Protecting future antimalarials from the trap of resistance:Lessons from artemisinin-based combination therapy (ACT) failures

Having faced increased clinical treatment failures with dihydroartemisinin-piperaquine(DHA-PPQ),Cambodia swapped the first line artemisinin-based combination therapy(ACT)from DHA-PPQ to artesunate-mefloquine given that parasites resistant to piperaquine are susceptible to mefloquine.However,triple mutants have now emerged,suggesting that drug rotations may not be adequate to keep resistance at bay.There is,therefore,an urgent need for alternative treatment strategies to tackle resistance and prevent its spread.A proper understanding of all contributors to artemisinin resistance may help us identify novel strategies to keep artemisinins effective until new drugs become available for their replacement.This review highlights the role of the key players in artemisinin resistance,the current strategies to deal with it and suggests ways of protecting future antimalarial drugs from bowing to resistance as their predecessors did.

China's foreign aid for global poverty alleviation:artemisinin-based combination therapies against malaria in Togo

From providing funds for the global fight against infectious diseases,to actively participating in global health security actions,to strengthening mutual cooperation in the field of health,and providing medical treatment,training and scholarships to countries in need,China’s foreign aid on global poverty alleviation is increasingly diversified and expanding in scale.Indeed,China is playing an increasingly important leading role in the global health agenda.It is worth mentioning that over the years,artemisinin compound have saved millions of lives all over the world,especially in poverty-stricken areas.China’s work mode of malaria elimination has also been written into WHO’s technical documents and recommended to other countries.Since 2007,Chinese medical staff has carried out the Artemisinin Compound Malaria Control Project in Comoros,bringing Chinese prevention and treatment programs to the local area.By 2014,Comoros had achieved zero deaths from malaria,and the number of cases had dropped by 98%.Now,this program is also extended to Togo,another African country.This article preliminarily summarizes the malaria profile in Togo and introduces China-Togo Cooperative Artemisinin Malaria Control Demonstration Project to provide a reference for better anti-malaria assistance in Togo,and also shows one of the substantive actions of China’s participation in global health governance,which contributes Chinese wisdom and offers Chinese solutions to global poverty alleviation.

Effect of Primaquine on Gametocyte Carriage in the Case-Management of Uncomplicated Falciparum Malaria with Acts: Nigerian Perspective

Background: Drugs that kill or inhibit sexual stages of Plasmodium such as Primaqiune (PQ) could potentially amplify or synergize the impact of first line antimalarials by blocking transmission to mosquitoes. This study examined the effect of Primaquine on gametocyte carriage in the case management of uncomplicated falciparum malaria with artemisinin-based combination therapy (ACT) with the overall purpose of possibly recommending it as an adjunct drug for malaria control. Methods: A total of 181 patients with uncomplicated falciparum malaria, normal glucose-6-phosphate dehydrogenase (G6PD) enzyme levels, and haemoglobin levels ≥ 8 g/dL completed this two-arm randomized blinded clinical trial to test the efficacy of a single dose PQ (0.75 mg/kg) on falciparum gametocytaemia. 88 subjects were assigned to a standard 3-day course of Dihydroartemisinin-Piperaquine (DHP) alone (n = 88) while 93 others had DHP combined with a single dose of PQ on day 3 (n = 93). A 28-day follow-up schedule carried out in the outpatient clinic of a Primary health facility in Vom, Plateau State Nigeria where study participants were seen on days 1, 3, 7 and then weekly to assess the presence of asexual parasites and gametocytes by microscopy. A Kaplan-Meier analysis was employed to determine the survival function of gametocytes on day 3. The data was analyzed using Epi info version 7.1.5. Results: With a gametocyte prevalence of 27.1%, gametocyte carriage rate was lower in the PQ group due to higher probability of clearing gametocytes (Breslow test χ2 = 8.306, df = 1, p = 0.004) and significantly less likely to harbor gametocytes by day 7 when compared to the DHP-alone group (χ2 = 6.218, df = 1, p = 0.013). Conclusion: Addition of single-dose 0.75 mg/kg PQ was associated with reduced gametocyte carriage as a result of faster gametocyte clearance and lower incidence of gametocyte development in DHP-treated patients. PQ as gametocytocidal drug may be useful in combination with artemisinin-based combination therapy (ACT) regimen to clear gametocytes and thereby interrupt malaria transmission to mosquito vector more effectively than ACT alone.

Preference for Artemisinin-based combination therapy among healthcare providers,Lokoja,North-Central Nigeria

Background:In Nigeria,Artemisinin-based Combination Therapy(ACT)is the recommended first line antimalarial medicine for uncomplicated malaria.However,health care providers still continue the use of less efficacious medicines such as Sulphadoxine-pyrimethamine and chloroquine.We therefore determined preference for ACT(PFA)and factors associated with PFA among healthcare providers(HCP)in Lokoja,North-Central Nigeria as well as assessed healthcare providers’knowledge of malaria case management.Methods:We conducted a cross-sectional study among physicians,nurses,pharmacists,community health officers(CHOs),community health extension workers(CHEWs)and,patent and proprietary medicine vendors(PPMVs).Interviewer-administered questionnaires were administered to collect data on respondents’characteristics,previously received malaria case management training and knowledge of malaria treatment.Knowledge scores≥3 were categorised as good,maximum obtainable being 5.Results:Of the 404 respondents,214(53.0%)were males.Overall,219(54.2%)respondents who received malaria case management training included PPMVs:79(65.8%),CHEWs:25(64.1%),CHOs:5(55.6%),nurses:72(48.7%),physicians:35(47.3%)and pharmacists:3(23.1%).Overall,202(50.0%)providers including physicians:69(93.2%),CHO:8(88.9%),CHEWs:33(84.6%),pharmacists:8(61.5%),nurses:64(43.2%)and PPMVs:20(16.5%),had good knowledge of malaria treatment guidelines.Overall,preference for ACT among healthcare providers was 39.6%.Physicians:50(67.6%),pharmacists:7(59.3%)CHOs:5(55.6%),CHEWS:16(41.0%),nurses:56(37.8%)and PPMV:24(19.8%)had PFA.Receiving malaria case management training(adjusted odds ratio[aOR])=2.3;CI=1.4-3.7)and having good knowledge of malaria treatment(aOR=4.0;CI=2.4-6.7)were associated with PFA.Conclusions:Overall preference for ACT use was low among health care providers in this study.Preference for ACTs and proportion of health workers with good knowledge of malaria case management were even lower among PPMVs who had highest proportion of those who received malaria case management training.We recommend evaluation of current training quality,enhanced targeted training,follow-up supportive supervision of PPMVs and behavior change communication on ACT use.

Pattern of Uncomplicated Malaria Treatment and Antimalarial Prescription Practices among Health Workers in the Littoral Region of Cameroon: An Assessment of Ten Years Post-Malaria Treatment Policy Change

Following highly prevalent Plasmodium resistant strains to antimalarial monotherapies in malaria endemic countries, uncomplicated malaria treatment policy changed to artemisinine-based combination therapies (ACTs). After adoption of this new treatment policy in a country, sufficient care is needed to be taken to prevent occurrence of resistance to the latest drugs. As Cameroon shifted to ACT in 2004, this study aimed to assess knowledge and practices of health workers in government health facilities of the Littoral region regarding mild malaria management in health facilities as well as according to prescription qualities of ACTs in leaflets received in pharmacies. A total of 66 physicians and 16 nurses were questioned in 10 health facilities and 503 medical leaflets with ACTs prescriptions were viewed in 17 pharmacies. All medical workers questioned correctly were defined mild malaria and were aware of the antimalarial policy change in Cameroon. Overall ACTs prescription for mild malaria management in children and adult patients was 72.2% and 87.8% respectively. An important proportion of health workers prescribed antimalarial monotherapies and non recommended antimalarial for uncomplicated malaria treatment. 31.7% of participants did not systematically recommend laboratory diagnostic test before antimalarial prescription. Of leaflets viewed in pharmacies, ACTs were prescribed by physicians, nurses and laboratory technicians. Age was the only criteria for ACTs prescription. Appropriate ACTs quality prescription ranged between 81.2% and 94.4%. Of the ACTs prescribed, blisters had the highest (92.9%) appropriate quality prescription and solutions the lowest (83.3%). According to qualification of prescribers, physicians had the highest score (93.1%) of appropriate quality prescription and laboratory technicians the lowest score (28.1%). For all ACTs containing medical leaflets, concomitant medications were recorded namely antipyretic (73.9%), antibiotic (21.9%), non steroid anti-inflammatory (19.9%) or vitamins (18.1%). Data gathered indicated that although health workers were aware of uncomplicated malaria treatment policy change in Cameroon, mild malaria mismanagement was prevailing in health facilities of the Littoral region and ACTs quality prescription in medical leaflets was not optimal. Therefore, awareness is still needed among prescribers in order to prevent or at least slow the occurrence of Plasmodium resistant strains to ACTs in Cameroon.

The influence of Fe extracting as a filler of fiber concrete performance

This research is showing the effect of increasing an Fe extracting from the compression strength, tension and bending moment. The variations in this experiment are the increasing of Fe extracting 0.5%, 1% and 1.5% of concrete volume. Water Cement Ratio （WCR） variation of 0.48, 0.56 and 0.60. The result of increasing 1.5% Fe extracting causes the increasing of tension strength 44.028 kN/cm2, the increasing of slit tension strength 2.226 kN/cm2, the increasing of bending moment 14.81 kN/cm2 from normal concrete. 0.48 WCR produces tension strength, slit tension strength and bending moment more than 0.56 and 0.60 WCR. The increasing of Fe extracting with the distribution variation area and the spread concrete in the tension concrete area produce 3.705 kN/cm2 bending moment higher than the spread fiber in all of concrete area. The 4 cm fiber length produces the higher bending moment than the 2 cm fiber length. The difference is equally 5.185 kN/cm2. The combination result of the examined acting varieties by continuation statistic test gives the result to get the maximum tension and split tensile. It is a concrete combination of increasing 1.5% fiber percentage, 0.48 WCR, full spreading area and the 4 cm fiber length. The maximum bending moment is the increasing of 0.5% fiber percentage, 0.48 WCR, full spreading area and the 4 cm fiber length.

Therapeutic efficacy and effects of artemisinin-based combination treatments on uncomplicated Plasmodium falciparum malaria-associated anaemia in Nigerian children during seven years of adoption as first-line treatments

Background:Artemisinin-based combination treatments(ACTs)are the first-line treatments of uncomplicated Plasmodium falciparum malaria in many endemic areas but there are few evaluation of their efficacy in anaemic malarious children.Methods:Therapeutic efficacy of 3-day regimens of artesunate-amodiaquine and artemether-lumefantrine was evaluated in 437 anaemic and 909 non-anaemic malarious children following treatment during a seven-year period(2008-2014).Patterns of temporal changes in haematocrit were classified based on haematocrit values<30%and≥30%.Kinetics of the disposition of the deficit in haematocrit from 30%following treatment were evaluated using a non-compartment model.Results:PCR-corrected parasitological efficacy 28 days after start of treatment was significantly higher in artesunateamodiaquine-compared to artemether-lumefantrine-treated children[97%(95%CI:92.8-100)versus 96.4%(95%CI:91.3-99.4),P=0.02],but it was similar in non-anaemic and anaemic children.Fall in haematocrit/1000 asexual parasites cleared from peripheral blood was significantly greater at lower compared to higher parasitaemias(P<0.0001),and in non-anaemic compared to anaemic children(P=0.007).In anaemic children at presentation,mean anaemia recovery time(AnRT)was 15.4 days(95%CI:13.3-17.4)and it did not change over the years.Declines in haematocrit deficits from 30%were monoexponential with mean estimated half-time of 1.4 days(95%CI:1.2-1.6).Anaemia half-time(t_(1/2anaemia))correlated positively with AnRT in the same patients(r=0.69,P<0.0001).Bland-Altman analysis of 10 multiples of t_(1/2anaemia) and AnRT showed narrow limit of agreement with insignificant bias(P=0.07)suggesting both can be used interchangeably in the same patients.Conclusions:Artesunate-amodiaquine and artemether-lumefantrine remain efficacious treatments of uncomplicated P.falciparum infections in non-anaemic and anaemic Nigerian children in the last 7 years of adoption as first-line treatments.These ACTs may also conserve haematocrit at high parasitaemias and in anaemic children.Trials registration:Pan African Clinical Trial Registry PACTR201508001188143,3 July 2015;PACTR201510001189370,3 July 2015;PACTR201508001191898,7 July 2015 and PACTR201508001193368,8 July 2015.

妇产科医生对复方短效口服避孕药的雌激素剂量和服药方案的认知调查研究

目的了解当前我国妇产科医生对不同种类复方短效口服避孕药(COC)服药方案及其雌激素剂量的认识和适应症应用情况,以期为临床个体化用药决策提供参考。方法2022年8月至12月在全国20个省、自治区、直辖市的155家医院邀请妇产科医生进行问卷调查,了解其对国内目前五种常用COC的雌激素剂量和服药方案的认知及适应症应用情况。采用卡方检验、Bonferroni法、Crame' s V系数、雷达图等方法对数据进行统计分析及归纳总结。结果向653名妇产科医生发放调查问卷,回收有效问卷650份,回收率99.54%。妇产科医生对国内目前五种常用COC的知晓率差别较大,其中以屈螺酮炔雌醇片(Ⅱ)(20μg/片,87.69%;24/4方案,84.77%)知晓率最高,去氧孕烯炔雌醇片(20μg/片,45.69%;21/7方案,83.54%)最低。对于治疗痤疮、经前焦虑障碍、易怒、抑郁、经前综合征、多毛症和多囊卵巢综合征,28.77%~31.69%的妇产科医生选择24/4方案,37.54%~47.85%的妇产科医生选择雌激素剂量20μg/片的COC;其中对改善易怒症状(χ^(2)=9.403,P=0.009)方面,硕士及以上妇产科医生选择选择24/4方案的比例高于本科及以下学历者,差异有统计学意义。在改善月经周期规律性、治疗月经过多、经期周期控制效果方面,49.38%~50.00%的妇产科医生选择两方案效果相似,44.46%~56.31%的妇产科医生选择两剂量效果相似;其中在改善月经周期规律性(χ^(2)=8.402,P=0.015)和治疗月经过多(χ^(2)=6.451,P=0.040)方面,选择两剂量相似的副主任医师及以上的比例高于主治医师及以下者,差异均有统计学意义。妇产科医生对不同雌激素剂量和服药方案的选择呈弱相关(0.2<Cramer's V<0.3,P<0.05)。结论国内妇产科医生对不同COC的知晓率参差不齐,普遍存在对COC的作用机制认知不足。鉴于COC应用的广泛性,建议对妇产科医生加强COC药物作用机制的相关培训,了解雌孕激素剂量、种类与服药方案的关系,准确掌握适应症,以期更好地提供个体化推荐用药。

Parasite reduction ratio one day after initiation of artemisinin-based combination therapies and its relationship with parasite clearance time in acutely malarious children

Background:In acute falciparum malaria,asexual parasite reduction ratio two days post-treatment initiation(PRRD2)≥10000 per cycle has been used as a measure of the rapid clearance of parasitaemia and efficacy of artemisinin derivatives.However,there is little evaluation of alternative measures;for example,parasite reduction ratio one day after treatment initiation(PRRD1)and its relationship with parasite clearance time(PCT)or PRRD2.This study evaluated the use of PRRD1 as a measure of responsiveness to antimalarial drugs.Methods:In acutely malarious children treated with artesunate-amodiaquine(AA),artemether-lumefantrine(AL)or dihydroartemisinin-piperaquine(DHP),the relationships between PRRD1 or PRRD2 and PCT,and between PRRD1 and PRRD2 were evaluated using linear regression.Agreement between estimates of PCT using PRRD1 and PRRD2 linear regression equations was evaluated using the Bland-Altman analysis.Predictors of PRRD1>5000 per half cycle and PRRD2≥10000 per cycle were evaluated using stepwise multiple logistic regression models.Using the linear regression equation of the relationship between PRRD1 and PCT previously generated in half of the DHP-treated children during the early study phase,PCT estimates were compared in a prospective blinded manner with PCTs determined by microscopy during the later study phase in the remaining half.Results:In 919 malarious children,PRRD1 was significantly higher in DHP-and AA-treated compared with AL-treated children(P<0.0001).PRRD1 or PRRD2 values correlated significantly negatively with PCT values(P<0.0001 for each)and significantly positively with each other(P<0.0001).PCT estimates from linear regression equations for PRRD1 and PRRD2 showed insignificant bias on the Bland-Altman plot(P=0.7)indicating the estimates can be used interchangeably.At presentation,age>15months,parasitaemia>10000/μl and DHP treatment independently predicted PRRD1>5000 per half cycle,while age>30months,haematocrit≥31%,body temperature>37.4°C,parasitaemia>100000/μl,PRRD1 value>1000 and no gametocytaemia independently predicted PRRD2≥10000 per cycle.Using the linear regression equation generated during the early phase in 166 DHP-treated children,PCT estimates and PCTs determined by microscopy in the 155 children in the later phase were similar in the same patients.Conclusions:PRRD1 and estimates of PCT using PRRD1 linear regression equation of PRRD1 and PCT can be used in therapeutic efficacy studies.Trial registration:Pan African Clinical Trial Registration PACTR201709002064150,1 March 2017,http://www.pactr.org.

Declining responsiveness of childhood Plasmodium falciparum infections to artemisinin-based combination treatments ten years following deployment as first-line antimalarials in Nigeria

Background:The development and spread of artemisinin-resistant Plasmodium falciparum malaria in Greater Mekong Subregion has created impetus for continuing global monitoring of efficacy of artemisinin-based combination therapies(ACTs). This post analyses is aimed to evaluate changes in early treatment response markers 10 years after the adoption of ACTs as first-line treatments of uncomplicated falciparum malaria in Nigeria.Methods: At 14 sentinel sites in six geographical areas of Nigeria, we evaluated treatment responses in 1341 children under 5 years and in additional 360 children under 16 years with uncomplicated malaria enrolled in randomized trials of artemether-lumefantrine versus artesunate-amodiaquine at 5-year interval in 2009-2010 and 2014-2015 and at 2-year interval in 2009-2010 and 2012-2015, respectively after deployment in 2005.Results: Asexual parasite positivity 1 day after treatment initiation (APPD1) rose from 54 to 62% and 2 days after treatment initiation from 5 to 26% in 2009-2010 to 2014-2015(P=0.002 and P<0.0001, respectively).Parasite clearance time increased significantly from 1.6 days (95% confidence interval [CI]: 1.55-1.64) to 1.9 days (95% C,1.9-2.0) and geometric mean parasite reduction ratio 2 days after treatment initiation decreased significantly from 11 000 to 4700 within the same time period (P< 00001 for each). Enrolment parasitaemia > 75 000 μl^-1, haematocrit > 27% 1 day post-treatment initiatiortreatment with artemether-lumefantrine and enrolment in 2014-2015 independently predicted APPD1. In paralle , Kaplan-Meier estimated risk of recurrent infections by day 28 rose from 8 to 14% (P=0005) and from 9 to 15%(P=0.02) with artemether-lumefantrine and artesunate-amodiaquine, respectively. Mean asexual parasitaemia half-life increased significantly from 1.1 h to 1.3h within 2 years (P<0.0001).Conclusions:These data indicate declining parasitological responses through time to the two ACTs may be due to emergence of parasites with reduced susceptibility or decrease in immunity to the infections in these children.

恩替卡韦联合长效干扰素治疗HBeAg阳性慢性乙型肝炎临床研究

目的探讨恩替卡韦(ETV)联合长效干扰素α(IFN-α)治疗乙型肝炎(简称乙肝) e抗原(HBeAg)阳性慢性乙肝的效果。方法共纳入100例首次接受抗病毒治疗的HBeAg阳性慢性乙肝患者,随机分为研究组和对照组,各50例,两组患者均口服恩替卡韦片(0. 5 mg/d),研究组患者加用聚乙二醇干扰素α-2a注射液(180μg,皮下注射,1次/周),持续治疗48周。结果治疗48周时,研究组HBeAg转阴率及血清学转换率分别为36. 00%和32. 00%,明显高于对照组的18. 00%和16. 00%(P <0. 05);研究组乙肝表面抗原(HBsAg)转阴率及血清学转换率分别为6. 00%和4. 00%,与对照组的2. 00%和2. 00%相当(P> 0. 05);研究组乙肝病毒脱氧核糖核酸(HBV DNA)转阴率为86. 00%,与对照组的82. 00%相当(P> 0. 05);两组ALT、天门冬氨酸氨基转移酶(AST)、总胆红素(TBil)均明显下降,且研究组ALT和TBil降幅明显大于对照组(P <0. 05);高、低ALT水平组HBeAg血清学转换率、HBV-DNA转阴率均相当(P> 0. 05)。结论恩替卡韦联合长效干扰素治疗HBeAg阳性慢性乙肝48周时,可有效提高HBeAg转阴率和血清学转换率。

基于OODA环的合成部队光电装备作战效能评估

针对光电装备评估问题,研究陆军合成部队光电装备在观察-判断-决策-执行(OODA)环中的作战效能。分析基于OODA环的光电装备的作用,面向侦察打击全过程建立光电装备作战效能评估模型。采用指标聚合方法评估合成部队主要光电装备在体系对抗中的作战效能。结果表明:观察单元光电装备的性能和数量均对体系作战能力具有显著影响,当打击单元整体能力处于较高水平时,单纯提高观察单元的性能对整体作战能力提高影响有限,模型评估结果与实际情况基本相符;采用基于OODA环的评估模型在体系对抗中评估光电装备的作战效能,能够客观评估光电装备的作战能力,为合成部队光电装备作战效能评估、结构和编配优化提供支撑。

动能拦截弹姿控发动机组合点火算法研究

为了提高拦截弹的拦截精度,通常要在弹体上引入侧喷直接力姿控系统。对于由小型固体脉冲式发动机阵列构成的该系统,必须解决多发动机组合点火问题。根据组合点火问题的特点,将动能拦截弹姿控发动机组合点火算法问题转化为用0-1规划模型处理的数学问题。鉴于常规的求解0-1规划问题算法的复杂度均比较大,无法满足高超声速动能拦截弹对响应时间的要求。而贪心算法具有时间复杂度小、求解结果比较合理等特点,故采用了贪心算法对该问题进行了快速近似求解。仿真实例结果表明由贪心算法实现的点火策略计算时间稳定在1-0 5S数量级上,且所得到的解与理论值相比误差不超过3.7%,完全满足高超声速动能拦截弹的要求。

布地奈德联合福莫特罗治疗支气管哮喘临床研究

目的:观察布地奈德联合福莫特罗治疗支气管哮喘的疗效。方法:选取来我院初治确诊为支气管哮喘轻度以及中度病人120例作为研究对象,随机分为布地奈德联合福莫特罗组(n=60),吸入布地奈德联合福莫特罗冻干粉,每组吸160μg/4.5μg;布地奈德组(n=60),吸入布地奈德冻干粉,每组吸200μg。每个实验对象均1吸/次,2次/d;两组疗程均为12wk。观察、分析两组病人在临床试验前后的治疗前后的1 s用力呼气容积占预计量百分比(FEV 1%),最大呼气流量占预计值百分比(PEF%),以及临床症状改善情况等指标。结果:吸入布地奈德联合福莫特罗冻干粉治疗后病人临床症状和肺功能较布地奈德组改善更明显。治疗前后差异有统计学意义(P<0.05)。结论:布地奈德联合福莫特罗可减轻哮喘发作症状,提高肺功能,使用方便,是目前治疗哮喘较为理想的药物。

青蒿素抗疟研究的不断追求:快速消灭疟疾——纪念执行“523”任务50周年

在国家"523"(防治疟疾新药项目代号)任务实施50周年之际,对广州中医药大学青蒿素抗疟研究科研团队采用青蒿素复方防治疟疾的历程与所取得的进展进行评述。广州中医药大学作为"523"项目研究小组之一,其青蒿素抗疟研究科研团队相继主持了采用青蒿素及其衍生物不同剂型、剂量、疗程治疗疟疾的临床研究(1974~1989)、青蒿素复方(Artekin及Artequick)治疗疟疾的临床研究(1984~2006),并于近10年中在东南亚地区及非洲全力推行快速消灭传染源清除疟疾(Fast Elimination of Malaria by Source Eradication,FEMSE)的抗疟项目。青蒿素抗疟研究科研团队所做的探索与获得的成就为青蒿素类药物走向世界做出了重要贡献,并为全球快速消灭疟疾创建了一种简单、易行、省钱的新方法。

双作用多级液压缸的缓冲设计

研究了双作用多级液压缸的原有结构设计缺陷和问题,提出了在活塞上插装多功能液压复合阀实现多级缸的顺序伸出动作和缩回时固定节流缓冲的效果。为了解决各级伸出时到前端的冲击,提出了将有杆腔的供排油流道设计成大小孔前后并行的结构,大孔在靠近前盖侧,在每级油缸运动到接近前盖时,大的孔进入前盖导向环形区域遮盖,有杆腔的回油通过小孔固定节流排出,实现多级伸缩油缸每一级到前端的缓冲。

想象的数罪还是实质的数罪——论想象竞合犯应当数罪并罚

想象竞合犯具有多个犯罪的社会危害性,对其“从一重罪”处断不能实现罪刑公正。当一个自然行为蕴含多个危害行为的意义时,构成多个危害行为的竞合,其实质是危害行为的复数。行为竞合的概念,在理论上不仅可能,而且正当。想象竞合犯实质上是复数危害行为的竞合,该复数危害行为分别符合复数的犯罪构成,属于实质的数罪。应当对想象竞合犯数罪并罚,这不仅是其罪数本质的要求,也是罪刑法定、罪刑公正的要求。

民政工作的开放性及社会福利服务的整合

在中国,民政工作是一个极具开放性的政府工作系统。在改革开放不断深化的大背景下,新的矛盾和问题可谓层出不穷,由此而产生的新的工作和任务,需要有一个"不管部"来承接,这个政府部门就是民政部门。从1980年代中期开始,民政部以主动求变和不断扩张的姿态,成功地摆脱了在政府工作中被边缘化的处境。进入2010年代,民政部门的下一个目标应该是社会福利服务,而且要以"三社联动"为手段来实现。

速效呃逆平汤联合针刺治疗化疗后顽固性呃逆虚证的临床研究

目的:探讨速效呃逆平汤联合针刺对化疗后顽固性呃逆虚证的治疗效果。方法:选取2018年1月至2019年6月唐山市人民医院确诊为恶性肿瘤化疗后顽固性呃逆患者150例,按简单随机化随机余数分组法分为五组,每组30例。对照组患者肌内注射盐酸消旋山莨菪碱注射液,穴位注射组患者于足三里穴肌内注射盐酸甲氧氯普胺注射液;速效呃逆平组患者口服速效呃逆平汤剂;针刺组患者采用普通针刺穴位治疗;联合组患者口服速效呃逆平汤剂联合针刺穴位治疗。5 d为1个观察疗程,观察五组患者的临床疗效、呃逆复发及不良反应发生情况。结果:治疗5 d后,联合组患者的临床显效率为90.00%(27/30),明显高于对照组(53.33%,16/30)、穴位注射组(66.67%,20/30)、速效呃逆平组(70.00%,21/30)和针刺组(70.00%,21/30),差异均有统计学意义(P<0.05);1个疗程结束后第5日,联合组患者呃逆复发率为6.67%(2/30),明显低于对照组(36.67%,11/30)、穴位注射组(26.67%,8/30)、速效呃逆平组(13.33%,4/30)和针刺组(16.67%,5/30),差异均有统计学意义(P<0.05);联合组患者不良反应发生率低于其他四组。结论:以虚论治是中医治疗化疗后顽固性呃逆的重要原则,速效呃逆平汤与针刺的联合应用,通过多种治疗方式产生多重补虚效应,疗效显著,可减少呃逆复发和不良反应,为临床治疗顽固性呃逆提供参考依据。

工业革命时期英国的结社法研究

英国的结社法是政府为限制工人结社而制定的法律。在18世纪之前,英国并没有特别针对结社的立法,多半是在一些劳工法令中有限制劳工结社的条款。1720年英国通过了第一个结社法,此后历经数次修正。工业革命时期英国的结社法对于工人结社以及工会运动的发展起到了很大的阻碍作用。1871年,结社法不复存在而代之以工会法,工会取得合法地位,工会运动得到了一定发展。