Strategy Management” is one of the best management models of the western countries. It can create outstanding achievements, obtain the long-term profit at the best degree, and cultivate an excellent management group. The feature of the model is to discuss the relationship between strategy and action. It is a new model coming from commercial management, which combines the strategy thought with the organization action. In order to guide the higher medical education evaluation of our county, we should learn from the strategy management thought and the operative method.

Background In clinic practice,three or four rectus muscles often are needed to perform operation for the correction of large angle (＞50Δ) exotropia to avoid eye limited abduction due to lateral rectus superrecession.However,recent study reported that lateral rectus super-recession surgery can effectively correct large angle exotropia without remarkable abduction limitation.This outcome still need to be verified in clinical practice.Objective This study was to observe the outcome of bilateral rectus super-recession or medial rectus resection of the combined non-dominant eye for large angle exotropia.Methods A series case study was carried out.Fifty-one patients with intermittent or constant exotropia were enrolled in Tianjin Eye Hospital from May 2013 to October 2014.There were 29 intermittent exotropia and 22 constant exotropia among the 51 patients.Combined with adjustable sutures,bilateral lateral rectus super-recession or medial rectus resection of combined non-dominant eye was performed in all the eyes,and the examination of the anterior segment,fundus,ocular movement and binocular vision were performed before and after surgery.The deviation angle was measured by prism and alternate cover test.The individualized surgery procedure was designed according to medical history,ocular movement,sensory status and deviation angle.The patients were followed-up for at least 6 months.The eye position,ocular movement and binocular sensory function were compared between peoperation and postoperation.This study was approved by the Ethics Committee of Tianjin Eye Hospital.Written informed consents before the operation were obtained from all patient or their parents.Results Thirty-three patients underwent bilateral lateral super-recession and 18 patients underwent bilateral lateral super-recession of the medial rectus resection of the combined non-dominant eye.The mean angle of exotropia for seeing distance of 5 meters was (-70.57 ± 16.46) Δ (from-52 Δ to-120 Δ) and was (-75.65 ±16.14) Δ for seeing near (33 cm) (from-55Δ to-130Δ).The mean amount of left eye recession was 8-15 mm ([11.17±1.67] mm) and the right eye recession was 9-15 mm ([11.28±1.62] mm).The medial rectus of the dominant eye was resected by 3-6 mm.At the end of following-up,the mean angle of exotropia for seeing distance was (-3.45±4.20) Δ (from +4Δ to-14Δ) and was (-5.49±3.96) Δ for seeing near (from +4Δ to-14Δ).Surgical outcome was effective in 41 patients (80.4％),and 10 patients were undercorrected.The stereopsis of 32 patients improved after surgery,and 18 of 27 patients without preoperative stereopsis function obtained stereopsis after surgery.No ocular motility disorder was found in this group of patients after surgery.Conclusions Bilateral lateral rectus super-recesssion or medial rectus resection of combined non-dominant eye can effectively correct large angle exotropia and reduce the number and amount of surgical muscles without ocular motility disorder.

Objective To explore the protective effect of monosialoganglioside (GM1) on rats with acute brain trauma and its relevant mechanism.Methods Localized brain contusion model in rats were constructed by Feeney's method.65 SD rats were randomly divided into three groups: sham-operation group (n=5), brain injury group (n=30) and GM1 group (n=30).The rats were killed at 3, 7, 14, 28, 56, 168 h after administration, 5 rats in each group (1 rats in sham-operation group).Bax and Bcl-2 protein expression and PARP were decected by immunohistochemical method.The neuronal apotosis was detected by TUNEL.Results There were significant differences in expression of Bax and Bcl-2 protein between brain injury group and sham-operation group at each time point (P<0.05).There were significant differences in expression of Bax and Bcl-2 protein between GM1 group and brain injury group at each time point ( P <0.05 ) , while there were no significant differences in expression of Bax and Bcl-2 protein after 14 h between GM1 group and sham-operation group.After administration, the Bax/Bcl-2 values decreased and was obvious at 14 h.Degradation of PARP and rate of neuronal apotosis in brain injury group at each time point were significantly higher than those in sham-operation group (P<0.05).Degradation of PARP in GM1 group at 28 h, 56 h, 168 h were significant lower than those in brain injury group (P<0.05), and rate of neuronal apotosis was lower at each time point than those in brain injury group (P<0.05).Conclusion GM1 could reduce value of Bax/Bcl-2, degradation of PARP and apoptosis in rats with traumatic injury brain.

Objective To investigate whether mixed venous-arterial carbon dioxide difference (Pv-aCO2) combined with passive leg raising (PLR) could better guide volume management for patients post off-pump coronary artery bypass grafting (OPCABG).Methods Eighty patients experienced OPCABG, and admitted to Tianjin Chest Hospital from June 1st to October 1st in 2016 were enrolled. They were randomly divided into two groups: observation group given Pv-aCO2 combined with PLR directed therapy and control group given central venous pressure (CVP) directed therapy, 40 cases in each group. The difference in body temperature (T), heart rate (HR), mean arterial pressure (MAP), CVP, oxygenation index (PaO2/FiO2), mixed venous oxygen saturation (SvO2), Pv-aCO2, blood lactate (Lac), fluid intake, scores of the vasoactive agents at 6 hours post-operation, sequential organ failure assessment (SOFA) of 24 hours, mechanical ventilation time, the length of intensive care unit (ICU) stay, and hospitalization time were compared. The correlation between Pv-aCO2 and cardiac index (CI), Pv-aCO2 and Lac were analyzed by Spearman analysis in observation group.Results The T, HR, MAP, CVP, PaO2/FiO2, SvO2 and Lac at 6 hours post-operation were higher than those at admission in two groups, and Pv-aCO2 were significantly decreased. The SvO2 and fluid intake in observation group were higher than those in control group [SvO2: 0.671±0.068 vs. 0.634±0.052, fluid intake (mL): 454±151 vs. 304±106, bothP < 0.05], Pv-aCO2, Lac and scores of the vasoactive agents were lower than those in control group [Pv-aCO2 (mmHg, 1 mmHg = 0.133 kPa): 6.1±1.8 vs. 7.0±1.8, Lac (mmol/L): 1.7±0.5 vs. 2.8±0.6, scores of the vasoactive agents: 3.18±1.01 vs. 4.48±1.50, allP < 0.05], mechanical ventilation time and the length of ICU stay were less than those in the control group (hours: 16.52±6.41 vs. 21.96±9.00, 45.51±9.36 vs. 51.76±13.66, bothP< 0.05). There was no significant difference in SOFA, hospitalization time between the two groups. There was negative correlation with Pv-aCO2 and CI (r = -0.752,P < 0.01), and no correlation with Pv-aCO2 and Lac (r = -0.154,P = 0.171).Conclusion Pv-aCO2 combined with PLR can better guide volume management in the patients post OPCABG, reduce the usage of vasoactive agents and decrease the mechanical ventilation time and the length of ICU stay.

Objective To study the development of visual function in blepharophimosis-ptosis-epianthusinversm syndrome(BPES) and evaluate the clinical effect of Multistage Correction.Design Retrospective case series.Participants 51 cases of BEPS in Beijing Tongren Hospital from June 2005 to May 2009.Methods Refraction and general ophthalmology were performed for each patient. Family history was inquired and corrected surgery were performed for every one.Main Outcome Measures Refraction,the length, width of palpebral fissure,and inner canthal distance were measured both preoperatively and postoperatively.Results 13 of the 51 cases had family history,27 cases had amblyopia and 12 cases had refractive error.4 cases combined with strabismus.Conclusions The risk of refractive error and amblyopia in patients with BPES is much higher than that of normal population,so careful regular visual follow -up and early surgery are necessary.BPES patients tend to have much more chance to get amblyopia,which will impact on the development of visual function,therefore surgery correction at early age is highly suggested.

Objective To explore the optimal method of treatment for radiation proctitis by keeping coloclysis with traditional Chinese medicine (TCM), including administation temperature, infusion time, dosage and catheter depth. Methods The orthogonal experimental design was adopted. Sixty-three patients with radiation proctitis were randomly divided into 9 groups, and they were under enema for 6 weeks according to different test conditions. TCM syndrome score, radiation injury effect and Karnofsky scores were set as evaluation indexes. An orthogonal design and analysis of variance were conducted for optimization. The best technical schemes for traditional Chinese herb in treating radiation proctitis were obtained. Results The obtained optimum methods are:drug temperature of (39±0.5)℃, infusion time of 30 minutes, dosage of 100 mL, catheter depth of 20 cm. Conclusion The optimal scheme of enema for the treatment of radiation proctitis is reasonable and feasible.

OBJECTIVE:To study the pharmacokinetic characteristics of triflusal capsule in healthy volunteers. METHODS:In ran-domized test,36 healthy volunteers were randomly divided into 3 groups. They were given low-dose,medium-dose and high-dose of Triflusal capsule(300 mg,600 mg and 900 mg),qd,for one day,and then pharmacokinetic study of single dose of Triflusal capsule was conducted;Triflusal capsule medium-dose group was continuously given medicine for 13 days,and then pharmacokinetic study of multiple dose of Triflusal capsule was conducted. The plasma concentration of triflusal was determined by LC-MS/MS,and Zorbax SB-C18 column was used with methanol-0.2% formic acid (80:20,V/V) at the flow rate of 0.2 ml/min. ESI was adopted in MRM mode,negative ion detection was carried out,quantitative analysis m/z 247.1→161.1(triflusal),m/z 294.0→250.0(internal standard, diclofenac sodium). Pharmacokinetic parameters were calculated by using WinNonlin 6.2 software,and the difference of them were compared. RESULTS:The linear range of triflusal were 0.05-20 μg/ml. The main pharmacokinetic parameters of triflusal capsules high-dose,medium-dose and low-dose groups were as follows:t1/2 were (0.45 ± 0.20),(0.47 ± 0.10),(0.43 ± 0.20) h;tmax were (0.56±0.20),(0.60±0.20),(0.47±0.40)h;cmax were(3.30±0.98),(10.65±3.26),(13.96±4.88)μg/ml;AUC0-8 h were(3.99±0.93), (13.29±1.72),(19.62±6.78)μg·h/ml;within dose of 300-900 mg,linear relationship was found between cmax,AUC0-8 h and dose(R2=0.954,0.986). When reaching stable state of multiple dose,average blood concentration was(0.71±0.20)μg/ml;main pharmacokinetic parameters were as follows:AUCs(17.10±4.82)μg·h/ml,t1/2(0.49±0.10)h,tmax(0.85±0.62)h,cmax(11.58±3.99)μg/ml,AUC0-8 h (16.99±4.84)μg·h/ml,AUC0-∞(17.08±4.81)μg·h/ml;accumulation factor(1.28±0.40). tmax and t1/2 of single dose were similar to those of multiple dose. CONCLUSIONS:LC-MS/MS can determine the content of triflusal in human plasma rapidly and accurately, and accumulation phenomena exist in healthy Chinese volunteers,which shows linear pharmacokinetic characteristics.

Objective To explore the effects of Shengmai Injection on tumor growth and the expression of P-gp in transplanted tumor of human gastric carcinoma of SGC7901/VCR cell in nude mice.Methods Transplanted tumor model of human gastric carcinoma of SGC7901/VCR cell in nude mice was built, which was divided randomly into five groups: normal saline control-group, 5-FU group, 5-FU + verapamil group, 5-FU +Shengmai group, Shengmai group. Nude mice growth state was observed, average weigh and inhibition rate of transplanted tumor were calculated, and the expression of P-gp was detected.Results There was significanf difference in terms of transplanted tumor weight,volume among 5-FU+Shengmai group and 5-FU group and normal saline group(P0.05); P-gp express had difference between normal saline group and shengmai group, P

Objective To investigate the effects of minimally invasive intracranial hematoma clearance on the perihematomal glutamate(Glu) level,permeability of blood-brain barrier(BBB) and brain edema.Methods Thirty rabbits with body weight of 2.80-3.40 kg were used to established the model of spontaneous intracerebral hemorrhage(ICH) and randomly divided into the minimally invasive group(MI) and control group(MC) after the model was prepared successfully.The MI group underwent minimally invasive procedures for removing intracranial hematoma by stereotactic instrument within 6 h after establishing the ICH model.The brain tissue was extracted on postoperative 1,3,7 d,and the perihematomal brain tissues were taken to detect the Glu level,BBB permeability and water content of brain tissue,which were compared with those in the control group.Results The Glu level,BBB permeability and brain water content on 1,3,7 d in the MI group were lower than those in the MC group,and the differences were statistically significant(P＜0.05).Conclusion The minimally invasive surgery for removing intracranial hematoma is helpful to reduce perihematoma Glu level,BBB permeability and brain water content.