High-quality hospital development calls for high-quality hospital culture.Hospital culture is the core of hospi-tal management,which deeply affects the development direction and operation mode of the hospital,throughout the whole process of high-quality development of the hospital,but also an indispensable component of social culture.This paper discusses and con-siders the definition and value of hospital culture,the dilemma of the ideological level and management level of hospital culture construction,and countermeasures,which provides a reference for hospital management and promotes the high-quality develop-ment of hospitals.

Objective To explore the safety and efficiency of robot-assisted laparoscopic resection of pediatric adrenal region masses.Methods Six cases with adrenal region mass underwent robot-assisted laparoscopic adrenalectomy(RALA)from October 2019 to March 2022 in our hospital by using the da Vinci Robotic Surgery System.The patient was routinely placed in the 60°position on the healthy side.Two robotic arms were used to operate,and additional auxiliary operation holes were added as needed.The tumor was revealed by the combination of sharp and blunt separation,and the tumor trophoblastic vessels were identified.The tumor vessels were isolated by clamping with silk wire or biological clips.The tumor was fully freed and excised completely.Smaller specimens were removed by a slightly enlarged operation hole,and larger specimens were removed by another incision in the lower abdomen.Results All the 6 cases of procedures were successfully performed without conversion to open surgery.The operative duration was 90-240 min(mean,133.3 min),and the blood loss was 15-50 ml(mean,31.7 ml).In 2 cases,the drainage tube was not placed.In the remaining 4 cases,the indwelling time of the drainage tube after surgery was 4-8 d(mean,5.5 d).The postoperative hospital stay was5-15 d(mean,8.7 d).There were no complications except for one patient with postoperative bleeding.All the patients were followed up for 10-24 months(mean,16.7 months).CT examinations showed no recurrence of tumors.Conclusion Robotic-assisted laparoscopic resection of pediatric adrenal region masses is safe with satisfactory results.

Objective:To explore the protective effect and underlying mechanism of hyperbaric oxygen (HBO) on delayed encephalopathy after carbon monoxide poisoning (DEACMP) in mice.Methods:Totally 225 adult male Kunming mice were selected to establish CO poisoning model via intraperitoneal injection carbon monoxide (CO), and were randomly divided into the air control group, CO poisoning group, and HBO group. Each group was further divided into five time points group, that was 1, 3, 7, 14 and 21 d. The mice in the air control group were injected intraperitoneally with the same amount of air, and the HBO group received HBO treatment at the same time every day. DEACMP mice model was screened by behaviors using the open field test, new object recognition test and nesting test, and the content of myelin basic protein (MBP) were assayed. The mouse brain tissue and mitochondrial were prepared and malonialdehyde (MDA) and adenosine triphosphate (ATP) content were measured with ultraviolet spectrophotometer. MBP content in brain tissue and cytochrome C (CytC) content in the mitochondrial were measured by ELISA. The mitochondria membrane potential (MMP) was measured by flow cytometry.Results:Compared with the air control group, the content of carboxyhemoglobin (COHB) in blood increased significantly and the content of MBP in brain tissue decreased significantly in CO poisoning mice. CO poisoning mice showed motor ability and cognitive dysfunction. Compared with the air control group, the contents of MMP, CytC and ATP were significantly decreased ( P<0.01) in the CO poisoning group; while the MDA content was significantly increased ( P<0.01). Compared with the CO poisoning group, mice behaviors were improved significantly ( P<0.05), the content of MBP, MMP, CytC and ATP were increased ( P<0.05), while the MDA content decreased significantly ( P<0.01) in the HBO group. Conclusions:The abnormal mitochondrial function might be closely related to the occurrence and development of DEACMP, and HBO therapy plays an effective role in preventing and treating the DEACMP mice model via the mitochondrial pathway.

【Objective】 To investigate the penile appearance, sexual function, psychological status and related influencing factors of adult patients who underwent hypospadias repair surgery in their minors, so as to provide reference for the diagnosis, treatment and prognosis of hypospadias. 【Methods】 This study included 50 adult hypospadias patients who underwent urethroplasty in our hospital during May 2005 and Aug. 2018. The present appearance, sexual function and psychological status were evaluated. The correlation and consistency between hypospadias objective scoring evaluation (HOSE) and pediatric penile perception score (PPPS) were analyzed. Factors affecting the results were determined with univariate and multivariate regression analysis. 【Results】 The satisfaction rate of HOSE was significantly correlated with the urethral length and complications (P=0.024, P=0.033). The satisfaction rate of PPPS was significantly correlated with the number of urethral operations and postoperative complications (P=0.041, P=0.023). There was a weak correlation between HOSE and PPPS (r=0.291, P=0.040), but almost no consistency (Kappa=0.2, P=0.107). Sixty percent of the patients paid attention to the ventral appearance of penis, whose dissatisfaction rate of PPPS was higher than those who did not pay attention to the ventral appearance of the penis (19/30 vs. 6/20, P=0.021). Patients with multiple operations (>1), postoperative complications or unsatisfactory penile appearance were more likely to have inferiority complex (52.6% vs. 22.6%, P=0.029; 59.1% vs.14.3%, P=0.001;61.5% vs. 24.3%, P=0.015). Multivariate regression analysis showed that dissatisfaction with the appearance of the penis was an independent risk factor for patients’ perception of their own physical defects. Among the patients who believed that they had physical defects, the percentage of patients with grade IV penile erectile hardness was significantly lower than that of those who denied they had physical defects (9/17 vs. 27/33, P=0.047). 【Conclusion】 The undesirable postoperative penis appearance is likely to have a negative impact on patients’ long-term psychological state, which might further damage the sexual function in adulthood. Surgeons should pay attention to the penile appearance during the conduction of hypospadias repair.

Objective:This study aims to explore the possible development path of hospital research assistants in China based on the cognition of the demand and management status quo from research management personnel in tertiary hospitals.Methods:62 scientific research management personnel from all over the country were surveyed, data about their cognition and the current status of scientific research assistants, that including the willingness of employ, position cognition, eligibility and competence, quantity and efficiency, management implementation, influencing factors and difficulties in team development, were collected and analyzed. Regarding to the practical needs and management status, the results were described by frequency, percentage and average score, and the rank sum test was used to verify whether there was any difference in the employment intention between the management department and the project team in the cognition of the survey subjects.Results:From the perspective of scientific research managers, there is a strong willingness at hospital level to employ the research assistant, positions require applicants with bachelor′s degree or above in medicine or other related majors. The most urgent needs are management of project funds, equipment and consumables, research integrity and ethics.The interviewees who work with research assistants think that the effect of research assistants on improving scientific research efficiency is obvious.However, the percentage of formulation of research assistants management measures is less than 40%, and the percentages of uniformly organized training and assessment are relatively low. There are still problems and challenges, such as incomplete cognition of the positioning and function, incomplete functional and vocational system, imperfect incentive mechanism and insufficient support for ability cultivation and improvement.Conclusions:It′s necessary to strengthen the top-down design of the development of scientific research assistant team and the construction of career system, improve the management basis and implementation mechanism, supporting resources should be in place, and promote capacity building system in order to develop a long-term mechanism of mutual promotion between the team building of scientific research assistants and the innovation of hospital scientific research management.

Immunoproteasome is a variant of proteasome with structural differences in 20S subunits optimizing them for the production of antigenic peptides with higher binding affinity to major histocompatibility complex (MHC)-I molecules. Apart from this primary function in antigen presentation, immunoproteasome is also responsible for the degradation of proteins, both unfolded proteins for the maintenance of protein homeostasis and tumor suppressor proteins contributing to tumor progression. The altered expression of immunoproteasome is frequently observed in cancers; however, its expression levels and effects vary among different cancer types exhibiting antagonistic roles in tumor development. This review focuses on the dichotomous role of immunoproteasome in different cancer types, as well as summarizes the current progression in immunoproteasome activators and inhibitors. Specifically targeting immunoproteasome may be a beneficial therapeutic intervention in cancer treatment and understanding the role of immunoproteasome in cancers will provide a significant therapeutic insight for the prevention and treatment of cancers.

Background::The APPEC study is a large-population randomized controlled trial in China evaluating the role of low-dose aspirin prophylactic treatment for pre-eclampsia. There was no statistically significant difference in postpartum hemorrhage (PPH) incidence between the aspirin and control groups. This study aimed to evaluate the potential bleeding risk of 100 mg aspirin in high-risk pregnant women and the difference in the incidence of PPH according to maternal characteristics.Methods::This is a secondary data analysis of the APPEC study. Platelet counts and coagulation test results were collected at five follow-up visits. Subgroups defined by maternal age (<35 years and ≥35 years), pre-pregnancy body mass index (pre-BMI, <28 kg/m 2 and ≥28 kg/m 2), parity, gestational age at enrollment, and medical history, including pre-eclampsia, chronic hypertension, and diabetes mellitus, were analyzed. Logistic regression analysis was used to determine the statistical significance of the difference in the incidence of PPH after aspirin administration in pregnant women in each subgroup. Adjustment using multiple logistic regression models followed these analyses. Binary logistic regression was used to determine the relationship between pre-BMI and PPH. Results::There was no significant difference between the aspirin and control groups in bleeding risk (3.4% [16/464] vs. 3.0% [13/434], T = 0.147, P = 0.701). No significant difference was found in the incidence of PPH in total (relative risk = 1.220, 95% confidence interval [CI] = 0.720–2.067, P = 0.459; aspirin group vs. control group, 6.5% [30/464] vs. 5.3% [23/434], P = 0.459) or in subgroup analysis. A significant correlation between pre-BMI and PPH was found in the aspirin group, while in the control group there was no significant correlation (aspirin group, odds ratio [OR] = 1.086, 95% CI = 1.004–1.175, P = 0.040; control group, OR= 1.060, 95% CI = 0.968–1.161, P = 0.209). Conclusions::A dosage of 100 mg of aspirin per day, initiated from 12 to 20 gestational weeks until 34 weeks of gestation, did not increase the risk of potential bleeding and PPH regardless of the maternal characteristic. In the aspirin group, the positive correlation between BMI and PPH was significant.Trial Registration::ClinicalTrials.gov, NCT01979627.

【Objective】 To develop and verify high performance liquid chromatography (HPLC) detection for tromethamine (Tris) residues in human coagulation factor Ⅷ. 【Methods】 Alanine was used as internal standard, and AQC for pre-column derivation. Inertsil^® ODS-SP was adopted, and acetic acid-sodium acetate buffer and acetonitrile were used for gradient elution at the flow rate of 1 mL/min and column temperature of 37℃. The 25 μL sample was loaded and determined by UV-detector with detection wavelength at 248 nm. This method was then verified. 【Results】 Glycine, sodium citrate and calcium chloride showed no interference with the detection of tromethamine (Tris) residues. The recovery rate of spike samples was within 90.0%~100.8%. The RSD in repeatability test were 2.5%, 0.7% and 1.2%, respectively, and in intermediate precision test 0.8%. The tromethamine (Tris) at concentrates of (0.5~4.0)μg/mL showed good linear relationship to the peak area to internal standard, of which the regression equation was Y=0.012 9X-0.000 782, R=0.999 97.The quantitative detection limit was 0.04μg/mL. 【Conclusion】 The HPLC for determination of tromethamine (Tris) residues in human coagulation factor Ⅷ was successfully developed, which showed good linearity as well as high specificity, precision and accuracy.

Objective:To summarize our preliminary experience of the individual transurethral en bloc resection of bladder tumor (ERBT) based on vesical imaging-reporting and data system (VI-RADS).Methods:The clinical data of 32 bladder cancer patients admitted from January 2019 to October 2019 were retrospectively analyzed, including 26 males and 6 females. Among them, there were 27, 5, 26 and 6 patients who had primary, recurrent, single or mutiple blader tumors, respectively. And the median number of bladder tumor was 1(1-3) and the mean diameter was 2(0.6-4.5)cm.The patients were aged 37 to 82 years, with a median age of 63 years. All patients underwent multi-parameter magnetic resonance imaging (mpMRI) before surgery and acquired a VI-RADS score. Among the 32 patients, there were 8, 17, 2, 5, and 0 patients in the VI-RADS score category 1, 2, 3, 4, and 5, respectively. Based on the VI-RADS score and tumor size, morphology and number provided by the mpMRI, the urologists classified the tumor types into type 1, 2a, 2b, 2c, 3a, 3b, 3c, 4a, 4b or 5, and designed the surgical protocol for each type including the resection plan, boundary and depth. There were 8, 6, 7, 4, 0, 1, 1, 3, 2 and 0 patients in each type, respectively. The tumor types were further confirmed during the operation, and the operation was completed according to the surgical plans for different tumor types.Patients received intravesical therapy of gemcitabine within 24 hours after surgery.Results:All operations were successfully completed and none was converted to the traditional transurethral resection of the bladder tumor. The operation time was 5 to 35 minutes with a median time of 15 minutes. Tumor specimens from all patients contained the muscularis propria. Among the patients with scores 1, 2, 3 and 4, there were 8, 16, 1 and 0 patients diagnosed with non-muscle invasive bladder cancer (NMIBC), respectively. All the patients with NMIBC had negative basal resection margins and 6 out 7 muscle invasive bladder cancer (MIBC) patients had negative resection margins. There were no intraoperative complications such as bladder perforation and obturator reflex. Four patients experienced obvious postoperative bladder irritation and relieved after symptomatic treatment or removing catheter. Twelve patients received second resections, including 10 NMIBC patients and 2 MIBC patients. No residual tumor was found in the re-resected specimens. There were 9 and 12 NMIBC patients received regular intravesical therapy of gemcitabine or BCG, respectively. Among the 7 MIBC patients, 5 received radical cystectomy and two received bladder-preserving treatment including second resection, adjuvant chemotherapy and radiotherapy. The follow-up period was 3-12 months, with a median of 6 months. One NMIBC patient relapsed at 9th months after surgery and underwent ERBT.Conclusions:The personalized ERBT based on VI-RADS is safe and feasible, and can achieve negative margins in all NMIBC and some MIBC without severe complications.

Objective:To understand the evaluation of 90 pharmaceutical service posts by pharmacists in hospitals, so as to provide basis for rational allocation of pharmaceutical personnel in hospitals.Methods:A questionnaire survey was conducted among 2 582 hospital pharmacists in 31 provinces from August 2019 to April 2020. The survey contents included post classification, staffing qualification and scores related to drug safety.Results:Among the 90 pharmaceutical posts investigated, there were 39 posts with a safety correlation score of 5(the highest score), 36 with 4 and 15 with 3. There were 41 posts in advanced pharmaceutical care and 49 posts in basic pharmaceutical care. The minimum qualifications required was 21 posts with pharmacy related college degree or assistant pharmacist, 61 posts with pharmacy related or clinical pharmacy bachelor degree or pharmacist title, and 8 posts with higher qualification. Advanced pharmaceutical care posts had high drug safety relevance scores and high personnel qualification requirements, mainly involving drug treatment, scientific research and comprehensive management posts.Conclusions:Pharmacists with different qualifications should be allocated according to different levels of pharmaceutical care projects, which can reasonably allocate limited human resources and make the best of their talents.