Objective To make a comprehensive analysis of the index of benefit and medical service ability of disease,and provide references for the operation management of public hospital based on disease.Methods TOPSIS was used to compre-hensively evaluate the income contribution,income structure,daily income,the proportion of operation/grade 4 operation,DRG-CMI and other indexes.According to the Boston matrix,two-dimensional quadrant analysis was carried out to determine the dominant diseases in the operation management.Results Twelve main diseases in a hospital specialty were analyzed,and the comprehensive scores of two dimensions of benefit and medical service ability were formed.According to the scores,a two-dimen-sional quadrant map was drawn,and the characteristics of diseases in each quadrant were summarized to identify the dominant diseases that contribute greatly to the economic operation and technical difficulty evaluation of the specialty.Conclusion The combined application of TOPSIS and Boston matrix in specialty operation analysis can help public hospital to realize the classifica-tion management of disease balancing benefit and difficulty,so as to optimize the disease structure and improve the utilization rate of medical resources.

Objective:To investigate the effect of capsaicin on lipopolysaccharide(LPS)-induced microglial inflammatory response by modulating silent mating type information regulation 2 homolog 1(SIRT1)/high mobility group box-1 protein(HMGB1)/nuclear factor κB(NF-κB)signaling pathway.Methods:BV2 mouse microglia were cultured in vitro,and pretreated with capsaicin(10 μmol/L),SIRT1 inhibitor EX527(100 μmol/L),capsaicin+EX527(10 μmol/L capsaicin+100 μmol/L EX527)for 3 hours,and then treated with LPS(1 μg/ml)for 24 hours,the corresponding groups were LPS group,LPS+capsaicin group,LPS+EX527 group,and LPS+capsaicin+EX527 group,a normal cultured control group(Control)was also set up.Morphological changes of BV2 cells in each group were observed under a microscope;CCK-8 method was used to detect the viability of BV2 cells in each group;immunofluo-rescence staining was applied to detect the positive expressions of ionic calcium adaptor protein(Iba-1)and the polarization of M1(positive for CD16/32)/M2(positive for CD206)subtypes in BV2 cells in each group;ELISA was applied to detect levels of inflamma-tory factors in BV2 cells in each group;Western blot and co-immunoprecipitation were applied to detect expression of SIRT1/HMGB1/NF-κB signaling pathway-related proteins in each group.Results:Compared with Control group,BV2 cells in LPS group were atro-phied,with shortened processes,the cell viability,and levels of IL-1β,TNF-α and IL-6 were increased,Iba-1 positive expression of BV2 cells and M1 type BV2 cells were increased,while expression of SIRT1 protein was decreased,expressions of acetylated(ace)-HMGB1 protein,cytoplasmic HMGB1 protein and nuclear NF-κB protein were increased(P<0.05);after capsaicin pretreatment,the above conditions were improved,and the M2 type BV2 cells were increased;adding EX527 pretreatment on the basis of capsaicin pre-treatment,the above conditions were all aggravated.Conclusion:Capsaicin can inhibit the inflammatory response induced by LPS-in-duced BV2 cell activation,which may be achieved by modulating the SIRT1/HMGB1/NF-κB signaling pathway.

Objective:To observe the clinical effect of free perforator flap of deep medial plantar artery and with sensory nerve in reconstruction of soft tissue defect in heel.Methods:From May 2022 to June 2023, a total of 15 patients with soft tissue defect of heels that caused by various reasons were admitted to the Department of Orthopedics, Zhengzhou Orthopaedic Hospital. The patients were 6 males and 9 females aged 21 to 45 years old, at 32 years old in average. The size of defects was 5 cm×8 cm-10 cm×14 cm. Free perforator flaps of deep medial plantar artery with cutaneous medial plantar nerve were used, at 5 cm×8 cm-11 cm×14 cm in size. Cover the first phase of VSD dressing in the supply site, remove it after 1 week, fill the wound with granulation tissue, and then perform full-thickness skin graft.Results:All 15 flaps survived after surgery. Postoperative outpatient follow-up lasted for 8 to 15 (average 12)months. Appearance and texture of the reconstructed heels were satisfactory, the affected feet were able to bear normal weight without obvious tenderness or ulcer formation. The reconstructed heals were resistant to wear and cold with good sensation. TPD of the flaps achieved 5 mm to 7 mm, without sense of heterotopia after rehabilitation. There was no obvious pigmentation or cicatricial contracture.Conclusion:It is satisfactory to apply a free perforator flap of deep medial plantar artery with sensory nerve in reconstruction of soft tissue defect of heel.

Objective:To evaluate the efficacy of botulinum toxin A injection therapy with ultrasound-guided for benign masseter hypertrophy.Methods:Twenty cases (40 sides) of masseter hypertrophy were injected with botulinum toxin A, among which 10 cases were taken as experimental group and the other 10 cases as control group. The experimental group had preoperative ultrasound examination to measure the thickness of masseter, and use ultrasound-guided precise injection during the operation, and then ultrasound recheck to measure the postoperative masseter thickness; The other 10 cases of control group adopt traditional 3-point injection method.Results:The masseter thickness of the two groups at different period of times after treatment was decreased ( P<0.001), the most obviously decrease happened 4-12 weeks after injection. The mean reduction was 26.8% at 4 weeks and 28.4% at 12 weeks after injection. Masseter muscle thickness recovered by 22% at 24 weeks and by 20% at 36 weeks. The average follow-up was 6.0±2.4 months with no serious complications occurred. In the control group, there was a partial masseter bulge in one case. The satisfactory rate of the patients in the experimental group was higher than that of the control group. Conclusions:Botulinum toxin A injection therapy with ultrasound-guided for benign masseter hypertrophy is an effective treatment, which is more accurate and effective than the traditional injection method.

Objective:To figure out the structure and relevant data measurements of zygomatic ligament by cadaver anatomy and review of previous studies.Methods:From July 2018 to January 2020, the zygomatic areas of 20 Chinese frozen fresh cadaver hemifaces were dissected in the Department of Anatomy, Health Science Center of Hangzhou Normal University. Then the structures of zygomatic ligaments were shown. The characters of the ligament and the relationship with adjacent tissue were described and measured. And 16 previous studies were reviewed to get a comprehensive description about the characters of zygomatic ligaments.Results:Zygomatic ligaments were even and dense fibrous tissue structures distributed vertically between the skin and the subcutaneous tissue. Under the SMAS plane, the ligaments divided into two bundles. The origin of major bundle located beyond the origin of the zygomatic major muscle on the periosteum, and the origin of minor bundle located between the origin of the zygomatic minor and major muscle.Conclusions:The anatomy of the zygomatic ligament has a regular pattern, and its anatomical data has certain directive significance for clinical application.

Betacoronavirus ; Coronavirus Infections ; Humans ; Pandemics ; Pneumonia, Viral ; Single-Cell Analysis

Objective:To identify the association of sex hormone and sex hormone-binding globulin (SHBG) levels in patients with Graves′ disease.Methods:Between December 2017 and July 2019, 152 patients with Graves′ disease were enrolled in the Department of Endocrinology and Metabolism of Zhongshan Hospital, Fudan University. Parameters such as height, weight, thyroid function, sex hormone, fasting blood glucose, insulin, C-peptide, glycosylated albumin, HbA 1C, and liver function were collected. The associations between SHBG and bioclinical characteristics were analyzed. Results:The glycosylated albumin level was negatively associated with SHBG in all subjects ( β=-0.308, P<0.01), while this association was not significant after the adjustment for thyroid hormones. Male patients had significantly lower SHBG level than female patients ( P<0.01). In male patients, SHBG was associated with luteinizing hormone ( r=0.465, P<0.01), estradiol ( r=0.629, P<0.01), testosterone ( r=0.786, P<0.01). While in female patients, SHBG was also associated with testosterone ( r=0.191, P<0.05). In multivariate linear regression analysis, estradiol was independently associated with SHBG ( β=0.329, P<0.01) in male subjects. Conclusion:The hypogonadism and infertility in Graves′ disease patients could partially be attributed to the association between SHBG and Graves′ disease.

The new method of negative pressure wound therapy not only greatly improves the level of treatment on hard healing wounds in plastic surgery, but also widely used in the field of major surgery. The clinical efficacy of this technique in prevention of surgical incision complications, treatment of postoperative wound infection and fissure, treatment of postoperative infection and exposure of various implants, treatment of special burn wounds, and temporary closure of abdominal cavity after open abdominal surgery were reviewed. The impact of negative pressure wound therapy with instillation for infected wounds and the application of endoscope assisted negative pressure therapy in the treatment of complications after hollow viscera anastomosis were also reviewed. This review provides a new idea for the treatment of various refractory wounds and wound complications.

Objective: To evaluate the clinical value of the the hypopharynx and chest esophageal carcinoma. Methods: 20 patients surgical treatment data of the hypopharynx and chest esophageal carcinoma from January 2013 to July 2019 were reviewed. Results: The simultaneous hypopharynx and esophageal carcinoma 11 cases. The heterochronic hypopharynx and chest esophageal carcinoma 9 cases. 20 cases are all squamous cell carcinoma. The synchronus operation included total pharyngolaryngo esophagectomy, gastric tube interposition pharyngo gastric anastomic, neck and mediastinal lymph nodes dissection, tracheostomy. The heterochronic operation included the first stage radical hypopharygealectomy, the second stage radical esophagealectomy. Postoperative complications included in hospital death in one, double pneumonia in 3 and anastomosis stricture in one case. Pharynx gastric fistula in 2. Swallowing function were all recovered. Conclusion Although laryngo pharyngo esophagectomy and pharyngogastric anastomoses for the hypopharynx and chest esophageal carcinoma is a simple and acceptable procedure, the quality of life is not satisfactory. And although colon interpasation for esophageal replacement is complicated the quality of life is the best.

Objective To investigate the expression of Notch receptors and its relationship with clinicopathological features and prognosis in gastric cancer tissues. Methods Immunohistochemical SP method was used to detect the expression levels of Notch1, Notch2, Notch3 and Notch4 corresponding receptors in 45 patients with gastric cancer from January 2014 to May 2015 in the Third Affiliated Hospital of Hunan University of Traditional Chinese Medicine. The correlation between expression levels of Notch receptors and lymph node metastasis, TNM staging, disease-free survival (DFS) and overall survival (OS) were analyzed. Results Notch1, Notch2, Notch3 and Notch4 corresponding receptors were mainly distributed in the cytoplasm, and the positive expression rates in gastric cancer tissues were 93.3％ (42/45), 86.7％ (39/45), 80.0％ (36/45), and 77.8％ (35/45), which were higher than those in adjacent tissues [31.1％ (14/45), 24.4％(11/45), 40.0％ (18/45), and 46.7％ (21/45)], and the differences were statistically significant (all P< 0.05). There was no correlation between the expression of Notch1, Notch2, Notch3 and Notch4 corresponding receptors and lymph node metastasis, TNM staging, DFS and OS in gastric cancer tissues (all P> 0.05). Conclusion Notch receptors are highly expressed in gastric cancer tissues, and have no correlation with lymph node metastasis, TNM staging, DFS and OS of patients after surgery.