家庭医生服务能力自我评估调查问卷的开发与应用

目的:开发并应用家庭医生服务能力自我评估调查问卷。方法:选取我国8469名已经或即将从事家庭医生工作的基层卫生机构医生为研究对象,采用自行开发的家庭医生服务能力自我评估调查问卷对其进行调查。结果:基本医疗服务能力7项职责中,家庭医生具备承担常见病、多发病诊治职责能力的比例最高,为94.69%,社区康复服务和合理用药、用械职责能力的比例相对较高,分别为90.94%和90.75%。基层医生具备承担危急重症应急处置、医疗服务协同等职责能力的比例较低,分别为53.74%和56.68%。73.27%的家庭医生基本医疗服务能力得分≥4分,东、中、西部地区的家庭医生基本医疗服务能力得分≥4分者分别占73.72%、77.03%、67.49%。农村地区的家庭医生基本医疗服务能力得分≥4分者占74.62%,高于城市地区(70.63%)。全科医生基本医疗服务能力得分为7分者占比最高(27.48%),执业医师占比为19.99%。结论:本研究构建的家庭医生服务能力自我评估调查问卷可行性和可靠性较高,家庭医生服务能力自我评估调查问卷的应用有利于识别基层医生服务能力短板,能够反映家庭医生实际能力水平,符合基层工作实际情况,城乡家庭医生和不同类别的家庭医生基本医疗服务能力存在差别。

胃神经内分泌癌的研究进展

胃神经内分泌癌(gastric neuroendocrine carcinoma,G-NEC)发病率极低。患者确诊时多数已处于晚期,且通常比胃腺癌更具侵袭性,更易发生脉管癌栓、神经侵犯及术后肝转移。目前治疗方法有限且尚未形成统一的规范化方案,导致患者预后较差。随着人类G-NEC的基因组图谱的构建,识别出MYC作为疾病的关键驱动因子,开发小鼠模型来研究其分子和细胞特征,通过大规模的遗传和药理筛选,为理解G-NEC的生物学特性及治疗提供了新的思路。目前对于G-NEC的发病机制、分子生物学特征、临床病理特点及诊治仍缺乏足够的认识,为进一步提升对该疾病的系统认知,本文对国内外文献进行系统总结,旨在为G-NEC的大样本临床基础转化研究提供系统的理论支持。

Map-based cloning of q LP_(A01.1),a favorable allele from the Gossypium tomentosum chromosome segment line

Cotton is an important natural fiber crop worldwide which plays a vital role in our daily life.High yield is a constant goal of cotton breeding,and lint percentage(LP)is one of the important components of cotton fiber yield.A stable QTL controlling LP,qLP_(A01.1),was identified on chromosome A01 from Gossypium hirsutum introgressed lines with G.tomentosum chromosome segments in a previous study.To fine-map qLP_(A01.1),an F2 population with 986individuals was established by crossing G.hirsutum cultivar CCRI35 with the chromosome segment substitution line HT_390.A high-resolution genetic map including 47 loci and spanning 56.98 cM was constructed in the QTL region,and qLP_(A01.1)was ultimately mapped into an interval corresponding to an~80 kb genome region of chromosome A01in the reference genome,which contained six annotated genes.Transcriptome data and sequence analysis revealed that S-acyltransferase protein 24(GoPAT24)might be the target gene of qLP_(A01.1).This result provides the basis for cotton fiber yield improvement via marker-assisted selection(MAS)and further studies on the mechanism of cotton fiber development.

Composition optimization and performance prediction for ultra-stable water-based aerosol based on thermodynamic entropy theory

Water-based aerosol is widely used as an effective strategy in electro-optical countermeasure on the battlefield used to the preponderance of high efficiency,low cost and eco-friendly.Unfortunately,the stability of the water-based aerosol is always unsatisfactory due to the rapid evaporation and sedimentation of the aerosol droplets.Great efforts have been devoted to improve the stability of water-based aerosol by using additives with different composition and proportion.However,the lack of the criterion and principle for screening the effective additives results in excessive experimental time consumption and cost.And the stabilization time of the aerosol is still only 30 min,which could not meet the requirements of the perdurable interference.Herein,to improve the stability of water-based aerosol and optimize the complex formulation efficiently,a theoretical calculation method based on thermodynamic entropy theory is proposed.All the factors that influence the shielding effect,including polyol,stabilizer,propellant,water and cosolvent,are considered within calculation.An ultra-stable water-based aerosol with long duration over 120 min is obtained with the optimal fogging agent composition,providing enough time for fighting the electro-optic weapon.Theoretical design guideline for choosing the additives with high phase transition temperature and low phase transition enthalpy is also proposed,which greatly improves the total entropy change and reduce the absolute entropy change of the aerosol cooling process,and gives rise to an enhanced stability of the water-based aerosol.The theoretical calculation methodology contributes to an abstemious time and space for sieving the water-based aerosol with desirable performance and stability,and provides the powerful guarantee to the homeland security.

Resource allocation for D2D-assisted haptic communications

Haptic communications is recognized as a promising enabler of extensive services by enabling real-time haptic control and feedback in remote environments,e.g.,teleoperation and autonomous driving.Considering the strict transmission requirements on reliability and latency,Device-to-Device(D2D)communications is introduced to assist haptic communications.In particular,the teleoperators with poor channel quality are assisted by auxiliaries,and each auxiliary and its corresponding teleoperator constitute a D2D pair.However,the haptic interaction and the scarcity of radio resources pose severe challenges to the resource allocation,especially facing the sporadic packet arrivals.First,the contentionbased access scheme is applied to achieve low-latency transmission,where the resource scheduling latency is omitted and users can directly access available resources.In this context,we derive the reliability index of D2D pairs under the contention-based access scheme,i.e.,closed-loop packet error probability.Then,the reliability performance is guaranteed by bidirectional power control,which aims to minimize the sum packet error probability of all D2D pairs.Potential game theory is introduced to solve the problem with low complexity.Accordingly,a distributed power control algorithm based on synchronous log-linear learning is proposed to converge to the optimal Nash Equilibrium.Experimental results demonstrate the superiority of the proposed learning algorithm.

CircTIAM1 overexpression promotes the progression of papillary thyroid cancer by regulating the miR-338-3p/LASP1 axis

Background:Papillary thyroid cancer(PTC)is the most prevalent histological type of differentiated thyroid malignancy.Circular RNAs(circRNAs)have been implicated in the pathogenesis and progression of various cancers.circTIAM1(hsa_circ_0061406)is a novel circRNA with aberrant expression in PTC.However,its functional roles in PTC progression remain to be investigated.Methods:The expression levels of circTIAM1 in the PTC and the matched para-cancerous tissues were detected by quantitative real-time reverse-transcription PCR(qRT-PCR).The subcellular localization of circTIAM1 was examined by fluorescence in-situ hybridization(FISH).Kaplan-Meier plot was used to analyze the association of clinicopathological features with circTIAM1 expression.Bioinformatics databases were utilized to predict the target miRNAs of circTIAM1 and the downstream target mRNAs.RNA pulldown,RIP assay,and dual-luciferase reporter assay were used to confirm the interactions.Functional experiments,such as CCK-8,EDU staining,and apoptosis assays,as well as in vivo xenograft model were employed to explore the impacts of circTIAM1,miR-338-3p,and LIM/SH3 protein 1(LASP1)on the malignant phenotype of the PTC cells.Results:CircTIAM1 was highly expressed in PTC cells.Moreover,circTIAM1 silencing suppressed the proliferation and invasion of PTC cells in vitro and impaired tumorigenesis in vivo.Furthermore,miR-338-3p was verified as a miRNA target of circTIAM1.LASP1 was also identified as a downstream target of miR-338-3p.The anti-tumorigenic effect of miR-338-3p overexpression and the pro-tumorigenic effect of LASP1 was further explored by functional assays,which demonstrated that circTIAM1 modulated the PTC progression through targeting miR-338-3p/LASP1 axis.Conclusion:The overexpression of circTIAM1 is associated with the malignant progression of PTC.A high level of circTIAM1 promotes the malignancy of PTC cells via the miR-338-3p/LASP1 axis.

大跨径异形斜塔斜拉桥无支架施工关键技术研究

永定河特大桥主桥110m+50m+40m的梁固结体系独斜塔斜拉桥,该桥跨越永定河北小捻与南前卫埝。基于高斜塔分段预制安装难度大、焊接变形控制难度大、索力调整与线形控制难度大等施工难题,研究了主梁及主塔施工关键技术。主梁采用履带式起重机和临时支架配合施工,主塔分16个节段,采用无支架安装工艺进行施工,研究并详细阐述了临时支架搭设、临时索施工、主塔吊装、节段连接等关键技术,并提出了钢箱梁精确定位与线形控制措施。数值模拟结果表明:支架各主要杆件的强度、变形及地基承载力均满足设计规范要求。

Study of Quality Standards of Xiao’er Qingre Enema Preparation in Hospitals

Objective:To establish the quality standards for the preparation of Xiao’er Qingre enema in hospitals.Method:Thin-layer chromatography(TLC)was used to identify Radix Isatidis and Glycyrrhizae in the prescription.The content of(R,S)-Goitrin was determined by high-performance liquid chromatography(HPLC).Results:In TLC identification,there was no interference between the negative controls of Radix Isatidis and glycyrrhizae,and the spots were well-separated.The HPLC results of(R,S)-Goitrin showed a good linear relationship between the peak area and concentration within the range of 0.476-95.2μg·mL-1(r=0.9999).Conclusion:The TLC and HPLC methods established in this experiment are simple,reproducible,and specific,making them suitable for the quality control Xiao’er Qingre enema preparation in hospitals.

Research and Practice of the Blended Teaching Model of BOPPPS Teaching Method Under the Background of Digital Education: Taking Operations Research Course as an Example

The rapid development of digital education provides new opportunities and challenges for teaching model innovation.This study aims to explore the application of the BOPPPS(Bridge-in,Objective,Pre-assessment,Participatory learning,Post-assessment,Summary)teaching method in the development of a blended teaching model for the Operations Research course under the background of digital education.In response to the characteristics of the course and the needs of the student group,the teaching design is reconstructed with a student-centered approach,increasing practical teaching links,improving the assessment and evaluation system,and effectively implementing it in conjunction with digital educational technology.This teaching model has shown significant effectiveness in the context of digital education,providing valuable experience and insights for the innovation of the Operations Research course.

打造引领世界高等教育数字化发展风向标——《无限的可能:世界高等教育数字化发展报告》序言一

高等教育是孕育和创造新技术的重要源泉,也应该是新技术运用的先行者。近年来,以互联网、大数据、云计算为代表的数字技术创新和迭代速度明显加快,数字化转型已成为世界高等教育发展的必然趋势。中国高度重视高等教育的数字化变革。

企业社会责任对财务困境的影响

财务困境往往酝酿着严重的企业危机,当企业无法摆脱财务困境时可能面临债务重组甚至破产清算。根据利益相关者理论,企业社会责任能够满足利益相关者需求进而降低企业风险。从利益相关者的视角,选取2010—2020年中国沪深A股上市公司数据,研究企业社会责任对财务困境的影响。实证分析显示,具有较高社会责任水平公司的财务困境风险较低。此外,这种关系在治理机制强的公司中更加明显。较高的社会责任绩效可以获得债权人以及客户的支持,降低企业的融资成本、提高企业的议价能力进而降低企业陷入财务困境的可能性。研究结果表明,企业社会责任是一种良好的风险管理机制,承担社会责任还能够使企业与部分利益相关者实现良性互动。

TNF-α,IL-6 and hs CRP in patients with melancholic,atypical and anxious depression:an antibodyyarrayanalysis related to somatic symptoms

Background The association between inflammation and major depressive disorder(MDD)remains poorly understood,given the heterogeneity of patients with MDD.Aims We investigated inflammatory markers,such as interleukin(IL)-6,high-sensitivity C reactive protein(hsCRP)and tumour necrosis factor-α.(TNF-α)in melancholic,atypical and anxious depression and explored whether baseline inflammatory protein levels could indicate prognosis.Methods The sample consisted of participants(aged 18-55 years)from a previously reported multicentre randomised controlled trial with a parallel-group design registered with ClinicalTrials.gov,including melancholic(n=44),atypical(n=37)and anxious(n=44)patients with depression and healthy controls(HCs)(n=33).Subtypes of MDD were classified according to the 30-item Inventory of Depressive Symptomatology,Self-Rated Version and the.17-item Hamilton Depression Rating Scale.Blood levels.of TNF-α,IL-6 and hsCRP were assessed using antibody array analysis.Results Patients with MDD,classified according to melancholic,atypical and anxious depression subtypes,and HCs did not differ significantly in baseline TNF-α,IL-6 and hsCRP levels after adjustment.In patients with anxious depression,hsCRP levels increased significantly if they experienced no pain(adjusted(adj.)p=0.010)or mild to moderate pain(adj.p=0.038)compared with those with severe pain.However,the patients with anxious depression and severe pain showed a lower trend in hsCRP levels than patients with atypical depression who experienced severe pain(p=0.022;adj.p=0.155).Baseline TNF-α(adj.p=0.038)and IL-6(adj.p=0.006)levels in patients in remission were significantly lower than those in patients with no remission among the participants with the atypical depression subtype at the eighth-week follow-up.Conclusions This study provides evidence of differences in inflammatory proteins in patients with varied symptoms among melancholic,atypical and anxious depression subtypes.Further studies on the immunoinflammatory mechanism underlying different subtypes of depression are expected for improved individualised therapy.

南京地区3~16岁儿童青少年颈围的参照标准值及其评估腹型肥胖准确性的横断面调查

背景颈围是近年来新引入的体格测量指标,但我国尚无建立儿童青少年颈围的参照标准值及生长曲线的研究。目的 建立3~16岁儿童青少年颈围的参考值范围并探讨颈围评价腹型肥胖的截断值,为儿童青少年体格评估的临床应用提供新的指标和参考依据。设计横断面调查。方法 纳入2021年7月至2022年9月在南京医科大学附属儿童医院儿童保健门诊健康体检的3~16岁儿童及青少年。排除患有可能影响颈围、生长发育的疾病或四肢残疾、姿势异常、畸形的患儿。自制质控标准和操作手册,由3名测量人员严格按照操作手册完成颈围、身高、体重、腰围和体成分测量,并任意抽取10%的样本重复验证,验证前后的符合率应≥99%。对数据的录入、整理实行双人双轨录入和逻辑检查。按性别和年龄建立3~16岁儿童青少年颈围的标准参考值,采用LMS方法构建生长曲线。将6~16岁男童和6~9岁女童腰围身高比(WHtR)>0.48、 10~16岁女童WHtR>0.46定义为腹型肥胖。分析颈围和其他体格测量指标以及腹型肥胖的相关性,以受试者工作特征(ROC)曲线的AUC分析颈围判断腹型肥胖的准确性。主要结局指标3~16岁儿童青少年的颈围参照标准值和6~16岁儿童青少年颈围评估腹型肥胖的截断值。结果 18 371名3~16岁儿童青少年进入本文分析,男童10 701名(58.2%),女童7 670名;腹型肥胖儿童5 407名(29.4%)。除体脂质量外,男童颈围、年龄、身高、体重、BMI、腰围、WHtR、骨骼肌、骨骼肌百分比(PSM)均显著高于女童,体脂百分比(PBF)低于女童,差异均有统计学意义(P均<0.05)。(1)3~16岁男童和女童的颈围随着年龄增长而增长,且每个相同年龄段男童颈围始终大于女童。男童和女童平均年增长幅度分别为0.85 cm和0.65 cm,7~8岁年增长幅度相近,7岁前和8岁后男童年增长幅度均大于女童,12岁后更加明显。(2)男女童颈围与腹型肥胖(r_(男)=0.614,r_(女)=0.541)、BMI(r_(男)=0.824,r_(女)=0.800)、腰围(r_(男)=0.827,r_(女)=0.801)、WHtR(r_(男)=0.729,r_(女)=0.683)及PBF(r_(男)=0.669,r_(女)=0.679)均呈显著正相关,与PSM(r_(男)=-0.497,r_(女)=-0.470)呈负相关。(3)6~16岁男童颈围评估腹型肥胖的最佳截断值为27.15~37.05 cm,女童颈围评估腹型肥胖的最佳截断值为26.25~30.50 cm,均位于各性别年龄组的P_(75);各年龄阶段男童和女童颈围评估腹型肥胖的AUC分别为≥0.83和>0.79。结论 3~16岁儿童青少年不同年龄段男童颈围皆大于女童,且均随年龄增加而增长;6~16岁男童和女童颈围评估腹型肥胖的截断值分别为27.15~37.05 cm和26.25~30.50 cm,AUC分别≥0.83和>0.79,准确性较高。

胃肝样腺癌:在摸索和争议中前进

胃肝样腺癌(hepatoid adenocarcinoma of stomach,HAS)是一种特殊类型的胃癌。其发病率不高,但由于HAS具有高度侵袭性的生物学行为,容易发生淋巴转移及肝转移,预后较差,受到临床广泛关注。随着HAS临床病理特征、预后以及分子生物学特征等的持续研究,关于HAS的认识正不断深入。然而,目前在HAS研究领域仍存在一些容易被忽视并亟需解决的问题。本文梳理既往关于HAS的病例报道及研究,在HAS的范畴、起源、诊断方法、分子生物学特征及预后等方面进行总结和探讨,以期为HAS的后续研究提供一定方向。

注意缺陷多动障碍儿童的体格生长和膳食特征:一项横断面研究

目的调查注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)儿童的体格生长及膳食特征,并分析其与ADHD核心症状的关系。方法纳入2020年6—12月在南京医科大学附属儿童医院初诊为ADHD的患儿268例(ADHD组),另选取同期健康体检的非ADHD儿童102例作为对照组。对两组儿童进行体格测评、膳食调查,并依据美国精神障碍诊断与统计手册第5版进行ADHD诊断及评分,采用因子分析、Spearman秩相关分析及中介效应分析评估ADHD核心症状、膳食模式及体格生长之间的关系。结果ADHD组超重/肥胖检出比例显著高于对照组(35.8%vs 21.6%,P<0.05)。依据食物频率问卷共提取3种膳食模式:素食膳食模式、传统膳食模式及零食快餐模式。其中ADHD组儿童零食快餐模式因子得分高于对照组(P<0.05)。ADHD症状评分、零食快餐模式因子得分及体脂百分比两两之间呈显著正相关(P<0.05)。中介效应分析显示,零食快餐模式因子得分在ADHD症状评分与体脂百分比的关系中起到了部分中介作用,中介占比为26.66%。结论ADHD儿童超重/肥胖率高于非ADHD儿童;ADHD儿童核心症状与膳食模式、体格生长状况相关,其中零食快餐模式在ADHD核心症状与体格生长状况之间发挥了部分中介作用。

Green,Sustainable Architectural Bamboo with High Light Transmission and Excellent Electromagnetic Shielding as a Candidate for Energy-Saving Buildings

Currently,light-transmitting,energy-saving,and electromagnetic shielding materials are essential for reducing indoor energy consumption and improving the electromagnetic environment.Here,we developed a cellulose composite with excellent optical transmittance that retained the natural shape and fiber structure of bamboo.The modified whole bamboo possessed an impressive optical transmittance of approximately 60%at 6.23 mm,illuminance of 1000 luminance(lux),water absorption stability(mass change rate less than 4%),longitudinal tensile strength(46.40 MPa),and surface properties(80.2 HD).These were attributed to not only the retention of the natural circular hollow structure of the bamboo rod on the macro,but also the complete bamboo fiber skeleton template impregnated with UV resin on the micro.Moreover,a multilayered device consisting of translucent whole bamboo,transparent bamboo sheets,and electromagnetic shielding film exhibited remarkable heat insulation and heat preservation performance as well as an electromagnetic shielding performance of 46.3 dB.The impressive optical transmittance,mechanical properties,thermal performance,and electromagnetic shielding abilities combined with the renewable and sustainable nature,as well as the fast and efficient manufacturing process,make this bamboo composite material suitable for effective application in transparent,energy-saving,and electromagnetic shielding buildings.

Spliceosomal GTPase Eftud2 regulates microglial activation and polarization

Elongation factor Tu GTP binding domain protein 2(Eftud2)is a spliceosomal GTPase that serves as an innate immune modulator restricting virus infection.Microglia are the resident innate immune cells and the key players of immune response in the central nervous system.However,the role of Eftud2 in microglia has not been reported.In this study,we performed immunofluorescent staining and western blot assay and found that Eftud2 was upregulated in microglia of a 5xFAD transgenic mouse model of Alzheimer’s disease.Next,we generated an inducible microglia-specific Eftud2 conditional knockout mouse line(CX3CR1-CreER;Eftud2^(f/f) cKO)via Cre/loxP recombination and found that Eftud2 deficiency resulted in abnormal proliferation and promoted anti-inflammatory phenotype activation of microglia.Furthermore,we knocked down Eftud2 in BV2 microglia with siRNA specifically targeting Eftud2 and found that Eftud2-mediated regulation of microglial proinflammatory/anti-inflammatory phenotype activation in response to inflammation might be dependent on the NF-κB signaling pathway.Our findings suggest that Eftud2 plays a key role in regulating microglial polarization and homeostasis possibly through the NF-κB signaling pathway.

胃混合性腺神经内分泌癌淋巴结转移的临床研究进展

胃混合性腺神经内分泌癌(gastric mixed adenoneuroendocrine carcinoma,G-MANEC)是一种罕见的胃肠道肿瘤,发病率虽不高但有上升趋势,由于其具有高度侵袭性的生物学行为,且容易发生淋巴转移及远处转移,预后较差,因此备受研究者的关注。其由腺癌和神经内分泌癌两种成分组成,且两者成分占比均不小于30%。近年来,G-MANEC的相关研究不断开展,然而,目前关于G-MANEC的淋巴结转移成分的研究仍有不足且存在亟需解决的问题。本文结合胃癌的研究,系统回顾了既往关于混合性神经内分泌-非神经内分泌肿瘤(mixed neuroendocrine-non-neuroendocrine neoplasms,MiNEN)的病例报道及研究,主要探讨了GMANEC的流行病学、生物学起源、诊断、淋巴结转移模式、淋巴结转移与血行转移、远处转移的关系、治疗,以期为G-MANEC的后续研究提供方向。

基于混合VR技术的智慧教室在口腔颌面外科学中的应用

目的:依托混合虚拟现实技术来打造智慧教室,将其应用于口腔颌面外科教学,评价教学效果。方法:以新疆医科大学四年级口腔学生为研究对象,试验组采用智慧教室互动式教学模式授课,对照组采用以教师讲授为主的传统模式授课。结果:试验组的测试成绩和教学满意度高于对照组(P<0.05)。结论:基于混合VR技术的智慧教室在口腔颌面外科教学中的应用,可以提高教学满意度和教学质量,值得推广。

The protective effect of oleic acid on Lactiplantibacillus plantarum during freeze-drying

Membrane characteristics are determined by the fatty acids composition,which affects survival rates after freeze-drying.However,it is unknown which composition provides the greatest effect.In this study,we found that the addition of Tween 80 and Tween 20 significantly increased survival rates of Lactiplantibacillus plantarum,which reached a maximum of 93.1%.Conversely,Tween 60 caused a significant decrease.We further found that the difference between the effects of adding Tween 80 and Tween 60 was the change in oleic acid contents.To verify the role of oleic acid,we used CRISPR-Cas9 to knock-out the key synthesis gene cla-er.The survival rates of L.plantarum AR113Δcla-er declined to 5.48%.The addition of oleic acid restored the rates to those of wild type strains.Moreover,the membrane integrity and fl uidity of knockout strains markedly decreased.This is the fi rst confi rmation that Tween 80 or Tween 20 increases the survival rate by increasing the content of oleic acid in the cell membrane.These fi ndings also indicated that oleic acid in cell membranes has a substantial protective effect on L.plantarum during freeze-drying.