枕骨大孔-第二颈段血管周细胞瘤1例报道并文献复习

目的:探讨血管周细胞瘤的临床病理学特点及诊断要点.方法:对1例血管周细胞瘤进行临床资料、病理形态学及免疫组化观察,并结合文献对其诊断及鉴别诊断进行探讨.结果:本例镜下观肿瘤细胞为梭形,血管丰富,形成弥漫的网状结构,鹿角状的血管将肿瘤细胞分割小叶状,瘤细胞体积较大,胞浆丰富,边界不清,核呈圆形、卵圆形,病理性核分裂相多.免疫组化染色结果显示肿瘤细胞Vimentin(+)、CD34(+)、FVIII(+)、S-100(?)、CEA(?)和GFAP(?).结论:血管周细胞瘤,非常少见,因此缺乏对其认识,从而易与其他肿瘤混淆导致误诊.提高对血管周细胞瘤的认识,对避免误诊是至关重要的.     

谁在为中国中小学生的健康守门?——中小学校医室人员的现状、功能定位及发展方向

目的：通过研究了解目前中小学校医室人员的现状及功能定位,分析当前健康服务能否满足需求,并就中小学校医室的发展方向提出建议。方法：采用分层抽样方法选择6省18县的中小学校,采取网络问卷和现场访谈结合的调研方式获取数据资料,结合定量与定性研究方法进行描述分析。结果：中小学校医室人员以大学本科及以上学历为主,但多为兼职。工作内容以健康教育、传染病预防、急救为主,在心理咨询、学生健康体质监测方面较为缺乏。未来校医室的发展依赖教育部门与卫生部门的多方合作、校医室及其人员功能的明确定位、校医队伍的培训及发展途径的改善。     

建立针灸特色辨证论治体系，提供针灸临床诊疗思维模式--《针灸临床技能实训》学习体会

通过学习《针灸临床技能实训》下篇“针灸临床诊治思维”,体会到该书有以下主要特点：突出针灸四诊特点,强调经络腧穴诊察;注重中西医结合,适应现代临床需求;旨在探讨建立针灸特色辨证论治理论体系;指导学生形成具有针灸特色的临床诊疗思维模式。该教材突出了以实践技能为主线,以临床思辨为核心的教学方法,对提高学生的临床思维、临证分析能力有较大帮助。     

口腔科患者电子病历程序的建立

目的通过系统结构设计、专家指标论证等方式,建立起有循证医学意义的口腔疾病病案管理系统框架图和口腔科患者病案管理系统的电子程序。方法使用模拟退火模型收录可能的诊断指标、治疗指标、复查指标,使用9分度专家打分法分别建立三个指标的层次分析模型,对于三个指标进行分层,并运用ACCESS+ASP技术构建网络框架体系。结果设计出的口腔科电子病历管理网站可包涵四大业务模块:面向患者模块;面向医生模块;费用管理;数据模块。结论口腔门诊电子病历管理网站的建立能很好地保证病案的完整性,系统地进行口腔疾病统计,促进口腔医患互动和圈内病例的交流学习。     

胃肠胰神经内分泌肿瘤临床病理特征及预后分析

目的 分析胃肠胰神经内分泌肿瘤的临床及病理特点。 方法 收集本院病理诊断为胃肠胰神经内分泌肿瘤的病例15例,按照2010年第4版《WHO消化系统肿瘤分类》标准进行病理复核,回顾分析其临床资料,总结其临床及病理特点。 结果 15例胃肠胰神经内分泌肿瘤中,中位发病年龄为56岁。发病部位多见于食管,其次为胰腺,CgA阳性率为73%,Syn阳性率为87%,分期为IV期及病理分级为3级的患者预后差。 结论 胃肠胰神经内分泌肿瘤具有很高的异质性,临床分期及分级是主要的预后因素,早期诊断及治疗可改善患者预后。     

Pro-equity immunization and health systems strengthening strategies in select Gavi-supported countries

BackgroundAchieving universal immunization coverage and reaching every child with life-saving vaccines will require the implementation of pro-equity immunization strategies, especially in poorer countries. Gavi-supported countries continue to implement and report strategies that aim to address implementation challenges and improve equity. This paper summarizes the first mapping of these strategies from country reports.MethodsThirteen Gavi-supported countries were purposively selected with emphasis on Gavi’s priority countries. Following a scoping of different documents submitted to Gavi by countries, 47 Gavi Joint Appraisals (JAs) for the period 2016–2019 from the 13 selected countries were included in the mapping. We used a consolidated framework synthesized from 16 different equity and health systems frameworks, which incorporated UNICEF’s coverage and equity assessment approach – an adaptation of the Tanahashi model. Using search terms, the mapping was conducted using a combination of manual search and the MAXQDA qualitative analysis tool. Pro-equity strategies meeting the inclusion criteria were identified and compiled in an Excel database, and then populated on a tableau visualization dashboard.ResultsIn total, 258 pro-equity strategies were implemented by the 13 sampled Gavi-supported countries between 2016 and 2019. The framework determinants of social norms, utilization, and management and coordination accounted for more than three-quarters of all pro-equity strategies implemented in these countries. The median number of strategies reported per country was 17. Afghanistan, Nigeria, and Uganda reported the highest number of strategies that we considered as pro-equity.ConclusionFindings from this mapping can be useful in addressing equity gaps, reaching partially immunized, and ‘zero-dose’ vaccinated children, and valuable resource for countries planning to implement pro-equity strategies, especially as immunization stakeholders reimagine immunization delivery in light of COVID-19, and as Gavi finalizes its fifth organizational strategy. Future efforts should seek to identify pro-equity strategies being implemented across additional countries, and to assess the extent to which these strategies have improved immunization coverage and equity.     

Patient Preferences of Primary Care Support to Increase Physical Activity

A free clinic in rural New England recently implemented an exercise prescribing program. As a follow-up, a pilot survey questionnaire was sent by mail to a sample of 206 patients to assess their preferences for support of physical activity efforts. A total of 57 surveys were returned for a response rate of 28%. Patients preferred low-impact, low-cost, and low-intensity physical activity. Survey respondents identified no clear preference for group activity versus individual activity. Key findings included patient preferences for the use of low-fidelity education materials, a fitness advisor, and peer support to encourage physical activity.     

明胶海绵微粒TACE治疗Barcelona临床肝癌分期B期肝细胞癌对外周血中髓系来源抑制性细胞的影响

目的探讨应用明胶海绵微粒TACE(GSMs-TACE)治疗Barcelona临床肿瘤(BCLC)分期B期肝细胞癌(HCC)对患者外周血中髓系来源抑制性细胞(MDSCs)的影响。方法对5例临床确诊为BCLC B期的HCC患者(HCC组)行GSMs-TACE治疗。采用流式细胞仪分别检测患者术前、术后10天及术后30天外周血中MDSCs频率(即MDSCs细胞团占HLA-DR~-细胞群的比例)。另收集7名健康志愿者(正常对照组),于HCC组术前同期进行MDSCs频率检测。比较HCC患者术前及术后不同时间MDSCs频率的差异及HCC组术前与正常对照组同期MDSCs频率的差异。结果 HCC组GSMs-TACE术前外周血中MDSCs频率为(30.26±12.12)%,术后10天降至(10.22±3.79%),术后30天降至(7.33±3.38)%,总体差异有统计学意义(P0.001);两两比较显示术后30天(P0.001)及术后10天(P=0.011)均明显低于术前。HCC组术前MDSCs频率明显高于正常对照组同期水平[(30.26±12.12)%vs (3.41±1.89)%,t=5.876,P0.001)。结论 BCLC B期HCC患者经GSMs-TACE治疗后外周血中MDSCs频率显著降低;GSMs-TACE对患者的机体免疫功能具有正向调节作用。     

Comparison of Drug-Eluting Embolics versus Conventional Transarterial Chemoembolization for the Treatment of Patients with Unresectable Hepatocellular Carcinoma: A Cost-Effectiveness Analysis

PurposeTo compare the cost-effectiveness of using doxorubicin-loaded drug-eluting embolic (DEE) transarterial chemoembolization versus that of using conventional transarterial chemoembolization for patients with unresectable hepatocellular carcinoma (HCC).Materials and MethodsA decision-analysis model was constructed over the lifespan of a payer’s perspective. The model simulated the clinical course, including periprocedural complications, additional transarterial chemoembolization or other treatments (ablation, radioembolization, or systemic treatment), palliative care, and death, of patients with unresectable HCC. All clinical parameters were derived from the literature. Base case calculations, probabilistic sensitivity analyses, and multiple two-way sensitivity analyses were performed.ResultsIn the base case calculations for patients with a median age of 67 years (range for conventional transarterial chemoembolization: 28–88 years, range for DEE-transarterial chemoembolization: 16–93 years), conventional transarterial chemoembolization yielded a health benefit of 2.11 quality-adjusted life years (QALY) at a cost of $125,324, whereas DEE-transarterial chemoembolization yielded 1.71 QALY for $144,816. In 10,000 Monte Carlo simulations, conventional transarterial chemoembolization continued to be a more cost-effective strategy. conventional transarterial chemoembolization was cost-effective when the complication risks for both the procedures were simultaneously varied from 0% to 30%. DEE-transarterial chemoembolization became cost-effective if the conventional transarterial chemoembolization mortality exceeded that of DEE-transarterial chemoembolization by 17% in absolute values. The two-way sensitivity analyses demonstrated that conventional transarterial chemoembolization was cost-effective until the risk of disease progression was >0.4% of that for DEE-transarterial chemoembolization in absolute values. Our analysis showed that DEE-transarterial chemoembolization would be more cost-effective if it offered >2.5% higher overall survival benefit than conventional transarterial chemoembolization in absolute values.ConclusionsCompared with DEE-transarterial chemoembolization, conventional transarterial chemoembolization yielded a higher number of QALY at a lower cost, making it the more cost-effective of the 2 modalities.