Fatal haemolytic anaemia complicating a case of common variable hypogammaglobulinaemia

A fatal case of common variable hypogammaglobulinaemia (CVH) is described. The patient presented with fulminant haemolytic anaemia. Post mortem examination revealed evidence of chronic hypogammaglobulinaemia.     

某企业职工健康监护结果分析

目的掌握某企业接触有毒有害因素的人群健康状况,为该人群的职业病防治提供依据和建议。方法按照《职业健康监护技术规范》GBZ 188-2007对该企业374名接触电焊烟尘、噪声的在岗工人进行健康检查。结果健康检查374人,其中74人职业健康检查结果无明显异常,占体检人数的19.79%;接触电焊烟尘作业人员检查112人,异常胸片7人,占6.25%;接触"噪声"作业人员检查314人,异常电测听113人,占35.99%。结论该企业存在的职业病危害因素,损害了劳动者的健康,企业必须采取有效的职业病防治措施,预防控制职业病的发生。     

某尼龙化工厂己二酸作业工人职业健康检查结果分析

目的了解某尼龙化工厂己二酸对作业工人的身体健康的影响,探索己二酸作业工人职业健康监护内容。方法于2009—2011年对某尼龙化工厂己二酸作业工人进行职业健康检查,检查项目包括血压、心电图、B超、血常规、尿常规和肝功能检查,并对检查结果进行统计分析。结果 2009、2010年结果显示,不同工龄组之间,B超脂肪肝检查结果差异有统计学意义,P值分别为0.033,0.018,其他检查结果差异均无统计学意义(P0.05)。2011年结果显示,不同工龄组之间,检查结果差异均无统计学意义(P0.05)。结论对于己二酸作业接触工人的职业健康监护除常规健康检查项目以外,应加入X线胸片检查以及肺功能测定。     

Toxicity in man due to stain removers containing 1,2-dichloropropane

There are reports that 1,2-dichloropropane, a constituent of many commercial solvents and stain removers in Italy, has caused severe liver damage and, sometimes, acute renal failure. Between 1980 and 1983 three cases of 1,2-dichloropropane intoxication (1 by ingestion, 2 by inhalation) were observed. Clinical features included severe liver damage, acute renal failure (2 patients), haemolytic anaemia, and disseminated intravascular coagulation. The most surprising features were haemolytic anaemia and disseminated intravascular coagulation which have not been reported before. The clinical picture was similar despite different modes of exposure.     

Haemolytic anaemia after childhood Escherichia coli O 157 .H7 infection: are females at increased risk?

We conducted a 4-year retrospective cohort study to better define the risk of haemolytic anaemia and haemolytic uraemic syndrome (HUS) in children following sporadic gastrointestinal infection with the O 157.H7 serotype of Escherichia coli. Of the 72 children infected with this organism, 9 (12.5%) developed haemolytic anaemia, 6 of whom had HUS. No child in a cohort of 72 age-matched controls with Campylobacter jejuni gastroenteritis developed haemolytic anaemia (P = 0.003). Females had a significantly greater risk of developing haemolytic anaemia after E. coli O 157. H7 infection than did males (8/29 females v. 1/43 males; P = 0.003). In a logistic regression model, female gender emerged as the only statistically significant risk factor for haemolytic anaemia (odds ratio 3.85; 95% confidence interval 1.24-12). These results are consistent with recent reports of a moderate increase in the risk of HUS for females.     

职业性苯系物接触员工1881名健康状况的分析

目的了解深圳市宝安区职业性苯系物接触员工的健康状况,为职业防护提供依据。方法为受检者发放职业卫生健康体检表,按表内项目逐一填写。采集静脉血3ml,分别做血常规与肝功能检查;采集尿液10ml,做尿常规检测;及进行心电图和肝脾B超的检查。资料应用Excel软件进行数据处理。结果1881名受检者,血常规检查WBC减少者占3.24％,中性粒细胞减少者占2.02％,PLT减少者占0.32％,RBC减少者占0.11％,Hb减少者占0.69％,无全血细胞减少者。尿常规检查发现异常者占8.33％,其中尿潜血阳性占64.44％（58／90）,尿蛋白阳性占2.22％（2／90）。血清ALT升高占2.13％。肝脾B超异常者占1.17％。心电图异常者占0.85％。结论部分职业性苯接触人员的检查结果有异常发现,且以血常规异常为尤,应引起重视,防患未然。     

Toxicity in man due to stain removers containing 1,2-dichloropropane.

There are reports that 1,2-dichloropropane, a constituent of many commercial solvents and stain removers in Italy, has caused severe liver damage and, sometimes, acute renal failure. Between 1980 and 1983 three cases of 1,2-dichloropropane intoxication (1 by ingestion, 2 by inhalation) were observed. Clinical features included severe liver damage, acute renal failure (2 patients), haemolytic anaemia, and disseminated intravascular coagulation. The most surprising features were haemolytic anaemia and disseminated intravascular coagulation which have not been reported before. The clinical picture was similar despite different modes of exposure.     

合肥市某机构近5年职工健康体检结果分析及健康干预对策

目的通过对合肥市某机构近5年来职工健康体检状况的综合分析,探寻危害职工健康的主要因素,为实施相应的健康干预对策提供依据。方法收集近5年职工体检报告,分析体检指标年度变化趋势和异常指标在不同年龄职工分布情况。结果 5年来职工相关指标异常由高到低依次为:高血脂16.49%、脂肪肝12.07%、高胆固醇7.66%、高尿酸6.77%、高血糖4.57%、心电图异常4.42%。高血脂、脂肪肝、高血糖检出率呈逐年上升趋势;除心电图异常外,高血脂、脂肪肝、高胆固醇、高尿酸、高血糖以35岁以上职工检出率最高。结论慢性生活方式疾病危险因素是影响职工当前和未来健康的主要危害因素,加强健康生活方式指导,改变不良的生活方式行为,是提高职工身心健康水平的方法和主要干预对策。     

2012年北京市昌平区从业人员职业健康检查结果分析

目的了解北京市昌平区接触职业病危险因素从业人员的高血压检出情况。方法对昌平区2012年职业病危害（高温、苯系物、锰、汽油、粉尘、铅等）从业人员健康检查资料进行分析。结果该区共检查4 469名从业人员,均未发现疑似职业病患者;其中检查701人有1项或多项的结果异常,异常检出率为15.69%。检出职业禁忌证21人。其中血压异常检出率为30.03%,尿常规异常率为9.67%;铅作业和苯作业工人职业禁忌证检出率分别为2.94%和2.29%。结论该区在所监测的职业禁忌证中,接触铅作业从业人员检出率居首位,其次是接触苯系物从业人员,接触高温、无机粉尘检出率较低。应坚持常规的职业健康检查,掌握劳动者的健康状况,及早发现职业禁忌证对职业病的预防会起到非常重要的作用。     

A multi-faceted approach to risk assessment of laboratory animal allergens at two facilities

BACKGROUND: Risk assessment of exposure to allergens is difficult because the relationship between exposure, sensitization, and symptoms has not been fully established. Laboratory animal allergens (LAA) are an important occupational health risk factor; 10-32% of workers exposed to these allergens develop allergic diseases. This article introduces a versatile approach to assessing the risks posed by LAA at two laboratory animal facilities. METHODS: The risk assessment approach that was used at the laboratory animal facilities included questionnaires for management and employees, a hazard identification visit and measurements in the workplaces, as well as the creation of a list of generally recommended procedures to reduce allergen exposure. RESULTS: The prevalence of work-related allergic symptoms was 17%. Suggested countermeasures at the sites included changes in ventilation and work practices, reduction of unnecessary exposure, recommendations for more comprehensive use of personal protective equipment, and wider communication about LAA risks. CONCLUSIONS: The approach managed to identify critical points and potential means for controlling LAA exposure.     

Clinical epidemiological study of employees exposed to surfactant blend containing perfluorononanoic acid

Introduction

An epidemiological study was conducted of a perfluorononanoic acid (PFNA) surfactant blend, to investigate whether clinical differences were apparent between employees who were potentially exposed to the surfactant and those who were not exposed. The surfactant blend, which is related to other previously studied perfluorinated materials, is used in the production of some high‐performance polymers.

Methods

All 630 individuals employed at a polymer production facility using PFNA (CAS No 72968‐38‐8) at any time between 1 January 1989 and 1 July 2003 were included in the cohort. Plausibly related laboratory test results were abstracted from annual medical examination records, including liver enzyme function and blood lipids. Detailed work histories, available for all employees, provided the basis for determining exposure category. Thirty two clinical parameters were evaluated by exposure level at five points in time, determined to reflect changes in possible exposure intensity, as well as greatest number of records available. Annual cross‐sectional analyses and longitudinal analyses that accounted for multiple measurements per person were conducted separately for men and women, by exposure groups.

Results

Differences by exposure group for all laboratory measures, adjusted for age and body mass index, were small and not clinically significant. Although some statistically significant pair‐wise differences were observed, these observations were not consistent between men and women, or over the five analysis windows. For the seven outcome variables (liver enzymes and blood lipids) examined in separate longitudinal models, no significant increase or decrease was observed by unit increase in cumulative exposure intensity score.

Conclusion

This is the first epidemiological study investigating the possible health effects in humans associated with exposure to PFNA blend. Based on laboratory measures assessed over more than a decade, no adverse clinical effects were detected from occupational exposure to PFNA blend.For more than a decade, the public health relevance of exposure to perfluorooctanoic acid (PFOA or C8) has been examined because of its biological persistence and the lack of information on possible long‐term health implications. PFOA has been detected in blood bank samples across the US as well as in individuals across the globe (World Wildlife Fund, 2004).¹ A related long‐chain fluorinated hydrocarbon, perfluorononanoic acid (PFNA or C9), is the principal carbon chain‐length in a surfactant or “slip‐agent” blend (CAS No 72968‐38‐8) used in the production of some high‐performance polymers. The remaining fluorinated hydrocarbons in the blend consist primarily of C11 and C13 congeners. Because the perfluorinated compounds in the blend may also persist biologically, management of a chemical production facility using this blend was interested in whether measurable health effects were associated with employee exposures. A limited number of toxicological studies have been conducted by the manufacturers and users of PFNA, and no epidemiological studies have been published to date. Therefore, the limited toxicological data on PFNA and the epidemiological findings regarding the related compound, PFOA, served to frame the research questions.A 90‐day rat PFNA feeding study with a 60‐day recovery period suggested that the liver was the main target organ, with effects on serum clinical chemistry, higher liver weights, and evidence of peroxisome proliferation in both males and females. Microscopic lesions in the liver and gastrointestinal tract were noted in the male rats. At the end of the recovery period most of the affected parameters had partially or completely returned to normal. The enhanced effect in the males was consistent with the observed higher serum levels of the surfactant (WIL Research Laboratories, LLC. Study number WIL‐497002, 2006). Similarly, toxicity studies of PFOA in animals have shown effects on lipid metabolism (for example, reduction of serum cholesterol) and changes in liver function (for example, hepatic enzyme tests).²The epidemiological investigations conducted at plant sites where PFOA is either manufactured or used in polymer production provided additional guidance for relevant clinical hypotheses. Two studies that evaluated possible liver effects associated with PFOA exposure in a polymer production area found no impairment of liver function based on blood liver function tests (DuPont, 1981, 1983). Similarly, studies of 3M employees found no excess of liver cancer deaths attributable to PFOA (University of Minnesota School of Public Health, 2001),^3,4 and no changes in liver function parameters were observed.⁵ A more extensive study of serum concentration of perfluorooctanesulfonate (PFOS), another C8 fluorocarbon compound, found no association with changes in blood clinical chemistries or haematology after adjusting for other clinical measures, such as age and lifestyle factors.⁶ This study was consistent with studies of PFOA exposures, finding no adverse changes in blood chemistries (that is, markers of disease) or increases in cancer mortality.Based on the positive findings for liver and blood lipid changes in rats exposed to PFNA blend, and the choice of blood chemistry tests evaluated in the epidemiological studies of a similar compound, PFOA, the current study evaluated a number of clinical laboratory measurements collected over a period of more than 25 years among employees of a US production facility using the PFNA blend. The facility, which manufactures a variety of chemicals and polymers, is located in a rural area, and employees typically reside in communities near the plant. The study was designed to identify whether any differences in clinical measures could be identified between employees in surfactant‐exposed jobs compared to employees in non‐exposed jobs.     

2010～2012年大连市某泵类加工企业职工职业健康体检结果

目的了解大连市某泵类加工企业职工职业健康检查情况,为职业病防治工作提供依据。方法 2010～2012年期间,对该企业接触职业病危害因素作业工人的健康体检并做综合分析。结果 2010～2012年合计检测385人,各指标异常的126人,异常率为32.73%。不同年龄组中,39岁以下和40岁以上年龄组作业工人体检异常率的差异有统计学意义（P〈0.05）;在异常体检结果中,血压、肝功能的异常检出率较高,分别是11.43%和8.83%;在接触不同种类职业病危害因素的工人中,接触电焊烟尘的工人异常检出率前两位的是转氨酶（14.52%）、血压（9.68%）;接触苯系物的工人肝功（26.32%）和血压（23.68%）异常率均较高;接触粉尘、噪声工人异常检出率前两位的是肝功（19.18%）、血压（10.96%）;接触噪声工人异常检出率最高的是血压（10.40%）。结论企业要加强职业卫生管理工作,减少职工职业病危害因素的接触机会、时间,采取综合性防护措施预防职业病的发生。     

Adverse pregnancy outcomes in offspring of fathers working in biomedical research laboratories

BACKGROUND: Laboratory work may constitute a possible health hazard for workers as well as for their offspring, and involves a wide range of exposures, such as organic solvents, carcinogenic agents, ionizing radiation, and/or microbiological agents. Adverse pregnancy outcomes in the offspring of male employees in biomedical research laboratories are examined. METHODS: Offspring to males employed 1970-1989 at four Swedish universities were identified via the Medical Birth Register (MBR), along with other pregnancy parameters. Offspring of fathers with laboratory work (n = 2,281) is considered exposed, and of non-laboratory employees unexposed (n = 1,909). Exposure data were obtained by questionnaires to research group leaders. Logistic regression analysis estimated odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Paternal laboratory work in general showed no statistically significant increased ORs concerning birth weight and/or gestational age, but work specifically with radioactive isotopes gave OR 1.8 (CI 1.0-3.2) for high birth weight and a relative risk of 1.2 (CI 1.0-1.4) for sex ratio (male/female). CONCLUSIONS: There was no clear association between periconceptional paternal laboratory work and adverse reproductive outcomes, but use of radioactive isotopes showed increased OR for high birth weight in offspring.     

Early-onset endocrine disruptor-induced prostatitis in the rat

BACKGROUND: Androgens are critical for specifying prostate development, with the fetal prostate sensitive to altered hormone levels and endocrine-disrupting chemicals (EDCs) that exhibit estrogenic or antiandrogenic properties. Prostatic inflammation (prostatitis) affects 9% of men of all ages, and > 90% of cases are of unknown etiology. OBJECTIVES: In this study we aimed to evaluate effects of in utero exposure to the antiandrogenic EDC vinclozolin, during the period of male reproductive tract development, on neonatal, prepubertal, and postpubertal prostate gland function of male offspring. METHODS: Fetal rats were exposed to vinclozolin (100 mg/kg body weight) or vehicle control (2.5 mL/kg body weight) in utero from gestational day 14 (GD14) to GD19 via oral administration to pregnant dams. Tissue analysis was carried out when male offspring were 0, 4, or 8 weeks of age. RESULTS: In utero exposure to vinclozolin was insufficient to perturb prostatic development and branching, although expression of androgen receptor and mesenchymal fibroblast growth factor-10 was down-regulated. Prostate histology remained normal until puberty, but 100% of animals displayed prostatitis postpubertally (56 days of age). Prostatic inflammation was associated with phosphorylation and nuclear translocation of nuclear factor-kappa B (NFkappaB) and postpubertal activation of proinflammatory NFkappaB-dependent genes, including the chemokine interleukin-8 and the cytokine transforming growth factor-beta1. Significantly, inflammation arising from vinclozolin exposure was not associated with the emergence of premalignant lesions, such as prostatic intra-epithelial neoplasia or proliferative inflammatory atrophy, and hence mimics nonbacterial early-onset prostatitis that commonly occurs in young men. CONCLUSIONS: These data are the first to unequivocally implicate EDCs as a causative factor and fill an important knowledge gap on the etiology of prostatitis.     

Is there a need for special preventive medical check-ups in employees exposed to experimental animal dust?

Objective  Due to new legal requirements in Germany, the employer must request preventive medical check-ups for activities involving exposure to dust from experimental animals in the rooms in which the animals are kept. The objective is to report our first experiences with these medical check-ups in the context of academic research. Methods  The check-ups were carried out since November 2005 and comprised a questionnaire and a medical examination, including a pulmonary function test with whole-body plethysmography. Respiratory, nasal and ocular symptoms related to occupational exposure to animals were documented. Participation in skin prick tests (ubiquitous inhalation allergens and laboratory animal allergens), a bronchial provocation test with methacholine, and serological examinations for total IgE and specific IgE antibodies was voluntary. Results  Data on 132 persons are presented. One hundred and six of these had already been exposed for at least 1 year. Main complaints at the workplace were sneezing and runny nose. Ocular symptoms and bronchial asthma were reported infrequently. The development of at least one of these symptoms occurred in 34% of employees with an exposure of at least 1 year. If the weekly exposure duration was at least 5 h, the proportion of employees with complaints rose to 44.9%. In employees occupationally exposed to mice and rats, work-related complaints occurred in 33.7 and 37.8%, respectively, and sensitisation rates were 12.7 and 16.3%, respectively. Employees with and without complaints differed in history of allergic symptoms, and workplace safety measures. Conclusions  In employees with occupational contact with laboratory animal dust, the frequency of complaints was high. The results confirm the necessity of regular medical check-ups for employees with contact with laboratory animal dust. Nevertheless, the medical check-ups must be part of a prevention strategy including education, engineering controls, administrative controls, use of personal protective equipment and vocational integration.     

1807例脂肪性肝病与相关危险因素关系的分析

目的分析脂肪性肝病特别是非酒精性脂肪性肝病的患病率与相关危险因素的关系。方法对所辖地区部分公职人员的人体学指标和血脂、血糖及腹部B型超声波等进行检查,参数采用χ2检验和相关分析,P0.05为差异有统计学意义。结果资料完整应检者8 580人中脂肪性肝病1 807例,患病率21.06%。其中体质指数(BMI)不足者3例(0.17%),正常者314例(17.38%)、超重者1 098例(60.76%)及肥胖者392例(21.69%);各年龄组别患病例数分别为:20~岁79例(4.37%)、30~岁375例(20.75%)、40~岁625例(34.59%)、50~岁415例(22.97%)、60岁313例(17.32%);本组病例中高甘油三酯症844例(46.71%)、高胆固醇症97例(5.37%)、混合性高脂血症432例(23.91%)、高血压318例(17.60%)、空腹血糖受损247例(13.67%)和糖尿病150例(8.30%)。脂肪性肝病6种危险因素χ2检验差异均有性统计学意义,与高血压、甘油三酯、总胆固醇和血糖4种危险因素均有正相关性。结论该地区公职人员脂肪性肝病患病率高,疾病的发生和发展可能与多种危险因素存在有密切联系。     

某石油炼制企业汽油作业工人健康状况分析

目的 通过分析某石油炼制企业汽油作业人员的职业健康状况,揭示石油炼制企业职工的健康损害与其接触的职业病危害因素的相关性。 方法 对某石油炼制企业902名汽油作业工人和1 057名非汽油作业工人的职业健康检查结果进行统计学分析。 结果 女性工人中,汽油作业工人白细胞计数减少的异常检出率与非汽油作业工人相比,差异有统计学意义(χ2=4.48,P < 0.05)。经多因素Logistic回归分析,提示汽油接触是女性工人白细胞计数减少的危险因素(OR=2.56,95% CI:1.04~6.29);女性工人中,汽油作业工人的血红蛋白平均含量低于非汽油作业工人,差异有统计学意义(t=-3.18,P < 0.01)。 结论 该企业在目前的生产条件下,汽油接触可能使女性作业工人的白细胞受到损伤,企业应改善作业场所环境,并定期组织接触汽油的人员进行职业健康检查,以保护作业人员的身体健康。     

某制药企业职业健康监护工作探讨

目的对某制药企业10年的职业健康监护工作进行总结,为今后更好地开展此项工作积累经验,提出改进措施。方法按照《中华人民共和国职业病防治法》、《职业健康管理监护管理办法》等相关法律、法规的要求确定该企业职业病危害因素的种类、工种岗位、接触人群、体检项目、体检周期、作业场所职业病危害因素监测及服务机构的选择。对其体检结果、监测结果进行分析。结果该制药企业存在的职业病危害因素主要为噪声、高温、粉尘(滑石尘、煤尘)、氨、甲醛、氢氧化钠、乙醇、硫化氢、锰等。应检查职业病危害因素接触人员共6 473人,实查5 975人,体检率为92.31%。未发现疑似职业病者;在5 975人中噪声观察对象29人,占0.49%;听力下降人数194人,占3.25%;职业禁忌证15人,占0.25%;高血压人数565人,占9.46%;脂肪肝人数530人,占8.87%;白细胞减少人数161人,占2.69%;心血管疾病人数89人,占1.49%。作业场所职业病危害因素监测超标的主要为噪声。结论该制药企业生产过程中职业病危害种类多,对接触的员工可以造成不同程度的职业损害,应加强职业卫生管理,加大监督力度。     

低浓度苯系物对作业工人的健康影响

目的探讨低浓度苯系物（苯、甲苯、二甲苯）对作业工人健康的影响。方法选择漳州市某光电企业接触苯系物的作业工人186名作为接触组,选择同地区106名饮食行业食品从业人员作为对照组,进行内科常规健康检查和实验室指标检测。用个体采样器采样,用气相色谱法分析测定空气中苯系物浓度。结果职业接触低浓度苯系物的工人高血压和白细胞减少的检出率高于对照组（P〈0.05）。结论长期接触苯系物可能导致血压升高和白细胞减少。     

三硝基甲苯作业工人健康损害的调查

目的了解TNT(三硝基甲苯)对作业工人的健康损害,以提出对转产后病人的妥善安置。方法查阅厂方的工时记录、职工健康监护档案,并对工人进行问卷和体格检查。结果81名TNT作业工人的眼晶状体全部受到损害,其中71名诊断为职业性三硝基甲苯白内障;血红蛋白与对照组比较明显低下(P<0.05)。结论TNT的慢性职业危害主要是对接触工人眼晶状体的损害和影响血红蛋白。