Objective:To explore an evaluation method for the operational status of tertiary public hospitals, identify strengths and weaknesses in hospital operations, and provide decision-making support for hospital managers.Methods:In 2023, an evaluation index system for the operation of tertiary public hospitals was constructed based on literature analysis and the Delphi method. The combined weights of the evaluation indexes were determined using the cooperative game theory method. An evaluation model for hospital operational status based on the extensible cloud model was established, with the determination of evaluation index thresholds and standards based on the operational data of a tertiary public hospital in Liaoning Province from 2020 to 2022. The operational status of the hospital was then comprehensively evaluated using the evaluation model based on the hospital′s operational data from 2023.Results:The constructed evaluation index system for the operation of tertiary public hospitals included five dimensions and 14 indicators: financial health, service efficiency, medical quality, satisfaction, and sustainable development. The indicators with higher weight values were net cash flow (0.135), average appointment rate for outpatient patients (0.088), and budget savings from government procurement (0.087). The overall operational status evaluation score of the sample hospital was 4.48, with an evaluation grade of level V. The scores for the dimensions of financial health, medical quality, and sustainable development were 4.99, 4.74, and 5.00, respectively, all reaching level V. The scores for service efficiency and satisfaction were 4.00 and 3.70, respectively, both at level Ⅳ.Conclusions:The evaluation index system and the determined weights constructed in this study were reasonable to a certain extent. The hospital operational status evaluation model based on the extensible cloud model can objectively reflect the operational status of the hospital, and the evaluation results can provide decision-making support for managers.

Objective:To explore an evaluation method for the operational status of tertiary public hospitals, identify strengths and weaknesses in hospital operations, and provide decision-making support for hospital managers.Methods:In 2023, an evaluation index system for the operation of tertiary public hospitals was constructed based on literature analysis and the Delphi method. The combined weights of the evaluation indexes were determined using the cooperative game theory method. An evaluation model for hospital operational status based on the extensible cloud model was established, with the determination of evaluation index thresholds and standards based on the operational data of a tertiary public hospital in Liaoning Province from 2020 to 2022. The operational status of the hospital was then comprehensively evaluated using the evaluation model based on the hospital′s operational data from 2023.Results:The constructed evaluation index system for the operation of tertiary public hospitals included five dimensions and 14 indicators: financial health, service efficiency, medical quality, satisfaction, and sustainable development. The indicators with higher weight values were net cash flow (0.135), average appointment rate for outpatient patients (0.088), and budget savings from government procurement (0.087). The overall operational status evaluation score of the sample hospital was 4.48, with an evaluation grade of level V. The scores for the dimensions of financial health, medical quality, and sustainable development were 4.99, 4.74, and 5.00, respectively, all reaching level V. The scores for service efficiency and satisfaction were 4.00 and 3.70, respectively, both at level Ⅳ.Conclusions:The evaluation index system and the determined weights constructed in this study were reasonable to a certain extent. The hospital operational status evaluation model based on the extensible cloud model can objectively reflect the operational status of the hospital, and the evaluation results can provide decision-making support for managers.

Objective To analyze the relationships of expressions of serum microRNA(miR)-20a-5p and miR-128-3p with cranial nerve development in the premature infants with hypoxic-ischemic en-cephalopathy(HIE).Methods A total of 95 HIE premature infants were selected as HIE group,and according to the severity of HIE,they were divided into mild group(n=27),moderate group(n=46)and severe group(n=22);another 95 premature infants without HIE in the same period were se-lected as control group.Apgar score and the Neonatal Behavioral Neurological Assessment(NBNA)score were performed in both groups;the expression levels of miR-20a-5p and miR-128-3p in serum were detected by real-time fluorescence quantitative polymerase chain reaction(qRT-PCR);Spearman method was used to analyze the correlations of serum miR-20a-5p and miR-128-3p levels with Apgar score and NBNA score;the values of serum miR-20a-5p and miR-128-3p levels in diagnosing HIE in premature infants were analyzed by receiver operating characteristic(ROC)curve.Results Compared with the control group,the levels of serum miR-20a-5p and miR-128-3p in the HIE group increased sig-nificantly,while the Apgar score and NBNA score decreased significantly(P＜0.05).In the mild,moderate,and severe groups,the levels of serum miR-20a-5p and miR-128-3p increased gradually,while the Apgar score and NBNA score decreased gradually,with the significant between-group differences(P＜0.05).Spearman analysis results showed that the level of serum miR-20a-5p was negatively correlated with the Apgar score and NBNA score(r=-0.659,-0.548,P＜0.001),and the level of serum miR-128-3p was negatively correlated with the Apgar score and NBNA score(r=-0.582,-0.499,P＜0.001).The combined prediction of serum miR-20a-5p and miR-128-3p for HIE in premature infants had an area under the curve(AUC)of 0.920,with a sensitivity of 78.95％and a specificity of 97.89％.The predictive efficacy of the combined model was superior to that of miR-20a-5p and miR-128-3p alone(P＜0.05).Conclusion The serum levels of miR-20a-5p and miR-128-3p increase in the premature infants with HIE,and are closely related to the severity of the disease and the development of brain nerves.The combined detection of miR-20a-5p and miR-128-3p has good predictive value for the occurrence of HIE in premature infants.

Objective To analyze the relationships of expressions of serum microRNA(miR)-20a-5p and miR-128-3p with cranial nerve development in the premature infants with hypoxic-ischemic en-cephalopathy(HIE).Methods A total of 95 HIE premature infants were selected as HIE group,and according to the severity of HIE,they were divided into mild group(n=27),moderate group(n=46)and severe group(n=22);another 95 premature infants without HIE in the same period were se-lected as control group.Apgar score and the Neonatal Behavioral Neurological Assessment(NBNA)score were performed in both groups;the expression levels of miR-20a-5p and miR-128-3p in serum were detected by real-time fluorescence quantitative polymerase chain reaction(qRT-PCR);Spearman method was used to analyze the correlations of serum miR-20a-5p and miR-128-3p levels with Apgar score and NBNA score;the values of serum miR-20a-5p and miR-128-3p levels in diagnosing HIE in premature infants were analyzed by receiver operating characteristic(ROC)curve.Results Compared with the control group,the levels of serum miR-20a-5p and miR-128-3p in the HIE group increased sig-nificantly,while the Apgar score and NBNA score decreased significantly(P＜0.05).In the mild,moderate,and severe groups,the levels of serum miR-20a-5p and miR-128-3p increased gradually,while the Apgar score and NBNA score decreased gradually,with the significant between-group differences(P＜0.05).Spearman analysis results showed that the level of serum miR-20a-5p was negatively correlated with the Apgar score and NBNA score(r=-0.659,-0.548,P＜0.001),and the level of serum miR-128-3p was negatively correlated with the Apgar score and NBNA score(r=-0.582,-0.499,P＜0.001).The combined prediction of serum miR-20a-5p and miR-128-3p for HIE in premature infants had an area under the curve(AUC)of 0.920,with a sensitivity of 78.95％and a specificity of 97.89％.The predictive efficacy of the combined model was superior to that of miR-20a-5p and miR-128-3p alone(P＜0.05).Conclusion The serum levels of miR-20a-5p and miR-128-3p increase in the premature infants with HIE,and are closely related to the severity of the disease and the development of brain nerves.The combined detection of miR-20a-5p and miR-128-3p has good predictive value for the occurrence of HIE in premature infants.

Objective To investigate the correlation between vital capacity, pulmonary ventilation and morphological parameters among children living in different altitude areas, so as to provide a reference basis for the development of prevention and control strategies for high altitude illness. Methods From January 2019 to June 2020, primary and secondary school students aged 7 to 15 years old were randomly selected from three different altitude areas, which were Xining (2 260m, low altitude group), Haixi (2 900m, medium altitude group), and Yushu (4 493m, high altitude group), respectively. The vital capacity, pulmonary ventilation and morphological parameters of the selected children were recorded. Results The vital capacity, pulmonary ventilation and morphological parameters showed statistically significant difference among three groups (P<0.05). The vital capacity and pulmonary ventilation were positively correlated with lung volume, but negatively correlated with lung density and lung artery diameter (P<0.05). Logistic regression analysis showed that there were three factors affecting children's vital capacity and lung ventilation: mean lung density, total lung transverse diameter, and total lung volume (P<0.05). Conclusion The monitoring of lung morphological indexes, mean lung density, total lung transverse diameter, and total lung volume can effectively judge children's lung function, and have certain value in the prevention and treatment of related high-altitude illness.

The new cardiopulmonary resuscitation (CPR) guideline emphasize the importance of chest compression, which was considered as the first step to CPR. The duration for CPR is usually limited to 30 minutes. With the development of new technology and evidence-based medicine, the success of extra longtime CPR has become possible, which is of great significance to some patients with cardiac arrest (CA), but the time limit has not been determined. On February 23rd in 2016, a 76-year-old female patient with respiratory and cardiac arrest who was on the third day after transurethral resection of bladder tumor (TUR-BT) was admitted to the intensive care unit of the General Hospital of Fushun Mining Bureau. On the basis of the comprehensive treatment measures such as ventilator support ventilation, physical cooling with ice cap, 1 mg adrenaline for intravenous injection, low molecular heparin of 5000 U for subcutaneous injection, and the continuous chest compression were carried out in a timely and effective manner for 125 minutes, which make the patient recover to sinus rhythm and her brain function recovered well without any sequelae, and follow-up of the patient in 1 year showed well. The key to success or failure of CPR depend on the patient's condition. If the patients in healthy, single cause, a good response to the resuscitation, the pulsation of the large artery can be seen now and then during the rescue, and the recovery of the spontaneous breathing, CPR should be kept on. In the process of CPR, individualized assessment of the disease progression without the 30-minute time limit, may benefit the patients in maximum. In the future clinical practice, we should actively explore more favorable evidence, so that CA patients can be rescued more.

BACKGROUND: A few devices have been reported to be used for studies on trauma, but these devices are unavailable for establishing the animal models of trauma because of their limited application range. OBJECTIVE: To develop a multifunctional impact system and evaluate its application effect, thus paying ways for establishing the animal models of trauma and basic experiments.METHODS: The multifunctional impact system was designed based on the theory of energy storage device, simple multifunctional impact device and impact parameter measuring equipment, and its effectiveness and stability were detected. The rat chest and different visceral organs were subjected to the closed impact experiment using a 5 cm2 impact at the predetermined parameter of 200, 300, 400, 500 kPa, respectively. Afterwards, the rats were sacrificed for morphological observation.RESULTS AND CONCLUSION: The multifunctional impactor was successfully developed, of which the maximum impact stress could be adjusted from 0 to 200 kg and compressive and extrusion stress also could be continuously adjusted from 0 to 100 kg. The experimental results showed that the impactor made certain damage to the rat lung, liver and spleen suggesting its favorable effectiveness (P < 0.05) and repeatability (P > 0.05). These findings suggest that the impactor is easy to operate in various ways and holds good effectiveness and stability, and its impact parameters can be detected in real time. Therefore, the impactor is suitable for both establishing the animal model of trauma and basic experiments.

Based on the statistics of the tide and key words of three magazines in 2015,a total of 30 documents and after expert consultation and analysis,the literature was divided into 10 research fields,and four aspects including correlation with teaching,talent cultivation,development of student and assessment were elaborated on to explore the current hot issues of medical education in China.In the ending part,the author summarized and put forward four shortages that covered deficiency of theoretical research,illegibility of talent orientation,teaching reform combining without actual condition and not paying attention to the development of teachers in study of medical education research,and provide suggestions and references for further research on medical education.

Objective To investigate the efficacy of holmium laser coagulation under choledochoscope for the treatment of intrahepatic hemobilia.Methods The clinical data of 55 patients with intrahepatic hemobilia who received holmium laser coagulation under choledochoscope at the General Hospital of Chengdu Military Area from June 2003 to August 2011 were retrospectively analyzed.After the hemobilia was confirmed with choledochoscopy,an optical fiber of holmium laser was inserted into the intrahepatic bile duct from the hole of choledochoscope.The top of the optical fiber was posed close to the bleeding region,and then the laser was stimulated for coagulation under direct vision.If the observation of the bleeding area was influenced by the bleeding,the porta hepatis was temporarily occluded with a rubber hose combined with pressurized liquid injection bag.For patients with distal bile duct stenosis and bleeding,the narrow area was first expanded by biliary balloon or laser,then hemostasis was completed after the flow of bile duct was restored.Results The hemorrhage of the 55 patients was controlled,with an average time of 5.5 minutes (range,2-15 minutes).Temporary hepatic portal clamping was applied for 16 patients (27 times),and the average blocking time was 2.2 minutes (range,1-4 minutes).Biliary rehaemorrahagia occurred after operation in 2 patients,and they were cured by non-surgical treatment.All patients were discharged after successful hemostasis.The time of follow-up was 35-49 days.The epithelium of the bile duct coagulated by intraoperative holmium laser restored flat in 41 patients,and new biliary stricture was not found in the other 14 patients.Conclusion Holmium laser coagulation under choledochoscope for intrahepatic hemobilia is simple and effective.

Objective To explore a new method of parapancreatic abscess treatment and establish an idea of minimally invasive technologies for parapancreatic abscess to improve the recovery rate of acute pancreatitis. Methods The patients had experienced percutaneous puncture and placed drainage tube under the ultrasound guidance first, then the sinus tract was expanded gradually to 24F perimeter by Cook's fascia expender. Finally, the necrotic tissue and pyogenic membrane was removed and repeatedly washed under guidance of choledochoscopy. Results The recovery rate was 91.1 %(33/36). The complication incidence was 10.7% (hemorrage:2 cases, external intestinal fistula:3 cases, and fatal MOF: 1 case). Conclusions The viewpoint which parapancreatic abscess only can be cured by drainage operation can be changed by associating debridement by choledochoscope with percutaneous puncture drainage under the ultrasound guidance. It is a simple, safe and effective method. It can be used to reduce the patients' damage, complication and mortality and accomplish the idea of damage control by minimally invasive technologies.