螺内酯对2型糖尿病肾病患者单核细胞趋化蛋白-1和Ⅳ型胶原的影响

目的探讨螺内酯对2型糖尿病肾病患者单核细胞趋化蛋白-1（MCP-1）和Ⅳ型胶原（CⅣ）水平的影响。方法2型糖尿病患者60例根据尿白蛋白排泄率（UAER）分为三组：正常尿白蛋白组、微量尿白蛋白组及临床尿白蛋白组，每组随机分为螺内酯治疗组和常规治疗组。分别采取治疗前和治疗12周后静脉血和24h尿。用ELISA法测定糖尿病患者血清CⅣ和尿MCP-1，以放射免疫法测定24h尿白蛋白含量。结果MCP-1和CⅣ在微量尿白蛋白组及临床尿白蛋白组中均明显高于健康对照组（P〈0．01或〈0．05）。螺内酯治疗组治疗12周后，三组患者MCP-1、CⅣ及UAER的降低差异均有统计学意义。结论CⅣ和MCP-1可能在糖尿病肾病中起重要作用，螺内酯治疗糖尿病肾病的机制可能是通过抑制核因子-κB（NF-κB）的表达实现的。     

不同疗程三联疗法治疗HP阳性的十二指肠球部溃疡的疗效观察

目的观察不同疗程三联疗法治疗幽门螺杆菌（HP）阳性十二指肠溃疡（DU）的溃疡愈合情况及HP根除率，从而寻找疗程短HP根除率及愈合率高的治疗方法。方法收集我院门诊，经胃镜检查确诊的80例HP阳性的DU患者，随机分为一周疗程组和二周疗程组，各40例，治疗结束第四周复查胃镜，观察溃疡愈合情况及HP根除情况。结果溃疡愈合率和HP根除率：一周组分别为90％，87．5％；二周组分别为95％，90％。两组比较无显著差异（P〉0．05）。结论一周三联疗法能达到理想的溃疡愈合率和HP根除率，且副作用少，值得临床推广应用。     

弹力纤维及Ⅳ型胶原和CD44v6表达与肺腺癌转移的研究

目的 探讨弹力纤维、Ⅳ型胶原、CD44v6表达与肺腺癌转移的相关性。方法应用弹力纤维染色、免疫组织化学方法观察56例肺腺癌，了解弹力纤维、Ⅳ型胶原、CD44v6的表达状况，分析其与肺腺癌转移的关系。结果弹力纤维、Ⅳ型胶原、CD44v6表达在有、无淋巴结转移组中皆有显著差异（P=0．000）；并与淋巴结有否转移显著相关（r=-0．581、0．476、0．635：P〈0．01）。结论弹力纤维、Ⅳ型胶原、CD44v6表达与肺腺癌转移密切相关，对其检测有助于对肺腺癌转移及预后做出判断。     

四联疗法联合铝碳酸镁治疗结直肠癌合并幽门螺杆菌感染患者的效果

目的 探究四联疗法联合铝碳酸镁治疗结直肠癌合并幽门螺杆菌（HP）感染患者的效果及对血清Ⅰ型前胶原氨端肽原、胃泌素17水平的影响。方法 选择2016年1月至2018年1月间结直肠癌和合并幽门螺旋杆菌感染的患者93例作为研究对象，按照治疗方法不同分为对照组41例和观察组52例。对照组使用四联疗法治疗，观察组在对照组基础上同时联合铝碳酸镁治疗。结果 观察组的治疗后4天、8 天和14 天的HP清除率均显著高于对照组(P＜0.05)。治疗前对照组和观察组血清白细胞介素-6(IL-6)、C反应蛋白(CPR)水平比较差异无统计学意义（P＞0.05）；治疗后观察组血清IL-6、CPR水平显著低于对照组，差异均有统计学意义(P＜0.05)，观察组下降幅度大于对照组(P＜0.05)。结论 铝碳酸镁联合四联疗法可有效提高HP清除率并降低血清炎性因子水平，降低血清G-17水平，提高预后。同时还可以提高PINP水平。     

根除幽门螺杆菌对胃癌伴幽门螺杆菌感染患者化疗效果及不良反应的影响

目的探讨根除幽门螺杆菌(Helicobacter pylori,HP)对胃癌伴HP感染患者化疗效果及不良反应的影响。方法选择2010年1月—2014年1月收治的171例选择化疗的胃癌伴HP感染患者,根据是否进行根除HP治疗分为两组:未进行根除HP治疗的63例设为对照组,根除HP治疗的108例设为观察组。2个化疗疗程后对比两组化疗疗效及不良反应,同时分析根除成功与根除失败者相关差异。计量资料采用t检验,计数资料采用χ2检验,P0.05为差异有统计学意义。结果观察组HP根除成功83例,失败25例,失败者化疗后DOB值(8.51±2.92)明显低于对照组(16.76±3.19),差异有统计学意义(P0.05)。观察组HP根除成功者化疗疗效有效率77.11%明显优于根除失败者的52.00%及对照组的50.80%,差异有统计学意义(P0.05)。观察组根除成功者、根除失败者无消化道不良反应者比例(68.68%、52.00%)均明显高于对照组(26.99%),差异均有统计学意义(均P0.05),Ⅰ~Ⅱ度反应和Ⅲ~Ⅳ度反应发生率(22.39%、24.00%和8.43%、24.00%)均低于对照组(38.09%、34.92%),其中根除成功者与对照组差异均有统计学意义(均P0.05);观察组根除成功者Ⅲ~Ⅳ度反应发生率明显低于失败者,差异有统计学意义(P0.05)。结论根除HP感染可提高胃癌患者化疗疗效,降低消化道不良反应,减轻HP感染程度可减少化疗所致消化道不良反应,有提高化疗疗效趋势,故对伴胃癌伴HP感染者建议将HP根除方案纳入一线治疗方案,但对其具体作用机制尚须进一步深入研究。     

根除胃幽门螺旋杆菌感染方法比较

目的 寻找经济、高效治疗胃幽门螺旋杆菌(HP)感染方法。方法将经内镜检查、尿素酶试验和病理学检查证实有HP感染的132例病人随机分为2组，A组67人，接受奥美拉唑 替硝唑 庆大霉素缓释片(OTG)治疗1周；B组65人，接受洛赛克 克拉霉素 阿莫西林(LCA)治疗1周。停药后1月和6个月进行随访，随访时对患者行C^14呼吸试验确定HP根除率，必要时进行胃镜和尿素酶试验。结果 132例患者两种方案初次随访，HP清除率分别为86．5％和92．3％；6个月后第二次随访两种方案HP清除率分别为79．3％和87．7％。二者比较差异无显著性。结论 治疗HP感染相关性胃炎和胃溃疡患者，OTG和LCA方案疗效相当，而OTG费用低，安全性好，是一种值得推广的方案。     

贲门癌自体荧光的实验研究

目的探讨贲门癌组织显微自体荧光特征及作为自体荧光成分的Ⅲ、Ⅳ型胶原在贲门癌组织与正常胃组织中分布的不同。方法采用激光扫描共聚焦显微镜以氩离子（Ar^＋）激光（Ex=488nm）和氦氖（He-Ne）激光（Ex=543nm）为激发光的双通道法对20例贲门癌手术标本进行自体荧光图像分析；采用免疫组化技术，半定量计分法分析Ⅲ、Ⅳ型胶原在正常胃组织和贲门癌组织中的分布差异。结果贲门癌组织自体荧光信号与正常胃组织各层相比均显著减弱（P〈0．01）。正常胃组织的Ⅳ型胶原抗体反应呈强阳性，贲门癌组织则明显减弱；丽Ⅲ型胶原在贲门癌间质中的抗体阳性反应较正常胃组织变化不明显。结论贲门癌组织与正常胃组织的显微自体荧光无论在形态、颜色、分布，还是在荧光强度上都存在巨大的差异。贲门癌组织比正常胃组织细胞外基质内Ⅳ型胶原显著减少，丽Ⅲ型胶原减少不明显；Ⅳ型胶原可能是胃底贲门黏膜细胞外基质自体荧光的主要来源。     

血液灌流对尿毒症患者微炎症状态的影响

目的观察血液灌流对慢性肾衰尿毒症患者体内炎症因子的清除效果。方法选择本科血液净化中心维持性血液透析患者85例，随机分为两组：血液灌流联合血液透析组（HP／HD组）43例，单纯血液透析组（HD组）42例，分别于治疗前后采血；25例健康人为对照组；运用ELISA法检测血中C反应蛋白（CRP）、白细胞介素-6（IL-6）、肿瘤坏死因子α（TNF—α）水平。结果透析及灌流前2组患者血CRP、IL-6、TNF—α．水平均高于正常对照组（P〈0.001），两组之间各因子水平差异无统计学意义（P〉0．05）；透析及灌流治疗后各因子水平较治疗前均降低，其中HP／HD组差异有统计学意义（P〈0.001），HD组差异无统计学意义（P〉0.05）。结论血液灌流是治疗慢性肾衰尿毒症患者微炎症状态的有效手段。     

用PCR技术检测胃粘膜活检标本幽门螺杆菌DNA

本文利用聚合酶链反应（PCR）技术检测32例胃癌、48例慢性浅表性胃炎、37例胃溃疡、12例疣状胃炎、十二指肠球部溃疡24例及15例正常对照胃粘膜及胃液标本HP－DNA、并与HP染色（Warthin－Starry法）进行了比较，以探讨HP感染与胃癌的关系。结果表明：（1）各组患者HP－DNA－PCR阳性检出率均较Warthin－Starry染色阳性率有高度显著性差异（P＜0．01），且特异性均为100％；（2）胃癌患者胃粘膜及胃液标本的HP－DNA－PCR阳性率达90．7％（29/32），略高于疣状胃炎及胃溃疡病人，与慢性浅表性胃炎患者有显著性差异（P＜0．05），而与正常对照组相比有高度显著性差异（P＜0．01）；（3）在胃癌病人，病灶中央部位的NP—DNA—PCR阳性率与其周围组织及胃液标本相比有高度显著性差异（P＜0．01）。研究提示，PCR技术是检测胃粘膜标本及胃液标本HP最敏感、特异性最高的方法，但要注意防止污染并且要联合检测；HP感染与胃癌的发生发展密切相关。     

粘多糖贮积症Ⅳ型酶学诊断与产前诊断

粘多糖贮积症Ⅳ型（Morquio病）是常染色体隐性遗传病。它包括粘多糖贮积症Ⅳa型与粘多糖贮积症Ⅳb型两个亚型。Ⅳa型是由半乳精-6-硫酸盐硫酸酯酶缺乏所致，Ⅳb型为β-D半乳糖苷酶缺乏所致。粘多糖贮积症Ⅳ型主要导致硫酸软骨素（CS）和硫酸角质素（KS）降解障碍，在骨和软骨细胞沉积，使骨发育障碍。     

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.     

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.