For the current situation of the time background and the cultivation of innovation ability of undergraduates, the problems of fracture classification, function evaluation and postoperative rehabilitation were realized by a software research team which mainly consisted of medical undergrad-uates. We put the project into practice in forms of software production and software promotion trial separately in the field of teaching and clinical practice to encourage students to be involved in learn-ing in the process of software production of professional knowledge. The implementation of the project worked well, and developed the well-designed relevant mobile software which was convenient in clini-cal practice and acquired computer software copyright, indicating that it can effectively motivate the undergraduates' innovation interest and consciousness through participating in the various links and the software production process, and it can also contribute to the cultivation of the comprehensive practical and innovation ability of medical undergraduates.

Objective? To summarize the nursing care for giant condyloma acuminatum patients with surgery cutting and photodynamic therapy. Methods? From January 2015 to December 2018, we selected 30 patients with giant condyloma acuminatum in Department of Dermatology of Affiliated Hospital of Nantong University. All of patients received surgery cutting and photodynamic therapy for warts. After surgery, intervention was provided with the method of nursing in sequence with multi-drug for wound. We observed the surgical wound complications and recurrence rate of disease. Results? Among 30 giant condyloma acuminatum patients, the surgical wounds were not with infection and bleeding. Disease recurred in one patient followed up 6 months after discharge. Conclusions? Nursing in sequence with multi-drug for wound in giant condyloma acuminatum patients with surgery cutting and photodynamic therapy can reduce wound complications, improve comfort of patients and decrease the recurrence rate of disease.

OBJECTIVE:To provide reference for guarantee the supply of short-landed drugs.METHODS:A questionnaire survey was conducted to investigate the drug shortage in 40 medical institutions in China.Based on the survey data,the econometric model was built to analyze the reasons for drug shortage in medical institutions.RESULTS:40 questionnaires were issued and 26 valid questionnaires were collected with effective recovery rate of 65.0％.The institutions surveyed received 87 samples of short-landed drugs,involving 33 drugs;82.8％ of short-landed drug samples were in short supply for more than 3 months,and even 21.8％ short-landed drug samples were in short supply for more than 12 months.The common reasons for drug shortage mainly included:not entering the provincial bidding directory;adopting the government pricing method;being redistribution system;not establishing provincial normal reserve mechanism.In addition to common reasons,there were some personality reasons for drug shortage based on the necessity of clinical needs,drug attributes and drug price.CONCLUSIONS:There are many reasons for the shortage of drugs in medical institutions.There are both common causes and personality reasons.It is necessary to solve many problems of drug shortage from the source,and it needs many policies and systems to cooperate with them.

Objective:To investigate the clinical effect of the orbital septum-method for the repair of pretarsal fullness after double eyelid blepharoplasty.Methods:Date of patients with pretarsal fullness double eyelid who underwent repair surgery in Hunan Provincial People’s Hospital from January 2020 to December 2020 were anlalyed retrospectively. All patients were treated with orbital septum-method double eyelid blepharoplasty. During the operation, the scar adhesion was completely released. After the loose adipose fascia tissue under the muscle was removed, the orbital septum was cut horizontally. Using the fusion of the levator aponeurosis with septum as a pedicle, the lower part of the orbital septum was turned downward and then sutured to the upper border of the lower orbicularis oculi muscle and posterior pretarsal fascia. We evaluated the outcomes of this double eyelid repair surgery in the patients undergoing the procedure.Results:Fifty-one patients in this group were followed up for 6-12 months. At 7 days postoperatively, the skin wounds were well healed and the sutures were removed in all patients. At 6-12 months postoperatively, the surgical results were satisfactory in 41 patients (satisfactory rate was 80.4%), basically satisfactory in 8 patients, and unsatisfactory in 2 patients. These two patients had obvious bilaterally asymmetrical double-eyelid folds, one eye was obviously bigger than the other, and the smaller eye displayed mild ptosis. After reoperation to correct the mild ptosis, the results were rated as basically satisfactory.Conclusion:The use of orbital septum-method in the repair of pretarsal fullness double eyelid after surgery has a good effect.

Objective To discuss the rationality of stage pT3 in the AJCC 8th TNM criteria of gallbladder carcinoma. Methods A retrospective study was performed to analyze the clinical and pathological data of 88 patients with pT3 gallbladder carcinoma admitted to Department of Second Biliary Surgery of Eastern Hepatobiliary Surgery Hospital, affiliated to Naval Medical University from May 2013 to September 2018.pT3 stage tumors were divided into two groups: (1) pT3a stage:tumors had penetrated serosa but not directly invaded liver and/or an adjacent organ or structure;(2) pT3b stage:tumor penetrating serosa and directly invaded liver and/or an adjacent organ or structure. There were 45 patients with pT3a stage, including 15 males and 30 females,aged 36 to 80 years,with a median age of 59 years;43 patients with pT3b, including 24 males and 19 females,aged 41 to 78 years old,median aged 63 years old.Patients with pT3a and pT3b were further divided into two groups respectively: radical resection group and extended radical resection group according to surgical radicalization. Independent sample t?test was used for comparison between two groups with normal distribution measurement data. Wilcoxon rank sum test was used between groups of non?normally distributed measurement data.The comparison of the count data was performed by χ2 test or Fisher exact probability method. Survival analysis was performed using Kaplan?Meier method, and survival rate was compared using Log?rank test.Results (1)Serum total bilirubin(15.6(90.3)mmol/L), albumin(40.2(4.8)mmol/L), and CA19?9(132.90(455.78)U/ml) levels in pT3b patients were higher than that in pT3a patients(10.2(6.8)mmol/L, 41.8(4.9)mmol/L, 14.35(36.27)U/ml), respectively(Z=-3.816,-1.966,-3.739, all P<0.05),postoperative complication rate in pT3b patients(24.4%) was higher than that in pT3a patients(8.9%)(P<0.05),postoperative hospital stay(12(7)days) and overall hospital stay((26±17)days) of pT3b patients were longer than that of pT3a patients((10±5) days and (19±7)days)(P<0.05).(2) The 1?,3?, 5?year survival rates of pT3b and pT3a patients were 53%,22%,22% and 69%, 46%,38%,and the median survival time was 13 months and 26 months, respectively. The difference in survival rates between the two groups was statistically significant(χ2=5.117, P=0.024). (3)The 1?, 3?year survival rates of extended radical resection group(n=19) and radical resection group(n=24) in the pT3b stage were 73%, 36% and 28%, 7%, respectively.The survival time was 20 months and 9 months,respectively,and the difference in survival rates between the two groups was statistically significant(χ2=4.976, P=0.026). Conclusions pT3 gallbladder carcinoma could be further subdivided into pT3a stage and pT3b stage based on the TNM criteria of AJCC 8th gallbladder carcinoma. Extended radical resection for pT3b gallbladder carcinoma should be further considered after comprehensive assessment of the patient′s basic condition and surgical tolerance.

Objective To discuss the rationality of stage pT3 in the AJCC 8th TNM criteria of gallbladder carcinoma. Methods A retrospective study was performed to analyze the clinical and pathological data of 88 patients with pT3 gallbladder carcinoma admitted to Department of Second Biliary Surgery of Eastern Hepatobiliary Surgery Hospital, affiliated to Naval Medical University from May 2013 to September 2018.pT3 stage tumors were divided into two groups: (1) pT3a stage:tumors had penetrated serosa but not directly invaded liver and/or an adjacent organ or structure;(2) pT3b stage:tumor penetrating serosa and directly invaded liver and/or an adjacent organ or structure. There were 45 patients with pT3a stage, including 15 males and 30 females,aged 36 to 80 years,with a median age of 59 years;43 patients with pT3b, including 24 males and 19 females,aged 41 to 78 years old,median aged 63 years old.Patients with pT3a and pT3b were further divided into two groups respectively: radical resection group and extended radical resection group according to surgical radicalization. Independent sample t?test was used for comparison between two groups with normal distribution measurement data. Wilcoxon rank sum test was used between groups of non?normally distributed measurement data.The comparison of the count data was performed by χ2 test or Fisher exact probability method. Survival analysis was performed using Kaplan?Meier method, and survival rate was compared using Log?rank test.Results (1)Serum total bilirubin(15.6(90.3)mmol/L), albumin(40.2(4.8)mmol/L), and CA19?9(132.90(455.78)U/ml) levels in pT3b patients were higher than that in pT3a patients(10.2(6.8)mmol/L, 41.8(4.9)mmol/L, 14.35(36.27)U/ml), respectively(Z=-3.816,-1.966,-3.739, all P<0.05),postoperative complication rate in pT3b patients(24.4%) was higher than that in pT3a patients(8.9%)(P<0.05),postoperative hospital stay(12(7)days) and overall hospital stay((26±17)days) of pT3b patients were longer than that of pT3a patients((10±5) days and (19±7)days)(P<0.05).(2) The 1?,3?, 5?year survival rates of pT3b and pT3a patients were 53%,22%,22% and 69%, 46%,38%,and the median survival time was 13 months and 26 months, respectively. The difference in survival rates between the two groups was statistically significant(χ2=5.117, P=0.024). (3)The 1?, 3?year survival rates of extended radical resection group(n=19) and radical resection group(n=24) in the pT3b stage were 73%, 36% and 28%, 7%, respectively.The survival time was 20 months and 9 months,respectively,and the difference in survival rates between the two groups was statistically significant(χ2=4.976, P=0.026). Conclusions pT3 gallbladder carcinoma could be further subdivided into pT3a stage and pT3b stage based on the TNM criteria of AJCC 8th gallbladder carcinoma. Extended radical resection for pT3b gallbladder carcinoma should be further considered after comprehensive assessment of the patient′s basic condition and surgical tolerance.

Objective:To investigate the clinical effect of the orbital septum-method for the repair of pretarsal fullness after double eyelid blepharoplasty.Methods:Date of patients with pretarsal fullness double eyelid who underwent repair surgery in Hunan Provincial People’s Hospital from January 2020 to December 2020 were anlalyed retrospectively. All patients were treated with orbital septum-method double eyelid blepharoplasty. During the operation, the scar adhesion was completely released. After the loose adipose fascia tissue under the muscle was removed, the orbital septum was cut horizontally. Using the fusion of the levator aponeurosis with septum as a pedicle, the lower part of the orbital septum was turned downward and then sutured to the upper border of the lower orbicularis oculi muscle and posterior pretarsal fascia. We evaluated the outcomes of this double eyelid repair surgery in the patients undergoing the procedure.Results:Fifty-one patients in this group were followed up for 6-12 months. At 7 days postoperatively, the skin wounds were well healed and the sutures were removed in all patients. At 6-12 months postoperatively, the surgical results were satisfactory in 41 patients (satisfactory rate was 80.4%), basically satisfactory in 8 patients, and unsatisfactory in 2 patients. These two patients had obvious bilaterally asymmetrical double-eyelid folds, one eye was obviously bigger than the other, and the smaller eye displayed mild ptosis. After reoperation to correct the mild ptosis, the results were rated as basically satisfactory.Conclusion:The use of orbital septum-method in the repair of pretarsal fullness double eyelid after surgery has a good effect.

Objective To understand the incidence and characteristics of adverse drug reactions(ADRs)of carbapenems,explore the relevant risk signals,and provide a reference for clinically safe drug use.Methods All spontaneous reports of carbapenem drug-related ADRs from January 2008 to October 2022 in the Adverse Drug Reaction Monitoring Center,PLA General Hospital's ADR database were retrieved,and information such as patients'general conditions,involved systems and organs damage,and the names of ADRs involved were retrospectively analysed.Using the reporting odd ratio method,the proportional reporting ratio method,the Medicines and Healthcare Products Regulatory Agency method,and information component method to obtain risk signals of carbapenem antimicrobial drug-related ADR.Results A total of 2 642 ADR reports of carbapenems were reported,of which 410 serious ADR reports(15.52％)were serious ADR reports,five cabapenem antimirobial drug species were mainly involved.In descending order of composition were imipenem cilastatin(51.28％),meropenem(32.13％),biapenem(8.10％),ertapenem(7.68％),and panipenem(0.79％).The male to female ratio of patients was 1.74:1,with the most age＞60 years(59.69％).A total of 14"drug-ADR name"combinations generated risk signals in all four data mining methods,with meropenem being the most signals,and imipenem cilastatin and ertapenem had a high number of reported ADR in nervous system.Conclusion The results of risk signal mining are basically consistent with the known carbapenem ADR information,during the use of carbapenem antimicrobial drugs in the clinic,it is recommended to monitor patients'liver and kidney functions as well as blood biochemical indexes,so as to strengthen the awareness of vigilance in the clinical use of carbapenem antimicrobial drugs,and timely recognize and deal with ADRs in a timely manner,and to avoid the occurrence of serious ADRs.

Objective To construct a module for drug-induced central nervous system adverse reactions(CNS-ADR)within the Clinical Adverse Drug Event Active Monitoring and Intelligent Assessment Alert System-Ⅱ(ADE-ASAS-Ⅱ),and to conduct a large-scale,real-world active monitoring and evaluation of CNS-ADR specifically related to imipenem/cilastatin.Methods Based on literature review,spontaneous report evaluation,and initial word set of CNS-ADR related descriptions in electronic medical records,text recognition technology was used to construct and optimize the condition settings of the CNS-ADR automatic monitoring module.Hospitalized patients using imipenem/cilastatin were retrospectively monitored from 2017 to 2021,and the positive patients which had CNS-ADR were statistically described in terms of the demographic characteristics,CNS symptoms,and hospital departments.Results Based on a repeated testing optimization using 1 185 manually monitored results,the best setting for the determined module includes 62 sets of keywords,with a positive predictive value(PPV)of 13.63％and a recall rate of 100％.Expanding the monitoring to 8 222 medication users using this module,281 cases of positive causality were identified,with an incidence rate of 3.42％.Among them,patients over 60 years old accounted for 50.17％,and the main manifestations of CNS-ADR were epileptic seizures,headaches,mania,and delirium.Conclusion The CNS-ADR automatic monitoring module established based on ADE-ASAS-Ⅱ provides fast and reliable text data mining support for conducting real-world research on CNS-ADR.

OBJECTIVETo observe the effects of transcutaneous electrical acupoint stimulation (TEAS) on gastric emptying in patients undergoing selective surgery based on velocity of gastric emptying by ultrasonography.

METHODSA total of 75 patients with selective operation of subarachnoid block at lower limb in the afternoon were randomly assigned to a TEAS group, a sham group and a control group, 25 patients in each one. All the patients were provided with semi-fluid diet at 8 a.m. The TEAS group was treated with TEAS 5 min after semi-fluid diets at bilateral Zusanli (ST 36) and Neiguan (PC 6) for 30 min, with frequency of 5 Hz and intensity which was 1 mA lower than the tolerance threshold. The sham group patients were stimulated at the same acupoints with current intensity which was 1 mA lower than the sensory threshold. The control group received no treatment. On the day of operation, and ultrasonography was given at time of empty stomach (T0), immediately after the semi-fluid diets (T1), and every 30 min after diets (T2-T6), respectively, to measure the gastric content and emptying time at semire-clining position and right lateral position.

RESULTSThe volume of gastric content in the three groups at T3-T6 was significantly less than that at T1 (all<0.05). The volume of gastric content at T4-T6 at semire-clining position in the TEAS group was significantly less than that in the control group and sham group (all<0.05). The volume of gastric content at T5-T6 at right lateral position in the TEAS group was significantly less than that in the control group and sham group (all<0.05). The gastric emptying time in the TEAS group was significantly less than that in the control group and sham group (both<0.05).

CONCLUSIONThe gastric emptying velocity could be evaluated by ultrasonography. TEAS could improve the velocity of gastric emptying and reduce the gastric emptying time.