The appearance of theoretical medic ine is an inevitable result of develo pment of medicine.The development of molecular biology an d molecular immunology has laid the b asis of theoretical medicine,which studies various systems in life so as to reveal the essential laws of life phenomen a.The mystery of fracture healing wi ll be explained only from the viewpoint of theoretical medicine.The primary c allus response(PCR)is the basic event of fracture healing that is a process of numerous repetition of PCR and accum ulation of the surplus repair of PCR.The pathologic process of fracture healing shares very similar cellular and molecular mechanisms with the physiologic process of bone remodeling.This theory has been referred to as monistical theory of fracture healing.[

To discuss the advantages and disadvantages of fibular osteosynthesis and osteotomy in the treatment of tibial fractures. Medical literature was searched for articles concerning “fibular fracture”and“fibular osteotomy”on Medline to have a comprehensive idea of experiences of others. The results of others and of ours were analyzed and interpreted. Fractures of distal tibia and fibula with displaced distal tibial articular fractures were classic indications of fibular osteosynthesis, but distal tibiofibular syndesmosis and stability of ankle joint were seldom affected by the fibular fracture when tibia was fractured. It is not necessary to perform routine osteosynthesis for distal fibula fracture. Fibular osteotomy may be considered as an adjuvant procedure when atrophic nonunion or deformity union of tibia occurs. It is wise in treatment of tibial fractures not to perform fibular osteosynthesis or osteotomy whenever possible.

Background Multimorbidity imposes a heavy burden on individuals, families, and society. There are relatively few studies exploring patterns of multimorbidity among middle-aged adults in China. Objective To explore the current status of multimorbidity, associated risk factors, and multimorbidity patterns among adults aged 45-64 years in China, so as to provide a scientific basis to prevent and control multimorbidity in China. Methods A total of 5494 adults aged 45-64 years from the Chinese Health and Nutrition Survey (CHNS) in 2018 were selected. Of these, 2494 (45.39%) were men and 3000 (54.61%) were women. The nine diseases included were hypertension, diabetes, dyslipidaemia, obesity, mild cognitive impairment (MCI), myocardial infarction, stroke, asthma, and tumor. The prevalence of each disease or multimorbidity was expressed as N (%). Comparisons of multimorbidity prevalence between different groups were performed using the χ² test or Cochran-Armitage trend test. Association rule with the Apriori algorithm was used to explore the pattern of multimorbidity, with parameters set at a minimum conditional support of 3.00%, a minimum rule confidence of 50.00%, and a lift of >1.20. Logistic regression was used to evaluate the associations between selected risk factors and multimorbidity. Results In 2018, 37.44% of participants reported multimorbidity in 15 provinces of China. The prevalence of diseases in descending order was dyslipidaemia (39.99%), hypertension (39.48%), obesity (16.42%), MCI (14.47%), diabetes (14.16%), tumor (1.09%), stroke (1.04%), myocardial infarction (0.71%), and asthma (0.64%). A total of seven multimorbidity patterns were identified in this group. Obesity paired with hypertension, and diabetes paired with dyslipidemia were the two major patterns of multimorbidity in the general population and age or sex subgroups. The multimorbidity patterns of different populations were concentrated in the combination of obesity, hypertension, diabetes, and dyslipidemia. The risk of multimorbidity was lower in females than in males (OR=0.85, 95%CI: 0.75, 0.97). The multimorbidity risk was 1.56 times higher in the 55-64 years group than in the 45-54 years group (OR=1.56, 95%CI: 1.40, 1.75). Drinking in the past year increased the risk of multimorbidity by 25% (OR=1.25, 95%CI: 1.08, 1.45) compared to no alcohol comsumption in the past year. High and medium levels of physical activity were associated with a decreased OR (high: OR=0.74, 95%CI: 0.65, 0.85; medium: OR=0.81, 95%CI: 0.70, 0.93) with low level of physical activity as reference. Conclusion In 2018, there was a high prevalence rate of multimorbidity among middle-aged adults in China. The main multimorbidity patterns were obesity-hypertension and diabetes-dyslipidemia. Surveillance and interventions should be strengthened particularly for men, individuals with alcohol consumption or insufficient physical activity, and those with major multimorbidity patterns.

Objective: To explore the anatomy of expended facial artery perforator flaps with cervical small perforators and its clinical application for extensive facial defects with this flap. Methods: Necks of fresh cadavers were dissected for studying the anatomy basis of expended facial artery perforator flaps with cervical small perforators. Based on the anatomy, two-stage operation was performed. In the first stage, expander was embedded above the platysma and the pedicle, cervical small facial artery perforator was reserved. In the second stage, the expended perforator flap was transferred as propeller flap, advanced flap or tunnel flap to reconstruct extensive facial defects. Results: Cadavers dissection revealed 3 or 4 perforators were derived from facial artery when it crossed marginal mandibular and vertically penetrated platysma to the superficial fascia layer to supply cervical skin. In clinic, all flaps presented with satisfactory functional and aesthetic outcomes. Conclusions This design of expended facial artery perforator flaps with cervical small perforators provide an excellent method for reconstruction of extensive facial defects.

Objective: To investigate the clinical outcome of modified peeling method by divisional design in labia minora reduction in the treatment of labial hypertrophy. Methods: From Feb 2015 to Oct 2017, 32 nympha hypertrophy patients underwent labia minora reduction by the modified peeling method with divisional design. The labia minora area was divided into medial and lateral divisions, from which the dermis and subcutaneous tissue were removed asymmetrically. Results: The patients were followed up 1 to 6 months postoperatively. All incisions healed with excellent blood circulation of labia minora, except for 1 case with V-shaped dehiscence. All of the patients were satisfied with the eventual aesthetic appearance and the functional improvement. Conclusions The modified peeling method by divisional design in labia minora reduction is a safe and effective method with many advantages, such as nature contour, wide range of indications, fewer complications, and high satisfaction.

Objective:To evaluate the implementation of national continuing medical education (CME) base programme about infectious disease control and prevention during 2013-2020, so as to improve the quality management of CME.Methods:According to data from national CME system, Excel and SPSS 27.0 were used to analyze project hosting days, places, teachers, students, project directors and training effect. The counting data were expressed by frequency and percentage [cases (%)], chi-square test was used to make comparison between groups, Mantel-Haenszel chi-square test was used for trend test, and the significance test level of the difference was α = 0.05. Results:A total of 116 projects were conducted from 2013 to 2020, with execution rate of 87.9%(116/132). Most hosting days were 2 to 3 days [57.8% (67/116)]. The majority [65.2% (5 785/8 871)] of trainees had junior and intermediate technical titles. As for trainers, trainers with senior technical titles accounted for 87.6% (758/865), and those with intermediate titles accounted for 12.4% (107/865). Mantel-Haenszel chi-square test showed that there was a linear relationship between the proportion of technical titles and the year ( χ2趋势 = 4.97, P趋势 = 0.026). Project directors almost had senior professional title, and nearly one third of them had the experience of undertaking three or more base projects within 8 years. The top three training modules were parasitic diseases prevention and control, AIDS prevention and control, and viral diseases prevention and control. Trainees were highly satisfied with the training contents. Conclusion:The implementation of the infectious disease prevention and control base programme went well in general from 2013 to 2020. In the future, it’s needed to be demand-oriented, rationally design training programs, enhance the evaluation of training effects, strengthen the construction of public health core capacity, and adopt a strategy of brand development in the process of the infectious disease prevention and control base programme.

Objective To analyze the epidemic status of principal human parasites, so as to provide scientific evidence for making prevention countermeasures for Guangdong Province in the future. Methods In 2015, a survey was performed according to the scheme of "The 3rd National Survey of Principal Human Parasites"as well as the incidence of parasites disease in Guangdong Province,the residents at 48 investiation sites in counties were surveyed. The survey of the soil-transmitted nematodes (Ascariasis, Ancylostoma, Trichuris trichiura and Enterobius vermicularis) and intestinal protozoa were performed based on the ecological regions and stratified by economic and geographic situation.The survey of food borne Clonorchis sinensis was performed along with the soil-transmitted nematodes in rural areas, and it was performed by the sample method of random cluster in cities and towns.The residents in each investigation site as the object, the ovum of the soil-transmitted nematodes, Clonorchis sinensis and other helminths were examed by the modified Kato-Katz method, test tube filter paper was used to identify Hookwormspecies, and the intestinal protozoa was checked by direct smear method. The transparent tape anal swabs method for children aged 3 - 6 years to check Enterobius vermicularis. Results Totally 12 401 residents of 48 survey sites from 22 counties were surveyed, and the total infection rate of intestinal parasites was 8.29%(1 028/12 401). The infection rate of soil-transmitted nematodes was 3.39% (420/12 401),in which the infection rate of Ascariasis, Ancylostoma, Trichuris trichiura and Enterobius vermicularis were 0.52% (64/12 401), 1.89%(234/12 401),0.46%(57/12 401),and 0.52%(65/12 401),respectively.The infection rate of Clonorchis sinensis was 4.90%(608/12 401). Nine hundred and sixty-seven children were tested for eggs of Enterobius vermicularis with the infection rate of 12.41% (120/967). The number of hook larva culture was 153, among them, 140 were hookworm larvae of America and no duodenal hookworm larvae and other nematode species were found.Totally 9 309 residents were tested for intestinal protozoa infection,and the infection rate was 0.31%(29/9 309). Conclusion In Guangdong Province, the infection rate of soil-transmitted nematodes is decreasing while the infection rate of Clonorchis sinensis is still high, and the control work of parasites still should be strengthened especially for food borne parasitic diseases.

Objective:To analyze and compare the association between different obesity-related indices and vitamin D deficiency in middle-aged and elderly population dwelled in Lanzhou city.Methods:From May, 2011 to September, 2012, middle-aged and elderly individuals with complete baseline data were included via randomly cluster sampling from 3 communities in Lanzhou. The subjects were divided into 4 subgroups by vitamin D levels and various obesity-related indices were compared across subgroups with the same gender. The relationship between the obesity-related indices and the severity of vitamin D deficiency was analyzed using Spearman correlation analysis, and the effects of different obesity-related indices on the severity of vitamin D deficiency was analyzed using multivariate logistic regression analysis.Results:A total of 9 437 residents were included. The overall prevalence of vitamin D deficiency was 97.7%. Compared with the group with lower vitamin D level, participants in the group with higher vitamin D level showed evidently lower body mass index (BMI), waist circumference (WC), lipid accumulation product (LAP), visceral adiposity index (VAI) and triglyceride/ high density lipoprotein cholesterol (TG/HDL-C) ratio in the total population and females, while only WC, LAP, VAI and TG/HDL-C in the males (all P<0.05). Spearman correlation analysis showed that BMI, WC, LAP, VAI and TG/HDL-C were positively correlated with the severity of vitamin D deficiency in the total population and the females, while only LAP, VAI and TG/HDL-C in the males (all P<0.05) . Multivariate logistic regression analysis showed that higher levels of these obesity related indices were correlated with more severe vitamin D deficiency in the total population and the females, while only higher LAP, VAI and TG/HDL-C in the males (all P<0.05). The effects of higher LAP was the most prominant in the total population ,the females and the males. Conclusion:Various obesity phenotypes are closely related to vitamin D deficiency in middle-aged and elderly women, while only visceral obesity and abnormal lipid metabolism are related to vitamin D deficiency in middle-aged and elderly men, with LAP being the most important influencing factor.

Objective To investigate the effect of oral fish oil on wound healing and related indexes in patients with diabetic foot ulcer(DFU).Methods A randomized,double-blind,placebo-controlled design was used to recruit 68 patients with DFU aged 18-80 years old in the hospital,and the baseline clinical data of the patients were collected.The patients were randomly divided into experimental group(32 cases,fish oil soft capsule,3 g/d)and control group(33 cases,corn oil soft capsule,3 g/d)by random number generated by Ex-cel,and the intervention lasted for 12 weeks.The primary endpoints included the proportion of complete wound healing and healing area≥50%.The secondary endpoints included wound area,healing time,inflamma-tion index,glucose metabolism index,nutrition related index and wound reinfection.Additionally,the influen-cing factors of wound healing were analyzed.Results After intervention,the proportion of complete wound healing and healing area≥50%in the experimental group was significantly higher than that in the control group(P=0.007,0.039).In the subjects with complete wound healing,the mean healing time in the experi-mental group was shorter than that in the control group,but the difference was not statistically significant(P=0.132).The reduction area of wound area in the experimental group was significantly larger than that in the control group(P=0.045).The decrease of interleukin(IL)-6 and IL-8 in the experimental group was significantly higher than that in the control group(P<0.05).There was no significant difference in the reduc-tion of C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),neutrophil-to-lymphocyte ratio(NLR),glycated hemoglobin A1c(HbA1c)and platelet-to-lymphocyte ratio(PLR)between the two groups(P>0.05).The improvement of prealbumin(PA)in the experimental group was higher than that in the control group,but the difference was not statistically significant(P>0.05).Multivariate logistic regression analysis showed that oral fish oil intervention(OR=6.771,95%CI:1.787-25.652),HbA1c(OR=4.149,95%CI:1.026-16.770)and ulcer type(OR=4.319,95%CI:1.026-18.173)were the influencing factors of wound healing(P<0.05).Conclusion Oral fish oil promotes wound healing in patients with DFU,which may be re-lated to improving the level of chronic inflammation in the body.

Objective: To understand the internship of students majoring in preventive medicine in 6 colleges and universities in China, and provide reference suggestions for the improvement of internship arrangement. Methods: By using the method of combined clustering and convenient sampling, the fifth grades students majoring in preventive medicine in six universities in the eastern, central and western China were surveyed by using questionnaires to collect the information of their attitudes (to) and suggestions for clinical and public health internships. Results: A total of 596 students were surveyed. In terms of the benefits of clinical internship and public health internship, students who thought that the internship was fruitful accounted for >88%, and more students thought that reform is needed in clinical internship compared with public health internship. In clinical internship, the students through that the time arrangement was not appropriate enough (95, 39.58%), the content should be more detailed and in-depth (73, 30.42%) and the content did not conform to the professional direction (54, 22.50%). In public health internship, the students thought that the time arrangement was not appropriate (77, 45.56%), the content should be more detailed and standardized (65, 38.46%) and the types of internship bases should be more diversified (20, 11.83%). Conclusions The undergraduates majoring in preventive medicine felt to be benefited from clinical practice and public health internships and thought they are of necessity. At the same time, there are still many problems which needs to be improved in the two types of internships. It is necessary to make joint efforts from students, teachers, colleges and practice bases to promote the continuous improvement of undergraduate internship.