Inclusive health

We propose the concept of Inclusive Health to encapsulate the Health for All ethos; to build on the rights-based approach to health; to promote the idea of inclusion as a verb, where a more proactive approach to addressing distinctive and different barriers to inclusion is needed; and to recognise that new initiatives in human resources for health can offer exciting and innovative ways of healthcare delivery. While Inclusive Education has become a widely recognised and accepted concept, Health for All is still contested, and new thinking is required to develop its agenda in line with contemporary developments. Inclusive Health refers both to who gets health care and to who provides it; and its ethos resonates strongly with Jefferson's assertion that 'there is nothing more unequal, than the equal treatment of unequal people'. We situate the timeliness of the Inclusive Health concept with reference to recent developments in the recognition of the rights of people with disability, in the new guidelines for community-based rehabilitation and in the World Report on Disability. These developments offer a more inclusive approach to health and, more broadly, its inter-connected aspects of wellbeing. A concept which more proactively integrates United Nations conventions that recognise the importance of difference - disability, ethnicity, gender, children - could be of benefit for global healthcare policy and practice.     

Evaluación de la distancia al recto medio en la exotropía consecutiva mediante tomografía de coherencia óptica y medida intraoperatoria

PurposeTo assess the agreement between the intraoperative measurements of the distance from the medial rectus muscles insertion to the limbus and preoperative spectral-domain optical coherence tomography (SD-OCT) in consecutive exotropia (cXT).MethodsAn analysis was performed on total of 14 medial rectus (MR) muscles of 14 patients who underwent surgery for the treatment of cXT. The limbus-insertion distance of the MR muscles was measured using preoperative SD-OCT and intraoperatively using a calliper. The intraclass correlation coefficient (ICC) and Bland Altman plots were calculated to determine the agreement between the two methods, as well as the correlation.ResultsMean age was 36.3 ± 16.0 years (range 13-60), with 60% being women. Mean preoperative deviation was 38.7 ± 16.9 prismatic dioptres (PD) (range 16 to 65), being +1.3 ± 6.3 PD (range -12 to +10 PD) after surgery. Intraoperatively the MR insertion was found at 8.7 ± 2.1 mm (range 5.5 - 12.0) and by OCT at 7.7 ± 1.2 mm (range 5.3 - 10.0). The ICC showed a moderate to good agreement (0.659; 95% confidence interval: 0.157-0.885; P < .001), with a correlation of R = 0.792 (P = .011). A better agreement was observed in those MR that were less retro-inserted.ConclusionsSD-OCT is able to measure the insertion to the limbus distance of the medial rectus muscles that have been previously operated on, showing moderate to good agreement with intraoperative measurements. However, the agreement was poor in muscles with a large retro-insertion.     

103例江苏汉族类风湿关节炎患者HLA-G14bp插入/缺失多态性研究

目的探讨江苏汉族类风湿关节炎(RA)患者HLA-G14bp插入/缺失多态性与疾病易感性及其他临床特征的相关性。方法采用序列特异性引物PCR(PCR-SSP)的方法检测江苏籍103例汉族RA患者及104例无血缘关系健康人的HLA-G14bp插入/缺失多态性,分析相关临床特征与不同基因型的关系。结果 HLA-G14bp插入/缺失多态性在健康人和RA患者均显示Hardy-Weinberg平衡,RA患者与健康人对照组比较,HLA-G14bp+/+、+/-和-/-基因型阳性率差异无统计学意义(P均0.05);RA患者不同合并症及不同病程病例组间HLA-G14bp插入/缺失多态性差异无统计学意义(P0.05);HLA-G14bp+/+组类风湿因子(RF)阳性率与-/-组比较,差异有统计学意义(P0.05)。结论江苏汉族HLA-G14bp插入/缺失多态性与RA疾病易感性无关,但可影响患者RF的形成。     

High resolution melting analysis of deletion/insertion polymorphisms: A new method for the detection and quantification of mixed chimerism in allogeneic stem cell transplantation

Increasing mixed chimerism after allogeneic stem cell transplantation has been associated with a high risk of relapse and probable graft failure in patient with hematological malignancies as well as non-malignant conditions. We evaluated a new method for chimerism detection, based on the quantitative High Resolution Melting Analysis (HRMA) of deletion/insertion polymorphisms (DIPs).The study consisted in the selection of a panel of DIPs, all generating genotype-specific melting curves, and in the use of samples containing opposite molecular species (homozygous INS/INS and DEL/DEL) mixed in different percentages to create a standard curve for each polymorphism.The detection of mixed chimerism with the HRMA attained a sensitivity of <1%, as well as good accuracy and precision with Percent Errors and Coefficients of Variation not exceeding 30% in reconstruction experiments with DNA mixtures.The present approach provides accurate and precise estimates of mixed chimerism and makes the method open to evaluation for its use in clinical practice.     

Gene Editing–Mediated Disruption of Epidermolytic Ichthyosis–Associated KRT10 Alleles Restores Filament Stability in Keratinocytes

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Association of insertion/deletion polymorphism of the angiotensin-converting enzyme gene with angio-oedema accompanying chronic urticaria but not chronic urticaria without angio-oedema or the autologous serum skin test response

Background Chronic urticaria is defined as the daily or almost daily occurrence of weals for more than 6 weeks. The underlying pathophysiology is reported to be mast cell activation, with release of mast cell mediators, predominantly histamine. Substance P is a neuropeptide and has the capacity to provoke histamine release from skin mast cells. Angiotensin‐converting enzyme (ACE), widely expressed in skin, is one of the major peptidase for the degradation of substance P. An insertion/deletion polymorphism (I/D) in the ACE gene has been reported to be related to the levels of enzyme. Objective An increase in substance P levels due to a polymorphism in ACE gene might be related to the pathology. Thus, we aimed to investigate whether there is an association between ACE I/D polymorphism and chronic ordinary urticaria. Methods Ninety‐five patients with chronic ordinary urticaria were recruited and divided into two groups according to autologous serum skin test status and accompanying angio‐oedema. One hundred and sixty‐one healthy subjects were enrolled as control group. All participants were genotyped for I/D polymorphism in intron 16 of the ACE gene by polymerase chain reaction. Results A statistically significant association was not found between ACE I/D polymorphism and chronic ordinary urticaria. Further analyses of chronic ordinary urticaria patients showed that ACE I/D polymorphism was not associated with autologous serum skin test status of patients. However, the frequencies of II genotype and I allele were statistically significantly higher in chronic ordinary urticaria patients with accompanying angio‐oedema with regard to angio‐oedema‐negative patients (II genotype: 24% vs. 9%, P = 0.0002; I allele: 58% vs. 27%, P = 0.0001) and control group (II genotype: 24% vs. 19%, P = 0.01; I allele: 58% vs. 41%, P = 0.03). Conclusion The results of this study suggest no evidence of an association between ACE I/D polymorphism and risk of developing chronic ordinary urticaria. However, it can be a contributing factor to susceptibility of angio‐oedema in chronic ordinary urticaria.     

A new set of markers for human identification based on 32 polymorphic Alu insertions

A number of genetic systems for human genetic identification based on short tandem repeats or single nucleotide polymorphisms are widely used for crime detection, kinship studies and in analysis of victims of mass disasters. Here, we have developed a new set of 32 molecular genetic markers for human genetic identification based on polymorphic retroelement insertions. Allele frequencies were determined in a group of 90 unrelated individuals from four genetically distant populations of the Russian Federation. The mean match probability and probability of paternal exclusion, calculated based on population data, were 5.53 × 10⁻¹⁴ and 99.784%, respectively. The developed system is cheap and easy to use as compared to all previously published methods. The application of fluorescence-based methods for allele discrimination allows to use the human genetic identification set in automatic and high-throughput formats.     

ACE基因的插入/缺失多态性与2型糖尿病伴高血压的相互关系

目的探讨血管紧张素转换酶（ACE）基因插入/缺失（I/D）多态性与2型糖尿病伴高血压之间的相互关系。方法以ACE基因为候选基因,应用PCR方法,检测用例2型糖尿病伴高血压患者及117例2型糖尿病无高血压患者的ACE基因。结果2组研究对象DD、DⅠ、Ⅱ基因型分布频率分别为27.16％vs 20.51％、41.98％vs 41.88％、30.86％vs37.61％,D、I等位基因携带率分别为48.15％vs41.45％、51.85％vs58.55％,均有显著性差异（P<0.05）,提示ACE基因DD型及D等位基因与2型糖尿病并发高血压的发生有相关性。糖尿病患者中ACE基因I/D多态呈DD型者发生高血压的风险率为Ⅱ型者的1.32倍,且糖尿病伴高血压患者病程显著延长。正常血压糖尿病患者ACE基因 I/D多态性与单纯收缩压（SBP）升高患者ACE基因I/D多态性之间无显著差异,而与单纯舒张压（DBP）升高患者ACE基因I/D多态性之间显著相关。结论ACE基因I/D多态性参与2型糖尿病伴高血压的发病,D等位基因可能是2型糖尿病并发高血压的一个危险因子,且DBP升高在糖尿病伴高血压的发生中起重要作用。     

血管紧张素Ⅰ转换酶基因多态性与2型糖尿病肾病相关性研究

目的 探讨血管紧张素Ⅰ转换酶(ACE)基因插入／缺失(I／D)多态性与2型糖尿病。肾病发生和发展的关系。方法 对298例2型糖尿病患者(T2DM总组)和87名非糖尿病正常人(Non-DM组)进行病例对照研究。将T2DM总组分为无糖尿病。肾病(DN-0)组和糖尿病肾病(TDN)组，后者进一步分为微量蛋白尿(DN-1)组和临床蛋白尿(DN-2)组。采用聚合酶链反应-4％琼脂糖凝胶电泳法检测ACE基因内含子16的1个287bp的Alu顺序I／D型多态标志。结果 ①2型糖尿病未合并。肾病与合并。肾病及。肾功能不全等各亚组之间基因型频率的差异无显著性(DN-0、DN-1和DN-2组DD：DI：II别为27．5％：43．8％：28．8％、23．3％：39．5％：37．2％和22．5％：47．2％：30．3％)。②基因型组合DD DI与II各组间比较的差异无显著性。③等位基因频率的差异无显著性(DN-0、DN-1和DN-2组D：1分别为49．4％：50．6％、43．0％：57．0％和46．1％：53．9％)。结论 ACE I／D多态性与2型糖尿病。肾病的发生和发展无显著相关性。     

Primary pyomyositis of the paraspinal muscles: a case report and literature review

The objectives of this study were (1) to quantify the benefit of computer assisted orthopaedic surgery (CAOS) pedicle screw insertion in a porcine cadaver model evaluated by dissection and computed tomography (CT); (2) to compare the effect on performance of four surgeons with no experience of CAOS, and varying experience of pedicle screw insertion; (3) to see if CT with extended windows was an acceptable method to evaluate the position of the pedicle screws in the porcine cadaver model, compared to dissection. This was a prospective, randomised, controlled and blinded porcine cadaver study. Twelve 6-month-old porcine (white skinned Landrace) lumbar spines were scanned pre-operatively by spiral CT, as required for the CAOS computer data set. Computer randomisation allocated the specimens to one of four surgeons, all new to CAOS but with different levels of experience in spinal surgery. The usual anatomical landmarks for the freehand technique were known to all four surgeons. Two pedicles at each vertebral level were randomly allocated between conventional free hand insertion and an electromagnetic image guided surgery (NAVITRAK^®) and 6.5 mm cancellous AO screws inserted. Post-operatively, spiral CT was blindly evaluated by an independent radiologist and the spine fellow to assess the accuracy of pedicle screw placement, by each method. The inter- and intra-observer reliability of CT was evaluated compared to dissection. The pedicle screw placement was assessed as perfect if within the pedicle along its central axis, or acceptable (within < 2 mm from perfect), and measured in millimetres from perfect thereafter. One hundred and sixty-six of 168 pedicles in 12 porcine spines were operated on. Complete data were present for 163 pedicles (81 CAOS, 82 freehand). In the CAOS group 84% of screws were deemed acceptable or perfect, compared to 75.6% with the freehand technique. Screw misplacement was significantly reduced using CAOS (P = 0.049). Seventy-nine percent of CAOS screws were ideally placed compared with 64% with a conventional freehand technique (P = 0.05). A logistic linear regression model showed that the miss placed pedicle screw rate was significantly reduced using CAOS (P = 0.047). CAOS benefited the least experienced surgeons most (the research registrars acceptable rate increased from 70 to 90% and the spine fellow from 76 to 86%). CAOS did not have a statistically significant effect on the experienced consultant spine surgeon increasing from 70 to 79% (P = 0.39). The experienced general orthopaedic surgeon did not benefit from CAOS (P = 0.5). CT compared to dissection showed an intra-observer reliability of 99.4% and inter-observer reliability of 92.6%. The conclusions of this study were as follows: (1) an increased number of pedicle screws were ideally placed using the CAOS electromagnetic guidance system compared to the conventional freehand technique; (2) junior surgeons benefited most from CAOS; (3) we believe CAOS (Navitrak^®) with porcine lumbar spines evaluated by post operative CT, represents a useful model for training junior surgeons in pedicle screw placement; (4) experienced spine surgeons, who have never used CAOS, may find CAOS less helpful than previously reported.