Stroke is the disease which caused by many risk factors.The relationship between insulin resistance(IR) and young adult stroke is one of the focuses now in the neurological field.IR refered to the series of pathological and physiological changes,it happens when the response of the target tissue organ to insulin is depressing or losing.There are many ways of detection of IR,the insulin sensitivity index(ISI) is one of the most satisfied indexes to reflect the sensitivity to insulin.IR could cause a series of pathological and physiological changes,which caused hyperinsulinemia,hyperglycemia,hyperpiesia,blood-fat derangement,fibrinolytic system anomaly,blood vessel endothelium change,artherosclerosis,et al,maybe in ways of many metabolic risk factors.Atherosclerosis is the main etiopathogenisis factor in young adult stroke,as a conclusion,IR is also existed in young adult stroke.But,does IR exist in all types of young adult stroke? What is the mechanism? Is the level of IR related with the pathogenetic condition and prognosis? These questions are still not clear at present,and the study on the relationship between IR and young adult stroke is important to prevent young adult stroke.

In China's new healthcare reform, the pilot local governments explore the practice of establishing a new model of hierarchical diagnosis and treatment system.Zhejiang Province has adopted a special policy of effectively allocating hospital resources and human resources, and efficiently improving primary healthcare institution capability and patient satisfaction(hereinafter referred to as double allocation, double improvement), focusing on the implementation of the 'Healthcare Talents Project', in order to fill a vacancy of human resources in primary healthcare institutions.This paper uses system dynamics modeling and the WISN method of WHO to estimate the gap in physician supply in primary healthcare institutions.After building the system dynamics model of 'Healthcare Talents Project', this paper simulates the influence of the policy on the vacancy of doctors in primary healthcare institutions and analyzes the sensitivity of regulatory factors.The simulation results show that, there are a big gap in physician supply of about 14,000 to build the hierarchical diagnosis and treatment system.The project can gradually increase the number of primary doctors, and the policy may fill the vacancy by 2021.However, if the efficiency of the hospital doctors who give assistance to primary institutions is increased by 10%, the targeted training and recruitment 100% achieve the policy plans and objectives, the project goal may be achieved by 2020.Therefore, this project can effectively adjust the human resources structure quickly and reasonably, and it can be used as reference for the reform of hierarchical diagnosis and treatment system.