简介:摘要在20世纪以前,美国医学教育模式参差不齐,招生入学缺乏标准,教育过程缺乏品质管控,执照制度长期缺失。1910年《弗莱克斯纳报告》(Flexner Report)的发布引发了美国医学教育的剧烈变革,包括提高入学和学制标准,确立医学院教师的学术身份,配备实验室和教学医院,改变医学院运营的资金来源等。这极大地提高了医学教育的质量,促进了医学的职业化进程,使得医生成为精英职业,但也同时带来了低收入人群较难获得正规医疗服务等问题。我国应当从美国医学教育改革历程中吸取经验,更好地解决医学教育体制学制、资金支持、师资队伍、课程体系等问题,为全民健康提供保障。
简介:摘要胃肠微生态学是研究消化道微生物群落与宿主间相互关系和作用的科学。胃肠微生态的发展与方法学的进展密切相关。胃肠微生态的研究方法从分离培养法、分子生物学检测发展为宏基因组学、转录组学、蛋白质组学、代谢组学等多组学技术,胃肠微生态的结构和功能逐渐被揭示,多组学技术的发展大大加快了胃肠微生态与消化系疾病和其他系统疾病相关的临床转化研究的进展。饮食调整、微生态调节剂的补充、肠道微生态环境的重建等微生态干预措施为多种疾病的预防和治疗提供了新的靶点和途径。回顾40年来《中华消化杂志》发表的胃肠微生态相关研究和国际发表的重要临床研究,对了解胃肠微生态的发展历程、把握未来研究方向具有重要意义。
简介:摘要目的分析我国2018年0~19岁人群哮喘死亡情况及2008年至2018年哮喘死亡人数的变化趋势,以期指导我国哮喘控制管理和预防策略的研究,降低我国儿童哮喘死亡率。方法应用全国疾病监测系统(DSPs)的数据。计算我国0~19岁人群2008年至2018年不同年龄组、性别、居住地、地理区域人群哮喘死亡率,结合中国统计年鉴的全国人口数估算全国的哮喘死亡人数,计算哮喘死亡率年度变化百分比(APC)和哮喘死亡率平均年度变化百分比(AAPC),分析我国2018年0~19岁哮喘人群死亡情况及2008年至2018年哮喘死亡率变化趋势。结果2018年中国0~19岁人群哮喘死亡率在不同年龄、居住地、地理区域的性别差异均无统计学意义(均P>0.05)。2008年至2018年我国0~19岁哮喘死亡率为0.023/10万~0.046/10万,2009年、2012年哮喘死亡率最高,2018年最低。估算全国范围内0~19岁哮喘人群死亡人数,2009年最高(148例),2018年最低(70例)。估算全国2008年至2018年0~19岁哮喘死亡人数为1 158例。2008年至2018年中国0~19岁人群哮喘合计死亡率明显下降(AAPC=-7.6%,95%CI:-10.4%~-4.7%)。各组别中,男性组(AAPC=-7.4%,95%CI:-12.5%~-2.0%)、女性组(AAPC =-7.5%,95%CI:-12.7%~-2.0%)、1~<5岁组(AAPC=-11.4%,95%CI:-17.9%~-4.5%)、15~19岁组(AAPC=-14.4%,95%CI:-24.8%~-2.6%)、农村(AAPC=-9.0%,95%CI:-13.1%~-4.8%)及中部地区(AAPC=-13.1%,95%CI:-24.0%~-0.5%)人群哮喘死亡率均明显下降,差异均有统计学意义(均P<0.05)。结论我国0~19岁人群哮喘合计死亡率在2008年至2018年间明显下降,在全球范围内处于较低水平。
简介:摘要随着影像学检查设备的不断发展,消化影像技术不断进步。回眸《中华消化杂志》40年发表的相关论文,涵盖了从最初的消化道造影,到计算机断层扫描和磁共振成像的应用,再到功能成像和人工智能技术的新进展,消化影像技术在疾病诊断、术前评估、预后判断和机制研究等方面均体现出重要的应用价值。虽然仍面临一些挑战,但随着新设备、新技术的持续研发,消化影像技术将为临床工作提供更大助力。
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简介:摘要目的根据外照射个人监测异常结果及调查,分析异常结果剂量区间分布、职业类别分布、不同职业类别异常结果发生率、异常结果发生原因以及异常值高低的影响因素,为法规标准的制定和医院放射防护管理提出科学依据。方法收集2017年我国19个省份上报的医疗机构放射工作人员个人监测结果超过1.25 mSv的389例异常结果数据及相关调查并进行分析。结果异常结果的剂量分布区间主要在1.25~5 mSv;诊断放射学工作人员异常结果占比最高,为59.64%;介入放射学工作人员的异常结果发生率最高,为4.17‰。异常结果主要是不规范佩戴或操作个人剂量计导致;东部地区的异常值较其他地区高,中位数为6.41 mSv;原因不详组异常值较其他组高,中位数为10.32 mSv。结论应进一步加强放射防护知识的宣传培训,提高放射工作人员防护意识;介入放射学工作人员的职业照射需要特别关注。
简介:AbstractThe novel coronavirus disease 2019 (COVID-19) is the third coronavirus outbreak in the last two decades. Emerging and re-emerging infections like COVID-19 pose serious challenges of the paucity of information and lack of specific cure or vaccines. This leaves utilisation of existing scientific data on related viral infections and repurposing relevant aetiologic and supportive therapies as the best control approach while novel strategies are developed and trialled. Many promising antiviral agents including lopinavir, ritonavir, remdesivir, umifenovir, darunavir, and oseltamivir have been repurposed and are currently trialled for the care for COVID-19 patients. Adjunct therapies for the management of symptoms and to provide support especially in severe and critically ill patients have also been identified. This review provides an appraisal of the current evidence for the rational use of frontline therapeutics in the management of COVID-19. It also includes updates regarding COVID-19 immunotherapy and vaccine development.
简介:AbstractBackground:The pandemic of the coronavirus disease 2019 (COVID-19) has caused substantial disruptions to health services in the low and middle-income countries with a high burden of other diseases, such as malaria in sub-Saharan Africa. The aim of this study is to assess the impact of COVID-19 pandemic on malaria transmission potential in malaria-endemic countries in Africa.Methods:We present a data-driven method to quantify the extent to which the COVID-19 pandemic, as well as various non-pharmaceutical interventions (NPIs), could lead to the change of malaria transmission potential in 2020. First, we adopt a particle Markov Chain Monte Carlo method to estimate epidemiological parameters in each country by fitting the time series of the cumulative number of reported COVID-19 cases. Then, we simulate the epidemic dynamics of COVID-19 under two groups of NPIs: (1) contact restriction and social distancing, and (2) early identification and isolation of cases. Based on the simulated epidemic curves, we quantify the impact of COVID-19 epidemic and NPIs on the distribution of insecticide-treated nets (ITNs). Finally, by treating the total number of ITNs available in each country in 2020, we evaluate the negative effects of COVID-19 pandemic on malaria transmission potential based on the notion of vectorial capacity.Results:We conduct case studies in four malaria-endemic countries, Ethiopia, Nigeria, Tanzania, and Zambia, in Africa. The epidemiological parameters (i.e., the basic reproduction number R0 and the duration of infection DI) of COVID-19 in each country are estimated as follows: Ethiopia (R0 = 1.57, DI = 5.32), Nigeria (R0 = 2.18, DI = 6.58), Tanzania (R0 = 2.47, DI = 6.01), and Zambia (R0 = 2.12, DI = 6.96). Based on the estimated epidemiological parameters, the epidemic curves simulated under various NPIs indicated that the earlier the interventions are implemented, the better the epidemic is controlled. Moreover, the effect of combined NPIs is better than contact restriction and social distancing only. By treating the total number of ITNs available in each country in 2020 as a baseline, our results show that even with stringent NPIs, malaria transmission potential will remain higher than expected in the second half of 2020.Conclusions:By quantifying the impact of various NPI response to the COVID-19 pandemic on malaria transmission potential, this study provides a way to jointly address the syndemic between COVID-19 and malaria in malariaendemic countries in Africa. The results suggest that the early intervention of COVID-19 can effectively reduce the scale of the epidemic and mitigate its impact on malaria transmission potential.
简介:【摘要】 介绍1例原钙黏蛋白19(PCDH19)基因相关癫痫的综合护理方法。PCDH19基因相关癫痫目前在国内报道尚少,严密的病情监测、丛集性发作期间正确处理、安全防护、康复训练及健康指导等护理措施对原钙黏蛋白19(PCDH19)基因相关癫痫丛集性发作的控
简介:AbstractThe pandemic of coronavirus disease 2019 (COVID-19) has already evoked massive influence. The global pandemic has been ravaging the whole world for a year, with the number of confirmed human infection cases over 150 million and a death toll exceeding 3 million. Although the genomic sequence of the cognate pathogen SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has been quickly determined, there are still many unknown aspects, including the virus origin and evolution trend, and the effectiveness of current vaccines and drugs against the mutating virus. This review summarizes current knowledge and advances about COVID-19, including virus origin, transmission and infection, with the aim to improve the understanding of COVID-19 and provide a new perspective for future studies.