Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Objective To explore the risk factors for healthcare-associated infection(HAI)in lung transplant re-cipients(LTRs),and construct a predictive nomogram model.Methods Clinical data of patients who underwent lung transplant in Wuxi People's Hospital from January 2019 to December 2023 were analyzed retrospectively.The patients were divided into a training set(n=506)and a validation set(n=218).Independent risk factors were screened through LASSO regression,and multivariate logistic regression was included to construct a nomogram pre-diction model.The discrimination,calibration,and clinical applicability of the model were evaluated using receiver operating characteristic(ROC)curves,Hosmer-Lemeshow goodness-of-fit,and decision curves.Results Among the 506 LTRs,201 developed HAIs,with an incidence of 39.72％.The major infection site was lower respiratory tract,and the major pathogen were Gram-negative bacilli(Acinetobacter baumannii).Older age,use of extracorpo-real membrane oxygenation(ECMO),double-lung transplant,surgery duration＞3 hours,long duration of contin-uous fever,frequent abnormal blood routine examination,and long duration of combined use of antimicrobial agents were identified as independent risk factors for HAI after lung transplant.The ROC curve analysis results showed that the areas under the curve(AUCs)of the training set and the validation set were 0.74(95％CI:0.70-0.78)and 0.71(95％CI:0.64-0.78),respectively.The Hosmer-Lemeshow test results showed that there was no sta-tistically significant difference between the predictive and actual probability of HAI(P＞0.05).The clinical decision curve results indicated that the model had clinical benefits at a threshold probability value of 7％-71％.Conclusion The nomogram prediction model constructed in this study can effectively evaluate the risk of postoperative infection in LTRs.The model is stable and has high clinical application value,providing scientific reference for postoperative infection prevention and control.

Objective To analyze the characteristics of postoperative hospital-acquired infections and drug sensitivity in lung transplant recipients over the past 5 years in a single center. Methods A total of 724 lung transplant recipients at Wuxi People's Hospital from January 2019 to December 2023 were selected. Based on the principles of hospital-acquired infection diagnosis, a retrospective analysis was conducted on the hospital infection situation and infection sites of lung transplant recipients, and an analysis of the distribution of hospital-acquired infection pathogens and their antimicrobial susceptibility test status was performed. Results Among the 724 lung transplant recipients, 275 cases of hospital-acquired infection occurred, with an infection rate of 38.0%. The case-time infection rate decreased from 54.2% in 2019 to 22.8% in 2023, showing a downward trend year by year (Z=30.98, P<0.001). The main infection site was the lower respiratory tract, accounting for 73.6%. The pathogens were mainly Gram-negative bacteria, with the top four being Acinetobacter baumannii (37.1%), Pseudomonas aeruginosa (17.3%), Klebsiella pneumoniae (13.7%), and Stenotrophomonas maltophilia (13.4%), with imipenem resistance rates of 89%, 53%, 58% and 100%, respectively. Gram-positive bacteria were mainly Staphylococcus aureus (3.6%), with a methicillin resistance rate of 67%. Conclusions Over the past 5 years, the hospital-acquired infections in lung transplant recipients have shown a downward trend, mainly involving lower respiratory tract infections, with the main pathogens being Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae, all of which have high resistance rates to imipenem.

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 evaluate the effect of multi-disciplinary team(MDT)management mode on the preven-tion and control of carbapenem-resistant Enterobacterales(CRE)infection after lung transplant surgery,and explore the influencing factors for CRE infection after lung transplant.Methods A total of 654 lung transplant recipients from Lung Transplant Center of Wuxi People's Hospital from January 2014 to July 2023 were selected as the re-search subjects.According to the time nodes of the implementation of MDT management mode,lung transplant re-cipients from January 2014 to December 2019 were assigned to the control group without implementation of MDT management mode.Lung transplant recipients from January 2020 to July 2023 were in the intervention group with MDT management mode implementation.Kaplan-Meier method was used to calculate the risk of CRE infection in lung transplant recipients 90 days after surgery.Cox regression model was used to adjust variables such as length of hospital stay,surgical duration,and catheterization days of three catheters,and the effect of implementing MDT management mode on the risk of CRE infection was analyzed.Results Among 654 lung transplant recipients,215 had healthcare-associated infection(HAI),including 158 cases from the control group and 57 from the intervention group,with HAI rates of 38.54％and 23.36％,respectively.The incidence of HAI in lung transplant recipients in the intervention group was lower than that in the control group(x2=15.965,P＜0.001).A total of 74 cases of CRE infection were confirmed,and CRE infection rate in the intervention group was lower than that in the control group(7.79％[19/244]vs 13.41％[55/410];x2=4.828,P=0.028).By the end of the 90-day follow-up period,the cumulative infection risks of the control group and intervention group were 14.67％and 8.26％,respectively,with a statistically significant difference between the two groups(P＜0.05).The implementation of MDT manage-ment mode was a protective factor for post-operative CRE infection in lung transplant recipients,while duration of surgery,duration of ventilator use,and duration of urinary catheterization were risk factors for CRE infection(all P＜0.05).Conclusion Implementing MDT management mode in lung transplant recipients can effectively reduce the risk of post-operative CRE infection.Continuously standardizing and implementing MDT management of multidrug-resistant organisms in hospitals is an important mean of preventing CRE infection and controlling transmission.

Objective To explore the risk factors for healthcare-associated infection(HAI)in lung transplant re-cipients(LTRs),and construct a predictive nomogram model.Methods Clinical data of patients who underwent lung transplant in Wuxi People's Hospital from January 2019 to December 2023 were analyzed retrospectively.The patients were divided into a training set(n=506)and a validation set(n=218).Independent risk factors were screened through LASSO regression,and multivariate logistic regression was included to construct a nomogram pre-diction model.The discrimination,calibration,and clinical applicability of the model were evaluated using receiver operating characteristic(ROC)curves,Hosmer-Lemeshow goodness-of-fit,and decision curves.Results Among the 506 LTRs,201 developed HAIs,with an incidence of 39.72％.The major infection site was lower respiratory tract,and the major pathogen were Gram-negative bacilli(Acinetobacter baumannii).Older age,use of extracorpo-real membrane oxygenation(ECMO),double-lung transplant,surgery duration＞3 hours,long duration of contin-uous fever,frequent abnormal blood routine examination,and long duration of combined use of antimicrobial agents were identified as independent risk factors for HAI after lung transplant.The ROC curve analysis results showed that the areas under the curve(AUCs)of the training set and the validation set were 0.74(95％CI:0.70-0.78)and 0.71(95％CI:0.64-0.78),respectively.The Hosmer-Lemeshow test results showed that there was no sta-tistically significant difference between the predictive and actual probability of HAI(P＞0.05).The clinical decision curve results indicated that the model had clinical benefits at a threshold probability value of 7％-71％.Conclusion The nomogram prediction model constructed in this study can effectively evaluate the risk of postoperative infection in LTRs.The model is stable and has high clinical application value,providing scientific reference for postoperative infection prevention and control.

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 evaluate the effect of multi-disciplinary team(MDT)management mode on the preven-tion and control of carbapenem-resistant Enterobacterales(CRE)infection after lung transplant surgery,and explore the influencing factors for CRE infection after lung transplant.Methods A total of 654 lung transplant recipients from Lung Transplant Center of Wuxi People's Hospital from January 2014 to July 2023 were selected as the re-search subjects.According to the time nodes of the implementation of MDT management mode,lung transplant re-cipients from January 2014 to December 2019 were assigned to the control group without implementation of MDT management mode.Lung transplant recipients from January 2020 to July 2023 were in the intervention group with MDT management mode implementation.Kaplan-Meier method was used to calculate the risk of CRE infection in lung transplant recipients 90 days after surgery.Cox regression model was used to adjust variables such as length of hospital stay,surgical duration,and catheterization days of three catheters,and the effect of implementing MDT management mode on the risk of CRE infection was analyzed.Results Among 654 lung transplant recipients,215 had healthcare-associated infection(HAI),including 158 cases from the control group and 57 from the intervention group,with HAI rates of 38.54％and 23.36％,respectively.The incidence of HAI in lung transplant recipients in the intervention group was lower than that in the control group(x2=15.965,P＜0.001).A total of 74 cases of CRE infection were confirmed,and CRE infection rate in the intervention group was lower than that in the control group(7.79％[19/244]vs 13.41％[55/410];x2=4.828,P=0.028).By the end of the 90-day follow-up period,the cumulative infection risks of the control group and intervention group were 14.67％and 8.26％,respectively,with a statistically significant difference between the two groups(P＜0.05).The implementation of MDT manage-ment mode was a protective factor for post-operative CRE infection in lung transplant recipients,while duration of surgery,duration of ventilator use,and duration of urinary catheterization were risk factors for CRE infection(all P＜0.05).Conclusion Implementing MDT management mode in lung transplant recipients can effectively reduce the risk of post-operative CRE infection.Continuously standardizing and implementing MDT management of multidrug-resistant organisms in hospitals is an important mean of preventing CRE infection and controlling transmission.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Objective To evaluate the effectiveness of multi-disciplinary team (MDT) mode in the prevention and control of multidrug resistant organism (MDRO) infection in lung transplant recipients. Methods Lung transplant recipients admitted to the hospital from 2019 to 2022 were enrolled. MDT expert group was established in January, 2020. A series of prevention and control measures were conducted. The implementation rate of MDRO prevention and control measures and the detection rate of MDRO on the environmental surface from 2020 to 2022, and the detection rate of MDRO in lung transplant recipients from 2019 to 2022 were analyzed. Results The overall implementation rate of MDRO prevention and control measures for medical staff was increased from 64.9% in 2020 to 91.6% in 2022, showing an increasing trend year by year (P<0.05). The detection rate of MDRO on the environmental surface was decreased from 28% in 2020 to 9% in 2022, showing a downward trend year by year (P<0.05). The detection rate of MDRO in lung transplant recipients was decreased from 66.7% in 2019 to 44.3% in 2022, showing a decreasing trend year by year (P<0.001). Conclusions MDT mode management may enhance the implementation of MDRO prevention and control measures for medical staff, effectively reduce the infection rate of MDRO in lung transplant recipients and the detection rate of MDRO on the environmental surface, which is worthy of widespread application.