Objective:To evaluate the clinical effect of orbital fat releasing and repositioning through supra-suborbicularis oculi fat (SOOF) in lower eyelid blepharoplasty.Methods:The authors retrospectively analyzed the clinical data of patients who received lower eyelid blepharoplasty in the Department of Plastic Surgery, Beijing Tsinghua Changgung Hospital from January 2017 to January 2023. Lower eyelid blepharoplasty with orbital fat releasing and repositioning through supra-SOOF was performed. The tear trough ligament and orbicularis retaining ligament were released between the orbicularis oculi muscle and SOOF via skin approach. Orbital septal fat was released to this space, lateral fat flap was fixed to the SOOF capsule, medial fat flap was fixed to the superficial fascia of the levator labii superioris muscle, orbital septum was repositioned, and lateral canthus was suspended. After the operation, lower eyelid morphology and complications were evaluated.Results:A total of 58 patients were enrolled, including 8 males and 50 females with the age of (49.8 ± 10.4) years (32 to 70 years). All patients had obvious lower eyelid bags on both sides, combining the tear trough deformity and (or) palabromalar groove. Fifty-seven patients were followed up for (29.1 ± 16.9) months (6-67 months). All patients were satisfied with the operation. The appearance of lower eyelid was greatly improved, with elimination of fat prominence and tear trough deformity. Mild lower eyelid ectropion was observed two cases 1 week after the operation, and were relieved by moderate massage 2 weeks postoperatively. In one case, mild lower eyelid retraction was observed 1 month postoperatively, with no complaint of discomfort or further treatments. Bulbar conjunctival hemorrhage occurred in 1 case and recovered without further interventions.Conclusion:Lower eyelid blepharoplasty with orbital fat releasing and reposting through supra-SOOF can effectively release the tear trough ligament and the orbicularis retaining ligament, with stronger fat fixation and less surgical difficulty. After the operation, eyelid contour was flat and tight with fewer complications and higher patient satisfaction.

Objective:To study the position of computed tomography(CT)slice of marker points of radiotherapy,which was determined by control scan(CS)method,on the application effect of patients with head and neck tumors who received radiotherapy.Methods:Based on Control Scan(CS)method,a calculator program of mark-point slice position was made,which was an enterprise WeChat program that could be used in calculating position and CT position scan of patients with head and neck tumor(slice thickness was 3mm).A total of 60 patients with head and neck tumor were selected,and the patients who underwent CT positioning scan by using CS method were divided into observation group,and patients who underwent CT position scan by using conventional method were divided into control group,with 30 cases in each group.The number of cases with three metal marker points displayed at the same slice,and the number of slices containing the CT images of marker point between the located CT scan were compared.Results:The number of patients in the observation group and the control group who showed three markers at the same level at the same time were respectively 26 cases and 13 cases,and observation group increased by 13 cases(43.4%)than control group,and the difference was significant(x2=12.382,P<0.05).The number of CT images with only 1 slice of observation group and control group were respectively 4 cases and 0 cases,which increased by 4 cases(13.3%)than the control group,and the difference was significant(x2=2.411,P<0.05).Conclusions:The CT localization scan of radiotherapy,which uses CS to assist patients with head and neck tumor,can precisely calculate and obtain the primary position of target of CT localization scan.It can take the images of 3 mental marker points of patient who receives radiotherapy to occur at the same CT slice as soon as possible,which has better application effect.It can effectively improve the convenience and work effectiveness of radiotherapy.

Objective To investigate the effect of parent-child alienation on depression in surface ship officers and soldiers based on the theory of"diathesis-stress",and the mediating role of resilience between parent-child alienation and depression in them.Methods A cross-sectional study was conducted on 599 officers and soldiers from a surface ship unit.The participants were surveyed with inventory of alienation toward parents,connor-davidson resilience scale and patient health questionnaire-9 to obtain and analyze their demographic-military characteristics of their depression scores.The participants with depression scores ≥5 were recruited as the subjects,and Spearman correlation analysis was used to explore the correlation among parent-child alienation,resilience and depression.On the basis of hierarchical regression analysis,AMOS software was used to establish a structural equation modelling of intermediary effects.Results The depression score was 1(0,4)in the participants,and the depression scores of those with service length ≥11 years were comparatively higher than those with shorter length.Our results indicated that parent-child alienation was positive correlated with depression(r=0.451,P＜0.001),while resilience was negatively correlated with depression and parent-child alienation(r=-0.412,-0.407,P＜0.001).Regression analysis revealed that parent-child alienation had a direct positive predictive value for depression(β=0.574,P＜0.001),and resilience showed a negative predictive value for depression(β=-0.211,P＜0.01).Model analysis displayed that resilience had a significant mediating role in the effect of parent-child alienation on depression among these surface ship officers and soldiers,with an effect value of 0.088,and accounting for 15.86％of the total effect.Conclusion Parent-child alienation has a significant influence on depression among surface ship officers and soldiers,with resilience playing a partial mediating role.

Objective:To evaluate the clinical effect of orbital fat releasing and repositioning through supra-suborbicularis oculi fat (SOOF) in lower eyelid blepharoplasty.Methods:The authors retrospectively analyzed the clinical data of patients who received lower eyelid blepharoplasty in the Department of Plastic Surgery, Beijing Tsinghua Changgung Hospital from January 2017 to January 2023. Lower eyelid blepharoplasty with orbital fat releasing and repositioning through supra-SOOF was performed. The tear trough ligament and orbicularis retaining ligament were released between the orbicularis oculi muscle and SOOF via skin approach. Orbital septal fat was released to this space, lateral fat flap was fixed to the SOOF capsule, medial fat flap was fixed to the superficial fascia of the levator labii superioris muscle, orbital septum was repositioned, and lateral canthus was suspended. After the operation, lower eyelid morphology and complications were evaluated.Results:A total of 58 patients were enrolled, including 8 males and 50 females with the age of (49.8 ± 10.4) years (32 to 70 years). All patients had obvious lower eyelid bags on both sides, combining the tear trough deformity and (or) palabromalar groove. Fifty-seven patients were followed up for (29.1 ± 16.9) months (6-67 months). All patients were satisfied with the operation. The appearance of lower eyelid was greatly improved, with elimination of fat prominence and tear trough deformity. Mild lower eyelid ectropion was observed two cases 1 week after the operation, and were relieved by moderate massage 2 weeks postoperatively. In one case, mild lower eyelid retraction was observed 1 month postoperatively, with no complaint of discomfort or further treatments. Bulbar conjunctival hemorrhage occurred in 1 case and recovered without further interventions.Conclusion:Lower eyelid blepharoplasty with orbital fat releasing and reposting through supra-SOOF can effectively release the tear trough ligament and the orbicularis retaining ligament, with stronger fat fixation and less surgical difficulty. After the operation, eyelid contour was flat and tight with fewer complications and higher patient satisfaction.

Objective:To conduct a scoping review of studies on the assessment content and early functional exercise of various functional disorders occurring in the limbs on the operated side after cardiac implantable electronic device implantation, so as to provide a reference for the future early identification of different functional disorders in the limbs on the operated side and the guidance of early rehabilitation and exercise in the postoperative period.Methods:According to the scoping review methodology,we systematically searched PubMed, Embase, Cochrane Library, Web of Science, CINAHL, CNKI, VIP, Wanfang and CBM. The retrieval time limit was from the establishment of the database to October 31, 2023. The included studies were summarized and analyzed.Results:Totally 15 studies were included. These included 7 randomized controlled trials and 6 cohort studies, and 2 case-control studies. Postoperative series of limb-related dysfunction on the operative side after cardiac implantable electronic device implantation including shoulder pain, limited range of motion of the shoulder, decreased grip strength, and scapular dyskinesia. Shoulder range of motion limitations included flexion, abduction, and internal and external rotation angle limitations. Shoulder pain and impaired active forward flexion had the highest prevalence, reaching 61% and 60% respectively. The most restricted population was ICD implanted patients. The assessment tools included subjective and objective tools. These tools included 3 types of scales to assess shoulder pain and goniometer for assessing shoulder range of motion and hydraulic hand dynamometer for evaluating grip strength, and tests and tape measures to assess scapular dyskinesia and 5 types of scales to assess overall limb function on the operative side.The various dysfunctions associated with the limb on the operated side basically appeared at 2 weeks postoperatively, and these dysfunctions began to improve at 3 months postoperatively and normalized at 12 months and fully recovered at 5 years.The longest duration was in patients with ICD implants. The rehabilitation exercise program consisted of five types, of which the pendulum exercise was a single program and the remaining four were comprehensive rehabilitation exercise programs, all of which were effective.Intervention time points included postoperative days 1 and 2, as well as postoperative weeks 1 and 2.Conclusions:We need to focus on the presence of serial related dysfunction in the operated limb after cardiac implantable electronic device implantation. Assessment tools are diverse and we need to choose appropriately based on measurement priorities. All of these dysfunctions are self-limiting, however, they still have a long time to heal themselves. All of these individuals need to be included in screening and comprehensive interventions at regular outpatient follow-up visits for one year after surgery. Conducting a comprehensive functional exercise program is beneficial in reducing the incidence and duration of different dysfunctions in the patient′s operated limb. These exercise programs have value for further clinical application. However, these exercise programs are not uniform.In order to provide early intervention for patients, the further validation of which types of activity programs or a combination of certain types of activity programs need to be further investigated. The timing of early functional exercise is not uniform and further work is needed to determine these times.

Abstract: Objective　To investigate the influencing factors related to the recent transmission of multidrug-resistant tuberculosis (MDR-TB) in Hainan Province, with the goal of providing an epidemiological basis for the region's prevention and control strategies, as well as clinical decision-making regarding MDR-TB. Methods Clinical respiratory specimens from MDR-TB patients treated at the Second Affiliated Hospital of Hainan Medical University from July 2019 to June 2021 were collected for mycobacterial isolation and cultivation. Isolates of multidrug-resistant Mycobacterium tuberculosis (MDR-MTB) identified through proportional drug-susceptibility screening were subjected to whole-genome sequencing (WGS). In conjunction with clinical and epidemiological data, factors influencing recent MDR-TB transmission were analyzed. Results A total of 202 MDR-TB patients were included in the study, primarily distributed across 18 cities and counties of Hainan Province (excluding Sansha City), and the patients were predominantly male. Phylogenetic analysis of the MDR-MTB strains showed that 56.4% (114/202) belonged to Lineage 2.2 (Beijing), 27.2% (55/202) to Lineage 2.1 (non-Beijing), 13.4% (27/202) to Lineage 4 (Euro-American), and 3.0% (6/202) to Lineage 1 (Indo-Oceanic). Through genetic distance analysis, 42 strains of MDR-MTB were found to be grouped into 15 clusters, with a clustering rate of 20.8%, indicating a significant level of recent transmission. Analysis of transmission-related factors revealed that non-agricultural occupations, initial treatment, and unmarried status were positively correlated with recent MDR-TB transmission, while older age and a history of smoking were negatively correlated. Notably, Lineage 2.2 (Beijing) showed a higher likelihood of MDR-TB transmission compared to Lineage 2.1 (non-eijing). Multivariate logistic regression analysis further identified that patients receiving initial treatment were an independent risk factor for recent MDR-TB transmission. Conclusions MDR-TB in Hainan Province exhibits distinctive genetic diversity, with Lineage 2.2 (Beijing) being the predominant epidemic strain. Recent transmission of MDR-TB in Hainan Province is associated with non-agricultural occupations, initial treatment, unmarried status, and Lineage 2.2 (Beijing), with the initial treatment being a likely independent risk factor for transmission. These findings offer vital clues for controlling MDR-TB and are expected to guide the formulation of targeted prevention and control strategies to reduce the transmission of the MDR-TB epidemic.

Objective:To explore the application experience of autologous fat transplantation in improving the facial contour of young cosmetic patients.Methods:From October 2017 to October 2020, the plastic surgery department of Beijing Tsinghua Changgung Hospital admitted 10 young cosmetic patients with poor facial contours, including 1 male and 9 females, aged 18-35 years, with an average of 28 years. Autologous subcutaneous fat was harvested by liposuction and static purification and then injected into the areas with poor facial contour with an amount of 10%-30% over.Results:The facial contour of 10 young cosmetic patients was well improved, and there were no postoperative complications such as facial asymmetry, local uneven skin, skin infection and necrosis or fat embolism. 8 cases were filled once and 2 cases were filled twice. The patients were followed up for 6-24 months and the postoperative effect was good. The excellent and good rate evaluated by patients, plastic surgeon and the third party doctor was more than 80%.Conclusions:The use of autologous fat to improve the facial contour of young cosmetic patients is easy to operate with less trauma and good effect, which is worthy of promotion.

Objective:To carry out opening experiments on occupational health and occupational medicine for students majoring in preventive medicine, reform the experimental teaching mode, and explore the teaching methods to improve students' professional quality and scientific research ability.Methods:Opening experiments were carried out in the experimental course of occupational health and occupational medicine for students of preventive medicine major. A total of 147 students majoring in preventive medicine of Batch 2016 were classified as the control group, and the routine confirmatory experiment was carried out in the group; 176 students majoring in preventive medicine of Batch 2017 were classified as the experimental group, and this group carried out opening experiment. The evaluation was made from three aspects: comprehensive evaluation results, teacher self-evaluation and student satisfaction survey. SPSS 22.0 software was used for analysis and comparison by independent-samples t-test and Chi-square test. Results:The theoretical scores of the experimental group and the control group students were (84.37±10.45) vs. (81.44±9.22) ( t=2.68, P=0.008), and the experimental skills scores were (93.66±3.89) vs. (88.41±5.67) ( t=9.51, P<0.001). Questionnaire investigation showed that the students in the opening experimental group were more satisfied with the courses arrangement ( χ2=8.31, P=0.004), group cooperation ( χ2=21.10, P<0.001), assessment form ( χ2 =7.92, P=0.005), improvement of the writing ability of scientific research papers ( χ2 =17.56, P<0.001), improvement of practical skills ( χ2=11.70, P=0.001), logical thinking, language organization and expression ability ( χ2=10.33, P=0.001). They considered the opening experiment was helpful to cultivate innovative thinking and ability, but it had limited effect on the cultivation of employment advantages. And the students considered the opening experiments of setting up professional courses was sufficient and necessary. Conclusion:Carrying out opening experiments for students majoring in preventive medicine is helpful to improve students' professional quality and cultivate their practical ability and scientific research ability.

Abstract： Objective　To analyze the characteristics and corresponding drug resistance of pathogenic bacterial spectrum in eight major infection sites of hospitalized patients, and to provide epidemiological data for the rational selection of antibiotics in clinical practice. Methods　A total of 396 bacterial strains isolated from clinical specimens of hospitalized patients in member institutions of the Hainan Provincial Bacterial Resistance Monitoring Network from September 1, 2020, to September 30, 2022, were included in this study. Data were screened and filtered from the database of MH120 Microbial Identification and Drug Sensitivity Analysis System based on the technical scheme of the National Bacterial Drug Resistance Surveillance Network and Science and Technology Basic Resources Investigation Project research plan in 2020. The testing data were integrated, summarized, and analyzed using EXCEL and WHONET 5.6 software, and statistical analysis was conducted using SPSS 26.0 software. Results　Among of 396 strains of bacteria, 78 (19.7%) were isolated from respiratory tract specimens, 74 (18.7%) from urinary tract specimens, 72 (18.2%) from blood specimens, 54 (13.6%) from abdominal cavity specimens, 48 (12.1%) from skin and soft tissue specimens 48 strains (12.1%), 30 (7.6%) from reproductive tract specimens, 22 (5.6%) from central nervous system specimens, 18 (4.5%) from digestive tract specimens. Gram-negative bacteria accounted for 69.4% of the isolates, while gram-positive bacteria accounted for 30.6%. The top five gram-negative bacteria isolated were Klebsiella pneumoniae (14.9%), Escherichia coli (14.4%), Pseudomonas aeruginosa (10.4%), Acinetobacter baumannii (5.3%), and Salmonella species (4.5%). The top five gram-positive bacteria were Staphylococcus aureus (11.1%), Streptococcus agalactis (7.8%), Enterococcus faecalis (3.0%), Enterococcus faecium (2.8%), and Streptococcus suis (1.8%). Respiratory failure and bloodstream infection were independent influencing factors of treatment response (P<0.01). The resistance rate of Escherichia coli to ampicillin was 81.4%, and the resistance rate of Staphylococcus aureus to gentamicin and levofloxacin were both below 7%. Conclusions　The pathogen spectra vary with different infection sites of patients, and rational selection of antibiotics based on drug susceptibility testing is crucial to shorten the treatment time of patients and avoid the unnecessary emergence of drug-resistant strains caused by drug abuse.

Abstract: Objective　To identify the species of Mycobacteroides abscessus complex (MABC) in patients with pulmonary infection from the Second Affiliated Hospital of Hainan Medical University, and to investigate the species types, drug sensitivity and population distribution of MABC in pulmonary infection in Hainan. Methods　Respiratory tract specimens were collected from suspected tuberculosis patients who visited the Second Affiliated Hospital of Hainan Medical University from January 2014 to December 2021 and cultured for Mycobacterium isolation. Non-tuberculous mycobacteria (NTM) strains were preliminarily identified by p-nitrobenzoic acid/thiophen-2-carbohydrazide (PNB/TCH) medium and DNA microarray chip, and then MABC and its subspecies were identified by hsp65 and rpoB gene sequencing. In vitro antimicrobial susceptibility test was performed by broth microdilution method. Results　A total of 3 025 respiratory specimens from suspected pulmonary tuberculosis patients were collected during the study period. Among the 123 patients with identified MABC isolates, 124 MABC strains were isolated and identified, including 74 strains of Mycobacteroides abscessus subsp. abscessus, 38 strains of Mycobacteroides abscessus subsp. massiliense and 12 strains of Mycobacteroides abscessus subsp. bolletii. Among them, 118 patients had single MABC subspecies infection, one patient had mixed infection with two MABC subspecies, two patients had mixed infection with MABC and other NTM, and two cases had mixed infection with MABC and M.tuberculosis. There were more female patients than male patients with a ratio of 1:0.64, and those aged 50 and above amounted to 76.42% (94/123, 95%CI: 67.93%-83.61%). There was no significant difference in age distribution between male and female patients (Z=-0.944, P=0.347). The drug susceptibility results showed that all MABC strains were sensitive to Tigecycline (TGC), with a resistance rate of 0.81% (1/124) to Amikacin (AK), and resistance rates of 6.45% (8/124), 32.26% (40/124), and 74.19% (92/124) to Cefoxitin (FOX), Linezolid (LZD), and Imipenem (IPM), respectively. For Clarithromycin (CLR), MABC showed induced resistance , and there was a statistically significant difference in the CLR (14D) resistance rates among the three subspecies (χ2=66.335, P<0.001). The resistance rates to Tobramycin (TOB), Doxycycline (DOX), Moxifloxacin (MFX), Ciprofoxacin (CIP), Trimethoprim/Sulfamethoxazole (TMP-SMX), and Amoxicillin/Clavulanic acid (AMC) were high, all >80%. Conclusion　 In Hainan Province, pulmonary infections with MABC are mainly caused by Mycobacteroides abscessus subsp. Abscessus, which show high rates of inducible resistance to CLR. Timely and accurate identification of MABC to subspecies and drug susceptibility testing are of significant important for clinical decision-making.