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 analyze the perioperative conditions and long-term survival of patients with non-small cell lung cancer (NSCLC) after thoracoscopic lobectomy. Methods 119 patients with NSCLC underwent thoracoscopic lobectomy from January 2006 to December 2012 were enrolled in the study, then collecting and analyzing their perioperative indicators, pathological results and follow-up data. Results 9 patients converted to thoracotomy with a conversion rate of 7.0 %. The median operation time, the median intraoperative blood loss and off-bed activity time were 170 min (65~440 min), 90 ml (15~3 000 ml) and (32.9 ± 16.3) h after operation respectively. The time and amount of postoperative drainage, the length of hospital stay were (6.7 ± 3.2) d, (1 690.0 ± 410.5) ml, (9.2 ± 4.0) d respectively. The incidence of perioperative mortality and postoperative complications were 0.8 %, 13.4 % respectively. For postoperative pathological type, 96 cases of adenocarcinoma, 19 cases of squamous carcinoma, 2 cases of adenosquamous carcinoma and 2 cases of large cell carcinoma. For discharge patients, the median follow-up time was 34.5 months (0 ~ 102 months). The incidence of local recurrence and distant metastasis in observation group were 5.0 % and 17.6 % respectively. 1-year overall survival (OS) and disease free survival (DFS) were 85.3 % and 79.5 %, 3-year OS and DFS were 69.8 % and 64.8 %, 5-year OS and DFS were 60.8 %and 58.6 % respectively. There was no significant difference in 1-year, 3-year and 5-year OS and DFS between adenocarcinoma and squamous carcinoma (P > 0.05) while there were significant difference in local recurrence and distant metastasis among different stages (P < 0.05). In addition to slightly low OS, DFS of Ⅲ a , Ⅲ b and Ⅳ DFS and OS, the overall living conditions among all stage were similar. Conclusions The long-term survival condition of thoracoscopic lobectomy for NSCLC is ideal, and it’s a safe and effective operation, worthy of clinical promoting.

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 systematically review the efficacy and safety of drug-eluting stent(DES) versus coronary artery bypass grafting(CABG) in the treatment of left anterior descending coronary artery(CAD) stenosis.Methods Literature about the efficacy and safety of DES versus CABG for LAD stenosis was retrieved from digital databases of MEDLINE, EMbase, PubMed, and the Cochrane Library by November 2016.Data extraction and quality assessment of included studies were conducted by two independent reviewers.RevMan 5.3 software was used to perform meta-analysis.Results Ten studies involving 9771 patients were finally included.The results of meta-analysis showed that there was no significant difference in mortality [RR=0.88,95%CI(0.70,1.11),P=0.28],major adverse cardiovascular events[MACE,RR=1.04,95%CI(0.88,1.24),P=0.63] or myocardial infarction [MI,RR=0.92,95%CI(0.56,1.53),P=0.75], but PCI-DES significantly increased the risk of TVR [OR=2.43,95%CI(1.61,3.69),P<0.0001].Conclusion For LAD stenosis, PCI-DES strategy causes as high a rate of mortality, MACE and MI as CABG or DES, but PCI-DES can significantly increase the risk of TVR, so we should be cautious clinically.

Objective To explore the clinical value ofmulti-slice spiral CT (MSCT) to carcinomatous intestinal obstruction of colon.Methods The clinical and MSCT data of 40 patients with carcinomatous intestinal obstruction of colon diagnosed by MSCT were analyzed.Results In the 40 cases,complete intestinal obstruction were in 17 cases,incomplete intestinal obstruction in 23 cases,39 cases were carcinomatous intestinal obstruction of colon confirmed by surgery and pathology,and 1 case was intussusception intestinal obstruction by multiple polyps.The MSCT qualitative analysis of obstruction reason was 97.5％ (39/40),the MSCT diagnostic accuracy of intestinal obstruction was 100.0％ (40/40).The obstruction site was at ascending colon showed in 14 cases,transverse colon in 4 cases,splenic flexure of colon in 2 cases,descending colon in 6 cases,sigmoid colon in 12 cases,both ascending colon and transverse colon in 1 case,colon and small intestine in 1 case.The obstruction site accuracy rate of MSCT was 100.0％ (40/40).Conclusion MSCT has obvious advantages in obstruction existing,obstruction site,obstruction reason to carcinomatous intestinal obstruction of colon,it can offer reliable examination data to clinic.

Hospital entrustment will incur cultural conflicts,which calls for cultural integration as the best means to ease such frictions and conflicts between two hospitals of cultural difference.Renmin Hospital of Wuhan University (Hubei general hospital)directly hosted Hanchuan people's hospital,and implemented the president responsibility system under the leadership of the management committee.By means of cultural integration to reshape Hanchuan hospital culture,Hubei general hospital has rebuilt the latter's culture.Such reshaping features the following:development as the core,scientific management as the breakthrough,employees as the center,technology upgrade as the basis,and patients service as the direction.Cultural integration has furthered development of the hospital entrusted,and turned frictions and conflicts into infiltration and integration.As a result,Hanchuan hospital is upgraded in general in terms of management and service quality.

OBJECTIVETo report on prenatal diagnosis and follow up of two patients with paternal uniparental disomy of chromosome 6 (pUPD6).

METHODSFetal cells were subjected to in situ culturing and G-banded chromosomal analysis. DNA samples of the fetuses and their parents were also analyzed with single nucleotide polymorphism microarray (SNP array).

RESULTSBoth fetuses had a normal male karyotype. SNP array analysis showed both have carried pUPD6.

CONCLUSIONpUPD6 can lead to transient neonatal diabetes mellitus type 1. Homozygous status of recessive mutations, disorder of gene imprinting, and its influence on placental function are the main factors to be considered during prenatal diagnosis and genetic counseling for pUPD6.

Objective To establish new classification criteria for early rheumatoid arthritis (E-RA) based on large samples of early inflammatory arthritis patients and to evaluate the value of this criteria in China.Methods Patients who had arthritic complaints with disease duration less than one year were enrolled.They were divided into RA group and non-RA group according to the clinical diagnosis by experienced rheumatologists.The clinical and laboratory parameters were analyzed and those with high sensitivity or specificity were selected as the new classification criteria.Statistical analysis was carried out by using t test,x2 test and Logistic regression.Results ① A total of 803 patients with early inflammatory arthritis were included in this study.Five hundreds and fourteen patients were diagnosed as early RA and 251 were diagnosed as other rheumatic diseases,and the diagnosis of 38 patients remained unestablished by the end of follow-up.② New E-RA classification criteria were established based on the parameters with high sensitivity and/or specificity.The sensitivity of the new E-RA criteria was 84.4％,which was higher than 1987 ACR criteria (58.0％),while the corresponding specificities were similar,which were 87.4％ and 93.6％ respectively.③ Compared with the complex scoring system of 2010 ACR/EULAR criteria,the E-RA criteria was more simple and practical.The diagnostic sensitivity and specificity of E-RA criteria were higher than those of 2010 ACR/EULAR criteria reported in the literatures.④ New classification criteria based on scoring system using Logistic regression analysis was established.The sensitivity of this criteria was 86.4％,which was higher than 1987 ACR criteria (58.0％).Conclusion The diagnostic value of the E-RA criteria developed in this study for early RA is better than 1987 ACR criteria,and is more simple than 2010 ACR/EULAR criteria.It may be used as a new classification criteria for early RA diagnosis.

Although carbon monoxide (CO)-based treatments have demonstrated the high cancer efficacy by promoting mitochondrial damage and core-region penetrating ability, the efficiency was often compromised by protective autophagy (mitophagy). Herein, cannabidiol (CBD) is integrated into biomimetic carbon monoxide nanocomplexes (HMPOC@M) to address this issue by inducing excessive autophagy. The biomimetic membrane not only prevents premature drugs leakage, but also prolongs blood circulation for tumor enrichment. After entering the acidic tumor microenvironment, carbon monoxide (CO) donors are stimulated by hydrogen oxide (H₂O₂) to disintegrate into CO and Mn²⁺. The comprehensive effect of CO/Mn²⁺ and CBD can induce ROS-mediated cell apoptosis. In addition, HMPOC@M-mediated excessive autophagy can promote cancer cell death by increasing autophagic flux via class III PI3K/BECN1 complex activation and blocking autolysosome degradation via LAMP1 downregulation. Furthermore, in vivo experiments showed that HMPOC@M+ laser strongly inhibited tumor growth and attenuated liver and lung metastases by downregulating VEGF and MMP9 proteins. This strategy may highlight the pro-death role of excessive autophagy in TNBC treatment, providing a novel yet versatile avenue to enhance the efficacy of CO treatments. Importantly, this work also indicated the applicability of CBD for triple-negative breast cancer (TNBC) therapy through excessive autophagy.