Objective To investigate the relationship of fetal total bile acid (TBA) concentration with the change of fetal pancreas endocrine secretion and its impact on fetal growth and development in intrahepatic cholestasis of pregnancy(ICP). Methods The concentrations of TBA, insulin, glucagon and glucose in the cord blood were measured in 30 fetuses with maternal ICP (case group) and 30 fetuses of normogravidas(control group) after elective cesarean section during the same period in the Department of Obstetrics of Xiangya Second Hospital of Central South University from March 2007 to February 2008. The cord blood TBA concentration was investigated by enzyme method and the concentrations of insulin and glucagon were investigated by radioimmunoassay. The glucose was measured by oxidase-superoxide method. The neonatal weight, length and the ponderal index (PI) were measured after parturition. Results (1) The cord blood insulin concentration (9.0±3.3) mU/L and the ratio of insulin over glucagon 0. 048±0. 028 in the case group was significantly lower than that of controls(10.1±3.7) mU/L,0.050±0. 020 (P<0.05). The concentrations of TBA(10.3±3. 8)μmol/L and glucagon(235±57) ng/L in case group were obviously higher than that in controls (4.1±1.3)μol/L, (205±34) ng/L(P<0.05). But no difference was shown in the glucose concentration in cord blood between the ease and control groups [(3.4±1.1) mmol/L vs (3.6± 1.2 )mmol/L, P > 0.05]. (2)The neonatal weight and length in case group were significantly lower than that of control [(3163±478) g vs (3498±393)g, (46.5±2.3) cm vs (49.3±1.9)cm, P<0.01]; while the Ponderal index in ease group was significantly higher than that of control group (3.13±0. 23 vs 2. 92±0. 29,P <0.01). (3) The cord blood TBA concentration respectively showed a linear relationship with the cord blood insulin concentration, the cord blood glucagon concentration and the ratio of insulin over glucagon in the case group. With the increase in cord blood TBA concentration, the cord insulin concentration and the ratio of insulin over glucagon decreased; meanwhile the cord blood glucagon concentration rose(P<0.01). The cord blood insulin concentration and the ratio of insulin over glucagon in case group were respectively positively correlated with the neonatal weight and length, and were negatively correlated with the PI (P<0.01); while the cord glucagon concentration was respectively negatively correlated with the neonatal weight and length, and positively correlated with the P1 (P < 0.01 ).Conclusions In 1CP fetus pancreas, there are hypoinsulinism, glucagon oversecretion, and decrease of the ratio of insulin over glucagon, which is closely correlated with fetal TBA concentration. The endocrine function of fetal pancreas affects the fetal growth and development.

Objective To study the application of suture and ligature and swelling technique in the removal of giant skin benign tumor in none-extremity position.Methods The swelling technique was merely used in those whose lesions were located on face and neck before operation.If the lesions were located on scalp or truck,suture and ligature and swelling technique would be combined in the treatment.Firstly,the lesion was sutured and ligated one or two circles all around.Then swelling fluid was injected under lesion,and incision was done inside or between sutures.Results The area of lesion once excised was 154.00-2394.75 cm2,and the quantity of swelling fluid was 150 1950 ml.The longest time to suture and to ligate the lesion was one hour,and operative bleeding was obviously decreased.Conclusions Suture,ligature and swelling technique might be helpful to decrease operative bleeding during excision of giant skin benign tumor in none-extremity position,and therefore increase operative safety.

Objective To probe the definition of cicateicial cryptotia and its plastic and reconstructive surgery.Methods Local skin flaps combined with full-thickness skin graft by zonation grafting technique were used to treat twenty-six patients with thirty-three cicateicial cryptotia.A cicateicial adhesion between auricle and cranial wall and mastoidea was removed,cranioaural angle was reformed,and helix and auricular lobule were reconstructed.Results All skin flaps survived,and the survival rate of skin grafts reached over 95 ％.The appearance of auricle was very good,its major constructions might be noted,and cranioaural angle nearly returned to normal.The follow-up results from three months to one year post-operation showed that the appearance of auricle kept well,and the patients felt satisfactory.Conclusions In view of deformity characteristics of cicateicial cryptotia,it might be an effective approach to treat cicateicial cryptotia to take a seris of appropriate surgical procedures.

Objective To summarize the experience of emergency treatment and cosmetic repair of facial trauma.Methods The clinical materials of 584 wounds from 291 cases of facial trauma,recruited in hospital from January 2010 to August 2012,were summed up retrospectively.The principles of medical aesthetics and plastic and cosmetic surgery were followed.A high pressure douching technique was employed to carry out thorough debridement,but occasion of the debridement did not emphasize with intensive attention.A wound without skin and soft tissue defect was sutured accurately according to tissue zonation with a new suture technique,and the needle distance or side distance was limited in 0.2 cm to 0.3 cm.Otherwise,the wound was repaired by full-thickness skin graft or various flaps according to the repair principle ofrather near than further,rather simple than complicated.Attention was paid to rehabilitation care.Results After debridement,328 wounds were sutured directly,147 wounds were repaired by full-thickness skin grafting and 109 wounds by various flaps.A total of 571 wounds healed on the first stage,and the healing rate reached 97.8％.The wounds were in satisfactory apposition and without obvious cicatrix.Five senses did not appear in malposition and deformity.The other 13 wounds did not heal because of bad taking of skin grafts and flaps or wound splitting.Among them,4 wounds were repaired by second operation,and 9 wounds healed by changing dressings.By means of rehabilitation care,scar hyperplasia and pigmentation appeared slightly in those 13 wounds.A total of 454 wounds from 217 cases were followed up.The results showed good appearance and slight cicatrix hyperplasia,a pigmentation in different degree appeared in 11 wounds covered by skin grafting.In addition,eyebrow excalation,auricle excalation or total lose appeared in 12 cases.Conclusion During treating emergency cases of facial injuries,if an idea cosmetic repair of traumais followed,the theory of aesthetics and the techniques of plastic and cosmetic surgery are fully used,a multiple-discipline cooperation is brought into full play,and a prompt and accurate treatment is put into practice,the aim of cosmetic repair would come true.

OBJECTIVETo explore the timing and suitable method of reconstructing penile defects caused by devastating electrical burn.

METHODSThirteen patients with penile defects after devastating electrical burn, hospitalized from September 1998 to August 2013, were included in this study. After the necrotic tissues in the wounds were removed by dressing changes, a local or a hinge-like flap constructed from scrotum or abdominal wall, a prelaminated hinge-like flap from forearm, or a free forearm flap was selected, according to the injury degree of the penis, for the repair of the defect or reconstruction of penis respectively.

RESULTSThe flaps survived and the wounds healed well in 2 patients repaired with local flaps from scrotum or abdominal wall. Urethritis occurred in 2 patients 6 to 9 months after the transplantation of hinge-like flaps from scrotum, and they were cured by appropriate drugs. Functions of urination and erection of penis were recovered in these 4 patients. All flaps survived in the 5 patients repaired with hinge-like flaps from abdominal wall or prelaminated flaps from forearm. The wounds in 2 patients healed; wound dehiscence occurred in the other 3 patients in different degrees, and they healed after suturing for 2 or 3 times. The function of erection of penis recovered in these 5 patients, but with discontinuity of urinary stream during urination. Among them, 3 married patients enjoyed satisfactory sexual life. All free forearm flaps survived and the wounds healed well in 4 patients. Urinary fistula occurred in 1 patient, and it was repaired by a secondary operation. These 4 patients experienced normal urination function, but only 2 patients in whom corpus spongiosum partially remained retained the function of erection of penis to certain degree. All these 4 patients could not perform normal sexual intercourse. All patients were followed up for 6 to 13 months after surgery. Under ordinary state, the length of penis was 5.9-9.3 cm, and the circumference of penis was 8.4-10.0 cm. Wound scar was not obvious in all cases. Nine patients reported a restricted erection.

CONCLUSIONSPenile defect caused by devastating electrical burn should be repaired with a suitable flap after necrotic tissues are removed with dressing change. To repair affected penis with necrosis of a small part of cavernous body and/or corpus spongiosum, or combined with urethra defects, local flaps from scrotum or abdominal wall or hinge-like flap from scrotum should be employed. To repair those with necrosis of a large part or the whole of corpus spongiosum combined with urethra defects, hinge-like skin flaps from abdominal wall or prelaminated flaps from forearm should be employed. In patients with necrosis of a large part of cavernous body and corpus spongiosum combined with urethra defect, or total loss of penis, free forearm flaps should be employed to reconstruct penis.

Burns, Electric ; surgery ; Free Tissue Flaps ; Humans ; Male ; Necrosis ; Penis ; injuries ; surgery ; Postoperative Complications ; Reconstructive Surgical Procedures ; methods ; Scrotum ; Skin Transplantation ; Surgical Flaps ; Time Factors ; Treatment Outcome ; Wound Healing

Objective To explore the effects of "3+1+1" talent cultivation model on key competency in five-year higher vocational nursing students. Methods In March 2015, we selected five-year 80 higher vocational nursing students majoring in clinical nursing in 2013 of Wuxi Higher Health Vocational Technology School as subjects by convenience sampling. All of the 80 nursing students were divided into experimental group (n=38) and control group (n=42) according to classes. Nursing students of experimental group received the "3+1+1" talent cultivation model. Nursing students of control group were treated with the "4+1" cultivation model. The evaluation index system for key competency of five-year higher vocational nursing students was used to evaluated nursing students of two groups. We also compared the theoretical achievement and skills performance of nursing students between two groups. Results There were no statistical difference in key competency of nursing students between two groups at the end of the 2.5th school year (P＞0.05). The score of key competency of nursing students in experimental group was higher than that in control group at the end of the fourth school year with a significant difference (P＜ 0.05). There were no statistical differences in theoretical achievement and skills performance of nursing students between two groups at the end of the 2.5th school year (P＞0.05). The theoretical achievement and skills performance of nursing students in experimental group were higher than that in control group at the end of the fourth school year with significant differences (P＜ 0.05). Conclusions The "3+1+1" talent cultivation model can improve nursing students' key competency and school achievement.

Objective To assess the prognosis and effect on renal function of pediatric urolithiasis caused by melamine-contaminated milk powder (PUMMP) in a long-term follow-up.Methods One hundred and two of 8335 children (≤ 6-year-old) with history of consuming melamine-contaminated milk powder screened in our hospital were followed up for eighteen months after diagnosis. Urinary system ultrasonography, urinalysis, urinary microprotein profiles [microalbumin (ALBU), immunoglobulin G (IgG), and N-acetyl-β-D-glucosidase (NAG)], urinary melamine and cyanuric acid were examined in the first visit and at the end of follow-up. Results Follow-up was completed in 91 children and the stone was excreted in 82 children (90.1%).Stones less than 5 mm in diameter were most vulnerable to discharge, and stones larger than 10 mm could not be expelled without interventions. At the end of follow-up, no melamine or cyanuric acid was found in the urine samples of 74 patients. Urinalysis showed that incidences of proteinuria, microscopic hematuria and leukocyturia were 0%, 5.1% and 2.0%, which were significant different from those in the first visit (Pproteinutria=0.123, Phemnatuna=0.038 and Pleukocyhuris=0.005).Urinary microprotein profiles revealed that some children whose urinalysis was normal still presented glomerular and renal tubular injury and the abnormal rates were 8.8% and 12.1%respectively. The glomerular injury was mainly related to persistent stone, male and younger.Conclusions 90.1% of children with PUMMP passes urinary stones at the end of follow-up.Stone size is the major risk factor of discharge. No melamine or cyanuric acid is found in the urine of children. After eighteen months, glomerular and renal tubular injury is still found in some patients. Further follow-up is necessary.

Objective:To explore a low dose CT scanning method on novel coronavirus (COVID-19) pneumonia based on infection prevention and control.Methods:A total of 140 patients with confirmed novel coronavirus pneumonia in Xiehe hospital from January 20, 2020 to February 28, 2020 were undertaken CT scan and divided into low dose group and conventional dose group. The patients in low dose group(120 kV, 31 mAs) consisted of mild type(51), severe type(15) and critically ill type(4); and those in conventional dose group(120 kv, adaptive milliampere second) consisted of mild type(48), severe type(17) and critically ill type(5). The effective radiation dose, SNR and CNR of CT scan were compared between two groups. A senior and a middle radiologist made the image subjective quality scores, respectively.Results:The effective dose in low dose group was lower than that of conventional dose group( t=-48.343, P<0.05). There was no significant difference in SNR and CNR between two groups( P>0.05). For severe and critically ill patients, the score in low dose group was significantly lower than that in conventional dose group( t=-2.781, P<0.05). There was no significant difference in scores between two groups for mild patients( P>0.05). Conclusions:Low-dose CT scanning could meet the image quality needs for patients with COVID-19 and meanwhile significantly reduce the radiation dose.

Objective:To investigate the clinical effect of using chimeric perforator flap with muscle flap in repairing deep dead space of refractory wound.Methods:From February 2015 to February 2019, 22 cases of refractory wounds with deep dead space were admitted to the Burn and Plastic Surgery Center of the 940th Hospital of the Joint Logistic Support Force of the PLA, including 17 males and 5 females, aged from 17 to 72 years old, with an average age of 36.4 years old. 6 cases were located in the plantar, 6 in the calf and ankle joints, 5 in the perineum, 2 in the elbow, 2 in the back and 1 in the orbit. Defect area ranged from 5 cm×4 cm to 16 cm×11 cm. Dead space ranged from 3 cm×2 cm to 10 cm×4 cm. 14 cases were repaired with free transplantation of anterolateral femoral chimeric perforator flap, 5 cases with anterolateral femoral chimeric perforator flap, 1 case with peroneal artery chimeric perforator flap, 1 case with superficial peroneal artery chimeric perforator flap, and 1 case with posterior tibial artery chimeric perforator flap.Results:In the 22 cases of this group, the flap area ranged from 6 cm×5 cm to 17 cm×12 cm, and the muscle flap area ranged from 3 cm×2 cm to 10 cm×4 cm. One case of refractory wound repaired by superficial peroneal artery perforator chimeric flap was poorly healed in the margin of the flap, which was healed by skin grafting in the second stage after dressing change. One case of refractory wound repaired by anterolateral femoral chimeric perforator flap presented subcutaneous sinus after surgery. The wound was healed after dressing change and debridement. All the other 20 cases survived well. The patients were followed up for 3-18 months, and the appearance and function of the wound were recovered satisfactorily.Conclusions:In the chimeric perforator flap with muscle flap, the muscle flap filled up the dead space and the flap covered the wound on body surface at the same time, which is one of the good methods to repair the refractory wound with deep dead space.

Objective:To investigate the clinical effect of using chimeric perforator flap with muscle flap in repairing deep dead space of refractory wound.Methods:From February 2015 to February 2019, 22 cases of refractory wounds with deep dead space were admitted to the Burn and Plastic Surgery Center of the 940th Hospital of the Joint Logistic Support Force of the PLA, including 17 males and 5 females, aged from 17 to 72 years old, with an average age of 36.4 years old. 6 cases were located in the plantar, 6 in the calf and ankle joints, 5 in the perineum, 2 in the elbow, 2 in the back and 1 in the orbit. Defect area ranged from 5 cm×4 cm to 16 cm×11 cm. Dead space ranged from 3 cm×2 cm to 10 cm×4 cm. 14 cases were repaired with free transplantation of anterolateral femoral chimeric perforator flap, 5 cases with anterolateral femoral chimeric perforator flap, 1 case with peroneal artery chimeric perforator flap, 1 case with superficial peroneal artery chimeric perforator flap, and 1 case with posterior tibial artery chimeric perforator flap.Results:In the 22 cases of this group, the flap area ranged from 6 cm×5 cm to 17 cm×12 cm, and the muscle flap area ranged from 3 cm×2 cm to 10 cm×4 cm. One case of refractory wound repaired by superficial peroneal artery perforator chimeric flap was poorly healed in the margin of the flap, which was healed by skin grafting in the second stage after dressing change. One case of refractory wound repaired by anterolateral femoral chimeric perforator flap presented subcutaneous sinus after surgery. The wound was healed after dressing change and debridement. All the other 20 cases survived well. The patients were followed up for 3-18 months, and the appearance and function of the wound were recovered satisfactorily.Conclusions:In the chimeric perforator flap with muscle flap, the muscle flap filled up the dead space and the flap covered the wound on body surface at the same time, which is one of the good methods to repair the refractory wound with deep dead space.