Department of General Medicine in Zhongshan Hospital,Fudan University was founded in 1994,which was the only unit established in a tertiary hospital in the country at that time,engaged in clinical practice,teaching and research of general practice.Zhongshan Hospital won the second prize of National Teaching Achievement in 2014 forExploration and innovation of training system of general practitioners in China,which contributed to development of standardized training system of general practitioners suitable to China's national conditions.This article summarizes the experience in training general physician,development of disciplines and enhancing influence of Zhongshan Hospital over years,hopefully it will be of reference value for medical educators.

Objective:To investigate parents′ knowledge and attitude toward post-operative pain management in pediatric orthopedics and analyze influencing factors.Methods:A total of 170 parents of 6 to 16 years old children who underwent selective surgeries and were hospitalized because of limb fracture were conveniently selected in Children′s Hospital of Soochow University from April to December in 2019, They were investigated using the general data questionnaire, Pain Management Knowledge and Attitudes Questionnaire.Results:There were 167 parents completed questionnaires in our study. The mean score of parents′ knowledge, general attitude and negative attitude to pain medication were 15.0(3.00), 24.0(4.00) and 17.0(3.00) respectively. There were statistical differences between different educational levels of parents′ knowledge ( χ2 value was11.599, P=0.021), as well as different age of parent′s general attitude ( χ2 value was 7.053, P=0.029). Spearman-related results showed that parents′ cognition was positively correlated with general attitudes ( r value was 0.394, P<0.01). Conclusions:The majority of parents are at moderate to high level of knowledge, general attitude and negative attitude to pain medication. Pediatric nurses should pay more attention to parents′ knowledge deficit of and negative attitude toward pain assessment tools and pain-drugs to develop targeted educational intervention programs for promoting parental involvement.

ObjectiveTo investigate the effect of focal ischemic preconditioning (IPC) on the expression of protein kinase-like endoplasmic reticulum kinase ( PERK ) and glucose-regulated protein 78 (GRP78) mRNA and protein after focal cerebral ischemia/reperfusion (I/R) in rats.MethodsAll 120 male SD rats were randomly divided into three groups: sham-operation group,middle cerebral artery occlusion (MCAO) group and brain ischemia preconditioning (BIP) group.Each group was further divided into 4 subgroups according to 12 h,1,2 and 3 d after I/R.The IPC models were made in order to measure the expression of PERK,GRP78 mRNA and protein by in situ hybridization and Western blot,and the apoptosis rate of neuron by flow cytometry. Results ①The expression of PERK mRNA increased and reached the peak at 12 h,then decreased continuously after 1 d.BIP could decrease its expression.The expression of PERK protein increased at 12 h and reached the peak at 24 h,then decreased continuously after 2 d.BIP could decrease its expression.②The expression both of GRP78 mRNA and its protein all increased and reached the peak at 12 h,then decreased continuously.BIP could increase their expression (mRNA:12 h: 136.70±9.53,F=32.265; 24 h:147.54 ±9.97,F=54.920; 2 d:158.16 ±9.44,F=45.374; 3d: 165.85±10.26,F=16.493,P＜0.05; protein:12 h: 1.319±0.116,F=5.619,P＜0.05; 24 h: 1.226±0.108,F=33.742,P＜0.01; 2 d:1.183 ±0.112,F =46.556,P ＜0.01; 3 d:1.115± 0.098,F =11.730,P＜0.05).③The rate of apoptosis neuron of rats in MCAO increased markedly at 12 h after reperfusion,and reached the peak at 1 d,then decreased continuously.BIP could decrease the rate of apoptosis neuron. Conclusion BIP can protect neurons through inhibiting the expression of PERK and inducing the expression of GRP78 after endoplasmic reticulum stress in rats.

Objective:To explore the relationship among serum neutrophil gelatinase associated lipocalin (NGAL), cystatin C (Cys-C) levels and cardiac, renal function;and diagnostic value of NGAL and Cys-C for early renal damage in aged patients With coronary heart disease (CHD).Methods:According to NYHA cardiac function classi-fication,a total of 84 aged CHD patients Were divided into class I group (n=30),class Ⅱ group (n=28)and classⅢ-Ⅳ group (n=26).Another 31 aged healthy objects Were selected as healthy control group.Serum N terminal pro B-type natriuretic peptide (NT-proBNP),NGAL and Cys-C etc. levels Were measured,and the correlation a-mong serum NGAL,Cys-C levels and cardiac function,estimated glomerular filtration rate (eGFR)Were analyzed. The accuracy of serum NGAL and Cys-C diagnosing renal insufficiency Was evaluated by receiver operator character-istic curve (ROC).Results:Along With NYHA class increased,there Were significant increase in serum levels of NGAL [(36.96±21.23)μg/L vs.(87.80±61.40)μg/L vs.(141.21±92.96)μg/L vs.(198.15±98.46)μg/L] and Cys-C [(0.75±0.64)mg/L vs.(1.40±1.88)mg/L vs.(2.33±2.03)mg/L vs.(3.45±1.81)mg/L]in healthy control group,NYHA I,Ⅱ,Ⅲ-Ⅳ groups,and they Were highest in NYHA class Ⅲ-Ⅳ group,there Was significant difference in serum NGAL level betWeen any tWo groups among the four groups (P<0.01),and so Was serum Cys-C level (P<0.05 or <0.01)except healthy control group and NYHA class I group (P>0.05). Pearson correlation analysis indicated that serum NGAL and Cys-C levels Were positively correlated With NT-proBNP (r=0.842,0.718,P<0.01 both),and negatively correlated With eGFR (r=-0.689,-0.448,P<0.01 both), and serum NGAL level had closer correlation With NT-proBNP and eGFR.Area under ROC of serum NGAL and Cys-C Were 0.884 and 0.744 respectively in diagnosing renal insufficiency.Conclusion:Serum NGAL and Cys-C lev-els have good correlation With cardiac and renal function in aged CHD patients,Which are sensitive and accurate in-dexes for diagnosing early renal damage.

The nutritional status, serum lipids, protein, Ca, and Zn of 85 toxemic and 42 normal pregnant women were estimated longitudinally from the first trimester to delivery. The results of dietary survey revealed that correlative and regressive relationship closely existed between serum TC, LDL-C, LDL-C/HDL-C, AI, and percentage of animal fat. In the toxemic cases, there were significant increases of serum LDL-C/HDL-C, AI, and decrease of HDL-C, HDL-C/TC and Ca in the 1st trimester as compared with those of the normal. In the 3rd trimester, there were significant increases of serum TG, TC, LDL-C, LDL-C/HDL-C, AI and MUFA, and decrease of serum HDL-C, HDL-C/TC, Ca, Zn, total protein and albumin in the toxemic cases. The regressive relationship was found between GI (ges-tosis index) and serum Ca in the 1st trimester or GI and serum P/S, A/G, LDL-C/HDL-C, AI in 3rd trimester. The problem of nutritional factors on development of toxemic cases was discussed and some nutritional suggestions were made.

The clinical data of 7 patients with porokeratosis (PK) were analyzed retrospectively.In 7 PK patients, 4 cases were disseminated superficial actinic porokeratosis (DSAP),1 case was disseminated superficial porokeratosis (DSP),1 case was giant porokeratosis (GP) and 1 case was hypertrophic porokeratosis (HP).The characteristic cutaneous manifestations were annular well-circumscribed keratotic plaques with slightly atrophic center and elevated border.All patients shared a common histological hallmark, the cornoid lamella.Four cases of DSAP patients had family medical history, consistent with autosomal dominant inheritance.DSP, GP and HP patients denied family medical history.Diagnosis of PK should be based on clinical manifestations, family medical history and histopathological examination.

AIM: To observe the curative effect of Compound Shouwu Granule on hyperlipemia. METHODS: Compound Shouwu Granule was composed of Radix Polygoni multiflori,Fructus,Crataegi Hirudo,Radix Puerariae,Lobatae,etc.the herbs were extracted with the method of percolation respectively.Each gram of extract equals to 8.2 g original medicine material.to take 2 g,each time,twice a day.Six weeks was one treating course.Patients were treated for two treating course.The changes of total cholesterol(TC),triglyceride(TG),high density lipoprotein(HDL-C) s,low density lipoprotein(LDL-C)s,were compared before and after treatment. RESULTS: The blood fat descended obviously after 6 weeks treatment. After 12 weeks,the TC descended by 38.4%,the TG descended by 80.8%,the HDL-C went up (91.3%),the LDL-C descended by (30.9%)(P

Objective To provide references for enriching and innovating patterns of TCM syndrome differentiation by exploring the relationship between pathological changes and TCM syndrome differentiation of delayed graft function (DGF) after renal transplantation. Methods Totally 57 patients with DGF after renal transplantation who were diagnosed by pathological biopsy were also diagnosed by TCM doctors to obtain TCM syndromes. And the pathological diagnoses were compared with the distribution of TCM syndromes to discuss the relationship between them. Results All the patients were classified into four TCM syndromes:spleen-kidney qi deficiency, liver-kidney yin deficiency, qi-stagnation and blood stasis, and deficiency of both qi and yin. The results of pathological biopsy were as follows:acute tubular necrosis, calcineurin inhibitor toxicity and acute rejection. Quantitative corresponding relation was found between the pathological diagnoses and the TCM syndromes. Conclusion There are inner links between pathological diagnosis and TCM syndromes of DGF, which can be references for diagnosis and treatment of TCM syndrome differentiation.

Objective To clone 2-hydroxyacid dehydrogenase (HADH) gene from Ketogulonigenium vulgare(KGV) Y25 and investigate its expression , purification, and enzymatic characterics .Methods The hadh gene was amplified from ketogulonigenium vulgare Y 25 and cloned into the expression plasmid pITG .The recombinant plasmid was transformed into Escherichia coli BL21(DE3).HADH was then successfully expressed with induction .To explore its enzymatic characteris-tics,HADH was purified by Ni +exchange chromatography .Results HADH constituted more than 50% of the total cell proteins analyzed by SDS-PAGE,with a relative molecular mass of about 35 ×103.With 2-keto-gulonic acid(2-KGA) as substrate, the optimal pH of HADH was at 8.0 ,while the optimal temperature of the purified HADH was at 45℃.Mean-while, such metal ions and chelating agents as Cu 2+, Ca2+, Mg2+, EDTA, and DEPC exerted little effect on enzymatic activities.The maximum initial activity of the enzyme towards 2-KGA reached 27 U/mg, and the Km was calculated as 2.6 mmol/L.The results of in vivo enzyme activity assay showed that HADH could metabolize 2-KGA.Conclusion The HADH gene form Y25 is successfully expressed in E.coli BL21 ( DE3 ) and the enzymatic characteristics of HADH are explored, which will facilitate subsequent studies on sorbose metabolic pathways and sugar acid conversion .

Objective To explore the influence of antidepression therapy on symptom score and quality of life in elderly benign prostatic hyperplasia with depression.Methods A total of 94 elderly patients with benign prostatic hyperplasia and depression were randomly divided into two groups:control group (regular drugs) and therapy group adding citalopram 20 mg,once daily for 3 months.The changes of internatio nal prostate sympeom score (IPSS) symptom score,hamilton depression (HAMD) and scores of short form (36) health survey before and after treatment were compared between the two group.Results After treatment,IPSS symptom score [(10.74 ± 4.72) vs.(16.42±8.09)] was much lower in therapy group than in control group (t=4.16,P＜0.05).Each dimension of quality of life was increased after antidepression treatment [physical function (67.75 ± 9.99) vs.(63.09±7.90),SF-36 role physical (70.90±10.85) vs.(62.81±9.16),bodily pain indices (72.75± 10.59) vs.(63.13 ± 9.47),general health (62.59 ± 9.38) vs.(53.67 ± 7.52),vitality (64.09±8.96) vs.(58.11 ± 7.87),social functioning (71.84 ± 6.87) vs.(64.99 ± 7.21),roleemotional (70.15±9.93) vs.(65.01±9.18),mental health (68.74±8.23) vs.(61.77±7.83),all P＜0.05].Conclusions More attention should be paid to antidepression therapy in the elderly with benign prostatic hyperplasia and depression.