分模块网络通识课程在独立医学院校中的应用分析与建议——以首都医科大学为例

通识教育是高等教育的重要组成部分，肩负着提升大学生综合素养的重任。而独立医学院校相较于综合性大学，校内开设的选修课存在着专业性过强、课程类别不够丰富等问题。如何优化医学生的知识结构，提高科学素养和人文素养一直是独立医学院校教育教学改革的重要议题。通过对首都医科大学连续6个学期超星尔雅分模块通识课的情况进行系统分析，拟为独立医学院校进一步利用网络通识课程的优势，改进和优化网络通识课程体系，提出合理化建议。     

Book review of Delis-Kaplan Executive Function System. By D. C. Delis,E. Kaplan and J. H. Kramer (Texas: Psychological Corporation, 2001). [Pp. n/a]. £621.92 incl. VAT,with CD scorer; £489.18 incl. VAT,without CD scorer.

Objective: To develop and field-test a physical performance measure (MPS-PPM) for individuals with Mucopolysaccharidosis I (MPS I), a rare genetic disorder. Methods: Motor performance and endurance items were developed based on literature review, clinician feedback, feasibility, and equipment and training needs. A standardized testing protocol and scoring rules were created. The MPS-PPM includes: Arm Function (7 items), Leg Function (5 items), and Endurance (2 items). Pilot data were collected for 10 subjects (ages 5–29 years). We calculated Spearman's rho correlations between age, severity and summary z-scores on the MPS-PPM. Results: Subjects had variable presentations, as correlations among the three sub-test scores were not significant. Increasing age was related to greater severity in physical performance (r = 0.72, p<0.05) and lower scores on the Leg Function (r = ?0.67, p<0.05) and Endurance (r = ?0.65, p<0.05) sub-tests. The MPS-PPM was sensitive to detecting physical performance deficits, as six subjects could not complete the full battery of Arm Function items and eight subjects were unable to complete all Leg Function items. Subjects walked more slowly and expended more energy than typically developing peers. Conclusions: Individuals with MPS I have difficulty with arm and leg function and reduced endurance. The MPS-PPM is a clinically feasible measure that detects limitations in physical performance and may have potential to quantify changes in function following intervention.     

Compensation and Malingering in Traumatic Brain Injury: A Dose-Response Relationship?

The purpose of this study was to determine if there is a dose-response relationship between potential monetary compensation and failure on psychological indicators of malingering in traumatic brain injury. 332 traumatic brain injury patients were divided into three groups based on incentive to perform poorly on neuropsychological testing: no incentive; limited incentive as provided by State law; high incentive as provided by Federal law. The rate of failure on five well-validated malingering indicators across these groups was examined. Cases handled under Federal workers compensation laws showed considerably higher rates of failure and diagnosable malingering than cases handled under State law. The findings indicate that monetary compensation associated with workers compensation claims is a major motive for exaggeration and malingering of problems attributed to work-related brain injuries. The clinician's index of suspicion regarding exaggeration and malingering of symptoms and deficits should be much higher in the context of Federal workers compensation claims, particularly in patients who have suffered only mild traumatic brain injury.     

The Queuine Micronutrient: Charting a Course from Microbe to Man

Micronutrients from the diet and gut microbiota are essential to human health and wellbeing. Arguably, among the most intriguing and enigmatic of these micronutrients is queuine, an elaborate 7-deazaguanine derivative made exclusively by eubacteria and salvaged by animal, plant and fungal species. In eubacteria and eukaryotes, queuine is found as the sugar nucleotide queuosine within the anticodon loop of transfer RNA isoacceptors for the amino acids tyrosine, asparagine, aspartic acid and histidine. The physiological requirement for the ancient queuine molecule and queuosine modified transfer RNA has been the subject of varied scientific interrogations for over four decades, establishing relationships to development, proliferation, metabolism, cancer, and tyrosine biosynthesis in eukaryotes and to invasion and proliferation in pathogenic bacteria, in addition to ribosomal frameshifting in viruses. These varied effects may be rationalized by an important, if ill-defined, contribution to protein translation or may manifest from other presently unidentified mechanisms. This article will examine the current understanding of queuine uptake, tRNA incorporation and salvage by eukaryotic organisms and consider some of the physiological consequence arising from deficiency in this elusive and lesser-recognized micronutrient.     

The effects of low-level laser irradiation on bone tissue in diabetic rats

Diabetes mellitus (DM) leads to a decrease in bone mass and increase the risk of osteoporosis and in this context, many treatments have shown to accelerate bone metabolism. It seems that low-level laser therapy (LLLT) is able of stimulating osteoblast activity and produced increased biomechanical properties. However, its effects on bone in diabetic rats are not fully elucidated. The aim of this study was to evaluate the effects of LLLT on bone formation, immunoexpression of osteogenic factors, biomechanical properties and densitometric parameters in diabetic rats. Thirty male Wistar rats were randomly distributed into three experimental groups: control group, diabetic group, and laser-treated diabetic group. DM was induced by streptozotocin (STZ) and after 1 week laser treatment started. An 830-nm laser was used, performed for 18 sessions, during 6 weeks. At the end of the experiment, animals were euthanized and tibias and femurs were defleshed for analysis. Extensive resorptive areas as a result of osteoclasts activity were noticed in DG when compared to control. Laser-treated animals showed an increased cortical area. The immunohistochemical analysis revealed that LLLT produced an increased RUNX-2 expression compared to other groups. Similar RANK-L immunoexpression was observed for all experimental groups. In addition, laser irradiation produced a statistically increase in fracture force, bone mineral content (BMC) and bone mineral density compared to DG. The results of this study indicate that the STZ model was efficient in inducing DM 1 and producing a decrease in cortical diameter, biomechanical properties and in densitometric variables. In addition, it seems that LLLT stimulated bone metabolism, decreased resorptive areas, increased RUNX-2 expression, cortical area, fracture force, BMD, and BMC. Further studies should be developed to provide additional information concerning the mechanisms of action of laser therapy in diabetic bone in experimental and clinical trials.     

Medial sustainable nail versus proximal femoral nail antirotation in treating AO/OTA 31-A2.3 fractures: Finite element analysis and biomechanical evaluation

Objectives

Using finite element analysis and biomechanical tests, the biomechanical behaviors of Medial Sustainable Nail (MSN) and Proximal Femoral Nail Antirotation (PFNA) were compared for the fixation of fracture type of AO/OTA 31-A2.3.

Closing the survivorship gap in children and adolescents with Hodgkin lymphoma

The treatment of Hodgkin lymphoma (HL) is one of early success. However, disease-free survival (DFS) does not reflect latent organ injury and its impact on health status and well-being beyond 5 years. In fact, we are at a crossroads, in terms of needing individualized approaches to maintain DFS, while minimizing late effects and preserving health-related quality of life (HRQoL). Premature morbidity and mortality translate to a high societal cost associated with the potential number of productive life years ahead in this population who are young at diagnosis. The discordance between short-term lymphoma-free survival and long-term health and HRQoL creates a “survivorship gap” which can be characterized for individuals and for subgroups of patients. The current review delineates contributors to compromised outcomes and health status in child and adolescent (paediatric) HL and frames the survivorship gap in terms of primary and secondary prevention. Primary prevention aims to titrate therapy. Secondary prevention entails strategies to intervene against late effects. Bridging the survivorship gap will be attained with enhanced knowledge of and attention to biology of the tumour and microenvironment, host genetic factors, HRQoL and sub-populations with disparate outcomes.     

1990年至2017年中国人群石棉肺的疾病负担分析

目的 分析1990—2017年中国人群石棉肺的疾病负担水平及其变化趋势。方法 利用全球疾病负担2017年（GBD 2017）研究结果和数据，分析1990—2017年中国人群石棉肺的疾病负担状况并与全球人群进行比较。按年份、年龄、性别分析中国人群石棉肺的发病数、死亡数、伤残调整寿命年（DALY）、过早死亡损失寿命年（YLL）、伤残损失寿命年（YLD）；同时采用2000—2025年世界人口的平均年龄结构作为标准人口计算中国和全球人群石棉肺的标化发病率、标化死亡率、标化DALY率、标化YLL率、标化YLD率。计算2017年与1990年的变化幅度，分析疾病负担指标的变化。结果 2017年中国人群因石棉肺造成的DALY为9 984人年，占中国人群因尘肺病造成DALY（247 619人年）的4.03%，占中国总DALY（371 485 307人年）的0.0027%，在293种疾病中排名第262位，较1990年（269位）上升了7位；占全球人群因石棉肺造成DALY（69 074人年）的14.45%，在195个国家和地区中排名第1位。2017年中国人群石棉肺的发病数、死亡数、DALY分别为1 942例、285例、9 984人年，较1990年分别增长85.5%、46.9%、26.2%，增幅均低于全球水平；2017年的标化发病率、死亡率、DALY率分别为0.100/10万、0.016/10万、0.524/10万，分别较1990年下降6.8%、33.5%、34.3%，降幅均高于全球水平。中国人群石棉肺的发病数、死亡数、≥40岁DALY进入高发状态，分别为1 839例（占94.7%）、269例（占94.5%）、8 919人年（占89.3%）；2017年发病年龄和死亡年龄的中位数分别为63.6岁、70.1岁，较1990年分别延长9.4岁、6.4岁。结论 石棉肺对中国人群引起的疾病负担相对较轻，但占全球人群石棉肺疾病负担较大比重，应综合考虑过去我国石棉生产和使用量大、石棉肺潜伏期长等特征，持续关注石棉肺等相关疾病的健康风险和疾病负担。