From his own experience the author has introduced the feature of the internal medicine residency training in USA and suggested popularizing and standardizing residency training in our country, modifying the distribution mechanism for residency training graduates so as to narrow down the quality gap between the doctors in urban and rural area and improve the availability of high quality health care for all citizens.

OBJECTIVETo investigate the reconstruction of thumb II-III degree defect by big toe wrap-around flap combined with second toe proximal interphalangeal joint.

METHODSBetween May 2004 to July 2012, 25 cases with thumbs II-III degree defects were treated. The ipsilateral big toe wrap-around flap combined with second toe proximal interphalangeal joint was designed to reconstruct the thumb defects based on the thumb size on the healthy side. The distal end of hallux was covered by flap at tibial side. The wound at the fibula side was covered by skin graft and flap. The bone defect at the second toe was filled with remnant hallux or iliac bone.

RESULTSAll the 25 reconstructed thumbs survived completely. The patients were followed up for 6-26 months without any joint degeneration. According to the finger reconstruction functional criterion publicized by China Medical Association, the finger function was assessed as excellent in 10 case, good in 11 cases, poor in 4 cases. Joint necrosis happened in 2 cases and bone malunion in 2 cases. The 4 cases received dead bone debridement and iliac bone graft. No malfunction occurred in the donor site.

CONCLUSIONSOur surgical method is a currently effective way to reconstruct II-III degree thumb defects. Satisfactory functional and cosmetic results can be achieved both in donor site and recipient site.

Aged ; Bone Transplantation ; methods ; China ; Hallux ; Humans ; Ilium ; transplantation ; Necrosis ; etiology ; Postoperative Complications ; pathology ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; methods ; Surgical Flaps ; Thumb ; surgery ; Toes

Objective To investigate the anatomic landmarks during the exposure of thalamus via the transcorpus callosal ventricle approach between microscope and endoscope to provide an anatomic foundation for clinical application. Methods The transcorpus callosal ventricle approach to expose the thalamus was simulated in selected 6 (12 sides) red and blue latex-perfused cadaver head specimens. The anatomic structures of four stages-interhemispheric, septum pellu?cidum cavity, lateral ventricle and third ventricle were examined by microscope and endoscope and relevant anatomic date was obtained during the process. Results Both microscope and endoscope could show the anatomic structures clear?ly during the interhemispheric and septum pellucidum cavity stages. The major landmarks of the interhemispheric cavity included callosal margin artery, cingulate sulcus, pericallosal artery and corpus callosum, and landmarks of septum pellu?cidum cavity included the septum pellucidum and body of fornix. Lateral ventricle stage-the major landmarks contained foramen of monro, septum vein, thalamus striatum vein, choroid plexus, body of fornix and body of caudate nucleus. The blind field under microscope such as anterior part of frontal horn (25.7mm±1.7mm vs. 14.2mm±1.2mm, P<0.05), lateral part (1/3) (12.1mm ± 0.7mm vs. 7.0mm ± 0.9mm, P<0.05) and posterior part (2/5) (28.8mm ± 1.4mm vs. 18.7mm ± 1.4mm, P<0.05) of thalamus could be made up by endoscope. Third ventricle stage-neither microscope nor endoscope could show the medial part of thalamus effectively due to the restriction of fornix and internal cerebral vein. Conclusions The anatomic landmarks can be identified during the exposure of thalamus via the transcorpus callosal ventricle approach. The coordination of microscope and endoscope can be helpful to identify eloquent structures and make up blind surgical field.

Dendritic cells (DC) represent a heterogeneous cell population including many subsets. DC subpopulations with different characteristics and functions have been identified. The liver, as an immunological organ, is important in induction of immune tolerance. The unique anatomical architecture and immune properties of the liver have given DC the ability to maintain liver homeostasis and respond quickly to liver tissue damage. This article reviewed the role of hepatic DC subsets in the maintenance of tissue homeostasis and repair of damaged tissue in the liver.

This paper illustrates the immunology teaching reform of higher medical education to meet demands of the 21st century. The teaching reform includes cultivating students’humanities quality,scientific consciousness,ability to research and the following-up of immunology progress. According to the teaching practice and the results from the questionnaire,the new teaching model is better than traditional teaching model and is approved by the students.

OBJECTIVETo retrospectively investigate the effectiveness of sphenzygomatic suture as a guide in the reduction of zygomatic complex fracture.

METHODS55 cases of zygomatic complex fracture classified according to Zingg classification were treated, sphenozygomatic suture in group 1 (n = 36) was reduced first, then the other fracture line was reduced, in group 2 (n = 19), malar bone was reduced according to superficial fracture line. Patients were followed up for 4 weeks to 3 months, aesthetic result and X-ray symmetry were observed.

RESULTSAll patients in group 1 were restored with satisfactory facial contour, 35 cases got precise reduction, 5 cases in group 2 were asymmetry.

CONCLUSIONDuring open reduction of complex zygomatic fracture, sphenozygomatic suture should be reduced at first as a guide, so as to get precise zygomatic complex reconstruction and normal aesthetic outcome.

Adolescent ; Adult ; Cranial Sutures ; Female ; Follow-Up Studies ; Fracture Fixation ; methods ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sphenoid Bone ; surgery ; Zygoma ; surgery ; Zygomatic Fractures ; surgery

Objective To investigate the clinical characteristics of patients infected with human adenovirus type 7 and to provide guidance for early diagnosis and timely control of the outbreak.Methods A total of 301 patients infected with the human adenoviruses who were quarantined in hospital from December 2012 to February 2013 were observed.Epidemiological questionnaires were used to collect data of clinical features of the disease including symptoms,signs,images and laboratory tests.To confirm infection,real time polymerase chain reaction was performed using patients' swabs to detect viral nucleotide.Results Most cases happened in December to the next February.Totally 277 cases of the 301 patients were male,and only 24 cases were female.Mean age was (19.1±1.9) years old,range 15 to 29 years old.Identifiable epidemiologic links were seen between patients.The most common symptoms were fever (100.0％),cough (70.4％),expectoration (48.2％),and sore throat (47.8％).In addition,some patients presented with headache,dizziness,chills,fatigue.The most common signs were pharyngeal congestion (62.5％),enlargement of tonsils (56.5％) and lymphatic follicular hyperplasia (26.6％).Some patients' tonsil was covered with white secretions.Lung images were abnormal in 75 cases,which were presented with mild pneumonia with or without surrounding exudative lesions and pleural effusion in lung images.Laboratory tests showed that the number of white blood cells in the peripheral blood in most of the patients (99.0 ％) was elevated or normal.The proportions of neutrophils (54.2％) and monocytes (80.7％) and the level of C-reactive protein (42.2％) increased,while the proportion of lymphocytes reduced (67.1％).The average course of disease was (6.6±2.9) d.With the treatment of intravenous ribavirin and reduning,all patients were cured.Conclusions Human adenovirus type 7 is quite contagious and may cause epidemic outbreak,especially in winter.The majority exhibits mild symptoms of upper respiratory tract infection with short duration,including fever,cough,expectoration and sore throat.Through timely and active treatment,all patients have a good prognosis.

Objective To explore long-term effects of flow-restricted portal vein arterialization on hepatic function and structure in a rat model. Methods SD rats were divided into three groups to undergo respectively total portal vein arterialization ( PVA) , arterial inflow restricted portal vein arterialization (RPVA) ,and sham operation (SO). Postoperative portal blood flow and cross section after one month and six months, portal vein pressure, liver function and structure after six months were observed. Results The cross section and blood flow of the portal vein in PVA group consistently increased, serum ALT level was elevated after six months(F=7. 72,P