The clinical practice in Pediatrics of Chinese medicine is the first step of the students to combine the theory with the clinical practice. The optimization teaching methods for clinical practice in Pediatrics of Chinese medicine was formed by using Delphi method of the extensive consultation from experts in colleges and universities of Pediatrics of Chinese medicine. We used this teaching method in students of Beijing University of Chinese medicine in 2011. Comprehensive evaluation to the implementation of effect was from assessment from students and analysis of exam results. The results showed that based on the survey of the students in the practice, the students in the experimental group give more positive evaluation than the control group on the necessity, satisfaction and harvest in the clinical practice in pediatrics of Chinese medicine.

Objective To explore the advantages and disadvantages between the RapidArc plans and fixed-field IMRT plan (IMRT).Methods Ten cases of cervical cancer,aged 55 (36-70),who were to receive post-operative radiotherapy were selected randomly.Single arc (Arc 1),two arcs (Arc 2),and three arc (Arc 3) RapidArc plans and fixed-field IMRT plan were designed respectively in the Eclipse 8.6 planning system.The designing,treatment time,target area,and dose distribution of organs at risk by these 4 planning techniques were compared.Results The values of average planned treatment time by the Arc 1,Arc 2,and Arc 3 ten cases was 98,155,185,and 46 min,respectively.The values of average treatment time in the Varian IX accelerator were 2.15,3.32,4.48,and 6.95 min,respectively.The average mean doses were (48.99±1.08),(49.40±0.51) ,(49.51±0.62) ,and (48.65±0.92) Gy,respectively.The values of homogeneity index (HI) of target were 1.11±0.07,1.07±0.02,1.06±0.02,and 1.12±0.05,respectively.The values of eonformal index (CI) of target were 0.73±0.13,0.87±0.06,0.87±0.06,and 0.79±0.06,respectively.The doses at rectum,bladder,and small intestine calculated by IMRT plan were the lowest,and the doses at the femoral neck calculated by these 4 plans were similar.Conclusions The RapidArc plan is superior in dose distribution at target,HI,CI,and treatment time to IMRT,but IMRT plan is superior to RapidArc in planned dose calculation time and protection of organs at risk.However,in general,the RapidArc plan is better in clinical application than IMRT plan.

The clinical efficacy and safety of topical propranolol hydrochloride gel in the treatment of superficial infantile hemangiomas (IHs) were assessed. Fifty-one cases of IHs from Oct. 2010 to Sept. 2011 were subjected to the topical propranolol hydrochloride gel intervention in Fuzhou General Hospital of Nanjing Military Commands, China. Changes in size, texture, color, peak systolic velocity of the hemangiomas, resistance index and adverse effects were observed. The results were evaluated by using Achauer system, and responses of IHs to pranpronolol were considered scale II (poor) in 4 patients (17.24%), scale II (moderate) in 18 patients (24.14%), scale III (good) in 22 patients (44.83%) and scale IV (excellent) in 7 patients (13.79%). The response of superficial hemangiomas was significantly better than other hemangiomas (P<0.05), and no differences in response were found among different primary sites (P>0.05). Our study indicates that topical application of 3% propranolol hydrochloride gel is effective and safe in treating IHs.

Objective:To evaluate the effectiveness of hierarchical management for patients with bronchial asthma.Methods:One hundred and eighty seven patients with bronchial asthma were recruited from January 2018 to November 2019 in Daxing District People′s Hospital. Patients were randomly divided into two groups, 94 patients received disease management education and therapeutic guidance from doctors in the community hospital and district hospital (study group), and 93 patients were followed up in outpatient visits only (control group). After one year, the scores of inhalation technique, treatment adherence, disease management awareness, the Asthma Control Test (ACT), the Mini Asthma Quality of Life Questionnaire (MiniAQLQ) and pulmonary function were evaluated and compared between two groups. The annual acute attack times and time to first exacerbation were also compared between the two groups.Results:After one year of management the treatment adherence rate in study group was higher than that in control group [80.85% (76/94) vs. 51.61% (48/93), χ2=2.834, P=0.02]. The scores of inhaled corticosteroids (ICS) inhalation technique [(6.47±1.28) vs. (4.05±1.37), t=2.241, P=0.04], the correct rates of exhaling before ICS inhalation [94.68% (89/94) vs.56.98% (53/93), χ2=4.436, P=0.01],inhalation [90.43%(85/94) vs.68.82% (64/93),χ2=2.943, P=0.04],holding breath after inhalation [89.36% (84/94) vs.58.06% (54/93),χ2=4.098, P=0.02],rinsing mouth after ICS inhalation [92.55%(87/94) vs.65.59%(61/93),χ2=2.876, P=0.04] in study group were higher than those in control group. The awareness rates of chronic inflammatory airway disease [70.21%(66/94) vs.44.08% (41/93),χ2=2.673, P=0.02], causative factors [85.10% (80/94) vs. 56.99% (53/93),χ2=2.760, P=0.02],treatment misunderstanding [88.29%(83/94) vs.53.76%(50/93),χ2=4.874, P<0.01], therapeutic goal [86.17% (81/94) vs. 49.46% (46/93),χ2=4.491, P<0.01] and requiring long-term treatment [90.43% (85/94) vs.48.38% (45/93),χ2=4.503, P<0.01] in study group were higher than those in control group. The scores of ACT [(22.71±2.81) vs. (19.50±5.34), t=2.041, P=0.04] and miniAQLQ [(84.28±11.16) vs. (64.23±14.38), t=3.298, P<0.01] in study group were higher than those in control group. The number of annual acute exacerbation was less [0(0, 1) vs.2(1, 3), Z=-3.237, P<0.01] and the time to first exacerbation was longer [184(96, 284)d vs. 96(59, 177)d, Z=3.873, P<0.01] in study group than those in the control group after one year of management. Conclusion:The hierarchical management can effectively enhance the inhalation technique and treatment adherence of the patients with bronchial asthma, and improve the quality of life of patients.

Objective To investigate the effects of exposure to cigarette smoke on the counts and functions of tolerogenic dendritic cells(tDC) and regulatory T cells(Treg) in a mouse model of asthma. Methods Forty female BALB/c mice at age 20 days were randomly allocated into four groups including the normal saline ( NS)/air treatment group, the NS/cigarette smoke ( CS) treatment group, the ovalbumin (OVA)/air treatment group and the OVA/CS treatment group (n=10).A mouse model of asthma was es-tablished by intraperitoneally injecting OVA in an interval of two weeks to cigarette smoke for three weeks. The percentages of Treg cells in PBMCs and the changes of CD80 and CD86 expression on the surface of DCs of the mice in each group were analyzed by flow cytometry analysis.The transcriptional levels of forkhead box P3 ( Foxp3) in lung tissues were measured by real-time quantitative PCR.The levels of IFN-γ, IL-4, IL-6, IL-10, IL-12p40, IL-17A and TGF-β1 in bronchoalveolar lavage fluid ( BALF) samples were measured by ELISA.Results Exposing young mice to cigarette smoke significantly increased the percentages of Treg cells in PBMCs and the expression of Foxp3 at mRNA level in lung tissues of mice with asthma.High levels of TGF-β1 and IL-10 were detected in BALF samples of the heathy mice and those with asthma exposed to CS at a young age.The mice with asthma exposed to CS at an early age showed decreased expression of CD80 and CD86 on the surface of DCs.Lower levels of IL-12p40 and IL-6 and higher levels of IFN-γ, IL-4 and IL-17A in BALF samples were observed in mice from the OVA/CS treatment group.Conclusion Expo-sing to cigarette smoke at an early age was involved in the dysfunction of T cell-mediated immune responses in mice with asthma.This study might provide new ideas for the prevention and treatment of asthma.

Objective To explore the application value of CT perfusion imaging for predicting the tiny lymph nodes metastasis and micrometastasis of squamous cell carcinoma in cervix after neoadjuvant chemotherapy.Methods The clinical data and CT perfusion parameters of 46 patients with cervical squamous cell carcinoma who underwent neoadjuvant chemotherapy followed by surgery were enrolled in the study.Based on the surgical pathology findings and short-term follow up,the cases were divided into without tiny lymph nodes metastasis (short axle diameter of lymph nodes＜10 mm) group (n=32) and with tiny lymph nodes metastasis group (n=14).All perfusion data were analyzed retrospectively and the diagnostic value were investigated.Results Blood flow (BF),blood volume (BV) and the maximum diameter of tumor per-chemotherapy in with tiny lymph nodes metastasis group were higher than those in without tiny lymph nodes metastasis group (all P＜0.05).The differences of the maximum diameter of tumor after chemotherapy,permeability,time to peak (TTP) between two groups were not statistically significant (all P＞0.05).Multivariate Logistic regression analysis showed BF and the maximum diameter of tumor per-chemotherapy were independent predictors of the tiny lymph nodes metastasis in cervix after neoadjuvant chemotherapy.ROC showed BF (AUC=0.86,P＜0.001,95％CI [0.75,0.96]) had higher predictive value than maximum diameter of tumor per-chemotherapy (AUC=0.70,P=0.02,95 ％ CI [0.54,0.88]).Conclusion CT perfusion imaging shows the significant predictive value for the tiny lymph nodes metastasis of squamous cell carcinoma in cervix after neoadjuvant chemotherapy.

Objective:To evaluate the effect of sevoflurane on necroptosis in isolated hippocampal neurons and the relationship with ryanodine receptor.Methods:Primarily cultured hippocampal neurons of fetal rats of Sprague-Dawley rats were inoculated in culture wells (100 μl/well) or culture flasks (3 ml/bottle) at a density of 5×10 5 cells/ml at 7 days of culture and divided into 3 groups ( n=24 each) using a random number table method: control group (group C), sevoflurane group (group S) and ryanodine receptor antagonist group (group R). Group C received routine culture.Ryanodine receptor antagonist Dantrolene at a final concentration of 3 μmol/L was added in group R. Thirty minutes later, the cells were placed in the incubator containing 2% sevoflurane and cultured for 5 h at 37 ℃ in S and R groups.Then cells were collected, the morphology of neurons was observed with an inverted microscope, the concentrations of free calcium ion ([Ca 2+ ] i) in cytoplasm were determined by flow cytometry, the expression of ryanodine receptor and phosphorylated MLKL protein (p-MLKL) was detected by Western blot, the expression of RIP3 was measured by immunofluorescence, and necroptosis rate was calculated. Results:Compared with group C, the [Ca 2+ ] i were significantly increased, the expression of ryanodine receptor and p-MLKL was up-regulated, and the necroptosis rate was increased in S and R groups ( P<0.05). Compared with group S, the expression of ryanodine receptor and p-MLKL was significantly down-regulated, and the [Ca 2+ ] i and necroptosis rate were decreased in group R ( P<0.05). There was no obvious abnormality in the morphology of neurons in group C. The cell body of neurons were shrunk, the processes were broken, and the network between processes was sparse in group S. The cell body was round, and the morphology was close to normal in group R. Conclusion:Sevoflurane can cause necroptosis in isolated hippocampal neurons of rats, and the mechanism is related to up-regulating the expression of ryanodine receptors and leading to calcium overload.

Objective: To explore the role of angiotensin receptor type I (AT1)-calcineurin (CaN) signaling pathway in transient outward potassium ion channel (Ito) remolding in hypertrophic atrial myocytes of neonatal rats. Methods: 1 day old neonatal rats’ atrial myocytes were isolated and the cells were divided into 4 groups:①Control group, normal cells were cultured for 24 h,②Stretching group, the cells were cultured for 24 h with mechanical stretching to induce hypertrophy,③Telmisartan group, the cells were treated by telmisartan at 1 μmol/L for 1 h, then cultured for 24 h and ④Cyclosporin-A (CsA) group, the cells were treated by CsA at 0.25 μg/ml for 1 h, then cultured for 24 h. The ratios of protein/DNA in myocytes were compared between Control group and Stretching group, cell hypertrophy was deifned by mRNA expression of atrial natriuretic peptide (ANP). Ito changes were detected by whole-cell patch clamping technique, proteins expressions of Kv4.3 and CaN A subunit were examined by Western blot analysis. Results: Compared with Control group, Stretching group showed obviously decreased Ito density and Kv4.3 protein expression, while increased CaN A protein expression; Compared with Stretching group, the above effects were reduced in Telmisartan group and CsA group. Conclusion: AT1-CaN signaling pathway was involved in the regulation of Ito channel remodeling in hypertrophic atrial myocytes of neonatal rats.

Objective:To investigate therapeutic efficacy and mechanisms of action of oncolytic agent derived from herpes simplex virus type 2 (oHSV2) in a xenograft mouse model bearing CT26 colorectal cancer. Methods:BALB/c mice were subcutaneously inoculated with CT26 cells to establish a xenograft mouse model of colorectal cancer. 1) After intratumoral administration of oHSV2, enzyme-linked im-munosorbent assay was used to determine granulocyte-macrophage colony-stimulating factor (GM-CSF) expression levels in the blood. 2) Model mice were divided into three groups:PBS group (negative control), oHSV2 group, and 5-fluorouracil (5-FU) group (positive control). After drug administration, drug effectiveness was evaluated on the basis of weight, tumor volume, general state, and survival time. 3) Cells from the draining lymph nodes (TDLN) and tumor were surgical y removed and used to quantify mature dendritic cel s (DCs) and T lym-phocytes by flow cytometry. Result:1) In the CT26 xenograft model, level of GM-CSF continuously elevated. At day 8, peak value was attained in the blood at concentration of 3150±327.1 pg/mL. Then, GM-CSF expression gradually reduced as time progressed. 2) In in vivo study, both oHSV2 and 5-FU exerted antitumor effects relative to PBS group (50 days vs. 36 days, P<0.01;51 days vs. 36 days, P<0.01), and oHSV2 proved to be less toxic and safer. At day 28, the 5-FU group presented highly significant difference in mouse body weight compared with that of PBS group (16.61 g vs. 22.07 g, P<0.01). However, oHSV2 group did not show statistical y significant change (al P>0.05). Skin of virus injection region did not present necrosis and ulceration. 3) In the TDLN, the frequency of DC was increased when treated with oHSV2 compared with the control group (6.49%vs. 3.73%, P<0.01). Similarly, the percentage of CD4+and CD8+T-cel s from the oHSV2-treated group was signifcantly higher than mock-treated tumors (15%vs. 8.57%, P<0.01;8.19%vs. 5.15%, P<0.01). However, number of cells in the 5-FU group were significantly reduced with respect to that of the negative group (al P<0.01). Conclusion:oHSV2 exerted potent antitumor effects in a murine colorectal cancer model. Compared with 5-FU, oHSV2 treatment caused fewer side effects. Such antitumor effect may be induced by stimulation of immune activity by GM-CSF production.

Objective To evaluate the effect of nimodipine on the activity of calcineurin (CaN) in the hippocampus of aged rats.Methods Sixty healthy male Sprague-Dawley rats,aged 18 months,weighing 550-650 g,were divided into 2 groups (n=30 each) using a random number table:surgery group (group S) and nimodipine group (group N).Nimodipine 1 mg/kg was intraperitoneally injected in group N,while the cqual volume of normal saline was given instead in group S,and 30 min later exploratory laparotomy was performed.Ten rats in each group were randomly selected on 1 day before operation and 3 and 7 days after operation,and Morris water maze test was performed.After the end of Morris water maze test,10 rats were selected and sacrificed,brains were removed,and hippocampi were isolated for detection of apoptosis in hippocampal neurons (by flow cytometry) and expression of CaN,phosphor-BAD (p-BAD) and caspase-3 in hippocampal tissues (by Western blot).Apoptotic rate was calculated.Results Compared with the value at 1 day before operation,the escape latency was significantly prolonged,the frequency of crossing the original platform was decreased,the time of staying at the platform quadrant was shortcned,apoptotic rate was increased,and the expression of CaN,p-BAD and caspase-3 in hippocampal tissues was up-regulated at each time point after operation in group S (P＜0.05).Compared with group S,the escape latency was significantly shortened,the frequency of crossing the original platform was increased,the time of staying at the platform quadrant was prolonged,apoptotic rate was decreased,and the expression of CaN,p-BAD and caspase-3 in hippocampal tissues was down-regulated at each time point after operation in group N (P＜0.05).Conclusion The mechanism by which nimodipine inhibits apoptosis in hippocampal neurons and reduces postoperative cognitive dysfunction may be related to inhibition of CaN activation in aged rats.