宫腔镜手术联合左炔诺孕酮宫内缓释系统预防子宫内膜息肉术后复发

目的探讨宫腔镜下子宫内膜息肉切除术联合左炔诺孕酮宫内缓释系统（曼月乐）治疗子宫内膜息肉的疗效及安全性。方法总结、分析120例患者经官腔镜下切除及术后放置曼月乐治疗子宫内膜息肉的临床及随访资料。结果全部患者官腔镜手术均顺利完成，无手术并发症发生，术后病理结果为子宫内膜息肉，排除子宫内膜恶性病变，于术后7-10d放置曼月乐。所有患者随访满2年，患者月经模式改变，月经过多者月经量明显减少，血红蛋白值明显升高，手术前与手术后子宫内膜厚度各组间比较差异均有统计学意义（P〈0．001）；无病例复发；无明显不良反应发生。结论宫腔镜下切除及术后应用左炔诺孕酮宫内缓释系统治疗子宫内膜息肉临床效果肯定，可抑制子宫内膜增长，随访无复发病例，安全、有效，值得临床推广。     

宫腔镜子宫内膜息肉电切术后应用曼月乐预防复发的临床观察

[目的]探讨子宫内膜息肉经宫腔镜手术治疗后应用左炔诺孕酮宫内缓释系统(商品名曼月乐)预防复发的临床效果。[方法]应用宫腔镜对120例子宫内膜息肉患者实行电切除术,术后随机分为治疗组60例和对照组60例,治疗组术后放置曼月乐,对照组不应用任何治疗。随访4年后,观察两组患者的子宫内膜息肉复发情况。[结果]治疗组子宫内膜息肉复发率为1.6%,对照组为15.0%,两组差异有统计学意义(P0.05)。[结论]宫腔镜可对子宫内膜息肉做出较明确的诊断及治疗,术后应用曼月乐治疗有助于预防子宫内膜息肉的复发。     

左炔诺孕酮宫内缓释系统预防子宫内膜息肉复发的临床疗效

目的:观察子宫内膜息肉患者诊刮或宫腔镜治疗后放置左炔诺孕酮宫内缓释系统的效果。方法:选择2005年1月～2011年1月在浙江省青春医院就诊的已行诊断性刮宫或宫腔镜手术的子宫内膜息肉患者87例,观察组51例术后自愿接受曼月乐治疗,其余为对照组,随访24个月,观察两组子宫内膜厚度及息肉复发情况。结果:随访发现,与对照组相比,曼月乐使用者子宫内膜厚度变薄,子宫内膜息肉复发率低,两组比较差异有统计学意义(P<0.05)。结论:子宫内膜息肉患者术后应用左炔诺孕酮宫内缓释系统有助于预防子宫内膜息肉的复发。     

曼月乐在子宫内膜息肉治疗中的应用

目的对曼月乐在子宫内膜息肉治疗中的应用进行观察分析.方法抽取我院于2013年1月-2015年1月间妇科收治的患有子宫内膜息肉并实施宫腔内电切除术的90例患者作为实验对象,分成观察组和对照组两组,患者比例设为1:1.其中,观察组患者予以术后宫腔内置入曼月乐宫内节育器治疗,对照组则不予以处理,对两组患者治疗后的月经量及子宫内膜息肉的复发率进行比较.结果治疗后2年,组间比较发现,对照组的子宫内膜复发率明显高于观察组,P<0.05;治疗后观察组月经减少量及子宫内膜变薄程度显著优于治疗前,P<0.05.结论术后应用曼月乐治疗,降低子宫内膜息肉复发的效果显著,安全性高,值得推广.     

宫腔镜电切术联合术后放置左炔诺孕酮缓释系统治疗子宫内膜息肉的临床观察

目的探讨子宫内膜息肉电切术(transcervical resection of polyp,TCRP)联合术后应用左炔诺孕酮缓释系统(曼月乐)治疗子宫内膜息肉的临床效果。并观察其预防息肉复发的效果及对内分泌、子宫内膜厚度的影响。方法选择2013年3月—2014年1月收治的子宫内膜息肉患者60例作为研究对象,随机分为对照组和曼月乐组各30例。对照组行TCRP并在术后给予常规抗感染治疗,曼月乐组行TCRP并在术后宫腔放置曼月乐。随访1年,观察两组子宫内膜息肉复发情况及内分泌、子宫内膜厚度变化情况。计量资料采用t检验,计数资料采用χ2检验,P0.05为差异有统计学意义。结果曼月乐组放置后6、12个月子宫内膜厚度分别为(8.89±2.02)、(6.65±1.02)mm,均明显小于对照组的(10.78±4.45)、(10.76±4.02)mm,差异均有统计学意义(均P0.05)。曼月乐组1年后复发率为0,明显低于对照组的33.33%,差异有统计学意义(P0.05)。结论 TCRP联合应用曼月乐治疗子宫内膜息肉能有效降低子宫内膜厚度,有助于预防子宫内膜息肉的复发,对患者内分泌水平无影响,不良反应小,值得在临床推广应用。     

宫腔镜下切除及术后应用左炔诺孕酮宫内缓释系统治疗子宫内膜息肉的疗效及安全性分析

目的:探讨宫腔镜下切除及术后应用左炔诺孕酮宫内缓释系统(曼月乐)治疗子宫内膜息肉的疗效及安全性。方法:总结、分析129例围绝经期患者经宫腔镜下切除及术后放置曼月乐治疗子宫内膜息肉的临床及随访资料。结果:全部患者宫腔镜手术均顺利完成,无手术并发症发生,术后病理结果为子宫内膜息肉,诊断性刮宫、子宫内膜病理结果排除子宫内膜恶性病变,于术后7～10日放置曼月乐。所有患者随访满2年,患者月经模式改变,月经过多者月经量明显减少,血红蛋白值明显升高,术前血红蛋白水平为(96.23±10.22)g/L,术后6、12、24个月血红蛋白值分别为(115.46±7.38)g/L、(120.16±8.23)g/L和(126.56±9.79)g/L,手术前与手术后各组血红蛋白值比较差异均有统计学意义(P<0.05);术前及术后6、12、24个月子宫内膜厚度分别为(1.48±0.36)cm、(0.78±0.22)cm、(0.69±0.16)cm和(0.58±0.13)cm,手术前与手术后子宫内膜厚度各组间比较差异均有统计学意义(P<0.001);无病例复发;术后患者血清雌、孕激素水平均无明显变化,无明显不良反应发生。结论:宫腔镜下切除及术后应用左炔诺孕酮宫内缓释系统治疗子宫内膜息肉临床效果肯定,可抑制子宫内膜增长,随访无复发病例,安全、有效,值得临床推广。     

子宫内膜息肉宫腔镜术后使用孕激素预防复发的疗效分析

目的：观察子宫内膜息肉（EP）宫腔镜术后放置左炔诺孕酮宫内缓释系统（曼月乐）和口服地屈孕酮2种不同孕激素治疗对预防EP复发的效果。方法：观察156例在宫腔镜下EP刮除或电切术后患者,分为曼月乐组、口服地屈孕酮组和单纯手术组（对照组）,术后3、6、12、24个月随访,观察各组术后EP复发及临床症状改善情况。结果：曼月乐组2年内复发率为0％,口服孕激素组6．5％,对照组27．5％,曼月乐组与地屈孕酮组EP复发率明显低于对照组（P〈0．05）;曼月乐组及口服地屈孕酮组术后异常子宫出血症状明显好转,术后复查子宫内膜变薄,2组与对照组比较差异均有统计学意义（P〈0．05）。结论：宫腔镜下EP刮除或电切后宫腔内放置曼月乐或口服地屈孕酮是防止EP复发的有效方法。     

左炔诺孕酮宫内缓释系统辅助宫腔镜子宫内膜息肉切除术治疗子宫内膜息肉临床分析

目的:探讨左炔诺孕酮宫内缓释系统辅助宫腔镜子宫内膜息肉切除术治疗子宫内膜息肉临床疗效。方法:选近年来于本院就诊接受宫腔镜下子宫内膜息肉电切术的患者132例,将患者分成两组,观察组82例行宫腔镜下子宫内膜息肉电切后置1枚曼月乐节育器(左炔诺孕酮宫内缓释系统);对照组50例行宫腔镜下子宫内膜息肉电切术后服用优思明(屈螺酮炔雌醇片)。观察并记录两组患者子宫内膜息肉复发率及子宫内膜厚度。结果:以月经失血图(PBAC)评分为指标评估,自随访6个月起观察组月经量明显少于对照组,子宫内膜厚度也明显变薄(P<0.05);此外,联合左炔诺孕酮宫内缓释系统治疗观察组术后子宫内膜息肉复发率分别为8.5%,显著低于对照组(P<0.05)。结论:宫腔镜子宫内膜息肉切除术是子宫内膜息肉治疗的首选方式,但术后为降低息肉复发率,联合放置左炔诺孕酮宫内缓释系统辅助治疗效果更好。     

不同孕激素预防子宫内膜息肉术后复发的临床疗效

目的：观察口服孕激素和宫腔内放置左炔诺孕酮宫内缓释系统（LNG-IUS,商品名曼月乐）对预防子宫内膜息肉术后复发的临床疗效。方法：系统回顾对比研究73例子宫内膜息肉宫腔镜电切术后使用孕激素预防复发的患者,包括周期口服地屈孕酮片的对照组（40例）和宫内放置LNG-IUS的试验组（33例）。比较2组月经量、子宫内膜厚度改变、复发和不良反应情况。结果：2组患者治疗后月经量较术前均明显减少,子宫内膜明显变薄,试验组效果更显著（P=0.000）。随访6个月时试验组点滴出血发生率高于对照组（P=0.000）,12个月时2组间差异无统计学意义（P=0.809）。对照组的不良反应发生率高于试验组。对照组有2例复发,试验组无复发。结论：孕激素治疗对预防子宫内膜息肉术后复发有效,LNG-IUS预防子宫内膜息肉术后复发使用方便、见效快,不良反应少。     

左炔诺孕酮宫内释放系统在预防子宫内膜息肉术后复发的研究

目的:研究左炔诺孕酮宫内释放系统预防子宫内膜息肉宫腔镜下切除术后复发的临床效果。方法:选取2010至2012年间在嘉兴市妇幼保健院行宫腔镜下子宫内膜息肉切除术患者300例进行随机分组,研究组在宫腔镜术后子宫内即时放置左炔诺孕酮宫内释放系统,而对照组不予放置,所有患者追踪随访2年,了解患者子宫内膜息肉复发情况。结果:所有患者均手术成功,随访2年,对照组16例子宫内膜息肉复发,复发率为10.88%,而研究组无一例复发,差异有统计学意义(P<0.01)。结论:左炔诺孕酮宫内释放系统能预防子宫内膜息肉术后的复发及形成。     

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.