资中县HIV/AIDS纳入对新型合作医疗统筹基金的影响分析

为了了解资中县HIV／AIDS纳入新型合作医疗所产生的影响，分析该渠道筹集并解决艾滋病医药费用的可行性。结果发现，HIV／AIDS纳入新型合作医疗一定程度上可以有效分担艾滋病医药费用，但若感染者人数超过合作医疗所能覆盖的临界范围，则需开启政府分担功能，设立艾滋病专项基金用于补偿合作医疗无法覆盖的部分。     

Hysterectomy for hematometra in a 15-year-old mentally handicapped girl with congenital cervicovaginal agenesis and concomitant ovarian adenoma

We report a case of hematometra and bilateral hematosalphinx in a 15-year-old mentally handicapped adolescent girl, complicated by vaginal agenesis over cervical atresia in the presence of an ovarian adenoma. The case was managed by abdominal hysterectomy and bilateral salphingectomy of the hematosalphinx, which had formed a tubo-ovarian mass. One ovary was preserved. This case also considers the management of the mentally handicapped patient unable to comprehend pain arising from cryptomenorrhea.     

Surviving 27 weeks fetus expelled out of the ruptured rudimentary horn and detected a month later as a secondary abdominal pregnancy

A pregnant woman, gravida 3 with two living children, who frequently experienced syncope from 23(+5) weeks of pregnancy onwards and recurring every week for a period of 3 weeks, was repeatedly treated in line for a case of acid peptic disease/appendicitis in various peripheral hospitals of Nepal, until ultrasonogram/magnetic resonance imaging diagnosis of an (undisturbed) live 27(+5) weeks abdominal pregnancy was made at our hospital. On laparotomy, this materialized to be secondary to the rupture of a left rudimentary horn pregnancy (evidenced from its sealed margin) which still retained a complete placenta, from where an umbilical cord was seen, traversing across towards the right side of the abdominal cavity just below the liver, securing its attachment to the surviving fetus and enclosed in an intact amniotic sac. Excision of the rudimentary horn containing the placenta was accomplished, after the delivery of a live baby weighing 650 g who unfortunately died on the third day of life.     

Colles骨折手法整复后竹夹板固定与石膏固定的疗效比较

目的 通过随访对Colles骨折手法整复后竹夹板固定与石膏固定的疗效进行比较,确定Colles骨折手法整复后的有效治疗方案.方法 将120例Colles骨折患者按随机数字表法随机分为竹夹板外固定组60例及石膏外固定组60例,骨折手法整复成功后,按照组别分别给予竹夹板固定及石膏固定治疗,外固定拆除后均给予中药熏洗1个月,6个月后进行随访,并按照Gartland and Werley腕关节评分比较两组骨折患者的腕关节评分,以评价疗效.结果 竹夹板固定组优良率为83.3%,优于石膏固定组的56.7%(P<0.01).结论 Colles骨折手法整复后竹夹板固定的疗效优于石膏固定.     

中医外治法在慢性萎缩性胃炎中的应用研究进展

慢性萎缩性胃炎（CAG）是消化系统常见的慢性疾病,被认为是胃癌癌前病变,严重危害人类健康。如何有效促进胃黏膜的修复、抑制腺体的萎缩、阻断癌变是临床研究的热点。目前西医尚缺乏特效的治疗手段,近年来,大量研究结果表明,中医外治法在治疗CAG方面取得了显著成果,且具有简、便、效、廉等优势,深受患者青睐。现查阅近年来包括针刺法、灸法及贴敷法等在内的常用中医外治法治疗CAG的相关文献并进行综述,以期为临床治疗该病提供参考。     

Climate variability and transmission of Japanese encephalitis in eastern China

A time-series analysis was conducted to study the impact of climate variability on the transmission of Japanese encephalitis in eastern China. Correlation and regression analyses were used to examine the relationship between monthly climatic variables and monthly incidence of Japanese encephalitis in Jieshou County, China over the period 1980-96. Spearman's correlation analysis showed that maximum and minimum temperatures and rainfall were all associated with the transmission of Japanese encephalitis in the county. Regression analysis suggested that monthly mean minimum temperature and monthly precipitation had a significant relationship with the transmission of Japanese encephalitis, with a 1-month lag effect. The results indicated that these climatic variables might be treated as possible predictors for regions with similar geographic, climatic, and socio-economic conditions to Jieshou County.     

The view from two sides: a qualitative study of community and medical perspectives on screening for colorectal cancer using FOBT

BACKGROUND: Population-wide screening for people at average risk of colorectal cancer (CRC) by faecal occult blood test (FOBT) is under consideration in Australia. METHODS: Qualitative methods were used to examine the views of community members who did (n = 18) or did not (n = 12) participate in a pilot program of FOBT screening. In addition, views were obtained from general practitioners (GPs) and specialist gastroenterologists directly involved in the implementation of the program. Two focus group sessions were conducted with screening participants and interviews were conducted with nonparticipants, GPs and gastroenterologists. RESULTS: The findings suggest that CRC screening by FOBT distributed to households by mail was well accepted by the community and by the medical practitioners involved in its implementation. The trial had little negative effect on general practice. Both medical practitioners and consumers raised concerns about the efficacy of FOBT screening. Medical practitioners were also concerned about the potential burden mass screening could place on the public (government-funded) health care sector. CONCLUSIONS: It would seem that CRC screening using FOBT will not enjoy unqualified support from the community or from medical practitioners involved in the continuum of screening. Information about the objectives of screening programs, in general, and the efficacy of FOBT screening in particular, needs to be provided to the community to ensure informed individual choice.     

Characterization and biological evaluation of a microparticle adjuvant formulation for plasmid DNA vaccines

We describe the physiochemical characterization and immunological evaluation of plasmid DNA vaccine formulations containing a nonionic triblock copolymer adjuvant (CRL1005) in the presence and absence of a cationic surfactant, benzalkonium chloride (BAK). CRL1005 forms particles of 1-10 microns upon warming above its phase-transition temperature (approximately 6-8 degrees C) and the physical properties of the particles are altered by BAK. DNA/CRL1005 vaccines formulated with and without BAK were evaluated in rhesus macaques to determine the effect of CRL1005 and BAK on the ability of plasmid DNA to induce a cellular immune response. Immunogenicity results indicate that the addition of CRL1005 to human immunodeficiency virus-1 gag plasmid DNA formulated in phosphate-buffered saline leads to an enhancement in the gag-specific cellular immune response. Moreover, the addition of BAK to human immunodeficiency virus-1 gag plasmid DNA/CRL1005 formulations produces an additional enhancement in gag-specific cellular immunity. In vitro characterization studies of DNA/CRL1005 formulations indicate no detectable binding of DNA to CRL1005 particles in the absence of BAK, suggesting that the enhancement of cellular immunity induced by DNA/CRL1005 formulations is not due to enhanced DNA delivery. In the presence of BAK, however, results indicate that BAK binds to CRL1005 particles, producing cationic microparticles that bind DNA through electrostatic interactions. If BAK is present at the phase-transition temperature, it reduces the particle size from approximately 2 microns to approximately 300 nm, presumably by binding to hydrophobic surfaces during particle formation. Zeta potential measurements indicate that the surface charge of CRL1005-BAK particles changes from positive to negative upon DNA binding, and DNA bound to the surface of CRL1005-BAK particles was visualized by fluorescence microscopy. These results indicate that the addition of BAK to DNA/CRL1005 formulations leads to the formation of approximately 300 nm CRL1005-BAK-DNA particles that enhance the cellular immune response in rhesus monkeys.     

The impact of heatwaves on emergency department visits in Brisbane,Australia: a time series study

Introduction

The acute health effects of heatwaves in a subtropical climate and their impact on emergency departments (ED) are not well known. The purpose of this study is to examine overt heat-related presentations to EDs associated with heatwaves in Brisbane.

Methods

Data were obtained for the summer seasons (December to February) from 2000–2012. Heatwave events were defined as two or more successive days with daily maximum temperature ≥34°C (HWD1) or ≥37°C (HWD2). Poisson generalised additive model was used to assess the effect of heatwaves on heat-related visits (International Classification of Diseases (ICD) 10 codes T67 and X30; ICD 9 codes 992 and E900.0).

Results

Overall, 628 cases presented for heat-related illnesses. The presentations significantly increased on heatwave days based on HWD1 (relative risk (RR) = 4.9, 95% confidence interval (CI): 3.8, 6.3) and HWD2 (RR = 18.5, 95% CI: 12.0, 28.4). The RRs in different age groups ranged between 3–9.2 (HWD1) and 7.5–37.5 (HWD2). High acuity visits significantly increased based on HWD1 (RR = 4.7, 95% CI: 2.3, 9.6) and HWD2 (RR = 81.7, 95% CI: 21.5, 310.0). Average length of stay in ED significantly increased by >1 hour (HWD1) and >2 hours (HWD2).

Conclusions

Heatwaves significantly increase ED visits and workload even in a subtropical climate. The degree of impact is directly related to the extent of temperature increases and varies by socio-demographic characteristics of the patients. Heatwave action plans should be tailored according to the population needs and level of vulnerability. EDs should have plans to increase their surge capacity during heatwaves.     

伏邪理论在感染性疾病中的应用现状

伏邪理论源于《黄帝内经》,奠基于汉晋唐宋时期,成熟于明清时期。伏邪有狭义、广义之分。根据伏邪伏而不发、正邪交争,邪自内发的致病特点,发现其与临床中较多感染性疾病的致病特点相吻合,可广泛应用于感染性疾病（如病毒感染性疾病、细菌感染性疾病、其他感染性疾病）中,可用来指导临床这些疾病的诊断和治疗,且疗效颇为显著。