心肌损伤标志物联合检测在急性心肌梗死诊断中的应用评价

目的 探讨心肌损伤标志物联合检测在急性心肌梗死(acute myocardial infarction,AMI)诊断中的应用.方法 对在本院接受诊断与治疗的急性心肌梗死患者进行心肌损伤标志物联合检测.结果 发病2hAMI组与对照组比较,Myo差异有统计学意义(P＜0.05);发病4hAMI组与对照组比较,Myo、CK- MB差异有统计学意义(P＜0.05);发病8hAMI组与对照组比较,Myo、CK-MB、cTnI差异有统计学意义(P＜0.05).cTnI+Myo+ CK- MB 2项或3项联合检测,更能提高特异性,cTnI+Myo+ CK - MB在发病4h的敏感性和特异性分别是44.26％(27/61),90.16％(55/61),发病8h的敏感性和特异性均为100％,具有很高的诊断率.结论 联合监测Myo、cTnI、CK-MB可提高对AMI诊断的敏感性和特异性,同时对再梗死发生、预后及观察疗效具有重要意义.     

多指标联合检测在急性心肌梗死早期诊断的应用评价

目的探讨联合检测肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、肌红蛋白(Myo)和N末端脑钠素原(NT-proBNP)早期诊断急性心肌梗死(AMI)的价值。方法回顾性选取已确诊的急性心肌梗死患者78例(AMI组)和随机选取的医院体检正常的健康人80例(对照组)作为研究对象。对158例观察对象在不同时间点采集静脉血,定量检测cTnI、CK-MB、Myo、NT-proBNP的结果进行统计学分析。结果和对照组相比,AMI组cTnI、CKMB、Myo、NT-proBNP各时间点的含量均高于对照组,差异有统计学意义(P<0.05);单独检测cTnI、CK-MB、Myo、NT-proBNP的敏感度和特异度分别是87.17%和81.25%、84.62%和78.75%、89.74%和72.50%、76.90%和76.25%,联合检测时灵敏度和特异度达到了93.58%和91.25%,高于单项检测,差异有统计学意义(P<0.05)。结论 cTnI、CK-MB、Myo、NT-proBNP四项联合检测可提高AMI早期检测的敏感度和特异度。     

羊水胎粪污染新生儿血清cTnI及CK-MB变化及其临床意义

[目的]探讨心肌肌钙蛋白Ⅰ(Cardiac Troponin Ⅰ,cTnI)及磷酸肌酸激酶心型同工酶(creatine kinase,CK-MB)在Apgar评分正常、有不同程度羊水胎粪污染(MSAF)新生儿血中的变化,及对心肌损害的早期诊断价值.[方法]设正常足月新生儿16例为对照组,另两组为MSAFⅡ度组12例及NSAFⅢ度组20例.分别测定3组新生儿脐血(0h)、生后24～36 h及72～96 h血清cTnI及CK-MB的水平.[结果]①NSAFⅢ度组生后72～96 h cTnI浓度较NSAFⅡ度组和正常对照组均明显升高(P<0.05).②3组新生儿血清cTnI浓度经不同时点两两间的比较:NSAFⅢ度组0h、24～36 h分别与72～96 h间比较均有统计学差别(P＜0.05);MSAFⅡ度组0hcTnI浓度分另4与24～36 h及72～96 h问比较,差异有统计学意义(P＜0.05);对照组经不同时点两两间的多重比较,cTnI浓度羞别均有统计学意义(P＜0.05).③MSAFⅢ度组0 h、24～36 h及72～96 h血清CK-MB浓度均高于对照组(P＜0.05),MSAFⅡ度组与对照组比较无统计学差异(P＞0.05).④三组新生儿自身血清CK-MB浓度不同时点间比较均有统计学差别(P＜0.05),CK-NB浓度生后24～36 h最高,72～96 h次之,0 h最低.⑤追踪NSAF新生儿cTnl浓度异常者,NSAFⅢ度组中cTnI浓度异常共15例,现已有8例完全恢复正常.未治疗即正常者1例,是生后1 d cTnI浓度升高,4 d恢复正常;余7例中cTnI浓度升高持续时间最长1例是生后10 d(转院者),恢复正常时间最短32 d,最长48 d,平均42 d.MSAFⅡ度组中cTnI浓度异常4例,2例是生后1 d cTnI浓度升高,干生后4 d自行恢复;余2例均治疗后门诊复查,cTnI浓度恢复正常时间1例是19 d.另一例是21 d.[结论]①对MSAFⅢ度新生儿,无论出生时Apgar评分是否正常均需早期干预;②通过对血清cTnI及CK-MB浓度的联合检测,可以早期发现围生期新生儿微小心肌损害;③生后早期动态检测血清cTnI浓度,可做为监测微小心肌损害治疗效果及追踪随访的可靠指标.     

脑钠肽前体、肌钙蛋白I及心肌酶对急性有机磷中毒心肌损害的临床意义分析

114例急性有机磷中毒患者心肌N端B型脑钠肽前体(NT-proBNP)、肌钙蛋白I(cTnI)及心肌酶检测结果显示,轻度中毒组NT-proBNP显著高于对照组;重度中毒组NT-proBNP、CK、CK-MB、cTnI显著增高(P0.05),且心电图异常、心脏相关症状、中间型综合征(IMS)、多器官功能衰竭综合征(MODS)、猝死及住院期间死亡率均显著高于轻、中度中毒组(P0.05)。IMS患者入院后首次测得的NT-proBNP、CK、CK-MB、cTnI及心电监护异常率均显著高于非IMS患者。提示NT-proBNP、cTnI及心肌酶能准确反映急性有机磷中毒心肌损害情况。     

Apgar评分与CK-MB和cTnI的相关性及临床应用

目的:通过Apgar评分和CK-MB、cTnI含量的测定,为早期评价缺血缺氧性心肌损害并进行干预提供理论依据。方法:记录出生后72 h内的心脏事件并于出生后24 h、72 h、7 d测定不同Apgar评分新生儿血清CK-MB、cTnI含量,然后进行分析。结果:血清CK-MB、cTnI的含量随时间延长逐渐下降(P<0.01),同一时间点在有窒息组和无窒息组之间有显著差异(P<0.01),有窒息组组间也有显著差异(P<0.01),无窒息组组间差异无统计学意义(P>0.05)。心脏事件的发生率随Apgar评分的增加逐渐降低(P<0.01)。Apgar 1 m in评分与CK-MB、cTnI 24 h测定值之间具有很好的相关性(P<0.01)。结论:Apgar评分和CK-MB、cTnI均可作为缺血缺氧性心肌损害的评价指标。     

AMI患者发病后血浆UCA1、CK-MB、cTnI变化及其诊断价值分析

目的分析急性心肌梗死(AMI)患者发病后血浆尿路上皮癌相关1(UCA1)、肌酸激酶同工酶MB(CK-MB)、肌钙蛋白I(cTnI)变化及其诊断价值。方法选取2016年7月至2017年6月本院收治的80例AMI患者及30例健康志愿者为研究对象,分别纳入AMI组、对照组,采用实时荧光定量聚合酶链反应法(qPCR)检测UCA1,比较两组入院后0～2、2～6、6～12、12～24、24～48、48～72、72～96 h血浆UCA1及CK-MB、cTnI水平,分析AMI组中合并不同基础疾病(高血压、糖尿病、高脂血症)患者UCA1、CK-MB、cTnI水平差异。结果与对照组比较,AMI组UCA1整体表达水平下调,且AMI组入院后0～48 h UCA1低于对照组(P<0.05),AMI组中UCA1在6～12 h降至最低(P<0.05),后升高(P<0.05),至入院后48～72 h、72～96 h与对照组比较差异无统计学意义(P>0.05);AMI组入院后2～48 h CK-MB、cTnI水平高于对照组(P<0.05),CK-MB在6～12 h达峰值,cTnI在12～24 h达峰值(P<0.05);AMI组中单纯AMI、合并高血压、合并糖尿病、合并高脂血症、合并2种及以上患者UCA1、CK-MB、cTnI表达水平分别两两比较差异无统计学意义(P>0.05);入院后6～12 h UCA1诊断AMI的灵敏度、特异度、准确度、ROC曲线下面积分别为85.42%、83.14%、86.11%、0.954,均较CK-MB、cTnI高。结论 AMI患者发病后血浆UCA1表达水平可作为其潜在诊断标志物及治疗靶点,尤其在入院后6～12 h的UCA1有较高监测价值。     

急性ST段抬高型心肌梗死患者心电图QRS延长与心肌损伤的相关性

目的探讨急性ST段抬高型心肌梗死(STEMI)患者心电图QRS波延长与心肌损伤之间的相关性。 方法采用回顾性病例对照研究分析2017年2月至2019年11月经确诊为冠心病患者90例,根据QRS波长是否延长分为延长组(n＝52)和非延长组(n＝38),分析QRS延长与临床特征的关系,比较延长组和非延长组患者的心肌损伤指标CTnI、CK-MB、Myo及两组患者心脏功能LVEF、LVFS、LVEDd水平,分析延长时间与心肌损伤相关指标的相关性。 结果QRS延长组血清CTnI、CK-MB和Myo指标均高于非延长组,差异有统计学意义(P<0.05),QRS延长组LVEF和LVFS的水平低于非延长组,LVEDd高于非延长组,差异有统计学意义(P<0.05);QRS延长水平与血清CTnI、CK-MB和Myo指标呈正相关(P<0.05),与LVEF和LVFS的水平呈负相关(P<0.05),与LVEDd水平呈正相关(P<0.05)。 结论STEMI患者心电图QRS延长与心肌损伤程度呈正相关,监测ECG的QRS波群有助于评估STEMI患者的心肌损伤程度。     

全身麻醉联合前锯肌神经阻滞对乳腺癌手术患者生存质量及术后疼痛的影响

目的观察全身麻醉联合前锯肌神经阻滞对乳腺癌手术患者生存质量、术后疼痛的影响。方法回顾分析桂林医学院附属医院2020年1月至2021年3月收治的80例择期行乳腺癌改良根治术患者的临床资料, 根据麻醉方法不同分为对照组与观察组, 每组40例。对照组接受单纯全身麻醉, 观察组接受全身麻醉联合前锯肌神经阻滞麻醉。采用疼痛数字评价量表(NRS)评分评价两组患者术后3、6、12、24 h疼痛程度, 采用40项恢复质量评分量表(QoR-40)评分及健康调查简表(SF-36)评分评价患者术后24 h的恢复情况及术后3 h、术后6个月的生存质量, 比较两组患者术后24 h的血清与疼痛相关的细胞因子[神经肽Y(NPY)、前列腺素E2(PGE2)、5-羟色胺(5-HT)]水平。记录两组并发症发生情况。结果观察组术后6、12 h NRS评分低于对照组(均P<0.05)。观察组术后24 h QoR-40评分及术后6个月SF-36各项评分均高于对照组(均P<0.05)。两组术后并发症发生率比较差异无统计学意义(P>0.05)。观察组患者术后24 h NPY、PGE2、5-HT水平均低于对照组(均...     

西宁地区联合检测心脏标志物在新生儿缺氧缺血性心肌损害中的临床意义

目的:探讨肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白(cTnI)和肌红蛋白(Myo)测定在诊治窒息后新生儿缺氧缺血性心肌损害(HIM)的价值。方法:测定西宁地区新生儿HIM轻、重度窒息组(104例)和对照组(38例)CK-MB、cTnI和Myo水平。结果:与正常新生儿比较,轻、重度窒息组CK-MB、cTnI和Myo值均显著升高,差异有非常显著性(P<0.01),轻、重度度窒息组两者有统计学意义(P<0.05);随窒息程度加重而升高,其中Myo灵敏度最高,cTnI特异性最强,CK-MB、cTnI和Myo 3项联合检测的诊断灵敏度为95.2%,特异度为92.5%。结论:联合测定CK-MB、cTnI和Myo 3项指标有助于HIM的早期诊断、程度估计、预后及转归的判断。     

同步测定血清CK-MB/CK及心肌肌钙蛋白Ⅰ对急性有机磷农药中毒病情评判的临床意义

目的 探讨同步测定血清肌酸激酶同工酶(CK-MB)与肌酸激酶(CK)比值( CK-MB/CK)及心肌肌钙蛋白I(cTnI)在急性有机磷农药中毒(AOPP)中的变化及其在病情判断、评估中的临床价值和意义.方法 对868例无心、肺、脑、肾、肌肉及其他结缔组织疾病史的AOPP患者于中毒后2、12、24、48、96、120 h抽取空腹静脉血4ml同步测定CK、CK-MB及cTnI,计算出CK-MB/CK.其中轻度中毒279例(轻度组),中度中毒289例(中度组),重度中毒300例(重度组),合并发生中毒中间型综合征(IMS) 208例(IMS组),未发生IMS 660例(非IMS组).并与同期288例健康查体者(对照组)比较.结果 (1)中毒后2～ 12、13～24、25 ～ 120 h轻度组、中度组、重度组CK、CK-MB、cTnI显著高于对照组,CK-MB/CK显著低于对照组,差异均有统计学意义(P＜ 0.01);轻度组、中度组、重度组CK、CK-MB、cTnI、CK-MB/CK组间两两比较差异均有统计学意义(P＜ 0.01或＜0.05).IMS组中毒后2～120 h CK、CK-MB、cTnI显著高于非IMS组,CK-MB/CK显著低于非IMS组,差异均有统计学意义(P＜ 0.05或＜0.01).IMS组心脏猝死发生率23.08％( 48/208),多器官功能障碍综合征(MODS)发生率37.50％(78/208);非IMS组分别为4.24％(28/660)、9.85％(65/660).两组心脏猝死和MODS发生率比较差异均有统计学意义(P＜0.01).(2)对IMS组及非IMS组建立以cTnI(X1)、CK(X2)及CK-MB/CK(X3)为自变量的判别分析方程式:Y=-0.0014X1+ 0.0225X2+ 65.2376X3,F=21.4911,P＜0.01.判别临界值Y0=2.8124.若Y＜2.8124属IMS组,Y≥2.8124属非IMS组.其中各指标的贡献率X1为34.5％,X2为25.4％,X3为40.1％,回代符合率为91.26％.结论 CK-MB/CK 变化与AOPP程度呈负相关,cTnI与AOPP程度呈正相关.CK-MB/CK变化、cTnI可用于协助AOPP 临床分级、病情判断及指导AOPP的急诊、救治和预后评估;利用cTnI、CK及CK-MB/CK所得的函数方程可早期作为IMS和MODS及心脏猝死的有效预报指标.     

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.