经尿道等离子双极电切术治疗膀胱肿瘤效果观察

目的：观察经尿道等离子双极电切术治疗膀胱肿瘤效果。方法：经尿道等离子双极电切系统切除膀胱肿瘤76例，术后用无菌蒸馏水浸泡膀胱，留置1气囊导尿管，以顺铂20mg＋0．9％生理盐水20ral封闵基底化疗，定期丝裂霉素40mg加生理盐水50m膀胱灌注，每3个月复查一次膀胱镜、B超等复查。随访时间1～3年。结果：76例患者均一次手术成功，手术平均时间（25±10）min。出血少，无一例输血。共有14例复发，复发率为18．4％，其中，原位复发8例，异位复发6例，14例复发患者中，对12例进行再行经尿道等离子体双极电切治疗，2例作开放性膀胱部分切除术。结论：经尿道等离子双极电切系统切除膀胱肿瘤手术具有组织损伤小，视野清晰，安全可靠的特点，是一种有效的手术方法。     

经尿道等离子体双极电切术治疗浅表性膀胱肿瘤126例

目的 探讨经尿道等离子体双极电切术治疗浅表性膀胱肿瘤的安全性与有效性.方法 采用经尿道等离子体双极电切术治疗浅表性膀胱肿瘤126例,肿瘤病理分级Ⅰ级36例,Ⅱ级63例,Ⅲ级27例.切除范围包括肿瘤及距离肿瘤基底部0.5～1.0 cm的正常膀胱黏膜,切除深度达到浅肌层或深肌层,电凝肿瘤基底部创面,术后定期进行表柔比星或吡柔比星膀胱腔内灌注化疗.结果 手术时间10～55 min,平均(51.3±1.5)min.3例膀胱穿孔.126例患者均随访6～36个月,肿瘤复发17例(13.5%),其中原位复发6例,异位复发11例.结论 经尿道等离子体双极电切术治疗浅表性膀胱肿瘤具有安全、有效、简单、并发症少等优点,可在临床推广应用.     

经尿道电切术治疗浅表性膀胱肿瘤的效果

目的 观察浅表性膀胱肿瘤在临床治疗中予以经尿道膀胱肿瘤电切术的疗效和应用价值。方法 选取2017年6月—2020年6月在天津市蓟州区人民医院接受治疗的浅表性膀胱肿瘤患者38例,所有患者的手术方式均为经尿道膀胱肿瘤电切术,回顾性分析患者临床资料,评价治疗效果。结果 38例患者手术一次成功,手术时间（30.45±14.48）min,未发生继发出血、膀胱穿孔、尿路梗阻、感染等并发症;术后导尿管留置时间（5.05±1.15）d,术中出血量（45.60±2.95）mL,住院时间（7.60±1.95）d;治疗后,对38例患者实施为期1年的随访,发现复发2例,复发率为5.26%,再次实施经尿道膀胱肿瘤电切术。结论 对浅表性膀胱肿瘤患者予以经尿道膀胱肿瘤电切术效果突出,优势为损伤小,在操作起来比较简单,且有着一定的可重复性,患者的恢复比较快,有着比较高的安全性,其能够对经尿道单级高频电刀切除术进行代替,还可作为首选治疗方式,值得推广。     

经尿道电切术治疗72例膀胱浅表性肿瘤的临床疗效研究

目的：评价经尿道电切术治疗膀胱浅表性肿瘤的临床疗效及安全性。方法：对本院收治的72例膀胱浅表性肿瘤患者术前予以前列腺、膀胱、输尿管超声及CT检查及含静脉肾盂造影检查,并在膀胱镜下肿瘤组织活检后在连续硬膜外麻醉或腰麻下予以经尿道膀胱肿瘤电切术。术后采用40mg丝裂霉素进行灌洗。结果：72例患者手术均获成功,平均手术时间为（39．5±6.3）min。术中、术后未出现膀胱穿孔、明显出血等情况。随访1-3年,复发11例,9例予以第2次经尿道膀胱肿瘤电切除术后未再复发,另2例患者因肿瘤出现进展而予以全膀胱根治性切除术。72例患者随访至2012年3月,未出现死亡病例。结论：经尿道膀胱肿瘤电切术创伤小、操作简单,在治疗膀胱浅表性肿瘤过程中手术时间短,且术中及术后出血少,安全性好,并发症少,值得推广应用。     

同期经尿道电切术治疗膀胱肿瘤合并前列腺增生26例

目的探讨膀胱肿瘤合并前列腺增生同期行经尿道电切术的疗效及可行性。方法采用经尿道电切术治疗膀胱肿瘤合并前列腺增生患者26例。结果 23例获得随访,3例失访,随访2个月-36个月,平均12个月。6例复发,复发部位均未发生于前列腺窝及后尿道,1例死于膀胱癌全身转移。结论膀胱肿瘤合并前列腺增生同期行经尿道电切术的治疗效果显著,安全性好,且前列腺窝及后尿道肿瘤种植风险低。     

经尿道电切术与开放手术治疗膀胱肿瘤疗效比较

目的:评价经尿道电切手术治疗膀胱肿瘤的临床价值。方法:回顾性研究经尿道电切术及开放性手术治疗膀胱肿瘤的临床病例,并对两组病例各项指标进行比较。结果:电切手术在手术时间、并发症,在院天数、等方面明显好于传统手术,差别显著;复发几率方面无差异。结论:分期在Ta-T2a期的膀胱肿瘤经尿道电切优于传统开放手术治疗。     

经尿道等离子体双极汽化电切术治疗浸润肌层膀胱肿瘤

目的 研究经尿道等离子体双极汽化电切术治疗浸润肌层膀胱肿瘤的疗效.方法 对46例浸润肌层膀胱肿瘤患者采用经尿道等离子体双极汽化电切术治疗,切除肿瘤所在部位的膀胱壁全层,同时切除肿瘤基底部周围2 cm的膀胱黏膜.术后应用卡介苗及丝裂霉素交替膀胱灌注.结果 41例患者获得随访,随访时间为6～60个月,平均34个月,肿瘤复发率为29.3%(12/41),死亡4例,1例死于肝硬化,1例死于术后脑出血,2例死于膀胱肿瘤复发.结论 经尿道等离子体双极汽化电切术治疗浸润肌层膀胱肿瘤是一种有效方法.     

经尿道表浅膀胱癌汽化电切加电切术的临床应用

目的探讨经尿道膀胱肿瘤汽化电切术(TVBt)加电切术(TURBt)治疗表浅膀胱癌(SBC)的疗效。方法对52例表浅膀胱癌患者行TVBt TURBt术,其中8例合并前列腺增生症(BPH)者同时行经尿道前列腺电汽化术(TVP)。结果本组52例膀胱肿瘤一次切除。平均手术时间TVBt TURBt为30min;TVBt TURBt TVP为90min。无输血。术后随访0.5~5.0年,肿瘤复发13例。结论TVBt TURBt具有操作简便、止血效果好、汽化深度可靠、术后并发症及复发率低、恢复快等优点,是治疗SBC的首选方法。     

经尿道双极等离子体电切术治疗浅表性膀胱肿瘤28例

目的 探讨治疗浅表膀胱肿瘤的有效方法 和疗效。方法 采用经尿道双极等离子体膀胱肿瘤电切术治疗浅表膀胱肿瘤28例,肿瘤分级:I级8例,Ⅱ级14例,Ⅲ级6例。术后行丝裂霉素膀胱灌注治疗。结果手术过程顺利,术中无大出血,无中转开腹手术,无需输血。随访3~12个月,2例复发,为多发性膀胱肿瘤术后7个月复发,二次行双极等离子体膀胱肿瘤电切术。其余26例未见肿瘤复发。结论 经尿道双极等离子体膀胱肿瘤电切术治疗浅表膀胱肿瘤,手术安全,出血少,创伤小,生活质量高,是治疗浅表膀胱肿瘤的理想方法 。     

经尿道电切气化加膀胱灌注治疗浅表性膀胱癌疗效观察

目的观察和分析经尿道电切气化加膀胱灌注治疗浅表性膀胱癌的疗效。方法回顾性分析我院2008年3月至2010年3月经尿道电切气化加膀胱灌注治疗浅表性膀胱癌26例的临床资料,对其治疗过程及治疗后的复发情况进行分析。结果手术时间15～35min,平均20min。术中无一例输血。无骨髓抑制现象发生,无尿道挟窄发生,无膀胱穿孔,肝肾功能均未见明显异常,术后随访4～24个月,2例复发,术后追踪观察至今未见复发。结论经尿道电切气化加膀胱灌注治疗浅表性膀胱癌疗效确切,复发率低。     

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.