提上睑肌折叠联合重睑成形术治疗老年性眼睑松弛症临床观察

目的：探讨老年性眼睑松弛症的手术治疗效果。方法：采用提上睑肌折叠固定于睑板上缘,联合上眼睑松弛的皮肤、眼轮匝肌及眶脂肪部分切除以矫治老年性眼睑松弛症状。结果：对34例（68眼）患者施本手术治疗后,上眼睑皮肤松弛症状改善明显,眼睑闭合良好,重睑线弧度流畅。结论：提上睑肌折叠联合重睑成形术治疗老年性眼睑松弛症临床效果满意。     

眼袋生成原因多

眼袋是眼睑皮肤松弛、眶隔薄弱、眶脂膨隆、轮匝肌肥厚以及诸多因素导致眼睑皮肤向前隆起造成的,严重者眼睑皮肤可形成悬垂的袋状结构。导致眼袋产生的原因主要为:眼睑皮肤松弛症多见于老年人,偶见于中年人,如累及上睑则表现为上睑皮肤过多且松弛,出现皱褶;眼睑皮肤与轮匝肌眶骨连接的部位组织肥厚松弛,皮肤向下悬垂,甚至超过睑缘,使睑裂缩小变形,呈三角形睑裂,造成假性或真性上睑下垂,遮挡部分视野。眼睑松弛症是一种原因不明的眼睑疾病,可能与遗传和内分泌因素有关。多数患者表现为反复发作的眼睑皮肤血管性水肿,主要累及上睑,以女性青年…     

三种重睑术术后并发症的分析

重睑即是在睁眼时上睑沟之上的皮肤下垂形成的。关于重睑形成的机制有多种理论,有学者认为是由于眼睑皮肤纤薄,皮下组织非常疏松,使眼睑皮肤可在肌肉表面自由滑动[1]。而且电镜观察也发现重睑者上睑皮肤与深层纤维结缔组织间穿肌层有明显的纤维联系结构,而非重睑者则没有。另有人认为上睑提肌腱膜纤维穿过眼轮匝肌附着于睑板上方的皮肤中,上睑提肌的收缩,睑板上提,睑板前方的皮肤随之上提,形成重睑皱襞[2]。此外,皮肤质地,肌肉厚薄、脂肪多少等因素也在一定程度上影响重睑的形成[2]。虽然单睑与重睑的美学意义在理论上并不绝对,但如今重睑术已成为我国开展最广泛,数量最多的美容整形手术。重睑成形术最早起源于一百余年前,眼科医生实施的上睑内翻矫正术[3]。经过多年发展,重睑术的手术方法已有数十种,主要有切开法,埋线法,缝线法,微创法及利用其他辅助设备的重睑术,如激光等。各种重睑术的原理都基本相同:要将单睑变成重睑,必须使睑板前的皮肤与上睑提肌腱膜的纤维在睑板上缘有牢固的粘连,这样在上睑提肌做上提运动时形成重睑皱褶。本文对浙江大学附属邵逸夫医院整形外科2002年10月至2009年12月行的664例单纯重睑手术的术后并发症,进行评价分析。现将结果报道如下。     

改良Park法重睑术与传统切开法重睑术治疗上睑松弛伴臃肿患者的效果对比

目的 探讨改良Park法重睑术与传统切开法重睑术治疗上睑松弛伴臃肿患者的效果。方法 45例上睑松弛伴臃肿患者按治疗方法的不同分为对照组（传统切开法重睑术）和观察组（改良Park法重睑术）,比较两组的手术情况、眼睑形态、修复满意度及并发症。结果 观察组的手术时间、拆线时间及术后恢复时间均短于对照组,术后3个月的眼睑形态评分及修复满意度评分均高于对照组（P <0.05）。两组的并发症总发生率相比,差异无统计学意义（P>0.05）。结论 与传统切开法重睑术相比,改良Park法重睑术治疗上睑松弛伴臃肿的效果更显著,安全性更高,可改善患者眼睑形态,提高修复满意度。     

老年性上睑皮肤松弛伴睑内翻矫正术

目的：探讨上睑皮肤松弛伴睑内翻矫正术的临床疗效。方法：对15例上睑皮肤松弛伴睑内翻的老年患者进行重睑成形并切削增厚睑板,术后随访3-12个月。结果：15例患者术后形态效果好,均取得满意效果,双眼基本对称,上睑内翻倒睫均得到矫正,外形流畅自然。随访3-12个月,治愈率100％,满意率为100％。结论：重睑成形并切削增厚睑板是治疗老年性上睑皮肤松弛伴睑内翻的有效治疗方法。     

眼袋整复术后与潜在下睑外翻的隐患

目的 探讨年龄较大的眼轮匝肌明显松弛患者眼袋整复术的方法,以避免发生术后下睑外翻,提高眼袋整复术远期疗效.方法 对52例年龄较大的眼轮匝肌明显松弛患者进行眼袋整复术.切开后在皮下分离皮肤接近眶下缘,打开眶隔,祛除脱出的眶脂肪后加固缝合眶隔、分离睑板部轮匝肌,于颞侧1/3处垂直于睑缘切除松弛的轮匝肌,用可吸收缝线“8”字形间断缝合两断端,使该部肌肉张力加大.切除多余的皮肤后缝合切口.结果 术后随访3个月至10年,眼袋消失且自然,无凹陷,无一例出现下睑外翻,下睑张力明显增加,除2例下睑轮匝肌吻合处有小的瘢痕结节外,患者满意.结论 祛眼袋手术不可破坏睑板部的眼轮匝肌,为了追求手术显效而去除过多的皮肤和眼轮匝肌,不仅容易发生术后立即看得到的睑球分离,睑缘退缩和外翻,更会给患者留下潜在的下睑外翻隐患.下睑外翻是手术后常见的失误,已得到重视,术中如果消弱了轮匝肌力量会给受术者留下潜在的下睑外翻的隐患这点认识还不足,估计等到若干年步入老年后,似老年性下睑外翻的发生率在祛眼袋的人群中将会大大提高,这点更应该引起我们的极大关注.     

微创小切口睑板前联合筋膜重建的重睑术

目的：探索一种损伤小、恢复快、效果持久、具有生理特征重睑术的临床效果。方法：在重睑线内、外眦及黄金点处三点微创切开。去除睑板前眼轮匝肌、臃肿的眶隔脂肪。在三点微创处，用切口下唇皮肤直接与睑板前联合筋膜相缝合的方式形成重睑皱襞。结果：通过对130对单睑患者施行重睑术，术后平均7—10天消肿，形成的重睑形态稳定，2个月左右恢复自然，在睁眼时呈现出生动的重睑线，而闲眼时重睑线不明显，随访3-24个月，均获得满意效果。结论：该法与传统重睑相比，创伤小、术后肿胀期短、符合生理特征的重睑成形术，值得临床推广应用。     

改良三点式重睑术治疗上睑皮肤松弛的临床分析

目的探讨改良三点式重睑术治疗上睑皮肤松弛的临床效果。方法回顾性分析我院2010年2月至2012年5月收治的120例上睑皮肤松弛患者,随机分为2组,其中观察组89例(改良三点式重睑术),对照组31例(传统重睑手术方式),对比分析观察组与对照组患者的术后并发症及满意度情况。结果观察组患者术后对重睑形态都较满意,仅1例出现切口瘢痕增生,经再次修复后满意,术后恢复时间(1±0.5)月;对照组有9例对重睑形态不满意,1例患者在术后2个月时间发生重睑消失,再次修复后满意,术后回复时间(3±0.5)月。结论改良三点式重睑手术可有效改善上睑皮肤松弛,大大增加患者对重睑形态的满意度,减少并发症,术后恢复时间较短,值得向临床推荐。     

眼轮匝肌蒂推进皮瓣在眼睑缺损修复中的效果

目的分析眼轮匝肌蒂推进皮瓣在眼睑缺损修复中的效果。方法选取2017年1月-2018年8月深圳市人民医院在眼睑缺损修复中应用眼轮匝肌蒂推进皮瓣的80例患者作为研究对象,对其临床效果进行分析。结果手术后睑裂长度差及睑裂高度差改善明显优于手术前,差异有统计学意义(P0.05)。其中皮瓣全部成活,经换药,治疗痊愈72例,术后因为皮瓣略显臃肿或者切口痕迹开展2次手术8例,术后功能均无障碍,随访至少2个月,效果满意。结论眼轮匝肌蒂推进皮瓣在眼睑缺损修复中的应用效果满意,本研究为拓宽眼轮匝肌蒂推进皮瓣在修复手术中的应用范围提供相应的理论依据,疗效满意,值得临床进一步推广。     

真皮眼轮匝肌瓣内固定法重睑成形术的临床价值

目的 分析真皮眼轮匝肌瓣内固定法重睑成形术的临床价值。方法 选取80例重睑成形术患者,入院时间为2019年3月—2020年3月。应用简单随机法分为对照组、观察组（n=40）。对照组患者接受传统皮肤-上睑提肌腱膜固定技术治疗,观察组为患者开展真皮眼轮匝肌瓣内固定法重睑成形术治疗,比较两组患者情况。结果 观察组患者的双侧脸裂高度、睫毛暴露长度及睫毛上翘度、优良率、手术时间、术后康复时间、满意度均明显优于对照组（P <0.05）。结论 真皮眼轮匝肌瓣内固定法重睑成形术可以模拟生理重睑的原理,有利于良好、持久和光滑平整重睑外观的形成。     

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.