原位肝移植合并重症脓毒症病人的临床研究

Objective To improve the treat effect of the orthotopic liver transplantation patients with severe sepsis. Methods Fif-ty-six post-surgery patients were enrolled in this study. Patients were divided into two groups. One was non-OLT group (A group) and the other was OLT group (B group). Besides general data, the surveillance of blood lactate, the number of failure organs, APACHE Ⅱand MODS were recorded. 28-days survival rate and follow-up were checked. Results The mortality of hospitalization in non-OLT group was 30% and 57.6% in OLT group. The level of blood lactate in OLT group at the 1 st day increased significantly, which was statistically differ-ent with that in non-OLT group (P <0.01). It decreased but kept higher than that in non-group in following seven days. The numbers of failure organs in OLT group were more than in non-OLT group (P <0.01). The continuous APACHE Ⅱ score had no significant difference between two groups. But the continuous MODS score in OLT group was higher than in non-OLT group (P <0.01). Conclusions The 28-days mortality of OLT with severe sepsis is almost two times as much as that of non-OLT. It should cause more attention. The OLT with se-vere sepsis is more likely suffered from failure organs and difficult to recovery. To assess the condition of failure organs in OLT patients with severe sepsis, MODS score is better than APACHE Ⅱ score in this study. It is suggested that the standard of score system could be improved or come up with new score for organ transplantation. It will be better if blood lactate score is included.     

Ultrasonic follow‑up observation on size changes of 4C type thyroid micronodule classified by C‑TIRADSCSCD

Objective To observe the size changes under ultrasound of 4C type thyroid micronodules classified by 2020 Chinese Thyroid Imaging Reporting and Data System (C‑TIRADS) during follow‑up. Methods In this cross‑sectional study, the data of thyroid ultrasonography in physical examination center in the Affiliated Zhongshan Hospital of Dalian University between December 2017 and December 2021 were retrospectively included, thyroid nodules were classified according to C‑TIRADS, to observe the changes by ultrasound of maximum diameter and volume of 4C type thyroid micronodules during follow‑up. Results A total of 102 subjects receiving physical examinations with 103 thyroid micronodules were enrolled in this study. The maximum diameter and volume of thyroid micronodules at initial examination was 5.0 (4.0, 7.0) mm and 52.5 (25.2, 113.4) mm3respectively, and it was 6.0 (4.0,7.0) mm、65.6 (25.2,147.0) mm3 at the last examination, respectively. Of the thyroid micronodules, 79 (76.7%) remained stable, 14 (13.6%) magnified and 10 (9.7%) shrunk during the follow‑up. The cervical lymph nodes in all physical examiners were normal. There were significant changes in the maximum diameter and volume in the thyroid micronodules between the initial and last examination in subjects whose micronodules shrunk or magnified during the follow‑up (all P<0.05). Conclusion Size of most C‑TIRADS 4C thyroid micronodules remains stable or even decreases during ultrasound follow‑up observation, for such thyroid nodules, follow‑up observation appears to be a safe and feasible way to postpone surgery. © 2023 Chinese Journal of Health Management. All rights reserved.     

骨牵引和DHS治疗老年股骨粗隆骨间骨折的临床比较研究

Objective The purpose of this study is to observe the difference of the six-month mortality,complications and function recovery between the skeletal traction group and DHS group.Methods This retrospective study was undergone in the department of orthopaedics of Longhua hospital.According to the methods of tareatment,87 cases were divided into two groups:skeletal traction group and DHS group.To comapare the rate of six-month moaality,general complications(which include pulmonary infeetion,bed-sore,minary infection and deep venous thrombosis)and coxa yams between the two groups,while the Harris hip score in the third month and sixth month after injury were also compared.Reuslt ①About the rate of six-month momdity,there was one case(2.27%) in the skeletal traction group,and one ease also(2.33%) in the DHS group,there was no difference between the two groups.(P=1.0) ②About the rate of general complications,there were 15 cases(34.09%) in the skeletal traction group,and 14 cases(32.56%) in the DHS group,there was no difference between the two groups.(P=0.879) ③About the rate of coxa varus,there were seven eases (16.28%) in the skeletal traction group,and one ease(2.38%)in the DHS group,there was no difference between the two groups.(P=0.068).But for the unstable intertrochantefic fractures,there were seven cases out of 29(24.14%)in the skeletal traction group,and one case out of 31 (3.23%),these showed that the rate of coxa yams is higher in the skeletal traction group than in the DHS group.(P=0.045) ④In the third month after injury,the Harris hip score was 52.99±4.86 in the skeletal traction group,and 65.87±3.39 in the DHS group,these showed that the Harris hip score is higher in the DHS group than in the skeletal traction group(P<0.0001).While in the sixth month after injury,the Harris hip score was 84.44±5.79 in the skeletal traction group,and 85.69±4.07 in the DHS group,these showed that there was no difference between the two groups(P=0.254).Conclusion ① A low mortality and complications morbidity could be found in the treatment of intearochanteric fractures in aged patients by the skeletal traction associated with careful nursing.②For the unstable fratures,compared to the DHS fLxation the conservative method may get higher rate of the coxa varus.③Although the operative fixation is the first choice for the treatment of the intertreehanterie fractures in aged patients,the skeletal traction method are not to be out of date thoroughly.     

无症状性颈动脉狭窄老年患者认知功能减退与皮质萎缩的相关性CSCD

Objective To analyze the correlation between cognitive impairment and cortical atrophy in elderly patients with asymptomatic carotid artery stenosis (ACAS). Methods In this cross‑sectional study, 40 consecutive elderly patients with ACAS treated in the Department of Neurology, Northern Jiangsu People′s Hospital from July 1, 2020 to June 30, 2021 (ACAS group), and 40 elderly healthy controls who accepted physical examination during the same period (control group) were included. Cognitive assessment was performed using the Mental State Examination Scale (MMSE) and the Montreal Cognitive Assessment Scale (MoCA), and brain magnetic resonance imaging scanning was performed in the ACAS group. The artificial intelligence technique was applied for brain lobe segmentation and cortical volume calculation. The χ2‑test, independent sample t‑test and Wilcoxon non‑parametric test were used to analyze the difference of clinical data and cognitive scores between the two groups. In the ACAS group, the cortical volumes of the side with carotid stenosis was compared with that of the normal side, and Spearman′s correlation analysis was used to assess the correlation between cognitive scores and cortical atrophy. Results Compared with the control group, the ACAS group got significantly lower scores of MMSE and MoCA, as well as lower scores of visuospatial executive function, attention and calculation, language function, abstraction ability and delayed recall [(25.60±2.49) vs (27.18±1.01), (22.05±3.59) vs (25.60±1.43), (2.73±1.04) vs (4.08±0.62), (4.53±0.93) vs (5.03±0.66), 2.00 (0.00) vs 3.00 (0.00), 1.00 (1.00) vs 2.00 (0.00), and (2.95±0.96) vs (3.35±0.62)] (all P<0.05). There was not significant differences in naming and orientation ability between the two groups (both P>0.05). The volume of cortical, temporal lobe, frontal lobe, parietal lobe and insular lobe on the side with carotid stenosis in the ACAS group were significantly smaller than those on the normal side [186.23 (177.97, 202.53) vs 194.67 (185.65, 204.82) cm3, 54.74 (50.66, 56.95) vs 55.61 (51.24, 58.49) cm3, 72.98 (70.76, 78.34) vs 75.27 (72.34, 80.66) cm3, 53.66 (51.11, 57.86) vs 56.59 (52.80, 60.09) cm3, 6.57 (6.35, 7.07) vs 6.72 (6.46, 7.34) cm3] (all P<0.05). The MoCA score in the ACAS group was positively related to the cortical volume ratio of the two sides (r=0.427, P<0.01). The attention (r=0.353) and abstraction (r=0.226) ability scores were positively correlated with the temporal lobe volume ratios of the two sides (both P< 0.05). The visuospatial executive (r=0.187) and language (r=0.373) ability scores were positively correlated with frontal lobe volume ratios of the two sides (both P<0.05), and visuospatial executive (r=0.386), naming (r=0.344), language (r=0.517), abstraction (r=0.335) and delayed recall (r=0.333) ability scores were positively correlated with parietal lobe volume ratios of the two sides (all P< 0.05). Conclusion In elderly patients with ACAS, the cognitive impairment and cortical atrophy on the sides with carotid stenosis are significant and a positive correlation is detected between them. © 2023 Chinese Journal of Health Management. All rights reserved.     

融合空气数据的深度网络慢阻肺评估测试评分预测模型的构建及意义CSCD

Objective To construct a chronic obstructive pulmonary disease (COPD) assessment test (CAT) score prediction model based on a deep network fused with air data, and to explore its significance. Methods From February 2015 to December 2017, the outdoor environmental monitoring air data near the residential area of the patients with COPD from the Respiratory Outpatient Clinics of Peking University Third Hospital, Peking University People′s Hospital and Beijing Jishuitan Hospital were collected and the daily air pollution exposure of patients was calculated. The daily CAT scores were recorded continuously. The CAT score of the patients in the next week was predicted by fusing the time series algorithm and neural network to establish a model, and the prediction accuracy of the model was compared with that of the long short‑term memory model (LSTM), the LSTM‑attention model and the autoregressive integrated moving average model (ARIMA). Results A total of 47 patients with COPD were enrolled and followed up for an average of 381.60 days. The LSTM‑convolutional neural networks (CNN)‑autoregression (AR) model was constructed by using the collected air data and CAT score, and the root mean square error of the model was 0.85, and the mean absolute error was 0.71. Compared with LSTM, LSTM‑attention and ARIMA, the average prediction accuracy was improved by 21.69%. Conclusion Based on the air data in the environment of COPD patients, the fusion deep network model can predict the CAT score of COPD patients more accurately. © 2021 Journal of Clinical Otorhinolaryngology Head and Neck Surgery. All rights reserved.     

The expression and meaning of TGF-β and TGIF in endometrosis

Objective To explore the role of TGF-βand TGIF in the pathogenesis of endometriosis. Methods The expression of TGF-β and TGIF was detected by immunohistochemistry method in the ectopic and eutopic endometrium of 30 cases with endometriosis (ec-topic endometrium group and eutopic endometrium group) and in the normal endometrium of 40 cases without endometriosis (control group). Result The expression of TGF -β in ectopic endometrium group was significantly higher than that in eutopic endometrium group and control group (P < 0.05). There was no significant difference in the expression of TGF- βbetween eutopic endometrium group and control group(P > 0.05). The expression of TGIF in ectopic endometrium group was significantly lower than that in eutopic endometrium group and control group( P <0.05). There was no significant difference in the expression of TGIF between eutopic endometrium group and control group(P > 0.05). There were negative correlation between the expressions of TGF - β and TGIF in ectopic endometrium group and eutopic endome-trium group(rs= - 0.769, - 0.549, P < 0.05). Conclusion The abnormal expression of TGF-β and TGIF in ectopic endometrium of pa-tients with endometriosis may be associated with the genesis and progression of endometriosis.     

Effectiveness of automated machine learning models in predicting the risk of preeclampsia in the first trimesterCSCD

Objective To explore the application value of automated machine learning (autoML) model in predicting the risk of preeclampsia in the first trimester. Methods From January 2017 to October 2020, 2 180 singleton pregnant women who were registered in Jinan Second Maternal and Child Health Hospital and underwent pregnancy examination at 12 weeks of gestation were selected. The pregnant women were divided into preeclampsia group (103 cases) and control group (2 077 cases) according to the occurrence of preeclampsia. The differences in clinical data and hematological indexes in the two groups were compared, and the correlation between each index and the risk of preeclampsia was analyzed too. All the pregnant women were randomly divided into training set and test set according to the ratio of 7∶3, and the autogluon autoML algorithm was used to build a variety of machine learning models, and training and cross‑validation were performed in the training set to compare the accuracy of the different models. The importance of each index in the autoML model was analyzed, and the autoML model and the logistic regression model were used to predict the risk of preeclampsia in pregnant women in the test set respectively, and the receiver operating characteristic (ROC) curve was used to evaluate the prediction performance of the autoML and the logistic regression model. Results The age, pre‑pregnancy body mass index, body mass index at 12 weeks of gestation, waist circumference at 12 weeks of gestation, proportion of drinking history, high‑sensitivity C‑reactive protein (hs‑CRP), triglyceride, low‑density lipoprotein cholesterol (LDL‑C), aspartate aminotransferase (AST), platelet distribution width (PDW), mean platelet volume, thyroid stimulating hormone (TSH) and β‑human chorionic gonadotropin were all significantly higher than those in the control group (all P<0.05), and the free tri‑iodothyronine (free T3), free thyroxine (free T4), placental growth factor (PIGF), soluble fms‑like tyrosine kinase‑1 (sFlt‑1) and pregnancy‑associated plasma protein‑A (PAPP‑A) were all significantly lower than those in the control group (all P<0.05). Correlation analysis showed that the correlation between pre‑pregnancy body mass index, body mass index at 12 weeks gestation, waist circumference at 12 weeks gestation, hs‑CRP, triacylglycerol, AST, TSH, free T3, free T4, β‑HCG, PIGF, sFlt‑1, PAPP‑A and preeclampsia risk were obviously higher; but the correlation between each index were lower. A total of 18 models in 8 categories were constructed with the autoML model algorithm, and the neural network _L2 based on FastAI had the highest accuracy in the training set (0.963) and the validation set (0.971). The TSH, LDL‑C, PDW, waist circumference at 12 weeks of gestation, sFlt‑1, AST were more important in the model, while the free T4, total cholesterol, pregnancy times, drinking history, parity and family history of hypertension were less important indicators. The area under the ROC curve of the autoML model for predicting the risk of preeclampsia in the first trimester was significantly higher than that of the logistic regression model (0.984 vs 0.765, P= 0.002), while there was no statistical difference in the prediction accuracy of the two prediction models in the training set (P>0.05). The prediction accuracy and sensitivity of the autoML model in the test set were both significantly higher than those of the logistic regression model (99.54% vs 98.32%, 93.75% vs 75.00%, both P<0.05). Conclusions Factors such as TSH, LDL‑C, PDW, waist circumference, sFlt‑1 and AST in the first trimester of pregnancy have a certain correlation with the risk of preeclampsia. The autoML model based on the indicators of the first trimester has a high predictive value for the risk of preeclampsia. © 2021 Journal of Clinical Otorhinolaryngology Head and Neck Surgery. All rights reserved.     

急性乙型肝炎临床特征和病毒标志物动态变化分析

Objective To explore the dynamic change of viral marker and clinical features in acute hepatitis B (AHB)and distinguish AHB from chronic hepatitis B(CHB) in acute onset. Methods Viral marker, HBV DNA in serum and clinical features were analyzed in 105 patients with AHB (AHB group) and 102 patients with CHB in acute onset (CHB group) between 2005 and 2009. Results There was no statistical difference in the mean levels of ALT, TBil, HBsAg, HBeAg and HBV DNA between AHB and CHB group on admission. However, the titer of auti-HBc-IgM in AHB group was(26.34 ±3.74)S/CO, which was obviously higher than that in CHB group, which was( 14.46 ± 3.10)S/CO, there was a statistical difference between the two groups( P < 0.05). After 2 weeks treatment, the levels of ALT and TBil in AHB patients decreased (1540.50±225.54)IU/L and (103.60± 46.48) μmol/L respectively, the decreased levels in AHB group were high compared to CHB group; the levels of HBsAg, HBeAg and HBV DNA in AHB group decreased (2558.46 ±644.26) IU/mL, (420.20± 63.20) S/CO and (4.53± 1.42) log10copies/mL respectively, and the levels decreased obviously compared to CHB group (P < 0.05). The decreased level of anti-HBc-IgM in AHB group was no statistical difference to CHB group after 2 weeks treatment (P > 0.05). 19.04% of the AHB patients were HBV DNA negative seroconversion before they were hospitalized. The level of HBsAg and HBeAg in AHB group declined quickly. Separately, 90.47% and 94.24% of the AHB patients had HBsAg and HBeAg seroconversion at the end of follow-up in AHB group. The level of ALT in AHB decreased quickly but its normalization was slower than the clearance of HBV. Conclusions There is no difference in viral marker, HBV DNA and clinical features between AHB and CHB in acute onset patients on admission, but the recovery of liver function in AHB is obviously after treatment. Anti-HBc-IgM (≥20 S/CO), dynamic change and seroconversion viral marker, ALT ≥20×ULN and recovery can be used to differentiate AHB from CHB in acute onset.     

急性乙型肝炎临床特征和病毒标志物动态变化分析

Objective To explore the dynamic change of viral marker and clinical features in acute hepatitis B (AHB)and distinguish AHB from chronic hepatitis B(CHB) in acute onset. Methods Viral marker, HBV DNA in serum and clinical features were analyzed in 105 patients with AHB (AHB group) and 102 patients with CHB in acute onset (CHB group) between 2005 and 2009. Results There was no statistical difference in the mean levels of ALT, TBil, HBsAg, HBeAg and HBV DNA between AHB and CHB group on admission. However, the titer of auti-HBc-IgM in AHB group was(26.34 ±3.74)S/CO, which was obviously higher than that in CHB group, which was( 14.46 ± 3.10)S/CO, there was a statistical difference between the two groups( P < 0.05). After 2 weeks treatment, the levels of ALT and TBil in AHB patients decreased (1540.50±225.54)IU/L and (103.60± 46.48) μmol/L respectively, the decreased levels in AHB group were high compared to CHB group; the levels of HBsAg, HBeAg and HBV DNA in AHB group decreased (2558.46 ±644.26) IU/mL, (420.20± 63.20) S/CO and (4.53± 1.42) log10copies/mL respectively, and the levels decreased obviously compared to CHB group (P < 0.05). The decreased level of anti-HBc-IgM in AHB group was no statistical difference to CHB group after 2 weeks treatment (P > 0.05). 19.04% of the AHB patients were HBV DNA negative seroconversion before they were hospitalized. The level of HBsAg and HBeAg in AHB group declined quickly. Separately, 90.47% and 94.24% of the AHB patients had HBsAg and HBeAg seroconversion at the end of follow-up in AHB group. The level of ALT in AHB decreased quickly but its normalization was slower than the clearance of HBV. Conclusions There is no difference in viral marker, HBV DNA and clinical features between AHB and CHB in acute onset patients on admission, but the recovery of liver function in AHB is obviously after treatment. Anti-HBc-IgM (≥20 S/CO), dynamic change and seroconversion viral marker, ALT ≥20×ULN and recovery can be used to differentiate AHB from CHB in acute onset.     

Influence of airway mucus plugs on patients with bronchial asthma and its managementCSCD

Objective To explore the influence of airway mucus plugs on patients with bronchial asthma and its management. Methods In this cross‑sectional study, from January 2020 to June 2022, 100 patients who were diagnosed with asthma and underwent chest CT examination in the Outpatient Department of Peking University Third Hospital were included. The chest CT results and medical history, pulmonary function, fractional exhaled nitric oxide (FeNO), blood routine, total allergen IgE, Aspergillus fumigatus M3 allergen‑specific IgE antibody test results were collected. According to the results of chest CT, the asthma patients were divided into group with mucus plugs and those without mucus plugs. Distribution of airway mucus plugs and the mucus plug scores based on lung segments were calculated. The relationships of mucus plugs with medical history, pulmonary function [These included before and after the bronchodilation test, forced vital capacity percent of predicted value (FVC%pred), forced expiratory volume in one second percent of predicted value (FEV1%pred), FEV1/FVC, peak expiratory flow percent of predicted value (PEF% pred), maximal mid‑expiratory flow percent of predicted value (MMEF%pred), maximal expiratory flow at 25%, 50%, 75% of vital capacity remaining percent of predicted value (MEF25%pred, MEF50%pred, MEF75%pred)], FeNO, and peripheral blood eosinophil (Eos) counts were analyzed. The logistic regression model was used to analyze whether airway mucus plug was a risk factor for asthma exacerbation, and the corresponding intervention strategies were explored. Results Among the 100 patients with asthma, 24 cases were in the mucus plug group and 76 cases were in the non‑mucus plug group. The distribution of mucus plug was more common in the lower lungs (30.53% and 9.16% in the lower and upper lobe of left lung, respectively; 29.01%, 14.50% and 16.80% in the lower, middle and upper lobe of right lung, respectively). The average score of mucus plug was (4.42±3.12) points. The body mass index (BMI), the number of visits to a doctor due to asthma exacerbations, FeNO, peripheral blood Eos counts in the mucus plug group were higher than those in the non‑mucus plug group [(24.95±4.34) vs (23.22±2.91) kg/m2, 0(0, 1) vs 0(0, 0), 97(37, 169) vs 31(18, 59) ppb (1 ppb=1×10‑9), 0.41(0.15, 0.70) vs 0.18(0.09, 0.37)×109/L](all P<0.05), and FVC% pred, FEV1%pred, FEV1/FVC, PEF% pred, MEF50%pred, MEF25%pred, MMEF% pred, MEF75%pred were lower than those in the non‑mucus plug group [(87.49±19.32)% vs (97.34± 14.24)%, (76.49±19.58)% vs (91.07±18.33)%, (72.44±10.91)% vs (79.48±8.13)%, (82.36±24.46)% vs (93.83±18.27)%, (53.03±24.81)% vs (75.75±27.15)%, (46.47±22.92)% vs (64.09±25.90)%, (50.28±23.73)% vs (74.53±26.80)%, (71.30±27.55)% vs (89.92±26.82)%] (all P<0.05). In the group with mucus plug, the airway mucus plug score was positively correlated with the patient′s body weight and the number of peripheral blood Eos counts at enrollment (r=0.413, 0.478; all P<0.05), and negatively correlated with FVC%pred and FEV1%pred (r=-0.576, -0.465; all P<0.05). Logistic regression analysis showed that airway mucus plug score was a risk factor for acute asthma attack (OR=1.269, 95%CI: 1.031-1.562; P=0.024). Conclusions Asthma patients have a high incidence of airway mucus plug, which is related to the level of Eos inflammation and body size. Airway mucus plugs can promote airflow obstruction and acute exacerbation of asthma. In clinical practice, appropriate asthma management policies can be formulated for airway mucus plugs to delay the progression of asthma and reduce the number of acute attacks. © 2023 Chinese Journal of Health Management. All rights reserved.     

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.     

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.     

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.     

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.