Teaching in out-patient clinic is a new and unique teaching mode,which is characteristic of one-to-one tutoring experiences.Students are put in the key positions while mentors serve as assistants in the whole process.By means of repeated practicing,summing-ups and perceiving,students improve their ability to combine theory with practice,enhance capabilities of communication,enrich their social experience and increase their talent of independent working.Meanwhile,further trainings may endow our medical students with better abilities of summarization.Through practice,teaching clinic has been proved to be a reasonable teaching mode which deserves promotion.

ObjectiveTo investigate the safety, efficacy and therapeutic mechanism of focused ultrasound surgery (FUS) on focal epilepsy of brain functional area in cat. MethodsThe focal epileptic models in the cats' motor cortex by penicillin were established. The different techniques were apphed in the animals epilepsy model. FUS, cortex thermocoagulation and multiple subpial transaction (MST) were compared in seizure control and functional preservation by observing behavior and electroencephalogram ( EEG), and the therapentic mechanism was compared by analysis of histopathology in the damaged cortex. ResultsIn seizure control and EEG changes, three kinds of techniques were similar without prominent difference in statistics (P ＞ 0.05). The same pathologic changes were showed in FUS group and cortex thermocoagulation group, ischemic change and coagulative necrosis of superficial layer nerval cells.The major pathologic change in MST group was an irregular crevice which was vertical with the surface of the cortex. The edema and mild gliosis were found around the crevice. ConclusionsThe focused ultrasound can effectively destroy and cut off the association of cortical horizontal fibre, meanwhile, the cortical function still to be reserved.Therefore, FUS is safe and effective as well as MST and cortex thermocoagulation on focal epilepsy in brain functional area.

OBJECTIVE: To establish a rapid and precise detective method of 33.5 kd vesicular protein and to screen an effective treatment of cholelithiasis. METHODS: Specific antibody of the biliary vesicular protein was obtained by immunizing rabbits and enzyme-linked immunosorbent assay (ELISA) kit was developed. The concentrations of 33.5 kd vesicular protein in serum and bile of gallstone patients and control were examined respectively. The effects of Cholagogue Dry Syrup and Eulektrol Capsule on decreasing 33.5 kd vesicular protein were also studied by ELISA kit. RESULTS: One-step ELISA equation was Y=0.035 X (r=0.99). The vesicular protein concentrations in serum and bile of cholesterol gallstone group [(179.8+/-97.9) mg/L and (213.4+/-70.1) mg/L respectively] were significantly (P<0.05) higher than in the pigment stone group and control. Data showed that, with 2-week administration, Cholagogue Dry Syrup significantly decreased both biliary and serum 33.5 kd vesicular protein of cholesterol gallstone patients, while Eulekrol Capsule and control groups didn't have the same results. CONCLUSION: The concentrations of 33.5 kd protein are different in cholesterol gallstone patients and healthy groups which might be related to cholesterol nucleation process. Cholagogue Dry Syrup is of cholagogic and litholytic effect by decreasing biliary lithogenesis.

Objective To investigate the changes at the motor end-plate (i. e. neuromuscular junction) following the free neurovascular muscle transfer. Methods Light and electron microscopy were used to study serially during 30 weeks the changes at the neuromuscular junction after free muscle transfer of the gracilis muscle in the adult Wistar rat. Results Under light microscopy, after staining with acetylthocholine the neuromuscular junction showed changes of degeneration with withdrawal of the innervating axon terminal followed by regeneration and reconstitution of the neuromuscular junction. With the electron microscope, mitochondrial sweelling and clumping of the synaptic vesicles were followed by withdrawal of the axon terminal from the muscle membrane on denervation. The infolding of the muscle membrane at the neuromuscular junction became less prominent. With reinnervation the ulatrastructure of the junction was only partially reestablishied with poorly reconstituted primary and secondary folds of the muscle membrane. The newly formed neuromuscular junction still lacked the structural detail seen in the control neuromuscular junction, even after 30 weeks. Conclusion The persistent weakness following free neurovascular muscle transfer may be attributed to the failure of full recovery of the intricate ultrastructure of the neuromuscular junction.

Objective:To establish an experimental phalloplasty model with sensory restoration in rabbits and to explore a new surgical technique to improve the postoperative sensory function in phallic reconstruction. Methods: Adult male New Zealand white rabbit was used. Penile reconstruction was performed with superficial epigastric faciovascular pedicle flap. Free saphenous nerve graft was dissected, embedded in the flap, and end-to-end anastomosed to dorsal nerve of penis. Postoperatively, H-E staining and CGRP immunohistochemical staining were applied to observe the morphology of the regenerated nerves in the reconstructed penis at different stages. Results:Only a few CGRP-positive fibers scattered in deep corium in the reconstructed penis 1 month after surgery, while the quantity of CGRP nerve fibers increased markedly and the CGRP-positive fibers appeared in both superficial corium and papillae corii after 3 months. Six months postoperatively, the positive nerve fibers were also observed around the cutaneous accessories and in the epidermis-corium boundary layer. Conclusion: This rabbit model demonstrates the possibility of a new method for phalloplasty with sensory recovery, which may redound to clinical application.

ObjectiveTo study the inhibiting effects on the invasion and metastasis of melanoma by CXCR4 gene silence in nude mice.MethodsThe CXCR4 specific recombinant plasmid vector was constructed and transfected into the cultured MV3 cell line with lipofectamine.The models of subcutaneous melanoma in nude mice were established with MV3 cells.The nude mouse model of lung metastasis was established by injection of MV3 cells into the tail vein.The animals were sacrificed at 8weeks after the melanoma cells injection.CXCR4-shRNA plasmid vectors were discontinuously injected directly into the established tumor and vein.The changes of weight and size of the tumors and the mice body weight during the therapy were calculated respectively.Histological observation was performed to evaluate the presence and number of metastatic tumors.ResultsThe subcutaneous melanoma tumors in nude mice were established successfully.The growth of tumors in the CXCR4-shRNA injected nude mice was inhibitted obviously through tumor growth curve. There were significant differences between negative shRNA control nude mice and blank control nude mice (P＜0.01).Melanoma cells with CXCR4 shRNA permanent transfection had a much lower lung and brain and liver metastatic potential in nude mice than control cells and mock control cells in vivo.ConclusionsCXCR4 gene silencing mediated by shRNA significantly suppresses the growth of MV3 cell in vitro.Silencing of CXCR4 mediated by shRNA can also effectively decrease the metastatic potential of lung and liver and brain.

Objective To evaluate the diagnostic accuracy of ELISA kit for cholesterol gallstone. Methods The ELISA kit of 33?500 vesicular protein was established by sandwich method, and the concentrations of the protein in gallbladder bile were examined among cholesterol, pigmental gallstone patients and control groups. Results The gallbladder 33?500 vesicular protein (213?70) ?g/ml is much higher in cholesterol gallstone patients than in pigmental gallstone patients (72?55) ?g/ml and control groups (65?52) ?g/ml (F=60.9, P

Objective To investigate the relationship between thyroid nodules with calcification and thyroid carcinoma and its significance in the screening of thyroid carcinoma in high risk group.Methods The clinical data of 1771 patient undergoing surgery for thyroid nodules from March, 2006 to March, 2009 in Huashan Hospital, Fudan University were retrospectively analyzed. Results Among 1771 patients, 500 were finally identified as having malignant tumors. Incidence of calcification in thyroid carcinoma was 68. 4%, and that in benign thyroid nodules was 27.0% ( χ2 = 259. 5, P ＜ 0. 05 ). The specificity of microcalcification for the diagnosis of carcinoma was 89. 4%, and its positive predictive value was 66. 3% ( χ2 = 368.6, P ＜ 0. 01 ). The incidence of thyroid carcinoma in patients ＜ 45 years was 39.2%, while that in patients ≥ 45 years was 22.9% ( χ2 = 51.12, P ＜ 0. 05 ). The incidence of carcinoma in patients of single thyroid nodule was 31.7% and that in those with multiple nodules was 26. 4% (χ2 =4. 766,P ＜ 0. 05). Metastasis was pathologically diagnosed in 26. 8% of lymph nodes found by preoperative ultrasonography. Conclusions The specificity of thyroid nodule calcification, especially microcalcification is high for the diagnosis of thyroid carcinoma. High-risk index for carcinoma includes thyroid nodules with microcalcification, ＜ 45 years old and single thyroid nodule.

Objective Observing the effect of Shuganyishen formula on hormone-dependant metastatic breast cancer and the mechanisms of anti-resistance and endocrine therapy. Methods 226 ITT cases were divided into two cohorts by treatment. 126 cases were treated with the combination of Shuganyishen formula and standard western medicine including endocrine therapy, and 100 cases were treated with western medicine alone. The end points were time to progress (TTP) and overall survival and quality of life (QOF). The effect of Shuganyishen formula on growth of TAM-resistance cell line in vitro was observed. Results There were statistical significances of median TTP between combination and western medicine in Luminal A (ER+ /PR+, HER2-) as well as Luminal B (ER+/PR+, HER2+), but no significances of OS; The extent and incidence of hot flush, sweat and syndromes related to bone were decreased significantly in combination treated group. Shuganyishen formula could reverse resistance to TAM. Conclusion Patients with LuminalA and LuminalB metastatic breast cancer benefit from Shuganyishen formula, which maybe related with its reverse resistance to endocrine therapy.

Ectopic ACTH syndrome caused by adrenal pheochromocytoma is very rare.A case was herewith reported and the domestic and foreign literatures were reviewed.The correct diagnosis of the syndrome depends on clinical,biochemical,hormonal,radiographic,pathological investigations,as well as tumor immunohistochemistry for final comprehensive judgments.