Objective To investigate the intervention ways of endoscopes in the treatment of esophagus stenosis due to carcinoma of esophagus and improvement of quality. Method 11 cases of advanced carcinoma of esophagus were included in this study. Operation and chemical therapy were unavailable for these patients. Memory trestle with membrane and made of alloy of Nickel－ titanium was inserted under intervention of endoscope. Trestle was posed in stenosis part of esophagus under direction of X－ ray. Trestle could be dilated 3－ 7 days after operation due to its reaction characteristics to temperature. So, redilated therapy was unnecessary. Trestle could reconstruct swallowing tract and made feeding through mouth become available during limited survival time.Results All trestles were successfully inserted.Half－ fluid feeding was available after operation. Obstruction was removed in all patients(100％ ).Conclusion Method described in this study was safe and effective .Effective swallowing tracts were reconstructed in all patients after trestle was planted and quality of life and survival time were both improved.

OBJECTIVETo retrospectively investigate the effectiveness of sphenzygomatic suture as a guide in the reduction of zygomatic complex fracture.

METHODS55 cases of zygomatic complex fracture classified according to Zingg classification were treated, sphenozygomatic suture in group 1 (n = 36) was reduced first, then the other fracture line was reduced, in group 2 (n = 19), malar bone was reduced according to superficial fracture line. Patients were followed up for 4 weeks to 3 months, aesthetic result and X-ray symmetry were observed.

RESULTSAll patients in group 1 were restored with satisfactory facial contour, 35 cases got precise reduction, 5 cases in group 2 were asymmetry.

CONCLUSIONDuring open reduction of complex zygomatic fracture, sphenozygomatic suture should be reduced at first as a guide, so as to get precise zygomatic complex reconstruction and normal aesthetic outcome.

Adolescent ; Adult ; Cranial Sutures ; Female ; Follow-Up Studies ; Fracture Fixation ; methods ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sphenoid Bone ; surgery ; Zygoma ; surgery ; Zygomatic Fractures ; surgery

Objective:To compare the clinical effectiveness of laparoscopic cholecystectomy (LC)+ laparoscopic choledocholithotomy (LCBDE)+ one-stage suture and primary choledocholithotomy with endoscopic retrograde cholangiopancreatography (ERCP)+ endoscopic duodenal sphincterotomy (EST)+ nasobiliary drainage (ENBD)+ LC in the treatment of choledocholithiasis complicated with gallbladder stones.Methods:A total of 200 patients with choledocholithiasis complicated with gallbladder stones admitted to the General Surgery Department of Shanxi Bethune Hospital from June 2015 to February 2021 were collected, and patients were divided into LC+ LCBDE+ one-stage suture (one-stage suture group, n=130) and ERCP+ EST+ ENBD+ LC (endoscopic surgery group, n=70) according to different treatments. The amount of intraoperative blood loss, operation time, postoperative feeding time, postoperative incidence of pancreatitis, cholangitis and other complications (biliary leakage, abdominal bleeding, wound infection), hospitalization costs, postoperative hospital stay, etc were compared between two groups. Results:The postoperative incidence of pancreatitis in the one-stage suture group (0.7% vs 5.7%) and the hospitalization cost [(2.74±0.39) ten thousand yuan vs (3.86±0.63) ten thousand yuan] were significantly lower than those in the endoscopic surgery group. The operation time [(103.21±9.36) min vs (88.18±7.20)min] was significantly longer than that of the endoscopic surgery group, and postoperative feeding time [(3.3±0.3)d vs (2.2±0.8)d] were significantly later than the endoscopic surgery group ( P<0.05). The amount of intraoperative blood loss [(36.0±3.0)ml vs (37.3±2.7)ml], the incidence of postoperative cholangitis (1.5% vs 2.9%) and other complications [biliary leakage (2.3% vs 1.4%), abdominal bleeding (1.5% vs 4.3%), wound infection(0 vs 0)], postoperative hospital stay [(6.8±1.3)d vs (7.1)d] had no significant differences between the two group. Conclusions:The two minimally invasive methods for the treatment of choledocholithiasis complicated with gallbladder stones had good efficacy, but LC+ LCBDE+ one-stage suture can retain the sphincter function of Oddis, maintain the normal anatomy and physiology of the biliary tract, reduce the incidence of related complications, and contribute to the recovery of patients, with high safety, effectiveness and feasibility.

Objective:To investigate the safety and efficacy of early oral feeding in the treatment of mild acute pancreatitis (MAP).Methods:Data of 100 MAP patients from April 2015 to June 2018 admitted in Department of General Surgery in Shanxi Bethune Hospital were collected. According to the time of food intake through the mouth, the patients were divided into early oral feeding group (food intake started when the symptoms of abdominal pain and abdominal distension were alleviated with gastrointestinal functional recovery, but serum amylase and lipase did not decrease to a level below 2 times of normal upper limits) and traditional oral feeding group (food intake started when the symptoms of abdominal pain and abdominal distension were alleviated with gastrointestinal functional recovery, but serum amylase and lipase decreased to a level below 2 times of normal upper limits), with 50 cases in each group. The incidence of abdominal pain or bloating, serum amylase, CRP, organ dysfunction, morbidity and mortality, and median length of hospital stay after eating were compared between the two groups.Results:There were no statistically significant differences on gender, age, etiology, abdominal pain and distension, increased serum amylase, increased blood CRP, and number of organ dysfunction cases between two groups, and there were no deaths in either group. However, the feeding time and length of hospital stay in the early oral feeding group were significantly shorter than those in the traditional oral feeding group, and the differences were statistically significant [(3.00±0.18)d versus (4.84±0.27)d, (8.24±0.33) D versus (9.00±0.26)d, both P<0.05]. Conclusions:Early oral feeding in MAP patients did not aggravate the disease, but helps to correct the nutritional status of the patients, with higher safety and effectiveness.

Objective To evaluate open reduction and internal fixation (ORIF) combined with Ilizarov joint distraction in the treatment of comminuted talar body fractures.Methods Between July 2010 and May 2016,16 patients with comminuted talar body fracture underwent ORIF followed by ankle joint distraction by Ilizarov external fixator at our department.They were 9 males and 7 females,aged from 17 to 56 years (average,35.6 years).Radiological assessments were conducted by plain radiographs and computed tomography (CT) scans pre-and post-operatively.Clinical outcomes were evaluated according to visual analogue scale (VAS),American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score,the short form (SF)-36 health survey scores and patients' satisfaction.Results Two patients were lost to follow-up.The remaining 14 patients were followed up for an average duration of 33.3 months (from 13 to 52 months).All the fractures united.Superficial wound infection occurred in one case.Eight patients developed post-traumatic osteoarthris;4 patients presented with avascular necrosis.At final follow-ups,the AOFAS scores ranged from 30 to 97 points (mean,69.8 points),the VAS scores from 0 to 6 points (mean,2.5 points),the physical component summary in SF-36 from 18.0 to 55 points (mean,41.7 points),and the mental component summary from 40 to 70 points (mean,54.1 points).Two patients reported strong satisfaction,5 satisfaction,4 moderate satisfaction,and 3 dissatisfaction.Conclusion For comminuted talar body fractures,ORIF combined with Ilizarov joint distraction is a new and effective treatment which can not only provide adequate fixation strength but also reduce the incidence of post-traumatic osteoarthris or avascular necrosis.

Objective To analyze the clinical outcomes of a standard protocol of open reduction and internal fixation using a variable angle foot plate for a consecutive series of patients with acute Lisfranc joint injury.Methods This study retrospectively evaluated the clinical outcomes of 11 Chinese patients(13 feet) with acute Lisfranc joint injury who had been treated by open reduction and internal fixation with a variable angle foot plate from December 2016 to June 2017 at Department of Orthopaedics,West China Hospital.They were 8 men(10 feet) and 3 women(3 feet),aged from 19 to 57 years(average,36.4 years).Of them,10 were complicated with fracture of metatarsus,6 with cuneiform fracture and/or dislocation,4 with cuboid fracture,and one with cuboid fracture.According to the Myerson classification for Lisfranc fracture-dislocations,one case(one foot) belonged to type A,2(2 feet) to type Bl,5(6 feet) to type B2,2(3 feet) to type Cl and one(one foot) to type C2.The outcomes were evaluated using the visual analogue scale(VAS) and the midfoot scores of American Orthopedic Foot and Ankle Society(AOFAS).Results This cohort was followed up for 18 to 24 months(average,22 months).Their VAS scores were decreased significantly from preoperative 7.3±1.2(from 6 to 9) to postoperative 1.2±0.2(from 0 to 2)(P<0.05);their AOFAS midfoot scores were increased significantly from preoperative 0 to postoperative 84.6±4.6(P<0.05) Anatomic reduction was obtained in all the patients and all the fractures united successfully without any delayed union or nonunion.Superficial necrosis of the wound edge occurred in 2 cases without deep infection;skin anesthesia occurred in 2 and skin hypesthesia in 4,indicating a lesion of the superficial peroneal nerve.Conclusion Fixation of acute Lisfranc joint injury with a variable angle foot plate can lead to rigid stability,precise reduction and satisfactory short-term clinical outcomes.

Objective:To identify the essential quality, expected quality and charm quality of outpatient doctors based on Kano model.Methods:The Kano model quality attribute questionnaire for outpatient doctors was designed from 4 dimensions and 18 indicators of service, quality, safety and cost. 220 outpatients were investigated in a tertiary hospital. The reliability and validity of 212 valid questionnaires were tested and the questionnaire data were analyzed.Results:Both the Cronbach α coefficient and the KMO value were higher than 0.7, which indicated that the reliability and validity were good. Nine of the 18 survey indicators were essential quality, focusing on the quality dimension and service dimension; 4 items were expected quality; 4 items were charm quality, focusing on disease cognition, prevention and drug safety; 1 item was indifferent quality.Conclusions:The essential quality of outpatient doctors is to provide basic and standardized medical services to patients. Studying the quality attribute can provide behavior guidance for outpatient doctors, improve patient satisfaction and quality of outpatient medical services.

Hepatocellular carcinoma (HCC) is a malignant tumor with a high incidence in China. Bone is a common extra hepatic metastasis site of HCC. Bone metastasis of HCC not only has a serious impact on the quality of life of patients, but also shortens their survival time. However, the pathogenesis of bone metastasis of HCC remains unclear. This review summarizes the clinical features, pathogenesis, prognostic factors, diagnosis and treatment progress and other aspects of bone metastasis of HCC, in order to provide new ideas for the clinical diagnosis and treatment.

Objective:To investigate the clinical efficacy of transfer of a free segment of the proximal second toe interphalangeal joint composite tissue flap in reconstruction of defects of interphalangeal joint of fingers, and simultaneously reconstruct the donor site defect left with the second toe by a transfer of a pedicled bone flap of the fibular proximal great toe.Methods:From December 2020 to April 2023, a total of 9 patients with interphalangeal joint defects of fingers were treated in the Department of Hand Microsurgery of Shunde Heping Surgery Hospital. The patients were 7 males and 2 females, aged 18-55 years old, with an average age of 31 years old. Firstly, transfers of a free segment of the proximal second toe interphalangeal joint composite tissue flap were performed to reconstruct the defects of finger joints. Simultaneously in the surgery, transfers of the fibular pedicled bone flap of the proximal great toe were conducted to reconstruct the donor site defects left in the second toe. Patients were instructed with appropriate postoperative functional exercises. K-wires were removed at 8-12 weeks after surgery. Outpatient visits, telephone and WeChat follow-ups were conducted to evaluate the appearance and functional recovery of the reconstructed interphalangeal joints and donor feet. Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, Vancouver Scar Scale (VSS) and American Orthopedic Foot and Ankle Society (AOFAS) foot function scoring standards were employed in the evaluation.Results:Postoperative follow-up lasted for 6 to 30 months. All of the 9 interphalangeal joint composite tissue flaps in the fingers survived with complete and good appearance. Function of the reconstructed interphalangeal joints of the fingers recovered well. According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, the average score achieved 12 points, with 6 patients of excellent, 2 of good and 1 of fair. After surgery, the appearance and function of the donor great toes and second toes all recovered well. The average score of the scars in donor second toe evaluated by VSS was 4 points. All the donor feet were kept with 5 toes, with full, intact and good in appearance. According to the AOFAS foot function scoring standard, the average score achieved 95 points, and were excellent.Conclusion:Application of transfer of free proximal segment of interphalangeal joint composite tissue flap of the second toe in reconstruction of the interphalangeal joint defect of a finger, and simultaneously reconstruct the defect left with the donor second toe with a fibular proximal great toe flap pedicled with bone tissue can achieve good clinical efficacy in reconstruction of the defects of interphalangeal joint of fingers, restore the function of the interphalangeal joint of fingers and the appearance and function of the donor foot.

Objective To analyze the results of acceptance testing of 60 extraoral dental X-ray equipment in Beijing, China from 2021 to 2022, and understand the main types and performance parameters of newly installed extraoral dental X-ray machines in the clinical market of Beijing, as well as the level of installation and trial run of the whole machine by various manufacturers, and to summarize the problems found in acceptance testing for improving equipment testing. Methods Field acceptance testing and evaluation were carried out according to the Specification for Testing of Quality Control in Medical X-Ray Diagnostic Equipment (WS 76—2020). Results The overall qualified rate of 60 extraoral dental X-ray equipment was 98.33%. Under the same condition of the same tube voltage for one dental equipment, the maximum deviation of the tube voltage indicated by the two modes (panorama and skull) is 5.5%, and the maximum difference of the half-value layer of the useful beam is 1.22 mm Al. There is also a certain difference between the exposure time indicating deviation from the panorama and the skull, with a maximum difference of 75.51%. Conclusion Strengthening ex-factory quality control, installing, and debugging of equipment can basically guarantee the performance of newly installed equipment. In the testing process, it is critical to ensure the effective point of measurement of the dose detector located on the central axis of the primary beam.