The paper discusses the issue of system transformation in large state owned hospitals. Proceeding from the service features of large state owned hospitals under the market economy, it expounds the relationship between system transformation and change in government functions, clarifies the impact of the state owned assets management mechanism on system transformation, proposes basic channels for the plurality of assets structure, identifies the significance of ensuring the objectivity and mechanism of share holding by the management and staff, and stresses the position and role of corporate management.

Through a thorough analysis of Shandong Provincial Hospital's trusteeship of Shandong Coal General Hospital,the paper delineates the objective conditions and process of the trusteeship,makes a deep study on the trusteeship plan,and expounds the relationship between hospital trusteeship and group construction.It summarizes in an all-round way the theoretical significance and practical value of this case of trusteeship and sets forth the deep-lying problems confronting hospital trusteeship based on group construction.

ObjectiveTo evaluate the feasibility and outcome of overnight laparoscopie cholecystectomy (OLC).MethodsThe clinical data of 149 patients with cholecystolithiasis or gallbladder polyps who were admitted to the Tianjin People's Hospital from October 2008 to December 2010 were retrospectively analyzed.All the patients underwent LC in the morning and were discharged 24 hours later.Modified Aldrete scoring was done 4-6hours after LC.Patients were contacted by telephone 3 days after LC and reexamined in the out-patient department 7 days after LC.The hospital cost of patients who underwent OLC or LC was compared using the t test.Results OLC was successfully performed on 149 patients,and the modified Aldrete scores of 130 patients were above 9.The visual analogue scale (VAS) of 118 patients were under 4,and the VAS of 31 patients were above 4.The condition of the 31 patients were closely monitered,and were administered morphine.Of the 149 patieuts,144were discharged 24 hours after operation,and the remaining 5 patients were admitted to general ward because of fever,peritoneal effusion or abdominal pain.The incidence of postoperative complication was 2.0％ (3/149) and the mortality was 0.All the patients were followed up,and none of the patients had an emergency readmission.The duration of incapacity was 5.2 days (range,2-7 days).The mean hospital cost of patients who received OLC was ( 7888 ± 396 ) yuan,which was significantly lower than ( 12121 ± 960) yuan of patients who received LC ( t =38.97,P ＜ 0.05 ).ConclusionOLC is effective and safe,and meets the requirement of health insurance policy.

Objective To study the Mediating effect of insecurity between childhood abuse and emotional distress of medical students,and to provide basis to intervene their mental disorder.Methods Through stratified sampling,262 medical students in Jiangsu were investigated by the Personal Report of Childhood Abuse( PRCA),Self-Rating Feeling of Insecurity Scale( SRFIS),Beck Depression Inventory( BDI ),Self-rating Anxiety Scale(SAS)and Suicide Ideation Scale(SIS).A path analysis was applied by Analysis of Moment Structures(AMOS) version 7.0.Results The path analysis showed that childhood abuse was directly related to insecurity of medical students ( β =0.538,P ＜0.01 ),and was directly related to emotional distress ( β =0.435,P ＜ 0.01 ).Insecurity were directly related to emotional distress of medical students ( β =0.342,P ＜ 0.05 ).Insecurity mediated partly the relationship between childhood abuse and emotional distress of medical students.The model fit indexes were X2/df =1.365 ＜ 3.000,P =O.082 ＞ 0.05,RMSEA =0.037 ＜ 0.050,GFI =0.971,AGFI =0.940,NFI =0.943,RFI =0.902,IFI =0.984,TLI =0.972,CFI =0.984.Conclusion Insecurity as mediated variable mediates the relationship between childhood abuse and emotional distress of medical students.

Objective To investigate the stress characteristics of atlanto-axial bony structure under conditions of anteflexion,posterior extension,lateral flexion,and rotation after artificial atlanto-odontoid joint arthroplasty using three-dimensional finite element method and to improve the orientation of artificial atlantoodontoid joint from perspective of stress.Methods A three-dimensional finite element model of prosthetic atlanto-odontoid joint arthroplasty was created from CT images of the artificial atlantoodontoid joint and cervical vertebrae using software Mimics,Freeform,and Ansys.Stress characteristics of the model dealt with proneness,posterior extension,lateral flexion,or rotation loads were observed.Biomechanical performance of the bony structure of the model was analyzed and the orientation in improving the prosthesis was discussed.Results Anteflexion loading produced a maximum stress of 0.138 ×l08 N/m2 at the junction of lateral mass and posterior arch of the atlas,and 0.201 × 108 N/m2 at axial nail hole,contact point of plates with the axis,and posterior arch of the axis.Posterior extension loading produced a maximum stress of 0.666 × 107 N/m2 at junction of lateral mass and posterior arch of the atlas and 0.254 × 108 N/m2 at arch of the axis.Besides,stress concentration occurred at atlantoaxis nail hole.Right bending produced a maximum stress of 0.124 × 108 N/m2 at nail hole of right mass of atlas and 0.178 × 108 N/m2 at right contact point of the axis with plates.Right rotation produced a maximum stress of 0.847 × 107 N/m2 at junction of lateral mass and posterior arch of the atlas and 0.170 × 109 N/m2 at contact point of the axis with plates.The finite element model comprised 28 620 nodes and 107 441 units and provided good defining of the structural properties of artificial atlanto-odontoid joint arthroplasty.Under different loading conditions,the stress was mainly distributed in contact point of the vertebral body with plates,nail holes,junction of lateral mass and posterior arch of the atlas,and axial pedicle.Conclusions Prosthetic atlanto-odontoid joint scatters a part of the stress and alters the stress distribution of the atlas and axis from the intact condition.Finite element method can obtain complete analysis of the stress distribution of the artificial atlanto-odontoid joint arthroplasty.

Objective To investigate the effect on the differentiation of bone marrow mesenchymal stem cells (BMSC) with non-contact co-culture with mechanical stimulated ligament fibroblasts. Methods A cyclic 10% uniaxia strain at 1 Hz was applied on rat pelvic ligament fibroblasts, then were co-cultured with BMSC for 3, 6 and 12 days in non-contact condition. The protein expression of collagen Ⅰ ,Ⅲ in BMSC were detected by SP method and revealed by the mean gray value. The mRNA expressions of collagens type Ⅰ and type Ⅲ in the BMSCs were measured with real-time (RT)-PCR ,and the results were indicated by the ratio between the mRNA and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) . Results (1) Protein expression; after 3 days co-culture with pelvic ligament fibroblasts, expression of collagen Ⅰ and Ⅲ in BMSC are 82. 4 ± 3. 4 and 76. 8 ± 2. 5. When compared with 80. 2 ± 2. 6 and 74. 6 ± 1. 1 in BMSC without co-culture, there was no significant difference (P > 0. 05) . After 6 days co-culture with pelvic ligament fibroblasts, the expression of collagen Ⅰ and Ⅲ of 126. 6 ±2. 2 and 118. 6 ± 1. 4 in BMSC were significantly higher than 82. 7 ±3. 0 and 76. 2 ± 1. 3 in BMSC without co-culture (P < 0. 05). Similarly, after 12 days co-culture with pelvic ligament fibroblasts, the expression of collagen Ⅰ and Ⅲ of 135. 3 ±3. 4 and 128. 7 ± 2. 6 in BMSC were significantly higher than 86. 6 ± 1. 3 and 81. 8 ± 1.4 in BMSC without co-culture (P <0.05). (2)mRNA expression:after 3 days co-culture with pelvic ligament fibroblasts , the mRNA expression of type Ⅰ and type Ⅲ collagens in BMSC are 2. 10 ±0. 20 and 1. 20 ±0. 30. When compared with mRNA expression of 2. 01 ±0. 12 and 1. 13 ±0.21 in BMSC without co-culture, no significant difference were observed (P > 0. 05). After 6 days co-culture with pelvic ligament fibroblasts , the mRNA expressions of type Ⅰ and type Ⅲ collagens mRNA were 5. 60 ±0. 21 and 2. 61 ±0. 20, which were significantly higher than 3. 70 ±0. 33 and 1. 82 ± 0. 14 in BMSC without coculture (P < 0. 05). After 12 days co-culture with pelvic ligament fibroblasts, the mRNA expressions of type Ⅰ and type Ⅲ collagens of 5. 91 ±0.31 and 2. 92 ±0. 23 were significantly higher than 4. 04 ±0. 21 and 2. 04 ±0. 13 in BMSC without co-culture (P <0. 05). Conclusion Non-contact co-culture with mechanical stretch stimulated ligament fibroblasts, it might promote synthesis of types Ⅰ and Ⅲ collagen in rat BMSCs and induced BMSC differentiated into pelvic ligament fibroblasts.

Objective To discuss the application value of urokinase in sclerotherapy of endometrial cystoma of ovary under ultrasonic guidance.Methods According to the sonographic characteristics,156 endometrial cystomas of ovary in 148 cases were divided into four types:the type of simple cyst(E1),the type filled with homogeneous echoes(E2),the type of multilocular endometrioma(E3)and the type mingled with solid in it(E4).Under ultrasonic guidance,the patients underwent selerotherapy with absolute alcohol after the cystomas washed repectively with urokinase(treatment group)and normal saline(control group).The recovery ratios and the remission of dysmenorrhea were observed.Results The recovery ratio,excellence ratio and inefficiency ratio of treatment group were 94.9%,5.1%and 0 respectively,while those of control group 76.9%,11.5%and 1 1.5%respectively.As to the recovery ratios,there were no statistical differences among types in treatment group.While the differences between E3,E4 and E1,E2 were significant (P＜0.05,P＜0.01).As to E3 and E4,there were statistical differences between the two groups(P＜0.01,P＜0.05).After 6 months'therapy,according to the visual analogue scales of dysmenorrhea,there was statistical difference between the two groups(t=7.802,P＜0.001).Conclusions Using urokinase to thoroughly dissolve and wash cellulose and mural blood clots in endometrial cystoma of ovary before the injection of sclerosing agent can definitely improve the recovery ratio and remit the symptoms of dysmenorrhea.

Objective To evaluate the clinical effect and safety of the occiput-cervicle or C1-C2 internal fixation and bone graft fusion in treatment of the unstable atlas fracture.Methods A retrospective study was performed in 38 patients with unstable atlas fractures treated by the occiput-cervicle or C1-C2 internal fixation and bone graft fusion from October 2004 to March 2009.Six patients with comminuted atlas fracture combined with instability of the occipito-atlantoid articulations were treated with occiput-C2 fusion(five patients)and with occiput-C3 fusion(one patient).There were seven patients with typical Jefferson fractures,three with semiring fractures,eight with atlas fractures combined with Anderson type Ⅱ odontoid process fractures,three with atlas fractures combined with Hangman's fractures (two patients with Levine and Edwards type Ⅲ Hangman's fractures were treated with occiput-C3 fusion and one patient Levine and Edwards type Ⅱ Hangman's fracture was treated with C1-C2 fusion),three with atlas fracture combined with lower cervicle injury,six with rupture of transverse ligament combined with instability of atlanto-axial joint(Dickman transverse ligament type Ⅰ injury)and two with comminuted fracture of the lateral mass associated with bony avulsion of the medial tubercle and transverse ligament(Dickman transverse ligament type Ⅱ injury).Of all,five patients were treated with occiput-C2 fusion,three treated with occiput-C3 fusion and 30 treated with C1-C2 fusion.Results All the patients were followed up for a range of 12-46 months(average 28 months),which showed improvement of clinical symptoms in some extent postoperatively.The operation time ranged from 80 to 190 min ates(average 135 minates),with intraoperative blood loss for 200-3 300 ml(average 460 ml)and average fluoroscopic time for 60 seconds.There were no neurological deficits,vertebral artery related complications or other complications in all the patients during the surgical operation.No neurological deficit was aggravated after the patient's mobilization with brace three days after operation.The enous plexus of blood vessel at C1-C2 rupture induced by the use of electrocautery was found in three patients who showed no cerebral hemodynamic deficit after hemostasis with hemostatic sponge and cotton piece.The follow-up X-ray and CT manifested osseous fusion in all the patients,with no looseness or breakage of the screws.The late follow-up showed pain associated with movement and limited range of motion in four patients(11%)and occipital neuralgia in one.Conclusions An occiput-cervicle fixation fusion or a C1-C2 fixation fusion combined with short external fixation can reestablish the upper cervical stability and prevent further injury of the spinal cord and nerve function and hence is an ideal option for C1 burst fracture with or without rupture of the transverse ligament.

This article analyzed the current problems existing in the public health master cur-ricula system, such as educational ideas being backward, tralning objectives not explicit, curricula teaching unsatisfactory and effects of practical curriculum needing to be improved. Based on the pro-fessional competencies, we discussed the ideas and principles of the new curricula system of master of public health, and proposed making sure of a refined professional competencies, making strict traln-ing standards, confirming tralning objectives, embodying advantages, setting up reasonable curricula, fostering practical abilities, strengthening cooperation and carrying on professional identification.

Objective To observe and analyze the therapeutic effect of focal uterine adenomyosis treated with percutaneous microwave ablation by contrast-enhanced ultrasound and dynamic contrast enhanced MRI (DCE-MRI).Methods From January 2013 to July 2016,42 patients with focal uterine adenomyosis voluntarily underwent percutaneous microwave ablation in the tumor hospital of Liaocheng.Contrast-enhanced ultrasound and DCE-MRI were performed before and after percutaneous microwave ablation.The therapeutic effects of percutaneous microwave ablation in treatment of uterine adenomyosis lesions were observed.Results After percutaneous microwave ablation of the 42 cases,the ablated zone showed no enhancement with contrast-enhanced ultrasound and DCE-MRI.Contrast-enhanced ultrasound showed that the volume and ablation rate of ablated zone were (49.0±29.5) cm3 and (91.6± 7.1)％,and that of DCE-MRI were (49.4 ± 29.9)cm3 and (91.9 ± 6.7)％,respectively.The results showed that percutaneous microwave ablation could cure focal uterine adenomyosis at the rate over 90％.Contrast-enhanced ultrasoundand DCE-MRI are in accordance in observing the ablation rate.Conclusions Contrast-enhanced ultrasound can accurately show the ablation rate of focal uterine adenomyosis treated with percutaneous microwave ablation,which is quite consistent with DCE-MRI.Contrast-enhanced ultrasound has its advantages such as identifying the lesions which need immiedately supplemental ablation.