Morita therapy has been bom for more than 100 years.Inpatient Morita therapy is highly oper-able and easy to master.It can improve many refractory neuroses through four-stage treatment.But more neuroses are treated in outpatient clinics,and Morita therapy cannot be used in hospitalized patients.Therefore,the formula-tion of expert opinions on outpatient operations is particularly important.This paper is based on domestic and for-eign references,and after many discussions by domestic Morita therapy experts,and then drew up the first version of the expert opinions on operation of outpatient Morita therapy.Meanwhile the operation rule of Morita therapy in three stages of outpatient treatment was formulated:in the etiological analysis stage,under the theoretical guidance of Morita therapy,analyze the pathogenic factors,to improve treatment compliance and reduce resistance;during the operating stage,guide patients to engage in constructive and meaningful actions,realizing the achievement of letting nature take its course principle;in the cultivating character and enriching life stage,pay attention to positive infor-mation,expanding the scope and content of actions,improving the ability to adapt to complex life,and preventing recurrence caused by insufficient abilities.It will lay a foundation for the promotion of Morita therapy in domestic outpatient clinics,so that more patients with neurosis and other psychological diseases could receive characteristic Morita therapy treatment in outpatient clinics.

Objective:To evaluate multi-channel transcatheter embolotherapy for type Ⅱ endoleak originating from lumbar arteries after endovascular abdominal aortic aneurysm repair (EVAR).Methods:Data of 8 cases of type Ⅱ endoleak after EVAR from Oct 2017 to Nov 2020 at the Department of Vascular and Endovascular Surgery, Henan Provincial People's Hospital were retrospectively analyzed.Results:All patients who suffered from type Ⅱ endoleak that originated from lumbar arteries after EVAR were successfully treated with coils and mixture of Compant medical glue and iodipin through multi-channel. The technical success rate was 100%, the operative time was 80-150 min. Right lower limb dyskinesia occurred in 1 patient after operation, the symptom disappeared by anticoagulation and trophic neurotherapy for 2 months. Type Ⅱ endoleak didn't recur in all patients, and no mortality during the 4-38(14.1) months follow-up period.Conclusion:Multi-channel transcatheter embolotherapy has definite effects for the treatment of type Ⅱ endoleak from lumbar arteries after EVAR, with high technical feasibility, few perioperative complications, low mortality among other advantages. The results of short and medium term are satisfactory.

Objective:To explore the clinical effect of pre-expanded flap on the treatment of perioral scar.Methods:The clinical data on the treatment of perioral scar with pre-expanded flap in the Department of Plastic and Reconstructive Surgery of the First Affiliated Hospital of Air Force Medical University from March 2009 to July 2019 were analyzed retrospectively. The pre-expanded flap composed of the pre-expanded local flap, the pre-expanded deltopectoral flap, the pre-expanded submental flap, and the pre-expanded frontal branch flap of the superficial temporal artery. Generally, the surgical procedure was divided into three stages, which included stage one: skin soft tissue expander implantation; stage two: pre-expanded flap design and transfer; stage three: delay of pre-expanded skin flap, and the amputation of the pedicle. The pre-expanded local flap did not require cutting off the pedicle. Selective laser hair removal was applied to pre-expanded frontal branch flap of superficial temporal artery to repair the scar. The blood circulation and the survival of the metastatic flap were observed after the operation. The appearance and function of the donor and recipient areas were followed up.Results:A total of 47 patients aged between 7 to 50 years old comprising 21 males and 26 females with perioral scars were enrolled, with an average age of 20 years old. Eight cases were treated with pre-expanded local flap. Twenty five cases were treated with pre-expanded deltopectoral flap, 3 cases were treated with pre-expanded deltopectoral flap combined with a pre-expanded local skin flap, 5 cases were treated with pre-expanded submental flap, 6 cases were treated with pre-expanded frontal branch flap of the superficial temporal artery. Postoperative follow-up time ranged from 3 to 108 months (mean 57 months). In all the patients, the perioral scars were repaired, with significant alleviation in mouth opening limitation. The color and texture of the transferred flap were similar to the surrounding skin, and the appearance was satisfactory.Conclusions:The pre-expanded flap is a good approach for the treatment of perioral scar.

Objective:To explore the clinical effect of pre-expanded flap on the treatment of perioral scar.Methods:The clinical data on the treatment of perioral scar with pre-expanded flap in the Department of Plastic and Reconstructive Surgery of the First Affiliated Hospital of Air Force Medical University from March 2009 to July 2019 were analyzed retrospectively. The pre-expanded flap composed of the pre-expanded local flap, the pre-expanded deltopectoral flap, the pre-expanded submental flap, and the pre-expanded frontal branch flap of the superficial temporal artery. Generally, the surgical procedure was divided into three stages, which included stage one: skin soft tissue expander implantation; stage two: pre-expanded flap design and transfer; stage three: delay of pre-expanded skin flap, and the amputation of the pedicle. The pre-expanded local flap did not require cutting off the pedicle. Selective laser hair removal was applied to pre-expanded frontal branch flap of superficial temporal artery to repair the scar. The blood circulation and the survival of the metastatic flap were observed after the operation. The appearance and function of the donor and recipient areas were followed up.Results:A total of 47 patients aged between 7 to 50 years old comprising 21 males and 26 females with perioral scars were enrolled, with an average age of 20 years old. Eight cases were treated with pre-expanded local flap. Twenty five cases were treated with pre-expanded deltopectoral flap, 3 cases were treated with pre-expanded deltopectoral flap combined with a pre-expanded local skin flap, 5 cases were treated with pre-expanded submental flap, 6 cases were treated with pre-expanded frontal branch flap of the superficial temporal artery. Postoperative follow-up time ranged from 3 to 108 months (mean 57 months). In all the patients, the perioral scars were repaired, with significant alleviation in mouth opening limitation. The color and texture of the transferred flap were similar to the surrounding skin, and the appearance was satisfactory.Conclusions:The pre-expanded flap is a good approach for the treatment of perioral scar.

Objective:To explore the feasibility, safety and effectivity of applying transmesenteric vein extrahepatic portosystemic shunt (TEPS) to treat extrahepatic portal vein obstructive disease (EHPVOD).Methods:From December 2020 to April 2021, 12 patients with EHPVOD in the Vascular Surgery Department of Zhengzhou University People′s Hospital were prospectively enrolled in the study. The infra-umbilical median longitudinal minilaparotomy was performed to expose the branch of superior mesenteric vein (SMV). RUPS-100 was introduced into the trunk of SMV. A balloon with a diameter of 20 mm was introduced through right internal jugular vein (RIJV) into inferior vena cava (IVC). Under fluoroscopy, RUPS-100 was used to puncture the balloon in IVC. A stiff guide wire was used to establish the pathway between RIJV and SMV. Finally the portosystemic shunt between IVC and SMV was established with a covered stent-graft. The total operative time, the time of establishing portosystemic shunt alone, the dosage of contrast agent, the preoperative and postoperative pressure of SMV were recorded. Paired t test was used to compare the preoperative and postoperative pressure of SMV. Results:All 12 patients were successfully performed TEPS. The total operative time was (113±32) min, the time of establishing portosystemic shunt alone was (31±5) min, the dosage of contrast agent was (129±48) ml. The postoperative pressure of SMV [(14.3±2.1) mmHg] decreased significantly ( t=20.125, P<0.01) compared to baseline [(27.8±2.7) mmHg]. All portal hypertension symptoms released after the operations.There was 1 case of delayed incision healing, 1 case of bacteremia and 1 case of slight hepatic encephalopathy, but all of them were cured. There was no death case. Postoperative CT showed all portosystemic shunts were patent. Conclusion:TEPS is a new, safe, effective and feasible treatment method for patients of acute and chronic EHPVOD.

Objective:To observe the denervation and reinnervation of the neuromuscular junction (NMJ) and muscle spindle after sciatic nerve crush in mice.Methods:From January, 2019 to October, 2019, 18 C57BL/6 mice were randomly and evenly divided into injured groups (sciatic nerve crush group, 12 mice) and control groups (sham group, 6 mice). Mice in the injured group were sacrificed at day-1, day-2, day-3 and 4 weeks after the sciatic nerve injury. Mice in the control group were sacrificed at day-3 and 4 weeks from the day of experiment. The tibialis anterior muscles with crushed nerve were collected for immunohistochemistry staining by neurofilament (NF), synaptophysin (Syn) and α-bungarotoxin (α-BTX). Data were analysed by unpaired t-test. P<0.05 was considered significant difference. Results:The completely denervation of NMJ reached (92.4±8.85)% at day-3 after the nerve crush, compared with (5.19±1.32)% in the control group ( P<0.05). However, the muscle spindle lost γ-motor neuron innervation at day-2 after the nerve crush and completely denervated at day-3 after the surgery. For the reinnervation, no difference of no reinnervation of NMJ [(3.02±0.78)% vs. (4.22±2.08)%], partial reinnervation of NMJ [(6.44±1.91)% vs. (7.94±2.12)%] and completely reinnervation of NMJ [(90.54±10.44)% vs. (87.84±13.89)%] were observed between the control group and the injured group 4 weeks after the injury. While, for the muscle spindle, only the acetylcholine receptors at each end were partly reinnervated. The innervation of the middle part of the muscle spindle was thin and discontinued without typical spiral winding structure. Conclusion:The denervation speed of NMJ and muscle spindle was comparable after the peripheral nerve injury. The γ-motor neuron lost innervation ahead of the sensory neuron in the muscle spindle. The reinnervation of NMJ is earlier than that of the muscle spindle, and the re-innervation of the γ-motor neuron is prior to the sensory neuron in the muscle spindle.

Objective To investigate the application of expanded local flap in repairing extremity scars.Methods Thirty patients with extremity scars contracture as a result of trauma,surgery or infection during July 2000 and March 2013 were included.There were 11 male and 19 female patients with age ranging from 11 to 34 years.Tissue expansion,scar resection,flap transfer and scar management were involved in this process.Results There 24 patients suffered from upper extremity scars and 6 patients suffered from lower extremity scars.Expander exposure was noted in 3 patients,and 3 patients suffered from infection during the expansion.During the 6-month to 1-year follow-up,all patients satisfied with the results in terms of the skin texture,color,flexibility after the treatment with expanded local skin flap.Conclusions The expanded local flaps are suitable for the repair of the longitudinal and oblique scars in the extremities.

Objective To investigate the characteristics of brain network based on brain electrical activity induced by somatosensory electrical stimulation,and to provide a theoretical basis for further understanding the mechanism of brain neural plasticity induced by somatosensory electrical stimulation.Methods Ten healthy subjects were selected and a somatosensory electrical stimulation experiment was constructed based on the directed transfer function (DTF).In the experiment,the DTF causal connection matrixes of the 32-channel EEG data of Delta,Theta,Alpha and Beta bands were obtained under the somatosensory electrical target and non-target stimulation,and the differences of clustering coefficient and global efficiency between two stimulation states were contrasted based on graph theory.Results Under the target stimulation and non-target stimulation states,the regions with stronger DTA causal connections were mainly concentrated in FCz,Cz,CPz and Pz channels.The causal connection intensity under target stimulation state was greater than that of non-target stimulation.Also,in the Delta,Theta,and Alpha bands,the clustering coefficient under the target stimulation state was significantly higher than that in the non-target stimulation state (P＜0.05).In the Delta and Theta bands,the global efficiency of the target stimulation state was significantly higher than that of the non-target stimulation state (P＜0.05).Conclusions Somatosensory electrical stimulation can activate and induce EEG brain networks.In the target stimulation state,the role of the parietal lobe in the EEG causal network is enhanced,which helps to induce attention to specific brain region plasticity,and thus realizing the nerve rehabilitation in the brain regions of interest.While in the non-target stimulation state,the synergistic interactions between brain regions were enhanced,which helps to activate and induce a wide range of associations in the whole brain network,so as to promote the global neural activity in the brain.

Objective To observe the effect of botulinum toxin type A (BTX-A) on the rate of skin expansion and the immediate retract rate of skin flaps in rats,and to explore new methods for drug-assisted skin expansion.Methods 18 Sprague-Dawley rats were randomly divided into two groups.After BTX-A or normal saline was injected intradermally into the back marking area,an expander was implanted.The expanders were inflated periodically by injecting normal saline to reach the designated intraexpander pressure.The inflation volume was recorded and the area of marked region was measured regularly.After 4 weeks of expansion,the expanded tissues were harvested and the immediate retract rates were measured.The hematoxylin-eosin staining was performed to observe the thickness of epidermis,dermis and the fibrous capsule,while Masson staining for detection of fibrous capsule collagen.Immunohistochemical staining with α-smooth muscle actin for myofibroblasts was also performed.Results The mean inflation volume and area of marked region of BTX-A group were significantly greater than those of the control group.There were lower immediate retract rate,thinner fibrous capsule,less collagen content and fewer α-SMA positive myofibroblasts in the fibrous capsule of the BTX-A group with statistically significant differences (P ＜ 0.05).There was no signigicant difference in the thicknesses of epidermis and dermis between the two groups (P＞0.05).Conclusions BTX-A can inhibit the formation of fibrous capsule to promote skin expansion,while reducing the immediate retract rate.It possess a potential for assisting effectively skin expansion.

Objective To investigate the efficacy and safety of enriched-calorie formula in post-operative infants with congenital heart disease and malnutrition.Methods All malnourished infants less than 6 months diagnosed congenital heart disease: ventricular septal defect and had undergone surgery in Guangzhou Women and Children`s Medical Center from December 1,2014 to May 30,2015 were included in this study.All cases were randomly divided into intervention group(energy-enriched formula,intervention group)and control group(standard formula,control group)for enteral nutrition intervention and observed for 3 months.Body mass,body length,upper arm circumference,blood prealbumin(PA),retinol binding protein(RBP),and B-terminal pro-brain natriuretic peptide(NT-proBNP)were measured before and after ICU,after discharge,and 1 month and 3 months after operation.Results Fifty-one cases were in intervention group and 50 cases in control group,respectively.There were no significant differences in body mass,body length,arm circumference,PA,RBP,mean enteral nutrition starting time,mechanical ventilation time,length of ICU stay,hospitalization time,and average fluid intake between the two groups(all P>0.05).The average caloric intake in intervention group was significantly higher than in control group [(437.24±6.68)kJ vs.(312.43±86.22)kJ,P=0.001].There was no significant difference in NT-proBNP,PA,and RBP at different time points between the two groups(all P>0.05).The improvement of nutrition in intervention group was significantly higher than that in control group at 1 month(25.0％vs.4.9％,P=0.011)and 3 months(64.1％vs.15.7％,P<0.001)after operation.Body mass increased in intervention group [(0.067±0.348)kg] compared with that in control group,and decreased [(0.125±0.425)kg] in control group(P=0.015).Body weight[(5.46±1.36)kg vs.(4.80±1.01)kg,P=0.008],weight for age Z score(WAZ)(-2.79±1.28 vs.-3.75±1.27,P<0.001),and height for weight Z score(WHZ)(-2.47±1.43 vs.-3.62±1.77,P=0.001)one month after surgery were significantly higher than those before operation.Body weight [(6.78±1.42)kg vs.(5.72±1.01)kg,P<0.001] arm circumference [(12.80±1.17)cm vs.(12.00±0.90)cm,P<0.001],WAZ(-1.60±1.17 vs.-3.10±1.40,P<0.001),height for age Z score(HAZ)(-1.41±1.63 vs.-2.10±1.41,P=0.034),and WHZ(-0.86±1.31 vs.-2.59±2.13,P<0.001)of the two groups at 3 months postoperative were significantly higher than those before operation,and the growth rate of intervention group was faster than control group.There were no significant adverse reactions in both groups.Conclusion Calorie-enriched formula powder can help malnourished infants to catch up after congenital heart disease surgery.