The ethics of executive compensation in the Canadian public health system

The method of executive compensation in the Canadian public health system presently contains complex ethical issues related to transparency and fairness, not only within single organizations, but across provinces, and in comparison with other wage earners. The increasing interest of the public, elected officials, and health decision makers in public sector compensation will bring heightened scrutiny and intervention in the future. This article explores some of the current ethical issues of executive compensation and their implications and points to reform initiatives for the future.     

11C-PIBPET在不同时期阿尔茨海默病中的研究进展

阿尔茨海默病（AD）作为神经变性病,起病隐袭,早期诊断困难。β淀粉样蛋白（Aβ）沉积形成的老年斑是其特征性病理改变,并且发生在疾病的早期阶段。N-[11C]甲基-2—4＇-甲基氨基苯基-6-羟基苯并噻唑（11C-PIB）作为Aβ特异性的分子探针,能够无创、实时、定量地监测脑内纤维状Aβ的变化。因此,明确PIB在不同时期AD中的分布特点,对AD的早期诊断、抗Aβ治疗的人群筛选以及疗效监测方面都具有重要意义。该文就近年来11C-PIBPET在不同时期AD中的应用作一综述。     

鼻内镜下鼻中隔穿孔修补15例临床分析

目的探讨经鼻内镜修补鼻中隔穿孔的手术方法及疗效。方法鼻中隔穿孔直径小于1.0 cm者鼻内镜下颞肌筋膜植入直接封闭,直径大于1.0 cm者鼻内镜下鼻底黏膜翻瓣或转移加筛骨垂直板和颞肌筋膜"三明治"式封闭,术后使用己烯雌酚纱布片贴附促进黏膜生长。结果直接封闭5例,翻瓣封闭6例,转移封闭4例,随访3~12个月,15例鼻中隔穿孔修补成功14例,成功率93.3%。结论鼻内镜下鼻中隔穿孔修补视野清晰,操作精细,大穿孔选用鼻底黏膜翻瓣或转移加筛骨垂直板和颞肌筋膜"三明治"式封闭成功率高。     

The illusive phantom: Does primary care meet patient need following limb loss?

Purpose:?Anecdotal evidence suggests that General Practitioners (GPs) vary in their understanding of phantom pain and associated factors in amputees. This has implications in that the GP's conception of the problem will determine what treatment or referral is offered.

Method:?The present study aimed to explore GP's knowledge and understanding of phantom limb pain using a postal questionnaire. A sample of 129 GPs responded resulting in a response rate of 38%.

Results:?The results suggest that GPs underestimate the prevalence, intensity and duration of phantom and residual limb pain. Moreover, inconsistencies in the reasons given for referral to specialist services for the management of phantom pain were reported.

Conclusion:?These findings have serious implications for the management of phantom limb pain, disability and psychological distress in amputees in that GPs not only provide first line treatment, but are also the gatekeepers for referral to other services. Given this, the role of other professionals within the primary health care team may prove an additional resource for providing both support and accurate information to amputees in the community.     

MGMT and MLH1 methylation in Helicobacter pylori-infected children and adults

AIM:To evaluate the association between Helicobacter pylori(H.pylori) infection and MLH1 and MGMT methylation and its relationship with microsatellite instability(MSI).METHODS:The methylation status of the MLH1 and MGMT promoter region was analysed by methylation specific methylation-polymerase chain reaction(MSPPCR) in gastric biopsy samples from uninfected or H.pylori-infected children(n = 50),from adults with chronic gastritis(n = 97) and from adults with gastric cancer(n = 92).MLH1 and MGMT mRNA expression were measured by real-time PCR and normalised to a constitutive gene(β actin).MSI analysis was performed by screening MSI markers at 4 loci(Bat-25,Bat-26,D17S250 and D2S123) with PCR;PCR products were analysed by single strand conformation polymorphism followed by silver staining.Statistical analyses were performed with either the χ 2 test with Yates continuity correction or Fisher’s exact test,and statistical significance for expression analysis was assessed using an unpaired Student’s t-test.RESULTS:Methylation was not detected in the promoter regions of MLH1 and MGMT in gastric biopsy samples from children,regardless of H.pylori infection status.The MGMT promoter was methylated in 51% of chronic gastritis adult patients and was associated with H.pylori infection(P < 0.05);this region was methylated in 66% of gastric cancer patients,and the difference in the percentage of methylated samples between these patients and those from H.pylori-infected chronic gastritis patients was statistically significant(P < 0.05).MLH1 methylation frequencies among H.pylori-infected and non-infected chronic gastritis adult patients were 13% and 7%,respectively.We observed methylation of the MLH1 promoter(39%) and increased MSI levels(68%) in samples from gastric cancer patients in comparison to samples from H.pylori-infected adult chronic gastritis patients(P < 0.001 and P < 0.01,respectively).The frequency of promoter methylation for both genes was higher in gastric cancer samples than in H.pylori-positiv     

Injury: a new perspective on an old problem

Injury-related morbidity and mortality have finally been acknowledged as major public health issues facing this country today. While injuries represent a serious problem for society as a whole, the rates are significantly higher among African-Americans, especially black males between 20 and 29 years of age. Moreover, injury and death resulting from acts of interpersonal violence are not only increasing, but are also significantly higher among blacks. Because injury-producing events have been shown to conform to the same biological laws that govern the expression and behavior of many infectious and chronic diseases, it has now been determined and verified that such events are largely predictable, and, in many instances, preventable. Because of the significant racial disparity in the incidence of injury-producing events, the authors encourage establishment of vigorous injury prevention, control-oriented curricula, and training opportunities in predominantly black medical schools. The authors assert that such institutions of higher learning represent an ideal point of introduction for innovative injury prevention and control strategies specifically aimed at the African-American population.     

Localization of occult breast lesions: practical solutions to problems of triangulation

The preoperative triangulation and localization of some occult breast lesions can be complicated if the lesion is located deep in the breast. Based on the authors' experience of 1,400 localization procedures, standard breast positions were modified to help locate lesions that were difficult to see in two projections. Standard compression plates were also modified, allowing placement of fenestrations over deep lesions--especially those in the axillary tail of the breast--to facilitate safe, accurate localization.     

Active release of glycine or D-serine saturates the glycine site of NMDA receptors at the cerebellar mossy fibre to granule cell synapse

The current and calcium influx generated by NMDA receptors depend on the concentration of the coagonist glycine, or its analogue d-serine, in the synaptic cleft. If there is no release of glycine, the ionic stoichiometry of the glial GlyT1 glycine transporters expressed near NMDA receptors in the brain should be able to lower the extracellular glycine concentration to below the EC50 for coactivation of NMDA receptors. We examined whether changing the glycine or d-serine concentration in the superfusion solution altered the NMDA receptor mediated component of the synaptic current at the rat cerebellar mossy fibre to granule cell synapse. Adding up to 100 microM glycine or d-serine had no effect, implying that the glycine site is saturated. Using the competitive glycine site antagonist 7-chlorokynurenate, and plausible values for the kinetic parameters of NMDA receptors, we estimate that during activation of the mossy fibres the concentration of glycine or d-serine in the synaptic cleft is at least 4.6 microM or 1.5 microM, respectively, requiring active release of glycine or d-serine.