目的 构建以立德树人为先、以研究生培养质量为导向的临床医学院研究生导师评价指标体系.方法 在查阅文献、总结工作实践经验基础上,采用德尔菲法对首都医科大学附属北京安贞医院的20位专家进行两轮专家函询,从导师思想素质、教学工作、科研工作、教学管理以及导师对研究生的培养几方面构建一套研究生导师评价指标体系.结果 本研究第一轮专家函询中,发出问卷20份,回收问卷20份,回收率100％,专家积极系数为100％.第二轮专家函询发出问卷20份,回收19份,专家积极系数为95％.两轮专家权威程度系数分别为0.80、0.81.专家意见的协调程度以本研究各个指标分值的变异系数表示,第一轮专家函询结果显示,各指标的变异系数为0.22～0.58;第二轮专家函询结果显示,全部指标的变异系数均在0.40以内.结论 以导师立德树人为先,以研究生导师参与教学培养工作过程及研究生培养质量为导向的导师综合评价指标体系,能够促使导师更好地履行研究生培养职责,保障研究生的高质量培养教育.

目的 探讨医患沟通技巧培训对提高医学本科生医患沟通技能的效果.方法 选择首都医科大学第六临床医学院2017级五年制医学本科生57人为研究对象,在大学四年级时进行医患沟通技巧培训.培训前后应用医患沟通技能评价量表(SEGUE)进行测评,比较其沟通技能的变化.结果 培训后,医学本科生准备阶段、信息收集、信息给予、结束问诊维度得分和SEGUE总分均有显著提升(P<0.05),但与美国通科医生相比仍存在差距.结论 对医学本科生进行医患沟通技巧培训,可以显著提高其医患沟通技能水平,值得在国内医学院校推广.

目的:旨在研究阻塞性睡眠呼吸暂停患者(OSA)夜间间歇性缺氧程度对肺动脉僵硬度(PAS)和右心室功能的影响.方法:对可疑OSA的患者进行多导睡眠图(PSG)和经胸超声心动图检查(n=376).按夜间最低脉搏血氧饱和度(SpO2)分为三组(对照组:SpO2≥90％,轻中度低氧组:80％≤SpO2<90％,重度低氧组:SpO2<80％).比较三组患者的PAS和右心室功能,并进一步分析其相关影响因素.结果:最终本研究对278例患者进行分析.重度低氧组PAS显著升高(P=0.003),与平均肺动脉压(mPAP)有良好的相关性(r=0.780,P<0.001),而mPAP在不同组间差异无统计学意义(P>0.05).各组间右心室功能相关参数,差异无统计学意义(P>0.05).单因素和多因素Logistic分析表明,只有夜间最低SpO2(OR=1.807,P=0.001)是PAS升高的相关因素.结论:在重度低氧血症的OSA患者中PAS增加,仅夜间最低SpO2是其相关因素.

阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)是一种常见的睡眠呼吸紊乱性疾病,其特点是睡眠中上呼吸道塌陷从而出现反复的呼吸暂停或低通气.这种疾病伴随着夜间间歇性低氧、高碳酸血症、睡眠中断、打鼾和白天嗜睡等症状,其患病率在9％ ～ 38％之间,尤以中老年男性居多[1].OSA通过促进交感神经系统激活、氧化应激、炎症反应、血管内皮功能受损等机制,导致动脉高压及心脏收缩和舒张功能障碍,增加了心血管疾病发生的风险[2].由于夜间间断性低氧导致了OSA患者肺血管收缩和重构,肺动脉压力升高,右心室(right ventricular,RV)后负荷增加等一系列心肺耦联系统的损伤[3].本文就OSA患者右心心肺耦联系统的损伤、发生机制以及OSA的治疗对其右心功能的影响进行综述,为OSA患者的个体化治疗及及早预防右心系统损伤提供依据.

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与代谢综合征(MS)及其组分之间的相关性.方法:本研究为回顾性研究,选取2008年1月至2018年8月,北京安贞医院收治的1 042例行多导睡眠监测的患者,总OSAHS组842例,并按睡眠呼吸暂停低通气指数(AHI)分为三个亚组,分别为轻度OSAHS组320例、中度OSAHS组224例、重度OSAHS组298例;人选AHI＜5且年龄、性别与OSAHS组相匹配的患者为对照组(200例).所有患者均测身高、体质量、腰围、血压,并检测FPG、血脂、尿酸、肝肾功能、HbAlc等指标.结果:OSAHS各组的MS患病率均明显高于对照组,且重度组明显高于轻度组(P＜0.05),随着OSAHS程度的加重,伴有多个(≥3个)MS的组分的比例也逐渐增加.AHI与MS、腹型肥胖、高血压、血脂异常均呈明显正相关(r=0.243、0.211、0.125、0.196,P＜0.01).总OSAHS组患者的MS患病风险是对照组的3倍(OR=3.077).轻、中、重OSAHS组患MS的风险分别是对照组的2.1倍、3.4倍、4.7倍(OR=2.084,3.426,4.691).多因素Logistic回归分析中,OSAHS进入方程(OR=1.638,P＜0.05).结论:OSAHS与MS密切相关,是MS的危险因素之一.

Objective To explore the relation between peripheral blood active circulating tumor cell (CTC) and clinical characteristics of non-small cell lung cancer(NSCLC).Methods From June 2017 to August 2018,51 NSCLC patients confirmed by imaging and pathological results were recruited in Beijing Anzhen Hospital,Capital Medical University(observation group),including 38 cases of adenocarcinoma and 13 cases of squamous cell carcinoma;21 patients with benign lung disease were recruited as benign lung disease group;18 healthy people were recruited as healthy control group.Peripheral blood active CTC was detected in vitro using recombinant virus vectors.Relation between the expression of CTC and the clinical and pathological features of NSCLC was analyzed.Results There were 44,4 and 0 positive CTC cases in NSCLC group,benign lung disease group and healthy control group,respectively.Sensitivity and specificity of CTC detection were 86.3％ (44/51) and 89.7％ (35/39).Numbers of active CTC in 6 ml peripheral blood showed significant differences between clinical stage Ⅰ-]Ⅱ and Ⅲ-Ⅳ,with and without distant metastasis(M0 vs M1) [1 (0,6) vs 3(0,54),1 (0,2) vs 3(1,8)](Z =-2.041,-2.623;P =0.041,0.009).Logistic regression showed that peripheral blood CTC level was independently associated with high risk of distant metastasis (odds ratio =1.356,95％ confidence interval:1.015-1.811,P =0.040);the risk of distant metastasis in NSCLC patients with peripheral blood CTC more than 3/6 ml increased nearly five times (odds ratio =5.356,95％ confidence interval:1.341-21.400,P =0.018).Conclusion Peripheral blood CTC detection,as a simple and noninvasive method,has high specificity and sensitivity in predicting distant metastasis of NSCLC.

目的 为了加强教学课题过程管理,改进传统的教育科研项目管理模式、完善教育科研管理制度,探索出适合临床医学院发展的教学科研项目管理模式.方法 采取调查问卷,座谈会,现场调研等方法通过将PDCA方法应用于本院教学科研项目管理,对教育教学科研项目实施动态管理,深入了解本院教学课题管理存在的不足和问题.结果 自2014年应用PDCA循环理论进行教学课题管理以来,本院的教学课题申报数量和中标率都大有提升,教学成果产出—教师和学生发表教学论文数显著增加.结论 说明PDCA方法的应用有利于改变传统的管理方式,能进一步规范教学科研项目管理行为,达到科学化管理.

Objective This article aims to reveal the role of transthoracic echocardiography(TTE) in each stage of percutaneous ventricular restoration.Methods Patients with anterior wall myocardial infarction were enrolled in the study.Combined with the TTE examination results,selected patients would be performed PVR surgery.TTE guided the process of PVR,and were performed in 7 days after the surgery.Results After preoperative TTE examination,3 patients were performed Parachute PVR successfully.Pre-procedural TTE was used to select suitable candidates.Peri-procedural TTE has a major role in guiding the device,screening of procedural complications and assessing procedural success.Post-procedural TTE was important in monitoring the outcome.Conclusions TTE is an essential tool at all stages of the procedure.

Objective To explore the causes of thrombocytopenia in acute heart failure (AHF) implanted with intra-aortic balloon pump (IABP).Methods Totally 50 cases with AHF implanted with IABP from November 2011 to November 2013 were retrospective enrolled.The time duration of IABP implantion and change of thrombocyte were recorded;the correlations of thrombocytopenia with disease type,size of ballon,gender were analyzed,the influence of thrombocytopenia on hospital mortality rate were assessed.Results The time duration of IABP implantion was (181 ±34) h (32.4-1 136.5 h).There was 27 patients with thrombocytopenia (mild:15 cases,moderate:9 cases,severe:3 cases),the time of the least platelet count was(100 ± 10) h.The incidence of thrombocytopenia in patients with acute myocardial infarction induced AHF was not significantly different from that in patients with other causes induced AHF [51.6％ (16/31) vs 57.9％ (11/19)] (P ＞ 0.05).The incidence of thrombocytopenia was significantly lower in patients applied with 30 CC balloon than that in patients applied with 40 CC balloon [31.3％ (5/16) vs 64.7％ (22/34)],was significantly lower in males than that in femals [46.2％ (18/39) vs 81.8％ (9/11)] (P ＜ 0.05).In 50 patients,17 cases was dead in hospital;the mortality rate in patients with thrombocytopenia was significantly higher than that in patients without thrombocytopenia [48.1％ (13/27) vs 17.4％ (4/23)] (P ＜0.05).Conclusion Thrombocytopenia can increase the morality rate in acute heartfailure patients implanted with IABP,which is correlated with the size of implanted balloon and gender.

社区卫生实践是临床医学专业（五年制）本科生毕业生产实习的重要组成部分，它的师资队伍建设与学生的学习效果息息相关。通过调查问卷了解学生需求，之后对带教老师进行有针对性的形式多样的培训，以提高教学意识及带教水平，从而提高学生的学习兴趣及学习效果，有利于让学生了解全科医学，有助于毕业生将社区医院作为就业选择。

国家医德规范及实施办法中对医务人员明确提出具体的医德规范并将其作为医德医风建设的重要内涵。医学院校在课程中设置医德修养课程正是为医学生树立正确的医德规范打下坚实基础。结合目前临床医学专业本科生医德修养的教育学模式,需要增加实践课时分配比例,调整理论授课时机,采用多种灵活形式进行实践授课,重视人文医学素质培训,以提升临床医学专业本科生医德修养。

医学专业认证指标体系中对本科临床医学专业毕业生应达到的基本要求中涵盖修德、修学、修能三方面。在培养医学生坚实基础、融会贯通的知识目标和钻研医道、救死扶伤的能力目标的同时，树立医学生品德优秀、医德高尚的思想道德与职业素质目标尤为重要。结合目前临床医学专业五年制本科生培养模式，亟待加强人文医学素质培养，建议从理论联系实际角度出发，根据临床实践时间表加强医学生人文医学执业实操技能，以提升临床医学专业五年制本科生人文医学素质。

Optimizing the treatment strategy and patient selection have been the challenging areas for cardiac resynchronization therapy (CRT) since the introduction of the therapy in the beginning of the Millennium. To optimize the treatment strategy, it is commonly related to the implantation of the left ventricular (LV) lead—its location with respect to the anatomical location of the LV, the presence of transmural scar tissue in the pacing site, its relationship with respect to the mechanical delay, and also the number of LV pacing sites. To achieve this task, there are two prerequisites that need to be fulfilled—the use of an appropriate imaging technology that allows the identification of the potentially optimal LV lead location and the use of a right implantation strategy that permits the secure placement of the LV lead in the target location. Factors that may affect the efficacy of LV pacing may include the presence of transmural scar tissue and the degree of the mechanical contractile delay at the location where the LV lead is placed. To assess the transmurality of LV scar tissue, cardiac MRI with delay enhancement is currently the preferred imaging of choice. It has been observed that patients who had a transmural scar at the postero-lateral wall in which the LV lead was placed would have a significantly a lower response rate than those …

Objective:To investigate the Color Doppler ultrasound in the diagnosis and treatment of traumatic arteriovenous fistula.Methods: The sonographic findings of ten patients with traumatic arteriovenous fistula were reviewed,including the occurrence of arteriovenous fistula,fistula location,fistula size,shape,degree of venous involvement widened,the performance of arterial and venous blood flow,arteriovenous shunt peak velocity spectrum of changes in blood flow,involving artery proximal end and distal end of the spectrum performance of affected intravenous,and compared with surgical findings or MRA results,Postoperative checking focused on observing whether the arteriovenous fistula closure,arteriovenous fistula at the gray-scale images and flow in.Results: Ultrasound diagnosis of arterovenous fistula of the location accuracy of 100%(10/10),qualitative diagnostic rate of 100%(10/10).Flow spectrum showed the specificity of high velocity,low resistance,andunilateral continuant spectral in fistula.In addition,the arterialized flow pattern was observed in affected veins.Vein involvement were widened,broadening the scope of intravenous 1.18-5.80 cm,(2.30±1.56)cm.Check the fistula was closed after the operation(9/9,100%),the arterialized fiow pattern was not observed in affected veins.Conclusion: Doppler ultrasound diagnosis of arteriovenous fistula with a non-invasive,simple,easy,and the advantages of high accuracy,and has high clinical value.

Objective To compare the value of speckle-tracking imaging and tissue Doppler strain imaging in evaluating left atrial (LA) mechanical contraction. Methods Forty patients after successful percutaneous atrial septal defect (ASD) closure were enrolled in this study. Two-dimensional strain imaging (2D strain echocardiography,2DSE) and tissue Doppler imaging (TDI) were performed one weak after ASD closure. Off-line analysis was done for atrial longitudinal peak systolic strain on the interatrial septum,in correspondence of the device,and on the lateral wall of the left atrium from apical 4 chamber view with 2DSE and color-coded strain imaging,respectively. Results There was no statistical difference of the inter-and intra-observer viability as well as time consumption on the off-line analysis between 2DSE and TDI. LA lateral wall strain was much higher than that of LA septum assessed by both color-coded strain imaging (47.31%±27.25% vs 30.06%±14.29%,P0.01) and 2DSE (43.49%±25.55% vs 12.74%±9.16%,P0.001). LA lateral wall strain was similar with either method (P=NS). However,at the site of ASD occluder,a non-contractile element,deformation was significantly higher in color-coded strain imaging than 2DSE (P0.001). Five patients (12.50%) presented absence of deformation on ASD occluder with 2DSE,whereas there was no patient with TDI assessment (χ2=5.33,P=0.027). Conclusion Speckle-tracking imaging is superior to tissue Doppler strain imaging in assessing left atrium mechanical function.

BACKGROUND: It has been widely paid attention that bone marrow mesenchymal stem cell (BMSC) transplantation repairs necrotic myocardium and improves cardiac function. Recent reports have shown that the laser has promotion effects on BMSCs in treatment of ischemic myocardium. OBJECTIVE: To evaluate superiority of autologous BMSC transplantation combined with transmyocardial laser revascularization (TMR) for treating acute myocardial ischemia in rabbits. DESIGN, TIME AND SETTING: The randomized controlled animal study was performed at the Laboratory of Surgery, Anzhen Hospital from January to July 2006. MATERIALS: A total of 32 adult male New Zealand rabbits were equally and randomly assigned into model control, cell transplantation, laser, and combination groups. METHODS: Bone marrow was obtained from rabbits by bilateral tibia puncture 3 days before model establishment. BMSCs were isolated, purified by density gradient centrifugation and medium change method, and then labeled with BrdU. In each group, anterior descending coronary artery of rabbits was ligated under general anesthesia to create acute myocardial ischemia models. 2 weeks later, rabbit models were injected with 0.5 mL α-MEM medium through three points in the model control group. The same volume of the fourth passage of BMSC suspension was injected into rabbits in the cell transplantation group, about 3«106 cells. Rabbits in the laser group were treated with TMR using high power CO2 apparatus, perforating 3 holes, at the power of 5 J. Rabbits in the combination group were treated with TMR, and then infused with an equal volume of cell suspension in the middle layer of myocardium surrounding the hole channel. MAIN OUTCOME MEASURES: Four weeks after treatment, the left ventricular myocardium of all sacrificing animals was harvested, and then the immunohistochemistrial sections were stained by anti-BrdU and anti-TnT to identify the survival or differentiation of BMSCs, as well as the CD146 + endothelial cells. Ultrasonicardiography (UCG) was performed to estimate cardiac function such as left ventricle ejection fraction, the displacement and strain of cardiac apex. RESULTS: Double stained positive cells were found, with black nuclei and brown cytoplasm in the cell transplantation and combination groups. Compared with the model control group, capillary vessel density significantly increased in the cell transplantation, laser and combination groups (P < 0.05), and the increase was significantly higher in the combination group than in the cell transplantation and laser groups (P < 0.05). The vascular density was similar between the cell transplantation and laser groups. Compared with pretreatment, ejection fraction value and the displacement or strain of cardiac apex was significantly improved at 4 weeks after treatment in the cell transplantation and combination groups (P < 0.05). There was significant difference in improvement of cardiac function compared with the model control and laser groups (P < 0.05). CONCLUSION: Autologous BMSCs from rabbits can differentiate into myocardium-like cells in myocardial microenvironment. Combining autologous BMSCs with TMR therapy has benefits of increasing myocardial capillary vessel density compared with BMSCs or TMR alone. The superiority in elevating cardiac function deserves further analysis.

Objective To explore the echocardiographic manifestations and diagnosis of superoinferior ventricles,and to discuss the relationship between superoinferior ventricles and crisscross heart.Methods Fourteen patients of superinferior heart were retrospectively reviewed with 2-dimensional,color Doppler echocardiography in this cross sectional study.Results All patients presented as the horizontal interventricular septum orientation with right ventricle located superiorly and the left ventricle inferiorly.Among 14 patients,9 were crisscross heart and 5 were tricuspid atresis with hypoplastic right ventricular as well as ventricular artery connection abnormality.The situs solitus was observed in 12 patients and inversus in 2,while the atrioventricular connections were concordant in 13 and discordant in 1 patients.Echocardiography revealed that 7 patients presented with transposition of great artery,7 with double outlet of right ventricle,and all with ventricular septum defect.Conclusion Echocardiography can clearly show the horizontal orientation of interventricular septum in suoeroinferior ventricles and make a definite diagnosis.Superoinferior ventricles is not identical to crisscross heart,which can be observed in other complicated congenital cardiac anomalies.

Objective Myocardium ischemia could be alleviated by the collateral circulation, but little is known about the collateral circulation between myocardium and cardiac cavity. The aim of this study is to assess such collaterals as well as their potential effect on ischemic myocardium by selective myocardium contrast echocardiography (MCE) and tissue velocity imaging (TVI). Methods A retrospective review was performed on 26 patients and 10 normal controls undergone selective intracoronary MCE. We assessed the presence of contrast leakage in cardiac cavity from myocardium directly and contrast path as well as sequence. The regional perfusion, peak systolic velocity (Sm) of the ischemic segments and the Vs time difference (Ts-dif) between ischemic segments and normal segments were measured with TVI. Results Contrast leakage was revealed in 15 segments in 7 patients by selective MCE. The perfusion, Sm and Ts-dif of segments with leakage were superior to the ischemic segments without leakage, but still lower than normal segments. No leakage was observed in normal controls. Conclusion The collateral circulation between myocardium coronary and cardiac cavity can be revealed by intracoronary MCE in patients with coronary artery disease, and the collateral can improve regional systolic function as well as regional perfusion of ischemic segments.

Objectives Cardiac function might be altered with the change of different pacing atrioventricular delay(PAVD)in congestive heart failure patients implanted with dual-chamber pacemaker,though little is known if it exerts the same effect in those with normal left ventricle function as well as the potential effect on diastolic function.The aim of this study is to assess both the systolic and diastolic function alteration in different PAVD with echocardiography.Methods Forty complete atrioventicular block patients receiving permanent dual-chamber pacemaker with right ventrieular pacing were assessed by conventional 2D and color-tissue Doppler Imaging echocardiography when programmed to different PAVD.The optimized PAVD was defined as the maximal cardiac output(CO).Results CO Was significantly affected by PAVD and mean optimal PAVD was (155.7±20.4)ms with around 70%optimized at 150 ms and 175 ms.Septal annulus E'and E/E'as well as Tei index were also improved at the optimized PAVD.Conclusion Optimizing PAVD could be in favorable of both systolic and diastolic function,suggesting the individual and long-term follow-up facilitate the maximal benign effect to those with DDD pacemaker.

Objective Speckle tracking imaging(STI)has been proposed as a novel tool to quantify myocardium function and to detect early systolic abnormality.However,the application in asymmetric hypertrophic cardiomyopathy(HCM)with preserved ejection fraction(EF)is still limited,and the different components of strain and systolic dyssynchrony derived from radial strain between obstruction type and non-obstruction type have not yet been explored.The aim of the study was to assess the alteration of the regional myocardium function as well as systolic dyssynchrony in HCM with STI.Methods Echocardiography was performed in 34 HCM patients(normal EF;15 with obstruction,19 without obstruction at resting)and 30 normal controls.Radial strain(RS),circumferential stain(CS),longitudinal strain(LS)and transverse strain(TS)were analyzed with STI in left ventricle(LV)short-axis and apical views.LV systolic dyssynchrony was also calculated as the time difference between septal and posterior wall peak strain(SPWPSD)at the level of short-axis papillary muscle view.Results Compared with healthy controls,all components of strain reduced in HCM with increase of systolic dyssynchrony.Further analysis showed more deterioration occurred in patients with obstruction than those without obstruction.Conclusion Deformation abnormality could deteriorate in preserved LVEF HCM which can be detected by STI.Increasing afterload may induce reduction of myocardium deformation as well increase of systolic dyssynchrony.