Yu Chang,a famous doctor in Qing dynasty,puts a high value on criterion, which is the most impor-tant characteristic in his medical moral thoughts. Based on the traditional medical moral, Yu Chang quoted Buddha into medicine and further expounded the medical moral criterion ( restrain the doctors by laws) referring to Buddhist commandment. This article analyzed the detailed medical moral criterion and requirements of carefulness,per-fection,honestyand pursuing the truththat mentioned in Medical Laws. Furthermore, it pointed out the es-sential features and significance of Yu Chang′s medical moral thoughts.

Objective To evaluate the effect of velocity of inspiratory flow on the severe asthma patients.Methods Twenty patients were ventilated thirty minutes respectively when the peak velocity of flow was 40L/min,60 L/min,80 L/min,100 L/min and 120 L/min,and then we measured their airway peak pressure(Ppeak),plateau pressure(Pplat)and intrinsic positive end expiratory pressure(PEEPi)and arterial blood gas analysis,accounting shunt fraction(QS/QT)and Dead space value(VD/VT).Results When velocity of flow enhanced from 40L/min to 60L/min,Ppeak increased while Pplat,PEEPi,VD/VT decreased obviously.When velocity of flow enhanced from 60L/min to 80L/min,Ppeak increased also but Pplat,PEEPi,QS/QT and VD/VT changed no significant.When velocity of flow enhanced from 60L/min to 100L/min,Pplat and PEEPi increased indistinctly while Ppeak,QS/QT and VD/VT increased distinctly.Conclusions The velocity of inspiratory flow,60~80L /min,can reduce PEEPi、QS/QT 及VD/VT and improve respiratory status.

Objective:To compare the accuracy and timeliness of 3-lead electrocardiography (ECG) and pulse oximetry (POX) in neonatal heart rate (HR) monitoring after birth.Methods:This prospective study recruited 42 high-risk newborns with gestational age ≥37 weeks and birth weight >1 500 g who were born through cesarean section without resuscitation requirement in Xi'an People's Hospital (Xi'an Fourth Hospital) from October 2019 to August 2020. 3-lead ECG electrodes and POX sensors were attached to the neonates immediately after drying to continuously monitor the HR within 10 min after birth. All procedure was recorded by video camera, and data were independently analyzed by a clinician after the procedure was completed. Differences in time required to connect the devices, time to obtain a reliable HR and the interval between them, the time needed for obtaining a reliable HR after birth, the proportion of neonates with reliable HR obtained within 5 min after birth and the consistency in the reliable HR readings between the two devices were compared using Wilcoxon signed-rank test, McNemar test, Spearman's correlation coefficient, intraclass correlation coefficient or Bland-Altman bias analysis.Results:The median time required to connect POX and 3-lead ECG and to acquire a reliable HR were 13.0 s (10.0-17.0 s) vs 23.0 s (18.0-28.3 s) ( Z=-5.050, P<0.001), and 79.5 s (56.2-128.0 s) vs 11.0 s (10.0-13.3 s) ( Z=-5.646, P<0.001), respectively. The total time from the beginning of connecting the devices and birth to acquiring a reliable HR were both longer for POX than those for 3-lead ECG [92.0 s (71.3-139.0 s) vs 35.0 s (30.0-39.5 s), Z=-5.579, P<0.001; 110.5 s (85.8-153.5 s) vs 52.0 s (45.0-66.3 s), Z=-5.579, P<0.001]. Reliable HRs were obtained in 69.1% (29/42) and 2.4% (1/42) of the infants by 3-lead ECG and POX within 1 min after birth, respectively. The percentage of infants for obtaining a reliable HR detected by 3-lead ECG within 5 min after birth were more than those by POX, but with statistically significant differences only at the first 60 s, 90 s, 120 s and 150 s (all P<0.001). The median HRs obtained by 3-lead ECG and POX within 10 min after birth were 161 beats/min (147-175 beats/min) and 160 beats/min (146-176 beats/min), respectively ( r=0.966, P<0.001). The mean difference of HR detected by the two devices was 0.56 beats/min (95% CI:-4.3 to 5.4 beats/min). The intraclass correlation coefficient was 0.961, showing good internal consistency. Conclusions:Neonatal HR can be assessed accurately by 3-lead ECG within 1 min after birth, which is far earlier than that by POX. Therefore, 3-lead ECG can be an option for continuously HR monitor in neonatal resuscitation.

Objective To observe the effect of the different bore diameter membranes on technological parameters of Radix Polygoni Multiflori Granula and to optimize the process of membrane filtration.Methods Three different membranes were tested under different parameters of operation to observe the changes in membrane flux and the content of effective components by Radix Polygoni Multiflori Granula.Results The membrane(50 nm)had the great flux,the transfering rate of stilbene glucoside was the highest;The optimum conditions:the operation differential pressure was 0.8-1.2 MPa;The operation temperature was 50-60 ℃;the membrane surface flow rate was 3.0 m/s.When the volume of filtration solution was condensed to 1/10 of former,entering the same volume deionized water into it,and when the effective components transfering rate reached 80%,the filtration was finished.Using the strong acid and strong alkali to wash it in turn,the flux could revive above 90%.Conclusion It can be obtained a good result that adopts the technology of ceramic membranes microfiltration to refine Radix Polygoni Multiflori Granula.This can provide the foundation for the application of ceramic membrane microfiltration in the refinement of water extraction of other Chinese materia medica.

As a safe,cheap and effective diabetes drug,metformin has been used for many years.Diabetes increases the risk of liver cancer and affects its prognosis.In recent years,it is found that metformin reduces the pancreatic cancer risk in the treatment of diabetic patients,a large of experiments also prove that it has anti-cancer and synergistic anticancer effect.This paper focused on the effects of metformin on treatment of Ⅱ type diabetes,discussed the curative effect on liver cancer,suggested the molecular biology mechanism of inhibiting tumor,listed the latest experiment researches,analyzed the existed clinical data,proposed the further study of anticancer mechanism and clinical treatment.Metformin for a future role in prevention of hepatocellular carcinoma in patients with type Ⅱ diabetes are briefly summarized and future prospects,which in type Ⅱ diabetic patients with liver cancer in a prospective study of the effect of treatment.Mefformin for application in other cancer prevention also raises possibilities.

OBJECTIVE: To establish a RP-HPLC method for the determination of the content of hesperidin in Yangweishu tablets.METHODS: The samples were separated on octadecyl silane bonded gel silica column(150 mm?4.6 mm,5 ?m) with the mobile phase consisted of methanol-7% acetic acid solution(32∶68) under a detection wavelength of 283nm.RESULTS: The linear range of hesperidin was 49.6～892.8 ng(r=0.999 9) with an average recovery rate of 99.02%(RSD=0.45%,n=9).CONCLUSION:The method is simple,accurate,reproducible and applicable for the quality control of Yangweishu tablets.

OBJECTIVE:To optimize the extraction technology of Zishen yangyin granules.METHODS:The yield of the extractum and the content of the extraction using 80% alcohol as solvent were used as indexes to optimize the extraction technology of Zishen yangyin granules by orthogonal experiment with the times of extraction,the extraction time and the amount of water added as factors.RESULTS:The optimal extraction conditions were as follows:the extraction was carried out for 3 times by adding water at an amount of 9 times,6 times and 6 times,respectively that of solid substance with decoction time of 3 h,2 h and 1 h,respectively.CONCLUSION:The optimal extraction process was proved to be time-saving and energy-saving and suitable for large production.

Objective To detect the mutations of COL7A1 gene in three cases of dystrophic epidermolysis bullosa pruriginosa (DEBP). Methods Clinical data were collected from 3 patients with DEBP. Skin lesions were obtained from these patients and subjected to transmission electron microscopy. DNA was extracted from the peripheral blood of the 3 patients, their 16 relatives, and 150 unrelated normal human controls, and PCR was performed to amplify all the exons and flanking sequences of COL7A1 gene followed by sequencing.Results The patient 1 and 2 had family history, whereas the case 3 was sporadic. Transmission electron microscopy showed tissue cleavage beneath lamina densa in case 1 and slightly decreased anchoring fibrils in some areas of the lesions in case 1 and 3. Three heterozygous mutations of COL7A1 gene, i.e., c. G6734T, c.G6859A and c. G5318T, which leaded to three amino acid mutations, i.e., p. G2245V, p. G1773V and p. G2287R, were found in patient 1, 2 and 3 respectively. Of them, p. G2245V and p. G1773V were novel mutations. The mutations strictly cosegregated with the phenotype in the patients of family 1 and 2. No mutation was detected in the unaffected parents of patient 3 or the 150 unrelated healthy controls. Conclusions The p. G2245V, p. G2287Rand p. G1773V mutations of COL7A1 gene may be responsible for the phenotype of DEBP in the three cases,and of them, p. G2245V and p. G1773V have never been reported.

BACKGROUND:Bisphosphonates that can suppress osteoclast activity strongly is a powerful inhibitor for bone resorption, which has been reported to have good effects in the treatment of fibrous dysplasia.
OBJECTIVE:To evaluate the clinical effect of surgical treatment combined with bisphosphonate therapy in the treatment of fibrous dysplasia.
METHODS: Fifteen patients with fibrous dysplasia of the long bone were subjected to surgical treatment and oral bisphosphonate therapy postoperatively. Limb pain, limb function, local X-ray manifestations and blood alkaline phosphatase activity were observed before and at 3, 6, 12, 24 months after treatment. The therapeutic effects were evaluated using modified Macnab standards.
RESULTS AND CONCLUSION:Al the 15 patients were folowed up for more than 24 months, and their pain symptoms were significantly relieved after the combined treatment of surgery and bisphosphonates, excelent in 12 cases and effective in 1 case, and the total efficiency was 100%. X-ray films showed that the density slightly decreased in operation areas after 3 months, but at 6 months after treatment, the cortical bone was thickened and the marrow cavity density increased in the operation areas, and non-focal zone was continuously enlarged. No fractures and recurrence were found in al patients. At 6 months after treatment, the serum alkaline phosphatase activity decreased significantly (P < 0.05). The results suggest that surgical operation with bisphosphonate treatment for bone fibrous dysplasia can effectively inhibit the bone resorption, promote bone formation, increase the intensity of the lesion, reduce fractures and recurrence rate, so as to achieve a better therapeutic effect in clinic.

Objective To explore the clinical application and value of percutaneous transhepatic gallbladder drainage (PTGD)under CT guide in high-risk emergency.Methods In all 57 old patients with high-risk acute cholecystitis in emergency,cuff-PTGD in 39 was performed and fractional step PTGD in 18 was also used.Results PTGD was successfully in all patients.After PTGD,except for 1 patient died of severe cardiac insufficiency,the abdominal pain and fever were alleviated during 72 hours,and the complications was not demonstrated.Conclusion As a safe,noninvasive and accurate method,CT-guided PTGD may relieve symptoms quickly,reduce the mortality and improve the treatment for some old patients with high risk acute cholecystitis.