Objectives:To analyze the clinical application effect of the preloaded snare technique in patients with risk of atrial septal occluder migration during percutaneous atrial septal defect(ASD)occlusion.Methods:The clinical data of 24 patients with secundum ASD who underwent preloaded snare-assisted transcatheter closure in Fuwai Central China Cardiovascular Hospital between December 2022 and August 2024 were retrospectively analyzed.The preprocedural echocardiography revealed that all patients presented with large secundum ASD or insufficient margins,indicating potential risk of device migration during percutaneous ASD occlusion.Consequently,preloaded snare technique was applied for ASD closure.Postprocedural evaluations were conducted to assess device stability(migration or shedding),residual shunt,pericardial effusion,and new-onset arrhythmia during the procedure,immediately after intervention,and at 1-month follow-up.Results:Among 24 patients,there were 4 males,with an average age of(37.88±13.18)years and an average weight of(59.70±10.78)kg.Twenty-two cases underwent successful interventional closure.Two cases occurred atrial septal occluder migration during the procedure,both were successfully retrieved using the preloaded snare and subsequently scheduled for surgical repair.Postprocedural electrocardiograms and echocardiograms(obtained immediately and at 1-month follow-up)demonstrated no device migration,residual shunt,occluder dislodgement,pericardial effusion,or new-onset arrhythmias.Conclusions:The preloaded snare technique can reduce the risk of atrial septal occluder migration and shedding,simplify the process of retrieving the occluder,enhance the safety of the intervention,and avoid emergency surgical intervention in high-risk populations.

Objective To identify the key points of forensic appraisal in ophthalmic medical-injury compensation cases and propose targeted measures to prevent disputes.Methods A retrospective analysis was conducted of the appraisal conclusions from 15 ophthalmology medical-injury liability lawsuits handled at a single tertiary hospital over the past five years.We summarized the constitutive characteristics of liability cases,causes of medical injury,and issues encountered during appraisal.Results Among cases undergoing medical-injury liability appraisal,retinal diseases and ocular tumors predominated.The main issues included inadequate informed consent,failure to exercise due care during surgery/treatment,non-standard medical record documentation,insufficient attention to medical risks,and inadequate clinical assessment.Conclusions By summarizing common faults in ophthalmic disputes and problems revealed by forensic appraisal,targeted responses can be implemented to ensure patient safety and promote high-quality medical services.

Objectives:To analyze the clinical application effect of the preloaded snare technique in patients with risk of atrial septal occluder migration during percutaneous atrial septal defect(ASD)occlusion.Methods:The clinical data of 24 patients with secundum ASD who underwent preloaded snare-assisted transcatheter closure in Fuwai Central China Cardiovascular Hospital between December 2022 and August 2024 were retrospectively analyzed.The preprocedural echocardiography revealed that all patients presented with large secundum ASD or insufficient margins,indicating potential risk of device migration during percutaneous ASD occlusion.Consequently,preloaded snare technique was applied for ASD closure.Postprocedural evaluations were conducted to assess device stability(migration or shedding),residual shunt,pericardial effusion,and new-onset arrhythmia during the procedure,immediately after intervention,and at 1-month follow-up.Results:Among 24 patients,there were 4 males,with an average age of(37.88±13.18)years and an average weight of(59.70±10.78)kg.Twenty-two cases underwent successful interventional closure.Two cases occurred atrial septal occluder migration during the procedure,both were successfully retrieved using the preloaded snare and subsequently scheduled for surgical repair.Postprocedural electrocardiograms and echocardiograms(obtained immediately and at 1-month follow-up)demonstrated no device migration,residual shunt,occluder dislodgement,pericardial effusion,or new-onset arrhythmias.Conclusions:The preloaded snare technique can reduce the risk of atrial septal occluder migration and shedding,simplify the process of retrieving the occluder,enhance the safety of the intervention,and avoid emergency surgical intervention in high-risk populations.

Objective To identify the key points of forensic appraisal in ophthalmic medical-injury compensation cases and propose targeted measures to prevent disputes.Methods A retrospective analysis was conducted of the appraisal conclusions from 15 ophthalmology medical-injury liability lawsuits handled at a single tertiary hospital over the past five years.We summarized the constitutive characteristics of liability cases,causes of medical injury,and issues encountered during appraisal.Results Among cases undergoing medical-injury liability appraisal,retinal diseases and ocular tumors predominated.The main issues included inadequate informed consent,failure to exercise due care during surgery/treatment,non-standard medical record documentation,insufficient attention to medical risks,and inadequate clinical assessment.Conclusions By summarizing common faults in ophthalmic disputes and problems revealed by forensic appraisal,targeted responses can be implemented to ensure patient safety and promote high-quality medical services.

Objective To deeply analyze the problems of public hospitals in medical service satisfaction,construct a more applicable and explanatory service satisfaction evaluation model,and provide reference for the improvement path of patients'medical service satisfaction.Methods Based on the ESCI model,this paper puts forward a research hypothesis,compiles the"Medical Service Satisfaction Evaluation Scale of Public Hospitals in S City",selects S public hospitals as the research object,and evaluates medical service satisfaction from the perspective of patients.Results At present,the main problems affecting the improvement of patients'satisfaction with medical service management in public hospitals in S city are as follows:it is urgent to improve the diagnosis and treatment technology in terms of hardware quality and optimize the environmental hygiene of public hos-pitals,and it is an urgent task to shorten the waiting time for medical treatment in software quality.The score of medical service satisfaction evaluation of S public hospitals was 3.76,and the satisfaction of patients in S public hospitals with their medical serv-ices was at a moderately low level.Conclusion In view of the above problems,it is recommended to strengthen the construction of key specialties,strengthen the construction of talent team,optimize the medical process,open digital linkage services,and strengthen service management,so as to promote the improvement of patients'satisfaction with medical services.

Objective To compare the detection rate of right hemicolonic polyp between indigo carmine staining and white light endoscopy.Methods A total of 1052 patients with colonoscopic examination in Qing-baijiang District People's Hospital of Chengdu City from July 2022 to March 2023 were selected as the study subjects and divided into the indigo carmine staining group and white light endoscopy group,526 cases in each group.The right hemicolon was observed by indigo carmine staining and white light pattern respectively.The difference in the detection rate of right hemicolonic polyp was compared between the two detection methods. Results Compared with the white light endoscopic examination group,the detection rate of the right hemico-lonic polyp (41.6％),detection rate of the right hemicolon adenoma (20.9％),detection rate of wide basal ser-rated lesion (2.1％),detection rate of proliferative polyps (20.3％),detection rate of Paris type 0-Ⅱ (38.0％),detection rate of NICE 1 type (pale lesion,22.2％),detection rate of polyps with a diameter<5 mm (30.5％) and the consistency rate of pathological biopsy (86.4％),specificity (84.7％) and sensitivity (88.2％) in the indigo carmine staining group were higher,and the differences were statistically significant (P<0.05).There was no statistical difference in the duration of mirror withdrawal between the white light endoscopy group and the indigo carmine staining group (t=1.407,P=0.160).Conclusion The endoscopic examination with indigo carmine staining has a higher detection rate for right hemicolonic polyp,and is easier to detect micropolyps and flat polyps with pale color.

Objective:To explore an applicative value of a 5-type precise diagnostic technique in integrated precise repair and reconstruction of digit-tip injuries.Methods:From March 2012 to June 2022, 45 digit-tip injuries (38 patients, with an average age of 33 years old) were classified under microscope on the basis of effectiveness of blood vessels remained in the severed tissue. Among the injured digits, there were 15 thumbs, 9 index fingers, 16 middle fingers, 4 ring fingers and 1 little finger. The diagnosis was categorised into 5 types according to involvement of blood vessels: Type I, injury of proper palmar digital artery (10 digits) ; Type II, injury of small artery (5 digits) ; Type Ⅲ, injury of whole vein (4 digits) ; Type IV, injury of superficial palmar arch (4 digits) ; and Type V, vessels missing (22 digits). The timing and therapeutic method of surgery were selected based on the precise classification of 5 types of diagnosis: (1) For type Ⅰ-Ⅳ injuries, 16 patients (23 digits) received in situ tissue replantation after emergency classification. Of which, type Ⅰ-Ⅱ injuries received conventional replantation, type Ⅲ injuries had replantation with arterialised vein, and type IV injuries received replantation with artery-vein shunt. (2) For the type V injuries, 22 patients (22 digits), staged and categorised flap reconstruction with toe flaps were performed. Of which, 7 were performed in emergency surgery, 12 in subemergency surgery and 3 in elective surgery. Based on the severity of defects, small tissue flaps of toe were used in reconstruction of type V injuries and following toe flaps were employed: 9 hallux nail flaps, 3 hallux nail flaps (for reconstruction of distal phalanx), 5 hallux fibular flaps, 3 hallux abdominal flaps and 2 compound tissue flaps with nail bed of the second toe. The sizes of the 45 replanted/transferred tissues flaps were 1.0 cm×0.6 cm×0.4 cm-2.2 cm×1.5 cm×0.8 cm. Donor sites directly sutured. Medical APP was applied in the rehabilitation exercises. Functions of digits were assessed by scheduled follow-ups at outpatient clinic and via remote medical APP to evaluate the clinical efficacy.Results:All small tissue blocks and (or) tissue flaps survived after replantation and (or) flap reconstruction of 45 injured digits. Postoperative follow-up lasted for 6 months to 7 years, with 36 months in average. The appearances of the reconstructed digit-tips were close to normal digits, with TPD at 3-7 mm. According to the Michigan Hand Outcomes Questionnaire (MHQ), 32 patients (37 digits) were in excellent, 5 patients (7 digits) in good, and 1 patient (1 digit) in poor, with 97.78% of excellent and good rate.Conclusion:Five-type precise diagnostic technique is the key to the integrated and precise reconstruction of digit-tip injuries. This method has been clinically validated and achieved realistic recovery from the injured digits.

Objective:To analyze the application effect of condition scale in nursing management of children bronchial asthma in acute attack stage.Methods:A total of 136 children with acute attack of bronchial asthma admitted to Shanxi Children's Hospital from January 2020 to December 2021 were selected by convenience sampling method, and randomly divided into observation group and control group according to random number table method, 68 cases in each group. Children in the observation group received graded nursing intervention based on disease scale, while children in the control group received routine nursing intervention. The first second forced expiratory volume (FEV 1), forced vital capacity (FVC), ratio of FEV l/FVC, peak expiratory flow rate (PEF), medical intervention frequency, the number of ICU transfer and length of stay were compared between the two groups. Results:The results of repeated measurement ANOVA showed that there were intergroup, time and interaction effects on the levels of FEV 1, FVC, FEV 1/FVC and PEF in the two groups, and the differences were statistically significant ( P<0.05). The frequency of medical intervention in observation group was less than that in control group, and the length of hospitalization was shorter, with statistical significance ( P<0.05). There was no significant difference in ICU patients transferred between the two groups ( P>0.05) . Conclusions:Application of Condition Scale in nursing management of children with acute attack of bronchial asthma can improve the lung function of children with acute attack bronchial asthma more effectively, reduce the frequency of medical intervention, shorten the length of hospital stay, and significantly improve the nursing effect.

Objective:To construct a color assessment tool for continuous bladder irrigation (CBI) drainage fluid and to explore its clinical value.Methods:The color assessment tool for CBI drainage fluid (tentative version) was constructed through literature review, expert meetings and practical development, and its consistency was tested and the tool was improved to form a color assessment tool for CBI drainage fluid. Convenience sampling was used to select patients with benign prostatic hyperplasia who underwent transurethral resection of the prostate (TURP) in the First Affiliated Hospital of Soochow University from April to May 2020. According to the assessment method of the tool, the patient's drainage fluid color was evaluated and recorded.Results:The color assessment tool for CBI drainage fluid included 6 color scales, and the corresponding Pantone color card codes were 503C, 3519C, 701C, 702C, 710C, 1807C respectively, and the blood concentration was 0.125%, 0.5%, 1.0%, 2.0%, 4.0% and 8.0% respectively. The tool was used to evaluate the drainage fluid color in 29 patients after TURP. Each evaluation took (5.12±2.41) s; when the color scale was greater than number two, complications such as the bladder spasm and blood clot blockage occurred.Conclusions:The construction method of color assessment tool for CBI drainage fluid is scientific and reliable, which can provide a basis for evaluating the CBI drainage fluid color, and can assist medical and nursing staff to quickly evaluate the drainage fluid color and find abnormal color scales.