氯吡格雷对高龄冠心病患者血小板功能的影响

目的 对比研究32例高龄冠心病患者服用氯吡格雷对血小板功能指标的影响.方法 利用血栓弹力图、流式细胞仪、血小板聚集仪三种检测方法,观察服用氯吡格雷前和服用7d后患者血栓最大幅度(MAthromhin、MAADP)、ADP诱导血小板抑制率、P选择素、活化GPⅡ b/Ⅲa、ADP诱导的血小板聚集率的改变.结果 连续服用氯吡格雷7d后,血小板抑制程度显著增加,MAADP显著减少(P＜0.01);血小板表面表达的P选择素、活化GPⅡb/Ⅲa明显减少(P＜0.01);血小板聚集率明显减少(P＜0.01).结论 高龄老年冠心病患者在服用氯吡格雷治疗后能够获得确切的抗血小板聚集效果.     

GPⅡb/Ⅲa受体拮抗剂-替罗非班在急性冠脉综合征中的应用与进展

血小板糖蛋白GPⅡb/Ⅲa受体拮抗剂可以有效抑制血小板聚集。作为目前较新的抗血小板药物,GPⅡb/Ⅲa受体拮抗剂在作用机制、用法等方面都不同于传统的阿司匹林和氯吡格雷等药物。本文针对唯一在中国上市的GPⅡb/Ⅲa受体拮抗剂-替罗非班(欣维宁)略作综述。     

GPⅡb／Ⅲa受体拮抗剂-替罗非班在急性冠脉综合征中的应用与进展

血小板糖蛋白GPⅡb／Ⅲa受体拮抗剂可以有效抑制血小板聚集。作为目前较新的抗血小板药物,GPⅡb／Ⅲa受体拮抗剂在作用机制、用法等方面都不同于传统的阿司匹林和氯吡格雷等药物。本文针对唯一在中国上市的GPⅡb／Ⅲa受体拮抗剂一替罗非班（欣维宁）略作综述。。     

CYP2C19中间代谢型个体化抗血小板治疗

目的通过血栓弹力图(TEG)监测ADP诱导的血小板抑制率,观察冠心病患者CYP2C19基因检测中间代谢型(*1/*2和*1/*3)服用氯吡格雷与替格瑞洛的疗效比较。方法自2014年10月开始选取入解放军总医院心血管内科住院治疗行经皮冠状动脉介入(PCI)术,且CYP2C19基因检测为中间代谢型(*1/*2和*1/*3)的冠心病患者48例,其中男34例,女14例,分为氯吡格雷组(25例)及替格瑞洛组(23例),术后在口服阿司匹林0.1 g,1次/d的基础上分别服用氯吡格雷(75 mg,1次/d),及替格瑞洛(90 mg,2次/d),分别于服药后1、4、12周观察ADP诱导的血小板抑制率的变化,并比较两组主要不良心血管事件的发生情况。结果 3个时间点1、4、12周与氯吡格雷组比较,替格瑞洛组治疗后,ADP诱导的血小板抑制率升高,差异均具有统计学意义(P0.05)。结论冠心病患者CYP2C19基因检测中间代谢型(*1/*2和*1/*3)服用替格瑞洛替代氯吡格雷明显升高ADP诱导的血小板抑制率,减少主要不良心血管事件。     

妊娠高血压综合征血小板活化分子标志物的变化及意义

目的:通过妊娠高血压综合征血小板分子标志物的测定,观察妊高征血小板的活化程度。方法:选择各期妊高征患者共60例,正常妊娠晚期孕妇(对照组)15例,采用流式细胞术(FC)测定全血P-选择素,GPⅡb/Ⅲa的含量。结果:妊高征组与对照组相比,P-选择素、GPⅡb/Ⅲa明显升高(P<0.05,P<0.01);轻中度妊高征与重度妊高征相比,P-选择素、GPⅡb/Ⅲa均有明显差异(P<0.01);重度妊高征与先兆子痫相比,P-选择素、GPⅡb/Ⅲa均无明显差异(P>0.05)。结论:重度妊高征血小板P-选择素,GPⅡb/Ⅲa的含量明显升高,血小板处于活化状态。     

血小板膜糖蛋白Ⅱb／Ⅲa受体拮抗剂的研究与应用

血小板活化形成的血小板血栓是动脉血栓形成的始动环节。血小板膜糖蛋白（glycoprotein，GP）参与血小板活化，GPⅡb／Ⅲa作为纤维蛋白原受体，介导血小板聚集的最终途径，是国内外研究的热点。GPⅡb/Ⅲa受体拮抗剂目前已成为一类新型、强效、合理的抗血小板药物。本文就GPⅡb／Ⅲa受体拮抗剂的研究及临床应用作一综述。     

咖啡对血小板糖蛋白ⅡbⅢa、CD40L表达的急性影响

目的研究咖啡对血小板功能的影响,阐明其中可能的机制。方法 12名健康男性被随机分配到三组之一,进行为期3w的交叉试验,分别饮用相同咖啡因含量(180 mg)的咖啡、咖啡因片剂或安慰剂。分别在即刻0、2、4h采血,对血小板进行全血流式细胞仪分析,测定血小板活化状态糖蛋白ⅡbⅢa(glycoprotein ⅡbⅢa,GPⅡbⅢa)、CD40L表达。另在体外,测定不同浓度咖啡因对血小板GPⅡbⅢa影响。结果与对照组比较,饮用咖啡抑制二磷酸腺苷(ADP)诱导的GPⅡbⅢa表达(2h和4h,P0.05)和CD40L表达(2h和4h,P0.05)。咖啡也抑制花生四烯酸诱导GPⅡbⅢa表达(2h和4h,P0.05)和CD40L表达(2h,P0.05)。安全剂量咖啡因的摄入不影响血小板活化后GPⅡbⅢa和CD40L表达。结论咖啡在体内可以通过减少血小板GPⅡbⅢa、CD40L表达,进而调节血小板功能,安全剂量下咖啡因没有显示以上作用。     

氯毗格雷联用阿司匹林对不稳定型心纹痛患者血小板聚集率的影响

目的 评价氯吡格雷联用阿司匹林对不稳定型心绞痛患者血小板聚集率的影响.方法 将60例不稳定型心绞痛患者按随机数字表法分为观察组(n=30)和对照组(n:30).观察组服用氯吡格雷75 mg/次,1次/d,阿司匹林100 mg/次,1次/d;对照组服用阿司匹林100 mg/次,1次/d,2组疗程2周.分析服药前后测定血小板最大聚集率的变化.结果 2组患者的基线实验室检测的各项参数差异无统计学意叉(P>0.05).治疗前后ADP值差异有统计学意义(F=4026.78,P<0.01),治疗后ADP值降低.观察组与对照组ADP差异有统计学意义(F=12046.36,P<0.01),观察组低于对照组.治疗分组与治疗时间存在交互作用(F=158.12,P<0.01),而治疗后2组ADP值下降速度不同,观察组降低更快.观察组有1例患者出现腹泻,1例患者出现齿龈出血,但症状轻微.结论 氯吡格雷联用阿司匹林能显著降低血小板聚集率,安全有效,患者耐受性好.     

氯吡格雷抵抗患者的预测评分方法的探索

目的探讨本地区氯吡格雷抵抗患者的预测评分方法。方法用RCT法选取2013年5月-2014年4月在本院心病科就诊的冠心病患者365例,检测血小板数量、血小板聚集率及CD62p。入选患者服用氯吡格雷300 mg,75 mg/d维持7 d检测血小板数量、血小板聚集率及CD62p。根据患病史、检测数据与患者服用氯吡格雷前后血小板聚集率的情况,用Logistic回归法分析,最终得出氯吡格雷抵抗的预测评分表。结果服用氯吡格雷前后,血小板聚集率和CD62p差异有统计学意义(t值分别为14.12、4.50,P=0.00)。高血脂、糖尿病、CD62p与氯吡格雷抵抗的关系较大,高血压相对较小。结论急性冠心病患者有糖尿病、高血脂病史或者CD62p活性高,则氯吡格雷抵抗的发生几率较大;积分越高,氯吡格雷抵抗的发生几率就越大。     

吸烟对慢性阻塞性肺疾病急性加重期患者血小板活化及预后的影响

目的 探讨吸烟对慢性阻塞性肺疾病急性加重(AECOPD)患者血小板活化及预后的影响。方法 收集某医院呼吸科所收治的80例AECOPD患者,根据其吸烟情况分为非吸烟组(32例)和吸烟组(48例)。记录2组患者性别、年龄、病程、住院时间及病死率;检测血常规和膜糖蛋白的阳性表达率。比较吸烟对患者血小板活化指标、住院时间及生存率的影响;分析血小板活化与患者预后的相关性。结果 与非吸烟组相比,吸烟组患者的平均血小板体积(MPV)、GPⅡbⅢa阳性表达率、P选择素阳性表达率、总住院时间和死亡率均有不同程度增加。吸烟指数≥200年×支的AECOPD患者血小板MPV值、GPⅡbⅢa阳性表达率、P选择素阳性表达率、总住院时间和死亡率均高于吸烟指数<200年×支的患者。死亡组患者血小板MPV值、GPⅡbⅢa阳性表达率、P选择素阳性表达率均高于存活组。吸烟指数与血小板MPV值、GP ⅡbⅢa和P选择素阳性表达率均成正强相关(r=0.340,0.343,0.333;P均<0.05);与AECOPD患者住院时间及病死率成正强相关(r=0.628,0.510;P均<0.01)。AECOPD患者死亡率与血小板MPV值、GPⅡbⅢa和P选择素阳性表达率均成正强相关(r=0.539,0.581,0.526;P均<0.01);住院时间与血小板MPV值、GPⅡbⅢa和P选择素阳性表达率均成正强相关(r=0.523,0.512,0.572;P均<0.01)。结论 吸烟能够促进血小板的活化,增加AECOPD患者的住院时间,降低患者的生存率。     

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.     

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.     

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.     

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.