The paper presented the payment system theory of the primary health care service in China,the current status of the health service system,and analyzed main challenges for the time being.Based on such studies,the authors made the following policy proposals.The first is adjustment of the fiscal payment method of the government to such institutions in line with the classification guidance principle; the second is to shift the payment method of primary public health services to the post payment of fee-for-service; the third is reform of the performance-based salary system to link payment to medical workers directly with the amount and quality of their services; the fourth is a set of result-oriented performance appraisal indicators,with rising proportion of performance pay; the fifth is to integrate the outpatient clinic fund covered by medical insurance and the primary public health service fund,into a capitation payment.

ObjectiveTo investigate the effect of β-adrenoceptor (β-AR) blockers on G protein and heart function changes in rats with acute myocardial infarction (AMI) MethodsWistar rats with AMI induced by left anterior descending coronary branch ligation were randomly divided into compared with sham operation group. Eight weeks after therapy, hemodynamics was assessed by inserting catheters and the level of G protein was detected by Western blot analysis. ResultsCompared with the sham operation group, systolic blood pressure(SBP), diastolic blood pressure (DBP), left ventricular systolic pressure(LVSP) and left ventrieular pressure maximal rate of rise and fall(±dp/dtmax) in AMI group were significantly decreased, while left ventricular end diastolic pressure (LVEDP) and Gs and Gi protein levels were significantly increased (all P<0.05). Compared with AMI group, LVSP and ± dp/dtmax were increased, but LVEDP and Gi protein level were significantly decreased in metoprolol and carvedilol group. LVEDP and Gi protein level were decreased in carvedilol group compared with metoprolol group. ConclusionsCarvedilol can effectively suppress the change of G protein and improve the heart function after AMI, and the effect is better than that of metoprolol. This may be related with its β2-AR blocking effect.

Objective:The paper is designed to reveal differences in stroke patients'hospitalization costs crea-ted by different socioeconomic factors , health insurance and occupational background , and analyze those differences on health outcome .Methods:18879 cases of hospitalized patients with stroke in five tertiary hospitals from four prov-inces from 2011 to 2014 were included in the database .Descriptive statistics was used to describe patients'hospitali-zation costs and health outcome .Multiple linear regression model and logistic regression were used to evaluate the im-pact of insurance and occupation .Results:After controlling for patients'social characteristics , health risks , premise during hospitalization process and clinical characteristics of patients with free healthcare costs , the socialized medi-cine was charged 19.7% higher than the private ones ( P <0.001 ), the retired people and civil servants were charged 4.2%(P<0.001) and 2.9%(P=0.049) more than farmers.The socialized medicine was also associated with health outcome.The risk of death in patients with free medical care is (OR=4.901) compared with private pa-tients (95%CI 1.652~14.537), and the retired people had increased risk of death compared with farmers (OR=2 .145 , 95%CI 1 .287 ~3 .573 ) .Conclusions: Due to the impact of social background factors , some groups are found to have a higher level of expenses than their counterparts during hospitalization , but the more hospitalization costs are not spent the better the health outcome of stroke was achieved .

Objective: To investigate the prevalence of hepatitis C virus (HCV) infections among five high-risk populations in Inner Mongolia Autonomous Region, so as to provide insights into improvements in the control strategy for hepatitis C. Methods: The detection of anti-HCV antibody was collected from patients receiving renal dialysis, patients receiving invasive diagnosis and treatment in hospitals, physical examination populations, unpaid blood donors and subjects admitted to family planning clinics in national hepatitis C surveillance sentinels in Inner Mongolia Autonomous Region from 2013 to 2021, and the year-, gender- and age-specific prevalence of anti-HCV antibody was analyzed. Results: The mean prevalence of anti-HCV antibody was 2.19%, 1.81%, 0.05%, 0.10% and 0.03% among 3 600 patients receiving renal dialysis, 3 600 patients receiving invasive diagnosis and treatment in hospitals, 18 000 physical examination populations, 18 000 volunteer blood donors and 3 600 subjects admitted to family planning clinics, respectively. The prevalence of anti-HCV antibody appeared a tendency towards a decline among patients receiving renal dialysis (χ2trend=49.065, P<0.001) and volunteer blood donors (χ2trend=11.419, P=0.001). The prevalence of anti-HCV antibody was higher among male patients receiving invasive diagnosis and treatment in hospitals than among females (2.34% vs. 1.36%; χ2=4.826, P=0.028), and no gender-specific prevalence of anti-HCV antibody was seen among other four high-risk populations (all P>0.05). The highest prevalence of anti-HCV antibody was detected among patients receiving renal dialysis (3.30%) and patients receiving invasive diagnosis and treatment in hospitals at ages of 50 to 59 years (3.35%), while the highest prevalence was found among physical examination populations at ages of 60 years and greater (0.18%). Conclusion The prevalence of anti-HCV antibody was high among patients receiving renal dialysis and patients receiving invasive diagnosis and treatment in hospitals and low among physical examination populations, volunteer blood donors and subjects admitted to family planning clinics in Inner Mongolia Autonomous Region from 2013 to 2021. Periodical monitoring of anti-HCV antibody is recommended among the elderly.

Objective To verify the influence of oncology nurses'empathy on the psychological dis-tress and benefit finding in breast cancer patients. Methods 30 oncology nurses were selected by random sampling and their empathy scores were measured with the interpersonal reactivity index (IRI-C).And they were divided into three groups based on empathy scores. 12 breast cancer patients from each primary nurse were selected by random sampling.Their psychological distress and benefit finding were measured by distress thermometer (DT) and benefit finding scale (BFS).Variance analysis was used to compare psychological distress and benefit finding among patients in different groups. The effect of nurse empathy on patients psy-chological distress and benefit finding was measured by Spearman correlation analysis and logistic regression. Results The empathy score of nurses was (44.87±17.23).The difference of empathy score in the three groups of nurses was statistically significant (F=55.941,P<0.01).There was no significant difference in psy-chological distress (low-score group:5.0(4.0,6.0),middle-score group:5.0(4.0,6.0),high-score group:5.0 (4.0,6.0)) and benefit finding (low-score group:47.5(42.0,52.8),middle-score group:48.0(43.0,54.0), high-score group:46.0(42.0,52.0)) in the three groups of patients at admission(P>0.05),while at dis-charge,the psychological distress of the patients in the high-score nurse group was lower than that of the low-score nurse group (P<0.01),and the benefit was higher than that of the low-score group (P<0.01).There was a negative correlation between the nurses'empathy abilities and patients'psychological distress ( r=-0.470, P<0.01) ,and a positive correlation between the nurses'empathy abilities with the patients'benefit finding ( r=0.521,P<0.01).When controlling for other variables,patients in nurse group with higher empathy scores would result in lower psychological distress(95％CI=0.042-0.397) and higher benefit finding (95％CI=0. 095-0.554) than patients in nurse group with lower empathy scores.Conclusion Oncology nurses'empathy effect breast cancer patients'psychological distress and benefit finding.Nurses should enhance their empathy further.

BACKGROUND:Haploidentical hematopoietic stem cell transplantation is associated with a higher rate of graft rejection and therefore often requires a higher CD34+ cell dose,but the findings reported in existing studies regarding the relationship between CD34+ cell dose and study endpoints after allogeneic hematopoietic stem cell transplantation are controversial. OBJECTIVE:To investigate the effect of CD34+ cell dose on clinical outcomes of haploidentical hematopoietic stem cell transplantation for malignant hematological diseases. METHODS:135 patients who underwent haploidentical hematopoietic stem cell transplantation at Hematopoietic Stem Cell Transplantation Center,Department of Hematology,First Affiliated Hospital of Zhengzhou University between January 2019 and December 2021 were included.Combining the results of previous studies and our center's experience,the cohort was divided into two groups using a CD34+ cell count of 5.0×106/kg as the cut-off point.Clinical outcomes related to graft implantation,relapse incidence,non-relapse mortality,overall survival and progression-free survival were evaluated in both groups. RESULTS AND CONCLUSION:(1)CD34+ cell dose correlated with platelet engraftment,with platelets implanted earlier in the high-dose group than in the low-dose group(14 days vs.16 days,P=0.013).(2)There was no significant difference in 3-year overall survival between the two groups(67.5%vs.53.8%,P=0.257);nor was there a significant difference in progression-free survival between the two groups(65.6%vs.44.2%,P=0.106),but stratified analysis based on disease risk index revealed an association with elevated 3-year progression-free survival in the high-dose group among low-risk patients(72.0%vs.49.3%,P=0.036).(3)The cumulative 3-year relapse incidence was smaller in the high-dose group than in the low-dose group(16.0%vs.33.5%,P=0.05).(4)The rate of non-relapse mortality within 100 days was greater in the high-dose group than in the low-dose group,but there was no significant difference(17.3%vs.6.7%,P=0.070);stratified analysis revealed that non-relapse mortality within 100 days was significantly higher in the high-dose group than in the low-dose group(20.0%vs.3.3%,P=0.046).(5)In conclusion,CD34+ cell doses>5.0×106/kg promote early platelet implantation,improve 3-year progression-free survival in low-risk patients at transplantation and reduce the cumulative relapse incidence.However,in high-risk patients,high-dose CD34+ cells result in increased non-relapse mortality within 100 days after transplantation,which is considered to be possibly associated with an increased occurrence of severe acute graft versus host disease in the early post-transplantation period.Therefore,it is considered that graft versus host disease monitoring should be enhanced in patients who transfused high-dose CD34+ cells.

Objective: To observe the influence of lower wide pedicle frontal periosteum flap on frontal bone absorption rate after cranioplasty. Methods: From February 2016 to July 2017, the lower wide pedicle frontal periosteum flap was produced in 12 patients of Shanghai Ninth People′s Hospital (7 males/5 females, aged 5-9 years, 10 hypertelorism, 2 Crouzon syndrome), who accepted intro-cranio-route plastic surgery, to cover the frontal bone window. A spiral CT scans were applied one week (t1) and one year (t2) after surgery. DICOM data was imported into Mimics software to reconstruct the 3D model of skull. The bone window covered the frontal bone was selected and the bone volume was calculated. The absorption rate was calculated as (Vt₁-Vt₂)/Vt₁×100%. As a control group, the CT data of 20 patients (from January 2010 to December 2015, 11 males/9 females, 7 hypertelorism, 12 Crouzon syndrome, 1 Pfeiffer syndrome) were analyzed retrospectively in the same way, and compared to the experimental group. Results: The average bone absorption rate in experimental group was 8.65%±2.56% (n=12), while in control group it was 26.51%±5.23% (n=20). Significant statistical difference was observed. No further cranial defect was observed in one-year follow-up in both two groups. Conclusions The lower wide pedicle frontal periosteum flap reduces the bone absorption rate after intro-cranio-route plastic surgery. It could also help to repair the anterior cranial base defect during the surgery. This technique was recommend as a regular step in craniofacial surgeries.