引导性反馈在内科模拟教学中的应用分析

目的探讨引导性反馈在内科模拟教学中的应用价值。方法此次研究所纳入的内科实习生均自2017年1月—2019年1月份进入本院,抽选量为80例。以随机数字表法完成分组,将应用常规内科模拟教学的40例内科实习生设立为参照组,将联合引导性反馈的40例患者设立为观察组。两组均由同组教师进行授课教学,教学后进行考核。经考核成绩分析和发放教学满意度问卷,比对两组实习生的教学情况。结果观察组的操作技巧、人文关怀、应急能力、理论知识分值更高,与参照组差异有统计学意义(P<0.05)。观察组的教学满意度更高,与参照组差异有统计学意义(P<0.05)。结论在内科模拟教学中开展引导性反馈,可强化学生对学习的反思,使学生教学积极性得到提高,有效提高学生教学成绩,改善教学质量。     

First-line nivolumab plus chemotherapy vs chemotherapy in patients with advanced gastric,gastroesophageal junction and esophageal adenocarcinoma: CheckMate 649 Chinese subgroup analysis

First-line chemotherapy for advanced/metastatic human epidermal growth factor receptor 2 (HER2)-negative gastric/gastroesophageal junction cancer (GC/GEJC) has poor median overall survival (OS; <1 year). We report efficacy and safety results from Chinese patients in the phase III global CheckMate 649 study of nivolumab plus chemotherapy vs chemotherapy for the first-line treatment of GC/GEJC/esophageal adenocarcinoma (EAC). Chinese patients with previously untreated advanced or metastatic GC/GEJC/EAC were randomized to receive nivolumab (360 mg Q3W or 240 mg Q2W) plus chemotherapy (XELOX [capecitabine and oxaliplatin] Q3W or FOLFOX [oxaliplatin, leucovorin and 5-fluorouracil] Q2W), nivolumab plus ipilimumab (not reported) or chemotherapy alone. OS, blinded independent central review-assessed progression-free survival (PFS), objective response rate (ORR), duration of response (DOR) and safety are reported. Of 1581 patients enrolled and randomized, 208 were Chinese. In these patients, nivolumab plus chemotherapy resulted in clinically meaningful improvement in median OS (14.3 vs 10.2 months; HR 0.61 [95% CI: 0.44-0.85]), median PFS (8.3 vs 5.6 months; HR 0.57 [95% CI: 0.40-0.80]), ORR (66% vs 45%) and median DOR (12.2 vs 5.6 months) vs chemotherapy, respectively. The safety profile was acceptable, with no new safety signals observed. Consistent with results from the global primary analysis of CheckMate 649, nivolumab plus chemotherapy demonstrated a clinically meaningful improvement in OS and PFS and higher response rate vs chemotherapy and an acceptable safety profile in Chinese patients. Nivolumab plus chemotherapy represents a new standard first-line treatment for Chinese patients with non-HER2-positive advanced GC/GEJC/EAC.     

不同剂量普奈洛尔治疗婴儿血管瘤的疗效评价

目的：探讨不同剂量普奈洛尔治疗婴儿混合型和深层血管瘤的临床效果，为血管瘤的治疗提供理论和实验依据。方法：将入选的62例混合型和深层血管瘤患儿随机分为普奈洛尔低剂量组和高剂量组，每组31例，分别采用1.5和3.0 mg.kg-1?d-1普奈洛尔口服，每日3次，疗程6个月，动态观察血管瘤的体积变化及不良事件发生率。结果：根据Achauer 疗效判定标准进行疗效比较，普奈洛尔低剂量组患儿总有效率为80.65%（其中Ⅰ级 6例，Ⅱ级 9例，Ⅲ级 11例，Ⅳ级5例)，普奈洛尔高剂量组患儿总有效率为93.55%(其中Ⅰ级 2例，Ⅱ级4例，Ⅲ级 10例，Ⅳ级15例)，普奈洛尔高剂量组疗效优于低剂量组(P<0.01)。不同部位和不同类型血管瘤疗效比较差异均无统计学意义(P>0.05)。2组患儿不良事件发生率比较差异无统计学意义(P>0.05)。 结论：普奈洛尔3.0 mg?kg-1?d-1口服治疗婴儿混合型和深层血管瘤疗效明显增加，但不良反应未见增加。建议临床治疗婴儿血管瘤时，可提高普奈洛尔的剂量，以提高治疗效果。     

Association of heart rate and diabetes among 0.5 million adults in the China Kadoorie biobank: Results from observational and Mendelian randomization analyses

Background and aimsObservational studies have associated resting heart rate with incident diabetes. Whether the associations are causal remains unclear. We aimed to examine the shape and strength of the associations and assessed the causal relevance of such associations in Chinese adults.Methods and resultsThe China Kadoorie Biobank enrolled 512,891 adults in China. Cox proportional hazard regression models was conducted to estimate hazard ratios (HRs) for the associations of resting heart rate with type 2 diabetes and total diabetes. Among 92,724 participants, 36 single-nucleotide polymorphisms (SNPs) related to resting heart rate were used to construct genetic risk score. We used Mendelian randomization analyses to make the causal inferences. During a median follow-up of 9 years, 7872 incident type 2 diabetes and 13,349 incident total diabetes were documented. After regression dilution bias adjustment, each 10 bpm higher heart rate was associated with about a 26% higher risk of type 2 diabetes (HR, 1.26 [95% CI, 1.23, 1.29]) and 23% higher risk of total diabetes (HR, 1.23 [95% CI, 1.20, 1.26]). Instrumental variable analyses showed participants at top quintile compared with those at bottom quintile had 30% higher risk for type 2 diabetes (HR, 1.30 [95% CI, 1.17, 1.43]), and 10% higher risk for total diabetes (HR, 1.10 [95% CI, 1.02, 1.20]).ConclusionsThis study provides evidence that resting heart rate is an important risk factor for diabetes risk. The results suggest that novel treatment approaches targeting reduction of high heart rate for incidence of diabetes may be worth further investigation.     

重症监护病房导管相关性尿路感染的影响因素及对院内感染的影响

目的探究重症监护病房导管相关性尿路感染的影响因素及对院内感染的影响。方法选取2018年6月至2019年10月本院收治的1128例重症患者,根据其是否发生导管相关性尿路感染分为观察组(65例)和对照组(1063例)。应用单因素分析及logistic回归分析重症患者导管相关性尿路感染的相关危险因素。结果1128例重症患者出现导管相关性尿路感染65例,发生率为5.76%(65/1128)。65例导管相关性尿路感染患者共分离病原菌79株。病原菌以革兰阴性菌为主,占43.04%(34/79);其次为真菌和革兰阳性菌,分别占25.32%(20/79)和24.05%(19/79)。两组合并糖尿病、住院时间、侵入性操作、留置导尿管时间及24 h尿量比较,差异均有统计学意义(P<0.05)。两组性别、年龄、体重指数(BMI)及合并高血压比较,差异均无统计学意义(P>0.05)。Logistic回归分析显示,合并糖尿病(OR=0.443,95%CI:0.228~0.860)、侵入性操作(OR=1.613,95%CI:1.163~2.104)、留置导尿管时间(OR=2.719,95%CI:2.314~4.106)、24 h尿量(OR=4.362,95%CI:1.974~10.915)是重症监护室患者发生导管相关性尿路感染的危险因素(P<0.05)。结论导管相关性尿路感染的危险因素包括合并糖尿病、侵入性操作、留置导尿管时间等。医务人员应采取相关措施以避免导管相关性尿路感染的发生,从而进一步减少医院感染。     

A meta-analysis of the prognosis in patients with breast cancer with ipsilateral supraclavicular lymph node metastasis versus patients with stage IIIb/c or IV breast cancer

ObjectiveTo systematically evaluate the prognosis in patients with breast cancer with ipsilateral supraclavicular lymph node metastasis (SLNM) versus patients with stage IIIb/c or IV breast cancer, so as to provide evidence for clinical practice and research.MethodsComputer retrieval from PubMed, Cochrane Libratory, CNKI (China National Knowledge Infrastructure), CBM and Wanfang Database with the assistance of other retrieval tools. All the studies evaluating the prognosis in patients with breast cancer with ipsilateral supraclavicular lymph node metastasis versus patients with stage IIIb/c or IV breast cancer were collected. Quality assessment was performed for the included data based on the quality assessment criteria appropriate for this study. Meta-analysis was performed using RevMan 5.3 software.ResultsA total of four references (1277 patients) were included. Assessment of influences on prognosis: As compared to the stage IIIb/c group, the 5-year survival rate was slightly lower in the SLNM group (relative risk (RR) 0.79; 95% confidence interval (CI) 0.59–1.06; Z = 1.55, P = 0.12), but there was no statistical significance; in contrast, the 5-year survival rate was significantly increased in the SLNM group as compared to the stage IV group (RR = 2.70; 95%CI: 1.36–5.37; Z = 2.84, P = 0.005). As compared to the stage IIIb/c group, the 5-year disease-free survival rate was lower in the SLNM group (RR = 0.65; 95%CI: 0.40–1.05; Z = 1.75, P = 0.08); however, there was no statistical significance.ConclusionsIn patients with advanced breast cancer receiving combined therapy, the prognosis in patients with breast cancer with ipsilateral SLNM was significantly better than in those with stage IV breast cancer, and slightly worse than those with stage IIIb/c breast cancer. However, with the scarcity and poor quality of these observational studies, the long-term prognosis remains to be further verified in large-sample, high-quality studies.     

南京市学龄前儿童视觉运动整合发育测验评估及相关因素分析

目的 对南京市学龄前儿童视觉运动整合能力发育情况进行调查,分析相关影响因素,为学龄前儿童的视觉运动整合临床工作提供参考。方法 2017年3—5月采用分层随机抽样的方法抽取南京市主城区6所幼儿园483名学龄前儿童,调查基本情况并进行视觉-运动整合发育测验评估。结果 1)随着儿童年龄增长,视觉运动整合能力原始得分呈上升趋势;2)各年龄组标准分性别间差异无统计学意义(P>0.05);3)除6岁8月~6岁9月组除外,各年龄组标准分均高于美国常模,差异有统计学意义(P<0.01);4)儿童学习舞蹈、乐器、父母文化水平因素与儿童视觉运动整合能力之间相关系数均在0.11~0.13之间,差异有统计学意义(P<0.05)。结论 视觉运动整合能力随年龄增长而提高,无性别差异,且与儿童学习舞蹈、乐器、父母文化水平因素存在一定的相关性。     

Automated radiosynthesis of [11C]UCB-J for imaging synaptic density by positron emission tomography

An automated radiosynthesis of carbon-11 positron emission tomography radiotracer [¹¹C]UCB-J for imaging the synaptic density biomarker synaptic vesicle glycoprotein SV2A was established using Synthra RNPlus synthesizer. Commercially available trifluoroborate UCB-J analogue was used as a radiolabelling precursor, and the desired radiolabelled product was isolated in 11 ± 2% (n = 7) nondecay corrected radiochemical yield and formulated as a 10% EtOH solution in saline with molar activities of 20 to 100 GBq/μmol. The method was based upon the palladium(0)-mediated Suzuki cross-coupling reaction and [¹¹C]CH₃I as a radiolabelling synthon. The isolated product was cGMP compliant as demonstrated by the results of quality control analysis.     

伴自杀未遂的儿童青少年抑郁症患者的家庭功能特点

目的 探索伴自杀未遂的儿童青少年抑郁症患者的家庭功能特点。方法 2019 年1 月 至2020 年1 月招募来自四川大学华西医院门诊、住院部11～18 岁的66 例儿童青少年抑郁症伴自杀未 遂的患者（抑郁症伴自杀未遂组）及75 例儿童青少年抑郁症不伴自杀未遂的患者（抑郁症不伴自杀未 遂组），通过张贴广告至社会及学校招募70 名健康儿童青少年（健康对照组）。采用贝克抑郁量表对病 例组进行抑郁严重程度评分；使用家庭一般情况调查表、家庭功能评定量表（FAD）对3 组对象的家庭 一般情况及家庭功能的七个维度进行调查并进行组间比较。采用多元有序Logistic 回归方法对儿童青 少年抑郁症伴自杀未遂的影响因素进行分析。结果 儿童青少年抑郁症伴自杀未遂组与抑郁症不伴 自杀未遂组贝克抑郁量表得分差异无统计学意义［35.00（28.00，42.00）比34.0（27.00，41.00），Z=1.310， P=0.190］。与健康对照组比较，儿童青少年抑郁症伴自杀未遂组情感反应因子［18.00（15.00，19.50）分 比15.00（13.00，17.00），Z=-4.741，P＜ 0.01］、沟通因子［25.00（22.50，28.00）分比21.00（19.00，23.00）分， Z=-5.310，P＜ 0.01］、角色因子［31.00（28.00，34.00）分28.00（26.00，30.00）分，Z=-4.434，P＜ 0.01］、情 感介入因子［16.00（14.00，19.00）分比13.00（12.00，15.00）分，Z=-4.426，P＜ 0.01］、行为控制因子［22.00 （20.00，23.00）分比20.00（18.00，22.00）分，Z=-3.451，P=0.002］、问题解决因子［15.00（12.00，17.00）分比 13.00（12.00，14.50）分，Z=-3.404，P=0.002］、总体功能［32.00（27.00，35.00）分比25.00（23.00，28.00），Z= -5.337，P＜0.001］。情感反应评分高（OR=1.150，95%CI：1.036～1.278，P=0.009）、家庭不和睦（OR=5.912， 95%CI：2.319～15.090，P＜ 0.01）、健康状况很差（OR=6.360，95%CI：1.964～20.594，P=0.002）、母亲本 科及以上学历（OR=5.392，95%CI：1.539～18.900，P=0.008）是儿童青少年抑郁症自杀未遂的相关因素。 结论 抑郁伴自杀未遂的儿童青少年抑郁症患者家庭功能较差，且家庭功能差是儿童青少年抑郁症出 现自杀未遂行为的相关因素。