血浆纤维蛋白原、脂蛋白a、D-二聚体与2型糖尿病合并心绞痛的相关性分析

目的探讨血浆纤维蛋白原、脂蛋白a、D-二聚体与2型糖尿病合并心绞痛的相关性。方法选择2015年6月~2018年12月青海省康复医院收治的2型糖尿病的患者157例,将存在冠状动脉狭窄的患者纳入A组共85例,将未合并心绞痛的患者纳入B组共72例,同时选择76例明确冠心病心绞痛诊断未合并糖尿病的患者纳入C组,同时期健康体检的正常健康人群80例纳入健康对照组,对比4组患者的血浆纤维蛋白原(FIB)、脂蛋白a[Lp(A)]、D-二聚体(D-D)水平。根据Gensini积分将A组和C组患者分为3个亚组,<30分组、30~60分组、>60分组,比较各组患者的基本资料,并对影响糖尿病患者合并心绞痛的危险因素进行logistic回归分析,采用Spearman相关性分析Gensini积分与FIB、D-D、Lp(A)水平的相关性。结果A组患者的FIB、Lp(A)、D-D水平显著高于其余3组,B组、C组的FIB、Lp(A)、D-D水平高于健康对照组,C组Lp(A)高于B组,差异均有统计学意义(P<0.05)。经过单因素及多因素回归分析,糖化血红蛋白(HbA1c)、Lp(A)、D-D、FIB是影响糖尿病患者合并心绞痛的危险因素(P<0.05)。相关性分析结果,FIB、Lp(A)、D-D与Gensini评分呈正线性相关(r=0.426,0.382,0.315,P<005)。结论2型糖尿病合并心绞痛的患者的FIB、Lp(A)、D-D水平升高,并且高于单纯糖尿病和单纯冠心病患者。此外HbA1c也是影响糖尿病患者合并心绞痛的危险因素,对于2型糖尿病患者应关注其FIB、Lp(A)、D-D水平变化,预防冠心病发生。     

2型糖尿病视网膜病变患者血脂谱分析

目的了解2型糖尿病视网膜病变患者血脂谱的变化及其与糖尿病视网膜病变(DR)发生的关系。方法选取2型糖尿病患者224例,分为无视网膜病变(NDR)组110例,DR组114例。进行血脂和糖化血红蛋白等生化指标的检测,分析两组患者间病程、糖化血红蛋白及各项血脂指标与视网膜病变的相关性。结果在各项血脂指标中,DR组载脂蛋白B(ApoB)、脂蛋白(a)[Lp(a)]高于NDR组,而载脂蛋白A(ApoA)/ApoB低于NDR组,两组差异有统计学意义(P<0.05)。多因素非条件Logistic回归分析显示,DR的发生与Lp(a)水平(OR=1.30,95%CI:1.01～1.67),ApoA/ApoB(OR=0.54,95%CI:0.33～0.87)及病程(OR=1.73,95%CI=1.30～2.30)相关联。结论 Lp(a)及ApoA/ApoB等血脂异常可能是DR的危险因素之一,积极地纠正血脂紊乱有利于糖尿病视网膜病变的防治。     

血清脂蛋白(a)和胱抑素C与2型糖尿病及微血管并发症的临床研究

目的分析血清脂蛋白(a)[Lp(a)]和胱抑素C(Cys-C)在2型糖尿病(T2DM)以及微血管并发症患者中的变化,探讨其与T2DM及微血管并发症之间的关系。方法分别测定各组糖化血红蛋白(Hb A1c)、低密度脂蛋白(LDL)、尿素氮(BUN)、血肌酐(SCr)、Lp(a)和Cys-C水平,比较其与微血管并发症的关系。结果 T2DM患者的血清Lp(a)和Cys-C水平升高,差异有统计学意义(P0.05)。与无微血管病变的T2DM组相比,DR组和DPN组血清Lp(a)水平升高,而DN组血清Lp(a)和Cys-C水平均升高,并且随着尿白蛋白排泄率(UAER)的升高,血清Lp(a)、Cys-C水平逐渐升高,差异均有统计学意义(P0.05)。Logistic回归分析显示,高水平的Lp(a)是2型糖尿病患者发生糖尿病肾病的危险因素。结论血清Lp(a)和Cys-C与2型糖尿病及微血管并发症具有相关性,Lp(a)在糖尿病肾病的早期就发生改变,同时检测血清Lp(a)和Cys-C对糖尿病微血管病变的早期发现有重要意义。     

血清脂蛋白a水平及三酰甘油与高密度脂蛋白胆固醇比值与2型糖尿病视网膜病变的相关性研究

目的 探讨2型糖尿病患者(T2DM)中血清脂蛋白(a)[Lp(a)]水平、三酰甘油与高密度脂蛋白胆固醇比值(TG/HDL-C)与糖尿病视网膜病变(DR)的相关性。方法 选取T2DM患者420例,分为无DR组(NDR) 179例,非增殖期DR组(NPDR) 143例,增殖期DR组(PDR) 98例,比较3组患者血清Lp(a)水平和TG/HDL-C的差异,并采用Logistic回归分析血清Lp(a)水平、TG/HDL-C与DR的关系。结果 与NDR组相比,NPDR和PDR组血清Lp(a)水平及TG/HDL-C均升高,且PDR组血清Lp(a)水平和TG/HDL-C均高于NPDR组,差异均有统计学意义(P <0.05);Logistic回归分析提示,血清Lp(a)水平和TG/HDL-C均是DR发生的独立危险因素; ROC曲线分析发现,血清Lp(a)水平和TG/HDL-C两者联合可更好地预测T2DM患者发生DR的风险。结论 在T2DM患者中,血清Lp(a)水平和TG/HDL-C与DR密切相关。     

血Lp(a)在糖尿病肾病早期诊断中的价值探讨

目的 探讨糖尿病患者Lp(a)、血糖(FBG)、24 h尿微量总蛋白(M-TP)及尿微量白蛋白排泄率(UAER)与早期糖尿病肾病的关系,寻找糖尿病早期肾病的危险预测因素.方法 测定90例糖尿病患者(包括38例无肾病组、36例早期肾病组及16例临床型肾病组)和24例健康对照者的血清Lp(a)、FBG、M-TP和UAER,分析Lp(a)、FBG、M-TP、UAER与早期DN的关系.结果 Lp(a)和尿M-TP水平与肾损害程度(UAER)呈正相关(r分别为0.4227,0.8125,P＜0.05).血糖与肾损害程度无明显相关(r=0.054).糖尿病无肾病组Lp(a)水平高于对照组(P＜0.01),糖尿病肾病组的M-TP水平明显高于糖尿病无肾病组及对照组(P均＜0.01).结论 血清Lp(a)水平与糖尿病肾损害程度有关,并早于各项尿蛋白指标的异常,有可能作为糖尿病肾病的危险性预测因素.     

脂蛋白（a）、同型半胱氨酸与男性冠状动脉疾病发生的风险研究

目的探讨脂蛋白（a）[Lp（a）]、同型半胱氨酸（Hcy）与男性冠状动脉疾病（CAD）发生的关系。方法选取222例男性患者为研究对象,按照冠状动脉造影结果,将其分为CAD阳性组（111例）与CAD阴性组（111例）。比较两组一般临床资料以及血浆Lp（a）和Hey水平。采用Logistic回归分析影响男性CAD发生的危险因素。结果Lp（a）水平≥0．3g／L时,可以引起CAD的发生（OR=5．04,95％CI1．88～13．51,P=0．001）。而Hcy与CAD的发生无相关性（OR=1．35,95％C10．63～2．89,P=0．443）。但当考虑两个因素交互作用时,血浆中较高的Lp（a）和Hcy水平是CAD发生的危险因素（D尺=11．54,95％C12．62～45．61,P=0．003）。结论血浆Lp（a）和Hey水平升高可能加快男性CAD的发病进程。     

2型DM合并脑梗塞与载脂蛋白、脂蛋白（a）关系的研究

目的：探讨载脂蛋白（Apo)和脂蛋白（a)[Lp(a)]与2型DM合并脑梗塞的关系。方法运用配比的病例对照研究方法,使用Logistic回归模型进行分析。结果：以其他病人作为对照,Apo和Lp(a)与2型DM合并脑梗塞有关;2型DM病人作为对照仅发现Lp(a)与2型DM合并脑梗塞有关,经以2型DM为对照人群归因危险比（PARP）分析,Lp(a)的PARP高达75．67％ 。结论Lp(a)合并脑梗塞的独立危险因素,为了降低2型DM合并脑搴的危险性,应注意控制Lp(a)。．     

冠心病患者血浆脂蛋自水平与冠脉病变相关性研究

目的通过实验室检测血浆脂蛋白水平,初步探讨这些因素与冠状动脉狭窄程度的关系,从而为冠心病的临床诊断和治疗及预后的评估提供一种便捷有效的检验指标。方法所有研究对象均于入院次日清晨取空腹12小时静脉血,通过实验室全自动生化仪分别以氧化酶法测定LP（a）生化指标。结果经T检验显示,CHD组Lp（a）水平明显高于非CHD组（P〈0．05）,Lp（a）危险因素的Logistic分析可见Lp（a）为冠心病的独立危险因素。结论血浆Lp（a）浓度与冠状动脉粥样硬化疾病存在相关性,水平升高是其独立危险因子,也是心肌梗死的预测因子。     

脂蛋白(a)、尿视黄醇结合蛋白与糖尿病视网膜病变的相关性研究

目的:比较T2DM视网膜病变(DR)不同时期,脂蛋白(a)(Lp(a))、尿视黄醇结合蛋白(RBP)变化,寻找早期发现DR的指标。方法:根据眼底病变程度将162例2型糖尿病患者分为无DR组(NDR)、背景型DR组(BDR)、增殖型DR组(PDR)。检测并比较各组受试对象血清Lp(a)尿RBP水平。结果:DR组与NDR组比较:DR组Lp(a)与尿RBP水平均显著高于NDR对照组(P0.05);BDR组与PDR组比较:PDR组Lp(a)与尿RBP水平也显著高于BDR组(P0.01)。结论:Lp(a)与尿RBP均与DR密切相关,糖尿病人Lp(a)与尿RBP联合检测有利于DR的早期发现,对于糖尿病DR的早期治疗和干预有较大的价值。     

冠心病患者血浆组织因子水平及影响因素分析

目的探讨血浆组织因子(tissue factor,TF)水平与冠心病的相关性。方法对237例疑诊为冠心病的患者进行冠状动脉造影,按结果分为冠心病组(n=149)和正常对照组(n=88)进行病例对照研究。所有入选对象检测血脂、血糖、血尿酸、超敏C反应蛋白、纤维蛋白原以及血浆TF的水平。采用spearman等级相关、pearson积差相关和Logistic多元回归等方法,分析血浆TF水平和冠心病的相关性,以及TF水平与冠心病其他危险因素的关系。结果冠心病组血浆TF较对照组明显升高(P<0.01);2组内男性和女性差异均无统计学意义(P>0.05);有糖尿病亚组和无糖尿病亚组的差异均有统计学意义(P<0.05)。血浆TF水平与冠心病呈正相关(r=0.791,P<0.001),与糖尿病、低密度脂蛋白胆固醇(LDL-C)、脂蛋白(a)[Lp(a)]、超敏C反应蛋白(Hs-CRP)、纤维蛋白原(FIB)均呈正相关(分别r=0.172,0.180,0.147,0.380,0.175;P均<0.05)。Logistic多元回归分析显示,排除年龄、LDL-C、糖尿病,高血压、吸烟等因素影响,血浆TF水平仍与冠心病发生存在有意义的回归关系。结论血浆TF升高可能是冠心病的重要危险因素之一,高水平的TF诱导血栓形成,促进冠心病的发生发展,也是冠心病患者预后的预测指标之一。     

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.