As the comprehensive reform of public hospitals enters a more challenging phase,the conventional extensive operation management no longer fulfills the requirements of high-quality development.This article investigates the current challen-ges in hospital operation management under the DIP payment system,proposes an optimized pathway as well as an outline for practical implementation.The proposed pathway suggests implementing a closed-loop resource allocation strategy integrating budg-et and performance based on disease groups and scores,establishing a cost management mechanism for enhancing resource effi-ciency,and development of a performance distribution system for stimulating self-management motivation among personnel.Addi-tionally,the article suggests the establishment of a Management Information System,aiming to provide practical references for en-hancing operational management capabilities in public hospitals under the DIP payment mode.

The establishment of pregnancy depends on the normal function of endometrium. CD55 is up-regulated in the secretory endometrium and reaches the peak during the window of implantation, while abnormal expression of CD55 is associated with recurrent abortion, repeated implantation failure, endometriosis, endometrial cancer and other endometria-related diseases. Besides inhibiting the complement-dependent cytotoxicity as a complement regulatory protein, CD55 in endometrium also plays a role in regulating cell cycle, promoting cell proliferation, inhibiting apoptosis, and promoting cell invasion, migration and adhesion. CD55 can also bind its ligand CD97 as inhibitory signals of T cells and natural killer (NK) cells and participate in promoting cell invasion and migration in non-immune cells. This review summarizes the role of CD55 in endometrium and its potential regulatory mechanism, providing more evidence for exploring the function of CD55 in endometrial receptivity establishment and embryo implantation.

Objective:To explore the influence of anxiety on the quality of life and its associated factors in patients with polycystic ovary syndrome (PCOS).Methods:PCOS patients were enrolled in this cross sectional study in Reproductive Endocrinology, Obstetrics and Gynecology Hospital of Fudan University from May 2019 to January 2022. Anxiety and quality of life were scored for patients diagnosed with PCOS. All patients were divided into PCOS with or without anxiety group. The associated factors of PCOS complicated with anxiety were screened from clinical features, endocrine, ovarian reserve function and metabolic status by logistic analysis and receiver operating characteristic (ROC).Results:Totally 125 PCOS patients were enrolled, of whom 44 were complicated with anxiety. The scores for the quality of life in patients with PCOS and anxiety related to obesity (12.7±1.4 vs. 18.8±0.9, P<0.001), abnormal menstruation (17.9±0.9 vs. 23.2±0.6, P<0.001) and PCOS itself (28.3±1.6 vs. 35.0±0.9, P<0.001) were all lower than those in PCOS patients without anxiety. The body mass index (BMI) [(25.74±0.97) kg/m 2vs. (23.46±0.45) kg/m 2, P=0.038] and area of insulin under the curve (IAUC) [(2 844.28±303.61) pmol/L vs. (1 834.28±147.89) pmol/L, P=0.001] of PCOS patients with anxiety were all higher, while sex hormone binding globulin (SHBG) levels [(33.29±6.21) nmol/L vs. (41.94±4.11) nmol/L, P=0.045] were lower than those without anxiety, and the differences were all statistically significant. Logistic regression analysis screened out the most relevant factor with anxiety in PCOS as IAUC ( OR=1.001, 95% Cl=1.000-1.001, P=0.021) and BMI ( OR=1.113, 95% CI=1.016-1.219, P=0.003). ROC analysis showed that IAUC was an associated factor for PCOS complicated with anxiety, and the area under the ROC curve were 0.701 ( P=0.020). Conclusion:The prevalence of anxiety in PCOS patients is higher than that in the general population. The quality of life is lower in PCOS patients with anxiety than those without. Anxiety may be closely related to weight gain and hyperinsulinemia/insulin resistance in PCOS patients.

The establishment of pregnancy depends on the normal function of endometrium. CD55 is up-regulated in the secretory endometrium and reaches the peak during the window of implantation, while abnormal expression of CD55 is associated with recurrent abortion, repeated implantation failure, endometriosis, endometrial cancer and other endometria-related diseases. Besides inhibiting the complement-dependent cytotoxicity as a complement regulatory protein, CD55 in endometrium also plays a role in regulating cell cycle, promoting cell proliferation, inhibiting apoptosis, and promoting cell invasion, migration and adhesion. CD55 can also bind its ligand CD97 as inhibitory signals of T cells and natural killer (NK) cells and participate in promoting cell invasion and migration in non-immune cells. This review summarizes the role of CD55 in endometrium and its potential regulatory mechanism, providing more evidence for exploring the function of CD55 in endometrial receptivity establishment and embryo implantation.

Objective:To explore the influence of anxiety on the quality of life and its associated factors in patients with polycystic ovary syndrome (PCOS).Methods:PCOS patients were enrolled in this cross sectional study in Reproductive Endocrinology, Obstetrics and Gynecology Hospital of Fudan University from May 2019 to January 2022. Anxiety and quality of life were scored for patients diagnosed with PCOS. All patients were divided into PCOS with or without anxiety group. The associated factors of PCOS complicated with anxiety were screened from clinical features, endocrine, ovarian reserve function and metabolic status by logistic analysis and receiver operating characteristic (ROC).Results:Totally 125 PCOS patients were enrolled, of whom 44 were complicated with anxiety. The scores for the quality of life in patients with PCOS and anxiety related to obesity (12.7±1.4 vs. 18.8±0.9, P<0.001), abnormal menstruation (17.9±0.9 vs. 23.2±0.6, P<0.001) and PCOS itself (28.3±1.6 vs. 35.0±0.9, P<0.001) were all lower than those in PCOS patients without anxiety. The body mass index (BMI) [(25.74±0.97) kg/m 2vs. (23.46±0.45) kg/m 2, P=0.038] and area of insulin under the curve (IAUC) [(2 844.28±303.61) pmol/L vs. (1 834.28±147.89) pmol/L, P=0.001] of PCOS patients with anxiety were all higher, while sex hormone binding globulin (SHBG) levels [(33.29±6.21) nmol/L vs. (41.94±4.11) nmol/L, P=0.045] were lower than those without anxiety, and the differences were all statistically significant. Logistic regression analysis screened out the most relevant factor with anxiety in PCOS as IAUC ( OR=1.001, 95% Cl=1.000-1.001, P=0.021) and BMI ( OR=1.113, 95% CI=1.016-1.219, P=0.003). ROC analysis showed that IAUC was an associated factor for PCOS complicated with anxiety, and the area under the ROC curve were 0.701 ( P=0.020). Conclusion:The prevalence of anxiety in PCOS patients is higher than that in the general population. The quality of life is lower in PCOS patients with anxiety than those without. Anxiety may be closely related to weight gain and hyperinsulinemia/insulin resistance in PCOS patients.

Objective: To evaluate the value of ultrasound-guided fine needle aspiration(US-FNA) combined with detection of BRAF V600E and thyroid imaging reporting and data system(TI-RADS) in diagnosis of benign and malignant thyroid nodules. Methods: In this study, 123 operative thyroid nodules from 114 patients who underwent US-FNA and detection of BRAF V600E were enrolled. TI-RADS was apply for the classification of each nodule before surgery. Specimens from each nodule were subjected for hematoxylin and eosin (HE) staining and cytological diagnosis and detection of BRAF V600E mutation. Results: ①BRAF V600E mutation was found in 71 (71/123) nodules with histologic confirmation of papillary-thyroid carcinoma, 58 of which were cytologically diagnosed as carcinoma and 13 were indeterminate. Compared with the postoperative pathological results, US-FNA combined with BRAF V600E could improve the sensitivity and accuracy of diagnosis to thyroid nodules compared with individual US-FNA, and the difference was statistically significant(P<0.001). ②The mutation rate of BRAF V600E was associated with thyroid capsular invasion(χ²=8.44, P=0.004), and combined with TI-RADS could indicate the high-risk of this invasion. ③Among 123 operative nodules, 18 nodules were BRAF V600E negative and cytologically diagnosed as indetermination, 10 of which were TI-RADS 3b or above. After thyroidectomy, 6 nodules were confirmed as papillary-thyroid carcinoma, 1 nodule was thyroid follicular carcinoma, and 3 nodules were benign ones. Conclusions US-FNA combined with detection of BRAF V600E and TI-RADS can improve the diagnostic accuracy and decrease the misdiagnosis in indeterminate nodules.

Objective To evaluate the immunopotentiating effect of cyclic guanosine monophos-phate-adenosine monophosphate (cGAMP) as an adjuvant on norovirus (GⅡ. 4) virus like particles (VLPs) in the development of norovirus vaccine. Methods BALB/c mice were intramuscularly immunized with norovirus (GⅡ.4) VLPs composed of capsid protein VP1 in combination with cGAMP or Al(OH)3. Norovirus VLPs-specific antibodies in serum were detected by ELISA. A synthetic histo-blood group antigen (HBGA)-VLPs blocking assay was used to analyze neutralizing antibodies against norovirus VLPs in serum samples. Results Immunization with norovirus VLPs in the presence of cGAMP induced a strong humoral immune response in BALB/c mice. Levels of specific IgG antibodies in serum induced by using cGAMP as the adjuvant were significantly higher than those induced by using Al(OH)3adjuvant when immunization of BALB/c mice with the same dosage of VLPs. The antibody level induced by 1 μg of VLPs in combination with cGAMP was equivalent to that elicited by 10 μg of VLPs combined with Al(OH)3adjuvant. Results of the synthetic HBGA-VLPs blocking assay showed that the blocking rate in cGAMP+VLPs immunization group were significantly higher than that in Al(OH)3+VLPs immunization group when using the same dosage of VLPs. No significant difference in blocking rate was observed between cGAMP+VLPs(1 μg) and Al(OH)3+VLPs (10 μg) immunization groups. Conclusion cGAMP significantly enhanced the specific humoral immune response induced by norovirus (GⅡ.4) VLPs in mice as compared with Al(OH)3adjuvant. It might be used as a novel adjuvant to replace the traditional aluminum adjuvant in the development of norovir-us vaccine.

Objective To investigate the physicochemical properties and immunogenicity of virus like particles(VLPs) in two different conformations assembled from the essential capsid protein VP1 of GⅡ.4 norovirus(NoV) in Hansenula polymorpha. Methods NoV GⅡ.4 VLPs in two different conforma-tions were prepared from high-density fermentation of recombinant engineered strains and VLPs purification. Physicochemical properties of the two forms of VLPs were identified by Western blot,size-exclusion high per-formance liquid chromatography (SEC-HPLC), dynamic light scattering(DLS) and transmission electron microscopy. Serum VLPs binding activities and blocking activities against VLPs binding to histo-blood group antigen(HBGA-VLPs) were evaluated after immunization of BALB/c mice with the two forms of VLPs. Re-sults VLPs of two different diameters with high homogeneity were obtained after purification. DLS results showed that particle sizes of two VLPs were 53.98 nm and 45.18 nm,respectively. The two VLPs were sim-ilar in binding abilities to HBGA receptors. Serum VLPs binding activities and blocking activities against HBGA-VLPs were found higher in NoV-VLP-L than NoV-VLP-S,but the difference was not statistically sig-nificant (P>0.05). Conclusion VLPs in two different conformations were obtained by expressing NoV GⅡ.4 VP1 proteins in Hansenula polymorpha. Though they were similar in physicochemical properties and immunogenicity,the NoV-VLP-L might be potential antigen candidates for the development of recombinant human norovirus vaccine.

Objective To evaluate the immune effects of virus-like particles ( VLPs) of VP1 pro-teins derived from norovirus GⅠ. 1 and GⅡ. 4 genotypes expressed in Hansenula polymorpha expression sys-tem. Methods SDS-PAGE and Western blot assay were performed to detect the purity of GⅠ. 1 and GⅡ. 4 VP1 proteins after purification. Morphologies of the recombinant VLPs were observed under transmission electron microscopy ( TEM) . Sizes and distributions of the VLPs were analyzed by dynamic light scattering analyzer. BT50(50% of blocking titer) was detected by HBGA (histo-blood group antigen) blocking assay in BALB/c mice immunized with different regimens. Results SDS-PAGE analysis of the purified recombinant GⅠ. 1 and GⅡ. 4 VP1 proteins showed that their purity were greater than 90%. Western blot assay con-firmed the specific bands of VLPs. TEM images showed that the sizes of purified GⅠ. 1 and GⅡ. 4 VP1 VLPs were at a mean diameter of 30-50 nm with clear border and high homogeneity, which was similar to that of wild virus. BT50 significantly increased in the groups, in which Al( OH) 3 was used as adjuvant. Con-clusion Animal studies have shown that administration of GⅠ. 1 and GⅡ. 4 VP1 VLPs in the presence of Al( OH) 3 induces detectable HBGA-blocking antibody, indicating that GⅠ. 1 and GⅡ. 4 VP1 VLPs are promising candidates for norovirus vaccine.

Objective: To explore the relation of psychological abuse and neglect in childhood and college students’ mental health. Methods: Cluster sampling was used to select 457 college students studying in the Central South University and Hunan Commercial College as subjects. The general information questionnaire,Child Psychological Abuse and Neglect Scale (CPANS) and Symptom Checklist 90 (SCL-90) were completed by all subjects. Results: 45.30% of the respondents experienced psychological abuse or neglect in childhood. The total score and scores of each factor of SCL-90 of the group of psychological abuse combined with neglect was above those of psychological-abuse group,neglect-group and neither-abuse-nor-neglect-group. Additionally,ten factor scores and total score of SCL-90 of neglect-group were distinctly higher than those of neither-abuse-nor-neglect-group. The scores of each aspect and sub-scale of CPANS were significantly correlated with every factor and total score of SCL-90(P