The paper discusses the necessity and urgency of hospital ownership reform. and pinpoints the focal and difficult points of the task. It also identifies the goals of the reform, viz. establishment of a medical and health system that fits in with the development demands of a socialist market economy, which is of great significance. It can be seen both in theory and in practice that for a pretty long period of time in China, public hospitals, providing basic medical security for the broad masses of people will occupy a leading position whereas private hospitals known for their outstanding service and quality, will play a bigger role only when the living standards of the general population have reached a fairly high level.

AIM:To conduct the relevance analysis of serum Dickkopf-1 (Dkk-1) and bone mineral density (BMD) in the different ages of female populations.METHODS: The women volunteers (n=100, 20~80 years old) were selected and divided into young group (20~39 years old), middle age group (40~59 years old) and elderly group (60~80 years old).The serum levels of Dkk-1 in the 3 groups of volunteers were detected by ELISA.In the middle age group, 25 people of 45~55 years old were selected and divided into postmenopausal group and premenopausal group to de-tect the serum level of Dkk-1 in the 2 groups of volunteers by ELISA.The BMD was measured by the method of dual energy X-ray absorptiometry.The differences of Dkk-1 expression levels among different ages of female populations, and the rele-vance with BMD were compared.RESULTS:With the increase in age, the serum Dkk-1 expression level increased ( P<0.05), and BMD were reduced (P<0.05).The blood level of Dkk-1 and BMD negatively correlated (P<0.05) in the 3 groups of volunteers.The serum levels of Dkk-1 and BMD had stronger negative correlation in postmenopausal women group than that in premenopausal women group.CONCLUSION:With the increase in age, the expression level of serum Dkk-1 increases and the BMD level decreases, which contribute to a risk of osteoporosis.In the same age range, the postmeno-pausal women express higher level of Dkk-1, and the decreased BMD is more obvious, which contribute to a greater risk of osteoporosis.The increased level of Dkk-1 also inhibits bone formation and promotes bone resorption.It may become a new target for preventing and treating osteoporosis.

Laparoscopic technique is now widely used in gastrointestinal surgery, but the limitation of its “tubular vision” pose disadvantages. Benefits from the realization of dynamic navigation which can match the preoperative dimensional reconstruction model and the surgical scene in real time, the computer-aided surgery(CAS) can supplement the insufficiency of laparoscopic view. Focusing on pancreas, the key organ in the laparoscopic gastrectomy for cancer cancer,the initial experience of dynamic navigation in such surgery using a virtual surgical model is shared. The method is as follows: First, the virtual model of pancreas and peripheral blood vessels was reconstructed with the Mimics17.0 based on the abdominal computed tomography data of the patients with gastric cancer; and the location information of the virtual marker was captured with the tracking software. Second, the three dimensional (3D) construction image displayed in SLT file, was read in ZEditTM3.21 and was printed by Spectrum ZTM510 printer. Then, the 3D model was fixed in a laparoscopic simulation training device to achieve the simulation operation. The location information of the laparoscopic training device , lens and laparoscopic instrument was recorded with tracking software. Besides, the coordinate information of simulation operation was also achieved. Third, we conducted a match between the virtual and simulation operation. Our study show that scenes splitting is conducive to the tracking and matching of the surgical navigation in laparoscopic surgery for gastric cancer.

Laparoscopic technique is now widely used in gastrointestinal surgery, but the limitation of its “tubular vision” pose disadvantages. Benefits from the realization of dynamic navigation which can match the preoperative dimensional reconstruction model and the surgical scene in real time, the computer-aided surgery(CAS) can supplement the insufficiency of laparoscopic view. Focusing on pancreas, the key organ in the laparoscopic gastrectomy for cancer cancer,the initial experience of dynamic navigation in such surgery using a virtual surgical model is shared. The method is as follows: First, the virtual model of pancreas and peripheral blood vessels was reconstructed with the Mimics17.0 based on the abdominal computed tomography data of the patients with gastric cancer; and the location information of the virtual marker was captured with the tracking software. Second, the three dimensional (3D) construction image displayed in SLT file, was read in ZEditTM3.21 and was printed by Spectrum ZTM510 printer. Then, the 3D model was fixed in a laparoscopic simulation training device to achieve the simulation operation. The location information of the laparoscopic training device , lens and laparoscopic instrument was recorded with tracking software. Besides, the coordinate information of simulation operation was also achieved. Third, we conducted a match between the virtual and simulation operation. Our study show that scenes splitting is conducive to the tracking and matching of the surgical navigation in laparoscopic surgery for gastric cancer.

BACKGROUND:Studies have found that chondrocyte ferroptosis can be used as an important pathogenesis to induce the occurrence and development of osteoarthritis.With the continuous development of Chinese medicine,some scholars have found that some traditional Chinese medicine monomers and traditional Chinese medicine compounds can inhibit chondrocyte ferroptosis through various mechanisms of action,and finally play a role in the treatment of osteoarthritis. OBJECTIVE:To explore the relationship between ferroptosis and osteoarthritis and the mechanism by which traditional Chinese medicine deals with ferroptosis in the treatment of osteoarthritis,in order to provide new ideas for the treatment and prevention of osteoarthritis. METHODS:With"osteoarthritis,ferroptosis,chondrocytes,lipid metabolism,traditional Chinese medicine,ROS,GPX 4"as the English and Chinese search terms,CNKI,PubMed,WanFang,and VIP databases were searched for relevant articles regarding the relationship between ferroptosis and osteoarthritis and its traditional Chinese medicine intervention until 2022.Then,a systematic analysis was conducted. RESULTS AND CONCLUSION:Intracellular iron overload will cause lipid peroxidation,resulting in the accumulation of reactive oxygen species and eventually the occurrence of ferroptosis,while excessive iron will accelerate the apoptosis of chondrocytes and affect chondrocyte homeostasis,thereby inducing the development of osteoarthritis.When amino acid metabolism is abnormal,an imbalance in glutamate and cystine exchange causes the accumulation of glutamate outside the cells,and high extracellular concentration of glutamate will cause the depletion of glutathione,indirectly inhibiting the function of ferroptosis-related factors,and contributing to ferroptosis.When cellular lipid metabolism is abnormal,unsaturated fatty acids,an important component of the cell membrane,lose their diallyl hydrogen atoms,leading to the destruction of cells to induce ferroptosis,while lipid metabolism is closely involved in the progression of osteoarthritis.Traditional Chinese medicine can play a role in the prevention and treatment of osteoarthritis by inducing the occurrence of ferroptosis.The research on iron death is still immature,and further research on its action mechanism is expected to open up new ways for the clinical treatment of osteoarthritis.

Objective:To explore the risk factors of oral-mucosal pressure injury (OMPI) in patients with tracheal intubation in ICU and to establish a nomogram model.Methods:Using the convenient sampling method, a total of 640 patients with oral tracheal intubation admitted to ICU of the First Affiliated Hospital of Xinjiang Medical University from January to May 2023 were selected as the research objects. They were divided into the occurrence group ( n=286) and the non-occurrence group ( n=354) according to whether OMPI occurred or not. Binomial Logistic regression analysis was used to explore the risk factors for OMPI in patients with tracheal intubation in ICU. A risk nomogram model was created based on independent risk factors, and internal verification was conducted by Bootstrap repeated sampling method. Results:OMPI occurred in 286 of 640 ICU patients with tracheal intubation. Binomial Logistic regression analysis showed that high APACHEⅡ score, modified Beck oral score greater than or equal to 11 points, use of sedative drugs, prone ventilation, long retention time of tracheal catheter, low oxygenation index less than 200 mmHg (1 mmHg=0.133 kPa) and tracheal catheter fixation frequency of 1 time /24 h were the risk factors for OMPI in patients with tracheal intubation in ICU ( P<0.05). A risk nomogram model for OMPI in patients with tracheal intubation in ICU was established based on independent risk factors. The results showed that the predictive performance (area under the receiver operating characteristic curve of subjects was 0.918, 95% confidence interval was 0.897 to 0.938) and calibration (χ 2 value of 4.647, P=0.795) of the risk nomogram model for OMPI in patients with tracheal intubation in ICU were good. When the threshold probability was 0 to 1, the decision curve showed that the model had good clinical effectiveness. Conclusions:The OMPI risk nomogram model of tracheal intubation patients in ICU established in this study has good calibration and differentiation, which can be used as an effective tool for screening high-risk patients.

In recent years, the clinical experts consensuses or guidelines of ankylosing spondylitis (AS)/spondyloarthritis (SpA) have been constantly updated, but to better understand and practice, patient self-participation management is one of the key points to improve the level of diagnosis and treatment. Through questionnaire survey of these patients, we screened out the most concerned issues, and established the AS/SpA patient practice guideline working group with multidisciplinary physicians and patients. Fifteen opinions, as the AS/SpA patient practice guidelines, are proposed in accordance with the relevant principles of the "WHO guidelines development manual" , and with the international normative process.

Multiple plant lineages have independently evolved sex chromosomes and variable kary-otypes to maintain their sessile lifestyles through constant biological innovation.Morus notabilis,a dioecious mulberry species,has the fewest chromosomes among Morus spp.,but the genetic basis of sex determination and karyotype evolution in this species has not been identified.In this study,three high-quality genome assemblies were generated for Morus spp.[including dioecious M.notabilis(male and female)and Morus yunnanensis(female)]with genome sizes of 301-329 Mb and were grouped into six pseudochromosomes.Using a combination of genomic approaches,we found that the putative ancestral karyotype of Morus species was close to 14 protochromosomes,and that sev-eral chromosome fusion events resulted in descending dysploidy(2n=2x=12).We also charac-terized a～6.2-Mb sex-determining region on chromosome 3.Four potential male-specific genes,a partially duplicated DNA helicase gene(named MSDH)and three Ty3_Gypsy long terminal repeat retrotransposons(named MSTG1/2/3),were identified in the Y-linked area and considered to be strong candidate genes for sex determination or differentiation.Population genomic analysis showed that Guangdong accessions in China were genetically similar to Japanese accessions of mul-berry.In addition,genomic areas containing selective sweeps that distinguish domesticated mul-berry from wild populations in terms of flowering and disease resistance were identified.Our study provides an important genetic resource for sex identification research and molecular breeding in mulberry.

BACKGROUND:As tissue engineering brings new hope to the worldwide problem of articular cartilage repair,the construction of light-curing 3D printed hydrogel scaffolds with biomimetic composition is of great significance for cartilage tissue engineering. OBJECTIVE:To construct a biomimetic methacryloylated hyaluronic acid/acellular Wharton's jelly composite hydrogel scaffold by digital light processing 3D printing technology,and to evaluate its biocompatibility. METHODS:Wharton's jelly was isolated and extracted from human umbilical cord,then decellulated,freeze-dried,ground into powder,and dissolved in PBS to prepare 50 g/L acellular Wharton's jelly solution.Methylallylated hyaluronic acid was prepared,lyophilized and dissolved in PBS to prepare 50 g/L methylallylated hyaluronic acid solution.Acellular Wharton's jelly solution was mixed with methacrylyacylated hyaluronic acid solution at a volume ratio of 1:1,and was used as bio-ink after adding photoinitiator.Methylacrylylated hyaluronic acid hydrogel scaffolds(labeled as HAMA hydrogel scaffolds)and methylacrylylated hyaluronic acid/acellular Wharton's jelly gel scaffolds(labeled as HAMA/WJ hydrogel scaffolds)were prepared by digital light processing 3D printing technology,and the microstructure,swelling performance,biocompatibility,and cartilage differentiation performance of the scaffolds were characterized. RESULTS AND CONCLUSION:(1)Under scanning electron microscope,the two groups of scaffolds showed a three-dimensional network structure,and the fiber connection of HAMA/WJ hydrogel scaffold was more uniform.Both groups achieved swelling equilibrium within 10 hours,and the equilibrium swelling ratio of HAMA/WJ hydrogel scaffold was lower than that of HAMA hydrogel scaffold(P＜0.05).(2)CCK-8 assay showed that HAMA/WJ hydrogel scaffold could promote the proliferation of bone marrow mesenchymal stem cells compared with HAMA hydrogel scaffold.Dead/live staining showed that bone marrow mesenchymal stem cells grew well on the two groups of scaffolds,and the cells on the HAMA/WJ hydrogel scaffolds were evenly distributed and more cells were found.Phalloidine staining showed better adhesion and spread of bone marrow mesenchymal stem cells in HAMA/WJ hydrogel scaffold than in HAMA.(3)Bone marrow mesenchymal stem cells were inoculated into the two groups for chondrogenic induction culture.The results of qRT-PCR showed that the mRNA expressions of agglutinoglycan,SOX9 and type Ⅱ collagen in the HAMA/WJ hydrogel scaffold group were higher than those in the HAMA hydrogel scaffold group(P＜0.05,P＜0.01).(4)These findings indicate that the digital light processing 3D bioprinting HAMA/WJ hydrogel scaffold can promote the proliferation,adhesion,and chondrogenic differentiation of bone marrow mesenchymal stem cells.

Adipocytokines are polypeptides or proteins that are secreted by fat cells with a wide range of biological activities. Adiponectin is a fatty cytokine with insulin sensitization. It possesses the function of anti- diabetes, atherosclerosis and anti-inflammation. Adiponectin may participate in regulating the development of cognitive impairment, which is considered as a new regulatory factor for cognitive impairment.
Adiponectin ; Cognitive Dysfunction ; Diabetes Mellitus ; Humans ; Insulin ; Insulin Resistance