Accuracy of endoanal ultrasound in the follow-up assessment for squamous cell carcinoma of the anal canal treated with radiochemotherapy

Background  Radiochemotherapy has largely replaced surgery in the treatment for squamous cell cancer of the anal canal. Transanal ultrasonography is well documented as an important investigation method in the management of anal carcinoma. This study aimed to evaluate the accuracy of endoanal ultrasound in the study of the postradiation findings and to distinguish between postradiation fibrosis, residual tumor, and local recurrence. Methods  The study enrolled 16 consecutive patients with biopsy-proven squamous carcinoma of the anal canal between 2003 and 2006. All the patients underwent a pretreatment and at least four posttreatment endosonographies, according to the follow-up period. All the patients were treated with the same radiochemotherapy protocol. Results  Nine patients had stage uT2 disease; none had uT3 disease; and seven had uT4 disease. There was no evidence of residual tumor in the T2 group after treatment. In the T4 patients after treatment, ultrasound demonstrated tumor regression or abnormalities considered to be radiation-induced changes rather than residual diseases. Only for three patients was a posttreatment biopsy performed to evaluate recurrence (two uT2 and one uT4). Surgical treatment of recurrence was performed for two uT4 patients. Conclusions  Endoanal ultrasound is a safe and effective method for evaluating and following anal cancer before and after treatment. Experience and evaluation during the period of the ultrasonographic abnormalities could give a clear idea concerning the evolution of the anal tumors treated with radiochemotherapy.     

Requirements for the design and implementation of checklists for surgical processes

Background  The use of checklists is a promising strategy for improving patient safety in all types of surgical processes inside and outside the operating room. This article aims to provide requirements and implementation of checklists for surgical processes. Methods  The literature on checklist use in the operating room was reviewed based on research using Medline, Pubmed, and Google Scholar. Although all the studies showed positive effects and important benefits such as improved team cohesion, improved awareness of safety issues, and reduction of errors, their number still is limited. The motivation of team members is considered essential for compliance. Currently, no general guidelines exist for checklist design in the surgical field. Based on the authors’ experiences and on guidelines used in the aviation industry, requirements for the checklist design are proposed. The design depends on the checklist purpose, philosophy, and method chosen. The methods consist of the “call-do-response” approach,” the “do-verify” approach, or a combination of both. The advantages and disadvantages of paper versus electronic solutions are discussed. Furthermore, a step-by-step strategy of how to implement a checklist in the clinical situation is suggested. Conclusions  The use of structured checklists in surgical processes is most likely to be effective because it standardizes human performance and ensures that procedures are followed correctly instead of relying on human memory alone. Several studies present promising and positive first results, providing a solid basis for further investigation. Future research should focus on the effect of various checklist designs and strategies to ensure maximal compliance.     

Quantitative assessment of technical proficiency in performing needle-knife precut papillotomy

Background  Although needle-knife precut papillotomy (NKPP) is considered a useful alternative for achieving selective biliary cannulation, controversy remains regarding the technical proficiency needed to perform the procedure and its safety. This study evaluated whether procedural experience with NKPP predicted either successful cannulation or the development of complications. Methods  This study retrospectively investigated 104 patients, out of 589 consecutive patients with native papillary, who underwent NKPP performed by a single endoscopist between October 2002 and July 2006. To demonstrate changes in NKPP, the 104 patients were divided chronologically into two groups according to periods: period A (October 2002 to September 2004) and period B (October 2004 to July 2006). Results  Of the 104 consecutive patients who underwent NKPP, 41 (41/267, 15%) were treated in period A and 63 (63/322, 20%) in period B. There was no significant difference in the overall success rate between periods A (90%) and B (98%) (p = 0.08). However, the initial success rate was higher in period B (95%) than in period A (80%) (p < 0.05). The complication rates were not significantly different between the two groups (10% vs 16%; p = 0.56). Although all complications involved pancreatitis, severe pancreatitis was not observed. Conclusion  Whereas the initial success rate for NKPP can increase with procedural experience, the complication rate does not seem to decrease. Furthermore, the need for NKPP does not appear to decrease with increasing endoscopic retrograde cholangiopancreatography (ERCP) experience.     

2006-2007年深圳市水痘流行病学分析

目的了解深圳市2006-2007年水痘疫情的流行情况,为制定水痘疫情防制措施提供科学依据。方法对2006-2007年水痘疫情及水痘事件用描述流行病学方法进行分析。结果2006-2007年深圳市共报告水痘病例2 302例;14岁以下人群占病例报告总数的76.62%。2006-2007年深圳市共报告水痘事件30起,全部发生在学校和托幼机构。2006年深圳市健康人群水痘平均抗体阳性率为69.70%,其中1～5岁仅为39.5%,5～10岁年龄组水痘抗体阳性率仅为46.1%。结论做好患病学生的隔离工作以及在重点人群中接种水痘疫苗是预防和控制水痘最有效的措施。     

某企业乙丙橡胶技术改造项目职业病危害预评价

目的识别和分析乙丙橡胶生产过程中可能产生的职业病危害因素及其主要环节,预测可能造成的职业病危害及程度,确定建设项目的职业病危害类别。方法依据该建设项目的职业病危害特点,采用类比法、检查表分析法等进行综合分析、定性和定量评价。结果通过对拟评价项目相似工程的职业卫生调查、相关技术资料的分析,本项目存在的职业病危害因素为正己烷、甲醇、氨、氯化氢、氢氧化钠及噪声,类比企业各工种工作日内甲醇、正己烷等有害物质TWA（甲醇0.156～0.569 mg/m^3、正己烷1.48～5.48 mg/m^3）、STEL（甲醇1.87～4.10mg/m^3、正己烷1.73～65.80 mg/m^3）均符合国家卫生标准要求。各工种工作日内接触生产性噪声等效连续A声级计算值均〈85 dB,符合国家卫生标准要求。结论本项目属职业病危害严重项目。本项目在落实职业卫生专项投资、落实可研报告中提出的各类职业病预防措施、落实控制职业病危害的补充措施、加强职业卫生管理的前提下,拟建项目在职业病危害控制方面是可行的。     

2008年溧阳市部分铅作业人员健康状况调查

[目的]探讨在低浓度铅环境中作业人员的健康状况。[方法]2008年4月以某企业在低浓度铅环境中工作1年以上的人员为接触对象,以同一企业中不接触铅的人员为对照,进行有针对性的健康检查,对所有资料进行统计分析。[结果]调查146人,其中接触铅组88人,对照组58人。铅接触组男性尿铅异常检出率为18.46%,女性为43.48%,女性高于男性。接触组与对照组实验室检查项目差异无统计学意义。[结论]职业人员在低浓度铅环境中作业,在加强防护的情况下,健康状况不会受到明显影响。     

急性冠脉综合征患者白细胞计数与病情的关系探讨

目的初步探讨急性冠脉综合征（ACS）患者白细胞计数（WBC）与病情的关系。方法ACS患者80例,分为不稳定型心绞痛（UA,n=38）组和急性心肌梗死（AMI,n=42）组,另按Gensini评分（Score）将80例患者分为（30及≥30组。比较各组的WBC变化并分析WBC与CK—MB、TnT、BNP、Score值的关系。结果AMI组WBC及CKMB、TnT、BNP、Score值均显著高于UA组（P〈O．05—0．01）;Score≥30分组的WBC显著高于Score＜30分组（P〈O．05）;WBC与Score、TnT、CKMB、BNP均呈显著正相关（r=0．289—0．344,均P（0．01）。结论ACS患者WBC升高与病情严重程度有一定关系。     

血糖监测对小儿手足口病病情和预后判断的价值分析

目的探讨血糖监测对小儿手足口病病情和预后判断的价值。方法检测了687例手足口病患儿(属于一般病例者204例,占29.69%,II期重症病例452例,占65.79%,III期病危者31例,占4.51%)入院时的空腹静脉血糖,并对所有病例住院过程中的血糖进行动态监测。分析不同病期患儿血糖检测结果、血糖检测值与病情相关性及血糖监测值与疾病预后之间的关系。结果①II期和III期病例在入院初期空腹血糖明显高于一般病例,分别为7.34±2.22mmol/L,16.54±5.33mmol/L和5.75±1.31mmol/L,差异有统计学意义(P<0.01);②在不同程度血糖升高组中,随着病情的加重,血糖检测值升高的程度越明显(P<0.01);③血糖升高组患儿平均住院日(7.1±2.5天)明显长于血糖正常组(4.1±1.2天)(P<0.01),出现后遗症的病例前者也明显多于后者(P<0.05),差异均有统计学意义。结论血糖监测在判断小儿手足口病病情变化和预后方面有着非常重要的意义。对于血糖短期内明显升高者应严密观察,及早进行干预,可部分阻止病情的进行性恶化。     

应用热扫描成像技术评价亚健康状态的诊断试验研究

目的应用热扫描成像（TTM）技术对人体进行健康体检,并进行诊断试验研究,旨在评价其对亚健康状态的诊断价值。方法采用横断面研究策略,选择进行体检的疑似亚健康状态者共130人。对研究对象分别双盲地进行TTM的检测和应用标准诊断方法对亚健康状态作以诊断。将其TTM榆测的阳性和阴性与标准诊断的是亚健康状态和非亚健康状态这四个数进行诊断试验四格表运算,以取得各项评价指标。结果TTM检查对脂肪肝、机体疲劳、睡眠不足敏感性强,分别为95.45％、95.12％、93.33％;对血压正常高值、空腹血糖调节受损、机体疲劳和睡眠不足特异性强,分别为85.54％、95.96％、83.15％和83.53％;对血压、血糖、脂肪肝、TC、LDL-C、机体疲劳和睡眠不足的准确度分别为：63.08％、90.00％、86.15％、52.31％、59.23％、86.92％和86.92％。结论TTM在健康体检中显示出高灵敏度、特异性强、无损伤、实时等优越性,作为一个体检项目对亚健康的检出有一定的实用价值,可作为大量体检的筛选项目。     

广西基本消除疟疾策略和技术措施研究

目的探讨广西疟疾流行规律,研究基本消除疟疾的策略和技术措施。方法建立疟疾防治管理体系,以自然村为单位划分疟区,分类防治。全面防治阶段,疟史率达到20%的村庄,采取现症病人根治,病灶村灭蚊,疟疾流行休止期和高峰前期全民根治,流行高峰期全民预防服药的综合措施。疟史率10%以上的村庄,采取现症病人根治,病灶村灭蚊,近两年内疟史者、脾肿大者、带虫者疟疾流行休止期和高峰前期抗复发治疗。其它病灶村,采取现症病人和病家周围人群根治,对象休止期抗复发治疗。疟疾监测阶段,采取现症病人和带虫者根治,该两者次年休止期抗复发治疗,活动性病灶点灭蚊处理。结果疟疾发病率从1954年296.7/万降至2000～-2008年0.009/万-0.09/万,居民疟原虫阳性率从1953～1958年7.1%～23.4%降至2000～2008年0.0003%～0.05%。到2008年,全区109个县(市、区)经卫生厅组织考核确认达到基本消除疟疾标准。结论研究采取的疟疾控制消除的策略和措施有效,至2008年广西基本消除疟疾。