羟乙基淀粉130/0.4对血液流变学的影响

目的观察新型羟乙基淀粉130／0．4(万汶)对血液流变学的影响。方法选择ASA I -Ⅱ级下肢骨科手术行硬膜外麻醉患者30例,随机分为两组:林格液组(15例)和万汶组(15例)。开放前臂静脉,以15ml／(kg·h)的速度分别持续输注林格液或6％羟乙基淀粉130／0．4 500 ml,在输注前和输注后分别采血行血液流变学检测。结果万汶组输注6％羟乙基淀粉130／0．4后全血高切变率、全血中切变率、全血低切变率、全血还原黏度、红细胞聚集指数、卡松黏度、卡松屈服应力明显低于扩容前和林格液组(P<0．05)。结论6％羟乙基淀粉130／0．4对血液流变学的改善优于林格液。     

醋酸林格液联合琥珀酰明胶用于脓毒症的液体复苏研究

目的 探讨醋酸林格液联合琥珀酰明胶用于脓毒症患者液体复苏的临床意义.方法 将59例脓毒症患者随机分为两组:乳酸林格液+羟乙基淀粉组(A组,27例)和醋酸林格液+琥珀酰明胶组(B组,32例),观察两组液体复苏的效果及期间各项参数指标的变化.结果 两组患者治疗过程中的中心静脉压、平均动脉压和去甲肾上腺素总的用量比较,差异均无统计学意义(P＞0.05).A组患者活化部分凝血活酶时间长于B组[6、24 h分别为(58 4±10)、(74±13)s和(48 ±7)、(54±11)s],纤维蛋白原浓度低于B组[6、24h分别为(3.3±0.8)、(1.6±0.3)g/L和(4.2±1.1)、(2.1 ±0.2)g/L],差异有统计学意义(P＜0.05). A组患者血清乳酸、肌酐、钙水平均高于B组,差异有统计学意义(P＜0.05).第3天两组患者急性生理学与慢性健康状况Ⅲ评分比较.差异无统计学意义(P＞0.05).结论 醋酸林格液联合琥珀酰明胶用于脓毒症患者液体复苏有与乳酸林格液联合羟乙基淀粉相似的效果,但对于凝血功能、血清乳酸水平、肾功能的影响更少,可能更适用于脓毒症患者的液体复苏,但更容易发生低钙血症,也没有可以改善脓毒症患者预后的证据.     

羟乙基淀粉130/0.4与琥珀酰明胶术前急性扩容对凝血功能的影响

目的对比羟乙基淀粉130/0.4(万汶)和琥珀酰明胶(佳乐施)术前急性扩容对手术患者凝血功能的影响。方法50例下腹部或下肢手术患者,随机分为乳酸林格液组(对照组,15例)、万汶组(20例)和佳乐施组(15例),术前分别用相应液体15ml/kg,30min内输完,在扩容前及扩容后即刻采取静脉血样,采用血栓弹力图测定凝血R时间、K时间、α角、MA等值,同时测定各时点的血红蛋白(Hb)、红细胞压积(Hct)、凝血酶原时间(PT)、国际标准化比值(INR)及活化部分凝血活酶时间(APTT),记录平均动脉压(MAP)和脉搏(HR)。结果扩容后三组R时间、K时间、α角、MA、Hb、Hct、APTT、MAP及HR差异均无统计学意义(P>0.05),万汶组和佳乐施组扩容后PT较扩容前均明显延长(P<0.05),佳乐施组扩容后PT高于对照组(P<0.05),对照组和万汶组扩容后INR明显低于佳乐施组(P<0.05)。结论万汶和佳乐施术前急性扩容对手术患者凝血功能影响较小,但前者优于后者。     

慢性汞中毒对凝血及纤溶系统的影响

目的探究慢性汞中毒对凝血、纤溶系统的影响及其可能的机制。方法采用病例对照及自身病例对照研究方法,采用酶联免疫吸附双抗体夹心法测定血栓调节蛋白(TM)、组织纤溶酶原激活物(t-PA)、组织纤溶酶原激活物抑制物(PAI)含量,并检测白细胞介素(IL)-13、IL-18、血管内皮细胞黏附因子(SICAM-1),采用酶化学法检测超氧化物歧化酶(SOD)活力和脂质过氧化产物(LPO)含量。结果慢性汞中毒患者治疗前TM[(2.36±0.16)ng/ml]较空白对照组[(4.36±0.24)ng/ml]明显降低,差异有统计学意义(P<0.01),经过治疗后,TM明显增高[(4.82±0.34)ng/ml],与治疗前的差异有统计学意义(P<0.05);慢性汞中毒患者t-PA[(3.44±0.34)ng/ml]较空白对照组[(4.52±0.16)ng/ml]明显降低,经过治疗后明显升高[(5.63±0.58)ng/ml],差异均有统计学意义(P<0.05);而PAI则较空白对照组明显升高,分别为(48.23±3.59)、(31.59±2.13)ng/ml,差异有统计学意义(P<0.05),治疗后与治疗前的差异无统计学意义(P>0.05)。慢性汞中毒患者SOD活力[(953.85±9.56)U/g Hb]较空白对照组[(1308.75±10.21)U/g Hb]明显降低,经过治疗后活力[(1217.95±6.29)U/g Hb]明显升高,差异均有统计学意义(P<0.05、P<0.01)。同时表现为LPO明显增加。慢性汞中毒患者IL-13、IL-18、SICAM-1较空白对照组明显升高,差异均有统计学意义(P<0.05、P<0.01),而治疗后与治疗前的差异无统计学意义(P>0.05)。结论慢性汞中毒可能导致患者TM/PC系统、t-PA/PAI系统失衡(抗凝血功能下降,纤溶系统功能抑制)而使机体处于继发性高凝血状态。     

碳酸氢钠林格液在创伤性肝脾破裂伴失血性休克早期复苏中对炎症因子及乳酸水平的影响

目的 探讨碳酸氢钠林格液在创伤性肝脾破裂伴失血性休克患者进行限制性复苏对炎症因子及乳酸水平的影响。方法 收集就诊于六安市人民医院急诊科60例创伤性肝脾破裂伴失血性休克病人,采用随机数据表法分为对照组和观察组,各30例。两组均采用限制性液体复苏,分别用乳酸钠林格液和碳酸氢钠林格液对两组进行复苏。在复苏前、复苏1 h后检测患者静脉血清中IL-6、TNF-α水平以及动脉血的乳酸值。结果 观察组IL-6、TNF-α水平在复苏1 h后均较复苏前明显下降,差异具有统计学意义（P<0.01）,而对照组复苏1 h后IL-6、TNF-α水平较复苏前升高,差异具有统计学意义（P<0.01）。复苏1 h后,观察组中IL-6和TNF-α水平明显低于对照组,差异具有统计学意义（P<0.01）。复苏1 h后,观察组乳酸水平显著低于对照组,差异具有统计学意义（P<0.01）;在观察组中复苏1h后乳酸水平明显下降,差异具有统计学意义,对照组在复苏前后比较差异不明显（P>0.05）。结论 应用碳酸氢钠林格液能更好地抑制创伤性肝脾破裂伴失血性休克患者外周血中炎症因子的表达,并且能够有效的纠正...     

MCP-1的变化与蛋白尿的关系及其在儿童IgA肾病中的作用

目的:探讨血液、尿液单核细胞趋化蛋白-1(MCP-1)的含量变化与蛋白尿的关系及其在儿童IgA肾病中的作用。方法:根据24 h尿蛋白定量将2008年1月～2011年10月收治的33例IgA肾病儿童分为大量蛋白尿组(>1.5 g)22例和小量蛋白尿组(≤1.5 g)11例,另外选取同期健康儿童50例作为正常对照组。采用ELISA法测定所有儿童血液和尿液MCP-1,对MCP-1与24 h尿蛋白定量、血肌酐、血尿β2微球蛋白以及肾脏病理分级的相关性进行分析。结果:大量蛋白尿组、小量蛋白尿组和正常对照组尿液MCP-1含量分别为(138.8±58.5)pg/ml、(76.4±36.2)pg/ml、(22.6±12.1)pg/ml,血液MCP-1含量分别为(23.9±5.1)pg/ml、(19.6±4.2)pg/ml、(17.6±2.5)pg/ml,尿液MCP-1含量两两比较,差异均有统计学意义(P<0.05),血液MCP-1含量三组比较差异均无统计学意义(P>0.05)。结论:MCP-1可能在儿童IgA肾病的病理损害中发挥重要作用,尿液MCP-1可作为评价IgA肾病肾功能的一项辅助指标。     

失血性休克限制性液体复苏的疗效评价

目的探讨限制性液体复苏方法对创伤性失血性休克病人的治疗结果,以提高治愈率。方法40例创伤性失血性休克病人随机分成常规液体复苏(常规)组(21例)、限制性液体复苏(限制)组(19例)。常规组在止血前早期、快速、足量补液,维持收缩压≥90mmHg(1mmHg=0.133kPa),限制组在止血前限制液体输入,维持平均动脉压(MAP)在6.65kPa,止血后输血输液。止血后两组维持MAP在9.31~10.64kPa。比较两组患者的平均输液量、治愈率。结果常规组死亡3例,治愈率85.7%;限制组无死亡,治愈率100%。两组治愈率比较差异有统计学意义(P<0.05)。平均输液量常规组为(2950±525)ml,限制组为(2050±360)ml,两组比较差异有统计学意义(P<0.05)。结论限制性液体复苏能避免过分扰乱机体的代偿机制和内环境,改善脏器灌注和氧供,显著降低了创伤性失血性休克病人的早期和后期病死率,改善预后。     

米索前列醇预防选择性剖宫产产后出血的临床观察

目的探讨舌下含服米索前列醇预防剖宫产产后出血的效果。方法将妊娠晚期单胎选择性剖宫产者180例随机分为三组,为组1、组2和组3,分别用米索前列醇配合催产素,单用催产素和单用米索前列醇。观察术中及产后2 h内平均出血量和用药前后收缩压、舒张压、平均动脉压及产前产后血红蛋白的变化。结果术中及术后2 h内平均出血量,组1、组2和组3分别为(185.3±50.7)ml和(203.2±53.7)ml、(267.2±49.1)ml和(324.8±60.3)ml(、256.8±46.4)ml和(320.3±57.4)ml。组1与组2及组3比较差异有统计学意义(P<0.05)。组2与组3比较差异无统计学意义(P>0.05)。比较用米索前列醇前后,三组收缩压、舒张压、平均动脉压变化差异无统计学意义(P>0.05)。三组术前、术后血红蛋白差异无统计学意义(P>0.05)。结论舌下含服米索前列醇促进子宫收缩作用与催产素相似,配合催产素可更有效地减少和预防产后出血。对于血压无影响可用于有心血管变化的高危产妇。     

霍姆复合液对创伤性休克兔凝血功能及血清钙的影响

目的探讨霍姆复合液对创伤性休克兔限制性液体复苏过程中凝血功能及Ca2+的影响。方法健康新西兰白兔54只,随机分成生理盐水组(NS)、霍姆复合液组(HHS)、2∶1晶胶复合液组(NHS)共三组,每组各18只,分别于休克时(T_0),休克后30 min(T_1)、60 min(T_2)、90 min(T_3),测量凝血酶原(PT)、部分凝血活酶时间(APTT)、纤维蛋白原含量(Fbg)、凝血酶时间(TT)、国际标准化比率(INR)及血钙浓度,分析凝血功能及血钙水平的变化。结果三组液体复苏后PT与T0时间相比P0.05,差异有统计学意义;三组液体复苏后APTT与T_0时间APTT相比均P0.05,差异有统计学意义;三组液体复苏后Fbg在T_1、T_2、T_3时间与T_0时间相比均P0.05,差异有统计学意义;霍姆复合液组较生理盐水组、2∶1晶胶复合液组可明显改善PT、APTT、Fbg水平,差异有统计学意义(P0.05)。结论采用霍姆复合液能明显改善低灌注和凝血功能,对于创伤性休克的复苏具有一定的指导意义。     

有限液体复苏治疗创伤失血性休克的疗效分析

目的探讨有限液体复苏在创伤失血性休克中的应用效果。方法选择2011年1月至2013年12月我院收治的48例创伤合并活动性失血性休克患者,按随机表随机分为有限复苏组和传统复苏组各24例。所有患者均进行液体复苏,有限复苏组使收缩压上升至80 mm Hg,传统复苏组收缩压上升至90 mm Hg,并分别维持该血压水平。比较两组液体输入量、输血量、血红蛋白含量、急性肾功能衰竭发生率和死亡率。结果与传统复苏组相比,有限复苏组的总输液量、红细胞输入量较少,住院费用较低,差异有统计学意义(P<0.05),住院期间两组患者中急性肾功能衰竭的发生率和死亡率差异无统计学意义(P>0.05)。结论对于失血性休克,在有效止血前先进行有限液体复苏,维持收缩压在80 mm Hg即可。     

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.