极重度脊柱畸形头盆环牵引治疗的护理体会

本院骨科从2011年9月-2012年6月利用头盆环牵引后行脊柱矫形手术治疗极重度脊柱畸形患者7例，获得满意效果。头盆环牵引作为脊柱矫形手术的前期治疗在治疗的全过程中起着重要作用，将护理体会总结如下。     

Lithostar体外碎石机原理与维修

西门子Lithostar碎石机是西门子公司上个世纪八十年代生产的,用于体外治疗泌尿系统结石的设备。该设备采用电磁冲击波源形式,把电能转化成冲击波,冲击波汇聚后,粉碎在焦点处的结石;该设备采用X光定位系统,设有双侧冲击波头。     

BJ—6B型直线加速器床定位系统改进

本文介绍了对BJ－6B型直线加速器床定位系统的改进，改进后的床定位系统既保留了原机器的电气机械设计，又满足了普通放疗和X－刀治疗的精度要求，使用安全可靠，造价低廉。     

HB—ESWL—VG体外碎石机维修两例

HB—ESWL—VG型体外冲击波碎石机是用于粉碎肾结石，膀胱结石，尿道结石等泌尿系结石的治疗仪。工作过程采用C形臂X射线定位系统、B超定位系统经电脑图像处理系统后，在体外产生冲击波聚焦碎体内结石。     

三维移动激光定位系统在肿瘤精确放疗中的应用

目的：利用三维移动激光定位系统对肿瘤放疗的患者进行定位复位，以提高放疗精度，确保放疗效果。方法：对85例实行肿瘤精确放疗患者，分别采用大孔径螺旋CT进行模拟定位扫描，通过网络将图像传至三维计划系统进行放疗计划设计。然后利用三维移动激光定位系统进行复位，确定出肿瘤的治疗中心。结果：利用电子射野影像系统（EPID）进行验证，85例病人的数据结果显示，首次摆位各个方向上治疗中心与实际靶区中心的重复误差值均〈3mm。结论：应用三维移动激光定位系统对肿瘤放疗的病人进行定位复位，其精确度高，重复性好。     

X刀治疗的质量控制

本文介绍了我院在安装和使用JX－100X刀系统过程中有关物理参数的测量方法,主要包括：（1）ST、TMR、OAR的测量;（2）直线加速器机械稳定性及等中定位系统等中心室位精度的测量,（3）用辐射仿真人体头模验证治疗计划与实际治疗中剂量分布的差异,这些参数的测量值和机械性能均在室X刀治疗的质量控制要求。     

女士,警惕身边的危险--穿环、美甲、美发卫生情况令人忧

日前，17岁的广州女孩小隋在一家个性店穿鼻环，脐环，两周后穿研环处发炎红肿还一直不退，直至感到头晕目眩去求医，才得知很可能是劣质材料导致的铅中毒。更有不少消费者在理发店洗头后头皮屑暴增，检查原来是真菌悄悄上了头。     

放疗激光定位系统的安装与校验

激光定位系统是放射治疗中必不可少的设备,它能够保证患者治疗体位的准确性和重复性。本文介绍了激光定位系统安装时进行精确定位的要点;同时,使用自制的校验器对激光定位系统进行校验,不仅能够满足误差要求,而且验证和调节非常方便。     

颅脑疾病的X刀治疗

目的：回顾性分析150例颅脑疾病X刀治疗后的临床及影像学变化。方法：1997年3月－2000年4月利用JX－100X刀系统常规固定头环及立体定向头架，以3mm层厚CT扫描，3DTPS图像重建，采用单次或分次治疗。全组150例获得8－44个月的随访，中位21个月。结果：145例生存期超过6个月，56例超过24个月；1年后CT或MRI复查86例病灶明显缩小。17例病灶消失。13例病灶增大。14例无明显变化；95例症状减轻，22例症状消失。结论：X刀治疗颅脑疾病疗效是肯定的，它适合颅内多种类型肿瘤和脑血管畸形及功能性病变的治疗。     

头盆环牵引治疗重度僵硬性脊柱侧凸103例报告

目的 利用头盆环缓慢牵引的作用,将难以治疗的重度僵硬性脊柱侧凸变成容易治疗的轻中度脊柱侧凸,再根据具体情况,行矫形加内固定术。方法 以髂前上棘上2～4厘米为进针点,以髂后上棘稍偏内约0.5厘米为出针点,在骨盆上穿两根4毫米的骨圆针连接盆环,用四根螺丝钉将头环固定在颅骨板外层,接上四条力柱作为支撑棍,平均每天撑高0.2～0.5厘米。结果 通过29～62天的缓慢牵引,103例重度僵硬性脊柱侧凸患者除1例神经纤维瘤病牵引无明显效果外,其余102例均增高5～23厘米,平均每例增高11.35厘米,脊柱畸形明显改善。结论 应用头盆环持续、缓慢地撑开牵引,既可避免脊髓不可逆损伤,又能取得单纯内固定矫形所无法取得的疗效。     

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 human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

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.     

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.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.