In the context of ongoing health reform,it is important to establish and improve the regulation system of public hospitals.By defining the concept of regulation,regulation theories for public hospitals,the regulation systems of the typical countries,the paper summarizes the international experience enlightenment to China's public hospital regulation reform.

Objective To learn the clinical features of severe pneumonia in northeast sichuan ,and to improve the diagnosis and treatment level .Methods Basic disease or concomitant diseases and it′s clinical features were retrospective analyzed in different age patients with severe pneumonia in 2011 .Results (1)basic diseases and fatality cases /deteriorated cases were increased in elderly patients with the increase of age .There were 4 patients infected with HIV (3 cases under 65 years old ,1 case over 70 year old) .(2) onset pattern was given first place to suffer from cold ,but 40% were showed for symptoms of nervous system ,heart disease and other respiratory system ;(3)The main respiratory failure types of severe pneumonia is Ⅰ (about 70% ) ,30% of patients needed support of machine ventilation ;(4)community pneumonia were main type(75% );detection rate of Fungal infections and G -bacteria were 25% -30% ,normal bacteria (Streptococcus and Neisser bacteria )were over 1/3 ,Staphylococcus aureus were about 10% ;(6) More than 70% of the patients with different degree of hypoalbuminemia ;(7)Cure accounts for 2/3 ,poor prognosis accounted for 1/3 ,in which death and voluntary discharge were each 16 .6% ,ventilator-dependent ,multi-organ failure ,infections and some com-plex social factors were the prognostic factors .Conclusion Understanding the features and treatment difficulty of the local commu-nity acquired pneumonia is helpful to improve the timely diagnosis ,treatment and rescue level of patients with severe pneumonia .

Objective:The present study was aimed to determine the value of cone beam CT (CBCT) in predicting the risk of lingual bone plate injury during extraction of impacted mandible third molar (IMTM).Methods:The original CBCT data of 150 teeth (50 in vertical, 50 in angular and 50 in horizontal ) in January 2018 to December 2019 in Panzhihua Central Hospital of Sichuan Province were collected and analyzed. The thickness of lingual bone plate in enamel cementum boundary (ECB), root middle (RM) and root tip (RT) of each IMTM was measured by the software of CBCT system, and datas were analyzed by one-way ANOVA.Results:The average thickness of lingual bone plate in ECB of IMTM was (1.36±0.43)mm, (1.21±0.44)mm and (1.28±0.40)mm in vertical, horizontal and angular groups, respectively, with no significant difference ( F=1.07, P=0.35). The average thickness of lingual bone plate in RM of IMTM was (1.48±0.33)mm, (1.06±0.57)mm and (1.11±0.45)mm, respectively, with statistically significant difference ( F=8.78, P<0.01). The average thickness of lingual bone plate in RT of IMTM was (1.44±0.49)mm, (0.84±0.58)mm and (0.86±0.64)mm, respectively, with statistically significant difference ( F=12.35, P<0.01). Compared with the mandibular second molar, there were statistically significant differences in the average thickness of the lingual bone plate in ECB ( F=5.03, P<0.01), the RM ( F=15.13, P<0.01) and the RT ( F=33.12, P<0.01) of the IMTM among the three groups. In addition, the horizontal and angular IMTM, the thinness of lingual bone plate in RT region was more likely to occur than in vertical, and the absence of lingual bone plate was most likely to occur in patients with partial buccal crown. Conclusions:The doctor-patient communication and risk prediction should be sufficient before IMTM extraction when CBCT shows that the lingual bone plate of RT region is thin or absent. At the same time, we should avoid violent operation and thoroughly protect the lingual bone plate in the process of tooth extraction, and guard against serious complications such as perforation or fracture of lingual bone plate of mandible, and root displacement.

OBJECTIVETo understand the high risk behaviors of female sex workers (FSWs) in Yunnan province in 2013.

METHODSA cross-sectional investigation was conducted during April to June, 2013 in Yunnan province, census was used to the investigation where the number of FSWs was close to 200, while probability sampling was used where the number of FSWs was obviously over 200. A total of 25 574 cases were investigated, and data on demography and risk behaviors were obtained by questionnaires one by one.

RESULTSA total of 25 574 cases were investigated, AIDS awareness among FSWs in high-level places, middle-level places and low-level place were 98.8% (92/7 401), 98.6% (150/10 995), and 96.0% (281/6 655). FSWs from low-level place had a lower rate than those from the other two types of places (P < 0.01). The rate of condom use each time when having sex with clients within the recent one month among FESs from high-level places, middle-level places and low-level place were 93.4% (6 307/6 755), 93.8% (10 109/10 782) and 90.4% (6 053/6 697), and the FSWs working in low-level place had a lower rate than those from the other two types of places(P < 0.01). Multi-factor logistic regression analysis showed that the following had a lower rate of condom use: the FSWs working in low-level place (OR = 1.56, 95% CI:1.36-1.79; OR = 1.36, 1.16-1.59), over 30 years old (OR = 0.77, 95%CI:0.69-0.85), Yunnan citizen (OR = 0.88, 95% CI:0.77-1.00), minority (OR = 1.32, 95% CI:1.16-1.50), under senior high school (OR = 0.61, 95%CI:0.49-0.75), married (OR = 0.81, 95% CI:0.71-0.92), living together (OR = 0.70, 95% CI:0.51-0.96), divorced or lost spouses (OR = 0.81, 95% CI:0.65-1.02), worked less than 6 months in local areas (OR = 1.74, 95% CI:1.34-2.27), drug users (OR = 1.65, 95% CI:1.11-2.46), had not accepted HIV interventions (OR = 2.91, 95% CI:2.36-3.58), had no knowledge about AIDS (OR = 4.50, 95% CI:3.48-5.82). The main reasons for not using condoms were the clients' unwilling to use, which accounted for 47.62% (270/567). The total rate of drug use was 1.0% (264/25 567) and the FSWs working in middle-level places had the highest rate of injecting drugs, which accounted for 0.6% (70/11 141). The FSWs working in low-level places had a higher rate than those who worked in high-level places and middle-level places in venereal diseases, which accounted for 1.2% (85/6 934) (P < 0.01). The rate of receiving effective interventions was 96.7% (24 717/25 574), the rate of accepting treatment and clean needles among drug users was 21.6% (57/264).

CONCLUSIONHigh risk behaviors were serious among the FSWs who worked in low-level places, especially among the olders, the minorities, people who had lower educational level, the new-comer and drug users, which indicated that more attention needs to be paid among these populations.

Age Factors ; China ; Condoms ; Cross-Sectional Studies ; Demography ; Drug Users ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Marital Status ; Risk-Taking ; Safe Sex ; Sex Workers ; Sexually Transmitted Diseases ; Socioeconomic Factors ; Surveys and Questionnaires

Objective:To summarize the clinical phenotype and genetic characteristics of one child patient with mitochondrial 3-hydroxy-3-methylglutaryl-CoA synthase deficiency (mHS) caused by HMGCS2 gene mutation. Methods:One child patient with mHS who received treatment in Chongqing University Three Gorges Hospital on April 10, 2020 was included in this patient. The child was hospitalized due to cough, shortness of breath and deep coma. After admission, gas chromatography-mass spectrometry of the blood and urine samples and high-throughput whole genome sequencing were performed. The pedigree of the child with gene mutation was analyzed. The child was diagnosed with mHS. Related publications published by June, 2020 were searched in Wanfang database, Chinese Journal Full Text Database, PubMed and HGMD databases using search terms "mitochondrial 3-hydroxy-3-methylglutaryl-CoA synthase deficiency", "HMGCS2" "mHS deficiency". Forty-three papers addressing mHS deficiency were retrieved. The clinical phenotype and genotypes of the child with HMGCS2 mutation were summarized. Results:As of June 2020, there were 44 children with mHS deficiency, including the child reported in this study. These children consisted of 15 males, 11 females and 18 unknown genders. Among these children, 29 were aged 0-24 months, 4 were aged > 24 months, 6 had no symptoms, and 5 were of unknown age of disease onset. The first symptoms of most children were fever, cough, acute gastroenteritis, and coma. Twenty-seven children had hypoglycemia, 21 children had metabolic acidosis, 15 children developed hepatomegaly, 16 children had increased FFA/D-3-HB, and 10 children were tested 4-hydroxy-6-methyl-2-pyrone positive. The child included in this study had hepatomegaly, elevated alanine aminotransferase and metabolic acidosis. Gas chromatography-mass spectrometry results showed that a variety of metabolites were increased. Tandem mass spectrometry results showed that C40 level was elevated, and long-chain carnitine contents were increased. High-throughput whole genome sequencing results revealed that there were two heterozygous mutations in HMGCS2 gene, (NM_0055) c.559+1G > A; c. 758 T > C heterozygous mutation. Sanger sequencing and parental origin analysis showed that the mutations in this child were from parents. The two gene mutations in this child were new mutations, which have not been reported in China and countries outside China. According to the criteria and guidelines for interpretation of ACMG sequence variation, the variation was determined to be pathogenic. Conclusion:When a child has hypoketotic hypoglycemia and/or metabolic acidosis, increased FFA/D-3-HB and acetylcarnitine levels, mHS deficiency should be considered. HMGCS2 gene examination can help diagnose mHS deficiency.

Objective To understand the high risk behaviors of female sex workers ( FSWs) in Yunnan province in 2013.Methods A cross-sectional investigation was conducted during April to June, 2013 in Yunnan province, census was used to the investigation where the number of FSWs was close to 200, while probability sampling was used where the number of FSWs was obviously over 200.A total of 25 574 cases were investigated, and data on demography and risk behaviors were obtained by questionnaires one by one.Results A total of 25 574 cases were investigated, AIDS awareness among FSWs in high-level places, middle-level places and low-level place were 98.8%( 92/7 401 ) , 98.6%( 150/10 995 ) , and 96.0%(281/6 655).FSWs from low-level place had a lower rate than those from the other two types of places(P<0.01).The rate of condom use each time when having sex with clients within the recent one month among FESs from high-level places, middle-level places and low-level place were 93.4%(6 307/6 755), 93.8%(10 109/10 782) and 90.4%(6 053/6 697), and the FSWs working in low-level place had a lower rate than those from the other two types of places(P<0.01).Multi-factor logistic regression analysis showed that the following had a lower rate of condom use: the FSWs working in low-level place(OR=1.56,95%CI:1.36-1.79;OR=1.36,1.16-1.59), over 30 years old(OR=0.77, 95%CI:0.69-0.85), Yunnan citizen (OR=0.88, 95%CI:0.77-1.00), minority(OR=1.32, 95%CI:1.16-1.50), under senior high school (OR=0.61, 95%CI:0.49-0.75),married(OR=0.81,95%CI:0.71-0.92), living together(OR=0.70, 95%CI:0.51-0.96), divorced or lost spouses(OR=0.81,95%CI:0.65-1.02), worked less than 6 months in local areas(OR=1.74, 95%CI:1.34-2.27), drug users(OR=1.65, 95%CI:1.11-2.46), had not accepted HIV interventions(OR=2.91,95%CI:2.36-3.58), had no knowledge about AIDS(OR=4.50, 95%CI:3.48-5.82 ) .The main reasons for not using condoms were the clients′unwilling to use, which accounted for 47.62%( 270/567 ) .The total rate of drug use was 1.0%( 264/25 567 ) and the FSWs working in middle-level places had the highest rate of injecting drugs, which accounted for 0.6%( 70/11 141).The FSWs working in low-level places had a higher rate than those who worked in high-level places and middle-level places in venereal diseases, which accounted for 1.2%(85/6 934)(P<0.01).The rate of receiving effective interventions was 96.7%(24 717/25 574), the rate of accepting treatment and clean needles among drug users was 21.6%(57/264).Conclusion High risk behaviors were serious among the FSWs who worked in low-level places, especially among the olders, the minorities, people who had lower educational level, the new-comer and drug users, which indicated that more attention needs to be paid among these populations.

Objective To understand the high risk behaviors of female sex workers ( FSWs) in Yunnan province in 2013.Methods A cross-sectional investigation was conducted during April to June, 2013 in Yunnan province, census was used to the investigation where the number of FSWs was close to 200, while probability sampling was used where the number of FSWs was obviously over 200.A total of 25 574 cases were investigated, and data on demography and risk behaviors were obtained by questionnaires one by one.Results A total of 25 574 cases were investigated, AIDS awareness among FSWs in high-level places, middle-level places and low-level place were 98.8%( 92/7 401 ) , 98.6%( 150/10 995 ) , and 96.0%(281/6 655).FSWs from low-level place had a lower rate than those from the other two types of places(P<0.01).The rate of condom use each time when having sex with clients within the recent one month among FESs from high-level places, middle-level places and low-level place were 93.4%(6 307/6 755), 93.8%(10 109/10 782) and 90.4%(6 053/6 697), and the FSWs working in low-level place had a lower rate than those from the other two types of places(P<0.01).Multi-factor logistic regression analysis showed that the following had a lower rate of condom use: the FSWs working in low-level place(OR=1.56,95%CI:1.36-1.79;OR=1.36,1.16-1.59), over 30 years old(OR=0.77, 95%CI:0.69-0.85), Yunnan citizen (OR=0.88, 95%CI:0.77-1.00), minority(OR=1.32, 95%CI:1.16-1.50), under senior high school (OR=0.61, 95%CI:0.49-0.75),married(OR=0.81,95%CI:0.71-0.92), living together(OR=0.70, 95%CI:0.51-0.96), divorced or lost spouses(OR=0.81,95%CI:0.65-1.02), worked less than 6 months in local areas(OR=1.74, 95%CI:1.34-2.27), drug users(OR=1.65, 95%CI:1.11-2.46), had not accepted HIV interventions(OR=2.91,95%CI:2.36-3.58), had no knowledge about AIDS(OR=4.50, 95%CI:3.48-5.82 ) .The main reasons for not using condoms were the clients′unwilling to use, which accounted for 47.62%( 270/567 ) .The total rate of drug use was 1.0%( 264/25 567 ) and the FSWs working in middle-level places had the highest rate of injecting drugs, which accounted for 0.6%( 70/11 141).The FSWs working in low-level places had a higher rate than those who worked in high-level places and middle-level places in venereal diseases, which accounted for 1.2%(85/6 934)(P<0.01).The rate of receiving effective interventions was 96.7%(24 717/25 574), the rate of accepting treatment and clean needles among drug users was 21.6%(57/264).Conclusion High risk behaviors were serious among the FSWs who worked in low-level places, especially among the olders, the minorities, people who had lower educational level, the new-comer and drug users, which indicated that more attention needs to be paid among these populations.

The correlations of global/local properties of brain networks with gambling behavioral scales in depression are explored.The task-state brain functional magnetic resonance imaging data of 24 patients with gambling behavior and depression and 24 healthy controls are analyzed,and preprocessed by SPM software.Graph theory analysis method is used to establish the functional brain networks in which local and global properties are calculated.Two sets of local attribute index including node degree and node efficiency are used to make edge analysis in different depression groups(major,moderate and mild depression groups,with 8 patients in each group)and healthy control group,and the changes in global properties are also discussed.Additionally,the correlations of scoring scale related to gambling behavior with 3 criteria on the global properties(small world attribute,global efficiency and local efficiency)are analyzed.The two-sample t-tests on depression groups and healthy control group confirm the significant connections among brain regions(P＜0.05),and reveal the significant negative correlations between the global brain network attribute indexes and different behavioral scales,which fully verifies the correlation between gambling behavior and depression,and provides the basis for further exploring correlation between the individual behavior attribute and depression,thereby assisting clinical diagnosis and treatment of depression patients.

OBJECTIVETo analyze the characteristics of risky behaviors among different age groups of HIV positive female sex workers, and to explore the strengthening of their management.

METHODSFrom January to June 2014, 22 814 female sex workers were investigated and tested HIV in 117 sentinel surveillance sites in Yunnan Province, and 181 were confirmed to be HIV antibody positive, who accepted questionnaire surveys. According to the age, the participants were divided into the < 35 years old age group and ≥ 35 years old age group. The demographic characteristics, knowledge about HIV/AIDS and related risk behaviors characteristics of the two groups were obtained via questionnaire surveys among 181 HIV positive female sex workers, and in-depth qualitative interviews were conducted from among 12 HIV positive sex workers.

RESULTSHIV antibody positive rate was 0.8% (181), the age of the 181 subjects were (35.83 ± 9.17) years old, 76 cases (42.0%) were < 35 years old, and 105 cases (58.0%) were ≥ 35 years old. The differences of marital status, workplace class, the last work site among two groups were statistically significant (χ(2) = 20.80, 28.32, 7.83; P < 0.001, P < 0.001, P = 0.020, respectively). Among 181 HIV, the proportion of AIDS awareness was 95.6% (173); the proportion of drug use among ≥ 35 years old age group was 51.4% (54), which was higher than that in < 35 years old age group (34.2%, 26/76) (χ(2) = 5.30, P = 0.021). 96.7% (175) received condom promotion or HIV counseling and testing in the past year. The proportion of continuing to engage in sexual services over 5 years after HIV infection was 48.5% (51/105) and the proportion of receiving antiretroviral treatment was 69.5% (73/105) in ≥ 35 years old age group, which were higher than those in the < 35 age group (30.2% (23/76), 52.6% (40/76); χ(2) = 12.26, 5.36; P = 0.002, 0.021, respectively). In-depth interviews among 12 HIV positive female sex workers found that regular clients, not consistent use of condoms were the main cause of no condom use. Economic and livelihood factors are important reasons for continuing to engage in sexual services among HIV positive sex workers.

CONCLUSIONHIV positive sex workers still have high risk behaviors including continuing to engage in commercial sexual service and no condom use after knowing their HIV infection status, and the proportion of using drugs in the ≥ 35 years old group was higher than that in < 35 years old group.

Adult ; China ; Condoms ; Female ; HIV Seropositivity ; Humans ; Marital Status ; Risk Factors ; Risk-Taking ; Safe Sex ; Sex Workers ; statistics & numerical data ; Sexual Behavior ; Substance-Related Disorders ; Surveys and Questionnaires