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.

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.

As the window of the hospital,the emergency department's medical quality determines the medical quality of the entire hospital.Emergency medical safety is the key to hospital construction.However,due to problems such as staffing and medical technology in the department of emergency of Chinese Medicine Hospitals,the development of medical quality is highly unbalanced.Aiming at the medical safety problems in the department of emergency of Chinese Medicine Hospitals in our country,the department of emergency of the Second Affiliated Hospital of Guangzhou University of Chinese Medicine analyzed the current situation at home and abroad,examined the causes of medical errors,and put forward suggestions for the reform of medical safety in the department of emergency of Chinese Medicine Hospitals.It is recommended to effectively reduce medical errors through a series of reform measures such as hardware transformation and upgrading,standardization of standard procedures,establishing a sound communication mechanism,and creating a safety culture.

Objective:To investigate the application of combined gastroscopy and laparoscopy (dual scope) in the treatment of early gastric cancer.Methods:In this descriptive case series study, we retrospectively collected data on 15 patients with cT1b stage gastric cancer who had undergone combined laparoscopic and endoscopic surgery in the 900th Hospital of the People's Liberation Army of China from May 2020 to October 2022. The study cohort comprised nine men and six women of median age 59 (range: 47–76) years and median body mass index 20.9 (range: 18.3–26.2) kg/m 2. Seven of the lesions were located on the lesser curvature of the gastric antrum and eight in the gastric angle. All lesions were biopsied for pathological examination and evaluated by endoscopic ultrasonography, followed by endoscopic submucosal dissection (ESD) and laparoscopic regional lymph node dissection. Studied variables included surgical and pathological features, postoperative factors, and outcomes. Results:In this group of patients, the median (range) operative time for ESD was 45 (30–82) minutes, the duration of laparoscopic lymph node dissection (45.1±8.6) minutes, and the median (range) intraoperative blood loss during lymph node dissection 30 (10–80) mL. Of the 13 patients with negative postoperative horizontal margins, four were stage SM1 and had no lymph node metastases (Stage SM1) and nine were Stage SM2, of which had one positive regional lymph node and two received additional standard distal gastrectomy with D2 lymphadenectomy concurrently because of positive ESD specimens (lymph node negative). No lymph node metastases were found in the surgical specimens of these patients. The remaining two patients had positive vertical margins; both had undergone concurrent standard distal gastrectomy with D2 lymphadenectomy. One of them was found to be lymph node positive (No. 3, one node). Four patients had impaired gastric emptying after dual-scope treatment, all of whom recovered well with symptomatic management; one patient with a suspected lymphatic leak was also managed conservatively. There were no cases of postoperative bleeding, abdominal infection, or incisional infection. At a median follow-up of 14 (6–26) months, no tumor recurrence or metastasis had been identified in any of the patients. Three patients had a grade B nutrition score 3 to 6 months after surgery, all of whom had undergone major gastrectomy, and two patients who had undergone dual-scope surgery reported an increase in acid reflux and belching after surgery compared with the preoperative period.Conclusion:A combined technique is safe and feasible for the treatment of early gastric cancer and is worthy of further exploration.

Objective:To investigate the application of combined gastroscopy and laparoscopy (dual scope) in the treatment of early gastric cancer.Methods:In this descriptive case series study, we retrospectively collected data on 15 patients with cT1b stage gastric cancer who had undergone combined laparoscopic and endoscopic surgery in the 900th Hospital of the People's Liberation Army of China from May 2020 to October 2022. The study cohort comprised nine men and six women of median age 59 (range: 47–76) years and median body mass index 20.9 (range: 18.3–26.2) kg/m 2. Seven of the lesions were located on the lesser curvature of the gastric antrum and eight in the gastric angle. All lesions were biopsied for pathological examination and evaluated by endoscopic ultrasonography, followed by endoscopic submucosal dissection (ESD) and laparoscopic regional lymph node dissection. Studied variables included surgical and pathological features, postoperative factors, and outcomes. Results:In this group of patients, the median (range) operative time for ESD was 45 (30–82) minutes, the duration of laparoscopic lymph node dissection (45.1±8.6) minutes, and the median (range) intraoperative blood loss during lymph node dissection 30 (10–80) mL. Of the 13 patients with negative postoperative horizontal margins, four were stage SM1 and had no lymph node metastases (Stage SM1) and nine were Stage SM2, of which had one positive regional lymph node and two received additional standard distal gastrectomy with D2 lymphadenectomy concurrently because of positive ESD specimens (lymph node negative). No lymph node metastases were found in the surgical specimens of these patients. The remaining two patients had positive vertical margins; both had undergone concurrent standard distal gastrectomy with D2 lymphadenectomy. One of them was found to be lymph node positive (No. 3, one node). Four patients had impaired gastric emptying after dual-scope treatment, all of whom recovered well with symptomatic management; one patient with a suspected lymphatic leak was also managed conservatively. There were no cases of postoperative bleeding, abdominal infection, or incisional infection. At a median follow-up of 14 (6–26) months, no tumor recurrence or metastasis had been identified in any of the patients. Three patients had a grade B nutrition score 3 to 6 months after surgery, all of whom had undergone major gastrectomy, and two patients who had undergone dual-scope surgery reported an increase in acid reflux and belching after surgery compared with the preoperative period.Conclusion:A combined technique is safe and feasible for the treatment of early gastric cancer and is worthy of further exploration.

Objective: To explore the relationship between dietary patterns and non-alcoholic fatty liver disease(NAFLD) among college freshmen of Hangzhou area, and provide scientific evidence for the prevention of NAFLD in universities. Methods: The 1 752 freshmen students from six universities were selected to perform a questionnaire survey, including general information, and dietary survey in the last year, by using a random sampling method. Factor analysis was used to achieve the major dietary patterns. Results: Three dietary patterns were obtained from the analysis, including the animal food, Western fast food, and traditional Chinese patterns. After adjusting for confounding factors, participants in the highest tertile of the animal food and Western fast food pattern had significantly higher BMI (P<0.01). Besides, participants in the highest tertile of the Western fast-food pattern had higher ALT and AST than those in the lowest tertile(P<0.05). Conversely, participants in the highest tertile of the traditional Chinese pattern had lower BMI, ALT and AST than those in the lowest tertile(P<0.05). Logistic regression analysis showed that Western pattern might increase the risk of NAFLD (OR=1.26, 95%CI=1.09-1.72, P<0.05), whereas the traditional Chinese pattern might decrease the risk of NAFLD (OR=0.51, 95%CI=0.38-0.74, P<0.05). Conclusion Different dietary patterns are closely related to NAFLD in college freshmen. Chinese traditional food should be kept their diet, red meat and fried food should be reduced to decrease. the risk of NAFLD.

BACKGROUND: Low power laser irradiation has positive effects on fracture healing, including shortening the time of bone union and enhancement of bone formation. OBJECTIVE: To evaluate the effects of different wave lengths in low power laser on eedy fracture healing. DESIGN, TIME AND SETTING: Randomized, controlled, animal experiment. The study was performed at the Laser Center of Dankook University Medical Center between May 2005 and May 2006. MATERIALS: A total of 60 female English Hartley guinea pigs, 9 weeks old, weighing (300～30) g, were used for this experiment. They were randomly divided into three groups control, 632, and 830 nm groups (n=20). METHODS: The right femoral middle shaft fractures were made with a bone cutter and fixed with intramedullary nails (1.4 mm diameter K-wire). The frequencies of 632 nm and 830 nm semi-conductor laser machines were used. The laser irradiations were started 48 hours after operation vertically at the fracture sites and were applied every two days, at 100 J/cm<'2> of the same irradiation doses and 2.52 cm<'2> of the same irradiation areas in different irradiation groups. Finally, 46 guinea pigs survived, including 14 in control group, 16 in 632 nm group and 16 in 830 nm group. MAIN OUTCOME MEASURES: Guinea pigs were sacdficed at 3 and 6 weeks separately. The bone healing was assessed by the Modified Zorlu Scoring System, including gross, radiologic and histologic examinations. RESULTS: In the gross and radiologic findings, both 632 nm and 830 nm irradiation groups shown a significantly greater rate of callus formation at postoperatively 3 weeks compared to the control group (P< 0.01). Quantity of callus formation in 830 nm group was more than 632 nm group, but there was no significant difference (P > 0.05). The result of histological findings showed a significant increase of osteoblastic proliferation in two irradiation groups than the control group at 3 weeks postoperatively (P < 0.01). Enhancement of osteoblastic proliferation was more obvious in 830 nm group than in 632 nm group at 3 and 6 weeks, but there was no significant difference (P > 0.05).CONCLUSION: Both 632 nm and 830 nm wave lengths are considered to be optimal irradiation wave lengths for eady fracture healing. Moreover, 830 nm irradiation is better than 632 nm irradiation for eady fracture healing.

Objective To investigate the influence of three kinds of different Ca~(2+) concentration of dialysate on serum calcium,calcium-phosphorus product,serum PTH and CRP in maintenance hemodialysis patients.Methods 45 patients of maintenance hemodialysis with ages ≥18 years were selected.They were divided randomly three groups,and be given three different kinds of Ca~(2+) concentration of dialysate to carry out hemodialysis with 3 months.Then the patients' variation of blood pressure and whether there were low calcium spasm or ostealgia were abserved during hemodialysis whole range.In addition,changes of their serum calcium、phosphorus、iPTH and CRP at pretherapy and three months after reatment were also detected.Results After three months of hemodialysis,serum iPTH in patients with low Ca~(2+) concentration dialysate increased obviously,and the serum CRP decreased significantly(P0.05),and serum CRP increase notably(P