拉米夫定预防性治疗非霍奇金淋巴瘤合并乙型肝炎病毒感染再激活的临床观察

目的 观察拉米夫定预防性治疗非霍奇金淋巴瘤(NHL)合并乙型肝炎病毒(HBV)感染再激活的疗效.方法 将2004年6月至2011年6月收治的NHL合并HBV感染患者84例按随机数字表法分为观察组和对照组,每组42例,观察组采用CHOP方案化疗+拉米夫定预防性应用,对照组仅采用CHOP方案化疗.分别观察化疗后两组患者HBV再激活发生率、肝功能损害、对化 疗顺利进行的影响.结果 HBV再激活发生率观察组为19.05％( 8/42),对照组为57.14％(24/42),两组比较差异有统计学意义(P＜0.01);肝功能损害发生率观察组为16.67％(7/42),对照组为59.52％( 25/42),两组比较差异有统计学意义(P＜0.01);因HBV再激活而延迟化疗或终止化疗发生率观察组为1 1.90％( 5/42),对照组为47.62％ (20/42),两组比较差异有统计学意义(P＜0.01).结论 对于NHL合并HBV感染的患者行拉米夫定预防性治疗可以明显降低化疗后HBV再激活发生率、减少肝功能损害,促使化疗顺利进行,值得在临床中推广使用.     

弥漫大B细胞淋巴瘤患者化疗后HBV再激活的影响因素

目的 探讨弥漫大B细胞淋巴瘤(DLBCL)合并乙肝病毒(HBV)携带或既往HBV感染患者化疗后HBV再激活影响因素。方法 选取2019年6月-2020年12月南阳市第二人民医院收治的96例HBV携带或既往HBV感染的DLBCL患者为研究对象,根据患者化疗前的乙肝病毒检查结果分为HBsAg阳性组40例和HBsAg阴性组56例。比较两组患者的临床资料,分析R-CHOP化疗6个疗程后疗效、肝功能、HBV再激活率,多因素logistic回归分析HBV再激活的影响因素。结果 HBsAg阳性组的化疗总缓解率(60.00%)低于HBsAg阴性组(82.14%)(P<0.05); HBsAg阳性组患者肝功能损害的发生率(42.50%)高于HBsAg阴性组(21.43%)(P<0.05); HBsAg阳性组患者HBV再激活发生率(22.50%)高于HBsAg阴性组的(3.57%)(P<0.05);抗-HBe(+)、抗-HBs(-)是患者化疗后HBV再激活的影响因素(P<0.05)。结论 抗-HBe(+)、抗-HBs(-)增加化疗后HBV再激活的风险,降低化疗缓解率,导致肝功能损害...     

乳腺癌患者化疗后肝功能损伤与乙型肝炎病毒感染的关系分析

目的分析乳腺癌患者化疗后肝功能损伤与乙型肝炎病毒(HBV)感染之间的相关性,为合并HBV感染的乳腺癌患者化疗后肝功能损伤的防治提供指导。方法选取医院2010年1月-2014年12月178例接受术后辅助化疗的乳腺癌患者为研究对象,根据化疗前是否合并HBV感染分为HBsAg阳性组62例和HBsAg阴性组116例;比较两组患者化疗后肝功能损伤发生情况,评价乳腺癌患者恩替卡韦抗病毒预防治疗对降低HBV感染肝功能损伤及HBV再激活的作用。结果 HBsAg阳性组患者化疗后肝功能损伤发生率37.1%,HBsAg阴性组患者化疗后肝功能损伤发生率12.1%,HBsAg阳性患者化疗后肝功能损伤发生率显著高于HBsAg阴性组,差异有统计学意义(P0.05);HBsAg阳性患者中抗病毒预防治疗22例与未进行抗病毒预防治疗40例患者HBV再激活率分别为9.1%与35.0%,肝功能损伤发生率分别为18.2%与47.5%,抗病毒预防治疗均明显低于未抗病毒预防治疗患者,差异均有统计学意义(P0.05)。结论合并HBV感染的乳腺癌患者化疗后易发生肝功能损伤,恩替卡韦预防性抗病毒治疗能减少化疗后HBV再激活率和肝功能损伤。     

HBV感染的乳腺癌患者化疗后HBV血清学标志物及肝功能变化分析

目的探讨乙型肝炎病毒(HBV)感染的乳腺癌患者化疗后HBV血清学标志物及肝功能指标的变化情况及抗病毒感染在预防化疗所致的HBV再激活中的作用。方法收集医院2012年1月-2017年6月接受术后化疗的乳腺癌患者320例,根据化疗前患者是否合并HBV感染分为乙肝表面抗原(HBsAg)阳性组(109例)和阴性组(211例),比较两组患者化疗后肝功能损伤情况以及化疗前后阳性组HBV血清学标志物变化情况,分析预防性使用(44例)和未使用(65例)抗病毒感染治疗对阳性组中患者发生肝功能损伤及HBV再激活的影响。结果阳性组化疗后肝功能损伤发生率高于阴性组(P<0.001);化疗期间阳性组HBsAg滴度、丙氨酸转氨酶(ALT)和谷草转氨酶(AST)水平均显著上升;阳性组中,抗病毒感染治疗患者肝功能损伤率及HBV再激活率均显著低于未使用抗病毒感染治疗患者(P<0.05)。结论合并HBV感染的乳腺癌患者在化疗期间存在HBV再激活可能性,并易发生肝功能损伤,抗病毒感染治疗可预防化疗所致的HBV再激活。     

HBV感染与弥漫性大B细胞淋巴瘤患者临床特征及化疗后肝功能的关系

目的 探讨乙型肝炎病毒(HBV)感染与弥漫性大B细胞淋巴瘤(DLBCL)患者临床特征及化疗后肝功能的关系。方法 选取2017年10月-2020年12月南阳市第二人民医院收治的HBsAg阳性DLBCL患者47例纳入HBsAg阳性组,HBsAg阴性DLBCL患者70例纳入HBsAg阴性组,比较两组患者临床分期、脾脏受累、淋巴结外器官受累、国际预后指数评分(IPI),分析HBsAg阳性组患者化疗前HBV-DNA病毒载量及化疗后病毒再激活与肝功能损伤的关系。结果 HBsAg阳性组与HBsAg阴性组性别、年龄、淋巴结外器官受累数量、IPI评分比较差异无统计学意义,HBsAg阳性组临床分期Ⅲ～Ⅳ期、脾脏受累比例高于HBsAg阴性组(P<0.05); HBsAg阳性组化疗后肝功能损伤发生率为(48.94%)高于HBsAg阴性组(22.86%)(P<0.05); HBsAg阳性组不同HBV-DNA载量患者肝功能损伤发生率比较差异有统计学意义(P<0.05),HBV-DNA>10⁷拷贝/ml患者肝功能损伤发生率为77.78%(7/9),<10^...     

急性白血病乙肝病毒感染与化疗后肝功能损害关系

目的　探讨急性白血病患者乙肝病毒 (HBV)感染与化疗后肝功能损害关系。方法　对 196例急性白血病患者化疗后肝功能变化情况进行分析 ,其中乙肝病毒感染 92例 ,化疗前肝功能均正常。结果　正规化疗后乙肝病毒表面抗原阳性 [HBsAg( + ) ]的急性淋巴细胞白血病患者肝功能损害占 67 2 4 % ,乙肝病毒表面抗原阴性 [HBsAg( - ) ]患者肝功能损害占 3 3 3 3 % (P <0 .0 1) ,HBsAg( + )的急性粒细胞白血病患者肝功能损害占 4 1 17% ,HBsAg( - )患者肝功能损害占 18 75 % (P <0 .0 5 )。结论　乙肝病毒感染的急性白血病患者化疗后易致肝功能损害 ,尤其是急性淋巴细胞白血病者 ,并用保肝药物可减少肝功能损害     

抗结核药物对乙肝表面抗原阳性肺结核患者肝功能影响的临床观察

目的 观察抗结核药物对乙肝表面抗原阳性肺结核患者肝功能的影响.方法 回顾性分析某院自2006年10月～2011年1月收治的136例乙肝表面抗原阳性的肺结核患者,与同期收治的130例乙肝表面抗原阴性肺结核患者,抗结核治疗肝功能损害及DNA水平变化的情况.结果 乙肝表面抗原阳性组共发生肝损104例(76.5％),乙肝表面抗原阴性组共发生肝损22例(16.9％),两组在轻度肝损、中度肝损及重度肝损方面差异均有统计学意义(P＜0.01).乙肝表面抗原阳性组及阴性组发生肝损的时间段主要分布在31～60 d及16～30 d,两组在肝损发生＞60d者,差异有统计学意义(P＜0.05).乙肝表面抗原阳性组年龄增加则肝损发生也增加.出现肝损的年龄主要分布在大于60岁组及41～60岁组,分布在45.2％及31.7％.乙肝表面抗原阴性组主要分布在31～40岁及41～60岁组,分别为31.8％及27.3％.重度肝损与中度肝损与轻度肝损组比较(P＜ 0.05,P＜ 0.01).结论 抗结核药物致肝损害,乙肝表面抗原阳性者比阴性者多,可能与用药前乙肝表面抗原阳性者肝脏病理损害有一定的相关.因此针对乙肝表面抗原阳性肺结核患者应选用肝损害小的药物并积极采取保护肝功能措施.     

短程化疗对乙肝表面抗原阳性患者肝功能影响

对采用３ＨＲＺＳ／３ＨＲ方案抗痨治疗的肺结核患者９８例的肝功能异常进行结果分析。肝功能异常发生率：ＨＢｓＡｇ阳性患者为２０、８％，ＨＢｓＡｇ阴性者为２０．０％。阳性组有２例因肝功能异常且伴黄疸而停药，阴性组无停药者，虽然两组肝功能异常发生率无明显差异，但肝损程度却明显不同。     

异甘草酸镁联合拉米夫定防治HBsAg阳性的恶性血液病患者化疗后肝功能损伤的临床研究

[目的]观察异甘草酸镁联合拉米夫定对HBsAg阳性的恶性血液病患者化疗药物所致肝损害的疗效. [方法]60例接受化疗的HBsAg阳性的恶性血液病患者随机分为联合用药组与单纯拉米夫定组.联合组32例,给予异甘草酸镁联合拉米夫定;单纯用药组28例,仅给拉米夫定. [结果]联合组乙肝病毒再激活率与对照组相似,差异无统计学意义(x2＝0.019,P=0.89).而化疗后联合用药组肝功能损害总发生宰低于对照组(x2=5.363,P=0.021),因肝功能异常延迟化疗较对照组下降,差异有统计学意义(x2=4.774,P=0.029).[结论]异甘草酸镁联合拉米夫定可明显减轻HBsAg阳性的恶性血液病患者的化疗相关性肝损害.     

抗结核组合药化疗对肺结核病人肝功能影响的观察

目的观察抗结核组合药化疗对肺结核病人肝功能的影响。方法比较乙型肝炎病毒标志物（HBVM）阳性组和阴性组肺结核病人组合药化疗前后肝功能损害程度，受损时间和恢复时间。结果960例病人中肝损率为18．95％，HBVM阳性组肝损率为35．77％，HBVM阴性组肝损率为12．24％，HBVM阳性组肝损率比HBVM阴性组明显高（P〈0．01）。其中HBsAg（＋）、HBeAg（＋）、HBcAb（＋）组比单纯HBsAg（＋）组病人肝损率明显增高（P〈0．05）。结论组合药化疗有明显肝功能损害，HBVM阳性病人比阴性病人多见，损害出现时间早而恢复时间相对延长。应用组合药化疗时应密切观察肝功能变化并积极采取综合防治措施。     

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.     

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.