Marketization has become the mainstream since the new public management emerges globally in second half of the 20th century. Some countries infuse private capital into medical institutions which used to be managed by the government originally, and cause the medical industry reforms to be market-oriented. Market-oriented reforms of medical institutions may have risks in the following aspects: the risk of uneven distribution of medical resources, the risk of market failure, the moral risk of government renting-seeking and corruption and the decay of social justice values. Measures of controlling these risks include deifning the function orientation of the government, completing the institution-building of healthcare system, improving primary medical system and strengthening social consciousness of hospitals.

Objective To evaluate the effects of gender on the median effective target plasma concentration (EC50) of propofol inhibiting responses to laryngeal mask airway (LMA) insertion in patients.Methods Fiftyfive ASA physical status Ⅰ or Ⅱ patients,aged 20-60 yr,with body mass index 18-25 kg/m2,requiring LAM insertion,undergoing elective surgery,were divided into 2 groups according to the gender:male group (group M,n =27) and female group (group F,n =28).Propofol was given by target-controlled infusion.Anesthesia was induced with target-controlled infusion of propofol.The concentration of propofol was determined by using modified Dixon's up-and-down method.The initial target plasma concentration of propofol was 3.0 μg/ml (group M) or 2.7μg/ml (group F) and the ratio between the 2 successive concentrations was 1.1.Fentanyl 1 μg/kg was injected intravenously at about 10 min of propofol target-controlled infusion.LMA was inserted after the effect-site and plasma concentrations were balanced.The positive response to LMA insertion was defined as development of swallowing,coughing,biting LMA,body movement and laryngospasm during insertion.When the response to LMA insertion was positive,the concentration of propofol was increased in the next patient and when the response was negative,the concentration was decreased in the next patient.The EC50 and 95 ％ confidence interval of propofol inhibiting responses to LMA insertion were calculated.Results The EC50 (95 ％ confidence interval) of propofol was 3.11 (2.92-3.30) μg/ml in group F and 2.70 (2.55-2.85) μg/ml in group M (/ ＜ 0.05).Conclusion The EC50 of propofol inhibiting responses to LMA insertion is higher in female patients than in male patients.

ObjectiveTo explore the efficacy and indications of three kinds minimally invasive surgery treatment of upper ureteral calculus (UUC) complicating hydronephrosis.MethodsFour hundred and ninety-two patients with UUC complicating hydronephrosis were divided into three groups:minimally percutaneous nephrolithotomy (mPCNL) group (310 patients),ureteroscopy lithotripsy(URSL) group ( 130 patients) and retroperitoneal laparoscopic ureterolithotomy (RLU) group (52 patients).The operation time,blood loss,length of stay,stone-free rate and postoperative complications in three groups were compared.ResultsThe stone-free rate was 91.0％(282/310) in mPCNL group,78.5％(102/130) in URSL group and 100.0％(52/52) in RLU group,mPCNL group and RLU group were significantly higher than URSL group (P ＜0.01 ).URSL group and RLU group had the advantage of less operation time,blood loss,length of stay and postoperative complications compared with mPCNL group [ RLU group:(55.8 ± 20.5 ) min,( 10.8 ± 3.2)ml,(6.3 ± 2.1 ) d,1.9％(1/52) ;URSL group:(56.5 ± 15.2) min,(8.6 ± 1.4) ml,(5.7 ± 1.6) d,1.5％(2/130);mPCNL group:(113.8 ±42.5) min,(132.8 ±40.2) ml,(12.5 ±2.4) d,8.4％(26/310),P＜ 0.01 ].Conclusions Minimally invasive surgery on the treatment of UUC is safe and effective.URSL is preferred to treating the small UUC,RLU can improve the success rate for larger UUC.Contrary to mPCNL,which is best for merger kidney calculus,has higher stone-free rate,can be used as supplement of URSL after treatment failure.

Objective To investigate the effect of repeat transurethral resection for superficial bladder cancer. Methods One hundred and twenty patients who were newly diagnosed superficial bladder cancer were divided randomly in to two groups by mechanical sampling method,60 patients underwent second of prostate TUPKVP 4 weeks after initial transurethral and received adjuvant MMC intravesically (experiment group) and the other 60 patients received adjuvant MMC following the initial TUPKVP(control group). The two groups were followed up by cystoscopy at 3-month intervals,and then compared the recurrences between the two groups. Carcinoma in situ or muscle invasive disease were excluded from the study. Results Mean following up time was 6-24 (12.0 ±6.5) months, within the following up period,recurrence was observed in 13 (21.7%, 13/60) patients in experiment group and in 38 (63.3%,38/60)patients in control group, there was signiticantly statistical difference between the two groups (P＜ 0.01). Of all the recurrences, the recurrence rate of high grade tumor was 26.2% (11/42) in experiment group and 70.0% (35/50) in control group,the recurrence rate in experiment group was obviously less than that in control group (P ＜ 0.01). Conclusions Repeat transurethral resection can lower the recurrence of superficial bladder cancer (especially for the high grade tumor) which with initial resection, it can improve the classification of malignant rumor, and find the residual tumor, so it has value in clinical treatment.

Objective Study the concentration of the hepatocyte growth factor(HGF) the expression product of recombinant human hepatocyte growth factor naked plasmid ,and whether the body generates immune responseafter wsing HCF. Methods Selected 21 patients with severe ischemic disease of lower extremity (Rutherford classification 4-6 class) , after signing the informed consent and divided them into four dosage groups( 4 mg, 8 mg, 12 mg and 16 mg) random.In each group the dosage was the lower limbs partly intramuscular injection following the feeding artery in experimental stage Dl and D15. The plasma samples were collected to determine the HGF concentration in Dl ( before administration), D8, D15 ( before administration) , D21, D59, and the HGF-antibody concentration in Dl, D15, D28, D59, D91. Results (1)The concentrations of HGF in the subjects ranged from 216 pg/mL to 1189.75 pg/mL.(2) HGF-antibodies were not dectected in the subjects' plasma. Conclusions After using recombinant human HGF naked plasmid through intramuscular injection, the concentration of HGF expression product in subjects' peripheral blood does not have abnormally changed and using the drug the human body immune response does not generate.