223例急性胆囊炎行腹腔镜胆囊切除术治疗的手术时机与疗效

目的 探讨急性胆囊炎使用腹腔镜胆囊切除术(LC)治疗的手术时机与疗效.方法 回顾性分析我科近5年收治的223例急性胆囊炎行LC治疗(LC组)的临床资料.依据发病至手术的时间分为早期手术组(≤48 h,早期组,n=97)和晚期手术组(＞48 h,晚期组,n=126),比较两组的临床资料.结果 早期手术组的手术时间、中转开腹率和术后住院时间均明显优于晚期手术组(P ＜0.05或P＜0.01).结论 LC是治疗急性胆囊炎安全有效的术式,而且及早(≤48 h)施行手术效果更佳.     

梗阻型胆源性胰腺炎内镜治疗时机及疗效的临床分析

目的 探讨梗阻型胆源性胰腺炎内镜治疗的时机与疗效.方法 回顾性分析160例梗阻型胆源性胰腺炎患者内镜治疗的临床资料.根据发病后内镜治疗时间分为两组:急诊组78例在发病<48 h行急诊内镜治疗;延期组82例在早期非手术治疗基础上于发病≥48 h行延期内镜治疗.结果 两组内镜治疗总成功率为96.2%(154/160).急诊组腹痛缓解时间[(4.98±1.75)d]、实验室指标恢复正常时间[(10.08±5.22)d]以及住院时间[(12.24±7.20)d]均显著低于延期组[分别为(5.54±2.53)、(12.93±6.60)、(16.38±6.94)d](P<0.05或<0.01).重症梗阻型胆源性胰腺炎急诊组术后总并发症发生率(9.6%,5/52)显著低于延期组(23.6%,13/55)(P<0.05),两组病死率比较差异无统计学意义(P>0.05).结论 重症梗阻型胆源性胰腺炎应在发病48 h内行急诊内镜治疗;轻症患者如早期非手术治疗无效或出现急性胆道感染症状,亦应争取及时行急诊内镜治疗.     

急性结石性胆囊炎腹腔镜胆囊切除的时机

目的探讨结石性胆囊炎急性发作时腹腔镜胆囊切除的时机.方法总结分析813例急性结石性胆囊炎腹腔镜胆囊切除之病例资料,比较发病72h以内(早期)和72h以外(延期)两组的治疗效果.结果全组病例治愈.延期组的平均手术时间、平均术后住院日较长,中转开腹率和严重并发症发生率均较早期组高.结论急性结石性胆囊炎LC宜及早施行,最好在发病72h以内,胆囊坏疽出现之前.只要掌握正确时机,适时中转手术,急性结石性胆囊炎LC是安全可行的.     

急性胆囊炎不同时期腹腔镜胆囊切除术治疗效果分析

目的 探讨急性胆囊炎不同时期腹腔镜胆囊切除术（LC）治疗的效果,为急性胆囊炎手术治疗时机选择提供临床依据.方法 回顾性分析236例急性胆囊炎行LC患者的临床资料,按发病到手术时间不同分为早期手术组（发病≤72 h行LC,103例）,延期手术组（发病＞72 h行LC,57例）,择期手术组（保守治疗症状缓解后择期行LC,76例）.比较三组手术疗效.结果 延期手术组手术时间、术中出血量长或多于早期手术组和择期手术组,差异有统计学意义（P＜0.05）,早期手术组长或多于择期手术组,但差异无统计学意义（P＞0.05）.早期手术组中转开腹率、术中副损伤发生率低于延期手术组和择期手术组,差异有统计学意义（P＜0.05）,择期手术组低于延期手术组,但差异无统计学意义（P＞0.05）.早期手术组和延期手术组抗生素使用时间和住院费用优于择期手术组,差异有统计学意义（P＜0.05）,早期手术组优于延期手术组,但差异无统计学意义（P＞0.05）.早期手术组住院费用少于延期手术组,延期手术组少于择期手术组,差异均有统计学意义（P＜0.05）.三组手术并发症发生率比较差异无统计学意义（P＞0.05）.结论 急性胆囊炎发病≤72 h为LC最佳手术时机,发病＞72h的延期LC仍是安全可行的,但难度会相应增加,过分强调保守治疗待症状缓解后择期手术并不能为患者带来益处.     

不同手术时机对老年急性胆囊炎患者术后康复的影响分析

目的:探讨不同手术时机对老年急性胆囊炎术后康复的影响。方法:选取2016年6月~2019年10月我院收治的46例老年急性胆囊炎患者,按手术时间分为对照组和观察组,各23例。对照组72h后进行手术,观察组72h内进行手术,手术均为开腹式,比较两组术后排气时间、术后下床时间、住院时间、并发症等。结果:观察组术后排气时间短于对照组[(1.5±0.3)d vs(2.1±0.6)d](P<0.05);下床时间观察组短于对照组[(3.2±1.4)d vs(4.3±1.8)d](P<0.05);观察组住院时间短于对照组[(10.5±2.3)d vs(15.2±3.5)d](P<0.05);观察组术后并发症发生率为8.70%,少于对照组的17.39%(P<0.05)。结论:老年急性胆囊炎术后72h内进行手术更有利于康复,并能减少住院时间及并发症。     

老年急性胆囊炎腹腔镜胆囊切除术时机及治疗体会

目的 探讨老年急性胆囊炎腹腔镜胆囊切除术时机及治疗体会.方法 回顾性分析112例老年急性胆囊炎行腹腔镜胆囊切除术患者的临床资料,发病72 h内入院者60例（早期手术组）,发病72 h以后入院者52例（晚期手术组）.比较两组手术时间、术中出血量、术后肠功能恢复时间、腹腔引流量、中转开腹率、住院时间的差异.结果 晚期手术组手术时间、术中出血量、术后肠功能恢复时间、腹腔引流量、住院时间均高于早期手术组[（76.7±7.8） min比（54.3±4.8） min,（41.2±5.9） ml比（25.2±6.5）ml,（2.2±0.7）d比（1.4±0.6）d,（49.6±7.2）ml比（48.7±6.9）ml,（6.4±0.7）d比（3.9±0.6）d],差异有统计学意义（P＜0.05）.两组中转开腹率比较差异无统计学意义[11.5％（6/52）比3.3％（2/60）,P＞0.05].结论 老年急性胆囊炎病情进展快,治疗难度大,风险高,早期采取腹腔镜胆囊切除术可明显缩短手术时间和住院时间,促进患者术后恢复.     

腹腔镜下子宫切除术治疗子宫内膜癌60例临床分析

目的探讨腹腔镜下行微创子宫切除术治疗早期子宫内膜癌的疗效。方法选取子宫内膜癌患者60例随机分为治疗组和对照组,分别采取腹腔镜手术和开腹手术治疗,对比两组患者的手术指标。结果手术时间、术中出血量、淋巴结清除个数、术后排气时间、住院时间对照组分别为(161.0±42.1)min、(489.0±104.2)ml、(64.0±9.4)个、(38.8±5.8)h、(13.3±4.8)d,治疗组分别为(251.5±29.1)min、(356.9±117.8)ml、(54.0±7.2)个、(23.7±4.9)h、(7.9±2.7)d。对照组发生尿潴留2例,占10.00%;治疗组发生尿潴留1例,占6.67%。结论腹腔镜下子宫切除术治疗早期子宫内膜癌,具有手术安全性高、疗效好的特点。     

小剂量氯胺酮对开胸手术患者炎性细胞因子影响的临床研究

目的 探讨静吸复合麻醉使用小剂量氯胺酮对开胸手术患者围手术期肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、IL-8和术后视觉模拟评分(VAS)的影响.方法 选择40例择期胸部肿瘤手术患者,ASA分级Ⅰ～Ⅱ级,按手术先后顺序随机分为氯胺酮组和对照组,每组20例,两组麻醉诱导后行双腔管气管插管,切皮前氯胺酮组静脉注射氯胺酮50 mg,继以静脉输注0.2%普鲁泊福和氯胺酮等复合液,对照组静脉注射芬太尼50μg,继以静脉输注0.2%普鲁泊福和芬太尼等复合液,间断吸入恩氟烷和追加阿曲库铵维持麻醉.观察两组患者TNF-α、IL-6、IL-8浓度变化;两组术后均同时实施患者自控静脉镇痛,记录术后4、24、48 hVAS.结果 氯胺酮组在手术开始后30min、手术开始后4 h、术毕24 h血清TNF-α浓度[(1.40±0.22)、(1.46±0.22)、(1.36±0.13)μg/L]明显低于对照组[(1.54±0.09)、(1.58±0.17)、(1.47±0.22)μg/L](P＜0.05);氯胺酮组在术毕48 h血清IL-6浓度[(30.53±3.35)ng/L]低于对照组[(34.64±2.61)ng/L](P＜0.05);两组各时间点血清IL-8浓度比较差异均无统计学意义(P＞0.05).氯胺酮组术后24、48hVAS[(3.2±0.2)、(3.1±0.7)分]低于对照组[(3.7±0.5)、(3.5±0.7)分](P＜0.05).结论 小剂量氯胺酮用于开胸手术患者,可抑制其炎性细胞因子(TNF-α、IL-6)的产生,术后24、48 h VAS降低,减轻围手术期炎性反应,提高术后镇痛效果.     

腹腔镜治疗急性结石性胆囊炎89例体会

目的：探讨急性结石性胆囊炎腹腔镜胆囊切除术LC的手术方法。方法：回顾性分析89例急性胆囊炎行LC的临床资料。结果：89例急性胆囊炎均施行LC,中转开腹4例,均治愈出院,疗效满意。结论：急性胆囊炎在发病48h内施行LC,成功率高,手术安全可靠。     

手术时机对急性胆囊炎腹腔镜胆囊切除术效果

目的通过探讨不同手术时机对急性胆囊炎腹腔镜胆囊切除术(LC)效果和安全性,旨在筛选出一种有效治疗急性胆囊炎LC的最佳时机。方法选取2014年10月-2017年10月武清区中医医院接受LC治疗的急性胆囊炎患者80例为研究对象,按照住院顺序随机分为对照组和观察组各40例,均采用"四孔法"实施LC,对照组发病72 h实施手术治疗;观察组发病≤72 h实施手术治疗。比较两组效果及不良反应发生率。结果观察组手术时间、术中出血量、VAS评分以及中途转开腹率均分别少于或小于对照组,差异均有统计学意义(P0.05)。对照组术后并发症总发生率为17.50%(7/40),高于观察组的5.00%(2/40),差异有统计学意义(P0.05)。结论在胆囊炎发病≤72 h采取LC,其疗效更好,安全性较高,应加以推广。     

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.     

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.     

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.     

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.