北京市冬季住宅内PM_(2.5)暴露水平及室内外关系的研究

目的研究自然通风条件下大规模人群的住宅内PM_(2.5)浓度水平,探讨PM_(2.5)浓度的室内外关系,为评估室内PM_(2.5)暴露提供重要数据支撑和新的研究思路。方法于2013年12月1日—2014年2月28日(2013—2014冬季)在北京市某区开展大规模人群的时间-活动模式和空气污染暴露影响因素调查,基于调查数据及PM_(2.5)空气动力学特性建立住宅内PM_(2.5)的质量平衡模型,利用环境监测站点PM_(2.5)监测数据模拟住宅内PM_(2.5)浓度,计算室内外PM_(2.5)浓度比(I/O),并探讨PM_(2.5)室内外关系。结果本研究1 092个样本2013—2014冬季住宅内PM_(2.5)浓度范围为26~167μg/m~3,PM_(2.5)浓度的中位数为73μg/m~3,四分位数间距为34μg/m~3。室外PM_(2.5)浓度范围分别为0~33μg/m~3、34~65μg/m~3、66~129μg/m~3、≥130μg/m~3时,PM_(2.5)浓度I/O分别为1.75、1.05、0.76和0.63;随着室外PM_(2.5)浓度的增加,I/O呈减小趋势,且分布趋于集中。结论基于大规模人群的时间-活动模式和空气污染暴露影响因素调查建立质量平衡模型,可实现大规模人群室内PM_(2.5)浓度的连续模拟。     

Personal PM2.5 and CO exposures and heart rate variability in subjects with known ischemic heart disease in Mexico City

Cardiovascular diseases are the main cause of death in Mexico City and have shown a rising trend over the past 20 years. Various epidemiological studies have reported an association between respirable particles and carbon monoxide (CO), with cardiorespiratory outcomes. The purpose of this study was to assess the effect of particulate matter with aerodynamic diameters of less than 2.5 microm (PM(2.5)), also known as respirable or fine particles and CO on heart rate variability (HRV) in 5-min periods in patients with known ischemic heart disease. 30 patients were selected from the outpatient clinic of the National Institute of Cardiology of Mexico and followed during 11 h, using electrocardiography (ECG) ambulatory electrocardiograms and personal monitors for CO and PM(2.5). We calculated frequency-domain measurements using power spectral analysis and assessed the association with pollutants using mixed models analysis in 5-min periods. We found a decrease in HRV measured as high frequency (Ln) (coefficient=-0.008, 95% confidence interval (CI), -0.015, 0.0004) for each 10 microg/m(3) (micrograms per cubic meter) increase of personal PM(2.5) exposure. We also found a decrease of low (ln) (coefficient=-0.024, 95% CI, -0.041, -0.007) and very low frequencies (ln) (coefficient=-0.034, 95% CI, -0.061, -0.007) for 1 parts per million (p.p.m.) increase in CO personal exposure after adjustment for potential confounding factors. These results show that for this high-risk population, the alteration of the cardiac autonomic regulation was significantly associated with both PM(2.5) and CO personal exposures.     

Spatial analysis of MODIS aerosol optical depth, PM2.5, and chronic coronary heart disease

Background  

Numerous studies have found adverse health effects of acute and chronic exposure to fine particulate matter (PM_2.5). Air pollution epidemiological studies relying on ground measurements provided by monitoring networks are often limited by sparse and unbalanced spatial distribution of the monitors. Studies have found correlations between satellite aerosol optical depth (AOD) and PM_2.5 in some land regions. Satellite aerosol data may be used to extend the spatial coverage of PM_2.5 exposure assessment. This study was to investigate correlation between PM_2.5 and AOD in the conterminous USA, to derive a spatially complete PM_2.5 surface by merging satellite AOD data and ground measurements based on the potential correlation, and to examine if there is an association of coronary heart disease with PM_2.5.     

室内外PM_(2.5)污染水平对慢性阻塞性肺疾病患者呼出气炎症指标的影响

目的探讨冬季室内外PM_(2.5)污染水平对慢性阻塞性肺疾病(简称慢阻肺)患者呼出气炎症指标的影响。方法以18名某三甲医院诊断的稳定期慢阻肺患者为研究对象,于2014年1月2日—2月18日,对研究对象室内PM_(2.5)水平进行实时监测,同步收集研究对象居室附近北京市固定监测点PM_(2.5)、气温和相对湿度数据,并采集研究对象呼出气一氧化氮(e NO)和呼出气硫化氢(e H2S)样品,采用Spearman相关分析和多元线性回归分析探讨室内外PM_(2.5)对研究对象呼出气指标的影响。结果调查地区冬季室内、外PM_(2.5)污染水平较高,x±s分别为(94.09±46.87)μg/m3和(119.27±54.78)μg/m3。室外PM_(2.5)暴露与e NO呈正相关关系(rs=0.311,P0.05),PM_(2.5)每上升1个四分位数间距(74.80μg/m3),可使e NO增加13.13μg/m3(P0.05),控制室外气温和相对湿度后,该相关关系仍然存在。未观察到室内PM_(2.5)与e NO以及室内、外PM_(2.5)与e H2S的相关关系。结论本次调查地区的冬季室内、外PM_(2.5)污染严重,室外PM_(2.5)可对慢阻肺患者e NO产生影响。     

经皮冠状动脉介入治疗和衰弱对老年冠心病患者不良预后的交互作用

目的  探讨经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)和衰弱对老年冠心病患者近期死亡率以及心源性再住院率的交互作用。方法  选取池州市人民医院2018年4月1日至2019年11月30日期间在心血管内科住院的老年冠心病患者作为研究对象,收集患者的临床资料,使用衰弱量表对每位患者进行衰弱评估。随访患者出院后的全因死亡情况和心源性再住院情况。采用Kaplan-Meier法生存分析、χ²检验、t检验进行数据分析。结果  共计273例住院老年冠心病患者纳入研究,76例符合衰弱标准,占比27.84%,160例行PCI,占比58.61%。衰弱相对于非衰弱发生死亡的比例增大到2.77(95% CI：1.41~7.04)倍、发生全因死亡/心源性再住院增大到2.73(95% CI：1.90~3.93)倍。其中,在PCI患者中,衰弱相对于非衰弱组发生死亡和全因死亡/心源性再住院的RR值分别增加到3.02(95% CI：1.32~6.93)和2.96(95% CI：1.89~4.62)。Kaplan-Meier法生存分析的结果显示,衰弱组患者随访期间全因死亡率、全因死亡/心源性再住院率高于非衰弱组(均有P＜0.05)。然而,在非PCI患者中,衰弱组患者随访期间全因死亡率与非衰弱组的差异无统计学意义(χ²=1.95, P=0.163)。结论  PCI增加了衰弱对老年冠心病患者的近期不良预后的发生风险,PCI与衰弱对老年冠心病患者的不良预后可能存在交互作用。     

Cholesterol-based personal risk assessment in coronary heart disease

Using data from the National Health and Nutrition Examination Survey (NHANES II) 1976-1980, we demonstrate how cross-sectional total serum cholesterol surveillance data can be used by an individual to assess current and future personal cholesterol risk status. We propose statistical models, based on a person's current measured cholesterol level and the relationship between cross-sectional age and cholesterol percentile estimates, that will allow prediction of future cholesterol levels or the age at which specified cholesterol risk levels will be reached if no cholesterol-altering intervention is taken. These models incorporate the observed variation in the NHANES II data and expected intraperson biological variation and intralaboratory analytical variation. We illustrate the adequacy of the models using data from the longitudinal Framingham Study.     

Influence of ambient (outdoor) sources on residential indoor and personal PM2.5 concentrations: analyses of RIOPA data

The Relationship of Indoor, Outdoor and Personal Air (RIOPA) study was designed to investigate residential indoor, outdoor and personal exposures to several classes of air pollutants, including volatile organic compounds, carbonyls and fine particles (PM2.5). Samples were collected from summer, 1999 to spring, 2001 in Houston (TX), Los Angeles (CA) and Elizabeth (NJ). Indoor, outdoor and personal PM2.5 samples were collected at 212 nonsmoking residences, 162 of which were sampled twice. Some homes were chosen due to close proximity to ambient sources of one or more target analytes, while others were farther from sources. Median indoor, outdoor and personal PM2.5 mass concentrations for these three sites were 14.4, 15.5 and 31.4 microg/m3, respectively. The contributions of ambient (outdoor) and nonambient sources to indoor and personal concentrations were quantified using a single compartment box model with measured air exchange rate and a random component superposition (RCS) statistical model. The median contribution of ambient sources to indoor PM2.5 concentrations using the mass balance approach was estimated to be 56% for all study homes (63%, 52% and 33% for California, New Jersey and Texas study homes, respectively). Reasonable variations in model assumptions alter median ambient contributions by less than 20%. The mean of the distribution of ambient contributions across study homes agreed well for the mass balance and RCS models, but the distribution was somewhat broader when calculated using the mass balance model with measured air exchange rates.     

Public health burden of coronary heart disease risk factors among middle-aged and elderly men

BACKGROUND: An epidemiological evidence shows that smoking, high total cholesterol, hypertension, overweight, and a low level of physical activity are significant risk factors for coronary heart disease mortality. Therefore, by turning these risk factors in a healthier direction, presumably a substantial proportion of the deaths would be preventable. METHODS: The avoidable proportion of coronary heart disease deaths associated with smoking, a high level of total cholesterol, systolic hypertension, overweight, and a low level of leisure-time physical activity was assessed with the use of the population attributable risks for initially 30- to 63-year-old Finnish men (six studies with 1,340-7,928 subjects) who were followed up from 7 to 30 years. RESULTS: The theoretical estimates of population at tributable risks derived from published studies were as follows: smoking 10 to 33%; high total cholesterol 9 to 21%; hypertension 6 to 15%; overweight 3 to 6%; and low level of leisure-time physical activity 22 to 39%. CONCLUSIONS: These estimations, based on observed mortality rates and risk factor prevalences, suggest that, even if modest estimates are used, the burden from coronary heart disease deaths can be substantially reduced by converting the risk factors to more healthful levels. The results also suggest that efforts to increase physical activity deserve as much consideration as those aimed at influencing more traditional risk factors.     

Particulate matter measurements PM2.5 and PM10 in Rome: comparison indoor/outdoor

The concentration of airborne particulate matter (PM2.5 and PM10) was assessed over 12 months (1999-2000) both outdoor and indoor (workplaces and homes without major PM sources) through a manual gravimetric method. Mean concentration values outdoors were moderately lower than indoor concentrations in summer, but higher in winter. The correlations between outdoor and indoor values are statistically significant, especially for PM2.5 in winter. The position of indoor sites with respect to street level was immaterial as far as mean values is concerned, whilst maximum values presented some differences accordingly. Day-to-day variability was higher outside than inside, especially in winter. The PM2.5/PM10 ratio was higher indoors, probably owing to the higher sedimentation speed of the coarse fraction.     

Exposure to fine particles (PM2.5 and PM1) and black smoke in the general population: personal, indoor, and outdoor levels

Personal exposure to PM(2.5) and PM(1), together with indoor and residential outdoor levels, was measured in the general adult population (30 subjects, 23-51 years of age) of Gothenburg, Sweden. Simultaneously, urban background concentrations of PM(2.5) were monitored with an EPA WINS impactor. The 24-h samples were gravimetrically analyzed for mass concentration and black smoke (BS) using a smokestain reflectometer. Median levels of PM(2.5) were 8.4 microg/m(3) (personal), 8.6 microg/m(3) (indoor), 6.4 microg/m(3) (residential outdoor), and 5.6 microg/m(3) (urban background). Personal exposure to PM(1) was 5.4 microg/m(3), while PM(1) indoor and outdoor levels were 6.2 and 5.2 microg/m(3), respectively. In non-smokers, personal exposure to PM(2.5) was significantly higher than were residential outdoor levels. BS absorption coefficients were fairly similar for all microenvironments (0.4-0.5 10(-5) m(-1)). Personal exposure to particulate matter (PM) and BS was well correlated with indoor levels, and there was an acceptable agreement between personal exposure and urban background concentrations for PM(2.5) and BS(2.5) (r(s)=0.61 and 0.65, respectively). PM(1) made up a considerable amount (70-80%) of PM(2.5) in all microenvironments. Levels of BS were higher outdoors than indoors and higher during the fall compared with spring. The correlations between particle mass and BS for both PM(2.5) vs. BS(2.5) and PM(1) versus BS(1) were weak for all microenvironments including personal exposure. The urban background station provided a good estimate of residential outdoor levels of PM(2.5) and BS(2.5) within the city (r(s)=0.90 and 0.77, respectively). Outdoor levels were considerably affected by long-range transported air pollution, which was not found for personal exposure or indoor levels. The within-individual (day-to-day) variability dominated for personal exposure to both PM(2.5) and BS(2.5) in non-smokers.     

Design and validation of a high-flow personal sampler for PM2.5

A high-flow personal sampler (HFPS) for airborne particulate matter has been developed and fully characterised, and validation tests have been carried out. The sampler is a low-cost gravimetric instrument designed to collect particulate matter with a 50% cut point at 2.5 microm aerodynamic equivalent diameter (PM2.5), where size selection is achieved by the use of porous polyurethane foam. Development of a porous foam selector was chosen over a cyclone or impactor due to the lightweight, low-cost, and compact design that could be achieved. The sampler flow rate of 16 1/min is achieved using a portable, flow-controlled pump; this flow rate is far higher than that of conventional personal samplers and the HFPS can therefore be used for personal sampling in the ambient environment over short sampling periods of much less than 24 h. The HFPS is currently being used in a study of particle exposure of urban transport users (cyclists, car drivers, bus and Underground rail passengers) where personal sampling over short time periods representing typical commuter journey times is required. The HFPS was fully characterised in chamber studies with a TSI aerodynamic particle sizer (APS). The sampler was then validated against a co-located U.S. EPA Federal Reference PM2.5 Well Impactor Ninety Six (WINS) and a KTL cyclone, and parallel testing was performed. Initial testing showed some penetration of particles through the porous foam structure; applying an oil coating to the foam eliminated this problem. Chamber testing was carried out on a number of different selector prototypes, with the final design giving a 50% penetration diameter (i.e., d50) of 2.4 microm at 16 1/min. The new sampler exhibited good agreement in three sets of co-located tests with established samplers, and parallel testing showed excellent agreement between paired HFPS samplers.     

室内空气PM2.5颗粒物中24种金属元素ICP-MS测定

目的 建立聚四氟乙烯膜微波消解-电感耦合等离子体质谱法（ICP-MS）同时测定室内空气PM_2.5颗粒物中24种金属元素的方法。方法 选择2013年1月份连续雾霾及2月份春节燃放烟花爆竹期间,于北京市区普通居民室内设定6个监测点,测定室内空气PM_2.5颗粒物中24种金属元素。结果 室内空气PM_2.5颗粒物中24种元素[铍（Be）、钒（V）、铝（Al）、铬（Cr）、锰（Mn）、钴（Co）、镍（Ni）、铜（Cu）、锌（Zn）、砷（As）、硒（Se）、钼（Mo）、银（Ag）、镉（Cd）、锑（Sb）、钡（Ba）、铊（Tl）、铅（Pb）、铀（U）、钠（Na）、镁（Mg）、钾（K）、钙（Ca）、铁（Fe）]浓度中位值分别为晴天0.01～281.40 ng/m³（Be～K）,雾霾天0.01～2 472.00 ng/m³（U～K）,放鞭炮天0.01～6 327.00 ng/m³（U～K）;精密度除Al（17.1%）、Na（20.4%）、Mg（12.8%）外,其余元素在3.4%~8.6%,达到方法学要求。结论 用聚四氟乙烯膜采样,硝酸-氢氟酸-硼酸体系微波消解,电感耦合等离子体质谱法适合测定空气颗粒物中24种金属元素的同时测定。     

老年冠心病患者的健康教育

目的:分析健康教育对冠心病患者的具体影响。方法:对220例冠心病患者进行分组,分为健康教育组110例,对照组110例,通过跟踪、调查、访查,对两组冠心病患者进行评估。结果:两组进行对比,进行健康教育的患者效果较对比组明显。结论:通过对老年冠心病患者实施健康教育,可以有效地提升冠心病患者的生活质量,让他们养成良好的习惯,并有利于病情的控制。     

Effects of fine and ultrafine particles on cardiorespiratory symptoms in elderly subjects with coronary heart disease: the ULTRA study

The ULTRA Study, a study investigating the association between fine and ultrafine particulate air pollution and cardiorespiratory health, was conducted during the winter of 1998-1999 in Amsterdam, the Netherlands; Erfurt, Germany; and Helsinki, Finland. At each study center, a panel of elderly subjects with coronary heart disease recorded cardiac and respiratory symptoms in a diary. Exposure to ambient air pollution was characterized by measuring daily mass concentrations of particles smaller than 10 micro m (PM(10)) and 2.5 micro m (PM(2.5)), number concentrations of ultrafine particles (NC(0.01-0.1)), and gases. Odds ratios for the relation of symptoms to air pollution, adjusted for time trend, respiratory infections, and meteorologic variables, were mostly homogeneous across the centers. No association was found between air pollution and chest pain. A 10- micro g/m(3) increase in PM(2.5) was positively associated with the incidence of shortness of breath (odds ratio (OR) = 1.12, 95% confidence interval (CI): 1.02, 1.24) and with avoidance of activities (OR = 1.09, 95% CI: 0.97, 1.22). NC(0.01-0.1) was only associated with the prevalence of avoidance of activities (OR = 1.10, 95% CI: 1.01, 1.19). In conclusion, PM(2.5) was associated with some cardiac symptoms in three panels of elderly subjects. PM(2.5 )was more strongly related to cardiorespiratory symptoms than ultrafine particles were.     

深圳市某区中小学教室可吸入颗粒物现况评价

目的了解深圳市某区中小学教室空气可吸入颗粒物状况,为改善中小学教学环境卫生状况提供科学依据。方法分层抽取深圳市某区19所中小学114个教室,采用DUSTMATE环境粉尘仪对PM 10,PM 2.5,PM 1.0进行检测。结果 PM 10最大值为0.418mg/m3,超出国家标准1.79倍;PM 2.5最大值为0.142 mg/m3,超出美国EPA新标准3.06倍;PM 1.0最大值为0.056 mg/m3。工业区中小学教室PM 10,PM 2.5,PM 1.0含量高于商业区和居民区,差异均有统计学意义(P值均<0.05)。小学教室PM 10、PM 2.5合格率均高于中学教室;教室PM 10,PM 2.5含量随着楼层增加而下降,差异均有统计学意义(P值均<0.05)。结论深圳市某区中小学教室颗粒物PM 10,PM 2.5,PM 1.0污染情况严重,应引起高度重视并采取综合控制措施。     

不同出行方式PM_(2.5)个体暴露水平的比较研究

目的在不同浓度大气PM_(2.5)水平下,比较不同出行方式的PM_(2.5)个体暴露水平,并进一步比较地铁站不同位置的PM_(2.5)浓度,以期为城市居民选择适宜的出行方式提供科学依据。方法于2015年12月30日至2016年1月4日,选择北京市城区的某条路线作为研究地点,使用便携式PM_(2.5)监测仪同时测量步行、乘坐公交车和地铁3种出行方式的PM_(2.5)个体暴露水平;对地铁站台、安检处和地铁车厢内的PM_(2.5)浓度进行同步监测并比较。结果在同一研究时期,步行、乘坐公交车和地铁测得的PM_(2.5)个体暴露浓度均值分别为219.34、209.61、167.56μg/m3。当大气PM_(2.5)浓度较低时(≤60μg/m3),乘坐地铁的PM_(2.5)个体暴露水平高于步行和乘坐公交车;当大气PM_(2.5)浓度较高时(100μg/m3),乘坐地铁的个体PM_(2.5)暴露水平明显低于步行和公交车,差异均有统计学意义(P0.05)。监测期间地铁站台、安检处和车厢内的PM_(2.5)浓度均值分别为196.90、170.20、136.82μg/m3。结论在不同的大气PM_(2.5)污染水平下,不同出行方式的人群PM_(2.5)个体暴露水平不同。     

老年人肺心病合并冠心病临床治疗方法及效果分析

目的分析老年人肺心病合并冠心病临床治疗方法及效果。方法随机将我院收治的60例老年人肺心病合并冠心病患者分为对照组和观察组,临床对对照组患者主要采用常规个体化治疗,而观察组患者在对照组治疗的基础上给予冠心宁注射液治疗,并观察两组患者治疗效果。结果观察组治疗总有效率达到90.0%,明显高于对照组73.33%,两组比较（χ^2=3.968,P〈0.05）,差异具有统计学意义,同时观察组患者不良反应发生率为10.0%;对照组不良反应发生率6.67%,两组不良反应发生率无明显差异（χ^2=0.000,P=1.000）,不具统计学意义。结论临床对老年肺心病合并冠心病患者实施常规个体化联合冠心宁注射液治疗效果显著,不良反应少,值得临床推广使用。     

The relationships between personal PM exposures for elderly populations and indoor and outdoor concentrations for three retirement center scenarios.

Personal exposures, indoor and outdoor concentrations, and questionnaire data were collected in three retirement center settings, supporting broader particulate matter (PM)--health studies of elderly populations. The studies varied geographically and temporally, with populations studied in Baltimore, MD in the summer of 1998, and Fresno, CA in the winter and spring of 1999. The sequential nature of the studies and the relatively rapid review of the mass concentration data after each segment provided the opportunity to modify the experimental designs, including the information collected from activity diary and baseline questionnaires and influencing factors (e.g., heating, ventilation, and air-conditioning (HVAC) system operation, door and window openings, air exchange rate) measurements. This paper highlights both PM2.5 and PM10 personal exposure data and interrelationships across the three retirement center settings, and identifies the most probable influencing factors. The current limited availability of questionnaire results, and chemical speciation data beyond mass concentration for these studies, provided only limited capability to estimate personal exposures from models and apportion the personal exposure collections to their sources. The mean personal PM2.5 exposures for the elderly in three retirement centers were found to be consistently higher than the paired apartment concentrations by 50% to 68%, even though different facility types and geographic locations were represented. Mean personal-to-outdoor ratios were found to 0.70, 0.82, and 1.10, and appeared to be influenced by the time doors and windows were open and aggressive particle removal by the HVAC systems. Essentially identical computed mean PM2.5 personal clouds of 3 micrograms/m3 were determined for two of the studies. The proposed significant contributing factors to these personal clouds were resuspended particles from carpeting, collection of body dander and clothing fibers, personal proximity to open doors and windows, and elevated PM levels in nonapartment indoor microenvironments.     

老年冠心病患者医院感染的相关因素分析

目的探讨高龄冠心病患者医院感染的相关影响因素,为其临床预防与治疗提供指导意义。方法回顾性分析医院心内科2012年1月-2013年9月收治入院的625例老年冠心病患者临床资料,对其医院感染的相关危险因素进行分析。结果 625例老年冠心病患者中发生医院感染96例,感染率为15.4%;单因素分析显示,年龄≥80岁、有吸烟史、糖尿病、住院时间≥30d、心功能Ⅲ^Ⅳ级、有侵入性操作的患者感染率分别为20.3%、21.0%、23.4%、23.9%、25.1%、22.8%,与其他组比较差异有统计学意义(P<0.05);多因素logistic回归分析显示,年龄大、有吸烟史、有糖尿病、住院时间长、心功能ⅢⅣ级、有侵入性操作的患者感染率分别为20.3%、21.0%、23.4%、23.9%、25.1%、22.8%,与其他组比较差异有统计学意义(P<0.05);多因素logistic回归分析显示,年龄大、有吸烟史、有糖尿病、住院时间长、心功能Ⅲ^Ⅳ级、侵入性操作是影响老年冠心病患者医院感染的独立因素(P<0.05)。结论老年冠心病患者易发生医院感染,其医院感染的危险因素较多、较复杂,临床应采取有效措施,以降低医院感染率。