Objective To observe the clinical and nerve electrophysiological features of sodium azide poisonin. Method The clinical data of 11 patients with sodium azide poisonin were analyzed retrospectively.Results In this group, the first symptoms was numbness in 4 cases, weakness in 3 cases, walking instability in 2 cases, dizziness and nausea in 2 cases.The major clinical manifestations were numbness in 8 cases, weakness in 6 cases, walking instability in 4 cases, dizziness and nausea in 3 cases, leptophonia in 2 cases, diplopia in 2 cases, limb muscle strength loss in 7 cases, reducing muscle tension in 3 cases, weakened tendon reflex in 3 cases, skin needle drops in 3 cases.Electrophysiological examination showed motor nerve conduction velocity ( MCV) was slower, distal latency ( DML) and amplitude ( AMP) were reduced; the sensory nerve conduction velocity ( SCV) was slower, and AMP was reduced.The latency (Lat) and wave interval of brainstem auditory evoked potential (BAEP) and visual evoked potential ( VEP) , somatosensory evoked potentials ( SEP) were prolonged, and AMP was reduced.Compared with pre-treatment, the abnormal rates of MCV, AMP, DML of median nerve, ulnar nerve, deep peroneal nerve and SCV, AMP of median nerve, ulnar nerve, superficial peroneal nerve, sural nerve and AMP of SEP after treatment had no statistically significant (all P>0.05).Compared with pre-treatment, the abnormal rates of Lat of BAEP, VEP, SEP andⅢ-Ⅴof BAEP and AMP of BAEP, VEP had no statistically significant (P<0.05-0.01).Conclusions The major clinical symptoms of sodium azide poisoning are numbness, weakness, unstable walking, dizziness, diplopia. Electrophysiological examination showed MCV is slower, DML and AMP are reduced; SCV is slower, and AMP is reduced.The Lat and wave interval of evoked potential are prolonged, and AMP is reduced.

Objective To investigate the clinical significance of detection of growth differentiation factor 3(GDF3), prostate specific antigen(PSA) combined with mucin 1(MUC1)for diagnosis of breast cancer.Methods50 cases of breast cancer were selected as the breast cancer group, 50 cases of benign breast disease were selected as the benign breast disease group, and 50 healthy people were selected as the normal group.GDF3, PSA, MUC1 and tumor markets carbohydrate antigen(CA)15-3,CA125,carcinoembryonic antigen(CEA) were detected, and sensitivity, specificity and accuracy were analyzed.ResultsCompared with benign breast disease group and normal group, GDF3, PSA and MUC1 in breast cancer group were higher(P<0.05), CA15-3, CA125 and CEA were higher(P<0.05).The sensitivity, specificity and accuracy of PSA+MUC1 were higher than other group(P<0.05),the sensitivity, specificity and accuracy of combined detection of GDF3, PSA and MUC1 were higher(P<0.05).ConclusionDetection of GDF3 combined with MUC1 and PSA for early diagnosis of breast cancer has more diagnostic significance.

BACKGROUND: Therapeutic effect on pterygium mainly focuses on studying surgical technique, assistant therapy methods,and recurrence rate following excision of pterygium; however, whether race factor is associated with occurrence, development, and recurrence of pterygium remains still unknown.OBJECTIVE: To compare the therapeutic outcomes in different race patients with pterygium treated using corneal limbal stem cell autograft combining with excision of pterygium.DESIGN, TIME AND SETTING: Retrospective case analysis, performed in the Department of Ophthalmology, Zhongshan Hospital Affiliated to Xiamen University between January 2000 and June 2006. PARTICIPANTS: 1 44 (152 eyes) primary cases were collected from Xiamen and 54 (54 eyes) relapsed Negroes were from Africa. There were no significant differences in age, sex, and pterygium length between the two groups (P 0.05).METHODS: 198 subjects were treated by excision of pterygium under a microscope, in which pterygium tissue was not found on the surface of cornea. A free transplantation of the superotemporal limbus with an adjacent piece of thin conjunctiva was placed in the excision area. All cases were followed-up to grade the appearances of the sites 6 weeks, 6 and 12 months after excision (grade 1 implied normal appearance, and grade 4 implied the relapse). MAIN OUTCOME MEASURES: Relapse, pterygium grading, and complication after corneal limbal stem cell autograft combining with excision of pterygium. RESULTS: No relapse was found at 6 weeks after operation. The recurrence rate of Chinese Han people and Africa black people were 6.6% and 14.8% respectively at 6 months, and 11.8% and 24.5% at 12 months. There was significant difference in the recurrence rate between the two races (t=4.607, P= 0.032). In addition, there were significant differences in the pterygium grading between the two groups at 6 weeks (x2=15.608, P < 0.01 ), and Chinese people recovered better. Contrarily, there was no statistical difference at 6 months and 12 months (x2=4.401, 6.206; P 0.05). Few complications were found except superficial scar of cornea and persistent irritation of ocular surface. CONCLUSION: Limbal stem cell autograft combining with excision of pterygium under a microscope can completely remove pterygium with minimal invasion, light postoperative response and low rate of recurrence. The relapse of black cases is higher than Chinese patients.

Objective To observe the effect of acupuncture plus acupoint injection on the hyperhomocystinemia in the convalescent stage of cerebral infarction patients.Method A total of 120 patients in the convalescent stage of cerebral infarction with hyperhomocystinemia were randomized into group A, group B, and group C, 40 cases in each group. The three groups were intervened by conventional western medicine treatment and rehabilitation therapy, the group A was byXing Nao Kai Qiao acupuncture treatment in addition, the group B was by acupoint injection with cobamamide for injection and the group C was byXing Nao Kai Qiao acupuncture plus acupoint injection treatment. The change of the plasma homocysteine (HCY) level, the Barthel Index (BI) score and National Institutes of Health Stroke Scale (NIHSS) score were observed before and after treatment.ResultEach index(the HCY level, BI score and NIHSS score) in the three groups was significantly changed after treatment(P<0.01). Each index in the group C was significantly different from that in the group A and group B after treatment(P<0.05,P<0.01). The HCY level of the group B after the treatment was significantly different from that of the group A.Conclusion Acupuncture plus acupoint injection can significantly change the HCY level of the convalescent stage of cerebral infarction patients with hyperhomocystinemia, improve the activity of daily living and nerve function.

Objective To explore the correlation of single nucleotide polymorphism (SNP) with PTEN gene involving in mammalian target of rapamycin (mTOR) C1 signaling genes polymorphisms and autism in children.Methods A total of 97 cases with autism were enrolled from Mar.2011 to Dec.2012 in this study,who came from the child and adolescent out-patient department in Shanghai Mental Health Center of Shanghai Jiaotong University School of Medicine.Single SNP association and haplotype association analysis were performed using the family-based association test and Haploview software.Results 1.In a family-based association test,two SNPs showed significant association with autism(rs17107001 G:Z =2.982,P =0.003 ; rs2299941 G:Z =2.524,P =0.012).After the correction of false discovery rate,they all remained significant.2.Haplotype association analysis showed significant transmission disequilibrium in haplotype T-T-G and C-T-A generated from rs532678-rs17562384-rs2299941 (block2) in LD Block,and haplotype T-T-G was over transmitted to offspring(Z =-2.986,P =0.003) while haplotype C-T-A was the opposite (Z =-2.197,P =0.028).Conclusion The SNPs of PTEN genes might have a correlation with autism in children.

Objective To investigate the clinical effect of the blood transfusion with equal ratio component in severe multiple in‐juries with acute traumatic coagulopathy(ATC) .Methods Thirty‐eight patients who had severe multiple injuries with ATC were divided randomly into control group and treatment group .Control group was treated with the different ratio packed red blood cells (PRBC)and fresh frozen plasma(FFP) ,while treatment group received the equal ratio PRBC and FFP .Hemoglobin(HB) ,pro‐thrombin time(PT) ,international normalized ratio(INR) ,fibrinogen(FIB)were measured on the 1st ,2nd ,3rd day after admission . The total amount of PRBC during these 3 days ,the days of hospitalization in ICU ,the corrected rate of shock ,the 28‐day mortality were compared between groups .Results Compared with the control group ,the levels of PT ,INR and FIB of treatment group on the 2nd ,3rd day after admission were better(P<0 .05) .The total amount of PRBC[(18 .5 ± 6 .3)U]during these 3 days ,the days of hospitalization in ICU [(5 .9 ± 4 .3)d] in treatment group were less than those in the control group [(25 .9 ± 7 .8)U ,(10 .5 ± 7 .6)d] (P<0 .05) ,while the corrected rate of shock(85 .0% )in treatment group was higher than that of the control group(44 .4% ) .The 28‐day mortality(10 .0% )in treatment group was lower than that of the control group(27 .8% )(P<0 .05) .Conclusion The blood transfusion with equal ratio component in severe multiple injuries with ATC could not only improve blood clotting index ,reduce the total amount of PRBC and the time in ICU ,but also increase the corrected rate of shock and decrease the 28‐day mortality .

Objective To summarize the experience of intraoperative care for the patients undergoing microsurgery via retrosigmoid keyhole approach, so as to improve the treatment effect and minimize complications. Method The clinical records on the intraoperative care of 100 patients undergoing microsurgery via retrosigmoid keyhole approach were retrospectively analyzed. Result Using the keyhole technique and small incision, the cerebellopontine angle lesions were exposed clearly. Moreover, the proper intraoperational cooperation shortened the duration of operation, reduced bleeding and minimized postoperative complications such as cerebrospinal fluid otorrhea, intracranial infection, intracranial hemorrhage, and subcutaneous hydrops. Conclusion Proper operational postures and intraoperative cooperation can make full use of the limited space of the microsurgery via retrosigmoid keyhole approach and ensure the success of the operation.

Aim To study the characteristics of the binding reaction of Troxetutin with bovine serum albumin (BSA) by fluorescence and ultra violet-visible absorption spectra.Methods The quenching mechanism of the fluorescence of BSA by troxerutin was studied with fluorescence.To determine the dynamic quenching constants and static binding constants,the Stern-Volmer equation and the double reciprocal Lineweaver-Burk equation were applied. The number of binding site was calculated with double logarithmic equation and the main binding force was discussed by thermodynamic equations. The binding distance and energy transfer efficiency between donor (BSA) and acceptor (troxerutin) were obtained effectively quenched fluorescence of BSA via static quenching processes. The binding constant Ka was calculated to be in the order of 106,indicating a strong interaction between Troxerutin and BSA. The number of binding site was approximately equal to 1,the binding distance was 1.97 nm,the energy transfer efficiency was 0.529,and the binding force was mainly hydrophobic force.Conclusion Troxerutin effectively quenchs the intrinsic fluorescence of BSA via static quenching mechanism,and the binding is mainly driven by the hydrophobic interaction.

Objective To analyze the clinical features of unilateral oculomotor nerve palsy caused by multiple myeloma(MM).Methods A 79-year-old female diagnosed MM for 3 years was admitted due to the disease relapse.The patient presented left oculomotor nerve palsy,bone marrow biopsy showed 4.5％ of myeloma cells,the serum level of λ light chain was up to 18 g/L,and brain CT/MRI scan revealed left parasphenoidsinus lesion.A diagnosis of relapsing intramedullary and extramedullary MM,IgGλ type,stage ⅢA was made.Ten cases were retrieved from literature since 1990,the clinical features of 11 cases were analyzed as follows.Results Among 11 cases of unilateral oculomotor nerve palsy caused by MM,7 were males and 4 females with a mean age of (60 ± 12) years (40-79 years).The sub-types of MM were IgG type (7 cases),IgA type (2 cases),biclonal of IgG and IgA type (1 case),and IgD type (1 case).Oculomotor nerve palsy was presented as the initial manifestation of MM in 9 cases,as a sign of relapse of MM in 1 case,and during MM treatment in 1 case.In 7 cases,oculomotor nerve was the only cranial nerve involved,while in other 4 cases,the Ⅳ,Ⅴ,Ⅵ cranial nerves were also involved.Neuroimaging revealed parasphenoid sinus lesions in 9 cases,and myeloma meningitis in 2 cases.Most of the reviewed cases achieved significant clinical improvement after chemotherapy and/or radiotherapy,except 2 cases with myeloma meningitis.The case in our department was improved significantly and rapidly after receiving chemotherapy with bortezomib.Conclusion MM should be considered when unilateral oculomotor nerve palsy is presented with or without the history of MM,the disease is sensitive to chemotherapy in most circumstances.

To cultivate high-quality medical talents,Shanghai Jiao Tong University School of Medicine established a multidisciplinary and comprehensive basic medical practical integration curriculum Medical Functional Experiment.Over several years' exploration and renovation,insisting on student-centered,this course has established a modular experiment teaching system with emphasis on foundation,combina-tion with clinical and focusing on innovation.Integration curriculum adopts four-stage teaching pattern which is suitable for medical students,and implements diversified teaching method and evaluation system.And meanwhile,the paper explores the ideas and approaches to further deepen the construction of teaching staff,expand experimental teaching techniques,strengthen the construction of curriculum materials,and strengthen the cultivation of teachers' innovative ability.