上尿路结石对窦性心率影响的研究与分析

目的研究肾、输尿管结石对心率的影响.方法对首诊肾和输尿管结石病人做体外震波碎石(ESWL)治疗前与治愈后各记录心电图(ECG),观察其心率变化情况.结果肾和输尿管结石并肾积水无绞痛组病人术前与治愈后心率无明显变化(P＞0.05);输尿管结石并早期肾积水绞痛组病人术前患窦缓人数明显高于治愈后窦缓人数(P＜0.005);治疗前三组患窦缓人数统计输尿管结石并早期肾积水绞痛组明显高于前两组(P＜0.005);治愈后三组患窦缓人数无明显差异(P＞0.05).结论输尿管结石并早期肾积水绞痛病人致心率减慢以致ECG描计表现窦缓,为输尿管梗阻初期主要由于肾髓质释放较多的前列腺素PGE2、PGI2致暂时副交感神经紧张增强所致.同时对输尿管结石的早期诊断有辅助的参考诊断意义.     

急性输尿管中下段结石梗阻的药物治疗分析

目的 探讨急性输尿管中下段结石梗阻的药物治疗选择与效果.方法 急性输尿管中下段结石梗阻90例根据药物使用的不同分为治疗组与对照组45例,对照组口服肾石通颗粒,治疗组在对照组治疗方案基础上予以口服坦索罗辛.结果 治疗组结石完全排出率显著高于对照组,结石排出时间、镇痛药的使用率也均显著低于对照组(P<0.05).结论急性输尿管中下段结石梗阻治疗应根据结石的具体情况选取合适的药物.     

128例肾输尿管结石临床分析

目的为探讨肾输尿管结石的临床特点,以提出更好的防治措施。方法对原西南师范大学医院1997-2004年治疗的128例肾输尿管结石病例的临床资料进行统计分析。结果本组病例男女之比为2.05∶1,29岁以下发病103例,占80.5%。2001年起发病呈上升趋势,2003年最高。每年9-10月是发病高峰,占本组病例的31.2%。经体外震波碎石99例,3个月结石排净率为83%,与文献报道的基本一致。结论该校肾输尿管结石患者,男性多于女性,30岁以下居多。发病近年增加,体外震波碎石疗效好。     

128例肾输尿管结石临床分析

目的 为探讨肾输尿管结石的临床特点,以提出更好的防治措施。方法 对原西南师范大学医院1997-2004年治疗的128例肾输尿管结石病例的临床资料进行统计分析。结果 本组病例男女之比为2.05 ：1.29岁以下发病103例。占80.5％。2001年起发病呈上升趋势,2003年最高。每年9-10月是发病高峰,占本组病例的31．2％。经体外震波碎石99例,3个月结石排净率为83％,与文献报道的基本一致。结论 该校肾输尿管结石患者,男性多于女性,30岁以下居多。发病近年增加,体外震波碎石疗效好。     

慢性阻塞性肺疾病患者血中炎性因子变化与呼吸功能的相关性研究

目的研究慢性阻塞性肺疾病(COPD)患者急性炎症期血中炎性因子如瘦素(leptin)、超敏C-反应蛋白(HsCRP)、肿瘤坏死因子-α(TNF-α)的变化与呼吸功能的相关关系。方法将49例COPD患者急性炎症期血lep-tin、HsCRP、TNF-α及动脉血气分析与其炎症控制期作自身对比分析,并分析急性炎症期各指标的相关性。结果急性炎症期与炎症控制期leptin、HsCRP及TNF-α及动脉血气pH值、PaCO2、PaO2、SaO2比较差异亦具有高度显著性意义(P<0.01)。急性炎症期COPD患者各指标间的相关分析示:leptin与HsCRP及TNF-α及动脉血气之PaCO2呈显著正相关(P<0.05～0.001);leptin与动脉血气之pH值、PaO2呈显著负相关(P<0.05～0.005);TNF-α与PaCO2呈显著正相关(P<0.01);与pH值、PaO2呈显著负相关(P<0.05～0.005)。HsCRP与PaCO2呈显著正相关(P<0.01);与pH值、PaO2呈显著负相关(P<0.05～0.005)。结论leptin可能是COPD急性炎症期的炎性标志物;leptin、HsCRP及TNF-α等炎性因子升高可能加重COPD患者全身各系统代谢的紊乱。     

16层螺旋CT低剂量平扫诊断肾及输尿管结石

目的评价16层螺旋CT低剂量平扫对肾及输尿管结石的诊断价值。方法收集65例临床拟诊肾及输尿管结石病例,每一病例在常规标准剂量(120 KV,160 mAs)扫描后再行低剂量扫描,在低剂量扫描中,管电流下降到60 mAs,其余参数及扫描范围均保持不变。三位高年资医师分别观察、记录:结石的有无、大小、位置、数目及结石的继发梗阻征象,分别记录放射剂量。结果在低剂量平扫中发现33例肾结石,17例输尿管结石,结石数目75个,肾积水24例,输尿管扩张16例。与标准剂量扫描结果比较,低剂量扫描发现肾及输尿管结石的敏感性及准确率分别为100%、97%,发现肾积水及输尿管扩张的准确率100%。与标准剂量扫描比较,低剂量扫描放射剂量下降62%,两者差异有统计学意义(P<0.05)。结论对于体重<90 kg的病人,在16层螺旋CT,管电流为60 mAs的低剂量平扫诊断肾及输尿管结石能够获得高的准确率,并且明显降低病人的放射剂量。     

经输尿管气压弹道碎石术后260例合并重症感染患者的早期诊疗分析

目的 探讨经输尿管气压弹道碎石术后合并重症感染的早期诊疗方法,以减少经输尿管气压弹道碎石术后合并重症感染的发生。方法 选择2012年1月-2015年12月收治的260例经输尿管气压弹道碎石术后合并重症感染患者为研究对象(观察组),另选同期经输尿管气压弹道碎石术后未发生感染的患者260例(对照组),比较两组患者的结石直径、尿液检查情况、术前感染情况、输尿管镜操作时间、手术时间、术中出血、术中灌注压、术后引流、碎石成功率及结石清除率。结果 观察组术前结石>15mm和尿液检查呈阳性的患者(207例、215例)多于对照组(32例、39例),差异有统计学意义(P<0.05);观察组术前感染未控制和术后引流不畅的患者(195例、179例)多于对照组(14例、27例),差异有统计学意义(P<0.05);观察组手术时间、输尿管镜操作时间[(72.19±14.31)min、(72.07±16.11)min]多于对照组[(65.14±12.01)min、(35.53±14.21)min],观察组术中出血量[(24.65±3.27)ml]多于对照组[(18.21±2.32)ml],观察组术中灌注压[(81.28±7.01)mmHg]高于对照组[(65.42±6.73)mmHg],差异有统计学意义(P<0.05);观察组患者碎石成功率和结石排除率(77.31%、70.00%)均低于对照组(88.85%、82.31%),差异均有统计学意义(P<0.05)。结论 结石直径较大、尿检阳性、术前感染未控制、手术时间过长、输尿管镜操作时间、术中出血量过多、术中灌注压过高、术后引流不畅易导致输尿管气压弹道碎石术后合并重症感染发生,在早期诊断和治疗过程中应给予有效的抗感染治疗,提高碎石技巧以及加强术后护理。     

软性输尿管镜下激光碎石术后感染并发症的危险因素分析

目的调查软性输尿管镜下激光碎石术后感染危险因素,同时评估术前尿培养物中病原体的分布和耐药率。方法回顾性收集2013年6月-2017年6月于本院接受软性输尿管镜激光碎石术的500例肾结石患者,术前对所有患者进行尿培养,尿培养阳性的患者进一步鉴定病原菌的多重耐药性。根据是否发生术后感染并发症将患者分为感染组45例和非感染组455例。比较两组患者的临床资料,对相关指标进行Logistic回归分析,分析感染危险因素。结果 500例结肾结石患者软性输尿管镜下激光碎石术后,45例发生术后感染并发症,发生率为9.0%。感染组与未感染组的性别、年龄、BMI、结石位置、结石手术史均无统计学差异(P0.05),但两组在糖尿病史、结石大小、术前尿培养结果、手术时间和住院时间方面具有统计学差异(P0.05)。尿培养阳性患者共69例,感染病原菌中革兰氏阴性菌多于革兰氏阳性菌。根据病原菌多重耐药分析结果,将术前尿培养阳性患者分为多重耐药组和非多重耐药组,两组病原菌分布无统计学差异(P0.05),但多重耐药组的耐药率显著更高(P0.001)。多因素Logistic回归分析发现,术前尿培养阳性-多重耐药菌感染是软性输尿管镜下激光碎石术后感染的独立危险因素(P=0.005)。结论术前尿培养阳性-多重耐药病原菌感染是软性输尿管镜下激光碎石术后感染并发症的重要危险因素。术前尿培养阳性患者感染的病原菌中,革兰氏阴性菌多于革兰氏阳性菌。     

输尿管镜手术和ESWL治疗小儿输尿管结石的临床疗效对比

目的探讨分析输尿管镜手术和体外冲击波碎石术(ESWL)治疗小儿输尿管结石的临床疗效。方法选取我院2012年1月至2015年3月期间接收治疗的230例小儿输尿管结石患儿作为研究对象,按入院单双号将其分为对照组和研究组,每组各115例。研究组患儿采用输尿管镜手术进行治疗,对照组采用ESWL进行治疗。比较两组的临床疗效以及预后情况。结果两组的碎石成功率和术后四周结石清除率比较,差异无统计学意义(P>0.05)。研究组输尿管上段结石的碎石成功率和术后四周结石清除率均显著低于对照组,研究组输尿管中下段结石的碎石成功率和术后四周结石清除率均显著高于对照组,差异均具有统计学意义(P<0.05)。结论治疗小儿输尿管结石可将输尿管镜手术方式作为治疗方案进行选择,尤其是中下段结石可首选此方案,其疗效显著。     

411例脑梗死病例发病特点及相关危险因素分析

目的分析脑梗死病例的发病特征及相关危险因素。方法分析病例的人群分布、季节及时点分布,将高血压、冠心病、糖尿病、高血脂、烟酒嗜好作为与脑梗死发病相关的危险因素,对各年龄组病例各因素所占比例进行分析比较。结果脑梗死发病男性多于女性,平均年龄65岁,高发年龄为60～79岁;发病月分布季节性较差,每天时点分布呈一定的“季节性”,第7时点发病最多;脑梗死病例中各种发病危险因素的比例明显高于正常人群,高血压所占比例最高,高血脂、烟酒嗜好在各年龄组病例中所占的比例差异有统计学意义。结论脑梗死发病的高峰时间为每天7～19时,高血压为发病的主要危险因素,高血脂及烟酒嗜好正在逐步成为中青年人发病的主要危险因素。     

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.