中国医学科学院学报最新文献

To cultivate composite medical professionals capable of adapting to the development of intelligent healthcare,this consensus is grounded in the competency-based medical education,integrating the competency model and Miller's pyramid of clinical competence. A two-round Delphi method involving a multidisciplinary expert panel was conducted,combined with a systematic literature review,to develop a 21-indicator artificial intelligence(AI) literacy competency list for medical students across three domains:knowledge (8 indicators),skills (8 indicators),and attitudes (5 indicators). Furthermore,the consensus proposes a practical assessment system:standardized testing for the knowledge domain,situational judgment tests for the attitudes domain,and objective structured clinical examinations incorporating AI-related scenarios for the skills domain. In addition,a longitudinal assessment strategy spanning the phases of admission,preclinical training,and clinical training is recommended. The competency list and assessment framework established in this consensus demonstrate strong scientific rigor,authority,and practical applicability,and can serve as an important reference for medical schools seeking to advance the deep integration of AI and medical education and to cultivate composite medical talents suited to the era of intelligent healthcare.

In response to the challenges posed by the profound integration of generative artificial intelligence(AI)into medical education,this consensus proposes a logically coherent,medically distinctive,forward-looking,and operable AI proficiency framework for medical educators(competency items of medical educators' AI proficiency,CAIP-ME).Through systematic literature review,preliminary framework construction,multiple rounds of expert pre-study,and a structured Delphi method involving extensive consultations with 60 interdisciplinary experts,the core competency items and assessment standards for AI proficiency among medical educators were demonstrated and calibrated.The framework encompasses five core dimensions and 25 specific competency items.The five dimensions are value recognition and ethical foundation,technical understanding and tool application,teaching integration and innovative practice,learning assessment and precise empowerment,and professional development and ecosystem co-construction.Competency items are categorized into 11 foundational competency items essential for all educators and 14 developmental competency items for those pursuing excellence.Each competency item is described in terms of its conceptual definition and key behavioral manifestations,accompanied by observable assessment indicators.This consensus aims to provide a scientific basis for the professional development of medical educators and the faculty building in medical institutions,while establishing a key reference standard for educator competency development in the context of digital transformation in medical education.

PICALM∶∶MLLT10 fusion gene-positive precursor B-cell acute lymphoblastic leukemia(pro-B-ALL)is clinically rare.This article reports the case of a 29-year-old female patient who presented a mediastinal mass.Diagnostic investigations confirmed PICALM∶∶MLLT10 fusion gene-positive pro-B-ALL.The patient sequentially received radiotherapy and multiple lines of chemotherapy but developed short-term drug resistance and lineage change,progressing to mixed-phenotype acute leukemia.A review of relevant literature was conducted to analyze its pathogenesis and molecular characteristics,aiming to provide references for clinical diagnosis and treatment.

Objective To evaluate the effect of pressure-controlled ventilation-volume guaranteed(PCV-VG)on the perioperative pulmonary oxygenation function of the patients undergoing off-pump coronary artery bypass grafting(OPCABG). Methods Forty patients aged 40-65 years,of both sexes,with the American Society of Anesthesiologists physical status Ⅲ or Ⅳ,preoperative cardiac function(NYHA)class Ⅱ or Ⅲ,scheduled for elective OPCABG were assigned via the random number table method into two groups(n=20):a volume-controlled ventilation(VCV)group(Group V)and a PCV-VG group(Group P). Other respiratory parameters of the anesthesia machine were set consistently in both groups. At the time of sawing the sternum(T₀),when left internal mammary artery harvesting with the operating table tilted 10° to the left(T₁),when left anterior descending coronary artery bypass grafting with the operating table tilted 10° to the right(T₂),when right coronary artery bypass grafting with the operating table in a 30° head-down and tilted 10° to the right(T₃),when circumflex coronary artery bypass grafting with the operating table in a 20° head-down and tilted 15° to the right(T₄),and at the end of the surgery(T₅),the peak airway pressure(Ppeak),mean airway pressure(Pmean),plateau airway pressure(Pplat),and pulmonary dynamic compliance(Cdyn)were recorded. The alveolar-arterial partial pressure difference of oxygen(PA-aDO₂),oxygenation index(OI),and respiratory index(RI)were recorded at the aforementioned time points as well as on postoperative day 1(T₆),day 3(T₇),and day 7(T₈). The dosages of intraoperative drugs(sufentanil,remifentanil,and rocuronium bromide),postoperative endotracheal tube indwelling time,the stay time in the cardiac surgery intensive care unit,and the occurrence of pulmonary complications within 7 days after the surgery were also recorded. Results Compared with Group V,Group P showed significant downward trends in Ppeak,Pmean,and Pplat during T₃-T₅,as well as in PA-aDO₂ and RI during T₃-T₈(all P<0. 05). Meanwhile,Group P exhibited significant upward trends in Cdyn during T₃-T₅ and in OI during T₃-T₈(all P <0. 05). Compared with those in Group V,the postoperative endotracheal tube indwelling time and the stay time in the cardiac surgery intensive care unit were shortened in Group P(all P<0. 05). There was no statistically significant difference in dosages of intraoperative drugs(sufentanil,remifentanil,and rocuronium bromide)or incidence of pulmonary complications within 7 days after the surgery between the two groups of patients(all P>0. 05). Conclusion Compared with VCV,PCV-VG can improve the perioperative pulmonary oxygenation function of the patients undergoing OPCABG.

Objective To evaluate the effect of applying palliative medicine teaching in the training of medical humanistic skills for resident physicians in the department of cardiovascular medicine. Methods A total of 36 resident physicians who received standardized training in the Department of Cardiology,China-Japan Friendship Hospital from June to December 2023 were allocated via the random number table method into two groups(n=18). According to the requirements of standardized training and palliative medicine teaching for resident physicians,the palliative medicine course was modulated and incorporated in the standardized training in the experimental group. The control group was taught in accordance with the requirements of standardized training for resident physicians and medical humanistic contents. After teaching,medical humanistic skills assessment and a self-evaluation questionnaire survey were employed to compare the teaching performance between the two groups. Results In terms of medical humanistic skills assessment:the experimental group scored higher than the control group in empathy,handling family feedback,reaching consensus,and overall score(all P<0. 05). The self-evaluation questionnaire survey showed that the experimental group had higher levels of interest in medical humanities and clinical communication skills than the control group(both P<0. 05). Conclusion Palliative medicine teaching can help stimulate the interest of resident physicians in humanistic medicine,improve clinical communication skills,and enhance medical humanistic skills.

Ischemic stroke(IS)remains a predominant contributor to mortality and disability,with current clinical interventions demonstrating suboptimal therapeutic efficacy. Recent studies have shown that circular RNA(circRNA)participates in pathological processes through the competing endogenous RNA(ceRNA)regulatory network,involving key processes such as apoptosis,inflammatory response,angiogenesis,autophagy,oxidative stress,and neuronal regeneration. This study reviews the molecular mechanism and application progress of circRNA regulating IS through the ceRNA network,aiming to provide theoretical support for the in-depth development of circRNA in the diagnosis and treatment strategies of IS and offer guidance for future related research and clinical practice.

Objective To explore the value of amide proton transfer-weighted imaging(APTw) and T2 mapping in assessing microsatellite instability(MSI) in endometrial adenocarcinoma. Methods The patients with clinically suspected endometrial cancer were prospectively enrolled and underwent APTw and T2 mapping before operation.Two radiologists independently outlined the regions of interest and measured the quantitative parameters.The intragroup correlation coefficients were calculated to assess the agreement of MRI parameters measured by the two radiologists.The independent samples t-test and Mann-Whitney U test were conducted to compare quantitative variables between the MSI and microsatellite stability(MSS) groups.The receiver operator characteristic curve was established to evaluate the prediction performance of different parameters.The DeLong test was implemented to compare the area under the curve(AUC) between single parameters and their combination. Results Twenty-one patients in the MSI group and 37 patients in the MSS group were finally enrolled in this study.The results showed excellent agreement between two radiologists in assessing MRI parameters.The MSI group had higher APTw values[(2.72±0.52)% vs.(2.08±0.39)%,P<0.001]and lower T2 values[92.25(90.82,99.91) ms vs.101.80(96.15,112.13) ms,P<0.001]than the MSS group.The receiver operating characteristic curve showed that the AUC of APTw and T2 values were 0.821(95%CI=0.698-0.909) and 0.793(95%CI=0.666-0.888),respectively.No significant difference in diagnostic efficacy was observed between the two sequences(P=0.692).The combination of APTw and T2 mapping yielded the highest AUC of 0.897(95%CI=0.789-0.961),which was higher than that of APTw and T2 mapping alone(P=0.042,P=0.025,respectively). Conclusions APTw and T2 mapping are valuable in assessing the MSI of endometrial adenocarcinoma,and the combination of the two demonstrates higher diagnostic efficacy,thus providing a basis for the selection of preoperative therapeutic modalities for the patients.

Objective To explore the association between dietary chili intake and cognitive function in the elderly population and the modifying effect of body mass index. Methods On the basis of the baseline survey data of the West China Elderly Health Cohort,a cross-sectional design was adopted,and 1 961 older adults aged 60 and above who had completed a dietary survey were included in this study.Multivariate linear regression and multivariate Logistic regression models were used to explore the associations of chili intake with cognitive function score and cognitive decline,respectively.Stratified analysis was performed to explore whether the associations varied among different body mass index groups. Results Among the surveyed older adults,1 119(57.06%) were diagnosed as with cognitive decline by minimum mental state examination.The results of multivariate linear regression analysis showed that after adjusting for possible confounding factors in turn,the score of chili intake had a stable positive correlation with cognitive function score(β=0.086,95%CI=0.010-0.163,P=0.027).Compared with those who did not have chili intake,the following groups had increased cognitive function scores:those with low chili intake(β=0.559,95%CI=0.023-1.096,P=0.041) or moderate chili intake(β=0.641,95%CI=0.075-1.207,P=0.026),those who had chili intake 1-5 days per week(β=0.994,95%CI=0.430-1.558,P=0.001),those who began chili intake over the age of 18(β=0.797,95%CI=0.172-1.422,P=0.013),those who began chili intake at the age of 18 and under(β=0.476,95%CI=0.045-0.907,P=0.031),those had mild chili intake(β=0.471,95%CI=0.047-0.896,P=0.030),and those who had high chili intake(β=0.982,95%CI=0.275-1.689,P=0.007).Logistic regression analysis showed that chili intake 1-5 days per week(OR=0.634,95%CI=0.474-0.849,P=0.002) was associated with a lower risk of cognitive decline than those without chili intake.Stratified analysis showed that the positive association between chili intake and cognitive function was more significant in the group with body mass index ≥24 kg/m²,and the higher score of chili intake corresponded to the lower risk of cognitive decline(OR=0.924,95%CI=0.875-0.975,P=0.004). Conclusions Appropriate chili intake may have a protective effect on cognitive function in the elderly population,especially in the overweight and obese elderly.Prospective studies are needed to further verify the causal relationship.

Non-thyroidal illness syndrome(NTIS)is commonly observed in critically ill patients.Sepsis is one of the leading causes of mortality among patients in intensive care units,where the incidence of NTIS is higher than that in general wards.Recently,increasing attention has been paid to thyroid metabolic abnormalities in sepsis patients.This article reviews the pathogenesis and clinical significance of NTIS in sepsis,aiming to offer evidence-based medical insights for future research directions for clinicians.

Narcolepsy type 1(NT1) is a chronic sleep disorder caused by the specific depletion of hypocretin(HCRT) neurons.The pathogenesis of NT1 involves human leukocyte antigen(HLA)-related genes(most NT1 patients carry the HLA-DQB1*06∶02 allele) and environmental factors.In Europe,there was a notable increase in NT1 cases among children and adolescents following the H1N1 pandemic in 2009 and 2010,particularly associated with the Pandemrix vaccination.Similarly,in China,the surge in NT1 incidence has been linked to H1N1 virus infections.It has been postulated that H1N1 virus infection may be a predisposing factor for NT1 development.In susceptible individuals,the confluence of the immune response triggered by the Pandemrix vaccine and the H1N1 virus infection could instigate autoimmunity against HCRT,leading to the loss of HCRT neurons mediated by T cells.This paper examines the involvement of influenza A H1N1 virus and its vaccines in the pathogenesis of NT1.