<International Circulation>: Organized stroke care，including emergency call centre， stroke triages， emergency medical services (EMS)， emergency rooms (ER)， stroke units (SU)， rehabilitation hospitals and community health care， is the most effective method for stroke care. How organized stroke care run in Iatly? Could you please introduce the experience about it?
《国际循环》：组织化卒中医疗，包括呼叫中心、卒中派遣、急诊医疗服务、急诊室工作、卒中单元、康复医疗、社区健康医疗等，被认为是治疗卒中最有效的治疗方法，意大利组织化卒中医疗的实施情况如何？有哪些成功的经验？

Colivicchi: At the moment， in Italy we are developing a network of stroke units and acute care units within the emergency departments of our referral centers， which are the hospitals. We have a network of hospitals in the Italian National Health Service， which is a public network of hospitals， including community centers; which are the so-called spoke centers and then we have referral centers which are the so-called hub centers. Patients with the most severe conditions such as acute stroke or acute myocardial infarction are moved with ambulances or helicopters from peripheral/community hospitals to referral centers. The experience is very favorable at the moment because we have very good results in providing acute care to most patients and improving the overall outcomes in terms of cardiovascular events following acute events. The experience is positive and we are trying to implement this strategy all over the country and following a plan which has been developed by the Italian Ministry of Health. This is our experience at the moment.
Furio Colivicchi教授：现在，在意大利医院转诊中心急诊内部正在发展卒中单元和急诊单元的网状系统。在意大利国家卫生局我们有医院网，这是一个医院公共网，包括社区中心即所谓的轮辐中心，和转诊中心即所谓的集线器。危重患者如急性卒中或急性心肌梗死患者用救护车或直升机从周边医院或社区医院运送到转诊中心。这些经验十分有用，因为对患者进行紧急医护后，改善了心血管事件随之而来的急性事件的预后。该经验有积极作用，我们正努力在全国实行这项策略，此计划由意大利卫生部主导。这就是我们目前的经验。

<International Circulation>: During the emergency care of stroke， time is key factor. Patients have the thrombolysis opportunity for ischemic stroke only they could enter the hospital within time window. How about stroke patients enter hospital within 3 hours in Italy? What do Italy about reducing time delay and how about the outcome?
《国际循环》：卒中急诊救治中，时间是非常关键的因素，只有在有效时间窗内到达医院，对于缺血性卒中患者，才有可能获得溶栓的机会，意大利在3小时时间窗内到达医院的比例如何？以及在减少就诊延迟做了哪些具体工作？效果如何？

Colivicchi: We are collecting data through some registries. I have to say that at the moment the percentage of acute stroke patients reaching the hospital within 3 hours is very low; it still is about less than 5%. So the thrombolysis is performed in not more than 3-4% of patients in urban areas; people in rural areas have lower percentages of reaching a hospital within 3 hours. We are working hard on the emergency medical system in order to reach a percentage of about 20% of patients reaching the hospital within 3 hours. This is our goal for the next five years and we are working hard on it. We have certain areas of Italy in which we are achieving very good results; large urban areas， while for rural areas we have big problems because they are dispersed in the mountains all over the country so it is difficult to reach the hospitals. 
Furio Colivicchi教授：我们通过注册研究收集数据。我必须说的是现在发病3小时内到达医院的急性卒中患者比例很低；仍然小于5%。因此市区进行溶栓的患者不超过3%~4%；农村地区在发病3小时内到达医院的急性卒中患者的比例更低。我们正致力于急诊医疗系统为了使发病3小时内到达医院的患者达到20%。这是我们下个五年计划的目标并且我们正在努力实现。在意大利大量市区取得了非常好的效果；然而在农村地区却有大问题，由于农村居民分散在全国各地的山区所以难以到达医院。

<International Circulation>: The magnitude of stroke burden will increase as the population ages. What Italy do about reducing the detriment of stroke?
《国际循环》：随着人口的老龄化，卒中越来越成为人类的负担，意大利在减少卒中危害中做了哪些工作？

Colivicchi: We are trying to a more efficient emergency medical service in the rural areas and to have more ambulances and physicians onboard in order to provide pre-hospital thrombolysis as much as possible both for acute myocardial infarction and acute stroke. This is a project for the future and we are trying to implement these strategies all across the country. As you may know， Italy is a very long country， so it is very difficult. We have large mountains in the center of the country， so it is rather difficult to implement a strategy which is usual for every area in the country. We need to tailor the strategy for the geographical area in which we are working.

Colivicchi: As Professor Hu has said very clearly， prevention is the key to reduce the incidence of acute cardiovascular events. We have to focus on prevention， reducing hypertension， and the impact of the disease. We have to reduce the number of smokers in the general population. If we are not effective in reducing these kinds of risk factors， we will not reduce the incidence， because as the population ages the impact of the risk factors increase very much. So， we have to lower the prevalence of the risk factors in the population， in particular in the aged population in our country， and I think that is the same strategy that should be employed in China.

Colivicchi: Actually， I saw yesterday that the percentage of smoking doctors in China is rather high; approaching 40%. We also have this kind of problem in Italy， even if the figures are lower， because we have about 20% of the general population in Italy who smokes， but for doctors it approaches 10%. It is less than in China but it is still a major problem

Furio Colivicchi教授：我们努在力农村地区实行更有效的急诊医疗服务并且配制更多的救护车和医生以便尽可能对急性卒中和急性心肌梗死患者进行院前溶栓。这是一项未来工程，我们正努力在全国实行这项工程。你可能知道意大利是个狭长国家，所以实行这项工程很困难。意大利中心有大量山脉，这使得实行这项到达全国每一个地方的工程相当困难。我们需要根据国家的地理情况制定相应的工作计划。正如胡大一教授所说，预防是减少急性心血管事件发生率的关键。我们必须集中精力于预防，减少高血压及疾病之间的影响。我们必须减少一般人群中吸烟者的数量。 如果我们不能有效减少危险因素，我们将不能减少发病率。因为随着人口的老龄化危险因素的影响大大增加，我们必须降低人群中危险因素的流行率，特别是我国老年人群。并且我认为中国也应该使用与意大利同样的对策。

昨天我看到中国吸烟医生的比例相当高，接近40%。我们国家也有这类问题，但数量较低。在意大利吸烟者占一般人群的20%，除医生以外，这个数字接近10%。虽然远远低于中国但仍然是个主要问题。