Objective:To explore the application of the flipped classroom teaching method in pediatric internship, evaluate the feedback from both students and faculty, and provide evidence for optimizing clinical medical education strategies.Methods:Fourth-year students ( n=174) enrolled in 2019 in the eight-year clinical medicine program at Peking University Health Science Center and instructors ( n=42) participated in this study. Questionnaire survey and exit examination scores were used to assess the effectiveness of the flipped classroom method. A statistical analysis was performed using SPSS 26.0. Kruskal-Wallis test and Dunn's multiple comparisons were used to evaluate the differences in satisfaction across teaching components. Chi-square test and Fisher's exact test were applied to compare satisfaction between high-score (top 30%) and low-score (bottom 30%) student groups. Results:①Overall student satisfaction with the flipped classroom reached 91.33% ("very satisfied" + "satisfied"). High satisfaction was reported for pre-class self-learning videos (80.35%), recommended clinical guidelines (82.80%), and English literature (71.10%), while satisfaction with the flipped classroom lectures was comparatively low (52.60%), with significant differences compared to other components ( P<0.05). ②High-score students exhibited significantly lower satisfaction than low-score students across all components (overall evaluation, 84.61% vs. 98.08%, Fisher's exact test, P=0.031; pre-class videos, 53.85% vs. 76.92%, χ2=6.12, P=0.013; preparatory assignments, 61.54% vs. 80.77%, χ2=4.68, P=0.030; English literature, 53.85% vs. 75.00%, χ2=5.80, P=0.016; and flipped class lectures, 36.54% vs. 59.62%, χ2=5.55, P=0.019). ③Enhanced competency in ≥2 core areas was reported in 71.68% of students, including theoretical knowledge acquisition (49.71%), self-directed learning (35.84%), clinical thinking (31.21%), research capabilities (25.43%), and communication skills (22.54%). ④Faculty feedback indicated that 83.33% of instructors perceived the flipped classroom as equivalent or superior to traditional teaching, particularly in cultivating clinical thinking (90.48%), self-directed learning (85.71%), theoretical knowledge acquisition (76.19%), and communication skills (76.19%). ⑤Student participation willingness was primarily influenced by pre-class time investment (46.51% reported excessive effort in preparing discussion materials), while faculty engagement depended on implementation effectiveness (42.86%) and curriculum design (35.71%). Conclusions:The flipped classroom method demonstrated promising initial outcomes in pediatric internship, with high satisfaction among both students and faculty. However, further exploration and practice are required in optimizing teaching components, implementing differentiated instructional strategies, and managing time investment.

Objective:To explore the application of the flipped classroom teaching method in pediatric internship, evaluate the feedback from both students and faculty, and provide evidence for optimizing clinical medical education strategies.Methods:Fourth-year students ( n=174) enrolled in 2019 in the eight-year clinical medicine program at Peking University Health Science Center and instructors ( n=42) participated in this study. Questionnaire survey and exit examination scores were used to assess the effectiveness of the flipped classroom method. A statistical analysis was performed using SPSS 26.0. Kruskal-Wallis test and Dunn's multiple comparisons were used to evaluate the differences in satisfaction across teaching components. Chi-square test and Fisher's exact test were applied to compare satisfaction between high-score (top 30%) and low-score (bottom 30%) student groups. Results:①Overall student satisfaction with the flipped classroom reached 91.33% ("very satisfied" + "satisfied"). High satisfaction was reported for pre-class self-learning videos (80.35%), recommended clinical guidelines (82.80%), and English literature (71.10%), while satisfaction with the flipped classroom lectures was comparatively low (52.60%), with significant differences compared to other components ( P<0.05). ②High-score students exhibited significantly lower satisfaction than low-score students across all components (overall evaluation, 84.61% vs. 98.08%, Fisher's exact test, P=0.031; pre-class videos, 53.85% vs. 76.92%, χ2=6.12, P=0.013; preparatory assignments, 61.54% vs. 80.77%, χ2=4.68, P=0.030; English literature, 53.85% vs. 75.00%, χ2=5.80, P=0.016; and flipped class lectures, 36.54% vs. 59.62%, χ2=5.55, P=0.019). ③Enhanced competency in ≥2 core areas was reported in 71.68% of students, including theoretical knowledge acquisition (49.71%), self-directed learning (35.84%), clinical thinking (31.21%), research capabilities (25.43%), and communication skills (22.54%). ④Faculty feedback indicated that 83.33% of instructors perceived the flipped classroom as equivalent or superior to traditional teaching, particularly in cultivating clinical thinking (90.48%), self-directed learning (85.71%), theoretical knowledge acquisition (76.19%), and communication skills (76.19%). ⑤Student participation willingness was primarily influenced by pre-class time investment (46.51% reported excessive effort in preparing discussion materials), while faculty engagement depended on implementation effectiveness (42.86%) and curriculum design (35.71%). Conclusions:The flipped classroom method demonstrated promising initial outcomes in pediatric internship, with high satisfaction among both students and faculty. However, further exploration and practice are required in optimizing teaching components, implementing differentiated instructional strategies, and managing time investment.

Objective:To preliminarily explore the association of pregnancy factors with cow's milk protein allergy in infants.Methods:This study was based on data from a subcohort of a study called ge-netic susceptibility to cow's milk allergy in Chinese children,including infants born in Peking University People's Hospital between March 1,2020,and December 31,2020.The infants were divided into a cow's milk protein allergy(CMPA)group and a control group according to whether they had developed cow's milk protein allergy at the age of 1 year.We retrospectively collected the clinical data of infants and their mothers before and during pregnancy,and analyzed the association of multiple factors during pregnancy with cow's milk protein allergy in infants.Results:A total of 278 infants were enrolled in this study,including 52 infants with CMPA and 226 infants without CMPA.Among them,there were 143 boys and 135 girls.The proportion of male infants in the CMPA group(69.2％)was higher than that in the control group(47.3％),and the difference was statistically significant(P=0.004).There were no significant differences in the distribution of birth weight,gestational age at birth,low-birth-weight in-fants,premature,umbilical cord entangle neck,and neonatal asphyxia between the CMPA group and the control group(P＞0.05).The proportion of mothers complicated with autoimmune diseases,anemia or antibiotics exposure during pregnancy in the CMPA group was higher than that in the control group,and there were statistical differences between the two groups(P＜0.05).There was no significant difference in the distribution of other pregnancy complications between the two groups(P＞0.05),such as eclamp-sia/preeclampsia,chronic hypertension/gestational hypertension,diabetes/gestational diabetes,thyroid diseases,and so on.There was no significant difference in the overall distribution of some blood routine indexes during pregnancy between the CMPA group and the control group(P＞0.05).Multivariate Lo-gistic regression analysis showed that male infant,mothers complicated with autoimmune diseases or ane-mia,antibiotic exposure during pregnancy were independent risk factors for cow's milk protein allergy.Conclusion:Male infant,mothers complicated with autoimmune diseases or anemia,antibiotic exposure during pregnancy were independent risk factors for cow's milk protein allergy.

Objective To explore the research hotspots on systemic lupus erythematosus(SLE)in pregnancy based on the bibliometric analysis of the related articles published from 2018 to 2023 and provide di-rections for the future research in this field.Methods PubMed,Web of Science,and Embase were searched for the articles on SLE in pregnancy that were published from January 1,2018 to December 31,2023.VOSviewer was used to visualize the high-frequency keywords in the selected articles.Results A total of 266 articles were selected,from which 25 high-frequency keywords were extracted.The bibliometric analysis showed that the available studies about SLE in pregnancy mainly focused on maternal complications,maternal and fetal outcomes,and medica-tions.The studies were limited regarding the predictors,autoimmunity,immunotherapy,and long-term outcomes of offspring.Conclusion Maternal complications,maternal and fetal outcomes,and medications are currently hotspots in the research on SLE in pregnancy,while predictors,autoimmunity,immunotherapy,and long-term outcomes of offspring may become future research directions.

Objective:To investigate the relationship between gestational weight gain (GWG) in twin pregnancies and adverse perinatal outcomes.Methods:This retrospective study included twin pregnant women with live births at≥25 weeks of gestation and their offspring, who delivered at Peking University People's Hospital from January 2012 to October 2022. Total GWG was standardized according to gestational age and categorized into three groups based on the 2009 Institute of Medicine (IOM) guidelines: insufficient GWG (GWG below IOM recommendations), appropriate GWG (GWG within IOM recommendations), and excessive GWG (GWG above IOM recommendations). Comparisons between data of the three groups used analysis of variance, Kruskal-Wallis test or Bonferroni correction or Chi-square partitions. Multivariable logistic regression models and generalized estimating equations with logistic regression models were used to analyze the independent effects of GWG on maternal and neonatal outcomes. Results:A total of 794 twin pregnant women and their 1 588 live-born neonates were included in the study. There were 360 women (45.3%) with appropriate GWG, 356 (44.8%) with insufficient GWG, and 78 (9.8%) with excessive GWG. Both insufficient and excessive GWG were associated with an increased risk of preterm birth [adjusted ORs of 1.39 (95% CI: 1.04-1.88) and 1.70 (95% CI: 1.05-2.78), respectively]. Insufficient GWG was associated with an increased risk of gestational diabetes mellitus (adjusted OR=1.42, 95% CI: 1.00-2.01) and low birth weight infants (adjusted OR=2.04, 95% CI: 1.57-2.66). Insufficient GWG was also associated with a reduced risk of eclampsia or preeclampsia (adjusted OR=0.50, 95% CI: 0.33-0.75), cesarean section (adjusted OR=0.48, 95% CI: 0.30-0.77), discordant twin growth (adjusted OR=0.56, 95% CI: 0.37-0.85), and large for gestational age infants (adjusted OR=0.46, 95% CI: 0.35-0.61). Excessive GWG was associated with an increased risk of eclampsia or preeclampsia (adjusted OR=2.85, 95% CI: 1.65-4.91), and large for gestational age infants (adjusted OR=2.49, 95% CI: 1.60-3.86), while with a decreased risk of low birth weight infants (adjusted OR=0.42, 95% CI: 0.27-0.65). Conclusions:More than half of the twin pregnancies have GWG outside the recommended range of the IOM guidelines. Both insufficient and excessive GWG are associated with adverse perinatal outcomes, particularly an increased risk of preterm birth.

Objective:To analyze the maternal and neonatal outcomes of pregnant women with leukemia.Methods:This retrospective study analyzed the clinical data of singleton pregnant women with leukemia and their neonates at the Obstetrics Department of Peking University People's Hospital from June 2009 to May 2021. Statistical analysis was performed using a two-sample t-test, the Wilcoxon Mann-Whitney rank sum test, and the Chi-square test (or Fisher's exact test). Results:(1) Ninety-one pregnant women were enrolled in this study, accounting for 2.8‰ of all deliveries during the same period. Among them, there were 15 (16.5%) with acute lymphoblastic leukemia, 38 (41.8%) with acute myeloid leukemia, and 38 (41.8%) with chronic myelogenous leukemia. Twenty-nine of the 91 pregnancies (31.9%) were terminated in the second or third trimester, and 62 babies (68.1%) were born through spontaneous delivery or cesarean section. The 62 parturients were (30.1±5.0) years old, of whom two died of complications of leukemia within 7 d after delivery, and five were transferred to the intensive care unit after delivery. Of the 62 cases, 18 (29.0%) received a blood transfusion and 12 (19.3%) received chemotherapy during pregnancy. (2) The proportion of patients with unremitted leukemia during pregnancy or newly developed leukemia was higher in women with terminated pregnancy than in those who continued the pregnancy [96.6% (28/29) vs 54.8% (34/62), χ2=15.83, P<0.001]. (3) The gestational age of the 62 newborns was (37.7±2.7) weeks. Premature, low birth weight and small-for-gestational-age infants accounted for 29.0% (18/62), 25.8% (16/62), and 12.9% (8/62), respectively. Hyperbilirubinemia occurred in 10 neonates (16.1%) and hypoglycemia in two (3.2%). Perinatal anoxia and asphyxia were reported in 13 cases (21.0%). Appearance, organ malformations, or chromosomal abnormalities were found in four neonates (6.4%) whose mothers did not receive chemotherapy during pregnancy. Fifty-nine infants underwent routine blood tests within 3 d after birth. The results showed that the mean white blood cell count, hemoglobin concentration, and platelet count were (16.1±7.0)×10 9/L, (181.5±20.0) g/L and (266.2±63.7)×10 9/L, respectively, and no juvenile cells were detected in their peripheral blood samples. Twenty children were followed up to 4 years and 4 months (9 months to 10 years and 3 months). No abnormalities in physical or mental development, motor function, or hematological system were reported. Conclusions:Pregnancy complicated by leukemia is rare and dangerous, which requires an individualized management strategy besides therapy for leukemia. A good prognosis is still expected with appropriate treatment.

Objective:To investigate the effect of oral glucocorticoid dose on maternal and infant outcomes in female patients with systemic lupus erythematosus(SLE), thus providing reference for clinical work.Methods:Clinical data of pregnant women with SLE admitted to Department of Obstetrics, Peking University People′s Hospital from July 2015 to June 2020 were retrospectively analyzed.According to the daily oral glucocorticoid dose during pregnancy(equivalent converted to Prednisone), pregnant women were divided into 2 groups: ≤7.5 mg group(67 cases) and >7.5 mg group(74 cases). The maternal and fetal outcomes of the 2 groups were analyzed by t-test or χ2 test or Fisher′ s exact probability method. Results:The neonatal birth weight, birth length, white blood cell count and platelet count in ≤7.5 mg group were significantly higher than those in >7.5 mg group[(2 990.69±532.20) g vs.(2 734.57±608.35) g, (48.97±2.34) cm vs.(47.43±3.38) cm, (17.69±6.16)×10 9/L vs.(15.11±6.00)×10 9/L, (276.92±74.51)×10 9/L vs.(240.05±69.29)×10 9/L], while the incidence of low birth weight and neonatal transfer rate were significantly lower(13.85% vs.30.43%, 12.31% vs.33.33%) ( t/ χ2=2.587, 3.068, 2.354, 2.841, 5.301, 8.321, all P<0.05). Meanwhile, the incidence of maternal complications like hypertension disorders in pregnancy and gestational diabetes mellitus in the ≤7.5 mg group were lower than those in the >7.5 mg group, but the incidence of anemia and postpartum hemorrhage increased, although no significant differences were detected (all P>0.05). Conclusions:The overall maternal and fetal outcomes of patients with SLE with oral Prednisone ≤7.5 mg/d were better those medicated >7.5 mg/d, but the incidence of anemia during pregnancy and postpartum hemorrhage was higher.An individual monitoring and treatment should be concerned to improve the maternal and infant outcomes.

Intracytoplasmic sperm injection (ICSI) is an important treatment option for male infertility at pre-sent.However, a few patients still suffer from repeated ICSI fertilization failure because their sperm is unable to activate oocytes.Artificial oocyte activation (AOA) technology can improve the fertilization rate, pregnancy rate, live birth rate, etc., but it remains unknown whether AOA has short- and long-term effect on offspring.In this article, recent literature about the effect of AOA technology on perinatal outcomes, genetics, physical development and neurological development of offspring was summarized.This paper aims to provide reference for reproductive medicine workers and pediatricians in clinical practice.

Objective:To investigate the effect of reproduction on maternal and infant outcomes in female patients with systemic lupus erythematosus (SLE).Methods:Clinical data of SLE patients complicated with pregnancy admitted in the Peking University People′s Hospital from July 2015 to December 2019 were analyzed retrospectively.According to the history of live birth, SLE patients complicated with pregnancy were divided into primiparity group (94 cases) and reproduction group (32 cases). Maternal and infant outcomes of the 2 groups were analyzed.Results:A total of 126 SLE patients complicated with pregnancy were included in the present study.The proportion of using immunosuppressants was significantly lower in reproduction group than that of primiparity group [3 cases (9.38%) vs.27 cases (28.72%)] ( χ2=4.927, P=0.026). Complications like lupus nephritis, thyroid disease and postpartum hemorrhage significantly increased in the reproduction group (all P<0.05), and the adverse neonatal outcomes like preterm infants, low birth weight infants and small for gestational age infants in the reproduction group were lower than those in primiparity group, but no significant differences were detected(all P>0.05). There were no significant diffe-rences in the results of the first blood routine examination of newborns and the incidence of neonatal pathological jaundice between the 2 groups (all P>0.05). Conclusions:For SLE patients complicated with reproductive pregnancy, although the incidence of some pregnancy complications increases, the incidence of adverse neonatal outcomes decreases.In addition, reducing the use of immunosuppressants may have positive implications on neonatal outcomes.

Objective:To study the effects of maternal moderate and severe gestational thrombocytopenia (GT) and primary immune thrombocytopenia (ITP) on neonates.Method:From Jan 2018 to Dec 2019, pregnant women with platelet count <100×10 9/L during pregnancy admitted to our hospital were retrospectively reviewed. The infants were assigned into GT group and ITP group according to their mothers' diagnoses. The clinical outcomes were compared between the two groups. Result:Of 104 mothers with platelet count <100×10 9/L, 32 (30.8%) were diagnosed with ITP and 72 (69.2%) with GT. Gestational age (GA) of the ITP group was smaller than the GT group [(37.0±1.5) weeks vs. (38.0±2.0) weeks, P<0.05]. The maternal platelet count within 24 h before delivery (39×10 9/L vs. 86×10 9/L) and the lowest platelet count during pregnancy (17×10 9/L vs. 75×10 9/L) in the ITP group were both lower than the GT group, the differences were statistically significant ( P<0.001). The maternal platelet count after birth in ITP group were lower than the GT group (184×10 9/L vs. 277×10 9/L, P<0.01). Neonates in the ITP group have an increased tendency to develop neonatal thrombocytopenia (NT) than the GT group (43.8% vs. 6.9%, P<0.001). The platelet count on the first day after birth (92×10 9/L vs. 170×10 9/L) and the lowest platelet count (43×10 9/L vs. 103×10 9/L) of NT newborns in the ITP group were lower than the GT group ( P<0.05). No differences existed for the time needed reaching the lowest platelet count in NT newborns between the two groups [(3.5±1.2) d vs. (4.4±0.4) d, P>0.05]. Neither group had intracranial hemorrhage. Conclusion:Neonates born to pregnant mother with platelet count <100×10 9/L have a tendency to develop NT. The incidence of NT in neonates born to mothers with ITP is higher than GT, but the overall prognosis of the newborns is good.