大剂量氨甲蝶呤化疗致皮肤烫伤样损伤的临床特征及发病机制分析

目的 了解大剂量氨甲蝶呤（HD-MTX）化疗引起皮肤损伤的临床特征，并探讨其发生机制。方法 总结儿童HD-MTX化疗致皮肤损伤的临床表现，并分析其发病机制。结果 皮肤损伤发生于用药后3～9d，表现为大片皮肤潮红甚至出现水疱及表皮剥脱，类似Ⅱ度烧伤，于第10～20天恢复，遗留色素沉着。症状严重者伴发热及呼吸道和消化道等器官受累。强化化疗前后大量水化等措施后皮肤损伤明显减少。结论 HD-MTX致皮肤损伤的机制在于直接的细胞毒性，并可能与排泄延迟有关。出现皮肤损伤时常伴其他系统受累，治疗上除继续大量补液、四氢叶酸解救及支持治疗外，积极抗感染治疗非常重要。     

放射性皮肤损伤机制的研究进展

皮肤是人体受到电离辐射时最先接触的器官,因其基底细胞层及毛细血管对射线很敏感,所以放射性皮肤损伤十分常见,急性放射性皮肤损伤常与表皮和真皮中的细胞改变和炎症有关,而皮肤的晚期损伤主要与辐射对血管影响有关。放射性皮肤损伤的临床表现为皮肤黏膜出现红斑、干性脱屑、湿性脱屑、溃疡,严重程度与射线种类、剂量等相关。目前,放射性皮肤损伤的潜在发生机制在很大程度上是未知的,辐射损伤后还未建立治疗的金标准,已知的放射性皮肤损伤的发生机制大致可分为3个途径：活性氧大量增加引发的氧化应激损伤、细胞因子被转录激活后引发的炎症、骨髓源性细胞引起的免疫反应。本文综述了放射性皮肤损伤发生机制的3大途径,为进一步研究放射性皮肤损伤的机制以及预防治疗提供参考。     

玻璃纤维致职业性变应性接触性皮炎一例报告

玻璃纤维致职业性变应性接触性皮炎一例报告焦建华，黎新平（湖北省襄樊市职业病防治院）报道：患者刘某，男，４７岁，维修工。１９８８年７月患者四肢裸露接触大量玻璃纤维后，四肢身躯皮肤出现红色斑丘疹，伴搔痒及双上肢水肿。由于工作需要边治疗边工作共５天。后出现...     

乳腺癌治疗的不良反应及护理

正乳腺癌是全身性疾病,其治疗需要结合手术、放疗、化疗、内分泌治疗等多种治疗方法。化疗、内分泌治疗及分子靶向治疗为全身治疗。药物在杀灭全身癌细胞的同时,人体正常组织细胞也会受到伤害,临床上就会出现一些不良反应会对患者治疗造成很多不利影响,甚至让患者放弃治疗。那么,应该如何应对这些不良反应呢?放疗的急性不良反应及护理皮肤损伤:放疗过的皮肤特别害怕闷、湿、热,所以一定要保持局部皮肤的凉爽、干燥。     

MR对关节周围骨及其附属结构损伤的临床评价

目的：探讨MR对膝关节周围骨及其附属结构损伤的表现及其临床价值。方法：150例膝关节损伤的患者行1.5T MR检查,全部为男性病例,年龄18~32岁,平均21.5岁。MRI检查时间自外伤后3~35 d,平均14 d。结果：83例表现为骨挫伤,其中56例表现为隐匿性骨折;102例伴有关节腔积液,79例伴半月板撕裂,68例伴前交叉韧带损伤,35例伴侧副韧带损伤,23例伴有后交叉韧带损伤。38例随访1~6个月局部骨质异常信号消失,17例3~18个月后局部异常信号强度减弱。结论：MRI可以准确评价膝关节周围骨及其附属结构损伤,而且能反映其病理改变及发病机制,对指导临床诊断治疗及其康复训练具有重要价值。     

一氧化碳中毒后迟发性脑病的研究进展

一氧化碳中毒迟发性脑病（DEACMP）,致残率较高,治疗效果较差。其核磁特征性主要表现为三型：双侧白质对称受累型、神经核团受累型、额顶叶皮层及皮层下区对称受累型。一氧化碳中毒昏迷时间、高龄、合并症和并发症的发生为本病的相关危险因素。发病机制：是缺血缺氧机制、炎症及免疫损伤、再灌注损伤和自由基生成、兴奋性氨基酸和细胞凋亡等共同作用的结果。治疗：主要是高压氧治疗、清除自由基、脑保护、糖皮质激素及改善循环、改善脑灌注等治疗。     

发热伴血小板减少综合征神经系统受累患者的临床特征

目的分析发热伴血小板减少综合征(SFTS)神经系统受累患者的临床特征。方法收集并回顾性分析2016年1月—2017年12月青岛市第六人民医院收治的SFTS患者的临床资料。按照有无神经系统受累分为两组,将两组患者的临床资料进行对照分析;同时将神经系统受累的SFTS患者根据最终结局分为死亡组及存活组,将两组患者的临床资料进行对照分析。结果 SFTS患者神经系统症状出现病程日数中位数为第6天。神经系统受累组患者与未受累组患者比较,两组在年龄、皮肤瘀斑/严重出血倾向、C反应蛋白、降钙素原、入院时Ca~(2+)、CD4~+细胞、心肌酶谱(LDH、CK、CKMB、HBDH)、肺部炎症情况、肝功能(ALT、Alb、AST)、APTT方面比较,差异均有统计学意义(均P0.05)。神经系统受累患者,死亡组与存活组之间比较,在皮肤瘀斑、PLT最低值、SFTSVIgM抗体转阳率、CD3~+细胞数、CD4~+细胞数、LDH、Alb、APTT比较,差异均有统计学意义(均P0.05)。结论SFTS神经系统受累患者多数为高龄患者,凝血功能、肝功能、心肌酶谱、免疫系统等损伤较重,肺部感染比例高。SFTS受累患者中死亡患者的凝血功能、免疫功能、肝功能、心肌酶谱受损较存活患者重。     

化疗期弥漫性大B细胞淋巴瘤患者皮肤损伤感染干预措施的研究

目的研究化疗期弥漫大B细胞淋巴瘤患者皮肤损伤感染护理干预效果及影响。方法随机选取2014年9月-2015年6月医院收治的弥漫大B细胞淋巴瘤患者82例,且所有患者在纳入研究时均处于化疗期,进行化疗时间2个月;并且均在护理过程中发生皮肤损伤及感染,根据护理过程中治疗方案一线和二线的区别分为OL组和TL组,两组患者各41例,对两组患者皮肤损伤感染的病理学原因,对比研究相应的干预措施。结果两组患者均出现不同程度的血红蛋白、白细胞、血小板、中性粒细胞减少,差异有统计学意义(P0.05),针对以上相关原因制定相应护理干预措施后,各项检查指标均好转,差异有统计学意义(P0.05)。结论研究结果表明,化疗期弥漫大B细胞淋巴瘤患者皮肤损伤感染与化疗后不良反应及白细胞低下有直接相关性。     

卵巢癌铂耐药机制及相关靶向治疗新进展

卵巢癌是临床较为常见的一种疾病,治疗方法包括手术治疗与化疗。其中,铂类药物是化疗的首选药物,具有细胞周期非特异性特征,能够与DNA结合并形成加合物,改变DNA结构,使其原有的复制转录功能出现障碍,进而引发细胞死亡,可应用于大部分卵巢癌患者,但在治疗过程中存在耐药现象。铂类化疗药物出现耐药的主要原因较为复杂,包括DNA损伤与修复、药物转运、药物代谢、肿瘤微环境、细胞死亡抑制等。本文主要针对卵巢癌铂耐药机制及靶向治疗进行综述。     

毫米波辐射的生物效应研究概况

通过毫米波辐射对生物体的局部(皮肤、视觉系统)效应,整体(中枢神经系统、免疫系统)效应和远后遗传效应,说明毫米波辐射的损伤机制可分为热效应和非热效应,前者机制已较为明确,后者机制尚未阐明。现就毫米波辐射对皮肤、眼、神经系统等的损伤效应进行综述。皮肤是首先受到毫米波作用的关键器官,≥94 GHz的毫米波辐射易引起皮肤热损伤效应,作用深度为0.5~2 mm;35~94 GHz的毫米波辐射对角膜结构有瞬时热损伤作用;42.2 GHz左右的毫米波辐射可导致学习记忆能力下降。此外,由于毫米波特殊的生物效应,近年来广泛用于临床治疗各类疾病,在肿瘤治疗方面尤为突出。     

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.