Health insurance is an important part of social security, and many problems have arisen in the con-struction of its legal system, such as legislative lag, lack of coordination among law enforcement, and serious disloca-tion of judicial relief. Therefore, under the vital time of performing the strategy of “rule by law”, the development and reform of the legal system for health insurance in China should be promoted. On the basis of summarizing the his-torical development of the legal system for health insurance in China, this paper proposes solutions such as centrali-zing legislative upgrades and expediting the process of unitary and special laws from the perspective of“rule by law”. The system of personal credit should be established and judicial transparency should be promoted to improve the legal system for health insurance.

Objective:To effectively improve the health insurance security level of urban-rural residents and of-fer corresponding policy recommendations, the paper makes an empirical analysis of the security level of China’s ur-ban and rural residents health insurance system( U&RRHIS) . Methods: Frequency distribution and dummy variable regression tests were conducted with Tianjin’s urban-rural residents health insurance database. Results There is a large gap between real rate of reimbursement and policy rate in U&RRHIS;many factors have significant impacts on the real rate of reimbursement, including deductible tables, nominal rates of reimbursement, the age of the insured, insurance payment levels, medical expenses, medical institution classifications, etc. Conclusion:In order to improve the real rate of reimbursement for the insured, more attention should be paid to the real rate of reimbursement which is an important index of health security levels for health insurance policy adjustments; meanwhile, efforts should be made in terms of implementation, for instance, criteria should be established for an evaluation of the gap between the real rate of reimbursement and the policy rate of reimbursement, while medical insurance policies should be refined and a scientific and laddered policy rate of reimbursement should be established; moreover, the government’s finan-cial input in healthcare should be increased and the medical insurance system should be improved.

Objective To know the drinking water quality in the rural areas in Fujian Province in order to provide the scientific basis for water improvement in the rural areas.Methods Fourteen counties were selected in Fujian,2004,10 monitoring sites in each county based on the population proportion of different drinking water types.Sixteen indicators were determined for every water sample.Results In the 14 investigated counties,38.71% of total population drinking water supplied with surface water,and 61.29% with ground water source.Drinking water from centralized water supply system was supplied to 58.24% of total population.The qualified rate of water samples was 26.39% for total 288 water samples,35.38% for surface water samples and 18.99% for ground water samples respectively.The hygienic state of surface water was much better(P

Objective To investigate the effect of Ulinastatin preconditioning on hyperthermia induced rat skeletal muscle injury and the possible mechanism. Methods Cultured skeletal muscle cells were divided into 7 groups: control group (Group C), as normal culture; hyperthermia treated group (Group H), in which cells were exposed to 42℃for 2 hours then transfered to normal culture; ulinastatin preconditioned group (Group U), which were only preconditioned 1 hour by the final concentration of ulinastatin at 1 250 U/mL; and four different concentration of ulinastatin preconditioned+hyperthermia treated groups (Group Ⅰ, Ⅱ, Ⅲ, Ⅳ), in which cells were preconditioned 1 hour by the final concentration of ulinastatin at 312 , 625, 1250, 2 500 U/mL, respectively. And then, all the four groups were exposed to 42℃for 2 hours. MTT assay and LDH leakage were performed to study the cytotoxicity. Superoxide dismutase (SOD) activity and malondialdehyde (MDA) formation were measured to reflect the activity of antioxidase. Results Compared with Group H, MTT value in ulinastatin preconditioned group in GroupⅠ, Ⅱ,Ⅲ, Ⅳsignificantly increased (P<0.05) LDH leakage significantly decreased (P<0.05). And the activity of SOD in cultured cells significantly increased (P < 0.05), the content of cellular MDA was also significantly decreased (P<0.05). But there were no significant difference among Group Ⅰ, Ⅱ,Ⅲ,Ⅳ(P>0.05). Conclusion Ulinastatin preconditioning may have protective effect against hyperthermia induced skeletal muscle injury and it may be related to its ability of inhibiting radical production and promoting radical scavenging.

Objective To observe the treatment response and potential issues related to antiretroviral therapy (ART) in pediatric patients with acquired immunodeficiency syndrome (AIDS) and to provide a basis for revising the treatment guideline and improving the clinical practice. Methods Children eligible for ART according to the current treatment guideline were recruited from Dehong area. Enrolled patients were provided with ART and followed up for regular clinical check and laboratory tests. Results By the end of March 2009, a total of 70 children had received ART. Among them, 60 patients were treated with regimen including zidovudine (AZT)+ lamivudine (3TC)+nevirapine (NVP). Twelve, eighteen, twenty-three and nineteen patients have tested for HIV viral load after 3 month, 6 month, 12 month and 18 month treatment, respectively. Among them, 7, 12,14 and 14 patients respectively achieved HIV viral load lower than 1000 copy/mL. Average CD4+ Tlymphocyte count increased from (317.8±288.8) × 106/L at baseline to (1037.2±1086. 1) × 106/Lafter 18 month treatment. Side effects mainly occurred within the first 3 months of treatment. Nearly 50% of children had gastrointestinal symptoms. Resistance to 3TC, NVP and efavirenz (EFV) were found in five patients who have completed 12 months of treatment. Conclusions Pediatric AIDS patients show good compliance and treatment response to ART. Most side effects happen in the first 3months of treatment and the most common side effects are gastrointestinal symptoms.

Objective To assess the clinical and pathological feature of patients with livedo vasculitis.Methods Clinical data were collected from 47 patients with livedo vasculitis,and retrospectively analyzed.All the patients were classified into three groups according to treatment strategy:anticoagulation group,anticoagulation + corticosteroids group,and anticoagulation + sulfasalazine group.Results Clinically,livedo vasculitis usually began as petechia or ecchymosis,edema with distending pain,followed by spotty necrosis which subsequently evolved into vermiculated ulcers and,finally,atrophie blanche.Pathological features included fibrinoid degeneration of and thrombus formation in small vessel walls within the superficial or deep dermis,as well as a sparse lymphocytic infiltrate around the injured vessels.The average time to onset of action of administrated drugs was (9.14 ± 3.48),(5.62 ± 1.04) and (8.23 ± 2.68) days,and time to remission was (2.57 ± 1.41),(4.06 ± 1.51) and (5.64 ± 1.32) months,in the anticoagulation group,anticoagulation + corticosteroids group and anticoagulation + sulfasalazine group,respectively.Conclusion Anticoagulation in combination with anti-inflammatory therapy appears to have a more rapid onset of action in the treatment of livedo vasculitis with a reduced recurrence rate compared with anticoagulation therapy alone.

Objective To evaluate the clinical value of the modified nerve-sparing open antegrade retropubic radical prostatectomy (MNS-ORP).Methods MNS-ORPs were performed in 30 patients with clinically localized prostate cancer.The modified technique included: endopelvic fascia was not incised, the prostate capsule was freed laterally from surrounding fasciae and dorsally;using the method of separating the peripheral fascia of the prostate, the Veil technique was applied to the open operation, that is, the modified Veil perserving nerve technology;pelvic lymph node dissections (9 regions and 5 groups) were extended;bladder neck preservation was completed;deep dorsal vein complex was bunched;jumper intussusception technology was applied for bladder and urethral anastomosis.Functional outcomes of continence and sexual function (IIEF-score) were followed-up.Results Median age of patients was 62 years old, and the level of PSA was 11.9 ng/ml.Median operating time was 150 minutes (75-240 minutes), blood loss was 350 ml (100-1 600 ml), preoperative IIEF-score was 21 scores (15-25 scores).Pathologic stage included pT1 (8 cases), pT2a (15 cases), pT2b (4 cases) and pT3a (3 cases).By Gleason score, there were 2 cases of 5 scores, 7 cases of 6 scores, 20 cases of 7 scores and 1 case of 8 scores.4 cases had positive margins including 2 cases (10.5 ％) of pT2 and 2 cases (67 ％) of pT3.There were no postoperative complications.Mean follow-up was 19 months (6-48 months).At the 1st month, 27 patients (90 ％) got full continence, and at the 3rd month, all of the patients had full continence.At the 3rd month and the 6th month, median IIEF-scores were 13 and 19 scores, respectively with baseline of IIEF-score reaching by 40 ％ (at the 3rd month) and 70 ％ (at the 6th month) of preoperative level.Conclusions MNS-ORP follows rationales of radical prostatectomy and might be considered for selected patients.Preserving all periprostatic fasciae/nerves can recover early continence and maintains potency without affecting outcomes.

Objective To analyze oncological outcomes of 125I permanent implant brachytherapy (125I-PIB) in clinically localized prostate cancer. Methods Between June 2008 and June 2015, 121 patients with clinically localized prostate cancer were treated with 125I-PIB, and their average age was 72.37 years old. Before treatment, the average prostate-specific antigen (PSA) level was 17.7 ng/ml, prostate volume was (51.4 ±15.0) cm3, the International Prognostic Scoring System (IPSS) score was (21.6 ±2.4) scores. The intermediate-risk and high-risk patients were treated with adjuvant endocrine or supplemental external beam radiotherapy. All patients were followed-up. Biochemical recurrence was defined as the PSA nadir plus 2.0 ng/ml. Results Average follow-up time of the 121 patients was 41.81 months. The prostate volume was (23.1 ± 10.2) cm3, and the IPSS score was (9.7±3.3) scores. Rates of 5-year overall survival, biochemical recurrence-free survival and cancer-specific survival were 86.7 %, 76.7 % and 96.5 %, respectively. 5-year biochemical recurrence-free survival rates were 88.5 %, 67.5 % and 65.2 % in the low-, intermediate-, and high-risk groups, respectively. Biochemical recurrence-free survival did not differ significantly by three risk groups (P=0.103), but the difference between high-risk and low-risk groups was statistically significant (P=0.028). According to multivariate analysis, higher prostate-specific antigen (P=0.021), higher Gleason score (P=0.023) and higher clinical T stage (P=0.037) were the significant covariates associated with biochemical recurrence-free survival. The addition of hormonal therapy or external beam radiation therapy was associated with significantly better outcomes than brachytherapy monotherapy (P=0.036, P=0.027). As for complications, there were 4 cases of surgery (trans-urethral resection of the prostate) and 4 cases of cardiovascular complications. Conclusions The 125I-PIB can bring excellent oncological outcomes and acceptable complications in patients. Adjuvant endocrine or external beam radiotherapy for the intermediate-risk and high-risk patients may improve the outcome. Factors influencing efficacy include the high PSA, Gleason score and clinical T stage.

Objective To evaluate the efficacy of 1-stage urethroplasty using pedicle circular fascioctaneous preputial flap for the treatment of complex anterior urthral strictures.Methods Between January 2006 and January 2013, 37 patients with complex anterior urethral stricture were treated by 1-stage urethroplasty using pedicle circular fascioctaneous preputial flap.The mean age was 41 years ( 22 -71 years) .The etiology of stricture included trauma of 13 cases, iatrogenieity of 13 cases, gonorrhea infection of 2 cases, unknown reason of 9 cases.The penile urethral stricture was found in 22 cases, the bulbourethral stricture in 9 cases, and stricture extending from penile to posterior urethra in 6 cases.The mean length of anterior urethral stricture was 8.1 cm (range 5.0-14.0 cm).A circumferential island of the preputial/distal penile skin was mobilized by the technique of preserving penile fasciocutaneous wide vascular pedicle. The pedicle is composed of two layers of the dartos and the superficial lamella of Buck′s fascia, and the flap was divided in the midventral/middorsal plane back to the penoscrotal junction to convert the circular configuration to a longitudinal trip for urethral reconstruction.The dorsal and ventral inlaid flap urethroplasty was performed in 27 cases and tubularized flap urethroplasty was performed in 10 cases.Results The mean operative duration was 3.1 h (2.5-3.5 h).The mean length of the circular fascioctaneous preputial flap was 10.4 cm (range 9.0 -14.0 cm).All the patients were followed up for mean 22 months (3 -51 months).Thirty-two cases voided well and the mean peak urinary flow rate was 22.3 ml/s (15.0-29.0 ml/s).One-stage healing achieved in 32 cases (86.5%).Recurrent stenosis was noted in 4 cases, and meatal stenosis occurred in 1 patient, who required re-operation.Re-repair succeeded in 4 cases and total success rate was 97.3% (36/37).Conclusions The pedicle circular fascioctaneous preputial flap has advantage of good blood supply and autograft for new meatus.It could be a reliable and durable method for the treatment of complex anterior urthral strictures(≥5 cm) in 1-stage urethroplasty.

Objective To explore the application and early efficacy of modified Veil nerve-sparing technique during laparoscopic radical prostatectomy(LRP).Methods Fifty-seven modified Veil nerve-sparing during LRP procedures were performed in patients with clinically localized prostate cancer between 2012 and 2016 by the same surgeon.Preoperative PSA level was 10.9 μg/ml,and Gleason score was 6.06(5-8).TNM clinical stage showed cT1 in 39 cases and cT2in 18 cases.All patients underwent transrectal ultrasonography before operation. Prostate volume was 40.2 (26- 99) ml. ECT bone scan excluded bone metastasis.MRI or CT examination showed no obvious prostate invasion and lymph node metastasis. The key technology was anatomical separation of detrusor apron, dorsal vascular complex (DVC) and the level between the prostate capsule, and a complete reservation was accomplished. Measurements: the rates and location of positive surgical margins (PSM) and tumor biochemical recurrence rate as well as functional outcomes were presented.Questionnaires were used to assess urine function and IIEF-5 score was used to estimate sexual function.Results Fifty-seven cases were followed up,and the average follow-up of 27.3(6-65)months.Five cases showed biochemical recurrence after 23 months.Five patients had a PSM(2 patients in apical margins,1 patient in left side,1 patient in right side and 1 patient in the bottom).At catheter removal,49 of 57 patients(86%)were dry(0 pads),and 8 of 57 patients(14%)needed one security pad.After 3 months and 6 months,42%(24 of 57 patients)and 60%(34 of 57 patients)presented an International Index of Erectile Function score>15(with or without phospho-diesterasetype-5inhibitors). Conclusions The modified Veil nerve-sparing technique during LRP can retain the fascia around the prostate more completely and restore postoperative urine and erectile function early.For selective cases, it will not increase the positive rate of surgical margins and biochemical recurrence rate.