0.05;estimation of merging effect value:OR merging 95%confidence interval was 2.034 - 3.004;OR merging test:x~2 =71.6119,P

Health insurance is an important part of social security, and many problems have arisen in the con-struction of its legal system, such as legislative lag, lack of coordination among law enforcement, and serious disloca-tion of judicial relief. Therefore, under the vital time of performing the strategy of “rule by law”, the development and reform of the legal system for health insurance in China should be promoted. On the basis of summarizing the his-torical development of the legal system for health insurance in China, this paper proposes solutions such as centrali-zing legislative upgrades and expediting the process of unitary and special laws from the perspective of“rule by law”. The system of personal credit should be established and judicial transparency should be promoted to improve the legal system for health insurance.

Objective To compare the efficacy and safety in patients received paravertebral block and epi-dural block for postoperative rehabilitation pain after unilateral ureterolithotomy.Methods 120 ASA Ⅰor Ⅱ patients were randomly allocated into research group (n =60)and control group (n =60).After operation,the research group received paravertebral block performed with peripheral nerve stimulator,the control group received epidural block.All patients received patient -controlled intravenous analgesia (PCIA)in the same time.The operation time,amount of bleeding,postoperative hospitalization time,operation completion,number of press PCIA,occurrence rate of postopera-tive adverse reaction in 48 h,and visual analog scores (VAS)at 4,8,16 and 24 h after surgery were recorded. Results The patients of the two groups were completed the stone surgery,there was no cases of conversion to open surgery.There was no significant difference in operation time,bleeding volume,postoperative hospital stay between the two groups (all P >0.05).But the PCIA times of the research group was (2.14 ±0.45)times,which of the control group was (4.20 ±0.68)times,the difference was statistically significant (t =4.27,P =0.029).The postoperative VAS scores of the research group[4 h (2.68 ±0.480)points,8 h (2.68 ±0.48)points,16 h (2.81 ±0.43) points,24 h (2.88 ±0.49)points]were significantly lower than those of the control group[(3.12 ±0.53)points, (3.37 ±0.58)points,(3.42 ±0.52)points,(3.39 ±0.55)points],the differences were statistically significant (t =2.68,3.13,306,311,all P <0.05).Of the research group,the nausea and vomiting occurred rate (23.33%), hypotension rate (0.00%),skin itching (5.00%),the incidence of decreased muscle strength (0.00%)were significantly lower than the control group(43.3%,31.6%,28.33% and 8.33%),the differences were statistically significant(χ2 =5.40,22.57,11.76,522,all P <0.05 ).Conclusion Nerve stimulator guidance for thoracic paravertebral nerve block for upper ureter incision to take stone surgery patients can significantly reduce postoperative pain and the PCIA analgesia drug dosage and the incidence of adverse reactions.

Currently adopted surgical approaches of laparoscopic combined organ resection for gastrointestinal cancer include laparoscopic pancreaticoduodenectomy and gastrectomy, laparoscopic gastrectomy combined distal pancreatectomy and splenectomy, laparoscopic gastrectomy and cholecystectomy, laparoscopic rectal anterior resection and total hysterectomy with bilateral salpingo-oophorectomy, and laparescopic colorectal and hepatic metastases resection. Satisfactory clinical outcomes of these procedures for gastrointestinal cancer were obtained in the reported cases. However, the number of cases in current studies on laparoscopic combined organ resection for gastrointestinal cancer was too small and no control groups involved, and multicenter clinical trials were not yet conducted. In conclusion, the future of laparoscopic combined organ resection for gastrointestinal cancer is promising, while its feasibility and safety require further investigation.

Objective To screen empowerment psychological care scale items for critically ill patients through Delphi method.Methods Totally 27 experts were invited to conduct two rounds consultation by using Delphi method,and the results were summarized.Results The effective response rate of the experts' questionnaire for the first round and the second round was 90％ and 100％.The specialist authority coefficient was 0.895.The coordination coefficients for 2 rounds were 0.432 and 0.448 respectively.After two-round consultation,empowerment psychological care scale items for critically ill patients was finally formulated,containing 4 dimensions and 24 evaluation items.Conclusions The selected experts were highly representative,and they were enthusiastically involved in the consultation.And the scale has remarkable authority and coordination;it can reflect the theme of the study,provide instructive function for clinical medical personnel in implementation and evaluation of empowerment psychological care.

Sentinel lymph node (SLN), the hypothetical first regional lymph node or group of lymph nodes to received lymphatic drainage from a primary tumor, can predict the likelihood of further nodal involvement. SLN mapping was initially applied to the treatment of breast cancer and melanoma, and it also shows gratifying effect on thyroid cancer, pancreatic cancer and gastrointestinal tumors. The development of SLN mapping in colorectal cancer has brought us a new approach to design personalized operation and adjuvant therapy plans. However,various SLN mapping techniques in colorectal cancer available present fluctuant navigation performances, which need to be replaced by an economical, convenient and accurate tracing technique. Hopefully the optimized SLN mapping can play a more important role in the management of increasing occurred early colorectal cancer.

The serial knowledge of cognate thoughts, culture, systems, language, engraving and edition of classic ancient books was organized based on their subject-guided reading activities, which plays a rather effective role in promoting the readers to read them. The selection of subject-guided reading activity contents, forms of subject-guided reading activity design, implementation of subject-guided reading activity were analyzed with the ancient e-dition of《Handbook of prescriptions for emergency》as an example. A knowledge chain-based subject-guided reading model of classic ancient books was proposed for promoting the reading of ancient books on traditional Chinese medi-cine and the reading of Chinese national culture in related academic libraries.

Objective To establish the evaluation methods of individual technology maturity based on SCI-covered papers and patent data using Gartner's Hype Cycle.Methods The SCI-covered papers and patent data were ana-lyzed by nonlinear regression analysis in combination with traditional X-radiography and photo-acoustic tomo-graphy, and represented as the bell-shaped curve and S-shaped curve for judging the technology maturity.Results The individual technology maturity was consistent with the qualitative review of experts.Conclusion The individual technology described in SCI-covered papers and patent data can be used in primary evaluation of its maturity.

The causes of dizziness and vertigo were complex.The traditional diagnostic paradigm was based on symptom quality- what do you mean dizzy? According to this system,a patient with vertigo has a different list of possible causes than those who endorselightheadedness.The new diagnostic paradigm was based on their description of the timing,triggers of symptom strengthened the context of the vertigo medicine.More emergency physicians (EPs) lacked a significant knowledge regarding bedside examination and extensively convinced neuroimaging,resulting in misdiagnosis of serious causes such as stroke,unnecessary use of neuroimaging,and failure to institute specific treatment for many patients with inner ear causes of dizziness.This article focuses on how to use bedside physical examination to more accurately diagnose patients who present with acue dizziness,vertigo,or other similar vestiblar symptoms.This,in turn,could lead to lower rates of misdiagnosis,decrease utilization of expensive imaging studies,and increase in prompt,and correct treatments,thereby to improve patient outcomes.

Objective To investigate the clinical characteristics,manifestation and management of adrenal ganglioneuromas. Methods The data of 15 cases of ganglioneuromas diagnosed by pathology were reviewed retrospectively.Of the 15 cases,5 was male,aged 24 to 45 with an average of 29 years,and other 10 was female,aged 25 to 69 with an average of 31.Ten tumors were located in the right side,which was twice as many as that of the left side.There were 8 patients discovered by B ultrasonograpgy during health check-up,4 patients were detected because of paroxysmal abdominal pain. Three cases mainly presented with paroxysmally hypertension,and one of them had a high level of aldosterone ( 112 pmol/L). One of them had a high level of epinephrine (210 nmol) and nor-epinephrine (496 nmol). The B-ultrasound showed low-echo in all cases.Five cases showed calcification,the border was legible.The border lines of the tumors are not clear with vana cava in two cases. On unenhanced CT scanning,all cases showed low density areas.Eleven of the 15 cases underwent the enhanced CT,but 10 cases showed no enhanced areas on CT scanning.One case underwent MRI and showed low signals in T1 WI and inhomogeneous high signals in T2WI. Results Twelve cases underwent adrenal glands tumorectomy with abdominal NO.11 intercostals incision while other 3 underwent adrenal glands tumorectomy through posterior abdominal laparoscope.The tumors were completely removed in 14 cases,partly removed in 1 case.All patients recovered soon without complications such as bleeding or adrenal crisis.All cases were followed-up 13 to 74 months.The blood pressure of 3 cases with hypertension decreased to normal.The tumors recurred in 1 case,but no metastasis 55 months later. Conclusions It is difficult to differentiate adrenal medullary tumor from ganglioneuromas.The imaging data of iconography before surgery can give helpful information in the diagnosis of ganglioneuroma.Complete surgical excision is the only method for curing and the outcome is satisfactory.