血液灌流治疗儿童过敏性紫癜疗效的 Meta分析

目的：评价血液灌流治疗儿童过敏性紫癜的疗效。方法检索PubMed、Ovid、Web of Science、Embase、Cochrane Library、中国生物医学文献数据库（ CBM）、中国期刊全文数据库（ CNKI）、中文科技期刊数据库（ VIP）和万方数据库,并辅以手工检索,检索时间均从建库至2015年6月30日公开发表的血液灌流治疗儿童过敏性紫癜的随机对照试验或临床对照实验,筛选符合标准的研究,应用Jadad评分法进行质量评价,使用Rev Man 5．0软件进行Meta分析。结果共7篇文献纳入研究,其中随机对照试验（RCT）6篇,临床对照试验（CCT）1篇,研究对象共416例,其中血液灌流组216例,对照组200例。 Meta分析结果显示,血液灌流组与对照组缩短皮疹持续时间,其合并加权均数差（WMD）＝－1．13（95％CI：－1．38～－0．87,P＜0．00001）;缩短腹痛持续时间,其合并WMD＝－1．23（95％CI：－1．46～－0．99,P＜0．00001）;缩短关节肿痛持续时间,其合并WMD＝－0．91（95％CI：－1．13～－0．70,P＜0．00001）。结论血液灌流联合药物等支持治疗能有效缓解儿童过敏性紫癜的临床症状,但其疗效需要大样本、多中心、设计良好的RCT进一步验证。     

宫颈上皮内瘤变锥切手术治疗对妊娠结局影响的 Meta分析

目的：探讨宫颈上皮内瘤变患者行宫颈锥形切除术对妊娠结局、分娩结局的影响。方法计算机检索Cochrane Library、PubMed、SCI及万方、CNKI、CBM等数据库并辅以手工检索相关期刊,检索时间至2013年3月。由两名研究者独立筛选文献、提取资料及方法学质量评价,用RevMan 5．1．7软件进行Meta分析。结果共纳入病例-对照试验11篇,包括721例病例组与5565对照组。 Meta分析结果显示：与未行宫颈锥切的正常人群相比,宫颈锥切手术对治疗年轻有生育要求的宫颈上皮内瘤变分娩时宫颈裂伤的发生率无统计学意义（OR＝2．15,95％CI：0．51～9．09,P＝0．30）,妊娠率无统计学意义（OR＝1．02,95％CI：0．59～1．76,P＝0．94）,分娩方式（剖宫产或阴道分娩）上无统计学意义（OR＝1．04,95％CI：0．86～1．27,P＝0．06）,流产的发生率无统计学意义（OR＝1．34,95％CI：0．81～2．23,P＝0．26）。但在早产率（OR＝2．16,95％CI：1．56～2．99,P＜0．00001）、胎膜早破的发生率（OR＝2．82,95％CI：1．70～4．67,P＜0．00001）、新生儿低体重儿的发生率（OR＝2．62,95％CI：1．62～4．24,P＜0．00001）等方面有统计学意义。结论与未行宫颈锥切的正常人群相比,宫颈锥切手术对术后妊娠率、分娩方式、宫颈裂伤以及流产率无影响,但会增加术后早产、胎膜早破及低出生体重儿的发生率。     

超声引导下射频消融治疗子宫肌瘤的近期与远期疗效研究

目的探讨超声引导下射频消融治疗子宫肌瘤近期与远期的疗效。方法选择从2004年7月～2008年1月接受射频消融治疗子宫肌瘤的患者108例,均为肌壁间子宫肌瘤,瘤体直径0．8～5．0cm,直径小于3cm87例,3～5cm21例。结果108例患者在射频治疗后1月子宫肌瘤总平均体积与治疗前比较,差异无统计学意义,6、12、24月子宫肌瘤总平均体积比治疗前明显缩小（P〈0．05）。本组随访时间3月～2年。治疗有效率93．52％（101／108）,治愈率63．89％（69／108）。结论射频消融治疗子宫肌瘤是一种能保留子宫的微创技术,可重复治疗,疗效确切,操作简单,易推广应用。     

高强度聚焦超声治疗子宫肌瘤和肌腺瘤临床分析

目的:观察高强度聚焦超声治疗子宫肌瘤、肌腺瘤的临床疗效。方法:采用北京源德公司生产的BY-01型高能聚焦肿瘤治疗机对15例子宫肌腺瘤、子宫肌瘤患者进行治疗,于治疗后的1、3、6个月分别进行随访,观察临床症状、瘤体大小、B超图像及病灶血供丰富程度。结果:治疗后3个月时临床症状明显改善,6个月时瘤体开始缩小,平均约1~1.5cm,12个月时缩小平均为3cm;声像图改变为1个月病灶回声稍增强,血流消失,大小无明显改变,3~6个月病灶回声增强,血流消失,瘤体缩小约1~2cm左右。结论:HIFU治疗时无创伤、无副作用,是治疗子宫肌瘤、肌腺瘤的安全、有效方法。     

高强度聚焦超声治疗97例子宫肌瘤的疗效探讨

目的：探讨高强度聚焦超声（HIFU）治疗子宫肌瘤的安全性及有效性。方法：2008年8月-2010年10月在章丘市中医院经彩色多普勒超声检查确诊为子宫肌瘤的已婚患者97例,对其进行高强度聚焦超声治疗,治疗前均行彩色多普勒超声检查以确定肌瘤个数、大小、部位、形态、回声特征、血流分布情况,于术后3个月、半年、1年随访观察,对比治疗前、后患者的临床症状及声像图变化,评价疗效。结果：97例子宫肌瘤患者HIFU治疗后49例瘤体不同程度缩小,边缘呈环形增强,部分边缘模糊,内部回声增强明显,瘤体内血流信号消失,临床症状明显改善;41例瘤体轻度缩小或无缩小,边缘回声无改变或稍增强,内部回声稍增强或强弱不均,瘤体内部血流信号减少,临床症状部分改善;7例瘤体增大,内部回声强弱不均,瘤体周边及内部血供丰富。HIFU治疗子宫肌瘤的有效率为92．78％（其中显效49例,占50．51％;有效41例,占42．27％）,无效7例占7．22％。结论：瘤体体积缩小、血流信号消失和临床症状改善是衡量高强度聚焦超声治疗子宫肌瘤疗效的可靠指标。高强度聚焦超声治疗子宫肌瘤疗效确切,安全性高,可重复多次治疗,是保全子宫的无痛无创治疗新技术。     

高强度聚焦超声治疗子宫肌瘤的初步观察

目的:探讨高强度聚焦超声(HIFU)用于治疗子宫肌瘤的效果。方法:采用JC 200型聚焦超声肿瘤治疗系统,治疗子宫肌瘤患者58例(88个肌瘤),观察临床效果。结果:治疗后超声造影显示靶肌瘤内部凝固性坏死发生率为98.9%(87/88),凝固性坏死体积占靶肌瘤体积98.9%。治疗后3个月,肌瘤最大径平均缩小11.04 mm,肌瘤体积平均缩小45.42%,与治疗前比较,差异有统计学意义(t=6.631,P=0.000)。不同大小子宫肌瘤治疗后的缩小率差异无统计学意义。治疗后3个月,患者症状均获得改善,有效率100%。全部病例无严重并发症发生。结论:不同大小的子宫肌瘤行HIFU治疗,疗效肯定、安全性好。     

不同剂量米非司酮治疗子宫肌瘤的临床研究

目的 探讨不同剂量米非司同治疗子宫肌瘤的疗效及对性激素的影响。方法 随子宫肌瘤患者分两组，服用不同剂量米非司酮3－6个月。B超测量子宫及肌瘤大小，用放免疫法测定性激素水平。结果 治疗后闭经、临床症状明显改善，A组瘤体积于服药后3个月时平均缩小52．56％，6个月时平均缩小61．69％；B组分别为缩小48．61％及52．12％。治疗6个月有显著性差异（P＜0．05），并呈时间依赖性。两组治疗后estradiol(E2)和Progestagen（P）下降明显（P＜0．01）。结论 米非司酮治疗子吕肌瘤疗效肯定，副作用小，为保守治疗子宫肌瘤开辟了一条新途径。并以服米非司酮25mg/d为较理想的治疗剂量。     

高强度超声聚焦治疗子宫肌瘤的临床观察

目的：探讨高强度超声聚焦治疗子宫肌瘤的有效性及安全性。方法：选择不愿意行手术切除子宫肌瘤的育龄期已生育患者23例,应用HIFU-2001型高强度聚焦超声肿瘤治疗机进行治疗,治疗后定期随访观察。结果：23例患者经高强度超声聚焦治疗后近期总有效率为96%（疗效显著3例、有效12例、部分有效7例）,无效1例（4%）。结论：高强度超声聚焦是无创治疗子宫肌瘤的有效方法。     

高强度聚焦超声治疗T2WI高信号子宫肌瘤的疗效及安全性分析

目的探究高强度聚焦超声治疗T2WI高信号子宫肌瘤的疗效及安全性。方法选取广州市第一人民医院在2013年1月-2015年12月期间收治的150例T2WI高信号子宫肌瘤患者。所有患者均行高强度聚焦超声治疗。分析患者治疗前后肌瘤体积消融率及能效因子(EEF)情况。所有患者均随访1年,记录并评价其不良反应及卵巢功能情况。结果子宫肌瘤位于后壁者的体积消融率较低,而EEF值较高,差异有统计学意义(t=9. 18、8. 50,P0. 01);子宫肌瘤大小与体积消融率差异无统计学意义(F=0. 08,P=0. 93),子宫肌瘤平均径线(d)7 cm者的EEF值低于d4 cm及4～7 cm者(t=8. 36、3. 85,P0. 01);所有患者卵巢激素水平无异常,其不良反应均为国际介入放射治疗学会(SIR) A-B类,无C-F类发生;肌瘤与宫腔距离5 mm者更易发生阴道分泌物异常(χ~2=8. 55,P0. 01)。结论高强度聚焦超声治疗T2WI高信号子宫肌瘤安全有效,值得临床推广。     

GnRHa预治疗对巨大子宫肌瘤患者腹腔镜手术的疗效

目的：探讨促性腺激素释放激素激动剂（ GnRHa）不同预治疗时间对巨大子宫肌瘤腹腔镜手术效果的影响。方法选择2009年8月至2014年8月在北京市昌平区妇幼保健院行GnRHa预治疗后实施腹腔镜手术的患者34例,分为试验组（18例,术前GnRHa预治疗2个月）和对照组（16例,术前GnRHa预治疗3个月）,观察并比较两组患者用药后子宫及肌瘤体积变化、手术情况、不良反应等。结果两组患者GnRHa治疗后子宫体积、最大肌瘤体积均较治疗前显著缩小（ t值分别为17．245、21．455,均P＜0．05）,但组间比较差异均无统计学意义（t值分别为2．791、1．078,均P＞0．05）。两组患者手术时间、术中出血量比较均无统计学差异（t值分别为3．328、1．746,均P＞0．05）,且不良反应比较无统计学差异（χ2＝0．946,P＞0．05）。结论术前使用GnRHa预处理2个月,子宫及肌瘤体积缩小程度与3个月疗程者无显著性差异,都能为巨大子宫肌瘤患者腹腔镜手术创造有利条件。     

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.