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 investigate the efficacy and safety of protein A immunoadsorption (PAIA) combined with rituximab (RTX) in highly sensitized patients who underwent haplo-hematopoietic stem cell transplantation (haplo-HSCT) .Methods:The clinical data of 56 highly sensitized patients treated with PAIA and RTX before haplo-HSCT at the First Affiliated Hospital of Soochow University and Soochow Hopes Hematonosis Hospital between March 2021 and June 2023 were retrospectively analyzed. The number of human leukocyte antigen (HLA) antibody types and the mean fluorescence intensity (MFI), humoral immunity, adverse reactions during adsorption, and survival within 100 days before and after adsorption were measured.Results:After receiving the PAIA treatment, the median MFI of patients containing only HLA Ⅰ antibodies decreased from 7 859 (3 209-12 444) to 3 719 (0-8 275) ( P<0.001), and the median MFI of HLA Ⅰ+Ⅱ antibodies decreased from 5 476 (1 977-12 382) to 3 714 (0-11 074) ( P=0.035). The median MFI of patients with positive anti-donor-specific antibodies decreased from 8 779 (2 697-18 659) to 4 524 (0–15 989) ( P<0.001). The number of HLA-A, B, C, DR, and DQ antibodies in all patients decreased after the PAIA treatment, and the differences were statistically significant (A, B, C, DR: P<0.001, DQ: P<0.01). The humoral immune monitoring before and after the PAIA treatment showed a significant decrease in the number of IgG and complement C3 ( P<0.001 and P=0.002, respectively). Forty-four patients underwent HLA antibody monitoring after transplantation, and the overall MFI and number of antibody types decreased. However, five patients developed new antibodies with low MFI, and nine patients continued to have high MFI. The overall survival, disease-free survival, non-recurrent mortality, and cumulative recurrence rates at 100 days post-transplantation were 83.8%, 80.2%, 16.1%, and 4.5%, respectively. Conclusions:The combination of PAIA and RTX has a certain therapeutic effect and good safety in the desensitization treatment of highly sensitive patients before haplo-HSCT.

FRMD6, a member of the 4.1 ezrin-radixin-moesin domain-containing protein family, has been reported to inhibit tumor progression in multiple cancers. Here, we demonstrate the involvement of FRMD6 in lung cancer progression. We find that FRMD6 is overexpressed in lung cancer tissues relative to in normal lung tissues. In addition, the enhanced expression of FRMD6 is associated with poor outcomes in patients with lung squamous cell carcinoma (n = 75, P = 0.0054) and lung adenocarcinoma (n = 94, P = 0.0330). Cell migration and proliferation in vitro and tumor formation in vivo are promoted by FRMD6 but are suppressed by the depletion of FRMD6. Mechanistically, FRMD6 interacts and colocalizes with mTOR and S6K, which are the key molecules of the mTOR signaling pathway. FRMD6 markedly enhances the interaction between mTOR and S6K, subsequently increasing the levels of endogenous pS6K and downstream pS6 in lung cancer cells. Furthermore, knocking out FRMD6 inhibits the activation of the mTOR signaling pathway in Frmd6^-/- gene KO MEFs and mice. Altogether, our results show that FRMD6 contributes to lung cancer progression by activating the mTOR signaling pathway.

Objective To explore the differences in the effectiveness of using different blood indicators individually,in combination,and for dynamic monitoring in the diagnosis,differential diagnosis,and prognosis of bacterial infections.Methods 1843 cases with infectious symptoms or signs from January 2015 to September 2022 at the People's Hospital of Yuxi City were selected as the case group,and 2298 uninfected individuals during the same period were selected as the control group.Blood indicators of the two groups were collected.Variables were grouped according to gender,age group,specimen type,etc.SPSS 24.0 and Medcalc 20.0 were used for statistical analysis.Results The individual diagnostic efficacy of various blood indicators for detecting infection ranges from 0.656 to 0.937.When used together,the efficacy ranges from 0.907 to 0.987.The efficacy of distinguishing between G+c and G-b in different specimens is as follows:when PCT is used alone in blood,the AUC is 0.875 for males and 0.769 for females.However,the individual diagnostic efficacy in male mucous secretions,sterile body fluids,and non-adult male sputum is all≤0.7.Yet,when used together,the efficacy is AUC(0.789,0.737,0.86)respectively.The dynamic monitoring of PCT,IL-6,CRP,WBC,and LAC in adult patients at 24 h,48 h,and 72 h after admission shows statistically significant differences in prognostic efficacy for G+c and G-b(P<0.05).Conclusions Blood indicators have a certain diagnostic value for determining whether there is a bacterial infection,and there are gender differences.The combined use of these indicators is more effective.The diagnostic value of using blood indicators alone or in combination for distinguishing between G+c and G-b in different types of specimens varies.The use of PCT alone in blood specimens is the most effective.For adult males,the combined use of body surface mucous secretions and sterile body fluids is most effective,while for underage males,the combined use of sputum is most effective.The combined use for females is not effective.Dynamic monitoring of PCT,CRP,IL-6,LAC,and WBC has a high value for evaluating the prognosis and therapeutic effect of infections.The evaluation of G+c infection is most effective at 24 hours for IL-6,and for G-b infection,it is most effective at 72 hours for PCT.

H 1-antihistamines are widely used in the treatment of various allergic diseases, but there are still many challenges in the safe and rational use of H 1-antihistamines in pediatrics, and there is a lack of guidance on the prescription review of H 1-antihistamines for children.In this paper, suggestions are put forward from the indications, dosage, route of administration, pathophysiological characteristics of children with individual difference and drug interactions, so as to provide reference for clinicians and pharmacists.

Objective:A rare case of δ-globin gene (HBD) mutation in Guangdong Province was analyzed to provide reference for avoiding misdiagnosis of δ-thalassemia in clinic.Methods:The patient was admitted to Guangdong Maternal and Child Health Hospital, and the peripheral blood sample was collected for hematological phenotypes [mean erythrocyte volume (MCV), mean erythrocyte hemoglobin content (MCH), hemoglobin (Hb)] and Hb typing analysis. The routine deletion and mutation of α-thalassemia and β-thalassemia genes were analyzed by PCR-flow fluorescence hybridization. At the same time, DNA sequencing was used to analyze the type of HBD mutation.Results:The results of hematological phenotypes analysis showed that MCV was 87.9 fl, MCH was 29.3 pg, and Hb content was 140 g/L. The results of Hb typing showed that the contents of Hb F, Hb A 2, Hb A 2 variant, and Hb A were 0.4%, 1.3%, 0.6%, and 97.7%, respectively. No abnormality was found in α-thalassemia and β-thalassemia genes by routine deletion and mutation detection. According to DNA sequencing analysis, the patient had HBD: c.349 C>G variant. Conclusion:The low Hb A 2 content (reference value is 2.5% - 3.5%) in this case is due to the mutation of HBD, HBD: c.349 C>G variant is rare in Chinese population.

【Objective】 To retrospectively investigate the antibody distribution and pregnancy outcome of pregnant women with Rh alloantibody in Guangzhou, and summarize the prevalence, diagnosis and treatment experience of hemolytic disease of newborn (HDN) caused by Rh alloantibody, so as to provide data for the prevention, diagnosis and treatment of Rh-HDN. 【Methods】 A total of 17 345 pregnant women in Guangzhou from January 2014 to December 2020 were selected for irregular antibody screening test.Those with Rh antibody were followed up for delivery, and the clinical and laboratory examination results of pregnant women and newborns were analyzed. 【Results】 A total of 71 cases (0.41%, 17/17 345) with Rh alloantibodies were detected.Among them, anti-D, anti-E, anti-Ec, anti-C, anti-Ce, anti-c, anti-e accounted for 26.76% (19/71), 46.48% (33/71), 9.86% (7/71), 7.04% (5/71), 5.63% (4/71), 2.82% (2/71) and 1.41% (1/71), respectively.Among the 71 pregnant women, 34 gave birth to children with HDN, with the total prevalence rate of 47.89%, among whom 100%, 78.94% and 42.42% were anti-c, anti-D and anti-E, respectively.And 71.43% (5/7) of the children who underwent transfusion were with anti-D.Although the yield rate of anti-E was the highest, it involved low morbidity and mild symptoms, which preferred to occur in the first fetus.No significant difference in gestational age, birth weight and the occurrence time of jaundice was notice between the anti-D group and anti-E group, but the total bilirubin of the anti-E group was lower while the Hb level were higher than those of the anti-D group (P<0.05). Two children died, and others were cured by phototherapy, albumin, IVIG and blood transfusion. 【Conclusion】 The publicity of Rh-HDN for early prevention and treatment should be strengthened to improve the cure rate and the prognosis.

Objective:To compare the outcomes of watch&wait (W&W) strategy in patients with locally advanced rectal cancer who achieved complete clinical response (cCR) after neoadjuvant therapy, with those who obtained pathological complete response (pCR) after total mesorectal excision (TME).Methods:This is a retrospective cohort analysis study. Patients histologically proven with locally advanced rectal adenocarcinoma (stage Ⅱ-Ⅲ) who had received neoadjuvant chemotherapy were eligible between January 2014 and December 2019. In whom we included patients who had cCR offered management with W&W strategy after completing neoadjuvant therapy and follow-up ≥1 year (W&W group), and patients who did not have cCR but pCR after TME (pCR group). The primary endpoints were 3-year and 5-year overall survival (OS), colostomy-free survival (CFS), disease-free survival (DFS), non-local regrowth disease-free survival (NR-DFS), and organ preservation rate. Kaplan-Meier analysis was used for survival analysis and log-rank test was performed. For comparative analysis, we also derived one-to-one paired cohorts of W&W versus pCR using propensity-score matching (PSM).Results:A total of 118 patients were enrolled, 49 of whom had cCR and managed by W&W, 69 had pCR, with a median follow-up period of 49.5 months (12.1-79.9 months). No difference was observed in the 3-year OS (97.1% vs. 96.7%) and 5-year OS (93.8% vs. 90.9%, P=0.696) between the W&W and pCR groups. Patients managed by W&W had significantly better 3-year and 5-year CFS (89.1% vs. 43.5%, P<0.001), better 3-year DFS (83.6% vs. 97.0%) and 5-year DFS (83.6% vs. 91.2%, P=0.047) compared with those achieving pCR. The 3-year NR-DFS (95.9% vs. 97.0%) and 5-year NR-DFS (92.8% vs. 97.0%, P=0.407) did not significantly differ between the W&W and pCR groups. Local regeneration occurred in six cases, and 87.7% of patients had successful rectum preservation in the W&W group. In the PSM analysis (34 patients in each group), absolutely better CFS (90.1% vs. 26.5%, P<0.001) was noted in the W&W group. A median interval of 17.5 weeks was observed for achieving cCR, while only 23.9% of patients achieved cCR within 5 to 12 weeks from radiation completion. Patients with short-course sequential chemoradiotherapy achieved cCR significantly later when compared with those with long-course concurrent chemoradiotherapy (19.0 vs. 9.8 weeks, P<0.001). Conclusions:The oncological outcomes of W&W strategy in patients with locally advanced rectal cancer are safe and effective, significantly improving the quality of life. Longer interval for cCR evaluation may improve rectal organ preservation rate.

Objective To investigate the protective effect of adult human liver-derived stem cell exosomes (HLSC-exo) intravenously injected at different time points against acute liver injury induced by concanavalin A (ConA) in mice. Methods HLSC-exo was extracted by differential centrifugation. Western blot was used to measure the expression of the marker proteins CD9 and CD63, and nanoparticle tracking analysis was used to investigate particle size distribution. A total of 56 male C57BL/6 mice were randomly divided into blank control group, ConA model group, and HLSC-exo treatment group. The ConA model group and the HLSC-exo treatment group were further divided into 3-, 6-, and 12-hour subgroups according to the interval between phosphate buffer or HLSC-exo injection and ConA injection. The serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), tumor necrosis factor-α (TNF-α), and interleukin-10 (IL-10) were measured, and the gross morphology and histopathology of the liver were compared between groups. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t -test was used for further comparison between two groups. Results HLSC-exo was a membranous vesicle with a diameter of 90-110 nm, with a clear saucer-like structure under an electron microscope and marked expression of its specific marker proteins CD9 and CD63. In the blank control group, the levels of ALT and AST were 31.81±6.74 U/L and 69.75±8.30 U/L, respectively. Compared with the blank control group, the 3-, 6-, and 12-hour ConA model groups had significant increases in the levels of ALT and AST (all P < 0.001); compared with the 3-and 6-hour ConA model groups, the 3-and 6-hour HLSC-exo treatment groups had significant reductions in the levels of ALT and AST (225.58±115.59 U/L vs 1989.32±347.67 U/L, 1174.71±203.30 U/L vs 2208.33±349.96 U/L, 303.53±126.68 U/L vs 2534.27±644.72 U/L, 1340.70±262.56 U/L vs 2437.13±288.13 U/L, all P < 0.001); compared with the 6-hour HLSC-exo treatment group, the 3-hour HLSC-exo treatment group had significantly greater reductions ( P < 0.001). In the blank group, the levels of IL-10 and TNF-α were 313.51±10.97 pg/ml and 476.05±7.31 pg/ml, respectively. Compared with the blank control group, the 3-, 6-, and 12-hour ConA model groups had a significant reduction in the level of IL-10 (all P < 0.001); compared with the 3-and 6-hour ConA model groups, the 3-and 6-hour HLSC-exo treatment groups had a significant increase in the level of IL-10(331.61±10.46 pg/ml vs 266.20±8.15 pg/ml, 288.13±10.74 pg/ml vs 264.41±9.12 pg/ml, both P < 0.001); compared with the 6-hour HLSC-exo treatment group, the 3-hour HLSC-exo treatment group had a significantly greater increase ( P < 0.001). Compared with the blank control group, the 3-, 6-, and 12-hour ConA model groups had a significant increase in the level of TNF-α (all P < 0.001); compared with the 3-and 6-hour ConA model groups, the 3-and 6-hour HLSC-exo treatment groups had a significant reduction in the level of TNF-α (478.26±12.99 pg/ml vs 551.31±17.70 pg/ml, 515.58±7.18 pg/ml vs 556.21±11.15 pg/ml, both P < 0.001); compared with the 6-hour HLSC-exo treatment group, the 3-hour HLSC-exo treatment group had a significantly greater reduction ( P < 0.001). Compared with the 3-and 6-hour ConA model groups in terms of the gross morphology and histopathology of the liver, the 3-and 6-hour HLSC-exo treatment groups had a significant reduction in the degree of hepatocyte necrosis, and the 3-hour HLSC-exo treatment group had a basically complete lobular structure, with sporadic spotty necrosis; the 12-hour HLSC-exo treatment group had no significant improvement in hepatocyte necrosis compared with the 12-hour ConA model group. Conclusion Intravenous injection of adult HLSC-exo can alleviate acute liver injury induced by ConA in mice, and injection at 3 hours in advance has the most significant protective effect. Regulation of cytokines is one of the important mechanisms for HLSC-exo to alleviate liver injury.

Objective To investigate the relationship between visceral fat related index and the severity of acute pancreatitis (AP). Methods A total of 308 patients hospitalized with AP at the First Affiliated Hospital of Guangxi Medical University from September 2014 to October 2021 were included. They were divided into mild acute pancreatitis (MAP) ( n =186), moderate severe acute pancreatitis (MSAP) ( n =60) and severe acute pancreatitis (SAP) ( n =62) for comparison in age, hospitalization cost and days, scoring systems and body mass indexes. Comparison of normally distributed continuous data with homogeneity of variance between groups was made by one-way analysis of variance, and intergroup and intragroup pairwise comparison of data with heterogeneity of variance was made by the Kruskal-Wallis H test. The receiver operating characteristic curves (ROCs) for each index were constructed and area under the curve ( AUC ) was calculated to evaluate the performance of each index. Univariable and multivariable logistic regression analyses were used to identify the independent risk factors of MSAP and SAP. Results There were significant differences among the three groups in terms of hospitalization costs and durations, TG, HDL-C, NLR, WBC, Alb, Cr, BUN, scoring systems, CMI, LAP, WTI and CVAI. Further pairwise comparisons revealed that CMI, LAP, WTI and CVAI were significantly higher in the MAP group than in MSAP and SAP groups. We also found correlation between CMI and the severity of AP ( r =0.352, P < 0.001). By comparing the AUC s, CMI was found to be the most accurate in predicting the occurrence of MSAP and SAP. Univariable logistic regression analysis showed that CMI, LAP, WTI, CVAI and WC were the risk factors of MSAP and SAP. After adjusting for confounding factors, CMI and CVAI were identified as the independent risk factors of MSAP and SAP. The risk of MSAP and SAP with CMI ≥ 0.801 was 3.740 times that with CMI < 0.801 (95% CI : 1.983~7.056, P < 0.001). Conclusions Visceral fat is related to the severity of AP. Among the four visceral fat related indexes (CMI, LAP, WTI and CVAI), cardiometabolic index is the most valuable in predicting the severity of AP and they are positively correlated. CMI, an independent risk factor for MSAP and SAP, can be used to predict and assess the severity of AP.