纳米银敷料、银离子敷料、磺胺嘧啶银治疗Ⅱ度烧伤的网状 Meta分析

目的：银制剂用于烧伤创面外用药已有数十年历史,主要有磺胺嘧啶银、纳米银敷料、银离子敷料,目前并没有同时比较三者在Ⅱ度烧伤的效果研究,因此本研究拟采用网状 Meta分析的方法,纳入随机对照试验,分析纳米银敷料、银离子敷料、磺胺嘧啶银治疗Ⅱ度烧伤的疗效,进而选择最佳的含银制剂。方法全面检索中英文数据库,纳入比较纳米银敷料、银离子敷料、磺胺嘧啶银治疗Ⅱ度烧伤的随机对照试验,两个作者独立筛选研究、提取资料和评价纳入研究质量,数据分析采取 Stata软件进行分析,二分类变量数据采用比值比（odds ratio ,OR）及其95％可信区间（95％ confidence interval ,95％ CI）为疗效分析统计量,连续性变量采用均数差（mean difference ,MD）及其95％ CI为疗效分析统计量。结果纳入14个研究（1211例患者）。纳米银敷料（M D ：－4．13,95％ C I：－5．74～－2．52）、银离子敷料（M D ：－3．25,95％ C I：－5．00～－1．49）较磺胺嘧啶银具有较快的伤口愈合时间,但是纳米银敷料和银离子敷料在伤口愈合时间上没有统计学差异（M D ：0．89,95％ C I：－1．49～3．27）。在伤口愈合时间上,纳米银敷料成为最佳治疗的可能性为77．2％,其次为银离子敷料（可能性为22．8％）,最后为磺胺嘧啶银（可能性为0％）。纳米银敷料的细菌感染发生率显著低于磺胺嘧啶银（OR：0．36,95％ C I：0．15～0．87）,银离子敷料的细菌感染发生率与磺胺嘧啶银（OR：0．52,95％ CI：0．18～1．51）、纳米银敷料（OR：1．43,95％ CI：0．36～5．66）无统计学差异。在细菌感染发生率上,纳米银敷料成为最佳治疗的可能性为70．3％,其次为银离子敷料（可能性为29．7％）,最后为磺胺嘧啶银（可能性为0％）。结论纳米银敷料可能是目前相对于银离子敷料和磺胺嘧啶银的最佳敷料,但是需要未来研究进行证实。     

Psychometric evaluation of the Cystic Fibrosis Questionnaire-Revised in a national sample

Purpose

The psychometric properties of a health-related quality of life (HRQOL) instrument, the Cystic Fibrosis Questionnaire-Revised (CFQ-R), were evaluated in a national sample of patients with cystic fibrosis (CF).

Methods

The Epidemiologic Study of CF is a national, multicenter, longitudinal cohort study containing CFQ-R and health outcomes data. Developmentally appropriate versions of the CFQ-R were available from 7,330 patients aged 6?C70?years and a proxy version from 2,728 parents of school-age children. The CFQ-R was completed during a ??stable?? or ??sick?? visit before recording health outcomes such as weight, lung function, and pulmonary exacerbations.

Results

There were few floor and ceiling effects and strong internal consistency (Cronbach alpha ??0.70) for most scales. The CFQ-R consistently discriminated between patients seen for sick-versus-well visits, and among stages of disease severity based on lung function. As predicted, women with CF reported worse HRQOL than men on scales not related to body image and weight. Strong parent?Cchild agreement was found on scales measuring observable behaviors (respiratory symptoms). Convergence between CFQ-R scales and health outcomes provided evidence of construct validity.

Conclusions

The CFQ-R demonstrated robust psychometric properties and consistent associations with health outcomes in a large national sample.     

Amphibole fibers in a taconite mine and in the lungs of the miners

Fibers of the amphibole mineral series have been demonstrated in the dust from an open taconite ore mine. Though the total dust levels in some places are high, exposures to fibers are below one fiber/cc. The energy dispersive X-ray spectra of the amphibole fibers correspond to those of cummingtonite-grunerite, hornblende, or actinolite. The same type and size distribution of fibers were found during post mortem analyses of lung tissue from two previously exposed miners. The pathological examination revealed an undifferentiated small cell carcinoma of left lung as well as pulmonary fibrosis in one of the cases. In the second case a poorly differentiated squamous cell carcinoma of left lung was found along with silicosis.     

Transplantation of the lungs

After years of disrepute, single-lung transplant now seems to be a suitable form of treatment for a carefully selected group of patients with end-stage pulmonary fibrosis. In addition, there is the prospect of treating a wider range of pulmonary diseases in the near future, with the appropriate use of double-lung and heart-lung transplants.     

Exposure-related health effects of silver and silver compounds: a review

A critical review of studies examining exposures to the various forms of silver was conducted to determine if some silver species are more toxic than others. The impetus behind conducting this review is that several occupational exposure limits and guidelines exist for silver, but the values for each depend on the form of silver as well as the individual agency making the recommendations. For instance, the American Conference of Governmental Industrial Hygienists has established separate threshold limit values for metallic silver (0.1 mg/m3) and soluble compounds of silver (0.01 mg/m3). On the other hand, the permissible exposure limit (PEL) recommended by the Occupational Safety and Health Administration and the Mine Safety and Health Administration and the recommended exposure limit set by the National Institute for Occupational Safety and Health is 0.01 mg/m3 for all forms of silver. The adverse effects of chronic exposure to silver are a permanent bluish-gray discoloration of the skin (argyria) or eyes (argyrosis). Most studies discuss cases of argyria and argyrosis that have resulted primarily from exposure to the soluble forms of silver. Besides argyria and argyrosis, exposure to soluble silver compounds may produce other toxic effects, including liver and kidney damage, irritation of the eyes, skin, respiratory, and intestinal tract, and changes in blood cells. Metallic silver appears to pose minimal risk to health. The current occupational exposure limits do not reflect the apparent difference in toxicities between soluble and metallic silver; thus, many researchers have recommended that separate PELs be established.