同种异体肌腱修复膝关节韧带损伤2年随访报道

目的探索应用同种异体肌腱修复膝关节韧带损伤的临床疗效,避免取自体肌腱造成的膝关节周围组织再损伤和并发症。方法采用经深低温冷冻加γ射线照射处理的同种异体骨-髌腱-骨移植,关节镜下修复膝关节交叉韧带损伤30例,前交叉韧带16例、后交叉韧带9例,前、后交叉韧带一期修复5例。其中1例镜下行半月板缝合,15例行半月板部分切除或完全切除,1例合并胫腓骨骨折,交锁髓内钉固定术后3周行交叉移植修复,3例合并髌骨骨折,与交叉韧带在关节镜下同时修复。结果29例患者获得2年以上随访,采用Lysholm膝关节功能评分法评估患膝手术前后的功能,术前平均36分,术后平均85分,优良率86%。客观检查,前抽屉试验阳性,术前21例,术后弱阳性2例,后抽屉试验阳性,术前14例,术后弱阳性3例,Lachman试验阳性,术前21例,术后弱阳性4例,术后遗留膝关节运动后疼痛2例,可忍受,膝关节屈曲活动受限(5°～20°)2例。其中7例术后1～2年取内固定或镜下行韧带固缩过程中,取少许异体髌腱活检,结果已全部转变为正常腱性组织。结论应用同种异体骨-髌腱-骨组织修复膝关节韧带损伤,术后通过系统的康复治疗,能有效恢复膝关节功能。     

同种异体肌腱重建膝关节前交叉韧带的临床研究

目的探讨关节镜下应用同种异体肌腱重建膝关节前交叉韧带的临床效果。方法选取我院27例近三年来行同种异体肌腱重建膝关节前交叉韧带患者,回顾性分析手术治疗前后的膝关节功能评分情况和并发症发生情况。结果27例患者术后均未发生严重并发症,所有患者术后随访12个月,Lysholm膝关节功能评分同术前相比较,差别有统计学意义(P<0.05)。结论关节镜下应用同种异体肌腱重建膝关节前交叉韧带具有手术损伤小、术后并发症少、膝关节功能恢复良好的优点。     

同种异体肌腱重建膝关节前交叉韧带的临床研究

目的探讨关节镜下应用同种异体肌腱重建膝关节前交叉韧带的临床效果。方法选取我院27例近三年来行同种异体肌腱重建膝关节前交叉韧带患者,回顾性分析手术治疗前后的膝关节功能评分情况和并发症发生情况。结果27例患者术后均未发生严重并发症,所有患者术后随访12个月,Lysholm膝关节功能评分同术前相比较,差别有统计学意义（P〈0．05）。结论关节镜下应用同种异体肌腱重建膝关节前交叉韧带具有手术损伤小、术后并发症少、膝关节功能恢复良好的优点。     

选用同种异体肌腱移植一次性治疗膝关节多发韧带损伤

目的探讨选用同种异体肌腱移植一次性治疗膝关节多发韧带损伤的手术方法及临床疗效。方法2003年4月～2005年5月，对11例膝关节多发韧带损伤患者采用同种异体跟腱移植一次性手术重建修复膝关节多发韧带损伤，术后进行系统的康复。结果全部病例均获随访，4例问卷式随访，7例门诊定期随诊，随访时间12～23个月。本组患者术后12个月进行疗效评定：优良8例，中3例。结论选用同种异体肌腱移植一次性手术治疗膝关节多发韧带损伤，创伤小、疗程短、恢复快，是治疗膝关节多发韧带损伤的良好选择。     

选用同种异体肌腱移植一次性治疗膝关节多发韧带损伤

目的 探讨选用同种异体肌腱移植一次性治疗膝关节多发韧带损伤的手术方法 及临床疗效.方法 2003年4月～2005年5月,对11例膝关节多发韧带损伤患者采用同种异体跟腱移植一次性手术重建修复膝关节多发韧带损伤,术后进行系统的康复.结果 全部病例均获随访,4例问卷式随访,7例门诊定期随诊,随访时间12～23个月.本组患者术后12个月进行疗效评定:优良8例,中3例.结论 选用同种异体肌腱移植一次性手术治疗膝关节多发韧带损伤,创伤小、疗程短、恢复快,是治疗膝关节多发韧带损伤的良好选择.     

关节镜下异体骨-髌腱-骨与异体胫前肌腱重建前交叉韧带的疗效比较

目的比较分析膝关节镜下异体骨-髌腱-骨与异体胫前肌腱两种重建前交叉韧带(ACL)的疗效。方法 26例异体胫前肌腱移植和87例异体骨-髌腱-骨移植重建ACL的情况,随访6～48个月,平均22.3个月。采用Lysholm膝关节评分、国际膝关节文献编制委员会分级评估标准(IKDC)及KT-2000检测评价疗效。结果 两组间患者满意度、关节稳定性及功能差异均无统计学意义。但异体骨-髌腱-骨较异体胫前肌排斥反应发生率要高得多。结论异体胫前肌可能是一种更加适合重建ACL的移植物,异体胫前肌腱重建前交叉韧带方法能更加适合重建ACL。     

关节镜下自体骨-髌腱-骨与半腱肌腱重建后交叉韧带的疗效比较

目的比较分析膝关节镜下自体骨-髌腱-骨与半腱肌腱重建后交叉韧带的疗效。方法回顾分析21例膝关节镜下自体骨-髌腱-骨移植、28例自体半腱肌腱移植重建PCL的情况,随访36～89个月,平均58.2个月。采用Lysholm膝关节评分、国际膝关节文献编制委员会分级评估标准(IKDC)和KT-1000评价疗效。结果两组间术后关节稳定性及功能差异均无统计学意义。术后后抽屉试验2例半腱肌、1例自体骨-髌腱-骨阳性。自体骨-髌腱-骨重建组3例(14.3%)膝关节10°屈曲受限;半腱肌腱重建组2例(7.1%)屈曲受限。自体骨-髌腱-骨重建组膝前痛发生率较半腱肌腱组高。结论关节镜下自体骨-髌腱-骨与半腱肌腱移植重建PCL的疗效相同。     

动、静力联合重建治疗陈旧性后交叉韧带断裂(附13例报告)

目的 介绍一种动、静力联合重建治疗陈旧性后交叉韧带断裂的新方法。方法 对13例陈旧性后交叉韧带断裂患者采用髌腱中1／3部分作为动力腱，髌胫束包裹碳纤维编织带作为静力腱，进行动、静力联合重建治疗，比较手术前后的膝关节症状和稳定性情况。结果 术后随访8—29个月，平均18个月，采用Lysholm膝关节评分法评估，平均得分由术前50分提高到术后89分。结论 本手术方法设计合理，易操作、创伤小，疗效确切、持久，可同时修复内、外侧副韧带、半月板的损伤。     

关节镜下＂二步法＂定位六股异体肌腱重建前交叉韧带

目的 观察前交叉韧带（ACL）损伤后应用同种异体肌腱重建ACL后的临床疗效.方法 对2007年3月～2010年7月89例采用同种六股异体肌腱,术中应用＂二步法＂定位重建前交叉韧带的病例进行回顾分析.结果 平均随访13年,所有患者关节活动度正常,无撞击综合征发生,查体前抽屉试验、Lachman试验、轴移试验均阴性.按Lysholm评分,术前为（543±72）分,术后为（902±35）分.结论 关节镜下＂二步法＂定位,六股异体肌腱重建前交叉韧带的方法定位准确,操作简便,手术创伤小,术后膝关节稳定,不易松动,取得满意疗效.     

骨-髌腱-骨移植重建膝关节前交叉韧带

目的评价应用关节镜行自体骨-髌腱-骨移植重建膝关节前交叉韧带(ACL)的疗效。方法均在关节镜下采用Arthrex,ACL重建器械,在股骨及胫骨隧道内口均采用可吸收界面挤压螺钉固定移植韧带。结果本组12例,术后膝关节功能Lysholm评分均在90分以上,前抽屉试验阴性,Lachman试验阴性。结论骨-髌腱-骨移植重建膝关节前交叉韧带,具有强大的抗折、抗拉性能,重建后骨块固定牢靠、疗效好,费用低。     

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.     

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.     

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.     

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.