网状推进皮瓣修复乳腺癌术中、术后皮肤缺损的探讨

目的探讨损伤小、安全简单、避免植皮手术的乳腺癌根治术中、术后皮肤缺损的修复方法。方法结合网状皮片和皮瓣的共同优势,将乳腺癌缺损创面两侧的皮瓣做成网状推进皮瓣,在无张力下相对推进,覆盖创面修复缺损。结果19例网状推进皮瓣全部成活,避免了植皮手术。网孔起到了引流效果,减少了引流管的数量。切口长分别为1.0cm、1.5cm、2.0cm左右的网孔,平均分别在9d、12d、16d被新生组织长入填充愈合。网孔越大,皮瓣扩张的面积越大,但网孔愈合时间相对延长。术后皮瓣弹性好,无胸廓紧缩感,术后不影响按时放化疗。结论网状推进皮瓣是修复乳腺癌术中、术后皮肤缺损的有效方法,可避免植皮手术,适合不同面积缺损的修复。     

乳腺癌术中术后皮肤缺损不同修复方法的疗效观察

目的比较不同的乳腺癌根治术中术后皮肤缺损的修复方法，找出一种损伤小、安全简单、避免植皮的修复方法。方法利用网状推进皮瓣、植皮术、换药3种方法修复30例乳腺癌术中术后皮肤缺损。结果15例网状推进皮瓣全部成活，避免了植皮手术，术后皮瓣弹性好，无胸部紧绷感，术后不影响化疗。5例植皮全部成活，但手术耗时较长，增加了患者新的创伤和痛苦，有胸部紧绷感。10例伤口换药全部愈合，但愈合时间较长，为1～2个月，愈合后手术瘢痕较明显，皮肤紧绷感较强。结论网状推进皮瓣是理想的乳腺癌术中术后皮肤缺损的修复方法，可用于不同面积的皮肤缺损修复，且创伤小，愈合后无胸部紧绷感。     

乳腺癌术中术后皮肤缺损不同修复方法的疗效观察

目的 比较不同的乳腺癌根治术中术后皮肤缺损的修复方法,找出一种损伤小、安全简单、避免植皮的修复方法.方法 利用网状推进皮瓣、植皮术、换药3种方法修复30例乳腺癌术中术后皮肤缺损.结果 15例网状推进皮瓣全部成活,避免了植皮手术,术后皮瓣弹性好,无胸部紧绷感,术后不影响化疗.5例植皮全部成活,但手术耗时较长,增加了患者新的创伤和痛苦,有胸部紧绷感.10例伤口换药全部愈合,但愈合时间较长,为1～2个月,愈合后手术瘢痕较明显,皮肤紧绷感较强.结论 网状推进皮瓣是理想的乳腺癌术中术后皮肤缺损的修复方法,可用于不同面积的皮肤缺损修复,且创伤小,愈合后无胸部紧绷感.     

腓肠神经营养血管皮瓣修复足踝部软组织缺损的临床应用

目的 探讨应用腓肠神经营养血管皮瓣修复足踝部软组织缺损的临床效果.方法 通过创面处理,皮瓣设计,实施手术和术后处理,完成修复过程.结果 应用该皮瓣修复足踝部软组织缺损38例.术后38例皮瓣全部成活,其中有3例皮瓣远端部分坏死,经换药植皮后愈合.结论 腓肠神经营养血管皮瓣皮肤质量较好,切取简便,供皮面积较大,不牺牲主要血管,成活率高,是修复足踝部软组织缺损的理想皮瓣.     

改良局部推进皮瓣在拇指指端缺损中的应用

目的 探讨应用改良局部推进皮瓣修复拇指指端缺损的临床疗效.方法 应用改良局部推进皮瓣修复拇指指端缺损15例15指,指端缺损面积为1.5 cm×0.8 cm～1.5 cm×1.4 cm,术中切取皮瓣面积为3.0 cm×2.0cm～3.5 cm×2.5 cm.结果 术后15例15指皮瓣全部成活,供受区创面均一期愈合.术后随访3～16个月,平均8个月.皮瓣质地柔软,外观满意,皮肤弹性好,伤指无疼痛,两点辨别觉5～8 mm,平均6 mm.按照中华医学会手外科学会上肢部分功能评定试用标准评定,优10指,良3指,中2指.结论 利用患指改良局部推进皮瓣修复拇指指端缺损,术后皮肤质量接近正常,有可靠的指脂垫、指端感觉接近正常,是修复拇指指端缺损的理想方法之一.     

乳腺癌手术采用锯齿形切口的报告

目的检验乳腺癌手术锯齿形切口的优劣。方法遵循肿瘤根治原则,应用转移皮瓣技术,将切口两端充足的皮肤向中间皮损区转移,解决手术中皮瓣缺损、缝合张力高的问题,观察新切口出现切口并发症的发生率。结果比较乳腺癌术后皮瓣坏死及切口裂开率,乳腺癌锯齿形切口手术组（4／86．4．64％）与同期传统乳腺癌梭形切口对照组（42／349,12．03％）相比．具有显著性差异（P=0．046）。结论乳腺癌锯齿形切口手术通过转移皮瓣修复皮肤缺损,在减少缝合张力．避免植皮,切口美观等方面有明显优势.     

指动脉终末背侧支岛状皮瓣修复指端损

目的 探讨指动脉终末背侧支岛状皮瓣修复指端缺损的疗效.方法 15例15指指端缺损患者,缺损面积0.8 cm×0.6cm～1.8cm×1.2cm,采用1.0 cm×0.8 cm～2.0 cm×1.5 cm指动脉终末背侧支岛状皮瓣修复,观察其疗效.结果 15例中14例皮瓣全部存活;1例术后出现少部分坏死,予以切除坏死组织,缩短部分骨质,创面愈合;1例术后第1天出现静脉危象,拆除部分缝线后好转.所有患者均在术后2周拆线,当时见皮瓣及植皮区皮肤组织均存活,随访3～9个月,皮瓣质地较健指稍差,无明显臃肿,无关节活动受限,供区无明显并发症.结论 指动脉终末背侧支岛状皮瓣修复指端缺损,能获得满意疗效.     

胫骨皮瓣供区植皮术后联合VSD负压封闭吸引与纱包加压包扎的临床对比疗效观察

目的观察应用胫骨皮瓣供区植皮术后联合VSD负压封闭吸引与纱包加压包扎的临床疗效对比。方法 2008年2月—2011年2月我科胫骨皮瓣治疗小腿创伤性骨皮缺损40例,随机分成两组,实验组采用植皮后采用VSD负压封闭吸引术,对照组采用传统纱包加压包扎,7d后分别拆除负压吸引装及加压纱包改为常规换药,观察指标为术后7d植皮感染率,感染面积百分比,创面愈合时间,植皮成活率。结果术后7d实验组拆除负压吸引装置,植皮2例出现轻微感染,感染率10%,平均感染面积百分比5.1%,创面愈合时间10～18d,平均14.6d,植皮成活率100%次;对照组术后7d植皮处仅三例未出现明显感染,感染率85%,平均感染面积百分比45%,创面愈合时间14～45d,平均28.6d,其中2例再次植皮至创面愈合,植皮成活率90%。结论胫骨皮瓣供区植皮术后联合VSD负压吸引术,创面愈合情况明显优于传统沙包加压包扎。     

点状植皮治疗乳腺癌术后局部皮瓣坏死68例的临床体会

目的探讨点状植皮治疗乳腺癌术后局部皮瓣坏死的临床价值。方法对我院68例乳腺癌术后局部皮瓣坏死的患者．采用点状植皮进行治疗,总结临床疗效及治疗体会。结果经点状植皮治疗后68例患者坏死创面100％愈合。结论治疗乳腺癌术后局部皮瓣坏死,点状植皮是一种简单易行、疗效良好的方法,值得临床推广。     

掌背动脉皮支筋膜蒂皮瓣修复手指皮肤缺损

目的：评价应用掌背动脉皮支筋膜蒂皮瓣修复手指皮肤缺损的临床疗效。方法：对18例26指皮肤缺损患者,分别采用第2、3、4掌背动脉皮支筋膜蒂皮瓣给予修复,皮瓣切取面积为：2.0cm×4.0cm～3.0cm×5.5cm。结果：术后18例26指皮瓣全部成活。术后随访时间为3个月～1年,皮瓣外形良好,不臃肿,感觉可。供区创面均Ⅰ期愈合,创口呈线性瘢痕,皮瓣少许色素沉着。结论：掌背动脉皮支筋膜蒂皮瓣切取方便、损伤小,是修复手指皮肤缺损的良好方法。     

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.     

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.