ObjectiveTo establish a regional risk assessment system for hospital-acquired infections in neurosurgery department of general hospital, and to evaluate its prevention and control effectiveness. MethodsFailure mode and effect analysis (FMEA) was used to identify the core risk factors for infections in neurosurgery department. The risk priority number (RPN) of each risk factor was calculated to determine the priority intervention targets. Targeted interventions were developed and continuously refined through the plan-do-check-act (PDCA) cycles. Data from January to June 2023 (control group) and July to December 2023 (intervention group) were collected to compare the differences in environmental hygiene monitoring qualification rate, incidence rate of hospital-acquired infections among inpatients, and detection rate of bacterial antimicrobial resistance. ResultsHigh-risk factors for hospital-acquired infections in neurosurgery department included patient-related risk factors, inadequate implementation of isolation measures for special infections, and poor compliance with surgical site infection (SSI) prevention protocols. After intervention, the environmental hygiene qualification rate significantly increased from 81.55% to 100.00% (χ²=120.49, P<0.001). The overall hospital-acquired infection rate among inpatients decreased from 2.62% to 2.45%, the infection rate of per case declined from 3.12% to 2.84%, and the detection rate of multidrug-resistant organism infections reduced from 43.72% to 36.79%. Additionally, antimicrobial utilization rate decreased from 48.75% to 42.53% (χ²=34.09, P<0.001). ConclusionThe FMEA-based risk assessment system can effectively identify critical infection risks in neurosurgery department, and targeted interventions can significantly improve infection prevention and control performance.

Objective:To analyze the gallbladder morphology in ultrasound examinations of children with biliary atresia, classify them accordingly, and compare the gallbladder size of different types of patients and healthy infants.Methods:Clinical data of 711 cases with biliary atresia treated at the Department of General Surgery at the Capital Center for Children's Health, Capital Medical University from January 2017 to July 2022 were retrospectively analyzed, including 407 males and 304 females, aged (46.5±26.9) days. Additionally, 106 healthy infants recruited from the same hospital between January 2024 and March 2024 were included in the control group, including 60 males and 46 females, aged (48.5±23.9) days. The gallbladder morphology was classified into four types (A, B, C and D) based on its size and shape on ultrasonography. The long diameter of the gallbladder gradually increased, with its shape gradually approaching normal. The proportions of gender, time of jaundice onset (calculated from birth), total bilirubin, direct bilirubin, γ-glutamyl transferase (γ-GT), gallbladder contraction rate, hepatic portal cyst, and cholangiography were compared among different types. The gallbladder length and width of type D were also compared with those of the healthy control group.Resluts:Among the 711 patients, 123(17.3%) were of type A, 330 (46.4%) were of type B, 112 (15.8%) were of type C, and 146 (20.5%) were of type D. There were no statistically significant differences in the male ratio, the timing of jaundice onset, total bilirubin levels, direct bilirubin levels, or γ-GT levels among the four types of patients (all P>0.05). However, the incidences of combined hepatic portal cysts in type C and D were higher than those in type A and B (all P<0.01). Notably, 68.5% (100/146) of type D patients had a gallbladder contraction rate of ≤25%, lower than the 91.8% (303/330) of type B and 95.5% (107/112) of type C ( χ2=42.41, 29.22, both P<0.001). The success rates of cholangiography for type C and D patients were 75.0% (84/112) and 76.7% (112/146), respectively, both higher than the 11.4% (14/123) for type A and 45.2% (149/330) for type B (all P<0.001). In the healthy control group, the length and width of gallbladder were larger than those in type D patients ( t=10.64, 11.62, both P<0.001). Conclusion:The ultrasonic gallbladder morphology in biliary atresia patients is diverse, and there are no significant clinical differences among the four types. However, there are differences in gallbladder contraction rates and the success rates of gallbladder imaging. The gallbladder length and width of type D patients, with a nearly normal gallbladder morphology, are smaller than those of healthy infants at the same age.

Objective:To explore the clinical and pathological features and survival outcomes of patients with early-onset intrahepatic cholangiocarcinoma (EOICC).Methods:This is a multicenter, retrospective cohort study. Data of 1 160 intrahepatic cholangiocarcinoma patients undergoing radical resection in 14 tertiary Grade A hospitals in China from January 2010 to November 2021 were retrospectively collected. The cohort included 632 males and 528 females, aged( M (IQR)) 61 (14) years (range: 22 to 93 years). ICC aged ≤50 years at the time of diagnosis was defined as EOICC and >50 years as late-onset intrahepatic cholangiocarcinoma (LOICC). Of these, there were 247 cases in the EOICC group and 913 cases in the LOICC. The clinical and pathological characteristics of both groups were analyzed and compared using the independent sample t-test, Mann-Whitney U test or Kaplan-Meier method. Univariate and multivariate Cox regression models for patient outcomes were constructed and forest graphed. Results:Compared with the patients in the LOICC group, patients in the EOICC group had lower carcinoembryonic antigen levels (2.5(4.0) μg/L vs. 3.1(5.2)μg/L, U=124 899, P=0.009) and CA19-9 level (63.4(524.7)U/ml vs. 77.9(611.3)U/ml, U=120 320, P=0.013), higher levels of ALT (29(35)U/L vs. 24(26)U/L, U=101 214, P=0.013), a lower score of the Eastern US Cooperative Oncology Group (0 score patients: 54.7% vs. 44.1%, χ2=12.472, P=0.014), higher TNM stage ( χ2=11.807, P=0.038), and proportion of lymph node dissection (62.3% vs. 54.1%, χ2=5.355, P=0.021). Patients in the two groups in sex, first diagnosis symptoms, intrahepatic bile duct stone history, nail protein, albumin, total bilirubin, transaminase, liver function Child-Pugh grade, T stage, stage, N stage, preoperative laparoscopic exploration proportion, tumor diameter, vascular invasion proportion, differentiation, margin, intraoperative bleeding, postoperative complications, postoperative hospital days were no statistical significance (all P>0.05). Patients in the EOICC group had better outcomes than the LOICC group (median survival time: 29.7 months vs. 25.0 months, 3-year overall survival: 45.1% vs. 37.8%, P=0.027). Conclusion:EOICC patients are better than LOICC patients in carcinoembryonic antigen, CA19-9, ALT, physical strength status and TNM stage, and the long-term prognosis is also better than LOICC patients.

Laparoscopic pancreaticoduodenectomy(LPD) poses a high risk of intraoperative bleeding due to the complex anatomy and rich blood supply in the pancreatic head region. This paper innovatively proposes a blood flow control technique system for LPD, adopting a strategy of “priority devascularization and pre-blocking”.By first addressing the peripheral collateral blood supply and the gastroduodenal artery, and then performing dual-system pre-blocking, the dorsal pancreatic artery and the inferior pancreaticoduodenal artery are treated in situ through a combined middle and left posterior approach. This progressive blood flow control method enhances surgical safety and oncological radicality, offering a new paradigm for the development of minimally invasive pancreatic surgery.

Objective:This article studies the abilities and quality that medical technical managers should possess and provides a reference for promoting the professional training and development of medical technical managers.Methods:The data were obtained through semi-structured interviews and literature collection. The interview subjects were 20 scientific researchers with transformation projects and 10 management staffs with technical manager certificates in medical colleges. The documents are 6 articles related to ″technical manager capabilities″ collected on open academic platforms. Grounded theory was used to code and analyze above data.Results:After three-level coding and combining with the iceberg competency model, the knowledge, skills, self-awareness, traits and motivation of medical technology managers were sorted out, totalling 5 core categories, 10 main categories, and 50 initial categories, to construct a competency model for medical technology managers.Conclusions:Based on the complex knowledge structure and high occupational requirements of medical technology managers, policy insights such as systematic knowledge training, raising skill requirements in practice, and enriching assessment standards and communication channels are proposed.

Objective:To analyze the gallbladder morphology in ultrasound examinations of children with biliary atresia, classify them accordingly, and compare the gallbladder size of different types of patients and healthy infants.Methods:Clinical data of 711 cases with biliary atresia treated at the Department of General Surgery at the Capital Center for Children's Health, Capital Medical University from January 2017 to July 2022 were retrospectively analyzed, including 407 males and 304 females, aged (46.5±26.9) days. Additionally, 106 healthy infants recruited from the same hospital between January 2024 and March 2024 were included in the control group, including 60 males and 46 females, aged (48.5±23.9) days. The gallbladder morphology was classified into four types (A, B, C and D) based on its size and shape on ultrasonography. The long diameter of the gallbladder gradually increased, with its shape gradually approaching normal. The proportions of gender, time of jaundice onset (calculated from birth), total bilirubin, direct bilirubin, γ-glutamyl transferase (γ-GT), gallbladder contraction rate, hepatic portal cyst, and cholangiography were compared among different types. The gallbladder length and width of type D were also compared with those of the healthy control group.Resluts:Among the 711 patients, 123(17.3%) were of type A, 330 (46.4%) were of type B, 112 (15.8%) were of type C, and 146 (20.5%) were of type D. There were no statistically significant differences in the male ratio, the timing of jaundice onset, total bilirubin levels, direct bilirubin levels, or γ-GT levels among the four types of patients (all P>0.05). However, the incidences of combined hepatic portal cysts in type C and D were higher than those in type A and B (all P<0.01). Notably, 68.5% (100/146) of type D patients had a gallbladder contraction rate of ≤25%, lower than the 91.8% (303/330) of type B and 95.5% (107/112) of type C ( χ2=42.41, 29.22, both P<0.001). The success rates of cholangiography for type C and D patients were 75.0% (84/112) and 76.7% (112/146), respectively, both higher than the 11.4% (14/123) for type A and 45.2% (149/330) for type B (all P<0.001). In the healthy control group, the length and width of gallbladder were larger than those in type D patients ( t=10.64, 11.62, both P<0.001). Conclusion:The ultrasonic gallbladder morphology in biliary atresia patients is diverse, and there are no significant clinical differences among the four types. However, there are differences in gallbladder contraction rates and the success rates of gallbladder imaging. The gallbladder length and width of type D patients, with a nearly normal gallbladder morphology, are smaller than those of healthy infants at the same age.

Objective:This article studies the abilities and quality that medical technical managers should possess and provides a reference for promoting the professional training and development of medical technical managers.Methods:The data were obtained through semi-structured interviews and literature collection. The interview subjects were 20 scientific researchers with transformation projects and 10 management staffs with technical manager certificates in medical colleges. The documents are 6 articles related to ″technical manager capabilities″ collected on open academic platforms. Grounded theory was used to code and analyze above data.Results:After three-level coding and combining with the iceberg competency model, the knowledge, skills, self-awareness, traits and motivation of medical technology managers were sorted out, totalling 5 core categories, 10 main categories, and 50 initial categories, to construct a competency model for medical technology managers.Conclusions:Based on the complex knowledge structure and high occupational requirements of medical technology managers, policy insights such as systematic knowledge training, raising skill requirements in practice, and enriching assessment standards and communication channels are proposed.

Objective:To explore the clinical and pathological features and survival outcomes of patients with early-onset intrahepatic cholangiocarcinoma (EOICC).Methods:This is a multicenter, retrospective cohort study. Data of 1 160 intrahepatic cholangiocarcinoma patients undergoing radical resection in 14 tertiary Grade A hospitals in China from January 2010 to November 2021 were retrospectively collected. The cohort included 632 males and 528 females, aged( M (IQR)) 61 (14) years (range: 22 to 93 years). ICC aged ≤50 years at the time of diagnosis was defined as EOICC and >50 years as late-onset intrahepatic cholangiocarcinoma (LOICC). Of these, there were 247 cases in the EOICC group and 913 cases in the LOICC. The clinical and pathological characteristics of both groups were analyzed and compared using the independent sample t-test, Mann-Whitney U test or Kaplan-Meier method. Univariate and multivariate Cox regression models for patient outcomes were constructed and forest graphed. Results:Compared with the patients in the LOICC group, patients in the EOICC group had lower carcinoembryonic antigen levels (2.5(4.0) μg/L vs. 3.1(5.2)μg/L, U=124 899, P=0.009) and CA19-9 level (63.4(524.7)U/ml vs. 77.9(611.3)U/ml, U=120 320, P=0.013), higher levels of ALT (29(35)U/L vs. 24(26)U/L, U=101 214, P=0.013), a lower score of the Eastern US Cooperative Oncology Group (0 score patients: 54.7% vs. 44.1%, χ2=12.472, P=0.014), higher TNM stage ( χ2=11.807, P=0.038), and proportion of lymph node dissection (62.3% vs. 54.1%, χ2=5.355, P=0.021). Patients in the two groups in sex, first diagnosis symptoms, intrahepatic bile duct stone history, nail protein, albumin, total bilirubin, transaminase, liver function Child-Pugh grade, T stage, stage, N stage, preoperative laparoscopic exploration proportion, tumor diameter, vascular invasion proportion, differentiation, margin, intraoperative bleeding, postoperative complications, postoperative hospital days were no statistical significance (all P>0.05). Patients in the EOICC group had better outcomes than the LOICC group (median survival time: 29.7 months vs. 25.0 months, 3-year overall survival: 45.1% vs. 37.8%, P=0.027). Conclusion:EOICC patients are better than LOICC patients in carcinoembryonic antigen, CA19-9, ALT, physical strength status and TNM stage, and the long-term prognosis is also better than LOICC patients.

Laparoscopic pancreaticoduodenectomy(LPD) poses a high risk of intraoperative bleeding due to the complex anatomy and rich blood supply in the pancreatic head region. This paper innovatively proposes a blood flow control technique system for LPD, adopting a strategy of “priority devascularization and pre-blocking”.By first addressing the peripheral collateral blood supply and the gastroduodenal artery, and then performing dual-system pre-blocking, the dorsal pancreatic artery and the inferior pancreaticoduodenal artery are treated in situ through a combined middle and left posterior approach. This progressive blood flow control method enhances surgical safety and oncological radicality, offering a new paradigm for the development of minimally invasive pancreatic surgery.

Objective To observe the characteristics of infant biliary atresia(BA)missed diagnosis by ultrasound.Methods Data of 72 BA infants missed by ultrasound(false-negative,group A),72 BA infants accurately diagnosed by ultrasound(true-positive,group B)and 72 non BA infants(controls,group C)were retrospectively analyzed.Clinical and ultrasonic features were compared between each 2 groups.Logistic regression analysis was performed to screen the impact factors for diagnosing and missed-diagnosing of BA.Results There were significant differences of total bilirubin,direct bilirubin,gamma glutamyl transpeptidase(GGT)and glutamic-oxaloacetic transaminase(GOT)between group A and C,also of total bilirubin,direct bilirubin and GGT between group B and C(all P＜0.05).Significant differences of the incidences of small gallbladder,gallbladder wall rigidity,poor gallbladder contraction function and fibrous plaques in the hepatic hilum were found between group A and B,of undetected or cystic changes in the gallbladder,gallbladder wall rigidity,poor gallbladder contraction function,fibrous plaques in the hepatic hilum and hepatic hilum cysts were noticed between group A and C(all P＜0.05),as well as of undetected or cystic changes in the gallbladder,small gallbladder,gallbladder wall rigidity,gallbladder wall thickening,poor gallbladder contraction function and fibrous plaques in the hepatic hilum were detected between group B and C(all P＜0.05).There were significant differences of display rate of common bile duct between each 2 groups(all P＜0.05).The lower incidence of fibrous plaques in the hepatic hilum and poor gallbladder contraction function were an impact factors for missed diagnosis of BA(both P＜0.05),while higher GGT,higher incidence of fibrous plaques in the hepatic hilum and poor gallbladder contraction function were all impact factors for diagnosis of BA in group A(all P＜0.05).Conclusion Infant BA missed diagnosis by ultrasound had lower incidence of fibrous plaques in the hepatic hilum and poor gallbladder contractile function.Combining with clinical data was helpful for reducing ultrasonic missed diagnosis of BA in infants.