肥胖人群糖脂代谢、体脂水平与胰岛素抵抗的关系

目的观察肥胖人群糖脂代谢、体脂水平与胰岛素抵抗的关系。方法将社区人群中体重指数(BMI)>25kg/m2者96例纳入本研究,测量血压、身高、体重、腰围、臀围、体脂含量及重量,并抽血检测空腹及口服75g葡萄糖2h后血糖(FBS,2hPBS)、胰岛素水平(Fins,2hIns),采用稳态模型评估法(HO-MA)中的HOMA-IR公式评价胰岛素抵抗程度;空腹检测血脂、尿酸及糖化血红蛋白(HbAlc)水平。结果①本组肥胖人群64.0%存在胰岛素抵抗,糖、脂代谢异常,高血压和高尿酸血症者分别为31.2%、74.4%、44.8%及43.2%;②存在糖代谢异常者HOMA-IR和(或)2hIns、WHR、TG高于糖代谢正常组;血脂或尿酸水平异常者WHR大于正常组;高血压组HDL水平低于血压正常组;胰岛素抵抗组WHR、体脂重量、体脂含量、FBS、TC及BMI高于非胰岛素抵抗组;③HOMA-IR指数与体脂重量和TG呈正相关(r=0.448,p=0.000;r=0.411,p=0.000)。结论本组肥胖人群存在糖脂代谢异常、体脂水平增高及胰岛素抵抗,对于肥胖患者应尽早进行相关代谢指标的筛查。     

2型糖尿病患者瘦素水平及其相关因素分析

目的　研究 2型糖尿病患者血清瘦素与性别、体重指数 (BMI)、腰臀比 (WHR)、胰岛素、血糖、总胆固醇和甘油三脂的关系。方法　随机选取 5 6例 2型糖尿病患者与 2 2例非糖尿病者 ,分别测定入选对象的体重指数、腰臀比值 (WHR)、空腹瘦素、空腹和餐后 2h血糖、总胆固醇和甘油三脂。结果　血清平均瘦素水平男性 ( 8 5± 0 9)ug/L ,女性 ( 17 2± 1 1)ug/L ,女性明显高于男性 ,血清瘦素与BMI呈显著正相关 (γ =0 64 ,P <0 0 1) ,与男性WHR显著正相关 (γ =0 5 0 ,P <0 0 1) ,血清瘦素与胰岛素显著正相关(空腹γ =0 3 6,P <0 0 1,餐后 2hγ =0 3 4,P <0 0 1) ,瘦素与血糖、血脂没有相关性。结论　血清瘦素浓度与BMI、男性WHR显著正相关 ,与胰岛素有显著正相关性。     

2型糖尿病合并非酒精性脂肪肝患者脂联素与胰岛素抵抗关系的研究

目的 探讨2型糖尿病(T2DM)合并非洒精性脂肪肝(NAFLD)血清脂联素与胰岛素抵抗的关系.方法 选取30例T2DM合并NAFLD患者(观察1组)、30例T2DM无NAFLD患者(观察2组)和30例健康体检者(对照组),测定三组的身高、体重、腰围、臀围、血压、空腹血糖、血脂、空腹胰岛素和脂联素水平,计算体重指数、腰臀比和胰岛素抵抗指数(HOMA-IR).结果 观察1组BMI、WHR、血清脂联素、SBP、DBP、FBG、FINS、TG、TC、HOMA-IR明显高于对照组;观察1组BMI、WHR、血清脂联素、FINS、TG、HOMA-IR明显高于观察2组;BMI、WHR、TG、脂联素与T2DM合并NAFLD发生IR密切相关.结论 T2DM合并NAFLD患者血清脂联素水平降低,并与胰岛素抵抗密切相关,脂联素可能在T2DM合并NAFLD患者胰岛素抵抗的发生、发展中起重要的作用.     

2型糖尿病患者血清脂联素与胰岛素抵抗相关性研究

目的 探讨2型糖尿病(T2DM)患者血清脂联素与胰岛素抵抗(IR)的关系.方法 收集初诊T2DM患者86例(T2DM组),另选门诊体检健康者50例(对照组),检测所有研究对象空腹状态下血清脂联索、血脂、尿酸、空腹血糖及胰岛素水平,采用稳态模型评估法计算IR指数(HOMA-IRI),同时计算体重指数(BMI)和腰臀比(WHR).结果 T2DM组脂联素显著低于对照组(P＜0.01),HOMA-IRI显著高于对照组(P＜0.05).脂联素与BMI、WHR、空腹血糖、空腹胰岛素、HOMA-IRI、低密度脂蛋白-胆固醇、甘油三酯呈负相关,与高密度脂蛋白-胆固醇呈正相关,与总胆固醇、尿酸无相关性.WHR、BMI、脂联素和空腹血糖是影响IR最显著的因素.结论 2型糖尿病患者存在IR、低脂联索血症,低脂联索血症可能影响T2DM患者IR的程度.     

不同类型血脂紊乱对初诊2型糖尿病患者胰岛素抵抗和胰岛功能的影响

目的比较不同类型的血脂紊乱对初诊2型糖尿病患者胰岛素抵抗程度和胰岛β细胞分泌功能的影响。方法263例初诊的2型糖尿病患者,按美国ATPIII标准分为血脂正常组和血脂异常组。后组又分为三个亚组:高甘油三酯组、高胆固醇组、混合型高脂血症组。用稳态模型评估法评价胰岛素抵抗及胰岛β细胞功能,并计算胰岛素早期分泌指数(EISI)和OGTT各时点胰岛素曲线下面积(AUCI)。结果263例2型糖尿病患者中血脂紊乱发生率为63%。高甘油三酯组和混合组BMI,WHR高于正常组(P<0.01或P<0.05)。高甘油三酯组的空腹胰岛素,空腹C肽,HOMA-IR,EISI较正常组显著升高(P<0.01,P<0.05),胰岛素敏感性指数(IAI)较其他各组低(P<0.05)。各组HOMA-β,AUCI无显著差别。结论2型糖尿病患者脂代谢紊乱类型以高TG血症最常见。血TG增高加重糖尿病患者胰岛素抵抗和胰岛素分泌负担。高TG血症反映了糖尿病患者胰岛素抵抗的程度。     

体脂含量对中老年人群血糖和胰岛素的影响

目的 研究体脂含量及分布对中老年人群血糖和胰岛素水平的影响。方法 以北京市西城区619名38～73岁之间的中老年人为研究对象，内容包括身高、体重、腰围、臀围测量以及空腹血糖、空腹胰岛素水平测定，并计算体质指数(BMI)、腰臀比(WHR)以及胰岛素敏感指数(ISI)，以BMI和WHR作为反映体脂含量及分布的指标，采用多元统计方法，分析不同BMI及WHR水平对空腹血糖、胰岛素、ISI以及血糖异常发生率的影响。结果 随着BMI和WHR水平的增加，空腹血糖、胰岛素以及血糖异常发生率均呈升高趋势，ISI则呈降低趋势，而且在女性中更加明显。在对年龄、性别等因素进行调整后。WHR对空腹血糖和BMI对空腹胰岛素的影响作用仍然显。结论 体脂含量及分布与血糖代谢之间存在着密切的关系，WHR对空腹血糖的影响不受年龄、性别和BMI的影响，而BMI是影响空腹胰岛素的独立因素。因此，控制体重并保持健康的体型对于丌型糖尿病的防治具有重要意义。     

2型糖尿病患者血清瘦素与胰岛素水平等因素的相关性研究

目的　探讨 2型糖尿病患者血清瘦素水平与胰岛素水平等因素的相关性。方法　用放免法测定 2 0例肥胖 2型糖尿病患者和 2 0例非肥胖 2型糖尿病患者的血清瘦素 (LP)浓度、体重指数 (BMI)、空腹胰岛素 (FINS)、空腹血糖 (FPG)、血脂、血压、腰臀比 (WHR)等指标。结果　⑴肥胖糖尿病组LP、FINS高于肥胖非糖尿病组 (P <0 0 5～ 0 0 1) ,而非肥胖糖尿病组LP、FINS与非肥胖非糖尿病组比较无显著性差异 (P >0 0 5 ) ;⑵无论糖尿病组或非糖尿病组肥胖者的LP显著性高于非肥胖者 (P <0 0 1) ,女性的LP平均为男性的 3 45倍 ;⑶LP与FINS、BMI、MBP、Tch、TG呈正相关 (P <0 0 5～ 0 0 0 0 ) ,与胰岛素敏感指数 (ISI)呈负相关 (P =0 0 0 1)。结论　肥胖 2型糖尿病存在明显的胰岛素抵抗及瘦素抵抗 ,非肥胖 2型糖尿病此种状态不明显 ;肥胖 2型糖尿病瘦素抵抗与胰岛素抵抗相关     

社区中老年人群血脂现状调查

目的了解社区人群血脂状况 ,为制订合理的高脂血症防治计划提供依据。方法采用整群随机抽样的方法抽取6 96名 35岁以上社区居民 ,开展问卷调查、体格检查及与血脂相关实验室检查。结果高脂血症患病率为 6 0 .6 3% ,血清总胆固醇 (TC)、甘油三酯 (TG)、空腹血糖 (FPG)、餐后 2 h血糖 (OGTT)、低密度脂蛋白胆固醇 (L DL - C)在各年龄组间差异有显著性 (P<0 .0 5 ) ,女性 TC、HDL - C水平显著高于男性 (P<0 .0 1) ,血糖、血压、体质指数 (BMI)、腰臀比 (WHR)非正常状态组 TC、TG明显高于正常状态组。结论通过调查发现 :1血脂水平随年龄而变化。2血脂水平存在性别差异。3血脂水平与血糖、血压水平以及 BMI、WHR有着密切的相互关联。 4控制高脂血症的发病率 ,是控制与之密切相关疾病(冠心病、高血压、糖尿病等 )发病率的关键措施之一。     

饮食控制对中老年糖耐量减低者血糖、血脂水平的影响

[目的 ]探讨饮食控制对中老年糖耐量减低 (IGT)者血糖、血脂的影响。 [方法 ] 2 0 0 1年在广州市对 42例中老年IGT患者进行为期 10个月的饮食控制 ,于饮食控制前后分别测定空腹血糖 (FSG)、餐后 2小时血糖 (PSG)、血清甘油三酯(TG)、总胆固醇 (TC)、胰岛素 (INS)、体重指数 (BMI)、糖化低密度脂蛋白 (G LDL)和红细胞内游离钙 [红细胞 (Ca2 )i]。[结果 ]饮食控制后 ,IGT患者FSG、PSG、TG、TC、INS、BMI、G LDL、红细胞 (Ca2 )i水平均较控制前下降 (P <0 0 1)。 [结论 ]饮食控制可明显改善IGT患者的糖与脂代谢     

血浆抗素水平与胰岛素抵抗的关系研究

目的:探讨血浆抗素(resistin)与肥胖、胰岛素抵抗及糖尿病之间的关系。方法:对型糖尿病(DM)组122例、糖耐量低减组(IGT)56例、糖耐量正常对照组(NGT)122例,采用争性酶联免疫分析法检测空腹血浆抗素浓度;同时测定血脂水平、空腹血浆葡萄糖浓度(FPG)和浆胰岛素浓度(FINS);测量身高、体重、腰围、血压(SBP、DBP),计算体质指数(BMI)、体脂百比(%Fat)、稳态模型胰岛素抵抗指数(HOMA-IR)。结果:与糖耐量正常组比较,糖尿病组体脂百分比甘油三酯(TG)、总胆固醇(TC)、血浆抗素水平、胰岛素抵抗指数较高(P<0.05)。相关分析显示浆Resistin水平与体质指数、体脂百分比、腰围、总胆固醇、胰岛素、血糖、胰岛素抵抗指数呈正关,调整BMI、年龄后,血浆抗素水平仍与胰岛素、血糖、胰岛素抵抗指数呈正相关。结论:Ⅱ型尿病患者血浆抗素水平较高,血浆抗素水平与胰岛素、空腹血糖水平及胰岛素抵抗指数相关,提示素是胰岛素抵抗发生的一个重要危险因素,在胰岛素抵抗与糖尿病之间建立联系。     

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.     

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.     

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.     

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.     

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.     

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.