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25 April 2018, Volume 17 Issue 02 Previous Issue    Next Issue

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Concurrent gene mutation analysis of a developmental delayed child with Rett syndrome and Noonan syndrome LU Jing, XU Yufei, QING Yanrong, HAN Cong, LI Niu, YU Tingting, YAO Ruen, WANG Jian 2018, 17 (02):  147-150.  DOI: 10.16150/j.1671-2870.2018.02.005 Abstract ( 566 )   PDF (599KB) ( 54 )   Objective: To identify the type and pattern of gene mutation of a developmental delayed child and her family members via gene mutation analysis for the accurate diagnosis of disease in this patient. Methods: Peripheral blood DNA was extracted from the proband as well as her family members - father and mother, and gene mutation screening was performed by high throughput sequencing. The pathogenic candidate genes were identified according to the clinical phenotype data combined with the results of gene mutation screening. Sanger sequencing technology was used to validate the pathogenic mutation sites of proband and her family pedigree. Results: Heterozygous missense variants in MECP2 gene and PTPN11 gene were identified in proband by high throughput sequencing, which were c.398G> A, p.Arg133His and c.188A> G, p.Tyr63Cys, respectively. Sanger sequencing revealed that the MECP2 gene mutation leading to Rett syndrome in proband was inherited from her mother and the PTPN11 gene mutation leading to Noonan syndrome was from her father. The two missense variations detected were pathogenic variants in concordance with the clinical phenotype of the proband, her mother and father, respectively. Conclusions: In this study, two pathogenetic variants are identified in the developmental delayed child by high-throughput sequencing, leading to the occurrence of two different hereditary syndrome in the same patient. It is suggested that two or more phenotypes of disease may be present in the same patient, and attention should be paid to this posibility. References | Related Articles | Metrics

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Phenotype and genotype analysis of a Chinese pedigree with 2N type von Willebrand disease JIN Peipei, LIANG Qian, DAI Jing, DING Qiulan, SUN Shunchang, WANG Xuefeng 2018, 17 (02):  151-154.  DOI: 10.16150/j.1671-2870.2018.02.006 Abstract ( 274 )   PDF (592KB) ( 64 )   Objective: To analyze the phenotype and genotype of one Chinese pedigrees with von Willebrand disease and to investigate the molecular pathogenesis of the disease. Methods: Indices including bleeding time(BT), activated partial thromboplastin time (APTT), ristocetin-induced platelet aggregation(RIPA), von Willebarand factor-ristocetin cofactor (vWF:Rco), von Willebrand factor antigen (vWF:Ag), von Willebrand factor activity (vWF:Act), von Willebrand factor collagen binding assay (vWF:CB) and von Willebrand factor FⅧ binding assay (vWF: FⅧ:B) were detected for phenotype diagnosis. Peripheral blood DNA was extracted, and all of the exons and exon-intron boundaries of the VWF and F8 gene were amplified by polymerase chain reaction (PCR) and analyzed with direct sequencing. Results: The results revealed that APTT and BT of proband were prolonged while plasma RIPA, vWF:Rco, vWF:Ag, vWF:Act and vWF:CB were normal. FⅧ:C and vWF: FⅧ:B were significantly decreased. Homozygous missense mutation c.2446C>T (p.Arg816Trp) in exon 19 of VWF gene was identified in proband and heterozygous mutation was identified in his son. No mutation in F8 gene was found in proband. Conclusions: Homozygous missense mutation c.2446C>T (p.Arg816Trp) in exon 19 of VWF gene is the cause of 2N type von Willebrand disease in the proband. References | Related Articles | Metrics

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AxB blood group phenotype caused by ABO gene c.2T>C mutation and GTA aberrant translation KONG Cunquan, HE Yi, LIAN Lixia, XU Shen, WANG Xuefeng, ZOU Wei, CAI Xiaohong 2018, 17 (02):  155-158.  DOI: 10.16150/j.1671-2870.2018.02.007 Abstract ( 396 )   PDF (576KB) ( 43 )   Objective: To identify ABO blood group of an ABO discrepancy sample and explore the underlying molecular mechanism. Methods: Serological ABO blood group typing including total plasma GTA transfer capacity was performed. ABO gene was analyzed by PCR amplification and direct sequencing or sequencing after cloning of 7 exons and their flanking regions. Results: AxB subgroup was serologically identified in this subject. Plasma total GTA transfer capacity was remarkably reduced in this subject（titer±）. A single mutation T>C was identified at the +2 position of exon 1 of an ABO*A101 allele. Conclusions: ABO gene c.2T>C mutation may cause AxB subgroup by affecting the initial translation start site or replacing it by Met in the transmembrane domain or stem region. References | Related Articles | Metrics

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Diagnostic value of UroVysion FISH for detecting urological malignancy and its use in monitoring recurrence of bladder cancer XU Ling, WANG Genfa, ZHANG Liang 2018, 17 (02):  159-164.  DOI: 10.16150/j.1671-2870.2018.02.008 Abstract ( 415 )   PDF (692KB) ( 51 )   Objective: To assess the value of UroVysion FISH for screening urological malignancy and to explore its potential application in monitoring of recurrence of bladder cancer. Methods: Fresh urine specimens were collected from 368 cases with hematuria and/or history of urological cancer during follow-up. Diagnostic performance of UroVysion FISH for screening urological malignancy was evaluated in accordance with the results of pathology. Further analysis especially in patients with hematuria was conducted to determine the value of UroVysion FISH for detecting urological malignancy as well as for monitoring recurrence of bladder cancer. Results: ① The sensitivity of UroVysion FISH for detecting urological malignancy (bladder cancer, renal cancer, carcinoma of ureter, prostatic cancer) in patients with hematuria was superior to that without hematuria(P<0.005). ② Results of UroVysion Fish were closely related to tumor grade of urological malignancy. The sensitivity and specificity of UroVysion Fish for diagnosing high-stage tumor were higher than those of low-stage, especially in patients with hematuria. ③ A total of 45.51%(71/156) patients who eventually diagnosed as bladder cancer had cancer recurrence, and 57.75%(41/71) of them could be predicted according to the results of UroVysion Fish. ④ Results of FISH for bladder cancer follow-up in patients with hematuria showed higher sensitivity than in patients with history of urological malignancy. Conclusions: UroVysion FISH has high sensitivity and specificity for detecting urological malignancy, and the results are strongly relevant to tumor malignancy and invasion. UroVysion FISH is valuable for monitoring recurrence of bladder cancer, especially in patients with hematuria. References | Related Articles | Metrics

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Validation of Cambridge-Hopkins questionnaire for diagnosing restless legs syndrome in a Chinese cohort ZHANG Jing, CHEN Jie, MA Jianfang, XU Yi, HONG Jianfeng 2018, 17 (02):  165-169.  DOI: 10.16150/j.1671-2870.2018.02.009 Abstract ( 514 )   PDF (529KB) ( 78 )   Objectives: To validate the application of CH-RLSq (Cambridge-Hopkins questionnaire for restless legs syndrome) in the diagnosis of Chinese RLS (restless legs syndrome) patients. Methods: Twenty-six RLS and 21 controls were enrolled in this study. RLS patients, "mimics" and healthy people were recruited from Out-patient Clinics of Department of Neurology and completed the CH-RLSq. Clinical data of RLS were also collected. The agreement of clinical RLS diagnosis with CH-RLSq diagnosis was assessed by kappa and Mcnemar tests. Results: CH-RLSq-based diagnosis was consistent with clinical diagnosis (kappa=0.745, McNemar test: P=0.216). The clinical characteristics of these RLS patients included female preference, high family history, and various concomitant diseases. Conclusion:CH-RLSq is a good screening questionnaire for diagnosing RLS in Chinese patients. References | Related Articles | Metrics

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Low expression of visfatin and its correlation with vilius degeneration in patients with missed abortion CAI Mei, WU Weibin, LIU Yuan, ZHANG Huijuan 2018, 17 (02):  170-175.  DOI: 10.16150/j.1671-2870.2018.02.010 Abstract ( 276 )   PDF (1008KB) ( 70 )   Objective: To detect and compare the plasma level and expression of visfatin in placental tissue of missed abortion (MA) and induced abortion of unwanted normal pregnancy for exploring the possible role of visfatin in the pathogenesis of MA. Method: A total of 36 cases of MA (5-11 gestational weeks) and 20 cases of induced abortion of unwanted normal pregnancy (5-11 gestational weeks) were collected in the International Peace Maternal and Child Health Hospital affiliated to Shanghai Jiao Tong University between October, 2016 to April 2017. The double antibody enzyme-linked immunosorbent assay (ELISA) and immunohistochemical method (IHC) were used to detect visfatin level in plasma and expression of visfatin in placenta tissue. Result: By ELISA, the plasma level of visfatin in MA patients was (55.98±10.30) ng/mL and the plasma level of visfatin in induced abortion of unwanted normal pregnancy group was(70.19±11.70) ng/mL, the difference was statistically significant(P<0.001). By IHC, the expression of visfatin in placenta tissue was significantly lower in MA patients than in induced abortion of unwanted normal pregnancy group (P<0.001). Moreover, there was a significant correlation between the plasma level and placenta expression of visfatin (r=0.711, P<0.01). The degeneration rate of placental villus in MA group was higher than that in induced abortion of unwanted normal pregnancy group, and the low expression of visfatin was correlated with placental villus degeneration rate (r=-0684, P<0.001), and this correlation was more obvious than that between level of plasma visfatin and placental villus degeneration. Conclusions: The low expression of visfatin in plasma and placenta tissues may be involved in the pathogenesis of MA. Determining plasma visfatin level may be used as one of the indicators for monitoring the progress of pregnancy. References | Related Articles | Metrics

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Study on relationship between vitamin D deficiency and incidence of diabetic nephropathy: A prospective follow-up study of three years TAN Jiaorong, TIAN Dongmei, YANG Xin, ZHANG Lijuan, WANG Fang, SU Yuxia 2018, 17 (02):  176-180.  DOI: 10.16150/j.1671-2870.2018.02.011 Abstract ( 380 )   PDF (474KB) ( 47 )   Objective: To study the effect of 25-hydroxyvitamin D level on incidence of diabetic nephropathy in type 2 diabetic patients by 3-year follow-up study. Methods: From June 2009 to June 2012, a total of 530 type 2 diabetic patients with normal albuminuria were recruited. The fasting blood glucose, C peptide, glycosylated hemoglobin, 25-hydroxyvitamin D, blood lipids and 24 h urinary albumin excretion rate were measured in all the patients at baseline. The study patients were divided into 3 groups based on the baseline 25-hydroxyvitamin D level. All patients were followed up for 3 years. At the end of follow-up, 24 h urine was taken to detect the urinary albumin excretion rate to determine whether there was diabetic nephropathy. The incidence of diabetic nephropathy in the three groups was analyzed at the end of 3-year follow-up. Results: After 3 years, the urinary albumin excretion rate in vitamin D deficiency group was significantly higher than that in vitamin D normal group[25.9(3.1-379.6) mg/24 h vs 18.8（2.5-103.7） mg/24 h, P<0.01]. The incidence of diabetic nephropathy in the vitamin D deficiency group was higher than those in the vitamin D normal group and vitamin D insufficient group (26.2% vs 5.3%, 26.2% vs 12.7% P<0.05). Regression analysis showed that vitamin D deficiency significantly increased the risk of diabetic nephropathy (RR=1.58, 95%CI: 1.13-2.79), and this effect remained after controlling other multiple risk factors (RR=1.23, 1.05-2.12). Conclusions: A 3-year prospective cohort study confirmes that vitamin D deficiency significantly increases the risk of diabetic nephropathy in patients with type 2 diabetes. Vitamin D deficiency is an important factor for the development and progression of diabetic nephropathy. References | Related Articles | Metrics

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Establishment of a normal reference range for 1,5-anhydroglucitol DU Yiqiao, WANG Wenhui, LIU Wanchao, NIU Jing, SHI Xuejuan, YANG Zhenhua 2018, 17 (02):  181-185.  DOI: 10.16150/j.1671-2870.2018.02.012 Abstract ( 225 )   PDF (537KB) ( 84 )   Objective: To establish a normal reference range for 1,5-anhydroglucitol (1,5AG) and to verify its clinical application. Methods: A total of 1 175 healthy people undergone physical examination during August 2015 to December 2017 were enrolled to establish a normal reference range and the differences in 1,5AG level between different age and sex were analyzed. According to the diabetes diagnostic criteria (WHO 1999), the subjects used for verifying the self-built refe-rence range were divided into the verified diabetes disease group (300 cases, 136 males) and the verified control group (169 cases, 75 males). When the 1,5AG level was within the self-built reference range, it would be regard as negative result, otherwise as positive result; the positive rates between the 2 verified groups were compared. Results: There were differences in 1,5AG level between different age groups, so were between male and female. For people under 30 years of age, normal reference range was 86-418 μmol/L in male, and was 37-382 μmol/L in female, and for people aged 30 to 59 years, were 79-406 μmol/L and 43-297 μmol/L, while for people older than 60 years were 86-404 μmol/L and 27-278 μmol/L. The level of 1,5AG of diabetes patients was lower than that of non-diabetic patients, and the positive rate according to the self-built reference range in diabetes patients was higher than that in non-diabetic patients (71% vs 5%）. Conclusions: A reference interval of 1,5AG is established based on the population in Shanghai area, which has gender and age differences. This study will provide a reference for future large-scale population study. References | Related Articles | Metrics

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An in vitro study on mechanism of ANP32B in the promotion of tumors ZHU Xiaona, YANG Shuo, HE Ping, ZHANG Huilin, FENG Ru, YU Yun 2018, 17 (02):  186-190.  DOI: 10.16150/j.1671-2870.2018.02.013 Abstract ( 181 )   PDF (771KB) ( 40 )   Objective: To investigate the molecular mechanism of ANP32B （acidic leucine-rich nuclear phosphoprotein 32B）in the promotion of tumors. Methods: ANP32B interaction proteins were searched and identified by immunoprecipitation(IP)-coupled LC-MS/MS technology. Immunofluorescence was used to identify the localization of ANP32B and karyopherin α6 (KPNA6). KPNA6 was knockdown by shRNA. GST-pulldown assay was used to identify the direct interaction of ANP32B and KPNA6 and domains of interaction. Results: Immunoprecipitation(IP)-coupled LC-MS/MS technology identified the interaction of KPNA6 with ANP32B, and the N-terminal 1-161 amino acid of ANP32B was not required for its interaction with KPNA6. In vitro GST-pulldown assay demonstrated the direct interaction between KPNA6 and ANP32B, and the nuclear localization signal (NLS) of ANP32B was essential for its interaction with KPNA6. Inhibition of KPNA6 expression by shRNA had no effect on the nuclear localization of ANP32B. Conclusions: ANP32B interactes with KPNA6 via its NLS domain, and ANP32B is co-localized with KPNA6 in the nucleus. Knockdown of KPNA6 does not influence the nuclear localization of ANP32B. References | Related Articles | Metrics

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Iodine value in dual source dual energy CT for evaluating the efficacy of neoadjuvant chemotherapy on advanced gastric adenocarcinoma ZHANG Yang, ZHANG Huan, YAN Jing, GAO Xiaoyuan, TAN Jingwen, WU Xinyang, YAN Fuhua 2018, 17 (02):  191-196.  DOI: 10.16150/j.1671-2870.2018.02.014 Abstract ( 299 )   PDF (1102KB) ( 54 )   Objective: To assess the iodine value in dual source dual energy CT (DSDECT) for evaluating the efficacy of neoadjuvant chemotherapy on advanced gastric adenocarcinoma and comparing the standardized iodine value and non-standardized iodine value in lesions as well as the difference in reduction ratio of iodine value before and after neoadjuvant chemotherapy. Methods: A total of 48 patients with pathologically confirmed gastric adenocarcinoma via endoscopy were enrolled and neoadjuvant chemotherapy was conducted. The DSDECT images before and after chemotherapy were analyzed to compare the difference between the reduction ratio of standardized iodine values (which were normalized with abdominal aorta) and non-standardized iodine values in portal phase and delayed phase. According to RECIST1.1 criteria, patients were divided into response group and non-response group. The differences in iodine value as well as reduction ratio of iodine value of lesions before and after neoadjuvant chemotherapy were compared between response and non-response groups. Results: ① There were no significant differences in the reduction ratio of standardized iodine values and non-standardized iodine values before and after neoadjuvant chemotherapy in both portal phase and delayed phase(P>0.05). ② The iodine values after neoadjuvant chemotherapy in the response group were significantly lower than those of the non-response group in the portal phase [values are expressed as (mean ± standard deviation) or median (guartile deviation)][iodine uptake in portal phase(IU-P), （1.71±0.49） mg/mL vs （2.15±0.55）mg/mL, P=0.008; normalized iodine uptake in portal phase(NIU-P), （0.30±0.09） vs （0.38±0.10）, P=0.003; total iodine uptake in portal phase (TIU-P): 18.30 mg（27.15 mg） vs 81.55 mg（81.20 mg）, P<0.001; normalized total iodine uptake in portal phase (NTIU-P): 15.86（22.65） vs 47.97（64.05）, P<0.001]. ③ The reduction ratio of total iodine uptake before and after neoadjuvant chemotherapy in response group were significantly higher than those in non-response group in both portal and delayed phase [ΔTIU-P, -83.34%（21.05%） vs -39.82%（47.90%）, P<0.001; ΔNTIU-P, -80.28%（19.61%） vs -42.33%（41.12%）, P<0.001; ΔTIU-D, -80.66%（19.97%） vs -36.99%（37.71%）, P<0.001; ΔNTIU-D, -79.57%（24.89%） vs -37.79%（36.48%）, P<0.001]. Conclusions: The iodine values and the reduction ratio of the iodine values after neoadjuvant chemotherapy obtained from DSDECT can be helpful for evaluating the efficacy of neoadjuvant chemotherapy on advanced gastric adenocarcinoma. References | Related Articles | Metrics

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The features and diagnostic value of 3D-FIESTA-C and IDEAL sequences for brachial plexus injury ZHAO Hua-li, XU Wenpeng, LIANG Zonghui 2018, 17 (02):  197-201.  DOI: 10.16150/j.1671-2870.2018.02.015 Abstract ( 561 )   PDF (617KB) ( 104 )   0bjective: To study the features and diagnostic value of MRI 3D-FIESTA-C (three-dimensional fast imaging employing steady state acquisition with cycled phases) and IDEAL (iterative decomposition of water and fat with echo asymmetry and least squares estimation）for traumatic brachial plexus injury. Methods: Thirty-two cases of traumatic brachial plexus injury were examined by MRI 3D-FIESTA-C and IDEAL sequences before operation. The imaging data were treated with post processing imaging. The diagnostic results were compared with the findings in operation. The value of MRI 3D-FIESTA-C and IDEAL sequences for diagnosing traumatic brachial plexus injury before operation was evaluated. Results: It revealed postoperatively that preganglionic brachial plexus injury occurred in 12 cases (39 nerves). The features of preganglionic brachial plexus injury in MRI 3D-FIESTA-C sequence included disappearance or disruption of nerve root(31), and decrease of nerve root filaments(7) with nerve root sleeve abnormality, meningeal cyst, sheath thickening and abnormal spinal cord signal. Compared with the findings in surgery, the sensitivity, specificity and accuracy of 3D-FIESTA-C sequence in diagnosing preganglionic brachial plexus injury were 97.5%, 100%, 98.3%, respectively. Postganglionic injury occurred in 31 cases (45 nerves), IDEAL sequence showed continuity interruption(42), and the others showed nerve trunk enlargement, distortion, rigidity, adjacent structure disorder and edema. Compared with the finding in surgery, the sensitivity, specificity and accuracy of IDEAL sequence in diagnosing postganglionic injury were 96.7%, 100%, 97.1%, respectively. Conclusions: MRI 3D-FIESTA-C and IDEAL sequences are excellent in revealing preganglionic brachial plexus injury and postganglionic injury. Their diagnosis accuracy rates are high. MRI is non-invasive and optimal for clinical diagnosis. References | Related Articles | Metrics

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Diagnostic efficiency of transvaginal ultrasound four-dimensional contrast hysterosalpingography in evaluation of fallopian tube patency and analysis of misdiagnosed cases YANG Minmin, LIU Min, CHEN Yan, HE Suhui, ZHENG Liya 2018, 17 (02):  202-206.  DOI: 10.16150/j.1671-2870.2018.02.016 Abstract ( 323 )   PDF (655KB) ( 169 )   Objective: To assess the diagnostic efficiency of transvaginal ultrasound four-dimensional contrast hysterosalpingography (TVS 4D-HyCoSy) in evaluation of fallopian tube patency and analyze the misdiagnosed cases. Methods: Fifty two infertile patients (97 fallopian tubes) underwent TVS 4D-HyCoSy and fallopian tube patency was assessed. The results were divided into obstructed and unobstructed groups (consisting of fully unobstructed and partially obstructed). The results of laparoscopic methylene blue test were used as the golden standard. The results were compared and contrasted with that of laparoscopic methyl blue test. Results: Among the 97 fallopian tubes, TVS 4D-HyCoSy showed 34 unobstructed tubes, 28 partially obstructed tubes, 35 obstructed tubes, resulting in a consistency of 83 tubes and inconsistency of 14 tubes with the findings of laparoscopic methylene blue test. The factors in false positive results included pelvic surgery, endometriosis of pelvis and tubal spasm, and for false negative results included the contrast agent in the unobstructed fallopian tubes diffusing into the diseased side, distal fallopian hydrops and expansion being mistaken for contrast agent diffusion and contrast agent reflux. The sensitivity, specificity, positive predictive value and negative predictive value of TVS 4D-HyCoSy were 78.4%(29/37), 90.0%(54/60), 82.9%（29/35）, 87.1%（54/62）, respectively. Conclusions: TVS 4D-HyCoSy is an effective method for evaluating the fallopian tube patency. If the above-mentioned factors in misdiagnosed cases occur, objective analysis should be conducted to distinguish the false positive and false negative ones. False positive result should be aware of when there is a history of pelvic surgery. Second time contrast imaging could be done if needed. References | Related Articles | Metrics

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Analysis on detection rates of 9 commonly seen pathogens in 2 241 cases with respiratory tract infection WANG Fang, LIN Jianmin, CHEN Huifeng, WANG Jinjin, ZHANG Jianlin, DENG Yanyan, GONG Qian 2018, 17 (02):  207-210.  DOI: 10.16150/j.1671-2870.2018.02.017 Abstract ( 216 )   PDF (441KB) ( 41 )   Objective: To analyze the infection rates of 9 commonly seen pathogens [Parainfluenza virus (PIV), Influenza virus A (INFA), Influenza virus B (INFB), Respiratory syncytial virus (RSV), Adenovirus (ADV), Legionella pneumophlia serogroup 1 (Lp1), Mycoplasma pneumoniae (MP), Coxiella burnetii (Cb)], Chlamydophila pneumonia (CP)] among patients with acute respiratory tract infection. Method: A total of 2 241 samples were collected from inpatients at the Qingpu Branch of Zhongshan Hospital, Fudan University during 2015-2016. IgM antibodies of the nine pathogens in inpatients with respiratory infection were detected by indirect immunofluorescence method. The clinical epidemiological characteristics by age group, pathogen type and seasons were analyzed. Results: Of all the 2 241 patients, 447 cases were shown to be positive for the 9 pathogens, with a total positive rate of 19.95%. There were 345 cases (77.18%) with single pathogen infection, and 102 cases (22.82%) with mixed infection. Of the 9 pathogens, constituent ratio of Mp infection was the highest [41.16% (184 cases)], followed by Lp1[121cases (27.07%)]. For seasons by spring, summer, autumn, winter, the positive rates were 16.42%, 18.08%, 20.72%, 23.94%, respectively. In different age groups, the positive rate were 21.84% (<12 years), 16.25% (12-59 years） and 21.08% (≥60 years), respectively. Conclusions: MP is the major pathogen in patients with respiratory tract infection for all 4 seasons. Detection rates of MP in patients with age <12 and 12-59 are the highest,and so is the detection rate of Lp1 during the summer. References | Related Articles | Metrics

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Application of 6 W theory combined with scenario-based teaching in clinical education of cardiovascular diseases LI Ping, KANG Lei, ZHANG Xiaohong, TAO Rong 2018, 17 (02):  231-234.  DOI: 10.16150/j.1671-2870.2018.02.022 Abstract ( 319 )   PDF (426KB) ( 52 )   Objective: To evaluate the application of 6 W (what, where, when, who, why and how) theory combined with scenario-based teaching on diagnosis and treatment of procedure-associated complications of cardiovascular diseases. Methods: A total of 58 newly-recruited (about two years) nurses were divided randomly into two groups with 29 students of each group: study group and control group. Students in the study group were trained by 6 W theory combined with scenario-based teaching and those in control group received traditional teaching. The capability of students for diagnosing and treating procedure-associated complications was assessed at the end of teaching and 3 months afterwards, and the differen-ces between the 2 groups were compared. Results: The scores for acquisition and assimilation of cognitive knowledge were significantly higher in the study group than those of the control group (90.2±2.1 vs. 82.3±2.3, P<0.05), and so was the assessment of operating skills (98.2±4.2 vs. 92.6±3.3, P<0.05) at the end of teaching. Moreover, three months after the end of teaching, scores of theoretical examination and practical performance were also remarkably higher in the study group than in control group（84.4±3.2 vs. 74.1±2.3, P<0.05; 95.5±3.2 vs. 88.6±5.4, P<0.05). Conclusions: The teaching program based on 6 W theory combined with scenario-based training is proved to be more effective than the traditional method for the acquisition of cognitive diagnostic knowledge as well as the practical performance both in short and long term. References | Related Articles | Metrics