Objective To summarize the experiences in treating 30 cases of skin soft tissue defects in head and neck by applying repeated expansion, and to explore an effective and satisfactory method of massive defect repair in head and neck. Methods Skin soft tissues were repeatedly expanded for 1 to 3 times after the first expansion. Massive skin defects in head and neck were repaired several times by useing repeated expansion of flap. The size of the skin defects ranged from 29cm?24cm to 10cm?8cm. The indications, complications and experiences in the treatment were discussed. Results A total of 30 cases were treated. Complication incidences of every expansive procedure were 27%, 15%, 14% and 0% respectively . After 6～12 months postoperative follow-up, the appearance and functional restoration was satisfactory. Conclusion Repeated expansion is an excellent method of repairing massive defects in head and neck.

OBJECTIVE: About 70% patients with stroke have dysfunction at various degrees in clinic, especially aphasia would affect their social communication and even offer a serious economic load for family and social. This paper aims to summarize the relevant articles on aphasia recovery so as to provide researching evidences in the future. DATA SOURCES: Relevant articles were retrieved from the Medline with the key words of "aphasia, recovery, language, recovery" in English from January 1980 to January 2004. STUDY SELECTION: All articles were selected firstly, those which were related to aphasia recovery were selected, and the non-randomly clinical papers were excluded. The full text of rest was looked up to determine whether they were randomized controlled studies or not. Randomized controlled researches were regarded as inclusion criteria regardless of blind way. DATA EXTRACTION: Among 22 articles on aphasia recovery, 12 were selected according to inclusion criteria and 10 were excluded because of duplicated papers.DATA SYNTHESIS: Recovery of language function was related to sex,age, ducational degrees, characteristics of lesion, range of lesion, duration from episode to language recovery, insight and self redress of language disorder. Therefore, there were various findings and views for previous re searches on mechanism of aphasia recovery. CONCLUSION: There is not uniform conclusion on mechanism of aphasia recovery. Compliance of language function in brain may be a mechanism of aphasia recovery.

The number of root canals varies most in the areas of mandibular anterior teeth, maxillary and mandibular premolars, and premolars. Generally, The mandibular anterior teeth have one root canal, but data suggest that the anatomical morphology of the root canals of mandibular incisors varies greatly, which easily leads to the neglect of root canals in endodontic treatment. This report described the case of a mother and a daughter whose mandibular anterior teeth have two symmetrical root canals.

Objective To study the mechanisms of Re Bi granule on treating RA.Methods Make SD maleness rats Adjuvant-Induced Arthritis(AA)which was derived by Freund's complete adjuvant(CFA)as investigation object.Make Wang Bi granule as positive control medicine,and divide it into six groups(blank group,model group,control group,Infusion of Re Bi granule high dose group and midst dose group and low dose group).Observe Re Bi granule's influence and mechanism to synovial cell apoptosis and T cell subsets.Results Re Bi granule could distinctly heighten synovial cell apoptosis ratio of AA rats,heighten CD8+cell's number and reduce CD4+cell's number,lower CD4+/CD8+ ratio,adjust T cells for two-way.Conclusion Re Bi granule not only is an effective treatment way for rheumatoid arthritis,but also can improve the abnormal immune status.

Objective To explore the effects of rosiglitazone on the expression of TNF-? in visceral adipose tissue of insulin-resistant rats induced by high-glucose diet. Methods Sprague-Dawley (SD) rats were fed with high-glucose diet for 6 months to reproduce the non-obesity insulin-resistant rat model (abbreviated as IR rats). The model rats were then randomized into insulin resistan (IR) group and rosiglitazone (ROS) group (10 each). Ten rats fed with normal diet were enrolled as controls (CN group). Rats in ROS group were administered with 10?mol/(kg?d) of rosiglitazone for 6 weeks from the 7th week of experiment,and those in CN and IR groups were administered with same amount of distilled water. At the 6th and 12th week,the systolic pressure,body weight,and biochemical parameters (fasting and 2-hour post-glucose load plasma glucose,insulin,free fatty acid,triglyceride,high density lipoprotein cholesterol) were measured,and insulin resistance index (HOMA-IR) was calculated. At the end of the 12th week,the visceral adipose tissue was collected to calculate the ratio of visceral fat to body weight (VF/BW),and to determine the protein and mRNA expressions of tumor necrosis factor-? (TNF-?) with inmmunohistochemical assay and RT-PCR. Results As compared with CN group,the systolic pressure,HOMA-IR,plasma insulin,triglyceride and free fatty acid increased,whereas high density lipoprotein cholesterol decreased (P0.05). Inmmunohistochemical examination showed positive expression of TNF-? in intercellular substance,but not in visceral adipocytes. The expressions of TNF-? protein and mRNA in visceral adipose tissue were dramatically higher in IR group than in CN and ROS groups (P0.05). Conclusion Rosiglitazone may significantly abate insulin resistance,reduce the abnormality of plasma lipid and blood pressure,and inhibit the over expression of TNF-? in visceral adipose tissue in the non-obesity insulin-resistant rats induced by high-glucose diet.

Objective To explore the clinical modalities and diagnosis of respiratory failure due to laryngotracheal disorders in children,in order to reduce the misdiagnosis.Methods Fifteen patients(11 cases were male,4 cases were female) with respiratory failure in Intensive Care Unit, Tianjin Children′s Hospital from Jul.2006 to Jul.2009 were selected.Data including history,characteristics and results of spiral computerized tomography(CT) and reconstruction and magnetic resonance imaging(MRI) were reviewed.Results The major clinical manifestations indicated that 7 cases had laryngeal stridor,6 cases had recurrent pneumonia,5 cases had cyanosis after crying,and 12 patients were complicated with respiratory failure in 12 hours.Nine cases were recovered,3 cases were given up,and 3 cases died.All patients were performed with CT about laryngohypopharynx,and the results were cyst of root of tongue in 3 cases,trachea pressed by cyst of parapharyngeal space in 1 case.There were 11 cases examined by spiral CT and reconstruction,in which 6 cases were confirmed as tracheal stenosis,2 cases were left bifid tracheostoma,2 cases were pulmonary artery sling,and 1 case was diagnosed as tracheomalacia.Chest X-ray radiograph indicated that bronchopneumonia in 8 cases,bronchitis in 3 cases and negative in 4 cases.Echocardiograph examination was performed among 11 cases,in which 2 cases were pulmonary artery sling,2 cases were atrial septal defect,1 case was patent ductus arteriosus, and 6 cases were negative.Conclusions There is high morbidity of respiratory failure caused by laryngotracheal disorders in infants,but misdiagnosis ccures usually because of non-specific symptoms.If the infant must depend on mechanic ventilation for a long time and has airway obstruction,he should be examined early by using spiral CT.

Objective To study the expression changes of IL-1β、FN-α6、IFN-γ and TNFR-m18 in peripheral blood within 2 hours in epileptic mice. Methods Semi quantitative real-time PCR was used to test the mRNA expres?sion level of IL-1β、FN-α6、IFN-γand TNFR-m18 in peripheral blood from normal and pilocarpine-induced epileptic mice at different time points (10 min, 30 min, 1 h and 2 h). Results The mRNA expression level of IL-1βincreased at 30 min(1.8±0.07), 1 h(2.9±0.98)and 2 h(1.45±0.11)after pilocarpine-induced status epilepticus comparing with that of control and SE 10 min(0.81±0.09)(P<0.05). The IFN-α6 mRNA expression level was lower at 10 min(0.59±0.05, P<0.05) than that of control. IFN-γmRNA expression level was higher at 10 min(2.85±0.11) than that of control and at oth?er time points during SE(P<0.01). TNFR-m18 mRNA expression level was higher at 1h(2.84±0.15) than that of control, and at other time points during SE(P<0.01). Conclusion The immune system of epileptic state is active, the imbalance of cytokine expression in peripheral blood may be related to the immune pathological process of acute stage of epilepsy.

Objective To apply the six sigma(6σ) quality management method to quantitatively analyze the quality control data of the detection items from different groups and conduct the comparison for analyzing the evaluation performance and improving the laboratory quality .Methods The data of the internal quality control and the external quality assessment were collected from35 de‐tection items in the clinical chemistry laboratory group and the hematology laboratory group during 2013 ,the σ value of every item was calculated and the analytical performance of the detection item was analyzed .Results Among 23 clinical detection items in the biochemistry group ,there were 10 items of σ ≥ 6 ,6 items of 5 ≤ σ < 6 ,3 items of 4 ≤ σ < 5 ,3 items of 3 ≤ σ < 4 and 1 item of σ < 3 , the average σ was 5 .962 .Among 12 clinical detection items in the hematology group ,there were 8 items of σ ≥ 6 ,2 items of 5 ≤ σ <6 ,2 items of 4 ≤ σ < 5 ,the average σ value was 7 .38 .The detection items in which the analytic performance did not reach 6σ in the biochemistry group accounted for 37% of the total items ,which in the hematology group accounted for 11% ,the differences in theσ quality level of detection items between the biochemistry group and the hematology group had statistical significance(P< 0 .05) , the differences in the σ quality level of detection items between the matched reagent and the non‐matched reagent had statistical sig‐nificance (P< 0 .05) .Conclusion The 6σ quality management method can be used used in the quality evaluation of clinical detection items and can be widely used in the quality management of clinical laboratory .

The development of medical imaging diagnosis technology has brought forward higher requirements for the teaching of oral and maxillofacial medical imaging diagnostics, In this study, we intro-duce the methods and concepts of comparative imaging to guide students to analyze and compare oral and maxillofacial diseases from different perspectives, and to promote the students' understanding of the disease image and mastery of disease diagnosis, improve the students' ability to choose the appropriate imaging method in the future clinical work. Comparative imaging is one of the important teaching methods in the diagnosis of oral and maxillofacial medical imaging, and it is also the direction of its future development.

Objective To explore the clinical characteristics of children with serious pneumonia with ventilatory support,and combined with heart failure,encephalopathy,hyponatramia,acute respiratory distress syndrome(ARDS) and multiple organ dysfunction syndrome(MODS).Methods One hundred and fifteen children(81 males,34 females) with serious pneumonia in ICU from Jul.2005 to Jul.2007 were reviewed,The duration of ventilation support was over 48 h.And blood electrolyte,blood gas,cerebrospinal fluid and CT were detected.Results Ninety-three cases had a good outcome,7 cases were given up,15 cases were dead.The complications included heart failure in 60 cases(52.17%);encephalopathy in 40 cases(34.78%),in which tics type in 38 cases(95%),apnea type in 11 cases(27.5%);hyponatremia in 42 cases(36.52%),of which tics type in 31 cases(73.81%),syndrome of inappropriate secretion of antidiuetic hormone in 27 cases(72.97%)resulted in hyponatremia;ARDS in 8 cases(6.96%),pa(O2)/FiO2