线粒体DNA拷贝数与相关因素的交互作用对煤矿工人高血压的影响

目的 探讨煤矿工人线粒体DNA（mtDNA）拷贝数与相关因素对高血压的影响及其交互作用。方法 采用病例对照研究设计,选取大同煤矿集团中378例患有高血压病的煤矿工人作为病例组,非高血压煤矿工人325例作为对照组。通过问卷调查收集研究对象基本情况、生活饮食习惯等信息,采用荧光定量PCR方法对外周血mtDNA进行扩增,定量分析mtDNA拷贝数的变异情况,采用logistic回归模型分析高血压的相关影响因素,并进行交互作用分析。结果 相对于mtDNA拷贝数0～5.67组,具有较高水平的mtDNA拷贝数者高血压患病风险较低,但差异无统计学意义（P=0.414）。饮酒（OR=1.80,95% CI：1.26～2.56）、高血压家族史（OR=1.74,95% CI：1.20～2.50）、倒班（OR=0.69,95% CI：0.48～0.99）、文化程度（P=0.012）和家庭收入（P<0.001）是高血压患病的相关因素。构建mtDNA拷贝数与相关因素的交互作用项,分析结果显示,饮酒与mtDNA拷贝数、高血压家族史与mtDNA拷贝数、家庭收入与mtDNA拷贝数存在相乘的交互作用。饮酒是高血压患病的危险因素［1.77（1.25～2.50）］,mtDNA高拷贝数与其交互作用使高血压患病风险降低（交互作用OR=1.20,95% CI：1.07～1.35）;高血压家族史是患高血压病的危险因素［1.81（1.26～2.59）］,mtDNA高拷贝数与其交互作用使患高血压患病风险降低（交互作用OR=1.24,95% CI：1.09～1.41）;家庭收入是高血压的保护因素［0.55（0.46～0.66）］,mtDNA高拷贝数与其交互作用使其对高血压患病的保护作用减弱（交互作用OR=0.90,95% CI：0.86～0.94）。结论 不同mtDNA拷贝数的研究对象高血压患病风险无统计学意义,但mtDNA高拷贝数与饮酒、家庭收入、高血压家族史之间的相乘交互作用使后三者对高血压的影响降低。     

饮酒与男性肺癌发病关系的前瞻性队列研究

目的 研究我国男性饮酒与肺癌发病风险之间的关联。方法 对开滦集团队列（2006－2015年）男性人群每两年随访一次,收集饮酒相关信息及肺癌发病资料;此外,检索开滦附属医院医疗信息系统、开滦集团社保系统、唐山市医疗保险系统,补充收集随访过程中可能遗漏的肺癌新发病例。以不饮酒人群为参比组,利用Cox风险比例回归模型分别分析饮酒频率、饮酒类型与男性肺癌发病风险的关联,计算发病风险比（HR）及其95% CI。按照吸烟状况对研究人群分层,分别分析从不吸烟与既往吸烟/现在吸烟人群中饮酒与肺癌发病的关联。结果 共纳入101 751名男性,总随访808 146.56人年,中位随访时间8.88年,共收集肺癌新发病例913名。调整年龄、吸烟状态、吸烟量、文化程度、粉尘暴露、BMI等潜在的混杂因素后,既往饮酒、现在饮酒频率<1次/d、现在饮酒频率≥1次/d人群肺癌发病风险HR值（95% CI）分别为1.30（0.90～1.88）、0.80（0.64～1.01）和1.04（0.85～1.27）。饮用啤酒/红酒（HR=0.91,95% CI：0.69～1.20）和饮用白酒（HR=0.99,95% CI：0.83～1.19）与肺癌发病无统计学关联。依据吸烟状况分层分析,所得结果类似。结论 本研究结果尚不支持饮酒与男性肺癌发病风险存在关联。     

血清叶酸与口腔癌发病关联的病例对照研究

  目的   探讨血清叶酸与口腔癌发病的关系。   方法   采用病例对照的研究方法, 收集福建医科大学附属第一医院2010年9月-2018年1月经病理确诊的口腔癌新发病例225例为病例组, 收集同时期社区和医院体检的健康人群225例为对照组。采用非条件Logistic回归分析模型, 分析血清叶酸与口腔癌发病风险的OR及其95% CI值, 并进行分层分析和相乘交互作用分析。   结果   病例组血清叶酸中位数为5.7 ng/ml, 低于对照组的8.2 ng/ml(P < 0.001), 差异有统计学意义; 无论性别、吸烟与否及摄入蔬菜水果的频次多少, 血清叶酸水平与口腔癌的发病风险均存在负相关; 叶酸与性别、吸烟、摄入蔬菜、水果在口腔癌的发生中存在相乘交互作用。   结论   高血清叶酸水平与口腔癌的发病风险呈负相关, 保证适量叶酸摄入、减少烟草消耗和适量增加蔬菜水果可能降低口腔癌的发病风险。     

PNPLA3、TM6SF2基因多态性及其与吸烟、饮酒交互作用对HBV相关肝癌的影响

目的 探讨PNPLA3、TM6SF2基因多态性及其与吸烟、饮酒交互作用对HBV相关肝癌（hepatitis B virus-associated hepatocellular carcinoma,HBV-HCC）的影响。方法 收集2010年1月至2014年3月HBV-HCC患者、慢性乙型肝炎（乙肝）患者（CHB）、肝硬化患者（LC）以及健康体检者的血液标本,应用飞行质谱技术检测patatin样磷脂酶域3（PNPLA3）基因位点rs738409和6号跨膜超家族成员2（TM6SF2）基因位点rs58542926的单核苷酸多态性（SNP）。利用在线SNP stats寻找基因多态性的最优赋值方法;检验SNP是否符合哈-温（H-W）遗传平衡定律;采用多分类logistic回归分析PNPLA3和TM6SF2多态性及吸烟、饮酒因素对HBV-HCC的影响,采用叉生分析和二分类logistic回归分析探讨基因-基因、基因-吸烟、饮酒交互作用对HBV-HCC的影响。结果 H-W遗传平衡检验结果显示,CHB组rs738409位点的基因型频率分布不符合H-W遗传平衡定律（χ²=11.980,P<0.005）,CHB组rs58542926位点、HBV-HCC组和LC组rs738409和rs58542926位点均符合H-W遗传平衡定律;调整年龄、性别的影响后,与健康体检者相比,HBV-HCC组rs58542926突变的OR=1.659,95% CI：1.026~2.684,P=0.039。与CHB组相比,HBV-HCC组饮酒的OR=1.680,95% CI：1.121~2.519,P=0.012。与LC组相比,HBV-HCC组饮酒与吸烟的OR值（95% CI）分别为1.539（1.071~2.213）和1.453（1.005~2.099）。交互作用分析显示,HBV-HCC组与CHB+LC组相比,rs738409与rs58542926交互作用的叉生分析相加模型OR=1.548（U=1.885,P=0.029）,logistic回归相乘模型OR=1.658（P=0.024）;饮酒与rs738409的交互作用叉生分析,饮酒且rs738409突变相加模型OR=1.811（U=1.965,P=0.024）,相乘模型无统计学意义;logistic回归相乘模型吸烟与饮酒的交互作用OR=1.756（P<0.001）。结论 TM6SF2基因突变、吸烟、饮酒是HBV-HCC的危险因素,PNPLA3与TM6SF2基因都突变、饮酒并且吸烟是HBV-HCC的危险因素。PNPLA3的单基因突变可以减弱饮酒对HBV-HCC的危害。     

饮茶、咖啡与口腔鳞状细胞癌发病关系的病例对照研究

目的 探讨经牛奶分层后饮茶、咖啡对口腔鳞状细胞癌（OSCC）发病的影响。方法 采用病例对照研究方法,收集2010年9月至2016年3月经病理确诊的OSCC新发病例593例和同期经性别、年龄频数匹配的医院体检人群及社区健康人群1 128例。应用非条件logistic回归计算咖啡、饮茶及其相关变量与OSCC发病风险的调整OR值及其95% CI,并进行相乘交互作用分析。采用相对超危险度比、归因比和交互作用指数等指标评价相加交互作用。结果 在总调查人群及饮和未饮用牛奶人群中,饮茶均可显著降低OSCC的发病风险,其调整OR值及95%CI分别为0.54（0.41～0.71）、0.47（0.31～0.71）和0.57（0.40～0.81）。进一步分析发现,开始饮茶年龄≥25岁、饮茶浓度适中、饮温茶、饮用绿茶和乌龙茶在以上3个人群中也均有保护作用,且在饮用牛奶人群中各因素的保护作用更明显。此外,随着每日饮茶量的增加、饮茶年限的延长,OSCC发病风险也随之降低（趋势检验均P<0.05）,但未见饮咖啡与OSCC的发病存在关联。饮茶与饮牛奶之间存在相乘交互作用（OR=0.52,95%CI：0.37～0.71）,但未发现两者存在相加交互作用;饮咖啡与饮用牛奶之间不存在相乘及相加交互作用。结论 饮茶是OSCC发病的保护因素,且饮茶与牛奶间存在交互作用,故适量饮茶、增加牛奶的摄入可一定程度降低OSCC的发病风险。     

外周血白细胞AOX1和IRF4基因甲基化与乳腺癌关系的病例对照研究

目的 探讨外周血中醛氧化酶1（AOX1）和干扰素调节因子4（IRF4）基因甲基化及其和相关环境因素的交互作用与乳腺癌发病的关系。方法 采用病例对照研究,选择2010－2014年纳入的401例乳腺癌病例和555例对照作为研究对象,使用高分辨率熔解曲线法检测AOX1和IRF4基因甲基化水平。应用非条件logistic回归分析基因甲基化水平及其和环境因素的相乘交互作用与乳腺癌的关系,采用Excel软件分析其相加交互作用。结果 AOX1非甲基化的个体发生乳腺癌风险是携带AOX1甲基化个体的1.37倍（95% CI：1.02～1.84）。AOX1甲基化与食用菌类（OR=2.06,95% CI：1.12～3.79）和运动（OR=2.18,95% CI：1.16～4.09）存在协同相乘交互作用,均未发现相加交互作用。IRF4非甲基化能够增加乳腺癌发病风险（OR=1.71,95% CI：0.99～7.43）;IRF4甲基化与环境因素无相乘和相加交互作用。结论 AOX1和IRF4非甲基化可能是乳腺癌发生的危险因素。     

microRNA合成通路基因SNP与头颈鳞癌发病风险的关联研究

目的 探讨microRNA合成通路基因单核苷酸多态性（SNP）与头颈鳞癌发病风险的关联。方法 采用病例对照研究设计,纳入年龄（±5岁）、性别频数匹配的576例头颈鳞癌患者和1 552名健康对照。应用Illumina Infinium BeadChip平台检测microRNA合成通路上DICER1、GEMIN3、PIWIL1的8个潜在功能性SNP位点。通过单因素和多因素logistic回归模型分析不同基因型与头颈鳞癌间的关联。结果 PIWIL1 rs1106042（G>A）的等位基因频率在病例组和对照组中的差异有统计学意义（P=0.011）;在调整年龄、性别、吸烟和饮酒等因素后,携带rs1106042 A等位基因的基因型个体发生头颈鳞癌的风险降低（相加模型：aOR=0.73,95% CI：0.57～0.93, P=0.011）;分层分析显示,rs1106042 A等位基因在年龄≥60岁、女性、非吸烟、非饮酒、口腔癌亚组中具有降低肿瘤发病风险的效应（P<0.05）。结论 PIWIL1基因的潜在功能SNP位点可能与中国人群头颈鳞癌的发病风险相关。     

青岛市成年人水果摄入与脑卒中发病关联的前瞻性研究

目的 了解青岛市居民的水果摄入情况,探讨水果摄入与脑卒中发病的关联。方法 利用中国慢性病前瞻性研究项目（CKB）青岛项目点30～79岁调查对象的基线信息和随访获得的脑卒中发病事件,采用Cox比例风险回归模型,评估水果摄入与脑卒中发病风险之间的关联。结果 基线共调查35 509人,男女性别比为1∶1.27,年龄（50.3±10.2）岁。水果摄入频率较高的研究对象更年轻,更多的是女性、文化程度高和家庭收入高的人群（均P<0.05）。本研究随访过程共观察到脑卒中发病事件1 011例,脑卒中发病密度为387.63/10万人年。多因素Cox回归分析结果显示,在调整了相关混杂因素之后,增加水果的摄入频率对脑卒中发病具有保护作用。与几乎不吃水果的研究对象相比,≥4次/周频率组的研究对象脑卒中发病的风险降低了44%（HR=0.56,95% CI：0.50～0.62,P<0.05）,在男性和女性中分别降低了46%（HR=0.54,95% CI：0.46～0.64）和42%（HR=0.58,95% CI：0.52～0.69）（均P<0.05）。进一步调整研究对象的腰围、BMI、SBP和随机血糖,没有改变水果摄入对于脑卒中发病的保护作用。结论 增加水果摄入能降低脑卒中的发病风险,我国居民应增加水果摄入,建立更健康合理的饮食习惯。     

上海市松江地区40岁及以上居民膳食模式对2型糖尿病患病影响的研究

目的 探索上海市松江地区 ≥ 40岁居民的膳食模式与2型糖尿病的关联及作用模式。方法 使用上海市"高峰计划"松江人群队列基线调查得到的资料进行分析,选择符合纳入排除标准的2型糖尿病患者作为病例组,并根据性别、年龄和饮酒情况匹配非糖尿病患者作为对照组;采用因子分析确立研究人群的膳食模式;采用条件logistic回归模型探索不同膳食模式以及膳食模式之间的相乘交互作用与2型糖尿病之间的联系。结果 经因子分析,本研究得到6种膳食模式,分别为肉类模式、甜品杂粮模式、调味品蛋类模式、饮料模式、谷薯类模式和水果蔬菜模式。经单因素和多因素条件logistic回归分析,肉类模式和甜品杂粮模式与2型糖尿病的相关性无统计学意义,而调味品蛋类模式(OR=0.543,95%CI:0.377~0.781)、饮料模式(OR=0.590,95%CI:0.409~0.852)、谷薯类模式(OR=0.592,95%CI:0.414~0.848)和水果蔬菜模式(OR=0.604,95%CI:0.417~0.876)与2型糖尿病的发病风险降低有关。分析膳食模式两两之间的相乘交互作用之后,有3个交互项与2型糖尿病的联系有统计学意义:肉类模式与调味品蛋类模式的相乘交互项与2型糖尿病的发病风险升高有关;谷薯类模式与肉类模式、谷薯类模式与水果蔬菜模式的相乘交互项与2型糖尿病发病风险降低有关。结论 6种膳食模式中谷薯类模式和水果蔬菜模式可能具有预防2型糖尿病的意义。此外,以谷类、薯类为主,搭配适量肉类,减少调味品摄入的膳食模式对降低2型糖尿病的患病风险可能也有积极作用。     

腌腊肉制品摄入及与其他饮食习惯、生活方式的交互作用和结直肠癌发生风险的探讨

目的 探讨腌腊肉制品摄入频次与结直肠癌发生风险之间的关系,并分析腌腊肉制品与饮食因素、生活方式的交互作用在结直肠癌发生中的作用。方法 采用1：1匹配的病例对照研究,应用自行设计的调查问卷收集经组织病理学确诊的400例原发、新发结直肠癌患者及同期400例健康体检者的一般人口学特征及饮食因素、生活方式资料,采用条件logistic回归模型、广义多因子降维法（GMDR）进行分析。结果 多因素条件logistic回归分析显示,与每年食用腌腊肉制品<8次者相比,8～23次者（OR=3.480,95%CI：2.022～5.991）、24～47次者（OR=4.526,95%CI：2.553～8.025）和≥48次者（OR=5.472,95%CI：3.105～9.642）罹患结直肠癌的风险逐步升高;相乘交互作用分析显示,进食腌腊肉制品与辣椒之间存在相乘交互作用（OR=0.379,95%CI ：0.190～0.758）。相加交互作用分析显示,腌腊肉制品与腌泡菜之间存在协同作用;腌腊肉制品与饮茶之间存在拮抗作用。GMDR法分析显示红肉、腌泡菜和腌腊肉制品三因素间可能存在交互作用（P=0.001）。结论 随腌腊肉制品摄入频次的增多,结直肠癌发病危险度逐渐增高。在对结直肠癌的发病影响中,腌泡菜与腌腊肉制品之间可能存在协同作用,经常饮茶、食辣椒与腌腊肉制品可能存在拮抗作用。红肉、腌泡菜和腌腊肉制品三者之间可能存在交互作用,共同影响结直肠癌的发生。     

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.