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.

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.

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.

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.

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

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.

Objective To compare the effect of intravenous resuscitation with sodium pyruvate (Pyr) Ringer solution against lactated Ringer solution on hemodynamic and organ functions during shock stage in dogs with burn.Methods 28 Beagle dogs were subjected to 50％ total body surface area (TBSA) burn,and they were divided into three groups:burn injury without fluid resuscitation (N R,n =8),Ringer lactate solution(RL,n =10),and Pyr Ringer solution (RP,n =10).They were given intravenous fluid resuscitation according to Parkland formula 30 minutes after burn.The hemodynamics,organ functions and mortality were observed in conscious state before burn injury,and 2,6,8,12,24 hours after burn injury.Results Within 24 hours after burn,all the dogs in NR group died,and those in RL and RP groups were all alive.At 2 hours after burn,the mean arterial pressure (MAP),cardiac index (CI),dp/dt max of left ventricular contractility were significantly reduced in NR,RL and RP groups compared with those before injury [MAP(mmHg,1 mmHg =0.133 kPa):45.33 ± 7.78 vs.141.67 ± 5.98,91.33 ± 10.25 vs.142.33 ± 6.16,98.67 ± 9.54 vs.142.83 ±5.47; CI (mL·s-1·m-2):8.17 ±0.83 vs.48.34 ±3.33,16.84 ±2.17 vs.47.34 ± 1.67,19.00 ± 1.50 vs.47.34 ± 1.33; dp/dt max (mmHg/s):426.83 ± 51.91 vs.1 372.50 ± 39.61,594.00 ± 88.23 vs.1 363.83 ± 44.92,645.00 ±66.82 vs.1 395.83 ± 19.49,all P＜0.05],and the systemic vascular resistance (SVR) and alanine transaminase (ALT),creatinine (Cr),serum MB isoenzyme of creatine kinase (CK-MB),diamine oxidase (DAO) were significantly higher [SVR (kPa·s ·L-1):1 322.50 ±36.37 vs.281.45 ± 8.84,777.50 ±41.84 vs.289.72 ± 6.70,571.40 ±40.01 vs.286.27 ±8.66; ALT (U/L):89.50 ±4.11 vs.40.57 ±3.63,89.25 ±4.88 vs.37.92 ± 2.62,86.30 ±5.61 vs.38.47 ±3.50; Cr (μmol/L):75.62 ±4.61 vs.41.58 ±2.78,77.00 ±5.92 vs.46.55 ± 3.17,74.13 ±2.56 vs.45.65 ± 1.83; CK-MB (kU/L):13.122 ±0.282 vs.1.557 ±0.009,8.885 ±0.272 vs.1.497 ± 0.009,8.692 ± 0.180 vs.1.490 ± 0.005; DAO (kU/L):2.26 ± 0.14 vs.0.25 ± 0.02,1.50 ± 0.07 vs.0.25 ± 0.01,1.37 ± 0.07 vs.0.25 ± 0.02,all P＜0.05].All parameters in NR group kept on worsening till death,while hemodynamic and organ functions of two intravenous resuscitation groups were gradually improved,CI,SVR and DAO in RP group were significantly superior to those of RL group from 2 hours on after burn (all P＜0.05),and dp/dt max and CK-MB in RP group were significantly better than those of RL group from 6 hours on after burn [dp/dt max (mmHg/s):1 082.33 ± 63.59 vs.1 018.60 ± 47.36,CK-MB (U/L):7 898.70 ± 255.74 vs.8 438.70 ± 442.00,all P＜0.05],and MAP (mmHg) was significantly better than that of RL group at 6 hours (124.67 ± 9.39 vs.114.33 ± 9.16,P＜0.05),and Cr (tμmol/L) was significantly better than that of RL group from 24 hours on after burn (53.42 ± 4.99 vs.60.77 ± 3.11,P＜0.05).Conclusion The Pyr Ringer solution was superior to the Ringer lactate solution in improving hemodynamic and organ functions for intravenous resuscitation in dogs with 50％TBSA full thickness burn.

Objective To analyze the subtypes of eae genes in various non-O157 Shiga toxin-pro-ducing Escherichia coli ( STEC) strains isolated in China.Methods The complete nucleotide sequences of 10 eae genes were amplified by PCR and sequenced.The BLASTn software was used to analyze the se-quences for eae gene subtyping.A phylogenetic tree was constructed based on the10 ea e gene sequences to-gether with the gene sequences of 30 different subtypes in GenBank and those of STEC strains of 7 prevalent serotypes (O157 ∶H7, O26 ∶H11, O103 ∶H2, O111 ∶H8, O145 ∶H28, O45 ∶H2 and O121 ∶H19) using MEGA 5.0.Multilocus sequence typing (MLST) was performed on the 10 STEC strains with reference to the Escherichia coli ( E.coli) MLST website ( http://mlst.warwick.ac.uk/mlst/dbs/Ecoli) for the typing of multiple loci.A minimum spanning tree ( MST) was constructed using the BioNumerics software to inves-tigate the phylogenetic relationships between the 10 eae gene-positive STEC strains in this study and hemolyt-ic uremic syndrome-associated enterohemorrhagic E.coli ( HUSEC) strains as well as all human STEC strains of O157, O26, O45, O103, O111, O121 and O145 serotypes submitted to the E.coli MLST website data-base.Results The complete nucleotide sequences of eae genes in 10 non-O157 STEC strains were 2.8 kb in length and belonged to 3 known subtypes.The predominant subtype wasβ1, accounting for 60%of the 10 STEC strains (6/10), followed byθandγ1 subtypes with two strains in each type.The eae gene sequences in certain strains were identical to those of the prevalent serotypes.Seven sequence types ( STs) were identi-fied from the 10 STEC strains carrying eae gene.Conclusion The eae genes harbored by the non-O157 STEC strains isolated from different specimens in China were diverse and had close phylogenetic relationships with the highly pathogenic and prevalent STEC strains.This study implied that the STEC strains harboring eae gene had high pathogenic potential.

Objective Retrospective investigate the significant application of bone marrow (BM)morphology in exploring the causes of anemia,and observed the changes of anemia disease spectrum in the past 10 years.Methods BM smears of 1 528 anemia patients from Shanghai Jiao Tong University Affiliated Shanghai First People's Hospital were stained with Wright's staining and cvtochemical staining and observed with microscope.Combined with relevant clinical data,we analyzed the changes of disease types from 1998 to 2002 and from 2008 to 2012.Results 1 139 cases (74.54％) were diagnosed with hematopoietic and lymphatic system diseases.Iron-deficiency anemia,megaloblastic anemia and leukemia were the three main causes of anemia.The BM morphology of 389 patients displayed infection anemia or descriptive diagnosis.Anemia disease spectrum changed a lot,iron-deficiency anemia decreased from 30.34％ (139/458) to 18.69％ (200/1 070),leukemia increased from 13.31％ (61/458) to 21.77％ (233/1 070),descriptive diagnosis of BM increased from 15.72％ (72/458) to 21.86％ (234/1 070).Conclusion BM examination is critical for finding the cause of anemia,which contrihutes to effective treatment.

Objective To explore the imaging features of primary bone tumors and tumor-like lesions of the skull,so that to improve the diagnostic accuracy of the disease.Methods 47cases with bone tumors and tumor-like lesions of the skull confirmed by pathology or typical imaging manifestations were retrospectively analysed.Results Of 47 cases,there were benign tumors in 22 cases,malignant tumors in 6 cases and tumor-like lesions in 19 cases.Benign tumors included osteoma of 11cases,epidermoid tumor and cyst of 4 cases,osteochondroma and neurofibromatosis of 2 cases respectively,carvernous angioma ,osteoid osteoma,and benign fibrohistiocytoma of 1case respectively.Malignant tumors included multiple myeloma and angiosarcoma of 2 cases respectively,Ewing’s tumor and osteosarcoma each and all in 1 case .Tumor-like lesions included fibrodysplasis of bone in 8 cases, Langerhans’ cell histiocytosis in 7 cases ,brown tumor and deformed osteitis each and all in 2 cases.Conclusion Primary bone tumor and tumor-like lesions of the skull are of a great variety,each one has its own imaging characteristics,the diagnosis of them should be combined with clinic and pathologic data.