Objective:To study the effectiveness and safety of combined intraoral and cutaneous using of long pulsed 1064 nm Nd∶YAG and 2940 nm Er∶YAG lasers in facial rejuvenation.Methods:Twenty-one female patients with different grades of nasolabial fold were treated with 6 sessions of the combination lasers therapy once a month. Standardized photographs of VISIA were taken before and after treatment to record any changes of facial contour and nasolabial folds. The efficacy assessment was judged by two non-group experienced dermatologists using modified Fitzpatrick Wrinkle Scale (MFWS), based on the VISIA photos at base line, twelve-week and six-month after treatment. Self-scoring of 5-level satisfaction from patients was also collected and analyzed. Any side effects and complications were recorded.Results:At 12 weeks, mild and moderate nasolabial folds were improved notably, the mean value of MFWS decreased from 1.59 to 0.90, whereas severe nasolabial folds had no remarkable improvement. Six-month after treatment, 18 patients had notable improved, among them: five out of 7 mild cases, 9 out of 10 moderate cases and 2 out of 4 severe cases, and the mean value of MFWS significantly decreased to 0.57 ( P<0.001). The general satisfactory rate of self-scoring was 86%. Two patients had tolerable light burning pain during treatment and two patients got temporary pigmentation that vanished in three months. There were no other adverse reactions and complications. Conclusion:Combined intraoral and cutaneous using oflong pulse 1064 nm Nd∶YAG laser and 2940 nm Er∶YAG laser is a safe and effective therapy for facial rejuvenation.

Objective:To explore the effect of mind mapping combined with continuous quality improvement in the teaching of interns in gastroenterology department.Methods:The 55 students who interned in the gastroenterology department of our hospital from September 2019 to January 2020 were set as the control group and adopted traditional teaching methods; the other 54 students who interned in the gastroenterology department of our hospital from February 2020 to June 2020 were set as the control group; 55 students who interned in the gastroenterology department of our hospital from July 2020 to November 2020 were set as a combined group, and received mind mapping combined with continuous quality improvement teaching. The gastroenterology knowledge and theory assessment results, practical skills operation assessment results and learning initiative, self-study ability, comprehensive thinking ability, teamwork ability, analysis and problem-solving ability, induction and summary ability and so on were compared between the two groups, and the teaching satisfaction rate at the time of leaving the department were also compared. SPSS 20.0 was used for t test and chi-square test. Results:Before the training, there was no statistically significant difference in the three groups of theoretical assessment scores, practical skills operation assessment scores and various ability scores. When leaving the department, the theoretical assessment scores of the combined group and the mind mapping group were (89.74±4.18) points and (86.52±3.72) points, and the performance evaluation scores of practical skills were (90.04±4.86) points and (87.46±4.52) points, respectively. The theoretical evaluation scores and practical skills evaluation scores of the two groups were higher than those of the control group, and the combined group was higher than the mind mapping group, with statistically significant differences ( P<0.05). The scores of various abilities of the combined group and the mind mapping group were higher than those of the control group, and the scores of all indicators in the combined group were higher than those of the mind mapping group, with statistical significance ( P<0.05). The total teaching satisfaction of combined group and mind mapping group was higher than that of the control group, and the total teaching satisfaction of the combined group was higher than that of the mind mapping group. Conclusion:Mind mapping combined with continuous quality improvement has a significant effect on the teaching of gastroenterology interns, which can improve students' abilities and the teaching satisfaction.

Objective:To analyze the causes of puncture wound infections induced by the high pressure resistant injectable PICC catheter in patients undergoing hematopoietic stem cell transplantation and management measures.Methods:linical data of 75 patients undergoing hematopoietic stem cell transplantation who were treated with the high pressure resistant injectable PICC catheter in our hospital from Nov.2017 to Nov.2019 were retrospectively analyzed.According to whether there were puncture wound infections, patients were divided into the infection group(n=26)and the non-infection group(n=49). Bacterial culture results of the infection group were recorded, and the related factors for puncture wound infections caused by the injectable PICC catheter were analyzed.Effective strategies to prevent high-risk factors, treatment frequency, treatment effect and healing time for patients with different degrees of puncture wound infections were discussed.Results:There were 26 patients in the infection group.The proportions of bacteria types associated with PICC catheter-related infections, in descending order, were as follows: Staphylococcus aureus(46.51%), Klebsiella pneumoniae(30.77%), Corynebacterium(15.38%)and others(7.69%). Significant differences were found in materials used, season of tube placement, timing of dressing changes, duration of catheterization, success rate of first tube placement and condition of dressing films between the non-infection and infection groups( t=5.5, 4.9, 5.0, 13.6, 9.4 and 6.2, all P<0.05). Logistic multi-factor analysis showed that non-U-shaped fixation, delay in dressing changes, long duration of tube placement, low success rate of first tube placement, and loose dressing films were the high-risk factors for PICC catheter-related infections( OR=2.78, 2.42, 3.16, 2.66 and 2.32, all P<0.05). Compared with patients with moderate and mild infections, patients with severe infections had a higher frequency of treatment, a lower total effectiveness rate and a longer healing time( F=10.353, 8.775 and 12.341, all P<0.05). Conclusions:Materials, timing of dressing changes, catheterization time, success rate of first tube placement and condition of dressing films are the high-risk factors for puncture wound infections caused by high pressure resistant injectable PICC catheters in patients undergoing hematopoietic stem cell transplantation.Developing effective intervention strategies can help control the incidence of wound infections.