Ocular drug delivery systems:An overview

The major challenge faced by today's pharmacologist and formulation scientist is ocular drug delivery. Topical eye drop is the most convenient and patient compliant route of drug administration,especially for the treatment of anterior segment diseases. Delivery of drugs to the targeted ocular tissues is restricted by various precorneal,dynamic and static ocular barriers. Also,therapeutic drug levels are not maintained for longer duration in target tissues. In the past two decades,ocular drug delivery research acceleratedly advanced towards developing a novel,safe and patient compliant formulation and drug delivery devices/techniques,which may surpass these barriers and maintain drug levels in tissues. Anterior segment drug delivery advances are witnessed by modulation of conventional topical solutions with permeation and viscosity enhancers. Also,it includes development of conventional topical formulations such as suspensions,emulsions and ointments. Various nanoformulations have also been introduced for anterior segment ocular drug delivery. On the other hand,for posterior ocular delivery,research has been immensely focused towards development of drug releasing devices and nanoformulations for treating chronic vitreo-retinal diseases. These novel devices and/or formulations may help to surpass ocular barriers and associated side effects with conventional topicaldrops. Also,these novel devices and/or formulations are easy to formulate,no/negligibly irritating,possess high precorneal residence time,sustain the drug release,and enhance ocular bioavailability of therapeutics. An update of current research advancement in ocular drug delivery necessitates and helps drug delivery scientists to modulate their think process and develop novel and safe drug delivery strategies. Current review intends to summarize the existing conventional formulations for ocular delivery and their advancements followed by current nanotechnology based formulation developments. Also,recent developments with other ocular drug delivery strategies employing in situ gels,implants,contact lens and microneedles have been discussed.

Frequent office visits of patients with chronic kidney disease: Is a prelude to prevention of dialysis

This study is an excerpt of broad-based offce practice which is designed to treat patients with diabetes and hypertension, the two most common causes of chronic kidney disease （CKD）, as well as CKD of unknown etiology. This model of offce practice is dedicated to evaluating patients with CKD for their complete well-being; blood pressure control, fuid control and main-tenance of acid-base status and hemoglobin. Frequent offce visits, every four to six weeks, confer a healthy life style year after year associated with a feeling of good well-being and a positive outlook. Having gained that, such patients remain compliant to their medica-tion and diet, and scheduled laboratory and offce vis-its which are determinant of a dialysis-free life.

The Status Quo of and Development Strategies for Healthcare Towns Against the Background of Aging Population

In consideration of elderly peopled need for healthcare in the context of aging population, authois of this paper stxidied tiie combination 〇 ￡ characteristic towns and the healthcare industry against the background, of a vigorous campaign for chafacteristic town construction. In addition to studying thevalue and status quo of healthcare towns, they put forward development strategies for healthcare towns in terms of the health industry, health preservation, eldercare, and vacationing, with a view to injecting new vitality into the construction of healthcare towns.

Colonoscopic perforation:A report from World Gastroenterology Organization endoscopy training center in Thailand

AIM： To determine the incidence of colonoscopic perforation （CP）, and evaluate clinical findings, management and outcomes of patients with CP from the World Gastroenterology Organization （WGO） Endoscopy Training Center in Thailand. METHODS： All colonoscopies and sigmoidoscopies performed between 1999 and 2007 in the Endoscopic unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok were reviewed. Incidence of CP, patients＇ characteristics, endoscopic information, intraoperative findings, management and outcomes were analyzed. RESULTS： A total of 17357 endoscopic procedures of the colon （13 699 colonoscopies and 3658 flexible sigmoidoscopies） were performed in Siriraj hospital over a 9-year period. Fifteen patients （0.09%） had CP： 14 from colonoscopy and 1 from sigmoidoscopy. The most common site of perforation was in the sigmoid colon （80%）, followed by the transverse colon （13%）. Perforations were caused by direct trauma from either the shaft or the tip of the endoscope （n = 12,80%） and endoscopic polypectomy （n = 3, 20%）. All patients with CP underwent surgical management： primary repair （27%） and bowel resection （73%）. The mortality rate was 13% and postoperative complication rate was 53%. CONCLUSION： CP is a rare but serious complication following colonoscopy and sigmoidoscopy, with high rates of morbidity and mortality. Incidence of CP was 0.09%. Surgery is still the mainstay of CP management.

A Review of 3D Printing Technology for Medical Applications

Donor shortages for organ transplantations are a major clinical challenge worldwide. Potential risks that are inevitably encountered with traditional methods include complications, secondary injuries, and limited source donors. Three-dimensional （3D） printing technology holds the potential to solve these limitations; it can he used to rapidly manufacture personalized tissue engineering scaffolds, repair tissue defects in situ with cells, and even directly print tissue and organs. Such printed implants and organs not only perfectly match the patient＇s damaged tissue, hut can also have engineered material microstructures and cell arrangements to promote cell growth and differentiation. Thus, such implants allow the desired tissue repair to he achieved, and could eventually solve the donor-shortage problem. This review summarizes relevant studies and recent progress on four levels, introduces different types of biomedical materials, and discusses existing problems and development issues with 3D printing that are related to materials and to the construction of extracellular matrix in vitro for medical applications.

Clinical audit,a valuable tool to improve quality of care:General methodology and applications in nephrology

Evaluation and improvement of quality of care provided to the patients are of crucial importance in the daily clinical practice and in the health policy planning and fnancing. Different tools have been developed, includ-ing incident analysis, health technology assessment and clinical audit. The clinical audit consist of mea-suring a clinical outcome or a process, against well-defined standards set on the principles of evidence-based medicine in order to identify the changes needed to improve the quality of care. In particular, patients suffering from chronic renal diseases, present many problems that have been set as topics for clinical audit projects, such as hypertension, anaemia and mineral metabolism management. Although the results of these studies have been encouraging, demonstrating the ef-fectiveness of audit, overall the present evidence is not clearly in favour of clinical audit. These findings call attention to the need to further studies to validate this methodology in different operating scenarios. This review examines the principle of clinical audit, focusing on experiences performed in nephrology settings.

Changing paradigm of cancer therapy：precision medicine by next-generation sequencing

Precision medicine aims to identify the right drug, for the right patient, at the right dose, at the right time, which is particularly important in cancer therapy. Problems such as the variability of treatment response and resistance to medication have been longstanding challenges in oncology, especially for development of new medications. Solid tumors, unlike hematologic malignancies or brain tumors, are remarkably diverse in their cellular origins and developmental timing. The ability of next-generation sequencing(NGS) to analyze the comprehensive landscape of genetic alterations brings promises to diseases that have a highly complex and heterogeneous genetic composition such as cancer. Here we provide an overview of how NGS is able to facilitate precision medicine and change the paradigm of cancer therapy, especially for solid tumors, through technical advancements, molecular diagnosis, response monitoring and clinical trials.

Medical decision making for older adults： an international perspective comparing the United States and India

There has been a significant decline in cardiovascular morbidity and mortality amidst pervasive advances in care, including percutane- ous revascularization, mechanical circulatory support, and transcatheter valvular therapies. While advancing therapies may add significant longevity, they also bring about new end-of-life decision-making challenges for patients and their families who also must weigh the advan- tages of reduced mortality to the possibility of longer lives consisting of high morbidity, frailty, pain, and poor quality of living. Advance care entails options of withholding or withdrawing therapies, and has become a familiar part of cardiovascular care for older patients in Western countries. However, as advanced cardiovascular practices extend to developing countries, the interrelated concept of advance care is rarely straight forward as it is affected by local cultural traditions and mores, and can lead to very different inferences and use. This paper discusses the concepts of advance care planning, surrogate decision-making, orders for resuscitation and futility in patients with cardiac dis- ease with comparisons of West to East, focusing particularly on the United States versus India.

Medical Foreign Bodies in Urinary Bladder: a Case Report

RETAINED foreign bodies in the urinary tract after surgical or diagnostic procedure, named iatrogenic foreign bodies, are rarely reported, though the estimated incidence was as high as 1/1500 cases.1 Prompt and proper retrieval is required due to potential complications. We report a case of iatrogenic foreign body into the bladder.

Energy has the same characteristics of Qi in traditional Chinese medicine

Giving the accurate definition of the core part of Traditional Chinese Medicine(TCM) is another way for the modernization of TCM. Many researchers had launched their original researches on this way and realized that qi got some characteristics of energy. In this paper, energy is also thought as having the same characteristics as qi for energy is invisible and filled with cell in different patterns. The movement of qi in cell can be understood as the transformations of the chemical energy. So, cell should be regarded as a device which is organized by biomelocules for the transformation from chemical energy to heat energy.

A Barefoot Doctor’s Manual as a“Medical Bible”:Medical Politics and Knowledge Transmission in China

This paper examines the origin,compilation,and circulation of A Barefoot Doctor’s Manual(Chijiao yisheng shouce赤脚医生手册),exploring the relationship between medical politics and knowledge transmission in China,and its impact on the promotion of Chinese medicine across the world.Barefoot doctors were a special group of rural medical practitioners active in a very special socio-political context.Various editions of barefoot doctor manuals and textbooks were published across China after the first publication of the Manual in 1969.The publication of these manuals and textbooks became an indelible hallmark of the“Cultural Revolution”(1966–1976),when political publications predominated.The Manual was not only a guide for barefoot doctors in their daily study and practice,but also a primary source of medical knowledge for ordinary people.In the middle of the 1970s,the Manual was translated into many languages and published worldwide.This paper argues that the publication of A Barefoot Doctor’s Manual embodied a public-oriented mode of knowledge transmission that emerged and was adopted during a very specific era,and though it was eventually substituted by a mode of training embedded in the formal medical education system,it demonstrated the impact of politics on medicine and health in the context of resource scarcity and low literacy.Changes in China’s geopolitical status,the West’s pursuit of alternative approaches to medicine and health,and the World Health Organization’s(WHO’s)concern over health universality and equity all contributed to the translation and circulation of the Manual,facilitating the dissemination of Chinese medicine worldwide.The paper thus presents empirical and theoretical contributions to research on the relationship between medical politics and knowledge transmission in China.

CLINICAL OBSERVATION ON 96 CASES OF PRIMARY DYSMENORRHEA TREATED BY MEDICINE-SEPARATED MOXIBUSTION AND INVESTIGATION ON ITS MECHANISMS

Objective： To observe the therapeutic effect of medicine-separated moxibustion for primary dysmenorrhea and its influence on plasma hormone level. Methods. Ninety-six patients suffering from primary dysmenorrhea were randomly and evenly divided into trealment group treated with medicine-separated moxibustion of Shenque （神阙 CV 8, 3-5 cones every time, beginning 1 week before onset of menstruation and stopping on the 3^rd day after onset, with 10 sessions being a therapeutic oourse, 3 courses all together）, and control group treated with oral administration of Yueyueshu （月月舒 menstruation-smoothing granule, 10 g/time, b.i.d, 3 courses altogether）. Menses prostaglandin E2（PGF2α） and plasma oxytocin （OT） during menstruation were determined by radioimmunoassay. Results; After the treatment, of the two 48 cases in treatment and control groups, 18 and 5 were cured, 24 and 9 had marked improvement in their symptoms, 6 and 26 had improvement, 0 and 8 failed in the treatment, with the total effective rates being 100. 096 and 83.3% respectively, the therapeutic effect of treatment group was markedly superior to that of control group （P〈0.05）. After the treatment, the contents of menses PGF2α in treatment group and plasma OT in both groups were significantly lower than those of pre-treatment （ P〈 0.01 ）. The therapeutic effect of moxibustion was significant- ly better than that of medication in lowering plasma OT. Conclusion： Medicine-separated moxibustion works well in treating primary dysmenorrhea, and moxibustion induced decrease of menses PGF2α and plasma OT may contribute to its effect in relieving dysmenorrhea.

Simulation training in contemporary obstetrics education

AIM: To investigate the use of the Gaumard's Noelle S550.100 Maternal and Neonatal Simulators for teaching forceps delivery.METHODS: Twenty two(n = 22) resident physicians were enrolled in a simulation course on operative forceps deliveries. The physicians enrolled in the course were all part of an accredited Obstetrics and Gynecology residency program and ranged in their training from post graduate year(PGY) 1-4. Each participant received simulation based teaching on the indications, contraindications, proper application, delivery and removal of forceps by a single teacher. The Gaumard's simulator and Simpson forceps were used for this course. Statistical analysis using SPSS statistical software was performed after the completion of the simulation training program. A paired student t-test was performed to compare the cohort's mean pretest and post simulation training scores. Follow up skills assessment scores at one month, 3 mo and 6 mo were compared to thebaseline pretest score using a paired student t-test. RESULTS: There was statistically significant improvement in the post simulation training performance evaluations compared to the pretest, 13.7(SD = 3.14) vs 7.9(SD = 4.92), P < 0.05. Scores at 1 mo, 3 mo, and 6 mo were compared to the pretest score and showed retention of skills: 4.6(SD = 5.5, 95%CI: 2.21-7.07), 4.4(SD = 5.2, 95%CI: 2.13-6.70), and 5.6(SD = 4.8, 95%CI: 3.53-7.75) points, respectively. There were statistically significant differences between residents by post graduate training year on pretest scores, however these differences were not present after simulation training. Pretest scores for PGY 1, 2, 3, 4 were 3.5(SD = 2.27, 95%CI: 2.13-5.00), 7.25(SD = 6.70, 95%CI: 1.50-13.00), 10.75(SD = 1.5, 95%CI: 9.50-12.00), 12.17(SD = 2.57, 95%CI: 10.33-14.00). After simulation training PGY 1 residents did as well as well as the upper level residents. Posttest mean test scores for PGY 1, 2, 3, 4 were 13.75(SD = 1.49, 95%CI: 12.75-14.63), 10.25(SD = 0.24, 95%CI: 4.25-14.00), 15.00(SD = 1.16, 95%CI: 14.00-16.00), 15.17(SD = 0.75, 95%CI: 14.67-15.67). CONCLUSION: Our simulation based training program not only produced short term gains, but participants were able to retain the skills learned and demonstrate their knowledge months later.

TREATMENT OF PRIMARY PALPEBRAL RETRACTION WITH ACUPOINT-INJECTION AND CHINESE MEDICINAL HERBS

In the present paper, the therapeutic effect of combined therapy of acupoint injection and Chinese medicinal herbs was observed in 59 cases of primary palpebral retraction patients. These 59 patients were divided into treatment group (n=38, treated with acupoint injection and Chinese medicinal herbs) and control group (n=21, treated with Chinese medicinal herbs alone). After 3 courses of treatment, of the 38 cases in treatment group, 25 (65.8%) were cured, 8 (21.1%) had marked improvement and 5 (13.2%) had improvement; of the 21 cases in control group, 8 (38.1%) were cured, 9 (42.9%) had marked improvement, 2 (9.5%) had improvement and 2 (9.5%) were ineffective. Statistical analysis showed a significant difference between the two groups in the therapeutic effect. The cure rate of experimental group was apparently higher than that of the control group, i.e. the therapeutic effect of the combined therapy of acupoint injection and Chinese medicinal herbs was superior to that of Chinese medicinal herbs alone.

Evaluation of the Regulation of Antibiotics Consumption in Bujumbura, Burundi

Abstract： Background： Antibiotic self-medication is highly prevalent in the developing countries. The objective of the study was to evaluate self-medication with antibiotics and the regulation of antibiotics consumption in the private and public pharmacies of the urban area of Bujumbura. Methods： A cross sectional study using self-administered questionnaire was conducted in private and public pharmacies of Bujumbura. 460 clients were randomly chosen and 32 sellers randomly selected from January to September 2015 and interviewed. Results： Of the 460 participants, 186 （40.43%） practiced self-medication to antibiotics. The average age was 34.89 years. Abdominal pain was the first motivation to practice self-medication （20.8%）. Amoxicillin was the antibiotic most commonly used （47.3%）. Inaccessibility to health care facilities due to the lack of financial resources was cited to be the root of this phenomenon （62%） and these antibiotics were mostly acquired from community pharmacies without prescriptions （84.4%）. Conclusions： The high cost of care and the low level ofstudy of the patients are factors favoring this phenomenon. A national policy for regulation use of antibiotics without a medical prescription and an educational program to general population on the effective use of antibiotics are therefore needed.

Research on social medical insurance of migrant workers --A case of Suqian city in Jiangsu province

City migrant workers, as one part of the city＇s development, economic development and other aspects of urban to make a great contribution, but the delay with the local residents do not enjoy the same level of medical care treatment is always blocked in outside the city＇s health care system, have less relevant departments, there is no practical system introduced regulations and policies, these things tell us to pay attention to the people, and the introduction of appropriate medical insurance of migrant workers possibly things, and timely medical security system of such groups and the local people medical protection for long support. Make medical insurance system can cities try it＇s best to help foreign workers Medicare, Medicare for the development of China has made a modest contribution.

Chahine algorithm to invert light scattering spectroscopy of epithelial dysplasia

To perceive the epithelial dysplasia from the light scattering spectroscopy (LSS) is an inverse problem, which can be transformed into the inversion of the size distribution of epithelial-cell nuclei. Based on the simulation of single polarized LSS for epithelial-cell nuclei, Chahine algorithm is adopted to retrieve the size distribution. Numerical results show that Chahine algorithm has high inversion precision for both single-peaked and bimodal models, which implies the potential to increase diagnostic resolution of LSS.

Common causes of geriatric medical emergencies in China

To the Editor One of the most significant demographic changes in our cotmtry is the increase in the elderly population. In China Mainland, the population aged 60 and older was 194 million in 2012, accounting for 14.3% of the total population. However, by 2053, it is estimated that the number of elderly will reach 487 million, representing 34.8% of the total population. Elderly patients represent an everncreasing populace in emergency medicine who often present with atypical signs and symptoms as well as eomorbidities that can complicate diagnoses and treatment.Ell The geographic factors and the developmental status of the country can influence the spectrum of common geriatric emergencies. Thus, this study presents a retrospective analysis of common causes of geriatric emergencies involving 9,628 elderly patients from Jan. 2008 to Dec. 2013 in an emergency department in Beijing, China.

Thoughts on Promoting TCM Intercultural Communication in UK

Due to the differences in culture and system and the influence of migration policy, etc., the spread of TCM in UK faces lots of difficulties. Therefore, to promote the TCM intercultural communication, we need to enhance the publicity of TCM cultural tastes, to strengthen the construction of TCM education system in addition to making full use of Chinese students in UK.

Right to Health or the Human Right of Access to Essential Healthcare

The Universal Declaration of Human Rights refers to the human right to health and well-being including medical care, but for the majority of people whom are not covered by health insurance this is better said than done. Ensuring the access of all citizens to the needed medical care requires the provision of health insurance coverage to a population pool and gradually expanding the pool to the whole nation. The ethical perspective of pooling resources across various groups of people with different levels of income and different health risks associated with age, genetics, and lifestyle, may raise the issue of individual autonomy versus social solidarity. Governmental, social, private, and community-based healthcare coverage have been used in different countries with varying details in the sources of funding, pooling of contributions, and the purchase of the covered healthcare services; these models have had varying levels of success depending on not only the availability of funds, but also on the political commitment of the state and the social solidarity and cultural attitude of the population towards universal healthcare. Therefore, universal healthcare requires not only a certain level of economic development, but also a strong sense of solidarity among the people as well as a political commitment in their government. I argue that the statement regarding the right to health, well-being, and medical care needs to be rethought, and instead universal access to essential healthcare should be regarded as a basic human right.