乌司他丁对体外循环下中性粒细胞凋亡与呼吸爆发的影响

目的 观察体外循环(CPB)心脏手术患者中性粒细胞(PMN)凋亡、呼吸爆发的变化及乌司他丁对其影响.方法 选择在CPB下行瓣膜置换术患者62例,随机分成乌司他丁组(U组)和对照组(C组),每组各31例.U组患者于麻醉诱导后给予乌司他丁,C组患者则给予等容积的0.9%NaCI溶液.分别于麻醉后手术前(T1)、CPB开始后30 min(T2)、CPB停止后30 min(T3)抽取动脉血,分离PMN,检测PMN凋亡率,呼吸爆发以及血浆中超氧化物歧化酶(SOD)和丙二醛(MDA)的水平.结果 C组PMN凋亡率在T1为(66.57±5.93)%,T2为(55.37±3.51)%,T3为(48.92±4.21)%,T2、T3均较T1显著降低(P<0.05),并于T3达最低值;U组PMN凋亡率在T1为(73.57±7.94)%,T2为(68.34±4.92)%,T3为(62.13±4.76)%,T2、T3均较T1显著降低(P<0.05),并于T3达最低值;C组PMN凋亡率显著低于U组(P<0.05).两组PMN呼吸爆发均表现为CPB开始后逐渐升高,T3达到峰值;U组T2(1105.94±84.15)MCF,T3(1156.52±93.20)MCF,与C组T2(1266.06±99.55)MCF,T3(1422.50±89.75)MCF比较明显降低(P<0.05).两组SOD均于手术开始后逐渐下降(P<0.05),C组T3SOD为(47.39±6.07)μU/L显著低于U组的(51.35±6.22)μU/L(P<0.05).两组MDA均于手术开始后逐渐升高(P<0.05),T3达高峰,C组为(13.72±1.15)μmol/L,U组为(8.40±0.88)μmoI/L,C组显著高于U组(P<0.05).结论 CPB引起PMN凋亡率降低、凋亡延迟,呼吸爆发增强,乌司他丁能有效地促进过度激活的PMN凋亡、抑制PMN呼吸爆发,提高SOD,降低MDA,减轻CPB对机体的炎性反应及氧化损伤,对机体具有保护作用.     

乌司他丁对中高危心脏手术患者体外循环术后心肺损伤的保护作用

目的探讨乌司他丁(Ulinastatin,UTI)对体外循环(CPB)心脏手术后心肺损伤的保护作用。方法 60例拟行择期心脏手术的中高危患者(欧洲心血管手术危险因素评分EuroScore≥4)随机分为2组:对照组(C组)和乌司他丁组(U组)。U组于麻醉诱导后和CPB开始时分别给予乌司他丁总量(30kU/kg)的1/2,C组于相同时间给予等容量的生理盐水。记录术后带管时间、ICU住院时间、心梗发生例数及住院期间死亡例数。于术前、手术结束后8h、1d、3d和5d测定血浆中肌酸激酶-同工酶(CK-MB)和肌钙蛋白I(cTnI)水平。并同时测定动脉血气,计算肺泡-动脉氧分压差(A-aDO2)和呼吸指数(RI)。结果 U组患者术后带管时间、ICU住院时间、心梗发生例数及住院期间死亡例数均显著低于C组(P﹤0.05)。术后8h起U组CK-MB、cTnI、A-aDO2和RI水平显著低于C组(P﹤0.05)。结论乌司他丁可有效减轻中高危心脏手术患者CPB术后心肺损伤,改善心肺功能,降低围术期心梗发生率及死亡率。     

乌司他丁对体外循环下中性粒细胞凋亡与呼吸爆发的影响

目的观察体外循环（CPB）心脏手术患者中性粒细胞（PMN）凋亡、呼吸爆发的变化及乌司他丁对其影响。方法选择在CPB下行瓣膜置换术患者62例,随机分成乌司他丁组（U组）和对照组（c组）,每组各31例。U组患者于麻醉诱导后给予乌司他丁,C组患者则给予等容积的0．9％NaCl溶液。分别于麻醉后手术前（T1）、CPB开始后30min（T2）、CPB停止后30min（T3）抽取动脉血,分离PMN,检测PMN凋亡率,呼吸爆发以及血浆中超氧化物歧化酶（SOD）和丙二醛（MDA）的水平。结果C组PMN凋亡率在T1为（66．57±5．93）％,T2为（55．37±3．51）％,T,为（48．92±4．21）％,T2、T1均较T1显著降低（P〈0．05）,并于L达最低值;U组PMN凋亡率在T。为（73．57±7．94）％,T2为（68．34±4．92）％,T3为（62．13±4．76）％,T2、L均较T1显著降低（P〈0．05）,并于T3达最低值;C组PMN凋亡率显著低于U组（P〈0．05）。两组PMN呼吸爆发均表现为CPB开始后逐渐升高,L达到峰值;U组T2（1105．94±84．15）MCF,T3（1156．52±93．20）MCF,与C组T2（1266．06±99．55）MCF,T3（1422．50±89．75）MCF比较明显降低（P〈0．05）。两组SOD均于手术开始后逐渐下降（P〈0．05）,C组T3SOD为（47．39±6．07）μU／L显著低于U组的（51．35±6．22）μU／L（P〈0．05）。两组MDA均于手术开始后逐渐升高（P〈0．05）,L达高峰,C组为（13．72±1．15）μmol／L,U组为（8．40±0．88）μmol／L,C组显著高于U组（P〈0．05）。结论CPB引起PMN凋亡率降低、凋亡延迟,呼吸爆发增强,乌司他丁能有效地促进过度激活的PMN凋亡、抑制PMN呼吸爆发,提高SOD,降低MDA,减轻CPB对机体的炎性反应及氧化损伤,对机体具有保护作用。     

乌司他丁、立芷雪对体外循环心脏手术患者的血液保护作用

目的探讨乌司他丁和立芷雪对体外循环心脏直视手术的血液保护的作用。方法选择180例体外循环心脏直视手术病人,随机分为乌司他丁组(U组)、立芷雪组(L组)和对照组(C组);每组各60例,乌司他丁30万U、立芷雪3 kU分别以生理盐水溶解稀释至20 ml,对照组为20 ml生理盐水,分别于麻醉后经静脉用微量泵30 min泵入。分别于麻醉后(T1)、体外循环转机30 min(T2)、手术结束时(T3)、手术结束后24 h(T4)4个时点自桡动脉取血,测定血红蛋白浓度、血小板计数、并记录术后胸腔引流量。结果三组血浆血红蛋白浓度、血小板计数于T2、T3、T4时明显下降,乌司他丁组和立芷雪组手术结束时血红蛋白浓度、血小板计数明显高于对照组,术后胸腔引流量也少于对照组。乌司他丁组和立芷雪组相比,各指标差异无显著性意义。结论在体外循环心脏直视手术期间血液纤溶系统亢进,血小板功能受损,乌司他丁可抑制纤溶系统的过度激活,保护了血小板的功能,具有和立芷雪相似的血液保护作用。     

体外循环期间应用乌司他丁对肾功能影响的临床研究

目的　探讨体外循环 (CPB)中应用乌司他丁 (UTI)对机体肾脏的影响。方法　择期CPB下心内直视术 40例 (ASAⅡ～Ⅲ级 )分为 2组 :乌司他丁组 (U组 ,n =2 0 ) ,于麻醉后、CPB开始前将UTI 2 0万U溶于 2 0ml 0 9%生理盐水中静脉注射 (约 10min) ;若CPB时间超过 4h ,可在CPB开始 4h后追加 1次 ,剂量方法同前。对照组 (C组 ,n =2 0 )不用UTI。分别于麻醉前及CPB结束 3h后检测血Bun、Cr及尿NAG、RBP、α1-MG、γ -GTP ,统计尿量并计算排尿量 /输液量。结果　麻醉前 :两组病人间血Bun、Cr和尿NAG、RBP、α1-MG、γ -GTP及排尿量均无显著性差异 (P >0 0 5 )。CPB结束后 :⑴两组病人其尿γ -GTP、NAG均分别高于麻醉前( P <0 0 5 ) ,但U组二者均分别低于C组 ( P <0 0 5 )。⑵两组病人其尿RBP、α1-MG均分别明显高于麻醉前 ( P <0 0 1) ,但U组二者分别低于C组 (P <0 0 5 )。⑶两组病人其排尿量均明显多于麻醉前 (P <0 0 1) ,但U组高于C组 (P <0 0 5 )。⑷U组病人其排尿量 /输液量高于C组 (P <0 0 5 )。结论　UTI对CPB下心内直视病人的肾脏功能有较强的保护作用     

乌司他丁对体外循环术后急性肺损伤的保护作用

目的：研究乌司他丁对体外循环后急性肺损伤的保护作用。方法：心脏瓣膜置换患者30例，分为乌司他丁组和对照组，每组各15例。乌司他丁组于体外循环开始前、术中静脉应用乌司他丁（2万U／Kg），对照组予以等量生理盐水。分别于转流前、停机后2h、6h用支气管纤维镜行肺泡灌洗，抽取肺泡灌洗液（BALF）标本，并计算氧合指数。检测BALF中IL-8，中性粒细胞弹性蛋白酶（PMNE）变化情况。结果：所有病例手术后BALF中IL-8和PMNE浓度较术前明显升高（P〈0．01），氧合指数明显升高（P〈0．05）；乌司他丁组IL-8，PMNE升高程度较对照组显著降低，肺功能损伤程度小（P〈0．05）。结论：体外循环术可以引起血浆和肺内炎性介质明显增多，乌司他丁可以减轻CPB术后急性肺性损伤的程度，具有肺保护作用。     

乌司他丁用于体外循环肺保护的临床研究

目的探讨乌司他丁对体外循环(CPB)所致急性肺损伤的保护作用.方法 30例择期首次心脏瓣膜置换术患者随机分为乌司他丁组和对照组,各15例.于麻醉诱导前、CPB前、CPB结束后30 min及24 h各时点分别测定肿瘤坏死因子(TNF-α)、白介素6(IL-6)、白介素8(IL-8)和白介素10(IL-10)血浆水平,于CPB前、CPB结束后10 min、30 min各时点分别测定呼吸指数(RI).结果 CPB结束后3 min及24 h,对照组TNF-α、IL-6、IL-8明显高于诱导前以及相同时点乌司他丁组的水平(P<0.01); CPB结束后30 min及24 h,两组IL-10水平均明显增高,但乌司他丁组明显高于对照组(P<0.01);CPB结束后10 min以及1 h,对照组RI较基础值以及乌司他丁组明显增高(P<0.05).结论乌司他丁具有抗炎以及肺保护作用.     

乌司他丁对体外循环瓣膜置换术患者围手术期炎性细胞因子水平的影响

目的：分析乌司他丁对体外循环瓣膜置换术患者围手术期炎性因子水平的影响。方法：选取接受体外循环瓣膜置换术治疗的患者92例,并随机分为观察组和对照组,每组46例;分别采用接受乌司他丁治疗和接受等容量生理盐水治疗的方法,检测手术过程中两组患者的炎性因子水平及肺换气功能差异。结果：1于体外循环（CPB）开始后1 h、结束后1 h观察组患者的肿瘤坏死因子α（TNF-α）、白细胞介素-6（IL-6）以及肺泡气-动脉血氧分压差（A-a DO2）水平均低于对照组（t=2.948,t=2.537,t=4.382,t=5.281;P〈0.05）;2两组患者的A-a DO2水平与TNF-α、IL-6水平呈正相关关系（r2=0.567,r2=0.531;P〈0.05）。结论：乌司他丁可以有效降低体外循环瓣膜置换术患者围手术期的炎性因子水平,减少对肺换气功能的影响,且炎性因子水平与A-a DO2水平呈正相关。     

抑肽酶、乌司他丁加氨甲苯酸与氨甲苯酸对血液纤溶系统的保护作用

目的 观察抑肽酶、乌司他丁加氨甲苯酸与氨甲苯酸对体外循环(CPB)心脏手术的血液纤溶系统的保护作用.方法 选择36例行风湿性心脏病瓣膜置换术的患者,随机分成三组.抑肽酶组(A组,12例):在预充液中一次性加人抑肽酶200万U;乌司他丁加氨甲苯酸组(UP组,12例):在预充液中加入乌司他丁12000U/kg、氨甲苯酸10mg/kg;氨甲苯酸组(P组,12例):在预充液中加入氨甲苯酸10 mg/kg.结果三组CPB时间、输血量比较差异无统计学意义;术后24 h胸腔引流量UP组(443.3±150.8)ml、P组(430.0±178.3)ml,与A组的(290.0±98.0)ml比较差异有统计学意义(P<0.05).A组有1例发生严重过敏反应.结论 抑肽酶、乌司他丁加氨甲苯酸和氨甲苯酸均有维持血液纤溶系统稳定、保护血小板功能的作用,从而减少术中及术后出血.     

乌司他丁对心脏瓣膜置换术患者围术期心肌缺血再灌注损伤的保护作用

目的　观察乌司他丁对心脏瓣膜置换术患者围术期心肌缺血再灌注损伤的保护作用。方法　选择择期在体外循环下行瓣膜置换术患者 2 6例 ,随机分为乌司他丁组 (W组 )和对照组 (C组 )。乌司他丁组按 1 2万U·kg-1,于麻醉诱导后劈胸骨前经静脉给予半量 ,另半量加入预充液中 ,经转机进入体内。对照组用等量复方氯化钠代替。分别于诱导后切皮前 (T1) ,转流 2 0min(T2 ) ,主动脉开放 3 0min(T3 ) ,术毕 4h(T4) ,术毕 2 4h(T5)抽取动脉血 ,测定HCT ,测定血浆CK -MB、、CK活性及cTnI浓度。记录CPB转流时间 ,主动脉阻断时间 ,手术时间及术后复跳情况。结果　与T1相比 ,两组患者CK、CK -MB、cTnI在T3 、T4、T5均明显升高 (P<0 0 5 ) ,其中CK -MB、cTnI均在T4达最高值 ,T5开始下降。两组患者之间CK、CK -MB、cTnI在T1、T2 时无明显差别 ,C组的CK、CK-MB在T5明显高于W组 (P <0 0 5 ) ,cTnI在T3 、T4、T5明显高于W组 (P <0 0 5 )。结论　围体外循环期间使用乌司他丁对心肌缺血再灌注损伤有保护作用。     

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.