腓肠神经营养血管逆行岛状皮瓣的应用体会

目的 探讨腓肠神经营养血管逆行岛状皮瓣修复软组织缺损的应用体会.方法 1997年8月～2004年12月对21例小腿中下段、足跟、跟腱及踝关节周围等处软组织缺损的患者,采用腓肠神经营养血管逆行岛状皮瓣转移修复.皮瓣面积最大15 cm×20 cm,最小4 cm×4 cm.结果 21例腓肠神经皮瓣中20例皮瓣全部成活,一期愈合;1例远端部分坏死,经换药后愈合.足背外侧缘皮肤感觉早期减退,术后1年全部恢复.皮瓣质地适宜、耐磨,血运外形好,具有保护性感觉.结论 腓肠神经营养血管逆行岛状皮瓣切取简便,血供可靠,不牺牲主要动脉,是较理想的修复小腿中下段、踝关节周围及足跟、跟腱等处软组织缺损的方法.     

带腓肠神经滋养血管蒂岛状皮瓣的临床应用

目的 探讨带腓肠神经滋养血管蒂岛状皮瓣的临床应用。方法 应用带腓肠神经滋养血管蒂岛状皮瓣修复胫前区中、下段，踝周及足跟部软组织缺损35例，修复面积最大为20cm×10cm。结果 35例皮瓣全部成活，术后皮瓣无水肿、淤血、水疱等静脉危象的表现，术后平均随访8个月，感觉恢复，皮瓣两点分辨感觉1—2cm。结论 带腓肠神经滋养血管蒂岛状皮瓣是修复小腿下段、踝周及足跟部软组织缺损的理想方法之一，有利于皮瓣成活，皮瓣感觉和足背外侧感觉都有比较满意的恢复，效果良好。     

逆行股前外侧岛状皮瓣移植修复膝关节周围及小腿中上段软组织缺损

目的探讨逆行股前外侧岛状皮瓣临床应用于修复膝关节周围及小腿中上段软组织缺损的效果。方法设计以旋股外侧动脉降支为血管蒂的逆行股前外侧岛状皮瓣，皮瓣面积为6cm×9cm～7cm×13cm，通过皮下隧道或明道逆行转移皮瓣，修复9例膝关节周围及小腿中上段软组织缺损。结果9例皮瓣8例成活，1例皮瓣远端1／4坏死，经换药后二期植皮每合。随访10～18个月，平均14个月，骨外露或软组织缺损创面均得以满意修复，功能和外形满意。结论以旋股外侧动脉降支为血管蒂的逆行股前外侧岛状皮瓣是修复膝关节周围及小腿中上段软组织缺损的较好方法。     

浅静脉-皮神经营养血管逆行岛状筋膜皮瓣修复足踝部软组织缺损临床研究

目的总结小腿浅静脉-皮神经营养血管逆行岛状筋膜皮瓣在足踝部烧伤后或瘢痕切除术后造成的组织缺损修复中的临床应用。方法足踝关节开放性损伤或瘢痕挛缩23例患者，踝关节有跟腱、跟骨外露、缺损或坏死，或瘢痕挛缩；分别采用大隐静脉-隐神经营养血管、小隐静脉-腓肠神经营养血管为蒂逆行岛状筋膜皮瓣修复创面。结果23例患者，采用大隐静脉-隐神经营养血管逆行岛状筋膜皮瓣8例，均甲级愈合；采用小隐静脉-腓肠神经营养血管逆行岛状筋膜皮瓣15例，3例皮瓣术后出现淤紫、肿胀，皮瓣边缘出现表皮坏死，经换药后愈合；其余皮瓣均甲级愈合。结论足踝关节烧伤后造成的组织坏死或瘢痕挛缩，扩创或将瘢痕切除后常造成关节开放、深部组织如跟腱、骨骼外露，采用浅静脉-皮神经营养血管逆行岛状筋膜皮瓣修复创面，皮瓣质量好，无挛缩，有利于关节的功能恢复，效果满意。     

浅静脉-皮神经营养血管逆行岛状筋膜皮瓣修复足踝部软组织缺损临床研究

目的总结小腿浅静脉-皮神经营养血管逆行岛状筋膜皮瓣在足踝部烧伤后或瘢痕切除术后造成的组织缺损修复中的临床应用。方法足踝关节开放性损伤或瘢痕挛缩23例患者,踝关节有跟腱、跟骨外露、缺损或坏死,或瘢痕挛缩;分别采用大隐静脉-隐神经营养血管、小隐静脉-腓肠神经营养血管为蒂逆行岛状筋膜皮瓣修复创面。结果23例患者,采用大隐静脉-隐神经营养血管逆行岛状筋膜皮瓣8例,均甲级愈合;采用小隐静脉-腓肠神经营养血管逆行岛状筋膜皮瓣15例,3例皮瓣术后出现淤紫、肿胀,皮瓣边缘出现表皮坏死,经换药后愈合;其余皮瓣均甲级愈合。结论足踝关节烧伤后造成的组织坏死或瘢痕挛缩,扩创或将瘢痕切除后常造成关节开放、深部组织如跟腱、骨骼外露,采用浅静脉-皮神经营养血管逆行岛状筋膜皮瓣修复创面,皮瓣质量好,无挛缩,有利于关节的功能恢复,效果满意。     

小腿皮神经营养血管逆行岛状皮瓣治疗跟骨骨髓炎及跟部创面

目的：探讨小腿皮神经营养血管逆行岛状皮瓣修复治疗跟骨髓炎及跟部创面的方法。方法：2006年3月至2008年12月,我院对15例跟骨髓炎及跟部皮肤缺损创面应用小腿皮神经营养血管逆行岛状皮瓣进行修复,其中跟骨骨髓炎8例,跟部创面7例。用隐神经营养学管逆行岛状皮瓣2例,腓肠神经营养血管逆行岛状皮瓣13例。皮瓣切取面积4．0cm×6．0cm-8．0cm×10．0cm。结果：术后15例皮瓣12例全部成活;1例远端部分坏死,经换药后痊愈;2例跟骨骨髓炎未愈合,但皮瓣无坏死,感染,其中1例经抗生素填塞,换药后愈合,1次再次行骨髓炎扩创＋冲洗引流后好转。随访：6—18月,皮瓣质地柔软,弹性好,外形满意,颜色接近正常,患者对皮瓣外形及治疗效果满意。供皮区植皮全部成活,外形满意。结论：小腿皮神经营养血管逆行岛状皮瓣是修复治疗跟骨骨髓炎及跟骨创面的一种较理想的手术方法。     

带蒂皮瓣治疗小腿和足部皮肤软组织缺损20例

目的探讨小腿和足裸部皮肤软组织缺损的手术方法及其疗效评价.方法2000年10月～加06年¨月,20例小腿及足裸皮肤软组织缺损的患者,男18例,女2例;年龄8～87岁,平均31岁;皮瓣面积大小不等.采用带蒂的肌皮瓣和筋膜皮瓣进行治疗分别是①腓肠神经营养血管蒂逆行岛状皮瓣修复小腿中下1/3,裸部及足跟皮肤软组织缺损10例;②小腿前内侧交腿皮瓣修复小腿中段胫前皮肤软组织缺损1例;③带胫后动脉小腿内侧逆行岛状皮瓣修复足背部皮肤软组织缺损1例;④小腿内侧远端蒂筋膜皮瓣修复小腿中下1/3胫前皮肤软组织缺损2例;⑤隐神经营养血管蒂逆行岛状皮瓣修复小腿中下1/3,裸部及足背皮肤软组织缺损6例.结果20例皮瓣中有18例术后全部成活,创面一期愈合,1例皮瓣浅层坏死.1例皮瓣远端边缘少许坏死,经短期换药后愈合.所有病例均得到随访,皮瓣全部良好.结论治疗小腿和足裸部皮肤软组织缺损应严格掌握手术适应证,合理选择皮瓣种类.腓肠神经和隐神经营养血管蒂岛状皮瓣是较理想的修复小腿及足裸部软组织缺损的材料.     

腓肠神经营养血管逆行岛状皮瓣的临床应用

目的探讨改进的腓肠神经营养血管逆行岛状皮瓣修复足跟部、踝部及足背软组织缺损的方法。方法我们将腓肠神经营养血管逆行岛状皮瓣进行改进设计（1）采用皮瓣回流静脉干高压时予以结扎小隐静脉干,或与受区静脉吻合;（2）皮瓣蒂部保留梨形皮桥,逆行转位修复;2007年~2009年,应用改进的腓肠神经营养血管逆行岛状皮瓣修复足跟部、踝部及足背软组织缺损9例。结果9例皮瓣全部成活,经8~12个月随访,效果满意。结论改进的腓肠神经营养血管逆行岛状皮瓣是一种新型、简便、实用的软组织缺损修复方法,利于临床推广应用。     

腓肠神经营养血管岛状皮瓣的临床应用

目的　总结腓肠神经营养血管岛状皮瓣的临床应用效果。方法　 1998年开始应用腓肠神经营养血管岛状皮瓣修复膝、小腿、踝及足部皮肤软组织缺损 18例 ,其中顺行蒂 3例 ,逆行蒂 15例。皮瓣面积 5cm× 7cm～ 8cm× 16cm。血管蒂长 9～ 16cm ,蒂宽 2～ 3cm。结果　术后 17例皮瓣完全成活 ,1例皮瓣尖端部分皮肤坏死 ,经换药愈合。经 3个月～ 1年随访 ,皮肤质地及外形较好。结论　该皮瓣血供可靠 ,不牺牲肢体主干动脉 ,操作简单 ,是修复膝、小腿、踝及足部皮肤软组织缺损较好方法。     

腓肠神经滋养血管顺逆行带蒂岛状皮瓣修复小腿及踝周皮肤软组织缺损

目的探讨应用腓肠神经滋养血管带蒂岛状皮瓣转移修复小腿中下段及踝周皮肤组织缺损的治疗效果。方法回顾分析我院2005年10月至2011年10月应用腓肠神经滋养血管带蒂岛状皮瓣修复小腿中下段及踝周皮肤组织缺损37例,其中26例应用腓肠神经滋养血管逆行带蒂岛状皮瓣修复小腿下段1/3及踝周皮肤组织缺损,11例应用腓肠神经滋养血管顺行带蒂岛状皮瓣修复小腿中下段皮肤软组织的缺损。结果 37例转移皮瓣全部成活,其中3例皮瓣远端部分坏死,经换药后痊愈。结论腓肠神经滋养血管皮瓣解剖恒定,操作简单,损伤小,不破坏下肢功能,成活率高,是修复小腿中下段及踝周皮肤组织缺损的较好方法之一。     

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.     

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.