七年制医学生消化内科临床见习带教体会

七年制医学生基础知识扎实、自学能力强,但临床分析和解决问题的实际工作能力欠缺,而临床见习是医学生理论联系实际的纽带和桥梁。因此,努力提高临床见习的带教效果,对于医学生理解、巩固所学基础知识,为临床实习奠定良好的实践基础至关重要。现结合我科多年带教七年制学生见习的具体情况,探讨如何提高七年制医学生临床见习的带教效果。1传统消化内科见习带教中的困难和缺陷消化内科理论课学时多、专业性强,学习内容多、概念抽象,使学生理解较困难。过去见习带教中大部分时间以教师讲课为主,学生多处于被动地位,部分学生出现厌烦、兴趣不浓…     

Calcium currents and transmitter output in cultured spinal cord and dorsal root ganglion neurons

The effects of repetitive activation upon voltage-dependent calcium currents (ICa) and transmitter release were studied in dissociated cell cultures of fetal mouse spinal cord and dorsal root ganglion. Sodium and potassium currents were suppressed with tetrodotoxin (TTX) and tetraethylammonium (TEA) ions, 4-aminopyridine (4-AP), and cesium sulfate. Calcium currents were compared under voltage clamp before and after a series of depolarizing clamp pulses in spinal cord (SC) and dorsal root ganglion (DRG) neurons. Repetitive activation resulted in an exponential decline in ICa, with the decrease in ICa being much more marked in DRG compared with SC neurons. Both voltage-dependent inactivation and inactivation related to the intracellular movement of Ca2+ appeared to be involved in the decrement in ICa with repetitive activation. A decrease in transmitter output occurred with repetitive activation in DRG neurons but not in SC neurons (either excitatory or inhibitory). DRG neuron synaptic boutons had fewer mitochondria than did the boutons of either excitatory or inhibitory of SC neurons. The decrement in both ICa and synaptic transmitter output in DRG neurons could last for prolonged periods (at least minutes) following repetitive activation. We hypothesize that this vulnerability of DRG neurons to repetitive activation may be related, at least in part, to a relative incapacity to maintain a low intracellular calcium ion concentration [Ca]i during periods of increased calcium ingress associated with excitation. Such an incapacity to buffer [Ca]i may be one mechanism leading to the inactive synapses seen in some studies in vitro and in vivo of synaptic transmission.     

心肌缺血／再灌注损伤时相性变化的电子示踪研究

本文以结扎家兔冠状动脉左室支为心肌缺血模型,应用镧电子示踪技术,生物体视学定量分析等方法,观察了心肌缺血不同时间再灌注后细胞膜系及线粒体超微结构以及镧示踪所提示的线粒体的功能变化等特点。结果表明,在心肌缺血20分时,细胞膜通透性升高,镧粒子进入细胞,再灌注时更为严重,即出现再灌注损伤。此时镧粒子多集于肌浆管。随缺血时间延长(30—40分),变化愈趋严重,缺血40分后再灌注,镧粒子大量涌入线粒体。而缺血60分,特别是再灌注时,心肌细胞严重破坏,几乎无完整线粒体,其中亦很少有镧颗粒。说明在此情况下的再灌损伤已属不可逆性。膜通透性的变化是由外及里的,即先肌膜而后为细胞内膜。就线粒体来讲则是先外膜而后内膜。实验结果提出可逆性(早期)再灌注损伤期,及不可逆性再灌注损伤期(晚期)的概念。     

Diagnosis and taxonomy of periodical psychosis

The concept and taxonomy of periodic psychosis still remains in controversy for the past 100 years. In China, it was first reported by Ji, and thereafter various rinds of terminology and views were given by different authors. In the presentation, clinical investigation and follow up were carried out in 62 cases. In many of these cases, the so-called "periodic psychosis" or "phasophrenia" was early clinical features of schizophrenia or manic-depression. In those cases with apparent symptoms and signs of diencephalic function, differential diagnosis should be carried out from organic brain syndrome. In a small number of cases, their clinical manifestations, conforming to previous diagnostic criteria, might be an uncommon syndrome. It was concluded by the authors that until now periodic could be considered only as a clinical syndrome rather than a disease entity.     

Dietary Habit Is Associated with Depression and Intelligence: An Observational and Genome-Wide Environmental Interaction Analysis in the UK Biobank Cohort

Dietary habits have considerable impact on brain development and mental health. Despite long-standing interest in the association of dietary habits with mental health, few population-based studies of dietary habits have assessed depression and fluid intelligence. Our aim is to investigate the association of dietary habits with depression and fluid intelligence. In total, 814 independent loci were utilized to calculate the individual polygenic risk score (PRS) for 143 dietary habit-related traits. The individual genotype data were obtained from the UK Biobank cohort. Regression analyses were then conducted to evaluate the association of dietary habits with depression and fluid intelligence, respectively. PLINK 2.0 was utilized to detect the single nucleotide polymorphism (SNP) × dietary habit interaction effect on the risks of depression and fluid intelligence. We detected 22 common dietary habit-related traits shared by depression and fluid intelligence, such as red wine glasses per month, and overall alcohol intake. For interaction analysis, we detected that OLFM1 interacted with champagne/white wine in depression, while SYNPO2 interacted with coffee type in fluid intelligence. Our study results provide novel useful information for understanding how eating habits affect the fluid intelligence and depression.     

公立医院优势学科病种绩效管理研究:以骨科为例

目的从循证视角建立公立医院优势学科病种绩效管理工具。方法以波士顿矩阵理论为指导,以“病种均次毛利率、病种均次住院日”为主要指标,“日均毛利率”为辅助指标,采用Microsoft office EXCEL 365 软件进行分析。结果2019年骨科平均住院日为4.99 d,均次平均毛利率为23.62%,日均毛利率平均值为4.73%。骨科200例以上病种、不同亚专科病区病种、同一亚专科病区内不同病种、不同亚专科病区相同病种,绩效均存在差异。结论 管理者应对不同病种绩效指标进行适当校正,探索精细化病种诊疗与管理模式。     

苏州市儿童青少年身高别血压筛查简表的效果评价

目的 基于苏州市7~17岁儿童青少年评价身高别血压筛查简表的效果,为制定儿童青少年血压综合防控策略和措施提供参考。方法 采用分层整群随机抽样方法,2017-2018年抽取苏州市7~17岁学生6 972名,进行问卷调查,测量其身高、体重和血压。依据《7～18岁儿童青少年血压偏高筛查界值(WS/T 610-2018)》为“金标准”,评价根据金标准建立的身高别血压筛查简表筛查正常血压高值和血压偏高的效果。结果 根据金标准和身高别血压筛查简表,苏州7~17岁儿童青少年正常血压高值检出率分别为16.7%和16.6%,血压偏高检出率分别为12.7%和12.8%;配对χ²检验显示两标准评价效果差异无统计学意义(χ²=1.376,P=0.711)。与金标准相比,身高别血压筛查简表筛查正常血压高值,血压偏高具有较好的一致性。筛查正常血压高值的受试者工作特征曲线下面积(95%置信区间)、灵敏度、特异度和Kappa值分别为0.900(0.887~0.913)、83.2%、96.8%和0.803,对应的筛查血压偏高值分别为0.925(0.911~0.938)、86.9%、98.0%和0.848。结论 身高别血压筛查简表使用方便,筛查正常血压高值和血压偏高效果很好。     

Undocumented Migrants Reintroducing COVID-19, Yunnan Province,China

To limit the spread of severe acute respiratory syndrome coronavirus 2, the government of China has been monitoring infected travelers and minimizing cold-chain contamination. However, other factors might contribute to recurring outbreaks. We analyze the role of undocumented migrants as potential transmitters of severe acute respiratory syndrome coronavirus 2 in China.     

The 6-Month Efficacy of an Intensive Lifestyle Modification Program on Type 2 Diabetes Risk Among Rural Women with Prior Gestational Diabetes Mellitus: a Cluster Randomized Controlled Trial

Prevention Science - This study aimed to evaluate the efficacy of an intensive lifestyle modification program tailored to rural Chinese women with prior gestational diabetes mellitus compared with...