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.

Objective:To study the influence of r-tPA and urokinase in curative effect and thrombolysis time on patients with acute and severe pulmonary embolism after interventional thrombectomy .Methods:After reviewing and analyzing the clinical data of 19 acute and severe pulmonary embolism patients , we classified them into two groups in accordance with the application of r-tPA and urokinase to compare the changes of their heart rate , blood pressure , pulmonary arterial pressure , arterial partial pressure of oxygen and hemachrome before and after thrombolysis , as well as the thrombolysis effect time the two groups took.Results: The heart rate, blood pressure, pulmonary arterial pressure , arterial partial pressure of oxygen of the patients in both groups gained remarkable improvement after operation ( P<0 .05 );the pulmonary arterial pressure of the r-tPA patient group dropped but not significantly compared with that before operation ( P>0.05); the pulmonary arterial pressure of the urokinase patient group dropped significantly compared with that study before operation ( P<0.05 ); the hemachrome of both patient groups did not significantly drop after operation ( P>0 .05 );the thrombolysis effect time by adop-ting r-tPA was remarkably shorter than that caused in thrombolysis by adopting urokinase ( P<0 .05 ) . Conclusion: Both r-tPA and urokinase are effective in interventional thrombolysis for acute and severe pulmonary embolism .However , r-tPA could significantly shorten the time caused in thrombolysis without increasing any bleeding risk.

Objective Measure the variation trend and the problems of bed allocation and its equity at primary medical institutions and provide theoretical basis for optimizing the policy of health resources allocation for the government.Methods Analysis of the distribution and equity of the inpatient beds at primary medical institutions in terms of geographical area by means of the survey of regular overall statistics forms and the methods of Gini coefficient and Theil index.Results From 2009 to 2012,the number increase of beds at such institutions geographically was 7.72%,while that in eastern,central and western regions of China were respectively 5.35%, 3.97% and 27.88%.The number increase at community healthcare centers was 46.58%,while that in eastern,central and western regions of the country were respectively 18.09%,29.57%和 81.53%.The number increase at township hospitals was 2.33%,while that in eastern,central and western regions were respectively - 3.83%,- 0.43% and 22%.The Gini coefficient of bed allocation at such institutions was beyond 0.6,while that in eastern, central and western regions were respectively under 0.3,0.3-0.4 and 0.6 above.The Gini coefficient of bed allocation at community healthcare centers fell from above 0.4 to under 0.4.The Gini coefficient in the western regions increased from 0.3-0.4 to over 0.4.The variation trend of township hospitals was similar with the overall conditions at such institutions.The intra-regional Theil indexes and their contribution rates of bed allocation at such institutions were higher than those of inter-regional. Conclusions The overall variation trend of bed allocation at such institutions was on the rise,yet its variation trend of equity remains unchanged.The bed allocation and its equity at such institutions were higher than those at township hospitals.The growth rate in western regions was the highest,but the absolute number was the lowest.Moreover,the equity of bed allocation in such regions was not only the lowest,but also was found rising.The influence of bed allocation in intra-region terms was large,while its equity was not only lower but falling as well.

Objective To determine the dose-response relationship of sufentanil blunting responses to double-lumen endotracheal intubation when combined with propofol given by target-controlled infusion (TCI) in patients with pulmonary tuberculosis.Methods One hundred patients of both sexes with pulmonary tuberculosis,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 24-58 yr,with body mass index ＜30 kg/m2,with Mallampati grade Ⅰ or Ⅱ,undergoing thoracic surgery under general anesthesia,were divided into Ⅰ-Ⅴ groups (n =20 each) using a random number table.Anesthesia was induced with iv sufentanil 0.35 μg/kg (group Ⅰ),0.40 μg/kg (group Ⅱ),0.45 μg/kg (group Ⅲ),0.50 μg/kg (group Ⅳ) and 0.55 μg/kg (group Ⅴ),and propofol TCI (target plasma concentration 3.5 μg/ml) and iv vecuronium 0.15 mg/kg.The patients were endotracheally intubated and mechanically ventilated.The response to double-lumen endotracheal intubation was defined as positive when mean arterial pressure increased by＞ 20％ of the baseline value and/or heart rate ＞ 90 bpm within 5 min after intubation.The median effective dose (ED50),ED95 and 95％ confidence interval (95％ CI) of sufentanil blunting the responses to double-lumen endotracheal intubation were calculated by Probit analysis.Results The ED50 (95％ CI) and ED95 (95％ CI) of sufentanil blunting the responses to intubation were 0.411 (0.370-0.441) μg/kg and 0.635 (0.556-0.888) μg/kg,respectively,when combined with propofol given by TCI.Conclusion When combined with propofol given by TCI (target plasma concentration 3.5 μg/ml),the ED50 and ED95 of sufentanil blunting the responses to double-lumen endotracheal intubation are 0.411 and 0.635 μg/kg,respectively,in patients with pulmonary tuberculosis.

Objective To summarize the experience in diagnosis and therapy of familial adenomatous polyposis with desmoid tumour. Methods Clinical data of 6 patients with familial adenomatous polyposis and desmoid tumour from Jan 1989 to Jan 2005 were retrospectively analyzed. Results Five patients received proctocolectomy and 1 abdominoperineal resection. The most common symptom was progressive painless mass in abdomen. All patients were confirmed by image examination. Four received surgery, 2 were treated by medicine postoperatively and 1 got watchful therapy. Postoperative recurrence developed in two cases and one suffered from short bowel syndrome. All patients were alive at the follow-up. Conclusions FAP with desmoid tumour is not a rare condition and we should pay attention to diagnosis and manage this disease entity. A reasonable remedy was selected according to general state of health and location of desmoid tumour which can improve prognosis and quality of life.

Objective To evaluate the technique of selective portal vein embolization before hepatectomy and its value in the preparation of major hepatic resection for those with insufficient future remnant liver.Methods From Jan 2008 to July 2012,6 patients who suffered from hepatic tumors underwent selective ipsilateral portal vein embolization (PVE) due to insufficient future remnant liver volume (FRLV) before second-stage major hepatic resection.Results Technically,all six PVE were completed successfully with only minor liver function damages.The average FRLV increased from (474.33 ± 89.19)cm3 to (722.67 ± 151.51) cm3 (t =-5.587,P =0.003).The average tumor burden (total tumor volume)increased from (134 ± 181) cm3 to (270 ± 346) cm3 (t =-1.64,P =0.16).Five cases underwent secondstage major hepatectomy 6 weeks after PVE,while in 1 case a resection attempt was abandoned because of uncontrolled tumor growth during the period.During the follow-up period (median 37 months),1 died,4 survived,2 were tumor-free.Conclusions Selective portal vein embolization is a safe and effective method to induce hepatic hypertrophy in the appropriate clinical setting.Before PVE,hepatic tumor should be controlled beforehand with chemotherapy or TACE to ensure the scheduled second-stage hepatectomy.

Objective To analyze the direct and indirect effects of influencing factors on suicide ideation among college students based on the structural equation model. Methods 1505 college students were investigated with ASLEC, Simplified Coping Style Questionnaire, SSRS, QSA and BDI. Results Incidence rate of college students' suicidal ideations during the past year was 6.67%. The goodness of fit for the structural equation model was satisfactory and 3 major indices( x2/df = 2.23, GFI = 0. 982, RMSEA = 0. 029 ) had met corresponding requirements. The depression was directly influencing factor on suicide ideation, while four factors including passive coping style, social support, positive coping style and suicide attitude, had indirect impacts. Negative life event not only directly affected suicide ideation, but also had indirect effects. According to the percentages of their contribution, the risk factors were ranked as follows:depression (41.08%), negativity life event (35.35%) and passive coping style (6.05%). Similarly, the top protective factor was: social support ( 11.94% ), followed by positive coping style (4.94%) and suicide attitude (0.63%). Conclusion Depression is an important risk factor of suicide,and has a direct impact. So, not only strengthen the mental health of college students, but also train students to face up the difficulties with a positive style, and make the college students get social supports sufficiently.

Objective:To study the morphology of middle cerebral artery ( MCA ) M1 segment .Me-thods:We selected the MRA data of 794 MCA (400 of the left side and 394 of the right side ) from Ja-nuary 1, 2011 to June 30, 2011 consecutively and analyzed the morphology of the MCA M 1 segment in axial, anteroposterior and lateral view , measured the length of the M1 segment, and analyzed the simila-rity of the left and right side M1 segment morphology .Results:In axial, anteroposterior and lateral view , the MCA M1 segment showed C-shape >L-shape >S-shape .In axial view , it was about 373 ( 47%) M1 segment performance for the C-shape, of which 340 (42.8%) M1 segments showed bowing to the dorsal side, only 33 (4.2%) M1 segments showed bowing to the ventral side .In anteroposterior view, it was about 322 (40.6%) M1 segments of the performance of the C-shape, of which 262(33.0%) M1 segments showed a bowing to the superior , 60 (7.6%) showed bowing to the inferior .The similarity of the left and right MCA M1 segments was 27.2% (114/419) in axial view and 42.7% (179/419) in anteroposterior view.It was more similar in anteroposterior view than in axial view .Along with the increase of age, in the axial view, L-shape converted to C-shape very obviously, but only mildly elevated in S-shape .In anteroposterior view , the L-shape converted to the C-shape or S-shape along with the increase of age.Conclusion:The different morphology of MCA M1 segment in axial and anteroposterior view may be involved in the development of intracranial atherosclerosis .

Objective:To analyze correlation factors of hemodynamic damage after carotid artery stenting.Methods:In this study, 66 cases (71 lesions) who undertook carotid artery stenting were col-lected and the correlation factors of hemodynamic damage were analyzed .Results:Hemodynamic damage emerged in 23 cases (32.4%), of which, 11.3%developed hypotension.The distance between bifurca-tion and lesions (P=0.002 0), plaque distribution (P=0.000 2), plaque character (P=0.001 9), post-dilation ( P =0.002 6 ) were associated with hemodynamic damage by single factor analysis . However, only eccentric plaque (P=0.015 3) and calcified plaque (P=0.009 7) were associated with hemodynamic damage by multiple factors analysis .All the patients could reach stable circulation by drugs during operation , and no cerebral ischemic events ( transient ischemic attack or stroke ) and cardiovascu-lar ischemic events happened .Conclusion: The distance between bifurcation and lesions , eccentric plaques, calcified plaques are correlation factors of hemodynamic damage .

Objective To evaluate the effect of mild hypothermia on the expression of phosphorylated eukaryotic translation initiation factor 2α (p-eIf2αt) in the hippocampus in a mouse model of cerebral ischemia-reperfusion (I/R).Methods Sixty pathogen-free healthy male C57BL6 mice,aged 8-12 weeks,weighing 20-30 g,were divided into 3 groups (n =20 each) using a random number table:sham operation group (group S),group I/R and mild hypothermia group (group H).Cerebral I/R was induced by 15-min occlusion of bilateral common carotid arteries followed by reperfusion in chloral hydrate-anesthetized mice.Surface cooling was started immediately after reperfusion to maintain the rectal temperature at 32-34 ℃ for 3 h in group H.The neurologic deficit score was evaluated at 24 h of reperfusion.The mice were then sacrificed,brains were immediately removed,and hippocampi were isolated for examination of pathologic changes of hippocampal CA1 region and for determination of neuroapoptosis (by TUNEL) and expression of peIf2α (by Western blot).The apoptosis rate was calculated.Results Compared with group S,the neurologic deficit scores at 24 h of reperfusion and apoptosis rate of hippocampal neurons were significantly increased,and the expression of p-eIf2α was up-regulated in I/R and H groups (P＜0.05).Compared with group I/R,the neurologic deficit scores at 24 h of reperfusion and apoptosis rate of hippocampal neurons were significantly decreased,and the expression of p-eIf2α was down-regulated in group H (P＜ 0.05).Conclusion Mild hypothermia reduces endoplasmic reticulum stress and inhibits neuroapoptosis through inhibiting the expression of p-eIf2α in the hippocampus in a mouse model of cerebral I/R.