A ‘community enterprise’ model for recreational cannabis: Lessons from alcohol licensing trusts in New Zealand

The legalisation of cannabis on the American continent in recent years has reinvigorated calls for cannabis law reform in many countries. Yet researchers have described potentially negative public health and social impacts of profit driven commercial markets for cannabis. Consequently, they have suggested exploring a number of alternative regulatory options, such as “not-for-profit” or “for-benefit” organisations. However, many of these new models are yet to be developed in detail. This paper presents a “community enterprise” model for recreational cannabis based on the alcohol licensing trusts which have existed in New Zealand for many decades. Alcohol licensing trusts are community-owned entities which operate alcohol retail outlets and return a portion of their profits back to local communities in the form of grants, loans and donations. The principal benefits of the “community trust” model are suppressing the commercial incentive to expand the market, establishing statutory obligations to distribute revenue back to the community, and establishing community governance over alcohol sales. The removal of a strong commercial incentive and community accountability may also contribute to lower levels of availability, higher prices and less harm. A further benefit is providing the local community with some oversight of a trust’s commercial activities via community elections of the trust board and the ability to call a “community poll” to vote on the future existence of the trust. Our proposed community cannabis licensing trust model seeks to address some of the challenges experienced by alcohol licensing trusts in New Zealand, including the lack of general oversight and balancing the commercial and social aims of the trusts. A limitation of this model includes a lack of research and evaluation of the existing alcohol licensing trusts and further research in this area would inform the application of the model to cannabis.     

电针干预周围神经损伤效应及机制的研究

周围神经损伤(PNI)是临床常见病,属于中医“痹证”“痿证”范畴。本着“评价疗效、探寻规律、阐明机制、指导临床”为研究总体思路,天津中医药大学实验针灸学研究中心郭义教授团队与日本铃鹿医疗科学大学石田寅夫教授团队合作,围绕电针治疗周围神经损伤开展了系列研究。明确了电针刺激可促进外周神经再生,早期干预效果更佳,低频电针效果更佳,且对失神经支配所造成的肌肉萎缩也有一定的疗效,肯定了经皮穴位电刺激治疗可显著改善糖尿病患者的临床症状,提高生命质量,可改善病变神经的运动和感觉功能。并从形态学、分子生物学角度明确了其干预机制。研究为临床更好使用电针治疗周围神经损伤提供了科学依据,推动了电针治疗神经损伤的临床应用。     

Once covered,forever covered: The actuarial challenges of the Belgian private health insurance system

The Belgian Law of 20 July 2007 has drastically changed the Belgian private health insurance sector by making individual contracts lifelong with the technical basis (i.e. actuarial assumptions) fixed at policy issue. The goal of the Law is to ensure the accessibility to supplementary health coverage in order to protect policyholders from discrimination and exclusion, essentially when these operate on the basis of age. Due to the unpredictable nature of medical inflation risk and the difficulty to model future increases of health claims, the legislator introduced medical indices together with a specific updating mechanism, which aim at establishing standardized and fair premium adjustments across the sector. This paper considers two major issues of the current Belgian system. The first one is related to the transferability of the reserves, whereas the second one is related to age-discrimination. We discuss these issues and their interplay, and we address the conflict between the goal of the Law and the practical problems arising in the light of the actuarial techniques.     

循经针刺对偏头痛的即刻疗效及其机制探讨

目的:观察循经针刺治疗偏头痛患者的即可疗效,并通过检测降钙素基因相关肽(CGRP)、血浆内皮素(ET)和五羟色胺(5-HT)的表达情况探讨其机制。方法:选取2017年2月至2018年2月天津中医药大学附属武清中医院收治的偏头痛患者85例作为研究对象,根据随机数字表法将患者分为观察组(n=43)和对照组(n=40),排除不良反应的5例,2组均为40例,观察组予以循经针刺法针刺少阳经的角孙、风池、外关、阳陵泉和丘墟穴,对照组予以非经非穴治疗。于治疗前及治疗后0. 5、1、2和4 h进行偏头痛积分和VAS(视觉模拟量表评分)评估;采用放射免疫法检测降钙素基因相关肽(CGRP)和血浆内皮素(ET),利用ELISA(酶联免疫吸附剂测定)检测五羟色胺(5-HT),观察2组患者治疗前和治疗后4 h的表达情况,探讨循经针刺的疗效机制。记录研究过程中存在的不良反应。结果:1)观察组循经针刺对偏头痛的临床有效率是90. 00%,对照组是67. 50%,观察组的临床有效率优于对照组,2组比较差异有统计学意义(P 0. 05)。2) 2组治疗后0. 5、1、2和4 h的偏头痛积分和VAS评分均较治疗前下降(P 0. 05),仅治疗后2 h及治疗后4 h的偏头痛积分和VAS评分较对照组低(P 0. 05)。3) 2组治疗前CGRP和ET的表达差异无统计学意义(P 0. 05);与治疗前比较,2组治疗4 h后均可下调CGRP和ET的表达水平(P 0. 05);观察组治疗后CGRP和ET的下调水平优于对照组(P 0. 05)。4) 2组治疗前5-HT的表达无比较,差异统计学异议(P 0. 05);与治疗前比较,2组治疗4 h后均上调5-HT的表达水平(P 0. 05),其中观察组优于对照组(P 0. 05)。5)研究过程中5例患者出现不良反应,其中观察组出现3例(晕针2例+局部出血1例),对照组2例(晕针1例+局部出血1例)。晕针患者平卧取针后即可恢复,局部出血则以局部按压进行止血处理。整个研究过程中均未出现严重不良反应。结论:循经针刺治疗偏头痛患者的即刻疗效于治疗后0. 5 h症状开始缓解,于治疗后4 h疗效最佳,其即刻疗效可能与上调CGRP和5-HT表达水平和下调ET表达水平有关。     

伤寒论床边教学研究探讨

《伤寒论》是一部理论与实际密切结合的临床专著,是对临床经验的高度总结,学习它的目的之一就是培养学生临床辨证分析的思维方法和能力。本文从《伤寒论》教学效果和床边教学特点出发,重点探讨了开展《伤寒论》床边教学的可行性及必要性。得出,《伤寒论》床边教学存在缺少相关教材和教学设计;床边教学缺乏有力的师资培训,教师队伍良莠不齐;学生的成绩、教师的水平缺乏有效的评价考核方式等问题。希冀能为《伤寒论》教学改革提供相应的思路。     

基于电生理信号的生物医学工程专业课程体系建设

生理电信号作为生物医学工程中的重要信号,其中蕴含了丰富的人体信息。该研究以生理电信号为主线,通过对其信号的学习、获取、分析、处理将生物医学工程的专业课串联起来,使学生将专业知识和实际仪器设计分析结合起来,能较为全面的掌握信号与系统方面的知识,加强学生的实际分析和解决医学问题的能力。     

石榴皮活性成分治疗痤疮作用机制的网络药理学预测及实验研究＊

目的 采用网络药理学及实验验证的方法，探索皮类中药石榴皮治疗痤疮的作用机制。方法 利用网络药理学技术筛选石榴皮治疗痤疮的活性成分和作用靶点，采用String数据库对活性成分靶点与痤疮疾病靶点进行蛋白互作网络分析，并通过David数据库对其结果进行KEGG通路富集分析。基于以上结果，采用Cytoscape3.6.1软件构建石榴皮治疗痤疮的“成分-靶点-通路”网络关系图。通过动物实验，观察石榴皮多酚乳膏对金黄地鼠皮脂腺斑面积及PI3K蛋白表达情况的影响。结果 本研究共获得药效成分31个，药物靶点193个，痤疮靶点1371个，药效成分与疾病的交集靶点79个。石榴皮治疗痤疮的主要成分为槲皮素、山奈酚、木犀草素等；核心靶点为Akt1、IL-6、VEGFA和PTSG2；关键信号通路可能包括PI3K-Akt信号通路、TNF信号通路、T细胞受体信号通路、FoxO信号通路等。体内实验证实，石榴皮能够降低金黄地鼠皮脂腺斑PI3K蛋白表达水平，抗皮脂腺斑增生。结论 本研究预测了石榴皮治疗痤疮可能的作用机制，为“以皮治皮”理论在中医皮肤科的应用提供现代理论依据。     

基于网络药理学和分子对接探讨钩藤-全蝎药对治疗支气管哮喘的作用机制＊

目的通过网络药理学和分子对接探究钩藤-全蝎药对治疗支气管哮喘的药理作用机制。方法通过TCMSP、TCMIP数据库搜集钩藤、全蝎的活性成分及其作用靶点,并使用Cytoscape软件进行可视化分析成分-靶点网。通过OMIM、GeneCards数据库搜集支气管哮喘的疾病靶点,整合钩藤-全蝎药对与支气管哮喘的共有靶点。利用String平台构建对共有靶点互作PPI网络,并进行GO和KEGG富集分析,通过Cytoscape软件构建成分-靶点-通路网络模型。最后通过Autodock分子对接进行验证。结果经过筛选发现钩藤-全蝎药对37个活性化合物和234个药物靶点,与哮喘6010个靶点取交集得到35个共有靶点。钩藤-全蝎包含槲皮素、山奈酚、育亨宾碱、β-谷甾醇等重要活性成分;根据PPI网络分析,核心网络连接度高的潜在治疗靶点有IL6、CASP3、ECFR、ESR1、MAPK8等;根据KEGG富集分析结果显示,钩藤-全蝎药对主要通过PI3 K-Akt信号通路、TNF信号通路,HIF-1信号通路、M APK信号通路、NF-κB信号通路等来治疗哮喘;钩藤-全蝎药对活性成分与核心靶点的分子对接结果均显示出较好的结合活性。结论钩藤-全蝎药对治疗哮喘呈现出多成分、多靶点、多通路的特点,其核心成分槲皮素、山奈酚、育亨宾碱、β-谷甾醇等可能通过CASP3、MAPK8、ESR1、IL6、ECFR等靶点调节多条通路发挥抗炎、调节免疫、抗氧化应激、改善气道重塑等作用,从而对哮喘达到有效的治疗。     

The role of payment and financing in achieving health equity

Objective

The aim was to identify healthcare payment and financing reforms to promote health equity and ways that the Agency for Healthcare Research and Quality (AHRQ) may promote those reforms.

Data Sources and Study Setting

AHRQ convened a payment and financing workgroup–the authors of this paper–as part of its Health Equity Summit held in July 2022. This workgroup drew from its collective experience with healthcare payment and financing reform, as well as feedback from participants in a session at the Health Equity Summit, to identify the evidence base and promising paths for reforms to promote health equity.

Study Design

The payment and financing workgroup developed an outline of reforms to promote health equity, presented the outline to participants in the payment and financing session of the July 2022 AHRQ Health Equity Summit, and integrated feedback from the participants.

Data Collection/Extraction Methods

This paper did not require novel data collection; the authors collected the data from the existing evidence base.

Principal Findings

The paper outlines root causes of health inequity and corresponding potential reforms in five domains: (1) the differential distribution of resources between healthcare providers serving different communities, (2) scarcity of financing for populations most in need, (3) lack of integration/accountability, (4) patient cost barriers to care, and (5) bias in provider behavior and diagnostic tools.

Conclusions

Additional research is necessary to determine whether the proposed reforms are effective in promoting health equity.     

吸烟与冠状动脉微血管功能障碍关系的研究新进展

冠状动脉微血管功能障碍(CMD)是由于冠状动脉微血管功能异常导致心肌供血和耗氧量不匹配,可伴有或不伴有阻塞性冠状动脉疾病等多种心血管疾病,与不良临床事件密切相关。目前有研究表明,吸烟可促进CMD发生发展,但其发生机制尚未明确;同时尚有流行病学研究表明,急性冠状动脉综合征吸烟者的长期预后优于不吸烟者,这种现象被视为吸烟悖论。因此,文章主要对吸烟造成CMD的机制进行综述。