Objective:To compare the efficacy of the injection of collagen, hyaluronic acid and their combined application in the treatment of lacrimal depression.Methods:From July 2022 to January 2023, 60 female patients with lacrimal depression, aged 19-49 years with an average age of 33.6 years, were treated by injection in Xi′an Rongyao FRESKIN Medical Cosmetology Clinic. There were 20 cases in the collagen injection group, 20 cases in the hyaluronic acid injection group, and 20 cases in the combined hyaluronic acid and collagen injection group. Preoperative, immediate, 1 month and 6 months after surgery, lacrimal groove deformity rating scale score and patient satisfaction at 1 month and 6 months after surgery were evaluated.Results:One month after operation, the satisfactory rate of patients in collagen group was 90%, that of hyaluronic acid group was 80%, and that of the combined treatment group was 90%. 6 months after operation, the satisfactory rate of patients in the collagen group was 80%, that of hyaluronic acid was 80%, and that of the combined treatment group was 90%. Postoperative follow-up showed no serious complications such as infection, embolism or visual loss in the 3 groups. Pigmentation occurred in 2 cases in the hyaluronic acid group and 1 case in the collagen group. No pigmentation occurred in the combined treatment group. Overall, all the three treatment methods were effective and safe.Conclusions:All three treatment methods can be used to improve lacrimal depression without serious complications.

Objective:To investigate the anatomic mechanism and risk factors of intracranial embolism caused by injection at temporal region.Methods:(1) Latex perfusion was performed on the vessels of 8 cranial specimens. The vessels from the superficial temporal artery to the carotid artery were dissected to measure the length, the diameter of starting point and ending point and the volume of vessels (drainage method). (2) Cranial CT angiography of 20 patients (excluding patients with cervical diseases) were obtained from the database of Zhejiang Provincial People’s Hospital from January 2021 to December 2022. The length, the diameter of starting point and ending point, and the volume of vessels were measured. (3) 5 plastic surgeons used pressure simulation measuring equipment to vigorously press the temporal region of the real skull model according to the clinical practice and maintain 2 s to obtain the maximum pressure value. The additional pressure on the temporal region was obtained by subtracting the common carotid artery base pressure [set at 90, 120, 150 and 200 mmHg (1 mmHg = 0.133 kPa)] from the maximum pressure.Results:(1) 8 arteries were collected from 4 skull specimens. The length of vessels was (169.5±7.2) mm, the diameter of the starting point of vessel was (4.29±0.28) mm, the diameter of the ending point of vessel was (1.31±0.15) mm, and the volume was (1.56±0.21) ml. (2) There were 11 males and 9 females among 20 patients aged 23-53 years. The length of vessels was (172.2±7.6) mm, the diameter of the starting point of vessel was (5.63±0.43) mm, the diameter of the ending point of vessel was (1.77±0.16) mm, and the volume was (1.59±0.23) ml. (3) The mean value of additional pressure generated by local pressure on the temporal region by 5 physicians was (127.2±10.1) mmHg (113.8-138.6 mmHg).Conclusion:When the injection volume into the superficial temporal artery was more than 1.6 ml, the artery was damaged, and the temporal area was pressed strongly (the local pressure was more than 110 mmHg above the basic pressure), the injection material might flow into the intracranial from the junction of the common carotid artery and into the internal carotid artery, which was the possible mechanism of the temporal filling leading to intracranial embolism.

Hyaluronic acid (HA) injections have already been one of most popular cosmetic procedures for around 18 years. However, blindness is one of the most serious complications caused by HA injections. There is still no consensus on the treatment for vision recovery. The efficacy and safety of different delivery administration of hyaluronidase such as retrobulbar injection and endovascular intervention are still controversial so far. Based on current status, prevention is prior to treatment, which is widely recognized in the world. The pathogenic mechanism of blindness induced by filler injection is still not clear, and there exist several theories including the artery embolism, ischaemia, artery spasm and venous involvement, which are all related to the ophthalmic artery and its branches. Therefore, acquiring anatomic knowledge and the relevant parameters will help us prevent to damage the ophthalmic artery and its branches during HA injections. The mechanism, treatment progress and prognosis of blindness caused by HA injections in recent years were analyzed and summarized in this article. We hope it will help the clinician to improve the relevant knowledge about vision loss caused by HA injection, as well as to promote the safety of filler injection.

Objective:To investigate the anatomic mechanism and risk factors of intracranial embolism caused by injection at temporal region.Methods:(1) Latex perfusion was performed on the vessels of 8 cranial specimens. The vessels from the superficial temporal artery to the carotid artery were dissected to measure the length, the diameter of starting point and ending point and the volume of vessels (drainage method). (2) Cranial CT angiography of 20 patients (excluding patients with cervical diseases) were obtained from the database of Zhejiang Provincial People’s Hospital from January 2021 to December 2022. The length, the diameter of starting point and ending point, and the volume of vessels were measured. (3) 5 plastic surgeons used pressure simulation measuring equipment to vigorously press the temporal region of the real skull model according to the clinical practice and maintain 2 s to obtain the maximum pressure value. The additional pressure on the temporal region was obtained by subtracting the common carotid artery base pressure [set at 90, 120, 150 and 200 mmHg (1 mmHg = 0.133 kPa)] from the maximum pressure.Results:(1) 8 arteries were collected from 4 skull specimens. The length of vessels was (169.5±7.2) mm, the diameter of the starting point of vessel was (4.29±0.28) mm, the diameter of the ending point of vessel was (1.31±0.15) mm, and the volume was (1.56±0.21) ml. (2) There were 11 males and 9 females among 20 patients aged 23-53 years. The length of vessels was (172.2±7.6) mm, the diameter of the starting point of vessel was (5.63±0.43) mm, the diameter of the ending point of vessel was (1.77±0.16) mm, and the volume was (1.59±0.23) ml. (3) The mean value of additional pressure generated by local pressure on the temporal region by 5 physicians was (127.2±10.1) mmHg (113.8-138.6 mmHg).Conclusion:When the injection volume into the superficial temporal artery was more than 1.6 ml, the artery was damaged, and the temporal area was pressed strongly (the local pressure was more than 110 mmHg above the basic pressure), the injection material might flow into the intracranial from the junction of the common carotid artery and into the internal carotid artery, which was the possible mechanism of the temporal filling leading to intracranial embolism.

Hyaluronic acid (HA) injections have already been one of most popular cosmetic procedures for around 18 years. However, blindness is one of the most serious complications caused by HA injections. There is still no consensus on the treatment for vision recovery. The efficacy and safety of different delivery administration of hyaluronidase such as retrobulbar injection and endovascular intervention are still controversial so far. Based on current status, prevention is prior to treatment, which is widely recognized in the world. The pathogenic mechanism of blindness induced by filler injection is still not clear, and there exist several theories including the artery embolism, ischaemia, artery spasm and venous involvement, which are all related to the ophthalmic artery and its branches. Therefore, acquiring anatomic knowledge and the relevant parameters will help us prevent to damage the ophthalmic artery and its branches during HA injections. The mechanism, treatment progress and prognosis of blindness caused by HA injections in recent years were analyzed and summarized in this article. We hope it will help the clinician to improve the relevant knowledge about vision loss caused by HA injection, as well as to promote the safety of filler injection.

Objective:To explore the benefit finding and influencing factors of primary caregivers of children with cerebral palsy.Methods:This study adopted the method of random sampling, 158 primary caregivers of children with cerebral palsy in the outpatient and inpatient wards of the Children′s Rehabilitation Department of the Second Affiliated Hospital of Wenzhou Medical University from November 2020 to January 2021 were selected as the research objects. The basic data questionnaire, Chinese version of benefit finding scale, simple coping style questionnaire and perceived social support scale were used to do investigation. The influencing factors of benefit finding of main caregivers of children with cerebral palsy were investigated by single factor analysis, Pearson correlation analysis and multiple linear regression analysis.Results:The score of benefit finding of the main caregivers of children with cerebral palsy was (62.4±7.0),which was above the middle level. The years of diagnosis, the payment method of medical expenses, the place of residence and the length of caring for children had a significant impact on the benefit finding of the main caregivers of children with cerebral palsy ( F=3.45, 3.75, 3.97, 6.60, all P<0.05). The main caregivers′ sense of benefit finding was positively correlated with positive coping style, family support, friend support, others′ support and perceived social support ( r=0.43, 0.20, 0.32, 0.24, 0.30, all P<0.05), and negatively correlated with negative coping style ( r=-0.36, P<0.01).The importance of those factors influencing the benefit finding of the main caregivers of children with cerebral palsy was as follows: positive coping style, place of residence and length of caring for children (standardized regression coefficients were 0.33, 0.22, -0.32, all P<0.05). Conclusions:The main caregivers of children with cerebral palsy have a good sense of benefit finding. The main factors affecting the benefit finding of the main caregivers are the children′s residence, the length of care and coping style.

Objective:To figure out the structure and relevant data measurements of zygomatic ligament by cadaver anatomy and review of previous studies.Methods:From July 2018 to January 2020, the zygomatic areas of 20 Chinese frozen fresh cadaver hemifaces were dissected in the Department of Anatomy, Health Science Center of Hangzhou Normal University. Then the structures of zygomatic ligaments were shown. The characters of the ligament and the relationship with adjacent tissue were described and measured. And 16 previous studies were reviewed to get a comprehensive description about the characters of zygomatic ligaments.Results:Zygomatic ligaments were even and dense fibrous tissue structures distributed vertically between the skin and the subcutaneous tissue. Under the SMAS plane, the ligaments divided into two bundles. The origin of major bundle located beyond the origin of the zygomatic major muscle on the periosteum, and the origin of minor bundle located between the origin of the zygomatic minor and major muscle.Conclusions:The anatomy of the zygomatic ligament has a regular pattern, and its anatomical data has certain directive significance for clinical application.

Objective:Facial artery is the main blood supply source of facial soft tissue, which has an important influence on facial plastic surgery and injection procedures. There are many types of facial arteries. They have wide coverage, and travel several layers. In this study, the detailed characteristics of the facial arteries were revealed by cadaver dissection.Methods:In 19 donated fresh cranial (28 sides) specimens, the facial arteries were dissected. And then the type, layer, relationship with nasolabial groove, length, diameter, distance from the oral commissure, branches and submental artery were observed and measured.Results:Facial arteries were found in all cadavers, starting from the external carotid arteries, branching submental arteries below the mandibular margins, ascending to the anterior edge of the masseter muscles, crossing the mandibles and entering the faces. After entering into the faces, the facial arteries branched the submental arteries(100%, 28/28), lower labial arteries (100%, 28/28), upper labial arteries (100%, 28/28), lateral nasal arteries (92.9%, 26/28) and the angular arteries (57.2%, 16/28) throughout the courses. According to the vascular route, the facial artery was classified into four types. In TypesⅠ(8 sides), all branches were included and the angular arteries arose directly from the lower segment of the facial arteries (28.6%). In TypesⅡ(8 sides), all branches were included and the angular arteries were the terminal branches (28.6%). In TypesⅢ(10 sides), angular arteries were absent (35.7%). In Type Ⅳ (2 sides), angular arteries and lateral nasal arteries were absent (7.1%). The lower segment of facial artery coursed under the facial expression muscles, and continued to the middle segment at the point which was (26.0±5.0) mm away from the oral commissure on the lateral side. The layer that the facial artery coursed was varied. It passed through the superficial layer of the facial expression muscles. After passing the horizontal line parallel to the lower margin of nasal sill, the upper segment continued to on the superficial layer of the facial expression muscles. The facial arteries were mostly located medial to the nasolabial fold(24 sides, 85.7%) and occasionally across the nasolabial fold(4 sides, 14.3%). The lengths of the upper, middle and lower segments of facial artery were (26.4±10.9) mm, (29.7±8.4) mm, and(33.5±6.9) mm, respectively. The diameters in starting point of upper, middle and lower sections were(2.45±0.48) mm, (1.85±0.12) mm, and (1.09±0.21) mm, respectively. The facial artery passed lateral to the oral commissure and the distance from the intersection of the horizontal line to the oral commissure was (26.0±5.0) mm. The starting point of the superior labial artery locacted below the horizontal line was (8.0±1.4)mm away from the horizontal line of the oral commissure and(55.0±5.2) mm from the mandibular angle. The starting point of the inferior labial artery located below the horizontal line was (17.1±11.1) mm from the horizontal line of the oral commissure, and the distance from the mandibular angle was (44.2±5.2) mm. The diameter of the submental artery in its starting point was (1.4±0.1) mm. The distance from the starting point of the submental artery to the horizontal line of the oral commissure was (34.9±2.6) mm, and the distance from the mandibular angle was (29.4±5.8) mm. The starting point of the submental artery was (6.4±0.8) mm from the lower margin of the mandible. In the midline of the mandible, the distance between the submental artery and the lower margin of the mandible was (9.0±1.0) mm. In the midsagittal plane, the starting point of the submental artery was(8.4±1.0) mm from the lower margin of the mandible.Conclusions:There were several types of facial arteries and the courses were various, but the way they branched and the layers they coursed had certain rules. Understanding the anatomy of facial arteries is helpful to keep the treatment safe.

Objective:Facial artery is the main blood supply source of facial soft tissue, which has an important influence on facial plastic surgery and injection procedures. There are many types of facial arteries. They have wide coverage, and travel several layers. In this study, the detailed characteristics of the facial arteries were revealed by cadaver dissection.Methods:In 19 donated fresh cranial (28 sides) specimens, the facial arteries were dissected. And then the type, layer, relationship with nasolabial groove, length, diameter, distance from the oral commissure, branches and submental artery were observed and measured.Results:Facial arteries were found in all cadavers, starting from the external carotid arteries, branching submental arteries below the mandibular margins, ascending to the anterior edge of the masseter muscles, crossing the mandibles and entering the faces. After entering into the faces, the facial arteries branched the submental arteries(100%, 28/28), lower labial arteries (100%, 28/28), upper labial arteries (100%, 28/28), lateral nasal arteries (92.9%, 26/28) and the angular arteries (57.2%, 16/28) throughout the courses. According to the vascular route, the facial artery was classified into four types. In TypesⅠ(8 sides), all branches were included and the angular arteries arose directly from the lower segment of the facial arteries (28.6%). In TypesⅡ(8 sides), all branches were included and the angular arteries were the terminal branches (28.6%). In TypesⅢ(10 sides), angular arteries were absent (35.7%). In Type Ⅳ (2 sides), angular arteries and lateral nasal arteries were absent (7.1%). The lower segment of facial artery coursed under the facial expression muscles, and continued to the middle segment at the point which was (26.0±5.0) mm away from the oral commissure on the lateral side. The layer that the facial artery coursed was varied. It passed through the superficial layer of the facial expression muscles. After passing the horizontal line parallel to the lower margin of nasal sill, the upper segment continued to on the superficial layer of the facial expression muscles. The facial arteries were mostly located medial to the nasolabial fold(24 sides, 85.7%) and occasionally across the nasolabial fold(4 sides, 14.3%). The lengths of the upper, middle and lower segments of facial artery were (26.4±10.9) mm, (29.7±8.4) mm, and(33.5±6.9) mm, respectively. The diameters in starting point of upper, middle and lower sections were(2.45±0.48) mm, (1.85±0.12) mm, and (1.09±0.21) mm, respectively. The facial artery passed lateral to the oral commissure and the distance from the intersection of the horizontal line to the oral commissure was (26.0±5.0) mm. The starting point of the superior labial artery locacted below the horizontal line was (8.0±1.4)mm away from the horizontal line of the oral commissure and(55.0±5.2) mm from the mandibular angle. The starting point of the inferior labial artery located below the horizontal line was (17.1±11.1) mm from the horizontal line of the oral commissure, and the distance from the mandibular angle was (44.2±5.2) mm. The diameter of the submental artery in its starting point was (1.4±0.1) mm. The distance from the starting point of the submental artery to the horizontal line of the oral commissure was (34.9±2.6) mm, and the distance from the mandibular angle was (29.4±5.8) mm. The starting point of the submental artery was (6.4±0.8) mm from the lower margin of the mandible. In the midline of the mandible, the distance between the submental artery and the lower margin of the mandible was (9.0±1.0) mm. In the midsagittal plane, the starting point of the submental artery was(8.4±1.0) mm from the lower margin of the mandible.Conclusions:There were several types of facial arteries and the courses were various, but the way they branched and the layers they coursed had certain rules. Understanding the anatomy of facial arteries is helpful to keep the treatment safe.

Objective:To understand the current status of family function and empathy ability among clinical nurses in some ClassⅢ Grade A hospitals of Zhejiang Province, and to explore the correlation between them.Methods:From January to May 2019, we selected 1 050 clinical nurses from five ClassⅢ Grade A hospitals in Zhejiang Province by convenience sampling to carry out a questionnaire survey. Questionnaires included the General Information Scale, Family APGAR Index as well as the Jefferson Scale of Empathy-Health Professionals (JSE-HP) . In this study, a total of 1050 questionnaires were distributed and 1 032 were collected with 98.3% for the questionnaire recovery rate.Results:Among 1 032 clinical nurses, the total scores of Family APGAR Index and JSE-HP were (6.04±2.90) and (87.33±21.02) respectively. Correlation analysis results showed that dimensions scores of Family APGAR Index had positive correlations with dimensions of JSE-HP with a statistical difference ( r=0.128-0.490, P<0.05) . Multiple linear regression analysis indicated that family function had a positive predictive effect on the empathy ability of clinical nurses with a statistical difference ( P<0.05) . Conclusions:Among clinical nurses in ClassⅢ Grade A hospitals, marital status and family function are important factors that affects the level of empathy. Nursing managers should actively pay attention to the empathy of nurses, and provide corresponding help by using relevant organizational support and social support so as to reduce the occurrence of empathy fatigue.