简介：摘要目的探讨产前筛查的孕妇是否必要选择扩展性无创产前检测(expanded non-invasive prenatal testing, NIPT-plus)。方法对比分析50例孕妇NIPT和NIPT-plus检测的测序数据量、胎儿游离DNA浓度、产前诊断结果和妊娠结局等。结果NIPT-plus与NIPT相比，胎儿游离DNA浓度相近，测序数据量提高了4.4倍。NIPT能够检测出NIPT-plus提示的4例21-三体、2例18-三体和9例性染色体非整倍体(sex chromosome aneuploidies，SCAs)高风险，漏检1例-18三体，无法检测出罕见染色体非整倍体(rare chromosome aneuploidies，RCAs)和染色体微缺失/重复综合征(microdeletion/microduplication syndrome，MMS)。NIPT-plus对21-三体、18-三体、SCAs、MMS和RCAs的PPVs分别为100%、100%、44.4%、30.4%和0%。NIPT对21-三体、18-三体和SCAs的阳性预测值分别为100%、100%和44.4%。结论孕妇有必要选择NIPT-plus，以提高常见的染色体三体、SCAs和MMS的检出率，降低出生缺陷率。

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简介：摘要目的提高对骨髓单克隆浆细胞比例小于10%的新诊断多发性骨髓瘤（NDMM）患者的认识。方法回顾性总结2009年1月至2017年12月北京协和医院36例骨髓浆细胞比例小于10%的NDMM患者的临床特点、实验室检查、治疗反应和预后情况，选择同期诊断的72例骨髓浆细胞比例≥10%的NDMM患者作为对照组，两组患者年龄和性别匹配。结果①在818例NDMM患者中，骨髓浆细胞比例小于10%的患者36例（4.4%），其中国际分期系统（ISS）Ⅲ期11例（30.6%），显著低于对照组患者[45例（62.5%）]（P=0.002）。与对照组相比，骨髓浆细胞比例小于10%的患者合并髓外病变比例更高（33.3%对5.6%，P<0.001），血清M蛋白中位值更低[1.04（0~50.10）g/L对4.50（0~63.10）g/L，P=0.016]，24 h尿轻链定量中位值更低（510 mg对2800 mg，P=0.023）。②骨髓浆细胞比例小于10%患者与对照组患者一线治疗后中位无进展生存（PFS）时间分别为26.4个月和19.9个月（HR=1.703，95%CI 0.167~0.233，P=0.002），总生存（OS）时间分别为65.8个月和46.2个月（HR=2.626，95%CI 0.439~0.541，P=0.058）。③按照M蛋白水平将研究组分为低肿瘤负荷组和高肿瘤负荷组，中位OS时间分别为66.4个月和24.0个月（HR=2.349，95%CI 0.603~0.696，P=0.046），中位PFS时间分别为33.1个月和15.5个月（HR=1.806，95%CI 0.121~0.399，P=0.077）。硼替佐米治疗对患者的生存结局无影响。结论骨髓浆细胞比例小于10%的NDMM患者疾病分期较早，肿瘤负荷较低，尽管合并髓外病变比例更高，一线疗效以及总体预后优于骨髓浆细胞比例≥10%的患者。

简介：摘要目的提高对骨髓单克隆浆细胞比例小于10%的新诊断多发性骨髓瘤（NDMM）患者的认识。方法回顾性总结2009年1月至2017年12月北京协和医院36例骨髓浆细胞比例小于10%的NDMM患者的临床特点、实验室检查、治疗反应和预后情况，选择同期诊断的72例骨髓浆细胞比例≥10%的NDMM患者作为对照组，两组患者年龄和性别匹配。结果①在818例NDMM患者中，骨髓浆细胞比例小于10%的患者36例（4.4%），其中国际分期系统（ISS）Ⅲ期11例（30.6%），显著低于对照组患者[45例（62.5%）]（P=0.002）。与对照组相比，骨髓浆细胞比例小于10%的患者合并髓外病变比例更高（33.3%对5.6%，P<0.001），血清M蛋白中位值更低[1.04（0~50.10）g/L对4.50（0~63.10）g/L，P=0.016]，24 h尿轻链定量中位值更低（510 mg对2800 mg，P=0.023）。②骨髓浆细胞比例小于10%患者与对照组患者一线治疗后中位无进展生存（PFS）时间分别为26.4个月和19.9个月（HR=1.703，95%CI 0.167~0.233，P=0.002），总生存（OS）时间分别为65.8个月和46.2个月（HR=2.626，95%CI 0.439~0.541，P=0.058）。③按照M蛋白水平将研究组分为低肿瘤负荷组和高肿瘤负荷组，中位OS时间分别为66.4个月和24.0个月（HR=2.349，95%CI 0.603~0.696，P=0.046），中位PFS时间分别为33.1个月和15.5个月（HR=1.806，95%CI 0.121~0.399，P=0.077）。硼替佐米治疗对患者的生存结局无影响。结论骨髓浆细胞比例小于10%的NDMM患者疾病分期较早，肿瘤负荷较低，尽管合并髓外病变比例更高，一线疗效以及总体预后优于骨髓浆细胞比例≥10%的患者。

简介：你能想象一亿有多大吗?我们先来看看1亿张A4纸摞起来有多高吧。怎么测量呢？难道真的要数1亿张4纸来吗？我先化繁为简、选取部分、找出与1亿之间的关系，然后开始测量、进行计算。于是我先测出100张A4纸厚约1厘米，再算1000张厚约: 1×100=100厘米，再求1亿张摞起来高约：100x10000=1000000厘米，也就是10000米。1万米又是多高呢？我想到了珠穆朗玛峰的海拔高度是8844.43米，那么，1亿张A4纸的高度比珠峰还要高1000多米呢！

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简介：摘要：在一个班级中，总会有那么几个学生，他们或学习态度差，成绩不理想，或思想表现欠佳，经常违规违纪……我们谓之“问题学生”。

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简介：摘要：作为一名小学教师，每天参与孩子们天真可爱，无忧无虑的童年成长中，细细品来有发自内心底处的自豪和满足！我在很多年前一个偶然的机会看到这样一个标语：爱自己的孩子是母亲，爱别人的孩子是圣人！渐渐的对教师这个职业越来越喜欢，在外人的高评价和称呼中也越来越觉得当一名老师的价值性！不自觉的去要求自我更要努力工作，才不会愧对每一个孩子。平时接触最多的就是自己所教班级的学生，日日在课堂中看得到他们熟悉的脸庞，他们也是日复一日地看到我熟悉的身影和讲课的声音，几乎没有什么机会去了解其他班级的学生，更不用说其他年级的学生了。

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简介：AbstractThe crude case fatality rate (CFR), because of the calculation method, is the most accurate when the pandemic is over since there is a possibility of the delay between disease onset and outcomes. Adjusted crude CFR measures can better explain the pandemic situation by improving the CFR estimation. However, no study has thoroughly investigated the COVID-19 adjusted CFR of the South Asian Association For Regional Cooperation (SAARC) countries. This study estimated both survival interval and underreporting adjusted CFR of COVID-19 for these countries. Moreover, we assessed the crude CFR between genders and across age groups and observed the CFR changes due to the imposition of fees on COVID-19 tests in Bangladesh. Using the daily records up to October 9, we implemented a statistical method to remove the delay between disease onset and outcome bias, and due to asymptomatic or mild symptomatic cases, reporting rates lower than 50% (95% CI: 10%-50%) bias in crude CFR. We found that Afghanistan had the highest CFR, followed by Pakistan, India, Bangladesh, Nepal, Maldives, and Sri Lanka. Our estimated crude CFR varied from 3.708% to 0.290%, survival interval adjusted CFR varied from 3.767% to 0.296% and further underreporting adjusted CFR varied from 1.096% to 0.083%. Furthermore, the crude CFRs for men were significantly higher than that of women in Afghanistan (4.034% vs. 2.992%) and Bangladesh (1.739% vs. 1.337%) whereas the opposite was observed in Maldives (0.284% vs. 0.390%), Nepal (0.006% vs. 0.007%), and Pakistan (2.057% vs. 2.080%). Besides, older age groups had higher risks of death. Moreover, crude CFR increased from 1.261% to 1.572% after imposing the COVID-19 test fees in Bangladesh. Therefore, the authorities of countries with higher CFR should be looking for strategic counsel from the countries with lower CFR to equip themselves with the necessary knowledge to combat the pandemic. Moreover, caution is needed to report the CFR.

简介：摘要：2020年COVID-19疫情平息将近两个月后，北京新发地农产品批发市场再次突发疫情。北京市政府及疾控中心充分学习总结防治新冠病毒经验后，处理疫情更加从容有序，不到一个月时间迅速有效控制病毒蔓延。

简介：AbstractBackground:Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread throughout the world. In this study, we aimed to identify the risk factors for severe COVID-19 to improve treatment guidelines.Methods:A multicenter, cross-sectional study was conducted on 313 patients hospitalized with COVID-19. Patients were classified into two groups based on disease severity (nonsevere and severe) according to initial clinical presentation. Laboratory test results and epidemiological and clinical characteristics were analyzed using descriptive statistics. Univariate and multivariate logistic regression models were used to detect potential risk factors associated with severe COVID-19.Results:A total of 289 patients (197 nonsevere and 92 severe cases) with a median age of 45.0 (33.0, 61.0) years were included in this study, and 53.3% (154/289) were male. Fever (192/286, 67.1%) and cough (170/289, 58.8%) were commonly observed, followed by sore throat (49/289, 17.0%). Multivariate logistic regression analysis suggested that patients who were aged ≥ 65 years (OR: 2.725, 95% confidence interval [CI]: 1.317-5.636; P = 0.007), were male (OR: 1.878, 95% CI: 1.002-3.520, P = 0.049), had comorbid diabetes (OR: 3.314, 95% CI: 1.126-9.758, P = 0.030), cough (OR: 3.427, 95% CI: 1.752-6.706, P < 0.001), and/or diarrhea (OR: 2.629, 95% CI: 1.109-6.231, P = 0.028) on admission had a higher risk of severe disease. Moreover, stratification analysis indicated that male patients with diabetes were more likely to have severe COVID-19 (71.4% vs. 28.6%, χ2 = 8.183, P = 0.004).Conclusions:The clinical characteristics of those with severe and nonsevere COVID-19 were significantly different. The elderly, male patients with COVID-19, diabetes, and presenting with cough and/or diarrhea on admission may require close monitoring to prevent deterioration.

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简介：摘要：《3-6岁儿童学习与发展指南》中提出：“喜欢听故事，看图书”，“激发幼儿的阅读兴趣，培养阅读习惯”。 阅读是一种基本学习的能力,是基础教育的重要内容。作为早期阅读教育实现的主要途径——早期阅读教学,在培养幼儿的阅读兴趣、习惯、能力等方面起着至关重要的作用。本文旨在了解幼儿园早期阅读教学的现状，发现存在的问题,并有针对性地提出培养阅读能力的发展策略。

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