The implementation of hierarchical diagnosis and treatment policies will have a significant impact on the entire health care system .From the view the implementation of the policies of provinces now , tertiary hospital has been defined as a whole , and did not consider differences between grade b class 3 hospital and grade a class 3 hospital.Based on the overview of the policies , this article analyzed the external environment of the grade b class 3 hospital facing from strengths , weaknesses , opportunities and threats by using SWOT Analysis .Then propose counter-measures and suggestions of enhancing its ability and competitiveness to respond to the policies .

Objective To investigate the clinical effect of Yimucao Injection combined with oxytocin in preventing postpartum hemorrhage after cesarean section.Methods 500 cases of pregnant women with cesarean section who were treated in Leshan Maternal and Child Health Hospital from January 2011 to June 2016 were divided into two groups randomly.The patients in the control group were only given oxytocin,while the patients in the observation group were given Yimucao Injection combined with oxytocin.To observe the clinical effect of the two groups,the amount of intraoperative hemorrhage volume,postoperative 2h bleeding,postoperative 24 h bleeding volume,the duration time of postpartum hemorrhage and hospitalization time,and the occurrence of adverse reactions in the two groups.Results The total effective rate of observation group was 90.40％ (226/250),which was significantly higher than the control group 73.20 (183/250) (P ＜ 0.05).Compared with the control group,the amounts of blood loss,2 h postoperative bleeding volume and 24 h postoperative bleeding volum in observation group were significantly decreased (P ＜ 0.05).The duration time of postpartum hemorrhage and hospitalization time in observation group were significantly shorter than the control group (P ＜ 0.05).24 h hemoglobin and red blood cell of the observation group were significantly lower than that of the control group (P ＜ 0.05).The incidence of adverse reactions was significantly lower than that of the control group (P ＜ 0.05).Conclusion Yimucao Injection combined with oxytocin can effectively reduce the amount of bleeding,shorten the time of bleeding and hospitalization time,safe and effective,which is worthy of clinical application.

Objective To analyze the mutation situation of K‐ras gene in 358 cases of lung cancer to provide the guidance for the personalized therapy of lung cancer .Methods The nested and low denatured temperature compound PCR (COLD‐PCR) method was used to analyze the K‐ras mutations situation in 358 patients with lung cancer .Results In 358 lung cancer patients ,the total mutation frequency of K‐ras gene was 8 .10% .The mutation rates were 2 .13% in 94 plasma samples ,9 .60% in 250 tumor tissue samples and 7 .14% in 14 pleural and ascites samples .The mutation types included G12C ,G12D ,G12A ,G12V ,G13D and Q61H ,the mutation rate had no statistical difference among 3 kinds of samples (P= 0 .064 8) ;the mutation rate was 6 .96% in male patients and 8 .59% in female patients ,the difference was not statistically significant (P= 0 .574 0) ;the mutation rates were 4 .76% in the patients aged 30 - < 45 years old ,5 .34% in the patients aged 45 - < 60 years old and 9 .22% in the patients aged ≥ 60 years old , the differences were not statistically significant (P = 0 .250 3) .Conclusion The mutation types of K‐ras gene are mainly G12C , G12D ,G12V and G13D .The mutation rate of K‐ras gene has no significant differences among different types of sample ,different genders and different ages .

AIM: To investigate the protective effect of crude Paecilomyces tenuipes polysaccharides(cPtPs) and Paecilomyces tenuipes polysaccharides(PtPs) in a rat model of acute hepatic necrosis induced by carbon tetrachloride(CCl4).METHODS: Wistar rats were divided into four groups(control group,CCl4 group,cPtPs+CCl4 group and PtPs +CCl4 group),the four groups were given intragastrically with normal saline,cPtPs and PtPs for 15 d,respectively.In the last two days,these groups except control group were injected peritoneally with CCl4.Serum levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),direct bilirubin(DBIL) and indirect bilirubin(IBIL) were detected by automatic biochemistry analyzer.Pathological changes of hepatic tissue were assessed by hematoxylin-eosine(HE) staining.The levels of superoxide dismutase(SOD) and malondialdehyde(MDA) in liver homogenate were analyzed using xanthinoxidase and thio-barbituric acid,respectively.The concentration of Ca2+ in hepatocyte mitochondria was determined by colorimetric method.The expression of ?-smooth muscle actin(?-SMA) was examined in hepatic tissue by immunohistochemical method.RESULTS: Compared with control group,serum levels of ALT,AST,TBIL,DBIL and IBIL in CCl4 group increased significantly,denaturation and necrosis implicated to the whole hepatic lobules.Compared with CCl4 group,serum levels of ALT,AST,TBIL,DBIL and IBIL in PtPs +CCl4 group decreased significantly,denaturation and necrosis located in the third region of hepatic lobules,the level of SOD increased and MDA decreased(P

This study analyzes the reason and situation of the educational inspection for colleges and universities.The author suggests the five points to solve these problems and provide countermeasures for improving the educational inspection.

Objective To explore the effects of modified radical surgery combined with chemo-therapy on postoperative complications and quality of life in breast cancer patients.Methods The clinical data of 175 patients with early breast cancer were retrospective analyzed.According to the different ways of surgical treatment,patients were divided into the control group(n =100)and the study group(n =75).In the study group,patients received modified radical mastectomy,and preoperative and postoperative chemo-therapy as adjuvant therapy.In the control group,patients received traditional standard radical surgery.The follow-up ranged from 1 to 3 years.Recurrence,mortality,postoperative complications,and quality of life were compared between the two groups.Results There were no significant differences in local recurrence (6.7% vs 6%)and axillary lymph node recurrence (2.7% vs 3%),distant metastasis (10.7% vs 11%),and 5-year survival rate(92% vs 91%)between the study group and control group(P >0.05).In the study group,the incidence of postoperative complications was significantly lower(6.7% vs 42%), while its score on quality of life significantly improved(P <0.05).Conclusion For early breast cancer, modified radical mastectomy combined with chemotherapy has similar effects as the standard radical mas-tectomy.It has obvious advantages in reducing complications and improving the quality of life,which is worthy of being spread clinically.

AIM: To explore the activative effect of water extract from cultured mycelium of Paecilomyces cicadae (P. cicadae) on peritoneal macrophages (PM?) and alveolar macrophages (AM?) of rats.METHODS: The rats were randomly divided into four groups: normal control group(Ⅰ), cyclophosphamide (Cy) group (Ⅱ), P. cicadae group(Ⅲ), Cy+ P.cicadae group(Ⅳ).The rats were bred in the same circumstance and were administered with corresponding drugs by subcutaneous injection for 26 days. PM? and AM? of rats were irrigated by normal saline and collected by centrifuge and incubated in a humidified incubator for 2 h at 37 ℃. The activities of acid phosphatase (ACP) and lactate dehydrogenase (LDH) in the PM? and AM? were determined by biochemical methods, and the capability of PM? and AM? in phagocytosis of neutral red were measured by colorimetric method too. RESULTS: After administering P. cicadae to rats, the activities of ACP and LDH in PM? and AM? of normal rats were elevated significantly,and the reduction of the activities of ACP and LDH in PM? and AM? of rats due to Cy was notably antagonized, and the capability of PM? and AM? phagocytizing the neutral red were strengthened significantly.CONCLUSION: P. cicadae can activate the PM? and AM? of rats.

AIM: To study the activation and the immune regulation of paecilomyces cicadidae total polysaccharides on macrophages in old rats. METHODS: The ability of devouring neutral red and stimulating index in the alveolar macrophages (AM) and peritoneal macrophages (PM) were observed. The activities of lactate dehydrogenase (LDH), acid phosphatase (ACP) and arginase (Arg) were detected by automatic biochemistry analyzer. The shape and structure of spleen macrophages were observed by electron microscope. RESULTS: Compared with control group, the activity of the LDH/ACP/Arg in the AM or PM and in the culture fluid of the AM or PM were significantly increased (P

AIM: To study the effects of paecilomyces cicadidae total polysaccharides on the immune function and free radical scavenging of tissues in immunosuppressed rats.METHODS: The activities of lactate dehydrogenase(LDH) and arginase(Arg) in liver,kidney,spleen,thymus of immunosuppressed rats were detected by automatic biochemistry analyzer.The content of lipid peroxide(LPO) and the reduced glutathione(GSH) level in liver,kidney,spleen,thymus of immunosuppressed rats were observed.RESULTS: The activity of the LDH,Arg and GSH level were significantly increased,and the LPO content were significantly declined in liver,kidney,spleen,thymus of immunosuppressed rats induced by cyclophosphamide.CONCLUSION: Paecilomyces cicadidae total polysaccharides promote immune function and the ability of free radical scavenging of tissues in immunosuppressed rats.

〔Abstract〕 Based on the retrieval sources of the official website of Inforway in Canada , Tongfang Knowledge Network and Internet re-sources, by investigating the conformance test of health informatization and health standards conducted by Inforway in Canada , the paper makes a comprehensive analysis of the conformance test of health information standards in Canada from 4 aspects, namely the certification subject, certification object , certification standard , certification process .It aims to provide references for the conformance test of health information standards in China .