Comparison of Life Satisfaction in Persons With Spinal Cord Injury Living in 22 Countries With Different Economic Status

ObjectiveTo analyze and compare life satisfaction (LS) in persons with spinal cord injury (SCI) living in 22 countries participating in the International Spinal Cord Injury (InSCI) community survey. The study tested the hypothesis that there are differences in LS across InSCI countries according to the countries’ economic status specified as gross domestic product per capita purchased power parity (GDP-PPP).DesignCross-sectional survey.SettingCommunity setting (22 countries representing all 6 World Health Organization regions).ParticipantsPersons (N=12,108) with traumatic or nontraumatic SCI aged at least 18 years, living in the community and able to respond to one of the available language versions of the questionnaire.InterventionsNot applicable.Main Outcome MeasuresLS measured by 5 items selected from the World Health Organization Quality of Life Assessment-BREF: satisfaction with overall quality of life, health, daily activities, relationships, and living conditions. LS index was calculated as the mean of these 5 items.ResultsThe highest level of LS was reported by persons with SCI living in the United States, Malaysia, and Switzerland (mean range, 3.76-3.80), and the lowest was reported by persons with SCI living in South Korea, Japan, and Morocco (mean range, 2.81-3.16). There was a significant cubic association between LS index and GDP-PPP. Regression tree analysis revealed the main variables differentiating LS index were GDP-PPP and monthly income, followed by time since injury and education.ConclusionsLife satisfaction reported by persons with SCI related mainly to their country economic situation expressed by GDP-PPP and monthly income. The results of this study underscore the need for policy dialogues to avoid inequalities and improve the life experience in persons with SCI.     

Status epilepticus associated with pregnancy: A cohort study

BackgroundStatus epilepticus (SE) is a neurological emergency associated with a high mortality rate and long-term cognitive sequelae. Status epilepticus in pregnancy poses a tremendous threat to both mother and fetus, making a correct diagnosis and treatment a challenging task for clinicians. The prevalence, underlying etiology, and outcomes of pregnancy-related SE remain largely unknown.MethodsWe retrospectively studied all SE episodes (n = 366) in patients admitted to our neurological ICU over a period of 8.5 years. The patients who developed SE during pregnancy and within 6 months after delivery were considered to have pregnancy-related SE. Patients with eclampsia were not included as they were usually cared for in our obstetric unit.ResultsSeven patients with pregnancy-related SE were identified (2.1% of all cases of SE), with the majority (85%) occurring de novo except for one patient who had a previous history of epilepsy-related SE due to withdrawal of antiepileptic medication. In terms of etiology, limbic encephalitis and cerebral venous sinus thrombosis were the two main etiologies of de novo SE associated with pregnancy. The overall mortality rate was 28.5% at discharge, and poor outcomes were especially noted in the patients with limbic encephalitis compared to other etiologies.ConclusionsPregnancy-associated SE is rare and predominantly occurs in patients without a history of epilepsy. An autoimmune etiology should be considered in pregnant patients with de novo SE, which was associated with poor outcomes. Thorough investigations and prompt treatment according to the etiology may be required to improve the final outcomes of both mother and fetus.     

Dynamic intraligamentary stabilization versus conventional ACL reconstruction: A matched study on return to work

PurposeThe dynamic intraligamentary stabilization (DIS) technique is based on a different treatment approach than ACL reconstruction in that it intends to promote self-healing of the ligament. It is only recommended for acute injuries (<21 days). The purpose of the present study was to compare DIS and ACLR with respect to the extent of work incapacity, revision rates, secondary arthroscopies, and treatment costs during recovery.MethodsThe study was a post-hoc analysis of prospectively collected data in the Swiss National Accident Insurance Fund (SUVA) database. All registered DIS cases treated until 31 December 2012 were included in the study. ACLR cases were matched to DIS cases using a propensity score approach and analysed in a follow-up period of 2 years after injury. Paired Student’s T-test and the Chi-square test were used to compare the outcome measures.ResultsAll 53 DIS patients were matched to an ACLR pair. The mean time period from injury to surgery was 14 days for DIS and 50 days for ACLR (p < 0.001). Overall work incapacity was 13% for DIS and 17% for ACLR resulting in a difference of nearly 1 month of absence from work (p = 0.03). The course of postoperative work incapacity was very similar between the groups, while the work incapacity prior to surgery lower in the DIS group. We found no difference in treatment costs, secondary arthroscopies and revision rates.ConclusionDIS patients benefited from nearly one month shorter absence from work than ACLR patients. This difference is likely related to the early surgical timing that is recommended for DIS. Since no differences were found between DIS and ACLR in terms of treatment costs, secondary arthroscopies and revision rates, the study supports the choice of DIS as an additional treatment option for acute ACL injuries. Further comparative studies are proposed to improve the evidence about optimal timing and best practice in ACL treatment.     

THE ENGINE AND THE REAPER: INDUSTRIALIZATION AND MORTALITY IN LATE NINETEENTH CENTURY JAPAN

Economic development improves long-run health outcomes through access to medical treatment, sanitation, and higher income. Short run impacts, however, may be ambiguous given disease exposure from market integration. Using a panel dataset of Japanese vital statistics and multiple estimation methods, I find that railroad network expansion is associated with a six percent increase in gross mortality rates among newly integrated regions. Communicable diseases accounted for most of the rail-associated mortality, which indicate railways behaved as transmission vectors. At the same time, market integration facilitated by railways corresponded with an eighteen percent increase in total capital investment nationwide over ten years.     

厦门市社会医疗保险覆盖外来员工的实践探索

由于流动性大,社会医疗保险在覆盖外来员工的问题上存在许多难点.本文通过对难点问题的剖析,对外来员工医疗保险的参保、缴费、待遇、费用控制等方面进行了探索,提出了解决问题的对策.     

Calcification and osteopontin localization in the peritoneum of patients on long-term continuous ambulatory peritoneal dialysis therapy.

BACKGROUND: Peritoneal calcification is an uncommon complication of continuous ambulatory peritoneal dialysis (CAPD), which is mainly observed in patients on long-term therapy. Although some asymptomatic patients must have microscopic calcification in their peritoneum, little information on this topic has been published. Recent studies have revealed active participation of adhesive/chemotactic protein osteopontin (OPN) in dystrophic calcification. METHODS: Peritoneal tissue was obtained by biopsy or at autopsy from 18 CAPD patients (median duration, 122 months), 5 control haemodialysis (HD) patients, and 3 pre-CAPD patients. The distribution of calcium deposits and OPN protein was determined by von Kossa staining and immunohistochemistry, respectively. Smooth muscle cells and macrophages were identified with anti-alpha smooth muscle actin (alpha-SMA) and anti-CD68 antibodies. RESULTS: Calcium deposits with various configurations were observed in specimens from 12 of the 18 CAPD patients. They included massive calcification facing the peritoneal cavity, scattered granular or crystalloid deposits in the submesothelial stroma, and oval-shaped deposits formed within hyalinized vasa. Most were present in highly sclerosed areas and accompanied by extracellular OPN precipitation. Cytoplasmic OPN was detected in infiltrating leukocytes, granulation tissue cells, fibroblast-like cells and mast cells. Computerized tomography examination also detected peritoneal calcification in seven of the CAPD patients. No calcium deposits or OPN staining was detected in control specimens. CONCLUSIONS:The results of our study suggest that microscopic peritoneal calcification is frequent in patients on CAPD for more than 10 years. Myofibroblast infiltration, OPN expression, calcium deposition, and associated OPN precipitation seem to be components of the peritoneal changes in such patients.     

HSQC—TOCSY技术在黄酮苷类中的应用

HSQC—TOCSY技术对于具有若干独立直旋系统的复杂分子的结构解析有十分重要的作用。本文以从益母草（Leonurus heterophyllus Sweet）中分离得到的heteronoside为例说明HSQC-TOCSY技术在黄酮苷类中的应用，并对其^13C，^1H化学位移进行了明确的归属。