34例早发型重度子痫前期治疗分析

目的:探讨早发型重度子痫前期对妊娠结局的影响。方法:回顾性分析132例重度子痫前期患者中早发型组34例(分析组)和晚发型组98例(对照组)的母婴结局。结果:早发型母亲妊娠高血压疾病性心脏病、子痫、胎盘早剥、HELLP综合征及孕产妇死亡等严重并发症总发生率为44.1%(15/34)明显高于晚发型组14.3%(14/98)(P<0.01)。早发型组分娩孕周为(33.2±2.6)周,早于晚发型组(38.4±1.8)周(P<0.01)。结论:早发型组孕妇严重并发症的发生率明显高于晚发型,应给予高度重视及更加严密的监测并适时终止妊娠;在严密监测下给予期待治疗可延长孕周,孕周≥32周、新生儿体重≥1300 g是新生儿有较良好预后的重要标志。     

157例重度子痫前期临床特点分析

目的 探讨早发型重度子痈前期一般临床特点及其引起的严重并发症情况. 方法 分析本院产科2007年4月1日～2008年10月30日住院的早发型(35例)和晚发型(122例)重度子痫前期患者的一般临床特点和严重并发症情况. 结果 重度子痈前期早发型组大量蛋白尿、血小板减少、胎盘早剥、HELLP综合征、胎儿生长受限、死胎的发生率均高于晚发型重度子痫前期组,差异有统计学意义(P<0.05). 结论 早发型重度子痫前期组母胎并发症严重,更易引起母胎不良后果.     

早发型重度先兆子痫期待疗法和母婴结局

目的 回顾性研究早发型重度先兆子痫的期待疗法及母婴结局.方法 选取2007年1月～2008年6月于北京妇产医院住院并分娩的329例诊断为重度先兆子痫的孕妇.按入院孕周的不同分为3组:Ⅰ组孕周≤27.6周,27例;Ⅱ组孕周28～33.6周,114例;Ⅲ组孕周≥34周,188例.3组均按入院后48h内是否终止妊娠分为立即终止组和期待组.分析和比较3组间孕妇并发症及围产儿结局.结果 Ⅰ组有22例(81.5%)行期待疗法,期待天数为3～59天,平均为14.5±18.7天,孕产妇并发症发生率为18.2%,围产儿死亡率高达864‰;Ⅱ组有84例(73.7%)行期待疗法,时间为3～12天,平均为9.4±7.1天,孕产妇并发症发生率为34.5%,围产儿死亡率为348‰,明显低于立即终止组(χ2=5.149,P<0.05).Ⅲ组有62例(33.0%)行期待疗法,时间为3～18天,平均5.1±3.0天,孕产妇并发症发生率为8.1%.Ⅰ组与Ⅱ组期待疗法的孕妇并发症发生率比较无显著性差异,Ⅱ组的围产儿死亡率明显低于Ⅰ组的(χ2=18.923,P<0.05).Ⅱ组孕妇并发症发生率、围产儿死亡率显著高于Ⅲ组.3组期待天数比较有显著性差异(F=10.735,P<0.05),Ⅰ组的期待天数明显高于Ⅱ组(F=5.140,P<0.05),Ⅰ组的期待天数明显高于Ⅲ组(F=9.420,P<0.05),Ⅱ组的期待天数明显高于Ⅲ组(F=29.780,P<0.05).结论 28周以前的重度先兆子痫患者采用期待疗法并未改善胎婴儿结局,发病于34周以后的重度先兆子痫期待疗法不能显著降低围产儿死亡率,故期待疗法意义不大.发病于28～34周的重度先兆子痫行期待疗法可明显降低围产儿死亡率,但期待疗法时间不宜过长.     

重度子痫前期213例临床分析

目的:探讨早发型重度子痫前期的临床特点及对母儿的影响。方法:回顾性分析2009年1月～2010年9月住院的45例早发型重度子痫前期患者与168例晚发型重度子痫前期患者的一般情况、并发症情况以及围生儿结局。结果:早发型重度子痫前期组在肝功异常、Hellp综合征、胎盘早剥、低蛋白血症、出生体重、胎儿生长受限等方面的发生率均高于晚发型组,差异有统计学意义(P<0.05)。结论:早发型重度子痫前期母儿并发症较重,严密监护下的期待治疗可改善母儿预后。     

41例早发型重度子痫前期患者母婴结局

目的:探讨早发型重度子痫前期对母婴预后的影响。方法:对十堰市妇幼保健院2007年1月~2008年12月收治的早发型重度子痫前期患者41例与同期收治晚发型患者128例母婴预后进行比较。结果:早发型重度子痫前期患者分娩孕周比晚发型早(P<0.01),治疗时间比晚发型长(P<0.01),早发型组围生儿体重低于晚发型组,早发型组围生儿早产、FGR、新生儿窒息、转入NICU及围生儿死亡率均分别高于晚发型组(P<0.01),早发型组与晚发型组母亲并发症差异无统计学意义(P>0.05)。结论:早发型重度子痫前期患者围生儿预后不良,保守治疗可改善母婴结局。     

子宫动脉血流阻力指数联合胎盘体积在评估早发型子痫前期中的应用

目的探讨子宫动脉血流阻力指数(RI)值联合胎盘体积在评估早发型子痫前期中的应用效果。方法选取广东省妇幼保健院确诊的早发型子痫前期孕妇68例作为观察对象,其中早发型轻度子痫前期37例(轻度组),早发型重度子痫前期31例(重度组),另取同期产检健康孕妇35例作为对照组。比较3组孕妇的血流RI值,胎盘大小,并采用ROC评价RI值联合胎盘大小在评估早发型子痫前期的价值。结果轻度组和重度组的胎盘体积均小于对照组孕妇,RI值则均高于参照组(均P0. 05),且重度组的胎盘体积均小于轻度组,RI值则高于轻度组(P0. 05),ROC曲线显示,联合血流RI值、胎盘最长径及最短径在预测早发型子痫前期中的灵敏度、特异度及曲线下面积均明显高于参考值(P0. 05)。结论子宫动脉血流RI值联合胎盘大小在评估早发型子痫前期的灵敏度和特异度均较高,价值良好,可作为评估早发型子痫前期的参考指标。     

神经节苷脂对早产儿脑损伤神经行为的影响

【目的】探讨神经节甘脂(GM-1)对早产儿脑损伤保护作用及临床疗效。【方法】82例发生脑室周围一脑室内出血(PVH-IVH)和脑室周围白质软化(PVL)脑损伤的早产儿分为GM-1组(42例)和对照组(40例)。GM-1组在常规治疗基础上加用GM-1治疗。观察与比较两组临床主要症状呼吸暂停发生率和吸吮-吞咽能力,并分别于校正胎龄40周和41周时予新生儿神经行为评分(NBNA)。【结果】GM-1组两次测查均明显高于对照组(P均<0.01)。临床主要症状吸吮-吞咽能力明显优于对照组(P<0.05),呼吸暂停发生率显著低于对照组(P<0.05)。【结论】GM-1为中枢神经系统损伤修复药物,对脑损伤的早产儿神经行为发育有促进作用,可改善近期预后,提高生存质量。     

早发型重度子痫前期79例妊娠结局分析

目的:探讨早发型重度子痫前期分娩方式与母儿结局的关系。方法:回顾分析79例早发型重度子痫前期妊娠结局,其中47例行剖宫产,32例阴道分娩,比较剖宫产组和阴道分娩组母亲并发症及围产儿结局的差异。结果:①两组孕妇年龄、体重、孕次、分娩孕周、血压、血清生化指标、尿蛋白等比较差异无统计学意义(P0.05)。②阴道分娩组产次、引产前宫颈Bishop评分显著高于剖宫产组,差异有统计学意义(P0.05);而产后出血的发生率显著低于剖宫产组,差异有统计学意义(P0.05);③两组新生儿出生胎龄、出生体重、新生儿窒息发生率、围生儿死亡率差异无统计学意义(P0.05)。结论:早发型重度子痫前期分娩方式应依据病情个体化制定,剖宫产并不能明显改善早发型重度子痫前期围产儿结局,且产后出血风险增加,需严格掌握手术指征;严格选择病例可以考虑引产和阴道分娩。     

178例不同类型子痫前期对不良围生儿结局的影响分析

目的探讨不同类型子痫前期产妇围生儿结局现状及相关影响因素分析。方法选取2017-05/2019-06期间达州市中心医院产科收治的178例子痫前期产妇,分为轻度早发型组(23例)、轻度晚发型组(41例)、重度早发型组(39例)、重度晚发型组(75例),比较4组研究对象的围生儿结局,采用Logistic回归分析探讨影响围生儿结局的危险因素。结果重度早发型组的围生儿结局发生率最高为79.49%,其次为轻度早发型组(39.13%)和重度晚发型组(29.33%),轻度晚发型最低(7.32%)。多因素Logistic回归分析显示,居住在农村、24 h尿蛋白、血清谷丙转氨酶、血清肌酐、血小板、活化部分凝血活酶时间、重度早发型、轻度早发型子痫前期是围生儿结局的危险因素(P0.05)。结论早发型子痫前期,特别是重度患者,发生不良妊娠结局和围生儿结局的比率较高,农村地区产妇由于医疗资源欠缺,产检不足,也是不良围生儿结局的重要因素。因此应当加大农村地区卫生投入,同时应密切监测不良围生儿结局的危险因素,如肝肾功、凝血等指标,对子痫前期产妇的病情研判和恰当治疗有重要意义。     

早发型与晚发型重度子痫前期母婴结局的对比研究

目的比较早发型与晚发型重度子痫前期母体并发症及其围产儿结局的差异,进而探讨早发型重度子痫前期患者期待治疗的重要性和可行性。方法对145例重度子痫前期进行回顾性分析,将34周作为早发型和晚发型重度子痫前期的分界,分析比较2组的一般临床资料、并发症情况及围产儿结局等指标。结果早发型重度子痫前期在收缩压、舒张压、并发症发生率(尤其是多器官受累)、围产儿结局等方面与晚发型相比,差异均具有统计学意义(P<0.05)。结论早发型重度子痫前期与晚发型重度子痫前期相比,具有发病早、病情重、母体并发症多、围产儿结局差等特点,应严密监测,尽可能延长孕周,适时终止妊娠。     

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.