Objective sampling method was used to conduct a questionnaire survey on outpatients in two hospitals in Guangdong province in order to evaluate patients’ satisfaction with the quality of medical service. This paper explored the factors that affect patients’ evaluation of medical service quality, and found that patients’ age was negatively correlated with the evaluation of medical service quality. It is suggested that the establishment of friendly medical institutions should be carried out according to the national policy. At the same time, the management mechanism of hospital should be improved, the number of medical service centers for "efficient" should be increased, and the medical service personnel should be regularly trained; carry out medical knowledge education in community, improve the popularization of personal medical knowledge and close the cognitive gap between doctors and patients.

Objective:To establish a three-dimensional model of locking plate fixation for 42A2 type oblique tibial fractures with different fracture line directions and different angles between the fracture line and the long axis of the tibia. Finite element analysis was used to calculate and analyze the biomechanics of locking plate, screw, and tibia, providing theoretical basis for clinical application.Methods:A healthy adult volunteer, 25 years old, male, with a height of 173 cm and a weight of 69.5 kg, was selected to perform computed tomography (CT) scans on the left tibia. Relevant data were obtained to establish a locking steel plate fixation model for 42A2 type tibia with different oblique fracture line directions and different angles between the fracture line and the long axis of the tibia. Eight hole pure titanium plates were used for fixation, respectively. We compared the Mises stress changes of locking plates, screws, and tibia in different angle fracture models.Results:In the case of a 42A2 type fracture in the left oblique direction with a fracture line from outside to inside, the maximum Mises stress in the tibia was 114 MPa, the maximum Mises stress in the screw was 279.8 MPa, and the maximum Mises stress in the locking steel plate was 302.4 MPa; In the case of a 42A2 type fracture in the right oblique fracture with a fracture line from the bottom to the top, the maximum Mises stress of the tibia was 93.41MPa, the maximum Mises stress of the screw was 353.4 MPa, and the maximum Mises stress of the locking steel plate was 411.8 MPa.Conclusions:Regardless of the oblique fractures in both left and right directions, the maximum stress values are: locking plate>screw>tibia; When the position of the locking steel plate is fixed, the maximum stress values of the locking steel plate and screw are both right oblique fracture>left oblique fracture; And the maximum stress values all increase with the increase of angle.

Objective:To analyze the symmetry of different reference planes in the surgical simulation design of patients with protrusive jaw deformity with high and low eyes.Methods:Fifteen patients with partial jaw deformity were selected from January 2019 to June 2020, including 3 males and 12 females, aged 18-26 years, with average 23.78 years. Inclusion criteria were that the patients, aged more than 18 years, were diagnosed as protrusive jaw deformity with maxillary occlusal plane tilt and high and low eyes by clinical and imaging analysis. Three different 3D reference plane systems were established by different modeling methods. The distance between the landmarks of soft and hard tissues and the median sagittal plane was measured. The symmetry of skull was qualitatively analyzed by mirror image technique. The difference of three reference planes in surgical simulation symmetry of patients with protrusion jaw and high and low eyes was evaluated by one-way ANOVA.Results:Qualitative analysis showed that in the three measurement planes, the symmetry of the third reference plane was the best, and the symmetry of the second and the first was poor. Quantitative analysis showed that in measurement index of hard tissue, there was statistical difference between the distance of each landmark in the reference plane established by Method 3 and Method 1, Method 2 [(1.65±1.19) mm; (3.37±1.58) mm; (3.26±2.36) mm, P<0.05], but there was no statistical difference between Method 1 and Method 2 (P > 0.05). The measurement result of soft tissue was consistent with that of hard tissue, and the distance of each landmark in Method 3 from the median sagittal plane was very small, and the mean error was less than 0.5 mm, which was consistent with the clinical results. Conclusions:Digital model surgery technology can assist orthognathic surgeons in the design and prediction of surgical scheme, especially for patients with special partial jaw deformity.

Objective:To evaluate the optimization efficacy of low-dose esketamine combined with propofol in the patients with major depressive disorder undergoing modified electroconvulsive therapy (MECT).Methods:Fifty-six American Society of Anesthesiologists physical statusⅠor Ⅱ patients, aged 18-64 yr, scheduled for MECT for the first time, were assigned into esketamine plus propofol group (group EP, n=28) and propofol group (group P, n=28) according to a ratio of 1∶1 by the random number table method.Esketamine 0.25 mg/kg was intravenously injected before anesthesia induction in group EP, while the equal volume of normal saline was given instead in group P. Propofol and succinylcholine were then intravenously injected to perform MECT in two groups.The primary outcomes were the remission rate and response rate, and the secondary outcomes included the number of MECT required for response and remission, the seizure duration, energy inhibition index and consumption of propofol for each MECT, and the occurrence of therapy-related adverse reactions and relapse. Results:Compared with group P, the remission rate and response rate were significantly increased, and the number of MECT required for response and remission was decreased, the seizure duration was prolonged, and energy inhibition index was increased, the consumption of propofol was reduced ( P<0.05), and no significant change was found in the incidence of therapy-related adverse reactions and relapse in group EP ( P>0.05). Conclusions:Low-dose esketamine combined with propofol can enhance the efficacy of MECT and shorten the course of therapy without increasing therapy-related adverse reactions in the patients with major depression.

Objective:To evaluate the efficacy of remimazolam combined with alfentanil for gastroscopy in frail elderly patients.Methods:Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ elderly patients, aged 65-85 yr, with body mass index of 18-30 kg/m 2, of Clinical Frailty Scale score≥5, scheduled for elective painless gastroscopy, were divided into 2 groups ( n=30 each) using a random number table method: remimazolam combined with alfentanil group (group R) and propofol combined with remifentanil group (group P). A combination of alfentanil 10 μg/kg and remimazolam 0.2 mg/kg was intravenously injected until loss of consciousness in group R. Remifentanil 0.5 μg/kg combined with propofol 1.0-2.0 mg/kg was intravenously injected until loss of consciousness in group P. According to the intraoperative conditions, 1/4 of the initial dose of remimazolam was intravenously injected in group R, and 1/4 of the initial dose of propofol was intravenously injected in group P. The time for gastroscopy, requirement for additional remimazolam or propofol, onset time of anesthesia, emergence time and time of post-anesthesia care unit stay were recorded.Physician′s satisfaction scores, patient′s satisfaction scores and Verbal Pain Scale scores were recorded.The occurrence of injection pain, respiratory depression, bradycardia, hypotension and nausea and vomit was recorded. Results:There was no significant difference in the requirement for additional remimazolam or propofol, onset time of anesthesia, time for gastroscopy, physician′s satisfaction scores, and patient′s satisfaction scores, Verbal Pain Scale scores and incidence of nausea and vomit between two groups ( P>0.05). Compared with P group, the emergence time and time of post-anesthesia care unit stay were significantly shortened, and the incidence of injection pain (0 vs.33%), respiratory depression (0 vs.20%), hypotension (3% vs.23%) and bradycardia (3% vs.23%) was decreased in R group ( P<0.05). Conclusions:Remimazolam combined with alfentanil is safe and effective, with rapid recovery from anesthesia, and provides better efficacy than the combination of propofol and remifentanil when used for gastroscopy in frail elderly patients.

Objective sampling method was used to conduct a questionnaire survey on outpatients in two hospitals in Guangdong province in order to evaluate patients’ satisfaction with the quality of medical service. This paper explored the factors that affect patients’ evaluation of medical service quality, and found that patients’ age was negatively correlated with the evaluation of medical service quality. It is suggested that the establishment of friendly medical institutions should be carried out according to the national policy. At the same time, the management mechanism of hospital should be improved, the number of medical service centers for "efficient" should be increased, and the medical service personnel should be regularly trained; carry out medical knowledge education in community, improve the popularization of personal medical knowledge and close the cognitive gap between doctors and patients.

Objective:To analyze the accuracy of digital orthognathic surgery by evaluating the effects of brackets, dentition status and registration method on the accuracy of registration of cone beam computed tomography(CBCT) dentition and laser scanning dental casts.Methods:A retrospective analysis of the data of patients who underwent digitally designed maxillary and mandibular surgeries from December 2017 to December 2019 in the Department of Orthognathic Surgery, Tianjin Stomatological Hospital. The CBCT and laser scanning dental mold data of the patients were imported into Mimics 20.0 software to build three-dimensional reconstructed dentition. Global registration and local registration of STL registration were used to register non-occlusal, occlusal CBCT dentition and laser scanning dental molds, which could be divided into four groups. Group 1: non-occlusal dentition using local registration, group 2: non-occlusal dentition using global registration, group 3: occlusal dentition using local registration, group 4: occlusal dentition using global registration. Each group included three subgroups, subgroup A used 3.0 mm distance parameters for registration once, subgroup B used 3.0 and 1.5 mm distance parameters for registration twice, and subgroup C used 3.0, 1.5 and 0.3 mm distance parameters for registration three times. With the assistance of the distance analysis function of Geomagic Studio software, the root mean square of the distance between the two images was obtained. The comparison of normal power data between subgroups was performed by analysis of variance, and the multiple comparisons among subgroups were performed by LSD- t test. After testing the normality and homogeneity of variance of the data, a general linear model was established to test the influence of bracket, dentition state and registration method on the accuracy of registration by multi-factor analysis of variance. Results:A total of 24 patients were enrolled, 7 males and 17 females, aged 19-30 years, 12 of which had orthodontic metal brackets and 12 had no brackets. (1) The local registration of each group is the best in subgroup A, and the global registration is the best in subgroup C. (2) The effects of bracket, dentition status and registration method on the registration result were statistically significant( P<0.05). The interaction among them was not significant ( P>0.05), but the interaction between bracket and dentition state, bracket and registration method, dentition status and registration method was significant ( P<0.05). Through simple effect analysis, it was found that in occlusal dentition registration/bracket registration, the simple single effect of registration method on registration accuracy did not exist ( P>0.05), while that of non-occlusal dentition registration/non-bracket registration had a simple single effect on registration accuracy ( P<0.05). Conclusions:If you use local registration, you only need to match the parameters of 3.0 mm once; if you use global registration, you need to register three times according to the parameters of 3.0, 1.5 and 0.3 mm. Bracket, dentition status, registration methods can all affect the accuracy of registration of CBCT dentition and laser scanning dental mold.

Objective:To analyze the accuracy of digital orthognathic surgery by evaluating the effects of brackets, dentition status and registration method on the accuracy of registration of cone beam computed tomography(CBCT) dentition and laser scanning dental casts.Methods:A retrospective analysis of the data of patients who underwent digitally designed maxillary and mandibular surgeries from December 2017 to December 2019 in the Department of Orthognathic Surgery, Tianjin Stomatological Hospital. The CBCT and laser scanning dental mold data of the patients were imported into Mimics 20.0 software to build three-dimensional reconstructed dentition. Global registration and local registration of STL registration were used to register non-occlusal, occlusal CBCT dentition and laser scanning dental molds, which could be divided into four groups. Group 1: non-occlusal dentition using local registration, group 2: non-occlusal dentition using global registration, group 3: occlusal dentition using local registration, group 4: occlusal dentition using global registration. Each group included three subgroups, subgroup A used 3.0 mm distance parameters for registration once, subgroup B used 3.0 and 1.5 mm distance parameters for registration twice, and subgroup C used 3.0, 1.5 and 0.3 mm distance parameters for registration three times. With the assistance of the distance analysis function of Geomagic Studio software, the root mean square of the distance between the two images was obtained. The comparison of normal power data between subgroups was performed by analysis of variance, and the multiple comparisons among subgroups were performed by LSD- t test. After testing the normality and homogeneity of variance of the data, a general linear model was established to test the influence of bracket, dentition state and registration method on the accuracy of registration by multi-factor analysis of variance. Results:A total of 24 patients were enrolled, 7 males and 17 females, aged 19-30 years, 12 of which had orthodontic metal brackets and 12 had no brackets. (1) The local registration of each group is the best in subgroup A, and the global registration is the best in subgroup C. (2) The effects of bracket, dentition status and registration method on the registration result were statistically significant( P<0.05). The interaction among them was not significant ( P>0.05), but the interaction between bracket and dentition state, bracket and registration method, dentition status and registration method was significant ( P<0.05). Through simple effect analysis, it was found that in occlusal dentition registration/bracket registration, the simple single effect of registration method on registration accuracy did not exist ( P>0.05), while that of non-occlusal dentition registration/non-bracket registration had a simple single effect on registration accuracy ( P<0.05). Conclusions:If you use local registration, you only need to match the parameters of 3.0 mm once; if you use global registration, you need to register three times according to the parameters of 3.0, 1.5 and 0.3 mm. Bracket, dentition status, registration methods can all affect the accuracy of registration of CBCT dentition and laser scanning dental mold.

Objective To investigate the condition of utilization of glasses aids adaption in Shanghai. Methods The numbers who accepted the services, funds invested, the models, etc. in 16 districts of Shanghai between 2012 and 2014 were collected, and analyzed with descriptive analysis, concentration index and correlation analysis. Results A total of 17,498 persons accepted glasses aids adaption services, which cost 335.37 yuan per person. The concentration index was 0.0951. Conclusion The glasses aids adaption service works well in Shanghai, but is variable among the districts.

Objective To explore the effect of CYP3A5 gene polymorphisms on the whole blood trough concentration (C0) of tacrolimus (TAC) in patients with idiopathic membranous nephropathy to identify an economical and optimal initial dosage delivering the best curative effect with minimum drug adverse reaction.Methods Sixty patients with idiopathic membranous nephropathy were enrolled in this study.The CYP3A5 genotype was tested by fluorescence in situ hybridization (FISH).According to CYP3A5 genotype, the patients were divided into three groups (AA, AG, and GG).At the same time, the C0 of TAC was measured by enzyme multiplied immunoassay technique (EMIT).C0 of TAC, daily dosage of TAC and the concentration/dose(C0/D) ratio of TAC were detected after taking medicine at 8, 12, 16 and 24 weeks respectively, so as to corroborate the relation between CYP3A5 gene polymorphisms and the dosage of TAC.Results The oral TAC dosage had great variation among individuals.The occurrence of the CYP3A5 genetic polymorphisms (A6986G) designated as G was 53.33％.D and C0 were significantly different at 8, 12, 16 and 24 weeks respectively (all P ＜ 0.05).To reach the same C0, the patients with AA needed 2-3-fold dosage of TAC than GG;and those with AG needed 1-2-fold dosage of TAC than GG.After 24-week treatment, the effective rate of AA group was markedly lower than AG and GG (16.67％ vs 81.25％, 16.67％ vs 87.50％, all P ＜ 0.001).Among CR, PR and NR, there were no significantly difference on C0 or C0/D of TAC (P ＞ 0.05).Conclusions CYP3A5 genotypes are correlated with blood concentration of TAC.CYP3A5 genotyping may be a new approach to predict the optimal initial dosage of tacrolimus in idiopathic membranous nephropathy.