充血性心力衰竭患者C-反应蛋白水平与心功能的关系

目的:观察充血性心力衰竭(CHF)患者CRP水平及与心功能的关系。方法:运用免疫比浊法测定充血性心力衰竭患者血清CRP水平,超声心动图检查左心室射血分数(LVEF)及心功能;采用NYHA心功能分级法,并进行组间均数t检验及相关性分析。结果:C -反应蛋白水平随心功能不同而变化,心功能(NYHA)为II、III、IV级者,其血清CRP水平依次为(3 .4 7±0 . 5 1)mg/L、(7 .98±0 . 6 7)mg/L、(16 . 83±0 . 4 7)mg/L ,LVEF分别为0 . 5 2±0 . 0 8、0 4 2±0 0 5、0 33±0 0 6 ;对照组CRP水平为(1 0 .9±0 . 33)mg/L ,LVEF为0. 6 9±0 . 0 4 ,与对照组比较差异有显著性(P <0 .0 1) ,且LVEF值与CRP水平呈负相关(r=- 0 .6 5 3,P <0 . 0 1)。结论:充血性心力衰竭患者血清CRP水平升高,其升高程度与心力衰竭严重程度相平行。     

牙周炎患者唾液潜血和口腔挥发性硫化物的研究

目的检测牙周炎患者在牙周基础治疗前后唾液潜血(SOB)、口腔挥发性硫化物(VSC)与牙周临床指标的水平变化。方法选取2017年12月—2018年10月在天津市公安医院口腔科就诊的36例牙周炎患者为研究对象,患者在进行牙周基础治疗前后,分别检测SOB和VSC,并对牙龈出血指数(BI)、菌斑指数(PLI)、探诊深度(PD)和附着丧失(AL)进行观察记录。结果治疗后6周SOB和VSC阳性率为11.11%和16.67%,明显低于治疗前的58.33%和66.67%,差异均有统计学意义(P0.01)。治疗后6周BI、PLI、PD和AL均低于治疗前,差异均有统计学意义(P0.01)。结论牙周基础治疗是降低牙周炎患者牙龈出血和减轻口臭程度的有效方法。牙周炎患者SOB和VSC与临床指标BI、PLI、PD和AL变化一致,可作为牙周治疗效果评价的客观指标。     

侵袭性牙周炎患者疱疹病毒感染和外周血病毒载量

目的分析不同严重程度侵袭性牙周炎(AGP)患者疱疹病毒(HV)感染情况和外周血病毒载量。方法选取2014年12月-2019年12月济南市市中区人民医院口腔科收治的2600例AGP患者,根据病变程度分为轻度AGP组(n=82)、中度AGP组(n=578)、重度AGP组(n=1940),以同期100名健康人群为对照组。入组后,检测龈沟液HV病毒感染情况和血浆单纯疱疹病毒1型(HSV-1)、EB病毒(EBV)、人类巨细胞病毒(HCMV)、人类疱疹病毒6型(HHV-6)载量、牙周特征和血炎症因子水平。结果AGP患者牙周菌斑指数(PLI)、探诊深度(PD)、附着丧失(AL)、出血指数(BI)高于对照组(P<0.05),HSV-1、EBV、HCMV、HHV-6感染率和病毒载量高于对照组(P<0.05),白细胞(WBC)、降钙素原(PCT)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)高于对照组(P<0.05);随着AGP病情严重程度增加,HSV-1、EBV、HCMV、HHV-6感染率和病毒载量、PLI、PD、AL、BI、WBC、PCT、IL-6、TNF-α和CRP均增加(P<0.05)。结论HV感染率和病毒载量与AGP患者血清炎症因子水平和牙周特征随病情严重程度增加而升高。     

C反应蛋白联合D二聚体检测在痛风患者血管损伤中的价值

目的探索C反应蛋白(CRP)联合D二聚体检测在痛风患者血管损伤中的诊断价值。方法实验分为健康对照组、无并发症的痛风组和合并冠心病的痛风组,采集血液标本并分别检测CRP、D二聚体水平。结果无并发症的痛风组CRP水平(6.3±2.2)mg/L和D二聚体(1.02±0.65)g/L明显高于健康对照组(3.4±1.6)mg/L和(0.15±0.02)g/L,但明显低于合并冠心病的痛风组(8.7±2.6)mg/L和(2.05±0.68)g/L,差异有统计学意义(p<0.05)。结论 CRP联合D二聚体检测可反映痛风患者血管内皮损伤程度,可作为监测痛风患者血管损伤的指标。     

小儿急性呼吸道感染时C-反应蛋白的检测及临床意义

目的:探讨C-反应蛋白(CRP)检测在小儿急性呼吸道感染中的临床意义。方法:对急性呼吸道感染的患儿发病时和治疗后的外周血CRP浓度及白细胞数进行检测。结果:细菌感染组患儿的血清CRP浓度和白细胞数分别为(60.14±18.14)mg/L、(1.76±0.82)×109/L,明显高于病毒感染组患儿的(7.47±3.78)mg/L、(8.7±0.47)×109/L和正常对照组的(5.87±2.17)mg/L、(8.5±0.22)×109/L(均P<0.01);其异常例数也明显多于病毒感染组和正常对照组。经治疗后,细菌感染组患儿的血清CRP浓度和白细胞数明显降低至(8.27±4.02)mg/L、(9.4±0.52)×109/L,异常例数也明显减少(均P<0.01),而病毒感染组患儿无明显变化(P>0.05)。结论:小儿急性呼吸道感染时血清CRP浓度的检测对感染的病原体鉴别和治疗效果的监测有一定的临床意义。     

CD64、降钙素原、血清淀粉样蛋白A及C反应蛋白在急性感染性疾病中的诊断价值

目的 探讨CD64、降钙素原(PCT)、血清淀粉样蛋白A(SAA)及C反应蛋白(CRP)联合检测在急性感染性疾病中的临床诊断价值.方法分别检测241例细菌感染者、162例病毒感染者和144名健康人的CD64、PCT、SAA及CRP.利用ROC曲线评价PCT、CRP、PCT及SAA的诊断价值.结果 细菌感染组CD64为(17.77±6.18)MFI、SAA为(179.37±116.56) mg/L、PCT为(1.22±0.39) ng/mL、CRP为(51.03±34.34) mg/L;急性病毒感染组分别为(9.85±2.69) MFI、(122.14±101.58) mg/L、(0.13±0.08) ng/mL和(15.62±13.04) mg/L;健康对照组分别为(9.35±2.16) MFI、(5.55±3.36)mg/L、(0.11±0.05) ng/mL、(3.93±2.77) mg/L;CD64、SAA、PCT和CRP在3组间的差异有统计学意义(F=59.449、32.710、31.531和34.439,P均＜0.01);SAA对急性病毒感染的曲线下面积为0.812,诊断灵敏度为0.783,诊断价值高于CRP.CD64对急性细菌感染的曲线下面积为0.882,诊断灵敏度为0.908,诊断价值优于PCT.4个参数联合检测对急性细菌感染的曲线面积为0.941,诊断灵敏度为0.983,对急性病毒感染曲线下面积为0.850,诊断灵敏度为0.800.结论 SAA是在判断感染特别是病毒感染方面明显优于CRP,CD64表达在细菌感染诊断上优于PCT.SAA、CRP、CD64和PCT联合检测对细菌感染和病毒感染鉴别诊断效能优于单独检测.     

非手术治疗中重度牙周炎对冠心病患者血脂及血清C-反应蛋白的影响

目的探讨牙周非手术治疗对伴有中重度牙周炎的冠心病患者血脂及血清C-反应蛋白的影响。方法选择2009年8月-2010年8月,口腔科治疗的伴有中重度牙周炎的冠心病患者30例,牙周非手术治疗前后检测牙周临床指标,包括菌斑指数(PLI)、出血指数(SBI)、附着丧失(AL)和牙周探诊深度(PD)、血脂:总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)和血清C-反应蛋白(CRP)水平。结果治疗后,患者的PLI、SBI、AL、PD均有显著改善,TC、TG、LDL-C治疗后分别为(4.10±1.01)、(1.75±0.28)、(2.56±0.66)mmol/L,均显著低于治疗前的(5.67±1.08)、(2.03±0.31)、(2.98±0.72)mmol/L,HDL-C由(1.05±0.52)mmol/L升高至(1.55±0.62)mmol/L,CRP水平由(14.22±0.88)mg/dl降至(4.29±0.76)mg/dl,差异均有统计学意义(均P<0.05)。结论预防和治疗牙周炎对预防冠心病有重要意义,冠心病患者应定期进行口腔卫生检查。     

某冶炼厂环境铅污染及其对人群健康影响的研究

目的　比较某冶炼厂 15年前后环境铅污染影响的变化 ,并为评价该厂扩建投产后污染变化提供依据。方法　选取 1980～ 1982年曾调查的污染区和对照区 ,于 1995～ 1997年再次调查两区稻米、蔬菜、饮水铅含量以及 7～ 14岁学龄儿童 (污染区 10 4名 ,对照区 6 8名 )的血铅及 δ- AL AD酶活力 ,并做比较分析。结果　米铅 (干重 )、菜铅 (湿重 )、学生血铅和 δ- AL AD酶活力的几何均值 :污染区分别为 2 6 .7± 1.6 5 mg/ kg、6 0 .4± 2 .6 7mg/ kg,2 0 6± 1.7μg/ L和 98± 1.3IU/ L;对照区分别为 13.2± 1.85 mg/ kg、44 .9± 2 .84mg/ kg、2 2 9± 1.3μg/ L和 2 2 5± 1.4IU/ L。污染区米铅显著上升而δ- AL AD酶活力显著性下降 (P<0 .0 1) ,污染区 2 2人 (占 2 1.2 % )血铅水平超过对照区最高值 (312 .9μg/ L) ,其中 8人高达 45 0～ 76 2 μg/ L;与 1980～ 1982年相比 ,污染区的稻米和蔬菜铅含量显著增加 (P<0 .0 1)。结论　该冶炼厂对污染区的铅污染有逐渐加重的趋势     

危重患者抗氧化维生素血浆水平观察

目的了解危重患者体内抗氧化维生素水平。方法2002年5月～2003年2月间新华医院外科ICU收治的112例危重患者,采用高效液相法测定体内抗氧化维生素水平。结果112例危重患者抗氧化维生素水平明显低于正常对照组眼维生素A:(33.8±25.1)μg/dLvs(78.2±31.2)μg/dL,P=0.000;维生素E:穴6.5±4.4雪mg/Lvs(10.1±6.2)mg/L,P=0.000;β-胡萝卜素:(184±185)μg/Lvs(756±794)μg/L,P=0.000;维生素C:(5.0±4.2)mg/Lvs(6.7±3.9)mg/L,P=0.000演。危重患者中各维生素缺乏症发生率高于正常人,分别为维生素A:25.9%vs0%(P=0.000);维生素E:44.6%vs17.0%(P=0.000);β-胡萝卜素:46.4%vs12.8%(P=0.000);维生素C:62.5%vs31.2%(P=0.000)。危重患者中男性维生素A水平明显高于女性眼分别为(38.8±26.2)μg/dLvs(26.2±21.5)μg/dL,P=0.012演,且随年龄增长,维生素A水平显著降低(r=-0.234,P=0.015)。抽血日前禁食天数>7d组患者与≤7d组患者相比,各抗氧化维生素呈下降趋势,但无统计学差异。结论危重患者血浆维生素A、E和β-胡萝卜素水平明显低于正常人,且该人群中抗氧化维生素缺乏非常普遍。     

术后外周血内毒素水平与术后并发症及创伤程度的关系

目的观察手术创伤与内毒素移位的关系,分析外周血内毒素水平与术后并发症、创伤程度及全身炎症反应综合征(SIRS)的关系. 方法 50例健康志愿者及111例外科手术患者参加本研究.分别于术前1天、术后3天、6天采外周血测内毒素水平,统计术后并发症、全身炎症反应综合征(SIRS)的发生情况. 结果 111例患者中术后3天外周血内毒素水平[(0.034±0.007)EU]较术前[(0.025±0.005)EU]明显增高(P=0.000),术后第6天[(0.032±0.009)EU]较术后3天[(0.034±0.007)EU]明显降低(P=0.004),并有恢复到术前水平的趋势.术后3天SIRS组外周血内毒素水平[(0.039±0.007)EU]明显高于非SIRS组[(0.032±0.006)EU],二者差异有显著性意义(P＝0.000).出现并发症组术后外周血内毒素水平[(0.047±0.007)EU]较无并发症组[(0.034±0.007)EU]明显增高(P＝0.000). 结论外科大中型手术可致肠道内毒素移位,表现在外周血内毒素水平升高.外周血内毒素水平增高与手术创伤程度、术后SIRS及术后并发症相关.     

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.     

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.     

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.