With the development of virtual reality (VR) technology and wide application of simulation-based medical education in clinical teaching, VR has been attracting growing attention in the field of simulation teaching in pediatrics. Studies have shown that VR technology can effectively improve pediatric clinical teaching effects by providing an immersive learning environment and enhancing the learning experience of students. VR also expands the teaching methods of pediatric simulation education. This paper discusses the application of VR technology in virtual standardized patients, simulation teaching of clinical practice skills, and clinical scenario simulation in pediatrics, as well as the use of ACEP SimBox in VR simulation teaching in pediatric emergency care. Future research needs to focus on the further development of VR technology and its application in simulation teaching, and find the best way to combine VR with traditional teaching methods.

Standardized patient (SP) has been widely used for medical teaching and assessment in medical colleges at home and abroad. Pediatric consultations are mostly directed toward parents, so in pediatric education, SP is usually referred to as standardized family (Sfam), which is trained to portray the patient's family members. At present, the development of Sfam in pediatric teaching in China is relatively slow. Based on the characteristics of pediatric teaching, the paper summarizes the necessity of Sfam, the application of different types of Sfam, the integration of Sfam with other clinical teaching methods, and the value of Sfam in pediatric teaching, and also discusses the future direction and prospects of Sfam combined with artificial intelligence in pediatric teaching. After years of development, Sfam has been proved to be an effective teaching model. We hope this paper can help more pediatric clinical educators gain a deeper understanding of the Sfam teaching method, and promote the application of Sfam in pediatric teaching to maximize its role in advancing the development of pediatric education.

Objective:To investigate the clinical diagnostic value of MRI retention enema cannula enhanced scanning in the high complex anal fistula.Methods:The clinical data of 60 anal fistula patients underwent surgery treatment from May 2020 to May 2022 in Affiliated Hospital of Shanxi University of Traditional Chinese Medicine were retrospectively analyzed. All patients underwent MRI plain scanning and enhanced scanning before operation. Compared with the surgical results, the difference between MRI plain scanning and enhanced scanning in the diagnosis of high complex anal fistula was compared.Results:All of the 60 patients successfully completed surgical treatment, and 58 cases internal orifices, 55 cases complex anal fistulas and 53 cases high anal fistulas were found intraoperatively. MRI plain scanning results showed 32 cases internal orifices, 46 cases complex anal fistulas and 42 cases high anal fistulas were found. MRI enhanced scanning results showed 54 cases internal orifices, 53 cases complex anal fistulas and 50 cases high anal fistulas were found. Based on surgical results, the coincidence rates of internal orifice, complex anal fistula and high anal fistula in MRI enhanced scanning were significantly higher than those in MRI plain scanning: 93.10% (54/58) vs. 55.17% (32/58), 96.36% (53/55) vs. 83.64% (46/55) and 94.34% (50/53) vs. 79.25% (42/53), and there were statistical differences ( χ2 = 21.76, 4.95 and 5.27; P<0.01 or <0.05). Conclusions:The MRI retention enema cannula enhanced scanning has obvious advantages in the diagnosis of high complex anal fistula, which provides scientific reference value for the diagnosis and operation of high complex anal fistula in clinic.

Objective:To investigate the clinical efficacy of vitamin D drops combined with insulin aspart in the treatment of gestational diabetes mellitus (GDM), and the effect of vitamin D drops on the serum levels of 1, 25 dihydroxyvitamin D 3 [1, 25(OH) 2D 3] and retinol binding protein 4 (RBP4). Methods:A total of 94 GDM patients admitted to the Baoding Second Central Hospital from March 2019 to March 2021 were selected and randomly divided into an observation group and a control group with 47 cases each using a random number table method. The control group received subcutaneous injection of insulin aspartate for treatment, while the observation group received oral vitamin D drops for treatment. After 4 weeks of continuous treatment, the blood glucose control effect and adverse reactions were observed in both groups. The glucose metabolism indicators of the two groups were compared before and after treatment, including fasting blood glucose (FPG), 2-hour postprandial blood glucose (2-hour PG), insulin resistance index (HOMA-IR), and pancreatic islets β Cell Function Index (HOMA-β) and serum levels of 1, 25(OH) 2D 3, RBP4, lipoprotein related phospholipase A2 (Lp-PLA2), and vascular cell adhesion molecule-1 (VCAM-1). All patients were followed up until the end of pregnancy, and Statistical analysis was conducted on the adverse outcomes of two groups of mothers and infants. Results:The time to reach the standard for FPG and 2-hour PG in the observation group, as well as the time for both to reach the standard were significantly shorter than those in the control group (all P<0.05). There was no statistically significant difference in the incidence of dawn phenomenon and hypoglycemia between the observation group and the control group (all P>0.05). After treatment, FPG and 2-hour PG in both groups were significantly reduced compared to those before treatment (all P<0.05); However, after treatment, there was no statistically significant difference between the groups (all P>0.05). Compared with before treatment, HOMA-IR in both groups significantly decreased (all P<0.05), All HOMA- β significantly increased (all P<0.05); And the improvement was more significant in the observation group (all P<0.05). After treatment, the serum levels of 1, 25(OH) 2D 3 in the observation group significantly increased compared to that before treatment ( P<0.05), but there was no significant change in the control group before and after treatment ( P>0.05). After treatment, the levels of serum RBP4, Lp-PLA2, and VCAM-1 in both groups significantly decreased compared to those before treatment (all P<0.05); After treatment, the serum levels of RBP4, Lp-PLA2, and VCAM-1 in the observation group were lower than those in the control group (all P<0.05). The incidence of adverse maternal and neonatal outcomes in the observation group was 14.9%(7/47) and 10.6%(5/47), respectively, which were lower than those in the control group [34.0%(16/47) and 27.7%(13/47)] (all P<0.05). There were 8 cases of hypoglycemia in 94 patients (3 in the observation group and 5 in the control group), and no other adverse events occurred. Conclusions:The combination of vitamin D drops and insulin aspartate in the treatment of GDM can safely, effectively, quickly, and steadily control patients′ blood sugar, improve IR and pancreatic islets β The effect of cell function on reducing the incidence of adverse maternal and fetal outcomes may be related to increasing serum 1, 25(OH) 2D 3 levels and down-regulating the expression levels of serum RBP4, Lp-PLA2, and VCAM-1.

[摘 要] 目的：探讨肝细胞癌（HCC）患者血清及癌组织中miR-203a和其靶基因的表达及其与患者临床病理特征和预后的关系。方法：利用生物信息学方法从TargetScan、miRDB和PicTar网站预测HCC组织中miR-203a的靶基因，通过双荧光素酶报告基因实验进行验证。选取2018年1月至2019年6月在常州市金坛区第二人民医院手术切除的96例HCC患者的癌和癌旁组织标本、血清和临床资料，以及90例健康体检者的血清作为对照。qPCR法检测血清miR-203a水平，以及HCC组织和癌旁组织中miR-203a及其靶基因表达，比较分析不同临床病理特征HCC患者miR-203a及其靶基因表达。随访3年，采用Kaplan-Meier法进行生存（OS）分析。结果：从数据库筛选出HCC中miR-203a相关的靶基因共10个，包括APC、CDK6、GATA6、HOXD3、IGF1R、IGFBP5、KCNE2、PAQR3、PRMT5和SOSC3。HCC组织中miR-203a和APC、PAQR3 mRNA表达水平均显著低于癌旁组织（均P<0.01），CDK6、GATA6、HOXD3、IGF1R、IGFBP5、KCNE2、PRMT5和SOSC3 mRNA表达水平均显著高于癌旁组织（均P<0.01）；血清miR-203a、HCC组织miR-203a及其靶基因表达均与患者肿瘤临床分期、分化程度、肝功能分级、OS率有关（均P<0.01）。结论：HCC组织中miR-203a呈低表达，miR-203a及靶基因表达均与患者肿瘤临床分期、分化程度、肝功能及远期OS率有关。

Objective: To evaluate the value of multi-detector CT (MDCT) upper airway imaging in the diagnosis of obstructive sleep apnea hypopnea syndrome ( OSAHS) and in determining the location of upper airway obstruction． Methods : MDCT was used to scan the upper airways of 85 clinically confirmed adult patients with different degrees of OSAHS (73 males and 12 females) in calm breathing phase and forced inhalation phase and 60 normal adults (50 males and 10 females) in calm breathing phase to obtain nasal cavity，nasopharynx，palatopharynx and oglosopharynx volumes．Parapharyngeal fat volume was measured in OSAHS patients and normal subjects．In addition，three groups of clinical data related to OSAHS patients were recorded，including sleep apnea hypopnea index (AHI) ，body mass index ( BMI) and lowest blood oxygen saturation ( LaSO2 ) ．Finally，the measured data and clinical data of each group were statistically analyzed. Results : The volume of nasopharynx and palatopharynx in the calm breathing group was significantly smaller than that in the control group，with statistical significance．Palatopharyngeal volume forced inspiratory phase was significantly smaller than calm breathing phase in the experimental group．The parapharyngeal fat volume in the experimental group was significantly higher than that in the control group．AHI was positively correlated with BMI and parapharyngeal fat volume．LaSO2 was negatively correlated with AHI and BMI，respectively． Conclusion MDCT upper airway imaging has good clinical application value in the diagnosis，treatment and postoperative evaluation of OSAHS disease due to the significant anatomical difference between OSAHS patients and normal subjects.

Objective:To explore the role of hippocampal γ oscillation abnormality in sepsis-associated encephalopathy (SAE).Methods:Seventy male Sprague-Dawley rats (2-3 months) were randomly (random number) divided into three groups according to the random digital table method: sham, CLP, and CLP + dopamine 4 (D4) receptor agonists RO-10-5824 group. The SAE animal model was established by cecal ligation and puncture (CLP). On day 10-14 after surgery, the open field, novel object recognition, and fear conditioning tests were performed. After that, the hippocampus was collected to measure expressions of parvalbumin (PV) and D4 receptor. In another set of experiment, CA1 local field potential (LFP) were recorded, and the relationship between LFP and time with novel object was analyzed. Independent sample t-test was used for pairwise comparisons, and multiple comparisons were performed by one-way ANOVA, followed by the Tukey multiple comparisons test. Correlation was analyzed using Pearson correlation. Statistical significance was assumed when P<0.05. Results:Compared with the sham group, hippocampal PV (77.54±4.61)%, D4 expression (56.36±3.88)% and γ oscillation power (41.1±8.62)%, object exposure time (36±3) s, new object recognition rate (49±4)%, and scene stiffness time (56±7) s were decreased significantly ( P<0.05). However, RO-10-5824 treatment could increase hippocaml γ oscillation power (92.3±6.7)%, and reverse the decreased new object exposure time (44±3) s and new object recognition rate (63±4)%. Correlation analysis showed that hippocampal γ oscillation power was positively associated with new object exposure time ( r=0.609 2, P=0.015 9). There was no difference in total distance traveled or time spent in the center among groups ( P>0.05). Conclusion:Hippocampal γ oscillation abnormality might play a key role in cognitive impairment associated with SAE.

Objective:To evaluate the relationships among contrast-enhanced ultrasound (CEUS) features, molecular type, and biomarker expression of breast cancer.Methods:A retrospectively analysis of breast cancer patients confirmed by pathology were performed using Breast Imaging Report And Data System (BI-RADS) ultrasound category lesions in the Second Affiliated Hospital Zhejiang University School of Medicine from May 2020 to April 2021. All patients underwent conventional ultrasound and CEUS before biopsy and/or surgery. The relationships among BI-RADS category, quantitative and qualitative CEUS features and biomarker expression of breast cancer were evaluated.Results:All 149 patients with 149 breast lesions were included. The numbers of BI-RADS category 4A, 4B, 4C, and 5 were 8, 60, 49, and 32, respectively. Among them, the numbers of Luminal A like, Luminal B like (human epidermal growth factor receptor-2 (HER-2) positive), Luminal B like (HER-2 negative), HER-2 overexpression and triple negative type were 81, 29, 17, 15, and 7. No significant correlations were found among BI-RADS category, molecular types, and biomarker estrogen receptor (ER), progesterone receptor (PR), HER-2, and antigen Ki-67 (Ki-67) expression (all P>0.05). There were no correlations between quantitative or qualitative CEUS features and molecular types of breast cancer (all P>0.05). There were no correlations between qualitative CEUS variables and ER, PR, HER-2, and Ki-67 expression (all P>0.05). Ascending slope (AS) were negatively correlated with ER and PR expression( r=-0.40, P=0.01; r=-0.35, P=0.03). Descending slope (DS) were positively correlated with ER and PR expression( r=0.42, P=0.01; r=0.36, P=0.03). Arrive time (AT) were positively correlated with HER-2 expression( r=0.37, P=0.02). Conclusions:AS and DS are correlated with ER and PR expression.Arrive time (AT) is correlated with HER-2 expression. The quantitative variables of CEUS are helpful for evaluation of biomarker expression in breast cancer.

Objective:To investigate the correlation between serum ferritin (SF) level and liver damage in the acute stage of dengue fever.Methods:A retrospective study was conducted to analyze 171 cases diagnosed with dengue fever as dengue fever group and 130 healthy patients as control group in Hangzhou 3A grade hospital from July to December 2017. Clinical data, SF and liver function related indicators were collected from both groups: alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL) to analyze the correlation between liver damage and SF in patients with dengue fever.Results:ALT, AST, and SF levels were significantly higher in the dengue fever group than those in the healthy control group ( Z = 11.553, 15.054 and 15.163, P < 0.001). SF levels were higher in the dengue fever combined with liver damage group than those without the liver damage group ( z = 6.930, P < 0.001). However, there was no statistically significant differences in age, gender, peak body temperature, and history of liver disease ( P > 0.05). In addition, Spearman’s correlation analysis showed that SF was positively correlated with ALT, AST, and TBIL ( r = 0.464, 0.531 and 0.315, P < 0.001). Among dengue patients with different SF levels, there were significant difference in ALT, AST levels and incidence of liver damage ( H = 14.240 and 17.584, χ2 = 49.547, P < 0.001). Patients with higher SF levels had higher ALT, AST levels and incidence of liver damage. Binary logistic regression analysis showed that hyperferritinemia (SF≥500 ng/ml) was the risk factor for dengue fever combined with liver damage ( OR = 8.120, P < 0.001). Furthermore, ROC curve analysis showed that the AUC for SF to judge dengue fever combined liver damage was 0.846 (95% CI: 0.785-0.908), and the sensitivity and specificity when the SF cut-off value was 1 506 ng/ml were 74.8% and 83.3%. Conclusion:There is a certain correlation between the SF level and the degree of liver damage in acute stage of dengue fever patients, and hyperferritinemia is a risk factor for dengue fever combined with liver damage.

Objective:To compare the predictive values of Bologna Outcome Algorithm for Stroke (BOAS) , Acute Stroke Registry and Analysis of Lausanne (ASTRAL) and Preadmission Comorbidities, Level of Consciousness, Age, and Focal Neurologic Deficit (PLAN) for stroke-associated pneumonia (SAP) and prognosis in elderly stroke patients in ICU.Methods:Using the convenient sampling method, a total of 198 elderly stroke patients who were hospitalized in ICU of Neurology Department of Henan Provincial People's Hospital were selected as the research objects from June 2017 to December 2019. According to whether SAP occurred within 4 weeks, patients were divided into SAP group, non-SAP group, severe SAP subgroup and mild SAP subgroup. According to the outcome within 4 weeks, they are divided into the poor prognosis group and the good prognosis group. The differences of BOAS, ASTRAL and PLAN scores among different groups were recorded and compared. ROC curve was used to analyze and compare the predictive performance of the three scales for SAP and its prognosis.Results:Pairwise positive correlation was found between BOAS, ASTRAL and PLAN scores ( P<0.05) . All the three scores of patients in SAP group were significantly higher than those in the non-SAP group, and ASTRAL and PLAN scores in severe SAP subgroup were higher than those in mild SAP subgroup, and the differences were significant ( P<0.05) . The area under ROC curve ( AUC) of BOAS, ASTRAL and PLAN scores were respectively 0.610, 0.692 and 0.705, and the AUC for predicting severe SAP were respectively 0.613, 0.661 and 0.709. In the SAP group and the non-SAP group, the scores of three scales of patients in the poor prognosis group were higher than those in the good prognosis group, and the differences were significant ( P<0.05) . The AUC of BOAS, ASTRAL and PLAN scores in the SAP group for predicting poor prognosis were respectively 0.736, 0.757 and 0.716, and AUC in the non-SAP group were respectively 0.699, 0.731 and 0.631. Conclusions:BOAS, ASTRAL and PLAN scores have certain predictive value for the SAP and prognosis of elderly patients in ICU. Among them, PLAN score has better predictive performance for SAP and ASTRAL has better predictive performance for prognosis.