The surgical management of resistant club foot by rotation skin flap and extensive soft tissue release

Summary Resistant club foot remains an unsolved problem because of the complex aetiological and pathological factors, and is still seen quite frequently, especially in developing countries. The posteromedial skin contracture is a potent deforming force which is responsible for many failures or relapses. I report the results of an operation in which a rotation skin flap was combined with an extensive soft-tissue release. The age of the children was from 9 months to 10 years. The follow-up period was from one to 9 years with an average of 43 months, and in 50 cases for more than 5 years. I consider that the outcome has been excellent or good in 94 out of 100 feet.

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Résumé Le pied bot invétéré demeure un problème mal résolu en raison de la complexité des facteurs étiologiques et anatomiques et il est encore bien souvent rencontré, notamment dans les pays en voie de développement. La rétraction cutanée postéro-interne représente un puissant élément de la déformation, qui est responsable de bon nombre d'échecs ou de récidives. Nous rapportons les résultats d'une opération qui associe un lambeau cutané de rotation à la libération des parties molles. L'âge des enfants était compris entre neuf mois et dix ans. Le recul est de un à neuf ans, avec une moyenne de 43 mois. Cinquante enfants ont été suivis plus de cinq ans. Les résultats sont excellents ou bons dans 94% des cas.

     

上海金山地区3种医疗服务方式的市场分析

以上海金山及其周边区域为样本地区,针对私人保健医生、特需门诊服务和健康俱乐部3种医疗服务方式,对4类人群进行了意向调查,以明确3种医疗服务方式在医疗服务需方中的接受程度,以及医疗服务供方的意愿提供程度.调查结果显示:医疗服务需方对3种医疗服务方式具有很高的接受程度,医务人员也乐意提供这样类型的服务;从市场供求关系来看,如价格定位在合理范围,私人保健医生、特需门诊服务、健康俱乐部等服务将普遍受调查对象欢迎.调查结果为以下观点提供了支持依据:提高医疗技术固然是医院发展的关键前提,但在现阶段,适应人民群众的服务需求,加强服务意识,提供便民的服务措施也不失为医院的发展途径之一.     

Abnormal white‐matter rich‐club organization in obsessive–compulsive disorder

Rich‐club organization is key to efficient global neuronal signaling and integration of information. Alterations interfere with higher‐order cognitive processes, and are common to several psychiatric and neurological conditions. A few studies examining the structural connectome in obsessive–compulsive disorder (OCD) suggest lower efficiency of information transfer across the brain. However, it remains unclear whether this is due to alterations in rich‐club organization. In the current study, the structural connectome of 28 unmedicated OCD patients, 8 of their unaffected siblings and 28 healthy controls was reconstructed by means of diffusion‐weighted imaging and probabilistic tractography. Topological and weighted measures of rich‐club organization and connectivity were computed, alongside global and nodal measures of network integration and segregation. The relationship between clinical scores and network properties was explored. Compared to healthy controls, OCD patients displayed significantly lower topological and weighted rich‐club organization, allocating a smaller fraction of all connection weights to the rich‐club core. Global clustering coefficient, local efficiency, and clustering of nonrich club nodes were significantly higher in OCD patients. Significant three‐group differences emerged, with siblings displaying highest and lowest values in different measures. No significant correlation with any clinical score was found. Our results suggest weaker structural connectivity between rich‐club nodes in OCD patients, possibly resulting in lower network integration in favor of higher network segregation. We highlight the need of looking at network‐based alterations in brain organization and function when investigating the neurobiological basis of this disorder, and stimulate further research into potential familial protective factors against the development of OCD.     

Conceptions of Risk in the Lives of Club Drug-Using Youth

This paper describes current patterns of club drug use and local conceptions of risk among New York City area youth. The data is drawn from a NIDA-funded ethnographic study of club drug initiation among “Bridge and Tunnel” youth. The paper entails an examination of the harmony and discontinuity between folk models of risk within this population and professional models of risk. The author explores how club drug-using youth conceive of risks related to club drug use, specifically ecstasy, and how such conceptions compare and contrast with current professional models of risk. These conceptions of risk are crucial to understand, as they form an informal logic by which club drug practices are guided. Ultimately, the author examines how the relationship between folk models and professional models might inform health promotion efforts targeting youth.     

Failing Masculinity at the Club: A Poststructural Alternative to Intoxication Feminism

With a starting point in women's studies, this article moves on to approach the nightclub as a place of embodiment for both genders by introducing neo-Lacanian insights combined with Baudrillardian concepts. We look at three young drug-experienced men interviewed for a Danish club study (2008–09). The article examines how the risks of losing masculinity, losing sexual opportunities, and losing friends are managed in nightlife. Since masculinity becomes invested in the fantasy of the drug and the utopian party, these young men can be perceived as risking their male position when the party does not work out as planned.     

A review of journal clubs in postgraduate medical education

OBJECTIVE: To review the goals, organization, and teaching methods of journal clubs, summarize elements of successful clubs, and evaluate their effect on reading habits, and effectiveness in meeting teaching goals. Examples of clubs that utilize principles of adult learning are reviewed. DATA SOURCES: English language articles identified through a MEDLINE search (1966–1997) using the MeSH terms “internship” and “residency,” and text words “journal club” and “critical appraisal.” STUDY SELECTION: Articles on learning goals and organization were included if they represented national or regional surveys with a response rate of 65% or greater. Articles that evaluated teaching effectiveness were included if they used a controlled, educational design, or if they exemplified important adult learning principles. DATA EXTRACTION: Data were manually extracted from selected studies and reviews. DATA SYNTHESIS: A major goal for most clubs is to teach critical appraisal skills. Clubs with high attendance and longevity are characterized by mandatory attendance, availability of food, and perceived importance by the program director. Residents who are taught critical appraisal report paying more attention to the methods and are more skeptical of the conclusions, and have increased knowledge of clinical epidemiology and biostatistics, but studies have failed to demonstrate that these residents read more, or read more critically. Reading guidelines may be useful for teaching critical appraisal skills, and may be associated with increased resident satisfaction. CONCLUSIONS: Journal club formats are educationally diverse, can incorporate adult learning principles, and are an adaptable format for teaching the “new basic sciences.” Received from the Department of Medicine, University of Florida, Gainesville.