丁苯酞联合依达拉奉治疗急性脑梗死的临床疗效观察

目的 探讨丁苯酞联合依达拉奉治疗急性脑梗死的临床疗效.方法 选取60例急性脑梗死患者按随机数字表法分为治疗组和对照组,每组30例.两组在改善微循环及抗血小板聚集等常规治疗的基础上,治疗组予以丁苯酞联合依达拉奉治疗,对照组单纯应用依达拉奉治疗,疗程14d.两组在治疗前后分别进行神经功能缺损程度评分、日常生活活动能力评分(改良Barthel指数)及血液流变学检测,并进行比较.结果 治疗前两组神经功能缺损程度评分、日常生活活动能力评分比较差异无统计学意义(P＞0.05).治疗后治疗组和对照组神经功能缺损程度评分均显著下降、日常生活活动能力评分均显著升高(P＜0.01),且治疗后治疗组神经功能缺损程度评分显著低于对照组[(14.13±1.15)分比(17.16±1.08)分](P＜0.01),日常生活活动能力评分显著高于对照组[(62.83±10.14)分比(58.02±9.99)分](P＜0.01).治疗组治疗后的全血黏度、血浆黏度、红细胞压积均较治疗前显著降低(P＜0.01或＜0.05);对照组上述指标治疗前后比较差异无统计学意义(P＞0.05).结论 丁苯酞联合依达拉奉治疗急性脑梗死对神经功能、日常生活活动能力及血液流变学改善效果显著.     

血浆同型半胱氨酸与急性脑梗死关系的临床研究

目的 探讨血浆同型半胱氨酸(Hcy)与急性脑梗死的关系及其临床意义.方法 86例急性脑梗死患者(急性脑梗死组)和同期66例体检正常的健康者(对照组)采用荧光偏振免疫分析法测定血浆Hcy,采用化学发光法测定叶酸和维生素B12,并将结果进行比较.结果 急性脑梗死组血浆Hcy为(20.08±8.72)μmol/L,对照组为(12.50±2.20)μmol/L,两组比较差异有统计学意义(P＜0.01);急性脑梗死组血浆叶酸为(4.98±5.01)μg/L,对照组为(7.68±2.02)μg/L,两组比较差异有统计学意义(P＜0.01);急性脑梗死组血浆维生素B12为(227.39±127.89)pmol/L,对照组为(311.64±152.15)pmol/L,两组比较差异有统计学意义(P＜0.01).结论 急性脑梗死患者血浆Hcy是升高的,而血浆叶酸和维生素B12呈下降趋势,Hcy是急性脑梗死的独立危险因素.     

重组组织型纤溶酶原激活剂联合丁苯酞治疗急性脑梗死的临床疗效及对血浆基质金属蛋白酶9的影响

目的 观察重组组织型纤溶酶原激活剂(rt-PA)联合丁苯酞治疗急性脑梗死的临床疗效及对基质金属蛋白酶9(MMP-9)的影响.方法 选取110例急性脑梗死患者,按随机数字表法分为溶栓组和溶栓加丁苯酞组,每组55例.并选取55例健康体检者作为对照组.溶栓组除基础治疗外给予rt-PA溶栓治疗,溶栓加丁苯酞组给予rt-PA溶栓治疗的同时口服丁苯酞治疗,疗程为14 d.观察比较溶栓组和溶栓加丁苯酞组治疗前后ESS评分、血浆MMP-9水平的变化及临床疗效.结果 溶栓组和溶栓加丁苯酞组治疗前ESS评分、血浆MMP-9水平比较差异无统计学意义(P＞0.05),两组治疗后ESS评分均较治疗前显著升高,治疗后14、21d溶栓加丁苯酞组的ESS评分显著高于溶栓组,且随着疗程的延长,其升高的程度显著优于溶栓组(P＜0.01).治疗后3个月溶栓加丁苯酞组总有效率为85.5％(47/55),显著高于溶栓组的69.1％(38/55)(P＜0.05).对照组血浆MMP-9水平为(12.94±9.23)ng/L,溶栓组和溶栓加丁苯酞组治疗前血浆MMP-9水平分别为(14.13±7.58)、(14.37±8.16)ng/L,治疗后3h分别为(21.64±10.13)、(23.05±11.26)ng/L,均较治疗前显著升高(P＜0.01),且均显著高于对照组(P＜0.01),但两组间比较差异无统计学意义(P＞0.05).溶栓加丁苯酞组颅内出血发生率为7.3％(4/55),病死率为5.5％(3/55),溶栓组分别为10.9％(6/55)、7.3％(4/55),两组比较差异均无统计学意义(P＞0.05).治疗后发生颅内出血患者血浆MMP-9水平升高程度显著大于未发生颅内出血患者(P＜0.05).结论 rt-PA联合丁苯酞治疗急性脑梗死在提高临床疗效的基础上并未增加溶栓后的出血风险,且无严重的不良反应发生,有较好的安全性.     

依达拉奉联合低分子量肝素钙治疗急性脑梗死的疗效观察及对血清C反应蛋白的影响

目的 观察依达拉奉联合低分子量肝素钙治疗急性脑梗死的疗效及对血清C反应蛋白(CRP)的影响.方法 82例急性脑梗死患者按随机数字表法分为两组,每组41例,观察组采用依达拉奉联合低分子量肝素钙治疗;对照组仅采用低分子量肝素钙治疗,比较两组的临床疗效及治疗前后神经功能缺损程度评分及血清CRP的变化.结果 观察组的总有效率为90.2％(37/41),明显高于对照组的70.7％(29/41),差异有统计学意义(P＜0.05).两组治疗后神经功能缺损程度评分均明显下降(P＜0.05).并且,观察组治疗后神经功能缺损程度评分明显低于同期对照组[(9.86±3.41)分比( 13.62±4.23)分](P＜0.05).观察组治疗后血清CRP水平明显下降(P＜0.05),并且明显低于同期对照组[(14.79±3.02) mg/L比(17.38±3.89) mg/L](P＜ 0.05),而对照组治疗前后血清CRP水平比较差异无统计学意义(P＞ 0.05).结论 依达拉奉联合低分子量肝素钙治疗急性脑梗死能够明显提高临床疗效,改善神经功能,减少炎性反应的发生,值得临床推广应用.     

丁苯酞对急性脑梗死患者血浆脑型肌酸激酶同工酶、内皮素及降钙素基因相关肽的影响

目的 探讨丁苯酞与急性脑梗死患者血浆脑型肌酸激酶同工酶(CK-BB)、内皮素(ET)、降钙素基因相关肽(CGRP)的关系.方法 60例急性脑梗死患者按随机数字表法分为常规治疗组和丁苯酞治疗组,每组30例.常规治疗组给予常规治疗,丁苯酞治疗组在常规治疗的基础上加用丁苯酞200 mg,3次/d.两组均连续治疗7d.分别于治疗前后测定血浆CK-BB、ET、CGRP水平,并进行比较.结果 两组治疗后血浆CK-BB、ET水平降低,CGRP水平升高,与治疗前比较差异有统计学意义(P＜0.01或＜0.05),并且丁苯酞治疗组治疗后血浆CK-BB、ET水平显著低于同期常规治疗组[(216.48±36.95) U/L比(333.07±54.03) U/L,(83.33±26.48)ng/L比(98.46±31.46)n/L],差异有统计学意义(P＜0.05),CGRP水平显著高于同期常规治疗组[(44.16±13.28)ng/L比(36.42±12.31) ng/L],差异有统计学意义(P＜0.05).结论 丁苯酞能降低血浆酶活性,调节ET/CGRP平衡,并且具有扩脑动脉效应以拮抗ET,改善脑缺血、缺氧,从而起到保护脑细胞与血管内皮细胞的作用.     

42例丁苯酞胶囊治疗急性脑梗死临床观察

[目的]探讨丁苯酞胶囊治疗急性脑梗死的疗效。[方法]将84例急性脑梗死患者随机分入治疗组和对照组各42例,对照组采用西医常规治疗,治疗组在西医常规治疗的基础上加用丁苯酞胶囊,治疗1个疗程后,观察两组的临床疗效。[结果]治疗组显效率(61.90%)明显高于对照组(38.10%),差异有统计学意义(P﹤0.05),每个组治疗后神经功能缺损程度评分均明显低于治疗前(P﹤0.05),治疗后,治疗组神经功能缺损程度评分(11.03±9.95)显著低于对照组(16.62±10.21)(P﹤0.05)。[结论]丁苯酞胶囊可提高急性脑梗死临床疗效。     

丁苯酞注射液联合依达拉奉治疗急性脑梗死的疗效研究

目的探究丁苯酞注射液联合依达拉奉治疗急性脑梗死的临床效果。方法选择2016年9月—2018年11月于某医院进行治疗的急性脑梗死患者108例,依据随机数字表法分成观察组与对照组,各为54例。对照组采用丁苯酞注射液治疗,观察组在对照组基础上联合依达拉奉治疗,将两组患者治疗后总有效率与治疗前后的美国国立卫生研究院卒中量表(NIHSS)评分、血清中炎症因子[C反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)]水平进行比较。结果观察组治疗总有效率为94.44%,高于对照组(81.48%),(P<0.05);治疗后,观察组NIHSS评分与CRP、IL-6、TNF-α水平分别为(8.93±2.36)分、(7.28±3.38)mg/L、(44.08±6.41)pg/mL、(17.41±1.34)pg/mL,均低于对照组的(12.28±3.32)分、(15.22±4.85)mg/L、(52.24±7.65)pg/mL、(20.30±2.25)pg/mL,差异具有统计学意义(P<0.05)。结论丁苯酞注射液联合依达拉奉治疗急性脑梗死的临床效果显著,能有效恢复患者的神经功能,减轻炎症反应。     

急性脑梗死患者血清C-反应蛋白和神经元特异性烯醇化酶水平变化及相关性研究

目的 观察急性脑梗死(ACI)发病早期血清CRP和神经元特异性烯醇化酶(NSE)水平变化与病情严重程度的关系以及两者的相关关系.方法 检测60例ACI患者(ACI组)以及40例健康体检者(对照组)的血清CRP、NSE水平,采用美国国立卫生院卒中量表(NIHSS)对ACI患者入院时的临床神经功能损害程度进行评价,比较CRP、NSE水平在不同大小梗死灶及不同临床神经功能损害程度中的差异,并与对照组比较.结果 ACI组血清CRP、NSE水平与对照组比较显著增高[(6.95±2.34)mg/L比(2.21±1.05)mg/L,(22.39±4.72)μg/L比(7.16±2.63)μg/L,P均＜0.01].梗死灶越大、临床神经功能损害程度越重,血清CRP、NSE水平越高.血清CRP、NSE水平分别与NIHSS评分呈正相关(r=0.51、r=0.44,P均＜0.01).血清CRP水平与NSE水平呈正相关(r=0.57,P＜0.01).结论 ACI发病早期血清CRP、NSE水平变化可反映梗死灶大小和临床神经功能损害的严重程度.CRP、NSE水平均可作为ACI患者病情评估的重要生物学指标.     

75例急性冠脉综合征患者血清同型半胱氨酸的检测

目的:探讨急性冠脉综合征(ACS)患者血清同型半胱氨酸(Hcy)的变化.方法:对75例ACS患者血清Hcy进行测定分析.结果:ACS组的Hcy含量为(39.88±3.79)μmol/L,显著高于正常对照组的(15.17±2.81)μmol/L(P＜0.05).ACS组Hcy异常检出率显著高于正常对照组(P＜0.01).结论:Hcy可用于ACS的诊断和病情观察.     

辛伐他汀对急性脑卒中患者血清脂联素和不对称性二甲基精氨酸水平的影响

目的 探讨辛伐他汀对急性脑卒中患者血清脂联素和不对称性二甲基精氨酸(ADMA)水平的影响.方法 选择急性脑卒中患者90例,按随机数字表法分为常规治疗组和干预治疗组,每组45例.计算两组患者脑梗死体积和临床神经功能缺损程度评分.酶联免疫吸附试验法检测两组治疗前后血清脂联素和ADMA水平.比较两组治疗前后脂联素和ADMA水平的变化,并分析其与脑梗死体积和临床神经功能缺损程度评分的相关性.结果 治疗前两组患者脂联素和ADMA水平比较差异无统计学意义(P＞0.05)；治疗后两组患者脂联素水平明显升高,ADMA水平明显下降,与治疗前比较差异有统计学意义(P＜0.05).但是干预治疗组治疗后脂联素水平明显高于同期常规治疗组,ADMA水平明显低于同期常规治疗组,差异有统计学意义[(5.92±0.15)mg/L比(4.51±0.13)mg/L,(0.96±0.13)μmol/L比(1.08±0.15)μ mol/L] (P＜ 0.05).等级相关分析结果显示患者治疗前脂联素水平与脑梗死体积和临床神经功能缺损程度评分均呈负相关,相关系数分别为-0.75和-0.59,P值均＜0.05.患者治疗前ADMA水平与脑梗死体积和临床神经功能缺损程度评分均呈正相关,相关系数分别为0.68和0.71,P值均＜0.05.结论 辛伐他汀能有效地升高急性脑卒中患者脂联素水平和降低ADMA水平,改善患者预后.     

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.     

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.     

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.     

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.     

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.     

Hydrazine inhalation hepatotoxicity

Abstract Hydrazine is a hazardous chemical commonly used as a reactant in rocket and jet fuel cells. Animal studies have demonstrated hepatic changes after hydrazine inhalation. Human case reports of hydrazine inhalation hepatotoxicity are rare. We report a case of mild hepatotoxicity following brief hydrazine vapour inhalation in a healthy young man, which resolved completely on expectant management.     

Fitness standards in airline staff

Employers have a legal duty to manage safety and to meet this duty it is necessary to control risks arising from pre-existing medical conditions. Such conditions can be identified at the time of job placement, but there is little published information about the approach to fitness standards by most airlines. This review is therefore limited to the practice of one major airline. It is illustrated by reference to various occupations within the airline, with the associated rationale.