学龄期近视进展儿童调节功能的客观检查和分析

目的　对学龄期近视进展儿童进行调节功能的客观检查与分析，观察调节功能与近视进展之间的相关性。方法　选取2017年至2018年在首都医科大学附属北京同仁医院视光学门诊定期就诊的71名学龄期儿童为研究对象，根据受试者近年的屈光度进展速度，按≤0.50 D·a^-1、>0.50~1.00 D·a^-1、>1.00~1.50 D·a^-1、>1.50 D·a^-1分为4组，使用人眼调节分析仪对受试者进行调节功能的客观测量与分析，记录不同调节刺激视标下4组的客观调节反应值和客观调节微波动值，并作对比。结果　在所有调节视标上，各组随着调节刺激幅度增加，客观调节反应值也逐渐增加，4组在不同调节刺激视标下的客观调节反应值及平均的客观调节反应值差异均无统计学意义（均为P＞0.05）。≤0.50 D·a^-1、>0.50~1.00 D·a^-1、>1.00~1.50 D·a^-1、>1.50 D·a^-1近视进展速度组调节微波动值分别为（62.2±5.6）D、（62.5±5.3）D、（66.5±6.0）D和（58.0±6.5）D，4组间差异有统计学意义（F=6.424，P=0.001），在+0.50~-0.50 D、-2.00 D调节刺激视标下，4组的客观调节微波动值比较差异均有统计学意义（均为P＜0.05），在其余调节刺激视标下差异均无统计学意义（均为P＞0.05）。结论　对于学龄期儿童的近视进展速度，客观调节微波动值相对于客观调节反应值可能是一个更为敏感的相关指标。     

六西格玛在肿瘤标志物质量目标选择上的应用

目的应用6σ理论对肿瘤标志物项目的分析性能进行评价，并初步确定各项目的质量目标。 方法收集本实验室2018年1至12月室内质控数据和国家卫生健康委临床检验中心室间质量评价结果，以生物学变异导出的质量规范和国家室间质量评价标准作为允许总误差(TEa)计算6项肿瘤标志物的σ水平，并依据质量目标选择流程图和肿瘤标志物分析性能验证图评价肿瘤标志物的分析性能，进而为肿瘤标志物选择合适的质量目标。 结果应用不同层级的生物学变异导出的质量规范和国家室间质量评价标准，肿瘤标志物项目的σ水平存在显著差异；依据质量目标选择流程图：选择生物学变异导出的"适当的"质量规范作为CA125项目的质量目标，选择生物学变异导出的"最低的"质量规范作为t-PSA、CEA、AFP、CA199和CA153项目的质量目标。 结论6σ能够客观评价肿瘤标志物的分析性能，并为实验室质量目标的选择提供重要的参考价值。     

血瘀证的研究发展脉络与评述

主要从4个方面论述了血瘀证50年来研究进展．理论研究，着重从古今文献论述血瘀证定义和含义；客观研究，着重对生理、生化、血液流变学、免疫学、病理学和微循环等方面对血瘀证进行研究；血瘀证的动物模型研究，主要对血瘀证动物模型的建立与造模方法和途径进行研究；诊断标准研究，包括诊断标准、诊断指标的研究。并对上述内容进行了评述，并提出了展望。     

内皮素和降钙素基因相关肽与梗阻性黄疸大鼠门脉压力的关系

目的　通过测定梗阻性黄疸大鼠门静脉血中内皮素和降钙素基因相关肽浓度 ,探讨内皮素和降钙素基因相关肽在梗阻性黄疸鼠门脉压力升高中的作用。方法　建立大鼠梗阻性黄疸模型 ,采用放射免疫法测定门静脉血中内皮素和降钙素基因相关肽的浓度。结果　内皮素在胆道结扎后各时相均明显升高 (P<0 .0 5 ) ,3天达峰值 (186.99± 3 6.0 3 pg/ m l) ,降钙素基因相关肽在胆道结扎后第 1天无明显变化 (2 13 .11± 3 5 .3 8pg/ m l vs 180 .14± 3 0 .66pg/ ml) ,3天后明显升高 ,并与对照组相差明显 (P<0 .0 5 )。梗阻性黄疸组大鼠门脉压力在各时相组均比对照组明显升高 (P<0 .0 5 )但未形成门脉高压。内皮素抗血清治疗可降低内皮素浓度和升高的门静脉压力。结论　梗阻性黄疸时内皮素和降钙素基因相关肽浓度均升高 ,失去内皮素和降钙素基因相关肽的正常平衡并伴有门脉压力的升高     

Fast Eating Is Associated with Increased BMI among High-School Students

Fast self-reported eating rate (SRER) has been associated with increased adiposity in children and adults. No studies have been conducted among high-school students, and SRER has not been validated vs. objective eating rate (OBER) in such populations. The objectives were to investigate (among high-school student populations) the association between OBER and BMI z-scores (BMIz), the validity of SRER vs. OBER, and potential differences in BMIz between SRER categories. Three studies were conducted. Study 1 included 116 Swedish students (mean ± SD age: 16.5 ± 0.8, 59% females) who were eating school lunch. Food intake and meal duration were objectively recorded, and OBER was calculated. Additionally, students provided SRER. Study 2 included students (n = 50, mean ± SD age: 16.7 ± 0.6, 58% females) from Study 1 who ate another objectively recorded school lunch. Study 3 included 1832 high-school students (mean ± SD age: 15.8 ± 0.9, 51% females) from Sweden (n = 748) and Greece (n = 1084) who provided SRER. In Study 1, students with BMIz ≥ 0 had faster OBER vs. students with BMIz < 0 (mean difference: +7.7 g/min or +27%, p = 0.012), while students with fast SRER had higher OBER vs. students with slow SRER (mean difference: +13.7 g/min or +56%, p = 0.001). However, there was “minimal” agreement between SRER and OBER categories (κ = 0.31, p < 0.001). In Study 2, OBER during lunch 1 had a “large” correlation with OBER during lunch 2 (r = 0.75, p < 0.001). In Study 3, fast SRER students had higher BMIz vs. slow SRER students (mean difference: 0.37, p < 0.001). Similar observations were found among both Swedish and Greek students. For the first time in high-school students, we confirm the association between fast eating and increased adiposity. Our validation analysis suggests that SRER could be used as a proxy for OBER in studies with large sample sizes on a group level. With smaller samples, OBER should be used instead. To assess eating rate on an individual level, OBER can be used while SRER should be avoided.     

Satisfaction with neighbourhood environment moderates the associations between objective neighbourhood environment and leisure-time physical activity in older adults in Beijing,China

Asia is ageing fast. To develop more effective health promotion initiatives among older adults, more knowledge of the environmental correlates of physical activity is needed. However, research in this age group is rare, and most existing studies have been conducted within Western contexts. The present study explores the interaction effects of objective neighbourhood environment and satisfaction with neighbourhood environment on leisure-time physical activity in older adults in Beijing, China. This study follows a cross-sectional design and involves older adults aged 65 years and over. The questionnaire was collected in 2018 and 2,061 older adults living in Yanshan, Beijing, China were included in the analysis. Linear regression was applied to examine the effects. The findings show that residents who live in places with higher levels of walkability, or those who are more satisfied with neighbourhood environment (either path/road/street condition or recreational resources) spent significantly longer participating in leisure-time physical activity. However, the objective neighbourhood accessibility of recreational resources was not a significant factor of physical activity. Satisfaction with neighbourhood recreational resources can significantly moderate the relationship between objective neighbourhood accessibility of recreational resources and leisure-time physical activity respectively. This is the first study conducted in China examining the relationships between objective neighbourhood environment, satisfaction with neighbourhood environment and leisure-time physical activity among older adults. This study may have implications for urban planning and service provision planning. The design of built environments that considers quality rather than only quantity can play a significant role in improving older adults' leisure-time physical activity.     

糖尿病肾病中医分型肾脏叶间动脉彩色多普勒超声分析

借助彩色多普勒频谱图,对糖尿病肾病患者肾脏叶间动脉血流参数进行分析,探讨该病中医分型的客观指标。方法：选择糖尿病肾病３５例,将其分为气阴两虚及阴阳两虚组,于每位患者双肾叶间动脉测量：收缩期峰值血流速度（ＶＳ）、舒张期末血流速度（ＶＤ）、平均血流速度（ＭＳ）、搏动指数（ＰＩ）、阻力指数（ＲＩ）。结果：气阴两虚组ＰＩ、ＲＩ值明显高于正常组（Ｐ＜０．０１）,阴阳两虚组ＰＩ、ＲＩ明显高于气阴两虚组（Ｐ＜０．０５）;阴阳两虚组ＶＤ值高于气阴两虚组及正常组（Ｐ＜０．０１）;气阴两虚组与正常组比较无统计学差异。结论：糖尿病肾病气阴两虚及阴阳两虚组中ＰＩ及ＲＩ,可以作为糖尿病肾病中医分型的客观指标。     

Problems related to dorsal root entry zone lesions

Summary Several clinical problems related to the dorsal root entry zone lesions (DREZLs) in 15 patients with chronic pain are presented and discussed in terms of ratings of pain relief following surgery, development of sensory or motor weakness and postmortem histologies. Subjective pain relief exceeding 70% was achieved at around 2 weeks after the operations in most patients (13/15), and then decreased in some to 30 from 70% in the follow-up observations. Our new objective pain relief score was tested in these patients. A significant positive correlation between subjective pain relief and our objective pain relief scale was found, but some discrepancies between them were also found during the follow-up. Sensory loss, motor weakness, paraesthesia and a new pain were found as complications in 12, 7, 4 and 6 patients, respectively. Postmortem histological findings of the spinal cord in two patients with systemic lupus erythematosus and uterine cancer, who received bilateral DREZLs twice and bilateral DREZLs plus commissural myelotomy, respectively, indicate that care should be taken to avoid extension of the coagulation beyond the dorsal horn.     

浅谈药用植物良种选育的目标和常规途径

针对传统药用植物的品质退化进行品质改良，选育优良品种，是优化中草药品质的根本途径。优质、高产、稳产、熟期适应、抗性强、适应性相对较广是各种药用植物育种的共同目标，但不同药用植物品种的侧重点和具体内容各有变化。在药用植物的良种选育工作中，确定育种目标是基础。通常用以下途径进行良种繁育：1．种质资源调查和收集；2．引种驯化；3．良种选育；4．建立良种繁育基地。     

The testing of clinical skills in dietetic students prior to entering clinical placement

Background One of the most important requirements for contemporary education of a health care professional is to develop a framework for theory and practise which results in attainment of professional competencies suitably robust for a lifetime of practise ( Howe, 2002 ). In the context of those educating preregistration dietitians, this offers the challenge of presenting the student with innovative curricula designed to deliver the appropriate level of knowledge and understanding together with emphasis on skill and attitude development. The purpose of this study was to allow preregistration students the opportunity to practise key clinical skills prior to clinical placement and test skills acquisition using the model of an objective structured clinical examination (OSCE). Methods The learning experience of the student was altered to accommodate a more conceptually‐driven, problem‐centred, case‐based approach. The curriculum was adjusted to incorporate a short clinical skills programme where emphasis was deliberately placed on skill acquisition. At the conclusion of this clinical skills programme, and prior to the students entering clinical placement, skill performance by students was tested using the OSCE. The method of testing was also evaluated by students. Results The OSCE was delivered to 37 preclinical students. Four of the test candidates (11%) failed in at least one of the skill areas: these students performed similarly during clinical placement. Twenty‐one (57%) students returned the post‐OSCE questionnaire. Twenty (95%) students reported a positive experience; 20 (95%) students reported initial anxiety that diminished as the test progressed. Conclusion The Project Team was confident with the novel approach taken in re‐designing the curriculum: to include a dedicated clinical skills programme, together with addition of the testing of clinical skills using the OSCE model. These curriculum changes were deemed to be highly appropriate additions to the student experience in determination of skill performance of students prior to clinical placement.