Objective To comprehensively understand the map of transcripts during mitosis and their regulatory mechanisms of HAP 1 cells by conducting transcriptome sequencing analysis after being released by mitotic synchro-nization arrest.Methods HAP1 cells were subjected to mitotic synchronous arrest with nocodazole and samples were collected after 0,20,80 min release,and RNA sequencing(RNA-seq)were performed.The transcriptome data was cleaned and the differentially expressed genes,expression trend clustering and functional enrichment com-bined with the protein interaction network were analyzed to explore the changes of signaling pathways in HAP 1 cells during mitosis.Results The transcriptome of HAP1 cells after synchronous release from mitosis underwent significant changes in time series,and differential gene cluster analysis revealed four gene clusters were enriched in important biological processes such as p53 signaling and cytoplasmic translation.Conclusions The transcriptome time-dependent dynamic changes during mitosis in HAP1 cells are coordinated regulation of key signaling pathways including cellular stress response,translational control and chromatin remodeling,ensuring a balance between growth and stress response upon mitotic exit.

Objective:To assess the validity and applicability of the questionnaires through the survey of patient-perceived service quality at the sample Internet hospital, gain the information of service quality of the Internet hospital and put forward suggestions for its improvement.Methods:Random cluster sampling method was used to conduct an online questionnaire survey on the perceived service quality of an Internet hospital in Beijing from September 15 to October 30, 2022. Altogether 450 valid questionnaires were collected. The questionnaire included 23 questions in 3 categories: environment quality, interaction quality and outcome quality; and it also investigated the patient′s demographic characteristics and chronic disease status. Cronbach′s alpha, Kendall′s W, and Bollen-Stine models were employed to analyze the reliability and validity of the questionnaire, Spearman correlation coefficient and Wilcoxon test were used to analyze the correlation and comparison of quality results, and expectation-performance gap and importance performance analysis methods were applied to analyze quality management issues and improvement priorities. Results:The Cronbach′s alpha of the questionnaire was 0.97, Kendall′s W was 0.36. The Bollen-Stine analysis showed that all the evaluation indicators met the consistency requirements. Taken 7 as the highest score, the overall perception score of the service quality of the Internet hospital was 5.22, the expected score was 5.41, and the difference was -0.19. Among the 23 indicators, 6 indicators had perceived scores exceeding the expected score, and 17 indicators had perceived scores below the expected score. The patient′s satisfaction score of the Internet hospital was 5.29, which was significantly correlated with the perceived score of service quality. The results of expectation-performance gap analysis and importance performance analysis suggested that emergency handling, risk notification, privacy protection, online and offline close combination, etc. should be the focus in the improvement of the Internet hospital′s service quality. Conclusions:The questionnaire of Internet hospital service quality is scientific and applicable, which can serve as references for future related research. The construction and operation of Internet hospitals need to focus on the aging needs, and improve the service quality and satisfaction level by strengthening medical security and information security management, coordinating online and offline medical resources, and improving the number and medical level of physicians.

Objective:To assess the validity and applicability of the questionnaires through the survey of patient-perceived service quality at the sample Internet hospital, gain the information of service quality of the Internet hospital and put forward suggestions for its improvement.Methods:Random cluster sampling method was used to conduct an online questionnaire survey on the perceived service quality of an Internet hospital in Beijing from September 15 to October 30, 2022. Altogether 450 valid questionnaires were collected. The questionnaire included 23 questions in 3 categories: environment quality, interaction quality and outcome quality; and it also investigated the patient′s demographic characteristics and chronic disease status. Cronbach′s alpha, Kendall′s W, and Bollen-Stine models were employed to analyze the reliability and validity of the questionnaire, Spearman correlation coefficient and Wilcoxon test were used to analyze the correlation and comparison of quality results, and expectation-performance gap and importance performance analysis methods were applied to analyze quality management issues and improvement priorities. Results:The Cronbach′s alpha of the questionnaire was 0.97, Kendall′s W was 0.36. The Bollen-Stine analysis showed that all the evaluation indicators met the consistency requirements. Taken 7 as the highest score, the overall perception score of the service quality of the Internet hospital was 5.22, the expected score was 5.41, and the difference was -0.19. Among the 23 indicators, 6 indicators had perceived scores exceeding the expected score, and 17 indicators had perceived scores below the expected score. The patient′s satisfaction score of the Internet hospital was 5.29, which was significantly correlated with the perceived score of service quality. The results of expectation-performance gap analysis and importance performance analysis suggested that emergency handling, risk notification, privacy protection, online and offline close combination, etc. should be the focus in the improvement of the Internet hospital′s service quality. Conclusions:The questionnaire of Internet hospital service quality is scientific and applicable, which can serve as references for future related research. The construction and operation of Internet hospitals need to focus on the aging needs, and improve the service quality and satisfaction level by strengthening medical security and information security management, coordinating online and offline medical resources, and improving the number and medical level of physicians.

Objective:To construct an evaluation index system of perceived service quality for Internet hospitals, and to provide references for scientific evaluation and effective management of such hospitals′ service quality.Methods:Thanks to literature review and expert interviews, an index system was initially built based on the Brady and Cronin model.From August to November 2021, Delphi expert consultation method was used in three rounds of correspondence questionnaire survey, and experts were consulted to assess the importance, familiarity and judgment basis of these indexes. The importance of the indexes was expressed by ± s, and the weight value of each index was calculated using analytic hierarchy process fuzzy comprehensive evaluation method and SPSS Au software. Results:The evaluation index system of perceived service quality for such hospitals included 3 level-1 indexes, namely environmental quality, interaction quality and result quality; and 10 level-2 indexes, namely software platform, service support, social factors, attitude, behavior, professional quality, service effect, service efficiency, service cost, satisfaction; and 30 level-3 indexes. Among these indexes, result quality of level-1 indexes scored the highest weight value(0.337); Software platform, professional quality, service support and attitude of level-2 indexes scored a higher weight values, respectively 0.119, 0.119, 0.109 and 0.109. Of level-3 indexes, reputation of Internet hospitals, service attitude of their doctors and doctor-patient communication skills of doctors online scored a higher weight values, respectively 0.102, 0.057 and 0.055.Conclusions:The index system for Internet hospital perceived service quality evaluation built in this study proved scientific, contributing positively to guiding Internet hospitals to improve their quality and safety management.

Background/Aims: Achalasia is a rare disease, but the incidence is increasing recently. Peroral esophageal myotomy (POEM) is an effective treatment.Regurgitation is a common symptom before and after POEM. Our aim is to investigate the factors related to preoperative and postoperative reflux symptoms. Methods: Our study was retrospective. The achalasia patients diagnosed by high-resolution manometry and gastroscopy were divided into reflux group and non-reflux group before and after POEM, respectively. General information, symptoms, POEM information, and manometric results were compared. Results: (1) Ninety-six of 130 patients had reflux symptoms before POEM. The lower esophageal sphincter pressure (LESP) in the reflux group was significantly higher than the non-reflux group (P = 0.023), while integrated relaxation pressure (IRP) was similar. The reflux group had longer esophagus than the non-reflux group (P = 0.006). Reflux symptoms were not related to subtypes of achalasia.(2) Twenty-five of 84 patients had reflux symptoms after POEM. Postoperative Eckardt scores, LESP, and 4-second IRP (4sIRP) were significantly lower than the preoperative values (P < 0.001). The preoperative values and POEM information were similar between the postoperative 2 groups and there was no significant difference in the presence of preoperative reflux symptoms between 2 groups.The postoperative LESP and 4sIRP were similar between the 2 groups, however, the postoperative UESP was significantly higher in the reflux group than the non-reflux group (P = 0.042). The non-reflux group had more declines in Eckardt scores and LESP than the reflux group. Conclusions The reflux symptoms of achalasia patients without treatment were mainly due to food retention. The postoperative reflux symptoms were not the sign of the excessive relaxation of lower esophageal sphincter.

Background/Aims: Achalasia is a rare disease, but the incidence is increasing recently. Peroral esophageal myotomy (POEM) is an effective treatment.Regurgitation is a common symptom before and after POEM. Our aim is to investigate the factors related to preoperative and postoperative reflux symptoms. Methods: Our study was retrospective. The achalasia patients diagnosed by high-resolution manometry and gastroscopy were divided into reflux group and non-reflux group before and after POEM, respectively. General information, symptoms, POEM information, and manometric results were compared. Results: (1) Ninety-six of 130 patients had reflux symptoms before POEM. The lower esophageal sphincter pressure (LESP) in the reflux group was significantly higher than the non-reflux group (P = 0.023), while integrated relaxation pressure (IRP) was similar. The reflux group had longer esophagus than the non-reflux group (P = 0.006). Reflux symptoms were not related to subtypes of achalasia.(2) Twenty-five of 84 patients had reflux symptoms after POEM. Postoperative Eckardt scores, LESP, and 4-second IRP (4sIRP) were significantly lower than the preoperative values (P < 0.001). The preoperative values and POEM information were similar between the postoperative 2 groups and there was no significant difference in the presence of preoperative reflux symptoms between 2 groups.The postoperative LESP and 4sIRP were similar between the 2 groups, however, the postoperative UESP was significantly higher in the reflux group than the non-reflux group (P = 0.042). The non-reflux group had more declines in Eckardt scores and LESP than the reflux group. Conclusions The reflux symptoms of achalasia patients without treatment were mainly due to food retention. The postoperative reflux symptoms were not the sign of the excessive relaxation of lower esophageal sphincter.

The positive interaction between medical treatment system and medical insurance system is of great significance to promote the reform of medical and health care system. Due to the complexity of the relationship between them, it is difficult to explain it comprehensively with a single theoretical method. The authors analyzed the relationship between medical treatment system and medical insurance system by applying system theory, game theory and synergy theory, and then put forward policy suggestions to optimize the linkage reform of medical treatment system and medical insurance system, so as to better promote the reform of " three medical linkage" and promote the construction of healthy China. The suggestions included optimizing the allocation of health resources, accelerating the construction of medical insurance legislation and health technical evaluation system, strengthening the construction of multi-level medical insurance system, promoting the inter regional information interconnection between medical care and medical insurance, improving the coordination mechanism, negotiation mechanism, incentive and constraint mechanism between medical care and medical insurance.

OBJECTIVE:To establish a method for simultaneous determination of tanshinol,caffeic acid,rosmarinic,salviano-lic acid B,salvianolic acid A,tanshinoneⅠ,cryptotanshinone,tanshinone ⅡA and ursolic acid in Compound xueshuantong cap-sules. METHODS:UPLC-MS/MS method was adopted. The determination was performed on ACQUITY UPLC? BEH C18 column with mobile phase consisted of acetonitrile-0.1%formic acid(gradient elution)at the flow rate of 0.2 mL/min. The column tempera-ture was 40 ℃,and the temperature of injector was 10 ℃. Analysis time was 7 min,and sample size was 5 μL. The electrospray ionization source(ESI)was used;ion source temperature was 150℃;capillary voltage was 3.5 kV;cone flow was 50 L/h;desol-vation temperature was 350 ℃;desolvation gas flow was 650 L/h;nebuliser pressure was 7 × 105 Pa;ion monitoring and multiple reaction monitoring (MRM) was performed. RESULTS:The linear ranges of tanshinol,caffeic acid,rosmarinic,salvianolic acid B,salvianolic acid A,tanshinoneⅠ,cryptotanshinone,tanshinone ⅡA and ursolic acid were 10.0-100.0 μg/mL (r=0.9998), 0.1-1.0 μg/mL(r=0.9998),4.0-40.0 μg/mL(r=0.9999),10.0-100.0 μg/mL(r=0.9999),15.0-150.0 μg/mL(r=0.9997), 8.0-80.0 μg/mL(r=0.9998),10.0-100.0 μg/mL(r=0.9997),50.0-500.0 μg/mL(r=0.9997)and 6.0-60.0 μg/mL(r=0.9998), respectively. The limits of quantitation were 40.0,9.6,38.0,88.0,130.0,39.0,4.4,3.2 and 10.0 ng/mL,separately. The limits of detection were 12.0,3.0,11.0,26.0,39.0,12.0,1.3,1.0 and 3.0 ng/mL,respectively. RSDs of precision,stability and repro-ducibility tests were all lower than 3%. The recoveries were 97.34%-103.20%(RSD=2.19%,n=6),97.22%-102.39%(RSD=2.03%,n=6),98.51%-101.70%(RSD=1.32%,n=6),97.86%-102.49%(RSD=2.09%,n=6),96.75%-103.12%(RSD=2.36%,n=6),98.43%-101.65%(RSD=1.25%,n=6), 97.59%-101.50%(RSD=1.50%,n=6), 96.45%-102.88%(RSD=2.58%,n=6),97.02%-103.11%(RSD=2.38%,n=6),separately. CONCLUSIONS:The method is simple and accurate,and can be used for simultaneous determination of 9 components in Compound xueshuantong capsules.

13th Five-Year period is China's comprehensive completion of the decisive stage of a well-off society,when the development of public hospitals is facing great opportunities and challenges.Five development concepts introduced by the fifth Plenary Session of the 18th CPC Central Committee,offer guidance on public hospital reform and development.Among such concepts,innovation is leading the first power of hospital development;Coordination is the inherent requirements of the hospital' s sustainable and healthy development;Green is a necessary condition for the sustainable development of the hospital,and also an important reflection of the hospital development achievement;Opening is the only way for the rapid development of hospital;Sharing is the essential requirement of hospital development.Five development concepts shall guide the reform and development of Chinese public hospitals during the period of 13th Five-Year.

Implementation of the clinical pathway is key to the ongoing health reform in China. However,the hospital is faced with such hurdles as low incentive among the medical workers,low utilization rate,high pathway-deviation rate among others.Therefore,this paper combined management practices of a tertiary military hospital,analyzed factors influencing its application,and discovered the key factors for the pathway system.Then the corresponding countermeasures were formulated and implemented with significant effects.