肝移植术后乙型肝炎病毒复发及再感染的防治策略

目的 探讨有效防治肝移植术后乙型肝炎病毒复发及再感染的防治方法 .方法 回顾性分析医院2004年4月-2008年10月因乙型肝炎相关的终末期肝病接受肝移植的病例79例,根据不同防治乙型肝炎复发及再感染的方案,分为单用拉米夫定组(A组)、拉米夫定联合小剂量乙型肝炎免疫球蛋白组(B组)和大剂量乙型肝炎免疫球蛋白组(C组),比较3组患者术后乙型肝炎复发及再感染的情况.结果 A组乙型肝炎复发率为33.33%,明显高于B组(7.14%)及C组(5.56%),差异有统计学意义(P＜0.05);复发患者中A组发生YMDD变异的比例为80%,同样明显高于B组(0)及C组(0),差异有统计学意义(P＜0.05);B组中术前HBeAg和HBV-DNA阳性的患者发生乙型肝炎复发比例是30.00%,高于C组的4.35%,差异有统计学意义(P＜0.05).结论 拉米夫定联合乙型肝炎免疫球蛋白预防肝移植术后乙型肝炎复发的效果优于单用拉米夫定,对于术前HBeAg和HBV-DNA阳性的患者,大剂量使用乙型肝炎免疫球蛋白能降低乙型肝炎复发的风险.     

肝移植术后乙型肝炎病毒再感染的预防

目的 探讨肝移植术后乙型肝炎病毒再感染的预防。方法 回顾性分析88例乙型肝炎病毒（HBV）相关终末期肝病，分别为慢性乙型重症肝炎、终末期肝硬化及合并肝癌患者，行肝移植术后联合应用拉米夫定、抗乙型肝炎免疫球蛋白（HBIg）的临床资料，术前均服用拉米夫定，术后3例患者单用拉米夫定，85例联合应用拉米夫定及小剂量抗HBIg，以临床血液病毒学、肝活检免疫组化及临床症状变化为指标，随访≥6个月。结果　单用拉米夫定组3例中有2例术后HBV再感染，最短时间为术后6个月；联合应用拉米夫定及小剂量HBIg组，85例患者仅3例再感染。结论肝脏移植是治疗HBV感染相关终末期肝病的有效手段，术前服用拉米夫定降低HBV的复制水平，术后联合应用拉米夫定及小剂量HBIg可更有效防治HBV感染相关性肝病行肝移植术后乙型肝炎病毒再感染。     

拉米夫定预防肝移植后乙型肝炎病毒再感染的临床分析

目的探讨拉米夫定在预防肝移植术后乙型肝炎病毒（HBV）再感染的效果。方法回顾性分析14例HBV相关疾病患者术后采用拉米夫定（100 mg/d）预防HBV再感染的临床资料,监测乙型肝炎血清标志物、血清HBV-DNA、YMDD区变异和肝活检组织查乙型肝炎标志物免疫组化。结果4例患者术后发生HBV再感染（28.6%）,2例HBV-DNA转阳性,其中1例YMDD区产生变异,术前HBV-DNA阳性的患者（2例）在肝移植术后HBV再感染率高（2例）。结论拉米夫定可有效的预防肝移植术后HBV再感染;HBV再感染可产生YMDD区变异;HBV相关疾病患者行肝移植时应使HBV-DNA转阴性。     

小剂量人乙型肝炎免疫球蛋白结合恩替卡韦对肝移植术后乙型肝炎病毒再感染的防治效果

目的探究小剂量人乙型肝炎免疫球蛋白(HBIG)结合恩替卡韦(ETV)对肝移植术后乙型肝炎病毒(HBV)再感染的防治作用。方法将2012年1月-2015年6月于宁波市医疗中心李惠利医院东部院区行肝移植且使用ETV预防HBV再感染的41例患者作为对照组,2015年7月-2019年1月使用ETV联合小剂量HBIG预防HBV再感染的115例肝移植患者作为联合组,均至少随访18个月,定期复查乙型肝炎表面抗原(HBsAg)、乙型肝炎表面抗体(HBsAb)、乙型肝炎e抗原(HBeAg)、乙型肝炎e抗体(HBeAb)及乙型肝炎核心抗体(HBcAb)及HBV DNA,统计HBV再感染情况;术后再感染者均行络氨酸-蛋氨酸-天门冬氨酸-天门冬氨酸(YMDD)基因变异筛查,观察YMDD变异情况,并记录治疗不良反应发生情况。结果联合组移植术后HBV再感染率为0.87%低于对照组(P0.05);联合组术后不同时间HBsAb抗体滴度均高于对照组(P0.05);对照组YMDD变异率为11.11%高于联合组,但差异无统计学意义(P=0.159);术前HBeAg(+)、术前HBV-DNA(+)患者HBV再感染率(13.33%、10.98%)均高于术前HBeAg(-)、术前HBV-DNA(-)患者(P0.05)。结论小剂量HBIG联合ETV防治肝移植术后HBV再感染效果优于单独应用ETV,安全有效,可减少HBV再感染率,提高HBsAb抗体滴度。     

替比夫定与乙型肝炎疫苗及免疫球蛋白联合阻断乙型肝炎病毒母婴垂直传播的研究

目的观察替比夫定与乙型肝炎疫苗、免疫球蛋白联合在阻断乙型肝炎病毒母婴垂直传播中的疗效。方法将2011年1月-2012年1月携带乙型肝炎病毒的孕妇随机分成两组,对照组采用乙型肝炎免疫球蛋白(HBIG)与乙型肝炎疫苗联合治疗,观察组在此基础上口服替比夫定600mg,1次/d;比较两组患者间治疗前和分娩前乙型肝炎核心抗体(HBcAb)、乙型肝炎病毒e抗原(HBeAg)、乙型肝炎病毒的脱氧核糖核酸(HBV-DNA)的差异及出生后24h、6、12个月HBsAg阳性率。结果治疗前两组孕妇间血清HBcAb、HBeAg、HBV-DNA水平差异无统计学意义;分娩前观察组血清HBeAg、HBV-DNA水平分别为(165.28±236.56)s/co、(0.67±0.62)106拷贝/ml,对照组分别为(467.38±368.41)s/co和(4.28±2.17)106拷贝/ml;婴儿间出生后24h、6、12个月HBsAg阳性率分别为16.67%、3.33%、3.33%,显著低于对照组同时期的36.67%、26.67%、16.67%。结论替比夫定联合乙型肝炎疫苗、免疫球蛋白能有效阻断乙型肝炎病毒母婴垂直传播,疗效显著优于乙型肝炎疫苗、免疫球蛋白方案。     

联合免疫后乙型肝炎病毒感染母婴传播相关因素的临床研究

目的探讨联合免疫后乙型肝炎病毒感染母婴传播的相关因素,为临床降低母婴乙型肝炎病毒之间传播提供参考依据。方法选取医院2012年6月-2015年6月联合免疫治疗的200例乙型肝炎病毒携带孕妇为研究对象,依据新生儿是否感染乙型肝炎病毒分为感染组18例与未感染组182例,并在新生儿娩出24h内和第4周注射乙型肝炎免疫球蛋白,分析乙型肝炎病毒在母婴之间传播的相关因素。结果 200例孕妇产后新生儿两个月的检查分析,182例新生儿获得免疫成功,免疫成功率91.0%;感染组与未感染组在孕妇血清HBV-DNA阳性和HBeAg阳性以及喂养方式方面比较差异有统计学意义(P0.05);分娩方式、分娩次数、出生体质量、新生儿性别和早产等因素比较差异无统计学意义;孕妇血清HBV-DNA阳性和HBeAg阳性均是母婴乙型肝炎病毒传播的危险因素(OR=1.093,P=0.004;OR=2.722,P=0.003)。结论母体中乙型肝炎病毒DNA和HBeAg阳性是乙型肝炎病毒感染母婴传播的危险因素,而联合免疫可以减少母婴垂直传播,并可提高新生儿的乙型肝炎病毒免疫成功率。     

益气养阴清热解毒法联合拉米夫定对慢性乙型肝炎免疫学指标的影响

目的 探讨益气养阴清热解毒法联合拉米夫定对慢性乙型肝炎免疫学指标的影响,为慢性乙型肝炎的治疗提供依据.方法 选取2005年8月-2011年5月医院收治的120例慢性乙型肝炎患者为研究对象,按照入院顺序随机分为观察组和对照组各60例,观察组患者给予益气养阴清热解毒利湿方剂联合拉米夫定治疗,对照组患者给予拉米夫定治疗,观察两组患者治疗前后HBV-DNA含量、乙型肝炎五项标志物检查,以及前S1抗原等指标的变化.结果 随着治疗时间延续,观察组治疗后1年HBsAg,、HBeAg、前S1抗原转阴率分别为25.00％、18.33％、28.33％,治疗后6个月3项转阴率分别为15.00％、11.67％、20.00％,比较差异无统计学意义;观察组治疗后1时HBV-DNA含量为(3.23±1.48)拷贝/ml,低于治疗后6个月的(5.39±1.59)拷贝/ml,比较差异有统计学意义(P＜0.05);观察组上述指标的变化明显优于对照组,但比较差异无统计学意义.结论 益气养阴清热解毒法联合拉米夫定治疗可明显提高HBsAg、HBeAg以及前S1抗原的转阴率,降低血清中HBV-DNA的含量,疗效优于单用拉米夫定治疗.     

乙型肝炎宫内感染免疫失败的原因

孕妇外周血乙型肝炎病毒高浓度、HBeAg阳性、先兆早产和胎盘绒毛毛细血管内皮乙型肝炎病毒感染是胎儿感染乙型肝炎病毒的高危因素。胎儿宫内感染的传播可经两条途径 ,即血源性和细胞性。乙肝免疫球蛋白或拉米夫定的阻断可降低乙型肝炎病毒宫内感染的发生率。变异病毒可以逃避新生儿接种疫苗所产生的免疫 ,乙型肝炎病毒变易株的选择性传播导致了免疫失败     

HBeAg阴性乙型肝炎患者HBV-LP及HBV-DNA检测分析

目的 分析HBeAg阴性的乙型肝炎患者血清HBV-LP及HBV-DNA检测的价值.方法 收集64份HBeAg阴性的乙型肝炎患者血清标本,分别采用实时荧光定量PCR检测HBV-DNA、ELISA法检测HBV-LP.结果 64例HBeAg阴性的乙型肝炎患者血清中,HBV-DNA阳性36例,总检出率为56.3％;HBV-LP阳性44例,总检出率为68.8％;HBV-DNA与PreS1抗原具有较好的相关性,HBeAg阴性的乙型肝炎患者血清HBV-DNA、HBV-LP阳性率差异无统计学意义,HBV-DNA复制拷贝数为＜103、103-5、106-7、＞107拷贝/ml,HBV-LP 检出率分别为60.7％、82.6％、60.0％、66.7％.结论 HBeAg阴性的乙型肝炎患者血清中HBV-LP检测可以作为HBV-DNA检测的有效补充.     

HBeAg阴性重型乙型肝炎预后分析

目的探讨乙型肝炎病毒（HBV）变异后的致病性。方法对87例重型乙型肝炎患者，以HBeAg阴性重型乙型肝炎患者为观察组，以HBeAg阳性的重型乙型肝炎患者作为对照组。2组分别进行血液生化，2型肝炎病毒标志物，乙型肝炎病毒基因（HBV-DNA）定量及甲、丙、丁、戊、庚型肝炎病毒抗体测定，并对比分析。结果87例重型乙型肝炎总病死率35.63%。HBeAg阴性而HBV-DNA阳性病死率明显高于HBeAg和HBV-DNA均阳性组病死率，2组差异有统计学意义（P〈0.05）。结论HBV变异后致病性强，患重性肝炎后病情重、并发症多、病死率高。     

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.     

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.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.     

Stress in the Norwegian police service

BACKGROUND: High levels of stress have been attributed to the conditions of police work, but there is little empirical evidence for this. AIMS: To develop a new instrument to measure job stress in the police; to assess the most severe and frequent police stressors; to compare levels of stress according to the demographic and organizational factors; and to study stress in relation to personality traits, work locus of control and coping strategies. METHODS: A comprehensive nationwide questionnaire survey of 3272 Norwegian police at all hierarchical levels, including the Norwegian Police Stress Survey (NPSS), the Job Stress Survey, the Basic Character Inventory, the Work Locus of Control Scale, and the Coping Strategies Scale. RESULTS: Work injuries were appraised as the most stressful but least frequent stressor and job pressure was reported the least severe but most frequent stressor. Females experienced job stressors less frequently, but appraised them as more severe than men did. Older police officers reported more job pressure severity and fewer work injuries. The police in districts where peer support was planned but not implemented, and who worked in districts with more than 50,000 inhabitants, perceived the lack of support more severely than others. The correlations between stress and personality traits, work locus of control, and coping were moderate. CONCLUSIONS: The NPSS captures police-specific stressors that are not adequately measured by global stress instruments. The study of stress in police work should preferably involve a nationwide use of police-specific stress instruments.