噪声对作业工人心率变异性的影响

目的 研究噪声对作业工人心率变异性(heart rate variability, HRV)的影响。
方法 选取某公司动力车间单纯接触噪声的作业人员96人为噪声接触组, 同时选取同一单位不接触噪声的工作人员95人为对照组, 两组均进行24 h动态心电图检查, 测量或计算24 h平均心率(HR)和HRV时域指标24 h全部窦性RR间期的标准差(SDNN)、24 h内全部窦性RR间期差值的均方根(RMSSD)、24 h内相邻两个正常窦性RR间期差值大于50 ms的个数所占的百分数(PNN50), 及频谱指标高频功率(HF)、低频功率(LF)、极低频功率(VLF), 比较接触组与对照组各指标的差异, 并分析接触组HRV各指标与工龄、年龄、性别、HR的相关性。
结果 接触组SDNN、PNN50、LF、VLF低于对照组, HR高于对照组(P < 0.05);接触组中SDNN、PNN50、LF、VLF与工龄及HR呈负相关(r=-0.582~-0.283, P < 0.05), 与性别无相关性(P>0.05), SDNN、PNN50、LF与年龄呈负相关(r=-0.233~-0.211, P < 0.05)。
结论 噪声作业工人心率变异性降低, 提示长期的噪声接触可引起作业工人自主神经功能紊乱。
     

川崎病患儿心率变异性的特点分析

目的探讨川崎病患儿的心率变异性(HRV)特点。方法选择2012年10月至2014年8月,成都市妇女儿童中心医院收治的120例川崎病患儿为研究对象,并纳入川崎病组。再按照是否伴冠状动脉扩张,将其进一步分为冠状动脉扩张亚组(CAL亚组,n=46)和无冠状动脉扩张亚组(NCAL亚组,n=74)。随机选择同期于本院接受体检的57例健康儿童纳入对照组。对两组儿童的24h窦性心律进行HRV分析,并观察时域分析统计指标[正常窦性R-R间期标准差(SDNN)、全部记录中每5min N-N间期平均值的标准差(SDANN)、相邻N-N间期标准差的平均值(SDNN index)、相邻N-N间期差值的均方根值(rMSSD)、相邻N-N间期之差>50ms的心搏数占心搏总数的百分率(PNN50)]和频域分析统计指标[极低频功率(VLF)、低频功率(LF)、高频功率(HF)、低频/高频(LF/HF)]。各组患儿的性别构成比、年龄等一般临床病历资料比较,差异无统计学意义(P>0.05)。本研究遵循的程序符合成都市妇女儿童中心医院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象监护的人的知情同意,并与之签署临床研究知情同意书。结果川崎病组患儿的时域分析统计指标SDNN、SDNN index、rMSSD、PNN50均较对照组降低,且差异均有统计学意义(t=5.82,2.20,4.81,3.64;P<0.05);而两组SDANN比较,差异却无统计学意义(t=1.92,P=0.085)。川崎病组患儿的频域分析统计指标VLF、LF、HF均较对照组降低,LF/HF值较对照组升高,并且差异均有统计学意义(t=2.50,4.50,2.85,2.14;P<0.05)。CAL亚组的SDNN、SDANN、PNN50、LF较NCAL亚组明显下降,并且差异有统计学意义(t=3.38,2.46,2.15,7.92;P<0.05)。结论川崎病患儿存在心脏自主神经功能损害,HRV对预测川崎病的发展和预后具有一定价值。     

有或无心脏症状的更年期女性心率变异分析

目的:探讨更年期女性有或无心脏症状与心率变异性(HRV)的关系。方法:96例更年期女性按照有无心脏症状分为无症状组(46例)和有症状组(50例),应用24 h动态心电图对两组患者进行HRV的对比分析。结果:有症状组SDNN、SDNN Index、rMSSD、PNN50、TP、LF及HF较无症状组明显降低(P<0.01),LF/HF比值增高(P<0.01)。结论:更年期女性有心脏症状者HRV降低,表现为交感神经张力增高,迷走神经张力降低,两者协调作用失衡。     

糖尿病伴焦虑抑郁患者心率变异分析的临床研究

目的观察糖尿病伴焦虑抑郁情绪障碍患者与心率变异性的关系,探讨合理的抗焦虑抑郁治疗方案.方法①对确定焦虑抑郁症的糖尿病患者计算其在我病房的构成比.②应用holter-star24H全信息动态心电图系统对39例确诊为糖尿病不伴焦虑抑郁症的患者和81例糖尿病合并焦虑抑郁症的患者进行心率变异性频域、时域的检测.③60例糖尿病合并焦虑抑郁症的患者随机分为药物治疗(百忧解和黛力新)30人和心理治疗组30人,观察治疗8w后患者的SDNN、rMSSD、NN50、PNN50、SDANN、TP、VLF、LF、HF、VLF、LF/HF;HAMD的评分.结果①糖尿病患者在我病房的发生率为67.5%,其中轻度焦虑抑郁为20%,中度焦虑抑郁为29.17%,重度焦虑抑郁为18.33%.②糖尿病合并焦虑抑郁患者SDNN,SDANN,TP,HF,LF的测量值随焦虑抑郁的严重程度下降,与单纯糖尿病比较差异有统计学意义.rMSSD,PNN的测量值随焦虑抑郁的严重程度上升,且差异有统计学意义,P＜0.05;③药物治疗组和心理治疗组8w治疗后对患者的HAMD评分两组差异没有统计学意义,P≧0.05,SDNN、rMSSD、NN50、PNN50、SDANN、TP、VLF、LF、HF、VLF、LF/HF的测量值差异没有统计学意义,P≧0.05.结论①糖尿病合并焦虑抑郁患者存在有心交感神经的张力增加;②合理的抗焦虑抑郁治疗(药物和心理治疗)利于改善患者的焦虑抑郁情绪,改善交感神经的张力.     

不同围绝经期阶段女性短程心率变异检查结果分析和应用价值

目的对比分析不同围绝经期阶段女性短程心率变异(HRV)检查结果差异,探讨其对围绝经期女性围绝经期综合征严重程度的临床价值。方法选择来该院行健康体检的不同围绝经期阶段的90例女性作为研究对象,其中绝经前30例设为A组,绝经期30例设为B组,绝经后期30例设为C组。对3组受试者行5 min HRV检查,并对所有受试者采用更年期综合征Kupperman评分法对其围绝经期症状严重程度进行评估。收集整理3组受试者一般资料,对数据进行分析。结果 B组受试者Kupperman评分高于A组和C组(P0.05),A组和C组比较,差异无统计学意义(P0.05);B组受试者短程HRV中的全程窦性心搏RR间期的标准差(SDNN)、全部相邻RR间期差值的均方根(RMSSD)、相邻RR间期差值超过50 ms百分比(PNN50)及低频功率(LF)及高频功率(HF)均较A、C两组低,A组较C组低,低频与高频功率比值(LF/HF)较A、C两组受试者高,A组较C组高,上述指标组间差异均有统计学意义(均P0.05);(3)经相关性分析显示,围绝经期女性Kupperman评分与RRSDNN、RMSSD、PNN50、LF及HF均呈负相关(r=-0.534、-0.607、-0.573、-0.509及-0.528,均P0.01),与LF/HF呈正相关(r=0.704,P0.01)。结论不同围绝经期阶段女性的短程HRV各指标呈现出明显的差异,且HRV各指标与围绝经期女性更年期综合征症状严重程度呈高度相关性,可对更年期女性临床症状严重程度、药物治疗观察等提供更为客观的观察指标,具有较高的临床价值。     

心内神经对蟾蜍心率变异的调节及其作用机制的研究

目的通过监测蟾蜍的心电图,比较动物清醒安静状态、离体灌流时HRV的不同,分析自主神经和体液因素对HRV的影响,观察心内神经对HRV的调节并分析其作用机制。方法选健康雄性中华蟾蜍50只,随机分为5组,在体组;离体组,阿托品(atropine,Atr)组;酚妥拉明(phentolamine,Phe)+β受体阻断剂普蔡洛尔(propranolol,Pro)组;Atr+Phe+Pro组,观察比较各相关指标。结果心脏离体后,与在体情况下相比,HR显著升高。正常心动周期的标准差(SDNN)显著降低,相邻正常心动周期差值的均方根(rMSSD)降低。离体给药组HRV各指标的比较,单独给予Atr后,HRV时域指标变化不明显,频域指标中HF变化不明显,LF、LF/HF显著增加;给予Phe+Pro后,HR显著降低,SDNN和rMSSD升高,LF、LF/HF降低;同时给予Atr+Phe+Pro后,HR变化无统计学意义,SDNN和rMSSD降低,HF降低,LF、LF/HF升高。结论离体状态下,心内神经对蟾蜍的HR和HRV有重要的调节作用,且以心内交感神经调节为主。     

急性心肌梗死早期应用螺内酯对心功能及心脏固有节律的影响

目的 探讨急性心肌梗死在标准治疗的基础上加用螺内酯,对心功能及心脏固有节律的影响.方法 选取首次急性心肌梗死患者60例,随机分为两组,每组30例.对照组采用常规治疗,螺内酯组在常规治疗基础上加螺内酯20mg每日1次口服.4周后行心脏彩色多普勒超声和24h动态心电图检查,计算Tei指数及了解心率变异性(HRV).结果 螺内酯组Tei指数显著小于对照组(P<0.01);时域指标中正常R-R间期的标准差(SDNN)、每5 min正常R-R间期平均值的标准差(SDANN)、相邻正常R-R间期差值的均方根(rMSSD)、相邻R-R间期之差大于50 ms所占百分比(PNN50)螺内酯组均显著大于对照组(P<0.01);频域指标中低频功率(LF)两组比较差异无统计学意义,但高频功率(HF)螺内酯组大于对照组(P<0.05),LF/HF螺内酯组小于对照组(P<0.05》.结论 在β-受体阻滞剂、ACEI或血管紧张素Ⅱ受体拮抗剂治疗的基础上合用螺内酯,4周后可以提高患者心脏功能,使HRV趋于正常化. -R间期的标准差(SDNN)、每5 min正常R-R间期平均值的标准差(SDANN)、相邻正常R-R间期差值的均方根(rMSSD 、相邻R-R间期之差大于50 ms所占百分比(PNN50)螺内酯组均显著大于对照组(P<0.01);频域指标中低频功率(LF)两组比较差异无统计学意义,但高频功率(HF)螺内酯组大于对照组(P<0.05),LF/HF螺内酯组小于对照组(P<0.05).结论 在β-受体阻滞剂、ACEI或血管紧张素Ⅱ受体拮抗剂治疗的基础上合用螺内酯,4周后可以提高患者心脏功能,使HRV趋于正常化. -R间期的标准差(SDNN)、每5 min正常R-R间期平均值的标准差(SDANN)、     

高尿酸血症对初诊糖尿病患者高敏C反应蛋白和心率变异性的影响及早期干预效果

目的探讨高尿酸血症(HUA)对初诊2型糖尿病(T2DM)患者高敏C反应蛋白(hs-CRP)和心率变异性(HRV)的影响及苯溴马隆早期干预效果,为糖尿病心脏自主神经病变(CAN)的防治提供依据。方法选取2010年1月至2016年6月在保定市第一医院内分泌科新诊断的T2DM患者60例为T2DM组,将新诊断的126例T2DM合并HUA患者随机分为苯溴马隆组和常规治疗组,每组63例。T2DM组和常规治疗组给予低盐、低脂、低嘌呤饮食及二甲双胍治疗;苯溴马隆组在常规治疗组的基础上加用苯溴马隆50 mg/d,口服,共治疗12周。治疗前及治疗后12周,对患者进行空腹血糖(FPG)、糖化血红蛋白(Hb A1C)、血脂、血尿酸(SUA)、高敏C反应蛋白(hs-CRP)及肝肾功能的检测;行24 h动态心电图监测,分析HRV时域和频域指标。应用SPSS 17.0软件对数据进行统计分析。结果治疗前,与T2DM组比较,苯溴马隆组和常规治疗组SUA、hs-CRP水平均明显升高,总体标准差(SDNN)、差值均方的平方根(r MSSD)、爱丁堡指数(PNN50)、低频(LF)、高频(HF)及LF/HF比值降低,差异均有统计学意义(P0.05,P0.01)。治疗后,苯溴马隆组与本组治疗前和常规治疗组治疗后比较,SUA、hs-CRP水平均明显降低,SDNN、r MSSD、PNN50、LF、HF均明显升高,差异均有统计学意义(P0.05);LF/HF比值高于本组治疗前,差异有统计学意义(P0.05,P0.01),但与常规治疗组治疗后比较,差异无统计学意义(P0.05)。结论 HUA可影响初诊T2DM患者的hs-CRP和HRV,通过降低SUA水平,可以改善患者hs-CRP水平和HRV,其疗效可能与机体炎症反应的改善有关。     

血浆同型半胱氨酸与2型糖尿病心率变异性的相关性分析

目的探讨血浆同型半胱氨酸(Hcy)与2型糖尿病患者心率变异性(HRV)的相关性。方法选择2型糖尿病(DM)患者100例,按照血浆Hcy水平将其分为两个亚组:高Hcy组50例(DM-HH)(Hcy≥15μmol/L);正常Hcy组50例(DM-NH)(Hcy15μmol/L);另选年龄、性别相匹配的健康人群50例作为对照(NC)。测量所有受试者的血浆Hcy及HRV指标。比较三组间血浆Hcy、HRV各指标。结果与NC组相比,2型糖尿病两亚组血浆FPG、Hb A1c明显升高(P0. 05),两亚组之间无差别(P0. 05); Hcy在DM-HH组明显高于NC组和DM-NH组(P0. 05),而DM-NH组略高于NC组,但无统计学差异(P0. 05); HRV各时域指标SDNN、SDANN、r MSSD、PNN50从DM-NH组到DM-HH组逐渐下降;频域指标LF/HF逐渐升高(P0.05),在糖尿病伴有Hcy升高时SDNN、SDANN、r MSSD、PNN50下降最显著,频域指标LF/HF升高最明显,均具有统计学差异(P0. 05)。相关分析发现,血浆Hcy与各时域指标SDNN、SDANN、r MSSD、PNN50呈负相关,与LF/HF呈正相关,具有统计学差异(P0.05)。结论高Hcy和高血糖是2型糖尿病心率变性下降的重要危险因素,高血糖伴Hcy升高时心率变性下降更明显。因此在降血糖的同时应积极降低血浆Hcy水平,以便改善心率变异性。     

晕船病与心率变异性的关系

目的分析心率变异性(heart rate variability,HRV)与晕船病的关系,探索预测晕船病易感性的生理指标。方法采集58名健康受试者陆上安静状态下和海上航行中的的短程心率变异指标,根据航海中是否出现晕船反应分为晕船病组26人和不晕船对照组32人。应用心率变异性时域、频域分析方法,分别评价其自主神经功能状态。结果海上航行中,晕船病组心率变异性时域指标明显高于对照组:RR间期平均值(MRR)增高21.26%,RR间期平均值的标准差(SDNN)增高27.75%,相邻RR间期差值的标准差(rMSSD)增高18.42%,相邻RR间期相差大于50ms占总心动周期的百分比(PNN50)增高32.14%,心率变异性指数(HRVI)增加24.05%。心率变异频域指标中,晕船病组与对照组比较,低频带(LF)增高81.98%,高频带(HF)增高13.59%,总功率谱密度(TP)增加32.43%,LF与HF比值(LF/HF)降低31.82%。在陆地上安静状态下,晕船病组心率变异性指标与对照组比较:SDNN、PNN50、HRVI分别增加26.68%、30.32%、30.48%,VLF、LF、HF、TP分别增加31.82%、45.05%、41.98%、37.62%;LF/HF降低32.43%。结论自主神经功能在运动病的发生中起着重要作用。晕船病者固有的自主神经张力较高,而且在发生晕船病时自主神经张力明显增高,特别是以迷走神经张力为主。心率变异性检测可以作为预测晕船病易感性的一个重要指标。     

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.