Based on the experience of Public-Private Partnership (PPPs) model in domestic and foreign medical field, this study innovatively explored and designed the Build-Transfer-Operate-Transfer (BTOT) operational structure taking the second phase project of ZP Hospital in Pudong New District as a case study.The exploration results showed that the model established the social capital of private non-profit medical institutions by setting up the project company, and used the asset rental and operating management fees in the form of return path.In view of this, the study put forward some relevant countermeasures and suggestions from the aspects of the institution nature and national treatment, property right ownership and risk mitigation, balancing of interests and the cooperation period and solving the core staff etc.All of these measures were taken in order to explore the replicable PPP model in the field of public hospital reform and development.

Objective:To observe the effects of acupuncture at Houxi(SI3)and Huantiao(GB30)on the expression levels of nuclear factor kappa B(NF-κB),inducible nitric oxide synthase(iNOS),and nitric oxide(NO)of NF-κB inflammatory signaling pathway in L5 spinal nerve root of lumbar disc herniation(LDH)model rats and explore the mechanism of acupuncture in LDH treatment.Methods:Forty specific-pathogen-free healthy male Sprague-Dawley rats were randomly divided into a sham operation group,a model group,acupuncture group 1,and acupuncture group 2,with 10 rats in each group.The non-compression nucleus protrusion model was made by puncturing L4-L5 spinous process space and injecting autologous nucleus suspension.Acupuncture at bilateral Shenshu(BL23),Dachangshu(BL25),and Weizhong(BL40)was carried out in acupuncture group 1,and acupuncture at bilateral Houxi(SI3)and Huantiao(GB30)in acupuncture group 2.All rats were treated with balanced reinforcing and reducing needling manipulations,and the needles were retained for 30 min/time with one episode of needling manipulation every 10 min,once a day,14 times in total.The threshold value of paw withdrawal pain was measured by a thermal stimulation pain instrument;the serum NF-κB,iNOS,and NO levels were measured by enzyme-linked immunosorbent assay.The pathomorphological changes of spinal nerve roots were observed by hematoxylin-eosin(HE)staining;quantitative reverse transcription polymerase chain reaction was used to detect iNOS mRNA expression in spinal nerve roots;the NF-κB and iNOS protein expression in spinal nerve roots was detected by the immunofluorescence method.Results:Compared with the sham operation group,the threshold of paw withdrawal pain in the model group was decreased,and the expression levels of serum NF-κB,iNOS,and NO were increased;HE staining showed many degenerated and dissolved Schwann cells in spinal nerve roots with vacuolar changes;meanwhile,the expression levels of NF-κB and iNOS proteins,and the iNOS mRNA in spinal nerve roots were increased.Compared with the model group,the paw withdrawal pain thresholds in acupuncture group 1 and acupuncture group 2 were increased,and the increase in acupuncture group 2 was greater(P<0.05);the expression levels of serum NF-κB,iNOS,and NO in acupuncture group 1 and acupuncture group 2 were decreased,especially in acupuncture group 2(P<0.01);the vacuolar changes of spinal nerve roots,and the degeneration and lysis of Schwann cells in acupuncture group 1 and acupuncture group 2 were decreased,which were more obvious in acupuncture group 2;the NF-κB and iNOS protein expression and the iNOS mRNA expression levels in spinal nerve roots of acupuncture group 1 and acupuncture group 2 were decreased,especially in acupuncture group 2(P<0.01).Conclusion:Acupuncture at Houxi(SI3)and Huantiao(GB30)can improve the morphology of spinal nerve roots,inhibit the NF-κB and iNOS protein expression levels in spinal nerve roots and the serum NO level,and relieve the pain caused by inflammation of spinal nerve roots,which may be one of the mechanisms of acupuncture in LDH treatment.

Objective To investigate the influence factors of mortality among human immunodeficiency virus (HIV)-infected children under highly active antiretroviral therapy (HAART).Methods Retrospective cohort study of 652 children initiated HAART from 2005 to 2014 was conducted,and enrolled patients were followed-up until December,2015.Survival data was analyzed using Kaplan-Meier method and Cox regression model was used to identify independent predictors of mortality among these children on HARRT.Chi-square test and Fisher's exact test were used for comparison between groups.Results Overall,26 of the children died over a follow-up period of 3 116.24 child-years,with a mortality rate of 0.83 per 100 child-years.Twelve (46％)of deaths occurred during the first six months after starting HAART.Cox regression analysis of variables showed that the World Health Organization (WHO) clinical stages Ⅲ/Ⅳ (hazard rate [HR] =10.717,95％confidence interal [95％ CI]:4.189-4.749,P =0.000),baseline hemoglobin ＜ 80 g/L (HR =14.768,95 ％ CI:5.721-38.125,P =0.000),tuberculosis co-infection (HR =4.794,95％ CI:2.105-10.918,P =0.000),baseline CD4+T lymphocyte ＜ 50 cells/μL (HR =4.219,95％ CI:1.524-11.680,P =0.006),weight-for-age z-score ＜-2 (HR =2.983,95 ％ CI:1.094-8.135,P =0.033) were independently associated with death,whereas the age ＜ 7 year-old at HAART initiation was protectire (HR =0.293,95％ CI:0.126-0.684,P =0.005).Conclusions The mortality of children receiving HAART is strongly associated with WHO stages Ⅲ/Ⅳ,hemoglobin ＜ 80 g/L,weight-for-age z-score ＜-2,tuberculosis co-infection and older age at treatment.

Objective:To investigate the situation of patients with human immunodeficiency virus (HIV) infection who re-engaging treatment after dropping-out during anti-retroviral therapy (ART), and the influencing factors of ART re-engagement in Yunnan Province.Methods:The total dropping-out cases of ART up to December 31, 2018, including cases of lost-of-follow-up and withdrawing medications in Yunnan Province were included. The status of drop-out and demographic data were collected from survey questionnaires and the extracted medical-visiting records from the China National Free Antiretroviral Treatment Program Database of Chinese Center for Disease Control and Prevention. Chi-square test was used in statistical analysis and logistic regression was applied in analyzing factors related with re-engagement.Results:Among the total 6 075 cases with HIV infection which were recorded with the status of drop-out during ART in Yunnan Province, 5 340(87.9%) cases were confirmed drop-out, 540(8.9%) cases were false dropping-out due to belated medical visiting records, 109(1.8%) cases provided invalid answers or had no response to survey questionnaire, and 86(1.4%) cases failed to report results. Among 5 340 confirmed drop-out cases, the findings showed that 923(17.3%) cases were tracked and successfully re-initiated ART, 2 327(43.6%) cases could not be contacted, 1 443(27.0%) cases refused ART, 100(1.9%) cases died, 39(0.7%) cases came back for treatment by self-willing, 91(1.7%) cases were detained, and 417(7.8%) cases were in other situations. Tracking the dropping-out cases were through the workers based on the health facilities including ART clinics, centers for disease control and prevention and the community-based organizations. They tracked the dropping-out cases by phone, through household visiting or face-to-face communication. Statistically significant differences were found in the proportion of patients re-engagement by gender, re-engagement age, route of infection, education level and time from entry to last loss ( χ2=6.14, 21.26, 8.24, 17.69, 12.75, respectively, all P<0.050). The logistic regression suggested that the protective factors related with the re-engagement included female (adjusted odds ratio (a OR)=1.34, 95% confidence interval ( CI) 1.12 to 1.61, P=0.002), re-engagement age≤30 year-old (a OR=1.78, 95% CI 1.25 to 2.55, P<0.001), age of 31 to 60 year-old (a OR=1.33, 95% CI 1.01 to 1.76, P=0.043), education level with primary school to high school or technical secondary school (a OR=1.56, 95% CI 1.21 to 2.01, P<0.001), the period>24 months between first initiating ART and dropping-out (a OR=1.37, 95% CI 1.11 to 1.70, P=0.004). Conclusions:The program of tracking and re-engagement for ART dropping-out patients in Yunnan Province needs multi-department participation and investing large resources, but the success rate of tracking and re-engagement is not high. The protective factors related with re-engagement are female, re-engagement age≤60 year-old, education level with primary school to high school or technical secondary school, the period>24 months between first initiating ART and dropping-out.

Objective:To explore the clinical and imaging features of leucine-rich glioma inactivated 1 antibody associated autoimmune encephalitis (LGI1-AE).Methods:Nine LGI1-AE patients had conformed diagnosis in Department of Neurology, First Affiliated Hospital, School of Medicine, Zhejiang University from January 2016 to December 2021 were enrolled. A retrospective analysis was performed on the clinical manifestations, MRI and PET-CT features, and clinical outcomes of these patients.Results:One patient had acute onset due to sudden disturbance of consciousness; 3 had subacute onset with a duration of 10-15 d, manifested as dizziness, memory loss, unconsciousness and limb convulsions; 5 had chronic onset with a duration of 6 months-2 years, manifested as amnesia, memory loss, dizziness, and headache in the early stage of the disease, including 2 accompanied by emotional stress and personality changes. Eight patients were followed up for an average of 8 months: 1 with acute onset had organic mental disorder (dementia state), 3 had recurrent seizures (1 with subacute onset and 2 with chronic onset), and the remaining 4 had symptom relief or disappearance. In these 9 patients, 8 patients, enjoying good prognosis, showed typical imaging findings: lesions were located at the limbic system, morphological swelling was accompanied by increased T2WI signal, and PET showed reduced or increased metabolism; 1 patient, enjoying poor prognosis, had atypical imaging finding: asymmetric hyperintensity in the basal ganglia, the clinical symptoms were more severe than the 8 patients having lesions at the limbic system, and rapid disease progress was noted.Conclusion:The prognosis of LGI1-AE patients with atypical imaging manifestations might be relatively poor.