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There are many difficulties in digital medical teaching, including new course content, multiple key and difficult points, wide knowledge coverage, large knowledge structure span, high requirements for teachers, and few shared resources for online teaching during the epidemic. This research aims to give full play to the advantages of our team in the field of digital medicine, and promote the construction of network resources of this course and its extensive development in more universities through the exploratory and research on the course construction and teaching mode of the Digital Medicine MOOC (massive open online course). The questionnaire study found that the satisfaction score of the average satisfaction score of MOOC teaching in terms of students' pre-class preview, quick grasp of knowledge points in class and after-class review reached more than 90 points, and the score of improving students' learning initiative was (88.10±10.87) points. It can be seen that the use of MOOC teaching mode can significantly help students to preview before class, master knowledge points in class and review after class, and improve students' initiative in learning. The research suggests that the production of Digital Medicine MOOC should keep the consistency and individuality of all knowledge points under the framework of digital medical knowledge; teachers should focus on the explanation of basic knowledge points and deepen in further step integrated with frontiers of this field; it’s suggested to make a separate MOOC on frontier knowledge and application explanation, so as to cope with the outdated courseware content caused by the development and update of this subject.
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Objective@#To investigate the morphology and structure of the perpendicular plate of ethmoid and measure its anatomical parameters among Chinese population. To discuss the safety range of harvesting perpendicular plate of ethmoid in rhinoplasty.@*Methods@#Sixty-four healthy Chinese were included in accordance with certain requirements and their paranasal sinus was examined using 64 slices computed tomography (CT). The three-dimensional (3D) structure of their perpendicular plate of ethmoid was reconstructed, and the area, length, height and thickness were measured by Mimics 17.0 software. Statistical analysis was completed by SPSS 22.0 software and was checked out by t-test.@*Results@#According to the result from 3D anatomical analysis, the length of the anterior border of perpendicular plate of ethmoid was (28.58±2.91) mm, the inferior border was (26.17±5.76) mm and the posterior border was (19.84±3.17) mm. The thickness of the anterior border three sections were (3.07±0.72) mm, (3.09±0.73) mm and (1.75±0.55) mm respectively. The thickness of the inferior border in three sections were (1.96±0.62) mm, (1.94±0.73) mm and (1.87±0.67) mm, respectively. The length of the middle and lower third of the perpendicular plate of ethmoid anterior border was (10.04±2.39) mm. As to the superior border, the length was (35.31±6.52) mm. The total area of the perpendicular plate of ethmoid was (1 057.85±184.38) mm2, the lower section area was (474.09±109.60) mm2, and the ratio of middle and lower third to the total area was 0.45±0.07.@*Conclusions@#The thickness of the lower 1/3 segment of the vertical plate of the ethmoid bone is thinner than that of the upper segment, and it is far away from the skull base, which is easily to harvest and meet the application in surgery.
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Objective To evaluate the reliability and accuracy of three-dimensional digital fusion anatomy in the preoperative evaluation and therapeutic strategy choice of intracranial tumors.Methods MRI scan,including regular MRI,MRA,MRV and DTI,were performed in 87 case.Then tumor themselves as well as tumor-associated structures were reconstructed and fused through iPlan 2.6 software.Based on the reconstructed images,therapeutic strategy were established,preoperative and intraoperative imags were compared.Results The digital reconstruction were successfully finished in all cases.Meanwhile,digital images,originally radiological images and actual images matched well.No approach-associated complication were met in our series.Among tumors in the convexity,the relationship of the reflux veins and the tumors were divided into three types:anterior(12 cases),posterior(19 cases) and overriding(3 cases).All of the relationships were seen in the preoperative fusion image,and the veins were all effectively protected during operation.The tumor-associated arteries could be pushed or wraped by the tumors,and the three-dimensional fusion image could provided their virtually aberrant pathway as well as their relationship with tumor.During microsurgical managment of tumors in the deep brain parenchyma,safe approach were found with the help of comprehensive understanding of the tumors and their adjacent structures.Conclusion Three-dimensional digital fusion anatomy can vividly and accurately display full rang of information about the tumor,and facilitate tumor treatment safely.
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Objective To explore the locating, parameter measurement and 3D display of nucleus accumbens in human brain in terms of digital anatomy .Methods The raw data of the head specimen of a 45-year-old male adult with 0.5mm as the section spacing was collected by using digital milling machine .Three hundreds images of continual cross sections containing brain were chosen and the segmentation of the caudate nucleus , putamen and nucleus accumbens was accomplished with Photoshop CS .The nucleus accumbens on the images of continual coronal section reconstruction were distinguished according to Harvard Medical School ’ s segment method to calculate the volume of nucleus accumbens and collect the correlative location information .The caudate nucleus , putamen and nucleus accumbens were 3D visualize with the software of Amira 3.1.1.Results The nucleus accumbens , the adjoining structure and the lesion target of nucleus accumbens were all clearly visible .The left nucleus accumbens volume was 972.5mm3 , and the right was 830.6mm3 .The 3D coordinate value was the left ( -11.0, 24.4, 1.3) and the right (9.3, 23.9, 1.7).Conclusion The digital anatomy of nucleus accumbens can distinctly display the nucleus accumbens , form and confirm it ’ s volume, location and adjoining area , which is useful to clinician .
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Objective To introduce the clinical apply of middle and small skin defect in finger injury with lateral arm free perforator flap.Methods (1) Ten cadavers were injected with a modified lead oxide-gelatin mixture.Later,CT scan,three-dimensional reconstruction of the cutaneous perforator vessels on the later arm.Then simulate the flap design.All cadavers were dissected before CT scanning.(2) Eighteen cases of middle and small skin defects in finger injury were treated with lateral arm free flap.The defect area were from 3 cm × 4 cm to 6 cm × 9 cm.Results Our research showed that the average caliber diameter of perforators of profunda brachial artery(PBA) was (0.71 ± 0.15) mm,and Posterior radial collateral artery(PRCA) was (0.94±0.22)mm.The results of pedicle length of perforator of PBA was (2.74 ±0.42) cm:(2.96 ±0.37) cm,and PRCA was (4.78 ±0.63) cm:(4.86 ±0.51) cm.3D reconstructive results showed that the perforators of PBA and PRCA dominated the lateral upper arm area.The flap of 18 cases survived after the operation.The wound of providing area was directly sutured or skin grafting and got healing.All cases were followed up for 6 months to 3 years,and the average follow-up time was 11 months.There was a little swelling on the outlooks of the flap,but the texture and sensation of the flap was good.Conclusion The lateral arm free perforator flap has a stable vessel pedicle,good texture and sensation,so it was a good method to repair middle and small skin defect in finger injury.
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Objective To provide anatomical landmarks with which to facilitate flap dissection,we studied the perforator artery of the dorsal forearm including its source,quantity,origination,caliber,variation and pedicle length. Methods Ten fresh cadavers were injected with a modified lead oxide-gelatin mixture,and three-dimensional graphics of the perforator vessels of the dorsal forearm were reconstructed with a computed tomography. In addition, twenty upper extremity specimens were injected with red latex via the axillary artery.The integument of the forearm was dissected,and perforators were identified,including type,course,size and location were documented.Surface areas were measured with Scion Image. Results The average number of the posterior interosseous artery cutaneous perforators in the dorsal forearm was (5±2),the average outer diameter of the perforator artories was (0.5 ± 0.1) mm,and the pedicle length was (2.5 ±0.2) cm.The average cutaneous vascular territory was (22.0 ± 15.0) cm2.The dorsal branch of the anterior interosseous artery dispersed on the wrist dorsum or the distal third of the dorsal forearm. It's average diameter was 0.8 mum. Conclusion The free transplantation of the posterior interosseous perforator artery flaps or rotary flap pedicled by the dorsal branch of the anterior interosseous artery for defect reconstruction are feasible.
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Objective To summary the microsurgery clinical experience of 21 patients with cerebellopontine angle tumor by the help of three dimensional individual digital anatomy. And to evaluate the value of three dimensional individual anatomy in the treatment of tumors in cerebellopontine angle. Methods Between January 2011 and November 2011,21 patients with various cerebellopontine angle tumor,managed at the Third Affiliated Hospital of Sun Yat-Sen University, underwent CTA scan, and reconstruct the local anatomy by 3D view software. According to the individual anatomical model, the microsurgery program by restrosig moid approach was developed. Results All patients had reposition of the bone flap at original site after craniectomy during the same operative setting mentioned above with retrosigmoid approach. No complication was noted.Patients did not have any delayed postcraniectomy pain at operation site.Postoperative computed tomography of the skull showed good healing and shaping of the suboccipital bone at the surgical region. Conclusion With the help of three dimensional individual anatomy, the microsurgery of cerebellopontine angle tumor underwent less postoperative complications.This study provides a safe and effective individualized microsurgical methods by restrosig moid approach.
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ObjectiveTo evaluate the curative effect of reconstruction of the hand and foot defects with bones and tendons exposure using free medial sural artery perforator flap(MSAP). MethodsRadiographs of 2 cadavers injected with a modified lead oxide-gelatin mixture were digitally analyzed. Between April 2007 and December 2010, thirty-four patients with soft tissue defects in the distal limb were treated with the free MSAP flap transplantation. The sizes of the defect ranged 6 cm × 4 cm-13 cm × 8 cm, and the flaps ranged 7 cm× 5 cm-14 cm × 9 cm. These clinical cases included 25 hands and 9 feet, all of them with bones and tendons exposure.In these defects,twenty-two were clean,twelve got infections.In our cases, twenty-three flaps were nourished with single perforator vessel and else 11 with two;perforator vessel fifteen flaps were dissected one superficial vein to anastomose with that of the recipient sites in addition to accompanying vein anastomosis;The sensation of 9 flaps recovered the hands were reconstructed with cutaneous nerve anastomosis. ResultsA partition of the calf skin blood vessels,and three-dimensional reconstruction image of the sural artery were obtained.All flaps survived,five of them appeared partially violet and bubbles. Followed up 6-21 months, the cosmetic results were satisfactory and without apparent bulkiness.The flap colors were similar to recipient sites. The flap senses reconstructed with neural anastomosis recover to S2-S3. ConclusionThe new flap is very suitable to repair the soft tissue defect in the distal limbs,because the fairly constant perforator vessel,the reliable blood supply and the cosmetic shape of the MSAP flap are all advantages of it in addition to no damage to low leg chief artery and gastrocnemius.
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Objective To provide anatomical basis for the free saphenous branch of descending genicular artery flap and evaluate its clinical outcomes for the hand soft-tissue defects. Methods Fifteen fresh cadavers injected with lead oxide-gelatin mixture for three-dimensional visualization reconstruction using a spiral computed tomography scanner. The origin, course and distribution of the perforators of descending genicular artery were observed.From January 2005 to October 2011,seven patients with skin defect on the distant limbs were treated.The flap size was 5 cm × 6 cm-11 cm × 14 cm,vascular pedicle length 5.4 (4-7)cm. ResultsThe saphenous branch was consistent. It arised from the descending genicular artery (68％) or femoral artery(32％).The diameter of the saphenous branch was 1.5(1.1-1.7)mm at its origin above 9.0(4.0-16.0)cm from the medial epicondylar.Seven cases of flaps all survived,the average followup of 28 months,close to hand flap of skin texture,some sensory recovery,two-point discrimination 8-12mm. Conclusion Free saphenous branch of descending genicular artery flap is a reliable option for the treatment of soft tissue defect in hands. The pedicles were invariable of anatomy, thickness of the flaps is comparable,and procedure is simple and time saving.
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Objective To discuss the femoral neck anteversion(FNA) of developmental dislocation of the hip(DDH) and guide operation with visual and digitalized picture in the dimensional(3D) CT.Methods Ninety children with unilateral DDH were selected,and they were analyzed using 3D CT.Children whose FNA exceed 45 degree received the subtrochanter osteotomy with images from different direction,FNA of hip was measured respectively before and after operation and was measured in normal and abnormal hips respectively,FNA of hip received respectively statistical treatment.Ninety patients (90 hips) were followed up ranging from 3 months to 2 years with the mean of 13 months.Results In the group younger than 18 months,the FNA whose in normal hips was(19.40?3.512)degree,the FNA while(68.45?12.272)degree in dysplasia hips respectively,the FNA measured after operation was (20.45?2.940) degree;in the group elder than 6 years,there were significantly statistical differences,the FNA in normal hips was(19.44?3.561)degree,in dysplasia hips respectively was(73.49?12.678)degree,while the FNA measured after operation was(18.28?1.931)degree.Clinical assessment was performed according to Mckay′s classification.The results showed that the overall excellent or good rate was 95.6%.Conclusions 3D CT method is a new accurate and convenient and reduplicative method for measuring FNA.It will be more helpful for related operations when 3D images are considered.
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Objective To determine the anatomical basis of an algorithm to safely elevate the deep circumflex iliac artery osteocutaneous perforator(DCIAP) flap. Methods 1.Six unfixed corpses underwent whole body gelatine/lead oxide injection.Specimens were dissected by layers.Angiography and photography were used to document the precise course,size,location,and type of individual perforators in the lateral lumbar region.The surface areas of cutaneous territories and perforator zones were measured and calculated with Photoshop and Scion Image.2.One specimen also underwent whole body carboxymethylcellulose/lead oxide injection,CT scan and 3D-Reconstrution. Results An average of 1.6 DCIA perforators with a diameter of 0.7mm was present in 92% of specimens.Perforators were located 5～10 cm posterior to the anterior superior iliac spine,12～35mm above the crest,with a perforator zone of 31 cm~2.The DCIA reliably perfused the medial aspect of the iliac crest.Conclusion The DCIA reliably perfused the medial aspect of the iliac crest and lateral lumbar region.It offers a large quantity of bone on a pedicle of large diameter.The mobility of the skin component allows better tissue positioning during complex reconstructions.
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Objective To explore the evidence for the morphologic comparability between the meridians and interstitial connective tissues in the lower limb with auto-marked and 3D-Rebuilding technology. Methods First,the muscles were extracted and noise was eliminated;With edge detection a convex hull of the muscles edge was found;The interstitial connective tissue points were marked in the cross section images of left leg from the digital dataset of Virtual Chinese Human-Male1(VCH-M1).Finally,the auto-marked images were reconstructed with 3D-Doctor. Results The reconstructed meridians in the lower limb auto-marked with computer procedures tallied basically with the meridians and collaterals recorded in Traditional Chinese Medicine(TCM) illustrative graphics.Conclusion Having the advantages of digital anatomic study on acupuncture points earlier and mature 3D-Rebuilding techniques,the department of Anatomy of South Medical University cooperated with the Department of Scientific Calculation and Computer Application of Sun Yat-sen University to devise a set of computer programs which could be used to AutoMark interstitial connective tissues in Virtual Human lower limbs and then reconstruct virtual fascia meridians which corresponded with the TCM records.This method avoided man-made error to a certain degree in the process of recognizing and rebuilding of fascias.The study is significant to explore the morphologic comparability between the meridians and collaterals and interstitial connective tissues in human lower limb.