Objective To explore divest arcuate edge orbicularis muscle surgery reconstructive treatment of the symptoms of clinical efficacy and recovery.Methods 80 patients with tear trough and palphromalar groove pouch,according to the operation method,were divided into group A and group B.The patients received stripped arcuate margin of orbicularis oculi muscle operation and true orbital fat too much fat operation,operation treatment,respectively.The satisfaction and revisit the rebound rate of the two groups after surgery were compared.Results Of 40 patients in A group,37 cases (92.5％)were satisfied with the treatment,general satisfaction in 3 cases (7.5％),0 case (0.0％) was not satisfactory.In B group,28 cases (62.5％)were satisfied with the treatment,general satisfaction in 9 cases (22.5％),3 cases (15.0％)were not satisfactory.The clinical efficacy between the two groups was significantly different(Z =18.481,P ＜ 0.01).During follow-up,in A group,one case (2.5％)relapsed.In B group,7 cases (17.5％) relapsed after 2 years.The postoperative recurrence rate between the two groups had significant difference (Z =7.314,P ＜ 0.05).Conclusion For patients with tear trough and palpbromalar groove pouch,treatment by stripping arcuate margin of orbicularis oculi muscle operation method can effectively correct the tear trough and palabromalar groove deformity postoperative reduction performance,has high degree of satisfaction,the recurrence rate is low,the clinical effect is significant,it is worthy of further clinical application and research.

BACKGROUND:In various clinical treatments of soft tissue defects, vacuum sealing drainage technology can effectively control wound infection, shorten the treatment time, and accelerate wound healing. OBJECTIVE:To further understand the features and characteristics of hydrated ethanol polyethylene foam vacuum sealing drainage treatment, and compare the treatment effects against soft tissue defects with the conventional dressing change treatment. METHODS:A total of 140 cases of large soft tissue defects were divided randomly into two groups. Observation group received hydrated ethanol polyethylene foam vacuum sealing drainage treatment, while control group was treated by conventional dressing change. The degree of pain relief during treatment, the family satisfaction, the survival rate of first skin-grafting, the time needed before skin-grafting, the hospitalization time, the number of operations, the readmission rates, the complication rate and other clinical effectiveness indicators were compared between the two groups. RESULTS AND CONCLUSION: In the observation group, visual analog scale scores decreased 5.76±0.68, in the control group visual analog scale score decreased 2.85±0.53, with significant differences between the two groups (P < 0.05), and family satisfaction degree of the observation group was higher (P < 0.05). The survival rate of first skin-grafting of the observation group was higher than the control group (P < 0.05), the time needed before skin-grafting, the hospitalization time, the number of operations, the readmission rates, and the complication rate were lower than the control group (P < 0.05). The results showed that, compared with conventional dressing change treatment, hydrated ethanol polyethylene foam vacuum sealing drainage has advantages of light pain, short treatment time, low rate of complications, and high efficacy.

Objective To evaluate the outcome and safety of endoscopic submucosal dissection (ESD) versus endoscopic mucosal resection (EMR) in the management of esophageal mucosal lesion.Methods The clinical data of 70 patients with esophageal mucosal lesion were analyzed.Twenty-five patients were treated by ESD (ESD group) and 45 patients were treated by EMR (EMR group).The enbloc resection rate,tissue healing resection rate,operation time,complication and recurrence rate were compared between two groups.Results The enbloc resection rate,tissue healing resection rate in ESD group were significantly higher than those in EMR group [60.0％(15/25) vs.48.9％(22/45),48.0％(12/25) vs.40.0％ (18/45)] (P ＜0.05).The local recurrence rate in ESD group was lower than that in EMR group [4.0％ (1/25) vs.20.0％ (9/45)] (P ＜ 0.05).The severe complication such as delayed hemorrhage,perforation,stenosis between two groups had no significant difference (P ＞ 0.05).The operation time in ESD group was (64.3 ±27.1) min,and significantly longer than that in EMR group [(27.6 ± 14.1) min] (P ＜0.05).Conclusions Compare with EMR,ESD has better enbloc resection rate,tissue healing resection rate,and lower recurrence rate.It is more safe and effective in the therapy of esophageal mucosal disease.

Objective To investigate the health care workers'(HCWs) knowledge and attitude towards perioperative warming as well as patients' warming status, provide reference for warming in perioperative period and reduce surgical site infection(SSI).Methods Convenience sampling was used to select 198 HCWs in surgical department and operating room as well as 160 patients undergoing operation.HCWs were investigated by referring foreign literatures and designing questionnaires, on-site observation method was used to collect information about warming measures implemented for surgical patients.Results The median (quartile range) of scores of HCWs' knowledge and attitude towards patients' perioperative warming were 9 (2.25) and 25 (1.25) respectively.There was no statistical significance in scores of knowledge and attitude among HCWs with different age, education degree and occupation(all P>0.05).The awareness rates of hypothermia, active warming, and passive warming modes were 21.21%, 43.94%, and 30.81% respectively.80.30%, 89.90%, and 86.36% of HCWs thought that it was essential to keep warming before, during and after surgery.68.13% of surgical patients were warmed by covering cotton quilt and shoulder pad during operation.Conclusion HCWs hold positive attitude towards perioperative warming, but they lack sufficient knowledge about perioperative warming, it is necessary to improve facilities of perioperative warming.

Objective To describe the surgical technique in reconstructing anterior cruciate ligament (ACL) with six strands harmstring tendon graft fixed by bioabsurbable rigidfix cross pins under arthroseopy and to e-valuate its efficacy. Methods From March 2005 to June 2008,39 patients with ACL injury were treated with ACL reconstruction by transplantation of six strands autogenous harmstring tendon , fixed by bioabsorbable rigidfix cross pins in femoral side. There are 22 male and 17 female,ages from 22 to 55 (the average age is 37). 19 cases were hurt in traffic accident, and another 20 cases in accidental injury. The state of illness is 7 days to 38 months. 13 cases merge the meniscus rupture, and 4 cases of meniscus suture,8 partial meniscectomy, 1 meniscectomy were performed simultaneously ;4 cases associating with the medial collateral ligaments Ⅲ degree injure underwent medial collateral ligament neo-plasty or reconstruction ;no cases merge posterior cruciate ligament injury, the patients were followed up 12 to 51 months , Pre-and post-operative knee joint function and stability were evaluated according to the Lysholm scoring scale system and the results of KT-2000 arthrometer , the clinical results and the reliability of the fixation were analyzed. Results 32 patients were followed-up and there is no limitation of the extention in the knee joints. The flexation of the knee joint is greater than 120°,and the anterior drawer test in 90° of flexation were negative in all patients. The postoperative Lachman test was strong positive in 1 case, negative in 26 cases and positive in 5 cases. The Lysholm scores was (92.6±4.2) points. The results of KT-2000 arthrometer: 31 cases 0-4.5 nun, average 3.2 mm;1 case 6. 5 mm. Conclusions It is a safe and reliable method to reconstruct ACL with six strands harmstring tendon graft fixing by bioabsorbable rigidfix cross pins under arthroscopy, and this procedure can obtain primary stabilization and long term stabilization of the autografts.

BACKGROUND:Complex scapular fractures were mainly treated by implant fixation. Standard fixation approach (Judet approach) had long incision and big trauma. With the application of spiral CT and three-dimensional reconstruction, minimal y invasive incision could be designed before implant fixation, and then fixation could be finished by physicians. Thus, trauma was reduced and repair effect was elevated. OBJECTIVE:To observe the effects of the three-dimensional reconstruction design combined with titanium plate reconstruction or lag screw for treatment of scapular fractures. METHODS:From February 2007 to January 2012, 33 cases of scapular fractures were enrol ed from Department of Orthopedics, No. 1 Hospital of Qinhuangdao in China. They were scanned by three dimensional reconstruction of CT before implant fixation to identify the regions needed to be repositioned and fixed. Thus, minimal y invasive incision of implant fixation was designed. The dissection of skin, subcutaneous tissue and muscle was reduced. Reposition was performed. Titanium plate and/or lag screw were used for fixation. RESULTS AND CONCLUSION:The operation lasted for 90-130 minutes in 33 patients, with intraoperative blood loss for 300-400 mL. Fracture was total y healed, and the healing time was 2-4 months. The fol ow up lasted for 12-24 months. According to Hardegger standard, there were excellent in 17 cases, good in 12 cases, average in 3 cases and poor in 1 case, with an excellent and good rate of 88%. These results suggested that three-dimensional reconstruction design combined with minimal y invasive incision treatment for scapular fractures showed fewer traumas, can complete the satisfactory fracture reduction and implant fixation, and obtain good repair effect.

Supervision of teaching is of great significance to the substantive equivalence of "online" and "offline" teaching. Compared with the conventional supervision of offline teaching, supervision of online teaching has its particularity. The School of Medicine of Shanghai Jiao Tong University has formulated the online teaching supervision program, relying on the constantly improving supervision system in long-term practice and based on the quality control concept of OBE (outcomes-based education) which aims to improve the learning effect of students. The supervision program of online teaching includes full coverage of expert supervision, smooth feedback channels for students, prompt communication and solutions by management supervision, etc. And the effect of online teaching supervision on students' learning effect can be tested in practice. The effect of the online teaching has been investigated by the questionnaire survey. The results show that online teaching expert supervision has higher satisfaction and students learning effect is better, which illustrates that the online supervision program has played a positive role in teaching.

Objective To investigate the influential factors on congenital gastrointestinal malformation and to provide evidences for prevention.Methods A hospital-based case-control study was conducted among infants with or without congenital gastrointestinal malformation at Children's hospital of Hunan province,from April 2011 to August 2012.Parents of 120 cases with congenital gastrointestinal malformation and another 170 controls were asked to fill in a questionnaire.Data was analyzed using SPSS 18.0 software.Results Congenital gastrointestinal malformation was associated with intakes of maternal medication (OR=3.35,95％CI:1.51-7.41) and folic acid (OR=0.28,95％CI:0.15-0.52),exposure to paints (OR=5.05,95％CI:1.32-19.29) and pesticides (OR=15.20,95％CI:1.55-148.99) prior to or during pregnancy,and also associated with medication intake of the father (OR=3.70,95％CI:1.13-12.10),smoking (OR=2.39,95％CI:1.24-4.62),drinking alcohol (OR=2.47,95％CI:1.20-5.07),exposure to the agents for indoor cleaning (OR=16.42,95％ CI:1.71-157.92) and exposure to paints (OR=9.92,95％ CI:2.66-36.98) before conception.Conclusion Congenital gastrointestinal malformation was affected by multiple factors.Potential risk factors for congenital gastrointestinal malformation would include intakes of medication by the pregnant mother,exposure to paints exposure and pesticide exposure before or during pregnancy,and medication intake by the father,smoking,drinking alcohol,exposure to indoor cleaning agents/paint before conception.The amount of folic acid intake by mother before or during pregnancy was likely to reduce the risk for congenital gastrointestinal malformation.