Objective:To investigate the clinical features, diagnostic methods and treatments of left ventricular apical fibroma.Methods:The clinical manifestations, ECG, imaging features and treatment plans of 2 patients with giant fibroma of left ventricular apex diagnosed in September 2020 and May 2022 were analyzed retrospectively, and the related literature was reviewed.Results:Both patients had slight chest distress and discomfort after activities. The ECG showed T-wave inversion of different degrees, which were misdiagnosed as “myocarditis” and “coronary heart disease” respectively. The cardiac magnetic resonance imaging and echocardiography showed left ventricular apical mass. Coronary artery stenosis was not found in coronary angiography. One patient required conservative treatment, and there was no significant change in clinical symptoms and tumor size in the follow-up for half a year; Another patient underwent cardiac mass removal, and the pathological examination after operation confirmed that it was cardiac fibroma, and there was no recurrence in the follow-up 2 years.Conclusion:Fibroma of left ventricular apex is a rare cardiac tumor, which is easy to be missed and misdiagnosed, and is one of the rare causes of T-wave inversion. Cardiac magnetic resonance imaging, CT and echocardiography are commonly used imaging methods to diagnose cardiac fibroma, and surgical resection is an effective treatment.

Objective:To explore the influence factors of neurodevelopmental disorders in children with SCN8A-related early-onset epilepsy through analyzing their clinical characteristics and following up their neurodeve-lopmental status. Methods:A retrospective analysis was carried out on 21 children (13 males and 8 females, the age ranged from 4 months to 8 years, average 31.6 months)with SCN8A-related early-onset epilepsy treated in Guangzhou Women and Children′s Medical Center and Kunming Children′s Hospital between January 2017 and February 2021.All patients underwent whole-exome sequencing and Sanger sequencing.The pathogenicity was estimated according to the American College of Medical Genetics and Genomics guidelines.The clinical data of all patients were also collected, including the age of onset of the disease, forms of seizures, seizure frequency, neurological development at onset, electroencephalogram (EEG) and brain magnetic resonance imaging (MRI). Besides, the patients were followed up to acquire the effect of sodium channel blockers after the onset of seizures, the process or improvement of neurodeve-lopment, EEG evaluation and neurodevelopmental outcomes.Patients were grouped based on data analysis results.The Fisher′s exact test was conducted to measure the effect of various factors on the neurodevelopmental process and outcome, and corresponding coe-fficients were calculated. Results:The average onset age of 21 patients was 0-9 months.The follow-up duration was 4 months-8 years.Three cases died.Sixteen cases (76.2%) had early infantile epileptic encephalopathy (EIEE), 5 cases (23.8%) had epilepsy without encephalopathy, and 1 case had benign infantile epilepsy.Fourteen cases (66.7%) belonged to drug resistant epilepsy.Only one child showed normal neurodevelopment.Eleven children showed delayed neurodevelopment, but improvement was observed.Nine children were retrogressed and stagnated in terms of neurodevelopment.Small age at onset ( Fisher=9.517, P=0.020, r=0.571), high seizure frequency ( Fisher=10.512, P=0.003, r=0.572), EEG background ( Fisher=10.512, P=0.003, r=0.572), epileptic discharges ( Fisher=8.288, P=0.008, r=0.542), and EEG changes before and after treatment ( Fisher=10.437, P=0.009, r=0.586) were important factors affecting the neurodevelopmental process.Neurodevelopmental outcome was normal in only 1 case, 1 child belonged to mild mental retardation (MR), 7 children belonged to moderate MR, 3 children belonged to severe MR, and 9 children belonged to profound MR.Statistical analysis indicated that the clinical phenotype ( Fisher=10.059, P=0.004, r=0.739) and drug resistance ( Fisher=13.706, P=0.001, r=0.640) were significantly correlated with neurodevelopmental outcomes.However, the forms of seizures, EEG findings at onset and mutation sites were not related to neurodevelopmental disorders. Conclusions:Most children with SCN8A-related early-onset epilepsy are accompanied with neurodevelopmental retardation of varying degrees.Epileptic encephalopathy and poor response to drug treatment will lead to severe neurodevelopmental disorders.

Objective:To explore the effect of well-being therapy on fatigue and self-management efficacy of leukemia patients undergoing chemotherapy.Methods:From January 2018 to December 2019, totally 76 leukemia patients who undergoing chemotherapy were divided into experimental group and control group according to the enrolled time, with 38 cases in each group. Patients in the control group recieved routine nursing, the experimental group carried out well-being therapy. Before and after intervention, the effects were assessed by Cancer fatigue scale-Chinses version (CFS-C) and Strategies used by people to promote health-Chinses version (SUPPH-C), respectively.Results:After intervention, the physical fatigue, affective fatigue, cognitive fatigue, and total fatigue scores in CFS-C were 7.64±3.63, 7.28±1.60, 5.19±1.24 and 20.11±3.96 in the experimental group, significantly lower than those in the control group (9.57±3.52, 8.76±2.60, 6.08±1.62 and 24.41±3.86); the positive coping, stress reduction, making decisions, and total scores in SUPPH-C were 57.56±9.72, 40.11±5.99, 12.17±1.95 and 109.83±11.69 in the experimental group, significantly higher than in the control group (50.54±10.80, 36.70±7.62, 10.86±2.10 and 98.11±14.13), the difference was statistically significant ( t value was 2.119-3.856, P<0.05). Conclusion:Well-being therapy can effectively allivate cancer fatigue and promote self-management efficacy of leukemia patients undergoing chemotherapy.

Objective:To explore the accuracy and clinical application value of a Multi-Agent Reinforcement Learning framework (MARL framework) in three-dimensional ultrasound to automatically locate the coronal plane of the uterus.Methods:A total of 144 female patients who underwent routine gynecological examinations in Luohu People′s Hospital during May 2020 were selected as the experimental subjects. The three-dimensional volume data of the uterus of all the experimental subjects were collected by using the Resona-8 high-end color Doppler ultrasound system. A sonographer with more than 5 years of clinical experience manually locate the coronal plane of the uterus in all collected data, and at the same time automatically locate the coronal plane of the uterus MARL framework. The coronal plane images of the uterus obtained by the two methods were saved, and the operation time of the two methods was recorded. The coronal plane uterine images obtained by the two methods were mixed together, and the images were scored 0-1 by two senior ultrasound experts in a double-blind manner. The average score greater than or equal to 0.6 points was considered qualified.Results:①In 144 volunteers, among the coronal planes of the uterus located by the two methods, 131 were qualified by the manual method, and 137 were qualified by the automatic method.There was no statistical difference between the manual and automatic coronal plane images of the uterus (χ 2=1.934, P=0.164) by the chi-square test. ②Using interquartile range analysis, the median and interquartile range of the image score of the automatic group was 0.80(0.75, 0.90), while the median and interquartile range of the image score of the manual group was 0.80(0.75, 0.90). The Wilcoxon signed rank test was used to analyze the quality of the coronal plane images obtained by manual and automatic methods, and the difference was not statistically significant ( Z=1.241, P=0.215). ③The paired t test was used to compare the time required to locate the coronal surface of the uterus, by manual method (63.65±10.182)s, by automatic method (3.25±0.294)s, the difference between the two methods was statistically significant ( t=19.52, P<0.001). Conclusions:The method based on MARL framework has a high correlation with the manual locating of the coronal plane of uterus in three-dimensional ultrasound, and greatly reduces the operation time. It can be effectively applied in clinical practice and lays a foundation for the automatic diagnosis of uterine related diseases.

Objective:To investigate the implementation effect of micro-video assisted physiological theory teaching based on functional experiments.Methods:There were 140 clinical undergraduates (control group) from Class 1 and Class 2, and 123 clinical undergraduates (experimental group) from Class3 and Class 4 of Batch 2017 in our university who were involved in this study. The control group adopted traditional teaching method, the experimental group adopted micro-videos to assist traditional teaching in the teaching of selected chapters, and these micro-videos were collected from the recording and editing of functional experiments. After the course, questionnaire survey in terms of course design, implementation and effect, as well as final exanimation performance analysis were conducted to evaluate the teaching effect. SPSS 17.0 was used for t test. Results:The final examination scores of the experimental group were significantly higher than those of the control group [(81.02±9.64) vs. (73.41±11.39)], with significant differences ( t=-5.805, P<0.001). Among them, the scores of Chapter 2 of the two groups were [(8.07±0.94) vs. (6.14±1.05), t=-15.616, P<0.001)], the scores of Chapter 4 were [(16.16±1.79) vs. (10.90±2.23), t=-20.903, P<0.001)], and the scores of Chapter 6 were [(6.04±0.53) vs. (5.82±0.78), t=-2.638, P=0.009)], all with significant differences. 100% of questionnaires were recovered, and more than 90% of students were interested in this teaching method which could strengthen their understanding of the key and difficulties in physiology and was also helpful to cultivate their ability of induction and summarization. Conclusion:Micro-videos based on functional experiments assisted teaching can improve the teaching effect of physiology, and it's worth popularizing.

Objectives:To summarize the clinical and genetic characteristics of the patients with isolated methylmalonic acidemia and investigate the strategies for the diagnosis, treatment and prevention.Methods:Three hundred and fourteen patients (180 males, 134 females) with isolated methylmalonic acidemia were ascertained from 26 provinces or cities across the mainland of China during January 1998 to March 2020. Genetic analysis was performed by Sanger sequencing, gene panel sequencing, whole exome sequencing, multiplex ligation-dependent probe amplification or quantitative PCR. According to the age of onset, the patients were divided to early-onset group (≤12 months of age) and the late-onset group (>12 months of age). They were treated by cobalamin, L-carnitine and (or) special diet and symptomatic treatment. Statistical analysis was done using Chi-square test.Results:Fifty-eight of 314 (18.5%) patients were detected by Newborn screening using liquid chromatography tandem mass spectrometry. Five cases (1.6%) had a postmortem diagnosis. Two hundred and fifty-one patients (79.9%) were clinically diagnosed with an age of onset ranged from 3 hours after birth to 18 years. One hundred and fifty-nine patients (71.0%) belonged to early-onset groups, 65 patients (29.0%) belonged to the late-onset group. The most common symptoms were metabolic crises, psychomotor retardation, epilepsy, anemia and multiple organ damage. Metabolic acidosis and anemia were more common in early-onset patients than that in late-onset patients (20.8%(33/159) vs. 9.2% (6/65), 34.6% (55/159) vs. 16.9% (11/165), χ 2=4.261, 6.930, P=0.039, 0.008). Genetic tests were performed for 236 patients (75.2%), 96.2%(227/236) had molecular confirmation. One hundred and twenty-seven variants were identified in seven genes (MMUT, MMAA, MMAB, MMADHC, SUCLG1, SUCLA2, and MCEE), of which 49 were novel. The mut type, caused by the deficiency of methylmalonyl-CoA mutase, was the most common ( n=211, 93%) cause of this condition. c.729_730insTT, c.1106G>A and c.914T>C were the three most frequent mutations in MMUT gene. The frequency of c.914T>C in early-onset patients was significantly higher than that in late-onset patients (8.3% (18/216) vs. 1.6% (1/64), χ 2=3.859, P=0.037). Metabolic crisis was more frequent in mut type than the other types (72.6% (114/157) vs. 3/13, χ 2=13.729, P=0.001),developmental delay and hypotonia were less frequent in mut type (38.2% (60/157) vs. 9/13, 25.5% (40/157) vs. 8/13, χ 2=4.789, 7.705, P=0.030, 0.006). Of the 58 patients identified by newborn screening, 44 patients (75.9%) who were treated from asymptomatic phase developed normally whereas 14 patients (24.1%) who received treatment after developing symptoms exhibited varying degrees of psychomotor retardation. Conclusions:The characteristics of phenotypes and genotypes among Chinese patients with isolated methylmalonic acidemia were analyzed. Expanded the mutation spectrum of the associated genes. Because of the complex clinical manifestations and severe early onset of isolated methylmalonic acidemia, Newborn screening is crucial for early diagnosis and improvement of prognosis. MMUT gene is recommended for carrier screening as an effort to move the test earlier as a part of the primary prevention of birth defects.

Objective To investigate the effectiveness of Microlecture plus PowerPoint (PPT) in physiology experiment teaching.Methods The students of clinical medicine in Grade 2015 of Hubei University of Medicine were selected as the subjects.Among them,61 students in Class 1 were studied as the control group,while 59 students in Class 2 as the experimental group.The control group adopted the traditional teaching method and required students to complete the experimental report with handwriting,while the experimental group adopted teaching method of Microlecture plus PPT.In the experimental group,students watched the microlecture for preview and could also repeat watching at any time to correct the mistakes during the operation.After class,students of the experimental group were required to complete the experiment report in the form of PPT and send it to the teacher through QQ within the prescribed time.The learning outcomes were evaluated by using descriptive analysis and t test based on the class operation,final examination and questionnaire.Results Both the average score of experiment operation and the average scoreof final theory exam in the experimental group were higher than those of the control group [(95.074 ± 3.233) vs.(81.706 ± 2.901) and (92.204 ± 3.074) vs.(77.913 ± 2.611)],and the differences were of statistical significance(P＜0.05).The recovery rate of questionnaire survey was 100％ in the experimental group.Over 80％ students thought Microlecture plus PPT could help enhance autonomous learning ability,deepen the understanding of theory and increase group cooperation ability,et al.Conclusion Microlecture plus PPT teaching can improve the teaching effect of physiology experiment teaching,which is worthy of promotion.However,it is still necessary to combine other teaching methods to achieve better teaching results.

Objective To evaluate the effects of Ulinastatin (UTI) on the expressions of TNF-α,IL-6 and neurons apoptosis in cerebral cortex of rats after cardiopulmonary resuscitation (CPR).Methods Thirty-six healthy male adult Wistar rats were induced ventricular fibrillation untreated for 7 min and then received CPR.The animals were infused UTI 100 000 U/kg or phosphate-buffered solution (PBS) at once after ROSC.At 2,4 and 8 h after ROSC,cerebral cortex were removed to determine the mRNA expressions and levels of TNF-α protein and IL-6 protein,the translocation ratio of NF-κB p65 from cytoplasm to nucleus and the apoptotic neurons.Results The plasma levels of TNF-α (ng/mL) in animals of UTI group were (17.7 ± 1.4),(21.9 ± 2.1) and (17.1 ± 0.6) at 2,4 and 8 h after ROSC respectively,and significantly lower than those in PBS group at the given intervals.Mean while,the levels of IL-6 (ng/mL) were (208.9 ± 14.1),(281.5 ±25.9) and (251.8 ± 15.3) at 2,4 and 8 h after ROSC respectivèly in animals of UTI group,and lower than those in PBS group.The expressions of TNF-α mRNA and IL-6 mRNA and protein levels of TNF-α and IL-6 in UTI group were both lower than those in PBS group at given intervals,respectively.The translocation ratio of NF-κB p65 from plasma to nucleus in PBS group at each given interval after ROSC was significantly higher than that in UTI group.The number of viable neurons in cerebral cortex in UTI group was higher than that in PBS group,while the number apoptosis neurons was fewer in UTI group.Conclusions UTI attenuated the general inflammatory response after ROSC in rat,decreased the activation of NF-κB pathway,and subsequently attenuated the expression of TNF-α and IL-6,and finally decreased the neurons apoptosis.

Objective To study the expression of Gult-1 in cervical adenocarcinoma and prognosis analysis.Methods Gult-1 was detected by immunohistochemistry (EnVision) in cervical adenocarcinoma and cancer adjacent tissue.Results In cancer adjacent tissue and cervical adenocarcinoma,the positive rates of Gult-1 were 2.22 ％ (1/45),58.67 ％ (44/75),respectively,and there was statistical significance between them (x2 =38.23,P =0.00).The expression of Gult-1 was not correlated to age,histological classification and infiltrated depth (all P ＞ 0.05).However,it was correlated to tumor size,histological grade and lymphatic nodes metastasis (all P ＜ 0.05).The survival rate of positive Gult-1 patients was lower than negative Gult-1 patients (x 2 =4.27,P =0.04).Conclusion The over-expression of Guh-1 in cervical adenocarcinoma indicates poorly differentiated cancer,the possibility of lymphatic nodes metastasis and unfavourable prognosis.

Based on the developing trend of laboratory medicine and the internal rules of discipline construction,series of research and reform practices in the curriculum system were put forward,including practice teaching,innovation education and instructional technology for laboratory medicine.An innovation talents training mode for laboratory medicine is gradually formed and innovative education is pushed on systematically,effectively and abidingly.The new mode has made periodical results and good prospects in cultivating students with innovative quality and ability.