Objective: To explore the anatomy of tibiofibular syndesmosis for the clinic treatment of tib-iofibular syndesmosis injury. Methods: Twelve embalmed adult lower legs were selected. The configurations , structures and plane which ligaments attached to were observed. Results:Tibiofibular syndesmosis consists of ligaments, plica and synostosis. It's tower-shaped. The plane which ligaments attached to has a shape of swallow's tail. Conclusion:Tibiofibular syndesmosis is strong and elastic. The fixation of injuried tibiofibular syndesmosis should be elastic.

The success of total hip replacement relies on detailed preoperative pla nning and reliable localization during operation.Currently,great advances have been made in the research and application of localization s ystem.The traditional preoperative planning is based on plain radiographs of the p elvis and femur as well as the profile outline of each prosthetic component.Now image-gu ided system(IGS)is used to perform virtual implantation.Surgeons used to localize during total hip replacement only wi th eyes or unreliable localization d evices,but now they begin to use imag e-guided system for surgical navigation during operation.[

Through discussing the connotation of medical humanities spirit and the current situation of medical humanities education in our country, the authors put forward that in clinical practice, respiratory medicine interns medical ways for the cultivation of the humanistic spirit, which include: guide the trainee doctors in treating pa-tients alike, on the basis of understanding and respect for life and death;to cultivate the ability of effective commu-nication between patient and physician internship; interns cultivated the spirit of collaboration and leadership skills;the in-depth, on the basis of clinical practice, in practice the doctor to write a detailed records;construc-tion of a high level of teacher love team, set an example for the students.

Ischemia reperfusion injury (IRI) is a multistep pathophysiological process involving a complex of multi-factors.To alleviate the IRI is of great importance in clinical liver transplantation,especially for marginal donor livers.This article overviewed the protective strategies and the latest progress for alleviation of IRI in three stages of liver transplantation,which includes liver procurement,preservation and reperfusion.

Objective To investigate the interactive mechanism of dopamine and α-synuclein in SH-SY5Y cells,and to explore their effects on Parkinson's disease (PD).Methods The concentration of exogenous dopamine was definited by MTT method.The effect of exogenous dopamine on the expressions of α-synuclein and caspase-3 active fragments and malondialdehyde (MDA) content were detected by Western blot and commercial kit.Recombinant plasmid of wild-type α-synuclein was transfected into SH-SY5Y cells.Level changes in dopamine concentration,MDA content and expression of caspase-3 active fragment were observed.Furthermore,the effect of GBR12935,an inhibitor of dopamine transporter,on these outcomes were detected.Results Intracellular dopamine concentration was increased by 16 folds in SH-SY5Y cells which were added 300 umol/L exogenous dopamine for 24 hours as compared with blank controls (t=7.32,P＜0.01).Expressions of α-synuclein and caspase-3 active fragments and MDA content were increased in exogenous dopamine treated group as compared with blank controls (t=4.92,17.14,6.55,all P＜0.01).Intracellular dopamine concentration,MDA content and expression of caspase-3 active fragment were increased in SH-SY5Y cells transfected with recombinant plasmid of wild-type α-synuclein as compared with SH-SY5Y cells transfected with empty plasmid (F =32.97.107.80,55.54,all P＜0.01),whlie these increases could be partially inhibited by GBR12935.Conclusions Dopamine promotes the expression of α-synuclein,while over-expressed α-synuclein increases intracellular dopamine concentration,which forms a vicious cycle of cytotoxicity in SH-SY5Y cells.

The bone is a common site of metastasis for gastric cancer. High-risk factors of metastatic gastric cancer include young age, poorly differentiated adenocarcinoma, Borrmann type III tumors, depth of invasion at Se and Pm levels, positive lymph nodes, and gastric cancer with concomitant body of stomach cancer. More than half of the transfer pathway belongs to the non-portal system. Cases of gastric cancer with bone metastasis but without liver metastasis accounted for 69%of the total gastric cancer cases, whereas the incidence rate of bone metastasis with lymph node metastasis (≥3 cm away from the primary lesion) was 27%. In addition to the tumor markers human chorionic gonadotropin and carcinoembryonic antigen, radionuclide scan of the bone metastasis provides diagnostic pathways and reliable basis for treatment. Chemoradiation and surgery as symptomatic treatments are alternative therapies for stomach cancer. Bone metastasis confers unfavorable prognosis, and the survival time is often less than six months.

Objective To detect the preliminary results of combined periacetabular and intertrochanteric osteotomies for complex hip dysplasia.Methods From January 2006 to August 2011,23 patients (25 hips) with complex hip dysplasia were treated with combined periacetabular and intertrochanteric osteotomies (ITO).Valgus ITO was performed on 2 hips and varus ITO on others.The averagc age of patients at the time of index procedure was 20.5± 3.9 years (range:15 to 26).The hip pain period before surgery varied from 5 to 24 months (mean 11±4.7 months).The Shenton's line was broken in every hip and the mean preoperative lateral central edge angle (LCEA) was 5.6°±4.6°.The average preoperative fenoral neck-shaft (CCD) angles were 158°±3.2° and 110° in 23 valgus hips and both of two varus hips respectively.The preoperative Harris hip score was 76.7±3.7.According to T(o)nnis osteoarthritis grades,there were 7 hips at grade 0,12 hips at grade Ⅰ and 6 hips at grade Ⅱ.Results The mean followup period was 40±18 months (range:12 to 78).The CCD angle (130°±2.1°),LCEA (28.6°±2.9°) and Harris hip score (90.8±3.3)were all improved postoperatively,whereas no progression was found in preoperative T(o)nnis grades.The postoperative Harris hip scores were excellent in 17 hips and good in 8 hips.The T(o)nnis osteoarthritis grades were grade 0 in 6 hips,grade Ⅰ in 11 hips and grade Ⅱ in 8 hips.There wcre six cases with lateral femoral cutaneous nerve injury,three cases with limp and two cases with broken Shenton's line.Neither femoral head necrosis nor bone nonunion was found in this study.Conclusion Satisfactory preliminary results could be obtained through combined periacetabular and intertrochanteric osteotomies among patients with complex hip dysplasia.The risk of femoral head necrosis and bone nonunion was low.

Objective To analyze and compare the anti-HCV reactivity,HCV nucleic acid detection results and HCV recom binantion immunoblot assay(RIBA) confirmatory test results in blood donors.Methods The blood samples collected from the volunteer blood donors from October 2013 to March 2015 were performed the HCV screening by using the domestic ELISA reagents from two different manufacturers and an imported nucleic acid detection reagent and matching detection system.The samples of anti-HCV reactivity or/and NAT detection positive were performed RIBA.Then the results of reactivity detected by two kinds of ELISA reagents,nucleic acid detection reagent and RIBA confirmatory test results were analyzed and compared.Results A total of 133959 samples of volunteer blood donors were detected,in which 113 380 samples covered the nucleic acid detection results,the reactivity samples proportion of anti-HCV detection was 0.19 ％ (252/133959),27 cases were positive in NAT detection with the positive detection ratio of 0.02 ％ (27/113 380);the proportion of HCV reactive samples confirmed by RIBA was 19.8 ％ (50/252),the negative proportion was 54.8％ (138/252),and the uncertain proportion was 25.4％ (64/252);27 samples of nucleic acid detection positive were double reagent reactivity in ELISA detection and positive in confirmatory test.The difference among the results of two ELISA reagents,RIBA confirmatory test results and nucleic acid detection results had statistical significance(P＜0.05).Conclusion The detection strategy selecting twice ELISA+1 kind of nucleic acid detection is more secure.Aiming at higher proportion of false positive samples,the follow up system of blood donors should be established for maximizing the retention of blood donors.

The authors attempted to sort out the training experience of higher education pedagogy in America , and truthfully recorded the understanding and experience of the higher medical elite education of America during visiting the University of Nebraska Medical Center .Combined with the current situation of high medical education in Chi-na, the formation and the embodiment of medical elite education mode of America has also been concretely ana -lyzed , which was expected to bring new enlightenment and reference for the development of high medical elite edu -cation mode and the medical teaching remodeling .

Objective: To investigate the spatio-temporal clustering characteristics of influenza in Yinzhou District, Ningbo City, Zhejiang Province from 2017 to 2021, so as to provide insights into prevention and control of influenza. Methods Data of influenza in Yinzhou District from 2017 to 2021 were collected from the Chinese Disease Prevention and Control Information System. The software ArcGIS 10.8 was employed for spatial autocorrelation analysis, and SaTScan 10.1 was employed for spatio-temporal scanning to analyze the temporal and spatial clustering characteristics of influenza incidence in Yinzhou District. Methods: Data of influenza in Yinzhou District from 2017 to 2021 were collected from the Chinese Disease Prevention and Control Information System. The software ArcGIS 10.8 was employed for spatial autocorrelation analysis, and SaTScan 10.1 was employed for spatio-temporal scanning to analyze the temporal and spatial clustering characteristics of influenza incidence in Yinzhou District. Results: Totally 60 543 influenza cases were reported in Yinzhou District from 2017 to 2021, with an incidence of 0.76%. The incidence of influenza peaked in December 2019 (9.35%) and January 2020 (9.28%) during the period between 2017 and 2021. Spatial autocorrelation analysis showed that there was a positive spatial correlation of influenza incidence in Yinzhou District from 2018 to 2021 (all P<0.05), and a high clustering in 2019 and 2021. Zhonghe Street showed a low-high clustering from 2017 to 2020; Jiangshan Town showed a low-high clustering in 2017 and 2020, and a high-high clustering in 2019 and 2021; Shounan Street showed a high-high clustering from 2018 to 2020; Yunlong Street showed a high-high clustering in 2021. Spatio-temporal scanning analysis showed that the class Ⅰ clusters were located in the central region which centered in Dongqianhu Town, with aggregation time in August 2017, in the northwest region with aggregation time in December and January from 2018 to 2020, and in the west region with aggregation time in August 2021. Conclusion The incidence of influenza in Yinzhou District from 2017 to 2021 showed a spatio-temporal clustering in the northwestern region in winter and summer.