[Objective]Discussion on TCM name and pathogenesis of hypertension. [Method]To further explore and analyze the TCM name, location as wel as pathogenssis of hypertension after learning“Neijing”. [Result]Hypertension corresponding TCM diseases should be the veins bulge from“Neijing”. The location of the disease is heart,while it relates to internal organs. The main pathogenesis is that heart commanding blood abnormality. [Conclusion ]The traditional classical dialectical mode from the liver treatment of hypertension should be changed,the clinical treatment of hypertension is due to the heart according to the theory of pathogenesis which the heart commands blood vessels.Seeking the key reason is important to differential treatment of hypertension.

Objective: To investigate the clinical effect of free medical sural artery perforator myocutaneous flap for repairingof the woundwith osteomyelitis. Methods: 17 patients suffered from the wound with osteomyelitis were treated in the Ningbo First People′s Hospital, There were 11 males and 6 females with an mean age of 53.2 years (range, 21-76 years). The sizes of the defect ranged 5 cm×4 cm to 13 cm×6 cm. All patients underwent debridement and used antibiotic-loaded bonecement to cover the wound. Meanwhile, patients were treated with sensitive antibiotics, operation and free medical sural artery perforator myocutaneous flap were used to treat the wound. Preoperative use ultrasound and CT angiography to positioning perforator, The flap area ranged from 6 cm×4 cm to 13 cm×7 cm and the donor sites were closed directly. The author provided the patients with the treatment of anti-inflammatory, anti-spasmodic and anti-coagulantin the postoperative. Used infrared thermograms to assess the flap blood supply. Results: One flap skin margin was non union due to poor blood supply.All of the other 16 flaps success survived and the donor sites were closed directly. Postoperative follow-up period was 4 to 23 months and the flaps had satisfied texture and appearance.All the donor sites had a good healing with no pain and complications, also the osteomyelitis was controlled. Conclusions The free medical sural artery perforator myocutaneous flap is reliable for reconstruction of the wound with osteomyelitis.

Objective To explore the method and clinical efficacy of microsurgical reconstructive surgery af-ter malignant tumors radical resection on the surface. Methods From June, 2015 to March, 2017, a total of 32 pa-tients in this group underwent radical resection of malignant tumors. All of them resulted in a large area of soft tissue defect with loss of function.The average defect area was 10.0 cm×12.0 cm.All types of free flap and pedicle flap were selected. Myocutaneous flaps or local flaps were used to repair large areas of soft tissue defect on the basis of micro-surgical techniques to protect the blood supply of the flaps and to reduce the damage to the donor area by evaluating the defect size, surrounding anatomical characteristics, and other factors. Results Thirty-two flaps survived com-pletely. After 4 to 18 months of followed-up, the color of flap was close to that of the surrounding skin. The texture was good. There was no bloated swelling, and the skin protective sensation was restored. There was no obvious scar hyperplasia, no chills, no pain and no other complications in the donor site. Conclusion After the radical mastec-tomy of the body surface, different types of flaps can be selected for the first-stage microsurgery according to the characteristics of the different parts and the tumor excision wounds to obtain a good clinical efficacy.

Objective :To explore therapeutic effect of emergency percutaneous coronary intervention (PCI) combined ticagrelor on patients with acute ST elevation myocardial infarction (STEMI ) and its influence on level of tumor necrosis factor (TNF)—α.Methods : A total of 98 patients with acute STEMI treated in our hospital from Jan 2016 to Jan 2017 were selected .Patients were randomly and equally divided into clopidogrel group and ticagrelor group , each group received corresponding medication before PCI .LVEF ,LVEDd ,TNF—α level before and one month after treatment and TIMI grade before and after PCI ,recanalization time ,postoperative corrected TIMI frame (CTFC) , percentages of thrombus aspiration ,auxiliary IABP and no—reflow ,and incidence of adverse events during six—month follow—up after PCI were observed and compared between two groups .Results : Compared with before PCI and treatment ,there were significant rise in LVEF on one month after treatment and TIMI grade after PCI ,and signifi—cant reductions in LVEDd and TNF—α level in two groups on one month after treatment , P＝0.001 all.Compared with clopidogrel group on one month after treatment ,there was significant rise in LVEF [ (49.80 ± 4.17 )% vs. (57.32 ± 5.10)%] ,and significant reductions in LVEDd [ (57. 94 ± 4. 70) mm vs .(47.11 ± 3.49) mm] ,TNF—α level [ (17. 82 ± 2.84) pg／ml vs .(8.40 ± 2. 04 ) pg／ml] and postoperative percentage of no—reflow (24.44% vs. 4.44%) in ticagrelor group , P＜0. 01 all ,there were no significant difference in other operative related indexes be—tween two groups , P＞0.05 all.After six—month follow—up ,incidence rate of composite endpoint events in ticagrelor group was significantly lower than that of clopidogrel group (11. 11% vs.31. 11%) , P＝0.021 ,there were no sig—nificant difference in percentages of in—stent thrombus ,infarct related artery revascularization and recurrent unsta—ble angina pectoris between two groups , P＞0.05 all .Conclusion : Short—term therapeutic effect of emergency PCI combined ticagrelor is significant .It can significantly improve prognosis ,which is worth extending .

Objective:To investigate the therapeutic effect of conjoint fascia sheath suspension and levator palpebrae muscle shortening on congenital severe blepharoptosis.Methods:From June 2014 to December 2018, 30 cases (40 eyes) of congenital severe ptosis were treated in Ningbo First Hospital and Shaoxing Women and Children＇s Hospital. All patients were corrected by conjoint fascia sheath suspension and levator palpebrae muscle shortening. Six months after operation, the distance between the middle point of upper eyelid margin and corneal reflex point was measured to evaluate the correction effect of blepharoptosis; the improvement of upper eyelid appearance was evaluated by 5-point Likert scale (LS), and the incidence of complications was counted.Results:Thirty patients (40 eyes) were followed up for 6-12 months. Correction effect showed that preoperative marginal reflex distance (MRD) was (0.10±0.05) and postoperative MRD was (3.80±0.55); the difference was statistically significant ( t=0.95, P<0.05); 38 eyes (95%) were corrected and 2 eyes (5%) were undercorrected; appearance of upper eyelid showed that preoperative LS was (0.50±0.05) and postoperative LS (3.80±0.55); the difference was statistically significant ( t=0.98, P<0.05). Only one case was complicated with keratitis caused by improper early nursing after incomplete closure exposure, and the patient was cured by sealing the eyes combined with drug conservative treatment. Conclusions:Combined conjoint fascial sheath suspension and levator palpebrae shortening in the treatment of severe blepharoptosis has significant effect, with the advantages of simple operation, small surgical trauma, low recurrence rate, low incidence of complications, high predictability of surgical results and high satisfactory rate of patients.

Objective:To investigate the repair effect of autologous costal cartilage combined with silicone prosthesis on injection rhinoplasty.Methods:From July 2016 to July 2019, 28 patients who were dissatisfied with the appearance of injectable rhinoplasty and required surgical repair were treated in our hospital. Among them, 26 patients were injected with hyaluronic acid as filler, and 2 patients were unknown filler. On the basis of thoroughly cleaning the filler and releasing the adhesive tissue, the method of autogenous costal cartilage combined with silicone prosthesis was adopted: the costal cartilage was taken to support the nasal tip, and the silicone prosthesis was used to fill the nasal dorsum. The incidence of complications was observed postoperatively, and the score of each patient before and 6 months after operation was evaluated by ROE questionnaire.Results:No postoperative complications such as skin infection and necrosis, prosthesis deformation and displacement, and pneumothorax were observed in all the patients, and the incision healing was smooth. All patients were followed up for 6-18 months. Among the 6 questions on the preoperative and postoperative ROE questionnaire, except for question 2, the difference between the the two was statistically significant ( t=7.58, P<0.05). Conclusions:The use of autologous costal cartilage combined with silicone prosthesis can effectively repair injection-type rhinoplasty, which can not only achieve satisfactory postoperative results, but also reduce surgical complications. It is easy to operate and worthy of choice in clinical practice.

To investigate the clinical efficacy of one-stage repairing the wounds after excision of soft tissue malignant tumor in lower limb with deep inferior epigastric perforator (DIEP) flaps. Methods From Au-gust, 2016 to July, 2018, 11 patients(8 males and 3 females; aged 35-76 years) with the soft tissue defects in the low-er limb underwent immediate reconstructive operations with DIEP flap after their tumor resection. The defects ranged in area from 11 cm×7 cm to 25 cm×10 cm after extended resection, including 5 cases of bone exposure. The DIEP flap area ranged from 11 cm×8 cm to 26 cm×18 cm.Among them, 9 cases were treated with free transplantation and 2 cases with pedicle transplantation.The donor sites were closed directly. The patients’ limb function, tumor recurrence and the healing of surgical incision had been followed-up. Results Eleven flaps survived and the donor sites healed directly. One flap had skin pigmentation due to postoperative vascular crisis, and the other flaps had satisfied texture and appearance. All patients were followed-up from 6 to 30 months. The lower limb movement was normal. All the donor sites had a good healing with no pain and abdominal complications. No tumor recurrence was observed during the followed-up period. Conclusion DIEP flap have many advantages, such as large cutting area, which is suitable for large-area wound repair after extended excision of soft tissue malignant tumor in lower limb. At the same time, the perforator vessel is constant and the caliber are thick, also the donor area is concealed and can be sutured directly.This kind of the technique for reconstruction of lower limb soft tissue defects after malignant tumor resection is well acceptable.

Objective To compare the effects of propofol and midazolam on the prognosis of patients treated with noninvasive positive pressure ventilation.Methods A prospective,single-blind,randomized controlled trial (RCT) was conducted in 90 patients who were treated with noninvasive ventilation for acute dyspnea in the ICU of the Sixth People's Hospital Affiliated to Shanghai Jiaotong University from October 2014 to December 2016.They were randomly divided into three groups according to the digital table,with 30 cases in each group.The control group was not given sedation treatment.The propofol group was given propofol 0.5 ～ 1 mg/kg,and then administered by intravenous infusion of 1 mg · kg-1 · h-1 with a micropump.The midazolam group was given midazolam 0.05-O.1 mg/kg,and then with intravenous infusion of 0.05-0.1 mg · kg-1 · h-1 maintaining the patients'sedation goals(Ramsay score of 2).The vital signs and blood gas analysis indicators were recorded.The incidence of tracheal intubation,the incidence of hospital infection,length of ICU and hospital stay,mortality and sedation-related complications were compared.Results The tracheal intubation rate in the propofol group was similar to that in the midazolam group (20.0％ vs.23.3％,x2 =2.65,P ＞ 0.05),while the tracheal intubation rate (46.7％) in the control group was significantly higher (x2 =4.21,4.17,all P ＜ 0.05).The length of ICU and hospital stay in the pmpofol group [(7 ± 3)d and (15 ± 5) d] and midazolam treatment group[(8 ± 4) d and (16 ± 4) d] were significantly shorter than those in the control group[(13 ± 4) d and (20 ± 6) d] (t =2.384,2.371,2.392,2.389,all P ＜ 0.05).The mortality rates of 30d (20.0％,6/30) and 90d (30.0％,9/30) in the control group were higher than those in the propofol group(10.0％,3/30;20.0％,6/30),and the midazolam group (13.3％,4/30;23.3％,7/30),but the differences were not statistically significant(P ＞ 0.05).The incidence rates of hospital infection in the pmpofol group and midazolam group were 6.6％ (2 cases) and 10.0％ (3 cases),which were significantly lower than 33.3％ (10 cases) in the control group (x2 =4.32,4.23,all P ＜ 0.05).Conclusion The use of mild sedation in patients of acute dyspnea treated with noninvasive positive pressure ventilation can improve the patients' tolerance rate,reduce the rate of tracheal intubation and the incidence of hospital infection,and decrease the length of ICU and hospital stay,without significant adverse reactions.There was no significant difference between propofol and midazolam.

Objective:To explore the feasibility and clinical effectiveness of preoperative positioning grid combined with CTA assisted design of anterolateral thigh perforator flap (ALTPF) in reconstruction of soft tissue defects around foot and ankle.Methods:From May 2018 to December 2021, a total of 18 cases with soft tissue defects around foot and ankle were admitted to the Department of Plastic and Reconstructive Surgery, First Affiliated Hospital of Ningbo University. The patients were 11 males and 7 females, aged from 32 to 78 years old, with an average age of 57.5 years old. Among them, 10 had chronic ulcer wounds, 6 had traumatic wounds, and 2 had postoperative wounds after malignant tumor resection. The sizes of soft tissue defect ranged from 6.0 cm×8.0 cm to 9.0 cm×13.0 cm, and the flap sizes ranged from 8.0 cm×10.0 cm to 11.0 cm×15.0 cm. Preoperative positioning grid combined with CTA three-dimensional reconstruction were used to mark the exit point of the perforator vessels in digital format, in order to restore the course of vessels and calculate the length of the vascular pedicles. ALTPFs were accurately designed based on the digitally reconstructed images, and then the ALTPFs were used to repair the soft tissue defects around the ankle. The flap donor sites were directly closed in stage Ⅰ. After the operation, all the patients were included in scheduled follow-ups at the outpatient department to observe the appearance of the recipient flaps and donor sites. The functional evaluation of the affected feet were assessed according to the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.Results:All 18 flaps survived, and the wounds in both the recipient and donor sites healed in stageⅠ. Postoperative follow-up for the 18 patients were 5 to 36 months, with an average of 13 months. At the last follow-up, the appearances of the flaps were good without swelling, the donor sites had good recovery, and there was no obvious scar hypertrophy. The function evaluation of the affected feet were found at excellent in 10 cases, good in 6 cases, and fair in 2 cases.Conclusion:Preoperative position grid combined with CTA three-dimensional reconstruction can digitally mark the exit points and running courses of the perforator vessels. It is an effective method for accurate position of perforator vessels before surgery. It can effectively reduce the operation time, lower the surgical risks, and achieve a high survival rate of the flap, thus holding considerable clinical value.

Objective: To investigate the clinical effect of reconstruction of sensory anterolateral thigh perforator flaps in repairing soft tissue defects after radical operation for Paget disease of perineum. Methods: From April 2017 to July 2017, Ningbo First Hospital treated 3 male patients with Paget′s disease of perineum, 2 patients with RayA2 stage and 1 patient with RayB stage. The range of soft tissue defect after resection of tumors is 8 cm×10 cm to 10 cm×12 cm. The anterolateral thigh perforator flaps were designed to repair skin defect, and the lateral thigh cutaneous nerve branch was contained to reconstruct protective sensation and restore autonomic nerve function. Tension-free direct suture was performed in part of the donor site, of which 3 cases were difficult to suture directly, 2 cases were treated with skin grafting and 1 case was closed with skin distractor. Results: All 3 flaps survived. The average area of the flaps was about 12 cm×14 cm. The average follow-up period was 3 months. The appearance and function of the flaps were satisfactory. The average sensory recovery of the flaps was as high as S3. The autonomic nervous function was partially restored. Some of the skin had sweating function and normal skin temperature. At the same time, there was no difference between the urination function and sexual competence before operation. The donor site wound healed well and its appearance and function recovered well. Conclusions The reconstruction of sensory anterolateral thigh perforator flaps is an good method for repairing soft tissue defect after radical resection of Paget disease of perineum. It has satisfactory results in the protection and reconstruction of donor and recipient areas.