肝癌患者血脂和载脂蛋白代谢水平分析

目的了解肝癌患者血清脂质和载脂蛋白的改变。方法将我院近几年肝病住院病人中已确诊为肝癌的患者中40例做了血清甘油三脂（TG）、胆固醇（TCh）、高密度脂蛋白胆固醇（HDL—C）、载脂蛋白AI（ApoAI）、载脂蛋白B（ApoB）测定的患者与我院保健科体检的40例健康人员做比较分析。结果肝癌组TG、TCh和正常组差异无显著性（P〉0．05），而ApoB低于正常组（p〈0．05），HDL—C和ApoAI明显低于正常组（p〈0．01），结论肝细胞损害致肝功能低下会导致血脂及载脂蛋白代谢异常。     

民航飞行人员高血脂的影响因素调查

目的了解影响民航飞行人员血脂水平的因素,为民航飞行人员与高血脂相关疾病的防治提供依据。方法随机选取某航空公司健康体检飞行员（驾驶员、领航员、通信员、机械员）170名,均为男性,年龄25～59岁。从健康地面人员中随机抽取36名作为对照组,年龄22-59岁。飞行人员以总胆固醇（TC）、甘油三酯（TG）,高密度脂蛋白胆固醇（HDL—C）和低密度脂蛋白胆固醇（LDL—C）几个项目为评价指标;地面人员只测量了TC、TG;采用规定方法检测并进行比较。结果飞行人员甘油三酯（TG）,胆固醇明显高于地面组（P〈0．05,P〈0．01）,TG、TC及LDL—C（低密度脂蛋白）均随年龄、工龄的增加而增加,而HI）L—C（高密度脂蛋白）则相反,随年龄、工龄增加而降低。最小和最大年龄组之间TG、TC的统计学比较差异有显著性和差异有非常显著性（P〈0．05,P〈0．01）。在最小和最大工龄组之间TC、HDL-C、LDL—C之间差异有显著性和差异有非常显著性,（P〈0．05,P〈0．01）,在男女性别间TG的统计学差异有显著性（P〈0．05）。结论民航飞行员中存在患冠心病及与高血脂症相关疾病的危险因素,比地面人员有较高的普遍性,且随年龄和工龄的递增而递增,应采取积极防治措施。     

妊娠高血压综合征与血脂、载脂蛋白及脂蛋白(a)的关系

目的探讨妊娠高血压综合征(简称妊高征)患者血脂代谢水平的变化及其临床意义。方法测定正常孕妇及妊高征患者的血清甘油三脂(TG)、总胆固醇(TC)、载脂蛋白AI(ApoAI)、载脂蛋白B(ApoB)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及脂蛋白(a)水平。结果妊高征组血清TG(P<0.01)、ApoB(P<0.01)、LDL-C(P<0.05)及LP(a)(P<0.05)较正常孕妇显著升高,ApoAI、HDL-C则显著降低(P<0.05),TC在两组间差别无显著性意义(P>0.05)。在轻、中、重妊高征患者之间,ApoAI(P<0.05)及HDL-C(P<0.01)依次降低,组间比较有显著性意义,LDL-C(P<0.01)及LP(a)(P<0.01)依次升高,组间有极显著性差异。TG、TC和ApoB组间比较,差别无显著性意义。结论血脂代谢异常可能在妊娠高血压疾病的发病中起一定作用。     

高血压病人血脂和脂蛋白水平变化与肾损害的关系

目的探讨高血压病人血脂、脂蛋白水平变化与肾损害的关系。方法将106例高血压患者分为高血压未发生肾损害组（n=44）、高血压早期肾损害组（n=40）、高血压肾损害组（n=22），以104例血压正常者作为对照组，检测血清总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白A1及B（apoA1、apoB）、脂蛋白（a）[LP（a）]，进行比较分析。结果高血压病人血清TC、TG、HDL—C、LDL-C、apoB、LP（a）水平明显高于正常对照组，差异有显著性意义（P均〈O．01），HDL-C水平明显高于正常对照组p〈0．05）。TC、LDL—C、apoB水平随高血压早期肾损害的加重呈现升高的趋势，高血压肾损害组病人血清LP（a）水平及异常率明显高于高血压早期肾损害组和未发生肾损害组，差异有显著性意义（p〈0．05，p〈0．01），其余各指标异常率均无显著性意义。结论高血压病人存在着明显的脂质异常，高血压肾损害与脂质代谢紊乱相关联，肾损害加重脂质代谢紊乱。     

2型糖尿病肾病患者脂代谢异常38例分析

目的观察2型糖尿病肾病（DN）和无肾病患者的脂代谢异常的特点。方法72例2型糖尿病患者根据尿白蛋白排泄率（UAER）分为三组：无DN组（UAER〈20μg／min）34例；DN组38例，其中微量白蛋白尿期组（UAER为20—200μ／min）20例，临床白蛋白尿期组（UAER〉200μg／min）18例。测定空腹血糖（FBC）、糖化血红蛋白、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白-胆固醇（HDL—C）、低密度脂蛋白-胆固醇（LDL—C）、载脂蛋白A1（ApoA1）、载脂蛋白B（ApoB），并与正常对照组比较。结果DN组病程、TG、LDL—C、ApoB明显高于非DN组，差异有统计学意义（P〈0．01）；两组的TC、HDL—C、ApoA1差异无统计学意义（P〉0．05）；DN组的FBG、糖化血红蛋白高于非DN组，但差异无统计学意义（P〉0．05）。结论2型糖尿病患者有明显的脂代谢紊乱，病程越长，DN发生机会越多，脂代谢紊乱越明显。     

北京市体重正常和超重肥胖儿童血糖血脂状况分析

目的探讨超重、肥胖儿童血糖、血脂水平变化特点，为儿童肥胖的干预研究提供依据。方法选择北京市3所中学、2所小学，根据2005—2006年中小学生体检身高、体重结果进行筛选，对自愿参加的1045名7～15岁学生进行身高、体重测量。采集空腹肘静脉血测定血清总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL—C）、低密度脂蛋白胆固醇（LDL—C）和空腹血糖（FPG）。结果FPG，TG，HDL—C，LDL—C在不同体型男、女儿童间差异均有统计学意义（P值均〈0．01），HDL—C水平为肥胖组〈超重组〈正常组，FPG，TG，LDL—C水平均为肥胖组〉超重组〉正常组。男童TC异常检出率差异无统计学意义，FPG，TG，LDL—C偏高和HDL—C偏低的检出率均为肥胖组〉超重组〉正常组；女童FPG，TC，LDL—C异常检出率差异均无统计学意义（P值均〉0．05），TG偏高和HDL—C偏低的检出率为肥胖组〉超重组〉正常组。结论超重和肥胖儿童较体重正常儿童存在明显的血糖和血脂异常。应加强超重和肥胖儿童血糖和血脂检测，并进行综合干预.     

阿托伐他汀和烟酸缓释片联用治疗老年混合型高脂血症疗效观察

目的观察阿托伐他汀联用烟酸缓释片治疗老年混合型高脂血症的疗效与安全性。方法将符合入选条件的43例患者随机分为观察组22例和对照组21例，观察组采用阿托伐他汀10mg／d＋烟酸缓释片500mg／d，po；对照组单用阿托伐他汀10mg／d，190，疗程3个月。结果治疗3个月后两组血清总胆固醇（TC）、低密度脂蛋白胆固醇（LDL—C）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL—C）的水平均有不同程度的改善，TC、LDL—C降低（P〈0．01），但观察组的TC、LDL-C降低效果更为明显；达标率明显提高（观察组的TC、LDL—C达标率为77.27％和63．64％，对照组为66．67％和52.38％，P〈0．01）；观察组TG降低、HDL—C升高（P〈0．01及P〈0．05）。未见明显不良反应。结论阿托伐他汀、烟酸缓释片联用治疗老年混合型高脂血症较单用阿托伐他汀更有效、调脂更全面，且具有良好的安全性和耐受性。     

冠心病合并高血压与高血脂和同型半胱氨酸水平的相关性

目的探讨冠心病合并高血压与高血脂及同型半胱氨酸的相关性,为冠心病的防治提供理论依据。方法127例冠心病患者根据血压水平分为单纯冠心病组58例和合并高血压组69例,另选取健康体检者52例为对照组,测定血脂水平及血清同型半胱氨酸（Hcy）水平,并进行相关性分析。结果单纯冠心病组和合并高血压组患者的总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL—C）和Hey水平均明显高于对照组,高密度脂蛋白胆固醇（HDL—C）水平明显低于对照组,差异均有统计学意义（P〈0．05）;合并高血压组患者TC、TG、LDL—C和Hcy水平均明显高于单纯冠心病组,HDL—C水平明显低于单纯冠心病组,差异均有统计学意义（P（0．05）;冠心病患者脉差压（PP）水平与TC、TG、LDL—C和Hey水平呈正相关（r值分别为0．58、0．56、0．47、0．73,P〈0．05）,与HDL—C水平呈负相关（r=-0．45,P〈0．05）,冠心病患者血清Hcy水平与血清TC、TG和LDL—C水平呈正相关（r值分别为0．62、0．67、0．68,P〈0．05）,与HDL—C水平呈负相关（r=-0．52,P〈0．05）。结论高血脂和高同型半胱氨酸血症是原发性高血压发生冠心病的独立危险因素,两者协同作用可促进高血压性冠心病的发生发展。     

2型糖尿病合并非酒精性脂肪性肝病患者检测同型半胱氨酸及血清铁蛋白的临床意义

目的探讨在2型糖尿病（T2DM）合并非酒精性脂肪性肝病患者中检测空腹血清同型半胱氨酸（tHCY）及血清铁蛋白（sF）的临床意义。方法将195例T2DM患者分为单纯糖尿病组（A组）83例,合并非酒精性脂肪肝组（B组）60例及合并非酒精性脂肪性肝炎组（C组）52例,分别测定身高,体重,抽空腹血检查tHCY、SF、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL—C）、低密度脂蛋白胆固醇（LDL-C）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、谷氨酰转肽酶（GGT）、糖化血红蛋白（HbA1C）、空腹血糖（FBG）及空腹胰岛素（FINS）等。计算体质指数（BMI）及胰岛素抵抗指数（HOMA—IR）。结果B组BMI、TG、TC、LDL～C、ALT、AST、GGT、tHCY、SF、FINS、HOMA—IR均明显高于A组（P〈O．05）,C组均明显高于B组（P〈0．05）。而B组HDL—C均明显低于A组（P〈0．05）,C组均明显低于B组（P〈0．05）。3组间HbA-c、FBG及年龄差异无统计学意义。Pearson相关分析结果显示,tHCY与BMI、TG、TC、LDL—C、FINS、HOMA—IR呈显著正相关（P〈0．05）,与HDL—C呈显著负相关（P〈0．05）;SF与BMI、TG、TC、LDL—C、FINS、HOMA—IR呈显著正相关（P〈0．05）,与HDL—C呈显著负相关（P〈0．05）。结论tHCY及SF是T2DM合并非酒精性脂肪性肝病的危险因素,并且与BMI、TG、TC、I．DL—C、FINS、HOMA—IR、HDL—C水平具有相关性。     

2型糖尿病患者血清脂蛋白比值与胰岛素抵抗的相关性研究

目的探讨2型糖尿病（T2DM）患者血清脂蛋白比值与胰岛素抵抗的相关性。方法随机选取62例T2DM患者（T2DM组）及60例健康者（对照组）,分别测定空腹血糖（FBG）、空腹胰岛素（FINS）、甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL—C）、低密度脂蛋白胆固醇（LDL—C）等,计算TG／HDL-C、TC／HDL—C及LDL．C／HDL—C比值,采用稳态模型（HOMA）计算胰岛素抵抗指数（HOMA—IR）,并作相关统计学分析。结果T2DM组的TG／HDL．C、TC／HDL—C及LDL．C／HDL—C比值均显著高于对照组（P〈0．01）,且均与HOMA-IR呈正相关（P〈0．01）。ROC曲线分析表明TC／HDL．C用于诊断T2DM合并胰岛素抵抗时具有较高的敏感性和特异性。结论T2DM患者血清脂蛋白比值与胰岛素抵抗之间呈正相关,对T2DM合并胰岛素抵抗的诊断及指导治疗具有重要参考价值。     

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.     

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.     

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.     

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.