Objective: To explore the in vitro inhibition effect of Zuojin pills on 6 cytochrome P450 isoenzymes ( CYP1A2, CYP2C8, CYP2C9, CYP2C19, CYP2D6 and CYP3A4) in human liver microsomes. Methods:The water extract of Zuojin pills, Cop-tidis Rhizoma and Euodiae Fructus was respectively incubated with human liver microsomes in the presence of seven probe substrates of CYP450 isoenzymes, and seven metabolites of cytochrome P450 probe substrate ( paracetamol/CYP1A2, 6α-hydroxypaclitaxel/CYP2C8, 4-hydroxydiclofenac/CYP2C9, 4-hydroxymephenytoin/CYP2C19, dextrorphan/CYP2D6, 6β-hydroxytestosterone/CYP3A4 and 1-hydroxymidazolam/CYP3A4) were simultaneously measured by LC-MS/MS, and the inhibitory effects were evaluated with IC50 value. Results:The IC50 value of Zuojin pills on CYP2D6, CYP1A2 and CYP3A4_T was 11. 6, 77. 4 and 97. 0 μg·ml-1 , respec-tively. The other IC50 values were from 334 to 690μg·ml-1 on CYP2C8, CYP2C9, CYP2C19 and CYP3A4_M isoenzymes. The IC50 value of Coptidis Rhizoma on CYP2D6, CYP1A2 and CYP3A4_T was 5. 8, 36. 8 and 59. 2 μg·ml-1 , respectively. The other IC50 values were from 163 to 476 μg·ml-1 on CYP2C8, CYP2C9, CYP2C19 and CYP3A4_M isoenzymes. The IC50 value of Euodiae Fructus on CYPs was over 107 μg·ml-1 . Conclusion:Zuojin pills shows notable inhibitory effect on CYP2D6, and weak inhibitory effects on CYP1A2 and CYP3A4_T. Coptidis Rhizoma has similar effects on CYPs and may be the main herbal medicine in the formu-la. Therefore, much attention should be paid to the combination of Zuojin pills and the drugs metabolized by human CYP2D6 in clin-ics.

AIM:To set up a method of simultaneously determining the contents of ephedrine and pseudoephedrine in Zhisou Lixiao Oral Liquid (Herba Ephedrae, Radix et Rhizoma Glycyrrhizae, Semen Raphani, etc). METHOD: The HPLC-quantitative analysis was carried out on a column of Sinochrom ODS-BP by using a mobile phase of acetonitrile-0.02 mol/L potassium dihydrogen phosphate (pH=2.7), (4∶100, with 0.1% triethylamine) under a flow rate of 1.5 mL/min. 207 nm was selected as the wavelength of detector. RESULTS: The linear range of ephedrine was 20.8-208.0 ?g/mL(r=0.999 7) and pseudoephedrine's was 15.0-150.0 ?g/mL(r=0.999 8). The recoveries of them were all between 95% and 105%(RSD

OBJECTIVE: To prepare ethacridine lactate solution and to evaluate its quality.METHODS: The solution was prepared with ethacridine lactate as principal components and sterilized by steam sterilization.HPLC method was used for the determination of ethacridine.Calesil ODS column was used with mobile phase consisted of methanol-acetonitrile-0.05% sodium laurysulfonate (pH=3.0,20 ∶ 20 ∶ 60) at detection wavelength of 270 nm.The column temperature was set at 30 ℃ and injection volume was 10 ?L.The effect of sterilization on the content of preparation was determined.RESULTS: The preparation assumed as yellow transparent solution.The linear range of ethacridine was 5～50 ?g?mL-1(r=0.999 9) with an average recovery of 101.47% (RSD=1.32%,n=9).The content of ethacridine in the solution was not changed after sterilization.CONCLUSION: The quality of prepared ethacridine lactate solution is up to the standard.

Objective To strengthen the ability of clinical thinking and the ability to solve practical clinical problems for medical students.Methods Medical undergraduates studying in affiliated hospitals of Tongji university from 2005 to 2010 were enrolled The clinical thinking training and assessment in clinical teaching were enhanced by introducing problem-based learning,case-based learning and by strengthening the role of interns in clinical work and emphasizing clinical thinking ability assessment during various kinds of clinical skills examinations.Meanwhile,the teaching management and supervision were improved.The awareness and ability of clinical teachers to train students′ clinical thinking were aroused and cultivated through teaching staff training so as to ensure that clinical thinking training and assessment were involved in the whole process of clinical teaching.Results The students' abilities of self-study,scientific thinking and oral expression were improved.The passing rates of our graduates in national general medical practitioner test were increasing yearly from 2006 to 2008.Conclusion Strengthening clinical thinking ability training during clinical teaching plays an active role in improving clinical skills in medical students.

Objective: To investigate and compare the advantages of surgical treatment of ingrown toenail with the traditional Winograd method. Methods: From Aug. 2013 to Jun. 2015, 77 cases (89 toes) with 15-58 years were involved in the study. 37 cases (42 toes) were treated with Winograd method and other 40 cases (47 toes) were treated with a method using lateral incision without cutting the nail fold. The time of returning to normal activities, infection rate, recurrence rate, pain VAS score and shape satisfaction VAS score were evaluated to display the aesthetic and functional result of the both methods. Results: All patients were followed up with an average of 8.6 months. The patients treated with the novel method returned to normal activities after (5.3±0.5) d post-surgery, which was much shorter than that (7.3±0.6) d in patients with the Winograd method (P<0.05). And the infection rate in the lateral incision group was also lower than that in the Winograd method group (P<0.05). At 3 days post-surgery, the pain VAS score in Winograd method group was higher (P<0.05), but the difference of pain VAS score disappeared after 1 and 6 months post-surgery (P>0.05). The shape satisfaction VAS score were 9.2±0.6 in the lateral incision group and 7.1±0.7 in the Winograd group, showing significant difference (P<0.05). Conclusions The lateral incision method without incising the nail fold reserves the nail groove and brings faster recovery to normal activities with less pain, lower infection rate and more satisfactory toenail shape.

Polygonum multiflorum （PM）， a commonly used Chinese herbal medicine in clinical practice， has been associated with frequent reports of liver injury in recent years， and the medication safety of PM has attracted more and more attention in China and globally. This article reviews the recent research advances in the signaling pathways and mechanisms of PM in causing drug-induced liver injury （DILI） and aims to provide new ideas for the proper and rational use of PM in clinical practice. The results show that PM is involved in the regulation of various signaling pathways， and it leads to the death of hepatocytes by destroying mitochondrial function， exacerbating bile acid accumulation， and inducing immune response， oxidative stress， and endoplasmic reticulum stress， thereby inducing the development and progression of DILI through multiple targets， pathways， and levels.