Cataract is the world's leading cause of blindness, and surgery is the most effective treatment for cataract. With the development of femtosecond laser technology and ophthalmic surgical equipment, the application of femtosecond laser systems in cataract surgery is becoming increasingly widespread. It can be used in cataract surgery for corneal incisions, anterior capsulotomy, lens fragmentation, arcuate incisions and other key operations. Compared to traditional surgery, femtosecond laser assisted cataract surgery(FLACS)offers significant advantages in precision, safety and postoperative visual outcomes. Its clinical benefits have garnered growing recognition among ophthalmologists. However, the key technologies and high-precision equipment for FLACS remain predominantly controlled by Western countries. In China, the research in this field began later. This article reviews the technological advancements in FLACS, with a focus on femtosecond laser technology, optical coherence tomography(OCT), artificial intelligence, and clinical application progress. The objective is to provide theoretical foundations and practical insights for the development of ophthalmic medical technology in China.

OBJECTIVE: To observe the effect of the direct stimulation of acupuncture at extraocular muscle attachment point on acquired extraocular muscle palsy. METHODS: Thirteen patients with acquired extraocular muscle palsy were treated with acupuncture directly at extraocular muscle (paralytic muscle) attachment point. Firstly, the intraocular conjunctival sac drops of topical anesthetic (procaine hydrochloride eye drops) were administered, 0.2 mL each time, once every 10 minutes, for a total of 3 times. Acupuncture was delivered immediately after the third drop. The sterile acupuncture needle for single use, 0.25 mm×25 mm, was inserted at the anatomical location of the corneal limbal attachment of paralytic extraocular muscle, with an angle of 10° to 15° formed between the needle tip and extraocular muscle, and a depth of 0.3 mm to 0.5 mm. Pivoted by the needle tip, the eyeball was moved passively towards the direction of normal action of orbital muscle, 30 to 50 times until the patient felt soreness of the eyeball; afterwards, the needle was removed. After acupuncture, levofloxacin eye drops were administered once (0.2 mL) at the affected eye. The treatment was given twice a week, and completed when diplopia disappeared. Before and after treatment, the diplopia and the synoptophore circumference were observed respectively. RESULTS: After 7 to 24 (15.46±5.56) times of direct stimulation with acupuncture at extraocular muscle attachment point, the symptoms of diplopia disappeared in 13 patients, the eye position restored to orthophoria, and the circumference of synoptophore was reduced to be (4.04±0.82)° from (19.38±3.98)° detected before treatment (P<0.05). CONCLUSION Acupuncture directly at extraocular muscle attachment can attenuate diplopia and improve ocular muscle function in patients with acquired extraocular muscle palsy.
Humans ; Acupuncture Therapy ; Male ; Female ; Middle Aged ; Adult ; Oculomotor Muscles/physiopathology* ; Aged ; Acupuncture Points ; Ophthalmoplegia/physiopathology*

The Ehlers-Danlos syndrome(EDS)is a rare inherent connective tissue disorder.The prev-alence of EDS in the population is estimated at one out of ten thousand to one out of a hundred thousand.The vascular EDS(vEDS)are rare among the subtypes but are the worst in prognosis.The article reports a case of vEDS admitted to the hospital.The patient was a young man complaining of a sudden onset of aphasia in right hemiparalysis and severe left abdominal pain for unknown reasons.The diagnosis was made after the genetic testing.The patient suffered from vEDS.Then,the multi-disciplinary team(MDT)made a treatment plan tailored to this young patient.The complexity in classification and delusive presentations of the EDS make the correct diagnosis very challenging.This article hopes to report this case and to share the experiences to the bet-ter understanding of this disease.

Objective To establish a gas chromatography for simultaneous determination of camphor residue and borneolum content in Qingchang Suppository. Methods Gas chromatograph method was used. The chromatographic column was Agilent capillary column(30 m×0.25 mm×0.25 µm). The column temperature was 140 ℃. The sample injection temperature was 250 ℃. The FID detector temperature was 250 ℃. Results Camphor，borneol and isoborneol content showed good linear in the extent of 0.0299~1.497(r=1.000), 0.0205~1.025(r=1.000), 0.0097~0.4830 µg (r=1.000). RSDs of precision，stability and repeatability test results were less than 2%. The recovery was 99.7%, 101.0%, 102.5%. Conclusion This method is simple and quick with accurate result, which could be used for the content determination of Borneol in Qingchang Suppository.

Hospitals need to explore based on their own specifics how to establish a modern hospital governance system and how a lean hospital administration level be achieved. This paper introduced the practice and exploration of modern hospital governance system construction in Beijing Tsinghua Changgung Hospital as follows. The hospital is run by a board of administration featuring co-administration by both Beijing Municipal Hospital Administration Center and Tsinghua University; A hospital charter is developed and agreed upon to regulate decision-making, day-to-day operations and supervision; The hospital president′s responsibility is under the leadership of the hospital′s Communist Party Committee; Benefiting from best practices of Taiwan Changgung′s medical system, the hospital′s specialized medical teams and professional administrative teams operate in cooperative governance, and under professional management model and a lean operation management system. The practice and exploration of Beijing Tsinghua Changgung Hospital can serve as references for building and perfecting a modern hospital governance system.

Objective:To investigate the clinical effect of posterior tibial artery perforator propeller flap in repairing soft tissue injury of medial malleolus.Methods:From June 2016 to March 2019, five male patients with ankle trauma were treated in Ningbo Ninth Hospital, aged 30-64 years (average 45 years). There were 3 cases of right and 2 cases of left. Causes: traffic injury in 2 cases, crush injury in 3 cases. There were 4 cases with fracture, 1 case with plate and bone exposure, 2 cases with local infection and 1 case with skin avulsion. Preoperative soft tissue defect area: 2.0 cm × 3.0 cm-4.0 cm × 6.0 cm. After debridement, the posterior tibial artery perforator propeller flap was designed to repair the wound. During the operation, the target perforator was searched between the deep fascia superficial flexor longus and digitorum flexor longus, and the perforator pedicle was fully exposed carrying a small amount of fascial tissue and the length of the pedicle ≥ 2 cm. After the skin flap was completely cut from the superficial layer of the deep fascia, the skin flap was rotated to cover the wound. After confirmation of good blood supply of the skin flap, the wound was loosely sutured, and the donor site was directly sutured or covered with skin grafts. Routine fluid rehydration, anti-infection, anti-spasm, and anti-thrombosis treatments were performed postoperatively. The ankle joint was raised in a neutral position and immobilized with plaster. The temperature, color, tension and reflux of the skin flap were monitored, and rehabilitation exercises were gradually carried out. The patient’s postoperative repair effect was observed.Results:All the flaps survived. The distance between the perforator and the medial malleolus was about 5.5-8.5 cm. The area of the flap was 4.0 cm × 6.5 cm-4.0 cm × 10.0 cm. The donor sites were sutured directly except one case. No flap related complications occurred during the follow-up period of 3-16 months (average of 12 months). No obvious scar hyperplasia was observed in flaps, which was similar to the adjacent skin characteristics, ankle joint movement could be achieved, and the skin flap could restore the protective feeling.Conclusions:The propeller flap with perforating branch of posterior tibial artery characterizes simple operation, similar soft tissue characteristics, stable and reliable blood supply, less damage to the donor and recipient sites, and less complications. It is one of the ideal methods to repair the soft tissue defects of the medial malleolus.

Objective:To investigate the clinical effect of posterior tibial artery perforator propeller flap in repairing soft tissue injury of medial malleolus.Methods:From June 2016 to March 2019, five male patients with ankle trauma were treated in Ningbo Ninth Hospital, aged 30-64 years (average 45 years). There were 3 cases of right and 2 cases of left. Causes: traffic injury in 2 cases, crush injury in 3 cases. There were 4 cases with fracture, 1 case with plate and bone exposure, 2 cases with local infection and 1 case with skin avulsion. Preoperative soft tissue defect area: 2.0 cm × 3.0 cm-4.0 cm × 6.0 cm. After debridement, the posterior tibial artery perforator propeller flap was designed to repair the wound. During the operation, the target perforator was searched between the deep fascia superficial flexor longus and digitorum flexor longus, and the perforator pedicle was fully exposed carrying a small amount of fascial tissue and the length of the pedicle ≥ 2 cm. After the skin flap was completely cut from the superficial layer of the deep fascia, the skin flap was rotated to cover the wound. After confirmation of good blood supply of the skin flap, the wound was loosely sutured, and the donor site was directly sutured or covered with skin grafts. Routine fluid rehydration, anti-infection, anti-spasm, and anti-thrombosis treatments were performed postoperatively. The ankle joint was raised in a neutral position and immobilized with plaster. The temperature, color, tension and reflux of the skin flap were monitored, and rehabilitation exercises were gradually carried out. The patient’s postoperative repair effect was observed.Results:All the flaps survived. The distance between the perforator and the medial malleolus was about 5.5-8.5 cm. The area of the flap was 4.0 cm × 6.5 cm-4.0 cm × 10.0 cm. The donor sites were sutured directly except one case. No flap related complications occurred during the follow-up period of 3-16 months (average of 12 months). No obvious scar hyperplasia was observed in flaps, which was similar to the adjacent skin characteristics, ankle joint movement could be achieved, and the skin flap could restore the protective feeling.Conclusions:The propeller flap with perforating branch of posterior tibial artery characterizes simple operation, similar soft tissue characteristics, stable and reliable blood supply, less damage to the donor and recipient sites, and less complications. It is one of the ideal methods to repair the soft tissue defects of the medial malleolus.

Objective:To analyze effects of shared outpatient management model on healthy dietary behavior and stability of blood glucose control in patients with diabetes mellitus.Methods:Using the convenient sampling method, 98 patients with type 2 diabetes mellitus who were followed up in Endocrinology Clinic of Yangzhou First People's Hospital from July 2018 to April 2019 were selected. According to the ending numbers of patients' outpatient medical records, patients with odd numbers ( n=44) were included in the routine outpatient management group, while patients with even numbers ( n=54) were included in the shared outpatient management group. The routine outpatient management group was given routine outpatient follow-up schemes. On the basis of routine outpatient management, the shared outpatient management group was given shared outpatient management model, that was, a single outpatient service activity equipped with professional guidance from diabetes specialists, diabetes education nurses, nutritionists, rehabilitation therapists, psychological counselors and pharmacists in various aspects. After 6 months of intervention, the Healthy Dietary Behavior and Attitude and Social Impact Scale were used to evaluate the healthy dietary behavior of patients and the dynamic blood glucose monitoring system was used to evaluate the stability of patients' blood glucose control. Results:After 6 months of intervention, the scores of attitude scale (24.57±4.64) and Social Impact Scale (27.74±5.47) in the shared outpatient management group were higher than those in the routine outpatient management group, and the differences were statistically significant ( t=-8.632, -16.192; P< 0.01) . Mean amplitude of glycemic excursions (MAGE) , largest amplitude of glycemic excursions (LAGE) , coefficient of variation (CV) of blood glucose and coefficient of variation of fasting blood glucose (CV-FPG) of patients in the shared outpatient management group were respectively (2.23±0.46) mmol/L, (3.24±0.51) mmol/L, (17.32±5.87) and (9.81±4.17) , all lower than those of the routine outpatient management group, and the differences were statistically significant ( t=16.344, 15.056, 3.292, 2.834; P<0.01) . Conclusions:Compared with routine outpatient management, shared outpatient management can standardize the healthy dietary behavior of patients with diabetes mellitus and improve the stability of blood glucose control.

Objective To investigate feasibility of bowel preparation for colonoscopy in endoscopic ambulatory surgery ward. Methods A total of 352 patients at endoscopic ambulatory surgery ward receiving colonoscopy at Zhongshan Hospital, Fudan University from May 25, 2018 to July 13, 2018 were surveyed by questionnaires. Data of 344 patients, including patient demographics, bowel preparation information and Boston bowel preparation scores and subjective perception of patients were analyzed. Data of 8 others were excluded because they did not complete colonoscopy for the first time due to failure of bowel preparation. Chi-square test and logistic regression analysis were conducted to analyze the quality of bowel preparation and its influencing factors. Results A total of 18. 0％( 62/344) of bowel preparations were inadequate. Morning colonoscopy ( P = 0. 005, OR = 2. 505, 95％CI:1. 312-4. 781 ) and yellow residual last stool before colonoscopy (P=0. 045,OR=0. 475,95％CI:0. 230-0. 982) were independent risk factors for inadequate bowel preparation. Patients' tolerance was 88. 1％(303/344), satisfaction was 77. 9％(268/344), and 54. 9％(189/344) were willing to be hospitalized in ambulatory surgery ward again if necessary. Conclusion Bowel preparation before colonoscopy in endoscopic ambulatory surgery ward is feasible but not optimal.

OBJECTIVE:To provide reference for further improving the rationality of perioperative prophylactic use of antibiotics in laparoscopy surgery. METHODS:Electronic medical records and medical orders of 5 288 inpatients underwent laparoscopy surgery were collected from our hospital during Jan. 1st-Dec. 31st,2016 by using related information system software. The perioperative prophylactic use of antibiotics was investigated retrospectively. Rationality of medical orders was evaluated. RESULTS:Among 5 288 patients underwent laparoscopy surgery,1 890 patients used antibiotics for infection prevention during perioperative period. The rate of prophylactic use of antibiotics was 35.7%. The rate of prophylactic use of antibiotics in stomach,duodenum and small intestine operation was the highest(69.4%);the rate of prophylactic use of antibiotics in hepatobiliary and pancreatic surgery also reached 68.0%;prophylactic use of antibiotics was not found in the surgery of abdominal external hemia. The majority of 1 890 patients who had used antibiotics prophylactically during perioperative period used antibiotics alone(83.4%). Top 3 drugs in the list of use frequency were cefuroxime sodium(63.9%),metronidazole(13.5%)and cefotaxime sodium(11.85). There were irrational medical orders in 151 cases(8.0%)of perioperative prophylactic use of antibiotics;among prescriptions of irrational drug use,the majority was unsuitable drug selection(50.3%),followed by unsuitable drug selection among nonstandard medical orders. CONCLUSIONS:The overall situation of perioperative prophylactic use of antibiotics is basically satisfactory in laparoscopic surgery of our hospital. The rate of prophylactic use of antibiotics is relatively high in type Ⅰ incision surgery,and irrational drug use is found in some medical orders of prophylactic drug use. It is necessary to formulate regulations for prophylactic use of antibiotics in accordance with the actual situation of the hospital,strengthen medical order evaluation for perioperative prophylactic use of antibiotics in laparoscopy surgery,relevant rational drug use education.