微创经皮肾穿刺取石术并发出血的治疗体会

目的探讨微创经皮肾穿刺取石术并发出血的治疗体会。方法回顾和分析2001年2月~2006年5月应用微创经皮肾穿刺取石术治疗上尿路结石3910例中出现大出血的20例资料。结果20例中19例治愈(16例行介入栓塞治疗,2例采用输血和导管压迫止血等保守治疗,1例行患肾切除术)。但还有1例经上述治疗无效,最后并发DIC死亡。结论出血是微创经皮肾穿刺取石术最常见和最主要的并发症。术中细致操作,术后细致观察,及时采取相应治疗措施,患者的手术安全性一定会得到很大提高。     

微创经皮肾镜取石术并发严重出血的处理

目的总结微创经皮肾镜取石术并发严重出血的诊治体会。方法回顾性分析1995年1月~2004年2月收治的3857例微创经皮肾镜取石术的患者资料。14例并发严重出血(0.4%),男11例,女3例;年龄20~68岁,平均45岁。结果早期3例为止血行患肾切除术。11例行肾动脉造影术,其中肾动静脉瘘5例,假性动脉瘤4例,肾动静脉瘘合并假性动脉瘤1例,肾血管损伤1例。11例均经超选择性肾动脉栓塞术治愈。结论微创经皮肾镜取石术并发严重出血是一种少见且难以预测的并发症,选择性肾动脉造影+栓塞术是诊断和治疗微创经皮肾镜取石术并发严重出血安全、有效的方法。     

微创经皮肾穿刺造瘘取石术治疗上尿路结石780例报告

目的分析微创经皮肾穿刺造瘘取石术治疗肾、输尿管上段结石的疗效,探讨治疗上尿路结石的新方法。方法对780例微创经皮肾穿刺造瘘取石术治疗肾、输尿管上段结石的临床资料进行总结和分析。结果780例中741例一次性取石成功;2例术中大出血改手术治疗;5例术后继发性大出血,行放射介入作高选择肾动脉栓塞治疗;5例肾穿刺造瘘失败改手术治疗。结石综合处理成功率达96%。结论微创经皮肾穿刺造瘘取石术具有创伤轻微、出血少,并发症低,手术操作简化等优点。已成为替代上尿路结石开放手术的手术方法。     

肾结石微创经皮肾穿刺取石术

目的总结微创经皮肾穿刺取石术的治疗经验。方法58例肾结石采用微创经皮肾穿刺取石治疗。结果结石取净率91.3％（53／58）,平均住院时间7d;无术中及术后迟发大出血。结论微刨经皮肾取石术具有安全、创伤小、出血少,术后恢复快,取石较彻底等优点。     

微创经皮肾穿刺取石术治疗复杂肾结石(附23例报告)

目的探讨复杂肾结石的微创治疗方法。方法经皮肾穿刺微造瘘,用输尿管镜通过造瘘通道,进行气压弹道碎石及取石。结果23例手术全部成功,Ⅰ期取石15例,Ⅱ期取右8例,结石取净率87%。结论微创经皮肾穿刺腔内碎石取石术是一种安全、可靠的治疗复杂肾结石的重要方法,它与开放手术及传统经皮肾穿刺取石术相比,能减少术中出血及并发症,明显提高结石的取净率,具有对患者创小、恢复快、住院时间短等优点。     

微创经皮肾穿刺造瘘取石术治疗复杂肾结石(附192例报告)

目的探讨微创经皮肾穿刺造瘘取石术(MPCNL)治疗复杂肾结石的安全性与有效性。方法回顾性分析192例采用MPCNL治疗的复杂肾结石患者资料。结果192例微创经皮肾造瘘取石术均一期顺利完成,其中单通道取石115例,多通道取石77例;1次取石138例,2次以上取石54例,结石清除率为89.1%;中位手术时间85 m in,术中估计出血量中位数45 m l,术后中位住院时间5 d,无严重并发症发生。结论微创经皮肾穿刺造瘘取石术具有创伤小、安全高效和恢复快的优势,是治疗肾脏复杂结石的良好方法之一,可以使绝大多数患者避免开放手术。     

微创经皮肾穿刺取石术治疗复杂肾结石的疗效观察

复杂性肾结石是指鹿角形肾结石。微创经皮肾穿刺取石术（MPCNL）是目前公认的治疗复杂性肾结石的有效方法。我院自2004年10月～2008年10月开始采用微创经皮肾穿刺取石术治疗复杂。肾结石,取得满意疗效,报告如下。     

手术室护理干预用于微创经皮肾穿刺取石术患者中的效果观察

目的:观察在微创经皮肾穿刺取石术患者中应用手术室护理干预的效果.方法:将2014年1月1日至2016年12月31日在本院接受微创经皮肾穿刺取石术的30例肾结石患者计算机随机分成两组,15例/组.A组予以手术室护理干预,B组采取常规护理干预.比较两组手术用时、患者住院天数及术后并发症发生情况.结果:A组的手术用时(96.56±9.57分钟)、住院天数(4.85±1.37天)均短于B组,术后并发症发生率(6.67%)较B组更低(p<0.05).结论:手术室护理干预应用在微创经皮肾穿刺取石术患者中效果令人满意.     

超选择性肾动脉栓塞治疗经皮肾穿刺取石术后严重出血的护理

目的探讨超选择性肾动脉栓塞治疗经皮肾穿刺取石术(PCNL)后严重出血的护理对策。方法对30例经皮肾穿刺取石术并发严重出血行超选择性肾动脉栓塞治疗的患者给予心理护理、穿刺处的观察和护理、栓塞后并发症的预防及护理等。结果30例患者均顺利康复,结果满意。结论对超选择性肾动脉栓塞治疗PCNL术后出血的患者采取心理护理、术后有效的观察、预防及护理,能促进患者的术后恢复。     

微创经皮肾取石术治疗老年感染性结石25例疗效观察

目的探讨微创经皮肾取石术（MPCNL）治疗老年感染性结石的安全性和有效性。方法回顾性分析25例老年感染性结石患者微创经皮肾治疗的临床资料。结果一期结石取净16例，二期结石取净4例。术中未发生大出血和感染性休克等严重并发症，术后随访6个月至1年，均未见结石复发。结论微创经皮肾取石术是治疗老年感染性结石的一种安全有效方法。     

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.     

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.     

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.     

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.     

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.