This paper reviews the long-term care policy in Japan and discusses successes and challenges in order to provide policy guidelines for China. All Japanese adults aged 65 or over are covered by the long-term care in-surance ( LTCI) program and are eligible for both in-home and institutional-care services following a thorough, sys-tematic care certification process. The program is financed by a mix of general tax revenues from the three levels of gov-ernment , income-tested premiums, and standardized co-payments. A key success of the policy is its universal and compre-hensive coverage. Notwithstanding this success, increasing costs remain a challenge as Japan’s population ages and the number of LTCI users increases. Learning from the experience of Japan, China should establish a long-term care system, which covers all the aged population, mainly focuses on in-home care, and qualifies social funding to invest.

BACKGROUND:Incidence of diabetic lower extremity vascular disease is increasing, so how to improve blood vessels of the lower limbs and increase angiogenesis becomes the research focus. Umbilical cord mesenchymal stem cells have been employed clinical y via local intramuscular injection, but the specific therapeutic effect and mechanism are not clear.
OBJECTIVE:To investigate the effects of hypoxic preconditioning and cobalt chloride medium on the differentiation of umbilical cord mesenchymal stem cells into vascular endothelial-like cells in vitro.
METHODS:Umbilical cord mesenchymal stem cells were isolated and cultured, and then treated with different concentrations of cobalt chloride. Enzyme linked immunosorbent assay was used to detect levels of basic fibroblast growth factor and vascular endothelial growth factor gene in cellsupernatants, and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide to detect cellproliferation. The safety of umbilical cord mesenchymal stem cells before and after cobalt chloride induction was detected using chromosome. The umbilical cord mesenchymal stem cells were cultured in Dulbecco’s modified Eagle’s medium/Ham’s nutrient mixture F-12 containing 10μg/L vascular endothelial growth factor, 10μg/L basic fibroblast growth factor and 10%fetal bovine serum, which were induced to differentiate into vascular endothelial-like cells. Endothelial-like cellphenotype CD31 and von Wil ebrand factor were identified before and after induction, through the observation of three-dimensional model of angiogenesis, the angiogenic capacity of umbilical cord mesenchymal stem cells was determined.
RESULTS AND CONCLUSION:Umbilical cord mesenchymal stem cells strongly expressed the surface marks. After the cobalt chloride induction, the proliferation of umbilical cord mesenchymal stem cells was positivelycorrelated with the time of induction. Based on the levels of vascular endothelial growth factor and basic fibroblast growth factor, the optimal concentration of cobalt chloride was 200 μmol/L. Chromosome detection showed the stability of cells after cobalt chloride induction. After induction, CD31 and von Wil ebrand factor were strongly expressed. Three-dimensional observation showed umbilical cord mesenchymal stem cells could be induced to form the lumen-like structure with different diameter sizes, and umbilical cord mesenchymal stem cells could be induced to differentiate into endothelial-like cells, and have a angiogenic capacity.
RESULTS AND CONCLUSION:Umbilical cord mesenchymal stem cells strongly expressed the surface marks. After the cobalt chloride induction, the proliferation of umbilical cord mesenchymal stem cells was positivelycorrelated with the time of induction. Based on the levels of vascular endothelial growth factor and basic fibroblast growth factor, the optimal concentration of cobalt chloride was 200 μmol/L. Chromosome detection showed the stability of cells after cobalt chloride induction. After induction, CD31 and von Wil ebrand factor were strongly expressed. Three-dimensional observation showed umbilical cord mesenchymal stem cells could be induced to form the lumen-like structure with different diameter sizes, and umbilical cord mesenchymal stem cells could be induced to differentiate into endothelial-like cells, and have a angiogenic capacity.

By studying the academia criterion of the first hospital affiliated of wenzhou medical univertisy full-time graduate,result display that part of the graduate student academic criterion consciousness is faint,lack of academic criterion related knowledge,academic anomie behavior sometimes appear,Supervisor is partly absent from academic criterion guide.Aiming at this situation,University should strengthen the education of Supervisor,improve the system of rewards and punishment,purify academic atmosphere,promote graduate degree of academic criterion.

Objective:To analyze the status quo and problems of the health human resources of township health center.Methods:296 township health centers in 18 counties of 6 provinces were selected with typical sampling and workers in the centers as target population.Relative administrative officials and directors of township health centers were interviewed.Descriptive analysis and thematic analysis were conducted with quantitative data and qualitative da-ta.Results:The volume and distribution of human resources in township health centers are not balanced and the allo-cation standard of the middle area is low.The null establishment and the employees out of establishment coexist.The allocation of health human resources inside township health centers is not reasonable and the ratio of health profes-sionals is lower than national standard.The rate of senior professionals is low.That health workers are out of stock is a potential problem in some counties.Medical education is not matched with the demand of township health centers.The recruitment policy is inappropriate and the remuneration of health professionals is low.It is difficult for the worker in township health centers to get professional promotion.Recommendations:The structure of workers in township health centers and the recruitment policy should be adjusted.The path of professional promotion should be clear in order to ex-pand the space of career development of workers in township health centers.Improving the remuneration of workers in township health centers should be considered to increase the attractiveness of the post in township health centers.

Objective:To Compare the operational status of the New Rural Cooperative Medical Scheme( NCMS) in 14 Counties of 6 provinces. Methods:Two provinces were selected from eastern, central and western areas respec-tively and then two counties were chosen randomly from each province, but each of Jiangsu and Guangxi Provinces pro-vided 3 to reach the sample number of 14 counties. Excel 2007 was used for descriptive and comparative analysis of fund and in-patient service for NCMS. Results:The average funding standard was about 300 and 350 Yuan for 2012 and 2013. Hospitals outside county were frequently used and the ratio was over 40% in county I. Except Jiangsu and An-hui, the rate of enrollees who get compensation for inpatient service was over 10% and the actual compensation rate more than 50%, Fujian being an exception. Average hospitalization costs per time were different among counties and significantly rose in 2013. The ratio of out of pocket inpatient service expenses to the net rural household income was diverse among counties and it declines in some of them in 2013. The rate of fund for hospitals outside county was high and that of G counties was more than50%. The fund surplus rate was negative in that same year and was accumulatively ranging between 1 and 2%. Conclusions:The NCMS financing level was low and the personal financing responsibility was lighter;the enrollees didn’t contribute enough. In-patient service utilization structure was not rational in different level hospitals. The actual compensation rate for inpatient service didn’t increase a lot and the medical expenses burden didn’t alleviate apparently. The funds supervision was weak and it probably leaded to a high risk fund deficit.

Objective: To analyze the current status of village health worker practice and their remuneration in six provinces. Methods: After 18 counties (cities/districts) from 6 provinces are selected based on their levels of economic and social development, this paper uses self-designed questionnaires to survey all village clinics under the jurisdiction of these 18 counties. Results: The average numbers of village health workers range from 6. 79 to 19. 05 per 10,000 rural populations and 1. 36 to 3. 24 per village. In some provinces, more than 20% of the village health workers are 60 years old, and the educational level of more than 50% is technical secondary school and they have village health worker prac-ticing certificates only. The coverage ratio of medical malpractice liability insurance among village health workers in two western provinces is less than 11%. Except Jiangsu province, village health workers in the other five provinces have mainly joined the New Rural Pension Scheme ( NRPS) . Jiangsu province ranks the highest in subsidies for the services of public health and essential medicines per village health workers, and Fujian province ranked the lowest. Village health workers who are included in the administrative staffing management of township health centers account for less than 20%. Except Jiangsu province, more than 70% village health workers provide 24-hour service. The number of the outflow personnel is higher than the number of the inflow. Conclusions and Suggestions:The problem of village health worker aging is getting worse. Their education level, practicing quality and remuneration are low. This paper suggests the government not only improve the practicing quality and define the legal status of village health workers, but also in-crease the remuneration, incentives and job satisfaction of village health workers Further studies should be conducted in order to put forward a more practical advice about how to attract more health workers in rural areas.

Setting Li Dai Zhong Yao Pao Zhi Zi Liao Ji Yao as clue, this article searched each edition of China Pharmacopoeia, National Processing Standard of Traditional Chinese Medicine issued in 1988, and relevant materials of local processing standards and modern processing study, and concluded and combed the contents about Asari Radix et Rhizoma processing in ancient and modern literature. There are records about Asari Radix et Rhizoma processing methods in history, including net processing, cutting processing, heating processing and processing excipient. However, Asari Radix et Rhizoma processing methods in modern time are relatively simple. In addition to the version of the Processing Standard of Traditional Chinese Medicines in Shanghai issued in 2008, containing the honey Asari Radix et Rhizoma, other editions of China Pharmacopoeia and processing standards only recorded net processing and cutting processing. Recent research showed that processing methods of modern stir frying processing, alkali processing, wine processing, low temperature ultrafine comminution processing and so on, can effectively reduce the toxicity of Asari Radix et Rhizoma and enhance the safety of clinical application. This article summarized the history and research progress of Asari Radix et Rhizoma processing, and provided a reference for the study on modern processing.

Objective To summarize the perioperative nursing of acute intracranial arterial occlusion treated with mechanical thrombectomy with Solitaire AB stent.Methods Fifty-three cases of acute intracranial arterial occlusion were treated with mechanical thrombectomy with Solitaire AB stent.Before the operation,emergency green passage was established and after the operation,the nursing measures included close observation of conditions,intensified basic nursing,control and management of blood pressure and medication,prevention from the complications by reperfusion injury and early rehabilitative training.Results The mechanical thrombectomy with Solitaire AB stent was successful for all the 53 patients.The occlusions in the blood vessels of 44 cases were fully removed and those in 9 cases were partially removed,3 treated with stent for stenosis.Conclusion The nursing points for acute intracranial arterial occlusion treated with mechanical thrombectomy with Solitaire AB stent include preoperative effective preparation, close observation of the disease conditions such as changes in their consciousness and blood pressure,prevention from reperfusion injury and early rehabilitative training.

BACKGROUND: Guided tissues regeneration (GTR) has been successfully used in the treatment of periodontal diseases by using biocompatible membrane to prevent tooth epithelial cell growing towards root and to facilitate the formation of a certain gap which is favorable for periodontal membrane cells to occupy the surface of the root, thereby to rebuild the peridental structure. OBJECTIVE: To verify whether GTR can promote the repair of periodontal bone defect and the formation of new bones and whether combined use of GTR membrane, artificial bone, and growth factors can acquire much more new periodontal tissue. DESIGN, TIME AND SETTING: An animal observation experiment was performed at the laboratory of Medical College of Dalian University between February and July 2006. MATERIALS: Basic fibroblast growth factor (bFGF) freeze-dry powder (50 mg/ampoule) was thoroughly dissolved with ddH2O to prepare 5 g/L bFGF solution, bFGF solution was dropped onto collagen membranes with a size of 10 mm ×10 mm (5 mg bFGFs per piece of collagen membrane). METHODS: Cementum and the alvelor bone 6 mm below the cement-enamel junction were removed to induce periodontal defect in 16 rabbits with big ears. Artificial bone with bFGF and GTR membrane were used to fold around the defect on the right side, followed by reduction and suture, serving as experimental side. The left side underwent identical experimental procedure, with the exception of application of artificial bone with bFGF and GTR membrane, serving as control side. MAIN OUTCOME MEASURES: Carrier material absorption, inflammation of inner connective tissues, and status of junctional epithelium were examined through the use of microscope. RESULTS: The control side exhibited no concrescence, while the expedmental side displayed concrescence of the cementum to various extents. CONCLUSION: Application of GTR membrane, artificial bone, and bFGF can promote the concrescence of damaging bone.

Objective To investigate the modified methods and effects of the flaps with nutrient vessels of superficial vein-cutaneous nerve of lower limb which used for repair of the lower extremity soft-tissues defects.Methods Between December 2003 and September 2009, 18 patients were treated with this modified skin flap, in which 11 cases male; 7 cases were female, age from 5 to 73 years.Average age was 45.9 years.Repair parts: 4 cases of dorsal foot, 3 cases of foot, heel in 2 cases, the ankle weeks in 2 cases, calves under 1 / 3 of 7 cases, of which 8 cases of bone exposure wounds, tendons exposed in 3 cases.Surgical repair of soft tissue defect size of about 6 cm×4 cm-22 cm × 10 cm, which retained the donor sural nerve function retrograde sural nerve flap in 4 cases, with a thin layer of muscle retrograde sural nerve flap in 4 cases.Results All the flaps were survived completely without any complications.The appearance and functional results were satisfactory with following up for 3 to 36 months.18 cases of flap were survived completely, primary healing, without any complications such as vein congestion or engorgement.The 4 cases which remains the cutaneous nerve in site had an average recovery time about 13 days of the donor site.The innervated region of the cutaneous nerve had no acroesthesia or dysesthesia.Conclusion This modified operation methods of flap, enhanced the blood support of the flap, impmved the survive rates and also preserved the sensory function of the patients' donor site.This modified flap with nutrient vessels of superficial vein-cutaneous nerve is a convenient and safe method in repairing lower extremity soft-tissues defects.