Objective:To evaluate the structural features, stability and postoperative effect of integrated framework, 1+ 1 framework, 2+ 1 framework, 4+ 1 framework, and Y-shaped nasal framework.Methods:A retrospective analysis was performed based on the clinical data of patients underwent in Department of Plastic and Aesthetic (Burn) Surgery, the Second Xiangya Hospital, Central South University from February 2019 to November 2020. According to rhinoplasty framework, the patients were divided into integrated framework group, 1+ 1 framework group, 2+ 1 framework group, 4+ 1 framework group, and Y-shaped framework group. Based on the principle of plane photography, the stability of the nasal framework was evaluated by measuring the nasal tip projection and the nasolabial angle 1 month after surgery, and 12 months after surgery. The satisfaction of patients and the incidence of postoperative complications were collected. The difference in nasolabial angle and nasal tip projection data of postoperation 1 month and postoperative 12 months among each group were analyzed by one-way analysis vaniance or Kruskal-Waliis H test.Bonferroni test or Nemenyi test was used for pairwise comparison between groups. P< 0.05 was considered statistically significant. Results:A total of 201 patients (18 males and 183 females, aged 18-46 years, average aged 26.6±5.9 years)were included in this study and followed up for 12-21 months. There were 45 patients in the integrated framework group, 45 patients in the 1+ 1 framework group, 34 patients in the 2+ 1 framework group, 35 patients in the 4+ 1 framework group, and 42 patients in the Y-shaped framework group. Four patients with Y-shaped framework had significant nasal tip supination 12 months after surgery. Among the patients with 1+ 1 framework, 1 patient showed slight columella distortion 6 months after surgery, and 3 patients showed significant nasal tip subrotation 12 months after surgery. One patient in 2+ 1 framework group developed nasal infection 92 days after surgery. No complications were found in other groups during follow-up. In terms of nasal tip projection during postoperative follow-up, the median difference of nasal tip projection between 12 months and 1 month after surgery in 2+ 1 framework group, integrated framework group, 1+ 1 framework group, and 4+ 1 framework group, and Y-shaped framework group was -0.08 cm, -0.09 cm, -0.20 cm, -0.10 cm and -0.17 cm, respectively. The difference of nasal tip projection among the five groups was statistically significant ( P<0.01). The difference between 2+ 1 framework group and 1+ 1 framework group or Y-shaped framework group was statistically significant( P<0.05). The difference between 4+ 1 framework group and 1+ 1 framework group or Y-shaped framework group was statistically significant ( P<0.05). The difference between integrated nasal framework group and 1+ 1 framework group or Y-shaped framework group was statistically significant ( P<0.05). The difference between Y-shaped framework group and 1+ 1 framework group was statistically significant ( P<0.05). In terms of nasolabial angle during postoperative follow-up, the median difference of nasolabial angle between 12 months and 1 month after surgery in 2+ 1 framework group, integrated framework group, 1+ 1 framework group, and 4+ 1 framework group, and Y-shaped framework group was -4.20°, -3.80°, -6.50°, -4.10° and -6.35°, respectively. The difference of nasolabial angle among the five groups was statistically significant ( P<0.01). The difference between 2+ 1 framework group and 1+ 1 framework group or Y-shaped framework group was statistically significant( P<0.05). The difference between 4+ 1 framework group and 1+ 1 framework group or Y-shaped framework group was statistically significant ( P<0.05). The difference between integrated nasal framework group and 1+ 1 framework group or Y-shaped framework group was statistically significant ( P<0.05). Patient satisfaction evaluation, 2+ 1 framework group had the highest satisfaction(34/34, 100.00%), followed by 4+ 1 framework group (34/35, 97.14%), integrated framework group(42/45, 93.33%), Y-shaped framework group(36/42, 85.71%), 1+ 1 framework group(37/45, 82.22%). Conclusion:The changes of nasolabial angle and nasal tip projection in 2+ 1 framework, integrated framework, and 4+ 1 framework were smaller than those in Y-shaped framework and 1+ 1 framework.2+ 1 framework was convenient and had good postoperative stability and high patient satisfaction.

Objective:To evaluate the structural features, stability and postoperative effect of integrated framework, 1+ 1 framework, 2+ 1 framework, 4+ 1 framework, and Y-shaped nasal framework.Methods:A retrospective analysis was performed based on the clinical data of patients underwent in Department of Plastic and Aesthetic (Burn) Surgery, the Second Xiangya Hospital, Central South University from February 2019 to November 2020. According to rhinoplasty framework, the patients were divided into integrated framework group, 1+ 1 framework group, 2+ 1 framework group, 4+ 1 framework group, and Y-shaped framework group. Based on the principle of plane photography, the stability of the nasal framework was evaluated by measuring the nasal tip projection and the nasolabial angle 1 month after surgery, and 12 months after surgery. The satisfaction of patients and the incidence of postoperative complications were collected. The difference in nasolabial angle and nasal tip projection data of postoperation 1 month and postoperative 12 months among each group were analyzed by one-way analysis vaniance or Kruskal-Waliis H test.Bonferroni test or Nemenyi test was used for pairwise comparison between groups. P< 0.05 was considered statistically significant. Results:A total of 201 patients (18 males and 183 females, aged 18-46 years, average aged 26.6±5.9 years)were included in this study and followed up for 12-21 months. There were 45 patients in the integrated framework group, 45 patients in the 1+ 1 framework group, 34 patients in the 2+ 1 framework group, 35 patients in the 4+ 1 framework group, and 42 patients in the Y-shaped framework group. Four patients with Y-shaped framework had significant nasal tip supination 12 months after surgery. Among the patients with 1+ 1 framework, 1 patient showed slight columella distortion 6 months after surgery, and 3 patients showed significant nasal tip subrotation 12 months after surgery. One patient in 2+ 1 framework group developed nasal infection 92 days after surgery. No complications were found in other groups during follow-up. In terms of nasal tip projection during postoperative follow-up, the median difference of nasal tip projection between 12 months and 1 month after surgery in 2+ 1 framework group, integrated framework group, 1+ 1 framework group, and 4+ 1 framework group, and Y-shaped framework group was -0.08 cm, -0.09 cm, -0.20 cm, -0.10 cm and -0.17 cm, respectively. The difference of nasal tip projection among the five groups was statistically significant ( P<0.01). The difference between 2+ 1 framework group and 1+ 1 framework group or Y-shaped framework group was statistically significant( P<0.05). The difference between 4+ 1 framework group and 1+ 1 framework group or Y-shaped framework group was statistically significant ( P<0.05). The difference between integrated nasal framework group and 1+ 1 framework group or Y-shaped framework group was statistically significant ( P<0.05). The difference between Y-shaped framework group and 1+ 1 framework group was statistically significant ( P<0.05). In terms of nasolabial angle during postoperative follow-up, the median difference of nasolabial angle between 12 months and 1 month after surgery in 2+ 1 framework group, integrated framework group, 1+ 1 framework group, and 4+ 1 framework group, and Y-shaped framework group was -4.20°, -3.80°, -6.50°, -4.10° and -6.35°, respectively. The difference of nasolabial angle among the five groups was statistically significant ( P<0.01). The difference between 2+ 1 framework group and 1+ 1 framework group or Y-shaped framework group was statistically significant( P<0.05). The difference between 4+ 1 framework group and 1+ 1 framework group or Y-shaped framework group was statistically significant ( P<0.05). The difference between integrated nasal framework group and 1+ 1 framework group or Y-shaped framework group was statistically significant ( P<0.05). Patient satisfaction evaluation, 2+ 1 framework group had the highest satisfaction(34/34, 100.00%), followed by 4+ 1 framework group (34/35, 97.14%), integrated framework group(42/45, 93.33%), Y-shaped framework group(36/42, 85.71%), 1+ 1 framework group(37/45, 82.22%). Conclusion:The changes of nasolabial angle and nasal tip projection in 2+ 1 framework, integrated framework, and 4+ 1 framework were smaller than those in Y-shaped framework and 1+ 1 framework.2+ 1 framework was convenient and had good postoperative stability and high patient satisfaction.

Objective:To discuss the mechanism of the high risk factors for hemorrhage by the study on the combination of warfa-rin and magnesium valproate to provide reference for the rational drug selection. Methods:Clinical pharmacists analyzed and adjusted the antiepileptic drug treatment scheme for one patient with cerebral hemorrhage induced by the combination of warfarin and magnesium valproate after mitral valve replacement complicated with epilepsy.The adjusted scheme was as follows:magnesium valproate was sus-pended,0.25 g levetiracetam was used,po,bid,and then the dose was raised to 0.5 g after 14 days for the anti-epileptic treatment. Pharmaceutical care was performed during the whole process of the treatment. Results: After 20-day hospital stay, the international normalized ratio (INR) was controlled within the range of 2.5-3.0,and the patient was discharged in stable conditions with no occur-rence of epilepsy. Conclusion:Levetiracetam has few interactions with warfarin,suggusting the combination is reasonable.