Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Objective Study on the relationship between detection of 10 driver gene mutations in non-small cell lung cancer tis-sues and clinical pathological characteristics,as well as the diagnostic value of multi gene combined models.Methods Selected 79 patients diagnosed with NSCLC in Zhongshan People's Hospital from December 2022 to April 2023 as the research objects,collected tissue samples,used PCR technology for mutation detection,obtain the detection rate of each driver gene,and explore gene mutations and NSCLC patients correlation of clinicopathological characteristics.Logistic regression method was used to es-tablish a multi-gene joint model of joint predictors and evaluate its diagnostic value.Results Among the 79 cases,the total muta-tion rate of the ten driving genes was 81.01%(64/79),Among them the mutation rate of EGFR was 54.43%(43/79),the mutation frequency of KRAS was 13.92%(11/79),the mutation rate of HER2 was 3.80%(3/79),the fusion frequency of ALK was 2.53%(2/79),the fusion frequency of ROS1 was 2.53%(2/79),the mutation rate of MET was 2.53%(2/79),the mutation rate of NRAS was 1.27%(1/79),and no mutations were detected in RET,BRAF and PIK3CA.The mutation frequency of EGFR in fe-male patients was higher than that in males(χ2=20.512,P<0.001),ALK fusion was also more common in females(χ2=192.080,P<0.001),while KRAS was the opposite.The mutation frequency in male patients was higher than that in females(χ2=4.545,P<0.05).EGFR mutations were more common in individuals＜60 years old(χ2=33.907,P<0.001),while KRAS mutations had a higher individuals in patients≥60 years old than in those＜60 years old(χ2=8.909,P<0.001).The positive mutation of EGFR was more common in stage IV patients(χ2=15.429,P<0.001).ROS1 fusion is more common in stage III b patients(χ2=4.000,P<0.05),EGFR mutation had a significantly higher mutation rate in non-smoking patients than in smoking patients(χ2=50.651,P<0.001),and ALK fusion had a higher mutation rate in smoking patients than in non-smoking patients(χ2=4.000,P<0.05).Con-structed a Logistic regression model to evaluate the diagnostic value of driver gene joint detection,and constructed a Logistic re-gression model to predict the occurrence of NSCLC in patients.The model expression was:logit(P)=-0.190+0.168 EGFR muta-tion(X1)+0.516 KRAS mutation(X2)+0.331 ALK fusion(X3)+0.403 ROS1 fusion(X4)+0.429 NRAS mutation(X5)+0.515 HER2 mutation(X6)+0.405 MET mutation(X7).The ROC curve results show that the diagnostic value of the joint prediction model for NSCLC was higher than that of a single indicator.Conclusion There is a correlation between driver gene mutation status and pathological characteristics,and the co-mutation information provided by multi-gene joint detection can make a more accurate diagnosis of NSCLC.

Objective Study on the relationship between detection of 10 driver gene mutations in non-small cell lung cancer tis-sues and clinical pathological characteristics,as well as the diagnostic value of multi gene combined models.Methods Selected 79 patients diagnosed with NSCLC in Zhongshan People's Hospital from December 2022 to April 2023 as the research objects,collected tissue samples,used PCR technology for mutation detection,obtain the detection rate of each driver gene,and explore gene mutations and NSCLC patients correlation of clinicopathological characteristics.Logistic regression method was used to es-tablish a multi-gene joint model of joint predictors and evaluate its diagnostic value.Results Among the 79 cases,the total muta-tion rate of the ten driving genes was 81.01%(64/79),Among them the mutation rate of EGFR was 54.43%(43/79),the mutation frequency of KRAS was 13.92%(11/79),the mutation rate of HER2 was 3.80%(3/79),the fusion frequency of ALK was 2.53%(2/79),the fusion frequency of ROS1 was 2.53%(2/79),the mutation rate of MET was 2.53%(2/79),the mutation rate of NRAS was 1.27%(1/79),and no mutations were detected in RET,BRAF and PIK3CA.The mutation frequency of EGFR in fe-male patients was higher than that in males(χ2=20.512,P<0.001),ALK fusion was also more common in females(χ2=192.080,P<0.001),while KRAS was the opposite.The mutation frequency in male patients was higher than that in females(χ2=4.545,P<0.05).EGFR mutations were more common in individuals＜60 years old(χ2=33.907,P<0.001),while KRAS mutations had a higher individuals in patients≥60 years old than in those＜60 years old(χ2=8.909,P<0.001).The positive mutation of EGFR was more common in stage IV patients(χ2=15.429,P<0.001).ROS1 fusion is more common in stage III b patients(χ2=4.000,P<0.05),EGFR mutation had a significantly higher mutation rate in non-smoking patients than in smoking patients(χ2=50.651,P<0.001),and ALK fusion had a higher mutation rate in smoking patients than in non-smoking patients(χ2=4.000,P<0.05).Con-structed a Logistic regression model to evaluate the diagnostic value of driver gene joint detection,and constructed a Logistic re-gression model to predict the occurrence of NSCLC in patients.The model expression was:logit(P)=-0.190+0.168 EGFR muta-tion(X1)+0.516 KRAS mutation(X2)+0.331 ALK fusion(X3)+0.403 ROS1 fusion(X4)+0.429 NRAS mutation(X5)+0.515 HER2 mutation(X6)+0.405 MET mutation(X7).The ROC curve results show that the diagnostic value of the joint prediction model for NSCLC was higher than that of a single indicator.Conclusion There is a correlation between driver gene mutation status and pathological characteristics,and the co-mutation information provided by multi-gene joint detection can make a more accurate diagnosis of NSCLC.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Dura mater is a tough collagen connective tissue attached to inner surface of skull and wrapped around brain.As a buffer bridge between brain tissue and skull,its physiological function and role in skull development and repair have always been a focus of research.Recent studies have found that dura mater not only directly participates in skull development during skull growth,but also secretes a variety of cytokines that control the development of central nervous system.There are abundant material exchange and cell communication between the two.This article reviews the role of dura in development and repair of skull,and provides clues for further discovery of the relevant mechanisms of dura in development and repair of skull.

Objective To explore the clinical efficacy of staged surgery for non-lactating mastitis. Methods A retrospective analysis was conducted on 317 patients with non-lactating mastitis admitted to our department from January 2015 to December 2020, all of whom underwent staged surgical treatment. The recovery time, recurrence rate, and breast appearance score were observed. Results The median follow-up time was 24(17，33) months, the recovery time was (25.5±17.9) days, and the recurrence rate was 4.4%. There were 96.2% of patients satisfied with the breast appearance. Conclusions Staged surgery for non-lactating mastitis can effectively shorten the course of the disease, protect the appearance of breast, and have good clinical efficacy.

Objective To examine the characteristics of the prevalence of congenital cleft lip with/without cleft palate in the ethnic Tibetan population and to provide support for the precise prevention and treatment of cleft lip with/without cleft palate in the Tibetan population.Methods The clinical data of Tibetan patients with cleft lip with/without cleft palate were collected and the clinical characteristics of the patients were analyzed.The patients'age ranged from 2 months to 51 years old.All the subjects were admitted to West China Stomatology Hospital,Sichuan University for the treatment of cleft lip with/without cleft palate between January 2016 and August 2023.Most of the subjects came from Sichuan Province and the Tibet Autonomous Region.Results A total of 1 051 patients were enrolled and children aged under 12 months(460 cases)accounted for the largest proportion.Among the subjects,383 had cleft lip only(36.44%),140 had cleft palate only(13.32%),and 528 had cleft lip with cleft palate(50.24%).The male-to-female ratios of patients with cleft lip only(0.99∶1),cleft palate only(0.54∶1),and cleft lip with cleft palate(1.67∶1)exhibited significant differences(P＜0.001).However,there was no significant difference in the male-to-female ratio in patients with cleft lip only or those with cleft lip with cleft palate when the subjects were divided into two groups according to whether they had unilateral or bilateral cleft lip with/without cleft palate.Most of the patients with bilateral cleft lip were female,while most of the patients with unilateral cleft lip and unilateral or bilateral cleft lip with cleft palate were male.The unilateral cleft lip with/without cleft palate was located predominantly on the left side.Syndromic cleft lip with/without cleft palate accounted for 3.43%of all the cases and the most common concomitant deformity was congenital heart disease.3.81%(40 cases)of the patients had a family history.In the patients with cleft lip only and those with cleft palate only,the proportion of patients having parents with corresponding phenotypes was higher than those of other phenotypes of cleft lip with/without cleft palate.Regarding the birth time distribution of the children with cleft lip with/without cleft palate,Spring saw the highest number of births of these children(311 cases,29.59%),while Winter saw the lowest number of births(231 cases,21.98%).Conclusion The cases of cleft lip with/without cleft palate in the ethnic Tibetan population are predominantly cleft lip and palate.Unilateral cleft lip only or cleft lip with palate is predominantly located on the left side.Lip disease phenotypes may be more heritable.

Objective Congenital cleft lip and palate is a common birth defect that seriously affects the lives of the afflicted children and their families.Previously,no research has been done to investigate the pathogenic characteristics of cleft lip and palate among ethnic minorities,for example,Tibetans,a minority ethnic group with a large population in China.This study aims to investigate the relationship between the occurrence of cleft lip and palate in Tibetans and Han Chinese in western China and the distribution of ABO blood groups and Rh blood groups to provide a theoretical basis for the precise prevention and treatment of cleft lip and palate.Methods In this study,statistics on Tibetan patients with cleft lip and palate,some Han patients with cleft lip and palate,and normal controls from western China were retrospectively collected.All participants were patients from West China Stomatology Hospital,Sichuan University.All patients with cleft lip and palate received treatment at the hospital between January 2016 and September 2023.The normal controls were outpatients or inpatients who did not have cleft lip and palate,and who received treatment at the hospital between January 2020 and October 2023.Information on the A,B,O,and AB blood groups and Rh positive and negative blood groups of the patients was collected and compared with that of the normal controls.The incidence of different phenotypes,including cleft lip alone,cleft palate alone,and cleft lip with cleft palate,in patients of blood groups A,B,O and AB were statistically analyzed by Chi-square test.Results A total of 1227 Tibetan patients with cleft lip and palate,4064 Han patients with cleft lip and palate,and 5360 normal controls were included in the study.Among all the patients with cleft lip and palate,1863 had cleft lip alone,1425 had cleft palate alone,and 2003 had cleft lip with cleft palate.The ABO blood group distribution of Tibetan patients with cleft lip and palate was characterized as O＞B＞A＞AB,with Rh positive blood group accounting for 100%,blood type O accounting for 41.15%,and blood type B accounting for 30.64%.The blood group distribution of the Han patients with cleft lip and palate was characterized as O＞A＞B＞AB,with Rh positive blood group accounting for 99.58%,blood type O accounting for 35.78%,and type A accounting for 30.54%.There was a significant difference in ABO blood groups between Tibetan and Han patients with cleft lip and palate(P＜0.005),but no significant difference in Rh blood groups.The ABO blood group distribution of the Tibetan patients with cleft lip and palate showed an obvious difference from that of the control group,while those of the Han patients with cleft lip and cleft palate and the control group did not show obvious differences.In the analysis of the subtypes,it was found that the blood group distribution in the subtypes of cleft lip alone,cleft palate alone,and cleft lip with cleft palate in the Tibetan population was O＞B＞A＞AB,while that in the Han Chinese population was O＞A＞B＞AB.There were differences in blood group distribution between Tibetans and Hans of the subtypes of cleft lip alone and cleft lip with cleft palate(P＜0.001),but there was no difference in blood group distribution in the population of cleft palate-only subtype.The proportion of blood type O in Tibetan patients with cleft lip and palate was significantly higher than that in the Han patients with cleft lip and palate.The blood group distribution of Tibetan patients with cleft lip and palate in Sichuan Province,Xizang Autonomous Region,and Qinghai Province was always O＞B＞A＞AB.Tibetan patients from Shiqu County and Baiyu County,Ganzi Tibetan Autonomous Prefecture and Chaya County,Qamdo City were predominantly of blood type B,and those from other regions were mainly of blood type O.Conclusion There were significant differences in the phenotype composition and ABO blood group distribution between the Tibetan and Han populations with cleft lip and palate in western China.The distribution of blood group O in the population with cleft lip and palate was higher than that in the normal population,and the same trend was observed for different phenotypes.However,differences between Tibetan and Han populations in ABO blood group distribution were only found in the phenotypes of cleft lip only and cleft lip with palate.Tibetans with blood type O are more prone to cleft lip deformity than Han people,and the effect in the phenotype of cleft lip with palate is less pronounced than that in the phenotype of cleft lip only.

Objective:To explore the application effect of massive open online course (MOOC) combined with peer mutual assistance in cardiopulmonary resuscitation teaching.Methods:A total of 140 students in the same class of Batch 2015 were divided into the experimental group and the control group. In the teaching of cardiopulmonary resuscitation, the experimental group was based on the MOOC teaching platform, watched videos and topic tests before class, and used the peer mutual assistance in class. While the control group adopted traditional classroom teaching mode. The teaching effect of the two groups were evaluated by comparing the operation assessment scores and questionnaire survey of students' satisfaction with teaching. SPSS 22.0 was used for t-test and Chi-square test. Results:The operating assessment score of the experimental group was (82.20±2.31), and the operating assessment score of the control group was (75.80±1.72). The difference was statistically significant ( t=3.27, P<0.05). The questionnaire survey showed that the course satisfaction and learning motivation of the experimental group were better than those of the control group. In learning burden, the two groups had similar results ( P=0.739). Conclusion:MOOC combined with peer mutual assistance in cardiopulmonary resuscitation teaching can help students better master skills, improve students' course satisfaction and learning motivation, without increasing their learning burden.

Hip fracture is considered as the most severe osteoporotic fracture characterized by high disability and mortality in the elderly. Improved surgical techniques and multidisciplinary team play an active role in alleviating prognosis, which places higher demands on perioperative nursing. Dysfunction, complications, and secondary impact of anaesthesia and surgery add more difficulties to clinical nursing. Besides, there still lack clinical practices in perioperative nursing for elderly patients with hip fracture in China. In this context, led by the Orthopedic Nursing Committee of Chinese Nursing Association, the Expert consensus on clinical practice in perioperative nursing for elderly patients with hip fracture ( version 2023) is developed based on the evidence-based medicine. This consensus provides 11 recommendations on elderly patients with hip fracture from aspects of perioperative health education, condition monitoring and inspection, complication risk assessment and prevention, and rehabilitation, in order to provide guiding advices for clinical practice, improve the quality of nursing and ameliorate the prognosis of elderly patients with hip fracture.