乳腺癌并肺癌性淋巴管炎7例分析

目的:探讨乳腺癌并肺癌性淋巴管炎的临床特点.方法:对7例乳腺癌并肺癌性淋巴管炎的临床特点进行分析.结果:7例乳腺癌并肺癌性淋巴管炎患者均有肺外远处转移;影像学表现为从肺门向肺野呈放射状、条索状不均一阴影,部分条索可达胸膜并见小结节;或肺野呈网格状改变.呼吸道症状经内科治疗无效,但化疗有效.结论:经内科治疗呼吸道症状无效的乳腺癌患者,应高度怀疑肺癌性淋巴管炎,予以化疗可能取得较好疗效.     

老年间质性肺炎的影像诊断分析

目的探讨老年间质性肺炎的影像学特征,分析其诊断价值。方法选取2012年1月—2013年1月的40例临床诊断为间质性肺炎的老年患者,回顾分析临床资料,并结合相关文献对其影响诊断进行分析。结果胸部X线片:22例患者见肺纹理增多,网状或蜂窝状改变,两下肺野较上肺野明显,左右侧肺野没有差别。CT及HRCT检查:患者小叶间隔增厚,可见结节状和磨玻璃样异常阴影。结论老年间质性肺炎的诊断主要依赖于临床表现、胸部CT、HRCT等特征性表现,并排除其他间质性疾病,确诊还需肺活检。     

肺部弥漫性病变肺结核高分辨率CT征象表现与分析

目的 探讨肺部弥漫性病变肺结核患者肺小叶结构异常高分辨率CT(HRCT)征象表现和HRCT在肺部弥漫性病变肺结核中的诊断价值.方法 对78例肺部弥漫性病变肺结核患者(其中急性血行播散性肺结核40例,亚慢性血行播散性肺结核21例,支气管播散肺结核17例)行HRCT检查,图像用高分辨重建.结果 ①小叶间隔异常可见于急性血行播散性肺结核中占62.5%(25/40),亚慢性血行播散性肺结核中占52.4%(11/21),主要表现为小叶间隔呈结节状和串珠状改变;支气管播散肺结核中仪5.9%表现为小叶间隔呈不规则增厚,与两组血行播散性比较差异均有统计学意义(P<0.05).②支气管播散性肺结核患者中有88.2%(15/17)表现为小叶核心结节和树芽状,血行播散性病变仅可见小叶核结节状增大,支气管播散性肺结核组与两组血行播散性比较差异均有统计学意义(P<0.05).③小叶实质异常在三组中均表现为小叶实质内散在结节.三组比较差异无统计学意义(P>0.05). 结论 HRCT在显示肺小叶结构异常时具有明确的特征性表现,利用HRCT征象分析肺小叶结构异常特点可以提高肺部弥漫结节性病变的诊断和鉴别水平.     

肺外周早期肺癌与炎症并存影像表现分析

目的 提高对发生于肺外周的早期肺癌影像学表现的认识,达到早期诊断的目的。方法 结合肺癌早期病理改变,回顾性分析23例发生在肺部周边的早期肺癌癌炎并存影像学表现,总结其特点,讨论影像学表现的病理基础,提出客观的诊断方法。结果 早期肺癌与炎症并存的影像学表现具备肺癌典型的特点较少;发生在肺部边缘的早期肺癌,常常合并周围炎症浸润;癌炎并存的影像学表现可以是结节状、云雾状、淡片状、条状或者毛玻璃状等;没有明显临床症状的肺部边缘小病灶要高度警惕;早期肺癌与炎症并存常常只有胸膜增厚。肺边缘部位的癌炎并存多见于细支气管肺泡癌。结论 充分认识肺癌早期癌炎并存的影像学表现和病理基础,增加警惕性,可以在形成肿块之前做出有意义的诊断或提示。     

浅析早期周围型肺癌的HRCT影像征象

肺癌是临床上常见的恶性肿瘤。在我国,其“发病率第一”及“死亡率第一”已经得到医学界公认。经X线平片及常规CT筛查出肺内结节阳性的病例,再对其行HRCT扫描,能更好的显示病灶边缘形态及内部结构,对结节定性及评价具有重要的临床应用价值。笔者对本院近5年经手术或穿刺活检确诊为周围型肺癌的患者的CT及HRCT影像表现做一综述,旨在进一步探讨早期周嗣型肺癌在HRCT中的影像征象,以期提高早期肺癌的诊断率。     

周围型小肺癌46例CT诊断分析

目的分析周围型小肺癌的CT征象特征。方法收集经手术、穿刺或癌检等病理证实的周围型小肺癌患者46例的临床资料，对其内部结构、边缘形态、周围组织改变及增强后的CT表现进行目赢性分析。结果46例圆形或类圆形结节28例，不规则结若18例，有分叶43例，细短毛刺或毛刺30例，空泡征13例，胸膜凹陷18例，邻近胸膜增厚2例，邻近血管聚集52例。27例进行了增矗扫描，癌体均有强化，平均强化幅度38HU。结论CT特别是靶区HRCT扫描及靶区增强CT扫描可以提高周围型小肺癌的影像学诊断准确率。     

变应性支气管肺曲霉菌病的HRCT表现

目的 探讨变应性支气管肺曲霉菌病(ABPA)的HRCT影像学特点,以提高对该病的认识及诊断准确率。方法 回顾性分析11例经临床确诊的ABPA患者的HRCT影像学表现。结果 11例患者的HRCT表现主要为中心性支气管扩张11例,支气管粘液栓形成9例,斑片状浸润阴影7例,树芽征为特征的小叶中心结节形成6例,3例伴有胸膜局限性增厚和纵膈淋巴结增大。结论 ABPA的HRCT表现具有特征性,即以中心性支气管扩张为主并多伴有支气管腔内粘液栓形成,可据此影像学特点结合临床及实验室检查进行诊断。     

肺部高分辨率CT对老年特发性肺纤维化的诊断价值

目的研究高分辨率CT（HRCT）在老年性特发性肺纤维化（IPF）患者的诊断价值。方法回顾经纤镜肺活检（TBLB）,CT导向穿刺活检,开胸活检确诊的16例患者所做的HRCT检查并与常规胸部x线检查,常规胸部CT比较。结果HRCT提示IPF特征是：（1）磨玻璃密度阴影;（2）网状、线条状阴影;（3）蜂窝状阴影;（4）胸膜下线（5）肺小叶结构变形;（6）交界面不规则;（7）胸膜增厚。以上阴影呈散灶性分布,以中下肺、胸膜下分布为主,各种阴影可并存。结论HRCT作为无创伤性检查对本病诊断、分期、指导治疗和疗效观察有重要意义,是目前最方便、最敏感的无创性检查方法。但完全正确的诊断仍需要影像,临床、血清学和组织病理相结合。     

早期周围型小肺癌的X线CT影像诊断分析

目的探讨分析周围型小肺癌的x线、CT影像学表现，提高诊断效率。方法收集临床和病理证实的早期无明显临床症状肺癌24例，对其影像学进行回顾分析。结果病变部位：右肺15例，其中上叶9例、中叶3例、下叶3例。左肺9例，其中上叶6例、下叶3例。早期肺癌x线为斑片状、小结节状影。CT表现为斑片状、小结节状、轻度分叶状肿块，小毛刺、血管集束征、胸膜凹陷征、空泡征、支气管气像，大多直径在1．4-2．0cm。无纵隔淋巴结及肺门转移，且临床症状不明显。结论临床医师应熟练掌握周围型小肺癌的影像学特征，提高其诊断效率。     

肺周围型小腺癌37例薄层螺旋CT表现

目的:探讨肺周围型小腺癌的高分辨率CT(HRCT)表现及病理特征,为临床影像学诊断寻找重要依据。方法:收集启东市中医院2014年7月至2016年7月共37例病理诊断为肺周围型小腺癌患者的临床资料,所有患者术前均行多层螺旋CT扫描筛查,病灶行HRCT扫描,观察分析病灶的影像学表现及病理特征。结果:37例均表现为单发毛玻璃结节影,均位于周围肺野。其中纯毛玻璃结节21例(56.8%),混合密度16例(43.2%);病灶最大直径0.9~2.8cm,平均(2.2±0.3)cm。其他影像学征象为细支气管扩张征、边缘清晰、胸膜凹陷、分叶及毛刺征。Matsuguma量化分型:Ⅰ~Ⅲ型29例(78.4%),Ⅳ~Ⅴ型8例(21.6%)。病理特征:肿瘤细胞沿肺泡壁呈附壁性生长,肺泡间隔增厚。结论:患者经HRCT检查时发现毛玻璃结节影,如果同时伴有边缘清晰、分叶征、支气管截断征、毛刺征、胸膜凹陷征、空泡征及量化分型较低,应高度警惕肺周围型小腺癌可能。     

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.     

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.     

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.     

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.     

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.     

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.