Objective To analyze the risk factors for gait disorder in patients with developmental dysplasia of the hip(DDH)after total hip replacement.Methods Sixty DDH patients who underwent total hip replacement at The Second People's Hospital of Kunshan from August 2018 to August 2023 were selected as research objects.Of them,19 patients with gait disorders were assigned to observation group,and 41 without gait disorders were taken as control group.Univariate and multivariate logistic regression analyses were conducted to identify the risk factors for gait disorders in DDH patients after total hip replacement.Results There was no significant difference in the gender,age,disease duration,place of residence,educational level,American Society of Anesthesiologists(ASA)grade,surgical time,intraoperative blood loss,Tonnis classification,or symmetrical skin lines on lower limbs between the two groups(P>0.05).But there were significant differences in terms of equal length of lower limbs,anterior pelvic tilt,cerebral small vessel disease,Parkinson disease,and peripheral nerve injury in lower limbs between the two groups(P<0.05).Equal length of lower limbs,anterior pelvic tilt,cerebral small vessel disease,Parkinson disease,and peripheral nerve injury in lower limbs were risk factors for gait disorders in DDH patients after total hip replacement(P<0.05).Conclusion The occurrence of gait disorders is related to the equal length of lower limbs,anterior pelvic tilt,cerebral small vessel disease,Parkinson disease,and peripheral nerve injury in lower limbs in DDH patients after total hip replacement.Symptomatic treatment should be given timely so as to prevent gait disorders and improve the prognosis.

China's healthcare payment reform seeks to combine a medical insurance point-system with a global budget.The focus and difficulty in implementing the payment reform is how to make effectively link.On the basis of theoretical analysis,it selects the regions that have implemented the payment by disease under regional total budget and the payment by disease under institutional total budget,and summarizes the synergistic mechanism of total budget and payment by disease,including the strict control of total budget at the regional level,the reasonable setup of the budget or the standard of expected service volume at the institutional level,and the rate fluctuation and discount mechanism for the settlement of excess service;and further sort out the additional incentive mechanism to support innovation and quality enhancement under the background of the total budget and the payment by disease.Lessons can be drawn from the experiences of typical regions to strengthen the synergy between regional budgets,institutional budgets and payment by type of disease,and cautiously deal with the risks of excessive competition and"punching points"that may arise from the regional point method.

China's healthcare payment reform seeks to combine a medical insurance point-system with a global budget.The focus and difficulty in implementing the payment reform is how to make effectively link.On the basis of theoretical analysis,it selects the regions that have implemented the payment by disease under regional total budget and the payment by disease under institutional total budget,and summarizes the synergistic mechanism of total budget and payment by disease,including the strict control of total budget at the regional level,the reasonable setup of the budget or the standard of expected service volume at the institutional level,and the rate fluctuation and discount mechanism for the settlement of excess service;and further sort out the additional incentive mechanism to support innovation and quality enhancement under the background of the total budget and the payment by disease.Lessons can be drawn from the experiences of typical regions to strengthen the synergy between regional budgets,institutional budgets and payment by type of disease,and cautiously deal with the risks of excessive competition and"punching points"that may arise from the regional point method.

China's healthcare payment reform seeks to combine a medical insurance point-system with a global budget.The focus and difficulty in implementing the payment reform is how to make effectively link.On the basis of theoretical analysis,it selects the regions that have implemented the payment by disease under regional total budget and the payment by disease under institutional total budget,and summarizes the synergistic mechanism of total budget and payment by disease,including the strict control of total budget at the regional level,the reasonable setup of the budget or the standard of expected service volume at the institutional level,and the rate fluctuation and discount mechanism for the settlement of excess service;and further sort out the additional incentive mechanism to support innovation and quality enhancement under the background of the total budget and the payment by disease.Lessons can be drawn from the experiences of typical regions to strengthen the synergy between regional budgets,institutional budgets and payment by type of disease,and cautiously deal with the risks of excessive competition and"punching points"that may arise from the regional point method.

China's healthcare payment reform seeks to combine a medical insurance point-system with a global budget.The focus and difficulty in implementing the payment reform is how to make effectively link.On the basis of theoretical analysis,it selects the regions that have implemented the payment by disease under regional total budget and the payment by disease under institutional total budget,and summarizes the synergistic mechanism of total budget and payment by disease,including the strict control of total budget at the regional level,the reasonable setup of the budget or the standard of expected service volume at the institutional level,and the rate fluctuation and discount mechanism for the settlement of excess service;and further sort out the additional incentive mechanism to support innovation and quality enhancement under the background of the total budget and the payment by disease.Lessons can be drawn from the experiences of typical regions to strengthen the synergy between regional budgets,institutional budgets and payment by type of disease,and cautiously deal with the risks of excessive competition and"punching points"that may arise from the regional point method.

China's healthcare payment reform seeks to combine a medical insurance point-system with a global budget.The focus and difficulty in implementing the payment reform is how to make effectively link.On the basis of theoretical analysis,it selects the regions that have implemented the payment by disease under regional total budget and the payment by disease under institutional total budget,and summarizes the synergistic mechanism of total budget and payment by disease,including the strict control of total budget at the regional level,the reasonable setup of the budget or the standard of expected service volume at the institutional level,and the rate fluctuation and discount mechanism for the settlement of excess service;and further sort out the additional incentive mechanism to support innovation and quality enhancement under the background of the total budget and the payment by disease.Lessons can be drawn from the experiences of typical regions to strengthen the synergy between regional budgets,institutional budgets and payment by type of disease,and cautiously deal with the risks of excessive competition and"punching points"that may arise from the regional point method.

China's healthcare payment reform seeks to combine a medical insurance point-system with a global budget.The focus and difficulty in implementing the payment reform is how to make effectively link.On the basis of theoretical analysis,it selects the regions that have implemented the payment by disease under regional total budget and the payment by disease under institutional total budget,and summarizes the synergistic mechanism of total budget and payment by disease,including the strict control of total budget at the regional level,the reasonable setup of the budget or the standard of expected service volume at the institutional level,and the rate fluctuation and discount mechanism for the settlement of excess service;and further sort out the additional incentive mechanism to support innovation and quality enhancement under the background of the total budget and the payment by disease.Lessons can be drawn from the experiences of typical regions to strengthen the synergy between regional budgets,institutional budgets and payment by type of disease,and cautiously deal with the risks of excessive competition and"punching points"that may arise from the regional point method.

China's healthcare payment reform seeks to combine a medical insurance point-system with a global budget.The focus and difficulty in implementing the payment reform is how to make effectively link.On the basis of theoretical analysis,it selects the regions that have implemented the payment by disease under regional total budget and the payment by disease under institutional total budget,and summarizes the synergistic mechanism of total budget and payment by disease,including the strict control of total budget at the regional level,the reasonable setup of the budget or the standard of expected service volume at the institutional level,and the rate fluctuation and discount mechanism for the settlement of excess service;and further sort out the additional incentive mechanism to support innovation and quality enhancement under the background of the total budget and the payment by disease.Lessons can be drawn from the experiences of typical regions to strengthen the synergy between regional budgets,institutional budgets and payment by type of disease,and cautiously deal with the risks of excessive competition and"punching points"that may arise from the regional point method.

China's healthcare payment reform seeks to combine a medical insurance point-system with a global budget.The focus and difficulty in implementing the payment reform is how to make effectively link.On the basis of theoretical analysis,it selects the regions that have implemented the payment by disease under regional total budget and the payment by disease under institutional total budget,and summarizes the synergistic mechanism of total budget and payment by disease,including the strict control of total budget at the regional level,the reasonable setup of the budget or the standard of expected service volume at the institutional level,and the rate fluctuation and discount mechanism for the settlement of excess service;and further sort out the additional incentive mechanism to support innovation and quality enhancement under the background of the total budget and the payment by disease.Lessons can be drawn from the experiences of typical regions to strengthen the synergy between regional budgets,institutional budgets and payment by type of disease,and cautiously deal with the risks of excessive competition and"punching points"that may arise from the regional point method.

Objective:To evaluate left atrial(LA) function and its value in predicting left ventricular(LV) remodeling in patients with coronary heart disease (CHD) by four dimensional automatic left atrial quantitation (4D Auto LAQ).Methods:A total of 176 patients with CHD were prospectively enrolled in Fuwai Central China Cardiovascular Hospital from October 2021 to September 2022. They were divided into two groups according to left ventricular mass index: LV remodeling group (female>95 g/m 2, male>115 g/m 2, n=88) and Non-LV remodeling group (female≤95 g/m 2, male≤115 g/m 2, n=88). The 3D dynamic image of LA was analyzed by 4D Auto LAQ on machine to obtain the LA parameters, including the minimum, maximum, pre-systolic and emptying volumes of LA (LAVmin, LAVmax, LAVpreA, LAEV), LA ejection fraction (LAEF), LA reservoir longitudinal and circumferential strains (LASr, LASr-c), LA conduit longitudinal and circumferential strains (LAScd, LAScd-c) and LA contraction longitudinal and circumferential strains (LASct, LASct-c). Logistic regression models were used to analyze the value of LA parameters in predicting LV remodeling in patients with CHD. ROC curve was used to evaluate LA parameters and left atrial volume index (LAVI) to predict the diagnostic efficiency of LV remodeling. Results:Compared with the Non-LV remodeling group, LAVmin, LAVmax, LAVpreA were significantly increased and LAEF, LASr, LAScd, LASct, LASr-c, LAScd-c, LASct-c were significantly decreased in the LV remodeling group ( P<0.05). Logistic regression model showed that LASct-c was an independent risk factor for LV remodeling in patients with CHD after adjustment( OR=2.018, 95% CI=1.214-3.355). ROC curve analysis showed that the area under the curve of LASct-c for predicting LV remodeling in CHD patients was 0.844, the sensitivity was 0.784, and the specificity was 0.761. Conclusions:4D Auto LAQ can effectively evaluate LA function in patients with CHD.LASct-c can be used as a reference index to predict LV remodeling in patients with CHD, which provides a new evaluation method in prognosis evaluation of CHD patients.