ICGR15测定在肝癌术前对肝脏储备功能的评估

目的 探讨快速肝储备功能检测系统(DDG)中ICGR15测定在肝癌术前对肝脏储备功能的评估.方法 将50例肝癌切除病人,按随机数字表法分为Child-Pugh评分组和ICGR15组.比较两组术后肝功能不全发生率的变化和分析Child-Pugh评分与ICGR15的关系.结果 Child-Pugh评分组术后出现腹水9例,黄疸5例,肝性脑病3例,死亡1例,肝功能不全发生率为37.5％;ICGR15组术后出现腹水7例,黄疽4例,肝性脑病1例,肝功能不全发生率为26.9％;两组肝功能不全发生率比较差异有统计学意义;ICGR15组Child-PughB级病人ICGR15均值为(14.36±8.1)％,显著高于Chitd-PughA级病人(7.82±4.6)％(P＜0.05).结论 Child-Pugh评分与ICGR15值关系密切,ICGR15比Child-Pugh评分更准确评估肝脏储备功能,对肝癌切除范围及预后评估有指导作用.     

终末期肝病模型评分与Child-Pugh分级系统评估肝癌患者肝脏储备功能围手术期风险的对比

目的 比较终末期肝病模型（MELD）评分与Child-Pugh分级系统两种方法评估肝癌患者肝脏储备功能进行肝切除术风险的应用价值.方法 回顾性分析212例因原发性肝细胞癌行肝切除术患者的临床资料.术前计算MELD评分和Child-Pugh分级和评分,分析两者与术后发生肝功能不全的关系.结果 术后共有94例患者出现肝功能不全.Child-PughA级患者术后肝功能不全发生率44.0％（84/191）,Child-PughB级患者发生率47.6％（10/21）,两者比较差异无统计学意义（P＞0.05）.MELD评分≤14分患者术后肝功能不全发生率37.8％ （68/180）,MELD评分＞14分患者发生率为81.2％（26/32）,两者比较差异有统计学意义（P＜0.01）.MELD评分＜8分、MELD评分8～14分、MELD评分＞14分患者术后肝功能不全的发生率分别为34.2％（51/149）,54.8％（17/31）,81.2％（26/32）,差异有统计学意义（P＜0.05）.Spearman等级相关检验显示MELD评分与Child-Pugh分级系统密切相关（r=0.303,P＜0.01）.MELD评分、Child-Pugh分级系统的受试者工作特征曲线下面积分别为0.714和0.598 （P＜ 0.05）.结论 与Child-Pugh分级系统比较,MELD评分能更有效地预测肝切除术后肝功能不全的发生情况.术前MELD评分＞14分的患者术后发生肝功能不全的风险较高,需严格把握适应证.     

肝硬化合并肝癌患者血氨与血清层粘连蛋白和总胆汁酸的关系

目的 探讨肝硬化合并肝癌患者血氨(NH3)、血清层粘连蛋白(LN)和总胆汁酸(TBA)与肝功能Child-Pugh分级间的关系.方法 选取108例肝硬化合并肝癌患者(肝癌组),按照Child-Pugh肝功能分级标准,A级28例,B级32例,C级48例.另选择同期健康体检者67例作为对照组.采用化学发光法检测血清LN,连续监测法检测血NH3,速率法检测血清TBA.比较肝癌组与对照组、肝癌组不同Child-Pugh分级间血NH3、血清LN和TBA的变化.结果 肝癌组血NH3、血清LN和TBA含量明显高于对照组(P＜0.05).Child-Pugh分级A、B、C级患者的血NH3、血清LN和TBA含量均高于对照组,差异有统计学意义(P＜0.05).血NH3、血清LN和TBA含量随着肝功能Child-Pugh分级的增高而上升(P＜0.05).108例肝硬化合并肝癌患者在不同Child-Pugh分级中,血NH3与血清LN呈正相关(r=0.5562、0.6900、0.3423,P＜ 0.01或＜0.05),与血清TBA无明确相关性.结论 肝硬化合并肝癌患者血NH3与血清LN有显著相关性.血NH3、血清LN和TBA联合检测对肝硬化合并肝癌的无创性诊断有一定的临床意义.     

肝硬化及肝硬化合并肝癌时补体C3的表达意义

目的 探讨肝硬化及肝硬化合并肝癌患者不同Child-Pugh分级时补体C3的表达意义。方法 选取肝硬化患者68例（肝硬化组）,肝硬化合并肝癌患者56例（肝硬化合并肝癌组）,健康体检者35例（对照组）,均测定补体C3含量。并比较肝硬化组及肝硬化合并肝癌组同等Child-Pugh 分级状态时补体C3水平的差异。应用ROC曲线测定Child-Pugh分级时补体C3的界值。结果 肝硬化组和肝硬化合并肝癌组血清补体C3水平均显著低于对照组,差异有统计学意义(P＜0.05),随着Child-Pugh分级由A级至C级变化血清补体C3水平逐渐降低,差异有统计学意义(P＜ 0.05),不同Child-Pugh分级时肝硬化组血清补体C3水平均低于肝硬化合并肝癌组,差异有统计学意义(P＜0.05)。应用ROC曲线可测出两组间不同Child-Pugh分级时补体C3的界值分别为A级679.5 mg/L,B 级535.5 mg/L,C级323.0 mg/L。结论 血清补体C3与肝功能损伤严重程度相关,对肝硬化患者是否合并肝癌有临床提示意义。     

冷沉淀治疗肝癌术后创面广泛渗血4例

国人肝癌 85 %合并肝硬化 ,所以肝功能较差 ,在行肝癌切除手术后 ,极易出现凝血功能障碍 ,导致肝脏创面广泛渗血。我们收治 4例病人 ,因术后肝脏创面广泛渗血险致病人死亡 ,在及时应用冷沉淀后 ,使病人得以转危为安。1　临床资料4例病人均为原发性肝癌 ,男 3例 ,女 1例 ,术前肝功能分级 ,Ⅰ级 1例 ,Ⅱ级 3例 ,行右半肝切除 1例 ,左半肝切除 1例 ,肝Ⅳ、Ⅴ段切除 1例 ,肝Ⅵ、Ⅶ段切除 1例 ,术中出血 60 0～ 15 0 0ｍｌ,肝门阻断时间 15～ 2 0ｍｉｎ ,肝脏创面均行仔细止血 ,纤维蛋白胶喷洒。肝段切除者 ,肝脏切面对拢缝合 ,半肝切除者创面用…     

原发性肝癌介入治疗后并发肝性脑病的相关危险因素分析

目的 探讨原发性肝癌(PLC)介入治疗后并发肝性脑病(HE)的相关危险因素.方法 行介入治疗的PLC患者93例,根据治疗效果分为好转组(32例)和恶化组(61例).对两组患者年龄、性别、家族史、Child-Pugh分级、HE分期、肝癌分型、肝外转移、肝癌合并症以及腹腔淋巴结转移等22项PLC介入治疗后并发HE的相关因素进行统计学分析.结果 肝癌合并症≥3个、肝癌合并肝硬化、凝血酶原时间、尿素氮、胆碱酯酶、Child-Pugh分级C级、HE分期Ⅲ～Ⅳ期为影响PLC介入治疗后并发HE的预后相关因素,Logistic多因素回归分析表明,肝癌合并症≥3个、Child-Pugh分级C级、HE分期Ⅲ～Ⅳ期为影响PLC介入治疗后并发HE预后的独立危险因素.结论 肝癌合并症≥3个、Child-Pugh分级C级、HE分期Ⅲ～Ⅳ期可以作为评价PLC介入治疗后并发HE预后的标准.     

腹腔镜肝切除术10例报告

目的探讨腹腔镜肝切除术的安全性和可行性。方法回顾分析我院2007年1月至2009年12月独立完成的腹腔镜肝切除术10例,其中原发性肝癌4例,肝转移鳞癌（肺癌术后）1例,肝局灶性结节增生2例,肝海绵状血管瘤并胆囊结石1例,多囊肝1例,肝局灶性肝细胞脂肪变伴胆囊结石1例。肝功能Child-Pugh分级A级9例,B级1例。结果 10例均成功行腹腔镜肝切除术,无中转开腹。手术时间92～362分钟,平均（209±77.64）分钟,术中出血20～1800ml,平均（787±643.7）ml,无严重并发症。10例术后随访12～47个月,其中4例原发性肝癌患者中1例术后3个月复发,12个月后死亡。另3例均无瘤生存,最长1例成活39个月。结论腹腔镜肝切除术安全可行,其不但适用于良性肿瘤,也部分适用于恶性肿瘤。     

腹腔镜肝切除术10例报告

目的探讨腹腔镜肝切除术的安全性和可行性。方法回顾分析我院2007年1月至2009年12月独立完成的腹腔镜肝切除术10例,其中原发性肝癌4例,肝转移鳞癌(肺癌术后)1例,肝局灶性结节增生2例,肝海绵状血管瘤并胆囊结石1例,多囊肝1例,肝局灶性肝细胞脂肪变伴胆囊结石1例。肝功能Child-Pugh分级A级9例,B级1例。结果 10例均成功行腹腔镜肝切除术,无中转开腹。手术时间92～362分钟,平均(209±77.64)分钟,术中出血20～1800ml,平均(787±643.7)ml,无严重并发症。10例术后随访12～47个月,其中4例原发性肝癌患者中1例术后3个月复发,12个月后死亡。另3例均无瘤生存,最长1例成活39个月。结论腹腔镜肝切除术安全可行,其不但适用于良性肿瘤,也部分适用于恶性肿瘤。     

长期抗病毒治疗对乙型肝炎肝硬化失代偿期患者生存率的影响

目的 研究长期抗病毒治疗对Child-Pugh B级和C级乙型肝炎肝硬化失代偿期患者生存率的影响.方法 分析2005年1月1日至2010年1月1日就诊的386例乙型肝炎肝硬化失代偿期患者的临床资料,根据Child-Pugh分级对患者进行分组,观察长期抗病毒对不同分级患者生存率的影响.结果 所有HBV相关肝硬化失代偿期患者的5年累计生存率为63.73％(246例).5年累计生存率Child-Pugh B级组患者为73.05％,C级组为56.62％,两组比较差异有统计学意义(x2=12.723,P＜0.01).Child-Pugh B级组第1、2、3年的生存率分别为95.81％、91.88％、95.92％,高于C级组(87.21％ 、83.77％、90.00％),组间差异均有统计学意义(x2=8.595、5.330、3.887,P＜0.05);Child-Pugh B级和C级组患者第4、5年生存率分别为93.62％、92.42％和95.14％ 、90.51％,两组之间比较差异均无统计学意义(x2=0.309、0.289,P＞0.05).经抗病毒治疗5年生存的Child-Pugh B级、C级组患者的肝功能指标、凝血酶原活动度、Child-Pugh评分比较差异均无统计学意义(P均＞0.05).结论无论Child-Pugh B级或C级HBV相关肝硬化失代偿期患者,长期抗病毒治疗的生存率均能超过55.00％,B级患者优于C级患者.Child-Pugh分级较差的生存者经长期抗病毒治疗可获得与分级较轻患者相似的疗效.     

介入治疗肝癌致肝性脑病的原因分析及护理

在我国,原发性肝癌是一种常见肿瘤,每年大约有20万人死于该病。由于很多病人在发现时已属晚期,从而丧失了手术切除的机会。自从肝动脉插管化疗栓塞术(Therapentic ArterialEmbolization;简称TAE)问世以来,使许多肝癌晚期的病人,得到了相应的治疗,并取得了显著疗效。目前,TAE术已被越来越多的临床医院所应用。我院自1997年8月～2000年3月,已先后为98例肝癌病人进行了TAE术,其中有9例病人在TAE术后出现肝性脑病,现将其原因分析及护理要求介绍如下。1 临床资料 9例患者均为肝炎后肝硬化基础上发生的肝癌,肝功能Child-Paugh分级;A级5例,B级4例。3例病人术前查大便常规,发现隐血实验阳性;4例病人术前曾长期服用利尿药物;2例     

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.     

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.