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。     

Rotenone,an environmental toxin,causes abnormal methylation of the mouse brain organoid's genome and ferroptosis

More and more reports have pointed out that rotenone, as an insecticide, has high neurotoxicity and reproductive toxicity to livestock and mammals. As a highly physiological correlation system of internal organs, quasi-organs have great potential in the fields of drug toxicity and efficacy test, toxicology research, developmental biology and so on. In this study, brain organs (mBOs) derived from mouse neural stem cells were used to investigate the effects of rotenone on the physiological activity and epigenetic modification of mBOs. At the same time, Rotenone could significantly stimulate the increase of the concentration of LPO, lactic acid and hydroxyl radical in mBOs, and inhibit the expression of neuronal marker Tuj1, CHAT, PAX6 and so on. Further analysis showed that Rotenonem could induce mitochondrial damage in mBOs. The results of qPCR and Western blot showed that Rotenone could up-regulate the expressions of ferroptosis promoting protein p53, Cox2 and so on, while inhibit the expressions of negative regulatory protein of ferroptosis GPX4, FTH1, SLC7A11. In addition, the results of RRBS-Seq sequencing showed that the methylation modification at DMR level in Rotenone-treated mBOs group was significantly higher than that in Ctrl group. The results of KEGG analysis showed that compared with Ctrl, the genes with hypermethylation of promoter and Genebody in Rotenone-treated mBOs were mainly located in the Neuro active ligand-receptor interaction signal transduction pathway. In summary, rotenone can significantly lead to abnormal methylation of mouse brain organs, and lead to the loss of normal physiological function of neurons by inducing ferroptosis.     

对接大健康产业发展的康复治疗学人才培养体系的构建

在大健康产业发展背景下,康复服务产业发展模式和服务理念逐步转变。康复人力资源是康复服务产业发展的基石,文章基于《国际功能、残疾和健康分类》(international classification of functioning,disability and health,ICF)康复科学理论体系,切合康复服务产业化和专业化需求,重构康复治疗学专业人才培养的课程体系,强化实践教学,探讨构建康复治疗学专业人才培养新模式。     

三全育人视角下中医临床课程思政建设的探索

课程思政建设是立足“培养什么样的人、如何培养人以及为谁培养人”这个根本问题,实现课程教学与思政课教学同向同行,形成协同效应,有利于“全面发展的人”的培养。深入发掘医学专业课程的育人元素,充分发挥中医临床课程的育人功能,以培养学生学习能力、实践能力、创新能力为核心,推进医学院校全员、全过程、全方位打造德智体美劳全面发展的应用型人才是时代所需、发展之要。我们从“梳理思政教育元素、课程设计、课程反馈”三方面构建了中医临床课程思政育人路径,实现了专业课知识传递与德育相融合,以期在医学临床教学的课程思政建设提供一定思路。     

基于“一动力三循环”管理模式的“3S”方法在临床研究生导师队伍建设中的应用

研究生教育是国家高水平教育的代表,也是医院发展的体现,在一定程度上可以看出医院的医疗、教学、科研、学术地位。研究生导师是高层次和高水平师资的主要代表,是一个医院提升自身教学实力、影响力、竞争力的关键。本文针对专科医院研究生导师队伍建设存在以下问题进行阐述：对外交流培训不足,师资队伍评价体系不科学,师资队伍结构不合理。基于“一动力三循环”管理模式,探索提出“3S”研究生导师队伍建设模式：加强对外交流与培训,建立科学的评价体系,建立结构合理的导师队伍,以优化研究生导师队伍建设为目标,打造一支业务能力专业、评价体系科学、师资结构合理的导师队伍,不断提升医院研究生导师队伍建设水平,是每个研究生培养单位的重要任务。同时概括了现阶段研究生导师队伍建设的成效和不足,并给予了反馈与意见。     

产儿科住院医师整合培养模式探讨

随着医学教学模式的更新,整合医学教育及围产医学理念的不断强化,产科与儿科的人才培养模式有了新的定位。临床案例中多学科合作抢救的模式的频频成功,产科与儿科的合作交流促进有了新的需求。分析产科与儿科目前住院医师规范化培训的特点,总结阐述整合培养不仅可以增强产儿科医师的自信力和职业归属感,提升围产保健的质量和救治力,而且可以培养出“高精尖”的产儿科储备人才以及缓和产儿科特殊的医患关系。从实际出发,针对具体的整合培训时长,可优化的带教形式,模拟训练的模式,反馈及奖惩制度等各方面进行探讨研究,以使整合培养的模式能落到实处,真正实现“高精尖”人才的培养,最终更好的服务于孕产妇及新生儿,提高我国围产医学领域的影响力。     

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。     

基于早期预警评分应用于子痫前期患者的效果

目的 探讨基于早期预警评分应用于子痫前期患者的效果及对母婴结局的影响。方法 将2019年1月—2020年12月我院收治的80例子痫前期患者纳入研究,按照随机数字表法分为两组,对照组40例予以常规妇产科干预,研究组40例予以基于早期预警评分的护理。比较两组干预前后心理状态、实施救治所需时间、终止妊娠时孕周、住院时间、血压、24 h尿蛋白量以及母婴结局。结果 研究组HAMD、HAMA评分低于对照组（P <0.05）。研究组实施救治所需时间、住院时间短于对照组,终止妊娠时孕周长于对照组（P <0.05）。研究组血压和24 h尿蛋白量低于对照组（P <0.05）。研究组产后出血、胎盘早剥、肝肾损伤发生率低于对照组（P <0.05）。研究组胎儿生长受限、胎儿窘迫、新生儿死亡、新生儿窒息发生率均低于对照组（P <0.05）。结论 子痫前期患者应用基于早期预警评分可有效改善患者心理状态,缩短患者的救治时间,延长孕周,控制病情进展,缩短住院时间,改善母婴结局。     

Effects of In-Process Ultrasonic Vibration on Weld Formation and Grain Size of Wire and Arc Additive Manufactured Parts

Wire and arc additive manufacturing (WAAM) is a competitive technique, which enables the fabrication of medium and large metallic components. However, due to the presence of coarse columnar grains in the additively manufactured parts, the resultant mechanical properties will be reduced, which limits the application of WAAM processes in the engineering fields. Grain refinement and improved mechanical properties can be achieved by introducing ultrasonic vibration. Herein, we applied ultrasonic vibration to the WAAM process and investigated the effects of wire feed speed, welding speed, and ultrasonic amplitude on the weld formation and grain size during ultrasonic vibration. Finally, a regression model between the average grain size and wire feed speed, welding speed, and ultrasonic amplitude was established. The results showed that due to the difference in heat input and cladding amount, wire feed speed, welding speed, and ultrasonic amplitude have a significant influence on the weld width and reinforcement. Excessive ultrasonic amplitude could cause the weld to crack during spreading. The average grain size increased with increasing wire feed speed and decreasing welding speed. With increasing ultrasonic amplitude, the average grain size exhibited a trend of decreasing first and then increasing. This would be helpful to manufacture parts of the required grain size in ultrasonic vibration-assisted WAAM fields.     

Immune checkpoint inhibitors in head and neck squamous cell carcinoma: A systematic review of phase-3 clinical trials

BACKGROUNDThe outcomes of patients diagnosed with head and neck squamous cell carcinoma (HNSCC) who are not candidates for local salvage therapy and of those diagnosed with recurrent or metastatic disease are dismal. A relatively new systemic therapy option that emerged in recent years in the treatment of advanced HNSCC is immunotherapy using immune checkpoint inhibitors (ICIs). The safety profile and anti-tumor activity of these agents demonstrated in early phase clinical trials paved the way to the initiation of several promising phase-3 trials in the field.AIMTo evaluate the evidence on the effectiveness of ICIs in HNSCC, based on published phase-3 clinical trials.METHODSWe searched PubMed, Cochrane Library, Embase, and Scopus to identify published literature evaluating immunotherapy using ICIs in recurrent or metastatic HNSCC (R/M HNSCC) and locally advanced head and neck squamous cell carcinoma (LAHNSCC). We used a combination of standardized search terms and keywords including head and neck squamous cell carcinoma, recurrent, metastatic, locally advanced, immunotherapy, immune checkpoint inhibitors, monoclonal antibodies, programmed cell death protein-1 (PD-1), programmed death-ligand 1 (PD-L1), cytotoxic T- lymphocyte associated protein-4 (CTLA-4), and phase-3 clinical trial. A sensitive search filter was used to limit our results to randomized controlled trials.RESULTSFive phase-3 clinical trials have reported the data on the effectiveness of immunotherapy in HNSCC so far: Four in R/M HNSCC and one in LAHNSCC. In patients with R/M HNSCC, anti-PD-1 agents nivolumab and pembrolizumab demonstrated improved survival benefits in the second-line treatment setting compared to the standard of care (standard single-agent systemic therapy). While the net gain in overall survival (OS) with nivolumab was 2.4 mo [hazard ratio (HR) = 0.69, P = 0.01], that with pembrolizumab was 1.5 mo (HR = 0.80 nominal P = 0.0161). The anti-PD-L1 agent durvalumab with or without the anti-cytotoxic T- lymphocyte associated protein-4 agent tremelimumab did not result in any beneficial outcomes. In the first-line setting, in R/M HNSCC, pembrolizumab plus platinum-based chemotherapy resulted in significant improvement in survival with a net gain in OS of 2.3 mo (HR = 0.77, P = 0.0034) in the overall population and a net gain in OS of 4.2 mo in the PD-L1 positive (combined positive score > 20) population compared to standard of care (EXTREME regime). In patients with PD-L1 positive R/M HNSCC, monotherapy with pembrolizumab also demonstrated statistically significant improvement in survival compared to EXTREME. In LAHNSCC, immunotherapy using avelumab (an anti-PD-L1 agent) along with standard chemoradiation therapy did not result in improved outcomes compared to placebo plus chemoradiation therapy.CONCLUSIONAnti-PD-1 agents provide survival benefits in R/M HNSCC in the first and second-line settings, with acceptable toxicity profiles compared to standard therapy. There is no proven efficacy in the curative setting to date.