Objective:To evaluate the safety and feasibility of catheter ablation in patients with atrial fibrillation(AF) and left atrial appendage(LAA) sludge.Methods:Patients with AF and LAA sludge who underwent catheter ablation were enrolled consecutively from 1st January, 2020 to 1st December, 2021 in Center of Atrial Fibrillation, Beijing Anzhen Hospital.The general clinical data, echocardiographic results, laboratory test results, drug therapy, catheter ablation and left atrial appendage occlusion(LAAO) were collected.Patients were followed up at 3, 6 and 12 months after the procedure by telephone or via outpatient service.We recorded the procedure-related complications both in-hospital and post-discharge, including death, thromboembolism, vascular access complications and so on.Results:Nine patients were included in the study, the average age was (68.8±10.2) years old, and eight were male.Nine patients were all diagnosed with persistent AF.The median duration of AF was 3(1, 5)years.The nine patients all achieved bilateral pulmonary veins electrical isolation and complete block of ablation lines.Among them, five patients underwent synchronous LAAO, there were no residual shunt and device translocations during operation.After a median follow-up of six months, there were no perioperative death, thromboembolism, vascular access complications, cardiac tamponade, atrial-esophageal fistula.Only one patient developed pericardial effusion, which was absorbed spontaneously.Conclusion:It may be safe and feasible for patients with AF and LAA sludge to undergo catheter ablation with/without synchronous LAAO.Further studies with larger patient cohort are warranted to confirm this conclusion.

目的 观察病灶大小对剪切波弹性成像(SWE)鉴别诊断甲状腺良、恶性结节效能的影响.方法 回顾性分析214例甲状腺结节患者,共215枚结节,良性93枚、恶性122枚,根据结节最大径分为小结节组(最大径＜1.00 cm,85枚)、中结节组(1.00 cm≤最大径＜1.50 cm,67枚)及大结节组(最大径≥1.50 cm,63枚);对比良、恶性结节及各组结节最大弹性模量(Emax)差异,采用受试者工作特征(ROC)曲线观察Emax诊断甲状腺良、恶性结节的截断值及曲线下面积(AUC),评价结节横径、前后径及最大径与Emax的相关性.结果 恶性结节Emax大于良性结节(P＜0.01).各组恶性结节Emax均大于良性(P均＜0.01).各组间恶性结节Emax差异有统计学意义(P＜0.01),且大结节组大于小结节及中结节组(P均＜0.05),小结节与中结节组差异无统计学意义(P＞0.05).各组间良性结节Emax差异无统计学意义(P＞0.05).Emax鉴别全部甲状腺结节、小结节组、中结节组及大结节组良、恶性病变的截断值分别为30.65、29.40、30.70及52.65 kPa,AUC分别为0.82、0.79、0.76及0.89,差异均无统计学意义(P均＞0.05);针对大结节组将截断值调整为52.65 kPa时,诊断特异度达100％.Emax与结节横径、前后径及最大径线均呈正相关(r=0.29、0.29、0.55,P均＜0.05).结论 以SWE参数Emax判断甲状腺良、恶性结节时存在尺度效应;针对最大径≥1.50 cm的甲状腺结节,适当提高Emax截断值有助于改善诊断效能.

目的:调查了解北京石景山地区人工流产情况以及避孕失败的相关因素.方法:随机整群选取2018年1月-2020年1月北京石景山地区部分计划生育服务机构共5766例人工流产女性,问卷调查并分析人工流产妇女基本情况及避孕失败的影响因素等.结果:发放调查问卷5766份,回收有效问卷5687份,有效问卷回收率为98.6％.5687例被调查对象年龄(33.3±3.4)岁(14～49岁),其中≤20岁14.3％、21≤30岁32.0％、31～40岁45.6％、＞40岁占8.1％.教育背景以高中/中专(21.5％)和初中及以下(69.3％)居多,职业以无业(34.0％)、农民(30.8％)占比较高;已婚占68.5％、未婚占27.4％、离异4.1％.避孕失败(61.2％)是导致非意愿妊娠主要因素;64.7％有既往生育史,18.9％有过1次既往流产史,49.4％有≥2次流产史.已生育女性主要采用宫内节育器避孕(43.2％),未生育女性主要采用安全套避孕(47.5％),避孕方式有差异(P＜0.05).多因素logistic回归分析显示,不掌握避孕知识、无业或农民、初中及以下教育背景、避孕方式使用不当是导致避孕失败的独立风险因素(P＜0.05).结论:北京石景山地区人工流产女性以低教育背景、无业或农民、已婚等占比最高,不掌握避孕知识、教育背景、职业、避孕方式不当是导致避孕失败的主要因素.应强化该地区育龄女性避孕知识宣教工作,以降低人工流产发生.

目的 探讨肥胖程度与常见慢性病之间的关联关系,为常见慢病的预防和管理提供大数据支撑.方法基于社区公共卫生系统数据集,通过使用Apriori关联规则算法挖掘高血压、冠心病、糖尿病这3种常见慢病与肥胖程度(超重或肥胖)之间的关联关系,并根据关联规则的支持度、置信度和提升度评价肥胖程度对发生常见慢病的影响.结果共对196554名居民的健康数据进行分析,高血压的患病率(48.6％)明显高于冠心病(22.9％)和糖尿病(20.3％),51.0％的人至少患有其中一种慢病,10.6％的人同时患有该3种慢病.关联规则分析结果显示,超重与高血压、冠心病之间均有强关联性,肥胖与高血压之间也有强关联性,而糖尿病与体型因素的关联性较弱.3种慢病之间均有强关联性,饮食嗜好与这3种慢病都有关联,老年人常常伴随发生高血压、糖尿病与冠心病.结论超重和肥胖会增加高血压、冠心病和糖尿病的发生风险,因此,为尽可能减少这些慢病的发生,健康人群要关注自身的肥胖情况,特别是老年人、有饮食偏好的人以及女性.

目的 利用居民健康大数据预测高血压的患病风险,并分析高血压相关的重要因素.方法 基于社区公共卫生系统数据集,利用机器学习中的Logistic回归、随机森林和支持向量机算法建立高血压患病风险预测模型,并比较三者的预测性能,另通过随机森林中的基尼系数下降法分析高血压患病的影响因素.结果 支持向量机模型的准确率(87.00％)、精确率(85.00％)、召回率(88.00％)、F1值(0.88)和ROC曲线下面积(0.932)优于随机森林模型(85.00％、84.00％、87.00％、0.87和0.929)和Logistic回归模型(83.00％、85.00％、81.00％、0.81和0.920).Gini系数分析显示,冠心病、年龄、糖尿病和教育水平在预测高血压患病风险中具有重要作用;现教育水平、职业类型、其他慢病、婚姻情况、体重指数、父亲患有高血压、母亲患有高血压、饮酒、饮食偏咸、吸烟、锻炼在预测高血压患病风险中具有一般作用;性别、饮食偏素、饮食偏甜、饮食偏油、饮食偏辣在预测高血压患病风险中作用不大.结论 支持向量机预测模型的预测高血压患病风险最优.文化程度低、合并患有冠心病、糖尿病和其他慢病、有家族史和老年人为高血压易患人群,针对此类人群应重点关注体重指数、饮酒和饮食习惯(偏咸)方面.

目的 探讨替诺福韦酯在乙型肝炎孕妇母婴传播阻断中的作用.方法 选择2017年1月至2019年6月于首都医科大学附属北京同仁医院妇产科分娩的乙型肝炎孕妇102例为研究对象,按照药物使用情况将其分为观察组和对照组,每组各51例.对照组患者不接受抗病毒治疗,定期接受产前检查,孕期仅采取一般保肝治疗;观察组患者于孕24周开始服用替诺福韦酯,至分娩当日停药.两组新生儿均于出生后12 h在不同部位注射重组酵母乙型肝炎疫苗和乙型肝炎免疫球蛋白,并分别于第1个月和6个月接种第2针和第3针重组酵母乙型肝炎疫苗.比较两组患者孕24 h周和分娩时乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)阳性率、乙型肝炎e抗原(hepatitis B e antigen,HBeAg)阳性率、谷丙转氨酶(alanine aminotransferase,ALT)和log10乙型肝炎病毒(hepatitis B virus,HBV)DNA水平变化,剖宫产、早产和产后24 h出血量,新生儿出生后7个月HBsAg和HBeAg阳性率.结果 两组患者孕24周HBsAg和HBeAg阳性率、ALT和log10 HBV DNA水平及分娩时ALT水平比较差异均无统计学意义(均P>0.05);两组患者分娩时HBsAg和HBeAg阳性率均显著低于本组孕24周(均P<0.05),分娩时ALT水平与本组孕24周比较差异均无统计学意义(均P>0.05);观察组患者分娩时HBsAg和HBeAg阳性率均显著低于对照组(均P<0.05),对照组患者分娩时log10 HBV DNA水平与本组孕24周比较差异无统计学意义(P>0.05);观察组患者分娩时log10 HBV DNA水平显著低于本组孕24周和同期对照组(均P<0.05).两组患者早产率和产后24 h出血量比较差异均无统计学意义(均P>0.05).观察组新生儿出生后7个月HBsAg和HBeAg阳性率均显著低于对照组(均P<0.05).结论 替诺福韦酯对乙型肝炎产妇母婴传播阻断效果良好,可明显降低新生儿分娩后7个月HBsAg和HBeAg阳性率.

目的 观察心理辅导等积极干预对产后无泌乳及睡眠障碍的影响结果.方法 回顾性分析2016年1月～2018年1月在首都医科大学附属北京朝阳医院自然分娩的初产妇资料,以2016年1～12月开展产后治疗前分娩的653例产妇作为对照组,以2017年1月～ 2018年1月开展产后治疗后分娩的799例产妇作为观察组;于产后4d统计两组产妇中无泌乳及睡眠障碍的发生率,评估产妇产后1和4d时的心理状态,同时观察产妇泌乳量、开始泌乳时间、血清泌乳素(PRL)水平、乳房疼痛程度及睡眠质量的变化情况.结果 产后4d时,观察组产妇产后无泌乳率为1.88％、睡眠障碍率为5.76％,对照组分别为7.2％、18.07％,观察组均低于对照组,差异有统计学意义(P＜0.05);两组产妇心理状态、匹兹堡睡眠质量指数量表(PSQI)各维度评分均有所改善,观察组均较对照组更加理想,差异有统计学意义(P＜0.05);观察组产妇开始泌乳时间、泌乳量、血清PRL、VAS均优于对照组,差异有统计学意义(P＜0.05).结论 产妇经过积极有效干预,可有效减少产妇产后无泌乳及产后睡眠质量降低的发生率,提高产妇的泌乳量,缓解产妇乳房疼痛,改善产妇心理状态,提高母乳喂养率,增加产妇母乳喂养成功的信心.

Objective:To investigate the feasibility and characteristics of ultrasound imaging in diagnosing fractures in neonates.Methods:Thirty neonates with bone fracture in Beijing Chaoyang District Maternal and Child Healthcare Hospital during January 2018 to June 2019 were retrospectively recruited. The causes and ultrasound imaging features of these cases were analyzed. The ultrasound findings were compared with the results of X-ray examination.Results:Among the 30 cases, 29 (96.7%) were diagnosed as fracture due to birth trauma, including 28 (93.3%) of clavicle fracture and one (3.3%) of humerus fracture, and one (3.3%) with rib fracture probably caused by metabolic osteopathy. The ultrasound imaging characteristics included interruption of bone continuity, dislocation and/or angulation of fracture ends, and callus formation during recovery. All of the 30 cases were diagnosed by ultrasound. However, X-ray examination failed in the diagnosis of one clavicle fracture.Conclusions:Ultrasound is an accurate and reliable method for the diagnosis of neonatal fracture. The main characteristics of ultrasound imaging include interruption of bone continuity, dislocation and/or angulation of fracture ends and callus formation.

As a new examination model, network examination system has been more and more used in medical examination. This paper analyzed the background and necessity of network examination, elaborated the construction of software and hardware platform, function realization and practical application of network examination system for graduation examination for clinical degree, pointed out the advantages of network examination, and summarized the practical significance of network examination system for graduation examination of medical students.

目的 对比羟考酮与芬太尼用于七氟烷全身麻醉行眼科手术小儿预防术后躁动的效果.方法 前瞻性选择2018年9～12月在首都医科大学附属北京同仁医院择期行斜视矫正手术的患儿80例,年龄3～7岁,美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级.采用随机数字表法将患儿分为两组:羟考酮组(0组)及芬太尼组(F组).采用8％七氟醚与4 L/min氧气吸入诱导,待麻醉深度合适后置入喉罩,术中保留自主呼吸单纯七氟烷吸入维持,手术结束前15 min,O组静脉缓慢滴注盐酸羟考酮0.075 mg/kg,F组患儿静脉缓慢滴注芬太尼1μg/kg,并给予同步间歇指令通气(SIMV).术毕停用七氟烷,拔除喉罩送入麻醉恢复室.记录患儿年龄、性别构成比、体重、手术时间、七氟醚吸入时间、意识恢复时间、恢复室停留时间,并定时评估术后躁动评分(PAED)、镇痛评分(FLACC),记录低氧血症、头晕、嗜睡、恶心呕吐及排便障碍等不良反应发生率.结果 O组与F组患儿年龄、性别、体重、手术时间及七氟醚吸入时间比较差异无统计学意义.O组患儿意识恢复时间及恢复室停留时间分别为(15.9±3.8)、(27.9±5.1) min,与F组[(16.1±4.2)、(25.1±4.4) min]比较,差异无统计学意义(P＞0.05).O组患儿术后PAED评分为4.9(3.8)分,与F组6.0(3.4)分比较,差异无统计学意义(P＞0.05);0组患儿术后躁动发生率为10.0％ (4/40),与F组术后躁动发生率15.0％ (6/40)比较,差异无统计学意义(P＞0.05).O组患儿FLACC评分为1.0[2.1],与F组3.6[2.0]比较差异具有统计学意义(P=0.001);O组术后疼痛发生率为5.0％ (2/40),与F组20.0％ (8/40)比较,差异具有统计学意义(P=0.043).两组患儿各种不良反应的发生率比较,差异无统计学意义(P＞0.05).结论 静脉应用羟考酮与芬太尼同样可安全应用于七氟烷全身麻醉行眼科手术小儿,术后躁动发生率低;与芬太尼相比,静脉应用羟考酮的患儿术后疼痛评分更低,舒适度更高.

目的 探讨动静态平衡训练联合四肢联动训练对帕金森病患者平衡功能及日常生活活动能力的作用.方法 对符合纳入标准的50例帕金森病患者随机分为试验组(25例)和对照组(25例),对照组仅进行常规的康复训练,试验组在对照组的基础上进行动静态平衡训练及四肢联动训练,干预疗程为4周.两组在治疗前、治疗4周后均进行Berg平衡量表(BBS)、起立-行走计时测试(TUGT)及改良的Barthel指数(MBI)评定,以组内和组间比较康复治疗前后平衡功能及日常生活活动能力的变化.结果 与治疗前比较,经过4周治疗后试验组和对照组的BBS,TUGT,MBI均有所改善(P<0.01),而试验组的BBS,TUGT,MBI均显著优于对照组(P<0.01).结论 动静态平衡训练联合四肢联动训练能够提高帕金森病患者的平衡功能及日常生活活动能力.

目的 探讨第二产程时限对母婴结局的影响.方法 纳入阴道试产的2000例初产妇,根据第二产程时限分为A组(<2.0 h)、B组(2.0～<2.5 h)、C组(2.5～<3.0 h)、D组(≥3 h),每组500例.比较4组的剖宫产率、产钳助产率、产妇不良结局发生率及新生儿不良结局发生率.结果 B组、C组、D组剖宫产率及产钳助产率均高于A组(均P<0.05).C组、D组产后出血、产后发热、切口愈合不良、产后尿潴留的发生率均高于A组(均P<0.05),但B组与A组以上指标比较,差异无统计学意义(均P>0.05).D组的新生儿窒息发生率高于A组(P<0.05),C组、D组的新生儿住院人数及新生儿代谢性酸中毒发生率均高于A组(均P<0.05).结论 第二产程时限≥3 h均可对母婴造成不同程度的不良影响;第二产程<2.5 h对新生儿结局的影响可能较小.

Objective To explore the influence of Rosenthal effect on the psychological status of pregnant women at risk of miscarriage in early pregnancy. Methods From January 2014 to June 2015 151 cases of early pregnancy abortion risk women were set as the control group, and was given conventional psychological intervention.From July 2015 to December 2016 135 cases of early pregnancy abortion risk women were named as the observation group by convenient sampling selection, which was given interventionbased on Rosenthal effect on the basis of routine psychological intervention. The Self-rating Depression Scale (SDS) and the Self-rating Anxiety Scale (SAS) score, the introversion and extroversion scores and the satisfaction degree with intervention were compared between the two groups before and after the intervention. Results There was no significant difference in SDS and SAS scores, inotropic challenge and extroversion challenge between the two groups before treatment (P >0.05). The scores of SDS and SAS, the inotropic challenge and extroversion challenge scores were 41.45 ± 4.26, 40.34 ± 5.82,4.76 ± 1.03,5.55 ± 1.26 in the observation group after intervention,and 47.22 ± 3.93,47.18 ± 7.04,5.39 ± 1.12, 6.43 ± 1.86 respectively in the control group. There were significant difference in scores of SDS and SAS, the inotropic challenge and extroversion challenge (t=2.215-2.573, P <0.05). The satisfaction rates of the observation group and the control group were 93.32%(126/135)and 74.17% (112/151) respectively, the difference was statistically significant (χ2=5.921, P<0.05). Conclusions The intervention based on Rosenthal effect on the basis of conventional psychological intervention for early pregnancy abortion risk women can relieve negative emotions such as anxiety and depression, besides it can also improve satisfaction degree of inpatients with intervention.

Objective To investigate the clinical value of hysteroscopy in helping identify the etiology of intrauterine fluid collection in postmenopausal women.Methods One hundred and thirtyfour postmenopausal women with intrauterine fluid collection,detected via transvaginal sonography,were admitted in the department of gynecology and obstetrics at Beijing ChaoYang Hospital from May 2014 to October 2016.All clinical data were retrospectively analyzed.All patients underwent hysteroscopy and biopsy of the endometrium.The results of hysteroscopy were analyzed against biopsy results.Results Hysteroscopy revealed that 116 of the 134 cases had uterine fluid(86.6％).Based on hysteroscopy results,44 (37.9 ％) had endometritis,10 (8.6 ％) had atrophic endometritis,5 (4.3 ％) had endometrial carcinoma,and 7(6.0 ％)had endometrial polyps,but the case numbers and rates for these conditions from microscopic examination were39 (33.6％),15 (12.9％),6 (5.2％),and 7 (6.0 ％),respectively.When microscopic examination was used as the gold standard,the sensitivities and specificities of hysteroscopy in the diagnosis of endometritis,atrophic endometritis,endometrial cancer and endometrial polyps were 82.0 ％ and 85.7 ％,66.7 ％ and 97.1％,80.0 ％ and 98.2 ％,and 100.0％ and 97.3％,respectively.The diagnostic coincidence rates were 84.6％,93.2％,94.4％ and 97.4％,respectively.Conclusions Postmenopausal women with intrauterine fluid collection shown on transvaginal sonography should receive hysteroscopy for early detection of endometrial lesions.

Objective To study the relationships between neonatal weight and blood lipids levels of gestational diabetes mellitus (GDM) pregnant women with different weights.Methods A total of 120 pregnant women with GDM who were treated in the hospital from January 2015 to August 2016 were enrolled into this study as observation group,including 16 cases with weight＜50.5 kg,68 cases with weight 50.5 ～65.0 kg,36 cases with weight≥65.0 kg.A total of 120 healthy pregnant women receving prenatal examination inthe hospital were selected as control group during the same period;the blood lipid levels of pregnant women in the two groups were compared,blood lipid levels of GDM pregnant women and the corresponding neonatal conditions of patieuts with different weights in observation group were compared,the correlations betweens blood lipids levels and neonatal weight in observation group were analyzed.Results The levels of total cholesterol (TC) and triglyceride (TG) in observation group were statistically significantly higher than those in control group (P＜0.05).There was no statistically significant difference in the levels of low-density lipoprotein (LDL-C) and high-density lipoprotein (HDL-C) between the two groups (P＞0.05).TC and TG levels increased with the increase of weight in observation group,and the differences among different weight groups were statistically significant (P＜0.05).Neonatal weight increased with the increase of maternal weight in observation group,the differences among different weight groups were statistically significant (P＜0.05).Spearman analysis showed that TC and TG levels were positively correlated with neonatal weight in observation group,but there was no significant correlation between TC and TG levels and neonatal head circumference,chest circumference;LDL-C and HDL-C levels were not correlated with neonatal weight,head circumference,and chest circumference.Conclusion TC and TG levels significandy increase in GDM pregnant women with elevated weight,which are positively correlated with neonatal weight.

Objective To study the efficacy of insulin combined with nursing intervention in treating gestational diabetes mellitus. Methods 80 patients with gestational diabetes mellitus treated by insulin in our hospital during the period from January 2014 to October 2015 were randomized into the control group ( routine nursing ) and the observation group ( nursing intervention ) according to the random number method, 40 cases in group. The compliance behavior, blood glucose controlling, the standard time of blood glucose, and the com-plications of maternal and neonatal during the treatment period in two groups were compared. Results Compared with the control group, the scores of compliance behavior was significantly increased and the levels of fasting blood glucose, postprandial 2 h blood glu-cose, insulin dosage and the standard time of blood glucose were obviously decreased in the observation group;the incidence of maternal and neonatal complications were significantly reduced in the observation group ( P ﹤ 0. 05 ) . Conclusion Nursing intervention can effec-tively control the blood glucose level for patients with gestational diabetes mellitus during the insulin treatment period, increase the patients' compliance to treatment, improve the maternal and neonatal outcomes.

目的 探讨女性盆底疝患者的发病与绝经及雌激素水平的关系.方法 将2013年1月至2016年1月首都医科大学附属北京朝阳医院收住的女性盆底疝患者以是否绝经分为两组,分别检测患者血清雌激素水平,并与正常对照组进行分析比较.结果 绝经前及绝经后女性盆底疝患者雌激素水平均显著低于正常对照组,差异有统计学意义(P＜0.05).结论 雌激素水平明显下降是女性患盆底疝的危险因素,是女性绝经期后盆底疝发病率升高的重要原因之一.

The difficulties of adult education is the adaptability of the content of adult education. Apply the relevant level "general enlightenment" teaching system for full-time education programs during the adult education, resulting in duplication and waste between in adult education and full-time education. It is particularly important to establish experimental teaching system in line with the Medical Adult Education. We explore and practice on adult undergraduate medical teaching system in the experimental teaching of biochemistry. In this way, association and creative of the students are excited, and laid the foundation for creative thinking and innovation ability to improve for the students.

[案例]孙先生今年46岁了,作为单位的一名中层领导,他每天非常忙碌,白天几乎要花一整天在办公室里处理各类文件,晚上外出的应酬又很多,生活压力蛮大的,这不中年已经明显发福,身高1.75米,而体重却有85千克,体重指数达到27.8千克/米2,属于肥胖人群. 最近孙先生被确诊得了2型糖尿病,医生给出了适合他的治疗方案,但特别强调了一点,那就是他必须减肥,医生说:如果他的体重一直超标,血糖会越来越难达标.

中医专业的生物化学教育教学内容的适应性是中医本科实验教学的难点.套用相关西医的教育课程制定的教学体系,造成了实验教学以验证性、演示性内容为主,使人体系统知识被人为分割.建立符合中医学医学本科教学的实验教学体系尤为重要.在生物化学实验教学中对中医学本科教学体系进行了探讨与实践,激发学生的联想与创造性,为学生创新思维和创新能力的提高奠定了基础.