OBJECTIVE To explore the application of digital twin technology in modeling and simulating the hospi-tal-associated transmission pathways of multidrug-resistant organisms(MDROs)and propose MDRO transmis-sion prevention and control strategies based on digital twins.METHODS Real-time hospital data and person-nel mobility information from Jun.2023 to Jun.2024 were collected and analyzed.A dynamic model of the hospi-tal's internal environment and MDROs transmission was established by digital modeling and 3D simulation tech-nology of the hospital environment.A simulation platform was utilized to analyze the impact of different preven-tion and control measures on MDROs transmission risks.Digital twin technology was employed for predicting and real-time monitoring of organism transmission pathways.RESULTS Simulation data showed that under initial pre-vention and control conditions,Ward A had 8 infected individuals and a transmission duration of 12 days.Af-ter implementing comprehensive measures of"increased cleaning frequency+enhanced personnel protection",the number of infected individuals reduced to 4,the transmission duration shortened to 6 days and the transmis-sion risk reduction rate reached 45.00％.The digital twin model can effectively reflect the transmission patterns of MDROs within the hospital and provide quantitative risk assessments under different prevention and control strat-egies.CONCLUSIONS Digital twin technology can predict and simulate organism transmission pathways in real-time,providing scientific decision-making support for hospitals.It has the potential to become a new paradigm for MDROs prevention and control.

Objective:To investigate the clinical efficacy of perforator-based bilobed flaps in the treatment of stage 4 pressure ulcers.Methods:This retrospective observational study included 29 patients (21 males, 8 females) with stage 4 pressure ulcers admitted to the Department of Burn and Plastic Surgery and Wound Repair at Xuzhou First People's Hospital from August 2021 to May 2023. The patients' ages ranged from 12 to 82 (61.3±15.7) years. For ischial tuberosity pressure ulcers, reconstruction was performed using a posterior femoral bilobed flap based on the first perforator of the deep femoral artery, combined with a small gluteus maximus muscle flap. Sacrococcygeal pressure ulcers were repaired using a bilobed flap based on the superior or inferior gluteal artery perforator. Post-operative follow-up lasted for 2-36 months, during which flap survival and complications were assessed.Results:All the 29 bilobed flaps were successfully rotated and provided for adequate coverage without the need for pedicle division or perforator vessel dissection. Primary healing was achieved in 26 cases, with suture removal occurring two weeks post-operatively. Three patients experienced partial wound dehiscence and marginal necrosis due to post-operative pressure, which healed after two weeks of debridement and dressing changes. During follow-up for 2-36 months, no pressure ulcer recurrence was observed. The flaps demonstrated excellent survival, with soft texture, good elasticity, and adequate blood supply. The donor sites healed with only linear scars, and no severe complications were reported.Conclusion:Bilobed flaps based on artery perforators demonstrate excellent clinical outcomes in the treatment of stage 4 pressure ulcers.

The application of research-oriented thinking to audit work represents a new-era requirement for audit practices.Research-based audit enhances audit effectiveness and strengthens oversight outcomes.Based on the characteristics of public hospitals,it expounds the connotation of research-based internal audit of public hospitals based on audit elements,and proposes three research-based internal audit models of public hospitals:policy-centered,project-centered,and fund-centered approaches.The characteristics and applicable conditions of the three modes are analyzed to provide references for public hospitals to conduct internal audits under the goal of achieving high-quality development.

The application of research-oriented thinking to audit work represents a new-era requirement for audit practices.Research-based audit enhances audit effectiveness and strengthens oversight outcomes.Based on the characteristics of public hospitals,it expounds the connotation of research-based internal audit of public hospitals based on audit elements,and proposes three research-based internal audit models of public hospitals:policy-centered,project-centered,and fund-centered approaches.The characteristics and applicable conditions of the three modes are analyzed to provide references for public hospitals to conduct internal audits under the goal of achieving high-quality development.

OBJECTIVE To explore the application of digital twin technology in modeling and simulating the hospi-tal-associated transmission pathways of multidrug-resistant organisms(MDROs)and propose MDRO transmis-sion prevention and control strategies based on digital twins.METHODS Real-time hospital data and person-nel mobility information from Jun.2023 to Jun.2024 were collected and analyzed.A dynamic model of the hospi-tal's internal environment and MDROs transmission was established by digital modeling and 3D simulation tech-nology of the hospital environment.A simulation platform was utilized to analyze the impact of different preven-tion and control measures on MDROs transmission risks.Digital twin technology was employed for predicting and real-time monitoring of organism transmission pathways.RESULTS Simulation data showed that under initial pre-vention and control conditions,Ward A had 8 infected individuals and a transmission duration of 12 days.Af-ter implementing comprehensive measures of"increased cleaning frequency+enhanced personnel protection",the number of infected individuals reduced to 4,the transmission duration shortened to 6 days and the transmis-sion risk reduction rate reached 45.00％.The digital twin model can effectively reflect the transmission patterns of MDROs within the hospital and provide quantitative risk assessments under different prevention and control strat-egies.CONCLUSIONS Digital twin technology can predict and simulate organism transmission pathways in real-time,providing scientific decision-making support for hospitals.It has the potential to become a new paradigm for MDROs prevention and control.

Objective:To investigate the clinical efficacy of perforator-based bilobed flaps in the treatment of stage 4 pressure ulcers.Methods:This retrospective observational study included 29 patients (21 males, 8 females) with stage 4 pressure ulcers admitted to the Department of Burn and Plastic Surgery and Wound Repair at Xuzhou First People's Hospital from August 2021 to May 2023. The patients' ages ranged from 12 to 82 (61.3±15.7) years. For ischial tuberosity pressure ulcers, reconstruction was performed using a posterior femoral bilobed flap based on the first perforator of the deep femoral artery, combined with a small gluteus maximus muscle flap. Sacrococcygeal pressure ulcers were repaired using a bilobed flap based on the superior or inferior gluteal artery perforator. Post-operative follow-up lasted for 2-36 months, during which flap survival and complications were assessed.Results:All the 29 bilobed flaps were successfully rotated and provided for adequate coverage without the need for pedicle division or perforator vessel dissection. Primary healing was achieved in 26 cases, with suture removal occurring two weeks post-operatively. Three patients experienced partial wound dehiscence and marginal necrosis due to post-operative pressure, which healed after two weeks of debridement and dressing changes. During follow-up for 2-36 months, no pressure ulcer recurrence was observed. The flaps demonstrated excellent survival, with soft texture, good elasticity, and adequate blood supply. The donor sites healed with only linear scars, and no severe complications were reported.Conclusion:Bilobed flaps based on artery perforators demonstrate excellent clinical outcomes in the treatment of stage 4 pressure ulcers.

Pleural mesothelioma （PM） is a rare malignant tumor originating from the pleura. Most patients are already in the advanced stage at the time of diagnosis， resulting in a low overall survival rate. MicroRNA （miRNA）， as key regulators of tumor epigenetic modification， have an intertwined interactive network with PM drug resistance. The mechanisms of drug resistance in PM to chemotherapeutic drugs include increasing drug efflux， reducing drug intake， enhancing DNA repair， and altering drug targets. The mechanisms of resistance to targeted therapy drugs include activating alternative signaling pathways， establishing a favorable tumor microenvironment， and triggering epithelial-mesenchymal transition. MiRNA plays a key part in the aforementioned resistance mechanisms， with some miRNAs promoting the drug sensitivity of cancer cells， while others contribute to increased drug resistance. In light of these key regulatory functions， targeting the dysregulated expression of endogenous miRNAs in the process of resistance formation using miRNA antagonists or miRNA mimics may be an effective therapeutic strategy to reverse drug resistance in PM.

The modemization of medical and health governance is an integral part of the modernization of national govemance and a key livelihood issue.As an important part of the Party and state supervision system,audit supervision has played a positive role in the field of medical and health management.With the requirement of modernization of medical and health management,the medical and health system has undergone fundamental reform.On the basis of analyzing the modernization of medical and health governance and combining the needs of national audit for the modernization of medical and health governance,it builds a national audit supervi-sion system to promote the modernization of medical and health governance,explores the collaborative implementation path of audit business,in order to provide references and inspiration for carrying out audits in the field of medical and health governance.

The modemization of medical and health governance is an integral part of the modernization of national govemance and a key livelihood issue.As an important part of the Party and state supervision system,audit supervision has played a positive role in the field of medical and health management.With the requirement of modernization of medical and health management,the medical and health system has undergone fundamental reform.On the basis of analyzing the modernization of medical and health governance and combining the needs of national audit for the modernization of medical and health governance,it builds a national audit supervi-sion system to promote the modernization of medical and health governance,explores the collaborative implementation path of audit business,in order to provide references and inspiration for carrying out audits in the field of medical and health governance.

The modemization of medical and health governance is an integral part of the modernization of national govemance and a key livelihood issue.As an important part of the Party and state supervision system,audit supervision has played a positive role in the field of medical and health management.With the requirement of modernization of medical and health management,the medical and health system has undergone fundamental reform.On the basis of analyzing the modernization of medical and health governance and combining the needs of national audit for the modernization of medical and health governance,it builds a national audit supervi-sion system to promote the modernization of medical and health governance,explores the collaborative implementation path of audit business,in order to provide references and inspiration for carrying out audits in the field of medical and health governance.