This paper summarizes the kinds of long term care facilities, service delivery organization, service model, service role and experience of long-term service system in the United States. It provides referral implications for China to explore and establish its own long-term care service system. . There is a variety of long-term care services such as short and long-term stay, adult day care, and home care services, with a gradual change from institutional services to home and community ones. Long-term care services are provided by paid both formal and mostly unpaid informal caregivers. Informal family caregivers are most frequently daughters (29. 3%), followed by spouses with (21. 2%). With the increased availability of the family and community-based services, the family caregivers are more likely to share long term care services with the paid formal ones. The United States has a well-structured long-term care service system whose access mechanism is rigorous and systematic, emphasizing the evaluation of service quality and effectiveness. Moreover, the U. S. long term care service system pays more attention on elders' wishes, respecting their preferences and rights of choice on the services. Based on the experience of the United States, China should primarily focuses on establishing a family and community-based long term care service system with a variety of service delivery facilities, give a full play to the community health facilities, social partners, and families. The Chi-nese government should not only give a focus to the service institutions and content diversification, but should as well establish a sound and detailed assessment and evaluation standard system to access the services and assure the effec-tiveness of service quality with a humanized concern.

Objective:The aim of the present study was to conduct an international comparison of the high-val-ue drugs payment systems of some selected countries, and introduce them to the Chinese context. Australia, America and Germany's high-value drugs payment systems were selected to serve as references for China. Methods: The main content and characteristics of three countries' payment systems were analyzed in four aspects:expenditure copayment mode, paid-scope selection, drug price negotiation, and drug rational use management which were then compared with the Chinese status. Results:Through the difference in healthcare system tradition, the above countries have vari-ous copayment mode, but they all select paid-drug by cost-effectiveness analysis with corresponding control measures. Conclusions:China should: establish a co-payment mode for the high-value drugs on the basis of a critical illness medical insurance found;build a national pharmaco-economic evaluation index system and improve the national nego-tiation superiority, while emphasizing on risk-sharing mechanism; and make series specifications to guarantee the drug to be rationally used.

Objective To investigate the efficacy of TTC and FTC regimens as neoadjuvant chemotherapy in breast cancer. Methods Collecting clinical data of 325 patients received neoadjuvant chemotherapy with TIC and FTC regimens from June 2004 to April 2008, among them 138 patients received neoadjuvant chemotherapy with TTC regimen in one group, and 187 patients received neoadjuvant chemotherapy with CTF regimen in the other group. The expression of Topo Ⅱ a in specimen of 325 patients before neoadjuvant chemotherapy were detected by immunohistochemical method. Results Among the 325 cases of neoadjuvant chemotherapy, the overall response rate (RR) was 87.7 % in TIC arm and 67.4 % in FTC arm (P=0.000), but in the group of Topo Ⅱ a(+) Her-2(-), the overall response rate (RR) was 87.8 % in TTC arm and 79.4 % in FTC arm (P=0.266), and in the groups of Topo Ⅱ a(-), there was statistical significance; the pathologic complete response rate (pCR) was 13.7 % in TIC ann and 11.2 % in CTF ann (P=0.491). Conclusion TIC regimen is superior to FTC regimen in the response rate of neoadjuvant chemotherapy, but patients with negative expression of Topo Ⅱ a may get more benefits from 9eoadjuvant taxane and anthracycline chemotherapy.

55%)in 3 during postoperation.It were found better in the post-operative gait than in the pre-operative(P

[Objective]To investigate the long-term result of total hip replacement with a Ribbed hydroxyapatite-coated proximally femoral stem and cup component.[Method]From June 1999 to May 2002,24 cases (26 hips) with hip joint disease received cementless total hip replacement with a Ribbed hydroxyapatite-coated proximally femoral stem and cup component. There were 14 males and 10 females with the average age of 59.4 years. The disorders included avascular necrosis of the femoral head in 13 cases,femoral neck fractures in 9 cases,hip dysplasia in 2 cases. X-ray scans were recorded at 7~10 days,6 month,and every 1 year after operation respectively. Harris score was evaluated at last follow-up for hip joint function evaluation.[Result]According to Harris evaluation,16 cases (18 hips) received 85-100 points,8 cases (8 hips) received 75-84 points. Mild thigh pain happed in 1 case. Slight bone absorption was found in 1 case. No case needed second revision. Six month-3 year postoperative X-ray showed bone absorption in Gruen zone 5,6 and 2,3 near HA coating in 1 case (1 hip). Bone density increase was found in both cancellous and cortical bone,which revealed good prosthesis-bone fixation.[Conclusion]A Ribbed proximally hydroxyapatite-coated femoral stem and cup implant are able to enhance the initial fixation of implants,to accelerate bone in-growth and osseous fixation of the femoral stem and cup component,to seal the interface between the implant and osseous,and to prevent ingress of polyethylene particles which lead to thigh pain and bone absorption. It has showed good long-term results.

Objective To sum up the experience for the treatment of splenic trauma. Methods Data of 129 cases of traumatic splenic rupture from 1984 to 2004 were retrospectively analyzed. Results Conservative management was undertaken in 17 cases, splenorrhaphy in 16 cases, total splenectomy in 86 cases, partial splenectomy in 8 cases, and splenic autotransplantation in 23 cases. The results were all satisfactory. Conclusion In splenic trauma, treatment modality should be on adopted case to case basis according to the types of splenic rupture. Combined splenic salvage can be used on certain conditions.

BACKGROUND:Tissue-engineered biomaterials have the similar structure and function with autologous tissues. OBJECTIVE:To explore the osteoinduction of the bone biomaterial composited with rat bone marrow mesenchymal stem cel s in the treatment of large costal defects. METHODS:Forty Wistar rats were enrol ed used for the preparation of right large costal defect models, and then randomized into two groups, fol owed by the implantation of calcium chloride-sodium alginate gel (control group) or chloride-sodium alginate-bone marrow mesenchymal stem cel s (experimental group). At 2, 4 and 8 weeks after implantation, chest X-ray radiograph and histological examination of the defect region were conducted. RESULTS AND CONCLUSION:X-ray showed that in the experimental group, the defect area had no significant changes at the 2nd week after implantation until the formation of few bones at the 4th week;and at the 8th week, both ends of the defect region gradual y connected, and newly formed bones were ful of the defect. In contrast, the defect region in the control group showed no obvious bone healing, and both ends of the defect closed and osteosclerosis occurred. In the experimental group, there were a smal amount of fibrous tissues and numerous inflammatory cel s infiltratied in the material compartment, and no connection occured between the material and broken ends;there were numerous inflammatory cel s but no bone tissues in the control group at the 2nd week. At the 4th week, the scaffold degraded gradual y and abundant bone tissues were seen in the experimental group;the scaffold degraded little, and bone tissues aggregatied at the both defect ends in the control group. Up to the 8th week, the two kinds of scaffolds degraded mostly. A large number of bone tissues and trabeculae formed and the both defect ends were connected with the newly formed bones in the experimental groups, while in the control group, osteosclerosis appeared at both ends of the defect. To conclude, the bone biomaterial composited with rat bone marrow mesenchymal stem cel s promotes the repair of large costal defects.

Breast cancer metastasis suppressor gene 1 (BRMS1) significantly reduces the invasion and metastasis of cancer cells.BRMS1 gene expression is decreased or deleted in the cells of various malignant tumors.BRMS1 gene can inhibit tumor cells invasion and metastasis by means of regulating gene transcription and protein translation by phosphoinositide signaling and nuclear factor-κB (NF-κB) signaling pathways,repairing intercellular communication and interacting with the mSin3-histone deacetylase (HDAC) complex,estrogen receptor and other proteins.BRMS1 gene may be a new target for the gene treatment of tumor metastasis.

In this paper, we propose an image-based key frame gating method to reduce motion artifacts in intravascular ultrasound (IVUS) longitudinal cuts. The artifacts are mainly caused by the periodic relative displacement between blood vessels and the IVUS catheter due to cardiac motion. The method is achieved in four steps as following. Firstly, we convert IVUS image sequences to polar coordinates to cut down the amount of calculation. Secondly, we extracted a one-dimensional signal cluster reflecting cardiac motion by spectral analysis and filtering techniques. Thirdly, we designed a Butterworth band-pass filter for filtering the one-dimensional signal clusters. Fourthly, we retrieved the extremes of the filtered signal clusters to seek key frames to compose key-frames gated sequences. Experimental results showed that our algorithm was fast and the average frame processing time was 17ms. Observing the longitudinal viewpictures, we found that comparing to the original ones, the gated sequences had similar trend, less saw tooth shape, and good continuity. We selected 12 groups of clinical IVUS sequences [images (876 +/- 65 frames), coronary segments length (14.61 +/- 1.08 mm)] to calculate vessel volume, lumen volume, mean plaque burden of the original and gated sequences. Statistical results showed that, on one hand, both vessel volume and lumen volume measured of the gated sequences were significantly smaller than those of the original ones, and there was no significant difference on mean plaque burden between original and gated sequences, which met the need of the clinical diagnosis and treatment. On the other hand, variances of vessel area and lumen area of the gated sequences were significantly smaller than those of the original sequences, indicating that the gated sequences would be more stable than the original ones.
Algorithms ; Artifacts ; Heart ; Humans ; Motion ; Ultrasonography, Interventional

Objective To amplify the 16S RNA fragments of 7 clinically isolated strains of Brucella spp. by PCR-RFLP technique, so as to provide experimental basis for the studies on diagnostics, genetics and epidemiology of Brucella spp. Methods According to the gene sequence of ATCC 25840 standard strain in GenBank, special primers for the 16S RNA conservative area in the Brucella spp. were designed. DNA extraction and PCR amplification of the 16S RNA fragments were performed with the 7 isolated strains. PCR products were then sequenced and RFLP analysis was conducted with appropriate restricted enzymes to study the homology and the mutation sites in those strains. Meanwhile, the clinical data of infected patients were retrospectively analyzed to evaluate the relationship between the clinical features and genotypes of Brucella infection. Results The amplified target fragments were about 1500bp in length and consistent with what was expected. The sequencing and homology analysis showed a 98.88% homology and 11 mutation sites among the 7 isolated strains. Four genotypes were identified by RFLP. Retrospective analysis of the clinical data indicated that no obvious relationship existed between the genotypes and the clinical features. Conclusions Amplifying 16S RNA fragments by PCR technique is a feasible method to make an early diagnosis of Brucella infection. The 7 clinically isolated strains are different in genotypes and 16S RNA fragment is a highly conservative fragment in bacterial genome with some mutations. The research provides evidence for the genetics and epidemiology of brucellosis.