电子模拟人优化心脏听诊教学的探讨

Objective To explore the assistant teaching effects with electronic simulated patients in the heart auscultation teaching. Methods 106 students were divided into the electronic simulated patient teaching group (experimental group ) and the traditional method teaching group (control group ) at random. Through the questionnaire survey, the written examination and the practice skill inspection form,we compared the students' learning situation of the two groups. Results There was no significant differ-ence in the written examination results between the two group students ( P ＞ 0.05 ); the practice skill in-spection results of the experimental group was obviously higher than those of the control group, there being significant difference ( P ＜ 0.05 ). The questionnaire survey about teaching satisfaction degree with electronic simulated patients showd that 77.36% of the students appraiseot for good, 18.87% for general,3.77% for poor. Conclusions The assistant teaching with electronic simulated patients was helpful in improving students' practice operation skills. It had many merits, such as comprehensive contents, directviewing and strong repeatability, which might optimize the heart auscultation teaching.     

造纸厂热能负荷动态优化调度

建立了造纸厂能耗大的间隙式设备蒸球的动态优化调度模型，对该模型运用隐枚举（ＩＥ）算法和扩充了接收新解准则的模拟退火（ＳＡ）算法，分别进行了求解，最后从给出的仿真结果证明了该模型和算法的有效性．     

模拟跳伞着陆冲击力与冲击时间的关系

在实验室模拟条件下,研究着陆冲击力与着陆冲击时间的关系。被试者为3名年轻健康的男伞兵。当其负荷26.5k或无负荷,分别从1.0,1.5和2.0m的平台上跳下时,用高速摄影法记录他们身上的标记。计算结果表明:(1)作用在各活动节段上的着陆冲击力,随着陆冲击时间的延长而减少,作用在足部的着陆冲击力峰值与着陆冲击时间亦有相同的关系;(2)着陆冲击时间为0.08～O.26s时,上述诸力与其在0.08s时的值相比,减少40.6～64.1％;(3)作用在足部的着陆冲击力峰值与着陆冲击时间的关系曲线,与其回归方程的曲线相比,非常接近。     

Articulated Thoughts About Antigay Hate Crimes

This study employed the articulated thoughts in simulated situations (ATSS) paradigm in the investigation of college students' thoughts upon confrontation with a conspiracy to commit a sexual-orientation-based hate crime versus a nonbias crime. In a between-subjects experimental design, participants were exposed to an audiotaped scenario depicting either the planning of a hate crime or a comparable nonhate crime. Content analysis of participants' articulated thoughts in response to these stimuli revealed that the hate crime resulted in more intentions to physically aggress against the perpetrator. This supports the notion that hate crimes have a greater potential than other crimes to lead to future violence. More people were also willing to intervene and help the hate crime victim than the nonhate crime victim. In addition, antigay attitudes turned out to be predictive of anger against the hate crime victim, disapproval of the hate crime victim, and support of the hate crime perpetrators. Implications of these findings, as well as suggestions for future research, are discussed.     

The simulated microgravity enhances the differentiation of mesenchymal stem cells into neurons

Growing evidence shows that physical microenvironments and mechanical stresses, independent of soluble factors, help influence mesenchymal-stem-cell fate. rMSCs (rat mesenchymal stem cells) present spread, spindle shape when cultured in normal gravity (NG) while in simulated microgravity (SMG) they become unspread, round shape. Here we demonstrate that simulated microgravity can enhance the differentiation of mesenchymal stem cells into neurons, which might be a new strategy for the treatment of central nervous system diseases. rMSCs were cultured respectively in normal gravity and in a clinostat to simulate microgravity, followed with neuronal differentiated medium. The neuronal cells derived from rMSCs in SMG express higher microtubule-associated protein-2 (MAP-2), tyrosine hydroxylase (TH) and choline acetyltransferase (CHAT). Furthermore, as rMSCs are subjected to SMG, they excrete more neurotrophins like nerve growth factor (NGF), brain derived neurophic factor (BDNF) and ciliary neurotrophic factor (CNTF). Neuronal cells from SMG group generated more mature action potentials and displayed repetitive action potentials by comparison to cells from NG group. We conclude that simulated microgravity can enhance the differentiation of mesenchymal stem cells into neurons.     

Effects of simulated hypovolaemia on haemodynamics, left ventricular function, mesenteric blood flow and gastric Pco2

BACKGROUND: Compensated clinically silent hypovolaemia may lead to low cardiac output, hypoperfusion and ischaemia. We investigated the cardiovascular effects of simulated hypovolaemia to determine whether it caused mesenteric ischaemia detectable by gastric tonometry. METHODS: Thirteen healthy volunteers, aged 21-36 years, were investigated. Lower body negative pressure (LBNP) was used to simulate normotensive hypovolaemia. Cardiovascular parameters were measured using echocardiography. Mesenteric blood flow was investigated using Doppler sonography of the superior mesenteric artery (SMA). Gastric Pco(2) (P(g)co(2)) was measured using gas tonometry. Data were collected at baseline, LBNP and during a recovery period. RESULTS: Normotensive hypovolaemia was induced successfully in 11 volunteers. There were no significant differences in mean arterial pressure between the three data points (91 +/- 6, 93 +/- 10 and 95 +/- 9 mmHg, respectively). With the induction of LBNP, the heart rate increased from 64 +/- 16 to 73 +/- 16 beats/min (P < 0.001), the cardiac index decreased from 2.7 +/- 1.0 to 1.8 +/- 0.6 l/min/m(2) (P= 0.002) and the systemic vascular resistance increased from 1535 +/- 445 to 2270 +/- 550 dyn s/cm(5) (P < 0.001). The SMA mean flow velocity decreased from 53 +/- 18 to 37 +/- 20 cm/s (69 +/- 20%) (P= 0.007), and increased to 56 +/- 34 cm/s (106 +/- 38%) (P= 0.001) during reperfusion. The SMA resistance increased from 92 +/- 30 to 174 +/- 110 mmHg/l/min (P= 0.004). These changes were reversible after termination of LBNP. By contrast, there were no significant differences in P(g)co(2) between the three data points. CONCLUSIONS: In these volunteers, the mesenteric vascular bed contributed importantly to the maintenance of arterial pressure during normotensive hypovolaemia. However, this compensated hypovolaemia did not compromise the mesenteric perfusion sufficiently to increase P(g)co(2) and to allow detection by tonometry.     

Forward models of inertial loads in weightlessness

In this experiment, we investigated whether the CNS uses internal forward models of inertial loads to maintain the stability of a precision grip when manipulating objects in the absence of gravity. The micro-gravity condition causes profound changes in the profile of tangential constraints at the finger–object interface. In order to assess the ability to predict the micro-gravity-specific variation of inertial loads, we analyzed the grip force adjustments that occurred when naive subjects held an object in a precision grip and performed point-to-point movements under the weightless condition induced by parabolic flight. Such movements typically presented static and dynamic phases, which permitted distinction between a static component of the grip force (measured before the movement) and a dynamic component of the grip force (measured during the movement). The static component tended to gradually decrease across the parabolas, whereas the dynamic component was rapidly modulated with the micro-gravity-specific inertial loads. In addition, the amplitude of the modulation significantly correlated with the amplitude of the tangential constraints for the dynamic component. These results strongly support the hypothesis that the internal representation of arm and object dynamics adapts to new gravitational contexts. In addition, the difference in time scales of adaptation of static and dynamic components suggests that they can be processed independently. The prediction of self-induced variation of inertial loads permits fine modulation of grip force, which ensures a stable grip during manipulation of an object in a new environment.     

北京协和医院内科学系复合型精英医学人才培养探索

临床医学博士后项目是国家人力资源和社会保障部推行的复合型医学精英人才毕业后教育项目。2016年北京协和医院设立了临床医学博士后培养项目,内科学系在既往住院医师培养模式的基础上,创新设立了分层培养模式、阶梯式培养评估反馈体系、360°评价体系及危重症模拟培训课程等,并在实施过程中对项目进行持续改进和优化。本文对北京协和医院内科学系临床医学博士后培养项目运行实践进行总结,为培养具有国际视野的复合型医学精英人才提供借鉴和参考。