PURPOSE:Standardised Training of Paediatric Resident (STPR) plays an essential role in training qualified paediatricians. Until now, China had no paediatric resident competency index system to effectively guide and evaluate the competence of paediatric residents. This study aimed to establish a competency index system for paediatric residents in China to provide a reference for improving the training system and quality of STPR.STUDY DESIGN AND SETTING:This study conducted two rounds of Delphi expert consultation survey among paediatric medical experts (n=16), followed by screening, revising and supplementing indicators using the boundary value method. Next, the analytic hierarchy process was used to determine the weight of indicators and finally establish a competency index system for paediatric residents.RESULTS:The results of the statistical analysis revealed a positive coefficient of 100% for both rounds of expert consultation. The expert authority coefficient values were 0.82 and 0.83, and the expert coordination coefficient test was p<0.01. After referring to experts' opinions, a competency index system for paediatric residents with 5 primary indicators, 14 secondary indicators and 73 tertiary indicators was finally formed and the weight of each indicator was calculated. The five primary indicators were professional quality (0.3187), knowledge and skills (0.2734), communication and cooperation (0.1986), lifelong learning (0.1302), and teaching ability (0.0791).CONCLUSIONS:In this study, a competency index system for paediatric residents was constructed following the characteristics and quality requirements for paediatric residents in China and is expected to significantly improve the overall level of paediatricians' medical service quality and supply.

目的 探讨拜新同联合琥珀酸美托洛尔缓释片治疗部分顽固性高血压的疗效.方法 选取2013年12月～2017年12月我院收治的顽固性高血压患者80例作为研究对象,将其随机分为研究组和对照组,各40例,给予对照组单纯拜新同治疗,研究组在对照组基础上增加琥珀酸美托洛尔缓释片治疗,对比分析两组患者的治疗效果以及不良反应情况.结果 研究组的治疗总有效率为95.00％,对照组为75.00％,可以看出研究组的治疗效果明显比对照组好,差异有统计学意义(P<0.05);研究组中有5例发生不良反应占比为12.50％,对照组中有14例患者发生不良反应占比为35.00％,可以看出不良反应发生率研究组明显低于对照组,差异有统计学意义(P<0.05).结论 使用拜新同联合琥珀酸美托洛尔缓释片治疗部分顽固性高血压的效果明显,能有效降低患者血压,安全性高,减少不良反应的发生情况,提高患者及家属的满意程度,值得临床上推广使用.

目的:探讨2型糖尿病合并脑梗塞的相关危险因素,提出防治措施;方法:将医院在2013年1月-2017年12月接诊的52例2型糖尿病合并脑梗塞患者作为临床观察组,选取同期接诊的50例单纯糖尿病患者作为对照组,对两组患者的血糖、血压、血脂等作为相关因素进行分析比较;结果:观察组中TG、LDL水平明显升高,差异具有统计学意义(P<0.05),而且FPG、MAP明显高于对照组,P<0.05,组间差异具有统计学意义;结论:糖尿病合并脑梗塞发病原因不但与血糖水平高有关,而且与患者高血压、高血脂等因素有关,积极预防或治疗糖尿病,严格控制血糖、血压及调节血脂,对预防及减少脑梗塞的发生,改善患者预后具有重要的意义.

BACKGROUND:Esophageal squamous cell carcinoma (ESCC) is a frequently occurring cancer with poor prognosis despite combined therapeutic strategies. The aim of the current study was to elucidate a further finding on the clinicopathologic significance of immunohistochemical expression of cyclooxygenase-2 (COX-2), vascular endothelial growth factor (VEGF), and epidermal growth factor receptor (EGFR) in Chinese patients with ESCC.METHODS:Formalin-fixed paraffin-embedded surgically resected tumor samples were obtained from 140 randomly selected Chinese patients with ESCC. Sections were immunohistochemically stained for COX-2, VEGF, and EGFR. The correlations between clinicopathological features and the high expression of COX-2, VEGF, and EGFR were analyzed using the Statistical Package for the Social Sciences 19.0 software (IBM Inc., Chicago, IL, USA).RESULTS:In the present study, high expression of COX-2, EGFR, and VEGF was found in 64.3%, 62.1%, and 65.0%, respectively. Results showed that COX-2 overexpression was significantly correlated with degree of differentiation (P = 0.000), and lymph node metastasis (negative/positive, P = 0.002). EGFR and VEGF overexpression was significantly correlated with a differentiated degree, T stage, N stage, and tumor, node, metastases stage.CONCLUSION:High expression of COX-2, EGFR, and VEGF is an unfavorable prognostic factor in ESCC, and could be used as a poor prognosis indicator for the ESCC patients. Targeting therapy to these three targets should be considered to the combined treatment in ESCC.

Signal pathways mediated by epidermal growth factor receptor (EGFR) and E-series of prostaglandin receptors (EPs) are closely correlated to the pathogenesis of tumor. This experiment was designed to investigate the expression and clinical significance of EP2 and EGFR in esophageal squamous cell carcinoma (ESCC). Tissue samples were collected reterospectively from 87 patients with ESCC (first diagnosed). The patients were followed up for 5 years after radical surgery. The expression of EP-2 and EGFR were examined by tissue chip technology and immunohistochemistry methods. Clinicopathological and prognostic impact were evaluated. Overexpression of EGFR and EP-2 was more observed in ESCC than the control group (58.6% vs. 13.9%; 52.9% vs. 4.88%, P < 0.001, respectively); which correlated with tumor infiltration depth, lymph node metastasis, and tumor-lymph node-metastasis staging. Both the EP-2 and EGFR overexpression were detected in 39 specimens and exhibited the positive correlation (P < 0.001, r = 0.404). Overexpression of EP2 and EGFR exhibited significant correlation with worse 5-year overall survival than those with negative result (17.6% vs. 27.8%, P = 0.011; 10.9% vs. 34.1%, P < 0.001, respectively). Cox proportional hazard model showed that the T-staging, lymph node metastasis, and EGFR overexpression were the independent risk factors of the prognosis. The present study exhibited that the overexpression of EP2 and EGFR in ESCC tissues might play an important role in carcinogenesis and the progression of ESCC.

microRNA‑34a (miRNA‑34a) plays an important role in the pathogenesis of leukemia. This study aimed to explore its role in the proliferation of HL‑60 cells and the correlation with some of its predicted target genes: the cyclin‑dependent kinase 4 (CDK4), the oncogene MYB and the silent information regulator 1 (SIRT1). We first analyzed the expression of miR‑34a, CDK4, MYB and SIRT1 in peripheral blood samples from acute leukemia (AL) patients and healthy controls, and conducted a correlation analysis. HL‑60 cells were then transfected with miR‑34a and control 'scramble̓ miRNA, and quantitative RT‑PCR and western blotting were used to analyze the effects of the interfering sequence in HL‑60 cells. The expression of miR‑34a was significantly reduced in AL patients compared to healthy controls (P<0.01), and negatively correlated with the expression of CDK4 and MYB. Sub‑group analysis revealed that the expression of MYB was significantly lower in AL children <3 years old compared to those >3 years. Following the transfection of HL‑60 cells with miR‑34a, the mRNA level of CDK4, MYB and SIRT1 decreased by 53.2, 43.3 and 33.5%, respectively, compared to the control, similarly to the respective changes in protein levels. This study showed that the expression of miR‑34a negatively correlates with the expression of CDK4 and MYB in pediatric patients with acute leukemia. miRNA‑34a downregulates the expression of the CDK4, MYB and SIRT1 genes in vitro; it may thus represent a novel therapeutic target for acute leukemia.

回顾半个多世纪以来，我国众多的儿科血液学专业老中青医务工作者在征服白血病艰难漫长的历程中，经过早期束手无良策，只会用V和P（即长春新碱和泼尼松）；中期遇到临床疗效不理想，逼得大家只好摸着石头过河自找出路。到了上世纪八十年代，喜逢改革开放良机，有了学习国外先进医技更多路径，加速了我国小儿白血病的诊、治、研水平的飞速发展。随后如雨后春笋般许多医院相继实现本单位小儿血液病五年无病生存率零的突破，至今国内一些三甲规模医院诊治小儿急性淋巴细胞白血病水平已接近或达到国际水平，取得了可喜成就。

Objective: To investigate anti-cancer activity of the novel survivin siRNA Folate Receptor (FR)-targeted Polyethylene-Glycol Liposomes (PEG) liposomes in K562-bearing nude mice. Methods: The leukemia cell line K562 xenograft model was established in balb/c nu/nu mice, and survivin siRNA FR-targeted PEG liposomes was administrated by intraperitoneal (i.p.). The same volume of liposomes was administrated as placebo control. The real time PCR and western blotting were used to examine the knocking down effect. The tumor weight and size in nude mice was measured to evaluate the inhibitory effect in vivo. Results: The expression ratio of survivin mRNA in siRNA group was 0.35 ± 0.1 (survivin/GAPDH) vs. 1.85 ± 0.65 in control group with significant difference (p < 0.05), as well as protein level by western blotting analysis (p < 0.05). The results also showed the novel survivin siRNA liposomes could inhibit the growth of K562 in xenograft model. Conclusion: This novel survivin siRNA FR-targeted PEG liposome delivery system may be a potential gene therapy for the treatment of leukemia.

免疫性血小板减少性紫癜（immune thrombocytopenia, ITP）是儿童时期最常见的出血性疾病，ITP患者血液循环中血小板数量小于100×109/L，儿童ITP每年发病率大约4/10万，年幼儿更加多见，通常患病前为完全健康儿童，多数为良性自限性病程，仅有极少数患者会出现危及生命的严重出血表现。80%以上患儿为急性病程，1年内血小板完全恢复正常；仅有20%左右患者转为慢性。目前针对严重出血倾向ITP的治疗仍为糖皮质激素，注射用丙种球蛋白，抗D免疫球蛋白等；而对于无症状型及轻型病例，随着对于该病的逐渐了解，临床医生的诊疗观念也有很大改变，从必须纠正血小板至正常水平到采取观察和等待（Watch and Wait）的方式转变。

Neuroblastoma is the most common extra-cranial solid tumor in infants and children,which is very easy to metastasis and its malignant degree is very high.Because of its clinical differences,so far treatment of neuroblastoma is still difficult.Currently comprehensive therapies,including surgery,chemotherapy,radiation,stem cell transplantation,131 I-meta-iodobenzylguanidine therapy,biological therapy and immune therapy as well as target therapy dominant the treatment of this disease,and introduce the some of the treatment protocols for this disease.

<正>肺炎支原体(Mycoplasma pneumoniae,MP)于1962年从人类原发性非典型肺炎患者的痰液中分离培养出来[1],为一种介于细菌和病毒之间的能自行繁殖的原核微生物,是引起儿童呼吸道感染的常见病原体之一。由MP感染引起的支原体肺炎(my-coplasma pneumoniae pneumonia,MPP)发病率逐年升高,约占社区获得性肺炎的20%~40%[2]。

Doctors and nurses from general outpatient and emergency department usually lack the treatment experience of hemophilia,therefore,emergency system and diagnostic criteria for hemophilia is es-sential.Physicians of emergency department should be trained on identifying the undiagosed patients with inherited bleeding disorders and assessing the condition of bleeding.Prompt clotting factors replacement therapy should be given to the patients with hemophilia once bleeding is suspected.Physicians should be aware that inhibitors make the emergency treatment more complicated.

Objective To learn the status of diagnosis and treatment as well as control level of childhood asthma in Beijing central area and to provide data for improving the prevention and management of childhood asthma in Beijing.Methods Children diagnosed as asthma in the 3rd Beijing Childhood Asthma Prevalence Survey were included in the study.Measurements of lung function,exhaled nitric oxide (eNO) were carried out in part of school-age children with asthma.Analysis of asthma diagnosis,comorbidity,medication and asthma management and asthma control level were conducted.Results Of the 497 children diagnosed as asthma in the survey,59.4％ had been previously diagnosed,19.1％ (95/497 cases) were not given a confirmed diagnosis,and 21.5％ (107/497 cases) were not diagnosed of any wheezing disease.Among the previously diagnosed asthmatic children,bronchodilators and inhaled glucocorticosteroids were used in 79.0％ and 46.4％ of the patients respectively,while antibiotics was used in 82.4％ of patients,and only 66.1％ (195/295 cases) of patients underwent allergy tests.In children with asthma above 5 years old,13.6％ (53/399 cases) used peak flow meter for monitoring.In the 99 cases of asthmatic children who were followed up,wheezing was heard in 14.1％ of the patients and forced expiratory volume in one second ＜ 80％ predicted value was found in 29.3％ of the patients.It was also found 62.6％ of the 99 patients with eNO ≥ 20 ppb,and 41.4％ of the patients with eNO ＞ 35 ppb.In the past 1 month,19.2％ (19/99 cases) of the children used inhaled glucocorticosteroids,and 65.7％ of the patients were controlled.Conclusions There were still a considerable number of asthmatic children who were not diagnosed or not treated timely or properly,even in central area of Beijing.The asthma control rate was not so high as expected,and the management of childhood asthma needs to be strengthened further.

<正>在儿科,日益复杂的慢性疾病以及相关治疗所导致的骨质疏松越来越多见。其中,糖皮质激素性骨质疏松症(GIOP)在继发性骨质疏松症中最为常见。儿童及青少年时期是钙需求量相对较大的时期,也是骨骼形成的关键时期,儿童低骨密度严重影响生长发育,并使骨折风险增加。因此加强对儿童GIOP的认知和管理,并且将其作为疾病治疗计划中密不可分的一部分是至关重要的。为此,《中国实用儿科杂志》组织全国儿科肾内、血液和呼吸领域的部分权威专家就儿童糖皮质激素性骨质疏松症的规范诊治进行了深入探讨,编辑部特别邀请三位分别来自呼

<正>尤文肉瘤(Ewing sarcoma,ES)是青少年和儿童期相对少见的肿瘤性疾病。局部病灶的患儿,长期生存率可达70%,而转移性ES,长期生存率仅10%~20%[1,2]。10年来,ES的治疗似乎进入瓶颈,近30%的患儿出现不能预知的复发,如何改善治疗现状,仍是巨大挑战。现就ES疾病的诊治进展进行综述。一、概述ES不是孤立的一个疾病,而是一组疾病,包括经典ES、骨外ES、ASKIN’S肿瘤或称胸壁ES,以及

<正>2011年,儿科血液肿瘤专业的同道在儿童白血病、淋巴瘤、骨髓衰竭等疾病的规范化诊治工作、机理探寻等方面有了进一步深入的研究,并继续开展多中心协作,在常见病(如缺铁性贫血)及少见病(如先天性骨髓衰竭)临床工作方面均取得了很大进展。本文将对2011年以来国内在儿童血液病领域的临床工作进展进行简述。

<正>2012年5月9-12日第25届美国儿童血液肿瘤学会(ASPHO)年会在美国新奥尔良举行,来自全球58个国家的1240位儿童血液肿瘤专家出席了这次世界最大规模的儿童血液肿瘤专科会议。我国儿童血液学代

In the present study, we demonstrated the cell cycle periodicity of Erbin expression with the maximal expression of Erbin in G2/M phase. A significant increase in Erbin promoter activity was observed in G2/M phase-synchronized cells. Sequence analysis revealed a c-Myb site in the core promoter region of Erbin. Mutagenesis of c-Myb consensus sequences abrogated the increased Erbin promoter activity in G2/M phase. ChIP and oligonucleotide pull-down assays validated that the recruitment of c-Myb to the consensus sequences was specific. The interaction of c-Myb with c-Myb site in the Erbin promoter was significantly enhanced in G2/M phase. Ectopic overexpression of c-Myb led to the up-regulation of Erbin promoter activity and c-Myb silencing by small interfering RNA significantly decreased Erbin protein level. Transfection of c-Myb rescued Erbin expression that was impaired by c-Myb knockdown. It proves that c-Myb and the c-Myb response element mediate the cell cycle-dependent expression of Erbin. Inactivation of Erbin causes an acceleration of the G1/S transition, the formation of multipolar spindles and abnormal chromosome congression. These results unravel a critical role of c-Myb in promoting Erbin transcription in G2/M phase and also predict an unappreciated function of Erbin in cell cycle progression.

报道分析一例儿童急性血行播散型肺结核致感染性休克及呼吸窘迫综合征病例,显示其诊断难点在于虽然影像学存在典型双肺粟粒影,但缺乏细菌学阳性指标；治疗的重点是积极抗结核治疗及呼吸机辅助改善通气的同时,加强对全身其他脏器功能的评估及保护.