Objective:To evaluate the efficacy of digitally assisted design of surgical template for fibular composite tissue flap in reconstruction of segmental mandibular defect with soft tissue defect.Methods:A retrospective analysis was conducted on 30 patients who were treated at the Department of Otolaryngology Head and Neck Surgery, the 920th Hospital of the Joint Logistics Support Force of Chinese PLA from July 2020 to May 2024 for segmental mandibular defects combined with soft tissue defect. The cohort comprised 19 males and 11 females and aged 11-71 years (44.33 years±15.31 years). Pathological diagnoses of the patients were ameloblastoma (14 cases), squamous cell carcinoma (9 cases), osteomyelitis (4 cases), and odontogenic keratocyst (3 cases). Primary reconstructive surgery were performed on 21 patients after surgical resection of lesions, and 9 patients received secondary reconstructive surgery. The length of mandibular defect ranged from 75.83 mm to 111.45 mm (87.31 mm±12.00 mm), and soft tissue defects were measured at 5.0 cm×1.8 cm to 8.6 cm×2.1 cm (mean area 13.63 cm 2±2.42 cm 2). Preoperative CTA was performed to locate the perforator of peroneal artery and for design of digital surgical template. Intraoperatively, a modified fibula composite tissue flap harvesting technique was employed and that involved in: CTA-guided perforator planning, fibula osteotomy, anterior intermuscular septum exposure for identifying the peroneal artery, and a digital template-assisted fibula crafting for reconstruction of mandibule and soft tissue defect. Postoperative follow-ups were conducted at 1, 3, and 6 months, followed by quarterly reviews at outpatient clinic or via telephone interviews. Statistical analysis was performed using SPSS 27.0 software with descriptive statistical methods. Results:After surgery, all the fibula composite tissue flaps were viable and the incision wound healed well. Two patients had partial necroses at distal edge of the flaps, and they were healed after treatment. One patient had donor site infection and healed after anti-infective treatment. One month after the surgery, patients were assessed according to the recovery of face, mouth opening and occlusion, of which 25 patients (83.3%) were rated of Grade I, 4 (13.3%) of Grade Ⅱ, and 1 (3.4%) of Grade Ⅳ, with an excellent and good rates of 96.6%. The average distance of condylar movement on the affected side was 1.28 mm±0.35 mm. Postoperative follow-up lasted for 10 to 22 months, with 19.17 months±2.14 months in average. Assessment at the final follow-up was found that a total of 26 patients (86.8%) were of Grade I, 3 (10.0%) of Grade Ⅱ, and 1 (3.3%) of Grade Ⅳ and all the transferred fibula showed good alignment with the mandible over the postoperative follow-up period.Conclusion:Digital template-assisted design of fibular composite tissue flap enables a precise vascular protection, individualised osteotomy and functional restoration in reconstruction of segmental mandibular defect with soft tissue defect. It demonstrates a high clinical feasibility.

Objective:To evaluate the efficacy of digitally assisted design of surgical template for fibular composite tissue flap in reconstruction of segmental mandibular defect with soft tissue defect.Methods:A retrospective analysis was conducted on 30 patients who were treated at the Department of Otolaryngology Head and Neck Surgery, the 920th Hospital of the Joint Logistics Support Force of Chinese PLA from July 2020 to May 2024 for segmental mandibular defects combined with soft tissue defect. The cohort comprised 19 males and 11 females and aged 11-71 years (44.33 years±15.31 years). Pathological diagnoses of the patients were ameloblastoma (14 cases), squamous cell carcinoma (9 cases), osteomyelitis (4 cases), and odontogenic keratocyst (3 cases). Primary reconstructive surgery were performed on 21 patients after surgical resection of lesions, and 9 patients received secondary reconstructive surgery. The length of mandibular defect ranged from 75.83 mm to 111.45 mm (87.31 mm±12.00 mm), and soft tissue defects were measured at 5.0 cm×1.8 cm to 8.6 cm×2.1 cm (mean area 13.63 cm 2±2.42 cm 2). Preoperative CTA was performed to locate the perforator of peroneal artery and for design of digital surgical template. Intraoperatively, a modified fibula composite tissue flap harvesting technique was employed and that involved in: CTA-guided perforator planning, fibula osteotomy, anterior intermuscular septum exposure for identifying the peroneal artery, and a digital template-assisted fibula crafting for reconstruction of mandibule and soft tissue defect. Postoperative follow-ups were conducted at 1, 3, and 6 months, followed by quarterly reviews at outpatient clinic or via telephone interviews. Statistical analysis was performed using SPSS 27.0 software with descriptive statistical methods. Results:After surgery, all the fibula composite tissue flaps were viable and the incision wound healed well. Two patients had partial necroses at distal edge of the flaps, and they were healed after treatment. One patient had donor site infection and healed after anti-infective treatment. One month after the surgery, patients were assessed according to the recovery of face, mouth opening and occlusion, of which 25 patients (83.3%) were rated of Grade I, 4 (13.3%) of Grade Ⅱ, and 1 (3.4%) of Grade Ⅳ, with an excellent and good rates of 96.6%. The average distance of condylar movement on the affected side was 1.28 mm±0.35 mm. Postoperative follow-up lasted for 10 to 22 months, with 19.17 months±2.14 months in average. Assessment at the final follow-up was found that a total of 26 patients (86.8%) were of Grade I, 3 (10.0%) of Grade Ⅱ, and 1 (3.3%) of Grade Ⅳ and all the transferred fibula showed good alignment with the mandible over the postoperative follow-up period.Conclusion:Digital template-assisted design of fibular composite tissue flap enables a precise vascular protection, individualised osteotomy and functional restoration in reconstruction of segmental mandibular defect with soft tissue defect. It demonstrates a high clinical feasibility.

Objective:To investigate the correlation between serum uric acid/high density lipoprotein cholesterol (URH) and diabetic nephropathy in patients with type 2 diabetes mellitus (T2DM) .Methods:According to urinary albumin creatinine ratio, 171 patients with T2DM were divided into simple T2DM group (group A1), microalbuminuria group (group A2) and macroalbuminuria group (group A3). The general data, HbA1c, biochemical indices were compared, and URH was calculated.Results:The systolic blood pressure, diastolic blood pressure, SUA, TG and URH of A1 group were lower than those of the other two groups [ (129.7±15.78) vs (141.65±16.04) vs (147.31±17.01) mmHg, (78.9±10.71) vs (83.79±10.67) vs (84.61±12.19) mmHg, 291.5 (253.75, 351.25) vs 346 (280, 409) vs 344.5 (274.75, 425.75) μmol/L, 26.12 (19.71,32.96) vs 33.45 (26.55,42.2) vs 33.45 (26.55,42.2) ] ( P<0.05). HDL-C was higher than those of the other two groups [1.19 (1.02,1.29) vs1.02 (0.87,1.21) vs 1.07 (0.93,1.25) mmol/L] ( P<0.05), the course of disease and SCr of group A3 were higher than those of the other two groups [10.5 (7.25, 15) vs 8.5 (4,12) vs 8 (3,11) years; 82.5 (70.57,101.75) vs 66 (52.75,73.75) vs 64 (51, 84) μmol/L ] ( P<0.05), and eGFR was lower than those of the other two groups [91.63 (67.09, 112.21) vs 116.7 (96.6, 142.53) vs 109.85 (85.64, 152.39) ml/min/1.73 m 2] ( P<0.05). There were no significant differences in gender, smoking history, drinking history, age, BMI, TC, LDL-C, BUN, FPG or HbA1c among different groups (P> 0.05). Correlation analysis showed that the course of disease, systolic blood pressure, diastolic blood pressure, TG, SUA, URH were positively correlated with UACR, while HDL-C was negatively correlated with UACR. Logistic regression analysis showed that course of disease was a risk factor for macroproteinuria, while systolic blood pressure and URH were risk factors for microproteinuria and macroproteinuria. ROC curve showed that the AUC value of URH was the highest, and the accuracy rate was 69.3%. Conclusions:URH is closely related to the occurrence of DKD and is a risk factor of DKD. Dynamic monitoring of URH in T2DM patients is helpful for early screening of DKD, which is superior to SUA and HDL-C.

Objective To explore the effect of compound Xueshuantong capsule Dendrobium luminous pill combined with amiotide eye drops in the treatment of vitreous opacity.Methods According to the digital table, 120 patients with vitreous opacity were divided into two groups,60 cases in each group.The control group was given conventional amiotide eye drops treatment,and the observation group was given compound Xueshuantong capsule Den-drobium luminous pill for treatment on the basis of conventional therapy.The clinical effect was observed and com-pared after treatment.Results The total effective rate in the observation group was 66.67%,which was significantly higher than 38.33% of the control group(χ2 =9.09,P <0.05).The total effective rate of young patients in the obser-vation group was 78.79%,which was significantly higher than 51.85% of the elderly patients(χ2 =8.24,P <0.05). The vitreous opacities total effective rate of the observation group after treatment within two years was 58.33%,which was significantly higher than 28.33% of the control group(χ2 =11.67,P <0.05).Conclusion Compound Xue-shuantong capsule Dendrobium luminous pill combined with ammonia iodine peptide drop has a positive effect in the treatment of ocular fluid of vitreous opacity,improve the clinical total effective rate,recovery of affected vision,and avoid the recurrence of vitreous opacity after operation,has the advantages of safety,effectiveness,which should be widely applied in clinic.

Objective To analyze risk factors and antimicrobial use for hospital-acquired pneumonia (HAP)due to multidrug-resistant organisms (MDROs)in an intensive care unit(ICU),so as to perform risk assessment and guide antimicrobial use.Methods From January 2012 to December 2013,HAP patients were conducted retrospective co-hort study,risk factors for MDRO-HAP and rationality of antimicrobial use were analyzed.Results A total of 110 cases of HAP occurred in ICU,63 cases (57.27%)were MDR-HAP.Logistic regression analysis revealed that re-cent hospital stay ≥5 days (OR=19.94),transference from other hospitals (OR =19.33),infection type of late-onset HAP (OR=7.98),and antimicrobial use in recent 90 days (OR =3.42)were independent risk factors for MDR-HAP.Initial empirical anti-infective treatment revealed that there were no significant difference in timing of antimicrobial administration within 24 hours after clinical diagnosis was confirmed,and rationality of antimicrobial selection between MDR-HAP group and non-MDR-HAP group (both P >0.05);The isolation rate of pathogens in MDR-HAP group was lower than non-MDR-HAP group (73.02% vs 91 .49% P <0.05 ).Targeted antimicrobial therapy revealed that there were no significant difference in selection,dosage,and frequency of antimicrobial use be-tween two groups(all P >0.05 );the rationality rate of therapy course in MDR-HAP group was higher than no-MDR-HAP group,but rationality rate of combination use of antimicrobial agents was slightly lower than the latter (both P < 0.05 ).Conclusion Patients in ICU should be conducted risk factor assessment,and according prevention and control measures should be formulated,so as to reduce the occurrence of MDR-HAP,health care workers should standardized the initial empirical anti-infective treatment.

Objective To evaluate the effect of plan-do-check-act (PDCA)cycle method in improving disinfection efficacy of object surface in intensive care unit (ICU).Methods On the basis of management of healthcare-associat-ed infection (HAI)and prevention of multidrug-resistant organisms,disinfection efficacy of object surface in an ICU was intervened,data about surface object specimens taken before,during,and after intervention,HAI in patients, as well as detection of MDROs were collected.Results The total qualified rate of specimens taken before,during, and after intervention was 58.24%,76.74%,and 88.71 %,respectively,there was an increased tendency,the difference was significant (χ2 =17.41 ,P =0.009);the incidence of HAI was 3.72%,2.42%,and 1 .78%,respec-tively,there was a decreased tendency(χ2 =6.03,P =0.039),case infection rate was 4.36%,2.75%,and 2.37%respectively,there was a decreased tendency (χ2 = 7.24,P = 0.046 );detection rate of MDROs was 34.03%, 27.45%,and 14.05%,respectively,there was a decreased tendency (χ2 =33.84,P =0.007),the percentage of pa-tients who were detected MDROs and HAI caused by MDROs showed a decreased tendency(χ2 =6.14,6.02,both P<0.05).Conclusion The implementation of PDCA cycle can effectively improve disinfectant efficacy of ICU object surface,and reduce the incidence of MDRO HAI.