There were some limitations existed in current teaching mode of diagnostics,including simple evaluation methods,mechanical internship for body sign,tedious internship for laboratory diagnosis and unsustainable interest-stimulating.Interest teaching was proposed in the teaching reform and some concert measures were implemented including interesting inquiry,interesting skill examination,interesting teaching of laboratory diagnostics,simulated case discussion,interesting training of centesis as well as interesting clinical involvement and interesting medical community activities.The interesting teaching contributed to the improvement of students'comprehensive analysis ability,practical ability,adaptability,humanistic quality,English communication ability and doctor-patient communication,which is of grate importance.

Under the diagnosis-related groups(DRG) prospective payment system, innovative health technologies with high costs and risks may be limited to some extent. How to balance the increase of health care cost and the development of innovative health technology is a difficult problem to be solved in the current reform. By studying the relatively mature payment systems of innovative health technologies in the world, the authors found that countries generally adopted additional payment or compensation to encourage the development of new technologies. But at the same time, a relatively perfect health technology assessment and payment management mechanism had been established to ensure the standardized operation of payment plan. These international advanced experience and practice could provide references for China′s innovative health technology payment strategy under the DRG payment system. It is suggested to establish a scientific and reasonable assessment mechanism of innovative health technology, create a special access channel for innovative health technology with limited short-term evidence, and gradually form a long-term incentive mechanism of innovative health technology in DRG payment system.

Objective:To explore the imaging rate and diagnostic rate of positioning the fetal conus medullaris by three-dimensional ultrasound method to detect atlantoaxial intervertebral space, comparing it with the traditional two-dimensional and three-dimensional ultrasound methods.Methods:Consecutively 318 singleton fetuses received routine ultrasound screening during the second trimester were enrolled from November 2017 to December 2018 in Shenzhen Luohu People′s Hospital and Shenzhen People′s Hospital. These fetuses included 276 normal cases and 42 abnormal cases. The abnormal group contained 11 cases tethered cords fetuses(tethered cords group) and 31 cases non-tethered fetuses(non-tethered group). A new ultrasound method named detecting atlanto-axial intervertebral space with three-dimensional ultrasound and traditional two-dimensional and three-dimensional ultrasound methods were used to acquire and store the images. The positions of the fetal conus medullaris were analyzed blindly and recorded by three experienced physicians using three different methods with off-line software.Results:①The χ 2 test comparing multiple sample rates was used to compare the imaging acquisition success rate of fetal conus medullaris by three ultrasound methods. The test level was adjusted to be α′=0.05/4=0.0125, the results showed that there were no statistically significant differences between the three methods in the normal group (χ 2=7.39, P=0.025) and the abnormal group (χ 2=5.32, P=0.070). ②The χ 2 test comparing multiple sample rates was used to compare the diagnostic accuracy of fetal conus medullaris position in normal group by three methods, it showed there was no significant difference in the correct rate of conus medullaris position in the normal group (χ 2=2.52, P=0.284). ③The χ 2 test comparing multiple sample rates was used to compare the diagnostic accuracy of the fetal conus medullaris in tethered cord group and non-tethered group using 3 methods, the difference was not statistically significant in tethered cord group (χ 2=1.22, P=0.543), while the difference was statistically significant in non-tethered group(χ 2=9.69, P=0.008). Conclusions:The method of detecting atlanto-axial intervertebral space with three-dimensional ultrasound has a high imaging rate and diagnostic accuracy in positioning the fetal conus medullaris. Positioning of fetal conus medullaris by detecting atlanto-axial intervertebral space with three-dimensional ultrasound is better than traditional two-dimensional and three-dimensional ultrasound in the abnormal non-tethered fetuses, which can provide more valuable information for prenatal diagnosis consultation and prenatal and postnatal care.

OBJECTIVE： To study the chemical constituents of n-Butanol part from the roots of Camellia oleifera， and to provide reference for elucidating the pharmacodynamic substance basis of it’s anti-tumor effect. METHODS： The ethanol extracts were obtained by using 95％ ethanol as extraction solvent to extract the roots of C. oleifera， and the n-Butanol part was obatined after the extracts were extratced with ethyl acetate and water-saturated n-butanol solution in turn. The chemical constituents of n-butanol part were isolated and purified by D101 macroporous resin column， silica gel， atmospheric pressure reversed phase column chromatography， sephadex gel SephadexLH-20 column chromatogram and preparative HPLC. The structure of the compounds was identified by spectroscopic analysis of physicochemical constants， electrospray ionization mass spectrometry， 1H-NMR and 13C-NMR. RESULTS： Eight compounds were isolated from the roots of C. oleifera and elucidated as quercetin 3′ -O-β-D-glucoside （compound 1）， apigenin-7-O-β-D-glucoside （compound 2）， （+）-lyoniresinol-3α-O-β-D-glucopyranoside （compound 3）， rubusoside （compound 4）， dulcoside B （compound 5）， 4-hydroxy-3-methoxyphenol 1-O-β-D-[6-O-（4-hydroxy-3，5-dimethoxylbenzoate）-glucopyranoside （compound 6）， 3，4，5-trimethoxyphenyl-6-O- syringoyl-β-D-glucopyranoside （compound 7）， gordonoside P （compound 8）.  CONCLUSIONS： Compounds 1-8 were isolated from this plant for the first time. This not only enriches the chemical constituents of this genus， but also provides a reference for elucidating the anti-tumor bioactive substances in this part.

AIM: To evaluate the effect of TDF withdrawal time on changes of serum HBV-M, HBV DNA and ALT level in the mother-to-child blocking of the maternal population. METHODS: A prospective, randomized and controlled study was conducted. The 120 pregnant women with HBV who took TDF during 24 to 28 weeks of gestation were randomly divided into group A (withdrawal at delivery) and group B (withdrawal at 4 weeks postpartum), levels of HBV-M, HBV DNA, and ALT at different times were detected. The results were statistically analyzed by Wilcoxon Rank-sum test and χ