蒙古族人群2型糖尿病瘦素水平与胰岛素抵抗

目的 在蒙古族人群中探讨血清瘦素水平与2型糖尿病胰岛素抵抗的关系.方法 在蒙古族人群中选择2型糖尿病患者54例及健康对照36人,检测其血清瘦素(Leptin)水平、空腹血糖(FPG)、空腹胰岛素(FINS)、体质指数(BMI)、血压、血脂等指标,并计算胰岛素敏感指数(ISI).结果 病例组与对照组比较,瘦素、FPG、FINS、BMI、甘油三酯(TG)、明显高于对照组,而ISI、高密度脂蛋白(HDL-C)明显低于对照组(P<0.05);糖尿病组瘦素与BMI、FINS、TG、总胆固醇(TC)呈正相关,而与ISI呈负相关(P<0.05);多元逐步回归分析显示,影响胰岛素敏感指数(ISI)的独立预测因素是瘦素、BMI、FINS(P<0.05).结论 2型糖尿病患者血清瘦素水平明显升高,肥胖、瘦素抵抗与胰岛素抵抗(IR)密切相关.     

2型糖尿病患者血清瘦素与胰岛素水平等因素的相关性研究

目的　探讨 2型糖尿病患者血清瘦素水平与胰岛素水平等因素的相关性。方法　用放免法测定 2 0例肥胖 2型糖尿病患者和 2 0例非肥胖 2型糖尿病患者的血清瘦素 (LP)浓度、体重指数 (BMI)、空腹胰岛素 (FINS)、空腹血糖 (FPG)、血脂、血压、腰臀比 (WHR)等指标。结果　⑴肥胖糖尿病组LP、FINS高于肥胖非糖尿病组 (P <0 0 5～ 0 0 1) ,而非肥胖糖尿病组LP、FINS与非肥胖非糖尿病组比较无显著性差异 (P >0 0 5 ) ;⑵无论糖尿病组或非糖尿病组肥胖者的LP显著性高于非肥胖者 (P <0 0 1) ,女性的LP平均为男性的 3 45倍 ;⑶LP与FINS、BMI、MBP、Tch、TG呈正相关 (P <0 0 5～ 0 0 0 0 ) ,与胰岛素敏感指数 (ISI)呈负相关 (P =0 0 0 1)。结论　肥胖 2型糖尿病存在明显的胰岛素抵抗及瘦素抵抗 ,非肥胖 2型糖尿病此种状态不明显 ;肥胖 2型糖尿病瘦素抵抗与胰岛素抵抗相关     

单纯性肥胖儿童血清瘦素水平与血糖及血脂变化的关系

目的 研究单纯性肥胖儿童血清瘦素水平与血糖、胰岛素抵抗及血脂异常的关系。方法 采用放射免疫分析法、酶法对42对7-10岁肥胖及健康对照儿童进行血清瘦素、胰岛素水平及血糖、血脂水平的测定。结果 肥胖及对照儿童瘦素水平分别为2．74-45．125μg/L和0．53-10．18μg/L,经对数转换后肥胖组平均水平非常显著高于体重正常组。血清瘦素水平与体重指数(BMI)、腰臀围比(WHR)及体脂百分比均呈显著正相关关系。83％的肥胖儿童有瘦素抵抗,肥胖瘦素敏感组与体重正常组的血糖、胰岛素及血脂水平均差异无显著性,而肥胖瘦素抵抗组总胆固醇、甘油三酯(TG)、低密度脂蛋白胆固醇及胰岛素水平均显著高于体重正常组,肥胖瘦素敏感与瘦素抵抗儿童年龄、性别分布及BMI、WHR的差异无显著性,但瘦素抵抗组TG显著高于瘦素敏感组,高密度脂蛋白胆固醇显著低于瘦素敏感组。结论 肥胖儿童即存在瘦素抵抗,瘦素抵抗与代谢综合征及心血管疾病的危险因素密切相关,可作为筛查高危肥胖儿童的有用指标。     

肥胖儿童血清瘦素水平分析

目的:检测肥胖儿童和正常对照儿童血清瘦素水平,探讨瘦素与体重指数、空腹血糖、胰岛素、胰岛素抵抗指数及血脂等的相关性。方法:对100例肥胖儿童及100例正常对照儿童测量身高、体重,计算体重指数(BMI);检测空腹血糖(FPG)、胰岛素(FINS)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A(ApoA)、载脂蛋白B(ApoB);胰岛素抵抗采用稳态模式评估法的胰岛素抵抗指数(HOMA-IR)指标;血清瘦素采用酶联免疫吸附试验检测。结果:肥胖儿童组血清瘦素显著高于正常对照组儿童(P<0.05);血清瘦素与BMI、ALT、TG、LDL-C、APB、FINS、HOMA呈正相关r,值分别为(0.647,0.5840,.328,0.198,0.314,0.5230,.484,P值均<0.05);与HDL-C呈负相关(r=-0.151,P<0.05)。结论:瘦素作为一种脂肪因子,在儿童肥胖的发生中起重要作用。     

肥胖患者血清真胰岛素及其胰岛素抵抗的关系研究

目的　观察单纯性肥胖患者血清真胰岛素和胰岛素抵抗的关系。　方法　单纯性肥胖者 70例 ,正常对照组3 0例 ,均检测身高、体重、腰围、臀围 ,同时测定血清真胰岛素 (TI)、空腹血糖 (FPG)、血甘油三脂 (TG)、胆固醇 (CHO) ,计算胰岛素敏感指数 (ISI) [ISI =1/(FPG×TI) ] ,并对ISI与各指标进行相关性分析。　结果　肥胖患者血清真胰岛素水平明显高于对照组 (P <0 0 1) ,ISI显著低于对照组 (P <0 .0 1) ,直线相关分析显示 ,ISI与BMI、体重、腰围、TG呈负相关 ,r依次为 -0 .678、-0 .5 40、-0 .5 68(P <0 .0 1) ,-0 .2 47,(P <0 .0 5 )。多元逐步回归分析显示影响肥胖患者ISI的最重要因素是BMI( -0 .5 14 )、TG( -0 .3 5 0 )、腰围 ( -0 .3 11) (R2 =0 .669,F =3 3 .814 ,P <0 .0 1)。去除BMI的影响因素后 ,ISI与TG明显负相关 (r =-0 .2 96,P <0 .0 5 )。　结论　肥胖患者有高真胰岛素血症和胰岛素抵抗 ,胰岛素抵抗与BMI、甘油三脂、腰围明显相关。     

肥胖患者血清胰岛素、真胰岛素的变化及其胰岛素抵抗的影响因素分析

目的　观察单纯性肥胖患者血清胰岛素、真胰岛素变化 ,并分析胰岛素抵抗的影响因素。方法　单纯性肥胖者 70例 ,正常对照组 3 0例 ,均检测身高、体重、腰围、臀围 ,同时测定血清真胰岛素 (TI)、免疫活性胰岛素 (IRI)、空腹血糖 (FPG)、血甘油三脂 (TG)、胆固醇 (CHO) ,计算胰岛素敏感指数 (ISI) [ISI1=1/(FPG×TI) ,ISI2 =1/(FPG×IRI) ] ,并对ISI1与各指标进行相关性分析。结果　肥胖患者血清胰岛素、真胰岛素水平明显高于对照组 (P <0 0 1) ,ISI1、ISI2 显著低于对照组 (P <0 0 1) ,但ISI1的降低要比ISI2 降低明显 ( P <0 0 1) ;直线相关分析显示 ,ISI1与BMI、体重、腰围、TG呈负相关 ,γ依次为 -0 678、-0 5 40、-0 5 68( P <0 0 1) ,-0 2 47,(P <0 0 5 )。多元步回归分析显示影响肥胖患者ISI1的最重要因素是BMI( -0 5 14 )、TG( -0 3 5 0 )、腰围 ( -0 3 11) ( χ2 =0 669,F =3 3 814 ,P <0 0 1)。去除BMI的影响因素后 ,ISI1与TG明显负相关 (γ =-0 2 96,P <0 0 5 )。结论　肥胖患者有高胰岛素血症和胰岛素抵抗 ,真胰岛素水平比免疫活性胰岛素水平更能反映胰岛素抵抗的程度 ,胰岛素抵抗与BMI、甘油三脂、腰围明显相关。     

肥胖高血压患者血清瘦素与肾素-血管紧张素-醛固酮系统及胰岛素相关性分析

目的分析瘦素与肾素-血管紧张素-醛固酮系统（RAAS）、胰岛素的相关性,探讨瘦素在肥胖高血压患者发病中的病理生理机制。方法收集肥胖高血压患者38例,非肥胖高血压患者32例,肥胖者33例,健康对照者33例。测定瘦素、空腹胰岛素（FINS）、肾素（PRA）、血管紧张素Ⅱ（AngⅡ）、醛固酮（ALD）和空腹血糖（FPG）,计算胰岛素敏感性指数（ISI）。测量身高、体重,计算体质指数（BMI）。结果肥胖高血压组、高血压组和肥胖组患者ISI均低于对照组（P〈0.05）。肥胖高血压组、肥胖组患者瘦素水平高于对照组（P〈0.05）,肥胖高血压组患者瘦素水平高于肥胖组（P〈0.05）。以瘦素为因变量进行多元逐步回归分析,发现影响血清瘦素水平的因素主要是性别、收缩压、BMI、ISI和PRA（r^2=0.596,P〈0.05）。各组患者瘦素水平均与ISI负相关（P〈0.05）。肥胖高血压组患者瘦素水平与PRA、ALD正相关（P〈0.05）,高血压组患者瘦素水平与AngⅡ正相关（P〈0.05）,肥胖组患者瘦素水平与PRA正相关（P〈0.05）。将肥胖高血压组和高血压组合并后,按PRA分为高肾素组（B组）、低肾素和正常肾素组（A组）,B组患者瘦素水平高于A组（P〈0.05）。结论肥胖者、肥胖高血压者均存在瘦素抵抗和胰岛素抵抗,二者相互作用。瘦素通过影响RAAS活性导致肥胖者血压增高,主要表现为收缩压升高,并且这一效应独立于胰岛素。     

代谢综合征患者血清抵抗素和瘦素水平关系的探讨

目的探讨代谢综合征(MS)患者血清抵抗素、瘦素水平与血脂、肥胖和胰岛素抵抗的关系。方法按体重指数将60例MS患者分为肥胖组和非肥胖组,采用ELISA方法测定受试者空腹血清抵抗素及瘦素水平,同时检测其身高、体重、腰围、臀围、血压、血糖、血脂及胰岛素,并计算体重指数(BM I)、腰臀比(WHR)和胰岛素抵抗指数(HOMA-IR)并与对照组比较。结果MS患者肥胖组和正常对照组相比其血清抵抗素及廋素水平明显升高(P<0.01)。MS非肥胖组和正常对照组相比其血清抵抗素及廋素水平明显升高(P<0.05,或P<0.01)。肥胖组和非肥胖组相比其血清抵抗素、瘦素水平无统计学意义。显示血清抵抗素水平与腰臀比、空腹胰岛素、胰岛素抵抗指数呈显著正相关(r=0.22,0.22,0.19;P<0.05);与体重指数、腰围、臀围、瘦素呈显著正相关(r=0.31,0.32,0.36,0.28;P<0.01);与高密度脂蛋白胆固醇(HDL-C)呈显著负相关(r=-0.24;P<0.05)。相关分析也显示血清瘦素水平与体重指数、腰围、臀围、腰臀比、收缩压、舒张压、甘油三酯、空腹胰岛素、胰岛素抵抗指数呈显著正相关(r=0.59,0.64,0.53,0.64,0.47,0.53,0.49,0.39,0.32;P<0.01),与血糖呈显著正相关(r=0.23;P<0.05),与高密度脂蛋白胆固醇(HDL-C)呈显著负相关(r=-0.40;P<0.01)。结论MS患者血清抵抗素、瘦素水平均明显升高,并存在一定的瘦素抵抗,且与肥胖、腹型肥胖及胰岛素抵抗程度有明显相关性,因而抵抗素、瘦素、瘦素抵抗可能在肥胖和胰岛素抵抗、MS的发生及发展中具有重要的作用。     

2型糖尿病患者瘦素水平及其相关因素分析

目的　研究 2型糖尿病患者血清瘦素与性别、体重指数 (BMI)、腰臀比 (WHR)、胰岛素、血糖、总胆固醇和甘油三脂的关系。方法　随机选取 5 6例 2型糖尿病患者与 2 2例非糖尿病者 ,分别测定入选对象的体重指数、腰臀比值 (WHR)、空腹瘦素、空腹和餐后 2h血糖、总胆固醇和甘油三脂。结果　血清平均瘦素水平男性 ( 8 5± 0 9)ug/L ,女性 ( 17 2± 1 1)ug/L ,女性明显高于男性 ,血清瘦素与BMI呈显著正相关 (γ =0 64 ,P <0 0 1) ,与男性WHR显著正相关 (γ =0 5 0 ,P <0 0 1) ,血清瘦素与胰岛素显著正相关(空腹γ =0 3 6,P <0 0 1,餐后 2hγ =0 3 4,P <0 0 1) ,瘦素与血糖、血脂没有相关性。结论　血清瘦素浓度与BMI、男性WHR显著正相关 ,与胰岛素有显著正相关性。     

超重及肥胖儿童胰岛素敏感性及β细胞功能研究

【目的】研究超重及肥胖儿童胰岛素敏感性、胰岛素抵抗及β细胞功能。【方法】随机抽取新疆乌鲁木齐市天山区六所中小学10～15岁的在校学生527人,根据体重指数(bodymassindex,BMI)分为超重肥胖组和正常对照组,并进行体格检查和实验室生化检测。采用HOMA-IR,HOMA-B及胰岛素敏感指数(insulinsensitiveindex,ISI)评价。【结果】超重及肥胖组的ISI显著低于正常组(P<0.01),胰岛素抵抗指数(insulinresisindex,IR)、β细胞功能指数(β-cellfunctionindex,HBCI)显著高于正常组(P<0.01)。同时ISI与BMI负相关,IR与BMI、WHR呈正相关,HBCI与BMI呈正相关,与WHI呈负相关。【结论】超重肥胖儿童存在胰岛素的敏感降低、胰岛素抵抗及β细胞功能异常。     

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.