Objective:To observe the efficacy and safety of intraoperative neurophysiological monitoring (IONM) in spinal surgery.Methods:Clinical studies on the application of IONM in spinal surgery were retrieved from CNKI, VIP, Chinese Medical Journal Full-text Database, PubMed, and Web of Science, with the retrieval time ranging from January 2014 to March 2025. The incidence of intraoperative nerve injury, preoperative and postoperative Japanese Orthopaedic Association (JOA) score, and lesion clearance rate were collected. Meta-analysis was performed using Stata 18.0 statistical software. When the heterogeneity between groups was small, the fixed-effect model was used for analysis, and when the heterogeneity between groups was large, the random-effect model was used.Results:A total of 17 studies involving 1,865 patients were included in the meta-analysis. Among them, there were 13 Chinese literatures and 4 English literatures, 2 randomized controlled trials and 15 observational studies, all of which were of high quality. The results of meta-analysis showed that the incidence of intraoperative nerve injury in the monitoring group was lower than that in the non-monitoring group [ OR=0.52, 95% CI(0.37, 0.74), P<0.001]. There was no statistically significant difference in preoperative JOA scores between the two groups [ SMD=0.01, 95% CI(0.37, 0.74), P=0.971]. However, the postoperative JOA score in the monitoring-group was higher than the preoperative score, and the difference was statistically significant [ SMD=5.34, 95% CI(0.29, 10.39), P=0.038]. There was no statistically significant difference in JOA scores before and after surgery in the non-monitoring group [ SMD=3.51, 95% CI(-0.56, 7.59), P=0.091]. There was no statistically significant difference in lesion clearance rate between the two groups [ OR=1.17, 95% CI(0.88, 1.57), P=0.281]. Conclusion:The use of IONM in spinal surgery can reduce the incidence of intraoperative nerve injury and improve functional scores.

Objective:To observe the efficacy and safety of intraoperative neurophysiological monitoring (IONM) in spinal surgery.Methods:Clinical studies on the application of IONM in spinal surgery were retrieved from CNKI, VIP, Chinese Medical Journal Full-text Database, PubMed, and Web of Science, with the retrieval time ranging from January 2014 to March 2025. The incidence of intraoperative nerve injury, preoperative and postoperative Japanese Orthopaedic Association (JOA) score, and lesion clearance rate were collected. Meta-analysis was performed using Stata 18.0 statistical software. When the heterogeneity between groups was small, the fixed-effect model was used for analysis, and when the heterogeneity between groups was large, the random-effect model was used.Results:A total of 17 studies involving 1,865 patients were included in the meta-analysis. Among them, there were 13 Chinese literatures and 4 English literatures, 2 randomized controlled trials and 15 observational studies, all of which were of high quality. The results of meta-analysis showed that the incidence of intraoperative nerve injury in the monitoring group was lower than that in the non-monitoring group [ OR=0.52, 95% CI(0.37, 0.74), P<0.001]. There was no statistically significant difference in preoperative JOA scores between the two groups [ SMD=0.01, 95% CI(0.37, 0.74), P=0.971]. However, the postoperative JOA score in the monitoring-group was higher than the preoperative score, and the difference was statistically significant [ SMD=5.34, 95% CI(0.29, 10.39), P=0.038]. There was no statistically significant difference in JOA scores before and after surgery in the non-monitoring group [ SMD=3.51, 95% CI(-0.56, 7.59), P=0.091]. There was no statistically significant difference in lesion clearance rate between the two groups [ OR=1.17, 95% CI(0.88, 1.57), P=0.281]. Conclusion:The use of IONM in spinal surgery can reduce the incidence of intraoperative nerve injury and improve functional scores.

The polyfoliate perforator flap is a new type of flap that was developed on the basis of the traditional polyfoliate myocutaneous flap, polyfoliate fascial flap and perforator flap. It overturns the traditional idea that the deep fascial vascular network is the fundamental for a survival of the flap, and enables the flaps to achieve the best profile and function of the recipient areas with minimal damage to the donor area. In order to improve the understanding of the polyfoliate perforator flap and further standardise its clinical application, this paper forms a consensus on the definition, classification, indications, operative points and precautions of the polyfoliate perforator flap, so as to provide references in diagnosis and treatment process and practical application for the surgeons.

International collaboration in education enables learning from advanced teaching experience and promotes the reform, optimization, and upgrading of medical education and teaching. We analyzed the difficulties and challenges in the education concept, curriculum system, and teaching language mode of infectious diseases under the condition of international cooperation in education in Chongqing Medical University. We tried to upgrade the teaching concepts, optimize the curriculum, and explore teaching language mode in the practice of teaching infectious diseases. We used the methods of deepening cooperation between departments, strengthening the communication between teachers and students, and emphasizing teacher training. We also adopted a variety of teaching methods and flexible teaching modes based on teaching content. With these methods, we explored teaching models of infectious diseases suitable in the context of international cooperation in education.

The polyfoliate perforator flap is a new type of flap that was developed on the basis of the traditional polyfoliate myocutaneous flap, polyfoliate fascial flap and perforator flap. It overturns the traditional idea that the deep fascial vascular network is the fundamental for a survival of the flap, and enables the flaps to achieve the best profile and function of the recipient areas with minimal damage to the donor area. In order to improve the understanding of the polyfoliate perforator flap and further standardise its clinical application, this paper forms a consensus on the definition, classification, indications, operative points and precautions of the polyfoliate perforator flap, so as to provide references in diagnosis and treatment process and practical application for the surgeons.

OBJECTIVE：To investigate the s ynergy between centralized drug volume-based purchasing （called“volume- based purchasing”for short ）and medical insurance negotiation policy. METHODS ：From the aspects of economic and social benefits ， the synergy of volume-based purchasing and medical insurance negotiation was analyzed by using the methods of literature analysis，policy interpretation and interview. The corresponding suggestions were put forward for the problems of the supply and use of drugs. RESULTS & CONCLUSIONS ：The synergy of volume-based purchasing and medical insurance negotiation in terms of economic benefits include medical insurance fund management optimization to improve fund utilization efficiency improvement ； medical insurance fund payment optimization to reduce transaction cost ；network promotion of medical security information platform to reduce the cost of information exchange. The synergy of volume-based purchasing and medical insurance negotiation in terms of social benefits includes relevant index assessment of drug quality evaluation to improve drug quality evaluation system ； medical service level improvement to form compound medical insurance payment mode under total budget management ；enterprise supervision driven by market to reduce the pressure of government supervision. The relevant departments should continue to strengthen the comprehensive management of medical institutions to reduce the phenomenon of irrational drug use ；strengthen policy convergence ，avoid the poor implementation of medical insurance drug adjustment policy ，so that the policy dividend of volume-based purchasing and medical insurance negotiation can benefit the people more through system reform ，optimal allocation of funds ，etc.

Objective To study the clinical effect of total parathyroidectomy (TPTX) on treatment of secondary hyperparathyroidism (SHPT) in patients with chronic renal failure.Methods 24 patients undergoing TPTX in Mianyang Central Hospital from Jan.2014 to Nov.2016 were retrospectively analyzed.The preoperative,postoperative and follow-up intact parathyroid hormone (iPTH),serum calcium,serum phosphorus and calciumphosphorus product were statistically analyzed.The postoperative complications and recurrence were observed.Results For preoperative,1 week after operation,3 months after operation,6 months after operation,12 months after operation,24 months after operation and 36 months after operation,the mean values of iPTH were (1771.7± 244.5) pg/ml,(70.2±18.2) pg/ml,(106.5±35.3) pg/ml,(114.3±31.3) pg/ml,(122.1±27.8) pg/ml,(128.1±12.5) pg/ml and (113.8±24.9) pg/ml.The mean values of serum calcium were (2.6±0.4) mmol/L,(1.9±0.4) mmol/L,(2.1±0.3) mmol/L,(2.1±0.2) mmol/L,(1.8±0.2) mmol/L,(1.8±0.2) mmol/L and (1.8±0.3) mmol/L.The mean values of serum phosphorus were (2.1±0.7) mmol/L,(1.4±0.6) mmol/L,(1.3±0.4) mmol/L,(1.4±0.3) mmol/L,(1.3±0.3) mmol/L,(1.5±0.2) mmol/L and (1.4±0.4) mmol/L.The mean values of calcium-phosphorus product were (61.9±17.0) mg2/dl2,(34.6±19.4) mg2/dl2,(37.4±14.4) mg2/dl2,(40.4±12.3) mg2/dl2,(29.2±5.3) mg2/dl2,(35.0 ±7.1) mg2/dl2 and (32.4 ± 11.3) mg2/dl2,respectively.Compared with those before operation,postoperative iPTH,serum calcium,serum phosphorus and calcium-phosphorus product decreased significantly at 1 week after operation,3 months after operation,6 months after operation,12 months after operation,24 months after operation and 36 months after operation,and the differences had statistical significance (all P＜0.05).Temporary injury of recurrent laryngeal nerve was found in one patient (4.2％).Early postoperative hypocalcemia rate was 91.7％ (22/24).No recurrence developed after operation.Conclusion TPTX is safe and effective in treatment of SHPT in patients with chronic renal failure,with low recurrence rate and satisfactory treatment outcome.

Objective: To investigate the clinical effect and safety of entecavir capsules in the treatment of treatment-naïve HBeAg-positive patients with chronic hepatitis B (CHB). Methods: A total of 158 HBeAg-positive CHB patients were given oral entecavir capsules at a dose of 0.5 mg/time once a day for 144 weeks. Clinical outcome and safety were evaluated at baseline and at 24, 48, 72, 96, 120, and 144 weeks of treatment respectively. The Fisher’s exact test was used for the analysis of categorical data. Results: After 144 weeks of treatment, 90.91% of all patients achieved virologic response (< 69 IU/ml), the normalization rate of alanine aminotransferase was 88.18%, the clearance rate of HBeAg was 33.33%, and the seroconversion rate of HBeAg was 24.07%. Of all patients, 2 dropped out due to adverse events and 5 experienced serious adverse reactions. Conclusion Entecavir capsules can inhibit viral replication and have good safety in treatment-naïve HBeAg-positive CHB patients.

Objective To evaluate the safety and short‐term efficacy of delta‐shaped anastomosis in the Billroth‐I reconstruc‐tion of totally laparoscopic distal gastric cancer radical operation (TLDG) .Methods The clinical data in 35 patients with TLDG Delta anastomosis(TLDG group) and 35 patients with laparoscopic assisted distal gastric cancer radical operation (LADG) extraper‐itoneal anastomosis (LADG group) in the gastroenterology department of our hospital from January to December 2014 were ana‐lyzed retrospectively .The intraoperative bleeding volume ,operative time ,gastroenterological function recovery time ,hospitalization duration ,postoperative pathological examination results and hospitalization total cost were compared between the two groups .Re‐sults Seventy cases successfully completed the operation without the cases of conversion to laparotomy and death .The TLDG group had no anastomotic leakage ,bleeding and stenosis after operation ;while the LADG group had 1 case of gastroparesis ,1 case of anastomotic bleeding and 2 cases of anastomotic leakage .The introperative bleeding volume ,tumor size ,number of lymph nodes dissection and distant and proximal incisal margin distance had no statistically significant differences between the two groups (P>0 .05);the operation time ,digestive tract reconstruction time ,first exhaustion time ,time taking liquid diet and postoperative hospital stay time in the TLDG group were significantly shorter than those in LADG group (P< 0 .05) ,but the hospitalization cost was higher than that in the LADG group ,the differences were statistically significant (P<0 .05) .Conclusion The delta‐shaped anasto‐mosis technique is safe and feasible for using in LADG ,moreover has better short‐term effect .

Objective To build a multi‐level hierarchical structure model of the influencing factors for hierarchical medical system ,to identify the role relationship between all the factors and transmission pathways ,and to recommend on developing China′s hierarchical medical system . Methods Thirty influencing factors were identified in a screening based on literature review for the hierarchical medical system .On such basis ,16 influencing factors were identified by three health policy experts ,which affect operations of the current system .Interpretative structural modeling was called into play in the end to analyze the hierarchy relationship between various influencing factors and the conduction loops .Results There exist among the 16 factors a 3‐level hierarchical structureand two conduction loops .The factor directly limiting the hierarchical medical system is two‐way referral,and most internal core drivers arehuman resources development and governance mechanism.By means of self‐growth and external constraints ,they exert their influence on the operation of hierarchical medical system .Conclusions There are interactive hierarchical effects among the factors ,merging into three node elements of functional role,inter‐entity relationshipand patient participation.