Obiective: To explore the method and clinical effect of epicanthal plasty. Methods: Transverse incision of epicanthus was applied on the horizontal line of the epicanthus to separate and release the orbicularis oculi muscle and the fibrous tissue and moderately remove the abnormal orbicularis oculi muscle. The redundant triangular flap under the incision was removed, and the superficial ligament of epicanthus was sutured and fixed to the dorsal nasal fascia with 1 stitch, so as to achieve correcting the epicanthus. Results: The epicanthus of the 121 patients was corrected after the surgery with their lacrimal caruncle exposed. The appearance of the endocanthion is pleasing, the skin of the endocanthion is smooth, the scar is invisible, and the oculi rimae is lengthened 1 to 3 mm. Conclusions The operation has achieved a satisfactory effect. Therefore, the horizontal transection to remove the triangular flap is applicable for most epicanthus due to its simplicity and practicality, as well as the invisible scar and simultaneous manipulation with other operations. These features might be significant for a wider clinical application.

Objective:To evaluate the effect of general anesthesia combined with epidural block on postoperative sleep in the frail elderly patients undergoing gastrointestinal tumor surgery.Methods:Ninety frail patients of either sex, aged 65-80 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiology physical status Ⅱ-Ⅲ, scheduled for elective open gastrointestinal tumor surgery (FRAIL score >2), were divided into 2 groups ( n=45 each) using a random number table method: general anesthesia group (GA group) and general anesthesia combined with epidural block group (GE group). Combined intravenous-inhalational anesthesia was carried out in group GA.Epidural block was performed before induction of anesthesia, and the method of general anesthesia was the same as that described in group GA, and the consumption of propofol and remifentanil was adjusted according to the BIS value, sweat and tears, heart rate and blood pressure during operation in group GE.Postoperative intravenous analgesia was performed to maintain VAS score ≤3.Wearable devices were used to monitor sleep parameters at 1 day before surgery and 1, 3 and 7 days after surgery.Sleep quality was assessed using Pittsburgh Sleep Quality Index and Quality of Recovery-15 questionnaire at 1 day before surgery and 1, 3, 7 and 30 days after surgery.The intraoperative consumption of propofol, sufentanil and remifentanil were recorded.The requirement for postoperative rescue analgesia and total pressing times of patient-controlled analgesia (PCA) within 48 h after surgery were recorded.Serum C-reactive protein concentrations were determined by immunoturbidimetry at 1 day before surgery and 1 day after surgery, and the adverse reactions at 7 days after surgery were recorded. Results:Compared with group GA, the consumption of remifentanil was significantly reduced, the total sleep score, deep sleep ratio, rapid eye movement ratio and Quality of Recovery-15 score were increased, the Pittsburgh Sleep Quality Index was decreased, and the incidence of postoperative nausea and vomiting was decreased on 1st and 3rd days after operation ( P<0.05), and no significant change was found in the serum C-reactive protein concentration and postoperative requirement for rescue analgesia, and total pressing times of PCA in group GE ( P>0.05). Conclusions:General anesthesia combined with epidural block can improve short-term sleep quality and recovery quality after gastrointestinal tumor surgery in elderly frail patients.

Objective:To systematically review and evaluate the safety and efficacy of high-flow nasal oxygen (HFNO) for pre-oxygenation before anesthesia induction.Methods:Pubmed, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database and China Biomedical Literature Database were searched from inception to March 2022.All randomized controlled trials comparing HFNO and facemask ventilation for pre-oxygenation before anesthesia induction were collected.Two researchers independently assessed the quality of trials and extracted data.The primary outcome was the safe apnea time, the secondary outcomes were the lowest SpO 2 during intubation, oxygenation-related complications, patient comfort, PaO 2 and PaCO 2 before and after pre-oxygenation and after intubation.Meta-analysis was performed using RevMan 5.4 software. Results:Seventeen randomized controlled trials involving 843 patients were included in this meta-analysis.The results of meta-analysis showed that the safe apnea time was significantly longer ( MD=67.61, 95% CI 5.94-129.28, P=0.03), the lowest SpO 2 was higher during tracheal intubation ( MD=3.27, 95% CI 2.25-4.29, P<0.01), and PaO 2 was higher after pre-oxygenation ( MD=54.39, 95% CI 9.32-99.46, P=0.02) in the patients using HFNO than those using facemask ventilation.There were no statistically significant differences in the other outcomes ( P>0.05). Conclusions:HFNO for pre-oxygenation before anesthesia induction can significantly prolong the safe apnea time, increase the lowest SpO 2 during tracheal intubation, and improve the levels of PaO 2 after pre-oxygenation, and HFNO does not affect the patient′s comfort or increase the development of preoxygenation-related complications when compared with facemask ventilation.

Objective:To evaluate the gastric emptying in the patients with cholelithiasis and in the patients following cholecystectomy by ultrasonography.Methods:Thirty patients with cholelithiasis, 30 post-cholecystectomy patients and 30 healthy volunteers, of either sex, aged 18-64 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰor Ⅱ, were selected and divided into cholelithiasis group (group CH), post-cholecystectomy group (group PC) and healthy volunteer group (group HV). The indigestion scores of the enrolled subjects in the past 3 months were assessed; the subjects took a semi-solid test meal (300 kcal) in the fasting state, and the cross-sectional area (CSA) of the gastric sinus was measured using ultrasound at fasting (T 0) and 5, 15, 30, 45, 60, 90 and 120 min after the test meal was taken (T 1-7). The gastric emptying fraction at T 5, 6 was calculated. The gastric half-emptying time and remaining area of the gastric sinus at T 7 were also calculated. Results:Compared with group HV, dyspepsia scores were significantly increased within the past 3 months ( P<0.05), the CSA of the gastric sinus was increased at T 3-7, the gastric emptying fraction was decreased at T 5-6, the gastric half-emptying time was prolonged, and the remaining area of the gastric sinus was increased at T 7 in group CH and group PC ( P<0.05). Compared with group CH, the CSA of the gastric sinus was significantly increased at T 4-7, the gastric emptying fraction was decreased at T 5, 6, the gastric half-emptying time was prolonged, and the remaining area of the gastric sinus was increased at T 7 in group PC ( P<0.05). Conclusions:Gastric emptying time is longer in the patients with cholelithiasis and in the patients following cholecystectomy than in healthy subjects and is further prolonged after cholecystectomy in the patients.

Objective:To evaluate the effect of preoperative oral carbohydrate on gastric emptying in the patients undergoing laparoscopic cholecystectomy.Methods:One hundred patients of both sexes, aged 18-64 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, were divided into 2 groups ( n=50 each) using the random number table method: control group (group C) and preoperative oral carbohydrate group (group P). Patients underwent solid food fasting after 20: 00 on the night before surgery in both groups and drinking fasting after 21: 30 on the night before surgery in group C. Group P received 800 ml of 12.5% oral carbohydrate at 21: 30 on the night before surgery and 400 ml of oral similar carbohydrate from 5: 00 to 5: 30 in the morning before surgery.All the patients underwent ultrasound examination of the gastric sinus at 7: 30 on the operation day (2 h after oral carbohydrate, T 1) to determine the nature of gastric contents according to the qualitative analysis of images, and Perlas grade was performed, and the cross-sectional area (CSA) of the gastric sinus in a semi-sitting position and right lateral decubitus position was calculated, and gastric volume (GV) and gastric volume to weight ratio (GV/W) were calculated.For solids in the stomach or GV > 1.5 ml/kg was defined as a full stomach.Patients assessed as a full stomach at T 1 underwent antrum ultrasonography again before induction of anesthesia (at 3 h after oral carbohydrate, T 2). The occurrence of satiety at T 1 and T 2 in each group was recorded.The patient′s hunger score, thirst score, and satisfaction score during fasting were recorded at T 2.The reflux aspiration, occurrence of nausea and vomiting at 24 h after operation, postoperative time to first flatus and postoperative total length of hospital stay were recorded. Results:Compared with group C, the CSA in a semi-sitting position, CSA, GV and GV/W ratio in a right lateral decubitus position, incidence of satiety, and Perlas grade were significantly increased at T 1 ( P<0.05), no significant change was found in the incidence of satiety at T 2 ( P>0.05), preoperative hunger and thirst scores were significantly decreased, satisfaction scores were increased, the incidence of nausea and vomiting was decreased at 24 h after surgery, and the postoperative time to first flatus was shortened ( P<0.05), and no significant change in the postoperative total length of hospital stay was found in group P ( P>0.05). Conclusions:Oral carbohydrates before laparoscopic cholecystectomy may result in delayed gastric emptying in the patients with cholelithiasis, and the time window for oral carbohydrates can be appropriately shifted forward (3 h before surgery).

Objective:To evaluate the effects of controlled low central venous pressure (CLCVP) on the cerebral blood flow in the patients undergoing open hepatectomy.Methods:Thirty American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ patients of either sex, aged 18-60 yr, with body mass index of 18-30 kg/m 2, with Child-Pugh classification A and expected operation time of 2-4 h, undergoing elective open hepatectomy, were enrolled.After anesthesia induction, patients were placed at head-up tilt position, nitroglycerin 0.5-1.5 &mu;g·kg -1·min -1 was infused, and furosamide 5-10 mg was intravenously injected when necessary to maintain CVP less than 5 cmH 2O during hepatectomy.After the end of hepatectomy, CLCVP was stopped, the infusion rate was increased to 10 ml·kg -1·h -1 with a crystalline gel ratio of 1∶2 to restore CVP to more than 5 cmH 2O.At 5 min after anesthesia induction (T 0), 5 min after head-up tilt (T 1), 5 and 15 min after CVP reaching the target (T 2, 3) and 5 min after the end of CLCVP (T 4), the blood flow of internal carotid artery was detected by ultrasound, and peak systolic velocity(IBVs), end diastolic velocity (IBVd)and vessel diameter of the internal carotid artery (ID)were measured by doppler ultrasound.Mean velocity [IBVm=(IBVs+ IBVd×2)÷3] and internal carotid artery blood flow [IBF=IBVm×π×(ID/2) 2×HR] were calculated.Heart rate (HR), mean arterial blood pressure (MAP), cardiac output (CO), stroke volume (SV), end-tidal pressure of carbon dioxide (P ETCO 2) and maximum airway pressure (P max) were recorded at each time point. Results:Compared with the baseline at T 0, MAP, CO, SV, IBVm and IBF were significantly decreased at T 2, 3 ( P<0.001), and no significant change was found in HR, P ETCO 2 and P max at T 1-4 ( P>0.05). The results of linear mixed-effects model analysis showed that the regression coefficients for CO, MAP, HR, and SV were 0.600 3, 0.022 88, 0.363 7, and 0.614 8, respectively ( P<0.05 or 0.01). Conclusions:CLCVP can decrease the cerebral blood flow in the patients, which is closely associated with decreased CO, MAP, HR and SV when used for open hepatectomy.

Optimizing operation management mode is the core task to promote the high-quality development of public hospitals.Drawing on the typical experiences and practices of operation and management of representative in-ternational hospitals in the United States,the United Kingdom,Singapore and West China Hospital of Sichuan Univer-sity,Shanghai Jiao Tong University School of Medicine Affiliated Xinhua Hospital,Jilin University China-Japanese Union Hospital of Jilin University,and carrying out a full range of comparative analyses.Put forward the new situation of China's public hospital operations and management to establish a"big operations management"concept.By iden-tifying the operation management role,rationalizing the operation management organization structure and training operation management compound talents to discuss stablishing a committee system,integrating multi-departmental resources to form a scientific and sound problem identificaiton,feedback,consultation and improvement of working mechanism,and promote the high-quality development of publit hospitals.

Comprehensively improving the new efficiency of high-quality development of public hospitals is the key top-level design for deepening the reform of public hospitals during the"14th Five-Year Plan"period.In view of the changes in the macro environment faced by public hospitals in recent years,such as the cancellation of the addi-tion of pharmaceutical consumables and the deep promotion of the reform of payment methods,as well as the out-standing problems existing at the micro level of public hospital operation,such as the separation of diagnosis and treatment business from economic operation activities,extensive decision-making methods,unreasonable alloca-tion of resources and urgent optimization of processes.By referring to relevant theories such as value management theory,a new"trinity"public hospital lean operation management model based on"integration of industry and fi-nance,lean operation and evidence-based decision-making"is explored and constructed.It breaks the relatively parallel operation barriers of clinical diagnosis and treatment business and economic operation management,innovates a new method of linear staff management with the integration of industry and finance,gives full play to the role of experts in governing hospitals,and integrates the professional committee system driven by"technology+manage-men"into the hospital decision-making staff system to provide data evidence-based basis for assisting the hospital leadership to make scientific decisions.

The access evaluation of new medical technology is an important part of the preclinical application of medical technology and plays a vital role in ensuring the quality and safety of medical services.However,in the con-crete practice of access evaluation,there are still some problems such as imperfect access theoretical framework,imperfect evaluation index system.With the strategic support of health policies,laws,and regulations,the theory and method of HB-HTA are used for reference,core elements such as assessment subject,assessment object,and assessment content are comprehensively considered,the index system is designed from the dimensions of tech-nical characteristics,safety,effectiveness,economy and applicability,and the access evaluation framework of im-ported medical new technologies is constructed.To offer a theoretical framework and evidence-based basis for medi-cal facility medical technology access management.

Objective To measure and comprehensively analyze the operation efficiency of coronary heart disease Center of National Regional Medical Center for Cardiovascular Disease from the dimensions of department service in-come,department service quality,department service efficiency and department service benefit,and put forward targeted operation management optimization strategies based on the analysis results.Methods The operation effective-ness evaluation index of CHD centers in sample hospitals from 2020 to 2022 was measured by the empirical re-search method from the overall level of the center and the level of clinical departments,and the scores were com-pared and analyzed.Results From 2020 to 2022,the operation effectiveness evaluation index of CHD centers in sam-ple hospitals showed a good trend,increasing from 80.57 points to 82.86 points.The 3-year average score was 81.74;Among them,the score rate of department service benefit dimension is higher,the average is 96.64％;The score rate of department service efficiency was lower,with an average of 68.53％.The departments with the lowest operational efficiency scores from 2020 to 2022 are all A2 departments,with 74.39,72.41 and 75.89 scores respec-tively,mainly due to the relatively low scores of A2 departments in the dimensions of department service revenue and department service efficiency.Conclusion The results of clinical department operation effectiveness evaluation can provide the evidence-based basis for hospital operation management,and hospitals can establish benchmarking management departments according to the evaluation results and take targeted measures to improve the comprehen-sive operation efficiency of departments.