面动脉穿支螺旋桨皮瓣修复上唇皮肤恶性肿瘤切除后创面

目的探讨面动脉穿支螺旋桨皮瓣修复上唇皮肤恶性肿瘤切除后创面的疗效。方法2012 年 7 月—2017 年 1 月，收治上唇皮肤恶性肿瘤 17 例。男 3 例，女 14 例；年龄 35～82 岁，平均 57 岁。其中鳞状细胞癌 5 例，基底细胞癌 12 例。病程 4 个月～11 年，平均 20 个月。肿瘤范围 1.4 cm×0.3 cm～3.1 cm×1.4 cm。术中扩大切除肿瘤后，根据创面位置、大小、形状及超声多普勒探查血管情况设计面动脉穿支螺旋桨皮瓣，以穿支动脉所在位置为旋转点切取皮瓣修复创面及部分供区，皮瓣切取面积为 5 cm×2 cm～7 cm×3 cm；穿支血管蒂长度为 0.5～1.0 cm，平均 0.8 cm。供区直接拉拢缝合。结果术后 3 例皮瓣远端出现青紫，经对症处理后愈合；其余皮瓣均顺利成活，创面 Ⅰ 期愈合。供区切口均 Ⅰ 期愈合。患者均获随访，随访时间 6～36 个月，平均 18 个月。患者上唇形态良好，供区无明显瘢痕，无口角畸形、嘴唇歪斜、鼻翼偏移，张、闭口口裂基本对称，面部无紧绷感，鼻腔通气无影响。随访期间肿瘤无复发。末次随访，患者自评满意度达非常满意 13 例、满意 4 例。结论面动脉穿支螺旋桨皮瓣具有血供好、旋转幅度大、色泽与受区相似、供区损伤小等优点，用于修复上唇皮肤恶性肿瘤切除后创面不仅能恢复良好功能，还能实现理想的美学修复。     

Innovation in Chemistry,Manufacturing, and Controls—A Regulatory Perspective From Industry

This review describes the landscape of novel modalities such as cell and gene therapies, viruses, other novel biologics, oligomers, and emerging technologies, including modern analytics. We summarize the regulatory history and recent landmark developments in some major markets and examine specific chemistry, manufacturing, and controls (CMC) challenges, including suggestions for exploration of potential science-based approaches in support of regulatory strategy development from an industry perspective. In addition, we evaluate the economic factors contributing to patient access to innovation and discuss the impact of regulation. There is a desperate need for a consistent form of regulation where global approaches to regulatory strategies can be harmonized, and specific CMC challenges can be dealt with using the appropriate science and risk-based tools. Although these tools are well described in current guidance documents, the specifics of applicability to complex novel modalities can still result in differing regulatory advice and outcomes. The future goals for efficiently regulating innovative modalities and technologies could be aided by more regulatory harmonization, regulatory education, and industry cooperation through consortia, enabling industry to supply key information to regulators in a transparent yet well-defined manner, and utilizing mutually understood risk-benefit analyses to produce drugs with appropriate safety, efficacy, and quality characteristics.     

膝关节自体软骨细胞移植术后康复的研究进展

目的总结膝关节自体软骨细胞移植术（autologous chondrocyte implantation，ACI）术后康复的研究进展。方法查阅近年来国内外 ACI 术后康复相关的基础及临床研究，并进行总结分析。结果研究表明，ACI 术后移植物成熟分为 4 个阶段：增生期（术后 0～6 周）、过渡期（术后 6～12 周）、重塑期（术后 12～26 周）、成熟期（术后 26 周～2 年）。为了避免早期移植物损伤，适当刺激移植物和骨骼的整合过程，更快恢复关节功能，临床需针对术后不同阶段移植物的生物力学特性设计康复锻炼方案，主要体现在术后负重、运动范围、康复训练方式的过渡和调整。结论膝关节 ACI 术后应科学地逐步增加负重和运动范围，在不同阶段可借助相应的康复锻炼手段。但目前相关研究的证据等级较低，仍需更高质量、更大样本量的随机对照试验，进一步探讨完善康复方案。     

选择性修薄股前外侧皮瓣修复足跟及足跟后区缺损

目的探讨选择性修薄股前外侧皮瓣修复足跟及足跟后区缺损的疗效。方法2013 年 4 月—2015 年 8 月，收治 8 例不同原因导致的足跟及足跟后区缺损患者。男 6 例，女 2 例；年龄 15～49 岁，平均 31.2 岁。创面范围为 14 cm×10 cm～19 cm×14 cm。手术切取对侧股前外侧皮瓣，将拟覆盖足底非承重区和足跟后区部分行不同程度修薄。皮瓣切取范围为 14 cm×10 cm～19 cm×14 cm。供区游离植皮修复。结果术后皮瓣均顺利成活，创面 Ⅰ 期愈合。2 例发生供区局部皮片坏死，经换药后愈合；其余植皮均顺利成活。患者均获随访，随访时间 8～20 个月，平均 12.3 个月。患者恢复正常行走，其中 2 例皮瓣发生破损，经换药后自愈。7 例皮瓣外观无臃肿，不影响穿鞋；1 例于术后 1 年行二期皮瓣修薄术。结论选择性修薄股前外侧皮瓣修复足跟及足跟后区缺损，可获得较理想足部外观和功能。     

Translating vaccine policy into action: A report from the Bill & Melinda Gates Foundation Consultation on the prevention of maternal and early infant influenza in resource-limited settings

Immunization of pregnant women against influenza is a promising strategy to protect the mother, fetus, and young infant from influenza-related diseases. The burden of influenza during pregnancy, the vaccine immunogenicity during this period, and the robust influenza vaccine safety database underpin recommendations that all pregnant women receive the vaccine to decrease complications of influenza disease during their pregnancies. Recent data also support maternal immunization for the additional purpose of preventing disease in the infant during the first six months of life.     

Does injury claim status and benefit status predict low back pain outcomes?

Background

In New Zealand the Accident Compensation Corporation (ACC) is a state-funded insurance agency that accepts claims for accidental injuries, including lumbar spine injuries. It is unknown whether ACC claim status (accepted, not accepted) affects low back pain (LBP) outcomes, or whether benefit status (e.g., sickness, disability) further affects outcomes in patients without ACC cover

Aims

This study aimed to determine whether ACC claim and benefit status are likely to influence a range of outcomes for people with LBP in New Zealand.

Methods

A prospective survey of low back pain patients was performed (April 2008–October 2010). ACC claim status was recorded, and individuals without accepted claims indicated benefit status. Surveys were sent at multiple time points; pain, functional limitation, psychological factors, and general health were assessed. Statistical analysis was undertaken using ANCOVA and ANOVA (p<0.05).

Results

In total, 168 patients completed the study. Six-month measures showed individuals with no ACC claim for LBP to overall have poorer outcomes (mental health, p=0.039; pain, p=0.045; functional limitation, p=0.049); sub-group analysis (no ACC claim) between those with or without a benefit showed those on benefits to have significantly higher functional limitation (p<0.001), poorer physical health (p=0.002), greater pain (p=0.027), and stronger fear avoidance behaviours for both work (p=0.047) and physical activity (p=0.35).

Conclusion

Findings indicate individuals with accepted ACC claims for LBP have significantly better outcomes than those without, and patients on benefits with no accepted ACC claim for LBP have even poorer outcomes.     

Evaluation of a policy to strengthen case management and quality of diabetes care in general practice in Denmark

ObjectivesTo evaluate the utilization of a policy for strengthening general practitioner's case management and quality of care of diabetes patients in Denmark incentivized by a novel payment mode. We also want to elucidate any geographical variation or variation on the basis of practice features such as solo- or group practice, size of practice and age of the GP.MethodsOn the basis registers encompassing reimbursement data from GPs and practice specific information about geographical location (region), type of practice (solo- or group-practice), size of practice (number of patients listed) and age of the GP were are able to determine differences in use of the policy in relation to the practice-specific information.ResultsAt the end of the study period (2007–2012) approximately 30% of practices have enrolled extending services to approximately 10% of the diabetes population. There is regional – as well as organizational differences between GPs who have enrolled and the national averages with enrolees being younger, from larger practices and with more patients listed.ConclusionsOur study documents an organizationally and regionally varied and limited utilization with the overall incentive structure defined in the policy not strong enough to move the majority of GPs to change their way of delivering and financing care for patients with diabetes within a period of more than 5 years.     

大病医疗保险补偿模式及补偿效果分析——以L市为例

目的:分析西部L市农村居民大病医疗保险补偿模式及补偿效果,为完善和推广科学的大病医疗保险补偿模式提出可行性建议。方法:对补偿模式进行政策分析,运用受益率、患者自付费用、实际补偿比等指标分析大病医疗保险实施效果。结果:2013年L市大病医疗保险受益率为3.2%,基金使用率为92%,不同区县基金使用率差异较大。实行大病保险后患者自付费用下降明显,该市大病医疗保险和新农合累计实际补偿比达到84.8%,其中新农合实际补偿比已达68.9%,但同时新农合基金出现赤字。结论与建议:科学设置起付线、补偿比例、补偿范围,取消封顶线,完善大病医疗保险补偿方案;采取措施减少大病医疗保险地市统筹带来的各区县之间的不公平;实现大病医疗保险补偿模式和新农合补偿模式的有效衔接。     

北京市新农合大病保险实施效果分析与评价

目的:测算分析北京市新农合大病保险对患者疾病经济负担的减轻作用,对制度实施效果进行评价。方法:按照经济发展水平和大病保险承办方式选取北京市三个区县,再从中选择大病患者较多的2~3个乡镇。通过与大病保险管理者进行访谈,了解其运行现状;对样本乡镇全部大病患者进行问卷调查了解患者主观感受,收到有效问卷497份。利用新农合管理中心信息平台测算患者疾病经济负担。对定量和定性资料分别采用统计分析与主题框架法进行分析。结果:经大病保险报销,三个区县大病患者平均自付费用明显减轻,实际补偿比均有不同程度的提高,但灾难性卫生支出情况无显著改善。结论:应通过提高大病保险起付线与报销比例,拓宽报销目录等举措提高其补偿水平,重点缓解极重患者疾病经济负担。