ObjectiveTo report the clinic result of bone and skin defects of forefoot and defects of forefoot treated by allograft and complex flap of crural artery with nerve and periosteum. Methods Allograft and complex flap with periosteum of tibien were used to repair bone and skin defects of forefoot in 9 cases ,in which the defects of forefeet were reconstructed by sequential connection with the complex flaps of tibialis posterior artery with saphenous nerve and periosteum in 2 cases. Results Six cases were survived completely;distal part in surface layer of flaps were necrosis partly in 3 cases and healed by dressing. After operation ,the repaired bone and joint showed normal position and recovered arcus pedis transversalis and arcus pedis longitudinalis by X-ray films. The patients were followedup from 3 months to 3 years,all grafted allograft had showed bone union and hadnt showed complications such as absorption,infection and repulsion. The injuried foot was restored its weight-bearing and walking functions and obtained a satisfactory contour. After operation,sensory recovery of foot occurred about 2 months. ConclusionUsed allograft is easy to do and recover arcus plantaris. The reverse complex flaps of tibialis anterior artery with periosteum have advantages as follow :the advoidance of influencing blood supply of injuried foot ,advancing symphysis ,short treatment course,simply procedure ,walking functions recovered ,good appearance and sensation.

Objective To study the blood_flow_activating and blood_stasis_removi ng actions of Qushang Tablet (QT) and its safety. Methods Thirty rats were randomly allocated to Group A (normal control), Group B (models control) and G r oup C (treated with QT). Rat models with traumatic blood_stasis syndrome were in duc ed by the bruise of falling iron hammer. Effects of QT on blood rheology of rat model were studied. Acute and chronic toxic effect of QT was also studied. Res ults QT had obvious effect on blood rheology of rat model and could improve th e concentration, viscosity, aggregation and coagulability of blood. No acute and chronic toxic effect of QT was found. Conclusion QT exerts obvious blood_fl ow_activating and blood_stasis_removing actions and is safe to be applied in cli nic.

ive] To explore a new method of evaluating the healing of fractures. [Methods] Self-con trolled trial was applied. Bone mineral density ( BMD) of fracture end (region 3, R 3 ) and its neighboring proximal and distal regions ( R 2 and R 1 respectively) in 126 cases of fracture of lower end of radius was deter mined by dual-energy X-ray absorptionmetry. [Results] BMD of R3 elevated as compared with that of R 2 and R1 (P

Objective To investigate the effects of bedside blinding method of active indwelling of nasojejunal tube combined with the nasogastric tube gastrointestinal decompression for patients with severe stroke.Methods 50 patients with severe stroke were selected and divided into two groups by using random number tables,which are the observation group and the control group,with 25 cases in each group.The patients in the observation group were treated with bedside blinding method of active indwelling of nasojejunal tube combined with the nasogastric tube gastrointestinal decompression,while the patients in the control group simply received bedside indwelling of nasogastric tube.The enteral nutritional goal -rate of target feeding volume on the 7th day and the 14th day after admission and trace the incidence of gastric stasis,the reflux and aspiration,the aspiration pneumonia in the patients of the two groups within 14 days and the situation of the days of mechanical ventilation,the days in ICU and the 30 -day mortality of patients were compared in the two groups.Results The enteral nutritional goal -rate of target feeding volume on the 7th day and the 14th day in the observation group were superior to those of the control group[The goal -rate of target feeding volume on the 7th day:88% vs.64%,χ2 =3.947,P =0.047;the goal -rate of target feeding volume on the 14th day:80% vs.52%,χ2 =4.367,P =0.037].Meanwhile the incidence of gastric stasis,the reflux and aspiration,the aspiration pneumonia in the patients of the observation group within 14 days were significantly lower than those in the patients of the control group within 14 days[The gastric retention rate:8% vs.56%(14 /25 ),χ2 =10.784,P =0.001;the reflux rate:0% vs.24%(6 /25),χ2 =4.735,P =0.03;the aspiration rate:8% vs.32%,χ2 =4.500,P =0.034;the incidence of aspiration pneumonia:24% vs.68%,χ2 =9.742,P =0.002].The days of mechanical ventilation and the days in ICU of the patients in the observation group are far less than those of the patients in the control group[The days of mechanical ventilation:(11.16 ±4.86)d vs.(13.72 ±3.67)d,t =-2.101,P =0.041;the days in ICU:(15.36 ±5.66)d vs.(18.72 ±2.99)d,t =-2.625,P =0.012].While there was no significant difference between the two groups on the 30 -day mortality(24% vs.32%,χ2 =0.397,P =0.529).Conclusion The bedside blinding method of active indwelling of nasojejunal tube combined with the nasogastric tube gastrointestinal decompression can significantly improve the enteral nutritional goal -rate of target feeding volume for patients with severe stroke and greatly reduce the incidence of gastric stasis,the reflux and aspiration,the aspiration pneumonia,and limit the days of mechanical ventilation and the days in ICU.Accordingly,it has the value of popularization in the clinical application.

As the comprehensive reform of public hospitals enters a more challenging phase,the conventional extensive operation management no longer fulfills the requirements of high-quality development.This article investigates the current challen-ges in hospital operation management under the DIP payment system,proposes an optimized pathway as well as an outline for practical implementation.The proposed pathway suggests implementing a closed-loop resource allocation strategy integrating budg-et and performance based on disease groups and scores,establishing a cost management mechanism for enhancing resource effi-ciency,and development of a performance distribution system for stimulating self-management motivation among personnel.Addi-tionally,the article suggests the establishment of a Management Information System,aiming to provide practical references for en-hancing operational management capabilities in public hospitals under the DIP payment mode.