Objective To introduce a new flap of cutaneous branches of posterior tibial artery on the part of superior medial malleolus to repair soft tissues defect on the feet and the ankles Methods From October 1997 to December 2001,a flap with the pedicle called cutaneous branches of posterior tibial artery on the part of superior medial malleolus were used to repair 11 cases which suffered skin and soft tissue defect on the feet and the ankles due to various trauma Results The flaps were survived completely on 10 cases and the flaps distal had about 2 cm necrosis on 1 case,the size of the flap ranged from 28 cn?11 cm to 8 cm?6 cm,all of the 11 cases were evaluated as satisfactory after 6 months to 2 years follow-up Conclusions The new procedure can repair mostly soft tissue defect on the foot and the ankle and does not sacrifice the major arteries. The flap is easy to be performed,and it is an safety and ideal method.

Objective To observe the clinical efficacy of yang-supplementing moxibustion in treating cancer-induced fatigue of yang-deficiency type. Method Seventy-five patients with cancer-induced fatigue of yang-deficiency type were randomized into 3 groups by using random number table: yang-supplementing fire moxibustion group, fire therapy group, and a conventional control group, 25 patients in each group. The improvements of fatigue, quality of life and traditional Chinese medicine (TCM) syndrome were observed. Result The three treatment protocols were all effective in improving fatigue, quality of life and TCM syndrome, and the effects of yang-supplementing fire moxibustion were more significant than the other two treatments, and that of fire therapy group was superior to that of the conventional control group. Conclusion Yang-supplementing fire moxibustion can effectively improve fatigue, yang-deficiency symptoms, and the quality of life in cancer-induced fatigue of yang-deficiency type.

Objective To explore the risk factors of newly emerging advanced schistosomiasis patients in endemic areas.Methods The study areas were selected in two counties of Dongting Lake regions and a 1 :2 match case-control study was designed.Sixty schistosomiasis patients,who newly evolved into advanced schistosomiasis from 2006 to 2007,were selected into the case group,and 120 cases with chronic schistosomiasis into the control group.Questionnaires including potential risk factors of advanced schistosomiasis were designed and the information was collected based on face to face interviews.SPSS 12.0 was used to analyze the simple factors and multi ones (logistic regression) attributable to the development of advanced schistosomiasis.Results The history of hepatitis B (OR = 10.729),models of water contact (OR = 3.919) ,yearly exposure days to the infested water (OR = 5.457) and times of chemotherapy in the nearly 10 years(OR = 1.578) were the risk factors of development of advanced schistosomiasis.The times of examinations with positive schistosome eggs were protective factors.No association was found between yearly income,education degree,times of checking for schistosomiasis,times of examination with sera positive results and the emergence of advanced schistosomiasis.Conclusion The high frequency of exposure to the infested water,repeated infections,incomplete diagnosis and treatment are the risk factors of advanced schistosomiasis.The concurrent infection with hepatitis B is associated with the acceleration of development of advanced schistosomiasis.

Abnormal metabolism in vivo of uric acid leads to many diseases.Recent discovery shows that glucose transporter-like protein-9,which belongs to glucose transporter family not only transports glucose,but also plays an important role in the process of uric acid transport,which is also affected by pH,glucose,estrogen,etc.The variation of glucose transporter-like protein-9 results in metabolic diseases.Therefore,the study of glucose transporterlike protein-9 in uric acid transport and related drug will provide new ideas to control the development of hyperuricemia and related cardiovascular disease.

PBL (Problem-based learning) is a kind of teaching method, which is helpful for guiding students to solve practical and complex problems. The compiling of PBL teaching plans is the key to the implementation of PBL teaching. According to the teaching outline of internal medicine, we set the PBL teaching plan, formulated the teaching goal, collected the clinical real cases, finished the compiling of PBL cases of student version and teacher version, and preceded teaching practice accord-ing to the PBL cases. Improving and constructing the compiling framework of internal medicine PBL teaching plan laid the theoretical foundation for carrying out internal medicine PBL teaching.

aration caused by varieties of violence does not catch the attention of domestic orthopedic surgeons enough in the past years.This passage is to discuss the damage mechanism,clinical treatment and prognosis evaluation of this kind of injury through the analysis of the case of Logsplitter injury.Methods Retrospective analysis 23 patients of Logsplitter injury from December 2006 to December 2014,male in 17 cases,female in 6 cases,average age (43.68±12.67) years (21-60 years).Hurt injury in 9 cases,sports injury in 1 case,falling injury in 2 cases,traffic injuries in 10 cases,crushing injury in 1 case.Open injures in 10 cases,of which the Gustilo Ⅱ type in 7 cases,Gustilo Ⅲ A type or above in 3 cases,closed injuries in 13 cases.According to the AO/OTA fracture classification,44c type in 19 cases,44b type in 3 cases,44a type in 1 case.Fibula fractures in 22 cases,19 cases of medial malleolus fracture.Results 23 patients received follow-up,with an average period was (0.91±0.26) years (0.4-2.37 years).21 cases underwent open reduction internal fixation (ORIF),2 cases underwent closed reduction external fixation and K-wire fixation.17 cases were fixed with the syndesmosis screws,among them,1 screw was used to fix 14 cases,two screws were used to fix 3 cases;the utilization rate of 3.5 mm screws is higher,at 94.1％,and all screws were entered through 3 layers of cortical;Combined with medial malleolus fracture cases were fixed with cannulated screws/K-wire internal fixation.Average healing time of the skin surrounding the ankle skin was (2.26±1.91) weeks;average healing time of fracture was (15.34±5.13) weeks;Joint pain ocurred combined with joint space narrowing after loading in 18 cases,at 78.3％;Postoperative infection,2 cases,the proportion was 8.7％;Fracture delayed union 1 case.Functional examination of the ankle joint (angle measurement method):Dorsiflexion average angle (23.9±2.21)degrees,Plantar flexion average angle (32.1 ±4.13) degrees.Average angle of introversion was (23.91 ±2.24) degrees.Hallux valgus average angle (27.6±3.81) degrees.75 points and over were got in AOFAS in 21 cases,the ratio of excellent was 91.3％.Conclusion Logsplitter injury represents a kind of important and unique ankle fracture,dislocation and the inferior tibiofibular syndesmosis separation caused by varieties of violence,accompany with potentially soft tissue injury and platford injury,according to existing treatment principle and treatment strategy summarizied by us,the clinical therapeutic effect of this damage is ideal,functional recovery is relatively satisfactory prognosis.

Objective To evaluate the reproducibility of normal liver ADC measurements by different respiratory motion compensation techniques. Methods A total of 31 young healthy volunteers who are 20 to 40 years old without any hepatic diseases were selected to research. Each volunteer underwent liver DWI twice in 24 hours with the same parameters and location. The imaging was performed with free-breath(FB), breathhold(BH), rspiratory-triggered(RT)and navigator-triggered(NT)techniques, and the ADC values of the left hepatic lobe and right hepatic lobe (upper, middle and lower) was acquired with two scans. Analysis the the ADC values of various anatomic locations of liver with two-way analysis of variance of randomized block design. Reproducibility of ADCs was assessed with the Bland-Altman method. Analysis of variance and paired-sample t test was used to assess ADCs from both right and left liver lobe among the four techniques. Result The ADC values acquired from the four techniques were significant differences (P<0.01),and the ADC values of the right lobe were less than the left lobe's(P<0.01). It showed a trend to decrease moving from superior to inferior levels in both left and right lobes, and the ADC values among The middle and lower were significant differences (P<0.01). The limit of agreement of ADC of twice imaging among the four techniques were as follow: the right lobe was less than the left lobes, and the breathhold was less the others. As the result, reproducibility in the right liver lobe was better to that in the left and the reproducibility with breathhold was better than the other respiratory motion compensation techniques. Conclusions Both anatomic location and DWI technique influence the liver ADC measurements and their reproducibility. The reproducibility of BH is the best.

Objective To investigate the independent echocardiographic pathogenesis associated with left atrial spontaneous echo contrast(SEC) formation in patients with atrial fibrillation(AF).Methods Twenty-one patients with valvular AF and twenty-three patients with nonvalvular AF undergoing transthoracic and transesophageal echocardiography(TTE/TEE) were studied.Morphological and functional parameters of the heart in patients with AF were detected by TTE,while the sizes of the left atrial appendage(LAA),its Doppler flow patterns,Doppler flow patterns of the left upper pulmonary vein and integrated backscatter(IBS) values of left atrial SEC relative to those of the left ventricle were measured by TEE.Results There were the following 10 variables significantly associated with the left atrial SEC,some of which associated positively with SEC were left atrial diameter(r=(0.40252),P=(0.0061)),diameter of the open mouth of LAA to the left atrium(r=(0.37816),P=(0.0161)),while the others of which associated negatively with SEC were antegrade/retrograde blood flow velocity peak,integrate(RVi) and retrograde blood flow velocity mean(RVm) values,and S/D wave peak,S wave integrate(Is) and D wave mean(Md) values,their r values ranged from(-0.40379) to(-0.32832),their P values between(0.0018) and(0.0386).Collinearity analyses suggested that RVi,RVm,Is,Md represented completely all the blood flow velocity parameters of LAA and the left upper pulmonary vein,respectively.Multivariate analyses demonstrated that RVm and Md were the independent predictors of the left atrial SEC in patients with AF(both P

The improvement of diagnostics teaching system,including the establishment of curriculum system and evaluation system,is the base of promoting clinical- medicine teaching.Our study showed that the theoretical knowledge and clinical skill of medical students could be improved by constructing clinical diagnostics curriculum system and improving organization management and assessment system,which could pave the way for the transition from medical students to clinicians.

Objective To investigate the renal pelvic pressure(RPP) during minimally invasivepereutaneous nephrolithotomy(MPCNL),and inspect its influence to postoperative fever. MethodsThe RPP was measured by baroeeptor,and these data about pressure and postoperative fever wereevaluated statistically. Results The mean RPP was 14.72 mm Hg,the mean accumulative time of RPP≥30 mm Hg was 116.06 s. Fifteen cases(18. 75%)had a postoperative fever. Logistical analysissuggested that postoperative fever did not correlate to sex(P=0.195),age(P=0.641),urinary tractinfection (P=0.663),white blood cell≥10 × 109/L in blood routine examination postoperatively (P=0.751),once an occurrence of RPP≥40 mm Hg(P=0.662),while infection calculi (P=0.000),percutaneous tract size(P=0.029),mean RPP(P=0.036) ,mean RPP≥20 mm Hg(P=0.013),accumulative time of RPP≥30 mm Hg(P=0.010) and RPP≥30 mm Hg longer than 50 s(P=0.024)contributed to postoperative fever. Conclusions Renal pelvic pressure generally remains lower than alevel to back flow (30 mm Hg) during MPCNL. A transient renal pelvic pressure≥30 mm Hg don'tcountribute to postoperative fever,while a temporary high pressure status(50 s)would had an accumulated effect which means an enough back flow to bring a fever.