This paper presented the practice of Zhejiang in introducing the drug zero-profit reform.A comparative analysis was made to the pilot county hospitals regarding their business performance,patients' burden,financial subsidy and medical insurance expenditure.The reform has scored a success as expected with the following outcomes:sharp rise in medical services volume,medical income and financial aid on one hand; drop of the proportion of drug income and changes in the medical income makeup; controlled increase of average cost of outpatient and inpatient care,and significant drop of pharmaceutical costs; increased expenditure yet stable operation of medical insurance funds;proportional increase of medical insurance compensation,with drops of the proportion of both out-ofpocket expenses and visits to doctors out of their county.This reform,however,has such shortcomings as follows:insufficient adjustment toward true costs of medical services,lack of a clear and sustainable financial compensation mechanism,and that of supporting measures.Based on these,the authors call for accelerated payment system reform,dynamic and scientific adjustment of medical service prices,exploration of clear financial compensation methods,optimization of internal management of hospitals,and acceleration of the formation of a medical staff income distribution mechanism.

[Summary] Thyroid-associated ophthalmopathy ocular damage involved in lacrimal, tear film, cornea, and conjunctiva which can lead to ocular discomfort and decreased visual.The mechanism of thyroid-associated ophthalmopathy ocular surface damage and treatment is reviewed.

Objective To assess the performance of the methylation‐sensitive high‐resolution melting curve analysis (MS‐HRM analysis) on the detection of the methylation in stool DNA for colorectal cancer screening .Methods Eighty‐two qualified stool samples were collected from 27 patients with colorectal cancer patients (CRC group) ,25 patients with advanced adenomas (AA group) ,and 30 healthy people (control group) .The methylation status of vimentin gene in all of the stool samples was detected by the MS‐HRM analysis on the LightCycler 480 platform .The fecal occult blood test (FOBT) was also used for the same samples . Results The positive rates of the MS‐HRM assay in the CRC group ,AA group ,and control group were 81 .5% (22/27) ,80 .0%(20/25) ,and 6 .7% (2/30) respectively .The positive rates of FOBT in the three groups were 37 .0% (10/27) ,12 .0% (3/25) and 3 .3% (1/30) respectively .The diagnostic sensitivity of the MS‐HRM assay for colorectal cancer and advanced adenomas (80 .8% , 42/52) was significantly higher than that of FOBT (25 .0% ,13/52)(P<0 .05) .No significant difference was found in the diagnos‐tic specificity between the MS‐HRM assay (93 .3% ,28/30) and the FOBT (96 .7% ,29/30) (P>0 .05) .Conclusion MS‐HRM performs better than FOBT and has great application potential in the detection of stool DNA methylation for colorectal cancer screening .

The article reviewed the current status, reform measures and progress of the tiered medical services in Zhejiang province, and analyzed main roadblocks in such a system.Proposals made in the paper include such reform measures as further expanding quality medical resources of better talents and equipments to enhance primary medical institutions;forming the gatekeeper practice featuring firstvisit at community health centers with enhanced primary capabilities;insisting on joint reform of medical treatment, medical insurance and drugs, promoting the development of tiered medical services and utilization efficiency of medical resources in the province.

Since the launch of the comprehensive public hospital reform in Zhejiang Province, the price of medical services has been adjusted, and the charging structure of medical services has been improved. Likewise, medical insurance policies have been optimized. Through several price adjustment strategies, such as the“loosen-re-strain” policy, the labor of medical personnel has been better valued, the operation of public medical institutions has been stabilized, and the allocation of medical resources has been optimized. Hence, this paper aims to measure the achievements and drawbacks of the medical service price adjustments by analyzing the various strategy. It is suggested that the comprehensive public hospital reform should be further intensified via the advancement of coordination of healthcare, medical insurance and medicine, the exploration of new procurement mechanisms for drugs and medical equipment, the establishment of dynamic adjustment mechanisms for medical service pricing, the exploration of new management mechanisms for medical services, and the strengthening of medical service supervision.

Objective To study the prognosis of gastroesophageal reflux disease ( GERD) in children, and explore the factors which impacts on the prognosis of GERD. Methods One hundred and thirteen children with GERD were enrolled on the basis of positive result of 24-hour pH-monitoring between January 2007 and November 2011. The number of patients who were followed up was 87,and the parents of children were contacted with the telephone. The prognosis was evaluated by comparing the degree of patients′symptom relief,and the cumulative symptom relief rate was calculated by Kaplan-meier product limit method. The univariate Log-rank test and the COX proportional hazardmodel multivariate analysis were applied to detect the factors impacting on the prognosis,including age,gender,the regularity of treatment,reflux index,and Boix-Ochoa standard score,with esophageal hiatal hernia or without,receiving surgical treatment or not,the diet and lifestyle improved or not,receiving anti-acid treatment or not,as well as with allergies his-tory or without. Results At last,76 out of 87 children had symptom relieved. Survival curve showed the cumulative symptom relief rate at different time points,the median cumulative symptom relief rate reached 6 months,the final relief rate was close to 90. 0%,and the continuous treatment time was 44 months. The study showed that 14. 9% (13/87 ca-ses) of children′s growth and development were affected and the life and learning in 16. 1% (14/87 cases) of children were impacted. Age (P=0. 012,Wald=6. 376) and the regularity of treatment (P=0. 000,Wald=13. 059) were the risk factors in the prognosis of GERD. Conclusions Age and the treatment regularity were the factors in the prognosis. The children aged more than 1-year old have poor prognosis compared with those less than 1-year old,and the irregular treatment is the risk factor in the prognosis.

The authors reviewed the practice of integrated health care delivery system( IDS) at home and abroad, and based on experiences of collaborations between medical service institutions in Zhejiang province,proposed the strategic positioning,responsibilities and service innovation of urban public hospitals in a regional medical service system. It is held that the direction of China′s health care reform should move towards IDS in the future,and such hospitals should play an active role in the process via integration of its own resource and provide multi-level,diversified services for the regional health care system.

Objective To investigate the preventive effect of nano-powder of Wugong-sanqi (NW),the rhizome of Anemone flaccid,on postoperative intestinal adhesion in rats.Methods Fifty SD rats were subjected to operation with Ellis' method for establishing intestinal adhesion models,then randomly divided into 5 groups (n=10),namely model,positive (Dexamethasone,i.m.10 mg/kg),NW high,medium and low dose group (p.o.450,225 and 112 mg/kg,respectively).Another ten normal rats were selected as normal control group.After administration 3 days pre-operation and 7 days post-operation,all of rats were killed,the intestinal adhesion was graded and the tissues were observed by optical microscope.Results NW evidently reduced the severity of postoperative adhesion (P＜0.05 or P＜0.01),compared with model group.The histopathologic changes such as proliferation of fibroblast cells and capillary,interstitial granulomas and inflammatory cells infiltration in intestinal tissues were also improved significantly in NW groups.Conclusion NW could inhibit the formation of postoperative intestinal adhesion effectively.

Objective To summarize the clinical features of the pancreaticopleural fistula (PPF) in children in order to improve the understanding of PPF and to make early diagnosis and treatment of the disease.Methods Five cases of pediatric PPF in Beijing Children's Hospital Affiliated to Capital Medical University from December 2007 to March 2014 were studied by retrospective analysis.The clinical features, laboratory results, image characteristics, treatment and prognosis were reviewed.Results Five cases of PPF were diagnosed aged between 2 years to 10 years and 5 months old, history from more than 1 month to 6 months.The main symptoms were chest tightness (3 cases), chest pain (3 cases) , fever(3 cases) , wheeze (1 case) , dyspnea (1 case).Only 1 case was with abdominal pain and abdominal distension when he was admitted to hospital.All patients had massive pleural effusions, included right side (3 cases),left side(1 case) ,bilateral sides(1 case), 1 case complicated with massive ascites.Pleural fluid amylase of all the cases was significantly elevated (＞ 1 000 U/L) ,the highest was more than 50 000 U/L.Four cases had positive findings of pancreas by transabdominal ultrasound.Five cases had morphological changes in pancreas by magnetic resonance cholangiopancreatography (MRCP).Four cases had PPF and pancreatic pseudocysts respectively.Conservative treatment was given to 5 cases, but further 3 cases reveived stent insertion by endoscopic retrograde cholangiopanereatography, and 2 cases reveived surgical therapy.Conclusions PPF is rare in children, the main clinical feature is massive pleural effusion with respiratory symptoms.Pleural fluid amylase would be significantly elevated.The diagnosis of PPF generally relies on imaging, MRCP is considered the imaging study of choice for PPF due to its superiority in identifying a fistula in the pancreatic region and its noninvasiveness as compared to endoscopic retrograde cholangio pancreatography.Endoscopic and surgical therapy can be used if internal therapy is not satisfactory.

Objective To discuss the clinical diagnostic and guiding treatment value of changed positions of hyoid bonein the upper airway of patients with obstructive sleep apnea hypopnea syndrome. Methods 128-slice computed tomography was performed for 52 patients with severe OSAHS and 32normal healthy people to measure thehyoid bone in the upper airway in sober state and Muller maneuver. The correlationsbetweenthese indexes were analyzed under linear relation. Results (1)In comparison of the Muller maneuver with sober state , chinnodules and palatal plane to the hyoid in the OSAHS group were statistically higher than the healthy controlgroup (P < 0.001). (2)The distance of hyoid to chinnodules in the OSAHS group was significantlylonger and greater than that of the healthy control group (P < 0.001).(3)The distance of palatal plane to the hyoid was positively correlated with AHI , while thedistances of palatal plane andchinnodules to the hyoidwere both negatively correlated with MSaO2. Conclusion The changes ofhyoid positionare indicative for the clinical diagnosis and is helpful for the guidance of clinical treatment of OSAHS.