Objective:To investigate the impact of the number of cesarean deliveries on adverse maternal and neonatal outcomes.Methods:A retrospective analysis was conducted on 11 904 singleton pregnant women who underwent cesarean delivery at the Third Affiliated Hospital of Guangzhou Medical University from January 1st, 2019 to December 31st, 2023. The women were grouped according to the number of cesarean deliveries: those undergoing their first cesarean delivery (1CD group, 7 231 cases), those undergoing their second cesarean delivery (2CD group, 3 749 cases), those undergoing their third cesarean delivery (3CD group, 841 cases), and those undergoing their fourth or more cesarean deliveries (4CD group, 83 cases). Differences in clinical characteristics, related surgical procedures, and adverse maternal and neonatal outcomes among the groups were compared. Binary logistic regression analysis was used to assess the impact of the number of cesarean deliveries on related surgical procedures and adverse maternal and neonatal outcomes.Results:(1) During the 5-year period, the total number of women undergoing cesarean delivery in our hospital showed a slight downward trend, while the proportion of women undergoing three or more cesarean deliveries increased. (2) Compared with women undergoing their first cesarean delivery, women in each repeat cesarean delivery group were older, had higher proportions of advanced maternal age and pre-pregnancy body mass index, and had more pregnancies, deliveries, and induced abortions; the incidence of placenta previa, placental implantation, antepartum hemorrhage, gestational hyperglycemia, and failed trial of labor requiring conversion to surgery was higher, while the incidence of premature rupture of membranes was lower; the proportions of ureteral stent placement, adhesiolysis of the pelvic and abdominal cavities, uterine rupture, uterine reconstruction, uterine artery ligation, hysterectomy, postpartum hemorrhage, and postoperative intestinal obstruction were higher, and the amount of postpartum hemorrhage was greater; the gestational age at delivery of neonates was earlier, but the rates of preterm birth at 28-31 +6 and 32-33 +6 weeks of gestation were lower; the differences were statistically significant ( P<0.05) for all comparisons. (3) The number of cesarean deliveries was not an independent risk factor for the dose-dependent occurrence of placenta previa (a OR=0.99, 95% CI: 0.98-1.01; P=0.261). In women without placenta previa, the number of cesarean deliveries was not a risk factor for placental implantation (a OR=1.12, 95% CI: 0.90-1.39; P=0.320). However, in women with placenta previa, the number of cesarean deliveries was a risk factor for placental implantation (a OR=4.01, 95% CI: 3.08-5.22; P<0.001). In the overall population, the number of cesarean deliveries was a risk factor for ureteral stent placement, adhesiolysis of the pelvic and abdominal cavities, bladder rupture repair, uterine rupture, uterine reconstruction, uterine artery ligation, hysterectomy, postpartum hemorrhage, and preterm birth (all P<0.05). However, the number of cesarean deliveries was not a risk factor for postoperative intestinal obstruction, admission to the intensive care unit, neonatal asphyxia, admission to the neonatal intensive care unit, or neonatal death (all P<0.05). Conclusions:The number of cesarean deliveries could lead to adverse maternal and neonatal outcomes, but the relationship is not simply dose-dependent. It is speculated that the occurrence of severe adverse maternal and neonatal outcomes is more closely related to maternal complications and comorbidities, as well as whether multidisciplinary comprehensive management was received.

The accuracy of medical imaging diagnosis will directly impact the clinical forensic evaluation's scientific validity and objectivity.This study systematically analyzed the primary causes of misdiagnosis and missed diagnosis in imaging examinations,focusing on representative cases,including rib fractures,traumatic subarachnoid hemorrhage,joint injuries with ligament damage,nasal fractures,congenital skeletal variations,and epiphyseal injuries.Key contributing factors encompassed limitation of imaging technologies,the insufficient interpretive experience of examiners,the complexity of injury mechanisms,and inadequate post-traumatic dynamic imaging follow-up.To address these issues,improvement strategies are proposed,which were establishing standardized imaging review protocols,implementing multimodal imaging approaches,rigorous evaluation of original imaging data,and enhancing professional knowledge regarding anatomical variations and injury differentiation.These measures aim to elevate the quality of forensic imaging diagnosis,providing more precise and reliable strategies for forensic clinical identifications.

Objective:To investigate the impact of the number of cesarean deliveries on adverse maternal and neonatal outcomes.Methods:A retrospective analysis was conducted on 11 904 singleton pregnant women who underwent cesarean delivery at the Third Affiliated Hospital of Guangzhou Medical University from January 1st, 2019 to December 31st, 2023. The women were grouped according to the number of cesarean deliveries: those undergoing their first cesarean delivery (1CD group, 7 231 cases), those undergoing their second cesarean delivery (2CD group, 3 749 cases), those undergoing their third cesarean delivery (3CD group, 841 cases), and those undergoing their fourth or more cesarean deliveries (4CD group, 83 cases). Differences in clinical characteristics, related surgical procedures, and adverse maternal and neonatal outcomes among the groups were compared. Binary logistic regression analysis was used to assess the impact of the number of cesarean deliveries on related surgical procedures and adverse maternal and neonatal outcomes.Results:(1) During the 5-year period, the total number of women undergoing cesarean delivery in our hospital showed a slight downward trend, while the proportion of women undergoing three or more cesarean deliveries increased. (2) Compared with women undergoing their first cesarean delivery, women in each repeat cesarean delivery group were older, had higher proportions of advanced maternal age and pre-pregnancy body mass index, and had more pregnancies, deliveries, and induced abortions; the incidence of placenta previa, placental implantation, antepartum hemorrhage, gestational hyperglycemia, and failed trial of labor requiring conversion to surgery was higher, while the incidence of premature rupture of membranes was lower; the proportions of ureteral stent placement, adhesiolysis of the pelvic and abdominal cavities, uterine rupture, uterine reconstruction, uterine artery ligation, hysterectomy, postpartum hemorrhage, and postoperative intestinal obstruction were higher, and the amount of postpartum hemorrhage was greater; the gestational age at delivery of neonates was earlier, but the rates of preterm birth at 28-31 +6 and 32-33 +6 weeks of gestation were lower; the differences were statistically significant ( P<0.05) for all comparisons. (3) The number of cesarean deliveries was not an independent risk factor for the dose-dependent occurrence of placenta previa (a OR=0.99, 95% CI: 0.98-1.01; P=0.261). In women without placenta previa, the number of cesarean deliveries was not a risk factor for placental implantation (a OR=1.12, 95% CI: 0.90-1.39; P=0.320). However, in women with placenta previa, the number of cesarean deliveries was a risk factor for placental implantation (a OR=4.01, 95% CI: 3.08-5.22; P<0.001). In the overall population, the number of cesarean deliveries was a risk factor for ureteral stent placement, adhesiolysis of the pelvic and abdominal cavities, bladder rupture repair, uterine rupture, uterine reconstruction, uterine artery ligation, hysterectomy, postpartum hemorrhage, and preterm birth (all P<0.05). However, the number of cesarean deliveries was not a risk factor for postoperative intestinal obstruction, admission to the intensive care unit, neonatal asphyxia, admission to the neonatal intensive care unit, or neonatal death (all P<0.05). Conclusions:The number of cesarean deliveries could lead to adverse maternal and neonatal outcomes, but the relationship is not simply dose-dependent. It is speculated that the occurrence of severe adverse maternal and neonatal outcomes is more closely related to maternal complications and comorbidities, as well as whether multidisciplinary comprehensive management was received.

The accuracy of medical imaging diagnosis will directly impact the clinical forensic evaluation's scientific validity and objectivity.This study systematically analyzed the primary causes of misdiagnosis and missed diagnosis in imaging examinations,focusing on representative cases,including rib fractures,traumatic subarachnoid hemorrhage,joint injuries with ligament damage,nasal fractures,congenital skeletal variations,and epiphyseal injuries.Key contributing factors encompassed limitation of imaging technologies,the insufficient interpretive experience of examiners,the complexity of injury mechanisms,and inadequate post-traumatic dynamic imaging follow-up.To address these issues,improvement strategies are proposed,which were establishing standardized imaging review protocols,implementing multimodal imaging approaches,rigorous evaluation of original imaging data,and enhancing professional knowledge regarding anatomical variations and injury differentiation.These measures aim to elevate the quality of forensic imaging diagnosis,providing more precise and reliable strategies for forensic clinical identifications.

Objective:To explore the reform path of clinical laboratory technical talents training in local universities under the background of "New Medicine".Methods:The present situation of medical laboratory technical personnel training under the background of "New Medicine" was analyzed, and the teaching mode, teaching platform and practical teaching were reformed according to the reality of Guizhou Medical University.Results:An open education system of "healthcare-education collaboration and academia-industry alliances" and the talent training mode of "three-oriented drive, four-sided integration" had been formed, which improved the training quality and provided a large number of qualified medical laboratory technical undergraduate talents to the grass-roots of Guizhou Medical System.Conclusion:The reform and practice of applied talent training in Guizhou Medical University can be used as a reference for local colleges and universities to educate applied medical laboratory technical talents.

Objective:To discuss the effect and prognostic factors of immediate facial nerve rehabilitation in malignant parotid gland tumor surgery.Methods:The patients with malignant parotid gland tumor who underwent facial nerve rehabilitation surgery in Peking University School and Hospital of Stomatology from January 2004 to July 2020 were retrospectively analyzed. Their demographic characteristics, preoperative and postoperative facial nerve function according to the House-Brackmann (HB) facial nerve grading system from HB grade Ⅰ to HB grade Ⅵ, injury sites of facial nerve including the trunks injury and branches injury, surgical timing including immediate rehabilitation and elective rehabilitation and rehabilitation methods such as facial nerve anastomosis, nerve transplantation, nerve transfer and muscle flap suspension were recorded. Patients were divided into two groups: satisfactory outcomes with HB grades Ⅰ-Ⅲ and unsatisfactory outcomes with HB grades Ⅳ-Ⅵ, and the factors that may affect the prognosis of facial nerve function were statistically analyzed. T-test was used to compare measurement data, chi-square test or Fisher’s precision probability test was used to compare count data. P<0.05 was considered statistically significant. Results:Eighty-nine patients were included in the study, including 50 males and 39 females, aged 9-82 years, the median age was 49.0 years. Preoperative facial nerve function outcomes were HB Ⅰ ( n=57), HB Ⅱ ( n=5), HB Ⅲ ( n=8), HB Ⅳ ( n=2), HB Ⅴ ( n=15) and HB Ⅵ ( n=2). Fifty-seven patients underwent immediate rehabilitation and 32 patients received elective rehabilitation. In 53 cases, the main trunk and/or the temporal and cervical trunk were injured, and 36 cases were branches injury. Facial nerve anastomosis was performed in 35 cases, 39 cases required nerve transplantation, 12 cases underwent nerve transfer, and 3 cases underwent muscle flap suspension. The follow-up time was 6-72 months. Postoperative facial nerve function outcomes were HB Ⅰ ( n=6), HB Ⅱ ( n=17), HB Ⅲ ( n=26), HB Ⅳ ( n=27), and HB Ⅴ ( n=13). Forty-nine cases were classified as group with postoperative HB grades Ⅰ-Ⅲ, and 40 cases were classified as group with postoperative HB grades Ⅳ-Ⅵ. Statistical analysis showed that there was no significant difference in terms of age and gender between two groups ( P>0.05). Among the patients with postoperative HB grades Ⅰ-Ⅲ, 73.5% (36/49) of the patients had immediate rehabilitation, 36.7% (18/49) of the patients had injury of the nerve trunks, 89.8% (44/49) of the patients had preoperative HB grades Ⅰ-Ⅲ, and 59.2% (29/49) of the patients had nerve anastomosis. Among the patients with postoperative HB grades Ⅳ-Ⅵ, 52.5% (21/40) of the patients had immediate rehabilitation, 87.5% (35/40) of the patients had injury of the nerve trunks, 65.0% (26/40) of the patients had preoperative HB gradesⅠ-Ⅲ, and 15.0% (6/40) of the patients had nerve anastomosis were in the group. There were statistically significant differences between the two groups ( P<0.05 or <0.01). Conclusions:Immediate reconstruction of the facial nerve defect during the operation of malignant parotid gland tumor can obtain better result. Furthermore, injury sites of facial nerve may affect the prognosis of facial nerve function as well.

Objective:To discuss the effect and prognostic factors of immediate facial nerve rehabilitation in malignant parotid gland tumor surgery.Methods:The patients with malignant parotid gland tumor who underwent facial nerve rehabilitation surgery in Peking University School and Hospital of Stomatology from January 2004 to July 2020 were retrospectively analyzed. Their demographic characteristics, preoperative and postoperative facial nerve function according to the House-Brackmann (HB) facial nerve grading system from HB grade Ⅰ to HB grade Ⅵ, injury sites of facial nerve including the trunks injury and branches injury, surgical timing including immediate rehabilitation and elective rehabilitation and rehabilitation methods such as facial nerve anastomosis, nerve transplantation, nerve transfer and muscle flap suspension were recorded. Patients were divided into two groups: satisfactory outcomes with HB grades Ⅰ-Ⅲ and unsatisfactory outcomes with HB grades Ⅳ-Ⅵ, and the factors that may affect the prognosis of facial nerve function were statistically analyzed. T-test was used to compare measurement data, chi-square test or Fisher’s precision probability test was used to compare count data. P<0.05 was considered statistically significant. Results:Eighty-nine patients were included in the study, including 50 males and 39 females, aged 9-82 years, the median age was 49.0 years. Preoperative facial nerve function outcomes were HB Ⅰ ( n=57), HB Ⅱ ( n=5), HB Ⅲ ( n=8), HB Ⅳ ( n=2), HB Ⅴ ( n=15) and HB Ⅵ ( n=2). Fifty-seven patients underwent immediate rehabilitation and 32 patients received elective rehabilitation. In 53 cases, the main trunk and/or the temporal and cervical trunk were injured, and 36 cases were branches injury. Facial nerve anastomosis was performed in 35 cases, 39 cases required nerve transplantation, 12 cases underwent nerve transfer, and 3 cases underwent muscle flap suspension. The follow-up time was 6-72 months. Postoperative facial nerve function outcomes were HB Ⅰ ( n=6), HB Ⅱ ( n=17), HB Ⅲ ( n=26), HB Ⅳ ( n=27), and HB Ⅴ ( n=13). Forty-nine cases were classified as group with postoperative HB grades Ⅰ-Ⅲ, and 40 cases were classified as group with postoperative HB grades Ⅳ-Ⅵ. Statistical analysis showed that there was no significant difference in terms of age and gender between two groups ( P>0.05). Among the patients with postoperative HB grades Ⅰ-Ⅲ, 73.5% (36/49) of the patients had immediate rehabilitation, 36.7% (18/49) of the patients had injury of the nerve trunks, 89.8% (44/49) of the patients had preoperative HB grades Ⅰ-Ⅲ, and 59.2% (29/49) of the patients had nerve anastomosis. Among the patients with postoperative HB grades Ⅳ-Ⅵ, 52.5% (21/40) of the patients had immediate rehabilitation, 87.5% (35/40) of the patients had injury of the nerve trunks, 65.0% (26/40) of the patients had preoperative HB gradesⅠ-Ⅲ, and 15.0% (6/40) of the patients had nerve anastomosis were in the group. There were statistically significant differences between the two groups ( P<0.05 or <0.01). Conclusions:Immediate reconstruction of the facial nerve defect during the operation of malignant parotid gland tumor can obtain better result. Furthermore, injury sites of facial nerve may affect the prognosis of facial nerve function as well.

Objective:To evaluate the efficacy of postoperative radiotherapy (PRT) for dermatofibrosarcoma protuberans (DFSP).Methods:A systematic review and meta-analysis of articles published before February 23, 2019 were conducted. A total of 655 studies were retrieved consisting of 195 DFSP patients. Among them, 50 cases were assigned into the PRT group and 145 cases in the surgery alone (SA) group. The recurrence rate was statistically compared between two group.Results:Meta-analysis showed that the recurrence rate in the PRT group was significantly lower than that in the SA group (8% vs. 24.1%, OR=0.28, P=0.010). The recurrence rate of patients with positive margins in the PRT group was significantly lower compared with that in the SA group (8% vs. 61.5%, P=0.002). The recurrence rate of patients with negative margins in the PRT group had a decreasing trend than that in the SA group (6% vs. 21.6%, P=0.205). Conclusions:The recurrence rate of surgery combined with PRT is lower than that of SA. The recurrence rate of patients with positive margins is higher than that of those with negative margins. For patients with positive margins, PRT can decrease the recurrence rate. The recurrence rate trends to decline in patients with negative margins after receiving PRT.

Objective:To explore the application of experiential teaching combined with case-based learning (CBL) in the teaching of nursing students in intensive care unit (ICU).Methods:A total of 63 nurses who had internship in the ICU of our hospital from April 2016 to March 2017 were selected as group A, 63 nurses from April 2017 to March 2018 were selected as group B, 63 nurses from April 2018 to March 2019 were selected as group C, and 63 nurses from April 2019 to March 2020 were selected as group D. Group A adopted conventional teaching method, group B adopted conventional teaching method + CBL, group C adopted conventional teaching method + experiential teaching method, and group D adopted conventional teaching method + CBL + experiential teaching method. All of them had been taught for 3 months. The scores of theory and skills examination, humanistic care, supportive communication and critical thinking ability before and after teaching, and satisfaction with teaching mode were compared among the four groups. SPSS 26.0 was used for one-way variance analysis, SNK -q test and χ2 test. Results:The scores of theory and skill examination in group D were higher than those in the other three groups, and those in group B and C were higher than those in group A ( P<0.05). After teaching, the scores of humanistic care, supportive communication and critical thinking ability of the four groups were higher than those before teaching ( P<0.05). After teaching, the scores of humanistic care, supportive communication and critical thinking ability of group D were higher than those of the other three groups ( P<0.05), and those of group B and group C were higher than those of group A ( P<0.05). The satisfaction scores of teaching skills, teaching content and teaching effect in group D were higher than those in the other three groups ( P<0.05), and those in group B and C were higher than those in group A ( P<0.05). Conclusion:On the basis of conventional teaching method, experiential teaching and CBL can improve the performance of nursing students, improve the ability of humanistic care, supportive communication and critical thinking, and improve the satisfaction of nursing students. The combination of the two has a better effect.

In order to develop a method to more accurately determine the surgical boundary of extramammary Paget′s disease, reflectance confocal microscopy was used to determine the tumor boundary followed by modified extended excision in 2 cases of pathologically diagnosed extramammary Paget′s disease of the vulva. No residual tumor was observed in the resection margins by postoperative pathological examination at 4 positions (12, 3, 6 and 9 o′clock) , and follow-up showed no recurrence 1 year later.