米索前列醇后穹窿放置在疤痕子宫人流术中的应用

目的探索米索前列醇用于一年内疤痕子宫妊娠人流术的安全性和优越性。方法将我院一年内疤痕子宫妊娠拟行无痛流产的179例随机分为两组,观察组即用米索前列醇放置阴道后穹隆行无痛流产94例,对照组不加药行无痛流产85例,两组进行临床分析。结果观察组应用米索前列醇使宫颈软化扩张总有效率100％,满意率92．5％,对照组宫颈扩张总有效率45．9％,满意率9．4％;手术时间：观察组（1．5±0．35）min,对照组（3．5±0．55）rain;术中出血量：观察组（11±3．4）ml,对照组（21±3．5）ml,两组间比较差异有统计学意义（P〈0．01）。对照组一例为剖宫产后4个月哺乳中疑似穿孔。结论米索前列醇湿片放置后穹窿用于疤痕子宫妊娠无痛流产,缩短了手术时间,减少了术中出血,提高了手术的安全性值得推广。     

剖宫产术后应用缩宫素联合米索前列醇预防产后出血的疗效观察及护理体会

目的探讨缩宫素联合米索前列醇预防剖宫产术后出血的效果及护理体会。方法将870例子宫下段剖宫产术的产妇分成两组，观察组435例剖宫产术后的产妇给予缩宫素20U静脉滴注并用米索前列醇200ug置入直肠；对照组435例剖宫产术后的产妇单用缩宫素20U静脉滴注。分别观察术后2h、24h阴道出血、子宫收缩情况及术后肠功能恢复时间。结果观察组术后2h内阴道出血（120±60）ml，24h阴道出血（168±45）ml，与对照组比较明显减少，差异具有显著性意义（P〈0．05）。观察组肠功能恢复时间（20±3．5）h，与对照组比较明显缩短（P〈0．05）。结论缩宫素联合米索前列醇可明显加强子宫收缩，减少剖宫产术后出血量，肠功能恢复快、效果显著、副作用少。     

米索前列醇联合催产素治疗子宫收缩乏力引起产后出血的疗效分析及护理

目的探讨米索前列醇联合催产素治疗子宫收缩乏力引起产后出血的疗效。方法将50例子宫收缩乏力引起产后出血的产妇随机分成两组,每组25例,观察组用米索前列醇联合催产素进行治疗,对照组单纯用催产素静脉滴注。结果两组胎儿娩出到处置前出血量无明显差异（P〉0．05）,观察组产后2h总出血量、产后24h总出血量明显少于对照组（P〈0．05）。结论米索前列醇联合催产素治疗子宫收缩乏力引起产后出血疗效明显。     

宫体缝扎联合米索治疗剖宫产时子宫收缩乏力的临床观察

目的：探讨宫体局部缝扎联合米索前列醇在治疗剖宫产时子宫收缩乏力者产后出血量的临床效果。方法：回顾性分析某医院剖宫产术中出现子宫收缩乏力、出血大于400ml 者,观察组40例予宫体局部缝扎联合米索前列醇400UG应用,对照组38例予缩宫素20U 静脉应用,40U 宫体局部肌注。比较两组产后出血量及产后出血率。结果：宫体局部缝扎联合米索前列醇治疗剖宫产术中子宫收缩乏力者产后出血量及产后出血率均明显低于对照组,两组比较差异有统计学意义（P〈0.05）。结论：宫体局部缝扎联合米索前列醇治疗剖宫产术中的子宫收缩乏力可以明显减少产后出血量,降低产后出血率,且操作简单、效果确切,是治疗剖宫产术中子宫收缩乏力的有效手段。     

卡前列素氨丁三醇联合子宫下段横形环状压迫缝合术治疗疤痕子宫剖宫产子宫收缩乏力的临床分析

目的分析卡前列素氨丁三醇联合子宫下段横形环状压迫缝合术在临床中治疗疤痕子宫再次行剖宫产,术中出现子宫收缩乏力的效果。方法选择2018年6月—12月间因疤痕子宫第二次行剖宫产分娩的120例产妇,术中均出现子宫收缩乏力现象,以随机数字表法分为对照组与观察组,每组各60例,对照组接受卡前列素氨丁三醇干预,观察组在其基础上联合子宫下段横形环状压迫缝合术干预,观察统计产时出血量,产后2 h出血量、产后24 h出血量、新生儿体重、输血率。结果观察组产时出血量、产后2 h出血量等情况均显著优于对照组(P <0. 05);观察组输血率以及新生儿体重情况均显著优于对照组(P <0. 05)。结论将卡前列素氨丁三醇联合子宫下段横形环状压迫缝合术应用到疤痕子宫再次行剖宫产,术中出现子宫收缩乏力的患者中,可有效减少出血量,且输血率较低,值得推广。     

巧特欣联合米索前列醇防治剖宫产产后出血的作用分析

目的探讨巧特欣联合米索前列醇用于剖宫产产后出血防治的应用价值。方法选择近年来笔者所在科行剖宫产的74例产妇，均应用巧特欣与米索前列醇联合防治产后出血，并与之前62例单纯应用缩宫素的对照组进行比较，比较治疗后子宫收缩效果及止血效果。结果观察组的剖宫产后子宫收缩良好占93．2％，显著优于对照组的82．3％（P〈0．05）；治疗后24h，止血有效，有效率98．5％，产后3h、12h，观察组阴道平均出血量为（127．9±77．3）m1、（142．5±72．6）ml，显著低于对照组平均出血量（P〈0．05）。结论巧特欣联合米索前列醇用于剖宫产产后出血疗效明显。     

米索前列醇直肠给药预防病理性剖宫产术后出血临床观察

目的观察米索前列醇预防病理性剖宫产术后出血的效果。方法选择2006年10月至2008年10月行病理性剖宫产患者100例,随机分成两组,每组各50例,观察组术前麻醉成功后给予米索前列醇片200μg肛门纳入,术中胎儿娩出后给予催产素针20u静脉滴注;对照组术中胎儿娩出后给予催产素针20U宫底肌肉注射和催产素针20u静脉滴注。观察两组术中、术后出血量。结果观察组术中出血量（220±60）ml,术后阴道积血（70．0±12．5）ml;对照组术中出血量（242±58）ml,术后阴道积血（80．0±17.3）ml;两组比较差异均有统计学意义（P〈0．01）。结论米索前列醇直肠用药能有效促进子宫收缩,用于预防产后出血。     

小剂量米索前列醇联合利凡诺在瘢痕子宫妊娠引产中的应用效果

目的：研究小剂量米索前列醇结合利凡诺注射在瘢痕子宫妊娠引产中的应用效果。方法将2014年8月至2015年9月在宝鸡市中心医院就诊的58例瘢痕子宫妊娠患者根据引产方法随机分组,研究组29例采用小剂量米索前列醇结合利凡诺注射;对照组29例仅用利凡诺注射引产,对比两组引产效果。结果研究组引产成功率为96．55％,显著高于对照组的79．31％（χ2＝4．06,P＜0．05）;研究组的引产时间（5．11±2．23）h和总出血量（137．54±10．36）mL均显著低于对照组（t值分别为7．153和6．361,均P＜0．05）;研究组有2例患者出现发热不良反应,不良反应发生率为6．90％;对照组有8例患者出现不良反应,其中5例的临床症状表现为发热,1例出现大出血,2例出现软产道裂伤,不良反应发生率为17．24％。研究组的不良反发生率低于对照组,差异具有统计学意义（χ2＝5．873,P＜0．05）。结论采用小剂量米索前列醇结合利凡诺注射能有效提高瘢痕子宫产妇引产成功率,且用药过程中安全性较高,对患者身体的危害性较小。     

米索前列醇预防产后出血高危因素效果观察

目的观察米索前列醇应用于防治有产后出血高危因素的产妇剖宫产术中、术后出血的有效性和安全性。方法对338例有产后出血高危因素的产妇行计划性剖宫产术。术中胎儿娩出后按宫缩剂使用情况分为两组,缩宫素组160例,缩宫素20U宫体注射,10U加入液体中静滴;缩宫素＋米索前列醇组178例,缩宫素20u宫体注射,10U加入液体中静滴,米索前列醇400μg舌下含服,计算术中、术后2h及术后24h总出血量,并观察两组的副反应。结果（1）两组产妇术中出血量分别为缩宫素组（412±243）ml,缩宫素＋米索前列醇组（322±206）ml,两组比较,差异有统计学意义（P〈0.01）;（2）两组术后2h出血量分别为缩宫素组（197±173）ml,缩宫素＋米索前列醇组（111±97）ml,两组比较差异有统计学意义（P〈0.05）;（3）两组产妇24h总出血量≥1000ml的27例,其中缩宫素组19例,缩宫素＋米索前列醇组8例,无1例切除子宫。缩宫素组总出血量明显多于缩宫素＋米索前列醇组;分别为（698±319）ml及（471＋224）ml,两组比较,差异有统计学意义（P〈0.01）;（4）副反应发生率缩宫素组为1.6％,缩宫素＋米索前列醇组为8.5％,后者主要以恶心、呕吐为常见症状,短时间好转消失。结论米索前列醇＋缩宫素用于有产后出血高危因素的产妇剖宫产,可明显减少术中及术后出血量。     

剖宫产术中应用米索前列醇预防产后出血的临床观察

目的：观察米索前列醇用于预防剖宫产术后出血的效果。方法：收治产后出血高危因素的剖宫产患者300例,随机分为米索前列醇＋缩宫索组150例与缩宫素组150例。观察组胎儿娩出后立即宫体肌注射缩宫素20IU,同时舌下含化米索前列醇0．2mg,对照组宫体肌注射缩宫素20IU。观察两组术中、术后出血量的差异。结果：米索前列醇＋缩宫素组术中、产后24h出血量均明显少于缩宫素组（P〈0．05）。结论：米索前列醇联合缩官素能有效促进子宫收缩,减少剖宫产术中、术后出血。     

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.