223例急性胆囊炎行腹腔镜胆囊切除术治疗的手术时机与疗效

目的 探讨急性胆囊炎使用腹腔镜胆囊切除术(LC)治疗的手术时机与疗效.方法 回顾性分析我科近5年收治的223例急性胆囊炎行LC治疗(LC组)的临床资料.依据发病至手术的时间分为早期手术组(≤48 h,早期组,n=97)和晚期手术组(＞48 h,晚期组,n=126),比较两组的临床资料.结果 早期手术组的手术时间、中转开腹率和术后住院时间均明显优于晚期手术组(P ＜0.05或P＜0.01).结论 LC是治疗急性胆囊炎安全有效的术式,而且及早(≤48 h)施行手术效果更佳.     

梗阻型胆源性胰腺炎内镜治疗时机及疗效的临床分析

目的 探讨梗阻型胆源性胰腺炎内镜治疗的时机与疗效.方法 回顾性分析160例梗阻型胆源性胰腺炎患者内镜治疗的临床资料.根据发病后内镜治疗时间分为两组:急诊组78例在发病<48 h行急诊内镜治疗;延期组82例在早期非手术治疗基础上于发病≥48 h行延期内镜治疗.结果 两组内镜治疗总成功率为96.2%(154/160).急诊组腹痛缓解时间[(4.98±1.75)d]、实验室指标恢复正常时间[(10.08±5.22)d]以及住院时间[(12.24±7.20)d]均显著低于延期组[分别为(5.54±2.53)、(12.93±6.60)、(16.38±6.94)d](P<0.05或<0.01).重症梗阻型胆源性胰腺炎急诊组术后总并发症发生率(9.6%,5/52)显著低于延期组(23.6%,13/55)(P<0.05),两组病死率比较差异无统计学意义(P>0.05).结论 重症梗阻型胆源性胰腺炎应在发病48 h内行急诊内镜治疗;轻症患者如早期非手术治疗无效或出现急性胆道感染症状,亦应争取及时行急诊内镜治疗.     

不同手术时机对老年急性胆囊炎患者术后康复的影响分析

目的:探讨不同手术时机对老年急性胆囊炎术后康复的影响。方法:选取2016年6月~2019年10月我院收治的46例老年急性胆囊炎患者,按手术时间分为对照组和观察组,各23例。对照组72h后进行手术,观察组72h内进行手术,手术均为开腹式,比较两组术后排气时间、术后下床时间、住院时间、并发症等。结果:观察组术后排气时间短于对照组[(1.5±0.3)d vs(2.1±0.6)d](P<0.05);下床时间观察组短于对照组[(3.2±1.4)d vs(4.3±1.8)d](P<0.05);观察组住院时间短于对照组[(10.5±2.3)d vs(15.2±3.5)d](P<0.05);观察组术后并发症发生率为8.70%,少于对照组的17.39%(P<0.05)。结论:老年急性胆囊炎术后72h内进行手术更有利于康复,并能减少住院时间及并发症。     

急性胆囊炎不同时期腹腔镜胆囊切除术治疗效果分析

目的 探讨急性胆囊炎不同时期腹腔镜胆囊切除术（LC）治疗的效果,为急性胆囊炎手术治疗时机选择提供临床依据.方法 回顾性分析236例急性胆囊炎行LC患者的临床资料,按发病到手术时间不同分为早期手术组（发病≤72 h行LC,103例）,延期手术组（发病＞72 h行LC,57例）,择期手术组（保守治疗症状缓解后择期行LC,76例）.比较三组手术疗效.结果 延期手术组手术时间、术中出血量长或多于早期手术组和择期手术组,差异有统计学意义（P＜0.05）,早期手术组长或多于择期手术组,但差异无统计学意义（P＞0.05）.早期手术组中转开腹率、术中副损伤发生率低于延期手术组和择期手术组,差异有统计学意义（P＜0.05）,择期手术组低于延期手术组,但差异无统计学意义（P＞0.05）.早期手术组和延期手术组抗生素使用时间和住院费用优于择期手术组,差异有统计学意义（P＜0.05）,早期手术组优于延期手术组,但差异无统计学意义（P＞0.05）.早期手术组住院费用少于延期手术组,延期手术组少于择期手术组,差异均有统计学意义（P＜0.05）.三组手术并发症发生率比较差异无统计学意义（P＞0.05）.结论 急性胆囊炎发病≤72 h为LC最佳手术时机,发病＞72h的延期LC仍是安全可行的,但难度会相应增加,过分强调保守治疗待症状缓解后择期手术并不能为患者带来益处.     

急性结石性胆囊炎腹腔镜胆囊切除的时机

目的探讨结石性胆囊炎急性发作时腹腔镜胆囊切除的时机.方法总结分析813例急性结石性胆囊炎腹腔镜胆囊切除之病例资料,比较发病72h以内(早期)和72h以外(延期)两组的治疗效果.结果全组病例治愈.延期组的平均手术时间、平均术后住院日较长,中转开腹率和严重并发症发生率均较早期组高.结论急性结石性胆囊炎LC宜及早施行,最好在发病72h以内,胆囊坏疽出现之前.只要掌握正确时机,适时中转手术,急性结石性胆囊炎LC是安全可行的.     

老年急性胆囊炎腹腔镜胆囊切除术时机及治疗体会

目的 探讨老年急性胆囊炎腹腔镜胆囊切除术时机及治疗体会.方法 回顾性分析112例老年急性胆囊炎行腹腔镜胆囊切除术患者的临床资料,发病72 h内入院者60例（早期手术组）,发病72 h以后入院者52例（晚期手术组）.比较两组手术时间、术中出血量、术后肠功能恢复时间、腹腔引流量、中转开腹率、住院时间的差异.结果 晚期手术组手术时间、术中出血量、术后肠功能恢复时间、腹腔引流量、住院时间均高于早期手术组[（76.7±7.8） min比（54.3±4.8） min,（41.2±5.9） ml比（25.2±6.5）ml,（2.2±0.7）d比（1.4±0.6）d,（49.6±7.2）ml比（48.7±6.9）ml,（6.4±0.7）d比（3.9±0.6）d],差异有统计学意义（P＜0.05）.两组中转开腹率比较差异无统计学意义[11.5％（6/52）比3.3％（2/60）,P＞0.05].结论 老年急性胆囊炎病情进展快,治疗难度大,风险高,早期采取腹腔镜胆囊切除术可明显缩短手术时间和住院时间,促进患者术后恢复.     

腹腔镜下子宫切除术治疗子宫内膜癌60例临床分析

目的探讨腹腔镜下行微创子宫切除术治疗早期子宫内膜癌的疗效。方法选取子宫内膜癌患者60例随机分为治疗组和对照组,分别采取腹腔镜手术和开腹手术治疗,对比两组患者的手术指标。结果手术时间、术中出血量、淋巴结清除个数、术后排气时间、住院时间对照组分别为(161.0±42.1)min、(489.0±104.2)ml、(64.0±9.4)个、(38.8±5.8)h、(13.3±4.8)d,治疗组分别为(251.5±29.1)min、(356.9±117.8)ml、(54.0±7.2)个、(23.7±4.9)h、(7.9±2.7)d。对照组发生尿潴留2例,占10.00%;治疗组发生尿潴留1例,占6.67%。结论腹腔镜下子宫切除术治疗早期子宫内膜癌,具有手术安全性高、疗效好的特点。     

小剂量氯胺酮对开胸手术患者炎性细胞因子影响的临床研究

目的 探讨静吸复合麻醉使用小剂量氯胺酮对开胸手术患者围手术期肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、IL-8和术后视觉模拟评分(VAS)的影响.方法 选择40例择期胸部肿瘤手术患者,ASA分级Ⅰ～Ⅱ级,按手术先后顺序随机分为氯胺酮组和对照组,每组20例,两组麻醉诱导后行双腔管气管插管,切皮前氯胺酮组静脉注射氯胺酮50 mg,继以静脉输注0.2%普鲁泊福和氯胺酮等复合液,对照组静脉注射芬太尼50μg,继以静脉输注0.2%普鲁泊福和芬太尼等复合液,间断吸入恩氟烷和追加阿曲库铵维持麻醉.观察两组患者TNF-α、IL-6、IL-8浓度变化;两组术后均同时实施患者自控静脉镇痛,记录术后4、24、48 hVAS.结果 氯胺酮组在手术开始后30min、手术开始后4 h、术毕24 h血清TNF-α浓度[(1.40±0.22)、(1.46±0.22)、(1.36±0.13)μg/L]明显低于对照组[(1.54±0.09)、(1.58±0.17)、(1.47±0.22)μg/L](P＜0.05);氯胺酮组在术毕48 h血清IL-6浓度[(30.53±3.35)ng/L]低于对照组[(34.64±2.61)ng/L](P＜0.05);两组各时间点血清IL-8浓度比较差异均无统计学意义(P＞0.05).氯胺酮组术后24、48hVAS[(3.2±0.2)、(3.1±0.7)分]低于对照组[(3.7±0.5)、(3.5±0.7)分](P＜0.05).结论 小剂量氯胺酮用于开胸手术患者,可抑制其炎性细胞因子(TNF-α、IL-6)的产生,术后24、48 h VAS降低,减轻围手术期炎性反应,提高术后镇痛效果.     

腹腔镜治疗急性结石性胆囊炎89例体会

目的：探讨急性结石性胆囊炎腹腔镜胆囊切除术LC的手术方法。方法：回顾性分析89例急性胆囊炎行LC的临床资料。结果：89例急性胆囊炎均施行LC,中转开腹4例,均治愈出院,疗效满意。结论：急性胆囊炎在发病48h内施行LC,成功率高,手术安全可靠。     

PTGD联合早期腹腔镜胆囊切除术对急性重症胆囊炎患者炎性因子的影响

目的探讨经皮经肝胆囊穿刺置管引流术(PTGD)联合早期腹腔镜胆囊切除术(LC)对急性重症胆囊炎患者炎性因子的影响。方法选择2018年10月至2019年10月我院收治的126例急性重症胆囊炎患者,随机平均分为两组。对照组行PTGD,在引流管拔除5～14 d后行LC;观察组行PTGD,引流管拔除72 h后行LC。比较两组的临床指标、炎性因子及并发症。结果观察组LC术后住院时间、 LC术中出血量、 LC手术时间均少于对照组(P <0.05)。LC术后,两组的hs-CRP水平低于术前,IL-6、 TNF-α水平高于术前,观察组的hs-CRP、 IL-6、 TNF-α水平低于对照组(P <0.05)。观察组术后并发症发生率低于对照组(P <0.05)。结论 PTGD联合早期LC治疗急性重症胆囊炎患者,炎性反应较轻,并发症较少,利于患者术后恢复。     

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.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Empathic processes: perception by medical students of patients'' anxiety and depression

Perceptions by medical students of patients' affective states were investigated, and the effect of the students' own emotions on such perceptions. One hundred and one fourth-year medical students rated the levels of anxiety and depression of three women patients presented on videotape, rated their own levels of anxiety and depression and completed a questionnaire on aspects of the rating process. Students had widely different and often inappropriate perceptions of patients' levels of anxiety and depression. Students who consistently overrated anxiety or depression in patients, compared to those who consistently underrated, were themselves significantly more anxious or depressed. These data suggest a need in medical education for systematic teaching of empathic skills and for recognition of potential bias in clinical decision-making arising from the clinician's own emotional state.     

The reported incidence of work-related ill-health in Scotland (2002-2003)

BACKGROUND: Although incidence data for work-related ill-health in the UK are available, more detailed information for smaller geographical areas has hitherto been unpublished. AIMS: To estimate the incidence of work-related ill-health reported by clinical specialists in Scotland, 2002-2003. METHODS: THOR (The Health and Occupation Reporting network) is a UK wide reporting scheme for work-related ill-health. In 2002-2003, 241 out of 2162 physicians in THOR were based in Scotland. We have summarized the reported cases and calculated incidence rates for categories of ill-health by age, gender and industry. The UK Labour Force Survey (2002) was used to provide denominator data, with comparisons made between rates for Scotland and the rest of the UK. RESULTS: In 2002-2003, 4043 estimated cases were reported from Scotland. Mental ill-health was most frequently reported (41%); followed by musculoskeletal disorders (31%), skin disorders (16%), respiratory disease (10%), hearing disorders (2%) and infection (1%). The reported average annual incidence rate per 100,000 employees for all work-related ill-health in Scotland was 86.0. The highest reported rate for mental ill-health was found for employees in public administration and defence (76.7 per 100,000), and health and social work (72.3 per 100,000). The construction industry had the highest reported rate of musculoskeletal disorders (41.6 per 100,000), while hairdressers appeared at most risk of developing occupational contact dermatitis (rate=86.4 per 100,000). CONCLUSIONS: Despite its limitations, THOR has indicated types of work-related ill-health and related industries for targeted disease prevention in Scotland.     

Function of the protein RPE65 in the visual cycle

A protein called RPE65 performs a key role in the trans-cis isomerization of retinol in the retinal pigment epithelium of the eye. The palmitoylation of RPE65 serves to switch off the visual cycle in darkness and to switch it on in the light.     

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.     

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.     

Acute symptoms following work with pesticides

BACKGROUND: Serious accidental poisoning by pesticides is rare in the UK, but more minor pesticide-related illness may be under-reported. Anecdotally, use of sheep dip has been linked with flu-like symptoms. AIM: To explore the frequency, nature and determinants of acute symptoms following work with pesticides. METHODS: A postal survey of men in three rural areas of England and Wales provided data on occupational use of five categories of pesticide, occurrence of 12 specified symptoms within 48 h of using pesticides and tendency to somatize. Risk factors for pesticide-related symptoms were assessed by modified Cox regression. RESULTS: Of 10 765 responders (response rate = 31%), 4108 had at some time used pesticides occupationally, including 935 (23%) who reported symptoms following such work on at least one occasion. In two areas, acute symptoms were most frequent following use of sheep dip (29 and 32% of users), but in the third area the rate was significantly lower (13% of users). The relative frequency of symptoms was similar for all five categories of pesticide, and flu-like symptoms did not cluster unusually among users of sheep dip. Risk of pesticide-related symptoms increased with somatizing tendency (prevalence ratio for highest versus lowest category 2.4, 95% confidence interval 2.0-3.0) and was higher in men who had used pesticides most often or handled concentrate. CONCLUSION: Acute symptoms are common following work with pesticides, but in many cases the illness may arise through psychological rather than toxic mechanisms.