急性硫化氢中毒后阵发性自主神经不稳与肌张力不全1例分析

目的 探讨急性硫化氢(H2S)中毒后阵发性自主神经功能不稳与肌张力不全(PAID)的临床特点及治疗对策.方法 回顾性分析本院收治的1例急性H2S中毒后PAID患者的临床资料.结果 患者出现阵发性躁动、发热、多汗、呼吸急促、心动过速、血压升高、肌张力障碍和抽搐症状,经治疗后,处于植物状态,遗留间断性肌张力不全.结论 急性H2S中毒后PAID是脑损伤后康复阶段较少见的一个并发症,临康上尚无特效的治疗手段.     

A型肉毒毒素与巴氯芬治疗偏侧面肌痉挛的疗效对比

目的 比较局部注射A型肉毒毒素(BTXA)与口服巴氯芬治疗偏侧面肌痉挛(HFS)的效果.方法 将2010年7月至2012年6月确诊HFS患者66例按随机数字表法分为BTXA治疗组和巴氯芬治疗组,对BTXA治疗组33例患者进行局部多点靶肌注射BTXA治疗,对巴氯芬治疗组33例患者给予口服巴氯芬治疗,采用Cohen痉挛分级评分法,分别在治疗前、治疗2周、治疗4周对两组患者进行痉挛程度评分.结果 两组治疗前痉挛程度评分比较差异无统计学意义(P＞0.05);两组治疗2、4周时痉挛程度评分均较治疗前明显缓解[BTXA治疗组:(1.80±0.70)、(1.57±0.17)分比(3.15±0.43)分;巴氯芬治疗组:(2.14±0.60)、(1.14±0.70)分比(3.00±0.48)分],差异有统计学意义(P＜0.01);巴氯芬治疗组治疗2、4周时痉挛程度评分均较BTXA治疗组改善明显,差异有统计学意义(P＜ 0.05或＜0.01);治疗4周时两组痉挛缓解程度等级比较差异有统计学意义(P＜0.05).BTXA治疗组不良反应发生率为15.15％(5/33),巴氯芬治疗组不良反应发生率为51.52％(17/33),两组比较差异有统计学意义(P＜0.01).结论 局部注射BTXA与口服小剂量巴氯芬治疗HFS均可达到明显缓解,但BTXA治疗症状改善达峰时间较巴氯芬治疗短,且痉挛改善更完全,不良反应较少,患者依从性高,可作为HFS治疗首选方法.     

穴位注射治疗中风后偏瘫患者恢复的疗效观察

目的探讨穴位注射对中风后偏瘫患者肌力恢复的疗效.方法将60例中风偏瘫患者随机分成两组,对照组30例,接受常规针灸治疗与护理;治疗组30例,接受常规针灸治疗的同时,给予黄芪注射液+丹参注射液穴位注射,观察两组治疗后肌力恢复情况.结果治疗组的患者的肌力恢复明显高于对照组(P＜0.05).结论穴位注射能有效提高偏瘫患者的肌张力.     

腹针治疗中风后肢体肌张力增高的临床研究

目的探讨腹针治疗中风后肢体肌张力增高的临床疗效。方法将腹针治疗中风后肢体肌张力增高的患者58例,与传统取穴方法治疗的58例作疗效对比。结果治疗前2组患者肢体Ashoworth张力评分及Fugl-M eyer运动功能评分比较差异无统计学意义(P>0.05);治疗后2组张力评分评定差异有统计学意义(P<0.05);运动功能评分与治疗前比较均明显升高(P<0.01),但治疗组与对照组比较,肢体运动功能改善更显著(P<0.01)。结论腹针治疗中风后肢体肌张力力增高,疗效较传统的针刺方法更明显。     

康复配合针灸治疗中风后肌张力增高的疗效观察

目的：观察分析康复配合针灸治疗中风后肌张力增高的疗效。方法：选取我院在2011年8月至2012年7月收治的62例中风后肌张力增高患者的临床资料进行研究分析，分析康复配合针灸治疗中风后肌张力增高的疗效。结果：对比两组患者治疗前后Ashworth评定疗效，治疗后0级、1级、2级及3级同治疗前相比，有统计学意义（P〈0．05）；1＋级及4级之间没有显著差异性，无统计学意义（P〉0.05）。结论：康复配合针灸在中风后胍张力增高疾病临床上效果显著，可有效改提高患者生活质量。     

A型肉毒毒素治疗急性共同性内斜视的疗效与安全评估

目的 本研究旨在考察A型肉毒毒素注射治疗急性共同性内斜视的临床疗效和安全性。方法 对在2015年10月—2020年10月在医院接受BTXA治疗的AACE患儿数据进行了回顾性研究。经内直肌附着处1～2mm的球结膜微小切口暴露内直肌止端,后进行BTXA注射治疗,行鼻下Parks结膜切口,约2 mm,于肌肉附着点处约15 mm缓慢注入A型肉毒毒素至肌腹。注射后分别于1周、1个月及3个月时进行复查,观察正位率及并发症情况。结果 注射前平均斜视度为（33.6±8.3）~△,注射后1周平均斜视度（9.5±2.4）~△（P=0.000 24）;注射后1个月平均斜视度（7.7±0.6）~△（P=0.000 06）;注射后3个月斜视度（7.3±1.4）~△（P=0.000 02）。治疗3个月后,BTXA注射组斜视度减少量为（26.8±1.4）~△,23例AACE患儿在3个月后达到三棱镜检查斜视度正位±10 PD的治愈标准,正位率达82.14%(23/28)。结论BTXA注射治疗小至中度数的AACE具备安全性和有效性,对于恐惧和拒绝手术的儿童患儿,BTXA注射治疗可考虑作为首选治疗方案。     

牵伸训练联合蜡疗对降低中风偏瘫患者肢体肌张力的疗效观察

目的探讨牵伸训练联合蜡疗对降低中风偏瘫患者肢体肌张力的疗效。方法选取我院收治的70例中风偏瘫患者,按治疗方案的不同平均分为两组。常规组单纯进行蜡疗,研究组采用牵伸训练联合蜡疗。比较两组患者的肢体功能改善情况、肢体肌张力和临床总有效率。结果两组患者的Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级、Ⅴ级功能障碍比例比较差异均无统计学意义(P>0.05)。研究组的肢体肌张力0级比例显著高于常规组(P<0.05)。研究组的临床总有效率为97.14%,显著高于常规组的80.00%(P<0.05)。结论采用牵伸训练联合蜡疗治疗中风偏瘫患者,可有效改善其肢体功能,降低肢体肌张力,提高临床疗效。     

A型肉毒毒素深部肌肉注射治疗脑外伤后肢体肌痉挛

目的探讨A型肉毒毒素(BTX-A)治疗脑外伤后四肢肌痉挛的注射方法及疗效。方法选取32例2004年1月至2007年2月在我院神经外科及康复科治疗的脑外伤后肢体肌肉痉挛病人,每例行国产A型肉毒毒素痉挛肌等距离多点均匀深部注射治疗,每次注射总量不超过100U,每次注射1-2块肌肉。若肌肉较大或多块肌肉痉挛,可分次注射,每次间隔至少7天,同时辅以常规肢体功能锻炼.注射后3天、7天、14天、1月、2月、3月、6月采用改良Ashworth量表测定肌张力改变,每例病人随访6月。结果32例治疗病人均在注射BTX-A后第3-7天内肌张力下降,在2-8周时达到明显效果(P<0.05),3月后有4例出现不同程度复发,6月后25例复发,痉挛程度较注射前轻,重复注射BTX-A后可缓解。BTX-A注射后有4例出现局部轻度淤血,未发现明显全身并发症。结论等距离深部肌注A型肉毒毒素治疗脑外伤后四肢肌痉挛安全有效,操作简单,并发症少,为康复治疗赢得时间,值得在临床推广。     

发作性运动诱发肌张力障碍的临床与视频脑电图研究

[目的]探讨发作性运动诱发肌张力障碍(paroxysmalkinesigenicdystonia,PKD)的临床和视频脑电图特征。[方法]观察3例PKD患者的临床和视频脑电图特点,进行头颅核磁共振检查,同时使用卡马西平治疗并观察其转归。[结果]3例患者共观察到15次发作,表现为发作性一侧或双侧肢体的肌张力障碍和舞蹈症,持续10～20s,均有明显的诱发因素:从坐位起立或从静止开始行走、接受询问、受惊吓和接电话,发作时无意识障碍。24hVEEG检查未见癫痫样放电。头颅核磁共振阴性。短期随访卡马西平治疗有效。[结论]PKD是以运动诱发的表现为短暂性舞蹈样手足徐动症等肌张力障碍为特征的良性疾病,脑电图多无异常,卡马西平能有效控制其发作。     

GnRH-a联合宫腔镜及曼月乐治疗围绝经期子宫腺肌病的疗效

目的探究促性腺激素释放激素激动剂(GnRH-a)联合宫腔镜及曼月乐对围绝经期子宫腺肌病患者治疗的临床效果。方法选取2013年11月-2016年11月在该院就诊的围绝经期子宫腺肌病患者200例为研究对象,经过随机数表法分为对照组和观察组,每组各100例。对照组患者运用肌内注射GnRH-a进行治疗,观察组患者运用肌内注射GnRH-a联合宫腔镜及子宫内放置曼月乐进行治疗。对两组患者的子宫体积、子宫内膜厚度、月经量、口述疼痛分级评分法(VRS)的评分及两组患者不良反应的发生率进行比较。结果两组患者治疗后1、3、6个月,子宫体积、子宫内膜厚度与治疗前比较差异有统计学意义(P0. 05),且观察组患者各项指标水平显著小于对照组(P0. 05)。治疗后1、3、6个月,两组患者月经量、痛经评分均与治疗前比较差异有统计学意义(P0. 05),且观察组患者各项指标显著小于对照组患者(P0. 05)。两组患者治疗前FSH、LH、E2水平与治疗后比较差异有统计学意义(P0. 05)。观察组患者不良反应发生率显著低于对照组(P0. 05)。结论采用GnRH-a联合宫腔镜及曼月乐治疗围绝经期子宫腺肌病可显著改善患者子宫体积、子宫内膜厚度、月经量,降低患者痛经程度,降低患者不良反应发生率,值得临床推广。     

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.