输血传播性丙型肝炎病毒感染的相关因素探讨

目的研究输血传播性丙型肝炎与输血量、抗-HCV和ALT筛检献血血液、国内厂商的抗-HCV试剂盒质量的关系。方法抗-HCV采用ELISA检测，ALT用速率法测定，HCVRNA用RT-PCR定性测定，相关因素的统计分析应用2检验和相关回归分析。结果输血传播性丙型肝炎发生率与输血量X（U）呈正相关。输入经抗-HCV筛检的血液比输入未经抗-HCV筛检的血液的丙肝发生率减少79．76％，有非常显著的意义（χ^2=315．,06，P〈0．001）。献血者ALT异常数与抗-HCV阳性两者有关联性（χ^2=176．81，P〈0．001），但关系很疏远（Pearson列联系数C=0．046）。国产ELISA抗-HCV试剂盒的弱阳性重复性符合率的差异无统计学意义（χ^2=2．66，P〉0．05），合计弱阳性重复性符合率是62．84％，不确定率是37，16％；总体阳性重复性符合率之间的差异有非常显著的统计学意义（χ^2=10．02，P〈0．001），合计总阳性重复性符合率是90．01％，总不确定率是9．99％。配对比较国产ELISA抗一HCV试剂阳性检出率差异有非常显著的统计学意义（χ^2=8．05、30．11，P〈0．01）。结论随着输血量的增大，输血后丙型肝炎感染的危险性随之增大，符合Frost—Reed模型。建议血站用高质量的ELISA抗HCV试剂，并增加HCVAg或HCVRNA检测以缩短感染的“窗口期”，减少HCV病毒感染的残余风险度，保证输血安全。     

输血后丙型肝炎病人10年前瞻性研究

目的研究26例丙肝病人的演变过程.方法采用前瞻性的研究方法,以26例已跟踪10年以上的丙肝病人作为研究对象,对所采集到的输血前及输血后血清,进行ALT和抗HCV检测及HCV RNA检测.结果对该26例输血后丙肝病人跟踪时间平均128个月,输血后抗HCV最早于第15天被检测到,最晚出现于第80天,平均窗口期为42d,至第11年时其抗HCV阳性率仍维持在约70%.大多数病人在输血后的30d内其ALT即出现异常,随后其ALT的变化大致可分为3种类型:短期异常后转为正常并维持至今;ALT维持较长时间异常;ALT呈波浪式反复异常.笔者所跟踪的26例输血后丙肝病人中,24例病人的ALT或只有一个异常峰,但维持时间较长(平均16个月),或呈现波浪式多次的高异常,其抗HCV在第¨年时仍绝大多数维持阳性,说明丙肝病毒在人体内引起的免疫反应较弱而持久.2例病人在ALT异常5个月后转为正常,随后其抗HCV及HCV RNA亦转为阴性,至今已超过10年未发现肝炎症状,HCV感染人体以后能引起较快、较强的免疫反应,该被感染者又能通过免疫系统将病毒清除掉.结论大多数丙型肝炎病人转为慢性化,少数丙型肝炎病人则存在自愈.     

输血后丙型肝炎病毒感染者转归研究

本文采用前瞻性研究方法,调查了92名抗-HCV阴性,ALT正常的一次性受血者,输血后丙型肝炎病毒感染率为57.6％(53/92),其中输血后丙型肝炎占79.2％(42/53)。潜伏期20～90天,平均39.5±18.2天;输血后24～90天ALT开始异常,平均48.3±16.0天;抗-HCV检出时间为输血后24～192天。平均69.9±42.6天;HCVRNA检出时间为输血后30～81天,平均42.2±18.1天。12个月临床痊愈率为50.0％;24个月为57.1％,输血后丙型肝炎病人HCVRNA12个月阳性率为66.7％(4/6),抗-HCV12个月和24个月阳性率均为100.0％。     

丙型肝炎病人重叠感染乙肝病毒的血清学分析

目的：探讨丙型肝炎病人重叠感染乙肝病毒（HBV）的血清状况。方法：用TC-PC多聚酶链反应及ELISA酶联免疫吸附测定方法对丙型肝炎病人血清进行HCV-RNA及抗-HCV检测，并用ELISA方法与对照组一同进行抗-HCV、HBsAg、抗-HBc、HBeAg检测。结果：丙型肝炎病人的HBV重叠感染率为78．18％和正常人群的HBV感染率24．60％相比，P〈0．001，有显著性差异。重叠感染HBV的丙型肝炎病人和单一HCV感染的丙型肝炎病人的抗-HCV水平的均值比，P〉0．05，无显著性差异；丙型肝炎病人重叠感染HBV后其HBeAg阳性率很低，和正常人群相比无显著性差异，P〉0．05。结论：丙型肝炎病人极易重叠感染HBV；丙型肝炎病人抗-HCV抗体水平较低，重叠感染后其抗HCV抗体水平不受影响；结果还支持HCV和HBV的重叠感染会干扰抑制HBV的复制的论点。     

1732例输血前HBsAg、ALT、HIV、HCV、TP结果分析

为防范医疗风险，我国《输血技术规范》规定，给病人输血前需对其进行乙肝、丙肝、艾滋病、梅毒等方面检查。据悉，目前的医疗水平还不能在患者感染这些病患后，确定其感染途径是什么，唯有对比前后检查结果，方可判断是否因输血引起。本文对本院2004年1月-2006年12月份1732例输血前检查乙型肝炎表面抗原HBsAg,丙氨酸氨基转移酶ALT、艾滋病抗体（抗-HIV）、丙型肝炎抗体（抗-HCV）、梅毒螺旋体抗体（抗-TP）五项结果报告如下：     

抗-HCV、HCV-RNA、ALT在HCV感染病程中的分布

目的：了解抗-HCV、HCV-RNA、ALT在输血后HCV感染者病程中的动态变化。方法：运用ELISA法及PCR法对205例输血后肝炎进行检测，对105例输血后HCV感染病例进行追踪调查。结果：抗-HCV及HCV-RNA阳性率分别为57.1％和55.1％，抗-HCV阴性中HCV-RNA阳性率达30．2％。抗-HCV、HCV-RNA及ALT在急性及慢性病人临床病程中呈现不同的特点。结论：PCR法在HCV感染的确诊、血源筛选等方面具有一定的流行病学意义。     

荧光定量PCR法筛查混合血浆中HCV的临床意义

输血是感染丙型肝炎的主要传播途径。我国在九十年代开始对献血员进行抗一HCVELISA法检测，较好地控制了输血后丙型肝炎的传染。但因“窗口期”、病毒变异、免疫静默感染等原因，血清学方法筛查丙型肝炎抗体仍存在一定的漏检，因而可能会造成少数患者输血后感染HCV。为了解我市献血员中（抗-HCV阴性）隐匿性HCV感染状况，笔者采用FQ—PCR方法对2000例抗-HCV阴性献血员血液进行FQ—PCR检测，现报告如下。     

110例丙型肝炎病人HBV重叠感染的血清学分析

[目的]为探讨丙型肝炎HBV重叠感染的血清状况.[方法]用TC-PC多聚酶链反应及ELISA酶链免疫吸附测定方法对110例丙型肝炎病人血清进行HCVRNA及抗-HCV检测,并用ELISA方法与对照组一同进行抗-HCV、HBsAg、抗-HBc、HBeAg检测.[结果]丙型肝炎的HBV重叠感染率为78.18%(86/110)和正常人群的HBV感染率24.60%(33/125)相比P《0.001,OR(观测率)值为9.99,ARP为90%;丙型肝炎的HBV重叠感染和单一HCV感染的抗-HCV水平(S/Co比值)均值比P《0.20,差异无显著性;HBV和HCV重叠感染其HBeAg感染率很低,和正常人群相比差异无显著性,P》0.05.而且,HBeAg的(S/Co比值)均值比差异也无显著性,P》0.05.[结论]丙型肝炎病人极易重叠感染HBV;丙型肝炎病人抗-HCV抗体水平较低,重叠感染后其HCV抗体水平不受影响;HCV与HBV重叠感染干扰抑制HBV的复制.     

母亲丙肝抗体阳性儿童的丙型肝炎病毒感染及相关性肝脏疾病

由于丙型肝类（HCV）在围产期传播极少，有关HCV感染自然病史的报道少见，该研究旨在调查一组抗HCV阳性母亲所生的HCVRNA阳性的婴儿及一组母亲为唯一可能传染源的慢性丙型肝炎患儿的临床、血清学及病毒学特征。方法第一组为14例抗HCV阳性母亲所生的1岁内感染HCV的婴儿，根据出生后3个月及以后血清标本至少一次检到HCVRNA做出诊断。此组均无围产期输血及血制品史，无手术史，且均非母乳喂养。生后第3个月起每3个月体检一次并检测ALT、抗HCV和HCVRNA，ALT增高者同时检测HBSAg、甲型肝炎病毒、巨细胞病毒和EB病毒的IgM抗体…     

献血感染丙型肝炎人群转归分析

目的研究献血感染丙型肝炎病毒（HCV）人群16年后的转归。方法对该人群问卷收集一般情况,肝脏B超检查;采集5ml静脉血,进行丙型肝炎病毒抗体、RNA、谷丙转氨酶（ALT）和血清生化指标（透明质酸、Ⅲ型前胶原肽、Ⅳ型胶原）检测。结果162名研究对象尚未出现晚期肝病患者。抗-HCV阳性率95.68%,RNA阳性率77.78%,ALT异常率20.37%。不同急性期症状感染者,16年后抗-HCV阳性率、ALT异常率和RNA阳性率差异无统计学意义。经性别分层分析,女性感染年龄〉40岁抗体较易阴转（χMH^2=8.26,P=0.04）。结论HCV感染16年后,不同急性期症状感染者转归无差异,病毒清除与性别和初始感染年龄有关。     

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.     

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.     

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.     

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.     

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.     

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.     

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.