Prognostic Factors for Mortality in Severe Traumatic Brain Injury at HGZ 46, Villahermosa, Tabasco, Period from March 1, 2021 to December 31, 2022

Introduction: A traumatic brain injury (TBI) is caused by a forceful bump, blow, or jolt to the head or body, or by an object that pierces the skull and interrupts the normal function of the brain. Severe TBI is estimated at 73 cases per 100,000 people. The mortality of severe TBI can be reduced if a timely diagnosis and treatment of the injuries are made through prognostic factors. Objective: To determine the prognostic factors related to mortality in severe traumatic brain injury at the Hospital General de Zona No. 46. Material and Methods: Retrospective, cross-sectional and descriptive study in beneficiaries admitted to the Hospital General de Zona (HGZ) No. 46 of the Mexican Institute of Social Security (IMSS by its acronym in Spanish), with a diagnosis of severe TBI;the possible prognostic factors related to mortality of severe TBI were obtained from their records. Measures of central tendency and chi square were used for data analysis. Results: The study sample consisted of 60 subjects diagnosed with severe traumatic brain injury, of which 5 (8%) were women and 55 (92%) were men, and all 60 (100%) patients died. The average age of the sample was 26 with a standard deviation of 9 years. The variables that had a p value less than or equal to 0.05 were: Mydriasis, seizures, Hyperglycemia, Normoglycemia, Hypothermia and Hypotension. This means that these variables were associated with mortality. Conclusion: Statistical significance is demonstrated in prognostic factors of mortality in severe traumatic brain injury with p < 0.05 in the case of mydriasis, seizures, hyperglycemia, normoglycemia, hypothermia and hypotension.

Current approach to treatment of minimal hepatic encephalopathy in patients with liver cirrhosis

Minimal hepatic encephalopathy(MHE)corresponds to the earliest stage of hepatic encephalopathy(HE).MHE does not present clinically detectable neurological-psychiatric abnormalities but is characterized by imperceptible neurocognitive alterations detected during routine clinical examination via neuropsychological or psychometrical tests.MHE may affect daily activities and reduce job performance and quality of life.MHE can increase the risk of accidents and may develop into overt encephalopathy,worsening the prognosis of patients with liver cirrhosis.Despite a lack of consensus on the therapeutic indication,interest in finding novel strategies for prevention or reversion has led to numerous clinical trials;their results are the main objective of this review.Many studies address the treatment of MHE,which is mainly based on the strategies and previous management of overt HE.Current alternatives for the management of MHE include measures to maintain nutritional status while avoiding sarcopenia,and manipulation of intestinal microbiota with non-absorbable disaccharides such as lactulose,antibiotics such as rifaximin,and administration of different probiotics.This review analyzes the results of clinical studies that evaluated the effects of different treatments for MHE.

Quality of Life in Women with Endometriosis Pelvic Pain Treated with the Levonorgestrel-Releasing Intrauterine System

Objective: To evaluate the quality of life in patients with endometriosis pelvic pain before and after the application of the levonorgestrel-releasing intrauterine system (LNG-IUS). Design: Open non-comparative study. Setting: Obstetrics and Gynecology Hospital at Monterrey, Mexico. Sample: 29 women aged 18 to 40 years with pelvic pain associated with endometriosis confirmed by laparoscopy. Methods: After laparoscopy but before LNG-IUS insertion (basal visit) and 6 months afterwards, modified Endometriosis Health Profile (EHP-30) was applied. Main outcomes measures: Size of change of questionnaire scores, need of additional analgesic therapy and adverse effects. Statistical Analysis: Differences in the questionnaire scores before and after intervention were analyzed by Student t-test. Results: Final analysis set included 29 women aged 31.7 ± 4.7 years years. The ASRM surgical staging of endometriosis was mild in 19.3 moderate in 13.7 and severe in 76% of the patients. The general perception of quality of life improved from 52 at baseline to 98% at six months (p < 0.001). Adverse events were mild in nature, 19 patients reported no adverse events during the study (65.5%). Two patients (6.9%) required the use of concomitant therapy with non-steroidal analgesics for relief of pain. Conclusion: The application of LNG-IUS in patients with pelvic pain associated with endometriosis improved significatively all aspects related with quality of life as measured with Endometriosis Health Profile (EHP-30). We concluded that LNGIUS may be an effective and convenient therapeutic alternative for the management of pain associated with endometriosis.

Prognostic value of ^(13)C-phenylalanine breath test on predicting survival in patients with chronic liver failure

AIM: To evaluate the prognostic value of percentage of 13C-phenylalanine oxidation (13C-PheOx) obtained by 13C-phenylalanine breath test (13C-PheBT) on the survival of patients with chronic liver failure. METHODS: The hepatic function was determined by standard liver blood tests and the percentage of 13C-PheOx in 118 chronic liver failure patients. The follow-up period was of 64 mo. Survival analysis was performed by the Kaplan-Meier method and variables that were significant (P < 0.10) in univariate analysis and subsequently introduced in a multivariate analysis according to the hazard model proposed by Cox. RESULTS: Forty-one patients died due to progressive liver failure during the follow-up period. The probability of survival at 12, 24, 36, 48 and 64 mo was 0.88, 0.78, 0.66, 0.57 and 0.19, respectively. Multivariate analysis demonstrated that Child-Pugh classes, age, creatinine and the percentage of 13C-PheOx (HR 0.338, 95% CI: 0.150-0.762, P = 0.009) were independent predictors of survival. When Child-Pugh classes were replaced by all the parameters of the score, only albumin, bilirubin, creatinine, age and the percentage of 13C-PheOx (HR 0.449, 95% CI: 0.206-0.979, P = 0.034) were found to be independent predictors of survival.CONCLUSION: Percentage of 13C-PheOx obtained by 13C-PheBT is a strong predictor of survival in patients with chronic liver disease.

Effect of Breathwalk on body composition,metabolic and mood state in chronic hepatitis C patients with insulin resistance syndrome

瞄准：识别人体测量，新陈代谢并且在丙肝病毒(HCV ) 的心情状态从墨西哥并且到的西方感染了病人评估效果 Breathwalk (BW ) ，走的联合，同步 breathing 和集中的注意，在那些病人上。方法：在试验性的研究，有 HCV 的血清学、分子的诊断的 17 个病人，不接受药理学治疗，被学习。BW 的一个小时会议在星期被练习 3 次六个月。身体作文被电的阻抗估计。生物化学的侧面和抗胰岛素性(红外) 冒的风险被常规方法估计。心情状态在开始并且在节目的结束与特定、待研究的问题被评估。结果：百分之七十个病人超重或肥胖，并且 77% 病人在学习的开始与红外介绍了。改进在第三瞬间被观察，并且统计上，有效差量用健康分数在 第6 瞬间被记录( 76 对 83 ， P 【 0.01 )，在丙氨酸 aminotransferase (中高音)( 106 +/- 93 U/L 对 59 +/- 32 U/L ， P 【 0.01 )，全部的胆红素( 0.09 +/- 1 mg/dL 对 0.62 +/- 0.2 mg/dL ， P 【 0.01 )，中高音/著名计算机生产厂商比率( 1.04 对 0.70 ， P 【 0.01 )， triglycerides ( 165 +/- 86 mg/dL 对 124 +/- 49 mg/dL ， P 【 0.01 )并且 IR 风险( 4.0 对 2.7 )。大多数病人(88%) 显示了感觉到擅长 BW 的结束(P 【 0.01 ) 。结论：Breathwalk 在身体作文，类脂化合物侧面和肝酶上有重要效果。它也是容易的，便宜并且穿上有益的效果新陈代谢并且在 HCV 病人的心情状态。

Association between Metabolic Syndrome and Erythrocyte Fatty Acid Profile in Mexican Adolescents: A Trans Fatty Acid Approach

The type of fat consumed in the Mexican diet could predispose to the development of Metabolic Syndrome (MS) which has been associated with an increased risk to develop cardiovascular disease and type 2 diabetes mellitus. Our study included adolescents between 12 and 16 years of age, divided in two groups: Control Group (n = 31) and MS Group (n = 44). Waist circumference, blood pressure, fasting glucose, triglycerides, and HDL-cholesterol were determined. Erythrocytes’ fatty acids methyl esthers were quantified using gas chromatography with ionized flame detector. We identified 16 fatty acids (FA) with chain lengths from C12 to C24, with emphasis in four trans FA (TFA) isomers: vaccenic (C18:1n7t), elaidic (C18:1n9t), linoelaidic (C18:2n6t), and conjugated linoelaidic acids (C18:2n7t). MS Group had a less proportion of: myristic (C14), palmitoleic (C16:1), C18:1n7t, and linoleic acids (C18:2);and a higher one of C18:1n9t, C18:2n7t, and nervonic acids (C24:1) when compared to the control group. C24:1 and C18:1n9t had a significant positive association with MS (OR = 14.17 and OR = 12.94, respectively);whereas C14 (OR = 0.14), C18:1n7t (OR = 0.14), and C18:2 (OR = 0.22) appear to have a protective effect against the disease. The proportion of specific FAs in erythrocytes’ membranes differs between adolescents with MS and healthy controls;these FA not only showed a strong association with MS, but also correlated with most of its individual components. Interestingly, TFA displayed an antagonic behavior;while C18:1n9t had a strong association with MS, apparently C18:1n7t confers a protective effect;these results suggest that analyzing each TFA separately will constitute a more accurate approach to determine the role of TFAs in the pathogenesis of MS or other related metabolic disorders.

A comparative, randomized study of levonorgestrel Intrauterine System (LNG-IUS) vs Copper T 380 A intrauterine device applied during cesarean section

Objective: To assess levonorgestrel-releasing intrauterine system LNG-IUS (Mirena?) application at caesarean section (CS). Design: Randomized, comparative study. Setting: Department of obstetrics and gynecology in a primary reference hospital at Puebla City, Mexico. Sample: 396 women requiring CS signed informed consent and were randomly allocated to the post-placental application of LNG-IUS (198) or Copper T 380 A (198). Methods: Follow up visits at 6 weeks, and 6 and 12 months were performed. Main Outcomes Measures: IUDs expulsion, maternal and babies’ health conditions, breastfeeding and menstrual patterns, adverse effects and pregnancies. Differences between groups were analyzed by Fisher and X2 tests, Odds ratios, relative risk and 95% confidence limits, as appropriate. Results: After one year of follow up, no pregnancies were reported. The IUD expulsion rate was 4.5% in each group. LNG-IUS users had a higher incidence of amenorrhea (OR 2.5 95% CI 2.2 - 3) and menstrual patterns significantly brief and lighter than Copper T 380 A (p < 0.001) with lower incidence of dysmenorrhea (OR 0.1 95% CI 0.04 - 0.2). No detrimental effects of LNG-IUS on breastfeeding was observed and interestingly babies weights of LNG-IUS users was slightly above the average for age compared with Copper T 380 A users. This was probably related with a major proportion of women with normal ferritin serum levels (94% vs 68%) leading to better mother’s general condition. Conclusions: LNG-IUS inserted during CS provides high efficacy contraception with additional benefits, mainly reducing menstrual bleeding and doing so, faster recovery of ferrous homeostasis after CS.

Assessment of Lipid Quality and Composition of Commercial Infant Milk Formulas in Mexico: Emphasis on Trans Fatty Acid Isomers

Objective: To assess the lipid quality focusing on trans fatty acids (TFA) content of standardized milk formulas marketed in Mexico for infants aged from 0 to 36 months. Material and Methods: A total of 27 infant formulas from eight different leading brands were analyzed. Nine of them belonged to stage 1 (age 12 months). Acquired products were treated by duplicate for extraction of total lipid content with the modified Folch method before their expiration date. Fatty acids were esterified in an alkaline medium followed by an acid-catalyzed esterification. Analysis was performed on a gas chromatograph (5890 Series II;Hewlett-Packard, USA) with a flame ionization detector. Results: Thirty-four fatty acids (C8 to C22) were identified. Most products complied with ESPHAGAN compositional requirements. Only one product exceeded the suggested limit (>3%) for TFA. Long chain polyunsaturated fatty acids (LC-PUFAs) content was consistently meager (≈78%), with low amounts of arachidonic (Conclusion: Most milk formulas complied with ESPHAGAN global recommendations. The content of TFA and LC-PUFAs was scarce in the majority of samples.

Concordance in the Interpretation of Cervical Cytology for the Early Diagnosis of Cervical Cancer

Objective: To identify the diagnostic concordance in the interpretation of cervical smears. Material and Methods: Cross-sectional study from October 2011 to January 2013. 50 samples were read by every 4 cyto-technologists who are the total staffs that read and interpret cytological specimens from a public health institution of the city of San Luis Potosí, México. The cytological diagnosis was confirmed by a certified pathologist. Checklist was developed to determine the quality of the interpretation composed of three sections: adequate sample, inadequate sample and cytological diagnosis. The diagnostic report was made by Bethesda System 2001 classification. Diagnostic concordance was measured through the Kappa coefficient. To establish the differences in cytological diagnosis between each cyto-technologist, chi square test was applied. Results: The concordance is acceptable in the classification of samples as inadequate (k = 0.66). The negative diagnosis was a significant concordance between each cytotechnologist and pathologist;however, no case had very good concordance. In the epithelial abnormalities, only the cytotechnologist 2 had significant concordance with the pathologist, however, its concordance is low. In the case of glandular abnormalities, only cytotechnologist 1 had no significant concordance with the pathologist. The percentage of true negatives was 30%, true positives 20%, false negatives 50% and false positives 0 %. There are significant differences between the readings of cyto-technologist 1 and 2 (p < 0.008), between 1 to 4 (p < 0.001), between 2 and 3 (p < 0.05), and finally between 3 and 4 (p < 0.003). Conclusions: The concordance between cyto-technologists and pathologists is below the required minimum level set by national and international standards.

Body Composition, Gynecologic-Obstetric Variables, and Prolactin Levels in Patients with Breast Cancer

Objective: The aim of this study was to determine body composition, gynecological, and obstetric data, sex hormones, and prolactin serum levels in pre- (PREW) and postmenopausal women (PMW) with breast cancer (BC) and compare them with a control group (CG) of healthy women. Methodology: BC patients without treatment or use of hormone replacement therapy, or hormonal birth control, and without data of metastasis were included. CG was matched for age, BMI, and menstrual cycle status. FSH, LH, E2, progesterone, testosterone, and prolactin (PRL) were measured using radioimmunoassay kits. Comparisons between BC and CG were made with “t” tests, and with the Mann-Whitney U-test;χ2 test was used to compare the qualitative variables between the groups. Results: Seventy-two patients with BC, and 74 CG women were evaluated. Both groups presented overweight data, BMI (kg/mt2) = 27.21 ± 5.51 vs. 28.40 ± 4.66, p = ns, for BC patients and CG, respectively. In PREW, the age at menarche was later in BC patients compared to the CG (13.3 ± 1.36 years vs. 12.41 ± 1.27 years, p = 0.005). The PMW with BC presented a higher age at menarche and menopause compared to the women of the CG (13.51 ± 1.48 vs. 12.91 ± 1.41, p = 0.09, and 49.03 ± 2.86 vs. 45.5 ± 8.78, p = 0.03, respectively). PRL levels were significantly higher in PMW with BC, in comparison with the CG;median and minimum and maximum values (min-max) were: 14.7 ng/mL (3.6 - 52.7) vs. 5.9 ng/mL (1.9 - 33.3), p = 0.005). A higher percentage of PMW with BC (26.0% vs. 7.1%, χ2 = 5.57, p = 0.01) presented hyperprolactinemia (PRL serum levels > 20 ng/mL), compared to the GC. Conclusions: The higher levels of PRL in PMW with BC compared with CG, suggest a proliferative effect of this hormone in the affected breast tissue. This study demonstrates the need to use biological markers such as PRL to determine the risk of BC in PMW.

Platelet count/spleen diameter ratio to predict esophageal varices in Mexican patients with hepatic cirrhosis

AIM:To validate whether the platelet count/spleen size ratio can be used to predict the presence of esophageal varices in Mexican patients with hepatic cirrhosis.METHODS:This was an analytical cross-sectional study to validate the diagnostic test for hepatic cirrhosis and was performed between February 2010 and December 2011.Patients with a diagnosis of hepatic cirrhosis were included and stratified using their ChildPugh score.Biochemical parameters were evaluated,and ultrasound was used to measure the longest diameter of the spleen.The platelet count/spleen diameter ratio was calculated and analyzed to determine whether it can predict the presence of esophageal varices.Upper gastrointestinal endoscopy was used as the gold standard.Sensitivity and specificity,positive and negative predictive values,and positive and negative likelihood ratios were determined,with the cutoff points determined by receiver-operating characteristic curves.RESULTS:A total of 91 patients were included.The mean age was 53.75±12 years;50(54.9%)were men,and 41(45.0%)women.The etiology of cirrhosis included alcohol in 48(52.7%),virally induced in24(26.3%),alcoholism plus hepatitis C virus in three(3.2%),cryptogenic in nine(9.8%),and primary biliary cirrhosis in seven(7.6%).Esophageal varices were present in 73(80.2%)patients.Child-Pugh classification,17(18.6%)patients were classified as class A,37(40.6%)as class B,and 37(40.6%)as class C.The platelet count/spleen diameter ratio to detect esophageal varices independent of the grade showed using a cutoff value of≤884.3,had 84%sensitivity,70%specificity,and positive and negative predictive values of 94%and 40%,respectively.CONCLUSION:Our results suggest that the platelet count/spleen diameter ratio may be a useful tool for detecting esophageal varices in patients with hepatic cirrhosis.

Pharmacogenetic considerations for optimizing tacrolimus dosing in liver and kidney transplant patients

The introduction of tacrolimus in clinical practice has improved patient survival after organ transplant.However,despite the long use of tacrolimus in clinical practice,the best way to use this agent is still a matter of intense debate.The start of the genomic era has generated new research areas,such as pharmacogenetics,which studies the variability of drug response in relation to the genetic factors involved in the processes responsible for the pharmacokinetics and/or the action mechanism of a drug in the body.This variability seems to be correlated with the presence of genetic polymorphisms.Genotyping is an attractive option especially for the initiation of the dosing of tacrolimus;also,unlike phenotypic tests,the genotype is a stable characteristic that needs to be determined only once for any given gene.However,prospective clinical studies must show that genotype determination before transplantation allows for better use of a given drug and improves the safety and clinical efficacy of that medication.At present,research has been able to reliably show that the CYP3A5 genotype,but not the CYP3A4 or ABCB1 ones,can modify the pharmacokinetics of tacrolimus.However,it has not been possible to incontrovertibly show that the corresponding changes in the pharmacokinetic profile are linked with different patient outcomes regarding tacrolimus efficacy and toxicity.For these reasons,pharmacogenetics and individualized medicine remain a fascinating area for further study and may ultimately become the face of future medical practice and drug dosing.

Portal vein thrombosis with protein C-S deficiency in a noncirrhotic patient

There are several conditions that can lead to portal vein thrombosis(PVT), including including infection, malignancies, and coagulation disorders. Anew condition of interest is protein C and S deficiencies, associated with hypercoagulation and recurrent venous thromboembolism. We report the case of a non-cirrhotic 63-year-old male diagnosed with acute superior mesenteric vein thrombosis and PVT and combined deficiencies in proteins C and S, recanalized by short-term low molecular heparin plus oral warfarin therapy.

Antioxidant drugs to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis:What does evidence suggest?

AIM:To determine whether or not the use of antioxidant supplementation aids in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis.METHODS:A systematic review of randomized controlled trials(RCTs) was made to evaluate the preventive effect of prophylactic antioxidant supplementation in post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP).The inclusion criteria included:acute post-endoscopic retrograde cholangiopancreatography pancreatitis in adults; randomized clinical trials with the use of any antioxidant as an intervention compared with placebo,to reduce PEP.The outcome measure was the incidence and severity of PEP.Twelve RCTs involving 3110 patients since 1999 wereincluded.The antioxidants used were selenite,β-carotene,and pentoxifylline(each one in one trial),N-acetylcysteine(NAC) in three trials,and allopurinol in six trials.The group of patients treated with NAC received different doses; either oral or intravenous,and allopurinol-treated patients received five different oral doses in two different administration periods.The results are expressed with raw numbers,proportions,as well as mean and standard deviations.The incidence of pancreatitis between groups was analyzed with Pearson's χ2 test or Fisher's exact test(F).The main outcome is expressed as relative risks and 95%CI.RESULTS:The incidence of pancreatitis in all antioxidant treatment groups was 8.6%,whereas it was 9.7% in the control group.The antioxidants used were selenite,β-carotene,and pentoxifylline(each one in one trial),NAC in three trials,and allopurinol in six trials.In allopurinol trials,three different dosifications were used; two trials reported a low dosage(of less than 400 mg),two trials reported a moderate dose(600 mg) and the remaining two employed higher doses(more than 900 mg).Supplementation was not associated with a significant reduction in the incidence of PEP [relative risk(RR) = 0.93; 95%CI:0.82-1.06; P = 0.28].In addition,the incidences of PEP in patients treated with allopurinol and those treated with other antioxidants were similar to that observed in patients who received the placebo(RR for trials with allopurinol,0.92; 95%CI:0.78-1.08; P = 0.31) and,with the use of other antioxidants,the incidence of PEP was 8.9%,whereas it was 9.7% in the control group(RR = 0.95; 95%CI:0.77-1.18; P = 0.19).CONCLUSION:Antioxidant supplementation shows no beneficial effect on the incidence of PEP.There is a lack of robust trials to support the use of antioxidants for prevention.

Intestinal pseudo-obstruction caused by herpes zoster:Case report and pathophysiology

Herpes zoster(HZ) infection occurs in approximately 10% to 30% of individuals. Visceral neuropathies secondary to HZ can cause cystitis and urinary retention. But colonic pseudo-obstruction can also occur. Peripheral neuropathy may reveal segmental motor paresis of either upper or lower limbs, the abdominal muscles or the diaphragm. We report the case of a 62-year-old male patient who presented with abdominal distention and cutaneous vesicular eruption on the left side of the abdominal wall. Plain X-rays and computed tomography scan showed distended small bowel. A diagnosis of intestinal pseudo-obstruction was made secondary to segmental paresis of the small intestine and visceral neuropathy. Conservative management was successful and the patient was discharged uneventfully. Intestinal pseudo-obstruction ought to be consideredwhen dealing with non-obstructive(adynamic) conditions of the digestive tract associated with HZ infection; since early recognition may help to avoid unnecessary surgery.

Cardiovascular Risk in Adults and its Association with Health Services Utilization. ENSANUT 2018-2019

Background The use of health services by the adult population is related to cardiovascular risk and its stratification. Cardiovascular risk (CVR) stratification should be a tool for the assessment of the patients and the appropriate control during the process of medical care and utilization of health services for the adults. Objective Evaluate the association between cardiovascular risk (CVR) in adults and the utilization of health services. Material and Methods A secondary analysis was performed of the data from the National Health and Nutrition Survey (ENSANUT) 2018-2019. The CVR classification (risk score) was obtained in 43,070 adults with a previous diagnosis (self-report) and 1,237 adults newly diagnosed. Independent, risk factors and the association between groups of CVR and utilization of preventive, outpatient and hospital services were analyzed. Results More than 85% of adults interviewed have some degree of CVR. Almost half of them have low CVR (48.2%). Older adults with social security predominate in the group with high and very high CVR. Seventy-five percent of adults recently diagnosed have low CVR. In both, there is very little utilization of health services. For adults previously diagnosed CVR, the higher the CVR, the greater the likelihood of utilization of outpatient, preventive and hospital services, in contrast to adults without CVR independent of the marital status, sex, health institution and socioeconomic level. Conclusion The results give evidence of areas of opportunity for improvement in the quality of health services. The evaluation of CVR in primary care and promotion and prevention of CVR should be strengthened.

Improvised technique for measuring tracheal tube cuff pressure

We agree with the editorial published by Feng et al concerning the insufficient routine monitoring of tracheal tube cuff pressure(TTCP) by anesthesiologists, and propose an improvised technique that can facilitate and promote such routine monitoring by intensive care staff who attend to patients receiving mechanical ventilation. Insufficient monitoring of tracheal cuff pressure has also been documented for intensive care unit nurses. Measurements of cuff pressure are beneficial when used in management of air leakage around an endotracheal tube, and can be easily obtained with the aid of a personalized and simple technique performed using materials that are readily available in all hospitals. Other investigators have previously demonstrated the usefulness of employing an improvised technique. We considered that possible disadvantages are similar to those encountered when using standardized equipment. With our improvised technique, we seek to promote among the nursing staff the determination of the TTCP in intubated patients to reduce the risk of related medical complications.

非典型肾上腺增生

Among 297 women with nonclassic adrenal hyperplasia(NCAH), premature pubarchewas the most common complaint in girls (87%), and the frequency of hirsutism increased progressively with age from adolescence (50%) to adulthood (70%). The frequency of spontaneous miscarriages was high in NCAH patients (20%), but it decreased significantly after treatment.

The public-private partnerships in healthcare sector in China

This manuscript is a narrative review on experience in the healthcare public-private partnerships(PPP)field project in China.The PPP model allows healthcare officials to share the risk of building new facilities with the private sector.The objective of this study is to evaluate and to review the PPP of healthcare sector in China,and to investigate the critical success factors and best practice of PPP.We adapted the PPP evaluation framework of the World Bank Independent Evaluation Group as our conceptual framework to summarize the literatures.The current study systematically reviewed the evolution and current status of public and private hospitals development in China,and to investigate factors related to the successful and less successful deployment and performance of PPP in the healthcare sector of China,and to develop best practice models of PPP among hospitals of China.We found that the PPP organizations providing finance and political risk coverage,thus enabling specific PPP transactions to reach financial closure-potentially setting demonstration effects.Such PPPs may then contribute to improving access to infrastructure and social services,which drives economic growth and other optimal outcomes.

中国养老保障制度发展展望(英文)

本文在描述我国城乡养老保障制度框架及主要保障政策的基础上,分析了现行城乡养老保障制度的运行情况。从建立覆盖城乡养老保障制度的角度,可以发现现制度存在的问题,包括城乡社会保障发展失衡、群体差距大、制度缺失、制度碎片化和被人为分割、政府责任不清等。本文提出了建立城乡无保障居民老年补贴制度、完善城镇职工基本养老保险、改革机关事业单位退休养老制度、建立农村养老保险等方面的建议。