Objective To investigate the current status,evolving hotspots,and emerging trends in the field of human re-source allocation research in public hospitals,both domestically and internationally,to provide a reference for future research di-rections in China.Methods CiteSpace was used to conduct a visual analysis of the research literature on human resource alloca-tion in public hospitals based on China National Knowledge Infrastructure(CNKI)and the Web of Science(WOS).The analysis encompassed co-authorship,institutional collaboration,keyword co-occurrence and clustering,and burst detection.Results A total of 1 417 Chinese articles and 981 international articles were included.Domestic research in this field focused more on healthcare reform and management,resource allocation,hierarchical diagnosis,and treatment,and informatization and efficiency improvement.On the contrary,international research primarily centered on the employee satisfaction,healthcare system quality,work environment and medical staff.Future trends in domestic research included cost reduction,efficiency enhancement,and a greater emphasis on public welfare in public hospitals,while international research was beginning to explore the influence of polit-ical concepts in this field.Conclusion Compared to international research,domestic research needs to further improve its theo-retical and localized understanding,broaden its research scope,explore the interdisciplinary collaboration opportunities,and delve into research directions such as the application of artificial intelligence and automation technology in healthcare services,management of a diverse workforce,and innovative management techniques and applications.

Objective:To investigate the risk factors of non-alcoholic fatty liver disease (NAFLD) in patients with hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) breast cancer (HR+/HER2-BC) and the impact of NAFLD on the survival of patients.Methods:54 HR+BC patients were enrolled in this study. The liver fat accumulation was examined by magnetic resonance imaging (MRI). The patients were divided into two groups: non-NAFLD and NAFLD. Student's t test or Fisher's test was used to analyze the clinical indicators of the two groups. Logistic univariate and multivariate tests were used to analyze the clinical risk factors related to NAFLD. Receiver operating characteristic curve (ROC curve) was used to further analyze the sensitivity of clinical risk factors to predict the diagnosis of NAFLD. The Disease-free survival (DFS) and Overall survival (OS) of the two groups were analyzed by Log-rank (Mantel-Cox) test. Results:There were 22 NAFLD patients and 32 non-NAFLD patients diagnosed by MRI. Student's t test or Fisher's test showed that BMI, waist circumference, AST, ALT, GGT, TG, LDL and HDL were statistically different between the two groups (all P<0.05). Logistic univariate and multivariate analysis showed that AST ( OR=1.05, 95% CI: 1.02-1.10, P=0.007), GGT ( OR=1.04, 95% CI: 1.01-1.09, P=0.038), TG ( OR=1.03, 95% CI: 1.01-1.06, P=0.011) and HDL ( OR=1.06, 95% CI: 1.01-1.12, P=0.037) were the risk factors associated with NAFLD. ROC curve analysis showed that the combination of AST, GGT, TG and HDL had high sensitivity in predicting NAFLD (AUC=0.869, P<0.05). There was no difference in DFS ( HR=1.830, 95% CI: 0.983-3.409, P=0.057) or OS ( HR=2.482, 95% CI: 0.761-8.093, P=0.132) between the two groups. Conclusion:AST, GGT, TG and HDL are the independent risk factors for NAFLD in HR+BC patients during treatment, but concurrent NAFLD has no significant effect on DFS or OS.

Objective:To investigate the correlation between serum miR-122-5p and FOXO3 levels and osteoporosis (OP) in postmenopausal women with non-alcoholic fatty liver disease (NAFLD) .Methods:The clinical data and serum of 30 postmenopausal women with NAFLD and 48 postmenopausal women with no-NAFLD were collected. The levels of miR-122-5p and FOXO3 in serum were detected by qRT-PCR. Triglycerides, high-density lipoproteins, and low-density lipoproteins were detected by biochemical autoanalyzer. The bone mineral density of lumbar vertebrae 1-4, Wards triangular bone, femoral neck, greater trochanter and total hip was detected by bone mineral density analyzer. The correlation between the above clinical indicators and OP was analyzed.Results:The expression of miR-122-5p in postmenopausal female NAFLD patients (0.76±0.28) was lower than that in non-NAFLD patients (1±0.31) ( t=3.43, P=0.001) . The downstream target gene FOXO3 of miR-122-5p was identified by bioinformatics website analysis. The expression of FOXO3 in postmenopausal female NAFLD patients (1.31±0.30) was higher than that in non-NAFLD patients (1±0.27) ( t=4.73, P<0.001) . Student’ s t test and Logistic regression analysis showed that triglyceride, miR-122-5p and FOXO3 levels were risk factors for NAFLD (all P<0.05) . Pearson correlation coefficient showed that miR-122-5p level was significantly positively correlated with BMD of femoral neck ( r=0.488, P=0.006) , greater trochanter ( r=0.367, P=0.046) and whole hip ( r=0.404, P=0.027) . FOXO3 level was negatively correlated with bone mineral density of femoral neck ( r=-0.445, P=0.014) and whole hip ( r=-0.507, P=0.004) , while other indexes were not significantly correlated (all P>0.05) . Conclusion:Decreased serum miR-122-5p level and increased FOXO3 level in postmenopausal women with NAFLD may increase the risk of OP.

Objective:To determine the epidemiological characteristics of acute aortic dissectionand the negative rate of D-dimer of type A and B acute aortic dissection, and to explore the factors related to the negative rate of D-dimer with onset time≤ 24 h.Methods:The study retrospectively analyzed the age, sex, clinical manifestations, medical history, and laboratory test data of patients with acute aortic dissection in the Emergency Department of Xiangya Hospital of Central South University from September 1, 2017 to August 31, 2020. Exclusion criteria included 1) aortic aneurysm, 2) intermural aortic hematoma, 3) penetrating aortic ulcer, and 4) patients with prior aortic dissection, but no new hairclip was shown on this CTA. Stanford typing was used for aortic dissection. The patients were divided into two groups for analysis: onset time ≤ 24 h and onset time in 1-14 days. All statistical analyses were performed using GraphPad Prism 9. Student t-test was used for normal distribution and Mann-Whitney U test for non-normally distributed continuous variables. Comparisons of ratios between groups were performed using the χ2 test or Fisher's exact test. Binary logistic regression analysis was performed to identify independent factors related to the negative rate of D-dimer. A P<0.05 was considered statistically significant. Results:A total of 352 patients with acute aortic dissection were included in this study. Male patients accounted for 79.26%, patients with a history of hypertension accounted for 70.45%, and the ratio of patients with type A:B acute aortic dissection was 2:3. The overall negative rate of D-dimer was 13.64%. The negative rate of D-dimer of type A acute aortic dissection (7.09%) was significantly lower than that of type B acute aortic dissection (7.09% vs. 18.01%, P=0.004). A total of 17 patients died in the emergency department, with an overall mortality rate of 4.83%. The mortality rate of type A acute aortic dissection patients was significantly higher than that of type B acute aortic dissection ( P<0.05). A total of 235 patients (66.76%) with acute aortic dissection had an onset time of ≤24 h. In the hyperacute phase of ≤24 h, there were no statistically significant differences in sex, age, underlying diseases, and vital signs between the normal and elevated D-dimer groups ( P>0.05). In the laboratory test results, the levels of platelet, blood urea nitrogen, creatinine, lactate dehydrogenase, myoglobin, fibrin degradation product, prothrombin time and international normalized ratio of patients in the normal D-dimer group were significantly lower than those in the elevated D-dimer group ( P<0.05). Binary logistic regression analysis showed that the level of FDP was closely related to D-dimer ( P<0.001). Conclusions:The negative rate of D-dimer of type A acute aortic dissection was significantly lower than that of type B acute aortic dissection, but the mortality rate of patients with type A acute aortic dissection was significantly higher than that of type B acute aortic dissection, and the level of FDP was closely related to D-dimer.

Objective:To explore the nurses' knowledge hiding behavior and its correlation with organizational climate and innovative behavior.Methods:From August to November 2021, 208 registered nurses from Henan Provincial People's Hospital were selected as the research object by convenient sampling. The nurses were investigated with the General Information Questionnaire, Knowledge Hiding Behavior Questionnaire, Organizational Climate Scale for Nursing, and Nurse Innovative Behavior Scale.Results:The score of nurses' knowledge hiding behavior was 18 (13, 26) , the total score of nursing organizational atmosphere was (93.76±15.95) , and the score of nurses' innovative behavior was (34.45±8.39) . The total score of knowledge hiding behavior was negatively correlated with the score of the Organizational Climate Scale for Nursing ( P<0.05) , and was negatively correlated with the innovative behavior of nurses ( P<0.05) , and the differences were statistically significant. Multiple linear regression analysis showed that gender, intimacy and enterprising atmosphere behavior were the influencing factors of knowledge hiding behavior ( P<0.05) . Conclusions:Nurses have knowledge hiding behavior, which is influenced by gender, intimacy and enterprising atmosphere. The knowledge hiding behavior can be reduced by creating a harmonious organizational atmosphere, so as to enhance the innovative ability of nurses, and improve the team fee performance and group competitiveness.

Cholangiocarcinoma (CCA) has emerged as an intractable cancer with scanty therapeutic regimens. The aberrant activation of Yes-associated protein (YAP) and transcriptional co-activator with PDZ-binding motif (TAZ) are reported to be common in CCA patients. However, the underpinning mechanism remains poorly understood. Deubiquitinase (DUB) is regarded as a main orchestrator in maintaining protein homeostasis. Here, we identified Josephin domain-containing protein 2 (JOSD2) as an essential DUB of YAP/TAZ that sustained the protein level through cleavage of polyubiquitin chains in a deubiquitinase activity-dependent manner. The depletion of JOSD2 promoted YAP/TAZ proteasomal degradation and significantly impeded CCA proliferation

Objective:To investigate the clinicopathological features and immunohistochemical phenotypes of hybrid oncocytic/chromophobe tumor (HOCT) of the kidney and its associations with renal oncocytoma (RO) and eosinophilic chromophobe renal cell carcinoma (eChRCC).Methods:A total of 8 HOCT cases were collected from 2008 to 2019 at the Affiliated Hospital of Qingdao University (5 cases) and 971 Hospital of PLA Navy (3 cases), Qingdao, China for morphological studies, immunohistochemical staining and follow-up. The immunohistochemical results of HOCT were compared with those of 27 typical RO and 17 eChRCC.Results:Among the 8 patients, 3 were male and 5 were female. Their ages ranged from 39 to 75 years (median: 56 years). All cases were sporadic. Seven patients were asymptomatic and one suffered from lumbago. During a mean follow-up of 37 months in 7 patients, none of them developed tumor recurrence or metastasis. Seven cases were solitary and one was multiple. The tumor size ranged from 1.4 to 5.7 cm (mean, 3.6 cm). The cut surface of the tumors was dark red or yellowish. Histologically, the tumors were well-defined. Six cases were directly adjacent to the surrounding renal tissue, 2 cases had pseudocapsule, 3 cases showed entrapped renal tubules at the edge of tumor tissue, and one circumscribed with focal infiltrating borders. There were two types of histological morphology: one type (4 cases) was composed of mixed areas of otherwise typical RO and areas resembling chromophobe renal cell carcinoma; another type (4 cases) showed the morphological characteristics of both RO and eChRCC. Three second-type tumors showed nest-like, trabecular, and solid growth patterns with conspicuous edematous stroma. The cell border was conspicuous and the cytoplasm showed an eosinophilic appearance. The nuclei were small and round with clear perinuclear halo. One tumor showed a multi-nodular and solid growth pattern, and the cytoplasm was eosinophilic, hypochromatic or transparent. The nuclei were small and round, and some of them had obvious perinuclear halo. Immunohistochemically, the tumor cells in all 8 cases were positive for Ksp-cad but negative for vimentin. CD117 was diffusely positive in 6/8 cases. CK7 staining showed patchy positivity in 6/8 cases. S-100A1, cyclin D1 and claudin7 showed variable positivity in 4/8, 6/8 and 5/8 cases, respectively, but the range and intensity were narrower and weaker than those in RO and eChRCC.Conclusions:HOCT is a low-grade eosinophilic renal tumor with morphological characteristics resembling RO and eChRCC. The combined application of immunohistochemical stains of CK7, CD117, Ksp-cad, cyclin D1, claudin7 and S-100A1 may play an auxiliary role in the differentiation of the three tumors. HOCT has a good prognosis after surgical resection and can be regarded as a tumor with uncertain malignant potential.

Objective:To investigate the application value of obliquus externus abdominis pedicle flap graft technique in repair of giant abdominal incisional hernia.Methods:The retrospective and descriptive study was conducted. The clinical data of 14 patients with giant abdominal incisional hernia who were admitted to Affiliated Hangzhou First People′s Hospital of Zhejiang University School of Medicine from June 2015 to June 2018 were collected. There were 5 males and 9 females, aged (67±10)years, with a range from 45 to 80 years. All the 14 patients underwent repair of abdominal wall defect and functional reconstruction with obliquus externus abdominis pedicle flap graft technique. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) hernia-related quality of life; (4) follow-up. Follow-up using outpatient examination was performed at postoperative 1 and 12 months, and once a year thereafter to detect the recurrence of incisional hernia or abdominal bulging up to June 2019. Measurement data with normal distribution were represented as Mean± SD, and comparison within groups was analyzed using the paired sample t test. Measurement data with skewed distribution were described as M (range). Count data were described as absolute numbers or percentages. Results:(1) Surgical situations: all the 14 patients underwent repair of abdominal wall defect and functional reconstruction with unilateral obliquus externus abdominis pedicle flap graft technique successfully, and reinforced repair with mesh. All the meshes were standard polypropylene meshes which were placed in the retro muscular or preperitoneal space. The operation time, volume of intraoperative bleeding, mesh size of the 14 patients were (153±34)minutes, (119±59)mL, (450±156)cm 2, respectively. (2) Postoperative situations: the duration of hospital stay of the 14 patients were (14±3)days. Of the 14 patients, 1 had type Ⅲ seroma and was cured after conservative treatment. There were no complications such as ischaemia and necrosis of external oblique muscle flap, incision dehiscence, infection of operation site, intestinal obstruction or intestinal fistula observed in the 14 patients. (3) Hernia-related quality of life: the score of hernia-related quality of life of the 14 patients before operation and at postoperative 12 months were 38±8 and 77±15 respectively, showing a significant difference ( t=12.729, P<0.05). (4) Follow-up: 14 patients were followed up for 12-48 months, with a median follow-up of 16 month. During the follow-up, none of the 14 patients had recurrence of incisional hernia or abdominal wall bulging. Conclusion:Obliquus externus abdominis pedicle flap graft technique can be used for repair of giant abdominal incisional hernia, which will lead to less surgical complications and improve hernia-related quality of life of patients.

Objective:Peripheral nerve invasion (PNI) is associated with local recurrence and poor prognosis in patients with advanced gastric cancer. A risk-assessment model based on preoperative indicators for predicting PNI of gastric cancer may help to formulate a more reasonable and accurate individualized diagnosis and treatment plan.Methods:Inclusion criteria: (1) electronic gastroscopy and enhanced CT examination of the upper abdomen were performed before surgery; (2) radical gastric cancer surgery (D2 lymph node dissection, R0 resection) was performed; (3) no distant metastasis was confirmed before and during operation; (4) postoperative pathology showed an advanced gastric cancer (T2-4aN0-3M0), and the clinical data was complete. Those who had other malignant tumors at the same time or in the past, and received neoadjuvant radiochemotherapy or immunotherapy before surgery were excluded. In this retrospective case-control study, 550 patients with advanced gastric cancer who underwent curative gastrectomy between September 2017 and June 2019 were selected from the Affiliated Hospital of Qingdao University for modeling and internal verification, including 262 (47.6%) PNI positive and 288 (52.4%) PNI negative patients. According to the same standard, clinical data of 50 patients with advanced gastric cancer who underwent radical surgery from July to November 2019 in Qingdao Municipal Hospital were selected for external verification of the model. There were no statistically significant differences between the clinical data of internal verification and external verification (all P>0.05). Univariate analysis and multivariate logistic regression analysis were used to determine the independent risk factors for PNI in advanced gastric cancer, and the clinical indicators with statistically significant difference were used to establish a preoperative nomogram model through R software. The Bootstrap method was applied as internal verification to show the robustness of the model. The discrimination of the nomogram was determined by calculating the average consistency index (C-index). The calibration curve was used to evaluate the consistency of the predicted results with the actual results. The Hosmer-Lemeshow test was used to examine the goodness of fit of the discriminant model. During external verification, the corresponding C-index index was also calculated. The area under ROC curve (AUC) was used to evaluate the predictive ability of the nomogram in the internal verification and external verification groups. Results:A total of 550 patients were identified in this study, 262 (47.6%) of which had PNI. Multivariate logistic regression analysis revealed that carcinoembryonic antigen level ≥ 5 μg/L (OR=5.870, 95% CI: 3.281-10.502, P<0.001), tumor length ≥5 cm (OR=5.539,95% CI: 3.165-9.694, P<0.001), mixed Lauren classification (OR=2.611, 95%CI: 1.272-5.360, P=0.009), cT3 stage (OR=13.053, 95% CI: 5.612-30.361, P<0.001) and the presence of lymph node metastasis (OR=4.826, 95% CI: 2.729-8.533, P<0.001) were significant independent risk factors of PNI in advanced gastric cancer (all P<0.05). Based on these results, diffused Lauren classification and cT4 stage were included to establish a predictive nomogram model. CEA ≥ 5 μg/L was for 68 points, tumor length ≥ 5 cm was for 67 points, mixed Lauren classification was for 21 points, diffused Lauren classification was for 38 points, cT3 stage was for 75 points, cT4 stage was for 100 points, and lymph node metastasis was for 62 points. Adding the scores of all risk factors was total score, and the probability corresponding to the total score was the probability that the model predicted PNI in advanced gastric cancer before surgery. The internal verification result revealed that the AUC of nomogram was 0.935, which was superior than that of any single variable, such as CEA, Lauren classification, cT stage, tumor length and lymph node metastasis (AUC: 0.731, 0.595, 0.838, 0.757 and 0.802, respectively). The external verification result revealed the AUC of nomogram was 0.828. The C-ndex was 0.931 after internal verification. External verification showed a C-index of 0.828 from the model. The calibration curve showed that the predictive results were good in accordance with the actual results ( P=0.415). Conclusion:A nomogram model constructed by CEA, tumor length, Lauren classification (mixed, diffuse), cT stage, and lymph node metastasis can predict the PNI of advanced gastric cancer before surgery.

Objective:To investigate the effectiveness of an enhanced CT automatic recognition system based on Faster R-CNN for pancreatic cancer and its clinical value.Methods:In this study, 4 024 enhanced CT imaging sequences of 315 patients with pancreatic cancer from January 2013 to May 2016 at the Affiliated Hospital of Qingdao University were collected retrospectively, and 2 614 imaging sequences were input into the faster R-CNN system as training dataset to create an automatic image recognition model, which was then validated by reading 1 410 enhanced CT images of 135 cases of pancreatic cancer.In order to identify its effectiveness, 3 750 CT images of 150 patients with pancreatic lesions were read and a followed-up was carried out.The accuracy and recall rate in detecting nodules were recorded and regression curves were generated.In addition, the accuracy, sensitivity and specificity of Faster R-CNN diagnosis were analyzed, the ROC curves were generated and the area under the curves were calculated.Results:Based on the enhanced CT images of 135 cases, the area under the ROC curve was 0.927 calculated by Faster R-CNN. The accuracy, specificity and sensitivity were 0.902, 0.913 and 0.801 respectively.After the data of 150 patients with pancreatic cancer were verified, 893 CT images showed positive and 2 857 negative.Ninety-eight patients with pancreatic cancer were diagnosed by Faster R-CNN.After the follow-up, it was found that 53 cases were post-operatively proved to be pancreatic ductal carcinoma, 21 cases of pancreatic cystadenocarcinoma, 12 cases of pancreatic cystadenoma, 5 cases of pancreatic cyst, and 7 cases were untreated.During 5 to 17 months after operation, 6 patients died of abdominal tumor infiltration, liver and lung metastasis.Of the 52 patients who were diagnosed negative by Faster R-CNN, 9 were post-operatively proved to be pancreatic ductal carcinoma.Conclusion:Faster R-CNN system has clinical value in helping imaging physicians to diagnose pancreatic cancer.