Objective:Multi-facial reflective type of nano-ultrasound contrast agents（UCAs）loaded with hollow self-decomposable silica nanoparticles（SiO 2 NP）of different particle sizes were prepared to investigate the effect of the particle size of SiO 2 NP on the structural and physicochemical characteristics of the nano-UCAs，as well as on the intensity of ultrasound contrast. Methods:Two types of SiO 2 NP with large and small particle sizes（SiO 2 NP L and SiO 2 NP S）were prepared by adjusting the material ratios，and nano-UCAs with different particle sizes of SiO 2 NP S loaded at a concentration of 2 mg/ml were prepared by the thin film hydration method（SiO 2 NP L@NBs and SiO 2 NP S@NBs），and compared with the commercial SonoVue and the prepared nano-bubbles（NBs）for comparing the particle size，zeta potential and stability，scanning electron microscopy to observe the structure，CCK8 method to assess cytotoxicity，and comparison of ultrasonography imaging intensity in in vivo and in vitro experiments. Results:The particle sizes of the two SiO 2 NP（SiO 2 NP L and SiO 2 NP S）were（213.270 ± 16.890）nm and（53.870 ± 8.246）nm，respectively，and the particle size of the synthesized nano-UCA was SiO 2 NP L@NBs（628.40 ± 89.97）nm and SiO 2 NP S@NBs（493.40 ± 36.35）nm respectively，there was no difference in particle size（ P>0.05）. The scanning electron microscope showed a "fig" structure. The stability of SiO 2 NP S@NBs was better than that of SiO 2 NP L@NBs and SonoVue. Safety tests showed that both SiO 2 NP L@NBs and SiO 2 NP S@NBs were safe and usable. Compared with NBs，the intensity of contrast-enhanced ultrasound contrast in SiO 2 NP@NBs with multiple reflection interfaces was significantly enhanced，and the enhanced intensity of contrast-enhanced ultrasound in vitro and in vivo in the SiO 2 NP L@NBs group was significantly higher than that of the NBs group，the SiO 2 NP S@NBs group，and the SonoVue group（all P<0.05）. There was no significant difference in the enhanced intensity of in vitro contrast-enhanced ultrasound between the SiO 2 NP S@NBs group and that of SonoVue（ P>0.05），and the enhanced intensity of contrast-enhanced ultrasound in vivo was significantly higher than that in the SonoVue group（ P<0.05）. Conclusions:The large and small SiO 2 NPs prepared by adjusting the material ratio do not affect the nanoparticle size of UCA.The ultrasonic enhancement ability of nano-UCA with large particle size SiO 2 NP is stronger，but the stability time at room temperature is shorter than that of nano-UCA with small particle size SiO 2 NP.

Objective This study aims to investigate and analyze the effects of the incentive-coordination-supervision mechanism applied to training management of medical staff under the modern hospital management system.Methods A total of 84 medical staff members working at the hospital from February 2022 to February 2024 were selected for the study.They were di-vided into a reference group(n=42,February 2022 to February 2023)and a study group(n=42,March 2023 to February 2024)based on the time period.The reference group underwent routine management,while the study group underwent manage-ment based on the incentive-coordination-supervision mechanism.The quality of management,occurrence of adverse events,management satisfaction,and core competencies were compared between the two groups.Results The study group had higher scores in cultural construction,reward and punishment mechanism,reporting system,and communication and coordination mech-anism than the reference group(all P＜0.05).The occurrence rate of adverse events was lower in the study group than in the reference group(7.14％vs 23.81％)(P＜0.05).The study group had higher satisfaction rates in management methods,man-agement content,management forms,and communication skills(95.24％,92.86％,97.62％,and 95.24％,respectively)compared to the reference group(78.57％,73.81％,76.19％,and 73.81％,respectively)(all P＜0.05).The study group had higher scores in all core competencies compared to the reference group(all P＜0.05).Conclusion The application of the incentive-coordination-supervision mechanism in training management of medical staff shows favorable effects,improving the qual-ity of management,management satisfaction,and core competencies,and reducing the occurrence of adverse events.

Objective This study aims to investigate and analyze the effects of the incentive-coordination-supervision mechanism applied to training management of medical staff under the modern hospital management system.Methods A total of 84 medical staff members working at the hospital from February 2022 to February 2024 were selected for the study.They were di-vided into a reference group(n=42,February 2022 to February 2023)and a study group(n=42,March 2023 to February 2024)based on the time period.The reference group underwent routine management,while the study group underwent manage-ment based on the incentive-coordination-supervision mechanism.The quality of management,occurrence of adverse events,management satisfaction,and core competencies were compared between the two groups.Results The study group had higher scores in cultural construction,reward and punishment mechanism,reporting system,and communication and coordination mech-anism than the reference group(all P＜0.05).The occurrence rate of adverse events was lower in the study group than in the reference group(7.14％vs 23.81％)(P＜0.05).The study group had higher satisfaction rates in management methods,man-agement content,management forms,and communication skills(95.24％,92.86％,97.62％,and 95.24％,respectively)compared to the reference group(78.57％,73.81％,76.19％,and 73.81％,respectively)(all P＜0.05).The study group had higher scores in all core competencies compared to the reference group(all P＜0.05).Conclusion The application of the incentive-coordination-supervision mechanism in training management of medical staff shows favorable effects,improving the qual-ity of management,management satisfaction,and core competencies,and reducing the occurrence of adverse events.

Objective:Multi-facial reflective type of nano-ultrasound contrast agents（UCAs）loaded with hollow self-decomposable silica nanoparticles（SiO 2 NP）of different particle sizes were prepared to investigate the effect of the particle size of SiO 2 NP on the structural and physicochemical characteristics of the nano-UCAs，as well as on the intensity of ultrasound contrast. Methods:Two types of SiO 2 NP with large and small particle sizes（SiO 2 NP L and SiO 2 NP S）were prepared by adjusting the material ratios，and nano-UCAs with different particle sizes of SiO 2 NP S loaded at a concentration of 2 mg/ml were prepared by the thin film hydration method（SiO 2 NP L@NBs and SiO 2 NP S@NBs），and compared with the commercial SonoVue and the prepared nano-bubbles（NBs）for comparing the particle size，zeta potential and stability，scanning electron microscopy to observe the structure，CCK8 method to assess cytotoxicity，and comparison of ultrasonography imaging intensity in in vivo and in vitro experiments. Results:The particle sizes of the two SiO 2 NP（SiO 2 NP L and SiO 2 NP S）were（213.270 ± 16.890）nm and（53.870 ± 8.246）nm，respectively，and the particle size of the synthesized nano-UCA was SiO 2 NP L@NBs（628.40 ± 89.97）nm and SiO 2 NP S@NBs（493.40 ± 36.35）nm respectively，there was no difference in particle size（ P>0.05）. The scanning electron microscope showed a "fig" structure. The stability of SiO 2 NP S@NBs was better than that of SiO 2 NP L@NBs and SonoVue. Safety tests showed that both SiO 2 NP L@NBs and SiO 2 NP S@NBs were safe and usable. Compared with NBs，the intensity of contrast-enhanced ultrasound contrast in SiO 2 NP@NBs with multiple reflection interfaces was significantly enhanced，and the enhanced intensity of contrast-enhanced ultrasound in vitro and in vivo in the SiO 2 NP L@NBs group was significantly higher than that of the NBs group，the SiO 2 NP S@NBs group，and the SonoVue group（all P<0.05）. There was no significant difference in the enhanced intensity of in vitro contrast-enhanced ultrasound between the SiO 2 NP S@NBs group and that of SonoVue（ P>0.05），and the enhanced intensity of contrast-enhanced ultrasound in vivo was significantly higher than that in the SonoVue group（ P<0.05）. Conclusions:The large and small SiO 2 NPs prepared by adjusting the material ratio do not affect the nanoparticle size of UCA.The ultrasonic enhancement ability of nano-UCA with large particle size SiO 2 NP is stronger，but the stability time at room temperature is shorter than that of nano-UCA with small particle size SiO 2 NP.

Cornea ; Epithelium, Corneal ; Iontophoresis ; Riboflavin

Objective to analyze the differences and changes before and after the introduction of supply processing distribution (SPD) supply chain management mode in a public hospital, analyze the typical problems existing in the clinical practice and development of SPD mode, and explore the countermeasures to improve the SPD supply chain management. Methods the changes of 20 management functions before and after the introduction of SPD supply chain management mode were compared. The advantages and disadvantages of SPD management mode were analyzed. The improvement measures and countermeasures were proposed. Results among the 20 management functions, 11 of them were reduced, 5 of them were equal, and 4 of them were increased. The overall efficiency of hospital management was improved. Because the external medicine supplier has not been included in the hospital rules, regulations system and process. The role positioning was not clear. There were defects in institutional and continuous guarantee. Conclusion SPD supply chain management mode can be improved and innovated to promote the supply channel reform of drugs and medical consumables, and improve the fine management level of drugs and medical consumables.

Objective:To evaluate the feasibility and clinical efficiency of robot-assisted laparoscopic radical prostatectomy (RARP) via extraperitoneal PORT-free single incision approach.Methods:The data of 33 patients with prostate cancer underwent the extraperitoneal PORT-free single incision RARP from November 2020 to January 2021 in Sichuan Provincial People's Hospital was retrospectively reviewed. The average age was 66.7 (58-78) years, the median PSA was 20.77 (2.89, 56.44) ng/m, and the mean Gleason score was 7.0 (6.0-9.0). The mean prostate volume was 48.4 (25.0-220.0) ml. Clinical stage: 32 cases was in cT 2a-2cN 0M 0, 1 case in cT 3aN 0M 0. 16 cases had a history of operation. All 33 operations were performed by the same operator. All operations were performed by extraperitoneal PORT-free single-incision approach. The surgical condition, postoperative complication, pathology, and follow-up results were observed. Results:In this study, 33 operations were successfully completed without conversion to open or additional single hole channel instruments. The average operation time was 61.3 (38.0-120.0) min, with the mean intraoperative bleeding volume of 72.2 (45.0-220.0) ml and the mean bladder neck urethral anastomosis time of 11.7 (8.5-15.7) min. The mean postoperative hospital stay was 7.9 (6.0-15.0) d, the mean postoperative indwelling time of urinary catheter was 6.8 (6.0-14.0) d, and the mean postoperative evacuation time was 1.0 (0.5-3.0) d. The average incision length was 5.2 (4.6-5.8) cm. There was no obvious complications. The postoperative pathological stage: 21 cases were in < pT 3a, 12 cases were in ≥ pT 3a, and 6 cases (18.8%) had positive resection margin. 29 cases (88.9%) acquired satisfactory urinary continence after operation, and the frequency of urinary pad use was ≤ 1 tablet/day. Conclusions:The extraperitoneal single-incision RARP surgical channel without PORT is safe and feasible with a satisfying cosmetic effect, which saves costs and requires less specific channel device. Simultaneously, the new approach has strong replicability, short-term tumor control and urinary control effect with rapid postoperative recovery. However, the sample size of this study is relatively small, which needs further research and demonstration

Objective:To compare the clinical efficacy of transperitoneal robot assisted laparoscopic radical prostatectomy (RARP) versus extraperitoneal single port RARP.Methods:A retrospective analysis was perfoumed on 142 cases of RARP from July 2019 to June 2020 in Robotic Minimally Invasive Center of Sichuan Provincial People's Hospital, including 82 cases(Group A) , aged 70.0(65.6-78.0), undergoing transperitoneal RARP and 60 cases(Group B), aged 68.2 years old(60.1-79.2), undergoing extraperitoneal single port RARP. For group A, PSA was 12.9(5.6-64.0) ng/ml, with 26 cases of less than 10 ng/ml(31.7%), 40 cases of 10-20 ng/ml(48.8%), and 16 cases of more than 20 ng/ml(19.5%), the Gleason score was 7.2(6.0-10.0), with 14 cases(17.1%) of ≤6, 56 cases(68.3%) of 7, and 12 cases(14.6%) of ≥8, and the prostate volume was 61.3(29.0-112.0) ml. There were 49 cases with BMI≤25 kg/m 2, accounting for 59.8%, and 33 cases with BMI>25 kg/m 2, accounting for 40.2%. There were 17 cases(20.7%) of T 1, 44 cases(53.7%) of T 2 and 21 cases(25.6%) of T 3. The proportion of lymph node dissection was 17.1%, and 4 cases(4.9%)had a history of operation. For group B, the PSA was 12.2(1.0-42.6)ng/ml, with 20 cases (33.3%) of <10 ng/ml, 31 cases(51.7%)of 10-20 ng/ml, and 9 cases (15%) of >20 ng/ml. Gleason score was 7.1(6.0-9.0), with 12 cases (20.0%) of ≤6, 42 cases (70.0%) of 7, and 6 cases (10.0%)of ≥8. Prostate volume was 42.4(31.2-72.8)ml on average. There were 37 cases (61.7%) with BMI≤25 kg/m 2, and 23 cases (38.3%)with BMI >25 kg/m 2 . There were 17 cases(28.3%)of T 1, 32 cases(53.3%)of T 2 and 11 cases(18.3%)of T 3.The proportion of lymph node dissection was 11.7% and 4 cases (6.7%) had a history of operation.There was no statistically significant difference in term of age, PSA level, Gleason score, BMI, clinical stage, proportion of lymph node dissection or history of operation between the two groups( P>0.05), but there was statistically significant difference for prostate volume( P<0.05). All operations were performed by the same operator. Four different ways of bladder neck and urethral dissociation was selected according to the intraoperative conditions in Group A, include VIP style, T-shape incision style, VIP plus T-shape incision style or the style along the lateral side of the bladder neck. Small and single anterograde incision stripping of bladder neck was routinely performed in the Group B. Postoperative follow-up was performed to compare the operation time, intraoperative blood loss, bladder neck and urethral anastomosis time, postoperative hospital stay, postoperative exhaust time, postoperative complications, positive rate of surgical margin, indwelling time of urinary catheter, urinary continence satisfaction rate of immediately after operation, 3 months and 6 months after operation, wound healing and aesthetics. Results:All of the operations were successfully completed under robot-assisted laparoscopy, and there was no conversion to open surgery. The operation time was 56.0(45.0-112.0) min in the Group A and 65.4(55.5-96.8) min in the Group B, and there was no statistically significant difference( P>0.05). The intraoperative blood loss was 76.2(30.0-120.5) ml and 55.6(45.5-114.6) ml, respectively, and the difference was not statistically significant( P>0.05). The time of bladder neck urethral anastomosis was 18.9(12.6-25.6) min and 16.2(10.7-19.3) min, respectively, and the difference was not statistically significant( P>0.05). The postoperative hospital stay days were 9.3(8.0-16.0) d and 8.4(7.0-13.0) d, respectively, and the difference was not statistically significant( P>0.05). The postoperative exhaust time was 1.3(0.7-3.0) d and 3.4(2.0-7.0) d, respectively, and the difference was statistically significant( P<0.05). There was 1 case of anastomotic fistula with ureteral injury in Group A, and no serious complication in Group B, and the difference was not statistically significant( P>0.05). The number of positive surgical margin in the two groups was 13(15.9%)and 9(15.0%)respectively, and the difference was not statistically significant( P>0.05). The indwelling time of urinary catheter after operation was 9(7-21) d and 6(4-8) d, respectively, and the difference was statistically significant( P<0.05). The number of patients with satisfactory urinary continence immediately after surgery, 3 months and 6 months after surgery in the two groups were 8(9.8%), 51(62.2%), 62(75.6%) and 17(28.3%), 43(71.7%) and 54(90.0%), respectively. The differences were statistically significant( P<0.05). The total incision lengths in the two groups were 12.1(10.4-13.4) cm and 5.6(5.0-6.0) cm, respectively, and the difference was statistically significant( P<0.05). Conclusions:The extraperitoneal single port RARP is safe and feasible, and the postoperative effect is similar to that of transperitoneal RARP. It has the advantages of shorter recovery time, higher urinary continence satisfaction rate, neater and more beautiful incision. The long-term therapeutic effect needs further confirming by prospective study.

Objective:To investigate the clinical effect of different bladder neck separation methods in robot-assisted laparoscopic radical prostatectomy (RARP).Methods:To retrospective analysis the data of robot-assisted laparoscopic radical prostatectomy (RARP)in our center from October, 2014 to October, 2018. All operations were performed by the same urologist. According to the different methods of bladder neck separationAccording to the different methods of bladder neck separation, all the patients were divided into four groups. Group A routine forward peeling method (500 cases): Make a 1cm incision at 12 o'clock on the front of the bladder neck, cut off the detrusor muscle and cut the bladder neck. Group B T-cut incision of the bladder neck (133 cases): identify the bladder and prostate Junction, T-shaped incision of the anterior wall of the bladder neck. Group C conventional stripping method combined with T-shaped incision of the bladder neck (81 cases). Group D lateral approach (36 cases): along the lateral side of the bladder neck and the medial posterior ligament of the prostate is separated and merges with the previously established Dirichlet space. The general data of patients were analyzed statistically.The average ages of groups A, B, C, and D were 63 years (62.5 to 67 years), 65 years (61 to 68 years), 66 years (64.5 to 70.5 years), and 62 years (59.5 to 66.5 years)respectively, there was no statistical significance difference in terms of age in 4 groups( P>0.05); PSA is 13 ng/ml(9.0 to 22 ng/ml), 7.4 ng/ml(6.4 to 26.0 ng/ml), 6.2 ng/ml(5.3 to 27.0 ng/ml), 14ng/ml(8.4 to 21.0 ng/ml), ( P>0.05); Gleason scores of puncture were 6.9(5 to 9), 7(6 to 12), 9(8 to 16), 10(6 to 18), ( P>0.05); the prostate volume was 66ml(42 to 78 ml), 70ml(50 to 89 ml), 53ml (43 to 72 ml), 80 ml (68 to 92 ml), ( P>0.05); the proportions of body mass index ≤25 kg/m 2 were 60.0%, 63.9%, 39.1%, 42.0%, and>25 kg/m 2 were 40%, 36.1%, 60.9%, and 58.0%, respectively, ( P>0.05). The operation time, bleeding volume, anastomosis time, postoperative hospital stay, postoperative complications, positive rate of proximal incision margin, urinary indwelling time, and urinary control rate in the four groups analyzed. Results:All 750 RARP operations were successful, and none were converted to open.The operation time of groups A, B, C, and D were 100 min(70 to 120 min), 89 min(70 to 95 min), 105 min(80 to 127 min), and 110 min(90 to 130 min), ( P>0.05); anastomosis time was 20.5 min (18.0 to 25.0 min)、16.1min (10.7 to 17.3 min)、25.4 min (18.9 to 27.0 min)、and 28.5 min (21.0 to 32.0 min), the anastomosis time in group B was significantly shorter than other groups ( P<0.05); the postoperative hospital stays were 9.3 days (8.0 to 13.0 days), 8.4 days (6.0 to 16.0 days), 10.8 days (8.0 to 16.0 days)and 7.8 days (7.0 to 14.0 days), ( P>0.05). Postoperative complications: Anastomotic fistula and ureteral injury occurred in 3 cases in group A, and no serious complications occurred in the other 3 groups. Proximal marginal positive rate: 40 cases (8.0%) in group A, 0 cases in group B, 6 cases (7.3%) in group C, 3 cases (8.3%) in group D, and low positive rate of margin incision in group B( P<0.05). The urinary indwelling time was 7 d (6 to 8 d), 6 d(4 to 8 d), 12 d(6 to 18 d), 10 d(6 to 13 d), ( P>0.05). Six-month postoperative urine control rate: 381 cases (75.2%) in group A, 102 cases (76.9%) in group B, 61 (75.4%) in group C, and 27 (73.8%) in group D, ( P>0.05). Conclusions:The above four method of bladder neck separation during robot-assisted laparoscopic radical prostatectomy is safe and feasible, which can effectively avoid ureteral damage. Each method can obtain better urine control within six months after surgery rate. The positive rate of proximal incision margin after T-shaped bladder neck was lowest among four groups.

Six patients with prostate cancer, treated by suprapubic extraperitoneal single-port robot-assisted radical prostatectomy, had been studied retrospectively from December 2019 to January 2020. All 6 patients have been treated by suprapubic peritoneum single port robot assisted laparoscopic surgery without other channels. The robot assisted laparoscopic radical prostatectomy via suprapubic peritoneum is safe and feasible when based on reasonable selection criteria of patients. It has been shown that the postoperative recovery was fast and the tumor control and continence rate were good under the short-term follow-up. However, the long-term outcome should be evaluated by a long-term follow-up.