系统性红斑狼疮的遗传流行病学调查

对９１例系统性红斑狼疮进行遗传流行病学研究，以探讨系统性红斑狼疮（ＳＬＥ）的可能危险因素。数据分析应用相关软件，进行了条件Ｌｏｇｉｓｔｉｃ回归计算和遗传度估计。结果表明，ＳＬＥ病人在年龄方面未发现异质性；遗传度为５３．４４％，提示可能为一多因子疾病。经多因素条件Ｌｏｇｉｓｔｉｃ回归分析，发现冻疮和光敏感两个病前伴随因素，ＯＲ分别为３．１３（Ｐ＝０．００４）和３３．４２（Ｐ＜０．００１）。上述结果提示，该病可能是在一定的遗传背景下，受某些诱发因素的影响而发生的。     

系统性红斑狼疮遗传易感性的研究进展

系统性红斑狼疮（SLE）是一种自身免疫性疾病，其发病机制尚不清楚。同卵双生子发病的高一致性，家族聚集现象都表明SLE有很强的遗传因素。多种遗传基因与SLE的易感性有关，如HLAⅡ基因的多态性，Fas／FasL异常，补体的缺陷等。到目前为止，已确定的SLE易感基因有12个，但在不同人口确定的SLE易感基因不完全相同。     

PDCD1 和 CD22 基因多态与中国南方汉族人群系统性红斑狼疮相关性研究

目的 探讨 PDCD1 (programmed cell death-1)和 CD22 基因单核苷酸多态性(SNP)与中国南方汉族人群系统性红斑狼疮(systemic lupus erythematosus,SLE) 的相关性.方法 采用病例对照研究,收集 164 例病例和 163 例对照,应用 PCR-RFLP 技术检测 PD1.2G＞A 和 CD22A＞T 两个位点的 SNPs,进行关联性分析(基因型、等位基因分析等).结果 PD1.2 G＞A 位点的基因型频率分布在 SLE 病例组和对照组之间差异有统计学意义(χ2 =9.806,P=0.007,υ=2),其中 A 等位基因的 OR 为 0.661,95% CI:0.463～0.943.CD22A＞T 位点的基因型在病例组和对照组中的分布差异无统计学意义 (χ2 =4.111,P=0.128,υ=2),而 T 等位基因的 OR 为 0.656,95%CI: 0.431～0.999.PD1.2 G＞A 位点和 CD22A＞T 位点的基因型未发现交互作用(χ2 =4.172,P=0.383,υ=4).结论 在中国南方汉族人群中,PDCD1 基因 PD1.2G＞A 位点和 CD22A＞T位点多态性与 SLE 具有相关性,PD1.2G＞A 的 G→A 突变和 CD22A＞T 的 A→T 突变可能都是 SLE 的保护因素.     

系统性红斑狼疮的复合分离分析

目的：系统性红斑狼疮（SLE）的遗传流行病学研究表明,该病具有一定的遗传倾向性。方法：应用POINTER程序对215例先证及其核心家系进行复合分离分析,以探讨可能的遗传模式。结果：非递模型被拒绝,接受多基因模型（包括显性和隐性模型）。结论：由于主基因模型和多因子模型被接受,提示本病可能是一种具有多主基因的多因子疾病,SLE不符合单基因遗传模式,应关注SLE亚型或表型与非MHC（non-MHC)的遗传易感性关系及其可能表现出的遗传模式。     

无家族性系统性红斑狼疮3例

系统性红斑狼疮(svstemic lupus ewthemtosus,SLE)是一种典型的严重危害人类健康的自身免疫性疾病,好发于20～40岁育龄妇女,其病因、发病机制非常复杂。我们报道某五金厂同一车间3例SLE患者的家族史及发病前的暴露状况,以探讨其与遗传和环境因素的关系。     

系统性红斑狼疮的治疗

系统性红斑狼疮(英文缩写为SLE)以年轻女性多见,男性较少。目前认为红斑狼疮患者的血液中,存在有对自己体内细胞核、白细胞、红细胞等形成的自身免疫抗体,所以属于一种自身免疫性疾病。红斑狼疮患者的临床典型表现为发病急,38℃～40℃高烧,关节痛,肌肉疼痛,颜面两侧有蝶形红斑,病例诊     

系统性红斑狼疮

文章对基层卫生人员必须掌握的系统性红斑狼疮的病因及诊治等相关内容进行介绍。     

HLA—DM基因遗传多态性对系统性红斑狼疮易感性的影响

目的：探索HLA－DM等位基因频率与基因型分布对系统性红斑狼疮（SLE）易感性的影响。方法：用多聚酶链反应－限制性片断长度多态性（PCR－RFLP）确定DM的基因型，用病例对照研究的方法探索DM与SLE的关联性。结果：检测到的7种DMA与DMB等位基因和42例种单体型在SLE线与正常对照组分布一致。DMB*0102／0103基因型在对照组的分布频率明显高于SLE组（P＜0．05），但校正后差异无显性，其余13种基因在两组差异均无显意义。结论：HLA－DM基因的遗传多态性对SLE的发病没有直接影响。     

系统性红斑狼疮脑病21例临床分析

目的 探讨系统性红斑狼疮脑病的临床特点、发病机理.方法 对21例系统性红斑狼疮脑病临床特点、影像资料、治疗及预后进行对比分析.结果 系统性红斑狼疮脑病的发病是多种因素的综合结果.结论 系统性红斑狼疮脑病表现多样,需要排除许多继发因素导致脑损害后方可诊断.早期诊断及恰当治疗是减少死亡率和致残率的关键.     

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.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

Hydrazine inhalation hepatotoxicity

Abstract Hydrazine is a hazardous chemical commonly used as a reactant in rocket and jet fuel cells. Animal studies have demonstrated hepatic changes after hydrazine inhalation. Human case reports of hydrazine inhalation hepatotoxicity are rare. We report a case of mild hepatotoxicity following brief hydrazine vapour inhalation in a healthy young man, which resolved completely on expectant management.     

The management of influenza in people of working age

Influenza is common, causing considerable morbidity and sickness absence from work in most winters. Influenza vaccines have been available for >40 years, but are not extensively used in the workforce (in the UK). Amantadine has been available for 25 years as a treatment and prophylactic against influenza A infection, but has scarcely been used. In the last 3 years, two neuraminidase inhibitor antivirals, zanamivir and oseltamivir, have been introduced to the market for the treatment and prophylaxis of influenza A and B infections. This review focuses on aspects of prevention and treatment of influenza appropriate to people of working age. Decisions based on the cost-effectiveness of prevention and treatment options differ when viewed from the perspective of the healthcare provider, the employer or the employee. Options currently available need to be directed to a wider range of people than those conventionally regarded as the target risk group.     

Fitness standards in airline staff

Employers have a legal duty to manage safety and to meet this duty it is necessary to control risks arising from pre-existing medical conditions. Such conditions can be identified at the time of job placement, but there is little published information about the approach to fitness standards by most airlines. This review is therefore limited to the practice of one major airline. It is illustrated by reference to various occupations within the airline, with the associated rationale.     

Falls and fractures in women at work

BACKGROUND: Older women have been observed to have more serious injury particularly fractures after slips, trips or falls at the workplace. It is unclear whether this excess reflects a greater likelihood of falling or a greater proportion presenting with fractures once the fall has occurred. METHODS: Two studies were carried out: Study A, of 130 women who fell at work and matched referents, and Study B, of 120 women who fell at work and sustained a major fracture and 314 matched referents who fell but for whom no fracture was recorded. In Study A, the workplace of the case and referent was observed, questionnaires completed and objective health measures carried out. Study B relied on information obtained from the subject by postal questionnaire. RESULTS: Women who fell were older than referents matched on workplace and occupation, but age did not continue to be a significant factor after allowing for bodyweight and use of spectacles. Fractures were more common in older women who fell, particularly post-menopausal women with low body mass. The risk of fracture increased steadily with age without an obvious discontinuity around the likely age of menopause. CONCLUSIONS: The observed excess of fractures in older women falling at work appeared to be explained by the greater risk of fracture among those who fell.     

A five-year study comparing early retirements on medical grounds in ambulance personnel with those in other groups of health service staff: Part I: Incidences of retirements

The objective of this study was to compare morbidity betweenambulance staff and other groups of health service workers,to facilitate planning of occupational health (OH) services.A retrospective study of employees of The Eastern Health andSocial Services Board, Northern Ireland was conducted. Subjectswere 181 men and 353 women assessed at OH between 1988–92and found eligible (on the basis of permanent incapacity) toapply for early retirement on medical grounds (EROMG). Ambulancepersonnel showed a high rate of EROMG (55.9/1,000 per annum)both compared with previous ambulance studies (5.7–22.5/1,000),and with other groups in the present study (manual 24.8/1,000,nursing 5.9/1,000 and non-manual 2.6/1,000). Indirect standardizationwas used to correct for age-sex differences between groups,by deriving standardized early retirement ratios (SERR). Ambulanceand manual staff showed high SERRs (636, Cl=558–714 and164, Cl=149–179), whereas nursing and non-manual staffshowed low SERRs (91, Cl=75–107 and 38, Cl=25–52),(all results except that for nursing staff being significantat <0.001). There is evidence that ambulance staff are agroup with high morbidity, and thus deserving of particularattention in terms of preventative and health promotional activities.Other issues requiring consideration in relation to ambulancestaff are redeployment and lowering of the retirement age.     

Determinants of spirometric abnormalities among silicotic patients in Hong Kong

BACKGROUND: Silicosis is the second commonest notified occupational disease in Hong Kong. AIM: To characterize the determinants of spirometric abnormalities in silicosis. METHOD: The spirometric patterns of consecutive silicotic patients on confirmation by the Pneumoconiosis Medical Board from 1991 to 2002 were correlated with demographic characteristics, occupational history, smoking history, tuberculosis (TB) history and radiographic features by univariate and multiple regression analyses. RESULTS: Of 1576 silicotic patients included, 55.6% showed normal spirometry, 28.5% normal forced vital capacity (FVC>or=80% predicted) but reduced forced expiratory ratio (FER<70%), 7.6% reduced FVC but normal FER, and 8.4% reduced both FVC and FER. Age, ever-smoking, cigarette pack-years, industry, job type, history of TB, size of lung nodules and progressive massive fibrosis (PMF) were all significantly associated with airflow limitation on univariate analysis (all P<0.05), while sex and profusion of nodules were not. Only age, cigarette pack-years, history of TB, size of lung nodules and PMF remained as significant independent predictors of airflow obstruction in multiple logistic regression analysis. After controlling for airflow obstruction, only shorter exposure duration, history of TB and profusion of nodules were significant independent predictors of reduced FVC. As well as age, history of TB, cigarette pack-years, PMF and nodule size contributed comparable effects to airflow obstruction in multiple linear regression analyses, while profusion of nodules was the strongest factor for reduced vital capacity. CONCLUSIONS: In an occupational compensation setting, disease indices and history of tuberculosis are independent predictors of both airflow obstruction and reduced vital capacity for silicotic patients.     

Carbon disulphide absorption during xanthate reagent mixing in a gold mine concentrator

A xanthate reagent mixer at a gold mine concentrator was exposed to carbon disulphide by extensive skin contamination with xanthate powder and solution during the reagent mixing process. Absorption of carbon disulphide was confirmed by the detection of urinary 2-thiothiazolidine-4-carboxylic acid (TTCA). Drager colorimetric tube testing during subsequent mixing recorded a maximum concentration of at least 60 ppm carbon disulphide. An illness consisting of predominantly gastrointestinal symptoms began 20 h after the exposure. Although this may have been due to carbon disulphide toxicity this is by no means certain. The need for engineering controls, impervious protective clothing and full-face respirators with particulate and organic vapour cartridges is discussed. This episode occurred at another mine site, unrelated to Mount Isa Mines Limited.