新生儿缺氧缺血性脑病脑血流动力学变化及价值

目的:探讨新生儿缺氧缺血性脑病(HIE)的脑血流动力学变化及血流频谱特点,并探讨其临床意义。方法:对52例HIE患儿进行经颅多普勒超声(TCD)检测,包括大脑中动脉(MCA),大脑前动脉(ACA),大脑后动脉(PCA)的血流速度,频谱形态,搏动指数(PI),阻力指数(RI),异常声频的检测,以健康新生儿15例为正常对照组。结果:①脑血流轻度组舒张末期流速(Vd)、收缩峰流速(Vs)局部降低,中、重度组Vd广泛降低,Vs局部降低,重度组尤为显著(P<0.05);②PI、RI轻度组与对照组差异无统计学意义,中度组局部增高,重度组双侧大脑动脉PI、RI普遍增高(P<0.05)。结论:运用脉冲多普勒超声检测脑血流动力学变化,可用于HIE的早期诊断,病情判断和预后评估,对指导治疗具有重要意义。     

彩色多普勒超声在妊娠期高血压疾病患者胎儿宫内窘迫诊断中的应用价值

目的:探讨彩色多普勒超声在妊娠期高血压疾病(HDCP)患者胎儿宫内窘迫诊断中的应用价值。方法:选取110例正常晚期孕妇作为对照组,同时选取胎儿窘迫的110例孕妇作为观察组。比较两组孕妇的胎儿脐动脉、大脑中动脉及肾动脉搏动指数(PI)、阻力指数(RI)、动脉收缩末期血流峰值(S)与舒张末期血流速度(D)的比值(S/D)及两组新生儿产后1 min Apgar评分<7分、胎心率异常、羊水污染以及新生儿异常发生率。结果:观察组胎儿脐动脉S/D、RI和PI均显著高于对照组,差异有统计学意义(P<0.05);观察组胎儿大脑中动脉S/D、PI和RI值均低于对照组,差异有统计学意义(P<0.05);观察组肾动脉S/D、PI和RI值均高于对照组,差异有统计学意义(P<0.05)。对照组新生儿1 min Apgar评分<7分、胎心率异常、胎儿羊水污染以及新生儿异常发生率均显著低于观察组,差异均有统计学意义(P<0.05)。结论:采用彩色多普勒超声对胎儿脐动脉、大脑中动脉和肾动脉血流进行联合检测对预测胎儿宫内窘迫具有重要的临床意义,对确定合适的分娩时机和挽救胎儿性命有帮助。     

单纯性肥胖儿童血脂和载脂蛋白变化观察

目的:探讨单纯性肥胖儿童血脂和载脂蛋白的变化及增加动脉粥样硬化(AS)危险性的可能机制。方法:对单纯性肥胖儿童50例与正常儿童55例测定血清甘油三酯(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)、极低密度脂蛋白胆固醇(VLDL-C)、载脂蛋白A1(APOA1)和载脂蛋白B(APOB)水平。结果:单纯性肥胖组儿童TG、VLDL-C、APOB的水平均明显高于对照组(P<0.01);HDL-C、APOA1的水平明显低于对照组(P<0.01);两组TC含量无显著性差异(P>0.05)。结论:单纯性肥胖儿童血脂及载脂蛋白代谢异常,监测血脂水平、控制肥胖,对于预防AS及冠心病等心脑血管疾病具有重要意义。     

新生儿窒息后脑及肾动脉血流变化和临床意义

本文应用彩色多普勒对30例正常新生儿和25例窒息儿于日龄1、2、3、5、7天连续检测双侧大脑前动脉、大脑中动脉、大脑后动脉及肾动脉.记录收缩期峰值流速(Vmax),舒张末期流速(Vmin)、时间平均流速(TAMX)、阻力指数(RI)、搏动指数(PI).脑动脉的Vmax、Vmin、RI、PI窒息组与对照组比较有显著性差异(P<0.05).窒息新生儿脑动脉RI表现增高(0.70～1)、正常和降低(0.25～0.42).肾动脉显示Vmin降低和RI增高,和正常组比较P<0.05或P<0.01.本研究进一步证实,窒息时机体血流再分布及再灌注性脑损伤的理论.     

综合健康干预措施对肥胖儿童血脂水平的影响

目的 评估综合健康干预措施对单纯性肥胖儿童血脂水平的影响.方法 采用综合健康干预措施对在深圳市宝安区人民医院治疗的67名单纯肥胖儿童(肥胖组)进行为期1年的干预试验,测定干预前后身高、体重、体重指数(BMI)、血压及血脂水平变化,同时选取65名体重正常儿童作为对照组.结果 肥胖组儿童干预前体重、BMI值、收缩压、舒张压、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)均显著高于对照组(P<0.05或P<0.01);干预后BMI、收缩压和TG显著低于干预前(P<0.05或P<0.01),HDL-C明显高于干预前(P<0.05)但显著低于对照组(P<0.05).结论 综合健康干预措施能有效降低单纯性肥胖儿童的体重和BMI,改善其血脂水平,起到调节异常内分泌代谢的作用.     

经颅多普勒超声在颅内感染患儿中的应用

目的应用经颅多普勒超声(TCD)观察颅内感染患儿脑血流动力学的变化情况,并了解脑血流动力学与颅内压之间的联系。方法以大脑中动脉(MCA)为靶血管,观察颅内感染组及对照组患儿脑血流动力学情况;腰穿或应用甘露醇前后各指标的变化。结果颅内感染组Vp、Vm、PI、RI明显高于对照组;患儿在腰穿前大脑中动脉Vp、Vm、PI、RI均高于腰穿后;使用甘露醇后大脑中动脉Vp、Vm、PI、RI均低于使用甘露醇前。结论颅内感染患儿脑血流动力学多异于正常,脑血流动力参数可因颅内压而变,TCD可反映颅内脑血流灌注情况;因此TCD有助于判断颅内感染患儿病情、指导临床治疗和评估预后。     

血管回声跟踪技术评价单纯性肥胖儿童颈动脉弹性的研究

目的 应用血管回声跟踪技术(E-Tracking技术)评价单纯性肥胖儿童颈动脉弹性.方法 采集50例单纯性肥胖儿童(肥胖组)及50例健康儿童(对照组)双侧颈总动脉的超声图像,测量内膜-中层厚度(IMT)、阻力指数(RI)、搏动指数(PI)及收缩期与舒张期比值(S/D),应用E-Tracking技术自动测量颈总动脉收缩末期内径(Ds)、舒张末期内径(Dd)、压力应变弹性指数(E ρ)、硬度指数(β)、顺应性(AC)、增大指数(AI)、单点脉搏波传导速度(PWV β).结果肥胖组IMT较对照组明显增厚[左侧颈总动脉(0.60±0.07)mm比(0.46±0.04)mm;右侧颈总动脉(0.61±0.05)mm比(0.47±0.03)mm,P<0.01],两组Ds、Dd、RI、PI、S/D和Al比较差异无统计学意义(P>0.05).而肥胖组Eρ、β、PWVβ均明显高于对照组,AC显著低于对照组(P<0.05).结论 单纯性肥胖儿童颈动脉有早期动脉粥样硬化趋势,应用E-Tracking技术能快速、无创、准确地定量评价颈动脉弹性.     

彩色多普勒超声评估高危妊娠晚期胎儿生长受限的应用价值

目的 探讨彩色多普勒超声评估高危妊娠晚期胎儿生长受限(FGR)的应用价值。方法 选取2018—2020年杭州市临安区第一人民医院收治的103例高危妊娠晚期孕妇(高危妊娠组)为研究对象,另选择同期在本院行孕期检查的100例正常妊娠晚期孕妇作为对照组,均予以彩色多普勒超声检查,计算并比较高危妊娠组和对照组的胎儿脐动脉搏动指数(PI)、阻力指数(RI)、S/D值[收缩期峰值流速(PSV)/舒张期末流速(EDV)]、大脑中动脉PI、RI。将高危妊娠组胎儿分为FGR组与正常组,对比两组脐动脉PI、RI、S/D与大脑中动脉PI、RI,并采用ROC曲线分析脐动脉PI、RI、S/D与大脑中动脉PI、RI对高危妊娠晚期FGR发生的评估价值。结果 高危妊娠组FGR发生率19.42%显著高于对照组的1.00%,差异有统计学意义(P<0.05)。高危妊娠组脐动脉PI、RI、S/D分别为(0.94±0.18)、(0.65±0.12)、(2.67±0.53),对照组脐动脉PI、RI、S/D分别为(0.82±0.15)、(0.57±0.11)、(2.29±0.48),高危妊娠组脐动脉PI、RI、S/D均高于对...     

复杂先天性心脏病胎儿脐动脉及大脑中动脉血流动力学研究

目的:探讨复杂先天性心脏病胎儿的脐动脉(UMA)及大脑中动脉(MCA)血流动力学变化的检测方法。方法:应用彩色多普勒超声检测14例患有复杂先天性心脏病胎儿的大脑中动脉和脐动脉的血流动力学指标,包括阻力指数(RI)、搏动指数(PI)、收缩期最大流速(S)与舒张末期血流速度(D)的比值(S/D值)、MCA-RI/UMA-RI和MCA-PI/UMA-PI值。另选取80例正常胎儿作为对照组。结果:病例组MCA的S/D值、PI值和RI值明显低于对照组(P<0.05)。病例组UMA的S/D值、PI值和RI值均高于对照组(P<0.05),MCA-RI/UMA-RI和MCA-PI/UMA-PI值低于对照组(P<0.05)。结论:复杂先天性心脏病胎儿存在脑血管阻力降低现象,彩色多普勒超声可检测到这一血流动力学变化。     

新生儿缺氧缺血性脑病红细胞胞浆游离钙及脑血流动力学变化的临床意义

目的:探讨新生儿缺氧缺血性脑病(HIE)对红细胞胞浆游离钙(RBC[Ca2+]i)水平及脑血流动力学的影响及意义。方法:HIE组30例,正常对照组20例。HIE患儿于生后24h内采集静脉血2ml,采用Fura-2/AM法检测RBC[Ca2+]i水平;应用经颅彩色多普勒超声仪监测脑血流动力学参数,包括大脑中动脉收缩期峰值流速(PSFV)、舒张末期血流速度(EDFV)、平均血流速度(Vm)、阻力指数(RI)。并与正常对照组进行对比。结果:①HIE患儿RBC[Ca2+]i水平显著高于正常对照组[(2.68±0.05)vs(2.15±0.18);(2.80±0.17)vs(2.15±0.18),P<0.01]。HIE程度与患儿体内RBC[Ca2+]i水平具有相关性(r=0.453,P<0.05)。②HIE患儿PSFV、EDFV及Vm均低于正常对照组(P<0.01);RI高于正常对照组(P<0.01),存在明显的脑血流动力学紊乱,血流速度减慢,阻力指数增大。结论:RBC[Ca2+]i参与了HIE的病理生理过程,在HIE发病机制中可能起重要作用。监测RBC[Ca2+]i水平和脑血流动力学变化可能有助于HIE的早期诊断和预后判断,并指导临床治疗。     

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.