氯沙坦钾和依那普利联合治疗Ⅳ期糖尿病肾病的临床观察

目的 观察氯沙坦钾和依那普利联合治疗Ⅳ期糖尿病肾病(DN)的疗效.方法 将74例Ⅳ期DN患者随机分为三组,氯沙坦钾组:口服氯沙坦钾100 mg,1次/d;依那普利组;口服依那普利10 mg,1次/d;联合治疗组:同时服用以上两种药物,且剂量不变.三组患者治疗均在3年以上.监测治疗前后24 h尿蛋白定量及血清肌酐.结果 三组患者24 h尿蛋白定量较治疗前均下降,差异有统计学意义(P＜0.05),联合治疗组效果更好(P＜0.01).血清肌酐仅联合治疗组下降,差异有统计学意义(P＜0.05).结论 联合应用氯沙坦钾和依那普利可以有效控制Ⅳ期DN患者蛋白尿,延缓肾脏病进展.     

氯沙坦钾和依那普利联合治疗Ⅳ期糖尿病肾病的临床观察

目的观察氯沙坦钾和依那普利联合治疗Ⅳ期糖尿病肾病（DN）的疗效。方法将74例Ⅳ期DN患者随机分为三组，氯沙坦钾组：151服氯沙坦钾100mg，1次／d；依那普利组；151服依那普利10mg，1次／d；联合治疗组：同时服用以上两种药物，且剂量不变。三组患者治疗均在3年以上。监测治疗前后24h尿蛋白定量及血清肌酐。结果三组患者24h尿蛋白定量较治疗前均下降，差异有统计学意义（P〈0．05），联合治疗组效果更好（P〈0．01）。血清肌酐仅联合治疗组下降，差异有统计学意义（P〈0．05）。结论联合应用氯沙坦钾和依那普利可以有效控制Ⅳ期DN患者蛋白尿，延缓肾脏病进展。     

黄芪与氯沙坦治疗临床期糖尿病肾病的对比研究

目的比较黄芪与氯沙坦对临床期糖尿病肾病的疗效.方法将血糖、血压控制比较理想的68例临床期糖尿病肾病患者随机分为氯沙坦组24例、黄芪组26例和糖尿病肾病组18例,疗程8周.结果⑴氯沙坦组治疗后24h尿白蛋白、24h尿蛋白、尿β2-MG明显下降(P均＜0.05),肾小球滤过率升高(P＜0.05).⑵黄芪能显著降低24h尿白蛋白、24h尿蛋白、尿β2-MG(P均＜0.01),升高肾小球滤过率(P＜0.01),其效果明显强于氯沙坦(P均＜0.05).⑶糖尿病肾病对照组24h尿白蛋白、24h尿蛋白、尿β2-MG、肾小球滤过率则无明显变化(P均＞0.05).结论黄芪是治疗临床期糖尿病肾病比较有效的药物.     

硝苯地平联合氯沙坦治疗高血压肾病疗效观察

目的：探讨硝苯地平联合氯沙坦治疗高血压肾病的疗效。方法：50例符合纳入标准的高血压肾病患者随机分为2组,每组各25例。对照组给予硝苯地平治疗,观察组在对照组的基础上联合使用氯沙坦治疗。比较两组患者高血压治疗疗效及反映肾功能指标Scr、BUN和24h尿蛋白定量变化情况。结果：观察组高血压治疗的总有效率为88.0%,明显高于对照组60.0%的总有效率,比较有统计学差异（p〈0.05）。治疗前,两组患者Scr、BUN及24h尿蛋白定量比较无统计学差异（p均〉0.05）。与对照组相比,观察组治疗上述指标均明显下降,比较均有统计学差异（p均〈0.05）。结论：硝苯地平联合氯沙坦治疗高血压肾病的疗效可靠,可以提高高血压治疗总有效率,并降低Scr、BUN和24h尿蛋白定量指标,有效改善肾功能,值得临床上进一步研究及推广。     

血管紧张素Ⅱ受体抑制剂联合前列地尔治疗早期糖尿病肾病观察

目的 观察氯沙坦和厄贝沙坦分别联合前列地尔对早期糖尿病肾病蛋白尿的疗效.方法 早期糖尿病肾病患者55例按随机数字表法分为A组(氯沙坦+前列地尔,29例)和B组(厄贝沙坦+前列地尔,26例),氯沙坦基础剂量为50mg/d,厄贝沙坦基础剂量为150mg/d,两组均静脉滴注前列地尔注射液10μg/d,治疗前和治疗2周后监测血压,检测血肌酐、血尿素氮、血尿酸、24 h尿蛋白.结果 A组和B组治疗后24 h尿蛋白较治疗前均明显下降[分别为(0.46±0.21)g比(0.85±0.32)g、(0.38±0.19)g比(0.91±0.37)g],差异有统计学意义(P＜0.01),但两组治疗前后比较差异无统计学意义(P＞0.05),两组治疗前后血肌酐、血尿素氮、血尿酸无明显改变.A组伴有高尿酸血症16例患者血尿酸水平治疗后较治疗前显著下降[(445±58)μmol/L 比(527±69)μmol/L](P＜0.05),B组伴有高尿酸血症11例患者血尿酸水平治疗前后比较差异无统计学意义(P＞0.05).结论 在血糖控制平稳,血压控制达标情况下,血管紧张素Ⅱ受体抑制剂联合前列地尔治疗能有效降低早期糖尿病肾病患者的尿蛋白;氯沙坦更能显著降低血尿酸,在伴有高尿酸血症的患者中更具保护作用.     

氯沙坦治疗糖尿病肾病的研究

目的　观察血管紧张素受体拮抗剂氯沙坦对糖尿病肾病病人尿蛋白排泄的影响。方法　选择 4 7例血压控制良好的糖尿病肾病病人 ,并设置相应对照组 ,治疗组用氯沙坦每天 5 0mg ,观察治疗前及治疗后 1个月、3个月、6个月的尿白蛋白排泄以及其他生化指标的变化。结果　治疗组用氯沙坦后 1个月、3个月、6个月的尿白蛋白排泄均有显著下降 (组内配对比较 ,P <0 .0 1) ,与对照组比较亦有显著性差异 (P <0 .0 1)。结论　氯沙坦具有不依赖其降压作用而降低糖尿病肾病的尿白蛋白排泄的作用。     

盐酸贝那普利片联合苯磺酸氨氯地平片治疗糖尿病肾病伴高血压临床观察

目的观察盐酸贝那普利片联合苯磺酸氨氯地平片治疗糖尿病。肾病伴高血压的临床疗效。方法将64例早期糖尿病肾病随机分成两组,对照组给予饮食管理、纠正糖代谢紊乱、盐酸贝那普利片控制血压、调脂等处理,治疗组在对照组基础上联合苯磺酸氨氯地平片治疗。疗程为8周。治疗前后检测24h尿白蛋白定量等指标。结果两组治疗前后收缩压、舒张压均有显著变化（P〈0．01）,治疗组降压效果优于对照组;两组治疗后24h尿蛋白定量水平均有下降,且治疗组较对照组下降明显,二者比较差异有统计学意义（P〈0．05）。结论盐酸贝那普利片联合苯磺酸氨氯地平片治疗糖尿病肾病伴高血压l临床疗效确切,而且对肾功能有保护作用。     

前列腺素E1治疗糖尿病肾病的效果观察

目的观察探讨前列腺素E1治疗糖尿病肾病的临床效果,总结其临床应用价值。方法选取我院2009年7月至2011年7月46例糖尿病肾病的患者,按照其临床分期,分为A组(Ⅲ期)17例,B组(Ⅳ期)16例,C组(Ⅴ期)13例,皆给予前列腺素E1治疗,观察比较三组的治疗效果。结果 A、B、C组治疗后3个月的24h尿蛋白水平、血肌酐水平、微量白蛋白水平皆明显下降,其中A组下降程度最为显著(P<0.05),具有统计学意义;A、B、C组治疗后6个月的24h尿蛋白水平、血肌酐水平、微量白蛋白水平皆不同程度下降,其中B、C组下降程度较A明显(P<0.05),具有统计学意义。结论前列腺素E1治疗糖尿病肾病的临床效果明显,早期使用能够显著降低24h尿蛋白水平、血肌酐水平、微量白蛋白水平,肾脏细胞受损越严重,需要治疗的时间越长,见效比早期治疗慢,及早使用前列腺素E1治疗是阻碍肾脏细胞功能进一步受损的关键,具有重要的临床意义。     

氯沙坦联合胰激肽原酶治疗早期糖尿病肾病疗效分析

目的观察氯沙坦联合胰激肽原酶对早期糖尿病肾病的疗效。方法选择早期糖尿病肾病患者80例,治疗组40例,对照组40例,治疗组口服氯沙坦及胰激肽原酶,疗程为六个月。比较两组治疗前后患者的24小时尿蛋白定量、糖化血红蛋白、纤维蛋白原及血压。结果治疗组治疗前与治疗后24小时尿蛋白定量、糖化血红蛋白、纤维蛋白原及血压的变化有显著性差异（P〈0．05）。结论氯沙坦联合胰激肽原酶可使早期糖尿病肾病患者尿白蛋白排泄下降,并降低血液粘稠度,可延缓糖尿病肾病的进一步发展。     

氯沙坦治疗慢性肾衰竭高血压的临床研究

目的　观察氯沙坦对慢性肾衰竭 (失代偿期 )高血压病人的血压及其 2 4h尿蛋白、血尿酸、血清钾及肝肾功能的影响。方法　将 6 2例病人随机分为A、B 2组 ,研究 (A)组服用氯沙坦 ,对照 (B)组服用硝苯地平 ,共治疗 8周。定期检测动脉血压、2 4h尿蛋白、血尿酸、血清钾、肾功能及肝功能。结果　 2组治疗 8周后血压均下降明显 (P <0 .0 5 ) ,2组比较其降压作用相当 ,组间差异无统计学意义 (P >0 .0 5 )。研究组用药后尿蛋白、血尿酸降低均明显 (P均 <0 .0 1) ,与对照组比较有显著差异。研究组治疗后血肌酐下降 ,肌酐清除率升高 (P <0 .0 5 ) ,与对照组比较差异有统计学意义。未发现肝功能恶化、干咳等不良反应。结论　氯沙坦降压效果好 ,副作用少 ,且对患者的肾功能有保护作用 ,是治疗慢性肾衰竭病人高血压的理想药物。     

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.