General practice is the core of primary care, and it has become the fundamental part of some high-valued health care system. The function-orientated definition of primary care comprise of five core attributes, which are first-contact, accessibility, continuity, coordination and comprehensiveness of service. This paper started from the definition of general practice and sought to clarify and summarize the definitions, contents and functions of its five core attributes;meanwhile, the high-performance functional mechanism of health care system was also explored. On this basis, four suggestions are put forward: The basic medical health care system should be renamed primary care system;Five core attributes of primary care should be emphasized when strengthening the primary care system; the primary care system should be improved, and the key points are the number of general practitioners (GPs), payment system, primary care purchasing, educational system of GPs and etc.;The management system and service process should be developed which would benefit the implementation of the core attributes of primary care at an organizational level.

Objective To evaluate the long-term prognostic capacity of the SYNTAX score Ⅱ(SxScore Ⅱ) and SYNTAX score (SxScore) in patients undergoing left main percutaneous coronary intervention (LM-PCI). Methods A total of 209 patients undergoing unprotected LM-PCI in the Cardiology Department of the Affiliated Hospital of PAP of Logistic College were prospectively collected. Follow up was carried out by telephone or outpatient or rehospitalization. The clinical endpoint focused on MACCE after PCI including composite death, nonfatal myocardial infarction, target vessel revascularization and stroke. The secondary endpoint included cardiac death and stent thrombosis. The SxScore and SxScoreⅡ were retrospectively calculated according to results of coronary angiography and clinical features of patients. Patients were stratified according to tertiles of low (≤22), intermediate (23-32), and high (≥33). The clinical data were comparedbetween three groups. The predictive ability of two scoring systems to MACCE after PCI was compared by COX regression evaluation. Results In 209 patients, 12 patients were lost to follow-up (5.7%), and the median follow-up was 30.2 months, 56 cases (28.4%) were observed to suffer from MACCE. The incidence rates of MACCE were 19.0%, 28.6%and 44.4%in SxScore low, intermediate and high groups respectively. The incidence rates of MACCE were 12.8%, 23.8%and 45.5%in SxScoreⅡlow, intermediate and high groups respectively. Single factor analysis showed that SxScore, SxScoreⅡ, age, diabetes and left ventricular ejection fraction (LVEF) were the independent predictors of MACCE. Multivariate analysis showed that SxScore and SxScoreⅡwere still risk independent predictors for MACCE. Conclusion Both SxScore and SxScoreⅡare independent risk predictors for MACCE in patients with unprotected left main coronary artery disease undergoing PCI treatment.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; administration & dosage ; adverse effects ; Carcinoma, Non-Small-Cell Lung ; drug therapy ; pathology ; Cisplatin ; administration & dosage ; adverse effects ; Deoxycytidine ; administration & dosage ; adverse effects ; analogs & derivatives ; Drug Chronotherapy ; Female ; Humans ; Leukopenia ; chemically induced ; Lung Neoplasms ; drug therapy ; pathology ; Male ; Middle Aged ; Nausea ; chemically induced ; Neoplasm Staging ; Neutropenia ; chemically induced ; Remission Induction ; Taxoids ; administration & dosage ; adverse effects

Abstract?Since the introduction of 25-gauge/23-gauge ( 25G/23G ) sutureless micro -incision vitrectomy surgery ( MIVS ) at the beginning of the 21 century, we have stepped into an era of micro-incision vitreoretinal surgery more than10a. The current 25/23G MIVS provide numerous advantages over the conventional 20G vitrectomy surgery including simplified surgical procedure, shortened operating time, decreased complications as well as smaller sclerotomy wound.As a result, vitreoretinal surgeons have been shifting gradually from 20-gauge to 25/23-gauge vitrectomy in the past decade. As the 25/23G MIVS adapted worldwide, however, its drawbacks were also increasingly reported. Most criticism regarding to current 25/23G MIVS are focusing on would sealing related complications.Based on stablished notion regarding vitrectomy -“the smaller the better”, researchers and doctors were keeping on exploring the next generation of vitrectomy system. Thanks to the innovation and development in new generation vitrectomy machines, high lumen output light source, more delicate manufacturing technology and clear wild angle fundus view system, Dr.Oshima from Japan launched the first 27-gauge vitrectomy surgery system.It provided us novel surgical experience with smaller sclerotomy wound and faster cut rate. Further development and refinement of vitrectomy with 27-gauge or more are still on its way and will continue in the future. Undoubtedly, MIVS would be heated debated regarding its pro/con, complications, indications and future development.Combined with our own experiences, here we briefly reviewed the 27-gauge vitrectomy surgery.

Trials in public hospital reforms bear special significance for rational deployment of health resources and exploring the separation of hospital management from routine operations. The paper identified such setbacks in the present trials as easy technology measures, numerous models of separations, difficulty in setting pharmaceutical service fees, and inadequate governance. Authors also recommended such measures as searching for appropriate reforms for public hospitals locally, greater financial resources for completing the compensation mechanism of public hospitals, streamlining their management system for separation of management from operations, and improving governance. All these efforts are designed to enhance the public benefit nature of public hospitals.

Objective:The objective of this study was to evaluate and compare the core attributes of the four general practice models in Guangzhou, Dongguan and Shenzhen, and to provide the suggestions for strengthening the general practice functions. Methods: We used the two stage sampling method in this study. Firstly, three CHCs in Guangzhou, two in Dongguan and two in Shenzhen, and the general medical outpatient department in the Shenzhen Hospital of the University of Hong Kong were selected. Secondly, we used the convenience sam-pling method to perform investigation. A PCAT-AE modified Chinese edition was adapted to measure the patients’ primary care experience. A total of 1 712 patients participated in the questionnaire survey, the number of which 1 645 copies were valid. Results: Generally, the general practice core attributes’ total scores from that hospital were higher than those from Guangzhou communities (55. 3 vs. 45. 9, P<0. 05), Dongguan commu-nities (55. 3 vs. 49. 2, P<0. 05) and the Shenzhen communities (55. 3vs. 51. 7, P<0. 05). Conclusion:The primary care implementation was different in accordance with the characteristics of regions, and the general practice core attributes had different characteristics in different models. It could constantly improve the primary care services to each model’s specific circumstances.

Objective:The general practice attributes constitute a basis for the high primary care performance. In this paper, the general practice attributes are measured, their influencing factors are analyzed, the causes of exist-ing problems are explored, and suggestions are straight forwarded to strengthen the general practice function. Meth-ods:In this study, a PCAT-AE modified Chinese edition was adopted. The research was conducted into 8 community health centers and the general outpatient clinic of the University of Hong Kong, Shenzhen Hospital. They were eligi-ble adult patients who could communicate properly and had visited the same general practitioners at least three times. One-to-one interviews were conducted and a total of 1 712 patients participated in the survey, a number of which 1 645 effective samples were considered for analysis. Results: The total general practice attributes score was 49. 0. The first-contact score of 69 . 8 , continuity score being 63 . 1 and the cultural competence score of 51 . 2 were relatively high. The scores for the access (40. 8) and community orientation (31. 0) were relatively low. The general practice attribute scores were influenced by the social demographic and health characteristics, and the health care service uti-lization. Also, the general practice core attributes were positively related to the patient satisfaction (OR>1). Con-clusion:Comparing to the numbers in the developed countries, the general practice attribute scores were still low in China. Therefore, to strengthen the general practice function, works could be done at the individual, organization and system levels.

Objective To investigate the influence of low calcium dialysate (DCa1.25) and midodrine hydrochloric (MHC) on blood pressure in hemodialysis patients. Methods Dialysate calcium concentration was changed from 1.5% (DCa1.5) to 1.25% in patients with hypercalcaemia pre- or post-dialysis.For patients with intradialytic hypotension(IDH), pre-dialysis antihypertensive drugs were ceased.If that didn′t work, MHC 2.5 or 5 mg was administered to them 30 minutes before dialysis were ceased.MHC was also administered to patients who had not taken antihypertensive drugs. The blood pressure (BP) and blood volume were recorded during dialysis. UCG and autonomic nerves function test including BP supine and standing test and sustained hand-grip test were measured as well. Results Twenty-one hemodialysis patients were involved in this study including male 9 and female 12. The average age was (54.4?14.2) years old,the time on dialysis (33.04?30.1) months. When DCa1.5 was changed to DCa1.25, 9 cases (42.9%) could maintain stable BP, but IDH occurred in 10 patients(47.6%) with symptoms such as swirl,sweat or cramp, one with lower extremities cramp and one with heart discomfort but without IDH. Patients with IDH had higher proportion of abnormal BP supine and standing tests compared with patients without IDH(50% vs. 0%, P

Objective To establish a method of TRFIA with high sensitivity and broad detecting range for serum HBV large surface protein (HBV-LP).Methods The monoclonal antibody of HBV-LP was covered on the microwell plate and incubated with HBV-LP in blood sample,then Eu3+ labeled antibody of HBs was added.HBV-LP in standard substance,blood samples of 66 chronic hepatitis B patients and 30 healthy controls was detected by the TRFIA and ELISA.x2 test and linear correlation analysis were used for data analysis.Results The dose-response curve of standard substance with TRFIA had good linear correlation (r=0.999).Normal reference range was established at 0-1.36 mg/L based on the ELISA results of 30 healthy controls.The sensitivity was 0.10 mg/L.The specificity was 100％ (30/30).Correlation coefficient between the TRFIA and the ELISA was 0.800 9 (P＜0.001).The positive detecting rates of the 2 methods were significantly different (89.4％(59/66) vs 77.3％(51/66),x2 =6.13,P＜0.01).The recovery rate for HBV-LP was between 95.93％-107.62％.The effective detecting range(CV＜10％) of TRFIA was 1.35-2 764.00 mg/L,and that of ELISA was 10.8-691.0 mg/L.Conclusion The TRFIA was established for HBV-LP detection with higher sensitivity and wider detecting range compared to ELISA.It has potential value for HBV screening and monitoring of antiviral therapy.

Objective To investigate the role of self-made auxiliary device in pelvic tumor radiotherapy with phantom immobilization using Varian cone-beam CT (CBCT).Methods A total of 50 patients with pelvic tumor were enrolled and randomly divided into study group and control group according to the order of enrollment.The patients in the study group were immobilized with thermoplastic phantom and self-made auxiliary device,and those in the control group were immobilized with thermoplastic phantom.CBCT scan and online matching were regularly performed before radiotherapy to obtain the setup errors of the left-right (x),cranial-caudal (y),and anterior-posterior (z) directions.The independent-samples t-test was used for comparison between groups.Results The set-up errors in the x-,y-,and z-directions in the study group were 1.56± 1.00 mm,1.60± 1.29 mm,and 1.36± 1.00 mm,respectively,and those in the control group were 1.76±1.33 mm,2.76±1.69 mm,and 1.92±0.91 mm,respectively (P=0.551,0.009,and 0.043).Conclusions Self-made auxiliary device helps to eliminate the errors in the cranial-caudal direction and solve the problem of involuntary activities of the lower limbs.