小切口下角膜后弹力层剥除联合深板层内皮移植术的实验研究

目的 探讨小切口下角膜后弹力层剥除联合深板层内皮移植术(DSEK)的手术方法、疗效、并发症、内皮细胞的评价及组织学检查.方法 为实验研究.将24只新西兰大白兔随机分为3组,每组8只兔(8只眼),供体为新西兰大白兔16只眼.A组于角膜缘处行5 mm长隧道切口,剥去角膜中央直径10 mm的后弹力层,将等大的带有少量基质的后弹力层内皮细胞膜片植入受体眼;B组行单纯角膜后弹力层环形撕除术;C组在角膜后弹力层剥除后行去内皮细胞的带少许角膜基质和后弹力层膜片植入.术后观察1个月,比较3组兔角膜的透明性、植片贴附情况、角膜内皮细胞密度及并发症情况.结果 A组8只眼术前角膜内皮细胞密度平均值为(2728±108)个/mm2,术后角膜均恢复透明,内皮细胞密度平均为(2195±77)个/mm2,差异有统计学意义(t=12.455,P＜0.001);组织切片证实角膜内皮细胞植片与受体植床愈合良好,层间无瘢痕形成.B组8只眼术后均有严重的角膜水肿,持续1个月未恢复,组织学检查术后28 d时仅在后弹力层剥除的交界处有极少数的内皮细胞长入.C组8只眼术后1周内角膜植片均水肿,5只眼植片脱位;术后至观察1个月,角膜中央水肿仍较明显,伴有角膜新生血管长入,组织学检查植片部位未见内皮细胞长入.结论 角膜后弹力层剥除联合深板层内皮移植术具有安全、损伤小、术后恢复快及无层间瘢痕的优点,是治疗大泡性角膜疾病的优选术式.     

Equity in health care financing: The case of Malaysia

Background

Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implications would help policy makers in achieving equitable financing.

Objective

The primary purpose of this paper was to comprehensively assess the equity of health care financing in Malaysia, which represents a new country context for the quantitative techniques used. The paper evaluated each of the five financing sources (direct taxes, indirect taxes, contributions to Employee Provident Fund and Social Security Organization, private insurance and out-of-pocket payments) independently, and subsequently by combined the financing sources to evaluate the whole financing system.

Methods

Cross-sectional analyses were performed on the Household Expenditure Survey Malaysia 1998/99, using Stata statistical software package. In order to assess inequality, progressivity of each finance sources and the whole financing system was measured by Kakwani's progressivity index.

Results

Results showed that Malaysia's predominantly tax-financed system was slightly progressive with a Kakwani's progressivity index of 0.186. The net progressive effect was produced by four progressive finance sources (in the decreasing order of direct taxes, private insurance premiums, out-of-pocket payments, contributions to EPF and SOCSO) and a regressive finance source (indirect taxes).

Conclusion

Malaysia's two tier health system, of a heavily subsidised public sector and a user charged private sector, has produced a progressive health financing system. The case of Malaysia exemplifies that policy makers can gain an in depth understanding of the equity impact, in order to help shape health financing strategies for the nation.

     

经结膜入路不缝合骨膜的眼眶骨折修复术疗效观察

目的:探索经结膜入路不缝合骨膜修复眼眶骨折的手术方法的临床效果和临床可行性。方法:本研究采用回顾性调查,包括单纯性眶壁骨折51例,复合型骨折21例。采用经下睑结膜切口或经泪阜切口。探查并还纳嵌顿组织,根据骨折特点,采用羟基磷灰石复合材料或钛板、钛网修复眼眶骨折。所有病例均不缝合骨膜,结膜对合后,应用可吸收缝线缝合3针,然后缝合外眦韧带。观察术后各种并发症,包括结膜愈合状况;植入物暴露、感染和移位;外眦畸形;下睑退缩等。结果:所有病例术后平均随访4～18(平均11)mo,结膜切口愈合良好。其中3例出现外眦畸形,1例出现下睑内翻倒睫伴下睑退缩。无1例出现植入物暴露、感染和移位。结论:经结膜入路不缝合骨膜的眼眶骨折修复术术后发生并发症的几率较低,且无严重并发症,可以将该技术应用于单纯性和复合型骨折的临床修复。     

Pleomorphic liposarcoma of the head and neck: Presentation of two cases and literature review

Background

Pleomorphic liposarcoma (PL) is an exceedingly rare tumor of the head and neck. This aggressive liposarcoma variant portends a poorer prognosis compared to more typical sarcomatous tumors.

盐酸小檗碱对急性缺血性脑卒中患者神经功能及血清丙二醛的影响

目的探讨盐酸小檗碱对急性缺血性脑卒中患者神经功能及血清丙二醛（malondialdehyde, MDA）的影响。方法将102例急性缺血性脑卒中患者随机分为盐酸小檗碱组52例和对照组50例。对照组给予改善循环、营养神经、抗血小板聚集及调脂等基础治疗;盐酸小檗碱组在对照组治疗基础上加用盐酸小檗碱片0.5 g,每日3次,连续应用14 天。均在入院治疗前和治疗后7天、14 天抽取卧位静脉血,采用酶联免疫吸附测定法检测血清中MDA的水平;均在入院治疗前和治疗后7天、14 天采用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)进行神经功能缺损评分。结果治疗后小檗碱组及对照组NIHSS评分及血清MDA较治疗前均有下降,但小檗碱组NIHSS评分及MDA均低于对照组（P<0.05）。结论盐酸小檗碱可以降低急性缺血性脑卒中降低MDA表达水平,改善神经功能缺损程度。     

持续监测和控制人工气道气囊压力对机械通气患者呼吸机相关肺炎发生率影响的Meta分析

目的系统评价机械通气患者持续或间断监测和控制人工气道气囊压力对呼吸机相关肺炎（VAP）发生率的影响。 方法计算机检索PubMed、Medline、EMbase、OVID、Cochrane、CNKI中国知网、中国生物医学文献数据库（CBM）、维普中文科技期刊数据库（VIP）、万方数据库中关于持续监测和控制人工气道气囊压力（干预组）及间断监测和控制人工气道气囊压力（常规组）对机械通气患者VAP发生率影响的随机对照研究,检索时间为2006年1月到2015年12月。由2名研究者按照纳入及排除标准独立进行文献筛选、资料提取和质量评估后,采用Revman 5.3软件对数据进行Meta分析。 结果共纳入6篇文献,机械通气患者1 263例,其中进行持续监测和控制人工气道气囊压力的干预组机械通气患者654例,进行间断监测和控制人工气道气囊压力的常规组机械通气患者609例。Meta分析结果显示,干预组患者VAP发生率较常规组明显降低[OR = 0.43,95%CI（0.31,0.60）,Z = 5.53,P< 0.05]。但干预组患者ICU病死率较常规组未明显降低,两组比较差异没有统计学意义[OR = 1.02,95%CI（0.71,1.46）,Z = 0.36,P> 0.05]。 结论对机械通气患者进行持续监测和控制人工气道气囊压力可以降低VAP发生率,但对ICU病死率没有明显影响。     

Case Report: Incidental Splenic Granuloma due to Burkholderia pseudomallei: A Case of Asymptomatic Latent Melioidosis?

We report a rare case of an asymptomatic latent melioidosis lesion in a posttraumatic splenectomy specimen from a diabetic patient. The 2-cm yellowish, lobulated lesion was found in the splenic parenchyma well away from the traumatized areas. Microscopically, it consisted of a central area of necrosis and exudate surrounded by macrophages, epithelioid cells, lymphocytes, and occasional multinucleated giant cells. Burkholderia bacilli were detected by a novel in situ hybridization (ISH) assay, and confirmed by polymerase chain reaction and sequencing to be Burkholderia pseudomallei. As melioidosis was not suspected initially, bacterial culture was not done but electron microscopy showed morphologically viable and dividing bacilli in the lesion. Moreover, the surgical wound became infected with B. pseudomallei several days post-surgery. After treatment with ceftazidime and trimethoprim/sulfamethoxazole, the wound infection cleared. We believe this could be a unique case of asymptomatic latent melioidosis in the spleen. In endemic countries, chronic granulomas should be investigated for B. pseudomallei infection, and if available, ISH may be helpful for diagnosis.     

老年陈旧性症状性骨质疏松性胸腰椎骨折后路长节段内固定术后近端交界性后凸的危险因素

目的:探讨后路长节段内固定治疗老年Ⅳ型陈旧性症状性骨质疏松性胸腰椎骨折（CSOTLF）后近端交界性后凸（PJK）发生的相关危险因素。方法:采用病例对照研究分析2013年1月至2018年6月西安交通大学附属红会医院收治的95例老年Ⅳ型CSOTLF患者临床资料,其中男32例,女63例;年龄60~85岁［（67.4±6.5）...     

Quantitation of ATP-binding cassette subfamily-A transporter gene expression in primary human brain cells

Five ATP-binding cassette (ABC) subfamily-A transporters (ABCA1, ABCA2, ABCA3, ABCA7 and ABCA8) are expressed in the brain. These transporters may regulate brain lipid transport; however, their relative expression level in isolated human brain cells is unknown. We developed real-time polymerase chain reaction assays to quantify the expression of these genes in human neurons, astrocytes, oligodendrocytes, microglia and cell lines. Neurons expressed predominantly ABCA1 and ABCA3; astrocytes ABCA1, ABCA2 and ABCA3; microglia ABCA1 and oligodendrocytes ABCA2 and ABCA3. Although ABCA7 and ABCA8 expression was relatively low in all cells, the highest expression occurred in microglia and neurons, respectively. ABCA gene expression in the NTERA-2 and MO3.13 cell lines closely resembled the ABCA expression pattern of primary neurons and oligodendrocytes, respectively.