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

Objective:To study influence of type 2 diabetes mellitus (T2DM) on coronary artery lesion and plaque sta‐bility using optical coherence tomography (OCT) in patients with coronary artery disease (CAD) manifesting unsta‐ble angina pectoris (UAP) . Methods :A total of 200 patients diagnosed as CAD manifesting UAP were selected.According to complicated with diabetes mellitus or not ,they were divided into normal blood glucose group (n=98) and complicated T2DM group (T2DM group ,n=102). Coronary angiography (CAG) and OCT were used to eval‐uate coronary artery lesion ,assess plaque nature and measure the thickness of plaque fibrous cap in order to confirm plaque stability . Results:Compared with normal blood glucose group ,there were significant rise in percentages of multi-vessel coronary disease (48.98% vs. 78.43% ) ,severe artery stenosis (20.57% vs. 40.21% ) ,lipid plaques (25.00% vs. 39.84% ) and plaques with fibrous cap thickness <65μm (25.93% vs. 45.24% ) in T2DM group , P<0.05 or < 0.01 .Conclusion :Patients with coronary artery disease have more severe coronary artery lesion and high ‐ er incidence rate of multi‐vessel coronary disease and unstable plaque when complicated with type 2 diabetes mellitus .

Objective:To assess the compliance and efficacy of mirtazapine or armitriptyline in the maintance treatment of depression. Methods:60 depressive outpatients were randomly allocated to two groups treated with mirtazapine or armitriptyline for 52 weeks. Before treatment and at the ends of 12 weeks and 52 weeks of treatment, to assess the efficacy using the Hamiltion Depression Scale (HAMD)and Clinical Global Impression(CGI),to assess the compliance and the adverse-effects using the Hamilton Depression Scale (HAMD)and Clinical Global Impression(CGI),to assess the compliance and the adverse-effects using Treatment Emergent Symptom Scale (TESS).Results:After 12 weeks, significant improvement was observed respectively in the two groups(P

Adult ; Female ; Gastritis ; therapy ; Humans ; Male ; Massage ; Middle Aged

Objective To determine the safety location of the bony tunnel in reconstruction of the coracoclavicular ligaments on the basis of digital characterization of the anatomy of the clavicle and coracoid process.Methods Unilateral shoulder spiral CT scan was conducted in 30 patients without injury to the clavicle or coracoid process.They were 15 men and 15 women,aged from 20 to 71 years old (average,49.3 years).Thirty 3D digital models of the clavicle and coracoid process were constructed using the CT scan data by Mimics13.0.Half of the models were of the left shoulder and half of the right.Anatomic measurements of the clavicle and coracoid process were carried out on these models.Virtual transclavicular-transcoracoid bony tunnels were established according to the anatomy of the conoid ligament.Parameters of these bony tunnels were measured before the safety location was calculated.Results The mean clavicular length was 147.70 ± 5.34 mm in males and 133.09 ± 6.61 mm in females; the distance between the lateral edge of the clavicle and the center of the conoid tuberosity (CCD) was 35.90 ± 3.16 mm in males and 30.48 ± 0.54 mm in females; the distance between the lateral edge of the clavicle and the center of the trapezoid tuberosity (CTD) was 22.68 ± 1.23 mm in males and 18.69 ± 1.65 mm in females,with significant differences between genders (P ＜ 0.05).There were no significant differences between male and female regarding the ratio of the CCD to the clavicular length,the ratio of CTD to the clavicular length,or the mean internal rotational angle of the coracoid process (P ＞ 0.05).According the attachments of the conoid ligament on the clavicle and coracoid,from the superior-posterior edge of the clavicle to the anterior midpoint of the coracoid basement,the bony tunnels were established.These tunnels nearly bisected the cross section of the clavicle and coracoid basement,35.23° ± 2.36° medially inclined to the sagittal section and 5.91° ± 2.14° posteriorly inclined to the coronal section of the body.Conclusions To ensure that the bony tunnel should pass through the center of the clavicle and coracoid,it should be drilled from the superior-posterior edge of the clavicle and located at the clavicular attachment of the conoid ligament,tilting about 35° medially and 6° posteriorly to aim at the anterior midpoint of the coracoid basement.