基本医疗保险70年:从无到有实现人群基本全覆盖

新中国成立70年以来，政府在医疗保险领域做了大量的努力，尤其是进入21世纪以来，基本医疗保险制度实现了人群基本全覆盖，各项制度筹资水平和保障水平不断提高，城镇居民医疗服务利用水平和健康水平明显提高。中国基本医疗保险发展的基本经验可以表述为选择了社会保险的模式，遵循了全覆盖、保基本、多层次、可持续的原则。本文认为当前基本医疗保险应发挥核心作用，商业健康保险提供差异化、多样性的医保服务；面临的医保二元结构等问题，可通过职工家庭联保和属地参保来增加职工参保人减少居民参保人，实现全民统一覆盖、平等且充分的目标。     

Are dental patients able to perceive erosive tooth wear on anterior teeth?: An internet-based survey assessing awareness and related action

BackgroundErosive tooth wear (ETW) is irreversible loss of dental hard tissue. The authors examined patients’ ability to recognize ETW relative to sound teeth and teeth with caries.MethodsUsing Amazon’s crowdsourcing service, the authors recruited participants (N = 623) to view standardized images of buccal surfaces of teeth (sound, ETW, or caries). Participants reported whether a dental condition existed (yes or no), likelihood to seek care, and esthetic attractiveness for teeth with no, initial, moderate, or severe signs of ETW or caries.ResultsDental patients showed poor recognition of cases of ETW, especially compared with sound and caries-affected teeth at each level of severity. Patients were less likely to schedule a dental appointment for care or treatment of teeth with ETW than for teeth with caries at each level of severity. Patients also found ETW more esthetically attractive than caries at each level of severity and found initial ETW more attractive than sound teeth.ConclusionsDental patients struggle to recognize ETW, in general and compared with caries, at each level of severity and particularly for early stages of ETW. These recognition difficulties likely arise, in part, from tooth esthetic attractiveness standards (smooth and shiny teeth look more esthetic), possibly leading to lack of appropriate care-seeking behavior.Practical ImplicationsThis internet-based tool may be used to assess dental patients’ awareness and ability to recognize cases of ETW. Improved patient awareness might lead to seeking professional care to prevent or delay ETW progression.     

Detecting the developmental toxicity of bFGF in the embryonic stem cell test using differential gene expression of differentiation-related genes

Basic fibroblast growth factor (bFGF) is a mitogenic cytokine that can stimulate mesoderm-and neuroectoderm-originated cell proliferation. This study was performed to investigate the effects of bFGF on cell differentiation and the expression of specific markers at different embryonic developmental stages. We firstly evaluated the embryotoxic potential of bFGF in vitro using a modified EST protocol. Sequentially, we further investigated how bFGF impact the different tissue-special genes and proteins expressions during the differentiation of murine ES cells in vitro and attempt to reveal the effects of bFGF on differentiation processes. This analysis was focused on key tissue- and stage-specific genes involved in ectodermal, mesodermal, and endodermal differentiation, including ectodermal-specific gene Nestin, Oligo2 and Syn, mesodermal-specific gene MHC and MyoD, and endodermal-specific gene GATA6, TTR and ALB, as well as undifferentiated gene Sox-2 and Oct-4. The results demonstrate that bFGF could promote expression of ectodermal-specific genes and protein, but suppress the expressions of endoderm-specific and some mesoderm-specific gene and protein. A conclusion can be drawn that bFGF exhibits weak embryotoxicity and mainly promotes ES cell differentiation towards the ectodermal lineages but suppress differentiation into endoderm lineages. These opposing effects of bFGF on the embryonic development of the three germ layers may be related to its weak embryotoxic potential. More specifically, inhibition of expression of the endodermal-specific markers transthyretin (TTR), and albumin (ALB) by bFGF may be of more value in detecting the embryotoxic potential of bFGF.     

提高医用化学理论大课质量的教学实践和探索

理论大课能直接反映教师的教学水平和学生的学习质量。为了提高医学院校医用基础化学大课的教学质量，教师采取一系列措施和方法，从备课、上课、课后答疑、辅导、考试等各个环节入手，进行教学实践和探索，以期学生的成绩和能力有明显提高，经过多年的实践和探索，收到了良好的效果，达到了教学目的。     

妇产科病区基础护理中存在的问题与对策

目的 了解分析基层医院妇产科病区基础护理的现状,合理制订对策,提高临床基础护理质量.方法 回顾性分析我院2008年6月至2010年8月妇产科病区的98例患者,调查其基础护理中存在的问题并提出护理对策,在实施护理对策后重新选择100例患者进行调查,评价护理对策的实施效果.结果 妇产科病区基础护理中存在的问题包括基础护理意识淡漠,护理人员配置不足,基础护理工作劳酬不明和护理职业的忠诚度不高.实施新的对策后基础护理合格率平均达94.90％,患者满意度平均达96.94％,实施前分别为73.00％和72.00％,实施前后比较差异显著.结论 加强基础护理质量管理,是市场经济体制下密切护患关系的重要举措.     

Immunohistochemical localization of basic fibroblast growth factor in choroid plexus of the rat

Abstract

In the present study, we report that an intense bFGF-immunoreactivity has been detected in the choroid plexus of the brain ventricles of adult rats. These results suggest that epithelial choroid plexus cells may be the source of the cerebrospinal fluid bFGF. [Neurol Res 1994; 16: 310-312]     

Early-life exposures associated with antibiotic use and risk of subsequent Crohn's disease

Objective. An inappropriate immune response to normal bowel flora is implicated in the etiology of Crohn's disease. Tolerance to bowel flora develops in infancy, so factors disrupting normal patterns of bowel colonization may increase the risk of Crohn's disease. The aim of this study was to test the hypothesis that antibiotic therapy between birth and age 5 years may disrupt the pattern of bowel colonization and increase the risk of Crohn's disease. Material and methods. Some 1098 patients with Crohn's disease and 6550 controls matched by delivery unit, year of birth, sex, and born between 1973 and 1997 were identified through the Swedish population registers. Seven inpatient diagnoses between birth and age 5 years associated with antibiotic therapy were identified by prospectively recorded data. Results. Of the seven diagnoses, only pneumonia and otitis media were sufficiently common for use in the analyses. Pneumonia and otitis media were not independent of each other in their association with Crohn's disease and the more important association was with pneumonia. Pneumonia by age 5 years was statistically significantly associated with both pediatric- and adult Crohn's disease, with odds ratios (and 95% CI) of 2.74 (1.04–7.21) and 4.94 (1.83–13.23), respectively. Pneumonia after age 5 years was not statistically significantly associated with Crohn's disease. Conclusions. Pneumonia prior to age 5 years, but not later, was associated with subsequent Crohn's disease and this may represent either susceptibility or causation. The results are consistent with early exposures influencing immune function, such as through disruption of bowel colonization, and thus increasing the risk of Crohn's disease.