Objective To analyze the medical malpractice technical appraisals accepted by a health administration department,and to provide suggestions for the work improvement of the health administration department and its affiliated medical institutions.Methods A total of 57 cases of technical appraisals for medical malpractice accepted from 2015 to 2023 were analyzed retrospectively.Yi fa hui's reasons for the failure of medical institutions were taken as the main classification basis of the medical fault.Results There were 51 cases of the first appraisal and 6 cases of the second appraisal.Among them,38 cases were completed,and the completion rate was 66.67%,involving 15 departments;17 cases were deemed medical accidents.The most frequent category was Grade 1 medical malpractice with minor liability borne by the healthcare provider,involving 8 types of faults.Conclusion The majority of appraisals accepted by a health administration department is the first appraisal,and the completion rate of appraisal needs to be improved.It is suggested that the health administration department should do well in the explanation and communication in the process of medical malpractice technical appraisal,and medical institutions should strengthen their supervision responsibility for clinical work.

Objective To explore the risk factors for portal vein thrombosis(PVT)in patients with cirrhosis in the decompensated stage and construct a risk prediction model for PVT so as to improve the early diagnosis rate of decompensated liver cirrhosis PVT.Methods The clinical data of patients with cirrhosis in the decompensated stage admitted to Department of Gastroenterology,The First Affiliated Hospital of Xi'an Jiaotong University between June 2018 and June 2023 were collected and divided into cirrhosis PVT group(n=135)and cirrhosis non-PVT group(n=225)according to whether or not portal vein thrombosis was formed.We made a univariate analysis of the general data,laboratory indexes,liver function scores and imaging findings of the patients in the two groups,and indexes with statistically significant differences were included in binary Logistic regression for multifactorial analysis to screen out independent risk factors.A predictive model of binary Logistic regression was established based on the independent risk factors.The clinical data of the validation set were incorporated into the model,the accuracy of the prediction model was evaluated by receiver operating curve(ROC),and the practicability of the model was evaluated by consistency curve to complete the validation and evaluation of the constructed prediction model.Internal stability of the model was verified with Bootstrap method.Finally,R software(4.3.1)was used to draw a nomogram of the prediction model to visualize the model.Results Univariate analysis revealed statistically significant differences between patients in the PVT and non-PVT groups in the following five aspects:history of splenectomy,history of endoscopic varicose vein treatment,portal vein diameter,and neutrophil-to-lymphocyte ratio(P＜0.05).Binary Logistics regression analysis showed that a history of splenectomy(P=0.002,OR=3.012,95％CI:1.500-6.047),a history of endoscopic varicose vein treatment(P=0.001,OR=2.276,95％CI:1.400-3.698),widening of portal vein diameter(P=0.007,OR=1.942,95％CI:1.202-3.136),increased neutrophil-to-lymphocyte ratio(P=0.009,OR=1.886,95％CI:1.170-3.041),and elevated D-dimer(P＜0.001,OR=3.725,95％CI:2.149-6.485)were independent risk factors for the formation of portal vein thrombosis in patients with cirrhosis in the decompensated stage of cirrhosis chemically presented(P＜0.05).The area under the ROC curve of the predictive model and the model after internal validation was 0.760 and 0.7494,respectively.The model still had good prediction ability and accuracy in the verification set.Conclusion A history of splenectomy,history of endoscopic varicose vein treatment,widening of portal vein diameter,increased neutrophil-to-lymphocyte ratio,and elevated D-dimer concentration are independent risk factors for the formation of portal vein thrombosis in patients with decompensated cirrhosis.The Logistic prediction model and visual nomogram constructed based on the above independent risk factors have a good ability to predict the occurrence of PVT in patients with decompensated cirrhosis and have important clinical guiding significance for early screening patients with PVT in decompensated cirrhosis.

Objective To explore the risk factors for portal vein thrombosis(PVT)in patients with cirrhosis in the decompensated stage and construct a risk prediction model for PVT so as to improve the early diagnosis rate of decompensated liver cirrhosis PVT.Methods The clinical data of patients with cirrhosis in the decompensated stage admitted to Department of Gastroenterology,The First Affiliated Hospital of Xi'an Jiaotong University between June 2018 and June 2023 were collected and divided into cirrhosis PVT group(n=135)and cirrhosis non-PVT group(n=225)according to whether or not portal vein thrombosis was formed.We made a univariate analysis of the general data,laboratory indexes,liver function scores and imaging findings of the patients in the two groups,and indexes with statistically significant differences were included in binary Logistic regression for multifactorial analysis to screen out independent risk factors.A predictive model of binary Logistic regression was established based on the independent risk factors.The clinical data of the validation set were incorporated into the model,the accuracy of the prediction model was evaluated by receiver operating curve(ROC),and the practicability of the model was evaluated by consistency curve to complete the validation and evaluation of the constructed prediction model.Internal stability of the model was verified with Bootstrap method.Finally,R software(4.3.1)was used to draw a nomogram of the prediction model to visualize the model.Results Univariate analysis revealed statistically significant differences between patients in the PVT and non-PVT groups in the following five aspects:history of splenectomy,history of endoscopic varicose vein treatment,portal vein diameter,and neutrophil-to-lymphocyte ratio(P＜0.05).Binary Logistics regression analysis showed that a history of splenectomy(P=0.002,OR=3.012,95％CI:1.500-6.047),a history of endoscopic varicose vein treatment(P=0.001,OR=2.276,95％CI:1.400-3.698),widening of portal vein diameter(P=0.007,OR=1.942,95％CI:1.202-3.136),increased neutrophil-to-lymphocyte ratio(P=0.009,OR=1.886,95％CI:1.170-3.041),and elevated D-dimer(P＜0.001,OR=3.725,95％CI:2.149-6.485)were independent risk factors for the formation of portal vein thrombosis in patients with cirrhosis in the decompensated stage of cirrhosis chemically presented(P＜0.05).The area under the ROC curve of the predictive model and the model after internal validation was 0.760 and 0.7494,respectively.The model still had good prediction ability and accuracy in the verification set.Conclusion A history of splenectomy,history of endoscopic varicose vein treatment,widening of portal vein diameter,increased neutrophil-to-lymphocyte ratio,and elevated D-dimer concentration are independent risk factors for the formation of portal vein thrombosis in patients with decompensated cirrhosis.The Logistic prediction model and visual nomogram constructed based on the above independent risk factors have a good ability to predict the occurrence of PVT in patients with decompensated cirrhosis and have important clinical guiding significance for early screening patients with PVT in decompensated cirrhosis.

Performance appraisal of public hospitals have given a guidance for the development of public hospitals at all levels.A Class A tertiary hospital reviewed the problems in the development of the hospital at the present stage and focused on the following four aspects:①insufficient fine management;②No clear orientation of discipline development;③The bottleneck of the improvement of medical operation efficiency;④New challenges in the reform of payment mode.The tertiary hospital launched a fine management practice in May 2022,in order to solve the problems by taking the Department of Surgery as a pilot area,laying the foundation for fine management through information system construction,improving the efficiency of medical operation through management process optimization,improving the overall competitiveness of disciplines through the construction of sub-specialty and Discipline Alliance and adjusting the performance appraisal index system to play the role of performance incentives.The measures effectively improve the overall capacity and efficiency of hospital medical services and help the hospital to achieve high-quality development.

Objective To explore the quality of outpatient medical records of 5 military hospitals from 2021 to 2022,so as to improve the writing quality of outpatient medical records.Methods A total of 358 outpatient medical records of 5 military hospitals from 2021 to 2022 were sampled and evaluated based on the supervision standards of outpatient medical records of the corresponding hospitals.The reliability coefficient of the standard was 0.417,KMO value was 0.6,and the significance of Bartlett's sphericity test was less than 0.05.Results The qualified rate of 358 outpatient records of 5 military hospitals from 2021 to 2022 was 81.56％.The qualified rate of outpatient records was 94.12％in the departments of medical specialties,which was significantly higher than that of the departments of surgery and internal medicine(84.35％,74.86％,P<0.05).The defect items of medical records were mainly past history,current medical history,treatment and auxiliary examination.The defect rates of past history and physician signature in outpatient medical records of level Ⅱ hospitals were 33.56％and 8.90％,respectively,which were significantly higher than those of level Ⅲ hospitals(19.81％,3.77％,P<0.05).The defect rates of auxiliary examination and physical examination in outpatient medical records of level Ⅲ hospitals were16.51％and 14.62％,respectively,which were significantly higher than those of level Ⅱ hospitals(8.22％,6.16％,P<0.05).The defect rates of past history and general items in outpatient records of the department of surgery were 37.39％and 16.52％,respectively,which were significantly higher than those of other departments(P<0.05).The defect rates of current medical history,chief complaint and auxiliary examination in outpatient records of the departments of medical specialties were 36.76％,23.53％,and 25.00％,respectively,which were significantly higher than those of other departments(P<0.05).The defect rates of physical examination and diagnosis in outpatient records of the department of internal medicine were 14.86％and 12.00％,which were significantly higher than those of other departments(P<0.05).Conclusion The overall quality of outpatient medical records is good in 5 military hospitals from 2021 to 2022,but there are some writing defects.It is essential to strengthen the writing training and quality control of outpatient medical records,so as to continuously deepen the quality management of outpatient medical records.

Osteoarthritis （OA）， rheumatoid arthritis （RA）， gouty arthritis （GA）， and intervertebral disc degeneration （IVDD） are the most common bone and joint-related diseases in clinical practice. They can all affect related joints， leading to joint pain， swelling， dysfunction， and other symptoms. The difference is that OA is mainly caused by joint wear and age-related degradation and is manifested as joint pain， stiffness， and limited movement. RA is an autoimmune disease， manifested as joint pain， swelling， morning stiffness， and systemic symptoms. GA is caused by abnormal uric acid metabolism， manifested as acute arthritis， and IVDD is caused by intervertebral disc degeneration. Studies have shown that the mechanism of the occurrence and development of these bone and joint diseases is extremely complex. Pyroptosis is closely related to these bone and joint-related diseases by participating in bone and joint inflammation， cartilage metabolism imbalance， extracellular matrix degradation， and pathological damage of bone and joint. Inhibition of bone and joint-related pyroptosis will effectively prevent and treat bone and joint-related diseases. At the same time， many studies have confirmed that traditional Chinese medicine （TCM） has a prominent curative effect and obvious advantages in the prevention and treatment of bone and joint-related diseases. TCM can reduce the inflammatory reaction of bone and joints， improve the pathological damage of bone and joint diseases， and relieve bone and joint pain by inhibiting pyroptosis. Therefore， this article aims to briefly explain the relationship between pyroptosis and the occurrence and development of bone and joint-related diseases and summarize the latest research reports on the intervention of pyroptosis in the treatment of bone and joint-related diseases by TCM monomers， TCM extracts， and TCM compounds. It offers new ideas for the in-depth study of the pathogenesis and drug treatment of bone and joint diseases and provides a basis for the clinical use of TCM to prevent and treat bone and joint diseases.

Purpose/Significance To investigate and analyze the current status and influencing factors of digital health literacy(DHL)of the elderly,and to provide references for relevant departments.Method/Process The eHEALS scale is used to investigate the DHL status of 419 elderly people aged 60 and above in Shanghai through convenience sampling,and the influencing factors are explored through binary logistic regression analysis.Result/Conclusion Low education,smoking,and health anxiety are risk factors,while regular physical exami-nation is protective factor.Relevant departments should focus on the elderly people with lower education,and strengthen research and edu-cation on health examinations,smoking hazards,and the alleviation of anxiety.

Objective:To explore the feasibility and preliminary effectiveness of case-based learning (CBL) teaching based on network resources in standardized residency training for nuclear medicine.Methods:Open network resources of CBL curriculum (13 sessions in total) were used to perform the collective teaching of 21 residents who received training in our professional base, with a total of 61 person-times. The residents received the test on objective questions before class, immediately after class, and at 1 week after class (7-10 days) to assess the learning effect of residents at these time points, and an evaluation form of teaching effectiveness was used after each class to assess the teaching effect. SPSS 23.0 was used to perform a one-way analysis of variance.Results:As for the test score of objective questions, there were 61 valid scores before class, 61 valid scores immediately after class, and 51 valid scores at 1 week after class (7-10 days), with a mean score of (49.43±13.37), (84.43±14.44), and (80.88±10.04), respectively (with 100 points as the total score), which showed a significant difference ( F=105.80, P<0.01). As for the evaluation of teaching effectiveness, a total of 61 valid forms were received, and the results of "very satisfied, satisfied, fairly good, and dissatisfied" accounted for 34.4% (21/61), 52.5% (32/61), 9.84% (6/61), and 3.28% (2/61), respectively, with an overall satisfaction rate (very satisfied+satisfied) of 86.9% (53/61). Conclusion:It is feasible and effective to make full use of network resources to carry out CBL teaching in standardized residency training for nuclear medicine, which has achieved a good preliminary effect.

【Objective】 To study the effects of different storage temperature and different storage time on the activity of key growth factors in platelet-rich plasma(PRP), and to provide a theoretical basis for maximize the role of PRP in clinical treatment. 【Methods】 PRP was collected by blood cell isolation and apheresis, stored at 22℃ and -80℃, respectively. VEGF, TGF-β and PDGF were detected by ELISA. The content of growth factors in PRP was detected when stored at 22℃for 1, 3 and 5 days, and the growth factors content of PRP stored at 22℃ for 3 days was detected after thrombin activation for 0.5, 1 and 1.5 hours. The content of growth factor in frozen PRP (stored at -80℃ for 30 days after initial 3-days storage at 22℃ ) and fresh PRP (stored at 22℃ for 3 days) was compared. The growth factor content in PRP frozen at - 80℃ for 30, 60 and 180 days, and the growth factor content in PRP frozen at -80℃ for 180 days after repeated freeze-thaw for 1, 2, 3, 5 and 10 times were detected. 【Results】 The growth factor content of apheresis PRP was significantly higher than that of platelet-poor plasma. No statistical difference was noticed in VEGF, TGF-β and PDGF content in PRP at 1, 3 and 5 days stored at 22℃; no statistical difference was noticed in VEGF, TGF-β and PDGF content in PRP stored at 22℃ for 3 days after thrombin activation for 0.5, 1 and 1.5 hours. There was no statistically significant difference in growth factor content between PRP stored at 22℃ for 3 days versus frozen at -80℃ for 30 days after initial 3-days storage at 22℃. No statistical difference was found in VEGF, TGF-β and PDGF contents in frozen PRP repeatedly frozen and thawed for 1 to 10 times. 【Conclusion】 Apheresis PRP can release a large amount of growth factors after activation. Fresh PRP stored at 22℃ for 5 days or frozen at -80℃ for 180 days has no impact on the content of growth factors, and frozen PRP at -80℃ can achieve long-term, effective and safe preservation, which is conducive to multiple use of PRP in treatment.

Objective:To assess the value of S-Detect and contrast-enhanced ultrasound (CEUS) in the differential diagnosis of Breast Imaging Reporting and Data System(BI-RADS) 4 breast lesions.Methods:A total of 104 breast lesions in 100 patients diagnosed as BI-RADS category 4 by conventional ultrasound were prospectively enrolled, and all of them were received S-Detect and CEUS examination at the same time. Taking pathology as the gold standard, ROC curve was constructed to compare the diagnostic efficacy of conventional ultrasound, S-Detect, CEUS and their combination.Results:Among the 104 BI-RADS category 4 breast lesions, 63 were benign and 41 were malignant. The sensitivities of conventional ultrasound, S-Detect, CEUS and S-Detect combined with CEUS were 73.17%, 87.80%, 87.80%, 90.24%; the specificities were 57.14%, 60.32%, 68.25%, 77.78%; the positive predictive values were 52.63%, 59.02%, 64.29% and 72.55%; the negative predictive values were 76.60%, 88.37%, 89.59% and 92.45%; the accuracies were 63.46%, 71.15%, 75.96% and 82.69%; and the areas under the ROC curve (AUC) were 0.652, 0.741, 0.780 and 0.840. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of S-Detect and CEUS diagnosis were improved compared with conventional ultrasound. The AUC of combined diagnosis was higher than that of S-Detect, CEUS alone, and the differences were statistically significant(all P<0.05). The AUC of CEUS was higher than that of conventional ultrasound, and the difference was statistically significant ( P<0.05). There were no significant differences in AUC between any two of other groups (all P>0.05). Conclusions:The combined application of S-Detect and CEUS could achieve complementary advantages, which is of great significance for the differential diagnosis of benign and malignant in BI-RADS 4 breast lesions.