Objective:To explore the disease spectrum and corresponding clinical indicators of infantile cholestasis so as to provide a basis for the diagnosis of this type of disease at an early stage.Methods:The clinical data was collected from 203 hospitalized children diagnosed with infantile cholestasis at the Department of Gastroenterology of Maternal and Child Health Care, Guiyang City, from January 2018 to March 2023, including 130 males and 73 females. Patients general condition, personal history, and blood biochemical test indicators, including liver and coagulation function, blood ammonia, blood lipid profile, blood sugar, TORCH, thyroid function, and others, were retrospectively analyzed after admission. Cholangiography and high-throughput gene sequencing were performed in certain patients. The etiology of the enrolled cases were analyzed. Children's clinical data were compared with distinct inherited metabolic liver diseases (Group A) and biliary atresia (Group B). The statistical analysis was conducted using the t-test, Mann-Whitney test, Kruskal-Wallis test, or χ2 test, according to different data. Results:In 33 cases, infectious factors—primarily CMV infection—were the etiology of cholestasis. Forty cases had aberrant bile duct development, primarily biliary atresia, choledochal cysts, and intrahepatic bile duct dysplasia. In 26 cases, genetic metabolic factors mainly included citrin protein deficiency, sodium-taurocholate co-transporting polypeptide deficiency, and Alagille syndrome. 11 cases had drug/poisoning factors (parenteral nutrition-associated cholestasis). 19 cases had idiopathic infantile cholestasis. Three cases had other factors; however, all of them had Kawasaki disease. 71 cases had an unclear diagnosis. There was no statistically significant difference in terms of gender and age between groups A and B ( P>0.05). The alkaline phosphatase (ALP) and bile acid levels were significantly higher in Group A than Group B, with a P<0.05, while the gamma glutamyltransferase (GGT), direct bilirubin (DBil), and albumin levels were lower than those in Group B, with a P<0.05. The cytomegalovirus infection rate was higher in Group B (62.50%) than Group A (34.62%), and the difference between the two groups was statistically significant ( χ2=3.89, P<0.05). The alanine aminotransferase, aspartate aminotransferase, GGT, DBil, and albumin were significantly lower in patients with citrin protein deficiency than those in patients with biliary atresia, while ALP, bile acid, and blood ammonia were higher than those in patients with biliary atresia. Patients with sodium-taurocholate co-transporting polypeptide deficiency had higher bile acid than patients with biliary atresia, while the DBil was lower than that in patients with biliary atresia, and the difference was statistically significant ( P<0.05). Conclusion:Infantile cholestasis etiology is diverse. ALP, bile acids, GGT, DBil, and albumin levels can serve as simple indicators for early-stage differentiation between inherited metabolic liver disease and biliary atresia. The cholestasis etiology should be determined as early as possible following biliary atresia exclusion by actively completing genetic metabolic gene detection.

Objective: Based on the information-motivation-behavioral skills (IMB) model theory, the structural equation model(SEM)was used to analyze the effect of using new media to carry out AIDS health education among young students. Methods: Stratified random cluster sampling method was used to select 2 561 students from four colleges in Yantai to conduct a questionnaire survey, and to carry out various forms of new media AIDS health education for the intervention group. Data were analyzed with structural equation model. Results: After intervention，the awareness rate of AIDS were 85.9% and 94.0% respectively(χ2=46.67，P<0.01). The structural equation model fits well, and the fitted indices were: RMSEA=0.04, GFI=0.97, AGFI=0.96, IFI=0.97, CFI=0.98. The direct effects of new media interventions on prevention information and prevention motivation were 0.30 and 0.65 respectively. The influence of information and motivation on preventive behavior was mainly reflected through the indirect effect of behavioral skills. The overall effects of standardization were 0.09 and 0.29 respectively. The overall effect of behavioral skills on preventive behavior was 0.80, which was the main factor affecting HIV prevention behavior. Conclusion The use of new media to carry out AIDS health education among young students had a significant effect. Motivation promotion should be used as a new breakthrough point for future work, and information, motivation, and behavioral skills should be used to promote the prevention of AIDS prevention among young students.

Objective: To investigate the incidence of complications following minimal invasive subcutaneous internal fixator (INFIX) for the treatment of anterior pelvic ring instability, and to analyze control measures. Methods: Data of 42 patients with anterior pelvic ring instability who were treated by anterior subcutaneous internal fixation in our hospital from January 2016 to December 2017 were retrospectively analyzed. There were 15 females and 27 males with an average age of 45.4 years (range, 18-67 years). There were 26 traffic injuries, 10 falling injuries, 3 crush injuries and 3 low energy injuries. According to Tile classification, 24 cases of B2 type, 16 cases of B3 type, 1 case of C1 type and 1 case of C2 type. According to Young-Burgess classification, there were 20 cases of LCI, 18 cases of LCII, 1 case of LCIII, 1 case of APCI, 1 case of APCII, and 1 case of VS. Fourteen cases were combined with limb fractures, and 11 cases were combined with thoracic or abdominal injuries requiring surgical treatment, while 16 cases were with brain injuries. For type APC2, LC1, and some LC2 fractures, fixation for the anterior pelvic ring is enough with INFIX technique alone. For some LC2, LC3, or VS fractures, the anterior and posterior ring were both fixed. Postoperative reduction was evaluated by Matta radiological criteria. Lateral thigh numbness and pain, quadriceps muscle power were recorded during follow-up, and clinical efficacy was evaluated by Majeed score at 6 months after operation. Results: All the 42 patients were followed up for 6 to 12 months, with an average of 9.3 months. Matta standard evaluation for fracture reduction showed that 28 cases were excellent, 14 cases good, and the excellent and good rate was 100%. The early complication rate (within 3 month after operation) was 23.8% (10/42) including 6 cases of lateral femoral cutaneous nerve injury and 2 cases of femoral nerve injury. The symptoms were obviously relieved after the treatment of nutrient nerve and hyperbaric oxygen; 1 case had incision infection which was healed after anti-infection therapy and internal plant removal; 1 case suffered from superior gluteal artery injury which was controlled by pressure hemostasis. Six months after surgery, no case had lost reduction. At 6 months follow-up, the Majeed score was 72-96, with an average of 84.96, of which 32 were excellent and 10 were good, thus the excellent and good rate was 100% (42/42). Conclusion INFIX is an effective internal fixation method for the treatment of unstable anterior pelvic ring injury. However, it has a high rate of early complications, among which nerve injury has the highest incidence.

Objective:To compare the difference of serum levels of M-phospholipaseA2 receptor ( PLA2R) antibodies in patients with idiopathic membranous nephropathy(IMN) detected by two different methods and evaluate the diagnostic value of two methods. Methods:Patients diagnosed as membranous nephropathy and other diseases with biopsy-proven from december 2014 to october 2015 in Shengjing Hospital of China Medical University were enrolled and devided into IMN group and non-IMN group. The serum levels of anti-PLA2R antibody were detected by both indirect immunofluorescence assay(IFA) and enzyme linked immunosorbent assay(ELISA). Results:The sensitivity of IFA and ELISA in IMN were 71. 3% and 68. 5%,and the specificities of two methods were the same as 100%. The area under ROC curves of anti-PLA2R antibody for IMN diagnosis were 0. 860 and 0. 839. The diagnostic value of IFA and ELISA was no statistically significant differences in IMN ( P>0. 05 ) , and the consistency of two methods was better (κ=0. 876). The IMN patients of positive anti-PLA2R antibody be susceptible to the low level of serum albumin (P<0. 05). The higher levels of PLA2R antibody were linked with the worse hypoproteinemia and the higher rate of nephrotic-range proteinuria in IMN patients. Conclusion:Two methods of detecting sera PLA2R antibody have higher sensitivity and specificity,so the sera anti-PLA2R antibody was a better biomarker in the diagnosis of idiopathic membranous nephropathy.

Objective To investigate therapeutic effects of β-TCP/PLGA scaffolds seeded bone marrow mesenchymal stem cells (BMSCs) combing with hyperbaric oxygen (HBO) on bone defect with seawater immersing in rabbit radius.Methods BMSCs were seeded into the β-TCP/PLGA scaffolds to construct tissue engineering bone.60 New Zealand rabbits were created 1.5 cm bone defect in bilateral radius,and then bilateral wound limbs were immersed in seawater for 3 h.After debridement,all rabbits were randomly divided into 4 groups.In group A nothing was implanted into the bone defect.Only BMSCs was implanted in group B.BMSCs + HBO was given in group C.β-TCP/PLGA BMSCs + HBO was given in group D.At postoperative 4,8,12 weeks rabbits were sacrificed after radiography radius.X-ray radiography,HE staining,immunohistochemical observation were used to evaluate repairing effect of bone defect with seawater immersing.Results Radiographic analysis demonstrated that the bone defects were completely repaired with recanalization of the medullary cavity in group D,bone defects were partially repaired with partal recanalization of the medullary cavity in group C,bone defects were incompletely repaired in group B;bone defect repair unfinished and the broken ends were sclerous in group A.Each time point group D＞group C＞group B＞group A in callus grey value (P＜0.05).HE staining indicated after 12 weeks,a small amount of lainellar bone formated in group A;a small amount of lamellar bone formated in group B;a large amount of lamellar bone formated in group C;a large amount of lamellar bone formated in group D.Immunohistoehemical result indicated at postoperative 4 weeks,the expressions of osteocalcin(OCN) in each group were at high levels,the expressions decreased significantly at Postoperative 8 weeks,the expressions were at a low level at postoperative 12 weeks.At postoperative 4 and 8 weeks,the expression levels of OCN were group D＞ group C＞ group B＞group A (P＜0.05),there was no significant difference at postoperative 12 weeks between the 4 groups (P＞0.05).Conelusion the β-TCP/PLGA composite BMSCs combined hyperbaric oxygen is the effective method to repair seawater immersed bone defect in rabbit.

Objective To observe the effects of Yushen Heji on expressions of Heme Oxygenase (HO-1) and HO-2 in kidney of diabetic rats;To explore its mechanism in diabetic nephropathy. Methods SD rats were randomly divided into normal group, model group, control group and treatment group. Models were duplicated by subcutaneous injection STZ. Control group and treatment group were given gavage with related medicine, while normal group and model group were given gavage with the same amount of distilled water. Eight weeks later, the urine of rats was collected to detect the 24 h Upro and Ucr;the rats were sacrificed to detect the levels of CO, BUN and Scr;the kidneys were harvested for observing the expressions of HO-1 and HO-2 by immunohistochemistry.Results Compared with normal group, the contents of BUN, 24 h Upro and Scr all increased in model group;Ccr and plasma CO decreased;the expressions of HO-1 and HO-2 in kidney tissues were obviously reduced (P<0.01). Compared with model group, the contents of BUN, 24 h Upro and Scr all obviously decreased in treatment group and control group;Ccr and plasma CO increased;the expressions of HO-1 and HO-2 in kidney tissues obviously increased (P<0.05,P<0.01). Compared with control group, the contents of 24 h Upro decreased in treatment group;plasma CO increased;the expressions of HO-1 and HO-2 in kidney tissues obviously increased (P<0.05,P<0.01).Conclusion Yushen Heji has therapeutic effect on diabetic nephropathy rats, which may related with HO/CO system.

Objective To study the Gadolinium-enhanced MRI and diffusion weighted imaging (DWI) characteristics of the chondroid matrix-forming sarcomas.Methods Contrast-enhanced MRI and DWI were performed in 14 eases of chondroid matrix-forming sarcomas (10 chondrosarcomas,4 chondroblastic esteosarcomas) and 13 cases of other types of osteosarcomas.DWI was obtained with a single-shot echo-planar imaging (EPI) sequence using a 1.5 T MR imager with two different b values of 0 and 700 s/mm2.The apparent diffusion coefficient (ADC) values were obtained in GE Functiontool software.The contrast-enhancement pattern was evaluated and the ADC values of ehondroid matrix-forming sarcomas was compared with that of other types of asteosarcoma.Independent sample t-test was performed to evaluate the difference of ADC values between the group of chondroid matrix-forming sarcoma and the group of other types of osteosarcoma.In addition, nonparametrie test was used to assess the difference of ADC values between the chondrosareoma and the chondroblastic osteosarcoma.P value less than 0.05 was considered to represent a statistical significance.Results For 14 eases of ehondroid matrix-forming sarcomas, peripheral enhancement was found in all cases, septonodular enhancement was identified in 12 cases.While 13 eases of other types of osteosarcowas demonstrated heterogeneous enhancement.The mean ADC value of chondroid matrix-forming sarcomas [(2.56 ±0.35) × 10 -3 mm2/s] was significantly higher than that of other types of osteosarcoma [( 1.16±0.20) × 10-3 mm2/s] (t = 12.704,P <0.O1 ).There was no significant difference in the ADC value between the chondrosarcoma and the chondroblastie osteesarcama(Z =0.507 ,P =0.959).Conclusion Contrast-enhanced MRI and DWI can improve differentiation between chondroid matrix-forming sarcomas and other types of osteosarcomas.

Objective To investigate the value of time-intensity curve of dynamic contrast enhancement MR imaging in the discrimination of benign and malignancy in musculoskeletal tumors. Methods Ninety patients were examined with fast acquisition with muhiphase enhanced fast GRE series. The TIC of lesions were obtained using slope images in which pixel intensity reflected the slope value. The curves were classified according to their shapes as type Ⅰ , washout enhancement; type Ⅱ, plateau enhancement; type Ⅲ, gradual enhancement. Taking pathological diagnosis as gold standard, the power of the maximal enhancement slope and curve types in discriminating benign and malignant lesions was evaluated by appropriate statistic analysis. Results There were 49 malignant and 44 benign lesions. The distribution of curve types for malignant tumors was type Ⅰ 75.5% ( 37/49), type Ⅱ 24. 5% (12/49). While the numbers for benign tumors was type Ⅰ 59. 1% ( 26/44 ), type Ⅱ 15.9% ( 7/44 ) and type Ⅲ 25.0% ( 11/44 ), respectively. The patterns of curve types in malignant lesions were different from benign lesions significantly ( χ2 = 14. 008, P < 0. 01 ). The slope value in benign lesion was 6. 80 + 3. 35 and that in malignant lesion was 6. 80±2. 71. The difference was not statistically significant( t = 0. 008, P > 0. 05 ). Type Ⅰ and type Ⅱ (excluding lesions with typical benign morphology ) were suggestive of malignant tumors. Type Ⅲ was indicator of a benign lesion. The diagnostic indices for the shape of TIC criterion were: sensitivity 100%, specificity 50%, positive predictive value 78%, negative predictive value 100% and accuracy 82%, respectively. Conclusion Combined with the characteristic of morphology, the TIC improves the power of MR imaging in discriminating benign from malignant musculoskeletal tumors.

BACKGROUNDVascular endothelial growth factor (VEGF) is known to be one of the most important factors for angiogenesis and tumor cell infiltration. The aim of this study is to determine the influence of phosphorothioate-moeified antisense VEGF oligodeoxynucleotides (ASODN) formulated in cationic liposome on microvessel density (MVD) and VEGF expression of lung cancer.

METHODSLewis lung carcin- oma model was established by subcutaneous injection of Lewis lung carcinoma cells into 40 C57BL/6 mice. Within 24h after inoculation, mice were randomly assigned to four groups treated with ASODN, sense oligodeoxynucleotides (SODN), mismatch oligodeoxynucleotides (MODN), or liposome alone respectively, twice a week for 4 weeks. The weight and volume of subcutaneous tumors were measured. The morphological and ultrastructural changes of tumor cells were observed under microscope and electron microscope. MVD and expression of VEGF protein and VEGF mRNA were detected by immunohistochemical staining and RT-PCR.

RESULTSThe tumor weight in the control group was (7.83±0.78)g, and (4.49±0.43)g in the ASODN group (P < 0.01). The inhibition rate of tumor growth in the ASODN, SODN and MODN groups was 42.6%, 5.1% and 3.2% respectively. MVD and expression of VEGF protein and VEGF mRNA were decreased markedly in the ASODN group compared to the other three groups (P < 0.01).

CONCLUSIONSThe results demonstrate that MVD and VEGF expression of lung cancer can be inhibited by VEGF ASODN injected into tumor tissue in C57BL/6 mice.

The authors compared the purpose,and the main content of three international standards in medical education developed by the Institute for International Medical Education (IIME), World Health Organization Western Pacific Regional Office (WHO/WPRO), and World Federation for Medical Education (WFME) respectively. The IIME's standard is deferent from the others. The IIME's standard contains seven broad educational outcome domains and 60 items in the domains. The purpose of IIME's standard is to improve the common core competency of individual medical graduates of each medical school in the world, and the standard focuses the outcome of medical education and belongs to summative individual evaluation. The WHO/WPRO's and WFME's standards are quite similar. They define the standards across nine broad areas of medical schooling divided into 38 sub-areas. The ultimate goal of the WHO/WPRO's standard is to encourage national governments to adopt a quality assurance process in medical education. The aim of the two standards is to promote the quality assurance of medical schools. Both of the two standards focus the whole process of medical schooling and medical schools, and belong to formative evaluation.