化工行业职业性机械伤害危险因素的病例-交叉方法研究

目的 研究化工行业机械伤害的有关诱发因素，估计其作用强度。方法 采用病例-交叉设计的方法。以操作和检修时受伤的化工工人为研究对象，每个对象在受伤后2d内完成调查，收集他们受伤前10min、上一工作日同一段时间和受伤前1周内有关诱发因素暴露的信息，用配对时间段方法和一般频数法进行分析，评估各种诱发因素的危险度。结果 一般频数法分析的结构表明，操作方法异常、设备工具缺陷、工作紧迫、注意力不集中、不使用防护用品、精神状况较差、与同事配合不协调、工作环境发生变化等瞬时危害因素的RR值及95%可信限的下限均大于1。配对时间段方法分析的结果与其相拟，但95%可信限较宽。结论 化工行业职业性机械伤害的发生存在着诸多诱发因素。病例-交叉研究中的一般频数法与配对时间段方法相比，前者所得结果较为可靠，研究的相对效率较高。建议进一步使用多个时间段方法进行研究，以减小混杂因素的影响。     

Importance of Albumin, 25(OH)-Vitamin D and IGFBP-3 as Risk Factors in Elderly Women and Men with Hip Fracture

The relative importance of vitamin D deficiency, secondary hyperparathyroidism, nutritional deficiency and low bone mineral density (BMD) as risk factors for hip fracture is not definitely established. In the framework of a case-control study of risk factors for hip fractured, biochemical markers of bone metabolism and nutrition and femoral BMD data were compared in 136 female and 43 male hip fracture patients, 126 female and 44 male age-matched hospitalized controls, and 47 healthy elderly women (8 men). Patients with hip fracture had lower albumin (−10%9 and 25(OH)-vitamin D (25(OH)D; −19%) compared with hospitalized controls, and lower albumin (−28%) and 25(OH)D levels (−52%) compared with the elderly controls. Serum values of IGFBP-3 were also significantly lower (−33%) in hip fracture patients than in community controls. BMD of femoral neck was lower (p < 0.001) in patients than in hospitalized and community controls. In hip fracture patients, parathyroid hormone (PTH) correlated weakly with BMD (neck: r = −0.19, trochanter: r = −0.17; both p < 0.05). When all women were pooled (n = 233), albumin correlated significantly (age-adjusted) with BMD at all sites (neck: r = 0.27, trochanter: r = 0.25; all p < 0.001). Albumin, but not 25(OH)D, also correlated with skinfold thickness (r = 0.19, p < 0.0025) and with body mass index (BMI) (r = 0.14, p < 0.05). Male patients with hip fracture had lower BMD and albumin (both p < 0.001), 25(OH)D (p = 0.02) and IGFBP-3 levels (p <: 0.005) compared with the controls. When male patients and controls were pooled together, albumin, skinfold thickness and BMI were significantly correlated with each other, but not with BMD. IGFBP-3 was highly correlated with albumin (p < 0.0001), 25(OH)D (p < 0.005) and, less significantly, with PTH (p < 0.05), but not with BMI or skinfold thickness. IGFBP-3 was significantly correlated with BMD at all sites (neck: r = 0.27, p < 0.05); trochanter: r = 0.40, p < 0.0005). In conclusion, low albumin and low BMD were both important risk factors for hip fracture. Low serum albumin was the strongest independent variable correlated with hip fractures. In men, IGFBP-3 was correlated with BMD. The femoral BMD depended only weakly on PTH and 25(OH)D, but was correlated at all sites with albumin, a non-specific parameter of nutrition and general health.     

Interleukin-2, its soluble receptor,and soluble T8 antigen in acute ischemic stroke

The treatment of neoplasia with interleukin-2 (IL-2) can be complicated by neurological deficits resembling transient Ischemic attack and stroke. We investigated whether interleukin-2 contributes to the natural course of cerebrovascular ischemia and particularly to the pathogenesis of infection-associated stroke. Plasma levels of interleukin-2 were below the level of detectability in almost all measurements. Patients with and without previous infection (n = 11, 805 ±445 U/ml vs n = 19, 824 ± 501 U/ml) did not have significantly higher levels of soluble interleukin-2 receptors than control subjects with (n = 14, 667 ± 229 U/ml) or without vascular risk factors (n = 17, 567 ± 176 U/ml). Receptor levels increased in patients during the first week after stroke (n = 15, 1157 ± 1013, p < 0.02). Levels of soluble T8 antigen (sT8) were higher in patients (n – 26, 320 ± 112 U/ml) than in healthy control subjects (n = 15, 246 ± 92 U/ml; p < 0.05) and sT8 levels increased during the first week after stroke (p < 0.05). These results reflect an immunological response to the cerebral infarct; they do not indicate a general role of the IL-2 system in the pathogenesis of ischemic stroke with or without previous infection.     

Practical guidelines for physicians in the management of febrile seizures

Recent studies have shown that adequate medication can prevent the recurrence of febrile seizures (FS). It has also been clarified that the vast majority of, though not all, FS patients follow a benign course. Then, questions arise as to whether or not FS should be prevented, particularly in light of the risks of side effects from drugs. Which kinds of FS can be prevented, if necessary? The guidelines presented here are aimed primarily at helping general practitioners in considering how to manage FS most appropriately. The guidelines stress that judgements should be individualized, while referring to a few specific ‘warning factors’. The guidelines follow a ‘laissez-faire’ principle for the majority of FS cases, whereas intermittent therapy with diazepam and continuous medication with either phenobarbital or valproate are indicated in other limited cases meeting respective definite criteria.     

药物洗脱支架直接置入治疗A型和B_1型病变的临床观察

目的　评价直接置入药物洗脱支架 (CYPHERTM,codis)在A或B1 型病变的冠心病患者治疗中的安全性、可行性。方法　 6 2例接受CYPHERTM 支架直接置入的患者 (直接支架组 )和一般情况匹配的 5 1例球囊扩张后行冠脉支架术的患者 (常规支架组 ) ,比较两组的一般情况 ,冠脉造影及介入治疗即刻和临床随访结果。结果　直接支架组介入操作时间明显短于常规支架组 [(17.2± 8.6 )比 (2 6 .3± 7.1)min ,P <0 .0 1],直接支架组平均扩张压明显高于常规支架组 [(14± 3)比 (12± 1.9)atm ,P<0 .0 1],两组无一例发生介入治疗相关的严重心脏事件。随访期间两组严重心脏不良事件发生率无显著差异。结论　A或B1 型病变的冠心病患者CYPHERTM 支架直接置入术可缩短介入操作时间 ,即刻效果、并发症及中期临床随访与常规支架组差异无显著性意义     

新华社区部分高血压患者危险因素分析

目的 了解本社区高血压患者的危险因素现状，探讨干预对策。方法 采用分层整群抽样的方法，随机抽取社区4个里委2级、3级高血压患者402例作为研究对象，收集各项危险因素如性别、年龄、血脂、血糖、吸烟、饮食、体育锻炼、体重等，并进行统计分析。结果402例高血压患者1年内进行所有相关辅助检查者有14例，占3．48％；1年内进行相关辅助检查一项者306例，占76．12％。饮食控制及进行体育锻炼有300例，占74．43％；吸烟62例，占15．42％。结论 高血压患者对饮食控制及体育锻炼、吸烟有害的知晓率明显提高，而对相关辅助检查认识不足。     

A review of incisional hernia repairs: preoperative weight loss and selective use of the mesh repair

At the Shouldice Clinic pre-operative weight loss is used prior to incisional hernia repairs. Mesh repair is selectively used, based on specific hernia characteristics. A series of 236 patients were reviewed and followed up for 36 months. Data were available on 188 patients (80%). There were 15 recurrences (8%). The number of obese patients was reduced from 67 (35.6%) to 25 (13.3%) through the weight loss program. The hernia diameter, gastrointestinal complications, and surgical site infection were significantly related to recurrence but not the type of repair, obesity, location, or previous recurrences. The risk factors of incisional hernias include size, intestinal complications and infections. A selective use has a comparable result to the exclusive use of mesh repair. Weight reduction has yet to be shown to affect the rate of recurrence, and further prospective studies are required.     

精神分裂症子女的行为问题及相关因素分析

目的 探讨精神分裂症子女的行为问题及相关因素。方法 以Achenbach儿童行为量表(CBCL)为工具，对260名精神分裂症患者的子女(研究组)行为问题及其影响因素进行调查，并与正常健康者的子女(对照组)进行对照。结果 精神分裂症子女行为问题检出率为31．2％。显著高于对照组的12．3％；其主要影响因素为儿童健康状况差、孕产期不利因素、家庭教育方式不当、亲子关系差、居住地社会风气差和学习成绩差。结论 精神分裂症子女的行为问题发生率较高，为生物、心理及社会因素共同作用的结果，并需全面干预。     

Prognostic implications of the motor symptoms of Parkinson's disease with respect to clinical,computertomographic and psychometric parameters

Summary Forty-four Parkinson patients (19 patients of the rigid-akinetic type, 13, of the rigid-akinetic-tremor type, and 12, of the tremor type) were included in a study in order to analyse correlations of the expression of the motor symptoms tremor, rigidity, akinesia, with other clinical parameters, computertomographic aspect of brain atrophy and psychometrically assessed cognitive parameters. Rigidity and akinesia are significantly positively correlated with the severity of motor dysability, stage of the disease, and brain atrophy, as is akinesia with a history of pharmacotoxic psychosis. Tremor is significantly negatively correlated with motor dysability, stage of the disease, and history of pharmacotoxic psychosis. Akinesia is correlated with visuomotor dysfunction (tested with Bender Gestalt Test) and rigidity with the depression score (Zung scale). The tremor type is favorable, the rigid-akinetic type unfavorable with respect to motor disability and psychosis.     

急性重症肝炎患者发生肝性脑病危险因素多元Logistic回归研究

目的探索急性重症肝炎患者发生肝性脑病的危险因素，以便进行早期干预。方法收集血浆凝血酶原时间（PT）延长，活动度〈40％的急性重症肝炎患者69例，对69例患者的年龄、性别和基础疾病等临床背景资料和总胆红素、直接胆红素、谷草转氨酶（AST）、谷丙转氨酶（ALT）、血浆白蛋白、胆碱脂酶、血浆凝血酶原时间（PT）、白细胞计数（WBC）、血小板计数（Plt）等实验室检查数据进行单因素分析和多元Logistic回归分析。结果单因素分析和多元Logistic回归分析均提示年龄、血胆红素水平和血浆凝血酶原时间在肝性脑病组和非肝性脑病组之间有统计学差异。结论约30％的急性重症肝炎患者发展成为肝性脑病。高龄、血浆凝血酶原时间延长、活动度下降、高血浆总胆红素等是急性重症肝炎患者发展成为肝性脑病的潜在危险因素。