An analysis of the present development of general practitioners in China,probed into the bottlenecks found.The paper proposed to set forth from the training,use and incentives of GPs to promote the systematic design of China's GP system.These measures center on the regulation of GPs development,while building a multi-channel and multi-level GP development system.Other recommendations include raising the professional standing and attractiveness of GPs as a discipline,and enhancing GPs capacity building to promote general practitioners development.

Adult ; Aged ; Alveolar Ridge Augmentation ; methods ; Dental Implantation ; methods ; Female ; Humans ; Male ; Maxillary Sinus ; surgery ; Middle Aged

Objective To investigate the effects of levocarnitine on pregnancy outcome of the patients with obstructive azoospermia treated with intracytoplasmic sperm injection ( ICSI ) . Methods A total of 74 patients with obstructive azoospermatism treated with ICSI randomly divided into 2 groups:treatment group( n=38) , taking levocarnitine before treatment with ICSI 1 g twice a day for three months;control group( n=36) , taking vitamine E before treatment with ICSI 0.1 g twice a day time for three months.tumor necrosis factor-α(TNF-α), reactive oxygen species(ROS) level, epididymal sperm motility and morphology in epididymal fluid of the two groups were determined before and after treatments. The number of matured oocytes, fertilization, and embryos of adequate quality, the rate of fertilization and embryo of adequate quality, and pregnancy rates after PESA-ICSI were compared between the two groups. Results TNF-α in epididymal fluid before and after the treatment was (5.39±2.28)and(4.05±2.14)ng.mL-1 in the treatment group(P<0.05), and(4.97±2.13)and(4.83±2.35)ng.mL-1 in the control group.ROS in epididymal fluid before and after the treatment was(62.72±8.51),(56.28±8.70)RLU.s-1(P<0.05)in the treatment group( P<0. 05 ) , and ( 62. 61 ± 7. 55 ) and ( 61. 05 ± 6. 77 ) RLU . s-1 in the control group. After treatment with levocarnitine, epididymal sperm motility was significantly increased(P<0.05).There were no significant differences in all the indexes in the control group before and after the treatment(P>0.05).After PESA-ICSI, the number and percentage of high quality embryo in the treatment group were significantly higher than those of the control group(P<0.05). Conclusion Levocarnitine can down-regulate epididymal TNF-α and ROS in patients with obstructive azoospermatism, thereby improve the environment of the epididymis and elevate the quality of sperm and ICSI pregnancy outcome.

BACKGROUND:The finite element analysis method is more accurate and fast to construct the three-dimensional model of the human skeleton and design the bone surgical medical instrument.
OBJECTIVE:To establish locking plate model according to the clavicle model, analyze and evaluate stress distribution of locking plate of the finite element model under bending and torsion conditions.
METHODS:Chest scan was carried out in a healthy young adult male by adopting 64-row spiral CT and his two-dimensional image data were gotten. The obtained data were analyzed with Mimics 10.0 software to establish the three-dimensional clavicle finite element model. The clavicle locking fixation plate model was established by applying the UG software. The locking fixation plate was evaluated by utilizing the abaqus software when the plate was bent while down to give force of 200 N, and twisted while 200 N?mm, to simulate the force and analyze the stress distribution of the locking plate.
RESULTS AND CONCLUSION:Based on the original image parameters provided by CT, this experiment produced a three-dimensional model of the clavical titanium plate which fitted better to bones. This model can obtain a single individual, personalized plate by three-dimensional printing technology. The finite element analysis basical y can simulate the actual stress of the plate. For straight plate and“S”-shape plate, in lateral bending and axial torsion loads, the maximum stress distribution of the seven-hole titanium plate is located in the center of the center hole. During actual surgical procedures, clavicle fracture fragments and middle locking hole had stress superposition. If the titanium plate can avoid the stress concentration, it can effectively avoid the occurrence of the broken plate after implantation, provide theoretical guidance for clinical practice, and provide reference and technical route for biomechanical analysis of other types of titanium plate.

Objective To detect the mRNA expression of KPNA2 in hepatocellular carcinoma(HCC) tissue and to investigate its relationship with the clinicopathological features of HCC so as to provide the basis for predicting HCC infiltration ,metastasis and early treatment .Methods The HCC tissue and paracarcinoma normal tissue from 30 operative cases of HCC in the hepatobiliary surgery department of this hospital from January 2011 to November 2013 were collected and detected KPNA2 expression at the transcriptional level by RT-PCR .The correlation between the mRNA expression of KPNA2 with the clinicopathological factors of HCC was analyzed by consulting the medical record data .Results Among 30 cases of HCC ,the ratio of KPNA2 mRNA in the HCC tissue and the paracarcinoma normal tissue in 25 cases(83 .33% ) was up-regulated (grey value >2 times) .Therefore ,the KP-NA2 gene exhibited the high expression in the HCC tissue and low expression in the paracarcinoma normal tissue .Conclusion KP-NA2 is highly expressed in the HCC tissue and lowly expressed in the paracarcinoma normal tissue ;the high expression of KPNA2 is positively correlated with the stage and pathological grading of HCC ;KPNA2 may be used as an important indicator for early di-agnosing HCC and judging the malignant degree and potential metastais ability of HCC .

Objective To evaluate the results of endovascular intervention for infrapopliteal arterial occlusion in 40 patients. Methods There were 41 affected limbs in these 40 patients receiving 44 times of endovascular intervention for infrapopliteal arterial occlusion during Nov. 2006 and Dec. 2007. The average age was 76±6. The ABI(ankle brachial index)before intervention was 0.39±0.20 in anterior tibial artery and 0.39±0.23 in posterior tibial artery. CLI (critical limb ischemia) was 80.49% (33/41). Results The after intervention ABI increased by 0.43±0.22 (P<0.01) in anterior tibial artery and 0.43±0.25(P<0.01)in posterior tibial artery. 35 patients (36 limbs) were followed-up for (6±3) months. The limbs of Fontaine Ⅰ and Fontaine Ⅱ A were 28 (77.78%), CLI decreased to 19.44% (7/36) (P<0.01). At follow-up the ABI in anterior tibial artery was 0.63±0.22 and 0.56±0.22 in posterior tibial artery. The difference were all significant when compared with that before intervention and after intervention. The perioperative amputation rate was 0. The perioperative mortality rate was 2.5%. The total mortality rate was 15%. The limb salvage rate were 100%. Conclusion The effect of endovascular intervention for infrapopliteal arterial occlusion is satisfactory.

Objective To study the relationship between polymorphisms of E-selectin gene and ischemic stroke (IS) in Zhuang nationality of Guangxi province. Methods The G98T polymorphism in the exon 2 and the S128R polymorphism in the exon 4 of E-selectin gene were detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis and DNA sequencing among 205 patients with IS of Zhuang nationality in Guangxi and 210 healthy controls. The serum level of E-selectin was determined by enzyme-linked immunosorbent assay (ELISA). Results IS group showed significantly higher serum levels of E-selectin than control group (P0.05). Conclusion E-selectin S128R polymorphism was associated with IS, and R allele may be a genetic risk factor of IS among Guangxi Zhuang natioalities, in whom the E-selectin SR genotype carriers maybe increase the risk of ischemic stroke by enhancing the E-selectin expression.

Modern medical staff are facing the challenge to survive in competitions and develop through cooperation.Thus it is of great importance for the future medical staff,that is,medical students to cultivate and enhance their teamwork for future demand.Cultivating approaches mainly include creating a collaborative environment,carrying out cooperative scientific research,creating teamwork in the curriculum,and launching community service activities.

OBJECTIVE: To evaluate the efficacy of endoscopic minitrephination combined with endoscopic frontal sinusotomy in the management of complex chronic frontal sinusitis. METHOD: Twenty-six patients suffering from chronic frontal sinusitis with complex frontal drainage approach were analyzed. Eleven patients (13 sides) received endoscopic minitrephination combined with endoscopic frontal sinusotomy, while the other 15 patients (18 sides) received endoscopic frontal sinusotomy only. Postoperatively all cases were followed up to evaluate the efficacy. RESULT: The ostia of frontal sinus were successfully opened in the group of patients received endoscopic minitrephination combined with endoscopic frontal sinusotomy without any complications. In the endoscopic frontal sinusotomy only group, three cases of complications were observed, one with the injury of anterior ethmoidal artery and the other two with the injury of papyraceous lamina. After 10 to 24 months of follow up postoperatively, the symptoms were relieved in all cases without recurrence. The combined surgery group with endoscopic minitrephination showed an endoscopic frontal sinus patency rate of 85%, and the endoscopic frontal sinusotomy only group exhibited an endoscopic frontal sinus patency rate of 83%. CONCLUSION Endoscopic minitrephination combined with endoscopic frontal sinusotomy is a simple, convenient, safe and effective method for management of complex chronic frontal sinusitis.
Adult ; Endoscopy ; Female ; Follow-Up Studies ; Frontal Sinus ; surgery ; Humans ; Male ; Middle Aged ; Nose ; surgery ; Retrospective Studies ; Trephining ; methods ; Young Adult

Clavicular crook plate is designed based on anatomic features of acromioclavicular joint,which matches clavicle appearance,and well attaches the shaft.Not passing through the joint,the internal fixation exhibits many advantages,such as convenient usage,reliable fixation and micromovement of fixed acromioclavicular joint.So the patients could move the joint early and avoid osteoarthritis.Allogenous tendon has abundant sources,simple sampling process,and short repairing duration and can reduce injury to patients.Cryopreserved allogenous tendon has low antigenicity and immunological refection,good histocompatibility.Reconstructed coracoclavicular ligament by allogenous tendon has good material intensity,and can meet the requirements of local stress,better substitute integrity and function of coracoclavicular ligament.Moreover,it has precise effect and simple operation.It acts as long-term fixator following plate removal,thus is important supplement of clavicular crook plate fixation.Clavicular crook plate fixation in combination with allogenous tendon transplantation reconstructs acromioclavicular joint stability,effectively provides early mechanical stability and subsequent biological stability,and maximizes restoration of acromioclavicular joint structure and function.