By improving the existing pattern that different medical institutions with competition fragmentary health care mode,the bundled payment could improve the coordination and cooperation between medical institutions,improve the overall medical service quality and reduce medical service cost.It provided a helpful thought for the supply-side reform in health field in China.Foreign experience indicated that in order to implement bundled payment mode,China should build a complete medical service supply chain to promote integration of medical institutions;shift economic stimulus to economic constraints,build orderly competition environment;strengthen the construction of informatization and promote the applications of healthy big data.

Objective To establish the norms of Self-rated Health Measurement Scale Version 1. 0 ( SRHMS V1.0) for urban residents in Guangdong. Methods We used regional stratified random sampling method to select 6000 urban residents of 5 cities in Guangdong ( including Guangzhou, Maoming, Shantou, Shaoguan and Shenzhen) for a questionnaire investigation with SRHMS V1. 0, and establish the norms of mean,percentile and threshold based on characteristics of SRHMS V1.0 scores. Results The residents can be divided into 8 groups on the basis of gender and cut-off point of age 40,50 and 60. The mean norms of SRHMS V1.0 total scores were:(78.57±10.10),(76.93±9.90),(75.33±10.66),(69.45±13.90)for males under age40,40-50,50-60 and above 60 respectively;(77.03±10.00),(74.55±10.27),(72.24±11.76), (66.48±14.37)for females under age40,40-50,50-60 and above 60 respectively. The percentile norms of SRHMS V1.0 from 5 percent to 95 percent were established with 5% as interval. The norms of cutting off scores were established as five states according to the scores of TS,namely severe poor health,poor health,gen-eral health,good health and fairly good health,with( x-s),( x-0.5s),( x+0.5s),( x+s) as cutting off scores. Conclusion The study established the SRHMS V1.0 norms for urban residents of Guangdong preliminarily,which provides reference for further research of the population''s health status and its impacting factors.

Background Lead exposure induces microglial cell death, of which the mechanism is unclear. Ferroptosis is a new death form and its role in microglia death has not been reported. Objective To investigate the role of ferroptosis in microglia following lead exposure in order to provide a theoretical basis for the mechanism of lead neurotoxicity. Methods Microglial cell line BV-2 cells were co-cultured with 0, 10, 20 and 40 μmol·L⁻¹ lead acetate for 24 h. The 40 μmol·L⁻¹ lead acetate group with iron chelator (DFO) was named the 40+DFO group. Changes in BV-2 cell morphology after lead exposure were observed under an inverted microscope; tissue iron kit and glutathione kit were used to detect intracellular iron and glutathione (GSH) respectively; flow cytometry was applied to detect lipid reactive oxygen species (lipid ROS) immunofluorescence intensity. Western blotting and qPCR were adopted to detect the expressions of glutathione peroxidase 4 (GPX4), solute carrier family 7 member 11 (SLC7A11), transferrin receptor 1 (TFR-1), divalent metal transporter 1 (DMT1), ferroportin 1 (FPN1) protein and mRNA. Results Compared with the control group, the number of BV-2 cells decreased with increasing doses of lead and the cells showed a large, round amoeboid shape. The intracellular levels of iron of BV-2 cells were (1.08±0.04), (1.29±0.03), and (1.72±0.10) mg·g⁻¹ (calculated by protein, thereafter) in the 10, 20, and 40 μmol·L⁻¹ lead acetate groups, respectively, significantly higher than that in the control group (P<0.05), and the intracellular level of iron in the 40+DFO group, (1.34±0.10) mg·g⁻¹, was lower than that in the 40 μmol·L⁻¹ lead acetate group, (1.72±0.03) mg·g⁻¹ (P<0.05). Compared with the control group, the TFR-1 and DMT1 protein and mRNA expressions were increased in BV-2 cells in the 10, 20, 40 μmol·L⁻¹ lead acetate groups (P<0.05), especially in the 40 μmol·L⁻¹ lead acetate group; the FPN1 protein expression did not change significantly, but the FPN1 mRNA expressions in BV-2 cells in the 10, 20, 40 μmol·L⁻¹ lead acetate groups were significantly decreased (P<0.05). Compared with the control group, the intracellular GSH level decreased and the lipid ROS content increased in all three lead acetate groups; compared with the 40 μmol·L⁻¹ lead acetate group, the GSH level increased by 12.30% and the lipid ROS content decreased by 13.00% in the 40+DFO group (P<0.05). The expressions of GPX4 protein were reduced to 50.00%, 35.00%, and 17.00% of that of the control group in the 10, 20, and 40 μmol·L⁻¹ lead acetate groups respectively, while the expressions of GPX4 mRNA were also significantly reduced; the expressions of SLC7A11 protein and mRNA in the 20 and 40 μmol·L⁻¹ lead acetate groups were lower than that in the control group, with the most significant decrease in the 40 μmol·L⁻¹ lead acetate group (P<0.05). Conclusion Lead exposure could induce ferroptosis in BV-2 cells, in which iron transport imbalance and oxidative damage might be involved.

Objective To study the impact of various donor hepatectomy techniques on clinical rehabilitation and postoperative liver regeneration on living donor liver transplant (LDLT) donors.Methods The data of 13 consecutive LDLT carried out from May 2006 to May 2011,including the surgical techniques,postoperative liver function,and liver regeneration in the donors were retrospectively studied.Results The donor operations included 8 right hepatectomies without the middle hepatic vein,2 right hepatectomies with the middle hepatic vein and 3 left hepatectomies.Hepatic function and blood coagulation function returned to normal within two weeks of hepatectomy in all the donors.There was no severe complication and no death.There was a significant positive correlation between the donor liver volume as measured preoperatively on CT and the resected liver weight as measured intraoperatively (r=0.838,P＜0.01).The volume of the remnant liver increased soon after transplantation.The liver regenerated significantly faster in right than in lefft liver donors.The remnant liver of the right liver donors with middle hepatic vein preservation grew faster than the right liver donors without middle hepatic vein preservation.However,there was no significant difference in the recovery of the liver function between the three groups.Conclusions Donor hepatectomy is safe.The postoperative liver regeneration is affected by multiple factors including the remnant liver volume and blood supply of the remnant liver.

Objective To build the indicators system for clinical pathway management as required by clinical pathway control.Methods An indicators system was proposed by means of evidence-based review,focus group discussions,and ratings of the indicators' importance by doctors and nurses.A multidisciplinary panel of 60 experts from across the country were selected.A 3-round Delphi survey was made on the proposed indicators.The weights of the indicators were established by analytical hierarchy process (AHP).The response rate,Cronbach's α,and the authority coefficient of experts were used as a measure of reliability.Results The response rates of the 3 rounds were 85％,70％,and 94％; the experts authority coefficient was 0.80.The ccoefficient of variation falls with the rising number of consultations.The Kendall's W ranged from 0.40 to 0.83.Following the 3 rounds,consensus was achieved among experts as such a system comprising three first-level,9 second-level,and 36 third-level indicators.Conclusion The expert consultation has achieved reliable results.The established indicators system can serve as a useful instrument for standardized development of clinical pathways management and constant improvement.

Objective To understand the direct economic burden of healthcare-associated infection(HAI)due to multidrug-resistant organisms(MDROs).Methods Computer retrieval of CNKI,Wanfang,VIP,PubMed,Sci-enceDirect,and Cochrane databases on literatures about economic burden of MDRO HAI at home and abroad were performed,the retrieval time was from database establishment to December 2015,systematic evaluation of the liter-atures was obtained.Results According to the inclusion and exclusion criteria,as well as through Newcastle-Otta-wa Scale (NOS)for evaluating the literatures,19 literatures were included.In 12 studies about methicillin-resistant Staphylococcusaureus infection,the direct economic cost varied from $916.61 to $62908.00;in 4 studies about MDRO Acinetobacterbaumannii infection,the direct economic cost varied from$4644.00 to $98575.00.Direct economic cost due to extended-spectrumβ-lactamases-producing Enterobacteriaceae was $2824.14-$30093.00. Conclusion MDRO HAI will increase economic cost of both hospitals and patients,prevention and control measures should be taken .

Objective To assess the structure validity of application of sub-health measurement scale version 1.0(SHMS V1.0)in college students in Guangzhou City to lay a foundation for further analyzing the healthy status in this group and its influen-cing factors.Methods Nine hundreds college students were selected by adopting the stratified random sampling method for conduc-ting the questionnaire survey.The SPSS20.0 and AMOS21.0 were adopted to conduct the exploratory factor analysis(EFA)and confirmatory factor analysis(CFA)respectively.Results EFA obtained 7 factors with eigenvalue more than 1,the cumulative vari-ance contribution rate was 56.766%,moreover 7 factors were basically consistent with the theoretical structure of SHMS V 1.0. CFA conducted the model fitting for 3 total scales and 3 subscales,the results showed that the fitting of 3 subscales was good,the fitting result of total scale could be accepted,but did not reach the desired effect.Therefore,five times modification was applied in the total scale,and the fitting indexes after modification were CMIN/DF=2.723,GFI=0.907,IFI=0.917,TLI= 0.905,CFI=0.917,RMSEA=0.046,the fitting effect was comparatively excellent.Conclusion The dimension division of sub-health measure-ment scale is basically reasonable,and using this scale for measuring the sub-health status of college students in Guangzhou City has a better structure validity.

【Objective】 To explore the application value of ¹⁸F-PSMA PET/CT on the detection of metastatic lesions of prostate cancer with serum total prostate specific antigen (tPSA) ≤20 ng/mL and the predictive variables affecting the imaging results, and to establish a predictive nomogram for the metastasis of prostate cancer. 【Methods】 The imaging, pathological, serum and clinical data of 175 pathologically confirmed prostate cancer patients who underwent ¹⁸F-PSMA PET/CT examination during Jan.2020 and Oct.2021 were retrospectively collected.The patients were divided into metastatic group and non-metastatic group according to PET/CT imaging results, and the positive detection rate of metastatic lesions was calculated.The independent influencing factors of ¹⁸F-PSMA PET/CT in the positive detection of metastatic lesions were determined with univariate and multivariate logistic regression analyses.The predictive nomogram was established. 【Results】 Of the 175 patients, metastatic lesions were detected in 78 cases and not detected in 97 cases, with a detection rate of 44.6% (78/175).There were statistically significant differences between the metastatic group and the non-metastatic group in urinary tract symptoms, androgen deprivation treatment (ADT) at the time of PET/CT examination and the risk level of Gleason score (GS) (P<0.05).Univariate logistic regression showed that urinary tract symptoms(OR=3.64, P<0.001), GS risk (OR=3.96, P<0.001) and concurrent ADT treatment (OR=3.71, P<0.001) were associated with the positive detection rate of metastatic lesions.Multivariate Logistic regression showed that urinary tract symptoms (OR=3.19, P=0.002), GS high-risk group (OR=2.95, P=0.005) and concurrent ADT treatment (OR=3.27, P=0.001) were independent predictors of positive detection rate. 【Conclusion】 The probability of metastasis in newly diagnosed prostate cancer patients with tPSA≤20 ng/mL is high.¹⁸F-PSMA PET/CT is of high value for the early detection of metastasis.Urinary tract symptoms, GS high-risk group and concurrent ADT treatment are independent predictors of metastatic lesions.The predictive nomogram can help assist clinical optimization of imaging examination path.

Background Bromadiolone is the second-generation anticoagulant rodenticide widely used all over the world. Exposure to bromadiolone in early life stage can lead to neurodevelopmental toxicity, but its toxic mechanism of neurodevelopment is not clear so far. Objective To investigate the developmental neurotoxicity and mechanism of bromadiolone to zebrafish embryos. Methods Zebrafish embryos were randomly divided into four groups: a solvent control group (dimethylsulphoxide) and three bromadiolone exposure groups (0.39, 0.78, and 1.18 mg·L⁻¹). The exposure period was from 4 h to 120 h post-fertilization. The number of spontaneous movement per minute was recorded at 24 h post-treatment. The locomotor ability of zebrafish larvae and the activity of acetylcholinesterase (AChE) were tested at 120 h post-treatment. The relative expression levels of neurodevelopment-related genes (elavl3, gap43, mbp, and syn2a) were measured by fluorescence quantitative PCR. Results Compared with the control group, the number of spontaneous movement per minute at 24 h decreased significantly in the 1.18 mg·L⁻¹ bromadiolone exposure group (P<0.05). Compared with the control group, the total distance travelled of the zebrafish larvae in the 0.78 and 1.18 mg·L⁻¹ bromadiolone exposure groups decreased by 60% and 69% respectively (P<0.05, P<0.01), and the total movement time decreased by 34% and 65% respectively (P<0.05, P<0.01). The AChE activity in the 1.18 mg·L⁻¹ bromadiolone exposure group increased by 36% when compared with the control group (P<0.05). The fluorescence quantitative PCR results showed that compared with the control group, the expression levels of neurodevelopment-related genes elavl3, syn2a, and mbp were significantly down-regulated by 66%, 69%, and 65% in the 1.18 mg·L⁻¹ bromadiolone exposure group respectively (P<0.01), the expression level of gap43 was up-regulated by 56% in the 0.78 mg·L⁻¹ bromadiolone exposure group (P<0.01) and down-regulated by 34% in the 1.18 mg·L⁻¹ bromadiolone exposure group (P<0.05). Conclusion Bromadiolone exposure could inhibit spontaneous movement and locomotive behavior, down-regulate the expression levels of neurodevelopment-related genes, hinder the release of neurotransmitters, and result in neurodevelopmental toxicity in the early-staged zebrafish.