经皮肤吸收氟乙酰胺急性中毒1例

近年来,急性杀鼠剂氟乙酰胺中毒常见报道,中毒多为误服,经皮肤吸收中毒者较少见.最近,我院收治1例经皮肤吸收氟乙酰胺急性中毒病例,现报告如下.     

对制订TNT经皮肤吸收卫生标准的商榷

硝铵炸药(含TNT10%左右)生产目前仍为半机械化,由于加强了防尘措施,车间空气中TNT 粉尘浓度已明显降低。然而,TNT 的慢性影响和中毒性白内障发病未能得到控制,例如,某矿硝铵炸药厂的十年动态观察,自1977年以来车间空气中TNT 浓度已接近或低于MAC,但工人的中毒性白内障检出率却逐年增加,由1973年的25.5%上升到1983年的61.5%。另有报道,接触     

152例经消化道吸收有机磷农药中毒和100例经皮肤吸收有机磷农药中毒临床分析

目的：探讨经消化道吸收和经皮肤吸收有机磷农药中毒在临床中的区别。方法：回顾性分析我院自2001年7月至2008年12月共收治252例急性有机磷农药中毒患者的临床资料,其中152例经消化道吸收,100例经皮肤吸收,比较这两种中毒途径临床表现、进展、愈后。结果：经皮肤吸收吸收有机磷农药中毒组就诊时间较经消化道吸收组明显延长,入院时临床表现轻入院后病情进展恶化。结论：对经皮肤吸收有机磷农药中毒要提高警惕,注意观察。     

双层手套对乙型肝炎病毒经手术感染的防护效果

目的评价双层手套预防乙型肝炎病毒(HBV)经手术传播的效果。方法在确定乙型肝炎表面抗原(HBsAg)阳性者的HBV传染性、手术中HBV感染阈值和双层手套防护阈值基础上,评价单、双层手套对HBV感染的防护效果。结果HBsAg阳性者的HBV传染性范围为100~109感染剂量(ID)/mL,阴性者为100~104ID/mL。单层手套的防护阈值为105ID/mL;双层手套的防护阈值为106ID/mL,可杜绝23.33%传染源的传染性。结论双层手套只能杜绝部分手术中HBV传染源的传染性;在外科医师普遍接种乙型肝炎疫苗的基础上再使用双层手套防护,才能在理论上完全防止HBV经手术传播。     

FZ—1防护霜的透皮吸收及其在振动性白指患者的应用

本文报告了ＦＺ－１防护霜的透皮吸收及其在振动性白指患者的应用情况。结果表明，以钙拮抗剂Ｎ组成的ＦＺ－１防护霜剂，在氮酮的助渗下可经皮吸收。１７例主诉振动性白指者双手涂擦霜剂一个月后，冷试后，５分钟、１０分钟平均每分钟手指皮温升温值提高，Ｐ＜０．０５；３０分钟内皮温恢复率增大，Ｐ＜０．０５；甲皱微循环及指端血流状况明显改善。     

皮肤防护剂预防放射性皮肤反应的临床观察

目的观察皮肤防护剂预防放射性皮肤反应的临床效果。方法将在荆州市第一人民医院住院的头颈部肿瘤患者94例,按照放疗的初始日期单双号随机分为观察组和对照组,将皮肤防护剂均匀涂于观察组病人的照射野皮肤上,用直线加速器常规照射,观察两组发生放射性皮肤反应情况。结果两组病人放射野皮肤反应程度,经统计学处理,P〈0.01,差异有统计学意义;观察组色素沉着、干性皮炎、湿性皮炎的皮肤损伤体征显著低于对照组;皮肤防护剂还能推迟放射性皮肤反应的发生。结论应用皮肤防护剂,可有效预防放射性皮肤反应,减轻皮肤损害,提高皮肤耐受性,有利于放疗的顺利进行。     

铊化合物对家兔及小鼠的局部刺激及皮肤吸收实验

铊是高毒金属具有蓄积性,为强烈的神经毒物[1],在工业生产及应用中,对作业工人及接触者带来极大的危害.为了解铊对粘膜、皮肤的危害,我们进行了家兔的眼粘膜刺激试验,皮肤涂敷、吸收及小鼠浸尾试验.现将实验结果报告如下.     

FZ－1防护霜的透皮吸收及其在振动性白指患者的应用

本文报告了ＦＺ－１防护霜的透皮吸收及其在振动性白指患者的应用情况。结果表明，以钙拮抗剂Ｎ组成的ＦＺ－１防护霜剂，在氮酮的助渗下可经皮吸收，１７例主诉振动性白指患者双手涂擦霜剂一个月后，冷试后５分钟、１０分钟平均每分钟手指皮温升温值提高，Ｐ＜０．０５；３０分钟内皮温恢复率增大，Ｐ＜０．０５；甲皱微循环及指端血流状况明显改善。     

毒物经皮肤吸收的防护研究

随着工农业生产的发腱,人们与化学物的接触机会愈益增多,职业中毒中约1/4是经皮肤吸收所致。空气中毒物的浓度,即使低于最高容许浓度,毒物仍会由皮肤侵入人体而引起中毒。农药中毒原因有71.4％是由皮肤吸收而引起。农田杀虫脒喷药员皮肤的污染量为呼吸道吸入量的120倍。车间内杀虫脒包装工仅两前臂皮肤表面的污染量已为呼吸道吸入量的26.7倍。国外最近提出由于喷洒农药而沉积在所接触皮肤表面的量为呼吸道吸入量的20～1,700倍。可见,研究毒物经皮肤吸收的防护,有着重要的实际意义。本文旨在述及毒物经皮肤吸收的防护研究现况,并提出为现场接触化学物的防护措施。     

三氯乙烯诱导皮肤角质形成细胞凋亡的体外研究

目的 检测三氯乙烯（TCE）对人表皮角质形成细胞（NHEK）的凋亡诱导作用,探讨TCE皮肤毒性的作用靶.方法 采用中性红吸附试验测定TCE对体外无血清培养的NHEK的中性红吸附减少50%的浓度（NR50值）,确定TCE染毒剂量;测定丙二醛（MDA）含量和超氧化物歧化酶（SOD）活力反映细胞脂质过氧化作用和氧化状态;用透射电子显微镜（TEM）和流式细胞仪（FCM）观察细胞凋亡形态学改变和测定细胞DNA含量,计算凋亡发生率及增殖指数（PI）.结果 TCE对NHEK的NR50值为4.53（3.92～5.13）mmol/L;TCE处理NHEK 4 h后,MDA含量的增加和SOD活力的抑制均具有剂量-效应关系（r=0.98,r=0.93,P＜0.01）;TEM观察显示,与对照相比,TCE处理组细胞可见明显凋亡改变;FCM测定显示,DNA含量直方图中G1期前可见明显的凋亡峰,与对照组相比,TCE处理组细胞凋亡率明显增高（空白对照及TCE 0.125、0.500、2.000 mmol/L组分别为18.42%、31.83%、38.63%、44.35%）,而PI则明显降低（空白对照及TCE 0.125、0.500、2.000 mmoL/L组分别为4.99%、3.26%、2.48%、2.07%）.结论 在体外培养条件下,TCE可通过脂质过氧化和氧化应激作用诱导NHEK凋亡,抑制其增殖.     

Skin absorption in vitro of glycol ethers

Objectives: The increased use of glycol ethers (GEs) for water-based paints and cleaning products, combined with a lack of information about many of these products, particularly with regard to the effects of percutaneous exposure, led us to evaluate the skin absorption rates of a group of glycol ethers in vitro. Methods: Skin permeation was calculated using the Franz cell method with human skin. A physiological solution was used as the receiving phase. The amount of solvent passing through the skin was analysed with a gas chromatographic technique employing flame ionization detection. A permeation profile was obtained and steady state, lag time and permeation constant flux was calculated for each of the following solvents: ethylene glycol monoethyl ether (EGMEE), propylene glycol mono-methyl ether (PGMME); propylene glycol mono-methyl ether acetate (PGMMEac); 2-propylene glycol 1-butyl ether (2PG1BE), ethylene glycol dimethyl ether (EGDME), ethylene glycol diethyl ether (EGDEE) and diethylene glycol dimethyl ether (DEGDME). All solvents were tested in their pure form and with 70% acetone. Results: For all solvents tested the lag time was less than 2 h, and for the majority of them was about 60 min. Flux at steady state ranged between 0.017 ± 0.005 and 3.435 ± 1.897 mg/cm²/h and permeation rate was from 0.0192 to 1.02 × 10⁻³ cm/h. The presence of acetone in the solution caused a reduction in lag time and an increase in permeation rate, higher for EGMEE, lower for EGDEE, indicating the enhancing effect of this mixture of solvents. Conclusions: Our results confirm the high percutaneous absorption of the GEs tested. The Franz method might be helpful for obtaining a grading of skin notation for hydrophilic substances: in the case of glycol ethers, it can give us precise information about permeation risk, particularly important in the evaluation of exposure. In the case of solvents with high dermal absorption, the air concentration is no longer a sufficient measure of the total exposure to workers, and therefore merely respecting threshold limit values (TLVs) in the air is not necessarily enough to protect them. Received: 16 June 1998 / Accepted: 9 May 1999     

Dermal in vitro penetration of methiocarb, paclobutrazol, and pirimicarb: effect of nonylphenolethoxylate and protective gloves

Dermal exposure has become the major route of human occupational exposure to pesticides. Detergents are used as part of formulated pesticide products and are known to change the barrier properties of human skin in vitro. However, studies on the influence of detergents as well as protective glove materials on dermal penetration of pesticides are scarce. In an experiment using in vitro static diffusion cells mounted with human skin, we evaluated the effect of nonylphenol-ethoxylate on dermal penetration of three extensively used pesticides--methiocarb, paclobutrazol, and pirimicarb--and the protection against dermal penetration offered by protective gloves made of latex or nitrile. There was a general tendency, though not statistically significant for all pesticides, for nonylphenolethoxylate to decrease the percutaneous penetration of the three pesticides. The nitrile generally offered better protection against percutaneous penetration of pesticides than did latex, but the degree of protection decreased over time and depended on the pesticides used.     

Effectiveness of skin protection creams in the prevention of occupational dermatitis: results of a randomized,controlled trial

Objectives  The aim of the trial was to investigate whether the publicized effects of skin protection creams can be replicated in a real occupational setting during activities that expose the skin. Methods  A prospective, randomized, four-tailed controlled pilot trial was performed to compare the effect of skin protection and skin care alone or in combination with cleansing against a control group (only cleansing). Two branches were selected for the investigation: the building industry and the timber industry. A total of 1,006 workers from these two branches were recruited, and out of these 485 workers were examined longitudinally for at least three time points over 1 year (lost for follow-up: 430 workers, exclusion: 91 workers). At each time point, as a primary outcome measure, we assessed the condition of the skin at both hands in a blinded manner and the individual was assigned to one of the following categories: no eczema, mild, moderate and severe eczema. As a secondary outcome measure, the worker’s transepidermal water loss (TEWL) was measured under standardized conditions at the back of both hands. In addition, the workers were asked to evaluate their skin condition during the study. Results  With regard to differences in the occurrence of eczemas, we found only in workers in building industry without application of skin protection or skin care creams a statistical significant increase in the incidence between the first and the second visit and a statistical significant decrease in the incidence between the second and third visit. When evaluating the secondary outcome-measurement changes in the TEWL values, an improvement was found for the group skin protection and skin care in combination and by skin care alone. Females in the timber industry started with better TEWL values than males, which may be due to better overall skin care. In this group we found an improvement for the group skin protection and skin care in combination and by skin protection alone. For skin protection alone, we noted a slight, but not significant improvement in all other groups. The subjective improvement of skin condition was reported from the participants who used skin protection and skin care in combination. Conclusions  Taking all these secondary-outcome measurements together, the main result of this study was that skin protection creams alone have a small effect on the skin barrier in workers in the building and timber industries compared with skin care alone or in combination with skin protection. Supported by the General Austrian Accident Insurance Institution.     

烟碱类农药吡虫啉的体外经皮渗透实验

目的 研究吡虫啉体外经皮渗透吸收的效果,分析样品浓度和皮肤蓄积作用等对农药风险评估的影响.方法 采用Franz垂直扩散池,以雄性Wistar大鼠离体腹部新鲜皮肤或冷冻皮肤为渗透屏障,C/MS/MS法测定接受液和皮肤中的吡虫啉含量,分别比较高低两种吡虫啉溶液和两类皮肤的透皮效果.结果 在使用新鲜皮肤的体外试验中,高、低两种浓度的接受液中吡虫啉含量占总受试物的比例均数分别为6.8％,6.6％,皮肤残留中吡虫啉含量占总受试物的比例均数分别为10.7％,1.3％,经皮渗透吸收率为分别17.5％和7.9％.在使用同种(低浓度)浓度新鲜和冷冻皮肤的体外试验中,新鲜皮肤和冷冻皮肤的接受液中吡虫啉含量占总受试物的比例均数分别为6.6％,0.7％,皮肤残留中吡虫啉含量占总受试物的比例均数分别为1.3％,10.7％,经皮渗透吸收率分别为7.9％和11.4％.结论 高浓度吡虫啉在新鲜皮肤上的经皮渗透吸收率最大,是本实验吡虫啉暴露“最坏情况”的估计值,也是可用于风险评估的参考值.     

Early immune responses in skin and lymph node after skin delivery of Toll-like receptor agonists in neonatal and adult pigs

The skin is potentially an important vaccine delivery route facilitated by a high number of resident antigen presenting cells (APCs), which are known to be stimulated by different Toll-like receptor agonists (TLRa). In this study, neonatal and adult pigs were vaccinated in the skin using dissolving microneedle patches to investigate the immuno-stimulatory potential of different TLRa and possible age-dependent differences early after vaccination. These patches contained TLR1/2a (Pam3Cys), TLR7/8a (R848) or TLR9a (CpG ODN) combined with inactivated porcine reproductive and respiratory syndrome virus (PRRSV) or with an oil-in-water stable emulsion. Vaccinated skin and draining lymph nodes were analysed for immune response genes using microfluidic high-throughput qPCR to evaluate the early immune response and activation of APCs. Skin pathology and immunohistochemistry were used to evaluate the local immune responses and APCs in the vaccinated skin, respectively.In both neonatal and adult pigs, skin vaccination with TLR7/8a induced the most prominent early inflammatory and immune cell responses, particularly in the skin. Skin histopathology and immunohistochemistry of APCs showed comparable results for neonatal and adult pigs after vaccination with the different TLRa vaccines. However, in vaccinated neonatal pigs in the skin and draining lymph node more immune response related genes were upregulated compared to adult pigs. We showed that both neonatal and adult skin could be stimulated to develop an immune response, particularly after TLR7/8a vaccination, with age-dependent differences in regulation of immune genes. Therefore, age-dependent differences in local early immune responses should be considered when developing skin vaccines.     

Biological surveillance of workers exposed to dimethylformamide and the influence of skin protection on its percutaneous absorption

Summary Two studies were carried out among workers exposed to dimethylformamide (DMF) in an acrylic fiber factory. The first study involved 22 exposed workers and 28 control workers. Blood was examined at the beginning and at the end of a working week for the presence of biological signs of liver dysfunction. Pre- and post-shift urine samples were also collected during 1 week for determination of N-methylformamide (NMF) concentration. The airborne concentration of DMF was determined at different work places during the same period. On prevention of direct skin contact with DMF solution a significant correlation was found on a group basis between the concentration of DMF vapor and the NMF concentration in post-shift urine samples. When the concentration of NMF in post-shift urine samples from a group of workers does not exceed 30 mg/g creatinine, then their integrated exposure is probably below 60 mg/m³ × h (10 mg/m3 for 6 h). This exposure appears to be safe with regard to the risk of liver damage but does not necessarily preclude episodes of alcohol intolerance in some workers.During a second study, NMF concentrations in pre- and post-shift urine samples were followed-up in seven workers during three weeks when different personal protective devices were used. In an acrylic fiber factory, skin absorption was found to be more important than inhalation in the overall exposure to the solvent when no personal protective devices were used. The use of impermeable gloves with long sleeves appears to be the best method of preventing skin absorption of DMF. Silicone or glycerol barrier creams are less effective and should not be recommended.Part of this work was presented at the First International Congress on Toxicology in Toronto 1977     

皮肤交感反应在慢性正己烷中毒自主神经功能损害中的变化

目的 通过皮肤交感反应(SSR)的变化探讨慢性正己烷中毒对自主神经功能的影响.方法 将我院收治的37例职业性慢性正己烷中毒患者按照职业病诊断结果分为轻、中、重度中毒组,并选择30例健康对照组,做SSR及神经传导速度(NCV)检查.中毒组每l～2个月复查1次,观察各组SSR参数(潜伏期、波幅)的差异及重度中毒组SSR参数与NCV参数(传导速度、波幅)随病程动态演变的关系.结果 各组上肢SSR潜伏期及各组上、下肢SSR波幅的差异有统计学意义(P＜0.05),相邻两组SSR参数比较,差异无统计学意义(P＞0.05);各组上肢SSR潜伏期及上、下肢SSR波幅在不同病程差异有统计学意义(P＜0.05);SSR参数与神经传导速度动态变化一致;上肢SSR最长潜伏期及上、下肢SSR最低波幅较动作电位最低波幅要提早1～2个月出现.结论 正己烷对自主神经损害程度随着中毒程度的加重而加重.自主神经损害与大纤维的髓鞘损害动态演变符合,和大纤维的轴索损害比较,时间提早1～2个月.SSR检查可以作为慢性正己烷中毒自主神经功能损害客观检查的方法之一.     

伽玛刀3.0T磁共振定位降低皮肤灼伤与感染发生率的方法

目的 控制磁共振射频能量(SAR)影响参数,以降低头部伽玛刀治疗时,在3.0T磁共振定位中局部皮肤的灼伤与感染发生率.方法 对200例伽玛刀3.0T磁共振定位患者进行临床随机分组研究,试验组100例患者选择合适扫描序列、调整TR参数等措施以控制射频能量进行磁共振定位,对照组100例患者采用常规方法磁共振定位.结果 试验组手术后7例患者有头架固定头钉部的局部轻度灼伤,发生率为7.0％;对照组常规方法定位有28例患者头架固定头钉部的局部轻度灼伤,发生率为28.0％,两组间感染发生率差异有统计学意义(P＜0.01).结论 合理调整SAR影响参数,控制射频能量,可以明显控制伽玛刀3.0T磁共振定位中的局部灼伤与感染,使患者缩短住院床日,早日康复出院.     

乙酰肝素酶在非黑素性皮肤癌中的表达及临床意义

目的 探讨乙酰肝素酶（heparanase,Hpa）在非黑素性皮肤癌[基底细胞癌（BCC）和皮肤鳞状细胞癌（CSCC）]组织中的表达及其与CSCC病理分级和淋巴结转移的关系.方法 采用RT-PCR法和免疫组化法检测38例CSCC、33例BCC及19例正常皮肤组织中Hpa的表达水平,分析Hpa的表达与CSCC临床病理特征的关系.结果 CSCC组织中Hpa mRNA、Hpa蛋白的阳性表达率（68.4%、60.5%）均显著高于它们在BCC组织（24.2%、18.2%）和正常皮肤组织（10.5%、5.3%）中的表达（均P〈0.01）;CSCC组织中有淋巴结转移（92.3%、84.6%）和Broders分类Ⅲ～Ⅳ级Hpa mRNA、Hpa蛋白的阳性表达率（92.3%、84.6%）明显高于无淋巴结转移（56.0%、48.0%）和Ⅰ、Ⅱ级（56.0%、48.0%）中的表达（均P〈0.05）.结论 CSCC组织中Hpa表达高于BCC组织和正常皮肤组织,并与CSCC病理分级和淋巴结转移有关.