28例重症多形红斑临床分析

目的总结重症多形红斑的发病原因、临床特点和治疗体会。方法对28例重症多形红斑的临床资料进行分析。结果28例患者中有25例由药物导致发病,3例原因不明。结论重症多形红斑大多数由药物引起,停用致敏药物是治疗的关键,而皮质类固醇激素是治疗该病的首选药物。     

重症多形红斑的护理

目的：探讨护理在重症多形红斑治疗中的作用。方法：对18例重症多形红斑住院患者的护理进行总结。结果：通过精心的护理促进疾病的恢复,减少了并发症的发生。结论：根据患者的病情及皮损变化,采取针对性的护理措施并加强皮肤粘膜的护理,对重症多形红斑的治疗和恢复具有重要临床意义。     

接种吸附无细胞百白破疫苗致大疱型多形红斑1例报告

目的报告1例因接种第3剂吸附无细胞百白破联合疫苗致大疱型多形红斑病例。方法按照预防接种异常反应调查规范对1例接种第3剂吸附无细胞百白破联合疫苗后出现大疱型多形红斑病例开展调查,组织诊断。结果根据饮食、用药情况排除食物或药物过敏;接种操作流程符合技术规范,排除实施差错;同批次疫苗接种均未发现类似病例,排除疫苗质量问题。接种疫苗10 h后在接种部位发现红点,增大红斑,出现水疱,在时间上存在关联;经县级疑似预防接种异常反应调查专家组诊断,确诊为大疱型多形红斑。结论该病例是接种吸附无细胞百白破联合疫苗后出现大疱型多形红斑,属于预防接种异常反应。     

白银市2起学校寒冷性多形红斑聚集性发病分析

多形性红斑主要由各种感染、药物及内脏某些疾病等因素[1]诱导抗原一抗体变态反应所致,而寒冷性多形红斑则与冻疮一样由寒冷所致,并与免疫反应有关[1-2].2009年3月,白银市相继出现2起寒冷性多形红斑聚集性发病,分别发生在2所学校.为了更好地应对和处置发生在集体单位中的疫情,探讨其发生原因,制定预防控制措施,为指导今后学校疾病防控工作提供科学依据,现将2起聚集性发病调查处理情况分析如下.     

孕妈妈慎防皮肤病

正妇女在妊娠期间,母体会发生一系列适应性变化。在这个过程中,孕妇很容易发生一些皮肤病。孕期皮肤病会影响孕妇的健康,轻者可令患者瘙痒不止,寝食难安,重者可危及胎儿的发育,甚至胎死腹中,因此千万不可小视。常见的妊娠期皮肤病,包括妊娠疱疹、妊娠多形红斑、妊娠期天疱疹、妊娠期结节性红斑、妊娠期瘙痒性毛囊炎、妊娠期多形疹、妊娠痒     

复种百白破制剂引起多形红斑形皮疹的报告

南充市高坪区卫生防疫站预防接种门诊于2003—07—10接种百白破制剂时发生l例多形红斑形皮炎，现将结果报道如下。     

莫把多形红斑当冻疮

进入冬季，小丽双手背及脚趾出现了一些甲盖大小的红斑，其中一部分红斑表现为周围鲜红、中央正常的环形，小丽觉得可能得了冻疮，随即戴上了手套，还买了一盒冻疮膏搽，并且有空就活动手脚、揉搓皮肤，心想早点把病治好。但是过了两个星期，小丽手上的红斑不但没有减少，反而增多了，有的甚至变成了紫红色，她只好去医院检查，医生告诉她得的并不是冻疮，而是一种皮肤病——多形红斑。多形红斑属于变态反应性（俗称过敏性）皮肤病，在某些变应原的作用下引起人体免疫系统出现对皮肤血管内皮的攻击形为，发生皮肤血管炎症，血管内红细胞外渗…     

三氯乙烯致大疱表皮坏死松解症的护理

三氯乙烯（TCE）是常用的有机溶剂,广泛用于电子、五金、电镀板等行业,主要用于清洗、去污、脱脂等。2006-2008年,我院共收治47例三氯乙烯药疹样皮炎的患者,根据皮疹的表现形式,临床可分为：剥脱性皮炎、多形红斑、重症多形红斑、大疱表皮坏死松解症4种类型,其中大疱表皮坏死松解型患者常因护理不当并发感染而死亡,现将我院大疱表皮坏死松解型患者的护理总结报道如下,供临床护理参考。     

三氯乙烯对人体健康的影响

三氯乙烯(trichloroethylene,TCE),化学式CHCLCCL2,无色液体,有似氯仿的嗅味,分子量131.4,沸点86.7℃。不溶于水,溶于乙醇、乙醚等有机溶剂。具有较强的脱脂作用,主要用作脱脂剂、萃取剂、溶剂,也用于农药制备、有机合成、衣服干洗等。本品可经呼吸道、消化道和皮肤吸收。短期大量接触本品可引起以中枢神经系统抑制为主的全身性疾患。也是引起职业性剥脱性皮炎、重症多形红斑、大疱性表皮坏死松解症和多形红斑的主要致病物。Schwartz等早在。1947年就描述了TCE引起的全     

育儿小语

六新生儿皮肤表面的角质层尚未形成，真皮较薄，纤维组织少，但毛细血管网发育良好。一些轻微刺激（如衣物、药物）．便会使其皮肤充血，表现为大小不等、边缘不清的多形红斑，多见于头部、面部、躯干及四肢。这属正常生理变化，一般无须治疗，红斑多会在1-2天内自行消退。     

Cholera in Haiti and other Caribbean regions, 19th century

Medical journals and other sources do not show evidence that cholera occurred in Haiti before 2010, despite the devastating effect of this disease in the Caribbean region in the 19th century. Cholera occurred in Cuba in 1833-1834; in Jamaica, Cuba, Puerto Rico, St. Thomas, St. Lucia, St. Kitts, Nevis, Trinidad, the Bahamas, St. Vincent, Granada, Anguilla, St. John, Tortola, the Turks and Caicos, the Grenadines (Carriacou and Petite Martinique), and possibly Antigua in 1850-1856; and in Guadeloupe, Cuba, St. Thomas, the Dominican Republic, Dominica, Martinique, and Marie Galante in 1865-1872. Conditions associated with slavery and colonial military control were absent in independent Haiti. Clustered populations, regular influx of new persons, and close quarters of barracks living contributed to spread of cholera in other Caribbean locations. We provide historical accounts of the presence and spread of cholera epidemics in Caribbean islands.     

Human biomonitoring in Israel: past, present, future

The first human biomonitoring (HBM) studies in Israel in the 1970s and 80s focused on measuring exposure to polychlorinated biphenyls (PCBs) and organochlorine insecticides in the general population and organophosphate pesticides in agricultural workers. In the late 1990 s, a regional human biomonitoring study found differences in blood lead levels in children from Israel, Jordan, and the Palestinian Authority. Taken together with data on time trends in lead emissions in Israel, the study indicated the benefits from phasing out of leaded gasoline. More recently, a pilot study in pregnant women in Jerusalem, conducted in collaboration with the US-CDC, found widespread exposure to phthalates, organophosphate pesticides, and the carbamate bendiocarb. Creatinine-adjusted total dimethyl (DM) metabolite concentrations were between 4 and 6 times higher than populations of pregnant women in the United States. The Israel Ministry of Health is currently collaborating with the Hebrew University of Jerusalem and Al Quds University to study exposures to phthalates and organophosphates in pregnant women in Israel and the Palestinian Authority. The Israel Ministry of Health has also begun the first National Biomonitoring Study to measure exposures to bisphenol A, phthalates, organophosphates, polyaromatic hydrocarbons, the phytoestrogens genistein and daidzein, and cotinine in the Israeli adult population. This study is being carried out in collaboration with the University of Erlangen-Nuremberg in Germany. Until recently, HBM programs in Israel were targeted at selected occupational groups (workers potentially exposed to metals, volatile organic compounds (VOCs), and cholinesterase inhibitors) and naval divers potentially exposed to environmental contaminants. The future of HBM in Israel lies in extending such programs to measuring exposures in representative samples of the general population, increasing international collaboration in this field, developing analytical capacity and expertise, and increasing use of human biomonitoring studies in forming and evaluating environmental health policy.     

Conceiving of risk in childbirth: obstetric discourses,medical management and cultural expectations in Switzerland and Jordan

In highly industrialised societies, risk shapes representations and practices surrounding childbirth. However, few studies examine the impact of the transnational diffusion of risk in medium and low income societies, where, despite the adoption of biomedical protocols on an institutional level, women and birth attendants often seem to follow different rationales in their practices. In this article, we are interested in the various components of the notion of risk, which shall be understood and examined in relation to specific socio-economic, political and cultural configurations. Drawing on two ethnographic studies conducted, respectively, in a Swiss university hospital and in three Jordanian government hospitals, we investigate how surveillance and medical interventions are deployed in pregnancy and childbirth in unequally structured health systems and describe negotiations and appropriations surrounding this management. These two contrasting cultural, socio-economic and health ‘system’ contexts reveal important differences in the way birth attendants and women consider the notion of risk in childbirth in that it is seldom present in clinicians’ and women’s discourses and practices in Jordan, whereas it plays a pertinent role in Switzerland. We argue that the heterogeneous configurations of risk mobilised by the participants in these studies reveal that dissimilar histories in terms of medical institutions and health care service provisions, political regimes, economic conditions, and social configurations shape the cultural and techno-medical arrangements of the institutions we studied. Comparing our Jordanian and Swiss ethnographies, we show that the mobilisation of biomedical risk does not happen in a vacuum but rather intertwines with specific social arrangements, eliciting resistance and adaptation that fashion the discourses and behaviours of birth attendants and pregnant women.     

Metal levels in eggs of common terns (Sterna hirundo) in New Jersey: temporal trends from 1971 to 2002

Managers and public policy makers require information on the status of and trends in contaminant levels in organisms to assess ecosystem health. Seabirds are excellent bioindicators because they are long-lived, feed at different trophic levels, and are at the top of the food chain, and many are abundant and widely distributed. They can reveal spatial or temporal trends in contaminant levels. In this paper, we examine temporal trends in the levels of cadmium, chromium, lead, manganese, mercury, and selenium in eggs from common terns (Sterna hirundo) nesting on several salt marsh islands in Barnegat Bay, New Jersey. We test the null hypothesis that there are no temporal differences in levels of cadmium, lead, and mercury from 1971 to 2002 and in chromium, manganese, and selenium from 1992 to 2002. Arsenic was also analyzed in recent years. Levels were highest for manganese, followed by selenium, mercury, arsenic, lead, chromium, and cadmium. The eggs of Barnegat Bay common terns show a decline in levels of cadmium, chromium, and lead. Mercury declined from 1971 to 1982, increased dramatically in 1999, and declined thereafter. Manganese, an essential element, showed a decline (except for 2001), and selenium declined initially, but then remained stable. The data indicate that common terns can serve as useful bioindicators of temporal trends in exposure and that some of the metals of concern in estuarine environments (lead, cadmium) have declined over the past 30 years, although mercury levels are higher than in the early 1980s. The spike in 1999 is unexplained.     

南宁市危重症孕产妇转运平台建设效果评价

目的 探讨危重症孕产妇转运平台在降低危重症孕产妇死亡率中的作用与效果.方法 回顾性收集南宁市6个产科急救中心和六县一区共13个县级产科急救中心2010至2014年的孕产妇活产数、高危数、死亡数等数据,就危重症孕产妇转运平台建立运行后,对高危孕产妇救治及死亡情况进行研究分析.结果 各年份的死亡孕产妇例数相比,差异无统计学意义(χ2=5.325,P=0.256).2014年的高危孕产妇高于2010年、2011年、2012年、2013年(χ2值分别为122.056、433.176、43.802、33.479,均P<0.05);2014年危重孕产妇例数高于2010年、2011年、2012年(χ2值分别为11.727、16.524、24.672,均P<0.05);2014年危重孕产妇和高危之间比例高于2010年、2011年、2012年(χ2值分别为8.329、9.211、21.709,均P<0.05);但2014年死亡孕产妇与危重之间的比例要低于2010年、2011年、2012年、2013年(χ2值分别为10.887、11.581、4.053、4.034,均P<0.05).2010-2014年各级医院危重症孕产妇构成比例基本相同,差异无统计学意义(均P>0.05).一级医院2014年危重孕产妇转诊率较2010年明显升高,差异有统计学意义(χ2=4.352,P=0.037);二级医院2014年危重孕产妇转诊率较2010年和2011年明显升高,差异有统计学意义(χ2值分别为23.358、20.530,均P<0.05).一级医院转诊所花费的时间从2010年的84min下降至2014年约48min,各年份间危重孕产妇转运平均时间比较,差异有统计学意义(F=22.578,P<0.05),且2014年转诊时间均明显短于2010年、2011年、2012年、2013年(t值分别为7.945、6.946、4.443、2.873,均P<0.05).二级医院转诊所花费的时间从2010年的76min下降至2014年的约42min,各年份间危重孕产妇转运平均时间比较,差异有统计学意义(F=130.734,P=0.000),且2014年转诊时间均明显短于2010年、2011年、2012年、2013年(t值分别为19.626、16.460、9.357、6.595,均P<0.05).2010-2014年南宁市孕产妇共死亡人数111例,直接原因导致的死亡人数为53例,占总死亡人数的47.75%;间接原因导致的死亡人数为58例,占总死亡人数的52.25%.统计学分析显示,2013年直接产科原因致死的孕产妇所占死亡人数比例显著低于2010年(χ2=3.978,P<0.05).结论 危重症孕产妇三级转诊平台的有效运行和不断改进,是提高危重症孕产妇救治成功率和降低孕产妇死亡率的有效保障.     

基于CiteSpace可视化分析的发达地区与欠发达地区医院感染研究现状对比

目的　 分析近5年发达地区与欠发达地区在医院感染领域的研究现状,为医院感染领域研究者提供进一步研究思路。方法 运用CiteSpace 5.7.R1软件,选取发达地区的上海、江苏、浙江、广东、福建和欠发达地区的河南、河北、甘肃、广西、贵州作为调查样本,选取2016年1月1日—2020年8月31日这些省份医疗机构在《中华医院感染学杂志》、《中国感染控制杂志》、《中国消毒学杂志》上发表的文章,进行作者、研究机构、关键词的可视化分析。结果 成功纳入发达地区有效文献2 228篇,欠发达地区有效文献1 513篇,从核心作者分析,发达地区以陈文森发文较多,欠发达地区是以杨怀等发文量排名前列。从发文机构分析,发达地区感染领域机构发文量以宁波市第二医院居多,欠发达地区以南阳市中心医院发文较多。发达地区高频关键词为病原菌、医院感染、耐药性,欠发达地区为医院感染、病原菌、感染。关键词突现及关键词聚类发达地区与欠发达地区各有侧重,总的趋势是研究方向转向临床和基础。结论 发达地区与欠发达地区医院感染领域研究内容与热点主题存在一致性也存在差异性,应加强团队间合作,以促进该领域的全面发展。     

Effect of beta-carotene supplementation on the concentrations and distribution of carotenoids,vitamin E,vitamin A,and cholesterol in plasma lipoprotein and non-lipoprotein fractions in healthy older women.

We studied the effect of beta-carotene supplementation on the concentrations and distribution in plasma lipoprotein and non-lipoprotein fractions of carotenoids, alpha-tocopherol, retinol, and cholesterol.

Ten women ingested either 90 mg of beta-carotene or placebo daily for 3 weeks while residing in their homes and eating their usual meals. Carotenoids (beta-carotene, lycopene, lutein/zeaxanthin), retinol, alpha-tocopherol, and cholesterol were measured in plasma lipoprotein and non-lipoprotein fractions before and after treatment.

In the beta-carotene-supplemented group, total plasma beta-carotene increased 14-fold from 0.48 +/? 0.13 to 6.83 +/? 2.12 mumol/L (p = 0.04). Although the greatest increase in beta-carotene was in low-density-lipoproteins (LDL), the magnitude of increase was similar in LDL, high-density-lipoproteins (HDL), and very-low-density-lipoproteins (VLDL). Thus, the relative distribution of beta-carotene in lipoproteins was unchanged: approximately 71% was in LDL, approximately 15% in HDL and approximately 12% in VLDL, before and after beta-carotene supplementation. There were no changes in amounts and distribution in lipoproteins of the other carotenoids, alpha-tocopherol, and cholesterol. There was no change in the amount of retinol in lipoprotein-deficient plasma. There were no changes in total plasma triglycerides. Significant positive correlations were found between LDL- or VLDL-cholesterol and alpha-tocopherol in LDL or VLDL, respectively; between LDL- or VLDL-cholesterol and lutein/zeaxanthin in LDL or VLDL, respectively; and between HDL-cholesterol and beta-carotene in HDL.

beta-Carotene supplementation (90 mg/day for 3 weeks) in healthy older women results in an enrichment of all plasma lipoprotein fractions with beta-carotene, but does not alter the relative distribution of beta-carotene in lipoproteins. beta-Carotene supplementation has no effect on the amounts and relative distribution of lycopene, lutein/zeaxanthin, and alpha-tocopherol in lipoproteins, or of retinol in the non-lipoprotein fraction of plasma. Short-term beta-carotene supplementation has no effect on the concentrations of plasma total triglycerides, total cholesterol, HDL-, LDL-, and VLDL-cholesterol.     

Role of birthplace in chronic disease in adults and very old individuals: national cohorts in the UK and USA, 2009–2010

Objectives

To understand the role of birthplace in chronic disease in adults and very old individuals.

Study design

Two national and population-based studies (UK Longitudinal Household Survey and US National Health and Nutrition Examination Surveys) in 2009–2010 were included.

Method

Information on demographics, lifestyle factors and self-reported chronic diseases was obtained by household interview. Analyses included Chi-squared test, t-test and logistic regression modelling.

Results

In the UK, there were more cases of heart failure and myocardial infarction in adults (aged 20–79 years) born in Scotland, and more cases of coronary heart disease in adults born in Northern Ireland. There were fewer cases of asthma, depression and hypothyroidism in adults born in Northern Ireland and not born in the UK, and fewer cases of cancer, chronic bronchitis and epilepsy in adults not born in the UK. In USA, there were fewer cases of asthma, cancer, chronic bronchitis, heart failure and heart attack, but more cases of liver disease in adults born in Mexico. Similarly, there were fewer cases of asthma, cancer and chronic bronchitis in adults born in other Spanish or non-Spanish countries, although there were more cases of liver disease in other Spanish-born adults and more cases of diabetes in other non-Spanish-born adults. In very old (≥80 years) individuals, there were more cases of chronic bronchitis in those born in Wales, more cases of myocardial infarction in those born in Northern Ireland, and more cases of diabetes and liver disease in those not born in the UK. Overall, diabetes was more common in foreign-born adults, and respiratory illness and cancer were more common in native-born adults.

Conclusions

It is suggested that future health policy and public health programmes should consider birthplace.     

2010年与2015年江西省老年人群恶性肿瘤疾病负担研究

目的 分析2010年和2015年江西省老年人群恶性肿瘤的疾病负担及其变化趋势,为该省肿瘤防控策略的制定提供依据。 方法 从2015年中国分省份疾病负担研究中选取2010年和2015年江西省老年人群恶性肿瘤的发病数、死亡数、过早死亡损失寿命年(years of life lost, YLL)、伤残损失寿命年(years lived with disability, YLD)和伤残调整寿命年(disability-adjusted life year, DALY)等数据,使用2010年全国人口普查数据作为标准人口,计算标化的发病率、死亡率和DALY率,以此评价江西省老年人群恶性肿瘤的发病、死亡和疾病负担的变化情况。 结果 江西省老年人群恶性肿瘤总体标化发病率、标化死亡率和标化DALY率均为男性>女性。 2015年相比2010年,恶性肿瘤总体标化发病率在50～<70岁组和70~岁组中分别上升1.66%和下降5.24%,标化发病率前五位为肺癌、胃癌、肝癌、乳腺癌和结肠癌;总体标化死亡率在两个年龄组分别下降4.18%和9.12%,而总体标化DALY率分别下降5.24%和11.63%,标化死亡率和DALY率前五位均为肺癌、肝癌、胃癌、结直肠癌和食管癌。此外,2010年和2015年,YLL/DALY达95%以上;前三位癌种肺癌、肝癌和胃癌的DALY占总体的60.56%和60.00%。 结论 2015年疾病负担相对2010年有所下降。江西省老年人群需要重点防治的恶性肿瘤是肺癌、肝癌和胃癌,男性是重点防控对象。     

动物性食品中兽药残留水平及膳食安全性评价

目的 :了解成都地区动物性食品中兽药残留水平 ,探讨其污染来源 ,评价其膳食安全性。方法 :采用分层多级整群随机抽样 PPS(按容量比例概率抽样 )确定 ,高效液相色谱法测定样品 ,测定结果依 GB16 86 9— 2 0 0 0及最大允许限量 (MRL )和日允许摄入量 (ADI)评价。结果 :氯霉素、呋喃唑酮、喹乙醇、林可霉素、四环素类、磺胺类等 18药物均被检出 ,总阳性检出率为 8.387% ;残留量最高为 2 1.32 0 (金霉素 ,猪肝 ) ,最低为 0 .0 2 3mg/ kg(磺胺 ,鸡肉 )。其中 ,林可霉素、氯霉素、四环素类阳性检出率分别为 8.0 0 %、1.71%和 6 .85 7% ;其阳性超标率分别为 92 .86 %、10 0 %和 73.91%。磺胺类阳性检出率为 12 .5 86 % ;呋喃唑酮检出率为 8.84 9% ;喹乙醇检出率为 5 .30 9%。其阳性超标率分别为 85 .71%、90 .0 0 %和 83.33% ;城乡牛肉、鸡肉中林可霉素残留量分别达到 MRL 10 .2 2倍、12 .8倍、12 .4 3倍和 2 8.2倍 ;城乡猪肉中土霉素、金霉素残留量分别达到 MRL的14 .5 8倍、11.3倍、5 .4倍和 2 .4倍 ;城市牛肉、猪肉、鸡肉中甲氧苄啶残留量分别达到 MRL的 8.75倍、1.3倍和 1.4倍 ,农村牛肉、猪肉、鸡肉中甲氧苄啶残留量分别达到 MRL的 3.7倍、6 .6倍、4 .5倍 ;城乡猪肉、猪肝中喹乙醇残留量分别达到 MRL的 6