Objective:To compare and analyze the changes and the influencing factors of out of pocket(OOP) expenditure before and after the new medical reform.Methods:2000-2015 time series data was used to compare the changes of OOP in different years.The cross-section data was applied to compare the OOP of China and other countries.The principle component analysis method was used to research the contribution rates of different factors for the OOP ratio changes.Result:According to the vertical comparison,it found that the OPP ratio showed steady decreasing trend.The horizontal comparison found that there were great gap for OOP ratios of China and other countries.The per capita GDP,under five mortality and proportion over 65 years were significant factors for OOP.Conclusion:The OOP ratio still needed to be devreased,which needed to promote the economic growth,implement medical insurance system,improve the public health input and decrease the health economic burden for residents.

Objective: To compare the clinical efficacy of minimally invasive closed reduction and open reduction and internal fixation in the treatment of ankle fractures. Methods: 133 cases with ankle fractures were selected.They were divided into closed group (65 cases) and incision group (68 cases) according to random table method.The closed group was treated with minimally invasive closed reduction, and the incision group was treated with open reduction and internal fixation.The therapeutic effect, amount of bleeding, time of fracture healing, time of operation and postoperative complications were compared between the two groups. Results: The good rate of the closed group (98.46%) was higher than that of the control group(85.29%, χ²=7.594, P<0.05). The amount of bleeding in the closed group[(19.40±3.56) mL] was less than that in the incision group[(39.84±4.15)mL], the fracture healing time in the closed group[(10.24±2.15)weeks] was shorter than that in the incision group[(15.46±3.67)weeks], the operation time in the closed group[(38.94±8.71)min] was shorter than that the incision group[(59.38±13.25)min](t=30.424, 9.950, 10.462, all P<0.05). The incidence rate of postoperative complication in the closed group (1.54%) was lower than that in the incision group (16.18%, χ²=8.675, P<0.05). Conclusion Minimally invasive closed reduction in the treatment of ankle fractures is better than open reduction and internal fixation, and has important research value.

OBJECTIVETo discuss the probable causes of the post-surgery complications with the intra-artcular fracture of calcaneus, the proper steps for prevention and solution.

METHODSSeventy-one patients (76 injured feet) included 49 males and 22 females aged from 19 to 56 years old (mean 35.6 years). According to Sanders' classification, 23 cases (24 injuried feet) belonged to type II, 36 (38 injured feet) were type III, the remain 12 (14 injured feet) met the criteria of type IV. All the patients received the operation of open reduction, autogenous bone grafting and internal fixation with stainless steel plates.

RESULTSThirteen injuried feet developed early complications. Two injuried feet got the superficial layer of the wound disrupted and infected, I had the deep layer of the wound disrupted and infected. Cutaneous necrosis at the pointed end of the wound occurred in 7 cases. Another 1 developed osteomyelitis. Two cases suffered from sural nerve damage. Two injuried feet developed late complications, both of them suffered from arthritis of talocalcaneal joint. All the patients were followed up at least 6 months (ranged from 6 to 42 months, mean 19 months). According to Kerr's post-surgery evaluation criteria, 34 injuried feet were excellent, 32 were fine, 9 were acceptable, only 1 was bad.

CONCLUSIONIf proper measures are taken, the post-surgery complications of intra-articular fracture of calcaneus will be reduced. This requires us to be strict in selecting operation indication, to make a good plan and preparation, to select a right time for operation, to improve surgical skills and pay more attention to peri-surgery nursing. If complications happen, according measures should be taken in order to get a better outcome.

Adult ; Calcaneus ; injuries ; Female ; Follow-Up Studies ; Foot Joints ; injuries ; Fractures, Bone ; pathology ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology ; prevention & control ; Young Adult

Adult ; Bone Plates ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; instrumentation ; Humans ; Humeral Fractures ; diagnostic imaging ; physiopathology ; surgery ; Male ; Middle Aged ; Radiography

Objective:To investigate the detection rate of motoric cognitive risk(MCR)syndrome and explore the possible risk factors at different age groups.Methods:A total of 561 patients from geriatric outpatient clinic of Hubei Provincial Hospital of Traditional Chinese Medicine from November 2018 to December 2019 were divided into two age groups under 70 years old(n=241)and 70 years old and above(n=320). The general information, Pittsburgh Sleep Quality Index, Geriatric Depression Scale-15(GDS-15), 4-meter walking test, Mini-Mental State Examination and Morse Fall Scale were collected.Patients with MCR were screened out according to the MCR diagnostic criteria.Logistic multiple regression analysis was used to analyze the associated risk factors.Results:7 cases(7/241, 2.9%)met the MCR diagnostic criteria in age<70 years group, and 34 cases(34/320, 10.7%)in age ≥ 70 years group.The proportion of hearing impairment complaints and GDS-15 scores of MCR patients were higher than those of the non-MCR group in age<70 years group, and the Morse Fall Scale of MCR patients was higher than that of the non-MCR group in age ≥70 years old group( P<0.05). After adjusting for associated confounding factors, multiple logistic regression analysis showed that hearing impairment complaints( OR=26.394, P<0.05)and GDS-15( OR=1.385, P<0.05)were independent risk factors for MCR in age<70 years group.And female( OR=0.445, P<0.05)was a protective factor for MCR in age ≥70 years old group. Conclusions:Motoric cognitive risk syndrome has different risk factors in different age groups, which may indicate that the causes and predictive significance of MCR in these two different age groups are different.

OBJECTIVE: To investigate the characteristics of forensic clinical identification on common peroneal nerve injury in traffic accident. METHODS: Eight cases of common peroneal nerve injury in traffic accidents were analyzed, including general condition of the wounded, the way of injury, the imaging results, the EMG results, and the degree of injury, etc. RESULTS: In 8 cases, 2 cases of complete common peroneal nerve injury were determined to grade 9 (disability degree) and 6 cases of partial common peroneal nerve injury were determined to grade 10 (disability degree). CONCLUSION By comparison, the disability degree of complete common peroneal nerve injury is higher than that of partial common peroneal nerve injury. The forensic clinical identification of common peroneal nerve should be made with synthetical consideration of medical history, symptoms, and auxiliary examinations.
Accidents, Traffic ; Adult ; Age Distribution ; Disability Evaluation ; Expert Testimony ; Female ; Fibula/injuries* ; Fractures, Bone/physiopathology* ; Humans ; Leg Injuries/physiopathology* ; Male ; Middle Aged ; Peroneal Nerve/physiopathology* ; Peroneal Neuropathies/physiopathology* ; Radiography ; Trauma Severity Indices

Objective:To explore whether endoscopic surgery can achieve the same effect on thyroid cancer as open surgery.Method:44 cases were selected to endoscopic thyroidectomy with breast areola approach, who were prepared to accept the surgical treatment of thyroid cancer with cT1N0 stages, female, ≤60 years old, no history of neck surgery and beauty desire. Fifty patients with the same conditions undergoing thyroid open surgery were as the control group.Results:Operative time of endoscopic group[ (170.0±28.0) min] was longer than that of the open operation group[ (90.0±21.0) min ( t=15.610, P=0.000) ]. There was no significant difference between the two groups in surgical complications ( P>0.05) . There was no statistical difference between the number of paratracheal and anterior tracheal lymph nodes of endoscopic group (6.0 ±4.2) and open surgery group (5.5 ±3.7) ( t=0.692, P>0.05) . There was no statistical difference between the number of anterior laryngeal lymph nodes of endoscopic group (0.7 ±1.1) and open surgery group (0.5 ±0.9) ( t=1.186, P>0.05) . Conclusion:The breast areola approach endoscopic thyroidectomy is safe and reliable in treatment of thyroid cancer, and the central cervical lymph node dissection is sufficient, which can be used as the choice of operation mode for thyroid cancer patients in cT1N0 stage.

【Objective】 To evaluate the efficacy of sacral neuromodulation (SNM) in the treatment of neurogenic bladder (NB) with Meta-analysis, so as to provide reference for clinical treatment options for NB. 【Methods】 Relevant literatures regarding the efficacy of SNM in treating NB during Jan.2010 and Dec.2022 were collected from the PubMed and CNKI databases, and screened with inclusion and exclusion criteria.After the quality of literatures was assessed, data were extracted and then analyzed using Review Manager 5.3. 【Results】 The research included 14 studies involving 601 patients.Meta-analysis showed that SNM significantly improved urinary frequency (WMD=4.30, 95%CI: 2.84-5.77, P<0.01), daily episodes of urinary incontinence (WMD=2.92, 95%CI: 2.76-3.07, P<0.01), single void volume (WMD=-113.93, 95%CI: -159.91- -67.98, P<0.01), maximum flow rate (WMD=-3.23, 95%CI: -4.04- -2.42, P<0.01), residual urine (WMD=111.79, 95%CI: 79.93-143.64, P<0.01), maximum bladder capacity (WMD=-65.63, 95%CI: -84.38- -46.88, P<0.01), and bladder compliance (WMD=-4.65, 95%CI: -8.75- -0.55, P=0.03). 【Conclusion】 SNM is effective in the treatment of NB, but more randomized controlled trials are needed to verify the efficacy.

Objective To investigate the effects of eicosanoic acid(C20DC)on the proliferation and migration of human retinal endothelial cells(HRECs)and its mechanism.Methods The optimal working concentration of C20DC in human retinal pigment epithelium 19(ARPE-19)cells and HRECs was determined as 30 mg·L-1 and 25 mg·L-1,respec-tively.HRECs were divided into the C20DC treatment group(HRECs treated with C20DC)and the control group[HRECs treated with dimethyl sulfoxide(DMSO)].The effects of C20DC on the migration and proliferation of HRECs were detec-ted by cell proliferation and migration experiments.The molecular docking method was used to simulate the binding ability of C20DC to peroxisome proliferator-activated receptor δ(PPARδ).ARPE-19 cells were divided into the C20DC+ARPE-19 group(ARPE-19 cells treated with C20DC)and the DMSO+ARPE-19 group(ARPE-19 cells treated with DMSO).The ex-pression levels of PPARδ and angiopoietin-like protein 4(ANGPTL4)in ARPE-19 cells and ANGPTL4 protein in HRECs were detected using Western blot.The ANGPTL4 protein expression levels in ARPE-19 cells and HRECs were quantitatively analyzed using enzyme-linked immunosorbent assay(ELISA).Results Compared with the control group,the prolifera-tion and migration of cells in the C20DC treatment group significantly increased(both P＜0.05),and C20DC could stably bind to PPAR8(binding energy:-7.20 kcal·mol-1).Western blot showed that the expression level of ANGPTL4 protein in the C20DC+ARPE-19 group was higher than that in the DMSO+ARPE-19 group,and the difference was statistically sig-nificant(P＜0.05);there was no statistically significant difference in the expression level of PPARδ receptor protein be-tween the two groups(P＞0.05).The expression level of ANGPTL4 protein in the C20DC treatment group was higher than that in the control group,and the difference was statistically significant(P＜0.05).ELISA quantitative analysis showed that the expression level of ANGPTL4 in the C20DC+ARPE-19 group was higher than that in the DMSO+ARPE-19 group(P＜0.001);the expression level of ANGPTL4 in the C20DC treatment group was higher than that in the control group,and the difference was statistically significant(P＜0.05).Conclusion C20DC can promote the expression of ANGPTL4 pro-tein by binding to PPARδ and thus increase the proliferation and migration of retinal related cells(HRECs and ARPE-19 cells).Its mechanism may be related to the increased angiogenesis in retinopathy of prematurity.

This article reviews the current situation, influencing factors, evaluation tools, and intervention measures of sleep disorders in family caregivers of Alzheimer disease (AD) patients, so as to provide reference for improving the sleep quality and quality of life of family caregivers in AD patients.