江西省消除血吸虫病面临的挑战与对策

江西省历史上是我国血吸虫病流行最为严重的省份之一。经过六十多年的不懈努力,江西省血吸虫病防治工作取得了巨大成就,并已开启了全面消除血吸虫病的新征程。本文简要回顾了江西省血吸虫病防治历程,阐述了当前江西省血吸虫病流行现状及防治工作特色与经验,分析了在消除血吸虫病进程中面临的困难与挑战,并提出了应对策略。     

预防“高脂血症”,要把好进口关

<正>生活水平提高了,物质资源丰富了,人们的饮食开始有了很大转变,鸡、鸭、鱼肉已经不是过年的专利,成为了百姓的家常饭肴。人们在改善生活的同时也发现自己的体重增加了、体力不如以前了,好像生活质量并没有随着生活水平的提高而提高,那些老年人常见的高     

并发症逼得她险些跳楼

并发症往往会成为患者心灵的“紧箍咒” “下班了!”不知是谁说了一句，老吴收拾了一下自己的东西，走出了单位大门。迎面一阵冷风吹来，他打了一个寒战，紧了紧衣服领口，想到妻子景霞还一个人在家，不由得加快了脚步。     

“糖友”运动无须太“给力”

老张今年55岁了,在工作岗位上奋斗了一辈子,马上就快到退休年龄了。两年前,老张被诊断出2型糖尿病。为了调养身体,他慢慢将大部分工作移交给了年轻人,自己更多的时候只是指导一下。为了控制血糖,老张也趁空闲的时候参加一些运动。这次,公司组织羽毛球比赛,老张也毫不犹豫地报名参加了。但刚刚上场10分钟,老张的肩膀就疼了起来,勉强支撑了半场,他就不得不被替换下来。当天晚上,肩膀疼痛虽然减弱了一些,可是脚掌又起了疱,一夜折腾,基本没有合眼,第二天,血糖蹭蹭地高了起来!     

老年人的心理健康

50多岁的张阿姨,几年前查出了糖尿病。起初她根本接受不了自己得病的事实。觉得自己活不长了。于是整天闷闷不乐,不愿意跟人沟通了。时间一长,她的女儿着急了,带着张阿姨去了医院,内分泌的大夫建议她看一下心理门诊。到了心理门诊才知道。张阿姨患了老年抑郁症。     

保护脊柱，保护健康（上）

进入到秋季,秋高气爽,就是人身上开始没有汗了,皮肤变得很清爽,这个时候早晚的温差大了。日照时间短了,阳光也温和了。粮食丰满,蛋白质、脂肪、矿物质的总量都非常丰富。此时的能量消耗也少了。     

让我们把果实分享

春天来了,樱桃树结满了鲜艳的果实,树枝都被压弯了。红艳艳的果实吸引了穿梭在密林中的小鸟,它们从四面八方飞来,享受着樱桃的盛宴。很快,樱桃树上的红樱桃就被鸟们啄食一空。假花生树看着樱桃树,叹了口气,你辛辛苦苦结的果实,都被鸟吃光了,自己什么也没留下,多可惜啊。樱桃树笑笑,能让这些可爱的小鸟填饱肚皮,在春天里飞翔,这是多么开心的一件事啊。盛夏刚过,山核桃树就迫不及待地开花结果了,它的果实毛茸茸的,一点也不好看,还裹着一层厚厚的外壳。小鸟们飞来了,啄不动,又飞走了。一个迷路的山民,路过山核桃树下,又饿又累的他,看见山核桃树上挂满的果实,忍不住摘下一颗,敲开,尝尝,虽然有点苦涩,但味道还不错。他想,如果摘回去,炒熟了吃,味道一定更好。于是,他解下行囊,摘了满满一袋子,背回了     

诺和笔4——糖尿病患者的好伴侣

从事内分泌工作二十多年了．亲眼目睹了随着人们生活水平的提高．糖尿病的发病率也逐年上升．越来越多的糖尿病患者的治疗离不开胰岛素。而诺和笔的出现．给患者减少了麻烦,减轻了痛感,更减少了心理恐惧,成为越来越多的糖尿病患者的好伴侣。     

自我检测血糖，指导我健康生活

我今年58周岁了,我们这一代人历经了许多磨难,青年时代上山下乡,恢复高考又拖儿挈女地读书,工作时上有老下有小艰苦奋斗,赡养老人,供儿女读书,这些年生活好了,儿女们长大成人了,自己也老了,身体又出了这样那样的毛病,     

戒烟竟然诱发糖尿病,您是否要戒烟？

案例 马先生是吸烟多年的老烟民了,半年前因为胸闷、胸痛查出来了冠心病,医生要求他戒烟,虽然很不情愿,但是为了健康,便开始了漫漫戒烟之旅.烟是戒了,可是马先生的体重在半年内竟飙升了15公斤.他最近总觉得浑身没劲,特别容易累,而且总觉得口渴要喝水,于是又来到医院做检查,血糖竟然高了!马先生非常烦闷,这究竟是怎么回事,戒烟怎么还引起了糖尿病？还有些人会想,无论抽不抽烟都要生病,那究竟还要不要戒烟了？     

TB and HIV integration: obstacles and possible solutions to implementation in South Africa

Objectives To identify key obstacles to operational integration of TB and HIV services and to suggest strategies to promote integration in the prevention, treatment and care of patients with TB and HIV. Methods This is a health systems research case study of operational integration of TB and HIV in South Africa. Peer‐reviewed and grey literature together with the experiences of the authors were used to identify key obstacles to integration in service implementation practices and community‐level care. Relevant legislation, policies and guidelines were analysed to determine whether they facilitated or undermined the integration of TB and HIV services. Results Obstacles to integration exist at contextual and epidemiological levels as well as at intervention design and implementation levels. Importantly, integration at an operational level is undermined by fundamentally different principles underpinning the design of TB and HIV programmes and national policies and legislation which mitigate against integration. Conclusion South Africa has an opportunity to effect changes that will facilitate TB/HIV integration and improve care for all those infected with TB, HIV or both conditions. An analytic approach necessary to understand the obstacles to and ensure effective strategies facilitating integration is required. This needs to be followed by mobilisation of clinical and health systems expertise, health infrastructure, commitment and experience in creative and appropriate ways for the variety of health care settings.     

Simultaneous dynamic proctography and peritoneography for pelvic floor disorders

PURPOSE: We sought to evaluate a new diagnostic technique for the identification of rectal and pelvic floor pathology in patients with obstructed defecation, pelvic fullness/ prolapse, and/or chronic intermittent pelvic floor pain. METHODS: Thirteen symptomatic women with either a nondiagnostic physical examination or nondiagnostic dynamic proctography (DPG) were studied. After placement of intraperitoneal and intrarectal contrast material, resting and straining pelvic x-rays were obtained in all patients, and defecation was videotaped using fluoroscopy. RESULTS: Simultaneous DPG and peritoneography identified clinically suspected and unsuspected enteroceles in 10 of the 13 patients studied. An enterocele or other pelvic floor hernia was ruled out by the technique in three of the women studied. Rectoceles and rectal prolapse that were identified during physical examination were confirmed by DPG with peritoneography. Simultaneous DPG and peritoneography also gave a qualitative assessment of the severity and clinical significance of the identified pelvic floor disorders. Results of simultaneous DPG and peritoneography affected operative treatment planning in 85 percent of patients studied. CONCLUSION: Simultaneous DPG and peritoneography identifies both rectal and pelvic floor pathology and provides a qualitative assessment of pelvic floor pathology severity, which allows for better treatment planning in selected patients with obstructed defecation and pelvic prolapse.Video presentation at the meeting of The American Society of Colon and Rectal Surgeons, Chicago, Illinois, May 2 to 7, 1993.     

组织多普勒评价健康肥胖和超重女性心功能研究

目的探讨组织多普勒成像(TDI)技术评价我国健康肥胖和超重女性的左心功能。方法选择哈尔滨医科大学附属第一医院心内科2006年8月至2007年8月健康肥胖和超重成年女性60例和106例及体检健康者50名,以TDI技术测量其在二尖瓣瓣环六个取样点的收缩期、舒张早期和晚期峰值运动速度(Sm、Em和Am)及Em/Am,并计算各指标平均值(MSm、MEm、MAm和MEm/Am)。结果肥胖组、超重组和对照组在二尖瓣瓣环各取样点Em、Em/Am以及MEm、MEm/Am均差别明显;肥胖组超重组和对照组在各检测部位Sm减低、Am升高,MSm和MAm亦有相似改变;超重组Sm、Am、MSm和MAm与对照组差别无统计学意义。结论TDI技术通过测量心肌组织的运动速度显示成年健康肥胖和超重女性左心功能已出现异常改变,其敏感性优于常规超声心动图,为肥胖和超重女性左心室局部和整体功能的早期评价提供了理想的检测手段。     

Impact of the kidney transplantation on renalase and blood pressure levels in renal transplant donors and recipients

Introduction and objectivesPrevalence of hypertension increases as glomerular filtration rate (GFR) declines. Renalase metabolizes catecholamines and have an important role in blood pressure (BP) regulation. The purpose of the study was to evaluate the effect of kidney transplantation on renalase levels and BP in kidney donors and recipients.Materials and methodsTwenty kidney transplant recipients and their donors were included in the study. Serum renalase levels and ambulatory BP values were measured in both donors and recipients before and after transplantation. Factor associated with change in renalase and BP levels were also evaluated.ResultsIn donors; mean GFR and hemoglobin levels decreased while night-time systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels and serum renalase levels increased simultaneously after nephrectomy. Day-time SBP and DBP levels did not changed and the night/day ratio of mean arterial pressure (MAP) increased significantly. In recipients, mean GFR increased, while mean serum renalase levels, creatinine and BP levels decreased after transplantation. Correlation analysis revealed that changes in MAP correlated with alteration in serum renalase levels and GFR.ConclusionsAfter transplantation, serum renalase levels increased in donors and decreased in recipients. The renalase levels are associated with change in MAP and circadian rhythm of BP in donors and recipients.     

Diltiazem maintains renal vasodilation without hyperfiltration in hypertension: Studies in essential hypertensive man and the spontaneously hypertensive rat

Summary The systemic and renal hemodynamic effects of diltiazem were determined in patients with mild to moderately severe essential hypertension and in rats with spontaneous hypertension (SHR). Seven patients were treated for one full year (300 mg/day, average dose) and 10 SHR and 10 normotensive Wistar-Kyoto (WKY) rats received 1 and 2 mg/ kg, intravenously. In both man and rat with genetic hypertension, arterial pressure was reduced through a fall in total peripheral resistance without associated reflexive increases in heart rate and cardiac index; and the patients demonstrated no change in plasma volume. In both man and the SHR: renal blood flow increased (in SHR not statistically significant) as arterial pressure and renal vascular resistance fell; glomerular filtration rate (GFR) remained unchanged and the filtration fraction (FF) significantly fell; and calculated intrarenal hemodynamic indices (using the Gomez formulae) demonstrated falls in afferent and efferent glomerular arteriolar pressures and resistances and in intraglomerular pressures, thereby explaining the unchanged GFRs and the decline in FF. These findings in both hypertensive man and rat are in contrast with those of the normotensive WKY that only demonstrated a fall in afferent glomerular arteriolar resistance. Thus, these data demonstrate that diltiazem controlled arterial pressure in both forms of genetic hypertension associated with falls in systemic and renal arteriolar resistances and with improved intrarenal hemodynamics without glomerular hyperfiltration.     

A biochemical and ultrastructural study of the species variation in myocardial cell damage

Species differences (rat, mouse, guinea pig and rabbit) to anoxic damage, glucose protection and reoxygenation damage were investigated using isolated perfused hearts arrested by K⁺ during the anoxic period. Myocardial damage, as assessed by enzyme release and ultrastructural changes, was related to changes in myocardial glycogen, adenosine triphosphate, creatine phosphate and lactate. The results suggest that the speed of onset, magnitude of early tissue damage, and the extent to which reoxygenation can exacerbate damage are related to the characteristics of myocardial membranes, and that while rat and mouse hearts are resistant to the early onset of damage, reoxygenation can greatly exacerbate damage in these species. In contrast, guinea pig and rabbit hearts exhibit an early onset of damage and are therefore less susceptible to reoxygenation exacerbation. Major species differences also exist in the extent to which glucose can protect the anoxic myocardium and thereby reduce tissue damage and enzyme release. In the rat and the guinea pig, glucose consistently protected myocardial glycogen, adenosine triphosphate and creatine phosphate levels, reduced enzyme release and maintained myocardial ultrastructure. In contrast in the mouse, glucose was less able to protect myocardial energy supplies and extensive ultrastructural damage and enzyme release occurred. Variable protection was observed in the rabbit, in some instances ultrastructural damage and enzyme release were greatly reduced and in this sub-group, glucose maintained myocardial energy reserves. In other rabbits, glucose failed to protect energy supplies and extensive ultrastructural damage and enzyme release was observed. The results suggest that glucose protects the anoxic, arrested myocardium primarily through its ability to act as a substrate for glycolytic ATP production and that any variation in its efficacy either within or between species is due to variations in their maximum capacity for glycolytic flux.     

Prevention of Pathological Atrial Remodeling and Atrial Fibrillation: JACC State-of-the-Art Review

Atrial enlargement in response to pathological stimuli (e.g., hypertension, mitral valve disease) and physiological stimuli (exercise, pregnancy) can be comparable in magnitude, but the diseased enlarged atria is associated with complications such as atrial fibrillation (AF), whereas physiological atrial enlargement is not. Pathological atrial enlargement and AF is also observed in a small percentage of athletes undergoing extreme/intense endurance sport and pregnant women with preeclampsia. Differences between physiological and pathological atrial enlargement and underlying mechanisms are poorly understood. This review describes human and animal studies characterizing atrial enlargement under physiological and pathological conditions and highlights key knowledge gaps and clinical challenges, including: 1) the limited ability of atria to reverse remodel; and 2) distinguishing physiological and pathological enlargement via imaging/biomarkers. Finally, this review discusses how targeting distinct molecular mechanisms underlying physiological and pathological atrial enlargement could provide new therapeutic and diagnostic strategies for preventing or reversing atrial enlargement and AF.     

Patient–provider perceptions on engagement in HIV care in Argentina

Approximately 30% of patients participating in the national antiretroviral therapy (ART) program in Argentina fail to achieve an undetectable viral load, and approximately 25% are not retained in care. This qualitative study was designed to explore and identify factors associated with engagement and retention in public and private health care in Buenos Aires, Argentina. Qualitative data from key informants (n = 12) and focus groups (n = 4 groups) of patients and providers from private and public HIV treatment facilities were recorded and transcribed. Predetermined and arising themes related to adherence, engagement, and retention in care were coded and analyzed using qualitative data analysis software. Reasons identified for patients' lack of adherence or engagement in care differed between patients and providers, and patients attributed limitations to low self-efficacy, fear and concerns about HIV, and lack of provider involvement in treatment. In contrast, providers viewed themselves as decision-makers in patient care and patients as responsible for their own nonadherence due to lack of commitment to their own health or due to medication side effects. Patients reported health care system limitations and HIV concerns contributed to a lack of engagement, and providers identified limited HIV literacy and stigma as additional problems. Both agreed that chronic illness and substance addiction impacted adherence and retention, and agreed on the importance of trust, honesty, and communication in the patient–provider relationship. Results support the incorporation of system-, provider-, and patient-focused components into interventions to facilitate patient engagement, adherence, and retention in public and private settings in Argentina.     

Developmental,Nutritional, and Hormonal Regulation of the Pancreatitis-Associated Protein I and III Gene Expression in the Rat Small Intestine

Background: The pancreatitis-associated protein (PAP) I and III, but not PAP II, mRNAs are constitutively expressed in the small intestine of rats.

Methods: We studied expression of both PAP I and PAP III mRNAs during development and on nutritional and hormonal manipulations.

Results: Between day 20 of gestation and day 21 of age, PAP mRNAs could barely be detected. Their concentrations increased dramatically from day 21 to day 45 of age and remained constant thereafter. Rats adapted to a diet with low carbohydrate content showed a significant decrease in PAP mRNA concentrations. Finally, whereas thyroidectomy and ovariectomy induced a decrease in both mRNA concentrations, and adrenalectomy a limited decrease in PAP HI mRNA only, diabetes and castration did not alter the expression of either gene.

Conclusion: Gene expression of PAP I and III mRNAs is regulated in a coordinate manner in the rat small intestine during development and on nutritional and hormonal manipulations.     

Launch and preliminary analysis of Hospital de La Princesa's inter-specialists biological therapies unit

We herein describe an inter-specialists unit for the monitoring and management of biological therapies and analyze the utilization of biological agents across specialties and diseases. Protocols and therapeutic objectives, as well as outcomes and protocol deviations, are shared and discussed periodically between specialists. All patients treated at one centre with any biological treatment from January 2000 by rheumatology, gastroenterology, dermatology, or neurology, regardless diagnosis, are identified by Clinical Pharmacy and included in an ongoing database that detects use and outcome. The drugs, survival, and reasons for discontinuation differ significantly across specialties. This approach has helped us recognizing the challenges and size of the problem of sharing expensive medications across specialties, and has served as a starting point to contribute to the better use of these compounds.