Due to factors such as an aging population, the Hospital Authority(HA) of Hong Kong is facing a contradiction between limited health resource supply and continuously increasing demand. In order to effectively address challenges, the HA prompted three measures to bridging the demand-supply gap. The HA relied on its management system advantages to continuously increase its capital construction to enhance the service capacity of public health institutions; transformed service delivery mode so as to improve the experience, quality, and efficiency of service delivery; established cooperation with private service providers and communities to shunt population health demand. The practices of HA can provide reference for public hospitals and their sponsors in other regions of China.

Non-neonatal tetanus is an acute, specific, toxic disease in patients over 28 days of age, characterized by continuous rigidity and paroxysmal spasms of the skeletal muscles throughout the body caused by the intrusion of Clostridium tetani through skin or mucosal membrane into the body and reproducing in anaerobic environments to produce exotoxins. The mortality rate of severe patients is close to 100% without medical intervention. Even with aggressive comprehensive treatment, the global mortality rate remains at 30%-50%, making it a potentially fatal disease. In order to standardize the diagnosis, treatment and prevention of non-neonatal tetanus, based on "Regulation for Diagnosis and Treatment of Non-neonatal Tetanus (2019 Edition)", experts have revised this regulation according to clinical practice and recent research progress in this field to guide medical institutions in the prevention and control of non-neonatal tetanus. This article interprets the key points and basis for updating the 2024 edition regulation to guide clinical implementation and application.

Rabies is one of the important zoonotic infectious diseases, with a mortality rate of almost 100%. Rabies is a vaccine preventable disease, and proper rabies exposure prophylaxis can effectively prevent the occurrence of human rabies. In recent years, there has been significant progress in clinical research on the rabies exposure prophylaxis both domestically and internationally. World Health Organization (WHO) released the Rabies Vaccine: WHO Position Paper-April 2018. In order to guide medical institutions of all levels in rabies exposure prophylaxis, the National Administration of Disease Prevention and Control, in conjunction with the National Health Commission of the People's Republic of China, organized the Rabies Vaccine Working Group of the National Immunization Program Technical Working Group and invited experts to revise and issue the National Regulation for the Rabies Exposure Prophylaxis (2023 Edition). This article compares the National Regulation for the Rabies Exposure Prophylaxis (2009 Edition) and interprets the updated key points and supporting basis of the new version of the guidelines to guide clinical application and implementation.

Objective:To anatomically study the external bone graft axis from the pedicle (canal) to the endplate designed for compression healing fractures of the anterior vertebral column in freshly dried vertebral specimens from T10 to L5.Methods:Eight groups of freshly dried vertebral specimens from T10 to L5 (128 vertebral bodies and 256 lateral pedicles and lateral vertebral bodies) were used to observe the vertebral axis of the pedicle (canal), the internal sagittal diameter of the pedicle (canal), and the sagittal diameter of the vertebral body, and the position of vertebral pedicle (canal) axis (f-angle) before design of the external bone graft axis from the pedicle (canal) to the endplate of the compression healing vertebral body. (1) The internal sagittal diameter of the pedicle (canal) was divided into 3 segments. The lateral segment of the vertebral plate was wide, the middle segment of the isthmus of the vertebral arch was narrow and the medial segment of the terminal segment of the vertebral arch was wide. The narrow isthmus of the middle arch (canal) was used as a transposition axis in the design of the axis of the bone graft from the vertebral arch (canal) to the endplate of the compression healing vertebral body. (2) The axis of the vertebral body of the pedicle (canal) was located medial to the transposition axis, parallel to the f-angle at 0° as described by Saillant G. (3) The compression degree of the vertebral body was measured at the outer edge of the lateral anterior column, with Ⅰ° for less than 1/4 compression of the anterior column of the vertebral body, Ⅱ° for 1/4 to 2/4, Ⅲ° for 2/4 to 3/4 and Ⅳ° for more than 3/4 of the compression. (4) The f-angle described by Salliant G at the entry end which was corresponding to the endplate of the compression healing vertebral body was used to design the pedicle (canal) to the outer implant axis of the endplate of the compression healing vertebral body.Results:At an f-angle of 8° to 10°, the bone graft axis was aligned with the Ⅱ° compression healing vertebral endplate on the superior endplate side of the vertebral body axis of the arch; at an f-angle of 16° to 18°, the bone graft axis corresponded to the superior endplate of the Ⅰ° compression healing vertebral body. At an f-angle of -10°~-8°, the bone graft axis corresponded to the Ⅲ° compression healing vertebral endplate on the inferior endplate side of the vertebral body axis of the arch; at an f-angle of -18°~-16°, the bone graft axis corresponded to the inferior endplate of the Ⅳ° compression healing vertebral body.Conclusions:The external axis from the pedicle (canal) to the endplate designed in the present anatomic study for compression healing fractures of the anterior vertebral column allows for safe and easy granular bone implantation due to the toughness of the cortical bone around the arch root (canal) in addition to the precise design of the bone graft axis from the pedicle to the endplate from T10 to L5.

In order to improve the teaching competence of clinical teachers in standardized nursing training and ensure the teaching quality of the training, since 2014, Chongqing Municipal Health and Family Planning Commission has held a unified training course for teachers in a standardized training base for new nurses in the city annually, and formulated a teacher training system; on the basis of fully considering the study needs of clinical teachers, the course of "taking teaching competence as the direction and improving clinical teaching ability as the core" has been set up, and the training teachers are evaluated by various ways. At the end of the training, the satisfaction survey on the training effect has been carried out, and the participants are satisfied with the contents and methods of the teaching. Higher satisfaction can improve the teaching competence of teachers.

Objective:To analyze the risk factors of systemic inflammatory response syndrome (SIRS) caused by wasp stings.Methods:A prospective case-control study was conducted to analyze the clinical data of 225 patients with wasp stings admitted to Taihe hospital of Shiyan City and Ankang Central Hospital from January 2014 to December 2018, including 131 males and 94 females, with the age of 49 (41, 60) years. The patients were divided into SIRS group ( n=62) and non-SIRS group ( n=163) according to the SIRS diagnostic criteria. The data were collected including gender, age, sting in the head, sting in waist and back, sting in the abdomen, sting in the limbs, number of stings, admission time, hospitalization day, and mortality. The plasma levels of interleukin(IL)-6 and IL-8 in peripheral blood of the patients were analyzed by ELISA method. The whole genome DNA was extracted from white blood cells, and the IL-6: -174G/C, -572G/C, -597G/A, -634C/G and IL-8: -251A/T, -738T/A, -845T/C, + 396T/G were selected for research. The PCR method was used to perform bidirectional sequencing and comparison after amplification, and record the genotyping and frequency. The risk factors of SIRS caused by wasp stings were investigated by univariate analysis and multivariate Logistics regression analysis. Results:(1) The two groups showed significant differences in sting in the limbs, sting in waist and back, sting in the abdomen, number of stings, hospitalization day and mortality ( P<0.01), while there were no significant differences in gender, age, sting in the head and admission time ( P>0.05). (2) ELISA test showed the plasma levels of IL-6 and IL-8 in SIRS group were higher than those in non-SIRS group ( P<0.01). (3) Three genotypes of CC, GC and GG were observed in IL-6-572G/C. There were significant differences in the frequencies of genotypes and alleles between SIRS group and non-SIRS group ( P<0.01). Three genotypes of AA, AT and TT were observed in IL-8 -251A/T. There were significant differences in the frequencies of genotypes and alleles between SIRS group and non-SIRS group ( P<0.01). (4)Univariate analysis showed sting in waist and back, sting in the abdomen, sting in the limbs, number of stings, IL-6-572G allele, IL-8-251T allele were related to SIRS caused by wasp stings ( P<0.01). (5)Multivariate Logistics regression analysis showed limb stings ( OR=2.15), number of stings ≥10 ( OR=11.10), IL-6-572G allele ( OR=3.91) and IL-8-251T allele ( OR=3.97) were significantly related to SIRS caused by wasp stings ( P<0.05 or 0.01). Conclusions:The plasma levels of IL-6 and IL-8 are increased in patients with SIRS after wasp stings. The limbs stings, number of stings ≥10, IL-6 -572G and IL-8 -251T are all independent risk factors for SIRS caused by wasp stings.

Tetanus consists of neonatal tetanus and non-neonatal tetanus. Non-neonatal tetanus remains a serious public health problem, although neonatal tetanus has been eliminated in China since 2012. Non-neonatal tetanus is a potential fatal disease. In the absence of medical intervention, the mortality rate of severe cases is almost 100%. Even with vigorous treatment, the mortality rate remains 30%-50% globally. These specifications aim to regulate non-neonatal tetanus diagnosis and treatment in China, in order to improve medical quality and safety. These specifications introduce the etiology, epidemiology, pathogenesis, clinical manifestations and laboratory tests, diagnosis, differential diagnosis, grading and treatment of non-neonatal tetanus.

Tetanus consists of neonatal tetanus and non-neonatal tetanus.Non-neonatal tetanus remains a serious public health problem,although neonatal tetanus has been eliminated in China since 2012.Non-neonatal tetanus is a potential fatal disease.In the absence of medical intervention,the mortality rate of severe cases is almost 100％.Even with vigorous treatment,the mortality rate is still 30％-50％ globally.These specifications aim to regulate non-neonatal tetanus diagnosis and treatment in China,in order to improve medical quality and safety.These specifications introduce the etiology,epidemiology,pathogenesis,clinical manifestations and laboratory tests,diagnosis,differential diagnosis,grading and treatment of non-neonatal tetanus.

Post-traumatic tetanus is the main type of non-neonatal tetanus.To reduce the incidence and mortality rateof tetanus and guide the primary medical institutions to prevent and control tetanus after trauma,the National Immunization Planning Technical Working Group of the Chinese Center for Disease Control and Prevention has compiled this document in the reference with Position Paper by World Health Organization,and the latest research progress both at home and abroad.The guidelines focus on the basic procedures for the prevention and treatment of post-traumatic tetanus,the application of tetanus vaccines and immune preparation,and pre-exposure immunization in high-risk populations of trauma.

Tetanus consists of neonatal tetanus and non-neonatal tetanus. Although neonatal tetanus in China has been eliminated since 2012, non-neonatal tetanus remains a serious public health problem. Non-neonatal tetanus is a potential fatal disease, and the mortality rate of severe cases is almost 100% in the absence of medical intervention. Even with vigorous treatment, the mortality rate is still 30~50% globally. In order to standardize the diagnosis and treatment of non-neonatal tetanus in China, this specification is hereby formulated. This standard includes etiology, epidemiology, pathogenesis, clinical manifestations, laboratory tests, diagnosis, differential diagnosis, classification, grading and treatment of non-neonatal tetanus.