The National Health Commission's initiative of"Enhancing Medical Services and Patient Experience"neces-sitates a comprehensive enhancement of the precision,scientific rigor,and standardization of medical quality and safety manage-ment.It also calls for an optimized allocation of medical resources and service balance,and the promotion of new service models for admission management.This paper discusses the multiple aspects of hospital admission management.Through digital transfor-mation,we aimed to establish a centralized operation model encompassing multiple tasks,responsibilities,and uniform services across all sectors of a hospital,maintaining simplicity without compromising quality.Innovative service methods were employed to facilitate both online and offline admission procedures.Leveraging digital tools,we implemented the"beds for patients"model to directly address patient medical experience challenges.This enabled the application of information intelligence in the operation and management of large,multi-campus tertiary hospitals.The paper provided insights into the methods,specific tasks,and fu-ture value of implementing admission management and operation in large-scale comprehensive hospitals based on smart hospital models.These insights can serve as valuable references for admission management and operation in hospitals.

Objective To explore the impact of implementing a refined management mode on the proportion of daytime surgery in elective surgery.Methods The"Five-Three-Three Management Model,including top-level design,system planning,key elements,information transformation,and data monitoring,was strictly followed to ensure the safety of daytime operations,efficient information exchange,and orderly coordination between patient admission and discharge.Pre-hospital anesthesia consul-tations were also introduced to enhance the timeliness and safety and maintain data monitoring of daytime surgeries.Results In 2023,the proportion of day surgeries was 21.85％,an increase of 7.14％compared to 2021,with an average hospitalization du-ration decrease of 5.62％,and a 27.60％reduction in preoperative waiting time for bed.These advancements contributed to the hospital's the hospital's national exam ranking rising to second in the country.Conclusion Comprehensive and systematic re-fined management measures,with the Five-Three-Three management model at the core,can ensure the quality,safety,and effi-ciency of day surgery operations.

OBJECTIVE：To in vestigate the effects of dexmedetomidine （Dex）on SIRT 1/Akt/GSK3β/β-catenin signaling pathway in cerebral injury of sepsis model rats ，and explore the mechanism of its protecitve effect on cerebral injury. METHODS ： A total of 80 male SD rats were randomly divided into sham operation group （Sham group ），sepsis group （CLP group ），CLP+Dex group（10 μg/kg Dex），CLP+Dex+Sirtinol group （10 μg/kg Dex+2 μL/100 g SIRT 1 inhibitor sirtinol ），with 20 mice in each group. Two hours before modeling ，CLP+Dex+Sirtinol group was injected with sirtinol via lateral ventricle. Sepsis model was induced by cecal ligation and perforation in each group （in sham group ，only operation was performed but no ligation was performed）. At 0，3，6 h after modeling ，CLP+Dex group and CLP+Dex+Sirtinol group were given Dex （10 μg/kg） intraperitoneally，Sham group and CLP group were given constant volume of normal saline intraperitoneally. Cerebral tissue water content，Evans blue （EB）content，apoptosis in cerebral cortex ，the levels of IL- 1β and TNF-α in cerebral tissue as well as the protein expression of SIRT 1，p-Akt，p-GSK3β and β-catenin in hippocampus were detected 24 h after last medication. RESULTS ： Compared with Sham group ，cerebral tissue water content ，EB content ，the number of apoptotic cells in cerebral cortex as well as the levels of IL- 1β and TNF-α in cerebral tissue were increased significantly（P＜0.05），while the protein expression of SIRT 1， p-Akt，p-GSK3β and β-catenin in hippocampus were decreased significantly （P＜0.05）. Compared with CLP group ，cerebral tissue water content ，EB content ，the number of apoptotic cells in cerebral cortex as well as the levels of IL- 1β and TNF-α in cerebral tissue were decreased significantly in CLP+Dex group （P＜0.05），while the protein expression of SIRT 1，p-Akt，p-GSK3β and β-catenin in hippocampus were increased significantly （P＜0.05）. Sirtinol could significantly reverse the above-mentioned cerebral protection and factor regulation effects of Dex （P＜0.05）. CONCLUSIONS ：Dex can protect the cerebral tissue of sepsis model rats，which may play an anti-inflammatory and anti-apoptotic role by activating SIRT 1/Akt/GSK3β/β-catenin signaling pathway ，so as to reduce cerebral edema ，protect blood-brain barrier and reduce cerebral injury.

Objective To evaluate the effectiveness of a rat model for comorbidity of Tourette syndrome and anxiety with empty water bottle stimulation plus iminoodipropionitrile(IDPN) injection.Methods The 48 male SD rats were randomly divided into four groups:the blank control group,the TS group,the anxiety group and the comorbidity group.The blank control group was injected with saline for 7 days.The TS groop was injected with 3,3-iminodipropionitrile (IDPN) with 250 mg/kg once a day for 7 consecutive days.The anxiety group was given empty water bottle stimulation for 21 consecutive days.The comorbidity group was given empty water bottle stimulation plus IDPN injection.At the end of the 3rd week,the behavioral changes of the stereotyped movement,elevated plus-maze and open field of the rats in each group were measured,and the contents of monoamine neurotransmitters in striatum and hippocampus were determined by HPLC.Results The results of stereotyped movement showed that there was no significant difference between the groups except for the blank control group.The elevated plus-maze test showed that the 0E/TE values of the comorbidity group (21.33±11.35) ％ and the anxiety group (17.68±16.89) ％ were significantly decreased,lower than that of the blank control group (73.24± 19.33) ％ and TS group(61.43±21.84) ％.The results of open field test showed that the total scores of open field in the comorbidity group(15.22±9.87)and anxiety group (11.17±10.76) were lower than that of the blank control group (41.86±33.30) and TS group(48.83± 17.65) (P＜0.01).However,there was no significant difference between the comorbidity group and the anxiety group.The test of monoamine neurotransmitters in striatum showed that the content of HIAA in the comorbidity group(0.03±0.00) ng/mg was the highest,and that of the TS group and anxiety group (0.02±0.00) ng/mg was higher than that of the blank control group (0.01±0.00) ng/mg (P＜0.01).The DA test showed that the content of DA in the comorbidity group (0.03±0.00) ng/mg was the highest,and that of the comorbidity group,TS group(0.02±0.00) ng/mg and anxiety group was higher than that of the blank control group(0.01±0.00) ng/mg (P＜0.01).The expression of 5-HT was most significant among the groups (P＜0.01),and there was significant difference between the anxiety group ((0.011 ± 0.001) ng/mg)and the comorbidity group ((0.014±0.002) ng/mg) (P＜0.01).The expression of HVA in the three model groups ((0.05±0.00) ng/mg) was higher than that in the blank group ((0.02±0.00) ng/mg) (P＜ 0.01).The expression of DOPAC in the TS group ((0.23±0.02) ng/mg) was higher than that in the blank control group((0.16±0.01) ng/mg) and comorbidity group ((0.16±0.02) ng/mg) (P＜0.01).The test of monoamine neurotransmitters in hippocampus showed that the content of 5-HT in the comorbidity group ((0.14±0.02) ng/mg) was the highest,followed by the anxiety group ((0.1 ± 0.03) ng/mg) and the TS group ((0.07±0.04) ng/mg),which were all higher than the blank control group((0.04±0.03) ng/mg) (P＜0.05,P＜0.01),and there were significant differences between the comorbidity group and the TS group or anxiety group (P＜0.01).The expressions of HIAA and HVA were higher in the comorbidity group((0.44±0.04)ng/mg,(0.01±0.00) ng/mg),TS group ((0.46±0.15) ng/mg,(0.01 ±0.01) ng/mg) and anxiety group ((0.46±0.08)ng/mg,(0.01±0.00) ng/mg) than that in the blank control group((0.21±0.10)ng/mg,(0±0) ng/mg) (P＜0.05,P＜0.01).Conclusion This study confirms the reliability of the model and it is an ideal animal model for the study of TS with comorbidity of anxiety,which can be used for follow-up research.

Objective To establish a practical and effective predictive model for predicting carotid plaque/thickened intima,and to provide a novel perspective for stroke screening.Methods A retrospective analysis of the community screening data collected from September 2012 to March 2013 was performed.The data of blood pressure,serum lipid profile and fasting blood glucose and ultrasonographic checks of carotid artery were documented.One thousand subjects were randomly sampled from totally 14 226 individuals and divided into 2 groups according to the presence of carotid plaque/thickened intima.Analysis of relevant data of subjects with Logistic regression were performed.Predictive model was established according to the odds ratio for each risk factor and evaluated by C statistics.Results In the randomly sampled 1000 subjects,164 ones were found to be with carotid plaque/thickened intima.The mean age was (60.23 ± 10.09) years old,110 (67.1％) were male.Smoker,hypertension,angina pectoris,diabetes and hyperlipidemia were seen more often in the subjects with carotid plaque/thickened intima.Logistic regression analysis showed the independent risk factors for carotid plaque/thickened intima included advanced age (OR =1.15,95％ CI:1.12-1.84,P＜0.01),male (OR=3.97,95％CI:2.49-6.33,P＜0.01),smoking (OR=1.80,95％CI:1.24-2.56,P =0.002),diabetes (OR =1.80,95％ CI:1.15-2.98,P =0.012),hypertension (OR =2.82,95％ CI:1.15-2.98,P ＜ 0.01),high total cholesterol level (OR =1.63,95％ CI:1.31-2.02,P ＜ 0.01) and high LDL-C (low density lipoprotein-cholesterol) level (OR =1.70,95 ％ CI:1.35-2.14,P ＜ 0.01).The advanced age was found to be the strongest predictive factor in this model.The C statistics of this model is 0.804,which overweighs other models previously reported.The optimal cutoff point for prediction was 3.5,with a sensitivity of 0.713 and a specificity of 0.757.Conclusion An practical and effective model for predicting carotid plaque/thickened intima established from sampling data of community residents is favorable for both stroke screening and primary stroke prevention.