Objective To discuss the mode of onset,clinical characteristics,treatment and prognosis of children with granulocyte sarcoma (GS),in order to provide guidance for early diagnosis and effective treatment of GS.Methods Six cases of children with GS diagnosed at the Department of Hematology,Children's Hospital Affiliated to Soochow University between June 2009 and June 2014 were analyzed,the data including the mode of onset,clinical manifestation,diagnosis,treatment and outcome.Results There were 2 cases with a painless mass onset (1 case was 2 years old,characterized by right waist mass,about 10 cm × 5 cm;the other case was 6 years old,characterized by axillary lump,about 2 cm × 3 cm),and both of them received surgical removal of the tumor,then the postoperative tumor was examined by pathologic and immunohistochemical method,and at last the primary granulocyte sarcoma was diagnosed.The third case was a 7 years old girl,she was onset characterized by scalp lump,about 2 cm × 3 cm,and was diagnosed by the pathologic and immunohistochemical method,and changes in hematological system appeared a month later and acute myeloid leukemia(AML) was confirmed by bone marrow examination.The onset ages of other 3 cases were in 10 months,1 year and 7 months,13 years and 3 months old respectively,characterized by scalp lump (about 2 cm × 3 cm),spinal canal tumor (about 1.0 cm × 1.5 cm),intracranial tumors (6.0 cm × 4.9 cm),with AML occurring at the same time,which was confirmed by surgical pathology,immunohistochemistry and bone marrow cell morphology,immune classification,chromosome,and fusion gene diagnosis.Four cases were hematopoietic malignancies by pathology,2 cases of then belonging to small round cell tumor.The immune pathology showed 5 cases of myeloperoxidase positive,CD68-positive,3 cases of CD43-positive,CD123-positive.All children CD3,CD20 levels in all children were negative.Four cases underwent surgery combined with chemotherapy,other 2 cases received surgery and then gave up treatment,1 case discontinued follow-up 3 months later,and the other case died of intracranial hemorrhage after 3 months,which induced by thrombocytopenia.The treated 4 cases were followed up 3 to 58 months,and all had disease-free survival.Conclusions Children with GS have low incidence and non-specific diagnostic criteria,its diagnosis depends on immune pathology,and the treatment is mainly in accordance with AML program for high-dose chemotherapy.The systematic chemotherapy helps to prolong overall survival;at the same time,the hematopoietic stem cell transplantation with bone marrow may help to improve the prognosis.

Innovative education on business venturing at medical colleges and universities is a need of both the time of knowledge economy and the socialization of medicine.Innovative venturing education is a new model to cultiv ate high-caliber medical talents with wide social perspective,profound knowledge,creativity and entrepreneurship.Approaches to implementing such education in the transition of educational model may include enhancing cultural and sociological education,promulgating venturing practices in medical field,establishing favorable at mosphere for innovative venturing education,fostering English language skills in the whole process,emphasizing clinical practices,setting up effective competency assessment system and establishing a high-caliber faculty team.

Objective To study the expression of nitricoxide(NO) and intercellular adhesion molecule-1(ICAM-1) in the animals with hypercholesterolemia and atherosclerosis(AS) in order to investigate the relationship of hypercholesterolemia with AS and vascular endothelium function and ICAM-1. Methods Fed rabbits with high-cholesterol diet to establish the models of hypercholesterolemia and AS,and the control group was fed with normal diet;Blood was collected from vein in 0,8 and 16 weeks in two groups,and the concentrations of TC,LDL,NO and ICAM-1 were measured;The correlation among TC,LDL and NO,ICAM-1 was observed;After 16 weeks,the rabbits were put to death,and immunohistochemistry analysis and RT-PCR were performed to measure the expression of ICAM-1 in the aortas.Results TC and LDL in 8 weeks were higher in the high-cholestrol diet group,but NO and ICAM-1 had no change;NO decreased and ICAM-1 increased in 16 weeks(P

Objective To explore the expression and significance of matrix metalloproteinase (MMP)-9, IV collagen and CD34 in epithelial ovarian tumor. Methods Eighty-two patients with epithelial ovarian tumor, among them,there were 48 malignant epithelial ovarian carcinomas, 23 borderline epithelial ovarian tumors and 11 benign epithelial ovarian tumors. The expression of MMP-9, IV collagen and CD34 were detected by immunohistochemistry. Results The expression of MMP-9 was strongly linked to the degree of malignant ovarian carcinomas (F= 39.306,P< 0.01). The expression of CD34 was also strongly linked to the degree of malignant ovarian carcinomas [benign epithelial ovarian tumors was (17.18±5.64)%,borderline epithelial ovarian tumors was (29.76±7.18)%,well-differentiated malignant epithelial ovarian carcinomas was (57.20±8.55)%,moderately-differentiated malignant epithelial ovarian carcinomas was (71.20±8.48)%, poorly-differentiated malignant epithelial ovarian carcinomas was(90.38±20.03)%](F= 100.072, P < 0.01). The expression of IV collagen in malignant epithelial ovarian carcinomas was different from that in borderline epithelial ovarian tumors and benign epithelial ovarian tumors (F = 11.554,P<0.0l). The expression of MMP-9 was positive correlation with the loss expression of IV collagen and the expression of CD34 (r=0.796,0.802,P< 0.01).Conclusions The positive expression of MMP-9,CD34 and the negative expression of IV collagen are obviously relevant to degree of malignant ovarian carcinomas.The combined testing on expression of MMP-9,CD34, IV collagen on ovarian carcinomas is significant to decide degree of malignant ovarian carcinomas and evaluate future development.

Objective To study the feasibility of in vitro release of γ-interferon tests (IGRA) in screening of tuberculosis for children with close TB contacts. Methods 185 children with close TB contacts were detected by IGRA at the pediatric clinic in our hospital. Results In IGRA-positive group, the rate of strong positive PPD (PDD≥15 mm) was 50.9%, which was higher than 9.1% in IGRA-negative group (X2 =37.263, P < 0.00). The morbidity rate for children with close TB contacts was 30.2% in IGRA-positive group, and it was significantly higher than 3.0% in IGRA-negative group (X2 = 28.928, P < 0.00). The sensitivity was 80% and the specificity was 77.6% for IGRA screening in children who had close contacts with TB patients. The sensitivity would be 95.0%, as the test was combined with PPD test. Conclusions IGRA screening in children with close TB contacts can increase the detection rate of tuberculosis and reduce imaging screening.

OBJECTIVE To investigate the clinical character and risk factor of nosocomial lower respiratory tract(infection)(NLRTI) due to Burkholderia cepacia in intensive care units(ICU) and discuss how to control infection.METHODS The clinical data of 37 cases were reviewed and analyzed,and 43 cases with non-B.cepacia NLRTI served as control group.RESULTS The difference in ICU stay time,mechanical ventilation,bronchoscopy,H_2-receptor blocker/antacid,use of antibiotics≥2 kinds and vein catheter between patients with and without B.cepacia(NLRTI) was statistically significant.CONCLUSIONS ICU stay time,mechanical ventilation,bronchoscopy,(H_2-receptor) blocker/antacid,use of antibiotics≥2 kinds and vein catheter are risk factors of B.cepacia NLRTI.Susceptibility of antibiotics to B.cepacia showed multidrug resistance to which should be paid attention in ICU,respiratory tract invasive operation limitation,medical facility sterilization and rational use of antibiotics are very important.

Objective To evaluate the development of extravascular leakage of 6％ hydroxyethyl starch (HES) 130/0.4 when used for acute hemodilution in the pediatric patients undergoing open heart surgery.Methods Forty-eight American Society of Anesthesiologists physical status Ⅰ or Ⅱ pediatric patients,aged 2-12 yr,weighing 12-53 kg,scheduled for elective surgical repair of ventricular or atrial septal defect,were divided into 2 groups (n =24 each) according to age:preschool group (2 yr ≤ age ≤ 6 yr) and school-age group (6 yr＜age ≤ 12yr).After anesthesia induction and endotracheal intubation,a volume of 6％ HES 130/0.4 equivalent to 10％ of the blood volume was infused via the central veins at 0.5 ml · kg-1 · min-1 in two groups.Immediately before infusion of HES (T0) and at 15 and 30 min after the end of infusion (T1,2),blood samples were collected fron the central vein for determination of plasma colloid osmotic pressure (COP) and hemnoglobin (Hb) concentrations.The concentrations of 6％ HES 130/ 0.4 in plasma at T1 and T2 and in urine at T2 were measured by the anthranone colorimetric method.Results Compared with the baseline value at T0,the concentrations of Hh in plasma were significantly decreased at T1,2 in preschool group,and the concentrations of Hb in plasma were significantly decreased and plasma COP was increased at T1,2 in school-age group (P＜0.05).There were no significant differences in plasma Hb concentrations or COP at each time point between two groups (P＞0.05).The plasma 6％ HES 130/0.4 concentrations were significantly lower at T2 than at T1 in two groups (P＞0.05).Compared with school-age group,the plasma 6％ HES 130/0.4 concentrations were significantly decreased at T1,2 in preschool group (P＜0.05).There was no significant difference in 6％ HES 130/0.4 concentrations in urine between the two groups (P＞0.05).Conclusion When 6％ HES 130/0.4 is used for acute hemodilution,extravascular leakage happens after acute hemodilution and is more obvious in the preschool pediatric patients undergoing open heart surgery.

Objective:To meet the demand of medical system for talents, the training of medical students' competency has become a new direction of medical education. This study aims to evaluate the effectiveness of training quality in medical graduates through the competency scale.Methods:Taking "attitude", "skill" and "knowledge" as the evaluation dimensions, the competency development was divided into four levels of "state", "explain", "apply" and "transfer", and we proposed the competence concept of "A.S.K.-SEAT" and formulated an evaluation scale. Questionnaires and behavior event interviews (BEI) were conducted in medical graduates of Shantou University in 2018. Reliability and validity of the questionnaire were evaluated and current situation of different competency items were analyzed.Results:A total of 155 questionnaires were collected with good reliability and validity, and 15 graduates participated in BEI. A total of 21 A.S.K. competency items (including five basic competency items and two discriminating competency items) and SEAT textual descriptions were finally established.Conclusion:A.S.K.-SEAT scale can provide valid references for the competency evaluation of medical graduates.

Objective:To explore the application of scenario simulation teaching based on PBL in communication skills training of hematology students in Children's Hospital.Methods:The training of doctor-patient communication skills was conducted among trainees who had the standardized residency training at the Department of Hematology of the Children's Hospital of Soochow University. All the residents were randomized into the control group and observation group by lottery, with 24 residents in each group. The control group adopted the traditional narrative teaching method, and the observation group adopted PBL combined with scenario simulation teaching method. The Liverpool communication skills assessment scale (LCSAS) was used to compare the differences between the two groups before and after training, and the differences between the two groups after training. Then the degree of residents' recognition of these two teaching methods was investigated. Finally, the examination results were used to evaluate knowledge mastery of doctors in department of hematology. SPSS 20.0 was used for Chi-square test and t-test. Results:LCSAS scores of the two groups before training were respectively (11.61±2.21) and (11.95±2.22), with no statistically significant difference ( P >0.05). After PBL-based scenario simulation teaching and training in the observation group, the LCSAS score of the observation group (27.41±2.53) was higher than that of the control group (23.30±1.81), and the difference between the two groups was statistically significant ( P<0.05). Questionnaire survey results showed that the favorable rating rate of PBL-based scenario simulation teaching was 91.67% (22/24), higher than that of the traditional narrative teaching method [62.50% (15/24)], and the difference was statistically significant ( P<0.05). The examination of students' mastery of professional knowledge showed that after the PBL-based scenario simulation teaching and training, the trainees had a better grasp of knowledge and a higher score, with excellence rate of 91.67% (22/24）, which was higher than 66.67% (16/24) of the control group, with a statistically significant difference ( P<0.05). Conclusion:The scenario simulation teaching based on PBL could improve the communication ability and professional knowledge of trainees taking standardized residency training in the department of hematology, and the trainees are highly satisfied with this teaching method.

ObjectiveTo investigate the role of chemoradiotherapy in the preoperative radiotherapy for locally advanced head and neck squamous cell carcinoma. MethodsFrom Sep. 2002 to Dec. 2008,totally 157 locally advanced head and neck squamous cell carcinoma (HNSCC) patients was assigned to preoperative concurrent chemoradiotherapy group ( n =81 ) or preoperative radiotherapy alone group ( n =76 ) randomly. The chemotherapy regimen was consisted of cisplatin 30 mg/m2, weekly. The radiotherapy in both groups was identical. The primary lesion will continue concurrent chemoradiotherapy or radiotherapy for those the tumor response was or nearly complete remission (CR) and those who refused surgery when evaluated at DT50 Gy, the others will receive surgery 1 month later if the tumor response was less than CR.For N3 patients, the planed neck dissection will be done. ResultsThe follow up rate was 98. 1％, 91patients followed up more than 5 years, there were 46 in concurrent chemoradiotherapy group and 45 in radiotherapy alone group. The rate of 5-year local control, overall survival, disease free survival and distant metastasis-free survival for preoperative concurrent chemoradiotherapy group and preoperative radiotherapy alone group were 63％ and 50％ ( x2 =0. 40,P =0. 528), 46％ and 38％ ( x2 =0. 48,P =0. 490) ,41％ and 35 ( x2 =0. 29, P =0. 593 ) ,76％ and 65％ ( x2 =3.38, P =0. 066 ) respectively. Subgroup analysis showed that the 2-years distant metastasis-free survival of preoperative concurrent chemoradiotherapy group and preoperative radiotherapy alone group were 88％ and 60％ ( x2 =5.99,P =0. 014). ConclusionsPreoper -ative concurrent chemoraidotherapy with the regimen of cisplatin 30 mg/m2 weekly did not improve the overall survival for locally advanced HNSCCwhen compared with preoperative radiotherapy alone.Preoperative concurrent chemoradiotherapy improved the distant metastasis-free survival of locally advanced hypopharyngeal and laryngeal carcinoma.