Firefighters' and instructors’ absorption of PAHs and benzene during training exercises

IntroductionTraining fires may constitute a major portion of some firefighters’ occupational exposures to smoke. However, the magnitude and composition of those exposures are not well understood and may vary by the type of training scenario and fuels.ObjectivesTo understand how structure fire training contributes to firefighters' and instructors’ select chemical exposures, we conducted biological monitoring during exercises involving combustion of pallet and straw and oriented strand board (OSB) or the use of simulated smoke.MethodsUrine was analyzed for metabolites of polycyclic aromatic hydrocarbons (PAHs) and breath was analyzed for volatile organic compounds (VOCs) including benzene.ResultsMedian concentrations of nearly all PAH metabolites in urine increased from pre-to 3-hr post-training for each scenario and were highest for OSB, followed by pallet and straw, and then simulated smoke. For instructors who supervised three trainings per day, median concentrations increased at each collection. A single day of OSB exercises led to a 30-fold increase in 1-hydroxypyrene for instructors, culminating in a median end-of-shift concentration 3.5-fold greater than median levels measured from firefighters in a previous controlled-residential fire study. Breath concentrations of benzene increased 2 to 7-fold immediately after the training exercises (with the exception of simulated smoke training). Exposures were highest for the OSB scenario and instructors accumulated PAHs with repeated daily exercises.ConclusionsDermal absorption likely contributed to the biological levels as the respiratory route was well protected. Training academies should consider exposure risks as well as instructional objectives when selecting training exercises.     

腰痛散循经火疗治疗寒湿腰痛临床研究

目的:观察腰痛散循经火疗治疗寒湿腰痛的临床疗效。方法:选取寒湿腰痛患者60例,按随机数字表法分为治疗组和对照组各30例。对照组采用腰痛散湿热敷,治疗组在对照组湿热敷的基础上运用腰痛散循经火疗。采用疼痛数字评分法(NRS)和日本骨科协会评估治疗分数(JOA)分别对2组患者进行客观评价,比较2组临床疗效。结果:治疗组总有效率为96.66%,显著高于对照组73.33%(P<0.05)。治疗前,2组NRS评分、JOA评分比较,差异均无统计学意义(P>0.05)。治疗后,2组NRS评分较治疗前降低,JOA评分较治疗前升高(P<0.05);且治疗组NRS评分低于对照组,JOA评分高于对照组(P<0.05)。结论:腰痛散循经火疗治疗寒湿腰痛效果显著,症状改善明显,安全有效,进一步提高了患者的生活质量。     

Assessment of blood 2-aminothiazoline-4-carboxylic acid concentrations: Age and sex differences,and correlation with carboxyhemoglobin in fire victims

Recently, 2-aminothiazoline-4-carboxylic acid (ATCA), a cyanide (CN) metabolite, has been proposed as a stable diagnostic marker of CN poisoning. In this study, liquid chromatography coupled with electrospray ionization – tandem mass spectrometry was used to quantify ATCA concentrations in human postmortem blood samples, and differences in ATCA concentrations according to age and sex were determined. Both age and sex had significant effects on blood ATCA concentrations. Although ATCA concentrations exhibited an inverted U shape with increasing age in men, in women ATCA concentrations plateaued at around 40–59 years of age. There were significant differences between the sexes in ATCA concentrations for the 20–39 and 40–59 year age groups (P < 0.05 and P < 0.01, respectively). Correlations between ATCA concentrations and carboxyhemoglobin (CO-Hb) saturation were also examined in fire victims. ATCA concentrations increased significantly with increasing CO-Hb saturation (r = 0.382, P < 0.01). In addition, ATCA concentrations were also correlated to CN concentrations (r = 0.309, P < 0.05). The results of our study may provide novel information about the contribution of CN poisoning to the cause of death at fire scenes.     

子午流注火针刺法对急性痛风性关节炎的临床疗效观察

目的选择急性痛风性关节炎患者为研究对象,基于子午流注理论采用火针治疗方式,观察临床疗效及对血清尿酸水平的影响。方法将符合急性痛风纳入标准的60例随机分组,治疗组采用基于子午流注火针疗法,对照组采用口服依托考昔及少量秋水仙碱。疗程1周,观察对比患者治疗前后临床证候(关节疼痛、压痛、红肿及活动度)积分、疗效指数及血清尿酸水平。结果治疗组总有效率达100.00%,明显优于对照组总有效率83.33%(P<0.01);治疗组血清尿酸降低水平优于对照组。结论子午流注火针疗法可明显改善急性痛风患者的临床症状,降低血清尿酸水平。     

Hot ash burns in the children of Western Australia: How and why they happen

Introduction

Burns from hot ash are common in the paediatric population in Western Australia. Fifty children were admitted to the paediatric burn centre with hot ash contact burns to the feet in 2011 and 2012. It is important to examine the extent of the problem, seasonal variations, and identify those at risk to determine strategies for prevention campaigns.

Method

Retrospective review of medical notes for all admissions to the paediatric burns unit was undertaken for 2011 and 2012. Data were collected for patient demographics, time, circumstance of injury, burn severity and treatment.

Results

Hot ash burns accounted for 8.6% of admissions but 16.1% of burns sustained in non-metro areas. Median age was just under 3 years, male or female. Median burn TBSA was 2%, and 44% of children required surgery. The burns were less common in summer, more common on non-school days and in children who were on camping trips away from home.

Discussion

Previous work has shown the value of targeted campaigns. The group for targeted prevention campaigns are the carers of very young children who go camping. Information distributed at camping shows and stores about the principles of campfire safety would reach the people at risk.     

火针治疗非哺乳期乳腺炎评介

火针疗法是一种独特的中医传统外治方法,具有以针代刀提脓泻毒等多种功效。非哺乳期乳腺炎是一种常见的难治性乳腺良性疾病,其病情复杂多变,易形成脓肿和窦道、瘘管,迁移难愈,适合火针治疗,但相关研究较少。在总结古今医家运用火针治疗非哺乳期乳腺炎临床经验的基础上,对火针治疗非哺乳期乳腺炎的适应证、禁忌证、操作方法及注意事项进行了规范。     

Fire/flames mortality in Australian children 1968–2016, trends and prevention

IntroductionMortality attributed to fire and flame for children (0?14 years) over a fifty-year period has not been previously analyzed in Australia. The literature has focused on these deaths over a shorter time period or disaggregated with other causes of burns or deaths in one burns center. However, mortality associated with fire/flames affects this age group the greatest. The aims of this study are to: (1) develop a trends analysis of fire and flames mortality between1968 to 2016, using the Australian Bureau of Statistics (ABS) mortality database and, (2) determine the association of interventions with fire and flames mortality using the Haddon's categorical intervention framework.MethodsInternational Classification of Disease (ICD) codes were extracted and code equivalencies between ICD 8, 9, 10 and the Australian Bureau of Statistics for fire/flames data between 1968-–2016 were assessed. To determine whether population changes affected the risks of mortality, the frequency and, rates per 100,000 were used. A literature review was conducted that summarized the current knowledge of interventions associated with the major decreases in the fire and flames mortality rate.ResultsIn Australia, we found was a downward trend for the period although with significant variation from year to year when compared to external cause mortality. Additionally, there were multiple successful interventions associated with a sustained decrease in mortality. After 2016, child fire-related mortality remains a problem particularly in low socioeconomic groups and indigenous peoples. A combination of research, public awareness, engineering, legal enforcement, advancements in burns care and, evidence-based policy development all have a role to play in future injury prevention initiatives. Although direct causation to an individual is not possible, associations can be drawn from interventions on a population level to decreases in mortality.ConclusionWe found was a steady decline in both rates and frequency of childhood fire and flames mortality from 1968 to 2016 associated with multiple interventions.     

复式针刺补泻对臀大肌挛缩术后髋关节和膝关节屈伸角度的影响

目的：观察复式针刺补泻对臀大肌挛缩术后患者运动步态髋、膝关节屈伸角度的影响。方法：将66例臀大肌挛缩术后患者按随机数字表分为两组,每组33例。观察组在康复治疗基础上,予针刺患侧秩边、环跳、居髎,行透天凉泻法;患侧髀关、伏兔、足三里、丰隆、血海、地机、阳陵泉,行烧山火补法。对照组仅予与观察组相同的基础康复治疗。每日治疗1次,30天为1个疗程,连续治疗3个疗程,疗程间休息1星期。使用Lokomat全自动机器人步态评定系统对患者进行运动步态髋、膝关节的屈伸角度测定。结果：观察组患者髋关节屈曲角度值(HFA-FF)、髋关节屈曲角度最大值(MAX-HFA)、髋关节伸展角度最大值(MAX-HEA)、膝关节屈曲角度值(KFA-FF)、支撑相膝关节屈曲角度最大值(MAX-KFA-TP)、摆动相膝关节屈曲角度最大值(MAX-KFA-WP),及对照组患者髋关节屈曲角度值(HFA-FF)、髋关节伸展角度最大值(MAX-HEA)和膝关节屈曲角度值(KFA-FF)与治疗前均有统计学差异(P＜0.05)。观察组髋关节屈曲角度值(HFA-FF)、髋关节屈曲角度最大值(MAX-HFA)、髋关节伸展角度最大值(MAX-HEA)、膝关节屈曲角度值(KFA-FF)及支撑相膝关节屈曲角度最大值(MAX-KFA-TP)与对照组差异有统计学意义(P＜0.05)。结论：复式针刺补泻可提高臀大肌挛缩术后髋、膝关节功能,改善步态运动。     

郑寿全《医理真传》贵“中”思想浅探

通过分析郑寿全《医理真传》,认为郑氏虽为"火神派"的代表,虽然擅用姜、附、桂,但是其更加重视中土脾胃,即贵"中"。贵"中"思想更能代表郑氏的学术思想。提出贵"中"思想可以使我们更加全面地认识和继承郑氏的学术思想。