胃癌患者胃大部切除术后感染的危险因素分析

目的 分析医院胃癌患者行胃大部切除术后感染的相关影响因素,为术后感染的预防治疗提供参考依据.方法 回顾性分析医院2007年1月-2011年10月普外科行胃大部切除术的胃癌患者临床资料190例,单因素分析其术后感染的危险因素.结果 190例行胃大部切除术的胃癌患者共发生感染32例,感染率为16.8％;术后感染以手术切口感染为主,占40.6％,其次为腹腔、呼吸道和肠道感染,分别占25.0％、21.9％和12.5％;单因素x2检验显示,年龄＞60岁、手术时间＞100 min,肿瘤临床分期差、术中输血、白细胞计数＜2×109/L是胃癌患者胃大部切除术后感染的高危因素(P＜0.05),而与患者的性别和手术方式无显著相关性.结论 胃癌患者胃大部切除术后以手术切口感染为主,其次为腹腔和呼吸道感染,年龄、手术时间、临床分期、术中输血、白细胞计数是胃癌患者胃大部切除术后感染的高危因素.     

产妇剖宫产围术期切口感染因素分析

目的探讨产妇剖宫产围术期切口感染的相关因素,为临床降低刨宫产产妇感染提供有效的预防措施。方法回顾性分析2009年1月-2012年12月产科2 128例产妇行剖宫手术资料,将发生切口感染的52例产妇作为观察组,同期未发生感染的2 076例产妇作为对照组,采用单因素及多因素logistic分析对导致剖宫产产妇围术期切口感染因素进行相关分析。结果 2 128例行剖宫产手术产妇,共发生切口感染52例,感染率为2.44%;单因素结果显示,观察组产妇体质量指数、备皮至手术时间、手术时间、术中出血量、住院时间,分别为(25.80±2.35)kg/m2、(90.50±25.65)min、(90.80±25.50)min、(450.60±58.90)ml、(11.60±2.40)d,对照组分别为(20.10±1.24)kg/m2、(50.42±15.37)min、(50.30±20.10)min、(247.6±78.2)ml、(7.6±1.8)d,两组比较差异有统计学意义(P<0.05);经多因素分析,体质量指数、住多人病室、手术时间、胎膜早破是影响剖宫产产妇围术期切口感染的独立危险因素。结论剖宫产产妇应妥善处理围手术期的各种不良因素,加强医院卫生消毒管理,缩短手术时间,有效预防术后切口感染发生,有效提高产妇术后生存质量。     

子宫切除术后发生切口感染的危险因素回顾性调查及预防策略探讨

目的探讨子宫切除术后发生切口感染的危险因素,并且针对性地提出预防策略。方法收集414例子宫切除术患者临床资料,回顾性调查分析可能引起患者术后切口感染的相关因素。结果术后发生切口感染者26例,切口感染率6.28%,其中浅部切口感染20例,深部切口感染6例,感染率为4.83%、1.45%。单因素分析显示患者年龄≥60岁、恶性病变、合并糖尿病、手术时间≥3 h、开腹手术、子宫全切除术、术中出血量≥300 ml、围术期输血、术中手术室人员数量≥5人、接台手术时切口感染率分别为11.46%、14.13%、16.13%、13.11%、11.03%、7.69%、11.94%、15.15%、14.10%、8.21%,高于无以上因素时的感染率,差异有统计学意义(P<0.05),患者有无合并高血压时切口感染率比较差异无统计学意义(P>0.05)。logistic回归分析显示恶性病变、合并糖尿病、手术时间≥3 h、开腹手术、子宫全切除、术中出血量≥300 ml、围术期输血、术中手术室人员数量≥5人是引起切口感染发生的独立危险因素(P<0.05)。结论子宫切除术后切口感染发生率相对较低,患者合并有糖尿病、疾病病变性质、手术方式及手术范围、手术时间、术中出血量及围术期输血情况、术中手术室的人员流动性等因素均会影响到术后切口感染发生风险性,上述因素为独立危险因素,应在围术期针对上述危险因素采取措施进行干预以降低术后切口感染的发生。     

血管介入术围手术期抗菌药物的选择

目的探究肝动脉栓塞术(TACE)和颈静脉肝内门体分流术(TIPS)在围手术期应用抗菌药物对术后感染的预防评价,为术后患者合理用药提供依据。方法分析2010年2月-2015年1月医院行TACE和TIPS治疗的肝硬化患者的临床资料,按照是否使用抗菌药物分组,其中252例行TACE,抗菌药物组158例,非抗菌药物组70例;138例行TIPS患者抗菌药物组98例,非抗菌药物组40例;观察患者术后是否发生感染,并对术后感染进行单因素及多因素logistic回归分析。结果行TACE和TIPS患者抗菌药物组和非抗菌药物组术后感染率差异无统计学意义;单因素分析发现,年龄、Child-Pugh分级、手术时间、肿瘤大小与TACE和TIPS术后感染有关,差异均有统计学意义(P0.05);以术后是否发生感染为因变量,进行多因素logistic分析,结果显示,年龄、Child-Pugh分级、手术时间、肿瘤大小是行TACE和TIPS患者术后感染的危险因素。结论 TACE和TIPS在围手术期应用抗菌药物的意义不大,但对于年龄大、肝功能严重异常、手术时间长、肿瘤大的患者,应给予抗菌药物进行预防术后感染。     

食管及贲门癌患者术后感染危险因素研究

目的 探讨食管、贲门癌患者术后感染危险因素,为疾病诊治和术后感染预防提供依据.方法 对医院2009年1月-2012年12月收治的620例食管、贲门癌患者进行回顾性分析,分析其术后感染率、感染部位和病原菌分布;选择性别、年龄、吸烟等16个变量进行单因素回归分析,并应用logistic回归分析分析食管、贲门癌术后感染的危险因素.结果 620例食管、贲门癌患者术后感染率为13.2％,其中切口、肺部、胸腔感染率分别占41.5％、46.3％、3.7％;经单因素logistic回归分析,吸烟、糖尿病、手术方式、术后发热、术后白细胞、肿瘤部位和肺部疾病7个变量与术后感染相关(P＜0.05);经多因素logistic回归分析,吸烟、手术方式、术后发热和肺部疾病4个变量是食管、贲门癌患者术后感染独立危险因素(P＜0.05).结论 食管、贲门癌患者术后感染发病率较高,吸烟、糖尿病、手术方式、术后发热、术后白细胞、肿瘤部位和肺部疾病等与术后感染有关,针对以上因素应积极采取有效措施,降低术后感染发生率.     

结肠癌患者术后感染的影响因素分析及列线图模型构建

目的分析影响结肠癌患者术后感染的危险因素并构建列线图模型。方法回顾性分析安徽省肿瘤医院2019年5月至2022年6月220例结肠癌患者的临床资料。其中, 发生术后感染55例(感染组), 未发生术后感染165例(非感染组)。采用受试者工作特征(ROC)曲线分析各指标预测结肠癌患者发生术后感染的效能;采用多因素Logistic回归分析影响结肠癌患者发生术后感染的独立危险因素。采用R语言3.5.2软件构建预测结肠癌患者发生术后感染的列线图模型并验证和评估。结果两组性别构成、体质量指数、肿瘤分期、术中输血、高血压、吸烟史、饮酒史、肿瘤直径和血红蛋白比较差异无统计学意义(P>0.05);感染组年龄、糖尿病比例、手术时间和排气时间明显大于非感染组[(49.60 ± 4.40)岁比(47.20 ± 4.12)岁、63.64%(35/55)比30.30% (50/165)、(197.80 ± 12.55)min比(192.23 ± 12.05)min和(3.42 ± 1.18)d比(2.60 ± 0.80)d], 白蛋白明显低于非感染组[(28.29 ± 3.02)g/L比(32.80 ± 3....     

肝包虫病患者手术部位感染危险因素的logistic回归分析

 目的 分析肝包虫病患者手术部位感染的危险因素。方法 选取2017年1月-2020年12月在青海省人民医院接受肝包虫病手术治疗的患者,根据是否发生手术部位感染分为感染组和对照组。回顾性分析患者病历资料,采用单因素和多因素logistic回归分析,分析肝包虫病患者手术部位感染的危险因素。结果 共纳入681例患者,发生手术部位感染59例,感染率为8.66%,其中切口感染23例,腹腔感染28例,切口+腹腔感染6例,膈下感染2例。感染患者共分离出63株病原菌,其中革兰阴性菌占63.49%,革兰阳性菌占34.92%。主要以铜绿假单胞菌、鲍曼不动杆菌和粪肠球菌为主,分别占17.46%、9.53%和7.94%。多因素logistic回归分析显示,合并糖尿病、有肝包虫病手术史、术后胆漏、引流管留置时间≥ 15 d、手术时间≥ 250 min是肝包虫病患者手术部位感染的独立危险因素(均P<0.05)。结论 肝包虫病患者手术部位感染危险因素较多,围手术期及术后积极控制血糖、尽可能避免肝包虫病复发从而减少肝包虫病手术史,积极预防术后胆漏,缩短手术时间,以及减少引流管留置时间等在预防肝包虫病手术部位感染中可起积极作用。     

结直肠癌术后切口感染相关危险因素分析

目的探讨结直肠癌术后切口感染相关危险因素,预防结直肠癌患者切口感染。方法对2006年6月-2010年6月100例结直肠癌术后切口感染患者的临床资料进行回顾性分析,对影响其感染的相关危险因素进行单因素及多因素分析;采用SPSS 17.0统计软件进行统计分析。结果 1 620例手术患者中发生医院感染303例,其中切口感染100例,感染率为6.2%,单因素分析显示,切口感染与患者体质量指数、糖尿病、术前低白蛋白血症、手术部位、手术方式、术中输血、围手术期低体温及手术时间有关;多因素分析显示,切口感染的独立性危险因素为术前低白蛋白、手术方式、围手术期低体温及手术时间。结论结直肠癌术后切口感染因素复杂,通过改善患者营养状况、大力推广腔镜手术、避免围手术期出现低体温及有效控制手术时间,可减少切口感染的发生。     

胰腺癌术后医院感染病原学特点及影响因素探究

目的探究胰腺癌术后医院感染的影响因素及感染病原学特点。方法回顾性分析2011年6月-2017年6月医院收治的289例胰腺癌手术治疗患者临床资料,根据术后是否感染分为感染组和非感染组,对比两组患者一般临床资料,治疗、手术及术后并发症等情况。观察术后感染患者病原学特点,采用单因素及多因素Logistic分析探究胰腺癌术后发生感染的影响因素。结果胰腺癌患者术后发生医院感染27例,感染率为9.34%,术后感染患者临床送检标本共培养病原菌40株,革兰阴性菌24株占60.0%,其中以大肠埃希菌为主,革兰阳性菌10株占25.0%,其中以屎肠球菌为主,真菌6株占15.0%;合并糖尿病、术前血清白蛋白水平低、术中出血量大、术中输血、围手术期抗菌药物使用、中心静脉置管、留置导尿时间长,术后胰瘘、胆瘘、住ICU时间和总住院时间为胰腺癌患者术后发生医院感染的影响因素,多因素logistic回归分析显示:并发胰瘘、胆瘘及术中输血是术后感染的独立性影响因素。结论胰腺癌术后并发胰瘘、胆瘘及术中输血是术后感染的影响因素,术中规范操作尽量降低胰瘘、胆瘘发生率,尽量避免术中输血可降低术后感染率。     

食管癌及贲门癌术后肺部感染危险因素分析

目的 分析食管癌及贲门癌术后肺部感染危险因素,探讨临床防治措施,为临床工作提供借鉴.方法 选取医院2008年12月—2012年8月行食管癌、贲门癌手术切除且术后出现肺部感染患者30例临床资料,设为观察组,并以同期未出现肺部感染患者80例设为对照组,进行相关危险因素单变量及logistic回归多变量分析.结果 对照组患者年龄、吸烟例数、合并低蛋白血症例数、病程、术中出血量、镇痛药物使用及合并慢性阻塞性肺疾病例数分别为(46.1±5.5)岁、15例、11例、(5.1±1.7)个月、(269.5±68.5)ml、7例、8例;观察组患者分别为(57.5±6.3)岁、16例、15例、(6.4±2.3)个月、(516.7±104.0)ml、9例、14例;两组间比较,差异有统计学意义(P＜0.05);经logistic多变量回归分析证实术中出血量、低蛋白血症及慢性阻塞性肺疾病是食管癌贲门癌术后肺部感染独立危险因素.结论 食管癌贲门癌术后肺部感染与患者术中出血量、合并低蛋白血症及慢性阻塞性肺疾病密切相关;临床医师应当加强围手术期感染防治工作以有效降低术后肺部感染发生风险.     

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.     

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.     

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.     

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.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.