抗氧化治疗对维持性血液透析患者微炎症及氧化应激状态的影响

[目的]探讨口服维生素C、维生素E对维持性血液透析患者微炎症及氧化应激状态的影响. [方法]选择我院门诊及住院维持性血液透析患者44例,随机分为血透组(MHD组)和治疗组(TRE组)各22例,另选体检健康者22例为对照组(CON组).MHD组给予慢性肾衰的常规治疗方法;TRE组在常规治疗的基础上口服维生素E100 mg,3次/d、维生素C 200 mg,3次/d,连用12周.MHD组、TRE组于上机前及CON组均采集空腹外周静脉血,检测微炎症指标C反应蛋白(CRP);氧化应激指标:血浆脂质过氧化物丙二醛(MDA)、晚期蛋白质过氧化物(AOPP). [结果]3组比较CRP、MDA、AOPP有统计学差异(P<0.001);与MHD组比较,TRE组CRP显著降低(P<0.05)、MDA、AOP均降低(P<0.01);CRP与MDA、AOPP呈正相关关系(P<0.01). [结论]①MHD患者存在微炎症和氧化应激状态,且微炎症与氧化应激之间具有互为因果、相互促进的关系;②口服维生素C和维生素E可以改善MHD患者的微炎症和氧化应激状态.     

营养干预在改善血液透析患者营养不良-微炎症状态中的应用

目的探讨营养干预对维持性血液透析患者营养不良-微炎症状态的影响。方法 60例接受血液透析的患者随机等分为对照组和干预组,干预组患者在接受与对照组相同的治疗、护理措施外强化饮食营养指导,在营养指导3个月后采用SGA评分法评价患者营养状况、检测血清CRP、IL-6、TNF-α等炎症相关因子水平并进行组间比较。结果营养干预组患者营养状况优于对照组患者,且血清CRP、IL-6、TNF-α等因子水平低于对照组患者,差异有统计学意义(P<0.01)。结论合理的营养干预可改善透析患者的营养不良和微炎症状况。     

左卡尼汀对维持性血液透析患者营养不良及微炎症状态的影响

目的探讨左卡尼汀(LC)在维持性血液透析(MHD)患者营养不良及微炎症状态治疗中的作用。方法选择我院进行血液透析3个月以上的患者,随机分为LC组及对照组。观察治疗前、后血清白蛋白(ALB)、转铁蛋白(TF)、血红蛋白(Hb)、C反应蛋白(CRP)、身体质量指数(BM I)等指标。结果LC组患者血清ALB、TF、Hb、BM I水平较治疗前提高(P<0.05),CRP水平较治疗前明显降低(P<0.05)。LC组CRP低于对照组(P<0.05),血清ALB、TF、BM I高于对照组(P<0.05)。结论LC可明显改善患者的营养状态,降低血CRP浓度,改善患者微炎症状态。     

非糖尿病肾病维持性血液透析患者胰岛素抵抗、微炎症状态与脂质代谢紊乱的相互关系研究

[目的]探讨非糖尿病肾病维持性血液透析患者胰岛素抵抗、微炎症状态与脂质代谢紊乱关系.[方法]测定86例维持性血液透析(MHD)患者及20例健康自愿者血脂、空腹胰岛素(FINS)、空腹血糖(FBS)、血C反应蛋白(CRP)及体重指数(BMI)等指标,并计算胰岛素抵抗指教(HOMA-IR).[结果]MHD患者出现血清甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、HOMA-IR CRP明显升高,高密度脂蛋白胆固醇(HDL-C)明显减低,BMI也轻度降低:其HOMA-IR与TG、LDL-C、CRP、BMI成正相关,与HDL-C成负相关;其CRP与TG、LDL-C、FINS、HOMA-IR成正相关,与HDL-C成负相关.[结论]MHD患者存在胰岛素抵抗和微炎症状态,它们与脂质代谢紊乱密切相关.     

维持性血液透析患者C-反应蛋白与透析膜和透析方式相关关系的研究

目的探讨维持性血液透析患者(MHD)C-反应蛋白(CRP)的变化与透析膜和透析方式的关系。方法回顾性分析某院自2007年1月～2010年10月收治的需进行MHD的患者34例,分别应用血仿膜与聚砜膜,HD与HDF两种不同的透析方式,比较CRP值的变化。同时选取健康人群30例为对照组。结果 MHD组患者CRP水平显著高于正常对照组(P﹤0.000)。血仿膜与聚砜膜对CRP水平无显著影响(P﹥0.05)。HD、PD治疗组的CRP均高于对照组,差异有统计学意义(P﹤0.05),HD组C反应蛋白高于PD组(P﹤0.05)。结论 MHD患者的CPR水平与采用不同的透析膜无光,但采用不同的透析方式可以改善MHD患者微炎症状态。     

维持性血液透析病人的营养状况评价

目的:应用主观全面评定法(SGA)对维持性血液透析(MHD)病人的营养状况进行评价.方法:采用SGA结合有关生化指标,人体测量指标和饮食评估,对127例MHD病人的营养状况进行综合评价.结果:127例病人中营养良好者75例,轻中度营养不良39例,重度营养不良13例,总营养不良发生率为40.9%.各营养状况组之间血清ALB、PA、肌酐、肱三头肌皮皱厚度、饮食蛋白摄入量和蛋白质分解率差异显著,而三组间Kt/V无显著差异.结论:血液透析病人营养不良的发生率较高,与蛋白质摄入不足、炎症、血液透析过程本身等因素有关.     

血必净对维持性血液透析患者微炎症状态的影响

目的研究血必净对维持性虹液透析（MHD）患者氧化应激及微炎症状态的影响。方法选择2007年1月至2008年3月在笔者所在医院血液净化中心透析时间超过3个月的MHD患者38例,分为治疗组（A组）和对照组（B组）。对照组为西药常规治疗,治疗组是在西药常规治疗基础上静脉注射血必净注射液,疗程为14d。观察用药前后白介素6（IL-6）、肿瘤坏死因子-α（TNF-Ⅱ）、C反应蛋白（CRP）等炎症指标的变化。结果给予静脉注射血必净注射液治疗后,患者炎症指标IL-6、TNF—α和CRP较治疗前明显降低（P〈0．01）。结论静脉注射血必净注射液可以改善血液透析患者的微炎症状态,短期应用血必净注射液未见明显不良反应。     

3种不同血液净化方式对MHD患者微炎症状态和钙磷代谢的影响

目的 研究3种不同血液净化方式对维持性血液透析(MHD)患者微炎症状态、钙磷代谢的影响。方法 选择2018年1月至2019年1月于本院血液透析室行MHD者70例,根据采用的血液净化方式不同将患者分为：高通量血液透析组25例、血液透析滤过组22例及常规透析联合血液灌流组23例。分别检测各组患者透析前后炎症因子血清超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)水平;检测各组患者透析前后甲状旁腺素(PTH)、血钙(Ca)、血磷(P)、白蛋白(Alb)、血红蛋白(Hb)及β2微球蛋白(β2-MG)水平。结果 治疗前,各组hs-CRP、TNF–α及IL-6水平比较差异均无统计学意义(均P>0.05);治疗后,各组hs-CRP、TNF–α及IL-6水平均显著降低,与治疗前比较差异均有统计学意义(均P<0.05)。常规透析联合血液灌流组治疗后上述指标均显著低于高通量血液透析组和血液透析滤过组,差异均有统计学意义(均P<0.05);高通量血液透析组和血液透析滤过组治疗后上述指标水平比较差异均无统计学意义(均P>0.05)。治疗前,各组P...     

维持性血液透析并发CKD-MBD患者淋巴细胞亚群和微炎症状态变化

目的 探讨维持性血液透析(MHD)并发慢性肾脏病矿物质和骨异常(CKD-MBD)患者外周血T淋巴细胞亚群、微炎症状态变化。方法 选择2018年1月-2021年3月166例诸暨市人民医院肾内科MHD患者为研究对象,根据是否并发CKD-MBD分为CKD-MBD组48例与非CKD-MBD组118例。检测外周血T淋巴细胞亚群(CD₄⁺、CD₈⁺、CD₄⁺/CD₈⁺)、微炎症状态水平[肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)]、CKD-MBD相关指标[血磷、血钙、全段甲状旁腺素(iPTH)],采用受试者工作特征曲线(ROC)分析T淋巴细胞亚群及微炎症状态水平对并发CKD-MBD的预测价值。结果 CKD-MBD组年龄≥65岁、透析时间≥5年、合并HBV感染比例高于非CKD-MBD组(P<0.05),CD₈⁺、TNF-α、CRP、IL-...     

甲状旁腺素水平对维持性血液透析患者微炎性反应及营养状态的影响

目的 通过观察维持性血液透析(MHD)患者的血清全段甲状旁腺素(PTH)水平以及微炎性反应和营养指标的变化,探讨PTH对MHD患者微炎性反应及营养状态的影响.方法 选择透析龄超过3个月的MHD患者98例(MHD组),健康对照者60例(对照组),用电化学发光免疫法(ECLIA)检测血清全段PTH水平.同时检测微炎性反应指标:CRP、IL-1β、IL-6、IL-8、TNF-α;营养状态使用改良定量整体主观评估法(MQSGA)进行评分,检测人体学指标:肱三头肌皮褶厚度(TSF)、上臂围(MAC),并计算上臂肌围(MAMC)和相对体重(RBW).分析PTH对MHD患者微炎性反应及营养状态的影响.结果 MHD组患者血清全段PTH水平为(353.46±102.41)ng/L,较对照组[(57.45±5.76)ng/L].显著升高(P<0.01),且CRP、TNF-α、IL-1β、IL-6、IL-8水平均显著高于对照组,差异有统计学意义(P<0.01或<0.05);MHD组患者RBW、TSF、MAC和MAMC与对照组比较均显著降低(P<0.05或<0.01),而MQSGA评分较对照组显著升高,差异有统计学意义(P<0.01);直线相关分析结果显示,MHD患者血清全段PTH水平与血清CRP、IL-1β、IL-6、TNF-α、脂蛋白(a)、磷水平及透析龄呈正相关(P<0.05或<0.01),与RBW、MAC、MAMC、白蛋白、Hb、TC呈负相关(P<0.01或<0.05),而与MQSGA评分呈正相关(P<0.05.结论 MHD患者PTH升高不仅影响骨代谢,还可通过影响患者摄食、增加蛋白质分解代谢、抑制骨髓红细胞生成等作用来影响患者的营养状态,同时还可能加重微炎性反应状态.PTH可能在营养不良-炎性反应-动脉粥样硬化综合征的发生机制中起着重要的作用.     

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.