Confronted with many problems such as the aged population, increase in the demand for long-term care and financial pressure resulted from the previously defective social security system, after years of efforts, Germa-ny eventually succeeded in putting forward an effective national compulsory long-term care system in 1994 . The sys-tem which is based on the original health insurance system and supports multiple payments involves both local govern-ments and private organizations. Specific rules are clarified in terms of the insurance relations, application qualifica-tions, payment conditions and financial mechanism. Shares and contributions of the long-term care have been in-creased after years of practice. Besides, the number of applicants and beneficiaries is rising. Yet on the other hand, problems and controversies still exist in service quality, qualifications and contents for application and financial mech-anism. Germany’s experience in improving the social security system, the quality management of long-term care and effective control of financial balance serves as a significant reference for China in planning and implementing long-term care insurance system.

Objective To analyze the association between serum uric acid (SUA)level and diabetic peripheral neuropathy(DPN)in the elderly patients with type 2 diabetes mellitus(T2DM).Methods A total of 1 091 cases of elderly T2DM in-and out-patients in our hospital from January 2012 to December 2015 were enrolled in this study.The patients with DPN was diagnosed by neuropathy disability score.All the subjects were divided into two groups according to whether the patients with DPN:NDPN(n=574)and DPN group(n=517).The differences in clinical manifestations and biochemical parameters were compared between the two groups,meanwhile the mobidity rates of hyperuricemia between the two groups were calculated.Logistic regression analysis was used to analyze odds ratios between SUA and the prevalence of DPN.Results The mean serum uric acid of DPN group was(338.79±93.76)μmol/L versus NDPN group's(301.82± 58.94)μmol/L(P＜0.05).The prevalence of hyperuricemia was 20.12％ in DPN group,higher than that in NDPN group(13.24％)(x2 =15.962,P =0.000).Compared with NDPN group,age,duration of diabetes,history of cerebral infarction and the levels of SUA,HbA1C and TG in DPN group were significantly increased,and the levels of eGFR and TBIL decreased(P＜0.05),and there were no significant differences in the other indexes between the two groups (P＞ 0.05).Logistic regression analysis showed that increased SUA level was an independent risk factor for DPN,OR =2.293 (95 ％ CI:1.497-3.824) (P ＜ 0.05).Conclusions It has closely correlation between SUA level and DPN,and SUA is one of the independent impact factors for DPN in the elderly patients with type 2 diabetes mellitus.

OBJECTIVE: To observe the synergetic effect of Xuebijing injection and Cefoperazone Sodium/Sulbactam Sodium for the treatment of patients with sepsis.METHODS: Patients with sepsis were randomly assigned to receive Cefoperazone Sodium/Sulbactam Sodium 3 g bid alone by iv drip(Control Group,75 cases) or in combination with Xuebijing injection(100 mL bid,79 cases) for 7 days.RESULTS: The total efficective rate after 7-day treatment had significant difference between two groups(86.67% in control group versus 94.94% in treatment group,(P

Cervical artificial disc replacement (CADR) as a new method for the treatment of cervical spondylosis, is becoming a basic and clinical research. Compared with the anterior cervical discectomy and fusion (ACDF), the biggest difference of CADR lies in the reconstruction of the cervical vertebra height and physiological curvature, retaining the spinal physiological function maximally and reducing the degenerative changes in adjacent segments. A large number of clinical investigation have suggested that ACDR can become an operation method to replace the ACDF. However, the complications and the problems of prosthesis itself are gradually exposed, such as that the prosthesis, can't completely simulate the biological effects of human intervertebral disc, the other factors and including the operation methods and prosthesis itself. At the same time, the problem that how to prevent complications and problems is required to be solved. Whether, the effect of CADR on the activity of the operation segment, and the prevention of adjacent segment degeneration can be guaranteed for a long time has drawn more and more attention from scholars.
Cervical Vertebrae ; surgery ; Humans ; Postoperative Complications ; etiology ; Total Disc Replacement ; adverse effects

BACKGROUND:Combination of mid-third clavicle fracture with acromioclavicular joint dislocation is a rare injury. The internal fixation treatment of this injury remains controversial.
OBJECTIVE:To investigate the treatment of a rare injury of mid-third clavicle fracture combined with acromioclavicular joint dislocation.
METHODS:Three patients with mid-third clavicle fracture with acromioclavicular joint dislocation from 2005 to 2011 were analyzed retrospectively. The three patients were treated with clavicle anatomic locking plate+wire subcoracoid cerclage, clavicle anatomic locking plate+clavicular hook plate and clavicle anatomic locking plate+dual Endobutton plate coracoclavicular ligament reconstruction, respectively. The treatment effects of these three methods were compared, including the operation time, blood loss, and the shoulder function evaluation.
RESULTS AND CONCLUSION:One case was misdiagnosed as simple mid-third clavicle fracture. Al the three patients were fol owed-up for more than 12 months, and the clavicle fracture healed in al three cases. The internal fixators were moved out at 12, 9 and 11 months, the Endobutton plate was stil in the body, and no redislocation happened in al cases. The pain, daily function, activity and muscle strength were compressively assessed before and after internal fixator removal. The scores of the three patients were 64, 71 and 92 before surgery, and 68, 79 and 95 after surgery. Patient treated with double Endobutton and locking plate had the best recovery. Double Endobutton plus clavicle plate are good choice as internal fixation in the treatment of mid-third clavicle fracture combined with acromioclavicular joint dislocation.

0.05),but costs spent by thymosin and lamivudine combination group was much less(P

BACKGROUND:Treatment of complex tibial plateau fracture is a difficulty in orthopaedic trauma. Comprehensive assessment and appropriate surgical plan before surgery are the key points of surgery.
OBJECTIVE:To investigate the application value of three-dimensional reconstruction and virtual surgical techniques in assessing and surgical planning of complex tibial plateau fracture before surgery.
METHODS:The CT scan data of 30 patients with tibial plateau fracture were imported into the Mimics 13.0 software to establish the three-dimensional digital models of complex tibial plateau fracture, and three-dimensional measurements and reclassification was performed according to three-column classification were made. Virtual surgeries such as bone window operation, reduction of the fracture and bone grafting were made in these models.
RESULTS AND CONCLUSION:Reconstructed three-dimensional digital models of complex tibial plateau fracture could indicate the characteristics of fracture accurately, could be observed at any direction, and could help doctors to reclassify the fracture according to three-column classification. Virtual surgeries of bone window operation, reduction of the fracture and bone grafting made in computer by Mimics 13.0 were confirmed to be vividly simulate the clinical surgery, and helpful in estimating the amount of bone grafting. Three-dimensional reconstruction and virtual surgical techniques play an important role in assessing and surgical planning of complex tibial plateau fracture before surgery, which should be a conventional step in the management of complex tibial plateau fracture.

Objective To investigate the change of P300 of the attention - deficit/hyperactivity disorder children before and after they took litalin, according to this objective subject to guide the clinical treatment of ADHD children. Methods Using the looking se-ducible electricity stimulates 22 ADHD children, and check the change of latency and the rate of the wave before and after they took litalin. Results After ADHD children took litalin, their latency of P300 has decreased clearly, and the amplitude had no change. Conclusion The changes of P300 latency in ADHD children after they took litalin can be adopted as the guidelines of clinical treatment for the ADHD children.

Objective To explore the interactive effect of acupuncture and exercise on severe traumatic brain injury (TBI). Methods 120 comatose patients following TBI after routine surgery were equally divided into combined group (acupuncture and exercise), acupuncture group, exercise group, and control group (neither acupuncture, nor exercise). They were assessed with Glasgow coma scale (GCS),Fugl-Meyer assessment (FMA), modified Brathel index (MBI) and neurological deficit scores (modified Edinburgh-Scandinavia stroke scale, MESSS) before and after the treatment. Results The scores of GCS, FMA, MESSS and MBI improved more in the combined group than in the control group (P<0.05). The scores of GCS and MESSS improved more in the acupuncture group and the exercise group than in the control group (P<0.05). The scores of MESSS improved more in the combined group than in the exercise group (P<0.01). Conclusion Both acupuncture and exercise can synergetically reduce the disability and coma of comatose patients following TBI.

Objective:To summarize the current policies and measures in curbing health corruption in China, and to evaluate the implementation results of these policies and measures.Methods:We made a systematic review to search and screen the literatures, with related thematic information extracted, compared and classified to form an integrated view by the data integration method of thematic synthesis.Results:A total of 147 literatures were included, covering such health policies and measures as the basic drug system, the centralized bidding and purchasing and centralized drug purchasing, the " two-invoice system" , hospital information disclosure system, adverse records of commercial bribery, doctor′s virtue evaluation system and no bribery agreement. These five policies and measures prove effective in curbing the corruption, but some types of corruption tend to evade such restrictions.Conclusions:The five types of policy measures summarized in the study have effectively curbed the high risk exposure of corruptions found in drugs, medical consumables and medical devices, and also guided and restrained the profit-oriented behaviors of the behavior subjects. Stronger measures should be integrated into a broader reform of the healthcare system, in combination with institutional compensation and operational mechanism reform, medical personnel compensation and incentive system, and modern pluralistic governance reform. Meanwhile, studies in the field of corruption need to focus on the direct and indirect effects of multi-level medical reform policies on corruption governance from an integrated perspective, while attention needs to cover more types of corruption behaviors, and to diversify research methods, so as to provide more practical policy support.