Objective To evaluate the effect of case-based learning combined with standardized patients in probation of nuclear radionuclide therapy.Methods 360 interns were randomly assigned separately into CBL+SP group and LBL group (180 people),case based on SP as the center of clinical teaching mode was used for CBL+SP group,while traditional classroom teaching mode was used for LBL group.Theoretical test,case analysis and teaching satisfaction survey were used to evaluate the two teaching mode,using SPSS 20.0 software for statistical analysis of the data.t test was used for two independent samples of both theoretical test and case analysis and chi-square test was used for teaching satisfaction survey.Results The score of theory and case analysis of CBL+SP group was higher than that of LBL group,and the difference had statistical significance [(83.26 ± 4.18) vs.(80.36 ± 3.62),t=-7.041,P=0.000;(85.79 ± 4.15) vs.(81.26 ± 3.96),t=-10.844,P=0.000].Satisfaction survey showed that satisfaction degree of CBL+SP group in stimulating and training the correct clinical thinking,grasping the information skills and cultivating their ability to analyze and solve the problem was higher than that of LBL group,and the difference had statistical significance (x2=40.319,x2=33.620,x2=23.493,x2=23.283;P=0.000).Conclusion Case-based learning combined with standardized patients in probation of nuclear radionuclide therapy can obtain satisfactory teaching effort.

OBJECTIVETo explore the value of magnetic resonance enterography (MRE) for diagnosis of small intestinal diseases in children.

METHODA total of 92 children who received MRE from July 2009 to January 2014 were included into this study. The clinical value of MRE in children was evaluated by describing the image presentation of MRE based on clinical diagnosis.

RESULTAll the 92 cases (average age was nine year and one month, among whom 61 were boys, and 31 were girls) received MRE examination with good tolerance and had no complications. Eleven cases (12%) did not show good distension of small bowel loop during MRE and could not evaluate the bowel wall pathologies correctly. A total of 66 cases (72%) showed pathological MRE images. All patients with Crohn's disease showed pathological gut and 53% (16/30) showed extramural changes with MRE, 97% (29/30) showed colon lesions with colonoscopy, 73% (20/22) showed small intestine lesions with capsule endoscopy. All patients with intestinal obstruction (7 cases) showed abnormal gut distension, 4 of whom showed obstruction point. Five patients with small intestinal neoplasms showed the mass with MRE. One of the patients with intestinal tuberculosis showed enlarged lymph nodes with ring strengthening. Nine cases with eosinophilic gastroenteritis (75%) and 1 case of gastrointestinal bleeding showed increased contrast enhancement for small bowel. The main finding of MRE were abnormal wall thickening and enhancement, gut stricture, bowel expansion, etc.

CONCLUSIONMRE for children was safe and reliable. It can be a suitable method for determining the location and extent of gut for small intestinal diseases, especially suitable for Crohn's disease in children.

Capsule Endoscopy ; Child ; Colonoscopy ; Crohn Disease ; diagnosis ; Enteritis ; diagnosis ; Eosinophilia ; diagnosis ; Female ; Gastritis ; diagnosis ; Gastrointestinal Hemorrhage ; diagnosis ; Humans ; Intestinal Obstruction ; diagnosis ; Intestine, Small ; physiopathology ; Magnetic Resonance Imaging ; Male

Objective To study the expressions and the clinicopathologic significance of Ezrin and PTEN protein in intrahepatic cholangiocarcinoma.Methods The ICC tissues (the ICC group) and the corresponding para-carcinoma tissues (the control group) were collected from 50 patients with intrahepatic cholangiocarcinoma (IHC) to detect the expressions of Ezrin and PTEN protein by using SP immunohistochemistry (IHC).The clinicopathologic parameters were analyzed.Results The positive expression rates of Ezrin were 78.0％ (39/50) and 46.0％ (23/50) in the ICC group and the control group,respectively.The difference in expression between the two groups was statistically significance (P＜0.05).The expression of Ezrin in the ICC group was highly related to tumor size,differentiation grade,TNM stage,and lymphatic metastasis (P＜0.05),but it was not related to age,gender,serum CA19-9 level,hepatitis B virus infection,intrahepatic duct calculus (P＞0.05).The positive expression rates of PTEN was 46.0％ (23/50) and 88.0％ (44/50) in the ICC group and the control group,respectively.The difference in expression between the two groups was statistically significance (P＜0.05).The expression of PTEN in the ICC group was highly related to differentiation grade,TNM stage,and lymphatic metastasis (P＜0.05),but it was not related to age,gender,serum CA19-9 level,hepatitis B virus infection,tumor size,intrahepatic duct calculus (P＞0.05).There was a negative correlation between the expression of Ezrin and PTEN protein in ICC (r=-0.382,P＜0.01).Conclusion The abnormal and negative correlation between the expression of Ezrin and PTEN protein in ICC may play an important role in invasion and metastasis of ICC.

Medical quality and safety are the foundation for the high-quality development of public hospitals.The concept of Multi-disciplinary Treatment(MDT)is of great value for functional departments of hospitals to collaborate in carrying out medi-cal quality management practices.Children's Hospital,Zhejiang University School of Medicine explored a new quality manage-ment model,constructed the MDT practice path for medical quality in administration,and formed a closed-loop management process where clinical departments actively initiate consultations,various administrative functional departments collaborate and in-teract in a two-way manner,accurately identify and solve clinical problems,and continuously track and feedback outcomes.After the inception of this path,the overall level of medical quality and safety in the hospital has been comprehensively improved,mainly manifested in the enhancement of quality control capabilities of clinical departments,optimization of core performance e-valuation indicators,and remarkable improvement in patient satisfaction,thereby holding profound significance for high-quality development of the hospital.

Objective: To explore the clinical features and complications of foreign bodies in the upper gastrointestinal tract in children and to investigate the effectiveness of endoscopic management. Methods: Data of patients with foreign bodies in upper gastrointestinal tract were collected retrospectively at Endoscopy Center, the Children's Hospital, Zhejiang University School of Medicine, from January 2011 to December 2016. Clinical characteristics, the types of foreign bodies, the location and duration of foreign body impaction were summarized. The risk factors of complications and endoscopic removal failure were analyzed by using Logistic regression analysis. Results: A total of 1 334 patients (825 males and 509 females) were enrolled. The median age was 2.5 years, with a range from 0.25 to 15 years and peak age 1-3 years. Twenty patients had esophageal diseases. The most common foreign body ingested was coin (n=964, 72.3%). Foreign bodies were most commonly located in the esophagus (n=1 002, 75.1%), especially in the upper esophagus (n=857, 85.5%). The duration of foreign body impaction ranged from 3 hours to 5 years. Among 1 334 patients, 252 patients (18.9%) developed complications, including ulcers (n=101, 40.0%) and perforations(n=13, 5.2%). The success rate of endoscopic removal was 96.6% (n=1 288). By Logistic regression analysis, sharp foreign body ingestion (OR=6.893, 95%CI: 4.421-10.746) , esophageal impaction (OR=5.253, 95%CI:3.352-8.233) and foreign body impaction longer than 24 hours (OR=4.336, 95%CI:3.091-6.082) were risk factors of complications. Sharp foreign body ingestion was the risk factor of endoscopic failure (OR=5.372, 95%CI:2.773-10.406) . Conclusions Coin is the most common foreign body in upper gastrointestinal tract. Sharp foreign bodies impacted in the esophagus over 24 hours increase the risk of complications. Endoscopic removal of foreign bodies from the upper gastrointestinal tract in children has a high success rate. Sharp foreign body ingestion increases the risk of failure in endoscopic removing.

The performance appraisal of tertiary public hospitals is key to their high-quality development. Since 2019, Children′s Hospital of Zhejiang University School of Medicine has taken the following measures to leverage performance appraisal. Namely promoting medical technology innovation to enhance the diagnosis and treatment capabilities of difficult and critical diseases; Reasonably setting a target system, improving the performance appraisal mechanism of the hospital; Improving operational efficiency, enhancing the sense of gain by children patients; Building a high-quality talent pool, promoting sustainable development, and effectively promoting high-quality development of hospitals. These measures can provide reference for promoting the high-quality development of hospitals.

Objective:To investigate the differences of gastric mucosa microbiota between children with chronic gastritis and duodenal ulcer under the condition of Helicobacter pylori (Hp) infection. Methods:This prospective cohort study involved 57 children with Hp infection diagnosed by gastric endoscopy who were admitted to the Children′s Hospital of Zhejiang University School of Medicine due to "abdominal pain, abdominal distension and vomiting" between January 2018 to August 2018. According to gastroscopy and pathological examination, the children were divided into chronic gastritis group and duodenal ulcer group. Gastric mucosa from Hp infected patients were sampled, and the flora DNA was analyzed by high-throughput sequencing. The statistical difference of α diversity, β diversity between two groups were analyzed. The relative abundance of the two groups in each taxonomic level was analyzed statistically. T test, Rank sum test or χ 2 test was used for comparison between the two groups. Results:A total of 57 children diagnosed with Hp infection were enrolled in this study, including 42 cases of chronic gastritis (the age was (9.3±2.8) years, 22 males and 20 females) and 15 cases of duodenal ulcer (the age was (11.1±3.3) years, 9 males and 6 females). Alpha diversity index Chao and ACE in Hp infected chronic gastritis group were significantly higher than those in Hp infected duodenal ulcer group (217±50 vs. 183±64, t=2.088, P=0.009;218±47 vs. 192±76, t=1.566, P=0.016, respectively). The Beta-diversity index such as nonmetric multidimensional scaling (NMDS) analysis were significantly different in the two groups (analysis of similarity R=0.304, P=0.028). Among the main bacteria genera, there were 6 genera with significant differences between the two groups, which were Prevotella (0.190% (0.008%-1.983%) vs. 0.021% (0.005%-2.398%), Z=-2.537, P=0.011), Alloprevotella (0.097% (0.010%-0.813%) vs. 0.015% (0.003%-0.576%), Z=-2.492, P=0.013), Haemophilus (0.109% (0.004%-0.985%) vs. 0.014% (0.004%-0.356%), Z=-2.900, P=0.004), Neisseria (0.074% (0.004%-0.999%) vs. 0.024% (0.003%-0.255%), Z=-2.718, P=0.007), Streptococcus (0.166% (0.008%-1.869%) vs. 0.045% (0.006%-0.879%), Z=-2.537, P=0.010), and an unclassified- Microbacteriaceae (0.214% (0.060%-1.762%) vs. 0.117% (0.010%-0.954%), Z=-2.120, P=0.034). Linear discriminant analysis (LDA) effect sized analysis showed that at the genus level, only Prevotella was significantly enriched in the duodenal ulcer group (LDA=2.90, P=0.010), while Streptococcus, Neisseria and Haemophilus were significantly enriched in the chronic gastritis group (LDA=2.83, 2.82, 2.69, P=0.011, 0.007, 0.004, respectively). Conclusions:The gastric mucosal microbiota in duodenal ulcer associated with Hp is significantly different from that in chronic gastritis. Hp may promote the occurrence of peptic ulcer together with gastric microbiota.