宫内节育器与子宫异常出血的关系分析

目的 了解与放置宫内节育器有关的子宫异常出血的相关因素.方法 采用病例对照研究方法,比较放置宫内节育器后子宫异常出血的132例患者(研究组)与放置宫内节育器后无异常子宫出血的132例妇女(对照组)的放置时机、类型和子宫内膜炎等情况.结果 研究组中金属宫内节育器比例最高(48.48%),对照组则以活性带铜宫内节育器最多(37.88%),两组使用节育器类型比较有显著性差异(χ2=6.01,P<0.05).研究组中人工流产后立即放置宫内节育器的比例高于对照组,经比较有显著性差异(χ2=12.97,P<0.05).研究组有59.09%患有子宫内膜炎,其中宫内节育器异位合并子宫内膜炎者占53.85%,明显高于宫内节育器异位无子宫内膜炎者的20.37%,经比较有显著性差异(χ2=14.88,P<0.05).结论 宫内节育器类型、放置时机、子宫内膜炎和节育器异位与子宫异常出血有关.     

爱迪联合放射综合治疗老年中晚期食管癌的临床疗效观察

[目的]探讨爱迪联合放射综合治疗老年中晚期食管癌的疗效和安全性。[方法]80例老年中晚期食管癌患者按随机数字表法分为观察组和对照组各40例。对照组采用单纯放疗,观察组加用爱迪注射液。[结果]观察组近期疗效有效率为77.5%(31/40),对照组为55.0%(11/40),差异有统计学意义(χ2=4.53,P﹤0.05);观察组生活质量有效率为87.5%(35/40),对照组为65.0%(26/40),差异有统计学意义(χ2=5.59,P﹤0.05);观察组毒副反应较轻,Ⅲ～Ⅳ度白细胞减少和食管黏膜反应明显少于对照组,差异有统计学意义(χ2=4.50,P﹤0.05);观察组1年生存率为72.5%(29/40),对照组为47.5%(19/40),差异有统计学意义(χ2=5.21,P﹤0.05)。[结论]爱迪联合放射综合治疗老年中晚期食管癌能明显提高疗效,减轻毒副反应,改善生活质量,延长生存期,更易为老年患者所接受,值得临床推广应用。     

葛根饮品对Ⅱ型糖尿病人膳食干预效果研究

[目的]观察葛根饮品对Ⅱ型糖尿病人膳食干预效果。[方法]将70例患者随机分为2组,干预组35例,应用葛根饮品,对照组35例,口服安慰剂,共实施干预6个月。[结果]两组干预效果比较,干预组空腹血糖、餐后血糖较对照组下降明显(P﹤0.05)。干预组、对照组自觉症状减轻现象分别为62.9%,17.1%,差异有统计学意义(χ2=22.500,P﹤0.01)。干预组、对照组减药或停药现象分别为57.1%,5.7%,差异有统计学意义(χ2=21.477,P﹤0.01)。[结论]应用葛根饮品对Ⅱ型糖尿病人的干预效果较好。     

人细小病毒B19感染与类风湿性关节炎发病的关联分析

[目的]探讨人细小病毒B19(B19)感染导致类风湿性关节炎(RA)的机理及免疫因素在其中的作用。[方法]随机抽取住院RA患者56例为病例组,外伤和骨关节炎55例作为对照组,应用聚合酶链反应(PCR)对其血液和关节液标本进行B19-DNA检测。同时对另外31例RA病例和11例对照的骨髓标本也进行B19-DNA检测。应用酶联免疫吸附测定法(ELISA)对上述血液标本进行B19-VP2-IgM检测以及血清中的炎症细胞因子(CK)TNF-α,IL-1,IL-6,IL-8的检测。[结果]病例组血标本B19-DNA阳性19例(33.9%),关节液标本B19-DNA阳性20例(35.7%);B19-VP2-IgM阳性14例(25.0%)与对照组间差异均有统计学意义(血χ2=14.69,P﹤0.01,关节液χ2=14.69,P﹤0.01,B19-VP2-IgMχ2=10.272,P﹤0.05)。在56例RA中,12例B19-DNA、B19-VP2-IgM阳性,2例仅B19-VP2-IgM阳性,7例仅B19-DNA阳性,同时B19-DNA、B19-VP2-IgM阴性35例;一致率为83.9%(P﹥0.05)。RA患者31例骨髓标本中16例B19-DNA阳性,阳性率为51.6%,与对照组(9.1%)比较差异有统计学意义(χ2=4.284,P﹤0.05)。RA患者骨髓标本B19-DNA阳性率高于血清(χ2=4.313,P﹤0.05)和关节液(χ2=4.313,P﹤0.05)。病例组CK水平高于对照组,两组间差异具有统计学意义。病例组B19-DNA阳性和B19-DNA阴性间上述细胞因子水平的比较差异无统计学意义。[结论]RA患者有较高的B19病毒感染率,B19病毒与RA密切相关,但B19并非是导致RA的唯一因素,作为一种诱发刺激因素,与其他致病因素协同作用,导致部分患者免疫功能紊乱,从而导致RA的发生。     

11690例体检心电图分析

[目的]了解武汉地区城市居民异常心电图的分布情况,为今后防治心血管疾病提供科学依据。[方法]对11690例体检人群心电图检查结果进行统计,对不同年龄组异常心电图分布情况及心电图异常与性别、年龄的关系进行分类统计分析。[结果]正常心电图占61.8%,异常心电图占38.2%。异常心电图发生率依次为ST-T改变(12.4%)、窦性心律失常(12.2%)、传导阻滞(3.7%)、其他异常(3.6%)、左室高电压(2.2%)、异位心律失常(1.9%)、房室肥大(1.0%)、低电压(1.0%)、陈旧性心梗(0.2%)。经年龄组相关系数分析,房室肥大(r=0.890,P﹤0.05)、陈旧性心梗(r=0.913,P﹤0.05)、左室高电压(r=0.895,P﹤0.05)、低电压(r=0.931,P﹤0.05)、异位心律失常(r=0.939,P﹤0.05)、传导阻滞(r=0.948,P﹤0.05)年龄分布为正相关,故检出率随年龄增长而增加。ST—T改变,40岁以上年龄组明显高于39岁以下年龄组,差异有统计学意义(χ2=79.21,P﹤0.01)。异常心电图检出率男性高于女性,差异有统计学意义(χ2=33.76,P﹤0.01)。[结论]定期开展心电图检查,对早期发现各种心脏疾患有重要意义。     

鼻内镜下切除治疗鼻腔鼻窦内翻性乳头状瘤的临床研究

[目的]探讨鼻内镜下切除鼻腔鼻窦内翻性乳头状瘤(NIP)的治疗效果和可行性。[方法]回顾性分析2005年10月～2010年8月行手术治疗的100例NIP患者的临床资料,行鼻侧切开术治疗57例(鼻侧切开组),行鼻内窥镜手术治疗42例(鼻内镜组)。术后随访1～3年,平均(32±11)个月,观察术后复发率和并发症发生率。[结果]鼻内镜组术后肿瘤复发率为18.6%,显著低于鼻侧切开组(29.3%),差异有统计学意义(χ2=6.574,P﹤0.01);Ⅱ、Ⅲ级患者术后肿瘤复发率均显著低于鼻侧切开组,差异有统计学意义(χ2=9.150、5.648,P﹤0.01);Ⅳ级患者术后肿瘤复发率显著高于鼻侧切开组,差异有统计学意义(χ2=9.100,P﹤0.01)。鼻内镜组术后并发症发生率为9.3%,显著低于鼻侧切开组(24.6),差异有统计学意义(χ2=8.200,P﹤0.01);Ⅱ、Ⅲ级患者术后并发症发生率均显著低于鼻侧切开组,差异有统计学意义(χ2=7.721、6.102,P﹤0.01);Ⅳ级患者术后并发症发生率均显著高于鼻侧切开组,差异有统计学意义(χ2=9.019,P﹤0.01)。而两组Ⅰ级患者术后肿瘤复发率和并发症发生率比较差异无统计学意义(χ2=1.761,2.361,P﹥0.05)。[结论]鼻内镜下切除治疗NIP临床效果好,术后复发率低、并发症少,但在治疗NIP时应根据Krouse分级选择合适的术式。     

汉族及哈萨克族IL-6基因-174G/C多态性及CRP基因+1059G/C多态性与代谢综合征的相关性研究

[目的]探讨新疆哈萨克族及汉族IL-6基因-174G/C及哈萨克族CRP基因+1059G/C多态性与代谢综合征(MS)的相关性。[方法]应用PCR-RFLP方法分别对新疆哈萨克族及汉族200例MS组及201例对照组IL-6基因-174G/C位点及哈萨克族200例MS组及201例对照组CRP基因+1059G/C位点进行检测。[结果]①IL-6-174G/C位点:哈萨克族两组中GG型频率分别为94.00%和98.50%,GC型分别为6.00%和1.50%,在MS组中CC型有1例被检出,两组基因型对比差异有统计学意义(χ2=5.66,P﹤0.05),G和C等位基因频率分别为97.00%和3.00%,对照组分别为99.30%和0.70%;两组等位基因频率差异有统计学意义(χ2=5.55,P﹤0.05),以G等位基因为参照,C等位基因的OR值为4.12(OR95%CI:1.38～12.29);汉族两组中GG型频率分别为93.43%和97.51%,GC型分别为6.57%和2.49%,CC型在两组中未检出,两组基因型差异有统计学意义(χ2=4.52,P﹤0.05),MS组中G和C等位基因频率分别为96.71%和3.29%,对照组中分别为98.76%和1.24%,G和C等位基因频率在两组间差异有统计学意义(χ2=4.42,P﹤0.05),以G等位基因为参照,C等位基因的OR为2.88(OR95%CI:1.08～7.70);两民族MS组及对照组IL-6-174位点基因型及等位基因频率的差异均无统计学意义(P﹥0.05);②CRP+1059G/C位点:MS组与对照组GG基因型频率分别为93.00%和99.00%,GC基因型频率分别为7.00%和1.00%,CC基因型未检出,G和C等位基因频率在MS组分别为96.50%和3.50%,两组基因型差异有统计学意义(χ2=9.43,P﹤0.01),等位基因频率差异有统计学意义(χ2=9.24,P﹤0.01),以G等位基因为参照,C等位基因的OR值为7.25(2.04～25.76)。[结论]哈萨克族和汉族IL-6-174G/C及哈萨克族CRP+1059G/C基因多态性与MS有一定关联。     

ACE基因和AT1R基因多态性与2型糖尿病早期肾病相关性的研究

[目的]探讨ACE和AT1R基因多态性与2型糖尿病肾病的相互关系,从分子水平揭示发病机制。[方法]应用多聚酶链反应(PCR)结合限制性酶切技术,检测40例正常人和60例2型糖尿病患者ACE、AT1R的基因型和等位基因频率。[结果]①糖尿病(DM)组与糖尿病肾病(DN)组间的AT1R基因型构成和等位基因频率差异均无统计学意义(χ2=0.017,P﹥0.05;χ2=0.012,P﹥0.05)。DM组与DN组分别同对照组相比AT1R基因型构成差异均有统计学意义(χ2=8.40,P﹤0.01;χ2=7.06,P﹤0.01);等位基因频率差异也均有统计学意义(χ2=7.14,P﹤0.01;χ2=6.11,P﹤0.05);②DM组、DN组与对照组3组之间ACE基因型构成、等位基因频率差异均无统计学意义(P﹥0.05);③糖尿病肾病患者每分钟尿白蛋白排泄率与ACE和AT1R基因多态性可能无明显相关性(P﹥0.05)。[结论]ACE基因的DD基因型和D等位基因可能不是2型糖尿病及糖尿病肾病发生的危险因子;AT1R基因的C等位基因是2型糖尿病及糖尿病肾病发生的危险因子;D和C等位基因可能不是糖尿病肾病患者出现蛋白尿的危险因素。     

维生素B12合剂联合金因肽对Ⅱ度放射性皮肤损伤的治疗疗效

[目的]探讨放疗患者急性放射性皮肤损伤的防治方法。[方法]在2008年1月～2009年12月期间,对130例放疗患者出现Ⅱ度放射性皮肤损伤时进行配对分组治疗,研究组用维生素B12合剂湿敷联合金因肽外喷,对照组使用普通烧伤膏及红外线照射。[结果]两组疗效差异有统计学意义(Z=5.007,P﹤0.001);平均愈合天数明显减少(t=10.68,P﹤0.001);总有效率(痊愈+缓解)研究组为98.48%,对照组为87.50%,两组差异有统计学意义(χ2=4.499,P=0.034)。[结论]维生素B12合剂湿敷联合金因肽外喷是治疗急性放射性皮肤损伤的一种既经济又有效的方法。     

延边地区慢性丙型肝炎与2型糖尿病的相关性分析

[目的]通过调查延边地区慢性丙型肝炎患者2型糖尿病患病率,探讨朝汉民族慢性丙型肝炎与2型糖尿病之间的关系。[方法]①367例慢性丙型肝炎(朝鲜族218例,汉族149例)、352例慢性乙型肝炎患者和681例健康体检者进行对照研究,明确其是否合并2型糖尿病。②用ELISA方法,对851例2型糖尿病患者及782例体检人群进行抗-HCV、HBsAg检测。[结果]①朝鲜族与汉族慢性丙肝患者2型糖尿病患病率为分别是24.31%,26.85%,差异无统计学意义(χ2=0.18,P﹥0.05);朝汉合并慢性丙肝患者2型糖尿病患病率为25.34%,慢性乙肝患者2型糖尿病患病率为9.38%,差异有统计学意义(χ2=18.36,P﹤0.01),与正常对照组2型糖尿病患病率9.84%进行比较差异也有统计学意义(χ2=36.60,P﹤0.01),慢性乙肝患者与正常对照组比较,2型糖尿病患病率差异无统计学意义(χ2=1.09,P﹥0.05)。②851例2型糖尿病患者中抗-HCV阳性72例(8.46%),HBsAg阳性33例(3.88%);782例体检人群中抗-HCV阳性23例(2.94%),HBsAg阳性78例(9.97%),两组抗-HCV阳性率、HBsAg阳性率差异均有统计学意义(P﹤0.01)。[结论]①慢性丙型肝炎患者易合并2型糖尿病,朝汉民族之间差异无统计学意义。②2型糖尿病患者中丙型肝炎病毒感染率高于普通人群,提示丙型肝炎病毒感染与糖尿病发生有一定关系。     

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.