There has been ongoing progress in the new technique and equipment in vitreoretinal surgery in recent years, contributing to the improvement of treatment of various vitreoretinal diseases. The application of 3D heads-up display viewing system (3D viewing system) has been one of the most fascinating breakthroughs in vitreoretinal surgery. Unlike the traditional method in which the surgeons have to look through the microscope eyepieces, this system allows them to turn their heads up and operate with their eyes on a high-definition 3D monitor. It provides the surgeons with superior visualization and stereoscopic sensation. And increasing studies have revealed it to be as safe and effective as the traditional microscopic system. Furthermore, the surgeons can keep a heads-up position in a more comfortable posture and lesson the pressure on cervical spine. Meanwhile, 3D viewing system makes it easier for the teaching and learning process among surgeons and assistants. However, there are still potential disadvantages including the latency between surgeon maneuver and visualization on the display, learning curves and cost. We hope that the 3D viewing system will be widely used and become a useful new tool for various vitreoretinal diseases in the near future with rapid development in the technology and constant upgrade of the system.

Unplanned readmission to intensive care unit (ICU) is one of the indicators to evaluate the quality of medical care in ICU. Patients who were readmitted to ICU usually show worse outcomes, longer length of stays, increased mortality, and more consumption of medical resources. This article reviews the definition, incidence, risk factors, risk prediction models and measures to reduce the incidence of unplanned readmission to ICU in critically ill patients, providing a reference for ICU medical and nursing staff, as well as scholars in China to carry out relevant clinical practice and research.

Objective:To investigate the current situation and influence factors of prehospital thrombolysis treatment for ST segment elevation myocardial infarction (STEMI) in China, to analyze the main factors affecting prehospital thrombolysis implementation, and optimize the pre-hospital thrombolysis strategy for STEMI to reduce mortality.Methods:A multicenter cross-sectional survey was conducted. 21 cities from six major geographical regions in China were selected by using convenient sampling method. An anonymous online electronic questionnaire was used to investigate the current situation and influence factors of prehospital emergency physicians and grassroots physicians implementing prehospital thrombolysis treatment for STEMI patients. Chi-square test was used to analyze the differences in count data between groups, and multivariate logistic regression was used to analyze the factors affecting prehospital thrombolysis in STEMI.Results:A total of 5 163 prehospital emergency physicians and physicians from grassroots township health centers/community health service centers or village clinics participated in this survey. Among them, 3208 (62.13%) have never implemtent thrombolysis, and 1 955 (37.87%) have did it before. The results of the multivariate logistic regression analysis indicated that physicians with 5-10 years of experience ( OR=1.41, 95% CI: 1.18-1.69, P<0.01), 11-20 years of experience ( OR=1.25, 95% CI: 1.03-1.52, P=0.02), those working in village clinics ( OR=1.30, 95% CI: 1.05-1.61, P=0.02), those in pre-hospital emergency medical institutions/departments ( OR=3.19, 95% CI: 2.80-3.64, P<0.01), those whose units are equipped with remote ECG transmission capabilities ( OR=1.72, 95% CI: 1.50-1.96, P<0.01), or ECG AI-assisted diagnostic tools ( OR=1.31, 95% CI: 1.15-1.49, P<0.01), and those who believe that thrombolysis is highly effective and should be widely adopted ( OR=2.55, 95% CI: 2.09-3.12, P<0.01) or consider it somewhat effective but warranting caution ( OR=2.11, 95% CI: 1.73-2.59, P<0.001), were more likely to make pre-hospital thrombolysis decisions for STEMI patients. To improve the current situation of pre-hospital thrombolysis for STEMI, the top four measures prioritized by pre-hospital emergency and grassroots physicians were enhancing the rescue capabilities of primary care doctors (92.22%), strengthening guidance from higherlevel hospitals (84.99%), increasing support for information technology (83.37%), and improving public health education (74.75%). Conclusions:The implementation rate of prehospital thrombolysis for STEMI in China still needs to be improved. Optimizing the prehospital thrombolysis strategy for STEMI, strengthening the allocation of basic medical resources and information technology support, and improving the referral mechanism are conducive to the implementation of prehospital thrombolysis for STEMI.

Objective:To explore the popularization and practice ofearly mobility idea in Intensive Care Units (ICUs) in Sichuan Province.Methods:Based on literature review, we designed the Early Mobility Implementation Questionnaires for ICU patients by ourselves. We selected ICUs at 103 ClassⅡ Grade A and above hospitals in 18 cities, Sichuan Province, to carry out the survey.Results:There were statistical differences in different levels hospitals whether it was from an affiliated hospital of a university, with different numbers of beds and bed utilization rates ( P<0.05) . Among 70 ICUs that developed the early mobility, there were statistical differences in early mobility implementation of patients in the ICU whether to form a special team, whether to conduct a written evaluation for patients, whether to sign the early mobility informed consent and whether there was an emergency plan ( P<0.05) . Between ICUs with early mobility of ICU patients and standard plan, and ICUs without early mobility, single factor Logistic regression analysis showed that the influencing factors of early mobility implementation of ICU patients included the numbers of beds, nurse-bed ratios, bed utilization rates, equipping with rehabilitation therapists and respiratory therapists, implementing the daily interruption as well as sedation score with statistical differences ( P<0.05) ; between ICUs with early mobility of ICU patients and without standard plan, and ICUs without early mobility, the influencing factors of early mobility implementation of ICU patients included the nurse-bed ratios, equipping with rehabilitation therapists and respiratory therapists and implementing the daily interruption with statistical differences ( P<0.05) . Multivariate Logistic regression analysis indicated that the influencing factors of early mobility implementation with standard plan were the nurse-bed ratios, bed utilization rates, equipping with rehabilitation therapists and respiratory therapists with statistical differences ( P<0.05) ; the influencing factors of early mobility implementation without standard plan were the nurse-bed ratios, equipping with rehabilitation therapists and respiratory therapists with statistical differences ( P<0.05) . Conclusions:The implementation rate of early mobility in ICU is still insufficient in Sichuan Province, and implementation quality is no ideal. We should further explore the relevant issues, such as multidisciplinary cooperation as well as human resource allocation, and improve the early mobility forms, strengthen the evidence-based clinical practice and formulate a scheme suitable for China.