CTFC在急性心肌梗死PCI中的价值及腺苷干预的研究

目的评价急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)中校正的心肌梗死溶栓治疗临床实验(TIMI)帧数(CorrectedTIMIFrameCount,CTFC)的价值及应用腺苷前后的变化。方法CTFC测定以造影剂充盈冠状动脉开始至冠状动脉远端某一解剖标志显影之间的帧数来表示,以<30帧为血流正常者,≥30为血流缓慢者。67例AMI后10～15d行冠状动脉造影和介入治疗,PCI前后分别经冠状动脉内注射腺苷注射液20mg,并观察CTFC的变化,PCI后均行二维超声心动图测定左心室射血分数(LVEF),并观察住院期间的主要心脏不良事件(MACE)。结果67例AMI患者CTFC为12～93帧,平均42.23±20.41帧,PCI术后的CTFC较术前明显减少(P<0.01),各梗死相关动脉和血流缓慢者PCI前应用腺苷后的CTFC较腺苷应用前均明显减少(P<0.05);血流正常者PCI治疗前、后以及血流缓慢者PCI后冠脉内应用腺苷前、后比较均无明显差异(P>0.05);血流正常者LVEF明显高于血流缓慢者(P=0.001),MACE发生率血流缓慢者明显高于血流正常者(P<0.05)。左心室射血分数和CTFC呈负相关趋势(γ=-0.21,P=0.002)。结论CTFC测定结果重复性好,与病人的心功能、MACE发生率相关性良好,不受检测者临床经验的限制,评价梗死相关动脉血流优于TIMI血流分级。而PCI前后冠脉内腺苷应用可明显降低CTFC,减少无复流或慢复流现象。     

溶栓后即刻经皮冠状动脉介入治疗对心肌梗死面积的影响

目的　探讨溶栓后即刻经皮冠状动脉介入 (PCI)治疗对急性心肌梗死 (AMI)患者心肌梗死面积的影响。方法　采用回顾性分析首次AMI患者 94例 ,发病时间均在 12h以内。 36例接受溶栓联合PCI治疗 ,5 8例接受直接PCI治疗 ,并于PCI术后 1周行核素心肌灌注显像测定心肌梗死面积 ,了解二者对AMI患者心肌梗死面积的影响。结果　两组患者自发病至PCI时间比较无明显差异 ;首次冠状动脉造影显示 :溶栓后即刻PCI组PCI术前梗死相关动脉TIMI 3级血流者明显较直接PCI组多 ;溶栓后即刻PCI组介入治疗成功率高 ,且术后TIMI 3级血流者多于直接PCI治疗组 ;PCI术后 1周时溶栓后即刻PCI组心肌梗死面积明显小于直接PCI组 ;两组比较出血并发症发生率无明显差异。结论　溶栓后即刻PCI治疗急性心肌梗死安全有效 ,早期再通率高 ,心肌梗死面积小 ,更有利于保护心室功能 ,且不增加出血并发症     

替罗非班对急性心肌梗死患者急诊PCI治疗疗效的影响

目的评估替罗非班用于急性ST段抬高型心肌梗死（STEM]）患者急诊经皮冠状动脉介入治疗（PCI）时的安全性及有效性。方法已确诊的STEMI患者PCI术前随机分为试验组和对照组,试验组PCI术前静脉使用盐酸替罗非班。观察2组患者PCI术前、术后前向血流（TIMI）血流情况、术后1周左心室射血分数、出血并发症和30d内发生心血管事件。结果与PCI组相比,替罗非班组PCI术后TIMIⅢ级血流获得率较PCI组高,差异有统计学意义（P〈0.05）;术后1周左室射血分数高于PCI组,差异有统计学意义（P〈0.05）,出血并发症发生率有高于PCI组趋势,但差异无统计学意义（P〉0．05）,无严重出血。30d内的主要心血管事件发生率低于PCI组,差异有统计学意义（P〈n05）。结论替罗非班可改善STEMI患者梗死相关血管的TIMI血流,可安全用于STEMI的急诊介入治疗中,明显减少急性心肌梗死患者30d内心血管事件的发生率。     

直接PCI与溶栓后即刻和补救PCI对AMI患者近期心功能的影响

目的　评价直接经皮冠状动脉介入治疗 (PCI)与小剂量rt -PA溶栓后即刻和补救PCI对急性心肌梗死 (AMI)患者的有效性和安全性 ,并观察其对近期左室重构及功能的影响。方法　对初次发病、发病 6h内且无溶栓禁忌症的AMI患者随机给予直接PCI或小剂量rt -PA溶栓加即刻和补救PCI治疗 ,于术后 3、3 0、90d行二维超声心动图检查并记录有关心脏事件。结果　共入选63例患者 ,随机分为直接PCI组 (对照组 ,A) 3 2例 ,溶栓加补救PCI组 (观察组 ,B) 3 1例。依据首次造影血流是否达TIMI 3级将所有病人再分为两组。术后 3、3 0、90d两组间左室收缩末期容积指数 (ESVI)、左室舒张末期容积指数 (EDSI)、左室射血分数 (EF)和室壁运动指数 (WMSI)均无显著差异 ( P >0 0 5 ) ;各组内 3 0d、90d与 3d比较均有显著差异 ;首次造影血流达TIMI 3级组与未达TIMI 3级组 3 0、90d各指标均显著改善。结论　直接PCI与小剂量rt -PA溶栓后即刻和补救PCI同样安全有效 ,改善左室功能并降低心脏事件的发生。     

38例急性心肌梗死介入治疗的研究及分析

目的研究及分析急诊冠状动脉介入治疗急性心肌梗死的临床疗效及安全性.方法急性心肌梗死患者38例行急诊冠脉介入治疗.梗死的相关动脉狭窄70%～100%,急诊置入支架49枚.结果梗死的相关动脉开通率100%,成功置入49枚支架,恢复TIMI 3级血流.结论急诊冠状动脉介入治疗急性心肌梗死是安全有效的方法和手段,提高了心血管危重患者抢救的成功率.     

急性心肌梗死择期冠脉介入治疗时间对心肌再灌注的影响

目的 通过测定急性心肌梗死（AMI）患者在不同时间行择期经皮冠状动脉支架植入术（PCI）后的梗死相关血管（IRA）的TIMI血流分级及校正TIMI帧数（CTCF）,来探讨急性心肌梗死择期PCI时间对心肌再灌注的影响.方法 60例急性心肌梗死,但已错急诊PCI手术时机病例60例,按发病后12 h～7 d（20例）、8～30 d（40例）期间行PCI治疗分为2组,测定各组内AMI患者PCI术后梗死相关动脉TIMI血流分级及校正TIMI帧数.结果 60例急性心肌梗死患者经择期PCI治疗后无死亡病例,12 h～7 d组中TIMI血流＜3级的患者较多（40% vs 12.5%,P＜0.05）;CTFC大于等于30帧的患者较多（45% vs 17.5%,P＜0.05）;CTFC较高（30.1±4.99 vs 19.2±4.18,P＜0.05）,差异有统计学意义.结论 急性心肌梗死患者在8～30 d内行择期PCI能使心肌得到更好的灌注.     

血清同型半胱氨酸水平对急性心肌梗死介入治疗患者预后的影响

目的 观察血清同型半胱氨酸(Hcy)水平对急性ST段抬高性心肌梗死患者直接经皮冠状动脉介入治疗术(PCI)后的心肌灌注及预后的影响.方法 对心内科接受直接PCI治疗的96例资料完整的急性ST段抬高性心肌梗死患者进行了回顾性分析,根据患者血清Hcy水平分为2组:A组Hcy＜15 μmol/L,B组Hcy≥15 μmol/L.评估PCI术后TIMI血流分级及TMPG心肌灌注分级;发病后1周内行超声心动图检查测定左心室射血分数(LVEF),评价心脏收缩功能.结果 冠脉造影结果中两支及以上血管病变的比例两组差别无统计学意义(分别为48.1%,65.9%,P＞0.05).PCI术后梗死相关血管TIMI血流分级3级两组无明显差异(分别为90.4%,90.9%,P＞0.05),心肌灌注分级(TMPG)0～2级A组低于B组(分别为21.2%,45.5%,P＜0.05),3级A组高于B组(分别为78.8%,54.5%,P＜0.05).PCI术后1周内超声心动图A组LVEF高于B组[分别为(56.6±8.9)%,(49.0±8.1)%,P＜0.01].结论 血清Hcy水平可能影响急性ST段抬高性心肌梗死患者在介入治疗后的心肌灌注与心功能.     

血栓抽吸导管在急性心肌梗死介入治疗中的应用

目的 观察血栓抽吸导管在急性心肌梗死（AMI）介入治疗中的应用效果.方法 选择86例已确诊的AMI患者,其中应用抽吸导管及冠状动脉介入治疗（PCI）的患者40例,为实验组;另有常规PCI组46例,为对照组.比较两组术后心肌梗死溶栓（TIMI）血流分级、心电图ST段回落率、术后1月心功能变化及住院期间心血管不良事件的发生率.结果 实验组术后梗塞相关血管：血流TIMI 3级36例、TIMI 2级4例、TIMI 0～1级0例,而对照组分别为29、15、2例,2组比较差异有统计学意义（P＜0.01）,实验组术后1h心电图ST段完全回落的患者25例、部分回落13例、无回落2例,对照组分别为17、21、8例,2组比较差异有统计学意义（P＜0.05）,术后1月实验组左室射血分数（51.4±4.3）％明显高于对照组（47.9±3.1）％,左室舒张末期内径（50.3±3.4）cm明显低于对照组（54.2±3.4）cm,术后实验组：1例再梗、2例心绞痛,对照组：3例再梗、3例心绞痛,2组均无死亡病例,2组术后主要心血管不良事件差异有统计学意义（P＜0.05）.结论 血栓抽吸联合传统PCI能明显改善AMI介入术后梗死相关血管的远端血流,促进术后心功能的恢复,减少术后心血管不良事件的发生.     

老龄急性ST段抬高性心肌梗死患者的急诊经皮冠状动脉介入治疗

目的评价老龄患者(年龄≥75岁)急诊经皮冠状动脉介入(PCI)治疗的安全性、有效性以及对左室功能的影响。方法对老龄急性ST段抬高心肌梗死的患者行急诊PCI治疗。结果53例急诊PCI治疗中,梗死相关动脉为前降支43例,右冠状动脉8例,左回旋支2例。53支梗死相关动脉,成功开通50例,于球囊扩张后置入支架55枚,2例PCI因大量的血栓负荷而失败,1例术中死于心源性休克。术后即刻造影成功率为94.3%,手术操作成功率为92.4%。术后1例住院期间死于心脏破裂。梗死后1周的平均左室射血分数为(51.2±3.3)%。结论急诊PCI治疗对老龄ST段抬高心肌梗死的患者是安全有效的,有助于左室功能的恢复。     

急诊介入治疗中AMI患者早期ST段下降幅度的临床意义

目的观察经皮冠脉内介入治疗(PCI)达TIMI血流3级的急性心肌梗死(AMI)患者的早期ST段下降幅度与梗死面积度及左室功能(LVEF)的相关性。方法经急诊PCI且TIMI血流3级的86例首次ST段抬高AMI患者,测量并比较PCI术前、术后2小时梗死相关导联ST段下降幅度,以∑St段下降>50%为A组,<50%为B组,应用心电图记分法和超声心动图分别测量两组梗死面积、LVEF。结果急诊PCI的AMI患者早期ST段下降幅度较TIMI血流更能反映心肌灌注和LVEF的改善状况,系观察PCI早期疗效的又一直观、简易、可靠性强的床边诊断指标。     

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.