自体肋骨肋软骨游离移植修复一侧下颌骨缺损的效果观察

目的探讨自体肋骨肋软骨游离移植修复一侧下颌骨缺损的效果。方法对13例因肿瘤导致一侧下颌骨缺损的患者,用自体肋骨肋软骨游离移植修复,观察临床疗效。结果其中12例术后未出现植骨床感染,植骨区创口I期愈合;1例术后出现局部感染,经全身抗炎治疗及局部处理后创口愈合。植骨成功率为100%。结论对颌骨缺损、需行颞下颌关节重建时,在血管化骨移植尚未普及的情况下,肋骨肋软骨游离移植是一种较好的修复方法。     

下颌骨成釉细胞瘤骨移植钛板重建

目的 探讨游离髂骨移植、重建板固定修复下颌骨成釉细胞瘤术后下颌骨缺损的手术方法和疗效.方法 对15例发生于下颌磨牙区、下颌角及升支部成釉细胞瘤术后使用游离髂骨移植、重建板固定.结果 术后伤口均一期愈合,随访3个月、1年及5年,植骨块愈合良好,患者的外形及功能恢复满意.结论 游离髂骨移植、重建板固定修复下颌骨成釉细胞瘤术后下颌骨缺损具有可操作性强、并发症少、成功率高等特点.     

应用髂骨松质骨移植修复牙槽嵴裂的观察与分析

目的观察自体髂骨松质骨移植行牙槽嵴裂Ⅱ期修复术后的骨性愈合情况、上颌骨连续性、植骨区牙槽嵴高度和鼻翼基底的形态。方法将39例腭裂术后残留牙槽嵴裂的患者采用髂骨松质骨移植进行Ⅱ期修复,并通过临床随访和拍摄X光片追踪观察其伤口愈合情况、上颌骨连续性、植骨区牙槽嵴高度和鼻翼基底的形态。结果39例患者髂骨供区伤口和口内伤口术后均一期愈合。6—24个月后拍x线片显示37例上颌骨连续性好,植骨区牙槽嵴高度和鼻翼基底的形态均好。结论自体髂骨松质骨移植修复牙槽嵴裂,临床效果满意。     

自体骨打压支撑植骨术治疗非创伤性股骨头坏死的动态影像学分析

目的探讨改良减压植骨术一自体骨打压支撑植骨术治疗非创伤性股骨头坏死的治疗效果。方法自体骨打压支撑植骨术治疗非创伤性股骨头坏死12例16髋,按ARCO分期：ⅡB期3髋,ⅡC期6髋,ⅢA期2髋,RIB期3髋,RIC期2髋。以术后1、3、6、12、24个月骨盆正位及蛙式位X线片植骨区、腓骨棒及股骨头外形表现及末次ARCO分期为观察项目。结果平均24个月随访,X线片提示病灶植骨区修复良好、腓骨棒与受区融合,但负重行走1年后股骨头植骨区周围碎裂甚至塌陷;末次随访时ARCO分期：Ⅲ期9髋,Ⅳ期7髋。结论自体骨打压支撑植骨术促进了股骨头坏死区修复,腓骨棒起到了有效支撑作用,但需进一步改进手术方式及手术器械以扩大病灶的清除及植骨范围,探索病人负重时机及负重程度,以减少因应力集中而导致良好修复后的股骨头发生碎裂、塌陷。     

自体髂骨松质骨移植修复牙槽突裂的临床应用

目的 评价自体髂骨松质骨移植在牙槽突畸形修复中的临床应用.方法 42例唇腭裂术后牙槽突裂患者行自体髂骨松质骨移植;术后对X线影像进行分析,评价临床效果.结果 42例中除1例移植骨外露,修整后重新缝合,创面Ⅱ期愈合,其余均Ⅰ期愈合.有3例基本无连续骨桥,植骨成活率为92.9%.结论 自体髂骨松质骨移植修复牙槽突裂是一种有效的治疗方法.     

腰椎结核Ⅰ期后路病灶清除治疗体会

目的　通过腰椎结核I期后路病灶清除治疗与传统术式比较,评价其优越性.方法　腰椎结核32例分为2组,其中治疗组16例行Ⅰ期后路病灶清除、植骨融合结合内固定术;对照组16例行前路病灶清除、植骨融合、内固定术.结果　与对照组相比,治疗组术后3个月复查椎间植骨处均骨性愈合良好,胸椎结核cobb角得到明显改善(P＜0.05).治疗组的手术平均时间、平均术中出血量与平均住院时间都明显少于对照组(P＜0.05).结论 腰椎结核I期后路病灶清除治疗临床疗效明确,是手术治疗腰椎结核的一种优秀术式.     

下颌骨骨折同期牙种植1例的护理体会

目的:探讨全麻颌骨骨折切开复位坚强内固定术同期牙种植术的护理配合方法.方法:总结下颌骨骨折患者1例护理体会,全麻下行下颌骨骨折复位同期植入种植牙,并加强围术期规范化护理,针对下颌骨骨折复位同期植入种植牙术做特征性护理.结果:患者术后创口Ⅰ期愈合,术后全景片示下颌骨骨折对位愈合良好,无钛板断裂、松动现象;种植体植入方向及骨结合良好,无感染、松动、脱落.结论:全麻下种植牙围术期规范化护理可提高种植牙手术成功率.     

异种脱细胞真皮基质膜在齿槽裂植骨术中的临床应用

目的 在齿槽裂手术中,将异种脱细胞真皮基质膜覆盖齿槽裂植骨区,观察新骨形成状况,评价植骨修复效果.方法 选择67例单侧齿槽裂患者,按治疗方法不同分为对照组和试验组.对照组单纯应用髂骨骨松质移植41例,试验组应用异种脱细胞真皮基质膜加髂骨骨松质移植26例.术后1,3,6,12,18,24个月随访,X线片观察齿槽裂植骨区新骨生成情况.结果 对照组病例术后6个月齿槽裂植骨区新骨形成Ⅰ,Ⅱ,Ⅲ,Ⅳ级分别为15,11,9,6例,齿槽裂植骨成活率为84.5％,临床成功率为63.7％.而试验组病例植骨区新骨形成Ⅰ,Ⅱ,Ⅲ,Ⅳ级分别为13,9,3,1例.齿槽裂植骨成活率为97.8％,临床成功率为84.3％.两组植骨成活率、临床成功率比较差异有统计学意义（P＜0.05）.结论 自体髂骨加异种脱细胞真皮基质膜联合应用于齿槽裂植骨术中,可有效提高植骨成功率.     

引导骨再生术中三维预成型钛网与成品钛网的临床效果分析

目的 采用回顾性随机试验,从临床和影像学角度评价量化引导骨再生(guided bone regeneration,GBR)手术后,种植体周围骨组织稳定性。方法 收集2020年1月—2023年5月因上颌或下颌骨严重骨吸收在锦州医科大学附属第二医院接受GBR手术的94例患者(94个GBR手术位点),随机分为观察组和对照组各47例。观察组采用三维预成型钛网屏障膜覆盖植骨区;对照组采用成品钛网屏障膜覆盖植骨区。除去钛网暴露病例后,分别对观察组43例和对照组45例患者植骨手术术后即刻、6个月后进行锥束计算机断层扫描,进一步确定原骨壁到骨增量术后骨壁的相对位置和距离,以评估水平骨宽度增加程度。收集术后6个月的种植体稳定指数(implant stability quotient,ISQ),评估GBR术后植体负重能力。结果 GBR术后6个月,观察组和对照组所有部位平台骨水平新骨增加量组间差异无统计学意义(P>0.05);相对于GBR术后即刻骨增量水平,6个月后观察组和对照组硬组织增量有所减少,组间差异无统计学意义(P>0.05)。观察组与对照组暴露率差异无统计学意义(P>0.05)。...     

Ⅰ期植骨、锁定加压接骨板治疗肱骨干粉碎性骨折

目的评价Ⅰ期植骨、锁定加压接骨板内固定治疗肱骨干粉碎性骨折的临床疗效。方法Ⅰ期植骨、锁定加压接骨板内固定治疗,中上段骨折行前外侧纵形切口,中下段骨折采用后正中切口。结果全部病例骨折均达到骨性愈合,平均为4.3个月,患肢功能恢复好,无功能障碍。结论Ⅰ期植骨、锁定加压接骨板内固定治疗肱骨干粉碎性骨折主要是锁定加压接骨板内固定极大地稳定了骨折端,避免了内固定松动引起的骨不连,也有利于早期功能锻炼,同时Ⅰ期植骨既能填充粉碎性骨折产生的骨缺损,又可诱导成骨,促进骨折早期愈合,预防骨不连的产生。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.