In the United States of America, the physician group practice has become one of the most common practice models, and has a relatively perfect and clear system of laws and regulations in its monitoring.In view of the policy side, the federal government has published the Stark Law to regulate the registration, properties, operation, service contents in details for the physician group practice.Taking the market side, it is practiced to protect the physician groups and medical practice behaviors through medical insurance policies.In China, the emergence of physician group has received widespread attention and concern.But since the short development time and unclear development path, the relevant laws and regulations for physician groups are still are not perfect.This paper aims to summarize the development and status quo of the American physician group as well as the regulations related to the groups` operating system, which will provide a good reference to China.The purpose is to provide policy recommendations for the standardized development and perfect regulations of physician groups in China.The following recommendations were put forward: improve the relevant laws and regulations;promote the establishment of the corresponding security policies;speed up and enhance the research and development of medical liability insurance;do continuous tracking and timely summarize practices.

Objective:The therapeutic methods and clinical efficacy of hallux varus were analyzed retrospectively, and further discussion was made to facilitate the selection of clinical treatment.Methods:The data of iatrogenic hallux varus patients who accepted surgery operation in Beijing Tongren Hospital from April 2002 to May 2012 were retrospectively analyzed. The conditions of the patients were researched comprehensively, using the following several ways to treat hallux varus deformity respectively: (1) soft tissue release(STR) combined with joint reconstruction of the lateral structure(JRLS); (2) reverse osteotomy(RO) combined with STR and JRLS; (3) metatarsophalangeal joint fusion(MJF); (4) interphalangeal joint fusion. JRLS mainly means hallux longus extensor partial tenodesis and extensor hallucis brevis tenodesis (EHBT). The hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA), and the forefoot scores of American Orthopedic Foot and Ankle Society (AOFAS) were compared before and after procedures. The patients’ satisfaction with postoperative outcomes was statistically analyzed (not satisfied, in general, satisfied, very satisfied). Measurement data with normal distribution were expressed as Mean±SD, and comparison before and after operation was performed by paired t-test. Results:A total of 37 patients (41 feet) with iatrogenic hallux varus were enrolled, including 2 male and female 35 cases, aged 20-77 years old. (1) Operation method: 7 feet of STR combined with JRLS, 20 feet in which RO, STR combined with JRLS, 12 feet with MJF, 2 feet with interphalangeal joint fusion. Involving hallux longus extensor partial tenodesis (3 feet), EHBT (19 feet). (2) Analysis of surgical effect: the mean follow-up was 18.1 months (range, 12.5-24.0 months). Depend on the last survey, X-ray analysis showed that IMA and HVA were significantly improved after operation [(6.19±2.67)° vs. (2.97±2.03)°; (8.43±1.72)° vs. (-11.50±4.37) °; all P<0.01]. The AOFAS score increased from 56.39±18.78 preoperatively to 81.73±6.10 postoperatively ( P<0.01). The satisfaction survey of 41 feet with operation showed that 2 feet were not satisfied, 5 were generally satisfied, 28 were satisfied and 6 were very satisfied, the satisfaction rate was 82.9% (34/41). Conclusions:MJF is a standard choice for the treatment for rigid hallux varus with joint destruction. According to the conditions of patients, if need to preserve metatarsophalangeal joint, the operation should be combined with RO and STR. Depend on conditions of varus and stiffness, the operation may focus on reverse osteotomy or soft tissue surgery. Lateral structure reconstruction of metatarsophalangeal joint by EHBT has little negative effect on the function of the hallux, easy to operate, and good effect.

Objective:The therapeutic methods and clinical efficacy of hallux varus were analyzed retrospectively, and further discussion was made to facilitate the selection of clinical treatment.Methods:The data of iatrogenic hallux varus patients who accepted surgery operation in Beijing Tongren Hospital from April 2002 to May 2012 were retrospectively analyzed. The conditions of the patients were researched comprehensively, using the following several ways to treat hallux varus deformity respectively: (1) soft tissue release(STR) combined with joint reconstruction of the lateral structure(JRLS); (2) reverse osteotomy(RO) combined with STR and JRLS; (3) metatarsophalangeal joint fusion(MJF); (4) interphalangeal joint fusion. JRLS mainly means hallux longus extensor partial tenodesis and extensor hallucis brevis tenodesis (EHBT). The hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA), and the forefoot scores of American Orthopedic Foot and Ankle Society (AOFAS) were compared before and after procedures. The patients’ satisfaction with postoperative outcomes was statistically analyzed (not satisfied, in general, satisfied, very satisfied). Measurement data with normal distribution were expressed as Mean±SD, and comparison before and after operation was performed by paired t-test. Results:A total of 37 patients (41 feet) with iatrogenic hallux varus were enrolled, including 2 male and female 35 cases, aged 20-77 years old. (1) Operation method: 7 feet of STR combined with JRLS, 20 feet in which RO, STR combined with JRLS, 12 feet with MJF, 2 feet with interphalangeal joint fusion. Involving hallux longus extensor partial tenodesis (3 feet), EHBT (19 feet). (2) Analysis of surgical effect: the mean follow-up was 18.1 months (range, 12.5-24.0 months). Depend on the last survey, X-ray analysis showed that IMA and HVA were significantly improved after operation [(6.19±2.67)° vs. (2.97±2.03)°; (8.43±1.72)° vs. (-11.50±4.37) °; all P<0.01]. The AOFAS score increased from 56.39±18.78 preoperatively to 81.73±6.10 postoperatively ( P<0.01). The satisfaction survey of 41 feet with operation showed that 2 feet were not satisfied, 5 were generally satisfied, 28 were satisfied and 6 were very satisfied, the satisfaction rate was 82.9% (34/41). Conclusions:MJF is a standard choice for the treatment for rigid hallux varus with joint destruction. According to the conditions of patients, if need to preserve metatarsophalangeal joint, the operation should be combined with RO and STR. Depend on conditions of varus and stiffness, the operation may focus on reverse osteotomy or soft tissue surgery. Lateral structure reconstruction of metatarsophalangeal joint by EHBT has little negative effect on the function of the hallux, easy to operate, and good effect.

L-tryptophan, one of the aromatic amino acids, is widely used in the fields of medicine, food and feed additives. The phosphoenolpyruvate-carbohydrate phosphotransferase system (PTS) plays an important role in glucose transport and phosphorylation in Escherichia coli. PTS-mediated regulation dominates the carbohydrates' uptake and metabolism in E. coli. We constructed L-tryptophan-producing bacteria containing two typical PTS mutations (ptsHIcrrglf⁻ glk⁺ and ptsG⁻) by Red homologous recombination system, and studied in 50 L jar fermenter using fed-batch fermentation. Both PTS system mutants had a great impact on the biomass (increasing 47.0% and 17.6%, respectively), L-tryptophan production (increasing 25.9% and 9.4%, respectively), glucose conversion rate (increasing 26.5% and 17.4%, respectively) and byproduct acetic acid generation (slightly increased and decreased，respectively).