OBJECTIVE: To discuss the goal and the measures that should be taken in the reform of Chinese medical and health system. METHODS: The changes of Chinese medical and health system were briefly reviewed and the current problems in which were analyzed, then the goals and the corresponding measures in the future medical and health system reform were put forward. RESULTS & CONCLUSION: The reform of Chinese medical and health system should in line with medical insurance reform and drug circulation system reform. The central financial expenditure system should be reformed by carrying out the principle of “common benefits” and eliminating differential treatment between city and countryside or among areas so as to implement equalization in medical and health service. The concerned departments should improve resource management system and optimize medical resources allocation. The government should strengthen the monitoring on medical and health service industry to facilitate its healthy development.

Objective To evaluate the cilincial value of Min-probe sonngraphy(MPS)for submucosal protrusion lesion in gastric.Methods 82 cases with submucosal protrusion lesion in gastric were detected by Min-probe sonography(MPS)and treated according to the diagnosis.Results 82 cases were fibroid,38 stromal tumor,among which 12 cases from muscularis mucosa,26 case from the proper muscle layer,4 malignant stromal tumor,6 lipoma,3 angioma,3 gastric cysts,11 gastric polypi,8 heterotopic pancreas,9 pressures from outside organ.29 cases were accepted EMR and 18 cases accepted surgical operation.Conclusion MPS is more valuable in the diagnosis and the differential diagnosis of submucosal protrusion lesion in gastric and can guide the further therapy.

Objective To evaluate the effects of surgical treatment of acute deep vein thrombosis (DV T) of lower extremity. Methods Thirty-six patients with a cute DVT of lower extremity were treated by thrombectomy with thrombolytic,a nticoagulant and compression on the affected lower extremity during and after op eration. Results No death and serious complications happened i n this series. Thirty-one patients were followed-up for 2 to 20 months with a n average of 9 months. Symptoms disappeared totally in 23 patients , 8 patien ts had slight edema in the lower extremities. Conclusions Com bination of thrombectomy the thrombolytic and anticoagulant agent,and comp ression of the affected lower extremity is a safe and effective method in the t reatment of acute DVT of lower extremity.

Objectives:To evaluate essential medicines accessibility from the availability, drug price level and affordability perspective in Beijing. Methods:Data was collected from a sample of a Beijing social security database on diabetes in 2013 and a field research on 4 primary healthcare institutions. The essential medicine equipping rate, medium price ratio ( MPR) and poverty-inducing effect were selected as accessibility indicators. Results:Among 21 sample drugs, the nitrendipine, magnesium sulfate, sodium nitroprusside, prazosin, phentolamine and glyburide e-quipping rates are less than 15%. The 9 sample drugs MPR varied from 1. 3 to 27. 4. The hypertension, hyper-lipemia and diabete poverty-inducing rate varied from 0. 44% to 0. 70% in urban areas, and varied from 1. 17% to 1. 88% in rural areas. Conclusion:Some essential medicines in Beijing are equipped with a very low rate, but have a high price level, and the poverty-inducing population is large. We recommend strengthening the monitoring of es-sential medicines accessibility and introducing appropriate supporting policies.

Objective To study the management of vascular injury.Methods Retrospective analysis was made on the clinical data of 59 cases of vascular injury,including 55 cases of vascular injury in neck and(extremity) and 4 cases of portal vein and vena cava injury.Among them,21 cases had femoral artery injury with infection and 4 cases had vascular injury due to intervention therapy.All patients with vascular wound of extremity or neck had undergone hemostasis by compression and antishock treament before hospital admission.All cases of femoral artery injury with infection underwent hemostasis by arterial ligation and incision and(drainage) of abscess.Vascular anastomosis was performed in 11 cases,vascular grafting in 12 cases,and(vascular) repair in 14 cases.Results There were 2 deaths.5 cases had amputation(including a case of(femoral) embolism due to intervention trerapy).Postoperative intermittent claudication,decreased skin(temperature) and other signs of ischemia occurred in 21 cases of femoral artery injury with infection,but none developed limb gangrene. The other cases were discharged in good health.Conclusions In the treatment of vascular injury,wound hemostasis and antishock treatment should be done first to save the patient′s life and the management of the vascular injury depends on the situation,with the aim to try by all means to save the extremity.Vascular reconstruction is the main method for treatment of vassular injury.Vascular ligation can be done in cases of femoral artery injury with infection.

Objective To summarize the experience in the diagnosis and treatment of hepatic trauma. Methods The clinical data of 260 patients with hepatic trauma admitted from January 1988 to December 2007 were retrospectively reviewed with regard to degree of trauma, treatment methods, therapeutical effects, complications and SO on. Results One hundred and fifty-three eases were treated by operative management,1 07 cases by nonoperative management.236 cases were cured,24 cases died,and the case fatality rate was 10.2%.There were no death among 139 patients with hepatic trauma grades Ⅰ～Ⅱ,22 death among 119 grades Ⅲ～Ⅴ patients, all death of 2 in grade VI, which demonstrated the correlation between death and hepatic trauma grade was statistically significant. Complications appeared in 82 eases, mainly including Secondary hemorrhage, abdominal infection and so on. Conclusions Nonoperative management is suitable for hepatic trauma with stable hemodynamics. Operative management is rapidly selected when the hemodynamics aren't stable. The cooperation of many specialities can enlarge the application of nonoperative management and decrease complications.