冠心病患者阿司匹林抵抗与炎症因子相关性研究

目的探讨冠心病患者阿司匹林抵抗（AR）与炎症的关系。方法对110例冠心病心绞痛服用阿司匹林患者及健康对照组采用比浊法测定花生四烯酸（AA）、二磷酸腺苷（ADP）诱导的血小板聚集率，按标准将患者分为阿司匹林抵抗（AR）组、阿司匹林半抵抗（ASR）组和阿司匹林敏感（AS）组；测定血常规，放免法测定白细胞介素-1 β（IL-1β）、白细胞介素-6（IL-6）及超敏C-反应蛋白（hs-CRP）。结果入选患者AR发生率为2．73％；ASR发生率为7．27％。其中ADP诱导者占5．45％，AA诱导者占1．82％；AR或ASR合计为10．00％，而AS发生率为90．00％。对各组hs-CRP、IL-1β及IL-6三种炎症因子研究发现，AR与IL-1β无关；AR组或ASR组患者虽然hs-CRP呈上升趋势，但较AS组差异无统计学意义，而IL-6则较AS组显著上升。结论hs-CRP、IL-1β不适合作为AR的预测和筛查指标，而IL-6的升高与AR密切相关。     

冠心病患者阿司匹林抵抗相关因素分析

目的 探讨服用小剂量阿司匹林冠心病患者的阿司匹林抵抗(AR)现象及其相关因素.方法 经冠状动脉造影确诊为冠心病患者137例,服用阿司匹林100 mg/d≥1周后,分别用花生四烯酸(AA)、二磷酸腺苷(ADP)作为诱导剂检测血小板聚集率.满足AA诱导的血小板平均聚集率≥20%、ADP诱导的血小板平均聚集率≥70%两项者为AR;仅符合其中一项者为阿司匹林半抵抗(ASR);均不满足者为阿司匹林敏感(AS).结果 AR发生率为22.63%(31/137),ASR发生率为17.52%(24/137),AR+ASR发生率为40.15%(55/1137),AS发生率为59.85%(82/137).AR+ASR患者中糖尿病、不稳定型心绞痛比率均较AS患者高(P＜0.05);AR+ASR患者血浆总胆周醇浓度显著高于AS患者(P＜0.05),血浆低密度脂蛋白胆固醇浓度有高于AS患者倾向,但差异无统计学意义(P=0.053).结论 服用小剂量阿司匹林的冠心病患者AR或ASR者血浆总胆固醇浓度较高,糖尿病、不稳定型心绞痛发生率较高.     

冠心病患者阿司匹林抵抗相关因素分析

目的 探讨服用小剂量阿司匹林冠心病患者的阿司匹林抵抗(AR)现象及其相关因素.方法 经冠状动脉造影确诊为冠心病患者137例,服用阿司匹林100 mg/d≥1周后,分别用花生四烯酸(AA)、二磷酸腺苷(ADP)作为诱导剂检测血小板聚集率.满足AA诱导的血小板平均聚集率≥20%、ADP诱导的血小板平均聚集率≥70%两项者为AR;仅符合其中一项者为阿司匹林半抵抗(ASR);均不满足者为阿司匹林敏感(AS).结果 AR发生率为22.63%(31/137),ASR发生率为17.52%(24/137),AR+ASR发生率为40.15%(55/1137),AS发生率为59.85%(82/137).AR+ASR患者中糖尿病、不稳定型心绞痛比率均较AS患者高(P＜0.05);AR+ASR患者血浆总胆周醇浓度显著高于AS患者(P＜0.05),血浆低密度脂蛋白胆固醇浓度有高于AS患者倾向,但差异无统计学意义(P=0.053).结论 服用小剂量阿司匹林的冠心病患者AR或ASR者血浆总胆固醇浓度较高,糖尿病、不稳定型心绞痛发生率较高.     

新疆维吾尔族冠心病患者阿司匹林抵抗的临床分析

目的探讨新疆维吾尔族冠心病患者中阿司匹林抵抗（AR）临床特点。方法选取110例维吾尔族冠心病住院患者,服用阿司匹林100mg/d,连服7d,分别以二磷酸腺苷（ADP）和花生四烯酸（AA）为诱导剂检测患者的血小板聚集率,观察阿司匹林抵抗（AR）与丰抵抗（ASR）的临床特点：结果入选患者中阿司匹林抵抗发生率为5．5％（6／110）,阿司匹林半抵抗（ASR）发生率为24．5％（27／110）。AR或ASR与阿司匹林敏感者（AS）相比：老年患者[（63．82±6．78）岁比（59．04±4．35）岁,P〈0．05）]与女性患者较多（60．6％比38．9％,P〈0．05）;低密度脂蛋白浓度较高（P〈0．01）;与高血压、糖尿病、血小板计数无关。结论在服用阿司匹林的新疆维吾尔族冠心病患者中5．5％出现AR,说明部分服用阿司匹林治疗的患者血小板聚集功能未被有效抑制,存在AR现象、     

冠心病患者阿司匹林抵抗分析及与预后的相关性研究

[目的]分析冠心病(coronary heart disease,CHD)患者二磷酸腺苷(adenosine diphosphate,ADP)和花生四烯酸(arachidonic acid,AA)诱导的最大血小板聚集率(maximum platelet agglutination rate,MPAR),评价CHD患者阿司匹林抵抗的危险因素及其与随访1年的主要不良心血管事件(Major Adverse Cardiovascular Events,MACE)的关系。[方法]203名住院患者检测ADP及AA诱导的MPAR,记录患者合并的心血管疾病危险因素、伴随临床疾病、超声心动图、冠状动脉造影结果及介入治疗措施。记录随访1年的MACE。所有数据采用Excel软件建库,SPSS11.5统计软件进行分析。[结果]203名患者中,冠状动脉造影(CAG)正常组16例(7.9%),稳定性心绞痛(SAP)组22例(10.8%),不稳定性心绞痛(UAP)组115例(56.7%),急性心肌梗死(AMI)组50例(24.6%)。各组AR的发生率分别为12.5%、36.4%、49.6%和66.0%,差异有统计学意义(P=0.001)。AR组hs-CRP、LDL-C水平及糖尿病患病率明显高于阿司匹林敏感(aspirin saitivity,AS)组。随访1年55例(27.1%)患者发生MACE,AR与AS组MACE发生无统计学差异(P=0.449)。[结论]冠心病患者AR与疾病的严重程度相关,hs-CRP、LDL-C水平升高及临床合并糖尿病是AR的危险因素,AR与患者1年MACE的发生无关。     

脑梗死患者治疗过程中平均血小板体积水平与阿司匹林抵抗的相关性分析

目的探讨脑梗死患者在治疗过程中平均血小板体积水平(MPV)与阿司匹林抵抗(AR)的相关性。方法选取150例脑梗死患者,根据血小板聚集试验分为阿司匹林抵抗组(AR)32例、阿司匹林半抵抗组(ASR)66例、阿司匹林敏感组(AS)52例,观察和比较三组患者的平均血小板体积水平。结果在红细胞、白细胞、血小板计数方面,三组患者比较无统计学差异(P>0.05)。AR组、ASR组患者的平均血小板体积水平显著高于AS组(P<0.05);AR组的平均血小板体积>8.5 f L所占比例显著高于ASR组和AS组(P<0.05)。结论在脑梗死患者中,阿司匹林抵抗与平均血小板体积水平具有一定的相关性。     

缺血性卒中合并阿司匹林抵抗患者血小板源性CD40和CD40配体的表达水平和诊断意义

目的探讨缺血性卒中合并阿司匹林抵抗患者血小板源性CD40、CD40配体(CD40L)的表达水平及临床意义,为临床中阿司匹林抵抗的诊断提供新思路。方法选择2017年1月至2018年3月于嘉兴市第二医院神经内科就诊的缺血性卒中患者80例(ASR组),其中阿司匹林抵抗患者35例(AR组),非阿司匹林抵抗患者45例(AS组),选择同期体检中心的25名健康体检者作为对照组。体外分离患者和健康人的血小板、血清以及血浆。血小板采用二磷酸腺苷(ADP)诱导后采用流式细胞术检测表面CD40、CD40L和血小板P选择素(CD62P)的水平。用酶联免疫吸附法(ELISA法)检测血清中可溶性CD40(s CD40)、可溶性CD40配体(sCD40L)和CD62P的水平,用全自动凝血分析仪测定血浆AT-III活性水平。采用SPSS 11.5软件进行配对t检验、独立样本t检验。结果 ADP诱导前和诱导后,ASR组血小板源性CD40、CD40L和CD62P的水平均显著高于对照组,差异均有统计学意义(P0.01)。ADP诱导前和诱导后,AR组患者血小板源性CD40、CD40L和CD62P的水平均显著高于AS组,差异均有统计学意义(P0.01)。ASR患者sCD40、sCD40L和CD62P的水平显著高于对照组,AR组患者sCD40、sCD40L和CD62P的水平显著高于AS组,差异均有统计学意义(P0.01)。ASR患者AT-III的活性显著低于对照组,AR组患者AT-III的活性显著高于对照组和AS组,差异均有统计学意义(P0.01)。血小板源性CD40在ADP诱导前和诱导后作为阿司匹林抵抗诊断的敏感性分别为0.842、0.965,血小板源性CD40L在ADP诱导前和诱导后作为阿司匹林抵抗诊断的敏感性分别为为0.890和0.721,血小板源性CD62P在ADP诱导前和诱导后作为阿司匹林抵抗诊断的敏感性分别为0.961和0.916。结论血小板源性CD40和CD40L在阿司匹林抵抗的患者中高表达,提示CD40和CD40L是血小板活化的标志之一,对于阿司匹林抵抗的诊断有着参考价值。     

不同阿司匹林抵抗类型的超早期脑梗死患者血栓素B_2与6-酮-前列腺素检测及其意义

目的 探讨不同阿司匹林抵抗类型的超早期脑梗死患者服用阿司匹林后血栓索B_2(TXB_2)与6-酮-前列腺素(6-k-PG)F1 α水平的变化及临床意义.方法 将63例超早期脑梗死患者根据阿司匹林抵抗类型分为阿司匹林抵抗(AR)组、阿司匹林半抵抗(ASR)组和阿司匹林敏感(AS)组,分别测定三组患者服用阿司匹林(100 mg/d)前及2周后TXB_2及6-k-PGF1α水平及两者比值,并进行对比分析及预后评估.结果 AS组总有效率[87.0%(20/23)]显著高于ASR组[55.0%(11/20)]和AR组[30.0%(6/20)],差异有统计学意义(P<0.05);AS组TXB_2和6-k-PGF1α比值增高的患者比例较低.用药前三组患者TXB_2、6-k-PGF1α水平比较差异无统计学意义.用药2周后,三组患者TXB2水平较用药前均显著下降,6-k-PGF1α水平较用药前均显著上升(P<0.01),而且AR组下降或上升幅度小于AS组和ASR组(P<0.01).结论 阿司匹林可降低超早期脑梗死患者的TXB_2水平,并提高6-k-PGF1α水平,有可能在一定程度上降低其再次血栓形成的危险,同时监测TXB_2和6-k-PGF1α比值有助于评估预后.     

2型糖尿病对急性脑梗死发生阿司匹林抵抗的影响

目的探讨2型糖尿病对急性脑梗死发生阿司匹林抵抗的影响。方法选取江门市人民医院120例急性脑梗死患者作为研究对象,根据有无糖尿病分为两组,对两组患者均给予拜阿司匹林治疗,服用后检测两组患者血小板聚集率以及阿司匹林抵抗(AR)发生率与阿司匹林半抵抗(ASR)发生率。结果合并糖尿病组花生四烯酸诱导下及二磷酸腺苷诱导下血小板聚集率分别为(67.9±8.5)%、(77.4±10.5)%,较未合并糖尿病组有明显上升,差异有统计学意义(P0.01);合并糖尿病组患者的AR、ASR发生率分别为30.61%、38.78%,较未合并糖尿病组有明显升高,差异有统计学意义(P0.05)。结论急性脑梗死患者合并2型糖尿病后AR、ASR发生率明显上升,故临床应重视对糖尿病患者血糖的监控,定期监测血小板聚集率。     

2型糖尿病患者阿司匹林抵抗的临床特征

目的前瞻性评价糖尿病病患者发生AR的流行病学概况，进一步探讨AR的预测因子。方法病情稳定的糖尿病住院患者，纳入观察对象共120例，服用阿司匹林100mg／d，连服7d，服用最后一剂后24h内抽取空腹静脉血为血样。分别用二磷酸腺苷（ADP）、花生四烯酸（AA）诱导血小板凝集试验（PAgT），检测血小板聚集率。结果糖尿病患者中AR发生率为2．5％，阿司匹林半敏感（ASR）者占30％，且AR或ASR患者中的女性比率较阿司匹林敏感者（AS）高（P〈0．05），而AS者中吸烟者较AR或ASR者多（P〈0．01）。结论阿司匹林用于抗血小板治疗及预防动脉硬化事件的糖尿病患者可产生AR，预测AR及抗血栓治疗个体化，将有利于抗血栓治疗。     

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.