Objective:To explore the value of ultrasound features modified version 2022 of the Ovarian-Adnexal Imaging Reporting and Data System（O-RADS）Category 4 in the differential diagnosis of benign and malignant ovarian-adnexal tumors.Methods:Retrospective analysis was conducted in 501 cases with ovarian masses classified into 4 categories according to the 2022 version of O-RADS who were collected from 4 clinical centers［the Second Afliated Hospital of Harbin Medical University（188 cases），Zhejiang Provincial People's Hospital（146 cases），Sichuan Provincial Maternity and Child Health Care Hospital（90 cases），and Fuling Hospital of Chongqing University（77 cases）］from January 2018 to July 2024 with concomitant surgical resection.The 424 cases from 3 of the clinical centers（the Second Hospital of Harbin Medical University，Zhejiang Provincial People's Hospital，and Sichuan Maternal and Child Health Hospital）were randomly divided into a training group（339 cases）and an internal validation group（85 cases）according to an 8∶2 randomization，while the cases from the other clinical center（Fuling Hospital of Chongqing University）were selected as the external validation group（77 cases），and the pathological diagnosis was used as the “gold standard”.Univariate and multifactorial logistic regression analyses were performed on the ultrasound characteristics of the training group to screen the independent predictors associated with ovarian carcinogenesis，and to formulate the stratification rules for the 4 types of masses in O-RADS. The ROC curve of this stratification method was plotted and the area under the curve（AUC）was calculated，and it was validated in the internal validation group and the external validation group；and the diagnostic accuracy was compared with that of the 2022 version of O-RADS.Results:Univariate logistic analysis showed that cysts with solid components，≥ 4 papillary projections，smooth inner wall of the cyst，color flow score ≥ 3 points，and acoustic shadowing were independent predictors of ovarian cancer（all P < 0.05）；while multifactorial logistic analysis showed that cysts with a solid component and a color flow score ≥3 points were independent risk factors of ovarian cancer（all P < 0.05），and smooth cyst walls and acoustic shadows were independent protective factors（all P < 0.05）.The diagnostic accuracies of the modified training group，internal validation group，and external validation group were 73.7%，68.2%，70.1%，respectively，which were significantly higher than the diagnostic accuracies of the 2022 version of the O-RADS（38.9%，37.6%，33.8%）（all P < 0.05）.The diagnostic sensitivity，specificity and AUC of the training group were 0.871，0.652，0.762，respectively，while the internal validation group were 0.844，0.585，0.714，and 0.846，0.627，0.737 in the external validation group. Conclusions:Improvement of the 2022 version of O-RADS category 4 using ultrasound features may improve the identification of benign and malignant ovarian-adnexal tumors.

Objective:To investigate the applicability and surgical effect of direct horizontal suture in the repair of defects after the excision of eyelid nevus.Methods:The clinical data of patients with eyelid nevus who were admitted to Department of Facial and Neck Plastic Surgery, Plastic Surgery Hospital of Chinese Academy of Medical Sciences from March 2015 to March 2023 were retrospectively analyzed. After the eyelid nevus was removed, the defect was closed by horizontal suture parallel to the eyelid margin. In the preoperative simulation suture scheme, one or more horizontal lines were marked on the eyelid skin according to the scope of the nevus. The intersection points of the horizontal lines and the edges of the nevus were marked for simulated suturing. If the marked points aligned horizontally, direct suturing was applied. After 3 months of postoperative follow-up, the therapeutic effect was evaluated based on eyelid function (classified as excellent, good and poor), cosmetic effects (classified as excellent, good and poor) and patient satisfaction (classified as very satisfactory, satisfactory and dissatisfactory). At the same time, the effect of different wound length (<1 cm, 1-2 cm, >2 cm) on the therapeutic effect was also analyzed. SPSS 27.0 software was used for statistical analysis of the data. The counting data were represented by examples and percentages, and Kruskal-Wallis H test was used for comparison between groups. P<0.05 indicated that the difference was statistically significant. Results:A total of 71 patients were enrolled, including 30 males and 41 females. Aged 4 to 35 years old, with an average age of 15 years old. The lesions involved the upper eyelid in 47 cases, the lower eyelid in 14 cases, and co-involved in 10 cases. Lesion areas ranged from 0.5 cm×0.5 cm to 2.3 cm×2.0 cm. None of the lesions involved the palpebral margin and conjunctiva, and the depth did not reach the orbicularis oculi muscle. Immediately after the operation, all the patients had different degrees of eyelid deformation, and some severe patients had difficulty opening their eyes. The above symptoms were relieved within 7 days to 3 months after the operation, and eventually the eyelid movement returned to normal, leaving only mild scarring. In cases where the eyelid nevus was close to or involved the eyebrow area, eyebrow shape changed after surgery, and it gradually returned to normal after 1 month. Some patients with part of the eyebrow defect were able to improve their appearance through eyebrow tattoos, eyebrow transplatation and other methods. The eyelid function of 71 patients was excellent. The evaluation of cosmetic effect, 41 cases (58%) were excellent, and 30 cases (42%) were good. The evaluation of patient satisfaction, 56 cases (79%) were very satisfied, and 15 cases (21%) were satisfied. Statistical analysis showed that with the increase of the horizontal length of the wound, the cosmetic effect and patient satisfaction would be affected to a certain extent, but the differences were not statistically significant ( P>0.05). Conclusion:For eyelid nevus excision defects that can be closed horizontally, direct suturing method should be considered priority. This method is simple to perform, offers stable postoperative effects, and leads to high patient satisfaction.

The incidence of epicanthal folds is high in the Asian population, and aesthetic correction surgery is currently the most effective method for improving appearance. Common techniques include flap transposition, flap advancement, and skin reposition, with the Z-plasty-based approach as the most widely adopted method. This article begins by classifying and grading epicanthal folds and provides a systematic review of the development and evolution of Z-plasty-based techniques. It highlights advancements in surgical design, flap design, and tension-release strategies that have emerged from an improved understanding of the anatomical features and formation mechanisms of epicanthal folds. The aim is to provide a theoretical foundation and practical reference for the ongoing optimization and future advancement of surgical techniques in this field.

Objective To systematically evaluate the effect of threshold inspiratory muscle training on pulmonary rehabilitation in postoperative lung cancer patients,with a focus on exploring the difference in efficacy under different interven-tion modes.Methods Randomized controlled trials on the effect of threshold inspiratory muscle training on pulmonary rehabilitation in postoperative lung cancer patients were retrieved from PubMed,Cochrane Library,Embase,Web of Science,CNKI,Wanfang data,VIP and China Biomedical Literature Database.Meanwhile,gray literature from ProQuest and clinicaltrials.gov was searched as supplements.The retrieval period was from the establishment of each data-base to May 9,2025.Cochrane 5.1.0 was used to evaluate the quality of literature,and a meta-analysis was per-formed using RevMan 5.4.Results Twelve studies involving 701 patients were included,all of which were of moderate to high quality.Threshold inspiratory muscle training could reduce the pulmonary complications of postoperative lung cancer patients(OR=0.45,95%CI 0.29 to 0.68,P<0.001),shorten the hospital stay(MD=-1.85,95%CI-3.29 to-0.42,P=0.010),improve the inspiratory muscle strength(MD=5.84,95%CI 0.96 to 10.71,P=0.020),enhance their ex-ercise endurance(SMD=0.40,95%CI 0.10 to 0.71,P=0.010),and did not increase the risk of pulmonary air leakage(OR=0.88,95%CI 0.47 to 1.63,P=0.680).Subgroup analysis revealed that shortening of hospital stay(MD=-2.98,95%CI-5.87 to-0.09,P=0.040)and the improvement in exercise endurance(SMD=0.57,95%CI 0.14 to 1.00,P=0.009)were significant only when threshold inspiratory muscle training was combined with aerobic exercise.However,standalone threshold inspiratory muscle training showed no statistical signifi-cance in these two outcomes.Conclusion Threshold inspiratory muscle training can effectively reduce postoperative pulmonary complications and im-prove inspiratory muscle strength in postoperative lung cancer patients with good safety.Threshold inspiratory muscle training could shorten hospital stay and improve exercise endurance only when combining with aerobic exercise.

Objective:To analyze the present status and problems for management services in a public hospital, and explore the strategies to enhance the performance of hospital management services drawing on the experience of the reforms to streamline administration and delegate power, improve regulation, and upgrade services in the public service sector.Methods:In June 2023, a convenience sampling method was employed to select staff from all clinical departments, medical technology departments, and administrative units within a tertiary public hospital as survey participants. An anonymous online questionnaire was conducted to assess overall satisfaction with hospital management services, satisfaction with the " one-stop" service windows, satisfaction with individual administrative departments, and to gather suggestions for improving hospital management services. The Likert 5-level scoring method was used to evaluate the satisfaction. Suggestions and opinions were categorized and analyzed based on the three dimensions of the reforms to streamline administration and delegate power, improve regulation, and upgrade services.Results:A total of 962 valid questionnaires were collected. The overall satisfaction score for hospital management service was 4.40±0.89 points, with interdepartmental collaboration scoring the lowest score at 4.26±0.99 points. Information management, outpatient services, and research management processes were identified as areas requiring optimization, each mentioned over 100 times. Excessive and overly frequent inspection and evaluations, as well as documentation requirements were the most prominent manifestations of formalism and bureaucracy within administrative units. The average satisfaction score for the " one-stop" service windows was 4.59±0.68 points, and unclear service guidelines/processes and incomplete information provided by window staff were the primary causes of multiple return visits. The average satisfaction score of 32 administrative units was 4.53±0.09 points. A total of 322 valid suggestions were collected, with 13.35% concerning " streamline administration and delegate power", 28.58% addressing " improve regulation", and 58.07% focused on " upgrade services" .Conclusions:Staff at the hospital expressed overall satisfaction with the institution′s management services, but noted areas for improvement in departmental coordination, management of operational processes, and the implementation of the " one-stop service" initiative, and so on. Hospitals should optimize the following aspects: improving " upgrade services" as the primary task and important approach, focusing on building a service-oriented management culture; adhering to the " improve regulation", establishing and improving the modern hospital management system; deepening the " streamline administration and delegate power", transforming management styles and simplifying approval interventions.

Objective:To analyze the present status and problems for management services in a public hospital, and explore the strategies to enhance the performance of hospital management services drawing on the experience of the reforms to streamline administration and delegate power, improve regulation, and upgrade services in the public service sector.Methods:In June 2023, a convenience sampling method was employed to select staff from all clinical departments, medical technology departments, and administrative units within a tertiary public hospital as survey participants. An anonymous online questionnaire was conducted to assess overall satisfaction with hospital management services, satisfaction with the " one-stop" service windows, satisfaction with individual administrative departments, and to gather suggestions for improving hospital management services. The Likert 5-level scoring method was used to evaluate the satisfaction. Suggestions and opinions were categorized and analyzed based on the three dimensions of the reforms to streamline administration and delegate power, improve regulation, and upgrade services.Results:A total of 962 valid questionnaires were collected. The overall satisfaction score for hospital management service was 4.40±0.89 points, with interdepartmental collaboration scoring the lowest score at 4.26±0.99 points. Information management, outpatient services, and research management processes were identified as areas requiring optimization, each mentioned over 100 times. Excessive and overly frequent inspection and evaluations, as well as documentation requirements were the most prominent manifestations of formalism and bureaucracy within administrative units. The average satisfaction score for the " one-stop" service windows was 4.59±0.68 points, and unclear service guidelines/processes and incomplete information provided by window staff were the primary causes of multiple return visits. The average satisfaction score of 32 administrative units was 4.53±0.09 points. A total of 322 valid suggestions were collected, with 13.35% concerning " streamline administration and delegate power", 28.58% addressing " improve regulation", and 58.07% focused on " upgrade services" .Conclusions:Staff at the hospital expressed overall satisfaction with the institution′s management services, but noted areas for improvement in departmental coordination, management of operational processes, and the implementation of the " one-stop service" initiative, and so on. Hospitals should optimize the following aspects: improving " upgrade services" as the primary task and important approach, focusing on building a service-oriented management culture; adhering to the " improve regulation", establishing and improving the modern hospital management system; deepening the " streamline administration and delegate power", transforming management styles and simplifying approval interventions.

Objective:To explore the value of ultrasound features modified version 2022 of the Ovarian-Adnexal Imaging Reporting and Data System（O-RADS）Category 4 in the differential diagnosis of benign and malignant ovarian-adnexal tumors.Methods:Retrospective analysis was conducted in 501 cases with ovarian masses classified into 4 categories according to the 2022 version of O-RADS who were collected from 4 clinical centers［the Second Afliated Hospital of Harbin Medical University（188 cases），Zhejiang Provincial People's Hospital（146 cases），Sichuan Provincial Maternity and Child Health Care Hospital（90 cases），and Fuling Hospital of Chongqing University（77 cases）］from January 2018 to July 2024 with concomitant surgical resection.The 424 cases from 3 of the clinical centers（the Second Hospital of Harbin Medical University，Zhejiang Provincial People's Hospital，and Sichuan Maternal and Child Health Hospital）were randomly divided into a training group（339 cases）and an internal validation group（85 cases）according to an 8∶2 randomization，while the cases from the other clinical center（Fuling Hospital of Chongqing University）were selected as the external validation group（77 cases），and the pathological diagnosis was used as the “gold standard”.Univariate and multifactorial logistic regression analyses were performed on the ultrasound characteristics of the training group to screen the independent predictors associated with ovarian carcinogenesis，and to formulate the stratification rules for the 4 types of masses in O-RADS. The ROC curve of this stratification method was plotted and the area under the curve（AUC）was calculated，and it was validated in the internal validation group and the external validation group；and the diagnostic accuracy was compared with that of the 2022 version of O-RADS.Results:Univariate logistic analysis showed that cysts with solid components，≥ 4 papillary projections，smooth inner wall of the cyst，color flow score ≥ 3 points，and acoustic shadowing were independent predictors of ovarian cancer（all P < 0.05）；while multifactorial logistic analysis showed that cysts with a solid component and a color flow score ≥3 points were independent risk factors of ovarian cancer（all P < 0.05），and smooth cyst walls and acoustic shadows were independent protective factors（all P < 0.05）.The diagnostic accuracies of the modified training group，internal validation group，and external validation group were 73.7%，68.2%，70.1%，respectively，which were significantly higher than the diagnostic accuracies of the 2022 version of the O-RADS（38.9%，37.6%，33.8%）（all P < 0.05）.The diagnostic sensitivity，specificity and AUC of the training group were 0.871，0.652，0.762，respectively，while the internal validation group were 0.844，0.585，0.714，and 0.846，0.627，0.737 in the external validation group. Conclusions:Improvement of the 2022 version of O-RADS category 4 using ultrasound features may improve the identification of benign and malignant ovarian-adnexal tumors.

Objective:To investigate the applicability and surgical effect of direct horizontal suture in the repair of defects after the excision of eyelid nevus.Methods:The clinical data of patients with eyelid nevus who were admitted to Department of Facial and Neck Plastic Surgery, Plastic Surgery Hospital of Chinese Academy of Medical Sciences from March 2015 to March 2023 were retrospectively analyzed. After the eyelid nevus was removed, the defect was closed by horizontal suture parallel to the eyelid margin. In the preoperative simulation suture scheme, one or more horizontal lines were marked on the eyelid skin according to the scope of the nevus. The intersection points of the horizontal lines and the edges of the nevus were marked for simulated suturing. If the marked points aligned horizontally, direct suturing was applied. After 3 months of postoperative follow-up, the therapeutic effect was evaluated based on eyelid function (classified as excellent, good and poor), cosmetic effects (classified as excellent, good and poor) and patient satisfaction (classified as very satisfactory, satisfactory and dissatisfactory). At the same time, the effect of different wound length (<1 cm, 1-2 cm, >2 cm) on the therapeutic effect was also analyzed. SPSS 27.0 software was used for statistical analysis of the data. The counting data were represented by examples and percentages, and Kruskal-Wallis H test was used for comparison between groups. P<0.05 indicated that the difference was statistically significant. Results:A total of 71 patients were enrolled, including 30 males and 41 females. Aged 4 to 35 years old, with an average age of 15 years old. The lesions involved the upper eyelid in 47 cases, the lower eyelid in 14 cases, and co-involved in 10 cases. Lesion areas ranged from 0.5 cm×0.5 cm to 2.3 cm×2.0 cm. None of the lesions involved the palpebral margin and conjunctiva, and the depth did not reach the orbicularis oculi muscle. Immediately after the operation, all the patients had different degrees of eyelid deformation, and some severe patients had difficulty opening their eyes. The above symptoms were relieved within 7 days to 3 months after the operation, and eventually the eyelid movement returned to normal, leaving only mild scarring. In cases where the eyelid nevus was close to or involved the eyebrow area, eyebrow shape changed after surgery, and it gradually returned to normal after 1 month. Some patients with part of the eyebrow defect were able to improve their appearance through eyebrow tattoos, eyebrow transplatation and other methods. The eyelid function of 71 patients was excellent. The evaluation of cosmetic effect, 41 cases (58%) were excellent, and 30 cases (42%) were good. The evaluation of patient satisfaction, 56 cases (79%) were very satisfied, and 15 cases (21%) were satisfied. Statistical analysis showed that with the increase of the horizontal length of the wound, the cosmetic effect and patient satisfaction would be affected to a certain extent, but the differences were not statistically significant ( P>0.05). Conclusion:For eyelid nevus excision defects that can be closed horizontally, direct suturing method should be considered priority. This method is simple to perform, offers stable postoperative effects, and leads to high patient satisfaction.

The incidence of epicanthal folds is high in the Asian population, and aesthetic correction surgery is currently the most effective method for improving appearance. Common techniques include flap transposition, flap advancement, and skin reposition, with the Z-plasty-based approach as the most widely adopted method. This article begins by classifying and grading epicanthal folds and provides a systematic review of the development and evolution of Z-plasty-based techniques. It highlights advancements in surgical design, flap design, and tension-release strategies that have emerged from an improved understanding of the anatomical features and formation mechanisms of epicanthal folds. The aim is to provide a theoretical foundation and practical reference for the ongoing optimization and future advancement of surgical techniques in this field.

Objective To systematically evaluate the effect of threshold inspiratory muscle training on pulmonary rehabilitation in postoperative lung cancer patients,with a focus on exploring the difference in efficacy under different interven-tion modes.Methods Randomized controlled trials on the effect of threshold inspiratory muscle training on pulmonary rehabilitation in postoperative lung cancer patients were retrieved from PubMed,Cochrane Library,Embase,Web of Science,CNKI,Wanfang data,VIP and China Biomedical Literature Database.Meanwhile,gray literature from ProQuest and clinicaltrials.gov was searched as supplements.The retrieval period was from the establishment of each data-base to May 9,2025.Cochrane 5.1.0 was used to evaluate the quality of literature,and a meta-analysis was per-formed using RevMan 5.4.Results Twelve studies involving 701 patients were included,all of which were of moderate to high quality.Threshold inspiratory muscle training could reduce the pulmonary complications of postoperative lung cancer patients(OR=0.45,95%CI 0.29 to 0.68,P<0.001),shorten the hospital stay(MD=-1.85,95%CI-3.29 to-0.42,P=0.010),improve the inspiratory muscle strength(MD=5.84,95%CI 0.96 to 10.71,P=0.020),enhance their ex-ercise endurance(SMD=0.40,95%CI 0.10 to 0.71,P=0.010),and did not increase the risk of pulmonary air leakage(OR=0.88,95%CI 0.47 to 1.63,P=0.680).Subgroup analysis revealed that shortening of hospital stay(MD=-2.98,95%CI-5.87 to-0.09,P=0.040)and the improvement in exercise endurance(SMD=0.57,95%CI 0.14 to 1.00,P=0.009)were significant only when threshold inspiratory muscle training was combined with aerobic exercise.However,standalone threshold inspiratory muscle training showed no statistical signifi-cance in these two outcomes.Conclusion Threshold inspiratory muscle training can effectively reduce postoperative pulmonary complications and im-prove inspiratory muscle strength in postoperative lung cancer patients with good safety.Threshold inspiratory muscle training could shorten hospital stay and improve exercise endurance only when combining with aerobic exercise.