Objective To describe the financial burden on TB patients for transportation during treatment, and to evaluate the impacts of the “transportation subsidy initiative on poor TB patients” in rural China for improving poor patients’ access to TB treatment. Methods A Case-cohort of 429 TB patients was investigated through questionnaire interviews in four counties of two provinces in China. Information on the financial burden for transportation during TB diagnosis and treatment was collected. Qualitative in-depth interviews with 26 TB patients were carried out to understand their perceptions of transportation subsidy initiative. Results The mean transportation cost of TB medical care was 97 CNY (70 CNY in median), varying from 0 to 700 CNY. About 51% of the patients spent more than 10 CNY per round trip to the TB dispensary. Of the 429 TB patients investigated, 139 had received transportation subsidies after getting TB diagnosis; 15/139 (10.9%) showed dissatisfaction, mainly because the subsidy amount being insufficient. The income of patients receiving transportation subsidies was significantly lower than those not receiving the subsidies (p<0.05). The impression that an appropriate transportation subsidy enables patients to complete the required visits during their TB treatment was obtained after observation of over 80% of the patients. Conclusion The transportation subsidy plays an important role in reducing financial burden on poor TB patients for the completion of treatment. However, the coverage was limited and the amount of subsidy was not enough under the present policy. Considering the poverty of rural TB patients, a universal coverage and a rational amount of transportation subsidy should be proposed.
To evaluate the effect of cholecystokinin (CCK) during extracorporeal shockwave lithotripsy (ESWL) in the clearance of common bile duct (CBD) stones in endoscopic retrograde cholangiopancreatography (ERCP).Between January 2007 and September 2012, patients with large CBD stones who were treated with ESWL and ERCP were identified retrospectively. Patients were randomized in equal numbers to cholecystokinin (CCK) and no CCK groups. For each CCK case, a dose (3 ng/kg per min for 10 min) of sulfated octapeptide of CCK-8 was administered intravenously near the beginning of ESWL. ERCP was performed 4 h after a session of ESWL. The clearance rate of the CBD was assessed between the two groups.A total of 148 consecutive cases (CCK group: 74, no CCK group: 74) were tallied. Overall there were 234 ESWLs and 228 ERCPs in the 148 cases. The use of CCK showed a significantly higher rate of successful stone removal in the first ESWL/ERCP procedure (71.6% vs 55.4%, P = 0.035), but resulted in similar outcomes in the second (42.8% vs 39.4%) and third (41.7% vs 40.0%) sessions, as well as total stone clearance (90.5% vs 83.8%). The use of mechanical lithotripsy was reduced in the CCK group (6.8% vs 17.6%, P = 0.023), and extremely large stone (≥ 30 mm) removal was higher in the CCK group (72.7% vs 41.7%, P = 0.038).CCK during ESWL can aid with the clearance of CBD stones in the first ESWL/ERCP session. Mechanical lithotripsy usage was reduced and the extremely large stone (≥ 30 mm) clearance rate can be raised.
By analyzing observation data from cloud condensation nucleus counter and airborne PMS in August,2007 in Alxa Left Banner of Inner Mongolian and Huinong District of Shizuishan City in Ningxia,the vertical variations of concentration of cloud condensation nucleus(CCN) near the ground and in the upper layers in the both sides of the Helan Mountains were discussed.CCN came mainly from underlying land surface,and its concentration in contaminated areas was significantly higher than over the desert because its concentration was greatly affected by urban pollution.Daily change of CCN concentration was apparent.The particle spectrum types were different under different supersaturation,mainly as single peak.The greater the supersaturation degree was,the greater number of the activated CCN was,and the greater the radius of particles produced.Observation in upper air showed that CCN concentration and aerosol number concentration were higher in the near-surface,and decreased with height,but the concentration would abruptly increase when it encountered inversion layer.Activated droplet spectrum of CCN presented bimodal type.Compared with CNN near the ground,the particle spectra of CNN in upper air moved to the side of large particles,and particle radius peak values were about 4 μm and 6 μm.Particle sizes of most aerosol particles were less than 0.3 μm.Activated droplet spectrum of CCN was close to the continental nuclear spectrum.CCN concentration,activation spectrum and activated droplet spectrum were different in different areas or different time.In order to understand the effect of CCN concentration and CCN spectral types on precipitation process and climate change,long-term continuous observation for CCN spectral type in different areas and different seasons was needed.Chemical compositions of CCN were different in different areas,and its effects on CCN concentration and spectrum distribution were also different,so observation of chemical composition of CNN was needed to deeply understand the characteristics of CNN spatial-temporal distribution.
AIMTo compare the efficacy of a session of extracorporeal shock wave lithotripsy (ESWL) before endoscopic retrograde cholangiopancreatography (ERCP) vs ERCP only for problematic and large common bile duct (CBD) stones. METHODSAdult patients with CBD stones for whom initial ERCP was unsuccessful because of the large size of CBD
Difficult bile duct intubation is a big challenge for endoscopists during endoscopic retrograde cholangiopancreatography (ERCP) procedure. We report a case of percutaneous transhepatic cholangial drainage (PTCD)-guided methylene blue for fistulotomy using dual-knife for bile duct intubation.A 50-year-old male patient had developed obstructive jaundice, and ERCP procedure need to be performed to treat the obstructive jaundice. But intubation cannot be performed if the duodenal papilla cannot be identified because of previous surgery for a perforated descending duodenal diverticulum. We used PTCD-guided methylene blue to identify the intramural common bile duct before dual-knife fistulotomy, and bile duct intubation was successfully completed.The method that combing methylene blue and dual-knife fistulotomy to achieve bile duct intubation during difficult ERCP is safe and effective.
The Hendy Test is widely used for assessing whether isotopic equilibrium was reached in speleothems by examining the δ18O and δ13C correlation along a single growth layer. However, stalagmite micro-layers are typically only a few micrometers thick and taper off from the center towards the sides, making it challenging to sample within the same growth layer in practice. To address this, we selected three caves in the monsoon region of China (Shihua Cave in the north, Heshang Cave in the central, and Baojinggong Cave in the south) to verify whether the modern cave calcite has reached equilibrium fractionation with drip water. We examined the spatial variations in the δ18O and δ13C values of farmed calcite on glass plates, which are analogous to a single growth layer. The δ18O and δ13C correlations of farmed calcite from different cave sites are consistently strong, suggesting that kinetic fractionation effects are prevalent, especially at the drip sites with lower drip rates due to longer CO2 degassing. The δ18O–δ13C covariations can also occur along speleothem growth axes on short time scales, while isotopic variations over longer time scales are still in response to climate change. We propose that the Hendy Test criteria might not be prerequisites to isotopic equilibrium, and a Replication Test provides a more reliable indication of the integrity of isotopic proxies in paleoclimate research.
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