股骨远端轴位X射线片对全膝关节假体置换术中股骨假体旋转力线的评估价值

目的:探讨股骨远端轴位X射线片对于确定股骨后髁扭转角的价值及在全膝关节假体置换术中的意义。方法:选择2004-01/2005-05在南方医院接受全膝关节置换术的患者22例,共30例膝(均可以弯曲到90°)行术前的股骨远端轴位X射线检查和膝关节CT扫描。轴位X射线片在膝关节屈曲90°,小腿重力牵引下拍摄,CT采用1mm薄层扫描。在X射线片和CT片上,分别标记出临床上髁轴和后髁轴,并计算出股骨后髁扭转角。应用SPSS13.0软件两组数据进行方差分析和相关性分析。结果:受检股骨远端在轴位X射线片上都得到了良好的显示,患者在检查过程中没有感到明显的不适。由轴位X射线片和CT片上测得的股骨后髁扭转角分别为(6.9±1.6)°,(6.8±1.5)°,两种方法测得的股骨后髁扭转角平均差值为(0.6±0.5)°,无显著性差异,且存在强相关(r=0.903,P<0.001)。结论:股骨远端轴位X射线片可用于全膝关节置换术前确定股骨假体旋转力线,具有同CT相当的准确性。     

个体经营药店参与结核病控制的阻碍因素:定性抽样调查分析

目的:分析阻碍个体经营药店参与结核病控制的潜在因素。方法:实验于2005-07在重庆市区完成。调查主要采用了定性的方法,共调查了29名对象,采用方便抽样和滚雪球抽样的方法对15家经营时间1年以上的个体经营药店的管理人员或者工作人员进行了个人深入访谈;采用目的性抽样的方法对4名卫生监督所,药监局以及结核病防治所的相关官员及领导进行了关键人物访谈;采用专题小组访谈的形式,对2家结防专业机构的10名医护人员进行访谈。采用定性方法对采访对象进行了个人深入访谈、小组访谈、关键人物访谈。借助MAXqda软件,采用主体框架法进行分析。主要调查内容:①药店参与结核控制的现状,包括宣传结核病知识,发现、转诊结核病例。②药店参与结核病例发现的能力,包括员工的专业背景知识,对结核病知识的了解,接受新知识的机会。③药店参与结核病控制的客观阻碍因素,包括利益冲突、消费者的态度等。结果:29名受访对象均进入结果分析。①药店是患者接受健康教育的一个潜在的、重要的部门,绝大部分顾客在购药时都会咨询药店工作人员的意见,药店在发现以及转诊结核病患者中也起到一定促进作用,药店工作人员曾有发现结核病疑似患者并建议其接受医生治疗的经历。②药店从业人员仅了解部分结核病基础知识,缺少对结核病相关知识的知晓。但部分员工有医学或护理方面的专业背景,并且接受新知识的渠道也较多,如定期职能部门培训、电视以及报纸宣传等,但结核病知识的专题培训却相当少。③虽然绝大多数药店从业人员都认为推荐患者去结防所治疗不会对药店生意造成太大的影响,但也有部分人认为利益冲突会间接影响到药店参与结核病控制的行为。结论:药店在结核病控制工作中起到一定促进作用,但药店从业人员对结核病相关知识的了解有必要加强,采取一系列可行性措施解除这些阻碍因素,利益冲突会间接影响到药店参与结核病控制的行为。     

Cognitive outcomes at ages seven and nine years in South African children from the children with HIV early antiretroviral (CHER) trial: a longitudinal investigation

IntroductionMany children living with HIV (CLWH) display impaired cognition. Although early combination antiretroviral therapy (ART) produces improved cognitive outcomes, more long‐term outcome data are needed. After concluding the Children with HIV Early antiRetroviral (CHER) trial in 2011, we investigated cognitive performance, at seven and nine years of age. Participants had been randomized to deferred ART (ART‐Def; n = 22); immediate time‐limited ART for 40 weeks (ART‐40W; n = 30) and immediate time‐limited ART for 96 weeks (ART‐96W; n = 18). We also recruited HIV‐exposed uninfected (CHEU; n = 28) and HIV‐unexposed (CHU; n = 35) children.MethodsData were collected between May 2012 and December 2017. Mixed‐model repeated‐measures ANOVAs assessed differences over time between CLWH (ART‐40W, ART‐96W and ART‐Def) and CHIV‐ CHEU and CHU between ART‐Early (ART‐40W and ART‐96W), ART‐Def, CHEU and CHU; and between ART‐40W, ART‐96W, ART‐Def, CHEU and CHU.ResultsAll comparisons found significant effects of Time for most outcome variables (better scores at nine than at seven years; ps < 0.05). The first ANOVAs found that for (a) motor dexterity, CLWH performed worse than CHIV‐ at seven years (p < 0.001) but improved to equivalence at nine years, (b) visual‐spatial processing and problem solving, only CLWH (p < 0.04) showed significant performance improvement over time and (c) working memory and executive function, CLWH performed worse than CHIV‐ at both seven and nine years (p = 0.03 and 0.04). The second ANOVAs found that for (a) working memory, CHU performed better than ART‐Early and CHEU (p < 0.01 and <0.04), and (b) motor dexterity, ART‐Def performed worse than ART‐Early, CHEU and CHU at seven years (p = 0.02, <0.001 and <0.001 respectively) but improved to equivalence at nine years (ps > 0.17). Similarly, for motor dexterity, ART‐Def performed worse than ART‐96W, CHEU and CHU at seven years (p < 0.04, <0.001 and <0.001) but improved to equivalence at nine years (ps > 0.20).ConclusionsAlthough neurocognitive developmental trajectories for treatment groups and controls were largely similar (i.e. performance improvements from 7 to 9), all ART‐treated children, regardless of treatment arm, remain at risk for cognitive deficits over early school ages. Although the nature of these deficits may change as cognitive development proceeds, there are potential negative consequences for these children’s future learning, reasoning and adaptive functioning.     

The changing face of gastroschisis and omphalocele in southeast Georgia

Objective: To document trends in the clinical characteristics of gastroschisis and omphalocele in southeast Georgia, USA, from 1994 to 2002.

Methods: All babies with an abdominal wall defect in a 19-county region were referred to one Perinatal Center for genetic counseling, level II ultrasound scans, pregnancy follow-up and delivery. Karyotyping was offered for omphalocele, advanced maternal age, family history predisposing to aneuploidy, and gastroschisis with an additional anomaly.

Results: There were 64 patients, 34 with gastroschisis and 30 with omphalocele. From 1994 to 2002, the birth prevalence of gastroschisis was 1:3600 and omphalocele 1:3400, but from 2000 to 2002, gastroschisis increased to 1:1667, while omphalocele increased to only 1:2709. Gender distribution was different: for gastroschisis the M:F ratio was 1:2.1; for omphalocele the ratio was 1.7:1. In the patients with omphalocele, 90% had an amniocentesis and 9/27 were aneuploid: five had trisomy 18, three had trisomy 13 and one had trisomy 21. Seventy-six per cent of the patients with omphalocele had associated anomalies, but only 17.6% of those with gastroschisis. Mothers whose babies had gastroschisis showed a trend to progressively younger age, while no such trend was observed among mothers whose babies had omphalocele.

Conclusion: The birth prevalence of abdominal wall defects in general is increasing, but more notably for gastroschisis. Maternal age continues to decrease for gastroschisis. In the study population, gender distribution showed a statistically significant variation between the defects.