上海市岗前职业健康检查人群尿中6种重金属负荷水平分析

目的 了解上海市岗前职业健康检查人群尿中持久性有毒重金属及微量元素铜的负荷水平。 方法 采用多阶段分层整群随机抽样法,抽取1 183名非职业暴露人员,对其岗前职业健康检查所得尿液中6种主要重金属水平进行分析。 结果 尿砷、铜、铅、锰、汞平均值分别为0.14 μmol/L、0.07 mg/L、0.106 μmol/L、0.011 mg/L、0.013 μmol/L,均在现有参考值范围内。尿铬平均值为0.031 mg/L,高于现有参考值。尿铅水平P₉₅(0.177 μmol/L)、尿锰水平P₉₅(0.012 mg/L)明显低于现有正常参考值。尿铬水平P₉₅(0.181 mg/L)明显高于现有正常参考值。尿砷、铬、铜、铅、锰、汞水平在各年龄组间差异均无统计学意义(P>0.05)。尿铬、铅、锰、汞水平在男女性别间差异无统计学意义(P>0.05)。 结论 应重视铬在本地区人群的负荷水平。在职业健康检查或职业病诊断中采用各年龄段和性别间统一的尿铬、铅、锰、汞参考值是可行的;应进一步验证尿砷、尿铜在男女性别间的统计学差异。     

两种尿汞表达方式在汞中毒实际的应用比较

目的比较尿汞mg/L、μg/g Cr两种表达方式应用于汞中毒诊断及预防实际中的效果。方法收集188名正常人(对照组)、1046名职业接触汞人员(试验组)随机尿样于聚乙烯塑料瓶中,用校正后的F732-Ⅴ型测汞仪、酸性氯化亚锡还原-冷原子荧光法测定尿总汞含量,用手工碱性苦味酸法检测尿液肌酐含量,尿汞结果分别以mg/L、μg/g Cr两种方式报告。结果对照组及试验组尿总汞含量两种表达结果均成正偏态分布,对照组尿汞mg/L的几何均数为0.00123、尿汞μg/g Cr的几何均数为0.96,两种报告方式的结果之间存在正相关关系(r=0.9967,P0.001);试验组尿汞mg/L的几何均数为0.00287、尿汞μg/g Cr的几何均数为2.42,两种报告方式的结果之间存在正相关关系(r=0.9935,P0.001)。以0.01 mg/L与4μg/g Cr为正常人参考值标准判断试验组检测结果时,差异有统计学意义(P0.01)。结论以0.01 mg/L为正常人参考值做标准判断结果的漏诊率较高;判断个体样本的测定值是否超过正常参考值或生物限值,以μg/g Cr方式报告尿汞含量更符合临床实际;但大样本调查研究,以mg/L、μg/g Cr两种方式报告得出的结论差异无统计学意义。     

ICP-MS法同时测定生物样品中5种元素

目的建立同时测定血液、尿液中铅、镉、砷、铬、汞的电感耦合等离子体质谱(ICP-MS)分析方法,为开展金属污染对人体健康的影响研究提供检测手段。方法样品经硝酸消化后,以铋、铟、钪、钇作为内标元素,用ICP-MS测定铅、镉、砷、铬、汞5种元素,采用全血、全尿标准物质实施质量控制。结果各元素线性相关系数均0.999;铅的检出限为0.003 8μg/L,镉的检出限为0.005 6μg/L,铬的检出限为0.025μg/L,砷的检出限为0.047μg/L,汞的检出限为0.006 2μg/L;对标准物质测定结果均在标准值范围内;测定过程中对同一样品重复测定,其相对标准偏差均10%;加标回收率为82%~115%。结论电感耦合等离子体质谱法操作简便、灵敏度高、特异性好,适用于大批量样品中多种元素的同时测定。     

尿液的采集时间对尿汞测定结果的影响

目的更准确地掌握人体不同尿液采集时间尿汞含量的大小,以便为临床治疗汞中毒提供更可靠的数据。方法采集不同时间点的尿液,用WS/T97的方法测定尿肌酐,用原子荧光光谱法测定尿汞。结果同一患者3 d晨尿、随机尿液(每天3次)以及24 h尿液的尿汞肌酐校正平均值与T值(所有尿汞肌酐校正值的平均值)的差异分别为0.5%、0.8%、22.4%、22.4%、0.1%;不同患者晨尿与T24(24小时尿液的尿汞肌酐校正值)差异值在10%以内,而随机尿液与T24的差异值波动较大,从2.2%～196%,且无特定规律。结论 24 h尿液和晨尿的尿汞肌酐校正值最为稳定,住院患者最好留取24h尿液,而门诊患者应留取晨尿,随机尿液的尿汞肌酐校正值差异较大,不具有临床意义。     

深圳市产妇、新生儿和少儿体内重金属负荷水平研究

目的了解深圳市敏感人群体内铬、砷、镉、汞、铅5种重金属的负荷水平。方法选择环境重金属污染敏感人群(包括产妇、新生儿和3~5年级儿童),采集产妇静脉血、胎儿脐血、儿童静脉血以及产妇和儿童的尿液,采用电感耦合等离子体质谱法测定全血和尿液中镉、铅、铬、砷、汞的含量。结果产妇静脉血中铬、砷、镉、汞、铅质量浓度分别为2.58、1.57、0.99、1.66和18.52μg/L,新生儿脐带血重金属质量浓度分别为1.63、1.49、0.03、3.28和15.38μg/L;产妇尿中5种重金属的质量浓度分别为4.41、94.85、1.58、2.02和6.14μg/g·肌酐,尿镉和尿汞超标率分别为2.63%和7.14%;儿童静脉血中铬、砷、镉、汞、铅质量浓度分别为3.90、1.94、0.48、1.67和30.85μg/L,3名儿童血铅超标,尿中5种重金属的质量浓度分别为4.19、107.67、0.79、1.20和4.21μg/g·肌酐,仅1名儿童尿砷超标,12名儿童尿汞超标;尿样与血样中砷、镉、汞质量浓度呈显著正相关(P0.05)。结论人体生物样本中重金属质量浓度个体差异较大,本次调查的深圳地区重金属污染敏感人群(产妇、新生儿和儿童)体内重金属负荷水平远低于大多数其它国家和地区,但仍存在重金属铅、砷、汞、镉超标情况。     

尿液基质效应对尿铅含量检测的影响

目的探讨尿液不同基质对尿铅含量检测的影响。方法将尿铅样品按浓度分成3个区间,低浓度(100μg/L)、中浓度(100~1000μg/L)和高浓度(≥1000μg/L),采用不同稀释方法处理样品后,用石墨炉原子吸收光谱法进行测定。结果尿液样品稀释倍数大于10倍时,尿液基质改变使得尿铅测定结果明显低于实际浓度;不同稀释方法对尿铅检测结果影响很大,加入正常人尿样稀释处理后,尿铅检测回收率最好(95.5%~101.8%)。结论加入正常人尿样对尿液样品进行稀释处理,可最大程度地减少基质效应对尿铅检测的影响。     

关于尿铅正常值的几点意见

本刊创刊号俞筱芬同志在“现行尿铅正常值的商榷”中建议全国统一尿铅测定方法。统一,当然很好。不过,关于尿铅的诊断价值,测定方法不统一只是问题之一,另外还有正常值的计算方法等几个问题值得讨论。例如俞文表中所列各地区尿铅的正常测定值,都以mg/L计算,有时可以导致不正确的诊断。今年夏季高温时期,我们病房中旧铅中毒及铅吸收等患者,每天(24小时)尿量大多在500ml左右,个别人因为上海水质不好而不愿喝水者只三百多毫升;与春秋冬三季相比,尿量相差三、四倍,尿铅以mg/L计要商出二、三倍。这个情况,每年夏季都有发生。很多南方同志同我讨论过,都认为尿铅(及尿汞等)用mg/L计算,至少在夏季是容易造成错误的。     

电感耦合等离子体质谱法快速测定血液尿液中的铅和镉

目的:建立一种能同时测定血液尿液中铅和镉的方法。方法:用0.1%Triton X-100-0.5g/LED-TA-2%氨水混合溶液稀释血液和尿液,然后直接用电感耦合等离子质谱仪测定铅镉的含量。结果:铅镉的方法检出限分别为0.181μg/L和0.189μg/L,样品测定的精密度<6%,铅的回收率在92.2%～115.6%之间,镉的回收率在103.1%～107.2%之间。对冻干牛血(GBW09139g、GBW09130g)、冻干人尿铅(GBW09105e)、冻干人尿镉(ZK018-2)中铅和镉的含量进行了分析,测定值与标准参考值吻合。结论:本方法快速灵敏,精密度和准确度均符合要求,结果令人满意。     

20例汞吸收者驱汞疗效观察

王志民(吉林省前郭炼油厂工卫科)报道:20名汞吸收者,男16名、女4名;平均年龄30.6岁;最短接汞工龄4年以下,其尿汞值均超过0.05mg/L(双硫腙法)。住院后用二巯基丙磺酸钠进行驱汞治疗,每月给予二巯基丙磺酸钠250mg,行一次肌肉注射,用药3月休4月为一疗程,共驱汞四个疗程。治疗前尿汞最高值为0.132mg/L,最低值为0.052mg/L,平均0.066mg/L;治疗后最高值为0.05mg/L,最低值为0.005mg/L,平均     

溧阳市2011年涉铅企业职工尿铅水平

目的了解溧阳市涉铅企业在职工人尿铅水平状况。方法 2011年对溧阳市379名涉铅企业职工,采用石墨炉原子吸收光谱法进行尿铅水平检测。结果尿铅均值为0.08 mg/L,超标率为11.87%;其中,男职工117人,尿铅均值为0.09 mg/L,超标率为17.09%,女职工262人,尿铅均值为0.07 mg/L,超标率为9.54%,差异有统计学意义(P<0.05);工龄较长职工尿铅超标率较高,差异有统计学意义(P<0.01)。结论长期接触铅可导致铅在人体内的蓄积量增加,做好防护工作,定期检查,及时治疗,可减轻铅对人体的危害。     

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.