The profit-seeking mechanism which has emerged as an unexpected result of a series of policy choices during the market-oriented healthcare reform is the root cause of almost all problems among the public hospi-tals, and hence the key to the public hospital reform.The mechanism is comprised by three components including the pressure mechanism to create the revenue, the enlargement mechanism to reimburse costs, and the linkage mecha-nism between employee income and hospital surplus.Therefore, a comprehensive policy package should be adopted to undertake these three aspects among which the linkage mechanism is the crucial one.

Objective By analyzing the effect of adopting the responsibility system for entrusted asset management targets in some public hospitals the paper aims to explore the feasibility of doing so as to provide lessons for the reform of public hospitals in China. Methods Interviews of focus groups and surveys through questionnaires were conducted to find out about reform in the management of public hospitals in Wuxi City of Jiangsu Province, including successes and problems. Results Some problems remain to be solved while effects have been achieved in the entrusted management of public hospitals. Conclusion Reform of hospitals through entrusted management is currently a way of deepening the reform of public hospitals. Some preliminary conditions are already in place for reform in the system of public hospitals, yet support is stili needed in terms of sound policy and environment. In future reform should go a step further in personnel and distribution systems, supervised asset management, and the estabh'shment and perfection of the Corporation management structure. More efforts need to be made by the state in encouraging explorations and strengthening guidance.

Objective To improve the level of diagnosis and treatment of the sharp injury in the back. Methods 47 cases which were treated from Jan 1991 to May 2000 were reviewed. ResultsAmong 37 cases who underwent the exploration, 5 cases died. Among 10 cases who underwent conservative treatment, 2 cases died. ConclusionThe condition of sharp injury in the back is very complicated,it is easy to be misdiagnosed, the mortality is high. Saving should be equalled with the diagnosis and treatment. The application of wound exploration, abdominal puncture, ultrasound examination and X-ray checking is valuable to the diagnosis. The patients with operation indications should be operated at once,while the others should be observed for some time to prevent the delayed clinical manifestation.

In recent years, it has been well known that non-small cell lung cancer (NSCLC) patients with muta-tions of epidermal growth factor receptor (EGFR) response better to EGFR-tyrosine kinase inhibitor treatment. Although DNA-based assays (e.g. DNA sequencing) are the most frequently used and a relatively reliable method to detect EGFR muta-tions, they are complex, time-consuming and relatively expensive for routine use in clinical laboratories, besides they require high quality tumor samples. In contrast, the immunohistochemistry (IHC) methods make up fully for the above shortcomings and can serve as screening tests for EGFR mutations. However, there are many factors that can inlfuence the results of IHC methods, such as different staining procedures, different antigen retrieval solutions and different sets of criteria, etc. hTus the IHC methods for detecting EGFR mutations have not been widely used in clinic and only in the research stage. hTis article re-views the use of IHC methods by different researchers and further discusses how to make the IHC methods work best for the detection of EGFR mutations.

Background and objective Patients with non-small cell lung cancer (NSCLC) harboring mutations of the epidermal growth factor receptor (EGFR) respond well to EGFR-tyrosine kinase inhibitor therapy. Immunohistochemistry (IHC) is a simple and widely used technique in clinical pathology laboratories. IHC also features cost effectiveness and rapid detection ofEGFR mutations compared with molecular methods. hTis study aims to determine the accuracy of IHC forEGFR mutation detection in NSCLC.Methods Specimens (obtained from surgery or biopsy) from 97 NSCLC cases were stained through IHC with mutation-specific antibodies. The clinicopathological features of patients with positive immunostaining results were analyzed. Positive specimens were subjected to liquid chip technology to detect the actual EGFR status. Forty NSCLC specimens obtained from surgery and conifrmed to haveEGFR mutations through liquid chip technology were collect-ed. These specimens were then subjected to IHC analyses with mutation-speciifc antibodies. The sensitivity of IHC in detect-ingEGFR mutations was calculated.Results Seventeen of the 97 NSCLC specimens were stained positive, and positive results were mostly observed in females, patients with adenocarcinoma, and non-smokers. About 76.9% of specimens with positive IHC results harbored mutations. The sensitivity of IHC was 40% among the 40 cases identiifed as containingEGFR mutations through liquid chip technology.Conclusion The strong positive immunostaining result is accurate, but the sensitivity of the method may not be optimal and signiifcantly varies in different studies. The widespread application of IHC in clinics must be further investigated.

Background and objectiveAppropriate immunohistochemistry (IHC) scoring criteria can guarantee the reliability of mutation detection results. Most current studies suggest that the “four-grade criterion” may be the best among all scoring systems. hTe aim of this study is to discuss the inlfuence of different four-grade immunohistochemistry scoring criteria on the test results.MethodshTree different four-grade immunohistochemistry scoring criteria were respectively used to evaluate the EGFR status of 83 cases of non-small cell of lung cancer (NSCLC) samples. hTe sensitivity, speciifcity, positive predictive value (PPV), negative predictive value (NPV), the agreement of each criterion compared with the gold standard, and whether statistical signiifcance exists between each criterion were calculated.Results No statistical difference was found among the three criteria in detectingEGFR mutations. All three criteria exhibit considerably better speciifcity than sensitivity. For samples with scores of “3+”, PPV could reach up to 100%.ConclusionNo deifnite best criterion is among different four-grade scoring criteria. Regardless of the kind of criterion used, the speciifcity of IHC method in detectingEGFR mutations is markedly better than the sensitivity. For samples with scores of “3+”, mutation status can be conifrmed, and samples can receive EGFR-TKI therapy directly.

OBJECTIVE: To assess the practical and health economical values of non-invasive prenatal test (NIPT) in Changsha Municipal Public Welfare Program. METHODS: A retrospective analysis was carried out on 149 165 women undergoing NIPT test from April 9, 2018 to December 31, 2019. For pregnant women with high risks, invasive prenatal diagnosis and follow-up of pregnancy outcome were conducted. The cost-benefit of NIPT for Down syndrome was analyzed. RESULTS: NIPT was carried out for 149 165 pregnant women and succeeded in 148 749 cases (99.72%), for which outcome were available in 148 538 (99.86%). 90% of pregnant women from the region accepted the screening with NIPT. 415 (0.27%) were diagnosed as high risk. Among these, 381 (91.81%) accepted amniocentesis, which led to the diagnosis of 212 cases of trisomy 21 (PPV=85.14%), 41 cases with trisomy 18 (PPV=48.81%) and 10 cases with trisomy 13 (PPV=20.83%). The sensitivity and specificity of NIPT for trisomy 21, trisomy 18 and trisomy 13 were (97.70%, 99.98%), (97.62%, 9.97%) and (100%, 99.97%), respectively. In addition, 213 and 30 cases were diagnosed with sex chromosomal aneuploidies (PPV=46.2%) and other autosomal anomalies (PPV=16.57%), respectively. For Down syndrome screening, the cost and benefit of the project was 120.79 million yuan and 1,056.95 million yuan, respectively. The cost-benefit ratio was 1: 8.75, and safety index was 0.0035. CONCLUSION NIPT is a highly accurate screening test for trisomy 21, which was followed by trisomy 18 and sex chromosomal aneuploidies, while it was less accurate for other autosomal aneuploidies. The application of NIPT screening has a high health economical value.
Aneuploidy ; Cost-Benefit Analysis ; Female ; Humans ; Noninvasive Prenatal Testing ; Pregnancy ; Retrospective Studies ; Trisomy 18 Syndrome/genetics*

Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.