Assessment of primary health care resources in Thailand

In response to a perceived lack of graduate-level training in Public Health (the ultimate goal being improved primary health care, PHC) in the Asia-Pacific region, the US agency for International Development and the University of Hawaii entered a cooperative agreement to assist institution of the Asia-Pacific Consortium for Public Health improve their PHC training and other aspects of institutional development. Research performed for the initial phase of the project in Thailand is presented. In collecting data on human resources, the concentration was on public health colleges and regional training centers for PHC in 4 regions, midwifery schools (6), nursing colleges (10), community medicine and nursing and (in 1 case) public health in 3 universities. Out of 121 instructors, 33 had masters degrees or the equivalent. The rest had Bachelors degrees in specialties such as Education, Nursing, Sanitation. 48 had ever attended PHC training programs run by the Training Center for PHC development at Mahidol University. 87 instructors reported needing more training. Only 9.9% of instructors thought that teaching methods (consisting mostly of lectures, and less frequently of discussion, guest speakers, reports, and projects) were adequate. 89.3% said that textbooks used for PHC teaching were inadequate. Some further problems and obstacles to PHC development included a lack of emphasis on field training of instructors, unclear lines of authority, and a high rate of trained village health communicator migration to jobs abroad, indicating a poor reward system. Recommendations include improved training on management topics needed for PHC, problem-centered as opposed to subject-oriented training and standardization of university curricula.     

新式阴道前、后壁联合修补术临床分析

目的探讨新式阴道前、后壁联合修补术治疗盆腔脏器脱垂(POP)的临床效果。方法选择2017年1月至2021年1月,于南京医科大学附属淮安第一医院接受手术治疗的120例POP患者为研究对象。根据采用的手术方式,将其分为研究组(n=60,采用新式阴道前、后壁联合修补术)及对照组(n=60,采用腹腔镜下全子宫双侧附件切除术+传统阴道前、后壁修补术)。采用独立样本t检验及χ^(2)检验,对2组患者一般临床资料,术中及术后情况进行统计学比较。本研究经南京医科大学附属淮安第一医院医学伦理委员会批准(审批文号:YX-P-2020-023-01)。所有患者知情同意并与之签署临床研究知情同意书。结果①2组POP患者年龄、人体质量指数(BMI)、产次、绝经者比例及POP脱垂程度比较,差异均无统计学意义(P>0.05)。②研究组POP患者手术时间、术中出血量、总住院时间、术后住院时间及住院费用分别为(88.0±30.6)min、(24.7±36.0)mL、(7.3±2.1)d、(4.6±1.4)d及(10727±1812)元,均短于或低于对照组的(118.0±33.4)min、(56.7±43.8)mL、(9.8±2.3)d、(6.4±1.6)d及(26318±3890)元,并且差异均有统计学意义(t=5.130、4.372、6.218、6.558、28.138,均为P<0.001)。2组POP患者术后3、6、12个月复发率构成比比较,差异无统计学意义(P>0.05)。结论新式阴道前、后壁联合修补术在不增加POP患者术后复发率的基础上,不仅能缩短手术时间、减少患者术中出血量,还可以缩短住院时间、减少住院费用,并且易于操作,适宜推广。     

Podocyte EGFR Inhibits Autophagy Through Upregulation of Rubicon in Type 2 Diabetic Nephropathy

Renal epidermal growth factor receptor (EGFR) signaling is activated in models of diabetic nephropathy (DN), and inhibition of the EGFR signaling pathway protects against the development of DN. We have now determined that in cultured podocytes, high glucose led to increases in activation of EGFR signaling but decreases in autophagy activity as indicated by decreased beclin-1 and inhibition of LC3B autophagosome formation as well as increased rubicon (an autophagy inhibitor) and SQSTM1 (autophagy substrate). Either genetic (small interfering [si]EGFR) or pharmacologic (AG1478) inhibition of EGFR signaling attenuated the decreased autophagy activity. In addition, rubicon siRNA knockdown prevented high glucose–induced inhibition of autophagy in podocytes. We further examined whether selective EGFR deletion in podocytes affected the progression of DN in type 2 diabetes. Selective podocyte EGFR deletion had no effect on body weight or fasting blood sugars in either db/db mice or nos3^−/−; db/db mice, a model of accelerated type 2 DN. However selective podocyte EGFR deletion led to relative podocyte preservation and marked reduction in albuminuria and glomerulosclerosis, renal proinflammatory cytokine/chemokine expression, and decreased profibrotic and fibrotic components in nos3^−/−; db/db mice. Podocyte EGFR deletion led to decreased podocyte expression of rubicon, in association with increased podocyte autophagy activity. Therefore, activation of EGFR signaling in podocytes contributes to progression of DN at least in part by increasing rubicon expression, leading to subsequent autophagy inhibition and podocyte injury.     

关节镜手术联合内服中药膝痛康方治疗膝骨关节炎临床研究

目的 探讨关节镜手术联合内服中药膝痛康方治疗膝骨关节炎的疗效。方法 将马鞍山市人民医院2015年1月至2016年4月收治的41例膝骨关节炎病人采用随机数字表法分为两组,选择不同治疗方式。其中治疗组20例,应用关节镜手术联合内服中药膝痛康方治疗;对照组21例,应用单纯关节镜手术治疗。选用Lequsne 疗效评定、Lysholm膝关节评分评定其临床疗效。结果 所有病人均进行6个月以上随访。治疗后,两组膝关节功能及临床症状较前均有明显的好转。在Lequsne疗效评定上,总有效率治疗组85.00%明显优于对照组71.42%(χ²=4.113,P=0.042);在Lysholm膝关节评分上,治疗前两组评分差异无统计学意义(t=0.031,P=0.897);治疗后3个月、6个月与对照组相比,治疗组明显优于对照组(t=9.134,P=0.000;t=9.245,P=0.000)。结论 关节镜手术联合内服中药膝痛康方治疗膝骨关节炎取得了较好的疗效,具有较高的临床应用价值。     

二种方法治疗手外伤术后早期有炎性反应伤口的比较

目的 评价传统局部换药与点式直线偏振光近红外线疼痛治疗仪Super-Lizer HA-550(商品名"超激光疼痛治疗仪",S-L)照射加传统局部换药治疗手外伤术后早期有炎性反应伤口的疗效.方法 观察组先用生理盐水清洁后使用点式直线偏振光近红外线照射后再用传统换药法治疗.对照组使用传统局部换药疗法.结果 观察组:伤口治愈22例;伤口显效13例;伤口无变化1例;伤口加重0例,总有效率97.2%(35/36);对照组:伤口治愈6例;伤口显效17例;伤口无变化12例;伤口加重1例,总有效率63.9%(23/36).2组经χ2检验,有显著性差异(P＜0.05).结论 使用点式直线偏振光近红外线照射后再用传统换药法治疗对手外伤术后早期有炎性反应伤口疗效优于单用传统局部换药法.     

Nonketotic hyperglycinemia in two siblings with neonatal seizures

Seizures are a common problem in neonates. Differential diagnoses include infection, trauma, hypoxia and congenital metabolic disorders. Among these, congenital metabolic disorder is less familiar to general pediatricians. We report two patients with nonketotic hyperglycinemia (NKH), a rare and lethal congenital metabolic disease. Transient hyperammonemia and transient hypouricemia, uncommon features found in NKH, were detected in one patient. High doses of sodium benzoate and dextromethorphan failed to modify the clinical course. Neuropathology denoted characteristic diffuse vacuolization and changes in reactive and gliotic astrocytes. The clinical course, biochemical findings, diagnostic approaches and diagnostic tests are discussed in detail. Recent modalities of treatment are reviewed. Because of its rarity and rapidly progressive course, it maybe underdiagnosed resulting in death before being recognized. Awareness of the possibility of congenital metabolic disorder in early neonatal catastrophe will increase the diagnostic rate.     

Evaluation of synthetic DNA probes for confirmation of Clostridium perfringens enterotoxin gene PCR products

A new diagnostic reagent was developed that is capable of detecting the presence of Clostridium perfringens rapidly and accurately compared to the conventional methods. C. perfringens enterotoxin (cpe) gene is the gene of interest since it encodes the enterotoxin responsible for food poisoning. Two new cpe-specific labeled DNA probes were evaluated using Southern and dot blot hybridization. Bacterial DNA was amplified by a duplex PCR procedure. The results showed that 40 enterotoxin producing C. perfringens strains generated two bands of amplicons with sizes of 420 and 280 bp, whereas 40 non-enterotoxin producing strains produced a single band of 280 bp on agarose gel-electrophoresis. No bands were observed from 32 strains of Clostridium spp and other bacteria. Southern blot analysis using either cpe-specific DNA or oligonucleotide probe showed hybridization specifically to the 420 bp band in enterotoxin-positive C. perfringens. On the dot blot membrane, both cpe-specific DNA and oligonucleotide probes were able to hybridize specifically with the corresponding DNA templates but with different efficacy (100% vs 91.1%).     

Induction of type I collagen and osteocalcin in human dental pulp cells by retinoic acid

Retinoic acid has been known to play a key role in the regulation of bone cell differentiation and function. The effects of retinoic acid on human dental pulp cells, which contain several characteristics similar to those of bone cells, has yet to be elucidated extensively. The effects of retinoic acid on human dental pulp cells in terms of type I collagen and osteocalcin induction were investigated in vitro. Dental pulp cells obtained from the teeth of young patients (age between 18-22 years) were cultured and subsequently treated with various concentrations of retinoic acid (0, 10(-7), 10(-6), 10(-5) M) in serum-free DMEM. At different time intervals (8, 12 and 24 hours), the levels of type I collagen and osteocalcin secreted were determined using Type I Procollagen C-Peptide and Gla-type Osteocalcin EIA kits, respectively. Induction effects were evaluated using analysis of variance and the Duncan's multiple rank test. Retinoic acid at concentrations of 10(-5), 10(-6), 10(-7) M was able to induce type I collagen and osteocalcin production in human dental pulp cells within 12 hours of exposure. Dose-dependent induction was observed only after 24 hours. A two-fold increase in osteocalcin level was detected after exposed to 10(-5) M retinoic acid within 24 hours. Our data suggest that retinoic acid at concentrations of 10(-5), 10(-6), 10(-7) M has the ability to induce type I collagen and osteocalcin secretions in human dental pulp cells in vitro.     

Effects of Ya-hom on the gastric secretion in rats

The effects of Ya-hom, Thai traditional recipe, on gastric-secretory function was evaluated to verify its use for stomach discomfort treatment. The actions of Ya-hom on the gastric acid, pepsin and mucus secretions were studied in histamine- and carbachol-induced gastric fistula rats. After the first hour of collection, histamine (10 mg/kg, intramuscular injection) or carbachol (20 microg/kg, intravenous injection) were injected to stimulate gastric secretion, and water or redissolved lyophilized Ya-hom extract (0.5, 1, 2 and 4 g/kg) were intraduodenally injected. The gastric samples were collected every hour for 5 h, at the end of which, the glandular part of the stomach was assayed for the visible mucus content. Ya-hom inhibited both histamine- and carbachol-induced gastric acid, pepsin and soluble mucus secretions in a dose-dependent manner. Ya-hom had a lower maximum inhibition on the acid-stimulating effects of the histamine than that of carbachol. Ya-hom had higher maximum inhibition on the pepsin and soluble mucus-stimulating effects of histamine than that of carbachol. Ya-hom also had a higher elevated effect on histamine-induced visible mucus than that of carbachol. This study reveals that Ya-hom inhibits the stimulatory effects of histamine and carbachol on the acid, pepsin and soluble mucus secretion but potentiates the visible mucus secretion. Attenuating gastric secretion by secretagogues and increasing gastric barrier effects are parts of Ya-hom's action on stomach discomfort treatment.