原发性甲状腺功能减退症患者治疗后血脂水平的变化

目的探讨原发性甲状腺功能减退(原发性甲减)患者左旋甲状腺激素治疗后的血脂水平的变化。方法64例原发性甲减患者在诊断初和经左旋甲状腺素治疗3月后分别测定空腹血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(sTSH)、血总胆固醇(TC)、甘油三脂(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)。结论左旋甲状腺素治疗可使原发性甲减患者症状改善,显著降低血浆TC、LDL-C,从而减少心血管事件。     

左旋甲状腺素对亚临床甲状腺功能减退症孕妇血管内皮功能及血清促甲状腺激素和脂质水平的影响

目的探讨左旋甲状腺素对亚临床甲状腺功能减退症(简称加减)孕妇血管内皮功能及血清促甲状腺激素(TSH)和脂质水平的影响。方法选取2016年7月-2017年9月在重庆市黔江中心医院产科门诊建立生产档案并确诊为亚临床甲减的76例孕妇为病例组,选择同期在同院产科门诊建立生产档案的76例健康孕妇为对照组。病例组给予左旋甲状腺素治疗。测定对照组及病例组治疗前后血清一氧化氮(NO)、内皮素-1 (ET-1)、超敏C-反应蛋白(hs-CRP)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、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)、内皮依赖性扩张百分率(FMD%)。结果与对照组比较,病例组治疗前血清NO、FMD%水平明显降低,血清ET-1、hs-CRP水平明显升高(均P0. 05);病例组治疗后,血清NO、ET-1、hs-CRP、FMD%水平与对照组比较差异均无统计学意义(均P0. 05);与病例组治疗前相比,病例组治疗后血清NO、FMD水平明显升高,血清ET-1、hs-CRP水平明显降低(均P0. 05)。与对照组比较,病例组治疗前血清TSH水平明显升高(P0. 05);病例组治疗后血清TSH水平与对照组相近,差异无统计学意义(P0. 05);与病例组治疗前相比,病例组治疗后血清TSH水平明显降低(P0. 05);对照组、病例组治疗前、病例组治疗后血清FT3、FT4水平相近,差异均无统计学意义(均P0. 05)。与对照组比较,病例组治疗前血清TC、TG、LDL-C水平明显升高,血清HDL-C水平明显降低(均P0. 05);病例组治疗后,血清TC、TG、LDL-C、HDL-C水平与对照组相近,差异均无统计学意义(均P0. 05);与病例组治疗前相比,病例组治疗后血清TC、TG、LDL-C水平明显降低,血清HDL-C水平明显升高(均P0. 05)。结论左旋甲状腺素能明显降低亚临床甲减孕妇血清TSH水平,具有保护血管内皮功能及降低血脂的作用,应积极在临床上推广应用。     

亚临床甲状腺功能减退症血脂水平的临床意义

目的观察亚临床甲状腺功能减退症(亚甲减)患者血脂水平变化,分析其与促甲状腺素(TSH)关系。方法测定并比较52例亚甲减、47例甲减患者和50名健康人群的血清TSH、游离甲状腺素(FT4)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-c)、高密度脂蛋白胆固醇(HDL-c)和甘油三酯(TG)水平,并分析TSH与血脂水平的相关关系。结果与健康人群组比较,亚甲减组、甲减组TC、LDL-c水平显著升高,甲减组与亚甲减组比较,TC、LDL-c水平亦显著升高,相关分析显示TSH与TC、LDL-c密切相关(r=0.40,P<0.01;r=0.47,P<0.01)。结论亚甲减组与健康人群比较TC和LDL-c水平明显升高;TSH水平与TC和LDL-c水平呈正相关。     

妊娠期糖尿病合并甲状腺功能减退患者甲状腺功能与糖脂代谢和胰岛素抵抗水平的相关性

目的 探讨妊娠期糖尿病(GDM)合并甲状腺功能减退(甲减)患者甲状腺功能与糖脂代谢、胰岛素抵抗水平的相关性,为临床诊疗提供指导。方法 选择2018年3月—2020年6月舟山市普陀区人民医院收治的GDM孕产妇185例,根据是否合并甲状腺功能减退,分为观察组(GDM合并甲减,52例)和对照组(单纯GDM,133例)。分析比较两组孕产妇血清促甲状腺素(TSH)、游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、空腹血糖(FPG)、高密度脂蛋白固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、总胆固醇(TC)、空腹胰岛素(FINS)水平及HOMA-IR值。结果 两组孕产妇血清FT3比较,差异无统计学意义(t=0.173,P>0.05);观察组血清TSH、FT4水平明显低于对照组(t=5.292、10.650,P<0.05)。两组孕产妇血清FPG、HDL-C及TG水平比较,差异无统计学意义(t=1.378、0.900、0.845,P>0.05);观察组血清LDL-C、TC、FINS水平及HOMA-IR值均明显高于对照组(t=2.342、2.176、13.004、6.956,均P<0.05)。Pearson相关分析显示,LDL-C、TC、FINS及HOMA-IR与FT4呈负相关(r=-0.128、r=-0.163、r=-0.461、r=-0.573,均P<0.05)。结论 GDM合并甲减患者甲状腺功能与糖脂代谢、胰岛素抵抗水平关系密切,临床需加强监测并合理干预。     

右归丸治疗TPOAb阳性亚临床甲状腺功能减退症临床效果

目的:探讨右归丸对甲状腺过氧化物酶抗体(TPOAb)阳性亚临床甲状腺功能减退症孕妇血清促甲状腺激素(TSH)、游离甲状腺素(FT4)、TPOAb、血脂及妊娠结局的影响。方法:将82例妊娠合并亚临床甲状腺功能减退症(TPOAb阳性)患者分为观察组和对照组。对照组采用左甲状腺素钠片治疗,观察组在对照组治疗基础上,加用右归丸治疗。检测两组治疗前后血清TSH、FT4、TPOAb、血脂水平,记录不良妊娠情况。结果:两组治疗后甘油三酯(TG)、血清总胆固醇(TC)、低密度脂蛋白(LDL-C)、TSH、TPOAb等降低,观察组低于对照组(均P0.05); FT4两组治疗前后均无明显改变(P0.05);两组产后出血、胎儿窘迫、流产比较无差异(P0.05),剖宫产、妊娠高血压、低体重儿、早产比等观察组低于照组低(P0.05)。结论:左甲状腺素钠联合右归丸能促进亚临床甲状腺功能减退症孕妇血清TSH、TPOAb的水平降低,改善血脂和妊娠结局。     

亚临床甲状腺功能减退合并冠心病患者血脂、纤维蛋白原及颈动脉硬化的相关性分析

目的探讨亚临床甲状腺功能减退(亚临床甲减)合并冠心病患者血脂、纤维蛋白原(FIB)及颈动脉硬化的相关性。方法选择2015年7月—2016年6月本院收治的冠心病患者及合并未经治疗的亚临床甲状腺功能减退患者96例作为研究对象,冠心病合并亚临床甲减患者49例作为观察组,单纯冠心病患者47例作为对照组。分别测定两组促甲状腺激素(TSH)、血清游离三碘甲状腺(FT3)、游离甲状腺素(FT4)、空腹血糖(FBG)、三酰甘油(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)、FIB和颈动脉内膜中层厚度(IMT)。计量资料采用t检验,相关性分析采用直线相关回归分析,P0.05为差异有统计学意义。结果观察组TG、TC、LDL-C、FIB、IMT水平为(2.6±1.22)、(5.56±0.52)、(3.75±0.55)mmol/L、(3.26±0.46)g/L、(1.19±0.3)mm,较对照组的(1.91±0.61)、(4.32±0.69)、(3.12±0.42)mmol/L、(2.23±0.19)g/L、(0.96±0.19)mm升高,差异均有统计学意义(均P0.05)。TSH与TC、TG、LDL-C、FIB、IMT呈正相关(r=0.267、0.312、0.361、0.332、0.393,P0.05),而与HDL-C无明显相关性(P0.05)。结论亚临床甲减与血脂紊乱、FIB及颈动脉硬化密切相关,从而可能增加冠心病患者发生心脑血管疾病的风险,应尽早干预亚临床甲减。     

亚临床甲状腺功能减退症患者血脂水平临床分析

目的分析亚临床甲状腺功能减退症（亚甲减）患者的血清总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白（LDLC）、高密度脂蛋白（HDL-C）、脂蛋白a（LP-a）水平与促甲状腺素（TSH）之间的关系。方法选取2012年3月~2013年4月期间我院收治的亚临床甲状腺功能减退症30例作为观察组,同时选取此期间在我院自愿进行健康体检的健康人员30例作为对照组,分别对两组人员的TC、TG、LDL-C、HDL-C、及LP-a进行测定,并比较两组之间的差异。结果观察组患者TC、TG及LDL-C水平显著高于对照组,差异具有统计学意义（P〈0.05）,两组的HDL-C与LP-a水平之间无明显差异,无统计学意义（P〉0.05）,TSH与TC、TG、LDL-C之间呈正相关。结论 TSH对甲状腺功能状态具有极高的敏感性,其水平变化与患者体内的TC、TG、LDL-C水平呈正相关,TSH对亚临床甲状腺功能减退症的诊断与治疗情况判定具有指导意义。     

激素替代治疗甲状腺功能减退症的脂代谢水平变化

目的 探讨甲状腺功能减退症患者激素替代治疗前后脂代谢水平的变化.方法 188例甲状腺功能减退症患者(观察组)给予左甲状腺素钠片治疗,对比观察组治疗前后的甲状腺激素、血脂水平变化并与100例健康人(对照组)作比较.结果 观察组治疗前游离三碘原氨酸(FT3)、游离甲状腺素(FT4)低于对照组,超敏促甲状腺激素(sTSH)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)高于对照组;治疗后观察组FT3、FT4增高,sTSH、TC、TG、LDL-C降低;差异均有统计学意义(P<0.05).观察组治疗后FT3、FT4、sTSH、TC、TG、LDL-C与对照组比较无显著差异(P>0.05).结论 甲状腺激素替代治疗可有效恢复甲状腺功能减退症患者的甲状腺功能,并显著降低血脂水平.     

妊娠期甲状腺功能异常患者血脂及血糖代谢情况

目的研究妊娠期甲状腺功能异常患者血脂、血糖代谢情况。方法收集2014年9月-2015年9月在该院门诊就诊且临床确诊的甲状腺功能代谢异常患者84例,其中妊娠期甲状腺功能亢进组(甲亢组)37例、妊娠期甲状腺功能减退组(甲减组)47例,同时收集甲状腺功能正常女性40例为对照组;对比分析其空腹血糖(FPG)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)与总胆固醇(TC)水平。结果 3组患者血脂中TG、HDL-C、TC及血糖值比较,甲亢组血脂低于其他两组,空腹血糖高,甲减组反之,差异均有统计学意义(P0.05)。其中,甲减组和亚临床甲减组较低甲状腺素(T_4)血症组TG、HDL-C、TC下降明显。此外,甲亢组及甲减组的妊娠期糖尿病(GDM)患病率明显高于对照组(P0.05)。结论妊娠期甲状腺功能异常女性引起糖类、脂类代谢异常的几率较高,需重点监护。     

左旋甲状腺素治疗原发性甲状腺功能减退及对心肌酶谱影响分析

目的评估左旋甲状腺素治疗原发性甲状腺功能减退的疗效及其对患者心肌酶谱的影响。方法选取2012年12月到2014年4月于我院接受治疗的120例原发性甲状腺功能减退症患者作为研究对象,对所有患者均给予左旋甲状腺素治疗,对比治疗前后患者血清FT4(游离甲状腺素)、TSH(促甲状激素)、FT3(游离三碘甲状腺原氨酸)、TG(甘油三酯)、TC(总胆固醇)、LDL-C(低密度脂蛋白胆固醇)、CK(肌酸激酶)、CK-MB(肌酸激酶-同工酶)、AST(门冬氨酸氨基转移酶)、LDH(乳酸脱氢酶)水平的变化情况。结果治疗前患者血清TC水平与FT3、FT4水平呈负相关,与血清TSH水平呈正相关,但TG水平与患者甲状腺功能变化情况无明显相关性。治疗后,患者FT3、FT4水平明显提升,相较治疗前差异显著(P<0.05);且TC、CK、CK-MB、AST、TSH水平相较治疗前降低明显,对比差异显著(P<0.05)。结论原发性甲状腺功能减退症患者由于甲状腺素缺乏,可能导致心肌酶谱及血脂发生异常改变,采取左旋甲状腺素治疗可明显降低患者血清心肌酶谱水平。     

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.     

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.     

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.