In order to accelerate the comprehensive reform of clinical education,the Ministry of Education and the Ministry of Health decided to implement the program of excellent doctor education training plan in 2012.On the basis of the plan,taking a certain medical college as an example,on the problems such as lack of teachers,unreasonable age structure,the lack of advanced experimental technology and comprehensive talents and the lack of innovation and enterprising spirit and so on,the author puts forward some proposals from the development of experimental teaching,the teachers' personal and professional growth and the institutional and policy level,such as strengthening the foreign exchange,making learning training plan and personal development planning,establishing the evaluation system of the experiment teaching quality and opening up a variety of learning methods to improve the teachers' comprehensive ability.

BACKGROUND:The characteristics of condylar morphology should be first understood in patients with unilateral cleft lip and palate. OBJECTIVE:To investigate the bilateral condylar morphology in adult patients with unilateral cleft lip and palate. METHODS:This study included 25 patients with unilateral cleft lip and palate (study group), and 25 normal volunteers (control group). The upper condylar height, ramal height, condylar height and condylar width were measured on panoramic radiographs. The ratio of the upper condylar height to the ramal height and the ratio of the condylar height to the condylar width were calculated. RESULTS AND CONCLUSION:Compared with the control group, upper condylar height, condylar width, condylar height and the ratio of the upper condylar height to the ramal height were reduced in the study group between the normal and affected sides (P<0.05). Moreover, significant differences in condylar morphology were detected between the two groups. No significant difference in ramal height and the ratio of the condylar height to the condylar width was detected between the two groups (P>0.05). No significant difference in upper condylar height, ramal height, condylar width, condylar height, the ratio of the upper condylar height to the ramal height, the ratio of the condylar height to the condylar width, and condylar morphology was detectable between the normal and affected sides in the experimental group (P>0.05). These data show that adult patients with unilateral cleft lip and palate presented short condylar process and narrow neck, and the condylar process is shorter than ramus, which provides clinical evidence for patients with unilateral cleft lip and palate.

Objective To improve the recognition and diagnosis of pseudohypoparathyroidism (PHP). Methods Six subjects with PHP of 4 generations in one family were investigated and studied. There were 4 males (including 2 deaths) and 2 females. The age of 4 surviving patients was from 8 to 55 years. All cases were proved by clinical biochemistry tests. Plain film of hands and head CT scans were performed in 2 selected patients. Results The somatotype of Albright hereditary osteodystrophy (AHO) and short fingers and toes were found in all cases. Radiologic features were as follows:(1)short metacarpals and phalanges.(2)skull thickening and symmetrical calcification of basal ganglia. Conclusion The diagnosis of PHP can be established by close combination of radiologic findings and clinical manifestations.

Objective To summarize the experience of diagnosis,treatment and clinical effects of Ni-Ti shape memory alloy embracing fixator for severe chest trauma complicated with multiple rib frac-tures.Methods From January 2009 to June 2013,the clinical data of 148 cases with embracing fixator and 47 cases with non-internal fixation were retrospectively analyzed and compared.Results Internal fix-ation was superior to non-internal fixation in hospital stay,pain perception,mechanical ventilation time, pulmonary function recovery and complications(P<0.05).Conclusion Ni-Ti shape memory alloy em-bracing fixator is better than other conservative therapies in the treatment of multiple rib fractures and it's worthy of spreading.

Currently, saliva tests have been regarded as a potential promising diagnotic tool because of its noninvasiveness, quickness and simplicity, high accuracy, fullness of biomarkers, and other advantages. It has been applied in clinical diagnosis, treatment evaluation, epidemiological survey and other clinical works, while its potential applications have not yet been fully recognized by Chinese pediatrician. This review presents an overview on the application of salivary diagnostics in pediatrics ophthalmology and otorhinolaryngology, immune system diseases, nervous-mental system diseases and other system diseases, and offers a new potential research strategy for accurate diagnosis and treatment of pediatric diseases.

Objective:To compare and analyse the clinical outcome, advantages and disadvantages of submental artery island flap (SAIF) and free anterolateral thigh flap (ALTF) in the repair and reconstruction of tongue after radical surgery of tongue cancer.Methods:From January, 2016 to December, 2018, a total of 40 patients received tongue repair and reconstruction with either SAIF or ALTF after radical resection of tongue cancer. There were 28 males and 12 females, with an average age of 51 years old. Eighteen patients received tongue repair and reconstruction with SAIF and 22 with ALTF. Postoperative follow-up were carried out and the clinical data were collected. Swallowing, speech and softness of the tongue between the 2 repair methods were compared and statistically analysed. P<0.05 indicated a significant statistical difference between 2 groups. Results:All flaps survived. One ALTF had a venous vascular crisis. The flap survived after the removal of thrombus at the anastomotic site. Functional recovery of tongue was analysed after the follow-up of 12-48 months. It was found that there was no significant difference in speech function between the 2 groups (SAIF vs ALTF: 13 vs 15, P=0.206). The swallowing dysfunction in SAIF group was significantly higher than that of the ALTF group (SAIF vs ALTF: 15 vs 7, P=0.014). Moreover, the average time of surgery in SAIF group (3.5 h) was significantly less than that of the ALTF group (6.8 h), which had statistically significance ( P<0.05). Conclusion:The SAIF and ALTF are ideal flaps for repairing the tongue defect caused by tongue cancer surgery. SAIF features a simple surgical procedure and a short time for flap taking. ALTF provides sufficient amount of tissue to cover the scars left by the surgery, reduce donor site complications, and benefit the recovery of swallowing and speech functions.

Objective To evaluate the effects and safety of uterine artery embolization for uterine leiomyoma. Methods Total of 185 patients with uterine leiomyoma were treated by UAE. They were followed for one to 6 years to observe the changes of leiomyoma size and improvement in clinical symptoms. Ovarian function was evaluated in 44 cases. Results Bilateral embolization of uterine arteries was performed in 185 patients. Follow-up of 1 ～6 years for 292 leiomyoma indicated that one to 9 months after embolization, shrinkage of leiomyoma size was the most significant factor. One year after embolization, leiomyoma sizes decreased a little. Shrinkage of submucous leiomyoma was more significant than that of intratumoral one, and the latter was more significant than subserous one. Shrinkage of leiomyoma with large size ( volume ≥ 150cm~3) was less than that of small one. Menorrhagia, anemia and pressure symptoms were all resolved. There was no significant difference between pre- and post embolization ovarian hormone level. Conclusions The significant reduction in leiomyoma volume and resolution of clinical symptoms confirmed that the treatment validity of symptomatic leiomyomas by UAE. UAE is an effective therapeutic procedure which has no adverse effect on the ovarian function.

Objective To investigate the effect of orthodontic tooth extraction and non-extraction on dental arch width and esthetical smile. Methods 100 patients treated without extraction and 100 patients treated by 4 first-premolars extraction were selected. The study models of the patients were measured before and after the treatment and compared statistically. Measurements were made in the maxillary and mandibular canine regions from the most labial aspect of the buccal axial surfaces of the canine roots. Results Before treatment, maxillary and mandibular arch widths were the same between both groups (P＞0.05). In non-extraction group, mandibular arch width of posttreatment was 0.88 mm larger than that of pretreatment (P＜0.001), and maxillary arch width of posttreatment was 0.84 mm large (P＜0.001). In extraction group, mandibular arch width of posttreatment was 1.64 mm larger than that of pretreatment (P＜0.001), and maxillary arch width of posttreatment was 1.50 mm large (P＜0.001). After treatment, the width of mandibular arch in the extraction group was 0.59 mm larger than that in the non-extraction group (P>0.05), while the width of maxillary arch in the extraction group was 0.10 mm less (P>0.05).Conclusion Both extraction treatment and non-extraction treatment do not result in narrower dental arch, but wider. The view that orthodontic extraction results in narrower arch widths and unaesthetic smiling is untenable.

Objective To investigate the the treatment of class Ⅲ malocclusion by orthognathic surgery combined with postoperative orthodontics.Methods Nine patients with skeletal class Ⅲ malocclusion were treated by surgery-first approach without pre-surgical orthodontic from January 2012 to August 2014.The studied sample consisted of 7 women and 2 men (aged 15-28 years old, mean age 19.7 years), who had obvious mandibular protrusion.2 to 3 days after surgery, intermaxillary traction was used to made the maxilla and mandible together by board;we replaced a rubber band every 2 to 3 days and lasted for four weeks.We would dismantle board and performed conventional orthodontic treatment after patient's facial swelling subsided, and the positional relationship between the jaw stabilized.Results The face type of 9 patients were greatly improved after orthodontic treatment for 6.5 to 19.5 months.Patients and their family members felt satisfied, and their occlusal function returned to normal.At 3 to 32 months follow-up, the postoperative appearance and occlusion were becoming good without obvious signs of recurrence.Conclusions The surgery-first approach is an effective method to treat skeletal class Ⅲ malocclusion.

Objective To investigate the signal pathway of platelet activation in acute respiratory distress syndrome (ARDS). Methods Thirty healthy Sprague-Dawley (SD) rats were randomly divided into control group (n = 6) and model group (n = 24). The model of ARDS was reproduced by intravenous injection of oleic acid (0.25 mL/kg), and the rats in control group were injected with the same amount of normal saline. The blood of abdominal aorta was collected at 2, 6, 24, and 72 hours after model reproduction, the platelets were separated, and c-Jun N-terminal kinase phosphorylation (pJNK) levels which was one of major protein kinases in the mitogen-activated protein kinases (MAPKs) signal pathway was determined by Western Blot. The rats were sacrificed, the lung tissues were harvested, and lung coefficient (lung weight/body weight ×100%) and lung wet/dry (W/D) ratio were calculated. Pathological changes in the lung tissue were observed with hematoxylin-eosin (HE) staining in light microscope. Results Comp ared with the control group, platelet pJNK level in ARDS model group was significantly increased at 2 hours after model reproduction (gray value: 0.72±0.09 vs. 0.22±0.01), and peaked at 6 hours (gray value: 0.91±0.03 vs. 0.22±0.01), then it was decreased gradually. It was also significantly higher than that of control group till 72 hours after model reproduction (gray value: 0.39±0.06 vs. 0.22±0.01, all P < 0.05). Lung coefficient and lung W/D ratio in ARDS model group were significantly increased at 2 hours after model reproduction as compared with those of control group [(1.30±0.20)% vs. (0.60±0.10)%, 6.00±0.60 vs. 3.30±0.30], then they were decreased gradually. They were also significantly higher than those of control group till 72 hours after model reproduction [(0.90±0.10)% vs. (0.60±0.10)%, 4.80±0.70 vs. 3.30±0.30, all P < 0.05]. It was showed by light microscopy that lung tissue of rats in the control group had no significant pathological changes. At 2 hours after model reproduction in model group, clearly visible alveolar edema and interstitial edema, interstitial lung infiltration of inflammatory cells, small blood vessels dilation and congestion were found, and the re were a lot of protein exudates. The lesions of lung peaked at 24 hours. At 72 hours, absorption of most of fluid leaking in alveolar, alveolar space narrow, alveolar septum thickening, the reduction of inflammatory cells infiltration, fibrous tissue proliferation, and micro thrombosis formation were found. Conclusion In ARDS, in addition to pathological changes in the lung tissue, platelet activation occurs, and its activation process is related to the priming of JNK signal transduction pathways.