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基层全科医生常见病诊疗能力现状与能力提升需求调查

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中国全科医学 2025年第4期28卷 443-449,464页

作者：李玲琦高银燕张玉琴孙鼎奎吴心音张卫茹中南大学湘雅公共卫生学院湖南省长沙市410000 中南大学湘雅医院全科医学科湖南省长沙市410000

背景建立基层卫生“守门人”制度,实现基层首诊、有序分流是落实分级诊疗制度的关键,而实施基层首诊的关键在于基层医疗卫生队伍能力建设。目的了解湖南省基层全科医生的常见病诊疗能力、转诊和循证实践能力现状,并了解其能力提升培训... 详细信息

背景建立基层卫生“守门人”制度,实现基层首诊、有序分流是落实分级诊疗制度的关键,而实施基层首诊的关键在于基层医疗卫生队伍能力建设。目的了解湖南省基层全科医生的常见病诊疗能力、转诊和循证实践能力现状,并了解其能力提升培训的需求,为开展以需求为导向的培训提供依据。方法2023年4—5月采用便利抽样的方法,选取近5年在中南大学湘雅医院参加过住院医师规范化培训或全科医师转岗培训的基层全科医生为调查对象,采用自行设计的调查问卷,包括基本信息、常见病诊疗能力的自我评价、循证实践能力的自我评价、能力提升的需求四个部分,利用“问卷星”平台进行数据收集,采用描述性分析方法对结果进行呈现和描述。结果共收集到来自湖南省各个地级市、自治州的337份有效问卷,其中128份来自社区卫生服务中心,209份来自乡镇卫生机构。乡镇卫生机构与社区卫生服务中心全科医生的性别、年龄、职称、基层工作年限、编制情况比较,差异均有统计学意义(P<0.05)。调查结果显示,75.1%(253/337)的基层全科医生认为自己具备基层常见病的诊疗能力;16.6%(56/337)的医生表示对某些疾病能力欠缺,这些疾病的前六位为抑郁[89.3%(50/56)]、压力性尿失禁[69.6%(39/56)]、痴呆[66.1%(37/56)]、脑卒中[53.6%(30/56)]、共病[51.8%(29/56)]、结核[46.4%(26/56)],结果在社区全科医生和乡镇全科医生中相似。71.8%(242/337)的基层全科医生表示对转诊规范和流程不够熟悉。73.0%(246/337)的医生表示对循证医学不够了解,85.8%(247/288)的基层全科医生表示循证医学在日常诊疗中的应用有限。77.2%(260/337)的医生对基层常见病的诊疗指南不够了解;90.8%(306/337)的医生在决策困难时一般不会选择查找指南,其原因主要是认为指南不能解决复杂的病情[50.0%(153/306)]、不清楚获取指南的操作[43.1%(132/306)]和来源[34.3%(105/306)]等;目前获取诊疗指南的渠道主要是微信公众号平台[72.5%(237/327)]、知网等数据库[50.2%(164/327)]。97.0%(327/337)的基层全科医生对能力提升的培训有需求,并提出应根据基层需求个性化开展培训[60.8%(205/337)];期望的途径主要是上级医院进修[71.3%(233/327)]和高诊疗能力的基层医疗卫生机构培训[56.3%(184/327)];期望的培训项目主要是常见疾病[78.0%(263/337)]和多病共存[69.4%(234/337)]的规范诊疗和转诊。结论湖南省基层全科医生中大多数认为自己具备基层常见病的诊疗能力,但对抑郁、压力性尿失禁、痴呆、脑卒中、共病、结核等疾病的诊疗能力相对欠缺;大多数医生规范转诊、循证医学实践、指南检索和应用等能力有待提高,提示这些可作为能力提升培训的侧重项目。基层全科医生对培训的需求较高,主要希望通过去高诊疗能力的卫生机构进修学习,对基层常见疾病和多病共存的规范诊疗、转诊培训有较高需求,具体的培训方式和内容可在广泛了解基层需求后根据实际情况制定。

关键词：全科医学基层卫生服务全科医生诊疗能力培训需求

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Impacts of communication delay on vehicle platoon string stability and its compensation strategy:A review

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Journal of Traffic and Transportation Engineering(English Edition) 2023年第4期10卷 508-529页

作者： yuqin zhang Zhihang Xu Zijian Wang Xinpeng Yao Zhigang Xu School of Information Engineering Chang'an UniversityXian 710064China Shandong Key Laboratory of Smart Transportation Jinan 250000China

Based on the four-element model,this paper reviewed the important research progress in vehicle platoon,compared the advantages and disadvantages of different models in each element longitudinally,and summarized the linkage between each element *** stability criteria are briefly reviewed from three dimensions:local stability,string stability,and traffic flow *** impact of communication delay on vehicle platoon is quantitatively summarized from two aspects:the variation of controller gains and the variation of headway time *** at the inevitable communication delay in vehicle platoon,the compensation strategies are analyzed from five levels.(1)Optimizing the communication network structure.(2)Reconstructing acceleration information.(3)Tuning controller gains.(4)Constructing a multi-branch selection structure.(5)Improving the *** results show that,although these compensation strategies can alleviate the negative impact of communication delay to a certain extent,they also have some defects such as difficulty in adapting to complex and various real road conditions,poor accuracy and real-time performance,insufficient security,and limited application *** is necessary to further improve the accuracy and real-time performance of the device,design an encrypted and scalable network architecture to ensure communication security and adaptability,and conduct further real vehicle testing.

关键词： Traffic engineering Vehicle platoon CACC Communication delay Compensation strategy Stability

Micro-spherical ZnSnO3 material prepared by microwave-assisted method and its ethanol sensing properties

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Chinese Chemical Letters 2020年第8期31卷 2087-2090页

作者： Dan zhang yuqin zhang Yu Fan Na Luo Zhixuan Cheng Jiaqiang Xu NEST Lab Department of PhysicsDepartment of ChemistryCollege of ScienceShanghai UniversityShanghai 200444China

Monodispersed ZnSnO3 microspheres are successfully prepared via a facile microwave-assisted method together with subsequently calcination *** X-ray diffraction(PXRD)results indicate that the structure of the products shifted from crystalline to amorphous under high-tempe rature *** emission scanning electron microscope(FESEM)and the transmission electron microscope(TEM)observations demonstrate that the as-obtained products are composed of uniform microspheres with rough surfaces and the mean diameter is measured as-700 ***,the morphology of ZnSnO3 microspheres can be well controlled by adjusting the ratio of Zn2+and Sn4+.The gas sensing properties of ZnSnO3 microspheres with different ratios of Zn2+/Sn4+are *** results indicate that the ZnSnO3 microspheres exhibit good selectivity and high sensitivity towards ethanol at the optimum working temperature of 230℃.When the sensor is exposed 50 ppm ethanol,the value of response is 47 and the response/recovery times are 11 s and 12 s,respectively.

关键词： ZnSnO3 microspheres Microwave synthesis Morphology Ethanol Gas sensor

Reversible magnetocaloric effect and refrigeration capacity enhanced by two successive magnetic transitions in DyB2

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Science China(Technological Sciences) 2012年第2期55卷 501-504页

作者： MENG Hui LI Bing HAN Zheng zhang yuqin WANG XianWei zhang ZhiDong Shenyang National Laboratory for Materials Science and International Center for Materials PhysicsInstitute of Metal ResearchChinese Academy of SciencesShenyang 110016China

A large and reversible magnetocaloric effect is found in the compound DyB2, which is associated with two successive mag- netic transitions： a spin-reorientation-like transition followed by a ferromagnetic-paramagnetic transition. These two transitions appreciably enlarge the magnetic-refrigeration temperature window and yield a huge refrigeration capacity of 610 J kg^-1, with a maximum magnetic entropy change -ASmax of 17 J kg^-1K^-1, at a magnetic-field change of 5 T. The corresponding values for low magnetic-field change of 2 T are 193 J kg^-1 and 7.4 J kg-lK^-1, respectively.

关键词： DyB2 magnetocaloric effect refrigeration capacity

VvAGAMOUS Affect Development of Four Different Grape Species Ovary

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Phyton-International Journal of Experimental Botany 2023年第4期92卷 1125-1138页

作者： Pengfei zhang yuqin zhang Qifeng Zhao Tiequan Niu Pengfei Wen Jinjun Liang College of Horticulture Shanxi Agricultural UniversityTaigu030801China Pomology Institute Shanxi Agricultural UniversityShanxi Academy of Agricultural SciencesTaigu030801China

Grape pistil has an important influence on fruit size and ***,there were few studies on grape ovary,and the development process of the ovary is still ***,in this paper,four different grape varieties with different lengths of small inflorescences,namely‘Musct Hambourg’grape(Vitis vinifera),‘Concord’grape(Vitis labrusca),‘ShanPuTao’grape(Vitis amurensis)and‘GongNiang2Hao’grape(Vitis amurensis×Vitis vinifera)were used as test *** varieties ovary were significant differences by means of stereomicroscope,paraffin *** expression of ovary determining gene VvAGAMOUS(VvAG)and its development related genes VvCRABS CLAW(VvCRC)and VvAGAMOUS-LIKE 11(VvAGL11)with similar functions during the development of different grape varieties were preliminarily explored using fluorescence quantitative *** relationship between VvAG and VvCRC,VvAG and VvAGL11 were analyzed using Y1H *** results showed that there were obvious abdominal sutures on the surface of expect for‘Musct Hambourg’grape,and existing poly *** ovary development of‘ShanPuTao’and‘GongNiang2Hao’grape was completed when the inflorescence length was less than 1 cm,while the‘Concord’and‘Musct Hambourg’grape were fully developed when the length of inflorescence was 3–4 and 4–5 cm,*** and VvCRC began to express in large quantities after the formation of stamen primordia,while VvAGL11 during the forming of ovule ***,VvAG and VvCRC mainly regulated the development of stamens and carpels and also promote the development of ovules,while VvAGL11 major regulated the development of *** promoters of VvCRC and VvAGL11 were bound by *** study provides an important theoretical basis for further research on the molecular mechanism of grape ovary development.

关键词： Grape carpel ovule VvAGAMOUS VvCRABS CLAW VvAGAMOUS-LIKE 11 flower development process

IL-13/IL-13RA2 signaling promotes colorectal cancer stem cell tumorigenesis by inducing ubiquitinated degradation of p53

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Genes & Diseases 2024年第1期11卷 495-508页

作者： Baoyu He Jing Liang Qianqian Qin yuqin zhang Shuo Shi Jinghe Cao Zhixin zhang Qingli Bie Rou Zhao Li Wei Baogui zhang Bin zhang Department of Laboratory Medicine Affiliated Hospital of Jining Medical UniversityJining Medical UniversityJiningShandong 272000China Postdoctoral Mobile Station of Shandong University of Traditional Chinese Medicine JinanShandong 250355China Department of Reproductive Medicine Affiliated Hospital of Jining Medical UniversityJining Medical UniversityJiningShandong 272000China Department of Gastrointestinal Surgery Affiliated Hospital of Jining Medical UniversityJining Medical UniversityJiningShandong 272000China Institute of Forensic Medicine and Laboratory Medicine Jining Medical UniversityJiningShandong 272067China

Cancer stem cells(CSCs)are considered tumor-initiating cells and the main drivers of disease *** these rare cancer cells,however,remains challenging with respect to therapeutic ***,we report the up-regulation of IL-13RA2 expression in colorectal cancer(CRC)tissues and spheroid *** expression of IL-13RA2 was positively correlated with canonical stemness markers in *** further demonstrated that the level of IL-13 was up-regulated in the serum of CRC ***,recombinant IL-13(rIL13)stimulation promoted the sphere formation,proliferation,and migration of CRC cells in vitro and enhanced tumorigenesis in *** phenotype could be reversed by knocking down ***,IL-13 activated autophagy by inducing LC3I/LC3II transformation in CRC-CSCs,which was crucial for the biological functions of *** further demonstrated that IL-13RA2 acted as a modular link of the E3 ligase UBE3C and the substrate p53 protein,enhancing the interaction of UBE3C and p53,thereby inducing the K48-linked ubiquitination of *** conclusion,the IL-13/IL-13RA2 signaling cascade promotes CRC-CSC self-renewal and tumorigenesis by inducing p53 ubiquitination,adding an important layer to the connection between IL-13 and p53,which can be translated into novel targeted therapies.

关键词： Autophagy Colorectal cancer stem cells IL-13/IL-13RA2 signaling p53

A review of road 3D modeling based on light detection and ranging point clouds

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Journal of Road Engineering 2024年第4期4卷 386-398页

作者： Bin Yu Yuchen Wang Qihang Chen Xiaoyang Chen yuqin zhang Kaiyue Luan Xiaole Ren School of Transportation Southeast UniversityNanjing 211189Chind

Increasing development of accurate and efficient road three-dimensional(3D)modeling presents great opportunities to improve the data exchange and integration of building information modeling(BIM)models.3D modeling of road scenes is crucial for reference in asset management,construction,and *** detection and ranging(Li DAR)technology is increasingly employed to generate high-quality point clouds for road *** this paper,we specifically investigate the use of Li DAR data for road 3D *** purpose of this review is to provide references about the existing work on the road 3D modeling based on Li DAR point clouds,critically discuss them,and provide challenges for further ***,we introduce modeling standards for roads and discuss the components,types,and distinctions of various Li DAR measurement ***,we review state-of-the-art methods and provide a detailed examination of road segmentation and feature ***,we systematically introduce point cloud-based 3D modeling methods,namely,parametric modeling and surface *** and rules are used to define model components based on geometric and non-geometric information,whereas surface modeling is conducted through individual faces within its ***,we discuss and summarize future research directions in this *** review can assist researchers in enhancing existing approaches and developing new techniques for road modeling based on Li DAR point clouds.

关键词： Road engineering LiDAR data 3D modeling Point cloud Segmentation Key feature extraction

Spatiotemporal dynamics of the microbial diversity on salt-preserved goatskins assessed by culturing and 16S rRNA gene amplicon sequencing

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Journal of Leather Science and Engineering 2022年第1期4卷 440-451页

作者： Xiaoguang Li Keya Sen yuqin zhang Yongqiang Tian Bi Shi Author details 1 Key Laboratory of Leather Chemistry and Engineering Ministry of Education and College of Biomass Science and EngineeringSichuan UniversityChengdu 610065People’s Republic of China Division of Biological Sciences STEMUniversity of WashingtonBothellWA 98011USA Institute of Medicinal Biotechnology Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100050People’s Republic of China

Wet-salted skin,as a special artificial high-salt environment,is rich in protein,fat,collagen and other nutrient substrates,and is a rich resource of halotolerant and halophilic ***,knowledge gaps regarding the microbial community structure and inter taxa associations of wet-salted skin are *** this study,the spatiotemporal dynamics and community structure of microorganisms present on wet-salted goatskins were investigated using 16S rRNA gene amplicon sequencing and culturable *** diversity analysis based on Sobs,Chao,Ace and Shannon indices revealed that microbial diversity on the wet-salted goatskins exhibited a trend of‘down→up→down→flat’with *** preservation,genera belonging to the bacteria domain such as Aci-netobacter,Weissella and Streptococcus were slowly dying out,whereas those belonging to halophilic archaea such as Natrialba and Haloterrigena were gradually ***,to resist high-salt stress,microorganisms on the wet-salted goatskin gradually migrated from the outside to the inside,eventually leading to the microbial diversity inside the skin being the same as or even higher than that on the skin *** diagram analysis revealed that the strains of some genera,including Psychrobacter,Salimicrobium,Salinicola,Ornithinibacillus,Halomonas,Bacillus and Chromohalobacter,were distributed throughout the interior and exterior of the wet-salted goatskin and existed during various ***,45 protease-producing halophilic or halotolerant microorganisms were isolated and screened from the wet-salted goatskin using the gradient dilution plate ***,16S rRNA genes of some bacteria exhibited less than 99.5%similarity to valid published species,indicating that they likely are novel spe-cies and have a good potential for application.

关键词： Wet-salted skin Spatiotemporal dynamics Community structure 16S rRNA gene amplicon sequencing

Wnt3a expression during the differentiation of adipose-derived stem cells into cholinergic neurons

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Neural Regeneration Research 2012年第19期7卷 1463-1468页

作者： Bin Liu Chunying Deng yuqin zhang Jinxia zhang First Department of Neurology Hospital Affiliated to Hebei United UniversityTangshan 063000Hebei ProvinceChina

The present study analyzed changes in Wnt3a expression during differentiation of adipose-derived stern cells into cholinergic neurons. Immunocytochemistry and immunofluorescence revealed significantly increased nestin, neuron-specific enolase, microtubule-associated protein 2, and choline acetyltransferase expression in adipose-derived stem cells isolated from Sprague-Dawley rats and cultured in vitro in neural-induced medium. These expressions increased with prolonged induction time. Real-time reverse transcription-PCR and western blot assay results demonstrated significantly increased choline acetyltransferase and Wnt3a protein and mRNA expressions, respectively, in adipose-derived stem cells following induction. Choline acetyltransferase expression positively correlated with Wnt3a protein and mRNA expressions. These results demonstrated that neural-induced medium induced differentiation of adipose-derived stem cells into cholinergic neuronal-like cells, with subsequent increased Wnt3a expression.

关键词： adipose-derived stem cells cholinergic neurons Wnt3a induction differentiation neural stem cells neural regeneration