Reconsideration and definition on the concept “Public Private Partnership” in the field of international health / 国際保健医療

Objectives  Recently, a Public Private Partnership (PPP) has drawn attention as an efficient strategy to response toward increasing different needs for health in low-income and middle-income countries under tremendously growing private sectors and restricted public finance. Neveretheless, in the society of international health development, there is no commonly acceptable definition of PPP. To make the targets and purpose of the PPP clear, the study attempted to define the PPP, reconsidering the relationship among five concepts, which have been recently used to solve social issues, such as BOP business, social business, Corporate Social Responsibility (CSR), and Creating Shared Values (CSV) as well as PPP.Methods  We conducted scrutiny of definitions of PPP in other literatures using bibliographic retrieval and associated PPP with the other four concepts in order to attempt to define PPP.Results and conclusion  We analysed the contents and relationship of the five concepts. Thus, the PPP can be defined as a process in which public and private sectors collaborate to aim to solve a social issue, not only to reply to societal expectation but also to achieve company growth.

Expression of Wisp-1, β-catenin, TGF-β1 and Smad4 in gold hamster induced intrahepatic cholangiocarcinoma and their significance / 临床与实验病理学杂志

Purpose To establish a golden hamster model of intrahepatic cholangiocarcinoma (ICC) using BOP [N-nitrosobis (2-oxo-propyl) amine] and to explore the protein expression of Wisp-1,β-catenin, TGF-β1 and Smad4 in ICC and their relationship with the tumorigenesis. Methods 57 female golden hamsters aged 8 to 9 weeks (39 in experimental group, 18 in control group), the experi-mental animals were subjected to subcutaneous injection of BOP, the control group was injected with saline. The liver was removed and paraffin sections were prepared for histopathological observation. The protein expression of Wisp-1,β-catenin, TGF-β1 and Smad4 was detected by immunohistochemistry (IHC) in these blocks. Results Most of the animals in the experimental group (29/39) developed ICC, part of the animal (8/39) developed bile duct dysplasia, 1 developed focal bile duct hyperplasia, and 1 was not found bile duct hyperplasia. The positive expression rates of four protein markers in ICC, bile duct dysplasia and normal intrahepatic bile duct tissues were Wisp-1,79. 3%, 87. 5% and 5. 0%,β-catenin, 96. 6%, 100. 0% and 15. 0%, Smad4, 96. 6%, 100. 0% and 25. 0%, TGF-β1, 62. 1%, 12. 5% and 5. 0%, respectively. The positive expression rates of Wisp-1, beta-catenin and Smad4 protein in both the ICC and the tissue of bile duct dysplasia were higher than that of normal intrahepatic bile duct tissue ( P<0. 001 ) , The positive ex-pression of TGF-β1 in the ICC tissue was higher than that of normal intrahepatic bile duct tissue and bile duct dysplasia (P<0. 001). Conclusions The study showed that BOP can induce a golden hamster model of ICC and provides a reliable animal model for the study of ICC. The high expression of Wisp-1,β-catenin, TGF-β1 and Smad4 in BOP-induced intrahepatic cholangiocarcinoma is closely re-lated to occurrence, development and infiltration of ICC.

Indirect ELISA for diagnosis of Brucella ovis infection in rams / ELISA indireto para diagnóstico da infecção por Brucella ovis em carneiros

Brucella ovis is a major cause of epididymitis in sexually mature rams, resulting in subfertility, infertility, and economic losses for the sheep industry worldwide. The aim of this study was to develop an indirect ELISA (iELISA) using recombinant proteins, namely rBoP59 and rBP26, as antigens for serological diagnosis of B. ovis infection. The BoP59 and BP26 recombinant proteins were expressed in E. coli and purified by affinity chromatography. Antigenicity was tested by Western blot and iELISA. Standardization of iELISA was performed with 500ng and 1µg BoP59 and rBP26 per well, testing serum from uninfected and experimentally infected rams. rBP26 was effective in distinguishing positive from negative rams. The rBP26 iELISA developed in this study is the first to use a completely purified rBP26 as antigen resulting in high sensitivity (100%) and specificity (90.2%), and an overall accuracy equal to 1.0...

Brucella ovis é uma das principais causas de epididimite em carneiros sexualmente maduros, resultando em subfertilidade e infertilidade e consequentes perdas econômicas para a ovinocultura em todo o mundo. O objetivo deste estudo foi desenvolver ELISA indireto (ELISAi), utilizando como antígeno proteínas recombinantes BoP59r e BP26r para diagnóstico da infecção por B. ovis. BoP59r e BP26r foram expressas em E. coli e purificadas por cromatografia de afinidade e a antigenicidade testada por Western blot e ELISAi. A padronização do ELISAi foi realizada testando 500 ng e 1 µg de BoP59r e BP26r por poço e soros de carneiros infectados e não infectados. A BP26r foi eficiente em diferenciar ovinos negativos de positivos. O ELISAi com BP26 desenvolvido neste estudo foi o primeiro a utilizar BP26 completamente purificada como antígeno, resultando em elevada sensibilidade (100%) e sensibilidade (90,2%), com acurácia igual a 1,0...

Prevenção da insônia em bebês / Prevention of insomnia in babies / Prevención del insomnio en bebés

A partir dos achados de pesquisa com mães de bebês com insônia (Tenembojm), evidenciando que estas apresentam diferença estatisticamente significante relativa aos grupos adaptativos da EDAO - Escala Diagnóstica Adaptativa Operacionalizada (Simon) e do Inventário de Depressão de Beck, é possível compor uma história natural da insônia em bebês. A partir desta, é possível organizar um programa de prevenção da insônia em bebês, com apoio de psicólogos, obstetras, ginecologistas e pediatras. A ajuda psicológica às mães e seus familiares baseia-se principalmente no atendimento em PBO – Psicoterapia Breve Operacionalizada (Simon), aplicada no período de gestação, no grupo de maior risco. E acompanhada pela equipe de prevenção após os primeiros meses do nascimento. É enfatizada a importância da detecção da insônia do bebê como indicativa de dificuldades adaptativas na mãe, na dupla, e mesmo do grupo familiar, requerendo intervenção em PBO para evitar prejuízo na evolução psíquica.

Starting from the research data gathered by Tenembojm with mothers of babies with insomnia – that show theypresent statistically significant differences to the adaptive groups of the AODS – Adaptive Operationalized Diagnostic Scale, by Simon, and the Beck Depression Inventory – it is possible to organize a natural history of insomnia in babies. Starting from this it is possible to organize a program to prevent insomnia in babies with the support of psychologists, obstetricians, gynecologists and pediatricians. The psychological help to mothers and relatives is mainly based on attention through BOP – Brief and Operationalized Psychotherapy (Simon), offered during gestation to thegreatest risk group and accompanied by the prevention team after the first months after birth. It is emphasized theimportance of the detection of insomnia in the baby as an indication of the adaptative difficulties of the mother, ofthe couple and of the family group, demanding intervention through brief and operationalized psychotherapy (BOP) to prevent breakdown in the emotional development.

A partir de los resultados de una investigación con madres de bebés con insomnio (Tenembojm) y que evidencianque estas presentan una diferencia estadísticamente significante de los grupos adaptativos de la EDAO - EscalaDiagnóstica Adaptativa Operacionalizada (Simon) y del Inventario de Depresión de Beck, es posible componer una historia natural del insomnio en bebés. A partir de esta es posible organizar un programa de prevención del insomnio en bebés con el apoyo de psicólogos, obstetras, ginecólogos y pediatras. La ayuda psicológica a las madres y susfamiliares se basa principalmente en la atención a través de PBO – Psicoterapia Breve Operacionalizada (Simon)aplicada en el periodo de gestación en el grupo de risco más grande. Esta es acompañada por el equipo de prevencióndespués de los primeros meses de nacimiento. Es enfatizada la importancia de la detección del insomnio en el bebécomo indicativo de dificultades adaptativas en la madre, en la pareja y aun mismo en el grupo familiar, lo que puede demandar intervención por PBO para evitar lesiones en la evolución psíquica.

Anterior Ceervical Interbody Fusion: Comparison Study between Simple Fusion, Locked and Non-locked Plating Systems

The use of metallic plate and screws in the anterior cervical fusion has become generally acceptable and popular. Mainly, there are two different plating systems available. However, there has been few attempts to compare their clinical results with and without a plating system or between two different systems in a single series of clinical study. The authors reviewed 117 patients who underwent anterior cervical fusion during the period of January 1992 to September 1996. Simple fusion without a plating system was applied in 55 cases(group 1), a bicortical non-locked plate screw system in 25(group 2), and a monocortical locked plate screw system in 37(group 3). The average follow-up period was 13. 2 months. In group 1, twenty-two patients(40%) with fracture-dislocation or corpectomy required a rigid brace such as halo brace and Minerva cast for 3 months postope ratively and seven patients(13%) experienced graft complications, mainly graft extrusion. In group 2 and 3, the patients required only soft b races for 4 to 8 weeks and no patients experienced serious graft complications like ones in group 1 but, instead two patients with screw breakages, two back-outs and one non-union were observed. In comparison of the clinical complications such as hoarsness, there were no significant differences between the groups. In conclusion, the plating system in anterior cervical fusion appears to be safe despite the facts that mo re technical demands are required during surgery. It also provides better postoperative stability in the spine and permits earlier ambulation without a rigid brace. A monocortical locked plate screw system appears to have less hardware failures and better su rgical results than a bicortical non-locked plate screw system.

The Evaluation of the Ilium and Biocompatible Orthopaedic Polymer(BOP) as Graft Material in Cervical Spine Surgery

Traditional anterior interbody fusion with autograft has limitations such as graft collapse, graft extrusion, pseudoarthrosis, and donor site morbidity. A short hospital stay and reduced donor site complications can be achieved by using synthetic graft materials such as Biocompatible Orthopaedic Polymer(BOP). A retrospective study to evaluate bone graft was carried out in a series of 111 patients in whom interbody fusions were performed for cervical spondylosis and cervical spine injury using anterior(modified Trans-Unco-Discal) approach with autogenous ilium or BOP between January 1988 and December 1994 at our hospital. The radiological assessments were made between postoperative and follow-up x-ray findings, and the postoperative clinical results and complications were statistically analyzed. The major results were as follows: 1) Clinical results of spondylotic patients were graded excellent in 57%, good in 32% and fair in 11% in ilium group, and excellent 65%, good 25%, fair 5% and poor 5% in BOP group. Clinical results patients with cervical injury were graded excellent in 25%, good in 25%, fair in 25% and poor in 25% in ilium group, and excellent 29%, good 21%, fair 29% and poor 21% in BOP group. As to graft materials, there were no statistically significant difference in clinical results(p=0.76, p=0.75). 2) Mean height of graft bone were 13.0mm in ilium group and 10.0mm in BOP group at postoperative x-ray findings, and 11.6mm in ilium group and 6.1mm in BOP group at follow-up x-ray findings. Incidence where the height of graft bone at follow-up x-ray findings was less than 80% of immediately postoperative height were 7% in ilium group and 58% in BOP group, and there was a statistically significant difference(p<0.05). BOP sank into the adjacent end plate as compared to ilium. 3) Mean duration of period required for fusion was about 40 days in ilium group and 132 days in BOP group with a statistically significant difference (p<0.01). 4) The rate of complications related to bone graft was 16% in ilium group and 30% in BOP group. Incidence of complications was higher in BOP than ilium group, but there was no statistically significant difference(p=0.28). According to the above results, clinical results were not significantly different between both graft materials, but ilium was superior to BOP as a good spacer with maintenance of height of graft bone and good bony fusion.

Surgical Treatment of Odontoid Type II Fracture with Anterior Screw Fixation: Analysis of 15 Cases

Fracture of the odontoid process is subdivided into type I, II and III. The treatment of type II is problematic, in that both conservative treatment and surgery are usually unsatisfactory; in the other type, conservative management alone gives good results. Recently, however, the operative procedure has changed, in accordance with advances in surgical equipment and technique. The anterior or posterior approach may be used, and the anterior screw fixation is increasingly the operaive procedure of choice; indications, operative technique, complications and long-term prognosis have not, however, been reported. The procedure was initially applied to patients who had suffered posterior displacement, and in whom nonunion was likely, but because of improved equipment and technique, was seem to be succesful and safe and so was used in the initial management of all odontoid type II fracture. A anterior screw fixation effectively attaches displaced bony fragment to the odontoid process and immobilizes one that is fractured. The BOP(Biocompatible Osteoconductive Polymer) pin is more physiologic than metal screw, and does not compromise the area to be fused, eventhough it has no lag effect. The major advantages of anterior fixation are immediate stability and restoration, and the preservation of normal biomechanics of the spine. It can be used as the procedure of choice in most patients with odontoid type II fracture, while anterior fixation with a BOP pin may be suitable for some selected patients.

Anterior Cervical Interbody Fusion with or Without Plate and Screws System

Although anterior cervical plates are thought to be good tools, their clinical results have not been compared with those of anterior cervical fusion without a plating system in the domestic scientific literature. As there are some advantages as well as shortcomings in these two surgical methods, it is imperative to know which one might be better in terms of the postoperative complications and management. Therefore, the authors reviewed 80patients undergoing anterior cervical fusion during the period of January 1992 to May 1994. Top plate placement was made in 25 and simple fusion without a plating system was applied in 55. The average follow-up period was 9.6 months. In the patients undergoing simple cervical fusion, thirty-two patients(58%) needed rigid braces such as halo braces and Minerva casts for 3 months postoperatively. Thirteen patients(24%) showed graft complications including graft extrusion, whereas patients undergoing plate placement needed only semi-rigid Philadelphia braces for 4 to 8 weeks pos toperatively. Two patients(8%) showed graft setting and screw breakage without any indication of reoperation. However there appeared no difference in the immediate postoperative course of clinical symptoms and the fusion rate(95 vs 96%) at the final follow-up day between the simple fusion and the plate placement patients. The authors conclude that a plating system in anterior cervical fusion may be safe in spite of more extensive operations, and is more likely to offer postoperative stability in the cervical spine and early ambulation and rehabiliation without rigid braces.

Anterior Cervical Interbody Fusion with or Without Plate and Screws System

Although anterior cervical plates are thought to be good tools, their clinical results have not been compared with those of anterior cervical fusion without a plating system in the domestic scientific literature. As there are some advantages as well as shortcomings in these two surgical methods, it is imperative to know which one might be better in terms of the postoperative complications and management. Therefore, the authors reviewed 80patients undergoing anterior cervical fusion during the period of January 1992 to May 1994. Top plate placement was made in 25 and simple fusion without a plating system was applied in 55. The average follow-up period was 9.6 months. In the patients undergoing simple cervical fusion, thirty-two patients(58%) needed rigid braces such as halo braces and Minerva casts for 3 months postoperatively. Thirteen patients(24%) showed graft complications including graft extrusion, whereas patients undergoing plate placement needed only semi-rigid Philadelphia braces for 4 to 8 weeks pos toperatively. Two patients(8%) showed graft setting and screw breakage without any indication of reoperation. However there appeared no difference in the immediate postoperative course of clinical symptoms and the fusion rate(95 vs 96%) at the final follow-up day between the simple fusion and the plate placement patients. The authors conclude that a plating system in anterior cervical fusion may be safe in spite of more extensive operations, and is more likely to offer postoperative stability in the cervical spine and early ambulation and rehabiliation without rigid braces.

Ligamentoplasty in Lumbosacral Vertebrae using BOP

BOP is made of N-Vinyl pyrrolidone-Methylmethacrylate monomer, polyamide fibres, and calcium glusconate. BOP is biocompatible, biodegradable, and osteoconductive matrix, easy to use and quite safe. Authors have operated 14 patients who has bilateral hernaiated nucleus pulposus, multiple herniated nucleus pulposus, or herniated nucleus pulposus accompanied with spinal stenosis, spondylolysis or spondylolisthesis in lumbosacral portion from September, 1989 till August, 1990. The results were satisfactory. We analysed this patients and report the method of ligamentoplasty with the discussions about spinal fusion and spinal instability.