Objective To compare the results of emergency clinical training for medical students and to put forward some suggestions.Methods Toatlly 207 medical students of Grade 4 studied in the first people' s hospital of Shanghai Jiaotong university from 2009 to 2011 were divided into the traditional group (n =90 ) and the experimental group (n =117 ).The students in the experimental group participated in emergency clinical training in summer vacation while those in the traditional group did not.Questionnaires about their self-learning ability,clinical communicating ability and critical thinking ability after training the were conducted and the data were analyzed by descriptive statistical analysis.Results One hundred and five effective questionnaires were recovered from the experimental group,with the recovery rate 89.7％ and 62 effective questionnaires were recovered from the traditional group,with the recovery rate 68.9％.The scores about clinical communicating ability and critical thinking ability of the experimental group were significantly highcr than those of the traditional group [ (79.45 ± 9.354)vs.(75.87 ± 9.926),(263.38 ± 30.925 ) vs.(251.36 ± 23.679),P ＜ 0.05 ].However,there was no significant difference in scores about self-learning ability between the two groups [ ( 153.97 ± 23.725 ) vs.( 149.83 ± 13.891 ),P ＞ 0.05].Conclusion Emergency clinical training is helpful to improve medical students' clinical communicating ability and critical thinking ability.It is worth popularizing.

ObjectiveTo analyze the results of implementing the tutorial system for medical interns, and to put forward some suggestions. MethodsThe medical interns and the doetors selected as tutors were asked to do questionnaires to study the tutorial system's feasibility and effectiveness. Simultaneously, we adopted the Objective Structured Clinical Examination ( OSCE ) to assess its process and resuits. Results74.3％ of the students and 75.5％ of the doctors think that they need the tutorial system,73.2％of the students think that this system can train better clinical skills,67.9％ of the doetors think that they can review the knowledge learned through teaching. Implemented after one year, students' OSCE scores are improved. ConclusionTutorial system for medical interns has achieved preliminary success, and the preparatory work and related-system building need to be further improved.

Objective To investigate the expression of lymphocyte function-associated antigen-1 (LFA-1)on peripheral blood mononuclear cells(PBMCs)from patients with SLE and its relation to the occurrence and development of SLE.Methods PBMCS were obtained from 30 patients with SLE and 24 normal human controls.Atier labeled with anti-CD3-FITC and anti-CD11 a-PE,PBMCS were detected for the expression of CD11a by flow cytometric analysis.Results The positivity rate of CD11a was significantly higher in patients with SLE and those with active SLE than in the normal controls (73.74%±7.89%and 77.11%±7.46%vs 68.21%±4.58%.both P＜0.05).Furthermore,increased positivity rate of CD11a was observed in patients with active SLE compared with those with stable SLE (77.11%±7.46%vs 69.33%±6.27%,P＜0.05).but there was no significant difieFence between the latter group and normal controls(P＞0.05).In addition.the expression level of CD11a was positively correlated with SLE disease activity index (r=0.64,P＜0.0 1)in patients.Conclusion The overexpression of LFA-1 may take part in the occurrence of SLE and correlate with the activity of SLE.

Objective To explore the outcome of acetabular fractures operative treatment. Methods 62 patients with acetabular fractures were enrolled in this study. According to classification of Letournel, fracture of posterior wall 13 cases, fracture of posterior column 9 cases, fracture of anterior column 5 cases, transverse fracture 4 cases, transverse fracture with fracture of posterior wall 6 cases, double column fracture 10 cases, fracture of posterior wall and posterior column 8 cases, fracture of T type 7 cases. Results 62 patients were followed-up for more than one year after operation. All cases had bone union without complications of the infection and sciatic nerve injury. Traumatic arthritis occurred in 2 cases, and the function of the hip-joint was limited in 3 cases. Conclusion Operative reduction and internal fixation can notably increase forward outcome of acetabular fractures.

Lymph nodes (LN)are the main parts of the esophageal cancer metastasis,and the current status of LN is the important indicator of prognosis.LN metastasis appears in early stage of esophageal cancer.One side,LN metastasis easily appears in the regions near the tumor and some special areas.On the other side,LN metastasis has the characteristics of wide metastasis and skip metastasis.Therefore,the researches of the pattern of esophageal cancer lymph node metastasis can help to comform the scope of the esophageal cancer lymph node dissection and the target regions of radiotherapy.

OBJECTIVE:To understand the drug use of sample hospitals,and to provide reference for drug production,man-agement and service department. METHODS:Statistical analysis was conducted in the data of drug use in national 1 248 sample hos-pitals during 4th quarter of 2012-3rd quarter of 2013. RESULTS&CONCLUSIONS:Anti-infection medicine,Chinese patent medi-cine,nervous system drugs has being ranked the top 3 in the list of consumption sum,and that of various drugs is in an upward trend. Top 20 drugs in the list of consumption sum mainly are biological products,drugs for the nervous system,digestive system drugs;that of human albumin and deproteinized calf serum have increased greatly. Top 10 imported pharmaceutical enterprises or joint ventures in the list of consumption sum mainly are multinational enterprises,and they are stable in ranking. The development of pharmaceutical enterprises should focus on brand,quality,price and service,etc.,so that their competitiveness can be improved.

Dopamine(DA) modulates diverse wake-related behaviors including movement,reward, and cognition.Dopaminergic neurons are located in the substantia nigra pars compacta and ventral tegmental area.There are five distinct DA receptors(R):D_1R,D_2R(D_(2S)R and D_(2L)R), D_3R,D_4R and D_5R in the central nervous system, in which D_1R and D_2R are majorly expressed. The affinity of D_2R for endogenous DA is significantly higher than that of D_1R.Re- cently,studies by pharmacological and gene knock-out animals revealed that dopamine D_2R is essential inmaintaining wakefulness.Here,we review the progress on roles of D_2R in sleep-wake regulation.

Objective To screen single nucleotide polymorphism(SNP)of DNA methyltransferase 1 gene in patients with systemic lupus erythematosus(SLE).and to investigate the significance of abnormal expression of DNA methyltransferase in the pathogenesis of SLE.Methods Peripheral blood mononuclear cells(PBMCs)were obtained from 11 patients with SLE and 12 normal human controls.DNA was extracted from the PBMCs.and PCR was performed to amplify some exons(1 to 7)and corresponding introns followed by direct sequencing.Results There was a 21397T/C SNP in the intron 7 between exon 7 and exon 8 of DNA methyltransferase 1 gene in patients with SLE.The frequency of CC homozygote increased in patients with SLE compared with that in normal controls(5/11 vs 1/12,X~2=4.10,P＜0.05).Conclusions There is a 21397T/C SNP in DNA methyltransferase 1 gene in patients with SLE.which may be a component of genetic background underlying the abnormal expression Of DNA methyltransferase 1.

Objective To compare the influence of different end-tidal concentrations of sevoflurane on transcranial electrical four-limb muscle motor evoked potential (MEP) monitoring. Methods Twenty ASA Ⅰ-Ⅱpatients aged 23-62 years undergoing craniotomy were enrolled. Triangular muscle, biceps brachii muscle, triceps brachii muscle, brachioradialis muscle, extensor digitorum communis muscle, abductor pollicis brevis abductor digiti minimi muscle, rectus femoris muscle, tibialis anterior muscle, gastrocnemius muscle and abductor hallucis were selected for MEPs recording. Sevoflurane was introduced at 0.5, 0.75, 1.0 and then 1.3 MAC (15 min each), and the effects on MEPs were studied. Results ①Maximum MEP amplitude was observed at abductor pollicis brevis muscle in upper limb and abductor hallucis muscle in lower limb at baseline and 0.5 MAC. Up to 1.0 MAC, there was no significant difference in MEP amplitude among extensor digitorum communis muscle, abductor pollicis brevis and abductor digiti minimi muscle. ②The success rate of MEP recording from abductor pollicis brevis muscle and abductor hallucis muscle was 100% during the administration of 0.5-1.0 MAC sevoflurane. ③The MEP amplitude was decreased and the latency was increased in a sevoflurane dose-dependent manner. Conclusions Abductor pollicis brevis muscle and abductor hallucis muscle were suitable for MEP monitoring during the administration of 0.5-1.0 MAC sevoflurane.