Objective:To explore the impact mechanism of strategic human resource management (SHRM) capabilities in hospital clinical departments on departmental organizational performance, providing references for improving the overall performance of hospitals.Methods:The research subjects were 46 clinical departments of a tertiary public hospital in Beijing. Using a stratified sampling method, at least one middle-level manager was selected from each department, and 30% of the medical staff were randomly sampled from each professional title level within the department. A self-made questionnaire was used to investigate the SHRM capabilities of each department from September to December 2023. The organizational performance of clinical departments was assessed using the departmental performance evaluation system established by the hospital. First, the performance target values for each department in 2023 were set based on the historical data from 2020 to 2022. Then, the actual performance evaluation data of 2023 were compared with the target values to calculate the achievement rate or deviation. Finally, the comprehensive performance scores of each department were calculated by weighting. The performance scores of the departments in 2023 were used as the outcome variable, while SHRM capabilities, department size, number of beds, and whether the department was a key department were used as antecedent condition variables. Fuzzy-set qualitative comparative analysis (fsQCA) was employed to explore the combinations of antecedent conditions that lead to high and low organizational performance in clinical departments.Results:A total of 1 391 valid questionnaires were collected. The weighted average score of SHRM capabilities in clinical departments was (4.23±0.27) points, and the total score of organizational performance evaluation in 2023 was 70.75 (52.50, 79.47) points. The consistency of each antecedent condition variable did not reach the critical value of 0.90, indicating that none of them were sufficient to be a necessary condition for high or low organizational performance in the departments. Two pathways to high organizational performance and two pathways to low organizational performance were identified. The solution consistency for the high organizational performance pathway was 0.83, with a coverage of 0.35, and both core conditions, acquisition capability and maintenance capability, were present. The solution consistency for the low organizational performance pathway was 0.85, with a coverage of 0.08, and the core conditions, development capability, was absent.Conclusions:Different combinations of antecedent condition variables, including the strategic human resource management capability of clinical departments, had varying impacts on the organizational performance of clinical departments. The possession of human resource acquisition, maintenance, and development capabilities by clinical departments was an essential condition for achieving high organizational performance. It is recommended to strengthen the construction of these three capabilities and emphasize the coordinated development of human resource management capabilities to enhance the organizational performance of clinical departments.

Objective To investigate the diagnostic value of 4 novel inflammatory markers related to routine blood tests,namely neutrophil-to-lymphocyte ratio(NLR),red blood cell distribution width(RDW),hemoglobin-to-RDW ratio(HRR)and systemic immune-inflammation index(SII),in elderly patients with chronic cardiovascular disease(CVD)complicated with frailty.Methods Retrospectively analyze 110 patients with chronic stable CVD who were hospitalized in the cadre ward of cardiovascular medicine at the Air Force Characteristic Medical Center from January 2022 to June 2023.According to the assessment results of the Fried scale,they were divided into three groups:non-frailty group(Fried score=0,n=30),the pre-frailty group(Fried score 1 or 2,n=40)and frailty group(Fried score≥3,n=40).The differences in general information,the impairment rate of daily living activities,miniature nutritional assessment-short form(MNA-SF)scores,mini-mental state examination(MMSE)scores,and the indicators such as NLR,RDW,HRR,and SII among the three groups were compared.Spearman rank correlation was used to analyze the correlation between NLR,RDW,HRR,SII and frailty scores as well as each frailty indicator.Multivariate logistic regression analysis was performed to identify the independent risk factors for frailty in elderly patients with chronic CVD,and the receiver operating characteristic(ROC)curve was used to assess the clinical diagnostic value of NLR and HRR in elderly patients with chronic CVD complicated with frailty.Results Compared with non-frailty group and pre-frailty group,patients in frailty group were older,with higher impaired rates of daily living activities,NLR,RDW,and SII,and lower MNA-SF scores,MMSE scores,and HRR,and differences were statistically significant(P<0.05).Spearman rank correlation analysis showed that the frailty score was positively correlated with NLR(rs=0.354,P<0.001),and RDW(rs=0.448,P<0.001),negatively correlated with HRR(rs=-0.232,P=0.024),and had no significant correlation with SII(rs=0.144,P=0.167).Further analysis of the correlation between the above novel inflammatory markers and the 5 components of frailty showed that NLR was positively correlated with fatigue(rs=0.228,P=0.017),slowed walking speed(rs=0.299,P<0.001),and low physical function(rs=0.319,P<0.001);RDW was positively correlated with decreased grip strength(rs=0.321,P<0.001),slowed walking speed(rs=0.422,P<0.001),and low physical function(rs=0.246,P=0.001);and HRR was negatively correlated with slowed walking speed(rs=-0.230,P=0.025),and low physical function(rs=-0.299,P=0.003).Multivariate logistic regression analysis showed that MNA-SF score(OR=0.577,95%CI 0.342-0.973)was an independent protective factor for pre-frailty in elderly patients with chronic CVD(P<0.05);NLR(OR=7.866,95%CI 1.101-56.185)was an independent risk factor for frailty,while HRR(OR=0.344,95%CI 0.120-0.983)and MNA-SF score(OR=0.292,95%CI 0.146-0.580)were independent protective factors for frailty in elderly CVD patients(P<0.05).The area under the ROC curve of NLR and HRR for diagnosing frailty in elderly patients with chronic CVD were 0.778 and 0.749,respectively.Conclusion NLR and HRR have high clinical diagnostic value for frailty in elderly patients with chronic CVD,and are expected to become effective inflammatory markers for screening elderly patients with chronic CVD complicated with frailty.

Objective:To explore the impact mechanism of strategic human resource management (SHRM) capabilities in hospital clinical departments on departmental organizational performance, providing references for improving the overall performance of hospitals.Methods:The research subjects were 46 clinical departments of a tertiary public hospital in Beijing. Using a stratified sampling method, at least one middle-level manager was selected from each department, and 30% of the medical staff were randomly sampled from each professional title level within the department. A self-made questionnaire was used to investigate the SHRM capabilities of each department from September to December 2023. The organizational performance of clinical departments was assessed using the departmental performance evaluation system established by the hospital. First, the performance target values for each department in 2023 were set based on the historical data from 2020 to 2022. Then, the actual performance evaluation data of 2023 were compared with the target values to calculate the achievement rate or deviation. Finally, the comprehensive performance scores of each department were calculated by weighting. The performance scores of the departments in 2023 were used as the outcome variable, while SHRM capabilities, department size, number of beds, and whether the department was a key department were used as antecedent condition variables. Fuzzy-set qualitative comparative analysis (fsQCA) was employed to explore the combinations of antecedent conditions that lead to high and low organizational performance in clinical departments.Results:A total of 1 391 valid questionnaires were collected. The weighted average score of SHRM capabilities in clinical departments was (4.23±0.27) points, and the total score of organizational performance evaluation in 2023 was 70.75 (52.50, 79.47) points. The consistency of each antecedent condition variable did not reach the critical value of 0.90, indicating that none of them were sufficient to be a necessary condition for high or low organizational performance in the departments. Two pathways to high organizational performance and two pathways to low organizational performance were identified. The solution consistency for the high organizational performance pathway was 0.83, with a coverage of 0.35, and both core conditions, acquisition capability and maintenance capability, were present. The solution consistency for the low organizational performance pathway was 0.85, with a coverage of 0.08, and the core conditions, development capability, was absent.Conclusions:Different combinations of antecedent condition variables, including the strategic human resource management capability of clinical departments, had varying impacts on the organizational performance of clinical departments. The possession of human resource acquisition, maintenance, and development capabilities by clinical departments was an essential condition for achieving high organizational performance. It is recommended to strengthen the construction of these three capabilities and emphasize the coordinated development of human resource management capabilities to enhance the organizational performance of clinical departments.

Objective The aim of this study was to explore the impact of implant robots on the oral func-tion and aesthetic effects of immediate implant patients in the aesthetic area of anterior teeth.Methods A total of 68 patients with single anterior tooth defects admitted to the hospital from January 2021 to January 2023 were enrolled and divided into a study group of 34 cases and a control group of 34 cases randomly.In the study group,anterior tooth immediate implantation was performed with the assistance of an oral implantation robot,while the control group underwent conventional immediate anterior tooth implantation.The implantation accuracy,postopera-tive bite function,aesthetic restoration,and occurrence of complications were compared between the two groups,and complications were all recorded.Results After final restoration,all patients were followed up for 2 years,and the implant success rate was 100%(68/68 cases).The study group exhibited significantly lower postoperative apical point error and implant angle error compared to the control group(P＜0.05).There was no significant differ-ence in speech clarity,bite pressure,and pain intensity between the two groups(P＞0.05).The ratio of implant bite pressure to that of the contralateral homonymous tooth was higher in the study group than in the control group(P＜0.05).The postoperative pink esthetic score(PES)and white esthetic score(WES)in the study group were higher than those in the control group(P＜0.05).There was no statistically significant difference in the incidence of complications between the two groups(P＞0.05).Patient satisfaction in the study group was higher than that in the control group(P＜0.05).Conclusion The use of oral implantation robots for immediate implantation in the aesthetic zone of anterior teeth resulted in higher intraoperative positioning accuracy and yielded favorable outcomes in postoperative restoration of bite function and aesthetics.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To analyze the effect of additional surgery on the survival and prognosis of high-risk T1 colorectal cancer patients who have undergone endoscopic resection.Methods The clinical data of patients with high-risk T1 colorectal cancer were retrospectively collected.The patients were divided into the endoscopic resection(ER)plus additional surgical resection(SR)group,or the ER+SR group,and the ER group according to whether additional SR were performed after ER.Baseline data of the patients and information on the location,size,and postoperative pathology of the lesions were collected.Patient survival-related information was obtained through the medical record system and patient follow-up.The primary outcome indicators were the overall survival and the colorectal cancer-specific survival.Univariate Cox regression analysis was used to screen survival-related risk factors and hazard ratio(HR)was calculated.Multivariate Cox regression analysis was used to analyze the independent influencing factors.Results The data of 109 patients with T1 high-risk colorectal cancer were collected,with 52 patients in the ER group and 57 patients in the ER+SR group.The mean age of patients in the ER group was higher than that in the ER+SR group(65.21 years old vs.60.54 years old,P=0.035),and the median endoscopic measurement of the size of lesions in the ER group was slightly lower than that in the ER+SR group(2.00 cm vs.2.50 cm,P=0.026).The median follow-up time was 30.00 months,with the maximum follow-up time being 119 months,in the ER+SR group and there were 4 patients deaths,including one colorectal cancer-related death.Whereas the median follow-up time in the ER group was 28.50 months,with the maximum follow-up time being 78.00 months,and there were 4 patient deaths,including one caused by colorectal cancer.The overall 5-year cumulative survival rates in the ER+SR group and the ER group were 94.44%and 81.65%,respectively,and the cancer-specific 5-year cumulative survival rates in the ER+SR group and the ER group were 97.18%and 98.06%,respectively.The Kaplan-Meier analysis showed no significant difference in the overall cumulative survival or cancer-specific cumulative survival between the ER+SR and the ER groups.Univariate Cox regression analysis showed that age and the number of reviews were the risk factors of overall survival(HR=1.16 and HR=0.27,respectively),with age identified as an independent risk factor of overall survival in the multivariate Cox regression analysis(HR=1.10,P=0.045).Conclusion For T1 colorectal cancer patients with high risk factors after ER,factors such as patient age and their personal treatment decisions should not be overlooked.In clinical practice,additional caution should be exercised in decision-making concerning additional surgery.

OBJECTIVE: To observe the effects of acupuncture on neurologic function and serum inflammatory factors in patients after thrombolysis in acute ischemic stroke (AIS). METHODS: A total of 102 AIS patients with onset to treatment time (OTT) ≤3 h were randomly divided into an observation group and a control group, 51 cases each group. In the control group, thrombolysis and conventional medical treatment were applied. On the basis of the treatment as the control group, acupuncture at Shuigou (GV 26), Zhongwan (CV 12), Qihai (CV 6), Neiguan (PC 6), etc. was applied in the observation group, 30 min each time, once a day. Both groups were treated for 2 weeks. Before and after treatment, the scores of National Institutes of Health stroke scale (NIHSS), modified Rankin scale (mRS), modified Barthel index (MBI) and serum level of homocysteine (Hcy), hypersensitive C-reactive protein (hs-CRP) were compared, and the clinical efficacy was evaluated in the two groups. RESULTS: After treatment, the scores of NIHSS, mRS and serum level of Hcy, hs-CRP were decreased compared with those before treatment (P<0.05), while the MBI scores were increased (P<0.05) in the two groups. The scores of NIHSS, mRS and serum level of Hcy, hs-CRP in the observation group were lower than those in the control group (P<0.05, P<0.01), the MBI score in the observation group was higher than that in the control group (P<0.01). The total effective rate was 88.2% (45/51) in the observation group, which was superior to 70.6% (36/51) in the control group (P<0.05). CONCLUSION Acupuncture could promote the recovery of neurologic function in patients after thrombolysis in AIS, improve the ability of daily living, which may be related to reducing the level of inflammatory factors, thus inhibiting inflammatory response and improving cerebral ischemia reperfusion injury.
United States ; Humans ; Ischemic Stroke ; C-Reactive Protein ; Acupuncture Therapy ; Inflammation ; Homocysteine ; Hypersensitivity ; Thrombolytic Therapy

Aim To study the effect of tetrandrine derivative HL-49 on the conformation and biological ac-tivity of Bloom helicase ( BLM ) , and to explore its antitumor mechanism.Methods The effect of HL-49 on the conformation of BLM helicase was studied by ultra- violet spectroscopy.The effects of HL-49 on DNA binding activity, DNA chain dissociation activity and ATPase activity of HL-49 on BLM DNA helicase were analyzed by fluorescence polarization and malachite green-ammonium phosphomolybdate colorimetric method.Results HL-49, a tetrandrine derivative, indirectly inhibited the ATPase activity of BLM DNA heli- case and DNA unwinding activity by reversible binding with DNA.The results of fluorescence polarization experiments showed that HL-49 could not affect the bind ing activity of BLM DNA helicase to DNA (dsDNA/ss- DNA) , but could bind to DNA in a concentration-de- pendent manner (P < 0.01).With the increase of HL- 49 concentration, the DNA unwinding ability of BLM DNA helicase decreased, and the Kobs value decreased gradually.The results of malachite green-ammonium phosphomolybdate colorimetry showed that HL-49 could significantly inhibit the ATPase activity of BLM DNA helicase.Conclusions HL49 can inhibit the ATPase activity and DNA unwinding activity of BLM DNA helicase by the reversible binding with DNA.

Objective:The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China.Methods:This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems.Results:According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%).Conclusion:Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

Previous studies suggest that the reduction of SMAD3 (mothers against decapentaplegic homolog 3) has a great impact on tumor development, but its exact pathological function remains unclear. In this study, we found that the protein level of SMAD3 was greatly reduced in human-grade IV glioblastoma tissues, in which LAMP2A (lysosome-associated membrane protein type 2A) was significantly up-regulated. LAMP2A is a key rate-limiting protein of chaperone-mediated autophagy (CMA), a lysosome pathway of protein degradation that is activated in glioma. We carefully analyzed the amino-acid sequence of SMAD3 and found that it contained a pentapeptide motif biochemically related to KFERQ, which has been proposed to be a targeting sequence for CMA. In vitro, we confirmed that SMAD3 was degraded in either serum-free or KFERQ motif deleted condition, which was regulated by LAMP2A and interacted with HSC70 (heat shock cognate 71 kDa protein). Using isolated lysosomes, amino-acid residues 75 and 128 of SMAD3 were found to be of importance for this process, which affected the CMA pathway in which SMAD3 was involved. Similarly, down-regulating SMAD3 or up-regulating LAMP2A in cultured glioma cells enhanced their proliferation and invasion. Taken together, these results suggest that excessive activation of CMA regulates glioma cell growth by promoting the degradation of SMAD3. Therefore, targeting the SMAD3-LAMP2A-mediated CMA-lysosome pathway may be a promising approach in anti-cancer therapy.