真丝线段血管内栓塞治疗脑动静脉畸形

目的：探讨应用国产医用真丝线段行血管内栓塞治疗脑动静脉畸形的疗效。方法：３３ 例行选择性全脑血管造影，取得主要供血动脉后，采用Ｍａｇｉｃ １．８Ｆ微导管超选择进入大脑前、中动脉直至病灶内。栓塞剂为５／０ 真丝线段，栓塞至畸形血管团消失或减少。结果：畸形血管团完全消失６ 例，消失达９５％ ７ 例，９０ ％ ６ 例，７０％ ５ 例，５０ ％ ～７０％ ７ 例。无死亡及严重并发症发生。结论：真丝线段血管内栓塞后临床症状改善显著，显示了介入放射学的优越性     

血管内栓塞治疗脑动脉脉畸形48例

血管内栓塞已成为当今治疗脑动静脉畸形方法之一。我院于 1991年至 1997年期间利用真丝线段和丁基 - 2氰基丙烯 (Ｎ -ｂｕｔｙｌｃｙａｎｏａｃｒｙｌａｔｅ ,ＮＢＣＡ)作为栓塞剂行血管内栓塞治疗 4 8例脑动静脉畸形患者 ,并测量其中 11例患者 ,供血动脉内的压力变化及血流速度 ,探讨栓塞的参考指标 ,现报告如下。1　资料与方法1·1　一般资料　 4 8例患者均为住院病人 ,男 33例 ,女 15例 ,年龄 14～ 56岁 ,平均年龄 37 5岁。 4 4例采用丝线线段栓塞 ,其中 8例先后栓塞 2次 ;4例采用ＮＢＣＡ栓塞。1·2　栓塞前脑血管造影　小型畸形血管团 …     

脑动静脉畸形的临床特征及介入治疗

目的 探讨脑动静脉畸形的临床特征及显微手术治疗的效果和安全性.方法 选取2005年1月至2008年1月就诊的脑动静脉畸形患者112例作为研究对象,均通过全脑数字减影血管造影(DSA)检查确诊,了解畸形血管团的部位和特点,所有病例均进行血管内栓塞治疗,并对治疗后患者的疗效和安全性进行评估.结果 本组病例畸形血管团直径1～8cm;经过治疗后,显效79例,占70.5%;有效16例,占14.3%;无效12例,占10.7%;死亡5例,占4.5%.总有效率为84.8%(95/112).术后并发症以偏瘫发生率较高,为8.9%(10/112),其次是失语,为5.4%(6/112).结论 脑动静脉畸形在青年人中发生率较高,且男性高于女性.显微外科手术是治疗脑动静脉畸形的最佳方式,在治疗巨型脑动静脉畸形时,栓塞联合手术切除切实可行.     

三维数字减影血管造影在脑动静脉畸形血管内治疗中的价值

[目的]探讨三维数字减影血管造影(3D-DSA)在脑动静脉畸形(CAVM)血管内治疗中的临床应用价值.[方法]选择26例脑动静脉畸形进行血管内治疗,在治疗过程中均行3D-DSA,分析供血动脉、回流静脉的特征和畸形团内部结构.[结果]3D-DSA能够帮助选择合适工作角度、明确微导管走形方向以及正确评价畸形团栓塞程度.[结论]3D-DSA在脑动静脉畸形血管内治疗中比常规DSA提供更多信息,具有重要的应用价值.     

三维DSA在颅内动脉瘤的诊断与治疗中的应用

目的:通过三维DSA的临床应用,探讨其在颅内动脉瘤的诊断与颅内动脉瘤介入栓塞治疗中意义。方法:收集36例蛛网膜下腔出血患者行三维DSA检查并全部行血管内介入治疗。结果:36例患者中发现39个颅内动脉瘤,其中2例为颅内多发动脉瘤6个,4个微小动脉瘤,1例为脑动脉血管扭曲畸形;三维DSA显示微小动脉瘤的结构及小动脉血管间关系较常规DSA明显优越,所有血管三维重建的图像均能清晰的显示动脉瘤瘤体、瘤颈形态及载瘤动脉关系。39个动脉瘤全部行动脉介入栓塞治疗,栓塞程度0级33个,1级6个。结论:三维DSA对于颅内动脉瘤的诊出率及动脉瘤瘤体、瘤颈结构形态及载瘤动脉关系,动脉瘤与邻近血管关系显示的清晰度较常规DSA明显提高,同时也大大提高了血管介入栓塞技术的治疗水平。     

DSA下介入栓塞在肾动静脉畸形治疗中的价值研究

目的:探讨DSA下介入栓塞在肾动静脉畸形治疗中的应用价值。方法:择取我院2014-2015年收治的21例突发性全程肉眼血尿患者作为本次研究对象,简要回顾本组病例DSA造影、超选择性造影资料与栓塞治疗方式。结果:DSA造影提示21例患者静脉曲张型肾动静脉畸形,其中7例左肾发生病变,14例右肾发生病变;19例获得成功栓塞治疗;无一例患者在随访期间血尿复发或继发严重并发症。结论:DSA已成为临床肾动静脉畸形诊断的金标准,采取微创且临床疗效显著的介入栓塞是肾动静脉畸形的理想治疗方法。     

脑动静脉畸形破裂出血急性期的临床特点及手术治疗方法探讨

目的探讨以急性出血发病的脑动静脉畸形(AVM)的临床和影像学特点以及外科治疗的策略。方法选择经颅脑CT或MR I检查确认为脑实质内出血并怀疑为AVM的28例患者,经过急性期出血的手术治疗等正确处理,DSA全脑血管造影或病理证实为脑AVM。结果急性期对28例脑AVM患者行急诊外科手术治疗,血肿清除术17例,发现畸形血管团14例(82.35%);血肿清除加AVM显微切除术8例;血肿清除加部分畸形血管电凝术9例;单纯脑室内血肿引流术4例;去骨瓣减压术8例;部分患者待病情稳定后2周经DSA栓塞或手术治疗后治愈。结论脑AVM出血急性期的正确外科处理,既清除血肿,又防止AVM再出血和继发性脑血管痉挛发生,达到针对病因、针对病症治疗的双重目的,为进一步血管内栓塞或手术切除奠定基础并创造良好条件。     

Onyx血管内栓塞脑动静脉畸形的护理

目的 探讨Onyx血管内栓塞脑动静脉畸形的护理价值.方法 回顾分析17例行Onyx介入治疗脑动静脉畸形患者的护理方法.结果 术后无远期并发症,3~6d出院.结论 Onyx血管内介入栓塞脑动静脉畸形效果显著,加强精心护理,采取一些特殊的护理措施是减少并发症发生的关键.     

不明原因消化大出血的造影诊断及介入治疗

目的:评价选择性动脉造影和动脉栓塞在不明原因的消化道大出血的诊断治疗中应用.方法:对我院收治的5例消化道大出血的病人行DSA造影,并行动脉栓塞或药物灌注止血治疗.使用5Fcobra导管和3Fsp微导管,选择性插管至腹腔干或肠系膜上、下动脉造影,并对明确出血血管行超选择插管至出血动脉行动脉栓塞止血治疗.结果:DSA示:3例造影未见明显的异常血管,仅给予缩血管药物灌注止血.2例有明确的出血征象,其中1例十二指肠降部动脉畸形,1例肠系膜上动脉的回结肠动脉末梢破裂出血,用微导管插至出血动脉末级分支行明胶海绵及真丝线段颗粒栓塞治疗,均达到止血作用.结论:选择性动脉造影对不明原因的消化道大出血具有一定的诊断价值,通过选择性插管行DSA并对异常血管或出血血管栓塞和药物灌注可以起到诊断与治疗作用.     

自发性蛛网膜下腔出血全脑血管造影病因分析及临床价值

目的 探讨全脑数字减影血管造影(DSA)对自发性蛛网膜下腔出血(subarachnoid hemorrhage,SAH)原因的诊断价值及临床指导意义.方法 回顾性分析53例自发性SAH患者的临床资料,所有患者均采用头颅CT扫描及全脑DSA检查,按照DSA检查结果分析病因并指导治疗,总结病因检出率、治疗和转归.结果 53例患者首次DSA阳性42例(79.2％),包括动脉瘤31例、脑动静脉畸形7例、脑膜动静脉瘘2例及烟雾病2例;二次DSA检出前交通动脉瘤及大脑前动脉畸形各2例;整体阳性率86.6％.阴性患者行内科保守治疗,阳性患者根据病因分别行介入栓塞、手术、放射、扩血管等对症治疗手段,随访6～9个月,16例(30.2％)遗留有轻中度精神障碍,死亡3例(5.7％).结论 全脑DSA在自发性SAH的病因分析中仍有不可替代的临床价值,用于指导其临床治疗准确性高.     

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 human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

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.