医学遗传学教学案例库的建设探究

医学遗传学是探讨遗传因素相关疾病的诊断、预防与治疗的基础医学类课程,本门课要求学生具备较强的逻辑思维,有独立思考和分析解决问题的能力。单一的“填鸭式”课堂教学很难调动学生的自主学习,无法达到医学遗传学的教学效果。案例研讨式教学打破了被动的传统教学模式,教师给出临床典型案例,学生围绕案例的相关问题准备材料,主动展开课堂讨论,以教与学互动的方式融汇贯通了本门课程的重点与难点,教学效果显著。自2013年起,本教研组针对临床医学本科生开展了案例研讨式教学。本文根据课程的教学计划和案例研讨式教学的实际情况,筛选并分类整理了所收集的临床案例资料,分章节归纳汇编了8个章节的教学案例库,基本涵盖了疾病遗传学与临床遗传学的教学重难点。医学遗传学教学案例库的建设实现了临床案例与教学的深度融合,学生以更为直观的方式理解掌握教学重难点,有助于激发学生的创新思维,提高学生的学习兴趣与课堂参与度。

The Chinese guideline for management of snakebites

In 2009,the World Health Organization included snakebite on the list of neglected tropical diseases,acknowledging it as a common occupational hazard for farmers,plantation workers,and others,causing tens of thousands of deaths and chronic physical disabilities every year.This guideline aims to provide practical information to help clinical professionals evaluate and treat snakebite victims.These recommendations are based on clinical experience and clinical research evidence.This guideline focuses on the following topics:snake venom,clinical manifestations,auxiliary examination,diagnosis,treatments,and prevention.

Cu_(64)Zr_(36)非晶合金粉末的高温氧化行为

通过气体雾化法制备Cu_(64)Zr_(36)非晶合金粉末。采用XRD、DSC、TGA、SEM和TEM等测试手段研究Cu_(64)Zr_(36)非晶合金粉末在内部因素(粉末粒径)和外部因素(氧化温度和氧化时间)影响下的高温氧化行为。分析非晶合金粉末的氧化动力学、氧化物组成、表面形貌和显微组织演变。实验结果表明,Cu_(64)Zr_(36)非晶合金粉末氧化后表面形成多层氧化物,氧化层主要成分为t-ZrO_(2)、m-ZrO_(2)、Cu_2O和CuO。氧化动力学遵循双级抛物线速率定律。氧化过程以O离子向内扩散和Cu离子向外扩散控制。热力学分析表明,随着粉末粒径的减小,氧化反应的吉布斯自由能变大,导致粒径更小的粉末氧化更为迅速且完全。

贸易政策不确定性与企业技术创新投融资决策——基于中美贸易摩擦的分析

本文以2011至2020年的A股上市公司为样本,从研发投入、技术产出、技术来源以及研发内部资金配置四个方面,采用固定面板模型,基于中美贸易摩擦背景,探究贸易政策不确定性对于企业技术创新投融资决策的影响。结果表明:①贸易政策不确定性提高企业技术研发投入,进而促进技术专利的产出;②贸易政策不确定性提高企业自主研发倾向,弱化技术引进;③贸易政策不确定性提高企业内源研发资金配置。此外,贸易政策不确定性在影响企业技术创新投融资决策中还存在产权性质异质性、企业规模异质性、行业异质性以及董事海外背景异质性。本文的研究结论可以为政府在中美贸易摩擦环境下的技术支持政策制定与调整提供理论支持,同时为企业技术创新投融资决策提供参考。

Automatic recognition of tweek atmospherics and plasma diagnostics in the lower ionosphere with the machine learning method

Tweek atmospherics are extremely low frequency and very low frequency pulse signals with frequency dispersion characteristics that originate from lightning discharges and that propagate in the Earth–ionosphere waveguide over long distances.In this study,we developed an automatic method to recognize tweek atmospherics and diagnose the lower ionosphere based on the machine learning method.The differences(automatic−manual)in each ionosphere parameter between the automatic method and the manual method were−0.07±2.73 km,0.03±0.92 cm^(−3),and 91±1,068 km for the ionospheric reflection height(h),equivalent electron densities at reflection heights(Ne),and propagation distance(d),respectively.Moreover,the automatic method is capable of recognizing higher harmonic tweek sferics.The evaluation results of the model suggest that the automatic method is a powerful tool for investigating the long-term variations in the lower ionosphere.

Inferior vena cava thrombosis in two adult patients with veno-arterial extracorporeal membrane oxygenation

Veno-arterial extracorporeal membrane oxygenation(VA-ECMO) is indicated in patients with severe cardiogenic shock.During extracorporeal membrane oxygenation(ECMO) use,systemic anticoagulation is generally used to ensure the normal functioning of ECMO.Hemorrhage and thrombosis are two important complications of ECMO.However,despite adequate anticoagulation,some patients still experience thrombosis,such as inferior vena cava thrombosis (IVCT),after the removal of ECMO.^([1,2])A metaanalysis showed that the incidence of venous thrombosis during ECMO treatment is approximately 10%,^([3])but IVCT is rarely reported.We report two cases of IVCT after the removal of VA-ECMO cannulas.

Cross-sectional study of the educational background and trauma knowledge of trainees in the “China trauma care training” program

Background:Since the trauma knowledge of trauma providers correlates with the outcomes of injured patients,this study aims to assess the socio-demographic characteristics and levels of trauma knowledge of trainees in the China trauma care training(CTCT)program in addition to their post-course test results to provide support for the development of trauma care training programs and trauma systems in China.Methods:A cross-sectional study was conducted by collecting demographic information,hospital-related information and trauma knowledge of the trainees from 19 regions in China.All participants were assessed by questionnaires collecting the socio-demographic data,the trauma care knowledge levels and the information of the hospitals.Results:There were 955 males(78.9%)and 256 females(21.1%)enrolled.Among them,854 were physicians(70.5%),357 were registered nurses(29.5%).In addition,64 of them also played an administrative role in the hospitals(5.3%).The score of the trainees who were members of the emergency department staff(72.59±14.13)was the highest among the scores of all the personnel surveyed,followed by those of the trainees from the intensive care unit(ICU)(71.17±12.72),trauma surgery department(67.26±13.81),orthopedics department(70.36±14.48),general surgery department(69.91±14.79)and other departments(69.93±16.91),P=0.031.The score of the professors(73.09±15.05)was higher than those of the associate professors(72.40±14.71),lecturers(70.07±14.25)and teaching assistants(67.58±15.16),P<0.0001.The score of the individuals who attended experts’trauma lectures(72.22±14.45)was higher than that of individuals who did not attend the lectures(69.33±15.17),P=0.001.The mean scores before and after the training were 71.02±14.82 and 84.24±13.77,respectively,P<0.001.The mean score of trauma knowledge after the training of trainees from different provinces and with different educational backgrounds was higher than that before the training,with a statistically significant difference(P<0.05).Conclusions:The level of trauma knowledge of trauma care providers was associated with their department,professional position and previous participation in related academic conferences.Trauma care experience and participation in academic lectures and training program including CTCT may effectively improve individuals’level of trauma knowledge.

Network correlation between investor’s herding behavior and overconfidence behavior

It is generally accepted that herding behavior and overconfidence behavior are unrelated or even mutually exclusive.However,these behaviors can both lead to some similar market anomalies,such as excessive trading volume and volatility in the stock market.Due to the limitation of traditional time series analysis,we try to study whether there exists network relevance between the investor’s herding behavior and overconfidence behavior based on the complex network method.Since the investor’s herding behavior is based on market trends and overconfidence behavior is based on past performance,we convert the time series data of market trends into a market network and the time series data of the investor’s past judgments into an investor network.Then,we update these networks as new information arrives at the market and show the weighted in-degrees of the nodes in the market network and the investor network can represent the herding degree and the confidence degree of the investor,respectively.Using stock transaction data of Microsoft,US S&P 500 stock index,and China Hushen 300 stock index,we update the two networks and find that there exists a high similarity of network topological properties and a significant correlation of node parameter sequences between the market network and the investor network.Finally,we theoretically derive and conclude that the investor’s herding degree and confidence degree are highly related to each other when there is a clear market trend.

E3泛素连接酶MG53在胰岛素抵抗及代谢性疾病中的作用

泛素是一种存在于大多数真核细胞的小蛋白，它的主要功能是标记需要分解掉的蛋白质；附有泛素的蛋白质在桶状蛋白酶的作用下会发生降解。蛋白质泛素化是后翻译修饰的一种常见形式，这一过程是一个三酶级联反应，即需要泛素活化酶（E1）、泛素交联酶（E2）和泛素连接酶（E3）的参与。其中E3泛素连接酶能识别特定的需要被泛素化的靶蛋白，并催化泛素分子转移到靶蛋白上。Mitsugumin53（MG53）是一种存在于人类、鼠类及其他哺乳动物体内的天然蛋白质，它特异性表达于骨骼肌和心脏中，是一种含三个特定模序结构的家族蛋白。该家族蛋白能结合在细胞不需要的蛋白质上，并将其降解。

Consensus statement on layout and delivery of automatic external defibrillator in China

1.Introduction Sudden cardiac death(SCD)refers to sudden death due to a variety of cardiac causes.It is manifested as a sudden loss of consciousness,cardiac arrest,and respiratory arrest and generally shows early symptoms that are atypical and not easily detected[1].According to a recent study,nearly 544000 patients suffer from SCD every year in China[2].

Agricultural and Rural Informatization Construction in China

Currently,faced with the rapid development of information technology and increasing competition of the global economy,many countries have been very concerned about the issues of informatization concerning agriculture and rural areas. The level of informatization in the developed countries has been universally high,and some developing countries are also highly concerned about how to actively promote the rural market information service. With the increasing level of China's economic development,agriculture and rural economy have placed a growing demand on informatization. From the overall perspective of agricultural and rural informatization,this paper gives a detailed analysis of current situation,goals,tasks and constraints about agricultural and rural informatization construction,and finally makes the corresponding recommendations.

中国前瞻性多中心出生队列的建设背景、设计和初步实施

中国前瞻性多中心出生队列(Prospective Omics Health Atlas birth cohort,POHA birth cohort)研究于2022年正式启动。本研究联合12个参与单位,旨在建设包含2万个自然妊娠家庭和辅助生殖家庭的高质量多维度队列,对亲代和子代进行长期随访,在重要的时间节点收集对应的生物标本。通过多组学检测和分析,开展母婴全生命周期的多组学大数据研究,以期寻找到母婴疾病新的生物标记物,为母体疾病和新生儿的健康相关的风险预测提供科学依据。

Preparation of tungsten-particle-reinforced Zr-based bulk metallic glass composites by two-step spark plasma sintering:microstructure evolution,densification mechanism and mechanical properties

A new two-step spark plasma sintering(TSS)process with low-temperature pre-sintering and high-temperature final sintering has been successfully applied to prepare the tungsten-particle(Wp)-reinforced bulk metallic glass composites(Wp/BMGCs).Compared to normal spark plasma sintering(NS),the densification rate and relative density of Wp/BMGCs can be improved by selecting TSS with appropriate sintering pressure in the low temperature pre-sintering stage.However,the compressive strength and plastic strain of 30%Wp/BMGCs prepared by TSS are both higher than those of the samples prepared by NS.The TSS process can significantly enhance the compressive strength of 30%Wp/BMGCs by 12%and remarkably increase the plastic strain by 50%,while the trend is completely opposite for 50%Wp/BMGCs.Quasi-in situ experiments and finite element simulations reveal that uneven temperature distribution among particles during low-temperature pre-sintering causes local overheating at contact points between particles,accelerating formation of sintering neck between particles and plastic deformation of Wp.When the volume fraction of Wp is low,TSS can improve the interface bonding between particles by increasing the number of sintering necks.This makes the fracture mode of Wp/BMGCs being predominantly transgranular fracture.However,as the volume fraction of Wp increases,the adverse effects of Wp plastic deformation are becoming more and more prominent.The aggregated Wp tends to form a solid"cage structure"that hinders the bonding between particles at the interface;correspondingly,the fracture behavior of Wp/BMGCs is mainly dominated by intergranular fracture.Additionally,reducing the sintering pressure during the low-temperature pre-sintering stage of TSS has been shown to effectively decrease plastic deformation in Wp,resulting in a higher degree of densification and better mechanical properties.

Zr-Ti系高熵非晶合金研究进展

高熵非晶合金是指由5种及5种以上元素(近)等原子比组成,符合无序致密堆积的结构特点,且在非晶形成过程中满足热力学、动力学及结构条件的合金.高熵非晶合金兼具高熵合金的成分特征和非晶合金的结构特征,具有优异的综合性能,有作为结构功能材料的潜力.本文以Zr-Ti系高熵非晶合金为例阐述其发展现状,首先总结高熵非晶合金的成分设计思路和晶化行为,然后介绍高熵非晶合金的力学、耐磨、耐腐蚀、热氧化、热塑性成形等性能,最后展望高熵非晶合金的发展前景与前沿研究方向.

Evaluation of the Effects of Standard Rescue Procedure on Severe Trauma Treatment in China

Background：This study aimed to evaluate the effects of standard rescue procedure （SRP） in improving severe trauma treatments in China.Methods：This study was conducted in 12 hospitals located in geographically and industrially different cities in China.A standard procedure on severe trauma rescue was established as a general rule for staff training and patient treatment.A regional network （system） efficiently integrating prehospital rescue,emergency room treatments,and hospital specialist treatments was built under the rule for information sharing and improving severe trauma treatments.Treatment outcomes were compared between before and I year after the implementation of the SRP.Results：The outcomes of a total of 74,615 and 12,051 trauma cases were collected from 12 hospitals before and after the implementation of the SRP.Implementation of the SRP led to efficient cooperation and information sharing of different treatment services.The emergency response time,prehospital transit time,emergency rescue time,consultation call time,and mortality rate of patients were 24.24 ± 4.32 min,45.69 ± 3.89 min,6.38 ± 1.05 min,17.53 ± 0.72 min,and 33.82% ± 3.87% （n =441）,respectively,before the implementation of the standardization and significantly reduced to 10.11 ± 3.21 min,22.39 ± 4.32 min,3.26 ± 0.89 min,3.45 ± 0.45 min,and 20.49% ± 3.11%,separately （n =495,P 〈 0.05） after that.Conclusions：Staff training and SRP can significantly improve the efficiency of severe trauma treatments in China.

Value of lung ultrasound score for evaluation of blast lung injury in goats

Purpose:To establish a severe blast lung injury model of goats and investigate the feasibility of lung ultrasonic score in the evaluation of blast lung injury.Methods:Twenty female healthy goats were randomly divided into three groups by different driving pressures:4.0 MPa group(n=4),4.5 MPa group(n=12)and 5.0 MPa group(n=4).The severe blast lung injury model of goats was established using a BST-I bio-shock tube.Vital signs(respiration,heart rate and blood pressure),lung ultrasound score(LUS),PO2/FiO2 and extravascular lung water(EVLW)were measured before injury(0 h)and at 0.5 h,3 h,6 h,9 h,12 h after injury.Computed tomography scan was performed before injury(0 h)and at 12 h after injury for dynamic monitoring of blast lung injury and measurement of lung volume.The correlation of LUS with PaO2/FiO2,EVLW,and lung injury ratio(lesion volume/total lung volume*100%)was analyzed.All animals were sacrificed at 12 h after injury for gross observation of lung injury and histopathological examination.Statistical analysis was performed by the SPSS 22.0 software.The measurement data were expressed as mean±standard deviation.The means of two samples were compared using independent-sample t-test.Pearson correlation analysis was conducted.Results:(1)At 12 h after injury,the mortality of goats was 0,41.67% and 100%in the 4.0 Mpa,4.5 MPa and 5.0 MPa groups,respectively;the area of pulmonary hemorrhage was 20.00%±13.14% in the 4.0 Mpa group and 42.14%±15.33% in the 4.5 MPa group.A severe lung shock injury model was established under the driving pressure of 4.5 MPa.(2)The respiratory rate,heart rate,LUS and EVLW were significantly increased,while PaO2/FiO2 was significantly reduced immediately after injury,and then they gradually recovered and became stabilized at 3 h after injury.(3)LUS was positively correlated with EVLW(3 h:r=-0.597,6 h:r=-0.698,9 h:r=-0.729;p<0.05)and lung injury ratio(12 h:r=-0.884,p<0.05),negatively correlated with PaO2/FiO2(3 h:r=-0.871,6 h:r=-0.637,9 h:r=-0.658;p<0.05).Conclusion:We established a severe blast lung injury model of goats using the BST-I bio-shock tube under the driving pressure of 4.5 MPa and confirmed that ultrasound can be used for quick evaluation and dynamic monitoring of blast lung injury.

Thermoplastic micro-formability of TiZrHfNiCuBe high entropy metallic glass

High entropy metallic glasses（MGs） have attracted tremendous attentions owing to high entropy that benefits the probing of new MG-forming systems. However, the micro-formability of high entropy MGs is lack of investigation in comparison with these conventional MG counterparts, which is crucial to the development of this kind of metallic alloys. In this work, the thermoplastic mciro-formability of TiZrHfNiCuBe high entropy MG was systemically investigated. Time-Temperature-Transformation（TTT）curve was first constructed based on isothermal crystallization experiments, which provides thermoplastic processing time of the supercooled high entropy MGs. By comparison with the deformation map,Newtonian flow was found beneficial to the thermoplastic formability. While the thermoplastic forming becomes arduous with reducing mould size to tens micrometer, because of the strong supercooled TiZrHfNiCuBe high entropy MG（fragility = 27）. Fortunately, the micro-formability of TiZrHfNiCuBe high entropy MG could be improved by vibration loading, as demonstrated by finite-element-method simulation. Our findings not only systemically evaluate the thermoplastic micro-formability of high entropy MG, but also provide fundamental understanding of the phenomenon.

Current trauma care system and trauma care training in China

Trauma is a life-threatening ＂modern disease＂. The outcomes could only be optimized by cost-efficient and prompt trauma care, which embarks on the improvement of essential capacities and conceptual revolution in addition to the disruptive innovation of the trauma care system. According to experiences from the developed countries, systematic trauma care training is the cornerstone of the generalization and the improvement on the trauma care, such as the Advance Trauma Life Support （ATLS）. Currently, the pre-hospital emergency medical services （EMS） has been one of the essential elements of infrastructure of health services in China, which is also fundamental to the trauma care system. Hereby, the China Trauma Care Training （CTCT） with independent intellectual property rights has been initiated and launched by the Chinese Trauma Surgeon Association to extend the up-to-date concepts and techniques in the field of trauma care as well to reinforce the generally well-accepted standardized protocols in the practices. This article reviews the current status of the trauma care system as well as the trauma care training.

A Novel CoFe2NiMn0.3AlCux High-Entropy Alloy with Excellent Magnetic Properties and Good Mechanical Properties

In the present study,we investigate the crystal structure of high-entropy alloys(HEAs)in the form of CoFe2NiMn0.3AlCux(x=0.25,0.50,0.75,and 1.00)and their mechanical and magnetic properties.The CoFe2NiMn0.3AlCux alloys are composed of a mixture of a body-centered cubic(BCC)and a face-centered cubic(FCC)solid solution.The increased amounts of copper(Cu)boost both alloy strength and plastic ductility.The CoFe2 NiMn0.3AlCu1.0 HEAs demonstrate excellent mechanical properties,such as a high strength of 1832 MPa and a large plastic ductility of 22.38%.Magnetic property measurements on this alloy system indicated high saturated magnetization and high coercivity.The coercivity of the tested alloys lies in the range between 40 and 182 Oe,suggesting that the alloys have semi-hard magnetic properties.This study suggests that the present CoFe2NiMn0.3AlCux HEAs could serve as potential candidates for soft magnets in electromagnetic applications.

Dynamic changes of serum cholinesterase activity after severe trauma

Objective： The aim of the present study was to examine dynamic changes in serum cholinesterase （ChE） activity during early-stage severe trauma and the clinical significance of these changes. Methods： This prospective, observational study included 81 patients with severe trauma who were treated between October 2011 and April 2013 in the emergency intensive care unit （EICU） of a university-affiliated, tertiary-care, grade A general hospital in China. Serum ChE activity was measured on Days 1, 3, and 7 post-injury. The correlation of dynamic changes in serum ChE activity with trauma severity and prognosis was assessed. Correlations between changes in serum ChE activity after injury and albumin （ALB）, prealbumin （PAB）, transferrin （TRF）, and C-reactive protein （CRP） levels were also analyzed Results： Serum ChE activity in trauma patients was 42.3%-50.2% lower on Days 1, 3, and 7 compared with the control （P〈0.001 for all time points）, and it continued to decrease after Day 7 in both the survival and death subgroups. In the subgroup with an injury severity score （ISS） of 〈25, serum ChE activity initially decreased, but eventually increased. However, activity decreased continuously in the ISS〉25 subgroup. ChE activity was significantly lower in both the death and the ISS〉25 subgroups than in the survival and ISS〈25 subgroups on Days 1, 3, and 7 after injury. Activity was negatively correlated with ISS and acute physiology and chronic health evaluation Ill （APACHE III） at all time points. When comparing the receiver operating characteristic （ROC） curves for predicting prognosis, the area under the curve （AUC） in the dot of serum ChE was similar to the AUCs in plots of ISS and APACHE Ⅲ, but significantly smaller than the AUC in the plot of the trauma and injury severity score （TRISS）. Serum ChE activity was positively correlated with ALB, PAB, and TRF at all time points post-injury. Activity was not significantly correlated with CRP on Day 1, but was significantly and negatively correlated with CRP on Days 3 and 7. Conclusions： There is a significant decrease in serum ChE activity after severe trauma. Serum ChE may be regarded as a negative acute phase protein （APP） and the dynamic changes in serum ChE may be useful as an auxiliary indicator for evaluating trauma severity and predicting prognosis.