Point-of-care hepatitis C screening with direct access referral to improve linkage to care among halfway house residents: a pilot randomised study

INTRODUCTIONLinkage to care among individuals with substance misuse remains a barrier to the elimination of the hepatitis C virus (HCV). We aimed to determine whether point-of-care (PoC) education, screening and staging for liver disease with direct access to hospitals would improve linkage to care among this group.METHODSAll participants were offered PoC education and HCV screening. HCV-positive participants were randomised to standard care (controls) or direct access, which provided a direct pathway to hospitals. Linkage to care was determined by reviewing electronic medical records. Linkage of care cascade was defined as attendance at the specialist clinic, confirmation of viraemia by HCV RNA testing, discussion about HCV treatment and initiation of treatment.RESULTS351 halfway house residents were screened. The overall HCV prevalence was 30.5% (n = 107), with 69 residents in the control group and 38 in the direct access group. The direct access group had a significantly higher percentage of cases linked to specialist review for confirmatory RNA testing (63.2% vs. 40.6%, p = 0.025), HCV treatment discussion (p = 0.009) and treatment initiation (p = 0.01) compared to the controls. Overall, only 12.6% (n = 13) had treatment initiation during follow-up. PoC HCV screening with direct access referral had significantly higher linkage to HCV treatment initiation (adjusted odds ratio 9.13, p = 0.005) in multivariate analysis.CONCLUSIONPoC HCV screening with direct access improves linkage to care and simplifies the HCV care cascade, leading to improved treatment uptake. PoC education, screening, diagnosis and treatment may be an effective strategy to achieving HCV micro-elimination in this population.     

穴位注射脑活素治疗小儿脑性瘫痪临床观察

目的: 探讨脑活素穴位注射治疗小儿脑性瘫痪(脑瘫)的临床疗效。方法: 我院1994年10月~2002年10月采用脑活素天柱穴注射治疗小儿脑瘫,对围生期有窒息及缺氧缺血性脑病史的患儿,做新生儿20项行为神经测定(NBNA)得分<35者早期干预治疗。结果: 患儿在肢体功能、语言功能及智能方面得到改善,总有效率81.3%以上。结论: 脑活素穴位注射可输通经络,平衡阴阳,改善脑部微循环,脑功能得以代偿,方法简单,治疗愈早效果愈好,可提高患儿生存质量。     

民政精神病患者抗精神病药使用时点调查

目的了解我院住院民政精神病患者抗精神病药物使用情况。方法采用自制调查表对我院住院民政精神疾病患者的抗精神病药物使用状况进行时点调查。结果我院住院民政精神病患者在抗精神病药物使用上仍以单一用药为主（78.78%）,其中以氯氮平使用率最高(45.68%),联合用药中均以氯氮平为主要配对方式,而新型非典型抗精神病药使用率极低。结论民政精神病人在抗精神病药物的选择上较为简单,非典型抗精神病药难于被广泛使用,如果能适当选择一些新型抗精神病药,将对提高民政精神病患者的认知,恢复其社会功能起到积极的作用。     

不同刺激量针刺关元穴对寒凝类痛经模型大鼠的影响

目的：观察不同的针刺刺激量施于关元穴对寒凝类痛经模型大鼠子宫组织中收缩素受体（ OTR）及肌球蛋白轻链激酶（ MLCK）含量的影响。方法将处于动情间期3月龄的SD雌性大鼠32只,随机分为盐水组、寒凝类痛经模型组24只,造模成功后将寒凝类痛经模型组又分为模型组、刺激量A组和刺激量B组,每组8只。除盐水组外,模型组、刺激量A组和刺激量B组均采用全身冷冻法结合苯甲酸雌二醇注射法造模。盐水组和模型组不予针刺,刺激量A组予以粗针、深刺、行手法;刺激量B组予以细针、浅刺、不施手法。采用荧光定量PCR方法检测大鼠子宫组织中缩宫素受体（ OTR）的含量。采用ELISA（酶联免疫法）测量大鼠子宫组织中MLCK的含量。结果与盐水组比较,模型组的子宫收缩波个数、波峰峰值、活动度及MLCK水平均升高（ P﹤0.01）;与模型组比较,刺激量A组的子宫收缩波个数明显减少（ P﹤0.05）、MLCK含量明显降低（ P﹤0.01）,刺激量B组的OTR mRNA相对表达量降低（ P﹤0.05）;与刺激量A组比较,刺激量B组收缩波个数增多（ P﹤0.05）、OTR mRNA相对表达量降低（ P﹤0.01）。结论不同刺激量针刺关元穴对寒凝类痛经模型大鼠的效应有所不同,粗针、深刺、行手法的效应较强于细针、浅刺、不行手法的针刺效应,提示针刺的刺激量也是决定针刺疗效的因素之一。     

聚苯乙烯在环己烷、甲基环己烷系统中的液液平衡 Ⅰ．雾点线和旋节线的实验测定

建立了高分子溶液雾点线和旋节线的测定方法及其实验装置，测定了环己烷－聚苯乙烯（Ｍ＿ｗ＝１９００００；Ｍ＿ｗ／Ｍ＿ｎ＝１．０４）、甲基环己烷－聚苯乙烯（Ｍ＿ｗ＝３７９００；Ｍ＿ｗ／Ｍ＿ｎ＝１．０１）系统的雾点线和旋节线，经与文献数据比较，表明本方法及其装置是可行的。     

基于HACCP理论构建基层药品不良反应培训模式初探

目的探索基层药品不良反应培训模式。方法通过引入HACCP理论,对当前基层药品不良反应培训过程中潜在的风险和危害进行识别、分析并采取有效措施加以预防控制。结果从培训师资、培训内容、培训方式等方面初步构建了基层药品不良反应培训模式。结论在培训过程中,注重抓住关键控制点,即培训内容要结合实际、培训对象要分层次、培训方式要有创新、培训效果要有长期性。     

Enhancing the Reliability in the Noninvasive Measurement of the His Bundle Magnetic Field Using a Novel Signal Averaging Methodology

Background: Extraction of the weak electrical activity of the “His Bundle” (HB) by noninvasive methods has not been very successful in the past. The study reassesses the use of signal averaged magnetocardiography (SAMCG), overcoming some of the limitations in earlier studies including in the signal averaging methodology. Methods: SAMCG on healthy subjects (14 male and 1 female) were performed using R‐peak as the fiducial point in all cases and also using QRS‐onset as the fiducial point in select cases. Results: A conspicuous feature (H) with a magnitude up to 200 femto Tesla (fT) attributed to the HB activity was observed in the PR segment at several spatial positions on the thorax, with onset at 35–50 ms before the QRS‐onset (V) in 15 out of 18 trials constituting 83% of cases studied. The QRS‐onset as the fiducial point resolved the feature better compared to the conventionally used R‐peak, especially in trials exhibiting spread in heart rate (HR). This is attributed to the fluctuations in Q_onRD (the time interval between QRS‐onset and R‐peak) compared to the temporal stability of the H‐V duration. Conclusions: SAMCG reveals a well‐resolved H feature. The double hump morphology of the feature extended at least up to a frequency of 150 Hz. The importance of the choice of QRS‐onset as the fiducial point is unequivocally demonstrated, illustrated by measurements on subjects exhibiting considerable heart rate variability. The latter has a general validity and should be applicable to SAECG as well.     

Drawing the Yongquan protocol into the different stages of the cardiopulmonary resuscitation sequence

AIM: To introduce new applications into the ILCOR-cardiopulmonary resuscitation (CPR) “chain” sequence.METHODS: Stages of the CPR sequence (“chain”): prior to the application of chest massage: assess the victim’s state of consciousness and lung-heart failure; seek help (call 911), or in situations in which it is impossible to start the ILCOR protocol: (1) if the victim is trapped in car crash, overturned car, landslide, massive number of victims or catastrophe; or (2) delayed CPR. During chest compression: Yongquan is simultane- ously stimulated by a third rescuer. During defibrillator application: activate K-1 Yongquan through needles before defibrillation. Unsuccessful CPR: “gold standard” for legal clinical death.RESULTS: Implies comparing two hypotheses: Ho (null hypothesis) demonstrates no association between the two variables studied; Ha (alternative hypothesis) implies some degree of relation between them. Difference between the two treatments is observed. If it is greater than the standard error multiplied by a coefficient of security, the difference is significant: Ha will be accepted and Ho rejected. First we will compare CPR without defibrillator (method “A”) and K-1 Yongquan method (method “B”), using percentages of representative samples (treatment “A”: 6.4% response, treatment “B”: 85% response). If │PA - PB│ is greater than the product of 1.96 times the standard error, the difference is significant. Because │PA - PB│ = 0.786 is greater than 0.098, the difference between 0.064 and 0.85 is statistically significant. Thus, we reject Ho and accept Ha as correct. Thus, it is improbable that chance was responsible for this association. This analysis shows that K-1 Yongquan method has a “quality guarantee”. Second, we compare defibrillators (“A”) with K-1 Yongquan method (“B”) (treatment “A”: 48%, treatment “B”: 84%, │PA - PB│= 0.36; │PA - PB│ = 0.36 is greater than SE × 1.96 = 0.0148 and also statistically significant, demonstrating again the comparative value of the Yongquan method.CONCLUSION: The Yongquan resuscitation manoeuver is a non-invasive, non-tiring, costless, and easy-to-apply procedure that provides a second chance when other options fail.     

人脑星型细胞瘤神经细胞黏附分子基因突变分析

目的：了解神经细胞黏附分子（neural cell adhesion molecule,NCAM) 基因突变在人脑星型细胞瘤发生中的作用。方法：对NCAM基因的外显子进行聚合酶链反应-单链构象多态性分析（polymerase chain reaction-single strand conformation polymorphism,PCR-SSCP）,找出可疑突变,回收PCR产物纯化测序及序列分析,ORF finder 软件分析蛋白质序列。结果：43例星型细胞瘤中有1例胶质母细胞瘤NCAM 7号外显子1 126号核苷酸由A颠换为C, 导致369号氨基酸由赖氨酸变为谷氨酰胺,该病人1年后死于复发。结论：NCAM基因点突变导致的蛋白质结构改变在星型细胞瘤的发生中可能有重要意义。