Objective:To evaluate the effectiveness of surgical methods for correcting pollybeak deformity in Chinese rhinoplasty.Methods:A retrospective chart review was conducted for patients who underwent pollybeak correction between January 2021 and December 2022 at the Department of Plastic and Aesthetic (Burn) Surgery, the Second Xiangya Hospital of Central South University. Individualized correction was tailored based on the etiology and severity of the nasal deformity of each patient, involving techniques such as resection of the anterior part of the nasal septum, reconstruction of nasal tip support, reconstruction of the middle part of the nasal vault, and excision of skin in the upper region of the nasal tip. A modified classification system for pollybeak deformity, the supratip fullness rating scale (SFRS), was developed to evaluate supratip fullness (0-3 points, with higher scores indicating more apparent deformity). The patients aesthetic outcomes were assessed by surgeons using the visual analogue scale (VAS) (0-10 points, with higher scores indicating more apparent deformity), and patient self-assessed using the rhinoplasty outcome evaluation (ROE) questionnaire (0-100 points, with higher scores indicating higher satisfaction). The measurement data of normal distribution was expressed as Mean±SD and analyzed by paired t-test; the measurement data of non-normal distribution was expressed as M( Q1, Q3) and analyzed by Wilcoxon signed rank test. Results:In a cohort study of 53 rhinoplasty patients (7 male, 46 female; age range 19-45 years, mean 29 years), comprising 15 primary and 38 secondary surgeries, nasal tip deformities were evaluated. Deformities were classified as mild (5 cases), moderate (25 cases), and severe (23 cases). Over a follow-up period of 6-17 months (mean 9.5 months), significant aesthetic improvements in the nasal tip region were observed. The SFRS scores decreased from 2(2, 3) preoperatively to 0(0, 0) postoperatively ( Z = -6.58, P < 0.001), and VAS scores decreased from 7.47±1.73 to 1.79±1.67 ( t = -25.61, P < 0.001). High patient satisfaction was indicated by a mean ROE score of 82.45±11.55. No significant complications, such as nasal tip ptosis, skin necrosis, or scar hyperplasia, were reported. Conclusion:Selecting an appropriate surgical method based on the severity and cause of pollybeak deformity can achieve satisfactory outcomes. Post-operative patients exhibit significant aesthetic improvement in the upper nasal tip area, resulting in high patient satisfaction.

Objective:To explore the clinical efficacy of modified superomedial pedicle technique using an inverted T-shaped incision for reduction mammaplasty and mastopexy.Methods:A retrospective analysis was conducted on clinical data of patients who underwent modified superomedial pedicle technique for breast reduction surgery with inverted T-shaped incision between March 2021 and March 2023 at the Department of Plastic and Aesthetic (Burn) Surgery, Second Xiangya Hospital of Central South University. Preoperatively, a handheld Doppler ultrasound blood flow detector was used to detect and mark the exit points of the 2nd to 4th perforating vessels of the internal thoracic artery, and a superomedial pedicle containing at least two perforators was designed based on the perforator locations, with a pedicle width generally about 6 cm. Intraoperatively, the pedicle was rotated superolaterally, moving the nipple-areola complex (NAC) upwards to construct a fuller upper pole of the breast and removing excess skin in the lower fold to form a inverted T-shaped incision. Postoperatively, the blood supply of the NAC, breast morphology, and incidence of complications were observed and followed up. Canfield Mirror 7.1.1 software was utilized to measure pre- and post-operative breast morphology data from lateral photographs at 6 months, including total breast area, maximum breast protrusion, upper pole protrusion, lower pole height, and nipple elevation height. The BREAST-Q questionnaire was used to survey patient satisfaction with breast appearance, psychosocial well-being, sexual well-being, and physical health before surgery and 6-12 months after surgery, with each dimension scoring 0-100 points, where higher scores indicate greater satisfaction and health. SPSS 28.0 software was used for data analysis, with normally distributed measurement data expressed as Mean±SD, and paired t-test was applied for comparisons of pre- and post-operative breast morphology data (the first 4 indicators) and BREAST-Q scores, with P<0.05 considered statistically significant. Results:A total of 56 female patients were included, with an age of (32.0±6.7) years and a body mass index of (29.1±5.7) kg/m 2. Preoperative Doppler ultrasound blood flow detection showed that none of the patients had missing or significantly variant perforators of the superomedial pedicle. The volume of breast tissue removed ranged from 890 to 1 800 ml, averaging 1 250 ml, with an average pedicle width of 5.4 cm (4.0-7.0 cm). The follow-up period was (13.3±2.5) months, during which all patients exhibited good blood supply to the NAC and favorable breast morphology, with universal high satisfaction with surgical outcomes. Postoperatively, one case developed incisional seroma, which resolved naturally within 3 months; two cases experienced minor incision dehiscence, which healed well after dressing changes; all other patients recovered well without any complications such as flap necrosis or hematoma. Comparison of breast morphology data showed significant reductions in postoperative left and right total breast area ( P<0.05 for both), and increases in maximum breast protrusion and lower pole height postoperatively ( P<0.05 for both), while the difference in upper pole protrusion was not statistically significant ( P>0.05 for both); postoperative left and right nipple elevation heights were (6.30±1.84) cm and (6.52±1.66) cm, respectively. Among the 44 patients who completed the BREAST-Q survey both before and after surgery, scores showed significant improvements in postoperative breast satisfaction [(50.30±10.30) points vs. (83.20±6.02) points] ( t=5.17, P=0.008) and psychosocial well-being [(56.20±17.20) points vs. (89.70±2.70) points] ( t=5.09, P=0.010), while sexual well-being and physical health scores did not differ significantly from preoperative scores ( P>0.05 for both). Conclusion:Preoperative identification of perforator locations using a handheld Doppler blood vessel detector, followed by the design of a modified superomedial pedicle technique for reduction mammaplasty with inverted T-shaped incision, can not only ensure NAC blood supply, avoiding ischemic necrosis due to vascular anomalies, but also maximally reduce pedicle width and increase pedicle rotation flexibility, achieving desirable breast shaping effects.

Objective:To compare the clinical efficacy between a single palmar lateral transverse approach and the modified Henry approach in the locking plate fixation for distal radius fractures.Methods:A retrospective study was conducted to analyze the data of 82 patients with distal radius fracture who had undergone locking plate fixation through either a single palmar lateral approach or the modified Henry approach between January 2016 and December 2022 at Department of Traumatic Orthopaedics, Taihe Hospital, Affiliated to Hubei University of Medicine. There were 25 males and 57 females, with an age of (53.8±12.7) years. Based on the difference in surgical approach, the patients were divided into a single transverse approach group ( n=42) and a modified Henry approach group ( n=40). The 2 groups were compared in terms of injury cause, injury location, time from injury to surgery, AO fracture classification, tourniquet time during surgery, incision length, fracture reduction, Patient and Observer Scar Assessment Scale (PSAS & OSAS) and Disability of the Arm, Shoulder, and Hand (DASH) score at the last follow-up, and complications after surgery. Results:There were no statistically significant differences in the baseline characteristics between the 2 groups, indicating comparability ( P>0.05). All patients were followed up for (8.2±3.5) months. Follow-ups revealed one case of injury to the palmar cutaneous branch of the median nerve but no other complications like infection, non-union, internal fixation failure, or tendon injury in the single transverse approach group. The single transverse approach group was significantly superior over the modified Henry approach group in incision length [(2.4±0.9) cm versus (5.3±1.6) cm], OSAS (8.1±4.2 versus 10.3±5.7), and PSAS (10.1±5.8 versus 14.7±6.4) ( P<0.05). There were no significant differences between the 2 groups in tourniquet time, fracture reduction quality, and DASH score at the last follow-up ( P>0.05). Conclusion:In locking plate fixation for distal radius fractures, in comparison with the modified Henry approach, a single palmar lateral approach is more minimally invasive so that more aesthetically pleasing outcomes can be achieved to facilitate patients' rapid return to work and society.

Objective:To investigate the current situation of the use of transjugular intrahepatic portosystemic shunt (TIPS) for portal hypertension, which should aid the development of TIPS in China.Methods:The China Portal Hypertension Alliance (CHESS) initiated this study that comprehensively investigated the basic situation of TIPS for portal hypertension in China through network research. The survey included the following: the number of surgical cases, main indications, the development of Early-TIPS, TIPS for portal vein cavernous transformation, collateral circulation embolization, intraoperative portal pressure gradient measurement, commonly used stent types, conventional anticoagulation and time, postoperative follow-up, obstacles, and the application of domestic instruments.Results:According to the survey, a total of 13 527 TIPS operations were carried out in 545 hospitals participating in the survey in 2021, and 94.1% of the hospital had the habit of routine follow-up after TIPS. Most hospitals believed that the main indications of TIPS were the control of acute bleeding (42.6%) and the prevention of rebleeding (40.7%). 48.1% of the teams carried out early or priority TIPS, 53.0% of the teams carried out TIPS for the cavernous transformation of the portal vein, and 81.0% chose routine embolization of collateral circulation during operation. Most of them used coils and biological glue as embolic materials, and 78.5% of the team routinely performed intraoperative portal pressure gradient measurements. In selecting TIPS stents, 57.1% of the hospitals woulel choose Viator-specific stents, 57.2% woulel choose conventional anticoagulation after TIPS, and the duration of anticoagulation was between 3-6 months (55.4%). The limitation of TIPS surgery was mainly due to cost (72.3%) and insufficient understanding of doctors in related departments (77.4%). Most teams accepted the domestic instruments used in TIPS (92.7%).Conclusions:This survey shows that TIPS treatment is an essential part of treating portal hypertension in China. The total number of TIPS cases is far from that of patients with portal hypertension. In the future, it is still necessary to popularize TIPS technology and further standardize surgical indications, routine operations, and instrument application.

Objective:Analyze the medical reimbursement rate and influencing factors under the DIP payment method to refine the DIP payment policy,promote the optimization of internal operations in medical institutions,and ensure reasonable compensation.Methods:Based on the 2022 DIP fund settlement data from 196 medical institutions in City A,the study used multiple linear regression to analyze the factors affecting medical reimbursement rate and conducted a heterogeneity analysis for medical institutions of different levels.Results:The medical reimbursement rate for medical institutions in City A in 2022 was 103.32%.Medical institutions with lower CMI standardized inpatient costs,lower rates of deviation cases,tertiary care institutions,lower proportion of level-four surgeries,and lower ratios of resident to employee medical insurance cases have higher medical reimbursement rate(P<0.05).Heterogeneity analysis reveals that therates of deviation cases,the proportion of primary care diseases,the ratio of resident to employee medical insurance cases,and the low-standard admission rate have different impacts on medical institutions of different levels.Conclusion:Medical insurance departments should improve policies for primary care diseases,dynamically adjust disease catalogs and payment standards,optimize funding levels and institutional coefficients,and increase penalties for violations to ensure effective use of funds.Medical institutions need to strengthen their understanding of policies,focus on refined internal management,promote standardized and rational diagnosis and treatment through performance assessment transformation,and leverage their own advantages in medical services to reasonably increase the medical reimbursement rate.

Objective:To evaluate the effectiveness of surgical methods for correcting pollybeak deformity in Chinese rhinoplasty.Methods:A retrospective chart review was conducted for patients who underwent pollybeak correction between January 2021 and December 2022 at the Department of Plastic and Aesthetic (Burn) Surgery, the Second Xiangya Hospital of Central South University. Individualized correction was tailored based on the etiology and severity of the nasal deformity of each patient, involving techniques such as resection of the anterior part of the nasal septum, reconstruction of nasal tip support, reconstruction of the middle part of the nasal vault, and excision of skin in the upper region of the nasal tip. A modified classification system for pollybeak deformity, the supratip fullness rating scale (SFRS), was developed to evaluate supratip fullness (0-3 points, with higher scores indicating more apparent deformity). The patients aesthetic outcomes were assessed by surgeons using the visual analogue scale (VAS) (0-10 points, with higher scores indicating more apparent deformity), and patient self-assessed using the rhinoplasty outcome evaluation (ROE) questionnaire (0-100 points, with higher scores indicating higher satisfaction). The measurement data of normal distribution was expressed as Mean±SD and analyzed by paired t-test; the measurement data of non-normal distribution was expressed as M( Q1, Q3) and analyzed by Wilcoxon signed rank test. Results:In a cohort study of 53 rhinoplasty patients (7 male, 46 female; age range 19-45 years, mean 29 years), comprising 15 primary and 38 secondary surgeries, nasal tip deformities were evaluated. Deformities were classified as mild (5 cases), moderate (25 cases), and severe (23 cases). Over a follow-up period of 6-17 months (mean 9.5 months), significant aesthetic improvements in the nasal tip region were observed. The SFRS scores decreased from 2(2, 3) preoperatively to 0(0, 0) postoperatively ( Z = -6.58, P < 0.001), and VAS scores decreased from 7.47±1.73 to 1.79±1.67 ( t = -25.61, P < 0.001). High patient satisfaction was indicated by a mean ROE score of 82.45±11.55. No significant complications, such as nasal tip ptosis, skin necrosis, or scar hyperplasia, were reported. Conclusion:Selecting an appropriate surgical method based on the severity and cause of pollybeak deformity can achieve satisfactory outcomes. Post-operative patients exhibit significant aesthetic improvement in the upper nasal tip area, resulting in high patient satisfaction.

Objective:To explore the clinical efficacy of modified superomedial pedicle technique using an inverted T-shaped incision for reduction mammaplasty and mastopexy.Methods:A retrospective analysis was conducted on clinical data of patients who underwent modified superomedial pedicle technique for breast reduction surgery with inverted T-shaped incision between March 2021 and March 2023 at the Department of Plastic and Aesthetic (Burn) Surgery, Second Xiangya Hospital of Central South University. Preoperatively, a handheld Doppler ultrasound blood flow detector was used to detect and mark the exit points of the 2nd to 4th perforating vessels of the internal thoracic artery, and a superomedial pedicle containing at least two perforators was designed based on the perforator locations, with a pedicle width generally about 6 cm. Intraoperatively, the pedicle was rotated superolaterally, moving the nipple-areola complex (NAC) upwards to construct a fuller upper pole of the breast and removing excess skin in the lower fold to form a inverted T-shaped incision. Postoperatively, the blood supply of the NAC, breast morphology, and incidence of complications were observed and followed up. Canfield Mirror 7.1.1 software was utilized to measure pre- and post-operative breast morphology data from lateral photographs at 6 months, including total breast area, maximum breast protrusion, upper pole protrusion, lower pole height, and nipple elevation height. The BREAST-Q questionnaire was used to survey patient satisfaction with breast appearance, psychosocial well-being, sexual well-being, and physical health before surgery and 6-12 months after surgery, with each dimension scoring 0-100 points, where higher scores indicate greater satisfaction and health. SPSS 28.0 software was used for data analysis, with normally distributed measurement data expressed as Mean±SD, and paired t-test was applied for comparisons of pre- and post-operative breast morphology data (the first 4 indicators) and BREAST-Q scores, with P<0.05 considered statistically significant. Results:A total of 56 female patients were included, with an age of (32.0±6.7) years and a body mass index of (29.1±5.7) kg/m 2. Preoperative Doppler ultrasound blood flow detection showed that none of the patients had missing or significantly variant perforators of the superomedial pedicle. The volume of breast tissue removed ranged from 890 to 1 800 ml, averaging 1 250 ml, with an average pedicle width of 5.4 cm (4.0-7.0 cm). The follow-up period was (13.3±2.5) months, during which all patients exhibited good blood supply to the NAC and favorable breast morphology, with universal high satisfaction with surgical outcomes. Postoperatively, one case developed incisional seroma, which resolved naturally within 3 months; two cases experienced minor incision dehiscence, which healed well after dressing changes; all other patients recovered well without any complications such as flap necrosis or hematoma. Comparison of breast morphology data showed significant reductions in postoperative left and right total breast area ( P<0.05 for both), and increases in maximum breast protrusion and lower pole height postoperatively ( P<0.05 for both), while the difference in upper pole protrusion was not statistically significant ( P>0.05 for both); postoperative left and right nipple elevation heights were (6.30±1.84) cm and (6.52±1.66) cm, respectively. Among the 44 patients who completed the BREAST-Q survey both before and after surgery, scores showed significant improvements in postoperative breast satisfaction [(50.30±10.30) points vs. (83.20±6.02) points] ( t=5.17, P=0.008) and psychosocial well-being [(56.20±17.20) points vs. (89.70±2.70) points] ( t=5.09, P=0.010), while sexual well-being and physical health scores did not differ significantly from preoperative scores ( P>0.05 for both). Conclusion:Preoperative identification of perforator locations using a handheld Doppler blood vessel detector, followed by the design of a modified superomedial pedicle technique for reduction mammaplasty with inverted T-shaped incision, can not only ensure NAC blood supply, avoiding ischemic necrosis due to vascular anomalies, but also maximally reduce pedicle width and increase pedicle rotation flexibility, achieving desirable breast shaping effects.

Objective:To evaluate the diagnostic efficacy and practicality of the Jaundice color card (JCard) as a screening tool for neonatal jaundice.Methods:Following the standards for reporting of diagnostic accuracy studies (STARD) statement, a multicenter prospective study was conducted in 9 hospitals in China from October 2019 to September 2021. A total of 845 newborns who were admitted to the hospital or outpatient department for liver function testing due to their own diseases. The inclusion criteria were a gestational age of ≥35 weeks, a birth weight of ≥2 000 g, and an age of ≤28 days. The neonate′s parents used the JCard to measure jaundice at the neonate′s cheek. Within 2 hours of the JCard measurement, transcutaneous bilirubin (TcB) was measured with a JH20-1B device and total serum bilirubin (TSB) was detected. The Pearson′s correlation analysis, Bland-Altman plots and the receiver operating characteristic (ROC) curve were used for statistic analysis.Results:Out of the 854 newborns, 445 were male and 409 were female; 46 were born at 35-36 weeks of gestational age and 808 were born at ≥37 weeks of gestational age. Additionally, 432 cases were aged 0-3 days, 236 cases were aged 4-7 days, and 186 cases were aged 8-28 days. The TSB level was (227.4±89.6) μmol/L, with a range of 23.7-717.0 μmol/L. The JCard level was (221.4±77.0) μmol/L and the TcB level was (252.5±76.0) μmol/L. Both the JCard and TcB values showed good correlation ( r=0.77 and 0.80, respectively) and agreements (96.0% (820/854) and 95.2% (813/854) of samples fell within the 95% limits of agreement, respectively) with TSB. The JCard value of 12 had a sensitivity of 0.93 and specificity of 0.75 for identifying a TSB ≥205.2?μmol/L, and a sensitivity of 1.00 and specificity of 0.35 for identifying a TSB ≥342.0?μmol/L. The TcB value of 205.2?μmol/L had a sensitivity of 0.97 and specificity of 0.60 for identifying TSB levels of 205.2 μmol/L, and a sensitivity of 1.00 and specificity of 0.26 for identifying TSB levels of 342.0 μmol/L. The areas under the ROC curve (AUC) of JCard for identifying TSB levels of 153.9, 205.2, 256.5, and 342.0 μmol/L were 0.96, 0.92, 0.83, and 0.83, respectively. The AUC of TcB were 0.94, 0.91, 0.86, and 0.87, respectively. There were both no significant differences between the AUC of JCard and TcB in identifying TSB levels of 153.9 and 205.2 μmol/L (both P>0.05). However, the AUC of JCard were both lower than those of TcB in identifying TSB levels of 256.5 and 342.0 μmol/L (both P<0.05). Conclusions:JCard can be used to classify different levels of bilirubin, but its diagnostic efficacy decreases with increasing bilirubin levels. When TSB level are ≤205.2 μmol/L, its diagnostic efficacy is equivalent to that of the JH20-1B. To prevent the misdiagnosis of severe jaundice, it is recommended that parents use a low JCard score, such as 12, to identify severe hyperbilirubinemia (TSB ≥342.0 μmol/L).

Objective:To observe the effect of combining robot-assisted gait training (RAGT) with task-oriented training (TOT) on the walking ability of children with dyskinetic cerebral palsy (DCP).Methods:Sixty DCP children were randomly divided into a conventional intervention group, an RAGT group, and a combined intervention group, each of 20. All of the children received conventional rehabilitation therapy, while the RAGT and combined intervention groups were additionally provided with RAGT, and RAGT combined with TOT, respectively. Before the experiment and after 12 and 24 weeks of treatment, the subjects′ walking ability was evaluated using the 10-metre walk test (10MWT), and the D energy zone (standing position) and the E energy zone (walking, running and jumping) of the Gross Motor Function Measurement-88 (GMFM-88) instrument.Results:After 12 and 24 weeks of treatment, the average 10MWT speed and D and E energy zone scores of all three groups had improved significantly. After 24 weeks the combined group′s averages on all three measures were significantly better than those of the other two groups.Conclusion:RAGT combined with TOT and conventional rehabilitation training significantly improves the walking ability of DCP children.

Objective:To explore the current status of surgery for portal hypertension to grasp current status and future development of surgery in China.Methods:This study is jointly sponsored by China Hepatobiliary & Pancreatic Specialist Alliance & Portal Hypertension Alliance in China (CHESS).Comprehensive surveying is conducted for basic domestic situations of surgery for portal hypertension, including case load, surgical approaches, management of postoperative complications, primary effects, existing confusion and obstacles, liver transplantation(LT), laparoscopic procedures and transjugular intrahepatic portosystemic shunt(TIPS), etc.Results:A total of 8 512 cases of portal hypertension surgery are performed at 378 hospitals nationwide in 2021.Splenectomy plus devascularization predominated(53.0%)and laparoscopy accounted for 76.1%.Primary goal is preventing rebleeding(67.0%) and 72.8% of hospitals used preventive anticoagulants after conventional surgery.And 80.7% of teams believe that the formation of postoperative portal vein thrombosis is a surgical dilemma and 65.3% of hospitals practiced both laparoscopy and TIPS.The major reasons for patients with portal hypertension not receiving LT are due to a lack of qualifications for LT(69.3%)and economic factors(69.0%).Conclusions:Surgery is an integral part of management of portal hypertension in China.However, it is imperative to further standardize the grasp of surgical indications, the handling of surgical operation and the management of postoperative complications.Moreover, prospective, multi-center randomized controlled clinical studies should be performed.