新生儿行为神经测定联合儿心量表在预测胆红素神经毒性中的价值探讨

目的 探讨新生儿行为神经测定(NBNA)联合儿心量表在预测胆红素神经毒性中的价值.方法 将2006年1～12月收治的足月无缺氧、窒息病史的高胆红素血症患儿76例,根据脑干听觉诱发电位(ABR)表现分成A、B、C三组,比较三组患儿治疗前、治疗后7、14 d的NBNA总分及随访至1岁行儿心量表检测的发育商(DQ),分析NBNA及儿心量表与ABR的相关性.结果 与A、B组比较,C组NBNA及儿心量表明显异常,可见NBNA及儿心量表与ABR的异常密切相关.结论 NBNA联合儿心量表是预测胆红素神经毒性的良好指标.     

新生儿神经行为测查及血清胆红素总量/白蛋白的比值在高胆红素血症处理中的作用

[目的]探讨新生儿神经行为测查及血清胆红素总量/白蛋白的比值在高胆红索血症处理中的作用.[方法]通过对90例高胆红素血症(简称高胆)患儿及75例正常足月儿于黄疸高峰期、黄疸消退中、黄疸消退后行新生儿神经行为测查(NBNA)测定3次,并对新生儿高胆患儿在入院时,对照组正常儿在黄疸高峰期进行胆红素总量及白蛋白水平测定,并计算胆红素总量/白蛋白(B/A)比值. [结果]①高胆患儿NBNA评分均低于对照组,两者差异均有显著性.②B/A与NBNA评分的直线相关分析显示两者之间具有负相关关系. [结论]①NBNA评分可应用早期诊断高胆所致的脑损伤.②B/A可作为评估胆红素神经毒性危险因素的指标之一,当B/A比值>(6.32±1.40)×10-3即应给予适当治疗.     

新生儿高胆红素血症总胆红素与白蛋白比值的临床意义

本文探讨总胆红素与白蛋白比值(B/A)与脑干听觉诱发电位(ABR)的关系及在预测胆红素神经毒性的价值。结果认为B/A比值是预测胆红素脑病的良好指标,对于足月高胆患儿B/A比值>5.0×10-3者,应采取积极的治疗措施。     

新生儿行为神经测定评分联合血清胆红素总量/白蛋白比值预测新生儿高胆红素血症并发急性胆红素脑病的临床价值

目的 探讨新生儿行为神经测定(NBNA)评分联合血清胆红素总量/白蛋白比值(B/A)预测新生儿高胆红素血症并发急性胆红素脑病的临床价值。方法 收集2020年5月—2021年6月杭州市妇产科医院收治的患儿62例为观察组,另选取在院进行健康体检的婴儿62例为对照组。检测两组NBNA评分、B/A水平,分析NBNA评分、B/A在高胆红素血症及其并发病情的表达水平以及对高胆红素血症以及并发症状的诊断价值。结果 观察组B/A表达水平高于对照组(8.51±2.03 vs. 5.69±1.35),NBNA评分表达水平低于对照组(26.88±4.23 vs. 35.33±5.61),差异有统计学意义(P<0.05)。logistic回归分析显示,B/A水平表达上升,NBNA评分表达水平下降是患有高胆红素血症以及并发不良病症患儿的重要影响机制。ROC曲线显示,两项联合对患有高胆红素血症及并发不良病症患儿的诊断价值高于NBNA评分、B/A单项诊断[AUC(95%CI):0.944(0.896~0.991)vs.0.823(0.749~0.897)vs.0.782(0.699~0.866)],差异有统计学意义(P<0.05)。结论 对于研究患有不良病症患儿情况变化,可检测出B/A水平表达上升,NBNA评分表达下降,能够有效地提前对患儿病情进行预测,减少不良反应的发生。     

B/A比值与BAEP的相关性及其预测高胆红素血症患儿神经毒性的临床价值

目的:探讨高胆红素血症患儿总胆红素/血清蛋白(B/A)比值与脑干听觉诱发电位(BAEP)的关系及其对患儿听觉及脑干功能损害的预测价值。方法:选取209例高胆红素血症患儿为研究对象,根据BAEP结果分为A组(BAEP正常组)72例,B组(仅脑干功能损伤组)58例,C组(仅听觉神经损伤)42例,D组(脑干及听觉神经均损伤)37例,对比各组总胆红素(TBIL)及B/A值,并探讨B/A值与BAEP的关系。结果:与A组、B组比较,C组、D组TBIL水平显著升高(P<0.05)。与A组比较,B组、C组、D组B/A值显著升高(P<0.05)。与B组比较,C组、D组TBIL水平、B/A值显著升高(P<0.05)。与C组相比,D组TBIL水平、B/A值无统计学差异(P>0.05)。与A组BAEP相比,B组、C组、D组潜伏期V波及峰间期Ⅰ-Ⅴ、Ⅲ-Ⅴ波具有统计学差异(P<0.05)。结论:B/A值与BAEP关系密切,可作为高胆红素血症患儿神经毒性的预测指标。     

早期振幅整合脑电图对重度高胆红素血症新生儿神经发育结局的预测

目的 分析早期振幅整合脑电图(aEEG)对重度高胆红素血症新生儿神经发育结局的预测作用。方法 选择2016年12月-2018年12月恩施州中心医院新生儿重症病房收治的86例重度高胆红素血症新生儿为研究对象。记录患儿基本临床特征,所有患儿均接受aEEG、MRI或听觉脑干反应(ABR)检查,并连续随访12个月,评估患儿神经发育结局。结果 在随访的72例(83.7%)患儿中,有16例(22.2%)患儿出现不良神经发育结局。与神经发育良好结局患儿比较,不良发育结局患儿总血清胆红素水平、总血清胆红素/血清白蛋白比值、神经功能障碍(BIND)得分>3比例、交换输血比例显著升高(P<0.05)。单独aEEG、ABR异常检查结果、aEEG联合ABR及MRI联合ABR异常检查结果均与患儿不良神经发育结局显著相关(P<0.05)。Logistic回归分析结果示,aEEG异常(OR=6.898,95%CI:1.047~45.563)和ABR异常(OR=16.998,95%CI:2.685~107.608)是患儿不良神经发育结局的重要危险因素。异常aEEG和异常ABR对新生儿不良神经发育结局预测的灵敏度为56.25%、85.71%,特异度为91.07%、73.33%,准确度为83.33%、77.27%,阳性预测值为64.29%、60.00%,阴性预测值为87.93%、91.67%。结论 早期aEEG可预测重度高胆红素血症新生儿的不良神经发育结局,特异性高,但敏感性低于ABR。     

早期振幅整合脑电图对重度高胆红素血症新生儿神经发育结局的预测

目的 分析早期振幅整合脑电图(aEEG)对重度高胆红素血症新生儿神经发育结局的预测作用。方法 选择2016年12月-2018年12月恩施州中心医院新生儿重症病房收治的86例重度高胆红素血症新生儿为研究对象。记录患儿基本临床特征,所有患儿均接受aEEG、MRI或听觉脑干反应(ABR)检查,并连续随访12个月,评估患儿神经发育结局。结果 在随访的72例(83.7%)患儿中,有16例(22.2%)患儿出现不良神经发育结局。与神经发育良好结局患儿比较,不良发育结局患儿总血清胆红素水平、总血清胆红素/血清白蛋白比值、神经功能障碍(BIND)得分>3比例、交换输血比例显著升高(P<0.05)。单独aEEG、ABR异常检查结果、aEEG联合ABR及MRI联合ABR异常检查结果均与患儿不良神经发育结局显著相关(P<0.05)。Logistic回归分析结果示,aEEG异常(OR=6.898,95%CI:1.047~45.563)和ABR异常(OR=16.998,95%CI:2.685~107.608)是患儿不良神经发育结局的重要危险因素。异常aEEG和异常ABR对新生儿不良神经发育结局预测的灵敏度为56.25%、85.71%,特异度为91.07%、73.33%,准确度为83.33%、77.27%,阳性预测值为64.29%、60.00%,阴性预测值为87.93%、91.67%。结论 早期aEEG可预测重度高胆红素血症新生儿的不良神经发育结局,特异性高,但敏感性低于ABR。     

足月儿高胆红素血症神经元特异性烯醇化酶、经皮小时胆红素、总胆红素/白蛋白水平变化及与远期神经发育的相关性

目的 探讨足月儿高胆红素血症血清神经元特异性烯醇化酶(NSE)、经皮小时胆红素(hTcb)、总胆红素/白蛋白(B/A)水平变化及与远期神经发育相关性,为预测高胆红素血症患儿的远期神经发育提供理论依据。方法 选取2017年1月—2020年6月深圳市龙华区中心医院新生儿科足月高胆红素血症患儿240例为观察组,同期正常足月儿240例为对照组,比较两组一般资料、血清NSE、hTcb、B/A水平、观察组治疗前后血清NSE、hTcb、B/A水平,应用Logistic回归分析探讨血清各指标与高胆红素血症发病的关系,并对观察组患儿观察12个月,依据神经发育结局分为良好结局患儿(n=214)、不良结局患儿(n=26),统计不同神经发育结局患儿治疗前后血清NSE、hTcb、B/A水平,观察血清NSE、hTcb、B/A对患儿远期神经发育不良的预测价值。结果 治疗前,观察组血清NSE、hTcb、B/A水平高于对照组(t值分别为57.464、14.967、38.399,P<0.001),且观察组治疗后均低于治疗前(t值分别为46.855、43.201、32.847,P<0.001);经Logisti...     

新生儿行为神经测定对高危儿预后评估的价值

围生期高危儿常因脑损伤而遗留各种后遗症。对其远期预后进行预测，是抢救治疗及早期干预的重要参考依据。新生儿行为神经评分(neonatal behavioral neurological assessment．NBNA)可全面评价新生儿的行为能力，早期发现新生儿的脑功能异常及预测预后。本研究采用NBNA对高危儿从新生儿期开始干预，用婴幼儿智能发育量表(CDCC)评估其发育商，旨在研究NBNA对高危儿预后的预测意义。     

新生儿高胆红素血症对行为神经影响的观察

目的探讨新生儿高胆红素血症对行为神经的影响。方法将符合研究对象标准的病例分为2组,高胆组和正常对照组,正常对照组选择新生儿出生后3～7天进行NBNA测定,高胆组分别于高胆治疗前后以新生儿行为神经测定(NBNA)20项进行2次测定。结果随着高胆红素血症的治疗NBNA评分结果有所增加,且多数能达到正常,仅对咯咯声反应、月国窝角的2项评分与正常对照之间仍有显著差异P<0.05。结论高胆红素血症对新生儿行为方面的影响大部分为可逆的,对咯咯声反应的异常提示在对这些患儿进行随访时应注意听力方面的监测,及早发现听力异常,并对这部分患儿进行听力方面的早期干预,减少伤残率。     

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.     

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.     

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.     

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.