With the deepening of the public hospital reform and the implementation of a series of policies,the external environment of the hospital has undergone profound changes,and the operation and management of the hospital has faced unprecedented pressure.Against this background,the case hospital has set up a special operation management team,established an operation evaluation index system that integrates business and finance,written an analysis report on"one policy for one department",set up an"operation management MDT clinic",and issued a list of operation problems to functional departments.A series of measures,such as the establishment of a set of operation management system with multi-line synergy,big data support,lean operation and evidence-based decision-making,have strongly guaranteed the scientific decision-making and efficient implementation of the hospital's operation management,and played a good role in the hospital's medical business,operation efficiency,cost structure,and management of the medical insurance fund,etc.The practical exploration of the operation management model has further improved the medical service level of the hospital and accelerated the pace of improving quality and increasing efficiency of the hospital.It is necessary to pay more attention to the refined management,continuously optimize the operation management system,and continuously promote the high-quality development of the hospital.

With the deepening of the public hospital reform and the implementation of a series of policies,the external environment of the hospital has undergone profound changes,and the operation and management of the hospital has faced unprecedented pressure.Against this background,the case hospital has set up a special operation management team,established an operation evaluation index system that integrates business and finance,written an analysis report on"one policy for one department",set up an"operation management MDT clinic",and issued a list of operation problems to functional departments.A series of measures,such as the establishment of a set of operation management system with multi-line synergy,big data support,lean operation and evidence-based decision-making,have strongly guaranteed the scientific decision-making and efficient implementation of the hospital's operation management,and played a good role in the hospital's medical business,operation efficiency,cost structure,and management of the medical insurance fund,etc.The practical exploration of the operation management model has further improved the medical service level of the hospital and accelerated the pace of improving quality and increasing efficiency of the hospital.It is necessary to pay more attention to the refined management,continuously optimize the operation management system,and continuously promote the high-quality development of the hospital.

Objective To establish an evaluation index system for medical services provided by primary diagnosis physi-cian groups in tertiary public hospitals,using the Delphi method and Analytic Hierarchy Process(AHP).Methods Based on existing policies and relevant literature,initial indicators were formulated.The Delphi method was used in two rounds to deter-mine the index system,with a participation rate of 100%and high expert authority coefficients(Round 1:Cr=0.851,Round 2:Cr=0.839).The AHP was then applied to calculate the weights of the indicators.Results The evaluation index system for medical services provided by primary diagnosis physician groups was established through two rounds of expert consultations.The AHP yielded the weights of the indicators,with four primary indicators:internal processes(0.406),finance(0.288),learning and growth(0.208),and customer(0.098),and 25 secondary indicators.The consistency ratio(CR)values for the weights of the indicators were all less than 0.01.Conclusion The proposed index system is scientific and feasible for evaluating medical services provided by primary diagnosis physician groups in tertiary public hospitals.It can be applied in hospital department man-agement to further enhance the quality of medical services and the level of hospital refinement management.

BACKGROUND:Tissue engineering is considered an ideal treatment for growth plate regeneration.However,most of the current research on regenerative tissue engineering is the traditional scaffold-based strategy.As the limitations of traditional scaffolds are gradually revealed,the research direction is gradually diversifying. OBJECTIVE:To summarize the application of scaffold-based and scaffold-free strategies in the treatment of growth plate cartilage regeneration and their respective advantages and disadvantages. METHODS:The relevant articles were searched from PubMed,Wiley,and Elsevier.The search terms were"growth plate injury,regeneration,tissue engineering,scaffold,scaffold-free,biomimetic,cartilage"in English.The time was limited from 1990 to 2023.Finally,104 articles were included for review. RESULTS AND CONCLUSION:The biomimetic strategy is to reduce the cell composition,biological signals and unique mechanical properties of each region to the greatest extent by simulating the unique organizational structure of the growth plate,so as to build a biomimetic microenvironment that can promote tissue regeneration.Therefore,the design of a biomimetic scaffold is to simulate the original growth plate as far as possible in terms of composition,structure and mechanical properties.Although some results have been achieved,there is still the problem of the unstable regeneration effect.The scaffold-free strategy believes that the limitations of scaffolds will have adverse effects on regenerative therapy.Therefore,the design of scaffold-free constructs relies as much as possible on the ability of cells to generate and maintain extracellular matrix without interfering with cell-cell signals or introducing exogenous substances.However,there are some problems,such as poor stability,low mechanical strength and greater difficulty in operation.Biomimetic strategy and scaffold-free strategy have different emphases,advantages and disadvantages,but they both have positive effects on growth plate cartilage regeneration.Therefore,subsequent studies,whether adopting a biomimetic strategy or a scaffold-free strategy,will focus on the continuous optimization of existing technologies in order to achieve effective growth plate cartilage regeneration therapy.

OBJECTIVE:At present,there are many reports on the related factors associated with the incidence of cervical spine instability in patients with rheumatoid arthritis,but there are problems such as small sample size and many confounding factors,and the research results of various studies on the same related factors are also different.This article analyzed the factors related to cervical spine instability in patients with rheumatoid arthritis by means of a systematic review. METHODS:Articles related to cervical spine instability in patients with rheumatoid arthritis were collected by searching both Chinese and English databases until March 2023.The outcome of cervical spine instability in patients with rheumatoid arthritis was used as the grouping criterion to abstract basic information,baseline patient characteristics,laboratory-related tests,medication use,and other relevant risk factors.Meta-analysis was done using Stata 14.0 software. RESULTS:(1)Sixteen relevant studies,all of moderate or above quality,were included,including seven studies with case-control studies and nine with cross-sectional studies.The overall incidence of cervical spine instability in patients with rheumatoid arthritis was 43.08%.(2)Meta-analysis showed:Related risk factors included female(OR=0.60,95%CI:0.44-0.82,P=0.002);age at disease onset(SMD=-0.52,95%CI:-0.86 to-0.18,P=0.003);duration of disease(SMD=0.58,95%CI:0.14-1.02,P=0.01);body mass index(OR=0.74,95%CI:0.63-0.88,P=0.001);rheumatoid factors positive univariate analysis subgroup(OR=1.33,95%CI:1.02 to 1.72,P=0.04),C-reactive protein(SMD=0.26,95%CI:0.16-0.35,P=0.00),erythrocyte sedimentation rate(SMD=0.15,95%CI:0.002-0.29,P=0.047),anti-cyclic-citrullinated peptide antibodies(OR=1.73,95%CI:1.19-2.51,P=0.004),28-joint Disease Activity Score(SMD=0.20,95%CI:0.04-0.37,P=0.02),destruction of peripheral joints(OR=2.48,95%CI:1.60-3.85,P=0.00),and corticosteroids(OR=1.91,95%CI:1.54-2.37,P=0.00)were strongly associated with the development of rheumatoid arthritis-cervical spine instability.Female and corticosteroid use were independently associated with the occurrence of rheumatoid arthritis-cervical spine instability. CONCLUSION:Based on clinical evidence from 16 observational studies,the overall incidence of rheumatoid arthritis-cervical spine instability was 43.08%.However,the incidence of cervical spine instability in rheumatoid arthritis patients varied greatly among different studies.Gender(female)and the use of corticosteroids were confirmed as independent correlation factors for the onset of cervical spine instability in patients with rheumatoid arthritis.The results of this study still provide some guidance for early clinical recognition,diagnosis,and prevention of rheumatoid arthritis-cervical spine instability.

Objective To describe and analyze the current situation of the four same type of departments in an hospital in order to provide a reference for the construction of"the most cost-effective medical care".Methods The CN-DRG were used to automatically group and compare the medical capacity and inpatient service efficiency of the hospital department groups,and in the refined analysis,one DRG disease group of in situ cancer and non-malignant disease loss uterine surgery and single species uterine fibroid was included,and the Kruskal-Wallis H test was used to further compare the differences in length of stay and various costs.Results It included a total of 22630 patients,whose weights varied from a maximum of 3948.62 in diagnostic group 1 to a minimum of 133.55 in diagnostic group 11.The cost consumption indexes ranged from a minimum of 0.89 in diagnostic group 5 to a maximum of 1.04 in diagnostic group 2,while the time consumption indexes ranged from a minimum of 0.48 in diagnostic group 11 to a maximum of 0.81 in diagnostic group 5.When comparing the diagnostic groups,there were statistically significant differences(P＜0.05)in hospitalization days,total cost,diagnostic cost,therapeutic cost,and cost of supplies.Specifically,when comparing the diagnostic and treatment groups within departments,the differences in hospitalization days and all costs were statistically significant(P＜0.05)in departments 1 and 2,the differences in diagnostic cost,therapeutic cost,and cost of supplies were statistically significant(P＜0.05)in department 3.Conclusion There exists a notable disparity in the extent to which each diagnostic and treatment group contributes to the hospital's service capacity and cost variability.Consequently,it is necessary to reasonably evaluate the length of hospital stay and medical cost of patients to achieve the highest cost-effective medical treatment.

Objective    To systematically review the efficacy and safety of single-port video-assisted thoracoscopic surgery (VATS) vs. multiple-port VATS in lobectomy for non-small cell lung cancer (NSCLC). Methods    The PubMed, EMbase, the Cochrane Library, CBM, CNKI, Wanfang, VIP and Web of Science were searched to collect clinical studies about single- vs. multiple-port VATS for patients with NSCLC from inception to August 2018. The literatures were screened, data were extracted and the risk of bias of included studies was assessed independently by two reviewers. The meta-analysis with the collected data was performed by using RevMan 5.3 software. Results    Eleven studies (4 randomized controlled trials, 1 prospective cohort study and 6 retrospective cohort studies), including 1 574 patients. Among them, 779 patients were in the single-port group, and 795 in the multiple-port group. The results of meta-analysis showed that there was no significant difference between the two groups in the operation time (MD=3.60, 95%CI –8.59 to 15.79, P=0.56), the conversion rate (OR=1.06, 95%CI 0.54 to 2.06, P=0.87), the incidence of postoperative complications (OR=0.76, 95%CI 0.53 to 1.10, P=0.15), postoperative hospitalization time (MD=0.74, 95%CI –1.60 to 0.12, P=0.09), chest tube placement time (MD=0.63, 95%CI –1.28 to 0.02, P=0.06) or harvested lymph nodes (MD=–0.11, 95%CI –0.46 to 0.24, P=0.54). The intraoperative blood loss (MD=–17.12, 95%CI –31.16 to –3.08, P=0.02) was less in the single-port group than that in the multiple-port group. The visual analogue score (VAS) on postoperative first day (MD=–1.30, 95%CI –1.85 to –0.75, P<0.000 01) and on postoperative third day (MD=–0.82, 95%CI –1.00 to –0.65, P<0.000 01) were lower in the single-port group than those in the multiple-port group. Conclusion    The meta-analysis indicates that the efficacy of single-port VATS for NSCLC is equivalent to multiple-port VATS. However the intraoperative blood loss, the VAS scores on postoperative first and third days in the single-port group are better.

Objective To analyze the role of lienal polypeptide injection in acute lung injury induced by lipopolysaccharide (LPS) in rats. Methods Eighty male SD rats were randomly allocated into 4 groups: a LPS group, a control group, a lienal polypeptide group and a LPS+ lienal polypeptide group (20 rats in each group). Lienal polypeptide or normal saline was given with an intramuscular injection 30 min after an intraperitoneal injection of LPS (5 mg/kg). The severity of pulmonary injury was evaluated 4 h after LPS challenge by enzyme-linked immunosorbent assay (ELISA), wet-to-dry weight ratio, hematoxylin and eosin (HE) staining, TUNEL and Western blotting. Results Lienal polypeptide injection treatment significantly attenuated LPS-induced pulmonary histopathologic changes, alveolar hemorrhage, and neutrophil infiltration. Moreover lienal polypeptide injection significantly suppressed LPS-induced activation of metastasis-associated protein-1 (MTA1). Conclusion Lienal polypeptide injection is demonstrated to protect rats from LPS-induced acute lung injury by the expression of MTA1.

Objective To investigate the radioactivity distribution of 131 I-bovine serum albumin ( BSA )-mesoporous silica nanoparticles ( MSNs )-anti-vascular endothelial growth factor receptor 2 (VEGFR2) in anaplastic thyroid carcinoma (ATC) and to explore its antitumor efficacy in ATC-bearing nude mouse models. Methods 131 I-BSA-MSNs-anti-VEGFR2 and 131 I-BSA-MSNs were constructed. FRO tumor xenografts were established and the SPECT/CT images of tumor-bearing mice were acquired at differ-ent time points after intratumoral injection with 131 I-BSA-MSNs-anti-VEGFR2 ( targeting group) , 131 I-BSA-MSNs ( non-targeting group) , Na131 I ( Na131 I group) and saline ( control group) , respectively. The changes of body mass and tumor volume in each group were recorded. Two-sample t test and log-rank test were used to analyze the data. Results After incubation for 3 h, the fluorescence intensity in targeting group was higher than that in non-targeting group (345.26±16.35 vs 280.61±9.65;t=5.90, P<0.05). After injection for 1-3 weeks, the radioactivity detected by SPECT/CT in targeting group was obviously stronger than that in non-targeting group ( t values:7.060-12.780, all P<0.05) . At the end of the observation, the tumor vol-ume of Na131I group, control group, non-targeting group and targeting group increased to (278.3±19.3)％, (296.6±24.2)％, (198.7±13.2)％ and (103.7±6.2)％ of the original volume, respectively. The body mass of the first 2 groups decreased to (88.6±3.0)％ and (86.2±3.1)％ of the original body mass respec-tively, while that of the latter 2 groups increased to (102.1±3.1)％ and (116.2±3.4)％ of the original body mass respectively. Survival analysis showed that the median survival time in targeting group ( 38 d) was sig-nificantly longer than that in non-targeting group (34 d;χ2=8.05, P<0.05). Conclusion 131I-BSA-MSNs-anti-VEGFR2 can effectively inhibit the tumor growth of ATC and prolong the survival of tumor-bearing nude mice, which gives a good suggestion for the treatment and prognosis evaluation of ATC.

Objective To analyze the correlation between the tubular gastric width and the anti gastroesophageal reflux after esophageal cancer operation,and to provide reference for the choice of surgical methods in treatment of esophageal cancer.Methods Selected 60 patients who received radical surgery for esophageal carcinoma combined with gastric tube reconstruction surgery in our hospital from January 2015 to October 2015,and divided them into two groups according to the way of stomach tube anastomosis (cervical anastomosis,thoracic anastomosis) and different width of gastric tube (greater than or equal to or less than 3 cm).Namely:cervical anastomosis + greater than or equal to 3 cm group(14 cases),cervical anastomosis + less than 3 cm group(15 cases),thoracic anastomosis + greater than or equal to 3 cm group(15 cases) and thoracic anastomosis + less than 3 cm group(16 cases).All patients recieved esophageal pH monitoring for 3 days continuously from the 11 th day after operation.The monitoring indicators include:number of reflux,accumulation time of pH ＜ 4,whether there were clinical symptoms (heartburn,chest pain,pharyngeal foreign body sensation,cough,asthma,etc.) after surgery,and the frequency and time of these clinical symptoms appeared.All the patients were given endoscopic examination at the 14th days postoperatively.Observed the esophageal mucosa of patients and conducted histopathological grading of gastric mucosal inflammation.And then made a correlation analysis of gastric tube width and esophageal mucosal inflammation grade among all the patients with reflux symptoms.Results The cumulative time and number of reflux,incidence rate of clinical symptoms,and pH values less than 4 were significantly different(P ＜ 0.05).The cumulative time and number of reflux,incidence rate of clinical symptoms,and pH values less than 4 in the cervical anastomosis + less than 3 cm group were significantly lower than that in the other 3 groups(P ＜ 0.05),with statistical significance between different groups of endoscopic esophageal mucosa inflammation grade difference (P ＜ 0.05).Esophageal mucosal inflammation grading in patients of the cervical anastomosis + less than 3 cm group was the lightest.It showed a linear correlation between the gastric tube width and esophageal mucosal inflammation grading in patients with reflux symptoms.Conclusion Postoperative gastroesophageal reflux is closely related to stomach esophagus width after resection of esophageal carcinoma with tubular stomach reconstruction of stomach esophagus,because it is unable to control gastric tube width to the appropriate range.And it should be strengthened in patients with reflux related indicators for monitoring,so as to take measures to prevent gastroesophageal reflux as soon as possible to improve the prognosis of patients with quality.