Objective To find out the tendency of medical accident arbitration in 5 hospitals of Shanghai and the causes. Methods Cases involving medical accident arbitration that occurred in the 15 years running from 1985 to 1999 in 5 third tier hospitals of Shanghai were collected and a retrospective correlation analysis was conducted. Then 45 of the cases were selected by random sampling and a detailed analysis was made. Results ①During the 15 years the number of cases involving medical accident arbitration by class 1 commissions was 295, with the average number per year in the latter five years rising 51% as compared with the first ten years. ②There was no significant correlation between the number of cases involving arbitration and the number of cases judged to be accidents. ③There was no correlation, either, between the total volume of emergency outpatient service, which amounted to 68, 6 million visits, and the number of cases involving medical accident arbitration. ④The sample survey showed that the operating room and the emergency room were sections where medical accidents occurred most frequently. Conclusion In the past 15 years, the number of cases involving medical accident arbitration has been on the rise, yet there is no correlation between the rise and the number of cases judged to be accidents or the volume of medical service. The causes for the rise include both iatrogenic and non iatrogenic ones. The paper puts forward 6 countermeasures.

Objective To evaluate the diagnostic value of power Doppler ultrasonography through vagina in malignant trophoblastic tumor(MTT).Methods The features of power Doppler flow imaging of 43 cases with MTT were studied retrospectively.The imaging differences in normal group,benign gestational trophoblastic tumors and malignant gestational tropho-blastic tumors were compared,and the relationship between imaging character and benign or malignant gestational trophoblastic tumors was analyzed.At the same time,the change of blood flow in uterine intramuscular layer was obeserved before and after chemotherapy combined with β-hCG.Results The blood folw character of uterine intramuscular layer in normal group was punctate and scattered blood flow signal,flow shape was regular;The blood folw character of uterine intramuscular layer in benign gestational trophoblastic tumors group was short pole blood flow signal,flow shape was less regular;The blood folw character of uterine intramuscular layer in malignant gestational trophoblastic tumors group was very rich blood flow signal,flow shape was anomalistic; After chemotherapy,the extent and diameter of the blood folw of uterine intramuscular layer was decreased seriously,while the β-hCG reduced.Conclusion PDI had diagnostic value in MTT and could be seemed as a guide for observing the chemotherapeutic effect and prognosis of MTT.

Objective To study a simple, safe and effective way in correction of prominent mandibular angle. Methods Curved osteotomy was employed for prominent mandibular angle through intra and extra oral approach with a small incision in 20 cases.Partial masseter resection was performed simutaneously in 5 cases with masseter hypertrophy, buccal fat pads were resected in 3 cases with broad faces, and genioplasty were performed in 3 cases with micrognathia. Nine cases only suffering from prominent mandibular angle were underwent curved osteotomy reconstruction. Results A series of 20 cases was followed up from six months to six years, in which 95 % was satisfactory.Conclusion The advantages of this method are simple, safe and symmetric with better result. It is easy to dissect under periosteum and perform curved osteotomy with less complication, quick recovery, and better contouring.

Objective To explore the development trends in community nursing. Methods The current situation of community nursing in Shanghai was analyzed by means of questionnaire surveys and literature review. Subjects A total of 3 173 questionnaires were distributed to community nurses, hospital nurses, community residents, and hospitalized patients and 2 942 of them were retrieved, the rate of retrieval being 93.8%. Results The demand for community nursing was not satisfied, the number of community nurses was insufficient and their general quality was low. Conclusion The scope of services in community nursing needs to be expanded with demand as a guide, more community nurses need to be cultivated, and the quality of the nursing contingent needs to be enhanced.

Objective To investigate sexual life associated with hysterectomy of young women and its related factors.Methods Data from 199 patients with hysterectomy were collected.Statistical analysis was performed between the postoperative recovery condition among them,including daily life and sex life.Results There was significant difference on sexual life quality of the patients by hysterectomy among patient age,occupation,education,postoperative time,disease and complication (P ＜ 0.05).The age of 41-50 years and 51-60 years old patients' quality of life satisfaction was significantly higher than that of age ≤40 years old patients (OR =3.8,95 ％ CI 1.36-10.66; OR =3.6,95 ％ CI 1.24-10.43).The patients of the occupation of service sectors,workers,and patients with free occupation have a decreased satisfactions compared with that of farmer patients (OR =0.46,95 ％ CI 0.12-1.75; OR =0.75,95 ％ CI 0.27-2.12; OR =0.94 95 ％ CI 0.45-1.98).There was a increasing satisfactions in administrative and the intellectuals (OR =1.11,95 ％ CI 0.34-3.62; OR =1.33,95 ％ CI 0.35-5.10).Patients with primary school educations as a reference for comparison,the quality of life of patients with associated college and above degree were increased than patients with primary school (OR =1.15,95 ％ CI 0.43-3.04),and were decreased in the patients of the high and middle school (OR =0.98,95 ％ CI 0.46-2.11; OR =0.63,95 ％ CI 0.26-1.54; OR =0.15,95 ％ CI 0.02-1.27).The quality of life satisfaction of long period patients (7-12 months,13-24 months,24 months after the operation)was significantly higher than that of short period patients with 6 months(OR =1.94,95 ％ CI 0.65-5.83; OR =6.32,95 ％ CI 2.17-18.38; OR =8.47,95 ％ CI 2.92-24.56,P ＜ 0.001).Conclusion The doctors need focus on relative knowledge education of perioperation.It is important to inform patients and their spouses to have the knowledge of female physiology,fully understanding the impact of the extent of surgery on sexual life of patients to enhance the confidence and improve the life quality of patients.

BACKGROUND: Through exercise and/or hypoxia to increase the body's stress level and timing of hypoxia, so as to improve the body's adaptation level to exercise and/or hypoxia. However, little was known concerning the effects of acute exercise and/or hypoxia on vascular endothelial cell growth factor (VEGF) expression in skeletal muscles.OBJECTIVE: To study the effects of acute exercise and/or hypoxia on VEGF expression in rats' gastrocnemius muscles. DESIGN, TIME AND SETTING: The randomized controlled animal experiment was performed at the Clinical Laboratory, People's Hospital of Jiangsu Province, between September 2005 and September 2006.MATERIALS: Totally 108 health male SD rats were randomly divided into 6 groups, namely, normoxia quiet, normoxia high intensity, normoxia moderate intensity, hypoxia quiet, living high-training low high intensity and living high-training low high intensity moderated intensity groups, with 12 animals in each group.METHODS: In acute normoxia exercise models, rats were performed adaptive activity at 48 hours prior to experiment. The high intensity exercise was comprised of 50 m/minx1.5 min training with 2 minutes rest. The moderate intensity exercise was 30 m/min×30 min. Hypoxia environment was produced by using low oxygen instrument to simulate hypoxia training, with hypoxia for 3 days, 22 h/d, 12.8% altitude, with 22 ℃ temperature and 55% humidity. In acute training low-living high models, rats were placed in above hypoxia environment after high intensity Or moderate intensity exercise. Four rats were sacrificed at hours 0, 2 and 4 after training, and the gastrocnemius muscles were obtained.MAIN OUTCOME MEASURES: The expression of VEGF in rats' gastrocnemius muscles was detected by using western-blot.RESULTS: Hypoxia and acute normoxia exercise enhanced the expression of VEGF, hypoxia after exercise weakened exercise-induced VEGF expression, and the exercise with long time and common intensity induced the higher level VEGF expression. The expression of VEGF was the most at the time points of instantaneousness and 2 hour after exercise, the sorting of the recovery speed of VEGF changes from fast to slow was: hypoxia or training low-living high and normoxic exercise. CONCLUSION: The expressions of VEGF in rats' skeletal muscles induced by acute exercise and/or hypoxia belong to the effect of immediate-early, with existing intensity-threshold, which recovery speed is inversely proportional to the expression amplitude;"training low-living high" may be able to enhance the adaptation of skeletal muscles to sports.

Objective To evaluate the efficacy of follicular unit extraction (FUE) in the repair of scarring eyebrow loss.Methods A total of 30 patients with scarring eyebrow loss were treated with FUE technique in the Department of Plastic Surgery of Zhengzhou First People's Hospital,including 18 females and 12 males with 41 eyebrow defects.Fine soft hairs with a length of 5-10 mm were extracted from the back of the ear and temporal region of the patients,and then were split into individual follicular units under a microscope at 6 × magnification.The transplant density ranged from 20 to 30 FU/cm2.Results During the 3-18 months of follow-up after the surgery,eyebrows in the recipient areas grew in a natural direction and showed good appearance.The survival rate of hair grafts was up to 90％,and the patients were satisfied with the results.Conclusion FUE may be an ideal method for the treatment of scarring eyebrow loss with less injury and high survival rate of hair grafts.

10.3969/j.issn.1000-3606.2013.06.010

OBJECTIVETo investigate the therapeutic effect of soft tissue expansion combined with follicular unit extraction( FUE) for burn cicatricial bald.

METHODS48 patients with burn cicatricial bald (> 25 cm2) were treated in three stages. The expanders were implanted on the first stage. After expansion for 8 weeks, the expanders were taken out and local flaps were transferred. One year later, follicular unit extraction( FUE) was applied on the bald area.

RESULTS48 cases were followed up for 5 years with satisfactory cosmetic results. The VAS assessment of satisfaction on hair appearance after three-staged surgery was 8.2 ± 2.1.

CONCLUSIONSSoft tissue expansion combined with FUE has a reliable effect for burn cicatricial bald.

Alopecia ; etiology ; surgery ; Burns ; complications ; surgery ; Female ; Hair ; transplantation ; Hair Follicle ; transplantation ; Humans ; Male ; Surgical Flaps ; transplantation ; Tissue Expansion ; methods ; Tissue Expansion Devices

Objective To investigate the current status of compliance with hand hygiene among health care work-ers (HCWs)in a comprehensive hospital in Xi’an.Methods Status of hand hygiene among HCWs in 73 clinical de-partments was observed directly.Results 404 moments for hand hygiene of 404 HCWs were observed,255 times of hand hygiene were implemented,181 times of hand hygiene were correct,the total compliance rate was 63.12%, and correct rate was 44.80%.Compliance rate and correct rate of hand hygiene of HCWs in intensive care unit were both higher than general wards (91.89% vs 60.22%,χ2 =14.485,P <0.001;81.08% vs 41.14%,χ2 =5.671,P=0.017).Among HCWs of different occupations,compliance rate and correct rate of hand hygiene of nurses were both the highest (73.76% and 60.18% respectively),while auxiliary persons were both the lowest (40.90% and 10.20% respectively);among five moments for hand hygiene,compliance rate was highest after body fluid and blood exposure (80.00%),correct rate was highest before aseptic procedure (62.96%).Conclusion There is a high compliance rate and low correct rate of hand hygiene among HCWs in this hospital.Compliance rate and correct rate of hand hygiene among HCWs in different departments,different occupations and different hand hygiene moments are varied,compliance with hand hygiene among HCWs should be paid extensive attention.