Objective To develop a value evaluation index system for health management and logistics positions in pub-lic hospitals,providing a research tool for future performance evaluations and salary reform.Methods Literature review,focus group interviews,and the point-factor method were employed to establish an initial index pool.A public hospital in Guangzhou was selected as a case study.Delphi expert consultation was then utilized to refine and finalize the indicators for the evaluation system.Results For the two rounds of Delphi expert consultation,the response rates were 87.5％and 100.0％,with the expert authority coefficient of 0.812.The Kendall's W coordination coefficients were 0.796 and 0.624 for the first round,and 0.747 and 0.918 for the second,(all＜0.001).The coefficients of variation ranged from 0.157 to 0.265 for the first round and from 0.108 to 0.230 for the second round.Experts provided four suggestions,leading to the removal of one secondary indicator and modifications to the definitions of three others.Finally,the evaluation system consists of 4 primary indicators and 12 secondary indicators.Conclusion This system can provide a research tool and reference for the follow-up performance evaluation,improve the salary reform of public hospitals,and promote the high-quality development of public hospitals.

The cellular and molecular components of the tumor immune microenvironment (TIME) and their information exchange processes significantly influence the trends of anti-tumor immunity. In recent years, numerous studies have begun to evaluate TIME in the context of previous cancer treatment strategies. This review will systematically summarize the compositional characteristics of TIME and, based on this foundation, explore the impact of current cancer therapies on the remodeling of TIME, aiming to provide new insights for the development of innovative immune combination therapies that can convert TIME into an anti-tumor profile.
Tumor Microenvironment/immunology* ; Humans ; Neoplasms/therapy* ; Immunotherapy/methods* ; Animals

Objective This study aims to explore the association between non-suicidal self-injury(NSSI)and suicide attempts(SA)in adolescents and the mediating effect of cognitive flexibility.Methods A total of 218 depression patients with NSSI who met the Diagnostic and Statistical Manual of Mental Disorders,5th Edition(DSM-5)diagnostic criteria for NSSI were enrolled.Patients were divided into SA group(n=105)and non-SA group(n=113)according to the presence or absence of SA in the last one year.The adolescent non-suicidal self-injury assessment questionnaire(ANSAQ)and the Wisconsin card sorting tests(WCST)was used to assess the frequency of NSSI and cognitive flexibility,respectively.A mediation model was constructed to conduct path analysis,and the product distribution method was utilized to test the mediation effect.Results The difference between SA group and non-SA group in NSSI(20.1±10.7 vs.14.7±9.1)and WCST scores[correct responses percentage(67.3％±14.2％vs.72.9％±12.2％),error responses(39.8±20.3 vs.31.6±17.9),perseverative response(6.7±3.8 vs.5.3±2.9),and non-perseverative errors(37.6±21.0 vs.28.9±18.1)]were significant(P<0.05).Dichotomous logistic regression analysis showed that the frequency of NSSI(OR=1.051,95％CI:1.021-1.082)and the score of perseverative response(OR=1.100,95％CI:1.008-1.199)were significantly associated with suicidal behavior among adolescents with NSSI(P<0.05).Moreover,perseverative response partially mediated the association between NSSI and SA(95％CI of Za×Zb:0.0003-0.0168).Conclusion High NSSI and low cognitive flexibility are risk factors for suicide attempts in NSSI adolescents and NSSI may also affect SA indirectly by lowering cognitive flexibility.

Objective To develop a value evaluation index system for health management and logistics positions in pub-lic hospitals,providing a research tool for future performance evaluations and salary reform.Methods Literature review,focus group interviews,and the point-factor method were employed to establish an initial index pool.A public hospital in Guangzhou was selected as a case study.Delphi expert consultation was then utilized to refine and finalize the indicators for the evaluation system.Results For the two rounds of Delphi expert consultation,the response rates were 87.5％and 100.0％,with the expert authority coefficient of 0.812.The Kendall's W coordination coefficients were 0.796 and 0.624 for the first round,and 0.747 and 0.918 for the second,(all＜0.001).The coefficients of variation ranged from 0.157 to 0.265 for the first round and from 0.108 to 0.230 for the second round.Experts provided four suggestions,leading to the removal of one secondary indicator and modifications to the definitions of three others.Finally,the evaluation system consists of 4 primary indicators and 12 secondary indicators.Conclusion This system can provide a research tool and reference for the follow-up performance evaluation,improve the salary reform of public hospitals,and promote the high-quality development of public hospitals.

Objective:To observe the effect of brain-computer interface exoskeleton(BCI-exoskeleton)on lower limb func-tional for stroke patients,and to explore the impact on the low-extremity function area of motor cortex in-duced by BCI-exoskeleton and its correlation with clinical efficacy.Method:Forty-two subjects with stroke were recruited and equally assigned to brain-computer interface exoskel-eton experiment group(BG,n=14),robotic exoskeleton experiment group(EG,n=14)and conventional con-trol group(CG,n=14)using random numbers generated by computer.Three groups were provided convention-al treatment,experiment groups received BCI-exoskeleton or lower-limb robotic exoskeleton training(LRET)for 4 weeks,respectively.FMA-LE,MBI,Berg and Holden scales were used to evaluate the lower limb func-tions pre-or post-treatment by a blinded assessor.The accuracy of BCI(BCIA),and the changes of α and β band event-related desynchronization(ERD)intensity at Cz channel of EEG were observed to explore its corre-lation with clinical efficacy.Result:All scales in the three groups were improved post-treatment,and the improvement of BG was better than that of EG and CG(FMA-LE:P＜0.001;MBI,Berg,Holden:P=0.001).The BCIA in BG were signif-icantly increased(P＜0.001).And ERD amplitude of Cz channel in BG were significantly decreased(P＜0.001).ERDα(P＜0.05)was significantly correlated with clinical scales and ERDβ had an extremely signifi-cant correlated with clinical scales(P＜0.01).Conclusion:The BCI-exoskeleton training is effective to improve the lower limb function and activities of dai-ly living for patients with stroke,and the effect is better than LRET and conventional rehabilitation.The effica-cy is related to the promotion of ERDα and ERDβ wave band activity in the lower limb functional area of mo-tor cortex,and the clinical efficacy is more closely correlated with ERD amplitude of Cz channel.

AIM:To investigate the effects of ethylisopropylamiloride(EIPA),an inhibitor of Na+/H+ex-changer 1(NHE1),on the proliferation,migration,invasion,cell cycle and apoptosis of hepatocellular carcinoma cells,and to explore its mechanisms.METHODS:The human hepatocellular carcinoma cell line Huh7 was cultured in vitro,and treated with different concentrations of EIPA.The mRNA and protein expression of NHE1 in Huh7 cells was assessed by RT-qPCR and Western blot.The proliferation of Huh7 cells was examined by kFluor488-EdU staining.The migration and invasion of Huh7 cells were assessed by Transwell assays.The cell cycle distribution and apoptosis of these cells were detected by flow cytometry.Moreover,the intracellular pH was measured via the PTI high-speed ion imaging system.RE-SULTS:Treatment with EIPA significantly suppressed the mRNA and protein expression of NHE1(P＜0.01).It signifi-cantly inhibited the proliferation,migration and invasion of Huh7 cells(P＜0.05 or P＜0.01),promoted their apoptosis(P＜0.01),and caused significant S-phase arrest(P＜0.01).It also significantly reduced the intracellular pH of Huh7 cells.CONCLUSION:The NHE1 inhibitor EIPA regulates the intracellular pH by inhibiting the expression and function of NHE1,which consequently affects the proliferation,migration,invasion,cell cycle,and apoptosis of Huh7 cells.There-fore,NHE1 may be a potential target for the treatment of hepatocellular carcinoma.

Objective This study aims to explore the association between non-suicidal self-injury(NSSI)and suicide attempts(SA)in adolescents and the mediating effect of cognitive flexibility.Methods A total of 218 depression patients with NSSI who met the Diagnostic and Statistical Manual of Mental Disorders,5th Edition(DSM-5)diagnostic criteria for NSSI were enrolled.Patients were divided into SA group(n=105)and non-SA group(n=113)according to the presence or absence of SA in the last one year.The adolescent non-suicidal self-injury assessment questionnaire(ANSAQ)and the Wisconsin card sorting tests(WCST)was used to assess the frequency of NSSI and cognitive flexibility,respectively.A mediation model was constructed to conduct path analysis,and the product distribution method was utilized to test the mediation effect.Results The difference between SA group and non-SA group in NSSI(20.1±10.7 vs.14.7±9.1)and WCST scores[correct responses percentage(67.3％±14.2％vs.72.9％±12.2％),error responses(39.8±20.3 vs.31.6±17.9),perseverative response(6.7±3.8 vs.5.3±2.9),and non-perseverative errors(37.6±21.0 vs.28.9±18.1)]were significant(P<0.05).Dichotomous logistic regression analysis showed that the frequency of NSSI(OR=1.051,95％CI:1.021-1.082)and the score of perseverative response(OR=1.100,95％CI:1.008-1.199)were significantly associated with suicidal behavior among adolescents with NSSI(P<0.05).Moreover,perseverative response partially mediated the association between NSSI and SA(95％CI of Za×Zb:0.0003-0.0168).Conclusion High NSSI and low cognitive flexibility are risk factors for suicide attempts in NSSI adolescents and NSSI may also affect SA indirectly by lowering cognitive flexibility.

AIM:To investigate the effects of ethylisopropylamiloride(EIPA),an inhibitor of Na+/H+ex-changer 1(NHE1),on the proliferation,migration,invasion,cell cycle and apoptosis of hepatocellular carcinoma cells,and to explore its mechanisms.METHODS:The human hepatocellular carcinoma cell line Huh7 was cultured in vitro,and treated with different concentrations of EIPA.The mRNA and protein expression of NHE1 in Huh7 cells was assessed by RT-qPCR and Western blot.The proliferation of Huh7 cells was examined by kFluor488-EdU staining.The migration and invasion of Huh7 cells were assessed by Transwell assays.The cell cycle distribution and apoptosis of these cells were detected by flow cytometry.Moreover,the intracellular pH was measured via the PTI high-speed ion imaging system.RE-SULTS:Treatment with EIPA significantly suppressed the mRNA and protein expression of NHE1(P＜0.01).It signifi-cantly inhibited the proliferation,migration and invasion of Huh7 cells(P＜0.05 or P＜0.01),promoted their apoptosis(P＜0.01),and caused significant S-phase arrest(P＜0.01).It also significantly reduced the intracellular pH of Huh7 cells.CONCLUSION:The NHE1 inhibitor EIPA regulates the intracellular pH by inhibiting the expression and function of NHE1,which consequently affects the proliferation,migration,invasion,cell cycle,and apoptosis of Huh7 cells.There-fore,NHE1 may be a potential target for the treatment of hepatocellular carcinoma.

Objective:To observe the effect of brain-computer interface exoskeleton(BCI-exoskeleton)on lower limb func-tional for stroke patients,and to explore the impact on the low-extremity function area of motor cortex in-duced by BCI-exoskeleton and its correlation with clinical efficacy.Method:Forty-two subjects with stroke were recruited and equally assigned to brain-computer interface exoskel-eton experiment group(BG,n=14),robotic exoskeleton experiment group(EG,n=14)and conventional con-trol group(CG,n=14)using random numbers generated by computer.Three groups were provided convention-al treatment,experiment groups received BCI-exoskeleton or lower-limb robotic exoskeleton training(LRET)for 4 weeks,respectively.FMA-LE,MBI,Berg and Holden scales were used to evaluate the lower limb func-tions pre-or post-treatment by a blinded assessor.The accuracy of BCI(BCIA),and the changes of α and β band event-related desynchronization(ERD)intensity at Cz channel of EEG were observed to explore its corre-lation with clinical efficacy.Result:All scales in the three groups were improved post-treatment,and the improvement of BG was better than that of EG and CG(FMA-LE:P＜0.001;MBI,Berg,Holden:P=0.001).The BCIA in BG were signif-icantly increased(P＜0.001).And ERD amplitude of Cz channel in BG were significantly decreased(P＜0.001).ERDα(P＜0.05)was significantly correlated with clinical scales and ERDβ had an extremely signifi-cant correlated with clinical scales(P＜0.01).Conclusion:The BCI-exoskeleton training is effective to improve the lower limb function and activities of dai-ly living for patients with stroke,and the effect is better than LRET and conventional rehabilitation.The effica-cy is related to the promotion of ERDα and ERDβ wave band activity in the lower limb functional area of mo-tor cortex,and the clinical efficacy is more closely correlated with ERD amplitude of Cz channel.

Objective:To explore the correlation between clinical classification and genotype and prognosis among Chinese children with Very-long chain acyl-CoA dehydrogenase deficiency (VLCADD).Methods:A Chinese pedigree affected with VLCADD admitted at the First People′s Hospital of Yunnan Province in February 2019 was selected as the study subject. The characteristics of disease onset, diagnosis and treatment and prognosis were retrospectively analyzed. Relevant literature was also systematically searched and reviewed.Results:The proband, a 1-year-old boy, had the clinical manifestations of frequently vomiting, hypoglycemia, abnormal liver function and myocardial enzymes. Tandem mass spectrometry screening showed significantly elevated C14, C14: 1, C16: 1, C16: 2, C18 and C14/C8. Genetic testing revealed that he has harbored compound heterozygous variants of the ACADVL gene, namely c. 664G>A (p.G222R) and c. 1345G>A (p.E449K), which were respectively derived from his father and mother. The child was diagnosed with VLCADD cardiomyopathy type and deceased 2 weeks later. Literature review has identified 60 Chinese children with VLCADD. The clinical classifications were mainly cardiomyopathy type and liver disease type, which accounted for 73.3% (43/60). The combination of ACADVL gene variants were correlated with the clinical classifications of VLCAD. Children with one or two loss-of-function (LOF) mutations showed more severe clinical manifestation and a higher mortality. Cardiomyopathy type had the poorest prognosis, with a mortality rate of 76.9% (20/26). C14: 1 may be used as an indicator for the diagnosis of VLCADD, but cannot be used for clinical subtyping and prognosis evaluation. The c. 1349G>A (p.R450H) variant had the highest frequency among the Chinese patients, accounting for 10.8% (13/120). Conclusion:The clinical classifications of VLCADD are strongly correlated with the prognosis, and LOF mutations are more common in those with severe clinical manifestations. c. 1349G>A (p.R450H) may be the most common variant among the Chinese patients, and early screening and diagnosis can greatly improve the prognosis of patients.