Analysis of setbacks found in the existing system and mechanism of public hospitals. Based on the health reform principles of Separation of administration and management, Separation of administration and operation, Separation of prescribing and dispensing, and Separation of for-profit hospitals and nonprofit hospitals, the authors named the following roadmap for public hospital governance reform. First, set up a management committee for each public hospital to coordinate the government function for medical service; set up a public hospital authority to upgrade the management level of these hospitals; transform functionality of health authorities to encourage diversity in medical service providers. Second, establish the tiered decision making mechanism, autonomous operation system and diversified supervision system, to separate administration and management. Third, formulate articles of association for hospitals to encourage their evolution to legal entities, consolidating the government reforms by legal means.

[Objective] To discuss the clinical manifestations,treatment,and therapeutic efficacy of lumbar disc herniation complicated by lumbar spinal stenosis in elderly patients.[Method]Thirty-six elderly patients with lumbar disc herniation complicated by lumbar spinal stenosis were treated with surgical treatment,including multi-segment fenestration,laminectomy,resection of nucleus pulposus,and internal fixation of pedicle screws.The therapeutic efficacy was retrospectively assessed.[Result]All patients were followed up with an average time of 3 years and 6 months.The good to excellence results was 83%.[Conclusion]In elderly patients with lumbar spinal stenosis,there are patients have special clinical manifestations.Different operations should be adopted for different patients.There are several important factors that affect the efficacy of operation,including operation modes,sufficient decompression,restotation of spinal instability,and postoperative exercises of lumbodorsal muscles.

[Objective]To analyze and evaluate the relevant factors of recurrent lumbar disc herniation for providing strategy of prevention of this syndrome.[Method]Sixteen cases of recurrent lumbar disc herniation were analyzed according to medical history,physical examination and image examination before re-operation and the primary operation,and all the patients received exploration during operation.[Result]The relevant factors of recurrent lumbar disc herniation were as follows:the extent of disc degeneration,the stability of lumbar spine,the time of getting out of bed after primary operation and the weight of the patients.[Conclusion]Besides iatrogenic factors,there are several factors related to recurrent lumbar disc herniation,including the characteristics of disc and lumbar spine,as well as the compliance of patients.To remove these factors is the main preventive strategy of recurrent lumbar disc herniation.

[Objective]To evaluated the clinical results of the ulnar osteotomy and external fixation for the treatment of chronic anterior dislocation of head of the radius in children.[Method]From 2002 to 2004,thirteen cases of children with chronic anterior dislocation of the radial head were treated by ulnar osteotomy,external fixation and close or open reduction of elbow joint but without repair of the annular ligament. Their mean age was 5.5 years(2 to 11) and the mean interval between the injury and reconstruction was 19 months(2 months to 3 years).[Result]All radial heads remained reduced at a mean follow-up of 14 months(2 months to 3 years).Normal ranges of movement for flexion,extension,pronation and supination were improved or unchanged in 12 patients.One patient had further decreased in 10? for supination.There were one superficial pin-track infections but with no serious complication.[Conclusion]Angular ulnar osteotomy and external fixation of the ulna can lead to stable reduction of the radial head with minimal complications.Reconstruction of the annular ligament is not necessary if satisfactory re-orientation of the ulnar is achieved in all planes.

Objective To evaluate the murine model of dry eye induced by hyperosmolar saline. Methods Sixty female BALB/c mice at the age of 6 -8 weeks were randomly divided into blank group,control group and experimental group,20 in each group. Mice in control and experimental groups were treated with 308 mOsmol/L and 500 mOsmol/L sodium chloride solution,respectively,5 times a day. Mice in blank group were not treated with sodium chloride solution. Schirmer test,fluorescein staining,corneal scoring,rose bengal staining,tear ferns experiment,corneal epithelial HE staining and thickness measurement,conjunctival epithelial PAS staining and Goblet cell counting were conducted on days 0,7,14,28,and 42,respectively. Corneal surface was observed by scanning electron microscopy on day 42. Results No significant difference was found in the above parameters on day 0 between the two groups. On day 7,the volume of tears was significantly smaller in experimental group ( 2. 3 ? 0. 4 mm) than in blank group ( 3. 0 ? 0. 5mm) and control group ( 3. 1 ?0. 5 mm) ( P

[Objective]To investigate the surgical treatment of recurrent lumbar disc herniation. [Methods]A total of 17 patients with recurrent lumbar disc herniation were grouped into stable,unstable and severe unstable groups according to the dynamic X-ray film. Patients in stable group and unstable group were treated with open-window discectomy, and those of severe unstable group were treated with full laminectomy, decompression, pedicle screw fixation and fusion. JOA and VAS system were used to follow up before and after operation. Statistic analysis was performed between the stable and unstable groups in pain score and recovery rate.[Results]All the patients were followed up for 3 month to 3 years. The average JOA score was 4.94 before operation, and 12.18 at follow-up,with an average recovery rate of 71.74%. There was no statistic difference between stable group and unstable group in recovery rate.[Conclusion]For patients with spinal instability and chief complaint of leg symptom, reoperative treatment for recurrent lumbar disc herniation can be done with open-window discectomy which may offer good outcome.

Objective Pulmonary benign metastasizing leiomyoma (PBML) is a rare entity that leiomyoma of uterus metastasized to the lung.The clinical characteristics of this rare disease were analyzed in this article.Methods The detailed clinical records of 7 patients diagnosed as PBML at Peking Union Medical College Hospital between January 2001 and June 2015 were reviewed.Results All patients were women with median age of 44 years (range 28-62).Symptoms included dyspnea (2/7),chest pain (1/7),cyanosis (1/7),cough (1/7) and bloody sputum (1/7),while 4/7 cases were asymptomatic.Six patients had the past-history of leiomyoma of uterus 20 months to 14 years ago among whom 5 patients received hysterectomy.Chest CT showed bilateral,random-distributed multiple round solid nodules,or diffuse-distributed miliary nodules,or single solid nodule,even some small cavities.Extra-pulmonary metastasis was found in left superclavicular lymph node (1 case) and right heart (1 case).Histological tissues were obtained by video-assisted thoracic surgery lung biopsy (4/7),mass resection on tricuspid valve (1/7),transbronchil lung biopsy (1/7),and CT-guided percutaneous lung biopsy (1/7).Pathology showed an interlacing pattern by spindle cells having elongated nuclei without cellular atypia.Ki-67 index was less than 1％.Molecules such as smooth muscle antibody,estrogen receptor (ER) and progestrone receptor (PR) were positive in immunohistochemistry staining.Neither letrozole nor zoladex was effective.Two patients responded to bilateral adnexectomy,presenting as shrunk nodules.No relapsed disease was seen in one patient with single nodule after resection.There was only one patient with disease-related mortality,whose chest CT showed milliary nodules.Conclusion Although CT findings of PBML are similar to malignancies,the clinical outcome is good.Despite the positive expression of ER and PR,the effectiveness of hormone related treatment is limited.And periodical follow up is suggested even to those uneventful patients.

Objective To explore the clinical characteristics and the treatments on traumatic diaphragmatic rupture and diaphragmatic hernia.Method A retrospective study was carried out in 49 cases of traumatic diaphragmatic rupture and diaphragmatic hernia.Results There were 32 cases with left diaphragmatic hernia,13 cases with right diaphragmatic hernia and 4 cases with bilateral diaphragmatic hernia.One case with closed combined thoraco-abdominal wound and shock,died of multiple organ failure after the surgery,3 cases were diagnosed more than 24 h after injury,the others closed injury patients were diagnosed within 24 h and cured.In patients with open diaphragmatic rupture and diaphragmatic hernia,16 cases underwent laparotomy surgery,5 cases of misdiagnosis experienced re-thoracotomy,7 cases thoracotomy,2 cases changed the thoraco-abdominal surgery.Three cases underwent thoraco-abdominal surgery.Twenty-five cases were cured; 1 patient with suppurative costal chondritis,duration up to 13months.Conclusion Traumatic diaphragmatic rupture and diaphragmatic hernia is easily missed and misdiagnosed,the establish of rational examination preoperatively can reduce complications,misdiagnosis and mortality.

Objective To evaluate the safety and efficacy of icotinib as first-line therapy in Chinese non-small cell lung cancer (NSCLC) patients harboring epidermal growth factor receptor (EGFR) sensitive mutations.Methods Patients with stage ⅢB/Ⅳ NSCLC who had EGFR sensitive mutation and had no previous treatment were enrolled into this study.The response rates , progress free survival ( PFS) , overall survival ( OS ) , and the safety were analyzed.Results Ninety advanced adenocarcinoma patients were enrolled in this study , 44 patients had partial response ( PR ) , 42 patients had stable disease ( SD ) , 4 patients had progressive disease (PD), with an overall response rate (ORR) of 48.9%, and a disease control rate (DCR) of 95.6%.The median PFS was 14.9 months (95%CI 13.5-16.3) and the OS was 37.0 weeks ( 95%CI 27.9 -46.1 ).Patients with brain metastases showed higher ORR ( P =0.049 ).Patients with stage ⅢB had longer PFS than those with stage Ⅳ( P=0.007 ).The most common adverse events were grade 1 -2 skin rash (38 patients, 40.9%).Other adverse events included dry skin , oral mucositis, diarrhea and liver function injury.Three patients withdrew because of severe liver injury or skin rash.No treatment related mortality occurred .Conclusions Icotinib is effective and safe as first-line treatment for Chinese advanced NSCLC patients with EGFR sensitive mutation.

In this study, to analyze the influence of the brightness value of the supranasal point and the apex nasi on their dominant wavelength and excitation purity according to the spectrocolorimetry data of the supranasal point and the apex nasi in healthy adults that were collected based on optical spectrum colorimetry.