超声在显微神经外科手术中的应用

传统的神经外科手术，存在一定的局限性，尤其足脑深部病变，或者病变组织与正常脑组织外观极为相似的情况下更是如此。为了减少不必要的损伤，降低手术并发症，国内外先后出现术中MRI、脑立体定向系统及神经导航系统的应用，但由于脑立体定向操作耗时费力，神经导航装置过于昂贵和复杂以及术中发生脑移位m^2而影响定位的准确以及可靠性和手术的安全性，使立体定向及导航的应用受到限制。而术中应用超声因其方便、安全，可实时精确定位而广泛应用。     

我国功能神经外科的发展现状和机遇

1947年Spiegel和Wycis将立体定向技术应用于临床,创立了立体定向功能神经外科。60多年来,传统的立体定向功能神经外科已经完成了向现代功能神经外科的转变。在理念上,强调通过神经功能的调节和重建而不是神经结构的损毁来恢复神经功能提高病人的生活质量。在方法上,     

应用临床护理路径对帕金森手术病人进行健康教育

帕金森（parkinson’s disease，PD）是一种严重威胁中老年人健康的中枢神经系统变性疾病。近年来，立体定向导航技术在临床的应用，推动了PD外科治疗的发展，是目前治疗PD的最佳手术方法。为促进病人早日康复，根据帕金森病人的特点，2003年3月～2005年12月，我科应用健康教育路径对立体定向导航手术治疗帕金森病人进行了健康教育，获得了满意的效果，现报告如下：     

神经导航辅助定位治疗听神经瘤的手术配合

神经导航手术定位系统近年来迅速发展成为神经外科手术的重要部分,它集立体定向、计算机影像学、红外线信号追踪和机器人自动化技术等高科技手段于一体,从而提高了肿瘤定位精确率,提高了听神经瘤的全切除率并降低手术并发症。     

超声在显微神经外科手术中的应用

传统的神经外科手术,存在一定的局限性,尤其是脑深部病变,或者病变组织与正常脑组织外观极为相似的情况下更是如此。为了减少不必要的损伤,降低手术并发症,国内外先后出现术中MRI、脑立体定向系统及神经导航系统的应用,但由于脑立体定向操作耗时费力,神经导航装置过于昂贵和复杂以及术中发生脑移位[1-2]而影响定位的准确以及可靠性和手术的安全性,使立体定向及导航的应用受到限制。而术中应用超声因其方便、安全,可实时精确定位而广泛应用。一、资料与方法1.一般资料:2001年6月～2003年6月我院收治的21例患者中,男13例,女8例,年龄16～68岁…     

帕金森病的现代观(三)

内容: 1.帕金森病的概念 2.早期发现和诊断帕金森病 3.帕金森病的药物治疗 4.帕金森病的外科治疗简介 5.帕金森病患者应当注意哪些问题 4 帕金森病的外科治疗简介 早在1947年国外已将微电极导向立体定向技术应用于人脑,开创了立体定向治疗帕金森病和其它运动障碍疾病的先河.1967年左旋多巴的问世后,立体定向手术治疗帕金森病则步入低谷.20世纪70年代后期,随着神经影像学、立体定向和电生理技术的进步,微电极导向立体定向手术重新兴起.外科治疗帕金森病的问题,学者们对手术靶点的选择进行了新的探索.同时,临床发现单纯用药物治疗帕金森病不能延缓病情发展,并发现长期左旋多巴治疗会有显著的毒副作用或药物不耐受.微电极引导立体定向手术治疗帕金森病,在国际上又成为广泛采用的治疗方法应用日益广泛.国内近几年对帕金森病和其它运动障碍也开展了这类手术.     

立体定向放射外科在神经外科的应用

1951年，瑞典神经外科医生Lars Leksell提出了放射外科这一概念，在理论上和许多实践方面研究和论证了不同放射源的优缺点，利用自己研制的立体定向头架进行了第1例放射外科手术，放射源为200kV的X线管。Leksell将这种技术称为立体定向放射外科（stereotactic radiosurgery）并沿用至今。     

伽玛刀放射防护监测与评价

伽玛刀即伽玛射线立体定向治疗系统，是一种融立体定向技术和放射外科于一体，以治疗颅脑疾病为主的立体定向放射外科治疗设备。我省某伽玛刀中心于１９９７年４月引进一台国产头部旋转式伽玛刀，我所于５月对该伽玛刀及其机房和周围环境进行了放射防护监护。１基本情况１...     

导航手术在神经外科的应用

导航辅助下的神经外科手术是微侵袭神经外科技术的重要组成部分之一，虽然20世纪90年代才逐渐发展起来，随着计算机技术甘新月异的发展，无疑会极大地推动神经外科技术的进步。导航技术是由立体定向手术、数字化扫描技术、计算机软硬件技术和显微外科技术等的最新进展综合发展而来的，是一种人工智能化的神经外科手术辅助系统，它使神经外科手术的定位更精确，术中精细测量变得非常简单，误差降低到最小，减少手术时间和侵袭性。     

立体定向手术进展

从15世纪末，Leonado Da Vinci提出立体定向的构想，19世纪末，Dittmen介绍立体定向术原理和动物试验，Zernov制造出极坐标定向仪，到20世纪初Clark和Horsley设计出三维坐标定向系统，直到1947年Spiegel和Wycis完成有史以来第1次人脑立体定向手术，人类在立体定向手术的前期准备花费了4个多世纪的漫长时间。1946年世界上第1台计算机问世，1979年Brown提出定向仪和CT相匹配，不久定向仪与MRI、DSA、PET结合相继有了报道，1986年Robert介绍了无框架立体定向系统。     

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.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

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.