Performance appraisal of public hospitals have given a guidance for the development of public hospitals at all levels.A Class A tertiary hospital reviewed the problems in the development of the hospital at the present stage and focused on the following four aspects:①insufficient fine management;②No clear orientation of discipline development;③The bottleneck of the improvement of medical operation efficiency;④New challenges in the reform of payment mode.The tertiary hospital launched a fine management practice in May 2022,in order to solve the problems by taking the Department of Surgery as a pilot area,laying the foundation for fine management through information system construction,improving the efficiency of medical operation through management process optimization,improving the overall competitiveness of disciplines through the construction of sub-specialty and Discipline Alliance and adjusting the performance appraisal index system to play the role of performance incentives.The measures effectively improve the overall capacity and efficiency of hospital medical services and help the hospital to achieve high-quality development.

Objective To establish an ultra-high liquid chromatography(UPLC)characteristic spectrum of Rheum tanguticum Maxim.ex Balf.water decoction and conduct chemical pattern recognition analysis,and to identify the medicinal materials of different origins and different processed products.Methods:UPLC was adopted to establish the characteristic spectra of 15 batches of Rheum tanguticum Maxim.ex Balf.Cluster analysis combined with principal component analysis was used to analyze their quality.Rhei Radix et Rhizoma from different origins and different processed products of Rheum tanguticum Maxim.ex Balf.were identified.Results:The characteristic spectrum of Rheum tanguticum Maxim.ex Balf.water decoction was established,18 common peaks were identi-fied,and 15 batches of Rheum tanguticum Maxim.ex Balf.were divided into 2 categories according to their origins by cluster analysis.The similarity between 15 batches of samples from different origins and the control spectrum was greater than 0.900.According to OPLS-DA analysis,a total of 6 markers(rhein-8-O-β-D-glu-cosid,resveratrol-4'-O-β-D-(6''-O-D-gallyl)glucopyranside,isolindleyin,rhein,epicatechin-3-O-D-gallate,and catechin)affecting the quality of Rheum tanguticum Maxim.ex Balf.water decoction samples were found.Rhei Radix et Rhizoma from different origins and different processed products of Rheum tanguticum Maxim.ex Balf.can be effectively distinguished.Conclusion:The established characteristic spectrum method is easy to operate and has good repeatability.It can be used for the quality control of Rheum tanguticum Maxim.ex Balf.water decoction,and can provide reference for the formulation of quality standard of formula granules of Rhei Radix et Rhizoma.

Objective:To analyze the prevalence of goiter among children aged 8 to 10 years old in Beijing and study the influencing factors of goiter in children.Methods:In 16 districts of Beijing, each district was divided into 5 sampling districts according to east, west, south, north and middle locations in 2018. One town/street was selected from each sampling district, one primary school was selected from each town/street, and 40 non-boarding students aged 8 to 10 years old were selected from each primary school. The size of thyroid was measured by B-ultrasound method, the volume of thyroid was calculated and whether goiter or not was determined according to the "Diagnostic Criteria for Endemic Goiter". Random urine samples were collected, urinary iodine was detected by arsenic-cerium catalytic spectrophotometry. Height and weight were measured, body mass index (BMI) was calculated, and the correlation of thyroid volume with height and weight was analyzed.Results:A total of 3 268 children were surveyed, in which 154 children with goiter; the goiter rate was 4.7%. The goiter rate in girls [5.7% (93/1 641)] was higher than that in boys [3.7% (61/1 627), χ 2 = 6.694, P < 0.05]. The goiter rates of children aged 8, 9 and 10 years old were 4.3% (15/346), 5.5% (85/1 534) and 3.9% (54/1 388), respectively, there was no significant difference between the ages (χ 2 = 4.544, P > 0.05). The median of urinary iodine in children was 175.3 μg/L, which was in an iodine appropriate level. The thyroid volumes of children aged 8, 9 and 10 years old were positively correlated with height and weight ( r = 0.143, 0.225, 0.323, 0.338, 0.321, 0.346, P < 0.01). Conclusion:The goiter rate of children in Beijing is high, children's thyroid volume is greatly affected by height and weight, and it is recommended to consider the influence of height and weight when study the diagnostic criteria of children's goiter.

Objective:To examine the association between maternal smoking during pregnancy and autism spectrum disorders (ASD) of children through Meta-analysis.Methods:We searched data on relative risk ( RR) and 95 % confidence interval ( CI) on cohort studies published between January 2000 and July 2019 from PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, and Wanfang database. We used Stata software 15.1 to perform the Meta analysis with random effect model applied to pool RRs according to the results of heterogeneity test through subgroup analysis and Meta regression analysis to explore the potential heterogeneity, publication bias and sensitivity. Results:A total of eleven cohort studies involving 1 631 618 samples and 9 276 ASD cases were included in this Meta-analysis. Results showed that maternal smoking was associated with the increased risk of autism spectrum disorder ( RR=1.16, 95 %CI: 1.02-1.32). For subgroup analysis, the pooled RR for prospective studies ( RR=1.16, 95% CI: 1.10-1.23) appeared higher than that in the retrospective studies ( RR=0.92, 95 %CI: 0.83-1.06). The pooled RR for studies with adjusted confounding factors ( RR=1.13, 95 %CI: 1.04-1.23) was higher than that without ( RR=1.12, 95 %CI: 1.04-1.20). In studies that exposure to smoking assessed before delivery, inter-study heterogeneity appeared higher than those after delivery. Sample size and time of assessment on smoking seemed the sources of heterogeneity. No significant publication bias was observed in this study, and the results were quite stable. Conclusions:Maternal smoking was associated with the increased risk of autism spectrum disorder. However, value of the combined effect seemed low. High-quality, large-sample, and prospective cohort studies should be conducted to further verify the causal relationship, based on the correction of potential confounding factors.

Objective To investigate the effects of leptin on Treg cells and the possible mecha-nism. Methods Leptin-deficient ( ob/ob) mice and homologous wild-type mice were used in this study. The percentages of Treg cells in spleen tissues and peripheral blood samples were measured by flow cytometry ( FCM) . Differences in Treg cell functionality were compared between the two groups. Splenic CD4+T cells, separated from the ob/ob mice and the wild-type mice by magnetic beads, were respectively cultured with leptin and anti-leptin neutralization antibody to evaluate the effects of leptin on Treg cells. Quantitative real-time PCR was performed to analyze the expression of Treg cell-related cytokines at transcriptional level. The levels of IL-10 and TGF-β in the supernatants of CD4+T cell culture were measured with Luminex technolo-gy. Results Compared with the wild-type mice, the ob/ob mice showed higher percentages of Treg cells in both peripheral blood samples and spleen tissues [(11. 56 ± 0. 72)％ vs (5. 47 ± 0. 81)％, (10. 16 ± 0.93)％ vs (6.29±0. 69)％]. Treg cells isolated from the ob/ob mice had stronger immunosuppressive effects on the proliferation of effector T ( Teff) cells and the secretion of TNF-α and IFN-γ than those from the wild-type mice [TNF-α:(1. 6±0. 2)％ vs (2. 4±0. 5)％, IFN-γ:(4. 3±0. 3)％ vs (7. 2±1. 2)％]. The percentages of Treg cells were decreased from (12. 2±1. 8)％ to (7. 6±0. 9)％ upon the in vitro treat-ment of CD4+ T cells from the ob/ob mice with leptin and the immunosuppressive effects of Treg cells were also weakened. However, the percentages of Treg cells were increased from (7. 8±0. 85)％ to (13. 1± 1. 5)％ upon the in vitro treatment of CD4+T cells from the wild-type mice with anti-leptin antibody and the immunosuppressive effects of Treg cells were improved as well. Moreover, the expression of Foxp3, IL-10 and TGF-β at transcriptional level and the levels of IL-10 and TGF-β in the ob/ob group were higher than those in the wild-type group. Conclusions Leptin deficiency significantly promoted the generation of Treg cells in mice and resulted in an increased expression of Foxp3, IL-10 and TGF-βat mRNA level and elevat-ed levels of IL-10 and TGF-β. The treatment of CD4+T cells with leptin might inhibit the generation of Treg cells through down-regulating the transcription of Foxp3, IL-10 and TGF-β.

AIM:To study the effect of centromere protein W ( CENP-W) down-regulation on human glioma U87 cells.METHODS:Small interfering RNA ( siRNA) was used to inhibit the expression of CENP-W in the U87 cells. The interference effect of siRNA was evaluated by RT-qPCR and Western blot .The proliferation of the cells was analyzed by MTT assay , BrdU staining and colony formation experiment .Transwell chamber assay was used to detect the invasion a-bility of the cells .The cell migration ability was measured by a scratch test .The changes of the cell cycle distribution and apoptosis were analyzed by flow cytometry .RESULTS:The results of MTT assay , colony formation experiment and BrdU staining showed that the cell proliferation and colony formation abilities in experimental group were significantly lower than those in control group and negative control group .The results of Transwell and scratch experiments showed that the migra-tion and invasion abilities in experimental group were weaker than those in blank control group and negative control group . The results of flow cytometry analysis showed that the cell cycle distribution in experimental group was arrested in G 0/G1 phase .The percentage of apoptotic cells in experimental group was higher than that in control group ( P<0.05 ) .CON-CLUSION:Down-regulation of CENP-W expression inhibits the proliferation , migration and invasion of human glioma cells and promotes the apoptosis of the cells , suggesting that CENP-W may be a potential target of gene therapy for human glioma.

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 observe microstructural changes of white matter in Alzheimer's disease (AD),and to find out the relationship between white matters lesion and declined cognition.Methods Twenty-four AD patients and 24 controls with normal cognition performed diffusion tensor imaging MR scan.Tract-based spatial statistical analysis (TBSS) was used to investigate microstructural change of white matter,and then its correlation with Mini-Mental State Examination (MMSE) scores was analyzed.Results Fractional anisotropy (FA) values were decreased in corpus callosum,fornix,left corticospinal tract,bilateral cerebral peduncle,superior cerebellar peduncle,internal capsule,corona radiata,posterior thalamic radiation,sagittal stratum including inferior longitidinal fasciculus and inferior fronto-occipital fasciculus,external capsule,cingulate gyrns,hippocampus,superior longitudinal fasciculus and uncinate fasciculus,while mean diffusivity (MD) values were increased in fornix,left hippocampus,bilateral internal capsule,corona radiata,posterior thalamic radiation,sagittal stratum including inferior longitidinal fasciculus and inferior fronto-occipital fasciculus,external capsule,cingulate gyrus,superior longitudinal fasciculus,superior fronto-occipital fasciculus and uncinate fasciculus (all P ＜ 0.05,threshold-free cluster enhancement corrected).MMSE scores had a positive correlation with decreased FA values of left sagittal stratum (r =0.535,P =0.007) and negative correlations with increased MD values of left sagittal stratum (r =-0.427,P =0.037),left superior longitudinal fasciculus (r =-0.424,P =0.039) and left uncinate fasciculus (r =-0.505,P =0.012).Conclusions There exist widespread white matter lesions in AD with impairment of white matter connections of intra-and inter-hemispheres.Impaired white matters in left hemisphere may have close relationships with cognition decline.

Objective To investigate the surgical methods and clinical effect of repairing forefoot soft tissue defects with free peroneal artery perforator flap in elderly patients.Methods From June,2011 to April,2015,17 cases of forefoot soft tissue defects repaired with free peroneal artery perforator flap in elderly patients.There were 10 cases of male and female in 7 cases with an average age of 65.8 years old ranging from 60 to 74 years.Causes of injury:traffic accident in 7 cases,heavy crushing in 9 cases,electrical bums in 1 case.Injury part:6 cases on the left side and 11 cases on the right side.Metatarsus and phalanges fracture in 9 cases,tendon injury in 5 cases.Defect area:3.0 cm × 4.0 cm-6.3 cm × 11.2 cm.Results All flaps survived.All wounds were primary healing.Skin graft survived for the foot flap donor site,and no complicated with infection.All patients were followed up from 8 to 36 months with an average of 17.6 months.The appearance of flaps were good,slight bloated.The texture and color of the flaps were close to the recipient site.Flap feel were good.Accortling to (AOFAS)criteria system,the AOFAS score of last follow-up was (77.5±13.2).Excellent in 6 cases,good in 9 cases,fair in 2 cases.VAS score was (2.6±0.4).Conclusion The free peroneal artery perforator flap with the advantages of vascular anatomy constant,blood supply is reliable,thickness moderate,etc.It is a useful clinical method to repair forefoot soft tissue defects in elderly patients.