停课不停学背景下对机能学实验虚拟实验平台建设的思考

北京中医药大学积极响应教育部"停课不停学"的要求,借助机能学实验虚拟实验平台切实保障机能学实验教学工作的顺利开展。此文通过对"停课不停学"背景下的机能学实验课程以及机能学实验虚拟实验平台进行系统思考,并且结合问卷调查、教师走访、纵向比较等方法,分析"停课不停学"背景下机能学实验虚拟实验平台的使用效果和不足之处,旨在为虚拟实验"金"平台的建设提供参考和思路。     

Association between clustering of cardiovascular risk factors and resting heart rate in Chinese population: a cross-sectional study

BACKGROUNDEpidemiologic studies have explored the association between a single cardiovascular risk factor (CVRF) and resting heart rate (RHR), but the research on the relation of multiple risk factors with RHR remains scarce. This study aimed to explore the associations between CVRFs clustering and the risk of elevated RHR.METHODSIn this cross-sectional study, adults aged 35–75 years from 31 provinces were recruited by the China PEACE Million Persons Projects from September 2015 to August 2020. We focused on seven risk factors: hypertension, diabetes mellitus, dyslipidemia, obesity, smoking, alcohol use, and low physical activity. Multivariate logistic regression was used to calculate odds ratios (OR) for elevated RHR (> 80 beats/min).RESULTSAmong 1,045,405 participants, the mean age was 55.67 ± 9.86 years, and 60.4% of participants were women. The OR (95% CI) for elevated RHR for the groups with 1, 2, 3, 4 and ≥ 5 risk factor were 1.11 (1.08–1.13), 1.36 (1.33–1.39), 1.68 (1.64–1.72), 2.01 (1.96–2.07) and 2.58 (2.50–2.67), respectively (P_trend < 0.001). The association between the CVRFs clustering number and elevated RHR was much more pronounced in young males than in other age-sex subgroups. Clusters comprising more metabolic risk factors were associated with a higher risk of elevated RHR than those comprising more behavioral risk factors. CONCLUSIONSThere was a significant positive association between the CVRFs clustering number and the risk of elevated RHR, particularly in young males. Compared clusters comprising more behavioral risk factors, clusters comprising more metabolic risk factors were associated with a higher risk of elevated RHR. RHR may serve as an indicator of the cumulative effect of multiple risk factors.

Over the past several years, the rapid development of smart wrist-worn devices has resulted in a convenient approach to monitoring resting heart rate (RHR) in daily life. RHR is becoming a promising indicator of cardiovascular health. Observational studies have shown that elevated RHR is associated with increased all-cause and cardiovascular mortality in populations with or without cardiovascular disease (CVD).^[1,2] Elevated RHR has also been found to be associated with cardiovascular risk factors (CVRFs), such as hypertension, diabetes mellitus, dyslipidemia, low physical activity and smoking, indicating its potential to reflect total cardiac risk.^[3–7] There is abundant epidemiologic evidence supporting the association between a single CVRF and RHR, but studies exploring associations between multiple CVRFs and RHR are limited. CVRFs tend to cluster within individuals, and several weak risk factors combined may result in a much higher risk than that due to a single strong risk factor. According to a cross-sectional survey in China, more than 45% of Chinese adults have two or more coexisting CVRFs.^[8] Thus, it is important to consider the situation of multiple CVRFs clustering. However, very few studies have analyzed the association between CVRFs clustering and RHR, and several aspects remain unknown. Firstly, prior studies mainly focused on the relation between metabolic risk factors and RHR.^[9–11] Behavioral risk factors such as smoking, physical activity and alcohol use have rarely been considered, even though these risk factors also have a significant effect on heart rate.^[3,5,7] Secondly, most studies merely dealt with the relation of CVRFs clustering number with RHR, while regarding each number of risk factors, different combinations of risk factors have not yet been considered before.^[9,12] It is important to consider different CVRF clustering patterns since some risk factors combined may lead to a higher risk of elevated RHR than others, even if the number of CVRFs is the same. Thirdly, prior studies did not assess associations stratified by sex and age. It has been well documented that RHR levels differ by sex and age. The RHR in women was on average 2–7 beats/min higher than that in men, and there was a decrease in the RHR with age.^[13,14] As such, whether the associations of CVRFs clustering with RHR varied between sex and age remains unclear. Taking advantage of the large sample size in our study, we are able to include a wider range of CVRFs (metabolic and behavioral risk factors), comprehensively evaluate the association between these CVRFs clustering and RHR, and further explore sex and age differences. This finding may inform us whether RHR can be used as a simple and efficient metric for the identification of high-risk individuals who require more intensive risk factor evaluation and earlier cardiovascular health monitoring in resource-constrained countries with substantial CVD burdens, such as China. To bridge this knowledge gap, we used data from the China PEACE Million Persons Projects, a nationwide screening project, to explore (1) the association between the number of CVRFs clustering and elevated RHR in the overall population and populations stratified by age and sex; and (2) the associations between different CVRFs clusters and the risk of elevated RHR in the overall population and populations stratified by sex.     

基于图论分析对自闭症谱系障碍儿童脑功能网络异常拓扑学属性的研究

目的 探讨自闭症谱系障碍(autism spectrum disorder,ASD)儿童与正常发育(typically developing,TD)儿童的脑功能网络拓扑结构差异。材料与方法 从国际自闭症脑成像交换数据库的4个站点中提取符合纳入标准的65例ASD儿童(ASD组)及65例TD儿童(TD组)的脑部静息态功能磁共振成像及T1加权结构像数据。应用图论分析研究大脑网络的拓扑结构,包括全局和局部拓扑参数。结果 在阈值范围内,ASD在聚类系数(clustering coefficient,Cp)和特征路径长度(characteristic path length,Lp)低于TD组(P<0.05);两组在全局效率(global efficiency,Eglob)、局部效率(local efficiency,Eloc)等指标的差异无统计学意义。ASD组和TD组的脑功能连接网络满足标准化的聚类系数(γ)>1和标准化的特征路径长度(λ)≈1,具有小世界网络属性,但两组间的γ和λ值差异无统计学意义。节点水平分析结果显示ASD组在双侧前扣带回、双侧尾状核、双侧海马、右侧顶下小叶等脑区的...     

白蛋白和免疫球蛋白检测在神经系统疾病诊断中的临床应用

目的探讨免疫球蛋白(Ig)和白蛋白(Alb)检测在神经系统疾病诊断中的应用价值。方法以16例非神经系统疾病为对照组,用散射光比浊法测定137例神经系统疾病患者脑脊液与血清中免疫球蛋白(IgG、IgA、IgM)和白蛋白的含量,通过Protis分析软件计算免疫球蛋白商值(QIg)、白蛋白商值(QAlb)和IgG指数,用以判断血脑屏障(BBB)功能状态及免疫球蛋白鞘内合成情况。结果1.正常组QAlb、QIgG、IgA和IgM分别为(4.3±1.4)、(2.1±0.8)、(1.2±0.6)、(0.3±0.2),与单纯BBB损害组和BBB损害伴有鞘内Ig合成组比较,三者差别具有统计学意义(P<0.05);2.单纯鞘内Ig合成组QAlb为(4.08±1.48),与正常组比较差异无统计学意义(P>0.05);3.单纯鞘内Ig合成组QIgA、QIgM值与正常组差别具有统计学意义(P<0.05),QIgG与正常组比较无统计学意义(P>0.05)。4.在正常组IgG指数为(4.7±1.2),与BBB损害伴有鞘内Ig合成组及单纯鞘内Ig合成组比较差别具有统计学意义(P<0.05),与单纯BBB损害组比较无统计学意义(P>0.05)。结论不同神经系统疾病BBB功能障碍发生频率、BBB损害程度、鞘内Ig合成类型及蛋白商值不同,因此,免疫球蛋白和白蛋白检测能够为某些神经系统疾病提供诊断及鉴别诊断依据。     

糖尿病肾病患者血清Ⅳ型胶原和层粘连蛋白水平的变化及临床价值

目的探讨糖尿病肾病(DN)患者血清中Ⅳ型胶原(C-Ⅳ)和层粘连蛋白(LN)水平的变化及其临床价值。方法用放射免疫法测定81例糖尿病(DM)患者(男48例,女33例)的血清C-Ⅳ和LN含量,分为正常白蛋白尿组36例,微量白蛋白尿组29例和大量白蛋白尿组16例,并以50例健康体检者为对照。用直线相关分析糖尿病患者血清C-Ⅳ、LN与其它临床指标之间的相关性。结果81例DM患者血清C-Ⅳ[(74.6±24.2μg/L]、LN[(137.1±29.5)μg/L]水平明显高于对照组[(45.4±7.9)、(98.6±15.4)μg/L,P<0.01];DM各亚组患者血清C-Ⅳ、LN水平均明显高于对照组(P<0.05,P<0.01);DM各组间血清C-Ⅳ、LN水平随尿白蛋白量的增加而升高,差异有统计学意义(P<0.05,P<0.01)。直线相关分折提示血清LN及C-Ⅳ水平均与BUN、Cr、HbA1C、UAER相关(P<0.05,P<0.01),血清C-Ⅳ、LN水平与FBG无相关性(P>0.05)。结论血清C-Ⅳ、LN水平与糖尿病肾病病程的发生发展密切相关,联合检测血清C-Ⅳ、LN、HbA1c、UAER可能更早、更全面地反映DN的病变程度。     

非桥粒芯糖蛋白抗体在寻常型天疱疮中的作用机制

既往发现寻常型天疱疮(pemphigus vulgaris,PV)发病机制与桥粒芯糖蛋白1(desmoglein,Dsg1)和Dsg3抗体有关,目前在PV患者中发现大量非Dsg自身免疫性抗体,包括桥粒胶蛋白1(desmocollin,Dsc1)和Dsc3、斑菲素蛋白1(plakophilin,PKP1)和PKP3、斑珠...     

住培基地管理人员线上培训学习与启示

介绍了北京市2020年8月住院医师规范化培训（住培）基地管理人员能力提升培训班线上授课的主要内容：包括住培制度建立的背景及重要性,住培相关政策介绍;基地评估的5个一级指标、16个二级指标、39个三级指标（住培工作重点）的具体评分标准,其中包括13项核心指标,是基地建设的关键,以及基地评审注意事项;住培招录相关文件政策简介,招录实施注意事项,招录工作中常见问题与解答,招录流程的规范要求;培训轮转安排的原则：依据培训细则的规定,尽量先安排必转科室的轮转,按照分层递进式轮转安排;住培考核分为过程考核和结业考核,过程考核是重点,主要包括：日常考核、出科考核、年度考核,简要介绍出科考核小组人员构成及考核流程等;以及住培医师入院入科教育、住院医师及住院师资日常管理等内容。通过培训,提升住培师资综合素质,为提高住培质量,培养合格的临床医师奠定基础。     

叙事医学在新生儿医学人文教育方面的应用

叙事医学是人文医学发展到一定程度的结果,体现了叙事思想在医学实践中的应用。目前国内外研究已经证实,叙事医学不仅在提高医务人员共情能力、自我反思引发、职业认同感增强等方面有良好的治疗效果,对间接改善患者生理、心理等也有很多益处。新生儿医学在我国起步较晚,目前我国的新生儿重症监护室（NICU）需要隔离监护,几乎不能做到母婴同室,甚至无法探视。新生儿科工作压力大,知识更新快,医学生需要在尽快掌握临床技术的前提下加强人文素养。扎实的临床基础是每一个新生儿科医生必备的,医学的发展也要求新生儿科医生在临床工作中的每个环节融入人文关怀精神。通过叙事医学教育,使新生儿科医生主动养成善于倾听患儿以及其背后家庭的故事,理解和同情患儿及其家属的心情及抉择,形成对患儿的共情能力以及专业的职业精神,促成以患儿为中心的临床思维。叙事医学在新生儿医学人文教育方面的研究还需在今后的临床实践中继续推进、不断应用和总结。     

“精准医学”理念下康复治疗人才培养的思考与实践

随着精准医学理念不断深入人心和“健康中国”国家战略的深入实施,患者对医疗水平的要求越来越高,康复医疗已向“精准康复”方向发展。作为人才培养的高等医学教育也必须顺应这种新的医学模式。我国康复治疗人才培养起步较晚,目前仍以“综合”康复治疗师培养为主,这种“庞杂”的康复治疗人才培养模式,与国际上专业分化培养的现状不接轨,导致培养的人才不精不专,甚至无法与国际专业组织及人员进行对话。这就要求我们要逐步改革目前康复治疗专业教育模式,构建与国际接轨、符合精准医学理念的人才培养模式。文章立足于国内康复治疗人才培养现状,从专业设置分化、课程体系和教学内容设立、教学师资队伍建设、教育教学模式和教学手段改革、临床实习带教队伍建设等5个方面,阐述了如何开展分方向培养康复治疗人才,培养符合精准医学理念的、满足国际国内需求的高、精、专高水平合格人才,以迎接精准医学教育时代的到来。     

不同保湿预处理法对口腔器械清洗灭菌效果的影响

目的 探究不同保湿预处理方法对口腔器械的清洗灭菌效果。方法 选择2019年11月—2020年11月本院口腔诊疗器械反光镜、牙钻手机、止血钳等共560件,随机分为观察组和对照组各280件,对照组进行无菌水擦拭,观察组在无菌水擦拭的基础上使用泡沫酶保湿剂,两组均保存于密闭容器中。集中由清洗消毒中心统一清洗消毒后,对两组常规检测结果、隐血残留检测结果、蛋白检测及三磷酸腺苷（ATP）检测结果进行对比。结果 两组经肉眼检查合格率观察组为100%,对照组为98.93%,经放大镜检查口腔器械合格率观察组为99.29%,对照组为98.57%,两组比较差异无统计学意义（P> 0.05）;观察组器械总隐血阳性率明显低于对照组（P <0.05）,器械表面的蛋白检测合格率为、ATP检测合格率均明显高于对照组（P <0.05）。结论 经无菌水擦拭联合泡沫酶保湿的预处理降低了口腔器械的隐血阳性率,提高表面蛋白检测及ATP检测的合格率,有效清除有机物残留,为后续清洗灭菌起到积极的作用。