小剂量重组人生长激素对腹腔脓毒症病人疾病严重度的影响

目的:观察腹腔脓毒症病人应用小剂量生长激素(GH)后疾病严重度的变化,评估GH对脓毒症病人病情和预后的影响,从而评价GH在脓毒症病人中应用的安全性.方法:18例非肿瘤、既往无代谢性疾病史的腹腔脓毒症病人,在进行外科引流并且血流动力学平稳后进入8天的研究,第1天为基准阶段,其后每天给予重组人生长激素(rhGH)10 U,肌内注射,检测每天的血清GH、IGF-1和IGFBP-3的浓度,应用APACHE-Ⅱ评分系统和Elebute＆Stoner的脓毒症评分系统,每天进行疾病严重度的评估.结果:应用rhGH后,血清GH、IGF-1和IGFBP-3的浓度均有明显升高,疾病严重度的评分均有明显下降.结论:rhGH在腹腔脓毒症病人中应用可以发挥其生物学效应;腹腔脓毒症病人在行病灶清除引流,生命体征平稳后应用rhGH是安全的.脓毒症病人的疾病严重度评分并未增加,脓毒症评分在用药期间明显减小.     

胸腺肽α1对严重腹腔感染大鼠蛋白质代谢和细胞因子的影响

目的:观察腹腔感染后胸腺肽α1(Tα1)对大鼠细胞因子和蛋白质代谢的影响.方法:采用盲肠结扎加穿孔(CLP)模型,观察腹腔感染后Tα1对大鼠血浆细胞因子TNFα、IL-6、IL-10,总蛋白、清蛋白、C反应蛋白(CRP)水平及大鼠氮平衡、病死率的变化.结果:腹腔感染后大鼠血浆TNFα、IL-6浓度明显高于对照组,IL-10浓度明显低于对照组;给予Tα1后血浆TNFα、IL-6浓度亦明显高于对照组,但TNFα、IL-6较感染组明显下降,IL-10较感染组明显上升;给予Tα1后血清蛋白、总蛋白浓度及体质量下降的程度较腹腔感染组明显减轻;血CRP浓度感染组和感染后用Tα1组明显升高,但给予Tα1后CRP升高的程度较感染组明显减轻;腹腔感染后大鼠负氮平衡,给予Tα1后5天恢复正氮平衡;7天累计病死率亦较感染组明显减少.结论:胸腺肽α1可改变严重腹腔感染大鼠的细胞因子水平和炎性反应,改善蛋白质代谢.     

胃癌病人体质量下降与白细胞介素-6及急性相反应蛋白的相关性

目的:研究体质量下降的胃癌病人血清白细胞介素-6(IL-6)与急性相反应蛋白水平的变化,从而初步探讨胃癌病人营养不良的发生机制.方法:43例胃癌病人按6个月内体质量下降的程度分为两组,即6个月内体质量下降≥10%为A组,＜10%为B组.对两组病人进行血清细胞因子IL-6及C反应蛋白的检测.结果:A组病人血清IL-6及C反应蛋白水平较B组显著升高(23.5 ng/L vs 11.99 ng/L;41.49 mg/L vs4.16 mg/L)(P＜0.05).结论:胃癌病人的体质量下降及营养不良与血清IL-6和急性相蛋白反应相关.     

脓毒症病人糖耐量异常的相关因素及机制研究

目的:探讨脓毒症(sepsis)病人糖耐量异常(IGT)的可能相关因素及其机制. 方法:符合脓毒症诊断的40例病人,根据静脉内葡萄糖耐量试验(IVGTT)分为两组:对照组(IVGTT正常,n=16)和IGT组(IVGTT异常,n=24).比较两组病人基础血胰岛素、高血糖素、皮质醇、TNF-α、IL-6和临床指标的差异,观察葡萄糖输注后激素和细胞因子的变化. 结果:脓毒症病人的病情严重度(APACHE Ⅱ评分和感染评分)、混合感染和血培养阳性对IGT有显著影响.IGT组的平均住院日较对照组明显延长(P<0.01).IGT组血中胰岛素、高血糖素、皮质醇和IL-6、TNF-α基础水平均较对照组明显升高.短时间输注高糖后,IGT组与对照组相比,血胰岛素升高幅度下降(P<0.05),高糖对高血糖素的抑制作用消失(P<0.01). 结论:脓毒症病人的病情严重度、有无混合感染和菌血症是影响糖耐量异常的重要因素.血中激素和细胞因子水平的异常,以及胰岛素和高血糖素对高血糖反应的异常,是引起脓毒症病人糖耐量异常的重要原因.     

重组人生长激素治疗腹腔感染后低白蛋白血症的实验与临床研究

探讨重组人生长激素 (rh GH)对腹腔感染引起的低白蛋白血症的治疗作用。分别在体外实验、动物实验和临床研究中 ,观察 rh GH对白蛋白 m RNA表达和白蛋白合成的影响。结果 :rh GH明显促进体外培养肝细胞白蛋白基因表达 ;在内毒素损伤的肝细胞模型中 ,rh GH显著减轻内毒素介导的白蛋白 m RNA表达抑制 ;在体内 ,rh GH明显促进正常大鼠和腹腔感染大鼠肝白蛋白 m RNA表达 ;并明显提高腹腔感染病人血清白蛋白、前白蛋白、转铁蛋白浓度。结果提示 ,rh GH对腹腔感染引起的低白蛋白血症有明显的防治作用。重组人生长激素治疗腹腔感染后低白…     

乳腺癌根治术后感染患者细胞因子及急性时相反应蛋白表达的研究

目的观察乳腺癌根治术后感染患者的相关细胞因子与急性时相反应蛋白的水平变化情况,为有效控制乳腺癌术后感染提供依据。方法选取2010年1月-2016年11月于医院接受治疗的68例乳腺癌根治术后感染的患者为观察组,选取同期68例乳腺癌术后非感染患者为对照组,比较两组患者的白细胞介素、干扰素、肿瘤坏死细胞因子及急性时相反应蛋白中的C-反应蛋白(CPR)、α2-巨球蛋白(α2-M)、转铁蛋白(TF)、结合珠蛋白(HP)、铜蓝蛋白(CP)的水平变化。结果观察组的白细胞介素指标(IL-2、IL-4、IL-8、IL-10)均显著高于对照组(P<0.05);干扰素指标(IFN-α、IFN-r)显著高于对照组(P<0.05);肿瘤坏死因子(TNF-α、TNF-β)比对照组水平略高(P<0.05);观察组CPR、α2-M、HP、CP的表达水平显著高于对照组,而TF较对照组水平略低(P<0.05)。结论乳腺癌根治术后感染患者的细胞因子和急性时相反应蛋白水平有明显的变化,并且这些指标的异常表达可能参与了感染的炎性反应。     

生长激素强化的TPN对创伤后细胞因子变化的影响

目的;了解生长激素（ＧＨ）强化的ＴＰＮ对创伤后细胞因子变化的影响,以探讨生长激素促进蛋白质合成作用的可能机制。方法：在手术创伤后病人采用ＴＰＮ加ＧＨ治疗１６例并与单纯ＴＰＮ治疗组进行对照,比较创伤应激后血清细胞因子和急性相蛋白水平的变化。结果：试验组在创伤应激后第４天,第６天的血清ＴＮＦ－α,ＩＬ－６和ＣＲＰ水平均显著地低于对照组。     

极化液个体化治疗对创伤后高血糖病人促/抗炎细胞因子的影响

目的:探讨极化液个体化治疗对创伤后高血糖病人促/抗炎细胞因子以及多器官功能障碍综合征(MODS)的影响,为极化液辅助治疗创伤后MODS提供实验依据.方法:将我院重症监护室收治的创伤后高血糖病人,随机分为极化液个体化治疗组(GIK组)和基础治疗组(C组).观察不同治疗组治疗3 d后创伤病人空腹血糖、乳酸、促炎细胞因子(CRP、TNF-α和IL-1β)和抗炎细胞因子(IL-4和IL-10)水平变化以及MODS的发生率和病死率.结果:GIK组治疗3 d后,空腹血糖、乳酸、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)和白细胞介素-1β(IL-1β)水平均明显低于C组,血IL-4和IL-10水平明显高于C组.GIK组MODS的发生率明显低于C组,MODS病死率虽略有下降,但与C组比无显著差异.结论:极化液个体化治疗创伤后病人可降低促炎细胞因子和升高抗炎细胞因子水平,对控制创伤后病人的高血糖效果明显.     

重组人生长激素对阻塞性黄疸大鼠肠黏膜IL-6变化的影响

目的探讨具有调整内分泌系统、激活并维护免疫系统作用的重组人生长激素对阻塞性黄疸大鼠肠黏膜IL-6表达变化的影响。方法 Wister大鼠分为3组:假手术组(SO组)、阻塞性黄疸组(OJ组)、重组人生长激素组(rhGH组)。分别于术后7 d、14 d检测门静脉血TBIL、DBIL、ALT值和内毒素含量,免疫组织化学(SABC法)检测小肠黏膜IL-6含量。结果阻塞性黄疸组和重组人生长激素组肠黏膜IL-6表达低于SO组(P0.01);重组人生长激素组较阻塞性黄疸组肠黏膜IL-6表达水平高(P0.01);阻塞性黄疸组和重组人生长激素组血浆内毒素水平高于假手术组(P0.05),并随着阻塞时间的延长而逐渐升高(P0.05);而重组人生长激素组相对于阻塞性黄疸组血浆内毒素含量有明显降低(P0.05)。结论对于阻塞性黄疸大鼠肠黏膜IL-6的基因表达,重组人生长激素能够起到很好的改善作用,并且可以有效降低血浆中内毒素的浓度,进而对肠黏膜的屏障功能起到保护作用。     

添加重组人生长激素的营养支持对烧伤脓毒症危重病人营养状况的影响

目的:观察添加重组人生长激素(rhGH)的营养支持对烧伤脓毒症危重病人营养状况的影响,探讨rhGH在烧伤脓毒症治疗中的作用.方法:42例烧伤脓毒症危重病人[烧伤面积(TBSA)≥30%]随机分为治疗Ⅰ组、治疗Ⅱ组和对照组,每组各14例.三组病人除实施相同的脓毒症综合治疗方案和标准营养支持外,其中两组皮下注射thGH为0...     

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.     

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.