曲普瑞林治疗子宫肌瘤的临床疗效及安全性探讨

目的：探讨曲普瑞林治疗子宫肌瘤的临床效果，并分析共安全性。方法：随机将78例子宫肌瘤患者分为两组，每组39例，观察组患者使用肌肉注射曲普瑞林，1次／d，每次3．75mg，对照组患者肌肉注射丙氨瑞林，1次／d，每次50μg，3个月为1个疗程。对比治疗前后两组的临床疗效并观察两组患者服药后不良反应。结果：治疗后，观察组患者雌、孕激素及血红蛋白水平得到显著改善，子宫肌瘤体积均明显减小，差异有统计学意义（P〈0．05），观察组临床治疗效果显著优于对照组。结论：曲谱瑞林能够有效减小子宫肌瘤体积，临床疗效显著，无明显不良反应，值得作为临床用药。     

碳纳米管丙氨瑞林对人子宫内膜癌细胞裸鼠皮下移植瘤生长及对Smuff2表达的影响

目的：观察碳纳米管丙氨瑞林对人子宫内膜癌裸鼠皮下移植瘤组织中转化生长因子β1（TGF-β1）诱导的泛素化调节因子2（Smurf2）表达的影响,探讨其可能的作用机制。方法：以人子宫内膜癌Hec-1-B细胞株皮下移植瘤组织作为研究对象,分别给予生理盐水、碳纳米管、丙氨瑞林、碳纳米管丙氨瑞林,四种不同的干预方式,每6天1次,共5次。在干预过程中观察肿瘤生长情况,测量肿瘤体积,干预结束利用免疫组化法（PV）检测各肿瘤组织中Smurf2蛋白的表达。结果：碳纳米管丙氨瑞林组裸鼠精神饮食情况明显优于其他三组,体重明显轻于其他三组。取出移植瘤体后比较,碳纳米管丙氨瑞林组瘤体体积最小,与其他三组比较差异均有统计学意义（P〈0.05）。碳纳米管丙氨瑞林干预组瘤组织中Smurf2蛋白的表达较其他三组表达增多,差异均有统计学意义（P〈0.05）。结论：丙氨瑞林可以抑制子宫内膜癌细胞裸鼠皮下移植瘤的生长,在相同药物剂量条件下,碳纳米管丙氨瑞林作为缓释剂可以更好地增加裸鼠体重和抑制移植瘤组织的生长,有利于减少药物毒副作用,其作用机制可能是通过上调移植瘤组织中Smurf2蛋白来抑制肿瘤生长的。     

不同剂量米非司酮联合曲普瑞林治疗子宫肌瘤的效果

目的 分析不同剂量米非司酮联合曲普瑞林治疗子宫肌瘤的效果。方法 选取丹巴长征骨科医院妇科2022年1—12月收治的80例子宫肌瘤患者,采用随机数字法分为2组,各40例。对照组实施曲普瑞林注射液与常规剂量米非司酮片治疗,观察组实施曲普瑞林注射液与低剂量米非司酮片治疗。分析2组患者治疗效果、血清性激素水平、子宫及肌瘤体积。结果 观察组患者治疗总有效率为97.50%(39/40),对照组为77.50%(31/40),观察组患者治疗总有效率高于对照组（P <0.05）。观察组患者治疗后雌二醇（estradiol,E2）、孕酮（progesterone,P）、黄体生成素（luteinizing-hormone,LH）、促卵泡激素（folliclestimulating-hormone,FSH）均低于对照组（P <0.05）。观察组治疗后子宫和肌瘤体积均小于对照组（P <0.05）。结论 不同剂量的米非司酮联合曲普瑞林治疗子宫肌瘤可以显著提高治疗的总有效率,调节患者的内分泌水平,并减小子宫和肌瘤的体积。     

高强度聚焦超声消融联合亮丙瑞林治疗子宫腺肌病的临床效果研究

目的 探讨高强度聚焦超声消融联合亮丙瑞林治疗子宫腺肌病的临床效果。方法 60例子宫腺肌病患者随机分为两组,对照组给予高强度聚焦超声消融治疗,观察组在对照组基础上给予亮丙瑞林治疗,比较两组的治疗效果。结果 观察组的治疗总有效率高于对照组,不良反应发生率低于对照组（P <0.05）。治疗后,观察组的疼痛评分、平均月经量均低于对照组,血红蛋白水平高于对照组（P <0.05）。结论 高强度聚焦超声消融联合亮丙瑞林治疗子宫腺肌病能够改善患者月经量及疼痛情况,安全性高。     

泰脂安治疗老年高脂血症的疗效评价

目的：评价泰脂安治疗老年原发性高脂血症的疗效及安全性，方法：60例原发性高脂血症患者分为两组，泰脂安加舒降之10mg组（A组）30例，泰脂安3粒口服，3次／d，同时睡前服用舒降之10mg，共8周。舒降之20mg组（B组）30例），睡前服用舒降之20mg，共8周，全自动生化分析法测定所有指标。结果：两组治疗后8周均有CT、TG、LDL－C、AI显著下降及HDL－C升高作用；经t检验，治疗前后均有显著性差异（P＜0．05或0．01），泰脂安组TC、TG、LDL－C依次下降27．48％，19．92％，25．90％，舒降之20mg组依次下降24．95％，17．11％，27．99％，两组HDL－C升高分别为35．37％、53．44％；治疗前后差异非常显著（P＜0．05）, 但组间差异无意义（P＞0．05）；两组无未见明显不良反应。结论：泰脂安与舒降之10mg/d联用同舒降之200mg/d具有相似的调脂作用，并可减轻药物不良反应。     

舒洛地特联合缬沙坦对高血压肾损害患者肾功能和尿蛋白的影响

目的观察舒洛地特联合缬沙坦治疗对高血压肾损害患者肾功能和尿蛋白的影响。方法60例高血压肾损害患者均进行基础治疗，然后随机分为两组，对照组30例，每天晨服缬沙坦胶囊80mg；治疗组30例，在对照组治疗基础上加服舒洛地特胶囊250LSU，每日2次。两组疗程均为3个月。检测治疗前后血肌酐（Scr）、尿素氮（BUN）、血尿酸（uA）、血清光抑素C（cystatin C）、24h尿蛋白、尿β2－微球蛋白（β2－MG）、尿旺。微球蛋白（α1－MG）、尿N－乙酰－β－D葡萄糖苷酶（NAG）。结果与治疗前相比，两组治疗后BUN、Cr、UA无明显变化（P〉0．05），cystatinC均明显减少（P〈0．01），而治疗组血cvstatin C减少更加明显（P〈O．01）；两组治疗后24h尿蛋白定量、尿α1－MG、β2－MG、NAG均明显减少（P〈O．01），而治疗组24h尿蛋白定量、尿仪。α1－MG、β2－MG、NAG减少更加咀显（P〈0．01）。结论舒洛地特联合缬沙坦治疗比单纯应用缬沙坦治疗能够更有效地降低2型糖尿病肾病患者的尿蛋白，对肾脏具有良好的保护作用。     

氨苄西林的药理作用与临床应用

氨苄西林别名安比林、安比西林、安必仙、氨苄青霉素。氨苄西林属β－内酰胺类抗生素，其抗菌谱广、作用强、疗效高、毒性低、临床应用广泛。笔者根据近几年的工作经验及大量国内外文献，总结出了氨苄西林的药理作用与临床应用注意事项，现报道如下。     

计划免疫文献索引

计划免疫文献索引脊髓灰质炎１王．２０００年目标－无脊髓灰质炎世界．中华流行病学杂志，１９９５，１６（６）：３２３２王克安，等．中国消灭脊髓灰质炎工作的形势与任务．中华流行病学杂志，１９９５，１６（６）：３２５３王克安．为消灭脊髓灰持炎的证实工作做准备...     

醋酸亮丙瑞林在腹腔镜下子宫肌瘤剔除手术前的应用

目的探究醋酸亮丙瑞林联合腹腔镜下子宫肌瘤剔除术治疗对子宫肌瘤患者血清性激素水平、月经恢复时间及术后复发率的影响。方法选取2016年3月～2018年3月我院收治的子宫肌瘤患者120例,采用随机数表法分为观察组和对照组各60例。对照组患者予以腹腔镜下子宫肌瘤剔除术治疗,观察组患者用醋酸亮丙瑞林治疗3个月后行腹腔镜下子宫肌瘤剔除术。比较观察组患者治疗前后子宫、肌瘤体积、血红蛋白(Hb)、性激素[卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、孕酮(P)]水平差异;比较两组患者手术指标(术中出血量、盆腔引流量、下床活动时间、住院时间)、月经恢复时间、术后阴道出血时间及术后复发率差异;记录不良反应发生情况。结果经3个月药物治疗后,观察组患者子宫、肌瘤体积均较治疗前缩小,血清Hb水平升高,血清FSH、LH、E2、P水平均较治疗前降低,差异有统计学意义(P﹤0.05);观察组患者术中出血量、盆腔引流量均少于对照组,下床活动时间、住院时间、术后阴道出血时间均短于对照组,月经恢复时间长于对照组,差异有统计学意义(P﹤0.05),复发率低于对照组,差异有统计学意义(P﹤0.05);观察组患者经药物治疗后出现潮热、多汗等不良反应,对照组患者未出现上述不良反应,两组患者均未出现手术并发症。结论术前用醋酸亮丙瑞林治疗可缩小患者子宫肌瘤体积,改善贫血情况,降低性激素水平,有利于腹腔镜下子宫肌瘤剔除术的顺利进行,可有效减少手术损伤,促进子宫创面愈合,缩短住院时间,并能预防复发。     

紫癜性肾炎

紫癜性肾炎华西医科大学附属一院肾脏科（６１００４１）屈燧林，周安宇紫癜性肾炎（Ｈｅｎｏｃｈ－ＳｃｈｏｎｌｅｉｎＮｅｐｈｒｉｔｉｓ，ＨＳＮ）是过敏性紫癜（Ｈｅｎｏｃｈ－ＳｃｈｏｎｌｅｉｎＰｕｒｐｕｒａ，ＨＳＰ）的病理和临床表现的重要组成部分。１８３７年...     

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.     

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.     

Assessing occupational and environmental exposure

Exposure assessment is a poorly understood component of the science of epidemiology. The relationship between exposure to chemicals and ill-health outcomes is often calculated using crude exposure measures such as ever/never exposed or duration. When investigating subtle effects, exposures need to be characterized much more fully in terms of intensity, frequency, duration and route. While occupational exposures tend to be much greater than those experienced from the wider environment there is a need to remember that, for many chemicals, exposure can occur occupationally, environmentally and through consumer use of products containing the material of interest. Inhalation exposure has generally been the traditional focus for most epidemiological investigations but there is now growing awareness of the importance of the dermal and ingested routes of contact and internalization. Quantification of the exposure also needs to be related to a biological mechanism of action and exposure metrics need to be selected accordingly. Occupational exposures can generally be measured using simple well-validated techniques. Environmental exposures require much more sensitive instruments and are more difficult to assess. Exposure modelling, particularly for the environmental fate of chemicals has undergone many recent developments and Monte Carlo techniques can be used to characterize model uncertainty and variability. This approach to exposure assessment can now be used in the setting of the wider environment and will enable a far better understanding of the relationship between exposure and disease.     

Mercury toxicity due to the smelting of placer gold recovered by mercury amalgam

A 19-year-old man developed tremor in both hands and fatigue after starting work at a placer gold mine where he was exposed to mercury-gold amalgam. Examination revealed an intention tremor, dysdiadochokinesis and mild rigidity. The 24-h urinary mercury concentration reached a peak of 715 nmol/l (143 ug/l) shortly before the clinical examination, after which he was removed from working in the gold room [Mercury No. Adverse Effect Level: 250 nmol/l (50 ug/l)]. On review 7 weeks later his tremor had almost resolved and the dysdiadochokinesis and rigidity had gone. The 24-h urinary mercury concentration had fallen to 160 nmol/l (32 ug/l). The principal exposure to mercury was considered to be the smelting of retorted gold with previously unrecognized residual mercury in it. The peak air concentration of mercury vapour during gold smelting was 0.533 mg/m3 (Mercury Vapour ACGIH TLV: 0.05 mg/m3 TWA). Several engineering and procedural controls were instituted. This episode occurred at another mine site, unrelated to Mount Isa Mines Limited.     

How Adults with Acquired Brain Damage Perceive Computer Training as a Rehabilitation Tool: A Focus-group Study

The aim of this study was to explore and describe how adult outpatients with acquired brain damage and referred to occupational therapy perceive computer training with the RehaCom programs, in order to evaluate the method of treatment as a tool in the rehabilitation of persons with cognitive disorders. By using focus-group discussions as a qualitative method of research when analysing the result, five themes with corresponding categories emerged, describing a development of understanding and learning about capacities. Themes describing how the participants could apply strategies to overcome shortcomings in daily occupations and the therapeutic role of the occupational therapist were identified as well. The result shows that a computer training program such as RehaCom can be used as an educational tool, for example, to guide a person who is trying to adopt compensatory strategies to avoid overload by taking pauses. It was found that anything the participants learned was also applicable to occupational performance in daily life.