腹水回输体内浓缩法治疗血液透析病人的腹水

:[目的 ]　探讨腹水回输体内浓缩法的疗效、安全性。 [方法 ]　对 4例尿毒症血液透析 (血透 )伴有顽固性腹水的病人进行 6 2次腹水直接回输至血透的体外循环中 ,经血透超滤、浓缩腹水。 [结果 ]　腹水回输前后血浆总蛋白分别为 6 5 .70± 11.70 g/L和 82 .5 0± 11.38g/L(P <0 .0 1) ,白蛋白分别为 2 3 .0 0± 2 .38g/L和 33.80± 8.0 3g/L(P <0 .0 1) ,球蛋白分别为 35 .6 0± 11.47g/L和 46 .17± 5 .92 g/L(P <0 .0 1)。血清肌酐 (scr)和尿素氮 (BUN)的下降率分别为 6 5 .47± 1.2 6 %和 6 8.40± 1.86 %。腹水回输量 2 0 0 0～ 5 0 0 0mL/次。不良反应有血性腹水、管路反应、一过性容量负荷过重 ,不影响治疗继续进行。 [结论 ]　本方法血透和腹水回输同步进行 ,同时达到清除氮质代谢产物和腹水浓缩回输的目的 ,有效、安全     

改良连续性血液滤过装置在腹水回输中的应用

我院自 1999年 1月～ 2 0 0 1年 2月采用改良连续性血液滤过装置行自体腹水体外浓缩回输治疗肝硬化顽固性腹水 34例 ,共 86例次 ,获良好效果 ,报道如下。1　资料与方法1 1　临床资料　本组 34例 ,男性 2 5例 ,女性 9例 ,年龄 4 8～ 75岁 ,平均 56 5岁。所有病人均符合肝硬化顽固性腹水的诊断[1] 。其中肝炎后肝硬化 2 7例 ,酒精性肝硬化 7例。腹水均为漏出液 ,腹水持续时间平均为 ( 18.6± 13 0 )个月 ,治疗前腹围平均 ( 89.5±10 .8)ｃｍ ,经药物综合治疗 ,腹水无明显消退。1 2　自体腹水体外浓缩回输的操作方法　病人取半卧位 ,常规消毒后…     

超滤浓缩回输治疗肝硬化顽固性腹水的疗效

目的：探讨自体腹水浓缩回输腹腔治疗肝硬化顽固性腹水的疗效。方法：对60例顽固性腹水患者进行自体腹水浓缩回输腹腔治疗3周。结果：治疗后患者腹围、24h尿量、体重明显下降（P〈0．05）,腹水中钠、钾、氯无明显改变（p〉0．05）,白蛋白有所升高（P〈0．05）。结论：自体腹水浓缩回输腹腔治疗肝硬化顽固性腹水可缓解临床症状,疗效确切。     

腹水超滤回输腹腔在肝炎肝硬化顽固性腹水患者治疗中的临床应用研究

目的 观察腹水超滤浓缩回输腹腔技术治疗肝炎肝硬化顽固性腹水患者的临床疗效.方法 将76例肝炎肝硬化顽固性腹水患者随机分为研究组和对照组.研究组在常规治疗基础上,采用腹水超滤浓缩回输腹腔治疗;对照组在常规治疗基础上,采用治疗性腹腔穿刺放腹水治疗.结果 研究组治疗后腹围、体重、24 h尿量、肌酐、血清白蛋白改善情况明显好于对照组（P〈0.05）,研究组临床疗效明显好于对照组（P〈0.01）.结论 腹水超滤浓缩回输腹腔术是治疗肝硬化腹水的一种有效方法,作为顽固性肝硬化腹水的内科对症治疗措施是一种较好的选择.     

腹水超滤浓缩回输治疗肝硬化顽固性腹水48例临床分析

目的：探讨腹水超滤浓缩腹腔回输治疗顽固性肝硬化腹水的效果。方法：采用腹水超滤治疗仪治疗，比较治疗前后患症状、体征、肝功能的变化。结果：治疗后总有效率80．3％，患腹围减小，体重下降，尿量增加，血清总蛋白、白蛋白提高。结论：腹水超滤浓缩腹腔回输治疗顽固性肝硬化腹水有较好的疗效。     

腹水超滤浓缩腹腔回输治疗顽固性腹水疗效观察

目的 观察腹水超滤浓缩腹腔回输治疗顽固性腹水的疗效.方法对37例顽固性腹水患者进行76次腹水浓缩回输治疗,观察治疗前后尿量、腹围、心率、血压、血电解质、血浆白蛋白、血总胆红素指标变化.结果治疗后较治疗前尿量明显增加[(1038.00±391.38) ml比(632.63±300.80) ml,P＜0.01],腹围明显减小[(86.49±10.61)cm比(96.71±10.16)cm,P＜0.01],治疗前后心率、血压、血电解质、血浆白蛋白、血总胆红素比较差异无统计学意义(P＞0.05).结论腹水超滤浓缩腹腔回输治疗顽固性腹水有一定疗效.     

持续腹水浓缩回输腹腔治疗顽固性腹水症

我们用双腔导管建立腹水持续体外循环径路 ,用血滤器将腹水中水份清除后的浓缩腹水回输腹腔方法对 15例顽固性腹水症病人进行了 4 3例次治疗 ,获得良好效果 ,现报道如下。1　材料与方法1·1　病例选择　对象为经利尿、卧床休息、限钠、限水等内科保守治疗无效的顽固性腹水症病人 ,其中男 12例 ,女 3例 ,年龄 2 7～ 59岁 ,平均 (4 4 2± 15 3)岁。原发病为乙型肝炎肝硬化 7例 ,酒精性肝硬化 4例 ,慢性肾衰 1例 ,肝癌晚期 2例 ,绒毛膜上皮癌晚期 1例。1·2　治疗方法　腹中线脐下 2ｃｍ处 ,局麻下将双腔导管 (ＱｕｉｎｔｏｎＩｎｓｔｒｕｍｅ…     

阿德福韦酯联合腹水超滤浓缩回输治疗乙型肝炎肝硬化顽固性腹水的临床研究

[目的]观察阿德福韦酯联合腹水超滤浓缩回输法治疗乙型肝炎肝硬化顽固性腹水的疗效。[方法]选择乙型肝炎肝硬化顽固性腹水住院患者94例,随机分为两组,治疗组47例,采用阿德福韦酯+腹水超滤浓缩回输+基础治疗:对照组47例,采用腹水超滤浓缩回输+基础治疗,疗程均为2个月。[结果]两组患者的临床症状均得到较好改善,患者体重及腹围显著下降,24h尿量增加,血浆及腹水中蛋白量增加,治疗组患者门静脉、脾静脉内径及血流量,血浆中HBVDNA及内毒素水平较治疗前显著下降,对照组患者则无明显改善,两组比较差异有统计学意义(P﹤0.05);治疗组患者腹水消退显效者26例,占55.3%,对照组只有7例,占14.8%,两组比较差异有统计学意义(P﹤0.05)。[结论]阿德福韦酯联合腹水超滤浓缩回输治疗肝硬化顽固性腹水有较好疗效,其作用机制可能与改善患者血浆内毒素水平有关。     

新型封闭式腹水超滤系统初步临床应用观察

腹水浓缩回输是治疗顽固性肝硬化腹水的有效方法之一 ,但国内一直缺乏理想的中空纤维腹水超滤器 ,为此我们应用一种新型封闭式腹水超滤系统 ,对其性能及临床疗效进行观察 ,现报告如下。1　临床资料1 1　一般资料　我院 1999年 1月～ 2 0 0 0年 8月完成了 56例腹水浓缩回输术治疗 ,观察 2 1例 ,男性14例 ,女性 7例 ,年龄 ( 61.2± 10 .4 )岁。1 2　应用指征　均为肝炎肝硬化患者 ,且限钠、限水、利尿、静脉输液白蛋白无效的顽固性腹水 ;ＣｈｉｌｄＣ级 ,无肝性脑病者 ,腹水均为漏出液 ,细胞培养阴性。2　器材和方法选用德国费森尤斯公司生产…     

腹水超滤浓缩腹腔回输治疗肝硬化顽固性腹水的临床研究

目的观察腹水超滤浓缩腹腔回输治疗肝硬化顽固性腹水的疗效。方法采用WLFHY-500型伟力电脑腹水超滤浓缩回输系统,对98例肝硬化顽固性腹水患者行190例次治疗,观察患者体重、腹围、24小时尿量、血肌酐、尿素氮、谷丙转氨酶、总胆红素、白蛋白等变化。结果经治疗后,患者24小时尿量增加,血清白蛋白水平增加,尿素氮、肌酐、谷丙转氨酶、总胆红素水平无显著性变化,总有效率69.4%,无严重并发症。结论腹水超滤浓缩腹腔回输治疗肝硬化顽固性腹水,方法简便易行,且安全有效。     

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.