How current risk assessment and risk management methods for drinking water in The Netherlands cover the WHO water safety plan approach

In the Netherlands, safe and sufficient drinking water is provided to the general population by ten drinking water companies. To guarantee safe drinking water the World Health Organization (WHO) developed a Water Safety Plan (WSP), a Risk Assessment and a Risk Management (RA/RM) framework. The objective of the study was to identify legally required RA approaches, to document application of RA/RM activities at Dutch drinking water companies and to determine to what extent these RA/RM activities as a whole cover all the elements of the WHO WSP approach. This study could be of interest to both managers of large water utilities and decision makers.The assessment was performed by means of a policy review and interviews with two to four staff members involved in RA/RM from all ten Dutch drinking water companies combined with a joint workshop. The drinking water companies are well aware of the potential hazards and risks that can influence the drinking water quality. To guarantee the supply of safe and sufficient drinking water, the Dutch drinking water sector uses six different legally required RA/RM approaches. This study shows that by using the six legally required RA/RM approaches, all WSP steps are covered. WSP entails a generic risk assessment for identifying all hazards and hazardous events from source to tap, whereas the six legally required RA/RM each focus on specific risks at an advanced level. Each risk assessment provides information on specific hazards and hazardous events covering a part of the water supply chain. These legal requirements are complemented with additional RA/RM activities at sector and water company level such as codes of practices and standard operating procedures. The outcomes of all RA/RM approaches combined provide information from source to tap. When using multiple RA/RM approaches, it is crucial to share and combine information derived from the different activities.     

药源性横纹肌溶解综合征回顾性分析

目的：了解药物所致横纹肌溶解综合征（RM）的发生情况及临床特点,提高防治水平。方法：收集与分析中国生物医学文献数据库及中国医院数字图书馆期刊全文库（1994年1月～2009年8月）药物所致RM的病例。结果：药物所致RM159例,口服给药比其他给药途径更易引起RM,有131人占总数的82.39%。发生于用药2个月内RM的有48例,占54.55%。常见药物有26种,按发生例数排序前4位的药物有：调节血脂药58例（占36.48%）排在首位,其中他汀类调节血脂药有49例。其次是乙醇32例（占20.13%）、有机磷农药30例（占18.87%）、阿片类药其中海洛因15例（占9.43%）。结论：许多常用药物均可引起RM,使其发病率日益增多,若不及时诊断,治疗常可威胁生命。     

孕妇维生素营养状况与胎儿生长发育的典型相关研究

目的 对孕妇维生素营养状况与胎儿生长发育的关系进行典型相关分析。方法 以湖南省长沙市224名孕妇为调查对象,测定了不同孕龄孕妇的血清维生素水平及胎儿生长发育评价指标,并对孕妇的膳食营养素摄入、生活因素进行了调查。结果 孕妇血清维生素E水平随妊娠进展明显上升,叶酸水平则下降,在孕晚期尤为明显;典型相关分析的结果显示:孕妇的4项血清维生素水平与孕妇产前宫高、腹围、胎儿股骨长、新生儿出生体重、新生儿Apgar评分5项指标呈正相关(P<0.05),提示孕妇维生素营养状况影响胎儿骨骼、肌肉、神经等的发育;对孕妇生活因素、膳食摄入进行综合分析的结果显示它们对胎儿生长发育的影响依次为孕妇的膳食援入(决定系数R~2=49.10％)、孕妇4种血清维生素水平(R~2=29.94％)、生活因素(R~2=14.32%)。结论 孕妇维生素营养状况与胎儿生长发育密切相关。     

Técnicas de imagen híbridas en cardiopatía isquémica

Hybrid imaging for ischemic heart disease refers to the fusion of information from a single or usually from multiple cardiovascular imaging modalities enabling synergistic assessment of the presence, the extent, and the severity of coronary atherosclerotic disease along with the hemodynamic significance of lesions and/or with evaluation of the myocardial function. A combination of coronary computed tomography angiography with myocardial perfusion imaging, such as single-photon emission computed tomography and positron emission tomography, has been adopted in several centers and implemented in international coronary artery disease management guidelines. Interest has increased in novel hybrid methods including coronary computed tomography angiography-derived fractional flow reserve and computed tomography perfusion and these techniques hold promise for the imminent diagnostic and management approaches of patients with coronary artery disease. In this review, we discuss the currently available hybrid noninvasive imaging modalities used in clinical practice, research approaches, and exciting potential future technological developments.     

轻中度癌痛患者的回顾性记忆与前瞻性记忆功能损害的临床研究

目的 探讨轻中度癌痛患者的回顾性记忆（RM）与前瞻性记忆（PM）功能，了解癌痛对记忆功能的影响。方法 收集轻中度癌痛患者和健康对照者各37例，进行总体认知评估及RM和PM问卷调查。结果癌痛组简易精神状态量表得分为24.19±3.20，低于健康对照组的27.54±1.83（P＜0.01）；PM得分为14.76±4.53，高于健康对照组的9.59±1.38（P＜0.01）；癌痛组RM得分略低于健康对照组（12.78±4.27 vs. 12.91±5.12），差异无统计学意义（P＞0.05）。结论 轻中度癌痛患者存在总体认知功能的损害，以记忆功能损害较为明显，其中以PM损害为主。     

Effects of Classic Progressive Resistance Training Versus Eccentric-Enhanced Resistance Training in People With Multiple Sclerosis

Objective

To compare the effects of classic progressive resistance training (PRT) versus eccentric strength-enhanced training (EST) on the performance of functional tests and different strength manifestations in the lower limb of people with multiple sclerosis (PwMS).

The specific contributions of force and velocity to muscle power in older adults

The purpose of this study is to examine the relative importance of the force-based and velocity-based measures of muscle performance to explain inter-individual differences in power production capability and functional task performance. Participants included seventy-nine men and women: middle-aged healthy adults (MH: 40-55years), older healthy adults (OH: 70-85years), and older adults with mobility limitations (OML: 70-85years). Muscle power at 180°/s, isometric maximal torque, and maximal contraction velocity at 40% 1RM were measured during unilateral leg extension. The Short Physical Performance Battery (SPPB) was used to differentiate between healthy and mobility limited older adults. Functional task performance was assessed using multiple chair rise and stair climb tests. Leg extensor force (torque), but not maximal contraction velocity, was significantly associated with muscle power in MH. Both torque and velocity were significantly associated with muscle power in OH. Maximal velocity, but not torque, was associated with power in OML. Maximal velocity demonstrated an association with multiple chair rise time and stair climb time in OML, but not MH or OH. It is concluded that movement velocity is an increasingly important determinant of maximal power output with advancing age. Furthermore, movement velocity is also a critical component of functional task performance with aging and may contribute to functional deficits. These findings help to explain why the rate-dependent variable power has emerged as a critical component of both assessment and rehabilitation of muscular performance and physical function in older adults.     

59例难治性肺癌化疗并异博定和（或）三苯氧胺疗效

５９例难治性肺癌：３５例接受常规联合化疗无效的为组１（Ｇ１）；２４例达缓解后复发和（或）转移者为组２（Ｇ２）。异搏定（ＶＰＬ）和（或）三苯氧胺（ＴＡＭ）始于化疗前３日，持续至化疗后４日止。ＶＰＬ及ＴＡＭ剂量各为６０－１２０ｍｇ／ｄ及６０－１２０ｍｇ／ｄ，均分３次服。