Visit Research Articles

Epidemiological analysis of imported malaria in Fujian, 2015-2019

Objective To analyze the monitoring data, and explore the epidemic characteristics of imported malaria in Fujian Province from 2015 to 2019, so as to provide a scientific basis for the monitoring work after elimination of malaria. Methods The epidemiological data on malaria cases in Fujian Province, 2015-2019 were collected. The epidemic situation, the distribution of cases in different regions, age, gender and season, malaria diagnosis and treatment were analyzed by Microsoft Excel 2007 software. Results A total of 562 cases of malaria were reported in Fujian Province, 2015-2019. All cases were imported from overseas, mainly from African (516 case, 91.81%). All cases were confirmed in reference laboratories, comprising 428 (76.16%) falciparum malaria cases, 72 (12.81%) vivax malaria cases, 39 (6.94%) ovale malaria cases, 19 (3.38%) quartan malaria cases and 4 (0.71%) mixed infection cases. The median time, which was from onset to see a doctor and from seeing the doctor to diagnosis, was 1 day and 0 day, respectively. The cases of definitive diagnosis were 426 at initial diagnosis (75.80%), the prefecture level hospital was the preferred selection for patients to visit after onset of the disease (350 cases, 62.28%). By report area, most cases were mainly distribution in Gulou district (421 cases, 74.91%), Fuzhou city, and by the present address, 174 cases (30.96%) were distributed in Fuqing country, Fuzhou city. Most malaria cases (527, 93.77%) were young men, whose age from 20 to 49. The malaria cases were reported in each month across the year, the most cases were 66 and 63 in January and February, accounting for 11.74% (66/562) and 11.21% (63/562) of the total cases, respectively. 5 deaths were reported in Fujian Province, 2015-2019. Conclusions Imported malaria cases were still existed after elimination of malaria, the diagnosis and treatment capacity of medical institutions should be further strengthened in the future, so as to consolidate achievements in malaria eradication. 摘要:目的 分析2015—2019年福建省输人性疟疾监测数据,探讨福建省消除疟疾阶段疟疾流行特点,为福建省 消除疟疾后监测工作提供科学依据。 方法 收集2015—2019年福建省疟疾疫情数据资料,应用Microsoft Excel 2007软 件对疫情概况、三间分布及诊治情况进行描述性统计分析。 结果 福建省2015—2019年共报告输人性疟疾病例562 例,均为境外输人,其中516例（91.81%)来自非洲；562例均为确诊病例,其中恶性疟428例（76.16%)、间日疟72例 (12.81%)、卵形疟39例(6.94%)、三日疟19例（3.38%)、混合感染4例(0.71%)。报告病例中发病到就诊的中位时间为 1 d,从就诊到确诊的中位时间为0d;首诊确诊的426例（75.80%),首诊单位以地市级医疗机构为主,为350例（占 62.28%)。按报告地分,病例主要分布在福州市鼓楼区,为421例,占74.91 % ;按现住址分,病例主要分布于福州市福清 市,174例,占30.96%。病例以青壮年男性(20~49岁）为主,527例,占93.77% ;各月份均有病例分布,累计报告病例数 较多的是1、2月份,分别为66例和63例,占总病例数的11.74%(66/562)和11.21%(63/562)。2015—2019年全省共报告 死亡病例5例。 结论 消除疟疾后输人性疟疾病例依然存在,今后应进一步提髙医疗机构的诊治能力,巩固消除疟疾 成果。

President Joseph E. Nyre and Provost Katia Passerini visit the Chesterton Institute

President Joseph E. Nyre and Provost Katia Passerini visit the Chesterton Institute

Diagnosis and management of pelvic floor dyssynergia

The term pelvic floor dyssynergia is commonly used interchangeably with the terms anismus, dyssynergic defecation or puborectalis syndrome. Patients with PFD commonly present with chronic constipation. The prevalence among the general population can range from 20-70% and among constipated patients it has been reported as high as 60%. This defecation disorder is basically caused by failure of relaxation or paradoxical contraction of the external anal sphincter and the puborectalis sling during defecation. Although there is no clear pathophysiological cause for this disorder, it has been linked to several factors such as abuse in childhood, poor toilet training, difficult childbirth, previous pelvic surgery or other psychological factors. The correct diagnosis is key to treating PFD and it starts with a thorough history and physical exam including a well performed digital rectal examination. Appropriate investigations following the initial visit can help to confirm the diagnosis and then treatment is prescribed accordingly. The patient should understand the nature of her constipation problem and participate fully in the management. The treatment is mainly conservative with diet, biofeedback and physiotherapy as the cornerstones of management. A multidisciplinary team approach will help for successful management of the patient. Surgery is normally not necessary for these patients and is only performed in extremely difficult refractory cases. By taking the time to make the correct diagnosis, patients with PFD can avoid frustration, unnecessary testing and surgery.

On the Visit of Henry of Prussia to the Far East in the Late 19<sup>th</sup> Century

On the Visit of Henry of Prussia to the Far East in the Late 19<sup>th</sup> Century

Cultural Tourism Model for Chinese Tourists Based on the Bali-China Cultural Landscape

Cultural Tourism Model for Chinese Tourists Based on the Bali-China Cultural Landscape

“Postnatal Care Utilization is Meant Only for Our Children”: Perceptions and Experience of Women in Nachingwea District Council, Tanzania

Background Postnatal care (PNC) is essential for ensuring the optimal health of women and their newborns. In Africa, most mothers and newborn do not visit healthcare facilities following childbirth despite the fact that majority of maternal and neonatal deaths occur during this period. Regardless the the existence of several programs for improving maternal and child health, the utilization of PNC yet remains low. The objective of this study was to assess the experiences and perceptions of women on postnatal care services utilization. Methodology A qualitative study design was used. The study was conducted in Nachingwea district. Women who delivered children within one year before the study and reside in Nachingwea district were recruited from Nachingwea district hospital and Naipanga dispensary. The selection was based on their age, education and parity. IDIs and FGDs were used. Qualitative content analysis was used for analysis. Results Sixty-six (66) women who brought their babies to PNC services for immunization and growth monitoring participated in the study. Sixteen (16) IDIs and seven FGDs were conducted. Upon analysis of data, three main categories that explain the experiences and perceptions of women on postnatal care services utilization were generated. These categories are women’s experiences on postnatal care services utilization; perceived benefits of postnatal care services utilization, and, perceived barriers towards PNC services utilization. Women had negative experience and perceptions regarding PNC services utilization and they did not understand the advantages of PNC services to them, except for their children. Conclusion Women’s negative perceptions on PNC services utilization were revealed. Women did not understand the benefits of PNC services to them, except for their children. Barriers such as health systems, socio economic and cultural factors also affected PNC utilization. The government should improve PNC services through health education, promotion interventions aiming at PNC utilization. Improvements should address the availability and accessibility of services and importance of PNC services for both mother and her newborn in reducing maternal and newborn morbidity and mortality during postnatal period. Key words: Experiences, Perceptions, Postnatal Care, Nachingwea District, newborn.

PENGARUH PROMOSI PERPUSTAKAAN DI MEDIA SOSIAL INSTAGRAM TERHADAP PEMANFATAAN PERPUSTAKAAN (STUDI PADA PERPUSTAKAAN POLITEKNIK NEGERI MALANG)

Promotion by the library there are various ways such as using existing social media facilities and growing at this time, such as Facebook, Instagram, Twitter because most users already have and use the account of social media. State Polytechnic Library of Malang which has a variety of collections and facilities that support the process of supporting the needs of information pemustaka. Therefore, social media such as Instagram in conveying the latest information to the visitors aimed to increase the visit and utilization of the collection and facilities provided will be as useful as possible. This research is a quantitative research that aims to determine the level of utilization in the Polytechnic Library of Malang. The results of this study in the form of information about promotions that have been done by the library through social media instagram can affect the utilization of libraries in the library State Polythechnic of Malang.

Rezension zu: Gunnel Ekroth/Ingela Nilsson (Hg.), Round Trip to Hades in the Eastern Mediterranean Tradition. Visits to the Underworld from Antiquity to Byzantium

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Comparative Study on Immediate and Delayed Extraction of Mandibular Molars in the Management of Acute Dentoalveolar Abscess

Objective: This study compared treatment outcome between two acute dentoalveolar abscesses in the same patients diagnosed simultaneously in both quadrants of the mandible, treated by either immediate or delayed extractions of the affected first and/or second molars. Methods: This is a prospective, cohort, clinical-based study. The timing of infected tooth is the predictor variable, whereas the healing parameters are the outcome variables. The outcome variables include timing of extraction, patients’ preference of immediate or delayed extraction, healing time of soft tissues surrounding extraction sockets, and development of complication(s). Other variables were grouped into demographic and clinical parameters. Descriptive and bivariate statistics were computed. Results: The sample composed of 77 patients with 154 molars grouped as follows: control (n= 77, 50%) extracted on first visit and experimental (n= 77, 50%) removed subsequently on the 5 th day. There was no significant association between acute dentoalveolar abscess and development of alveolar osteitis (P= 0.831) as complication rates were 5.2% in control group and 6.5% in experimental. Most patients preferred immediate extraction, and healing period of soft tissues was 0.5 weeks shorter in the control than experimental group (P= 0.57). Conclusion: The results of this study suggest that in patients with acute dentoalveolar abscess and accessible oral cavity, immediate extraction should be practiced.

ANOPAR – Autoaferição não orientada da pressão arterial: estudo metodológico

We describe the methodology of the MBPPG study in hypertensive patients as well as the association of blood pressure self-measurement (BP) with its control, the presence of anxiety disorders, unplanned visits to urgency and self-medication. This is a cross-sectional observational analytical study in which it is intended to evaluate 1000 volunteers with systemic arterial hypertension followed up on an outpatient basis in public and private hospitals located in Aracaju-Sergipe, Brazil. Data collection will be conducted applying a specific questionnaire for the research; BP control through Ambulatory Blood Pressure Monitoring (ABPM) or an average of measurements in the last three consultations; the self-assessment of anxiety through the State-Trait Anxiety Inventory (STAI), the determination of quality of life through the SF-36. In the statistical analysis, tests will be used for the hypothesis of independence between categorical variables, equality of means, logistic regression, effect sizes Cohen’s D and h, and a significance level of 5%. The results analysis intends to produce information about the impact of the self-measurement of blood pressure, not oriented, of the hypertensive population. With this, it is expected to provide public managers with information that will support more efficient health policies in relation to the practice of self-assessment performed by hypertensive patients.

Low-Value Care in Medicare Wellness Visits

Clinicians often order tests with little clinical value as a component of routine physical examinations or “wellness visits.” In this study,

Implementation of a pharmacist care manager model to expand availability of medications for opioid use disorder.

The rise in opioid prescribing, often for chronic pain management, resulted in an increased prevalence of opioid use disorder (OUD) throughout the United States, including within the Veterans Affairs (VA) healthcare system. The veteran population has been especially vulnerable to opioid-related harms, but rates of prescribing medications for OUD have been low. Use of care manager models for OUD have increased access to treatment. In this article we provide an overview of a clinical pharmacist care manager (CPCM) model for medications for OUD treatment implemented within the Minneapolis Veterans Affairs Health Care System. A CPCM model for medications for OUD was identified as a care model that would address patient and facility barriers to effective OUD treatment. Pharmacists were integral in program development and implementation and served as the main care providers. An interim evaluation of the program established that the proportion of patients with OUD receiving medications for opioid use disorder (MOUD) had increased, with use of the program resulting in treatment of 109 unique patients during 625 visits. Key program implementation facilitators included the facility leadership establishing increased use of MOUD as a priority area, identification of a physician champion, and a history of successful expansion of clinical pharmacy specialist practice within the VA system. Implementation barriers included factors related to provider engagement, patient identification, and program support. The CPCM model of provision of MOUD expanded the pharmacist role in buprenorphine management. The need to increase the number of patients receiving MOUD led to the implementation of a CPCM model. The program was effectively implemented into practice and expanded the availability of MOUD, which allowed patients to access treatment in multiple care settings.

Evaluation of Medicine Exposure During Pregnancy at a Tertiary Center of an Indian State

Context:Prescribing drugs in pregnancy is a challenging approach for doctors. Objective:To evaluate drugs used in pregnancy. Method:A prospective, cross-sectional, descriptive study was carried out by collecting and evaluating prescriptions on various parameters. Results:More than 50% of antenatal care attendees belonged to the 18-24 age group, and 102 (41.46%) were primigravidae. The main presenting complaints were abdominal pain (25.16%), followed by nausea and vomiting (22.60%) and fever (11.14%); the maximum number of visits to hospital was seen in the first trimester (40.53%), followed by the third trimester (38.42%). It was observed that 25.78% of prescriptions did not contain any medicine. The average number of prescribed medicines was 2.32, with the lowest in the first trimester (1.77) and the highest in the second trimester (2.78). It was noticed that 74.11% and 71.26% of all prescribed medicines were from essential medicine list and generics, respectively. Of all prescribed drugs, 11.52% were antimicrobials, and 4.11% injectable dosage forms. Vitamins and minerals were the preferred prescribed medicines (34.82%), followed by antimicrobial agents (11.52%) and doxylamine plus pyridoxine (10.16%). Also, doctors who made the drug choice during antenatal visits were more confident in evidence-based safety as per New Pregnancy and Lactation Rule (PPLR); 45.37% of drugs were prescribed from category A, followed by 38.25% from category B and none from group X. Conclusion:Doctors were concerned about prescribing safer drugs in pregnancy and were more confident in evidence-based medication.

Visita domiciliar e saúde mental: um relato de experiência

INTRODUÇÃO: As atividades práticas durante a graduação são oportunidades para os estudantes lidarem com sujeitos reais. Quando tais atividades ocorrem no âmbito do Sistema Único de Saúde, principalmente, na atenção primária, é oferecido ao estudante a noção de pluralismo sociocultural. OBJETIVO: Discutir a importância das Visitas Domiciliares enquanto atividade docente-assistencial, identificando os benefícios, as potencialidades e os desafios dessa ferramenta. METODOLOGIA: Trata-se de um relato de experiência sobre a prática das Visitas Domiciliares num contexto pedagógico, em um Internato de Psicologia. RESULTADOS E DISCUSSÕES: O internato em atenção primária à saúde acontece no Complexo Comunitário Vida Plena, localizado em Pau da Lima, bairro periférico de Salvador. Nessa unidade de saúde, o protocolo para visita domiciliar consiste em Planejamento, Visita, Supervisão e Confecção do relatório. O planejamento é realizado através da leitura do prontuário. Tal leitura proporciona o contato prévio com a família e a possibilita a confecção de objetivos específicos para visita. Durante a visita, é necessário lidar com o tempo emocional e cronológico, vínculo sem julgamento, escuta atenta, interferência dos familiares e vizinhos, vulnerabilidade e risco social, educação em saúde e, sobretudo, questões psicológicas dos usuários. A supervisão, compreendida como um momento de facilitação e suporte aos estudantes, desenvolveu nossa criticidade e amadureceu a correlação teoria-prática. Na confecção do relatório, as palavras registradas precisavam ser escolhidas com esmero para garantir o acompanhamento de qualidade dos usuários. CONCLUSÃO: As Visitas Domiciliares são instrumentos potentes de formação. Viver a experiência com autonomia e ao mesmo tempo tendo a orientação e o apoio da professora, foi o grande diferencial.

129: A Novel Protocol for the Management of Diabetic Ketoacidosis in COVID-19-Infected Patients

INTRODUCTION: In early March 2020, COVID-19 spread in New York City This paper shows trends of rising cases of DKA associated with a worsening COVID-19 pandemic in New York City With the potential for such a large number of DKA patients, our institution found a need for revised glycemic management protocol We discuss how a multidisciplinary team designed a protocol to care for patients with COVID-19 infection and DKA METHODS: Five of The Mount Sinai Health System's EDs are on a shared electronic health record system (Epic Systems, Verona, WI) Deidentified visit data extracted for routine quality review was made available for analysis We looked at total visits and select visit diagnoses related to DKA through March, April and May 2019 and compared those counts to the same period in 2020 Our protocol was developed by stakeholders in a multidisciplinary hospital team We focused on the basic tenets of DKA management: insulin therapy, fluid resuscitation, and electrolyte repletion RESULTS: A total of 93,218 visits were recorded across the five EDs from March 1-May 31, 2019 During that period there were 106 diagnoses of DKA made in the EDs (0 114% of visits) Across the same period in 2020 there were 59,009 visits, and 214 diagnoses of DKA (0 363% of visits) This coincides with the height of the Sars-CoV-2 pandemic in New York City To address this surge, our protocol decreased the frequency of fingerstick monitoring, with changes to insulin dosing allowing admission to non-ICU beds We transitioned from a provider-driven protocol to a nurse-driven protocol to avoid treatment delays due to order placement Insulin infusion rate charts were created to provide nurses guidance on dosing modifications To minimize ARDS risk, our protocol's fluid replacement recommendations lowered resuscitation and replacement rate volumes, adjusting based on provider reassessment Lab values were monitored every 3-4 hours CONCLUSIONS: There is a correlation between the rise of the Sars-CoV-2 pandemic in New York City and a net rise in patients diagnosed with diabetic ketoacidosis We believe our DKA protocol will facilitate safe and effective management of patients with COVID-19 and DKA, reducing the healthcare burden associated with protocols that necessitate frequent treatment modifications and ICU-level care

Ganho de peso na gestação, segundo estado nutricional prévio e idade de puérperas atendidas na maternidade de um hospital público de Macaé, Rio de Janeiro

Introdução: A gestação é uma etapa fisiológica que requer acompanhamento de saúde adequado, com vistas ao desfecho positivo para mãe e bebê. Dentre outros cuidados previstos no acompanhamento pré-natal, o ganho de peso é parâmetro a ser monitorado sistematicamente, diante de sua relevância para a saúde materno-infantil e da relação entre ganho de peso inadequado e intercorrências na saúde. Objetivo: Descrever o perfil de ganho de peso gestacional de puérperas assistidas em uma maternidade pública, segundo estado nutricional prévio e idade materna. Método: Estudo epidemiológico transversal descritivo, de base primária (prontuário hospitalar) e secundária (entrevista), realizado em 2014, com amostra de 113 mulheres de 20 a 40 anos com até 48h pós-parto. O estado nutricional pré-gestacional foi avaliado por meio do Índice de Massa Corporal (IMC) e a avaliação da adequação do ganho de peso gestacional considerou as recomendações do Institute Of Medicine (IOM). Resultado: 73,5% tinham idade entre 20-29 anos; 69,9% realizaram seis ou mais consultas de pré-natal e 42,2% tinham excesso de peso (sobrepeso ou obesidade) prévio à gestação. O estado nutricional pré-gestacional, segundo idade, revelou que 35,5%(n=79) daquelas entre 20-29 anos e 60%(n=30) das entre 30-40 anos apresentavam excesso de peso prévio. Houve associação significativa (p<0,01) entre as variáveis “ganho de peso gestacional” e “estado nutricional prévio”. Dentre as que tiveram ganho de peso excessivo, 73,1% tinham excesso de peso prévio. Conclusão: Parte expressiva das puérperas já possuía excesso de peso e teve ganho ponderal excessivo na gestação, sobretudo as mais velhas. Sugerem-se a idade materna e o estado nutricional prévio como fatores determinantes do ganho de peso e recomendam-se maior capilaridade e cobertura do acompanhamento nutricional pré-natal no sistema público de saúde como possibilidade de enfrentamento do ganho de peso excessivo, que contribui para o agravamento da epidemia de obesidade no Brasil.

The Journal of Social Media for Learning JSML V1(1) Complete Inaugural Issue

Welcome to The Journal of Social Media for Learning. This link provides access to the complete edition of the inaugural issue. Our ethos is centred around the creation of a supportive space where all colleagues, but particularly those new to publishing, can contribute to the scholarly discourse about their academic practice, and if they so wish secure opportunities to gain experience of peer-review and journal editing. To access individual papers please visit the journal website here: https://openjournals.ljmu.ac.uk/index.php/JSMLISSN: 2633-7843

A time-series analysis on the effects of climate on outpatient visits for psoriasis

Objective Through the relationship between climatic factors such as average temperature, relative humidity, sunshine duration and the number of outpatient visits of psoriasis patients, the influence of climatic factors on the pathogenesis of psoriasis was discussed. Methods We collected daily local outpatient visits' data for psoriasis from The Fifth People's Hospital of Hainan Province in Haikou, Hainan, from January 1 2016 to December 31 2018. Climatic factors, including average temperature, relative humidity, sunshine duration, during the same time were collected from Hainan Meteorological Bureau. Firstly, sequence diagrams were used to observe the average temperature, relative humidity and sunshine duration to determine the stationarity of sequence diagrams. Secondly, through the autocorrelation figure, partial autocorrelation, periodic correlation diagram was used to determine whether there is the correlation, and delay order number. The simple linear regression was carried out to determine the relationship between the various factors. Finally, the summation of time series analysis of the independent variable ARIMAX (Autoregressive Integrated Moving Average with an Independent variable) was used to fit the model and ultimately determine which climatic factors contribute to psoriasis. ARIMAX model parameters are calculated by auto-arima function in R language software. Results Weekly outpatient visits for psoriasis was correlated with the weekly average sunshine duration and the weekly average temperature, but not with humidity. There was a significant correlation between the weekly average temperature and the sunshine duration. The regression equation between them was as follows: Average temperature =183.427 + 0.159 23x duration of sunshine duration ( R 2 =0.512 4, P <0.001). Conclusions Changes in average temperature or sunshine duration can cause changes in the number of outpatient visits for psoriasis patients in Hainan province. These two climatic factors may be the influencing factors for the incidence of psoriasis patients in Hainan Province. 摘要：目的 通过平均气温、相对湿度和日照时长等气候因素与银屑病患者门诊就诊人数之间的联系, 探讨气候 因素对银屑病发病的影响。 方法 收集自2016年1月1日到2018年12月31日海南省第五人民医院银屑病患者门诊 每周的就诊人数。同时收集同一时间的气象资料 , 包括平均气温、相对湿度 、 日照时长等, 所有气候数据均来自海南省 气象局。首先通过时序图观察获知平均气温、相对湿度、日照时长的变化趋势, 初步确定时序图的平稳性, 再通过自相 关图、偏自相关相关图确定是否存在自相关性、周期性、以及延迟阶数, 并通过简单线性回归确定各因素之间的关系, 最后通过时间序列分析中带自变量的求和自回归移动平均模型（Autoregressive Integrated Moving Average with an Independent variable, ARIMAX)来拟合模型, 最终确定哪些气候因素是银屑病发病的影响因素。ARIMAX模型参数通过R 语言软件中的自动定阶auto.arima函数来计算获得。 结果 每周银屑病就诊人数与周平均日照时长和周平均气温之间 存在相关性, 与相对湿度不存相关性;而周平均气温与周日照时长之间存在明显相关性, 两者间回归方程:平均气温= 183.427+0.159 23X周日照时长( R 2 =0.512 4, P <0.001)。 结论 平均气温或日照时长的变化可以引起海南省银屑病患者 门诊就诊人数的变化, 此两项气候因素可能是海南省银屑病患者发病的影响因素。

A case report and discussion of Lichen myxedematosus

A case of myxedematous lichen is reported. A 60 years old male presented with pigmentation and pruritus for 2 years, and aggravated for 1 month. He was admitted to Hainan Fifth People's Hospital on March 6, 2019. Two years ago, there was no obvious inducement for the patient to have plaque on his face, which gradually increased, hardened and appeared dark brown pigmentation. With the gradual development of the disease, trunk skin appeared rough, hypertrophy, hardening and pigmentation, hand joints appeared stiff and affected activity. Special examination showed diffuse yellowish brown patches and plaques on the forehead, which were distributed in a grid shape, and scattered with atrophic hypopigmentation spots. Black and brown patches were scattered on the back, partially fused into pieces. Sclerotic and atrophic white plaques can be seen in the neck. The skin of the front chest and back is slightly thickened, and obviously hardened. It can still be pinched up. The skin lesions have no tenderness. The joints of the fingers are stiff and the movement is limited. Skin biopsy: The trochanterellus of epidermis disappeared, fibroblasts were arranged in the whole dermis, and some of them were disordered. Ashen blue staining showed that there were clumps of positive material deposition between collagen fibers and around hair follicles in the whole dermis, which was consistent with lichen myxedematosus (LM). The patient was treated with thalidomide 50 mg 3 times a day, prednisone 30 mg orally and acitretin 10 mg twice a day orally, combined with twice a week photochemical therapy (PUVA), external application of allantoin ointment, desonide cream, Halometasone Cream. On June 10, 2019, the patient's condition gradually became stable when he came to the follow-up visit, so the drug dosage was reduced to prednisone 15 mg once a day and acitretin 10 mg twice a day, once a week for photochemical therapy, and topical plaster continued. On September 8, 2019, the patient's condition was further improved when he came to the follow-up visit, so the patient's oral medication was reduced to acitretin 10 mg/d, and allantoin ointment was applied externally. On December 1, 2019, the patient's condition had improved significantly (the patient refused to take photos). Continued treatment was given to the case. 摘要： 报道1例黏液水肿性苔藓案例。患者男,60岁,因全身皮肤变硬伴色素沉着、瘙痒2年,加重1月,于2019年3 月6日就诊于海南省第五人民医院。患者2年前无明显诱因面部皮肤出现斑块,并逐渐增大、变硬及出现黑褐色色素 沉着。随病情逐渐发展,躯干皮肤出现粗糙,肥厚,变硬及色素沉着,手关节出现僵硬且影响活动。专科检査额部见弥 漫性黄褐色斑片、斑块,呈网格状分布,其上散在萎缩性色素减退斑。背部散在黑褐色斑片,部分融合成片。颈部可见 硬化萎缩性白色斑块。前胸后背皮肤轻度增厚,明显变硬,仍可捏起,皮损无触痛。指关节较僵硬,活动受限。皮肤病 理活检:表皮突变平消失,真皮全层见较多的成纤维细胞排列,部分混乱,阿申蓝染色:真皮全层的胶原纤维间、毛囊周 围见团块状阳性物质沉积,结合临床符合黏液水肿性苔藓（Lichen myxedematosus,LM)。予以沙利度胺50 mg 3次/d,强 的松30 mg顿服及阿维A 10mg2次/d 口服治疗,并结合每周两次的光化学疗法(PUVA),外擦尿囊素软膏、地奈德乳 膏,卤米松乳膏。2019年6月10日患者前来复诊时病情逐渐稳定,遂将药物用量减至强的松15 mg顿服及阿维A 10 mg 2次/d,每周一次光化学疗法,外用膏药继续。2019年9月8日患者前来复诊,病情进一步好转,遂将患者口服药 物减为阿维A 10 mg/d,外擦尿囊素软膏。2019年12月1日患者再次前来复诊,病情已明显好转(患者拒绝拍照）。遂对 该病例临床症状及治疗进行讨论。

A Teaching Case of Hands-on Activities on Cultural Arts Exchange : Lessons Learned from New Zealand Māori Visit to Korea

A Teaching Case of Hands-on Activities on Cultural Arts Exchange : Lessons Learned from New Zealand Māori Visit to Korea