AIM: To investigate the clinical effects of tongxinluo an d nitroglycerin in patients with congestive heart failure(CHF).METHODS: 112 CHF patients were assigned to the treatment group (60 cases) and the control group (52 cases) randomly.The patients in the control group were treat ed with nitroglycerin and routine general therapy, and those in the treatment gr oup were administrated with tongxinluo 3 capsules after each of three meals besi des nitroglycerin and routine general therapy. The echocardiography, hemorheolo gy and clinical examination were performed in patients with CHF prior and after 2-week treatment. The cardiac function and alternation of the hemorheology were observed after treatment. RESULTS: The total effective rate in the treatment group was higher than that in the control group. The cardiac func tion in the treatment group changed significantly,and the levels of plasma visc osity decreased in both groups significantly after treatment, especially in trea tment group. CONCLUSION: Tongxinluo can improve the cardiac fu nction and blood coagulation in patients with CHF.

The control handles( including financing, provider payment, organization, regulation and behavior) proposed by World Bank in health policy research as the basic framework,and the nature and positioning of family doctors′ contract-based service as the precondition, we recommended the system framework of such a mechanism, comprising one contract, three regulations, five control handles and seven supporting policies. Such a framework can serve as the cornerstone for family doctors′ contract-based service experiment in Zhejiang province for the sake of hierarchical medical system.

Objective To analyze the medical service capacity of primary healthcare in Zhejiang province since the ongoing healthcare reform and put forward suggestions. Methods Key indicators of healthcare resources and medical service utilization from 2009 to 2015 reflecting the primary healthcare were identified,for a quantitative analysis in terms of the structure-process-outcome dimensions. Results In terms of structural service capacity,the average headcount growth rate of primary healthcare′s technical personnel was 5. 7% per year; the personnel competence structure kept improving; the hospital beds at primary institutions and their ratio among all were slightly decreased,with better devices and informatization. In terms of procedural service capacity,the proportion of primary institutions with contract-based services amounted to 89. 9%,with the standard contract signing rate up to 18. 8%. In terms of consequential service capacity,the average growth rate of the number of outpatient visits at primary institutions was 6. 3%. The amount and proportion of inpatients were slightly decreased,while the hospital bed utilization ratio was increased slightly. Conclusions It is necessary to further strengthen the training and introduction of primary healthcare professionals. The functional orientation of hospitals at various levels should be clarified, encouraging contract-signing of general practitioners, promote the medical insurance payment reform featuring the capitation payment at primary level,and improve the income distribution and incentive mechanism.

Objective To investigate the efficacy and safety of transrectal ultrasound guided transurethral balloon dilation of the prostate (TUDP) for the treatment of benign prostatic hyperplasia (BPH).Methods A total of 23 men with BPH who had undergone TUDP were retrospectively analyzed,including 16 men with indwelling urinary catheters before the operation.During the TUDP,the prostatic apex and membranous urethra were dilated by inner balloon,and the prostatic urethra and bladder neck were dilated by outer balloon.The patients were followed up at the 1st,3rd,6th and 12th month after the operation,and the observation parameters included subjective symptoms,such as international prostatic symptom score (IPSS) and quality of life (QOL) score,and objective parameters,such as maximum flow rate (Qmax) and post-void residual (PVR).Results The operation time was 30-165 min,and the intraoperative hemorrhage volume was 5-50 ml.The IPSS scores at 1st,3rd,6th and 12th month after the operation were 10.4± 4.2,8.7±3.2,9.5±4.6 and 8.3±1.5 respectively,which were significantly decreased in comparison to the IPSS score (22.0±7.2) before the operation (P＜0.05).The QOL scores at 1st,3rd,6th and 12th month after the operation were 2.1±1.1,1.6±1.0,1.8±1.1 and 1.6±1.0 respectively,which were significantly improved in comparison to the QOL score (4.9±0.9) before the operation (P＜0.05).The Qmax at 1st,3rd,6th and 12th month after the operation were (10.5±3.4),(12.4±4.2),(10.9±3.9) and (12.7±4.6) ml/s respectively,which were significantly increased in comparison to the Qmax(1.9± 1.9 ml/s) before the operation (P＜0.05).There were 5,4,2 cases of urinary incontinence at the 1st,2nd and 3rd month after the operation,but they recovered at the 4th month follow-up.Besides,there were 3 cases suffered from epididymitis.Conclusion Transrectal ultrasound guided TUDP is a safe,effective and cheap option for the treatment of BPH,especially for the primary hospitals.

The application of TCM“Preventive Treatment for Disease”in community health care is a major approach to implementing the prevention-first health policy and realizing access to basic health services for all.Covered first in the paper is the significance of TCM“Preventive Treatment for Disease”in community health care.It is followed by a systematic description of the innovative community health care model in Hangzhou in 2008.This innovation started in 2009 to apply the TCM“Preventive Treatment for Disease”in community health care.The authors described the preliminary practice,specific measures and the main results of TCM“Preventive Treatment for Disease”in community health care.They went on to recommend the service model of TCM“Preventive Treatment for Disease”in community health care and provide references for application of TCm in community health care.

This paper summarized health care delivery system in remote areas of Japan including criteria for underserved areas, regular adjustment to the list, comprehensive national plans, integrated provision system, governmental responsibilities, establishment of Jichi Medical University, participation of social organizations.We raise such suggestions as leading role of the government, precision listing underserved areas,implementing special plan, financing and payment policy, human resources for health, and regional co-ordination of medical resource.

This study applied both qualitative and quantitative research methods to describe Norwegian health care reform, covering such performance indicators as key reform process, healthcare reform trends in number of beds per thousand, health care resource utilization, hospital management system, general practitioners, and public health management system. Moreover, the paper put forward suggestions for the reform in China, namely health governance mechanism, the transformation from scale expansion to quality and performance-based development, reforming family physician system.

Objective: To evaluate the clinical efficacy of percutaneous nephrolithotomy combined with flexible ureteroscopy and holmium laser lithotripsy in the treatment of complicated renal calculi. Methods: Clinical data of 139 patients with complicated renal calculi from March 2013 to March 2019 in Miyun Teaching Hospital, Capital Medical University were retrospectively analyzed. There were 76 males and 63 females, the average was (47.9±3.1) years, aged from 27 to 75 years. The total patients were divided into control group (n=69) and treatment group (n=70) according to different treatment method. The patients in the control group treated with percutaneous nephrolithotorny, the patients in the treatment group were treated with flexible ureteroscopy and holmium laser lithotripsy on the bassis of the control group. Compared the operation time, hospital stays, intraoperative blood loss, effective rate and complication incidence rate between two groups. Measurement data were expressed as mean± standard deviation (Mean±SD), and t-test was used for comparison between groups; count data was compared by Chi-square test. Results: In the control group, the operation time, length of hospital stay and intraoperative blood loss were (65.85±3.83) min and (8.83±4.00) d, (130.72±1.20) ml, respectively, the treatment group were (43.44±3.16) min, (5.72±1.07) d, (96.21±0.98) ml, respectively, the difference between group there was statistical significance (P<0.05); the total effective rate of the control group was 84.0% (58/69), which was significantly lower than that of the treatment group [95.7% (67/70)], and the difference between the groups was statistically significant (P<0.05). The incidence of postoperative complications of the treatment group[2.8% (2/70)] was significantly lower than the control group[14.5% (10/69)], and the difference between the two groups was statistically significant (P<0.05). Conclusion The complicated renal calculi by percutaneous nephrolithotomy combined with flexible ureteroscopy and holmium laser lithotripsy has the advantage of short operation time, less blood loss, faster recovery and low complication incidence rates, has clinical use and promotion value.

Objective To investigate the related factors of systemic inflammatory response syndrome after percutaneous nephrolithotomy in the treatment of upper urinary tract stones.Methods The clinical data of 101 patients after percutaneous nephrolithotomy from August 2016 to April 2018 in Miyun Teaching Hospital,Capital Medical University were retrospectively analysed.Screened the independent variable such as gender,with fever or not,with diabetes or not,with hydronephrosis or not,urine leucocyte count,volume of urinary calculi,CT attenuation value of urinary calculi and presence of intraoperative infection,and analyzed the relationship those with systemic inflammatory response syndrome after surgery.Univariate and multivariate logistic regression analysis the factors related to systemic inflammatory response in patients after surgery.Results Of the 101 patients,62 cases was male,and 39 cases was female,12 (11.9％) suffered postoperative systemic inflammatory response syndrome.Univariate regression analysis indicated that the risk factors of systemic inflammatory response syndrome after percutaneous nephrolithotomy were gender,with diabetes or not,urine leucocyte count,volume of urinary calculi and presence of intraoperative infection.Furthermore,multivariate logistic regression analysis revealed that with diabetes,intraoperative infection,urine leucocyte count and volume of urinary calculi were the independent factors of systemic inflammatory response syndrome after percutaneous nephrolithotomy.Conclusion Patients with diabetes,intraoperative infection,urine leucocyte count and volume of urinary calculi could be predicted as the independent factors of systemic inflammatory response syndrome after percutaneous nephrolithotomy,but it has no relationship with gender,with a history of fever or not,with hydronephrosis or not,and CT attenuation value of urinary calculi.

Based on an analysis of the compensation policy and its problems of the primary medical and health institutions, this paper put forward the corresponding reform framework in Zhejiang province. It proposed to change the compensation policy of " predefining revenue and expenditure, subsidizing its gap after performance appraisal" into " a mixed system of special subsidy and pay for performance". Related policies were also described including governmental functions, special subsidies for input-based payments, classified payments for output services, precautions against financial risks, etc. This paper also suggested that we focus on dealing with the six pairs of balance, such as that between subsidy for the supply and demand sides, and that between internal market and external market.