思维导图引导的微课对中医内科实习学生考核成绩、评判性思维能力及学习效率的影响

目的　分析思维导图引导的微课对中医内科实习学生考核成绩、评判性思维能力及学习效率的影响。方法　研究对象为2018年7月至2019年11月于本院中医内科轮转的实习学生86人,依据随机数字表法分为两组,对照组（n=43）采用传统教学开展教学活动,研究组（n=43）采用思维导图引导的微课开展教学活动。对比考核成绩、评判性思维能力、学习效率、综合能力评估结果。采用SPSS 21.0进行t检验和卡方检验。结果　研究组理论成绩、技能实践考核成绩均高于对照组（P＜0.05）。干预后两组评判性思维能力各维度评定结果均优于干预前,且干预后研究组评判性思维能力各维度评定结果均优于对照组（P＜0.05）。研究组学习效率总有效率明显高于对照组（P＜0.05）。研究组综合能力各维度评估结果均明显高于对照组（P＜0.05）。结论　将思维导图引导的微课应用于中医内科实习带教中,对实习学生评判性思维能力与综合能力培养产生积极影响,考核成绩优异,学习效率高。     

腹针治疗非典型抗精神病药物所致肥胖的治疗效果观察

目的 探讨腹针对非典型抗精神病药物所致肥胖患者体质量、腰围、体质量指数（body mass index,BMI）及血脂的影响。方法 将60例服用非典型抗精神病药物所致肥胖的患者,根据年龄、性别、病程、既往肥胖时间,按组间均衡的原则分为治疗组和对照组,每组30例。治疗组采用腹针治疗,对照组为健康指导。观察两组患者在治疗前、治疗第28天和治疗第56天体质量、腰围、BMI及血脂浓度的变化。结果 对研究结果采用重复多因素方差分析,治疗组腰围、BMI、三酰甘油与对照组相比,差异有统计学意义（P < 0.05）,治疗组效果优于对照组。进行两两比较分析结果发现,在治疗第28天时,治疗组腰围及BMI与对照组相比,差异有统计学意义（P < 0.05）;第56天时,治疗组体质量、腰围、BMI、三酰甘油与对照组相比,差异有统计学意义（P < 0.05）,治疗组效果优于对照组。结论 腹针能有效地降低服用抗精神病药物所致肥胖患者体质量、腰围、BMI,促进脂代谢,降低血脂水平。     

High-pressure study of lithium amidoborane using Raman spectroscopy and insight into dihydrogen bonding absence

One of the major obstacles to the use of hydrogen as an energy carrier is the lack of proper hydrogen storage material. Lithium amidoborane has attracted significant attention as hydrogen storage material. It releases ∼10.9 wt% hydrogen, which is beyond the Department of Energy target, at remarkably low temperature (∼90 °C) without borazine emission. It is essential to study the bonding behavior of this potential material to improve its dehydrogenation behavior further and also to make rehydrogenation possible. We have studied the high-pressure behavior of lithium amidoborane in a diamond anvil cell using in situ Raman spectroscopy. We have discovered that there is no dihydrogen bonding in this material, as the N—H stretching modes do not show redshift with pressure. The absence of the dihydrogen bonding in this material is an interesting phenomenon, as the dihydrogen bonding is the dominant bonding feature in its parent compound ammonia borane. This observation may provide guidance to the improvement of the hydrogen storage properties of this potential material and to design new material for hydrogen storage application. Also two phase transitions were found at high pressure at 3.9 and 12.7 GPa, which are characterized by sequential changes of Raman modes.Hydrogen economy has been considered as potentially efficient and environmental friendly alternative energy solution (1). However, one of the most important scientific and technical challenges facing the “hydrogen economy” is the development of safe and economically viable on-board hydrogen storage for fuel cell applications, especially to the transportation sector. Ammonia borane (BH₃NH₃), a solid state hydrogen storage material, possesses exceptionally high hydrogen content (19.6 wt%) and in particular, it contains a unique combination of protonic and hydridic hydrogen, and on this basis, offers new opportunities for developing a practical source for generating molecular dihydrogen (2–5). Stepwise release of H₂ takes place through thermolysis of ammonia borane, yielding one-third of its total hydrogen content (6.5 wt%) in each heating step, along with emission of toxic borazine (6–8). Recently, research interests are focusing on how to improve discharge of H₂ from ammonia borane, including lowering the dehydrogenation temperature and enhancing hydrogen release rate using different techniques, e.g., nanoscaffolds (9), ionic liquids (10), acid catalysis (11), base metal catalyst (12), or transition metal catalysts (13, 14). More recently, significant attention is given to chemical modification of ammonia borane through substitution of one of the protonic hydrogen atoms with an alkali or alkaline–earth element (15–21). Lithium amidoborane (LiNH₂BH₃) has been successfully synthesized by ball milling LiH with NH₃BH₃ (15–18). One of the driving forces suggested for the formation of LiNH₂BH₃ is the chemical potential of the protonic H^δ+ in NH₃ and the hydridic H^δ− in alkali metal hydrides making them tend to combine, producing H₂ + LiNH₂BH₃. LiNH₂BH₃ exhibits significantly different and improved dehydrogenation characteristics from its parent compound ammonia borane. It releases more than 10 wt% of hydrogen at around 90 °C without borazine emission. Also, the dehydrogenation process of lithium amidoborane is much less exothermic (∼3–5 kJmole⁻¹ H₂) (15–17) than that of NH₃BH₃ (∼22.5 kJmole⁻¹ H₂) (6–8), which greatly enhances the search for suitable regeneration routes (prerequisite for a hydrogen storage material). Although the rationale behind the improved dehydrogenation behavior is still unclear, these improved property modifications evidently originate from the substitution of one H in the NH₃ group by the more electron-donating Li, which exerts influences on the bonding characteristics, especially on the dihydrogen bonding, which is one of the characteristic bonds of ammonia borane (15). So, it is essential to understand details about the bonding behavior of this potential material.High-pressure study of molecular crystals can provide unique insight into the intermolecular bonding forces, such as hydrogen bonding and phase stability in hydrogen storage materials and thus provides insight into the improvement of design (22–30). For instance, Raman spectroscopic study of ammonia borane at high pressure provided insight about its phase transition behavior and the presence of dihydrogen bonding in its structure (25–30). We have investigated LiNH₂BH₃ at high pressure using Raman spectroscopy. We have found that, other than in NH₃BH₃, dihydrogen bonding is absent in lithium amidoborane structure and LiNH₂BH₃ shows two phase transitions at high pressure.     

Bolton指数指导正畸的临床应用

正畸治疗的目标就是要达到口颌系统功能的平衡,以及实现牙齿、颅、面型的美观和理想的咬合。Bolton于20世纪提出前牙比和全牙比的概念,并被广泛采纳和接受,成为错畸形的诊断、设计和预测错畸形治疗的一个常规指标和重要方法。Bolton指数还受很多因素的影响,但其决定因素还有待研究。     

从神经介入医师视角剖析SAMMPRIS研究:对颅内动脉支架成形术的评价

支架植入和强化药物治疗预防颅内动脉狭窄患者脑卒中复发(SAMMPRIS)研究是由研究者发起、美国国立神经病学与卒中研究所(NINDS)资助、50所医疗中心参与的随机对照临床研究,旨在验证其主要假设:对颅内动脉粥样硬化性狭窄(ICAS)伴复发性脑卒中高危特征[狭窄程度≥70%、近1个     

The animal experiment of a new optimised distraction implant

Our aim was to evaluate the function of a new optimised distraction implant. Six dogs with alveolar bone defects had a total of 18 distraction, and 6 normal, implants inserted into edentulous mandibular ridges after osteotomy. Five days after insertion the distraction implants were activated at a rate of 1 mm/2 days to achieve a distraction height of 6 mm. Radiographs were taken at 0, 1, 2, and 3 months after distraction. Two dogs were killed after 1, 2, and 3 months, respectively, and 12 distraction implants taken from the different time points were evaluated by microcomputed tomographic (MicroCT) scanning and histological examination. The other 6 distraction, and the 6 normal, implants were compared after osseointegration with a fatigue test. The results showed that all the distraction implants had successfully distracted the bone to the anticipated height. Radiographs showed that the density of the regenerated bone increased steadily during the consolidation period. MicroCT showed that the regenerated bone was comparable with the native bone 3 months after distraction. Both native and regenerated bone had osseointegrated histologically by 1 month and 3 months after distraction. The experiment successfully confirmed the usefulness and feasibility of this new distraction implant, and suggests interesting clinical uses.     

不同类型老年吸入性肺炎的病原学、抗生素应用及临床转归

目的 比较老年社区获得性吸入性肺炎(CAP)、医疗相关性吸入性肺炎(HCAP)及医院获得性吸入性肺炎(HAP,包括呼吸机相关性吸入性肺炎)三者病原学、抗生素应用及治疗转归的关系.方法 收集2005年1月一2010年12月北京二炮总医院呼吸科住院的216例老年吸人性肺炎患者病例,分析其病原学结果、抗生素应用的及治疗转归.结果 三种吸入性肺炎的病原学有显著差异,与CAP和HCAP相比,HAP患者G-杆菌的感染比例明显增多(P<0.001);抗生素应用方案有明显差异,CAP组病人未调整抗生素应用比率明显高于HCAP组与HAP组(P<0.001);抗生素应用策略不同,所致死亡率有明显差异,以升阶梯方案为最高,以降阶梯治疗为最低(P=0.03).结论 三种吸入性肺炎在感染病原菌种类、抗生素应用策略及治疗转归上有明显差异,应根据不同类型的老年吸入性肺炎特点合理经验性使用抗菌药物.     

A Gd-doped HfO2 single film for a charge trapping memory device with a large memory window under a low voltage

In this study, a performance-enhanced charge trapping memory device with a Pt/Gd-doped HfO₂/SiO₂/Si structure has been investigated, where Gd-doped HfO₂ acts as a charge trapping and blocking layer. The device demonstrates a large memory window of 5.4 V under a ±5 V sweeping voltage (360% of the device with pure HfO₂), which is extremely attractive in low-power applications. In addition, the device also exhibits good retention characteristics with a 24.5% charge loss after the retention time of 1 × 10⁵ seconds and robust endurance performance with a 1% degradation after 1 × 10⁴ program/erase cycles. It is considered that the high density of defect states and the reduction in the defect energy levels induced by Gd-doping contribute to the performance improvement.

In this study, a performance-enhanced charge trapping memory device with a Pt/Gd-doped HfO₂/SiO₂/Si structure has been investigated, where Gd-doped HfO₂ acts as a charge trapping and blocking layer.     

骨质疏松症中医体质与辨证分型的相关性研究——附300例临床分析

目的 探讨骨质疏松症中医体质与辨证分型之间的相关性。方法 按照中西医诊断标准,将确诊的骨质疏松症患者进行中医体质分类与中医辨证分型的临床研究,找出其相关性与规律性,并进行总结。 结果 对300例患者进行中医辨证分型发现脾胃气虚证最多,占总病例数的23.00%,其次为肝肾不足证,占22.00%,以后依次为肾阳虚证、肾阴虚证、气血不足证、血瘀证、骨痿证、肝气郁结证、痰湿证、湿热证;在9种体质分类中阴虚质发病率排在第一位,其次为气虚质,以后依次为阳虚质、血瘀质、特禀质、平和质、痰湿质、湿热质与气郁质。结论 提示9种中医体质中阴虚质与气虚质发病率较高, 辨证分型中发病率较高的2个证型是脾胃气虚型与肝肾阴虚型。说明了体质类型与OP发病率有密切的相关性。     

机器人胸腺扩大切除术在老年重症肌无力患者中的应用

目的评价达芬奇S（da Vinci S）机器人胸腺扩大切除术在老年重症肌无力患者中的应用价值。方法 2009年5月～2011年12月,使用da Vinci S机器人手术系统完成9例老年重症肌无力胸腺及胸腺瘤切除并进行胸腺周围脂肪组织清扫术。全身麻醉下双腔气管插管,仰卧位,一侧胸部垫高30°,术侧胸壁腋前线第5肋间皮肤切开1.5 cm,置入trocar作为观察孔,左右侧各约10 cm的距离（在腋前线第3肋间和锁骨中线第6肋间）置入左右机械手臂trocar,在腋中线第7肋间置入trocar作为辅助操作孔,连接机械手臂。人工气胸压力6～12 mm Hg。胸腺及周围脂肪组织置入一次性取物袋,经辅助操作孔取出。结果 9例均手术成功,无中转开胸。麻醉时间平均180 min（60～210 min）,机器人手术时间平均60 min（30～110min）,术中出血量平均100 ml（30～200 ml）。无手术输血,住ICU时间平均1 d（1～3 d）。9例随访5～32个月,平均12个月,DeFilippi分级1级2例,2级2例,3例5例,有效率100%。结论选择合适的老年患者,使用da Vinci S机器人手术系统行胸腺扩大切除术安全可行,效果确切。