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This paper applies a conceptual framework, developed by Boisot (1986), to an analysis of the behaviour of Chinese enterprise managers. In a replication of Mintzberg's 1973 study of US managers, six Chinese enterprise directors were time studied over a period of six days, and the findings analyzed using the framework. It appears that although Chinese enterprise managers in the sample share many behavioural characteristics with their US counterparts, they do so in an institu tional setting that places a different construction on their behaviour. In particular, the analysis suggests that the Chinese firm is not available to them as an extension of their managerial prerogative and, if anything, is institutionally designed to constrain it. In such a setting, opportunistic behaviour expresses a personal survival strategy rather than a quest for personal gain.

Background: While the community health service system was initially established in rural areas of mainland China, the utilization of community health service resources by the rural elderly population is not clear. Methods: Cross-sectional studies on the utilization of community health services by the rural elderly population in mainland China published within the last 10 years were retrieved from the China National Knowledge Infrastructure (CNKI), Wan Fang, Medline and Web of Science (WOS) databases. The quality of the article was evaluated by the Critical Appraisal Skills Programme (CASP), and obstacles to the utilization of community health services by the rural elderly population were analyzed based on the Andersen model. Results: Twenty-four studies were analyzed, and 3 gaps were found. (i) The cognition of rural elderly residents does not match the current health security system. (ii) There is a gap between the supply of health service resources in rural communities and the health needs of the elderly residents in these areas. (iii) The health services provided by rural primary health service institutions are not targeted. Conclusions: In mainland China, the provision of community health services to the rural elderly population has improved significantly. However, several factors from the individual level to the system level lead to low levels of access and utilization. This finding means that under the leadership of the government, it is necessary to integrate the strength of multiple departments to cooperate in improving the welfare system, policy publicity, health education, financial support, system guarantees and resource exchange and sharing for the elderly population in rural areas and to jointly promote community health services for the elderly population in rural areas.

Jin-Kai Feng,1,* Ju-Xian Sun,1,* Zong-Han Liu,1,* Jing-Wen Gu,2,* Zhen-Hua Chen,3 Chang Liu,1 Wei-Xing Guo,1 Jie Shi,1 Shu-Qun Cheng1 1Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, People's Republic of China; 2College of Basic Medical Sciences, Second Military Medical University, Shanghai, People's Republic of China; 3Department of General Surgery, Zhejiang Provincial Armed Police Corps Hospital, Hangzhou, People's Republic of China*These authors contributed equally to this workCorrespondence: Shu-Qun ChengDepartment of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, People's Republic of ChinaTel +86 21- 81875251Fax +86 21- 65562400Email chengshuqun@aliyun.comBackground: The occurrence of hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) is rare. The aim of the study was to evaluate the effectiveness and safety of transarterial chemoembolization (TACE) for patients with unresectable HCC with BDTT.Methods: This retrospective study was conducted on newly diagnosed HCC and BDTT patients who were initially treated with TACE or conservative management (CM) from 2009 to 2018. Survival outcomes of patients treated with TACE were compared with those of patients given CM. Multivariate analyses were performed to identify independent prognostic factors related to survival.Results: Out of 100 patients included in this study, 40 patients underwent TACE, while the remaining 60 received CM. The median survival time of the TACE group was 8.0 months longer than that of the CM group (13.0 versus 5.0 months, P < 0.001). The 6-, 12-, 18-, 24-month overall survival (OS) rates were 90.0%, 52.5%, 22.5%, and 12.5%, respectively, for the TACE group compared with 26.7%, 8.3%, 5.0%, and 3.3%, respectively, for the CM group. Multivariate analyses showed that treatment allocation (hazard ratio [HR], 0.421; 95% confidence interval [CI], 0.243– 0.730; P = 0.002), Child–Pugh status (HR, 2.529; 95% CI, 1.300– 4.920; P = 0.006) and total bilirubin level (HR, 1.007; 95% CI, 1.004– 1.009; P < 0.001) on first admission were independent predictors of OS. There was no procedure-related mortality within one month after TACE treatment.Conclusion: TACE is a safe and effective treatment method that may improve the OS of patients with unresectable HCC with BDTT.Keywords: hepatocellular carcinoma, bile duct tumor thrombus, transarterial chemoembolization, conservative management, overall survival