目的探索新冠肺炎疫情与“互联网+”医疗的开展对儿科线下就医门诊量的影响。方法选择全国门诊量最大的儿科综合医院——首都医科大学附属北京儿童医院为研究对象,收集2018年至2021年首都医科大学附属北京儿童医院门诊量较大的代表性科...目的探索新冠肺炎疫情与“互联网+”医疗的开展对儿科线下就医门诊量的影响。方法选择全国门诊量最大的儿科综合医院——首都医科大学附属北京儿童医院为研究对象,收集2018年至2021年首都医科大学附属北京儿童医院门诊量较大的代表性科室(皮肤科、耳鼻咽喉头颈外科、眼科等10个科室)线下门诊的月别门诊量,采用中断时间序列(interrupted time series,ITS)方法分析各科室门诊量的变化趋势。结果新冠肺炎疫情发生后,耳鼻咽喉头颈外科(-6649.00,P<0.05)、中医科(-2778.29,P<0.05)、血液肿瘤中心(-2490.26,P<0.05)、呼吸科(-2297.02,P<0.05)、神经科(-2288.39,P<0.05)、消化科(-1877.28,P<0.05)的瞬时门诊量显著降低(P<0.05);在疫情影响的2020年2月至2021年7月之间,除保健中心的月门诊量呈现逐渐上升趋势(125.69,P<0.05),其他科室趋势不变(P>0.05)。“互联网+”医疗实施9个月后,眼科(-780.00,P<0.05)、保健中心(-389.71,P<0.05)、神经科(-370.70,P<0.05)、风湿免疫科(-69.72,P<0.05)的线下门诊量变化呈逐月下降趋势;“互联网+”医疗开展后较疫情中未开展时期,门诊量增长速度有所减缓的科室分别为眼科(-1005.92,P<0.05)、保健中心(-515.41,P<0.05)、神经科(-384.50,P<0.05)。结论新冠肺炎疫情的爆发对于儿科线下诊疗造成了极大的影响,即时门诊量显著降低。“互联网+”医疗的开展对于缓解线下门诊诊疗压力的效果初显,在长远效果方面可以起到持续分流线下门诊量的作用。展开更多
目的探讨呼吸肌训练对肺癌患者术后康复的影响。方法检索PubMed、OVID、Cochrane Library、CINAHL、Web of science、中国知网(CNKI)、中国生物医学数据库(CBM),检索时间自建库至2020-05-15。使用软件RevMan5.3软件进行统计分析。结果...目的探讨呼吸肌训练对肺癌患者术后康复的影响。方法检索PubMed、OVID、Cochrane Library、CINAHL、Web of science、中国知网(CNKI)、中国生物医学数据库(CBM),检索时间自建库至2020-05-15。使用软件RevMan5.3软件进行统计分析。结果共纳入12篇文献,693例患者。Meta分析结果显示:呼吸肌训练能有效降低肺炎发生风险及减少住院时间,但对6 min步行试验(6MWT)、肺通气功能(FVC%、FEV1%)及机械通气时间延长无明显影响。而对肺不张、呼吸衰竭、等结局指标尚需更多大样本的随机对照试验方能得出更加准确的结论。结论呼吸肌训练能够减少肺癌患者术后肺炎发生率,缩短住院时间。在临床实践中,肺癌手术患者可考虑在术前1~3周定期进行呼吸肌训练,并以此作为一种呼吸康复方案。展开更多
目的评价新型冠状病毒肺炎疫情对北京儿童医院内分泌科门诊量的影响。方法收集2017~2021年北京儿童医院内分泌科共计60个月的门诊量数据,包含糖尿病门诊、矮小门诊、甲状腺门诊、性腺门诊及内分泌综合门诊。采用中断时间序列法(interrup...目的评价新型冠状病毒肺炎疫情对北京儿童医院内分泌科门诊量的影响。方法收集2017~2021年北京儿童医院内分泌科共计60个月的门诊量数据,包含糖尿病门诊、矮小门诊、甲状腺门诊、性腺门诊及内分泌综合门诊。采用中断时间序列法(interrupted time series,ITS)分析上述记录的变化趋势。结果2019年内分泌总门诊量初始水平为3619人次,疫情暴发后,门诊量即刻下降了1616人次(P=0.005)。在疫情常态化期间,长期趋势的变化量表现为每月上升140人次(P=0.001),较疫情发生前升高了125人次(P=0.003)。内分泌科总门诊人次、内分泌综合专业门诊量、矮小专业门诊、糖尿病专业门诊、甲状腺专业门诊、性腺专业门诊量的斜率改变量分别为125.292、88.111、30.633、7.868、-0.870、-0.451,P值分别为0.003、0.005、0.000、0.015、0.622、0.732,内分泌总门诊量、内分泌综合专业门诊量、矮小专业门诊量、糖尿病专业门诊量在疫情发生后斜率改变量差异有统计学意义,其中内分泌总门诊、综合专业、矮小专业、糖尿病专业较前期增长趋势更快,尤其是矮小专业每月增长率变化最为明显。结论新型冠状病毒肺炎疫情对北京儿童医院内分泌科门诊量影响较大,说明新型冠状病毒肺炎疫情影响了该院内分泌患儿的就诊需求。疫情常态化期间存在明显的门诊量反弹期,对该院的医疗资源分配及疫情防控工作提出了新的挑战。展开更多
Objective To characterize carbapenem （CPM）-non-susceptible Klebsiella pneumoniae （K. pneumoniae） and carbape-nemase produced by these strains isolated from Beijing Children＇s Hospital based on a five-year surveil...Objective To characterize carbapenem （CPM）-non-susceptible Klebsiella pneumoniae （K. pneumoniae） and carbape-nemase produced by these strains isolated from Beijing Children＇s Hospital based on a five-year surveillance. Methods The Minimal Inhibition Concentration values for 15 antibiotics were assessed using the Phonixl00 compact system. PCR amplification and DNA sequencing were used to detect genes encoding carbapenemases. WHONET 5.6 was finally used for resistance analysis. Results In total, 179 strains of CPM-non-susceptible K. pneumoniae were isolated from January, 2010 to December, 2014. The rates of non-susceptible to imipenem and meropenem were 95.0% and 95.6%, respectively. In the 179 strains, 95 （53.1%） strains carried the blalMP gene, and IMP-4 and IMP-8 were detected in 92 （96.8%） and 3 （3.2%） IMP-producing isolates, respectively. 65 （36.3%） strains carried the blaNDM_1 gene. 6 （3.4%） strains carried the blaKpc gene, and KPC-2 were detected in 6 KPC-producing isolates. In addition, New Delhi-Metallo-1 （NDM-1） producing isolates increased from 7.1% to 63.0% in five years and IMP-4 producing isolates decreased from 75.0% to 28.3%. Conclusion High frequencies of multiple resistances to antibiotics were observed in the CPM-non-susceptible K. pneumoniae strains isolated from Beijing Children＇s Hospital. The production of IMP-4 and NDM-1 metallo-13-1actamases appears to be an important mechanism for CPM-non- susceptible in K. pneumoniae.展开更多
Tuberculosis(TB),which is caused by the intracellular pathogen,Mycobacterium tuberculosis(Mtb),remains one of the deadliest infectious diseases worldwide,accounting for 1.45 million deaths in 2018[1].Thus,there is an ...Tuberculosis(TB),which is caused by the intracellular pathogen,Mycobacterium tuberculosis(Mtb),remains one of the deadliest infectious diseases worldwide,accounting for 1.45 million deaths in 2018[1].Thus,there is an increasing need to develop new antibiotics or to repurpose old drugs that have the potential to shorten the current duration of therapy.Metronidazole(MTZ)is a 5-nitroimidazole antibiotic that is mainly used in the treatment of anaerobic and protozoal infections[2].The action of mechanism for metronidazole has not been fully established.As a prodrug,MTZ is inactive until taken up and reduced by anaerobic bacteria and protozoa.It is possible that the reduction of Mtz leads to the production of toxic metabolites,which bind to deoxyribonucleic acid and electron-transport proteins of microbial pathogens,thus blocking nucleic acid synthesis[3].The impressive potency of MTZ against anaerobic bacteria indicates the potential for killing Mtb under anaerobic conditions.A previous in vitro study demonstrated that MTZ has potent activity against tubercle bacilli under anaerobic conditions[4].In a non-human primate model,MTZ has been shown to prevent reactivation of latent Mtb infection,indicating the in vivo role in targeting Mtb within an anaerobic environment[5].Although there is strong evidence for the role of MTZ in affecting anaerobic bacilli,the mechanism of action has not been elucidated in Mtb considering that MTZ must be catalyzed to a nitro-free radical form with endogenous nitroreductase.To provide insight=into how MTZ is activated in anaerobic Mtb bacilli,we first characterized the nitroreductase gene,Rv3131,and identified the key residue conferring the activation of MTZ in Mtb.展开更多
文摘目的 利用生物信息学方法挖掘并筛选与神经母细胞瘤(neuroblastoma, NB)生存预后相关的DNA损伤修复相关基因,构建NB生存的多基因预后模型。方法 从GSEA(gene set enrichment analysis)数据库中下载DNA损伤修复相关基因。TARGET(therapeutically applicable research to generate effective treatments)数据集作为训练集,结合基因表达谱数据和临床信息,运用最小绝对值收敛和选择算子(least absolute shrinkage and selection operator, LASSO)回归分析和多因素Cox回归分析构建NB的DNA损伤修复相关的多基因预后模型。GEO(gene expression omnibus)数据集作为验证集,评估预后模型的准确性。使用受试者工作特征曲线(receiver operating cure, ROC)计算预后模型曲线下面积(area under the curve, AUC)。使用Kaplan-Meier生存曲线进行生存分析。通过单因素Cox回归和多因素Cox回归分析评估预后模型的预测性能。利用公共数据库数据进行Kaplan-Meier生存曲线分析,验证COA8对NB预后的影响。CCK8实验和集落形成实验验证COA8表达量对NB细胞增殖的影响。结果 构建了包含10个DNA损伤修复相关基因的NB预后模型(IL4、HBE1、WRNIP1、RSF1、MDM4、COA8、PDCD10、HIST3H2A、PRODH和ATR)。模型风险评分可将患儿分为低风险组和高风险组,且低风险组比高风险组患儿预后好(P<0.0001)。生存分析证明COA8高表达导致NB预后不良。同时CCK8实验和集落形成实验证明降低COA8表达量,可抑制NB细胞增殖。结论 构建了具有良好预测功能的DNA损伤修复相关的NB多基因预后模型。验证了COA8是NB不良预后的潜在生物标志物。
文摘目的探索新冠肺炎疫情与“互联网+”医疗的开展对儿科线下就医门诊量的影响。方法选择全国门诊量最大的儿科综合医院——首都医科大学附属北京儿童医院为研究对象,收集2018年至2021年首都医科大学附属北京儿童医院门诊量较大的代表性科室(皮肤科、耳鼻咽喉头颈外科、眼科等10个科室)线下门诊的月别门诊量,采用中断时间序列(interrupted time series,ITS)方法分析各科室门诊量的变化趋势。结果新冠肺炎疫情发生后,耳鼻咽喉头颈外科(-6649.00,P<0.05)、中医科(-2778.29,P<0.05)、血液肿瘤中心(-2490.26,P<0.05)、呼吸科(-2297.02,P<0.05)、神经科(-2288.39,P<0.05)、消化科(-1877.28,P<0.05)的瞬时门诊量显著降低(P<0.05);在疫情影响的2020年2月至2021年7月之间,除保健中心的月门诊量呈现逐渐上升趋势(125.69,P<0.05),其他科室趋势不变(P>0.05)。“互联网+”医疗实施9个月后,眼科(-780.00,P<0.05)、保健中心(-389.71,P<0.05)、神经科(-370.70,P<0.05)、风湿免疫科(-69.72,P<0.05)的线下门诊量变化呈逐月下降趋势;“互联网+”医疗开展后较疫情中未开展时期,门诊量增长速度有所减缓的科室分别为眼科(-1005.92,P<0.05)、保健中心(-515.41,P<0.05)、神经科(-384.50,P<0.05)。结论新冠肺炎疫情的爆发对于儿科线下诊疗造成了极大的影响,即时门诊量显著降低。“互联网+”医疗的开展对于缓解线下门诊诊疗压力的效果初显,在长远效果方面可以起到持续分流线下门诊量的作用。
文摘目的探讨呼吸肌训练对肺癌患者术后康复的影响。方法检索PubMed、OVID、Cochrane Library、CINAHL、Web of science、中国知网(CNKI)、中国生物医学数据库(CBM),检索时间自建库至2020-05-15。使用软件RevMan5.3软件进行统计分析。结果共纳入12篇文献,693例患者。Meta分析结果显示:呼吸肌训练能有效降低肺炎发生风险及减少住院时间,但对6 min步行试验(6MWT)、肺通气功能(FVC%、FEV1%)及机械通气时间延长无明显影响。而对肺不张、呼吸衰竭、等结局指标尚需更多大样本的随机对照试验方能得出更加准确的结论。结论呼吸肌训练能够减少肺癌患者术后肺炎发生率,缩短住院时间。在临床实践中,肺癌手术患者可考虑在术前1~3周定期进行呼吸肌训练,并以此作为一种呼吸康复方案。
文摘目的评价新型冠状病毒肺炎疫情对北京儿童医院内分泌科门诊量的影响。方法收集2017~2021年北京儿童医院内分泌科共计60个月的门诊量数据,包含糖尿病门诊、矮小门诊、甲状腺门诊、性腺门诊及内分泌综合门诊。采用中断时间序列法(interrupted time series,ITS)分析上述记录的变化趋势。结果2019年内分泌总门诊量初始水平为3619人次,疫情暴发后,门诊量即刻下降了1616人次(P=0.005)。在疫情常态化期间,长期趋势的变化量表现为每月上升140人次(P=0.001),较疫情发生前升高了125人次(P=0.003)。内分泌科总门诊人次、内分泌综合专业门诊量、矮小专业门诊、糖尿病专业门诊、甲状腺专业门诊、性腺专业门诊量的斜率改变量分别为125.292、88.111、30.633、7.868、-0.870、-0.451,P值分别为0.003、0.005、0.000、0.015、0.622、0.732,内分泌总门诊量、内分泌综合专业门诊量、矮小专业门诊量、糖尿病专业门诊量在疫情发生后斜率改变量差异有统计学意义,其中内分泌总门诊、综合专业、矮小专业、糖尿病专业较前期增长趋势更快,尤其是矮小专业每月增长率变化最为明显。结论新型冠状病毒肺炎疫情对北京儿童医院内分泌科门诊量影响较大,说明新型冠状病毒肺炎疫情影响了该院内分泌患儿的就诊需求。疫情常态化期间存在明显的门诊量反弹期,对该院的医疗资源分配及疫情防控工作提出了新的挑战。
基金supported by Scientific Research Project of Beijing Children's Hospital(2012MS08)Beijing Municipal Science and Technology Project(D131100005313014)
文摘Objective To characterize carbapenem （CPM）-non-susceptible Klebsiella pneumoniae （K. pneumoniae） and carbape-nemase produced by these strains isolated from Beijing Children＇s Hospital based on a five-year surveillance. Methods The Minimal Inhibition Concentration values for 15 antibiotics were assessed using the Phonixl00 compact system. PCR amplification and DNA sequencing were used to detect genes encoding carbapenemases. WHONET 5.6 was finally used for resistance analysis. Results In total, 179 strains of CPM-non-susceptible K. pneumoniae were isolated from January, 2010 to December, 2014. The rates of non-susceptible to imipenem and meropenem were 95.0% and 95.6%, respectively. In the 179 strains, 95 （53.1%） strains carried the blalMP gene, and IMP-4 and IMP-8 were detected in 92 （96.8%） and 3 （3.2%） IMP-producing isolates, respectively. 65 （36.3%） strains carried the blaNDM_1 gene. 6 （3.4%） strains carried the blaKpc gene, and KPC-2 were detected in 6 KPC-producing isolates. In addition, New Delhi-Metallo-1 （NDM-1） producing isolates increased from 7.1% to 63.0% in five years and IMP-4 producing isolates decreased from 75.0% to 28.3%. Conclusion High frequencies of multiple resistances to antibiotics were observed in the CPM-non-susceptible K. pneumoniae strains isolated from Beijing Children＇s Hospital. The production of IMP-4 and NDM-1 metallo-13-1actamases appears to be an important mechanism for CPM-non- susceptible in K. pneumoniae.
基金supported by National Natural Science Foundation of China [81401739]
文摘Tuberculosis(TB),which is caused by the intracellular pathogen,Mycobacterium tuberculosis(Mtb),remains one of the deadliest infectious diseases worldwide,accounting for 1.45 million deaths in 2018[1].Thus,there is an increasing need to develop new antibiotics or to repurpose old drugs that have the potential to shorten the current duration of therapy.Metronidazole(MTZ)is a 5-nitroimidazole antibiotic that is mainly used in the treatment of anaerobic and protozoal infections[2].The action of mechanism for metronidazole has not been fully established.As a prodrug,MTZ is inactive until taken up and reduced by anaerobic bacteria and protozoa.It is possible that the reduction of Mtz leads to the production of toxic metabolites,which bind to deoxyribonucleic acid and electron-transport proteins of microbial pathogens,thus blocking nucleic acid synthesis[3].The impressive potency of MTZ against anaerobic bacteria indicates the potential for killing Mtb under anaerobic conditions.A previous in vitro study demonstrated that MTZ has potent activity against tubercle bacilli under anaerobic conditions[4].In a non-human primate model,MTZ has been shown to prevent reactivation of latent Mtb infection,indicating the in vivo role in targeting Mtb within an anaerobic environment[5].Although there is strong evidence for the role of MTZ in affecting anaerobic bacilli,the mechanism of action has not been elucidated in Mtb considering that MTZ must be catalyzed to a nitro-free radical form with endogenous nitroreductase.To provide insight=into how MTZ is activated in anaerobic Mtb bacilli,we first characterized the nitroreductase gene,Rv3131,and identified the key residue conferring the activation of MTZ in Mtb.
