Performance appraisal of public hospitals have given a guidance for the development of public hospitals at all levels.A Class A tertiary hospital reviewed the problems in the development of the hospital at the present stage and focused on the following four aspects:①insufficient fine management;②No clear orientation of discipline development;③The bottleneck of the improvement of medical operation efficiency;④New challenges in the reform of payment mode.The tertiary hospital launched a fine management practice in May 2022,in order to solve the problems by taking the Department of Surgery as a pilot area,laying the foundation for fine management through information system construction,improving the efficiency of medical operation through management process optimization,improving the overall competitiveness of disciplines through the construction of sub-specialty and Discipline Alliance and adjusting the performance appraisal index system to play the role of performance incentives.The measures effectively improve the overall capacity and efficiency of hospital medical services and help the hospital to achieve high-quality development.

Objective:To explore the characteristics, prevention and treatment strategies of lower urinary tract injury in transvaginal reconstructive pelvic surgery (vRPS).Methods:A retrospective analysis was conducted on 24 patients who suffered lower urinary tract injuries occuring in vRPS from January 2005 to June 2021, among which 4 cases were referred to our hospital from other hospitals.Results:(1) In our hospital, 1 952 patients underwent vRPS for anterior and (or) middle pelvic organ prolapse during that study period, with a 1.0% (20/1 952) incidence of lower urinary tract injuries occurring in 20 cases. (2) Ureteral injuries were observed in 14 cases who underwent transvaginal high uterosacral ligament suspension (1.4%, 14/966). The symptoms were relieved after the removal of sutures. (3) Bladder injuries occurred in 6 cases in our hospital, with 4 cases (0.7%, 4/576) in anterior transvaginal mesh surgery (aTVM), one (0.4%, 1/260) in colpocleisis, and one (0.7%, 1/150) in apical suspension for fornix prolapse. An additional 4 cases of bladder injury were referred to our hospital after aTVM. Among the 8 cases of bladder injury during aTVM, 2 cases were intraoperative incidents. Cystoscopy confirmed that the superficial branch or puncture rod of anterior vaginal mesh had penetrated into the bladder. Re-puncturing and placement of the mesh were successfully performed. No abnormalities were observed during a follow-up period of 4-5 years. Postoperative bladder injuries were identified in 6 cases, characterized by mesh erosion into the bladder and formation of calculi. These injuries were confirmed between 6 months to 2 years after vRPS. The exposed mesh and calculi in the bladder were removed through laparotomy or cystoscopy, followed up for 2-12 years. One case experienced slight re-erosion of mesh to the bladder.Conclusions:Lower urinary tract injuries are difficult to avoid in vRPS, particularly in transvaginal high uterosacral ligament suspension and aTVM. However, the incidence is low. Lower urinary tract injuries during vRPS could be easily detected and managed intraoperatively because of the use of cystoscopy. As long-term postoperative complications, erosion of transvaginal mesh to lower urinary tract postoperatively could be treated correctly, seldom with severe sequelae.

Objective:To explore the molecular basis for an individual with Bel subtype of the ABO blood type due to a novel c. 620T>C variant gene, and assess its impact on the structure of GTB transferase.Methods:An individual who had visited the First Affiliated Hospital of Zhengzhou University on February 11, 2023 was selected as the study subject. ABO phenotyping was initially conducted with serological methods, which was followed by direct sequencing of 7 exons of the ABO gene. Subsequently, single-strand sequencing was carried out by using allele-specific primers, and the variant in the B transferase was homology-modeled using the Modeller software. The impact of the variant on the transferase′s spatial structure was analyzed with the PyMOL software. Results:The serological phenotype of the patient was identified as the Bel subtype. Direct sequencing revealed that she has harbored a novel c. 620T>C variant, resulting in a p. Leu207Pro substitution in the polypeptide chain. Combined with single-strand sequencing, her genotype was ultimately determined as ABO* BELnew/ ABO* O.01.02. Three-dimensional protein structure modeling showed that, compared with the wild type, the distance of one hydrogen bond between Proline and Glycine at position 272 has increased, along with disappearance of another hydrogen bond. Conclusion:The novel c. 620T>C (p.Leu207Pro) variant of B allele may affect the structural stability of the glycosyltransferase. The weakened enzyme activity in turn may lead to reduced B antigen expression, manifesting as the Bel subtype by serological analysis.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

On-line and off-line blended teaching is one of the directions for future experimental teaching mode reform in universities. Blended teaching is characterized by systematic course design, repeatable knowledge nodes, autonomous learning and frequent interaction between teachers and students. The on-line and off-line blended teaching course of Biochemistry Experiments in Zhejiang University includes massive open online course (MOOC), off-line comprehensive series of experiments and independent experiments design and practice. The blended teaching practice of this course expanded experimental teaching content, developed standardized preparation, process and assessment mechanism, and promoted shared application of the course.
Humans ; Learning ; Students ; Curriculum ; Biochemistry

Objective:To investigate the efficacy of intense pulsed light (IPL) combined with meibomian gland expression for moderate to severe dry eye associated with meibomian gland dysfunction (MGD) in cataract patients during the perioperative period.Methods:A non-randomized controlled study was conducted.Forty patients (40 eyes) with moderate to severe dry eye associated with MGD who planned to undergo binocular cataract extraction combined with intraocular lens (IOL) implantation at Beijing Tongren Hospital, Capital Medical University were enrolled from October 2020 to December 2021.One eye of each patient was randomly included using Excel RAND function.All patients received artificial tears regularly to treat dry eye symptoms, and meibomian gland expression was performed as needed.Patients were divided into a treatment group (20 patients, 20 eyes) and a control group (20 patients, 20 eyes) according to whether they wished to receive IPL therapy.The treatment group received IPL therapy 3 times before surgery, with a 2-week interval between each therapy, and phacoemulsification combined with IOL implantation at least 2 weeks after the last treatment.The two groups were evaluated at baseline, 1 day before surgery (i.e.2 weeks after the last IPL treatment for the treatment group), 1 week after surgery and 1 month after surgery.Outcome measures included Ocular Surface Disease Index (OSDI), corneal fluorescence staining, Schirmer Ⅰ test (SⅠt), tear break-up time (TBUT), meniscus height, the number of eyes with different scores of meibomian gland atrophy and the number of eyes with different scores of meibomian gland excretion capacity.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Beijing Tongren Hospital, Capital Medical University (No.TRECKY2017-063). Written informed consent was obtained from each subject.Results:Baseline, 1-day preoperative, 1-week postoperative, 1-month postoperative OSDI scores were (47.83±10.17), (47.50±10.75), (66.08±12.68), (67.92±16.51) points in control group, and (62.50±12.04), (20.05±4.65), (24.75±5.98), (12.65±3.01) points in treatment group, respectively.There were significant differences in the overall comparison of OSDI scores between the two groups at different time points ( Fgroup=119.351, P<0.01; Ftime=86.219, P<0.01). The 1-day preoperative, 1-week postoperative and 1-month postoperative OSDI scores were lower and the baseline OSDI score was higher in the treatment group than in the control group, showing statistically significant differences (all at P<0.05). In the treatment group, the OSDI score 1 day before surgery was significantly lower than baseline, and 1 week after surgery was significantly higher than 1 day before surgery, but significantly lower than baseline, and decreased significantly again at 1 month after surgery (all at P<0.05). In the control group, the OSDI score was significantly higher at 1 week and 1 month after surgery than at 1 day before surgery and at baseline (all at P<0.05). The number of eyes with corneal fluorescence staining 1 day before surgery, 1 week after surgery and 1 month after surgery was significantly lower in the treatment group than in the control group (all at P<0.01). The SⅠt values 1 day before surgery, 1 week after surgery and 1 month after surgery were higher in the treatment group than in the control group but significantly higher than the baseline value, and the differences were statistically significant (all at P<0.05). The SⅠt value 1 month after surgery was significantly higher in the treatment group than before surgery and 1 week after surgery (both at P<0.05). The TBUT values 1 day before surgery, 1 week after surgery and 1 month after surgery were greater in the treatment group than in the control group and at baseline, and the 1-month postoperative TBUT of the treatment group was significantly higher than the 1-week postoperative TBUT (all at P<0.05). Meniscus height 1 day before surgery, 1 week after surgery and 1 month after surgery was greater in the treatment group than in the control group and at baseline, and the differences were statistically significant (all at P<0.05). There was no statistically significant difference in the number of eyes with different scores of meibomian gland atrophy between the two groups at different time points (all at Z=-0.628, P=0.530). There was no statistically significant difference in the number of eyes with different scores of meibomian gland excretion capacity between the control and treatment groups at baseline, 1 day before surgery, 1 week after surgery and 1 month after surgery (all at P>0.05). Conclusions:IPL is effective for treating dry eye associated with MGD in cataract patients during the perioperative period, and it can effectively improve dry eye symptoms and signs in patients after cataract surgery.

【Objective】 To analyze ABO system hemolytic disease of the fetus and newborn (HDFN) and its influencing factors in Obstetrics Department of our hospital. 【Methods】 The blood samples of 1 040 neonates and their mothers in the obstetric department of our hospital were retrospectively analyzed from September 2022 to January 2023, including ABO and RhD blood group of the neonates and mothers, as well as 3 tests of HDFN, Hb, total bilirubin (TBIL) and indirect bilirubin(IBIL) of the neonates. Relevant clinical data of the neonates and mothers were collected, including maternal and neonatal age, neonatal sex, maternal pregnancy history, gestational age and delivery mode, and their influences on ABO-HDFN were analyzed. 【Results】 Among 1 040 HDFN samples, 298 were ABO incompatibility, among which 113 were HDFN positive, with a positive rate of 37.9% (113/298); the positive rate of HDFN in neonates born to mothers with type O was significantly higher than that in neonates born to mothers with type A and B (71.4% vs 8.2%, P<0.05); the positive rate of HDFN in neonates with antigen-A incompatibility was significantly higher than that in neonates with antigen-B incompatibility (48.7%vs 26.7%, P<0.05), which was the highest in neonates with O-A incompatibility [83.6% (61/73)], followed by O-B incompatibility [58.2% (39/67)]. There was no significant difference in Hb and bilirubin among the other groups except for the difference of Hb between the O-A incompatibility HDFN positive group and the HDFN negative group [(145.0±16.0) vs(153.4±13.2), P<0.05)]. The levels of Hb, TBIL and IBIL in the "direct antiglobulin test+ indirect antiglobulin test+release test+" group were significantly different from those in the HDFN negative group[(144.9±21.6) vs (153.3±13.2), P <0.05; (36.9±11.8) vs (29.6±6.1), P<0.05; (30.6±12.7) vs (23.0±6.9), P<0.05, respectively]. Logistic regression analysis showed that maternal delivery frequency, mother-neonate incompatible antigen and maternal blood type were independent risk factors for HDFN. 【Conclusion】 ABO-HDFN occurred mainly in neonates born to O-type mothers, and the positive rate was the highest in neonates with O-A incompatibility. The severity of HDFN had little relationship with the mother-neonate blood type, but had relationship with the result of 3 tests of HDFN. Maternal delivery frequency, mother-neonate incompatible antigen and maternal blood type were independent risk factors for HDFN.

Objective:To determinate the active ingredients and predicte action targets in Sanhua Decoction for treating cerebral ischemia based on HPLC and network pharmacology methods. Methods:The HPLC analysis was performed on HC-C18 (250 mm × 4.6 mm, 5 μm) with the mobile phase of methanolacetonitrile-0.05% phosphoric acid with gradient elution at the flow rate of 1.0 ml/min and 0.8 ml/min. The detection wavelength was set at 254 nm, the column temperature was at 30 ℃, and the injection volume was 10 μl. TCMIP v2.0 platform was used to search the action targets of rhein, emodin, chrysophanol, hesperidin, magnolol and notopterygiol. We used Cerebral ischemia as a keyword searching the databases such as Genecards, OMIM, TTD, and Disgenet to screen six potential targets for the treatment of cerebral ischemia by active ingredients, construct a protein interaction (PPI) network and a disease-component-target-pathway integration network.Results:The literature search determined that rhein, emodin, chrysophanol, hesperidin, magnolol and qianhuol were the index components for the determination of Sanhua Decoction. Their linear ranges were 0.080 4-0.804 0 μg, 0.015 3-0.382 0 μg, 0.041 8-0.626 4 μg, 0.312 6-3.908 0 μg, 0.037 9-0.568 8 μg, 0.045 3-1.359 6 μg, respectively. The correlation coefficient R 2 is greater than 0.999 0. The content ranges of the above six components in seven samples were 0.887-0.971 mg/g, 0.094-0.101 mg/g, 0.110-0.119 mg/g, 1.494-1.669 mg/g, 0.126-0.145 mg/g and 0.153-0.167 mg/g, respectively. Network pharmacology analysis found that the targets of the six components for the treatment of cerebral ischemia may be TNF, TP53, MAPK14, JUN, IL1B, MYC, ESR1, ICAM1, PTGS2, PPARG and so on. Conclusions:A quality control method forthe six active ingredients in Sanhua Decoction treating cerebral ischemia was established. This method is simple and repeatable. The ten potential targets of the six active ingredients in Sanhua Decoction for the treatment of cerebral ischemia have been clarified, laying a foundation for further research on the action mechanism.

The positive interaction between medical treatment system and medical insurance system is of great significance to promote the reform of medical and health care system. Due to the complexity of the relationship between them, it is difficult to explain it comprehensively with a single theoretical method. The authors analyzed the relationship between medical treatment system and medical insurance system by applying system theory, game theory and synergy theory, and then put forward policy suggestions to optimize the linkage reform of medical treatment system and medical insurance system, so as to better promote the reform of " three medical linkage" and promote the construction of healthy China. The suggestions included optimizing the allocation of health resources, accelerating the construction of medical insurance legislation and health technical evaluation system, strengthening the construction of multi-level medical insurance system, promoting the inter regional information interconnection between medical care and medical insurance, improving the coordination mechanism, negotiation mechanism, incentive and constraint mechanism between medical care and medical insurance.

In the era of Internet +, teaching models in universities are undergoing changes due to the rapid development of information technology. Blended teaching, combining online with offline teaching, is being implemented and developed in universities. In order to reform teaching mode and improve teaching effect, the curriculum team carried out the exploration of blended teaching reform for the "Introduction to Life Sciences" for non-biology students. The course combined high-level MOOC (Massive Open Online Course), small class teaching, diversified platform and multi-dimensional teaching mode, built a multi-disciplinary collaborative teaching team, formed a multi-dimensional evaluation system focusing on process and ability, practiced the education concept of combining knowledge teaching and value leading, gained valuable practical experience, and achieved the expected teaching results. It can provide reference for the reform and construction of similar courses in other colleges and universities. The development of blended teaching expands the breadth and depth of teaching, stimulates students' interest and potential for learning, opens up students' thinking and perspective, cultivates students' scientific literacy and comprehensive ability, and plays a positive role in the cultivation of innovative and inter-disciplinary talents.
Biological Science Disciplines ; Curriculum ; Humans ; Learning ; Students ; Universities