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Objective:To investigate the current state of standardized training in trauma surgeons in medical institutions in Shanghai.Methods:Questionnaire surveys, focus discussions and expert conferences were conducted to investigate the professional background, status of standardized training on trauma care knowledge, training needs and suggestions in 236 trauma surgeons in 25 Shanghai medical institutions.Results:The investigation revealed that only 59.3% (140/236) of the trauma surgeons had received a standardized training on trauma care knowledge. Of them, those who participated in the training by an international, domestic and local medical institution accounted for 26.4% (37/140), 47.1% (66/140) and 84.3%(118/140), respectively. Only 83 surgeons (70.3%) received regular training and most of them 66.3% (55/83) did in a low frequency of 1-2 times a year. Only 12.7% (15/118) of the surgeons received a training course of ≥48 classes (45 min per class) in the past 3 years. The training courses by medical institutions were mostly lectures on theoretical knowledge and training of a single skill while the simulated scenario drills accounted for less than 48.3%(57/118). The surgeons who had received a standardized training on trauma care were more likely to use their training knowledge to grade and score the patients with trauma, significantly more than those who had not( P<0.05). Conclusions:The coverage, time or frequency of standardized training on trauma care was not enough in Shanghai. The standardized training of trauma care surgeons should be strengthened in all medical institutions and be supervised by the management administration. A set of standardized materials and assessment standards for trauma care training should be formulated as soon as possible which fits the domestic conditions in China. Training bases should be established in Shanghai for standardized care of severe trauma and trauma specialists. A training system for trauma specialists should be established to promote traumatology in shanghai.
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Objective To observe the post-laparoscopic analgesic effect of oxycodone combined with dexmedetomidine for gastric cancer patients.Methods A total of 40 gastric cancer patients who underwent laparoscopy during November 2016 and January 2017 and assessed with physical status Ⅰ or Ⅱ according to American Society of Anesthesiologists,were randomly divided into 2 groups:oxycodone group (group O,n =20) and oxycodone plus dexmedetomidine group (group OD,n =20).The anestheasic effects at the time points of hours 2,5,8,11 and 24 after the operation were assessed by using visual analog pain score,times for pressing the pump,Ramsay score and patient's satisfaction index of the two groups.At the same time,the adverse effects of two groups were recorded and observed.Results The analgesic effect after starting the pump at hours 2,5,8,11,24 and 25,the VAS scores and the pressure time in group OD were significantly lower than in group O (P ＜ 0.05),and the Ramsay scores were insignificantly different between the groups (P ＞ 0.05).In group OD,the patient's satisfaction level was significantly higher than in group O (P ＜ 0.05).Nausea,vomiting and dizziness occurred in both groups without significantly difference between the two groups.Conclusion Oxycodone combined with dexmedetomidine can provide satisfactory analgesia for gastric cancer patients receiving laparoscopic surgery.
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<p><b>BACKGROUND</b>With the increasing popularity of cosmetic facial filler injections in recent years, more and more associated complications have been reported. However, the causative surgical procedures and preventative measures have not been studied well up to now. The aim of this stady was to investigate the clinical characteristics and visual prognosis of fundus artery occlusion resulting from cosmetic facial filler injections.</p><p><b>METHODS</b>Thirteen consecutive patients with fundus artery occlusion caused by facial filler injections were included. Main outcome measures were filler materials, injection sites, best-corrected visual acuity (BCVA), fundus fluorescein angiography, and associated ocular and systemic manifestations.</p><p><b>RESULTS</b>Eleven patients had ophthalmic artery occlusion (OAO) and one patient each had central retinal artery occlusion (CRAO) and anterior ischemic optic neuropathy (AION). Injected materials included autologous fat (seven cases), hyaluronic acid (five cases), and bone collagen (one case). Injection sites were the frontal area (five cases), periocular area (two cases), temple area (two cases), and nose area and nasal area (4 cases). Injected autologous fat was associated with worse final BCVA than hyaluronic acid. The BCVA of seven patients with autologous fat injection in frontal area and temple area was no light perception. Most of the patients with OAO had ocular pain, headache, ptosis, ophthalmoplegia, and no improvement in final BCVA.</p><p><b>CONCLUSIONS</b>Cosmetic facial injections can cause fundus artery occlusion. Autologous fat injection tends to be associated with painful blindness, ptosis, ophthalmoplegia, and poor visual outcomes. The prognosis is much worse with autologous fat injection than hyaluronic acid injection.</p>