网络云交互技术辅助外科实践教学的创新应用探索

目的:探索传统教学模式结合网络云交互技术在外科实践教学中的应用效果。方法:于我校2011级五年制临床医学专业本科生中选取76人,随机平均分为两组,分别采取单纯传统大课教学模式、传统教学结合网络云交互技术教学模式;课程结束后进行闭卷理论考试和实践操作考试,综合两项成绩进行评定。同时向两组学员发放调查问卷,以此评价使用网络云交互技术辅助教学的效果。结果:采取传统教学结合网络云交互技术教学模式组的成绩优于采取单纯传统教学模式组,两组成绩差异具有统计学意义(P0.05)。结论:在传统教学模式的基础上添加网络云交互技术更能激发学生的学习兴趣,大大提高了学习效率,更有利于本科生外科实践的教学以及教学资源的整合及教学档案的建立。     

Interactive effects of task difficulty and personality on mood and heart rate variability

Susceptibility to stress would presumably be different from person to person and be affected by the cause of the given stress. The purpose of this study was to investigate the interactive effects of task difficulty and subject's personality on mood and autonomic nervous function when stress was induced experimentally by tasks involving 3 degrees of difficulty: easy (Task A), difficult but controllable (Task B), and very difficult and uncontrollable (Task C). Twelve healthy female subjects volunteered for the experiment. We assessed their personalities using the Minnesota Multiphasic Personality Inventory (MMPI) questionnaire. Mood states were evaluated by a profile of mood states and a frontal alpha laterality ratio (FALR). Autonomic nervous function was estimated by a spectral analysis of heart rate variability (HRV). Repeated measures analysis of variance applied to two groups (low- and high-) divided by a median split of MMPI clinical scales, revealed significant interactions of time course x task difficulty x Hs (hypochondriasis) in FALR and time course x task difficulty x Pt (psychasthenia) in a low-frequency component and in a high-frequency component of HRV, and in FALR. The differences between low- and high-Hs, and low- and high-Pt were more obvious in Task B session. High-Hs group, whose members tend to place overemphasis on existing physical disorders, showed more negative FALR throughout the session, which would indicate prolonged negative mood possibly due to the task. High-Pt group, whose members tend to be susceptible to stress, showed sympathetic predominance during task period and parasympathetic predominance after task period, which would imply a tendency to overreact. These results suggest that task difficulties would affect mood states assessed by FALR and/or autonomic nervous function differently depending on the subject's personality, especially on Hs and Pt.     

Observation effects on learning in horses

Sixteen horses, divided into 2 groups of 8, were used to study observational learning in horses. One group served as controls while the other group served as the treated group (observers). Observers were allowed to watch a correctly performed discrimination task for 5 days prior to testing their learning response using the same task. Discrimination testing was conducted on all horses daily for 14 days, with criterion set at 7 out of 8 responses correct with the last 5 consecutively correct. The maximum number of trials performed without reaching criterion was limited to 20 per day. Mean trials to criteria (MT) by group were: control, 11.25; observer, 10.70. Mean error (ME) scores were: control, 2.37; observer, 2.02. Average initial discrimination error scores were 11.13 for control and 10.38 for observers (P < 0.10). Asymptote was reached by Day 8 for both control and observer groups. Analysis of variance with repeated measures showed an extreme-day effect indicative of learning (P < 0.01), with non-significant differences in learning rate between experimental groups. Whether the initial ability of the horses to perform a discrimination learning task was enhanced by observation of other horses' performance of that task was not obvious from these data.     

医学模拟教学结合以问题为导向的教学模式在重症医学教学中的应用研究

目的:探讨医学模拟教学结合以问题为导向(PBL)的教学模式在重症医学教学中的应用价值。方法:选取2015年1月~2017年1月在我院重症医学科轮转实习的五年制医学生64人作为研究对象。按随机数字表法将64名医学生分为PBL组(n=32)和结合教学组(n=32)。PBL组采用PBL教学,结合教学组采用医学模拟结合PBL教学。分别在入科时和轮转实习结束时对两组学员进行理论考试和技能操作考核,记录成绩并比较。理论考试和技能操作考核后采取发放问卷进行调查的形式获得学员对教学效果的主观评价。结果:轮转实习结束时,两组理论考试分数差异无统计学意义(P0.05);而结合教学组技能操作考核成分数显著高于PBL组,差异具有统计学意义(P0.05)。两组学员在教学方法接受度高、学习兴趣提升、自学能力提升和临床诊疗水平提高所占比例差异无统计学意义(P0.05);结合教学组学员在团队协作能力提高、沟通能力与人文关怀提高和技能操作水平提高所占比例高于PBL组,差异有统计学意义(P0.05)。结论:与单独PBL教学相比较,医学模拟教学结合PBL的教学模式应用于重症医学教学对学员技能操作的掌握有更好的效果,同时能提高学员团队协作能力、沟通能力以及对患者的人文关怀,且受到学员的认同与喜爱,应在重症医学的教学实践中逐步完善并进一步推广应用。     

Acquisition of discriminations involving ambiguous or non-ambiguous features: an evaluation of two configural learning models

The present rat experiment evaluated the validity of two formal accounts of configural learning in the framework of discrimination tasks involving the serial presentation of feature and target stimuli: Rescorla's (1973) modification of the Rescorla-Wagner model (1972) and the Pearce model (1987). The first, ambiguous feature task was of the form X-->A+, Y-->A-, X-->B-, Y-->B+, in which X and Y represent visual features, '-->' signifies a serial arrangement, A and B are auditory target stimuli, and '+' and '-' symbolise food-reinforcement and non-reinforcement, respectively. The second, non-ambiguous feature task was of the form: X-->A+, Y-->A-, X-->B+, Y-->B-. The former task was much more difficult to solve than was the latter task. The Rescorla model is able to account for the observed differences between the two tasks in learning rates and in the associative strength of feature X with more plausible parameter values than is the Pearce model. It is suggested that models acknowledging a role for both elemental and configural learning can better account for discrimination learning in discrimination tasks of the sort presented in this study than do models that exclusively allow for configural learning.     

A single bout of exercise improves motor memory

Regular physical activity has a positive impact on cognition and brain function. Here we investigated if a single bout of exercise can improve motor memory and motor skill learning. We also explored if the timing of the exercise bout in relation to the timing of practice has any impact on the acquisition and retention of a motor skill. Forty-eight young subjects were randomly allocated into three groups, which practiced a visuomotor accuracy-tracking task either before or after a bout of intense cycling or after rest. Motor skill acquisition was assessed during practice and retention was measured 1 hour, 24 hours and 7 days after practice. Differences among groups in the rate of motor skill acquisition were not significant. In contrast, both exercise groups showed a significantly better retention of the motor skill 24 hours and 7 days after practice. Furthermore, compared to the subjects that exercised before practice, the subjects that exercised after practice showed a better retention of the motor skill 7 days after practice. These findings indicate that one bout of intense exercise performed immediately before or after practicing a motor task is sufficient to improve the long-term retention of a motor skill. The positive effects of acute exercise on motor memory are maximized when exercise is performed immediately after practice, during the early stages of memory consolidation. Thus, the timing of exercise in relation to practice is possibly an important factor regulating the effects of acute exercise on long-term motor memory.     

Dissociation between Active and Observational Learning from Positive and Negative Feedback in Parkinsonism

Feedback to both actively performed and observed behaviour allows adaptation of future actions. Positive feedback leads to increased activity of dopamine neurons in the substantia nigra, whereas dopamine neuron activity is decreased following negative feedback. Dopamine level reduction in unmedicated Parkinson’s Disease patients has been shown to lead to a negative learning bias, i.e. enhanced learning from negative feedback. Recent findings suggest that the neural mechanisms of active and observational learning from feedback might differ, with the striatum playing a less prominent role in observational learning. Therefore, it was hypothesized that unmedicated Parkinson’s Disease patients would show a negative learning bias only in active but not in observational learning. In a between-group design, 19 Parkinson’s Disease patients and 40 healthy controls engaged in either an active or an observational probabilistic feedback-learning task. For both tasks, transfer phases aimed to assess the bias to learn better from positive or negative feedback. As expected, actively learning patients showed a negative learning bias, whereas controls learned better from positive feedback. In contrast, no difference between patients and controls emerged for observational learning, with both groups showing better learning from positive feedback. These findings add to neural models of reinforcement-learning by suggesting that dopamine-modulated input to the striatum plays a minor role in observational learning from feedback. Future research will have to elucidate the specific neural underpinnings of observational learning.     

Hibernation effects on memory in European ground squirrels (Spermophilus citellus).

Effects of hibernation on memory were tested in European ground squirrels (Spermophilus citellus). The animals were trained in summer to successfully accomplish two tasks: a spatial memory task in a maze and an operant task on a feeding machine. One group hibernated normally, and the other was prevented from hibernation by maintaining ambient temperature at 22 degrees C. In spring, the same tasks were repeated for both groups and their individual performances compared to the initial training phase. The experimental groups differed significantly in both tasks. The nonhibernating animals had higher levels of retention and needed significantly fewer trials to relearn the tasks than the group that had hibernated. In addition to testing the retention of conditioned tasks, social memory was also studied. The ground squirrels were given a social recognition test in spring with one familiar and one unfamiliar conspecific. In contrast to the conditioned tasks, social memory did not seem to be affected by hibernation. The results indicate negative effects of hibernation on the retention of conditioned tasks, which could produce important constraints on animals. A potential explanation for this memory loss might be changes in neuronal activity, which occur during hibernation.     

Student retention of course content is improved by collaborative-group testing

We recently reported that collaborative testing (i.e., group test taking) increased student performance on quizzes. It is unknown, however, whether collaborative testing improves student retention of course content. Therefore, this study was designed to test the hypotheses that collaborative-group testing improves student retention of course content. To test this hypothesis, our undergraduate exercise physiology class of 38 students was randomly divided into two groups: group A (n = 19) and group B (n = 19). During exam 1, students from both groups answered questions in the traditional format as individuals. Immediately after completing the exam as individuals, students from group A answered a randomly selected subset of questions from exam 1 in groups of two (1 group had 3 students) to test the effectiveness of collaborative-group testing on test performance and level of student retention. On the next exam (exam 2, 4 wk later), students from both groups answered questions in the traditional format as individuals and responded to the same subset of questions from exam 1. The subset of questions was analyzed to determine the level of retention of the original test material. In addition, immediately after completing the exam as individuals, students from group B answered a randomly selected subset of questions from exam 2 in groups of two (1 group had 3 students). Finally, on the next exam (exam 3, 4 wk later), students from both groups answered questions in the traditional format as individuals and responded to the same subset of questions from exam 2. This protocol followed a randomized crossover design to control for time and order effects. Student retention of course content was reduced when students completed the original examinations individually. In sharp contrast, student retention was improved (P < 0.05) when students completed the original examinations in groups. Results suggest that collaborative testing is an effective strategy to enhance learning and increase student retention of course content.     

Learning new gait patterns is enhanced by specificity of training rather than progression of task difficulty

The use of motor learning strategies may enhance rehabilitation outcomes of individuals with neurological injuries (e.g., stroke or cerebral palsy). A common strategy to facilitate learning of challenging tasks is to use sequential progression – i.e., initially reduce task difficulty and slowly increase task difficulty until the desired difficulty level is reached. However, the evidence related to the use of such sequential progressions to improve learning is mixed for functional skill learning tasks, especially considering situations where practice duration is limited. Here, we studied the benefits of sequential progression using a functional motor learning task that has been previously used in gait rehabilitation. Three groups of participants (N = 43) learned a novel motor task during treadmill walking using different learning strategies. Participants in the specific group (n = 21) practiced only the criterion task (i.e., matching a target template that was scaled-up by 30%) throughout the training. Participants in the sequential group (n = 11) gradually progressed to the criterion task (from 3% to 30% in increments of 3%), whereas participants in the random group (n = 11) started at 3% and progressed in random increments (involving both increases and decreases in task difficulty) to the criterion task. At the end of training, kinematic tracking performance on the criterion task was evaluated in all participants both with and without visual feedback. Results indicated that the tracking error was significantly lower in the specific group, and no differences were observed between the sequential and the random progression groups. The findings indicate that the amount of practice in the criterion task is more critical than the difficulty and variations of task practice when learning new gait patterns during treadmill walking.     

经口腔前庭入路与经乳晕入路腔镜甲状腺切除术对甲状腺微小乳头状癌VAS评分、创伤-免疫指标及美观程度的影响

摘要 目的：对比经口腔前庭入路腔镜甲状腺切除术（TOETVA）与经乳晕入路腔镜甲状腺切除术（ETE）对甲状腺微小乳头状癌疼痛视觉模拟（VAS）评分、创伤-免疫指标及美观程度的影响。方法：回顾性分析我院2020年3月~2021年12月期间接收的100例甲状腺微小乳头状癌患者的临床资料。按照入路方式的不同将患者分为A组（n=47,经ETE治疗）和B组（n=53,经TOETVA治疗）。对比两组围术期指标、创伤-免疫指标、美观程度及并发症发生率。结果：两组术中出血量、中央区淋巴结清扫数目、术后住院时间对比无差异（P>0.05）。B组的手术时间长于A组,术后第1 d颈部VAS评分低于A组（P<0.05）。两组术后3 d CD8⁺、白介素-6（IL-6）、C反应蛋白（CRP）、皮质醇（Cor）升高,但B组低于A组（P<0.05）。两组术后3 d CD4⁺下降,但B组高于A组（P<0.05）。B组的温哥华疤痕评定量表（VSS）评分、患者与观察者瘢痕评估量表（POSAS）评分均低于A组（P<0.05）。两组并发症发生率组间对比统计学差异不明显（P>0.05）。结论：与经ETE相比,经TOETVA治疗甲状腺微小乳头状癌,可获得与其相当的手术效果,且经TOETVA可更好地减轻术后疼痛、术后创伤,提高美观度。     

不同泪道硅胶引流管留置时间对慢性泪囊炎患者视力、生活质量及复发率的影响

目的:探讨不同泪道硅胶引流管留置时间对慢性泪囊炎患者的生活质量、视力及复发率的影响。方法:回顾性选取2018年1月2019年12月期间于我院就诊的慢性泪囊炎患者91例(128眼),根据术后泪道硅胶引流管留置时间分为A、B两组,其中A组泪道硅胶引流管留置时间6周,44例(61眼),B组泪道硅胶引流管留置时间12周,47例(67眼)。对比两组疗效、视力、并发症发生率、主诉溢泪发生率、生活质量及复发率。结果:A组拔管当天的总有效率高于B组(P<0.05),两组拔管后3个月总有效率对比无明显差异(P>0.05)。拔管后6个月两组社会功能、躯体疼痛、精神健康、生理功能、精力、情感职能、生理职能、总体健康维度评分均较术前升高(P<0.05),但两组组间对比未见统计学差异(P>0.05)。两组患者术前、拔管后3个月视力组间及组内比较均未见统计学差异(P>0.05)。两组患者主诉溢泪发生率比较未见统计学差异(P>0.05)。A组并发症发生率、复发率低于B组(P<0.05)。结论:泪道硅胶引流管留置时间的长短对慢性泪囊炎患者疗效、视力、生活质量、主诉溢泪发生率无明显影响,但留置6周者并发症发生率、复发率低于留置12周者,提示临床应视患者具体情况尽量缩短泪道硅胶引流管留置时间。     

An observational learning task using Barnes maze in rats

Observational learning, which modulates one’s own behavior by observing the adaptive behavior of others, is crucial for behaving efficiently in social communities. Although many behavioral experiments have reported observational learning in monkeys and humans, its neural mechanisms are still unknown. In order to conduct neuroscientific researches with recording neural activities, we developed an observational learning task for rats. We designed the task using Barnes circular maze and then tested whether rats (observers) could actually improve their learning by observing the behavior of other rats (models) that had already acquired the task. The result showed that the observer rats, which were located in a metal wire mesh cylinder at the center of the maze and allowed to observe model rats escaping to the goal in the maze, demonstrated significantly faster escape behavior than the model rats. Thus, the present study confirmed that rats can efficiently learn the behavioral task by observing the behavior of other rats; this shows that it is conceivable to elucidate the neural mechanisms of social interaction by analyzing neural activity in observer rats performing the observational learning task.     

Long-term individual housing in C57BL/6J and DBA/2 mice: assessment of behavioral consequences

The aim of the present study was to investigate the effects of individual housing on mouse behavior. The male mice of the C57BL/6J and DBA/2 strains were separated at the age of 4 weeks and kept in individual housing for 7 weeks until behavioral testing began. Their behavior was compared to the group-housed mice in a battery of tests during the following 7 weeks. The single-housed mice were hyperactive and displayed reduced habituation in the tests assessing activity and exploration. Reduced anxiety was established in the elevated plus-maze, but an opposite effect was observed in the dark-light (DL) and hyponeophagia tests. Immobility in the forced swimming test was reduced by social isolation. The DBA mice displayed higher anxiety-like behavior than the B6 mice in the plus-maze and DL exploration test, but hyponeophagia was reduced in the DBA mice. Moreover, all effects of individual housing on the exploratory and emotional behavior were more evident in the DBA than in the B6 mice. Novel object recognition and fear conditioning (FC) were significantly impaired in the single-housed mice, whereas water-maze (WM) learning was not affected. Marked strain differences were established in all three learning tests. The B6 mice performed better in the object recognition and FC tasks. Initial spatial learning in the WM was faster and memory retention slightly enhanced in the B6 mice. The DBA mice displayed lower preference to the new and enhanced preference to the old platform location than the B6 mice after reversal learning in the WM. We conclude that individual housing has strong strain- and test-specific effects on emotional behavior and impairs memory in certain tasks.     

Cardiovascular Response to Interpersonal Provocation and Mental Arithmetic among High and Low Hostile Young Adult Males

To examine the relation between hostility and cardiovascular reactivity to stress, 42 undergraduate men were categorized into high and low hostile groups based on responses to the Cook Medley Hostility Scale. Participants engaged in two laboratory tasks: a Cognitive Task (mental arithmetic) and a Social Task (confrontation role-play). Cardiovascular measures of heart rate and blood pressure were obtained throughout rest and task periods and participants provided ratings of state anger and forgiveness following task completion. Results revealed that low hostile participants exhibited greater systolic blood pressure (SBP) responses to both tasks than high hostile participants (p < .05), but no significant group differences were observed for heart rate or diastolic blood pressure. High hostile men reported greater state anger during resting conditions and less forgiveness following completion of tasks than low-hostile counterparts, but neither of these findings moderated the relation between hostility and SBP reactivity. Higher ratings of forgiveness were associated with lower SBP reactivity. These findings show that hostility is not always associated with exaggerated cardiovascular reactivity to stress, and the influence of various moderating factors should be considered in elucidating this relation.     

基于问题教学法在骨科实习医生教学中的应用

摘要目的：通过基于问题教学方法（problem based learning,PBL）对骨科临床实习医师教学培训,探索提高实习医师临床实践的能力。方法：在骨科临床实习过程中,我们根据学生实习前平均成绩将实习医生分为2组,对18名实习医生采用传统教学模式,而对另18名实习医生采用基于问题教学模式,在临床实习过程进行问诊、初步诊断和分析、治疗处理、写病历、查房,骨科实习结束进行临床基本技能考核比较。结果：在体格检查、辅助检查、问题回答和患者评价项目考核比较,实验组实习医生出科成绩优于对照组;病历书写和病史采集两组没有区别。结论：通过对两组实习医师的临床实践成绩比较,在临床教学实践中,采用基于问题教学方法能够更好地提高实习医师掌握临床知识和技能的能力。     

经尿道等离子前列腺剜除术与经尿道前列腺电切术治疗良性前列腺增生症的临床疗效对比研究

摘要 目的：对比经尿道等离子前列腺剜除术（TUKEP）与经尿道前列腺电切术（TURP）治疗良性前列腺增生症（BPH）的临床疗效。方法：回顾性分析我院2018年1月1日至2021年3月17日期间收治的200例BPH患者的临床资料。根据手术方式的不同将患者分为A组（n=83）和B组（n=117）,A组手术方式为TURP,B组手术方式为TUKEP,比较两组围术期指标,随访6个月,对比两组性功能、尿流动力学变化及并发症发生情况。结果：B组手术时间、术中出血量、尿管留置时间、住院时间、术后冲洗时间短于A组（P<0.05）。术后6个月,两组患者的最大尿流速（Qmax）、膀胱顺应性（BC）升高,剩余尿量（PVR）降低（P<0.05）,且B组患者的Qmax、BC高于A组,PVR低于A组（P<0.05）。术后6个月,两组患者的勃起功能评分表（IIEF-5）、射精功能评分表（CIPE-5）评分降低（P<0.05）,但B组、A组IIEF-5、CIPE-5评分组间对比无明显统计学差异（P>0.05）。B组的并发症发生率小于A组（P<0.05）。结论：TUKEP、TURP治疗BPH,疗效相当,TUKEP在缩短手术时间、尿管留置时间、术后冲洗时间、住院时间,降低术中出血量,减少并发症发生率,改善尿流动力学方面更有优势。     

Role of unstained smears in determining sample adequacy

OBJECTIVE: To determine adequacy with air-dried, unstained smears. STUDY DESIGN: The study was conducted on a total of 70 cases. The cases were divided into 2 groups. Group I consisted of all 70 and was analyzed by a consultant, observer A. Group II consisted of 41 cases from group I. In addition to observer A, a junior resident with 3 months' experience in pathology (observer B), analyzed the slides independently. The results were compared with those on stained smears. RESULTS: When correlated with stained smears, in group I, 55 of 58 (94.8%) cases were reported as adequate, and 11 of 12 cases (91.7%) were labeled inadequate. All were proven correct. In group II, stained smears confirmed that 33 of 35 (94.3%) were labeled adequate by observer A and 33 of 36 (91.7%) by observer B. Stained smears did not confirm 1 of 6 (16.6%) cases labeled inadequate by observer A and 1 of 5 (20%) cases by observer B. CONCLUSION: Unstained smear examination is an effective technique for determining adequacy. An inexperienced practitioner can perform it as well.     

Effects of lesion of the inferior olivary complex by 3-acetylpyridine on learning and memory in the rat

Summary DA/HAN-strained male rats (pigmented rats) were submitted to two experimental tasks consisting of spatial learning (water-escape) and a passive avoidance conditioning. Both these tasks were performed by different animals. In order to destroy the inferior olivary complex, the animals were injected with 3-acetylpyridine either 9 days prior to the initial learning session or 24 h after completion of the learning task. They were retested (retrieval test) 10 days after the initial learning was achieved. Learning and retention were compared to those noted in control rats. Administration of 3-acetylpyridine before the initial learning did not prevent the spatial learning but the scores were greatly altered and the number of trials needed to reach the fixed learning criterion was much greater than in controls. However, 10 days later the animals had memorized their initial experience. Injection of 3-acetylpyridine after the initial learning session impaired memory: the animals had completely forgotten their initial learning. It can therefore be concluded that lesion of the afferent climbing fibres to the cerebellar cortex alters learning and retention of a spatial task. Such a lesion does not interfere with learning and retention of a passive avoidance conditioning, since in this condition the experimental animals injected with 3-acetylpyridine either before or after the initial learning behave similarly to controls. The effects of the inferior olivary complex lesion are obviously different according to the task to be learnt, suggesting that these two tasks do not require the integrity of the same nervous structures.Abbreviations 3-AP 3-acetylpyridine - C control - ILR initial learning-lesion-retrieval - IOC inferior olivary complex - LIR lesion-initial learning-retrieval     

Reduction in Learning Rates Associated with Anterograde Interference Results from Interactions between Different Timescales in Motor Adaptation

Prior experiences can influence future actions. These experiences can not only drive adaptive changes in motor output, but they can also modulate the rate at which these adaptive changes occur. Here we studied anterograde interference in motor adaptation – the ability of a previously learned motor task (Task A) to reduce the rate of subsequently learning a different (and usually opposite) motor task (Task B). We examined the formation of the motor system''s capacity for anterograde interference in the adaptive control of human reaching-arm movements by determining the amount of interference after varying durations of exposure to Task A (13, 41, 112, 230, and 369 trials). We found that the amount of anterograde interference observed in the learning of Task B increased with the duration of Task A. However, this increase did not continue indefinitely; instead, the interference reached asymptote after 15–40 trials of Task A. Interestingly, we found that a recently proposed multi-rate model of motor adaptation, composed of two distinct but interacting adaptive processes, predicts several key features of the interference patterns we observed. Specifically, this computational model (without any free parameters) predicts the initial growth and leveling off of anterograde interference that we describe, as well as the asymptotic amount of interference that we observe experimentally (R² = 0.91). Understanding the mechanisms underlying anterograde interference in motor adaptation may enable the development of improved training and rehabilitation paradigms that mitigate unwanted interference.