低氧环境下大鼠与高原鼠兔血液中NO与ET-1比较

目的比较低氧环境下大鼠与高原鼠兔血液中NO与ET-1含量。方法将Wistar大鼠暴露于3780m低氧环境中,分别于低氧24h、2周、3周后取血,以酶联免疫吸附法和硝酸还原酶法测定血液中ET-1、NO含量,计算NO/ET1比值,并与高原鼠兔比较。结果急进高原24h后,大鼠血液中的NO与ET-1比同海拔的鼠兔显著增加(P<0.01),而两者NO/ET-1比值却非常接近(P>0.05)。随着大鼠在高海拔停留时间延长,血液中NO呈减少趋势,而ET1呈上升趋势。高原鼠兔NO/ET-1值约是大鼠缺氧2、3周时的2倍(P<0.01)。结论适当的NO/ET-1比值是高原鼠兔对高原低氧环境的一种适应性选择。急进高原时,NO显著增加和适当的NO/ET-1值是机体对抗肺动脉高压的一种有效的代偿性机制;随着缺氧时间延长,NO、NO/ET1值的降低及ET-1的增加,可能是机体不适应低氧环境的一个指征。     

急进高原个体胃肠型高原反应发生情况及其原因

目的对平原个体急进高原现场后胃肠型高原反应发生情况及其原因进行调查分析。方法应用消化系统症状调查表对1753例急进高原个体的消化系统症状进行调查,并从中随机抽取20例分别于进入高原前1d、进入高原第3天和第7天行胃镜检查,并对其结果进行分析。结果 1753例急进高原个体中有1097例存在不同程度的消化系统症状(占62.58%),其症状主要有腹胀、食欲不振、恶心、呕吐、腹痛、便秘、腹泻、便血和黑便等,20例进行胃镜检查者,进入高原第3天及第7天胃镜检查阳性例数分别为17例(约85%)和10例(50%),与进入高原前比较,差异均具有统计学意义(P<0.01),胃镜表现主要有胃粘膜出血、充血、淤血、糜烂、溃疡及胆汁返流等,其中1例于进入高原第3天因胃黏膜出血住院治疗。结论平原个体急进高原现场后胃肠型高原反应发生率较高,急性高原缺氧所引发的胃肠道黏膜损伤是导致胃肠型高原反应发生的根本原因。     

急进高原个体外周血氧自由基变化与急性胃肠粘膜损伤分析

目的 对急进高原个体外周血氧自由基变化与急性胃肠粘膜损伤情况分析.方法 对加例由平原急进高原个体分别于进入高原前1 d、进入高原第3 d和第7 d进行胃镜检查.并同步抽取血液标本,对其外周血清丙二醛(MDA)、过氧化氢(H2O2)的含量进行检测.结果 20例平原个体急进高原后第3d及第7d胃镜检查阳性例数分别为17例...     

模拟高原低氧对大鼠心肌线粒体中钙浓度的影响及中药的保护作用

目的 观察急进高原及持续低氧对大鼠心肌线粒体中钙离子浓度的影响,探讨中药复方对心肌线粒体的保护作用.方法 SD雄性大鼠分为平原对照组(C)、急进高原1d组(H1)、中药干预1d组(Z1)、急进高原3d组(H3)、中药干预3d组(Z3)、急进高原7d组(H7)、中药干预7d组(Z7).用荧光分光光度法测线粒体内游离Ca2+浓度;采用分光光度法测线粒体Na+-K+-ATP酶、Ca2+-Mg2+-ATP酶.结果 与c组比较,急进高原的3组线粒体内Ca2浓度明显降低(P＜0.001),7H组线粒体膜钠钾泵活性、钙镁泵活性明显降低(P＜0.05).相等时间段比较表明,Z3组、Z7组线粒体内Ca2+浓度明显升高(P ＜0.001).Z7组钠钾ATP酶活力明显升高(P＜0.05).结论 急进高原使大鼠心肌线粒体中钙浓度明显降低,中药复方改善了低氧对线粒体的影响.     

Rho激酶抑制剂治疗尘肺合并肺动脉高压的疗效观察

将60例尘肺合并肺动脉高压(PAH)患者随机分为治疗组和对照组,均给予尘肺常规治疗,治疗组加用法舒地尔30 mg静脉滴注q12 h×14 d。分别在治疗前、治疗后1个月时检测肺动脉收缩压(SPAP)、降钙素原(PCT)、圣乔治呼吸问卷(SGRQ)评分等指标。治疗前后两组指标均有改善,但治疗组明显低于对照组(P<0.05),提示Rho激酶抑制剂对改善尘肺合并PAH疗效明显。 更多还原     

高频震荡通气联合米力农治疗新生儿持续肺动脉高压及对TGF-β、ET-1表达的影响

目的探讨高频震荡通气联合米力农治疗新生儿持续肺动脉高压及对转化生长因子-β(TGF-β)、内皮素-1(ET-1)表达的影响。方法选择2013年3月-2018年3月在榆林市榆阳区人民医院接受治疗的60例新生儿持续肺动脉高压(PPHN)患儿作为研究对象,随机分为对照组和研究组,每组各30例。对照组患儿接受高频震荡通气治疗,观察组患儿接受高频震荡通气联合米力农治疗。比较两组患儿治疗后的临床疗效,治疗前后的血气指标[动脉血氧饱和度(PaO2)、动脉血二氧化碳分压(PaCO2)、氧合指数(OI)]、收缩压(SBP)、肺动脉收缩压(SPAP)、血清TGF-β和ET-1水平。结果观察组患儿有效率显著高于对照组,差异有统计学意义(P<0. 05)。治疗前,两组患儿血气指标、SBP、SPAP、血清TGF-β和ET-1水平比较,差异均无统计学意义(均P>0. 05);治疗后,两组患儿血气指标、SBP、SPAP、血清TGF-β和ET-1水平比较,差异均有统计学意义(均P<0. 05)。同一组内治疗前后患儿血气指标、SBP、SPAP、血清TGF-β和ET-1水平比较,差异均有统计学意义(均P<0. 05)。结论米力农联合高频振荡通气可有效降低肺动脉压,改善血气指标,并且可更有效地控制TGF-β和ET-1水平,具有更好的临床疗效。     

平原人快速进入海拔4370米高原后尿八项生化指标的变化

通过对40名平原人乘飞机进驻海拔4370m高原后尿8项生化指标变化的动态分析和急性高原病(AMS)发病调查,可见尿液pH值在达高原的第1天为6.6,比平原值6.4略有升高,以后呈下降趋势,第5天与第6天降为5.8,明显低于第1天和平原值(P<0.01);尿蛋白阳性率在到达高原后头3天分别为20.6%、26.5%和25.9%,皆明显高于7.5%的平原值(P<0.05),第4天后逐渐降低;尿酮体阳性率在达高原后的第3～5天分别为92.6%、82.3%和47.1%,皆明显高于10%的平原值(P<0.01),其余时间未检出阳性;尿潜血阳性率于到达高原的第3天和第4天分别为14.8%与5.9%,其余时间和在平原时均未检出阳性;尿亚硝酸盐、尿糖、尿胆红素和尿胆元4项指标始终未见明显变化.AMS患者的尿pH值和尿蛋白浓度明显高于基本无AMS者(P<0.05);在13名AMS患者中,69.2%的人尿蛋白阳性,30.8%的人尿蛋白可疑,而且尿蛋白阳性者的AMS症状持续的时间明显长于尿蛋白可疑者(P<0.05).受试者在达高原第4天递增负荷运动后尿pH值明显降低和尿酮体明显增加,所测PWC_(170)明显低于平原值(P<0.05).结果提示,平原人乘飞机急进高原后肾功能会受到严重损伤,但经短期高原适应后可以很快恢复.     

PGE1对COPD合并缺氧性肺动脉高压的疗效

目的探讨前列腺素E1(PGE1)治疗老年慢性阻塞性肺疾病(COPD)合并缺氧性肺动脉高压的疗效.方法 60例COPD合并缺氧性肺动脉高压老年患者随机分为治疗组和对照组,每组30例,治疗组在常规治疗的基础上加用PGE1 10μg静脉注射,1次/d,15d为1疗程;对照组仅用常规治疗.在治疗前后测量肺动脉平均压(MPAP),动脉血氧分压(PaO2)及动脉二氧化碳分压(PaCO2),全血比黏度(%),血浆比黏度(%),红细胞压积(%),血小板黏附率(%)和血沉(mm/h).结果治疗后MPAP和PaCO2较治疗前明显降低(P《0.01),PaO2较治疗前明显升高(P《0.01),血液流变学各项参数较治疗前有明显改善(P《0.01),与对照组相比均有非常显著性差异(P《0.01).结论 PGE1治疗老年COPD合并缺氧性肺动脉高压有良好疗效.     

急进高原和高原训练对武警新兵血氧血压综合参数的影响

目的观察武警新兵急进高原和高原训练对血氧血压综合参数的影响,为探讨新兵高原习服提供科学依据。方法将受试者分为平原男性组、平原女性组、高原男性组和高原女性组。平原男性组分别在平原、急进高原的第1、第3、第5、第7天和新兵训练结束后测试。平原女性组在平原和高原训练前后测试。高10原男性组和高原女性组在高原训练前后测试。实验于2008年在成都和拉萨完成。结果平原男性组、平原女性组急进高原动脉血氧饱和度降低,差异有统计学意义(P<0.01);平原男性组在急进高原的第7天恢复到世居同龄人水平;高原训练前后血氧饱和度差异无统计学意义。平原女性组急进高原后血压升高,差异有统计学意义(P<0.01,P<0.05);平原男性组和平原女性组急进高原后脉率增快,差异有统计学意义(P<0.05,P<0.01)。结论血氧饱和度在急进高原7 d时基本习服,高原训练对血氧饱和度的影响不显著。     

急进高原对武警新兵心血管功能的影响

[目的]观察急进高原对武警战士心脏和血管功能影响,为探讨新兵高原习服提供科学依据。[方法]实验于2008年在成都和拉萨完成。用XXG-E3型自动心血管功能诊断仪记录平原、急进高原d 1、d 3、d 5、d 7心脏和血管功能指标。[结果]①与平原比较,急进高原的d 1、d 3,脉搏速率加快(P﹤0.001),d 3、d 5、d 7搏出量和心搏指数减少(P﹤0.01),d 5、d 7心脏指数减少(P﹤0.05,P﹤0.001),d 7心输出量减少(P﹤0.001),d 5、d 7有效循环血量减少(P﹤0.001),d 3、d 7心肌血流灌注量减少(P﹤0.001),心肌耗氧指数、心肌耗氧量、心搏功指数、心肌血流需要量的差别均无统计学意义。②与平原比较,急进高原d 5、d 7,脉搏压减小,d 3、d 7血管顺应度、血管弹性系数、主动脉排空系数减小(P﹤0.001,P﹤0.05),d 3、d 5、d 7总外周阻力、标准周阻增大(P﹤0.001,P﹤0.05),肺动脉阻力、肺动脉压的变化差异无统计学意义。[结论]急进高原心脏功能的变化主要为心率加速和搏出量减少;对血管的影响主要是增加体循环外周阻力。     

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.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

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.