Objective To investigate the effect and mechanism of microRNA-10b(miR-10b)on idiopathic short stature(ISS).Methods A total of 54 children with ISS and 54 healthy children were collected.The serum expression of miR-10b was detected by RT-qPCR,and the relationship between serum miR-10b expression and clinical data of children with ISS was analyzed.miR-10b inhibitor,si-TGFBR1 and their negative control transfection C28/I2 cells were used.CCK-8 experimental detection was used to detect C28/I2 cell proliferation.Western blot assay was used to detect gnome related transcription factor 2(RUNX2),collagen type X alpha 1 chain(COL10A1),transforming growth factor beta receptor 1(TGFBR1),SMAD3 and pSMAD3 protein expression.The target of miR-10b was screened in StarBase database,and the targeting relationship between miR-10b and TGFBR1 was verified by dual luciferase reporter gene assay.Results The serum expression of miR-10b was higher in the ISS group than that of the healthy control group,and the higher the miR-10b expression,the more obvious the decrease of child height,IGF-1 and alkaline phosphatase(P＜0.05).Compared with the NC group,the cell proliferation ability and RUNX2,COL10A1,TGFBR1,and pSMAD3 protein expression were up-regulated in the miR-10b inhibitor group(P＜0.05).StarBase database suggested that miR-10b had a binding site of TGFBR1,and dual luciferase reporter gene assay confirmed that TGFBR1 interacted with miR-10b(P＜0.05).Compared with the si-NC group,the expression of TGFBR1 was down-regulated and the cell proliferation ability was decreased in the si-TGFBR1 group(P＜0.05).Conclusion miR-10b inhibits chondrocyte proliferation and hypertrophy in idiopathic short stature by targeting TGFBR1/SMAD3 pathway.

Objective To explore the application value of multimodal MRI in the preoperative staging of cervical cancer.Methods The preoperative imaging data of 60 patients with cervical cancer confirmed by surgical pathology or biopsy were analyzed retro-spectively.The results of preoperative staging by multimodal MRI and postoperative pathological staging were compared.The diag-nostic accuracy of multimodal MRI in staging of cervical cancer was evaluated.Results Among the 60 cases,the preoperative staging results of multimodal MRI were 25 ⅠB,20 ⅡA1,9 ⅡA2,and 6 ⅢC.While the postoperative pathological staging results were 27 Ⅰ B,18 ⅡA1,9 ⅡA2,and 6 ⅢC.The staging results achieved by preoperative multimodal MRI and postoperative pathological staging were in good agreement.With the postoperative pathological staging as the gold standard,the diagnostic accuracy of multimodal MRI in preoperative staging was 100.00%(25/25),85.00%(17/20),77.78%(7/9),and 83.33%(5/6),respectively.Conclusion Multimodal MRI has a high accuracy in the preoperative staging of cervical cancer which can be used as a routine evaluation tool for the accurate preoperative staging of cervical cancer in clinical work.

Objective To investigate the application value of multimodality MRI in diagnosing placenta accreta(PA).Methods The imaging data of 62 patients with PA confirmed by clinical intraoperative diagnosis or postoperative pathology were analyzed retrospectively,and the diagnostic accuracy of multimodality MRI for PA was assessed by comparing multimodality MRI manifestations with clinical intraoperative diagnosis or postoperative pathology findings.Results According to the multimodality MRI findings,62 cases of PA were divided into adhesive PA(n=10),implanted PA(n=39),and penetrating PA(n=13).According to the clinical intraoperative diagnosis or postoperative pathology,62 cases of PA were divided into adhesive PA(n=10),implanted PA(n=40),and penetrating PA(n=12).The multimodality MRI manifestations were in good agreement with clinical intraoperative diagnosis or postoperative pathology,with an overall accuracy of 88.7％.Taking clinical intraoperative diagnosis or postoperative pathology as the"gold standard",the accuracy of multimodality MRI in diagnosing adhesive PA,implanted PA,and penetrating PA were 87.10％,88.71％,and 91.94％,respectively;the sensitivity were 70.00％,92.50％,and 91.67％,respectively;and the specificity were 94.00％,85.71％,and 97.87％,with Kappa values of 0.640,0.815 and 0.848,respectively.Conclusion Multimodality MRI has a high accuracy in diagnosing PA and can be used as a routine screening method for PA in clinical practice.

Objective:To investigate the clinical characteristics, diagnosis and treatment of mycoplasma pneumoniae(MP) pneumonia in children with pseudo-macrocytic erythrocytes.Methods:The clinical data of 50 children with mycoplasma pneumoniae pneumonia with pseudo-macrocytic erythrocytes in the Department of Pediatrics at Shengjing Hospital of China Medical University from January 2019 to August 2020 were analyzed retrospectively.Results:Among the 50 cases, there were 32 boys and 18 girls.The blood routine examination showed that pseudo-macrocytic erythrocytes, red blood cells decreased significantly, mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration increased significantly, as well as MP-IgM was positive.Sixteen cases were complicated with herpes simplex virus infection, one with Epstein Barr virus infection, and six with both herpes simplex virus and Epstein Barr virus infection at the same time.All 50 cases were MP pneumonia, pulmonary imaging showed lobar pneumonia, and 25 cases were complicated with pleural effusion, including 32 cases of refractory MP pneumonia.The clinical symptoms of three cases were extrapulmonary manifestations, hemolytic anemia and diagnosed with cold agglutinin syndrome.In 36 children with D-dimer more than 252 μg/L, one case had femoral vein thrombosis and one case had pulmonary embolism.Conclusion:Pseudo-macrocytic phenomenon may play important roles in clinical etiological diagnosis, severity of disease and refractory MP pneumonia.The children with hemolytic anemia suggest cold agglutinin syndrome, and the hypercoagulable state of MP infection may be related to the aggregation of red blood cells caused by cold agglutinin in MP infection.

Objective To investigate the clinical features,pathogenic distribution of children with in-fective endocarditis(IE)during the past 10 years.Methods Medical records of 30 children with IE admitted to Shengjing Hospital of China Medical University from October 2006 to October 2016 were retrospectively analyzed,including the clinical data and pathogenic characteristics.Results Among the 30 cases of IE,there were 18 males and 12 females,age ranged from 2 months to 13 years old.Fever was found as initial symp-toms in 21 cases(70.0%),respiratory symptoms in 4 cases(13.3%),neurological symptoms in 4 cases (13.3%),edema in 2 cases(6.7%),murmur in 1 case,precordial discomfort in 1 case,and peripheral blood cell reduction in 1 case. The most common underlying factor was congenital heart disease(17 cases, 56.7%).Surgery was performed in 6 children due to congenital heart disease before endocarditis.Vegetations were detected on echocardiography in all cases(100%).Blood cultures were positive in 50.0%,Staphylococ-cus aureus was the most common organism,accounting for 6 cases (40.0%).Other notable pathogens in-cluded Streptococcus pneumoniae(4 cases,26.7%),Enterococcus faecalis(2 cases,13.3%),Streptococcus suis(1 case),Streptococcus anginosus(1 case) and Staphylococcus epidermidis(1 case).C-reactive protein was raised in 25 cases(83.3%)at the time of admission.C-reactive protein was higher than 100 mg/L in 8 cases.Conclusion Early clinical manifestations of IE are atypical.Fever is the most common symptom. Congenital heart disease is the major risk factor of IE,Gram-positive cocci is the most common organism. Antibiotic treatment is not effective,then surgical treatment may be considered.

Objective To investigate the high risk factors of new dysfunction in Pediatric Intensive Care Unit.Methods A retrospective cohort case control analysis was performed in order to investigate the 906 patients admitted to the Pediatric Intensive Care Unit of Shengjing Hospital of China Medical University from January 2015 to January 2016.Assessment of Functional Status Scale(FSS) was performed at both admission and discharge.According to the new dysfunction diagnostic criteria,all cases were divided into new dysfunction group and control group.The 2 groups were compared in gender,glucocorticoids application time,mechanical ventilation application time,sedation application time,neuromuscular blockers application time,albumin,alanine aminotransferase,aspartate aminotransferase,creatine kinase,creatine kinase isoenzyme,leukocyte,hemoglobin and C-reactive protein.Multivariate Logistic regression was used to screen the risk factors leading to new dysfunction.All cases were divided into high risk factors group and control group according to the risk factors.The 2 groups were compared in initial FSS,FSS of discharge,ΔFSS and the discharge FSS of mental status domain,FSS of sensory domain,FSS of communication domain,FSS of motor domain,FSS of feeding domain,and FSS of respiratory domain.Results Among the 906 cases,547 cases were male and 359 cases were female,and average age was (28.1-± 1.9) months.There were 81 cases in new dysfunction group and 825 cases in control group.Factors such as mechanical ventilation application time [(3.7 ±-0.5) d vs.(1.1 ±-0.1) d],glucocorticoid application time [(3.2-±0.6) d vs.(1.7-±0.1) d],sedation application time[(4.7 ±0.7) d vs.(1.7 ±0.1)d],neuromuscular blockers application time [(0.7 ± 0.3) d vs.(0.1 ± 0.03) d],albumin [(35.6 ± 0.8) g/L vs.(40.5 ± 0.2) g/L],creatine kinase isoenzyme [(75.8 ± 12.4) U/L vs.(49.7 ± 2.6) U/L] had significant differences between the new dysfunction group and the control group(all P ＜ 0.05).Multivariate Logistic regression analysis revealed that more than 7 days of mechanical ventilation,more than 7 days of glucocorticoids application,more than 7 days of sedation application,hypoalbuminemia were risk factors to develop new dysfunction [OR =0.69 (95％ CI:0.62-0.78),OR=0.62 (95％ CI:0.75-0.94),0R=0.75 (95％ CI:0.68-0.84),0R=0.68 (95％ CI:1.06-1.16),all P ＜0.05].In the more than 7 days of mechanical ventilation group,FSS at discharge,FSS of mental status,FSS of sensory,FSS of communication,FSS of motor,FSS of feeding,FSS of respiratory were significantly different from those of the mechanical ventilation application time ≤ 7 d group (all P ＜ 0.05).In the more than 7 days of glucocorticoids application group,FSS of mental status,FSS of sensory,FSS of communication were significantly different from those of the glucocorticoids application time ≤7 d group (all P ＜ 0.05).In the more than 7 days of sedation application group,FSS at discharge,FSS of mental status,FSS of sensory,FSS of communication,FSS of motor were significantly different from those of the sedation application time ≤7 d group(all P ＜ 0.05).Concltsion More than 7 days of mechanical ventilation,glucocorticoids application and sedation application not only increase the incidence of new dysfunction,but also affect mental,sensory,communication,motor function,the muscle and cognitive function at discharge and prognosis.

Objective: To investigate the incidence and clinical characteristics of new-onset organ dysfunction of patients in pediatric intensive care unit (PICU). Method: A retrospective observational study identified all patients admitted to the PICU of Shengjing Hospital Affiliated to China Medical University from January 2015 to January 2016. The functional status score (FSS) was evaluated at admission and hospital discharge respectively, and the difference defined as ΔFSS between the FSS at hospital discharge and the FSS at admission was calculated. According to the initial FSS, the patients were divided into normal group (6-7 scores), mildly abnormal group (8-9 scores), moderate abnormal group (10-15 scores), severe abnormal group (16-21 scores) and extreme severe abnormal group (22-30 scores). According to the primary disease, all cases were divided into cardiovascular disease group, urinary disease group, surgery group, digestive disease group, neurological disease group, respiratory disease group, hematological disease group, poisoning group and other group. According to the FSS domain, all cases were divided into mental status group, sensory group, communication group, motor group, feeding group, respiratory group. The incidence of new-onset organ dysfunction, the case fatality rate and the FSS of each group were calculated. Comparisons were performed using a chi-square test, t test and analysis of variance. Result: The study population included 928 patients (561(60.5%) male, mean age (31.1±1.3) months). The incidence of new-onset organ dysfunction was 8.8%(82/928) and the case fatality rate was 1.3%(12/928). The FSS at hospital discharge(scores), ΔFSS (scores) and the incidence of new-onset organ dysfunction were significantly less in patients in the normal group (6.38±0.17, -0.20±0.17 and 1.3%(3/229), respectively) compared to patients in the mildly abnormal group (7.09±0.27, -1.39±0.27 and 7.2%(12/170), respectively, t=2.36, 3.93, χ²=7.39, all P<0.05), patients in the moderately abnormal group (8.86±0.28, -2.76±0.28 and 10.6%(38/359), t=6.56, 6.91, χ²=17.14, all P<0.05), patients in the severely abnormal group(13.56±0.88, -4.39±0.88 and 24.6%(19/79), t=12.29, 7.13, χ²=42.43, all P<0.05) and patients in the extreme severely abnormal group(18.68±0.99, -6.59±0.91 and 10.9%(10/91), t=18.15, 10.10, χ²=13.27, all P<0.05). Significant difference was found regarding the incidence of new-onset organ dysfunction among patients in cardiovascular disease group (27.3%, 24/88), surgery group (9.2%, 6/65), digestive disease group (8.2%, 8/97), neurological disease group (7.7%, 23/299), respiratory disease group (6.9%, 17/248), hematological disease group (3.9%, 2/51) and toxic group (0, 0/61) (χ²=37.75, all P<0.05). There were significant differences among primary disease groups regarding the FSS at admission, the FSS at hospital discharge, ΔFSS, Δmental status FSS, Δsensory FSS, Δcommunication FSS, Δmotor FSS, Δfeeding FSS, and Δrespiratory FSS (F=13.56, 8.97, 10.84, 6.30, 7.37, 7.84, 7.47, 9.97, 10.50, all P<0.05). Conclusion The incidence of new-onset organ dysfunction in PICU was high. The case fatality rate in patients with new-onset organ dysfunction was high. The functional status at hospital discharge was strongly associated with the functional status at admission. Patients in the cardiovascular disease group had the highest incidence of new-onset organ dysfunction and the most severe deterioration of functional status.More attention must be paid to motor function and respiratory function in cardiovascular disease, respiratory disease and hematological disease.

Objective:To understand the effect and existing problems of teaching reform about primary health care demands in local medical universities and colleges.Methods:With sampling survey method,150 students from Xi'an Medical College were investigated using questionnaires.Results:Totally 93.1％ of the freshmen approved of setting up the courses,72.6％ of the students thought that nursing ethics and skills were equally important,43.2％ of the students thought learning this course made themselves have a new understanding of nursing ethics.Totally 84.2％ of the students were satisfied with the teacher's teaching process,while 69％ of the students were not satisfied with the existing teaching materials.Conclusion:The teaching method oriented by practical problems and the teachers' own efforts are prerequisites for students' acceptance of this course.Content setting based on post needs is an important link of nursing ethics teaching effect.Setting up sustainable teaching time is the basis of the teaching effect.High quality teaching materials are necessary conditions to achieve the teaching orderly.

Objective To investigate the diagnostic value of plasma B-type natriuretic peptide(BNP) in left to right shunt congenital heart disease accompanied by heart failure in PICU.Methods We retrospectively reviewed the clinical data of 52 cases diagnosed left to right shunt congenital heart disease in the PICU of Shengjing Hospital of China Medical University from January 2012 to June 2014.The cases were divided into negative control group(n=18) and heart failure group(n=34) according to the criteria for the diagnosis of pediatric heart failure.We respectively compared plasma BNP,size of heart defects,left ventricular end-diastolic volume index(LVEDVI),ratio of left ventricular early diastolic filling blood flow velocity and left ventricular late diastolic filling blood flow velocity(E/A),left ventricular ejection fraction(LVEF),pulmonary artery systolic pressure(PASP),and cardiothoracic ratio between the two groups.We analyzed the correlation between plasma BNP and the size of heart defects,LVEDVI,E/A,cardiothoracic ratio,LVEF,PASP.The receiver operating characteristic curve was used to determine the optimal cut-off value of plasma BNP to diagnose heart failure.Results Plasma BNP were 87.7(22.7,165.7)pg/ml in negative control group and 716.5(326.8,1813.0)pg/ml in heart failure group.The plasma BNP level of heart failure group was significantly higher than that of negative control group(Z=5.3,P<0.01).Size of heart defects were 5.0(3.0,6.8) mm in negative control group and 7.4(5.5,9.0)mm in heart failure group.Size of heart defects of heart failure group was significantly higher than that of negative control group(Z=3.5,P<0.01).LVEDVI were (44.6±18.3)ml/m3 in negative control group and (70.8±38.4)ml/m3 in heart failure group.LVEDVI of heart failure group was significantly higher than that of negative control group(t=2.7,P=0.01).E/A were 1.3±0.3 in negative control group and 1.1±0.3 in heart failure group.E/A of negative control group was significantly higher than that of heart failure group(t=2.2,P=0.04).Plasma BNP had a positive relation with cardiothoracic ratio(r=0.49,P=0.01) and a negative correlation with E/A(r=-0.28,P=0.04).The optimal cut-off value of plasma BNP was 181.8 pg/ml.The sensitivity of diagnosis of heart failure was 94% and the specificity was 88%.The area under the receiver operating characteristic curve was 0.951.Conclusion Plasma BNP may comprise a sensitive marker for heart failure of left to right shunt congenital heart disease.It is recommended that 181.8 pg/ml is the optimal cut-off value to diagnose heart failure of left to right shunt congenital heart disease.

Objective To evaluate the feasibility of the combination of amplification refractory mutation system (ARMS) and quantitative real-time polymerase chain reaction (PCR) method in fast detection of clarithromycin resistance of Helicobacter pylori (H.pylori) in gastric mucosa.Methods A total of 150 gastric mucosal specimens with positive H.pylori culture were collected from the H.pylori positive patients who failed in H.pylori eradication from January to August in 2013.The drug resistant gene mutation types of H.pylori in these samples were detected by quantitative real-time PCR based on ARMS.And the accuracy was confirmed by sequencing.The clarithromycin resistance of H.pylori was determined by E-assay.Chi-square test was used for statistical analysis.Results Among 149 gastric mucosal specimens (one specimens without wild type or mutation type had been eliminated),the results of quantitative real-time PCR based on ARMS of two samples were not consistent with the results of sequencing;the consistent rate was 98.7％ (147/149).Among 149 specimens with positive H.pylori culture,104 samples (69.8％) were clarithromycin resistance.In 101 samples the clarithromycin resistance was detected by quantitative real-time PCR based on ARMS;the consistent rate was 97.1％ (101/104).Both E-assay and clarithromycin resistant rate detected by E-assay or quantitative real-time PCR based on ARMS was 69.8％ (104/149) and 67.8％ (101/149),respectively,and the difference was not significant (x2 =0.141,P=0.932).Conclusion The combination of ARMS and quantitative real-time PCR method in fast detection of clarithromycin resistance of H.pylori in gastric mucosa is strongly feasible and highly consistent has high consistent rate with sequencing and E-assay.