小切口无缝线白内障摘出联合人工晶体植入术的研究

目的 对比分析小切口无缝线白内障摘出术(SICS)、白内障囊外摘出术(ECCE)、晶状体超声乳化术(Phaco)三种手术方法的效果.方法 2120例2225眼老年性白内障随机分成三组,分别采用SICS、ECCE、Phaco手术,均一期植人人工晶体.对比观察术后1周视力、散光及并发症.结果 术后1周裸眼视力≥0.6者.SICS组多于ECCE组,差异有统计学意义(P＜0.05);SICS组与Phaco组比较,差异无统计学意义(P＞0.05).术后1周检查手术源性散光:SICS组低于ECCE组,P＜0.05;SICS组与Phaco组比较,P＞0.05.术中后囊膜破裂合并玻璃体脱出:SICS组42眼,ECCE组29眼,Phaco组38眼.术后第1天角膜水肿:SICS组64眼,ECCE组39眼,Phaco组74眼.结论 SICS疗效优于ECCE,SICS疗效与Phaeo相比差异无统计学意义.SICS效果好、成本低,适合基层医院推广普及.     

碎核在自闭式巩膜隧道切口白内障手术中的应用比较

目的观察在基层医院开展自闭式巩膜隧道切口手法碎核与不碎核自内障摘除联合硬质人工晶体植入手术的临床疗效。方法前瞻性地将120例（134眼）年龄相关性白内障患者按住院次序分成两组,碎核组60例（66眼）和不碎核组60例（68眼）分别行自闭式巩膜隧道切口手法碎核与不碎核白内障摘除术,均一期植入硬质人工晶体。结果术后1个月时视力〉10．5碎核组59眼,不碎核组52眼,两组比较差异有统计学意义（P〈0．05）。术后1周和1个月时手术源性散光碎核组明显小于不碎核组（P〈0．01）。术后1d时角膜水肿碎核组（35眼）多于不碎核组（23眼）（P〈0．05）;术后1周时角膜水肿两组比较差异无统计学意义（P〉0．05）。术后1d时前房炎性反应两组比较差异无统计学意义（P〉0．05）。结论自闭式巩膜隧道切口白内障摘除手术中,采用手法碎核技术具有手术操作简单、视力恢复好、角膜散光小等优点。     

两种碎核技术在无缝线小切口非超声乳化白内障摘除术的应用比较

目的比较隧道内碎核和前房内碎核技术在无缝线小切口非超声乳化白内障摘除术中应用的临床疗效。方法将88例（92只眼）年龄相关性白内障患者按住院次序半随机分为隧道内碎核组和前房内碎核组,比较2组术后1d、1周、1月时的视力和手术源性散光及术中晶体后囊破裂和术后并发症情况。结果术后1d时视力≥0．5者,隧道内碎核组明显优于前房内碎核组,差异有统计学意义（P〈0．05）;术后1周、1月时视力≥0．5者,2组差异无统计学意义（P〉0．05）。术后1周和1月时手术源性散光,两组差异无统计学意义（P〉0．05）。术中后囊破裂和术后角膜水肿,前房内碎核组高于隧道内碎核组,术后角膜水肿2组差异有统计学意义（P〈0．05）;前房闪辉及前房细胞,2组差异均无统计学意义（P〉0．05）。结论无缝线小切口非超声乳化白内障手术中,采用隧道内碎核技术较前房内碎核技术具有手术操作简便、相对安全、视力恢复快、对角膜内皮损伤小等优点。     

不同术式治疗梅毒螺旋体感染白内障患者视功能恢复及术后并发症

目的对比白内障超声乳化吸出术(Phaco)和现代囊外摘除术(ECCE)治疗梅毒螺旋体感染白内障患者视功能恢复及术后并发症。方法将杭州市余杭区第一人民医院眼科2016年7月-2019年6月收治的96例梅毒螺旋体感染白内障患者作为研究对象,采用简单随机分组法将患者分为Phaco组和ECCE组,各48例。Phaco组行Phaco联合人工晶状体植入治疗,ECCE组行ECCE联合人工晶状体植入治疗,两组术后均随访6个月,对比其术后不同时间点眼压、视力、角膜散光情况及术后并发症发生率。结果两组术后2 h、术后8 h、术后24 h眼压均高于术前(P0.05),术后48 h眼压与术前比较差异无统计学意义;Phaco组术后2 h、术后8 h、术后24 h眼压均低于ECCE组(P0.05),术后48 h眼压与ECCE组比较差异无统计学意义(P=0.767)。两组术后1 d、术后7 d、术后1个月、术后3个月和术后6个月视力均高于术前(P0.05);Phaco组术后7 d视力高于ECCE组(P0.001),术后1个月、术后3个月和术后6个月视力与ECCE组比较差异均无统计学意义。两组术后7 d、术后1个月角膜散光均高于术前(P0.05),术后3个月、术后6个月角膜散光与术前比较差异均无统计学意义;Phaco组术后7 d角膜散光低于ECCE组(P=0.017),术后1个月、术后3个月和术后6个月角膜散光均与ECCE组比较差异均无统计学意义。Phaco组术后并发症总发生率低于ECCE组(P=0.031)。结论相较于ECCE,Phaco更能有效促进梅毒螺旋体感染白内障患者术后早期视功能恢复,且可减少术后并发症发生。     

小切口非超声乳化手术与超声乳化治疗白内障的效果观察

目的:对比小切口非超声乳化手术(SICS)与超声乳化(Phaco)治疗白内障的效果观察。方法:回顾性分析2012年12月-2015年12月期间我院收治的78例白内障患者资料,分成A组40例(40眼)实施SICS手术治疗白内障,B组38例(39眼)实施Phaco手术,比较分析两组临床效果。结果:A组与B组术后视力矫正相近,对比无明显差异(P0.05);患者术后不同时段的角膜散光值优于术前(P0.05),但同时间段比较无明显差异(P0.0 5)。结论:A组与B组术后视力矫正相近,术后角膜散光好转,具一定临床应用与研究价值。     

高龄白内障患者小切口手术疗效分析

目的：研究探讨高龄白内障患者小切口手术疗效。方法：选取71例（共123眼）高龄白内障患者作为研究对象,年龄在76～96岁之间。将123眼随机分为研究组（55眼）和超乳组（68眼）。分别接受小切口手术和超声乳化治疗。结果：研究组和超乳组患者术后视力比较差异无统计学意义（P〉0．05）。2组分别有42眼和54眼出现角膜水肿。研究组和超乳组之间发生I级、II级及Ⅲ级角膜水肿的眼数差异无统计学意义（χ^2=0．81,P〉0．05）;但研究组发生Ⅲ级的比例少于超乳组。研究组患者角膜水肿术后消退时间快于超乳组,其中术后1天消退的眼数研究组多于超乳组（χ^2=6．45,P〈0．05）。术后研究组和超乳组内皮细胞计数分别是（2341±238）个和（2181±282）,两组间差异无统计学意义（P〉0．05）。研究组并发症发生率比较低。结论：小切口手术治疗高龄白内障,是一种比较安全、有效的方式。     

小切口非超声乳化白内障手术3种切口术后早期散光比较

目的研究3种白内障手术切口对术后早期散光的影响。方法150例（150只眼）老年性白内障患者随机分为A、B、C3组,每组各50只眼,A组采用6mm上方直线型巩膜隧道切口,B组采用6mm反眉状巩膜隧道切口,C组采用6mm反眉状巩膜隧道切口＋缝合,术后1周观察角膜散光情况。结果散光度反眉切口＋缝合组（C组）最小,反眉切口组（B组）次之,直切口（A组）最大,其差异有统计学意义（P〈0．05）,A组和B组患者散光以逆规性散光为主（74％-84％）,C组以顺规性散光为主（61％）,其差异有统计学意义（P〈0．05）。结论6mm反眉状巩膜隧道切口＋缝合明显减小术后早期角膜散光,提高术后早期裸眼视力。     

不做水分离行超声乳化白内障摘除术临床观察

目的探讨不做水分离行超声乳化白内障摘除术在临床应用的有效性和安全性。方法选择100例白内障患者（100只眼）,随机分为对照组500例50只眼,进行常规水分离术;观察组50例50只眼,不做水分离术,所有患者均由同一医师进行超声乳化白内障摘除术联合人工晶体植入术。临床观察超声时间,手术时间,术后第1天视力,术后第7天角膜内皮计数,术中、术后并发症。结果（1）平均超声时间：对照组为（0．3776±0．1497）min,观察组为（0．3378±0．1518）min,两组平均超声时间差异无统计学意义（t=1．32,P〉0．05）。两组平均手术时间：观察组（12．3600±2．8696）min,对照组（10．3400±2．3526）min,两组平均手术时间差异有统计学意义（t=3．8492,P〈0．05）;（2）术后第1天的矫正视力以t〉0．5为界,两组差异无统计学意义（,=0．1773,P〉0．05）;（3）术前角膜内皮计数：对照组（2564±311）个／mm^2,观察组（2563±308）个／mm^2（t=1．6154,P〉0．05）,术后7天角膜内皮计数：对照组（2259±276）个／mm^2,观察组（2258±286）个／mm^2（t=1．7790,P〉0．05）,两组差异无统计学意义;（4）术中术后并发症两组无明显差别。结论不做水分离术也可以安全有效的行超声乳化白内障摘除术联合人工晶体植入术。熟练掌握超声乳化术的操作技术,不做水分离,减少操作步骤,使手术更加安全、快速、有效。     

小切口非超声乳化白内障手术治疗硬核白内障的临床观察

目的观察小切口非超声乳化白内障手术治疗硬核白内障的疗效。方法选择Ⅳ～Ⅴ级硬核白内障患者269例291眼,随机分为两组,分别行小切口非超声乳化白内障摘除联合人工晶体植入术(小切口组,139例157眼)和现代白内障囊外摘除联合人工晶体植入术(ECCE组,130例134眼)。观察术后视力、角膜散光及并发症。结果术后小切口组和ECCE组比较,裸眼视力差异无统计学意义(p>0.05)。角膜散光、并发症差异有统计学意义(p<0.05),小切口组更优。结论小切口非超声乳化白内障手术具有术后视力恢复好、角膜散光小、并发症少等优点,疗效满意,值得在临床推广。     

使用改良性超声乳化手术治疗高度近视合并自内障80例的临床分析

目的探讨改良性超声乳化手术应用于高度近视合并白内障的临床治疗效果。方法选取160例（170眼）高度近视合并白内障的患者并平均分为研究组与对照组各80例（85眼）,对照组患者采用普通超声乳化手术进行治疗,研究组采用改良性超声乳化手术进行治疗,对两组患者的手术治疗效果进行对照比较。结果对两组患者当中术后视力在0．1以下的患者眼数进行对照比较,差异无统计学意义（P〉0．05）;角膜内皮细胞计数方面,研究组术后1个月以及3个月时变化较小,与对照组相比较,差异具有明显的统计学意义（P〈0．01）;术后并发症方面,研究组与对照组相比明显较低,差异具有统计学意义（P〈0．05）。结论在高度近视合并白内障的临床治疗当中应用改良性超声乳化手术,临床疗效显著,术后并发症发生率较低,能够有效减少角膜内皮细胞损伤,值得临床应用与推广。     

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.     

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.