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.

Thyroid-associated ophthalmopathy(TAO)is an autoimmune disease whose etiology and pathogenesis have not yet been clarified.It is generally believed that its occurrence is the result of a combination of immune,genetic,envi-ronmental,and other factors.In recent years,scholars have paid more attention to the influence of microorganisms on TAO,and they found that alterations of the ocular surface and intestinal flora can stimulate the immune system to generate a series of immune responses,which induces autoimmune responses to TAO.The"gut-eye axis"may be an important fac-tor involved in the development of TAO.The intestinal flora and its metabolites may affect ocular tissues through blood cir-culation and the lymphatic system.This interaction between the gut and eye axis may affect the occurrence and develop-ment of TAO through various pathways,including migration of immune cells,cross immune reactions,and metabolite cir-culation.This article reviews the research progress on the correlation between alterations of the ocular surface and intesti-nal flora and TAO and explores the possible mechanisms of the flora involvement in the development of TAO,providing new ideas for the diagnosis and treatment of TAO.

Objective To explore the application of ropivacaine local infiltration anesthesia combined with patient controlled intravenous analgesia(PCIA)for postoperative analgesia and its influences on pain stress indexes in elderly patients after laparoscopic cholecystectomy(LC).Methods 518 elderly patients underwent LC under general anesthesia in the hospital were retrospectively enrolled from January 2020 to October 2023.According to different analgesia regimens,they were divided into group A(n=316,ropivacaine local infiltration anesthesia combined with PCIA)and group B(n=202,PCIA).The perioperative anesthesia indexes,scores of visual analogue scale(VAS)and Ramsay sedation after surgery,dosage of PCIA drug,hemodynamics,pain stress indexes[adrenaline(AD),norepinephrine(NE),cortisol(Cor)]and adverse events at 24 h after surgery were compared between the two groups.Results There were no differences in anesthesia time,recovery time,extubation time or intraoperative dosages of main anesthetics(dexmedetomidine,remifentanil and cisatracurium besilate)between the two groups(P＞0.05).Rest VAS and motion VAS in group A were lower than those in group B at 6,12 and 24 h after surgery,Ramsay sedation scale were higher than those in group B at 12 and 24 h after surgery,the differences were statistically significant(P＜0.05),dosage of PCIA drug and effective compression times were lower than those in group B at 24 h after surgery,the differences were statistically significant(P＜0.05).There was no difference in percutaneous arterial oxygen saturation(SpO2)level between the two groups(P＞0.05).The levels of mean arterial pressure(MAP),heart rate(HR),AD,NE and Cor in group A were lower than those in group B,the differences were statistically significant(P＜0.05).There was no difference of adverse events rate between the two groups at 24 h after surgery(P＞0.05).Conclusion Ropivacaine Calot's triangle block combined with PCIA for postoperative analgesia can effectively reduce rest VAS and motion VAS,improve sedation effect,maintain hemodynamics balance and reduce levels of pain stress factors in elderly patients after LC,with good safety.

Objective To investigate the infection status and epidemiological characteristics of viral pathogens in hospitalized patients with severe acute respiratory infection (SARI) in Guangdong Province from 2019 to 2021, so as to provide reference for clinical diagnosis and prevention. Methods The respiratory tract samples of SARI patients collected from 2019 to 2021 were detected and analyzed for respiratory syncytial virus (RSV), adenovirus (ADV), human rhinovirus/enterovirus (HRV/EV), human metapneumonic virus (HMPV) and other common respiratory viruses using Luminex respiratory multi-pathogen detection technology. Results A total of 1 948 influenza-negative cases were collected, of which 24.28 % were positive detection of virus infection. HRV/EV was the highest (10.32%), followed by RSV (4.31%). The detection rates were statistically significantly different among different age groups (χ²=176.186，P<0.05), and the highest detection rate was found in the group aged at 0 to 4 years (41.50%). There was no statistically significant between the male virus detection rate and the female virus detection rate (χ²=0.042，P>0.05). The detection peaks of RSV were mainly concentrated in summer and autumn, while HMPV was prevalent in winter, and HRV/EV and ADV had no obvious seasonality. Mixed infection was found in 39 samples, and the mixed infection rate was 2.00%. In the mixed infection cases, HPIV and HRV/EV combined infection was the most common. Conclusion HRV/EV, RSV, HMPV and ADV are predominant viral pathogens in SARI influenza-negative hospitalized cases in Guangdong Province from 2019 to 2021. It is recommended to strengthen the surveillance of SARI cases in children under 5 years old.

BACKGROUND: Pneumonia-like primary pulmonary lymphoma (PPL) was commonly misdiagnosed as infectious pneumonia, leading to delayed treatment. The purpose of this study was to establish a computed tomography (CT)-based radiomics model to differentiate pneumonia-like PPL from infectious pneumonia. METHODS: In this retrospective study, 79 patients with pneumonia-like PPL and 176 patients with infectious pneumonia from 12 medical centers were enrolled. Patients from center 1 to center 7 were assigned to the training or validation cohort, and the remaining patients from other centers were used as the external test cohort. Radiomics features were extracted from CT images. A three-step procedure was applied for radiomics feature selection and radiomics signature building, including the inter- and intra-class correlation coefficients (ICCs), a one-way analysis of variance (ANOVA), and least absolute shrinkage and selection operator (LASSO). Univariate and multivariate analyses were used to identify the significant clinicoradiological variables and construct a clinical factor model. Two radiologists reviewed the CT images for the external test set. Performance of the radiomics model, clinical factor model, and each radiologist were assessed by receiver operating characteristic, and area under the curve (AUC) was compared. RESULTS: A total of 144 patients (44 with pneumonia-like PPL and 100 infectious pneumonia) were in the training cohort, 38 patients (12 with pneumonia-like PPL and 26 infectious pneumonia) were in the validation cohort, and 73 patients (23 with pneumonia-like PPL and 50 infectious pneumonia) were in the external test cohort. Twenty-three radiomics features were selected to build the radiomics model, which yielded AUCs of 0.95 (95% confidence interval [CI]: 0.94-0.99), 0.93 (95% CI: 0.85-0.98), and 0.94 (95% CI: 0.87-0.99) in the training, validation, and external test cohort, respectively. The AUCs for the two readers and clinical factor model were 0.74 (95% CI: 0.63-0.83), 0.72 (95% CI: 0.62-0.82), and 0.73 (95% CI: 0.62-0.84) in the external test cohort, respectively. The radiomics model outperformed both the readers' interpretation and clinical factor model ( P <0.05). CONCLUSIONS The CT-based radiomics model may provide an effective and non-invasive tool to differentiate pneumonia-like PPL from infectious pneumonia, which might provide assistance for clinicians in tailoring precise therapy.
Humans ; Retrospective Studies ; Pneumonia/diagnostic imaging* ; Analysis of Variance ; Tomography, X-Ray Computed ; Lymphoma/diagnostic imaging*

Cellular immune responses as well as generalized and periarticular bone loss are the key pathogenic features of rheumatoid arthritis (RA). Under the pathological conditions of RA, dysregulated inflammation and immune processes tightly interact with skeletal system, resulting in pathological bone damage via inhibition of bone formation or induction of bone resorption. Single-cell omics technologies are revolutionary tools in the field of modern biological research.They enable the display of the state and function of cells in various environments from a single-cell resolution, thus making it conducive to identify the dysregulated molecular mechanisms of bone destruction in RA as well as the discovery of potential therapeutic targets and biomarkers. Here, we summarize the latest findings of single-cell omics technologies in osteoimmunology research in RA. These results suggest that single-cell omics have made significant contributions to transcriptomics and dynamics of specific cells involved in bone remodeling, providing a new direction for our understanding of cellular heterogeneity in the study of osteoimmunology in RA.
Humans ; Osteoclasts/physiology* ; Arthritis, Rheumatoid/pathology* ; Inflammation/pathology* ; Bone and Bones/pathology* ; Bone Resorption/pathology*

Humans ; Stomach Neoplasms/pathology* ; Neoadjuvant Therapy ; Chemotherapy, Adjuvant ; Gastrectomy ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Neoplasm Staging

Objective:To investigate the value of CT features in predicting the invasion and degree of invasiveness of lung pure ground-glass nodules (pGGN) in the new histological classification in 2021.Methods:A total of 281 patients (304 lesions) with pGGN confirmed by surgical pathology from December 2018 to January 2021 in Shandong Provincial Hospital Affiliated to Shandong First Medical University were retrospectively analyzed. According to the pathological types, the patients were divided into prodromal lesion group [atypical adenomatous hyperplasia (AAH) and adenocarcinoma in situ (AIS), 129 cases], minimally invasive group [minimally invasive adenocarcinoma (MIA), 116 cases] and invasive group [invasive adenocarcinoma (IAC), 59 cases]. Clinical data (age, gender, smoking history, family history of cancer), and CT parameters [shape, boundary, lobulation, burr, vacuolar sign, bronchial abnormality sign, internal vessel sign, pleural traction sign, longest diameter, shortest diameter, unenhanced CT value, contrast-enhanced CT value in arterial phase, contrast-enhanced CT values in venous phase, the degree of enhancement (ΔCT A-N, ΔCT V-N)] were recorded and measured. The ANOVA, Kruskal-Wallis H and χ 2 test were used to compare the differences among the three groups. Binary logistic regression analysis was used to evaluate the independent risk factors of nodular invasion [prodromal lesion and invasive lesion (MIA and IAC)] and the degree of nodular invasion (MIA and IAC), and receiver operating characteristic (ROC) curve analysis was performed for each parameter. Results:There were statistically significant differences in age, pGGN morphology, lobulation, vacuolar sign, bronchial abnormality sign, internal vascular sign, pleural traction sign, longest diameter, shortest diameter, unenhanced CT value, contrast-enhanced CT value in arterial phase, contrast-enhanced CT value in venous phase among the precursor lesion group, minimally invasive group and invasive group ( P<0.05). Binary logistic regression analysis showed that vacuole sign (OR=2.832, 95%CI 1.363-5.887, P=0.005), internal vascular sign (OR=3.021, 95%CI 1.909-4.779, P<0.001) and unenhanced CT value (OR=1.003, 95%CI 1.001-1.006, P=0.019) were independent risk factors for invasion. Lobulation (OR=5.739, 95%CI 2.735-12.042, P<0.001), internal vascular sign (OR=1.968, 95%CI 1.128-3.433, P=0.017) and unenhanced CT value (OR=1.004, 95%CI 1.001-1.008, P=0.012) were independent risk factors for the degree of invasiveness. ROC curve analysis showed that the efficiency of internal vascular sign was the highest in distinguishing precursor lesion and the invasive, the area under the curve (AUC) was 0.757, the sensitivity was 50.3%, the specificity was 89.8%. The efficiency of lobulation was the highest in distinguishing MIA and IAC (AUC=0.702), with a sensitivity of 61.0% and specificity of 79.3%. Conclusions:CT features are of certain value in predicting the invasion and degree of invasiveness of lung pGGN in the new histological classification in 2021, and internal vascular sign is more effective in predicting the invasion of lung pGGN. Lobulation can predict the degree of invasiveness of pGGN better.

Objective:To evaluate the methodological quality and reporting quality of clinical practice guidelines or consensuses in the field of Chinese pancreatic diseases from 2016 to 2021, and provide reference for formulating clinical practice guidelines and consensuses in this field.Methods:VIP, Wanfang , CNKI and CBM databases were searched for articles published from January 2016 to March 2021. The main index terms were " pancreas" , " guideline" , " consensus" , and the supplementary index terms were " pancreatitis" , " pancreatic cancer" , " pancreatic head cancer" . Two researchers independently selected the literature. The appraisal of guidelines for research and evaluation (AGREE-China) was utilized to assess the methodological quality of the guidelines or consensuses, and the reporting items for practice guidelines in healthcare (RIGHT) tool was used to assess the reporting quality.Results:A total of 14 literature were included, including 7 literature on pancreatic cancer, 3 literature on acute pancreatitis, 1 literature on chronic pancreatitis and 3 literature on others. The results of the assessment by the AGREE-China tool showed that there were no document with a total score greater than or equal to 60.0 points, two with 40.0 to 59.9 points, eleven with 20.0 to 39.9 points, and one with less than 20.0 points. Among the results of RIGHT list, basic information was reported the highest(72.62%) and funding and declaration was the lowest(0).Conclusions:The methodological and reporting quality of the guidelines or consensuses on pancreatic disease in China from 2016 to 2021 are generally not high. In the process of developing domestic guidelines or consensuses on pancreatic diseases, the guideline developer should refer to AGREE-China and RIGHT to improve the quality of clinical practice guidelines or consensuses.

Objective:To investigate the effect of target-controlled infusion propofol combined with inhalation sevoflurane to maintain anesthesia on the postoperative changes of serum β-amyloid protein (β-AP), neuron specific enolase (NSE) and cognitive function in elderly patients with non-small cell lung cancer (NSCLC).Methods:The clinical data of 78 elderly patients with NSCLC who underwent thoracoscopic surgery from December 2017 to December 2019 in Jinhua Hospital of Traditional Chinese Medicine of Zhejiang Province were retrospectively analyzed. Among them, target-controlled infusion propofol to maintain anesthesia was in 39 cases (control group), and target-controlled infusion propofol combined with inhalation sevoflurane to maintain anesthesia was in 39 cases (study group). The serum levels β-AP, NSE and cognitive function (assessed by mini mental state examination, MMSE) before and after operation, the postoperative recovery (eye opening time, response time and extubation time) and incidence of adverse reactions were compared between 2 groups.Results:There were no statistical differences in β-AP and NSE before operation between 2 groups ( P>0.05); the β-AP and NSE immediately and 6 h after operation in study group were significantly lower than those in control group, β-AP: (416.13 ± 22.81) μg/L vs. (510.73 ± 24.27) μg/L and (373.53 ± 21.72) μg/L vs. (430.68 ± 22.15) μg/L, NSE: (8.35 ± 0.66) μg/L vs. (11.13 ± 0.73) μg/L and (7.81 ± 0.61) μg/L vs. (9.12 ± 0.68) μg/L, and there were statistical differences ( P<0.01); there were no statistical differences in β-AP and NSE 24 h after operation between 2 groups ( P>0.05). There was no statistical difference in MMSE score before operation between 2 groups ( P>0.05); the MMSE score 6, 24 and 72 h after operation in study group was significantly higher than that in control group: (22.32 ± 2.05) scores vs. (20.54 ± 2.31) scores, (25.19 ± 1.33) scores vs. (23.61 ± 1.08) scores and (26.84 ± 0.97) scores vs. (25.01 ± 1.15) scores, and there was statistical difference ( P<0.01); there was no statistical difference in MMSE score 7 d after operation between 2 groups ( P>0.05). The eye opening time, response time and extubation time in study group were significantly shorter than those in control group: (14.15 ± 3.20) min vs. (19.32 ± 3.14) min, (18.08 ± 3.52) min vs. (24.63 ± 4.10) min and (16.21 ± 4.40) min vs. (22.31 ± 4.71) min, and there were statistical differences ( P<0.01). There was no statistical difference in the incidence of adverse reactions between 2 groups ( P>0.05). Conclusions:Target-controlled infusion propofol combined with inhalation sevoflurane to maintain anesthesia in elderly patients with NSCLC can reduce the increase of serum levels of β-AP and NSE, reduce the damage to cognitive function, make patients recover quickly after operation, and will not increase the incidence of adverse reactions. Its security is higher.