SimMan3G模拟教学的应用进展

介绍SimMan3G模拟教学概况，综述国内基于SimMan3G的模拟教学应用进展，对我国未来基于SimMan3G的模拟教学模式进行展望并提出建议，为提高医学生素质、推动医学教育改革提供借鉴参考。     

SimMan模拟人在护生实习前强化训练中的应用

目的探讨SimMan综合模拟人在护生毕业实习前强化训练中运用效果。方法选择三年制护理专业08护三1~18班为研究对象,实验组采用SimMan模拟人对学生进行实习前强化训练,对照组采用传统方法进行强化训练。结果实验组护生强化训练效果优于对照组,两组比较有显著性差异。结论利用SimMan综合模拟人对学生进行强化训练提高了护生的综合能力,有利于缓解学生实习前焦虑情绪。     

SimMan综合模拟人在临床综合操作教学中的应用

在大四学生进入临床实习前,应用多媒体结合SimMan综合模拟人系统教学,开设“SimMan综合模拟人临床技能培训”课程,能够让学生真实地体会到临床中的各种病例,理论联系实际,有效地提高了学生的临床思维能力及临床综合操作水平,为其下一步进入医院实习打下良好的基础。     

SimMan综合模拟人在医务人员CPR短期培训中应用效果研究

目的：探讨SimMan综合模拟人在医务人员CPR短期培训中的应用效果。方法：医务人员随机分为模拟组和对照组。均由专业教师培训,模拟组提供SimMan综合模拟人培训对照组仅提供基础训练模型,统计分析两组成绩。结果：综合模拟人模拟组分数为93.15±4.71,明显高于对照组的81.61±8.86,P〈0.05,差异有统计学意义。结论：SimMan综合模拟人的应用能明显改善CPR培训效果,具有良好应用前景。     

SimMan模拟人在多专业联合小组综合实验教学中的应用

目的探讨SimMan综合模拟人在多专业联合抢救小组中对急危重症病例抢救训练中的运用效果。方法选择2009级护理专业、临床医学专业和针灸推拿专业的部分学生组成医疗团队。通过SimMan模拟人进行急危重症病例的抢救训练。结果94．4％的学生认为能够激发自主探究的欲望;72．2％的学生认为医护不同专业人员的协作,能够互相学习专业优势;94．4％的学生希望在更多的临床专业课程中引入此种教学方式。结论SimMan模拟人在临床实践教学中能够激发学生兴趣,提高其操作技能,调动其探究欲望,培养其自主学习能力,在有条件的情况下应积极采用。     

“学生模拟问诊”联合SimMan模拟人在内科临床见习中的应用

目的：探讨＂学生模拟问诊＂联合SimMan模拟人在内科临床见习教学中的作用。方法：学生随机分为实验组与对照组,分别实施模拟教学及传统教学,通过学生对教学效果的评价进行检验。结果：实验组比较对照组上课更有热情,病史采集更加全面,病人能配合良好,而且学生对病人更能感同身受。结论：＂学生模拟问诊＂结合SimMan模拟人体格检查在内科临床见习教学中作用显著。     

SimMan综合模拟人在临床技能教学中的应用

目的提高和培养医学生临床动手能力和临床综合诊断治疗等技能。方法将汕头大学医学院引进挪威Laerdal公司出品的SimMan综合模拟人应用到临床医学专业学生的临床技能教学和考核 ,并通过问卷调查了解学生对该教学方法的满意度。结果在临床技能教学和考核方面 ,收到了良好的成效并得到了师生广泛的肯定。问卷调查显示 ,88%的学生对此教学方法表示满意和比较满意。结论临床基本技能培养一直是医学院教育的薄弱环节 ,SimMan综合模拟人真实地模拟各种病理生理改变 ,表现临床各种症状体征 ,可根据临床教学需要随时设置 ,不会对病人造成伤害 ,对培养医学生临床动手能力和临床综合诊断治疗等技能具有重要意义。     

在部位麻醉教学中应用模拟人的实践与体会

部位麻醉教学是临床麻醉教学工作的重要组成部分。西南医院麻醉科有关教师在教学中应用SimMan综合模拟人进行教学,并实施量化考核及问卷调查,收到良好效果。作者主要分析了部位麻醉的现状,简要介绍几点教学体会。     

中国医学模拟教育的存在根源

随着世界医学模拟技术的不断成熟和进步，中国的医学模拟教育正在迅猛地发展，医学模拟教育的应用范围正在不断地扩大。追述历程，早在20世纪80年代末，中国就有运用复苏安妮进行心肺复苏训练的历史，但由于种种原因，模拟教育一直未纳入快速发展的轨道；直到2001年，汕头大学医学院在李嘉成基金的资助下第一个引入挪威Laerdal公司的SimMan综合模拟人，中国的医学模拟教育才迅速全面铺开。     

SimMan 3G情景模拟教学在麻醉学教学中的应用

目的　探讨SimMan 3G情景模拟教学在麻醉学教学中的应用效果。方法　选择2012级麻醉学专业五年制学生作为对照组（35名），2013级麻醉学专业五年制学生作为观察组（36名）。对照组（带教教师演示病例）采用多媒体课件集中授课，然后分组使用SimMan 3G模型进行病例模拟演示并总结。观察组（学生角色扮演模拟病例）采用多媒体授课，然后学生在模拟手术室进行角色扮演并全程录像，训练结束后，就各自在模拟训练中的表现（通过模拟录像回放）进行讨论，带教教师进行点评及总结。课程结束后两周，两组学生分别进行麻醉综合理论考核并采用调查问卷评估模拟教学设计和教学效果。采用SPSS ２５.0分别进行卡方检验和t检验。结果　两组学生在年龄、性别、平时专业理论成绩方面比较，差异无统计学意义（P＞0.05）；观察组麻醉综合理论成绩（79.44±5.41）分，对照组麻醉综合理论成绩（73.46±4.62）分，差异具有统计学意义（P=0.001）。观察组31人（86.1%）对教学内容满意，33人（91.7%）认为通过教学可锻炼临床思维，34人（94.4%）认为通过教学可提高团队协作和沟通能力；与对照组相比，上述指标满意度差异具有统计学意义（P=0.031，P=0.018，P=0.013）。结论　采用SimMan 3G进行角色扮演的情景模拟教学，可以显著提高学生的综合理论成绩，有利于临床思维的锻炼及团队协作能力和沟通能力的提高。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.