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2015—2017年重庆市大型汽车制造企业重点职业病危害因素监测结果

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职业与健康 2018年第13期34卷 1737-1739页

作者：陈凤琼冉瑞红邓华欣重庆市疾病预防控制中心职业卫生所与放射卫生所重庆400042

目的分析重庆市大型汽车制造企业2015—2017年职业病危害因素监测结果,提出防护措施建议。方法收集重庆市大型汽车制造企业2015—2017年职业病危害因素监测结果,分析不同年份监测结果的差异性。结果职业病危害因素总超标率为20.8%,且随... 详细信息

目的分析重庆市大型汽车制造企业2015—2017年职业病危害因素监测结果,提出防护措施建议。方法收集重庆市大型汽车制造企业2015—2017年职业病危害因素监测结果,分析不同年份监测结果的差异性。结果职业病危害因素总超标率为20.8%,且随年份推移有降低趋势(P0.01);噪声超标率最高为43.6%,且随年份推移呈降低趋势(P<0.01);其他粉尘超标率随年份呈升高趋势(P<0.01)。结论噪声、矽尘、锰及其化合物和电焊烟尘等仍是大型汽车制造企业主要职业病危害因素,大型汽车制造企业应加大对尘毒危害控制,加强噪声作业场所防控技术升级,合理布局,减少噪声对作业人员健康危害。

关键词：汽车制造职业病危害因素监测结果

自扩式金属支架与可塑性管缓解恶性吞咽困难的比较:153例连续患者的远期预后

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世界核心医学期刊文摘（胃肠病学分册） 2006年第4期2卷 48-48页

作者： Eickhoff A Knoll M Jakobs r. 张欣 Medical Department C Klinikum Ludwigshafen Bremserstr. 79 D-67063 Ludwigshafen GermanyDr.

Background: Malignant dysphagia due to esophagogastric cancer is associated with poor overall prognosis. Placements of self-expandable metal stents or plastic tubes are established methods as palliative treatment options. As an alternative and/or complementary therapy, radiologic techniques (external beam radiation/brachy therapy) and locally endoscopic techniques (laser, APC-beamer, PDT) are often used. Study and Goals: retrospective trial of 153 patients treated in our department between 1993 and 2001. Forty-five patients received a plastic tube ( Group A) and 108 patients were treated with metal stents (Group B). Both groups were compared for improvement of dysphagia score, survival, recurrent dysphagia and complications. results: Stent placement was successful in 41 of 45 (93%) pa tients of Group A and 107 of 108 (99%) of Group B. The median dysphagia score i mproved significantly in Group A (from 3.03 to 1.55, P = 0.010) and Group B (fro m 2.77 to 1.44, P = 0.009). recurrent dysphagia was noted in 12 of 45 (27%) pat ients of Group A and 27 of 108 (25%) patients of Group B. Median survival time after stent insertion was 78 days (Group A) and 113 days (Group B). Overall comp lications occurred in 15 of 45 (33%) patients of Group A and 28 of 108 (26%) p atients of Group B. However, significantly (P = 0.05) more major complications w ere seen in Group A than in Group B (22%vs. 9%). Conclusions: Our results indi cate a marginal clinical benefit for metal stents versus plastic tubes in malign ant dysphagia in the long run. However, metal stents seem to be safer and associ ated with a prolonged improvement of dysphagia score.

关键词：金属支架吞咽困难支架放置近距离放射疗法光动力疗法补充治疗性光复发率医院科室影像学技

临床未确诊的多发性硬化患者视神经炎后长期脑MrI改变

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世界核心医学期刊文摘（神经病学分册） 2005年第3期1卷 12-12页

作者： Gal r.L. 黄卫东 Jaeb Center for Health research 15310 Amberly Dr Tampa FL 33647 United States

Background: Long term follow up of the Optic Neuritis Treatment Trial (ONTT) cohort to evaluate brain magnetic resonance imaging (MrI) in patients who have not developed clinically definite multiple sclerosis. Objective: To determine th e proportion of patients with monosymptomatic optic neuritis who manifest new br ain MrI lesions without having developed clinically definite multiple sclerosis 10 to 14 years after enrollment in the ONTT. Design: Observational study. Settin g: Fourteen clinical centers. Participants: One hundred eight ONTT patients who had not developed clinically definite multiple sclerosis 10 to 14 years after st udy enrollment. Main Outcome Measure: Development of new T2 lesions on follow u p brain MrI. results: At least 1 T2 lesion 3 mm or larger was observed on follow up MrIs in 27 (44%) of 61 patients with normal baseline MrIs. Additional lesi ons (≥3 mm) were present on follow up MrIs in 26 (74%) of 35 patients with ab normal baseline MrIs. Conclusions: A subset of patients with monosymptomatic opt ic neuritis manifest neither clinical signs nor MrI evidence of demyelination af ter more than 10 years of follow up. In other cases followed up for this length of time, MrI signal abnormalities may accumulate without causing new clinical m anifestations of multiple sclerosis. This information is useful in counseling pa tients who develop first episode optic neuritis.

关键词：多发性硬化视神经炎表现正常内脑观察性研究脱髓鞘临床中心初发性治疗试验试验设计

乳糜泻与食管肠上皮化生(Barrett食管)

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世界核心医学期刊文摘（胃肠病学分册） 2005年第8期1卷 12-12页

作者： Maieron r Elli L Marino M 郝筱倩 P. le S. M. della Miseric ordia 33100 Udine Italy.Dr

Previous studies on celiac patients demonstrated that exposure to gliadin alte rs the motility of the upper gastrointestinal tract,leading to increased acid re flux. No literature is available regarding the possible presence of specialized intestinal metaplasia of the esophagus as a consequence of chronic reflux in adu lt celiac patients. Our purpose was to evaluate endoscopically and histologicall y the esophagi of a group of untreated celiac patients. We studied 60 celiac pat ients, 13 men and 47 women (mean age, 40 ±14 [SD] years; range, 18-80 years),a t their first endoscopy (following a normal diet). The distal esophagus was eval ua ted andmultiple biopsieswere taken. Hematoxylin-eosin and alcian blue stainin gs were performed. A group of non- celiac, age-and sex-matched patients was used as a control. We found intesti nal metaplasia in the distal esophagus of 16 of 60 (26.6%) celiacs (mean age, 4 5 ±13 years; range,27-75 years), in comparison with a control-group prevalenc e of 10.9%(Or, 3.9; 95%CI, 1.4-11.2%). Among the celiac group with metaplasi a, only one patient had reflux-like *** had esophagitis. In conclusio n, we observed an increased prevalence of esophageal metaplasia in patients with celiac *** finding could be the result of motor abnormalities leading to chronic acid reflux, combined with amucosa which is sensitive to gliadin.

关键词： Barrett食管乳糜泻肠上皮化生多点活检酸反流麦胶蛋白标准餐阿利辛蓝染色上消化道性别匹配

联合应用肾上腺素和双极电凝与单独应用双极电凝治疗出血性消化性溃疡疗效比较:一项随机对照研究

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世界核心医学期刊文摘（胃肠病学分册） 2005年第8期1卷 25-25页

作者： BiancoM.A rotondano G Marmo r 郝筱倩

Endoscopic treatment with combined modalities is considered standard of care f or patients with high-risk peptic ulcer bleeding. This study compared epinephri ne injection plus bipolar probe coagulation with bipolar probe coagulation alone in patients with high-risk peptic ulcer bleeding. patients with endoscopically confirmed peptic ulcer bleeding (active or visible vessel) seen from January 20 00 through December 2002 were prospectively randomized to two groups. The study group (n = 58) had epinephrine injection followed by bipolar coagulation; the co ntrol group (n = 56) was treated by bipolar coagulation alone. The primary outco mes assessed were the rate of initial hemostasis and the rate of recurrent bleed ing. Secondary outcomes were the following:need for surgical intervention to con trol bleeding,transfusion requirements, length of hospital stay (in days)-, and 30-day mortality. The rate of initial hemostasis was significantly higher in t he combination therapy group (p = 0.02; absolute risk reduction 31.6%: 95%CI [ 5.4, 57.7]).There was no significant difference between the two treatment groups with respect to all other outcomes measures,except that significantly fewer uni ts of blood were transfused in the combination therapy group (p = 0.006). In pat ients with active peptic ulcer bleeding, epinephrine injection plus bipolar coag ulation achieved significantly higher rate of initial hemostasis. All other outc ome measures were similar with either treatment in patients with non-bleeding s tigmata.

关键词：双极电凝消化性溃疡止血率活动性出血主要评价指标复发率外科手术无显著性差异单位数

医疗卫生保健系统对乳腺癌和宫颈癌妇女的作用

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世界核心医学期刊文摘（妇产科学分册） 2005年第9期1卷 61-61页

作者： Kirsner r.S. Fleming L. 高雪莲 University of Miami/Ve terans Administration Medical Center Department of Dermatology 1201 NW 16th St reet Miami FL 33125 United States Dr.

OBJECTIVE: Two common health care delivery systems in the United States are fe e-for-service and managed care systems, including health maintenance organizat ions (HMOs). Differences may exist in patient outcomes depending upon the health care delivery system in which they are enrolled. We evaluated possible differen ces in the stage at diagnosis for breast and cervical cancer between 2 Medicare health care delivery systems (ie, fee for service and HMO) over the period 1985 -2001. METHODS: We used a linkage of 2 national databases: the Medicare databas e from the Centers for Medicare and Medicaid Services and the National Cancer In stitute’s Surveillance, Epidemiology, and End results program database to evalu ate differences in stage at diagnosis between HMO and fee for service for breast and cervical cancer. rESULTS: We studied 130,336 Medicare-aged women with brea st cancer (83%Medicare fee for service) and 6,758 women with cervical cancer (8 7%Medicare fee for service). We found an earlier stage of diagnosis for HMO pat ients, which remained significant after adjusting for potential confounding vari ables. Women enrolled in HMOs with breast cancer were 17%more likely and those with cervical cancer 35%more likely to be diagnosed at an in situ stage of diag nosis than fee-for-service patients. It is of note that when women had other c ancer diagnoses, no statistically significant differences were seen in stage at diagnosis for either cancer between fee-for-service and HMO patients. CONCLUSI ON: Differences exist in stage at diagnosis between Medicare patients enrolled i n HMOs compared with fee for service. This is likely due in part to use of or ac cess to care.

关键词：医疗卫生保健医疗保健收费服务原位癌卫生保健系统国家癌症研究所癌症诊断维持组织项目数据库混杂变量

增加干扰素β-1a剂量和频率治疗复发性多发性硬化症提高药物疗效的EVIDENCE研究

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世界核心医学期刊文摘（神经病学分册） 2005年第9期1卷 22-22页

作者： Schwid S.r. Thorpe J. Sharief M. 江山 Department of Neurology University of Rochester Box 605 601 Elmwood Ave Rochester NY 14642 United StatesDr.

Background: The EVIDENCE (Evidence of Interferon Dose-response: European Nort h American Comparative Efficacy) Study demonstrated that patients with multiple sclerosis (MS) who initiate interferon beta-1a therapy with 44 μg 3 times week ly (TIW) were less likely to have a relapse or activity on magnetic resonance im aging (MrI) compared with those who initiate therapy at a dosage of 30 μg 1 tim e weekly (QW). Objective: To determine the effect of changing the dosage from 30 μg QW to 44 μg TIW in this extension of the EVIDENCE Study. Design/patients: patients with relapsing MS originally randomized to interferon beta-1a, 30 μg QW, during the comparative phase of the study changed to 44 μg TIW, whereas pat ients originally randomized to 44 μg TIW continued that regimen. patients were followed up, on average, for an additional 32 weeks. Main Outcome Measure: The w ithin-patient pretransition to posttransition change in relapse rate. results: At the transition visit, 223 (73%) of 306 patients receiving 30 μg QW converte d to 44 μg TIW, and 272 (91%) of 299 receiving 44-μg TIW continued the same therapy. The posttransition annualized relapse rate decreased from 0.64 to 0.32 for patients increasing the dose (P rom 0.46 to 0.34 for patients c ontinuing 44-μg TIW (P=.03). The change was greater in those increasing dose a nd frequency (P=.047). patients converting to the 44-μg TIW regimen had fewer active lesions on T2-weighted MrI compared with before the transition (P=.02), whereas those continuing the 44-μg TIW regimen had no significant change in T2 active lesions. patients who converted to high-dose/high-frequency interferon beta-1a therapy had increased rates of adverse events and treatment terminatio ns consistent with the initiation of high-dose subcutaneous interferon therapy. Conclusions: patients receiving interferon beta-1a improved on clinical and Mr I disease measures when they changed from 30 μg QW to 44 μg TIW.

关键词：多发性硬化症 EVIDENCE 复发率疗效研究比用

可植入式心脏复律除颤器患者预警装置:工具还是玩具?

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世界核心医学期刊文摘（心脏病学分册） 2005年第1期1卷 41-41页

作者： Becker r. ruf-richter J. Senges-Becker J.C. 苏显明 Universit y of Heidelberg/Cardiology Heidelberg GermanyDr.

Objectives The purpose of this study was to analyze the utility of patient-al ert features in implantable cardioverter defibrillators (ICDs). Background Vario us alert features producing acoustic warning signals have been implemented in ne wer generation ICDs, but their role in early detection of system-related compli cations has not been systematically evaluated. Methods In 240 patients implanted with Medtr-onic ICD devices, the following alert features were routinely activ ated: pacing lead impedance r > 2,000, high-voltage lead impedance r >200, low battery voltage (elective replacement indicator), long charge time (>18 s), >3 shocks delivered per episode, and all therapies in a zone delivered. Alert events occurring during follow-up were assessed in relation to actual fi ndings (hospital charts, chest X-rays, ICD printouts including sensing/pacing/d efibrillation threshold tests, episode data) to determine incidence, sensitivity , and specificity of the alert function. results During 12.2 ±8.9 months, 24 al ert events occurred in the 240 patients (pacing lead impedance, n=4; high-volta ge lead imped-ance, n=7; low battery voltage, n=1; >3 shocks, n=6; all therapie s, n=6). A total of 22 serious complications (necessitating reprogramming or dev ice/lead replacement)were observed, 14 of which were primarily identified throug h a patient alert (lead fracture, n=11; connector defect, n=1; T-wave oversensi ng, n=1; battery depletion, n=1). This reflects a sensitivity of 64%and a speci ficity of 96%of the alert function for serious complications. With 14 of 24 pat ient alerts being caused by serious complications, the positive predictive value reached 58%. Conclusions patient-alert features are a useful additional tool facilitating early detection of serious ICD complications, but they do not subst itute for regular ICD follow-up, because of their low sensitivity.

关键词：心脏复律起搏电极阻抗植入式感知过度电池电压警报信号充电时间早期检测阳性预测值特异性

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与钓鱼有关的眼外伤研究

世界核心医学期刊文摘（眼科学分册） 2005年第8期1卷 25-25页

作者： Alfaro III D.V. Jablon E.P. Fontal M.r. 张鹏 retina Consultants of Charleston 2093 Henry Tecklenburg Drive Charleston SC 29414 United States Dr.

PUrPOSE: To evaluate the characteristics of fishing-relat- ed ocular injuries. .DESIGN: retrospective observational analysis of a compute rized databank. METHODS: The United States Eye Injury registry was used to analy ze 143 patients with fishing-related ocular injury. Epidemiolgic and clinical i nformation was evaluated including the age and gender of the subjects, classific ation of ocular trauma, surgical management, and final visual acuity. rESULTS: O f the 732 cases of sportrelated ocular trauma, 143 (19.54%) occurred while fish ing; of these, 79%were male patients who ranged in age from 6 to 68 years (mean , 37 years). Corneal laceration, globe rupture, and hyphema were the most common diagnoses at presentation and were caused by fishing hooks, lures, and weights. Thirty-five bystanders are included in the study. Thirty-eight percent of pat ients had visual acuity less than 20/50, and 21%had a visual acuity of less tha n 20/200. Open globe injuries portended a poor visual outcome compared with clos ed globe injuries. CONCLUSIONS: Fishing-related ocular injuries represent a lar ge percent of sports-related trauma, often resulting in significant visual loss . Preventive measures such as the use of protective eyewear should be advised in this activity.

关键词：眼外伤角膜裂前房积血外伤类型眼球破裂眼外科登记系统计算机数据库防护措施临床诊断