城乡基本医疗保障制度衔接的可行性分析:以武汉市洪山区为例

目的:以武汉市洪山区为例,分析城乡基本医疗保障制度衔接的可行性。方法:对两种医保制度的相关政策文件进行归纳整理,综合比较。结果:两种制度的最终目标都是建立全民医保;基本原则都是要求多制度协调发展,自愿参加保险,采用收支平衡和以收定支、财政专户和专款专用的方法管理资金;参保对象都是无工作单位的非从业者,且在同一个统筹县区内,收入及生活水平相差不大;筹资模式都是个人缴费与政府补助相结合,且政府承担主要责任;报销待遇都是大病医疗为主,住院按医疗机构的三级转诊制度逐级报销,且报销比例逐级下降。结论:制度衔接在政策制定、社会效益、财政支持方面具有可行性。可以通过统一统筹范围、扩大参保对象和建立多层次标准等办法让两种制度更好地衔接。

Pre-assembled nanospheres in mucoadhesive microneedle patch for sustained release of triamcinolone in the treatment of oral submucous fibrosis

Objective:Drug-loaded mucoadhesive silk fibroin(SF)microneedle patch can overcome the limitations of low bioavailability and significant pain associated with traditional treatment methods,such as topical application or injection of triamcinolone for oral submucous fibrosis(OSF).However,these systems release the drug too quickly,failing to meet the clinical requirements.This study aims to construct a mucoadhesive SF microneedle patch pre-assembled with silk fibroin nanospheres(SFN)and explore its ability to sustain the release of triamcinolone in the treatment of OSF.Methods:SFN was pre-assembled via precipitation reaction and characterized by scanning electron microscope(SEM)for the morphology.The particle size andζ-potential were measured by dynamic light scattering(DLS).Triamcinolone was loaded onto SFN using a diffusional post-loading method.The effective loading of triamcinolone was confirmed using Fourier-transform infrared spectroscopy(FTIR).The concentration of unloaded triamcinolone was quantified by high-performance liquid chromatography.Drug encapsulation efficiency and loading capacity of SFN were then calculated to determine the optimal amount of drug loading.The SFN suspension was pre-mixed with SF solution to prepare the microneedle under-layer.The microneedle morphology was observed by SEM.Compression mechanical tests were performed to evaluate the fracture force of microneedles at different nanosphere contents(5%,10%,and 20%),determining the optimal pre-mixing ratio.Ex-vivo mouse oral mucosa permeation studies were performed to ascertain the insertion depth of the microneedles via histological sections.The adhesive top layer was synthesized using SF and tannic acid,with FTIR confirming its successful synthesis.Its viscoelasticity was characterized by a rheometer,and differential scanning calorimetry analyzed thermal properties.Tensile tests evaluated the interfacial bonding strength between the adhesive layer and microneedle base to ensure no detachment during use.Adhesion to wet oral mucosal tissues was tested and compared to commercial oral patches.Under the optimized conditions,the double-layered mucoadhesive microneedle patch with pre-assembled nanospheres was prepared.Its cell compatibility was evaluated by cell counting kit-8(CCK-8),live/dead staining,and phalloidin staining after co culturing with fibroblasts.The drug release experiment was conducted to demonstrate its sustained release efficacy.Results:SFN(mean diameter 46.25 nm)was successfully prepared.The maximum drug encapsulation efficiency was(63.88±1.09)%(corresponding loading capacity of SFN was(27.41±3.06)%when the weight ratio of triamcinolone/SFN was 0.5.The corporation of SFN did not affect microneedle morphology.The mechanical properties of microneedles decreased with increasing nanosphere amount.Only the fracture force of the group with 5%SFN[(0.07±0.01)N/needle]exceeded the minimum force required for mucosal penetration,thus selected as the optimal pre-mixing ratio.Histological sections confirmed that the SFN microneedles could penetrate the epithelial layer and deliver drugs to OSF affected areas.Adhesion strength between the microneedle base and top layer was(94.8±6.89)kPa,confirming strong bonding with no detachment during use.The wet adhesive strength of the double-layered mucoadhesive microneedle patch[(41.28±7.43)kPa]was significantly enhanced compared to commercial oral patches(4.5 kPa,P<0.01).CCK-8 and live/dead staining results confirmed no significant cytotoxicity.Drug release experiment showed the double-layered mucoadhesive microneedle patch with pre-assembled SFN enabled sustained release time of triamcinolone from 4 days to 14 days.Conclusion:Pre-assembling nanospheres in mucoadhesive SF microneedle patches can extend triamcinolone release time,meeting clinical requirements for sustained drug delivery.

中美口腔医学教育体系比较研究

目的:强化口腔医学教育改革,缩小医生医疗水平的差距,提高整体医疗质量,从源头上扭转口腔医疗资源过度集中的局面。方法:口腔医学教育分为学校口腔医学教育,毕业后口腔医学教育,继续口腔医学教育三个阶段,及与之匹配的口腔医师执照制度共四个方面,对中美两国口腔医学教育制度的相关政策和文献归纳、比较。结果:与美国相比我国口腔医学教育在生源、学校与学制,课程设置与教学方法,研究生教育与专科医师培训,继续口腔医学教育与医师执照制度上存在明显不足。结论:建议相关部门通过缩招专科与7年制和创立新型8年制,建立出入机制和加强监管力度,调整课程设置和革新教学方法,明确区分两种类型的研究生,完善专科医师培训制度,明确规定执照的学历需求,建立非终身和专科执照制度等方法完善我国口腔医学教育体系。