面向继续医学教育的多模态围产保健知识图谱构建研究

目的/意义将多模态知识图谱应用于围产保健继续医学教育,以提高医护人员围产保健服务质量。方法/过程结合北京协和医院围产保健继续教育项目学员需求和课程主要特点构建顶层本体,对本体类、关系和属性进行设计和定义,利用不同粒度教学资源表示教学内容,利用Protégé软件构建围产保健知识图谱概念层和实例层。基于团队自主研发的医学知识服务平台MedKaaS,实现多模态实体进一步交互式构建,以及围产保健课程知识的可视化、检索和问答。结果/结论该多模态知识图谱实现了围产保健课程内容的语义化整合,有助于学员直观和有针对性地学习围产保健知识。

Overexpression of low-density lipoprotein receptor prevents neurotoxic polarization of astrocytes via inhibiting NLRP3 inflammasome activation in experimental ischemic stroke

Neurotoxic astrocytes are a promising therapeutic target for the attenuation of cerebral ischemia/reperfusion injury.Low-density lipoprotein receptor,a classic cholesterol regulatory receptor,has been found to inhibit NLR family pyrin domain containing protein 3(NLRP3)inflammasome activation in neurons following ischemic stroke and to suppress the activation of microglia and astrocytes in individuals with Alzheimer’s disease.However,little is known about the effects of low-density lipoprotein receptor on astrocytic activation in ischemic stroke.To address this issue in the present study,we examined the mechanisms by which low-density lipoprotein receptor regulates astrocytic polarization in ischemic stroke models.First,we examined low-density lipoprotein receptor expression in astrocytes via immunofluorescence staining and western blotting analysis.We observed significant downregulation of low-density lipoprotein receptor following middle cerebral artery occlusion reperfusion and oxygen-glucose deprivation/reoxygenation.Second,we induced the astrocyte-specific overexpression of low-density lipoprotein receptor using astrocyte-specific adeno-associated virus.Low-density lipoprotein receptor overexpression in astrocytes improved neurological outcomes in middle cerebral artery occlusion mice and reversed neurotoxic astrocytes to create a neuroprotective phenotype.Finally,we found that the overexpression of low-density lipoprotein receptor inhibited NLRP3 inflammasome activation in oxygen-glucose deprivation/reoxygenation injured astrocytes and that the addition of nigericin,an NLRP3 agonist,restored the neurotoxic astrocyte phenotype.These findings suggest that low-density lipoprotein receptor could inhibit the NLRP3-meidiated neurotoxic polarization of astrocytes and that increasing low-density lipoprotein receptor in astrocytes might represent a novel strategy for treating cerebral ischemic stroke.

Diamond-Like Carbon Depositing on the Surface of Polylactide Membrane for Prevention of Adhesion Formation During Tendon Repair

Post-traumatic peritendinous adhesion presents a significant challenge in clinical medicine.This study proposes the use of diamond-like carbon(DLC)deposited on polylactic acid(PLA)membranes as a biophysical mechanism for anti-adhesion barrier to encase ruptured tendons in tendon-injured rats.The results indicate that PLA/DLC composite membrane exhibits more efficient anti-adhesion effect than PLA membrane,with histological score decreasing from 3.12±0.27 to 2.20±0.22 and anti-adhesion effectiveness increasing from 21.61%to 44.72%.Mechanistically,the abundant C=O bond functional groups on the surface of DLC can reduce reactive oxygen species level effectively;thus,the phosphorylation of NF-κB and M1 polarization of macrophages are inhibited.Consequently,excessive inflammatory response augmented by M1 macrophage-originated cytokines including interleukin-6(IL-6),interleukin-1β(IL-1β),and tumor necrosis factor-α(TNF-α)is largely reduced.For biocompatibility evaluation,PLA/DLC membrane is slowly absorbed within tissue and displays prolonged barrier effects compared to traditional PLA membranes.Further studies show the DLC depositing decelerates the release of degradation product lactic acid and its induction of macrophage M2 polarization by interfering esterase and PLA ester bonds,which further delays the fibrosis process.It was found that the PLA/DLC membrane possess an efficient biophysical mechanism for treatment of peritendinous adhesion.

Multi-omics analysis of human tendon adhesion reveals that ACKR1-regulated macrophage migration is involved in regeneration

Tendon adhesion is a common complication after tendon injury with the development of accumulated fibrotic tissues without effective anti-fibrotic therapies,resulting in severe disability.Macrophages are widely recognized as a fibrotic trigger during peritendinous adhesion formation.However,different clusters of macrophages have various functions and receive multiple regulation,which are both still unknown.In our current study,multi-omics analysis including single-cell RNA sequencing and proteomics was performed on both human and mouse tendon adhesion tissue at different stages after tendon injury.The transcriptomes of over 74000 human single cells were profiled.As results,we found that SPP1^(+)macrophages,RGCC^(+)endothelial cells,ACKR1^(+)endothelial cells and ADAM12^(+)fibroblasts participated in tendon adhesion formation.Interestingly,despite specific fibrotic clusters in tendon adhesion,FOLR2^(+)macrophages were identified as an antifibrotic cluster by in vitro experiments using human cells.Furthermore,ACKR1 was verified to regulate FOLR2^(+)macrophages migration at the injured peritendinous site by transplantation of bone marrow from Lysm-Cre;R26R^(tdTomato) mice to lethally irradiated Ackr1^(-/-)mice(Ackr1^(-/-)chimeras;deficient in ACKR1)and control mice(WT chimeras).Compared with WT chimeras,the decline of FOLR2^(+)macrophages was also observed,indicating that ACKR1 was specifically involved in FOLR2^(+)macrophages migration.Taken together,our study not only characterized the fibrosis microenvironment landscape of tendon adhesion by multi-omics analysis,but also uncovered a novel antifibrotic cluster of macrophages and their origin.These results provide potential therapeutic targets against human tendon adhesion.

基于Android平台的电子信息系统在手术室仪器设备电子化动态管理中的价值研究

目的:构建基于Android平台的电子信息系统,探讨其在手术室仪器设备电子化动态管理中的应用价值。方法:采用Java开发语言、SQL Server 2008 R2数据库开发工具、浏览器与服务器(B/S)架构,设置Linux内核层、运行层、函数库、应用框架和应用层构建基于Android平台的电子信息系统。选取2023年4-9月上海健康医学院附属崇明医院手术室在用的145件仪器设备,基于Android平台电子信息系统应用前采用人工手工登记,对比Android平台电子信息系统应用前后手术室仪器设备管理质量评分、运行质量和管理人员能力评分。结果:应用Android平台电子信息系统后仪器设备使用和归位速度、安全性能、维修速度和清洁质量评分分别为(39.01±1.38)分、(39.79±1.05)分、(38.85±1.22)分和(38.49±2.41)分,均明显高于应用前,其差异有统计学意义(t=3.313、19.407、26.957、8.010,P<0.05);应用Android平台电子信息系统后仪器设备开机率、成本效益增幅和社会效益增幅分别为(96.17±5.33)%、(7.93±1.15)%和(10.74±1.09)%,均高于应用前,仪器设备运转率为(9.21±1.35)%,低于应用前,其差异有统计学意义(t=9.386、59.769、47.946、27.078,P<0.05);应有Android平台电子信息系统后仪器设备管理人员的理论知识、操作能力和安全意识考核评分分别为(39.79±2.07)分、(39.11±2.18)分和(19.65±2.44)分,均明显高于应用前,其差异有统计学意义(t=9.261、7.645、7.253,P<0.05)。结论:基于Android平台的电子信息系统应用于手术室仪器设备管理,有助于实现仪器设备的电子化动态管理,提高仪器设备管理质量和管理水平。

3D printed fiber-optic nanomechanical bioprobe

Ultrasensitive nanomechanical instruments,e.g.atomic force microscopy(AFM),can be used to perform delicate biomechanical measurements and reveal the complex mechanical environment of biological processes.However,these instruments are limited because of their size and complex feedback system.In this study,we demonstrate a miniature fiber optical nanomechanical probe(FONP)that can be used to detect the mechanical properties of single cells and in vivo tissue measurements.A FONP that can operate in air and in liquids was developed by programming a microcantilever probe on the end face of a single-mode fiber using femtosecond laser two-photon polymerization nanolithography.To realize stiffness matching of the FONP and sample,a strategy of customizing the microcantilever’s spring constant according to the sample was proposed based on structure-correlated mechanics.As a proof-of concept,three FONPs with spring constants varying from 0.421 N m^(−1)to 52.6 N m^(−1)by more than two orders of magnitude were prepared.The highest microforce sensitivity was 54.5 nmμN^(−1)and the detection limit was 2.1 nN.The Young’s modulus of heterogeneous soft materials,such as polydimethylsiloxane,muscle tissue of living mice,onion cells,and MCF-7 cells,were successfully measured,which validating the broad applicability of this method.Our strategy provides a universal protocol for directly programming fiber-optic AFMs.Moreover,this method has no special requirements for the size and shape of living biological samples,which is infeasible when using commercial AFMs.FONP has made substantial progress in realizing basic biological discoveries,which may create new biomedical applications that cannot be realized by current AFMs.

Interoceptive regulation of skeletal tissue homeostasis and repair

Recent studies have determined that the nervous system can sense and respond to signals from skeletal tissue,a process known as skeletal interoception,which is crucial for maintaining bone homeostasis.The hypothalamus,located in the central nervous system(CNS),plays a key role in processing interoceptive signals and regulating bone homeostasis through the autonomic nervous system,neuropeptide release,and neuroendocrine mechanisms.These mechanisms control the differentiation of mesenchymal stem cells into osteoblasts(OBs),the activation of osteoclasts(OCs),and the functional activities of bone cells.Sensory nerves extensively innervate skeletal tissues,facilitating the transmission of interoceptive signals to the CNS.This review provides a comprehensive overview of current research on the generation and coordination of skeletal interoceptive signals by the CNS to maintain bone homeostasis and their potential role in pathological conditions.The findings expand our understanding of intersystem communication in bone biology and may have implications for developing novel therapeutic strategies for bone diseases.

Neutralization of excessive levels of active TGF-β1 reduces MSC recruitment and differentiation to mitigate peritendinous adhesion

PPeritendinous adhesion formation(PAF)can substantially limit the range of motion of digits.However,the origin of myofibroblasts in PAF tissues is still unclear.In this study,we found that the concentration of active TGF-β1 and the numbers of macrophages,mesenchymal stromal cells(MSCs),and myofibroblasts in human and mouse adhesion tissues were increased.Furthermore,knockout of TGF-β1 in macrophages or TGF-β1R2 in MSCs inhibited PAF by reducing MSC and myofibroblast infiltration and collagenⅠandⅢdeposition,respectively.Moreover,we found that MSCs differentiated into myofibroblasts to form adhesion tissues.Systemic injection of the TGF-β–neutralizing antibody 1D11 during the granulation formation stage of PAF significantly reduced the infiltration of MSCs and myofibroblasts and,subsequently,PAF.These results suggest that macrophage-derived TGF-β1 recruits MSCs to form myofibroblasts in peritendinous adhesions.An improved understanding of PAF mechanisms could help identify a potential therapeutic strategy.

医学知识标注体系设计与系统构建

目前,海量医学数据,尤其是电子健康病历等有价值的数据仍亟待挖掘。然而以深度学习为代表的最新的模型更适用于结构化数据。因此需要标注实现非结构化数据到结构化数据的转换。医学知识标注则需要以标准的标注体系及标注系统为基础。针对医学知识标注体系缺乏、标注系统功能缺失、知识标注方式单一的问题,提出医学知识标注体系设计以及医学知识标注系统构建范式,从标注体系设计、系统业务需求、用户分析、功能设计等方面,分析了医学知识标注体系的实现方法,并综合系统流程化标准需求、语义映射需求、标注可视化综合需求、人员管理需求等方面进行了详细描述,为医学知识标注的推广作为参考,并提供交互友好的医学知识标注平台。

调相机外冷水系统设备井的改造研究

调相机正常运行时会产生大量的热量,这些热量会传递至调相机本体的换热器,并最终传递到外部冷却系统。调相机采用外冷水系统时,冷却系统中会有部分设备安装在设备井内。文章通过对已投运的调相机设备井出现的问题进行排查,分析归纳出设备井内故障问题的类别,并由此提出设备井问题的处理措施,为设备井的改造提供参考,从而提高设备井内设备的安全性。

Distribution,risk evaluation,and source analysis of the heavy metals in the sediment deposition of the lower Shichuanhe River,Shaanxi,China

In this study, 30 sediment samples were collected from the lower reaches of the Shichuanhe River in Xi’an, Shaanxi Province, China, to test the distribution of heavy metal elements in this area and for an analysis of the pollution levels of this area, hope to provide guidance on agricultural production activities in this region. The results show that the heavy metal elements in this area are mainly concentrated at the Qinghe River and Shichuanhe River confluences. Furthermore, the element contents are higher than that of the background levels of the continental crust(UCC) and close to the background levels of the soil from Shaanxi Province;the two most enriched elements are Cd and As, with contents of 0.79 and 22.7 mg·kg-1, respectively, and their contents are 3.8 and 1.72 times higher than that of the background values. Herein, the heavy metal pollution assessment methods applied indicated that Cd and As are the two most abundant pollutant elements in the area’s soils. As has a peak geo-accumulation index value of 3, and the pollution level is high, while Cd exhibits high potential ecological risks due to its high toxicity(potential risk index of 143) and an active fraction of more than 64%.In addition, a principal component analysis and hierarchical cluster analysis study showed that there are two sources of the heavy metals in this area. The Zn, As, Ni, Cu, Pb,and Cr are mainly from natural sources, and the Cd likely comes from a discharge of untreated agricultural wastewater in the region. The Cd which poses a high potential risk and mainly results from human activities, needs to be further monitored.

Investigation of phase modulation and propagation-route effect from unmatched large-scale structures for Doppler reflectometry measurement through 2D full-wave modeling

To interpret the common symmetric peaks caused by the large-scale structure in the complex S(f)spectrum from the heterodyne Doppler reflectometry(DR)measurement in EAST,a 2D circular-shaped O-mode full-wave model based on the finite-difference time-domain method is built.The scattering characteristics and the influences on the DR signal from various scales are investigated.When the structure is located around the cutoff layer,a moving radial or poloidal large-scale structure k_(θ)k_(θ),match(k_(θ),match is the theoretic wavenumber of Bragg scattering)could both generate an oscillation phase term called‘phase modulation’,and symmetrical peaks in the complex S(f)spectrum.It was found that the image-rejection ratio A_(−1)/A_(+1)(A_(±1)represents the amplitudes of±1 order modulation peaks)could be a feasible indicator for experiment comparison.In the case when the structure is near the cutoff layer with the same arrangement as the experiment for the edge DR channel,the curve of A_(−1)/A_(+1)versus kθcan be divided into three regions,weak asymmetrical range with k_(θ)/k_(0)0.15(k_(0)is the vacuum wavenumber),harmonics range with 0.15k_(θ)/k_(0)0.4,and Bragg scattering range of 0.4k_(θ)/k_(0)0.7.In the case when the structure is located away from the cutoff layer,the final complex S(f)spectrum is the simple superimposing of modulation and Bragg scattering,and the modulation peaks have an amplitude response nearly proportional to the local density fluctuation,called the‘propagationroute effect’.Under the H-mode experiment arrangement for the core DR,a critical fluctuation amplitude Amp(n_(e,Mod.@route))/Amp(n_(e,Tur.@MSA)∼1.3–4.1(Amp(n_(e,Mod.@route))refers to the pedestal large-scale structure amplitude and Amp(ne,Tur.@MSA)refers to turbulence amplitude at the main scattering area)is needed for the structure in the pedestal to be observed by the core DR measurement.The simulations are well consistent with the experimental results.These effects need to be carefully considered during the DR signal analyses as the injecting beam passes through the plasma region with large-scale structures.

Comparison of methods for turbulence Doppler frequency shift calculation in Doppler reflectometer

The Doppler reflectometer(DR),a powerful diagnostic for the plasma perpendicular velocity(u⊥)and turbulence measurement,has been widely used in various fusion devices.Many efforts have been put into extracting the Doppler shift from the DR signal.There are several commonly used methods for Doppler shift extraction,such as the phase derivative,the center of gravity,and symmetric fitting(SFIT).However,the strong zero-order reflection component around 0 kHz may interfere with the calculation of the Doppler shift.To avoid the influence of the zerofrequency peak,the asymmetric fitting(AFIT)method was designed to calculate the Doppler shift.Nevertheless,the AFIT method may lead to an unacceptable error when the Doppler shift is relatively small compared to the half width at half maximum(HWHM).Therefore,an improved method,which can remove the zero-frequency peak and fit the remaining Doppler peak with a Gaussian function,is devised to extract the Doppler shift.This method can still work reliably whether the HWHM is larger than the Doppler shift or not.

中文临床医学术语系统分类框架设计原则与构建思路

建立具有中国特色和自主知识产权的中文临床医学术语系统,对实现临床电子病历信息标准化及卫生管理、医保支付等不同系统间信息的交互利用具有重要意义。论述了中文临床医学术语系统的分类框架设计原则和顶层概念类的构建思路,深入地为进一步全面构建中文临床医学术语系统奠定基础。

2012~2018年南宁市西乡塘区某社区本地儿童与流动儿童一类疫苗接种情况

目的调查2012~2018年南宁市西乡塘区某社区本地儿童和流动儿童一类疫苗接种情况。方法通过免疫规划信息系统,收集该社区2012~2018年流动儿童和本地儿童10种一类疫苗的接种信息,比较这两类儿童疫苗接种率和疫苗合格接种率。结果共收集儿童疫苗接种个案37194例,其中本地儿童个案33218例(89.31%),流动儿童个案3976例(10.69%)。本地儿童一类疫苗总接种率为95.05%(63371/66669),高于流动儿童的86.62%(6862/7922);本地儿童的乙肝疫苗、脊髓灰质炎疫、百白破疫苗、麻疹风疹疫苗、麻腮风联合疫苗、A+C群流脑疫苗、乙脑疫苗和甲肝疫苗接种率均高于流动儿童(均P<0.05)。本地儿童的总体一类疫苗合格接种率为87.37%(58248/66669),高于流动儿童的78.58%(6225/7922);除了A群流脑疫苗和白破疫苗外,本地儿童其余一类疫苗合格接种率均高于流动儿童(均P<0.05)。结论流动儿童大部分一类疫苗的接种率和合格接种率低于本地儿童;家长免疫接种意识淡薄,需进一步加大免疫接种的宣传力度,加强流动儿童预防接种管理,提高流动儿童免疫接种水平。

多语言领域术语系统构建工具TBench的设计与实现

目的:为满足领域术语系统的多样化构建需求,探讨一种灵活、快速的多语言领域术语系统构建方法。方法:提出了多语言领域术语系统构建工具(TBench)的整体架构与功能设计,建立了基于ISO 25964可自定义扩展的数据模型,实现了多语言环境下的术语、概念、关系的批量复用与灵活创建等内容建设,从访问冲突、工作流、用户、角色、权限等角度进行了协同控制与管理。结果:TBench基于Java语言开发完成,并用于开展中文临床医学术语系统(CSCT)大规模的概念及语义关系建设。结论:TBench适用于分类表、词表、本体等术语系统的协同构建与维护,也为领域术语系统构建的自定义扩展需求、灵活复用、跨语言对齐与重构等问题提供了一种新思路。

黑色素瘤单病种本体构建研究

利用百科知识、临床指南、科技文献、专家经验等多源异构资源进行本体顶层范畴界定,借助Ontofox、Protégé等本体工具采集并组织黑色素瘤疾病、分子异常、症状、解剖结构、药物、干预与操作、并发症等顶层范畴的概念和术语,构建黑色素瘤单病种本体并对其评估,开发本体展示和检索工具,为相关领域研究提供参考。

2016~2019年南宁市西乡塘区学龄前儿童流感疫苗接种情况分析

目的分析2016~2019年广西南宁市西乡塘区学龄前儿童流感疫苗的接种情况,为进一步做好妇幼保健工作提供参考。方法选择2016~2019年广西免疫规划信息管理系统在册管理的广西南宁市西乡塘区6月龄至5岁的学龄前儿童为研究对象,收集他们的性别、年龄、住址以及流感疫苗接种情况等资料,分析不同年份、不同年龄段儿童的流感疫苗接种率;比较常住儿童和流动儿童、城区儿童和农村儿童的流感疫苗接种率。结果2016~2019年广西南宁市西乡塘区6月龄至5岁儿童的流感疫苗接种率分别为12.27%、14.85%、17.64%和18.37%。6月龄~、2岁~、3岁~、4~5岁儿童的流感疫苗接种率分别为19.72%、20.16%、14.15%、11.94%;3岁以下儿童的接种率较高,4~5岁儿童的接种率较低,各年龄段儿童的接种率比较,差异有统计学意义(P<0.05)。2016~2019年各年度广西南宁市西乡塘区常住儿童的流感疫苗接种率均高于流动儿童的接种率,差异有统计学意义(P<0.05)。2016~2019年广西南宁市西乡塘区的城区学龄前儿童流感疫苗接种率均显著高于农村学龄前儿童的接种率,差异有统计学意义(P<0.05)。结论2016~2019年广西南宁市西乡塘区学龄前儿童流感疫苗接种率偏低,常住儿童、城区儿童的疫苗接种率明显高于流动儿童和农村儿童;加强流感、流感疫苗相关知识的宣教力度,进一步改善疫苗接种条件,大幅提高儿童的流感疫苗接种率才能有效减少流感的季节性流行。

临床药理学知识模型构建研究

分析临床药理学知识表示与模型研究现状,阐述临床药理学知识模型构建技术路线、知识来源、模型框架和具体方法,以非小细胞肺癌为例介绍模型应用并对可行性进行验证,最后提出不足并展望未来发展方向。

心力衰竭知识图谱的构建

目的:利用现有资源构建专病知识图谱,为临床决策提供知识与技术支持。方法:以心力衰竭为例,首先明确疾病、检查、手术、药物、科室、症状、解剖学7类顶层语义概念以及2类属性和14类语义关系,其次复用现有词表、本体按照语义概念类型分别进行层级关系构建和同义术语归并,最后利用知识库资源进行语义关系抽取和同义术语归并。结果:形成包含524个概念、4 360对语义关系的心力衰竭知识图谱。结论:利用现有词表、本体和知识库资源采用知识融合的方法可以实现专病知识图谱的构建。