Exploitation sexuelle des mineurs et traumatisme : revue narrative de littérature

ObjectiveThe sexual exploitation of minors is a multifaced phenomenon with deleterious consequences on the mental health of the children and adolescents who are victims. The traumatic dimension infiltrates this problem, both concerning the antecedents and the situations of sexual exploitation themselves and their psychological sequelae. This article aims to gather and discuss the current literature about the trauma in the sexual exploitation of minors.MethodA keyword and date (between 2010 and 2020) search was made on the search engine Summon 2.0 for articles on commercial sexual exploitation of children and trauma.ResultsTwenty-one articles were studied according to three lines of research, namely: (1) profiles of sexually exploited minors; (2) the traumatic consequences of sexual exploitation; (3) cares and treatments: from identification to therapy.DiscussionThese studies have some limitations. Validity, recruitment and representativeness biases, inherent in this specific population, are discussed. Recommendations for further research and practice were made.ConclusionThis narrative literature review highlights the difficulty of studying this population and insists on the need to carry out further national research with the aim to improve the understanding of commercial sexual exploitation of children in France and to experiment trauma-informed support and care devices, particularly those designed for the needs of these young people in great difficulty.     

我国Medical Mall空间设计初探

概述了Medical Mall的概念、模式及推动因素,从地理位置、建筑形态、业态分布和"医疗+商业"融合方面对其进行了总结。并围绕功能流线和个性化医疗空间两个方面对Medical Mall的空间设计特点进行分析,旨在为我国Medical Mall的建设与发展提供参考。     

高端医疗服务发展的国际经验与启示

高端医疗服务业是健康服务业发展的关键领域,但由于公立医院特需服务不断扩张、社会办医政策存"玻璃门"等原因,我国高端医疗服务业的发展尚处于初期阶段。事实上,高端医疗服务业在部分国家(特别是发达国家)已经初具规模,并在发展基础、运营模式、保障体系等方面积累了比较丰富的经验。本研究介绍了英国、美国、德国、新加坡、澳大利亚和印度发展高端医疗服务业的经验:建立国家安全网医院起兜底作用,实行分层定价和差异化补贴政策,借助商业健康保险,运用公私合作模式,优先发展若干领域。并结合我国实际情况,提出我国发展高端医疗服务业的启示:在确保基本医疗服务的前提下,实行有差别的支付政策;推广商业健康保险,拓展公私合作,确定发展高端医疗的优先领域。     

A developed HPLC method for the determination of Alogliptin Benzoate and its potential impurities in bulk drug and tablets

Alogliptin (AGLT), active ingredient of Alogliptin Benzoate (AGLT-BZ), is a new dipeptidyl peptidase-4 (DPP-4) inhibitor for the treatment of type 2 diabetes. This study aimed to build a suitable method to determine the potential related substances in AGLT-BZ bulk drug and tablets. Seven related substances in Alogliptin Benzoate substances were synthetized and identified by ¹H-NMR and ESI-MS. In addition, the impurities were detected by a gradient reverse-phase high performance liquid chromatography (RP-HPLC) with UV detection. The chromatographic system consisted of an Angilent Zobax SB-CN column (250 × 4.6 mm; 5 μm). The mobile phase consisted of water/acetonitrile/trifluoroacetic acid 1900:100:1 v/v/v (solution A) and acetonitrile/water/trifluoroacetic acid 1900:100:1 v/v/v (solution B) using a gradient program at a flow rate of 1.0 ml/min with 278 nm detection and an injection volume of 20 μl. Additionally, selectivity, the limit of quantitation (LOQ) and limit of detection (LOD), linearity, accuracy, precision and robustness were determined. Linearity was good over the concentration range 50–1000 ng/ml and the coefficient of determination (R²) were 0.9991–0.9998. RSD% of the determination of precision were <2% (n = 6). The method of RP-HPLC for the determination of impurities in AGLT-BZ was proved to be precise, accurate, robust and reliable. Three batches of self-made bulk drug and three dosages of commercial tablets were detected with this method.     

The Initial Electrocardiographic Pattern in Acute Myocardial Infarction

Background: The ECG is the most widely used accessory for early diagnosis and risk stratification of patients with acute myocardial infarction (AMI). Previous studies have concentrated on the association between either the number of leads with ST segment deviation (elevation and depression) or the total amount of ST segment elevation and/or depression and prognosis. However, the results are conflicting. Methods: A different method is to use the grades of ischemia as an estimate of infarct or size and prognosis. Grade I ischemia is defined as tall peak T waves with < 0.1 mV ST segment elevation; grade II as ST segment elevation with positive T waves, without distortion of the terminal portion of the QRS; and grade III as ST segment elevation, positive T waves, and distortion of the terminal portion of the QRS. Grade III ischemia on the admission ECG is associated with larger final infarct size and increased mortality. Results: In patients with inferior wall AMI, especially those with prior infarction, the pattern of precordial ST segment depression is even more important and maximal ST depression in V4-V6 is associated with high mortality. Moreover, meticulous interpretation of the initial ECG pattern provides information about the probable site of the culprit obstructive coronary lesion. Conclusion: Thus, the admission ECG of AMI can assist not only in diagnosis, but also in estimation of infarct size, correlation with the underlying coronary anatomy and risk stratification.     

Pharmacotherapy for the treatment of vaginal atrophy

Introduction: Despite its frequency, recognition and therapy of vulvovaginal atrophy (VVA) remain suboptimal. Wet mount microscopy, or vaginal pH as a proxy, allows VVA diagnosis in menopause, but also in young contraception users, after breast cancer, or postpartum. Intravaginal low dose estrogen product is the main therapy. Ultra-low-dose vaginal estriol is safe and sufficient in most cases, even in breast cancer patients, while hyaluronic acid can help women who cannot or do not want to use hormones.

Areas covered: The authors provide an overview of the current pharmaceutical treatment for vulvovaginal atrophy and provide their expert opinions on its future treatment.

Expert opinion: The basis of good treatment is a correct and complete diagnosis, using a microscope to study the maturity index of the vaginal fluid. Minimal dose of estriol intravaginally with or without lactobacilli is elegant, cheap and can safely be used after breast cancer and history of thromboembolic disease. Laser therapy requires validation and safety data, as is can potentially cause vaginal fibrosis and stenosis, and safer and cheaper alternatives are available.