急性脑梗死致多器官功能障碍综合征C-反应蛋白与胰岛素抵抗的相关性

目的探讨急性脑梗死(ACI)致多器官功能障碍综合征(MODS)时C-反应蛋白(CRP)与胰岛素抵抗之间的关系。方法分别测定40例正常健康体检者(正常对照组)和72例ACI患者出现首发症状14 d以内空腹血糖、胰岛素、CRP的含量,计算胰岛素敏感指数(ISI)。ACI患者中急性单纯性脑梗死(SACI组)44例,ACI致MODS(MODS组)28例。结果(1)SACI组及MODS组空腹血糖、胰岛素、CRP水平均显著高于正常对照组,ISI显著低于正常对照组,MODS组空腹血糖、胰岛素和CRP水平又显著高于SACI组,差异均有统计学意义。(2)SACI组与MODS组CRP及胰岛素的动态变化规律明显不同,MODS组为持续异常升高(。3)SACI组与MODS组CRP水平与胰岛素水平呈显著正相关,与ISI呈显著负相关。结论ACI致MODS时存在血CRP水平的异常增高和胰岛素抵抗,且胰岛素抵抗可导致CRP水平进一步上升,它们可能共同参与了MODS的发生及发展过程。     

老年高血压患者合并腔隙性脑梗死与胰鸟素抵抗的关系

目的研究高血压合并腔隙性脑梗死与胰岛素抵抗（IR）的关系。方法将65例老年高血压合并脑梗死患者按照梗死灶直径分为腔隙性脑梗死组和非腔隙性脑梗死组，测定空腹血糖、胰岛素、血脂，计算胰岛素敏感指数（ISI），并与30例健康对照者进行比较。结果高血压合并脑梗死病人血脂、胰岛素、ISI与对照组比较，差异有统计学意义（P〈0．05），腔隙性脑梗死组胰岛素明显高于非腔隙性脑梗死组（P〈0．05），腔隙性脑梗死组ISI较非腔隙性脑梗死组明显减低（P〈0．05）。结论高血压合并脑梗死存在胰岛素抵抗，胰岛素抵抗可能是独立危险因素之一，腔隙性脑梗死可能直接与IR有关。     

C-反应蛋白在多囊卵巢综合征中的变化及意义

目的:探讨多囊卵巢综合征(PCOS)患者血清中C-反应蛋白(CRP)的变化及与胰岛素抵抗的关系。方法:将46例PCOS患者按体重指数(BMI)分为非肥胖PCOS组(18例)和肥胖PCOS组(28例),27例正常妇女分为非肥胖对照组(11例)和肥胖对照组(16例)。测定血清卵泡刺激素(FSH)、黄体生成素(LH)、泌乳素(PRL)、雌二醇(E2)、睾酮(T)、空腹血糖(FPG)、空腹胰岛素(FINS)、CRP浓度。结果:PCOS组LH、LH/FSH、T、FINS显著高于对照组,胰岛素敏感指数(ISI)显著低于对照组,两组CRP水平无显著差异。肥胖PCOS组和肥胖对照组血清CRP水平均显著高于各自的非肥胖组。血清CRP水平与BMI、FINS呈正相关,与ISI呈负相关。结论:PCOS患者不存在慢性亚临床炎症,心血管病风险仅限于合并肥胖或胰岛素抵抗的PCOS患者。     

肥胖与非肥胖型多囊卵巢综合征患者血清C反应蛋白水平及意义

[目的]探讨肥胖与非肥胖型多囊卵巢综合征(PCOS)患者血清中C反应蛋白(CRP)的变化及与胰岛素抵抗的关系。[方法]将56例PCOS患者按体重指数(BMI)分为非肥胖PCOS组(22例)和肥胖PCOS组(34例),46例正常妇女分为非肥胖对照组(19例)和肥胖对照组(27例)。测定血清卵泡刺激素(FSH)、黄体生成素(LH)、泌乳素(PRL)、雌二醇(E2)、睾酮(T)、空腹血糖(FPG)、空腹胰岛素(FINS)、CRP浓度。[结果]PCOS组LH、LH/FSH、T、FINS显著高于对照组,胰岛素敏感指数(ISI)显著低于对照组,两组CRP水平无统计学差异。肥胖PCOS组和肥胖对照组血清CRP水平均显著高于各自的非肥胖组。血清CRP水平与BMI、FINS呈正相关,与ISI呈负相关。[结论]PCOS患者不存在慢性亚临床炎症,心血病风险仅限于合并肥胖或胰岛素抵抗的PCOS患者。     

不孕妇女性激素水平与胰岛素水平关系

目的 研究血清性激素、胰岛素水平与不孕的关系。方法 筛选120名不孕妇女，其中多囊卵巢综合征（PCOS）48例，非PCOS不孕妇女72例为实验组，测定血清黄体激素（LH），睾硐（T）卵泡刺激素（FSH），雌二醇（E2），空腹胰岛素（FINS），空腹血糖（FBG），并计算出胰岛素抵抗指数（HOMA-IR）。另设50名正常生育妇女作对照组。结果 （1）不孕组血清LH、T、FINS及HOMA-IR明显增高，FSH、E2和ISI明显下降（P〈0．01）；（2）与非PCOS组比较，PCOS组FINS、LH和T明显增高，E2、ISI明显下降（P〈0．01）；LH／FSH比值也明显高于非PCOS组（P〈0．01）；（3）不孕组的血清T水平与INS，HOMA-IR及呈正相关，与ISI呈负相关（P〈0．05），E2水平与INS、HOMA-IR呈负相关，与ISI呈正相关（P〈0．05）。结论 不孕妇女血清性激素水平异常，胰岛素抵抗尤其是PCOS患者表现为高胰岛素血症，高雄激素血症。     

急性脑梗死患者的胰岛素抵抗与血脂代谢异常的关系

目的探讨急性脑梗死(ACI)患者的胰岛素抵抗(IR)及其对血脂代谢异常的影响。方法选择72例急性脑梗死患者,检测其空腹血糖(FPG)、空腹血胰岛素(FINS)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)浓度,并按公式计算胰岛素抵抗指数(HOMA-IR)。同健康对照组60例比较。结果急性脑梗死患者FPG、FINS、HOMA-IR、TG、TC、LDL明显升高,而HDL明显降低(p<0.001或p<0.05)。结论急性脑梗死患者存在胰岛素抵抗(IR),且IR与血脂代谢异常密切相关。提示防治IR及血脂代谢紊乱可减少ACI的发生和发展。     

2型糖尿病胰岛素抵抗与脂代谢关系分析

目的 探讨2型糖尿病胰岛素抵抗（IR）与脂代谢异常之间的关系.方法 测定106例2型糖尿病患者和100例正常对照者空腹血糖（FPG）、空腹胰岛素及脂代谢指标,并进行相关性分析.结果 2型糖尿病组空腹血糖、血清、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、水平明显高于正常对照组（P〈0.01）,高密度脂蛋白胆固醇（HDL-C）水平明显低于正常对照组（P〈0.01）.结论 2型糖尿病患者有高胰岛素血症、胰岛素抵抗和脂代谢异常.     

超敏C反应蛋白和可溶性细胞间黏附分子-1 与慢性妊娠糖尿病患者胰岛素抵抗的关系

目的探讨炎性因子超敏C反应蛋白（hs—CRP）和可溶性细胞间黏附分子-1（sICAM-1）与妊娠糖尿病患者产生胰岛素抵抗的关系，为妊娠糖尿病的治疗提供依据。方法随机选择2009年1月至2012年12月期间来我院治疗的72例慢性妊娠糖尿病患者作为研究对象，另取60例口服葡萄糖耐量试验（OGTT）正常的健康孕妇、60例妊娠期糖耐量减低（GIGT）的孕妇作为对照组，比较3组孕妇的hs—CRP、sICAM-1、空腹胰岛素水平及血糖水平，计算孕妇胰岛素抵抗指数。结果妊娠糖尿病组孕妇的hs—CRP、sICAM-1、血糖、空腹胰岛素水平均明显高于GIGT组和健康孕妇组，而GIGT组孕妇明显高于健康孕妇组，差异均有统计学意义（P〈0．05）。结论炎症因子hs—CRP、sICAM-1和妊娠糖尿病患者的胰岛素抵抗有一定的关系。     

普伐他汀对原发性高血压高脂血症及胰岛素抵抗的影响

目的 观察普伐他汀对原发性高血压高脂血症及胰岛素抵抗的影响。方法60例1、2级原发性高血压伴高脂血症者随机分为治疗组和对照组各30例，在3个月降压治疗中，治疗组加用普伐他汀（10mg-20mg，qn），对照组维持原治疗，观察治疗前后的血脂、空腹血糖和胰岛素的变化。结果治疗组治疗后胆固醇下降12．8％，甘油三酯下降8．9％，低密度脂蛋白胆固醇下降10．7％，高密度脂蛋白胆固醇上升了8．2％，胰岛素敏感指数（ISI）显著改善（P〈0．05），且与对照组有显著差异；而对照组血脂水平、ISI虽有下降，但无显著性意义。结论普伐他汀治疗原发性高血压伴高脂血症患者效果明确，并且显著改善其胰岛素抵抗。     

非糖尿病慢性肾病患者游离脂肪酸水平与炎症因子及胰岛素抵抗的相互关系

目的 研究非糖尿病慢性肾病（CKD）患者游离脂肪酸（FFA）水平与炎症因子及胰岛素抵抗（Homa-IR）的相关性.方法 收集本院非糖尿病CKD84例（A组）,糖尿病肾病62例（B组）,健康体检者64例（C组）,检测其FFA、超敏C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、空腹胰岛素（FINS）、胰岛素敏感指数（ISI）、胰岛素抵抗指数（Homa-IR）及血脂等,分析FFA与炎症因子及Homa-IR等指标的关系.结果 A组非透析者与透析者除空腹血糖（FPG）、高密度脂蛋白（HDL）外各项指标差异均有统计学意义（P＜0.05）,与C组比较除FPG、FINS、总胆固醇（TC）、低密度脂蛋白（LDL）外余项差异均有统计学意义（P＜0.05）；A组、B组与C组多组间比较各项指标差异均有统计学意义（P ＜0.01,P＜0.05）；A、B组两组比较FFA、CRP、FPG、FINS、ISI、Homa-IR差异有统计学意义（P＜0.05）；A组FFA水平与CRP、TNF-α、FINS、Homa-IR、甘油三酯（TG）和脂蛋白α（LP-α）呈正相关（r=0.499,0.378,0.401,0.409,0.301,0.299,P＜0.01）,与ISI呈负相关（r=-0.399,P ＜0.01）.结论 非糖尿病CKD患者游离脂肪酸水平升高,且与炎症因子和胰岛素抵抗密切相关.     

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.