多发性骨髓瘤中表观遗传学修饰的研究进展北大核心

多发性骨髓瘤(multiple myeloma,MM)是一种病因不明,目前仍无法治愈的恶性血液系统性疾病。研究显示MM是一种复杂的表观遗传学修饰所驱动的恶性肿瘤,表观遗传学修饰是改变MM发病进展的重要机制,并影响治疗及预后。本文将对表观遗传学异常调控在MM的发生发展过程中的作用及相关耐药机制和治疗的现状进行综述。     

中耳胆脂瘤手术ICD-9-CM-3编码分析

手术治疗特别是中耳病变切除联合鼓室成形术是目前根治中耳胆脂瘤最主要的方法,依据2012年版的中耳炎手术分型指南内容,按照手术对外耳道后壁和鼓窦上鼓室侧壁处理方式不同,中耳病变切除具体类型和对应ICD-9-CM-3编码为:完壁式乳突根治术20.4900x009、开放式乳突根治术20.4900x008、完桥式乳突根治术20.49和上鼓室鼓窦切开术20.4900x007等,为避免上述手术编码的混淆,编码员应掌握每种术式的具体内涵。同时对于重要的其它手术操作如鼓室成形术19.4~19.5、耳甲腔成形术18.79、外耳道后壁重建术18.6和乳突缩窄术20.92等也不能漏编和多编。编码员应加强中耳结构和手术知识的学习,当不能确定手术具体类型时,应与耳鼻喉医师沟通,确定正确手术类型和内容时方可编码。     

单孔胸腔镜下肺癌术后胸腔引流时间的影响因素分析北大核心

目的:探讨单孔胸腔镜下肺癌手术术后胸腔引流时间的影响因素。方法:本研究采用回顾性分析方法,回顾我院2018年01月至2019年12月原发性肺癌患者经单孔胸腔镜手术治疗的病例199例。按照术后胸腔引流时间分为两组,Ⅰ组(术后胸腔引流时间<5天)和Ⅱ组(术后胸腔引流时间≥5天)。对于影响术后胸腔引流时间的可能因素在两组间先采用单因素分析的方法筛选,再将筛选出来的对术后胸腔引流时间可能有意义的影响因素进行二项Logistic多因素回归分析。结果:经单因素分析及二项Logistic多因素回归分析结果显示:年龄≥60岁、手术部位、肺段切除术、胸膜粘连、手术时间≥180 min、术后早期下床活动是术后胸腔引流时间的独立影响因素(P<0.05)。结论:对于具有多个延长术后胸腔引流时间的独立影响因素的患者,应制定个体化管理方案,尽可能减少术后胸腔引流时间,减少住院天数,加快患者康复。     

微视频联合微信在《神经病学》教学中的应用

目的研究微视频课堂播放联合课后微信平台共享教学模式在《神经病学》应用的教学效果。方法将《神经病学》教学任务中常见疾病的症状、体征及诊疗录制成微小视频,将预防医学和临床医学专业的22个班级随机分成对照组和试验组,分别进行常规模式教学和常规模式结合微视频课堂播放联合课后微信平台共享教学模式,通过理论考试、病案分析、文献检索能力及问卷调查方式综合评估教学效果。结果与对照组比较,试验组小考试及典型病案分析成绩的及格率、优秀率及平均分均提高(P<0.05)。试验组最终考试的及格率更高(P<0.05),差异具有统计学意义;两组最终考试的优秀率差异无统计学意义(P>0.05);试验组平均分更高(P<0.05)。结论微视频课堂播放联合课后微信平台共享教学模式在《神经病学》教学中的应用具有良好的教学效果。     

口语化疾病名称向国际规范疾病术语集的映射研究

目的：研究患者口语化疾病名称到术语疾病名称的映射，解决在线口语化疾病名称难以有效利用的问题。方法：抓取“微医网”上患者口语中的疾病名，将PubMed摘要、百度搜索页摘要与百科内容作为语料，训练词向量，用余弦距离计算相似度，由2名具有临床知识和从业经验的编码人员对结果的准确性进行检验。结果：将最相似词条的参数TopN设置为>= 30的时候效果比较好，映射到大类和细类的准确性分别稳定在60%和70%左右。结论：利用词向量将口语化疾病名称映射到国际疾病术语集，具有较强的通用性和可行性，对于在线问诊、智能分诊甚至自动化编码具有明显的参考借鉴价值。     

Assessment and management of the predicted difficult airway in babies and children

Although it is essential to take a history and examine every child prior to airway management, preoperative anticipation of a difficult airway is not totally reliable and therefore it is wise to be prepared for the unexpected difficult airway. Information about the airway can be gained from previous medical records, current history, physical examination and other tests. A natural consequence of airway assessment is development of an airway plan. Important anatomical and physiological features may be identified in an airway assessment which can then have a direct influence on the subsequent airway plan. Managing the predicted difficult airway is usually elective. This allows proper preparation of equipment, assistants, expertise and the environment required for the airway plan. This article will discuss paediatric airway assessment, outline those features that contribute to airway difficulty, and identify indications and risk factors associated with various airway techniques. Key objectives for an airway management plan are to maintain oxygenation and avoid trauma. This involves adopting techniques that avoid hypoxia and provide a high success rate with minimum attempts.     

微视频在ICU气管套管带管出院患者家属健康教育中的应用

目的探讨应用微视频对ICU气管套管带管出院患者的家属实施健康教育的效果。方法选取2018年9月—2020年9月的100例气管套管带管出院患者的家属,根据随机数字表法将其随机分为对照组和试验组各50例,对照组实施常规健康教育和随访;试验组在此基础上将患者出院后面临的共性问题进行归纳总结,制定并应用微视频对其实施健康教育。分别比较两组患者家属在气管套管相关知识知晓率、气管套管护理操作的准确性以及患者气管切开并发症发生率之间的差异。结果试验组家属在气管套管相关知识的知晓率和护理技能的得分均高于对照组家属(P<0.05),但患者气管切开相关并发症发生率低于对照组(P<0.05)。结论应用微视频实施健康教育可有效提高ICU气管套管带管出院患者家属的管路护理水平,提高患者带管期间的安全性。     

From the Cover: Echolocating bats rely on an innate speed-of-sound reference

Animals must encode fundamental physical relationships in their brains. A heron plunging its head underwater to skewer a fish must correct for light refraction, an archerfish shooting down an insect must “consider” gravity, and an echolocating bat that is attacking prey must account for the speed of sound in order to assess its distance. Do animals learn these relations or are they encoded innately and can they adjust them as adults are all open questions. We addressed this question by shifting the speed of sound and assessing the sensory behavior of a bat species that naturally experiences different speeds of sound. We found that both newborn pups and adults are unable to adjust to this shift, suggesting that the speed of sound is innately encoded in the bat brain. Moreover, our results suggest that bats encode the world in terms of time and do not translate time into distance. Our results shed light on the evolution of innate and flexible sensory perception.

Every organism must reliably sense its environment in order to survive and reproduce (1). Some sensory systems are innate and unalterable (2), allowing for efficient use even by naïve newborn animals (3–5). Others require learning or experience-dependent development—usually during a critical period during ontogeny (6, 7), though sometimes retained through adulthood (8), allowing for adapting sensing to changing environments (9, 10). The ability to accurately estimate distances with sub-centimeter accuracy is a hallmark of bat echolocation (11–13). Bats achieve this accuracy by means of delay-tuned neurons—neurons that are activated by specific call–echo time delays, supposedly encoding target distance (14–19), although it should be noted that some work suggests that the tuning width of delay-tuned neurons might not allow the accuracy that bats exhibit in delay perception (20). Though delay tuning has been shown to be (at least partially) innate at the neural level (21), this has never been tested behaviorally. Namely, when a newborn bat takes off for the first time, does its brain correctly translate time delays into distance?Translating time into distance relies on a reference of the speed of sound (SOS). This physical characteristic of the environment is not as stable as it may seem. The SOS may change considerably due to various environmental factors such as humidity, altitude, and temperature (22). Bats (Chiroptera) are a specious and widely distributed order of highly mobile and long-lived animals. They therefore experience a range of SOSs (with more than 5% variation, see below) between species, among species, and even within the life of a single individual. We therefore speculated that the reference of the SOS may not be innate to allow for the environmentally dependent SOS experienced by each animal.To test this, we examined the acquisition of the SOS reference by exposing neonatal bats to an increased SOS environment from birth (Materials and Methods). We reared two groups of bats from birth to independent flight in two flight chambers: six bats in normal air (henceforth: “air pups”) and five bats in a helium-enriched air environment (Heliox), where the speed of sound was 15% higher (henceforth: “Heliox pups”). Notably, Heliox pups were never active and did not echolocate in non-Heliox environment (Materials and Methods). This 15% shift is higher than the ecological range and was chosen because it is high enough to enable us to document behavioral changes but low enough so as to allow the bats to function (that is, to fly despite the change in air density). In order to feed, the bats had to fly to a target positioned 1.3 m away from their wooden slit roost. Once the bats learned to fly to the target independently (after ca. 9 wk), we first documented their echolocation in the environment where they were brought up, and we then moved them to the other treatment for testing (Materials and Methods). Because bats adjust their echolocation parameters to the distance of the target, before and during flight (23), we used their echolocation to assess the bats’ target range estimates. If the SOS reference is learned based on experience, the bats raised in Heliox should have learned a faster reference, so that when they flew in normal air, they would have perceived the target as farther than it really was. We also ran the same experiments on adult bats to test adult plasticity.