尿激酶联合苯那普利治疗IgA肾病的疗效观察

[目的]探讨尿激酶联合苯那普利治疗IgA肾病的临床疗效。[方法]140例IgA肾病患按随机数字表法分为对照组(70例)和观察组(70例),观察组患者应用尿激酶加苯那普利联合治疗,对照组单纯应用苯那普利。比较两组的治疗效果。[结果]6个疗程后,观察组的尿蛋白量和Scr水平与治疗前相比明显降低,Alb水平和Ccr显著升高(P﹤0.05,0.01),且改善水平显著优于对照组(P﹤0.05);观察组的总有效率为74.3%(52/70),明显高于对照组51.4%(36/70),差异有统计学意义(χ2=7.83,P﹤0.01)。[结论]尿激酶联合苯那普利治疗IgA肾病疗效确切,能显著改善肾功能,优于单纯使用苯那普利,值得临床进一步推广应用。     

爱迪联合放射综合治疗老年中晚期食管癌的临床疗效观察

[目的]探讨爱迪联合放射综合治疗老年中晚期食管癌的疗效和安全性。[方法]80例老年中晚期食管癌患者按随机数字表法分为观察组和对照组各40例。对照组采用单纯放疗,观察组加用爱迪注射液。[结果]观察组近期疗效有效率为77.5%(31/40),对照组为55.0%(11/40),差异有统计学意义(χ2=4.53,P﹤0.05);观察组生活质量有效率为87.5%(35/40),对照组为65.0%(26/40),差异有统计学意义(χ2=5.59,P﹤0.05);观察组毒副反应较轻,Ⅲ～Ⅳ度白细胞减少和食管黏膜反应明显少于对照组,差异有统计学意义(χ2=4.50,P﹤0.05);观察组1年生存率为72.5%(29/40),对照组为47.5%(19/40),差异有统计学意义(χ2=5.21,P﹤0.05)。[结论]爱迪联合放射综合治疗老年中晚期食管癌能明显提高疗效,减轻毒副反应,改善生活质量,延长生存期,更易为老年患者所接受,值得临床推广应用。     

联合应用泮托拉唑、铝碳酸镁和莫沙必利治疗胃食管反流病疗效观察

[目的]探讨联合应用泮托拉唑、铝碳酸镁和莫沙比利治疗胃食管反流病(GERD)的临床疗效。[方法]将101例GERD患者随机分为A(n=36)、B(n=34)和C组(n=31),分别采用泮托拉唑+铝碳酸镁+莫沙比利、泮托拉唑+莫沙比利及铝碳酸镁+莫沙比利治疗。4及8周后评价临床症状,8周后评价内镜下有效率。[结果]治疗4周后,A、B和C组患者临床症状总改善率分别为89.9%、79.4%和61.3%,A组与B、C组相比差异有统计学意义(P﹤0.05)。治疗8周后,A、B和C组患者临床症状总改善率分别为97.2%、88.2%和71.0%,内镜下有效率分别为94.4%、86.3%和67.3%,A组临床症状总改善率和内镜下有效率与B泮托C组相比差异有统计学意义(P﹤0.05;χ2=8.6496,P﹤0.05)。[结论]泮托拉唑联合铝碳酸镁和莫沙比利治疗GERD临床疗效良好。     

阿苯达唑治疗囊性包虫病影像学观察与其病理形态关系的探讨

目的对比观察23例无禁忌症的囊性包虫病例的29个不同病理形态的包囊,经阿苯达唑乳剂药物治疗一年以上,B超影像结果评价在药物治疗过程中,包囊病灶变化情况,了解药物对包囊病灶的疗效与其病理形态的关系。方法对23例包虫病患者,用阿苯达唑乳剂治疗(规格12.5mg/ml)0.8ml/kg/d,14岁儿童1.0ml/kg/d,早晚两次,餐后服用,连续服药一年以上,对比分析23例包虫病例的29个各种类型包囊病灶,(包括CE1单囊型7个、CE2多子囊型18个、CE3内囊破裂型4个、)。在治疗3个月内、6个月内、9个月内、12个月内,在相同部位、相同切面B超扫查,记录包囊形态及内部结构。结果各疗程、各类型的囊性包虫病病理形态发生改变的快慢不同,治愈率,有效率均不相同。总治愈率为82.76%(24/29)、总有效率89.66%(26/29)、总无效率为10.34%(3/29),其中对多子囊型(CE2型)病灶疗效最好,治愈率较高为100%(18/18)。结论阿苯达唑乳剂对囊性包虫病疗效好,治愈率较高,且包虫不同的病理形态,疗效差异很大。     

复方玄驹胶囊联合盐酸特拉唑嗪治疗Ⅲ型前列腺炎的疗效评价

[目的]评价复方玄驹胶囊联合盐酸特拉唑嗪治疗Ⅲ型前列腺炎患者的疗效和安全性。[方法]100例Ⅲ型前列腺炎患者分为观察组和对照组:50例为观察组,采用复方玄驹胶囊联合盐酸特拉唑嗪治疗;50例为对照组,口服盐酸特拉唑嗪片。[结果]观察组总有效率为86.00%(43/50),高于对照组总有效率64.00%(32/50),差异有统计学意义(P﹤0.01)。治疗后,观察组患者NIH-CPSI评分及EPS-WBC计数改善程度明显优于对照组,差异有统计学意义(P﹤0.01)。治疗期间两组均未见明显的不良反应。[结论]复方玄驹胶囊联合盐酸特拉唑嗪治疗Ⅲ型前列腺炎患者疗效可靠,副作用小,值得临床推广应用。     

鼻窦内窥镜手术预后的相关影响因素分析

[目的]结合临床实践经验,分析鼻窦内窥镜手术预后的相关影响因素。[方法]采用总结回顾分析法,将研究对象的临床资料进行搜集整理,分析鼻窦内窥镜手术预后的相关影响因素。用Microsoft Excel 2007建立数据库,运用SPSS 15.0统计软件进行统计分析。[结果]患者临床分型:Ⅰ型12例,Ⅱ型36例,Ⅲ型17例。按海口ESS疗效标准,Ⅰ型患者有效率为91.67%,Ⅱ型有效率为94.44%,Ⅲ型有效率为76.47%,3组比较差异有统计学意义(χ2=7.32,P﹤0.05),运用统计软件进行两两比较,各组之间差异亦有统计学意义(P﹤0.05),I型与Ⅱ型患者的有效率明显高于与Ⅲ型。[结论]鼻窦内窥镜手术的预后情况受各种因素影响,在做好规范性手术治疗的同时应把握好手术后综合性治疗原则,以局部治疗为主,全身治疗为辅,进行及时和规范的随访,以更好地促进患者康复。     

200例脑囊虫病疗效及不良反应分析

目的 评价阿苯达唑、吡喹酮治疗脑囊虫病的疗效及不良反应.方法 将2002-2007年收治的脑囊虫病病例资料,随机抽取200例,分单纯使用阿苯达唑治疗组58例和吡喹酮、阿苯达唑联合治疗组142例两组,进行上述目的 分析.结果 治疗后两组临床有效率差异无统计学意义(P>0.05);颅内高压症、癫痫发作、精神症状的不良反应发生率阿苯达唑组少于联合治疗组,差异有统计学意义(P<0.05);过敏反应两组差异无统计学意义(P>0.05).结论 阿苯达唑、吡喹酮治疗脑囊虫病疗效肯定,但吡喹酮和阿苯达唑联合用药的不良反应较阿苯达唑单独用药严重.     

肝包虫病患者超声影像动态观察

目的了解四川省石渠县肝包虫病患者B超影像的变化过程及趋势,分析变化规律,提高对包虫病的超声影像识别能力,了解阿苯达唑大规模社区治疗情况。方法通过现场超声检查及血清学检测,对患者进行跟踪随访;通过Excel建立2个队列数据库,分别比较病灶1年及2年后的影像变化特点;以Fisher确切概率法,对病灶退化率进行比较。结果共计随访606例,获得618个病灶的清晰图像; 1年随访后,与其他阶段的囊型包虫病相比,CE3型病灶退化率较高,达到16. 42%(P0. 05),其他各型之间退化率差异无统计学意义(P0. 05); 2年随访后,与其他阶段的囊型包虫病相比,CE3型病灶退化率较高,达到45. 45%(P0. 05),其他各型之间退化率差异无统计学意义(P0. 05)。结论本研究中涉及的病灶变化可推测为自然转归,表明阿苯达唑大规模社区治疗依从性差; CE3是囊型包虫病中最不稳定的类型,易退化为CE4; CE3、CE4的囊壁可直接被肝组织吸收;泡型包虫病中似血管瘤型不稳定,发展为伪囊型。     

美托洛尔联合稳心颗粒治疗心房颤动50例

[目的]探讨酒石酸美托洛尔联合稳心颗粒治疗AF的疗效。[方法]98例AF随机分为对照组(常规治疗加服酒石酸美托洛尔50～100mg/d,分2～3次口服)及治疗组(对照组治疗的基础上加服稳心颗粒每次1包(9g),3次/日)。[结果]治疗组的疗效优于对照组(χ2=5.26,P﹤0.05)。治疗组发生缺血性脑卒中的总发生率低于对照组,但差异无统计学意义(χ2=3.37,P﹥0.05)。[结论]洒石酸美托洛尔联合稳心颗粒治疗对AF具有较好的疗效。     

高压氧治疗重型颅脑损伤的临床疗效观察

[目的]探讨高压氧治疗重型颅脑损伤的临床疗效。[方法]回顾性分析2008年6月～2011年6月某院收治的79例重型颅脑损伤患者的临床资料,79例患者按治疗方式不同分为观察组和对照组,对照组给予常规治疗,观察组在常规治疗的基础上待患者病情稳定、排除禁忌证后给予高压氧治疗。比较两组近远期临床疗效。[结果]两组入院时GCS评分差异无统计学意义(Z=2.893,P﹥0.05),治疗后7d和14d观察组GCS评分显著高于对照组(Z=4.098,5.310,P﹤0.05);观察组恢复良好率显著高于对照组(χ2=5.853,P﹤0.05),植物生存率和死亡率显著低于对照组(χ2=5.388,9.469,P﹤0.05)。两组中、重度残疾率比较差异无统计学意义(χ2=2.939,2.963,P﹥0.05)。[结论]高压氧治疗治疗重型颅脑损伤临床疗效显著,可以提高患者恢复良好率、降低植物生存以及死亡率,值得临床应用。     

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.