Refresher training is the most important ways of continuing medical education. This paper introduces the training situation of refresher doctors of Children's Hospital of Fudan University by distribution of professional title, education departments and experience in training. We have sum-marized the management mode of refresher doctors from such aspects as the entrance management, pre-job training, authorization to work, strengthening clinical practice to expand knowledge, clinical research training, self-learning ability improvement, strengthening emotional communication, humani-zation management, emotional bonds establishment and creation of a follow-up development environment.

Objective To investigate the remote effects of epidermal growth factor(EGF)and early removal of eschar combined with skin grafting for the treatment of skin lesion produced by mustard gas.Methods A 3-year follow-up survey was condueted in 39 patients with skin lesion produced by mustard gas.The condition of healing was observed and evaluated.Results Good epithelial healing with pigmentation was observed in all the surveyed patients,and only in a few of them showed local recurrence of wound.Itching and paresthesia in the wounded parts were the main complaints.The sequelae remained unpredictable.Conclusion The early use of epidermal growth factor and early removal of eschar followed by skin grafting for the treatment of skin lesion produced by mustard gas may achieve satisfactory therapeutic effect.

Objective To study the morphological changes in peripheral blood cells and bone marrow cells of the patients suffering from mustard gas poisoning and their relationship with the degree of poisoning. Method The peripheral blood cells and marrow cells were examined morphologically after mustard gas poisoning. Results The total WBC count was reduced progressively in 44 patients, among them 10 patients showed granulocytopenia or agranulocytosis. Severe injury to eosinophils was seen also in the early period, and the percentage and absolute value of lymphocytes were significantly lowered too. However, platelets were not significantly influenced. The red cell count and hemoglobin level were elevated because of hemoconcentration. Blood marrow cells showed marked morphological changes. WBC became swollen with appearance of poisonous granules and vacuoles in their cytoplasm. Deformed lymphocytes (LY) could be found in the marrow cells of all the patients, mainly in the form of immature lymphocytes. It was shown that mustard gas produced serious damage to the hematopoitic cells of the bone marrow in the early period. Conclusions The examination of pheripheral blood and bone marrow cells is an important measure to determine the degree of mustard gas poisoning. The decrease in the absolute value of lymophocyte count and the time of its recovery, and degree of inhibition of hematopoiesis are closely related to the degree of mustard gas poisoning.

After the following aspects of information resources digitalization in domestic TCM were described, in-cluding different types and contents of digital information resources, effectively developed ancient book resources, expanded team construction, and strengthened cooperation between departments. Measures were put forward for the digitalization of information resources in domestic TCM according to the existed problems, such as insufficient de-velopment, lack of audiovisual products, and low accessibility of TCM information resources.

Objective To analyze the clinical characteristics and prognosis of 4 rare types of non -Hodgkin lymphoma(NHL)in children,and to discuss the progress in treatment.Methods Clinical data of 1 4 patients with rare types of NHL at Shanghai Children′s Medical Center,Shanghai Jiaotong University School of Medicine between January 2004 and December 201 4 were retrospectively analyzed,and their clinical features,treatment and prognosis were dis-cussed.Results Fourteen cases were reported including 6 subcutaneous panniculitis -like T -cell lymphoma (SPTCL),3 hydroa vacciniforme -like cutaneous lymphoma(HVLL),2 pediatric follicular lymphoma(PFL)and 3 ex-tranodal NK/T -cell lymphoma,and nasal type(ENKTL).Ten patients (71 .4%)primarily presented with skin lesions and underwent a long course of illness before they were finally diagnosed (the median was 1 0 months),71 .4%(1 0 /1 4 cases)of them associated with fever and 50.0%(7 /1 4 cases)with liver and spleen enlargement,and no evidence of central nervous system (CNS)and bone marrow (BM)involvement was observed,while 28.6% patients (4 /1 4 cases) had more than two lines′abnormalities in peripheral blood examination.Since there were no standard treatment guide-lines,most patients received CHOP (Cyclophosphamide +Adriamycin +Vincristine +Prednisone)and /or mature B -cell NHL -like therapy,and 50.0%(7 /1 4 cases)of them received interferon therapy in addition,while 1 patient re-ceived allogeneic hematopoietic stem cell transplantation after recurrence.The complete remission was achieved in 71 .4%(10 /14 cases)of all the patients.Two of them died,3 lost follow -up,and 1 relapsed.The 3 -year overall survi-val and event free survival rates were 0.84 and 0.57,respectively,after a median follow -up of 26 months (range 12 -64 months).Conclusions Pediatric rare types of NHL show atypical clinical manifestation,low incidence of CNS /BMinfil-tration and long course.It is hard to make pathological diagnosis and differentiation.It is also inappropriate to apply the commonly used staging system to these rare types of NHL.No standard treatment has been found by now.SPTCL,HVLL and PFL have relatively good outcomes when treated with mature B -cell NHL -type therapy plus interferon therapy.

Objective:To investigate the effect of pelvic motion in late pregnancy on the outcome of first trimester delivery.Methods:A total of 127 first-borns admitted to the midwifical clinic of Nanjing Maternal and Child Health Hospital from November 1, 2019 to March 10, 2020 were selected as the research objects, and they were divided into the walking group and the pelvic motion group according to the random number table method. In the end, 62 cases were included in the walking group and 65 cases in the pelvic motion group. The walking group did brisk walking in the third trimester. In the pelvic motion group, the motion in the third trimester consisted of the combined pelvic motion involving the two planes of the upright spine and the horizontal spine, and multiple peripelvic joints. The changes of fertility, birth canal and fetus before and after exercise were observed, and the outcomes of childbirth were compared between the two groups.Results:Indicators reflecting productivity: persistence time of "air bike" on the day before delivery was (27.12±7.73) seconds in the pelvic motion group and (20.56±6.60) seconds in the walking group, the difference was statistically significant ( t value was 5.12, P<0.01). The time of contractions after exercise before delivery was (269.38±123.70) seconds in the pelvic motion group and (591.29±201.82) seconds in the walking group, the difference was statistically significant ( t value was 10.89, P<0.01). The indicators reflecting the situation of the maternal birth canal were as follows: "sitting forward flexion level", pelvic motion group was (33.64±5.91) cm, walking group was (29.50±5.28) cm, the difference was statistically significant ( t value was 4.15, P<0.01). The cervical score during regular contractions was 8.01±1.69 in the pelvic motion group and 7.30±1.40 in the walking group, the difference was statistically significant( t value was 2.56, P<0.05). At the beginning of regular contractions, the proportion of fetal "occipital position" was 93.85% (61/65) in the pelvic motion group and 72.58%(45/62) in the walking group, the difference was statistically significant ( χ2 value was 10.41, P<0.01). The "no pain rate after exercise the day before delivery" was 72.31% (47/65) in the pelvic motion group and 29.03% (18/62) in the walking group, the difference was statistically significant ( χ2 value was 25.30, P<0.01). Time of the first labor was (395.84±165.24) min in the pelvic motion group and (574.35±152.23) min in the walking group, the difference was statistically significant ( t value was 6.32, P<0.01). The second stage of labor was (25.98±9.88) min in the pelvic motion group and (33.62±13.94) min in the walking group, the difference was statistically significant ( t value was 3.57, P<0.01). Conclusions:Pelvic motion in middle and late pregnancy can affect labor force, birth canal, fetus and other delivery factors, reduce movement pain and shorten the time of labor.

Objective To investigate the effect of sulforaphane on 1-methyl-4-phenylpyridinium (MPP +)-induced cell viability loss in cultured PC12 cells and to explore the possible mechanism.Methods MPP + induced damage in PC12 cells was prepared as oxidative damage model.Sulforaphane (0.5,1.O,2.5,5.0 and 10.0 μmol/L) was added in each group cell growth medium.Subsequent experiments were divided into 4 groups:(A) normal control group,(B) sulforaphane group,(C) MPP+ injury group,(D)sulforaphane pretreatment + MPP+ injury group.Cell viability was detected by MTT assay,and the sulforaphane pretreatment PC12 cell viability was observed in different concentrations.Flow cytometry was used to detect changes in the rate of apoptosis in different packet PC12 cells,and protein expression levels of nuclear factor erythroid2-related factor 2 (Nrf2),heme oxygenase (HO-1) and human NAD (P) H dehydrogenase,quinone 1 (NQO1) were detected by Western blot when the PC12 cells were incubated with sulforaphane (2.5 μmol/L) and (or) MPP+ (500 μmol/L) for 24 h in vitro.Results Compared to control group (cell survival rate was 98.70％),the survival percents of PC12 cells were significantly decreased in MPP+-treated group (58.16％).A significant difference was showed between group A and C (F =21.83,P ＜ 0.05),and the cell survival rate in group D was significantly improved.Compared to control group,the rate of apoptosis in MPP+ injury group was increased,and the rate of apoptosis after pretreatment of the sulforaphane was significantly reduced.Compared to MPP+ injury group,the levels of Nrf2,HO-1 and NQO1 protein expression were significantly increased in sulforaphane pretreatment group.Conclusion Sulforaphane have a protective effect against MPP+-induced PC12 cell model damage,and the protective effect may be achieved by activating the Nrf2-antioxidant response element pathway.

Objective To assess the diagnostic potential of circulating galactomannan (GM),(1,3)-β-D-glucan (BG), and a combination of both biomarkers among high-risk pediatric patients.Methods Circulating GM antigen was detected by ELISA kits (Platelia~(TM) Aspergillus) and BG antigen by a turbidimetric kinetic method (GKT-5M Set Kinetic Fungus Detection Kit).Positive tests were defined by two consecutive values of GM index ≥0.5 or by a single value ≥0.8, and by BG detection ≥ 10 pg/ml.Results A total of 130 patients were enrolled.Two was identified with proven IFI, twenty probable IFI.Sensitivity, specificity were 81.8%, 82.4% for plasma BG detection, respectively; 75.0%, 94.4% for GM detection, respectively; 50.0%, 96.3% for combined GM and BG detection, respectively.Conclusions Both circulating GM and BG detections are available for most of the common pathogens and demonstrated desirable sensitivity and specificity among pediatric high-risk population.Both assays can be used as prospective screening tools.Combination of detections of both biomarkers would improve specificity for IA diagnosis.

Objectives To evaluate pediatric neck masses with magnetic resonance imaging (MRI). Methods In this retrospective study, 140 children with neck masses underwent MRI were collected from May 2006 to December 2013. Of them 34 cases went through pathological examinations. The results of MRI diagnosis and pathology were compared in 34 cases. Results In 140 children with neck masses diagnosed by MRI, 103 (73.6%) cases were benign lesions, including 62 vascular malformations, 30 hemangiomas, then cysts, hamartoma, infectious lumps etc., 29 (20.7%) were malignant tumors, including 22 lymphomas, 3 rhabdomyosarcomas, 3 Langerhans cell histiocytosis, 1 neuroblastoma, and 8 (5.7%) cases were undeter-mined masses. Four in 103 cases with benign lesions were performed by pathological examination and all had been con-firmed. Tewenty-five in 29 cases with malignant tumors were performed by pathological examination and 22 cases had been confirmed. Conclusion MRI can help to diagnose the pediatric neck masses and to guide the treatment and follow-up.

Purpose　The aim is to sulfonize Hunai polysaccharide fr om p leurotus tuber-rigium(Fr.)Sing. and to evaluate the antioxidative activities of the sulfated po lysaccharide (S-HNP).Methods　S-HNP was prepared by the reacti on of Hunai polysaccharide with chlorosulfonic acid-Pyridine. The antioxidative activities o f S-HNP were evaluated as follows: (1) the inhibition effects on Fe2+- Vc inducing the injury of rat liver mitochondria in vitro, (2) the protectiv e ef fect on CuSO4 -Phen-Vc-H2O2 inducing the damage of DNA, (3) the scaven ging effect on O*-2. Results　 S-HNP could protect mitochondria from lipid peroxidation induced by Fe2+-Vc, i ncluding the inhibitions of the increase of TBARS content, the swelling of mitoc hondria and the decrease of membrane fluidity, and protect DNA from the damage induced by CuSO4-Phen-Vc-H2O2， and scavenge O*-2 generated in the sel f-oxidation of pyrogallic acid. Conclusion　S-HNP exhibi ted marked antioxidative activities.