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In response to calls of the state to share high quality medical resources with the primary levels for easier access of the local people to best medical care instead of pouring into tertiary hospitals in metropolitans, Xiamen city joined hands with Zhongshan Hospital of Fudan University to establish Xiamen Hospital affiliated to Zhongshan Hospital of Fudan University in an innovative model of " city-university cooperation and homogeneous management" . Open for full service in January 2018, the hospital is run by Zhongshan Hospital in a closed-type medical alliance, enjoying homogenous management in terms of administrative framework, quality of care, talent training and IT management. Thanks to this practice, the hospital has grown into one of the first pilot units of the national regional medical center program, rapidly upgrading medical service level of Xiamen city and its surrounding regions. This paper highlighted the practice of homogeneous management, and analyzed the challenges and solutions for references of building trans-regional closed-type medical alliances.
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How to promote rapid wound healing and reduce scar hyperplasia is an urgent problem to be solved in plastic surgery. Mesenchymal stem cells (MSCs) is a research hotspot in current cell therapy. The author reviewed the literature and summarized the mechanism of the MSCs effect on the macrophage. MSCs release multiple soluble cytokines, leading the polarization of anti-inflammatory type M2 cell which can reduce the inflammatory cytokines and promote tissue repair and regeneration.The writer concluded that the polarization effect of mesenchymal stem cells on macrophages provides a new therapeutic strategy and theoretical basis for solving the problem of wound healing.
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In recent years, the incidence of melanoma has increased rapidly worldwide. For the high malignancy and early metastasis of melanoma, many first-visit patients were diagnosed with distant metastasis and the tumor cannot be completely removed by surgery resection. Circulating melanoma cells are melanoma cells that enter the blood circulation from primary or metastatic lesions, playing an important role in tumor recurrence and metastasis. Previous studies have shown that testing for circulating melanoma cells by liquid biopsy can be used for early diagnosis, clinical staging, prognosis prediction and therapeutic evaluation, which have received extensive attention. This article reviewed the method of circulating melanoma cells detection and their related effects.
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Objective The vertical mammoplasty which improves the breast morphology and reduces the operative scar has become the first selection of breast reduction.However,the nipple-and-areola complex (NAC) had the risk of necrosis in those severe patients.In this report,we performed the vertical reduction mammoplasty based on Wu'ringer's horizontal septum to reduce the NAC necrosis possibility.Methods Typical Lejourmosque-dome design was performed.The inferior part of glandular tissue and the skin were excised.The NAC was elevated to normal position based on Wu'ringer's horizontal septum.The breast morphology was modified with vertical scar left.Results 79 patients were operated.4 patients had unilateral breast reduction.4 breasts had partial wound dehiscence.They were treated conservatively with topical dressing.No complete NAC necrosis occurred.Conclusions The vertical reduction mammoplasty based on Wu'ringer's horizontal septum is a safe and effective procedure.The NAC necrosis risk is reduced.This method deserves to be recommended.
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Objective To investigate the clinical efficacy of domestic terlipressin in the treatment of type II hepatorenal syndrome (HRS -II).Methods A total of 25 HRS -II patients admitted to our hospital from November 2011 to June 2014 were recruited into the treatment group,and 28 HRS -II patients treated with dopamine before 2011 were recruited into the control group.Patients in the treatment group were randomly divided into two subgroups:one subgroup (n =12)was given terlipressin once every 8 h,and the other subgroup (n =13) was given terlipressin once every 12 h.Both groups received albumin (Alb)infusion to expand the blood volume before treatment with terlip-ressin or dopamine,and the course of treatment was 7 days.The improvement in clinical symptoms,levels of blood urea nitrogen (BUN), serum creatinine and electrolytes,urine volume,changes in liver function,and ascites disappearance in the two groups before and after treat-ment were compared.Comparison of categorical data between the two groups was made by χ2 test,and comparison of continuous data was made by t test.Results Patients in the control group showed no obvious symptom relief,but those in the treatment group had varying de-grees of improvement in clinical symptoms.Neither group had significant changes in liver function and serum sodium level after treatment. The treatment group had significantly more patients whose ascites volume had decreased from large to medium than the control group (χ2 =5.705,P 0.05),whereas the urine volume showed significant difference after the treatment (t =15.534,P 0.05).Patients treated with terlipressin had mild and tolerable adverse reactions.Conclusion The domestic terlipressin combined with albumin infusion has good clinical efficacy and mild adverse effects in treating HRS -II.Its clinical application is highly recommended.
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Objective The vertical mammaplasty improves the breast morphology,and reduces the operative scar.However,the nipple-and-areola complex (NAC) has the risk of necrosis on those severe patients.In this report,we performed the vertical incision scar reduction mammaplasty based on Würinger's horizontal septum to reduce the NAC necrosis possibility.Methods Typical Lejour mosque-dome design was performed.The inferior part of glandular tissue and skin were excised.The NAC was elevated to normal position with medial-superior pedicle based on the horizontal septum.The breast morphology was modified with lateral and medial glandular pillar suturing using nonabsorbent thread.For reducing the vertical scar,the lower breast flap was thinned to induce the skin contraction.Results 27 patients with breast hypertrophy were operated from May 2009 to October 2012.1 patient had unilateral breast reduction,and 6 patients with 8 breasts had partial wound dehiscence.They were treated conservatively with topical dressings.No complete NAC necrosis occurred.Conclusions The vertical reduction mammaplasty based on Würinger's horizontal septum is a safe and effective approach,and the NAC necrosis possibility is reduced with this procedure.
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Objective To detect the feasibility of patients with specific behaviors in the facial trauma clinical teaching. Method 47 medical students were randomly divided into experimental group ( n = 22 ) and control group(n=25). Students from experimental group at least dealed with 5 ～ 10 facial trauma patients with specific behaviors, while specific behaviors patients in control group were not more than 2. Teaching results were compared. Results There was no significant difference in operation test scores between the two groups ( (84.68 ±3.41 ) vs ( 83.96 ± 3.46 ), P = 0. 476 ). Composite score of teachers in the experimental group was significantly higher than that in control group( (90.09 ± 5.69 ) vs (83.48 ± 5.19), P ＜ 0.01 ). The results of questionnaire survey showed that two in five self-assessment results were higher in the experimental group(P ＜ 0. 01 ). Conclusion Medical students are more appropriately involved in treating special behaviors patients, which can improve the overall quality of students. Teaching with special behaviors patients has good effect, and is feasible.
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Objective With the social and economic advancement, the morbidity of breast hypertrophy is increasing. Inverted T technique was the traditional breast reduction mammaplasty method. It left severe scar after operation. The aim of this study was to introduce our experience about breast reduction with pure liposuction that significantly reduced the operative scar after operation. Methods After using tumescent anesthesia, a small incision about 5 mm was performed at inframammary fold for proper selected patients, The entire breast and subcutaneous fat were thoroughly suctioned with small caliber cannulas for breast reduction. No surgical excision was applied. Compression garment was applied after the operation. Results A total of 11 patients were successfully treated. Only one patient had a unilateral seroma that was responded to multiple aspiration. All the patients were satisfied with the results. The morphology was good. The texture of the breast was improved. Conclusion Reduction mammaplasty with pure liposuction is simple and effective for those who had mild to moderate breast hypertrophy with no severe ptosis and more fatty tissue. The scar is invisible. It deserves to be recommended.
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Objective To introduce the clinical manifestations and treatment methods of concealed penis, which is relative rare in plastic surgery. Methods Vertical preputiotomy was performed. The hypoplastic tissuely was excised. After that, there was no prepuce redundant, so that no prepuce excision was needed. Results 7 patients were treated. All were satisfied with the results. Conclusion Concealed penis should be distinguished from phimosis. Circumcision should be avoided in concealed penis patient.
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Purpose To introduce our experience about the skin-sparing mastectomy and immediate breast reconstruction using transverse rectus abdominis myocutaneous flap(TRAM). Methods For early stage breast cancer,we preserved the breast skin,performed the subcutaneous glandular excision and axillary dissection,immediately reconstructed the breast using TRAM flap. Results 9 patients were treated by skin-sparing mastectomy and immediate TRAM breast reconstruction.The morphology of reconstructed breasts was excellent. Conclusions The skin-sparing mastectomy and immediate TRAM breast reconstruction is safe and effective for treating early stage breast cancer.The incision is relative small and more aesthestic.