老年食管癌合并糖尿病的围手术期处理

[目的]总结探讨老年合并糖尿病的食管癌围手术期的治疗.[方法]对32例≥60周岁的老年合并糖尿病的食管癌患者围手术期应用胰岛素治疗,控制血糖处于正常或略高水平,同时使尿糖维持在(±)～( ).手术方式均为食管癌根治术.[结果]32例手术根治切除率100%,术后并发症4例,肺部感染2例,电解质紊乱1例,切口感染1例,围手术期血糖控制良好,均愈合出院.[结论]正确有效的控制老年合并糖尿病的食管癌患者围手术期血糖水平,是保证手术成功,减少并发症,降低死亡率的关键.     

食管癌合并糖尿病患者的围手术期处理

目的：探讨食管癌合并糖尿病患者的外科手术围手术期处理。方法：回顾25例食管癌合并糖尿病患者的围手术期治疗经验。结果：25例全部手术切除，无围手术期死亡，无酮症酸中毒发生。结论：食管癌合并糖尿病患者在围手术期解决好营养支持与控制血糖问题，可大大地减少并发症的发生率，此类患者仍应首选手术治疗。     

糖尿病与妇科围手术期的关系

目的探讨合并糖尿病的妇科手术患者围手术期的处理方法。方法回顾分析50例糖尿病患者施行中型或大型妇科手术的临床资料。结果术前行降糖治疗,使术前、术中、术后血糖浓度控制在7．0-8．6mmol／L（120-150mg/dL）较安全。伤口Ⅰ期愈合47例,愈合率为94．0％;伤口感染Ⅱ期愈合3例,愈合率为6．0％;50例糖尿病患者全部安全度过围手术期。结论糖尿病患者术前、术后积极治疗,合理使用胰岛素,以保持围手术期血糖浓度的稳定,同时合理使用抗生素,选择合理的手术时间及麻醉方式是手术成功的关键。     

妇科手术与糖尿病

目的:探讨合并糖尿病的妇科手术患者围手术期处理方法。方法:回顾性分析48例妇科手术患者合并糖尿病的围手术期控制血糖的方法。结果:术中术后将血糖控制在7.0~8.0 mmol/L较安全,伤口Ⅰ期愈合46例(95.8%),伤口感染致Ⅱ期愈合2例(4.1%),均安全度过围手术期。结论:①对无糖尿病病史的妇科手术患者,当首次空腹血糖为5.6~6.9 mmol/L时,应检查餐后2 h血糖或随机血糖,以便及时发现糖尿病、及时治疗;②围手术期血糖保持稳定,是手术成功的关键因素之一。     

急腹症合并糖尿病患者的围手术期护理

目的总结急腹症合并糖尿病的围手术期的护理经验,提高护理水平。方法30例合并糖尿病的急腹症患者,不同的病情和治疗阶段采取有针对性的护理措施,特别是针对高血糖患者采取有效的护理措施。结果本组30例,治愈28例,死亡2例,切口1期愈合20例,延期愈合7例,3例长期不愈合。结论加强围手术期的观察和护理,对合并糖尿病的急腹症患者的治疗起着重要作用。     

外科病人合并糖尿病的围手术期处理

目的探讨糖尿病人的围手术期处理方法。方法对42例外科病人合并糖尿病的围手术期诊断与治疗进行回顾性分析。结果糖尿病以Ⅱ型为主,老年患者占85.7%,术前漏诊4例,术后发生低血糖反应3例,发生高渗性非酮症昏迷死亡1例。结论对糖尿病患者合理使用胰岛素,严格控制血糖,是围手术期处理的有效方法。     

糖尿病对肝脏损伤围手术期治疗的影响

目的探讨糖尿病对肝脏损伤围手术期治疗的影响及处理.方法对39例肝脏损伤并存糖尿病病人围手术期诊断与治疗进行回顾性分析.结果 39例病人中36例进行手术治疗,糖尿病以2型糖尿病多见,术后并发症发生率:切口感染7例次(17.95%),吻合口瘘或胆瘘3例次(7.69%),肺部感染2例次(5.13%),腹腔感染3例次(7.69%),泌尿系感染1例次(2.56%),高渗性非酮症昏迷及酮症酸中毒1例次(2.56%),病人术后平均住院时间32.9 d.结论糖尿病能增加肝脏损伤手术治疗围手术期并发症的发生,严格控制围手术期血糖,选择合理术式,有利于安全渡过围手术期.     

口腔手术合并糖尿病围手术期处理

目的探讨口腔手术合并糖尿病的为手术期处理。方法对22例合并糖尿病患者在围手术期采用胰岛素泵控制血糖。结果22例合并糖尿病患者,均在术后7d～10d拆线,切口甲级愈合。结论对合并糖尿病患者手术前后进行及时正确处理,可使患者安全耐受手术,减少伤口感染机会。     

口腔手术合并糖尿病围手术期处理

目的 探讨口腔手术合并糖尿病的为手术期处理.方法 对22例合并糖尿病患者在围手术期采用胰岛素泵控制血糖.结果 22例合并糖尿病患者,均在术后7 d～10 d拆线,切口甲级愈合.结论 对合并糖尿病患者手术前后进行及时正确处理,可使患者安全耐受手术,减少伤口感染机会.     

急腹症合并糖尿病患者的围手术期护理

目的 总结急腹症合并糖尿病的围手术期的护理经验，提高护理水平。方法 30例合并糖尿病的急腹症患者，不同的病情和治疗阶段采取有针对性的护理措施，特别是针对高血糖患者采取有效的护理措施。结果 本组30例，治愈28例，死亡2例，切口1期愈合20例，延期愈合7例，3例长期不愈合。结论 加强围手术期的观察和护理．对合并糖尿病的急腹症患者的治疗起着重要作用。     

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.