Objective To investigate the effect of early enteral nutrition(EN) support after gastreetomy and evaluate its feasibility. Methods Early enteral feeding was used in 129 eases with gastreetomy in 20 hours after operation. Result One hundred and twenty-nine eases accepted early enteral nutrition support, 5 ea-ses appeared diarrhea. After adjusting the infusion speed and the temperature of nutrient fluid, symptoms of 4 eases vanished, 1 ease could not complete the early enteral feeding plan. Conclusions The early nutri-tion after gastreetomy is safe, reliable, simple and economical. The early nutrition can improve the nutrition state of postoperative patient effectively.

The paper reviewed the history of drug price addition system and its impact on hospital management. Based on such facts,authors stated that the significance of abolishing drug price addition helped hospital management not to run their hospitals as a business, helped medical practitioners to make their clinical decisions based on medical needs, and to make the health care service deserve the professionals′value and contributions. Following the abolishment, the hospitals need to reform their internal operating mechanisms before they can achieve better performance.

Objective:To compare the maxillary sinus mucosa's stress distribution when elevated by three lift materials.Methods:Three Finite element models of maxillary sinus mucosa with 0.3 mm thickness elevated by implant,grafting autogenous cancellous bone and hydroxyapatite respectively were established in the specific units.ANSYS finite element analysis software was used to evaluate maxillary sinus mucosa deformation by the simulated closed sinus lift surgery.Differences of Von Mises stress values of mucosa surface were calculated when maxillary sinus mucosa lift height was increased from 1 mm to 5 mm according to the a large deformation theory. Results:The Von Mises stress values on membrane surface elevated by implant,grafting autogenous cancellous bone and hydroxyapa-tite bone substitute materials showed no difference within 5 mm elevation.Conclusion:Closed maxillary sinus floor lifting operation with implant elevating the maxillary sinus membrane directly is a simple and minimally invasive way for sinus floor elevation.

BACKGROUND:How to avoid iatrogenic maxil ary sinus mucosal perforation after closed maxil ary sinus augmentation.
OBJECTIVE:To compare the influence of maxil ary sinus mucosa at different thicknesses on the mucosal perforation in closed maxil ary sinus augmentation operation by using finite element analysis.
METHODS:Three finite element models of maxil ary sinus mucosa at different thicknesses of 0.3 mm, 0.5 mm, 0.8 mm respectively and implant with 4.2 mm diameter were established in the SHELL63 units. ANSYS finite element analysis software was used to evaluate maxil ary sinus mucosal deformation by the simulated closed maxil ary sinus augmentation surgery. Differences of Von Mises maximum stress values of mucosa surface were calculated according to the non-linear large-deformation theory.
RESULTS AND CONCLUSION:When maxil ary sinus mucosa height was increased from 1 mm to 5 mm, the large deformation was observed in the center of mucosa center. The maximum stress curve slope was shifted mild between 1-4 mm deformation, while shifted abruptly after 4 mm. There was no difference in the value of Von Mises maximum stress values between three maxil ary sinus mucosa at 0.3 mm, 0.5 mm, 0.8 mm thickness, when the lift height was increased from 1 mm to 5 mm (P>0.05). Maxil ary sinus mucosa are faced with a higher risk of mucosal perforation and elastic elongation when maxil ary sinus height is increased more than 4 mm. Maxil ary sinus mucosa at 0.3-0.8 mm thickness are faced the similar risk of mucosal perforation in closed maxil ary sinus augmentation operation within 5 mm. While more considerations should be paid on patients with less than 0.3 mm maxil ary sinus mucosa thickness.

OBJECTIVE: Using the method of lactate dehydrogenase (LDH) assay, to observe the activities of rat cerebral microvascular endothelial cells (CMECs) intervened by Tongluo Jiunao Injection (TLJNI), a traditional Chinese compound drug removing toxin to dredge brain collaterals, and then further study the effects of different kinds of conditioned mediums (CMECs-CM) of cerebral microvascular endothelial cells on ischemia and ischemia/reperfusion cerebral cortex cells, and to probe into the drug pharmacological mechanisms of CMECs in modulating the neurons. METHODS: Three kinds of CMECs (normal, ischemic and ischemic/reperfusional) were all treated by TLJNI previously, and then the three pairs of CMECs-CM without serum were collected respectively for LDH assay. Rat cerebral cortex neurons were also primarily cultured and then divided into similar three groups (normal, ischemic and ischemic/reperfusional). The neuron responses caused by CMECs-CM at different concentrations were observed by using LDH transudation rate assay. RESULTS: The LDH release values of ischemic and ischemic/reperfusional CMECs with TLJNI treatment were obviously reduced (P<0.01) compared with the same kinds of CMECs untreated. For ischemic neurons, both conditioned medium of ischemic CMECs (Is-CM) and conditioned medium of ischemic CMECs with drug treatment (IsT-CM) in high concentration of 100% increased the LDH transudation rate (P<0.01), while in low concentration of 10%, IsT-CM reduced the transudation rate (P<0.05). For ischemia/reperfusion neurons, all kinds of CMECs-CM reduced the transudation rate respectively (P<0.05 or P<0.01). As far as each group concentration was concerned, 10% or 50% showed relatively stronger effects, and both conditioned medium of normal CMECs (N-CM) group and conditioned medium of ischemic/reperfusional CMECs (Rp-CM) group had statistical significance (P<0.05 or P<0.01). For normal neurons, all kinds of CMECs-CM increased the transudation rate respectively (P<0.05 or P<0.01). As far as each group concentration was concerned, only conditioned medium of normal CMECs (N-CM) had statistical significance (P<0.05 or P<0.01). CONCLUSION: The study shows that TLJNI is capable of preventing the damage of CMECs from both ischemia and ischemia/reperfusion states. Chinese drug can restrain the brain ischemia and ischemia/reperfusion damage by the media that CMECs modulate the neurons, demonstrating the pharmacological mechanisms of TLJNI. This work also indicates that there exist some active substances against ischemia/reperfusion injury secreted from CMECs-CM with TLJNI treatment.

Objective: To treat the depressed scars by injecting nanofat and investigate its therapeutic effect. Methods: Autologous fat was harvested from abdomen or thigh using low-pressure suction. The lipoaspirate was mechanically emulsified after rinsing. Emulsification of the fat was achieved by shifting the fat between two 5 ml syringes connected to each other by a three direct connector. After this emulsification process, the fatty liquid was again filtered over the sterile nylon cloth. Nanofat was injected into the dermis of depressed scars using a 26-gauge needle and the injection volume was 1-2 ml/cm². After three months, another injection would be performed if the depressed scar remained obvious. Results: From January 2016 to October 2017, eighteen patients and thirty-three depressed scars were treated. There was a temporary erythema of the injected area that lasted two to three weeks. The clinical result gradually improved over time and were maximal from three months postoperatively for most cases. Three months after nanofat injecting, the cavity of scars was significantly decreased; The color of scars were significantly improved and more close to the adjacent skin; The stiffness of scars was also obvious decreased. The follow-up ranged 4 months to 18 months and the average was 11.0±4.6 months. Seventeen patients were satisfied with the result, one patients was not satisfied and the satisfaction rate was 94%. No infections, fat cysts, granulomas, or other unwanted side effects were observed. Conclusions Nanofat injecting is a definite and effective treatment for depressed scars with fewer complications.

OBJECTIVETo appraise the clinical efficacy, safety and compliance of the intervention of spleen-restoring decoction combined with dormancy hygiene education and the intervention of spleen-restoring decoction alone on sub-healthy insomnia of deficiency of both the heart and spleen pattern.

METHODStudy design took multi-centers, blind and randomized control trial, 107 participants with sub-healthy insomnia of deficiency of both the heart and spleen pattern were assigned to A group (52 cases) which was treated with the intervention of spleen-restoring decoction combined with dormancy hygiene education and B group (55 cases) which was treated with the intervention of spleen-restoring decoction single, compared by efficacy, PSQI score, CGI score, WHOQOL-BREF score and security.

RESULTThe efficacy of two group was 79.58%. There was no significant different between them. The PSQI scores before treatment was (11.80 +/- 2.08) and which afer treatment was (6.78 +/- 2.84) of A group. The PSQI scores before treatment was (11.61 +/- 2.00) and which afer treatment was (6.73 +/- 2.27) of B group. There was significant difference in PSQI scores both A group and B group after treatment (P < 0.01); the results of CGI score and WHOQOL-BREF score before and after measurement showed the same as PSQI. There were no significant difference between two groups in all scores after treatment and there was no interaction between time pots and treatment factors . Withdrawal reaction analysis: comparing CGI after withdraw 2 weeks and at the end of treatment course, there was no significant difference between two groups. The same result was in comparison among groups.

CONCLUSIONBoth the intervention of spleen-restoring decoction integrating with dormancy hygiene education and spleen-restoring decoction had obvious clinical efficacy on treating subhealthy insomnia of deficiency of both the heart and spleen pattern, and had high compliance and safety. The intervention of spleen-restoring decoction integrating with dormancy hygiene education showed no better clinical efficacy than spleen-restoring decoction did.

Adult ; Female ; Health Education ; Humans ; Hygiene ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Sleep Initiation and Maintenance Disorders ; drug therapy ; physiopathology ; Splenic Diseases ; drug therapy

Objective: To introduce a reconstruction procedure of natural sideburn, with combined expanded retroauricular flap and scalp flap. Methods: A retrospective study was produced in Plastic Surgery Hospital, PUMC, from January 2014 to December 2017. Twenty patients (21 sides) underwent sideburn reconstruction with combined expanded retroauricular flap and scalp flap (double pedicled flap, n=3; single pedicled flap, n=17) were included in this study. There were 12 male (12 sides) and 8 female (9 sides), with the mean age of (23.8±3.2) years. The sideburn defect was caused by burn in 19 patients, and it was resulted from hemangioma in 1 patient. Results: The size of flaps ranges from 8 cm×12 cm to 10 cm×16 cm. Venous congestion at the distal end of the flap occurred in 1 patient, which was cured after dressing change, and the sideburn was not affected. The reconstructed sideburns are natural, symmetric, and without obvious scar. The follow-up time was 3-40 months. Fourteen patients were very satisfied with the reconstructed sideburn, and 6 patients were satisfied. No severe complication was observed during follow-up time. Conclusions The combined retroauricular flap and scalp flap is an alternative method for sideburn reconstruction, which provide natural hair distribution, inconspicuous scars and less complications.

Objective: To explore a surgical method for the reconstruction of naturally dynamic double eyelid by fully reserving orbicularis oculi muscle. Methods: Incisional double eyelid blepharoplasty were performed on 352 patients. Orbicularis oculi muscle in incisional and pretarsal area were completely preserved. Muscle was elevated from plate by resecting deep muscular myolemma and muscles to form pretarsal myocutaneous flap. Thereafter, the orbital septum was completely exposed. The free end of muscle flap was fixed to a higher position of the levator aponeurosis. The orbital septum was repaired at the same time. Results: From June 2009 to December 2017, 352 patients were performed double eyelid blepharoplasty using above technique. They are 337 females and 15 males. Fifty-two patients were followed up for 6-60 months, with the mean time of 27 months. All the incisions were uneventfully healed. The new double eyelid presented smooth appearance, and the so-called " sausage" phenomena were not noticed. There was no concave groove or step-like deformity when eyes closed. Forty-five patients were satisfied with the outcomes. Two patients had shallower supratarsal folds on one side, and 1 patient underwent secondary repair. Two patients complained about asymmetry. Two patients suffered from mild unilateral eyelash eversion (without need of reparation). Conclusions The combined application of deep and superficial myolemma release of the orbicularis oculi muscle, and orbital septum reset, could create a double eyelid with natural and dynamic appearance.

The construction of a countywide community for medical and health services is designed to upgrade the service capacity of primary medical and health institutions, to promote resource sharing and collaborative services, and promote the hierarchical medical system. Huzhou of Zhejiang province has launched its initiative in building a countywide community for medical services since 2018. The authors summarized its main practices in promoting the integration of the management system and optimizing operating mechanism of countywide medical and health institutions, promoting the reform of the county medical and health governance system, as well as the achievements and shortcomings, with a view to providing reference for promoting the high-quality development of the countywide medical and health service system.