从天价医药费事件折射出当前我国医疗机构存在的问题

目前，我国许多医院的医疗卫生工作人员在为患者进行医疗卫生服务的过程中，为了医院和个人的经济利益，存在着过度医疗消费现象。最典型的是哈尔滨医科大学第二附属医院发生的天价医药费事件。导致这种现象出现的原因是由于法律的不健全、制度的不完善等而导致的监督力度不够，加之有些医务工作者在经济利益的驱使下使自己的职业道德滑坡，从而导致了老百姓看病贵现象的出现。     

Ex Vivo Application of Carbon Monoxide in University of Wisconsin Solution to Prevent Intestinal Cold Ischemia/Reperfusion Injury

Carbon monoxide (CO), a byproduct of heme catalysis, was shown to have potent cytoprotective and anti-inflammatory effects. In vivo recipient CO inhalation at low concentrations prevented ischemia/reperfusion (I/R) injury associated with small intestinal transplantation (SITx). This study examined whether ex vivo delivery of CO in University of Wisconsin (UW) solution could ameliorate intestinal I/R injury. Orthotopic syngenic SITx was performed in Lewis rats after 6 h cold preservation in control UW or UW that was bubbled with CO gas (0.1-5%) (CO-UW). Recipient survival with intestinal grafts preserved in 5%, but not 0.1%, CO-UW improved to 86.7% (13/15) from 53% (9/17) with control UW. At 3 h after SITx, grafts stored in 5% CO-UW showed improved intestinal barrier function, less mucosal denudation and reduced inflammatory mediator upregulation compared to those in control UW. Preservation in CO-UW associated with reduced vascular resistance (end preservation), increased graft cyclic guanosine monophosphate levels (1 h), and improved graft blood flow (1 h). Protective effects of CO-UW were reversed by ODQ, an inhibitor of soluble guanylyl cyclase. In vitro culture experiment also showed better preservation of vascular endothelial cells with CO-UW. The study suggests that ex vivo CO delivery into UW solution would be a simple and innovative therapeutic strategy to prevent transplant-induced I/R injury.     

AFOREIGN SURGEON′s VIEW OF LAPAROSCOPIC SURGERY IN A DEVELOPMENT COUNTRY IN ASIA

InrecentcorrespondencewithasurgeonfriendfromChina ,IwastoldthatChinahaschangedconsid erablyinthepastdecade.Icanbelieveit.Theever presentpressuresofsocietyandpolitics,theworld widedemandsforcooperationansmutualassistance ,therecentwarsandthreatsthereof,theapparentin creasedincidenceofnaturaldisasters ,andmoststrikinglythequantumleapoftechnologyandcommunica tionovertherecentpasthaveaffectedeveryareaoflife .Onecansaywithoutequivocationthatthewholeworldhaschangeddramaticallyoverthepastdecade .Th…     

医改尚未成功,路在何方?

目前我国医疗制度改革尚未取得成功,这与计划经济向市场经济转轨这历史时期及卫生工作的特殊性有关,出现问题,甚至失误,在所难免。提出(1)医改的目的是确保全国人民健康,人人享有医疗保健。(2)把卫生系统推向市场,医疗机构商业化,不是医改的方向。(3)预防为主,健全预防医学制系。(4)国家增加投入。(5)制定公立及私立医院各项制度,保护医务人员的合法权益。(6)加强社区基层医疗机构的建设。     

金黄色葡萄球菌在皮肤病医院对苯唑西林敏感性降低并无性系蔓延

2000年11月，作者得知从Aarhus大学医院皮肤科患者分离到的金黄色葡萄球菌对苯唑西林出现界线耐药（BORSA）。本文旨在描述其表型和基因型，并评估可能的传播途径以干预和阻止进一步蔓延。菌株由脉冲场凝胶电泳鉴定。几个感染控制方案的缺口显示患者间可直接或间接传播。皮肤屏障缺陷、皮肤病患者金黄色葡萄球菌的高携带率和院内双氯西林的高消耗率可促使传播。改善普通感染控制措施和重新评价院内抗生素政策后，该菌的暴发感染消失。     

Bifid mandibular canal.

PURPOSE: To determine the incidence and characteristics of bifid mandibular canals. METHODS: A retrospective study was performed using panoramic radiographs of 2012 patients subjected to dental treatment in the Dental Clinic of the Valencia University Dental School (Valencia, Spain) between 1996 and 1999. The goal was to investigate the presence of double mandibular canals. RESULTS: The extraoral panoramic radiographs revealed a total of 7 images suggestive of bifid canals. Mandibular computed tomography revealed the existence of this anatomic variant in 2 of 3 patients. An analysis was performed on the incidence of this type of image in extraoral panoramic radiography, its possible interpretations, and the clinical implications of bifid mandibular canals. CONCLUSIONS: In this study, 0.35% of canals were bifid. All cases were in women.     

The Neurosteroid Allopregnanolone Is Reduced in Prefrontal Cortex in Alzheimer’s Disease

BACKGROUND: Few data are currently available investigating neurosteroids (NS) in Alzheimer's disease (AD). The NS allopregnanolone may be decreased in serum and plasma in patients with AD, but it is unclear if allopregnanolone is also reduced in brain. Because a number of NS exhibit neuroprotective effects and impact cognitive performance in rodent models, these molecules may be relevant to the pathophysiology of neurodegenerative disorders. We therefore investigated prefrontal cortex (PFC) NS levels in AD. METHODS: Neurosteroid levels (allopregnanolone, pregnenolone, dehydroepiandrosterone [DHEA]) were determined in postmortem PFC in 14 male subjects with AD and 15 cognitively intact male control subjects by gas chromatography/mass spectrometry preceded by high-performance liquid chromatography purification. RESULTS: Subjects with AD exhibit significant reductions in allopregnanolone compared with cognitively intact control subjects (median levels = 2.50 ng/g vs. 5.59 ng/g, respectively; p = .02). Allopregnanolone levels are inversely correlated with neuropathological disease stage (Braak), r = -.49, p = .007. Median DHEA levels are elevated in subjects with AD (p = .01). CONCLUSIONS: Subjects with AD demonstrate significant reductions in PFC allopregnanolone levels, a finding that may be relevant to neuropathological disease stage severity. Neurosteroids may have utility as candidate biomarkers in AD.     

Derivation of Power M-Mode Transcranial Doppler Criteria for Angiographic Proven MCA Occlusion

BACKGROUND: Stringent transcranial Doppler (TCD) criteria for diagnosing occlusion are needed for more reliable TCD performance at bedside in the acute stroke setting. SUBJECTS AND METHODS: At three academic stroke centers, we performed TCD examination for patients with symptoms of cerebral ischemia who underwent digital subtraction angiography (DSA). We used a standard insonation protocol with power M-mode Doppler (PMD) TCD (TCD 100 M, Spencer Technologies Inc., Seattle, WA). We collected mean flow velocity (MFV), pulsatility indices (PI), and power M-mode resistance signature (absent, high, or low) in symptomatic middle (MCA), anterior (ACA), posterior (PCA), and in affected (a), ipsilateral (i), and contralateral (c-lat) cerebral arteries. Ratios of aMCA/c-lat MCA, aMCA/iACA, and aMCA/iPCA MFV were subsequently calculated. PMD-TCD flow findings were evaluated with a receiver-operating characteristic (ROC) analysis for angiographically proven MCA occlusion. RESULTS: We studied 120 patients with acute cerebral ischemia with PMD-TCD examinations prior to or immediately after DSA. Lower aMCA velocities pointed to higher probability of occlusion (P= .055). The aMCA/iPCA MFV ratio was superior to the aMCA/iACA ratio and strongly predictive of occlusion at a threshold ratio of 0.5 (RR 2.31 CI(95) 2.13-2.51). High resistance or absent M-mode flow signatures in the proximal MCA were present in 87% of M1 and M2 MCA occlusions (probability 87%). In the presence of a low-resistance PMD signature, obtaining the aMCA/iPCA MFV ratio <0.5 increases probability of occlusion to 87%. Normal MFV ratios and low-resistance M-mode signatures are highly predictive of a negative angiogram for MCA occlusion. CONCLUSION: In acute cerebral ischemia, reliable criteria for proximal MCA occlusion have been developed based on combination of MFV ratios and M-mode flow resistance signatures. Validation of these criteria will require multicenter studies.