Objective To explore the constituent elements of patients'sense of gain experience and provide theoretical insights for improving patient satisfaction with healthcare services.Methods Purposive sampling and convenience sampling were employed to select 46 experts in health management from universities,hospitals,government agencies,and academic societies across China for semi-structured interviews.Qualitative analysis of the interview data was conducted using grounded theory.Results Through three-level coding,159 initial concepts,19 categories,7 main categories,and 2 core categories were identified.A conceptual framework for the constituent elements of patients'sense of gain experience was constructed,centered on two core dimensions:micro-level experience and macro-level acquisition.Conclusion The concept of"patients'sense of gain experience"enriches the theoretical framework of"sense of gain"and breaks through the unidimensional approach to evaluating medical service quality.Its enhancement requires collaborative efforts from multiple stakeholders,including medical institutions,governments,policymakers,and other actors.

Objective To investigate the efficacy,safety and operation time of ultrasound-guided percutaneous polidocanol injection chemical ablation through 17 G coaxial needle for predominantly cystic thyroid nodules.Methods The clinical data of 176 patients with predominantly cystic thyroid nodules,who received ultrasound-guided percutaneous polidocanol injection chemical ablation at authors'hospital from January 2020 to June 2023,were retrospectively analyzed.Of the 176 patients,20 mL syringe needle was used in 96(control group)and 17 G coaxial needle was used in 80(study group).The clinical safety,efficacy,and operation time were compared between the two groups.Results After the chemical ablation therapy,the volume of thyroid nodules was obviously decreased in both groups,but the difference in the volume reduction ratio(VRR)between the two groups was not statistically significant(P＞0.05).The incidence of complications and the operation time in the study group were remarkably lower than those in the control group(both P＜0.05).Conclusion In treating predominantly cystic thyroid nodules with ultrasound-guided percutaneous polidocanol injection chemical ablation,the use of 17 G coaxial needle is superior to the use of 20 mL syringe needle in reducing the incidence of complications and in shortening the operation time,therefore,this technique is suitable for beginners to adopt.

Objective:To explore the teaching effectiveness of BOPPPS (bridge-in, objective, pre-assessment, participatory-learning, post-assessment, and summary) teaching model in the undergraduate education of pediatric surgery, compare the BOPPPS teaching model with the traditional teaching model, and examine the differences in students' understanding and mastery of knowledge, as well as their ability improvement.Methods:A total of 621 undergraduate students majoring in pediatrics at Chongqing Medical University in the 2021-2023 academic years were selected as the experimental group, and 552 undergraduate students majoring in pediatrics at Chongqing Medical University in the 2018-2020 academic years were selected as the control group. The traditional teaching method was used in the pediatric surgery teaching of the control group, while the BOPPPS teaching model was used in the experimental group. The two groups were compared based on theoretical examination scores, routine assessment scores, overall performance, and teaching satisfaction. A statistical analysis was conducted using SPSS 24.0 software. Continuous data conforming to a normal distribution were expressed as ( x?±s). Two independent samples mean t test was used for analysis. Results:The experimental group demonstrated significantly higher theoretical examination scores [(70.21±10.03) vs. (62.58±8.40)], routine assessment scores [(96.38±2.10) vs. (84.11±2.02)], and total scores [(80.68±11.30) vs. (71.19±9.50)] compared to the control group ( P<0.05). The overall satisfaction with teaching was significantly higher in the experimental group than in the control group [(91.60±1.75) vs. (90.57±0.80)] ( P<0.05). Conclusions:The application of BOPPPS teaching model in pediatric surgery teaching can improve undergraduate students' self-learning ability, clinical thinking ability, and team cooperation ability, thereby enhancing teaching quality.

Objective:To explore the teaching effectiveness of BOPPPS (bridge-in, objective, pre-assessment, participatory-learning, post-assessment, and summary) teaching model in the undergraduate education of pediatric surgery, compare the BOPPPS teaching model with the traditional teaching model, and examine the differences in students' understanding and mastery of knowledge, as well as their ability improvement.Methods:A total of 621 undergraduate students majoring in pediatrics at Chongqing Medical University in the 2021-2023 academic years were selected as the experimental group, and 552 undergraduate students majoring in pediatrics at Chongqing Medical University in the 2018-2020 academic years were selected as the control group. The traditional teaching method was used in the pediatric surgery teaching of the control group, while the BOPPPS teaching model was used in the experimental group. The two groups were compared based on theoretical examination scores, routine assessment scores, overall performance, and teaching satisfaction. A statistical analysis was conducted using SPSS 24.0 software. Continuous data conforming to a normal distribution were expressed as ( x?±s). Two independent samples mean t test was used for analysis. Results:The experimental group demonstrated significantly higher theoretical examination scores [(70.21±10.03) vs. (62.58±8.40)], routine assessment scores [(96.38±2.10) vs. (84.11±2.02)], and total scores [(80.68±11.30) vs. (71.19±9.50)] compared to the control group ( P<0.05). The overall satisfaction with teaching was significantly higher in the experimental group than in the control group [(91.60±1.75) vs. (90.57±0.80)] ( P<0.05). Conclusions:The application of BOPPPS teaching model in pediatric surgery teaching can improve undergraduate students' self-learning ability, clinical thinking ability, and team cooperation ability, thereby enhancing teaching quality.

Objective To explore the constituent elements of patients'sense of gain experience and provide theoretical insights for improving patient satisfaction with healthcare services.Methods Purposive sampling and convenience sampling were employed to select 46 experts in health management from universities,hospitals,government agencies,and academic societies across China for semi-structured interviews.Qualitative analysis of the interview data was conducted using grounded theory.Results Through three-level coding,159 initial concepts,19 categories,7 main categories,and 2 core categories were identified.A conceptual framework for the constituent elements of patients'sense of gain experience was constructed,centered on two core dimensions:micro-level experience and macro-level acquisition.Conclusion The concept of"patients'sense of gain experience"enriches the theoretical framework of"sense of gain"and breaks through the unidimensional approach to evaluating medical service quality.Its enhancement requires collaborative efforts from multiple stakeholders,including medical institutions,governments,policymakers,and other actors.

Objective To analyze the influencing factors for intestinal colonization and secondary infection of car-bapenem-resistant Klebsiella pneumoniae(CRKP)in neonates,and provide a basis for formulating prevention and control strategies for CRKP infection.Methods Neonates who were admitted to the neonatal ward of a hospital from January 2021 to October 2022 were selected as the study subjects,and the first screening of CRKP was con-ducted within 48 hours after admission.In addition,active anal swab screening for carbapenem-resistant Ente-robacterales(CRE)was performed weekly during hospitalization,and the infection status of CRKP strains was mo-nitored.Clinical data of neonates in the colonization group,non-colonization group,and infection group were ana-lyzed.Intestinal colonized strains and the non-repetitive CRKP strains isolated from clinical specimens of neonates with secondary infection after colonization were performed carbapenemase gene detection,multilocus sequence ty-ping(MLST)and pulsed-field gel electrophoresis(PFGE)analysis.Results A total of 1 438 neonates were active-ly screened for CRE,174 were CRKP positive,CRKP colonization rate was 12.1％.Among 174 neonates,35 were with secondary infection,with the incidence of 20.1％.The independent risk factors for neonatal CRKP intestinal colonization were cesarean section(OR=2.050,95％CI:1.200-3.504,P=0.009),use of cephalosporins(OR=1.889,95％CI:1.086-3.288,P=0.024),nasogastric tube feeding(OR=2.317,95％CI:1.155-4.647,P=0.018).Protective factors were breast-feeding(OR=0.506,95％CI:0.284-0.901,P=0.021),oral probiotics(OR=0.307,95％CI:0.147-0.643,P=0.002),and enema(OR=0.334,95％CI:0.171-0.656,P=0.001).Independent risk factors for secondary infection after intestinal colonization of neonatal CRKP were carbapenem anti-biotic use(OR=19.869,95％CI:1.778-222.029,P=0.015)and prolonged hospital stay(OR=1.118,95％CI:1.082-1.157,P＜0.001).The detection results of drug resistance genes showed that carbapenemase-producing genes of CRKP strains were all blaKPC-2,all belonged to type ST11.Homologous analysis showed that intestinal CRKP colonization was highly homologous with the secondary infection strains after colonization.Conclusion CRKP intestinal colonization during neonatal hospitalization may increase the risk of CRKP infection.Risk and pro-tective factors of neonatal intestinal colonization and secondary infections after colonization should be paid attention,and corresponding preventive and control measures should be taken,so as to reduce the occurrence and transmission CRKP healthcare-associated infection.

Objective To understand the spectrum and changes of pathogens causing healthcare-associated infec-tion(HAI)in neonatal intensive care unit(NICU).Methods Clinical medical records of neonates with HAI in a hospital from January 2018 to December 2022 were collected,spectrum of pathogens causing HAI were and analyzed retrospectively.Results A total of 7 597 hospitalized neonates were investigated,and 240 of whom had 263 cases of HAI,with an HAI incidence of 3.16％and healthcare-associated case infection incidence of 3.46％.96 cases(36.50％)were bloodstream infection,70(26.62％)were respiratory system infection,and 57(21.67％)were in-fection without clear sites.A total of 170 pathogens were detected from specimens,78(45.88％)of which were Gram-positive bacteria,with Staphylococcus spp.accounting for the highest proportion,78(45.88％)were Gram-negative bacteria,mainly Klebsiella pneumoniae,and 14(8.24％)were fungi.The detection rate of Gram-negative bacteria showed an upward trend from 2018 to 2022(P＜0.01).Conclusion The majority of HAI in NICU is bloodstream infection.In recent years,the detection rate of Gram-negative bacteria has been increasing year by year,and it is necessary to streng-then the prevention and control of HAI in clinical practice.

Objective To understand the epidemiological and clinical characteristics of healthcare-associated infec-tion(HAI)in neonates with different gestational ages and birth weights,and provide guidance for personalized cli-nical diagnosis and treatment.Methods According to the inclusion and exclusion criteria,240 neonates with HAI in the neonatal intensive care unit(NICU)of a hospital in Handan City from January 2018 to December 2022 were selected as the study group,720 neonates without HAI were selected as the control group based on systematic sam-pling method with a ratio of 1∶3.The incidence of HAI,distribution characteristics of infection site,pathogenic features of HAI,as well as the effect of different delivery modes on HAI in neonates with different gestational ages and birth weights were analyzed.Results Neonates with gestational age＜28 weeks and birth weight＜1 000 g had the highest incidence of HAI,which were 19.48％and 20.41％,respectively.Among neonates with gestational age＜28 weeks,unidentified site infection were the most(37.50％),while in all gestational age groups within 28-36+6 weeks,bloodstream infection(BSI)and respiratory system infection were predominant.For neonates with gestational age ≥37 weeks,BSI and unidentified site infection occurred frequently.Among neonates in all weight groups,BSI was the most frequent,followed by respiratory system infection.Pathogens from different sites of in-fections in neonates with different gestational ages and birth weights varied.Among neonates with gestational age of 28-31+6 weeks and birth weight of 1 000-1 499 g,the constituent of birth modes showed statistically significant difference between neonates with and without HAI(both P＜0.05).Conclusion Epidemiological and clinical chara-cteristics of HAI in neonates with different gestational ages and birth weights are different.For the prevention and control of HAI,individualized diagnosis and treatment plans should be developed to achieve precise prevention and control,reduce the incidence of HAI,and improve the overall treatment level of neonates.

Objective To assess the clinical short-term outcomes of implanting D-shant atrial shunt device(aSD)in a single center for patients with heart failure with reduced ejection fraction(HFrEF).Methods From January 2022 to January 2023,a retrospective analysis was conducted on 12 patients with HFrEF who underwent percutaneous implantation of a D-shant aSD.We assessed cardiac chamber size and ventricular function using echocardiography,right heart catheterization measurements and patient clinical indicators were collected,follow up data of 12 months postoperative and pre-implantation D-shant were compared.The primary endpoint of the study was the cumulative occurrence of adverse cardiac,neurologic,or renal events during the follow-up period.Secondary endpoints were improvements in functional status included cardiac function,quality of life,and exercise capacity.Results All 12 patients underwent successful percutaneous inter-atrial shunting procedures using the D-shant.Postoperative immediately fluoroscopy and echocardiography confirmed accurate localization and patency of the atrial shunt devices in all cases.Postoperative hemodynamic assessment revealed a significant decrease in pulmonary capillary wedge pressure[(29.8±3.4)mmHg vs.(17.8±0.8)mmHg,P＜0.001].During 12 months follow-up,the cumulative adverse event rate was 8.3％(one patient received a heart transplant),a significant reduction in left atrial diameter from(65.8±6.5)mm to(48.0±4.5)mm(P＜0.001)was observed.Furthermore,there was notable improvement in clinical cardiac function indices quality of life,and exercise capacity of the patients.Conclusions This single-center retrospective study found that the use of a D-shant aSD to perform percutaneous interatrial shunting in patients with HFrEF is safe and effective.Short-term follow-up demonstrated sustained patency of the shunt and that the intervention was associated with improved functional status.

Objective:To investigate the impact of neferine(NEF)on the blood-brain barrier in ischemic stroke(IS)rats by regulating the CC chemokine ligand 2(CCL2)-CC chemokine receptor 2(CCR2)signal pathway.Methods:SD rats were randomly divided into model group,low-dose NEF group(NEF-L group,25 mg/kg NEF),high-dose NEF group(NEF-H group,50 mg/kg NEF),and high-dose NEF+CCR2 antagonist group(NEF-H+RS102895 group,50 mg/kg NEF+10 mg/kg RS102895),sham opera-tion group(Sham group),with 15 rats in each group.The neurological function scores of rats in each group were compared.The perme-ability of blood-brain barrier of rats in each group was evaluated by Evans blue(EB)permeation method.The water content of brain tis-sue of rats in each group was determined by dry and wet weight method.The expression levels of CCL2 and CCR2 mRNA in rat brain tissue were measured by real-time fluorescence quantitative PCR(RT-qPCR).The expression levels of CCL2,CCR2,ZO-1 and Clau-din-5 proteins in rat brain tissue were detected by Western blot.Results:Compared with Sham group,the neural function score,EB content,water content,the expression levels of CCL2,CCR2 mRNA and protein in the right brain tissue of the model group were obvi-ously higher(P<0.05),the expression levels of ZO-1 and Claudin-5 were lower(P<0.05).Compared with the model group,the neuro-logical function score,water content,EB content,the expression levels of CCL2,CCR2 mRNA and protein in the right brain tissue of rats in the NEF-H group were obviously lower(P<0.05),the expression levels of ZO-1 and Claudin-5 were obviously higher(P<0.05).RS102895 enhanced the protective effect of NEF on the blood-brain barrier in IS rats.Conclusion:NEF may protect the blood-brain barrier of IS rats by inhibiting CCL2-CCR2 signal pathway.