Under the current system, the number of sole foreign -investment hospitals and foreign -domestic joint venture hospitals is growing.They are different from public hospitals in terms of their foperation , market share, medical-service pricing poli-cy and their quality and management of medical care.Mechanisms still need to be developed so that these hospitals could move forward to improve our health-system overall.In the meanwhile, public hospitals should be powered by the patient-centeredphilosophy and improve their management and services to enhance their competiveness.

Objective:To analyze the usage intention and key issues of medical staff to use telemedicine, for improving telemedicine service system in China.Methods:From October to November 2019, medical workers of both the inviting party and invited party who experienced telemedicine in seven provinces of Fujian, Hainan, Henan, Hunan, Guizhou, Sichuan and Qinghai were selected for an online questionnaire survey. Areas covered included their usage intention, satisfaction and cognitive appraisal of telemedicine. Descriptive statistical analysis and non-parametric test were used to discuss the intention of further use, satisfaction and challenges of medical workers in various provinces and regions.Results:1 084 valid questionnaires were recovered. The data found the overall satisfaction was 98.62%, and the proportion of their intention of further use was 98.25%, and those from the eastern and western provinces presented higher intention of usage. The top challenges as reflected by these medical workers were named as follows: timeliness of consultation progress and information feedback; long latency time; low Internet speed, poor and interrupted Internet signal; inadequate system equipments and inconvenient operation; difficulties in remote physical checkup and overall understanding of patient conditions; as well as substandard, incomplete and poor medical records.Conclusions:These medical workers are satisfied with the telemedicine services and willing to continue to use telemedicine.For those existing problems, it is suggested to strengthen the infrastructure and optimize the process of telemedicine services, so as to encourage them in greater use of telemedicine.

Objective:To analyze the actual and expected incentives and key issues of telemedicine providers in China and to provide important references for optimizing telemedicine incentive policies.Methods:The sample data came from a questionnaire survey of 1 084 providers in 7 provinces of Fujian, Hainan, Henan, Hunan, Guizhou, Sichuan and Qinghai in October and November 2019 and a semi-structured interview data at 6 hospitals in Henan province in January 2020. Descriptive analysis was used to sort such data into text data for classified summation.Results:The greatest gaps were found between actual incentives and expected ones in expense subsidies, title promotion and excellence awards, with such gaps as high as 18.65, 28.26, 29.28 percentages among providers of junior, deputy senior and senior academic titles respectively. Hospitals fall short in providing adequate incentives for telemedicine providers, not to mention lack of differentiation and diversification in personnel incentives, and poor implementation of incentive policies.Conclusions:It is suggested to strengthen incentive demand analysis, break the homogenization bottleneck of incentive policies, and consolidate internal publicity and implementation of incentive policies.

Objective To investigate the clinical significance of serum CEA , CA19-9, CA72-4, CA242, CA50, PGⅠand PGR ( PGⅠ/PGⅡ) in the Diagnosis of preoperative and postoperative gastric cancer.Methods Retrospective study.The levels of CEA , CA19-9, CA72-4, CA242, CA50, PGⅠand PGⅡin serum of 41 patients with gastric cancer preoperative and postoperative and 60 healthy people were detected by AutoLumo A2000 chemiluminescence immunoassay and compared.Statistical analysis was performed using Rank-sum test by SPSS 17.0.Results The median of CEA, CA19-9, CA72-4, CA242, CA50, PGI, PGII and PGR in postoperative gastric cancer group were 3.79 ng/ml, 17.85 U/ml, 3.50 U/ml, 14.52 U/ml, 17.62 U/ml, 32.81 ng/ml, 11.48 ng/ml, 3.35.The postoperative gastric cancer group were 1.67 ng/ml, 7.76 U ml, 1.73 U/ml, 6.30 U/ml, 7.57 U/ml, 20.56 ng/ml, 5.71 ng/ml, 2.94.The healthy group were 1.53 ng /ml, 7.59 U/ml, 1.47 U/ml, 6.08 U/ml, 5.68 U/ml, 90.86 ng/ml, 14.85 ng/ml, 6.67.There were statistical differences in the serum levels of CEA , CA19-9, CA72-4, CA242, CA50, PGⅠ, PGⅡand PGR among different groups (chi-squared values were 79.108, 20.678, 20.374, 7.252, 56.73, 131.212, 20.38, 86.37, P<0.05).By the Mann-Whitney rank sum test,the serum levels of CEA , CA19-9, CA72-4, CA242 and CA50 in patients with preoperative gastric cancer were significantly higher than those in healthy controls (Z values were -8.598, -4.425, -4.365, -2.000,-7.420, P<0.05).The level of postoperative group was significantly lower than that of preoperative group (Z value were -4.641, -2.383, -2.459, -2.399, -2.903, P<0.05).The serum PGⅠ, PGⅡand PGR levels in patients with preoperative gastric cancer were significantly lower than those in healthy controls (Z values were -10.309, -2.695, 8.637, P<0.05).The PGⅠlevel in the postoperative group was significantly lower than that in the preoperative group (Z value was -2.109, P<0.05).PGⅡ,PGR levels of postoperative group were lower than those of preoperative group , but the difference were not statistically significant.(Z values were -1.506,-0.838, P values were 0.132,0.402).Conclusion The detection of the seven serum markers can help to preoperative diagnosis and postoperative monitoring of gastric cancer .

Introduced in the paper is a success story of the Singapore National Eye Center (SNEC) and Singapore Eye Research Institute (SERI) in medical care,research and education.Especially noteworthy are their initiatives in talent development,research and international cooperation,which are expected to be learnt by large eye care and research institutions in China in their discipline development,translational research and interdisciplinary talents development.

Objective To evaluate the clinical value of multiple bladder biopsies in the diagnosis and treatment of non-muscle invasive bladder cancer (NMIBC) during transurethral resection of bladder tumor(TURBT).Methods The data of 408 NMIBC patients from January 2009 to December 2013 was analyzed retrospectively.There were 302 males and 106 females.The mean age of these 408 patients was 65 years old from 33 to 86 years.Bladder multipoint biopsies were performed in 216 patients (biopsy group),and were not performed in the other 192 patients (control group).The multipoint biopsies were taken from right and left bladder walls,anterior and posterior walls,dome,trigone,prostatic urethra and abnormal mucosa.There were 127 males and 89 females in the biopsy group,with a mean age of 64 years old (from 18 to 87 years).In the control group,118 males and 74 females aged between 15 and 92 years have an average age of 66 years old.There was no statistically significant difference in regard to gender and age between the two groups.The positive rate of biopsy and whether the diagnosis and treatment plan changed in the study group were recorded and the recurrence and progression rates were compared between study and control groups.Results Of these 216 multiple mucosa biopsies,the total abnormal detection rate was 48.1％ (104/216).There were urothelial carcinoma in 12.5％ (39/216),carcinoma in situ in 5.6％ (12/216),dysplasia in 9.7％ (21/216),cystitis in 20.4％.The final diagnosis were changed in fifteen patients (6.9％) due to the biopsy results,and 38 patients(17.6％) treatment plans were changed.The 1-,3-,and 5-year recurrence-free survival rates (RFS) of biopsy group and control groups were 96.3％ vs.85.4％(x2 =14.955,P=0.000),85.2％ vs.69.8％ (x2 =13.183,P =0.000) and 69.9％ vs.64.1％ (x2 =1.574,P =0.245);progression-free survival(PFS) were 99.1％ vs.96.3％ (x2 =8.253,P =0.006),94.0％ vs.87.0％ (x2 =5.901,P=0.017) and90.3％ vs.85.4％ (x2 =2.273,P=0.169).The 1-and 3-year RFS and PFS of biopsy group were higher than control group.There was no significant difference in the 5-year RFS and PFS between the two groups.Conclusions Multiple bladder biopsies could be helpful for pathological diagnosis and the post-TUR treatment of NMIBC.Furthermore,it may reduce the early recurrence and progression rates of NMIBC,but have no effect on long-term prognosis.

OBJECTIVE: To explore the causes and the management of serious eye complications occurring in the endoscopic sinus surgery. METHOD: Three patients of chronic sinusitis and nasal polyps suffered with blindness in endoscopic sinus surgery and in nasal packing with iodoform and petrolatum gauze were treated. RESULT: Orbital wall and structure were injured in 2 cases during endoscopic sinus surgery, among which, 1 case blinded with deformation of the eyeball during operation underwent optic nerve exploration and orbital muscle reparation immediately. One case developed periocular swelling, eyelid hematoma, conjunctiva edema and blinded 2 days later, and was treated with hematoma clearance and optic nerve decompression. Another 1 case blinded immediately after ethmoid packing, and vision recovered after nasal pack removed. Antibiotics, corticosteroid and nerve growth factor were administered for 4 weeks in all patients. After 6-month follow-up, 1 case was blinded with eyeball atrophy, 1 case was only photonasty, another regained normal vision. CONCLUSION The causes of blindness in endoscopic sinus surgery are directly related to orbital structure trauma and orbital hematoma. The optic nerve during operation should be protected carefully, if ethmoid sinus over development is demonstrated by CT scan. The application of gauze should be avoided when the medial orbital wall is injured. Decompression of optic nerve should be performed as early as possible, if vision damaged.
Adult ; Blindness ; etiology ; prevention & control ; Endoscopy ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Nose ; surgery ; Otorhinolaryngologic Surgical Procedures ; adverse effects ; Postoperative Complications ; prevention & control

Telemedicine can optimize deployment of medical resources and minimize diagnosis discrepancies.Formulation of a rational project pricing and scientific compensation policy will be conducive to its future development. The concept of human resource consumption in RBRVS was used as reference to improve the activity-based costing ( ABC ) method. The authors sorted out the resource cost repository, identified the activity system, classified the motivation resources into respective activity cost repositories, and calculated the cost of respective cost object distribution.The cost of three telemedicine service items(remote single discipline consultation, remote image consultation and remote pathology consultation were 119.69, 147.03 and 161.61 yuan respectively) was calculated by the improved ABC.It can better indicate project costs than that calculated by the traditional ABC(137.30, 147.17 and 144.08 yuan), and proves more consistent with the existing prices of other province(134.00, 150.00 and 174.00 yuan).

Driven by demand and policy guidance, the construction of Internet hospitals is on a fast track mode in China. To address such a situation, the state requires that before Internet hospitals are admitted, the provincial health authorities should establish an Internet medical service supervision platform to interconnect with the Internet hospital information platform for real-time supervision. This study discussed and introduced the Internet medical service supervision platform in Henan province, covering its system architecture, functions, regulatory indicators and operation mode. The platform is officially in operation and has completed docking with 7 medical institutions. It can implement entire process supervision with a total of 186 indicators in five categories in Henan, providing a reference for the construction of Internet medical service supervision platforms in other provinces.

In this study, we attempted to establish a culture system for in vitro spermatogenesis from spermatogonial stem cells (SSCs) of Bama mini-pig. Dissociated testicular cells from 1-month-old pigs were co-cultured to mimic in vivo spermatogenesis. The testicular cells were seeded in minimum essential medium alpha (α-MEM) supplemented with Knockout serum replacement (KSR). Three-dimensional colonies formed after 10 days of culture. The colonies showed positive staining for SSC-associated markers such as UCHL1, PLZF, THY1, OCT4, Dolichos biflorus agglutinin, and alkaline phosphatase. Induction of SSCs was performed in α-MEM + KSR supplemented with retinoic acid, bone morphogenetic protein 4, activin A, follicle-stimulating hormone, or testosterone. The results showed that STRA8, DMC1, PRM1, and TNP1 were upregulated significantly in the colonies after induction compared to that in testis from 1-month-old pigs, while expression levels of those genes were significantly low compared to those in 2-month-old testis. However, upregulation of ACROSIN was not significant. Replacement of α-MEM and KSR with Iscove's modified Dulbecco's medium and fetal bovine serum did not upregulate expression of these genes significantly. These results indicate that SSCs of Bama mini-pig could undergo differentiation and develop to a post-meiotic stage in α-MEM supplemented with KSR and induction factors.
Acrosin ; Activins ; Alkaline Phosphatase ; Bone Morphogenetic Protein 4 ; Dolichos ; Follicle Stimulating Hormone ; Humans ; In Vitro Techniques ; Infant ; Infant, Newborn ; Spermatogenesis ; Stem Cells ; Swine ; Testis ; Testosterone ; Tretinoin ; Up-Regulation