腹腔镜中低位直肠癌TME手术72例报告

目的探讨腹腔镜中低位直肠癌的全直肠系膜切除术（total mesorectal excision，简称TME）的可行性。方法回顾总结2004年10月-2006年10月用腹腔镜中低位直肠癌TME手术72例的临床资料，对其手术情况进行分析。结果72例均在腹腔镜下顺利完成手术，无中转及手术死亡病例。手术平均时间157min，术中平均失血80mL，术后胃肠功能平均恢复时间为2.1d。手术切除淋巴结平均为18个。随访6～30个月未见切口种植及吻合口复发。结论腹腔镜中低位直肠癌TME手术具有创伤小、术后恢复快等优点，可以取得比开腹手术更好的根治效果。     

腹腔镜低位／超低位直肠癌Dixon术式临床应用体会

目的探索腹腔镜下全直肠系膜切除（TME）治疗低位／超低位直肠癌Dixon术式的可行性、方法与优缺点。方法按开放手术的TME原则、应用双钉合技术,采用直肠外翻拖出式切除缝合法在腹腔镜下对32例肿瘤下缘距离肛缘3～10cm的中下段直肠癌患者实施了TME与低位／超低位结直肠吻合保肛手术,2例切除部分受侵犯的阴道后壁。结果32例患者手术顺利,无中转开腹,手术时间150（120～180）min,术中出血20（10～100）ml,术后1～2d恢复胃肠功能并进食流质、下床活动,术后住院时间10（6～18）d。术中术后无并发症发生。结论腹腔镜TME治疗低位／超低位直肠癌Dixon术式安全可行,具有创伤小、手术视野清楚、出血少、术后疼痛轻、恢复快等优点。     

腹腔镜与开腹低位直肠癌TME超低位保肛术88例非随机对比研究

目的：探讨腹腔镜TME超低位保肛术治疗低位直肠癌的安全性和可行性。方法：回顾2004年1月～2009年6月间我院普通外科低位直肠癌的腹腔镜TME超低位保肛手术的临床资料,并以其开腹手术作为对照,进行分析。结果：本组腹腔镜手术56例,开腹手术32例。88例手术均顺利完成。腹腔镜手术后发生吻合口漏3例,大便次数增加7例;开腹手术后发生吻合口漏2例,大便次数增加5例,均经保守治疗好转。无输尿管损伤、排尿障碍、大便失禁等其它并发症。腹腔镜的手术时间和淋巴结清除数在两组间的差别均无统计学意义（P〉0.05）。腹腔镜的术中出血量和术后腹腔引流量比开腹手术少,肛门排气时间和住院时间比开腹手术短（P〈0.05）。结论：腹腔镜TME超低位保肛术治疗低位直肠癌是安全、可行的,同时能体现手术的微创性。     

腹腔镜TME技术在低位、超低位直肠癌保肛手术中的应用

[目的]探讨腹腔镜TME技术在低位、超低位直肠癌保肛手术中的应用效果。[方法]选取2009年6月~2011年2月在某院确诊为直肠癌患者100例,全部病例随机分为两组:腹腔镜组与开腹组各50例。比较两组的手术质量评价指标:手术时间、出血量、肛门恢复排气时间、淋巴结数等;及近期疗效评价指标:切口感染、吻合口瘘、肠粘连、术后尿潴留、住院时间等。[结果]与开腹组比较,腹腔镜组的手术时间短(P﹤0.05),出血量少(P﹤0.05),肛门恢复排气时间快(P﹤0.05),淋巴结数目达到开腹水平(P﹥0.05)。腹腔镜发生切口感染、吻合口瘘、肠粘连、术后尿潴留的发生率明显降低(P﹤0.05)。且腹腔镜组的住院时间短于开腹组(P﹤0.05)。[结论]腹腔镜TME技术应用于低位、超低位直肠癌保肛手术中疗效确切,具有手术时间短、出血量少、肛门恢复排气时间快、术后并发症发生率低等优点,值得临床推广。     

腹腔镜全直肠系膜切除术治疗低位、超低位直肠癌的疗效观察

目的探讨腹腔镜全直肠系膜切除术（TME）治疗低住、超低位直肠癌的临床疗效。方法将86侈4低位直肠癌患者随机分为观察组和对照组,每组各45例,观察组患者行腹腔镜TME,对照组患者行开腹TME,术后观察两组患者的手术相关指标、肿瘤根治性指标、术后恢复指标、费用、术后并发症。结果观察组的术中出血量较对照组少（P〈0．05）;观察组的手术时间、术后肛门排气时间、留置导尿时间、术后住院时间较对照组短（P〈0．05）;观察组术后的切口感染、肠粘连、尿潴留明显较对照组少（P〈0．05）;观察组的肿瘤大小、切除标本长度、吻合口瘘发生率、清扫淋巴结数目、肿瘤远端切缘长度及肿瘤分期等方面与对照组比较差异无统计学意义（P〉0．05）;但观察组的手术费用、住院总费用高于对照组（P〈0．05）。结论腹腔镜TME治疗低位、超低位直肠癌具有确切的疗效,且创伤小,疼痛轻、出血量少、肛门快速恢复排气、降低术后并发症的发生率、疗程短及预后好等优点,整体上较为安全可靠,值得临床广泛应用。     

手助腹腔镜在中低位直肠癌根治术中的应用探讨

目的探讨手助腹腔镜应用于中低位直肠癌根治术操作可行性和临床疗效。方法回顾性分析20例应用手助腹腔镜技术施行中低位直肠癌根治术患者,并随访3～50个月。结果全部病例顺利完成手术,手术时间为175（92—313）min。术中出血量210（91～325）mL,术后肛门排气时间48（36—72）h,术后进食时间72（48—96）h,术后住院天数平均11（7—15）d,手术切除淋巴结平均12（0～21）个。全组无术中大出血或自主神经损伤,无吻合口瘘发生。随访3～50个月．无吻合口漏或瘘,无肿瘤复发或远处器官转移。结论手助腹腔镜应用于中低位直肠癌根治术操作可行,疗效确切,适宜基层医院开展。     

腹腔镜辅助中低位直肠癌保肛手术36例临床观察

目的探讨腹腔镜辅助下中低位直肠癌保肛手术的可行性及疗效。方法对笔者所在医院2009年5月～2011年6月通过腹腔镜辅助行中低位直肠癌保肛手术的36例患者的临床资料进行总结。结果36例患者顺利完成了腹腔镜辅助下中低直肠癌保肛手术，所有手术均获得成功，切口长度4～6cm，其中反麦氏切口29例，下腹正中切口7例。术后肛门排气时间平均4d（3～5d），拔尿管时间平均4d（3～5d）。术后7d拆线，9～10d出院，所有患者随访2～36个月，12例术后2～6月内大便次数增多，5—6次／d，2～6个月后减少至2—3次／d，余24例术后近期恢复良好。结论腹腔镜辅助中低位直肠癌保肛手术疗效可靠，保留肛门使患者的生活质量明显改善。     

直肠癌全系膜切除联合吻合器及超声刀治疗中低位直肠癌14例临床分析

目的探讨直肠癌全系膜切除联合吻合器及超声刀在治疗低位直肠癌中的应用。方法本文回顾性分析在笔者所在医院明确诊断为中低位直肠癌,并用TME及联合吻合器及超声刀手术治疗的14例患者。结果14例患者手术过程顺利,手术时间2-3h,术后胃肠功能恢复时间2-3d,术后8-10d出院。术后1例患者出现吻合口出血,1例患者出现吻合口漏,1例患者出现吻合口狭窄,经治疗均康复出院。术后均予以常规化疗,随访6-48个月,有1例患者复发。结论直肠癌全系膜切除联合吻合器及超声刀治疗中低位直肠癌既达到了根治性原则,解剖分离精细、快捷,有效缩短手术时间,又保留了肛门,改善了患者生活质量,是治疗中低位直肠癌的可靠方法。     

腹腔镜直肠全系膜切除术治疗中、低位直肠癌的临床效果

目的:探究中、低位直肠癌患者治疗中腹腔镜直肠全系膜切除术的应用效果。方法 :本次研究中的84例中、低位直肠癌患者均于2018年7月-2019年7月入我院进行治疗,实施开腹手术的42例为对照组,实施腹腔镜手术的42例为研究组,对比两组患者术后康复情况。结果 :研究组患者手术后胃肠道功能恢复时间、术后进食时间、下床活动时间以及住院时间与对照组相比均较少(P 0.05)。结论 :中、低位直肠癌患者治疗中腹腔镜直肠全系膜切除术的应用效果与传统开腹手术相比有非常显著的优势。     

腹腔镜低位直肠癌根治术的手术配合

目的讨论腹腔镜低位直肠癌根治术的手术配合经验。方法总结62例腹腔镜低位直肠癌根治术的手术配合经验,包括术前探视、术中巡回及洗手护士的手术配合经验。结果所有患者手术均顺利完成,术中出血少,术后恢复快,无严重并发症。结论腹腔镜直肠癌根治术要求手术室护士具有熟练的配合技巧及经验。     

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.