快速听性脑干反应在新生儿听力筛查中的应用价值

【目的】探讨快速听性脑干反应(autoauditory brainstem response,AABR)在新生儿听力筛查中的应用价值和特点。【方法】对700例未通过使用瞬态耳声发射(transient evoked otoacoustic emissions,TEOAE)筛查的新生儿和高危儿于生后42 d时应用TEOAE AABR进行听力复筛,AABR未通过者需进行ABR确诊。【结果】TEOAE复筛未通过率为18.3%,接受AABR筛查未通过率为12.7%。2例高危儿初筛TEOAE通过,而AABR复查未通过,后经两次ABR确诊为听力异常。【结论】AABR具有快速、方便、无创、灵敏、客观等优点,能降低TEOAE筛查假阳性和假阴性,是一种比较好的新生儿听力筛查方法,尤适合高危儿听力筛查。     

耳声发射与自动听性脑干反应联合应用早期发现新生儿高胆红素血症听力损伤

目的:探讨新生儿高胆红素血症患儿微量血胆红素水平与听力损伤的关系,以及瞬态耳声发射(TEOAE)与自动听性脑干反应(AABR)在诊断新生儿高胆红素血症听力损伤中联合应用的意义。方法:对580例(1 160耳)新生儿高胆红素血症患儿于生后3~14天采用TEOAE及AABR联合检查,对其中可疑的患儿于生后3个月进行听性脑干反应(ABR)及40Hz相关电位检查,并记录其微量血胆红素高峰值。结果:①三组患儿随微量血胆红素水平增高,听力筛查阳性率增加,差异有统计学意义(P<0.05);②经TEOAE和AABR筛查发现异常者,经ABR及40 Hz相关电位检查(40 Hz-AERP)诊断,均发现有听力损伤,最终确诊听力损伤3耳,与筛查手段无关。结论:①胆红素水平越高发生听力损伤的可能性越大。②TEOAE与AABR联合筛查有利于新生儿高胆红素血症患儿蜗后病变的早期发现。     

自动听性脑干反应在新生儿听力筛查中的应用

【目的】探讨将自动听性脑干反应(automatic auditory brainstem response,AABR)作为首选工具,进行新生儿听力初筛的可行性。【方法】192例(384耳)高危新生儿,检测AABR(Natus Algo3i听力筛查仪)和筛查型瞬态诱发性耳声发射(transient evoked otoacoustic emissions,TEOAE)(Madsen Accuscreen听力筛查仪),比较单用AABR、单用TEOAE、AABR TEOAE筛查的结果。筛查未通过的患儿6月龄时作全面听力学评估,测试听性脑干反应(ABR)、诊断型TEOAE(Madsen901耳声发射议)和1kHz探测音声导抗(Madsen Otoflex 100中耳分析仪),用诊断性实验方法评估AABR的可行性。【结果】AABR组、TEOAE组和AABR TEOAE组未通过率分别为9.4%(36/384)、8.1%(31/384)和7.0%(27/384),三组测试结果差异无显著性(χ2=1.382,P>0.05)。有6例(12耳)确诊为听力损失(3.1%),且AABR组和金标准组的结果差异有显著性(χ2=12.800,P<0.001)。诊断性实验分析示AABR组测试的一致百分率为93.23%±3.57%,灵敏度为0.92,特异度为0.93,漏诊率β=0.08,误诊率α=0.07,Youden指数J=0.85,阳性似然比为13.14,阴性似然比为0.086,ROC曲线下面积Az=0.97,提示其诊断准确性较高。本次调查发现1例复查符合听神经病临床表现。【结论】首选AABR进行初筛,不通过者给予全面听力学评估,是新生儿听力筛查的有效方法。     

瞬态耳声发射和自动听性脑干反应联合筛查高危新生儿听力结果分析

[目的]探讨瞬态耳声发射(transit evoked otoacoustic emisson,TEOAE)和自动听性脑干反应(automatic auditory brainstem response,AABR)联合应用于高危新生儿的意义.[方法]运用TEOAE和AABR对重症监护室治疗的145例高危新生儿进行听力筛查,可疑患儿在3月龄时进行听性脑干反应、40 Hz听觉相关电位、稳态诱发电位、声导抗测试等诊断性检查.[结果]在145例(290耳)中,有258耳通过了TEOAE和AABR联合筛查进入随访阶段;20耳未通过TEOAE和AABR筛查;TEOAE未通过而AABR通过11耳;1耳TEOAE通过而AABR未通过,经诊断有7例(13耳)存在不同程度的听力损伤.[结论]TEOAE和AABR联合筛查应用在高危新生儿,更有利于听力损伤患儿的早期发现、早期诊断和早期干预.     

35例新生儿胆红素脑病听力筛查分析

目的 探讨不同听力筛查方法在新生儿胆红素脑病患儿听力障碍筛查中的应用.方法 采用畸变产物耳声发射技术(DPOAE)和听性脑干诱发电位(ABR)同时对新生儿胆红素脑病患儿进行听力筛查,对初筛未通过者,于3个月后统一采用ABR复查.结果 DPOAE未通过耳数为25只,听力筛查异常率35.7%,ABR未通过耳数为68只,听力筛查异常率97.1%,两种筛查方法在新生儿胆红素脑病患儿中筛查的异常率有显著性差异,p<0.05.结论 ABR对新生儿胆红素脑病患儿听力损伤检测敏感性高于DPOAE,建议对所有新生儿胆红素脑病患儿采用ABR进行听力筛查.     

快速脑干听觉诱发电位在基层儿童保健工作中的应用

【目的】探讨快速脑干听觉诱发电位(auto-auditory brainstemresponse,AABR)在基层儿童保健听力筛查工作中的应用价值和模式。【方法】对本院出生的新生儿中300例重点筛查对象在出生后2～5 d至出院前采用耳声发射(transient evoked otoacoustic emission,OAE)+AABR进行初筛,未通过者于出生后42 d内进行复筛,仍未通过者转广州市儿童医院听力保健中心或其他具有新生儿疾病(听力)检测资格的三级医院进行脑干听觉诱发电位(auditory brain-stemresponse,ABR)确诊。【结果】初筛OAE未通过率为13.83%,接受AABR复筛未通过率为6.67%,31例复筛未通过者转入听力诊断程序。经过上级医院检查13例被确诊为听力损伤,所有病例AABR筛查结果均未通过,其中有2例双耳OAE筛查通过而单耳AABR筛查未通过。【结论】 AABR具有准确、快速、方便、无创等优点,能降低OAE筛查的假阳性和假阴性率,二者联合应用可减少转诊人数并且降低费用,值得在基层听力筛查中推广应用。     

窒息新生儿听力筛查136例临床分析

【目的】分析136例窒息新生儿听力筛查的结果,为早期干预治疗提供依据。【方法】对136例窒息新生儿及同期的正常新生儿5 346例进行听力筛查的结果进行比较。【结果】轻度窒息组瞬态诱发耳声发射(transitevoked otoacoustic emission,TEOAE)初筛未通过(率)17例(18.09%),42 d自动听性脑干反应(automatic auditory brain-stemresponse,AABR)复筛未通过(率)8例(8.51%);重度窒息组TEOAE初筛未通过(率)14例(33.33%),42 d AABR复筛未通过(率)9例(21.43%);对照组TEOAE初筛未通过(率)467例(8.74%),42 d AABR复筛未通过(率)56例(1.05%)。窒息新生儿的听力筛查未通过率明显高于正常新生儿;轻、重度窒息患儿听力初筛未通过率无差别,但两者复筛未通过率重度窒息高于轻度窒息,最终3例重度窒息患儿确诊为听力障碍,其中2例为中度听力损失,1例重度听力损失。【结论】窒息新生儿的听力筛查未通过率明显多于正常新生儿;窒息程度越严重,听力受损恢复越慢。提高对窒息新生儿的复苏质量,降低窒息程...     

高胆红素血症新生儿听力筛查临床意义

[目的]探讨对高胆红素血症(简称高胆)新生儿进行听力筛查的临床意义,为早期干预治疗提供依据.[方法]对286例高胆患儿和5 525例正常新生儿所做的听力筛查结果进行分析.[结果]普通高胆组瞬态诱发耳声发射(TEOAE)初筛未通过37例(17.70%),42 d自动听性脑干反应(AABR)复筛未通过16例(7.66%);严重高胆组TEOAE初筛未通过23例(29.87%),42 d AABR复筛未通过15例(19.48%);对照组TEOAE初筛未通过496例(8.98%),42 d AABR复筛未通过68例(1.23%).高胆新生儿的听力筛查未通过率明显多于正常新生儿,而且血清胆红素越高,听力异常率越高.所有高胆新生儿最终确诊为听力障碍为3例. [结论] 高胆红素血症对新生儿听力有影响,因此对高胆新生儿进行听力筛查和随访是必要的,同时及时对高胆红素血症新生儿进行干预治疗可以减少听力障碍等后遗症的发生.     

AABR+TEOAE联合在高危儿听力复筛中的临床意义

目的:探讨联合应用自动听性脑干反应(AABR)+瞬态耳声发射(TEOAE)在重症监护室(NICU)新生儿听力复筛中的临床意义。方法:对2008年3月1日~2009年2月28日在浙江省湖州市妇幼保健院NICU住院的新生儿(高危儿)681例(1 316耳)出院前使用TEOAE初筛,在生后42天时使用AABR+TEOAE进行复筛,TEOAE或AABR未通过者均行ABR检查。结果:TEOAE初筛有201例未通过。593例高危儿(87.08%)42天时接受TEOAE+AABR复筛,34例(5.73%)复筛未通过,其中28例接受ABR检查,最终确诊听力异常14例,听力障碍发病率为2.06%,其中2例为听神经病(0.34%)。结论:高危儿听力障碍发病率高,使用AABR+TEOAE复筛能降低听力筛查假阳性和假阴性,能发现更多有听力障碍的患儿,在高危儿听力筛查中具有重要的临床意义。     

耳声发射在基层医院新生儿听力筛查中的应用

目的了解耳声发射技术在基层医院新生儿听力筛查中的应用和意义。方法自2007年5月~2010年12月应用瞬态诱发耳声发射(TEOAE)对我院产科出生的5620例新生儿进行听力筛查,于出生后1～7d初筛,初筛未通过者在出生后42天行复筛,复筛仍未通过者,于生后3个月时进行听性脑干反应(ABR)检查进行诊断。结果初筛通过率为93.4%(5250/5620),初筛未通过率6.6%(370/5620),复筛率72.7%(269/370),复筛通过率98.1%(264/269),复筛未通过率1.9%(5/269),经ABR诊断为听损伤者3例。结论耳声发射技术是快捷灵敏的新生儿听力筛查工具,可广泛应用于基层医院新生儿听力筛查中,对早期发现新生儿听力损失有重大意义。     

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.