慢性肾衰竭高钾血症患者临床分析及治疗

目的分析出现高钾血症的慢性肾衰竭患者的临床资料．探讨其治疗方案。方法回顾性分析笔者所在医院近4年抢救的一组慢性肾衰竭并发高钾血症患者的临床抢救治疗过程。结果病史发现未严格控制饮食中钾的摄入是慢性肾衰竭患者出现高钾血症的主要原周。有90例次患者经及时抢救，应用药物及血液透析治疗后，血清钾浓度恢复到正常范围内，高血钾的心电图改变消失．临床症状缓。2例患者抢救无效死亡。结论慢性肾衰竭患者控制饮食中钾的摄入可减少高钾血症发生；应重视综合治疗，予以积极降钾及必要的生命支持治疗；血液透析是治疗高钾血症最直接有效的方法，效果确切，安全可靠，其他方法欠佳时应及早采用。     

血液净化抢救急性肾功衰并发高钾血症158例

目的应用血液净化治疗急性肾功衰并发高钾血症，清除患者体内过多的水分、，尿毒素，快速清除高血钾，使电解质及酸碱平衡得到纠正，血压下降，心衰及时得到控制，达到治疗的目的。方法本组158例急性肾功衰竭并发高钾血症，采用德国进口和瑞典进口人工肾机、进口空心纤维透析器，血仿膜及聚风膜，采用低分子肝素和肝素抗凝，每公斤体重0．5～1．2mg，进行了血液透析，治疗每个患者透析3～6次，每次3～5小时，部分患者采用丽珠树脂灌流器及爱尔碳肾串联血液透析进行了吸附透析治疗，同时配合临床病因及对症治疗。结果158例急性肾功衰竭并发高钾血症患者应用血液透析或血液灌流串联血液透析治疗后，141例肾功能恢复血钾下降正常治愈。有效率89．2％，死亡17例，死亡率10．76％。结论血液净化对急性肾功衰竭并发高钾血症抢救治疗时间短，见效快，可明显提高治愈率，降低死亡率。     

血液透析治疗老年重症肾衰竭患者的临床观察

目的观察血液透析治疗对老年重症肾衰竭患者的临床疗效。方法回顾性分析我院自2003年至2011年65例60岁以上的老年重症肾衰竭患者的临床疗效。其中65例中38例血液透析治疗(简称透析组),27例未接受血液透析治疗(简称非透析组)。结果透析组存活25例占(65.78%),未透析存活5例占(18.51%)。结论血液透析治疗老年重症肾衰竭患者能有效提高生存率,并有利于减少严重并发症,帮助肾功能恢复,是重症肾衰竭有效治疗方案。     

心电图对高钾血症的鉴别意义

目的探讨不同病因所致的高钾血症的心电图不同表现，为早期诊断、合理治疗提供帮助。方法对23例高钾血症患者的病因、心电图和血清钾浓度进行分析。结果由排钾障碍所致的高钾血症心电图改变与血清钾浓度有较好的相关性，而因钾的细胞内外分布异常所致的高钾血症心电图无高钾改变。结论心电图对假性高钾血症鉴别比血清钾浓度测定更敏感、准确。     

无肝素血液透析在肾衰竭并活动性出血患者42侵临床应用分析

目的总结用无肝素血液透析抢救肾衰竭并活动性出血患者经验。方法42例肾衰竭并活动性出血患者在内科常规治疗基础上,应用无肝素血液透析。结果本组患者中有40例临床治愈,2例家属放弃治疗。结论无肝素血液透析是抢救肾衰竭并活动性出血患者的有效手段。     

维持性血液透析患者高钾血症的影响因素分析

目的：时导致维持性血液透析患者高钾血症的影响因素进行分析研究。方法：选择临床维持性血液透析患者132例，对其常规检测一般生化指标包括透析前、后血清钾（K）．透析前血清钠（Na）、肌酐（Cr）、尿素氯（BUN）、血糖（Glu）、二氧化碳结合力（C02CP）；并对其应用药物血管紧张素转换酶抑制剂、血管紧张素受体阻断剂、B受体阻断剂等和残尿量，糖尿病史等的情况。结果用Pearson相关分析及Logistic回归法进行分析。结果：Pearson分析示MHD患者血钾水平与饮食钾摄八量相关（r—O．86，P=0．000），差异有统计学意义，Logistic回归分析提示MHD患者高钾血症的独立影响因素为饮食钾摄入量（ORl．049，96．8％，C11．295，1．096，P=0．000）。结论：患者血钾水平与饮食钾撮入量相关，对患者高钾血症的发生有着重要的影响意义，在临床中控制饮食中钾的摄入量可作为预防维持性血液透析高钾血症发生的重要的方式方法。     

横纹肌溶解症引起急性肾衰竭13例临床诊断和治疗分析

目的探讨横纹肌溶解症(RM)引起急性肾衰竭(ARF)的病因、临床特点、治疗及预后。方法回顾性分析我院收治的13例RM-ARF患者的临床表现、多种治疗效果及转归。结果13例患者治疗前血清肌酸激酶(CK)、乳酸脱氢酶(LDH)、天门冬氨酸基转移酶(AST)、丙氨酸氨基转移酶(ALT)峰值均超过正常值5倍以上,Scr>177μmol/L。给予综合治疗、血液透析、肢体筋膜切开减压术等治疗后,存活10例(76.92%),死亡3例(23.08%)。死于多器官功能障碍综合征2例,高钾血症1例。存活者出院时均脱离透析,血肌酐和血清酶恢复正常。结论RM-ARF时常表现为少尿型,高钾血症常见;血清酶学和血肌红蛋白检测可提高RM并ARF诊断率;早期综合治疗和血液净化,血液透析治疗效果良好,存活者肾功能多可恢复。     

血液透析在糖尿病肾衰竭治疗中的应用

目的探讨血液透析治疗糖尿病肾衰竭患者的效果及安全性。方法随机选取我院2015年1月至2017年1月收治的糖尿病肾衰竭患者78例,比较透析治疗前后患者的血清肌酐清除率(SCr)、尿素氮(BUN)、血钾(K+)和血糖(Glu)水平,统计治疗过程中的并发症情况,分析血液透析的治疗效果和安全性。结果治疗后,患者的SCr、BUN、K+和Glu水平均降低,与治疗前比较差异有统计学意义(P<0.05)。78名患者共透析400次,各并发症发生率最高为15.00%,最低为3.75%,并发症发生率较低。结论血液透析治疗糖尿病肾衰竭患者具有显著的效果,虽然治疗过程中会出现低血压、低血糖等情况,但能够通过针对性干预进行预防和治疗,血液透析的安全性较高。     

横纹肌溶解症引起急性肾衰竭13例临床诊断和治疗分析

目的探讨横纹肌溶解症（RaM）引起急性肾衰竭（ARF）的病因、临床特点、治疗及预后。方法回顾性分析我院收治的13例RM—ARF患者的临床表现、多种治疗效果及转归。结果13例患者治疗前血清肌酸激酶（CK）、乳酸脱氢酶（LDH）、天门冬氨酸基转移酶（AST）、丙氨酸氨基转移酶（ALT）峰值均超过正常值5倍以上,Scr〉177μmol／L。给予综合治疗、血液透析、肢体筋膜切开减压术等治疗后,存活10例（76．92％）,死亡3例（23．08％）。死于多器官功能障碍综合征2例,高钾血症1例。存活者出院时均脱离透析,血肌酐和血清酶恢复正常。结论RM—ARF时常表现为少尿型,高钾血症常见;血清酶学和血肌红蛋白检测可提高RM并ARF诊断率;早期综合治疗和血液净化,血液透析治疗效果良好,存活者肾功能多可恢复。     

高通量血液透析与血液透析滤过对慢性肾衰竭尿毒症患者透析效果的比较

目的:比较高通量血液透析和血液透析过滤对慢性肾衰竭尿毒症的透析效果.方法:通过收集采用两种方法对慢性肾衰竭尿毒症患者透析效果的数据,将数据按照透析方法和透析效果分成两组,利用统计学SPSS软件对数据进行分析,观察分析结果,进行比较.结果:根据分析得到两组数据之间存在显著相关性.结论:高透量血液透析对慢性肾衰竭尿毒症患者有显著的治疗效果.     

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.