ObjectiveTo investigate the clinical features of adult liver injury patients with drug reaction with eosinophilia and systemic symptoms (DRESS), adult-onset Still’s disease (AOSD) or hemophagocytic lymphohistiocytosis (HLH) and the correlation of the degree of liver injury with inflammatory indices and immune indices. MethodsRelated clinical data were collected from 58 patients with liver injury caused by the above three systemic inflammatory diseases who were admitted to Peking University First Hospital from January 2008 to April 2019, among whom 7 had DRESS, 29 had AOSD, and 22 had HLH. General information, liver biochemical parameters, inflammatory indices, and immune indices were collected before treatment. The t-test was used for comparison of normally distributed continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups, and the least significant difference t-test was used for further comparison between two groups. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the Kruskal-Wallis H test was used for comparison between multiple groups, and the Bonferroni method was used for further comparison between two groups. Four inflammatory indices were compared between the groups with different alanine aminotransferase (ALT) levels (≤200 U/L or ＞200 U/L), and a Spearman correlation analysis was used to investigate the correlation of ferritin and immune indices with ALT level. ResultsThe median age of the patients with DRESS or AOSD was 38 years, and the median age of the patients with HLH was 34 years. DRESS patients were mostly male (5/7, 71%), while most of AOSD patients (20/29, 69%) and HLH patients (12/22, 55%) were female. For liver injury indices, there were no significant differences between the three groups in ALT peak, aspartate aminotransferase level, and alkaline phosphatase level (all P＞0.05). For the indices for the synthetic function of the liver, there were no significant differences in blood glucose, albumin, and prothrombin activity between the three groups (all P＞0.05). For inflammatory indicators, there were significant differences between the three groups in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) (all P＜0.001), while there were no significant differences between the three groups in lactate dehydrogenase, ferritin, and procalcitonin (all P＞0.05); the AOSD group had significantly higher median CRP and ESR than the other two groups (all P＜0.05). For the patients with the three diseases, there were no significant differences in the four inflammatory indices between any two the groups with different ALT levels (all P＞0.05), and the level of ferritin was positively correlated with ALT level (R2=0.702 1, P＜0000 1). As for immune indices, there were no significant differences in IgG, IgA, C4, and the counts of NK and B cells between the three groups (P＞0.05), and CD8+ T cells were positively correlated with ALT level in HLH patients (R2=0.969 6, P＜0.000 1). ConclusionVarying degrees of liver injury are observed in patients with DRESS, AOSD or HLH. Ferritin and CD8+ T cells are well correlated with ALT level and can reflect liver injury, systemic inflammation, and immune status in patients with the three diseases, and therefore, they may become important indices for evaluating disease condition, guiding treatment, and judging treatment outcome and prognosis.

多样性和多元化是文化艺术的生命力所在,电影的民族特色是构成多样性的重要特征.综观世界电影的不同民族流派,从传统戏剧、歌舞、诗歌等艺术形式中汲取灵感来塑造电影民族性的案例比比皆是.在中国,戏曲被认为是融合了中国古典审美意象和民族传统艺术形式的综合艺术,百年来,无论是对影戏的理论研究还是融合两种艺术形式的创作实践都积累了丰富的经验和案例.对于中国电影民族化问题的讨论,重新审视戏曲和中国电影的关系无疑具有现实意义和重要价值.

近年来,随着社会经济的快速发展,各企业之间的竞争力也越来越激烈.企业产品的研发能力和技术的创新能力对于企业的发展有着重要意义,越来越多的企业逐渐开始加大企业的研发投入,努力提高自身自主创新能力,提高企业的价值,加强企业的综合实力.研发支出的后续投入会计处理方式有两种方式,一种是研发支出费用化一种是研发支出资本化,两种处理方式对企业的价值影响存在差异,基于此,本文探讨了企业研发支出资本化和费用化对企业产生的价值进行分析,并在此基础上提出了相应的解决方法.

目的:加深临床医师对食物依赖-运动诱发的过敏反应(food-dependent exercise-induced anaphylaxis,FDE-IAn)的认识.方法:收集2018年8月10日北京医院1 例FDEIAn患者的病例资料,并复习国内46例FDEIAn患者文献资料.根据患者病史、临床表现、治疗及预后资料做回顾性分析.结果:47例患者中,无明确的食物过敏史患者46例,服用阿司匹林患者20例.FDEIAn患者从发病到确诊中位病程为12个月,临床表现涉及皮肤、呼吸、消化道、心血管、神经等多系统.本组患者中,反复发作患者39 例(83%),其中曾至少发生过 1 次过敏性休克患者37 例(78. 7%),部分患者曾多次反复发作过敏性休克.发生过敏性休克的患者,以肾上腺素和糖皮质激素治疗为主.结论:目前临床医师对FDEIAn识别不足,正确认识该疾病,准确识别该疾病,并做出预警,对临床医师至关重要.

目的 探讨二级医院中医护理技术在临床工作中的推广与应用模式,分析问题,提出对策.方法 科室成立管理小组,制定培训计划,按照计划进行培训,使科内所有护士都能够掌握中医相关理论知识和中医护理适宜技术操作.结果 中医护理适宜技术在临床工作中的推广,得到科内所有护士的认可,均能积极主动参与.中医基础理论知识与操作水平评分得分也从推广前的(63.2±5.8)分提高至推广后的(80.9±10.6)分.结论 通过分次培训、规范管理,中医护理适宜技术取得了显著的效果;这种模式对进一步推广中医特色服务具有指导作用,值得推广.

[目的]比较京津冀高等护理院校《护理学导论》课程设置与校际合作态度.[方法]采用自设问卷对北京市、天津市、河北省3所院校的《护理学导论》课程设置进行问卷调查,问卷内容包括院校资料、《护理学导论》课程教学内容与教学资源、校际合作态度与参与意愿.[结果]3所院校所属部门、本科录取批次、招生人数不同,在《护理学导论》课程学时安排差异有统计学意义(P＜0.01),3所院校对《护理学导论》校际合作态度和参与意愿差异有统计学意义(P＜0.01).[结论]京津冀高等护理院校在《护理学导论》教学内容上各有所长,校际合作态度和参与意愿较强,具备进一步开展校际合作的基础.

Objective To investigate the clinical features, steroid response, and recurrence of IgG4 -associated sclerosing cholangitis (IgG4 -SC), and to shorten the time for clinical diagnosis and reduce recurrence rate .Methods A total of 12 patients with IgG4 -SC who were admitted to Peking University First Hospital from December 2011 to March 2017 were enrolled, and they all met the clinical diagnostic criteria for IgG4 -SC in 2012.A retrospective analysis was performed for their clinical data , clinical features, and follow -up data.Results Of all 12 patients, the male/female ratio was 11:1.The mean age of onset was 61.7 ±8.6 years, and the mean time to a confirmed diagnosis was 24.2 months.Of all 12 patients,11 (92%) had jaundice, with a mean serum total bilirubin level of 198.7 ±57.7 μmol/L.There were varying degrees of increase in serum alanine aminotransferase level (range 55 -453 U/L).Of all patients, 5 (41.7%) had acute abdominal pain, with a mean CA19 -9 level of 60.8 ±12.5 U/ml.Serum IgG4 was increased by 1.5 -18.9 times, with a mean level of 7.7 ±2.0 g/L.Magnetic resonance cholangiopancreatography (MRCP) performed for all patients showed typical manifestations including bile duct wall thickening, lumen stenosis, and intrahepatic and extrahepatic bile duct dilatation ; 11 patients (92%) were found to have autoimmune pancreatitis,and 2 (16.7%) had involvement of more than 3 visceral organs.In two patients who underwent biliary stent implantation before treatment, the biliary stent was removed after 4 -6 weeks of steroid treatment.The mean duration of steroid response was 5.4 months.Among the 8 patients who underwent steroid treatment , 4 (50%,4/8) experienced recurrence during the reduction of the dose of steroid , among whom 2 experienced recurrence within 8 -12 weeks after drug withdrawal.Conclusion IgG4 -SC needs a long time for prognosis,with frequent misdiagnosis and missed diagnosis .Serum IgG4 level should be measured for elderly male patients with an acute onset of jaun - dice and bile duct stenosis, bile duct wall thickening, and involvement of the pancreas on MRCP.Steroid treatment should be given as early as possible after diagnosis.Patients may need at least 5 -6 months to achieve steroid response.The dose of steroid should be reduced slowly and recurrence and tumorigenesis should be closely monitored .

“性格决定命运,这是东方的《哈姆雷特》!”来自俄罗斯的菲利波夫先生10月16日晚在法国戛纳OLYMPIA电影院观看了3D全景声京剧电影《曹操与杨修》后,在留言簿上这样写道.当天是《曹操与杨修》在欧洲首映,此前已于6月在上海国际电影节全球首映.已在全球公映多场的这部电影,豆瓣评分一度高达8.8分. 该剧改编自同名京剧,通过曹操与杨修两位人物的性格冲突来体现人性的纠葛与命运的无常.

Objective To report a case of X-linked ichthyosis complicated by Mal de Meleda,and to identify the gene mutations.Methods Clinical data were collected from the patient,and peripheral blood samples were obtained from the patient,his parents and 100 unrelated healthy people who served as controls.Genomic DNA was extracted from these blood samples,and PCR was performed to amplify all the exons and their flanking sequences of the SLURP-1 and STS genes.All the amplification products were analyzed by agarose gel electrophoresis,and amplification products of the SLURP-1 gene were analyzed by DNA sequencing.Results The patient presented with regularly-arranged polygonal brown or black scales all over the trunk and limbs,erythematous hyperkeratotic lesions on the palms and soles,elbows and knees,inguinal and perianal regions,which extended to the dorsa of the hands and feet.Then,the patient was diagnosed with X-linked ichthyosis complicated by Mal de Meleda.Genetic testing showed complete deletion of the STS gene,and a homozygous mutation (c.286C ＞ T) at position 286 in exon 3 of the SLURP-1 gene,which led to the formation of a premature termination codon at amino acid position 96 (p.R96*).His parents were heterozygous carriers of the mutation (c.286C ＞ T).No mutation was found in the unrelated healthy controls.Conclusion The complete deletion of the STS gene and the homozygous nonsense mutation in the SLURP-1 gene may be the reason for X-linked ichthyosis complicated by Mal de Meleda in the patient.

Chronic hepatitis B is a progressive disease that can develop into cirrhosis,liver cancer or even liver failure if it is not treated in time.Antiviral therapy is an important means to delay the progression of chronic hepatitis B disease,through long-term inhibition of HBV DNA replication can reduce liver cell inflammation and necrosis,fibrosis,delaying and reducing liver failure,cirrhosis,HCC and other complications,which can improve the life quality and prolong survival time.Based on the data of hepatitis B first-line Antiviral Agents such as entecavir and tenofovir And so on.being used worldwide,this paper expounds the influence of antiviral therapy on the outcome of chronic hepatitis B treatment.

Objective: To evaluate the effect of anchored instruction in the course ofNursing Research for undergraduate nursing students. Methods: Anchored instruction was applied in the course ofNursing Research among 24 nursing undergraduates. The outcomes were evaluated by semi-structured interviews of 17 students. Results: Students reported that anchored instruction could improve their autonomous and active learning, facilitate their study of knowledge about research, guide their research ideas, and improve their comprehensive abilities. However, students also proposed some problems and suggestions in the implementation of anchored instruction, such as time pressure, insufifcient communication among group members and different groups, unskilled application of knowledge. Conclusion: Compared with traditional instruction, anchored instruction has advantages in improving learning outcomes and students' comprehensive abilities, but also exists some problems. It is suggested to further optimize the implementation of anchored instruction.

目的 探讨基础护理学OSCE中标准化病人(standardized patients,SP)的培训方法与应用效果.方法 招募11名护理研究生,对其系统培训后,将其作为SP应用于基础护理学OSCE考核中.OSCE考核结束后召开座谈会,SP对考核过程中学生存在的问题进行交流,并提出教学改革建议.结果 99名经过OSCE考核的学生对SP评分为(82.98±13.53)分.其中,40名学生对SP考核形式提出开放性意见与建议,30.00％(12/40)的学生认为有SP的考核形有助于提高对知识更深的理解,锻炼考生的临床能力;37.50％(15/40)的学生认为平时可增加有SP的练习,锻炼考生处理问题的能力.结论 护理研究生作为SP可节约培训时间.SP作为评估者,对学生的评价客观有效;作为教学指导者,为基础护理技能教学方法的改革提供重要依据.

目的 构建《护理学基础》技能客观结构化临床考核站点.方法 应用Delphi法对来自护理教育、护理管理及临床护理领域的21位专家进行了两轮咨询.结果 确定了包括标准化病人和非标准化病人2项一级条目、5项二级条目、51项三级条目的《护理学基础》技能客观结构化临床考核站点.结论 专家咨询所构建的《护理学基础》技能客观结构化临床考核站点科学、可靠,可作为客观结构化临床考核应用于《护理学基础》技能考核时的站点设置依据.

目的 探索客观结构化临床考核(objective structured clinical examination,OSCE)在护理学基础技能考核中的应用效果.方法 以北京某高校护理学院2013级全体本科生为研究对象,实施护理学基础技能OSCE考核,并进行效果分析与评价.结果 ①本次考核,考生操作总得分平均分为(90.23±3.65)分.②考核总难度系数为0.9,总体区分度为0.62,内部一致性系数为0.73,平均内容效度比为0.93;与理论考试成绩的校标关联系数为0.51.③88％的考生同意本次OSCE考核全面合理,65％的考生愿意再次参加.结论 将OSCE应用于护理学基础技能考核中,能够科学、客观地评价考生护理学基础技能水平,有助于考生临床运用能力的提高,考生对此新型考核模式较为认可.

1998年，英国剑桥大学的Cliff教授曾对21世纪的感染病学界做出这样的预言：“我们将一如既往地迎接感染病的挑战，包括老的感染病引起的老问题，老的感染病引起的新问题，新的感染病引起的新的、也可以是老的问题”。近年来，多药耐药结核、耐甲氧西林金黄色葡萄球菌（ MRSA ）感染日渐增多，新型布尼亚病毒、新型冠状病毒等新发传染病的出现，均应验着Cliff教授的预言。可见，不论时光如何斗转星移，感染性疾病就在我们身边，不容忽视。

Objective: To investigate the status and correlation of the intention to stay and job satisfaction of the non-active civilian nurses in Beijing. Methods: A total of 116 non-active civilian nurses of several army hospitals in Beijing were recruited and investigated with intention to stay scale and Mc Closkey/Mueller Satisfaction Scale(MMSS). Results: The mean score of the intention to stay was(3.11±0.57), The mean score of nursesu0027 job satisfaction was(2.89±0.54). The first three of 8 dimensions of job satisfaction was the praise and recognition, relationship with colleagues, control and responsibility. All dimensions of job satisfaction were positively correlated with the intention to stay(P0.05). Conclusion: Hospital nurse managers should pay attention to the issue of non-active civilian nursesu0027 job satisfaction, and improve nursesu0027 intention to stay. Thus it could be helpful to reduce their turnover rate.

<正>科学技术水平的不断发展和医疗环境的日益复杂,对护士的能力提出了更高的要求,护理教育者也致力于寻求能促进学生临床能力和思维能力的有效教学方法。情境模拟教学法注重实效性,突出操作性,实现了理论与实践的高度结合,近年来在国内外护理教育领

Objective To investigate the current situation of nurse recruitment and the nursing talents' demand in tertiary hospitals in Beijing.Method The directors of nursing department in 53 tertiary hospitals in Beijing were investigated with a self-designed questionnaire on nurse recruitment and nursing talents demand.Results Of the new nurses recruited in the last three years,64.30% had associate degree.The proportion of the nurses with bachelor degree has reached 20.36%,but only 30% of them have regular staff status.The demand of nurses with bachelor and master degree in the next five years increas es year by year.Moreover,the demand of male nurses increases,which accounted for 7.00% ~8.00% of the total numbers.There were 76.09% of directors thought that the supply of nurses with bachelor degree fell short of demand.The most impor tant qualities of the undergraduate nursing personnel were adequate nursing expertise and humanistic knowledge,high level of team-work spirit,communication skills,nursing skills and problem-solving ability.Conclusion The demand of nursing talents in the tertiary hospitals in Beijing increases year by year.The higher nursing education organizations should take measures to train more well-educated and excellent qualified nursing personnel to meet the market demand.

目的:了解北京市某社区空巢老人接受社区照顾现状及其与空巢老人抑郁发生的关系.方法:采用自行设计的问卷,调查100例空巢老人接受社区照顾的情况和心理抑郁症状.结果:空巢老人抑郁平均分为(10.74±6.89)分,发生率为49％；有配偶、与子女亲友联系密切、接受社区照顾的空巢老人抑郁发生率低(P＜0.05).社区生活照顾、社区医疗服务、社区娱乐活动、社区心理支持均可降低空巢老人抑郁的发生风险.结论:社区照顾可以降低空巢老人的抑郁发生率,应制定相应措施,加强对空巢老人的社区照顾.

教师专业认同的建构是教师专业发展的核心问题.专业认同是由教师个体和教育内外的社会与文化共同塑造的,只有教师将外在的角色期待转化为内在的专业认同,教师才能积极地发挥参与改革的主体性作用.学习型组织营造合作型教师专业文化的氛围,使教师的专业认同在民主与互助中发展.在研究者与一线教师形成的实践共同体中,教师开展基于课堂关键问题,以“探究-行为展现-反思”为循环的教学行动研究,逐步实现实践性知识的显性化,提升学术话语能力并体现所从事职业的内涵与价值,在自主建构专业认同的过程中实现可持续专业发展.