Institutional one health and animal-human health connections in Nthongoni,Eastern Kenya

In recent years, there has been increased global advocacy for the use of a collaborative, multisectoral, and transdisciplinary approach: a One Health approach, with the goal to achieve optimal health outcomes for people, animals and their shared environment. This study explored One Health implementation and practice in Kenya. Further, I used a case study of Nthongoni, a remote rural area in Eastern Kenya, to help us to understand and think about implementation of One Health in an area where mainstream biomedical system runs parallel to or is in conflict with, a deeply entrenched indigenous health system. I used a qualitative research approach including participant observation, and key informant and general respondents' in-depth interviews. Data was transcribed verbatim, translated, checked for consistency and coded for content and thematic analysis. The findings indicate that although Kenya's One Health approach was hailed as a key strategy and a model for other countries in the region, the approach faced significant challenges including insufficient funding, competing priorities and concerns over its sustainability. But while the formal One Health is embroiled in structural and politico-economic influences that curtail its operationalization and success, this study illuminates a lay one health that is part of lived realities in Nthongoni, inviting us to reflect on the place for and status of traditional healers, and meaning of health for people and animals. The study further provokes our thoughts over whether One Health should integrate or do away with traditional health systems, or be abandoned altogether. I argue that incorporating traditional health knowledge and practitioners in One Health might help to make health care more robust and culturally responsive. The work contributes to debates on anthropology of health in general and to anthropological understanding of both the lay one health and the institutional One Health agenda.     

“六气为一气”及其文化内涵

从文理、医理以及文化内涵多角度剖析《灵枢·决气》所载"六气为一气"的思想内涵。精、气、津、液、血、脉"六气"为人体之基础,然同源于"一气",其功能体现了阴阳互根互用。"六气为一气"观的文化内涵包括三个方面:一是在中国古代地理、社会、政治、哲学文化大环境下,其思维方式以"尚同""求一"为根本;二是万物为"一气"的哲学思维,即"气一元论";三是"气一元论"的延伸即"整体思维",正是中国古代文化"同源"思想的体现。     

Root Canal Shaping Using Nickel Titanium,M-Wire,and Gold Wire: A Micro–computed Tomographic Comparative Study of One Shape,ProTaper Next,and WaveOne Gold Instruments in Maxillary First Molars

Introduction

The aim of this study was to evaluate the root canal shaping effect of instruments manufactured from nickel titanium, M-Wire, and Gold wire with different glide path preparation techniques.

电针复合TCI靶控输注在单肺通气食管癌开胸手术麻醉中的应用与安全性＊

目的 探讨电针复合靶控输注（Target Controlled Infusion， TCI）在单肺通气食管癌开胸手术麻醉中的应用价值。方法 选取于我院拟行单肺通气食管癌开胸切除手术患者60例作为研究对象。随机将其分为试验组与对照组，对照组30例采取气管插管全麻及TCI靶控输注维持麻醉深度，试验组30例则在对照组方案基础上辅助电针麻醉，记录两组患者手术麻醉时间、药物用量、苏醒时间、并发症；以及术前（T_Ⅰ）、插管前即刻（T_Ⅱ）、插管后1 min（T_Ⅲ）、切皮即刻（T_Ⅳ）、去骨时（T_Ⅴ）、拔管即刻（T_Ⅵ）时平均动脉压（MAP）、平均心率（HR）、BIS值；术前、术后1天、术后3天简易智能精神状态检查量表（MMSE）；并于麻醉诱导前（T₀）、手术开始2 h（T₁）、术后1天（T₂）、术后3天（T₃）时抽取患者外周静脉血检测IL-1β、IL-6、IL-10、TNF-α浓度。结果 试验组手术用时、麻醉时间略低于对照组，但差异无统计学意义（P>0.05），试验组异丙酚、舒芬太尼用量以及苏醒时间均明显低于对照组（P<0.05）；T_Ⅱ时两组平均动脉压（Mean Arterial Pressure， MAP）、心率（Heartrate， HR）较术前明显降低，且试验组MAP明显低于对照组（P<0.05），但两组T_Ⅱ时HR比较无显著差异（P>0.05）；T_Ⅲ、T_Ⅵ时对照组MAP、HR明显高于T_Ⅰ时，而试验组MAP、HR与T_Ⅰ比较无显著差异（P>0.05）。术后1天、3天试验组简易智能精神状态检查量表（Mini-Mental State Examination， MMSE）评分低于对照组，有显著性差异（P<0.05）。T₁、T₂、T₃时试验组白介素-1β（IL-1β）、白介素-6（IL-6）、肿瘤坏死因子（Tumor Necrosis Factor-α， TNF-α）水平明显低于对照组（P<0.05），白介素-10（IL-10）水平明显高于对照组（P<0.05）。结论 采用电针复合TCI靶控输注麻醉方案可有效提升单肺通气食管癌开胸手术麻醉效果，能够降低患者术后认知功能障碍发生风险。     

Low level of polymyxin resistance among nonclonal mcr-1–positive Escherichia coli from human sources in Brazil

We report 26 human isolates of mcr-1–positive Escherichia coli, most of them (65.4%) with a polymyxin B MIC of 2?mg/L. Seventeen out of the 24 mcr-1–positive E. coli proved to be nonclonal by rep-PCR which strengthens the hypothesis of environmental or animal origin of these strains and reinforces the one health context of antimicrobial resistance.     

“一带一路”倡议背景下中医药文化传播传承的建议与策略

"一带一路"中医药发展工作办公室强调了九个方面的重点工作,其中包括推进中医药文化传播。更好地传播和传承中医药文化势在必行。坚持古为今用、洋为中用,不断推陈出新,提倡多模式传播传承中医药文化,彰显中医药文化的活力和魅力,更好地发展中医药,从而提高国家软实力。     

公立医院多院区管理模式下的成本核算难点与实践

目的:针对多院区成本核算中的难点问题找到解决路径,提高成本精细化核算水平。方法:通过案例分析,以南京市儿童医院为例,结合医院三年来两院区成本核算过程中发现的难点问题,提出完善多院区成本核算的建议。结果:两院区成本核算准确性不断提高,成本分析与控制能有效运用。结论:紧密结合两院区临床各项诊疗作业的不同特点,分解细化成本项目,同时借助运用信息化的成本核算工具,不断完善医院成本核算。     

Accuracy of KinectOne to quantify kinematics of the upper body

Motion analysis systems deliver quantitative information, e.g. on the progress of rehabilitation programs aimed at improving range of motion. Markerless systems are of interest for clinical application because they are low-cost and easy to use. The first generation of the Kinect™ sensor showed promising results in validity assessment compared to an established marker-based system. However, no literature is available on the validity of the new ‘Kinect™ for Xbox one’ (KinectOne) in tracking upper body motion. Consequently, this study was conducted to analyze the accuracy and reliability of the KinectOne in tracking upper body motion.Twenty subjects performed shoulder abduction in frontal and scapula plane, flexion, external rotation and horizontal flexion in two conditions (sitting and standing). Arm and trunk motion were analyzed using the KinectOne and compared to a marker-based system. Comparisons were made using Bland Altman statistics and Coefficient of Multiple Correlation.On average, differences between systems of 3.9 ± 4.0° and 0.1 ± 3.8° were found for arm and trunk motion, respectively. Correlation was higher for the arm than for the trunk motion.Based on the observed bias, the accuracy of the KinectOne was found to be adequate to measure arm motion in a clinical setting. Although trunk motion showed a very low absolute bias between the two systems, the KinectOne was not able to track small changes over time. Before the KinectOne can find clinical application, further research is required analyzing whether validity can be improved using a customized tracking algorithm or other sensor placement, and to analyze test–retest reliability.     

左半结肠恶性肿瘤并发肠梗阻切除一期吻合的临床效果观察

目的探讨分析左半结肠恶性肿瘤并发肠梗阻切除一期吻合的临床效果。方法选取2008年10月~2010年11月因左半结肠恶性肿瘤并发肠梗阻就诊于本院进行治疗的120例患者为研究对象,随机分为治疗组(采用一期吻合手术治疗)60例患者,对照组(采用全结肠切除吻合术治疗)60例患者,统计两组患者术后出现并发症的情况及近期治疗效果。结果治疗组并发症总发生率为28.3%,明显低于对照组,一期吻合手术治疗组总有效率为56.7%,明显高于对照组,P0.05,差异存在显著性。结论一期切除吻合术治疗结肠癌并发肠梗阻治疗效果显著,并发症少。