临床护理教师胜任力现状及与护生的评价比较

目的 调查临床护理教师胜任力水平及影响因素，为提高临床护理教学质量提供参考。方法 采用临床护理教师胜任力问卷、学习动机量表对重庆市11所三级医院的749名临床护理教师及458名实习护生进行调查。结果 临床护理教师胜任力自评均分为4.38±0.49,护生评价均分为4.12±0.65,护生评价总分及6个维度得分显著低于教师自评(均P<0.01);护龄、职务和学习动机是临床护理教师胜任力的影响因素(均P<0.01)。结论 临床护理教师胜任力处于较好水平，但护生评价低于教师自评；护理管理者可通过激发教师的学习动机进一步培养和提升临床护理教师的胜任力。     

Machine learning to predict myocardial injury and death after non-cardiac surgery

Myocardial injury due to ischaemia within 30 days of non-cardiac surgery is prognostically relevant. We aimed to determine the discrimination, calibration, accuracy, sensitivity and specificity of single-layer and multiple-layer neural networks for myocardial injury and death within 30 postoperative days. We analysed data from 24,589 participants in the Vascular Events in Non-cardiac Surgery Patients Cohort Evaluation study. Validation was performed on a randomly selected subset of the study population. Discrimination for myocardial injury by single-layer vs. multiple-layer models generated areas (95%CI) under the receiver operating characteristic curve of: 0.70 (0.69–0.72) vs. 0.71 (0.70–0.73) with variables available before surgical referral, p < 0.001; 0.73 (0.72–0.75) vs. 0.75 (0.74–0.76) with additional variables available on admission, but before surgery, p < 0.001; and 0.76 (0.75–0.77) vs. 0.77 (0.76–0.78) with the addition of subsequent variables, p < 0.001. Discrimination for death by single-layer vs. multiple-layer models generated areas (95%CI) under the receiver operating characteristic curve of: 0.71 (0.66–0.76) vs. 0.74 (0.71–0.77) with variables available before surgical referral, p = 0.04; 0.78 (0.73–0.82) vs. 0.83 (0.79–0.86) with additional variables available on admission but before surgery, p = 0.01; and 0.87 (0.83–0.89) vs. 0.87 (0.85–0.90) with the addition of subsequent variables, p = 0.52. The accuracy of the multiple-layer model for myocardial injury and death with all variables was 70% and 89%, respectively.     

Assessment of the Benefits of Targeted Interventions for Pandemic Control in China Based on Machine Learning Method and Web Service for COVID-19 Policy Simulation

Taking the Chinese city of Xiamen as an example, simulation and quantitative analysis were performed on the transmissions of the Coronavirus Disease 2019(COVID-19) and the influence of intervention combinations to assist policymakers in the preparation of targeted response measures. A machine learning model was built to estimate the effectiveness of interventions and simulate transmission in different scenarios. The comparison was conducted between simulated and real cases in Xiamen. A web inter...     

Deepm5C: A deep-learning-based hybrid framework for identifying human RNA N5-methylcytosine sites using a stacking strategy

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六味地黄汤干预抑郁大鼠学习记忆的作用机制

目的:探讨六味地黄汤对慢性抑郁大鼠记忆障碍的改善作用,并探讨其可能的作用机制。方法:Wistar雌性大鼠随机分为正常组(生理盐水)、慢性不可预见性温和应激(CUMS)模型组(生理盐水)、六味地黄汤低、中、高剂量组(2. 60,7. 81,23. 50 g·kg~(-1)·d~(-1))。除正常组外,其余各组造成CUMS模型。每周称体质量,观察其行为学指标变化;实时荧光定量聚合酶链式反应(Real-time PCR)检测其海马G蛋白偶联雌激素受体(GPR30),胞内磷脂酰肌醇激酶(PI3K),环磷酸腺苷反应元件结合蛋白(CREB),脑源性神经营养因子(BDNF) mRNA的表达;酶联免疫吸附测定(ELISA)检测血清中雌激素含量。结果:与正常组比较,模型组体质量、活动能力、兴趣等明显降低(P 0. 05,P 0. 01);与模型组比较,六味地黄汤2. 60,7. 81,23. 50 g·kg~(-1)可明显提高CUMS大鼠糖水偏好度(P 0. 01)和旷场实验的站立次数(P 0. 01);7. 81,23. 50 g·kg~(-1)明显提高旷场实验的总距离(P 0. 05,P 0. 01);2. 60,7. 81 g·kg~(-1)可缩短水迷宫实验寻台潜伏期(P 0. 01);7. 81 g·kg~(-1)可增加血清中雌激素含量(P 0. 05);CUMS模型组大鼠海马组织内的GPR30,PI3K,CREB,BDNF mRNA表达明显下降(P 0. 05,P 0. 01),六味地黄汤2. 60 g·kg~(-1)显著增加海马组织内的GPR30,CREB mRNA表达(P 0. 05,P 0. 01),7. 81 g·kg~(-1)明显增加海马组织内的GPR30,PI3K,CREB,BDNF mRNA表达量(P 0. 05,P 0. 01)。结论:六味地黄汤具有抗抑郁作用,逆转CUMS大鼠抑郁样行为及学习记忆障碍,其中中剂量组药效最显著。其作用机制可能与增加血清中雌激素和提高大鼠海马GPR30,PI3K,CREB,BDNF mRNA表达有关。     

基于“317护”健教平台的慢性肝病患者健康教育效果评价

目的探讨"317护"健教平台在住院的慢性肝病患者健康教育应用中的临床效果。方法选择2018年1～6月我院170例15～65周岁的住院患者为研究对象,采用随机数字表法等分为观察组和对照组,对照组由责任护士进行常规面对面的健康教育指导,观察组采用"317护"微信平台开展健康教育,比较两组患者对入院须知、疾病知识、治疗方法、检查须知、药物知识、饮食指导、出院指导等知识的掌握程度,两组患者对所获健康知识方式的满意度。结果观察组患者对入院须知、疾病知识、药物知识、饮食指导等的知晓率达93.95%,知识掌握程度明显高于对照组的81.18%,差异有统计学意义(P0.05),观察组患者对健康教育的满意度高于对照组,差异有统计学意义(P0.05)。结论结合"317护"健教平台的管理模式,能提高患者对健康教育知识的知晓率,促进患者对疾病的自我管理,提高其对护理工作的满意度。     

鲜天麻对睡眠干扰诱导小鼠学习记忆障碍的改善作用

目的研究鲜天麻对睡眠干扰(sleep interruption,SI)诱导的小鼠学习记忆障碍的改善作用。方法 HPLC法测定鲜天麻中天麻素、对羟基苯甲醇的含量,苯酚硫酸法测定多糖的含量。60只ICR雄鼠随机分为对照组、睡眠干扰模型组、阳性药(莫达非尼)组和鲜天麻低(3 g/kg)、高(9 g/kg)剂量组。睡眠干扰造模14 d后,依次进行自主活动、新物体识别、水迷宫和避暗等动物行为学检测实验,并测定小鼠血清和海马组织超氧化物歧化酶(SOD)、丙二醛(MDA)水平及海马组织乙酰胆碱(Ach)、谷氨酸(Glu)和去甲肾上腺素(NE)水平。结果自主活动实验中,各组小鼠运动功能无显著性差异。与对照组比较,模型组小鼠在新物体识别实验中的相对辨别指数(DI)显著性下降,水迷宫寻台潜伏期明显延长,避暗实验错误次数增加、入暗潜伏期缩短;血清和海马组织MDA水平升高,海马组织的SOD水平降低;海马组织Ach、Glu和NE水平均显著降低。与模型组比较,莫达非尼和鲜天麻各剂量能不同程度增加小鼠新物体识别DI,提高新物体辨别能力;增强空间学习获得和保持能力,缩短水迷宫潜伏期;减少避暗错误次数、延长避暗潜伏期;提高血清和海马组织中SOD、Ach、Glu和NE水平,降低MDA水平。结论鲜天麻能改善睡眠干扰引起的学习记忆障碍,改善氧化应激和神经递质水平,是一种有潜力的改善学习记忆中药。     

Tumor mutational burden related classifier is predictive of response to PD-L1 blockade in locally advanced and metastatic urothelial carcinoma

BackgroundImmunotherapy has made encouraging progress in the treatment of urothelial carcinoma, but only a small percentage of patients respond effectively to the immune checkpoint blockade (ICB). Our study aims to develop a classifier could effectively predict the response to ICB.MethodsSupport vector machines recursive feature elimination (SVM-RFE) algorithm was used to feature selection, then compared nine common binary classification algorithms through machine learning, we selected the classifier with the highest prediction performance (LASSO logistics classifier). Ten-fold cross-validation was used to avoid the overfitting effect.ResultsWe developed a classifier on a urothelial carcinoma cohort treated with PD-L1 inhibitor Atzolizumab (IMvigor210 cohort, n = 272) and calculated a tumor mutational burden-related LASSO score (TLS) using the LASSO algorithm, which was significantly correlated with Tumor mutational burden (TMB) and neoantigen burden. We validated the efficacy of TLS in predicting prognosis and immunotherapy benefit in internal (IMvigor210) and external validation set (TCGA-BLCA, n = 406), respectively.ConclusionsAfter in-depth analysis, we provide a new idea for stratified treatment of such patients, that is, patients with high TLS should use ICB and also may benefit from hormone therapy, while patients with low TLS respond poorly to ICB and maybe benefit from targeting TGFβ.     

Learning theories and principles in surgical education and technical learning

What is important to think about in surgical education and technical skills training? Technical skills training is grounded in social cognitive theory and the concepts of modeling and self-efficacy. Cognitive and nontechnical learning is critical to supplement the overall proficiency of the surgical learner in performing an operation. Technical learning is cemented by deliberate practice and there is benefit to productive struggle and failure. External cognitive load should be minimized to maximized operative skills advancement.