Objective:To evaluate the clinical efficacy of modified all-arthroscopic reconstruction of medial patella femoral ligament (MPFL) for the treatment of recurrent patellar dislocation.Methods:A retrospective case series study was conducted to analyze the clinical data of 38 patients (46 knees) with recurrent patellar dislocation, who were treated at First Affiliated Hospital of Shenzhen University from January 2017 to January 2020. The patients included 12 males (12 knees) and 26 females (34 knees), aged 14-40 years [(24.6±5.4)years]. All patients underwent the modified all-arthroscopic MPFL reconstruction procedure. The femoral tunnel locations were assessed by 3D-CT immediately after surgery. The MRI was performed at 6 and 12 months after operation to assess the healing morphology of the reconstructed MPFL. The Lysholm score and Kujala score were used to assess the knee function before operation, at 6 months after operation, at 12 months after operation and at the last follow-up. The time to return to sports as well as complications were observed.Results:All patients were followed up for 26-48 months [(32.4±8.6)months]. Postoperative 3D-CT examination showed that the femoral tunnels were located in the groove area of the medial epicondyle of the femur and the adductor tubercle. At 6 and 12 months after operation, MRI T2 images showed that the reconstructed MPFL had a low signal and well tensioned ligament tissue, indicating that the MPFL was healed well. The Lysholm scores at 6 and 12 months postoperatively and at the last follow-up were (81.1±12.0)points, (91.2±3.8)points, and (92.2±9.8)points, respectively, being significantly higher than the preoperative (52.4±10.6)points (all P<0.01). The Kujala scores at 6 and 12 months postoperatively and at the last follow-up were (85.4±3.9)points, (91.4±3.6)points, and (93.1±8.5)points, respectively, being significantly higher than the preoperative (55.2±6.8)points (all P<0.01). Compared with 6 months postoperatively, the Lysholm score and Kujala score were significantly improved at 12 months postoperatively and at the last follow-up (all P<0.05). All patients returned to sports, with the time to return to sports for 3-12 months [(8.7±2.3)months] after operation. One patient had poor wound healing but was healed after dressing changes. No wound infection, nerve injury, joint stiffness, patella re-dislocation or other complications occurred. Conclusion:For recurrent patellar dislocation, the modified all-arthroscopic MPFL reconstruction has advantages of accurate bone tunnel positioning, good ligament healing, good function recovery, early return to sports, and less postoperative complications.

Objective:To deeply understand the evaluation of allergic rhinitis patients on the use of health education accurately linking system, analyze their real experience and needs, so as to provide improvement basis for optimizing intelligent mobile education system.Methods:From January to June 2021, 15 patients with allergic rhinitis were selected from the Otolaryngology and Head and Neck Surgery of Beijing Tongren Hospital affiliated to Capital Medical University by purposive sampling as the interviewee. A total of 15 patients with allergic rhinitis were interviewed semi structurally, and the results were analyzed by thematic analysis.Results:The experience of the health education accurately linking system was refined into three themes, namely, the practicality of the health education content, the effectiveness of the health education form, and the shortcomings of the education content and form.Conclusions:Through the health education accurately linking system as the carrier, the system presents standardized health education knowledge as the core of clinical application interviews. It is necessary to increase access to health information. The content of propaganda and education can mainly be short videos. The disease knowledge module can be improved according to the severity of the disease, so as to improve the quality of health education and promote the occurrence of health behaviors.

OBJECTIVE：To provide referen ce for improving commission management system of medical insurance in China. METHODS：By analyzing the problems of commission management system of medical insurance in China ，studying the specific types，responsibility division and its features of basic medical insurance contractors in the United States ，the suggestions were put forward for improving corresponding system in China. RESULTS & CONCLUSIONS ：There are some problems in the entrusted management of medical insurance in China ，including that the fair competition mechanism has not been established ；the operation and management of social security fund lacks of supervision mechanism ；the role of the government is unclear and inexperienced ； the imperfect supervision mechanism causes follow-up problems ；it is still uncertain whether the entrusted management system can improve the efficency of medical insurance management. In the United States ，the way of entrusted management of medical insurance was to introduce the third-party management. The contractors employed by the Centers for Medicare and Medicaid Services in the United States mainly included medical insurance contractor ，zone program integrity contractor ，comprehensive error rate test review contractor and statistical contractor ，supplemental medical review contractor ，qualified independent contractor and so on ，among which medical insurance contractor was in the core position. Each contractor had a clear division of labor in handling medical claims ，preventing medical fraud ，reviewing the correctness of payments ，evaluating medical records and handling appeals. This mode greatly reduced the work pressure of the government ，improved the efficiency of medical insurance management and operation，and promoted the continuous improvement of the whole system. It is suggested that China should expand the scope of social agency management ，clarify the responsibilities of government and social resources ，introduce various types of social economic organizations and establish a complete and effective performance supervision and management system in order to improve the modernization level of China ’s medical insurance governance.

OBJECTIVE：To pro vide reference f or resolving structural imbalance of “supply and demand dislocation ”in each stage of new drug R&D funds in China. METHODS ：Through analyzing the fund demand in each stage of new drug R&D and the problem of “supply and demand dislocation ”in detail ，a financing scheme matching the fund demand of each stage was designed ， and analyzed with the financing process of “Wanke”. RESULTS & CONCLUSIONS ：In the basic stage of new drug R&D ，there was a large demand for funds ，but there were great technical risks ，transformation risks and investment risks ，little attention and support from investors ，resulting in the lack of R&D funds in this stage. It is suggested to increase the investment of R&D enterprises themselves. In the stage of new drug discovery ，the risks of R&D and investment were still high ，more funds were needed and funds were in short supply. It is suggested to attract more venture capital into this stage. From preclinical stage to clinical stage Ⅱ，there was a greater demand for funds. It is suggested that this stage should mainly rely on venture capital and pledge financing with patents. From the clinical stage Ⅲ to pre-marketing ，R&D had entered the mature stage with less investment risk. Therefore ，more venture capital could be obtained in this stage ，and there was a situation of excess capital. At this time ，in addition to venture capital ，R&D enterprises can also choose listing financing. In the post-marketing stage ，the sales right of a certain region in the product sales link could be transferred to provide new reserve funds for the next round of new drug R&D ，so as to achieve a virtuous circle of R&D activities. One of the reasons for the success of “Wanke”R&D financing lied in the combination of various financing methods in the financing process. It is suggested that China should improve the financial financing system and patent value evaluation system at the national level ，so as to promote the drug patent pledge financing in China as soon as possible. Finally ，new drug R&D institute must establish the concept of independent innovation ，speed up the output of technological innovation results ，so as to achieve the improvement of China ’s independent R&D capability.

OBJECTIVE：To provide reference for deepening the reform of medical insurance payment mode in China. METHODS：By analyzing the specific reform process and driving factors of American Medicare ，and considering the background of current payment reform in China ，then some suggestions were put forward to promote the reform of medical insurance payment mode in China. RESULTS & CONCLUSIONS ：The payment mode of Medicare in the United States had undergone three stages ， which were post-payment system ，pre-payment system and value-based payment system. The payment modes included payment by service items ，payment by disease diagnosis related groups （DRGs）and payment by service value. The change was the result of the comprehensive effect of the three systems of technology ，politics and social culture in the United States. The demand for reasonable treatment and control fees drove the change from post-payment system to pre-payment system ，while the crisis of service quality ， the rise of service cost and the contradiction between doctors and patients drove the change to value-based payment. Payment mode reform had a positive impact on Medicare in the United States ，reducing medical expenditure and improving the quality of service. It is suggested that China should draw lessons from the experience of the United States in reforming the prepayment system nationwide on the basis of the current DRGs pilot projects. Meanwhile ，in order to avoid the medical quality crisis in the later period of the United States ，it is necessary to introduce the concept of value-based payment ，establish incentive and restraint mechanisms and strengthen the construction of the regulatory supporting system for the whole process.

Objective To investigate the epidemiological characteristics of a family clustering of COVID-19. Methods Field epidemiological survey was conducted. Result Case 1 of the long-term residents from Hubei province was the source of infection of this family clustering. There were 6 cases (from case 2 to case 7) infected in the whole incubation period. The incubation period was more than 14 days for 3 of the second-generation cases. Routes of transmission include respiratory droplets (from case 1 transmitted to case 6, from case 1 to her family members) and closecontact (from case 1 to other cases in her family). All the age groups were generally susceptible, while elderly were easier to progress to critically ill. Besides respiratory symptoms, there were also gastrointestinal symptoms, of which diarrhea was the most common one. Conclusion Family clustering had been an important part for COVID-19 cases.

Objective: To evaluate the efficacy and safety of nifekalan (NIF) on cardioversion in atrial fibrillation (AF) patients post radiofrequency ablation, and investigate the relevant factors related to the cardioversion efficacy of NIF. Methods: We screened patients with sustained AF rhythm after radiofrequency ablation between November 2016 and July 2018. Participants were treated with intravenous NIF 0.4 mg/kg within 5-10 minutes after ablation. We observed the adverse reaction, and monitored the rhythm, heart rate, QT interval and QTc interval before the medication and at 5, 10, 20, 120 min after the medication. According to the drug outcome of NIF, patients were divided into conversion group and non-conversion group, related factors affecting conversion efficacy were evaluated using logistic regression analysis. Results: (1)A total of 116 patients were enrolled in the study (63 males and 53 females, mean age was (64±18) years). Among them, 72 patients were converted to sinus rhythm, and the overall successful rate was 62.1%. There were 84 patients with persistent AF, of which 50 cases (59.2%) were restored to sinus rhythm. There were 32 patients with paroxysmal AF, 22 cases (68.8%) of them were restored to sinus rhythm. The conversion time was 1.5 to 12 (6.8±3.4)min. (2) In 116 patients, the QT interval and QTc interval were significantly longer after medication than before the drug administration (P<0.01), and peaked at about 10th min, and restored to the level before drug administration at about 120th min. (3) There were 8 cases of bradycardia (6.9%), 3 cases of frequent and short ventricular tachycardia (2.6%). (4) The duration of atrial fibrillation was shorter and left atrial diameter was smaller in the cardioversion group than in the non-cardioversion group (both P<0.05). There were no significant differences in gender, disease history, atrial fibrillation type and structural heart disease between the two groups (P>0.05). (5) Multifactorial logistic regression analysis showed that the duration of atrial fibrillation (OR=0.980, 95%CI 0.966-0.994, P=0.004) and the left atrial diameter (OR=0.888, 95%CI 0.814-0.967, P=0.007) were the factors that influence the cardioversion efficacy of NIF on atrial fibrillation post ablation. Conclusions The total effective rate of NIF was 62.1% in patients witrh sustained AF post radiofrequency ablation, was 68.8% in patients with paroxysmal AF. Besides, NIF has the advantage of short conversion time and few adverse reactions. Left atrium diameter and AF duration were relevant factors that influence the efficacy of NIF of cardioversion in patients with sustained AF after radiofrequency ablation.

OBJECTIVE： To provide reference for the improvement of OTC drug management system in mainland China. METHODS： By analyzing the classification， registration management， conversion procedures and supporting measures， instructions and packaging management of OTC drugs in Taiwan area of China， and considering the current situation and problems of OTC drug management in mainland China， suggestions for improving OTC drug management system in mainland China were put forward. RESULTS & CONCLUSIONS： OTC drugs of Taiwan area could be divided into drugs instructed by physicians and pharmacists （hereinafter referred to as “instructed drugs”） as well as patent drugs. The registration management of instructed drugs was implemented in accordance with the Criteria for the Review of Instructed Drugs. The criteria not only regulated the active ingredients， dosage forms， indications， usage and dosage， side effects， matters needing attention and warnings of instructed drugs， but also stipulated the requirements for labeling， instructions and outer-of-the-box printing of instructed drugs. Taiwan area had also established a mechanism for evaluating drug conversion to expand the variety range of prescription drugs converted to OTC drugs， and had equipped a series of supporting measures to reduce the safety risks arising from drug conversion. In 2016， Taiwan area also formulated the Format and Relevant Standards for Outer-of-the-Box of Generic Western OCT Drug， and revised the drug instructions and the outer-of-the-box. The format was more standardized and the terminology was easier to understand， which made it easier for the public to read. It is suggested that mainland China should refer to the experience of Taiwan area， set up special registration channels for OTC drugs and simplify the requirements for examination and approval， pay attention to and improve the matching measures for the conversion of prescription drugs to OTC drugs， encourage brand building and improve intelligibility of OTC drug instructions， so as to build an effective OTC drug management system.

Objective To evaluate the efficacy and safety of nifekalan (NIF) on cardioversion in atrial fibrillation (AF) patients post radiofrequency ablation, and investigate the relevant factors related to the cardioversion efficacy of NIF. Methods We screened patients with sustained AF rhythm after radiofrequency ablation between November 2016 and July 2018. Participants were treated with intravenous NIF 0.4 mg/kg within 5-10 minutes after ablation. We observed the adverse reaction, and monitored the rhythm, heart rate, QT interval and QTc interval before the medication and at 5, 10, 20, 120 min after the medication. According to the drug outcome of NIF, patients were divided into conversion group and non?conversion group, related factors affecting conversion efficacy were evaluated using logistic regression analysis. Results (1)A total of 116 patients were enrolled in the study (63 males and 53 females, mean age was (64±18) years). Among them, 72 patients were converted to sinus rhythm, and the overall successful rate was 62.1%. There were 84 patients with persistent AF, of which 50 cases (59.2%) were restored to sinus rhythm. There were 32 patients with paroxysmal AF, 22 cases (68.8%) of them were restored to sinus rhythm. The conversion time was 1.5 to 12 (6.8±3.4)min. (2) In 116 patients, the QT interval and QTc interval were significantly longer after medication than before the drug administration (P<0.01), and peaked at about 10th min, and restored to the level before drug administration at about 120th min. (3) There were 8 cases of bradycardia (6.9%), 3 cases of frequent and short ventricular tachycardia (2.6%). (4) The duration of atrial fibrillation was shorter and left atrial diameter was smaller in the cardioversion group than in the non?cardioversion group (both P<0.05). There were no significant differences in gender, disease history, atrial fibrillation type and structural heart disease between the two groups (P>0.05). (5) Multifactorial logistic regression analysis showed that the duration of atrial fibrillation ( OR=0.980, 95%CI 0.966-0.994, P=0.004) and the left atrial diameter ( OR=0.888, 95%CI 0.814-0.967, P=0.007) were the factors that influence the cardioversion efficacy of NIF on atrial fibrillation post ablation. Conclusions The total effective rate of NIF was 62.1% in patients witrh sustained AF post radiofrequency ablation, was 68.8% in patients with paroxysmal AF. Besides, NIF has the advantage of short conversion time and few adverse reactions. Left atrium diameter and AF duration were relevant factors that influence the efficacy of NIF of cardioversion in patients with sustained AF after radiofrequency ablation.

Objective To prevent the gastrointestinal intolerance in patients after laryngectomy by care bundles, so as to improve the effectiveness of enteral nutrition. Methods A total of 117 cases of laryngectomy patients were divided into control group (n=58) and experimental group (n=59) by random number table method. The patients in the control group were given routine nursing care, while the patients in the experimental group were treated by care bundles. The incidence of gastrointestinal intolerance was compared between the two groups in bloating, vomiting, gastroesophageal reflux, diarrhea and gastric retention. Results The incidences of bloating, vomiting, diarrhea and gastric retention of the experimental group were significantly lower than those of the control group, and the differences were statistically significant (P<0.05). The time of indwelling gastric tube in the experimental group and the control group was (12.35±2.29) days and (14.23±2.16) days respectively, and the difference was statistically significant (t=4.79, P< 0.01). Conclusions Care bundles can effectively prevent the occurrence of gastrointestinal intolerance in patients with indwelling gastric tube after laryngectomy.