Periodontal therapy for hopeless mandibular anterior teeth: a retrospective case report with a multidisciplinary approach and a 20-year follow-up

Introduction: This case report presents the intentional periodontal maintenance of two periodontal hopeless lower central incisors with a multidisciplinary approach and 20-year follow-up. Case presentation: A 36-year-old male, in 2001, was diagnosed with aggressive periodontitis, gingival swelling, bleeding, and mandibular central incisors with mobility and poor prognosis. Following periodontal therapy (phase I), root canal treatment, and occlusal adjustment, #31 and #41 were gently extracted to remove the granulation tissues, calculus, and infected cementum from the root surface. Then, tetracycline-HCl was applied for 5 minutes on the root surfaces. The teeth were repositioned into the sockets and splinted with a lingual bar. At 3 months, the bar was removed, and a free gingival autogenous graft was done to improve the local keratinized tissue width. Mobility scores, pocket depths, and clinical attachment levels were recorded, and radiographs were taken at 1, 5, and 20 years. The 5-year follow-up showed that the teeth were clinically and radiographically in function. There was a reduction in probing depth and a gain in clinical attachment and radiographic alveolar bone levels. After 20 years, #41 was stable, but #31 had external root resorption, leading to a new treatment plan (dental implants) and extraction. Conclusion: The clinical result of this case was satisfactory for 20 years. Intentional periodontal maintenance of the teeth may be an alternative treatment, even considering the high level of complexity.

Complicações relacionadas ao uso de polimetilmetacrilato na face: Análise de 209 casos / Complications related to the use of polymethyl methacrylate on the face: Analysis of 209 cases

Introdução: O polimetilmetacrilato é um produto de preenchimento permanente. A injeção deste material na face pode levar a complicações. O objetivo deste estudo é determinar em uma série de casos o tempo mediano de ocorrência de complicações, as áreas mais comprometidas, os tipos de complicações e tratamentos mais realizados. Método: Foram estudados 209 casos de pacientes portadores de complicações relacionadas ao uso de polimetilmetacrilato na face que buscaram tratamento entre o período de janeiro de 2000 a junho de 2021. Os dados analisados foram sexo, idade, número de injeções, momento da aplicação, intervalo de tempo até surgir a complicação, tipo de complicação, região comprometida e tratamento realizado. Resultados: A idade média dos pacientes foi de 45 anos (23 a 79 anos). Destes, 172 eram mulheres e 37 homens. O número de aplicações variou de 1 a 5. O tempo mediano de surgimento de complicações foi de 71 meses. As regiões mais comprometidas foram a malar, em 102 pacientes; mandibular, em 100; e zigomática, em 91. Granuloma foi observado em 135 pacientes; edema, em 120; e inflamação, em 78. O tratamento mais realizado foi a injeção de corticoide, em 111 pacientes, seguido de remoção cirúrgica, em 40. Conclusão: Os resultados podem servir como base de conhecimento para uma melhor compreensão das complicações com o uso de polimetilmetacrilato na face.

Introduction: Polymethylmethacrylate is a permanent filler product. Injecting this material into the face can lead to complications. The objective of this study is to determine in a series of cases the median time for complications to occur, the most affected areas, the types of complications, and the treatments most performed. Method: 209 cases of patients with complications related to the use of polymethyl methacrylate on the face who sought treatment between the period of January 2000 and June 2021 were studied. The data analyzed were gender, age, number of injections, moment of application, interval time until the complication arises, type of complication, affected region, and treatment performed. Results: The average age of patients was 45 years (23 to 79 years). Of these, 172 were women and 37 men. The number of applications ranged from 1 to 5. The median time for complications to appear was 71 months. The most affected regions were the malar, in 102 patients; mandibular, in 100; and zygomatic, in 91. Granuloma was observed in 135 patients; edema, in 120; and inflammation, in 78. The most common treatment was corticosteroid injection, in 111 patients, followed by surgical removal, in 40. Conclusion: The results can serve as a knowledge base for a better understanding of complications with the use of polymethylmethacrylate in the face.

Investigating Morphological Changes of the Hippocampus After Prolonged Aerobic Exercise in Mice: Neural Function and Learning Capabilities / Investigación de los Cambios Morfológicos del Hipocampo Después De un Ejercicio Aeróbico Prolongado en Ratones: Función Neuronal y Capacidades de Aprendizaje

SUMMARY: Both the academic and popular worlds have paid close attention to the link between exercise and cognitive performance. It is increasingly important to understand the numerous mechanisms by which exercise might influence cognitive abilities in view of the continuous societal issues caused by aging populations and the prevalence of disorders associated to cognitive decline. A rising amount of evidence showing a favorable association between physical activity and cognitive well-being serves as the foundation for the justification for studying the effects of exercise on cognitive function and learning ability. The study employed an 8-week treadmill based on exercise on male adults C57BL/6 mice. The exercise group were engaged in 5 sessions a week gradually increasing the intensity of the protocol by 5 % each week. The Mice cognitive assessments were done using Morris Water Maze and Novel Object Recognition tests. The long term-impact on learning ability were further assessed through immmohistochemistry and molecular analysis of the hippocampal and prefrontal cortex tissues of the animals' brain tissues. The findings showed improved spatial learning abilities, recognition memory, and heighted synaptic plasticity indicated by elevated synaptic makers. The study underscores the role of long-term aerobic exercise in augmenting cognitive performance. It not only contributes to the understanding of the interplay between neuroplasticity and cognitive benefits but also the growing body of research on the impact of exercise on cognitive function.

Tanto el mundo académico como el popular han prestado mucha atención al vínculo entre el ejercicio y el rendimiento cognitivo. Es cada vez más importante comprender los numerosos mecanismos por los cuales el ejercicio podría influir en las capacidades cognitivas en vista de los continuos problemas sociales causados por el envejecimiento de la población y la prevalencia de trastornos asociados al deterioro cognitivo. Una cantidad cada vez mayor de evidencia que muestra una asociación favorable entre la actividad física y el bienestar cognitivo sirve como base para justificar el estudio de los efectos del ejercicio sobre la función cognitiva y la capacidad de aprendizaje. El estudio se realizó en ratones machos adultos C57BL/6 utilizándose en los ejercicios una cinta rodante durante 8 semanas. El grupo de ejercicio realizó 5 sesiones por semana aumentando gradualmente la intensidad del protocolo en un 5 % cada semana. Las evaluaciones cognitivas de los ratones se realizaron utilizando las pruebas Morris Water Maze y Novel Object Recognition. El impacto a largo plazo en la capacidad de aprendizaje se evaluó mediante inmunohistoquímica y análisis molecular de los tejidos del hipocampo y la corteza prefrontal de los tejidos cerebrales de los animales. Los hallazgos mostraron mejoras en las habilidades de aprendizaje espacial, la memoria de reconocimiento y una mayor plasticidad sináptica indicada por unos creadores sinápticos elevados. El estudio subraya el papel del ejercicio aeróbico a largo plazo para aumentar el rendimiento cognitivo. No sólo contribuye a la comprensión de la interacción entre la neuroplasticidad y los beneficios cognitivos, sino también al creciente conjunto de investigaciones sobre el impacto del ejercicio en la función cognitiva.

Antimicrobial use in long-term care facilities: the participation of nurses / Indicação de antimicrobianos em instituições de longa permanência: participação do enfermeiro

Objective: To identify how antimicrobials are prescribed in long-term care facilities from the perspective of nurses. Methods: This descriptive study was conducted using an online survey. Participants were selected through conventional sampling methods and online recruitment. Data were collected through a 2-section self-administered questionnaire: the first section characterized the respondent and the institution, while the second investigated the antimicrobial prescription and usage in the institution. Results: Thirty-five responses were received, representing institutions from every state in Brazil. Sixty percent of the institutions had a part-time physician. More than 90% of the respondents said they contacted a prescriber to report signs and symptoms suggestive of infection, which led to subsequent antimicrobial use. Conclusions: The opinion of nurses has a significant impact on the prescriber's decision to begin antibiotic therapy in long-term care facilities, which indicates that nurses need training about the rational use of antimicrobials. (AU)

Objetivo: Identificar como ocorre a indicação de antimicrobianos nas instituições de longa permanência na perspectiva do profissional enfermeiro. Metodologia: Foi realizado um estudo descritivo por meio de um Survey online. Os participantes foram selecionados por meio de amostra convencional e o recrutamento foi realizado por meio de convite online. A coleta de dados foi feita a partir de um questionário autoaplicável constituído de dois blocos: o primeiro contemplando itens para a caracterização do respondente e da instituição; e o segundo, questões relacionadas ao uso e à indicação de antimicrobianos na instituição. Resultados: Foram recebidas 35 respostas, representando instituições de todos os estados brasileiros. A presença de médico em tempo parcial foi apontada em 60% das instituições. Mais de 90% dos participantes apontaram que acontecia o contato com prescritor para o relato de sinais e sintomas sugestivos de infecção apresentados pelo residente, implicando em uso subsequente de antimicrobianos. Conclusões: A opinião do profissional da Enfermagem tem grande impacto na decisão do prescritor em iniciar a antibioticoterapia nas instituições de longa permanência, demonstrando a necessidade de qualificação desse profissional direcionada ao uso racional de antimicrobianos. (AU)

Path analysis of urinary incontinence in older adults living in nursing homes / Fatores associados à incontinência urinária em idosos institucionalizados

Objective: To investigate the factors associated with urinary incontinence in older adults living in nursing homes. Methods: This was an exploratory, cross-sectional, observational, and quantitative study using exploratory and path analysis (PA). Eighty-six older adults living in nursing homes in the city of Salvador, Brazil, and the city of Brasília, Brazil, were included. Data were collected from January to March 2020, before the Covid-19 pandemic. The following variables were evaluated: sex, age group, functional performance, global cognitive function, comorbidities, and health conditions. Results: Urinary incontinence was associated with educational level, marital status, hypertension, one or more difficulties in basic activities of daily living, mood, insomnia, loss of appetite, fecal incontinence, and difficulty swallowing. In the PA, depression and difficulty swallowing were directly associated with urinary incontinence, and urinary incontinence was directly and significantly associated with insomnia and fecal incontinence. Conclusion: Given the variety of social and health components associated with urinary incontinence, it is necessary to assess, prevent, treat, and rehabilitate this condition in Brazilian nursing homes. Interventions in urinary incontinence demand integrated actions in functional, clinical, and mental health aspects to promote the well-being of older adults living in nursing homes. (AU)

Objetivo: Investigar os fatores associados à incontinência urinária em pessoas idosas institucionalizadas segundo a Análise de Caminhos. Metodologia: Trata-se de um estudo transversal. Foram avaliados 86 idosos em Instituições de Longa Permanência para Idosos brasileiras de Salvador (BA) e Brasília (DF), no período entre janeiro e março de 2020, período pré-pandemia de COVID-19. Os fatores analisados incluíram: sexo, faixa etária, desempenho funcional, desempenho cognitivo global, comorbidades e condições de saúde. Resultados: Observou-se que a incontinência urinária esteve associada ao nível de escolaridade, estado civil, hipertensão, uma ou mais dificuldades nas atividades básicas da vida diária, humor, insônia, perda de apetite, incontinência fecal e dificuldade de deglutição. Na Análise de Caminhos, os sintomas depressivos e as dificuldades de deglutição tiveram associação direta com a incontinência urinária, e a incontinência urinária teve associação direta e significativa com a insônia e a incontinência fecal. Conclusão: Dada a variedade de componentes sociais e de saúde associados à incontinência urinária, é necessário avaliar, prevenir, recuperar e reabilitar essa condição nas Instituições de Longa Permanência para Idosos brasileiras. Intervir na incontinência urinária requer ações integradas nos aspectos funcionais, clínicos e de saúde mental, que podem favorecer o bem-estar das pessoas idosas institucionalizadas. (AU)

Effect of Long-term Peripheral Nerve Stimulation on Neuro-Muscular Complex Morphologic Recovery in Experiment / Efecto de la Estimulación del Nervio Periférico a Largo Plazo sobre la Recuperación Morfológica del Complejo Neuromuscular en Experimento

SUMMARY: Peripheral nerve injury is an extremely important medical and socio-economic problem. It is far from a solution, despite on rapid development of technologies. To study the effect of long-term electrical stimulation of peripheral nerves, we used a domestically produced electrical stimulation system, which is approved for clinical use. The study was performed on 28 rabbits. Control of regeneration was carried out after 3 month with morphologic techniques. The use of long-term electrostimulation technology leads to an improvement in the results of the recovery of the nerve trunk after an injury, both directly at the site of damage, when stimulation begins in the early period, and indirectly, after the nerve fibers reach the effector muscle.

La lesión de los nervios periféricos es un problema médico y socioeconómico extremadamente importante. Sin embargo, y a pesar del rápido desarrollo de las tecnologías, aún no tiene solución. Para estudiar el efecto de la estimulación eléctrica a largo plazo de los nervios periféricos, utilizamos un sistema de estimulación eléctrica de producción nacional, que está aprobado para uso clínico. El estudio se realizó en 28 conejos. El control de la regeneración se realizó a los 3 meses con técnicas morfológicas. El uso de tecnología de electro estimulación a largo plazo conduce a una mejora en los resultados de la recuperación del tronco nervioso después de una lesión, tanto directamente en el lugar del daño, cuando la estimulación comienza en el período temprano, como indirectamente, después de que las fibras nerviosas alcanzan el músculo efector.

TIPS with bare stents and covered stents for the treatment of portal hypertension:analysis of its long-term efficacy / 介入放射学杂志

Objective To evaluate the long-term efficacy of transjugular intrahepatic portosystemic shunt(TIPS)with bare stents and Fluency covered stents in the treatment of portal hypertension,and to discuss its clinical value.Methods The clinical data of 29 patients with intractable ascites or esophagogastric fundus varices rupture and hemorrhage caused by cirrhotic portal hypertension,who received TIPS with bare stents and covered stents at the First Affiliated Hospital of Xinjiang Medical University of China(25 patients)and the Lishui Municipal Central Hospital of China(4 patients)between August 2012 and December 2017,were retrospectively analyzed.The patients were regularly followed up to check the survival status.The postoperative cumulative shunt patency rate and cumulative survival rate of the patients were analyzed by Kaplan-Meier method.Results The technical success rate of TIPS was 100％.The mean portal vein pressure was decreased from preoperative(40.21±3.24)cmH2O to postoperative(24.55±3.55)cmH2O(P＜0.05).The patients were followed up for 5.1-10.5 years.The postoperative 1-,3-,5-,7-year primary cumulative patency rates of the shunt were 89.7％,75.9％,75.9％ and 52.5％,respectively.The postoperative 5-,7-,9-and 10-year cumulative survival rates were 100％,66.9％,66.9％ and 33.4％,respectively.The incidence of hepatic encephalopathy was 13.8％(4/29).Conclusion Using bare stents combined with Fluency covered stents for TIPS is clinically safe and effective in the treatment of portal hypertension.This technique carries higher long-term shunt patency rate and low incidence of hepatic encephalopathy.Therefore,it can be used as a substitute for Viatorr stent when necessary.(J Intervent Radiol,2024,33:295-299)

Short-term and long-term curative effect of different polyvinyl alcohol embolic agents combined with coaxial microcatheter embolization on massive hemoptysis / 实用放射学杂志

Objective To explore the short-term and long-term curative effect of different polyvinyl alcohol(PVA)embolic agents combined with coaxial microcatheter embolization on massive hemoptysis.Methods According to different embolization agents,60 patients with massive hemoptysis were divided into polyvinyl alcohol embolization microsphere group(microsphere group,32 cases,polyvinyl alco-hol embolization microsphere+coaxial microcatheter embolization)and polyvinyl alcohol foam embolization microparticle group(micropar-ticle group,28 cases,polyvinyl alcohol foam embolization microparticle+coaxial microcatheter embolization).The curative effect,coagula-tion indexes,hemoptysis volume,incidence of complications and recurrence rate of hemoptysis were compared between the two groups.Results The difference in the response rates to treatment between the two groups was not statistically significant(P＞0.05).Hemoptysis volume was significantly less in the microsphere group than that in the microparticle group(P＜0.05).There was no significant difference in the incidence of complications between the two groups(P＞0.05).The recurrence rate of hemoptysis was lower in the microsphere group than that in the microparticle group(3.03％vs 21.43％)(P＜0.05).Conclusion The curative effect of both polyvinyl alcohol embolization microsphere and foam embolization microparticle combined with coaxial microcatheter embolization is highly effective on massive hemoptysis.The long-term prognosis of polyvinyl alcohol embolization microsphere combined with coaxial microcatheter embolization is better.

Pilot experience and thinking of long-term care insurance system in Panjin City / 沈阳医学院学报

Objective:To understand the pilot operation status of long-term care insurance system in Panjin City,and provide ideas and reference basis for improving the long-term care insurance system in Liaoning Province and the whole country.Methods:The protection content,fund raising,and treatment payment policies of long-term care insurance in Panjin City was systematically sorted out.And referring to other pilot cities combined with the actual situation in China,improvement suggestions were put forward.Result:After sorting and analyzing,it was found that the long-term care insurance system in Panjin City had a single financing channel,a small coverage of insurance coverage and insured objects,an unspecified payment service content,and an incomplete evaluation system.Conclusion:A long-term care special fund should be established,policy coverage should be expanded,and a scientific and reasonable evaluation system should be established.

Landmark Achievements in Treating Solid Tumors with Immune Checkpoint Inhibitors / 实用医学杂志

Tumor metastasis is a primary cause of death among solid tumor patients.Interventions such as chemotherapy with cytotoxic drugs and other targeted therapies focusing on specific genes or tumorigenesis can induce tumor shrinkage in most cases.However,these interventions do not substantially prolong the lives of patients.In recent years,immunotherapy has made significant breakthroughs in treating solid tumors with the introduction of immune checkpoint inhibitors(ICIs),following the clinical use of Ipilimumab,the first anti-tumor drug with ICIs initially approved in 2011.Currently,four types of ICIs including CTLA-4,PD-1,PD-L1,and LAG3 have been clinically applied and have demonstrated specificity towards more than 20 types of solid tumors.The significance of ICIs lies in their superiority to conventional drugs in three aspects:(1)They can prolong the survival of late-stage patients and even achieve"clinical cure";(2)They allow patients with rare tumors access a pan-tumor treatment based on specific biomarkers;and(3)They can free a majority of patients from invasive surgical approaches to preserve organ functions,thereby improving patient's quality of life.This article provides a summary of multiple clinical research projects and explores the clinical evidence derived from the notable achievements related to the three advantages.

A new strategy for the management of ascites in liver cirrhosis:A long-term albumin treatment / 实用医学杂志

Ascites is the most frequent decompensating event of cirrhosis.At present,ascites recurs at a high rate due to lack of effective management strategy and is frequently complicated with spontaneous bacterial peritonitis,hepatorenal syndrome,and liver failure,which increase the fatality rate.Albumin treatment for hepatocirrhosic ascites has a long history,but it is limited as an acute or short-term treatment.In contrast,long-term albumin administration represents a completely different treatment paradigm.Results from several recent clinical studies indicate that long-term albumin treatment can be able to modify the disease courses of some decompensated cirrhosis when albumin is given at a sufficient dose for a sufficient time.In this review,we analyze the available data acquired from long-term albumin treatments,trying to establish a secure and effective management scheme involving maximal target popula-tion,albumin dose,administration time,and standards for albumin withdrawal,and thus provide references for the clinical practice.

Effects of long-term subculture on biological characteristics of bone marrow mesenchymal stem cells / 中国组织工程研究

BACKGROUND:There is still controversy whether human bone marrow mesenchymal stem cells can maintain their biological characteristics,energy metabolism patterns,and multidirectional differentiation potential after long-term expression in vitro.Further comprehensive and systematic research is needed. OBJECTIVE:To evaluate the effects of long-term expansion in vitro on the biological characteristics of mesenchymal stem cells. METHODS:Human bone marrow mesenchymal stem cells cultured to passage 5,10,and 15 in vitro.MTT assay was used to detect cell proliferation ability.Flow cytometry was used to detect cell cycle.The multi-differentiation potential of mesenchymal stem cells was detected by inducing to adipogenic,osteogenic and chondrogenic differentiation.Cell migration and invasion abilities were detected by scratch test and Transwell assay.The mitochondrial oxidative phosphorylation and glycolysis function were analyzed using energy metabolism analyzer.The cell senescence was detected by senescence-associated β-galactosidase staining.The expression levels of p21,p16,and p53 proteins were detected by western blot assay. RESULTS AND CONCLUSION:Bone marrow mesenchymal stem cells at passages 5,10,and 15 grew adherently;the volume of passage 15 mesenchymal stem cells increased and its proliferation ability decreased;the percentage of S-phase cells decreased(P<0.05).With the increase of culture passages,the migration and invasion abilities decreased gradually(P<0.05).There was no significant difference in the differentiation potential,demonstrated by adipogenic,osteogenic and chondrogenesis induction.The ability of oxidative phosphorylation of mitochondria and glycolysis decreased gradually(P<0.05).The number of senescence-associated β-galactosidase-positive cells increased with the increase of passages(P<0.05),and the expression of senescence protein p21,p16,and p53 increased gradually(P<0.05).The results indicated that the biological characterization of mesenchymal stem cells changed after long-term in vitro expansion.Mesenchymal stem cells cultured over 10 passages may have a reduced activity due to increasing senescence.Therefore,bone marrow mesenchymal stem cells cultured less than 10 passages are suitable for clinical research/therapy.

Analysis of hotpots and evolution trends in the field of alzheimer's disease care / 现代医院

Objective To explore the research status and hot highlights in the field of Alzheimer's disease nursing,and provide reference and direction for future research.Methods The high-level articles on Alzheimer's disease nursing during 2012 to 2022 were collected from Web of Science core database,were analyzed and visualized by the CiteSpace 5.8.R3C software.Re-sults 956 articles were included in the Web of Science core database.The demand and focus on AD nursing research increased year by year.United States America had the largest number of articles(175 articles),followed by France(43 articles)and Chi-na(31 articles).Minnesota University and Harvard Medical School had the largest number of articles(11 articles).The authors'analysis shows that BRUNO VELLAS,an academician of the French Academy of Sciences,had the largest number of articles.Keyword co-occurrence analysis shows that the research in the past decade mainly focuses on"nursing home","people"and"quality of life","long-term care"and"exercise therapy"may become the key research directions in the future.Conclusion Domestic scholars should improve the social security system of long-term care,promote"people-oriented"humanistic nursing services and develop appropriate sports training programs in the future.

Advances on the long-term prognosis of septic shock in children / 中国小儿急救医学

The mortality rate of septic shock in children is high，and the number of cases has been increasing year by year.In recent years，the number of deaths has decreased with the development of medical technology.With the increasing number of surviving children with septic shock，the prognosis regarding these patients is gaining more attention of PICU physicians than before.The long-term sequelae of patients with septic shock，which often leads to multiple organ dysfunction and complications，severely affects the quality of children life after discharge from the hospital.Notably，the meaningful outcomes mainly include physical，mental，emotional，and social functioning.Currently，few studies focusing on quality of life in children surviving from septic shock have been reported in China.Herein，this review summarized the progress of research on the long-term prognosis of patients with septic shock.

Application of 4M1E Refined Management Method in Reducing Dispensing Time of Long-term Prescription in Outpatient Pharmacy / 医药导报

Objective To investigate the effectiveness of 4M1E refined management method in reducing dispensing time of outpatient prescription in outpatient pharmacies under the implementation of a long-term prescription policy.Methods The hospital started to implement 4M1E refinement management in July 2022.Ten thousand prescriptions were randomly selected for each of the pre-implementation(from January to June 2022)and post-implementation(from July to December 2022)human-machine hybrid dispensing windows.The dispensing time of a single prescription,the volume of prescriptions dispensed and the number of drugs prescribed during peak periods,the use of intelligent equipment,and patient satisfaction before and after imple-mentation were compared.Results After implementation,the single prescription drug dispensing time at the mixed human-ma-chine dispensing window was reduced from(96.88±1 401.17)s to(55.84±526.24)s(P<0.01);The number of prescriptions dispensed in the window increased from(135.20±21.06)to(147.19±21.24)prescriptions per 2 h,and the number of drugs pre-scribed increased from(871.74±215.61)to(1 008.53±267.87)prescriptions per 2 h during peak hours.The rate of straight prescription and the rate of equipment automation have been greatly improved.Outpatient satisfaction was higher than before man-agement.The data showed statistical differences(P<0.05).Conclusion Under long-term prescription pressure,hospital outpa-tient pharmacies can greatly reduce prescription dispensing time and improve patient satisfaction after applying the 4M1E fine management method.

Two directions that cannot be ignored in the study of endemic fluorosis and endemic arsenicosis in China: long-term exposure to low-dose fluoride and arsenic, and non-target organ damage / 中华地方病学杂志

With the comprehensive implementation of prevention and control measures for endemic fluorosis and endemic arsenicosis in China, and in accordance with the World Health Organization (WHO) recommended drinking water standards and the Chinese standards of allowable daily fluoride intake and limit values of arsenic content in drinking water, Chinese residents have entered the era of low-dose fluoride and arsenic exposure. However, there have been few studies focused on the long-term health effects of exposure to low-dose fluoride and arsenic both domestically and internationally. Further more, study on non-target organs of fluoride and arsenic has been neglected. The conclusions are also inconsistent, and there is an urgent need for systematic study to clarify them. Accordingly, this paper proposes to establish a cohort of people exposed to low-dose fluoride and arsenic, systematically carry out study on the long-term health effects and mechanisms of low-dose fluoride and arsenic exposure, and promote China's prevention and control experience to the "the Belt and Road" countries, in order to provide a scientific basis for the formulation of prevention and control strategies and measures for endemic fluorosis and endemic arsenicosis under the new situation in China.

Long-term Hospitalization Payment in the US.and Germany and the Enlightenment for Average Cost of Beds Based Payment in China / 中国卫生经济

The payment methods,such as Diagnosis Related Group(DRG)for hospitalization and capitation for outpatient treat-ment,have achieved positive results in protecting the rights and interests of insured persons and improving the efficiency of the use of medical insurance funds.However,for patients with chronic diseases and rehabilitation nursing,the hospitalization period is long and the conditions complicated,and the payment method of DRGs is not reasonable.It analyzes the experiences of paying for long-term hospital cases in the US.and Germany from the aspect of reform process,payment method and regulatory measures.In order to pro-vide references for the reform of per-diem payment in rehabilitation nursing and other long-term hospitalized cases,it puts forward suggestions from aspects of realizing value care,reflecting individual differences,exploring complex payment methods,improving data quality and establishing constraint mechanism.

The regulation and guidance of long-term care insurance to the demands of home and community-based care:International experiences and implications / 中国卫生政策研究

In order to implement a"people-centered"service concept and promote the sustainability of long-term care systems,countries worldwide are increasingly focusing on benefit package design when allocating and using public long-term care funds.This emphasis is aimed at regulating and guiding long-term care demand and developing home and community-based care.Based on the purchasing theory,this study categorized the long-term care benefit package models in representative countries into two types:"Institutional Eligibility Restrictions Type"and"Home-care-focused Benefit Type",and further elaborated the specific benefit package design.In China,long-term care insurance are still in the initial stages of development.We should optimize the service utilization structure and promote a rational allocation of resources through purchasing,while incorporating diverse benefit designs such as eligibility restrictions,differential benefit levels,and supplementary support,to establish a robust,multi-tiered long-term care system based on home and community-based care.

Analysis of long-term efficacy of radiotherapy for elderly patients with esophageal squamous cell carcinoma / 中华放射肿瘤学杂志

Objective:To evaluate the long-term efficacy of radiotherapy for elderly patients with esophageal squamous cell carcinoma.Methods:Clinical data of 118 elderly patients aged ≥65 years with esophageal squamous cell carcinoma treated with radiotherapy alone or concurrent chemoradiotherapy in Cancer Hospital affiliated to Xinjiang Medical University from January 2013 to January 2016 were retrospectively analyzed. All patients were randomly divided into the radiotherapy alone ( n=57) and concurrent chemoradiotherapy groups ( n=61). The effective rate, survival rate, adverse reactions and causes of death were compared between two groups. Rate and constituent ratio were used to describe the categorical variables, and Pearson Chi-square test was used for univariate analysis. Results:The effective rate (68.4% vs. 86.9%, P=0.016) and incidence of adverse reactions (21.1% vs. 50.9%, P<0.001) between radiotherapy alone and concurrent chemoradiotherapy groups were significantly differed. The 1-year overall survival rate significantly differed between two groups (75.4% vs. 91.8%, P=0.016), while no significant differences were observed in the 3-year overall survival rate (36.8% vs. 42.7%, P=0.088) and 5-year overall survival rate (10.7% vs. 18.0%, P=0.746). The main cause of death in two groups was recurrence combined with distant metastasis. Conclusion:Compared with the radiotherapy alone, concurrent chemoradiotherapy can significantly improve the effective rate and survival rate for elderly patients with esophageal squamous cell carcinoma, whereas it may increase the incidence of adverse reactions.

Effect of first drainage failure on postoperative prognosis of patients with perihilar cholangiocarci-noma / 中华肝胆外科杂志

Objective:To study the effect of first drainage failure on the prognosis of perihilar cholangiocarcinoma (PHCC).Methods:The clinical data of 68 patients with PHCC undergoing surgery in the Department of Pancreatic and Metabolic Surgery of Nanjing Drum Tower Hospital, Affiliated to the Medical School of Nanjing University, from April 2014 to December 2022 were retrospectively analyzed, including 46 males and 22 females, aged (63±9) (range, 39-80) years old. The patients were divided into two groups based on whether the first drainage was successful: successful group ( n=34) and failed group ( n=34). The patient's age, gender, first drainage, complications and other clinical data were collected. Patients were followed up by outpatient or telephone review. Kaplan-Meier method was used for survival analysis, and log-rank test was used for survival comparison. Results:Compared to the successful group, the drainage time [41(28, 52) d vs. 20(14, 28) d], the drainage tube adjustment rate [32.4%(11/34) vs. 0(0/34)], and the incidence of complications after drainage [88.2% (30/34) vs. 0(0/34)] were all increased in the failed group, with the adjustment rate of drainage position decreased [82.4%(28/34) vs. 100%(34/34)] (all P<0.05). Compared to the successful group, the incidence of abdominal infection was higher [70.6%(24/34) vs. 44.1%(15/34)] in the failed group ( P=0.027). The 5-year cumulative survival rates of the failed group and the successful group were 61.4% and 44.1%, respectively ( P>0.05). Conclusion:Compared to the patients of PHCC with first successful drainage, the risk of abdominal infection is increased when first drainage failed, while the incidence of postoperative complications, in-hospital mortality and long-term survival rate are comparable.