Comprehensively improving the new efficiency of high-quality development of public hospitals is the key top-level design for deepening the reform of public hospitals during the"14th Five-Year Plan"period.In view of the changes in the macro environment faced by public hospitals in recent years,such as the cancellation of the addi-tion of pharmaceutical consumables and the deep promotion of the reform of payment methods,as well as the out-standing problems existing at the micro level of public hospital operation,such as the separation of diagnosis and treatment business from economic operation activities,extensive decision-making methods,unreasonable alloca-tion of resources and urgent optimization of processes.By referring to relevant theories such as value management theory,a new"trinity"public hospital lean operation management model based on"integration of industry and fi-nance,lean operation and evidence-based decision-making"is explored and constructed.It breaks the relatively parallel operation barriers of clinical diagnosis and treatment business and economic operation management,innovates a new method of linear staff management with the integration of industry and finance,gives full play to the role of experts in governing hospitals,and integrates the professional committee system driven by"technology+manage-men"into the hospital decision-making staff system to provide data evidence-based basis for assisting the hospital leadership to make scientific decisions.

The access evaluation of new medical technology is an important part of the preclinical application of medical technology and plays a vital role in ensuring the quality and safety of medical services.However,in the con-crete practice of access evaluation,there are still some problems such as imperfect access theoretical framework,imperfect evaluation index system.With the strategic support of health policies,laws,and regulations,the theory and method of HB-HTA are used for reference,core elements such as assessment subject,assessment object,and assessment content are comprehensively considered,the index system is designed from the dimensions of tech-nical characteristics,safety,effectiveness,economy and applicability,and the access evaluation framework of im-ported medical new technologies is constructed.To offer a theoretical framework and evidence-based basis for medi-cal facility medical technology access management.

The establishment of an economic operating mechanisms for hospitals is a key factor in advancing the growth of public hospitals in the modern age.At present,the due value of key factors such as medical resources and labor value of medical personnel in public hospitals in China has not been fully reflected,which not only restricts the overall operation efficiency of hospitals,but also makes it difficult to realize the marginal value of hospital operation and management.The economic operating mechanisms of public hospitals is in urgent need of reform.Large public hospitals in Henan Province has established an economic operating mechanisms of public hospitals based on intelli-gent finance,comprehensive budget management as the core,and cost control and performance management as the major tools to realize the interconnection of various systems and promote the high-quality development of hospi-tals with the three major supports of industry and finance integration,financial integration and financial integration.

This paper takes the"departmental core group"of the logistics department of Beijing Tiantan Hospital as a practical case to explore the methods to improve the performance of the"departmental core group"of the logistics department of public hospitals and analyze the implementation effect.In 2021-2023,Tiantan Hospital adopted five measures:Heterogeneous membership structure,full division of responsibilities,institutionalized management norms,list of work objectives,risk control throughout the process and implemented the whole process of closed-loop management of"three major issues and one great is-sue".This paper compares the quality of management of"three major issues and one great issue"in the three years before and after the implementation of the five measures,and finds that after the adoption of the five measures,the management efficiency is improved,the number of topics increased fourfold compared with the previous three years,and the number of engineering,service and procurement projects completed on schedule doubled compared with the previous three years;the quality of decision-making is improved,decision-making management is legal and compliant,and there are no errors in work;the satisfaction of employees is improved,it was rated as advanced department and advanced grass-roots party organization.It was concluded that the five meas-ures are an effective way to improve the performance of the"departmental core group"in the logistics department,which can pro-vide a reference for the team building and departmental management of the"departmental core group"in public hospitals.

Objective To establish a fault identification and hazard management work model for identifying faults and managing hazards in fire safety facilities in large public hospitals.Methods In 2022,the case hospital implemented the PDCA cycle management method for fault identification and hazard management in fire safety facilities.The PDCA cycle management ap-proach and framework were used to identify and analyze issues in maintenance and management of fire safety facilities,and to de-velop improvement strategies.Results The implementation of the proposed strategies resulted in enhanced hazard identification capabilities,a reduction in the time required for hazard rectification,and a decrease in the number of hazards.A sustainable workflow for fault identification and hazard management of fire safety facilities was established.Conclusion The work mode for fault identification and hazard management of fire safety facilities based on the PDCA cycle management method can serve as an effective method for managing fire safety hazards in large public hospitals.This model has promotional value.

Objective:To develop a three-dimensional body image stimuli suitable for middle-aged people in China, and verify the validity and reliability of the body image stimuli.Method:According to China and World Health Organization body mass index classification standards of adults, a set of three-dimensional body image stimuli of Chinese middle-aged males and females with different body size was developed by using 3D Studio Max and Adobe Photoshop CC based on the literature and expert consultation method. Forty-two 45- and 59-year-old middle-aged people in Zhengzhou City, Henan Province were recruited to verify the three-dimensional body image stimuli. Through questionnaire survey and physical examination, the coincidence between the selected body type and the actual body type was tested; the body composition was measured by dual-energy absorptiometry (DXA), and the structure validity of the image was tested; the body size satisfaction was investigated by the body image stimuli and the standard questionnaire, and the empirical validity of the image was tested. The repeated survey was conducted 14 days after the initial survey, and three experts were invited to score the current somatotype of the subjects to test the test-retest reliability and inter-rater reliability of the body image stimuli. Pearson, Spearman, Kendall correlation and Kappa consistency analysis were used to evaluate the validity and reliability of the body image stimuli.Results:The average age of 42 subjects was 52.7 years old, including 13 males and 29 females. A group of three-dimensional body image stimuli of middle-aged men and women were developed, and each group included 8 images. 73.8% of the subjects chose the body size consistent with the actual body type, and the weighted Kappa coefficient was 0.755 ( P<0.01). The selected somatotype was positively correlated with body weight and body composition indexes such as fat content, and the Pearson correlation coefficient of construct validity was 0.623-0.717 ( P<0.05). The results of the two surveys were positively correlated, and the Spearman correlation coefficient of test-retest reliability was 0.784-0.821 ( P<0.05). The scores of the three experts on the current somatotype of the subjects were positively correlated, and the Kendall correlation coefficient of inter-rater reliability was 0.818-0.878 ( P<0.05). Conclusion:The development of principle and reference basis of three-dimensional body image stimuli of middle-aged people is reliable, and the validity and reliability of the body image stimuli are good.

Objective:To develop a three-dimensional body image stimuli suitable for middle-aged people in China, and verify the validity and reliability of the body image stimuli.Method:According to China and World Health Organization body mass index classification standards of adults, a set of three-dimensional body image stimuli of Chinese middle-aged males and females with different body size was developed by using 3D Studio Max and Adobe Photoshop CC based on the literature and expert consultation method. Forty-two 45- and 59-year-old middle-aged people in Zhengzhou City, Henan Province were recruited to verify the three-dimensional body image stimuli. Through questionnaire survey and physical examination, the coincidence between the selected body type and the actual body type was tested; the body composition was measured by dual-energy absorptiometry (DXA), and the structure validity of the image was tested; the body size satisfaction was investigated by the body image stimuli and the standard questionnaire, and the empirical validity of the image was tested. The repeated survey was conducted 14 days after the initial survey, and three experts were invited to score the current somatotype of the subjects to test the test-retest reliability and inter-rater reliability of the body image stimuli. Pearson, Spearman, Kendall correlation and Kappa consistency analysis were used to evaluate the validity and reliability of the body image stimuli.Results:The average age of 42 subjects was 52.7 years old, including 13 males and 29 females. A group of three-dimensional body image stimuli of middle-aged men and women were developed, and each group included 8 images. 73.8% of the subjects chose the body size consistent with the actual body type, and the weighted Kappa coefficient was 0.755 ( P<0.01). The selected somatotype was positively correlated with body weight and body composition indexes such as fat content, and the Pearson correlation coefficient of construct validity was 0.623-0.717 ( P<0.05). The results of the two surveys were positively correlated, and the Spearman correlation coefficient of test-retest reliability was 0.784-0.821 ( P<0.05). The scores of the three experts on the current somatotype of the subjects were positively correlated, and the Kendall correlation coefficient of inter-rater reliability was 0.818-0.878 ( P<0.05). Conclusion:The development of principle and reference basis of three-dimensional body image stimuli of middle-aged people is reliable, and the validity and reliability of the body image stimuli are good.

Objective To investigate the influence of low-tube current in combination with simultaneous iterative reconstruction algorithm on bone mineral density (BMD) of T12 and image quality with a chest phantom.Methods An adult male chest phantom was selected.CT scan of the chest was performed at tube voltage of 120 kV and five different tube currents (20,30,40,50,60 mAs) in combination with filtered back projection (FBP),iDose4 (Level 4) and iterative model reconstruction (IMR,Level 2),respectively.BMD of T12 in chest phantom and objective evaluation results on different tube currents and simultaneous iterative reconstruction techniques were compared.The subjective scoring of mediastinum and lung window imaging qualities at tube current of 20 mAs with IMR and tube current of 60 mAs with FBP were compared.The consistency between two observers was evaluated.Results There was no significant difference between BMD values nor CT values on different tube currents and simultaneous iterative reconstruction techniques of chest phantom (all P＞ 0.05),but the differences between SD values were statistically significant (P＜ 0.001).SD values obtained with IMR were lower than those of iDose4 and FBP at same tube currents (all P＜0.001).At tube current of 60 mAs with FBP,the consistency of two observers in mediastinum window was the best (Kappa=1,P＜0.001),while in lung window was medium (Kappa=0.64,P=0.002).At tube current of 20 mAs with IMR,the consistency of two observers in mediastinum window was medium (Kappa=0.64,P=0.002),while in lung window was the best (Kappa=1.00,P＜0.001).Conclusion Low-tube current in combination with simultaneous iterative reconstruction algorithm can reduce radiation dose without affecting the accuracy of BMD.

Objective To investigate the reproducibility and accuracy of spinal BMD (bone mineral density) by low mA using adaptive statistic iterative reconstruction based on phantom model.Methods European spine phantom (ESP) was scanned with 5 different tube currents (40,60,80,100 and 120 mA) on the GE Revolution prototype.All data were transferred to the quantitative CT (QCT) PRO workstation for measuring the bone mineral density (BMD).And all data were reconstructed using different adaptive statistical iterative reconstruction veo (ASiR-V) weighting percentages from ASiR-V 0 filtered back projection(FBP) to ASiR-V 100％,at interval of 20％.Quantitative measurements of CT value,noise,and contrast noise ratio (CNR) of L1,L2 and L3 were measured in each group.The singlefactor analysis of variance (ANOVA) was used to compare the bone mineral density values of different mA and ASiR-V weighting percentages.Results Volume CT dose index(CTDIvol) and dose length product (DLP) were positively correlated with tube current(r =1).The BMD of ESP phantoms had no statistically significant differences among the multi-center lumbar spines L1,L2 and L3 at different doses under the same ASiR-V weighting percentages (P ＞ 0.05),as well as at the same dose under different ASiR-V weighting percentages(P ＞ 0.05).The error of bone density accuracy was within 6％.Conclusions Low dosage of 120 kV and 40 mA using ASiR-V without affecting the accuracy of BMD has the potential effect to reduce radiation dose without compromising image quality.

Objective To explore the role of miR-20a on pulmonary surfactant synthesis of alveolar epithelial cells A549 and its potential mechanism.Methods Lentivirus miR-20a overexpression vector(miR-20a group) or lentivirus no-load vector(no-load group) was transfected into A549 cells,and the expression of green fluorescent protein(GFP) was observed to determinate the transfection effficiency;cell proliferation was detected by using 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT);the bioinformatics software and database were applied to predict and analyze the target genes of miR-20a about lung development;expressions of miR-20a,pulmonary surfactant-associated protein A(SP-A),pulmonary surfactant-associated protein B(SP-B),pulmonary surfactant-associated protein C(SP-C) and pulmonary surfactant-associated protein D(SP-D) mRNA were detected by using quantitative real-time PCR(qPCR);the expressions of SP-A protein,SP-B protein,SP-C protein,SP-D protein and protein signal transducers and activators of transcription 3 (STAT3) were detected by using Western blot.Results Observation of GFP expression under a fluorescent microscope indicated similar transfection efficiency,and real time-PCR showed that the expression of miR-20a increased after being transfected with lentivirus miR-20a overexpression vector(3.85 ± 0.18)compared with the normal group (0.99 ± 0.04)and the no-load group (1.21 ± 0.12),and the differences were significant(t =10.85,9.64,all P ＜0.001).As a result,lentivirus miR-20a overexpression vector was constructed successfully.Online software predicted that STAT3 gene was likely to be the target gene of miR-20a.Compared with the normal group (24 h,48 h,72 h:0.23 ± 0.01,0.39 ± 0.01,0.56 ± 0.03) and the no-load group (24 h,48 h,72 h:0.25 ± 0.01,0.44 ± 0.05,0.59 ± 0.01),miR-20a did not change the cell proliferation at different time points(24 h,48 h,72 h:0.26 ± 0.01,0.41 ± 0.02,0.58 ± 0.02) (all P ＞ 0.05).Compared with the normal group (1.00 ± 0.05,1.24 ± 0.20,1.31 ± 0.09,0.89 ± 0.12) and the no-load group (0.76 ± 0.10,1.31 ± 0.13,1.50 ± 0.11,1.01 ± 0.11),miR-20a up-regulated the mRNA expressions of SP-A,SP-B,SP-C and SP-D (2.05 ± 0.17,2.14 ± 0.10,2.84 ± 0.09,1.66 ± 0.08),and the differences were significant (all P ＜ 0.05).Compared with the normal group (0.46 ± 0.01,0.27 ± 0.03,0.69 ± 0.01,0.43 ± 0.01) and no-load group (0.43 ± 0.01,0.21 ± 0.01,0.79 ± 0.02,0.44 ± 0.02),miR-20a also increased the protein expressions of SP-A,SP-B,SP-C and SP-D (0.55 ±0.01,0.47 ±0.05,0.96 ±0.02,0.59 ±0.03),the diffe-rences were statistically significant (all P ＜0.05).The expression of STAT3 in miR-20a group(0.37 ±0.05) was significantly lower than that in the normal group(0.60 ±0.04) and the no-load group (0.68 ±0.06),and the differences were statstically significant (all P ＜ 0.05) in A549.Conclusions STAT3 is a downstream target gene of miR-20a.miR-20a can promote pulmonary surfactant synthesis of alveolar epithelial cells A549 by inhibiting STAT3.