HLA-B evolutionary divergence is associated with outcomes after SARS-CoV-2 infection

We examined the correlation between class I HLA evolutionary divergence (HED), a surrogate for the capacity to present different peptides, and the outcomes of 234 adult inpatients with confirmed SARS-CoV-2 infection. Genomic DNA was extracted from peripheral blood and genotyped by next-generation sequencing (NGS). HED scores for HLA class I (HLA-A, -B, and -C) genotypes were calculated using Grantham’s distance. Higher HED scores for HLA-B, but not HLA-A or -C, are significantly associated with a decreased probability of poor outcomes including ICU admission, mechanical ventilation, and death (OR = 0.93; P = 0.04) in the univariate analysis. In the multivariate analysis, increased HLA-B HED score, younger age, and no comorbidity were independently associated with favorable outcomes (P = 0.02, P = 0.01, and P = 0.05, respectively). This finding is consistent with the notion that broader peptide repertoires presented by class I HLA may be beneficial in infection control.     

翻转课堂联合CBL教学在中医辨证见习中的应用

目的探讨翻转课堂联合CBL教学法应用于中医学辨证见习教学中的效果。方法将60名学生随机分为两组,每组30名,学生均来自于中南大学湘雅医学院临床医学专业2016级五年制本科。翻转课堂联合CBL教学法被应用于试验组,传统教学模式被应用于对照组,教学效果评价采用理论知识考核与学生满意度调查的双向评价模式。结果试验组的见习内容知识考核卷面成绩和满意度调查得分均高于对照组,差异均有统计学意义(P <0.05)。结论在中医学辨证见习课中,翻转课堂联合CBL教学法的教学效果优于传统教学模式。     

基于MDT的对分课堂联合CBL教学模式在软组织肿瘤临床教学中的应用

目的:探讨基于MDT的对分课堂联合CBL教学模式在软组织肿瘤临床教学中的应用效果及学员对该教学模式的评价。方法:选取2017年1月至2019年10月在我科接受住院医师规范化培训的50名学员为研究对象。随机分为对照组和实验组，每组25人。对照组授课方式为传统教学法，实验组授课采用MDT联合对分课堂和CBL教学法。教学结束后，采用命题考试进行教学效果考核；采用问卷调查的方法评估学生对教学模式的满意度。结果:实验组的选择题、简答论述、病例分析和总成绩分别为26.36±2.75、18.24±2.40、30.76±3.09、75.36±5.96，而对照组分别为24.40±3.80、16.60±2.10、29.04±2.86、70.04±6.30，两组比较有统计学差异（P<0.05）。在提高课堂学习效率、学习兴趣、自学能力、理论知识的理解和记忆能力，扩充专业知识，提高文献检索能力、分析问题和解决问题的能力、临床思维能力，这8个维度的赞成度调查中，实验组均优于对照组（P<0.05）。实验组学员对本组教学模式的接受度更高（P<0.05），但也有更多的实验组学员认为本组教学模式增加了学习负担（P<0.05）。结论:MDT联合对分课堂和CBL的教学模式应用于软组织肿瘤临床教学中，有利于提高教学效果，且接受度更高。     

Identifying Syndemics for Sexually Transmitted Infections Among Young Adults in the United States: A Latent Class Analysis

Purpose

Syndemic theory suggests that the convergence of social, environmental, and ecological factors can interact to exacerbate behavioral health problems and are often intensified by social conditions and disparities. This study used latent class analysis (LCA) to determine gender and racial/ethnic specific classes for sexually transmitted infection (STI) risk.

Evaluating Resource Utilization for In-Person and Virtual Joint Classes in Total Joint Arthroplasty: An Analysis of Attendance Patterns at a Large Metropolitan Health System

BackgroundProvider-run “joint classes” educate total joint arthroplasty (TJA) patients on how to best prepare for surgery and maximize recovery. There is no research on potential healthcare inequities in the context of joint classes or on the impact of the recent shift toward telehealth due to coronavirus disease 2019 (COVID-19). Using data from a large metropolitan health system, we aimed to (1) identify demographic patterns in prepandemic joint class attendance and (2) understand the impact of telehealth on attendance.MethodsWe included data on 3,090 TJA patients from three centers, each with a separately operated joint class. Attendance patterns were assessed prepandemic and after the resumption of elective surgeries when classes transitioned to telehealth. Statistical testing included standardized differences (SD > 0.1 indicates significance) and a multivariate linear regression.ResultsThe in-person and telehealth attendance rates were 69.9% and 69.2%, respectively. Joint class attendance was significantly higher for non-White, Hispanic, non-English primary language, Medicaid, and Medicare patients (all SD > 0.1). Age was a determinant of attendance for telehealth (SD > 0.1) but not for in-person (SD = 0.04). Contrastingly, physical distance from hospital was significant for in-person (SD > 0.1) but not for telehealth (SD = 0.06). On a multivariate analysis, distance from hospital (P < .05) and telehealth (P < .0001) were predictors of failed class attendance.ConclusionThis work highlights the relative importance of joint classes in specific subgroups of patients. Although telehealth attendance was lower, telehealth alleviated barriers to access related to physical distance but increased barriers for older patients. These results can guide providers on preoperative education and the implementation of telehealth.     

微型种植体支抗与口外弓支抗对安氏Ⅱ类1分类错牙合畸形患者的矫治效果对比分析

目的:分析比较微型种植体支抗与口外弓支抗对安氏Ⅱ类1分类错牙合畸形患者的矫治效果。方法:收集笔者医院95例安氏Ⅱ类1分类错牙合畸形患者临床资料,根据其治疗方法将之分为口外弓支抗(MIA组)46例和微型种植体支抗组(HGA组)49例,比较其矫正前后头影测量结果和模型测量结果,矫治时间和不良反应。结果:治疗后,MIA组牙合平面与SN平面夹角(OP-SN)、上颌中切牙牙长轴与SN平面夹角(U1-SN)、上唇突度、下唇突度、上唇最凸点至E线垂直距离(E line-UL)、下唇最凸点至E线垂直距离(E line-LL)、覆牙合(OB)、覆盖(OJ)均小于HGA组(P<0.05),矫治时间短于HGA组(P<0.05),总不良反应发生率与HGA组差异无统计学意义(P>0.05)。结论:对比HGA,MIA对安氏Ⅱ类1分类错牙合畸形患者的矫治效果更佳,且能够缩短矫治时间。