胰岛素增敏剂在2型糖尿病中的应用

目的研究胰岛素增敏剂马来酸罗格列酮在2型糖尿病中的作用。方法采用病例对照研究，应用胰岛素增敏剂马来酸罗格列酮治疗2型糖尿病30例。结果本组30例病人中，FBS、2hPBS、TG、TC、HbAlc差异均有显著性（P〈0．01），胰岛素水平无显著性差异（P〉0．05）。结论马来酸罗格列酮可作为以胰岛素抵抗为主要病理生理特征的2型糖尿病患者治疗中，减少胰岛素抵抗，保护β细胞的一线药物和药物联合治疗中的基础用药。     

氟伐他汀钠联合马来酸罗格列酮治疗对2型糖尿病患者脉搏波传导速度的影响

目的观察氟伐他汀钠和马来酸罗格列酮联合使用对2型糖尿病患者脉搏波传导速度的影响。方法选取80例2型糖尿病患者,40例血脂正常者为对照组,40例血脂异常者为治疗组,在原有治疗的基础上全部加用马来酸罗格列酮,血脂异常者同时加用氟伐他汀钠,加用前及治疗6个月后,分别检测空腹血糖（FPG）、糖化血红蛋白（HbA1e）、总胆固醇（TC）、甘油三酯（TG）、臂-踝脉搏波传导速度（baPWV）,并比较各指标的变化。结果氟伐他汀联合马来酸罗格列酮治疗6个月后,患者FPG、HbA1c、TC、TG、baPWV均下降（P〈0．05）。结论联合使用氟伐他汀和马来酸罗格列酮能明显降低2型糖尿病患者的baPWV,改善动脉硬化。     

复方枸橼酸阿尔维林治疗肠易激综合征的药物经济学分析

目的:对复方枸橼酸阿尔维林(ACS)治疗肠易激综合征进行药物经济学评价。方法:采用文献研究方法,从全社会的角度对ACS进行成本-效果和成本-效用分析,并对其价格进行敏感性分析。选定Ducrotte等在2013年报道的《枸橼酸阿尔维林西甲硅油按需治疗与常规治疗在肠易激综合征治疗方面的比较:一项随机实用性研究的结果》为原始文献,对其数据进行本土化处理。结果:每降低1分严重程度症状评分,ACS按需治疗组和常规治疗组所需要的成本分别是8.79元和22.94元。与常规治疗组相比,ACS按需治疗组每多降低1分IBS-SSS可以节约17.62元。每改善1分效用值ACS按需治疗组和常规治疗组所需要的成本分别是106.03元和288.62元,ACS按需治疗组每获得一个质量调整生命年可以节约39 431.12元。当ACS的价格上调幅度在96%以下时,ICER和ICUR始终显示节约成本。当ACS的价格上调幅度达到437%时,其ICUR才触及WHO推荐的阈值上限。结论:与常规治疗相比,ACS按需治疗具有明显的药物经济学优势。     

评价罗格列酮钠治疗2型糖尿病长期效果的Markov模型

目的　评价新药罗格列酮钠治疗糖尿病的长期效果。方法　根据糖尿病治疗过程建立Markov状态转移决策树模型。结果　在10年研究期间,罗格列酮钠治疗组有14 . 2 %糖尿病患者转化为糖尿病并发症,3 8%糖尿病患者死亡,而非罗格列酮钠治疗组有2 2 . 7%糖尿病患者转化为糖尿病并发症,6 . 6 %糖尿病患者死亡。结论　Markov状态转移决策树模型是评价药物治疗长期效果的有效模型。     

四种抗菌药物治疗支气管炎方案的成本效果分析

目的评价支气管炎四种药物治疗方案。方法支气管炎患者SO例，分别选用左氧氟沙星、海夫佳、头孢噻肟钠、头孢唑啉钠为主要药物治疗．运用药物经济学对成本效果比进行分析。结果四种药物治疗支气管炎有效率分别为89．47％、93．33％、81．82％、60.00％；总费用分别为2429．32元、2408．94元、2871．97元和2171.94元；成本效果比分别为27．15元、25.81元、35.10元、36.20元。在方案D组的基础上，每再获得1个单位效果，A、B、C组所花费的成本分别为8．73元、7．11元、32．08元。结论海夫佳为最佳方案。     

马来酸罗格列酮对2型糖尿病微量尿白蛋白的影响

目的观察马来酸罗格列酮对2型糖尿病患者尿微量白蛋白的影响。方法40例2型糖尿病患者分为两组:治疗组26例及对照组14例,治疗组加用马来酸罗格列酮4 mg/d,共治疗12周。分别测定治疗前后空腹静脉血浆葡萄糖(FPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、胰岛素抵抗指数(IRI)、尿微量白蛋白(UAE)、血脂、血压等。结果患者用马来酸罗格列酮后UAE与治疗前及对照组相比明显下降(P<0.01),治疗前后FPG、HbA1c、FINSI、RI均下降(P<0.05),血脂水平变化不明显。马来酸罗格列酮具有良好的耐受性,无明显肝肾毒性。结论马来酸罗格列酮治疗2型糖尿病患者除有效降低血糖、胰岛素抵抗指数以外,能明显降低尿白蛋白的排泄,可达到改善糖尿病肾病的目的。     

罗格列酮联合胰岛素治疗口服磺脲类降糖药失效的Ⅱ型糖尿病的疗效

目的：观察罗格列酮联合胰岛素治疗口服磺脲类降低糖药失效的Ⅱ型糖尿病的疗效。方法：经口服磺脲类降糖药治疗3个月以上血糖控制的Ⅱ型糖尿病患者132例,随机分为2组,治疗组66例采用胰岛素联合马来酸罗格列酮治疗,对照组66例单独用胰岛素治疗,比较2组的疗效、胰岛素用量及不良反应情况。结果：经过12周治疗后,2组空腹血糖、餐后2h血糖、糖化血红蛋白均有明显的下降（P〈0．01）,治疗组胰岛素每日需要量明显少于对照组（P〈0．01）。结论：对口服黄脲类药物失效Ⅱ型糖尿病患者可联合罗格列酮联合胰岛素治疗,可使血糖得以良好的控制,临床副作用较小。     

3种不同用药方案治疗社区2型糖尿病的成本-效果分析

目的评价3种不同用药方案治疗2型糖尿病的疗效及经济成本。方法选择我院180例2型糖尿病患者，随机分为3组，实施3种联合用药治疗方案，12个月后进行成本-效果分析。3种不同方案为：二甲双胍＋格列本脲（A组）、二甲双胍＋格列齐特（B组）和二甲双胍＋格列吡嗪（C组）。结果A、B、C3组方案药物成本分别为434．28元、910．60元和813．91元；对空腹血糖的总有效率分别为85．0％、90．O％和88.3％；时餐后2h血糖总有效率分别为83．3％、88.3％和86．7％；空腹血糖的成本-效果比分别为2．53、7．68和6．74：餐后2h血糖的成本-效果比分别为2．58、7．83和6．86；B、C2组相对于A组对空腹血糖的增量成本比分别为95．30、140．60。B、C两组相对于A组对餐后2h血糖的增量成本比为95．00、237．20。结论3组治疗2型糖尿病的方案疗效约较好。从成本-效果比分析，二甲双胍＋格列本脲方案更符合药物经济学原则。     

信迪利单抗对比卡瑞利珠单抗一线治疗晚期非鳞状非小细胞肺癌的经济学评价

目的：对信迪利单抗联合化疗相比于卡瑞利珠单抗联合化疗治疗晚期非鳞状非小细胞肺癌的经济性展开评价。方法：采用Orient 11及Camel试验数据，基于分数多项式模型构建非恒定风险比例的网状Meta分析；采用分区生存模型进行决策分析；考虑到参数的不确定性，进行单因素敏感性分析与概率敏感性分析，并绘制龙卷风图、成本效果散点图及成本效果可接受曲线。结果：卡瑞利珠单抗组和信迪利单抗组总成本分别为113 656元和147 240元，总效用值分别为1.01和1.60QALY,ICER为56 922，显著低于研究阈值，信迪利单抗组具有明显的成本效果优势。结论：信迪利联合化疗治疗晚期非鳞状非小细胞肺癌相比于卡瑞利珠单抗联合化疗具有经济学优势。     

格列美脲与罗格列酮对2型糖尿病患者胰岛素抵抗、胰岛β细胞功能、游离脂肪酸的影响

目的 探讨应用格列羡脲与罗格列酮药物对2型糖尿病患者的胰岛β细胞功能及胰岛素抵抗、血FAA的影响。方法 141名2型糖尿病患者分为格列美脲及罗格列酮治疗组，测定治疗前后空腹血糖（FPG），空腹血清游离脂肪酸（FFA），免疫反应胰岛素（IRI）、真胰岛素（SI）、胰岛素原（PI）水平，计算PI占总胰岛素比例，并比较治疗前后HOMA模型中胰岛素抵抗指数（HOMA-IR）及β细胞功能指数（HOMA-IS）的变化，分析血糖下降对胰岛素抵抗。结果 ①两治疗组FPG、HbAIC均较治疗前有显著下降，两组间比较差异无显著性。②治疗后两组HOMA-IS均有较明显上升，格列美脲组上升72％；罗格列酮组上升57％，但两组间比较差异无显著性。两组HOMA-IR治疗后较治疗前均下降，格列美脲组下降15％：罗格列酮组下降32％，两组间比较有显著性差异（P（0．05）。③格列美脲与罗格列酮两治疗组与治疗前血清游离脂肪酸（FAA）均有较显著下降，分别为（P〈0．01、P〈0.001），两治疗组间比较，罗格列酮组血FAA比格列美脲组为低，有显著差异（P〈0．01）。治疗后服格列蔓脲者空腹PI及SI水平均略有下降，但无统计学差异；服罗格列酮者空腹血清PI及SI水平均略有上升，亦无统计学差异。结论 应用HOMA模型计算，服用格列美脲厦罗格列酮的患者HOMA-IS均有显著上升，HOMA-IR显著下降，都具有改善胰岛素抵抗和胰岛β细胞分泌功能，有较好胰外作用和降低血清FAA作用。因二者药理作用机制不同，格列美脲在改善患者β细胞胰岛素分泌功能比罗格列酮好，但罗格列酮在改善患者胰岛素抵抗、降低血FAA优于格列美脲。     

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 human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

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.     

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.     

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.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.