A critical assessment of published guidelines and other decision-support systems for the antibiotic treatment of community-acquired respiratory tract infections

Guidelines are an important means by which professional associations and governments have sought to improve the quality and cost-effectiveness of disease management for infectious diseases. Prescribing of initial antibiotic therapy for community-acquired respiratory tract infections (RTIs) is primarily empiric and physicians may often have a limited appreciation of bacterial resistance. Recent guidelines for managing RTIs have adopted a more evidence-based approach. This process has highlighted important gaps in the existing knowledge base, e.g. concerning the impact of resistance on the effectiveness of oral antibiotics for outpatient community-acquired pneumonia and the level of resistance that should prompt a change in empiric prescribing. In upper RTIs, the challenge is to identify patients in whom antibiotic therapy is warranted. Concentrated, sustained efforts are needed to secure physicians' use of guidelines. The information should be distilled into a simple format available at the point of prescribing and supported by other behavioral change techniques (e.g. educational outreach visits). Advances in information technology offer the promise of more dynamic, computer-assisted forms of guidance. Thus, RTI prescribing guidelines and other prescribing support systems should help control bacterial resistance in the community. However, their effect on resistance patterns is largely unknown and there is an urgent need for collaborative research in this area. Rapid, cost-effective diagnostic techniques are also required and new antibiotics will continue to have a role in disease management.     

胫骨上端外部形状及内部结构的模拟

目的，进行胫骨上端内部结构和外部形状的模拟。方法，采用高阶非线性骨再造速率方程和有限元方法相结合，引入拓扑优化的思想，选取大于模拟的胫骨上端外形的模拟域，从不固定外形出发，对正常力学环境下的胫骨上端内部结构及外部形状进行模拟。结果，模拟的胫骨上端的外部形状和内部结构与真实结构十分接近。     

老年组与中成年组髂外动脉的形态学比较

本文观微和测量了50具国人髂外动脉(左右合计100侧),并将所有观测项目按年龄分为老年组(60岁以上者)和中成年组(19—60岁)进行了统计学处理。结果发现:髂外动脉的长度、外径、髂外动脉与髂内动脉之间的夹角以及髂外动脉的弯曲程度在老年组与中成年组之间均有高度显著性差异。     

Effect of administration of diethylcarbamazine with and without fluconazole on experimental fungal infections in mice

Other researchers have found that diethylcarbamazine (DEC) is effective treatment for filariasis despite a lack of demonstrated in vitro antifilarial activity. The results of our previous investigations using feline and murine leukemia virus models encouraged us to investigate the use of DEC with other infections. In our current experiments, DEC treatment was associated with lower brain fungal burden in fluconazole-treated mice following intravenous injection of Aspergillus fumigatus or increasing numbers of Cryptococcus neoformans organisms, and lower brain and kidney levels of Candida albicans following intravenous injection of increasing numbers of C. albicans. Further investigation of combined DEC and fluconazole treatment of fungal infections is warranted.     

脑膜瘤术前颈外供血动脉超选择栓塞治疗

目的 回顾40例脑膜瘤施行术前血管内栓塞治疗,阐明栓塞的效果。方法 40例幕上脑膜瘤均行术前超选择颈外供血动脉明胶微粒栓塞,栓塞后1－7d行开颅脑膜瘤切除。结果 肿瘤单纯颈外供血19例,颈内、颈外均参与供血21例（其中颈内为主6例）。肿瘤全切除38例,大部分切除2例,无栓塞相关并发症。结论 单纯颈外供血或主要颈外供血者,栓塞后3－7d施肿瘤切除术,术中出血明显减少,手术时间显著缩短,并发症少。超选择栓塞治疗能减少栓塞治疗本身的并发症,是一种安全而有效的辅助治疗。     

Tuberculous otitis media-are we missing it ?

Tuberculosis of the middle ear it a rare disease. Due to change in the typical clinical pattern and decrease in incidence, there is a delayed or missed diagnosis and can lead to increased morbidity. We pretent 5 cases of Tuberculous Otitis Media treated over a period of 2 years, highlighting the fact that it must be considered as a differential diagnosis of persistent suppurative otitis media.     

A planimetric study of therapy-dependent development of temporal bone pneumatization in secretory otitis media

The present study is based on the results of a planimetric investigation of temporal bone pneumatization in 43 children. Radiological and clinical follow-up studies 10 years after therapy for secretory otitis media indicate an adaptation in the size of pneumatization to an almost normal area. The increase shows that a myringotomy is sufficient in cases of serous effusion, whereas a mucous fluid requires long-term middle ear ventilation. Received: 5 August 1999 / Accepted: 3 December 1999     

小儿化脓性中耳炎的病原学调查

目的　调查小儿化脓性中耳炎的主要病原菌及其对抗生素的耐药情况。方法　对 5 2例化脓性中耳炎患儿的中耳分泌物进行细菌培养 ,每份标本分别用 5 %～ 7%羊血平板和自制改良巧克力平板分离 ,置烛缸培养。对获得的病原菌用K -B纸片琼脂扩散法行药物敏感试验。结果　分离出 46株致病菌 ,嗜血杆菌 (15株 )和金黄色葡萄球菌为主 ,嗜血杆菌对青霉素和复方新诺明的耐药率分别为 83.3%和 40 % ,以金黄色葡萄球菌为主的临床常见菌对氨苄青霉素和氧哌嗪青霉素的耐药率分别为 95 .5 %和 5 4.2 %。结论　嗜血杆菌和金黄色葡萄球菌是本地区小儿化脓性中耳炎的主要致病菌 ,两者对青霉素类抗生素的耐药率皆较高。     

自制黄连滴耳液的临床疗效观察

目的　探讨自制黄连滴耳液治疗中耳炎的疗效。方法　应用自行研制的黄连滴耳液滴耳 ,早中晚各一次 ,每次 3～ 5滴 ,治疗急、慢性化脓性中耳炎 4 5例 ,并与常规治疗组用 3%氧氟沙星滴耳液滴耳 4 5例作对照。结果　治疗组总有效率为 93.3% ,对照组总有效率为 82 .2 2 % ,用 χ2 检验 ,两者有显著性差异 (P <0 .0 1)。结论　复方黄连滴耳液对急慢性化脓性中耳炎具有较好的有效性、安全性、实用性。 3%氧氟沙星滴耳液只有抗菌作用 ,而无黄连滴耳液直接促进中耳粘膜干燥、消肿止痛和收敛渗湿之功效。     

《伤寒论》外治法举隅

汉·张仲景著《伤寒论》中辨证论治体系也包括外治法的内容 ,《伤寒论》中的外治法有针、灸、温覆、熏、导、温粉等治疗方法 ,在临床上用于解表、泻下、和解、清热、温里、固涩、祛湿、预防传变等若干方面。