Variability in non-core vaccination rates of dogs and cats in veterinary clinics across the United States

Vaccination guidelines for dogs and cats indicate that core vaccines (for dogs, rabies, distemper, adenovirus, parvovirus; for cats, feline parvovirus, herpes virus-1, calicivirus) are essential to maintain health, and that non-core vaccines be administered according to a clinician’s assessment of a pet’s risk of exposure and susceptibility to infection. A reliance on individual risk assessment introduces the potential for between-practice inconsistencies in non-core vaccine recommendations. A study was initiated to determine non-core vaccination rates of dogs (Leptospira, Borrelia burgdorferi, Bordetella bronchiseptica, canine influenza virus) and cats (feline leukemia virus) in patients current for core vaccines in veterinary practices across the United States. Transactional data for 5,531,866 dogs (1,670 practices) and 1,914,373 cats (1,661 practices) were retrieved from practice management systems for the period November 1, 2016 through January 1, 2020, deidentified and normalized. Non-core vaccination status was evaluated in 2,798,875 dogs and 788,772 cats that were core-vaccine current. Nationally, median clinic vaccination rates for dogs were highest for leptospirosis (70.5%) and B. bronchiseptica (68.7%), and much lower for canine influenza (4.8%). In Lyme-endemic states, the median clinic borreliosis vaccination rate was 51.8%. Feline leukemia median clinic vaccination rates were low for adult cats (34.6%) and for kittens and 1-year old cats (36.8%). Individual clinic vaccination rates ranged from 0 to 100% for leptospirosis, B. bronchiseptica and feline leukemia, 0–96% for canine influenza, and 0–94% for borreliosis. Wide variation in non-core vaccination rates between clinics in similar geographies indicates that factors other than disease risk are driving the use of non-core vaccines in pet dogs and cats, highlighting a need for veterinary practices to address gaps in patient protection. Failure to implement effective non-core vaccination strategies leaves susceptible dogs and cats unprotected against vaccine-preventable diseases.     

微创Chevron-Akin截骨术治疗轻中度拇外翻的早期疗效分析

目的:探讨微创Chevron-Akin(minimally invasive Chevron-Akin,MICA)截骨术治疗轻中度拇外翻的早期临床疗效。方法:自2019年6月至2021年4月,采用MICA截骨术治疗26例(29足)轻中度拇外翻患者,其中男1例,女25例;年龄19~78(38.3±19.5)岁。观察并比较手术前后拇外翻角(hallux valgus angle,HVA),第1、2跖骨间角(intermetatarsal angle,IMA),第1跖骨短缩。末次随访时采用美国骨科足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)前足评分系统及视觉模拟评分(visual analogue scale,VAS)评价治疗效果,并记录相关并发症。结果:26例(29足)均获得随访,时间12~33(19.6±5.1)个月。HVA、IMA分别由术前的(32.3±6.6)°、(11.7±3.2)°矫正为术后的(13.0±5.3)°、(6.1±3.2)°,差异有统计学意义(P<0.01);第1跖骨短缩(2.7±1.1) mm。AOFAS评分由术前的(55.7±7.4)分提高到术后的(88.5±7.9)分(P<0.01),其中优15足,良11足,可3足。VAS由术前的(6.5±1.5)分改善为术后的(0.7±0.4)分(P<0.01)。结论:MICA截骨术创伤小,术后恢复快,并发症率低,并且能有效改善拇外翻畸形,是治疗轻中度拇外翻的安全可靠手术方法。     

逆行髓内钉辅助在儿童股骨延长中的应用

目的采用髓内钉辅助延长技术进行儿童股骨大段延长,评估其可行性,并对比同期矫正和分期手术的技术要点,明确此技术在儿童患儿中的应用价值。方法自2014年7月7日至2018年1月16日共规划完成逆行髓内钉辅助延长手术10例,其中男9例,女1例;年龄(13.10±2.18)岁。所有患儿延长截骨点均位于股骨远端干骺端,初诊至末次随访记录内容包括:性别、出生日期、不等长病因及治疗史、术时年龄、延长长度、带架时间、延长段愈合时间、屈膝角度、并发症等。比较同期延长和分期矫正的愈合时间,采用SPSS 22.0软件进行统计分析,提出合理的治疗策略。结果10例患儿患肢平均延长(7.07±1.01)cm,中位带架时间为8.5(4,16)个月,中位随访时间为39(34,54)个月。所有病例均获得了良好的临床和影像学愈合,并全部恢复正常行走功能,无延长后骨折发生。同期矫正与分期手术间在愈合速度为[(1.70±1.10)月/cm vs.(1.16±0.54)月/cm],膝关节功能(136.67°±20.82°vs.125.71°±26.37°)和并发症率方面的差异均无统计学意义。结论外固定架辅助逆行髓内钉技术进行股骨延长治疗儿童股骨短缩畸形是可行的,是股骨延长的有效手术方式之一;较轻的角度畸形和延长手术可同期进行;干骺端截骨延长成骨质量更佳,可有效减少带架时间;内生软骨瘤患儿的病变区延长是安全的。     

基于钚内照射剂量重建的尿钚分析方法

钚的内照射剂量可通过生物样本的测定结果和摄入滞留或排泄函数修正的办法来确定。本文从原理、方法学、在剂量重建中的应用几方面综述了尿钚分析方法。尿钚分析方法主要包括α谱仪分析方法、裂变径迹分析方法，电感耦合等离子体、热电离、加速器等质谱分析方法，每种方法优势不同。本文可为基于钚内照射剂量重建尿钚分析方法的选择提供参考。     

L’importance du discours intérieur dans la sémiologie psychiatrique

ObjectivesEntangled in a semiology that aspires to imitate medical semiology, psychiatry does not take seriously enough the question of internal discourse, while many psychiatric phenomena relate to the articulation between internal discourse and external discourse.The intention of this article is to draw the attention of psychiatry to the issue of internal discourse, which is insufficiently addressed within the discipline. Psychiatric semiology should be more interested in and should approach this issue of internal discourse differently. For this, it could integrate the contribution of modern linguistics and rediscover Jacques Lacan's theory of language.MethodThe article first recalls the basic principles of psychiatric semiology based on the work of Lanteri-Laura, Henri Ey, and, more recently, that of Steeves Demazeux. He shows how psychiatry has moved from a classical semiology based on the body to that of mental faculties, more or less attached to bodies. The question of internal discourse does not find its place in these approaches.DiscussionHallucinations, delusions, obsessive and melancholy ruminations… All these phenomena are related to the question of inner speech. This does not mean that they are similar or should be approached in a comparable way.ConclusionHuman beings seem to be both speaking through their outwardly directed speech and partly spoken, through their internal speech. This must be taken into account not only from a semiological point of view but also when it comes to organizing care.     

论中医多学科融合的发展路径--从《黄帝内经》谈起

从《黄帝内经》成书与多学科的关系角度出发,探讨中医学学科体系形成的客观原因,认为构建中医理论的经典著作《黄帝内经》的面世有深刻的时代烙印,是当时多学科融合的必然产物。开放包容并不断吸收多学科的学术成果不仅是中医学发展的规律和内在动力,对解决目前中医学的发展困境亦有重要的借鉴意义。当下的中医药科研工作者,应该借助现代科学技术来研究和解读中医,把宝贵的医学经验继承好、发展好、利用好。     

《黄帝内经》水模型化推理研究

模型化推理是指以模型特别是思维模型为中介或工具,由一个或几个前提推出结论的思维方法。《黄帝内经》由于其历史条件的限定,较多地采用了天然实物模型进行推理,而水与人类生活密切相关,自然也就成了人类认识事物乃至人体生命活动的最为普遍的天然模型。通过阐述水模型与《黄帝内经》血脉气血循环、经脉气血运行、十二经脉体系建构、六淫病因认识、气血津液病机以及相关临床诊治思维的关系,分析指出《黄帝内经》天然模型化推理具有直观性、经验性、功能性、非结构性、整体全息性、时序性等特征。     

内热针松解术治疗腰椎间盘突出症的疗效与安全性

目的 对内热针松解术治疗腰椎间盘突出症的疗效与安全性进行评价。方法 研究对象为我院2019年1月～2020年1月期间收治的50例腰椎间盘突出症患者，按照数字表法将其随机分为实验组与对照组，每组各25例，实验组使用内热针松解术进行治疗，对照组使用常规理疗进行治疗。对比分析两组患者VAS评分、SF-36评分、不良反应发生情况。结果 两组患者治疗1个月后与治疗3个月后的VAS评分显著低于治疗前、SF-36的各维度评分显著高于治疗前（P＜0.05），且实验组显著优于对照组（P＜0.05）；实验组不良反应总发生率显著低于对照组（P＜0.05）。结论 在腰椎间盘突出症治疗中使用内热针松解术，可有效减轻患者疼痛，提高患者生活质量，降低不良反应发生率，安全性良好，疗效显著。