低剂量甲状腺素治疗先天性甲状腺功能低下症疗效观察

【目的】　探讨新生儿期先天性甲状腺功能低下症的L甲状腺素恰当剂量 ,避免医源性甲亢的发生。　【方法】　采用 4～ 8μg/ (kg·d)的初始剂量 ,对平均年龄 2 0d的先天性甲状腺功能低下症患儿进行治疗随访。 　【结果】　治疗 10d ,血清T4升至正常范围低值 ,TSH开始下降。治疗 60d ,T4升至正常范围上限 ,TSH正常 ,临床症状消失 ,身心发育正常。　【结论】　 4～ 8μg/ (kg·d)的L甲状腺素可使患儿身心健康发育 ,血清T4是先天性甲状腺功能低下症初始治疗时的最敏感观察指标。     

158例先天性甲状腺功能低下症的防治及分析

[目的]探讨先天性甲状腺功能低下症（CH）患儿诊治措施及预后。[方法]对本院筛查中心确诊并随访3年以上的158例CH患儿资料进行分析,对筛查阳性可疑患儿召回后抽静脉血检测TSH、FT3和FT4水平,确诊后即给予左旋甲状腺素钠（优甲乐）口服治疗,并定期复查TSH、FT3和FT4,根据血激素水平相应进行个体化的药物剂量调整,并予以甲状腺核素扫描检查及对智能与体格发育情况进行评估。[结果]158例中,59例经优甲乐替代治疗2~3年后,停药观察6~12月,复查甲状腺功能正常,考虑为暂时性甲状腺功能低下终止治疗,余99例随访期间优甲乐剂量随年龄增长而渐加量,目前仍继续治疗。随访治疗中,除3例智能发育稍落后外（1例自行停药,2例确诊时临床症状明显）,其他患儿智能和体格发育均在正常范围。[结论]CH治疗随访后评估发现有一部分为暂时性甲状腺功能低下,采用优甲乐口服治疗既安全又有效。早期干预及规范的治疗和随访,完全能保证患儿正常的体格发育和智能发育。     

妥泰治疗小儿癫痫42例临床分析

【目的】　评价妥泰单药或添加治疗小儿癫痫的疗效和安全性。　【方法】　 42例患儿口服妥泰剂量从1～ 2mg/(kg·d) ,1日 1次开始 ;目标计量为 4～ 10mg/(kg·d) ,1日 2次。随访时间 4～ 8个月。并进行对照性研究。　【结果】　妥泰治疗 42例小儿癫痫患儿总有效率 76.2 % ,控制率为 3 3 .3 % ,显效率为 2 6.2 % ,有效率为 16.7% ,单药治疗与添加治疗总疗效比较差异无显著性 (P >0 .0 5 )。有 17例发生不良反应 ,占 40 .5 % ,多在服药 1～ 4周消失。随访观察血常规、尿常规、肝、肾功能均无异常发现。　【结论】　妥泰是一种广谱、高效、安全性好 ,副作用少 ,具有多重作用机制的新型抗癫痫药     

先天性甲状腺功能低下症44例临床分析

【目的】　分析先天性甲状腺功能低下症的临床资料 ,探讨筛查治疗方法。　【方法】　 44例甲状腺功能低下症筛查采用滤纸干血片生物素 亲合素酶标记法 ,确诊采用放射免疫法测定血清促甲状腺素 (thyroid stimulatinghormone ,TSH)、游离甲状腺素 (freethyroxine ,FT4)、游离三碘甲状腺原氨酸 (freetriiodothyronine ,FT3 ) ;口服左旋甲状素片 (L T4) ,初始剂量为 8～ 10 μg/(kg·d) ,维持量以临床上无甲状腺素过量的表现且FT4处于正常值上限为剂量的恰当标准。定期随访进行体格与智能发育监测骨龄测定和甲状腺扫描。　【结果】　所有病例治疗 1月后 ,临床表现消失 ,血清FT41月内恢复正常 42例 ,43例病儿体格发育及丹佛小儿智能发育筛查测试均在正常范围内 ,骨龄发育均正常。　【结论】　筛查是早诊断、早诊疗的保障 ,合理用药是关键 ,定期随访监测骨龄具有重要临床意义 ,甲状腺扫描是确诊的指标之一。     

新生儿高促甲状腺素血症转归研究

【目的】 探讨促甲状腺素(thyroid stimulating hormone,TSH) <14 mU/L的新生儿高TSH血症患儿的转归。 【方法】 对确诊TSH＜14 mU/L的高TSH血症患儿定期检测血TSH浓度变化,如TSH持续增高,予以左旋甲状腺素治疗。 【结果】 确诊TSH<14 mU/L的高TSH血症患儿197例,随防至18月龄,181例TSH逐渐恢复正常,10例TSH逐渐增高>20 mU/L,血清FT₄、T₄值在正常低值,予以优甲乐治疗,6例随访2年血清TSH仍偏高,波动于5.7~9.8 mU/L之间,继续随访。 【结论】 多数新生儿高TSH血症随年龄增长会逐渐恢复正常,仅有少部分患儿甲状腺功能出现失代偿而出现甲状腺功能异常。     

先天性甲状腺功能低下症病因及治疗

目的:了解先天性甲状腺功能低下症(congenitalhypothyroidsm,CH)的发病率、甲状腺变化、病因分类和治疗情况。方法:采集1999~2003年济宁市新生儿出生后72h血样滴于滤纸上,用酶免疫标记法测定促甲状腺素(TSH)含量;可疑阳性者取其静脉血,用放射免疫分析法测定血清TSH、T4、T3含量;同时用放射性核素99mTcO4甲状腺静态显像,确定甲状腺发育、位置和功能;确诊为CH患儿给予L-T4治疗并定期随访监测。结果:324444筛查血样中发现可疑患儿1092例,确诊CH163例,发病率1∶1999;其中132例CH甲状腺扫描显示甲状腺正常96例、发育不良17例、异位14例、缺如11例,甲状腺异常CH全部为永久性CH;107例病因分类的CH中,55例为永久性CH,42例为暂时性CH,10例失访未分类;治疗后CH患儿骨龄和智能发育正常。结论:济宁市CH发病率接近国内平均水平,甲状腺异常多发生在永久性CH中,规范的治疗可使CH预后良好。     

黑龙江省125万例新生儿疾病筛查状况分析

【目的】总结和分析黑龙江省开展新生儿疾病筛查的状况。【方法】收集1999—2009年历年在黑龙江省出生的新生儿滤纸干血斑标本数量,分析全省历年筛查率的变化,并对黑龙江省筛查两种疾病的患病率和治疗情况进行分析。其中检测促甲状腺素(thyroid-stimulating hormone,TSH)筛查先天性甲状腺功能减低症(congenital hypothyroidism,CH);检测苯丙氨酸(phenylalanine,Phe)筛查高苯丙氨酸血症(hyperphenylalaninemia,HPA)。【结果】1999—2009年全省共筛查新生儿1 251 887名,1999年全省筛查率1.20%,2009年全省筛查率92.21%;通过新生儿疾病筛查检出CH 385例,全省患病率为1/3 251,HPA 148例,全省患病率为1/8 458。CH和HPA共533例,治疗随访520例,4~6岁智商(IQ)或0~3岁发育商(DQ)测定正常(IQ或DQ≥90)者439例(84.60%),平均开始治疗年龄(35±5)d,IQ(或DQ)平均值为92.45;另IQ(或DQ)平均值为80.24者81例(15.40%),平均开始治疗年龄(112±16)d,其中IQ或DQ70智力低下者2例(0.38%),治疗时间越早,智力异常比例越低,差异有统计学意义(χ2=7.25,P0.01)。【结论】黑龙江省的新生儿疾病筛查率逐年提高。CH患病率与国内基本相同,而HPA的患病率明显高于我国平均HPA患病率。确诊患儿治疗年龄越早,智力发育水平越接近正常儿童。     

先天性甲状腺功能低下症甲状腺~(99m)Tc核素扫描与血清TSH、T_3、T_4表达关系的研究

目的:探讨先天性甲状腺功能低下症(congenital hypothyroidism,CH)的病因学分类,确定甲状腺发育、形态、位置变化与血清促甲状腺素(TSH)、T3、T4表达水平的关系。方法:采集1998～2007年济宁市新生儿出生72 h后血样滴于滤纸上,用酶免疫标记法测定TSH含量,用放射免疫分析法测定血清TSH、T4、T3含量,治疗前用放射性核素99mTcO4甲状腺静态显像确定甲状腺发育、位置,用秩和检验确定甲状腺变化与血清TSH、T4、T3表达的关系,确诊为CH的患儿给予左旋甲状腺素(L-T4)/优甲乐治疗并定期随访监测。结果:681 289例新生儿中确诊CH375例,发病率为1∶1 817;对其中367例CH患儿进行病因分类,其中203例为永久性CH,151例为暂时性CH,13例失访;甲状腺扫描显示甲状腺正常、发育不良、异位、缺如和摄锝功能低下的分别占61.03%、12.53%、10.08%、9.54%和6.81%。永久性CH中上述甲状腺的比例分别为30.44%、22.66%、16.75%、18.23%和12.32%,而暂时性CH甲状腺全部正常。暂时性甲状腺功能低下症和甲状腺基本正常的永久性甲状腺功能低下症患儿血清TSH、T4、T3含量与甲状腺形态和功能异常者比较差异有统计学意义(P<0.01),而甲状腺缺如、异位患儿血清TSH、T4、T3含量与甲状腺发育不良、摄锝功能低下患儿比较差异有统计学意义(P<0.01)。结论:永久性和暂时性CH的甲状腺形态、位置改变不同,血清TSH、T3、T4表达水平不同,可为先天性甲状腺功能低下症的病因分析、诊断、治疗和预后判断提供依据。     

菏泽市38万新生儿先天性甲状腺功能低下症与苯丙酮尿症筛查分析

【目的】探讨菏泽市新生儿疾病筛查先天性甲状腺功能低下症（congenital hypothyroidism，CH）与苯丙酮尿症（phenylketonuria，PKU）的发病情况。【方法】应用荧光分析法和时间分辨荧光分析法分别测定干血片苯丙氨酸（phe）浓度和TSH浓度。【结果】1998年11月～2005年12月，菏泽市共筛查了381141人，CH发病率为1／2611，PKU发病率为1／9529，CH发病率明显高于国内发病率，男女患儿性别比为1：2．11，差异有非常显著性（P〈0．01）。PKU发病率稍高于国内发病率，男女患儿差异无显著性（P〉0．05）。【结论】新生儿疾病筛查可早期发现，早期治疗CH与PKU患儿，避免智力低下，提高人口素质。     

深圳市新生儿先天性甲状腺功能减低症发生率监测报告

【目的】　了解深圳市新生儿先天性甲状腺功能减低症的发生率。　【方法】　活产新生儿出生 72小时 (正常哺乳 )后取足跟血 ,酶联免疫法测定干血片中TSH浓度 ;当TSH >2 0mU /L ,放免法测定血TSH、T3、T4 、FT3、FT4 。　【结果】　我院 980 6例活产新生儿中 ,实际筛查 8786例 ,筛查覆盖率为 90 .0 4 %。 5例确诊为甲低 ,先天性甲状腺功能减低症的发生率为 1/ 175 7,男女性比值为 3:2 ;同期深圳市先天性甲状腺功能减低症的发生率为 1/ 2 6 95 ,筛查覆盖率为 76 .2 3%。　【结论】　需加强新生儿先天性甲状腺功能减低症的筛查和监测工作 ,早期干预     

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.