In teaching forensic medicine as a common optional course for clinical medicine undergraduate students, we carried on the beneficial attempt in the overall set-up of teaching program, the effective implementation of the case-based and discussion-based teaching methods, the use of multimedia and internet classroom, plentiful of teaching models such as demonstration and practice, discussion forums between teachers and students etc. Through these efforts, we enhanced the teaching quality of the public elective course offorensic medicine.

AIM： To give some information for rational administration of oral antiepileptic drugs to epileptic patients in clinic METHODS： The serum concentrations of oral phenytoin sodium， phenobarbital and carbamazepine were determined in 88,63 and 63 epileptic patients（ total 214 times） by fluorescence polarization immunoassay， respectively The individualized drugs administration schemes were provided RESULTS： The sensitivity to the three kinds of antiepileptic drugs varied in different patients CONCLUSIONS： The administration of oral antiepileptic drugs to epileptic patients must be based on the data of drug concentration in serum We must comprehensively consider the other factors

Objective To investigate the clinical effect of percutaneous kyphoplasty (PKP) in treatment of osteoporotic vertebral fractures and collapse with intravertebral vacuum sign.Methods A retrospective study was conducted on the clinical and radiological data of 31 patients with osteoporotic vertebral fractures and collapse with intravertebral vacuum sign treated by PKP from June 2009 to June 2011.Vertebrae body variation,visual analog scale (VAS) and Oswestry disability index (ODI) before operation,during follow-up at postoperative one week and at postoperative 3-6 months were used as outcome measurements.Results All the patients went through operations successfully and presented significant mitigation of low back pain in 24 hours after operation.The vertebrae body height at postoperative one week [(17.2 ±4.2) mm] and at postoperative 3-6 months [(16.8 ±5.1)mm] were statistically different from that before operation [(11.4 ± 1.7) mm,P ＜0.01],while there was no statistical difference between the two follow-ups (P ＞ 0.05).VAS and ODI at postoperative one week [(2.8 ± 1.7) points and (31.6 ± 8.4) points] were statistically different from those before operation [(8.6 ± 1.3) points and (78.3 ±8.5) points,P＜0.01].VAS and ODI at postoperative 3-6 months [(2.3 ±0.8) points and (23.7 ± 2.3) points] presented statistical differences from those before operation (P ＜ 0.01),but no statistical differences from those at postoperative one week (P ＞ 0.05).Conclusion PKP obtains satisfactory clinical outcomes,for it relieves low back pain and restores vertebral body height.

Objective To evaluate the efficacy of unilateral open door laminoplasty and individualized cervical pedicle screw fixation for multisegmental cervical spondylotic myelopathy with flexibility type kyphosis.Methods Twenty one cases of multisegmental cervical spondylotic myelopathy with flexibility type kyphosis received surgical treatment.Unilateral open door laminoplasty and individualized cervical pedicle screw fixation.The Japanese Orthopaedic Association ( JOA) scoring system and disability index ( NDI) were applied to evaluate the neurological function and axial neck /shoulder pain before and after surgery.The Borden′method was employed to measure the cervical curvature.CT plain scan of cervical pedicle and sagittal two-dimensional imaging of transpedicular on the axial was examined.The unilateral open door laminoplasty and individualized cervical pedicle screw fixation was performed .Results A total of 168 pedicle screws were fixed successfully in 21 patients, the accuracy of screw placement reached 93.5%.The cervical curvature measured by Borden′method showed significant differences before and after operation.Compare to those before surgery , the JOA scores at 1 week after operation and at final follow-up were decreased and NDI scores were significant increased ( P <0.05 ).Conclusion Unilateral open door laminoplasty and individualized cervical pedicle screw fixation is effective for treatment of multisegmental cervical spondylotic myelopathy with flexibility type kyphosis.

Objective To establish a method for simultaneous determination for the contents of four flavones (ononin, calycosin, genistein and formononetin) of Hedysari Radix in Gansu Province with quantitative analysis of multi-components by single-marker (QAMS); To prove its feasibility and accuracy. Methods Calycosin was taken as internal standard substance. Relative correction factors (RCF) of ononin, genistein and formononetin to calycosin were established. The contents of ononin, calycosin, genistein and formononetin were determined to realize QAMS. Results RCF was with good repeatability. The results of QAMS were consistent with the results of the external standard method. Conclusion The method that determines the contents of ononin, genistein and formononetin with calycosin as internal standard substance, can be used for quantitative analysis of Hedysari Radix.

Objective To investigate the efficacy and safety of low dose tirofiban combined with reteplase in the thrombolytic treatment of young and middle-aged patients with acute myocardial infarction (AMI).Methods A total of 120 AMI patients were selected and randomly divided into group A and group B,60 cases in each group.The patients in the group A were given reteplase combined with low dose of tirofiban [0.05 μg/(kg·min)],and the patients in the group B were given reteplase combined with routine dose of tirofiban [0.1 μg/(kg·min)].The vascular recanalization rate,the platelet aggregation rate,the levels of coagulation and fibrinolysis related indicators,the main clinical events and bleeding complications were compared between two groups.Results The vascular recanalization rate of group A was 76.67%,which was similar to 81.67% of group B (P>0.05).After treatment,the platelet aggregation rate were significantly lower than that before treatment in both groups (P<0.05).After treatment,the levels of Fg and D-D were significantly lower than those before treatment in both groups,and the levels of PLT and t-PA were significantly higher than those before treatment (P<0.05).After one month of treatment,there was no significant difference in incidence rate of clinical events between two groups (P>0.05).The incidence rate of bleeding complications in group A was significantly lower than the group B (P<0.05).Conclusion The thrombolytic effect of low dose tirofiban on treatment of AMI is similar to that of the conventional dose,but it can reduce the risk of bleeding and improve medication safety.

Objective To investigate the efficacy and safety of low dose tirofiban combined with reteplase in the thrombolytic treatment of young and middle-aged patients with acute myocardial infarction (AMI).Methods A total of 120 AMI patients were selected and randomly divided into group A and group B,60 cases in each group.The patients in the group A were given reteplase combined with low dose of tirofiban [0.05 μg/(kg·min)],and the patients in the group B were given reteplase combined with routine dose of tirofiban [0.1 μg/(kg·min)].The vascular recanalization rate,the platelet aggregation rate,the levels of coagulation and fibrinolysis related indicators,the main clinical events and bleeding complications were compared between two groups.Results The vascular recanalization rate of group A was 76.67%,which was similar to 81.67% of group B (P>0.05).After treatment,the platelet aggregation rate were significantly lower than that before treatment in both groups (P<0.05).After treatment,the levels of Fg and D-D were significantly lower than those before treatment in both groups,and the levels of PLT and t-PA were significantly higher than those before treatment (P<0.05).After one month of treatment,there was no significant difference in incidence rate of clinical events between two groups (P>0.05).The incidence rate of bleeding complications in group A was significantly lower than the group B (P<0.05).Conclusion The thrombolytic effect of low dose tirofiban on treatment of AMI is similar to that of the conventional dose,but it can reduce the risk of bleeding and improve medication safety.

OBJECTIVE: To analyze the clinical features, biochemical characteristics and molecular pathogenesis of a girl with isovaleric acidemia. METHODS: Clinical features, blood spot amino acid profiles and urinary organic acid profiles of the patient were analyzed. Targeted capture, next generation sequencing and Sanger sequencing were carried out to detect potential variant of the IVD gene. RESULTS: The patient presented with poor weight gain, poor feeding, lethargy, and a "sweaty feet" odor 10 days after birth. Biochemical test suggested hyperammonemia. Blood spot amino acid profiles displayed a dramatic increase in isovalerylcarnitine (C5: 3. 044, reference range 0.04 - 0.4 μmol/L). Organic acid analysis of her urine sample revealed a high level of isovaleric glycine (669. 53, reference range 0 - 0.5). The child was ultimately diagnosed with isovaleric acidemia, and was found to harbor a paternally derived heterozygous variant c.149G>A (p.R50H) and a maternally derived heterozygous variant c.1123G>A (p.G375S) of the IVD gene. Her elder brother was a heterozygous carrier of c.1123G>A (p.G375S) variant. The c.149G>A (p.R50H) was a known pathogenic variant, while the c.1123G>A (p.G375S) variant was previously unreported. CONCLUSION The pathogenesis of the patient was delineated from the perspective of genetics, which has provided a basis for clinical diagnosis, treatment as well as genetic counseling.
Amino Acid Metabolism, Inborn Errors/genetics* ; Child ; Female ; Heterozygote ; Humans ; Isovaleryl-CoA Dehydrogenase/genetics* ; Male ; Mutation

Objective:To provide clinical references for the diagnosis and treatment of hemophilic pseudotumor (HPT) in maxillofacial region.Methods:Fourteen cases of HPT in maxillofacial region from the Department of Stomatology, Beijing Children′s Hospital from Jan 2009 to Jan 2019 were collected. Two cases were lost for follow-up and 12 patient,all boys, were finally followed up and included in the study. The patients aged from 13 months to 10 years old. The medical history, clinic manefestitions and the features of the radiology examination were recorded. The patients were treated by using replacement treatment first. If the conservative treatment was not effective, the patients then received operation combined with pereoperation replacement thearapy. The patients were followed up for 13 months to 10 years.There were 11 cases of hemophilia A, and 1 case of hemophilia B. Two cases were severe type, the others (10/12) were mild and moderate types. Only 1 case was diagnosed as hemophilia initially. Nine cases (9/12) were misdiagnosed as malignant tumors, 1 case was misdiagnosed as osteomyelitis and 1 case was misdiagnosed as hemangioma. Only 3 cases had identified history of trauma before.Results:All cases were treated with replacement therapy first, among which 10 cases were effective, 8 cases were cured by conservative therapy, 1 case had residual soft tissue fistula after conservative treatment and 1 case recurrented after conservative treatment for 8 months. Two patients with poor efficacy to the replacement treatment were performed operations and finally were cured.Conclusions:The misdiagnosis rate of HPT in maxillofacial region was high. The conservative factor replacement therapy could achieve good results in most children and could be used as the preferred treatment. If the conservative treatment was not effective, the surgical treatment was also a safe option.

Objective: Analyzing the characteristics of consonant errors in children with functional dysarthria in different age groups and the effect of speech training provides a reference for clinical treatment. Methods : This study followed medical ethics, and informed consent has been obtained from patients. Speech data from 388 patients with functional dysarthria were retrospectively studied. They were divided into two groups at the age of 6, namely, the preschool group (4-6 years old) of 226 patients and the school age group (6-13 years old, including 6 years old) of 162 patients. The characteristics of consonant pronunciation errors from four aspects were analyzed: average number of errors, pronunciation location, pronunciation method, and error type. One-on-one speech training was conducted, with a training frequency of once a week and once for 30 minutes. The training method was carried out in the order of phoneme training, syllable training, vocabulary training, sentence training, and short text and conversation training. The effects of speech training in the two groups were compared. Results: Analysis by pronunciation location: both age groups had the highest frequency of errors in tongue tip posterior sounds; the school age group had the lowest error frequency for labiodental consonants, and the preschool group had the lowest error frequency for bilabial consonants. According to the analysis of pronunciation mode, both age groups had the highest error frequency of aspirated affricate and the lowest error frequency of nasal sound. Analysis by error type: both age groups are mainly characterized by substitution and omission. Compared with the preschool group, most consonants of patients in the school group tend to improve in terms of pronunciation location, pronunciation mode, and error types. Compared with the preschool group, the two types of errors-palatalization and lateralization-increased in frequency in the school group, but the trend of increased lateralization was not statistically significant. After 6.7 and 5.5 sessions of speech training, the pronunciation of the preschool group and the school-age group significantly improved; the cure rate of the school-age group was 84.9% (118/139), and that of the preschool group was 77.1% (91/118). There was no statistically significant difference in the cure rate between the two groups. Conclusion Functional dysarthria may improve with age, but it may not completely self-heal. Children of different age groups can achieve good treatment results through scientific and reasonable speech training.