镍钛记忆合金硅橡胶可复性输卵管避孕栓的动物实验研究

目的:应用镍钛记忆合金硅橡胶可复性输卵管栓进行动物实验研究,观察其抗生育效果和取栓后生育力恢复情况。方法:新西兰成年雌兔(实验组30只、对照组5只),经腹暴露子宫后,子宫近输卵管1cm处做一纵向0．5cm切口,将输卵管栓放入特制放置器顶端,顺序推出内部针芯、外部套管,使栓子留在输卵管内。术后1个月开始与雄兔合笼,每周交配1次(每月交配4次),观察避孕效果,术后3个月10只雌兔取出输卵管栓子观察可复性。结果:栓子放置术后2个月,30只雌兔中除1 只因栓子放置位置不当而妊娠外,其余29只均未妊娠。10只取出栓子后1个月内交配3次均妊娠。结论:镍钛记忆合金硅橡胶可复性输卵管避孕栓是一种新型、有效和可复性的输卵管避孕器具。     

腹腔镜子宫切除合并输卵管切除术对子宫良性病变患者卵巢储备功能及反应性的临床研究

目的探究腹腔镜子宫切除合并输卵管切除术对子宫良性病变患者卵巢储备功能及反应性的影响,为合理的术式选择及患者生活质量的提高提供理论依据。方法回顾性分析2015年2月-2017年3月于该院行手术治疗的105例子宫良性病变患者,根据是否保留输卵管进行分组,将采用腹腔镜子宫切除合并输卵管切除术治疗的55例患者设为观察组,保留输卵管的50例患者设为对照组。比较两组患者治疗前、治疗3个月、6个月后雌二醇(E2)、抗苗勒氏管抑制物(AMH)、抑制素B(INHB)、黄体生成素(LH)及卵泡刺激素(FSH)水平,记录两组患者手术时间、术中出血量以及住院时间,比较围绝经期症状以及术后盆腔包块发生率,比较两组患者术后相关卵巢反应性指标。结果两组患者术后E2、FSH、LH均显著高于术前,AMH、INHB显著低于术前,观察组术后3个月、6个月AMH、INHB显著低于对照组(P0.05);两组手术时间、术中出血量以及住院时间比较,差异无统计学意义(P0.05);观察组围绝经期症状以及术后盆腔包块发生率分别为25.45%、14.55%,显著高于对照组(14.00%、6.00%),差异均有统计学意义(均P0.05);观察组卵泡早期卵巢大小与对照组比较,差异无统计学意义(P0.05),卵泡个数、卵子数均显著低于对照组(P0.05)。结论腹腔镜子宫切除合并输卵管切除术可能在短时间内影响患者的卵巢储备功能,降低卵巢反应性,这可能与输卵管切除对卵巢的血液供应和超排卵效果的影响有关。     

聚氨酯铋输卵管栓堵术18～24个序月的临床研究

为进一步了解聚氨酯铋输卵管栓堵的效果,采用一次性医用带囊双腔管,经宫腔注入聚氯酯铋行输卵管栓堵术585例,观察18～24个序月的栓堵效果及术后X光片显影,对10例术后检查输卵管通畅者实行补做。结果,随访至18个月者409例(70％);24个月者176例(30％),11例妊娠均发生在18个月内。术后2～3个月行输卵管通畅试验,其中造影者132例,123例堵塞成功;通水试验442例,成功383例。总成功率为86.7％,累积妊娠率为1.8％,无术中术后反应。经宫腔注入高分子材料的输卵管栓堵术为一种简便价廉、无副反应、不经腹部的输卵管绝育术。术后X光片检查双显者可做为成功指标,术后不能肯定者,需做输卵管通畅试验。不成功者立即补做,可提高成功率。     

两种术式治疗非脱垂良性子宫病变的效果比较

目的比较腹腔镜辅助阴式全子宫切除术(LAVH)和经阴式全子宫切除术(TVH)治疗非脱垂良性子宫病变的临床疗效。方法选取非脱垂良性子宫病变患者共70例,随机分为实验组和对照组。实验组予以LAVH手术,对照组予以TVH手术。对比两组患者手术一般情况、手术前后血红蛋白水平、切口甲级愈合率、术后性功能和术后并发症发生率。结果实验组手术时间与对照组比较显著延长(P0.01),实验组术中出血量、术后下床活动时间、术后排气时间以及住院时间与对照组比较,均显著缩短(P0.01);两组术后3个月血清血红蛋白含量与术前比较均显著上升(P0.05),且实验组较对照组上升幅度更明显(P0.01);两组患者切口甲级愈合率无统计学差异(P0.05);实验组术后性交障碍和性交痛较对照组显著改善,性高潮次数显著高于对照组(P0.05);实验组术后并发症发生率显著低于对照组(P0.05)。结论 LVAH治疗非脱垂良性子宫病变创伤较小,术后恢复快,患者性功能改善明显,并发症发生率较低,优于TVH。     

子宫肌瘤行子宫切除术后患者卵巢功能及生活质量的研究

目的:探讨腹式、阴式及腹腔镜子宫切除术对子宫肌瘤的临床疗效及卵巢功能的影响并观察子宫切除术后患者的生活质量。方法:对子宫切除选择3种不同的手术方式,分别于术前、术后3个月、6个月观察卵巢功能及生活质量的变化。结果:①与腹式子宫切除组比较,腹腔镜子宫切除组、阴式子宫切除组具有手术时间、排气时间、术后住院时间短,术中出血量少,术后并发症发病率低的特点,差异具有统计学意义(P0.05),腹腔镜子宫切除组与阴式子宫切除组比较差异无统计学意义(P0.05);②术后1个月3组患者的FSH、LH水平较术前显著上升,E2显著性下降,差异均有统计学意义(P0.05),术后6个月血清性激素水平恢复至手术前水平,无统计学差异(P0.05);3组患者相比,术后1、6个月血清性激素水平差异均无统计学意义(P0.05);③术后生活质量较术前改善明显(P0.05),与腹式子宫切除组比较,腹腔镜子宫切除组、阴式子宫切除组生活质量改善更为明显(P0.05),腹腔镜子宫切除组与阴式子宫切除组生活质量比较差异无统计学意义(P0.05)。结论:腹腔镜子宫切除术及阴式子宫切除术术后总体疗效优于传统的开腹式手术。     

输卵管远端梗阻患者腹腔镜术后的妊娠结局

目的探讨腹腔镜下输卵管不同分级及输卵管积水复发的妊娠结局。方法选择2010年6月—2011年10月在本院生殖中心因输卵管远端阻塞性不孕行腹腔镜手术的患者120例,术中对输卵管病变进行分级,依据术中情况选择输卵管造口术或输卵管根部灼断术,术后比较各级输卵管自然妊娠情况,比较Ⅰ、Ⅱ级及Ⅲ、Ⅳ级自然妊娠率,试孕失败后行体外受精-胚胎移植助孕治疗(in vitro fertilization and embryo transfer,IVF-ET)的妊娠情况,并分析影响输卵管分级的因素。计数资料采用χ2检验,P0.05为差异有统计学意义。结果严格按照评级标准评级后发现120例患者中Ⅰ级17例;Ⅱ级31例;Ⅲ级32例;Ⅳ级40例(其中8例行灼断术)。随访6~28个月,术后自然妊娠率分别为Ⅰ级47.06%(8/17)、Ⅱ级35.49%(11/31)、Ⅲ级6.25%(2/32)、Ⅳ级0(0/32)。Ⅰ、Ⅱ级妊娠率明显高于Ⅲ、Ⅳ级妊娠率,两者比较差异有统计学意义(χ2=17.199,P0.05);输卵管积水患者灼断后行IVF-ET助孕治疗组妊娠46.15%(6/13)明显高于灼断前IVF-ET助孕治疗组(7.69%,1/13),两者比较差异有统计学差义(χ2=4.887,P0.05),Ⅰ、Ⅱ级试孕12个月未孕者25例接受IVF-ET助孕治疗,孕9例(36.00%,9/25),Ⅲ、Ⅳ级IVF-ET治疗65例孕20例(30.76%,20/65),Ⅰ、Ⅱ级IVF-ET妊娠率与Ⅲ、Ⅳ级IVF-ET妊娠率比较,两者差异无统计学意义(χ2=1.768,P0.05)。结论对输卵管远端阻塞性不孕的患者行腹腔镜手术治疗时应在术中对输卵管状态进行评级,可根据评级结果选择不同的助孕方法。     

聚乙烯输卵管避孕栓避孕效果及可复性的动物实验

目的:观察聚乙烯输卵管栓抗生育效果、置栓后组织学改变和取栓后生育力恢复情况。方法:将31只新西兰实验兔随机分为放栓组(n=29)双侧输卵管放置聚乙烯输卵管节育栓,对照组(n=2)不放置输卵管栓。分别于节育栓植入3、6、12个月后观察避孕效果,并以显微镜及扫描电镜观察输卵管黏膜的组织变化,取栓后观察兔受孕情况。结果:对照组2例新西兰兔均受孕,妊娠率100%;放栓组29例放置避孕栓3个月,3例脱落(脱落率10.4%),余26例栓位置正常兔未受孕,避孕成功率达100%。6例观察6个月,3例观察12个月均未受孕。光镜下大部分放栓新西兰兔输卵管黏膜皱襞未见明显炎性细胞浸润,肌层未见充血和出血,浆膜无明显病理异常。电镜下分泌细胞及纤毛多数正常。取栓后妊娠率为100%。结论:聚乙烯输卵管避孕栓可能是一种避孕有效的、可复性好的输卵管避孕器具。     

2种不同术式用于非脱垂子宫患者的临床价值研究及对预后影响

目的分析2种不同术式用于非脱垂子宫治疗中的临床价值,以及对患者预后的影响。方法选取我院2013年1月~2016年10月收治的60例非脱垂子宫患者作为本次研究对象,按随机数字表法分为对照组和实验组,各30例,对照组行阴式子宫全切术,实验组行腹腔镜辅助下阴式子宫全切术。比较2组术中术后情况,随访1个月后比较并发症发生情况。结果实验组的术中出血量、术后肛门排气时间、住院天数、引流量均明显较对照组少,差异显著(P﹤0.05),但治疗费用则高于对照组(P﹤0.05),且2组手术时间无统计学差异(P﹥0.05);实验组的并发症发生率较对照组少,但2组比较无统计学差异(P﹥0.05)。结论在非脱垂子宫患者中采用腹腔镜辅助下阴式子宫全切术,可减少术中出血量、术后肛门排气时间、住院天数、引流量以及并发症发生率,但其治疗费用更高,因此应根据患者实际情况选择相应术式。     

百菲米预防输卵管复发性粘连的疗效分析

目的:探讨宫、腹腔镜联合COOK导丝输卵管再通术后输卵管管腔内放置百菲米在预防输卵管复发性粘连中的疗效及价值。方法:2010年9月～2011年3月因输卵管近端粘连导致不孕住院治疗的患者60例为研究对象,行宫、腹腔镜联合COOK导丝输卵管再通术,随机将其分为实验组30例术中输卵管管腔内放置百菲米和对照组30例术中输卵管管腔内未放置百菲米。术后随访半年,分析输卵管再通术后输卵管通畅率,手术后1个月输卵管通畅率及半年内宫内妊娠结局。结果:输卵管再通术后输卵管通畅率实验组94.55%(52/55),对照组92.59%(50/54),两组比较差异无统计学意义(P>0.05);手术后1个月输卵管通畅率实验组89.09%(49/55),对照组70.37%(38/54),两组比较差异有统计学意义(P<0.05);术后半年内宫内妊娠率实验组33.33%(10/30),对照组3.33%(1/30),两组比较差异有统计学意义(P<0.05)。结论:输卵管再通术后,输卵管管腔内放置百菲米可降低输卵管复发性粘连,提高宫内妊娠率。     

Embosphere微球子宫动脉栓塞对重症子宫腺肌病患者血清IGF-1水平、子宫体积及CMSS积分的影响

目的探讨Embosphere微球子宫动脉栓塞(UAE)对重症子宫腺肌病患者血清胰岛素样生长因子-1 (IGF-1)水平、子宫体积及COX痛经症状评分量表(CMSS)积分的影响。方法选取2016年10月-2018年10月在该院接受手术治疗的150例重症子宫腺肌病患者作为受试对象,按照手术方法将其分为对照组67例和UAE组83例。对照组患者接受腹腔镜下病灶切除治疗,UAE组患者接受Embosphere微球UAE治疗。观察两组患者手术前后视觉模拟评分(VAS),评估术后6个月两组患者痛经缓解情况,并观察两组患者手术前后血清IGF-1水平、子宫体积及CMSS积分。结果术前两组患者VAS评分比较差异无统计学意义(P0.05);术后6个月两组患者VAS评分均显著低于术前(P0.05),且UAE组明显低于对照组(P0.05)。术后6个月UAE组痛经总缓解率明显高于对照组(P0.05)。两组患者术前血清IGF-1水平、CMSS积分最高,子宫体积最大,其次为术后3个月;术后6个月血清IGF-1水平、CMSS积分最低,子宫体积最小,两两比较差异有统计学意义(P0.05)。与对照组相比,UAE组术前血清IGF-1水平、CMSS积分、子宫体积比较差异无统计学意义(P0.05);术后3个月、术后6个月UAE组患者血清IGF-1水平明显降低(P0.05),子宫体积显著减小(P0.05),CMSS积分显著降低(P0.05)。结论 Embosphere微球UAE治疗能明显降低重症子宫腺肌病患者血清IGF-1水平,缩小子宫体积,且可显著降低CMSS积分,效果优于腹腔镜下病灶切除治疗。     

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.     

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.     

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.     

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.