不同碳链脂肪乳剂对肝脏外科病人术后的影响

目的观察两种不同碳链脂肪乳剂对肝脏外科病人术后自然病程的影响。方法选择肝脏外科病人25例，随机分为两组；长链脂肪乳剂组（n＝12，简称LCT组），中／长链脂肪乳剂组（n=13，简称MCT组）。LCT组脂肪乳剂为20％Inralipid，MCT组为20％Lipofundin，连续观察1周。在术前，术后1、4、7天测定肝功能、血脂、血及尿液中肉毒碱（CNT）以及激素的变化。结果两组对肝脏酶学无明显影响。胆红素在术后1天明显升高，但MCT组随后显著下降，LCT组下降速度慢于MCT组，P＜0．05。PN期间血脂代谢无异常。CNT术后明显升高，尿排出减少，术后7天LCT组血CNT高于MCT组，尿CNT低于MCT组，P＜0．05。血皮质醇、胰岛素（I）、G以及G／I术后第1天均明显升高，随后逐渐下降，而LCT组术后7天，胰高糖素（G）以及G／I维持在较高水平。血糖术后明显升高，术后4、7天，LCT组持续在较高水平，MCT组已属正常。结论MCT／LCT乳剂可能是肝脏外科病人更为理想的脂肪能源。     

中链甘油三酯干预对2型糖尿病血脂和血浆游离脂肪酸的影响

目的探讨中链甘油三酯(MCT)干预对2型糖尿病(T2DM)患者体重、血脂和血浆游离脂肪酸的影响。方法以长链甘油三酯(LCT)为对照,将所有T2DM患者分为MCT组、MCT/LCT组和LCT组,在控制总能量和脂肪摄入量的基础上,3组分别连续食用100%MCT油、50%MCT油 50%LCT油和100%LCT油12周。在0、6和12周时检测血浆总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A1(ApoA1)和载脂蛋白B(ApoB)浓度以及血浆游离脂肪酸浓度。计算体质指数(BMI)、LDL/HDL、ApoA1/ApoB、总游离脂肪酸(TFFA)、长链饱和脂肪酸(LCSFA)和不饱和脂肪酸(USFA)浓度。结果在6和12周时,MCT和MCT/LCT组的体重和BMI均较LCT组低(P<0.05)。在12周时MCT/LCT组的TC水平较LCT组低(P<0.05)。与实验前相比,MCT/LCT组6和12周时的LDL-C水平均显著下降(P<0.05);与6周时相比,MCT组12周时的LDL-C水平显著下降(P<0.05)。12周时LCT组的HDL-C水平较MCT组高(P<0.05)。与MCT组相比,LCT组的LCSFA水平在6周时显著升高(P<0.05)。3组的TFFA和USFA水平差异无显著性。结论在控制总能量和脂肪摄入量的基础上,用MCT取代100%或50%的膳食油脂,患者的BMI和血脂谱得到改善,而血浆游离脂肪酸无明显变化。     

含不同脂肪成分的早期肠内喂养改善烧伤病人蛋白质代谢的临床研究

目的：比较烧伤病人早期肠内喂养含MCT／LCT或含LCT的肠内营养制剂对蛋白质代谢的影响，并探讨MCT／LCT改善烧伤后营养状态的作用机制。方法：选取30例总烧伤表面积（TBSA）＞30的病人，随机分为两组，瑞高组（Fresubin 750MCT,F组）饲以含MCT／LCT的肠内营养制剂瑞高，能全力组（Nutrison,N组）饲以只含LCT的肠内营养制剂能全力。于伤后24h内进行全肠内营养支持，共10天。在烧伤后1，4，7，10天分别观察两组病人蛋白质代谢的情况（包括血清转铁蛋白，前白蛋白，胰岛素，前列腺素E2，尿3－甲基组氨酸排出尿总氮）。结果：F组病人血清转铁蛋白，前白蛋白，胰岛素明显高于N组，尿总氮，尿3－甲基组氨酸排出及血清前列腺素E2明显低于N组。结论：含MCT／LCT的肠内营养制剂较只含LCT者能更有效地减轻烧伤后机体蛋白质分解，提高血清白蛋白水平，从而改善烧伤病人营养状况。     

2型糖尿病患者胰岛素抵抗和氧化应激反应

目的 探讨机体的氧化应激和抗氧化防御在胰岛素抵抗诱导的2型糖尿病（T2DM）发生发展过程中的作用。方法 通过口服糖耐量试验，将所有对象分成正常糖耐量（NGT）、葡萄糖不耐受（G1）和T2DM组。测定血浆丙二醛（MDA）含量，以评价机体氧化应激；测定血浆总抗氧化能力（TAOC）、红细胞谷胱甘肽（GSH）和超氧化物歧化酶（SOD）含量，评价机体的抗氧化防御，使用稳态模型评价机体的胰岛素抵抗及胰岛β-cell分泌功能。结果 T2DM组的血浆丙二醛（MDA）浓度明显高于G1和NGT组（P〈0．01，P〈0．001）；T2DM组血浆TACK；活性相对于G1组和NGT组显著下降（P=0．001，P〈0．01）。3组间空腹胰岛素（FP1）和胰岛素抵抗数（HOMAIR）差异均有统计学意义（P〈0．05）。胰岛素抵抗指数和体质指数（BMI）及血浆MDA呈显著正相关（P〈0．001，P=0．003）．和血浆TAOC、红细胞SOD呈显著负相关（P=0．017，P=0．014）。结论 氧化应激在胰岛素抵抗介导的T2DM起始及发生发展过程中可能发挥重要作用。     

妊娠期糖尿病孕妇血清载脂蛋白M与胰岛素和瘦素的关系

目的探讨妊娠期糖尿病（GDM）孕妇血清载脂蛋白M（ApoM）与胰岛素和瘦素之间的关系。方法GDM孕中期组（孕24—28周）87例、孕晚期组（分娩前1周）122例,对照组为同孕期正常孕妇,检测血清中载脂蛋白M（ApoM）、胰岛素、瘦素的表达水平,分析指标间的相关性。结果孕中期GDM孕妇ApoM表达水平（0．029±0．010）g／L显著低于同孕期正常对照组（0．036±0．013）g／L（t=-4．168,P=00001）,孕晚期GDM孕妇ApoM表达水平（0．028±0．010）g／L显著高于同孕期正常对照组（0．023±0．008）g／L（t=3．529,P=0．0005）。孕中期GDM组的胰岛素表达水平、胰岛素抵抗指数均高于同孕期正常对照组[胰岛素表达水平：12．975（7．968～22．237）比6．885（4．805—10．015）μg/L,Z=-5．618,P=0．000;胰岛素抵抗指数2．808（1．705～5．158）比1．336（0．897—1．925）,Z=-6．305,P=0．000],瘦素水平[0．026（0．015～0．044）比0．024（0．014—0．036）ng／L]两组比较差异无统计学意义（Z=-0．927,P=0．354）;孕晚期GDM组和同孕期正常对照组比较,胰岛素表达水平[9．5（5．645～13．265）比9．82（6．708—15．885）μg/L,Z=0．971,P=0．332]、胰岛素抵抗指数[1．637（0．977～2．471）比1．781（1．121—2．686）,Z=0．904,P=0．366]和瘦素[0．025（0．015—0．044）比0．029（0．015～0．043）ng／L,Z=0．494,P=0．621]差异均无统计学意义。采用多因素非条件Logistic回归分析显示,ApoM表达水平是GDM的独立危险因素。结论妊娠期糖尿病孕妇血清ApoM表达异常,ApoM可能与GDM的发生有一定的关系,但胰岛素和瘦素与ApoM之间无相关性。     

初诊2型糖尿病短期胰岛素强化治疗观察

目的观察初诊2型糖尿病短期胰岛素强化治疗的效果。方法76例初诊2型糖尿病（T2DM）患者随机分为胰岛素强化治疗组和磺脲组，观察其达标时间、治疗前后空腹和餐后2hC肽水平。结果治疗后胰岛素强化治疗组比磺脲组血糖达标时间短（t=5．54，P〈0．01），空腹和餐后2hC肽水平升高（t值分别为4．12和5．74，均P〈0．01）；胰岛素组中有11例仅饮食和运动治疗维持血糖达标长达8～16个月之久。结论初诊T2DM患者胰岛素强化治疗，能尽快解除高糖毒性，显著恢复胰岛β细胞的功能，远期疗效好。     

PPAR-γ在COPD所致的肺动脉高压患者中的表达变化

目的探讨COPD所致肺动脉高压患者PPAR-γ表达水平与肺动脉压力、胰岛素抵抗的关系。方法63例COPD患者中合并肺动脉高压（PAH组）30例,无肺动脉高压COPD组33例,20例体检者为对照组。采用实时荧光定量RT—PCR测定外周血单个核细胞PPAR-γmRNA表达水平,放免法检测空腹胰岛素（FIN）,葡萄糖氧化酶法测定空腹血糖（FPG）。结果COPD组及PAH组PPAR-γ表达水平下降,FPG、FIN及IRI升高;PAH组肺动脉压力增高,PPAR-γ表达下降及IRI升高更加明显;PPAR-γ表达水平与肺动脉压力、FPG、FIN及IRI均呈负相关（r=-0．683,-0．476,-0．553,-0．589,P〈0．05）,肺动脉压力与IRI呈正相关（r=0．505,P〈0．05）。结论PPAR-γ表达下调可能与空腹血糖异常、胰岛素抵抗、肺动脉高压形成有关。     

2型糖尿病胰岛素释放试验与糖耐量试验结果对比

目的通过对胰岛素释放试验与糖耐量试验对比分析，了解2型糖尿病（DM）病人糖代谢和胰岛功能情况，探讨对2型DM早期诊断的临床意义。方法对来内蒙古医学院附属人民医院就诊的50例DM患者及20例正常对照者行馒头餐，采用磁性分离酶联免疫（MAIA）法测定血清胰岛素，同步测定糖耐量（氧化酶法），依据糖耐量测定结果分3组：糖耐量正常对照组（NGT），糖耐量减低组（IGT），2型DM组（DM）；分别将各点胰岛素和血糖的结果进行比较。结果2型DM组的空腹血糖、胰岛素明显高于NGT组，血糖、胰岛素在餐后一二小时出现峰值，餐后3h仍不能恢复至空腹水平，NGT组的血糖和胰岛素在餐后0．5—1．0h出现峰值，2组在0、0．5、1、2、3h各点的血糖和胰岛素差异有统计学意义（P〈0．05或P〈0．01）；IGT组的空腹血糖和胰岛素与NGT组差异无统计学意义（P〉0．05），但是2组在餐后1、2、3h的血糖和胰岛素差异有统计学意义（P〈0．05或P〈0．01）。结论采用MAIA法测定胰岛素释放试验和氧化酶法测定糖耐量，可以及时了解2型DM病人糖代谢和胰岛功能情况，对早期诊断和治疗有重要的临床意义。     

甲醛对小鼠睾丸生殖细胞的DNA损伤及bcl-2、bax蛋白表达的影响

为了解Ⅱ型拟除虫菊酯类农药对雄性小鼠内脏器官的影响及对小鼠黑质纹状体多巴胺（DA）系统的毒性作用和可能的机制,将50只雄性昆明种小鼠随机分为5组（每组10只）,分别为溴氰菊酯（DM）1．8mg／kg组、3．6mg／kg组;氯氰菊酯（CP）4mg／kg组、8mg／kg组及色拉油对照组;连续1个月经口灌胃染毒后,测定脏器系数并采用高效液相色谱（HPLC）荧光检测法分别检测雄性小鼠全脑中多巴胺（DA）、去甲肾上腺素（NE）、5-羟色胺（5-HT）的含量。结果显示,染毒各组小鼠肝、脾脏器系数均高于对照组,脑的脏器系数有所降低。脑内DA、NE、5-HT的含量都有不同程度的下降,DA在DM高剂量组与对照组之间的差异有统计学意义（P〈0．01）;NE在DM高、低剂量组及CP高剂量组与对照组的比较中差异有统计学意义（P〈0．05,P〈0．01）;5-HT在各级两组之间的含量差异并无统计学意义。提示DM和CP可以影响实验雄性小鼠的内脏器官,也可以降低脑内单胺类递质的含量。     

2型糖尿病患者三酰甘油脂肪酶水平与肥胖及其胰岛素抵抗的关系

目的探讨2型糖尿病（T2DM）患者体质指数（BMI）、稳态模型胰岛素抵抗指数（HOMA—IR）、腰围、腰臀比（WHR）与血浆中三酰甘油脂肪酶（adipose triglyceride lipase,ATGL）水平之间的关系。方法选择T2DM患者131例,根据BMI分为正常体质量组（A组）、超重组（B组）和肥胖组（c组）,采用酶联免疫吸附法（ELISA）分别检测三组空腹血浆ATGL水平,同时测定各组血糖、血脂、空腹胰岛素水平,计算WHR、HOMA—IR,分析各指标与ATGL的关系。结果三组中A组空腹ATGL水平[（56．74±21．46）ng／ml]明显高于B组[（21．92±6．12）ng／ml],P〈0．01;B组ATGL水平[（21．92±6．12）ng／ml]高于C组[（8．90±2．28）ng／ml],P〈0．01;空腹ATGL与BMI、三酰甘油（TG）、空腹胰岛素（Fins）、HOMA—IR呈负相关,r值分别为-0．828,-0．739,-0．674,-0．570,P〈0．01。以ATGL为因变量,BMI、空腹血糖（FPG）、餐后2h血糖（2hPG）、Fins、HOMA—IR等为自变量进行多元线性逐步回归分析,结果显示,BMI是ATGL的独立影响因素。结论T2DM患者血清ATGL水平与肥胖密切相关,与胰岛素抵抗也具有一定的相关性。     

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.