利益相关主体医疗风险分担机制的探讨

随着科技的快速发展和信息的扁平化,人类社会的各种风险在不断扩大,个体承担风险的程度是有限的,利益相关主体的合理化分担是保证风险化解的基础。医学作为一门不精确的科学,接近真理和无法穷尽真理是客观事实,作为探索医学真理的利益相关主体的患者、医疗工作者、医院和政府,单一分担医疗风险是不合理的,只有按照相关的规则共同分担,才能保证医学科学的进步和发展。     

基于FMEA法的结肠癌根治术风险识别研究

目的 探讨结肠癌根治术的高危风险以及引起风险的主要原因,提出有效的干预策略。方法 应用失效模式与效应分析法对结肠癌根治术进行风险识别研究。 结果 分析得出结肠癌根治术共计8项流程,26项失效环节,排在前10位的高危风险分别为：观察患者药物反应失误、设备仪器准备不充分、检查时间过长、术前宣教不佳、麻醉前核对失误、手术时间过长、排药错误、术后注意事项告知有误、护士术后核对失误、手术者术后核对失误。结论 FMEA法可以有效地识别高危风险,据此有针对性地制定措施、采取策略,能够最终从源头上避免风险的发生。     

A study on risk factors for Parkinson?s disease in Indian population

Parkinson׳s disease is the second most common neurodegenerative disorder. The exact cause of selective dopaminergic neurodegeneration is unknown, but it is supposed that etiology of Parkinson׳s disease is multifactorial and consists of an interaction between environmental factors and genetic predisposition. To find out the association between environmental factors and risk of Parkinson׳s disease, a case control study was designed including 97 Parkinson׳s disease patients and 97 controls. Logistic regression analysis was used to determine the risk factors for Parkinson׳s disease. Results from the present study showed that gender, religion, education, place of living, occupation, dietary habits, tobacco chewing, smoking, alcohol intake, and head injury had no association with PD. However, chemical exposure and well water drinking were significantly associated with PD, which concluded that environmental factors could act as a risk factor for PD in some way.     

养殖污水直灌对稻田土壤氮、磷积累与垂直迁移的影响

尽管国内外对养殖污水处理已提出了一系列的工艺技术,但因经济原因养殖污水直接灌溉农田在我国农村地区仍较为常见.为了解长期畜禽养殖污水直灌对稻田土壤质量的影响,在浙江省绍兴市柯桥区选择了养殖污水直灌不同年限(0、4、7、13年)的稻田,比较研究了养殖污水直接灌溉对稻田土壤不同深度土层中各形态氮和磷含量的影响,探讨了长期养殖污水灌溉对氮、磷在土壤剖面中垂直迁移的影响.结果表明: 长期养殖污水直接灌溉可显著提高稻田土壤中氮和磷的积累,积累量随灌溉年限的增长而增加,其中磷素的增幅高于氮素.养殖污水灌溉4、7和13年后,土壤表层中全P和全N分别比对照增加了43.6%、95.2%、1484%和7.7%、17.0%、28.4%.土壤氮素的变化为NH₄⁺-N、NO₃^--N>酸解有机氮>非酸解有机氮;土壤有效磷的变化明显大于全磷.长期养殖污水灌溉可促进氮、磷在土壤剖面中的垂直迁移,增加对地下水的污染风险.
     

Periconceptional parental conditions and perimembranous ventricular septal defects in the offspring

Background: The perimembranous ventricular septal (pVSD) defect is the most common congenital heart disease phenotype. Several parental factors are associated with pVSD risk in the offspring. To contribute to the future prevention of pVSDs, we investigated associations with nongenetic parental conditions. Methods: In a case–control study with standardized data collection at 17 months after birth, 115 parents of a child with pVSD and 484 parents of a healthy child completed questionnaires about periconceptional nongenetic conditions. Univariable and multivariable logistic regression analyses were used to estimate odds ratios (OR) with 95% confidence intervals (95% CI). Results: Complete data were available for 588 families (98%). Maternal risk conditions associated with pVSD offspring were a positive family history of congenital heart disease (OR, 2.61; 95%CI, 0.98–6.91), medication use (OR, 1.80; 95%CI, 1.13–2.85) and advanced age (OR, 1.07; 95%CI, 1.02–1.12). Exposure to phthalates (OR, 1.93; 95%CI, 1.05–3.54) was the only paternal risk condition associated with pVSD offspring. Conclusion: Four periconceptional parental conditions contributed to pVSD risk in the offspring. Couples planning pregnancy should be counseled on these risk conditions which are partially modifiable to contribute to the future prevention of pVSDs. Birth Defects Research (Part A) 100:944–950, 2014. © 2014 Wiley Periodicals, Inc.     

Placental Transfer of a Fully Human IgG2 Monoclonal Antibody in the Cynomolgus Monkey,Rat, and Rabbit: A Comparative Assessment from during Organogenesis to Late Gestation

Understanding species differences in the placental transfer of monoclonal antibodies is important to inform species selection for nonclinical safety assessment, interpret embryo‐fetal changes observed in these studies, and extrapolate their human relevance. Data presented here for a fully human immunoglobulin G2 monoclonal antibody (IgG2X) revealed that, during organogenesis, in both the cynomolgus monkey (gestation day 35 [gd35]) and the rat (gd10) the extent of IgG2X placental transfer (approximately 0.5% maternal plasma concentration, MPC) was similar to the limited published human data for endogenous IgG. At this early gestational stage, IgG2X placental transfer was approximately 6‐fold higher in the rabbit (gd10). By the end of organogenesis, rat embryonic plasma concentrations (gd16) exceeded those in the cynomolgus monkey (gd50) by approximately 3‐fold. These data suggest that relative to the cynomolgus monkey, the rabbit (and to a lesser extent the rat) may overestimate potential harmful effects to the human embryo during this critical period of development. Beyond organogenesis, fetal IgG2X plasma concentrations increased approximately 10‐fold early in the second trimester (gd50–70) in the cynomolgus monkey and remained relatively unchanged thereafter (at approximately 5% MPC). Late gestational assessment was precluded in rabbits due to immunogenicity, but in rats, fetal IgG2X plasma concentrations increased more than 6‐fold from gd16 to gd21 (reaching approximately 15% MPC). In rats, maternal exposure consistent with that achieved by ICH S6(R1) high‐dose selection criteria resulted in embryonic plasma concentrations, reaching pharmacologically relevant levels during organogenesis. Furthermore, dose proportional exposure in both mothers and embryos indicated that this was unlikely to occur at the lower therapeutic dose levels used in humans     

Strong influence of dietary intake and physical activity on body fatness in elderly Japanese men: age-associated loss of polygenic resistance against obesity

Genome-wide association studies identified single nucleotide polymorphisms (SNPs) associated with body mass index (BMI) in middle-aged populations; however, it is unclear whether these SNPs are associated with body fatness in elderly people. We examined the association between genetic risk score (GRS) from BMI-associated SNPs and body fatness in elderly Japanese men. We also examined the contribution of GRS, dietary macronutrient intake, and physical activity to body fatness by different age groups. GRS was calculated from 10 BMI-associated SNPs in 84 middle-aged (30–64 years) and 97 elderly (65–79 years) Japanese men; subjects were divided into low, middle, and high GRS groups. Dietary macronutrient intake was assessed using a questionnaire, and physical activity was evaluated using both a questionnaire and an accelerometer. The middle-aged individuals with a high GRS had greater BMI; waist circumference; and total abdominal fat, visceral fat, and subcutaneous fat areas than the middle-aged individuals with low GRS, whereas the indicators were not different between the GRS groups in elderly individuals. Multiple linear regression analysis showed that GRS was the strongest predictor of BMI, total abdominal fat, and visceral fat in the middle-aged group, whereas fat, alcohol, and protein intakes or vigorous-intensity physical activity were more strongly associated with these indicators than was GRS in the elderly group. These results suggest that GRS from BMI-associated SNPs is not predictive of body fatness in elderly Japanese men. The stronger contribution of dietary macronutrient intake and physical activity to body fatness may attenuate the genetic predisposition in elderly men.     

三金排石汤对特发性钙结石患者24小时尿成石危险因素水平的影响

目的:分析三金排石汤对特发性钙结石患者24小时尿成石危险因素水平的影响,探讨其用于预防手术取石后的特发性钙结石患者结石复发的临床价值。方法:选择2009年9月~2013年9月入住我院的经皮肾镜取石术或输尿管镜取石术治疗的特发性钙结石患者100例,前瞻性将其随机分为治疗组和观察组,两组各50例。治疗组予三金排石汤每日一剂分两次煎服,观察组予正常饮食,测定和比较两组患者治疗前和治疗1个月后的24小时尿成石危险因素水平。结果:治疗1个月后,观察组24小时尿成石危险因素水平与治疗前比较差异均无统计学意义(P0.05);治疗组24小时尿量较治疗前显著增加,尿pH值、尿枸橼酸含量明显升高,尿钙显著降低,差异均有统计学意义(P0.05),但尿钠、尿镁、尿磷、尿尿酸及尿草酸水平与治疗前比较差异均无统计学意义(P0.05);与观察组比较,治疗组24小时尿量明显增加,尿pH值、尿枸橼酸含量显著升高,尿钙水平明显降低,差异均有统计学意义(P0.05),但两组尿钠、尿镁、尿磷、尿尿酸及尿草酸水平比较差异均无统计学意义(P0.05)。结论:三金排石汤治疗手术取石后特发性钙结石患者能够显著增加其24小时尿量及尿枸橼酸含量,并减少尿钙含量,抑制结石形成,这可能有助于降低特发性钙结石患者手术取石后的复发风险,值得临床研究和推广。