Objective To investigate the effect of teaching method using students as standardized patients on clinical practice teaching of neurology.Methods We randomly assigned 80 undergraduate majoring in clinical medicine into two groups:a control group where students were instructed with traditional clinical teaching methods,and an experimental group where students acted as standardized patients.Following the clinical placement,we administered an Objective Structured Clinical Exam-ination(OSCE)and a satisfaction survey to all participants.Results The experimental group performed significantly better than the control group in history taking and neurological examination in the OSCE(P＜0.05).The results of the questionnaire showed that the experimental group scored significantly higher than the control group in improving clinical thinking,stimulating learning interest,and improving communication skills(P＜0.05).Conclusion The teaching methods using student as standardized pa-tients in the process of clinical practice in neurology helps to improve the history taking and neurological physical examination skills of clinical students,yielding good educational outcomes.

Objective: To explore the relationship between fruit intake and the risk of overweight with obesity in children, so as to provide references for the prevention of childhood obesity. Methods: From September to November 2014, a stratified cluster sampling method was used to select 6 369 children aged 6-12 from two elementary schools of a country in rural Chongqing for physical examinations and questionnaire surveys, and 1 814 children in grades 1-2 at baseline were followed up from March to May 2019. The relationship between fruit intake and the prevalence of overweight and obesity was analyzed. Results: According to the percentile of fruit intake, the 6 369 children at baseline were assigned to three groups: Q 1 (< P 33.3 , fruit intake <100 g/d), Q 2 ( P 33.3 - P 66.7 , fruit intake:100-214.3 g/d), and Q 3 (> P 66.7 , fruit intake >214.3 g/d). For the baseline survey results, children in the Q 2 group had a lower weight and Body Mass Index (BMI) ( P <0.05); the prevalence of overweight and obesity among children in the Q 1 group was the highest (32.03%), and the prevalence of overweight and obesity among boys in the Q 2 group was the lowest (31.94%) after gender stratification ( P <0.05). The follow up survey results showed no significant differences between the three groups in terms of changes in height, weight, and BMI ( P >0.05); but the prevalence of obesity among youth in the Q 2 group was the lowest (5.07%, P <0.05). Compared with youth in the Q 2 group, the risk of obesity was higher among those in the Q 1 group at baseline survey ( OR=1.41, 95%CI=1.10-1.81, P <0.05), and was higher among those in the Q 3 group at follow up survey ( RR= 1.83, 95%CI=1.21-2.75, P <0.05). Conclusion Deviating from moderate fruit intake may increase the likelihood of overweight and obesity in children, and it is recommended that children are encouraged to consume fruits as part of a well balanced diet to prevent the occurrence of obesity.

【Objective】 To explore the safety and efficacy of a novel endoscopic two-wire guided dilation in the creation of channels in percutaneous nephrolithotomy (PCNL). 【Methods】 Clinical records of 180 patients undergoing PCNL during Oct.2020 and Oct.2022 were retrospectively analyzed. The patients were divided into three groups, 60 in AMD group (fascial amplatz dilation), 60 in OSD group (one shot dilation) and 60 in END group (endoscopic dilation). Time to establish channels, operating time, failure of access, stone clearance rate, drop in hemoglobin, embolization rate, fever rate, blood transfusion rate and postoperative hospitalization were compared among the three groups. 【Results】 There were no significant differences in the general data among the three groups (P>0.05). Compared with AMD and OSD groups, END group needed significantly reduced time to establish the first channel [(5.6±0.8) min vs. (4.9±1.4) min vs. (4.2±0.5) min, (P<0.05)] . Compared with OSD group, END and AMD groups had significantly more hemoglobin drop [(14.0±17.6) g/L vs. (19.4±12.6) g/L vs. (10.2±6.8) g/L, (P<0.05)] . There were no significant differences in terms of failure of establishing channels, operating time, stone clearance rate, embolization rate, fever rate, blood transfusion rate and postoperative hospitality. Four patients needed selective renal artery embolization (1 case in AMD group and 3 in OSD group). No serious complications such as organ injuries, septic shock or death occurred. 【Conclusion】 Endoscopic two-wire guided dilation is simple, with few complications and good application value.

Objective:investigate the effect of serum uric acid (SUA) on long-term cerebrovascular mortality and recurrent stroke in patients with acute cerebral infarction.Methods:A total of 132 patients from the same center were enrolled in this study. The patients were divided into three groups according to the quartile level of SUA: group 1 (SUA < 442 μmol/L, n= 69) , group 2 (SUA 442-620 μmol/L, n=35) and group 3 (SUA > 620 μmol/L, n= 28). SUA, blood urea nitrogen, serum creatinine, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total cholesterol, triglyceride and hypersensitive c-reactive protein (hs-CRP) were measured in the three groups, the National Institutes of Health Stroke Scale (NIHSS) score was determined on the day of admission, and the patients were followed up until December 31, 2020. The differences of recurrent stroke and cerebrovascular mortality in the three groups were analyzed. Results:Sixty-nine patients were selected in group 1, 35 in group 2 and 28 in group 3. Patients in group 2 and group 3 were younger, and had higher hs-CRP levels, higher SUA levels, and higher rates of recurrent stroke and cerebrovascular mortality, and the differences were statistically significant (all P<0.05). Cerebrovascular mortality (log-rank χ2 =13.19, P=0.001) and recurrent stroke (log-rank χ2 =10.30, P=0.006) were significantly increased in group 3. The risk of recurrent stroke in group 3 was 3.55 times higher than that in group 1. Conclusions:The risks of long-term cerebrovascular mortality and recurrent stroke were significantly increased in patients of acute cerebral infarction with elevated serum uric acid.

Objective:To explore the early prognosis on patient of idiopathic pulmonary fibrosis (IPF) combined with different degrees of pulmonary arterial hypertension (PAH) undertake lung transplantation (LTx).Methods:From January 2017 to December 2020, the clinical data of 134 patients with IPF who underwent LTx in Wuxi People's Hospital were analyzed retrospectively. According to the average pulmonary artery pressure detected by right cardiac catheter before operation, the patients were divided into mild PAH group (63 cases), moderate PAH group (47 cases) and severe PAH group (24 cases). The donor data and the recipient's preoperative, intraoperative and postoperative data were collected; the postoperative survival curve to analyze early survival among the three patient groups.Results:With the increase of pulmonary artery pressure, the rate of abnormal right ventricular function increased, the end diastolic diameter of left ventricle decreased before operation, and the rate of using veno-arterial extracorporeal membrane oxygenation (V-A ECMO) increased during the surgery ( P<0.05). Multivariate analysis found that combined severe PAH had significant effects on primary graft dysfunction (Primary graft dysfunction, PGD), retracheal intubation or tracheotomy, hypovolemic shock within 72 h, and 6-month survival after LTx. The survival surve showed that 30-day survival rates of patients with IPF complicated with mild, moderate and severe PAH were 85.7%, 80.8% and 66.7% respectively, and the 6-month survival rates were 80.9%, 74.0% and 62.2%, respectively. Conclusion:Patient of IPF combined with different degrees of PAH had a significant impact on cardiac function and intraoperative ECMO selection of LTx, and severe PAH could significantly reduce the early survival rate after LTx.

Objective To investigate the pathology, epidemiology of severe pneumonia in Xicheng District of Beijing. Methods From 2014 to 2020, in 3 sentinel hospitals, collected and detected the respiratory tract specimens of the severe pneumonia patients. Multiple pathogens including Stenotrophomonas maltophilia, Streptococcus pyogenes, Staphylococcus aureus, Klebsiella Pneumoniae, Haemophilus influenzae, Legionella pneumophila, Mycobacterium tuberculosis, Acinetobacter baumannii, Moraxella catarrhalis, Escherichia coli, Streptococcus pneumoniae, Pseudomonas aeruginosa, Pneumocystis,Parainfluenza virus, Bocavirus, Rhinovirus, Coronavirus, Influenza, Human metapneumovirus, Adenovirus, Respiratory syncytial virus, Enterovirus, Mycoplasma pneumoniae, Chlamydia pneumoniae were detected with PT-PCR. Analyze epidemic characteristics of the cases. Results Of the 1 247 respiratory samples cultured during the period from 2014 to 2020, 560(44.91%) are positive. The positive rates of virus(29.91%) is higher than Bacteria(20.21%). The top five pathogens were Acinetobacter baumannii(9.22%), Pseudomonas aeruginosa(8.26%), Stenotrophomonas maltophilia(7.78%), Klebsiella Pneumoniae（6.74%） and Parainfluenza virus（6.58%）. Conclusion There was a variety of pathogen in the severe pneumonia patients. Acinetobacter baumannii, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Klebsiella Pneumoniae and Parainfluenza virus were the main pathogens of respiratory infections in Xicheng district of Beijing. It is necessary to strengthen the surveillance of the disease.

Objective:To investigate the effect of hyperuricemia treatment on vascular endothelial function and blood pressure in patients with acute cerebral infarction.Methods:A total of 138 cases from the same center were enrolled in the study. 92 cases of acute cerebral infarction patients combined with hyperuricemia were selected. They were randomly divided into the experimental group (46 cases) and control group (46 cases). 46 cases of acute cerebral infarction patients with normal uric acid were selected in the same period. Patients in the experimental group received oral allopurinol for 3 months to treat hyperuricemia. Serum uric acid, blood lipid, and hs-CRP were tested before and after treatment in these populations. Blood pressure and body mass index (BMI) were also detected, and vascular endothelial function was evaluated using ultrasound non-invasive blood flow mediated vasodilation function (FMD). Comparison and statistical analysis were carried out in groups.Results:Uric acid [(479.7±49.0) μmol/L vs. (381.2±76.7) μmol/L]、hs-CRP[(8.1±6.7) mg/L vs. (5.1±4.6) mg/L]、systolic blood pressure [(124.7±26.3) mmHg vs. (97.4±13.5) mmHg] decreased significantly in the experimental group after 3 months of treatment with allopurinol ( P<0.05), and blood flow mediated vasodilation function [(7.6±3.5) vs. (11.2±3.9)]significantly increased ( P<0.05). The decrease of serum uric acid was positively correlated with the increase of FMD in the experimental group ( r=0.463, P<0.01). Multiple Regression analysis showed that serum uric acid was an independent predictor of FMD( β=-0.229, P=0.035). Conclusions:The treatment of hyperuricemia in patients with acute cerebral infarction can significantly improve the vascular endothelial function of patients, improve inflammation state and lower blood pressure. It is further confirmed that a higher uric acid level is related to worse endothelial function which may contribute to atherosclerosis.

Objective:To evaluate the efficacy of 0.5% timolol maleate aqueous solution in the treatment of superficial infantile hemangioma (IH) and explore the feasibility of L *a *b * color system to assess the lesion color. Methods:A retrospective analysis was conducted on the data of superficial IH who received 0.5% timolol aqueous solution and met the inclusion criteria in the Department of Plastic Surgery of Zhejiang Provincial People’s Hospital from January 2014 to December 2018. Visual Analogue Scale (VAS) was used to evaluate the efficacy. Therapeutic responses were graded as follow: poor (VAS score ranging from -100 to 0), fair (VAS score ranging from 1-49), good (VAS score ranging from 50-89) and excellent (VAS score ranging from 90 to 100). The lesion color was expressed in terms of the Commission Internationale de l’Eclairage(CIE) L *a *b * color system, where L corresponds to the lightness, a to the red-green coordinate and b to the yellow-blue coordinate. Paired t-test was used to evaluate the difference of L value, a value and b value (ΔL, Δa and Δb) before and after treatment respectively. Pearson correlation analysis was carried out between ΔL, Δa and Δb with VAS score respectively. Results:A total of 25 cases (30 lesions) were reviewed, including 13 lesions on the head and neck, 9 in the trunk and 8 in the limbs. VAS evaluation showed that the overall response of fair was in 2 (6.7%) lesion, good in 8 (26.7%) lesion and excellent in 20 (66.7%) lesion. Percentage of excellent response in head and neck, trunk and limbs was 69.2%(9/13), 66.7%(6/9) and 62.5%(5/8) respectively, with no significant difference ( χ2=0.101, P=0.951). After treatment, L value increased by 9.25±8.96, a value decreased by 4.68±11.08, and b value decreased by 2.44±7.18 respectively, having statistical difference ( t=-8.383, P<0.001; t=3.763, P<0.001; t=2.813, P=0.006). ΔL value was positively correlated with VAS score ( r=0.616, P<0.001), while Δa value was negatively correlated with VAS score ( r=-0.640, P<0.001), and Δb value had no correlation with VAS score ( r=-0.028, P=0.883). Conclusions:0.5% timolol maleate aqueous solution is effective in the treatment of superficial IH. ΔL and Δa are highly correlated with VAS score, indicating that L *a *b * color system accurately reflects the chromatism of the lesion and could be provided as an objective index to evaluate the efficacy of superficial IH.

Objective:To evaluate the efficacy of 0.5% timolol maleate aqueous solution in the treatment of superficial infantile hemangioma (IH) and explore the feasibility of L *a *b * color system to assess the lesion color. Methods:A retrospective analysis was conducted on the data of superficial IH who received 0.5% timolol aqueous solution and met the inclusion criteria in the Department of Plastic Surgery of Zhejiang Provincial People’s Hospital from January 2014 to December 2018. Visual Analogue Scale (VAS) was used to evaluate the efficacy. Therapeutic responses were graded as follow: poor (VAS score ranging from -100 to 0), fair (VAS score ranging from 1-49), good (VAS score ranging from 50-89) and excellent (VAS score ranging from 90 to 100). The lesion color was expressed in terms of the Commission Internationale de l’Eclairage(CIE) L *a *b * color system, where L corresponds to the lightness, a to the red-green coordinate and b to the yellow-blue coordinate. Paired t-test was used to evaluate the difference of L value, a value and b value (ΔL, Δa and Δb) before and after treatment respectively. Pearson correlation analysis was carried out between ΔL, Δa and Δb with VAS score respectively. Results:A total of 25 cases (30 lesions) were reviewed, including 13 lesions on the head and neck, 9 in the trunk and 8 in the limbs. VAS evaluation showed that the overall response of fair was in 2 (6.7%) lesion, good in 8 (26.7%) lesion and excellent in 20 (66.7%) lesion. Percentage of excellent response in head and neck, trunk and limbs was 69.2%(9/13), 66.7%(6/9) and 62.5%(5/8) respectively, with no significant difference ( χ2=0.101, P=0.951). After treatment, L value increased by 9.25±8.96, a value decreased by 4.68±11.08, and b value decreased by 2.44±7.18 respectively, having statistical difference ( t=-8.383, P<0.001; t=3.763, P<0.001; t=2.813, P=0.006). ΔL value was positively correlated with VAS score ( r=0.616, P<0.001), while Δa value was negatively correlated with VAS score ( r=-0.640, P<0.001), and Δb value had no correlation with VAS score ( r=-0.028, P=0.883). Conclusions:0.5% timolol maleate aqueous solution is effective in the treatment of superficial IH. ΔL and Δa are highly correlated with VAS score, indicating that L *a *b * color system accurately reflects the chromatism of the lesion and could be provided as an objective index to evaluate the efficacy of superficial IH.

This paper summarized the operation cooperation and management of the first case of bilateral lung transplantation assisted with double extracorporeal membrane oxygenation (ECMO) for the recipient with novel coronavirus pneumonia (COVID-19) in the world. The bilateral lung transplantation assisted by double ECMO had been accomplished successfully on a recipient with COVID-19, who was supported by ventilator and ECMO, with other organs function basically normal. The operation took 405 min and went smoothly. The cooperation and management guidelines of the operation room included the following: setting up of COVID-19 emergency operation group quickly; listing and preparing of the detailed operation supplies; transferring of the whole system of lung transplantation operating room in Wuxi People's Hospital to the Wuxi No.5 People's Hospital (isolation hospital); reconstruction of a negative pressure operating room for lung transplantation; formulating and strictly implementing the guidelines and management process for the operation of patient with COVID-19.