Objective It analyzes the problems existing in the performance management system of public hospi-tals,and explores the optimization path oriented by public welfare and high-quality development.Methods Based on literature research and policy analysis,this paper focuses on the current situation of the internal performance man-agement system of public hospitals,analyzes the problems from five dimensions:performance appraisal objectives,indicators,methods,processes,and result application,and proposes systematic optimization strategies.Results At present,the performance management system of public hospitals has some problems,such as target deviation,unreasonable index setting,lagging method,rigid process,and single application of results.Conclusion Public hospi-tals need to take public welfare and high-quality development as the"two-wheel drive",and build a scientific,effi-cient and sustainable performance management system by reconstructing the indicator system,innovating assess-ment methods,optimizing processes,deepening the application of results,strengthening data governance,and in-tegrating patient experience and long-term value,so as to achieve the organic unity of social benefits and operatio nal efficiency.

Objective It analyzes the problems existing in the performance management system of public hospi-tals,and explores the optimization path oriented by public welfare and high-quality development.Methods Based on literature research and policy analysis,this paper focuses on the current situation of the internal performance man-agement system of public hospitals,analyzes the problems from five dimensions:performance appraisal objectives,indicators,methods,processes,and result application,and proposes systematic optimization strategies.Results At present,the performance management system of public hospitals has some problems,such as target deviation,unreasonable index setting,lagging method,rigid process,and single application of results.Conclusion Public hospi-tals need to take public welfare and high-quality development as the"two-wheel drive",and build a scientific,effi-cient and sustainable performance management system by reconstructing the indicator system,innovating assess-ment methods,optimizing processes,deepening the application of results,strengthening data governance,and in-tegrating patient experience and long-term value,so as to achieve the organic unity of social benefits and operatio nal efficiency.

Objective     To explore the correlation between the imaging features of peripheral ground-glass pulmonary nodules and the invasion degree of lung adenocarcinoma, and the high risk factors for infiltrating lung adenocarcinoma under thin-slice CT, which provides some reference for clinicians to plan the surgical methods of pulmonary nodules before operation and to better communicate with patients, and assists in building a clinical predictive model for invasive adenocarcinoma. Methods    Clinical data of the patients with peripheral ground-glass pulmonary nodules (diameter≤3 cm) in thin-slice chest CT in the First Affiliated Hospital of Soochow University from January 2019 to January 2020 were continuously collected. All patients underwent thin-slice CT scan and thoracoscopic surgery in our center. According to the pathological examination results, they were divided into two groups: an adenocarcinoma lesions before infiltration group, and an invasive lung adenocarcinoma group. The thin-slice CT imaging parameters of pulmonary nodules were collected. The nodular diameter, mean CT value, consolidation tumor ratio (CTR), nodular shape, vacuolar sign, bronchial air sign, lobulation sign, burr sign, lesion boundary, pleural depression sign, vascular cluster sign and other clinical data were collected. Univariate and multivariate analyses were conducted to analyze the independent risk factors for the infiltrating lung adenocarcinoma, and to analyze the threshold value and efficacy of each factor for the identification of infiltrating lung adenocarcinoma. Results     Finally 190 patients were enrolled. There were 110 patients in the adenocarcinoma lesions before infiltration group, including 21 males and 89 females with a mean age of 53.57±10.90 years, and 80 patients in the invasive lung adenocarcinoma group, including 31 males and 49 females with a mean age of 56.45±11.30 years. There was a statistical difference in the mean CT value, nodular diameter, CTR, gender, smoking, nodular type, nodular shape, vacuolar sign, lobulation sign, burr sign, lesion boundary, pleural depression sign, vascular cluster sign between the two groups (P<0.05). However, there was no statistical difference between the two groups in age (P=0.081), lesion site (P=0.675), and bronchial air sign (P=0.051). Multiple logistic regression analysis showed that nodular diameter, mean CT value, CTR and lobulation sign were independent risk factors for differentiating preinvasive adenocarcinoma from invasive adenocarcinoma. At the same time, the threshold value was calculated by Youden index, indicating that the CTR was 0.45, the nodal diameter was 10.5 mm and the mean CT value was –452 Hu. Conclusion     In the peripheral ground-glass pulmonary nodules, according to the patient's CT imaging features, such as mixed ground-glass nodules, irregular shapes, vacuoles, short burrs, clear boundaries, pleural indentations, and vascular clusters, have a certain reference value in the discrimination of the invasion degree of ground-glass pulmonary nodules. At the same time, it is found in this research that peripheral ground-glass pulmonary nodules with diameter greater than 10.5 mm, CT value greater than –452 Hu, CTR greater than 0.45 and lobulation sign are more likely to be infiltrating lung adenocarcinoma.

Uncovering the risk factors of pulmonary hypertension and its mechanisms is crucial for the prevention and treatment of the disease.In the current study,we showed that experimental periodontitis,which was established by ligation of molars followed by orally smearing subgingival plaques from patients with periodontitis,exacerbated hypoxia-induced pulmonary hypertension in mice.Mechanistically,periodontitis dysregulated the pulmonary microbiota by promoting ectopic colonization and enrichment of oral bacteria in the lungs,contributing to pulmonary infiltration of interferon gamma positive(IFNγ+)T cells and aggravating the progression of pulmonary hypertension.In addition,we identified Prevotella zoogleoformans as the critical periodontitis-associated bacterium driving the exacerbation of pulmonary hypertension by periodontitis,and the exacerbation was potently ameliorated by both cervical lymph node excision and IFNγ neutralizing antibodies.Our study suggests a proof of concept that the combined prevention and treatment of periodontitis and pulmonary hypertension are necessary.

Cost data caliber governance is key to fine cost management. To tackle the troubles in cost data management at multiple campuses of one hospital, the authors built a multi-campus cost data caliber governance mode. By means of enhanced top-level design, the mode carried out data governance by such measures as the establishment of data dictionary mapping library, standardizing department names and caliber, classification of charging items of medical services, precisely matching between fixed assets and charging items, interconnecting the management system of charging library and the procurement library of consumables, as well as precisely matching surgical disease types and charging items. These measures accomplished the consistency and comparability of cost data across campuses, building an automated, streamlined, standardized and integrated data governance mode for reference of hospitals with multiple campuses in need of cost management.

Objective:The aim of this study was to explore the associations of muscle size and density with handgrip strength(HGS)and the Timed Up and Go(TUG)test.Methods:Totally 301 participants living in the Xinjiekou community near Beijing Jishuitan Hospital were recruited for CT imaging of the hip and a 1-cm slice of the mid-thigh.The cross-sectional area and density of the gluteus maximus and the mid-thigh muscles were estimated by the Osirix viewer based on CT images.HGS and TUG were also performed in these subjects.Logistic regression analysis was used to evaluate the correlations of muscle density and size with TUG and grip strength.Results:In women, after adjustment for age and BMI, the density of the gluteus maximus was negatively correlated with TUG( P trend=0.0366), while the size of the gluteus maximus and the mid-thigh muscles was not correlated with TUG.In men, the density or size of these muscles was not correlated with TUG.After adjustment for age and BMI, the density of the gluteus maximus was positively correlated with grip strength( P trend=0.0334)and the size of the mid-thigh muscles was also positively correlated with grip strength( P trend=0.0155)in men, but they were not correlated with grip strength in women. Conclusions:There were sex differences in the relationship between muscle size or density and grip strength or timed up and go.The density of the gluteus maximus is associated with muscle strength and physical performance while the size of the mid-thigh muscles is correlated with muscle strength.

Objective:To explore the clinical effect of the integrated model of doctors, nurses and patients in postoperative pain nursing of patients with osteosarcoma.Methods:A total of 20 patients with osteosarcoma who underwent surgical treatment in the Department of Orthopedics of Henan Provincial People's Hospital from June 2018 to June 2019 were selected as control group, and 20 patients with osteosarcoma surgery from July 2019 to July 2020 were selected as observation group. Control group was given routine nursing, and observation group carried out the integrated nursing of doctors, nurses and patients. One day before discharge, the Satisfaction Questionnaire on Postoperative Pain Management by the Patient and the limb salvage surgery efficacy scoring system (Musculoskeletal Tumor Society, MSTS) were distributed to patients to compare patients' satisfaction with postoperative pain management, pain status and limb function between two groups.Results:The hospital stay of control group was (45.63±8.56) d, and that of observation group was (36.78±7.69) d, the difference was statistically significant ( t=7.868, P<0.01) . The most severe postoperative pain score of observation group was (3.94±1.29) , which was lower than that of control group, and the difference was statistically significant ( t=4.458, P<0.01) . The satisfaction score of observation group for the pain effect was (4.11±0.64) , which was higher than that of control group, and the difference was statistically significant ( t=4.921, P<0.05) . The total score of MSTS in observation group was (25.98±2.15) , and that of control group was (20.54±2.08) , and the difference was statistically significant ( t=8.132, P<0.01) . Conclusions:The integrated model of doctors, nurses and patients can improve the satisfaction of perioperative pain management of patients with osteosarcoma, reduce the level of pain, and improve the level of limb function of patients.

Objective: : To investigate the relationship between the expression of RUNX1 isoforms and the clinical curative effect and the prognosis of acute leukemia (AL), in order to provide valuable experimental data for the individualized treatment, MRD (minimal residual disease) monitoring and prognosis prediction of AL. Methods: AL patients with primary treatment (PT, n=88) and recrudescence (RC, n=10) that treated at the Department of Hematology of Affiliated Hospital of Guangdong Medical University from April, 2012 to April, 2013 were included in this study. Real-time PCR was used to examine the mRNA expression of RUNX1 isoforms (RUNX1a and RUNX1b/c) in PT patients, RC patients and controls (non-malignant hematological disease patients).The changes in mRNA expression of RUNX1a and RUNX1b/c in patients before and after the chemotherapy were also observed. Results： ： (1)The expression levels of RUNX1a mRNAinAML andALL PT group andAML RC group was significantly higher than those of control group (P<0.05); The expression level of RUNX1a mRNAinAMLPT group was increased compared withALLPT group (P<0.05). (2) The expression levels of RUNX1a and RUNX1b/c mRNAinAML andALL patients at initial treatment were significantly higher than those after complete remission (CR) (P<0.05). (3) By comparing the expression levels of RUNX1a and RUNX1b/c mRNA at initial diagnosis, there was no significant difference between 6-month death group and survival group, CR group and NCR (non-complete remission) group after first cycle of chemotherapy, or the high leukocyte group and non-high leukocyte group (all P>0.05).The expression level of RUNX1a mRNA in AML-ETO positive group was higher than that of negative group (P<0.05). (4) The expression levels of RUNX1a and RUNX1b/c mRNA in patients with acute leukemia decreased with the increasing chemotherapy cycle, and significantly increased when had a relapse, which may even succeed the initial level.Conclusion: RUNX1a isoforms participate in the pathogenesis of acute leukemia, and isrelated to the relapse ofAML. The expression levels of RUNX1a and RUNX1b/c mRNAare related to the clinical efficacy that can be used as an indicator of curative effect, but have no significant correlation with the prognosis of the disease.Dynamic monitor of theexpression levels of RUNX1a and RUNX1b/c isomers can be used as an effective indicator of MRD monitoring after chemotherapy, which can be used to evaluate the efficacy and identify the risk of recurrence at early stage.

Objective To investigate the correlation of quantitative parameters (volume transfer constant [Ktrans],rate constant [Kep]) derived from dynamic contrast-enhanced MRI (DCE-MRI) and biomarkers of estrogen receptor (ER),progesterone receptor (PR),human epidermal growth factor receptor-2 (HER-2),Ki-67 in breast carcinoma patients.Methods Data of immunohistochemistry and pharmacokinetic parameters of 100 patients with breast carcinoma were retrospectively analyzed.The values of Ktrans,Kep among the different intensity of ER,PR,HER-2 and Ki-67 expression were compared,and the relationships were analyzed.Results No significant difference of Ktrans,Kep was found among differentintensity of ER in breast carcinoma patients (P＞0.05),whereas no obvious correlation of Ktrans,Kep with ER expression was noticed (P＞0.05).Ktrans,Kep had statistical differences among different intensity of PR,HER-2,Ki-67 expression in breast carcinoma patients (P＜0.05),and the values of Ktrans,Kep were positively correlated with PR,Ki-67 expression (P＜0.05).Conclusion The values of Ktrans,Kep were positively correlated with the intensity of PR,Ki-67 expression in breast carcinoma patients,which might provide helpful tissue characterization information.

Objective To translate the Tool for Evaluating the Ways Nurses Assess Pain (TENAP) in the aged into the Chinese version and to evaluate its reliability and validity. Methods The model of Brislin double translation and back translation as well as expert consultation were used to translate the English version TENAP into the Chinese version. A total of 210 nurses of geriatrics associated departments were investigated. At the same time, the reliability and validity of the TENAP were evaluated. Results The Chinese version TENAP consisted of two parts including the cognition subscale and the behavior subscale, along with a total 18 items. There were 12 items in the cognition subscale; exploratory factor analysis extracted three common factors of it (pain of the aged, analgesic of drugs and pain measurement) which accounted for 47.035% of the cumulative contribution rate; the correlation coefficients among scores of factors and the total score was 0.778 to 0.800; the Cronbach's α and retest reliability of the subscale were 0.756 and 0.762 respectively. There were 6 items in the behavior subscale whose one common factor was extracted with 52.097% for the cumulative contribution rate;the Cronbach's α and retest reliability of the subscale were 0.803 and 0.815 respectively. The average content validity of all items of the Chinese version TENAP was 0.92 and content validity index per item ranged from 0.8 to 1.0. Conclusions The Chinese version TENAP has the acceptable reliability and validity, which can be used to evaluate the knowledge-attitude-practice of nurses in assessing pain of the aged in China.