红细胞血型不规则抗体阳性患者199例结果分析

目的 分析红细胞血型不规则抗体在不同患者群体的分布特征,探讨对不同患者群体检测红细胞血型不规则抗体的价值.方法 鉴定从35 000例汉族患者中筛查出的199例红细胞血型不规则抗体阳性患者的抗体特异性、免疫球蛋白类型及37 ℃的反应性,统计红细胞血型不规则抗体在新生儿及有输血史和/或妊娠史的患者、无输血史及妊娠史的非新生儿患者中的分布情况.结果 199例红细胞血型不规则抗体阳性患者中,抗体来自母体的新生儿11例(5.53%),均为37 ℃反应的IgG类抗体;有输血史和/或妊娠史者138例(69.35%),其中IgG类抗体31例、IgG+IgM类抗体51例、IgM类抗体56例;无输血史及妊娠史的非新生儿患者50例(25.13%),其中IgG类抗体3例、IgG+IgM类抗体6例、IgM类抗体41例;在所检出的16例非特异性不规则抗体中,7例红细胞直接球蛋白试验阳性,表明其可致敏自身红细胞,引起自身免疫溶血性疾病.结论 对有输血史和/或妊娠史并预备输血的患者、孕妇、黄疸新生儿及疑似自身免疫溶血性疾病的患者检测红细胞血型不规则抗体,有利于预防溶血性输血反应,早期诊断非ABO血型不合新生儿溶血病,帮助诊断自身免疫溶血性疾病.     

妊娠妇女ABO/RhD血型和不规则抗体特征及临床意义

目的探讨妊娠妇女ABO/RhD血型和不规则抗体特征及临床意义,为预防新生儿溶血病(HDN)的发生提供参考依据。方法收集于空军军医大学第二附属医院就诊的5 782例妊娠妇女为观察组,以同期非妊娠、无输血史的健康体检女性1 800例为对照组,应用微柱凝胶法鉴定和筛查ABO/RhD血型和不规则抗体;有特异性抗体者用试管法检测抗体效价、Ig类型和37℃反应性;分析妊娠史与不规则抗体产生的关系。结果妊娠妇女的不规则抗体阳性率高于同期非妊娠健康体检女性,差异有统计学意义(P0.05)。5 782例妊娠妇女中不规则抗体阳性71例,其中Rh系统61例、MNS血型系统7例,Lewis血型系统2例;抗体特异性鉴定结果:抗-D 9例、抗-E 27例、抗-cE 10例、抗-C 6例、抗-c 4例、抗-Ce 5例、抗-M 7例、抗-Lea2例、抗-H1 1例;抗体效价:1∶8~1∶1 024;Ig类型:IgG类61例,IgM-IgG类7例,IgM类3例;37℃反应性:1+~4+;既往妊娠≥3次组不规则抗体阳性率高于既往妊娠1~2次组和无妊娠史组,1~2次组高于无妊娠史组,差异有统计学意义(均P0.05)。结论产前和输血前对妊娠妇女进行不规则抗体筛查是预防HDN和溶血性输血反应的重要措施之一。     

输血前红细胞血型抗体筛选的临床意义

目的探讨红细胞血型抗体筛选及鉴定在临床安全输血工作中的意义。方法采用微柱凝胶技术对1237例有输血史或妊娠史的需输血患者进行不规则抗体筛选，筛选阳性者应用抗球蛋白法进行抗体特异性鉴定，同时对检测结果进行分析。结果抗体筛选阳性6例，阳性率为0．485％。其中抗-D2例，抗-M1例，抗-E1例，抗-D、抗-C1例，抗-E、抗-C1例。结论输血前进行不规则抗体筛选能有效的减少和避免溶血性输血反应的发生，有利于提高患者输血的安全性和有效性。     

临床输血不良反应和免疫产生意外抗体的分析

摘要:目的　回顾分析临床输血不良反应情况,探讨有效降低输血不良反应的措施。方法　收集3家医院68 742例临床发生输血不良反应资料,统计分析临床输注不同血液制品后发生不良反应和免疫溶血反应产生抗体的情况。结果　68 742例临床输血患者中247例发生了输血不良反应,其中溶血性输血不良反应发生率为0.08％,非溶血性输血不良反应发生率为0.28％。193例非溶血性输血反应患者主要表现为过敏及发热反应,占86.01％;54例溶血输血反应患者中45例既往有输血史/妊娠史,产生的抗体多为IgG类Rh血型抗体和抗-HLA。结论　临床非溶血性输血反应以过敏及发热反应为主,溶血性输血反应多因患者既往免疫产生了IgG类抗体,引发急性溶血反应。临床明确输血反应种类后,选用合理血液成分输注和采取有效的预防措施以降低输血不良反应的发生。     

输血前不规则抗体筛查对输血安全的影响分析

目的:探讨患者输血前不规则抗体筛查在安全输血中的意义,为更好的指导临床用血.方法:采用微柱凝胶法对1825例需要输血的患者进行输血前不规则抗体筛查.结果:1825例输血治疗患者中检出不规则抗体12例,阳性率0.66%;其中女9例,均有妊娠史,男3例,男女均有输血史.对于申请输血的12例阳性患者经过提前选择无相应抗原的红细胞均无溶血性输血反应发生.结论:妊娠和反复输血可使患者不规则抗体阳性率增高,所以输血前检测不规则抗体能更好的防止溶血性输血反应的发生,提高输血的安全性.     

淄博地区ABO血型系统以外不规则抗体的筛查及分析

目的观察淄博地区ABO血型系统以外不规则抗体筛查结果 ,分析不规则抗体血型构成情况,探讨红细胞表面抗原分布规律,为安全输血治疗工作的开展提供条件。方法采用分层整群抽样回顾性分析的方法,抽取淄博地区2013年6月～2018年9月接受输血的1 720例患者,仔细阅览患者的临床资料,记录不规则抗体阳性检查结果 ,对比不同性别、不同妊娠情况及有无输血史者阳性筛查结果差异,观察不规则抗体阳性血液标本抗体分型规律。结果 1 720例接受输血治疗患者中检出16例不规则抗体为阳性者,阳性率为0.93%;其中不同性别及女性既往有无妊娠史比较,差异无统计学意义(P 0.05);既往接受输血治疗者阳性率高于无输血治疗者,差异有统计学意义(P 0.05)。经盐水法检出含有IgM型不规则抗体共2例,分别为抗-M、抗-c;经微柱凝胶法与抗人球蛋白法检出全部结果中,有43.75%为Rh系统,分别包括5例抗-E、1例抗-D、1例抗-c,提示Rh系统抗原内RhE、D、c抗原性较强,经免疫刺激后产生不规则抗体风险较大;其次分别为Kell与MNSs系统。结论红细胞表面除ABO血型系统抗原外,Rh系统、Kell系统等血型系统也广泛存在,在一定程度上将影响输血治疗,输血可能会刺激患者不规则抗体,产生输血免疫反应,对治疗效果产生负面影响,临床应做好输血前一系列除ABO血型系统外不规则抗体的筛查与鉴定,为安全的输血治疗提供技术保障。     

手术患者术前不规则抗体筛检和血型复检的意义

目的探讨术前不规则抗体筛检和血型复检的临床意义。方法利用微柱凝胶技术对需要备血的手术患者提前进行血型复检和不规则抗体筛检及鉴定。结果 4 021例患者中,共检出ABO血型不符4例;Rh(D)血型不符2例;不规则抗体阳性9例。结论对手术备血患者提前作不规则抗体筛检和血型复检,并完成交叉配血,对保障输血安全、有效和及时有重要意义。输血前作不规则抗体筛检对有输血史或妊娠史的择期手术患者尤为重要。     

Rh阴性稀有血型孕妇1例的产前预防性检查

目的通过1例有多次妊娠史、流产史孕妇检查结果的分析，发现Rh阴性妇女妊娠的特殊性。方法分别利用3种温度条件下的血清学检查和相关实验室检查，判断是否存在母婴Rh血型不合引起的新生儿溶血。结果孕妇ABO血型为B型，Rh血型为阴性；丈夫ABO血型为A型，Rh血型为阳性。孕妇抗人球蛋白试验：直抗＋、抗IgG＋、抗C-。结论孕妇血清中有IgM、IgG抗D抗体。是造成该孕妇多次妊娠、多次流产的真正原因。对Rh阴性孕妇妊娠有可能引起的母婴不合新生儿溶血，要及早做好产前预防性检查。     

无偿献血者Rh阴性表型及不规则抗体检测分析

Rh血型系统在临床输血中具有重要意义,RhD抗原是最重要的红细胞血型抗原之一,也是引起新生儿溶血病的主要红细胞抗原。RhD阳性血液输给RhD阴性的患者会产生免疫应答而导致溶血性输血反应。无偿献血者Rh阴性表型及不规则抗体检测分析有利于建立完善的Rh阴性稀有血型档案,避免同种抗体产生,为临床安全及时供血提供保障。     

有妊娠史女性患者的不规则抗体筛查

目的:对有妊娠史女性患者进行不规则抗体筛查,以确保临床输血安全,减少溶血性输血反应的发生。方法:选择有妊娠史女性患者1785例、无妊娠史女性患者924例作为对照。采用微柱凝胶法进行不规则抗体筛查与鉴定。结果:有妊娠史组和无妊娠史组的不规则抗体筛查阳性率分别为0.78%和0.11%,两组比较存在显著性差异(χ2=5.04,P0.05)。有妊娠史组确认特异性抗体13例、非特异性抗体1例;13例特异性抗体为抗D 4例、抗E 6例、抗Ec 1例、抗c 1例、抗M1例。无妊娠史组确认特异性抗体1例为抗E。结论:为确保临床输血的安全有效,对有妊娠史女性患者进行不规则抗体筛查很有必要;同时对有妊娠史的孕妇产前进行不规则抗体筛查,可有效防治新生儿溶血病。     

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.