Since its founding,the Management Center of Shenzhen Public Hospitals,on the basis of summarizing and inheriting reform outcomes in the past,has been working on to streamline the relationship between the government,public hospitals and the society in line with the general reform requirements of the stateupholding public welfare nature,motivating and ensuring sustainability.The center carries out a general reform covering the hospital management system,operating mechanism,supervision mode,and service mode.This way the center has built a set of contemporary hospital management system fitting Shenzhen' s conditions,encouraging hospital operations to better embody the interests of the government,medical workers and the society,and to better cover quality,equity and efficiency,thus effectively improving the management performance and services of the hospitals in question.

Shenzhen implemented the health reform on the separation of drug prescribing and dispensing.This policy abolished the drug price addition system,which interrupted the interest chain between hospitals and pharmaceutical enterprises,and curbed the over-medication and use of expensive drugs.Such a reform has lowered the average cost of diagnose and treatment,the out-of-pocket payment by those covered by social insurance,outpatient infusion and the utilization of antibiotics.To further strengthen these outcomes and maintain the momentum of this policy,Shenzhen will further improve the compensation system for public hospitals,encourage the medical staffs' work enthusiasm and implement the reform measures actively.

This articles introduced the development of the four systems and eight mechanisms in Shenzhen's health reform,and described the implementing measures of the public hospitals reform and major mechanisms reform.It also reviewed the major achievements and challenges met in the health reform and made an outlook of the future steps in the reform.

In order to reform the medical talent evaluation system, establish evaluation systems of physician competency, and implement physician resources management systems according to work position, and the compensa-tion system which reflects the value of medical services, The basic principles and standards of different physician tiers and grades are created in Shenzhen based on literature review, expert consultation and the methods from the American Centers for Medicare and Medicaid Services ( CMS) . Some results have achieved, including medical competency as-sessment of a certain number of physicians in the pilot project ( the coincidence rate of special hospitals is higher than general hospitals, respectively 78. 9% and 44. 8% ), comprehensive personnel systems reforms in public hospi-tals, and the trial selection of medical talents. The paper also provides some implications:The cognition of all sectors of society and physician themselves should be improved, Transitional policies for position recruitment and performance pay needs further improvement. Meanwhile, the grade evaluation system of non-physicians must also be given greater attention.

Objective:To investigate the value of bedside transthoracic echocardiography(TTE) in volume reactivity assessment of children with septic shock.Methods:A total of 41 children aged from 1 to 5 years with septic shock requiring mechanical ventilation admitted to PICU from January 2017 to June 2020 were prospectively included.Under the condition of complete mechanical ventilation, full sedation and analgesia, and no spontaneous breathing(tidal volume 8 to 10 mL/kg), volume expansion was given to children.Hemodynamic indexs such as cardiac index(CI), stroke volume index(SVI) and stroke volume variability(SVV) were measured before and after volume expansion by noninvasive cardiac output monitoring(NICOM) and TTE.Moreover, aortic flow velocity time integral variable degrees(ΔVTI), inferior vena cava variability(ΔIVC) and inferior vena cava dilation index(dIVC) were also measured by TTE.Patients were considered to be responsive to volume expansion if SVI NICOMincreased≥15%.Based on the responsiveness of volume expansion, all the patients were divided into response group and non-response group.The value of SVV TTE, ΔVTI, ΔIVC, dIVC, ΔCVP and SVV NICOMin predicting volume responsiveness were analysed. Results:(1) There were 23 cases in response group and 18 cases in non-response group.Before volume expansion, there were no statistically significant differences in general hemodynamic indexes HR, MAP, CVP, EF, CI NICOM, and CI TTEbetween two groups( P>0.05). (2) In response group, HR, MAP, CI, SVI and CVP were all improved after volume expansion( P<0.001). In non-response group, only CVP was significantly increased after volume expansion, while other indexes were not improved( P>0.05). (3)Before the volume expansion, SVV TTE, ΔVTI, ΔIVC, and dIVC in response group were higher than those in non-response group( P<0.001). After volume expansion, these indicators were significantly reduced in response group.In non-response group, only ΔIVC significantly reduced after volume expansion.(4) The receiver-operating characteristic curve analysis showed that the area under the curve of SVV TTEand ΔVTI was 0.971, with 12.04% as the threshold, the sensitivity was 0.957 and the specificity was 0.944. The area under the curve of ΔIVC was 0.981, with 25.98% as the threshold, the sensitivity was 0.870 and the specificity was 1.000.The area under the curve of dIVC was 0.980, with 29.86% as the threshold, the sensitivity was 0.870 and the specificity was 1.000. The area under the curve of ΔCVP was 0.778, with 2.5 cmH 2O(1 cmH 2O=0.098 kPa) as the threshold, the sensitivity was 0.913 and the specificity was 0.556. The area under the curve of SVV NICOMwas 0.874, with 12.50% as the threshold, the sensitivity was 0.869 and the specificity was 0.778. Conclusion:The dynamic indexes SVV, ΔVTI, ΔIVC and dIVC monitored by TTE have good accuracy in evaluating children′s volume responsiveness, among which the accuracy of ΔIVC and dIVC is relatively the highest; the value of ΔCVP in predicting volume responsiveness is limited.

Objective To analyze the clinical and nursing care of peripartum reversible posterior leukoencephalopathy syndrome (RPLS).Methods Thirty five cases with peripartum RPLS were retrospectively reviewed.Results All patients developed acutely,22.9％ in the antepartum period and 77.1％ in the postpartum period.The major clinical characteristics were headache (65.7％),seizures(62.9％),visual disturbances (54.3％),altered mental status (22.9％).The most common abnormality on neuro-imaging was edema predominantly involving the cortex and subcortical white matter in the posterior portions of the cerebral hemispheres,including the occipital lobes (77.1％),parietal lobes (65.7％),temporal lobes (28.6％) and frontal lobe (20.0％).MR diffusion-weighted imaging and ADC mapping revealed vasogenic edema.The treatments included aggressive blood pressure control and anticonvulsants with special nursing care.The clinical symptoms and the lesions on neuroimaging improved or resolved within 1 day to 2 months.Conclusions The prognosis for peripartum RPLS is ensured as long as the diagnosis is made properly and reasonable application of care program.

[Objective] The present study aimed to determine the protective role of Melatonin (MT) against Acrylamide (AA)-induced testicular toxicity and the potential molecular mechanism.[Methods] The animals were randomly divided into three groups,the control group (n =12),the AA group (n =12) and the AA+MT group (n =12).The rats in the AA and AA + MT group were gavaged with AA at a dose of 15 mg/(kg · day) for 4 consecutive weeks.After 3 weeks of AA treatment,MT was intraperitoneally injected 30 minutes before AA treatment at 10 mg/(kg· day) for 1 week in the AA + MT rats.Subsequently,the mitochondrial membrane potential measurement,TUNEL assay,Western blot and electron microscopic techniques were applied in the present study.[Results] The results showed that AA could decrease the testis mitochondrial membrane potential (P ＜ 0.05) which could be recovered by MT (P ＜ 0.05).Moreover,MT induced down-regulation of Bax expression and up-regulation of Bcl-2 expression in the testis,compared with AA rats.The amelioration of testicular apoptosis was further confirmed by the TUNEL labeling.Western blot results suggested that the decreased ratios of Bcl-2/Bax and Bcl-xL/Bak in the AA group (both P ＜ 0.05) could be recovered by MT treatment (both P ＜ 0.05).The levels of Cyt-c,Casp-3,p53 and NF-κB in AA group were markedly elevated compared with the control (all P ＜ 0.05),and reduced in MT treatment group (all P ＜ 0.05).MT could relieve abnormal mitochondrial structures in the seminiferous tubule in the electron microscopic level.[Conclusion] MT may exert productive effect through its anti-apoptotic properties associated with mitochondria.

Objective To establish the CTRP4 transgenic mouse model and investigate the function of the novel adipocytokine CTRP4.Methods CTRP4 overexpressing vector in pCAGGS was firstly constructed and then microinjected into zygote to establish the founder transgenic mice .F1 heterozygotes were generated by founder mice mating with wildtype mice, and the CTRP4 transgenic homozygotes were generated by F 1 littermates.The genotype was confirmed by PCR and test cross method .The expression level of CTRP 4 in transgenic mice was detected by western blot .Result The human CTRP4 transgenic homozygote mice line was established , and the expression level of CTRP 4 was confirmed raletively high in detected tissues including heart , liver, brain and kidney . Conclusion The human CTRP4 transgenic mice was successfully established .

Objective:To analyze the relationship between infection and transmission of HIV/AIDS, explore the characteristics of the HIV-1 transmission network, and provide evidence for formulating targeted prevention and control measures.Methods:The newly confirmed HIV/AIDS in Jiaxing from 2017 to 2018 were selected for the study. The sociodemographic and infection transmission-related information was gathered. The blood samples were collected and RNA was extracted, RT-PCR and nested PCR amplified the pol gene of HIV-1. The phylogenetic tree was constructed by Mega 6.0 software for subtype analysis. The genetic distance between strains was calculated, and the molecular transmission network was drawn by using Cytoscape 3.6.0 software. The results of the epidemiological study based on the molecular transmission network were analyzed. Results:There were fifteen HIV-1 gene subtypes in 517 cases of HIV/AIDS. The main subtypes were CRF01_AE (37.1%)、CRF07_BC (36.2%) and CRF08_BC (11.8%). Under the 1.0% gene distance threshold, 87 molecular clusters were established, and the total clustering rate was 45.8% (237/517). The cluster risk factors were 60-81 age group (compared with 14-24 age group, OR=2.690, 95% CI:1.058-6.844), married (compared with unmarried, OR=1.698, 95% CI:1.003-2.875), CRF07_BC subtype (compared with CRF01_AE, OR=2.203, 95% CI:1.426-3.404). The largest molecular cluster, CRF07_BC-1, consisted of 50 cases (including 21 cases confirmed in 2017 cases and 29 confirmed in 2018). Multivariate analysis showed that characteristics of unmarried (compared with married, OR=2.482, 95% CI:1.140-5.402), gays (compared with heterosexual, OR=3.163, 95% CI:1.543-6.483), cases with high-risk transmission (compared with other cases, OR=7.631, 95% CI:1.783-32.654), confirmed in Nanhu and Pinghu districts of Jiaxing (compared with other districts, OR=2.225, 95% CI:1.074-4.608) were risks for entering the largest molecular cluster. There were seven suspected high-risk transmission MSM in the largest molecular cluster. The first debut of homosexual behavior was from 2010 to 2018, and the median number of gay partners was 20 ( P 25, P 75：10, 100) within two years before being diagnosed. Six reported a recent history of looking for gay partners in an MSM dating place in Nanhu district. Conclusions:The HIV-1 subtypes of newly confirmed HIV/AIDS were diverse, mainly sporadic in Jiaxing from 2017 to 2018. There were geographical aggregation characteristics and suspected some high-risk transmission cases, suggesting that rapid transmission and targeted intensive intervention are needed.

Objective:To explore the effect of self-health monitoring information platform in health management of pregnant women at home, so as to provide a reference for self health management of pregnant women at home.Methods:From January 2020 to January 2021, a total of 1 683 pregnant women in Hangzhou Women's Hospital were selected as the research objects using the convenient sampling method, and divided into the intervention group ( n=815) and the control group ( n=868) . The control group received routine antenatal examination, and the intervention group conducted self-health monitoring information platform and routine antenatal examination. The school attendance rate, sleep quality during pregnancy, detection rate of fetal distress, pregnancy weight gain and premature birth rate were compared between the two groups. Results:The school attendance rate, sleep quality during pregnancy, detection rate of fetal distress of the the intervention group were higher than those of the control group, the number of pregnant women with normal weight gain was higher than that of the control group, premature birth rate of the intervention group was lower than that of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Self-health monitoring information platform can improve the quality of sleep and normal weight gain during pregnancy of pregnant women, reduce the incidence of preterm birth, which has important application value under the background of the national "universal three-child" policy.