Problem-based learning (PBL) teaching method combined with formative evalua-tion was used in the teaching practice of pediatrics education. This method was implemented by four phases: courses designing, group-preparing, problems-organizing and teaching practice. The method was evaluated by students' feedback and survey results of patients, teachers and teaching councilors. It was showed that the teaching effects of PBL combined with formative evaluation was better than tra-ditional teaching method in pediatrics teaching.

Objective To establish a chemiluminecentdetection method ( CLIA ) of HCV IgG antibody for the detection of HCV infection and therefore lay a foundation for the research and development of testing kit.Methods Based upon the indirect ELISA method, the microwell plate was coated with HCV-NS3 and HCV-Core antigen expressed through gene engineering, and the anti-human IgG antibody was labeled with horse radish peroxidase.In this way, the chemiluminesent detection method of HCV IgG antibody was established.Meanwhile, the serum specimen of randomly selected 198 patients infected with HCV from No.302 Hospital of PLA and 222 blood donors, and the results were compared.Results The HCV-IgG antibody, a positive consistent rate of 99.0%( 196/198 ) , a negative consistent rate of 98.2%(218/222), and a total consistent rate of 98.6%(414/420) were found through testing 420 serum specimen with self-made agent and contrast agent.One HCV positive serum was repetitively tested with the self-made agent for 10 times, and a coefficient of variation ( CV) of less than 10% was found.Conclusion The chemiluminescent detection method of HCV IgG antibody is initially established, and the method, with an outstanding specificity and sensitivity, is applicable for screening blood donors, clinically detecting HCV infection as well as epidemiological survey.

AIM: To observe the change of subunit of NADPH oxidation enzyme complex nox - 1 protein in cardiocyte hypoxia - reoxygenation injury and the role of cardiotrophin -1.METHODS: Cardiomyocytes from the hearts of 1 -3 d old neonatal rats were prepared by a modified method. Five groups were included in the study: control; hypoxia/ reoxygenation; hypoxia/reoxygenation + CT - 1; CT - 1 + hypoxia/reoxygenation + LY294002 (PIK3/Akt inhibitor) ; CT -1 + hypoxia/reoxygenation + PD98059 (ERK inhibitor) ; CT - 1 + hypoxia/reoxygenation + DMSO. The concentration of CT -1 was 10 μg/L. The survival rate of myocytes was evaluated by MTS method. Apoptosis, mitochondrial permeability transition pore ( △ψm) and reactive oxygen species ( ROS) were detected by flow cytometry. Nox - 1 protein was determined by Western blotting. RESULTS: Apoptosis of cardiomyocytes and the level of ROS (19.7% ±1.4% vs 2.1% ± 0.5% , 14.07% ± 1.25% vs 3.54% ± 0.86% , P < 0.05 ) increased markedly after hypoxia/reoxygenation, but cardio-myocyte survival rate and the level of△ψm (40.55% ±4.25% vs 86.28% ±7.15% , P <0.01) decreased significantly. The expression of nox - 1 protein was upregulated markedly. With CT - 1 intervention, cardiomyocyte survival rate increased markedly, apoptosis, both ROS and expression of nox - 1 protein reduced significantly. The level of△ψm increased obviously. The effect of CT - 1 was inhibited by LY294002.No significant effect was observed on cells survival in DMSO group, which confirmed that LY294002 was specifically involved in blocking the protective effect of CT - 1.CONCLUSION : The expression of subunit of NADPH oxidation enzyme complex nox - 1 protein is upregulated markedly in cardiocyte hypoxia - reoxygenation injury.CT - 1 protects cardiac cells against hypoxia - reoxygenation injury by downregulating the expression of nox -1 protein to decrease the level of ROS.

Objective To study the effect of Cardiotrophin-1 (CT-1) on cardiocyte hypoxia-reoxygenation injury,and to investigate the signaling pathways involved in the protective effect. Method This study was carried out in Key Lab of Molecular Medicine in Jiangxi Province. Cardiomyocytes from the hearts of 2-day-old Sprague-Dawley neonatal rats were prepared by a modified method. Five groups were included in the study. Group (ⅰ): control, Group (ⅱ): hypoxia/reoxygeuation, Group (ⅲ): hypoxia / reoxygenation + CT-1, Group (iv) : CT- 1 + hypoxia/ reoxygenation + LY294002 (PIK3/Akt inhibitor), Group (ⅴ): CT-1 + hypoxia / reoxygenation +DMSO. The concentration of CT-1 was 10 ng/mL. Myocytes survival rote was evaluated by MTS method, apopto-sis, mitochondrial permeability transition pore (△ψm) and reactive oxygen species(ROS) were detected by flow cy-tometer, phosphorylased GSK-3β and PI3K protein by western blotting. Analysis of variance and q test as statistical methods was used to analyze the data. Results Cardiomyocyte apoptosis and ROS increased markedly after hy-poxia/reoxygenation,but cardiomyocyte survival rate and the level of △ψm [(40.55±4.25) vs. (86.28±7.15), P < 0.01]decreased significantly. With CT-1 intervention, cardiomyocyte survival rate increased markedly (87%),apoptosis and ROS reduced significantly. The level of △ψm increased, the level of phosphorylased GSK-3β and phosphorylased PI3K protein obviously increased. The effect of CT-1 was inhibited by LY294002, but no significant effect was observed on ceils survival in DMSO group, which confirmed that LY294002 specifically in-volved blocking the protective effect of CT-1. Conclusions CT-1 can protect cardiac cells against hypoxia- reoxy-genation injury, these effects are dependent upon its ability to activate the PI3K/GSK-3β pathway.

Objective: To explore the correlation of monocyte to HDL-C ratio (MHR) and post-operative slow lfow or no relfow in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI). Methods: A total of 216 STEMI patients treated in our hospital from 2014-10 to 2016-05 were enrolled. The patients were divided into 2 groups: Slow lfow or no relfow group, the patients with TIMI grade≤2,n=43 and Normal lfow group, n=173. Receiver operating characteristic (ROC) curve was performed to assess the best cut-off value for MHR predicting slow lfow or no relfow with its sensitivity and speciifcity; Logistic regression analysis was conducted to studied weather MHR could be used as an independent risk factor for coronary slow lfow or no relfow in STEMI patients after PCI. Results: Compared with Normal lfow group, Slow lfow or no relfow group had the higher MHR (18.6±9.8) vs (10.9±5.5), P<0.001. Univariate Regression analysis indicated that MHR was a risk factor of slow lfow or no relfow occurrence (OR=2.22, 95% CI 1.58-3.28); multivariate regression analysis presented that MHR was an independent risk factor of slow lfow or no relfow occurrence (OR=1.55, 95% CI 1.01-2.38). ROC curve showed that the best cut-off value for MHR predicting slow lfow or no relfow occurrence was 13.37 with the sensitivity and speciifcity at 67.4% and 70.5% respectively, the area under curve (AUC) was 0.734, 95% CI 0.646-0.822. Conclusion: MHR was an independent risk factor for slow lfow or no relfow occurrence in STEMI patients after PCI.

Objective To investigate the urinary iodine level and thyroid function during different trimesters of pregnancy in Hangzhou residents and to provide evidence for monitoring iodine nutrition or screening thyroid function. Methods The urinary iodine level and thyroid function of 395 subjects from 5 hospitals in Hanzhou were investigated. The urinary iodine level was measured by arsenic-cerium contact process method. The serum TSH, FT3 and FT4 were measured by chemiluminescence method. Results (1) The urinary iodine median concentration during pregnancy in the 1st, 2nd and 3rd trimesters were 170.3, 170.2, 162.4 μ/L respectively, all significantly lower than that of non-pregnant women (251.9 μg/L, all P < 0.05); (2) The mean value of TSH during the 1st trimester of pregnancy was significantly lower than that of non-preguant women (P < 0.05). The mean values of FT4 and FT3 in the 2nd and the 3rd trimesters of pregnancy were significantly lower than those of the control (P < 0.05); (3) During 2nd trimester, there were 8.7% (9/104, in FT4) and 9.6% (10/104, in FT3) pregnant women below normal lower range while during 3rd trimester, these figures reached 22.7% (22/97) and 17.5% (17/97) resfectively. Conclusions More than half of the pregnant women in Hangzhou have good nutritional status of iodine. There are significant differences in thyroid hormone levels between the non-pregnant and pregnant women as well as between gestation periods. Therefore, it is necessary to establish a trimester-specific reference range of thyroid hormones for normal pregnancy. The screening for thyroid function is recommended for pregnant women besides monitoring routine urinary iodine.

Objective To review the clinical characteristics of H1N1 influenza A, and suggest the clinical practices for the diagnosis and treatment of H1N1 influenza A in the future. Methods Thirty-three cases of H1N1 influenza A hospitalized in Beijing Ditan Hospital from May 15 to June 22, 2009 were studied and the clinical data were statistically analyzed with SPSS 11.0 for Windows. Results Twenty-five of the 33 patients had a history of travelling in America, Canada, Japan etc within a week; the latent period was between 1 and 6 days in 12 close contact patients. The main symptoms of H1N1 influenza A are fever (66.7%), dry cough (60.6%), cough with sputum (42.4%) and sore throat (36.4%). The laboratory tests in 24 cases(72.7%) were normal, while mild abnormal results were found in the remaining patients.All of the 33 cases were discharged according to the Standard of Diagnosis and Treatment of H1N1 Influenza A published by The Minister of Health, China. The period between 2-consecutive negative results in viral nucleic acid RT-PCR detection and the presenting symptom was 2 to 16 days and the period of hospitalization was 3 to 16 days. Conclusion The new type of H1N1 influenza A is characterised by mild symptoms, short period of hospitalization and good prognosis. All the patients can be cured, if they do not suffer from other severe chronic disease.

OBJECTIVETo study the root canal curvatures of adolescents' maxillary first premolars in Guangdong province and the differences between male and female were studied.

METHODS200 maxillary first premolars among adolescents in Guangdong Province (100 males and 100 females) were numbered in proper. After access preparation, a K-file was inserted into the canal until the tip of the file was just seen at the apical foramen. Then standardized periapical images were taken from mesial-distal and buccal-lingual directions with radio visio graphy. The angle of canal curvature (CCA) was determined according to the method described by Schneider. Then the curved canals whose angle were more than 5 degrees were chosen, and the canal access angle (CAA), curvature height (X) and curvature distance (Y) were determined according to the method described by Günday. Linear correlations of the measurements were analyzed.

RESULTS59.21% of the total roots were curved in buccal-lingual directions. The incidence rates of males' and females' were 49.74% and 68.98%, respectively. 41.05% of the total roots were curved in mesial-distal directions. The incidence rates of males' and females' were 36.27% and 45.99%, respectively. 6.84% of the total roots were S-shaped curves. 4.15% and 9.63% of canals from male and female were S-shaped curves, respectively. The curvatures of single root canals between male and female had statistical differences in buccal-lingual directions (P<0.05). The curvatures of the lingual root canals from females in buccal-lingual directions and mesial-distal directions was higher than males' (P<0.05). The Y of buccal root canals in buccal-lingual directions and mesial-distal directions and the CCA of lingual root canals in buccal-lingual directions between male and female had statistical differences (P<0.05). The CAA of curved buccal canals and curved palatal canals from female and female had positive correlation with CCA and X (P<0.01), while negative correlation with Y (P<0.05).

CONCLUSIONThere are curved root canals in buccal-lingual and mesial-distal directions in the maxillary first premolars, and some curved root canals were S-shaped. The curved canals incidence rate of females was higher than males.

Objective:To explore the effects of external diaphragm electrical stimulation on the diaphragm thickness and function in mechanically ventilated children.Methods:A randomized controlled trial was conducted in children who were admitted to PICU at Children′s Hospital of Fudan University and received mechanical ventilation between June 2021 and April 2022.The control group was given the routine treatment of mechanical ventilation, and the intervention group was given external diaphragm electrical stimulation in the early stage of mechanical ventilation in addition to routine treatment.Diaphragm thickness was continuously measured by bedside ultrasound every day for one week after mechanical ventilation, and the changing trend of diaphragm thickness was observed, and the diaphragmatic thickening fraction (DTf) and the incidence of ventilator-induced diaphragmtic dysfunction(VIDD) were calculated at the same time.Results:A total of 32 valid samples were included, including 15 cases in intervention group (10 males) and 17 cases in control group (11 males). The median age of the patients was 33 (10, 77) months, and the median duration of mechanical ventilation was 12 (8, 21) days.The reasons for mechanical ventilation in children included respiratory insufficiency in ten cases, brain dysfunction in ten cases, heart failure in eight cases, and postoperative surgery in four cases.The diaphragm end-expiratory thickness (DTe) in intervention group and the control group showed a gradually decreasing trend from the 1st day to the 7th day.The left thickness was reduced by 11% on the 7th day compared to 1st day in intervention group, which was reduced by 18% in control group; the average daily DTe was reduced by 2% per day in intervention group and by 3% per day in control group.The trends on the right and left were similar.The DTe thickness in the intervention group was greater than that in control group, among which, the mean DTe thickness in the left side of the intervention group on the 7th day was (0.110 7±0.023 7)cm, which was greater than that in control group (0.093 5±0.016 9)cm, and the difference was statistically significant ( t=-2.372, P<0.05); On the second day, the mean DTe thickness on the right side in the intervention group was (0.1267±0.0277) cm, which was greater than that in control group (0.104 7±0.018 1)cm, and the difference was statistically significant ( t=-2.688, P<0.05). DTf in the intervention group was lower than that in control group at 7th day, but the difference was not statistically significant(left DTf: adjusted mean difference was -0.117, P=0.088; right DTf: adjusted mean difference was -0.065, P=0.277). The incidence of VIDD in the intervention group was lower than that in control group(33.3% vs.41.2%), but the difference was not statistically significant ( χ2=0.005, P=0.946). Conclusion:External diaphragmatic electrical stimulation may be helpful for alleviating diaphragmatic atrophy in mechanically ventilated children.However, whether the improvement of diaphragm atrophy is beneficial to clinical outcome still needs further study.

Objective:To learn about the iodine nutritional status of pregnant women in Suqian City, Jiangsu Province, and to provide evidence for scientific supplementation of iodine of pregnant women.Methods:From May 2016 to July 2020, five sampling districts were divided in each county (district) of Suqian City according to the oriation of east, west, south, north and center each year. One township (street) was selected from each district, and 20 pregnant women who lived in the local area for more than half a year were selected from each township (street). The 30 g of household salt samples of pregnant women and 5 ml of urine samples at random once were collected to test the salt iodine and urinary iodine content.Results:A total of 2 483 household salt samples of pregnant women were tested, and the median salt iodine was 23.9 mg/kg; among them, 2 454 were iodized salt, and the coverage rate of iodized salt was 98.8%; the qualified iodized salt was 2 383, the qualified rate of iodized salt was 97.1%, and the consumption rate of qualified iodized salt was 96.0%. There were statistically significant differences in coverage rate of iodized salt, qualified rate of iodized salt and consumption rate of qualified iodized salt between different years (χ 2 = 10.55, 13.23, 11.37, P < 0.05). A total of 2 483 urine samples of pregnant women were tested, and the median urinary iodine was 167.6 μg/L, which was at the appropriate iodine level. However, the median urinary iodine of pregnant women in 2020 was 146.7 μg/L, lower than the WHO/UNICEF/ICCIDD recommendation standard (150 μg/L). The differences of median urinary iodine of pregnant women in different years, pregnancy periods and regions were statistically significant ( H = 26.08, 8.17, 19.87, P < 0.05). Conclusions:The coverage rate of iodized salt, qualified rate of iodized salt and consumption rate of qualified iodized salt in Suqian City , meet the national standard for eliminating iodine deficiency disorders. Iodine nutrition of pregnant women in Suqian City is at an appropriate iodine level, but some pregnant women may have iodine deficiency.