Small scale restricted online course (SPOCs)+flipped classroomteaching is expected to become an important complement to the traditional teaching of dermatology. In this teaching mode, first of all knowledge nodes are divided separately according to the syllabus and for each node, 7 to 10 minutes of micro video or micro-lecture is made, which enables students to make best use of fragmented time through the network to master relevant knowledge independently before the trainee. In the flipped classroom, based on the difficulties and misunderstandings of learning reflected from the network monitor data, teacher can make full use of time on demonstrating typical cases, organizing discussion, grouping students to take diag-nostic and therapeutic exercise, answering targeted questions, teaching clinical thinking, experience and doctor-patient communication skills. Through this teaching mode, the new teaching idea can be imple-mented that students are in dominant position while teachers are in leading position, which contributes to deepening the understanding , absorption and application of knowledge and improving students' ability of communication, cooperation, diagnosis and treatment.

Objective: To develop a method for determination of carnitine in serum using HPLC. Methods: The serum proteins were precipitated by acetonitrile and methanol. The organic extract was added derivatizing reagent and the solution was warmed to 60℃ for 2 hours. Atlantis C18 column (4.6 mm?150 mm,5?m)was used as stationary phase and methanol-ispropand-acetonitrile (35∶45∶20,v/v) as mobile phase; flow rate 1.0ml/min, UV wavelengh at 260nm. Results: The typical chromatogram from serum samples showed clear separation of carnitine. Y= 8490X-48200, r= 0.9999. Intra-day RSD was 1.6%-13.2%, and inter-day 1.8%-12.1%. The recovery rate was 98.5%. Conclusion: A method for determination of carnitine in serum using HPLC by adding derivatizing reagent was developed and it is simple, rapid and precise, and can be used for clinical test.

Objective To investigate the effect of rehabilitation on cervical fracture-dislocation following spinal cord injury.Methods126 patients with cervical fracture-dislocation following spinal cord injury from August, 2002 to March, 2009 in our hospital had undergone cervical anterior surgical treatment. 22 cases were picked up as control group, who missed rehabilitation after surgery. 22 cases were chosen randomly from the rest of 104 cases as rehabilitation group, who had undergone rehabilitation. Prognosis was evaluated by Japanese Orthopaedic Association Scores score(JOA).ResultsFollow-up time was 8-32 months，mean time 18 months. The limb function of rehabilitation group improved significantly. JOA score and quality of life were much higher in rehabilitation group than in control group.ConclusionRehabilitation is very beneficial to improve the quality of life and prognosis, and reduce complications of patients with cervical fracture-dislocation following spinal cord injury at the early stage.

Objective To investigate the acid α glucosidase(GAA)gene mutations and clinical features of a Chinese patient exhibiting signs and symptoms of infantile glycogen storage disease type Ⅱ(GSD Ⅱ). Methods Clinical features of the patient were reviewed,and GAA activity in the patient＇s and her parents＇ whole leukocytes were measured. GAA coding regions were amplified by polymerase chain reaction(PCR),and analyzed by direct DNA sequencing. Results The patient showed feeding difficulties,generalized hypotonia and weakness starting at 2 months of age. Cardiomegaly and cardiomyopathy were found at 4 months. She died of cardiorespiratory failure at the age of 6 months. GAA activity in leukocytes was low in the patient(17.3% of the median normal range). Genotyping revealed the patient was a heterozygote for a novel nonsense mutation p.W738X and a previously reported nonsense mutation p.E888X. The reported pseudodeficiency allele c.1726G ＞ A;2065G ＞ Awas found in the patient and her mother. Conclusions Correct diagnosis was made for this patient by combination of GAA activity assay and genetic analysis. From the clinical course,this patient should be classified as infantile type of GSD Ⅱ,suggesting that the novel mutation p.W738X may have a damaging effect on the function of GAA. Pseudodeficiency allele found in this family highlights the importance of genetic analysis of GAA when performing diagnosis and prenatal diagnosis for the affected families,as this allele causes low GAA activity in normal individuals.

OBJECTIVETo investigate the incidence of congenital adrenal hyperplasia (CAH) in Shanghai areas by a neonatal screening program.

METHODSHeel prick blood samples were collected from 50 600 newborns in 50 maternal and child health care hospitals and maternity hospitals 72 hours after their birth and adsorbed onto standard filter paper for determining 17-hydroxyprogesterone (17-OHP) by enzyme linked-immunosorbent assay (ELISA).

RESULTSLevel of 17-OHP was significantly increased in eight cases of the 50 600 newborns, three cases of whom with established CAH with hyponatremia, hyperkalemia and hypertestosteronemia duo to 21-hydroxylase deficiency, and other five cases with high level 17-OHP due to preterm delivery.

CONCLUSIONSDetermining 17-OHP level on dried blood spotted filter paper is a reliable and practical approach for CAH mass screening in neonates. The incidence of CAH in Shanghai areas was 5.93 per 100 000 newborns (3/50 600).

17-alpha-Hydroxyprogesterone ; blood ; Adrenal Hyperplasia, Congenital ; blood ; diagnosis ; epidemiology ; China ; epidemiology ; Enzyme-Linked Immunosorbent Assay ; methods ; Female ; Humans ; Incidence ; Infant, Newborn ; Male ; Neonatal Screening ; methods

Objective: To explore the cardiac function and outcomes in patients of aortic stenosis (AS) after transcatheter aortic valve replacement (TAVR) within 6 months in order to provide the guidance for clinical treatment. Methods: A total of 49 consecutive severe AS patients with surgical contradiction or STS high risk score and received successful TAVR in our hospital from 2013-12 to 2015-12 were studied. Echocardiography and blood levels of NT-proBNP were examined at pre- and 1 month, 6 months after TAVR. Left ventricular ejection fraction (LVEF), aortic valve mean gradient (MG), peak gradient (PG) and peak velocity (PV) were recorded. Based on pre-operative LVEF, the patients were divided into 2 groups: Cardiac dysfunction group, LVEF<50%,n=15 (30.6%) and Normal cardiac function group, LVEF≥50%, n=34 (69.4%). Post-operative cardiac function and blood levels of NT-proBNP were compared between 2 groups. Results: In all 49 patients, the following parameters were significantly improved within 7 days after TAVR: LVEF (56.0±14.6) % vs (52.5±13.8)%, MG (11±5) mmHg vs (58±18) mmHg, PG (21.7±9.5) mmHg vs (93.0±28.6) mmHg, PV (2.3±0.5) m/s vs (4.8±0.7) m/s, blood NT-proBNP level [1831 (1098-3363)] pg/ml vs [3842 (1763-8664)] pg/ml and aortic valve area (1.57±0.43) cm2 vs (0.58±0.23) cm2 allP<0.05. Within 6 months after TAVR, LVEF was continuously increasing especially in Cardiac dysfunction group; MG, PV and NT-proBNP level were continuously decreasing, NYHA grade was continuously improving, allP<0.05. Conclusion: TAVR was an effective treatment in AS patients with surgical contradiction or STS high risk score; it may continuously improve cardiac function, especially in patients with left heart dysfunction.

OBJECTIVETo describe trends of changes in blood lead levels in children aged 1 - 6 years during the time period before and after introducing lead free gasoline in Shanghai 1997 and 1999.

METHODSBlood lead levels of 1 969 children aged 1 - 6 years were determined by a sampling survey in five districts of Shanghai in August and September, 1997. Blood lead levels of the same population were re-determined by the same method from April to June in 1998 and from August to September in 1999. Filter paper blood lead test was carried out monthly using the filter paper blood lead proficiency testing program of Centers for Disease Control in the United States. The results from blood lead samples were under acceptable ranges during the study.

RESULTSThe geometric means of blood lead levels were 83 microgram/L in 1997, 80 microgram/L in 1998 and 76 microgram/L in 1999, respectively. The prevalence rates of childhood lead poisoning (blood lead level was equal or more than 100 microgram/L) were 37.8% in 1997, 25.7% in 1998 and 24.8% in 1999. The amounts of decrease on average blood lead levels in the five districts between 1997 and 1999 were 10 microgram/L, 11 microgram/L, 6 microgram/L, 4 microgram/L and 2 microgram/L, respectively.

CONCLUSIONLead poisoning is a preventable disease. The average levels of lead in young children in Shanghai decreased significantly after the introduction of lead free gasoline to Shanghai. Lead emissions from vehicles running on leaded gasoline was one of the important contributors to increase the children's blood lead levels in Shanghai. Lead poisoning is not evenly distributed among children in Shanghai, resulting in the different levels of decline.

Child, Preschool ; China ; Environmental Monitoring ; methods ; standards ; Environmental Pollutants ; blood ; Gasoline ; standards ; Humans ; Lead ; blood ; Time Factors

OBJECTIVETo investigate the correlation between regulatory T (Treg) cells and postmenopausal osteoporosis and the antiosteoporotic effect of 1,25-dihydroxyvitamin D3 [1,25(OH)₂D₃] in relation to Treg cells.

METHODSFifty female BALB/c mice were randomly divided into five groups: the basal control (BAS), Sham, ovariectomy (OVX), OVX+diethylstilbestrol (OVX+DES), and OVX+1,25(OH)₂D₃. Tibias were harvested and processed with decalcification for quantitative bone histomorphometry. Femurs were stained by immunohistochemistry to detect Foxp3 protein expression. Spleens were used to detect Treg and Foxp3 gene expression by flow cytometry and quantitative RT-PCR, respectively.

RESULTSIn comparison with the Sham group, a significant decrease was found in the OVX group in such indices as trabecular bone volume/total tissue area (BV/TV), trabecular number (Tb.N) and trabecular thickness (Tb.Th). 1,25(OH)₂D₃and DES partly prevented the decrease in BV/TV, Tb.N, Tb.Th in OVX mice. Treg cell number, Foxp3 mRNA expression in spleen and Foxp3 protein expression in femur significantly decreased in the OVX-treated group compared with those in the sham group. 1,25(OH)2D₃and DES significantly increased Treg cell number and Foxp3 expression. Treg cells and Foxp3 gene expression were related to bone histomorphometric parameters.

CONCLUSIONThe decrease in Treg cell numbers is relevant to the postmenopausal osteoporosis. The antiosteoporosis of 1,25(OH)₂D₃is related to regulatory T cells.

Animals ; Bone Density Conservation Agents ; pharmacology ; therapeutic use ; Calcitriol ; pharmacology ; therapeutic use ; Female ; Gene Expression Regulation ; drug effects ; Mice ; Mice, Inbred BALB C ; Osteoporosis ; drug therapy ; Ovariectomy ; T-Lymphocytes, Regulatory ; drug effects