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.

Objective: To evaluate the effects of office blood pressure(OBP)combined with ambulatory blood pressure monitoring(ABPM)on the diagnosis of hypertension. Methods: The residents aged 35-79 years without hypertension history,whose casual OBP were 120~159 mm Hg/80~99 mm Hg,were enrolled from 4 communities of Hangzhou and Zhuji from 2015 to 2018. They were performed OBP measurements on other two days in 4 weeks and ABPM in a week. There were 2 criteria of OBP as elevated OBP on the first day or in 3 different days,and 4 criteria of ABPM as elevated mean BP in 24 hours, daytime, nighttime and either of the above time. Receiver operating characteristic(ROC)curve was employed to evaluate the effects of different OBP criteria combined with ABPM criteria on the diagnosis of masked hypertension(MH)and white-coat hypertension(WCH). Results: Taking 3-day-OBP as a golden standard,the 1-day-OBP with 4 ABPM criteria had the areas under the ROC curve(AUC)of 0.79-0.81,sensitivity of 57.58%-62.77% and specificity of 100.00% in MH;had the AUC of 0.95-0.98,sensitivity of 100.00% and specificity of 88.96%-96.80% in WCH. The Kappa values were all less than 0.6,known as low consistency. Taking either time of ABPM as a golden standard,24 hours,daytime and nighttime ABPM criteria with OBP had the AUC of 0.90-0.92,sensitivity of 79.17%-83.90% and specificity of 100.00% in MH(all Kappa>0.6),when with 1-day-OBP,the Kappa values were all more than 0.8,known as high consistency;had the AUC of 0.95-1.00,sensitivity of 100.00% and specificity of 89.54%-99.37% in WCH,the Kappa values of daytime ABPM were all more than 0.6,known as high consistency. Conclusions If limited by options, 1-day-OBP could be used instead of 3-day-OBP for detection of WCH or exclusion of MH yet with less accuracy; 24 hours or daytime ABPM instead of either time of ABPM was reliable.

Radiation-induced brain injury (RBI) is the most serious complication of head and neck tumor after radiotherapy. The pathogenesis of RBI is complicated, and the clinical course is irreversible, while no effective treatment available. The activation of glial cells is one of the main theories of RBI, and the prevention and treatment of RBI by targeting glial cells is the focus of current research. As a post-transcriptional regulatory factor, microRNA (miRNA) has been confirmed to be involved in regulatingglial cell radiosensitivity, inflammation type transformation, autophagy, exosomatic, long non-coding RNA (lncRNA), circular RNA (circRNA) and other related pathways, thereby mediating the occurrence and development of cascade reaction of inflammatory injury and neurological function repair of central nervous system (CNS) disease. Therefore, the establishment of miRNA - glial regulatory network may provide a new strategy for the prevention and treatment of RBI.

Objective To study the effect of SNORD47 over-expression on proliferation and invasion of U87-epidermal growth factor receptor (EGFR)vⅢ glioma cells. Methods U87-EGFRvⅢ glioma cells at logarithmic phase were assigned into lenti-SNORD47 group, lenti-NC group and blank control group. The recombinant lentiviruses containing lenti-SNORD47 or lenti-NC were transfected into U87-EGFRvⅢ glioma cells of the lenti-SNORD47 group and lenti-NC group, respectively. Forty-eight h after transfection, the SNORD47 expression in the three groups was measured by real time quantitative PCR. Western blotting was used to detect the protein expressions of matrix metalloproteinase (MMP) 2 and MMP9. The proliferation of U87-EGFRvⅢ cells 4, 24, 48, 72 and 96 h after transfection was evaluated by CCK-8 assay and colony formation assay. Transwell assay and wound-healing assay were used to examine the invasion and migration of these cells. Results The SNORD47 expression in the lenti-SNORD47 group was significantly higher than that in the lenti-NC group and control group (P<0.05). The protein expressions of MMP2 and MMP9 in the lenti-SNORD47 group were significantly decreased as compared with those in the lenti-NC group and control group (P<0.05). At 48, 72 and 96 h after transfection, the optical density and number of cloned cells in the lenti-SNORD47 group were significantly decreased as with those in the lenti-NC group and control group (P<0.05). The invasion and migration abilities of U87-EGFRvIII cells in the lenti-SNORD47 group were significantly suppressed as compared with those in the lenti-NC group and control group (P<0.05). Conclusion SNORD47 could inhibit the proliferative and invasive abilities of U87-EGFRvⅢ glioma cells.

Objective To study the effect of exsomes in SH-SY5Y cells after hypoxic ischemia/reperfusion injury.Methods Human umbilical vein endothelial cell hypoxic ischemia/reperfusion (HUVEC I/R) injury models were established,and the exosomes derived from HUVEC I/R were extracted and identified.SH-SY5Y cell hypoxic ischemia/reperfusion injury models (SH-SY5Y I/R) were established,and cells from SH-SY5Y I/R were divided into control group and exosomes-treatedgroup.The proliferation of SH-SY5Y cells was evaluated by CCK-8 assay 24,48and 72 h after cell inoculation.Transwell assay and wound-healing assay were used to examine the invasion and migration.Hochest33258 staining and Flow cytometry were used to monitor the changes of cell cycle and apoptosis.Expressions of Caspase-3,Bax and Bcl-2 were measured by real-time fluorescence quantificative-PCR and Western blotting.Results As compared with those in the control group,the proliferation abilities of SH-SY5Y cells in exosomes-treated group were significantly promoted (48 h:0.70±0.05 vs.0.94±0.08;72 h:0.83±0.05 vs.1.02±0.06),the cell cycle rate of S phase was significantly increased (14.39％±4.11％ vs.20.54％±3.46％),and G0/G1 phase was statistically decreased (71.26％± 5.24％ vs.66.87％±4.23％,P＜0.05).What's more,cell invasive was significantly promoted (44.00±6.56 vs.70.67±6.11),and relative wound injury area was significantly reduced in the exosomes treated group (0.61±0.07 vs.0.52±0.10);significant differences were noted between the two groups (P＜0.05).The mRNA expressions of Bax and Caspase-3 were significantly decreased and the mRNA expressions of Bcl-2 was significantly increased in the exosomes-treated group as compared with those in the control group (P＜0.05).Conclusion HUVEC I/R-derived exosomes play neuro-protective role in human SH-SY5Y cells after hypoxic I/R injury.

Objective To explore the effects of comprehensive health education on glucose control, anxiety and self-management level in patients with type 2 diabetes mellitus in community. Methods A total of 92 outpatients with type 2 diabetes mellitus (T2DM) of Wangkouxincun community in Liaocheng City of Shandong Province were selected by convenience sampling from January 2013 to December 2016. Patients were divided into observation group (n=46, routine health education along with comprehensive health education by the educational form of family-friendly) and control group (n=46, routine health education) with the random number table. This study compared the fasting plasma glucose (FPG), plasma glucose two hours after glucose load (2hPG), glycosylated hemoglobin (HbA1c) and the scores of anxiety and diabetes self-care activities of patients between two groups before and after intervention. Results Before intervention, there was no significant difference in blood glucose levels, the score of anxiety and self-care activities (P>0.05). After intervention, the FPG, 2hPG, HbA1c and the score of anxiety of patients between two groups all decreased; the score of self-care activities increased with significant differences (P<0.05). The FPG, 2hPG, HbA1c and the score of anxiety of patients in observation group after intervention was lower than those in control group along with the score of self-care activities higher than that in control group with significant differences (P<0.05). Conclusions The implementation of comprehensive health education for patients with T2DM in community by nursing care involving health care providers, patients and family members improves the capability of self-management and decreases the blood glucose and anxiety levels. It is worth to be used widely in clinical application.

Objective To investigate the expression of CENP-W in gliomas and its relationship with clinicopathological parameters and prognosis and to explore the effects of centromere protein W (CENP-W)on the invasion of gliomas cells.Methods The expressions of CENP-W in high-grade glioma tissues,low-grade glioma tissues,and adjacent brain tissues were detected by real-time fluorescence quantitative PCR and Western blotting. The correlation of the expression of CENP-W with clinicopathological parameters and prognosis was analyzed statistically.Human gliomas U2 5 1 cells in vitro were transfected with small interfering RNA to downregulate the expression of CENP-W.The invasion and migration capabilities of gliomas cancer cells were assessed by Transwell assays.Results The expression level of CENP-W was significantly higher in glioma tissues than in normal tissues. There was a positive correlation between the three protein expression levels and the pathological grade of gliomas. CENP-W siRNA was successfully transfected into U2 5 1 cells.Compared with those of the cells transfected with the scramble siRNA and control cells,the invasive and migration activities were inhibited in the U2 5 1 cells transfected with CENP-W siRNA.The Kaplan-Meier analysis and Log-Rank test showed significant differences in progress free survival (PFS)between the CENP-W high-expression and low-expression groups.Conclusion The expression level of CENP-W was positively correlated with the pathological grade of gliomas and CENP-W can promote glioma cell invasion.It implicates that CENP-W can be a novel target in gliomas treatment.

Objective To explore the expressions and correlation of RWD containing sumoylation enhancer (RSUME),small ubiquitin-like modifier (SUMO-1),hypoxia inducible factor-1α(HIF-1α)and vascular endothelial growth factor (VEGF)in gliomas of different pathologic grade.Methods We investigated the expression levels of RSUME mRNA,HIF-1α mRNA and VEGF mRNA with reverse transcription-polymerase chain reaction (RT-PCR),and investigated the immunohistochemical staining to determine the expressions of SUMO-1,HIF-1α and VEGF in 63 cases of human gliomas of different pathologic grade and 9 cases of normal brain tissues.We studied its correlation with the pathologic grade and the relationship between the expression of RSUME promoter sumoylation and HIF-1α/VEGF pathway in gliomas.Results There were significant differences (P <0.01)in the expressions of RSUME mRNA,HIF-1αmRNA and VEGF mRNA in glioma tissues.With the increasing degree of pathologic grade in tumor specimens,the expression levels of RSUME mRNA,HIF-1α mRNA and VEGF mRNA increased markedly (P <0.01 ).There was a positive correlation of the expression levels of RSUME mRNA with HIF-1αmRNA and VEGF mRNA.There were significant differences (P <0.01 )in the expressions of SUMO-1,HIF-1αand VEGF in glioma tissues by immunohistochemical staining.With the ascending of pathologic grade of tumor specimens,the expression levels of SUMO-1,HIF-1α and VEGF increased markedly (P < 0.01 ).There was a positive correlation between the expression level of SUMO-1 and HIF-1α(r =0.857,P <0.01).The Kaplan-Meier analysis and Log-rank test showed significant differences in progress free survival (PFS)between the RSUME high-expression and low-expression groups (χ2 =36.032,P <0.01).Conclusion RSUME may enhance HIF-1α/VEGF pathway through sumoylation in gliomas.It implicates that RSUME is related to angiogenesis in gliomas and can promote tumor invasion and progression,indicating that RSUME can be a novel target in gliomas treatment.

AIM:To investigate the effect of RWDD3 gene silencing on the biological characteristics of human glioma U251 cells.METHODS: A lentiviral vector expressing RWDD3 shRNA was constructed and transfeeted into the U251 cells.The expression of RWDD3 at mRNA and protein levels was detected by real-time PCR and Western blot , re-spectively .The cell activity was determined by MTT assay .The colony formation ability was detected by the colony forma-tion assay .The cell proliferation ability was detected by BrdU incorporation assay .The cell invasion and migration were evaluated by Transwell assay .Flow cytometry was used to monitor the changes of cell cycle distribution and apoptosis .RE-SULTS:Recombinant lentivirus was successfully transfected into U 251 cells.Compared with the cells transfected with the scrambled shRNA and control cells, the cell activity, colony formation ability, and the invasive and migratory activities were inhibited, the cell cycle was arrested in G 0/G1 phase, and the apoptosis was increased in the U 251 cells transfected with RWDD3 shRNA ( P <0.05 ) .CONCLUSION: RWDD3 plays a vital role in proliferation and invasion of glioma cells.It may serve as a potential target of gene therapy for glioma .

Objective To explore the diagnostic value of contrast enhanced ultrasound (CEUS) by comparison with enhanced MRI.Methods Thirty-two cases with pancreatic cystic lesions confirmed by surgery or biopsy were enrolled.Ultrasound,CEUS and MRI were applied respectively for the diagnosis of 32 cases.The diagnostic ability of different imaging methods were compared according to pathological results as the gold standard.Results The 32 cases include 8 cases of serous cystadenoma,6 cases of mucinous cystic neoplasm,3 cases of intraductal papillary mucinous neoplasm,4 cases of solid pseudopapillary tumor,3 cases of neuroendocrine tumor,6 cases of pancreatic carcinoma,1 case of cyst and 1 case of inflammatory myofibroblastic tumor.The diagnostic accuracies of ultrasound,CEUS and MRI were 46.88％ (15/32),75.00％ (24/32) and 78.13％ (25/32) respectively.There was no significant difference between the diagnostic accuracies of CEUS and MRI (P =0.768).The diagnostic accuracies of CEUS and MRI were higher than that of ultrasound (P ＜0.05).Conclusions CEUS has obvious superiority over ultrasound in the diagnostic accuracy of pancreatic cystic lesions.The diagnostic ability of CEUS is similar to that of MRI.