Objective To elucidate the molecular mechanism of sirtuin-3 (SIRT3) in regulating mitochondrial biogenesis in human renal tubular epithelial cells. Methods Cells were stimulated with different concentrations of H₂O₂ and divided into four groups: control (NC), 50 μmol/L H₂O₂, 110 μmol/L H₂O₂ and 150 μmol/L H₂O₂. SIRT3 protein expression was then measured. SIRT3 was knocked down with siRNA, and cells were further assigned to five groups: control (NC), negative-control siRNA (NCsi), SIRT3-siRNA (siSIRT3), NCsi+H₂O₂, and siSIRT3+H₂O₂. After 24 h, cellular adenosine triphosphate (ATP) and mitochondrial superoxide anion (O₂•⁻) levels were determined, together with mitochondrial expression of SIRT3, peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α), nuclear respiratory factor 1 (NRF1), mitochondrial transcription factor A (TFAM), superoxide dismutase 2 (SOD2), acetylated-SOD2 and adenosine monophosphate activated protein kinase α1 (AMPKα1). Results The 110 and 150 μmol/L H₂O₂ decreased SIRT3 protein (both P<0.05). ATP and mitochondrial O₂•⁻ did not differ between NC and NCsi groups (both P>0.05). Compared to the NCsi group, the siSIRT3 group exhibited elevated O₂•⁻ level, decreased SIRT3 protein and increased expression levels of SOD2 and acetylated SOD2 protein (all P<0.05). Compared to the NCsi group, the NCsi+H₂O₂ group exhibited decreased cellular ATP levels, elevated mitochondrial O₂•⁻ levels, and reduced protein expression levels of SIRT3, SOD2, TFAM, AMPKα1, PGC-1α and NRF1 (all P<0.05). Compared with the siSIRT3 group, the siSIRT3+H₂O₂ group showed a decrease in cellular ATP levels, an increase in mitochondrial O₂•⁻ levels, a decrease in SIRT3, SOD2, TFAM, AMPKα1, PGC-1α and NRF1 protein expression levels and a decrease in acetylated SOD2 protein expression levels (all P<0.05). Compared with the NCsi+H₂O₂ group, the siSIRT3+H₂O₂ group showed a decrease in cellular ATP levels, an increase in mitochondrial O₂•⁻ levels, a decrease in SIRT3, AMPKα1, PGC-1α and NRF1, TFAM protein expression levels, and an increase in SOD2 and acetylated SOD2 protein expression levels (all P<0.05). Conclusions SIRT3 promotes mitochondrial biogenesis in tubular epithelial cells via the AMPK/PGC-1α/NRF1/TFAM axis, representing a key mechanism through which SIRT3 ameliorates oxidative stress-induced mitochondrial dysfunction.

ObjectiveTo investigate the levels of serum antibodies against novel coronavirus （SARS-CoV-2） in healthcare workers after one month of natural infection， to explore the influencing factors and their correlations with the levels of antibodies， and to provide reference for strengthening the protection of healthcare workers and preventive intervention in Pudong New Area in Shanghai. MethodsVenous blood samples were collected from 1 102 medical staff in Pudong hospitals one month after infection. The serum levels of new coronavirus specific antibodies IgM， IgG and neutralizing antibodies were detected by chemiluminescent immunoassay. The information of gender， age， position， infection severity， vaccination， basic diseases and use of immunosuppressants were obtained by questionnaire to explore the influencing factors and their correlation with the antibody level. ResultsOne month after natural infection， 99.00% （1 091/1 102） of the subjects were found to be positive for IgG antibody against the new coronavirus， 17.79% （196/1 102） of the subjects were IgM antibody positive， and 99.00% （1 091/1 102） of the samples were positive for the neutralizing antibody. The level of antibody might be influenced by the severity of infection， the time of the last dose of vaccination， and the long-term use of immunosuppressants. The more severe the disease， the stronger the neutralizing antibody response. The antibody level in the people who received the final dose of vaccine within 6 months was higher than that of the people who received the vaccine 6 months ago， and the difference was statistically significant. The antibody levels were low in the subjects who received long-term immunosuppressants. ConclusionThe specific IgM， IgG and neutralizing antibody were found， one month after infection， in the medical workers in Pudong New Area， Shanghai， and the antibody titers were high， which had a good protective effect. The antibody level of the people who were vaccinated within 6 months was higher， it is recommended that people who receive the last vacination more than 6 months should be re-vaccinated with the booster vaccine， to improve the autoimmunity against the novel coronavirus.

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.

Objective To measure and comprehensively analyze the operation efficiency of coronary heart disease Center of National Regional Medical Center for Cardiovascular Disease from the dimensions of department service in-come,department service quality,department service efficiency and department service benefit,and put forward targeted operation management optimization strategies based on the analysis results.Methods The operation effective-ness evaluation index of CHD centers in sample hospitals from 2020 to 2022 was measured by the empirical re-search method from the overall level of the center and the level of clinical departments,and the scores were com-pared and analyzed.Results From 2020 to 2022,the operation effectiveness evaluation index of CHD centers in sam-ple hospitals showed a good trend,increasing from 80.57 points to 82.86 points.The 3-year average score was 81.74;Among them,the score rate of department service benefit dimension is higher,the average is 96.64％;The score rate of department service efficiency was lower,with an average of 68.53％.The departments with the lowest operational efficiency scores from 2020 to 2022 are all A2 departments,with 74.39,72.41 and 75.89 scores respec-tively,mainly due to the relatively low scores of A2 departments in the dimensions of department service revenue and department service efficiency.Conclusion The results of clinical department operation effectiveness evaluation can provide the evidence-based basis for hospital operation management,and hospitals can establish benchmarking management departments according to the evaluation results and take targeted measures to improve the comprehen-sive operation efficiency of departments.

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.

Background::Copper and zinc are involved in the development of multiple malignancies; yet, epidemiological evidence on hepatocellular carcinoma (HCC) is limited. This study aimed to investigate the association between dietary intake and serum levels of copper and zinc with the risk of HCC.Methods::A total of 434 case-control pairs matched for sex and age (±1 year) were included in this study. Cases with newly diagnosed HCC were from the Guangdong Liver Cancer Cohort (GLCC) study, and healthy controls were from the Guangzhou Nutrition and Health Study (GNHS). A semi-quantitative 79-item food frequency questionnaire (FFQ) was used to assess habitual dietary intakes of copper and zinc. Serum levels of copper and zinc were measured by using inductively coupled plasma mass spectrometry. The copper (Cu)/ zinc (Zn) ratio was computed by dividing copper levels by zinc levels. Conditional logistic regression models were performed to calculate the odds ratio (OR) and 95% confidence intervals (CI) for per 1 standard deviation increase (per-SD increase) in copper and zinc levels.Results::Higher dietary intake (OR per-SD increase = 0.65, 95% CI: 0.44, 0.96, Ptrend = 0.029) and serum levels of zinc (OR per-SD increase = 0.11, 95% CI: 0.04, 0.30, Ptrend <0.001) were both associated with a lower risk of HCC. Subgroup analyses showed that the inverse association was only pronounced in men but not in women ( Pinteraction = 0.041 for dietary zinc intake and 0.010 for serum zinc levels). Serum copper levels (OR per-SD increase = 2.05, 95% CI: 1.39, 3.03, Ptrend = 0.020) and serum Cu/Zn ratio (OR per-SD increase = 6.53, 95% CI: 2.52, 16.92, Ptrend <0.001) were positively associated with HCC risk, while dietary copper intake and dietary Cu/Zn ratio were not associated with HCC risk. Conclusion::Zinc may be a protective factor for HCC, especially among men, but the effects of copper on HCC risk are not clear.

The treatment of acute Stanford type A aortic dissection has always been extremely challenging. Organ malperfusion syndrome is a common severe complication of acute aortic dissection, which can cause organ ischemia and internal environment disorder. Malperfusion increases early mortality, and impacts the long-term prognosis. In recent years, many scholars have done some studies on aortic dissection complicated with malperfusion. They explored the pathogenesis, proposed new classification, and innovated new treatment strategies. However, at present, the treatment strategies of acute Stanford type A aortic dissection complicated with organ malperfusion are different at different centers and consensus on its treatment is still lacking. Therefore, this review summarized the pathogenesis, classification, treatment strategy, and prognosis of acute Stanford type A aortic dissection complicated with malperfusion.

Objective:To evaluate the clinical effects of " watching without dealing" aortic root repair technique in acute Stanford type A aortic dissection(ATAAD).Methods:From October 2017 to October 2018, " watching without dealing" technique was performed in ATAAD patients with mild aortic root involvement. The proximal aortic anastomosis was at the level of the sinotubular junction, without " pursuing" complete excision of the intra-sinus dissections. The perioperative clinical data and follow-up imaging results of the patients were collected and analyzed to evaluate early and mid-term efficacy of the technique.Results:A total of 20 patients received " watching without dealing" technique in our hospital, including 15 males and 5 females with a mean age of(48.0±12.1) years old(34-73 years old). The preoperative aortic sinus diameter was(41.3±3.6)mm and the aortic sinotubular junction diameter was(43.9±6.6) mm. All patients underwent ascending aortic replacement and total arch replacement plus frozen elephant trunk surgery. The cardiopulmonary bypass time was(179.5±41.5)min(132~255 min), the cross-clamp time was(120.3±23.7) min(95~180 min), and the circulatory arrest time was(8.8±7.6) min(2~22 min). During perioperative period, no adverse events such as death, secondary opening, renal failure, cerebral infarction, and paraplegia occurred. The CTA examination of the aorta before the patients were discharged showed that all residual false lumen in the sinus disappeared, the diameter of the aortic sinus was(30.8±2.6) mm, and the diameter of the aortic sinotubular junction was(27.2±2.5) mm. The patients were followed up for mean(28.5±7.8) months(3~35 months). No surgical re-intervention of the aortic root occurred. The aortic CTA during follow-up period showed no residual or new dissection in the aortic sinus, the diameters of the aortic sinus and aortic sinotubular junction were(30.9±2.4) mm and(27.5±2.7) mm respectively; the ultrasonic cardiogram showed normal aortic valve structure and function. No statistically significant differences were found when comparing the aortic sinus diameter and aortic sinotubular junction diameter between two time points of at discharge and follow-up.Conclusion:The " watching without dealing" aortic root repair technique for ATAAD is relatively simple to learn and safe in the perioperative period. Early and mid-term follow-up imaging showed normalization of the aortic sinus structure. Further follow-up and observation were necessary to figure out the long-term clinical outcome of this modified aortic root repair.

Objective:To compare the expression levels of candidate genes before and after Shuganjieyu capsule treatment, to analyze their correlation with depression symptoms and cognitive function, and to find and clarify the biomarkers related to the efficacy of Shuganjieyu capsule.Methods:Among 27 patients with mild to moderate depression (MMD), 24 items Hamilton depression rating scale (HAMD-24) was used to assess the severity of depression, Chinese revised Wechsler adult intelligence scale(WAIS-RC) and Chinese revised Wechsler memory scale(WMS) were used to assess cognitive function, and qRT-PCR was used to detect the expression levels of candidate genes in peripheral blood of patients with depression before and after treatment with Shuganjieyu capsule.SPSS 25.0 software was used for statistical analysis, paired t-test, non-parametric test, Spearman correlation analysis and receiver operating characteristic curve were used for data statistics. Results:The symptoms of MMD patients were relieved after Shuganjieyu capsule treatment(HAMD scores: baseline 14.00(9.75, 18.25), 8-week 4.00(2.00, 7.25), Z=-4.462, P<0.01), and the verbal intelligence quotient(VIQ) of WMS was puomoved (VIQ scores: baseline (123.00±10.24), 8-week (128.00±6.77), t=4.372, P<0.01). The level of gene expression brain derived neurotrophic factor(BDNF) (baseline 1.68(0.92, 2.63), 8-week 2.30(1.47, 4.34), Z=-2.781, P=0.005), glial cell derived neurotrophic factor(GDNF) (baseline 0.74(0.31, 1.15), 8-week 0.97(0.50, 1.71), Z=-2.159, P=0.031), 5-hydroxytryptamine receptor 2A(HTR2A) (baseline 0.60(0.39, 1.60), 8-week 0.98(0.44, 2.29), Z=-1.994, P=0.046) and glutamate ionotropic receptor AMPA type subunit 1(GRIA1) (baseline 1.19(0.66, 2.40), 8-week 1.76(0.86, 4.13), Z=-2.756, P=0.006) was up-regulated after treatment.The change rate of BDNF expression were correlated with the score of HAMD-24 ( r=-0.35, P=0.038) and performance intelligence quotient of WMS ( r=0.40, P=0.022). Conclusions:BDNF may be used as a therapeutic marker of Shuganjieyu capsule in the treatment of clinical symptoms and cognitive function of MMD patients, which is used to evaluate the efficacy of antidepressants.

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.