The developed countries have increasingly used private sector involvement in the practices of developing, financing and providing public health infrastructure and services through public-private partnerships (PPPs) in recent years.The main reasons for this uptake in these countries are manifold ranging from the rising expenditures for refurbishing, maintaining and operating public assets, and the increasing constraints on the governmental budgets stifle because of the economic downturn.As a result, the government needs funds to cover inadequate inputs and seeks innovation through private sector experts and management expertise aiming for better operational risks mitigation.In this paper, 18 risk factors in health sector of China were tracked through the literature research, and the research aims to identify the risk allocation by issuing the questionnaires and conducting interviews with experts from the academia, and public and private sectors.This paper finally provides the scheme about the appropriate risk allocation to focus on improving the mitigation of the existing risks in order to achieve successful PPP projects.

Recently, Public-private Partnerships (PPPs) are being increasingly used in the public facilities and services provision in China.The procurement system ranges from simple contracting of services to the involvement of the private sector in the infrastructure financing, design, construction, operation and maintenance.However, organizing a PPP is not an easy task due to its complexity and long term contractual obligations and this some projects to fail to attract the private sector in the partnership and in the services provision.18 critical success factors of PPP project in the Chinese health sector were undermined by the investigation of this research.The mostly identified CSFs are thorough and realistic benefit assessment, sound policies, appropriate risk allocation and risk mitigation, and the public/private sector responsibilities.This paper finally puts forward the recommendations based on the statistics that are published from the Integrated Information Platform of CPPPC in order to focus on validating them for successful PPP projects achievement.

Objective To understand the status of comprehensive health function impairment in elderly patients with rheumatoid arthritis, and to explore its influencing factors. Methods A total of 80 elderly patients with rheumatoid arthritis were enrolled in the first Affiliated Hospital of Kunming Medical University from December 2014 to October 2016. The quality of life SF-36 score was used to measure the physical health, mental health, daily activities and social health to assess the overall health status of patients. The factors influencing the comprehensive health function of the patients were analyzed by univariate analysis and multivariate linear regression analysis. Results The univariate and multivariate analysis showed that the low level of education, general occupation, marital misfortune, poor economic condition and self-treatment expense were the risk factors affecting the comprehensive health function in elderly patients with rheumatoid arthritis ( P<0.05). Conclusion Elderly patients with rheumatoid arthritis have problems of the functions of daily life, physical health, mental health and social health. To alleviate the high medical costs, improve the level of medical treatment, improve the people 's health and education level and maintain a good mood are the key to improve the overall health in patients with rheumatoid arthritis.

Around the world, the supply of health services faces challenges, especially in developing nations that suffer from inadequate infrastructure and aging equipment, frequent shortages of medicine and supplies, and low capacity and efficiency of primary health care. At present, more and more governments adopt public-private partner-ships to achieve public policy goals. Among those, Brazil, South Africa, and India have made greater achievements in changing the roles of local government, increasing the supply of primary health care and health care quality, pro-moting health care equality, meeting the needs of multi-level medical services, and promoting health capabilities by using public-private partnerships. This paper provides an overview of public-private partnership practices in the three countries, discusses their reform experiences, and concludes with implications which may be helpful for promoting and scaling up PPP in primary health care in China.

Adult ; Humans ; Male ; Patellar Dislocation ; congenital ; diagnosis ; therapy

AIM: To analyze the clinical feature and treatment of endogenous endophthalmitis caused by liver abscess. METHODS: A total of 9 eyes (7 cases) with endogenous endophthalmitis caused by liver abscess in our hospital from 2005 to 2010 were analyzed retrospectively. Microorganism was cultivated with blood or vitreous in all patients.4 eyes were performed vitrectomy. 2 eyes were injected antibiotics in vitreous cavity. 3 eyes were only treated with antibiotics.RESULTS: Two cases (2 eyes) were diagnosed with endophthalmitis firstly, then found liver abscess; 4 eyes were with diabetes mellitus, and 1 eye with abnormal glucose tolerance. Cultivation of microorganism was positive in 6 eyes (67%), including Pneumonia cray-research, Candida albicans and Escherichia coli. 5 eyes had useful vision after treatment, 1 eye had light perception,3 eyes became blindness. CONCLUSION: As an ocular emergency, endogenous endophthalmitis caused by liver abscess can severely damage visual function. Timely consultation, early diagnosis, proper systemic and topical anti-infective and anti-inflammatory treatment are the most effective methods for controlling infection. Vitrectomy with intravitreal antibiotics plays an important role in preserving useful vision function in patients.

AIMTo investigate the expressions of main subtypes of heat shock protein (HSP) in cervical cancer and precancerosis tissues.

METHODSAccording to the pathological diagnosis, 478 cases of cervical biopsy specimen were divided into invasive carcinoma of cervix group (63 cases), cervical intraepithelial neoplasia group (CIN, 106 cases), chronic cervicitis group (293 cases) and normal uterine cervix (16 cases).The expression levels of HSP70, HSP90a and HSP90beta3 mRNA were detected by quantitative RT-PCR with specific complex cRNA as internal control.

RESULTS(1) The expressions of HSP70, HSP90a and HSP90beta mRNA were significantly down-trended stepwise in invasive carcinoma of cervix, CIN, chronic cervicitis and normal cervix tissue (P < 0.01, respectively). (2) In the invasive carcinoma of cervix group, the expression level of HSP90beta mRNA was higher in advanced stage (FIGO II b) compared with incipient(FIGO-II a) carcinoma of the cervix (P < 0.05). (3) The expressions of HSP70 and HSP90 mRNA were each higher in poorly differentiated tumor than in well-differentiated tumor (P < 0.05, respectively). (4) The expression levels of all three HSP mRNA had no significant differences, it was observed with different histological types of cervical cancer (P > 0.05).

CONCLUSIONHeat shock protein may play some important roles in malignant transformation of cervix cell and aggravation of cervix cancer. HSP70 and HSP90alpha may promote cancer cell transition and proliferation, and HSP90beta may participate in cell differentiation.

Carcinoma ; metabolism ; pathology ; Female ; HSP70 Heat-Shock Proteins ; metabolism ; HSP90 Heat-Shock Proteins ; metabolism ; Humans ; Precancerous Conditions ; metabolism ; pathology ; Tumor Cells, Cultured ; Uterine Cervical Neoplasms ; metabolism ; pathology ; Uterine Cervicitis ; metabolism ; pathology

OBJECTIVETo improve the X-ray diagnosis of cervical spondylosis of vertebral artery type (VCS).

METHODSA blinded design research. The X-ray signs both 60 patients with VCS and 60 patients with cervical spondylotic radiculopathy were collected from January 2011 to November 2012. There were 36 males and 84 females, aged from 25 to 65 years old with an average of (48.4 ± 12.3) years old. Cervical curvature, atlanto-occipital joint angle, atlanto-axial joint angle, C2/C3 joint angle and lower cervical instability condition and segmental distribution were measured and recorded by X-rays. These data were analyzed and compared between the two groups after unblended. Combined with clinical manifestations,the X-ray imaging features of VCS were further analyzed.

RESULTSThere was significant difference in cervical curvature between two groups in anteflexion X-ray films (P < 0.05). There was significant difference in extension degree of atlanto-occipital joint angle between two groups (P < 0.01). There was significant difference in atlanto-axial joint angle between two groups in lateral X-ray films (P< 0.05). There was significant.difference in anteflexion degree of atlanto-axial joint angle between two groups (P < 0.05). There was no significant difference in C2/C3 joint angle between two groups. There was no significant difference in the lower cervical instability condition and segmental distribution between two groups. In VCS group, the mild and moderate dizziness was main symptom, flexion and extension activities of neck was most common cause in the dizziness; and always accompanied with headache; tenderness mostly concentrated in the upper cervical area.

CONCLUSIONBoth X-ray signs and clinical manifestations can prompt the abnormalities of the upper cervical structure or function in patients with VCS. Anteflexion activities of neck observed by functional position of X-ray films should be emphasized in diagnosis of VCS.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Radiculopathy ; diagnostic imaging ; Radiography ; Spondylosis ; diagnostic imaging ; Vertebral Artery ; X-Rays

OBJECTIVETo study the effect of endotoxin on the expression of peroxisome proliferator-activated receptor alpha (PPARa) in the development of nonalcoholic steatohepatitis in rats.

METHODSA model of nonalcoholic steatohepatitis (NASH) was developed with Wistar rats fed a chow containing 20% maize oil for 14 weeks. The endotoxin group rats were intraperitoneally injected with lipopolysaccharide (LPS, 1 g/L, 3.0 ml/kg) once 4 hours before the end of the experiment. The concentrations of lipids, endotoxin, tumor necrosis factor-a, malondialdehyde, free fatty acid in plasma and hepatic tissues were determined and the degree of hepatocytic steatosis was studied. The expression of PPARa mRNA in hepatic tissues was measured using reverse transcriptase-polymerase chain reaction (RT-PCR).

RESULTSThe expression of PPARa mRNA in the hepatic tissue of the LPS group was downregulated markedly in comparison to that of the control group. The level of free fatty acid and endotoxin by secreting tumor necrosis factor-a increased and triglyceride accumulated in the liver caused malondialdehyde content to increase, then lipid peroxidation process enhanced and ALT activity increased. Thus, hepatic injury and inflammatory reaction could be accelerated.

CONCLUSIONEndotoxemia can enhance hepatocellular steatosis and lead to NASH due to its downregulating the expression of PPARa mRNA.

Animals ; Down-Regulation ; Endotoxins ; pharmacology ; Fatty Liver ; metabolism ; Liver ; metabolism ; Male ; PPAR alpha ; biosynthesis ; genetics ; RNA, Messenger ; biosynthesis ; genetics ; Random Allocation ; Rats ; Rats, Wistar ; Reverse Transcriptase Polymerase Chain Reaction

OBJECTIVE To understand the synaptic remodel in inner ear after hearing injury by investigating growth associated protein 43(GAP-43) expression in the inner ear hair cells after exposed Kangmin mice to neural injury noise stimulation to induce permanent threshold shift(PTS) or temporary threshold shift(TTS).METHODS To compare the expressions of GAP-43 of NMDAR signal pathway during neural injury stimulation by immunocytochemistry.RESULTS The sustained GAP-43 increase occurs after 7d and 14d of PTS group,and there is not remarkable difference between them.Compared with normal control,the change is not significant in TTS group.CONCLUSION The increase of GAP-43 in spiral ganglion after 7d trauma reveals the synaptic remodel in inner ear.