Clinical practice is an important period to train student's skills in pediatric surgical learning,but it is confronted with difficult condition under the new doctor-patient relationship.How to resolve these difficulties is the key to carry on teaching successfully.Aaccording to the students' interests and the knowledge structure characteristics,teachers should cultivate their professionalism,train their communication skills,extend their thinking ability with appropriate use of teaching aid to increase the teaching interests and develop self-learning ability.

The clinical data of a WHIM syndrome child with cardiac malformation as the first symptom in December 2017 in Beijing Children′s Hospital Affiliated to Capital Medical University was retrospectively analyzed.A 5-year-old female patient presented with cardiac malformation, neutropenia and recurrent infection.Heterozygous mutation(c.1000C>T) was detected in CXCR4 gene.Echocardiography and CT exhibited cardiac malformation.WHIM syndrome is very rare, and it was the first case with cardiac malformation as the first manifestation in China, thus hoping to improve clinicians′ understanding of this disease.

Objective To examine the efficacy and safety of 125Iseed implantation for treating neuroblastoma (NB) in animal models.Methods A total of 45 nude mice models of neuroblastoma were constructed and divided into the 125Igroup.control group.and blank group at 15 mice per group.The long and short diameters of the tumor were measured every 3 days.and the tumor inhibition rate was calculated every 9 days.Apoptotic and proliferative protein expression levels in tumor tissue and peritumoral tissue.as well as endocrine markers and bone marrow of the nude mice.were analyzed.The independent sample t test was used to compare the mean scores.and ANOVA was used for comparison between multiple groups.Results Tumor volume inhibition rate was significantly higher in the 125Igroup than in the control group and blank group on days 9.18.and 27(all P<0.05).Caspase-3 expression in tumor tissues was significantly higher in the 125Igroup than in the control group and blank group (all P<0.05).whereas proliferating cell nuclear antigen (PCNA) expression was significantly lower in the 125Igroup than in the control group and blank group (all P<0.05).There was no significant difference in Caspase-3 and PCNA expression between the control group and blank group (all P>0.05).In addition.no significant difference in the expression of Caspase-3 and PCNA in peritumoral tissue was observed between the 125Igroup.control group.and blank group (all P>0.05).Cell apoptosis in tumor tissue was significantly lower in the blank group and control group than in the 125Igroup (all P<0.05).while there was no significant difference between the blank group and the control group (P>0.05).There was no significant difference in endocrine markers between the three groups (P>0.05).There was no significant bone marrow suppression in the 125Igroup.and this observation was similar to those in the control group and blank group (all P>0.05).Conclusions 125Iseeds have significant toxicity to NB.125Iseed implantation is safe in nude mice with NB within the therapeutic doses.

Objective:To evaluate the efficacy of Anshen-Shenghua Decoction combined with Paroxetine hydrochloride tablets in treating postpartum depression. Methods:Eighty-two postpartum depression patients admitted to our hospital from September of 2017 to November of 2018 were selected and were randomly divided into control group and observation group with 41 cases in each group by random number table methode. The control group received paroxetine hydrochloride tablets. The observation grouptook Anshen-Shenghua Decoction based on the control group. Both of the two groups were treated for 6 weeks. Hamilton Depression Scale (HAMD) factors and Edinburgh Postpartum Depression Scale (EPDS) were used to evaluate the depression degree. The ELISA method was used to detect serum levels of hypersensitive C-reactive protein (hs-CRP) and homocysteine (Hcy). The efficacy was evaluated for both groups. Results:The total clinical effective rate of observation group and control group was 97.6% (40/41) and 78.0% (32/41) respectively, with statistically significant difference ( χ2=5.581, P=0.018). The scores of anxiety, day and night, sleep disorders, weight, feelings of hopelessness, cognitive impairment, block of the observation group were obviously lower than those of the control group after the treatment ( t values were 12.391, 10.941, 14.764, 12.261, 8.446, 10.005, 8.871 respectively, all Ps<0.01). The scores of EPDS in observation group were significantly lower than that of the control group after the treatment ( t=7.893, P<0.01). After the treatment, the serum levels of hs-CRP and Hcy in the observation group were significantly lower than those of the control group ( t values were 8.005 and 6.553, respectively, all Ps<0.01). Conclusions:Anshen-Shenghua Decoction combined with paroxetine hydrochloride tablets in treating postpartum depression can effectively relieve the depression symptoms of postpartum depression patients, and the down-regulation of serum levels of hs-CRP and Hcy.

Malignant peripheral nerve sheath tumors(MPNST) of the bladder is a very rare malignant tumor, usually secondary to neurofibromatosis type 1 (NF-1), with a few sporadic cases. This paper reports a case of 70-year-old man with bladder MPNST who underwent transurethral resection. Adjuvant intravesical instillation with gemcitabine was given after surgery, and there was no local recurrence and distant metastasis after 12-month follow-up. This paper also made a corresponding literature review.

With the COVID-19 outbreak, many provinces and municipalities have announced the first-level response to public health emergencies. As the backbone of fighting the epidemic, medical staff are faced with many ethical dilemmas, such as the lack of medical protection materials, the high risk of virus infection, discrimination and so on, and their health and life rights and interests have been impacted. Starting with the concept of public health emergencies and the right to life and health, the theory and display basis of the right of life and health were discussed based on the practical guidelines of public health emergencies. Taking the COVID-19 epidemic as an example, this paper proposed measures for ensuring the right to life and health of medical staff in public health emergencies, so as to better cope with the epidemic of COVID-19 and protect the life and health of medical workers.

With the COVID-19 outbreak, many provinces and municipalities have announced the first-level response to public health emergencies. As the backbone of fighting the epidemic, medical staff are faced with many ethical dilemmas, such as the lack of medical protection materials, the high risk of virus infection, discrimination and so on, and their health and life rights and interests have been impacted. Starting with the concept of public health emergencies and the right to life and health, the theory and display basis of the right of life and health were discussed based on the practical guidelines of public health emergencies. Taking the COVID-19 epidemic as an example, this paper proposed measures for ensuring the right to life and health of medical staff in public health emergencies, so as to better cope with the epidemic of COVID-19 and protect the life and health of medical workers.

Objective To investigate the efficacy of blood purification for acute lymphoblastic leukemia pediatric patients with high-dose methotrexate (MTX)-induced hypermethotrexemia and acute kidney injury (AKI). Methods The clinical data of 50 acute lymphoblastic leukemia pediatric patients with hypermethotrexemia (the 45th hour MTX blood concentration ＞20 μmol/L) and AKI who were admitted to Beijing Children's Hospital Capital Medical University from May 2010 to August 2018 were collected. After the treatment of blood purification, the declining rate of MTX concentration, the incidence of drug-related side effects and the clinical transition were analyzed retrospectively. Results The median MTX blood concentration at the 45th hour after high-dose MTX chemotherapy was 31.5 μmol/L (20.0-80.3 μmol/L). After blood purification treatment, 48 patients (96%) survived, 1 patient (2%) died, and 1 patient (2%) gave up treatment. It costed 10.0 days (7.0-15.0 days) to decline the MTX concentration to the normal level by using blood purification. The median time of purification was 32.5 hours (2.0-168.0 hours), and the days of dialysis were 3.0 days (1.0-9.0 days). The AKI occurred in approximately 96% (48/50) of patients, which was the main side effect. The time of declining the high MTX concentration to the normal was positively correlated with the increase times of serum creatinine (r ＝ 0.371, P＝ 0.009) and urea nitrogen (r ＝ 0.486, P＝ 0.001), and the value of the alanine aminotransferase (r ＝0.364, P＝0.010) and gamma glutamyl transpeptidase (r ＝ 0.344, P＝ 0.010), and the days of dialysis (r ＝ 0.532, P < 0.01), but there was no relationship with the 45th hour MTX blood concentration (r＝0.110, P＝0.248). The reduction of MTX blood concentration from the 45th hour to the 69th hour after high-dose MTX chemotherapy was negatively correlated with the increase times of urea nitrogen (r ＝ -0.336, P＝ 0.009) and serum creatinine (r ＝ -0.260, P＝ 0.035). Conclusion When the MTX blood concentration of patients with hypermethotrexemia and AKI couldn't be declined to the normal level by using high-dose leucovorin, hydration and alkalization, and without the effective detoxification drug (carboxypeptidase G2), they should be offered blood purification, especially continuous renal replacement therapy as soon as possible, which can reduce the blood concentration of MTX quickly and decrease the incidence of side effects effectively.

The advancement of medicine and biotechnology is based on biomedical research. The rights and safety protection of subjects in biomedical research is one of the core issues of research ethics,and the protection of vulnerable subjects should be the top priority importantly,research ethics should provide special protection for vulnerable subjects. Chinese laws and regulations have not yet given a clear definition of the concept of vulnerability,and the content and regulations related to vulnerability are relatively rough and not perfect. By drawing on the main international and foreign research ethics policies and guidelines,introducing the definition of vulnerability,clarifying the source of vulnerability,and applying vulnerability to the process of biomedical research in China. When applying vulnerabilities,one should avoid using the label approach to include people with common characteristics into vulnerable groups,but mainly analyze the types and sources of vulnerability,and includes as many vulnerable subjects of different types as possible to provide them with more comprehensive and adequate protection in biomedical research.

At present, the contradiction between the lack of pediatricians and the increasing demand for pediatric medical services has become more and more prominent. Taking pediatricians as the research object, this paper explored the needs and motivation of professional development of pediatricians in China by referring to a series of excellent foreign research results, so as to improve the professional development of pediatricians, reconstruct the ecology of pediatricians and patients, then improve medical experience, and alleviate the "shortage of pediatricians" and "difficulty in seeing a doctor" in pediatrics. Enhancing the work enthusiasm and professional motivation of pediatricians can not only improve the satisfaction of patients, but also enhance the quality of medical services, so as to promote the growth of the hospital’s own economic and social benefits.