ObjectiveTo investigate the awareness and clinical practice of guidelines for the prevention and treatment of chronic hepatitis B （2022 edition） among clinicians. MethodsFrom July 19 to December 31， 2024， a self-designed electronic questionnaire was distributed via the WeChat mini program to collect related data from 1 588 clinicians nationwide， including their awareness and practice based on 18 questions regarding testing and referral， diagnosis and treatment， and follow-up. ResultsAmong all respondents， only 350 clinicians correctly understood all the updated key points of antiviral indications and treatment for special populations in the 2022 edition of guidelines for the prevention and treatment of chronic hepatitis B， with an overall awareness rate of 22.0%. Only 20% ‍—‍ ‍40% of the patients with positive HBV DNA and an age of >30 years receive antiviral therapy， while 80% ‍—‍ ‍100% of the patients with positive HBV DNA and a family history of hepatitis B cirrhosis or hepatocellular carcinoma receive antiviral therapy. The median follow-up rates at 1 year， 3 years， and 5 years were 67.5% 57.5% and 47.5%，respectively， showing a trend of gradual reduction， which might be associated with the influencing factors such as insufficient time for follow-up management by clinicians， insufficient awareness of the disease among patients， and poor adherence to follow-up. ConclusionThere is a gap between the awareness and practice of guidelines for the prevention and treatment of chronic hepatitis B （2022 edition） among clinicians. It is recommended to further strengthen training and focus on the whole process of “detection， diagnosis， treatment， and management” for patients with chronic hepatitis B in healthcare institutions， in order to promote the implementation of the guidelines.

Objective:To introduce a surgical technique of " short distances and multi-segment" buried-guiding suture method and its effects in the surgery of early descent of prosthesis after augmentation mammaplasty.Methods:From August 2019 to January 2022, 15 cases of early descent of prosthesis after augmentation mammaplasty due to axillary approach breast augmentation for micromastia were admitted to the Plastic Surgery Department of Sichuan Provincial People′s Hospital, aged 23-35 years (27.3±3.6) and duration of dislocation from 16 to 35 days (23.8±5.8). There were 12 patients showed unilateral prosthesis drops and 3 patients showed bilateral prosthesis drops. " Short distances and multi-segment" buried-guiding suture method was used to solve the problem, i. e., 2-0 non-absorbable sutures were used to eliminate the lower pole of prosthetic cavity with " short distances and multi-segment" sutures. The distance from the nipple to the midline of the sternum, the distance from the sternotomy to the nipple, the distance from the nipple to the inframammary fold and the distance from the midclavicular point to the inframammary fold were measured bilaterally before and after surgery, and statistical analysis was performed to evaluate the efficacy of the " short distances and multi-segment" buried-guiding suture method for early descent of prosthesis after breast augmentation.Results:All incisions healed by first intention without complications such as hematoma, infection, or scar hyperplasia. 15 patients were followed up for 6-12 months (8.0±1.9). 14 patients were satisfied with the results after surgery, and 1 patient received satisfactory results after secondary surgery. The distance from nipple to inframammary fold was shortened by 0.8-1.4 cm after surgery (1.2±0.2), and the distance from mid-clavicle to inframammary fold was shortened by 1.0-1.6 cm (1.3±0.4), and the differences were statistically significant as compared with the values before surgery ( t=31.17, P<0.05; t=33.78, P<0.05). After surgery, the change in the distance from nipple to sternal was 0.1-0.3 cm (0.16±0.10), and the change in the distance from sternal notch to nipple was 0-0.2 cm (0.12±0.10), and the differences were not statistically significant ( P>0.05). Conclusions:With the advantages of simple operation, little trauma and no additional incision, the " short distance and multi-stage" buried-guiding suture method in the surgery of early descent of prosthesis after augmentation mammaplasty is worthy of clinical application.

Objective:To explore the effect of the principle of tissue gradient difference in repairing the over wide eyelid fold after double eyelid operation by incision.Methods:From July 2019 to July 2020, we applied the principle of tissue gradient difference to 30 cases (a total of 60 eyes; age ranging 20-35 years with mean 30) of female patients with excessively wide eyelids after incision double eyelid surgery needing a repair. All cases were from the Plastic Surgery Department of Sichuan Provincial People＇s Hospital. The difference in tissue gradient was manifested as the difference in thickness, texture and tension of soft tissues such as the skin above and below the double eyelid line and the orbicularis oculi muscle.Results:Satisfactory evaluation results showed in a total of 30 patients with 60 eyes, 95.0% ( n=57) were satisfied, and 5.0% ( n=3) were dissatisfied. Two of the patients received the second repair due to the inconsistency of the double eyelid width after correction. One patient obtained satisfactory double eyelid morphology after the second repair, and the other patient obtained satisfactory double eyelid morphology after the third repair. Evaluation results of double eyelid morphology showed that it obeyed a normal distribution by analyzing the difference between preoperative and postoperative double eyelid morphology scores. The results of paired t test showed that the double eyelid morphology was significantly improved 6 months after operation compared with preoperative, and the difference was statistically significant ( t=15.86, P<0.01). Conclusions:The principle of tissue gradient difference guides the repair of double eyelid width that is simple and easy, the effect is good, and it is worth applying.

Objective:To investigate the clinical application and effect of orbicularis oculi muscle shaping in lower blepharoplasty.Methods:A retrospective analysis was performed on the clinical data of 32 cases of flabby blepharoplasty patients admitted to the Orthopedic Surgery Clinic of Sichuan people＇s Hospital from October 2018 to September 2019. At the same time of transcutaneous blepharoplasty, 32 patients were treated with orbicularis oculi muscle shaping to remove the relaxed orbicularis oculi muscle, to reconstruct the annular strength and shape of the orbicularis oculi muscle, to strengthen the supporting structure of the lower eyelid, to reset the relationship between the external canthus orbicularis muscle and the skin, and then to reconstruct the soft tissue filling degree of the lower eyelid margin. The safety, efficacy and stability of the operation were evaluated by Barton grading, postoperative complications and scoring before and after operation and satisfactory analysis based on patients＇ satisfaction scale after operation.Results:All the patients were free of postoperative infection and healed at stage I. There were 2 cases of ecchymosis, 3 cases of ocular foreign body sensation, and no cases of infection, lower eyelid retraction, lower eyelid ectropion, or retrobulbous hematoma. The mean Barton score of all patients before surgery was 1.88±0.49, and the mean Barton score after surgery was 0.53±0.51. The t-test showed that the difference was statistically significant ( t=15.75, P<0.05), and the postoperative lacrimal groove deformity was improved. According to the score of satisfaction scale, 7 people were basically satisfied (21.88%) and 25 people were very satisfied (78.12%). Conclusions:Forming in the orbicularis oculi muscle relaxation eyelid bag type of prosthesis, in addition to the part of the orbicularis oculi muscle relaxation, deformation, and widely shed canthus outside skin and orbicularis connection, make the next eyelid edge to reproduce the full shape, obviously the bulging under the eyelid relaxation, the shape of the degree of repair, lateral canthus wrinkles tail department have also improven, restoring the full eyelid platform. The operation has strong pertinence, simple procedures, less complications and better long-term effect.

Objective:To explore an optimal surgical approach for different types of labia minora hypertrophy and to design a better personalized surgical treatment plan for patients.Methods:From October 2017 to October 2020, 71 patients with labia minora hypertrophy were treated in the plastic surgery department of Sichuan Provincial People＇s Hospital, aged 18-38 years, with an average of 26 years. According to the type and degree of hypertrophy, the appropriate surgical method was selected. The wound healing and complications were observed after operation, and the shape of labia minora was followed up.Results:Among the 71 patients, 1 patient had postoperative hematoma and no flap necrosis after active treatment. 1 patient had poor healing of distal labia minora incision and improved after dressing change. The other patients had good blood supply of labia minora, no necrosis, no postoperative infection, hematoma and other complications. The patients were followed up for 1-6 months. The appearance of labia minora was natural, bilateral symmetry, and the incision scar was hidden. The improvement was significant compared with that before operation. The patients were satisfied with the shape and function.Conclusions:According to the degree of hypertrophy of the labia minora, the specific shape and the psychological expectation of patients, we can choose the appropriate operation method, which can achieve the aesthetic standard of symmetry and beautiful shape of the labia minora, and meet the normal physiological function and aesthetic requirements of patients.

Humans ; Benzodiazepines ; Hypnotics and Sedatives/therapeutic use* ; Intensive Care Units ; Midazolam

Sepsis is a clinical syndrome of life-threatening organ dysfunction caused by infection. When an infection occurs, as the first line of defense of the body's immune system, neutrophils are first recruited to the site of infection to capture and kill pathogens by releasing neutrophil elastase (NE). However, a large amount of NE release will injury the surrounding normal tissues and induce organ dysfunction or failure. NE inhibitors can inhibit NE activity and reduce inflammatory response, which may be a promising drug for the treatment of sepsis. Currently, a variety of NE inhibitors have been developed and reported, but there is no systematic overview of their characteristics, and the role and underlying mechanisms of NE and related inhibitors in sepsis have not been thoroughly discussed. This article will make a review in this regard, in order to elucidate the effect of NE and its inhibitors in sepsis.

Objective:To conduct a preliminary investigation on the establishment of a three-dimensional measurement database of upper lip-related indicators in the normal young Han population in Chengdu, and to establish reference values.Methods:A simple random sampling method was used to recruit 150 volunteers who visited Sichuan Provincial People’s Hospital between September 2012 and December 2019. The facial multi-slice spiral CT (MSCT) data were collected, and the image data was obtained to generate a three-dimensional model, which was analyzed by applying 3-matic Medical 13.0 software. The linear and proportional indices of upper lip correlation were measured including the crista philtra, right side point-the crista philtra, left side point (CphR-CphL), the right cheilion point- the left cheilion point (ChR-ChL), the middle point of crista philtra, right side point-the middle point of crista philtra, left side point (MphR-MphL), the apex of philtral column, right side point-the apex of philtral column, left side point(SbalR-SbalL), the stomion point-the sublabiale point (Sto-Sl)], ratio index [Ls-Sto/Sto-Li, MphR-MphL/ChR-ChL, MphR-MphL/CphR-CphL, Ls-Sto/Sn-Sto, Sto -Li/Sto-Sl]. In addition, the angle of the nasolabial angle was measured, and the radian of the upper lip was measured by the lip bead-bilateral angle three-point fitting circle method. The t test was used to compare the differences of the above indicators in different genders and ages (18-24, 25-30 years old). For the ChR-Ls-ChL, the Mphr-the middle point of subnasale and labrale-mphl(MphR-A-MphL), the SbalR-Sn-SbalL different radian position indexes were compared by ANOVA and SNK- q method. Results:A total of 150 volunteers were included in this study, including 68 males (45.3%) and 82 females (54.7%), ranging in age from 18 to 30 years old, with an average age of 24 years. Between different genders: the differences in linear indicators Ls-Sto, Sto-Li, Sn-Sto, Sn-Ls, Ls-Li, CphR-CphL, ChR-ChL, SbalR-SbalL, Sto-Sl were statistically significant ( P<0.05), there was no significant difference in MphR-MphL ( P>0.05); there were significant differences in Ls-Sto/Sn-Sto, Sto-Li/Sto-Sl in the ratio indicators ( P<0.01), Ls -Sto/Sto-Li, MphR-MphL/ChR-ChL, MphR-MphL/CphR-CphL had no significant difference ( P>0.05). There was no significant difference in nasolabial angle ( P>0.05); the difference in radian index ChR-Ls-ChL was statistically significant( P<0.05), there was no significant difference in MphR-A-MphL, SbalR-Sn-SbalL in radian index ( P>0.05). Between different age groups: there was no significant difference in each linear index, proportional index, angle index and radian index. ( P>0.05) Between different radian positions: the radian values of 3 different radian positions were significantly different ( P<0.01). ChR-Ls-ChL was compared with MphR-A-MphL, SbalR-Sn-SbalR the difference in SbalL was statistically significant ( P<0.01), but there was no significant difference between MphR-PoinA-MphL and SbalR-Sn-Sbal ( P>0.05). Conclusions:Based on the MSCT image data, this paper completed the preliminary survey of the three-dimensional measurement database of the upper lip-related indexes of the normal young Han population in Chengdu area, and established the reference value. The obtained data set can provide an intuitive reference for clinical evaluation and design. In addition, evaluating the upper lip by measuring the curvature of the upper lip is a new measurement method that can effectively reflect the physiological curvature of the upper lip.

Objective:To discuss the application of free double-layered auriclar composite tissue flap (auriclar cartilage and the skin) in repairing the full-thickness nasal alar defects.Methods:The clinical data of the patients with unilateral full-thickness nasal alar defects who were admitted to the Department of Plastic Surgery of Sichuan Provincial People’s Hospital from June 2016 to December 2019 were analyzed. The free double-layered auricular composite grafts were harvested from the unilateral nasal cavity as the nasal lining and covered with pedicled skin flap. The survival of free double-layered auricular composite grafts and pedicled skin flap as well as the appearance of the reconstructed nasal alar were observed.Results:A total of 12 patients with unilateral full-thickness alar defect were included, including 4 females and 8 males, aged from 6 to 53 years old, with an average of 35.3 years old. The areas of the defects were 0.7 cm × 1.0 cm-2.0 cm × 2.6 cm, and the areas of double-layered auricular composite grafts(skin) were 0.8 cm × 1.0 cm-2.1 cm × 2.7 cm. All the 12 patients healed primarily. No necrosis or infection occurred in the double auricle composite tissue flap and pedicled skin flap. After the completion of the whole treatment, the reconstructed nasal alar with similar shape and function to the normal nasal alar was obtained. After the last operation, the patients were followed up for 3 months to 32 months, with an average of 15 months.Conclusions:The free double-layered auricular composite grafts breaks the area limitation of free transplantation of full-layer auricle composite tissue flap. The combined grafting with pedicled flap shortens the treatment duration with skin flap alone, and it is easier to obtain vivid nasal alar.

Objective:To conduct a preliminary investigation on the establishment of a three-dimensional measurement database of upper lip-related indicators in the normal young Han population in Chengdu, and to establish reference values.Methods:A simple random sampling method was used to recruit 150 volunteers who visited Sichuan Provincial People’s Hospital between September 2012 and December 2019. The facial multi-slice spiral CT (MSCT) data were collected, and the image data was obtained to generate a three-dimensional model, which was analyzed by applying 3-matic Medical 13.0 software. The linear and proportional indices of upper lip correlation were measured including the crista philtra, right side point-the crista philtra, left side point (CphR-CphL), the right cheilion point- the left cheilion point (ChR-ChL), the middle point of crista philtra, right side point-the middle point of crista philtra, left side point (MphR-MphL), the apex of philtral column, right side point-the apex of philtral column, left side point(SbalR-SbalL), the stomion point-the sublabiale point (Sto-Sl)], ratio index [Ls-Sto/Sto-Li, MphR-MphL/ChR-ChL, MphR-MphL/CphR-CphL, Ls-Sto/Sn-Sto, Sto -Li/Sto-Sl]. In addition, the angle of the nasolabial angle was measured, and the radian of the upper lip was measured by the lip bead-bilateral angle three-point fitting circle method. The t test was used to compare the differences of the above indicators in different genders and ages (18-24, 25-30 years old). For the ChR-Ls-ChL, the Mphr-the middle point of subnasale and labrale-mphl(MphR-A-MphL), the SbalR-Sn-SbalL different radian position indexes were compared by ANOVA and SNK- q method. Results:A total of 150 volunteers were included in this study, including 68 males (45.3%) and 82 females (54.7%), ranging in age from 18 to 30 years old, with an average age of 24 years. Between different genders: the differences in linear indicators Ls-Sto, Sto-Li, Sn-Sto, Sn-Ls, Ls-Li, CphR-CphL, ChR-ChL, SbalR-SbalL, Sto-Sl were statistically significant ( P<0.05), there was no significant difference in MphR-MphL ( P>0.05); there were significant differences in Ls-Sto/Sn-Sto, Sto-Li/Sto-Sl in the ratio indicators ( P<0.01), Ls -Sto/Sto-Li, MphR-MphL/ChR-ChL, MphR-MphL/CphR-CphL had no significant difference ( P>0.05). There was no significant difference in nasolabial angle ( P>0.05); the difference in radian index ChR-Ls-ChL was statistically significant( P<0.05), there was no significant difference in MphR-A-MphL, SbalR-Sn-SbalL in radian index ( P>0.05). Between different age groups: there was no significant difference in each linear index, proportional index, angle index and radian index. ( P>0.05) Between different radian positions: the radian values of 3 different radian positions were significantly different ( P<0.01). ChR-Ls-ChL was compared with MphR-A-MphL, SbalR-Sn-SbalR the difference in SbalL was statistically significant ( P<0.01), but there was no significant difference between MphR-PoinA-MphL and SbalR-Sn-Sbal ( P>0.05). Conclusions:Based on the MSCT image data, this paper completed the preliminary survey of the three-dimensional measurement database of the upper lip-related indexes of the normal young Han population in Chengdu area, and established the reference value. The obtained data set can provide an intuitive reference for clinical evaluation and design. In addition, evaluating the upper lip by measuring the curvature of the upper lip is a new measurement method that can effectively reflect the physiological curvature of the upper lip.