The prognosis of patients with clinical stage Ⅱ nasopharyngeal carcinoma has been significantly improved by the application of intensity-modulated radiotherapy (IMRT). Although the NCCN guidelines recommend concurrent chemoradiotherapy strategies for clinical stage Ⅱ nasopharyngeal carcinoma, the evidence is mostly based on the research results under the condition of two-dimensional conventional radiotherapy, and whether combined chemotherapy is required under the condition of IMRT faces challenges. In this article, current research progress on chemotherapy for clinical phase Ⅱ nasopharyngeal carcinoma was reviewed. Several studies have shown that concurrent, adjuvant and induction chemotherapy failed to improve the efficacy but significantly increased the incidence of toxic and side effects. Because of the heterogeneity in clinical stage Ⅱ nasopharyngeal carcinoma, some studies have found that high-risk patients could benefit from chemotherapy. Currently, how to distinguish high-risk patients in clinical stage Ⅱ nasopharyngeal carcinoma is a hot spot. The characteristics of metastatic lymph nodes, EB virus DNA, inflammatory markers, and other factors have certain reference value for screening high-risk patients, which needs further verification. The prediction model integrating multiple tumor characteristics seems to better identify high-risk groups and guide the treatment decision of high-risk stage Ⅱ nasopharyngeal carcinoma.

目的 探索老年住院病人认知障碍与冠心病的关系.方法 选取678例研究对象,根据是否患冠心病将研究对象分为冠心病组(n=203)与非冠心病组(n=478).采用MoCA、MMSE对认知状态进行评估,采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(24项版)(HAMD-24评分)对焦虑抑郁状态进行评估,采用Barthel指数对日常生活活动能力(ADL)进行评估.采用Logistic回归分析冠心病的影响因素.结果 冠心病组MoCA、MMSE、Barthel指数低于非冠心病组,而HAMA评分、HAMD评分高于非冠心病组,差异具有统计学意义(P<0.05).多因素Logistic回归提示,MoCA评分高是冠心病的保护因素(OR=0.962,95％CI:0.931～0.994),高龄(OR=1.031,95％CI:1.004～1.058)、HAMA评分高(OR=1.042,95％CI:1.014～1.071)、高血压病程长(OR=1.024,95％CI:1.010～1.038)、糖尿病病程长(OR=1.036,95％CI:1.013～1.060)是冠心病的危险因素(P<0.05).结论 老年住院病人的冠心病可能与认知障碍、焦虑状态有关.

Objective:To investigate the relationship between sarcopenia and early renal dysfunction in elderly patients with type 2 diabetes mellitus(T2DM).Methods:A total of 198 elderly patients with T2DM aged over 60 years undergoing treatment in the Geriatric Department of Beijing Hospital from July 2018 to July 2019 were enrolled in this retrospective case-control study.The estimated glomerular filtration rate(eGFR)is calculated according to the CKD-EPI Cr-Cys formula.Based on the eGFR, the patients were divided into normal renal function group(n=63, in CKD 1 stage)and mild renal dysfunction group(n=135, in CKD 2-3a stage). All subjects underwent physical examination, laboratory examination and dual energy X-ray bone density examination. Results:The age, weight, body mass index, abdominal circumference, serum creatinine, cystatin C, uric acid, diastolic pressure, the proportions of diabetes and hypertension were lower, and the high-density lipoprotein cholesterol, appendicular skeletal muscle mass(ASM)and skeletal muscle mass index(SMI)were higher, in the normal renal function group than in the mild renal dysfunction group( P<0.05 or 0.01). Spearman correlation analysis showed that eGFR was positively correlated with SMI( r=0.343, P<0.01). Logistic regression analysis showed that body weight( OR=1.318, 95% CI: 1.091-1.594), uric acid( OR=1.007, 95% CI: 1.001-1.012), diastolic blood pressure( OR=1.072, 95% CI: 1.033-1.112), years of diabetes( OR=1.075, 95% CI: 1.013-1.142)were risk factors, and the LSM( OR=0.136, 95% CI: 0.047-0.392)and SMI( OR=0.778, 95% CI: 0.703-0.860)were protective factors for the early renal dysfunction in elderly patients with T2DM. Conclusions:Elderly patients with T2DM are often co-existed with sarcopenia.Sarcopenia is associated with early renal dysfunction in elderly patients with T2DM.

With the acceleration of the aging process in China, the incidence rates of coronary heart disease and cerebral infarction have significantly increased.And iodine contrast agent is often used in imaging diagnosis and percutaneous intervention therapy.The contrast medium is filtered from the glomerulus in its original form and is not absorbed by renal tubules.However, the accumulation of iodine contrast medium in the kidney can lead to acute kidney injury.Kidney is one of the most important excretory and endocrine organs in human body.The prevention and treatment of contrast-induced nephropathy(CIN)have been widely concerned.The incidence rate of contrast-induced renal damage is higher and the prognosis is poorer in the elderly than in the non-elderly due to the decline of organ function in the elderly.At present, the mechanism of action for oxygen free radicals in CIN of the elderly is still unclear.This article reviews the researches on the role of oxygen free radical in CIN of the elderly studied by domestic and foreign scholars in recent years.

[目的]分析副主编主导的选题策划制度的特点,旨在不断优化,提高选题策划成效.[方法]以《协和医学杂志》办刊经验为例,对副主编主导的选题策划制度在组稿效率、论文学术质量保障及科普转化性等方面的实践经验和效果进行系统总结.[结果]副主编主导的选题策划制度具有组稿效率高、论文质量高、科普转化性强、可持续性好的优越性,但也存在部分主题/栏目的论文受关注度不高,学术质量不高、拒稿难的局限性.[结论]副主编主导的选题策划制度是获取优质稿源的有力措施,是提高期刊影响力的重要途径,但仍需在实践中不断完善,形成长效机制.

Objective:To evaluate the application value of deep deconvolutional neural network (DDNN) model for automatic segmentation of target volume and organs at risk (OARs) in patients with nasopharngeal carcinoma (NPC).Methods:Based on the CT images of 800 NPC patients, an end-to-end automatic segmentation model was established based on DDNN algorithm. Ten newly diagnosed with NPC were allocated into the test set. Using this DDNN model, 10 junior physicians contoured the region of interest (ROI) on 10 patients by using both manual contour (MC) and DDNN deep learning-assisted contour (DLAC) methods independently. The accuracy of ROI contouring was evaluated by using the DICE coefficient and mean distance to agreement (MDTA). The coefficient of variation (CV) and standard distance deviation (SDD) were rendered to measure the inter-observer variability or consistency. The time consumed for each of the two contouring methods was also compared.Results:DICE values of gross target volume (GTV) and clinical target volume (CTV), MDTA of GTV and CTV by using DLAC were 0.67±0.15 and 0.841±0.032, (0.315±0.23) mm and (0.032±0.098) mm, respectively, which were significantly better than those in the MC group (all P<0.001). Except for the spinal cord, lens and mandible, DLAC improved the DICE values of the other OARs, in which mandible had the highest DICE value and optic chiasm had the lowest DICE value. Compared with the MC group, GTV, CTV, CV and SDD of OAR were significantly reduced (all P<0.001), and the total contouring time was significantly shortened by 63.7% in the DLAC group ( P<0.001). Conclusion:Compared with MC, DLAC is a promising method to obtain superior accuracy, consistency, and efficiency for the GTV, CTV and OAR in NPC patients.

目的 探讨医护一体模式对椎管内肿瘤患者术后并发症防控的效果.方法 选取2013年3月至2019年4月间中国医学科学院北京协和医学院肿瘤医院收治的140例椎管内肿瘤患者,采用医护一体模式在患者围术期进行术后并发症防控,措施包括医护联合进行术前评估,针对性进行术前准备,制定并发症防控预案;术后医护联合查房,加强沟通,医护联合进行健康教育,密切病情观察,统计椎管内肿瘤患者的术后并发症发生情况.结果 椎管内肿瘤患者出现术后并发症14例(10.0％),其中,尿路感染5例,切口感染4例,颅内感染3例,肺部感染1例,下肢深静脉血栓1例,经对症处理均治愈.结论 采用医护一体模式对椎管内肿瘤患者术后并发症进行防控,防控效果较好,并发症发生较少,值得临床推广.

目的 探讨在口服利伐沙班的80岁及以上高龄患者中监测抗Ⅹa因子活性的意义.方法 纳入2019年北京医院老年医学科高龄非瓣膜病心房颤动和静脉血栓栓塞症患者23例,口服利伐沙班抗凝治疗至少4d后测定其抗Ⅹa因子活性的谷峰浓度,并进行服药依从性和血栓、出血等事件的随访.结果 在23例高龄患者中,非瓣膜病心房颤动19例,静脉血栓栓塞症4例.利伐沙班服用剂量分别为15 mg/d 15例,10 mg/d 7例和5 mg/d 1例.监测抗Ⅹa因子活性,4例患者谷浓度大于200 ng/ml,8例患者峰浓度大于400 ng/ml(其中2例超过700 ng/ml),2例患者谷峰浓度差距较小.2例非瓣膜病心房颤动患者出院后自行停用利伐沙班,其他21例患者服药依从性较好.服药过程中3例出现黑便、便潜血阳性,1例出现血尿.19例非瓣膜病心房颤动患者抗凝过程中均未发生脑卒中事件;1例肺栓塞患者抗凝过程中再次出现下肢深静脉血栓;1例下肢深静脉血栓患者抗凝过程中发生急性心肌梗死.结论 本研究中部分高龄患者抗Ⅹa因子活性的谷峰浓度明显高于国外报道水平,尤其是肾功能不全的患者,建议根据抗Ⅹa因子活性测定结果和临床不良事件调整利伐沙班剂量.

目的 探讨护理风险管理在肿瘤专科医院神经外科中的应用效果.方法 选取实施护理风险管理前(2014年1月-2015年12月)的674例颅内肿瘤患者为对照组,选取实施后(2016年1月-2017年12月)的702例颅内肿瘤患者为观察组,对照组采用常规病区管理,观察组实施多种措施的护理风险管理.比较2组护理安全不良事件发生率、患者满意度以及实施前后护理人员风险防控理论知识与应急预案操作考核成绩.结果 观察组护理安全不良事件发生率低于对照组(χ2=4.100,P=0.043),患者对护理工作的满意情况好于对照组(Z=-4.779,P<0.001);实施后护理人员风险防控理论知识与应急预案操作考核成绩均高于实施前(t=-7.385,P<0.001;t=-6.895,P<0.001).结论 根据肿瘤专科医院神经外科患者特点,实施护理风险管理,可有效降低护理安全不良事件发生率,提高护理人员风险管控能力,提高患者满意度,值得在临床中推广.

目的 探讨脑转移瘤患者围术期护理特点及个性化护理干预方法.方法 选取2012年2月至2018年4月间中国医学科学院肿瘤医院收治的205例脑转移瘤患者,总结围术期护理特点及个性化护理干预措施.结果 脑转移瘤手术患者具有病程长、病情重及心理负担大等特点.本研究无围术期死亡患者,术后出现并发症33例(16.1％),所有并发症经保守治疗和对症处理均治愈.患者对护理工作满意度均在99.5％以上.结论 脑转移瘤患者围术期护理特点突出,应在正确评估的基础上,根据患者具体情况进行个性化针对性护理,以提高护理质量,促进患者平稳度过围术期.

Objective:To investigate the frequency of anemia, multimorbidity, impaired activities of daily living and frailty in advanced age inpatients, and to analyze the interrelations between them.Methods:A total of 255 inpatients over 80 years old at the department of geriatrics in our hospital were included.General conditions and chronic diseases of patients were collected.Activities of daily living(ADL)and frailty were evaluated by using the Barthel Index Scale and Clinical Frailty Scale-09(CFS-09), respectively, and laboratory tests for hemoglobin, mean red blood cell(RBC)volume, mean RBC hemoglobin concentration, folic acid, vitamin B12, serum iron, ferritin, and creatinine were conducted.The prevalence rates of anemia, impaired activities of daily living, frailty and multimorbidities and the characteristics of anemia were analyzed.Results:Of the 255 elderly inpatients, 174 had anemia, accounting for 68.2%.For patients with anemia, 143 had normocytic anemia(82.2%), and in terms of severity, 90 had mild anemia(51.7%), 77 had moderate anemia(44.3%), and 7 had severe anemia(4.0%). The causes of anemia included nutritional anemia(iron deficiency anemia or megaloblastic anemia)(65 cases, 37.4%), anemia of chronic disease(89 cases, 51.1%), anemia due to stage 3-5 chronic kidney disease(90 cases, 51.7%)and anemia due to multiple factors(84 cases, 48.3%). There was no significant difference in anemia between men and women.There was no significant difference in hemoglobin level, number of diseases, disease burden or comorbidity index between the advanced age group(80-89 years old)and the very advanced age group(90 years old or over)( P>0.05). There were significant differences in mean rank sums of ADL and CFS-09 between the advanced age group and the very advanced age group(118.19 vs.156.68, 118.12 vs.156.88, U=8039.5 and 8052.0, P=0.000). There were also significant differences in ADL( H=20.5, P=0.000), CSF-09( H=29.7, P=0.000), number of diseases( H=16.2, P=0.001), disease burden( H=20.7, P=0.000)and comorbidity index( H=12.6, P=0.006)between hospitalized elderly patients with different degrees of anemia. Conclusions:The prevalence rates of anemia, frailty and multimorbidity are high in advanced age inpatients.Anemia predicts increased impairment of living capacity, burden of disease and degree of frailty.Heightened emphasis is required on the management of anemia, frailty and multimorbidity in advanced age patients.

目的 探讨行动研究法在肿瘤专科医院神经外科标本采集质量改进中的应用效果.方法 选取行动研究实施前(2017年1月-12月)某肿瘤专科医院神经外科向检验科送检的出现过采集不合格的血常规、生化、凝血及尿常规类别的标本4 025例,另收集行动研究实施后(2018年1月-12月)向检验科送检的相同类别标本4 476例,采用行动研究法分析标本采集不合格原因,并有针对性采取改进措施,比较实施前后标本采集不合格率.结果 行动研究实施后,标本采集不合格率为6.7％ (30例),较低于实施前的1.1％(43例),差异有统计学意义(P＜0.05).结论 行动研究法应用于肿瘤专科医院神经外科标本采集质量改进,可降低标本采集不合格率,从而确保检验结果的准确性.

目的:探究分化拮抗非编码RNA-201(differentiation antagonizing non-protein coding RNA,DANCR-201)在单核-巨噬细胞炎症反应中的调控作用.方法:纳入中国医学科学院阜外医院疑为冠心病接受冠状动脉CT检查的患者25例,年龄≥45岁.根据冠状动脉CT血管造影图像,研究对象分为3组,包括无斑块健康对照组(n=10)、完全钙化斑块组(n=10)和易损斑块组(n=5).采用全转录组测序技术分析外周血全血中表达差异的长链非编码RNA分子.培养人单核细胞白血病细胞系(THP)-1细胞,用于建立M1和M2型巨噬细胞极化模型,采用慢病毒感染和Smart Silencer转染技术分别过表达和敲低DANCR-201,检测炎症因子、脂质代谢与血管钙化相关基因的表达水平,采用油红O染色法检测巨噬细胞脂质吞噬能力,采用胆固醇流出实验检测巨噬细胞胆固醇逆转运能力.结果:DANCR-201在易损斑块组患者外周血的表达水平显著升高.在单核细胞系中过表达DANCR-201,可促进单核趋化蛋白-1(MCP-1)和肿瘤坏死因子-α(TNF-α)高表达(P<0.01);反之,敲低DANCR-201时,可使MCP-1和TNF-α 的表达水平显著下降(P<0.01).在M1和M2型巨噬细胞中,DANCR-201显著抑制Runt相关转录因子2(Runx 2)表达水平(P<0.01),并促进骨保护素(OPG)高表达(P<0.05);反之,敲低DANCR-201时,M1和M2型巨噬细胞中的Runx 2表达水平升高,而OPG表达水平下降(P<0.01).DANCR-201对巨噬细胞脂质吞噬和胆固醇逆转运能力无显著影响.结论:DANCR-201促进M1和M2型巨噬细胞的炎症反应,其在动脉粥样硬化斑块形成中的作用机制仍需深入研究.

[目的]深入了解用户,探索优化医学期刊微信公众号运营的有效策略,以保证运营质量,为医学期刊同仁提供运营思路及方式借鉴.[方法]以《协和医学杂志》为例,根据对微信公众号用户的问卷调查及用户行为信息完善用户画像,分析画像特征,并结合用户基本属性、行为规律及需求偏好有针对性地调整运营策略,观察运营效果及质量.[结果]基于用户画像实施“靶向”运营,平台内容及功能结构更贴近用户预期,用户关注度、活跃度及内容传播度显著上升.[结论]用户画像为医学期刊微信公众号运营者进行系统性设计、优化运营提供重要依据,基于画像特征的“靶向”性优化运营,使用户、平台及期刊之间形成良好生态,提升平台运营质量,助力医学期刊内容传播.

目的:探究冠状动脉CT血管成像(CCTA)技术对冠状动脉易损斑块和主要不良心血管事件风险预测的评估价值.方法:连续入选2016年4月至2018年5月在中国医学科学院阜外医院门诊因冠状动脉粥样硬化性心脏病(冠心病)或疑似冠心病进行CCTA检查且显示冠状动脉斑块阳性的患者517例,其中男性327例,女性190例.根据CCTA检查结果将患者分为钙化斑块组(222例)和混合斑块组(295例),应用128排螺旋CT进行冠状动脉图像的重建与分析.通过电话、查阅病历以及联系主管医师等方式随访主要不良心血管事件发生情况,包括心原性猝死、急性心肌梗死、不稳定性心绞痛、冠状动脉旁路移植术、冠状动脉支架置入术、急性心力衰竭.采用多因素Logistic回归模型分析影响斑块易损性的相关危险因素,计算OR和95％CI;采用Cox生存回归模型分析冠状动脉斑块特征对心血管终点事件的影响,计算HR和95％CI.结果:本研究517例患者的平均年龄为(57.9±8.4)岁,男性占63.2％.混合斑块组患者的血清总胆固醇、低密度脂蛋白胆固醇显著高于钙化斑块组(P<0.05),而高密度脂蛋白胆固醇显著低于钙化斑块组(P<0.05).混合斑块组的脂质成分负荷和纤维成分负荷显著高于钙化斑块组(P=0.01),造成的血管狭窄率显著大于钙化斑块组(P=0.02).多因素Logistic回归模型分析发现脂质成分高负荷的斑块发生斑块易损性的风险增加(OR=2.30,95％CI:1.45～3.64;P<0.001),而纤维成分高负荷的斑块与斑块易损性风险呈负相关(OR=0.73,95％CI:0.38～0.91;P<0.001).平均随访15个月(范围3～29个月),所有患者随访结束时,有42例(8.1％)发生主要不良心血管事件.采用多因素Cox回归风险模型分析发现纤维成分高负荷的斑块发生主要不良心血管事件的风险增加(HR=3.33,95％CI:1.24～8.98;P=0.02),钙化高负荷的斑块也增加主要不良心血管事件的发生风险(HR=4.29,95％CI:1.47～12.46;P=0.01).结论:通过CCTA技术检测冠状动脉斑块总体积、脂质成分负荷、纤维成分负荷、钙化成分负荷等指标在冠状动脉斑块易损性和主要不良心血管事件发生风险的评价中具有应用价值,尚需多临床中心、大样本、前瞻性队列研究的循证依据.

Objective:To survey the attitudes and influencing factors towards advance -care planning(ACP)among elderly inpatients and their family members.Methods:A total of 197 elderly inpatients and 248 family members were enrolled by using a convenience sampling method, and they were investigated by a questionnaire.The differences in attitudes towards the nutrition support in the state of frailty and the advanced life support at the end of life between patients and their family members, and the influencing factors for making a living will were analyzed.Results:Compared with elderly inpatients, the proportions of their family members, who had heard of ACP/advance directives(ADs)(58.9% or 146/248 vs.41.6% or 82/197, χ2=13.070, P=0.000), who had discussed death(89.9% or 223/248 vs.55.3% or 109/197, χ2=69.334, P=0.000), who would make a living will(88.7% or 220/248 vs.46.7% or 92/197, χ2=92.461, P=0.000), who would know the true condition(97.2% or 241/248 vs.89.8% or 177/197, χ2=10.349, P=0.001), were significantly elevated.Towards the choice of tube feeding, percutaneous endoscopic gastrojejunostomy and deep-vein catheter insertion, family members had more positive attitudes than did patients themselves( χ2=42.996, 11.446 and 27.704, P=0.000, 0.003 and 0.000). Towards the life support during end-of-life including ventilator-assisted ventilation, electric defibrillation, extracorporeal cardiac compression and hemodialysis, there was no significant difference in attitudes between patients and family members( χ2=0.569, 1.866 and 4.337, P=0.752, 0.393 and 0.114), and the proportion of disapproval was higher in family members.The influencing factors for making a living will were the awareness of ACP/ADs( OR=0.187, 95% CI: 0.096-0.366, P=0.000)and having discussed death with family members( OR=0.450, 95% CI: 0.231-0.878, P=0.019). Conclusions:The proportion of elderly inpatients who are willing to make a living will is low in China, and its influencing factors are the awareness of ACP/ADs and having discussed death with family members.Thus, the promotion and education of ACP/ADs should be strengthened.

[目的]探讨我国出版伦理研究发展现状及趋势,为出版伦理相关研究的进一步开展提供借鉴和参考,以提升我国期刊的学术质量.[方法]采用文献计量学方法对2008—2019年我国出版伦理领域研究成果进行定量分析,从文献发表年份、作者、地区、机构/单位、期刊、研究主题等方面进行深入分析.[结果]国内出版伦理领域相关文献总体呈增长趋势;出版伦理问题日益受到社会的关注和重视;出版伦理相关研究视野比较狭窄,研究深度和广度不够,文献质量整体不高;研究人员之间缺乏协作,地区及单位间的合作有待加强.[结论]我国出版伦理建设具有良好的基础,建议应规范和完善出版伦理学科体系建设,深入开展出版伦理学术研究,强化出版伦理宣传教育,充分发挥其在提高刊物质量、增进社会效益等方面的积极作用.

目的 探讨医护一体化模式对颅内肿瘤患者术后深静脉血栓形成的防控效果.方法 选取2017年1月至2019年10月间北京协和医学院肿瘤医院收治的925例颅内肿瘤手术患者,采用医护一体化模式防控患者术后深静脉血栓形成,措施包括医护联合进行深静脉血栓风险评估,制定个性化防控方案;医护联合查房和健康教育,加强医护沟通及对病情的观察,及时发现并处理深静脉血栓.结果 术后出现深静脉血栓形成患者9例(1.0％),经对症处理8例治愈,1例因消化道大出血抢救无效死亡.结论 采用医护一体化模式防控颅内肿瘤患者术后深静脉血栓形成,效果良好,值得推广.

研究轮状病毒(Rotavirus,RV)非结构蛋白5(NSP5)在体外对RV复制的作用.以质粒pEGFP-N2为载体构建出可特异性表达重组蛋白NSP5的真核表达载体后,将重组质粒转染MA104细胞并分别通过免疫荧光和West-ern Blot检测NSP5在转染后不同时间的表达差异.随后,重组质粒转染组及对照组细胞分别接种相同剂量的RV,一定时间后根据GFP分布来确认重组蛋白NSP5在细胞内的迁移变化情况,并比较实验组和对照组之间的RV复制能力差异.结果发现,NSP5蛋白在重组质粒转染细胞48 h后表达达到顶峰.此外,GFP也显示NSP5蛋白随RV的感染从弥散状转变为点状聚集,且转染该重组质粒的细胞内RV复制水平明显高于对照细胞.说明了轮状病毒NSP5对病毒的复制具有明显促进作用,这也为深入了解RV的感染、复制及致病机理提供理论基础.

目的 探讨医护合作在防控皮肤恶性黑色素瘤患者手术后并发症的实践方法及效果.方法 选取2010年5月至2018年3月间中国医学科学院北京协和医学院肿瘤医院收治的行前哨淋巴结活检和手术治疗的118例皮肤恶性黑色素瘤患者,采用医护合作模式对患者术后可能出现的并发症进行预防和处理.措施主要包括:术前医护共同制定并发症防控预案,术后医护联合查房,并发症的预见性观察和护理,出现并发症及时处理等.结果 本研究中无围术期死亡病例,无皮瓣坏死等严重并发症,术后出现并发症7例(5.9％),发生率较低.其中1例患者出现腹股沟区脂肪液化,行二期清创缝合术后切口愈合,3例患者腹股沟区积液合并感染,3例患者切口少量渗出,经换药后愈合.结论 运用医护合作模式对皮肤恶性黑色素瘤患者术后并发症进行预见性管理可减少并发症的发生,确保患者围术期安全,促进早日康复.