We use PBL teaching mode in experimental teaching of clinical hematologic laboratory.By this method,the knowledge can be mastered by the students more efficiently and the analyzing ability was also improved.We hope that these experiences can be useful in our country's clinical laboratory teaching.

Objective:To explore the role of matrix metalloproteinase 12 (MMP12) in airway macrophages and pulmonary neu-rogenic substance P ( SP ) in the pathogenesis of asthma by analyzing their relationship in different categories of asthmatic patients.Methods:Twenty patients of asthma remission phase ( remission asthma group ) , twenty ones of mild acute exacerbation asthma (mild asthma group) and twenty healthy adults (normal control group) were included,respectively.After lung function was measured,the numbers of macrophage in induced sputum were counted.The expression levels of MMP12 mRNA and protein in sputum macrophages were detected by quantitative reverse transcription polymerase chain reaction and Western blot.The concentration of sputum SP was assayed by enzyme immunometric assay.Results: ( 1 ) Compared with the subjects in normal control group, forced expiratory volume in 1 second%predicted ( FEV1 ) and forced expiratory flow rates at 50% of the forced vital capacity % predicted ( FEF50 ) were much lower and the numbers of sputum macrophages were much higher in the patients in different asthmatic groups.Compared with the patients in remission asthma group,FEV1 and FEF50 were much lower in the ones in mild asthma group.(2) MMP12 expressions in the macrophages and the concentrations of SP in sputum were significantly increased in the patients in different asthmatic groups compared with those in normal control group;Furthermore,MMP12 and SP in mild asthma group were much higher than in remission asthma.(3) In all patients from different asthmatic groups,mRNA expressions of MMP12 in the macrophages were positively correlated with the levels of sputum SP or the numbers of sputum macrophages,whereas negative correlations between mRNA expressions of MMP 12 and FEV 1 or FEF50 were observed.Conclusion: The regulatory imbalance of macrophages′MMP12 and pulmonary neurogic SP may participate in the pathogenesis of asthma and become the potential targets for asthma therapy.

Purpose To discuss the clinical value of applying tissue motion tracking of mitral annular displacement (TMAD) technique to evaluate left ventricular global systolic function in patients with coronary heart disease. Materials and Methods Sixty patients with coronary heart disease who had at least one coronary stenosis ≥70% confirmed by coronary angiography were selected, and 35 healthy volunteer were enrolled as the control group. Three to five sequential two-dimensional dynamic images of cardiac cycle of four-chamber, three-chamber, and two-chamber apex cordis were collected and stored, and Qlab 7.0 software was used for off-line analysis. Maximal systolic displacement (Ds) of mitral annulus in six sites, systolic displacement of the middle point (D-mid) and left ventricular longitudinal fractional shortening (FSL) were measured and calculated for mean value respectively, which were then used for correlation analysis with left ventricular ejection fraction (LVEF) measured by simplified dual plane Simpson. Results ①Compared with control group, the mean value of Ds, D-mid and FSL of group A and B were significantly decreased, the difference of which was statistically significant (P<0.05). Compared with group A, the mitral annulus displacement parameters of group B decreased, the difference of which was statistically significant (P<0.05). ②Compared the time used for the two measuring methods: TMAD technology significantly reduced the measuring time compared to the two-dimensional dual plane Simpson's method (P<0.001). ③The mean values of Ds, D-mid and FSL in the control and coronary heart disease groups were all correlated with LVEF (r=0.77, 0.75, 0.78, P<0.001; r=0.78, 0.79, 0.78, P<0.001). ④Repeatability test: the intra-observer ICC values of the mean values of Ds, D-mid and FSL were 0.87, 0.85 and 0.93 respectively, and the inter-observer ICC values were 0.84, 0.84 and 0.88 respectively. Conclusion TMAD technology is time-saving, accurate and reproducible, which can be used to evaluate left ventricular systolic function in patients with coronary heart disease.

Objective:To observe the clinical characteristics and therapeutic effect of reactivation of retinopathy of prematurity (ROP) patients after intravitreal injection of ranibizumab (IVR).Methods:A retrospective case series study. Eleven children with ROP (21 eyes) who were reactivated after IVR in Shenzhen Eye Hospital from January 2019 to October 2021 were included in the study. Among them, there were 6 males (11 eyes) and 5 females (10 eyes), with the gestational age of (27.6±2.2) weeks and birth weight of (1 034.6±306.5) g. At the first IVR treatment, 14 eyes (63.7%, 14/22) had acute ROP (AROP), 8 eyes (36.3%, 8/22) had threshold lesions. Post-reactivation treatments include IVR, retinal laser photocoagulation (LP), or minimally invasive vitrectomy (MIVS). The follow-up time after treatment was 12 to 18 months. Birth gestational age, birth weight, treatment method, corrected gestational age at treatment, lesion stage before and after treatment, lesion reactivation and regression time were recorded. The clinical characteristics and efficacy were observed and analyzed.Results:The time from initial IVR treatment to reactivation was (8.2±3.5) weeks. The corrected gestational age of the child was (43.62±4.08) weeks. In 21 eyes, AROP, threshold lesion, prethreshold lesion, and stage 4 lesion were in 2, 4, 12, and 3 eyes, respectively. The patients were treated with IVR, LP, IVR+LP, IVR+MIVS in 2, 13, 4 and 2 eyes, respectively. After the first reactivation treatment, the time of regression and stability was (8.4±4.9) weeks after treatment. There were 5 eyes with secondary reactivation of the lesion, and the lesion stages were stage 3, stage 4a and stage 5 in 2, 1 and 2 eyes, respectively. The mean reactivation time was (19.3±6.0) weeks after the last treatment. The patients in stage 3, stage 4a and stage 5 were treated with LP, LP+MIVS and IVR, respecitively, and the lesions subsided steadily during follow-up. At the last follow-up, 19 out of 21 eyes showed complete regression of the lesions, stable photocoagulation, regression of crista-like lesions, no additional lesions, and retinal leveling. All retinal detachment was "funnel-shaped" in 2 eyes.Conclusions:The lesion reactivation of AROP after IVR treatment is more common. The early reactivation rate is higher after treatment. There is a possibility of reactivation twice after re-treatment.

Ovarian Leydig cell tumor(LCT), also known as ovarian testicular stromal cell tumor, is a rare sex cord stromal tumor, accounting for about 0.1% of all ovarian tumors. LCT is often accompanied by clinical manifestations of elevated androgen, and the imaging manifestations sometimes lack specificity. The diagnosis requires histopathological examination. Surgery is the primary treatment method, and postoperative prognosis is generally favorable. This paper retrospectively analyzes the diagnosis and treatment of a patient with LCT in our hospital combining relevant literature, explore the clinical characteristics, diagnosis, and treatment progress of LCT, aiming to improve disease management.

Objective To investigate the clinical manifestations, diagnosis, and treatment of H1N1 influenza A‐associated encephalopathy (IAE) in children. Methods The clinical manifestations, laboratory tests, cranial magnetic resonance imaging (MRI), electroencephalography (EEG) examinations and treatments of seven children with H1N1 IAE hospitalized in Guangzhou Women and Children′s Medical Center from December 2018 to January 2019 were retrospectively analyzed. Results Five of the seven children with H1N1 IAE were female. The age at admission was 4 years and 5 months (range 7 months-9 years). Neurological symptoms occurred simultaneously or early (0-3 days) after the flu‐like symptom appeared. The main clinical manifestations of neurological symptoms were seizures (repeated seizures in five cases and status convulsion in two cases, including one case of unexpected fever and repeated seizures in a nine‐year old girl) accompanied with altered consciousness (drowsiness in five cases and coma in two cases). Cranial MRI in three cases displayed multifocal lesions, mainly in the bilateral thalamus, brainstem and cerebellar hemisphere. MRI also showed reversible splenial lesion in the corpus callusumin in three cases. EEG tracings were characterized by diffuse slow wave activity in four cases, and status epilepticus was monitored in one case. All the 7 cases were treated with oral oseltamivir. Three cases were treated with pulsed methylprednisolone and intravenous immunoglobulin. One case was treated with intravenous immunoglobulin alone and all the patients received oral oseltamivir. All the patients survived, with three patients had minor neurological sequelae at discharge. Conclusions The main clinical manifestations of H1N1 IAE are seizures and altered consciousness. Cranial MRI combined with EEG is helpful for early diagnosis. Intravenous immunoglobulin and (or) methylprednisolone should be considered for severe cases.

Objective To explore the clinical features and risk factors of preoperative anemia in patients with gastric cancer.Methods The clinical data of 218gastric cancer patients who received gastric cancer surgery in the Second Affiliated Hospital of Nanjing Medical University from January 2015 to December 2018 were retrospectively analyzed.Patients were divided into the anemia group(n = 84)and non-anemia group(n =134)based on hemoglobin levels.The gender,age,hypertension,diabetes,body mass index(BMI),carcinoembryonic antigen(CEA),cancer antigen 199(CA199),cancer antigen 724(CA724),tumor location,tumor size,clinical stage and lymph node metastasis were collected.The Logistic regression analysis was performed to analyze the risk factors of preoperative anemia in patients with gastric cancer.Results Among 218 patients with gastric cancer,the incidence of preoperative anemia was 38.53%,including 51 cases(60.7%)of mild anemia and 50 cases(59.5%)of normocytic anemia.There were no statistically signifi-cant differences in BMI,hypertension,diabetes,CEA,CA199,CA724,tumor location,and lymph node metastasis between the two groups(P>0.05),while there were statistically significant differences in the terms of gender,age,tumor size,and clinical stage be-tween the two groups(P<0.05).Multivariate Logistic regression analysis showed that gender(P = 0.002),age(P = 0.023),tumor size(P =0.001),and clinical stage(P =0.003)were independent risk factors for preoperative anemia in patients with gastric cancer.Conclusion Gender,age,tumor size and clinical stage are independent risk factors for preoperative anemia in patients with gastric canc-er,which is helpful for clinicians to take some intervention strategies for patients.

Objective To observe the value of transesophageal echocardiography(TEE)for guiding left atrial appendage closure(LAAC)with LAmbre occluder.Methods Data of 40 non-valvular atrial fibrillation(NVAF)patients who underwent LA AC with LAmbre occluder were retrospectively analyzed.CT angiography(CTA)before treatment,TEE and digital subtraction angiography(DSA)findings during LAAC were comparatively observed,and the correlations of the anchor area diameter and left atrial appendage opening diameter measured with the above three as well as occluder size were analyzed,and TEE and DSA for evaluating peri-device leak(PDL)were compared.Results LAAC were successfully performed with LAmbre occlude in all 40 cases.The diameter of the fixed umbrella was positively correlated with anchor area diameter measured with CTA,TEE and DSA(r=0.79,0.82,0.91,all P＜0.01),of occlusion umbrella was positively correlated with left atrial appendage opening diameter measured with CTA,TEE and DSA(r=0.56,0.89,0.86,all P＜0.01).Immediately after the release of occluder in LAAC,PDL occurred in 16 cases and were detected with both TEE and DSA,while in the rest 24 cases no PDL was found with neither TEE nor DSA.Conclusion TEE had comparable value to DSA for guiding LAAC using LAmbre occluder.

Objective To explore the relation between neurologic function recovery and neurogenesis in subventricular zone (SVZ) and perinfarct area after bone marrow stromal cells (BMSCs) transplantation in stroke rats.Methods BMSCs were harvested from rats by density gradient centfifugation and adherent culture methods,and identified by flow cytometry.Middle cerebral artery occlusion (MCAO) rat models were established by electric coagulation method.They were randomly devided into control group and transplantation group (n=12).The rats in the transplantation group were injected by tail vein with BMSCs (5×106 cells/μL) labeled with Hoechst 33342.Rats in the control group were injected with 1 mL of serum free DMEM/F12.The functional recovery of rats in two groups was evaluated by using beam walking test before transplanation and 1 week and 2 weeks after BMSCs transplanation.The survival and distributions of transplated BMSCs in the subventricular zone (SVZ) and in peri-infarct area were observed by fluorescence microscope.Ki67 expression in SVZ and peri-infarct area was determined by immunohistochemisty.Results Scores of beam walking test in transplantation group (median are 5 and 7 one and two weeks after transplantations,respectively) were significantly higher than thoses in control group (median are 3 and 5,respectively,P＜0.05).One week and two weeks after transplantations,Hoechst positive cells were found in the peri-infarct area of rats in transplantation group (7.78±1.19 cell/field and 8.15±0.90 cell/field,respectively); the number of Ki-67 positive cells in the peri-infarct area and SVZ of rats in transplantation group (15.01.19±1.58 cell/field and 13.26±1.10cell/field; 42.57±3.1 1 cell/field and 39.70±1.87 cell/field) was significantly increased as compared with those in the control group (6.29±0.83 cell/field and 6.21±0.75 cell/field; 23.22± 1.08 cell/field and 21.82±1.78 cell/field,P＜0.05).Conclusions Neurogenesis in SVZ and perinfarct region of after bone marrow stromal cell transplantation infarct rats is closely related with the motor functional recovery of infarct rats.

Objective:To explore the effect of demographic sociological data on the critical thinking of clinical research nurses, in order to provide reference for improving the level of clinical research.Methods:Using the convenient sampling method, a total of 110 clinical research nurses responsible for clinical research related work in three ClassⅢ Grade A hospitals in Zhengzhou City of Henan Province from January to June 2021 were selected as the research objects. Demographic Sociological Data Questionnaire and Critical Thinking Disposition Inventory-Chinese Version (CTDI-CV) were used to conduct surveys among nurses. Multiple linear regression was used to analyze the effect of demographic sociological data on critical thinking of clinical research nurses. A total of 110 questionnaires were distributed, and 106 valid questionnaires were recovered. The effective recovery rate of the questionnaires was 96.36% (106/110) .Results:The total score of CTDI-CV of 106 nurses was (296.25±24.12) . The results of multiple linear regression analysis showed that age, education, professional title and working years were the influencing factors of the level of critical thinking of clinical research nurses ( P<0.05) . Conclusions:The critical thinking ability of clinical research nurses is affected by age, professional title, educational background and working years. It is suggested to take effective measures to improve the critical thinking ability of nurses according to the actual situation, and then improve the clinical research level of nurses.