Objective:To evaluate the effect of esketamine on cerebral ischemia-reperfusion (I/R) injury and the association with mitochondrial stress in mice.Methods:The experiment was performed in two parts. Part Ⅰ Eighteen SPF male C57BL/6 mice, aged 8-12 weeks, with body mass index of 28-30 g, were divided into 3 groups ( n=6 each) by a random number table method: sham operation group (S group), cerebral I/R group (IR group), and esketamine plus cerebral I/R group (E+ IR group). Cerebral I/R was produced by occlusion of middle cerebral artery for 1 h followed by 24-h reperfusion in anesthetized mice.Esketamine 10 mg/kg was intraperitoneally injected at 20 min before developing the model in E group. Neurological function was evaluated using the Zea Longa score and balance beam test (Feeney score). The cerebral infarct size was determined by TTC staining. Part Ⅱ Primary cortical neurons were isolated and cultured and then divided into 3 groups ( n=42 each) using a random number table method: control group (group C), oxygen-glucose deprivation-reoxygenation (OGD/R) group, and esketamine plus OGD/R group (group E+ OGD/R). Cells were subjected to O 2-glucose deprivation for 1 h followed by restoration of O 2-glucose supply for 24 h. The cells were treated with 25 μmol/L esketamine for 40 min before preparing the model in E+ OGD/R group. The neuronal viability was measured by the CCK-8 assay. The ultrastructure of neurons was observed with a transmission electron microscope. The levels of reactive oxygen species (ROS), glutathione peroxidase (GSH-px) and malondialdehyde (MDA) were determined, and the mitochondrial membrane potential was determined by JC-1 kit. The neuronal apoptosis was detected by TUNEL staining, and the apoptosis rate of neurons was calculated. The expression of Bax, cytochrome C (CytC), cleaved-caspase-9, caspase-3 and cleaved-caspase-3 was detected by Western blot. Results:Part Ⅰ Compared with S group, the Zea Longa score, Feeney score and cerebral infarct size were significantly increased in IR group ( P<0.01). Compared with IR group, the Zea Longa score, Feeney score and cerebral infarct size were significantly decreased in E+ IR group ( P<0.01). Part Ⅱ Compared with C group, the cell viability and activity of GSH-px were significantly decreased, the apoptosis rate of neurons, levels of ROS and MDA, mitochondrial membrane potential, and cleaved-caspase-3/caspase-3 ratio were increased, and the expression of Bax, Cyt C and cleaved-caspase-9 was up-regulated in OGD/R group ( P<0.01). Compared with OGD/R group, the cell viability and activity of GSH-px were significantly increased, the apoptosis rate of neurons, levels of ROS and MDA, mitochondrial membrane potential, and cleaved-caspase-3/caspase-3 ratio were decreased, and the expression of Bax, Cyt C and cleaved-caspase-9 was down-regulated in E+ OGD/R group ( P<0.01). Conclusions:Esketamine can alleviate cerebral I/R injury in mice, and the mechanism may be related to inhibition of mitochondrial stress in neurons, improvement in mitochondrial function, and inhibition of mitochondria-dependent apoptosis in neurons.

Objective: To analyze the characteristics of the daily exercise load and the One Hour of Moderate to Vigorous Physical Activity (MVPA) per day among primary school students, so as to provide a reference for improving the quality of the physical activity of primary school students in school. Methods: A total of 223 students from an elementary school in Beijing from May to June of 2023, were selected by stratified random cluster sampling method. The Polar Verity Sense heart rate arm band was used to monitor and evaluate the daily exercise load heart rate according to different grades, gender and physical quality. Results: The average heart rate of primary school students in outdoor class, zero point sports, recess and indoor class was (130.01±13.11, 119.89± 16.02,109.96±8.11,96.81±7.89) times/min, respectively, and only 4.04% students met the standard of 1 hour MVPA daily. From the perspective of different grades, the MVPA time ratio of lower grade students in outdoor class, zero point sports and big break was 28.41%, 42.47% and 8.24%, that of middle grade students was 18.33%, 6.41% and 5.90%, and that of senior students was 45.91%, 3.88% and 11.43%. The number of students who achieved 1 hour daily MVPA was 5.41%, 0 and 6.67%. Time ratio of MVPA in outdoor classes, zero hour sports and big breaks accounted for 30.09%, 16.34% and 9.23% for boys, 31.70%, 16.24 % and 6.13% for girls, and the interval distribution of boys and girls who achieved MVPA for one hour per day was 5.88% and 2.86%.Time ratio of MVPA for students with excellent physical fitness were 33.19%, 21.76% and 8.25% in outdoor class, zero point sports and big break, while those with good physical fitness were 29.76%, 12.93% and 8.19%.A total of 21.78%, 5.99% and 4.80% of the students passed the physical fitness test, and the number of students with excellent, good and passed the physical fitness test who achieved the daily 1 hour MVPA was 5.88%, 3.77% and 0. Conclusion In the present study, elementary and middle school students time for in school physical activity was adequate, but there are problems of low loading intensity and insufficient time for MVPA. It is necessary to arrange targeted physical activity programs for students of different grades, genders and physical fitness levels to increase the daily exercise load of students in school.

Objective:To evaluate the role of autophagy in morphine preconditioning-induced reduction of oxygen-glucose deprivation and restoration (OGD/R) injury in primary cortical neurons of mice and the relationship with c-Jun N-terminal kinase (JNK).Methods:Primary cortical neurons extracted from C57BL/6 neonatal mice within 24 h after birth were divided into 9 groups ( n=24 each) using a random number table method: control group (C group), OGD/R group, morphine preconditioning group (M group), autophagy inhibitor 3-methyladenine (3-MA) group (3-MA group), 3-MA+ morphine preconditioning group (3-MA+ M group), autophagy inhibitor chloroquine group (Ch group), chloroquine + morphine preconditioning group (Ch+ M group), JNK inhibitor SP600125 group (SP group) and SP600125 + morphine preconditioning group (SP+ M group). Morphine preconditioning: morphine was added at a final concentration of 3 μmol/L before OGD/R, and the cells were incubated for 2 h in OGD/R group. In 3-MA, Ch and SP groups, 3-MA 5 mmol/L, chloroquine 50 μmol/L and SP600125 25 μmol/L were added, respectively, and the cells were incubated for 150 min. In 3-MA+ M, Ch+ M and SP+ M groups, 3-MA 5 mmol/L, chloroquine 50 μmol/L and SP600125 25 μmol/L were added, respectively, at 30 min before morphine preconditioning. Then the cells were subjected to oxygen-glucose deprivation for 1 h followed by restoration of oxygen-glucose supply for 24 h. CCK-8 assay was used to detect the neuronal viability. The expression of JNK, phosphorylated JNK (p-JNK), microtubule-associated protein 1 light chain 3 (LC3), p62, Beclin1, caspase-3, and cleaved-caspase-3 was determined by Western blot. The autophagosomes and autolysosomes were counted using LC3-double fluorescent adenovirus transfection, and the neuronal apoptosis rate was determined by TUNEL staining. Results:Compared with C group, the neuronal viability was significantly decreased, the expression of Beclin1 was up-regulated, the expression of p62 was down-regulated, and the LC3Ⅱ/LC3Ⅰ ratio, p-JNK/JNK ratio, the number of autophagosomes and autolysosomes, cleaved-caspase-3/caspase-3 ratio and neuronal apoptosis rate were increased in OGD/R group ( P<0.001). Compared with OGD/R group, the neuronal viability, p-JNK/JNK ratio, LC3Ⅱ/LC3Ⅰ ratio and the number of autophagosomes and autolysosomes were significantly increased, the expression of Beclin1 was up-regulated, and the expression of p62 was down-regulated in M group, the LC3Ⅱ/LC3Ⅰ ratio was significantly decreased, and the expression of p62 was down-regulated in 3-MA group, the LC3Ⅱ/LC3Ⅰ ratio was significantly increased, and the expression of p62 was up-regulated in Ch group ( P<0.001), and no significant change was found in the parameters mentioned above in SP600125 group ( P>0.05). Compared with M group, the neuronal viability was significantly decreased, the LC3Ⅱ/LC3Ⅰ ratio was decreased, and the expression of p62 was up-regulated in M+ 3-MA group, the neuronal viability was significantly decreased, the LC3Ⅱ/LC3Ⅰ ratio was increased, and the expression of p62 was up-regulated in M+ Ch group, and the neuronal viability, LC3Ⅱ/LC3Ⅰ ratio and p-JNK/JNK ratio were significantly decreased, the expression of p62 was up-regulated, the number of autophagosomes and autolysosomes was decreased, the expression of Beclin1 was down-regulated, and the cleaved-caspase-3/caspase-3 ratio and neuronal apoptosis rate were increased in M+ SP group ( P<0.001). Conclusions:Morphine preconditioning can attenuate OGD/R injury by activating JNK, enhancing autophagy and inhibiting apoptosis in primary cortical neurons of mice.

Objective:To analyze the impact of the national tertiary public hospital performance assessment(hereinafter referred to as the national examination) on the functional orientation of the provincial public hospitals in Zhejiang province, for reference to improve the allocation of provincial medical resources and high-quality development of public hospitals.Methods:The data came from the hospital financial data of 17 provincial tertiary public hospitals in Zhejiang province from 2012 to 2021 and the DRG quality performance analysis report of the tertiary hospitals in Zhejiang province from 2020 to 2021. The information of the number of employees and actual number of beds at the end of the period, etc., were extracted to analyze the overall operation of the hospital. The ratio of outpatient times to discharged times and the proportion of discharged patients undergoing surgery, as well as the proportion of discharged patients′ day surgery and level-4 surgery in hospital and in province were took as evaluation indicators to analyze the functional positioning of tertiary public hospitals.Results:Compared with 2012 to 2018, the average number of employees at the end of the period and actual number of beds in 17 hospitals from 2019 to 2021 increased by 761 and 303 respectively, and the average number of hospitalization days decreased by 2.26 days. The average ratio of outpatient times to discharged times in the hospital decreased from 175.76 in 2012 to 67.51 in 2021. The average proportion of discharged patients undergoing surgery in general hospitals increased from 0.39 in 2012 to 0.46 in 2021, and that in non-general hospitals decreased from 0.67 to 0.43. The average proportion of discharged patients undergoing day surgery in hospital and in province increased from 0.20 and 0.03 in 2020 to 0.23 and 0.04 in 2021 respectively, and the average proportion of discharged patients undergoing level-4 surgery in province increased from 0.04 to 0.05.Conclusions:The national examination could be conducive to strengthening the functional orientation of public hospitals. After the national examination, the ratio of outpatient times to discharged times in the provincial tertiary public hospitals in Zhejiang province had declined as a whole, the proportion of discharged patients in general hospitals had increased, but the proportion of level-4 surgery in hospitals needs to be further improved. The author suggested that we should continue to strengthen the operation mechanism of functional positioning of provincial public hospitals, improve the service capacity of hospitals for difficult and critical diseases, and improve the performance evaluation system of tertiary public hospitals.

Objective To analyze the economical operation and technical efficiency of Zhejiang provincial hospitals, and give references for deepening public hospitals reform.Methods We compiled data from 17 provincial public hospitals from 2013 to 2017 in Zhejiang, then used descriptive analysis to study hospitals′operating performance, and used stochastic frontier analysis( SFA) to analyze hospitals′ technical efficiency.Results From 2013 to 2017, the 17 provincial hospitals′ annual growth rate of outpatients and discharges were 5.2% and 9.5% , the number of outpatients and discharges at the general hospitals were 1.8 times and 2.5 times of those in specialized hospitals respectively.In these hospitals, service efficiency had been improved, and the income structure had become more reasonable.However, internal and external factors of the hospitals lowered technical inefficiency in their economic operation. Conclusions The economic operation mechanism of provincial hospitals should be further strengthened, and their external environment be improved as well.Only in this way can the hospitals achieve their operational goal of " doing the right thing and in the right way".

Objective To establish a set of operational status assessment indicators to meet the needs of informationized hospital management.Methods Assessment indicators were selected and weights were set respectively through literature review,field interview,and questionnaire survey.Six target dimensions were key performance indicators medical business,operational performance,cost control,medical insurance,balance and risk management,and development capability.Thus a set of operational status evaluation indicators was established in IT means,and based on the informationization level of a tertiary A general hospital in Zhejiang province.Results In the principle of public welfare,objectivity,effectiveness and prospectiveness,we analyzed and sorted out relevant data in the current hospital informationization,identifying six quantitative indicators,15 level-1 indicators,and 86 level-2 indicators.Conclusions It is feasible to build a set of assessment indicators for hospital operation and management in view of both technology and methodology.

Large medical equipments feature complex technology,high investment and operational costs,bearing major impacts on medical expenses.Curbing overinvestment and excessive growth of such expenses at public hospitals hence becomes one of the government key goals in regulatory control for these equipments.Based on data of provincial hospitals in Zhejiang and core variants as regulatory measures for large medical equipments,the authors came to important findings.For example,when such influencing factors as the supplier and customer characteristics of provincial public hospitals,and the equipment investment and medical expenses of other public hospitals are under control,the administrative licensing control of such equipments can lower the investment of medical equipments and medical expenses by 32.2％ and 78.2％ respectively,in comparison with the approval mechanism.It is therefore important to strengthen the regulation on large medical equipments at provincial level,and encourage human capital investment of public hospitals with service quality as orientation.These efforts can lower excessive supply of medical technology of provincial hospitals,and help the government to improve its regulatory effects for large medical equipments.

Objective To learn the remuneration and pay expectations of doctors, for practical basis of the dynamic salary adjustment mechanism for doctors. Methods A questionnaire survey was made in October-November of 2017, on the remuneration level of 20 public hospitals in Zhejiang province and influencing factors. The survey covered such aspects as remuneration level, pay satisfaction, expected pay and pay constitutes. The data so acquired were subject to descriptive statistics. Results The remuneration of residents, attendings, associate chief physicians and chief physicians at these hospitals averaged 135 000, 187 000, 245 000, and 324 000 respectively in 2016. 60.1% of the doctors held the value of technical service, workload, performance appraisal and academic titles as key components for doctors' remuneration appraisal in the future. Conclusions It is recommended to optimize doctors' remuneration structure as guided by knowledge-based value, establish a dynamic adjustment mechanism based on social average pay and reasonable price relations, to conduct scientific performance appraisal, enhance resource use efficiency, and reform the current performance system, so as to realize the value of doctors.

The paper reviewed the history of drug price addition system and its impact on hospital management. Based on such facts,authors stated that the significance of abolishing drug price addition helped hospital management not to run their hospitals as a business, helped medical practitioners to make their clinical decisions based on medical needs, and to make the health care service deserve the professionals′value and contributions. Following the abolishment, the hospitals need to reform their internal operating mechanisms before they can achieve better performance.

Objective To investigate the role of GABAAα3and GABAB receptors in the ventrolateral periaqueductal gray in the development of paw acute pain in rats.Methods Twelve male SD rats, weighing 280~320 g, were randomly divided into two groups: normal saline group (group NS), formaldehyde-induced pain group (group F), 6 rats in each group.In group F, rats were subcutaneously injected with 2% formaldehyde 50 μl into the ventral surface of right hind paw to induce periphery inflammatory pain.In group NS, rats were subcutaneously injected with normal saline into the ventral surface of right hind paw.Mechanical threshold was assessed using von Frey hairs for every ten minutes.The rat pain behavior scores were recorded for every five minutes.The thickness of skin and skin temperature were recorded for every fifteen minutes.Results Mechanical hyperalgesia were induced in group F after formalin injection into right hind paw.Compared with group NS, rat pain behavior scores were increased significantly in group F at all time points after injection, mechanical threshold were decreased significantly in group F at 10-60 min after injection, the temperature of the skin and the skin thickness were increased significantly in group F at 15-60 min after injection (P<0.05), the levels of the expression of GABAAα3 and GABAB were significantly increased in group F (P<0.05).Conclusion GABAAα3and GABAB receptors mediates formalin-induced hyperalgesia at ventrolateral portion of the PAG (vlPAG) of rats.