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.

Comprehensive geriatric assessment (CGA) conducts comprehensive assessment of many aspects of health and well-being of an older patient including medical,functional,nutritional,psychiatric and behavioral issues and needs as well as family and social support.CGA is typically conducted by a multidisciplinary team led by a geriatrician.Based on the CGA findings,appropriate recommendations are provided to the patient and family.This paper introduces the CGA concept and its content,targeted population,and implementation methods.It will also describe clinical studies focusing on the effectiveness and utility of CGA.

Objective To investigate the changes and clinical significance of cerebrospinal fluid (CSF) non-protein-bound iron and malondialdehyde(MDA) in preterm infants with severe intraventricular hemorrhage (IVH) after serial lumbar punctures.Methods Non-protein-bound iron and MDA of CSF in twenty severe IVH preterm infants with first and end lumbar puncture were examined respectively.The control samples were determined for once from first to second week after birth.Results Both Non-protein-bound iron and MDA levels of the first CSF sample in twenty severe IVH preterm infants were higher than that in control[(0.66±0.38)μmol/L vs (0.24±0.12)μmol/L(P<0.01);(1.21±0.41)μmol/L vs (0.89±0.35)μmol/L(P<0.05)].Non-protein-bound iron levels of first and end CSF sample in severe IVH with posthemorrhagic ventricular dilatation (PHVD) were both higher than those without PHVD [(0.75±0.34)μmol/L vs (0.54±0.31)μmol/L;(0.57±0.21)μmol/L vs (0.35±0.18)μmol/L](P<0.05).However,there was no significant difference in MDA levels between both groups.The levels of non-protein-bound iron of end CSF in severe IVH with and without PHVD were significantly lower than those of the first CSF samples (P<0.05),while,there was no significant difference in MDA levels between the end and first CSF samples.Conclusion The non-protein-bound iron and MDA of CSF in severe IVH preterm infants were both significantly increased,non-protein-bound iron and oxygen free radicals may be involved in the preterm brain injury.Serial lumbar punctures can lower the levels of non-protein-bound iron in CSF.

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

Objective To summarize the strategies of nutritional support for patients with hyperlipidemic acute pancreatitis (HLAP). Methods The clinical data of six HLAP patients who were treated in our department from January 1998 to December 2009 were retrospectively reviewed. Results The disease conditions of all patients were improved after fasting and early nutritional support and lipid-lowering treatment. Three cases with severe HLAP received enteral nutrition via a nasojejunal tube. Another three patients with milder HLAP obtained low-fat diet and orally administered lipid-lowering drugs. The plasma triglyceride levels decreased from (25.30 ± 20. 48 ) mmol/L to (5.41 ±4.55) mmol/L. No relapse was noted during follow-up (range: 3 -24 months). Conclusions The approaches of nutritional support for HLAP patients should be customized based on the specific disease conditions,and the enteral nutrition and lipid-lowering drugs should be reasonably and carefully designed and applied. For severe HLAP, nasojejunal tube should be maintained in the early stage to ensure the application of enteral nutrition and lipid-lowering drugs, protect the integrity of gut mucosal barrier, and decrease the fluctuation of blood glucose.