健康教育项目设计PRECEDE诊断评价模式

美国著名健康教育专家Lawrence W.Green 提出的健康教育项目设计PRECEDE 诊断评价模式,站在社会健康的宏观高度,全面规划健康教育内容、方式与作用环节,并从项目设计开始就将监测评价纳入项目内容。由于设计思维的缜密与方法的科学性,保证了健康教育项目能够紧紧抓住重点健康问题,做到有的放矢。因此,在模式的引进和使用过程中,应结合我国妇幼卫生的现状和当地的实际情况,设计出适合我国国情的妇幼卫生健康教育项目规划,为发展我国妇幼卫生事业服务。     

严重晶状体不全脱位的小切口囊袋内吸出术

目的评价自闭性小切口囊袋内吸出术治疗严重晶状体不全脱位的疗效。方法对１４例１８眼悬韧带离断大于１８０°的严重晶状体不全脱位者,根据晶状体核硬度的不同,分别采用自闭性小切口手动囊袋内吸出术和超声乳化囊袋内吸出术。结果术后随访３月～２年,２例４眼因弱视矫正视力０１～０３,３例５眼０５～０７,８例外伤眼术中植入人工晶状体,７例裸眼视力０５～１０,另１眼因青光眼视神经损害视力００３。无术中及术后并发症。结论此手术方法具有切口小,对角膜、虹膜及玻璃体扰动小,便于联合其它手术,术中、术后并发症少,视力恢复好等优点,是一种安全、有效的手术方法。     

EFFICACY OF ACUPUNCTURE THERAPY ON A, B AND O BLOOD GROUPS ──Relationship between A, B, O blood groups and the acupuncture therapy

Acupuncturehasbeenusedforover2000years forawidevarietyofcomplaintswithminimalsideef fects.Clinicallyithasbeenobservedthatpatients havingsimilarailmentsrespondtoacupuncturethera pyinvaryingdegrees.Tofindoutthebasisofsuch variationofefficacyofacupuncturetherapy,surveyof patientswithABObloodgroupswastakenup.Inhu manbeingthechromosome9isaverypopulargene(ABOgene)thatdeterminesourbloodgroups.Link ofbloodgroupswithsomediseasesisknown,e.g.carcinomaofstomachismostfrequentlyseeninpeo plewithgroupA[1]…     

Rapid improvement in post-infectious gastroparesis symptoms with mirtazapine

We report the case of a 34-year-old woman with severe post-infectious gastroparesis who was transferred from an outside medical facility for a second opinion regarding management.This patient had no prior history of gastrointestinal symptoms.However,in the aftermath of a viral illness,she developed two months of intractable nausea,vomiting,and oral intake intolerance that resulted in numerous hospitalizations for dehydration and electrolyte disturbances.A solid-phase gastric emptying scan had confirmed delayed emptying,confirming gastroparesis.Unfortunately,conventional pro-kinetic agents and numerous anti-emetic drugs provided little or no relief of the patient’s symptoms.At our institution,the patient experienced a cessation of vomiting,reported a significant reduction in nausea,and toler-ated oral intake shortly after taking mirtazapine.Based on mirtazapine’s primary action as a serotonin(5-HT)1a receptor agonist,we infer that this receptor system mediated the clinical improvement through a combination of peripheral and central neural mechanisms.This report highlights the potential utility of 5-HT1a agonists in the management of nausea and vomiting.We conclude that mirtazapine may be effective in treating symptoms associated with non-diabetic gastroparesis that are refractory to conventional therapies.     

Genetic,environmental and epigenetic influences on variation in human tooth number,size and shape

The aim of this review is to highlight some key recent developments in studies of tooth number, size and shape that are providing better insights into the roles of genetic, environmental and epigenetic factors in the process of dental development. Advances in molecular genetics are helping to clarify how epigenetic factors influence the spatial and temporal regulation of the complex processes involved in odontogenesis. At the phenotypic level, the development of sophisticated systems for image analysis is enabling new dental phenotypes to be defined. The 2D and 3D data that are generated by these imaging systems can then be analysed with mathematical approaches, such as geometric morphometric analysis. By gathering phenotypic data and DNA from twins, it is now possible to use ‘genome-wide’ association studies and the monozygotic co-twin design to identify important genes in odontogenesis and also to clarify how epigenetic and environmental factors can affect this process. Given that many of the common dental anomalies affecting the human dentition are interrelated, apparently reflecting pleiotropic genetic effects, the discoveries and new directions described in this paper should have important implications for clinical dental practice in the future.     

Evaluation of the ‘Prostate Interdisciplinary Communication and Mapping Algorithm for Biopsy and Pathology’ (PIC-MABP)

Introduction

Experience from interdisciplinary cooperation revealed the need for a prostate mapping scheme to communicate multiparametric MRI (mpMRI) findings between radiologists, urologists, and pathologists, which should be detailed, yet easy to memorize. For this purpose, the ‘Prostate interdisciplinary communication and mapping algorithm for biopsy and pathology’ (PIC-MABP) was developed. This study evaluated the accuracy of the PIC-MABP system.

Methods

PIC-MABP was tested and validated in findings of 10 randomly selected patients from routine clinical practise with 18 histologically proven cancer lesions. Patients received an mpMRI of the prostate prior to prostatectomy. After surgery the prostates were prepared as whole-mount step sections. Cancer lesions, which were found suspicious on mpMRI, were assigned to the according PIC-MABP sectors by a radiologist. MpMRI slides were masked and sent to seven urologists from different centres, providing only the PIC-MABP location of each lesion. Urologists marked the accordant regions. Then mpMRI slides were unmasked, and the correctness of each mark was evaluated.

Results

One hundred and seventeen of the 126 marks (93 %) were correctly assigned. Detection rates differed for lesions >0.5 cc compared with lesions <0.5 cc (p < 0.005): 3/7 (43 %) marks were correctly assigned in lesions <0.3 cc, 16/21 (76 %) in lesions with 0.3–0.5 cc, and 98/98 (100 %) in lesions >0.5 cc. Interobserver agreement was good for lesions >0.5 cc and poor for lesions <0.3 cc (Fleiss Kappa 1 vs. 0.0175).

Conclusion

PIC-MABP seems to be a reliable system to communicate the location of mpMRI findings >0.5 cc between different disciplines and can be a useful guidance for cognitive mpMRI/TRUS fusion biopsy.

     

Surgical training for anatomical endoscopic enucleation of the prostate

Anatomical endoscopic enucleation of the prostate has been proposed as a potentially superior benign prostatic hyperplasia surgery than conventional transurethral resection of prostate. However, the learning curve of the procedure is steep, hence limiting its generalisability worldwide. In order to overcome the learning curve, a proper surgical training is extremely important. This review article discussed about various aspects of surgical training in anatomical endoscopic enucleation of the prostate. In summary, no matter what surgical technique or energy modality you use, the principle of anatomical enucleation should be followed. When one starts to perform prostate enucleation, a 50 to 80 g prostate appears to be the ‘best case’ to begin with. Mentorship is extremely important to shorten the learning curve and to prevent drastic complications from the procedure. A proficiency-based progression training programme with the use of simulation and training models should be the best way to teach and learn about prostate enucleation. Enucleation ratio efficacy is the preferred measure for assessing skill level and learning curve of prostate enucleation. Morcellation efficiency is commonly used to assess morcellation performance, but the importance of safety rather than efficiency must be emphasised.     

Report of the Task Force on Residency Training Information (2004-2005), American Board of Emergency Medicine

The American Board of Emergency Medicine gathers extensive background information on emergency medicine residency training programs and the residents training in those programs. We present the eighth annual report on the status of US emergency medicine residency programs.