从单中心大型超声心动图数据分析近十年中国心脏疾病患病率的变化趋势     

Hao Lu  Wen-zhi Pan  Quan Wan  Lei-lei Cheng  Xian-hong Shu  Cui-zhen Pan  Ju-ying Qian  Jun-bo Ge 《Journal of Zhejiang University. Science. B》2016,17(1):54-59

There is a paucity of data regarding trends in the incidence of heart disease in China during recent years. Using a large echocardiography database in our center, we analyzed trends in the prevalence of several common heart diseases from Dec. 2003. This study retrospectively analyzed the echocardiographic database in our Department from 2003 to 2012. A total of 385 682 cases were included in the study. The prevalence of rheumatic heart disease decreased over the 10-year period, from 4.04% in 2003 to 3.06% in 2012 (P<0.01). Infective endocarditis also decreased, from a mean prevalence of 0.37% in July 2003 to 0.27% in Dec. 2008 (P<0.001). The prevalence of hypertrophic cardiomyopathy, which includes 20% apical hypertrophic cardiomyopathy and 20% hypertrophic obstructive cardiomyopathy, was about 1.8%. The prevalence of the three most common adult congenital heart diseases (CHDs) decreased by about 10% from July 2003 to Dec. 2008 (all P<0.001). The prevalence of moderate pulmonary arterial hypertension (PAH) or left ventricular systolic dysfunction (LVSD) decreased during the 10-year period (P<0.001), but there was no change in the prevalence of severe PAH or LVSD (P>0.05). The present study indirectly demonstrates that the prevalence of several common heart diseases in China has declined in recent years.  相似文献   

An integrated microfluidic device for rapid serodiagnosis of amebiasis     

Wang Zhao  Li Zhang  Wenwen Jing  Sixiu Liu  Hiroshi Tachibana  Xunjia Cheng  Guodong Sui 《Biomicrofluidics》2013,7(1)

A microfluidic device was successfully fabricated for the rapid serodiagnosis of amebiasis. A micro bead-based immunoassay was fabricated within integrated microfluidic chip to detect the antibody to Entamoeba histolytica in serum samples. In this assay, a recombinant fragment of C terminus of intermediate subunit of galactose and N-acetyl-_D-galactosamine-inhibitable lectin of Entamoeba histolytica (C-Igl, aa 603-1088) has been utilized instead of the crude antigen. This device was validated with serum samples from patients with amebiasis and showed great sensitivity. The serodiagnosis can be completed within 20 min with 2 μl sample consumption. The device can be applied for the rapid and cheap diagnosis of other infectious disease, especially for the developing countries with very limited medical facilities.Entamoeba histolytica is the causative agent of amebiasis and is globally considered a leading parasitic cause of human mortality.¹ It has been estimated that 50 × 10⁶ people develop invasive disease such as amebic dysentery and amebic liver abscess, resulting in 100 000 deaths per annum.^{2, 3} High sensitive diagnosis method for early stage amebiasis is quite critical to prevent and cure this disease. To date, various serological tests have been used for the immune diagnosis of amebiasis, such as the indirect fluorescent antibody test (IFA) and enzyme-linked immunosorbent assay (ELISA).We have recently identified a 150-kDa surface antigen of E. histolytica as an intermediate subunit (Igl) of galactose and N-acetyl-_D-galactosamine-inhibitable lectin.^{4, 5} In particular, it has been shown that the C-terminus of Igl (C-Igl, aa 603-1088) was an especially useful antigen for the serodiagnosis of amebiasis. ELISA using C-Igl is more specific than the traditional ELISA using crude antigen.⁶ However, the ELISA process usually takes several hours, which is still labor-intensive and requires experienced operators to perform. More economic and convenient filed diagnosis methods are still in need, especially for the developing countries with limited medical facilities.Among all the bioanalytical techniques, microfluidics has been attracting more and more attention because of its low reagent/power consumption, the rapid analysis speed as well as easy automation.^{7, 8, 9, 10, 11} Especially with the development of the fabrication technique, microfluidics chip can include valves, mixers, pumps, heating devices, and even micro sensors, so many traditional bioanalytical methods can be performed in the microfluidics. Qualitative and quantitative immune analysis on the microfluidic chip was successfully proved by plenty of research with improved sensitivity, shorten reaction time, and less sample consumption.^{8, 10, 11, 12, 13, 14, 15, 16, 17} Moreover, with the intervention of other physical, chemical, biology, and electronic technology, microfluidic technique has been successfully utilized in protein crystallization, protein and gene analysis, cell capture and culturing and analysis as well as in the rapid and quantitative detection of microbes.^{13, 14, 15, 16, 17, 18, 19, 20}Herein, we report a new integrated microfluidic device, which is capable of rapid serodiagnosis of amebiasis with little sample consumption. The microfluidic device was fabricated from polydimethysiloxane (PDMS) following standard soft lithography.^{21, 22} The device was composed of two layers (shown in Figure ​Figure1)1) including upper fluidic layer (in green and blue) and bottom control layer (in red).Open in a separate windowFigure 1Structure illustration of microfluidic chip.To create the fluidic layer and the control layer, two different molds with different patterns have fabricated by photolithographic processes. The mold to create the fluidic channels was made by positive photoresist (AZ-50 XT), while the control pneumatic mold was made by negative photoresist (SU8 2025). For the chip fabrication, the fluidic layer is made from PDMS (RTV 615 A: B in ratio 5:1), and the pattern was transferred from the respective mold. The control layer is made from PDMS (RTV 615 A:B in ratio 20:1). The two layers were assembled and bonded together accurately, and there is elastic PDMS membrane about 30 μm thick between the fluidic layer channels and control layer.^{21, 22} The elastic membrane at the intersection can deform to block the fluid inside the fluidic channels, functioning as valves under the pressures introduced though control channels. There are two types of channels in fluidic layer, the rectangular profiled (in green, 200 μm wide, 35 μm thick) channel and round profiled channels (in blue, 200 μm wide, 25 μm center height). Because of the position of the valves on the fluidic channels, two types of valves (Figure ​(Figure2a)2a) were built, working as a standard valve and a sieve valve. The standard valves (on blue fluidic channels) can totally block the fluid because of the round profile of fluidic channel; the sieve valve can only half close because of the rectangular profile. The sieve valve can be used to trap the microspheres (beads) filled inside the green fluidic channels, while letting the fluid pass through. By this sieve valve, a micro column (in green) is constructed, where the entire ELISA reaction happens. The micrograph of the fabricated micro device is shown in Figure ​Figure2b.2b. The channels were filled with food dyes in different colors to show the relative positions of the channels. The pressures though different control channels are individually controlled by solenoid valves, connected to a computer through relay board. By programming the status (on/off) of various valves at different time periods, all the microfluidic chip operation can be digitally controlled by the computer in manual, semi-automatic, or automatic manner.Open in a separate windowFigure 2(a) Structure illustration of micro column, standard valve and sieve valve; (b) photograph of the microfluidic chip.To validate this device, 12 patient serum samples were collected. Sera from 9 patients (Nos. 1–9) with an amebic liver abscess or amebic colitis were used as symptomatic cases. The diagnosis of these patients was based on their clinical symptoms, ultrasound examination (liver abscess) and endoscopic or microscopic examination (colitis). We also identified the clinical samples using PCR amplification of rRNA genes.²⁴ As negative control, sera obtained from 3 healthy individuals with no known history of amebiasis were mixed into pool sera. The serum was positive for E. histolytica with a titer of 1:64 (borderline positive), as determined by an indirect fluorescent-antibody (IFA) test.^{23, 24} In our previously study, the sensitivity and specificity of the recombinant C-Igl in the ELISA were 97% and 99%.^{6, 25} In the current study, the serodiagnosis of amebiasis was also examined by ELISA using C-Igl.²⁶ The cut-off for a positive result was defined as an ELISA value > 3 SD above the mean for healthy negative controls²⁷ (shown in Figure ​Figure3).3). The seropositivity to C-Igl was 100% in patients with amebiasis.Open in a separate windowFigure 3ELISA reactivity of sera from patients against C-Igl. ELISA plate was coated with 100 ng per well of C-Igl. Serum samples from patients and healthy controls were used at 1:400 dilutions. The dashed line indicates the cut-off value. Data are representative of results from three independent experiments.In the diagnosis process with microfluidic chip, the 4 micro immuno-columns filled with C-Igl-coated microspheres were the key components of the device. The C-Igl was prepared in E. coli as inclusion bodies. After expression, the recombinant protein was purified and analyzed by SDS-PAGE. The apparent molecular mass was 85 kDa.²⁶The immune-reaction mechanism is illustrated in Figure ​Figure4.4. The anti-His monocolonal antibody was immobilized onto the microspheres (beads, 9 μm diameter) coated with protein A. The C-Igl was then immobilized onto the beads through the binding between the His tag and C-Igl. For the diagnosis, the microspheres immobilized with C-Igl and blocked by 5% BSA were preloaded into the columns for the rapid analysis of the patient serum samples. Generally, serum samples which were diluted 100 times were first loaded into the reaction column and incubated at room temperature for 5 min. After being washed by PBS buffer, FITC-conjugated goat anti-human polyclonal antibody was added into the column for 4 min incubation. The fluorescence image can be collected by the fluorescence microscope after the micro column was washed with PBS buffer. From loading diluted serum samples into column to collecting fluorescence images, the total time to complete the immunoassay is less than 10 min. The final fluorescence results were analyzed by Image Pro Plus 6.0.Open in a separate windowFigure 4Schematic representation of the ELISA in the chip.Different reaction conditions have been investigated to find the optimized ones. For each patient, 2 μl sample is enough for the analysis. The designed microfluidic chip with 4 micro columns is capable for 4 parallel analyses at the same time. More micro columns can be integrated into the device if more parallel tests are needed.Different incubating time for the diagnosis has also been investigated and no significant difference has been found for various time periods. It is enough to incubate the chip for only 5 min. The total diagnosis time for one sample is less than 10 min. The detection result appeared as the fluorescence intensity of the reaction column. As shown in Figure ​Figure5,5, the negative sample showed relatively low fluorescence intensity, because little FITC-conjugated goat anti-human polyclonal antibody could attach to the surface of microspheres; on the contrast, the positive sample showed much brighter fluorescence. The fluorescence intensity can be transferred to digital data (Table TABLE I.) by IPP software. The results showed good correspondence with the traditional ELISA results. The positive samples showed a significantly higher number than the negative one, and the standard deviation was nearly 1% to the average scores.

TABLE I.

ELISA on the chip (analyzed by IPP6.0).

Sample	Average scores	Standard deviation
1	33 790	368
2	23 269	271
3	39 598	307
4	7784	52
5	21 222	197
6	38 878	290
7	22 437	227
8	36 295	334
9	41 024	396
Negative	200	32

Open in a separate windowOpen in a separate windowFigure 5ELISA on the chip. The signals were collected by CCD of microscope. A: negative sample; B and C: positive samples.For the heterogeneous immunoreactions, the immobilization of the immune molecules is essential for the reaction efficiency. Herein, we utilized micro columns filled with pre-modified microspheres (beads) instead of the direct surface modification for the ELISA analysis. Compared with the traditional method, diagnosis using the microfluidic device took less than 10 min with only 2 μl sample consumption and little reagent consumption. The high efficiency might be attributed to the high surface modification efficiency by using beads as well as the advantages from microfluidic device itself. The C-Igl modified microspheres can be easily prepared in 1 h and preloaded inside the micro device for convenient application. The device is made from standard soft lithography by PDMS and its throughput can be easily improved by adding more micro columns into the microfluidic device in an economic manner, which is perfect for the onsite rapid and cheap diagnosis of amebiasis. Similar methodologies can be developed for diagnosis of other infectious disease, especially for the developing countries with very limited medical facilities.  相似文献   

设定医科毕业生国际标准的试验性研究     

梅人朗 《复旦教育论坛》2006,4(6):78-81,90

本文介绍了有关设定医科毕业生能力国际标准研究的目的、方法和程序，包括MCQ、OSCE和教师观测的国际标准设定，为进行医科毕业生的国际评价和比较提供了初步依据。  相似文献   

追踪国际医学教育发展动态,聚集亚洲医学教育改革热点——亚洲医学教育会议纵览   总被引：9，自引：1，他引：8  

汪青  鲁映青  孙利军 《复旦教育论坛》2006,4(3):83-86

作者将近期从各类亚洲医学教育会议上所获取的信息进行了汇总和整理,结合文献评述了当前国际医学教育发展动态,介绍了亚洲医学教育的基本现状及改革热点,希望能对传播现代医学教育理念、理性开展医学教育改革等提供有益的参考。  相似文献   

对医学教育证据的需要:作为熟悉、指导和支撑医学教育研究机会的最佳证据医学教育的发展   总被引：1，自引：0，他引：1  

梅人朗 《复旦教育论坛》2006,4(5):84-87,92

本文介绍了最佳证据医学教育（BEME）的起源,对日益增加的责任的需求和测量的需要,当前的进展,BEME和证据在医学教育研究界的作用,未来需要以及怎样将它们同BEME整合起来.  相似文献   

现代医学生科研素质和实践能力培养的探索与实践     

孙利军   《复旦教育论坛》2007,5(6):88-91

复旦大学上海医学院经过多年不断改革与探索,建立了一套行之有效的科研素质及临床实践能力培养机制,主要体现在全程导师制的实施、课程体系的优化及教学方法的改进、床旁教学的实施、课外科技活动的开展等诸方面.通过鼓励本科生早期接触科研实践、早期接触临床病人,培养学生严谨的科学态度、创新意识和团队合作精神,显著提高了医学生的研究创新能力和临床实践能力.  相似文献   

拉丁美洲医学教育的变化、趋势与挑战     

曾勇 《复旦教育论坛》2007,5(4):89-92

泛美医学院校协会(PAFAMS)董事PA Pulido等人撰文[Medical Teacher,2006,28(1):24-29]分析了拉丁美洲医学教育的多种影响因素,认为该地区的医学院校无计划地高速增长,质量得不到有效保障,卫生人力分布不合理.他们认为开展医学院校认证是解决上述问题的一条途径,并介绍了该地区医学院校认证的进展情况和趋势.  相似文献   

从学生的视角看PBL教学实践的效果和努力方向   总被引：4，自引：0，他引：4  

梁燕  汪青  钱睿哲  鲁映青 《复旦教育论坛》2009,7(4):92-96

目的:调查学生对PBL教学实施效果的评价,以利于进一步完善课程设计.方法:以CIPP评价模式为指导,以教育目标和教育环境为平台,搭建三维理论框架设计问卷,调查学生参与PBL教学前后的态度和能力变化情况.结果:学生对PBL教育环境认知处于较高水平,对PBL教学的各个环节总体比较满意,对自己在PBL中的学习效果持肯定态度.结论:PBL实施效果良好,但同时也暴露出PBL教学存在的瓶颈.从学生的视角反馈PBL教学实践的优势和不足,可作为完善教学的参照,真正体现以学生为本的宗旨.  相似文献   

土耳其的医学教育:从过去到未来     

Hatice Kurdak  Derya Altintas  Figen Doran  梅人朗 《复旦教育论坛》2009,7(4):88-91

本文从本科生医学教育、毕业后医学教育和继续医学教育的角度,论述了土耳其医学院校的历史和现状,医学教育的质量和专业风格,以及当前面临的问题和机遇.  相似文献   

改革与创新:近半个世纪美国的医学教育   总被引：5，自引：0，他引：5  

汪青 《复旦教育论坛》2006,4(5):93-96

本文回顾了近半个世纪美国医学教育的总体情况,涉及新建医学院校、医师培养的新侧重点以及在课程建设方面所作的改革等.同时通过介绍六所独具特色的医学院校,说明了美国医学教育的多样性.  相似文献