双生子人群的代谢综合征相关指标的遗传度分析

目的 探讨双生子人群血压水平、体质指数(BMl)、空腹血糖水平和各项血脂指标(总胆固醇、甘油三酯和高密度脂蛋白胆固醇)的遗传度。方法 对山东威海和浙江丽水双生子登记系统注册的双生子，在卵性鉴定的基础上，以组内相关系数法研究代谢综合征相关指标的遗传度。结果 本次调查双生子共260对，甘油三酯单卵和异卵双胞胎对内方差齐性检验差异无显著性，血糖、总胆固醇、高密度脂蛋白胆固醇、收缩压、舒张压、体质指数异卵双生子对内变异大于同卵双生子。估计遗传度h^2分别为，血糖：0．47，总胆固醇：0．34，甘油三酯：0．17，高密度脂蛋白胆固醇：0．26，收缩压：0．78，舒张压：0．67，体质指数：0．64。调整年龄和性别后，遗传度h^2分别是，血糖：0．56，总胆固醇：0．37，甘油三酯：0．18，高密度脂蛋白胆固醇：0．24，收缩压：0．96，舒张压：0．76，体质指数：0．88。结论 在代谢综合征相关性状中，血糖、收缩压、舒张压、体质指数可能受遗传因素的影响大于环境因素，而总胆固醇、甘油三酯、高密度蛋白胆固醇受遗传影响相对较小。     

2型糖尿病胰岛素抵抗与微量白蛋白尿的相关性研究

目的探讨2型糖尿病患者胰岛素抵抗及胰岛素抵抗综合征与微量白蛋白尿的相关性。方法收集231例2型糖尿病病例,分为正常白蛋白尿组和微量白蛋白尿组,测定体质量指数、腰臀比、空腹血糖、空腹胰岛素、糖化血红蛋白、血脂、血压等指标,用胰岛素抵抗指数估算胰岛素抵抗程度。结果微量白蛋白尿组比正常白蛋白尿组有更高的体质量指数、腰臀比、收缩压、舒张压、高血压患病率、胰岛素抵抗指数、低密度脂蛋白胆固醇水平及更低的高密度脂蛋白胆固醇水平;多元线性回归分析显示,体质量指数、舒张压、胰岛素抵抗指数、高密度脂蛋白胆固醇是与微量白蛋白尿相关的独立因素;多元Logistic回归分析显示,除了高血压,高水平的体质量指数、胰岛素抵抗指数及低水平的高密度脂蛋白胆固醇也是微量白蛋白尿的独立危险因素。正常血压个体微量白蛋白尿组比正常白蛋白尿组有更高的体质量指数、腰臀比、胰岛素抵抗指数和更低的高密度脂蛋白胆固醇,多元线性回归分析显示,体质量指数、空腹血糖、空腹胰岛素、胰岛素抵抗指数与微量白蛋白尿独立相关;多元Logistic回归分析显示,体质量指数、空腹血糖、空腹胰岛素、胰岛素抵抗、高密度脂蛋白胆固醇与微量白蛋白尿独立相关。结论2型糖尿病患者胰岛素抵抗是独立于高血压和肥胖之外的微量白蛋白尿的危险因素。     

蒙古族人群胰岛素抵抗与心血管病关系

目的探讨蒙古族人群中胰岛素抵抗与心血管病危险因素水平及其聚集性的关系。方法对1090名蒙古族成年人进行血压、身高、体重、腰围及臀围的测量和血糖、胰岛素、血脂的检测。按照胰岛素抵抗指数水平由低到高将全部研究对象等分为4组，比较4组间各危险因素及其聚集性差异。结果调整年龄、性别因素后，体质指数、腰臀比、收缩压、舒张压、甘油三酯、空腹血糖及高血压患病率均随着胰岛素抵抗指数的水平增高而上升（P〈0．05）。在调整年龄和体质指数后。胰岛素抵抗指数与腰臀比、收缩压、甘油三酯呈显著正相关。具有≥2个危险因素的个体所占百分比随着胰岛素抵抗指数增高而增高，在4组的比例分别为33．8％，44．5％，47．2％和66．5％（χ^2=60．2657，P〈0．0001）。结论胰岛素抵抗与多种心血管病危险因素具有相关性，并影响多种心血管病危险因素水平，增加其聚集强度。     

体质指数对血压、血糖、血脂的影响

目的 探讨超重、肥胖对血压、血糖、血脂的影响.方法 对2009年医院体检中心1017名健康体检人群的体质指数(BMI)、血压、血糖、血脂等结果 进行统计分析.结果 超重检出率31.37%,肥胖检出率4.92%;随BMI升高,高密度脂蛋白胆固醇水平减低,收缩压、舒张压、空腹血糖、总胆固醇、甘油三酯、低密度脂蛋白胆固醇水平逐渐升高,高血压、高血糖、高血脂检出率亦增高.结论 健康体检人群超重、肥胖率较高,超重、肥胖与高血压、高血糖、高血脂关系密切,需采取早期有效措施控制超重和肥胖倾向.     

人体测量指标和糖尿病危险状态指标的相关关系

目的 探讨人体测量指标与糖尿病危险状态指标（血糖、血清胰岛素、血脂和血压）的相关关系，确定人体测量指标组和糖尿病危险状态指标组中关联最密切的指标。方法 采用多级分层抽样法,随机抽取上海市长宁区华阳社区中40岁以上的常住人口1960人，测量身高、体重、腰围、腹围、臀围、股围、空腹血糖、血精胰岛素、总胆固醇、甘油三酯、高密度脂蛋白和血压。以资料完整的1967人作为研究对象，计算体重指数、腰／臀比、腹／臀比、锥消度度指数、腰腿周径比，用固定年龄的偏相关典型相关方法在两性别组中分别分析体重指数、腰／臀比、腹／ 臀比、锥消度指数、腰腿周径比与血糖、血清胰岛素、血脂、血压的相关关系，并寻找3组中作用最大的指标。结果 人体测量指标和糖尿病危险状态指标之间呈现显的典型相关（第一对典型相关系数男女组分别为0．50、0．61）；男性组人体测量指标组中的腰／臀比的标化第数和相关系数最大，腹／臀比其次；女性组中体重指数的标化系数的关系最大，腰／臀比其次。糖尿病危险状态组中，血清胰岛素的标化系数和相关系数最大，其次是甘油三酯和舒张压。结论 （1）人体测量指标格血糖、血清胰岛素、血脂、血压指标间存在显的典型相关关系，肥胖易于发生各种代谢紊乱和高血压。（2）血清胰岛素水平和腰／臀比、体重指数间的相关性最强，对最敏感、腰／臀比、体重指数大，血胰岛素水平越高。（3）腰／臀比是反映男性人群患糖尿病危险状况最有价值的指标；体重指数是反映女性人群患糖尿病危险状况的最佳指标。     

代谢综合征患者血清抵抗素和瘦素水平关系的探讨

目的探讨代谢综合征(MS)患者血清抵抗素、瘦素水平与血脂、肥胖和胰岛素抵抗的关系。方法按体重指数将60例MS患者分为肥胖组和非肥胖组,采用ELISA方法测定受试者空腹血清抵抗素及瘦素水平,同时检测其身高、体重、腰围、臀围、血压、血糖、血脂及胰岛素,并计算体重指数(BM I)、腰臀比(WHR)和胰岛素抵抗指数(HOMA-IR)并与对照组比较。结果MS患者肥胖组和正常对照组相比其血清抵抗素及廋素水平明显升高(P<0.01)。MS非肥胖组和正常对照组相比其血清抵抗素及廋素水平明显升高(P<0.05,或P<0.01)。肥胖组和非肥胖组相比其血清抵抗素、瘦素水平无统计学意义。显示血清抵抗素水平与腰臀比、空腹胰岛素、胰岛素抵抗指数呈显著正相关(r=0.22,0.22,0.19;P<0.05);与体重指数、腰围、臀围、瘦素呈显著正相关(r=0.31,0.32,0.36,0.28;P<0.01);与高密度脂蛋白胆固醇(HDL-C)呈显著负相关(r=-0.24;P<0.05)。相关分析也显示血清瘦素水平与体重指数、腰围、臀围、腰臀比、收缩压、舒张压、甘油三酯、空腹胰岛素、胰岛素抵抗指数呈显著正相关(r=0.59,0.64,0.53,0.64,0.47,0.53,0.49,0.39,0.32;P<0.01),与血糖呈显著正相关(r=0.23;P<0.05),与高密度脂蛋白胆固醇(HDL-C)呈显著负相关(r=-0.40;P<0.01)。结论MS患者血清抵抗素、瘦素水平均明显升高,并存在一定的瘦素抵抗,且与肥胖、腹型肥胖及胰岛素抵抗程度有明显相关性,因而抵抗素、瘦素、瘦素抵抗可能在肥胖和胰岛素抵抗、MS的发生及发展中具有重要的作用。     

农村人群中超重／肥胖与血脂,血压水平的流行病学联系

本文调查并分析了158例40岁以上农村人群中超重/肥胖程度与血脂、血压水平的联系,欲进一步探讨肥胖与心血管疾病各危险因素间的联系机制。研究内容包括体重、身高、血压、血清总胆固醇、甘油三酯、血清高密度脂蛋白胆固醇、血清低密度脂蛋白胆固醇、载脂蛋白A—I,载脂蛋白B,并计算体重指数(BMI)。统计分析结果表明:体重指数不随年龄而变化;不同性别间亦无显著差异;超重/肥胖者中血脂、血压水平有显著改变,舒张压随体重指数升高而显著提高(βi=1.8467,P<0.05),说明肥胖者主要表现为舒张压的升高。血脂方面则主要表现为血清高密度脂蛋白水平的下降和载脂蛋白B水平的升高,而这两者均与动脉粥样硬化及冠心病的发生有关。因此认为肥胖者易发生动脉粥样硬化性心血管疾病可能与舒张压水平升高及高脂血症有关。     

2型糖尿病家系的遗传异质性研究

目的 对收集的常州市115家2型糖尿病高发家系人群进行遗传异质性分析，以发现可能存在的2型糖尿病亚型群体。方法 采用遗传流行病学分析软件PPAP对家系人群的胰岛素敏感指数、胰岛分泌功能指数、β细胞功能指数、胰岛素抵抗指数、发病年龄、体质指数和腰围、腰臀比分别进行多个样本的秩和检验、双峰检验和亲属间相关分析。结果 胰岛分泌功能指数及腰围在多个样本的秩和检验和亲属间相关分析中有显著性差异(P=0．029；P=0．031)，并且女性低胰岛素敏感指数患者的比例高于男性(88．9％与80．0％，P=0．044)，伴有胰岛素抵抗者的比例也高于男性(37．9％与25．2％，P=0．029)。结论 在所研究的家系人群中，胰岛分泌功能和胰岛素抵抗可能存在遗传异质性。     

血清Hcy在单纯性肥胖儿童中的水平变化与糖脂代谢的相关性

目的探讨血清同型半胱氨酸(Hcy)在单纯性肥胖儿童中的水平变化与糖脂代谢的相关性。方法选取2018年3月至2019年6月本院儿科门诊或住院部收治的单纯性肥胖儿童106例为单纯性肥胖组,收集同期体检的健康儿童78例为对照组。现场测量两组儿童身高、体重、腰围、臀围,计算体质量指数和腰臀比;抽取清晨空腹外周静脉血,检测Hcy、空腹血糖、空腹胰岛素以及各血脂指标水平,计算胰岛β细胞功能指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)。结果单纯性肥胖儿童体质量指数、腰臀比明显高于对照组儿童,差异均有统计学意义(均P0.01)。单纯性肥胖组儿童血清Hcy、空腹血糖、空腹胰岛素、HOMA-IR明显高于对照组,HOMA-β明显低于对照组,差异均有统计学意义(均P0.05)。单纯性肥胖组儿童总胆固醇(4.76±0.81)mmol/L、甘油三酯(4.76±0.81)mmol/L、低密度脂蛋白(2.25±0.53)mmol/L明显高于对照组,高密度脂蛋白(1.31±0.19)mmol/L明显低于对照组,差异均有统计学意义(均P0.05)。血清Hcy与体质量指数、腰臀比、空腹血糖、空腹胰岛素、HOMA-IR、总胆固醇、甘油三酯、低密度脂蛋白呈正相关(均P0.01);血清Hcy与高密度脂蛋白呈负相关(P0.01)。结论单纯性肥胖儿童血清Hcy明显升高,与糖脂代谢异常密切相关。     

超重肥胖儿童血压、血脂及空腹胰岛素水平分析

【目的】　分析超重及肥胖对儿童血压、血脂和空腹胰岛素水平的影响。　【方法】　在北京城区 4所小学中随机选出 3 17名 8～ 11岁健康儿童进行体格、血压测量及血脂和胰岛素检测。　【结果】　超重肥胖儿童的检出率为 2 4% ,在对年龄性别修正后 ,超重肥胖儿童与正常儿童相比血压、胰岛素、甘油三脂、总胆固醇及脂蛋白 (a)显著升高 ,高密度脂蛋白 /低密度脂蛋白、载脂蛋白A/载脂蛋白B显著降低 ,逐步回归分析显示体质指数与收缩压、甘油三脂及胰岛素呈正相关关系 ,与高密度脂蛋白呈负相关关系。在对体重指数修正后 ,胰岛素与甘油三脂及收缩压的偏相关系数分别为 0 .2 0 (P <0 .0 1)和 0 .12 (P <0 .0 5 )。　【结论】　肥胖可引起儿童脂代谢紊乱和高血压 ,且胰岛素敏感性的改变可能在这一病理过程中起重要作用。     

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.     

Empathic processes: perception by medical students of patients'' anxiety and depression

Perceptions by medical students of patients' affective states were investigated, and the effect of the students' own emotions on such perceptions. One hundred and one fourth-year medical students rated the levels of anxiety and depression of three women patients presented on videotape, rated their own levels of anxiety and depression and completed a questionnaire on aspects of the rating process. Students had widely different and often inappropriate perceptions of patients' levels of anxiety and depression. Students who consistently overrated anxiety or depression in patients, compared to those who consistently underrated, were themselves significantly more anxious or depressed. These data suggest a need in medical education for systematic teaching of empathic skills and for recognition of potential bias in clinical decision-making arising from the clinician's own emotional state.     

The reported incidence of work-related ill-health in Scotland (2002-2003)

BACKGROUND: Although incidence data for work-related ill-health in the UK are available, more detailed information for smaller geographical areas has hitherto been unpublished. AIMS: To estimate the incidence of work-related ill-health reported by clinical specialists in Scotland, 2002-2003. METHODS: THOR (The Health and Occupation Reporting network) is a UK wide reporting scheme for work-related ill-health. In 2002-2003, 241 out of 2162 physicians in THOR were based in Scotland. We have summarized the reported cases and calculated incidence rates for categories of ill-health by age, gender and industry. The UK Labour Force Survey (2002) was used to provide denominator data, with comparisons made between rates for Scotland and the rest of the UK. RESULTS: In 2002-2003, 4043 estimated cases were reported from Scotland. Mental ill-health was most frequently reported (41%); followed by musculoskeletal disorders (31%), skin disorders (16%), respiratory disease (10%), hearing disorders (2%) and infection (1%). The reported average annual incidence rate per 100,000 employees for all work-related ill-health in Scotland was 86.0. The highest reported rate for mental ill-health was found for employees in public administration and defence (76.7 per 100,000), and health and social work (72.3 per 100,000). The construction industry had the highest reported rate of musculoskeletal disorders (41.6 per 100,000), while hairdressers appeared at most risk of developing occupational contact dermatitis (rate=86.4 per 100,000). CONCLUSIONS: Despite its limitations, THOR has indicated types of work-related ill-health and related industries for targeted disease prevention in Scotland.     

Function of the protein RPE65 in the visual cycle

A protein called RPE65 performs a key role in the trans-cis isomerization of retinol in the retinal pigment epithelium of the eye. The palmitoylation of RPE65 serves to switch off the visual cycle in darkness and to switch it on in the light.     

Acute symptoms following work with pesticides

BACKGROUND: Serious accidental poisoning by pesticides is rare in the UK, but more minor pesticide-related illness may be under-reported. Anecdotally, use of sheep dip has been linked with flu-like symptoms. AIM: To explore the frequency, nature and determinants of acute symptoms following work with pesticides. METHODS: A postal survey of men in three rural areas of England and Wales provided data on occupational use of five categories of pesticide, occurrence of 12 specified symptoms within 48 h of using pesticides and tendency to somatize. Risk factors for pesticide-related symptoms were assessed by modified Cox regression. RESULTS: Of 10 765 responders (response rate = 31%), 4108 had at some time used pesticides occupationally, including 935 (23%) who reported symptoms following such work on at least one occasion. In two areas, acute symptoms were most frequent following use of sheep dip (29 and 32% of users), but in the third area the rate was significantly lower (13% of users). The relative frequency of symptoms was similar for all five categories of pesticide, and flu-like symptoms did not cluster unusually among users of sheep dip. Risk of pesticide-related symptoms increased with somatizing tendency (prevalence ratio for highest versus lowest category 2.4, 95% confidence interval 2.0-3.0) and was higher in men who had used pesticides most often or handled concentrate. CONCLUSION: Acute symptoms are common following work with pesticides, but in many cases the illness may arise through psychological rather than toxic mechanisms.     

The Life Events Inventory: re-scaling based on an occupational sample.

The objective of this study was to compare the validity of the original weightings used by the Life Events Inventory (LEI) with those obtained from a contemporary occupational sample. Fifty male and 62 female manufacturing employees (age range 16-55 years) assigned scores to each item on a slightly modified version of the LEI scale. The current sample consistently assigned higher weights to events/items than did the original sample, but there was high agreement in terms of item ranking. Some distinct age and gender differences in scoring were apparent, and are discussed further. It was concluded that when separate weightings are employed for age and gender groups, the LEI remains a useful tool for quantifying background levels of stress in both workplace stress audits and epidemiological studies where statistical control for non-occupational sources of stress is required.     

Maxillofacial injuries related to work accidents: a new concept of a hospital-based full electronic occupational trauma surveillance system

The objective of this study was to investigate the occurrence of occupational maxillofacial injuries using a newly installed relational database. Twenty-six injuries were identified out of 28,624 patients admitted to the emergency unit during a 12 month period. Falls from height or being struck by moving objects were common causes of these injuries. Two-thirds of those identified were construction workers. This paper demonstrates the power of modern databases to identify specific occurrences that may provide the basis for prevention in the future.     

Rôles physiologiques des endocannabinoïdes dans le contrôle de l’homéostasie énergétique

Endocannabinoids are endogenous lipids which modulate the release of neurotransmitters and activate different signaling pathways, through the binding to cannabinoïd receptors, CB1 and CB2. Endocannabinoids are involved in the control of a variety of behavioural and neuroendocrine functions, including feeding behaviour. In the central nervous system, they essentially modulate the expression of orexigen or anorexigen neuropeptides thus resulting in the stimulation of food intake. Their peripheral targets are mainly the liver and the white adipose tissue where they stimulate lipogenesis, through the modulation of several enzymes and proteins expressions. Cannabinoïd receptor agonists are nowadays prescribed to improve appetite of people suffering from cancer or AIDS. In the same way, CB1 antagonist, such as Rimonabant, could provide efficient treatment of obesity.     

Stress in police officers: a study of the origins,prevalence and severity of stress-related symptoms within a county police force

BACKGROUND: High levels of stress-related illness are causing concern across industry. Against a background of impending legislative moves to try to improve this situation, there is a need to identify key work-related stressors. Police work tends to be regarded as inherently stressful because of the personal risk of exposure to confrontation and violence and the day-to-day involvement in a variety of traumatic incidents. As a result, high levels of stress-related symptoms might be expected in this population. OBJECTIVE: To examine the sources of stress-related symptoms within police officers and measure the prevalence of significant associated mental ill-health. METHOD: A cross-sectional questionnaire survey of a population of 1206 police officers was performed to assess levels of strain associated with a series of potential home and work related stressors. Participants were then split into low and high scoring groups on the basis of a General Health Questionnaire (GHQ) threshold score in order to identify those stressors most associated with mental ill-health effects. RESULTS: Occupational stressors ranking most highly within the population were not specific to policing, but to organizational issues such as the demands of work impinging upon home life, lack of consultation and communication, lack of control over workload, inadequate support and excess workload in general. The high scoring group constituted 41% of the population and differed significantly from those with low scores in perception of all stressors, ranking both personal and occupational stressors more highly, and from personality constraints appeared significantly more 'stress-prone'. A significant association between gender and mental ill-health was found, with females more likely to score more highly on the GHQ than males. CONCLUSION: This study confirms previous findings of organizational culture and workload as the key issues in officer stress. Given that the degree of symptomatology appears to be worsening, management action is required. Further research is indicated within the police population into a possible increased susceptibility in female officers.