Objective Using the scientific thinking mode,applied the standardized training in zero-based assistant of laparoscopic gastrointestinal surgery,observe and explore the effect of shorten learning curve.Methods Took 40 students studied in our hospital from February 2013 to December 2014 as object of our study,who were randomly divided into Group Ⅰ and Group Ⅱ.Group Ⅰ was given standardized training,group Ⅱ was given regular training.After total 200 cases of laparoscopic assisted colectomy,5cases each doctor,we analyzed the two teams outcome of surgery cooperation.Results Compared with the control group,doctors from observation group were better in the surgery cooperation and the examination.Conclusions Standardized training is very meaningful for the zero-based assistant of laparoscopic gastrointestinal surgery.

The human venous valve of the brachial,femoral and long saphenous veins wereexamined with light,transmission and scanning electron microscopy.The observationshows that the venous valve is composed of three functional layers covered withendothelium on both surfaces.A loosely structured layer is located underlying theendothelium.A network mainly containing randomly oriented elastic fibers was foundnear the side towards the lumen.To the side towards the venous wall,there is adense layer composed of eircumferentially and transversly oriented collagen bundles.Some smooth muscle cells extend from the wall of the vein to the base of thevenous valve.The elastic fibers and smooth muscle cells together with the collagenfibers contribute to the mechanical load-bearing performance of the valve and to thepassive closing and openning mechanism.In addition,the smooth muscle cells mightplay an active role in the normal functioning of the valve.The scanning and transmission electron microscopy of venous valve showdifferent arrangement of the endothelium.On the surface of the valve next to the wallof the vein,the endothelial cells are transversely arranged,while on the othersurface over which the current of blood flows,the cells are longitudinally arrangedin the direction of the current.These accord with the role of fluid mechanics.12 normal venous valves were tested by universal testing instrument (Instrontype 1122).The mean value of the maximum tension of the valve is 1 N.Theaverage value of the tensile ultimate strength is 10N/mm~2.

Objective To evaluate the effects of the two methods of propaganda and education, conventional training method and that combined with hand contamination survey method, on the medical and nursing staffs' hand hygiene compliance. Methods From October 2017 to April 2018, all medical and nursing staffs in 6 Departments:General Surgery Ⅰ, General Surgery Ⅱ, Orthopedics Ⅰ, Orthopedics Ⅱ, Internal Medicine Ⅰ and Internal Medicine Ⅲin Cangnan Second People's Hospital receiving health education were divided into two groups; both groups received routine training, while in the observation group, on the basis of routine training, the hand hygiene pollution investigation training mode was added, In the combined training method, when the wrong hand hygiene mode occurred, the hand specimens were collected and the correct hand washing method was instructed on the spot, and then the following hand specimens were taken to investigate the contaminated condition. One month before the training, the real situations of hand hygiene compliance in the two groups were investigated. In the 1st month after the beginning of training, both groups were cultivated by conventional propaganda and training methods. From the second month to the sixth month, the observation group was additionally trained to investigate hand hygiene pollution situation on the basis of conventional propaganda and training methods. After 6 months, the compliance rates of hand hygiene in the two groups were observed. Results Before training, there was no significant differences in the compliance rate of hand hygiene in the observation group and the routine trainning group [37.14% (52/140) vs. 36.36% (48/132), P > 0.05]. The compliance rates of hand hygiene after 1, 2, 3 months of training in the observation group were 56.61% (77/136), 60.61% (80/132) and 61.20% (82/134), respectively, and those in the routine trainning group were 56.25% (72/128), 59.26% (80/135) and 58.70% (81/138), which were all significantly higher than those before the training (all P < 0.05), but there were no statistical significant differences between the two groups (all P > 0.05). From the 4th month to the 6th month after training, the compliance rates of hand hygiene in the observation group were significantly higher than those in the observation group [61.97% (88/142) vs. 49.23% (64/130), 62.50% (80/128) vs. 47.73% (63/132), 62.31% (81/130) vs. 46.03% (58/126)], the differences between the two groups being statistically significant (all P < 0.05). Conclusion The routine training combined with hand contamination investigation survey training for consecutive 3 months can nicely promote the improvement of hand hygiene compliance of medical and nursing staffs.

Objective To investigate the outcomes of coronary artery bypass grafting(CABG) in insulin-treated diabetes mellitus(DM) patients with coronary artery disease(CAD) (age≤45 years old),and analyze the risk factors of major adverse cardiac and cerebrovascular events(MACCE) by logistic regression.Methods Data on 239 CAD patients combined with DM aged ≤45 who underwent CABG in our hospital were collected retrospectively from October 2007 to October 2016.There were 216 males and 23 females,the mean age was (42.15 ±2.59) years old.The mean LVEF was 0.59 ±0.09.43 patients (18.0％) had left main stenosis,and the average diseased vessel number was 3.20 ± 0.76.Results One patients (0.4％)in-hospital died of heart failure.Patients received (3.12 ±0.81) bypass grafts overall,12 patients (5.0％) were total artery revascularization.3 patients (1.3％) needed reoperation for bleeding and the perioperative atrial fibrillation rate was occured in 23 patients (9.6％).The follow-up rate was 95％ (226 cases),the median follow-up time was 5 years (1-9 years).8 patients (3.3％) died of all cause-mortality,and 183 patients (81.0％) were freedom from MACCE.The higher level of BMI、cholesterol and creatinine,LVEF ≤0.35,postoperative blood loss ≥ 1 000 ml and ventricular arrhythmia were the independent risk factors of MACCE.Conclusion CABG procedure in CAD patients under 45 years old accompanied DM is safety and reliable both in early and long-term outcomes.

Objective     To investigate the early and long-outcomes of coronary artery bypass grafting(CABG) in acute myocardial infarction (AMI) patients with coronary artery disease(CAD)(age≤45 years). Methods     Data of 596 adult CAD patients (include AMI and Angina) who underwent CABG in our hospital were collected retrospectively from May 2010 to October 2018. In an AMI group, 234 were male patients with an average age of 41.59±3.79 years; 26 were female patients with an average age of 41.64±3.03 years. In an angina group, 280 were male patients with an average age of 42.19±2.90 years; 56 were female patients with an average age of 41.54±3.52 years. Preoperative baseline variables, perioperative mortality, major adverse cardiac and cerebrovascular events (MACCE) were compared between two group.  Results    There was no significant difference in all preoperative variables. Seven patients were died and the hospital mortality rate was 1.23% (1.54% vs. 0.89%, P=0.477). The complications including reoperation for bleeding, cerebral infarction, renal failure and atrial fibrillation arrhythmia were without significant difference between two group  (P>0.05). The intensive care unit stay duration (30.66±27.46 h vs. 23.96±15.11 h), intubation duration (22.54±22.31 h vs. 18.64±11.81 h) and hospitalization costs (97 186±33 741¥ vs. 90 081±24 537¥, P=0.003) were greater in the AMI group. The hospital mortality rate and complications rate were without significant difference between STEMI (ST segment elevated myocardial infarction) and NSTEMI (non-ST-segment elevated myocardial infarction) subgroups (P>0.05). The follow-up rate was 92.6% (546 patients) and the follow-up time was 4 (0.5 to 8.5) years. All cause-mortality rate was 3.85%(21 patients), and freedom MACCE was 72.2%. The freedom from MACCE, recurred angina and cerebral infarction were without significant difference, but AMI was associated with higher rate of PCI procedure.  Conclusion     CABG procedure in CAD patients under 45 years accompanied AMI is safety and reliable both in early and the long-term outcomes.