大数据时代下基于智慧医疗建设的医学生岗位素质培育模式探索与实践

智慧医疗的发展也暴露出数据质量与标准化、技术与应用的差异等问题,这些挑战要求我们从源头着手,通过培养跨领域、跨专业的医学复合型人才来应对。大数据时代背景下,医学人才培养面临的问题和医学高等教育的转型,提出了对当代医学生岗位素质发展的新要求。本文重点探讨了医学生岗位素质培育的指标体系构建,从国内外的实践中汲取经验,提出了包含岗位知识等9个一级指标和34个二级指标的指标体系。此外,本文提出了以一流课程为依托,构建“课前课后知识项目自主化”“课堂教育项目岗位化”“第二课堂素质项目个性化”“学生评价动态化”四化一体的教学体系,旨在有效提升医学生的岗位素质。通过结合自主学习项目、翻转课堂项目、虚拟仿真项目、第二课堂项目等多种科学教育方法,激发职业潜能,提升岗位素养能力,以适应数字时代医学教育的改革和发展需求。

Leech Poecilobdella manillensis protein extract ameliorated hyperuricemia by restoring gut microbiota dysregulation and affecting serum metabolites

BACKGROUND Hyperuricemia(HUA)is a public health concern that needs to be solved urgently.The lyophilized powder of Poecilobdella manillensis has been shown to significantly alleviate HUA;however,its underlying metabolic regulation remains unclear.AIM To explore the underlying mechanisms of Poecilobdella manillensis in HUA based on modulation of the gut microbiota and host metabolism.METHODS A mouse model of rapid HUA was established using a high-purine diet and potassium oxonate injections.The mice received oral drugs or saline.Additionally,16S rRNA sequencing and ultra-high performance liquid chromatography with quadrupole time-of-flight mass spectrometry-based untargeted metabolomics were performed to identify changes in the microbiome and host metabolome,respectively.The levels of uric acid transporters and epithelial tight junction proteins in the renal and intestinal tissues were analyzed using an enzyme-linked immunosorbent assay.RESULTS The protein extract of Poecilobdella manillensis lyophilized powder(49 mg/kg)showed an enhanced anti-trioxypurine ability than that of allopurinol(5 mg/kg)(P<0.05).A total of nine bacterial genera were identified to be closely related to the anti-trioxypurine activity of Poecilobdella manillensis powder,which included the genera of Prevotella,Delftia,Dialister,Akkermansia,Lactococcus,Escherichia_Shigella,Enterococcus,and Bacteroides.Furthermore,22 metabolites in the serum were found to be closely related to the anti-trioxypurine activity of Poecilobdella manillensis powder,which correlated to the Kyoto Encyclopedia of Genes and Genomes pathways of cysteine and methionine metabolism,sphingolipid metabolism,galactose metabolism,and phenylalanine,tyrosine,and tryptophan biosynthesis.Correlation analysis found that changes in the gut microbiota were significantly related to these metabolites.CONCLUSION The proteins in Poecilobdella manillensis powder were effective for HUA.Mechanistically,they are associated with improvements in gut microbiota dysbiosis and the regulation of sphingolipid and galactose metabolism.

Data driven analysis reveals prognostic genes and immunological targets in human sepsis-associated acute kidney injury

BACKGROUND:The molecular mechanism of sepsis-associated acute kidney injury(SA-AKI)is unclear.We analyzed co-differentially expressed genes(co-DEGs)to elucidate the underlying mechanism and intervention targets of SA-AKI.METHODS:The microarray datasets GSE65682,GSE30718,and GSE174220 were downloaded from the Gene Expression Omnibus(GEO)database.We identified the co-DEGs and constructed a gene co-expression network to screen the hub genes.We analyzed immune correlations and disease correlations and performed functional annotation of the hub genes.We also performed single-cell and microenvironment analyses and investigated the enrichment pathways and the main transcription factors.Finally,we conducted a correlation analysis to evaluate the role of the hub genes.RESULTS:Interleukin 32(IL32)was identified as the hub gene in SA-AKI,and the main enriched signaling pathways were associated with hemopoiesis,cellular response to cytokine stimulus,inflammatory response,and regulation of kidney development.Additionally,IL32 was significantly associated with mortality in SA-AKI patients.Monocytes,macrophages,T cells,and NK cells were closely related to IL32 and were involved in the immune microenvironment in SA-AKI patients.IL32 expression increased significantly in the kidney of septic mouse.Toll-like receptor 2(TLR2)was significantly and negatively correlated with IL32.CONCLUSION:IL32 is the key gene involved in SA-AKI and is significantly associated with prognosis.TLR2 and relevant immune cells are closely related to key genes.

Emergence of Multidrug-Resistant Proteus mirabilis Harboring both blaNDM-1 and cfr genes

Proteus mirabilis is abundant in soil and water,and although it is part of the normal human intestinal flora(along with Klebsiella species and Escherichia coli),it is known to cause serious infections in humans,with a fatality rate of 20%-50%[1].Proteus mirabilis is intrinsically resistant to tetracycline,tigecycline,and colistin.The widespread and irregular use of antimicrobial agents,P.mirabilis antimicrobial resistance has mirabilis.They acquire antimicrobial resistance(AMR)by capturing plasmids,transposons,or other mobile elements harboring antimicrobial resistance genes.This mechanism allows the rapid selection and transmission of numerous AMR genes in clinical,veterinary,food production,transportation,and environmental settings.

Research Progress on Functions and Biosynthesis of D-Psicose

D-Psicose,a naturally occurring rare sugar,exhibits a sweetness approximately 70%that of sucrose.It possesses high solubility,antioxidant activity,anti-inflammatory properties,and the ability to regulate cholesterol levels and enhance insulin sensitivity.However,D-psicose is relatively scarce in nature,making large-scale extraction and utilization impractical.Consequently,the development of cost-effective synthetic strategies for D-psicose is pivotal for its industrial application.In recent years,the Izumoring strategy has emerged as an efficient alternative to chemical synthesis for producing D-psicose.Nonetheless,limitations in the biotransformation of D-psicose,primarily governed by the conversion rate of D-psicose 3-epimerase(DPEase)and enzyme yield,continue to pose challenges in achieving economically viable production.Enzyme engineering and the establishment of high-level expression systems remain crucial avenues for reducing the overall biosynthesis costs.

Fedora-type magnetic compression anastomosis device for intestinal anastomosis

BACKGROUND Although previous studies have confirmed the feasibility of magnetic compression anastomosis(MCA),there is still a risk of long-term anastomotic stenosis.For traditional MCA devices,a large device is associated with great pressure,and eventually increased leakage.AIM To develop a novel MCA device to simultaneously meet the requirements of pressure and size.METHODS Traditional nummular MCA devices of all possible sizes were used to conduct ileac anastomosis in rats.The mean(±SD)circumference of the ileum was 13.34±0.12 mm.Based on short-and long-term follow-up results,we determined the appropriate pressure range and minimum size.Thereafter,we introduced a novel“fedora-type”MCA device,which entailed the use of a nummular magnet with a larger sheet metal.RESULTS With traditional MCA devices,the anastomoses experienced stenosis and even closure during the long-term follow-up when the anastomat was smaller thanΦ5 mm.However,the risk of leakage increased when it was larger thanΦ4 mm.On comparison of the different designs,it was found that the“fedora-type”MCA device should be composed of aΦ4-mm nummular magnet with aΦ6-mm sheet metal.CONCLUSION The diameter of the MCA device should be greater than 120%of the enteric diameter.The novel“fedora-type”MCA device controls the pressure and optimizes the size.

Characteristics of fecal microbial communities in patients with non-anastomotic biliary strictures after liver transplantation

AIM To explore the possible relationship between fecal microbial communities and non-anastomotic stricture(NAS) after liver transplantation(LT).METHODS A total of 30 subjects including 10 patients with NAS, 10 patients with no complications after LT, and 10 nonLT healthy individuals were enrolled. Fecal microbial communities were assessed by the 16 S r RNA gene sequencing technology.RESULTS Different from the uncomplicated and healthy groups, unbalanced fecal bacterium ratio existed in patients with NAS after LT. The results showed that NAS patients were associated with a decrease of Firmicutes and Bacteroidetes and an increase of Proteobacteria at the phylum level, with the proportion-ratio imbalance between potential pathogenic families including Enterococcaceae, Streptococcaceae, Enterobacteriaceae, Pseudomonadaceae and dominant families including Bacteroidaceae. CONCLUSION The compositional shifts of the increase of potential pathogenic bacteria as well as the decrease of dominant bacteria might contribute to the incidence of NAS.

基于临床可用的亚甲基蓝近红外二区成像用于泌尿系统结构及功能成像的研究

精准的结构和功能成像对于泌尿系统疾病的诊断和预后至关重要。近红外二区(second near-infrared,NIR-Ⅱ;1000~1700 nm)荧光生物成像相较于传统的荧光生物成像具有更高的空间分辨率、更深的穿透力和更好的信噪比,但其临床适用性有限。本文首次报道了基于临床可用且经肾脏排泄的荧光染料亚甲蓝(methylene blue,MB)NIR-Ⅱ活体泌尿系统荧光成像,该方法不仅可以实现清晰的有创/无创尿路造影,而且可以有效且无创地检测肾功能。以上研究结果表明MB辅助的NIR-Ⅱ荧光成像在临床及基础研究中的泌尿系统结构和功能成像中具有巨大前景。

Magnetic-assisted laparoscopic liver transplantation in swine

Background:Although laparoscopic technology has achieved rapid development in the surgical field,it has not been applied to liver transplantation,primarily because of difficulties associated with laparoscopic vascular anastomosis.In this study,we introduced a new magnetic-assisted vascular anastomosis technique and explored its application in laparoscopic liver transplantation in pigs.Methods:Two sets of magnetic vascular anastomosis rings(MVARs)with different diameters were developed.One set was used for anastomosis of the suprahepatic vena cava(SHVC)and the other set was used for anastomosis of the infrahepatic vena cava(IHVC)and portal vein(PV).Six laparoscopic orthotopic liver transplantations were performed in pigs.Donor liver was obtained via open surgery.Hepatectomy was performed in the recipients through laparoscopic surgery.Anastomosis of the SHVC was performed using hand-assisted magnetic anastomosis,and the anastomosis of the IHVC and PV was performed by magnetic anastomosis with or without hand assistance.Results:Liver transplants were successfully performed in five of the six cases.Postoperative ultrasonographic examination showed that the portal inflow was smooth.However,PV bending and blood flow obstruction occurred in one case because the MVARs were attached to each other.The durations of loading of MVAR in the laparoscope group and manual assistance group for IHVC and PV were 13±5 vs.5±1 min(P<0.01)and 10±2 vs.4±1 min(P<0.05),respectively.The durations of MVAR anastomosis in the laparoscope group and manual assistance group for IHVC and PV were 5±1 vs.1±1 min(P<0.01),and 5±1 vs.1±1 min(P<0.01),respectively.The anhepatic phase was 43±4 min in the laparoscope group and 23±2 min in the manual assistance group(P<0.01).Conclusions:Our study showed that magnetic-assisted laparoscopic liver transplantation can be successfully carried out in pigs.

On the gating of mechanosensitive channels by fluid shear stress

Mechanosensation is an important process in biological fluid-structure interaction. To understand the biophysics underlying mechanosensation, it is essential to quantify the correlation between membrane deformation, membrane tension, external fluid shear stress, and conformation of mechanosensitive (MS) channels. Smoothed dissipative particle dynamics (SDPD) simulations of vesicle/cell in three types of flow configurations are conducted to calculate the tension in lipid membrane due to fluid shear stress from the surrounding viscous flow. In combination with a simple continuum model for an MS channel, SDPD simulation results suggest that shearing adhered vesicles/cells is more effective to induce membrane tension sufficient to stretch MS channels open than a free shear flow or a constrictive channel flow. In addition, we incorporate the bilayer-cytoskeletal interaction in a two-component model to probe the effects of a cytoskeletal network on the gating of MS channels.

A ggregation-induced emission nanoparticles for in vivo three-photon fuorescence microscopic rat brain angiography

Rodents are popular biological models for physiological and behavioral research in neuroscience and rats are better models than mice due to their higher genome similarity to human and more accessible surgical procedures.However,rat brain is larger than mice brain and it needs powerful imaging tools to implement better penetration against the scattering of the thicker brain tissue.Three-photon fluorescence microscopy(3PFM)combined with near-infrared(NIR)excitation has great potentials for brain circuits imaging beause of its abilities of anti scattering,deep-tissue imaging,and high signal-to-noise ratio(SNR).In this work,a type of AIE lumninogen with red fuorescence was synthesized and encapsulated with Pluronic F-127 to make up form nano-particles(NPs).Bright DCDPP-2TPA NPs were employed for in trino three-photon fuorescent laser scanning microscopy of blood vessels in rats brain under 1550 nm femtosecond laser exci-tation.A fine three-dimensional(3D)reconstruction up to the deepness of 600 pm was achieved and the blood flow velocity of a selected vessel was measured in vrito as well.Our 3PFM deep brain imaging method simultaneously recorded the morphology and function of the brain blood vessels in vivo in the rat model.Using this angiography combined with the arsenal of rodent's brain disease,models can accelerate the neuroscience research and clinical diagnosis of brain disease in the future.

Plasma electrolytic liquefaction of sawdust

As a renewable carbon resource, biomass can be converted into polyols, aromatic hydrocarbons, alkanes, and other products by traditional catalytic liquefaction method, which has been widely used in production and life. The efficient development and utilization of biomass energy will play a very positive role in solving the problems of energy and ecological environment. A way of combining the plasma electrolysis with traditional catalytic liquefaction realizes the efficient liquefaction of sawdust, which provides a new liquefaction way for traditional biomass conversion. In this experiment, the effects of solution composition, catalyst content and power supply on solution resistance and liquefaction rate are analyzed.It is found that solution composition and catalyst content have a great influence on solution resistance. The results show that the liquefaction rate is highest and the resistance is smallest when the solution resistance is 500 ?. The liquefaction rate is greatly affected by the solution temperature, and the solution temperature is determined by the output power between the two electrodes. The output power includes the heating power of the electric field and the discharge power of the plasma.We measure the electric potential field distribution in the solution and the plasma power. It is found that the output power between the two poles increases nonlinearly(from 0 to 270 W) with time. In two minutes, the electric field heating power increases from 0 to 105 W and then decreases to 70 W, while the plasma power increases from 0 to 200 W. It is well known that in the first 70 seconds of the experiment the electric field heating is dominant, and then the plasma heating turns into a main thermal source. In this paper, plasma electrolysis and traditional catalytic liquefaction are combined to achieve the efficient liquefaction of sawdust, which provides a new way for biomass liquefaction.

Thermally enhanced photoluminescence and temperature sensing properties of Sc2W3O12:Eu3+ phosphors

Recently, lanthanide-ion-doped luminescent materials have been extensively used as optical thermometry probes due to their fast responses, non-contact, and high sensitivity properties. Based on different responses of two emissions to temperature, the fluorescence intensity ratio(FIR) technique can be used to estimate the sensitivities for assessing the optical thermometry performances. In this study, we introduce different doping concentrations of Eu^(3+) ions into negative thermal expansion material Sc2W3O12to increase the thermal-enhanced luminescence from 373 K to 548 K, and investigate the temperature sensing properties in detail. All samples can exhibit their good luminescence behaviors thermally enhanced.The emission intensity of Sc2W3O12:6-mol% Eu3+phosphor reaches 147.8% of initial intensity at 473 K. As the Eu3+doping concentration increases, the resistance of the sample to thermal quenching decreases. The FIR technique based on each of the transitions 5D→7F_(1)(592 nm) and 5D→7F_(2)(613 nm) of Eu3+ions demonstrates a maximum relative temperature sensitivity of 3.063% K-1at 298 K for Sc_(2)W_(3)O_(12):6-mol% Eu3+phosphor. The sensitivity of sample decreases with the increase of Eu3+concentration. Benefiting from the thermal-enhanced luminescence performance and good temperature sensing properties, the Sc_(2)W_(3)O_(12):Eu^(3+)phosphors can be used as optical thermometers.

Gelatin filter capture-based high-throughput sequencing analysis of microbial diversity in haze particulate matter

Airborne particulate matter(PM),especially PM2.5,can be easily adsorbed by human respiratory system.Their roles in carrying pathogens for spreading epidemic diseases has attracted great concern.Herein,we developed a novel gelatin filter-based and culture-independent method for investigation of the microbial diversity in PM samples during a haze episode in Tianjin,China.This method involves particle capture by gelatin filters,filter dissolution for DNA extraction,and high-throughput sequencing for analysis of the microbial diversity.A total of 584 operational taxonomic units(OTUs)of bacteria and 370 OTUs of fungi at the genus level were identified during hazy days.The results showed that both bacterial and fungal diversities could be evaluated by this method.This study provides a convenient strategy for investigation of microbial biodiversity in haze,facilitating accurate evaluation of airborne epidemic diseases.

Peroral endoscopic myotomy for management of gastrointestinal motility disorder

Achalasia is a type of esophageal motility disorder,consisting of relaxation dysfunction of the lower esophagus and disturbed esophageal peristalsis.Related clinical symptoms include dysphagia,regurgitation,chest pain,and weight loss.Traditional treatment options include endoscopic botulinum toxin injection,endoscopic pneumatic dilation,and laparoscopic Heller’s myotomy.These therapies mainly relieve symptoms by reducing the pressure on the lower esophageal sphincter and reducing blood flow resistance at the esophagogastric junction.Based on endoscopic submucosal dissection and natural orifice transluminal endoscopic surgery,peroral endoscopic myotomy(POEM)is a purely endoscopic method of myotomy with minimal invasiveness and a low rate of adverse events when performed by experienced operators.Since then,numerous studies have shown the significant clinical efficacy and safety of POEM.The purpose of this article is to introduce different modified POEMs,special indications for different POEMs,and their advantages as well as disadvantages.

The Analysis on the Influence of Water Conservancy Investment on Agricultural Economic Growth: An Empirical Study Based on the Boom Period of Shandong Agriculture

This paper uses econometric methods to carry out a Granger causality test on the construction of water conservancy infrastructure construction and agricultural economic growth in the boom period(1981- 2002) of Shandong agriculture. Empirical results indicate that there exists two-way Granger causality between Shandong water conservancy infrastructure construction and Shandong agricultural economic growth.Therefore,water conservancy infrastructure construction has a significant influence on agricultural economic growth in Shandong.

心内科病房急性肾损伤且行肾脏替代治疗患者短期预后不良的危险因素分析

目的探究心内科病房接受肾脏替代治疗(RRT)的急性肾损伤(AKI)患者的临床特征,并分析其短期预后不良的危险因素。方法回顾性分析2009年1月1日至2018年12月31日期间在解放军总医院第一医学中心心血管内科住院接受RRT治疗的AKI患者。收集AKI患者人口学资料、伴随疾病、AKI病因、RRT启动时生命体征、实验室检查结果、RRT治疗时长、RRT适应症、血管活性药物评分(VIS)、去甲肾上腺素当量(NEE)、急性生理与慢性健康评估Ⅱ(APACHEⅡ)分数、病危和病重天数,以及RRT治疗后28 d患者的生存情况和肾脏预后等指标。对这些AKI患者按照预后情况分为生存组和死亡组后进行分析比较,Logistic回归分析影响患者预后的危险因素。结果共有143例患者入组,其中男性占91例(63.6%),患者年龄中位数为75.0(65.0,81.0)岁,28 d后共有87例死亡,死亡率为60.8%。大多数患者同时存在多种基础疾病,主要的AKI病因是肾脏灌注不足(63.3%),而主要的RRT适应症是容量负荷过重(81.1%)。在进行RRT治疗4周后,共有56例存活,其中14例(25%)可以停止透析,42例(75%)仍需透析。两组AKI患者的总APACHEⅡ评分为(20.65±5.63)分,但两组间无显著差异(P=0.187)。死亡组的VIS、NEE评分高于生存组(P均<0.05)。单因素Logistic回归分析显示,高龄、低身体质量指数(BMI)、低平均动脉压、高血红蛋白、开始RRT时的较低血清肌酐、凝血酶原时间(PT)、血浆活化部分凝血活酶时间延长、脑梗/脑出血、急性心肌梗死、高VIS评分和高NEE是死亡的危险因素。多因素Logistic回归分析显示,低BMI(OR=0.794,95%CI:0.648~0.930,P=0.004)、开始RRT时较低的血清肌酐(OR=0.736,95%CI:0.558~0.971,P=0.030)和PT延长(OR=1.019,95%CI:1.004~1.035,P=0.016)是患者死亡的危险因素。结论在心内科病房急性肾损伤且行肾脏替代治疗的患者中,入院时低BMI、开始RRT时较低的肌酐和凝血酶原时间延长为患者死亡的危险因素。

In situ preparation of g-C3N4/Bi4O5I2 complex and its elevated photoactivity in Methyl Orange degradation under visible light

A graphite carbon nitride(g-C3N4)modified Bi4O5I2 composite was successfully prepared insitu via the thermal treatment of a g-C3N4/Bi OI precursor at 400°C for 3 hr.The as-prepared g-C3N4/Bi4O5I2 showed high photocatalytic performance in Methyl Orange(MO)degradation under visible light.The best sample presented a degradation rate of 0.164 min^-1,which is 3.2 and 82 times as high as that of Bi4O5I2 and g-C3N4,respectively.The g-C3N4/Bi4O5I2 was characterized by X-ray powder diffractometer(XRD),scanning electron microscopy(SEM),transmission electron microscopy(TEM),Raman,X-ray photoelectron spectroscopy(XPS),ultraviolet-visible diffuse reflectance spectra(DRS),electrochemical impedance spectroscopy(EIS)and transient photocurrent response in order to explain the enhanced photoactivity.Results indicated that the decoration with a small amount of g-C3N4 influenced the specific surface area only slightly.Nevertheless,the capability for absorbing visible light was improved measurably,which was beneficial to the MO degradation.On top of that,a strong interaction between g-C3N4 and Bi4O5I2 was detected.This interplay promoted the formation of a favorable heterojunction structure and thereby enhanced the charge separation.Thus,the g-C3N4/Bi4O5I2 composite presented greater charge separation efficiency and much better photocatalytic performance than Bi4O5I2.Additionally,g-C3N4/Bi4O5I2 also presented high stability.·O2^- and holes were verified to be the main reactive species.

Progress in synthesis and application of zwitterionic Gemini surfactants

Zwitterionic Gemini surfactants have the Gemini molecular structure in which there are both multiple lipophilic groups and multiple hydrophilic groups.However,their hydrophilic groups have different charges.Due to the special molecular structure,this kind of surfactants possesses excellent properties,including high surface activities,isoelectric point(IP),low critical micelle concentration(CMC),less toxicity,low irritating,biodegradability,bioactive,interface modification,and so on.In this review,synthetic strategies of three kinds of zwitterionic Gemini surfactants,i.e.,an ioniccationic,cationic-nonionic and anionic-nonionic Gemini surfactants,are discussed,and their potential applications in life sciences,chemical industry and enhanced oil recovery(EOR)are illustrated.Their future development is also prospected.

Overcoming the limitation of in-situ microstructural control in laser additive manufactured Ti-6Al-4V alloy to enhanced mechanical performance by integration of synchronous induction heating

Although a variety of processing routes were developed to in-situ manipulate microstructure for fabricating high-performance Ti-6Al-4 V alloy by directed energy deposition(DED),the in-situ microstructural control ability has been limited and lead to a narrowed mechanical property control range.This work proved the microstructural correlation betweenβ-grains andα-laths resulting from the unique thermal characteristics of DED for the first time and solved such a dilemma through synchronous induction heating assisted laser deposition(SILD)technology.The results confirmed that the laser energy and inductive energy have a different effect on the solidification and solid phase transformation conditions.By adjusting the laser-induction parameters,the microstructural correlation can be tuned;theβ-grains andα-laths can be controlled relatively separately,thereby significantly enhancing the ductility of as-deposited sample(elongation from 14.2%to 20.1%).Furthermore,the mechanical properties of the tuned microstructures are even comparable to that of DED Ti-6Al-4 V with post heat treatment,which indicates that the potential of SILD to be a one-step manufacturing process to fabricate high performance components without post heat treatment.Furthermore,the tensile testing results of the tuned microstructures indicate thatα-lath size is more influential on the mechanical properties than theβ-grain size due to its stronger hindering effect on the slipping of dislocations.This work promotes the understanding of the microstructural formation mechanism in DED titanium alloy and proves that the combination of synchronous induction and laser can expand the ability to control the microstructure and properties of multi-layer deposition.