颅外颈动脉狭窄的血管内支架成形术

目的 分析血管内支架成形术治疗颈动脉狭窄的安全性、有效性和短期效果.方法 59例颅外颈动脉狭窄的患者采用自膨胀支架进行血管内支架成形术治疗.结果 59例患者均治疗成功,其中3例双侧颈内动脉颅外段狭窄患者同期各置入2个支架使血管基本恢复正常管径,2例同侧颈内动脉颅外段狭窄患者同期连续置入2个支架使血管基本恢复正常管径.支架成形术后颈动脉平均狭窄程度从(79±10)%降低到(11±7)%.结论 颅外颈动脉狭窄的血管内支架成形术是一种安全、有效、简单的方法,短期效果令人满意.     

颈内动脉血管内支架成形术治疗缺血性脑血管病临床分析

目的探讨血管内支架治疗颈动脉狭窄的疗效及安全性。方法2008年7月—2011年7月,对52例颈动脉狭窄患者采用颈动脉血管内支架成形术治疗,所有病例均使用远端保护装置,全身肝素化下置入自膨支架治疗颈动脉分叉部狭窄。结果52例患者共置入54枚支架,手术成功率100％,术后造影显示支架形态良好;术后6个月采用颈动脉彩超复查,未发现病变血管再狭窄。结论颈内动脉支架成形术治疗高危颈动脉硬化狭窄疾病有良好的安全性和确切的疗效。     

颈动脉支架成形术围手术期并发症的护理

目的本研究结合我院脑血管病中心近年来颈动脉支架围手术期护理经验,探讨颈动脉狭窄血管内支架成形术围术期的护理方案。方法通过回顾性分析我科59例行颈动脉支架成形术患者围手术期出现的并发症,总结护理经验,提出合理的护理方案。结果 59例患者共置入颈内动脉支架64枚,颈动脉支架64枚全部放置成功,技术成功率100%,但有4例发生手术相关并发症(占6.2%)。1例患者出现术后血压低,心率过慢,给予持续静滴阿托品及多巴胺1 w后恢复正常;1例患者术后肢体乏力加重,复查头颅MR见多发脑梗,考虑小栓子脱落;1例患者术中支架内急性血栓形成,给予尿激酶溶栓后完全恢复正常;1例患者出现术后颅内出血,脑疝死亡。结论对颈动脉狭窄接受经皮血管内支架成形术治疗的患者在围术期进行精心护理,是提高治疗效果的重要保证。术前心理护理、充分准备是手术成功的基础,术中密切观察患者生命体征变化及心理护理安慰和医护配合是支架成功的保证,术后生命体征和神经系统功能的监测以及对患者及其家属的术后防止出现并发症的指导是预防并发症的关键。     

颈动脉颅外段狭窄的介入治疗及术后效果随访观察

[目的]探讨颈动脉颅外段狱窄经皮血管内成形及支架置入术(PTAS)治疗及术后抗动脉硬化效果的远期疗效. [方法]31例颈动脉颅外段狭窄患者均应用保护伞采用自膨式支架经股动脉入路行PTAS,术后随访观察6-31个月. [结果]患者术前平均血管狭窄率82.92%,术后为10.22%,较术前明显下降,其中11例脑梗死患者神经功能缺损评分改善,9例脑梗死患者认知功能评分改善,TIA患者未再出现症状发作;平均随访时间20个月,随访期间脑缺血症状再发患者5例(脑供血不足3例,TIA1例,脑梗死1例),经过分析以上患者有治疗依从性差,危险因素控制不佳或免疫异常情况存在,其余患者治疗依从性好,无卒中症状再发,TCD检查显示支架部位血管保持再通良好. [结论]PTAS是治疗颈动脉颅外段狭窄低创、有效的手段,术中应用保护伞可提高安全性,术后应用抗血小板药物并普罗布考具有较好的疗效.     

腔内血管成形术及支架植入术治疗颈动脉狭窄围手术期护理

目的探讨腔内血管成形术及支架植入术治疗颈动脉狭窄围手术期护理。方法通过对56例腔内血管成形术及支架植入术患者围手术期护理,总结临床经验。结果56例颈动脉狭窄患者实施腔内血管成形术及支架植入术共植入支架68枚,手术成功,临床症状明显改善。结论腔内血管成形术及支架植入术围手术期护理是确保手术成功的关键环节。     

应用彩色多普勒超声对糖尿病合并脑梗死患者颈部动脉病变的研究

目的观察糖尿病（DM）合并脑梗死（CI）患者颈部动脉形态学和血流动力学的改变。方法健康对照组（NC组）25例，DM组23例，CI组30例，DM合并CI组（DE组）25例。应用彩色多普勒超声诊断仪观察颈部动脉管径和血流的变化。结果DM组、CI组和DE组患者主要表现为左侧颈内动脉和左侧颈外动脉管腔狭窄[（5．5±0．3）mm和（4．8±0．4）mm、（5．7±0．2）mm和（4．7±0．5）mm、（5．6±0．3）mm和（4．6±0．4）mm]，与NC组[（6．1±0．5）mm和（5．2±0．6）mm]比较，差异均有统计学意义。DE组患者颈外动脉收缩期峰值流速明显增快，同时颈部动脉血流阻力指数也明显高于其他三组。结论颈动脉硬化、管腔狭窄和颈部血流阻力增加是DM合并CI主要的颈部血管形态学和血流动力学改变。     

颈动脉支架成形术治疗症状性颈动脉狭窄的临床疗效观察

目的探讨应用颈动脉支架成形术治疗症状性颈动脉狭窄的可行性及安全性。方法对40例症状性颈动脉狭窄患者予以颈动脉支架成形术治疗。结果狭窄程度由术前（72．3±8．6）％下降到术后（11．6±7．2）％。所有患者在1周内神经功能损害症状改善。随访3个月至1年,无一例发生短暂性脑缺血发作及脑梗死;5例复查数字减影血管造影,未发现支架移位。结论颈动脉支架成形术是治疗症状性颈动脉狭窄安全、有效的方法。     

颈内动脉狭窄的血管内介入治疗

目的:探讨颈动脉(ICA)支架置入术(CAS)对治疗颈动脉狭窄的临床价值。方法:对38例患者颈内动脉狭窄血管内介入治疗的临床应用及操作进行回顾性分析。38例颈内动脉狭窄患者在局麻下行血管内介入支架治疗。结果:所有患者均顺利将支架放置理想位置。其中,7例患者滤网回收后,网内肉眼可见少量大小不等的组织碎片;1例患者在球囊扩张后出现一过性心率减缓;3例患者在回收保护伞时出现血管痉挛,经积极治疗后症状消失或缓解。结论:颈动脉支架置入术是一种创伤小、痛苦小的微创技术,它为颈动脉狭窄的治疗提供了一种新的途径,临床疗效显著。     

颈动脉支架成形术治疗症状性颈动脉狭窄的临床疗效观察

目的 探讨应用颈动脉支架成形术治疗症状性颈动脉狭窄的可行性及安全性.方法 对40例症状性颈动脉狭窄患者予以颈动脉支架成形术治疗.结果 狭窄程度由术前(72.3±8.6)%下降到术后(11.6±7.2)%.所有患者在1周内神经功能损害症状改善.随访3个月至1年,无一例发生短暂性脑缺血发作及脑梗死;5例复查数字减影血管造影,未发现支架移位.结论 颈动脉支架成形术是治疗症状性颈动脉狭窄安全、有效的方法.     

两种影像检查对短暂性脑缺血发作颈动脉狭窄的诊断价值

目的 评价颈部血管彩色多普勒超声(彩超)、磁共振血管成像(MRA)对短暂性脑缺血发作(TIA)患者颅外段颈动脉狭窄的价值.方法 选择同时经彩超、MRA检查,并且至少1项检查发现有颅外段颈动脉狭窄的45例TIA患者,再进行全脑数字减影血管造影(DSA),按照北美症状性颈动脉狭窄内膜切除试验(NASCET)计算颅外段颈动脉狭窄率.结果 以DSA诊断为金标准,45例TIA患者180条颅外段颈动脉狭窄分级,诊断的敏感度93.51%,特异度95.15%,准确度94.44%,Kappa=0.735;MRA诊断的敏感度92.21%,特异度94.17%,准确度93.33%,Kappa=0.681;彩超联合MRA诊断的敏感度97.40%,特异度99.03%,准确度98.33%,Kappa=0.872.结论 彩超诊断颅外段颈动脉狭窄的敏感度、准确度均高于MRA,适用于人群初选检查;彩超联合MRA诊断颅外段颈动脉狭窄与DSA一致性较好,但不能完全取代DSA.     

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.     

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.     

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.     

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.