Objective:To investigate the critical thinking disposition of pediatric professional graduate students and the influencing factors, and to put forward suggestions for teaching improvement.Methods:In this cross-sectional study, we administered the California Critical Thinking Disposition Inventory-Chinese Version (CTDI-CV) through an online survey tool (Wenjuanxing) to pediatric professional graduate students rotating in the Department of Critical Care Medicine of Children's Hospital of Chongqing Medical University from September 2022 to August 2023. CTDI-CV scores were described as mean ± standard deviation. The distribution of critical thinking disposition scores was analyzed using the t test, F test, trend analysis, and simple linear regression analysis with the use of SPSS 23.0. Results:A total of 130 usable questionnaires were returned. The overall mean CTDI-CV score of the pediatric graduate students was (235.76±30.73). The CTDI-CV score was significantly lower in male students than in female students [(224.40±28.50) vs. (242.86±30.08), P=0.001]. The students of the integrated "5+3" program scored significantly higher than the graduate students recruited through the national unified examination [(244.18±30.33) vs. (232.02±30.32), P=0.037]. The CTDI-CV scores of the first-, second-, and third-year graduate students were (219.79±37.41), (229.21±27.19), and (254.77±18.97), respectively, showing a significant upward trend ( H=30.34, P<0.000 1). Among all attributes, the score for truth-seeking in all students was highest (39.52±6.86), while the score for confidence in reasoning was lowest (28.65±7.23). Female students scored significantly higher than male students in truth-seeking ( P=0.027), open-mindedness ( P=0.025), analyticity ( P=0.031), systematicity ( P=0.016), confidence in reasoning ( P=0.005), and cognitive maturity ( P=0.013), with no significant difference in inquisitiveness ( P=0.073). Conclusions:Most pediatric graduate students exhibit diversified or somewhat little inclination towards critical thinking, with a willingness to seek truth but low confidence in critical thinking. Female students, those in the integrated "5+3" program, and upper-level students are more likely to have critical thinking. These findings underscore the need for more effective teaching methods to foster critical thinking.

Acupuncture has been proved to be safe and effective by large-scale and authoritative clinical observation at home and abroad. However, in recent years, the results of some randomized controlled trials of acupuncture in JAMA showed no significant difference between acupuncture effect and sham acupuncture effect. Acupuncture and moxibustion in clinical practice is a summary of academic and clinical rules. Different from chemical drugs, the amount of stimulation, methods of operation and techniques vary. At present, sham acupuncture in clinical trials at home and abroad has been questioned by many scholars, who believe that sham acupuncture is not fake, and call for "fake targeted research" to be stopped. In order to improve the sham acupuncture control design, 5G + VR technology and the principle elements of sham acupuncture should be combined. We also discussed and analyzed advantages and prospects of modern intelligent medical technology of 5G + VR technology in the sham acupuncture RCT. We hope to promote standardization of acupuncture clinical trials, and the development, innovation and application of acupuncture research at home and abroad.

Objective To investigate the anti-inflammatory effect and mechanism of sappanone A(SA)on lipopolysaccharide(LPS)-induced RAW264.7 cell model based on JAK2-STAT3 signaling pathway.Methods MTT assay was used to detect the effects of sappanone A,LPS and AG490 on RAW264.7 cell viability.The LPS-induced inflammatory model in RAW264.7 cells was established,and the secretion level of interleukin-6(IL-6)in the supernatant was detected by ELISA.mRNA expressions of IL-6,Janus kinase 2(JAK2)and signal transducer and activator of transcription 3(STAT3)were tested by RT-PCR.The protein expressions of JAK2,phosphorylated JAK2(p-JAK2),STAT3 and phosphorylated STAT3(p-STAT3)were determined by Western Blot.Results Compared with control group,IL-6 secretion level was significantly increased,mRNA expressions of IL-6,JAK2 and STAT3 were up-regulated,and protein expressions of p-JAK2 and p-STAT3 were increased(all P＜0.01)in model group.Compared with model group,high-dosed sappanone A(5 μg·mL-1)was significantly decreased the secretion of IL-6,down-regulated the mRNA expressions of IL-6,JAK2 and STAT3,and inhibited the protein expressions of p-JAK2 and p-STAT3(all P＜0.01).Conclusion Sappanone A may play an anti-inflammatory role by inhibiting the JAK2-STAT3 signaling pathway and hence inhibiting the secretion of IL-6.

Whether Fanconi anemia (FA) heterozygotes are predisposed to bone marrow failure and hematologic neoplasm is a crucial but unsettled issue in cancer prevention and family consulting. We retrospectively analyzed rare possibly significant variations (PSVs) in the five most obligated FA genes, BRCA2, FANCA, FANCC, FANCD2, and FANCG, in 788 patients with aplastic anemia (AA) and hematologic malignancy. Sixty-eight variants were identified in 66 patients (8.38%). FANCA was the most frequently mutated gene (n = 29), followed by BRCA2 (n = 20). Compared with that of the ExAC East Asian dataset, the overall frequency of rare PSVs was higher in our cohort (P = 0.016). BRCA2 PSVs showed higher frequency in acute lymphocytic leukemia (P = 0.038), and FANCA PSVs were significantly enriched in AA and AML subgroups (P = 0.020; P = 0.008). FA-PSV-positive MDS/AML patients had a higher tumor mutation burden, higher rate of cytogenetic abnormalities, less epigenetic regulation, and fewer spliceosome gene mutations than those of FA-PSV-negative MDS/AML patients (P = 0.024, P = 0.029, P = 0.024, and P = 0.013). The overall PSV enrichment in our cohort suggests that heterozygous mutations of FA genes contribute to hematopoietic failure and leukemogenesis.
Anemia, Aplastic/genetics* ; Epigenesis, Genetic ; Fanconi Anemia/genetics* ; Germ Cells ; Hematologic Neoplasms/genetics* ; Humans ; Leukemia, Myeloid, Acute/genetics* ; Retrospective Studies

Objective:By exploring the source of children's total fluoride intake and the relationship between children's total fluoride intake and dental fluorosis prevalence, to calculate the benchmark dose (BMD) of children's total fluoride intake and its 95% confidence lower limit (BMDL), and to provide the basis for revision of "Total Fluoride Intake for Inhabitants" (WS/T 87-2016).Methods:The villages that had water improvement for 5 years and more in 6 provinces of Jiangsu, Shandong, Hebei, Anhui, Henan and Shaanxi were selected as survey sites in April 2014. The water fluoride content of these villages was 0.3 - 3.0 mg/L, tap water samples from the centralized water supply were collected, and fluoride content was detected by ion selective electrode method. Children aged 8 to 12 years were selected, children's dental fluorosis was checked by Dean's method. Children's dietary and drinking water volume were surveyed by duplicate portion study (measurement for 3 d), and dietary fluoride content was detected according to the "Method for Determination of Fluorine in Foods". The mean and standard deviation of drinking water fluoride intake, dietary fluoride intake, and total fluoride intake were measured. According to the dose-response relationship between children's total fluoride intake and the detection rate of dental fluorosis, BMD and BMDL were calculated, and the reference dose (RfD) was calculated based on BMDL.Results:The mean of water fluoride of all 29 villages was 1.26 mg/L (from 0.41 to 2.85 mg/L). Totally 3 043 children aged 8 to 12 years were checked, and the detection rate of dental fluorosis was 30.2% (919/3 034). The lowest detection rate of dental fluorosis was 2.0% (2/100) and the highest was 71.4% (30/42) in the 29 villages. The children's dietary and drinking water volume of 769 person-time aged 8 to 12 years were surveyed, the children's daily drinking water fluoride intake, dietary fluoride intake, and total fluoride intake were (0.83 ± 0.66), (1.13 ± 0.61) and (1.96 ± 0.89) mg/d, respectively. The BMD of children's daily total fluoride intake was 2.43 mg, the BMDL was 2.21 mg, and the RfD was 2.21 mg.Conclusion:The BMD of 8 to 12 years old children's daily total fluoride intake is the same as the allowable limit (2.4 mg) of the national standard "Total Fluoride Intake for Inhabitants" (WS/T 87-2016).

Objective To investigate the clinical and molecular biological characteristics of mixed_phenotypic acute leukemia (MPAL) with SET_NUP214 fusion gene positive and extramedullary infiltration. Methods The clinical characteristics, diagnosis and treatment of one MPAL patient with SET_NUP214 and extramedullary infiltration who was admitted to Hebei Yanda Ludaopei Hospital in November 2017 were analyzed, and the literature was reviewed. Results The patient was diagnosed as MPAL with extramedullary infiltration. Gene detection found SET exon7_NUP214 exon17 fusion positive accompanied with PHF6, SRSF2 and NRAS mutations. After intensive chemotherapy, the patient achieved complete remission, and then received hematopoietic stem cell transplantation (HSCT), followed by early extramedullary relapse after transplantation, and achieved secondary remission after consolidation chemotherapy. Conclusions MPAL with SET_NUP214 fusion gene positive and extramedullary infiltration has a poor prognosis, and it is easy to relapse. Currently, HSCT is the best available treatment strategy for such patients.

OBJECTIVE: To investigate the toxic effects of nano-sized neodymium oxide( nano-Nd_2O_3) on the central nervous system in mice. METHODS: Specific pathogen free female ICR mice were randomly divided into control group,lowdose group and high-dose group,with 12 rats in each group. The mice in low-dose group and high-dose group were treated with nano-Nd_2O_3 by nasal drip method at 80 and 160 mg/( kg·d) body weight for 30 days,while the mice in the control group were given 0. 9% sodium chloride solution. The water maze experiment and jump platform experiment were used to evaluate learning and memory ability. Hippocampus was examined using Hematoxylin-Eosin( HE) staining and glial fibrillary acidic protein( GFAP) immunohistochemical staining. The level of malondialdehyde( MDA) and the activity of total superoxide dismutase( T-SOD) in brain tissue were detected by microplate reader. RESULTS: The escape latency increased and the step down latency decreased in the low-dose group and high-dose group compared with the control group(P < 0. 05). No obvious pathological changes were observed by HE staining in brain hippocampus. Immunohistochemistry staining showed that the expression of GFAP protein in the hippocampal astrocytes of the low-and high-dose groups was higher than that in the control group,especially in the high-dose group,when compared with the control group. The MDA level increased and the T-SOD activity decreased in the low-and high-dose groups compared with the control group( P <0. 05). CONCLUSION: nano-Nd2 O3 can reduce the learning and memory ability of mice and increased GFAP expression in hippocampal astrocytes. The mechanism may be related to oxidative stress.

Objective To evaluate the efficacy and safety of remifentanil (RF) for analgesia of post-operative children with congenital heart disease in pediatric intensive care unit.Methods A total of 250 patients were enrolled and divided into 5 groups by random numerical table method.Patients in group RF1, RF2,RF3,SF and M was treated with at the doses of reminfentanil 1-3 μg/(kg·h),3-6 μg/(kg·h), 6-9 μg/(kg·h),sufentanil 0.08 μg/(kg·h) and morphine 20 μg/(kg·h) respectively.All the analgesias were given intravenously with midazolam 2 μg / ( kg·min) for sedative.We recorded the faces pain scale, Ramsay,vital signs(mean arterial pressure,heart rate),blood gas analysis,cortisol,ventilation time,times of contemporary sedation drugs and incidence of side effects in 24 hours after operation(1 h,4 h,8 h,12 h,24 h).Results The analgesic satisfaction in group M were lower than those in the other four groups at 1 h,4 h (P＜0.05),and the analgesic satisfaction in group RF3 were higher than those in group RF1 and RF2 at 1 h, 4 h,8 h(P＜0.05).Compared with group M and SF,group RF1,group RF2 and group RF3 had a more sta-ble hemodynamics (mean arterial pressure,heart rate).The times of contemporary sedative in group M were maximum among the 5 groups.The incidence of low blood pressure in group M was higher than those in the other four groups(P=0.06),while the incidence of respiratory depression in group RF3 was the most(P=0.06).There were also no significant differences in blood gas analysis,cortisol and ventilation time among each group.Conclusion The efficacy of remifentanil is superior to morphine.Compared with sufentanil and morphine,remifentanil has less influence on hemodynamics. We recommend the dose of remifentanil 3-6 μg/(kg·h),compound with midazolam 2 μg/(kg·min),which is more reliable and durable.

Objective To investigate the effect of social support and childbirth self-efficacy-enhancing intervention on primiparas' childbirth self-efficacy,coping ability and pain during labor.Methods A randomized controlled trial was used with double blindness design.One hundredand six primiparas were recruited as the intervention group and control group,53 cases in each group.The two groups adopted the routine prenatal care.In addition,the intervention group participated in twice childbirth self-efficacy-enhancing educational courses.The Chinese Childbirth Self-Efficacy Inventory (CBSEI) was used to conduct the comparison between before and after intervention;the interventional effects in the natural childbirth pregnant women were compared between the two groups by adopting the Visual Analogue Scale (VAS) and Childbirth Coping Behavior Scale (CCB);the Multidimensional Scale of Perceived Social Support (MSPSS) was adopted to analyze correlation between the social support level with the CBSEI and CCB.Results The intervention group finally had 52 cases of effective sample and the control group had 51 cases of effective sample.The CBSEI score after intervention in the intervention group was 282.04± 27.38,which was higher than 236.69± 45.39 before intervention.The CCB score in the intervention group was 56.78 ± 6.95,which was significantly higher than 48.03 ± 6.26 in thecontrol group,and the VAS score in the intervention group was 6.96 ± 1.39,which was lower than 8.35 ± 1.43 in the control group,the difference was statistically significant(P＜0.01).The MSPSS score in the two groups was positively correlated with the OE score,efficacy expectancy (EE) score and CBSEI score before intervention(r=0.269,0.289,0.317,P＜0.01).Conclusion Launching the childbirth self-efficacy-enhancing educational intervention of the social support system can effectively improve the childbirth self-efficacy and coping ability of primiparas,and reduce the intrapartum pain level.

Objective To analyze the electroencephalograph (EEG) features of 43 patients with clinically possible or probable Creutzfeldt-Jakob disease (CJD) and its correlation with megnetic resonance imaging (MRI) imaging and clinical manifestations.Methods All patients diagnosed with suspected CJD who were hospitalized in Xuanwu Hospital from January 2013 to December 2015 were collected.The clinical data, EEG and MRI imaging features were analyzed retrospectively.Based on the periodic sharp wave complexes (PSWC) appearance in EEG results, the patients were divided into typically changed group (TCG), atypically changed group (ACG) and unchanged group (UCG).Age, disease duration, clinical manifestations and MRI features among three groups were analyzed and the correlations between patient′s EEG features and age, disease duration, clinical manifestations or MRI features were explored using spearman method.Results Among the 43 patients with possible or probable CJD disease, 26 were male and 17 were female with an average disease duration of 4 months.The age of onset ranged from 31 to 80 with an average of (58.0±9.8) years old, and 86.0% of patients were 51 years old or above.Clinical characteristics of CJD patients according to occurrence rate were as follows: 35 cases (81.4%) with cognitive impairment, 29 cases (67.4%) with mental and behavior disorder, 28 cases (65.1%) with pyramidal tract damage, 24 cases (55.8%) with cerebellar symptoms, 23 cases (53.5%) with extrapyramidal symptoms,17 cases (39.5%) with myoclonic, 13 cases (30.2%) with dyssomnia, 13 cases (30.2%) with visual disorder and 2 cases (4.7%) with akinetic mutism.Regarding EEG features, 39.53% (17/43) of patients showed typical periodic sharp wave complexes (PSWC) (TCG group), 51.2% (22/43) had irregular rhythm and different forms of slow wave (ACG group) and only 9.3% (4/43) had no EEG change (UCG group).The occurrence rate of ribbon sign in MRI was 82.4% (14/17) in TCG group, 77.3% (17/22) in ACG group and none in UCG group.The rates were significantly higher in TCG and ACG group than that in UCG group (both P<0.05).Spearman correlation analysis revealed that EEG features was correlated with disease duration (r=0.351, P=0.021) and visual impairment (r=-0.377, P=0.013) for all CJD patients.There was no correlation between EEG and MRI or other clinical manifestations such as myoclonic, age and so on (all P>0.05).Conclusions EEG showed typical changes associated with disease duration in different stages of disease.EEG and MRI are two different means to evaluate different aspects of patients with CJD disease, and combination of two means could achieve better evaluation results.