67岁的陈先生小腿部瘙痒难耐,忍不住挠了几下,没想到竞挠破了腿部血管,短时间内失血近1000毫升并导致休克,幸经抢救及时才转危为安. 陈先生退休前是名中学老师,十年前查出患下肢静脉曲张,由于不痛不痒,他一直没太在意.但近年来,其小腿上的血管凸起,弯弯曲曲像蚯蚓一般,晚上他时常感觉双腿酸胀不适.

By simulating the dynamic and structural characteristics of water eddies in a limited area,the paper analyzed the functions of impact factors like non-uniform wind field,water jet current,their superposition,environmental boundary,Coriolis force and etc. The eddies generated by wind fields are of larger size and deeper depth. Cyclone is of concave surface and anticyclone is of convex surface. The eddies generated by water jet appear on both sides of the jet and accord with the jet thickness. Their size is smaller and thickness is shallower,but their flowand strength are stronger. Topographic boundary plays a guiding role in the movement of eddy. The Coriolis force in the Northern Hemisphere is beneficial for the enhancement of negative eddy. Meantime the potential function presenting convergence and divergence of eddies for cyclone is stronger than that for anticyclone. It is more effective to cause the vertical upward motion for cyclone than to cause the downward motion for anticyclone. When non-uniform wind field overlapped water jet,the number of eddies increase,their size decreases and their patterns at bottom are of more obvious difference from those on the surface layer. There are many types of eddy structures: for some the whole layer is consistent; for some others consistency only existence on the upper layer; for still some others the upper and lower circulations reverse,etc; The eddies generated by wind field are mainly barotropic,the eddies forced by water jet are manly baroclinic. In kinetic energy exchange,it happens that the barotropic kinetic energy transforms into baroclinic kinetic energy at barotropic eddy area,and the barotropic kinetic energy transforms into baroclinic kinetic energy at baroclinic eddy area. Both kinetic energy transformations are beneficial for the maintenance of the two kinds of eddies.

Index selection is the important premise of selecting and building evaluation model.Based on reading numerous documents and expert consultation,the research used complete patients medical records of 17 general hospitals in Beijing in 2010,mainly used statistical methods to select the indexes,such as factor analysis,cluster analysis and correlation analysis,and finally screened four input indexes and four output indexes used for evaluating urban general hospitals’ bed utilization.

Analyzing and summarizing medical adverse events play a significant role in improving the quality of medical care.However,there are many obstacles in medical adverse event reporting.Through the investigation of medical adverse events reporting situation in 12 hospitals in Hubei,Jiangsu and Zhejiang Province,the reasons,which hinder the medical averse event reporting are analyzed,and then some suggestions are put forward.

Through analyzing the beds utilization efficiency evaluation method and results at home and abroad,the influence factors of beds utilization efficiency is summarized,the influence factors of hospital beds utilization efficiency,including the national related policies,the hospital administration,the medical personnel behavior,the structure of patient disease and other uncontrolled factors,are found out.The limitations of domestic study of the beds utilization efficiency include three aspects,which are the simple evaluation methods,the insufficient analysis of influence factors and the lackness of pertinence and operability of policy recommendations.

The bed utilization is one of the most important parts of the resource utilization in general hospitals.And there are always two problems in bed utilization:insufficient or excessive use.The key point to solve the problems is to build a reasonable and effective bed utilization efficiency evaluation model.Based on the analysis of plenty of references,the general hospitals' bed utilization efficiency evaluation model is analyzed and summarized at home and abroad,and the preliminary conceptions are given in order to build a reasonable and effective bed utilization efficiency evaluation model for general hospitals.

Allocation and utilization of medical resources in hospitals is one of critical factors to improve usage efficiency of health resources.Through analysis of the allocation and utilization of hospital beds,the problems can be found and the corresponding countermeasures can be put forward.This is very important to allocate limited medical resources rationally and use them effectively.

Objective: Through the analysis on the clinical pathway type II diabetes with the various factors associated with expenses in diabetes,pointing out influencing factors of the total cost of,in order to take corresponding measures to achieve more scientific and standardization medical behavior,guarantee the clinical pathway can achieve good quality and medical service quality under the most rational total cost.Methods: Analyzing 778 patients' costs indicators from a three level of first-class hospital whose first diagnosis is type II diabetes,using generalized linear model.Results: The influence factors of Type II diabetes' hospitalization fees are sex,medical insurance type,high blood pressure,coronary heart disease,brain VBI,respiratory system disease,prolapse of lumbar intervertebral disc,diabetic nephropathy,diabetic nerve complications,operation,be in hospital days in hospital and the times.Among the influential factors of hospitalization fees in type II diabetes,the factors to prompt hospital expenses are men,long hospital stay and more hospitalization number;The factors to reduce hospitalization fees are no surgery and without prolapse of lumbar intervertebral disc,diabetic nephropathy,nerve complications and so on.Conclusion: Although implemented a standardized standardized clinical pathway,hospital expenses still influenced by many factors,need to take further measures to make the hospitalization fees more Stable and reasonable.

Based on the unstructured grids and finite-volume coastal ocean model(FVCOM),a three-dimensional storm surge model was built in the Yangtze Estuary and Hangzhou Bay for typical typhoon events.Firstly the simulated tidal characteristics and water dynamic elements were verified for the coastal area,and the results showed that the application of the model to the area was satisfactory.Secondly,22 typhoons which influenced the Yangtze Estuary and Hangzhou Bay were analyzed and statistically calculated.Typhoons which invaded directly the Yangtze Estuary and Hangzhou Bay could be classified into two types from the 22 typhoons,namely the immediate landing and the moving northward along the coast.Their prototypes were typhoon No.9806 and No.0012.The simulated results showed that during the storm surge the coastal residual water elevation was influenced by typhoons,and it could get to nearly 1m.The surface residual currents could generate the jet which mainly resulted from the combined action of the strong wind of typhoon,coast obstruction and river runoff,the jet speed could reach 1-1.5 m/s.The maximum gradient of residual current in vertical section happened in offshore area of shallow water about 5-6 m in deep.The momentum of sea surface jet caused by typhoon transferring downwards could get to the bottom of the sea.

Objective We investigated the effect of glutamine-enriched enteral nutrition on plasma taurine concentrations in patients with severe trauma.Methods Twenty-nine patients with multiple trauma received glutamine-enriched nutrition and thirty-one patients received isocaloric, isonitrogenous control solution for 5d. Plasma taurine and glutamine concentrations were measured.Results Both patient groups had low taurine concentrations at day 1. From day 3 onward, the glutamine-fed patients had significantly higher plasma taurine concentrations.Conclusion Glutamine enrichment increases plasma taurine in trauma patients. The reduction in morbidity with glutamine enrichment could be explained in part by increased taruine availability.