对新型农村合作医疗定点医疗机构监管的途径与程序

根据定点医疗机构不规范行为产生的规律、特点和表现形式,探讨对定点医疗机构监管的途径,即内部监管和外部监管、组织监督和社会监督、专项监管和综合监管、法律、法规、部门规章、行业条例等监管、内部及外部审计等;制定了对定点医疗机构监管的程序,即制定监管计划—实施监管行动—监管信息反馈—奖优罚劣。     

经直肠B超定位注药治疗难治性慢性细菌性前列腺炎

目的探讨经直肠B超定位注药对临床上难治性慢性细菌性前列腺炎的疗效。方法92例病人经B超直肠定位后,准确注入敏感抗生素及其他相关药物于前列腺内。结果92例病人治愈59例,好转19例,无效14例,治愈及好转率达84%。结论经直肠B超定位注药是治疗难治性细菌性前列腺炎的有效手段,但不宜作为常规首选治疗方法。     

盐酸雷洛昔芬的合成改进

目的:优化盐酸雷洛昔芬的合成路线.方法:以3-甲氧基苯硫酚和4-甲氧基-α-溴代苯乙酮为起始原料,经取代反应,环合反应得到6-甲氧基-2-(4-乙酰氧基苯基)苯并[b]噻吩,再与4-[2-(1-哌啶基)乙氧基]苯甲酰氯盐酸盐发生Friedel-Crafts反应,然后发生脱甲基反应,最后经成盐反应,共5步主要反应制得目标产物.结果:目标化合物结构经红外光谱、核磁共振氢谱及质谱确证.结论:本方法反应条件温和,操作简便,并且提高了产率.     

Does post dural puncture headache exist in idiopathic intracranial hypertension? A pilot study

Background/ObjectiveOccurrence of post-dural puncture headache (PDPH) after diagnostic lumbar puncture (LP) for idiopathic intracranial hypertension (IIH) may seem very unlikely in clinical practice. Nevertheless, it has been suggested by several studies, mainly in sub-group analyses. We aimed to evaluate the prevalence of PDPH in an IIH population and determine any eventual predictive factors of PDPH occurrence.MethodsWe conducted a retrospective multiple-center observational study. All newly diagnosed IIH patients who met the International Classification of Headache Disorders (ICHD-3) or the Dandy modified criteria were included from three different French hospitals. They all underwent LP following the same process with the same type of needle. We recorded PDPH occurring within five days after LP, as defined by ICHD-3 criteria.ResultsSeventy-four IIH patients were recruited, of whom 23 (31%) presented with PDPH. Neither classical risk factors for PDPH such as body mass index, age or gender, nor cerebrospinal fluid opening pressure, or specific IIH features were associated with occurrence of PDPH.ConclusionPDPH can occur after LP in IIH patients. Clinicians should be aware of this possible event during the IIH diagnosis assessment and should not automatically reconsider IIH diagnosis. PDPH prevention using an atraumatic needle and dedicated PDPH treatment seem relevant in IIH patients.     

微塑料生殖和胚胎发育毒性的研究进展

目的 研究发现微塑料（粒径小于5 μm的塑料颗粒）在低等生物和哺乳动物中均可诱导生殖毒性和胚胎发育毒性。本文对微塑料在生殖和胚胎中的毒性效应和作用机制进行综述，可为预防和控制微塑料所致生殖毒性提供理论基础和科学依据。方法 以微塑料、暴露途径、毒性机制、生殖毒性、胚胎毒性为关键词在中国知网、PubMed 等数据库检索相关文献，并对国内外相关文献进行归纳与总结。结果 综述微塑料暴露途径及其转运和代谢分布、全面系统地概述微塑料生殖和胚胎发育毒性效应及毒性机制。结论 研究发现微塑料在低等生物和哺乳动物中均可诱导生殖毒性和胚胎发育毒性，但微塑料所致生殖毒性主要局限在表型研究，目前仍缺乏针对微塑料生殖毒性作用机制的系统研究，同时需在人群层面进一步研究。     

浆细胞性乳腺炎1例治疗体会

目的:采用中药内服与外治相结合的方法治疗浆细胞性乳腺炎早期。方法:采用穿刺法抽出脓液,用甲硝唑注射液行脓腔冲洗,再配合中药内服。结果:患者疗效好、病程短。结论:在浆细胞性乳腺炎早期脓肿形成还未破溃时,采用中药内服与外治相结合的方法能很快缓解病情,防止疾病进一步发展,具有经济、有效、创伤小、防止乳房变形等优点。     

上颌窦穿刺冲洗治疗儿童急慢性鼻窦炎的效果分析

目的分析上颌窦穿刺冲洗治疗儿童急慢性鼻窦炎的临床疗效。方法将320例儿童(7~12岁)急慢性鼻窦炎患者采用随机平行试验设计,分为实验组160例和对照组160例,两组均服用鼻窦炎口服液1次10 m l,每日3次,实验组在鼻腔黏膜麻醉下行上颌窦穿刺,用0.9%氯化钠溶液加甲硝唑注射液反复冲洗后,窦腔内注入地塞米松5mg,每周一次;鼻腔内滴1%呋喃西林麻黄素液,3次/d,15 d为一个疗程。对照组口服广谱抗生素+鼻腔内滴1%呋喃西林麻黄素液,3次/d,15 d为一个疗程。治疗结束后每月复查1次,6个月后进行疗效评定。结果实验组的治愈率84.38%,总有效率98.75%,均显著高于对照组,两组间比较有显著性差异(P<0.01)。结论上颌窦穿刺冲洗结合鼻窦炎口服液治疗儿童急、慢性鼻窦炎疗效可靠,穿刺前充分评估患儿病情,实施健康教育,加强心理护理是上颌窦穿刺治疗顺利进行的基础,也是上颌窦穿刺成功的重要保证。     

The Value of Percutaneous Shoulder Puncture with Contrast-enhanced Ultrasound in Differentiation of Rotator Cuff Tear Subtypes: A Preliminary Prospective Study

Imaging tests perform relatively well in the detection of rotator cuff tears (RCTs), exhibiting high sensitivity and specificity, mainly among larger full-thickness tears (tear width >1 cm). However, these tests are relatively less accurate in the detection of small full-thickness tears and partial-thickness tears. The purpose of this study was to determine the feasibility of percutaneous ultrasound-guided tendon lesionography (PUTL) using the SonoVue and the value of percutaneous shoulder puncture via contrast-enhanced ultrasound (CEUS)—a combination of percutaneous ultrasound-guided subacromial bursography (PUSB) and PUTL—in the detection of RCT subtypes. Conventional ultrasound (US), CEUS and magnetic resonance imaging (MRI) were performed and prospectively evaluated in 97 patients who had undergone arthroscopy because of suspected RCTs. The rates of detection of the various subtypes of RCTs using CEUS, PUSB, PUTL, US and MRI were evaluated. The RCT subtype detection rate via CEUS was significantly higher than the rates via US and MRI (96.9%, 74.2% and 76.3%, respectively), as were the detection rates for small full-thickness tears combined with partial-thickness tears (98.2%, 60.0% and 61.8%, respectively). The detection rate with PUSB was significantly higher than those with US and MRI in assessing full-thickness tears combined with bursal-side partial-thickness tears (93.9%, 65.3% and 65.3%, respectively). The detection rate with PUTL was significantly higher than those with US and MRI in assessing the corresponding subtypes (100.0%, 69.2% and 76.9%, respectively). On the basis of our findings, we consider PUTL a tolerable and feasible procedure. Percutaneous shoulder puncture using CEUS can be an effective alternative method with better diagnostic performance than US and MRI for the detection of RCT subtypes.     

Diagnostic Value of Positive Findings of Toxoplasma gondii-Specific Immunoglobulin M Serum Antibody in Uveitis Patients to Confirm Ocular Toxoplasmosis

Purpose: To assess the value of positive immunoglobulin (Ig) M serum antibody (Ab) findings in uveitis patients.

Methods: We reviewed medical records of patients who had a positive serological test for Toxoplasma gondii-specific IgM Ab. Their clinical data, including history, demographic characteristics, laboratory findings, clinical findings, treatment outcomes, and recurrences, were reviewed retrospectively.

Results: Of 2919 uveitis patients who underwent a serological test for suspected ocular toxoplasmosis (OT), 18 presented with positive Ig M results. All 18 patients (100.0% specificity) were clinically diagnosed with OT. None had any retinochoroidal scar at the initial visit, indicating the OT was a recent and primary infection. However, 15 patients (83.3%) had no history suspected to account for the Toxoplasma transmission.

Conclusions: The T. gondii IgM serum Ab is a specific biomarker for diagnosis of primary OT. Epidemiological studies are warranted to investigate the non-classic transmission routes of T. gondii in OT.     

Study of anomalies in the circle of Willis using magnetic resonance angiography in north eastern India

IntroductionThe circle of Willis is a large arterial anastomotic ring present at the basal cistern of the brain, uniting the internal carotid and the vertebrobasilar system. Branches from this arterial ring are distributed to supply the brain. In the year 1664, Sir Thomas Willis was the first to describe the importance of the circle in maintaining collateral flow. It was observed that there is very little mixing of blood between the collateral branches of the circle. These collaterals may however open up during occlusive episodes of the proximal feeding vessels. The anatomy of the circle is known to vary considerably and functionally a complete circle is a rare finding. This type of incomplete or variant forms off the circle may diminish its role as a collateral route.MethodsThe morphological pattern of circle of Willis of 70 healthy individuals from northeast India was studied retrospectively using Time of Flight-Magnetic resonance angiography (TOF-MRA).ResultsOnly 17 (24.28%) MRA's presented with a complete (classic) circle of Willis. Most common variant observed in our study was unilateral hypoplastic posterior communicating artery (20%). Most common variant observed in the anterior circulation was unilateral hypoplastic A1 segment of anterior cerebral artery (11.42%).DiscussionMost of the variant forms observed were comparable with earlier established findings. This variability (rare patterns) can be distinguished from an anomalous architecture if correlated phylogenically and embryologically.