Objective To investigate the effect of applying web based problem-based learning in the teaching of bilingual curriculum.Methods 2009 grade nursing undergraduate bilingual class (n =57) was taken as control group and traditional teaching method was used.2010 grade nursing undergraduate bilingual class (n =60) was taken as experimental group and bilingual course of introduction to nursing was used to do web based (Blackboard platform) PBL teaching.Teaching process of the grouping-question posing-data gathering-discussion-mid-term feedback-presentation-summary and evaluation was implemented.Result comparison method,network based PBL learning evaluation sheet and content analysis were employed to complete teaching effect evaluation.Data were analyzed by t test and P ＜ 0.05 signifies statistically significant differences.Results Test scores of experimental group were significantly higher than that in control group (P ＜ 0.05).Mean scores of positive items in web based PBL teaching scale were ≥3.84.Electronic learning file content analysis showed that excellent rates of 7 indicators (student participation,thinking ability,inquiry,etc) were ≥66.7％.Conclusion Web based PBL teaching model is good for improving teaching effectiveness in the teaching of bilingual curriculum.

Objective To explore the application of low-dose prospective ECG-triggering dualsource CT (DSCT) angiography in infants and children with Kawasaki disease (KD).MethodsNineteen children diagnosed of Kawasaki disease underwent low-dose prospective ECG- triggering DSCT angiography (DSCTA) with free breathing and transthoracic echocardiogram (TTE).The overall imaging quality was graded on a five-point scale. Interobserver agreement in subjective image quality grading was assessed by Kappa statistics.The location,number and size of the aneurysms and dilations were recorded and compared with those of TTE.Pearson correlation analysis was used to evaluate the agreement on measurements between DSCTA and TTE.The average effective dose of DSCTA in all 19 children was calculated.ResultsDSCTA was performed successfully in all 19 children.A total of 91.5 ％ (226/247) segments permitted visualization with diagnostic image quality. Fifteen patients were diagnosed with coronary artery lesions. A total of 28 aneurysms and 15 arterial aneurysmal dilations were detected by DSCTA,while 19 aneurysms and 13 arterial aneurysmal dilations were found by TTE.TTE failed to detect 9 aneurysms (2 in the distal right coronary artery,2 in the posterior descending artery,1 in the middle of left anterior descending artery,1 in the middle of left circumflex artery,2 in the distal of LCX and 1 in the obtuse marginal branch)and 2 arterial aneurysmal dilations (1 at the diagonal branch and 1 at obtuse marginal branch). The concordance of DSCTA and TTE in measurement of diameter and length of these aneurysms and aneurysmal dilatations are good (0.63 ± 0.20) and (0.58 ± 0.20) cm vs ( 1.49 ± 0.83 ) and ( 1.22 ± 0.66) cm ( r =0.989 and 0.965,P ＜ 0.05 ).There was a good agreement on overall image quality ( Kappa =0.87 ). The mean effective dose was(0.24 ± 0.08) mSv.ConclusionProspective ECG-triggering DSCTA with very low effective radiation dose is safe,reliable and more sensitive than TTE on diagnosing of coronary artery lesions,especially in the distal lesions,in infants and children with KD.

Objective To investigate the methods and results of perforator pedicled flaps by anastomosis of superficial veins for reconstructing the extremity defects.Methods From February, 2012 to September, 2012, a total of 14 patients with traumatic skin and soft tissue and artery defects in extremities were repaired by perforator pedicled flaps anastomosed superficial veins with the recipient vessels.Fourteen flaps were based on five kinds of perforator arteries, the posterior interrosseous artery in 5 cases, the ulnar artery in 3 cases, the metacarpal artery in 2 cases, the peroneal artery in 3 cases, the lateral supramalleolar artery in 2 cases, the ulnar artery in 2 cases,and the posterior interrosseous artery in 1 case.After the operation, the blood supplies of flaps were observed severely,postoperative flap swelling were evaluated by edema level classification.After 1 month the blood flow of vein anastomosis were examed by color Doppler ultrasound.Questionnaire of the flap aesthetic satisfactory were performed during fellow-up periods.Results Twelve flaps were all survived well, 2 flaps had partial marginal skin necrosis in the distal, which was managed with surgical debridement, and wound healed in 1 month.Flap swelling were light, edema level classification were one degree in 4 cases,two degree in 10 cases postoperation 7 days, one degree in 11 cases and two degree in 3 cases, after 6 months.Color Doppler ultrasound examinations showed 9 vein anastomosises were all bypassed well.Eleven cases had 6-12 months' fellow-up periods.The flaps had like-like appearance, good contour, high aesthetic satisfactory.Conclusion Perforator pedicledr flaps by anastomosis of superficial veins can reduce the flap venous pressure obviously, avoid transientvenous venous congestion, improve the survival quality of the flap.It's a safe and effective method for soft tissue coverage of traumatic extremity wounds.

Objective To compare the accuracy, image quality and radiation dose between prospective ECG?gated sequential and high?pitch acquisition on 128?slice dual?source CT (DSCT) angiography in infants and children with congenital heart disease (CHD). Methods Ninety?two children with CHD from October 2011 to February 2013 were prospectively enrolled and assigned into two groups according to random number table. Forty?six patients underwent DSCT angiography with sequential mode, and the other 46 patients were examined with high?pitch mode. With surgical and/or DSA results as the standard, the diagnostic accuracy and sensitivity of the two groups for the intracardiac structures, extracadiac and coronary artery anomalies were evaluated, and the comparison was analyzed by Fisher exact test. A 5?grade scoring system was used to interpret the image quality of intracardiac structures, great vessels and the proximal and middle segments of coronary arteries. Interobserver agreement on grades of image quality was assessed by Kappa statistics. The image quality scores were compared using the Mann?Whitney U test. The Student t test or the Mann?Whitney U test was used to analyze the differences between the two groups regarding to patients' age, weight , heat rate, CT attenuation, image noise and SNR in the ascending aorta and the pulmonary trunk as well as radiation dose. Results All 92 patients successfully underwent DSCT angiography. The diagnostic accuracies of intracardiac anomalies by high?pitch group and sequential group were 95.65%(88/92) and 99.28%(274/276), showed significant difference between the two groups (P<0.05), but no significant difference in the sensitivity of intracardiac anomalies (P>0.05) .There was no significant difference in the diagnostic accuracy and sensitivity of extracadiac anomalies between the two groups (P>0.05). The diagnostic accuracies of coronary artery anomalies by high?pitch group and sequential group were 93.48%(43/46) and 100.00%(46/46), showed no significant difference between the two groups (P>0.05), but there was significant difference in the sensitivity of coronary artery anomalies (50.00%(3/6) , 100.00% (11/11)) (P<0.05). There was excellent agreement for image quality scoring of the intracardiac structures, great vessels and the proximal and middle coronary arteries between the two observers (Kappa=0.81, 0.85, 0.85, P<0.05). The median image quality scores of extracardiac great vessels were both 5.00 in high?pitch group and sequential group, and there was no significant difference between the two groups (U=981.000, P>0.05). The median image quality scores of intracardiac structures and proximal and middle segments of coronary arteries respectively by high?pitch group were 4.00 and 3.00, and 5.00 and 4.00 respectively by sequential group. The image quality of intracardiac structures (U=594.500, P<0.05) and proximal and middle segments of coronary arteries (U=397.500, P<0.05) was significantly better in the sequential group than that in the high?pitch group. There was no significant difference between the two groups in CT attenuation, noise and SNR of the ascending aorta and pulmonary trunk. The mean effective doses of the high?pitch group and the sequential group were(0.27±0.11)and(0.39±0.17)mSv, and showed significant difference between the two groups (t=4.316, P<0.05). Conclusions Both sequential and high?pitch mode of 128?slice DSCT angiography provide high accuracy for the assessment of CHD in infants and children, while the high?pitch mode, though with some image quality declined, shows further significantly lower radiation dose.

Objective To evaluate feasibility and time efficiency of dual-source flash post-processing software (Bone Reading)for reconstruction of bronchial artery.Methods The imaging data of 70 patients with suspected bronchial artery dilatation who underwent bronchial artery-CTA were evaluated by 2 independent radiologists.First,the related contents of bronchial artery such as origination,number, type,route and lumen diameter were evaluated by multiple planar reconstruction (MPR),maximum intensity projection (MIP)and volume rendering technique (VRT).The results and process time were recorded.After a month,the post-processing software(Bone Reading)was used to evaluate the same contents.Results There was very good correlation between both readers for both reading methods without significant differences.There was significant difference of process time between with regular method and with Bone Reading (P<0.05)for both readers.Process time could be decreased by approximately 35%.Conclusion The application of CT software (Bone Reading)is feasible in the CTA of bronchial artery.This method may gain a significant time saving in comparison to regular method.

Objective To evaluate DTI for early diagnosis and prognosis of diffuse axonal injury (DAI)in the moderate and sever traumatic brain injury (sTBI).Methods 30 patients with sTBI and 30 healthy controls were studied with T1 WI and DTI.The frac-tional anisotropy(FA)and ADC were quantified from different regions of interest(ROI)including the genu of corpus callosum(gCC), the trunk of CC,the splenium of CC(sCC)and the integrity CC.The FA and ADC of the same R0I was compared between TBI group and control group,and FA and ADC of the different parts of CC were compared in TBI group.Correlations between the FA or ADC and coma duration of the TBI patients were analyzed by Pearson linear correlation.Results Compared with control group,the FA value decreased significantly in each ROI,while ADC was reversed.The FA or ADC of the different ROI were correlated with co-ma duration in TBI group.Conclusion DTI is sensitive to detect the white matter injury of TBI.FA value detected in the CC can help diagnose DAI earlier and evaluate the degree of injury.

Objective To observe ghrelin expression in gastric tissue and serum leptin level of the early over-fed rats given ω-3 polyunsaturated fatty acids (PUFAs) diets after weaning,and explore the effects of early over-feeding and diets intervention on the metabolic syndrome in adult rats.Methods Male Sprague-Dawley rats were divided into normal feeding group (NF group,10 per litter) or over-feeding group (OF group,3 per litter) in postnatal day 3,and then different diets were given after weaning (postnatal day 21).The OF group was separately given conventional diet (OF + Con group),high-fat diet (OF + HF group),or ω-3 PUFAs (OF + ω-3 group) ; while the NF group was separated into NF + Con group and NF + HF group.Body weight and food intake were recorded every week.In week 6 and week 16,glucose tolerance test was perforfmed.Serum leptin,ghrelin,and triglyceride were assayed by enzyme-linked immuno-absorbent assay.Ghrelin mRNA and protein levels in gastric tissue were quantified by real-time PCR and immunohistochemistry.Results At week 16,energy intake,body weight and glucose intolerance in OF + HF group were significantly higher than in NF + HF group (t =-3.453,P =0.014 ; t =-6.406,P =0.000 ; F =16.249,P =0.000),and serum triglycerides,ghrelin mRNA of gastric tissue were significantly higher than those of OF + Con group (t =4.72,P =0.005 ; t =8.486,P =0.000).At week 16,the serum leptin level in OF + Con group was higher than that in NF + Con group (t =-3.274,P =0.031),also higher in OF + HF group than that in OF + Con group (t =3.028,P =0.014).There were no significant differences in serum ghrelin and the area of ghrelin immuno-positive cells in the gastric tissue among groups.The above indicators in OF + ω-3 group were not different from those of NF + Con group.Conclusions Over-feeding during the lactation period may lead to high susceptibility to obesity and disordered glucose and lipid metabolism.It can also increase serum leptin and ghrelin mRNA expression in gastric tissue,aggravate leptin resistance and feeding control disorders.Dietary ω-3 PUFAs offered protection against excessive accumulation of adipose tissue,glucose intolerance,leptin resistance,and maintained normal levels of leptin and ghrelin.

Objective To explore the influences of extracellular matrices (ECM) secreted by ultraviolet B (UVB)-induced senescent fibroblasts on the proliferation of and extracellular signal-regulated kinase (ERK) signaling in HaCaT cells. Methods Fibroblasts were irradiated with UVB of 15 mJ/cm2 once daily for 5 days to induce premature senescence, which was identified by SA-β-gal staining 72 hours after the last irradiation.HaCaT cells were divided into 3 groups and inoculated into plates coated with extracellular matrices secreted by non-senescent (PRE-ECM) or senescent fibroblasts (SIPS-ECM) or into uncoated plates (NON-ECM), fol-lowed by additional culture. U0126, an inhibitor of ERK1/2, was used to treat the HaCaT cells 1 hour before inoculation. Then, MTT assay was carried out to detect the proliferation of HaCaT cells after a 3-day culture,Western blot to assess the phosphorylation of ERK at 0.5, 1, 2 and 4 hours after the inoculation, flow cytometry to analyse cell cycle and apoptosis after 24 hours of culture. Results The most rapid and intense phosphory-lation of ERK was observed in SIPS-ECM group. Inhibiting the activation of ERK pathway with U0126 could completely suppress the promoting effect of ECM from senescent fibroblasts on the proliferation of HaCaT cells.After the blocking of ERK activation, the proportion of HaCaT cells in S and G2/M phase decreased from 37.40%, 41.34% and 43.31% to 29.41%, 36.48% and 39.96%, respectively, in NON-ECM, PRE-ECM and SCIP-ECM group. Conclusion The ECM produced by UVB-induced senescent fibroblasts promote the prolifera-tion of HaCaT cells via inducing the phosphorylation of ERK.

ObjectiveTo investigate the value of prospective ECG-gated dual-source CT (DSCT)in the diagnosis of coarctation of aorta ( CoA ).MethodsSixteen patients clinically suspected of CoA underwent prospective ECG-gated DSCT angiography and color Doppler flow imaging (CDFI). The diagnostic accuracy of DSCT and CDFI were compared according to the results of operation or DSA.The nonparametric chi-square test was used for the statistics.ResultsSixteen patients were diagnosed as CoA by DSCT,4 were complicated with artial septal defect (ASD),9 with ventricular septal defect (VSD),1 with transposition of the great arteries,3 with dysplasia of aortic arch,7 with patent ductus arteriosus (PDA),1 with abnormal origin of the coronary artery, 1 with bronchus artery dilation. Fifteen patients were diagnosed as CoA by CDFI,1 was diagnosed as interruption of aortic arch. Four were complicated with ASD,9 with VSD,2 with bicuspid aortic valve (BAV),1 with transposition of the great arteries,2 with dysplasia of aortic arch,7 with PDA,1 with bronchus artery dilation.Abnormal origin of the coronary artery was not found.The diagnostic accuracy of DSCT and CDFI were 97.2％ ( 140/144)and 97.9％ (141/144)respectively,there was no significant difference (x2 =0.00,P ＞ 0.05 ).The sensitivity of DSCT and CDFI were both 93.2％ ( 41/44 ),the specificity were 99.0％ (99/100) and 100.0％ (100/100).The mean effective radiation dose was 0.42 mSv. Conclusion Prospective ECG-gated DSCT is a good imaging technique for the diagnosis of aortic coarctation in children.

Objective To compare the sensitivity and specificity of venereal disease research laboratory (VDRL) test versus several other laboratory tests in the diagnosis of neurosyphilis. Methods Lumber puncture was conducted to obtain cerebrospinal fluid (CSF) from untreated outpatients with latent syphilis (LS) or serofast outpatients with LS. Then, VDRL test, rapid plasma regain (RPR) test, Treponema pallidum particle agglutination (TPPA) assay, fluorescent treponemal antibody-absorption (FTA-ABS) test and protein quantification were performed on these CSF samples. The sensitivity, specificity, positive predictive value and negative predictive value were compared between VDRL test and four other laboratory tests in the diagnosis of neurosyphilis. Results Totally, 61 cases of latent syphilis were included in this study. The sensitivity, specificity,positive predictive value and negative predictive value were 93.44% (57/61), 99.32%(293/295), 96.61%(57/59), 98.65% (293/297)for CSF-RPR, respectively, 91.80% (56/61), 82.71% (244/295), 52.34% (56/107),97.99 (244/249) for CSF-TPPA, respectively, 93.44% (57/61), 82.71% (244/295), 52.78%(57/108), 98.39%(244/248) for CSF-FTA-ABS, respectively, and 49.18%(30/61), 97.29% (287/295), 78.95% (30/38),90.25% (287/318) for CSF protein quantification, respectively. Conclusions CSF-VDRL cannot be replaced by CSF-RPR, -TPPA, -FTA-ABS, or CSF protein quantification in the diagnosis of neurosyphilis. CSF-RPR shows a high sensitivity and specificity in the diagnosis of neurosyphilis, with an increased diagnostic capability (area under the receiver operating characteristic curve) compared with CSF-TPPA, CSF-FTA-ABS or CSF protein quantification.