The construction of national regional medical centers, a key initiative aimed at optimizing the allocation of medical resources and enhancing regional medical service capabilities, has created new opportunities for discipline development in large public hospitals. Taking Zhejiang Provincial People's Hospital as an example, this paper systematically examines its strategic planning, implementation approaches, and practical achievements in discipline construction during the period of national regional medical center construction. The research shows that by adopting measures such as formulating a "two hearts and four wings" development strategy, prioritizing breakthroughs in cutting-edge technologies, establishing high-level scientific research and innovation platforms, refining talent recruitment and training mechanisms, and strengthening regional radiation and leadership, the hospital has significantly enhanced its discipline strength. This has resulted in a replicable and scalable model for high-quality discipline development, offering valuable insights for the discipline construction of other regional medical centers.

To identify independent risk factors for postoperative pulmonary complications (PPCs) in patients receiving massive transfusion during retroperitoneal tumor resection and to analyze the impact of PPCs on short-term patient outcomes.

A retrospective analysis was conducted on 114 patients who underwent elective retroperitoneal tumor resection and received massive transfusion at Peking University International Hospital between January 2014 and December 2023. Data including baseline characteristics, intraoperative transfusion and fluid infusion, intraoperative body temperature, laboratory test results, and postoperative outcomes were collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for PPCs. The severity of postoperative complications, duration of mechanical ventilation, length of ICU stay, postoperative hospital stay, total hospital stay, rate of unplanned ICU admission, 24-hour mortality, and 30-day mortality were compared between patients with and without PPCs.

The incidence of PPCs was 57.0% (65/114). Multivariate logistic regression analysis identified hyperglycemia at the end of surgery as an independent risk factor for PPCs. Compared to the non-PPCs group, the PPCs group had significantly prolonged duration of mechanical ventilation and ICU stay. There was also a trend towards increased 30-day mortality in the PPCs group.

Elevated blood glucose at the end of surgery is independently associated with the occurrence of PPCs in patients undergoing retroperitoneal tumor resection with massive transfusion. PPCs significantly prolong the duration of mechanical ventilation and ICU stay and may increase mortality risk. Therefore, it is essential to strengthen perioperative blood glucose monitoring and management in these patients.

To quantitatively analyze diffusion parameters of the intraorbital optic nerve in healthy adults using magnetic resonance diffusion tensor imaging (MR-DTI), in order to provide baseline data for clinical research on optic neuropathy.

Fifty-five healthy adult volunteers who underwent orbital magnetic resonance imaging (MRI) without contrast at the Eye Hospital of the China Academy of Chinese Medical Sciences between May 2024 and September 2025 were enrolled, including 26 males and 29 females. The subjects ranged in age from 23 to 73 years, with an average age of (46.0±14.0) years. All participants underwent DTI and axial T1-weighted MRI (T1WI) scans using the United Imaging uMR660 1.5T MRI system. Independent sample t-tests were performed on the fractional anisotropy (FA), mean diffusivity (ADC), relative anisotropy (RA), volume ratio (VR), and axial T1WI optic nerve diameter of the dominant (using the cave method) and non-dominant eyes in the young group (age ≤45, 28 subjects) and the middle-aged and elderly group (age ＞45, 27 subjects).

Significant differences were observed in FA, RA, ADC, and VR values between the young and middle-aged/elderly groups (P＜0.01). FA and RA values correlated negatively with age (ρ=-0.420, P＜0.001), while ADC and VR values correlated positively with age (ρ=0.450, P＜0.001). No significant associations were found with gender or eye dominance.

DTI enables the quantitative assessment of optic nerve diffusion parameters, establishing normative baseline data for research into adult optic neuropathies. This capability supports early disease diagnosis and highlights the importance of using age-matched control groups in future DTI studies of optic nerve disorders. Notably, ocular dominance factors were not considered in this analysis—a point of particular relevance in conditions that may present unilaterally..

To evaluate the effects of fasting blood glucose (FBG) and glycated hemoglobin (HbA_1C) levels on coronary artery calcification (CAC) and mild cognitive impairment (MCI) in middle-aged and elderly populations (aged 40~80 years).

A cross-sectional survey was conducted from October to November 2019 in Xishan Community, Shijingshan District, Beijing, China, recruiting middle-aged and elderly individuals aged 40–80 years. FBG and HbA_1C values were collected. CAC was assessed via computed tomography (CT), and cognitive function was evaluated using the Chinese version of the Montreal Cognitive Assessment (MoCA-B). Multivariate logistic regression models were used to investigate the effects of FBG and HbA_1C on CAC and MCI, and restricted cubic spline curves were employed to visualize the trend of associations between variables. Subgroup analysis and sensitivity analysis were finally conducted to assess the robustness of the results.

A total of 1342 participants were enrolled, with a mean age of (59.9±7.1) years, including 492 males (36.7%). Among them, 609 participants (45.4%) had CAC, and 201 (15.0%) had MCI. Multivariate logistic regression analysis showed that after adjusting for confounders, each 1 mmol/L increase in FBG was associated with a 12% higher risk of CAC (odds ratio [OR]=1.12, 95% confidence interval [CI]: 1.03~1.23) and 13% higher risk of MCI (OR=1.13, 95%CI: 1.03~1.24). Each 1% increase in HbA_1C was associated with a 29% higher risk of CAC (OR=1.29, 95%CI: 1.07~1.55), while the increase in the risk of MCI was not significant. The associations between blood glucose levels and CAC/MCI were more significant in females and non-obese populations. In non-diabetic individuals, the effects of blood glucose levels on CAC and MCI might be confounded by other factors.

Elevated blood glucose levels are associated with CAC and cognitive decline in middle-aged and elderly populations, but this association is not significant in non-diabetic individuals.

To develop and validate a predictive model for difficult ureter (DU), defined as the failure to advance an 8/9.8 Fr semi-rigid ureteroscope (sURS) retrogradely without auxiliary measures above the iliac vessel level, in patients with proximal ureteral stones without pre-stenting.

A retrospective single-center study was conducted to include 154 patients with proximal ureteral stones from July 2023 to June 2025at the Jianhu Clinical Medical College of Yangzhou University. Patients were stratified into DU (n=44) and non-DU (n=110) groups according to the aforementioned definition. Clinical and pre-operative CT parameters were analyzed. Independent predictors were identified via univariate and multivariate logistic regression to build a predictive model, which was then internally validated using Bootstrap resampling (1000 iterations).

Four independent predictors were identified: stone anteroposterior diameter (odds ratio [OR]=0.737), the ratio of hydronephrosis width at the renal hilum to minimum stone diameter (OR=1.212), the difference in renal parenchyma CT value compared to the contralateral side (OR=1.069), and the thickness of the treated kidney (OR=0.942). The developed predictive model demonstrated good discrimination (area under the curve [AUC]=0.756; 95% confidence interval: 0.677~0.835) and calibration (Hosmer-Lemeshow test, P=0.113). Bootstrap validation confirmed parameter stability, yielding an optimism-corrected AUC of 0.74.

The predictive model developed in this study shows robust discriminative ability and stability. It can facilitate pre-operative identification of high-risk DU patients, optimizing surgical planning (e.g., preoperative stenting) to improve procedural efficacy and safety.

To compare the efficacy of linear staplers versus circular staplers in radical distal gastrectomy combined with Billroth-Ⅱ + Braun anastomosis, and to analyze the impact of these two techniques on patients' postoperative quality of life.

A total of 236 patients with gastric cancer who underwent distal gastrectomy combined with Billroth-Ⅱ + Braun anastomosis at the Fourth Hospital of Hebei Medical University from January to December 2022 were enrolled. They were divided into either a linear stapler group (n=152) and a circular stapler group (n=84) based on the anastomotic method used. The two groups were compared in terms of surgical data, postoperative recovery, complications, and scores on the Postgastrectomy Syndrome Assessment Scale (PGSAS-45). Statistical analyses were performed using SPSS 25.0 software, with a P value ＜0.05 considered statistically significant.

There were no statistically significant differences between the two groups in general data, surgical indicators, or the incidence of early and late postoperative complications (P＞0.05). The linear stapler group had significantly shorter time to first postoperative flatus, time to initiation of oral liquid diet, time to drainage tube removal, and hospital stay compared with the circular stapler group (P＜0.05). Based on the PGSAS-45 scores, the linear stapler group had lower scores specifically in the domains of eating discomfort, dissatisfaction with eating, and dissatisfaction with work than the circular stapler group (P＜0.05).

Both types of staplers are safe and feasible, with the linear stapler being more beneficial for the recovery of postoperative gastrointestinal function and the improvement of quality of life.

To conduct a quality evaluation and content analysis of guidelines and consensus statenments on oral mucosa management for patients with autoimmune bullous disease, aiming to provide evidence for clinical nursing interventions.

Based on the "6S" evidence model, systematic searches were conducted in domestic and international guideline websites, professional society websites, and Chinese-English databases for literature on oral mucosa management in patients with autoimmune bullous diseases, with the period spanning from the database establishment to June 30,2025. The included literature was independently evaluated by two researchers who had received systematic training in evidence-based nursing, while the guidelines were independently assessed by four researchers. The guideline evaluation was performed using the "Appraisal of Guidelines for Research and Evaluation II" (AGREE II). The quality assessment of expert consensus was conducted using the evaluation criteria of the Australian JBI Evidence-Based Healthcare Centre (2016 edition).

A total of ten articles were ultimately included. Of these, four were clinical guidelines, of which three received a Grade A recommendation and one received a Grade B recommendation according to the AGREE Ⅱ instrument. The remaining five articles were consensus statements. A total of 22 pieces of evidence on oral mucosa management in patients with autoimmune bullous diseases were synthesized, covering six categories: oral assessment, oral hygiene management, mucosal healing medication management, pain management, nutritional management, comprehensive management, and follow-up.

Current guidelines and consensus on oral mucosa management for patients with autoimmune bullous diseases require quality enhancement. It is recommended that relevant organizations refine oral mucosa care in future guidelines, drawing on tools like AGREE Ⅱ and the WHO Guidelines Development Manual. This study synthesizes the best evidence for oral mucosa management in autoimmune bullous disease patients. Healthcare providers should implement personalized care based on mucosal conditions and these evidence-based recommendations to promote mucosal recovery.

To explore the bidirectional causal relationship between blood cells and chronic diseases of the tonsil and adenoid (CDTA).

Eighty peripheral blood specimens were collected from patients with CDTA who were treated at the Department of Otorhinolaryngology, Head and Neck Surgery of Huai'an Second People's Hospital between January 2024 and January 2025. Meanwhile, 40 blood samples were collected from healthy controls. The age range of the included samples was 5 to 18 years old. The differences in the quantity of peripheral blood cells were compared. Based on two-sample Mendelian randomization (MR), using the "TwoSampleMR" R package, and comprehensively employing three estimation methods including inverse variance weighted (IVW), MR-Egger regression, and weighted median, bidirectional causal association analysis was conducted on genome-wide association study (GWAS) summary data for 91 blood cell traits and CDTA. Heterogeneity was tested by Cochran's Q statistics. The MR-Egger intercept was used for horizontal pleiotropy test. The influence of single nucleotide polymorphisms (SNPs) on IVW results was evaluated by the leave-one-out analysis, and the potential bias of strongly correlated SNPs was evaluated by funnel plot.

A difference was observed in the count of peripheral blood neutrophils. Forward MR analysis showed that neutrophil perturbation response (wdf Colchicine 20 h NE4 SD SF) (odds ratio [OR]=0.970, 95% confidence interval [CI]: 0.947~0.993, P=0.011), red blood cell perturbation response (ret Rotenone 6h overnight RBC SD FSC) (OR=0.969, 95%CI: 0.940~0.999, P=0.045), and white blood cell perturbation response (pltf Baseline WBC1 Med SSC) (OR=1.026, 95%CI: 1.003~1.050, P=0.025) had a causal association with the occurrence of CDTA. Reverse MR analysis showed that CDTA had a causal association with monocyte perturbation response (wdf TMAO 3.5 h MO2 Med SSC) (OR=2.048, 95%CI: 1.044~4.020, P=0.037), neutrophil perturbation response (wdf Pam3CSK4 19 h NE4 CV FSC) (OR=1.402, 95%CI: 1.034~1.902, P=0.030), red blood cell perturbation response (ret DMSO 4.5 h RBC1 SD FSC) (OR=0.261, 95%CI: 0.083~0.819, P=0.021), and reticulocyte perturbation response (ret Ciprofloxacin 22 h RET1 Med SSC) (OR=0.713, 95%CI: 0.538~0.943, P=0.018). Sensitivity analysis showed no heterogeneity or pleiotropy.

There is a bidirectional causal relationship between blood cells and CDTA. The results of this study provide a basis for clinical prevention, diagnosis, and treatment of CDTA.

The treatment of thyroid nodules is progressively shifting toward minimally invasive and precision-oriented strategies. While traditional high-temperature thermal ablation techniques such as microwave ablation and radiofrequency ablation have been widely adopted, potential risks associated with their thermal effects including thermal injury to surrounding tissues and incomplete ablation due to thermal sink effects have spurred increasing interest in non-thermal ablation methods. Non-thermal ablation techniques exhibit diverse mechanisms of action and varying clinical applications. This article aims to review the principles of non-thermal ablation techniques and their current applications and advancements in treating thyroid nodules. It focuses on exploring the evolution of therapeutic strategies from classic chemical ablation to emerging approaches like irreversible electroporation and cryoablation, offering new insights for selecting treatment plans for thyroid nodules in clinical practice.

Intussusception is a distinctive form of intestinal obstruction characterized by the telescoping of a segment of bowel and its mesentery into an adjacent distal segment. Although its exact pathogenesis remains unclear, it is frequently associated with abnormal intestinal peristalsis, submucosal lymphoid hyperplasia, and the presence of a pathological lead point. Small bowel intussusception typically presents in infants under 1 year of age, with fever and vomiting being common. In contrast, ileocolic intussusception occurs more frequently in children over 1 year old and is often associated with an abdominal mass and pain. The nuclear-to-wall ratio (lipid core thickness/outer bowel wall thickness) is the most accurate differentiator: a ratio ＞1 indicates ileocolic intussusception, while a ratio ＜1 suggests small bowel intussusception. Treatment strategies vary depending on the type and clinical context. For small bowel intussusception with a symptom duration under 24 hours and an intussuscepted segment length ≤3.0 cm, spontaneous reduction is likely, and initial management with fasting and supportive care is recommended. For ileocolic intussusception, fluoroscopy-guided pneumatic reduction or ultrasound-guided hydrostatic reduction is the first-line treatment. Surgical intervention is indicated upon failure of enema reduction after three attempts, or if there is ultrasonographic evidence of secondary/persistent intussusception, or specific imaging findings (e.g., "appendiceal sign" or "air encircling the intussusceptum") during air enema reduction, or abnormal laboratory values (D-dimer ＞1.005 mg/L, lactate ≥3.0 mmol/L, or lymphocyte-to-CRP ratio＜0.121). The surgical approach is tailored to the underlying etiology. For primary ileocolic intussusception, laparoscopic reduction with ileocecal-lateral peritoneal fixation is optimal. In cases of persistent small bowel intussusception, transumbilical single-incision laparoscopic reduction, with or without resection, may be performed. For secondary intussusception, surgical management must include reduction, excision of the pathological lead point, and resection of any necrotic bowels.