薄层低剂量CT扫描对周围型肺癌的诊断价值研究

目的评价薄层低剂量螺旋CT(LDCT)显示周围型肺癌基本征象。方法对43例肺癌病灶同时接受薄层LDCT和HRCT检查,准直宽度2.5mm,层厚2.5mm,重建间隔1.5～2.5 mm,球管旋转周期0.8s,薄层LDCT管电流为20～50 mA,HRCT为260～300 mA。分别对LDCT和HRCT所显示的肺癌征象进行分析,同时对病灶作定性诊断。结果薄层LDCT准确显示了周围型肺癌中基本征象,其中包括分叶征、支气管征、毛刺征、胸膜凹陷征和血管集中征等,并能对大部分病灶做出正确诊断,与HRCT扫描有很好一致性。结论薄层LDCT能准确显示周围型肺癌基本征象,当能做出准确定性诊断时,不需要做HRCT检查。     

胸部螺旋CT不同重建间隔及层厚与肺结节检出率的关系分析

目的　分析普通螺旋CT重叠重建图像及多层螺旋CT较薄层厚重建图像能否增加螺旋CT检测肺结节的数目。方法　对已确诊肺结节病人进行了 4 8次胸部螺旋CT扫描 ,并进行了重叠图像重建 (普通螺旋CT)及较薄层厚图像重建 (多层螺旋CT)。两位阅片者记录肺结节的大小、数目。结果　重叠重建图像比非重叠重建图像中分辨出更多的肺结节和更多的确定的肺结节 ;3mm层厚重建图像分辨比 8mm层厚重建图像分辨更多确定的肺结节。结论　胸部螺旋CT只有在重叠重建图像及较薄层厚重建图像上才能显示更多的小于层厚的肺结节。     

CT增强双期扫描在胸部疾病诊断中的应用

目的:初步探讨螺旋CT增强双期扫描技术在胸部疾病诊断中的应用价值。方法:对100例胸部疾病患者行螺旋CT增强双期扫描(以2～4ml/s的速度注入对比剂),分别在23～28s(血管期)及90~120s(延迟期)行胸部螺旋扫描,观察病变与血管及病变强化情况。结果:血管期能清晰显示病变与血管的关系,延迟期能准确显示病变强化情况。结论:在胸部CT增强扫描中推荐采用双期扫描技术。     

薄层CT扫描对早期周围型肺癌的诊断价值：附20例报告

本院自1991年5月至1994年5月对20例早期周围型肺癌进行了薄层CT扫描(层厚1.5mm,层距1.5mm)。全部病例均经手术及病理证实。其中腺癌14例,鳞癌5例,小细胞癌1例。其结果表明:薄层CT扫描对病灶的分叶、毛刺、细胞血管积聚征的显示率达100％。对胸膜凹陷征和空泡征的显示率达76.2％。诊断符合率达90％。由于可见薄层CT扫描     

低剂量多层CT最大密度投影检出肺小结节的研究

目的 研究多层CT（MSCT）低剂量扫描图像最大密度投影（MIP）重建对肺小结节的检出情况.方法 将8例尘肺患者的尸检离体肺脏制成充气固定肺标本,分别行多层CT常规剂量（100mA）和低剂量（50、30和10 mA）扫描,层厚5 mm,重建间隔5 mm,标准算法重建,并做1.25mm薄层无重叠重建,然后以1.25mm薄层图像行8.5 mm MIP重建,比较不同剂量重建图像对肺小结节的显示.结果 3种低剂量MIP与常规剂量MIP重建图像对8例尘肺标本检出的肺小结节数量分别为217、214、207及223,差异均无统计学意义（P＞0.05）.3种低剂量MIP显示结节的敏感性分别为97.31%、95.96%及92.83%,特异性分别为63.16%、63.16%和47.37%,阳性预测值分别为96.87%、96.83%和95.31%.结论 多层CT常规层厚、低剂量扫描,薄层重建后行MIP重建,能理想的显示常规剂量扫描MIP重建所能显示的肺小结节.     

64排螺旋CT低剂量普查早期肺癌的临床应用

目的:探讨64排容积CT(VCT)低剂量普查早期肺癌的扫描方法及临床应用。方法:对30例无症状的受试者行肺部低剂量64排螺旋CT扫描,扫描参数为:120 kVP、40~60 mAs,层厚5 mm,层距1 mm,螺距为1。在CT图像上,统计病变的检出例数,观察肺叶、段支气管显示情况。结果:100%叶、段支气管可显示;显示3mm以上的肺结节4例,纵隔淋巴结增大2例及冠状动脉钙化2例。结论:5mm 64排螺旋CT连续扫描方法适合开展低剂量普查早期肺癌。     

16层CT冠状MPR在支气管内膜结核中的应用

目的研究胸部16层螺旋CT冠状多平面重组（MPR）在支气管内膜结核中的应用价值。方法选用58例胸部病例,采用GE公司lightspeed 16层螺旋CT机进行扫描,扫描参数采用准直0．75mm,Feed／Rotation 12mm,扫描层厚0．75mm,重建间隔0．75mm,于CT主机或Volume Wizard工作站进行图像后处理。以正中矢状面为参考截面,气管的长轴作为冠状轴,行冠状多平面重组．重组层厚为0．8mm,重组间隔为0．5mm。结果冠状MPR可以良好显示支气管内膜结核的形态、程度和范同。周围病变可清晰显示其位置、形态、大小、周围结构的受累情况。结论胸部16层CT冠状MPR是横轴位的重要补充,在支气管内膜结核的诊断中有着广泛的应用前景。     

煤工尘肺胸膜病变的高分辨率CT形态学表现及其诊断价值

目的　通过煤工尘肺胸膜病变的CT和高分辨率CT(HRCT)检查研究煤工尘肺胸膜病变的可靠的诊断技术。方法　煤矿井下采掘混合工煤工尘肺患者 13 1例 (其中 ,0 14例、Ⅰ期 46例、Ⅱ期 58例、Ⅲ期 13例 )及对照组 2 0例 (均摄有同期高仟伏胸片 ) ,在胸部常规CT扫描后 ,另在 4个固定水平上及感兴趣区加作HRCT扫描 ,而后进行观察对比研究。结果　参照国家尘肺诊断标准中对胸膜病变 -胸膜斑的判定方法 ,共发现胸膜病变者 68例 (51.91% ) ,其中 ,尘肺Ⅰ期 12例 (17.65% )、Ⅱ期 43例 (63 .2 4% )、Ⅲ期 13例 (19.12 % )。据胸膜病变在HRCT的形态表现可分为 :结节型(73 .3 8% )、扁平型 (18.71% )、不规则型 (7.91% )、混合型 ;病变位于胸壁胸膜者占 65.0 2 %、纵隔面占2 2 .16%、心包占 12 .80 %。本组病例肺尖和肋膈角区均未见受累表现 ,胸膜病变厚度以 5～ 10mm者为多见 (88.17% )。结论　煤矿工人胸膜损害并非罕见。HRCT是显示胸膜病变的可靠检查方法 ,是常规CT的补充手段 ,具有重要的诊断和实用价值 ,但需进一步进行影像学与病理学的对照研究     

下肢磁共振成像技术的研究

目的:探讨下肢MRI扫描成像技术。方法:在1.5T磁共振机对50例患者做下肢MRI检查,其中:股骨28例、胫腓骨22例,使用4通道躯体线圈。脉冲序列包括:FSET2WI、SET1WI,所有FSET2WI均采用脂肪抑制技术,FOV42cm×42cm,在横轴位、冠状位、矢状斜位进行定位扫描,横轴位层厚8～10mm,冠状位或矢状位层厚4～5mm。结果:横轴位能清晰显示病变与周围解剖结构关系。冠状位、矢状斜位能清晰显示病变的大体轮廓及与相邻组织关系。结论:正确的扫描方法、合理的参数和脉冲序列的正确使用有助于显示正常下肢解剖结构及病变,帮助定位和诊断。     

弥漫性肺疾病高分辨CT与多排螺旋CT薄层重组的对照研究

目的：探讨高分辨CT（HRCT）与多排螺旋CT（MSCT）薄层重组对弥漫性肺疾病的诊断价值,以及HRCT是否能被MSCT薄层重组所替代。方法：搜集同时做HRCT及MSCT薄层重组的弥漫性肺疾病患者51例进行回顾性分析。结果：51例患者在MSCT薄层重组中48例有不同程度的肺内改变：双肺弥漫性或散在小结节影12例;肺内弥漫分布网格状改变22例,可显示小叶间隔线增厚;肺内弥漫分布囊状透亮区病变14例,可显示弥漫分布的囊性病变。HRCT图像可更加清晰地显示肺内小结节影分布情况,弥漫分布网格状影像,对于弥漫分布囊状透亮区,HRCT能够明确分辨小叶中央型及全小叶型病变,51例均有阳性发现。结论：MSCT薄层重组对弥漫性肺疾病的诊断阳性率与HRCT无明显差别,但细节分辨率及图像质量低于HRCT,因此不能完全替代HRCT扫描。     

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.     

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.     

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.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

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.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.