原发性十二指肠恶性肿瘤的X 线诊断

目的　探讨X线诊断原发性十二指肠恶性肿瘤的价值。方法　回顾性分析 2 1例原发性十二指肠恶性肿瘤的X线所见并与手术病理对照。结果　X线表现包括充盈缺损、黏膜改变、肠腔狭窄和龛影。结论　根据临床及X线表现 ,术前可以正确诊断原发性十二指肠恶性肿瘤。     

导致成人与儿童患者30天脑室腹腔分流失败的原因分析（英文）

OBJECTIVE The aim of this study was to provide a comprehensive benchmark of 30-day ventriculoperitoneal(VP)shunt failure rates for a single institution over a 5-year study period for both adult and pediatric patients,to compare this with the results in previously published literature,and to establish factors associated with shunt failure.METHODS A retrospective database search was undertaken to identify all VP shunt operations performed in a single,regional neurosurgical unit during a 5-year period.Data were collected regarding patient age,sex,origin of hydrocephalus,and whether the shunt was a primary or secondary shunt.Operative notes were used to ascertain the type of valve inserted,which components of the shunt were adjusted/replaced(in revision cases),level of seniority of the most senior surgeon who participated in the operation,and number of surgeons involved in the operation.Where appropriate and where available,postoperative imaging was assessed for grade of shunt placement,using a recognized grading system.Univariate and multivariate models were used to establish factors associated with early(30-day)shunt failure.RESULTS Six hundred eighty-three VP shunt operations were performed,of which 321 were pediatric and 362 were adult.The median duration of postoperative follow-up for nonfailed shunts(excluding deaths)was 1263 days(range 525-2226 days).The pediatric 30-day shunt failure rates in the authors'institution were 8.8%for primary shunts and 23.4%for revisions.In adults,the 30-day shunt failure rates are 17.7%for primary shunts and 25.6%for revisions.In pediatric procedures,the number of surgeons involved in the operating theater was significantly associated with shunt failure rate.In adults,the origin of hydrocephalus was a statistically significant variable.Primary shunts lasted longer than revision shunts,irrespective of patient age.CONCLUSIONS A benchmark of 30-day failures is presented and is consistent with current national databases and previously published data by other groups.The number of surgeons involved in shunt operations and the origin of the patient's hydrocephalus should be described in future studies and should be controlled for in any prospective work.The choice of shunt valve was not a significant predictor of shunt failure.Most previous studies on shunts have concentrated on primary shunts,but the high rate of early shunt failure in revision cases(in both adults and children)is perhaps where future research efforts should be concentrated.     

白芷近缘野生种兴安白芷的生药学研究

目的 对兴安白芷进行系统的生药学研究以区别于其他白芷类药材.方法 按照常规生药学方法进行来源、性状、显微鉴定,按<中国药典>2005年版白芷项下方法进行薄层鉴别与含量测定.结果 找出了兴安白芷在生药性状、组织构造及化学成分上的主要特征.结论 为白芷种质资源的评价提供了参考依据.     

User experiences, preferences and choices relating to functional electrical stimulation and ankle foot orthoses for foot-drop after stroke

Objectives

To explore experiences, preferences and choices relating to the use of ankle foot orthoses (AFOs) and functional electrical stimulation (FES) for foot-drop by people who have suffered a stroke and their carers, with the aim of informing clinical decision-making.

Design

Semi-structured interviews explored individual experiences through a phenomenological approach. The Interpretative Phenomenological Analysis framework was used to enable organisation and interpretation of qualitative interview data.

Setting

Participants who had used both transcutaneous FES and one of several types of AFO were recruited from a single FES clinic.

Participants

Nine people who had suffered a stroke and four carers were recruited purposively, including people between 2 and 9 years post stroke, with different degrees of difficulty in walking.

Results

Participants described experiences, preferences and choices relating to AFO and FES use. All but one person expressed a preference for FES use and related this to being able to move the ankle more freely; walk more normally, safely and independently; and greater comfort. Several people also used AFOs when the FES equipment failed, when travelling and near water. One person rationed their use of FES on a daily basis due to allergic reactions.

Conclusions

The consensus in this sample demonstrated positive and negative experiences of both FES and AFO use. Participants weighed up the pros and cons, and despite predominant preferences for FES, many also used AFOs due to some drawbacks of FES. Further research and development are required to reduce drawbacks and further explore users’ experiences.     

Staphylococcus aureus carriage among GPs in the Netherlands

Background

The extent to which GPs serve as a reservoir for antibiotic-resistant Staphylococcus aureus is unknown and not well studied.

Aim

To determine the prevalence of nasal S. aureus carriage among GPs in the Netherlands, as well as the antimicrobial resistance and the genotypes of isolated S. aureus.

Design of study

Observational, point-prevalence, and cross-sectional study.

Setting

GPs attending the annual conference of the Dutch College of General Practitioners in 2006.

Method

Nasal swabs were randomly taken from 395 GPs and analysed for the presence of S. aureus. Antimicrobial susceptibility was determined by a microbroth dilution method and the genotypes by spa typing, which was associated with multilocus sequence typing.

Results

Of the GPs, 129/395 (33%; 95% confidence interval [CI] = 28 to 37%) were carriers of S. aureus. No meticillin-resistant S. aureus (MRSA) was found. Resistance was observed to penicillin (71%; 95% CI = 63 to 79%), fusidic acid (7%; 95% CI = 3 to 13%), and clarithromycin (6%; 95% CI = 3 to 12%). In 72% of the isolates, an MRSA-related genotype of S. aureus was found.

Conclusion

The low antibiotic resistance found among S. aureus of GPs suggests that GPs are not a reservoir of antibiotic-resistant S. aureus strains. The relatively high resistance to fusidic acid, which has not previously been described in the Netherlands and is mostly because of antibiotic use, suggests that patients infect GPs and not the other way round. GPs may be at risk for nasal carriage of S. aureus with an MRSA-related genotype.