Objectives:Financial pressure could have severe consequences for research hospitals.Studying the financial statement information and management measures of"top"hospitals in the US.can provide references for research hospitals in China to ensure long-term financial sustainability and improve competitiveness.Methods:The latest audited financial statements of Mayo Clinic,Cleveland Clinic,The Johns Hopkins Health System,and Mass General Brigham in the United States were collected,descriptive statistical analysis was employed.Results:The"top"four medical institution have a good asset composition,moderate debt ratios,large investment,with net assets continue to increase.They have diversified sources of revenue,with specialists being its key asset,human resource expense accounting for 57％～58％of total expenses,pursuing technological leadership.When facing financial pressure,the first choice is to improve operational efficiency and continue to reinvest in core missions.Conclusion:The practice of four"top"research medical institutions in the US.has provide new perspective for research hospitals in China to ensure long-term financial sustainability and improve market competitiveness.

BACKGROUND:Exercises can reduce blood lipids and slow down the development of atherosclerosis.Atherosclerosis begins with mitochondrial dysfunction,and prohibitin 2 is involved in mitophagy by endurance training. OBJECTIVE:To explore the role of endurance training in the intervention of prohibitin 2 protein in the mitophagy autophagy pathway in atherosclerosis. METHODS:A total of 40 Wistar rats were randomly divided into control group,exercise group,atherosclerosis group and atherosclerosis combined with exercise group,with 10 rats in each group.A rat model of atherosclerosis was constructed by combining a high-fat diet(9 weeks)with vitamin D injections(weeks 1,3,and 6)in the latter two groups,while the two exercise groups were subjected to progressing intensity endurance training for 9 weeks.After the intervention,lipid and pathological detections were conducted to observe the modeling and interventional effects.Mitochondrial membrane potential and mitophagy proteins were detected by microplate reader and western blot.Immunofluorescence staining was used to observe the co-localization of mitophagy proteins in aortic tissue. RESULTS AND CONCLUSION:Lipid and pathological sections showed that compared with the atherosclerosis group,the serum low-density lipoprotein cholesterol and total cholesterol levels and aortic lipid deposition area were significantly reduced in the atherosclerosis combined with exercise group(P<0.001).The results of mitochondrial membrane potential showed that the significant decrease in mitochondrial membrane potential of the aorta in the atherosclerosis combined with exercise group was reversed(P<0.01).The results of western blot assay showed that compared with the control group,the mitochondrial protein expression of prohibitin 2,LC3Ⅱ/Ⅰ,PINK1 and Parkin was significantly increased(P<0.05),and the protein expression of PARL and PGAM5 decreased(P<0.05).Compared with the atherosclerosis group,the protein expression of PINK1 and Parkin in the mitchondria of rats in the atherosclerosis combined with exercise group was significantly decreased(P<0.05),and the protein expressions of prohibitin 2,LC3Ⅱ/Ⅰ,PARL and PGAM5 were significantly increased(P<0.05).Immunofluorescence results showed that compared with the control group,the co-localization of LC3 and PINK1 with TOMM20 was significantly increased in the atherosclerosis group(P<0.05),while compared with the atherosclerosis group,the co-localization of LC3 and PINK1 with TOMM20 was significantly increased in the atherosclerosis combined with exercise group(P<0.05).Co-localization of LC3 and PARL with prohibitin 2 was significantly increased in the atherosclerosis group compared with the control group(P<0.01),co-localization of LC3 with prohibitin 2 was significantly increased in the atherosclerosis combined with exercise group compared with the atherosclerosis group(P<0.01),and co-localization of PARL protein with prohibitin 2 was significantly decreased in the atherosclerosis combined with exercise group compared with the atherosclerosis group(P<0.01).To conclude,endurance training can induce the expression of prohibitin 2 in the inner mitochondrial membrane and promote the binding of prohibitin 2 to the mitophagy junction protein to complete mitophagy,restore mitochondrial function,and slow down the occurrence of atherosclerosis.

Background In the context of global climate change, heatwaves pose an increasing threat to human health. Emergency ambulance calls are an important outcome indicator of acute health response in populations during heatwave weather. However, studies on the association between emergency ambulance calls and heatwaves in China have primarily focused on the southern regions, and less attention is paid to the northern regions, which hinders a comprehensive assessment of acute health impact posed by extreme heat. Objective To quantify the association between heatwaves and emergency ambulance calls in Dezhou City, Shandong Province. Methods The data on daily records of emergency ambulance calls, meteorological factors, and air pollution from May to September of 2020 to 2022 in Dezhou City, Shandong Province were collected. Heatwaves were defined by combining thresholds at the 90th, 92.5th, 95th, and 97.5th percentiles (P₉₀, P_92.5, P₉₅, and P_97.5) of the year-round daily mean temperature and durations of ≥2, 3, or 4 consecutive days, respectively. A generalized additive model with a distributed lag nonlinear model was used to estimate the relative risk of emergency ambulance calls during heatwave days compared with non-heatwave days. Results During the study period, a total of 143393 emergency ambulance calls were analyzed, with 59.75% of individuals aged <65 years, 53.38% male, and 44.94% due to respiratory causes. Compared to non-heatwave periods, all 12 types of defined heatwaves were significantly associated with an increased risk of emergency ambulance calls. The heatwave effect intensified progressively with higher temperature thresholds and longer durations. The cumulative relative risk rose from 1.12 (95%CI: 1.07, 1.17) for the P₉₀_2d type to 1.26 (95%CI: 1.14, 1.40) for the P_97.5_4d type. No significant gender difference was observed in the association between heatwaves and emergency ambulance calls. Regarding age, older adults were more vulnerable, with a relative risk of 1.60 (95%CI: 1.42, 1.81) for the most severe heatwave type P_97.5_4d compared with non-heatwave periods. Among the different causes of calls, the association between respiratory diseases and heatwaves was the most pronounced, with the relative risk increasing from 1.22 (95%CI: 1.15, 1.29) for the mildest heatwave type P₉₀_2d to 1.72 (95%CI: 1.54, 1.93) for the most severe heatwave type P_97.5_4d. Conclusion In Dezhou City, Shandong Province, heatwaves are significantly associated with an increased risk of emergency ambulance calls. The effects of heatwaves on emergency ambulance calls vary by age and disease type, with the elderly and patients with respiratory diseases being more susceptible. These groups should take protective measures.

Objective To understand the current situation and influencing factors of work-related musculoskeletal disorders (WMSDs) in medical staff in Beijing City. Methods A total of 2 687 medical staff were selected as the research subjects using the multi-stage sampling method. The current situation of WMSDs and occupational stress, anxiety symptoms, depressive symptoms, and insomnia symptoms were investigated using the Musculoskeletal Disorders Questionnaire, the Core Occupational Stress Scale, the Generalized Anxiety Disorder Scale, the Patient Health Questionnaire Depression Scale, and the Self-Sleep Management Questionnaire. The Max-Min Hill-Climbing algorithm was used to construct a Bayesian network model to analyze the influencing factors and internal relationships of WMSDs and to conduct reasoning and prediction of the model. Results The prevalence of WMSDs among the research subjects was 88.9%. Binary logistic regression analysis was used to identify age, educational level, personal monthly income, anxiety symptoms, depressive symptoms, insomnia symptoms, prolonged forward-head desk work, and prolonged static posture work to construct the Bayesian network model. The model consisted of nine nodes and eleven directed edges. Prolonged static posture work, prolonged forward-head desk work, and anxiety symptoms were directly related to WMSDs. Age and educational level were indirectly related to WMSDs through their influence on prolonged forward-head desk work. Depression symptoms were indirectly associated with WMSDs through their influence on anxiety symptoms. The model's prediction accuracy was 90.5%. Conclusion The prevalence of WMSDs among medical staff in Beijing City is relatively high. Prolonged static posture work, prolonged forward-head desk work, and anxiety symptoms may directly increase the risk of developing WMSDs.

Objective:Under the background of the National Health Commission's recent notice to focus on preventing and resolving risks in the economic operation of public hospitals,guaranteeing the healthy and sustainable operation of public hospitals,and the need for localities to pay close attention to the key risks of public hospitals'failure to meet expenditures and revenues,long-term debt,and salary arrearage,the study of the methods used by the Mayo Clinic in the US to maintain solid growth in its financial performance over the long term may serve as a lesson for the high-quality development of China's research-based hospitals.Methods:Mayo Clinic's audited consolidated financial annual reports and related information for the years 2021-2022 and 2022-2023 were collected,and descriptive statistics were analyzed for the financial statements for the years 2021-2023.Results:Mayo Clinic's overall financial position,results of operations,and ability to generate cash from operations for 2021-2023 are strong.Conclusion:The composition of diversified revenue sources helps Mayo Clinic's financial performance to sustain solid growth.This is driven by the values of putting patients'needs and interests first,bringing together a large pool of talented individuals,and adopting a teamwork approach to efficiently deliver a quality experience that exceeds patients'expectations.It is recommended that Chinese research hospitals emphasize international healthcare,patent transfer and investment,and community donations to diversify their revenue streams,which will help to maintain robust financial performance.

Objectives:Financial pressure could have severe consequences for research hospitals.Studying the financial statement information and management measures of"top"hospitals in the US.can provide references for research hospitals in China to ensure long-term financial sustainability and improve competitiveness.Methods:The latest audited financial statements of Mayo Clinic,Cleveland Clinic,The Johns Hopkins Health System,and Mass General Brigham in the United States were collected,descriptive statistical analysis was employed.Results:The"top"four medical institution have a good asset composition,moderate debt ratios,large investment,with net assets continue to increase.They have diversified sources of revenue,with specialists being its key asset,human resource expense accounting for 57％～58％of total expenses,pursuing technological leadership.When facing financial pressure,the first choice is to improve operational efficiency and continue to reinvest in core missions.Conclusion:The practice of four"top"research medical institutions in the US.has provide new perspective for research hospitals in China to ensure long-term financial sustainability and improve market competitiveness.

Objective To explore the value of phase contrast(PC)MRI intracranial hemodynamic parameters for predicting acute mountain sickness(AMS).Methods Totally 72 healthy young volunteers were prospectively recruited.Intracranial hemodynamic parameters of internal carotid artery(ICA)and internal jugular vein(IJV)were measured using PC MRI under normal breathing,as well as mild,moderate and severe Valsalva maneuvers(VM)in plain area.The subjects were divided into AMS group(n=9)and non-AMS group(n=63)according to results of Lake Louise score(LLS)10 h after a rapid ascent to plateau area with altitude of 4 411 m.Univariate and multivariate logistic regression analyses were performed to screen independent predictors of AMS under different states and then construct single and combined VM states prediction models.Receiver operating characteristic curves were plotted,and the area under the curve(AUC)was calculated to evaluate the predictive efficacy of each model.Results ICA pulsatility index(PIICA)under mild VM,IJV cross-sectional area(SIJV)under moderate VM and IJV resistance index(RIIJV)under severe VM were all independent predictors of AMS(all P＜0.05).The efficacy of combined VM states model(AUC=0.869)for predicting AMS was higher than each single VM state model(AUC=0.698-0.738).Conclusion The model constructed based on PIICA under mild VM,SIJV under moderate VM and RIIJV under severe VM could be used to effectively predict AMS.

Objective To explore the value of phase contrast(PC)MRI intracranial hemodynamic parameters for predicting acute mountain sickness(AMS).Methods Totally 72 healthy young volunteers were prospectively recruited.Intracranial hemodynamic parameters of internal carotid artery(ICA)and internal jugular vein(IJV)were measured using PC MRI under normal breathing,as well as mild,moderate and severe Valsalva maneuvers(VM)in plain area.The subjects were divided into AMS group(n=9)and non-AMS group(n=63)according to results of Lake Louise score(LLS)10 h after a rapid ascent to plateau area with altitude of 4 411 m.Univariate and multivariate logistic regression analyses were performed to screen independent predictors of AMS under different states and then construct single and combined VM states prediction models.Receiver operating characteristic curves were plotted,and the area under the curve(AUC)was calculated to evaluate the predictive efficacy of each model.Results ICA pulsatility index(PIICA)under mild VM,IJV cross-sectional area(SIJV)under moderate VM and IJV resistance index(RIIJV)under severe VM were all independent predictors of AMS(all P＜0.05).The efficacy of combined VM states model(AUC=0.869)for predicting AMS was higher than each single VM state model(AUC=0.698-0.738).Conclusion The model constructed based on PIICA under mild VM,SIJV under moderate VM and RIIJV under severe VM could be used to effectively predict AMS.

Objective:Under the background of the National Health Commission's recent notice to focus on preventing and resolving risks in the economic operation of public hospitals,guaranteeing the healthy and sustainable operation of public hospitals,and the need for localities to pay close attention to the key risks of public hospitals'failure to meet expenditures and revenues,long-term debt,and salary arrearage,the study of the methods used by the Mayo Clinic in the US to maintain solid growth in its financial performance over the long term may serve as a lesson for the high-quality development of China's research-based hospitals.Methods:Mayo Clinic's audited consolidated financial annual reports and related information for the years 2021-2022 and 2022-2023 were collected,and descriptive statistics were analyzed for the financial statements for the years 2021-2023.Results:Mayo Clinic's overall financial position,results of operations,and ability to generate cash from operations for 2021-2023 are strong.Conclusion:The composition of diversified revenue sources helps Mayo Clinic's financial performance to sustain solid growth.This is driven by the values of putting patients'needs and interests first,bringing together a large pool of talented individuals,and adopting a teamwork approach to efficiently deliver a quality experience that exceeds patients'expectations.It is recommended that Chinese research hospitals emphasize international healthcare,patent transfer and investment,and community donations to diversify their revenue streams,which will help to maintain robust financial performance.

Purpose To investigate the value of pre-treatment relative cerebral blood flow(rCBF)and relative cerebral blood volume histogram of dynamic susceptibility contrast-enhanced perfusion weighted imaging in predicting the chemotherapy response of primary central nervous system lymphoma(PCNSL)patients.Materials and Methods Thirty-eight PCNSL patients with fifty-seven lesions treated with high-dose methotrexate chemotherapy from September 2016 to October 2023 were retrospectively involved in the study.The patients were divided into response group of 30 patients and non-response group of 8 patients.Region of interest was drawn in cerebral blood flow and cerebral blood volume images,and histogram paraments were extracted.Univariate and multivariate Logistic regression analysis were performed to identify the independent predictors for chemotherapy response in PCNSL,and then combined prediction model was constructed.The area under the receiver operating characteristic curve was used to compare the predictive performance of different paraments and combined model.Results The number of lesions(OR=9.726,95％CI 1.070-88.397,P=0.043)and rCBF90(OR=0.224,95％CI 0.072-0.704,P=0.010)were the independent predictors for chemotherapy response with the area under the curve of 0.681 and 0.798,respectively.The combined model of rCBF90 and the numbers of lesions showed the best predictive performance with the area under the curve of 0.846.Conclusion The pre-treatment quantitative parameters rCBF and relative cerebral blood volume of dynamic susceptibility contrast-enhanced perfusion weighted imaging could be used for predicting the response to high-dose methotrexate chemotherapy in PCNSL patients,and the rCBF90 is an independent predictor of chemotherapy response.