With medical system reform advancing,social requirement on comprehensive capability for health service management professionals enhances unceasingly.However,health service management in our country is a new branch of edge-crossed and needs to be improvd and perfected constantly to reduce the shortage in mode construction for talent cultivation. It is meaningful to explore and construct innovative cultivation mode for health management professionals from three aspects,management capability,learning capability and information feedback based on system self-organization principle.

With a high invasive ability and poor prognosis, the morbidity of pancreatic cancer is about 98%.Combination of chemotherapy and radiotherapy is the primary management for locoregionally advanced pancreatic cancer, but its efficacy is limited. Results from a number of meta-analysis have confirmed that gemcitabine is associated with significantly better clinical response and one-year overall survival rates;therefore, currently gemcitabine is the standard chemotherapy for advanced pancreatic cancer. Gemcitabine-based multi-drug regimens may have potentially favorable effects on patients' survival. However, evidence from phase Ⅲ clinical trials is lacking. Newer chemotherapy and targeted therapy agents are clearly needed for patients with advanced pancreatic cancer.

Objective To provide a theoretical reference for building a discharge planning program suitable for China's national conditions based on a comprehensive content analysis of international discharge planning guidelines.Methods Discharge planning guidelines from 1995 to 2012 which were retrieved from PubMed,NGS (National Guideline Clearinghouse),google were analyzed by 5W1H method.Results A total of 11 discharge planning guidelines were collected from 21 through the full text screening.Conclusions This study shows that discharge planning should focus on patients with their needs as orientation,to provide continuous care through interdisciplinary and interagency coordination and cooperation,and an effective planning should be implemented standardized management and carried out early on admission.

BACKGROUND:The current fixation methods for clavicle fracture are mainly anatomy plate or reconstruction plate. The specific devices for maintaining fracture alignment and fixation are rarely reported. The majority of physicians prefer reduction forceps to maintain fracture alignment and retain plate for internal fixation. However, reduction forceps have many disadvantages, such as large damage, instable fixation and difficult to bend or mould plates.
OBJECTIVE:To compare the clinical effect of new-style bone holder and reduction forceps in treatment of clavicular fractures.
METHODA total of 75 patients with clavicular fractures were recruited from Department of Orthopedics, Huai’an First Hospital, Affiliated to Nanjing Medical University, between December 2011 and December 2013. The involved patients were randomly divided into two groups, new-style bone holder (39 cases) and reduction forceps (36 cases). In new-style bone holder group, the wounds were opened and reduced using reduction forceps, then new-style bone holder was applied to maintain fracture alignment and internal fixation;in reduction forceps group, the wounds were opened and reduced using reduction forceps, then reduction forceps was applied to maintain fracture alignment and internal fixation. The length of incision, the time of operation, intraoperative blood loss, fracture healing time and clinical efficacy in two groups were compared.
RESULTS AND CONCLUSION:Al cases were fol owed up for over half a year. There was no significant difference between the two groups in the length of incision (P>0.05). The new-style bone holder group was obviously better than reduction forceps group in the time of operation, intraoperative blood loss and fracture healing time, with significant difference (P<0.01). The clinical efficacy was significantly higher than reduction forceps group. Experimental findings indicate that, new-style bone holder is characterized by simple operation, few trauma, stable fixation, short operation time, and rapid fracture healing.

Objective To investigate the expression of thymosin beta4 ( Tβ4 ) in the liver tissues of children with hepatoblastoma ( HB) , and further study the function of Tβ4 in HB metastasis in vitro. Methods Immunohisto-chemistry (IHC) was used to determine expression of Tβ4, E-cadherin andβ-catenin in liver tissues from 19 chil-dren with HB,and further to analyze its function in metastasis of HB cells. Results The positive rate of Tβ4 ( P<0.01 ) in HB liver tissues was significantly higher than it in the adjacent tissues. The positive rates of Tβ4 and nu-clearβ-catenin in HB with lymphnode metastasis were significantly higher than in HB without lymphnode metastasis ( P <0.01 ) . While expression of E-cadherin in HB with lymphnode metastasis was lower than in HB without lymphnode metastasis ( P<0.01 ) . Scratch-wound assay showed that HepG2 cells with Tβ4 knockdown had signifi-cantly lower metastatic ability (P<0.05). Conclusion Tβ4 plays an important role in HB metastasis, suggesting it is a potential target for HB metastasis.

Objective To provide basis for rational drug use of clinical practice by analysis of antidepressants application in Wuhan. Methods Antidepressants were classified according to the structure and mechanism. By using the analytical method of the defined daily dose (DDD) recommended by WHO,authors statistically analyzed the relative data of antidepressants used in 34 hospitals of Wuhan from 2011 to 2013. Results The consumption of the antidepressants had been increased year by year,selective serotonin reuptake inhibitor (SSRIs) and serotonin noradrenergic reuptake inhibitors (SNaRIs) were widely used and presented higher proportion than others in the consumption of antidepressants,the average amount of the sales was 50.49% and 21.81%,respectively.The application of tricyclic antidepressant (TCAs) decreased in Wuhan,the amount of sales for 3 years accounted for 0.56%,0.37% and 0.15%. Conclusion SSRIs and SNaRIs have already become the first-choice drugs in clinic practice because of good efficacy and high safety,other new types of antidepressants have a great potential for development,TCAs are fewly used now.

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Combined Modality Therapy ; Humans ; Neoplasms ; drug therapy ; radiotherapy ; surgery ; Particle Accelerators ; Radiation Dosage ; Radiotherapy, High-Energy ; methods ; Salvage Therapy

Objective To investigate the incidence and risk factors of concomitant atherosclerotic renal artery stenosis(ARAS)and coronary heart disease(CAD).Methods In the study period 247 patients with known or suspected CAD underwent combined cardiac catheterization and renal artery angiography.Results Incidence of ARAS was 20%(44/220)in CAD.Logistic regression analysis showed only age,degree of coronery artery stenosis,peripheral atherosclerosis disease were independently predictor of ARAS.Conclusions Renal artery angiography should be performed routinely to indentify ARAS,especially in the patients with mutil-vessel lesions,old age and peripheral atherosclerosis disease.

Objective To discuss the clinical effect and safety on rosiglitazone applied to patients with early type 2 diabetic nephropathy.Methods Ninety-six patients with early type 2 diabetic nephropathy were divided into the control group(n=48) and the research group (n =48).The patients of the control group were given mefformin treatment, while of research group were given rosiglitazone, both the courses were three months.The urinary albumin excretion rate (UAER), 24 h urine trace albumin (UAE), serum creatinine clearance (SCr) , fasting plasma glucose (FPG), postprandial blood glucose (2 hPG), glycosylated hemoglobin (HbA 1 c), triglycerides (TG), cholesterol (TC), low density lipoprotein (LDL-C), high density lipoprotein (HDL-C) before and after treatment and clinical effect between the two groups were compared.Results The HbA1c, FPG, 2 hPG, UAER, UAE, TC, TG of after treatment of all patients decreased obviously,while the HDL-C level increased remarkably, and compared with control group the differences were significant (HbA1 c: (7.32±0.84)％ vs (7.56±0.98)％, FPG: (8.02± 1.42) mmol/L vs (8.16± 1.54) mmol/L, 2 hPG: (11.54±2.11) mmol/L vs (12.02±1.97) mmol/L,UAER: (67.34±6.45) mg/24 h vs (52.56±5.35) mg/24 h,UAE: (108.64±22.64) mg/d vs (68.84± 11.43) mg/d, TC : (5.44± 0.72) mmol/L vs (4.76± 0.51) mmol/L, TG: (2.04± 0.53) mmol/L) vs (1.73±0.46) mmol/L);t =-4.172,-3.973,-4.026,-4.263,-6.634,-5.737,-5.635, -4.735,-4.633;P＜O.05).While there were no statistical significance about SCr before and after treatment(P ＞0.05).The total clinical effect of the research group was obviously higher than that of the control group (87.5％ (42/48) vs 66.7％ (32/48), x2 =5.363,P =0.035).There were not obvious adverse reaction occurred during treatment for all patients.Conclusion Rosiglitazone can effectively reduce the blood glucose in patients with early type 2 diabetic nephropathy and reduce urinary protein excretion, the effect is more obvious than that of metformin.

The fetal period is the critical time in the development of various organs.The changes in the intrauterine growth environment can cause fetal and neonatal multiple organ system underdevelopment and damage,which is also closely related to the adult diseases,including nervous system damage (such as brain development disorders,functional abnormalities and cerebral palsy,etc.),cardiovascular system damage(such as coronary heart disease,high blood pressure,etc.),growth disorders and metabolic disorders(such as insulin resistance,type Ⅱ diabetes,obesity,growth and development disorders),urinary system damage (such as interstitial renal disease,renal hypertension,etc.),respiratory system damage(such as respiratory distress syndrome,bronchial dysplasia,etc.),etc.In this paper,we introduced this to help clinicians to understand and strengthen the intervention measures to improve the quality of life.