An interview survey on the development of family doctor work mode in Shanghai Xuhui district / 中华全科医师杂志

Objective:To survey the status quo of family doctor work mode in Shanghai Xuhui district.Methods:Semi-structured and structured in-depth interviews were conducted in Shanghai Xuhui district from April to June 2021, 11 directors, 12 deputy directors in charge and 30 family doctors from 12 community health service centers participated in the survey and completed two stages and four sessions of interviews on the development of the integrated and high-quality family doctor work mode and the ways to realize and the challenges to face. The records of interviews were transcribed, sorted and analyzed using the Colaizzi 7-step analysis method.Results:The survey showed that the family doctor contracting was carried out in a large team mode in the whole district, mainly for the elderly, and most of contracted residents were not included in health management and follow-up services. The team was composed of family doctors and assistants, and the routine outpatient service was the main work pattern, and the regular services also included the chronic disease follow-up and health check-up for elderly. On the issue of how to output high-quality integrated services, the majority of doctors (12/13) believed that the contracted individual should be taken as the unit of fine service, carrying out overall health assessment, optimizing medication plan, lifestyle guidance, one-stop service in hospital, etc.; only one doctor suggested that the family should be the management unit. For upgrading the working mode and service quality, insufficient time and energy were the main obstacle. Public health work occupied a lot of working time, but it seemed not be transformed into favorable resources and conveniences in health management and services. The professional assistants should carry out some responsibility to save family doctor′s time. The survey suggests that informatization, service space, and sufficient drug supply are the keys for ensuring high-quality and high-efficiency integrated services.Conclusion:The organizational structure of the family doctor team in Shanghai Xuhui district is relatively mature, but the integrated and high-quality service output has not yet reached. It is necessary to make regional overall planning and increase efforts to achieve the integration of medical treatment and prevention, so as to gain time for family doctors to carry out high-quality services. At the same time, it is also necessary to cultivate effective family doctor assistants, provide an information work platform that matches the work attributes and goals of family doctors, open up an integrated health management service space, and ensure the full range supply of drugs.

Minadores de hojas del aguacate (Lepidoptera: Gracillariidae). Estado actual, Identificación, evaluación de daño y propuesta de manejo / Leaf miners of avocado (Lepidoptera: Gracillariidae). Status, identification, damage evaluation and management proposal

RESUMEN El cultivo de aguacate representa uno de los principales productos agrícolas de Colombia. Durante las últimas dos décadas, el área sembrada se quintuplicó y se ampliaron, notablemente, las zonas de siembra, en especial, para el cultivar Hass. Con el crecimiento de su producción, también se reportan nuevos problemas fitosanitarios, mayormente, por la adopción de sistemas productivos de otras latitudes del mundo, donde no se cuentan con ecosistemas con presencia de lauráceas y otras plantas relacionadas con el aguacate. Dentro de las especies plagas, se registra a los minadores de hojas del orden Lepidoptera, que se caracterizan por desarrollarse y alimentarse dentro de las hojas, cuyo efecto perjudicial, se genera, en principio, cuando son afectadas las poblaciones de sus enemigos naturales. El primer registro documentado de estos insectos en el país, se realizó a partir de muestras colectadas en un cultivo de aguacate cv. Hass, en Villamaría, (Caldas), que presentó una explosión de las poblaciones de minadores, como consecuencia de la aplicación calendario de plaguicidas, con el criterio de proteger de plagas al cultivo, como arañita roja y trips. Con el fin de evitar que se aumente la frecuencia de eventos, como el enunciado, se desarrolló el trabajo actual, el cual, tuvo como objeto presentar el estado actual de los minadores de hoja del aguacate en Colombia, identificación y descripción del daño del minador de hojas del aguacate en serpentina y en ampolla y brindar recomendaciones para su manejo, en las zonas productoras de Colombia.

ABSTRACT Avocado has become one of the most important crops in Colombia. During the last two decades, the area planted with avocado has quintuplicated, and it is widespread across a wide range of high-altitude lands growing in monoculture with Hass variety. As the plantation areas increase, new sanitary problems appear, as consequences of the adoption of technical recommendations from other latitudes where the ecosystems do not have laurels and other plants related to avocado. Within the pest species, the leafminers of Lepidoptera are reported, which the main characteristic is that they develop and feed inside the leaves. The damage they cause happens mainly when the population of their natural enemies is affected. The first record of leafminers in Colombia was done from samples collected in one orchard of avocado cv. Hass in Villa Maria, Caldas where a high infestation outbreak happened as a consequence of the pesticide application following calendar spraying to prevent the attack of pests like red spider mites and thrips. The objective of this paper is to present the status of leafminer pest of avocado leaves in Colombia, providing its identification, description of the serpentine and blotch damage, and proposing recommendations for its management. This will inform the scientific community and farmers about the presence of this pest in avocado crop regions in Colombia, contributing to minimize damaging events like the aforementioned.

Application of focused neuromonitoring in patients with severe brain injuries / 中国实用内科杂志

Focused neuromonitoring plays an important role in the management of severe brain injuries.Severe brain injuries have the pathophysiological complexity and diversity.The purpose of focused neuromonitoring is to detect abnormal links in the early stage;to screen etiology;to individualize patient care decisions;to monitor therapeutic response of some interventions and to avoidany potential adverse effects;to improve neurological outcome and quality of life in survivors.The first step in making good use of focused neuromonitoring is to allow clinicians to better understand the pathophysiology of complex disorders,and the second is to accurately obtain every parameter and correctly interpret them.Finally,multiple parameters of focused neuromonitoring were integrated and integrated with clinical indexes and pathophysiological changes.In the end,understanding the information transmitted by severe neurological patients and transforming the monitoring datas into scientific and rigorous treatment decisions.

Application of Simultaneous Integrated Boost Intensity Modulated Radiotherapy in Locally Advanced Non-small Cell Lung Cancer / 中国肺癌杂志

BACKGROUND@#The standard treatment for locally advanced non-small cell lung cancer (NSCLC) is radiotherapy concurrent with chemotherapy, but the survival was not satisfied. With the development of intensity modulated radiotherapy, simultaneous integrated boost technique (SIB) becomes the research direction of locally advanced NSCLC. The aim of this study is to investigate the efficacy and safety of SIB intensity modulated radiotherapy technique for locally advanced NSCLC.@*METHODS@#We retrospectively reviewed the clinical data of locally advanced NSCLC who were treated with radiotherapy by SIB technique in Peking University Cancer Hospital from June 2015 to December 2018. Kaplan-Meier method was used for analysis.@*RESULTS@#Ninty-three patients were included in the analysis. After a median follow-up of 34.23 months, 3-year overall survival (OS), progression-free survival (PFS), local-recurrence free survival (LRFS) and metastasis free survival (MFS) rates were 53.0%, 37.0%, 50.5% and 50.5%, respectively. The incidence of grade ≥3 esophagitis was 5.4%. There were 2 (2.2%) patients experiencing grade ≥3 radiation-related pneumonia.@*CONCLUSIONS@#Radiation with SIB intensity modulated radiotherapy technique is effective and safe for patients with locally advanced NSCLC.

A preliminary methodology and precision study of producing 3D printing heart model by multimodel medical image fusion technology / 中华超声影像学杂志

Objective To obtain abundant anatomical information using fusion of ultrasonic valve images and CT heart images and provide new methods of image processing for 3D heart printing . Methods Cardiac examinations of three-dimensional transesophageal echocardiography ( 3D-TEE) and DICOM images of 41 patients who had atrial fibrillation without structural cardiac diseases were analyzed retrospectively and the data afterward were processed by using Mimics software . For the single-mode image group ,only the heart CT were invoked as the data sources . For the multimodel image group ,CT and ultrasound images were invoked as the data sources . Valve structures of the 3D reconstructions were graded and the circumferences ,areas and other parameters of the two groups were measured . The images of two groups were overlapped ,and the angles between the two valve planes of each heart were evaluated and analysed . Results Score of valves reconstructed by ultrasound 3D construction was higher than those by CT reconstruction . Measurements of correlated parameters between the 3D-TEE group and the CT group showed no significant statistical difference ( P ＞ 0 .05 ) , and the consistency was well . Ultrasound measurements of 3D reconstructed valves were well concordant with CT reconstructed valves by Bland-Altman analysis . Mean value and standard deviation of the angles between mitral valve annulus and aortic valve ring plane of each heart in the two group were ( 3 .15 ± 0 .88)°,( 2 .87 ± 0 .76)°,respectively . Conclusions Ultrasonic valve images can fuse precisely with CT images and it provides a better displayed morphology . This will help improving simulation quality of the 3D printed hearts .

¿MULTIPLICAR Tetrastichus howardi (HYMENOPTERA: EULOPHIDAE) EN LA ORUGA DE LA SEDA AFECTA SU BIOLOGÍA? / Does Multiplying Tetrastichus howardi (Hymenoptera: Eulophidae) in the Silkworm Affect its Biology?

La multiplicación sucesiva de parasitoides en hospederos alternativos, puede afectar las características biológicas y comprometer los sistemas de cría masiva de estos. El objetivo de este trabajo fue evaluar la multiplicación de Tetrastichus howardi (Olliff, 1893) (Hymenoptera: Eulophidae) en pupas del hospedero alternativo Bombyx mori (Linnaeus, 1758) (Lepidoptera: Bombycidae), durante tres generaciones. Y si eso afecta su desempeño reproductivo, cuando se cría, posteriormente, en pupas del hospedero natural Diatraea saccharalis (Fabricius, 1794) (Lepidoptera: Crambidae). Las informaciones obtenidas en este estudio pueden mejorar y facilitar el control biológico de plagas, principalmente, con la utilización de parasitoides, debido a que T. howardi parasita y se desarrolla en pupas de B. mori. De forma general, la multiplicación de T. howardi durante tres generaciones en pupas del hospedero alternativo B. mori no compromete las características biológicas de este parasitoide cuando se multiplica en su hospedero natural D. saccharalis a los efectos de su utilización en programas de control biológico.

The successive multiplication of parasitoids in alternative hosts can affect the biological characteristics and compromise the systems for massive rearing. The aim of this study was to evaluate if the multiplication of Tetrastichus howardi (Olliff, 1893) (Hymenoptera: Eulophidae) in pupae of the alternative host Bombyx mori (Linnaeus, 1758) (Lepidoptera: Bombycidae) for three generations, affects its reproductive performance, when are reared, then in pupae of the natural host Diatraea saccharalis (Fabricius, 1794) (Lepidoptera: Crambidae). The information obtained in this study can improve and facilitate the biological control of pests, mainly with the use of parasitoids, due to the fact that T. howardi parasite and develops into pupae of B. mori. In general, the multiplication of T. howardi for three generations in the alternative host pupae of B. mori does not compromise the biological characteristics of this parasitoid when multiplied in its natural host D. saccharalis to the effects of their use in biological control programs.

Impact of continuous quality improvement initiatives on clinical outcomes in peritoneal dialysis / 医学研究生学报

Objective We evaluated the role of a quality improvement initiative in improving clinical outcomes in peritoneal di-alysis ( PD) . Methods In a retrospective analysis of 6 years of data from a hospital registry, the period between 1 July 2005 and 30 June 2008 ( control group) provided baseline data from before implementation of systemic outcomes monitoring, and the period between 1 July 2008 and 30 June 2011 [continuous quality improvement (CQI) group] represented the time when a CQI program was in place.Per-itonitis incidence, patient and technique survival, cardiovascular status, causes of death, and drop-out were compared between the groups. Results In the 370 patients of the CQI group and the 249 patients of the control group, the predominant underlying kidney diseases were chronic glomerulonephritis and diabetic nephropathy.After implementation of the CQI initiative, the peritonitis rate de-clined to 1 episode in 77.3 patient-months from 1 episode in 22.6 patient-months.In the CQI group, the complicance of blood pressure was more significantly improved than the control group ( 67.8% vs 47.4%,P<0.05).During the 3 years of follow-up,cardiothoracic ratio and IVST were significantly increased in the control group [0.55 ± 0.08 vs 0.51 ±0.05,P<0.05,11.07 ±1.66 mm vs 10.25 ±1.38 mm, P<0.05〗.The difference of LVID between the two groups was signifi-cant at the 2nd and 3rd year of follow-up(P<0.05).Patient survival at 1, 2, and 3 years was significantly higher in the CQI group (97.3%, 96.3%, and 96.3%respectively) than in the control group (92.6%, 82.4%, and 67.3%respectively, P<0.001).Imple-mentation of the CQI initiative also appeared to significantly improve technique survival rates:95.6%, 92.6%, and 92.6%in the CQI group compared with 89.6%, 79.2%, and 76.8%in the control group (P<0.001) after 1, 2, and 3 years respectively. Conclusion Integration of a CQI process into a PD program can significantly improve the quality of therapy and its outcomes.

Safety analysis of Intensity-modulated radiation therapy of glioblastoma with simultaneous integrated boost technique / 中华放射肿瘤学杂志

Objective To investigate clinical efficacy of simultaneous integrate boost for glioblastoma with intensity?modulated radiotherapy ( SIB?IMRT). Methods A total of 46 patients with glioblastoma who underwents SIB?IMRT from January 2013 to August 2014,were retrospectively analyzed. Toxicity after completion of SIB?IMRT were assessed. Kaplan?Meier method was used to analyze survival and progression?free survival. Multivariate analyses were performed to determine significant prognostic factors. Results There was no patients delayed by more than grade 3 radiation toxicity. The median overall survival and 1?year survival rates was 69 weeks and 73%,respectively. The progression free survival and 1?year progression?free survival rate were 43 weeks and 39%,respectively. The pattern of failure was identical (9 Local, 7 distant and 0 marginal recurrence). Multivariate analyses show that temozolomide concurrent chemoradiotherapy were independent factors correlated to prognosis. Conclusions The preliminary results demonstrate that SIB?IMRT for glioblastoma appear to be effective and safe. With the limted number of patients in this group,SIB?IMRT could be used for treating glioblastoma with caution,which deserves further study.

Optimization in the construction of the hospital PACS / 中国医学装备

Objective:To Integrated PACS and hospital information systems (HIS), and improve the efficiency of PACS, and improve the user experience. Methods:Base on deeply analysis of existing problems in system application, using process optimization, software optimization, and hardware upgrades manner optimize PACS. Results: PACS and HIS realized Integrated, improving the overall performance of the PACS. Enhance the user experience and expand the application scope of PACS. Conclusion: Deeply analysis of existing problems should be done before optimizing the system. Process optimization, software environment optimization should be considered as the most important and upgrading and replacement of the hardware as the secondary.

Sobre a amorfia (formlessness) em Winnicott e seu papel na simbolização / Sobre la amorfia (formlessness) en Winnicott y su papel en la simbolización / On Winnicott’s area of formlessness and its role in symbolization

Este ensaio examina o último trabalho de Winnicott no qual ele enfoca os estágios iniciais do desenvolvimento psíquico. Amorfia, relacionada ao conceito anterior de Winnicott de não integração, é um precursor necessário para a integração e o pensamento simbólico. Assim, o sujeito poderia ir da relação com o objeto para o uso do objeto. No derradeiro trabalho de Winnicott ele sugere a noção do pai como objeto inteiro no início. Aqui vou propor a noção de integrado paterno, vinculada ao conceito de o outro do objeto de André Green. Concluo que a noção de Winnicott do pai como objeto inteiro desde o início da vida completa sua matriz teórica, uma vez que inclui a noção de uma dinâmica triádica no estágio mais inicial da vida psíquica

This essay examines Winnicott’s late work in which he focuses on the earliest stages of psychic development. Formlessness, related to Winnicott’s earlier concept of unintegration, is a necessary precursor to integration and symbolic thinking. Thus the subject could move from object relating to object usage. In Winnicott’s very late work he suggests the notion of the father as a whole object at the beginning. Here, I will propose the notion of a paternal integrate linked with André Green’s concept of the other of the object. I conclude that Winnicott’s notion of the father as whole object from the beginning of life completes his theoretical matrix because it includes the notion of a triadic dynamic at the earliest stage of psychic life

Este ensayo examina el ultimo trabajo de Winnicott en el que enfoca las primeras etapas del desarrollo psíquico. Amorfia, relacionada al concepto anterior de Winnicott de la no integración, es un precursor necesario para la integración y el pensamiento simbólico. Por lo tanto, el sujeto podría ir de la relación con el objeto para el uso del objeto. En el trabajo final de Winnicott el sugiere la noción del padre como objeto entero al principio. Aquí voy a proponer la noción de integrado paterno, vinculada al concepto del otro allende del objeto de André Green. Concluyo que la noción de Winnicott del padre como objeto entero desde el comienzo de la vida completa su matriz teórica, una vez que incluye la noción de una dinámica tríadica en la etapa más inicial de la vida psíquica

Long-term Care of Dementia

In the year 2008, the Korean government has launched the long-term care insurance, which has served much of social service needs of the disabled elderly people. However, there are some problems in the insurance about the care for the subjects with dementia. First, many of the subjects with advanced dementia get lower grades by the assessment system. Second, care workers are not well educated for the management of dementia. Third, the institutions are not well designed for subjects with dementia. Fourth, the medical and social services for dementia are somewhat separated from each other. To overcome these problems, the following efforts need to be implemented. First, the assessment procedure should be revised so that the severity of the dementia can be measured more accurately. Second, the training system of the care workers should be refined. The education about the methods of dealing with the dementia patients should be part of the training. Third, the buildings of the institutions should be changed, for example, to include more one rooms. Forth, the medical and social services for dementia should be integrated. Through these efforts, the long-term care insurance will be developed to serve more of the needs of the dementia subjects and their family members.

Observation of the integrate attendance′s effect on maintenance hemodiafiltration patient / 中国实用护理杂志

Objective Discuss the integrate attendance′s effect on maintenance hemodiafiltration patient. Methods Our hospital implemented integrate attendance on 105 cases of maintenance hemodiafiltration patients during January 2004 to December 2005, to observe the patient′s blood pressure abnormal change occurence rate, puncture success rate,internal leakage obstruction rate, hospitalization rate, satisfaction rate; examined the Blood albumin(ALB) , blood serum albumin (PA) ,hemoglobin(Hb) and so on.There were 96 hemodiafiltration patients without integrate attendance in our hospital during January 2002 to December 2003.Then make a comparison between them with related data. Results Blood albumin , blood serum albumin ,hemoglobin and so on figures have a obvious rise after the implementation of integrate attendance(P

Mechanism on integrate adjustment of Chinese medicine in treatment of vascular lesion with interventionof Removing obstruction in heart collaterals—"Cheng Zhi Tiao Ping" / 中华中医药杂志

Through the combination of the traditional Chinese medicine and the no-linear science of complex system to approach the effective regularity of traditional Chinese medicine.To raise "Cheng Zhi Tiao Ping"—main control mechanism of life motion self-adapation and homeostasis state and compensatory adjustment of pathological injury,curing disease and the effective mechanism of integrate adjustment,which reflect the research experiment and clinical in curing vascular disease by removing obstruction in collaterals,display the target dynamic characteristic of health tendency.

Utilizing the Constructivism Learning Theory for the Setting of Clinical Integrate Curriculum / 中华医学教育探索杂志

The learning theory of constructivism, formed by the development of cognitive psychology, shaped well thecognitive structure of medical students. It paid attention to the curriculum configuration and integration, and also thoughtmuch of the situated instruction. The theory embodied the main ideology of regarding medical students as the instruc-tional central and the principle of independent study. It offered the theoretical basis and a new view for the setting ofclinical integrate curriculum.

Efeito da aplicação de silício em plantas de milho no desenvolvimento biológico da lagarta-do-cartucho Spodoptera frugiperda (J.E. Smith) (Lepidoptera: Noctuidae) / Effect of silicon application on corn plants upon the biological development of the fall armyworm Spodoptera frugiperda (J.E. Smith) (Lepidoptera: Noctuidae)

The effect of the application of silicon to corn plants on the development of the fall armyworm Spodoptera frugiperda (J.E. Smith) was evaluated. Silicon treatment consisted in applying 3.2 ml of a sodium silicate solution [25-28 percent (w/v) SiO2] plus 96.8 ml of water into the soil at 5, 10, 15, 20 and 25 days after emergence of corn plants kept in pots. Another group of plants were grown free of silicon. Larvae were fed on leaves obtained from silicon treated plants and their mortality at the end of the 2nd larval instar, length of the larval and pupal period, and pupal weight were compared to those of larvae fed on normal leaves. No effect of silicon was observed on the length of larval and pupal phase, pupal weight and mortality of pupae. However, increased mortality and cannibalism were registered in groups of fall armyworm at the end of the 2nd instar and greater mortality of the larvae was seen at the 2nd and 6th instars fed on silicon-treated corn plant leaves in comparison with the control. The jaws mandibles of fall armyworm at the 6th instar showed marked wear on the incisor region when in contact with leaves with higher silicon content. Silicon application can make fall armyworm feeding difficult, causing higher mortality and cannibalism, thus increasing plant resistance to this species.

Este trabalho, objetivou avaliar o efeito da aplicação de silício em plantas de milho no desenvolvimento da lagarta-do-cartucho Spodoptera frugiperda (J.E. Smith). O tratamento com silício consistiu na aplicação de 3,2 ml de solução de silicato de sódio [25-28 por cento (p/v) de SiO2], mais 96,8 ml de água, via solo aos cinco dias, 10, 15, 20 e 25 dias após a emergência de plantas de milho mantidas em vasos. Outro grupo de plantas foi cultivado sem aplicação de silício. Avaliou-se o desenvolvimento de lagartas alimentadas com folhas de milho retiradas de plantas tratadas com silício, em comparação com lagartas alimentadas com folhas de milho não tratadas, registrando-se a mortalidade ao final do 2° ínstar larval, a duração do período larval e pupal, a mortalidade larval e pupal e o peso de pupa. Não se observou efeito do silício na duração da fase larval e pupal, peso de pupa e na mortalidade de pupas. Entretanto, verificou-se maior mortalidade e aumento de canibalismo em grupos de lagartas ao final do 2° ínstar, e maior mortalidade de lagartas individualizadas no 2° e 6° ínstares, quando foram alimentadas com folhas de plantas de milho tratadas com silício, em comparação com a testemunha. Observou-se que as mandíbulas das lagartas, nos seis ínstares, apresentaram desgaste acentuado na região incisora quando em contato com folhas com maior teor de silício. A aplicação de silício pode dificultar a alimentação de lagartas, causando aumento de mortalidade e canibalismo e, portanto, tornando as plantas de milho mais resistentes à lagarta-do-cartucho.