 p16、p53基因蛋白、PCNA的阳性表达分别为 37.5%、75.0%、100%,与正常对照差异有显著性(P<0.05,P<0.01); p53、p16基因蛋白的阳性表达与患者的预后有关(P<0.05).结论 p16、p53基因蛋白、PCNA参与骨肉瘤细胞的增殖过程并与骨肉瘤的进展和预后有关;p16、p53基因蛋白作为骨肉瘤的预后指标对判断骨肉瘤患者的预后可能更有临床意义.

目的观察大面积自体游离髂骨膜移植于狗股骨头后的形态学变化.方法 16只成年健康杂种狗随机分为2组,实验组12只,对照组4只.咬除右侧股骨头关节软骨近端2/3,用纤维蛋白粘合剂将髂骨膜粘附于修整好的股骨头上并固定4～6针;对照组仅咬除软骨.术后2、4、8、12周分批处死动物,移植部位取材作光镜、电镜观察.结果实验组术后 2周移植骨膜内面细胞增殖活跃,8～12周形成透明软骨,表面光滑;对照组缺损区为纤维样组织充填.结论大面积自体骨膜游离移植在关节内环境中可以形成透明软骨.