Objective To explore the role of E1A binding protein p300 (EP300)-mediated crotonylation (Kcr) modification of malic enzyme 1 (ME1) in ferroptosis of renal tubular epithelial cells. Methods C57BL/6 mice were divided into Sham operation group (Sham group), DMSO vehicle control + ischemia-reperfusion (IR) injury group (Vehi + IR group), and EP300 inhibitor C646 + IR injury group (C646 + IR group), with 12 mice in each group. Pathological changes in renal tissues were evaluated in each group, and indicators of renal function, ferroptosis, and fibrosis were assessed. Another 24 mice were used to establish the IR injury model to analyze changes in Kcr modification levels and EP300 expression over the 14-day course of IR injury. The in vitro HK-2 cell experimental model was established and divided into control group, hypoxia/reoxygenation (H/R) group, and C646 + H/R group. Corresponding HK-2 cells were transfected with the ME1-K337R plasmid, in which lysine 337 (K) was mutated to arginine (R) to mimic the de-Kcr modification. Small interfering RNA was used to target EP300 and transfect the cells in order to obtain EP300 knockdown cells (siEP300). The expression of ferroptosis-related proteins and fibrosis phenotypes was detected. Results At 14 d after IR injury, the protein Kcr level and EP300 expression were increased in mice. Compared with the Sham group, the Vehi+IR group showed markedly disrupted renal tissue structure, extensive red collagen deposition in the renal interstitium, decreased expression levels of glutathione, reduced nicotinamide adenine dinucleotide phosphate (NADPH), and glutathione peroxidase 4 (GPX4, P＜0.01), increased malondialdehyde and serum creatinine levels (P＜0.01), decreased ME1 enzymatic activity (P＜0.001), and increased expression of fibronectin 1 and smooth muscle actin-α (P＜0.001). Compared with the Vehi+IR group, the C646+IR group showed alleviated renal pathological injury, improved renal function, and reduced ferroptosis and fibrosis (P＜0.05). Compared with the control group, HK-2 cells subjected to H/R treatment exhibited aggravated ferroptosis and fibrosis (P＜0.05); compared with the H/R group, the C646+H/R group showed reduced ferroptosis and fibrosis (P＜0.05). Transfection with the ME1-K337R plasmid and siEP300 showed reduced ME1 Kcr, ferroptosis, and fibrosis. Conclusions EP300 contributes to ferroptosis in renal tubular epithelial cells by mediating ME1 crotonylation, and inhibition of EP300 may help alleviate the chronic progression following IR injury.

The release of the medical service price item guide is an important content of deepening the reform of medical service price,and is also a major measure to unify and standardize the medical service price item.Taking the Nursing Medical Service Price Item Proposal Guide(hereinafter referred to as the Nursing item Proposal Guide)as an example,it introduces the preparation ideas,framework structure design and item element changes of the nursing item proposal guide,sorts out the progress of docking and implementation of the Nursing Item Proposal Guide in typical provinces,and makes comparisons to obtain inspiration for accelerating the implementation of the item proposal guide in other regions:ensure the participation of clinical and price experts,mapping old and new items and integrating elements according to item guidelines;comprehensive use of cost pricing,reference pricing and value pricing,check and standardize the integrated item price;to standardize the integration of new item price adjustment and medical insurance payment policy coordination,forming a positive superposition effect;make a list of consumables that can be charged separately,and do a good job in the connection between product registration and price medical insurance policies;strengthen publicity and training,update information systems,monitor service volume,and track the effect of price policy implementation.

Objective To investigate the expression and clinical significance of multiple endocrine neoplasia type 1(MEN1)gene in breast cancer.Methods The Cancer Genome Atlas(TCGA)database was used to analyze the relationship between MEN1 gene and clinicopathological characteristics of breast cancer.Kaplan-Meier method was used to observe the effect of MEN1 on survival of breast cancer patients.Gene Ontology(GO),Kyoto Encyclopedia of Genes and Genomes(KEGG),and gene set enrichment analysis(GSEA)were used to predict the function and signaling pathways of MEN1 related and interacting genes.Tumor Immune Estimation Resource(TIMER)and single sample gene set enrichment analysis(ssGSEA)were used to investigate the correlation between the level of immune infiltration and MEN1 expression in breast cancer.Results MEN1 was highly expressed in breast cancer patients,and its expression level was related to PAM50 subtype and menopause status(both P＜0.05).Kaplan-Meier survival analysis showed that high MEN1 expression was associated with poor clinical outcome(P=0.019).GO and KEGG enrichment analysis showed that MEN1 related and interacting genes were involved in biological processes(histone modification,histone-lysine methylation),cell components(methyltransferase complex and histone methyltransferase complex),molecular functions(histone-methyltransferase activity),and functional pathways(transcriptional disorders in tumors).GSEA identified that the highly expressed MEN1 phenotype was involved in vesicle-mediated transport,complement cascade,B-cell receptor signaling,lymphocyte-non-lymphocyte interaction,interleukin signaling,and cytokine signaling pathways in the immune system.CancerSEA single cell sequencing results indicated that the expression of MEN1 was positively correlated with angiogenesis in MDA-MB-231 cells(P＜0.05).TIMER analysis found that MEN1 in breast cancer was negatively correlated with the infiltration levels of macrophages and CD8+T cells,and positively correlated with the infiltration level of CD4+T cells(all P＜0.05).ssGSEA showed that the infiltration levels of 18 types of immune cells were negatively correlated with MEN1 expression(all P＜0.05).Conclusion High MEN1 level is associated with poor survival and immune infiltration in breast cancer patients.

The release of the medical service price item guide is an important content of deepening the reform of medical service price,and is also a major measure to unify and standardize the medical service price item.Taking the Nursing Medical Service Price Item Proposal Guide(hereinafter referred to as the Nursing item Proposal Guide)as an example,it introduces the preparation ideas,framework structure design and item element changes of the nursing item proposal guide,sorts out the progress of docking and implementation of the Nursing Item Proposal Guide in typical provinces,and makes comparisons to obtain inspiration for accelerating the implementation of the item proposal guide in other regions:ensure the participation of clinical and price experts,mapping old and new items and integrating elements according to item guidelines;comprehensive use of cost pricing,reference pricing and value pricing,check and standardize the integrated item price;to standardize the integration of new item price adjustment and medical insurance payment policy coordination,forming a positive superposition effect;make a list of consumables that can be charged separately,and do a good job in the connection between product registration and price medical insurance policies;strengthen publicity and training,update information systems,monitor service volume,and track the effect of price policy implementation.

In the implementation process,the current medical service price item standard faces the facts,including disconnection between item establishment and clinical improvement innovation,disconnection from the masses'demand and disconnection from price management needs.The compilation of the guidelines for the establishment of medical service price items marks that the unified standardization of national medical service price items has entered the"fast lane".It reviews the policy requirements to promote the standardization and unification of the current medical service price items by compiling up item guidelines in batches,analyze the framework structure of the medical service price item guidelines,and studies the main changes of the medical service price item guidelines:integrating stock,compatible improvement,and supporting innovation.The policy suggestions to accelerate the implementation and application of the medical service price item guide include:according to the item guidelines,determine the mapping relationship between old and new items,standardize and integrate the current price items,and stop the original items;carry out cost investigation and calculation,weighted average according to the service volume,shift the price of old items,and approve the price of new items;guide public hospitals to implement item guidelines,track price implementation,monitor service number,and strengthen charge supervision.

By the end of 2024,the National Healthcare Security Administration has compiled a guide for the establishment of medical service price items covering most disciplines,and basically completed the top-level design of standardization and standardization of national medical service price items.On the basis of sorting out the ideas for the preparation of the for the medical service price item setting guidelines,and combining the practice of docking and implementing the compilation guidelines for the price items setting in typical provinces,it analyzes the impact of the docking and implementation of the item setting guidelines on medical care,medical insurance and patients and the coping strategies:clarifying the boundaries of technical specifications and price items,reforming compatible with technological improvements according to the item guidelines,and supporting major innovations;carrying out price and cost investigation of sample hospitals,scientifically and reasonably approving the integrated item price according to the item guidelines;item guidelines better reflecting the degree of operational risk,technical difficulty,labor value,optimizing the income structure of the hospital;standardizing items with item setting guidelines,promoting transparent and reasonable fees,and making patient payments more clear.

In the implementation process,the current medical service price item standard faces the facts,including disconnection between item establishment and clinical improvement innovation,disconnection from the masses'demand and disconnection from price management needs.The compilation of the guidelines for the establishment of medical service price items marks that the unified standardization of national medical service price items has entered the"fast lane".It reviews the policy requirements to promote the standardization and unification of the current medical service price items by compiling up item guidelines in batches,analyze the framework structure of the medical service price item guidelines,and studies the main changes of the medical service price item guidelines:integrating stock,compatible improvement,and supporting innovation.The policy suggestions to accelerate the implementation and application of the medical service price item guide include:according to the item guidelines,determine the mapping relationship between old and new items,standardize and integrate the current price items,and stop the original items;carry out cost investigation and calculation,weighted average according to the service volume,shift the price of old items,and approve the price of new items;guide public hospitals to implement item guidelines,track price implementation,monitor service number,and strengthen charge supervision.

By the end of 2024,the National Healthcare Security Administration has compiled a guide for the establishment of medical service price items covering most disciplines,and basically completed the top-level design of standardization and standardization of national medical service price items.On the basis of sorting out the ideas for the preparation of the for the medical service price item setting guidelines,and combining the practice of docking and implementing the compilation guidelines for the price items setting in typical provinces,it analyzes the impact of the docking and implementation of the item setting guidelines on medical care,medical insurance and patients and the coping strategies:clarifying the boundaries of technical specifications and price items,reforming compatible with technological improvements according to the item guidelines,and supporting major innovations;carrying out price and cost investigation of sample hospitals,scientifically and reasonably approving the integrated item price according to the item guidelines;item guidelines better reflecting the degree of operational risk,technical difficulty,labor value,optimizing the income structure of the hospital;standardizing items with item setting guidelines,promoting transparent and reasonable fees,and making patient payments more clear.

With the reform of the medical and health system entering a critical period,public hospitals have also exposed new risks and challenges in economic operation.As an important means of hospital standardized management,internal control can better prevent and resolve the risk of hospital economic operation and ensure the sustainable operation of the hospital.By interpreting the requirements of current national policies on hospital internal control,it analyzes the functional positioning of financial and accounting supervision in hospital internal control,shares the internal control implementation path of sample hospitals from the perspective of financial and accounting supervision,and puts forward suggestions on strengthening internal control construction of public hospitals in the new era,in order to lay a good foundation for the high-quality development of hospitals.

The price supervision of medical services can affect the whole process of medical order issuance,treatment op-eration,inspection and examination execution,surgical anesthesia,nursing management,etc.It plays an important role in provi-ding standardized diagnosis and treatment services and saving treatment costs.This article analyzes the current status of hospital price management,sorts out price supervision policies,and uses the pre-remind,intervening and post-event supervision functions of the intelligent price monitoring platform to solve the problem of unreasonable charges such as repeated charges and over-restrict-ed frequency charges,so as to screen and rectify illegal diagnosis and excessive medical treatment.Take the price intelligent su-pervision platform as the starting point,let information and data go more widely,optimize related business processes,promote the satisfaction of both patients and hospital staff,and further improve the hospital management level and service level.