Clinical teaching way in pediatrics has been investigated,and its current state understood to provide the direction of clinical teaching in pediatrics.

The practice operation is an important method of clinical pediatric teaching during internship.We should fully consider the application occasions and select the most appropriate teaching cases when using this method on the clinical application teaching.The preparation before the intern should be emphasized because it is one of keys for students to learn much in the application.In order to correctly evaluate the effects of practice operation,we must focus on testing the working ability of students and standardizing the examination.

To test the hypothesis that the first degree relatives of Chinese women with polycystic ovarian syndrome (PCOS) have higher risk of cardiovascular disease than those without PCOS.The metabolic phenotype and risks of cardiovascular disease were evaluated in 110 family members of 35 women with PCOS and 85 unrelated healthy control subjects without family history of diabetes and PCOS ( four age- and weight-matched subgroups ).The prevalence of impaired glucose tolerance was 51.4％ in mothers and 57.5％ in fathers with their daughters suffering from PCOS.The first degree relatives of PCOS women had significantly higher serum fasting insulin level,homeostasis model assessment for insulin resistance,insulin area under the curve,and lower insulin sensitivity index in all subgroups than the control subjects( P＜0.05 ).The control subjects had significantly elevated high molecular weight-adiponectin levels and decreased high sensitive-C reactive protein levels compared to the first degree relatives of PCOS women in all subgroups.Parents and brothers,but not sisters,of women with PCOS had significantly higher total cholesterol and low density lipoprotein-cholesterol ( P＜ 0.05 ),as well as triglyceride levels ( P＜ 0.05 ),compared with control subjects.The first degree relatives of PCOS women had features of insulin resistance and increased risk of cardiovascular disease.

PPARγ2 gene C1431T polymorphism was assayed by PCR-RFLP in 200 polycystic ovary syndrome( PCOS)patients and 150 normal subjects. Serum adiponectin and leptin levels were determined by ELISA method. Polymorphism of the site might be associated with serum leptin and adiponectin concentrations and thiazolidinedione treatment in women with PCOS ( P<0.05 or P<0.01).

Forty women with polycystic ovary syndrome( PCOS) were enrolled. Basal plasma and urine cortisol, pituitary hormones, homeostasis model assessment for insulin resistance, and plasma cortisol in 0. 25 mg dexamethasone inhibition test were determined. In over-weight or obese PCOS patients, cortisol levels before and after inhibition test were increased (P<0. 05 or P<0. 01 ). The results suggest that the feed-back regulation of glucocorticoids to hypothalamas-pituitary is impaired and the change in hypothalamic-pituitary-adrenal axis is associated with insulin resistance.

TeamSTEPPS(Team Strategies & Tools to Enhance Performance & Patient Safety)is an evidence-based set of teamwork tools,aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals.It integrates teamwork skills with clinical practice to improve team performance in healthcare services and improve the quality of care effectively.The article introduces the TeamSTEPPS course and its clinical application.

TeamSTEPPS (team strategies and tools to enhance performance and patient safety) defines four core capabilities in teamwork which can be trained: leadership,situation monitoring,mutual support and communication.TeamSTEPPS is a successful medical team training project and its effectiveness has been proved.The application of TeamSTEPPS can provide a new teaching model for general practice training.

One hundred and fifty diabetic patients,who received management by community family doctors and hospital consortium (1+1+1) team for at least 1 year,were enrolled from January 2017 to May 2017.After that they continued to receive the management for 1 more year by the team which were trained with TeamSTEPPS (team strategies and tools to enhance performance and patient safety).The management effect before and after TeamSTEPPS training was compared.After the TeamSTEPPS training,the team management ability was improved,so that the compliance of diabetic patients with medical advice,regular examination of blood glucose,regular follow-up assessment,health education,regular exercise and diet control were all better than before,and the differences were statistically significant (all P＜0.01).Fasting blood glucose,postprandial 2 h-blood glucose,glycosylated hemoglobin and LDL-C levels were all lower than before,and the achieved rate of the above indicators were also increased (P＜0.05).It is suggested that application of TeamSTEPPS in team training can effectively enhance the management ability for chronic disease of family doctors and improve compliance and clinical indicators of patients with diabetes under management.

Objective To evaluate the application of TeamSTEPPS in training of community osteoporosis management team .Methods The TeamSTEPPS was applied for training of osteoporosis management team, and 1 513 residents aged ≥45 year were screened for osteoporosis in Kangjian community from January 2014 to March 2017.The identified patients with osteopenia and osteoporosis were intervened for one year.Cognitive level of the risk factors and symptoms associated with osteoporosis were assessed by questionnaires before and after the intervention .The bone density was examined at baseline and 6 months, 12 months after intervention.The effect of intervention was evaluated .Results A total of 467 patients (30.87%) with osteopenia and 476 patients (31.46%) with osteoporosis were detected .The cognitive levels of osteoporosis risk factors , including low calcium, vitamin D deficiency, lack of exercise, low weight, women menopause, matrilineal family history, smoking, excessive alcohol drinking and coffee drinking, were higher than those before intervention ( χ2＝62.909,78.742,59.974,50.478,29.512, 34.699,6.500,15.779,6.089,all P＜0.05).The awareness rates of symptoms , including lower back pain or body bone pain, shorter height and hunchback , low energy or nonviolent fracture , were also increased (χ2＝59.942,76.220,16.856,all P＜0.01).After intervention, the bone mineral density levels were increased compared to those before intervention (F＝530.28, P＜0.01 for osteopenia group; F＝339.51, P＜0.01 for osteoporosis group ); meanwhile, the differences were also significant between 6 months, 12 months after intervention and before intervention , between 12 months and 6 months after intervention (t＝-0.452,-0.968,-0.516,all P＜0.01 for osteopenia group; t＝-0.530,-1.045,-0.518, all P＜0.01 for osteoporosis group ).Conclusion The community osteoporosis management team trained by TeamSTEPPS can effectively improve the management levels of osteoporosis among residents in the community.

【Objective】 To analyze the status of the bacteria in the operative area of transnasal skull base surgery and its correlation with postoperative intracranial infection. 【Methods】 The procedure of transnasal skull base surgery was divided into three stages: nasal passage preparation (stage 1), tumor resection (stage 2), and skull base reconstruction (stage 3). Bacterial sampling was taken from the mucosa of the anterior wall of sphenoid sinus or clival recess of sellar floor at the beginning of each stage; and the positive rate of bacterial culture in different stages of operation and its correlation with postoperative intracranial infection were analyzed. 【Results】 A total of 105 patients were enrolled in this study, and 315 samples were taken. The average time point of sampling in the three stages was 20.3, 45.1 and 131.3 min after the beginning of operation, respectively. The positive results were 9 cases (2.9%) in the stage 1, 8 cases (2.5%) in the stage 2, and 23 cases (7.3%) in the stage 3, which were 24 cases of Staphylococcus epidermidis, 7 cases of Staphylococcus aureus, 3 cases of hemolytic streptococcus, 2 cases of Klebsiella pneumonia, and 4 cases of Escherichia coli. There was no significant difference in the positive cases between stage 1 and stage 2 (P=0.955), but there were significant differences between stage 1 or 2 and stage 3 (P=0.013; P=0.007). There were 36 (11.4%) patients with at least one positive result in the three stages, 17 (16.2%) with cerebrospinal fluid leakage, and 12 (11.4%) with intracranial infection. The risk of intracranial infection was 3.1 times higher in patients with positive bacterial culture than patients with negative bacterial culture (OR=3.1, 95% CI : 0.9-10.6), which was not statistically significant; patients with CSF leakage were 61.4 times higher than those without CSF leakage (OR=61.4, 95% CI: 11.2-337.1), which was statistically significant (P<0.001). The consistency rate of bacteria in nasal cavity and postoperative cerebrospinal fluid culture was 57.1%. 【Conclusion】 The positive rate of bacterial culture in the operative area of transnasal skull base surgery increases significantly with the extension of operation time, which is a potential risk index of postoperative intracranial infection.