Objective To investigate the feedback of eight-year program students to problem-based learning ( PBL ),and find out the existing problems and solutions.MethodsThe questionnaire survey was made in the eight-year program students.ResultsApplication of PBL could achieve good feedback.It helped to enhance the self-directed learning,expressing ability,accessing resource skill,and team spirit.ConclusionAlthough there are some problems in the practice of PBL,PBL is a good teaching method in eight-year program education.

Objective To investigate the relationship between wheezing and serum levels of 25-hydroxyvitamin D3.Methods 130 children with lower respiratory tract infection were selected as the subjects, the children with wheezing in group A([Abstract] Objective To investigate the relationship between wheezing and serum levels of 25-hydroxyvitamin D3.Methods 130 children with lower respiratory tract infection were selected as the subjects, the children with wheezing in group A(n=70),normal pneumonia (no wheezing) were group B(n=60); The healthy children who were examined in the hospital at the same period were selected as the control group (n=60). The serum levels of 25-hydroxyvitamin D3 were measured by ELISA in the control and hospitalized children. The pathogens and allergens of the two groups were also detected. Results The levels of serum 25-hydroxyvitamin D3 in group A and group B were (56.92±16.88) nmol/L, (70.68±21.96) nmol/L, respectively, which was significantly lower than that in control group (82.69±17.63) nmol/L, ( t=8.50, 3.30,P=0.00,0.00); compared with group A( t=3.85, P=0.00). The positive rate of group A was 65.71%, which was significantly higher than that of group B (35.00%, χ2=12.20,P=0.00). The positive rate of group A was 30.00% compared with the control group (35.00%, χ2=0.36,P=0.54). The serum level of 25-hydroxyvitamin D3 was 75.57% in group A, which was significantly higher than that in group B (60.00%,χ2=14.21, P=0.00). The positive rate of virus detection was 57.14% in 98 children with serum 25-hydroxy vitamin D3 level<75 nmol/L, which was significantly higher than that in serum 25-hydroxy vitamin D3 level≥75 nmol/L(18.75%, χ2=14.25, P=0.00). The positive rate of allergens in serum 25-hydroxy vitamin D3 level <75 nmol/L was 35.71%, which was significantly higher than that in serum 25-hydroxy vitamin D3 level≥75 nmol/L(21.88%, χ2=2.11, P=0.14). Conclusion The main risk factor for children with wheezing is viral infection, while the low level of serum 25-hydroxy vitamin D3 in children increases the risk of viral infection, resulting in increased risk of wheezing in patients,so the clinical can occur through the detection of serum 25- hydroxyvitamin D3 levels to predict and intervention for children with wheezing.

Objective To determine the feasibility and the optimal dose reduction of AIDR 3D on piglet chest CT which can provide image quality (IQ) comparable to filtered back projection (FBP).Methods Twenty-nine normal pigs with the weight of 3-12kg underwent 640-slice MDCT chest CT (Aquilion one,Toshiba) for 5 times with 80 kvp and various mAs.SureExposure3D technique were used and the index of noise were set to SD 10.0,12.5,15.0,17.5,20.0(Group A,B,C,D,E) to reduce dose successively.Group A were reconstructed with FBP,Group B,C,D,E were reconstructed using AIDR 3D (strong level).Quantitative image noise and signal to noise ratio(SNR) were measured in each group.Two radiologists graded subject image quality on both lung images (artifacts,central airway,lung tissue) and mediastinal images (mediastinal structure) and overall image quality using a 5-point scale in a blinded manner.Analysis of variance (ANOVA) and LSD test were used for comparisons of objective evaluation indices (CT value,noise,SNR)and radiation dose(CTDIvo1,DLP,ED) among the five groups.The Friedman test and Wilcoxon test were used for comparisons of demographic data and for detection of differences in subjective evaluation of IQ among groups.A receiver-operating characteristic (ROC) analysis was performed to establish a radiation reduction threshold up to which comparable IQ(score≥4) was maintained.Results Compared with Group A[noise(15.25 ± 3.14)HU,SNR 3.23 ± 1.07],Group B,C had significant lower noise and higher SNR [noise (12.11 ± 2.75),(13.18 ± 3.16)HU; SNR 4.13 ± 1.38,3.80 ± 1.20;F =7.38,3.11,P ＜0.05].Group D,E showed no significantly different noise and SNR with Group A[noise (15.14±4.51),(15.79 ±4.17)HU;SNR 3.40± 1.56,3.45 ± 1.70;P＞0.05].Group B,C had significant better subject image quality compared with Group A (P ＜0.01).Group D had no significantly different subject image quality compared with Group A (P ＞ 0.05).Group E had 5 pigs with overall image scores of ＜ 3.The ROC curve of IQ established SD 17.5 (Group D) as optimal cut-off point (AUC 0.75,95％ CI 0.58-0.92).Group D provided equivalent subjective image score and objective IQ measurements compared with FBP images in Group A.The ED of group D was 59％ lower than that of group A[CTDIvol (1.14±0.27) mGy vs (0.47 ±0.16)mGy,F=183.83,P＜0.01].Conclusion Using AIDR 3D technique,80 kvp with SureExposure3D (SD 17.5) can provide comparable IQ compared with routine dose with FBP reconstruction,and reduce 59％ dose in piglet model.

Objective:To analyze the trend relevant factors leading to death and their patterns over a 10-year period in inpatients with connective tissue diseases (CTDs).Methods:All clinical data about death in inpatients with CTDs were retrospectively reviewed between 2005 and 2014 at the Department of Rheumatology and Immunology in Xiangya Hospital of Central South University.Results:In the 10-year time period,the overall hospital mortality was 15.689‰.The disease itself accounted for 44.71% of the total causes of death,infection accounted for 42.94%,and comorbidities accounted for 12.35%.The constituent ratio of deaths and the average hospital mortality caused by the disease itself declined gradually year by year,and the constituent ratio of deaths caused by infection and comorbidities increased gradually year by year (P<0.05).In 2013-2014,infection was the leading cause of death,which accounted for 51.06%.The survival time for CTDs inpatients with interstitial lung disease (ILD) was shorter than that of CTDs inpatients without ILD,and even the risk of death was 1.722 times of the latter.The proportion of deaths caused by the disease itself was the highest in systemic sclerosis and systemic lupus erythematosus,that by infection was the highest in idiopathic inflammatory myopathy (IIM),and that by comorbidities was the highest in rheumatoid arthritis.Conclusion:The proportion of deaths and the hospital mortality in CTDs inpatients caused by the disease itself show a declining trend,while the proportion of deaths caused by infection and comorbidities increase.CTDs patients with ILD have shorter survival time and an increase in risk of death.

Objective:To investigate the effect of endometrial thickness(EMT) on the clinical outcome of blastocyst hormone replacement freeze-thawed embryo transfer (HRT-FET) on the first progesterone day, and to analyze the threshold and optimal thickness interval corresponding to ideal clinical pregnancy rate by statistical method.Methods:The endometrial preparation protocols of 2 825 blastocyst HRT-FET cycles from January 2013 to December 2016 in Henan Provincial People′s Hospital and the Second Hospital of Hebei Medical University were studied retrospectively. According to EMT on the first progesterone day, they were divided into 5 subgroups: group Q1(EMT: 3.5-7.9 mm), group Q2(EMT: 8.0-8.9 mm), group Q3(EMT: 9.0-9.5 mm), group Q4(EMT: 9.6-10.7 mm), group Q5(EMT: 10.8-21.0 mm). Univariate analysis, classification multivariate Logistic regression analysis, curve fitting and threshold effect analysis were used to investigate the effect of endometrial thickness on clinical outcome of blastocyst HRT-FET.Results:Group Q1 was set as the control group in classification multivariate Logistic regression analysis, after adjusting for confounding factors, the clinical pregnancy rate and live birth rate in other groups were higher than the control group. The clinical pregnancy rate and live birth rate in group Q3 and Q4 were significantly increased and the differences were statistically significant(all P<0.05). The cut-off value of the endometrial thickness was 9.6 mm. When endometrial thickness was less than 9.6 mm, with 1 mm increase of endometrial thickness, the clinical pregnancy rate increased by 23%( OR=1.23, 95% CI=1.11-1.36) and the live birth rate increased by 21%( OR=1.21, 95% CI=1.10-1.33). When the endometrial thickness was thicker than the threshold, the clinical pregnancy rate did not increase significantly( OR=0.92, 95% CI=0.84-1.02), and the live birth rate showed a downward trend( OR=0.88, 95% CI=0.81-0.96). Conclusions:In the blastocyst HRT-FET cycle, endometrial thickness showes a curvilinear relationship with clinical outcome. The optimal endometrial thickness range for ideal clinical outcome is 9.0-11.0 mm.

Rheumatic diseases are a kind of chronic inflammatory diseases mainly involving joints and surrounding tissues. Most patients with rheumatic diseases need long-term treatment, which is difficult to be avoided during pregnancy. Treatment efficacy, as well as maternal and fetal safety should be taken into account in the medical decision. Based on the domestic and foreign guidelines, consensus, diagnosis and treatment experience, Chinese Rheumatology Association developed the standardization of medication use in patients with rheumatic diseases preparing and during pregnancy, aiming on the application and precautions of commonly used medicines for rheumatic diseases in preparing pregnancy, pregnancy and lactation.