For the requirements of social development,the medical model has changed from the medical model of organism to the model that of society-mentality-organisms. Thus,pediatrician must change old ideas and old model of thinking,improve knowlege structure and reform medical education model.

Objective To determine the content of hesperidin in Weifukang capsules by HPLC,and to establish the quality standard of Weifukang.Methods HPLC method was performed on C18 column(4.6 ?200 mm,5 ?m).The mobile phase consisted of acetonitrile-sodium dihydrogen phosphate(0.05 mol/L)-phosphoric acid(200 ∶800 ∶0.5).The flow rate was 1.0 mL/min,column temperature was 25 ℃,and the detection wavelength was 283 nm.Results Hesperidin was linear at the range of 0.38 ?g～1.90 ?g(r=0.999 2)the mean recovery rate was 97.88 %,and RSD was 1.69 %.Conclusion This method is effective and reproducible and provides a basis for the quality control of Weifukang capsules.

Azathioprine(AZA) and 6-mercaptopurine(6-MP) have a well-established effect as an immunosuppressive agent for inflammatory bowel disease(IBD),Myelosuppression is the most serious side effect during treatment.Thiopurine methyltransferase(TPMT) plays an important role in the metabolism of 6-MP. This article reviews the literature on the role of TPMT measurement prior to treatment of IBD with AZA/6-MP.

Objective To evaluate the value of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP),C-reactive protein(CRP) and D-dimer(D-D) in prognosis of elderly patients confined to bed.Methods The clinical data of 150 elderly patients confined to bed were reviewed retrospectively,and 35 patients were in dead group and 115 patients were in survival group.The level o f plasma NT-proBNP,CRP and D-D were measured before treatment,during treatment and after treatment.Their characteristics and dynamic change were analyzed,and the value of NT-proBNP,CRP and D-D was evaluated in prognosis of elderly patients confined to bed.Results The level of NT-proBNP,D-D and CRP in dead group before treatment,during treatment and after treatment were significantly higher than those in survival group (P ＜ 0.05 or ＜ 0.01).The peak level of NT-proBNP,D-D and CRP in dead group emerged after treatment.By the way,the peak level of NT-proBNP,D-D and CRP in survival group emerged before treatment.Incidence of two or three markers positive in dead group [37.1％ (13/35),54.3％ (19/35)] was significantly greater than that in survival group [20.9％ (24/115),8.7％ (10/115)] (P =0.032,0.008).Multivariate Logistic regression analysis showed that the level of NT-proBNP,D-D and CRP were independent predictors of 28-day mortality (P ＜0.05).Conclusions The level of NT-proBNP,CRP and D-D are increased in severe elderly hospitalized patients.The level of above indexes have a dynamic change and reach peak before death.They are the independent prognostic markers of hospital mortality.Combined detection of NT-proBNP,D-D and CRP can improve the predictive value of hospital mortality in elderly patients confined to bed.

Objective To investigate clinical features,diagnosis and treatment of congenital adrenal hyperplasia (CAH) and to improve the knowledge of 21-hydroxylase deficiency form in CAH.Methods Ninteen neonatal CAH cases admitted to the neonatal intensive care unit of Shenzhen Children's Hospital from Jan 2004 to Aug 2011 were reviewed retrospectively.According to the early clinical manifestations,the serum levels of 17-hydroxyprogesterone,testosterone,progesterone,cortisol and adrenocorticotropic hormone (ACTH),early diagnosis was drawn and they were given to the glucocorticoid therapy.The alterations of blood sodium and potassium were compared before and after glucocorticoid therapy.Results Fourteen cases of 21-hydroxylase deficiency were salt-losing form who all were complicated with adrenal crisis and five cases were simple virilizing form.All CAH newborns(19 cases) appeared dark color of skin and mucosa.Fifteen cases had resistence to milk,poor response and feeding problem.The weight of eight cases at admission were lower than birth weight.Five cases suffered from repeating vomiting and diarrhea.After glucocorticoid therapy,there were significant improvement of hyponatremia[(110.2 ±9.5) mmol/L vs (138.7 ±5.2) mmol/L] and hyperkalemia[(7.40 ± 1.59) mmol/L vs (4.40 ±0.69) mmol/L] (P both ＜0.05).Conclusion We should raise the knowledge and level of diagnosis of neonatal CAH.We should diagnose the salt-losing form of 21 hydroxylase deficiency which is highly complicated with adrenal crisis through specific clinical manifestations and necessary biochemical assay as early as possible.The glucosteroid therapy is effective.

Delirium is a common disorder in aged people.Although it is in poor prognosis,delirium still has been under-recognized and inappropriately evaluated and treated.The clinical aspects of delirium on epidemiology,diagnosis,risk and precipitating factors,prevention and treatment were introduced in this paper.

ObjectiveTo evaluate the efficacy of nerve stimulator-guided thoracic paravertebral block in patients undergoing segmental mastectomy.MethodsFifty ASA Ⅰ or Ⅱ female patients,aged 18-64 yr,with body mass index ＜ 24 kg/m2,undergoing segmental mastectomy,were randomly divided into 2 groups ( n =25 each):thoracic epidural block group (group A) and nerve stimulator-guided thoracic paravertebral block group (group B).In group A,an epidural catheter was placed at T3,4 interspace and 0.5％ ropivacaine 7-10 ml was administrated via the epidural catheter.In group B,thoracic paravertebral block was performed at T4 under the guide of the nerve stimulator and 0.5％ ropivacaine 25 ml was administrated.The perioperative adverse cardiovascular events (hypotension and bradycardia) were recorded.Shivering,chest distress,and dyspnea during operation and nausea and vomiting after operation were also recorded.The range of block on the operated side was determined by pinprick test.The efficacy of anesthesia was evaluated.ResultsThe incidence of shivering,chest distress,and dyspnea during operation and nausea and vomiting after operation was significantly lower in group B than in group A (P ＜ 0.05).Adverse cardiovascular events and respiratory depression were not found in the two groups.There was no significant difference in the range of block on the operated side in the two groups ( P ＞ 0.05).The satisfactory anesthesia was found in 100％ of cases.ConclusionNerve stimulator-guided thoracic paravertebral block can be safely and effectively used in patients undergoing segmental mastectomy and the efficacy is better than that of thoracic epidural block.

The use of five or more drugs (polypharmacy) is common problem in the elderly,and need to attach importance.Optimization of drug treatment is a major part of medication in older adults,and also is a challenge to clinical physician.Beers Criteria provided by American Geriatrics Society (AGS) is a strong guarantee for improving medication safety in older adults

BACKGROUND:Construction of tissue engineering adult cardiac myocytes has been a new research hotspot in cardiovascular fields.
OBJECTIVE:To explore a simple, fast method for the separation of adult rat cardiomyocytes, and preliminarily explore the construction methods of tissue engineering adult cardiac myocytes.
METHODS:Segmented enzymatic digestion method was used to isolate cardiac myocytes from adult rats. Subsequently, cardiac myocytes were transfected with adenovirus and liposome-mediated red fluorescent protein gene. Construction efficiency of tissue engineering cells was qualified using inverted fluorescence microscopy and flow cytometry. Final y, cardiac myocytes were transfected with adenovirus-mediated hypoxia-inducible factor-1a, and the expression of hypoxia-inducible factor-1a was examined by western blot analysis.
RESULTS AND CONCLUSION:A lot of cardiac myocytes were col ected using the segmented enzyme digestion method. Flow cytometric analysis showed that the survival of adult cardiomyocytes was (87.03±0.70)%. Compared with liposomal transfection (transfection efficiency was 0), adenovirus infection efficiency was (70.31± 1.39)%, and the cells expressed red fluorescence under fluorescence microscope. After 4 days of adenovirus infection, transfected cells expressed hypoxia-inducible factor-1a protein. These results showed that segmented enzyme digestion is a fast way to isolate adult cardiac myocytes, and recombinant adenovirus vector is a good vector to transfect cardiac myocytes.

Objective:To study the cognitive characteristics of older women about the ethical issues and stipula-tion of test-tube baby technology. Methods:A survey was undertaken with 203 female patients, who were ran-domly selected from three hospitals in Xi′an accepted test-tube baby technology. The basic characteristics and ethical cognition regarding embryos, offspring, and informed consent were included in the questionnaire. Results:Female over 40 had a statistical significant higher score on the cognition of offspring (12. 48 ± 3. 08) and informed consent (13. 27 ± 2. 31) related ethical issues comparing to other age group (P<0. 05). Age, educational status, monthly income were statistically positive related to the scores of the Ethical Cognitive Scale ( P<0 . 05 ) . Conclu-sion:Older women paid more attention to medical risks and policy rules to test-tube baby. And they had a strong aspiration to obtain a child through surrogacy. For older women with low education, low-income, the ethical cog-nition was not ideal, hospitals should pay attention to the use of modern multimedia to help patients better under-stand related ethical issues in test-tube baby.