The Mayo Clinic in the United States is a non-profit medical institution that integrates clinical practice, education, and research. It has maintained a global top hospital brand image for a long time and its management ideas have been widely recognized and appreciated by the industry. From the perspective of strategic management, this study elaborated on the core values of Mayo Clinic, the multidisciplinary team cooperation diagnosis and treatment model, the high fixed salary salary system, the management model of doctor leadership-operation supervisor cooperation, the business mission of integrated clinical practice, education, and research, and the management points of digital marketing, which could provide references for the high-quality development and brand building of hospitals in China.

Purpose To investigate the value of pre-treatment relative cerebral blood flow(rCBF)and relative cerebral blood volume histogram of dynamic susceptibility contrast-enhanced perfusion weighted imaging in predicting the chemotherapy response of primary central nervous system lymphoma(PCNSL)patients.Materials and Methods Thirty-eight PCNSL patients with fifty-seven lesions treated with high-dose methotrexate chemotherapy from September 2016 to October 2023 were retrospectively involved in the study.The patients were divided into response group of 30 patients and non-response group of 8 patients.Region of interest was drawn in cerebral blood flow and cerebral blood volume images,and histogram paraments were extracted.Univariate and multivariate Logistic regression analysis were performed to identify the independent predictors for chemotherapy response in PCNSL,and then combined prediction model was constructed.The area under the receiver operating characteristic curve was used to compare the predictive performance of different paraments and combined model.Results The number of lesions(OR=9.726,95％CI 1.070-88.397,P=0.043)and rCBF90(OR=0.224,95％CI 0.072-0.704,P=0.010)were the independent predictors for chemotherapy response with the area under the curve of 0.681 and 0.798,respectively.The combined model of rCBF90 and the numbers of lesions showed the best predictive performance with the area under the curve of 0.846.Conclusion The pre-treatment quantitative parameters rCBF and relative cerebral blood volume of dynamic susceptibility contrast-enhanced perfusion weighted imaging could be used for predicting the response to high-dose methotrexate chemotherapy in PCNSL patients,and the rCBF90 is an independent predictor of chemotherapy response.

Objective To evaluate the safety, effectiveness and feasibility of robotic-assisted kidney transplantation (RAKT). Methods Clinical data of 16 patients who underwent kidney transplantation were collected. Among them, 8 recipients received RAKT (RAKT group) and 8 cases underwent open kidney transplantation (OKT) with the contralateral kidney from the same donor (OKT group). Perioperative status and the recovery of renal allograft function were compared between two groups. Results All patients successfully completed the surgery. In the RAKT group, no patient was converted to open surgery. The operation time in the RAKT group was longer than that in the OKT group (P=0.015). No significant differences were observed in the serum creatinine levels before surgery and upon discharge between two groups (both P>0.05). In the OKT group, one recipient developed delayed graft function (DGF), and the remaining recipients did not experience perioperative complications. No significant difference was noted in the short-term recovery of renal allograft function between two groups (P>0.05). Conclusions Postoperative recovery of the recipients in the RAKT group is equivalent to that of their counterparts in the OKT group. RAKT is a safe and effective procedure for the team expertise in kidney transplantation.

Objective:To explore the factors leading to communication disorders in ICU patients during mechanical ventilation from the perspective of both patients and medical staff, and to use the theoretical framework of acceptability to identify the barriers that can be improved by intervention.Methods:Using the method of descriptive phenomenology from July to August 2022, 11 patients with mechanical ventilation and 8 medical staff in the comprehensive ICU of a Yuhuangding Hospital in Yantai were selected for interviews by the purpose sampling method, combined with participatory observation. The interviews of patients were conducted off ventilator. With Nvivo12.0 Plus software, the seven-step analysis method of Colaizzi phenomenology was adopted to summarize the theme and the theoretical framework of acceptability was used to identify the obstacle factors that could be improved by intervention.Results:The age of 11 patients was 18-46 years old, the duration of mechanical ventilation was 9.5-312.3 h. The age of 8 medical staff was 26-54 years old, the length of service in ICU was 2-30 years. A total of 14 themes were extracted. For patients: defensive mood, difficulty in presenting information, introverted personality, communication tools are hard to use, emergency treatment conflict, deny the ability to communicate, thought slowness. For medical staff: defensive mood, cognitive load, high time cost, lack of humane communication strategies, poor training, other priorities, loss of confidence in effective communication, awareness of the importance of communication was not enough.Conclusions:There are many factors that can be improved for patients with mechanical ventilation in ICU. It is suggested to speed up the research and development of high-tech and personalized alternative communication tools in China, reduce negative communication between doctors and patients and nurses and patients, and implement evidence-based multi-mode and progressive communication intervention strategies.

ObjectiveTo obtain content characteristics of inorganic elements in Scutellariae Radix （aged 1-4 years）， and to explore the feasibility of identifying the growth years of Scutellariae Radix based on characteristic spectrum of inorganic elements combined with chemometric models. MethodAfter microwave digestion， the contents of Mn， Zn， Ca， Fe， Mg， Na， K， Cr， Cu， Se， As， Cd， Hg， Pb and Ni in 21 batches of Scutellariae Radix were determined by inductively coupled plasma atomic emission spectrometry （ICP-OES） and inductively coupled plasma mass spectrometry （ICP-MS）. Meanwhile， characteristic spectrum of inorganic elements in samples was drawn. The identification model was constructed to discriminate the growth years of Scutellariae Radix based on the combination of principal component analysis （PCA）， Fisher discriminant function and support vector machine （SVM）. ResultThe contents of Mn （7.79-36.48 μg·g^-1）， Zn （10.12-31.43 μg·g^-1）， Cu （6.38-17.20 μg·g^-1）， K （2.98-13.89 μg·g^-1）， Mg （3.45-7.78 μg·g^-1） and Ca （2.32-7.09 μg·g^-1） in Scutellariae Radix were detected by ICP-OES and ICP-MS， and their contents increased with the prolongation of growth years. PCA results showed that Cu， Ni， Cd， Na， Mg， Fe， Ca， Zn， Mn and Hg were characteristic elements of Scutellariae Radix. Samples with different years could be divided into four categories in the spatial characteristic diagram of Fisher discriminant analysis. The correct rate of SVM model for identifying the growth years of samples was 95.2%. ConclusionThis established method is accurate and rapid for discriminating the growth years of Scutellariae Radix， which can provide reference for the identification of other Chinese medicinal materials. It is suggested that some elements should be considered as indexes in subsequent construction of the quality evaluation system of Scutellariae Radix.

Objective and MethodChemical components in four varieties of Moringa Folium （MF）； traditional Indian YD， modified species of Indian species PKM1， modified species of PKM1 species PKM2， and red river No.1 variety HH） were qualitatively analyzed by ultra-high performance liquid chromatography quadrupole time of flight mass spectrometry（UPLC-Q-TOF-MS） and gas chromatography mass spectrometry（GC-MS）， and potential mechanism and material basis of MF in the treatment of constipation were revealed based on network pharmacology. ResultData of accurate relative molecular mass and fragment ions in primary and secondary mass spectra in both positive and negative ion modes were acquired by UPLC-Q-TOF-MS， and then 20 nonvolatile components were identified from the four varieties by comparison with references and consulting literature reports. Nineteen volatile components were identified by comparing mass spectrometry information and that in NIST （version 1.7） based on GC-MS， and 674 chemical component targets were predicted using SwissTargetPrediction and SEA after integration and duplicate elimination. A total of 1 086 constipation-related targets were predicted using GeneCards. With Venny， 88 intersection targets were obtained by mapping chemical component targets and disease targets and venny diagram was drawn. STRING and Cytoscape were used to plot protein-protein interaction（PPI） network diagram. Gene ontology（GO） function analysis and Kyoto encyclopedia of genes and genomes（KEGG） pathway analysis were completed through Metascape， which indicated that MF treated constipation mainly via thyroid hormone signaling pathway， advanced glycation end products/receptor for advanced glycation end products（AGE/RAGE） signaling pathway， and cancer signaling pathway. Additionally， the "component-target-pathway" map was plotted by Cytoscape， which predicted that the key components of MF in the treatment of constipation were adenosine， astragalin， geranylacetone， 2-methyloctan-3-one， palmitic acid and oleamide. Also， we inferred that the core targets might be prostaglandin-endoperoxide synthase 2（PTGS2）， tumor necrosis factor（TNF）， mitogen-activated protein kinase 1（MAPK1）， alpha 2A adrenergic receptor（ADRA2A）， and interleukin （IL）-6， which distributed in multiple tissues such as colon， small intestine， and rectum. ConclusionThis study clarified the volatile and non-volatile divisions in four varieties of MF comprehensively， and explained that MF treated constipation by reducing inflammatory state and promoting intestinal movement and secretion of intestinal fluid， which provided reference for further quality evaluation and clinical research of MF.

Objective:To investigate the efficacy and safety of ixazomib-based therapy for multiple myeloma.Methods:The data of 32 patients with multiple myeloma treated with isazomib-based regimen in the Affiliated Hospital of Jining Medical University from December 2020 to December 2021 were retrospectively analyzed. Among 32 patients, 17 cases were relapsed/refractory, and the remaining 15 cases had initial treatment. The treatment regimens included ID (isazomib + dexamethasone), IRD (isazomib + lenalidomide + dexamethasone) and ICD (isazomib + cyclophosphamide + dexamethasone). The short-term curative effect and adverse reactions of relapsed/refractory patients and patients at initial onset were analyzed.Results:The overall response rate (ORR) of relapsed/refractory patients was 52.9% (9/17), of which 6 cases achieved complete remission (CR), 2 cases achieved very good partial remission (VGPR) and 1 case achieved partial remission (PR). The ORR of refractory patients receiving bortezomib therapy was 40.0% (4/10). The ORR of patients at initial onset who could be evaluated the curative effect was 100.0% (14/14), including 9 cases of CR, 2 cases of VGPR and 3 cases of PR. After treatment, 2 patients (6.2%) had grade Ⅲ-Ⅳ adverse events (1 case of herpes zoster and 1 case of thrombocytopenia), and none of the patients had grade Ⅲ-Ⅳ peripheral neuropathy.Conclusion:Isazomib is effective and safe in the treatment of initially treated and relapsed/refractory multiple myeloma.

Programmed cell death ligand 1 (PD-L1)/programmed cell death protein 1 (PD-1) cascade is an effective therapeutic target for immune checkpoint blockade (ICB) therapy. Targeting PD-L1/PD-1 axis by small-molecule drug is an attractive approach to enhance antitumor immunity. Using flow cytometry-based assay, we identify tubeimoside-1 (TBM-1) as a promising antitumor immune modulator that negatively regulates PD-L1 level. TBM-1 disrupts PD-1/PD-L1 interaction and enhances the cytotoxicity of T cells toward cancer cells through decreasing the abundance of PD-L1. Furthermore, TBM-1 exerts its antitumor effect in mice bearing Lewis lung carcinoma (LLC) and B16 melanoma tumor xenograft

【Objective】 To explore the effects of ginsenoside Rg1 （ginsenoside Rg1） on cell apoptosis， oxidative stress and inflammation in young rats with hypoxic-ischemic brain damage （HIBD）. 【Methods】 Young Wistar rats were divided into healthy control group， model group （HIBD）， and HIBD+ginsenoside Rg1 group. Jumping test was used to detect the number of mistakes in each group of rats， brain tissue wet and dry weight method was used to calculate the brain water content and brain index of each group of rats. Hematoxylin-eosin （HE） staining was used to observe the degree of brain damage； TUNEL staining to observe the apoptosis level of brain tissue； Nissl body staining to detect neuronal cell apoptosis； Western blot to detect brain tissue Bax/Bcl-2， caspase-3， caspase-9 protein expressions； malondialdehyde （MDA） and superoxide dismutase （SOD） activity detection kit to detect MDA and SOD content， respectively； and ELISA to detect peripheral blood IL-6， iNOS， IL-4 contents. 【Results】 Compared with the model group， 20 mg/kg and 40 mg/kg ginsenoside Rg1 significantly reduced the number of mistakes in the jumping-off test of HIBD young rats， and brain index brain water rate and neuronal cell apoptosis （P<0.05）； alleviated brain tissue damage； down-regulated the protein expression levels of Bax/Bcl-2， cleaved cas9/cas9 and cleaved cas3/cas3 （P<0.05）； reduced IL-6 and iNOS protein content； and increased IL-4 protein content （P<0.05）. 【Conclusion】 Ginsenoside Rg1 improves brain tissue damage in young HIBD mice and inhibits neuronal cell apoptosis.

Objective:To establish virus culture method and full genome sequencing method for severe acute respiratory syndrome coronavirus (2019-nCoV), and to illuminate the variation of 2019-nCoV.Methods:The pharyngeal swab specimens were inoculated into Vero-E6 cells for isolation, and the cytopathic effect were observed day by day, and the result of virus isolation were confirmed by Real-Time RT-PCR. Some isolated viruses were diluted 10 times to detect the virus titer. Full-genome of 2019-nCoV was sequenced with the whole genome capture technology and next generation sequencing technology. Phylogenetic analysis and molecular characterization for obtained 2019-nCoV sequences were undertaken.Results:Twenty-two 2019-nCoV strains were isolated with Vero-E6 cell line in the Biosafety Level-3 Laboratory (BSL-3). Eighteen full-genome sequences obtained (almost 29 000 nucleotide) were analyzed with 99.94%~100% identity and 28 nucleotides and 20 amino acids variations. Phylogenetic analysis showed that the 2019-nCoV sequences belonged to different clades, including clade S and clade L with Europe lineage L. I and Europe lineage L. II.1. Furthermore, 5 of 18 2019-nCoV harbor the D614G mutation.Conclusions:2019-nCoV were successfully isolated with Vero-E6 cells, and partially illuminated the phylogenetic characteristics, which provided a basis for subsequent drug screening and biological characteristics research. Continuous monitoring and analysis of the sequences of new cases would be vital to understand the genetic evolution and rates of substitution of the 2019-nCoV.