Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce

Access to good-quality health services is crucial for the improvement of many health outcomes, such as those targeted by the Millennium Development Goals (MDGs) adopted by the international community in 2000. The health-related MDGs cannot be achieved if vulnerable populations do not have access to skilled personnel and to other necessary inputs. This paper focuses on the geographical dimension of access and on one of its critical determinants: the availability of qualified personnel. The objective of this paper is to offer a better understanding of the determinants of geographical imbalances in the distribution of health personnel, and to identify and assess the strategies developed to correct them. It reviews the recent literature on determinants, barriers and the effects of strategies that attempted to correct geographical imbalances, with a focus on empirical studies from developing and developed countries. An analysis of determinants of success and failures of strategies implemented, and a summary of lessons learnt, is included.     

Subclinical course of adult visceral Niemann–Pick type C1 disease. A rare or underdiagnosed disorder?

Summary  We present the third case of Niemann–Pick disease type C without neurological symptoms. The patient was a 53-year-old woman without significant prior health problems who died of acute pulmonary embolism. Autopsy findings of hepatosplenomegaly, lymphadenopathy and ceroid-rich foam cells raised the suspicion of the visceral form of acid sphingomyelinase deficiency (Niemann–Pick disease type B; NPB) or a much rarer disorder, variant adult visceral form of Niemann–Pick disease type C (NPC). To verify the histopathological findings, SMPD1, NPC1 and NPC2 genes were analysed. Two novel sequence variants, c.1997G>A (S666N) and c.2882A>G (N961S) were detected in the NPC1 gene. No pathogenic sequence variants were found either in the SMPD1 gene mutated in NPB or in NPC2 gene. The pathogenicity of both NPC1 variants was supported by their location in regions important for the protein function. Both variations were not found in more than 300 control alleles. Identified sequence variations confirm the diagnosis of the extremely rare adult visceral form of Niemann–Pick disease type C, which is otherwise dominated by neurovisceral symptoms. Although only three patients have been reported, this (most probably underdiagnosed) form of NPC should be considered in differential diagnosis of isolated hepatosplenomegaly with foam cells in adulthood. Electronic supplementary material  Supplementary material is available for this article at     

Expression of innate immune complement regulators on brain epithelial cells during human bacterial meningitis

Background  

In meningitis, the cerebrospinal fluid contains high levels of innate immune molecules (e.g. complement) which are essential to ward off the infectious challenge and to promote the infiltration of phagocytes (neutrophils, monocytes). However, epithelial cells of either the ependymal layer, one of the established niche for adult neural stem cells, or of the choroid plexus may be extremely vulnerable to bystander attack by cytotoxic and cytolytic complement components.     

医科院校学生心理危机管理浅探

结合医科院校学生心理危机管理的实践，阐述大学生心理危机的内涵、类型、特征及心理危机管理的特性，并从建立预警系统、增设心理委员、危机处理的专业化及危机干预策略等方面探讨在医科院校加强学生心理危机管理的对策。     

顽固性下颌磨牙根尖周炎患者的治疗和护理讨论

目的治疗顽固性下颌磨牙根尖周炎。并尽量减少对牙周膜的机械性损伤。方法采用下牙槽神经阻滞麻醉,并配合局部麻醉。拔牙钳的尖置放于釉牙骨质界以上,采用颊舌向摆动的方式将患牙拔下。在不断滴有生理盐水的条件下,立即用高速车针磨除患牙根尖2￣3mm的牙体组织,根管内3￣5mm深的充填物要用圆钻将其清除,再用牙胶尖和氢氧化钙糊剂充填。将患牙再植入牙槽窝之前,务必用生理盐水将牙槽窝冲洗干净,要求严格控制在15分钟内完成再植,并尽量减少对牙周膜的机械性损伤。再植牙齿一般不需要夹板固定,必要时可采用缝线缝合固定。结果我们选择的5例患者,术后随访1￣2年,1例患者再植失败,4例患者再植成功。结论特异性再植术治疗顽固性下颌磨牙根尖周炎疗效理想,而且较易掌握。     

Correction of frequency and phase variations induced by eddy currents in localized spectroscopy with multiple echo times.

As a consequence of the time-varying magnetic field induced by eddy currents, frequency drifting occurs when the sampling window of localized spectroscopy continuously shifts. The frequency drifting and the concomitant phase variations can severely affect spectroscopy results when data are acquired with multiple echo times (TEs), such as in the measurement of glutamate (Glu) concentration using the TE-averaged method. Specifically, the averaged spectra are further broadened and distorted in the presence of residual eddy currents, and editing of the coupled spins of Glu C4 protons is affected, resulting in errors in the measured relative intensity ratio. Postacquisition correction using unsuppressed water as reference can effectively minimize this detrimental effect, as manifested by the significantly enhanced signal intensity. Also, it is demonstrated that the methyl signals of creatine (Cr) at 3.0 ppm and choline (Cho) at 3.2 ppm can be used as internal references in finding frequency and phase disparities between different TEs.     

Pulmonary Lophomonas blattarum infection in patients with kidney allograft transplantation

The aim of the study was to analyse the clinical manifestation and management of pulmonary Lophomonas blattarum infection in four allograft transplantation recipients retrospectively. Four patients with pulmonary L. blattarum infection were diagnosed by using Fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) examination. Their clinical manifestation and management are summarized. Four cases of pulmonary L. blattarum were found during the period from the second month to the third month after transplantation. Concurring infection by other pathogens was found in three of them. Common initial symptoms included fever (>38 degrees C) without cough and breathlessness. Lower lobe shadowing could be found on chest X-ray. Body temperature decreased to the normal range in three patients and to 37.5 degrees C in the other one, after intravenous injection of metronidazole and tapering immunosuppressant. Radiological examination confirmed improved health condition of the patients afterwards. Two patients received repeated FOB and only dead L. blattarum was found. Pulmonary L. blattarum infection in allograft transplant recipients carry relatively obscure initial symptoms. Possible L. blattarum infection needs to be screened in post-transplantation pulmonary infection patients with similar symptoms, especially in those who respond poorly to anti-infection treatment. Microscopic examination of BAL fluid can help to identify pulmonary L. blattarum infection and metronidazole is an ideal treatment choice.     

神经修复导管的材料学及制备方法

目的:综合分析近年来国内外神经修复用导管材料以及制备方法的研究近况。资料来源:应用计算机检索ElsevierScience1996-01/2005-12有关神经修复及神经导管方面的文献,检索词分别为“nerveconduit,nerveguide,nerveregeneration”,限定文献语言种类为English。同时计算机检索清华数字期刊库、万方数据库1996-01/2005-12有关神经修复及神经导管方面的文献,检索词为“神经修复,导管”,限定语言种类为中文。资料选择:对检索到的神经再生、神经修复及神经导管方面的相关信息进行整理,选取针对性强的文章。同一领域的文献则选择近期发表或权威杂志的文章。资料提炼:共收集120篇关于神经修复、神经导管的文献,纳入23篇符合标准的文献。资料综合:用神经导管桥接断离神经是神经修复的重要方法之一,制备神经导管的材料按其降解性能分为生物不可降解材料和生物可降解材料,任何一种材料都有其优缺点,发展复合材料将是制备导管的主要方向。结论:虽然影响神经再生的因素还有许多,如神经生长因子、雪旺细胞等,但是新型的导管及制备方法将会有利于神经修复进一步发展。