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 analyze the clinical efficacy of laparoscopic common bile duct exploration and stone removal via the cystic duct with a flexible ureteroscope.Methods:The clinical data of 96 patients with cholecystolithiasis and choledocholithiasis who were admitted to the Department of Hepatobiliary Surgery, the Third Hospital of Nanchang from September 2021 to November 2024 were retrospectively analyzed. There were 49 male and 47 female patients, aged (59.2±13.9) years. The 96 patients were randomly divided into two groups according to the surgical methods: the flexible ureteroscope group ( n=48) and the choledochotomy group ( n=48), patients who underwent laparoscopic cholecystectomy plus flexible ureteroscope for common bile duct exploration and stone removal via the cystic duct were included in the flexible ureteroscope group; patients who underwent laparoscopic cholecystectomy plus choledocholithotomy and T-tube drainage placement were included in the choledochotomy group. Clinical data including operation time, intraoperative blood loss, postoperative intestinal function recovery time, abdominal drainage tube removal time, postoperative hospital stay and postoperative complications were compared between the two groups. Results:Compared with the choledochotomy group, the operation time [150 (120, 176) min vs. 197 (165, 240) min], intraoperative blood loss [20 (10, 30) ml vs. 30 (20, 50) ml], postoperative intestinal function recovery time [2 (1, 2) d vs. 3 (2, 4) d], abdominal drainage tube removal time [6 (4, 7) d vs. 7 (6, 8) d], and postoperative hospital stay [8 (6, 9) d vs. 16 (13, 17) d] in the flexible ureteroscope group were all reduced, and the differences were statistically significant (all P<0.05). The incidence of postoperative complications in the choledochotomy group was 10.4% (5/48), compared with 2.1% (1/48) in the flexible ureteroscope group. There was no statistically significant difference ( χ2=1.60, P=0.206). Conclusion:Compared with laparoscopic choledocholithotomy plus T-tube drainage, laparoscopic common bile duct exploration and stone removal via the cystic duct with a flexible ureteroscope can shorten the hospital stay of patients with choledocholithiasis, offering a minimally invasive, safe and effective treatment method.

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 analyze the clinical efficacy of laparoscopic common bile duct exploration and stone removal via the cystic duct with a flexible ureteroscope.Methods:The clinical data of 96 patients with cholecystolithiasis and choledocholithiasis who were admitted to the Department of Hepatobiliary Surgery, the Third Hospital of Nanchang from September 2021 to November 2024 were retrospectively analyzed. There were 49 male and 47 female patients, aged (59.2±13.9) years. The 96 patients were randomly divided into two groups according to the surgical methods: the flexible ureteroscope group ( n=48) and the choledochotomy group ( n=48), patients who underwent laparoscopic cholecystectomy plus flexible ureteroscope for common bile duct exploration and stone removal via the cystic duct were included in the flexible ureteroscope group; patients who underwent laparoscopic cholecystectomy plus choledocholithotomy and T-tube drainage placement were included in the choledochotomy group. Clinical data including operation time, intraoperative blood loss, postoperative intestinal function recovery time, abdominal drainage tube removal time, postoperative hospital stay and postoperative complications were compared between the two groups. Results:Compared with the choledochotomy group, the operation time [150 (120, 176) min vs. 197 (165, 240) min], intraoperative blood loss [20 (10, 30) ml vs. 30 (20, 50) ml], postoperative intestinal function recovery time [2 (1, 2) d vs. 3 (2, 4) d], abdominal drainage tube removal time [6 (4, 7) d vs. 7 (6, 8) d], and postoperative hospital stay [8 (6, 9) d vs. 16 (13, 17) d] in the flexible ureteroscope group were all reduced, and the differences were statistically significant (all P<0.05). The incidence of postoperative complications in the choledochotomy group was 10.4% (5/48), compared with 2.1% (1/48) in the flexible ureteroscope group. There was no statistically significant difference ( χ2=1.60, P=0.206). Conclusion:Compared with laparoscopic choledocholithotomy plus T-tube drainage, laparoscopic common bile duct exploration and stone removal via the cystic duct with a flexible ureteroscope can shorten the hospital stay of patients with choledocholithiasis, offering a minimally invasive, safe and effective treatment method.

In the process of multi-campus hospital development, the main challenge of hospital human resource management is to meet the rapidly increasing demand for human resources in new hospital areas, ensure the quality of medical human resources, improve the efficiency of human resource management, and ensure effective balance among the three. Over the years of practice, the Second Affiliated Hospital Zhejiang University School of Medicine had always adhered to " hospital area coordinated management" and " personnel homogeneous management" , coordinated personnel recruitment and introduction, coordinated human resource allocation across multi-campus in the same discipline, unified job management across multi-campus, unified employee qualification, assessment and training system, and established an integrated digital human resource management platform, which ensured the high-quality expansion and reasonable layout of the hospital′s human resources, and ensured the rational layout and orderly development of disciplines.

In the context of the construction of " double sinking and double upgrading" in Zhejiang province, a provincial hospital explored a pilot talent working mechanism of " provincial hospital recruit staff and county hospital get experts" in the process of cooperating with county hospitals. In view of the problem that high-quality medical human resources were difficult to sink, with the flexibility of the reform of post filing and staffing, we put forward the idea of " provincial hospital recruit staff and county hospital get experts" , established key support disciplines, recruited staff by provincial hospitals, and arranged experts to precisely " sink as needed" to help disciplines of county hospitals. It helped to explore the establishment of a long-term mechanism to promote the flow of excellent medical talents to remote mountain areas, built a " specialized community" of provincial and county hospitals, and improved the medical service capacity, medical quality and discipline construction of county hospitals.

Systematic and scientific training for all employees is an important means to improve the medical quality and service level of general hospitals. The authors′ hospital established a staff training university in 2012, built an integrated training management platform, and explored the combination of online and offline training for all its staff. Guided by the hospital′s development goals and service objectives, professional courses and comprehensive courses were set. Each specialty sets the course content and credit requirements according to the level of staffs, and dynamically adjusts the course setting according to the needs and training effect evaluation. This training mode ensured the effective implementation of in-hospital training, and the credit qualification rate of staffs had increased from 29.31% in 2012 to 85.37% in 2020; Improved the pertinence, timeliness and practicability of training; It enriched the training resources, broke the time and space constraints of training, and eliminated the contradiction between work and study.

Objective:To study the incidence and classification of chromosomal abnormalities in villi of missed abortion patients with assisted reproductive technology (ART) and natural conception (NC).Methods:Totally 637 patients with missed abortion villi from the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University during January 2016 and January 2020 were collected and divided into ART group and NC group according to the mode of pregnancy in this retrospective cohort study. The ART group was further divided into artificial insemination by husband (AIH), in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Next generation sequencing (NGS) was used to detect the copy number variations (CNVs) and chromosome number abnormalities of chorionic villi of missed abortion. Results:Among 637 missed abortion chorionic villi, 45.2% (288/637) of the samples had normal chromosome and 54.8% (349/637) had abnormal chromosome. CNVs accounted for 3.8% (14/637) of the total samples, and chromosome number abnormalities accounted for 52.5% (335/637) of the total samples. The abnormal rates of villi chromosome in ART group and NC group were 59.2% (226/382) and 51.0% (130/255), respectively, and there was no significant difference between ART group and NC group ( P>0.05). The abnormal rates of villus chromosome in AIH group, IVF group and ICSI group were 52.1% (25/48), 58.9% (146/248) and 64.0% (55/86), respectively. Compared with NC group, the abnormal rate of villus chromosome in IVF group and ICSI group was increased, but there was no significant difference ( P>0.008). Conclusion:In general, ART did not increase the incidence of chromosomal abnormalities in missed abortion villi. However, compared with natural pregnancy and AIH assisted pregnancy, IVF/ICSI had a higher chromosomal abnormality in missed abortion villi.

Objective:To study the incidence and classification of chromosomal abnormalities in villi of missed abortion patients with assisted reproductive technology (ART) and natural conception (NC).Methods:Totally 637 patients with missed abortion villi from the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University during January 2016 and January 2020 were collected and divided into ART group and NC group according to the mode of pregnancy in this retrospective cohort study. The ART group was further divided into artificial insemination by husband (AIH), in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Next generation sequencing (NGS) was used to detect the copy number variations (CNVs) and chromosome number abnormalities of chorionic villi of missed abortion. Results:Among 637 missed abortion chorionic villi, 45.2% (288/637) of the samples had normal chromosome and 54.8% (349/637) had abnormal chromosome. CNVs accounted for 3.8% (14/637) of the total samples, and chromosome number abnormalities accounted for 52.5% (335/637) of the total samples. The abnormal rates of villi chromosome in ART group and NC group were 59.2% (226/382) and 51.0% (130/255), respectively, and there was no significant difference between ART group and NC group ( P>0.05). The abnormal rates of villus chromosome in AIH group, IVF group and ICSI group were 52.1% (25/48), 58.9% (146/248) and 64.0% (55/86), respectively. Compared with NC group, the abnormal rate of villus chromosome in IVF group and ICSI group was increased, but there was no significant difference ( P>0.008). Conclusion:In general, ART did not increase the incidence of chromosomal abnormalities in missed abortion villi. However, compared with natural pregnancy and AIH assisted pregnancy, IVF/ICSI had a higher chromosomal abnormality in missed abortion villi.

Objective Based on the three-dimensional quality structure model,to construct the nursing quality evaluation index system for acute leukemia,in order to provide references for clinical evaluation of quality of nursing care for acute leukemia.Methods Based on the theory of Donabedian's structure-process-outcome quality structure model,through literature search,semi-structured interview,expert meeting,expert consultation and analytic hierarchy process,the quality evaluation index system and index weight for acute leukemia were determined.Results After two rounds of expert consultation,questionnaire response rates were 94.74％,100％;expert authority coefficients were 0.848,0.854;Kendall coordination coefficients were 0.273,0.420,and P values were all less than 0.01.The final index system consisted of 3 first-level indicators,8 second-level indicators,and 24 third-level indicators (3 structure indicators,7 process indicators,14 outcome indicators).Each of third-level indicators contained index names,calculation methods,and data collection methods.Conclusion The process of construction of nursing quality evaluation index system for acute leukemia is scientific,the contents are reasonable,which can reflect nursing characteristics of acute leukemia.