德国健康保险与预防性医疗服务

德国社会医疗保险具有悠久的历史,早在1883年俾斯麦执政时就引入了强制性医疗保险并奠定了社会保障的基础。德国的基本法规定了社会医疗保险的团结互助原则,保证了每个参保人拥有相同的医疗保障, 这在法律上体现了公平合理的原则。从上世纪80年代至90 年代,德国经济一直处于高速发展的繁荣期,社会医疗保险     

Effects of mycophenolic acid on high glucose-induced expression of TGF-beta and CTGF in mesangial cells.

The effects of mycophenolic acid (MPA) on high glucose-induced expression of transforming growth factor-beta (TGF-beta) and connective tissue growth factor (CTGF) in mesangial cells (MC) were investigated. Rat MC were cultured in the presence of different concentrations of MPA (1.0 and 10.0 micromol/L) or MPA plus high glucose for 72 h. The expression of TGF-beta and CTGF was detected by Western blot. The results showed that high glucose could induce the expression of TGF-beta and CTGF in MC, but MPA could inhibit this effects. MPA did not influence the expression of TGF-beta and CTGF in normal glucose. It was concluded that MPA might prevent the progression of diabetic nephropathy by inhibiting the expression of TGF-beta and CTGF in MC.     

实施品牌战略 实现医院可持续发展

从阐述品牌的内涵,分析实施品牌战略的意义,探寻实施品牌战略的有效途径等三个方面,论证了医院必须通过实施品牌,塑造医院良好形象,更新经营观念和调整营销策略来拓宽服务渠道,扩大服务范围,以增强社会对自身的认知,从而保持持久的竞争力,在激烈的市场竞争中得到发展。     

患者对预检分诊服务满意度理论框架的扎根理论研究

目的 通过扎根理论研究构建患者视角的预检分诊服务满意度理论框架,为评估和量化患者对预检分诊服务的满意度提供参考。方法 采用目的抽样和理论抽样的方法,选择27例接受过预检分诊服务的患者进行半结构式深度访谈;运用程序化扎根理论的研究方法,采用NVIVO12.0软件辅助对原始数据进行开放式编码、主轴编码及选择性编码,并进行理论饱和度检验。结果 析出患者期望、服务质量、信息供给、人本关怀、持续改进5个主范畴。结论 5个主范畴分别构成预检分诊服务满意度的主体因素、核心因素、关键因素、基本因素和保障因素。该理论框架可为改善预检分诊服务、评估患者满意度提供参考。     

Transnasal Endoscopic and Transoral Approaches in the Biopsies of Ventral Atlas and Axis Vertebrae: A Comprehensive Retrospective Study for Preprocedural Scheme,Biopsy Procedure,Core Technique Analysis,Diagnostic Yield and Clinical Outcome

ObjectiveThis study aims to describe and analyze the transoral and transnasal approaches for pathologies of the ventral atlas and axis vertebrae, which are considered technically challenging regions for diagnostic biopsy.MethodsA series of transnasal endoscopic approach (TNA) and transoral approach (TOA) biopsies for the pathologies of the first and second cervical vertebrae were conducted and retrospectively analyzed from July 2014 to May 2021. The depth of the biopsy trajectory was measured on computed tomography images for all nine patients (eight males and one female with an average age of 58.11 ± 11.60 years), as were the coronal, sagittal, and vertical biopsy safe ranges. The characteristics of each lesion, including radiographic features, blood supply, and destruction of anterior or posterior vertebral body edges, were evaluated to guide the biopsy. Four biopsy core techniques (BCTs), including “lesion perforating”, “aspiration”, “cutting‐and‐scraping” and “biopsy forceps utilization” were elaborated in this study. The biopsy procedures and periprocedural precautions were demonstrated. Patient demographics, clinical data, lesion characteristics, diagnostic yield, and complications were recorded for each case.ResultsEight TOA biopsies for the axis vertebral body and one TNA biopsy for the atlas anterior arch were successfully performed and yielded adequate pathologies. All biopsies were organized based on the preprocedural radiographic measurements, which showed that the average length of biopsy trajectory and coronal, sagittal, and vertical safe biopsy ranges were 85.00 ± 5.88, 20.63 ± 4.75, 16.25 ± 1.49, and 24.63 ± 2.26 mm, respectively, and these corresponding data were 95, 36, 9, and 26 mm in the TNA patient. Six osteolytic lesions (66.7%), one osteoblastic lesion (11.1%), and two mixed lesions (22.2%) were observed, among which seven lesions had a rich blood supply. Biopsy forceps and core needles were utilized to obtain samples in six and three patients, respectively. All the TNA and TOA biopsies were performed with cooperative application of multiple BCTs under compound anatomic and stereotactic navigations. Intraprocedural or postprocedural complications occurred in no patients who underwent the biopsy in the follow‐up period (1–39 months). No significant differences were found between the preprocedural and postprocedural blood indexes and visual analogue scale scores.ConclusionWith a sophisticated preprocedural arrangement, cooperative application of BCTs, and careful periprocedural precautions, transnasal endoscopic and transoral biopsies are two feasible, efficient, and well‐tolerated procedures that achieve satisfactory diagnostic yield, complication rate, and clinical outcome.     

感染与过敏性紫癜的研究现状

感染是过敏性紫癜(HSP)的诱发因素之一.该文介绍了各种感染(病毒、细菌、支原体等)与HSP关系的研究现状和研究方法,讨论了各种病原及其对HSP的临床影响和可能的诱发机制,表明感染、尤其是病毒感染与HSP的发生密切相关,且大多研究只能用血标本间接证明病原与HSP的相关性.揭示今后可对HSP患儿的皮肤或肾脏病理标本直接检测病原菌(特别是病毒,包括文献未研究的可能与HSP发病有关的呼吸道病毒等),用特定病原建立HSP动物模型,以直接证明感染与HSP的关系.     

Efficacy and safety of nafamostat mesilate anticoagulation in blood purification treatment of critically ill patients: a systematic review and meta-analysis

BackgroundNafamostat mesilate (NM), a broad-spectrum and potent serine protease inhibitor, can be used as an anticoagulant during extracorporeal circulation, as well as a promising drug effective against coronavirus disease 2019 (COVID-19). We conducted a systematic meta-analysis to evaluate the safety and efficacy of NM administration in critically ill patients who underwent blood purification therapy (BPT).MethodsThe Cochrane Library, Web of Science and PubMed were comprehensively searched from inception to August 20, 2021, for potential studies.ResultsFour randomized controlled trials (RCTs) and seven observational studies with 2723 patients met the inclusion criteria. The meta-analysis demonstrated that conventional therapy (CT) significantly increased hospital mortality compared with NM administration (RR = 1.25, p = 0.0007). In subgroup analyses, the in-hospital mortality of the NM group was significantly lower than that of the anticoagulant-free (NA) group (RR = 1.31, p = 0.002). The CT interventions markedly elevated the risk ratio of bleeding complications by 45% (RR = 1.45, p = 0.010) compared with NM interventions. In another subgroup analysis, NM used exhibited a significantly lower risk of bleeding complications than those of the low-molecular-weight heparin (LMWH) used (RR = 4.58, p = 0.020). The filter lifespan was decreased significantly (MD = −10.59, p < 0.0001) in the NA groups compared with the NM groups. Due to the poor quality of the included RCTs, these results should be interpreted with caution.ConclusionGiven the better survival outcomes, lower risk of bleeding, NM anticoagulation seems to be a safe and efficient approach for BPT patients and could yield a favorable filter lifespan. More multi-center RCTs with large samples are required for further validation of this study.     

糖尿病氧化应激环境中α-Klotho对巨噬细胞-血管内皮细胞串扰的影响

目的：探讨糖尿病氧化应激环境中过表达α-Klotho(KL)的小鼠单核巨噬细胞白血病细胞(RAW264.7)对人脐静脉内皮细胞(HUVECs)增生、迁移、管腔形成以及紧密连接的影响。

方法：将RAW264.7细胞分为对照组、4-羟壬二酸酯(4HNE)组、4HNE+KL组,采用免疫荧光实验检测RAW264.7细胞F4/80的表达。制备3组细胞的条件培养基用于培养HUVECs,分为Mø-NC组、Mø-4HNE组和Mø-4HNE+KL组。采用CCK8实验检测血管内皮细胞增生,采用划痕实验和Transwell实验检测迁移,采用管腔形成实验检测管腔形成,采用Western blot实验检测闭合蛋白5(Claudin 5)、咬合蛋白(Occludin)、带状闭合蛋白1(ZO 1)表达水平。

结果：免疫荧光实验结果显示,4HNE组RAW264.7细胞F4/80荧光强度较对照组明显增强,而4HNE+KL组F4/80荧光强度较4HNE组明显减弱(均P<0.05)。CCK8实验结果显示,相比于Mø-NC组,Mø-4HNE组HUVECs增生显著增加,而Mø-4HNE+KL组HUVECs增生较Mø-4HNE组显著下降(均P<0.01)。划痕实验和Transwell实验结果显示,相比于Mø-NC组,Mø-4HNE组HUVECs迁移显著增强,而Mø-4HNE+KL组HUVECs迁移较Mø-4HNE组显著减弱(均P<0.01)。管腔形成实验结果显示,相比于Mø-NC组,Mø-4HNE组HUVECs管腔数显著增加,而Mø-4HNE+KL组管腔数较Mø-4HNE组显著下降(均P<0.01)。Western blot实验结果显示,相比于 Mø-NC组,Mø-4HNE组HUVECs中Claudin 5、Occludin、ZO 1蛋白的相对表达量明显减少,而Mø-4HNE+KL组Claudin 5、Occludin、ZO 1蛋白的相对表达量较Mø-4HNE组明显增加(均P<0.01)。

结论：KL通过改变糖尿病氧化应激环境中巨噬细胞激活状态抑制了HUVECs的增生、迁移、管腔形成,并增强了HUVECs的紧密连接。