Sudden Death by Occult Metastatic Carcinoma

A 33-year-old female collapsed and died suddenly after presenting with acute dyspnea and increasing cough over the preceding several months. Autopsy revealed poorly differentiated linitis plastica adenocarcinoma of the stomach. Microscopic examination of the lungs showed features consistent with pulmonary tumor thrombotic microangiopathy (PTTM). PTTM is a well-described complication in patients with adenocarcinoma. The typical presentation involves acute pulmonary hypertension, right-sided heart failure, and sudden death, often before the adenocarcinoma is discovered. The pathophysiology of PTTM remains elusive; it has been suggested that carcinoma cells may produce substances that influence pulmonary vasculature. Our patient had classic clinical and histologic features of PTTM in addition to prominent extravascular compression by intralymphatic tumor cells. These features undoubtedly caused her precipitous decline and lethal pulmonary hypertension, induced by underlying adenocarcinoma. This case demonstrates that sudden death can occur from pulmonary hypertension induced by metastatic carcinoma with remarkably little prior symptomatology.     

Keeping the left at bay: Delegate selection system choice in US Democratic presidential nominations

In the modern era of US presidential nominations, every election cycle we witness around 20% change in delegate selection system types. This variance remains unexplained and for the most part unexplored. At the same time, prior formal and empirical models offer contradicting expectations of party leader behavior in their choice of system. This paper looks to bridge this divide. We argue state party leaders use delegate selection systems to select candidates favorable to their own ideological position. When the median partisan is ideologically left relative to the position of state Democratic leaders, the leaders of the Party will open up the delegate selection system to dilute the voices furthest on the left. We employ maximum likelihood estimation as a method to show that left positioning of citizens relative to state Democratic leaders increases the likelihood the state Democratic Party will use a primary system as opposed to a caucus.     

关于加强基层医疗卫生服务建设的建议——兼论推进疫情防控关口前移

加强基层卫生服务,推进疫情关口前移,是落实习近平总书记关于疫情防控重要指示精神的重要举措。本文在总结当前基层疫情防控现状的基础上,分析国外家庭医生制度特点及对我国的借鉴意义,探讨我国基层卫生服务建设的重点、难点与不足以及在重大疫情防控中的作用,并在此基础上提出建议:加强基层卫生服务体系建设,培养全科医生公共卫生应急技能,强化基层疫情应急服务,加强医防融合和全民健康教育,推进疫情防控关口前移,构建重大传染病的社会屏障。     

我国行政监察立案程序中的案件初步审查问题研究

行政监察的立案程序作为行政监察案件程序的启动程序，是行政监察案件处理的重要环节，其中的初步审查程序对于案件当事人的“行政命辱”有着重要影响。本文以行政程序公正与效率相统一的价值理念为基础，认为现行的行政监察法律制度问题在初步审查环节上主要表现为：立案条件规定不合理、立案标准设置不具体、缺乏必要的审查措施、缺乏审查时效制度。在对前列问题进行深入分析的基础上，提出了完善初步审查程序的制度设计。     

原发性脑干损伤组织学诊断要点

目的 探讨人头面部受击致原发性脑干损伤的组织病理学诊断标准。方法 用171例脑干损伤者的脑干颅神经根部作水平切块,HE染色光镜下观察;另取50例非脑干损伤死亡者作对照。并用统计学方法分析两组所见病变。结果 损伤组见脑干浅表部(32.7％-55.6％)或脑干内部挫伤(57.9％-85.9％)、颅神经根部损伤(动眼神经70.2％,面及位听神经53.8％,三叉神经49.7％等)、星形胶质细胞反应性增生、肥大(34.5％-57.3％)及水肿(19.3％-57.3％)改变,与对照组相比,脑干的挫伤、颅神经根部损伤和星形胶质细胞反应性增生、肥大有显著差异(P<0.001),水肿无明显差异(P>0.05)。结论脑干浅表部和/或脑干内部挫伤、颅神经根部损伤及星形胶质细胞反应性增生肥大可作为原发性脑干损伤的诊断依据。     

The Devil's Lettuce: Primary Caregivers have the Constitutional Right to Distribute Medicinal Marijuana to Their Terminally Ill Child

Pediatric cancer is a tragedy that affects many American families. Despite the effectiveness of pediatric cancer treatments, patients experience adverse side effects that can be relieved by medical marijuana. However, medicinal marijuana is only lawful in twenty‐eight states, including the District of Columbia. This Note proposes that all fifty states enact compassionate‐use statutes permitting parents to lawfully possess and distribute the herb to their terminally ill child (between the ages of five to fourteen) to alleviate the effects of cancer treatments. Medicinal marijuana use provides pediatric cancer patients with better‐quality lives and the determination to win the war against cancer.     

基本医疗服务法制化研究

获取基本医疗服务是公民保障生命健康的基本权利,应当通过法律加以明确,使之成为"拟制公共产品"。公共卫生服务与基本医疗服务是两种性质不同的服务,不宜用一部法律来统一规定,因此全国人大《基本医疗卫生保障法》的立法模式是不适宜的,应当单独出台《基本医疗服务法》。政府提供基本医疗服务的范围主要包括基本医疗保险、基本医疗救助、基本药物和基本诊疗项目、基本医疗服务体系和基本医疗设施、基本医疗服务人力。公民的医疗服务请求权可以通过诉讼救济,医疗服务请求诉讼的类型属于行政给付之诉。     

原发性高血压中医证型分布规律及其危险因素研究

目的 探讨原发性高血压中医证型的分布规律及其与危险因素的相关性。方法 收集290例原发性高血压患者的一般资料,采用无序多分类Logistic回归分析原发性高血压中医证型与性别、年龄、体质量指数、饮食偏嗜、吸烟史、饮酒史、高血压病家族史的相关性。结果 原发性高血压中医证型以痰湿壅盛证为主。单因素分析结果显示,原发性高血压中医证型与年龄、饮酒史、高血压家族史及饮食偏嗜具有相关性（P<0.05）。无序多分类Logistic回归分析显示,以阴阳两虚型为对照组,年龄≤65岁（P<0.05,OR=29.328）和高血压病家族史（P<0.05,OR=9.499）与肝火亢盛型相关;年龄≤65岁（P<0.05,OR=9.241）和饮食偏咸（P<0.05,OR=4.840）与痰湿壅盛型相关;年龄≤65岁（P<0.05,OR=10.304）和高血压病家族史（P<0.05,OR=8.312）与阴虚阳亢型相关。结论 痰湿壅盛型是原发性高血压的主要证型,饮食偏咸是痰湿壅盛型的危险因素;家族史是肝火亢盛型、阴虚阳亢型的危险因素。     

公平与效率的多重关系及其现实选择

公平与效率相互关系中的“公平” ,是指经济公平 ,而且主要是指收入分配的公平。收入分配的公平包括起点公平、过程公平和结果公平三个方面 ,前两者与效率之间不存在矛盾。公平与效率之间的矛盾 ,主要体现在分配结果比较均衡与效率之间存在矛盾。在公平与效率的两难选择中 ,必须坚持效率优先、兼顾公平的原则。在初次分配中必须注重效率 ,发挥市场的作用 ;在再分配中必须注重公平 ,发挥政府对收入分配的调节职能。     

Mechanisms of Lethal Cerebrovascular Accidents in Turner Syndrome

A case of intracerebral hemorrhage in Turner syndrome is reported with an analysis of possible causes of cerebrovascular accidents in this condition. A 42‐year‐old woman with known Turner syndrome died soon after hospital admission having been found unconscious at her home address. At autopsy, she showed typical features of Turner syndrome with short stature, webbing of the neck, underdeveloped breasts, and an increased carrying angle of the arm. Death was due to a large left‐sided intracerebral hemorrhage extending from the left basal ganglia into the white matter of the frontal lobe and lateral ventricle. Cases of unexpected death in Turner syndrome may arise from occult cerebrovascular accidents which may be hemorrhagic or nonhemorrhagic. Associated features include hypertension, vascular malformations, accelerated atherogenesis, cystic medial necrosis, and moyamoya syndrome. The possibility of Turner syndrome should be considered in cases where there has been a lethal cerebrovascular event in a younger woman.