依托六大平台 实施医疗质量与安全精准化监管

运用信息化手段实施精准化的医疗质量与安全监管正在被越来越多的医院管理者所重视和接受。通过建立授权管理平台、环节质控平台、指标监测平台、医疗安全管理平台、电子病历质控平台和信息交互平台,对临床信息进行收集、统计、分析,为医院决策和医疗管理提供数据支撑,并及时反馈应用到临床医疗服务中,形成戴明环（PDCA循环）管理机制,切实打造医疗质量和安全精准化监管系统。     

县级医院医务人员稳定性与影响因素实证研究

目的 分析县级医院医务人员的稳定性以及影响因素,以促进县级医院人才队伍的稳定性建设。方法 通过对我国4个省12家县级医院的在职医务人员进行现场调查,运用描述性与卡方检验的方法进行统计学分析。结果 有51.9%的县级医院医务人员都表示曾经想过离开本单位,而且高层次人才具有较高的离职倾向。工作条件中的业务活动经费不足和加班太多,以及工作困扰中的没有合作团队、工作不受重视和人际关系不和谐会显著影响县级医院医务人员的稳定性。结论 通过各种途径稳定人才队伍是县级医院得到长效发展的关键。     

我国与典型发达国家数字化医疗技术体系的对比研究

目的 对比研究我国与典型发达国家的数字化医疗技术,指导建立我国数字化医疗技术体系框架。方法 调研欧美发达国家和我国的数字化医疗现状和发展趋势,对数字化医疗所涉及的工程技术进行研究。结果 欧美发达国家已经建立了符合本国卫生政策的国家级数字化医疗工程项目,并开展了技术支撑研究。结论 我国医院信息化发展迅速,但是缺乏顶层统筹设计,技术支撑滞后,需要建立我国数字化医疗技术体系基本框架,以期对各地卫生信息化建设相关工作起到指导作用。     

医学检验服务支撑平台在区域医联体中的作用

自2013年以来,北京地区构建了多个区域医联体。在中日友好医院医联体运行的半年多时间里,针对遇到的问题,医联体内各医疗机构采取了许多相应的措施。针对医学检验信息互通,结果互认,样本转运等方面的问题,中日友好医院联合医联体内各成员单位引入医学检验服务支撑平台,探索一种“互助式”的新型医学检验服务模式,力求达到“六统一”的要求,实现医联体的优势互补、资源优化配置作用。     

Nonadditive Effects of Genes in Human Metabolomics

Genome-wide association studies (GWAS) are widely applied to analyze the genetic effects on phenotypes. With the availability of high-throughput technologies for metabolite measurements, GWAS successfully identified loci that affect metabolite concentrations and underlying pathways. In most GWAS, the effect of each SNP on the phenotype is assumed to be additive. Other genetic models such as recessive, dominant, or overdominant were considered only by very few studies. In contrast to this, there are theories that emphasize the relevance of nonadditive effects as a consequence of physiologic mechanisms. This might be especially important for metabolites because these intermediate phenotypes are closer to the underlying pathways than other traits or diseases. In this study we analyzed systematically nonadditive effects on a large panel of serum metabolites and all possible ratios (22,801 total) in a population-based study [Cooperative Health Research in the Region of Augsburg (KORA) F4, N = 1,785]. We applied four different 1-degree-of-freedom (1-df) tests corresponding to an additive, dominant, recessive, and overdominant trait model as well as a genotypic model with two degree-of-freedom (2-df) that allows a more general consideration of genetic effects. Twenty-three loci were found to be genome-wide significantly associated (Bonferroni corrected P ≤ 2.19 × 10⁻¹²) with at least one metabolite or ratio. For five of them, we show the evidence of nonadditive effects. We replicated 17 loci, including 3 loci with nonadditive effects, in an independent study (TwinsUK, N = 846). In conclusion, we found that most genetic effects on metabolite concentrations and ratios were indeed additive, which verifies the practice of using the additive model for analyzing SNP effects on metabolites.     

In Vivo Studies in Rhodospirillum rubrum Indicate That Ribulose-1,5-bisphosphate Carboxylase/Oxygenase (Rubisco) Catalyzes Two Obligatorily Required and Physiologically Significant Reactions for Distinct Carbon and Sulfur Metabolic Pathways

All organisms possess fundamental metabolic pathways to ensure that needed carbon and sulfur compounds are provided to the cell in the proper chemical form and oxidation state. For most organisms capable of using CO₂ as sole source of carbon, ribulose-1,5-bisphosphate (RuBP) carboxylase/oxygenase (Rubisco) catalyzes primary carbon dioxide assimilation. In addition, sulfur salvage pathways are necessary to ensure that key sulfur-containing compounds are both available and, where necessary, detoxified in the cell. Using knock-out mutations and metabolomics in the bacterium Rhodospirillum rubrum, we show here that Rubisco concurrently catalyzes key and essential reactions for seemingly unrelated but physiologically essential central carbon and sulfur salvage metabolic pathways of the cell. In this study, complementation and mutagenesis studies indicated that representatives of all known extant functional Rubisco forms found in nature are capable of simultaneously catalyzing reactions required for both CO₂-dependent growth as well as growth using 5-methylthioadenosine as sole sulfur source under anaerobic photosynthetic conditions. Moreover, specific inactivation of the CO₂ fixation reaction did not affect the ability of Rubisco to support anaerobic 5-methylthioadenosine metabolism, suggesting that the active site of Rubisco has evolved to ensure that this enzyme maintains both key functions. Thus, despite the coevolution of both functions, the active site of this protein may be differentially modified to affect only one of its key functions.     

液相质谱联用的代谢组方法优化及其在蓝细菌分析中的应用

为了准确鉴定光合蓝细菌中的各种代谢物,需要对基于液相色谱–质谱联用仪(LC-MS)的代谢组学分析方法进行有针对性的优化。本研究选取了24种涉及中心碳代谢和能量代谢的代谢物作为LC-MS的检测目标,获得了每个代谢物的最适色谱分离条件和质谱参数;同时以光合蓝细菌Synechocystis sp.PCC6803为主要对象,针对性地优化了样品前处理条件,结果显示适当延长梯度洗脱顺序表的时间并将流速设为0.2 m L/min可以得到最佳的分离效果,同时选择80%(V/V)甲醇(-80?C)作为代谢物萃取剂。分析结果证明这一代谢组分析技术可以成功地应用到光合蓝细菌的研究中。     

Warming and drought differentially influence the production and resorption of elemental and metabolic nitrogen pools in Quercus rubra

The process of nutrient retranslocation from plant leaves during senescence subsequently affects both plant growth and soil nutrient cycling; changes in either of these could potentially feed back to climate change. Although elemental nutrient resorption has been shown to respond modestly to temperature and precipitation, we know remarkably little about the influence of increasing intensities of drought and warming on the resorption of different classes of plant metabolites. We studied the effect of warming and altered precipitation on the production and resorption of metabolites in Quercus rubra. The combination of warming and drought produced a higher abundance of compounds that can help to mitigate climatic stress by functioning as osmoregulators and antioxidants, including important intermediaries of the tricarboxylic acid (TCA) cycle, amino acids including proline and citrulline, and polyamines such as putrescine. Resorption efficiencies (REs) of extractable metabolites surprisingly had opposite responses to drought and warming; drought treatments generally increased RE of metabolites compared to ambient and wet treatments, while warming decreased RE. However, RE of total N differed markedly from that of extractable metabolites such as amino acids; for instance, droughted plants resorbed a smaller fraction of elemental N from their leaves than plants exposed to the ambient control. In contrast, plants in drought treatment resorbed amino acids more efficiently (>90%) than those in ambient (65–77%) or wet (42–58%) treatments. Across the climate treatments, the RE of elemental N correlated negatively with tissue tannin concentration, indicating that polyphenols produced in leaves under climatic stress could interfere with N resorption. Thus, senesced leaves from drier conditions might have a lower nutritive value to soil heterotrophs during the initial stages of litter decomposition despite a higher elemental N content of these tissues. Our results suggest that N resorption may be controlled not only by plant demand, but also by climatic influences on the production and resorption of plant metabolites. As climate–carbon models incorporate increasingly sophisticated nutrient cycles, these results highlight the need to adequately understand plant physiological responses to climatic variables.