内镜辅助下血肿清除加去骨瓣减压术治疗重症脑出血患者的效果

目的探究内镜辅助下血肿清除加去骨瓣减压术治疗重症脑出血患者的效果。方法选取普宁华侨医院2019年3月-2021年3月收治的60例重症脑出血患者,按照简单随机数字表法分为对照组(n=30)和观察组(n=30),对照组采用内镜辅助下血肿清除术,观察组在对照组基础上采用去骨瓣减压术治疗。评估两组脑内血肿的清除情况、血清炎症因子、预后情况。结果术后3d,观察组血肿清除率高于对照组(P<0.05);术前两组患者血清肿瘤坏死因子ɑ(TNF-ɑ)、白细胞介素-1β(IL-1β)对比,差异无统计学意义(P>0.05),术后两组均降低,且观察组低于对照组(P<0.05);术前两组患者神经功能缺损评分(NIHSS)、格拉斯哥预后量表(GOS)、日常生活活动能力量表(ADL)评分对比,差异无统计学意义(P>0.05),随访结束后两组NIHSS评分均降低且观察组低于对照组(P<0.05),两组GOS以及ADL评分均升高且观察组高于对照组(P<0.05)。结论内镜辅助下血肿清除加去骨瓣减压术治疗重症脑出血患者通过提高血肿清除率,减轻术后炎症反应,进而加快患者神经功能的恢复,改善预后。     

开颅血肿清除术联合去骨瓣减压术治疗高血压脑出血的近期疗效及患者预后分析

目的探讨开颅血肿清除术联合去骨瓣减压术治疗高血压脑出血的效果。方法回顾性分析我院2014年1月至2018年3月收治的130例高血压脑出血患者的临床资料,根据手术方式将其分为观察组(开颅血肿清除术联合去骨瓣减压术, n=68)与对照组(微创锥颅血肿穿刺引流, n=62例),比较两组的手术效果。结果观察组的术中脑组织获得减压时间、手术时间以及住院时间明显长于对照组(P <0.05)。观察组血肿清除率明显高于对照组(P <0.05)。两组的NIHSS评分、 Barthel评分以及术后不良反应发生率比较均无统计学差异(P>0.05)。结论开颅血肿清除术联合去骨瓣减压术以及微创锥颅血肿穿刺引流均可有效治疗高血压脑出血。     

高血压脑出血小骨窗开颅术治疗67例临床观察

目的观察小骨窗开颅术用于高血压脑出血的临床疗效,评价其实际应用价值。方法采用小骨窗开颅术治疗67例高血压脑出血患者,编为观察组;同时回顾性分析采用传统开颅手术进行治疗的40例高血压脑出血患者,编为对照组,对两组患者术后死亡率、3个月神经功能评分(KPS)及预后评分(GOS)进行比较及统计学分析。结果应用小骨窗开颅术治疗的观察组疗效明显优于使用传统开颅手术进行治疗的对照组,死亡率较低,KPS及GOS指标明显改善,组间差异具有统计学意义(P<0.05)。结论小骨窗开颅术用于高血压脑出血疗效显著,值得临床推广应用。     

手术时机对微创清除术治疗急性脑出血患者效果的影响

目的探讨手术时机对微创清除术治疗急性脑出血患者效果的影响。方法选择2017年1月至2018年12月医院收治的120例急性脑出血患者,均施行微创清除术治疗,根据手术时机不同将其分为对照组与试验组,各60例。对照组于发病后8~12 h(不含8 h)施行微创清除术,试验组于发病后4~8 h(含8 h)施行微创清除术,比较两组的格拉斯哥昏迷量表(GCS)评分、术后再出血率及格拉斯哥预后量表(GOS)评分。结果术前1 h,两组GCS评分比较,差异无统计学意义(P>0.05);术后1个月,试验组GOS评分高于对照组,差异有统计学意义(P<0.05)。两组术后再出血率比较,差异无统计学意义(P>0.05)。结论急性脑出血患者在明确符合微创清除术的适应证后,应尽早施行手术治疗。     

双额叶脑挫裂伤不同时期去骨瓣减压术临床效果分析

目的 探讨双额叶脑挫裂伤不同时期去骨瓣减压手术后的临床效果.方法 2005年1月至2012年12月,共对48例双额叶脑挫裂伤患者进行去骨瓣减压手术,其中29例在入院后1～2d,根据颅内压监测和头颅CT变化指标,在患者神志尚清楚情况下行去骨瓣减压手术,作为治疗组；其余19例根据上述指标达到手术指征,但家属坚决要求先行保守治疗,在意识障碍加重情况下才进行手术,作为对照组,对两组病例的临床效果进行回顾性分析.结果 术后3个月根据格拉斯哥预后量表(GOS)评分,治疗组恢复良好19例,轻度残疾10例,无重度残疾及死亡病例；对照组恢复良好7例,轻度残疾5例,重度残疾3例,植物状态1例,死亡3例.治疗组恢复良好率明显优于对照组,差异有统计学意义(P＜0.05).结论 双额叶脑挫裂伤患者需严密监测颅内压及头颅CT动态变化,早期进行去骨瓣减压手术,能够明显降低致残率和病死率.     

58例微创治疗高血压脑出血疗效观察

目的观察比较传统手术治疗与微创治疗高血压性脑出血的疗效。方法将高血压脑出血116例患者随机分成两组,手术组行开颅血肿清除术;微创组行CT立体定位微创血肿清除术治疗;比较两组的神经功能缺损评分和治疗有效率。结果微创组治疗后神经功能缺损评分明显下降,两组比较差异有统计学意义(P<0.05);微创组治疗有效率63.79%,手术组有效率43.10%,差异比较有统计学意义(P<0.05)。结论CT立体定位微创血肿清除术治疗损伤小,疗效确切。     

微创颅内血肿清除术治疗脑出血的研究

目的 分析微创颅内血肿清除术治疗脑出血的效果，改善患者临床症状。方法 选取山东烟台业达医院2016年3月—2021年11月收治的50例脑出血患者进行研究，根据患者不同的治疗方式将其分为对照组和观察组各25例。对照组采取非手术治疗，观察组采取微创颅内血肿清除术。比较两组治疗1个月后格拉斯哥预后评分法(GOS)评分、并发症发生率、治疗1周后血肿周围水肿评分、治疗前后临床症状评分和日常生活能力评分、炎性因子水平及生活质量评分。结果 治疗1个月后，观察组患者GOS评分(3.56±0.43)分，高于对照组的(2.21±0.35)分，差异有统计学意义(t=12.174,P<0.05)；治疗1个月内，观察组患者并发症发生率为4.00%，低于对照组的24.00%，，差异有统计学意义(χ²=4.152,P<0.05)。治疗1周后，观察组血肿周围水肿评分为(12.65±2.85)分，高于对照组的(8.67±2.19)分，差异有统计学意义(P<0.05)。治疗1个月后，两组患者临床症状评分均低于治疗前，且观察组评分低于对照组，差异均有统计学意义(P<0.05)。...     

CT定位下血肿穿刺引流术治疗高血压性脑出血的疗效观察

目的探讨CT定位下血肿穿刺引流术治疗高血压性脑出血的效果。方法回顾性分析2017年9月至2018年11月我院收治的108例高血压性脑出血患者的临床资料,根据治疗方式的不同分为两组各54例。对照组采用传统开颅手术治疗,观察组采用CT定位下血肿穿刺引流术治疗,比较两组患者的预后情况、神经功能缺损程度及并发症发生率。结果术后,观察组的GOS评分高于对照组,NDS评分低于对照组,差异有统计学意义(P<0.05);观察组的并发症发生率为7.41%,低于对照组的27.78%,差异有统计学意义(P<0.05)。结论CT定位下血肿穿刺引流术在改善高血压性脑出血患者神经功能中可发挥重要作用,且具有预后良好、并发症少等优势,可作为治疗该疾病的首选方案之一。     

3D-slicer联合神经内镜术治疗高血压基底核脑出血的效果和安全性

目的探讨3D-slicer联合内镜手术治疗高血压基底核脑出血的临床效果。方法选取2018年4月至2022年5月庆阳市人民医院收治的116例高血压基底核脑出血患者作为研究对象,按照治疗方案不同分为研究组和对照组,每组58例。研究组采用3D-slicer技术联合神经内镜清除术治疗,对照组采用CT定位组钻孔引流术治疗,比较两组手术参数指标、血肿消除情况、颅内压水平、格拉斯哥昏迷评分法(Glasgow coma scale,GCS)评分、术后基本情况及术后6个月预后情况。结果研究组手术时间长于对照组,术中失血量低于对照组,差异有统计学意义(P<0.05)。术后1、7 d,研究组血肿清除率均高于对照组,差异有统计学意义(P<0.05)。术前,两组GCS评分和颅内压水平比较,差异无统计学意义(P>0.05);术后7 d,研究组GCS评分高于对照组,颅内压水平低于对照组,差异有统计学意义(P<0.05)。研究组引流管拔除时间、术后7 d水肿带直径及术后颅内感染发生率低于对照组,差异有统计学意义(P<0.05)。随访6个月后,研究组残疾率和死亡率低于对照组,差异有统计学意义(P<0.05)。结论3D-slicer联合神经内镜术治疗高血压基底核脑出血效果及安全性良好。     

CT引导下神经内窥镜微创手术治疗高血压脑出血的疗效观察及并发症分析

目的:观察CT引导下神经内窥镜微侵袭手术治疗高血压脑出血的临床疗效及并发症分析。方法:选取在医院接受手术治疗的76例患者的临床资料,根据手术方式的不同将患者分为观察组(40例)和对照组(36例)。观察组采用CT引导下神经内窥镜微侵袭血肿清除术治疗;对照组采用小骨窗显微镜下血肿清除术治疗。观察比较两组患者术中一般情况、血肿清除率,分别采用美国国立卫生研究院卒中量表(NIHSS)、简易智能精神状态检查(MMSE)量表和Barthel指数(BI)评定患者神经功能、恢复情况和日常生活能力,比较两组并发症发生率。结果:观察组在手术时间、术中出血量、皮肤切口长度、骨窗直径大小及住院时间上均显著低于对照组,差异有统计学意义(t=13.567,t=15.719,t=12.896,t=6.704,t=4.303;P<0.05);但两组血肿清除率比较,差异无统计学意义(t=0.467,P>0.05);观察组术后BI评定日常生活能力良好率为72.5%,高于对照组(44.4%),其差异有统计学意义(x^2=6.175,P<0.05);观察组术后2周和1年NIHSS评分均显著低于对照组,其差异有统计学意义(t=2.656,t=3.222;P<0.05);观察组术后2周和1年MMSE评分均显著高于对照组,其差异有统计学意义(t=3.179,t=2.308;P<0.05);观察组并发症发生率为12.5%,显著低于对照组(33.3%),其差异有统计学意义(x^2=4.736,P<0.05)。结论:CT引导下神经内窥镜微侵袭术与显微镜下血肿清除术相比,用时更短、手术创伤更小且术后疗效更佳,可明显降低术后并发症发生。     

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.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.