The paper,based on a review of the reform of state-owned enterprises,and of the duty positioning and supervision of state-owned assets management committee, described experiences of Shanghai Hospital Development Center (SHDC ) in learning from such reforms. Centering onappropriate separation of ownership and power of management and defining public hospitals as key player of state-owned assets,SDHD explored to build a state-owned assets investor system conforming to the institutional positioning,assets category and operating targets of such hospitals.This way a state-owned assets management mode is gradually set up,featuring to make regulations beforehand,to supervise in the course and to supervise afterwards.

Objective Studies of the positioning,framework and weight of the performance of directors of third-grade public hospitals will pave the way for launching a study of the performance of these directors,and for the performance appraisal of the directors of third grade public hospitals.Methods The following methods are called into play:Meta-analysis of literature to summarize the research outcomes of the appraisal thinking and modeling for managers of public hospitals;the balance score card to design the theoretical base of public hospital performance framework;the Delphi Method to identify the functionality expected of public hospitals,and the thinking and framework for performance appraisal;in addition to experts consultancy to demonstrate via questionnaires.Results Positioning of directors performance appraisal of third-grade public hospitals comprises both desirable social effect outcomes and desirable operating status.This performance appraisal consists of such five dimensions as social satisfaction,effective management,asset operation,development sustainability,and employee recognition,totaling 12 performance objectives.Conclusion Scientific and reasonable design of the framework and weight of the perfofinance appraisal for managers of public hospitals is conducive to assuring the public interest nature for public hospitals.

The scientific and standardized articles recognized and followed by all members of the hospital are significant tools to ensure that the hospital adheres to the development direction of public welfare, to guide the operation and development of the hospital, to guarantee the autonomy of hospital management, and to promote the legalization of hospital management system and operation mechanism. Public hospitals are the main body of their articles′ formulation, and other stakeholders such as the organization running hospitals, industry association, health administrative departments can also play an active role in the process of public hospital articles′ formulation. The articles of public hospitals should cover the basic situation of hospitals, internal organizational structure, decision-making system, management system, external governance structure and relationship, etc. In the formulation of the public hospital′s articles, we should not only comply with requirements from policy documents, but also reflect the characteristics of the hospital. We should not only standardize the hospital′s governance and management, but also coordinate the existing institutional arrangements of the hospital. And we should not only formulate the articles, but also actively promote their implementation.

Objective To explore methods for performance appraisal of directors of municipal hospitals in Shanghai.Methods To assess the management performance of directors of 24 tertiary hospitals each year,measured by five dimensions of social satisfaction,management efficiency,capital operation,development sustainability and staff satisfaction,and 23 indexes.Results Implementation of the performance appraisal has witnessed constant improvement of patient satisfaction and quality of medical care,as well as rational control of medical expenses and cost.In 2014 for example,the cost of emergency/outpatients per visit at such hospitals were 312 yuan and 1 5 600 yuan per hospitalization respectively,with 7.6 days of stay in average.Also improved were service efficiency,clinical research output and hospital business performance in general.Conclusion Performance appraisal of directors of public hospitals proves an important means for guiding the hospitals to adhere to public welfare, consistent with the government medical institution operation target, and to strengthen internal management of such hospitals.

Objective:To investigate ability of HCA587/MAGE-C2 protein combined with different adjuvants inducing antigen-specific immune response and antitumor effects in mice model.Methods:C57BL/6J mice were immunized with HCA587 protein com-bined with Freund's complete adjuvant(CFA)/Freund's incomplete adjuvant(IFA)and different doses of CpG ODN 1826(CpG),cellular and humoral immunity levels induced by different schemes were compared.ELISpot was used to evaluate frequency of IFN-γ-producing splenocytes.HCA587-specific antibodies were detected by ELISA.Intracellular cytokine staining(ICCS)analysis was mea-sured by flow cytometry.A tumor-bearing animal model was created by subcutaneously injection of B16-HCA587 tumor cells into right flank of C57BL/6J mice,which was treated with strategy with the strongest cellular and humoral immune response in immune compari-son protocol.Vernier calipers were used to measure tumor volume,and Log-rank test was used to analyze survival curve.Results:HCA587 protein combined with CFA and 50 μg CpG elicited strongest specific IFN-γ-secreting splenocytes and anti-HCA587 anti-bodies,which induced highest IFN-γ+CD4+T cells(P<0.05).In tumor treatment model,HCA587 protein combined with CFA and 50 μg CpG significantly inhibited tumor growth(P=0.026),while Log-rank test showed no significant effect on survival(P>0.05).Conclusion:HCA587 protein vaccine formulated with CFA and 50 μg CpG causes a significant cellular and humoral immune response and partial antitumor effect in mice model,providing new experimental data for preclinical research of tumor antigen protein vaccine.

OBJECTIVE To systematically evaluate the efficacy and safety of eltrombopag combined with immunosuppressive therapy （IST） for severe aplastic anemia （SAA）， and to provide evidence-based basis for clinical treatment of SAA. METHODS Retrieved from PubMed， Embase， Cochrane Library， ClinicalTrials.gov， VIP， CNKI and Wanfang data， randomized controlled trials （RCTs） and cohort studies about eltrombopag combined with IST （trial group） versus IST alone （control group） were collected from the inception to May 2023. After data extraction and quality evaluation （Cochrane manual 5.1.0） of included studies， meta-analysis， subgroup analysis， sensitivity analysis and publication bias analysis were performed by using RevMan 5.4 software. RESULTS A total of 12 studies were screened， including 1 344 patients. Compared with control group， objective remission rate （ORR） （RR＝1.34， 95%CI was 1.06-1.69， P＝0.01） and complete response rate （CRR） （RR＝1.88， 95%CI was 1.31-2.71， P＝ 0.000 6） at 3 months， ORR （RR＝1.33，95%CI was 1.23-1.43， P＜0.000 01） and CRR （RR＝1.88，95%CI was 1.57-2.25，P＜0.000 01） at 6 months were significantly increased in trial group. There was no statistically significant difference between the two groups in ORR （RR＝0.99， 95%CI was 0.82-1.18， P＝0.88） and CRR （RR＝1.02， 95%CI was 0.78-1.34， P＝0.87） at 12 months， two-year overall survival （OS） rate （HR＝0.61， 95%CI was 0.31-1.22， P＝0.17）， two-year event-free survival （EFS） rate （HR＝0.81， 95%CI was 0.61-1.07， P＝0.14）， clone evolution rate（RR＝1.01， 95%CI was 0.51-2.00， P＝ 0.98） or the incidence of adverse drug reactions such as liver/renal insufficiency， rash （P＞0.05）. Results of subgroup analysis showed that ORR and CRR of trial group at 6 months were higher than those of the control group in RCT and the cohort study subgroups （P＜0.05）. There was no statistically significant difference in the two-year OS rate， two-year EFS rate or clone evolution rate between trial group and control group in the two subgroups （P＞0.05）. The results of sensitivity analysis and publication bias analysis showed that the results of this study were robust and the possibility of publication bias was small. CONCLUSIONS The addition of eltrombopag in the IST regimen of SAA can improve the early hematological remission rate of patients， has no significant impact on short-term survival， and will not increase the occurrence of adverse drug reactions and clonal evolution.

Objective: To retrospectively analyze the distribution of non-fermentative bacteria causing bloodstream infection in hospitalized patients in Sichuan Province and their drug susceptibility to common antibiotics for better understanding their epidemiological characteristics. Methods: From January 1, 2015 to December 31, 2017, all of the non-fermentative bacteria isolated from patients with bloodstream infection in nine hospitals in Sichuan Province were collected. Species distribution and drug resistance test results were retrospectively analyzed. Results: A total of 6 291 strains of pathogenic bacteria were isolated, including 3 674 strains of gram-negative bacteria (58.4%) and 2 617 strains of gram-positive bacteria (41.6%). The gram-positive bacteria were 1 895 strains of Staphylococcus (30.1%), 372 strains of Streptococcus (5.9%), 317 strains of Enterococcus (5.1%) and 33 strains of other gram-positive bacteria (0.5%). The gram-negative bacteria were 3 191 Enterobacteriaceae strains (50.7%), 389 non-fermentative strains (6.2%) and 94 other gram-negative strains (1.5%). The isolated non-fermentative bacteria were mainly Pseudomonas aeruginosa (136 strains, 35.0%), Acinetobacter baumannii (126 strains, 32.0%) and Stenotrophomonas maltophilia (33 strains, 8.5%). There were 167 (42.9%), 112 (28.8%) and 82 (21.1%) non-fermentative bacteria isolated in internal medicine departments, ICUs and surgery departments, respectively. The drug resistance rates of Pseudomonas aeruginosa to cefepime, ciprofloxacin and gentamicin were 16.5%, 10.7% and 9.9%, respectively. Carbapenems-resistant Pseudomonas aeruginosa (CR-PA) accounted for 13.6%. No polymyxin-resistant Pseudomonas aeruginosa was found. The resistance rates of Acinetobacter baumannii to all antibiotics were over 30% except for minocycline and polymyxin and 75.7% of carbapenem-resistant Acinetobacter baumannii (CR-AB) were isolated. The drug resistance rates to levofloxacin, trimethoprim/sulfamethoxazole and ceftazidime were 0%, 0% and 37.0% in Stenotrophomonas maltophilia isolates and 10.5%, 4.2% and 19% in Burkholderia cepacia isolates, respectively. Conclusions Non-fermentative bacteria causing 6.2% of bloodstream infection in Sichuan, mainly by Pseudomonas aeruginosa and Acinetobacter baumannii. There were significant differences in the isolation rate of non-fermentative bacteria in different departments and most of the strains were isolated in internal medicine departments. The detection rate of Acinetobacter baumannii with multiple drug resistance was high, while other non-fermentative bacteria had good sensitivity to antibiotics.