基于层次分析法的手术室腔镜使用影响因素研究

随着医学科学的发展和工程技术的进步,越来越多的新技术及高精尖医疗设备被应用于临床。微创手术因具有比传统开放手术创伤小、痛苦少、手术瘢痕小、术后恢复快、住院时间短、医疗费低用等优点而被广泛应用于临床。腔镜设备是微创手术所需的重要设备,与患者直接接触,其科学管理工作十分重要。该研究采用层次分析法分析影响手术室腔镜正常使用的各影响因子指标和权重,以获得相应的改进方法与目标,从而采取针对性措施进行改进,提高手术室腔镜的正常使用率。经研究发现,医师的操作水平指标权重最大,对手术室腔镜的正常使用影响最大。通过层次分析法找出手术室腔镜正常使用的影响因素,为优化手术室腔镜使用管理提供了依据,能够有效提高手术室腔镜正常使用率及手术室运转效率。

Methylation Abnormalities in Mammary Carcinoma: The Methylation Suicide Hypothesis

Promoter silencing by ectopic?de novo?methylation of tumor suppressor genes has been proposed as comparable or equivalent to inactivating mutations as a factor in carcinogenesis. However, this hypotheses had not previously been tested by high resolution,?high-coverage whole-genome methylation profiling in primary carcinomas. We have determined the genomic methylation status of a series of primary mammary carcinomas and matched control tissues by examination of more than 2.7 billion CpG dinucleotides. Most of the tumors showed variable losses of DNA methylation?from all sequence compartments, but increases in promoter methylation were infrequent, very small in extent, and were observed largely at CpG-poor promoters. De novo methylation at the promoters?of proto-oncogenes and tumor suppressor genes occurred at approximately the same frequency. The findings indicate that tumor suppressor silencing by?de novo?methylation is much less common than currently believed. We put forward a hypothesis under which the demethylation commonly observed in carcinomas is a manifestation of a defensive system that kills incipient cancer cells.

Paleogene integrative stratigraphy,biotas,and paleogeographical evolution of the Qinghai-Tibetan Plateau and its surrounding areas

The Paleogene is a crucial period when terrestrial and marine ecosystems recovered from major disruptions and gradually approached their modern states.In the Qinghai-Tibetan Plateau and its surrounding regions,the Paleogene also represents a significant phase of tectonic evolution in the Qinghai-Tibetan Plateau-Himalaya orogeny,reorganization of Asian climates,and evolution of biodiversity.Due to limitations in research conditions and understanding,there are still many controversies regarding stratigraphic divisions in the Qinghai-Tibetan Plateau and its surrounding regions.In recent years,extensive studies on sedimentary petrology,magnetostratigraphy,and isotope dating have been conducted in the region.Numerous fossils have been discovered and reported,contributing to a more systematic understanding of biostratigraphy.These studies have laid a solid foundation for the comprehensive investigation of the stratigraphy,biotas and paleogeographic evolution of the Qinghai-Tibetan Plateau and its surrounding regions during the Paleogene.In this paper,we integrate recent research on fossils,isotopic dating,magnetostratigraphy,and geochemistry to refine the stratigraphic divisions and correlation framework of different tectonic units in the region,building upon previous studies.Since the Second Tibetan Plateau Scientific Expedition and Research,the knowledge of Paleogene floras has gradually expanded.This paper discusses the biostratigraphic significance of extinct and newly appeared taxa based on the latest dating results of these plant species.The new understanding of fossil species such as the“Eucalyptus”and Arecaceae establishes connections between the Paleogene flora of the Qinghai-Tibetan region and the biotas of Gondwana,specifically Oceania and South America.The evolutionary history of key taxa near the Yarlung Zangbo suture zone indicates that the collision between the Indian and Eurasian plates occurred approximately 65-54 Ma.Paleoelevation reconstructions,based on plant fossils,suggest that the Hengduan Mountain had already formed their current topographic pattern prior to the Early Oligocene.The warm and humid lowlands adjacent to the main suture zones in the Paleogene Qinghai-Tibetan Plateau served as the primary pathway for biota exchanges.The relatively low elevation of the Himalaya during the Paleogene did not effectively block the moisture from the Indian Ocean.

Antitumor activity of miR-188-3p in gastric cancer is achieved by targeting CBL expression and inactivating the AKT/mTOR signaling

BACKGROUND Altered miR-188-3p expression has been observed in various human cancers.AIM To investigate the miR-188-3p expression,its roles,and underlying molecular events in gastric cancer.METHODS Fifty gastric cancer and paired normal tissues were collected to analyze miR-188-3p and CBL expression.Normal and gastric cancer cells were used to manipulate miR-188-3p and CBL expression through different assays.The relationship between miR-188-3p and CBL was predicted bioinformatically and confirmed using a luciferase gene reporter assay.A Kaplan-Meier analysis was used to associate miR-188-3p or CBL expression with patient survival.A nude mouse tumor cell xenograft assay was used to confirm the in vitro data.RESULTS MiR-188-3p was found to be lower in the plasma of gastric cancer patients,tissues,and cell lines compared to their healthy counterparts.It was associated with overall survival of gastric cancer patients(P<0.001),tumor differentiation(P<0.001),lymph node metastasis(P=0.033),tumor node metastasis stage(I/II vs III/IV,P=0.024),and American Joint Committee on Cancer stage(I/II vs III/IV,P=0.03).Transfection with miR-188-3p mimics reduced tumor cell growth and invasion while inducing apoptosis and autophagy.CBL was identified as a direct target of miR-188-3p,with its expression antagonizing the effects of miR-188-3p on gastric cancer(GC)cell proliferation by inducing tumor cell apoptosis and autophagy through the inactivation of the Akt/mTOR signaling pathway.The in vivo data confirmed antitumor activity via CBL downregulation in gastric cancer.CONCLUSION The current data provides ex vivo,in vitro,and in vivo evidence that miR-188-3p acts as a tumor suppressor gene or possesses antitumor activity in GC.

医院应急医疗设备调配中心的建立与应用

目的解决医院急救及生命支持类设备部分科室闲置、不同科室借用困难及重复购置问题,提高该类设备的利用率,实现设备的科学化与精细化管理。方法建立应急设备调配中心,分析调配中心建立以来设备的租赁情况,对不同科室的借用情况进行分析,从设备产生的效益及设备损耗等方面进行论证,论述应急设备调配中心建立的优越性。结果2020年6月至2021年12月医院医疗设备调配中心设备使用占比为83.84%,租赁次数为5818次,租赁时长为402633 h,监护仪、注射泵、有创呼吸机3种设备的利用率分别提升至39.45%、38.63%、29.54%,医院调配中心2021—2025年43台监护仪最低预测净收益约为524644元。结论应急设备调配中心的建立方便了临床科室的工作,解决了临床科室设备闲置、设备借用困难等问题,极大地提高了此类设备的利用率,降低了医院设备购置与维修成本,实现了设备的科学化与精细化管理。

我院移动端医疗设备资产管理平台的设计和应用

目的设计一款医疗设备移动管理系统,实现医疗设备信息化和高质量管理。方法使用图特科技开发的手机APP管理工具,通过扫描二维码进行设备定位,从台账、维修、巡检、预防性维护保养多个角度对医疗设备进行可移动式管理。结果全院重要医疗设备都已录入系统,分管工程师积极参与此移动端管理工具的应用。2020年度,血透专职工程师使用该移动管理工具,维修量为231台次,平均维修天数为1.38 d;节前巡检142台次,完成率100%;重要参数检测69台次,电气质控138台次,设备保养量142台次,完成率100%。结论该系统使医院设备资产条理清晰;使工程师的工作效率与完成质量得到提高;使医疗技术的开展得到了充分的保障,代表着医疗技术前进的方向。

大学生人际关系适应与外向性和自我控制的关系

目的:探讨大学生的人际关系适应状况,分析其与外向性和自我控制的关系。方法:选取大学生3125名(男1497人,女1628人;年龄16～24岁),采用中国大学生适应量表(CCSAS)的人际关系适应维度、大五人格量表简化版(NEO-FFI)、自我控制量表(SCS)进行测量。结果:大学生人际关系适应的平均得分为(33. 3±3. 6)。回归分析表明,外向性、自我控制均与人际关系适应正向关联(β=0. 25、0. 08),外向性与自我控制的交互作用与人际关系适应负向关联(β=-0. 08);简单效应检验显示,低外向性大学生中,高自我控制者的人际关系适应得分高于低自我控制者(P <0. 001)。结论:本研究提示,大学生人际关系适应状况良好,高自我控制可能缓冲了低外向性对人际关系适应的消极作用。

Cenozoic topography,monsoons and biodiversity conservation within the Tibetan Region:An evolving story

The biodiversity of the Himalaya,Hengduan Mountains and Tibet,here collectively termed the Tibetan Region,is exceptional in a global context.To contextualize and understand the origins of this biotic richness,and its conservation value,we examine recent fossil finds and review progress in understanding the orogeny of the Tibetan Region.We examine the deep-time origins of monsoons affecting Asia,climate variation over different timescales,and the establishment of environmental niche heterogeneity linked to topographic development.The origins of the modern biodiversity were established in the Eocene,concurrent with the formation of pronounced topographic relief across the Tibetan Region.High(>4 km)mountains to the north and south of what is now the Tibetan Plateau bounded a Paleogene central lowland(<2.5 km)hosting moist subtropical vegetation influenced by an intensifying monsoon.In mid Miocene times,before the Himalaya reached their current elevation,sediment infilling and compressional tectonics raised the floor of the central valley to above 3000 m,but central Tibet was still moist enough,and low enough,to host a warm temperate angiosperm-dominated woodland.After 15 Ma,global cooling,the further rise of central Tibet,and the rain shadow cast by the growing Himalaya,progressively led to more open,herb-rich vegetation as the modern high plateau formed with its cool,dry climate.In the moist monsoonal Hengduan Mountains,high and spatially extensive since the Eocene but subsequently deeply dissected by river incision,Neogene cooling depressed the tree line,compressed altitudinal zonation,and created strong environmental heterogeneity.This served as a cradle for the then newly-evolving alpine biota and favoured diversity within more thermophilic vegetation at lower elevations.This diversity has survived through a combination of minimal Quaternary glaciation,and complex relief-related environmental niche heterogeneity.The great antiquity and diversity of the Tibetan Region biota argues for its conservation,and the importance of that biota is demonstrated through our insights into its long temporal gestation provided by fossil archives and information written in surviving genomes.These data sources are worthy of conservation in their own right,but for the living biotic inventory we need to ask what it is we want to conserve.Is it 1)individual taxa for their intrinsic properties,2)their services in functioning ecosystems,or 3)their capacity to generate future new biodiversity?If 2 or 3 are our goal then landscape conservation at scale is required,and not just seed banks or botanical/zoological gardens.

Cenozoic plant diversity of Yunnan： A review

Yunnan in southwestern China is renowned for its high plant diversity.To understand how this modern botanical richness formed,it is critical to investigate the past biodiversity throughout the geological time.In this review,we present a summary on plant diversity,floristics and climates in the Cenozoic of Yunnan and document their changes,by compiling published palaeobotanical sources.Our review demonstrates that thus far a total of 386 fossil species of ferns,gymnosperms and angiosperms belonging to 170 genera within 66 families have been reported from the Cenozoic,particularly the Neogene,of Yunnan.Angiosperms display the highest richness represented by 353 species grouped into 155 genera within 60 families,with Fagaceae,Fabaceae,Lauraceae and Juglandaceae being the most diversified.Most of the families and genera recorded as fossils still occur in Yunnan,but seven genera have disappeared,including Berryophyllum,Cedrelospermum,Cedrus,Palaeocarya,Podocarpium,Sequoia and Wataria.The regional extinction of these genera is commonly referred to an aridification of the dry season associated with Asian monsoon development.Floristic analyses indicate that in the late Miocene,Yunnan had three floristic regions:a northern subtropical floristic region in the northeast,a subtropical floristic region in the east,and a tropical floristic region in the southwest.In the late Pliocene,Yunnan saw two kinds of floristic regions:a subalpine floristic region in the northwest,and two subtropical floristic regions separately in the southwest and the eastern center.These floristic concepts are verified by results from our areal type analyses which suggest that in the Miocene southwestern Yunnan supported the most Pantropic elements,while in the Pliocene southwestern Yunnan had abundant Tropical Asia(Indo e Malaysia)type and East Asia and North America disjunct type that were absent from northwestern Yunnan.From the late Miocene to late Pliocene through to the present,floristic composition and vegetation types changed markedly,presumably in response to altitude changes and coeval global cooling.An integration of palaeoclimate data suggests that during the Neogene Yunnan was warmer and wetter than today.Moreover,northern Yunnan witnessed a pronounced temperature decline,while southern Yunnan experienced only moderate temperature changes.Summer precipitation was consistently higher than winter precipitation,suggesting a rainfall seasonality.This summary on palaeoclimates helps us to understand under what conditions plant diversity occurred and evolved in Yunnan throughout the Cenozoic.

Leaf fossils of Sabalites(Arecaceae)from the Oligocene of northern Vietnam and their paleoclimatic implications

Recent paleobotanical investigations in Vietnam provide a good opportunity to improve our understanding of the biodiversity and paleoclimatic conditions in the geological past of Southeast Asia.Palms(Arecaceae)are a diverse family of typical thermophilous plants with a relatively low tolerance for freezing.In this study,we describe well-preserved fossil palm leaves from the Oligocene Dong Ho Formation of Hoanh Bo Basin,northern Vietnam.Characters of the fossil leaves,such as a fan-shaped costapalmate lamina,an unarmed petiole,a costa slightly enlarged at the base that then tapers distally into the blade,and well-preserved amphistomatic leaves with cuticles,suggest that they represent a new fossil species,which we herein designate Sabalites colaniae A.Song,T.Su,T.V.Do et Z.K.Zhou sp.nov.Together with other paleontological and palaeoclimatic evidence,we conclude that a warm climate prevailed in northern Vietnam and nearby areas during the Oligocene.

Asian monsoon shaped the pattern of woody dicotyledon richness in humid regions of China

Understanding how geographical patterns of plant richness are established is a key scientific question in ecology and biogeography.Climate factors,such as environmental energy,water availability,and rainfall seasonality,have been widely proposed to account for geographical patterns of plant richness at large scales.Using a compiled distribution data set of 3166 native woody dicotyledons across 732 calibration grids at the county level in humid regions of China,we explored the geographical pattern of woody dicotyledon richness and its relationship to climatic variations,especially the Asian monsoonal climate.We found that species richness decreases with increasing latitude.Our study indicates that water availability(particularly mean annual precipitation,MAP)is the major abiotic factor in determining large-scale distribution patterns of species richness,Moreover,the seasonality of rainfall variables under the Asian monsoon climate largely contributes to species richness,because species richness correlates more significantly with precipitation during the three driest consecutive months(P3 DRY)than precipitation during the three wettest consecutive months(P3 WET).Therefore,we conclude that woody dicotyledon richness in humid regions of China is mainly affected by the Asian winter monsoon.

Elevated urine formaldehyde in elderly patients with primary open angle glaucoma

AIM：To investigate the risk factor of primary open angle glaucoma（POAG）,which is the leading cause of irreversible blindness worldwide.An abnormally high level of endogenous formaldehyde（FA） has recently been found correlated with cell death and neurodegenerative disease,raising the possibility of a putative correlation of abnormal endogenous FA with POAG.· METHODS：Thirty-four elderly patients with POAG and sixteen healthy controls were enrolled.Glaucomatous visual defects were present at both the functional（visual field） and structural[retinal nerve fiber layer（RNFL）thickness]levels.Morning urine samples were obtained and were analyzed by high-performance liquid chromatography（HPLC） to detect the endogenous FA level in a double blind manner.· RESULTS：Patients with POAG（P 〈0.05） had significantly higher urine FA levels.The urine FA level of patients with severe visual field defects[mean deviation（MD）≥12 dB]was significantly（P〈0.001） greater than that of patients with mild to moderate defects（MD〈12 dB）.By optical coherence tomography（OCT）,the superior and inferior RNFL thickness of POAG group was significantly（P〈0.001） thinner than in controls.Furthermore,the superior and inferior thinning of the RNFL was correlated with the elevation of urine FA concentration.CONCLUSION：Endogenous FA level is positively correlated with the neuronal defects of POAG.

Immunohistochemical investigation of voltage-gated potassium channel-interacting protein 1 in normal rat brain and Pentylenettrazole-induced seizures

Objective To explore the possible role of voltage-gated potassium channel-interacting protein 1 (KChIP1) in the pathogenesis of epilepsy. Methods Sprague Dawley female adult rats were treated with pentylenettrazole (PTZ) to develop acute and chronic epilepsy models. The approximate coronal sections of normal and epilepsy rat brain were processed for immunohistochemistry. Double-labeling confocal microscopy was used to determine the coexistence of KChIP1 and gamma-aminobutyric acid (GABA). Results KChIP1 was expressed abundantly throughout adult rat brain. KChIP1 is highly co-localize with GABA transmitter in hippocampus and cerebral cortex. In the acute PTZ-induced convulsive rats, the number of KChIP1-postive cells was significantly increased especially in the regions of CA1 and CA3 (P < 0.05); whereas the chronic PTZ-induced convulsive rats were found no changes. The number of GABA-labeled and co-labeled neurons in the hippocampus appeared to have no significant alteration responding to the epilepsy-genesis treatments. Conclusion KChIP1 might be involved in the PTZ-induced epileptogenesis process as a regulator to neuronal excitability through influencing the properties of potassium channels. KChIP1 is preferentially expressed in GABAergic neurons, but its changes did not couple with GABA in the epileptic models.

Late Pliocene diversity and distribution of Drynaria(Polypodiaceae) in western Yunnan explained by forest vegetation and humid climates

The palaeodiversity of flowering plants in Yunnan has been extensively interpreted from both a molecular and fossil perspective. However, for cryptogamic plants such as ferns, the palaeodiversity remains poorly known. In this study, we describe a new ferny fossil taxon, Drynaria lanpingensis sp. nov. Huang,Su et Zhou(Polypodiaceae), from the late Pliocene of northwestern Yunnan based on fragmentary frond and pinna with in situ spores. The frond is pinnatifid and the pinnae are entirely margined. The sori are arranged in one row on each side of the primary vein. The spores have a semicircular to bean-shaped equatorial view and a tuberculate surface. Taken together with previously described fossils, there are now representatives of three known fossil taxa of Drynaria from the late Pliocene of western Yunnan.These finds suggest that Drynaria diversity was considerable in the region at that time. As Drynaria is a shade-tolerant plant, growing preferably in wet conditions in the understory of forests, its extensive existence may indicate forest vegetation and humid climates in western Yunnan during the late Pliocene.This is in line with results from floristic investigations and palaeoclimatic reconstructions based on fossil floras.

Fossil fruits of Firmiana and Tilia from the middle Miocene of South Korea and the efficacy of the Bering land bridge for the migration of mesothermal plants

Determining whether the high-latitude Bering land bridge(BLB)was ecologically suitable for the migration of mesothermal plants is significant for Holarctic phytogeographic inferences.Paleobotanical studies provide a critical source of data on the latitudinal positions of different plant lineages at different times,permitting assessment of the efficacy of the BLB for migration.Here we report exceptionally preserved fossils of Firmiana and Tilia endochrysea from the middle Miocene of South Korea.This represents a new reliable record of Firmiana and the first discovery of the T.endochrysea lineage in the fossil record of Asia.The occurrence of these fossils in South Korea indicates that the two lineages had a distribution that extended much farther north during the middle Miocene,but they were still geographically remote from the BLB.In light of the broader fossil record of Asia,our study shows that,in the middle Miocene,some mesothermal plants apparently inhabited the territory adjacent to the BLB and thus they were possibly capable of utilizing the BLB as a migratory corridor.Some other mesothermal plants,such as Firmiana and the T.endochrysea lineages,however,are restricted to more southern regions relative to the BLB based on current fossil evidence.These lineages may have been ecologically unable to traverse the BLB,which raises questions about the efficacy of the BLB as a universal exchange route for mesothermal plants between Asia and North America during the middle Miocene.

INVASION TRAVELING WAVES FOR A DISCRETE DIFFUSIVE RATIO-DEPENDENT PREDATOR-PREY MODEL

This article is concerned with the existence of traveling wave solutions for a discrete diffusive ratio-dependent predator-prey model. By applying Schauder’s fixed point theorem with the help of suitable upper and lower solutions, we prove that there exists a positive constant c* such that when c > c* , the discrete diffusive predator-prey system admits an invasion traveling wave. The existence of an invasion traveling wave with c = c* is also established by a limiting argument and a delicate analysis of the boundary conditions.Finally, by the asymptotic spreading theory and the comparison principle, the non-existence of invasion traveling waves with speed c < c* is also proved.

Early Oligocene Itea (Iteaceae) leaves from East Asia and their biogeographic implications

Compressed materials of fossil foliage described here as Itea polyneura sp.nov.(Iteaceae)were collected from the Oligocene ofWenshan,Yunnan Province,southwestern China.The identification is based on the following characters:eucamptodromous secondary veins,strict scalariform tertiary veins,irregular tooth with setaceous apex.The leaf morphology of all modern and fossil species was compared with the new species from Wenshan and show that I.polyneura is most similar to the extant East Asian species Itea omeiensis,which inhabits subtropical forests of southern China.This discovery represents the first unambiguous leaf fossil record of Itea in East Asia.Together with other species in the Wenshan flora and evidence from several other flora in southern China,these findings demonstrate that Itea from East Asia arose with the Paleogene modernization.

Mesoscale Modeling Study of Severe Convection over Complex Terrain

Short squall lines that occurred over Lishui, southwestern Zhejiang Province, China, on 5 July 2012, were investigated using the WRF model based on 1°× 1° gridded NCEP Final Operational Global Analysis data. The results from the numerical simulations were particularly satisfactory in the simulated radar echo, which realistically reproduced the generation and development of the convective cells during the period of severe convection. The initiation of this severe convective case was mainly associated with the uplift effect of mesoscale mountains, topographic convergence, sufficient water vapor, and enhanced low-level southeasterly wind from the East China Sea. An obvious wind velocity gradient occurred between the Donggong Mountains and the southeast coastline, which easily enabled wind convergence on the windward slope of the Donggong Mountains; both strong mid–low-level southwesterly wind and low-level southeasterly wind enhanced vertical shear over the mountains to form instability; and a vertical coupling relation between the divergence on the upper-left side of the Donggong Mountains and the convergence on the lower-left side caused the convection to develop rapidly. The convergence centers of surface streams occurred over the mountain terrain and updrafts easily broke through the lifting condensation level（LCL） because of the strong wind convergence and topographic lift, which led to water vapor condensation above the LCL and the generation of the initial convective cloud. The centers of surface convergence continually created new convective cells that moved with the southwest wind and combined along the Donggong Mountains, eventually forming a short squall line that caused severe convective weather.

细胞因子、纤维化与青光眼滤过术的失败

目前对青光眼滤过术后滤过口瘢痕化的治疗虽有效,但常产生有害的副作用。对纤维化反应细胞学基础的研究会有助于抗纤维化治疗。伤口的修复包括血管新生和成纤维细胞的活化,它们都是在细胞因子的参与下完成的。细胞因子在这复杂的网络中相互作用促使成纤维细胞趋化、增殖和收缩,并刺激产生葡萄糖胺聚糖及胶原。干扰素可能会抑制上述纤维化反应的多个环节,其在眼部抗纤维化治疗中的作用尚需作进一步的评价。

New fossil seeds of Eurya （Theaceae） from East Asia and their paleobiogeographic implications

Eurya has an excellent fossil record in Europe,but it has only a few fossil occurrences in East Asia though this vast area houses the highest modern diversity of the genus.In this study,three-dimensionally preserved fossil seeds of Euiya stigmosa(Ludwig) Mai from the late Pliocene of northwestern Yunnan,southwestern China are described.The seeds are compressed and flattened,slightly campylotropous,and nearly circular to slightly angular in shape.The surface of the seeds is sculptured by a distinctive foveolate pattern,consisting of funnel-shaped and finely pitted cells.Each seed valve contains a reniform or horseshoe-shaped embryo cavity,a characteristic condyle structure and an internal raphe.These fossil seeds represent one of the few fossil records of Eurya in East Asia.This new finding therefore largely extends the distributional ranges of Eurya during Neogene.Fossil records summarized here show that Euiya persisted in Europe until the early Pleistocene,but disappeared thereafter.The genus might have first appeared in East Asia no later than the late Oligocene,and dispersed widely in regions such as Japan,Nepal,and southwestern China.