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.

Objective Exploring the influencing factors and coping strategies for Loss-Making Groups under DIP payment in public hospitals.Methods Using grounded theory,semi-structured interviews were conducted at a cardiovascular hospital in Henan Province from July to September 2023.The collected data were organized,coded,and integrated.Results Analysis of 19 interview transcripts yielded 54 initial concepts,13 initial categories,6 main categories and 3 core categories,leading to the construction of an optimization model for DIP loss-making groups in public hospitals.This model encompasses internal hospital control,incentive mechanisms,and support from health insurance policies.Conclusion It is recommended that hospitals enhance diagnostic and cost-control standards for DIP,establish a DIP-oriented performance evaluation system,and ensure reasonable reimbursement through health insurance policies.Additionally,policy measures should encourage innovation in new technologies to maximize resource efficiency and promote sustainable operations.

BACKGROUND: The FAVOR (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients with Coronary Artery Disease) III China trial demonstrated that percutaneous coronary intervention (PCI) lesion selection using quantitative flow ratio (QFR) measurement, a novel angiography-based approach for estimating fractional flow reserve, improved two-year clinical outcomes compared with standard angiography guidance. This study aimed to assess the cost-effectiveness of QFR-guided PCI from the perspective of the current Chinese healthcare system. METHODS: This study is a pre-specified analysis of the FAVOR III China trial, which included 3825 patients randomized between December 25, 2018, and January 19, 2020, from 26 centers in China. Patients with stable or unstable angina pectoris or those ≥72 hours post-myocardial infarction who had at least one lesion with a diameter stenosis between 50% and 90% in a coronary artery with a ≥2.5 mm reference vessel diameter by visual assessment were randomized to a QFR-guided strategy or an angiography-guided strategy with 1:1 ratio. During the two-year follow-up, data were collected on clinical outcomes, quality-adjusted life-years (QALYs), estimated costs of index procedure hospitalization, outpatient cardiovascular medication use, and rehospitalization due to major adverse cardiac and cerebrovascular events (MACCE). The primary analysis calculated the incremental cost-effectiveness ratio (ICER) as the cost per MACCE avoided. An ICER of ¥10,000/MACCE event avoided was considered economically attractive in China. RESULTS: At two years, the QFR-guided group demonstrated a reduced rate of MACCE compared to the angiography-guided group (10.8% vs . 14.7%, P <0.01). Total two-year costs were similar between the groups (¥50,803 ± 21,121 vs . ¥50,685 ± 23,495, P = 0.87). The ICER for the QFR-guided strategy was ¥3055 per MACCE avoided, and the probability of QFR being economically attractive was 64% at a willingness-to-pay threshold of ¥10,000/MACCE avoided. Sensitivity analysis showed that QFR-guided PCI would become cost-saving if the cost of QFR were below ¥3682 (current cost: ¥3800). Cost-utility analysis yielded an ICER of ¥56,163 per QALY gained, with a 53% probability of being cost-effective at a willingness-to-pay threshold of ¥85,000 per QALY gained. CONCLUSION: In patients undergoing PCI, a QFR-guided strategy appears economically attractive compared to angiographic guidance from the perspective of the Chinese healthcare system. TRIAL REGISTRATION ClinicalTrials.gov , NCT03656848.
Humans ; Cost-Benefit Analysis ; Percutaneous Coronary Intervention/methods* ; Male ; Female ; Coronary Angiography/methods* ; Middle Aged ; Aged ; Coronary Artery Disease/surgery* ; Quality-Adjusted Life Years ; Fractional Flow Reserve, Myocardial/physiology*

Operation management is an important tool to promote the high-quality development of public hospitals in China.Since the founding of New China,based on China's economic and social development and medical and health system reform,the evolution of operation management of public hospitals in China can be divided into four stages,the system building stage(1949-1978),the liberalization and revitalization stage(1979-1996),the operation mechanism reform stage(1997-2020),and the new stage of high-quality development(2021 present).The development trend of public hospital operation management in future should deepen the public welfare-oriented public hospital operation management,explore the value-oriented medical operation management model based on high-quality development and the refined operation and management model of public hospitals,so as to promote the high-quality development of public hospitals in China.

Promoting the innovation of the operational assistant service model of public hospitals is an important task to realize the lean operation management of public hospital.Through literature research,four typical operational assistant service models currently implemented in public hospitals in China are summarized:the specialized opera-tional assistant service model,the part-time operational assistant service model,the'team-based'operational assistant service model,and the hybrid financial assistant service model combining full-time and part-time roles.These four models are compared and analyzed from five dimensions:management system,role positioning,per-sonnel composition,selection and training,and service mechanism.Based on this,it is proposed that a new Spe-cialized Multi-Disciplinary Team operational assistant service model should be explored and developed according to local conditions to meet the new requirements for lean operational management and high-quality development of public hospitals in the new era.

Objective To construct a competency modeling index system for operation assistants,and to provide a scientific tool for the selection,training,assessment and evaluation of operation assistants in public hospitals.Methods The job analysis method is used to analyze the job responsibilities and functional positioning of operation assistants;key elements of operation assistant competency are extracted based on the iceberg model,and the competency evaluation indexes are constructed by borrowing thematic group discussion and expert consulting method;the CRITIC weight method is used to determine the weights of each index.Results A competency evaluation index system for operations assistants in public hospitals was established with five dimensions and 19 indicators,including professional knowledge,work skills,coordination ability,behavioral motivation and personal traits.Conclusion The competency evaluation index system for operations assistants in public hospitals constructed in this study is of good scientific quality and can provide a quantitative evaluation tool for realizing job matching.

Under the new situation,the selection of operation assistants in public hospitals is a major measure to improve the level of lean operation management of hospitals,so it is very important to design a scientific and reasonable selection and training mechanism for operation assistants.Through literature research and drawing on the competency model,a tertiary grade A cardiovascular disease hospital was selected as a case study to explore the construction of a selection mechanism from four aspects:selection objects,selection conditions,selection methods and selection criteria.Five training mechanisms were formulated from five aspects:capacity improvement,clinical service,data analysis,evaluation and feedback,and organizational behavior norms,and then it was proposed that attention should be paid to the scientific,feasible,replicable and innovative nature of the selection and training mechanism,so as to build an effective public hospital operation assistant team.

The operation assistant work team of public hospitals is an important bridge and link to realize the integration of industry and finance,and an important practitioner to promote the realization of lean operation management.It examines the service model of the operation assistant team engaged in Similar Multi-disciplinary Treatment,focusing on organizational structure,job responsibilities,and service mechanisms.Build a four-tiered lean operational management system and set up an operation assistant work team that combines production,university and research.Based on specific management matters,establish an operation assistant service mechanism such as problem assessment and classification management mechanism,project standardization management mechanism,reward and punishment assessment mechanism,etc.,to promote the optimization and integration of hospital medical education,research,prevention and management and core elements such as human,talent,material and technology resources.Help public hospitals to continuously improve their lean operation management level.

Objective Exploring the influencing factors and coping strategies for Loss-Making Groups under DIP payment in public hospitals.Methods Using grounded theory,semi-structured interviews were conducted at a cardiovascular hospital in Henan Province from July to September 2023.The collected data were organized,coded,and integrated.Results Analysis of 19 interview transcripts yielded 54 initial concepts,13 initial categories,6 main categories and 3 core categories,leading to the construction of an optimization model for DIP loss-making groups in public hospitals.This model encompasses internal hospital control,incentive mechanisms,and support from health insurance policies.Conclusion It is recommended that hospitals enhance diagnostic and cost-control standards for DIP,establish a DIP-oriented performance evaluation system,and ensure reasonable reimbursement through health insurance policies.Additionally,policy measures should encourage innovation in new technologies to maximize resource efficiency and promote sustainable operations.

Operation management is an important tool to promote the high-quality development of public hospitals in China.Since the founding of New China,based on China's economic and social development and medical and health system reform,the evolution of operation management of public hospitals in China can be divided into four stages,the system building stage(1949-1978),the liberalization and revitalization stage(1979-1996),the operation mechanism reform stage(1997-2020),and the new stage of high-quality development(2021 present).The development trend of public hospital operation management in future should deepen the public welfare-oriented public hospital operation management,explore the value-oriented medical operation management model based on high-quality development and the refined operation and management model of public hospitals,so as to promote the high-quality development of public hospitals in China.