全髋关节置换术后继发股骨假体周围骨折的发病率分析及临床比较

目的通过对全髋关节置换术后继发股骨远端骨折的患者进行发病率分析及不同手术方法并进行疗效对比观察,为临床全髋关节置换术后继发股骨远端骨折的治疗提供有效的临床治疗方法。方法将2004年2月至2008年12月间在哈尔滨市第五医院就治的符合研究需要的40例髋关节置换术后继发股骨假体周围骨折病人,进行发病率分析,同时随机分为治疗组(采用LISS内固定治疗)和对照组(采用形状记忆合金环抱器治疗)。分别对两组患者的手术时间、出血量、术后髋关节开始活动的时间、术后骨折愈合时间、及术后8周髋关节功能Harris评分及总体评分进行比较分析。结果应用LISS内固定术可以减少病人的术中出血量、早期促进股骨假体周围骨折愈合、使病人早期进行髋关节活动;应用LISS钢板内固定术后8周的Harris评分及总体疗效要优于形状记忆合金环抱器。结论应用LISS内固定术治疗,是一种操作相对简单、行之有效的治疗髋关节置换术术后股骨假体周围骨折方法。     

用镍钛记忆合金环抱式接骨板治疗尺桡骨骨折(附21例报告)

目的探讨用镍钛形状记忆合金环抱式接骨板治疗前臂骨折效果。方法21例尺桡骨骨折患者,用镍钛形状记忆合金环抱式接骨板作内固定材料,定期拍片。结果随访18个月,平均12个月。根据术后X线及前臂恢复功能情况评定疗效,均取得满意效果。结论尺桡骨骨折采用镍钛形状记忆合金环抱式接骨板是较理想的材料之一。     

钢针合并镍钛记忆合金环抱器(卡环)治疗锁骨骨折的疗效分析

目的通过应用钢针髓内固定同时合并使用镍钛记忆合金环抱器(卡环)髓外固定治疗锁骨骨折,探讨其临床效果。方法2008年4月~2009年4月对40例锁骨骨折,行切开复位后,采用钢针髓内固定同时合并使用镍钛记忆合金环抱器(卡环)髓外固定治疗,术后随访1~12个月,平均6个月。结果所有骨折均愈合良好,无内固定松动、脱落、骨折畸形愈合等,分别于术后3~5个月取出钢针,术后6~12个月取出环抱器(卡环),27例单纯取出钢针,未取出环抱器(卡环),无不良反应。结论钢针同时合并镍钛记忆合金环抱器(卡环)手术,有操作简便、固定牢固、允许患者早期功能锻炼、并发症低等优点,是治疗锁骨中段和中外1/3处骨折的一种理想的方法。     

肋骨内固定在多发性肋骨骨折治疗中的应用56例

目的：总结肋骨内固定在胸部创伤治疗多发性肋骨骨折中的应用经验。方法：56例胸部创伤多发性肋骨骨折,在气管插管全身麻醉下分离骨折断端,应用钛镍记忆合金环抱器,在冰水中将环抱器臂部张开并根据肋骨弧度塑形,迅速将其置于已经整复的骨折端上方,用热生理盐水（40℃~50℃）湿敷,使环抱器紧缩,紧紧环抱骨折端,固定肋骨。结果：本组无死亡病例,肋骨内固定后术前有呼吸困难的明显好转,出现急性呼吸窘迫综合症（ARDS）均顺利脱离呼吸机辅助呼吸,均痊愈出院。结论：应用钛镍记忆合金环抱器进行肋骨内固定对治疗胸部创伤,手术操作简单,时间短,效果确切,出现急性呼吸窘迫综合症的均能顺利脱离呼吸机,术后呼吸功能恢复快,缩短住院时间。     

环抱器治疗肋骨骨折的功能康复训练探讨

目的探讨环抱器治疗肋骨骨折的功能康复训方法并评价训练效果。方法选取环抱器治疗多发肋骨骨折病例45例。术前做呼吸道、躯干和下肢主动运动。术后早期功能康复及继续术前的功能康复训练。结果本组随访6-12个月,术后1个月复查胸片,肋骨骨折对位对线好,无环抱器松动移位,胸廓无畸形。术后3个月骨折全部愈合,术后3-6个月后恢复正常劳动力。未发生护理并发症。结论环抱器治疗肋骨骨折疗效可靠,正确的围手术期护理是手术取得良好效果的重要保证。     

肋骨环抱器应用于多发性肋骨骨折病人的护理

目的探讨和总结多发性肋骨骨折后应用记忆镍钛合金肋骨环抱器施行肋骨断端对位内固定术的病人的护理特点和经验。方法对29例多发性肋骨骨折患者肋骨断端复位后对于多发肋骨骨折,特别是伴有胸壁浮动、连枷胸、血气胸等并发症的病人应用记忆镍钛合金肋骨环抱器治疗时,进行常规护理基础上给予心理护理,观察患者的排痰、舒适度及对伤口的疼痛的影响和有无并发症发生,并实施特殊护理。结果应用记忆镍钛合金肋骨环抱器治疗多发性肋骨骨折,术后病人疼痛减轻;纵隔摆动消失,病人在术后均未带呼吸机。1周后胸片复查示胸廓对称,两肺复张良好,肋骨对位满意。结论应用记忆镍钛合金肋骨环抱器治疗多发性肋骨骨折,既简化了护理工作,又减轻了患者的心理压力与不适,患者乐意接受和配合护理。     

肋骨环抱器应用于多发性肋骨骨折病人的护理

目的探讨和总结多发性肋骨骨折后应用记忆镍钛合金肋骨环抱器施行肋骨断端对位内固定术的病人的护理特点和经验。方法对29例多发性肋骨骨折患者肋骨断端复位后对于多发肋骨骨折,特别是伴有胸壁浮动、连枷胸、血气胸等并发症的病人应用记忆镍钛合金肋骨环抱器治疗时,进行常规护理基础上给予心理护理,观察患者的排痰、舒适度及对伤口的疼痛的影响和有无并发症发生．并实施特殊护理。结果应用记忆镍钛合金肋骨环抱器治疗多发性肋骨骨折,术后病人疼痛减轻;纵隔摆动消失,病人在术后均未带呼吸机。1周后胸片复查示胸廓对称,两肺复张良好,肋骨对位满意。结论应用记忆镍钛合金肋骨环抱器治疗多发性肋骨骨折,既简化了护理工作,又减轻了患者的心理压力与不适,患者乐意接受和配合护理。     

下颌骨骨折同期牙种植1例的护理体会

目的:探讨全麻颌骨骨折切开复位坚强内固定术同期牙种植术的护理配合方法.方法:总结下颌骨骨折患者1例护理体会,全麻下行下颌骨骨折复位同期植入种植牙,并加强围术期规范化护理,针对下颌骨骨折复位同期植入种植牙术做特征性护理.结果:患者术后创口Ⅰ期愈合,术后全景片示下颌骨骨折对位愈合良好,无钛板断裂、松动现象;种植体植入方向及骨结合良好,无感染、松动、脱落.结论:全麻下种植牙围术期规范化护理可提高种植牙手术成功率.     

记忆合金聚髌器联合环扎钢丝治疗髌骨粉碎性骨折

目的观察镍钛形状记忆合金聚髌器联合环扎钢丝治疗髌骨粉碎性骨折内固定方法的疗效。方法选取两院2001年1月~2007年3月就诊的髌骨粉碎性骨折患者28例,均符合手术适应证,采用镍钛形状记忆合金聚髌器联合环扎钢丝治疗。结果经术后随访,优良率达96.8%,骨折愈合率达100%,随诊未发现聚髌器断爪、松动、戳破皮肤、骨折移位、骨不连及关节面阶梯等现象。结论该方法固定可靠,使用安全,疗效确切,符合髌骨骨折内固定的生物力学要求,改善了髌骨骨折内固定技术。     

记忆合金环抱器治疗髋关节置换术后股骨假体周围骨折疗效分析

目的 探讨记忆合金环抱器治疗髋关节置换术后股骨假体周围骨折的临床疗效.方法 对9例Duncan-Vancouver分型为B1型股骨假体周围骨折的患者进行切开复位、记忆合金环抱器内固定.结果 9 例患者随访6～24(15.9±4.5)个月,骨折均获愈合,对位满意,骨折愈合时间20～30(24.6±3.2)周.采用Hariis评分评估髋关节功能:优5例,良3例,可1例.结论 记忆合金环抱器内固定治疗髋关节置换术后股骨假体周围骨折可以获得满意的临床疗效.     

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.