CT三维定点坐标法对寰枢椎椎弓根的解剖学测量

目的设计一种定点参照测量法在螺旋CT三维重建下测量寰枢椎椎弓根。方法56例18岁～75岁(平均40.3岁)正常成人寰枢关节,螺旋CT扫描并重建,模拟寰枢椎弓根钉植入,3D重建后应用自行设计的定点测量法测量寰枢椎双侧椎弓根各主要解剖数值:椎弓根高度、宽度、进钉点距后正中矢状面距离、椎根弓内斜角及上斜角;应用SPSS12.0软件对人正常状态下寰枢椎椎弓根各测量数据进行分析。结果正常寰枢椎椎弓根各测量数据双侧差异均无统计学意义,取双侧平均值。正常寰枢关节寰椎椎弓高度(4.51±0.69)mm,上斜角7.00°±1.04°,内斜角13.93°±2.11°,椎弓根宽度(5.70±0.80)mm,长度(28.75±1.57)mm,进钉点距后正中矢状面距离(20.17±1.83)mm;枢椎椎弓根高度(7.20±1.11)mm,上斜角25.00°±3.20°,内斜角24.49°±3.70°,椎弓根宽度(5.40±0.85)mm,长度(28.10±1.20)mm,进钉点距后正中矢状面距离(19.44±1.32)mm。结论自行设计的定点参照测量法在CT三维重建下测量上颈椎椎弓根准确可靠,为临床上颈椎疾患诊治和手术设计、风险评估提供了一种新的影像解剖学测量方法。     

女性骨盆盆底结构对盆底功能障碍性疾病手术治疗的应用解剖学研究

目的研究女性骨盆盆腔支持结构,为盆底功能障碍性疾病的治疗提供解剖学依据。方法取成年女性防腐标本10具,作正中矢状切形成20具半侧盆腔标本,进行观测。观察子宫骶韧带、圆韧带、主韧带及骨盆结缔组织的解剖形态,并测量其相关数据。结果子宫骶韧带分颈部、中间部、骶骨部。骶韧带自起点至直肠端的距离是(20.44±4.23)mm,子宫端的宽度为(11.38±1.12)mm,直肠端的宽度为(21.42±2.10)mm;主韧带内侧的长度为(36.49±2.45)mm,宫颈段的距离是(18.68±3.29)mm,阴道段的距离是(19.10±4.13)mm;圆韧带子宫端至盆侧壁之间的距离,其长度为(86.77±4.64)mm。直肠阴道隔有两层筋膜,其长度为(37.41±3.68)mm。结论子宫骶韧带、圆韧带、主韧带及骨盆结缔组织的解剖形态对临床治疗盆底功能障碍性疾病有重要的指导意义。     

固定束质子治疗病人摆位系统的精确性评估:等中心旋转运动

目的 评估固定束质子治疗的病人摆位系统等中心旋转运动的精确性。方法 将2 mm直径金属小球固定于床面之上并校准到房间等中心(ISO)。依次选择11个角度分别对治疗床进行等中心旋转,到达设定位置后使用数字影像摆位系统(DIPS)分别测算出小球与房间等中心的位移偏差。在不同时间共重复进行了四次测量,统计分析四组测量结果。结果 所有数据中,治疗床在-110°时发生位移最大,X、Y、Z轴方向分别是(0.29±0.05)mm、(0.21±0.04)mm和(-0.21±0.04)mm,小球与ISO总位移偏差(0.41±0.07)mm(1SD)。治疗床在30°时发生位移最小(0°除外),X、Y、Z轴方向分别是(-0.03±0.05)mm、(0.05 ±0.05)mm和(0.00±0.00)mm,小球与ISO总位移偏差(0.05±0.06)mm。结论 等中心旋转是实现固定束质子等中心多角度照射的关键运动模式。它是一种复杂的组合运动,包括治疗床床面的角度旋转运动和治疗床底座的水平轴向运动。由于质子治疗对靶灶精确定位的严格要求,这种组合运动的精度在质子治疗摆位中就显得格外重要。测量结果数据均小于0.5 mm。完全满足质子治疗PPS摆位精度的要求。     

假性内斜儿童内眦距离及瞳距的观察

【目的】比较假性内斜儿童与同年龄组正常儿童内眦距离及瞳距有无差异,探讨假性内斜的早期简易辅助诊断方法。【方法】确诊的假性内斜儿童及同年龄组正常儿童均测量其内眦距离及瞳距,对数据进行t检验。【结果】83例假性内斜儿童内眦距离均值为(32.50±2.48)mm,瞳距均值为(46.81±3.19)mm;70例同年龄组正常儿童内眦距离均值为(32.36±2.01)mm,瞳距均值为(47.00±3.28)mm,两组间均值两两比较差异无显著性(P均>0.05)。【结论】本文所观察的83例假性内斜儿童与同年龄组正常儿童总体比较其内眦距离及瞳距并无明显差异。     

新生儿小脑延髓池穿刺术的应用解剖

目的　为给临床新生儿小脑延髓池穿刺术提供解剖学基础。方法　对 14具新生儿尸体的小脑延髓池进行解剖观测 ,确定进针位置、方向及安全穿刺深度。结果　穿刺点位于枕外隆凸下方 31.2～ 4 6 .0mm ,平均 ( 38.4±5 .8)mm ,即枕外隆凸至两侧肩峰连线垂直距的中、下 1/3处 ,方向指向两侧额结节连线中点 ,最小穿刺深度为 13.0～ 2 1.3mm ,平均 ( 17.5± 2 .3)mm ,最大穿刺深度为 16 .0～ 2 4 .4mm ,平均 ( 2 1.5± 2 .3)mm。结论　按照上述穿刺点和进针方向 ,可以获得最大的安全穿刺深度     

16层螺旋CT血管造影在诊断颅内动脉瘤中的应用

目的探讨16排螺旋CT血管造影(CTA)诊断颅内动脉瘤的临床价值。方法回顾158例颅内动脉瘤患者行16层螺旋CT血管造影检查,用高压注射器经肘正中静脉注射碘对比剂(370mgI/mL)100mL,注射速率2.5～4.0mL/s,CT扫描原始数据送到工作站上进行最大密度投影(MIP)、多平面重建(MPR)及容积重建(VR)。结果 158例患者,154例阳性,发现176个动脉瘤;4例CTA阴性。动脉瘤最小直径2.0mm,最大直径27mm。结论 16层螺旋CTA是诊断颅内动脉瘤安全、快速、无创、有效的方法,具有较好的特异性和敏感性,以及较好的三维显示能力,具有一定的临床应用价值。     

早产儿及胎儿胼胝体超声测量比较

目的:比较不同方式测量胎儿及早产儿胼胝体前后径的差异。方法:282例孕28～36周胎儿及222例出生孕周为28～36周的早产儿,分为胎儿组及早产儿组,胎儿组使用超声经母体腹部测量胼胝体前后径,早产儿组在出生当天使用超声经新生儿颅脑测量胼胝体前后径。比较两种方式测量胼胝体前后径的差异。结果:孕28～36周胎儿胼胝体前后径分别为:(34.56±1.27)mm、(35.53±1.30)mm、(37.66±1.41)mm、(37.11±1.53)mm、(38.54±1.99)mm、(38.20±1.07)mm、(39.53±2.13)mm、(42.59±1.57)mm、(43.56±2.31)mm;出生孕周为28～36周的早产儿胼胝体前后径分别为(33.50±1.67)mm、(34.14±2.01)mm、(36.50±1.21)mm、(36.69±1.45)mm、(37.68±2.04)mm、(38.36±1.97)mm、(38.62±1.34)mm、(40.54±1.57)mm、(42.94±2.11)mm。胎儿组经母体腹部测量胼胝体前后径与相同孕周出生早产儿出生当天经颅脑超声测量胼胝体前后径差异无统计学意义(P>0.05)。结论:经母体腹部与经新生儿颅脑两种方式测量胼胝体前后径差异无统计学意义(P>0.05)。胎儿胼胝体生长发育数据可以作为早产儿宫外胼胝体生长发育的对照参考。     

Prodisc-C人工椎间盘治疗颈椎病早期疗效观察

目的 探讨颈椎Prodisc-C人工椎间盘置换术手术要点和早期治疗效果.方法 采用Prodisc-C人工椎间盘置换术治疗颈椎病患者19例,其中脊髓型8例,神经根型5例,混合型6例.术前和术后3个月进行日本骨科协会(JOA)评分;并摄颈椎前屈后伸位、左右侧屈位X线片,观察假体稳定性、颈椎置换节段和C2～C7节段的活动度.结果 所有患者术后症状明显缓解.随访3～6个月,脊髓功能JOA评分由术前平均(9.0±2.4)分上升至术后平均(14.5±3.0)分;没有假体下沉和明显偏移.置换节段前屈后伸活动范围术前平均为4.43°±1.03°,术后平均为7.26°±1.19°,两者比较差异有统计学意义(P＜0.01);左右侧屈活动范围术前平均为2.19°±0.56°,术后平均为3.19°±0.87°,两者比较差异有统计学意义(P＜0.01).术后3个月颈椎前屈后伸活动度平均68.93°±4.70°,与术前平均65.58°±6.72°比较差异无统计学意义.结论 颈椎Prodisc-C人工椎间盘置换术可获得术后近期稳定性,保留置换椎间隙活动度,维持颈椎近似正常的活动范围.     

动态直肠排粪造影在盆底痉挛综合征中的应用价值

目的 探讨动态直肠排粪造影在盆底痉挛综合征中的应用价值。方法 回顾性分析44例明确诊断为盆底痉挛综合征患者及22例排粪造影未见异常者的图像资料,测量静息状态下和力排时的肛直角并计算两组的肛直角差。统计学分析采用t检验。结果 21例盆底痉挛综合征患者合并有直肠前突、直肠粘膜脱垂等其他异常;盆底痉挛综合征组静息时和力排时肛直角及其差分别为(103.2±8.62)°、(92.8±7.38)°、(10.4±7.9)°;正常对照组分别为(117.4±12.7)°、(137.1±10.4)°、(19.7±12.4)°。两组肛直角差之间差异有统计学意义(P < 0.01)。结论 动态直肠排粪造影能为诊断盆底痉挛综合征提供可靠的依据。     

经伤椎固定治疗相邻节段脊柱骨折脱位的临床研究

目的 探讨相邻节段脊柱骨折脱位、经伤椎椎弓根同定的手术方法及效果.方法 对12例相邻节段胸腰椎骨折脱位患者进行伤椎及上下椎体椎弓根固定治疗,伤椎根据骨折情况选择单侧或双侧固定,并进行后路椎板减压,横突间植骨融合术.骨折椎体:Tu～T12 5例,T12～L1 4 例,L1～L2 3例,均存在不同程度脱位.脊髓损伤ASIA分级:A级1例,B级4例,C级5例,D级2例.对手术前后及随访时的椎体前缘高度及后凸角度变化进行观察.结果 随访6～26个月,平均(15.04±3.05)个月,椎体前缘高度由术前(18.4±4.2)mm恢复为术后(34.8±2.3)mm,后凸角度由术前23.6°±2.3°恢复为术后4.4°±2.6°,远期随访无明显丢失.结论 经伤椎固定相邻节段脊柱骨折可有效地使脊柱骨折良好复位,固定牢靠,减少远期椎体高度的丢失及后凸形成.     

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.