Under the background of the Healthy China Strategy, public hospitals urgently need to break through the limitations of the traditional medical mode, build a precise and continuous medical service system to meet the growing personalized health needs of the people. In 2022, a tertiary public hospital launched a multidisciplinary whole course management service practice. By integrating multidisciplinary medical and health resources, clarifying service targets and contents, forming a whole course management service team, constructing a supporting information platform, linking full process services, creating standardized service processes, and providing patients with comprehensive, full process, professional, and accurate full cycle intervention management and care. The hospital covered diseases in stages, ensuring continuous medical for patients after leaving the hospital, improving their medical experience, and supporting the high-quality development of the hospital. As of June 2024, the hospital′s multidisciplinary whole course management services had covered 25 departments and 41 disease, and 43 management teams have been established. A total of 7 453 patients signed up for the whole course service. This practice achieved good results, could provide references for the implementation of whole course management services led by public hospitals.

Objective:To investigate the clinical effect of microplasma radiofrequency combined with oral traditional Chinese medicine (TCM) Babao Dan capsule to improve damp-heat TCM constitution in the treatment of hypertrophic scar.Methods:A prospective randomized controlled trial method was used to recruit patients diagnosed with damp-heat TCM constitution and suffering from hypertrophic scar who admitted to the Fourth Medical Center of Chinese PLA General Hospital from March to July 2024. All patients were randomly divided into microplasma radiofrequency combined with TCM treatment group (combination group), microplasma radiofrequency (RF) treatment group (RF group), and oral TCM treatment group (TCM group). Both the combination group and the RF group were treated with a microplasma radiofrequency instrument. Transverse, longitudinal and oblique scar grinding were performed three times with 90 W power, and regular scabs appeared in the treatment area as the treatment end point. After RF treatment in the combination group and the TCM group, Babao Dan capsule was taken with regular warm water, 0.6 g each time, 3 times/day, for 3 months. The Vancouver scar scale (VSS) score (higher score indicating more severe scar), visual analogue scale (VAS) of scar pain and itch (higher score indicating more severe symptom), and TCM constitution score (higher score indicating more severe moist heat constitution) were compared before treatment and 3 months after the first treatment. SPSS 26.0 software was used for statistical analysis. Measurement data conforming to normal distribution were expressed as Mean±SD, ANOVA was used for comparison among groups, and LSD- t method was used for pair comparison between groups. Paired sample t test was used before and after treatment in the same group. Counting data were expressed as cases (%), and the χ2 test was used for inter-group comparison. P<0.05 was considered statistically significant. Results:A total of 60 patients were included, 20 in each group. There were no significant differences in gender distribution, disease course, scar area and distribution among the three groups ( P>0.05), indicating comparability. Before treatment, there were no statistically significant differences in VSS, VAS and TCM physique scores among the 3 groups ( P>0.05). After treatment, VAS scores in the 3 groups, VSS scores in combination group and RF group, TCM physique scores in combination group and TCM group were improved compared with those before treatment, and the differences were statistically significant ( P<0.05). The VSS score of the combination group was significantly lower than that of the RF group and the TCM group ( P<0.05), but there was no statistical significance between the RF group and the TCM group ( P>0.05). The pruritus VAS score of the combination group was significantly lower than that of TCM group and RF group ( P<0.05), but there was no statistical significance between RF group and TCM group ( P>0.05). There was no significant difference in pain VAS scores among the three groups after treatment ( P>0.05). The TCM physique scores of the combination group and TCM group were significantly lower than those of the RF group ( P<0.01), but there was no statistical significance between the combination group and TCM group ( P>0.05). Conclusion:Microplasma radiofrequency combined with oral Babao Dan capsule can effectively improve the VSS score, pain and pruritus of hypertrophic scars in patients with damp-heat constitution, and the effect is better than that of radiofrequency or TCM alone.

Objective:To explore the efficacy of non-invasive prenatal testing (NIPT) of fetal free DNA in maternal peripheral blood in fetuses with increased nuchal translucency (NT).Methods:A retrospective analysis was conducted on 1 184 singleton pregnant women that underwent chromosomal microarray analysis (CMA) at Nanjing Drum Tower Hospital, Nanjing University Medical School from June 2014 to December 2022 due to fetal increased NT (≥3.0 mm). These subjects were categorized based on whether the increased NT was accompanied by other high-risk factors into isolated increased NT without advanced maternal age (further subdivided into 3.0 mm≤NT<3.5 mm, 3.5 mm≤NT<4.0 mm, and NT≥4.0 mm subgroups), isolated increased NT with advanced maternal age, increased NT with nasal bone abnormalities, increased NT with other soft markers, and increased NT with structural abnormalities groups. Assuming the sensitivity and specificity of NIPT and expanded NIPT at this center were both 100%, genomic abnormalities outside the detection range of NIPT or expanded NIPT were termed as residual risk of NIPT or expanded NIPT. Chi-square test and Bonferroni correction were used to compare the residual risks of NIPT and expanded NIPT among the three subgroups of isolated increased NT without advanced maternal age group. Results:(1) In the group of isolated increased NT without advanced maternal age: For the 3.0 mm≤NT<3.5 mm subgroup (329 cases), 19 abnormalities were detected by CMA [12 cases of chromosome aneuploidy, seven cases of pathogenic copy number variation (pCNV)], with residual risks of NIPT and expanded NIPT both at 2.1% (7/329). For the 3.5 mm≤NT<4.0 mm subgroup (173 cases), 29 abnormalities were detected by CMA (17 cases of chromosome aneuploidy, nine cases of pCNV, three cases of chromosome unbalanced translocation), with residual risks of NIPT at 8.1% (14/173) and expanded NIPT at 7.5% (13/173). For the NT≥4.0 mm subgroup (270 cases), CMA detected abnormalities in 70 cases (50 cases of chromosome aneuploidy, 16 cases of pCNV, three cases of unbalanced translocations, and one case of sex chromosome abnormality combined with pCNV). The residual risk of NIPT was 12.2% (33/270), and the residual risk of expanded NIPT was 7.0% (19/270). The residual risks of NIPT and expanded NIPT in the 3.0 mm≤NT<3.5 mm subgroup were lower than those in the 3.5 mm≤NT<4.0 mm and NT≥4.0 mm subgroups (Bonferroni correction, all P<0.017). (2) In the group of 92 cases with isolated increased NT and advanced maternal age, CMA detected abnormalities in 36 cases (29 cases of chromosome aneuploidy, five cases of pCNV, one case of trisomy 21 combined with sex chromosome abnormality, and one case of trisomy 18 combined with sex chromosome abnormality). The residual risk of NIPT was 7.6% (7/92), and that of expanded NIPT was 5.4% (5/92). (3) In the group of 49 cases with increased NT combined with nasal bone abnormalities, CMA detected abnormalities in 24 cases (23 cases of chromosome aneuploidy and one case of pCNV). The residual risks of NIPT and expanded NIPT were both 2.0% (1/49). (4) In the group of 26 cases with increased NT combined with other soft markers, CMA detected abnormalities in nine cases (six cases of chromosome aneuploidy, one case of pCNV, and two cases of chromosome unbalanced translocations). The residual risks of NIPT and expanded NIPT were both 11.5% (3/26). (5) In the group of 245 cases with increased NT combined with structural abnormalities, CMA detected abnormalities in 121 cases (107 cases of chromosome aneuploidy, seven cases of pCNV, four cases of chromosome unbalanced translocations, one case of trisomy 21 combined with trisomy 20, and two cases of trisomy 18 combined with sex chromosome abnormalities). The residual risk of NIPT was 16.7% (41/245), and that of expanded NIPT was 4.1% (10/245). Conclusions:For isolated NT≥3.5 mm or NT≥3.0 mm combined with other high-risk factors, chorionic villus sampling in early pregnancy can be recommended, advancing the timing of prenatal diagnosis from the second trimester to the first trimester. For fetuses with isolated 3.0 mm≤NT<3.5 mm, the 2.1% residual risk of chromosomal abnormalities should be fully informed during counseling, even if the risk of NIPT is low.

Objective:To explore the risk factors for complications of facial autologous fat transplantation.Methods:A total of 51 female patients (case group) with moderate to severe complications following facial autologous fat transplantation at the Fourth Medical Center of Chinese PLA General Hospital from November 2016 to October 2022 were included in this retrospective study. The median age was 31.0 (27.0, 40.0) years. After age and surgical date were matched with ratio of 1∶1, a total of 51 female patients who received autologous fat transplants at several official medical facilities and experienced no complications within a year after the procedure made up the control group. The median age of the control group was 32.0 (26.0, 41.0) years. The clinical characteristics of the two groups were compared, and the factors for complications of facial autologous fat transplantation were examined using a multivariate logistic regression model.Results:In the case group, complications included facial artery embolism (7 cases), ophthalmic artery embolism (19 cases), infection (19 cases), and fat necrosis (6 cases), with 26 severe and 25 moderate cases. No significant differences were found between the two groups in age, body mass index (BMI), marital status, history of hypertension, infectious diseases, allergies, smoking, or alcohol consumption (all P>0.05). However, significant differences were observed in a history of facial surgery, perimenstrual phase, surgical site, and fat donor site (all P<0.05). Multivariate logistic regression analysis revealed that a history of facial surgery ( OR=17.289, 95% CI: 4.851-61.616, P<0.001) and the surgical site being a clinic/outpatient department (compared to a hospital, OR=7.708, 95% CI: 2.482-23.939, P<0.001) were risk factors for postoperative complications after facial autologous fat transplantation. Conclusion:A history of facial surgery and the surgical site being a clinic/outpatient department (compared to a hospital) are risk factors for complications of facial autologous fat transplantation.

Objective:To explore the efficacy of non-invasive prenatal testing (NIPT) of fetal free DNA in maternal peripheral blood in fetuses with increased nuchal translucency (NT).Methods:A retrospective analysis was conducted on 1 184 singleton pregnant women that underwent chromosomal microarray analysis (CMA) at Nanjing Drum Tower Hospital, Nanjing University Medical School from June 2014 to December 2022 due to fetal increased NT (≥3.0 mm). These subjects were categorized based on whether the increased NT was accompanied by other high-risk factors into isolated increased NT without advanced maternal age (further subdivided into 3.0 mm≤NT<3.5 mm, 3.5 mm≤NT<4.0 mm, and NT≥4.0 mm subgroups), isolated increased NT with advanced maternal age, increased NT with nasal bone abnormalities, increased NT with other soft markers, and increased NT with structural abnormalities groups. Assuming the sensitivity and specificity of NIPT and expanded NIPT at this center were both 100%, genomic abnormalities outside the detection range of NIPT or expanded NIPT were termed as residual risk of NIPT or expanded NIPT. Chi-square test and Bonferroni correction were used to compare the residual risks of NIPT and expanded NIPT among the three subgroups of isolated increased NT without advanced maternal age group. Results:(1) In the group of isolated increased NT without advanced maternal age: For the 3.0 mm≤NT<3.5 mm subgroup (329 cases), 19 abnormalities were detected by CMA [12 cases of chromosome aneuploidy, seven cases of pathogenic copy number variation (pCNV)], with residual risks of NIPT and expanded NIPT both at 2.1% (7/329). For the 3.5 mm≤NT<4.0 mm subgroup (173 cases), 29 abnormalities were detected by CMA (17 cases of chromosome aneuploidy, nine cases of pCNV, three cases of chromosome unbalanced translocation), with residual risks of NIPT at 8.1% (14/173) and expanded NIPT at 7.5% (13/173). For the NT≥4.0 mm subgroup (270 cases), CMA detected abnormalities in 70 cases (50 cases of chromosome aneuploidy, 16 cases of pCNV, three cases of unbalanced translocations, and one case of sex chromosome abnormality combined with pCNV). The residual risk of NIPT was 12.2% (33/270), and the residual risk of expanded NIPT was 7.0% (19/270). The residual risks of NIPT and expanded NIPT in the 3.0 mm≤NT<3.5 mm subgroup were lower than those in the 3.5 mm≤NT<4.0 mm and NT≥4.0 mm subgroups (Bonferroni correction, all P<0.017). (2) In the group of 92 cases with isolated increased NT and advanced maternal age, CMA detected abnormalities in 36 cases (29 cases of chromosome aneuploidy, five cases of pCNV, one case of trisomy 21 combined with sex chromosome abnormality, and one case of trisomy 18 combined with sex chromosome abnormality). The residual risk of NIPT was 7.6% (7/92), and that of expanded NIPT was 5.4% (5/92). (3) In the group of 49 cases with increased NT combined with nasal bone abnormalities, CMA detected abnormalities in 24 cases (23 cases of chromosome aneuploidy and one case of pCNV). The residual risks of NIPT and expanded NIPT were both 2.0% (1/49). (4) In the group of 26 cases with increased NT combined with other soft markers, CMA detected abnormalities in nine cases (six cases of chromosome aneuploidy, one case of pCNV, and two cases of chromosome unbalanced translocations). The residual risks of NIPT and expanded NIPT were both 11.5% (3/26). (5) In the group of 245 cases with increased NT combined with structural abnormalities, CMA detected abnormalities in 121 cases (107 cases of chromosome aneuploidy, seven cases of pCNV, four cases of chromosome unbalanced translocations, one case of trisomy 21 combined with trisomy 20, and two cases of trisomy 18 combined with sex chromosome abnormalities). The residual risk of NIPT was 16.7% (41/245), and that of expanded NIPT was 4.1% (10/245). Conclusions:For isolated NT≥3.5 mm or NT≥3.0 mm combined with other high-risk factors, chorionic villus sampling in early pregnancy can be recommended, advancing the timing of prenatal diagnosis from the second trimester to the first trimester. For fetuses with isolated 3.0 mm≤NT<3.5 mm, the 2.1% residual risk of chromosomal abnormalities should be fully informed during counseling, even if the risk of NIPT is low.

Under the background of the Healthy China Strategy, public hospitals urgently need to break through the limitations of the traditional medical mode, build a precise and continuous medical service system to meet the growing personalized health needs of the people. In 2022, a tertiary public hospital launched a multidisciplinary whole course management service practice. By integrating multidisciplinary medical and health resources, clarifying service targets and contents, forming a whole course management service team, constructing a supporting information platform, linking full process services, creating standardized service processes, and providing patients with comprehensive, full process, professional, and accurate full cycle intervention management and care. The hospital covered diseases in stages, ensuring continuous medical for patients after leaving the hospital, improving their medical experience, and supporting the high-quality development of the hospital. As of June 2024, the hospital′s multidisciplinary whole course management services had covered 25 departments and 41 disease, and 43 management teams have been established. A total of 7 453 patients signed up for the whole course service. This practice achieved good results, could provide references for the implementation of whole course management services led by public hospitals.

Objective:To explore the risk factors for complications of facial autologous fat transplantation.Methods:A total of 51 female patients (case group) with moderate to severe complications following facial autologous fat transplantation at the Fourth Medical Center of Chinese PLA General Hospital from November 2016 to October 2022 were included in this retrospective study. The median age was 31.0 (27.0, 40.0) years. After age and surgical date were matched with ratio of 1∶1, a total of 51 female patients who received autologous fat transplants at several official medical facilities and experienced no complications within a year after the procedure made up the control group. The median age of the control group was 32.0 (26.0, 41.0) years. The clinical characteristics of the two groups were compared, and the factors for complications of facial autologous fat transplantation were examined using a multivariate logistic regression model.Results:In the case group, complications included facial artery embolism (7 cases), ophthalmic artery embolism (19 cases), infection (19 cases), and fat necrosis (6 cases), with 26 severe and 25 moderate cases. No significant differences were found between the two groups in age, body mass index (BMI), marital status, history of hypertension, infectious diseases, allergies, smoking, or alcohol consumption (all P>0.05). However, significant differences were observed in a history of facial surgery, perimenstrual phase, surgical site, and fat donor site (all P<0.05). Multivariate logistic regression analysis revealed that a history of facial surgery ( OR=17.289, 95% CI: 4.851-61.616, P<0.001) and the surgical site being a clinic/outpatient department (compared to a hospital, OR=7.708, 95% CI: 2.482-23.939, P<0.001) were risk factors for postoperative complications after facial autologous fat transplantation. Conclusion:A history of facial surgery and the surgical site being a clinic/outpatient department (compared to a hospital) are risk factors for complications of facial autologous fat transplantation.

Objective:To investigate the clinical effect of microplasma radiofrequency combined with oral traditional Chinese medicine (TCM) Babao Dan capsule to improve damp-heat TCM constitution in the treatment of hypertrophic scar.Methods:A prospective randomized controlled trial method was used to recruit patients diagnosed with damp-heat TCM constitution and suffering from hypertrophic scar who admitted to the Fourth Medical Center of Chinese PLA General Hospital from March to July 2024. All patients were randomly divided into microplasma radiofrequency combined with TCM treatment group (combination group), microplasma radiofrequency (RF) treatment group (RF group), and oral TCM treatment group (TCM group). Both the combination group and the RF group were treated with a microplasma radiofrequency instrument. Transverse, longitudinal and oblique scar grinding were performed three times with 90 W power, and regular scabs appeared in the treatment area as the treatment end point. After RF treatment in the combination group and the TCM group, Babao Dan capsule was taken with regular warm water, 0.6 g each time, 3 times/day, for 3 months. The Vancouver scar scale (VSS) score (higher score indicating more severe scar), visual analogue scale (VAS) of scar pain and itch (higher score indicating more severe symptom), and TCM constitution score (higher score indicating more severe moist heat constitution) were compared before treatment and 3 months after the first treatment. SPSS 26.0 software was used for statistical analysis. Measurement data conforming to normal distribution were expressed as Mean±SD, ANOVA was used for comparison among groups, and LSD- t method was used for pair comparison between groups. Paired sample t test was used before and after treatment in the same group. Counting data were expressed as cases (%), and the χ2 test was used for inter-group comparison. P<0.05 was considered statistically significant. Results:A total of 60 patients were included, 20 in each group. There were no significant differences in gender distribution, disease course, scar area and distribution among the three groups ( P>0.05), indicating comparability. Before treatment, there were no statistically significant differences in VSS, VAS and TCM physique scores among the 3 groups ( P>0.05). After treatment, VAS scores in the 3 groups, VSS scores in combination group and RF group, TCM physique scores in combination group and TCM group were improved compared with those before treatment, and the differences were statistically significant ( P<0.05). The VSS score of the combination group was significantly lower than that of the RF group and the TCM group ( P<0.05), but there was no statistical significance between the RF group and the TCM group ( P>0.05). The pruritus VAS score of the combination group was significantly lower than that of TCM group and RF group ( P<0.05), but there was no statistical significance between RF group and TCM group ( P>0.05). There was no significant difference in pain VAS scores among the three groups after treatment ( P>0.05). The TCM physique scores of the combination group and TCM group were significantly lower than those of the RF group ( P<0.01), but there was no statistical significance between the combination group and TCM group ( P>0.05). Conclusion:Microplasma radiofrequency combined with oral Babao Dan capsule can effectively improve the VSS score, pain and pruritus of hypertrophic scars in patients with damp-heat constitution, and the effect is better than that of radiofrequency or TCM alone.

OBJECTIVE: To analyze the prognosis of fetuses identified with de novo variants of unknown significance (VOUS) by chromosome microarray analysis (CMA). METHODS: A total of 6 826 fetuses who underwent prenatal CMA detection at the Prenatal Diagnosis Center of Drum Tower Hospital from July 2017 to December 2021 were selected as the study subjects. The results of prenatal diagnosis, and outcome of fetuses identified with VOUS of de novo origin were followed up. RESULTS: Among the 6 826 fetuses, 506 have carried VOUS, of which 237 were detected for the parent-of-origin and 24 were found to be de novo. Among the latters, 20 were followed up for 4 to 24 months. Four couples had opted elective abortion, 4 had developed clinical phenotypes after birth, and 12 were normal. CONCLUSION Fetuses with VOUS should be continuously follow-up, in particular those carrying de novo VOUS, in order to clarify their clinical significance.
Pregnancy ; Female ; Humans ; DNA Copy Number Variations ; Follow-Up Studies ; Prenatal Diagnosis/methods* ; Chromosomes ; Microarray Analysis/methods* ; Fetus ; Chromosome Aberrations

Objective:Focusing on the medical protection of marine sports events at the 19th Asian Games in Hangzhou. This paper analyzes the effect of the development and implementation of the medical protection program to provide a referable summary of experience for the medical protection of future large-scale international maritime events.Method:This paper retrospectively analyzed the medical protection of Ningbo Xiangshan Yafan Center during the preparation stage of the Asian Games Sailing Competition, and during the period from September 21 to September 27, 2023 when the Asian Games Sailing Competition is held. Analyze the organizational structure and scheme of medical support.Results:During this Asian Games sailing competition, there were a total of 14 paramedics, 4 rescue helicopter crews, 2 ambulances and 1 rescue helicopter in and around the competition venues. In the city, the designated hospital has set up a total of 12 working groups, 15 protection outpatient clinics and a number of various types of clinic areas. There are 129 medical and nursing staff directly participating in the medical protection work of the Asian Games. A total of 44 specialized beds were reserved in the designated hospitals. There were also a number of volunteers and logistic staff who relied on the support work. The top three major disease types were trauma with 66 cases (29.2%), upper respiratory tract infection with 34 cases (15.04%) and skin allergy with 19 cases (8.51%). The top two population groups consulted were staff with 95 visits (44.19%) and technical officers with 89 visits (41.40%).Conclusions:During the sailing competitions of the Asian Games, the medical care was smooth and orderly. Trauma, upper respiratory tract infections and skin allergies are the most prominent diseases. The number of medical consultations for staff and technical officials of the Asian Games Sailing Competition accounted for more than 80% of the total number of consultations for all personnel. They should be given priority care.