门脉流速与门脉内径比值联合食道钡剂造影在评估食道胃底静脉曲张破裂出血风险的临床意义

目的研究门脉流速与门脉内径比值结合食道钡剂造影确定食道静脉曲张程度在评估食道胃底静脉曲张破裂出血风险的临床价值。方法将239例晚血病人采用日本ALOKA公司生产的ProsoundSSD-3500型超声仪检测门脉流速（v）,门脉内径（d）,并计算出每个人的v／d值;采用FLUOREX公司生产的Finescope300型胃肠造影机,作食道造影,确定食道静脉曲张程度,按静脉曲张程度分组,统计各组v／d值均值,并把相邻两组作统计学检验分析其差异性;同时作各组均值变化趋势图。结果未见曲张静脉组46例,轻度曲张静脉组59例,中度曲张静脉组54例,重度曲张静脉（未曾破裂出血）组14例,重度曲张静脉伴破裂出血组66例;前后两组间v／d比值比较,差异有统计学意义（P〈0．01）。结论随着门脉压力增高,食道曲张静脉程度加重,v／d值均值逐步下降,食道静脉重度曲张伴出血组由于血容量下降,门脉灌流量不足,门脉压较低,v／d值上升。v／d值能反映门脉压变化趋势,预测出血风险。     

腹部B超对肝硬化门静脉高压诊断的临床价值

目的:分析腹部B超对肝硬化门静脉高压诊断的临床价值。方法:将57例肝硬化门静脉高压患者作为观察组,同时选取同期健康体检人员57例作为对照组,以腹部B超诊断,对比其诊断情况。结果:观察组脾长、脾脏厚度、DPV以及QSV/QPV等值均高于对照组,脾静脉内径≥1.0cm患者静脉曲张程度比脾静脉内径<1.0cm患者静脉曲张程度要重,DPV≥1.4cm患者静脉曲张程度比DPV<1.0cm患者静脉曲张程度要重,差异显著(P<0.05)。结论:腹部B超诊断肝硬化门静脉高压效果显著,对门静脉内径、血流动力学变化具有较高诊断价值。     

经颈内静脉肝内门腔分流术治疗肝硬化门脉高压症临床观察

目的探讨经颈内静脉肝内门腔分流术治疗肝硬化门脉高压症的临床疗效及并发症。方法肝硬化并发门脉高压症患者29例行经颈内静脉肝内门腔分流术,支架置入前后测量门静脉主干压力,术前术后分别测定门静脉内径及门静脉、分流道血流速度。结果分流术成功率100%,门脉主干压、门静脉内径、门脉主干血流速度较术前明显下降(P<0.01),分流道血流速度(139.0±48.8)cm/s。食道胃底静脉曲张、腹水等临床症状明显好转。常见并发症有肝性脑病、支架狭窄及闭塞。结论经颈内静脉肝内门腔分流术是治疗肝硬化门脉高压症的有效方法,它能有效地降低门脉压,控制食道、胃底静脉曲张破裂出血。     

门静脉主干及脾静脉宽度与肝组织纤维化程度的关系研究

目的　了解门静脉主干和脾静脉宽度与肝组织纤维化程度的关系。方法　 151例住院患者在B超引导下行肝活检 ,肝组织按肝纤维化分级标准分为S0 ～S4 。B超测量门静脉主干和脾静脉宽度。结果　S1至S4组门静脉主干和脾静脉宽度分别是 :S1为 (11 89± 1 39)mm和 (5 78± 1 33)mm ,S2 为 (12 2 2± 1 19)mm和(6 2 5± 1 2 8)mm ,S3为 (12 4 3± 1 2 6 )mm和 (7 0 3± 1 54)mm ,S4 为 (13 0 7± 1 2 3)mm和 (8 0± 1 80 )mm。S4组和S1、S2 组之间门静脉主干宽度差异具有显著性 (P值均 <0 0 1) ,S3组和S1组之间 (P值 <0 0 1)脾静脉宽度有显著性差异。结论　随着纤维化的发展 ,门静脉主干及脾静脉逐渐扩张。动态观察门静脉主干及脾静脉宽度对了解患者肝纤维化和门脉高压程度有一定的临床意义     

食道静脉曲张出血的硬化疗法及心得安治疗

食道静脉曲张出血常危及病人生命,且一旦出血,再次出血率很高。1939年瑞典的Crawford和Frankner首次向食道静脉内注射硬化剂来治疗食道静脉曲张出血的病人。1955年英国Macbeth报道治疗一组30人并热心倡导此法。硬化治疗的目的有二:一是紧急止血;二是预防再出血。其优点是只消除曲张的食道粘膜静脉而不损伤其它侧枝循环,因而不会     

生长抑素治疗食管胃底静脉曲张破裂出血疗效分析

目的观察生长抑素(施他宁)治疗食管胃底静脉曲张破裂出血的临床疗效。方法68例肝硬化食管胃底静脉曲张破裂出血患者随机分为生长抑素(施他宁)治疗组36例和垂体后叶素联合硝酸甘油治疗组32例。施他宁组先用施他宁250μg静注,随后按250μg/h持续静滴24h;垂体后叶素组以12u/h及硝酸甘油0·6mg/h,持续静滴24h。分别比较两组止血起效时间、止血有效率及药物不良反应。结果两组平均止血时间分别为(3·2±2·7)h和(10·2±7·1)h,24h内止血有效率分别为86%和68%;不良反应发生率分别为11·1%和37·5%。以上两组数据比较差异有显著性(p<0·05)。结论施他宁治疗食管胃底静脉曲张破裂出血的止血效果优于垂体后叶素联合硝酸甘油,不良反应发生率低,是内科治疗肝硬化食管胃底静脉曲张破裂出血的首选药物。     

彩色超声诊断肝硬化门脉高压征250例分析

目的 通过对内镜下证实肝硬化门脉高压征患者250例进行彩色超声检测分析,为彩色超声检测肝硬化门脉高压征提供更可靠的依据.方法 根据内镜结果将肝硬化门脉高压征患者250例按食管静脉曲张程度分为轻、中、重度3组,检测门静脉主干宽度、脾静脉宽度、脾脏厚度及胃左静脉宽度,研究其与食管静脉曲张程度的关系.结果 随食管静脉曲张程度的不同,门静脉主干内径、脾静脉内径、脾脏厚度、胃左静脉内径之间存在显著性差异,脾脏厚度与脾静脉内径之间存在显著差异.结论 门静脉系统的主要分支扩张的检测值及门静脉侧支循环的检测可为判断门静脉高压提供参考依据.     

复合益生菌制剂对长航核潜艇员体内矿物元素代谢的调节

目的观察复合益生菌制剂“海生元”对长航核潜艇艇员体内矿物元素代谢的调节作用。方法采用等离子体原子发射光谱法 (DCP -AES)测定用药组、未用药组和未出航组艇员血清Ca、Mg、Zn、Fe、Cu、Mn、Mo、Cd、Pb、Al、Cr、Co元素浓度 ,Na、K用全自动生化仪测定。结果未用药组艇员航后血清Na、Pb、Al分别为 (1 5 6 .89± 1 7.4 3)mmol·L- 1、(0 .6 9± 0 .1 0 ) μmol·L 1和 (2 .75± 0 .2 8) μmol·L- 1,与未出航组比较显著性升高 (P <0 .0 5 ) ,而Mg、Mn、Mo分别为 (0 .78± 0 .1 0 )mmol·L- 1、(0 .98± 0 .1 4 ) μmol·L 1和 (0 .5 0± 0 .0 4 ) μmol·L 1,较未出航组显著性降低 (P <0 .0 5 ) ,Zn为 (1 0 .33± 2 .86 ) μmol·L- 1,降低非常显著 (P <0 .0 1 ) ;用药组艇员航后血清Na、Pb、Al分别为(1 30 .77± 1 4 .85 )mmol·L- 1、(0 .35± 0 .1 8) μmol·L 1和 (1 31± 0 .2 5 ) μmol·L- 1,与未用药组航后比较明显降低 (P <0 .0 5 ) ,而血清Mg、Fe、Mn分别为 (1 .36± 0 .0 6 )mmol·L- 1、(2 8.6 9± 3.0 3) μmol·L 1和(1 .94± 0 .2 3) μmol·L- 1,较未用药组航后显著升高 (P <0 .0 5 ) ,Zn为 (2 0 .95± 3.2 4 ) μmol·L- 1,升高非常显著 (P <0 .0 1 ) ;用药组航后血清Zn亦显著高于航     

经皮胃冠状静脉栓塞术联合部分脾栓塞术治疗门静脉高压症

目的探讨经皮胃冠状静脉栓塞术（PTVE）联合部分脾栓塞术（PSE）在治疗门脉高压症中的地位与作用。方法对30例肝硬化门静脉高压症患者随机分组,A组15例,行经皮胃冠状静脉栓塞术（PTVE）联合部分脾栓塞术（PSE）,B组15例,行单纯PSE术,术前、术后分别采用多普勒超声检查门静脉侧支循环情况,对两组进行比较。结果两组脾功能亢进均得到缓解,A组术前术后门脉内径无明显变化,术后血流速度减慢,血流量降低（P〈0．05）,奇静脉内径变小（P〈0．01）,血流量下降（P〈0．01）,血流速度降低（P〈0．01）;B组门静脉管径变小,流速降低,流量下降（P〈0．01）,但奇静脉管径无明显改变,流速降低,流量下降。两组奇静脉血流量下降幅度有明显差异（P〈0．01）,两组随访3～12个月,B组出现食管胃底曲张静脉破裂出血6例,继发性门脉血栓形成1例,而A组仅出现1例食管胃底曲张静脉破裂出血。结论经皮胃冠状静脉栓塞术（FIVE）联合部分脾栓塞术（PSE）能有效治疗门脉高压食管胃底曲张静脉破裂出血和脾功能亢进,该方法操作相对简单,侵袭性小,尤其适用于肝功能差难以耐受外科仆流髓断浠丰术的帛者且右怖床椎广价信     

食管胃底静脉曲张破裂出血患者内镜下注射止血治疗后发生再出血的影响因素分析

目的 分析食管胃底静脉曲张破裂出血患者内镜下注射止血治疗后发生再出血的相关影响因素。方法 回顾性分析2018年10月至2020年10月于我院行内镜下注射止血治疗的120例食管胃底静脉曲张破裂出血患者的临床资料,统计患者治疗3d后再出血发生情况,经单因素及多因素分析找出患者发生再出血的相关影响因素。结果 120例食管胃底静脉曲张破裂出血患者经内镜下注射止血治疗后,有15例发生再出血,发生率为12.50%;经单因素和Logistic回归分析结果显示,Child-Pugh分级C级、静脉曲张血管数量>2支、曲张静脉内径较大是食管胃底静脉曲张破裂出血患者内镜下注射止血治疗后发生再出血的危险因素（OR>1, P <0.05）。结论 食管胃底静脉曲张破裂出血患者内镜下注射止血治疗后发生再出血可能受Child-Pugh分级、静脉曲张血管数量、曲张静脉内径等因素影响,临床应重视对上述危险因素的早期评估,并积极采取对症措施进行干预,以降低内镜下注射止血治疗后再出血的发生风险。     

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.     

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.