盐酸氨溴索对老年行非体外循环冠状动脉旁路移植术后肺泡表面活性物质的影响

目的：研究盐酸氨溴索对老年非体外冠状动脉旁路移植（OPCABG）术后肺泡表面活性物质（PS）的影响。方法：选择50例65～75岁冠心病行OPCABG术者,随机分为对照组（25例）和治疗组（25例）。对照组给予生理盐水10 mL静推,每8小时一次,术前3 d开始应用,术后应用3 d;治疗组给予盐酸氨溴索30 mg静推,每8小时一次,术前3 d开始应用,术后应用3 d。气管插管后手术前、术后及拔除气管插管前,分别做右侧支气管肺泡灌洗,测定灌洗液中总磷脂（TPL）、饱和卵磷脂（Sat PC）和总蛋白（TP）量。取Sat PC/TPL和Sat PC/TP比值作为判断PS活性水平的指标。结果：两组手术后Sat PC/TPL和Sat PC/TP值明显低于术前（P〈0.05）,拔管前基本恢复。治疗组术前、术后Sat PC/TPL和Sat PC/TP值明显高于对照组（P〈0.05）。结论：盐酸氨溴索能促进老年OPCABG患者PS的合成和分泌,防止PS下降,从而改善术后患者肺功能。     

不同剂量氨溴索对哮喘豚鼠肺表面活性物质的影响

目的比较不同剂量氨溴索对哮喘豚鼠肺表面活性物质(pulmonary surfactant PS)的影响.方法 24只豚鼠,分4组,即正常对照组、哮喘模型组、氨溴索小剂量组(7.5mg*kg-1*d-1), 氨溴索大剂量组(30mg*kg-1*d-1).用卵白蛋白腹腔注射与雾化吸入造成哮喘动物模型,测支气管肺泡灌洗液(BALF)中总磷脂(TPL)、饱和磷脂酰胆碱(DSPC)、总蛋白(TP)含量.结果哮喘模型组豚鼠DSPC下降,TP增加,DSPC/TP及DSPC/TPL比值下降,与正常对照组比较 P均＜0.01 .氨溴索大、小剂量组能对抗上述改变,使DSPC升高,TP降低,DSPC/TP及DSPC/TPL比值升高,与哮喘模型组比较P均＜0.01.氨溴索大、小剂量组之间差异无显著性(P＞0.05).结论氨溴索可减轻哮喘豚鼠PS活性水平的下降,氨溴索应用小剂量(7.5mg/kg.d)即可起到良好的作用.     

甲基强的松龙对瓦斯爆炸致伤大鼠肺泡表面活性物质的影响

目的 探讨瓦斯爆炸损伤伤大鼠肺泡表面活性物质（PS）系统的机制以及甲基强的松龙（MP）的影响.方法 制备瓦斯爆炸伤大鼠动物模型,伤后给予MP腹腔注射,观察电镜下动物模型肺脏的形态学超微结构以及支气管肺泡灌洗液（BALF）中PS组分的变化,检测其血清及BALF中肿瘤坏死因子α（TNF-α）水平.结果 瓦斯爆炸伤后大鼠肺泡Ⅱ型细胞变性、脱落,出现核固缩,胞质局灶性溶解（第1天最明显）;BALF中饱和卵磷脂、总磷脂、饱和卵磷脂与总蛋白的比值明显下降（第1天最明显）;血清及BALF中TNF-α水平呈逐渐升高趋势.MP可增加BALF中饱和卵磷脂、总磷脂、饱和卵磷脂与总蛋白的比值,同时降低血清及BALF中TNF-α水平.结论 瓦斯爆炸伤致动物肺部PS系统异常,TNF-α参与了瓦斯爆炸所致肺损伤的病理生理过程并损害了肺PS系统.MP可降低血清及BALF中TNF-α水平并改善肺PS系统的损伤.     

肺炎患儿支气管肺泡灌洗液中TNF-α和PS水平变化研究

[目的] 研究肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、肺泡表面活性物质(pulmonary surfactant,PS)在肺炎患儿肺泡灌洗液中的变化,探讨患儿发病机制. [方法] 肺炎患儿20例(肺炎组),非肺炎患儿20例(对照组),应用纤维支气管镜进行肺泡灌洗,收集肺泡灌洗液,肺泡灌洗液中TNFα采用酶联免疫法检测,总磷脂(total phos-pholipid,TPL)采用Bartlett法检测,饱和磷脂酰胆碱(Sat-PC)采用Mason法检测,总蛋白(total proteins,TP)采用Lowry法检测.以Sat-PC/TPL和Sat-PC/TP作为判断PS活性水平的指标. [结果] 肺炎组肺泡灌洗液中TNF-α含量明显升高(35.84±18.75)U/mL,与对照组比较差异有显著性(t=3.723,P<0.01).Sat-PC较低,但与对照组比较差异无显著性(t=1.062,P>0.05);Sat-PC/TPL和Sat-PC/TP较对照组低,差异有显著性(t=5.383和3.938,P<0.001). [结论] TNF-α和PS在肺炎患儿发病中有重要作用,TNF-α拮抗剂和PS替代疗法治疗肺炎是一种新的有效辅助方法.     

早期矽肺患者支气管肺泡灌洗液中生物标志物的研究

目的　探讨早期矽肺患者支气管肺泡灌洗液 (BALF)中生物标志物。方法　矽尘作业工人 18人 ,按X线诊断矽肺期别分为 0 组和Ⅰ期组 ;以健康吸烟农民 7人为对照组。经纤支镜支气管肺泡灌洗收集BALF ,进行细胞学检验 ,用细胞毒性试验测定肿瘤坏死因子 (TNF α)含量 ,酶联免疫吸附法测定其他细胞因子含量。结果　矽肺 0 组及Ⅰ期组BALF中TNF α含量分别为 (7.2 0±1.87)、(9.2 0± 1.10 )U/ml,明显高于对照组的 (5 .71± 0 .89)U/ml,差异有显著性 (P <0 .0 1) ;矽肺Ⅰ期组TNF α含量明显高于 0 组 ,差异有显著性 (P <0 .0 5 )。TNF α含量与矽尘接触年限存在剂量 -效应关系 (rs=0 .46 98,P <0 .0 5 )。纤维连接蛋白、肺表面活性蛋白A和前胶原Ⅲ肽与对照比较 ,差异无显著性 (P >0 .0 5 )。结论　BALF中TNF α含量升高可能是早期矽尘危害的效应指标     

早期煤工尘肺支气管肺泡灌洗液中SP-A及TNF-α含量的变化

目的　探讨煤尘职业接触者和早期煤工尘肺患者支气管肺泡灌洗液(BALF)中细胞因子含量改变的特点及意义。方法　采煤工23人,按X线胸片诊断为煤尘接触组(接尘组)、煤工尘肺0+和Ⅰ期组;健康农民7人为对照组。经纤支镜做支气管肺泡灌洗,收集BALF,用酶联免疫吸附法(ELISA)测定肺泡表面活性蛋白-A(SP-A)及肿瘤坏死因子(TNF-α)含量。结果　接尘组BALF中SP-A含量为(6528.2±1872.0)ng/ml,TNF-α含量为(8.23±1.61)U/ml,均明显高于对照组［(1050.1±912.2)ng/ml及(5.17±0.89)U/ml］,差异有显著性(P<0.01);且随煤工尘肺期别进展,SP-A及TNF-α含量降低,SP-A及TNF-α含量变化与煤工尘肺病变严重性之间呈负相关(前者r=-0.64,P<0.01;后者r=-0.45,P<0.05)。结论　BALF中SP-A和TNF-α含量升高可能是煤尘接触的效应指标。     

肺表面活性物质对全氟异丁烯吸入性肺损伤的预防效果

目的　通过观察外源性肺表面活性物质 (pulmonarysurfactant,PS)对小鼠全氟异丁烯 (perfluoroisobutylene ,PFIB)吸入性肺损伤的防护效果 ,以期寻找预防PFIB中毒的有效药物。方法　小鼠PFIB染毒前 2h经气管给予不同剂量的PS制剂 (含二棕榈酰磷脂酰胆碱 ,dipalmitoylphosphatidylcholine ,DPPC)。采用静式全暴露法染毒PFIB 5min ,观察 48h内给药组与对照组小鼠的活存率、肺含水量和支气管肺泡灌洗液 (bronchoalveolarlavagefluid ,BALF)中蛋白含量。结果　预防给予 3个剂量的PS制剂 (DPPC 2 5mg/kg、 5 0mg/kg和 10 0mg/kg)均能显著提高PFIB中毒小鼠的存活率 (P <0 0 1) ;DPPC 5 0mg/kg剂量组 ,在中毒后 16h和 2 4h小鼠肺含水量明显低于生理盐水对照组 (P <0 0 5 ) ,在中毒后 16hBALF中总蛋白和白蛋白的含量显著低于生理盐水对照组 (P <0 0 1)。结论　外源性PS对小鼠PFIB吸入性肺损伤具有一定的预防作用     

哮喘豚鼠肺泡表面活性物质分泌的实验研究

目的 探讨哮喘豚鼠肺泡表面活性物质分泌的影响,为哮喘的防治提供实验依据.方法 卵蛋白致敏复制哮喘豚鼠模型,用高效液相色谱法测定各组豚鼠支气管肺泡灌洗液(Broncho-alveolar lavage Fluid,BALF)中磷脂成分的含量.结果 哮喘豚鼠肺表面活性物质主要活性成分磷脂酰胆碱(Pc)、磷脂酰乙醇胺(Pe)的含量正常对照组显著降低,中药循经敷贴后能显著升高Pc、Pe的含量,与生理盐水、地塞米松各组比较差异均有统计学意义(P<0.05).结论 中药敷贴对哮喘有治疗作用,明显促进肺表面活性物质的磷脂分泌可能为其作用机制之一.     

二氧化硫对大鼠肺细胞膜通透性的损伤效应

目的 探讨二氧化硫(SO2)吸入对大鼠肺组织及肺细胞通透性的影响。方法 用生理盐水灌洗大鼠支气管肺泡，收集肺泡灌洗液(BALF)和肺泡巨噬细胞(AM)，从整体、细胞和亚细胞水平研究SO2对肺组织和细胞的通透性的影响。结果 SO2吸入后，大鼠体重增加减慢，肺组织湿重增大，干重减小；肺泡BALF中蛋白质含量和肺通透指数增加；肺血管通透性增大；BALF中乳酸脱氢酶(LDH)和酸性磷酸酶(ACPase)活力升高，而AM LDH和ACPase活力降低。结论 SO2导致大鼠肺组织损伤，肺血管通透性增加，AM膜通透性增加，细胞器(如溶酶体)结构和功能发生改变。     

支气管肺泡灌洗术治疗尘肺的护理

实施支气管肺泡灌洗术(BAL)治疗尘肺是将患者肺泡内的刺激粉尘排出,主要是增强肺的廓清能力,改善肺通气和换气功能,延缓肺部病变进展.2002年8月～2003年10月间,该院对112例尘肺患者实施支气管肺泡灌洗术治疗,采取必要的术前护理、有效的术中关怀和语言指导、完善的术后护理,是取得病人密切配合治疗成功的关键因素之一.     

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.