Hypoxia-inducibIe factor-1(HIF-1)is a main nucIear transcription factor for response to intratumor hypoxia. RecentIy,it has become a hot spot to attempt to improve hypoxia by inhibiting HIF-1. HIF-1 inhibitors' mechanisms of action are wide,which infIuences the two signaI transduction pathways that are phosphatidyIinositoI-3-kinase/ protein kinase B/ mammaIian target of rapamycin and Ras/ Raf/ mitogen-activated protein kinase kinase1-2/ extraceIIuIar signaI-reguIated kinase1-2,inhibits the function of heat shock protein 90,and reduces transcriptionaI activity of HIF-1. In combination with radiation,HIF-1 inhibi-tors significantIy enhance radiosensitivity and weaken radioresistance of hypoxia ceIIs,which contributes to the therapeutic effect of tumor irradiation.

Objective:To synthesize the real experiences of medical staff's organizational silence behavior.Methods:A systematic search was conducted in databases including PubMed, Web of Science, Embase, Cochrane Library, CINAHL, EBSCO, ProQuest, China National Knowledge Infrastructure, Wanfang Data, VIP, and China Biology Medicine disc, collecting qualitative studies on medical staff's experiences related to organizational silence behavior. The search period covered the establishment of the databases until June 2024. The quality of the included studies was assessed using the Joanna Briggs Institute's qualitative research quality evaluation standards, and results were integrated using an aggregative synthesis approach.Results:A total of 10 studies were included, with 65 findings summarized into 11 new categories, which were further synthesized into four overarching conclusions: organizational silence is complex, with respect and concern coexisting, many factors contribute to organizational silence, medical staff experience negative emotions as a result of organizational silence, there is a desire for recognition and support.Conclusions:The experience of organizational silence behavior among medical staff is complex. Managers should focus on this issue, encourage individuals to voice their concerns, provide diverse support mechanisms, and enhance positive experiences to reduce the prevalence of organizational silence.

Objective:To investigate the application in the preparation of supraclavicular island flap by "point line anterograde dissection (PLAD) ".Methods:A retrospective analysis was performed on 45 flaps of 43 patients treated with supraclavicular artery island flap from the Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital Affiliated to Capital Medical University from January 2013 to June 2019. The patients were all male, aged 35-72 years old. There were 26 cases of hypopharyngeal cancer, 4 cases of recurrent laryngeal cancer, 2 cases of cervical esophageal cancer, 1 case of tonsillar cancer, 1 case of parotid gland cancer, 3 cases of postoperative pharyngeal fistula after hypopharyngeal cancer, 2 cases of esophageal fistula after trauma, 2 cases of esophageal stricture after hypopharyngeal carcinoma operation, 1 case of autoimmune laryngeal stenosis, and 1 case of cheek defect after maxillary sinus cancer operation."Point" was the origin of the supraclavicular artery in the transverse carotid artery. "Line" was an extension line made along the starting point of the supraclavicular vessel for anterograde anatomy of 1-2 cm and the direction of the blood vessel. The extension line was used as the central axis of the designed island flap. Characteristics of flap blood supply, the time of flap preparation, flap survival, donor area recovery and clinical follow-up were recorded.Results:The arterial blood supply of the flap was constant, and the venous reflux was variable. The area of the prepared flap was (4-8) cm×(10-18) cm, and the preparation time was 30-60 min, with a median of 42 min. Skin flap survival rate was 100%. Partial necrosis of skin flap occurred in 1 patient and postoperative pharyngeal fistula occurred in 5 patients, all of whom were cured by dressing change. The donor site defects were closed and sutured directly. 3 patients had partial incision dehiscence and healed after dressing change. During the follow-up, 1 patient was lost, and the remaining 42 patients were followed up for 8 to 55 months.40 patients involved swallowing function, all of them returned to regular diet or soft fluid after operation.40 patients involved malignant tumors and local tumor recurrence in 3 patients among whom, there were 2 cases of lymph node recurrence, and 2 cases of distant metastasis, including 1 case of lung metastasis and 1 case of bone metastasis.Conclusion:PLAD is a simple, safe and efficient method for the preparation of supraclavicular island flap.

It collected relative policy documents systematically and analyzed the development process and policy objective evolution of Chinese basic medical insurance system.Based on this,it determined the performance assessment objectives of the designated medical institutions of basic medical insurance and constructed the assessment framework guided by the goal realization.Then,from the perspective of contract management and performance management,it determined the assessment elements of contract enforcement assessment system of designated medical institutions and the logical relationship between the elements,and to construct a conceptual model,which provides a reference for guiding the research of the contract enforcement assessment of the designated medical institutions of basic medical insurance.