急性前壁ST段抬高心肌梗死急诊经皮冠状动脉介入治疗后单导联ST段回落程度对预后的影响

目的 探讨急性前壁ST段抬高心肌梗死(STEMI)急诊经皮冠状动脉介入治疗(PCI)后单导联ST段回落程度对临床预后的影响,以早期识别高危患者,从而积极提高心肌组织的再灌注.方法 回顾性分析42例急性前壁STEMI患者的临床资料,其中ST段回落良好组31例,ST段回落不良组11例,比较两组患者冠状动脉造影结果、治疗前后用药及住院期间主要不良心脏事件(MACE)发生的差异.结果 ST段回落不良组糖尿病比例高于ST段回落良好组(10/11比7/31),左室射血分数低于ST段回落良好组[(48.2±10.1)%比(54.6±9.7)%],差异均有统计学意义(P<0.05).ST段回落不良组冠状动脉内明显血栓、术前TIMI血流0～1级、术后TIMI血流≤2级、MACE比例均高于ST段回落良好组,起病至球囊开通时间长于ST段回落良好组,差异均有统计学意义(P<0.05).结论 急性前壁STEMI患者PCI术后单导联ST段回落程度可以预测MACE发生率,能识别PCI后的高危患者.     

急性前壁ST段抬高心肌梗死急诊经皮冠状动脉介入治疗后单导联ST段回落程度对预后的影响

目的探讨急性前壁sT段抬高心肌梗死（sTEMI）急诊经皮冠状动脉介入治疗（PCI）后单导联sT段回落程度对临床预后的影响,以早期识别高危患者,从而积极提高心肌组织的再灌注。方法回顾性分析42例急性前壁STEMI患者的临床资料,其中sT段回落良好组31例,sT段回落不良组11例,比较两组患者冠状动脉造影结果、治疗前后用药及住院期间主要不良心脏事件（MACE）发生的差异。结果sT段回落不良组糖尿病比例高于sT段回落良好组（10／11比7／31）,左室射血分数低于sT段回落良好组[（48．2±10．1）％比（54．6±9．7）％],差异均有统计学意义（尸〈0．05）。ST段回落不良组冠状动脉内明显血栓、术前TIMI血流0～1级、术后TIMI血流≤2级、MACE比例均高于sT段回落良好组,起病至球囊开通时间长于sT段回落良好组,差异均有统计学意义（P〈0．05）。结论急性前壁STEMI患者PCI术后单导联ST段回落程度可以预测MACE发生率,能识别PCI后的高危患者。     

急性前壁心肌梗死急诊经皮冠状动脉介入治疗后ST段回落程度与预后关系的研究

目的 探讨急性前壁心肌梗死急诊经皮冠状动脉介入治疗(PCI)后ST段回落程度与预后的关系.方法 入选68例急性前壁心肌梗死行急诊PCI患者,术前及术后1h测量ST段回落程度,分为ST段回落≥50％组(49例)和ST段回落＜50％组(19例),于PCI后30、90和180d时测量左心室射血分数(LVEF),观察180d内有无主要心血管不良事件(MACE),对ST段回落程度与预后进行多因素相关性分析.结果 ST段回落≥50％组PCI后30、90和180 d时LVEF显著高于ST段回落＜50％组[(53.25±6.82)％比(50.82±4.83)％、(54.28±5.76)％比(51.08±3.62)％、(55.64±4.28)％比(50.27±4.23)％](P＜0.05).在180d的随访中,ST段回落≥50％组MACE发生率[12.2％(6/49)]显著低于ST段回落＜50％组[36.8％(7/19)](P＜ 0.05).Cox多因素回归分析表明,合并糖尿病、Killip分级Ⅱ～Ⅳ级和ST段回落＜50％是随访180 d内发生MACE的独立预测因子(P＜0.05).结论 急性前壁心肌梗死急诊PCI后ST段回落≥50％与LVEF相关,是180 d内发生MACE的独立预测因子,糖尿病及术前心功能对术后ST段回落有影响.     

参麦注射液对STEMI患者直接PCI术后氧化应激的影响

目的观察参麦注射液对ST段抬高型心肌梗死(ST elevation myocardial infarction,STEMI)患者直接经皮冠状动脉支架植入术(Percutaneous coronary intervention PCI)后氧化应激的影响。方法 60例接受直接PCI治疗的急性STEMI患者,随机分为对照组和治疗组(参麦注射液组)各30例。观察PCI术前及术后1d、7dMDA含量及SOD活性变化情况;术后冠脉血流及90min心电图ST段回落率变化。结果术后SOD活性下降,MDA含量明显增高。但治疗组术后1d、7dSOD活性高于对照组,MDA含量低于对照组,差异具有统计学意义(p<0.01);两组患者术后梗死相关动脉(Infarctedrelativeartery,IRA)的TIMI3级血流获得率无统计学意义差异(p>0.05),但参麦注射液组90min心电图ST段回落率快于对照组(p<0.05)。结论参麦注射液可加快急性心梗直接PCI术后心电图ST段回落率,且可能通过减轻氧化损伤机制而发挥作用。     

替罗非班对ST段抬高急性心肌梗死患者急诊PCI的疗效观察

目的 评价GPⅡb/Ⅲa受体拮抗剂替罗非班在ST段抬高急性心肌梗死（STEMI）急诊经皮冠状动脉介入治疗（PCI）中的效果.方法 46例急诊入院STEMI行PCI患者,分为实验组（替罗非班＋PCI）24例和对照组（直接PCI）22例.观察2组住院期间主要心血管事件（MACE）包括死亡、新近心肌梗死和顽固缺血状态、术后左心室射血分数（LVEF）及不良反应（出血、血小板减少）.结果 实验组住院期间主要心血管事件（MACE）发生率低于对照组,术后LVEF高于对照组;2组均未发生严重出血并发症（包括大量出血和颅内出血）;出血事件发生率实验组较对照组有增高的趋势.结论 血小板GPⅡb/Ⅲa受体拮抗剂替罗非班联合PCI可成为STEMI患者急诊PCI安全和有效的再灌注手段.     

急性心肌梗死再通后心电图演变与心功能的关系

目的探讨ST段抬高型急性心肌梗死急诊介入治疗（PCI）后心电图ST段和T波演变与左心功能的关系。方法选择初发ST段抬高型急性心肌梗死并行急诊PCI术的患者72例，按术后1hST段是否回落≥50％和24hT波是否倒置各分为两组。术后1h ST段回落≥50％组48例，〈50％组24例，发病后24hT波倒置组50例，未倒置组22例。随访6个月，分别于1个月和6个月时测量心功能。用三维彩色多普勒技术测量左室射血分数（LVEF）和左室舒末内径（LVD），用多普勒心肌组织显像技术（DTI）测量并计算Em／Am。比较左心功能恢复情况。结果1个月时ST段早期凹落组和T波早期倒置组LVEF、Em／Am值分别高于ST段未回落组和T波未倒置组（P〈0．05），而LVD无明显差异（P〉0．05）。6个月时ST段早期回落组和T波早期倒置组LVEF、Em／Am值均高于ST段未回落组和T波未倒置组（P〈0．05），ST段早期回落组和T波早期倒置组LVD值小于sT段未回落组和T波未倒置组（P〈0．05）。结论急诊PCI术后1h内ST段早期回落和24hT波早期倒置是反映左心功能恢复良好的指标。     

血糖水平对急性心肌梗死患者行经皮冠状动脉介入治疗术后ST段回落的影响

目的 探讨血糖水平对急性心肌梗死(AMI)患者行经皮冠状动脉介入(PCI)治疗术后ST段回落的影响.方法 选取行直接PCI治疗的急性ST段抬高心肌梗死患者46例,根据入院后第一次随机血糖水平分为两组:A组血糖水平＜7.8 mmol/L;B组血糖水平≥7.8 mmol/L.比较两组PCI治疗后2 h 12导联ECG的ST段回落程度.结果 A组ST段回落(60.0±19.8)%.B组ST段回落(31.6±15.0)%,两组比较差异有统计学意义(P＜0.01).结论 PCI治疗后12导联ECG抬高的ST段回落程度受血糖水平的影响,高血糖影响PCI治疗后心肌组织的微循环灌注.     

术前应用瑞舒伐他汀对非ST段抬高急性冠脉综合征患者血清hs-CRP、sLOX-1水平和LVEF的影响

目的探讨术前应用瑞舒伐他汀对非ST段抬高急性冠脉综合征(ACS)患者血清hs-CRP、sLOX-1水平和LVEF的影响。方法通过对我院2014年2月-2017年10月收治的104例择期行PCI术的非ST段抬高ACS患者的临床资料做回顾性分析,根据治疗方式的不同分为观察组、对照组(各52例)。对照组在PCI术前给予阿托伐他汀治疗,观察组在PCI术前给予瑞舒伐他汀治疗。比较两组患者住院期间MACE及不良反应发生率和各时段的血清hs-CRP、sLOX-1水平和LVEF。结果观察组的MACE发生率(1.92%)低于对照组(11.54%)(χ~2=3.829,P=0.049);两组患者术后24 h sLOX-1、hs-CRP水平均升高,术后1个月sLOX-1、hs-CRP水平均降低(P0.05),且观察组术后24h、术后1个月sLOX-1、hs-CRP水平均较对照组低(P0.05);术后1个月两组患者LVEF均较术前上升(P0.05),且观察组LVEF高于对照组(P0.05);两组患者不良反应发生率比较(7.69%vs 5.77%)无明显差异(χ~2=0.153,P=0.696)。结论在非ST段抬高ACS患者行PCI术前应用瑞舒伐他汀可有效地降低住院期间MACE发生率,降低血清hs-CRP、sLOX-1水平,提高LVEF,且安全可靠。     

心电图fQRS波及血清Serpina3、25-(OH)D3对STEMI患者PCI术后ST段回落的预测价值

探究心电图碎裂QRS（fQRS）波及血清丝氨酸蛋白酶抑制剂A3（Serpina3）、25 羟基维生素D3[25 (OH)D3]对ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）术后ST段回落的预测价值,以期为临床治疗提供参考。方法 选取2019年1月—2022年10月安徽省阜阳市肿瘤医院收治的200例行PCI术的STEMI患者为研究对象。PCI术后120 min根据ST段回落情况分为回落良好组（n=137）和回落不良组（n=63）。比较2组患者术前fQRS波发生率及血清Serpina3、25 (OH)D3水平,通过Kappa一致性检验分析fQRS波发生率与术后ST段回落不良一致性,绘制受试者工作特征曲线（ROC曲线）,探究血清Serpina3、25 (OH)D3对ST段回落不良的预测价值;随访6个月,比较2组患者主要心血管不良事件（MACE）发生情况。结果 回落不良组患者术前fQRS波发生率49.21%,高于回落良好组的10.22%,差异有统计学意义（P<0.05）;回落不良组患者血清Serpina3水平高于回落良好组,而25 (OH)D3水平低于回落良好组,差异均有统计学意义（P<0.05）。术前fQRS波发生率与PCI术后ST段回落不良一致性Kappa值为0.422;术前血清Serpina3、25 (OH)D3及二者联合预测PCI术后ST段回落不良的ROC曲线下面积分别为0.689、0.867和0.887;术后6个月,回落不良组MACE总发生率22.22%,高于回落良好组的8.03%,差异有统计学意义（P<0.05）。结论 STEMI患者术前心电图fQRS波与PCI术后ST段回落不良具有中度一致性,血清Serpina3、25 (OH)D3水平对术后ST段回落不良预测价值较高,三者可作为STEMI患者术后ST段回落不良的早期评估指标。     

急诊介入治疗中AMI患者早期ST段下降幅度的临床意义

目的观察经皮冠脉内介入治疗(PCI)达TIMI血流3级的急性心肌梗死(AMI)患者的早期ST段下降幅度与梗死面积度及左室功能(LVEF)的相关性。方法经急诊PCI且TIMI血流3级的86例首次ST段抬高AMI患者,测量并比较PCI术前、术后2小时梗死相关导联ST段下降幅度,以∑St段下降>50%为A组,<50%为B组,应用心电图记分法和超声心动图分别测量两组梗死面积、LVEF。结果急诊PCI的AMI患者早期ST段下降幅度较TIMI血流更能反映心肌灌注和LVEF的改善状况,系观察PCI早期疗效的又一直观、简易、可靠性强的床边诊断指标。     

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.