经桡动脉和经股动脉途径行冠状动脉造影的临床对比分析

目的比较经桡动脉和经股动脉行冠状动脉造影的优缺点。方法 2006年7月-2008年9月疑诊冠心病拟行冠状动脉造影术的患者287例,随机分成经桡动脉组（185例）和经股动脉组（102例）,对比观察其穿刺成功率、手术操作时间、X线曝光时间、止血包扎时间、肢体制动时间、术后住院天数和并发症的发生率。结果桡动脉组的平均X线曝光时间、穿刺成功率分别为（5.13±3.72）min和98.92%,经股动脉组为（4.78±3.51）min和100%,两组比较差异无统计学意义（P〉0.05）;手术操作时间分别为（19.62±3.58）min和（16.57±4.30）min,两组比较差异有统计学意义（P〈0.05）;经桡动脉组止血包扎时间和肢体制动时间分别为（0.72±1.15）min和4～6h,经股动脉组为（20±7.32）min和20～24h,两组比较差异有统计学意义（P〈0.05）;经桡动脉组的术后住院天数为（3.06±1.42）d,少于经股动脉组（4.97±3.07）d（P〈0.01）;两组局部血肿发生率分别为0和1.96%,差异有统计学意义（P〈0.05）;经桡动脉组动脉痉挛发生率为2.16%,经股动脉组无动脉痉挛发生,两组比较差异有统计学意义（P〈0.05）。结论经桡动脉径路行冠状动脉造影是安全有效的方法 ,具有止血容易、不需卧床、痛苦小、并发症少和住院时间短的优点,患者更易接受。     

经桡动脉与经股动脉途径行冠状动脉造影和经皮冠状动脉介入治疗的对比研究

目的 探讨经桡动脉与经股动脉途径行冠状动脉造影(CAG)和经皮冠状动脉介入治疗(PCI)的优缺点,及解决经桡动脉途径不足之处的方法.方法 选取CAG和PCI的患者共300例,按入路血管分为桡动脉组(150例)和股动脉组(150例),对比手术成功率、手术操作时间、X线曝光时间、并发症发生率、住院费用、住院时间,对比解决桡动脉痉挛不同方法的有效性,并进行统计学分析.结果 两组的手术成功率、PCI操作时间、X线曝光时间、冠状动脉并发症发生率比较差异均无统计学意义;桡动脉组在穿刺局部并发症发生率(2.0%,3/150)、术后全身不适率(0,0/150)、术后全身并发症发生率(0,0/150)、住院时间[(4.1±2.1)d]、住院费用[(3.7±2.8)万元]方面均显著优于股动脉组[分别为7.3%(11/150)、100.0(150/150)、2.7%(4/150)、(7.8±3.4)d、(5.0±3.4)万元],差异有统计学意义(P<0.05).结论 经桡动脉途径行CAG和PCI与经股动脉途径同样有效、可行,而且穿刺局部并发症少.     

经桡动脉与经股动脉穿刺行PCI术的护理观察

目的探讨经桡动脉与经股动脉穿刺行经皮冠状动脉介入治疗(PCI)的差别。方法将94例行PCI术的冠心病患者分为经桡动脉与经股动脉途径两组,对比观察其术后卧床时间、住院天数、术后并发症等方面的差异。结果桡动脉组在术后卧床时间、住院天数及术后并发症等方面均低于股动脉组(P<0.01,P<0.05)。结论经桡动脉穿刺行PCI术并发症少,卧床时间短,舒适度高,住院时间短,患者易于接受。     

经股动脉途径与经桡动脉途径行冠状动脉介入治疗临床比较的研究

目的 比较经股动脉途径和经桡动脉途径行冠状动脉(冠脉)介入治疗的临床疗效.方法 360例患者随机分为经股动脉介入(TFI)组和经桡动脉介入(TRI)组,观察分析术后两组患者的血管病变特征、可行性因素(介入治疗成功率、穿刺时间、手术时间及住院时间)及并发症情况.结果 两组患者血管病变特征比较,差异均无统计学意义(P值均＞0.05);TFI组和TRI组介入成功率分别为97.78％和96.67％,两组的介入治疗成功率、手术时间比较,差异无统计学意义(P值均＞0.05);而两组的平均穿刺时间、平均住院时间及并发症发生率的比较,差异有统计学意义(P值均＜0.05).结论 经股动脉途径和桡动脉途径行冠脉介入治疗的可行性及成功率相当;但经桡动脉行冠脉介入治疗的并发症较少,安全性高,在临床上具有推广和应用价值.     

经桡动脉冠状动脉造影同时行肾动脉造影可行性的探讨

目的 探讨经桡动脉冠状动脉造影同时行肾动脉造影的可行性和安全性.方法 选择2007年8月至2009年4月住院经桡动脉予5 FTIG共用导管行冠状动脉造影检查患者320例,同时行肾动脉造影,其中20例患者直接前送TIG共用导管(桡动脉TIG共用导管组)行左右肾动脉造影,300例患者换用5 F MP-A1造影导管到达肾动脉开口行左右肾动脉造影(桡动脉MP-A1导管组).以2004年1月至2009年4月经股动脉途径同时行冠状动脉和肾动脉造影患者625例作为对照(股动脉JR导管组),观察各组肾动脉造影成功率、总操作时间、造影剂用量、并发症情况.结果 桡动脉MP-A1导管组肾动脉造影成功率为97.0%(291/300),股动脉JR导管组为98.4%(6151625),均显著高于桡动脉TIG共用导管组的40.0%(8/20)(P<0.01).桡动脉MP-A1导管组总操 作时间(32.21±3.37)min,造影剂用量(52.72±7.91)ml,股动脉JR导管组总操作时间(30.78±3.23)min,造影剂用量(51.88±7.22)ml,两组总操作时间及造影剂用量比较差异均无统计学意义(P>0.05).桡动脉TIG共用导管组造影剂用量(51.72±10.11)ml,与其他两组比较差异无统计学意义(P>0.05),但其总操作时间(26.42±4.31)min,明显短于其他两组(P<0.05).经桡动脉途径造影患者术后并发症发生率(0.9%,3/320)少于经股动脉途径(3.0%,19/625)(P<0.05).结论 在目前经桡动脉途径行冠状动脉造影普遍开展的情况下,经同途径使用5 F MP-A1造影导管行肾动脉造影安全可行,并发症少,成功率高于直接使用TIG共用导管行肾动脉造影.     

经桡动脉与股动脉行冠状动脉介入诊疗术后护理对照研究

目的对比经桡动脉与股动脉行冠状动脉介入诊疗患者术后护理的优缺点,为护理提供依据。方法将150例行冠状动脉介入诊疗患者,随机分成桡动脉组98例和股动脉组52例,对其穿刺成功率、肢体制动时间、术后患者主诉、并发症的发生率、加压止血方法、平均住院时间进行分析。结果桡动脉组和股动脉组穿刺成功率比较差异无统计学意义（P〉0．05）。患者主诉症状、局部血肿发生率、迷走神经反射发生率,住院时间,桡动脉组比股动脉组明显减少（P〈0．01）。结论经桡动脉途径行冠状动脉介入诊疗,术后护理方便、创伤小、止血容易、患者不需卧床、痛苦小、并发症少、住院时间短、患者更易接受。     

经桡动脉与经股动脉途径行冠状动脉造影和经皮冠状动脉介入治疗的对比研究

目的探讨经桡动脉与经股动脉途径行冠状动脉造影（CAG）和经皮冠状动脉介入治疗（PCI）的优缺点，及解决经桡动脉途径不足之处的方法。方法选取CAG和PCI的患者共300例，按入路血管分为桡动脉组（150例）和股动脉组（150例），对比手术成功率、手术操作时间、X线曝光时间、并发症发生率、住院费用、住院时间，对比解决桡动脉痉挛不同方法的有效性，并进行统计学分析。结果两组的手术成功率、PCI操作时间、X线曝光时间、冠状动脉并发症发生率比较差异均无统计学意义；桡动脉组在穿刺局部并发症发生率（2．0％，3／150）、术后全身不适率（0，0/150）、术后全身并发症发生率（0，0/150）、住院时间[（4．1±2．1）d]、住院费用[（3．7±2．8）万元]方面均显著优于股动脉组[分别为7．3％（11／150）、100．0（150/150）、2．7％（4/150）、（7．8±3．4）d、（5．0±3．4）万元]，差异有统计学意义（P〈0．05）。结论经桡动脉途径行CAG和PCI与经股动脉途径同样有效、可行，而且穿刺局部并发症少。     

经股动脉与桡动脉冠脉介入治疗急性心梗的疗效观察

[目的]探讨经股动脉与桡动脉经皮冠状动脉介入(PCI)治疗急性心肌梗死的临床疗效及可行性。[方法]将我院自2008年8月～2010年10月收治的169例心肌梗死患者按照动脉穿刺途径,随机分为股动脉组84例,桡动脉组85例。对两组间的动脉穿刺点压迫时间、PCI的成功率、穿刺点局部并发症、下肢静脉血栓以及低血压、尿潴留的发生率进行对比分析,观察疗效。[结果]股动脉组成功率为94.05%(79/84),桡动脉组成功率为95.29%(81/85)。两组在PCI的成功率、下肢静脉血栓差异无统计学意义(P﹥0.05);穿刺点压迫时间、穿刺点局部的并发症、低血压及尿潴留的发生率,桡动脉组与股动脉组比较,桡动脉显著少于股动脉组,差异有统计学意义(P﹤0.05)。[结论]经桡动脉途径行急诊经皮冠状动脉介入治疗心肌梗死与经股动脉途径行PCI成功率相似,且血管并发症少,有利于有效安全的抗凝治疗,因此可以作为心肌梗死直接冠状动脉介入治疗选择的途径之一,值得临床推广。     

经桡动脉和股动脉行血管造影比较分析

目的:探讨经桡动脉和股动脉行冠状动脉造影的优缺点.方法:2009年1月～2010年12月间入院行冠状动脉造影的患者50例,随机分组至桡动脉和股动脉途径,比较其成功率、X线照射时间、手术操作时间、不良事件,并行统计学分析.结果:经桡动脉和股动脉血管造影的成功率分别为98%和100%(P＞0.05);X线照射时间分别为:(6.32±3.35)min和(5.70±3.53)min(P＞0.05),手术操作时间分别为(22.10±10.81)min和(20.02±10.34)min(P＞0.05),血管并发症发生率分别为2%和14%(P＜0.01)结论:经桡动脉途径行冠状动脉造影在成功率、X线照射时间和手术操作时间上均不差于股动脉,但有着更少的血管并发症,是一种更安全、有效的介入方法.     

经桡动脉急诊PCI治疗STEMI的可行性研究

目的探讨经桡动脉急诊经皮冠脉介入（PCI）治疗sT段抬高急性心肌梗死（STEMI）的临床疗效及可行性。方法选择确诊的因STEMI行急诊PCI治疗的患者共计225例,其中,经桡动脉组123例,经股动脉组共计102例。分析比较两组患者介入治疗的成功率、疗效、手术时间和术后并发症的发生率。结果两组患者在年龄、性别、体重指数、冠心病危险因素、心肌梗死的部位、血管病变的位置、严重程度等方面比较,均无统计学差异;股动脉组PCI成功率为92．3％,桡动脉组为94．3％,两组之间无统计学差异（P〉0．05）;桡动脉组术后并发症发生率（6．5％）明显低于股动脉组（16．7％）（P〈0．05）;手术平均时间、X线平均曝光时间和Door—balloon时间两组无显著差异;平均住院时间及住院期间主要心血管事件发生率两组之间无统计学差异。结论经桡动脉途径行急诊PCI治疗STEMI与经股动脉途径PCI成功率相似,Door—balloon时间相当,而术后并发症少,值得临床推广应用。     

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 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.     

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.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

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.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.