重组人生长激素治疗腹腔感染后低白蛋白血症的实验与临床研究

探讨重组人生长激素 (rh GH)对腹腔感染引起的低白蛋白血症的治疗作用。分别在体外实验、动物实验和临床研究中 ,观察 rh GH对白蛋白 m RNA表达和白蛋白合成的影响。结果 :rh GH明显促进体外培养肝细胞白蛋白基因表达 ;在内毒素损伤的肝细胞模型中 ,rh GH显著减轻内毒素介导的白蛋白 m RNA表达抑制 ;在体内 ,rh GH明显促进正常大鼠和腹腔感染大鼠肝白蛋白 m RNA表达 ;并明显提高腹腔感染病人血清白蛋白、前白蛋白、转铁蛋白浓度。结果提示 ,rh GH对腹腔感染引起的低白蛋白血症有明显的防治作用。重组人生长激素治疗腹腔感染后低白…     

严重感染病人低白蛋白血症的影响因素与临床意义

严重腹腔感染病人广泛存在低白蛋白血症 ,为了解腹腔感染与低白蛋白血症的关系 ,以及血清白蛋白浓度与病情严重程度及预后的关系 ,对我科 1970～ 1996年间 6 93例病人进行回顾性分析。根据有无感染分为感染组 (2 6 2例 )与非感染组 (431例 )。收集入院 72 h内第一次的生命体征、内稳态资料 ,并计算 APACHE评分。结果表明 :16 93例病人经直线回归 (逐步回归 )分析提示 ,血容量因素、感染因素、病情严重程度、病程及营养因素对血清白蛋白水平有显著的影响。而年龄、性别等因素没有显著的影响。 2感染组与非感染组在一般情况、营养因素等方…     

老年肝病患者医院感染临床分析

目的　探讨老年肝病患者医院感染状况及对转归的影响。方法　回顾性分析、比较老年组和非老年组 ,老年各类肝病组医院感染的发生率和病死率。结果　老年组医院感染发生率和病死率分别为 33.93%和2 5 .2 6 % ,明显高于非老年组的 1 4 .6 6 %和 5 .95 % (P <0 .0 1 ) ;老年急慢性肝炎、重型肝炎、肝硬化各组间医院感染率和病死率的差异显著 (P <0 .0 1 ) ,以重型肝炎组感染率和病死率较高 ;感染部位以呼吸系统最多见 ;病原菌以革兰阴性菌及真菌为主。结论　真菌已成为老年肝病患者医院感染的重要病原菌。老年肝病患者 ,尤其是重型肝炎患者 ,易发生各种医院感染 ,并严重影响其预后     

老年阿尔茨海默病住院患者肺部感染的危险因素及血PCT预警价值

目的探究老年阿尔茨海默病(AD)住院患者肺部感染的危险因素及血降钙素原(PCT)预警价值。方法选取2018年10月-2020年1月衢州市第三医院住院治疗的老年AD患者158例,筛选老年AD住院患者肺部感染的危险因素,评估PCT对老年AD肺部感染的预警价值。结果老年AD患者肺部感染发生率为27.85%。感染病原菌以革兰阴性菌(65.91%)为主,主要为铜绿假单胞菌(27.27%)与大肠埃希菌(22.73%);革兰阳性菌(34.09%)中金黄色葡萄球菌感染率(18.18%)最高;单因素分析显示合并糖尿病、长期卧床、合并低白蛋白血症、进食困难老年AD患者肺部感染发生率较高(P0.05);感染组患者PCT高于非感染组,淋巴细胞计数低于非感染组(P0.05);糖尿病、长期卧床、低白蛋白血症、进食困难均为老年AD患者发生肺部感染的独立危险因素(P0.05);PCT预测肺部感染敏感度、特异性分别为81.82%、94.74%。结论糖尿病、长期卧床、低白蛋白血症、进食困难及高PCT水平AD患者有更高的肺部感染风险;且PCT对其预警价值高,可作为监测肺部感染的依据。     

饮酒对血脂、血糖、血清白蛋白的影响及其与脂肪肝发病联系的初步研究

目的探讨饮酒对血脂、血糖、血清白蛋白含量的影响及其与脂肪肝发病的联系。方法将连续性体检男性人群分成非酒精组、白酒组及啤酒组 ,按日均饮酒量及饮酒时间又将白酒组及啤酒组再次分组 ,对比分析各组高脂血症、高糖血症及低白蛋白血症检出率。结果非酒精组及白酒组脂肪肝者较非脂肪肝者、啤酒组较非酒精组及白酒组非脂肪肝与脂肪肝者、5 0～ 10 0 g白酒组较非酒精组及 >10 0 g白酒组脂肪肝者、5 0～ 10 0 g白酒组较非酒精组非脂肪肝者高脂血症检出率明显增高 ,白酒组较非酒精组非脂肪肝及脂肪肝者低白蛋白血症检出率均明显增高 (P<0 .0 5～ 0 .0 0 1)。随着日均饮酒量增加 ,白酒组非脂肪肝与脂肪肝者低白蛋白血症检出率均有显著增高 (χ2 =6 .5 8,P<0 .0 5 ;χ2 =10 .0 5 ,P<0 .0 1)。而啤酒组非脂肪肝者及脂肪肝者高糖血症检出率与饮酒时间之间呈现出显著的正相关关系 (χ2 =11.4 6 ,P<0 .0 1;χ2 =7.0 2 ,P<0 .0 5 )。结论饮酒导致高脂血症或高糖血症参与酒精性脂肪肝的发病机制 ,以啤酒组中该作用机制最为明显 ,而在 >10 0 g白酒组脂肪肝的发病机制中有营养不良所致低蛋白血症这一因素参与。     

重组人生长激素对腹腔感染后低白蛋白血症的防治作用——实验与临床研究

本研究旨在探讨重组人生长激素 ( rh GH)对腹腔感染引起的低白蛋白血症的治疗作用。分别在体外实验、动物实验和临床研究中 ,观察 rh GH对白蛋白 m RNA表达和白蛋白合成的影响。结果示 rh GH明显促进体外培养肝细胞白蛋白基因表达 ;在内毒素损伤的肝细胞模型中 ,rh GH能显著减轻内毒素介导的白蛋白 m RNA表达抑制。在体内 ,rh GH明显促进正常大鼠和腹腔感染大鼠肝脏白蛋白 m RNA表达。在 TPN的基础上 ,rh GH明显提高腹腔感染病人白蛋白、前白蛋白、转铁蛋白血清浓度。因此 ,rh GH对腹腔感染引起的低白蛋白血症有显著的防治作用。     

血清瘦素对恶性肿瘤患者营养状况的影响

为探讨瘦素在恶性肿瘤中的作用及作为营养评价指标的价值。检测了325例癌症病人和66例健康人血清瘦素含量以及癌症病人的体质指数（BMI），血液血红蛋白，红细胞计数，血清白蛋白浓度（ALB），血脂和血清脂蛋白水平等。结果显示：全组癌症病人中，23％BMI小于18．5，14％为低ALB血症者；42％发生贫血，17．2％，发生高胆固醇血症，21．4％，发生高甘油三酯血症，肺癌组BMI小于18．5的发生率明显低于胃癌组（P＝0．022），而高血糖及甘油三酯血症发生率明显高于胃癌组（P分别为0．003，0．029），营养不良的癌症患者的血清瘦素含量明显低于营养正常或肥胖患者（P＝0．000），BMI均为18．5－25的相同性别的肺癌，胃癌病人，健康人的血清瘦素水平无显著性差异，BMI，性别和血白蛋白浓度均为影响恶性肿瘤病人的血清瘦素浓度的最显著因素，血清瘦素水平与BMI，性别，血白蛋白显著相关（r=0.599-0.698,P=0.000)，结果表明：癌症病人贫血发生率高；血清瘦素含量反映恶性肿瘤病人的BMI和营养状况的变化，且可作为其营养 状况的判断指标。     

微型营养评定法在恶性肿瘤病人中的应用

为探讨微型营养评定法 (MNA)在恶性肿瘤病人的营养状况评价中的价值 ,测定 2 6 2例恶性肿瘤病人的MNA总分、身高、体重、年龄、体力状况、血液血红蛋白量 (Hb)、红细胞数 (RBC)、血清白蛋白浓度 (Alb)、血清前白蛋白浓度 (PA)。计算实际体重 健康时平时体重比 (UBW % )。根据MNA总分评价病人营养状况 :营养不良组 (MNA总分 <17) ;营养不良危险组 (MNA总分介于 17～ 2 3 5 ) ;营养良好组 (MNA总分≥ 2 4)。结果显示 :MNA总分与UBW %、Alb、PA、BMI值呈显著相关 (r=0 5 0 1～ 0 72 4,P =0 0 0 0 )。MNA与UBW %、BMI、PA、Alb方法评价病人的营养状况有良好的一致性 ,符合率分别为 82 %、76 %、71%、6 8%。根据MNA方法评价全组病人 ,营养不良者占 31 7% (83 2 6 2例 ) ,营养不良危险者占 2 5 9% (6 8 2 6 2例 ) ,营养良好者占 42 4%(111 2 6 2例 ) ;营养不良与营养不良危险的发生率无显著性差异 ;老年与非老年患者营养不良发生率无明显差异。胃癌、肝癌的营养不良发生率明显高于肺癌 (P =0 0 0 1)。体力状况越差 (ECOG分级越高 )、营养不良发生率越高。贫血患者营养不良发生率明显高于非贫血者。感染患者营养不良发生率明显高于非感染者。结果提示 ,MNA对于恶性肿瘤患者具有良好的营养评价作用。胃癌?     

2型糖尿病合并感染多器官功能障碍综合征与干扰素调节因子5基因多态性的关联性

目的分析2型糖尿病(T2DM)合并感染多器官功能障碍综合征(MODS)与干扰素调节因子5(IRF5)基因多态性的关联性。方法选取2017年1月-2020年1月常山县人民医院收治的54例T2DM合并感染发生MODS患者为MODS组,以同期54例T2DM合并感染未发生MODS患者为非MODS组,54例单纯T2DM患者为T2DM组。入组第2天,检测所有对象白细胞计数(WBC)、肿瘤坏死因子α(TNF-α)、白细胞介素(IL)-6、C-反应蛋白(CRP)和IRF5水平,聚合酶链反应(PCR)检测IRF5 mRNA和IRF5基因rs2004640、rs10954213与rs3807306位点多态性。受试者工作特征曲线(ROC)分析IRF5 mRNA水平对MODS发生的预测价值。结果 MODS组TNF-α、IL-6、CRP、IRF5 mRNA和蛋白水平高于非MODS组(P0.05),非MODS组患者的WBC、TNF-α、IL-6、CRP、IRF5 mRNA和蛋白水平高于T2DM组(P0.05);MODS组rs2004640位点基因型GG、GT和TT的分布频数与T2DM组比较,具有统计学差异(P0.05),等位基因G的频率低于T2DM组(P0.05);T2DM合并感染患者IRF5 mRNA水平预测MODS发生的曲线下面积为0.733。结论 T2DM合并感染患者IRF5基因rs2004640位点等位基因G的频率明显下降,血清中表达水平明显升高,可用于预测MODS的发生。     

急性胰腺炎的全肠外营养与生长抑素治疗

目的 :观察在禁食、胃肠减压和预防感染的基础上 ,加用生长抑素和全肠外营养对胰腺炎非手术治疗的影响。　方法 :将 1990年 1月至 1994年 12月底收治的急性胰腺炎 2 6例 ,归为A组。自 1995年以来收治的急性胰腺炎 2 8例 ,归为B组。两组胰腺炎的病因和严重程度无明显差别。B组病人采用全肠外营养支持和生长抑素治疗。　结果 :A组病人入院时血清白蛋白为 (30 .0± 1.2 ) g/L ,治疗 15天后 ,白蛋白仍在 (30 .4± 0 .8) g/L。B组病人于入院后即行全肠外营养支持 ,时间为 (17± 6 )天 ,施他宁使用时间为 (7± 2 )天。其血清白蛋白入院时为 (2 9.0±1.3)g/L ,治疗 15天后 ,白蛋白上升至 (35 .7± 0 .9) g/L ,明显高于入院时 (P <0 .0 1)。B组病人的病死率及住院日、中转手术率、淀粉酶的恢复天数较A组病人有明显改善 ,并发症发生率明显减少。　结论 :在急性胰腺炎非手术治疗原则的基础上 ,通过加用全肠外营养和生长抑素可最大程度地抑制胰腺的分泌 ,改善病人的营养状态 ,减少并发症的发生率与病死率 ,缩短住院时间。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.