原发性肝癌患者肿瘤坏死因子水平变化的临床意义

[目的]探讨原发性肝癌(primary hepatic cancer,PHC)患者血清中肿瘤坏死因子(tumor necrosis factor,TNF-α)和甲胎蛋白(alpha-feta-protein,AFP)水平变化的临床意义。[方法]采用酶联免疫吸附法(Enzyme linkedimmunosorbent assay,ELISA)测定TNF-α,化学发光免疫法测定AFP。[结果]原发性肝癌患者血清TNF-α和AFP水平及阳性率均明显高于正常对照组及良性肝病组(P﹤0.05);PHC治疗后恶化或复发患者血清TNF-α和AFP水平比病情稳定组明显升高(P﹤0.01);联合检测的敏感性和诊断准确性均比单项检测高。[结论]联合检测TNF-α和AFP对PHC病情的观察、疗效的评价和预后的判断有重要价值。     

肝癌与肝硬化患者联合检测血清 CA125、AFP的临床意义

[目的]探讨血清肿瘤标记物 CA125、甲胎蛋白(AFP)在原发性肝癌(PHC)和肝硬化诊断中的临床价值.[方法]对PHC组56例,肝硬化组68例,正常对照组45例,检测血清CA125、AfP水平,并进行分析.[结果]原发性肝癌、肝硬化患者血清CA125浓度显著高于正常对照组(F=4.23～5.72,P<0.01),肝癌组与肝硬化组比较(P>0.05),差异无统计学意义.原发性肝癌、肝硬化患者AFP浓度均高于正常对照组,原发性肝癌组显著高于肝硬化组(F=4.77～6.45,P<0.01).PHC患者组AFP、CA125灵敏度分别为73.2%、69.6%,与肝硬化组比较(P＜(0.01),差异有统计学意义,其中AFP阳性(AFP>25ng/ml)的原发性肝癌患者中,血清CA125的灵敏度为73.9%,AFP阴性的原发性肝癌患者中,血清CA125的灵敏度为43.6%(P<0.05),差异有统计学意义.AFT、CA125联合检测原发性肝癌灵敏度提高到84.9%.[结论]血清AFP、CA125联合检测具有互补作用,可提高PHC的诊断率.     

血清AFP、TSGF、AFU、GGT及CEA联合检测对乙肝相关性原发性肝癌的早期诊断价值

目的探讨血清甲胎蛋白(AFP)、恶性肿瘤特异性生长因子(TSGF)、α-L-岩藻糖苷酶(AFU)、γ-谷氨酰转肽酶同工酶(GGT)及癌胚抗原(CEA)联合检测在乙肝相关性原发性肝癌(PHC)早期诊断中的临床价值。方法选取本院2014年4月至2016年7月收治的乙肝相关性PHC患者59例作为乙肝相关性PHC组,选取同期收治的乙肝肝硬化患者58例作为乙肝肝硬化组,另选同期健康体检者57例作为对照组,比较3组血清AFP、TSGF、AFU、GGT、CEA表达水平,对比血清AFP、TSGF、AFU、GGT、CEA单独诊断及联合诊断乙肝相关性PHC结果。结果乙肝肝硬化组血清AFP、TSGF、AFU、GGT、CEA水平均高于对照组,差异有统计学意义(均P0.05);乙肝相关性PHC组血清AFP、TSGF、AFU、GGT、CEA水平均高于乙肝肝硬化组、对照组,差异有统计学意义(均P0.05)。应用血清AFP、TSGF、AFU、GGT、CEA联合诊断乙肝相关性PHC特异度为80.87%(93/115)、灵敏度为88.14%(52/59)、准确度为83.33%(145/174),均高于血清AFP、TSGF、AFU、GGT、CEA单一诊断,差异有统计学意义(均P0.05)。结论血清AFP、TSGF、AFU、GGT、CEA联合检测对乙肝相关性PHC早期诊断应用价值较高,可显著提高诊断的特异度、灵敏度及准确度。     

微波消融治疗对原发性肝癌患者血清VEGF表达影响及临床意义

[目的]观察微波消融治疗原发性肝癌(PHC)对血清血管内皮生长因子(VEGF)的影响。[方法]采用ELISA方法测定60例PHC患者微波消融治疗前后和60例健康查体者血清VEGF水平。[结果]PHC组治疗前和治疗后血清VEGF水平均显著高于对照组,相比较差异有统计学意义(P﹤0.05);PHC组治疗后3d血清VEGF水平显著上升,治疗后7d血清VEGF水平显著下降,与治疗前比较有显著性差异(P﹤0.05);VEGF在不同年龄、性别、肿瘤直径大小患者血清中的表达差异无统计学意义(P﹥0.05),而VEGF水平在不同的临床分期、肿瘤远处转移与否之间比较差异有统计学意义(P﹤0.05)。[结论]微波消融治疗PHC可通过抑制VEGF的表达来达到抑制肿瘤生长和转移,血清VEGF水平可作为评估微波消融治疗的临床疗效及肿瘤残存、复发、转移的一个有效的预测指标。     

血清CEA、TPS、VEGF联合检测对乳腺癌的诊断价值

目的探讨血清癌胚抗原(CEA)、特异性组织多肽抗原(TPS)和血管内皮细胞生长因子(VEGF)在乳腺癌患者中的表达及其联合检测在乳腺癌诊断中的临床价值。方法采用酶联免疫吸附试验(ELISA)方法检测80例乳腺癌患者、73例乳腺良性疾病患者及75例健康女性血清中CEA、TPS和VEGF水平,并对检验结果进行统计学分析。结果乳腺癌患者血清CEA、TPS和VEGF水平(13.78±7.07 ng/ml、24.98±11.23 ng/ml和288.21±88.33 pg/ml)高于乳腺良性疾病患者血清CEA、TPS和VEGF水平(1.38±0.91 ng/ml、12.56±6.40 ng/ml和128.36±55.13 pg/ml)及健康女性血清中CEA、TPS和VEGF水平(1.49±0.87 ng/ml、11.34±5.49 ng/ml和122.87±43.71 pg/ml),差异有统计学意义(P0.01)。3项指标联合检测的敏感性为92.0%,显著高于单项检测,差异有统计学意义(P0.01)。结论血清CEA、TPS和VEGF水平单项检测在诊断乳腺癌疾病中具有临床意义,联合检测血清CEA、TPS和VEGF水平能提高乳腺癌诊断的敏感性。     

血清肿瘤标志物联合检测对原发性肝癌的诊断价值

[目的]探讨血清甲胎蛋白(AFP)、a-L-岩藻糖苷酶(AFU)、碱性磷酸酶(ALP)和γ-谷氨酰转移酶(GGT)联合检测对原发性肝癌(primary hepatocarcinoma,PHC)的诊断价值.[方法]对72例原发性肝癌患者血清中AFP、AFU、ALP和GGT进行联合检测并分析.[结果]原发性肝癌患者血清AFP、AFU、ALP和GGT水平及阳性率均明显高于正常对照组及良性肝病组(P<0.01);联合检测的敏感性和诊断准确性均比单项检测高.[结论]联合检测血清中的AFP、AFU、ALP和GGT对原发性肝癌的诊断具有重要临床价值.     

血清铁蛋白对AFP阴性原发性肝癌患者临床诊断和疗效监控的价值研究

目的探讨血清铁蛋白对AFP阴性原发性肝癌(PHC)患者的临床诊断和疗效监控的价值。方法选取2017年1月至2017年12月在我院诊断为原发性肝癌伴AFP阴性的患者78例为观察组,慢性肝炎患者75例为对照组。所有观察组病例均选择肝癌根治性切除术治疗,采用免疫化学发光法检测血清铁蛋白(SF)、癌胚抗原(CEA)、糖类抗原199 (CA199)和α-L-岩藻糖苷酶(AFU),生化酶学速率法检测γ-谷氨酸氨基转移酶(γ-GT)。通过ROC曲线分析SF对于PHC诊断和预测术后PHC复发的临床价值。结果观察组的SF、 AFU、 CEA、 CA199和γ-GT水平分别为(25.24±6.03)μg/mL、(34.61±9.35) U/L、(8.86±1.21) ng/m L、(51.22±10.23) U/mL和(301.23±54.37) U/L,显著高于对照组的(13.12±4.09)μg/mL、(30.29±5.73) U/L、(6.83±0.89) ng/mL、(47.73±10.28) U/mL和(285.55±61.35) U/L (P <0.05)。ROC曲线分析显示SF诊断PHC的AUC面积为0.885 (95%CI:0.794～0.945),敏感性和特异性分别为88.5%和91.2%;联合诊断的AUC面积为0.914(95%CI:0.830～0.965),敏感性和特异性分别为83.6%和93.7%。截止本研究终止, 2例PHC患者失访, 24例出现术后PHC复发,复发率为31.58%;复发组的SF、 AFU、 CEA、 CA199和γ-GT水平显著高于未复发组(P <0.05)。ROC曲线分析显示SF预测术后PHC复发的AUC面积为0.863 (95%CI:0.782～0.937),敏感性和特异性分别为88.4%和90.6%;联合检测的AUC面积为0.905 (95%CI:0.812～0.979),敏感性和特异性分别为81.8%和91.2%。结论血清铁蛋白对于AFP阴性的原发性肝癌患者的临床诊断和预测术后复发具有较高的临床价值,多指标联合检测的效果更好。     

不孕患者血清AsAb与TNF-α水平的变化

[目的]检测不孕患者血清AsAb与TNF-α的水平,探讨AsAb、TNF-α在不孕发病中的作用。[方法]用酶联免疫吸附法(enzymelinked immunosorbent assay,ELISA)检测了46例不孕患者及40例正常对照组血清AsAb与TNF-α水平。[结果]不孕患者血清AsAb阳性率30.43%明显高于正常对照组的5%(P﹤0.01);不孕患者血清TNF-α水平(168±15)ng/L明显高于正常对照组的(145±14)ng/L(P﹤0.01);AsAb( )组的TNF-α水平(177±16)ng/L明显高于AsAb(-)组的(160±15)ng/L(P﹤0.01);血清AsAb与TNF-α水平呈正相关(r=0.778,P﹤0.01)。[结论]AsAb、TNF-α是不孕的重要免疫因素,不孕患者高水平的TNF-α与AsAb的产生有密切的关系。     

慢性重型肝炎患者血清生化指标与预后的相关性研究

[目的]探讨慢性重型肝炎(CSH)患者血清生化指标与预后的相关性。[方法]将88例CSH患者根据预后分为死亡组和存活组,回顾性分析血清中总胆红素(TBIL)、甲胎蛋白(AFP)、清蛋白(A)、尿素氮(UN)、肌酐(Cr)和胆碱酯酶(CHE)水平与预后的关系。[结果]死亡组TBIL、Cr、UN高于存活组,且均高于正常对照组(P﹤0.01);A、AFP、CHE死亡组低于存活组(P﹤0.01)。CSH合并胆酶分离者较未合并者病死率高,预后差。[结论]CSH血清生化指标中TBIL、Cr、UN越高,A、AFP、CHE越低,且合并胆酶分离者,患者预后越差。     

多层螺旋CT扫描联合血清AFP、AFP-L3、GP73检测对原发性肝癌的诊断价值

目的研究原发性肝癌(PHC)患者多层螺旋CT扫描影像表现及联合血清甲胎蛋白(AFP)、甲胎蛋白异质体(AFP-L3)、高尔基体蛋白73(GP73)检测的诊断价值。方法选择2016年9月至2019年9月本院收治的PHC患者60例作为PHC组,另取同期在本院接受诊治的良性肝病患者60例作为良性肝病组。采用PHILIPS Brilliance 64排螺旋CT对所有受试者均进行常规CT平扫以及增强扫描,比较两组CT扫描影像表现。采集两组清晨空腹静脉血,检测血清AFP、AFP-L3、GP73水平,通过受试者工作特征(ROC)曲线明确多层螺旋CT扫描联合血清AFP、AFP-L3、GP73检测诊断PHC的价值。结果 PHC组血清AFP、AFP-L3、GP73水平分别为(281.36±34.26)μg/L、(127.52±40.45)ng/ml、(152.39±41.36)ng/ml,均明显高于良性肝病组的(13.95±3.11)μg/L、(28.59±8.42)ng/ml、(60.32±18.06)ng/ml,差异均有统计学意义(均P0.05)。经ROC曲线分析可知,多层螺旋CT扫描联合血清AFP、AFP-L3、GP73诊断PHC的曲线下面积、灵敏度、特异度均高于上述检查方式单独诊断。结论多层螺旋CT扫描联合血清AFP、AFP-L3、GP73检测诊断PHC的价值较高,值得推广应用。     

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.