Reform on medial service compensation mechanism,as a key point in the heahhcare system reform,runs through the entire reform process.It plays a key role for the establishment and improvement of urban medical care system,medical service system,medical management system and operating system,for its guidance and regulation effects.Such a refonn to build a scientific and perfect compensation model and mechanism will be highly significant for the smooth progress of the new round of healthcare reform and its success in the end.

Heart ; physiopathology ; Humans ; Infant, Newborn ; Long QT Syndrome ; complications ; Male ; Tachycardia, Ventricular ; complications ; Torsades de Pointes ; complications

Computed tomography perfusion imaging can accurately and promptly provide hemodynamic parameters of brain tissues after stroke,and it has a good correlation with the accepted hemodynamic measurement,the parameters got from xenon-computed tomography, functional magnetic resonance imaging and positron emission tomography.Therefore,CTP has been widely used in predicting the studies of ischemic penumbra after stroke.

The prognosis and outcome in patients with intracerebral hemorrhage are closely correlated with perihernatoma tissue injury and recovery.The pathophysiological mechanisms after intracerebral hemorrhage are extremely complicated.There are regional blood flow changes in perihematoma tissues,but whether there is a similar“penumbra”as in cerebral ischemia remains uncertain.At present,studies in this field have mainly focused on the imaging detection of regional cerebral blood flow and metabolism.The study methods frequently used include single photon emission computed tomography,functional magnetic resonance imaging,magnetic resonance spectroscopy,positron emission tomography and CT perfusion imaging,etc.The application of these imaging techniques have provided some valuable methods for identifying whether perihematoma penumbra is present or not,but further studies are needed to confirm it.

Objective To investigate the relationship among ultrafiltration (UF), diurnal rhythm of blood pressure (BP) and cardiac structure and function in hemodialyzed(HD) patients. Method 42 hemodialyzed patients were studied. Intensified UF during routine HD were given to them for 4 weeks. Before and after 4 weeks, everyone received 24 hours ambulatory blood pressure monitoring and cardiac doppler and recorded diameter of left atrium (LAD) ,left ventricle (LVEDD), thickness of posterior wall of left ventricle during end stage of diastolic period (LVPWT) ,thickness of interventricular septum(IVST) ,ejection fraction (EF). Result In hemodialyzed patients, non-dipper hypertension was much more than dippers (P < 0.05). There was significant difference between nocturnal BP and cardiac structure before and after 4 weeks of hemodialysis ( P < 0.05 ). Conclusion Nocturnal hyperten- sion of hemodialyzed patients is related to hypervolemia. Intensive ultrafihration can improve nocturnal hypertension and eardiac function.

Unleashed growth of gross healthcare expenses has emerged a major headache for public administration of countries at large.In China as well,such a rapid growth is incurred mostly by overtreatment due to irrational healthcare compensation.Against this background,it is highly significant to have a brand new insight into over-treatment in China' s viewpoint,and to further study the role of an improved mechanism for primary healthcare compensation for the purpose of curbing over-treatment.These efforts will help improve the primary healthcare service and realize goals of the ongoing health reform.

BACKGROUND:During artificial knee replacement for al kinds of severe knee disease or conservative treatment for end-stage knee disease, Deluxe-PS knee prosthesis and PFC Sigma RP knee prosthesis have their advantages.
OBJECTIVE: To compare and analyze the matching of the Deluxe-PS and PFC Sigma RP knee prostheses with bone cross section.
METHODS:According to the use of the knee prosthesis, 87 gonarthritis patients undergoing bilateral knee replacement were divided into two groups. 46 cases in the test group received Deluxe-PS knee prosthesis replacement. 41 cases in the control group received PFC Sigma RP knee prosthesis replacement. Operation time and intraoperative blood loss were compared between the two groups. American Knee Society score, knee score of American Special Surgical Hospital and knee joint range of motion were used to evaluate knee joint function before replacement, 3 months after replacement and during final folow-up. Anteroposterior X-ray films were obtained after replacement to measure valgus angle and flexion angle of femoral prosthesis.
RESULTS AND CONCLUSION: (1) Operation time and intraoperative blood loss were significantly better in the test group than in the control group (P< 0.05). (2) No significant difference in American Knee Society score, knee score of American Special Surgical Hospital and knee joint motion was detected between the two groups before replacement and 3 months after replacement (P > 0.05). Above indexes were significantly improved in both groups at 3 months after replacement and during final follow-up (P < 0.05). (3) No significant difference in valgus angle and flexion angle of femoral prosthesis was identified between test and control groups during final follow-up (P > 0.05). (4) These findings indicate that effect of Deluxe-PS type artificial knee prosthesis was identical to that of PFC Sigma RP knee prosthesis in knee osteoarthritis patients receiving bilateral knee joint replacement. Deluxe-PS type artificial knee prosthesis can perfectly realize high-accuracy combination of the prosthesis and the bone cross section, and enhance the fusion suitability of the prosthesis and the bone surface. Deluxe-PS type artificial knee prosthesis has the advantage of operation. This advantage is possibly because Deluxe-PS type artificial knee prosthesis is more in line with the anatomical structure of the knee joint of Chinese.

Adult ; Hand Injuries ; surgery ; Humans ; Male ; Occupational Diseases ; surgery ; Paint

OBJECTIVETo perform a meta-analysis on clinical outcomes of minimally invasive percutaneous plate osteosynthesis (MIPPO) or open reduction and internal fixation (ORIF) for distal tibial fractures in adults.

METHODSPubmed database (from 1968 to March 2014), Cochrane library and CNKI database (from 1998 to March 2014) were searched. Case-control study on minimally invasive percutaneous plate osteosynthesis (MIPPO) or open reduction and internal fixation (ORIF) for distal tibial fractures in adults were chosen,and postoperative infection, operative time, blood loss, fracture nonunion rate, delayed union,fracture malunion rate were seen as evaluation index for meta analysis. The system review was performed using the method recommended by the Cochrane Collaboration.

RESULTSTotally 5 studies (366 patients) were enrolled. Meta-analysis showed that there were significant meaning in postoperative infection between MIPPO and ORIF [OR = 0.23,95% CI (0.06,0.92), P = 0.04]; fracture nonunion rate in MIPPO was lower than in ORIF group [OR = 0.16, 95% CI (0.03,0.76), P = 0.02]; operative time in MIPPO was shorter than in ORIF group, and had significant difference [MD = -14.42, 95% CI (-27.79, -1.05), P < 0.05]; blood loss in MIPPO was less than in ORIF group [MD= -87.17,95%CI (-99.20, -75.15), P < 0.05]; there was no obviously meaning in delayed union between two groups.

CONCLUSIONFor distal tibial fractures in adults, MIPPO has, advantages of short operative time, less blood loss, lower incidence of infection and fracture non-uniom, but with high fracture malunion rate. MIPPO for distal tibial fractures in adults is better than ORIF, and the best treatment should choose according to patient's condition.

Bone Plates ; Fracture Fixation, Internal ; methods ; Fracture Healing ; Humans ; Minimally Invasive Surgical Procedures ; methods ; Operative Time ; Tibial Fractures ; surgery

OBJECTIVETo investigate the feasibility of applying three-dimensional printing in the fabrication of facial prostheses cavity.

METHODSThe computer aided design (CAD) model of negative mold of a nasal prosthesis was generated with Magics RP software according to an existed CAD model of the positive pattern of nasal prosthesis (STL file). The negative mold and positive pattern of the nasal prosthesis were fabricated by three dimensional printing. The actual nasal prosthesis was produced by pouring silicon into the negative mold. The actual nasal prosthesis and rapid prototyping (RP) fabricated positive pattern were both scanned with a three-dimensional scanning system. Quantitative measurements of registration errors were calculated to evaluate the surface matching degree between the two models.

RESULTSThe max positive error between the models of the actual silicon nasal prosthesis and the RP-fabricated positive pattern was 0.98 mm. It was located at the apex nasi area, and the max negative error was -0.64 mm.

CONCLUSIONSFacial prostheses cavity direct three dimensional printing can be one of the methods for automated fabrication of the facial prostheses.

Computer-Aided Design ; Face ; Imaging, Three-Dimensional ; Maxillofacial Prosthesis ; Printing, Three-Dimensional ; Prostheses and Implants ; Prosthesis Design ; Software