The impact of medical insurance and old-age security on the utilization of medical services by the older population with disabilities.

OBJECTIVE: In this study, the impact of medical insurance and old-age security on the use of medical services by the older population with disabilities is analyzed. A reference for decision makers is provided to improve medical and old-age security policies and enhance the use of medical services by the older population. METHODS: Data were drawn from 3,737 older people with disabilities aged 65 years or above from the 2018 China Longitudinal Healthy Longevity Survey. A two-part model based on social ecological theory was used for both analysis and group prediction. RESULTS: In terms of the use of outpatient medical services, old-age pension significantly increased the probability of outpatient visits for this population group (P < 0.05). Urban employee/resident medical insurance, the new rural cooperative medical insurance, and retirement pension significantly affected medical expenses. In terms of the use of inpatient medical services, the new rural cooperative medical insurance and retirement pension significantly influenced the choice of inpatient medical services; retirement pension increased inpatient medical expenditure (p < 0.01). The expected average probability of hospitalization, unconditional expected cost, and conditional expected cost for the older population with disabilities were 49.5%, RMB 6629.31, and RMB 3281.51, respectively. Both conditional and unconditional expected costs were significantly higher for older people with disabilities with the following attributes: male, married, no less than three chronic conditions, and unassisted daily care; costs were lower for older people with disabilities who are female, not married, had less than three chronic conditions, and had a spouse, child, or other caregiver. CONCLUSION: Medical insurance and old-age security can significantly promote the utilization of medical services by the older population with disabilities. It is therefore recommended to focus on strengthening the support and health management of these people who are unattended to improve the effective use of health services and better meet their needs.

Using Ultrasonography to Evaluate the Relationship between Capsular Invasion or Extracapsular Extension and Lymph Node Metastasis in Papillary Thyroid Carcinomas.

BACKGROUND: Previous studies have demonstrated that ultrasonography is the recommended imaging modality for preoperative staging of papillary thyroid carcinomas (PTCs). However, only a few studies have kept watch on preoperative evaluation of capsular invasion (CI) or extracapsular extension (ECE) and cervical lymph node metastasis using preoperative ultrasonography. This study aimed to investigate the relationship between the CI or ECE and the cervical lymph node metastasis in PTCs using preoperative ultrasonography and postoperative pathology in Chinese patients. METHODS: The data of preoperative ultrasonography and postoperative pathology of 166 patients who had a definitive diagnosis of PTCs from October 2011 to July 2014 at Xuanwu Hospital, Beijing were collected and reviewed. Preoperative ultrasonic parameters of thyroid nodules were compared with those of postoperative pathological diagnoses. All the patients were divided into bilateral PTCs group (n = 42, 78 nodules) and unilateral PTCs group (n = 124, 124 nodules), and the data of the nodule sizes, CI or ECE, and cervical lymph node metastasis by preoperative ultrasonography were compared between two groups. RESULTS: A total of 202 nodules of 166 patients which were confirmed by preoperative ultrasonography and postoperative pathology were analyzed. Hypoechogenicity (n = 201, 99.5%) and irregular margins (n = 167, 82.7%) were the main ultrasonic characteristics of PTCs. A significant moderate agreement between preoperative ultrasonic examination and postoperative pathology for CI or ECE (κ = 0.622, P< 0.001) was observed. The diagnostic sensitivity was 92.0%, and specificity was 71.1%. In bilateral PTCs group, 81.0% had CI or ECE, and 61.9% had cervical lymph node metastasis. In unilateral PTCs group, 76.6% had CI or ECE, and 58.1% had cervical lymph node metastasis. There were no significant differences in the incidence of CI or ECE and cervical lymph node metastasis between two groups (all P > 0.05). CONCLUSIONS: Ultrasonography was proved to be a valuable method for preoperative diagnosis of PTCs. Hypoechogenicity and irregular margins were strongly associated with PTCs. CI or ECE in unilateral PTCs strongly implied the cervical lymph node metastasis. Therefore, the cervical lymph nodes should be carefully examined by ultrasonography in patients with PTCs.

[Evaluation of left ventricular myocardial function in coronary atherosclerosis patients with type 2 diabetes mellitus by speckle tracking echocardiography].

OBJECTIVE: To evaluate the left ventricular (LV) myocardial function in coronary atherosclerosis patients with type 2 diabetes mellitus (DM) by two-dimensional speckle tracking echocardiography (2D STE). METHODS: A total of 60 patients with a diagnosis of coronary atherosclerosis (<50%) were divided into DM and non-DM groups (n = 30 each). And another 30 cases were selected as normal control group. LV regional longitudinal, circumferential and radial peak systolic strain (ε) were measured respectively. RESULTS: EF showed no difference among 3 groups. However the peak systolic longitudinal strain (ε) in LV basal segments, middle segments and apical segments were significantly lower in DM group than those in non-DM and control groups (P < 0.05). The peak systolic circumferential and radial strain parameters showed no significant difference among 3 groups. CONCLUSION: The systolic longitudinal myocardial function of LV become compromised before reduced LV global systolic function in coronary atherosclerosis patients with type 2 diabetes mellitus.

Cadmium uptake and speciation changes in the rhizosphere of cadmium accumulator and non-accumulator oilseed rape varieties.

Characteristics of cadmium (Cd) uptake kinetics and distribution of Cd speciation in the rhizosphere for Cd accumulator and non-accumulator oilseed rape varieties were investigated under nutrient solution and rhizobox soil culture conditions. The results showed that the maximal influx (V(max)) for Cd2+ and Km were significantly different for the two oilseed rape varieties. The value of V(max) for Cd accumulator oilseed rape Zhucang Huazi was two-fold greater than that for oilseed rape Chuan you II-93. The exchangeable Cd concentration in the rhizosphere was significantly lower than in non-rhizospheric soils supplemented with CdSO4 for both the varieties. Carbonate-bound Cd in the rhizosphere of Cd accumulator oilseed rape was significantly higher than that in the rhizosphere of non-accumulator oilseed rape and non-rhizospheric soil. Cd accumulator oilseed rape had a higher Cd2+ affinity and more ability to uptake insoluble Cd in the soil than the non-accumulator oilseed rape.

[Applicable value of ultrasound-guided renal biopsy in diagnosis of kidney diseases].

OBJECTIVE: To explore the applicable value of ultrasound guidance in percutaneous renal biopsy. METHODS: 168 patients with kidney diseases underwent ultrasound-guided renal biopsy. Pathological examination was conducted. Predictors of successful rate were assessed by multivariate logistic regression analysis. RESULTS: Successful biopsy was achieved in 157 of the 168 patients with a success rate of 93.45%. Satisfying results were obtained from 143 of the 157 samples and normal renal tissues were reported in 14 samples. No serious adverse events were observed in this study. The successful biopsy rate of female patients was 89.16%, significantly lower than that of the male patients (97.65%, P < 0.05). Age, puncture times, thickness of renal cortex, and type of clinical diagnosis were not significantly correlated with the successful rate of biopsy. CONCLUSION: Ultrasound-guided renal biopsy is a kind of safe diagnostic method for kidney disease. The successful rate of renal biopsy in females is lower than that in males.