Objective To assess the impact of the"one hospital with multiple districts"model on the quality of care and operational efficiency of inpatient surgical services in a tertiary care general hospital.Methods With 2019(before reform)and 2023(after implementation)serving as the observation nodes,the branch hospital district was designated as the intervention group and the main hospital district was allocated tothe control group.An empirical analysis was conducted with the method of Difference-in-Differences(Dl D),and the model robustness was verified by parallel trend test and placebo test.Fourteen core indicators were selected from four dimensions:medical capability,safety management,service efficiency and cost control,to assess the effect.Results After the reform,the medical capabilityindicators and service efficiency indicators were significantly optimized(P＜0.1);the mortality rate,the infection rate in class l incisionand 7-day readmission rate in the safety management indicators were significantly reduced(P＜0.1),but the rate of complications of inpatients undergoing elective surgery was significantly increased(P=0.007);the average hospitalization expenses,the average drug expenses and the average consumable expenses in the cost control indicators were significantly reduced(P＜0.10),and the increase in the average surgery cost was not statistically significant(P=0.765).Conclusion The"one hospital with multiple districts"model has achieved economies of scale through the integration and allocation of resources,improving medical capacity and operational efficiency without negative impact on cost control.

By using a literature review,explores the characteristics,classifications,development trends,and benefits of U.S.multi-hospital systems,with MD Anderson Cancer Center as a case.It offers recommendations for China's multi-campus public hospitals,including clarifying functional roles,enhancing standardized management,advancing information construction,and establishing a flexible management framework.These strategies aim to im-plement an integrated development model,optimize medical resource allocation,and promote balanced regional healthcare services.

By using a literature review,explores the characteristics,classifications,development trends,and benefits of U.S.multi-hospital systems,with MD Anderson Cancer Center as a case.It offers recommendations for China's multi-campus public hospitals,including clarifying functional roles,enhancing standardized management,advancing information construction,and establishing a flexible management framework.These strategies aim to im-plement an integrated development model,optimize medical resource allocation,and promote balanced regional healthcare services.

Objective To assess the impact of the"one hospital with multiple districts"model on the quality of care and operational efficiency of inpatient surgical services in a tertiary care general hospital.Methods With 2019(before reform)and 2023(after implementation)serving as the observation nodes,the branch hospital district was designated as the intervention group and the main hospital district was allocated tothe control group.An empirical analysis was conducted with the method of Difference-in-Differences(Dl D),and the model robustness was verified by parallel trend test and placebo test.Fourteen core indicators were selected from four dimensions:medical capability,safety management,service efficiency and cost control,to assess the effect.Results After the reform,the medical capabilityindicators and service efficiency indicators were significantly optimized(P＜0.1);the mortality rate,the infection rate in class l incisionand 7-day readmission rate in the safety management indicators were significantly reduced(P＜0.1),but the rate of complications of inpatients undergoing elective surgery was significantly increased(P=0.007);the average hospitalization expenses,the average drug expenses and the average consumable expenses in the cost control indicators were significantly reduced(P＜0.10),and the increase in the average surgery cost was not statistically significant(P=0.765).Conclusion The"one hospital with multiple districts"model has achieved economies of scale through the integration and allocation of resources,improving medical capacity and operational efficiency without negative impact on cost control.

Objective To observe the value of nomogram based on enhanced cortical phase CT Radscore combined with CT features for predicting synchronous distant metastasis(SDM)of renal cell carcinoma(RCC).Methods Totally 139 RCC patients from center A were retrospectively enrolled and divided into SDM group(n=46)and non-SDM group(n=93),also classified as training set(n=97)and test set(n=42)at a ratio of 7∶3.Additionally,20 RCC patients from center B were included as validation set(8 cases with SDM and 12 cases without SDM).Radiomics features were extracted and screened based on enhanced cortical phase CT images to calculate Radscore.Multivariate logistic regression analysis was performed to identify independent predictors of RCC SDM among clinical and CT features.Then a logistic regression model was constructed combining Radscore and independent predictors of RCC SDM and visualized as a nomogram.The receiver operating characteristic curve and the area under the curve(AUC)was used to assess the efficacy of the nomogram for predicting RCC SDM.Results The maximum tumor diameter,CT-T stage and perirenal adipose stranding were all independent predictors of RCC SDM(all P＜0.01).Radscore was calculated based on 5 optimal features.The nomogram was constructed based on perirenal adipose stranding,CT-T stage and Radscore.AUC of the model for predicting RCC SDM in training set,test set and validation set was 0.964,0.921 and 0.885,respectively.Conclusion Enhanced cortical phase CT Radscore combined with perirenal adipose stranding and CT-T stage could effectively predict RCC SDM.

ObjectiveTo explore the therapeutic effect and mechanism of the Danhe granules on hypercholesterolemia rats by observing the changes in the efficacy indicators and the levels of proteins related to the cholesterol metabolism pathway in the rats under the intervention of Danhe granules. MethodSD rats were randomly assigned to either the blank group or the model group based on their body weight. The blank group had normal chow diets， while the model group was fed high-fat diets for seven weeks. One week after the establishment of the model， the content of the serum total cholesterol （TC） in the model rats was detected. According to the TC value， the model group was further randomly divided into a control group， pravastatin sodium tablet group（4.02 mg·kg^-1）， Xuezhikang capsule group（0.12 g·kg^-1）， high-dose， middle-dose， and low-dose groups of Danhe granules（4.536， 2.268， 1.134 g·kg^-1）. After grouping the model groups， each treatment group received continuous oral gavage for six weeks， with weekly measurements of body weight and food intake （the difference between feed intake and feed surplus）. Six weeks later， the levels of serum TC， triglyceride （TG）， low-density lipoprotein cholesterol （LDL-C）， and high-density lipoprotein cholesterol （HDL-C） were measured. The liver pathology and lipid droplet distribution were evaluated by hematoxylin-eosin （HE） staining and oil red O staining， with scoring and calculation conducted. Rat liver tissue was collected， and western blot and immunohistochemistry （IHC） were used to detect the expression levels of cholesterol metabolism-related proteins namely phosphorylated adenosine 5'-monophosphate （AMP）-activated protein kinase （p-AMPK）， AMPK， 3-hydroxy-3-methyl glutaryl coenzyme A reductase （HMGCR）， low-density lipoprotein receptor （LDLR）， cholesterol 7α-hydroxylase （CYP7A1）， Acyl-coenzyme A： cholesterol acyltransferase 2 （ACAT2）， and apolipoprotein B （ApoB） in hypercholesterolemia rats. ResultCompared with the blank group， the model group showed a significantly higher level of serum TC （P<0.01）. The TG level had no significant change， and the HDL-C level was significantly decreased （P<0.05）. The liver index， steatosis score， total score of pathological state， and the positive area ratio of oil red O staining were significantly increased （P<0.01）， and the protein expression levels of p-AMPK， p-AMPK/AMPK， LDLR， and CYP7A1 were significantly decreased （P<0.05， P<0.01）， while the protein expression levels of AMPK， HMGCR， and ACAT2 were significantly increased （P<0.05， P<0.01）. Compared with the model group， the TC level in each dose group of Danhe granules was significantly decreased （P<0.05）， and the positive area ratio of oil red O staining in the pravastatin sodium tablet group and medium-dose group of Danhe granules was significantly decreased （P<0.05）. In each administration group， the protein expression levels of p-AMPK and p-AMPK/AMPK were significantly increased （P<0.05， P<0.01）， and the levels of HMGCR and ACAT2 were significantly decreased （P<0.01）. The ApoB level showed a downward trend. The CYP7A1 level in the pravastatin sodium tablet group and each dose group of Danhe granules was significantly increased （P<0.05， P<0.01）， and the LDLR level in the pravastatin sodium tablet group， Xuezhikang capsule group， and high-dose and medium-dose groups of Danhe granules was significantly increased （P<0.05， P<0.01）. ConclusionDanhe granules can reduce serum TC levels and improve hepatic steatosis. It may activate AMPK， down-regulate the expression of HMGCR， and inhibit cholesterol synthesis. It can also up-regulate the expression of LDLR and CYP7A1， promote cholesterol uptake and excretion， down-regulate the expression of ACAT2 and ApoB， reduce cholesterol absorption and assembly of LDL and other lipoproteins， and thus play a role in the treatment of hypercholesterolemia.

Objective To investigate the mechanism of morin-induced autophagy in non-small cell lung cancer A549 cells based on mTOR/STAT3 signaling axis.Methods A549 cells were divided into blank group and 30,60,90,120 and 150 μg·mL-1 of morin groups.After 24,48 and 72 hours of culture,the cell proliferation activity was detected by CCK-8 method,and the cell inhibition rate was calculated.A549 cells were divided into blank group and 30,90,150 μg·mL-1 morin groups.After 14 days of culture,the cell proliferation was detected by colony formation assay.After 24 hours of culture,the cell proliferation ability was detected by BeyoClickTM EdU-488.Apoptosis was detected by flow cytometry;acridine orange staining was used to detect cell autophagy;the formation of autophagosomes was observed by transmission electron microscopy.Western Blot was used to detect the expression levels of apoptosis,autophagy and mTOR/STAT3 signaling axis-related proteins in cells.A549 cells were divided into blank group,blank group + chloroquine(10 μg·mL-1)group,morin(30,150 μg·mL-1)group,morin(30,150 μg·mL-1)+ chloroquine(10 μg·mL-1)group.After 48 hours of intervention,the cell activity was detected by CCK-8 method,and the cell survival rate was calculated.Results Compared with the blank group,the inhibition rate of A549 cells in 60,90,120,150 μ g·mL-1 of morin group was significantly increased after 24 hours of intervention(P＜0.05,P＜0.001).The inhibition rates of A549 cells in 30,60,90,120 and 150 μg·mL-1 of morin groups were significantly increased after 48 and 72 hours of intervention(P＜0.001).The number of A549 cell colonies and the number of green fluorescent proliferation positive cells in the 30,90,150 μg·mL-1 of morin groups were significantly decreased(P＜0.01,P＜0.001),the apoptosis rate was significantly increased(P＜0.01,P＜0.001),and the protein expression level of cleaved-PARP was significantly increased(P＜0.001).The protein expression levels of p-P38/P38 MAPK in A549 cells of 90 and 150 μg·mL-1 of morin groups were significantly increased(P＜0.01,P＜0.001).Different degrees of orange fluorescence appeared in A549 cells of 30,90 and 150 μg·mL-1 of morin groups,and the orange fluorescence of 90 and 150 μg·mL-1 of morin groups was significant.Autophagosomes and autolysosomes appeared in the cytoplasm of A549 cells in 150 μg·mL-1 of morin group,respectively.The protein expression of LC3-Ⅱ in A549 cells of 150 μg·mL-1 of morin group was significantly up-regulated(P＜0.05).The protein expression of Atg16L1-Ⅱ in A549 cells of 90,150 μg·mL-1 of morin group was significantly up-regulated(P＜0.001),and the protein expressions of p-mTOR/mTOR and p-STAT3/STAT3 were significantly down-regulated(P＜0.001).Compared with the morin(150 μg·mL-1)group,the survival rate of A549 cells in the morin(150 μg·mL-1)+chloroquine(10 μg·mL-1)group was significantly increased(P＜0.05).Conclusion Morin can promote the apoptosis of A549 cells and induce autophagy in A549 cells,and the mechanism may be related to mTOR/STAT3 axis.

Objective To observe the value of nomogram based on enhanced cortical phase CT Radscore combined with CT features for predicting synchronous distant metastasis(SDM)of renal cell carcinoma(RCC).Methods Totally 139 RCC patients from center A were retrospectively enrolled and divided into SDM group(n=46)and non-SDM group(n=93),also classified as training set(n=97)and test set(n=42)at a ratio of 7∶3.Additionally,20 RCC patients from center B were included as validation set(8 cases with SDM and 12 cases without SDM).Radiomics features were extracted and screened based on enhanced cortical phase CT images to calculate Radscore.Multivariate logistic regression analysis was performed to identify independent predictors of RCC SDM among clinical and CT features.Then a logistic regression model was constructed combining Radscore and independent predictors of RCC SDM and visualized as a nomogram.The receiver operating characteristic curve and the area under the curve(AUC)was used to assess the efficacy of the nomogram for predicting RCC SDM.Results The maximum tumor diameter,CT-T stage and perirenal adipose stranding were all independent predictors of RCC SDM(all P＜0.01).Radscore was calculated based on 5 optimal features.The nomogram was constructed based on perirenal adipose stranding,CT-T stage and Radscore.AUC of the model for predicting RCC SDM in training set,test set and validation set was 0.964,0.921 and 0.885,respectively.Conclusion Enhanced cortical phase CT Radscore combined with perirenal adipose stranding and CT-T stage could effectively predict RCC SDM.

ObjectiveTo evaluate the effects of dehydrocostus lactone （DL） on the proliferation， apoptosis， and autophagy of human lung cancer cell A549 and to elucidate its related mechanism. MethodThe effect of DL with different concentrations （0， 5， 10， 15， 20， 25 μmol·L^-1） on the proliferation of human lung cancer A549 cells was investigated by cell counting kit-8 （CCK-8）， and its impact on the clonogenic ability of A549 cells was studied by cell clonogenic assay. The concentrations 10， 20 μmol·L^-1 were selected as DL low-dose group and high-dose group. Hoechst 33258 staining and western blot were used to observe the effect of DL on apoptosis of A549 cells. Autolysosomes were detected by acridine orange staining， and the expression level of microtubule-associated protein 1 light chain 3 （LC3） was determined by immunofluorescence and western blot. In addition， the effects of DL in combination with autophagy inhibitors bafilomycin A1 （BAF-A1） or 3-methyladenine （3-MA） on the autophagy of A549 cells was checked by CCK-8 assay. Finally， the role of DL in the regulation of A549 cell signaling pathway was explored by Western blot. ResultCompared with the conditions in the control group， the survival rate of A549 cells in the DL groups （10， 15， 20， 25 μmol·L^-1） was decreased （P<0.01）， and 5 μmol·L^-1 DL could inhibited the formation of A549 clone cells （P<0.01）， indicating that DL could inhibit the proliferation of human lung cancer A549 cells. The number of apoptotic cells was higher in both DL low-dose and high-dose groups than that in the control group， and the expression of apoptosis-related proteins poly （ADP ribose） polymerase （PARP） and B lymphocytoma-2 （Bcl-2）-associated X protein （Bax） were up-regulated （P<0.05， P<0.01）， while the expression of Bcl-2 was down-regulated （P<0.01） in DL high-dose group. The acridine orange staining showed that the orange fluorescence in the DL high-dose group was enhanced compared with that in the control group， indicating that DL could dramatically promote the formation of autolysosomes. Moreover， 20 μmol·L^-1 DL could increase the orange fluorescent particles of LC3 and up-regulated the expression level of LC3 Ⅱ （P<0.01）. After addition of autophagy inhibitors， the sensitivity of A549 cells to the effects of DL was attenuated （P<0.01）， which suggested that autophagy was involved in DL-induced A549 cell death. Compared with the control group， DL high-dose group had increased expression of autophagy-related protein 3 （Atg3） and autophagy-related protein 5 （Atg5） while reduced phosphorylation levels of protein kinase B （Akt）， mammalian target of rapamycin （mTOR） and signal transducer and activator of transcription 3 （STAT3） （P<0.05， P<0.01）. ConclusionDL could activate apoptosis and autophagy to inhibit the proliferation and clonogenic ability of A549 cells via suppressing Akt/mTOR/STAT3 signaling pathway.

Cancer still has elevated morbidity and mortality, which undoubtedly impacts the life quality of affected individuals. Remarkable advances have been made in cancer therapy, although the toxicities of traditional therapies remain an obvious challenge. Dahuang Zhechong Pill (DHZCP), developed by Zhongjing Zhang in the Synopsis of the Golden Chamber, represents an effective anticancer traditional Chinese medicine (TCM). In this review, it was found that DHZCP is therapeutically utilized in liver, lung, gastric, pancreatic and other cancers in clinic. Pharmacological evidence showed that its anti-tumor mechanisms mainly involve induced cell cycle arrest, apoptosis and autophagy, as well as suppressed tumor cell proliferation, obstructed angiogenesis and metastasis, enhanced immunity, and reversal of multidrug resistance. The present review provides a solid basis for the clinical application of DHZCP and may promote the wide use of TCM in clinical antitumor application.