Objective To systematically evaluate the overall reliability,test paper structure and rationality proportional distribution of the secondary discipline of western medicine comprehensive test papers from 2010 to 2012 to provide references for future improvement to the syllabus and test quality. Methods Data of 15 765 candidates from 2010 to 2012 were extracted and statistical analy-sis was performed to do generalized research and decision-making research from discipline factors and question type factors. Results ①Based on the discipline factor analysis,variance components of ba-sic disciplines were relatively high ,global score relative error was very small and the generalizability coefficient was above 0.930. ②Based on the question type factor analysis,variance components in X-type questions and A1-type questions were relatively high, global score relative error was very small and the generalizability coefficient was above 0.930. Conclusions ①From the discipline content, the accuracy of various disciplines is high;contribution of basic disciplines is relatively higher than that of clinical disciplines;further improving the discrimination of questions can help to improve measure-ment accuracy. ②From the question design,question measurement error is small,accuracy is high,and the question distribution is appropriate;scale of A3 type questions can be further improved.

BACKGROUND:Gait analysis enable to convert qualitative analysis and description used for a long time in orthopedic examination and rehabilitative treatment into objective and precise quantitative assessment. At the present, with the development of science and technology, three-dimensional (3D) gait analysis is more and more widely, extensively used in orthopedic surgery and rehabilitation medicine abroad, while much less in China.OBJECTIVE: To study the parameters of time-distance, kinematics, kinetic and electromyography (EMG) in healthy subjects and patients with backbone, hip, knee or ankle joint diseases.DESIGN: Comparative observation and control study.PARTICIPANTS: From December 2004 to July 2005, 40 healthy subjects and 112 patients suffering from backbone and hip, knee, ankle joint disease were selected from the Department of Rehabilitative Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University and analyzed by three dimensional gait analysis system (VICON 612 system made by Britain VICON Company). 112 patients including 42 males with the mean age of (46.2 ± 2.3) years and 70 females with the mean age (41.2 ± 3.5) years were screened by skilled clinicians after surgical and rehabilitative treatment.Among them there were 21 patients with cervical vertebra, 26 patients with prolapse of lumbar intervertebral disc and lumbar spinal stenosis. The number of hip, knee, ankle joint disease was 12, 34, 19 respectively. Total hip replacement was included in hip joint disease, anterior cruciate ligament (ACL) reconstruction was included in knee joint disease, talipes equinovarus was included in ankle joint disease. Meanwhile, 40 healthy subjects who were 20-40 years old, male or female, without any clinical symptom of backbone and limbs volunteered in the study.METHODS :Gait analysis were carried out on 40 healthy volunteers and 112 operational and rehabilitative treatment patients with spinal and lower limb diseases using VICON 612 system made by Britain VICON Company.MAIN OUTCOME MEASURES: The time-distance parameters (cadence, step length, walking speed), kinematics parameters (knee flexion/extension degree, hip flexion/extension degree, ankle dorsi/plantar degree), kinetic parameters (knee force in Z axis, hip force in Z axis, normalized force in Z axis) and EMG parameters (vastus lateralis SEMG) of lower limbs were examined.RESULTS: A total of 40 healthy subjects and 112 patients were involved in the analysis of results. ① Time-distance parameter: Cadence, as well as step length and walking speed of patients with backbone disease, patients with hip joint disease, patients with knee joint disease, and patients with ankle joint disease were lower than those of healthy subjects,and the difference between two groups was significant (P ＜ 0.05-0.01). ② Kinematic and kinetic parameters of all joints in upper limbs: One year after left ACL knee reconstruction, the extension of left knee in initial contact phase was 9° less than that of right one and the stress in Z axis of left knee was much less than that of right one; One year after left THA,the flexion of left hip in initial contact phase was 8.5° less than that of right one, the extension of left hip in terminal stance phase was 3° less than that of right one, during stance phase the stress in Z axis of left hip was much less than that of right one; As to an infantile paralysis patient with talipes equinovarus, the dorsiflexion of left ankle in initial contact phase was 12° less than that of right one, the plantar flexion of left ankle in terminal stance phase was 5° less than that of right one. The stress in Z axis of left ankle during stance phase was much less than that of right one. However, the difference in range of motion and stress in Z axis was not significant between the left and right knee joint in healthy people. ③ One year after left total knee arthroplasty, the dynamic surface electromyogram signals of left vastus lateralis is much lower than that of right vastus lateralis in a gait cycle.CONCLUSION: 3D gait analysis enables tprovide objective basis for making operation scheme for orthopedic surgery and after-operation rehabilitation therapy, and assessing curative effect of rehabilitation therapy.

Objective To investigate the effects of Shuxuetong on hemodynamics and serum sICAM-1,IL-6,TNF-α in patients with cerebral infarction.Methods A hundred patients with cerebral infarction were randomly divided into observation group and control group from Jan 2011 to Jan 2015.Fifty patients in control group were treated with conventional therapy alone and 50 patients in observation group were treated with conventional therapy combined with intravenous injection with Shuxuetong.The changes of hemodynamics were observed before and after treatment and the levels of serum sICAM-1,IL-6,TNF-α were detected by enzyme linked immunosorbent assay (ELISA).Results No statistical significance was found in hemodynamics of control group before and after treatment (P ＞0.05).The indexes of hemodynamics in observation group were significantly improved compared with those in observation group before treatment and those in control group after treatment (P＜ 0.05).The levels of serum sICAM-1,IL-6,TNF-α were significantly reduced in two groups after treatment (P ＜0.01) and the levels of serum sICAM-1,IL-6,TNF-α after treatment were significantly lower in observation group than those in control group (P＜0.01).Conclusion Shuxuetong can effectively improve the indexes ofhemodynamics and reduce the levels of serum sICAM-1,IL-6 and TNF-α.It has a positive effect on the treatment of cerevral infarction.

AIM:To develop a method for determining the contents of ferulic acid,rutin and salvianolic acid B in Xiaoshuan Tongluo Capsule(Rhizoma Chuanxiong,Radix et Rhizoma Salviale miltiorrhizale,Radix Astragali,Radix et Rhizoma notoginseng,Flos Sophorale,etc.) METHODS:The column was Linksil C18(250mm?4.6 mm,5 ?m).The mobil phase was methanol-acetonitrile -0.1% acetic acid(25:5 :70).The detection wave-lenght was set at 320 nm.The flow rate was 1.0 mL/min.RESULTS:The calibration curves of ferulic acid,rutin and salvianolic acid B were in good linearity over the ranges of 0.004-0.08 ?g,0.432-8.64 ?g,0.088-1.76 ?g,respectively(r=0.999 9).And average recoveries(n=5) were 98.9 %,100.1 % and 98.2 %,respectively and RSD were 1.1 %,1.5 %,1.4 %.CONCLUSION:The method is simple,rapid,reliable and can be used for the quality control of Xiaoshuan Tongluo Capsule.

BACKGROUND:Evaluation plan for the neuro-musculo-skeletal system model and motor function was little.However,the three-dimensional gait analysis can transfer qualitative analysis and object description which widely used in orthopedics and rehabilitation medicine to quantitative evaluation with more objective and precise.OBJECTIVE:To evaluate gait kinematics and kinetic changes after total knee replacement based on 12 months follow up using three-dimensional gait analysis.DESIGN,TIME AND SETTING:The comparative observation and case-control study was performed in the Gait Analysis Room of the Department of Rehabilitation Medicine in the Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University from January 2007 to May 2008.PARTICIPANTS:Ten patients with knee osteoarthritis following total knee replacement were chosen as treatment group;concurrently,ten patients whose baseline data were matched with the treatment group without problems in nerve,muscle,skeletal system and equilibrium were selected as the control group.METHODS:Ten patients in the treatment group underwent rehabilitation training,then compared time-distance,kinematic,and mechanical parameters which were measured at 3,6,12 months after total knee replacement with the control group.MAIN OUTCOME MEASURES:Time-distance parameter,kinematic parameter,mechanical parameter and knee functional scores.RESULTS:Pace,step frequency,gait speed,and time of injured leg standing were notably decreased,while time of uninjured leg standing,duration of gait cycle were obvious prolonged compared with the control group(P

AIM:To develop a method for determining the contents of ferulic acid,rutin and salvianolic acid B in Xiaoshuan Tongluo Capsule(Rhizoma Chuanxiong,Radix et Rhizoma Salviale miltiorrhizale,Radix Astragali,Radix et Rhizoma notoginseng,Flos Sophorale,etc.)METHODS:The column was Linksil C_(18)(250 mm×4.6 mm,5 μm).The mobil phase was methanol-acetonitrile-0.1% acetic acid(25:5:70).The detection wavelenght was set at 320 nm.The flow rate was 1.0 mL/min.RESULTS:The calibration curves of ferulic acid,rutin and salvianolic acid B were in good linearity over the ranges of 0.004-0.08 μg,0.432-8.64 μg,0.088-1.76 μg,respectively(r=0.9999).And average recoveries(n=5)were 98.9%,100.1 % and 98.2 %,respectively and RSD were 1.1 %,1.5 %,1.4 %.CONCLUSION:The method is simple,rapid,reliable and can be used for the quality control of Xiaoshuan Tongluo Capsule.

Objective To investigate the effects of ultrashortwave (USW) diathermy and electrical stimulation (ES) used in combination with nerve growth factor (NGF) in the treatment of experimental sciatic nerve injury.Methods Sixty adult Wistar rats were randomly divided into a normal control group, a model group, an NGF group,a physiotherapy group and a combined treatment group. A model of sciatic nerve injury was established in the latter four groups. Beginning on the 2nd day after the operation, no treatment was given in the model group, NGF was injected in the NGF group, diathermy and ES were administrated to rats in the physiotherapy group, and the combined treatment group was treated with USW diathermy, EW and NGF. Function, electrophysiology and morphology were evaluated at the 2nd, 7th, 14th and 30th days after the operation Results The average sciatic nerve function index (SFI), nerve conduction velocity (NCV) and nerve regeneration in the NGF, physiotherapy and combined treatment groups were significantly better than in the model group, with those in the combined treatment group improved to the greatest extent. At the 30th day there was no significant difference between the combined treatment group and the normal control group in terms of SFI, NCV, axon regeneration or myelin sheath thickness. The number of myelinated nerve fibers and the average axon diameter in the combined treatment group and normal control group were significantly higher than those in the model, NGF or physiotherapy group. Conclusions With NGF injection, additional application of USW diathermy and ES may significantly enhance the regeneration of the sciatic nerve and aid functional recovery after injury.

Objective To assess the diagnostic value of bone scanning and bone alkaline phosphatase (B-ALP) detection in diagnosis of osseous metastases in lung cancer. Methods 58 patients with lung cancer were examined by bone scanning and serum alkaline phosphates(ALP) and B-ALP detection. The results were analyzed. Results Among the 58 patients, bone scanning found osseous metastases in 33 patients, the incidence was 56.90 %. Among the 58 patients, the incidence of bone metastasis of adenocarcinoma was 70.97 % (22/33) and squamous carcinoma was 42.86 % (9/21) (x2 =4.109, P =0.0427). The incidence of bone metastases increased in B-ALP ≥150 U/L. B-ALP was significantly correlated with the number of metastatic loci in bone. The sensitivity of bone scanning is the highest (93.94 %), but specificity the lowest (92.00 %).The sensitivity combining bone scanning and B-ALP is the lowest (57.58 %), but the specificity the highest (100.00 %). Conclusion Whole-body bone scanning has high sensitivity in early detection of bone metastases. For diagnosis of osseous metastases in patients with lung cancer, bone scanning is the primary choice. Combining the bone scanning with B-ALP can increase specificity. B-ALP has certain using value to confirm bone metastasis and decide the disease extent.

OBJECTIVE: To explore the effect of different pressure on microcirculation of scar proliferation. METHODS: A total of 60 patients with scar proliferation after burning were collected, including 49 males and 11 females, with averagely aged 37 years. The patients were divided into low pressure (0.67-1.33 kPa), normal pressure (1.33-3.33 kPa) and high pressure (3.33-6.67 kPa) groups by envelope method. Pressure tension bandage was used at 1 week after wound healing and gradually increased, reached expected pressure at days 5-7 and sustained for 6 months. Then the changes of blood perfusion at the scar tissue were measured by laser Doppler perfusion imaging (LDPI). RESULTS: According to the intended processing analysis, all the 60 patients enter the result analysis. There were no significant differences of the scar tissue perfusion of the 3 groups before the therapy. After the therapy, the perfusion was decreased in the low pressure group, but there are no statistical changes compared to before the therapy (P > 0.05), while the perfusion was decreased in the normal pressure and high pressure groups (P < 0.05), which was lower in the high pressure group than the normal pressure group (P < 0.05). When the pressure increased to 3.33-6.67 kPa, the patients feel much more uncomfortable and the swelled signs appear, and 2 patients quit the experiment. CONCLUSIONS: The scar tissue perfusion is decreased obviously when adding the pressure to 3.33 kPa by using tension bandage. Using this method, the pressure should gradually increase to the maximum if patients can bear.

AIM:To observe the effect of botulinum neurotoxin type A heavy chain ( BoNT/A HC) on the pat-tern of spinal protein expression by intrathecal injection after spinal cord injury in rats , and to explore the role of BoNT/A HC intervention in spinal protein expression and some of its mechanisms in nerve regeneration after injury .METHODS:The model of unilateral lumbar spinal cord injury was established .The effects of BoNT/A HC intervention at different doses (2 μg, 4 μg, 6 μg and 8 μg) on the general pattern of protein expression in the spinal cord tissues at the injury site and the cranial part adjacent to the injury site was measured and evaluated by SDS-PAGE and Coomassie brilliant blue staining first, and then by two-dimensional SDS-PAGE.RESULTS:The histological structure of the ipsilateral side of lumbar spi-nal cord showed obvious destruction and degradation , mainly affecting both gray and white matter of the left side of the cord.The result of SDS-PAGE with Coomassie brilliant blue staining from injured spinal cord tissue displayed that the ex-pression of some proteins after one-time BoNT/A HC treatment appeared obviously different from that without BoNT /A HC treatment.Moreover, the pattern of the protein expression affected by BoNT/A HC was similar to that of the normal spinal cord.The more detail information from two-dimensional SDS-PAGE indicated that more than 10 proteins with different mo-lecular weight and isoelectronic points were differentially expressed at day 2 and day 20 after local injection of 6μg BoNT/A HC.This altered expression actually appeared a tendency toward the pattern shown in normal group .CONCLUSION:The immediate application of BoNT/A HC at the injury site after unilateral lumbar spinal cord injury is able to affect the pattern of local protein expression .The altered protein expression by injury could be reversed back to normal or approxi -mately normal by local BoNT/A HC administration.