局部脑血流断层显像在小儿癫痫中的应用分析

目的探讨利用放射性核素99m锝-乙撑双半胱氨酸二乙酯(99mTc-ECD)局部脑血流断层显像对小儿癫痫诊断的临床应用价值。方法对14例癫痫患儿进行99mTc-ECD单光子发射型计算机断层显像(SPECT),了解患儿脑局部血流灌注情况。结果放射性核素99mTc-ECD脑局部血流灌注显像阳性率高(78.57%)。结论99mTc-ECD局部脑血流断层显像是诊断小儿癫痫病灶的有效方法,对制订癫痫的治疗方案有一定帮助。     

肺癌患者SPECT／CT同机融合显像肋骨单发病灶影像分析

目的分析肺癌患者SPECT／CT同机融合显像肋骨单发病灶的特征和临床诊断之间的相互关系,并评价定位CT在诊断中的作用。方法在SPECT全身骨显像中发现肋骨单发病灶68例肺癌患者加行SPECT／CT同机融合显像,所有病变按位置分为前肋、侧肋、后肋、肋骨与肋软骨交界处四个部位,按病灶形状分为点状和条形两种,并进行分类分析,同时分析SPECT全身骨显像和SPECT／CT同机融合显像方法的诊断效能。结果SPECT全身骨显像肋骨骨折所致单发浓聚灶占52．94％（36／68）;条形病灶中肋骨转移占91．30％（21／23）;肋骨与肋软骨交界处病灶都呈点状,全部为良性病变;后肋病灶中肋骨转移占81,82％（18／22）。SPECT全身骨显像和SPECT／CT同机融合显像诊断单发浓聚灶骨转移敏感度分别为69．23％（18／26）,92．31％（24／26）,特异度59．52％（25／42）,85．71％（36／42）,准确度63．24％（43／68）,88．24％（60／68）,阳性预测值51．43％（18／35）,80．00％（24／30）,阴性预测值75．76％（25／33）,94．74％（36／38）。二者敏感度比较差异有统计学意义（p〈0．05）,特异度和准确度比较差异有统计学意义（P〈0．01）。结论肋骨单发病灶良恶性病变具有一定的图像特点,对于鉴别诊断具有十分重要的临床意义,SPECT／CT同机融合显像提高了诊断的准确性。     

单光子发射计算机断层成像/电子计算机断层扫描对前列腺癌骨转移的诊断价值

目的 探讨单光子发射计算机断层成像/电子计算机断层扫描(SPECT/CT)对前列腺癌骨转移的诊断价值。方法 选取2019年1月至2021年1月于厦门大学附属第一医院核医学科确诊的80例前列腺癌患者为研究对象,所有患者均行SPECT/CT断层融合显像检查、全身骨显像检查及病理学检查,并完成1年随访,以病理学检查或随访结果为金标准,比较全身骨显像与SPECT/CT断层融合显像对前列腺癌骨转移的诊断效能。结果 80例患者中,共检出162个病灶,其中骨转移病灶91个,良性骨改变71个;经Kappa一致性检验,结果显示,全身骨显像检查结果与病理学检查或随访结果具有较强一致性(Kappa=0.774),SPECT/CT断层融合显像检查结果与病理学检查或随访结果具有强一致性(Kappa=0.963);以病理学检查或随访结果为金标准,SPECT/CT断层融合显像诊断前列腺癌骨转移的灵敏度、特异度、准确度均高于全身骨显像,差异有统计学意义(P<0.05)。结论 SPECT/CT断层融合显像对前列腺癌骨转移具有较高的诊断价值。     

儿童孤独症的脑功能影像学改变及其与行为表现关系分析

目的 探讨孤独症儿童脑功能影像学的改变及其与行为表现的关系。方法 对26例孤独症患儿和8例非孤独症患儿进行脑（[99m]Tc)-ECD单光子发射型电子计算机断层显像（SPECT）检测,并采用孤独症治疗评估量表对26例孤独症患儿进行临床行为测量,分析比较其SPECT改变与量表总分及各单项分值的关系。结果 与对照组相比,孤独症患儿有明显的局灶脑血流灌注减少（76．9％）,主要发生部位是海马回13例次（13／33）,颞叶12例次（12／33）,额叶3例次（3／33）。孤独症患儿有局灶脑血流灌注减少组与未减少组的量表总分及各单项分值无显著性差异。结论 包括海马回路和岛叶的边缘系统及颞叶、额叶的功能异常与孤独症的发生及表现有关。     

SPECT脑血流灌注显像应用于多发性硬化患者认知功能障碍的临床研究

目的探讨SPECT脑血流灌注显像应用于多发性硬化(MS)患者认知功能障碍的临床效果。方法入选我院2010年1月至2013年1月收治的MS患者30例作为观察对象,根据CT、MRI等影像学检查分为脊髓型14例和脑/脑脊髓型16例,与同期15例健康体检人群进行对比,分析MS认知功能障碍患者的脑血流改变。结果脑/脑脊髓型MS组和脊髓型MS组认知障碍发生率62.5%(10/16)和42.9%(6/14),均显著高于对照组6.7%(1/15),MS病例组在多处放射性比值低于对照组,以右丘脑和左顶叶更明显,差异均具有统计学意义(均P<0.05)。结论 SPECT脑血流灌注显像可早期诊断MS患者认知功能障碍。     

一氧化碳中毒SPECT脑血流灌注显像研究

一氧化碳(CO)中毒可引起多种脑部病变，全面了解这些病变对诊断和治疗有很大的帮助。SPECT脑血流灌注显像已常规用于脑血管病、痴呆、癫痫、精神疾病的诊断中，并被证实具有不可替代的作用，但它应用于CO中毒诊断的报道尚少。我们对45例CO中毒患者不同时期的SPECT脑血流灌注显像结果进行总结，以期了解CO中毒者SPECT脑血流灌注显像特点及其临床应用价值。     

儿童孤独症368例临床脑影像学资料分析

目的 探讨孤独症脑影像学的特征,为孤独症的神经影像学进一步病因研究提供依据。方法 对368例孤独症患儿的结构性和功能性脑影像学资料进行回顾性分析。结果 孤独症患儿脑结构MRI异常率35.5%(55/155)＞CT异常率12.7%(26/205),其存在的主要异常部位为大脑皮层、脑白质、小脑、基底节和脑室系统。功能性脑影像学检查SPECT、fMRI、MRS、DTI中以SPECT应用最多,31例患儿SPECT 结果显示所有患儿脑血流灌注均有局部改变,其中局部脑血流灌注减少的有26例,发生率为83.9%,主要为额颞顶叶和海马区,局部脑血流灌注增加的部位均为基底节区。结论 孤独症的发生与大脑多个部位的结构或功能改变密切相关,功能性脑影像学比结构影像学检查对探讨孤独症的病理机制更为敏感,值得推广和进一步研究。     

SPECT/CT融合显像在甲状旁腺功能亢进症术前诊断中的应用价值

目的:探讨SPECT/CT融合显像在原发性甲状旁腺功能亢进症(PHPT)术前诊断中的应用价值。方法:回顾性分析2017年2月~2019年1月就诊于本院的52例PHPT患者临床资料,术前30d均接受99TCm-MIBI SPECT/CT融合显像检查。以病理诊断为金标准,分析99TCm-MIBI SPECT/CT融合显像检查PHPT的检出率和不同病灶的检出率。结果:52例患者经病理诊断共73处病灶,其中异位甲状旁腺腺瘤3例(3处病灶),甲状旁腺腺瘤42例(55处病灶),甲状旁腺增生3例(12处病灶),甲状旁腺癌术后淋巴结转移3例(3处病灶);经99TCm-MIBI SPECT/CT融合显像检查确诊患者52例,检出病灶63个,检出率为86.30%(63/73),其中异位甲状旁腺腺瘤3处(100.00%),甲状旁腺腺瘤52处(94.55%),甲状旁腺增生5处(41.67%),甲状旁腺癌术后淋巴结转移3处(100.00%)。结论:99TCm-MIBI SPECT/CT融合显像是检测PHPT的有效方式,可精确定位病灶,为手术提供重要参考依据。     

单光子发射计算机断层成像术脑静态显像分析

目的探讨单光子发射计算机断层成像术(SPECT)脑静态显像的临床应用。方法选取平煤神马医疗集团总医院2013年8月-2015年8月42例脑恶性肿瘤患者,采用CT和SPECT进行诊断,观察其临床价值。结果 SPECT与螺旋CT增强扫描临床诊断阳性率分别为97.06%(66/68)和89.71(61/68),差异无统计学意义(P0.05);放射治疗DT 40 Gy后肿瘤明显消退,病灶CR为22个,PR为30个,NR为14个,NR的14例病灶中10例是经脑胶质瘤术治疗后存在的残留灶,其总有效率为76.47%。3次核素脑瘤显像平均T/N值,实施放射治疗前为1.5±0.4,20 Gy治疗后为2.0±0.5,40 Gy治疗后为1.5±0.5,在放射治疗20Gy时,T/N值显著提高,放射治疗40 Gy时T/N基本恢复正常。结论 SPECT脑静态显像对脑恶性肿瘤具有明显临床价值。     

脑血流灌注显像对难治性发作性癫痫诊断的研究

目的 评价99mTc-单光子发射计算机断层(SPECT)脑血流灌注显像对难治性发作性癫痫的诊断价值,并分析其影像学特点.方法 对难治性发作性癫痫患者共238例分别进行SPECT、MRI、CT和脑电图(EEG)检查,并对诊断结果进行统计分析和比较.结果 SPECT对强直性发作、失神发作、单纯部分性发作和复杂部分性发作的癫痫病灶检出率分别为85.7%、95.7%、89.8%和90.9%,显著高于其他检查方法(P＜0.01);接受SPECT病灶定位诊断进行伽马刀治疗的36例患者中,23例随访1年以上,有效率为78.26%.结论 SPECT对癫痫病灶的检出率较高,对立体定向放射外科靶区的确定具有重要的临床价值.     

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.