Objective To develop a scientific,systematic,and operable healthcare quality evaluation system for Nation-al Regional Medical Centers(NRMCs),providing a theoretical basis and practical tool for objectively assessing their construction outcomes and guiding high-quality development.Methods Based on the classic"Structure-Process-Outcome"(SPO)quality management model,and aligned with national policy directives and the functional positioning of regional medical centers,a pre-liminary set of evaluation indicators was screened and an indicator system was constructed through literature review,policy analy-sis,and field investigations.Guangxi Hospital Division of The First Affiliated Hospital,Sun Yat-sen University was selected as the study subject,and cross-sectional data from March 2023 to June 2025 were collected for empirical application.Results A healthcare quality evaluation system for NRMCs was established,comprising 3 first-level dimensions(Structure Quality,Process Quality,Outcome Quality),10 second-level indicators,and 66 third-level indicators.This system covers multiple aspects,inclu-ding resource allocation,healthcare service efficiency,clinical practices,patient outcomes,and social benefits.Empirical results indicated that the center demonstrated a consistent upward trend in key indicators such as"Proportion of Discharged Patients Un-dergoing Level-4 Surgeries"(O1.2)and"DRG-CMI Value"(O2.1),while"Average Length of Hospital Stay"(P3.1)and"Cost Consumption Index"(O2.3)showed a steady decline.The indicator system effectively revealed the center's progress in en-hancing regional influence and operational efficiency.Conclusion The developed healthcare quality evaluation system is well-grounded in theory and practice,combining scientific rigor with policy relevance,and can serve as a decision-support tool for quality assessment and improvement in National Regional Medical Centers.

Objective To investigate the effect of modified Taohong Siwu Decoction combined with nadroparin in preventing deep venous thrombosis(DVT)of the lower extremities after hip re-placement.Methods A total of 85 patients undergoing hip replacement were randomly divided into experimental group(n=43)and conventional group(n=42).The conventional group received nadr-oparin postoperatively,while the experimental group received modified Taohong Siwu Decoction com-bined with nadroparin.The incidence of DVT,positive rate of limb swelling,coagulation factors[D-dimer(D-D),fibrinogen degradation products(FDP),plasmin-α2 plasmin inhibitor complex(PIC),thrombin-antithrombin Ⅲ complex(TAT)],platelet activation markers[glycoprotein Ⅱb/Ⅲa(GP Ⅱb/Ⅲa),P-selectin(CD62P),granule membrane protein 140(GMP-140),platelet glycoprotein fibrinogen receptor-1(PAC-1)],hemorheological indicators(plasma viscosity,low-shear whole blood viscosity,medium-shear whole blood viscosity,high-shear whole blood viscosity),and the occurrence of bleeding events were compared between the two groups before and after surgery.Results The inci-dence of DVT and positive rate of affected limb swelling were lower in the experimental group than those in the conventional group(P＜0.05).Fourteen days after treatment,the plasma levels of D-D,FDP,TAT,PIC,GP Ⅱb/Ⅲa,CD62P,GMP-140,PAC-1,as well as high-shear whole blood viscosity,medium-shear whole blood viscosity,low-shear whole blood viscosity,and plasma viscosity were all lower in the experimental group than those in the conventional group(P＜0.05).No bleeding events occurred in either group during treatment.Conclusion Modified Taohong Siwu Decoction combined with na-droparin can improve the thrombin and platelet status in patients after hip replacement,restore blood microcirculation,reduce the risk of DVT in the lower extremities,and alleviate swelling.

Objective To develop a scientific,systematic,and operable healthcare quality evaluation system for Nation-al Regional Medical Centers(NRMCs),providing a theoretical basis and practical tool for objectively assessing their construction outcomes and guiding high-quality development.Methods Based on the classic"Structure-Process-Outcome"(SPO)quality management model,and aligned with national policy directives and the functional positioning of regional medical centers,a pre-liminary set of evaluation indicators was screened and an indicator system was constructed through literature review,policy analy-sis,and field investigations.Guangxi Hospital Division of The First Affiliated Hospital,Sun Yat-sen University was selected as the study subject,and cross-sectional data from March 2023 to June 2025 were collected for empirical application.Results A healthcare quality evaluation system for NRMCs was established,comprising 3 first-level dimensions(Structure Quality,Process Quality,Outcome Quality),10 second-level indicators,and 66 third-level indicators.This system covers multiple aspects,inclu-ding resource allocation,healthcare service efficiency,clinical practices,patient outcomes,and social benefits.Empirical results indicated that the center demonstrated a consistent upward trend in key indicators such as"Proportion of Discharged Patients Un-dergoing Level-4 Surgeries"(O1.2)and"DRG-CMI Value"(O2.1),while"Average Length of Hospital Stay"(P3.1)and"Cost Consumption Index"(O2.3)showed a steady decline.The indicator system effectively revealed the center's progress in en-hancing regional influence and operational efficiency.Conclusion The developed healthcare quality evaluation system is well-grounded in theory and practice,combining scientific rigor with policy relevance,and can serve as a decision-support tool for quality assessment and improvement in National Regional Medical Centers.

Objective To compare the clinical outcomes of all-inside arthroscopic and open recon-struction of the anterior talofibular ligament(ATFL)and calcaneofibular ligament(CFL).Methods The clinical data of 51 patients with chronic lateral ankle instability(CLAI)and treated in our department between January 2017 and July 2021 were analyzed retrospectively.Among them,24 received ar-throscopic ATFL and CFL reconstruction(arthroscopy group),while 27 underwent conventional surgery(open group).The perioperative data including surgical time,intraoperative complications,hospitaliza-tion duration and time to resume normal walking were compared between the two groups.Moreover,postoperative CT examination was performed to evaluate the position of the bone tunnel.Before as well as 3 months,6 months,1 year,and 2 years after the operation,both groups were evaluated using the American Orthopedic Foot and Ankle Society Score(AOFAS),Karlsson score,visual analogue scale(VAS),drawer test,and inversion test.Meanwhile,the occurrence of complications was also recorded and compared.Results Both groups underwent the surgery successfully.The total length of incision and time to resume normal walking in the arthroscopy group were significantly shorter than the open group(P<0.05),while there was no significant difference between them in surgical time and hospital stay(P>0.05).Postoperative CT showed that in the arthroscopy group,1 case had suboptimal talus bone tun-nel position,while in the open group,1 had suboptimal calcaneus bone tunnel position and another suffered from suboptimal talus bone tunnel position,with the remaining bone tunnels located within the corresponding footprint area.All patients were followed up for 24 to 33 months.Significant improve-ment was observed in the average AOFAS score,Karlsson score,and VAS score in both groups after the operation(P<0.05),and both the drawer and inversion tests were of negative results.Three months postoperatively,the arthroscopic group had significantly better AOFAS,Karlsson and VAS score than the open group(P<0.05).Moreover,at 6 months postoperatively,the average AOFAS and Karlsson scores of the arthroscopy group were significantly superior to the open group(P<0.05).However,1 year and 2 years postoperatively,no significant differences were found between the two group in the AOFAS,Karlsson and VAS score(P>0.05).Moreover,no serious complications occurred during surgery and follow-up in both groups.Conclusion The efficacy of arthroscopic reconstruction of ATFL and CFL is comparable to open reconstruction in treating CLAI,with the former therapy resulting in faster recov-ery.

Objective:This study proposed a novel technique for aortic root reconstruction and evaluated its safety and effectiveness.Methods:Acute type A aortic dissection (ATAAD) patients who underwent Sun' s procedure from January 2020 to June 2022 in the First Affiliated Hospital of Xi'an Jiaotong University were retrospectively enrolled. These patients were divided into three groups according to their surgical procedures of aortic root: aortic root reinforcement combined with vascular grafts built-in and intermittent anastomosis technique (XJ-procedure) group, continuous suture and pledgeted interrupted reinforcement group and Bentall group. The perioperative data and postoperative follow-up results of the three groups were compared to analyze the efficacy of XJ-procedure in the root treatment of ATAAD.Results:A total of 509 patients were enrolled in this study, including 288 patients in the XJ-procedure group, 132 patients in the continuous suture and pledgeted interrupted reinforcement group and 89 patients in the Bentall group. The 30-day mortality of all patients was 7.5% (38/509), and were 7.3%, 8.3% and 6.7% in the XJ-procedure group, continuous suture and pledgeted interrupted reinforcement group and Bentall group, respectively. The operation time of the XJ-procedure group [355 (320, 380) min] was significantly lower than the other two groups. The cardiopulmonary bypass time [154 (140, 169) min] and the aortic cross-clamping time [80 (72, 89) min] of XJ-procedure group were lower than the Bentall group [166 (147, 184) min and 86 (77, 96) min]. The aortic root bleeding that required secondary cardiopulmonary bypass did not occur in the XJ-procedure group. There was no significant difference in early postoperative complications among the three groups. The incidence of residual aortic root dissection before discharge, in 3 and 6 months after operation was lower in the XJ-procedure group compared to the continuous suture and pledgeted interrupted reinforcement group ( P<0.001). Conclusion:The XJ-procedure technique is a safe, simple and mastered method for the aortic root treatment of ATAAD, which shows an accurate early clinical effect.

Objective:To investigate the current status, trends, and differences among institutions in the application of delivery room continuous positive airway pressure (DRCPAP) for very preterm infants treated in the institutions in the Chinese Neonatal Network (CHNN). Also, to explore the impact of DRCPAP on the outcomes of very preterm infants in China.Methods:A retrospective cohort study was conducted. Based on the CHNN very preterm infant cohort, very preterm infants (gestational ages ranging from 25 weeks +0 to 31 weeks +6) born in-hospital and treated in 79 tertiary neonatal intensive care units (NICUs) participating in the CHNN from 2019 to 2021 were included. The usage rates of DRCPAP in different hospitals, as well as gestational ages and years, were described. Data were analyzed using the Chi-square test (or Fisher's exact test) or t-test. A multivariate logistic regression model was established to explore the correlation between DRCPAP and clinical outcomes. Results:(1) A total of 18 048 very preterm infants were included. Among them, 3 666 (20.3%) received DRCPAP, and 14 382 (79.7%) did not. (2) The usage rate of DRCPAP for very preterm infants among different institutions is from 0.0% to 94.5%. Fourteen institutions did not use DRCPAP, and 55 institutions had a usage rate below 30%. The usage rate of DRCPAP in very preterm infants increased annually, from 13.8% (818/5 916) in 2019 to 26.0% (1 583/6 097) in 2021 ( χ2trend=122.00, P<0.001). (3) The DRCPAP group had higher rates of maternal assisted reproductive technology pregnancy, chorioamnionitis, a full course of antenatal corticosteroids, gestational diabetes, fetal distress, antenatal magnesium sulfate use, and cesarean delivery compared to the non-DRCPAP group [20.3% (744/3 665) vs. 17.6% (2 529/14 369), χ2=14.45; 23.0% (695/3 021) vs. 16.4% (1 956/11 926), χ2=72.57; 57.1% (2 090/3 660) vs. 54.3% (7 766/14 302), χ2=9.55; 23.0% (844/3 669) vs. 20.7% (2 969/14 342), χ2=9.77; 8.7% (319/3 666) vs. 7.0% (1 006/14 371), χ2=12.51; 87.1% (3 186/3 657) vs. 82.0% (11 736/14 312), χ2=81.38; 63.5% (2 327/3 664) vs. 60.7% (8 722/14 369), χ2=9.59; all P<0.05]. While the incidence of hypertensive disorders of pregnancy and the proportion of infants not using antenatal corticosteroids were lower in the non-DRCPAP group [17.1% (626/3 660) vs. 22.6% (3 183/14 084), χ2=44.70; 14.2% (520/3 661) vs. 19.7% (2 814/14 284), χ2=57.34; all P<0.05]. The DRCPAP group had lower birth weight and gestational age, higher 1 min and 5 min Apgar scores, and lower neonatal transport stabilization index scores [(1 308±314) g vs. (1 325±315) g, t=2.90; (29.5±1.7) weeks vs. (29.7±1.6) weeks, t=3.96; (7.9±1.8) scores vs. (7.6±1.9) scores, t=－9.80; (9.0±1.1) scores vs. (8.7±1.3) scores, t=－13.01; (11.0±9.4) scores vs. (13.1±9.8) scores, t=11.31; all P<0.05]. The incidence of early-onset sepsis was higher in the DRCPAP group than in the non-DRCPAP group [1.8% (68/3 578) vs. 1.3% (193/14 296), adjusted OR (95% CI): 1.417 (1.028-1.955)], while the rates of tracheal intubation within 72 hours, PS use, invasive mechanical ventilation, mortality, admission hypothermia, grade Ⅲ-Ⅳ intracranial hemorrhage, and stage≥3 ROP were all lower in the DRCPAP group compared to the non-DRCPAP group [22.6% (830/3 666) vs. 36.9% (5 310/14 374), adjusted OR (95% CI): 0.499 (0.448-0.555); 53.1% (1 947/3 666) vs. 58.3% (8 388/14 377), adjusted OR (95% CI): 0.764 (0.697-0.836); 30.1% (1 104/3 662) vs. 43.9% (6 307/14 366), adjusted OR (95% CI): 0.539 (0.487-0.595); 7.4% (274/3 666) vs. 10.6% (1 526/14 342), adjusted OR (95% CI): 0.709 (0.601-0.836); 57.5% (2 103/3 657) vs. 66.5% (9 501/14 287), adjusted OR (95% CI): 0.722 (0.661-0.788); 3.0% (101/3 366) vs. 5.9% (763/12 932)], adjusted OR (95% CI): 0.525 (0.412-0.669); 2.2% (65/2 954) vs. 3.3% (367/11 121), adjusted OR (95% CI): 0.692 (0.505-0.947); all P<0.05]. There were no statistically significant differences between the two groups in the incidence rates of BPD at a corrected gestational age of 36 weeks, patent ductus arteriosus ligation, spontaneous intestinal perforation, and pneumothorax. Conclusions:Domestically, the application of DRCPAP might be related to a decrease in the demand for invasive ventilation, the use of surfactants, and mortality, but it might not reduce the occurrence of bronchopulmonary dysplasia, at a corrected gestational age of 36 weeks. In recent years, the use of DRCPAP in very premature infants in China has increased, but the overall usage rate is still low, and there are significant differences between units, requiring continuous quality improvement.

Objective:To summarize the clinical manifestations and prognostic factors of patients with hepatic amyloidosis in a single center.Methods:The clinical data of 28 primary systemic light chain amyloidosis cases with liver involvement in our center from October 2012 to January 2023 were retrospectively analyzed. The main clinical manifestations and prognostic factors were studied. Statistical analysis were performed using the χ 2 test, Fisher's exact test, Wilcoxon rank test, or Kaplan-Meier survival curve log-rank test according to the different data. Results:The main clinical manifestations of patients with liver involvement were abdominal distension, hepatomegaly, and edema. CD56 and chemokine receptor 4 protein expression accounted for 52% (13/25) and 56% (14/25). 64.3% (9/14) patients were combined with t (11,14), and 21.4% (3/14) patients were positive for 1q21 (+), and no patients were detected with del(17p). Univariate analysis showed that Mayo 2004 and 2012 stages and total bilirubin (TBil) ≥34.2 μmol/L were associated with progression-free survival and overall survival. The median progression-free survival and overall survival were significantly inferior in patients with TBil≥34.2μmol/L group (0.178 years, 0.195 years) than with the TBil<34.2μmol/L group (0.750 years, 3.586 years) ( P ?

Objective:To investigate the current status, trends, and differences among institutions in the application of delivery room continuous positive airway pressure (DRCPAP) for very preterm infants treated in the institutions in the Chinese Neonatal Network (CHNN). Also, to explore the impact of DRCPAP on the outcomes of very preterm infants in China.Methods:A retrospective cohort study was conducted. Based on the CHNN very preterm infant cohort, very preterm infants (gestational ages ranging from 25 weeks +0 to 31 weeks +6) born in-hospital and treated in 79 tertiary neonatal intensive care units (NICUs) participating in the CHNN from 2019 to 2021 were included. The usage rates of DRCPAP in different hospitals, as well as gestational ages and years, were described. Data were analyzed using the Chi-square test (or Fisher's exact test) or t-test. A multivariate logistic regression model was established to explore the correlation between DRCPAP and clinical outcomes. Results:(1) A total of 18 048 very preterm infants were included. Among them, 3 666 (20.3%) received DRCPAP, and 14 382 (79.7%) did not. (2) The usage rate of DRCPAP for very preterm infants among different institutions is from 0.0% to 94.5%. Fourteen institutions did not use DRCPAP, and 55 institutions had a usage rate below 30%. The usage rate of DRCPAP in very preterm infants increased annually, from 13.8% (818/5 916) in 2019 to 26.0% (1 583/6 097) in 2021 ( χ2trend=122.00, P<0.001). (3) The DRCPAP group had higher rates of maternal assisted reproductive technology pregnancy, chorioamnionitis, a full course of antenatal corticosteroids, gestational diabetes, fetal distress, antenatal magnesium sulfate use, and cesarean delivery compared to the non-DRCPAP group [20.3% (744/3 665) vs. 17.6% (2 529/14 369), χ2=14.45; 23.0% (695/3 021) vs. 16.4% (1 956/11 926), χ2=72.57; 57.1% (2 090/3 660) vs. 54.3% (7 766/14 302), χ2=9.55; 23.0% (844/3 669) vs. 20.7% (2 969/14 342), χ2=9.77; 8.7% (319/3 666) vs. 7.0% (1 006/14 371), χ2=12.51; 87.1% (3 186/3 657) vs. 82.0% (11 736/14 312), χ2=81.38; 63.5% (2 327/3 664) vs. 60.7% (8 722/14 369), χ2=9.59; all P<0.05]. While the incidence of hypertensive disorders of pregnancy and the proportion of infants not using antenatal corticosteroids were lower in the non-DRCPAP group [17.1% (626/3 660) vs. 22.6% (3 183/14 084), χ2=44.70; 14.2% (520/3 661) vs. 19.7% (2 814/14 284), χ2=57.34; all P<0.05]. The DRCPAP group had lower birth weight and gestational age, higher 1 min and 5 min Apgar scores, and lower neonatal transport stabilization index scores [(1 308±314) g vs. (1 325±315) g, t=2.90; (29.5±1.7) weeks vs. (29.7±1.6) weeks, t=3.96; (7.9±1.8) scores vs. (7.6±1.9) scores, t=－9.80; (9.0±1.1) scores vs. (8.7±1.3) scores, t=－13.01; (11.0±9.4) scores vs. (13.1±9.8) scores, t=11.31; all P<0.05]. The incidence of early-onset sepsis was higher in the DRCPAP group than in the non-DRCPAP group [1.8% (68/3 578) vs. 1.3% (193/14 296), adjusted OR (95% CI): 1.417 (1.028-1.955)], while the rates of tracheal intubation within 72 hours, PS use, invasive mechanical ventilation, mortality, admission hypothermia, grade Ⅲ-Ⅳ intracranial hemorrhage, and stage≥3 ROP were all lower in the DRCPAP group compared to the non-DRCPAP group [22.6% (830/3 666) vs. 36.9% (5 310/14 374), adjusted OR (95% CI): 0.499 (0.448-0.555); 53.1% (1 947/3 666) vs. 58.3% (8 388/14 377), adjusted OR (95% CI): 0.764 (0.697-0.836); 30.1% (1 104/3 662) vs. 43.9% (6 307/14 366), adjusted OR (95% CI): 0.539 (0.487-0.595); 7.4% (274/3 666) vs. 10.6% (1 526/14 342), adjusted OR (95% CI): 0.709 (0.601-0.836); 57.5% (2 103/3 657) vs. 66.5% (9 501/14 287), adjusted OR (95% CI): 0.722 (0.661-0.788); 3.0% (101/3 366) vs. 5.9% (763/12 932)], adjusted OR (95% CI): 0.525 (0.412-0.669); 2.2% (65/2 954) vs. 3.3% (367/11 121), adjusted OR (95% CI): 0.692 (0.505-0.947); all P<0.05]. There were no statistically significant differences between the two groups in the incidence rates of BPD at a corrected gestational age of 36 weeks, patent ductus arteriosus ligation, spontaneous intestinal perforation, and pneumothorax. Conclusions:Domestically, the application of DRCPAP might be related to a decrease in the demand for invasive ventilation, the use of surfactants, and mortality, but it might not reduce the occurrence of bronchopulmonary dysplasia, at a corrected gestational age of 36 weeks. In recent years, the use of DRCPAP in very premature infants in China has increased, but the overall usage rate is still low, and there are significant differences between units, requiring continuous quality improvement.

Objective:This study proposed a novel technique for aortic root reconstruction and evaluated its safety and effectiveness.Methods:Acute type A aortic dissection (ATAAD) patients who underwent Sun' s procedure from January 2020 to June 2022 in the First Affiliated Hospital of Xi'an Jiaotong University were retrospectively enrolled. These patients were divided into three groups according to their surgical procedures of aortic root: aortic root reinforcement combined with vascular grafts built-in and intermittent anastomosis technique (XJ-procedure) group, continuous suture and pledgeted interrupted reinforcement group and Bentall group. The perioperative data and postoperative follow-up results of the three groups were compared to analyze the efficacy of XJ-procedure in the root treatment of ATAAD.Results:A total of 509 patients were enrolled in this study, including 288 patients in the XJ-procedure group, 132 patients in the continuous suture and pledgeted interrupted reinforcement group and 89 patients in the Bentall group. The 30-day mortality of all patients was 7.5% (38/509), and were 7.3%, 8.3% and 6.7% in the XJ-procedure group, continuous suture and pledgeted interrupted reinforcement group and Bentall group, respectively. The operation time of the XJ-procedure group [355 (320, 380) min] was significantly lower than the other two groups. The cardiopulmonary bypass time [154 (140, 169) min] and the aortic cross-clamping time [80 (72, 89) min] of XJ-procedure group were lower than the Bentall group [166 (147, 184) min and 86 (77, 96) min]. The aortic root bleeding that required secondary cardiopulmonary bypass did not occur in the XJ-procedure group. There was no significant difference in early postoperative complications among the three groups. The incidence of residual aortic root dissection before discharge, in 3 and 6 months after operation was lower in the XJ-procedure group compared to the continuous suture and pledgeted interrupted reinforcement group ( P<0.001). Conclusion:The XJ-procedure technique is a safe, simple and mastered method for the aortic root treatment of ATAAD, which shows an accurate early clinical effect.

Objective:To investigate the clinical efficacy of preoperative three-dimensional (3D) reconstruction planning in total hip arthroplasty for development dysplasia of the hip secondary to osteoarthritis.Methods:A total of 80 patients with osteoarthritis secondary to Crowe I-III developmental dysplasia of the hip who underwent primary unilateral total hip arthroplasty from October 2019 to March 2021 were retrospectively analyzed, including 18 males and 62 females and the mean age was 55.7±10.4 years (range 41-72 years). Forty patients in the 3D group, the prosthesis type and installation angle were planed on the 3D reconstruction software based on the full-length CT scan data of the lower limbs, and the length difference of the lower limbs and hip offset were calculated. Forty patients in the control group underwent preoperative planning using conventional film measurement, and lower limb length was judged based on the preoperative measurement data and intraoperative comparison of both lower limbs. The difference of postoperative leg length, hip offset, hip function score, operating time, intraoperative blood loss, and incidence of complications were compared between the two groups.Results:All 80 patients completed the surgery successfully and the follow-up time was up to 3 months after operation. The 3D group was better than the control group in operation time (70.9±7.7 min vs. 81.6±13.3 min, t=-4.91, P<0.001), the difference of postoperative lower limb length (2.78±1.31 cm vs. 5.35±2.15 cm, t=-5.74, P<0.001), and hip function score at 1 week after operation (75.67±3.35 vs. 67.35±4.21, t=12.33, P=0.002), with statistically significant differences. In the 3D group, 95% of acetabular prosthesis and 90% of femoral stem components were consistent with the planned model, while the rate were only 75% and 68% in the control group, and the difference was statistically significant (χ 2=7.51, P=0.023; χ 2=14.92, P=0.005). There were no intraoperative complications such as vascular and nerve injury, and no postoperative complications such as dislocation or periprosthetic infection in all 80 patients. Conclusion:3D preoperative planning assisted total hip arthroplasty in the treatment of Crowe I-III developmental dysplasia of the hip secondary to osteoarthritis can improve the accuracy of the operation, and has a good clinical effect on restoring the leg length and hip offset.