促红细胞生成素的运用对心功能不全的影响

目的观察促红细胞生成素(EPO)治疗慢性肾功能不全合并贫血时,对并发心功能不全的发生、发展的影响。方法104例慢性肾功能不全患者,Hb<110g/L的患者76例,38例接受EPO4000U每周2次皮下注射(治疗组),38例给予慢性肾功能不全常规治疗(对照1组),Hb≥110g/L患者28例作为对照2组,观察各组心功能不全新发例数,恶化、好转例数以及心功能状态未变化例数。结果治疗组与对照1组、对照2组的心功能好转率分别为50.0%、15.8%、28.6%;新发心功能不全率分别为7.9%、18.4%、17.9%,组间差异均有统计学意义。结论EPO治疗慢性肾功能不全合并贫血时,无论有无合并心功能不全均可获益。     

抗中性粒细胞胞浆抗体相关性血管炎的临床特点与治疗

[目的]分析抗中性粒细胞胞浆抗体(ANCA)相关性血管炎(AAV)的临床表现及治疗.[方法]对我院2005年4月～2010年4月收治的47例AAV患者的临床资料进行回顾性分析.[结果]本组47例患者中,38例(80.9%,38/47)环核型ANCA(pANCA)阳性,均识别髓过氧化物酶(MPO),8例(17.0%,8/47)胞浆型ANCA(cANCA)阳性,均识别蛋白酶3(PR3),1例cANCA及pANCA均阳性,同时识别MPO及PR3.6个月内确诊者27例(57.4%,27/47),6个月以上确诊者20例(42.6%,20/47).临床表现呈多器官受累,其中肾脏受累43例(91.5%,43/47),血肌酐升高36例(76.6%,35/47),肺脏受累30例(63.8%,30/47),咯血16例(34.0%,16/47).此外还有不同程度的消化系统、关节、肌肉、耳、眼、皮肤、神经系统、鼻等器官损害及非特异性表现.80%上患者有血沉增快、C反应蛋白升高及贫血.主要采用糖皮质激素联合环磷酰胺治疗,诱导缓解期总缓解率75.9%.[结论]抗中性粒细胞胞浆抗体(ANCA)相关性血管炎临床表现为多器官受累,ANCA检测有助于早期诊断.     

狼疮性肾炎的临床与病理关系分析

目的 探讨狼疮性肾炎(LN)的病理改变与临床表现之间的联系.提高诊治水平.方法 回顾性分析85例LN患者的病理分型,分析各病理分型的临床特征及实验室检查特点.结果 85例患者均有病理学异常,病理分型以Ⅳ型最多,占58.8%(50/85),其次为Ⅱ型,占24.7%(21/85),其他类型相对少见;Ⅳ型LN病变特征最突出,高血压、血尿、肾功能不全发生率较高;Ⅱ型临床症状轻,多表现为急、慢性肾炎综合征.临床表现为肾病综合征者病理分型多为Ⅳ、Ⅴ型.结论 系统性红斑狼疮临床表现复杂,主要累及肾脏,从临床表现和实验室检查可初步推测病理分型,对LN的治疗有一定的指导作用.     

多发性骨髓瘤肾损害23例临床特征及相关因素分析

目的 探讨多发性骨髓瘤肾损害的临床特征及相关因素.方法 回顾性分析23例多发性骨髓瘤肾损害患者的临床资料和实验室检查.结果 全组病例均有不同程度的贫血,20例(86.96%)有不同程度的蛋白尿,平均24 h尿蛋白定量(2.64±3.96)g.8例(34.78%)有镜下血尿,3例(13.04%)表现为肾病综合征.慢性肾功能不全14例(60.87%),急性肾功能不全3例(13.04%).血尿酸升高16例(69.57%).骨骼疼痛16例(69.57%),X线检查有改变12例(52.17%),血钙升高9例(39.13%).初诊误诊14例(60.87%).而与其他因素如年龄、血清白蛋白、血清球蛋白、骨髓瘤细胞、血尿酸、继发感染无关(P＞0.05).结论 多发性骨髓瘤临床表现复杂,伴有蛋白尿和(或)肾功能不全、贫血、骨骼疼痛等,高钙血症与高尿酸血症是多发性骨髓瘤肾损害的常见原因,可加重肾脏的损害,应尽早行骨髓穿刺检查.     

慢性心力衰竭合并肾功能不全的预后影响因素分析

目的 探讨影响慢性心力衰竭(CHF)合并肾功能不全患者预后的危险因素.方法 选择CHF合并肾功能不全患者121例,按血肌酐(SCr)水平将患者分为肾功能低下组33例(SCr160～200μmol/L)、氮质血症组38例(SCr 201～450μmol/L)及肾衰竭组50例(SCr＞450μmol/L),分析各组患者的临床特点及影响CHF患者预后的危险因素.结果 肾功能低下组、氮质血症组、肾衰竭组年龄分别为(59.7±6.4)、(64.1±7.6)、(69.2±8.4)岁,纽约心脏病学会(NYHA)心功能分级Ⅳ级患者所占比例分别为16.5%(13/79)、31.6%(25/79)、51.9%(41/79),左室射血分数分别为(46.7±5.1)%、(44.3±4.9)%、(41.6±4.3)%,组间比较差异均有统计学意义(P＜0.05),并且肾衰竭组住院时间最长(P＜0.05),病死率最高(P＜0.05).Logistic回归分析显示,SCr、收缩压、贫血及NYHA心功能分级是影响CHF患者预后的独立危险因素(P＜0.05).结论 CHF合并肾功能不全患者住院时间长、病死率高,SCr、收缩压、贫血及NYHA心功能分级是影响CHF患者预后的独立危险因素.     

某综合性医院84例膜性肾病临床流行病学分析

目的 分析84例膜性肾病(membranous nephropathy,MN)流行病学资料、临床表现、实验室检查、病理改变及变化趋势.方法 回顾性分析2004年1月～2013年12月膜性肾病患者的性别、年龄、临床表现、病理表现及流行病学特征.结果 临床表现为肾病综合征(73.81％,62/84)、镜下血尿(35.71％,30/84)、高血压(16.67％,14/84)和肾功能不全(17.86％,15/84),伴发高血压平均年龄(53.71±16.47)岁,肾功能不全平均年龄(53.80±17.71)岁.病理类型Ⅰ期占20.23％、Ⅱ期占36.90％.免疫荧光IgG阳性96.43％,C3阳性96.43％.男女之间实验室指标差异均无统计学意义(均有P ＞0.05).2004-2013年每年膜性肾病患者占同期肾活检比例分别为4.46％、5.13％、4.35％、5.83％、6.78％ 、5.83％、6.84％、8.06％、10.74％、12.50％.结论 对于中老年患者,临床表现为肾病综合征,伴高血压和肾功能不全,应积极行肾穿刺活检术.膜性肾病患者在同期肾活检患者中所占比例呈增长趋势,近5年肿瘤相关性膜性肾病呈增长趋势.     

38例川崎病临床分析

目的分析38例川崎病(KD)患儿临床特点,并探讨该病的早期诊断、静脉给丙种球蛋白(IVIG)的治疗疗效。方法回顾性分析我院从2008年12月~2011年12月儿童川崎病住院患者38例临床资料。结果①患儿平均年龄(5.0±2.5)岁,0~5岁发病患儿占84.2%(32/38),男性患儿占68.4%(26/38),略高于女性;②典型病例33例,不典型病例5例,两者相比,不典型(KD)的临床表现要少,但两者[白细胞(WBC)、反应蛋白(CRP)和)血沉(ESR)]三项临床炎症指标有一致性,均显著增高;③因早期KD表现无特异性,26.3%(10/38)的患儿误诊,以上呼吸道感染、皮炎、淋巴结炎等;④对IVIG治疗敏感占84.2%(32/38),IVIG疗效不佳者占15.8%(6/38),IVIG不敏感者炎症指标升高较明显。结论川崎病是一种婴幼儿多见的疾病,发病无显著性别、地域,季节差异,病因以及发病机制尚未明确,早期临床表现无特异性及实验室指标无特征性,容易误诊,常好发冠脉炎症,对于可疑症状患儿需警惕KD,典型KD给予IVIG疗效好。     

湖南省新型冠状病毒肺炎临床特征分析

目的 分析湖南省新型冠状病毒肺炎(简称新冠肺炎,COVID-19)病例临床特征,为病例的发现、治疗和预防提供科学依据。 方法 回顾性分析湖南省 2020年1月21日—2月13日的所有新型冠状病毒肺炎确诊病例临床资料。比较不同年龄段、不同临床分型病例的临床表现、实验室检查及胸部CT检测结果 的差异。 结果 918 例患者高发年龄为 15～64 岁,小于15岁的病例28例(仅占3.05%),轻型病例318例(占34.64%),普通型病例523例(占56.97%),重型70例(占7.63%),危重型7例(占0.76%);有一种以上基础疾病的240例(占26.14%)。主要临床表现有发热(占67.54%),干咳(占42.59%),部分患者出现乏力、咳痰、咳嗽、头痛症状;血常规表现白细胞总数以降低或正常为主(占97.37%),淋巴细胞下降(占43.93%),中性粒细胞百分比降低或正常(占66.46%);95%患者胸部CT检查有肺炎影像学特征。 结论 新型冠状病毒肺炎病例临床表现不典型,以发热和干咳为主要临床表现。患者的血象有改变,胸部CT检查有肺炎影像学特征。胸部CT检查是一种较好的辅助诊断方法。     

老年急性心肌梗死120例临床分析

老年急性心肌梗死在其临床表现及治疗方面有一定的特点。 1 996年 5月～ 2 0 0 4年 5月共收治急性心肌梗死 2 80例 ,其中老年患者 1 2 0例。现就其临床特点及治疗分析如下。1　临床资料1 1　一般资料　全部病例均符合世界卫生组织关于急性心肌梗死诊断标准。 1 2 0例中男 82例、女 38例 ,年龄 60～ 85岁。对照组 1 60例 ,其中男1 2 1例、女 39例 ,年龄 30～ 5 9岁。1 2　临床表现　胸痛 :老年组 80例 (占66 66% )、对照组 1 5 3例 (占 95 62 % ) ;无痛性梗死 :老年组 40例 (占 95 62 % )、对照组 7例 (占4 38% ) ;心功能不全 :老年组 60…     

重度子痫前期死胎患者临床特征分析

目的 分析重度子痫前期死胎患者的临床特征,从而加强对重度子痫前期不良妊娠结局的预防。方法 收集2006年1月—2017年1月于大连医科大学附属第一医院收治的91例重度子痫前期死胎患者的病例资料,包括患者的年龄、血压、孕/产次、病史、产检情况、临床表现、孕妇并发症及实验室指标等,并对以上数据进行统计学分析。结果 91例患者中初产妇占56.04%,经产妇占43.96%,不规律产检者占59.30%,出现症状不及时就诊者占61.5%,平均血压(183.51±23.46)/(120.76±18.82)mm Hg,平均发病孕周(25.04±4.05)周。重度子痫前期胎儿死亡患者最多见的临床表现为头晕头痛(61.54%),其次为进行性水肿(48.35%),出现恶心呕吐表现的患者中16例并发HELLP综合征(59.26%),与无此表现的患者相比差异有统计学意义(P<0.05)。13例出现胸闷气短的患者有3例出现心功能不全(23.08%),与无此表现的患者相比差异有统计学意义(P<0.05)。血小板≤100×10⁹/L中有9例发生HELLP综合征,与血小板>100...     

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.