In order to enhance their core competitiveness,hospitals will deal with medical service suppliers,patients,counterpart hospitals and other stakeholders constantly.Such multiple value activities constitute a patient-oriented and hospital-centered value group.Hospitals have to constantly meet the demand of patients in the provision of medical services,and patients will be satisfied through their own participation in medical activities,thus realize the increase of their value.The pattern of mutual value creation between hospitals and patients forms the new hospital-patient relationship.It is an important condition for the hospitals to gain competitive advantages in the medical service provision through the two models of value maximization and organization minimization,and is also profitable for the formation of a harmonious relationship between doctors and patients.

With the continuous economic development,the environment in which we live is undergoing change.Environmental pollution has greatly affected our physical and mental health.The occurrence of many diseases is derived from the environmental change.The health management of health problems caused by environmental pollution is of great significance in monitoring the impact of environmental pollution on people's health,timely detecting and preventing the occurrence of diseases,improving people's health,and building up a harmonious and healthy society.

Based on the realistic circumstances at home and successful experiences from abroad,this paper holds the idea to introduce medical liability insurance into medical market to relieve the currently tense physician-patient conflict and analyzes the role and function of medical liability insurance.Meanwhile,some problems and countermeasures are also explained in the functioning process of medical liability insurance.

PBL teaching is popular internationally as a teaching mode in recent years.It takes students as the main body and centers on problems,and the teaching process has the important effect to improving stuents'enthusiasm and developing their ability to innovate.This article has discussed the application of PBL teaching and attention in teaching,combined with aspects such as teaching objects,teaching contents,teaching objectives and teaching links in the teaching of medical insurance.

Purpose To investigate the expression of Wnt-1 and β-catenin protein in cervical squamous cell carcinomas ( CSCC) and their relationship with invasion and lymph node metastasis. Methods Expression of Wnt-1 and β-catenin protein were examined on immunohistochemistry containing 78 specimens of CSCC and 30 specimens of normal cervical tissues. Results The positive rates of Wnt-1 and β-catenin protein in normal cervical tissues were 20.0% and 10.0% respectively. The positive rates of Wnt-1 andβ-cate-nin protein in CSCC were 56.4%, and 74.4% respectively. There was a significant difference between the two groups (P<0.001). The positive rates of Wnt-1 andβ-catenin protein in 33 cases with lymph node metastasis of CSCC were 72.7% and 90.9% respective-ly. The positive rates of Wnt-1 andβ-catenin protein in 45 cases with no lymph node metastasis of CSCC were 44.4% and 62.2% re-spectively. The expression of Wnt-1 andβ-catenin protein was significantly related with grades of tumors and depth of invasion and FI-GO stages (P<0.05), and there was no significantly difference between the expression of Wnt-1 andβ-catenin protein and CSCC pa-tients age (P>0.05). Spearman analysis showed that the expression of Wnt-1 protein was positive related to the expression ofβ-cate-nin protein (rs =0.490, P<0.001). Conclusion The abnormal expression of Wnt-1 and β-catenin may be involved in initiation, development, invasion, and metastasis of CSCC, and it is suggested that Wnt-1 and β-catenin be considered as potential markers for invasion, metastasis, and prognosis.

Objective:To evaluate the effect of continuing intervention on prophylactic application of antibiotics in sterile operation in urology department by clinical pharmacist to provide reference for the clinical prophylactic application of antibiotics. Methods:All cases of discharged patients underwent sterile operation in urology department of our hospital from July 2010 to June 2014 were divided into three groups according to the intervention time and methods: non-intervention group(n=141), stage Ⅰ intervention group(n=139), stage Ⅱ intervention group (n=162) and stage Ⅲ intervention group (n=137). The prophylactic application of antibiotics was statistically analyzed. Results:After the continuing intervention, the prophylactic application rate of antibiotics in the three inter-vention groups was decreased significantly from 100% before the intervention respectively to 34. 5%,18. 5% and 14. 6% after the in-tervention (P<0. 01). The rationality rate of prophylactic application was improved significantly from 36. 9% before the intervention respectively to 58. 3%, 63. 3% and 85. 0% after the intervention (P<0. 01). The course of prophylactic application was decreased significantly from (138.2 ±31.6)h respectively to (89.9 ±48.0)h,(72.8 ±32.5)h and(45.1 ±29.5)h (P<0.01) and the post-operative infection rate was decreased from 2. 8% respectively to 2. 1%,1. 8% and 1. 4%. Conclusion:The pharmaceutical interven-tion is feasible and valid to improve the rational prophylactic use of antibiotics in urological surgery.

OBJECTIVE:To investigate the effect of clinical pharmacist intervention on prophylactic application of antibiotics in cardiothoracic surgery. METHODS:Medical records of patients underwent cardiothoracic surgery were collected from our hospi-tal during Mar. to Apr. in 2014 (before intervention) and during Jun. to Jul. in 2014 (after intervention). Those were divided into pre-intervention group(n=115)and post-intervention group(n=119). The prophylactic application effect of antibiotics was com-pared before and after intervention. RESULTS:After intervention,the rates of prophylactic application were decreased significantly from 96.5% to 72.3%;the rationality rate of antibiotics selection was improved significantly from 27.9% to 94.2%;The course of prophylactic medication decreased significantly from(5.4±2.8)days to(2.3±1.8)days;the difference had statistical significance before and after intervention(P<0.01). The postoperative infection rate was decreased from 13.0% to 5.9%,the difference had no statistical significance(P=0.074). The average hospitalization time,average drug costs,and average hospitalization expenses were decreased significantly,the difference had statistical significance(P<0.05 or P<0.01). CONCLUSIONS:Clinical pharmacist inter-vention to prophylactic application of antibiotics in cardiothoracic surgery can control the infection effective and guarantee reason-able and safe use of drugs during perioperative period.

Objective　To investigate the preventive measurement of vagal reflex occurrence on patients with percutaneous transluminal coronary angioplasty (PTCA).Methods　On the reason of vagal reflex occurrence,to 75 patients with PTCA adopt the measurement to prevent hypovolemia,control the excessive rebound of cavity viscera,adjust the patients mental state,and so on.Then to observe the level of patients with vagal reflex occurrence,and compare with the control group of 75 patients under common care.Results　The prevent group level of patients with vagal reflex occurrence is 2.61%;the control group is 28%.Conclusion　To patients with PTCA adopt the measurement to prevent hypovolemia,control the excessive rebound of cavity viscera,adjust the patients mental state,and so on.The effect to decrease the level of vagal reflex occurrence is great.

Objective To investigate the expression and relationship of TIP30(HIV-1 Tat interactive protein 2), vascular endothelial growth factor (VEGF) and MVD (detected by CD34) in the angiogenesis of human brain astrocytomas. Methods Expression of TIP30, VEGF and CD34 in 19 cases of normal brain tissue and 71 cases of astrocytoma were immunohistochemically examined with Elivision plus two-step method. Results The positive expression of TIP30 could be seen in cytoplasm of neuroglial cells and neurons of 19 normal brain tissues. The positive expression rate of TIP30 in 71 cases of astrocytoma was 33.80 % (24/ 71). The positive expression rate of TIP30 in astrocytoma of different grades was 52 % for grade Ⅱ, 34.78 % for grade Ⅲ and 13.04 % for grade Ⅳ. The positive expression rate of TIP30 in high grade (Ⅲ+Ⅳ) of astrocytoma was found significantly lower than that in low grade(Ⅱ) (χ2=5.71, P <0.05); The expression of VEGF and MVD detected by CD34 in astrocytomas were higher than that in normal brain tissue and increased as the tumor grade increased; In astrocytoma, the negtive correlation was found between the expression of TIP30 and VEGF (r=-0.428, P<0.05); no correlation was found between TIP30 and MVD(r=-0.065, P 0.05); the positive correlation was found between VEGF and MVD(r=0.684, P<0.01). Conclusion The positive expression rate of TIP30 in normal brain tissue is significantly higher than that in astrocytoma. The positive expression rate of TIP30 significantly decreases as the pathological grade of the astrocytoma increases; The expression of TIP30 and VEGF is negatively correlated in astrocytoma.

OBJECTIVE:To study the safety and efficacy of Neuroform self-expanding stent for symptomatic intracranial artery stenosis.METHODS:A total of 37 patients with symptomatic intracranial artery stenosis received treatment at the Department of Neurosurgery,Affiliated Hospital of Behua University and Xuanwu Hospital were selected,who were ineffective to anticoagulation and antiplatelet treatment,including 24 males and 13 females,aged from 49 to 72 years,mean aged 64 years.All patients were received Neuroform self-expanding stent following angiography.RESULTS:All patients underwent PTAS with mean preoperative stenosis were reduced from 64% to 24% after percutaneous transluminal angioplasty (PTAS).The technically successful rate was 100%.All the patients were received a 6-22 month follow-up (average 13 months).The average artery stents was retrieved by 50%-90% after stent deployment.There was no arterial dissection,acute occlusion of the target artery or symptomatic distal emboli.Within the follow-up period,1 patient endured asymptomatical artery full occlusion.Two stents were implanted simultaneously in 3 patients,1 of them suffered bilateral vertebral artery stenosis,and 2 had right vertebral arterial and basilar artery stenosis.One patient suffered acute in-stent thrombosis and recovered after thrombolytic therapy.No pathogenetic condition was aggravated in the follow-up.CONCLUSION:The application of Neuroform self-expanding stent can alleviate the ischemic symptoms of patients with vertebrobasilar stenosis and elevate the operative safety and effectiveness.However,further study is needed to evaluate the long-term therapeutic effect.