The family doctor service is an important measure to transform primary health care mode,makes the community health service institutions to take on the gatekeeper role of residents' health and health care costs,and promotes the achievements of hierarchical diagnosis and treatment.At present,there are some difficulties in the process of family doctor service.For example,the construction of the general practitioner team is lagging behind and the residents don't understand the specific contents of the family doctor service well.Medical social workers have both the social work professional skills and medical literacy,which makes them become the effective strength of community health service.Introducing medical social workers by the purchase of the governments,volunteer training,and job settings mode can meet the needs of the development of family doctor service to some extent,and bring in new ideas to the implementation of the family doctor service.

Objective To investigate the possibility of plastic and cosmetic operation incorporating epicanthoplasty with the double-eyelid procedure in one stage to achieve a more subtle scar in epicanthus patients with single eyelid. Methods After designing incision line of the epicanthic flap, double-eyelid line and the lower eyelid incision curved line, we cut the medial canthus skin transversely to reach a new medial canthus point, incised the part of front angle of medial palpebral ligamentum longitudinally and fixed the end point of front angle of medial palpebral ligamentum to nasal dorsum fascia firmly. Double eyelid operation was routinely performed to remove redundant small triangle skin as well as some patchy of orbicularis on the new medial canthus point. Along with eyelid edge about 1 to 2 mm to eyelash, the temporal side was cut with curved line till its disappearance by eyelid's "cat ear". The lower eyelid flap was separated downward and the superfluous flap and some patchy of orbicularis cut. The skin was su-tured to make postoperative scar hidden, blepharophimosis increased and the fold disappeared. Results 46 eyes (23 cases) were operated and satisfactory aesthetic results were obtained. Palpebral fissure was enlarged to 2 to 4 mm with epicanthic scar disappearance and formation of double-eyelid. Conclusions This is a simple and effective procedure with hidden epicanthic scar and the double-eyelid blepharoplasty could be performed simultaneously. Most patients receive satisfactory results during the 0.5 to 2 years' follow-up period except 2 cases with mild proliferation of epicanthus in half a year. It is especially suitable to correct the severe epicanthus palpebralis or epieanthus tarsalis.

Objective To compare the efficacy of small splint fixation and plaster fixation in treating distal radius fracture. Methods One hundred and four cases of type A2 distal radius fracture admitted from January of 2012 to May of 2013 were randomly divided into small splint fixation group and plaster fixation group. After reduction, patients in the two groups were fixed with small splint and plaster separately. Wrist function scores, 36-item Short Form ( SF-36) scores and roentgenographic scores were evaluated for the two groups at different time points. Results ( 1) Within 3 months of follow up, the improvement of wrist function in small splint fixation group was significantly superior to that in plaster fixation group (P<0.05), and the differences of wrist function scores were insignificant between the two groups with the prolongation of follow-up (P>0.05). (2) SF-36 scores of the two groups were gradually increased along with the follow up. After follow-up for one week, 2 weeks, one month and 3 months, the SF-36 scores in small splint fixation group were significantly higher than that in plaster fixation group ( P<0.05) , but there was no significant difference after 6 months ( P>0.05). ( 3) After follow up for one year, the excellent rate for roentgenographic scores was higher than 80% in both groups, and there was no significant difference between the two groups (P>0.05). Conclusion Both small splint fixation and plaster fixation have satisfacory efficacy in treating type A2 distal radius fracture. But during the therapeutic process, wrist function scores and life quality scores in the small splint fixation group were higher than those in the plaster fixation group.

BACKGROUND: Splint fixation was a common treatment for limb fracture, but there were some limitations, such as lack of individual difference, easy to lose and being unable to self-adjusting.OBJECTIVE: To explore the design method of digital splint and related finite element analysis.METHODS: Forearms were scanned with CT; periphery parameters were extracted, followed by reverse modeling and modifying. The digital splint models were constructed. Material attribute and mechanical loading were conducted. Thelimb length, maximum stress and displacement of the bone, soft tissue and splint were calculated by finite elementanalysis. RESULTS AND CONCLUSION: The digital splint has favorable tight attaching and balanced stress to skin, and whichkeeps well stability for the micro-motion fracture ends. Our study indicated that better tight attaching splint could bedesigned by digital modeling technology. Favorable fracture fixation and mechanical property could be also achieved.

Objective:To analyze the causes of hypoglycemia in elderly patients after resection of gastrointestinal polyps.Methods:We retrospectively analyzed the data of 120 elderly patients who underwent gastrointestinal polypectomy in our hospital from November 2019 to November 2020, and analyzed the reasons for postoperative hypoglycemia.Results:(1)There were significant differences between the hypoglycemic group and the non-hypoglycemic group in age, diabetes, preoperative fluid replacement, preoperative fasting time, preoperative waiting time, preoperative emotional instability, and preoperative night sleep time(all P<0.05). (2)Logistic regression analysis showed that postoperative hypoglycemia was associated with age >70 years( OR=4.266, 95% CI: 1.120-16.162); Diabetes mellitus( OR=4.094, 95% CI: 1.311-12.773); No fluid was taken before surgery( OR=10.923, 95% CI=2.882-41.386); Preoperative fasting time ≥10 h( OR=9.042, 95% CI: 2.571-31.645); Preoperative wait time ≥12 h( OR=7.035, 95% CI: 1.855-26.651); Preoperative emotional instability( OR=4.25, 95% CI: 1.263-14.370); The preoperative night sleep time <6 h( OR=5.952, 95% CI: 1.760-19.992)was closely related(all P<0.05). Conclusions:There are many reasons for the occurrence of hypoglycemia in elderly patients after gastrointestinal polyp removal.Therefore, evaluation work should be done and preventive measures should be taken to reduce the occurrence of hypoglycemia and ensure the effectiveness and safety of treatment for patients.

OBJECTIVE: To evaluate the surgical management for the severe stenosis of peripheral esophageal access. METHOD: Twenty-three patients who underwent severe stenosis of peripheral esophageal access from 2000 to 2009, were retrospectively reviewed. The surgical plan was selected by considering the stage of stenosis, dilatation, reconstruction of hypopharynx, oesophagus or larynx. RESULT: Twenty-two patients resumed a normal oral diet and 21 cases succeeded in decannulation, no stenosis recurred after a 1-9 years follow-up. CONCLUSION The severe stenosis of peripheral esophageal access can get good results when the appropriate surgical plan were choice.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Esophageal Stenosis ; surgery ; Esophagoplasty ; Female ; Humans ; Infant ; Male ; Middle Aged ; Pharyngeal Diseases ; surgery ; Retrospective Studies ; Young Adult

Objective:To investigate the mechanism of Xianglian Huazhuo Decoction in treating chronic atrophic gastritis (CAG) rats by detecting the protein and gene expressions of Wnt1, GSK-3β, β-catenin in Wnt signaling pathway.Methods:Totally 60 Wistar rats were randomly divided into blank group and model group. The CAG model was established by MNNG free drink combined with sodium salicylate gavage combined with abnormal hunger and satiety. After model establishment, the rats were randomly divided into model group, Xianglian Huazhuo Group and folic acid group. Folic acid group received the folic acid water solution 1.3 mg/kg for gavage; the Xianglian Huazhuo Group received Xianglian Huazhuo Decoction 15.5 g/kg for gavage; the blank group and the model group received the same volume of purified water for gavage. After 8 weeks of intervention, the general state and the atrophic degree of gastric mucosa were observed. The expressions of Wnt1, GSK-3β and β-catenin were detected by immunohistochemical method, and the mRNA expression of β-catenin expression was detected by real-time quantitative polymerase chain reaction PCR.Results:The general condition of rats in Xianglian Huazhuo group was improved, the atrophy of gastric mucosa was improved, and the effect was better than that in folic acid group. Compared with the model group, the positive area ratio of Wnt1 decreased in Xianglian Huazhuo group ( P<0.05), and the positive area ratio of β-catenin decreased in folic acid group and Xianglian Huazhuo group ( P<0.05 or P<0.01), the positive area ratio of GSK-3β increased ( P<0.05), and the β-catenin mRNA level of Xianglian Huazhuo group decreased ( P<0.05). Conciusion 　Xianglian Huazhuo Decoction may increase GSK-3β by downregulating abnormal expression of Wnt1, promoting β-catenin to degrade normally, thereby blocking the abnormal activation of the Wnt signaling pathway, delaying or reversing CAG carcinogenesis to a certain extent, and exerting therapeutic effects.

Objective To explore the prognostic value of early relevant clinical indicators in hemoperfusion patients with severe acute organophosphorus poisoning(AOPP).Methods The clinical data of 91 patients with severe AOPP admitted to Baoding NO.2 Central Hospital from March 2018 to October 2022 were retrospectively analyzed,including gender,age,comorbidities,body mass index(BMI),amount of drug taken,time from drug taking to gastric lavage,number of hemoperfusion,white blood cell count(WBC),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),blood urea nitrogen(BUN),serum cholinesterase(ChE)activity,lymphocyte count,pH value,arterial partial pressure of carbon dioxide(PaCO2),arterial partial pressure of oxygen(PaO2),blood K+,Na+,Cl-and inflammatory cytokine levels,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ),Glasgow coma scale(GCS),the occurrence of complications.The patients were divided into the death group and the survival group according to the prognosis within 72 hours.Differences in early clinical indicators between the two groups were compared,independent risk factors affecting the short-term prognosis of AOPP patients were analyzed by multivariate Logistic regression,and the predictive efficacy of each risk factor on the prognosis of patients was analyzed by plotting the receiver operator characteristic curve(ROC curve).Results The age of the death group was significantly higher than that of the survival group,the proportion of complicated with coronary heart disease,patients with dose of poison,time from poison to gastric perfusion,WBC,ALT,TNF-α,IL-1β and IL-6 levels at admission were significantly higher than those in survival group,and the number of hemoperfusion,TBil,ChE activity,PaCO2 were significantly lower than those in survival group(all P<0.05).Multivariate Logistic regression analysis showed that dose of poison,number of hemoperfusion,ALT,ChE activity and TNF-α were independent risk factors for poor prognosis in AOPP patients[odds ratio(OR)and 95％confidence interval(95％CI)were 1.865(1.032-3.370),2.282(1.406-3.703),2.522(1.258-5.057),2.843(1.036-7.802),2.077(1.107-3.897),respectively,all P<0.05];ROC curve analysis showed that dose of poison,number of hemoperfusion,ALT,ChE activity,TNF-α and the above combined indicators had certain predictive value for the prognosis of AOPP patients,and the combined detection had the highest predictive value,area under the ROC curve(AUC)=0.976,95％CI was 0.919-0.996.AOPP exhibited a sensitivity of 100.0％and a specificity of 85.7％,all P<0.05.With the increase of hemoperfusion times,compared with admission,the levels of WBC,ALT,AST,TBil,serum creatinine(SCr),ChE activity,TNF-α,IL-1β and IL-6 showed a significant decrease trend,while the levels of PaCO2 and PaO2 showed a significant increase trend(all P<0.05).Conclusion The early dose of poison,number of hemoperfusion,ALT,ChE activity,and TNF-α in severe AOPP patients can help predict short-term prognosis.