Objective To evaluate the impact of the"Surgical Quality and Safety Improvement Initiative"by analyzing changes in surgical quality and safety indicators at a tertiary hospital in Tianjin,and to provide policy recommendations for further enhancing surgical quality improvement pathways.Methods Surgical quality and safety monitoring data from 2022 to 2024 were collected from a tertiary hospital in Tianjin.Interrupted time series analysis(ITSA)was employed to assess the effects of im-provement measures on surgical quality and safety outcomes.Results Following implementation of the initiative,perioperative complication rates showed a declining trend(β3=-0.051,P＜0.05),unplanned reoperation rates significantly decreased(β2=-0.121,P＜0.05),and surgical mortality rates markedly declined(β2=-0.086,P＜0.05),indicating that the man-agement measures effectively improved hospital surgical quality and safety over the study period.Conclusion The"Surgical Quality and Safety Improvement Initiative,"which established a comprehensive,staff-involved pathway for continuous surgical quality improvement,successfully enhanced surgical quality and safety.Recommendations include emphasizing frontline staff par-ticipation in quality management,strengthening data monitoring and feedback systems,implementing reasonable performance in-centives to motivate systemic improvement,and leveraging health information technology to support refined surgical management.

Objective To evaluate the impact of the"Surgical Quality and Safety Improvement Initiative"by analyzing changes in surgical quality and safety indicators at a tertiary hospital in Tianjin,and to provide policy recommendations for further enhancing surgical quality improvement pathways.Methods Surgical quality and safety monitoring data from 2022 to 2024 were collected from a tertiary hospital in Tianjin.Interrupted time series analysis(ITSA)was employed to assess the effects of im-provement measures on surgical quality and safety outcomes.Results Following implementation of the initiative,perioperative complication rates showed a declining trend(β3=-0.051,P＜0.05),unplanned reoperation rates significantly decreased(β2=-0.121,P＜0.05),and surgical mortality rates markedly declined(β2=-0.086,P＜0.05),indicating that the man-agement measures effectively improved hospital surgical quality and safety over the study period.Conclusion The"Surgical Quality and Safety Improvement Initiative,"which established a comprehensive,staff-involved pathway for continuous surgical quality improvement,successfully enhanced surgical quality and safety.Recommendations include emphasizing frontline staff par-ticipation in quality management,strengthening data monitoring and feedback systems,implementing reasonable performance in-centives to motivate systemic improvement,and leveraging health information technology to support refined surgical management.

Objective To examine the serological and molecular prevalence as well as genotype characteristics of human Parvovirus B19 blood donors in Lanzhou,and to provide evidence for developing a screening strategy to reduce the risk of blood transfusion transmission.Methods A total of 5 722 blood samples collected from Lanzhou blood donors from April 2023 to October 2023 were tested for B19 DNA using real-time quantitative PCR(qRT-PCR).Additionally,383 samples were screened for anti-B19 IgG and anti-B19 IgM using synchronous enzyme-linked immunoassay(ELISA).Viral load and VP1 sequencing were conducted on the B19 DNA-positive samples and the Neighbor-Joining(N-J)method was used to construct an evolutionary tree for the sequenced samples.Results The prevalence of human Parvovirus B19 DNA,IgG antibody and IgM antibody was 0.47%(27/5 722),25.59%(98/383)and 0.26%(1/383),respectively,and the samples positive for B19 DNA,IgG antibody and IgM antibody were 0.26%(1/383).The co-positivity rate for B19 DNA and IgG antibody was 6.27%(24/383),while the positivity rates for B19 DNA or IgG antibody alone were 0.52%(2/383)and 19.06%(73/383),respectively.Viral loads ranged from 4.24 IU/ml to 5.67×102 IU/ml,all below 104 IU/ml.There was no statistical significance in the positive rate of B19 DNA in gender(χ2=0.86,P=0.35),but there was statistical significance in the positive rate of B19 DNA among all age groups(χ2=8.00,P=0.02).The highest positive rate of B19 DNA was 0.65%in the 18～30 age group.There was statistical significance in the positive rate of B19 IgG antibody in gender(χ2=5.03,P=0.02),but there was no statistical significance in the positive rate of B19 IgG antibody among all age groups(χ2=0.51,P=0.77).The highest positive rate of B19 IgG antibody was 29.09%in the age group of 41 to 60.There was no significant difference in the positive rate of B19 IgM antibody in gender(χ2=2.84,P=0.09).The highest positive rate of B19 IgM was 3.85%in the age group of 18～30 years old.Based on the VP1 sequence,the phylogenetic tree revealed that B19 strains in Lanzhou formed a distinct cladistic lineage within genotype 1,predominantly represented by genotype 1b.Conclusion The prevalence of B19 DNA and IgM antibodies among blood donors in the Lanzhou area is low,and so is the viral load.Therefore the risk of transmitting B19 through blood transfusion is relatively small.Since the prevalence of B19 IgG antibody is high,it is suggested to closely monitor the transmission situation in the area,regularly monitor the prevalence of B19 among blood donors,and track the situation of B19 DNA-positive blood donors to recipients to ensure the safety of clinical blood transfusion.

Objective To analyze the distribution characteristics and influencing factors of ultra-long hospitalization in malignant tumor patients and to explore strategies to reduce the average length of stay and enhance the efficiency of medical re-source utilization.Methods Ultra-long hospitalization was defined as the 99th percentile of hospital stay duration(P99=31 days).Data from patients discharged with malignant tumors in a specialized cancer hospital in 2024 were collected.The distribu-tion characteristics and influencing factors were analyzed using chi-square tests and logistic stepwise regression.Results Among the 36 097 patients with malignant tumors,the average length of stay was 4.95 days,with 375 cases classified as ultra-long hospi-talizations,accounting for 1.04％.These patients were predominantly over 55 years old,with a higher proportion of males.Pa-tients with stage Ⅲ malignant tumors,primary tumors classified as T2～T3,and primary sites in the esophagus,pancreas,and maxillofacial regions had a higher incidence of ultra-long hospitalizations.Significant factors influencing ultra-long hospitalization included treatment modality,complications(OR=20.319),number of discharge diagnoses(OR=6.915),ICU transfers(OR=4.714),unplanned reoperations(OR=4.416),tumor type,extent,and stage.Conclusion Medical institutions are advised to address the influencing factors of ultra-long hospitalizations by optimizing diagnostic and treatment processes,enhan-cing quality control systems,establishing early warning mechanisms,and strengthening information systems.These measures aim to improve the standardization of malignant tumor diagnosis and treatment,ensuring patient safety.

Objective To examine the serological and molecular prevalence as well as genotype characteristics of human Parvovirus B19 blood donors in Lanzhou,and to provide evidence for developing a screening strategy to reduce the risk of blood transfusion transmission.Methods A total of 5 722 blood samples collected from Lanzhou blood donors from April 2023 to October 2023 were tested for B19 DNA using real-time quantitative PCR(qRT-PCR).Additionally,383 samples were screened for anti-B19 IgG and anti-B19 IgM using synchronous enzyme-linked immunoassay(ELISA).Viral load and VP1 sequencing were conducted on the B19 DNA-positive samples and the Neighbor-Joining(N-J)method was used to construct an evolutionary tree for the sequenced samples.Results The prevalence of human Parvovirus B19 DNA,IgG antibody and IgM antibody was 0.47%(27/5 722),25.59%(98/383)and 0.26%(1/383),respectively,and the samples positive for B19 DNA,IgG antibody and IgM antibody were 0.26%(1/383).The co-positivity rate for B19 DNA and IgG antibody was 6.27%(24/383),while the positivity rates for B19 DNA or IgG antibody alone were 0.52%(2/383)and 19.06%(73/383),respectively.Viral loads ranged from 4.24 IU/ml to 5.67×102 IU/ml,all below 104 IU/ml.There was no statistical significance in the positive rate of B19 DNA in gender(χ2=0.86,P=0.35),but there was statistical significance in the positive rate of B19 DNA among all age groups(χ2=8.00,P=0.02).The highest positive rate of B19 DNA was 0.65%in the 18～30 age group.There was statistical significance in the positive rate of B19 IgG antibody in gender(χ2=5.03,P=0.02),but there was no statistical significance in the positive rate of B19 IgG antibody among all age groups(χ2=0.51,P=0.77).The highest positive rate of B19 IgG antibody was 29.09%in the age group of 41 to 60.There was no significant difference in the positive rate of B19 IgM antibody in gender(χ2=2.84,P=0.09).The highest positive rate of B19 IgM was 3.85%in the age group of 18～30 years old.Based on the VP1 sequence,the phylogenetic tree revealed that B19 strains in Lanzhou formed a distinct cladistic lineage within genotype 1,predominantly represented by genotype 1b.Conclusion The prevalence of B19 DNA and IgM antibodies among blood donors in the Lanzhou area is low,and so is the viral load.Therefore the risk of transmitting B19 through blood transfusion is relatively small.Since the prevalence of B19 IgG antibody is high,it is suggested to closely monitor the transmission situation in the area,regularly monitor the prevalence of B19 among blood donors,and track the situation of B19 DNA-positive blood donors to recipients to ensure the safety of clinical blood transfusion.

Objective To analyze the distribution characteristics and influencing factors of ultra-long hospitalization in malignant tumor patients and to explore strategies to reduce the average length of stay and enhance the efficiency of medical re-source utilization.Methods Ultra-long hospitalization was defined as the 99th percentile of hospital stay duration(P99=31 days).Data from patients discharged with malignant tumors in a specialized cancer hospital in 2024 were collected.The distribu-tion characteristics and influencing factors were analyzed using chi-square tests and logistic stepwise regression.Results Among the 36 097 patients with malignant tumors,the average length of stay was 4.95 days,with 375 cases classified as ultra-long hospi-talizations,accounting for 1.04％.These patients were predominantly over 55 years old,with a higher proportion of males.Pa-tients with stage Ⅲ malignant tumors,primary tumors classified as T2～T3,and primary sites in the esophagus,pancreas,and maxillofacial regions had a higher incidence of ultra-long hospitalizations.Significant factors influencing ultra-long hospitalization included treatment modality,complications(OR=20.319),number of discharge diagnoses(OR=6.915),ICU transfers(OR=4.714),unplanned reoperations(OR=4.416),tumor type,extent,and stage.Conclusion Medical institutions are advised to address the influencing factors of ultra-long hospitalizations by optimizing diagnostic and treatment processes,enhan-cing quality control systems,establishing early warning mechanisms,and strengthening information systems.These measures aim to improve the standardization of malignant tumor diagnosis and treatment,ensuring patient safety.

Objective:To analyze the characteristics of patients with chronic rhinosinusitis (CRS) in the South China region based on pathological tissue biomarkers for regional comparison.Methods:The study population consisted of CRS in-patients in the First Affiliated Hospital of Sun Yat-sen University from October 2019 to June 2022. Among all the 181 cases, 123 of them were male and 58 were female, with an average age of 40. Retrospectively collected clinical data included demographic information, preoperative symptom scores, preoperative endoscopic images, preoperative paranasal sinus computed tomography scanning images, and inflammatory serological features. In addition, 52 variables of pathological tissue biomarkers including cytokines, chemokines and remodeling factors were collected for analysis. Cluster analysis was performed on the integrated data of training set through centroid-based clustering algorithm, and the inflammatory characteristics, post-operation control status, and airway diseases comorbidity of each endotype were analyzed. R project (version 4.2.2) was used in statistical analysis.Results:Cluster analysis divided 181 patients with CRS into 4 endotypes. Cluster 1 ( n=101, 55.80%) showed a locally low inflammatory status. Cluster 2 ( n=23, 12.71%) showed a mixed type of inflammation with predominantly neutrophilic inflammation and tissue remodeling. Cluster 3 ( n=11, 6.08%) was characterized by type Ⅱ inflammation without tissue remodeling. Cluster 4 ( n=46, 25.41%) was mainly characterized by type Ⅱ inflammation with tissue remodeling, showing higher comorbidity rate of asthma and allergic rhinitis. This cluster presented more severe symptoms, significant olfactory dysfunction, extensive overall inflammation based on objective examination results, a notable increase in total eosinophil count and proportion in peripheral blood, and the highest uncontrolled rate observed one year post-surgery. In comparison to other regions, the endotype classification of CRS in Southern China was characterized by a predominant pattern of locally low inflammatory status, a moderate level of type Ⅱ inflammation with tissue remodeling, and a lesser presence of neutrophilic inflammation. Conclusion:CRS distribution in Southern China is mainly characterized by low inflammatory endotype and type Ⅱ inflammation with tissue remodeling. The latter shows more severe clinical manifestations and higher uncontrol rate after surgery.

Objective:To investigate the effects of Tiaogan Lifei Decoction on the level of symptom control in patients with bronchial asthma (asthma) treated with moderate and high dosage inhaled glucocorticoids (ICS).Methods:Randomized double-blind placebo controlled prospective study was used. Totally 90 patients with asthma (liver lung disharmony, wind phlegm blocking collateral syndrome) using moderate and high dosage ICS who met the inclusion criteria from January 2020 to December 2021 in Chaoyang District Hospital of Traditional Chinese Medicine in Beijing were divided into two groups according to random number table method, with 45 cases in each group. On the basis of using the original dosage of ICS, the treatment group used Tiaogan Lifei Decoction, while the control group used Tiaogan Lifei Decoction simulant. The course of treatment was 12 weeks. TCM symptom score of both group before and after the treatment was detected; asthma control test (ACT) was used to assess the effects of asthma on the patients; St George's Hospital Respiratory Questionnaire (SGRQ) was used to assess patients' quality of life; the peak expiratory flow rate (PEF) was measured with a peak expiratory flow meter. 2 ml of venous blood was collected for eosinophil (EOS) detection, and the serum allergen specific IgE level was determined by ELISA. The adverse reactions were observed during the treatment and the clinical efficacy was evaluated.Results:During the test, 3 cases and 2 cases in the treatment group and control group lost prevention respectively. 3 cases in the treatment group and 6 cases in the control group withdrew from the trial because of the aggravation of symptoms and the need to increase the dosage of ICS. The total effective rate in the treatment group was 78.6% (33/42), and that in the control group was 55.8% (24/43), with statistical significance ( χ2=4.98, P=0.026). After treatment, the scores of daily activities, early awakening, control and total scores in the treatment group were higher than those in the control group ( t values were 1.76, 1.99, 2.00, 2.69, respectively, P<0.01 or P<0.05); after treatment, the scores of cough, chest tightness, active wheezing, upset, pharyngeal itch and total score in the treatment group were lower than those in the control group ( t values were -5.89, -6.01, -5.66, -4.27, -6.67, -9.05, respectively, P<0.01); SGRQ score in the treatment group was lower than that of the control group ( t=-7.19, P<0.01). No serious adverse reactions occurred during treatment in the two groups. Conclusion:Tiaogan Lifei Decoction is helpful to improve the symptom control level of asthma patients who are using ICS, and effectively improve the quality of life of patients with asthma of liver lung disharmony and wind phlegm obstructing collaterals syndrome.

Objective:To summarize the clinical characteristics、diagnosis and treatment experience of children with reobstruction after pyeloplasty.Methods:A retrospective analysis was conducted on patients admitted to the Department of Urology, Beijing Children's Hospital from January 2015 to April 2022. Due to the unrelieved hydronephroplasty after the primary pyeloplasty, the anterior and posterior diameter of the pelvis was larger than that before the primary operation. Intravenous pyelography and diuretic renal radionuclide scanning confirmed the diagnosis of ureteropelvic reobstruction. Or underwent reoperation after undergoing puncture angiography for reobstruction. Fifty-four children were included in the study, 47 males (87.03%) and 7 females (12.96%), with a median age of 51.67(21.30, 117.24)month, and, 38 cases (70.37%) on the left side and 16 cases (29.63%) on the right side. The primary operation was open pyeloplasty (POP) in 20 cases and laparoscopic pyeloplasty (PLP) in 34 cases. 45 patients underwent primary operation in our hospital, and 9 patients were referred from other hospitals after primary operation. The interval between reoperation and initial operation was 7.25(6.15, 15.40)month. There were 28 cases with clinical symptoms before operation, and 26 cases without symptoms but reobstruction on imaging. 21 cases presented with recurrent abdominal pain, nausea and vomiting, and 7 cases presented with recurrent fever and urinary tract infection. All 54 patients underwent re-pyeloplasty after definite diagnosis of re-obstruction. In order to further study the feasibility of RLP, patients in the two groups were divided into RLP and ROP groups according to different surgical procedures. In the RLP group, there were 8 males (72.72%) and 3 females (27.28%). The median age was 82.21(49.83, 114.05) months, and obstruction was located on the left side in 8 cases (72.72%) and the right side in 3 cases (27.28%). There were 3 cases (27.28%) with POP and 8 cases (72.72%) with PLP. The time between the second operation and the primary operation was 12.83 (6.34, 16.86) months. APD before operation was 5.18 (4.25, 6.14) cm. There were 43 cases in the ROP group, including 38 males (88.37%) and 5 females (12.63%). The median age was 52.32 (26.62, 77.35) months; Obstruction was located on the left side in 31 cases (72.09%) and the right side in 12 cases (27.91%). The primary operation was performed in 19 cases (44.19%) with POP and 24 cases (55.81%) with PLP. The time between the second operation and the primary operation was 10.02 (8.03, 15.51) months. Preoperative APD was 5.42 (5.14, 5.90) cm. The causes of obstruction were found in the second operation: there were 28 causes (51.85%) of scar hyperplastic anastomotic stenosis, 7 cases (12.96%) of residual ectopic vascular compression, 8 cases (14.81%) of high ureteral anastomosis, 7 cases (12.96%) of ureteral adhesion distortion, and 4 cases (7.41%) of other causes (1 case of medical glue shell compression, 1 case of luminal polypoid hyperplasia, and 2 cases of complete luminal occlusion). Operation time, postoperative complications, APD, APD improvement rate (PI-APD), renal parenchyma thickness (PT), anteroposterior pelvis diameter/renal parenchyma thickness (APD/PT) at 3 and 6 months after operation were compared between RLP and ROP groups.Results:In this study, 54 patients were followed up with an average follow-up time of (34.41±20.20)month. APD of 3 months after pyeloplasty was 3.29(3.03, 3.52) cm, which was statistically significant compared with 5.45(5.13, 5.77)cm before pyeloplasty ( P=0.02). APD/PT changed from preoperative 21.71(21.08, 31.77)to 5.40(4.79, 6.79)3 months after surgery, and the difference was statistically significant ( P=0.03). The APD improvement rate was 37%(33%, 42%) 3 months after surgery and 49%(44%, 54%) 6 months after surgery. Among the 54 patients, 3 had lumbago and fever after clamping the nephrostomy tube, and 3(5.55%) had sinus angiography indicating that obstruction still existed and required reoperation. Therefore, the success rate of repyeloplasty in this group was 94.45%. Comparing RLP group and ROP group, operation time in RLP group was longer than that in ROP group [169.13(113.45, 210.66)]min vs. 106.83(103.14, 155.32)min, P=0.02]. The length of hospitalization in RLP group was shorter than that in ROP group [7.45(5.62, 9.28)d vs.11.64(10.45, 15.66)d, P=0.03], and the difference was statistically significant. The improvement rate of APD 3 months after surgery was compared between the two groups [30.48%(19.81%, 41.16%) vs.39.96%(35.16%, 47.76%), P=0.15], and the improvement rate of APD 6 months after surgery was compared between the two groups [48.00%(27.19%, 48.81%) vs.52.27%(46.95%, 56.76%), P=0.05], there was no significant difference in the success rate of operation between the two groups (90.90% vs. 95.34%, P=0.63). Conclusions:The common cause of reobstruction after pyeloplasty is cicatricial adhesion stenosis. The operation is challenging, but repyeloplasty can effectively relieve the obstruction and the overall success rate is 94.45%. RLP is a safe and effective surgical method for the treatment of reobstruction, which can achieve comparable surgical results with ROP.

Objective:To formulate the standardized nursing process for ultrasound guided joint cavity puncture based on evidence-based medicine, and explore its effect.Methods:In January 2021, the standardized nursing process for ultrasound guided joint cavity puncture in orthopedic based on evidence-based medicine was established. From July 2020 to August 2021, 200 outpatients with ultrasonic guided joint cavity puncture in orthopedic were selected from the Shanghai Sixth People's Hospital Affiliated to Shanghai JiaoTong University by convenience sampling. The patients before the implementation of the standardized process were taken as the control group, and the patients after the implementation of the standardized process were taken as the observation group, with 100 cases each. We compared the operation score difference of ultrasonic guided joint cavity puncture and the operation time of joint cavity puncture among nurses, as well as the pain, swelling and puncture-associated adverse events of the two groups among patients before and after the implementation of the standardized process.Results:After the implementation of the standardized process, the scores of nurses in the 5 aspects of pre operation preparation, operation process, proficiency score, theoretical total score and total score of the joint cavity puncture operation were higher than those before the implementation, and the differences were statistically significant ( P<0.05) . The operation time of joint cavity puncture in the observation group was shorter than that in the control group, with a statistically significant difference ( P<0.05) . The swelling score, pain degree and incidence of puncture-associated adverse events in the observation group 24 hours after operation were lower than those in the control group, with statistically significant differences ( P<0.05) . Conclusions:The standardized nursing process for ultrasound guided joint cavity puncture in orthopedic based on evidence-based medicine can help nurses improve the operation theory and proficiency, shorten the operation time during the operation, reduce the swelling and pain of patients after the operation, and avoid the occurrence of puncture-associated adverse events.