股骨头缺血性坏死导管介入溶通治疗的临床观察

目的:探讨股骨头缺血性坏死(ANFH)的DSA表现及介入治疗效果.方法:对38例ANFH患者的53髋先常规行股动脉DSA,后在股骨头的供血动脉旋股内、外侧动脉内灌注溶栓、扩血管药物,即在每支血管内注入稀释后的尿激酶20万u、丹参10ml及川芎嗪20mg;术后保留导管于动脉内,经导管每日注入同剂量的药物及肝素钠4500u,连用3天后拔管,治疗后复行股动脉DSA检查及行股骨头X线平片及/或CT、MR随访以评估疗效.结果:术后DSA示治疗后所有患者股骨头区血管计数较治疗前增多(P＜0.05),患者患髋疼痛症状明显减轻,关节功能不同程度改善,股骨头X线平片及/或CT、MR随访1～16个月(平均9.5个月)示FicatⅠ、Ⅱ期患者介入治疗后股骨头修复明显.结论:ANFH行股骨头供血动脉内的介入治疗是一种疗效肯定、安全的方法.     

21例股骨头坏死的介入治疗

目的探讨股骨头缺血性坏死(ANFH)的介入治疗效果。方法对21例ANFH患者的25髋先常规行X线平片、MRI、股动脉DSA,后在股骨头的供血动脉旋股内、外侧动脉内灌注溶栓、扩血管药物,即在每支血管内注入稀释后的罂粟碱25 mg、尿激酶25万u、低分子右旋糖酐80 ml、血栓通0.15 mg;术后每日静脉滴注低分子右旋糖酐500 ml、血栓通0.3 mg及肝素钠4 500 u,连用5 d,治疗后行股骨头X线平片及MRI、股动脉DSA,随访1年以评估疗效。结果术后患者患髋疼痛症状明显减轻,关节功能不同程度改善,随访6～12个月(平均10.0个月),股骨头X线平片及/或CT示FicatⅠ、Ⅱ期患者介入治疗后股骨头修复明显。结论股骨头供血动脉内的介入治疗是一种疗效肯定、安全的方法。     

股骨头缺血性坏死的介入治疗方法及临床疗效

随机选取我院收治的股骨头缺血性坏死病例40例，常规行磁共振成像（MRI）、X线平片、股动脉DSA检查，后在股骨头的内外侧动脉内行灌注溶栓及扩血管药物。治疗后对患者行x线平片检查、股骨头磁共振成像和股动脉DSA，治疗后定期随访患者6个月至1年时间，观察患者恢复状况，进行评估。经介入治疗后患者关节疼痛症状均得以缓解，患者关节功能得到不同程度的恢复，经6个月至1年的术后随访，患者MRI和（或）股骨头x线平片显示FicatⅠ、Ⅱ期患者介入治疗后股骨头明显修复。本文主要研究采用介入治疗对ANFH的患者进行治疗，同时评估患者治疗前及治疗后临床症状改善的情况，分析介入治疗对股骨头缺血性坏死患者治疗的疗效，为临床上治疗ANFH提供一定的参考。     

X线、CT、MR影像在早期股骨头缺血坏死诊断中应用的价值

目的:分析X线、CT、MR影像在早期股骨头缺血坏死诊断中应用的价值。方法:回顾性分析我院收治的50例早期股骨头缺血坏死患者的临床资料,并观察X线、CT、MR影像诊断的效果。结果:X线平片检测出阳性病例15髋,阴性45髋,阳性率达到19.2%;CT检测出阳性40髋,阴性20髋;阴性率达到65.4%;MR检测阳性56髋,阴性4髋,阳性率达到95.8%。结论:对早期股骨头缺血坏死的诊断阳性率由高到低依次是MR、CT和X线,其中MR是诊断早期股骨头缺血坏死的最佳方法。     

CT与核磁共振技术在股骨头坏死诊治中的比较研究

目的比较核磁共振成像（MRI）技术及CT在股骨头坏死（ANFH）早期诊断的应用价值。方法69例138髋中,X线平片正常,全部行CT、MRI检查,3例（6髋）全部为阴性,11例（17髋）为Ⅲ～Ⅳ期ANFH。55例（72髋）确诊为早期ANFH。其中Ⅰ期18髋,MRI：T1WI表现为小斑片状及线样低信号,及股骨头及颈部的大片状长T1长T2信号。Ⅱ期54髋,CT主要表现为股骨头的骨硬化及囊状透亮区。MRT表现为线样征及囊状长T1长T2信号,其中有45髋出现髋关节腔积液。比较CT、MRI对早期ANHF的阳性检出率;分别约72％和85％,MRI略优于CT。结论MRI较CT能更敏感地检出早期ANFH,是诊断股骨头坏死特别是早期坏死较为可靠且必备的方法。     

股骨头缺血性坏死的介入治疗

目的:探讨股骨头缺血性坏死(ANFH)介入治疗效果。方法:对44例股骨头缺血坏死患者,其中Ⅰ期28例、Ⅱ期12例、Ⅲ期4例,采用介入治疗的完整临床资料进行回顾分析研。结果:治疗后患侧髋关疼痛明显减轻或消失者89%,减轻者11%,关节功能恢复至正常或一级者为85%,活动行走改善,达到了预期效果。结论:介入治疗股骨头缺血坏死具有创伤小、并发症低、血管再通率高,能有效的改善股骨头的血管,临床症状和髋关节活动功能改善明显。     

体外冲击波碎石机治疗股骨头缺血性坏死26例疗效观察

目的 探讨体外冲击波碎石机在治疗股骨头缺血性坏死方面的临床疗效.方法 对26例股骨头缺血性坏死的患者,利用液电式体外冲击波碎石机进行治疗,工作电压9～11.5 KV,冲击波次数800～1200次.结果 26例患者在疼痛方面均有不同程度减轻或改善.随访X线平片、CT、MR可见股骨头明显修复,DSA检查显示股骨头血管数目增多或基本达到正常.结论 体外冲击波碎石机治疗股骨头缺血性坏死方面有确切疗效,是值得推广的一种好的治疗方法.     

64排CT血管成像在肝癌介入治疗中的应用价值

目的:探讨64排CT血管成像在肝癌介入治疗中的应用价值。方法:分析34例肝癌患者介入治疗前行64排CT血管成像检查,观察与数字减影血管造影两者肿瘤供血动脉的显示情况。结果:64排CT血管成像与数字减影血管造影检查显示的肿瘤供血动脉数量大致相同,但对于显示肿瘤供血动脉的三维结构,优于数字减影血管造影检查。结论:64排CT血管成像可更好地显示肿瘤供血动脉,在指导肝癌介入治疗中具有较好的应用价值。     

股骨头缺血坏死的MRI诊断与评价

目的研究股骨头缺血坏死（ANFH）的MRI征象，评价ANFH的分期。方法52例双侧股骨头行低场MRI和和X线片检查，部分行CT检查，并将ANFH的影像学分期进行了和对比。结果（1）52例（66个股骨头）中，双侧15例，单侧37例。其中18个（27％）X线平片为阴性。（2）将ANFH的Mitchell分型与Hungerford分期列于对应表中进行统计学处理。结果A型和B型与0—Ⅱ期之间，C型和D型与Ⅲ、Ⅳ之间有密切的对应关系（P〈0．005）。（3）Ⅲ，Ⅳ期ANFH合并积液量比0—Ⅱ期明显多。结论低场MRI可准确的显示早期ANFH的病变范围，程度及信号特征。ANFH的MRI分型与影像学分期之间有密切的对应关系，且低场MRI的敏感性及诊断价值高干CT及X线平片。因此临床上凡是有髓部疼痛、功能障碍、长期饮酒及服用类固醇激素者检查都应进行MRI检查，力求早期治疗。     

人工骨与骨水泥混合植入治疗青壮年股骨头缺血性坏死

目的观察采用人工骨（羟基磷灰石）与骨水泥混合植入治疗各种不同原因所致的青壮年股骨头缺血性坏死的疗效。方法2003年10月至2008年1月期问对FicatⅡ—Ⅲ期的15例（19髋）股骨头缺血性坏死患者行死骨清除人工骨与骨水泥混合植入治疗。术后定期门诊随访，观察疗效，并摄X线片。随访时间3个月至5年，平均24．6个月。结果手术前后采用改良Merled’Aubigne评分法对患髋功能进行评价。19髋由术前平均11．68分改善至术后平均15．11分。术后X线片示股骨头塌陷均有所恢复，外形改善，复查时大部分患者的股骨头仍能维持术后的形态，坏死范围未见扩大，患者均对治疗结果感到满意。结论人工骨与骨水泥混合植入法能防止股骨头进一步塌陷，保留髋关节功能，推迟人工髋关节置换术的时间，具有创伤小、手术简单、术后恢复快等优点，适用于FicatⅡ～Ⅲ期患者，尤其适用于年轻患者。     

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.