血清糖链抗原125与癌胚抗原在肺结核合并2型糖尿病患者中的临床价值

目的探讨血清糖链抗原125(CA125)与癌胚抗原(CEA)水平在继发性肺结核合并2型糖尿病患者中的诊断以及抗结核疗效价值。方法收集医院2012年1月-2013年12月163例浸润性肺结核患者临床资料,92例继发性肺结核合并2型糖尿病患者为肺结核合并糖尿病组,其中初治患者56例、复治患者36例;71例继发性肺结核患者为肺结核组,其中初治患者42例、复治患者29例;另收集21例肺细胞腺癌患者为肺癌组;36例2型糖尿病患者为糖尿病组;选择20名健康体检人员为正常对照组,采用化学发光免疫分析法检测所有受试人员血清CEA与CA125的水平,并进行比较分析;数据采用SPPS17.0统计软件进行分析。结果肺结核合并糖尿病组、肺结核组、糖尿病组及正常对照组受试人员CEA水平,均低于肺癌组患者,差异有统计学意义(P0.01);肺结核合并糖尿病初治患者血清CA125水平为(89.92±12.03)U/ml,高于复治患者的(35.93±7.53)U/ml,高于肺结核初治患者的(46.92±14.03)U/ml与复治患者的(28.97±4.46)U/ml,且显著高于糖尿病组患者的(18.24±6.76)U/ml及正常对照组的(12.39±1.45)U/ml,低于肺癌组患者的(332.04±88.29)U/ml,差异均有统计学意义(P0.01);经规范治疗后血清CA125水平均降至正常(P0.001)。结论血清CA125水平可以作为评价继发性肺结核合并2型糖尿病患者病情进展、预后和临床疗效的敏感指标,联合血清CEA与CA125水平变化可用于鉴别肺结核合并2型糖尿病与肺癌患者。     

肺结核合并糖尿病患者营养状况分析

目的分析肺结核合并糖尿病患者的营养状况以及营养干预的效果。方法以45例单纯肺结核患者为对照,以身体质量指数(BMI)、血红蛋白(HB)和血清白蛋白(ALB)水平为测量指标对45例肺结核合并糖尿病患者(简称"观察组")进行营养状况分析;并比较观察高热量、高蛋白、高纤维素、低脂饮食方案对营养状况的改善效果。结果对照组和观察组BMI方面的营养不良率无显著差异,对照组HB方面的营养不良率为40.00%,显著低于观察组的66.67%(2=6.428,P<0.05);对照组在ALB方面的营养不良率低于观察组;对照组和观察组干预前的BMI、HB和ALB水平的对比,差异均无统计学意义;观察组干预后的BMI为(20.23±2.85)kg/m2,HB为(96.28±22.03)g/L,ALB为(40.37±8.68)g/L,均显著高于干预前(t=6.683,2.094,74.051,P<0.05);对照组干预后的ALB为(35.06±10.35)g/L,显著高于干预前(t=2.746,P<0.05);对照组干预前后的BMI、HB水平的对比,差异均无统计学意义。结论肺结核合并糖尿病患者营养不良的发生率高,应注意增加蛋白质的摄入量,少吃多餐,在避免血糖过度波动的前提下,改善患者的营养状态,提高患者的免疫功能,促进病情的康复。     

温州市老年复治肺结核患者耐药情况分析

目的了解温州市老年复治肺结核患者耐药情况,为老年结核病防治提供依据。方法选取2012年1月—2017年10月温州市≥60岁的初治和复治涂阳肺结核患者,通过问卷调查和药敏试验比较初、复治肺结核患者的耐药类型和耐药谱分布,分析老年复治肺结核患者的耐药特征。结果最终纳入老年初治和复治肺结核患者各1 280例,初治患者总耐药率为31.72%,耐多药率为4.84%,广泛耐药率为0.63%;复治患者总耐药率为52.27%,耐多药率为25.23%,广泛耐药率为5.63%。老年复治患者链霉素(44.38%)、异烟肼(35.63%)、利福平(33.05%)、乙胺丁醇(22.50%)、氧氟沙星(15.70%)、对氨基水杨酸钠(6.72%)和卷曲霉素(4.69%)耐药率均高于初治患者(P0.05)。女性老年复治患者耐多药率和广泛耐药率分别为28.73%和7.69%,均高于男性的23.39%和4.53%(P0.05)。结论温州市老年复治肺结核患者耐多药率和广泛耐药率较高,女性耐多药率和广泛耐药率高于男性,且对一线抗结核药物的耐药率较高。     

糖尿病肺结核两病共存患者的营养治疗

[目的]探讨糖尿病和肺结核两病合并存在时如何进行饮食治疗.[方法]对58例患者进行饮食干预和临床观察.[结果]通过个性化饮食管理,可使患者的空腹血糖(FBG)、餐后血糖(PBG)有所下降(P<0.01),而各项营养指标如:BMI、Hb、TLC和ALB均有所增加(P<0.01).[结论]膳食的合理调控能够有效地降低血糖,提高患者的营养状况.     

微型营养评价法评价慢病住院老人的营养状况

[目的]用MNA法调查老年慢性住院患者的营养状况,并比较不同营养状况患者的传统营养评价指标的差异.[方法]随机抽取141例住院的慢性疾病的老年患者,用MNA对其进行营养状况评价,并收集和比较其常用的营养评价参数进行分析.[结果]慢性疾病的老年患者营养不良、营养不良危险的发生率分别为36.88%和26.95%,而营养状况良好的患者只占36.17%;对3种不同营养状况的患者常用营养指标分析后发现:3组患者BMI、ALB、HB、Na 、Ca2 、TLC和K 差异有统计学意义(P<0.01或P<0.05),营养状况好的患者,其BMI、ALB、HB和TLC较高,而TG和TC无明显统计学意义.[结论]慢性疾病老年住院患者营养不良和营养不良危险的发生率较高,营养不良和营养不良危险患者的常用营养评价指标也会下降.     

肺结核合并糖尿病患者外周血CD4~+CD25~+调节性T细胞的检测分析

目的:检测肺结核合并糖尿病患者外周血CD4+CD25+调节性T(Treg)细胞,探讨Treg细胞在疾病发生发展中的作用。方法:采用流式细胞技术多色荧光分析法,对81例肺结核合并糖尿病患者、63例肺结核患者及38例健康对照者外周血中Treg细胞测定,观察肺结核合并糖尿病患者与肺结核患者、健康对照者之间的差别。结果:肺结核合并糖尿病组与肺结核组外周血Treg细胞增多,两组间比较:t=2.24,P<0.05;肺结核合并糖尿病组与健康对照组外周血Treg细胞比较:t=3.79,P<0.01;肺结核组与健康对照组外周血Treg细胞比较:t=2.77,P<0.01。肺结核合并糖尿病初治组和复治组外周血Treg细胞比较:t=2.19,P<0.05;相关性分析显示肺结核合并糖尿病组中血糖浓度与Treg细胞数量之间呈正相关(r=0.269,P<0.01)。结论:肺结核合并糖尿病患者外周血Treg细胞数量增多,诱导免疫耐受,在疾病的发生发展中起到一定作用。     

初、复治肺结核合并肺部感染的病原菌及耐药性分析

目的了解初、复治肺结核患者合并肺部感染的病原菌分布及耐药情况。方法对湖南省胸科医院2013年7月-2014年3月确诊的初、复治肺结核合并肺部感染的住院患者的痰或支气管肺泡灌洗液和咽拭子,进行培养以及药敏试验,用SPSS 16.0软件统计分析。结果初治组检出病原菌136株,复治组检出病原菌106株,初治组与复治组均以革兰阴性杆菌感染常见,初治组革兰阴性杆菌构成比(69.85%)明显高于复治组(53.77%)。复治组真菌构成比(33.02%)明显高于初治组(15.44%)。两组革兰阳性球菌和肺炎支原体构成比差异均无统计学意义。药敏结果显示,主要革兰阴性杆菌对哌拉西林-他唑巴坦、亚胺培南、美罗培南、阿米卡星和左氧氟沙星耐药率均≤50.00%,葡萄球菌对左氧氟沙星和阿奇霉素有一定的敏感性,对利奈唑胺全部敏感。念珠菌属和肺炎支原体对临床常用抗真菌药物敏感。结论初、复治肺结核合并肺部感染的病原菌谱不同,复治组比初治组细菌耐药严重。     

泡型肝包虫病患者营养不良的危险因素分析

目的分析泡型肝包虫病患者营养不良的危险因素。方法选择我院收治的68例泡型肝包虫病患者作为研究对象,收集其临床资料,评估其营养状态,分析泡型肝包虫病患者营养不良的危险因素。结果单因素分析显示,营养不良组性别、糖尿病患病率、冠心病患病率、慢性心衰患病率、胃肠道疾病史、体质指数(BMI)、白细胞计数(WBC)、血肌酐(Cr)、血尿素氮(BUN)与非营养不良组均无显著差异(P0. 05),年龄、患病时间、厌食发生率、长期卧床比率、血红蛋白(Hb)、血清白蛋白(ALB)、低密度脂蛋白(LDL)、重度日常生活活动能力障碍发生率与非营养不良组均有统计学差异(P0. 05)。多因素分析显示,年龄、患病时间、厌食、长期卧床、重度日常生活活动能力障碍是泡型肝包虫病患者营养不良的危险因素(P0. 05),Hb、ALB、LDL是其保护因素(P0. 05)。结论泡型肝包虫病患者营养不良的危险因素包括年龄、患病时间、厌食、长期卧床、重度日常生活活动能力障碍,保护因素包括Hb、ALB、LDL。     

老年住院病人的营养状况评价

目的:应用微型营养评价精法(MNA-SF)评价老年住院病人的营养状况,并比较不同营养状况三组病人间传统营养评价指标的差异. 方法:随机选取234例老年住院病人,采用MNA-SF对其进行营养状况评价,同时测定传统营养指标,并进行分析. 结果:老年住院病人营养不良、营养不良风险的发生率分别为12.39％和46.58％,而营养正常的病人仅占40.03％.对三种不同营养状况病人的传统营养指标分析后发现,三组病人的体重指数(BMI)、上臂围(AMC)、小腿围(CC)、握力、体力活动水平(ADL)、总蛋白(TP)、清蛋白(ALB)和血红蛋白(Hb)等差异均有显著性统计学意义(P＜0.05);三组病人之间两两比较后,BMI、AMC、CC、握力、ADL、ALB均有显著性差异(P＜0.05).营养正常组病人TP和Hb明显高于营养不良组(P＜0.05),但与营养不良风险组之间无显著性差异.营养不良风险组病人Hb也明显高于营养不良组(P＜0.05). 结论:老年住院病人营养不良和营养不良风险的发生率较高,其类型多为蛋白质-热量营养不良.     

采用微营养评定法调查老年糖尿病住院患者营养状况

目的采用微营养评定法(MNA-SF)和临床营养相关指标对老年住院糖尿病患者营养状况进行调查,为进一步优化老年糖尿病住院患者的临床综合诊治提供思路。方法以2016年2至7月入住该院老年病科、内分泌科的糖尿病患者94例为研究对象,根据入组患者年龄分为:65~74岁(低龄组)43例、75~84岁(中龄组)29例、≥85岁(高龄组)22例。应用MNA-SF进行营养筛查,收集血清蛋白(ALB)、前清蛋白(PA)、C反应蛋白(CRP)、血红蛋白(HBG)和糖化血红蛋白(HbA1c)水平,对不同组别和不同营养状态患者进行分析。结果入组患者中合并其他疾病较多;总营养不良发生率为25.53%(24/94),营养不良风险发生率为30.85%(29/94),营养正常率为43.62%(41/94),与低龄组及中龄组比较,高龄组患者总营养异常率较高,差异均有统计学意义(均P0.05)。经Spearman相关分析,年龄与HBG、ALB、MNA-SF具有相关性(r=-0.383、-0.289、-0.412,均P0.05);HbA1c与MNA-SF具有相关性(r=-0.043,P0.05);CRP与PA具有相关性(r=-9.249,P0.05)。结论不同年龄段糖尿病患者的营养异常发生率及影响因素不同,在优化老年糖尿病患者诊疗方案时应关注患者的营养状态。     

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.     

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.     

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.