机械通气治疗急性重度有机磷中毒合并呼吸衰竭31例临床分析

目的探讨机械通气在救治急性重度有机磷农药中毒合并呼吸衰竭患者的作用。方法选某院急诊科从2009年7月～2011年5月收治的31例急性重度有机磷农药中毒合并呼吸衰竭患者,在综合性治疗基础上予及早建立人工气道,给予机械通气治疗,对其疗效进行回顾性分析。结果 31例急性重度有机磷农药中毒合并呼吸衰竭患者死亡3例,其余均治愈,抢救成功率90.3%。结论机械通气是抢救急性重度有机磷中毒所致呼吸衰竭、提高抢救成功率的重要措施。     

超早期人工通气在长途转运并救治重度有机磷中毒呼吸衰竭中的作用48例分析

目的 探讨超早期建立人工气道并机械通气在长途转运并救治重度有机磷中毒呼吸衰竭患者中的作用.方法 48 例重度有机磷中毒呼吸衰竭患者均于长途转运前采用经口或经鼻的方式建立人工气道,并于转运中应用车载呼吸机机械通气,至急诊重症监护室后换接多功能呼吸机采用IPPV（ 辅助/ 控制） 通气模式,病情稳定后模式为SIMV（ 同步间歇指令通气） ＋ PSV（ 压力支持通气）,脱机模式为SIMV（ 同步间歇指令通气）.结果 成功救治42 例（87.5%）,并发症5 例（10.4%）,死亡1 例（2.1%）.结论 超早期建立人工气道并机械通气是长途转运并救治重度有机磷中毒呼吸衰竭患者十分有效的方法.     

机械通气在急性有机磷农药中毒并呼吸衰竭中的应用分析

目的：探讨急性重度有机磷农药中毒合并呼吸衰竭时机械通气在救治中的作用。方法：收集46例重度急性有机磷农药中毒并呼吸衰竭患者的临床资料。在常规方法治疗的基础上,均加用机械通气救治,并对其效果进行回顾性分析结果：46例急性重度有机磷农药中毒并呼吸衰竭的患者经过机械通气及综合治疗后,成功41例,死亡5例,成功率为89.1%。结论：在抢救重度急性有机磷农药中毒并呼吸衰竭时,及时采用机械通气是救治成功的关键。     

机械通气在急性重度有机磷农药中毒救治中的疗效观察

目的 观察机械通气在急性重度有机磷农药中毒抢救的疗效.方法 对本院78例急性重度有机磷农药中毒抢救中应用机械通气进行回顾性分析.结果 机械通气治疗急性重度有机磷农药中毒,能迅速改善患者症状和低氧血症,是抢救有机磷中毒的一种安全有效的辅助治疗方法.     

机械通气救治急性有机磷农药中毒致呼吸肌麻痹63例效果观察

[目的]观察机械通气在救治急性有机磷农药中毒所致呼吸衰竭中的作用. [方法]对本院收治的重度有机磷农药中毒并发呼吸衰竭实施机械通气63例患者进行临床分析. [结果]呼吸衰竭抢救成功59例(93.65%),机械通气前后血气分析相差具有统计学意义. [结论]机械通气是治疗急性有机磷农药中毒所致呼吸衰竭的关键环节.     

机械通气抢救重度有机磷农药中毒继发急性呼吸衰竭

1993～1997年,我院共收住重度有机磷农药中毒继发急性呼衰30余例,对其中18例进行机械通气抢救治疗,存活11例,死亡3例,自动出院4例。现将治疗体会报告如下。     

急性有机磷中毒中间综合征17例临床分析

目的 探讨急性有机磷农药中毒并发中间综合征的诊断与治疗。方法 回顾性分析１７例ＩＭＳ患者的临床表现。结果 有机磷农药中毒并发ＩＭＳ的患病率为２．８％,其呼吸肌麻痹症状出现在急性中毒后１０￣７２ｈ,９例于５￣１２ｍｉｎ内成功建立人工气道及机械通气,其中７例治愈,另８例因各种原因未及时应用该疗法而死亡。结论 ＩＭＳ并非罕见,表现有特殊性,应提高认识,早期识别;建立人工气道与机械通气是抢救的重要方法。     

早期机械通气治疗有机磷农药中毒中间综合征体会

目的观察机械通气对急性有机磷农药中毒中间综合征的治疗效果。方法24例中间综合征(IMS)均采用机械通气治疗,总结其临床表现与治疗经过,提出其治疗经验。结果24例IMS患者均采用有创机械通气,21例存活,死亡2例,自动出院1例。结论及时识别重度急性有机磷农药中毒中间综合征的发生并尽快采用机械通气,是抢救成功的关键。     

不同连接方式的机械通气对重度COPD合并II型呼衰患者的疗效分析

目的:评价不同连接方式的机械通气在重度COPD合并II型呼衰患者中的治疗效果。方法:41例重度COPD合并II型呼衰患者在常规药物治疗的基础上按不同的气道连接方式分为三组:A组13例,为面罩机械通气,B组14例,为经口气管插管机械通气;C组14例,为气管切开机械通气。结果:机械通气24h后,A组各项指标改善不明显(P>0.05)。B、C组PCO2、PO2、PH值均较前有明显改善,相比有显著差异性(P<0.01),并且优于A组。在改善心率呼吸方面C组优于A、B组。结论:重度COPD合并II型呼衰患者有创机械通气疗效较无创面罩机械通气肯定,气管切开患者的依从性明显优于经口气管插管。     

急性重度有机磷中毒早期机械通气的临床应用

目的探讨人工机械通气救治急性重度有机磷中毒的疗效。方法对36例急性有机磷中毒患者行气管插管或气管切开后，进行机械通气治疗，观察临床效果。结果通气治疗后，36例患者自觉症状明显改善，生命体征稳定，血气分析正常，顺利脱机。抢救成功率83％，死亡3例，自动出院5例。结论机械通气治疗急性重度有机磷中毒，能迅速改善患者症状和低氧血症，是抢救急性重度有机磷中毒的一种安全有效的辅助治疗方法，值得临床推广。     

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.