The ongoing health reform features direct hosting of county-level hospitals by provincial level hospitals as an important means and effective attempt to improve comprehensive service capacity of the former.This paper introduces the“Hanchuan Model”,in which Hubei People’s Hospital has hosted Hanchuan city People’s Hospital,and analyzed the operation performance and hurdles found.Based on such studies,the authors recommend on the vertical integration of medical resources by means of hosting, and comprehensive reforms of county public hospitals.

Objective To establish and clinically evaluate a method to adjust tube current(mA)individually for obtaining images with consistent noise and optimized radiation dose in 64-slice spiral helical CT coronary angiography.Methods (1)80 patients,as a control group,were underwent CT coronary angiography(CTCA)using 64-muhislice spiral helical CT with fixed mA(650 mA).Two radiologists first assessed image quality of the fixed mA group by scoring from 1 to 5.A minimal dose requirement for meeting clinical diagnosis with the desired noise level(standard deviation SD0)were decided.By analyzing the images of the control group,we also established correlation between the image noises of timing bolus(TB)scans and cardiac(CA)scans and set up a formula to predict the required mA value for obtaining the desired cardiac image noise for individual patient.(2)Subsequently,another group of 80 patients(study group)wero scanned with individually adjusted mA using the established formula and the practicability of this method was then evaluated.The independent sample t test was used to compare the values of the two groups.Results (1)The noise of TB and CTCA scans was linearly correlated with r2=0.994. (2)A cardiac image noise level of 28 HU was found to be adequate for clinical diagnostic purpose based on the image quality analysis.(3)The average noise for the acquired cardiac images was found to be 28.97 HU for the study group with individually adapted mA using the established formula.The standard deviation of the image noisein study group was 1.93,which was much smaller than 5.14 in the fixed mA group,but the average image scores for the study group(4.27±0.68)and fixed group mA(4.03 4-0.93)were not statistically different.(4)In the study group,63 out of 80 patients required tube currents below the standard 650 mA,yielding an average CTDIvol of58.32 mGy,which was about 32.1%dose reduction than that of fixed mA(85.94 mGy).The lowest CTDIvol was 19.27 mGy with 160 mA which was 22.4%of the average CTDIvol in control group.Conclusion Adjusting mA individually based on timing bolus scan noise analysis is an accurate and practical method to obtain consistent image quality for different cardiac pailents and to minimize the radiation dose for individuals compared to the fixed mA.

Objective To evaluate the clinical application of 3 D ultrasound in the diagnosis of bladder diseases. Methods In 21 patients with bladder disease,3 D images were studied with a Voluson 530D diagnostic system.At first,the two dimensional images of lesions were collected,then defined 3 D volumes of interest were stored,reconstructed and analyzed. Results 3 D ultrasound provided a clear stereoscopic view and depicted the appearance of the 21 bladder diseases,displayed the internal structures,and showed invasive depth within and outside the bladder wall and also metastasis of the adjacent organs. Conclusions 3 D ultrasound can clearly demonstrate the morphologic characteristics and internal structures of the bladder disease and provide much more reliable information for the diagnosis of diseases.

Centering on hospital crisis communication management,the paper analyzed the relationship between hospital crises and new media environment.The new media form is studied as the basic dimension,to explore the new media′s timeliness,openness,interactivity and uncontrollability,as well as their impact on the hospital crisis management.It discussed the lack of hospital crisis communication management under the context of new media environment,and proposed how the hospitals make use of the new media,and adjust their strategies to respond to the crisis.These points prove both academic and practical for the construction of the new mechanism of China ’s hospital crisis communication management,and encourage the new media to play their social public functions.

Objective To investigate the effect of epinephrine combined with methoxamedrine on rate of successful cardiopulmonary resuscitation (CPR) in rabbit model of sudden cardiac arrest by the method of clamping the trachea to asphyxia.Methods Twenty-seven rabbits were randomly (random number)divided into methoxamedrine group,epinephrine group and epinephrine combined with methoxamedrine group.After the modeling,rabbits in the three groups were treated methoxamedrine,epinephrine,and epinephrine combined with methoxamedrine respectively by intravenous injection during CPR.The change of heart rate (HR),mean arterial pressure (MAP) and electrocardiogram (ECG),restoration of spontaneous circulation (ROSC) and mortality within 2 hours of each experimental group were recorded before suffocation and 15 min,30 min,60 min,120 min after the success of the resuscitation.The pathological changes of myocardium were observed under optical and electronic microscope.Results The number of ROSC rabbits in methoxamedrine group,epinephrine group and epinephrine combined with methoxamedrine group were 1,6,5 respectively.The heart rate and mean arterial pressure of the rabbits after ROSC were lowered compared with those before suffocation significantly (P ＜0.05).The levels of mean arterial pressure at 15 minutes and 30 minutes after ROSC in combined treatment group were higher than those of epinephrine group significantly (P ＜ 0.05).The myocardial structure of rabbits after ROSC observed by optical and electronic microscope showed an acute injury,however,the damage degree of myocardium in combined treatment group was slighter.Conclusions Epinephrine combined with methoxamedrine has no apparently additional effect on ROSC during CPR compare with epinephrine used alone,but this combination of two agents can be benefit for stabilizing hemodynamic at early post-ROSC stage,and methoxamedrine can reduce the damage of myocardium during CPR.

Objective To assess the value of ultrasonography in distinguishing pharyngoesophageal diverticulum from thyroid nodule.Methods High-frequency sonography was used to detect the size,shape, echo and blood flow of cervix masses in 1219 patients in a lateral decubitus position after drinking water. Results On enhanced power,the image changing rates of pharyngcesophageal diverticulum and thyroid nodule were 71.43% and 14.19% respectively,and their difference was statistically significant(P<0.05). On drinking water,the image change rates of pharyngoesophageal diverticulum and thymid nodule were 100.00% and 1.98% respectively,and their difference was statisfically significant(P<0.05).The detection rates for pharyngoesophageal diverticulum and thyroid nodule were 0.098% and 17.042% respectively. Conclusions Ultrasound examination is of value in distinguishing pharyngoesophageal diverticulum from thyroid nodule in general health check up and regular health examination.

Objective To explore connotative quality of how to improve the electronic medical records. Methods Combining with the ways of improving connotative quality in fact, the advantages and common defects of electronic medical records were reviewed and some suggests were brought forward. Results The connotative quality of electronic medical records could be enhanced by specific quality standards, the implementation of quality control of section links and the emphasis quality control suited to expert's specialty, at the same time, the connotative quality of electronic medical records was raised by monitor methods of informationazition platform. Conclusion Improving the whole medical level of hospitals is the crux of raising the connotative quality of medical records.

Objective To study the fetal developmental regulation and gestational weeks at labor for triplets pregnancies Methods To detect biparietal diameters and femoral length at different gestational weeks, record gestational weeks of labor and birth weights, and compare with those of singletons Results The fetal development of triplets slowed down from the beginning of the 28th gestational week compared with that of singletons (the mean difference was 2 1mm and 3 1 mm respectively, P

Objective Peking University Health Science Center,together with Keio University,King's College London and Karolinska Institutet developed a cooperative medical research summer school.It integrates the education methods of lectures,lab rotations and visits etc.,which forms a special model.This study aims to analyze and evaluate the effect,prospect and space for further improvement of the summer school.Methods Program documents review and evaluation,interview and questionnaire survey to teachers as well as students who engaged in such program.Results The sum mer school enhances the research cooperation and communication among faculties and students from participating universities;it is highly appraised by participating teachers and students;students are particularly satisfied in the following aspects:gain knowledge and skills in cross-cultural communication,develop global health knowledge,gain knowledge and skills in research,and also enhance the sense of commitment in research.Conclusions The research summer school can improve the postgrad uate education standard,promote scientific cooperation,and improve students' research capacity.However,there are still some space for further improvement,such as improve the recruitment process;enhance the platform support;strengthen the evaluation,feedback and follow up system;further develop the program in depth and breadth.

ObjectiveTo study the efficacy and safety of heated humidified high flow nasal cannula ( HHHFNC) and nasal continuous positive airway pressure( NCPAP) ventilation for prevention of extubation failure in extremely low birth weight(ELBW)infants in our NICU.MethodsFrom Jan.2011 to Dec. 2014, 129 ELBW infants admitted to our hospital were randomly assigned into HHHFNC group and NCPAP group. The inclusion criteria were gestational age ( GA ) <34 w, birth weight ( BW )<1000 g, admission within 7 d after birth and transition to noninvasive respiratory support after a period of mechanical ventilation with an endotracheal tube. The primary outcome included:the incidence of extubation failure, nasal injury, air leak, abdominal distention and bronchopulmonary dysplasia ( BPD). Results Statistically significant difference sexisted between the two groups on oxygen the rapyduration, the time required reaching total enteral feedings and the incidences of nasal injury, air leak, abdominal & nbsp;distention and necrotizing enterocolitis ( P<0. 05). The incidence of extubation failure within 7 days was 25. 8℅ in HHHFNC group and 47. 6℅ in NCPAP group ( P <0. 05 ) . No differences between the 2 groups on total ventilation duration, non-invasive ventilation duration, re-intubation rate at 3d after extubation, BPD, retinopathy of prematurity ( ROP ) , intracerebral hemorrhage ( ICH ) , periventricular leukomalacia(PVL)and patent ductus arteriosus(PDA).Conclusions HHHFNC is an effective and safe method for prevention of extubation failure in ELBW infants.