肥胖患者颈动脉内膜中膜厚度与血管内皮依赖性舒张功能相关性分析

目的：观察颈动脉内膜中膜厚度与血管内皮依赖性舒张功能的相关性。方法选择体检或就诊患者332例,肥胖组（腰围,男性≥85 cm,女性≥80 cm,或体重指数≥24 kg/m2）198例,正常对照组134例。采用高分辨彩色多普勒超声仪测量颈动脉内膜内表面至中膜外表面的厚度;测量肱动脉血管内皮依赖性舒张功能。结果肥胖组颈动脉内膜中膜厚度（0.64±0.13）mm高于正常对照组（0.60±0.10）mm;肥胖组肱动脉内皮依赖性血管舒张率（6.97±3.32）低于正常对照组（10.01±2.19）。结论颈动脉内膜中膜厚度（IMT）作为评估肥胖者血管内皮依赖性舒张功能的指标具有一定的临床可行性,同时也可作为肥胖症或代谢综合征药物治疗改善血管功能的评估指标。     

青春期单纯性肥胖儿童颈动脉内中膜厚度与脂联素水平分析

目的探讨肥胖超重青少年患者血清脂联素等生化指标水平的变化及与颈动脉内中膜厚度的关系,为预防肥胖相关的心血管疾病的发生提供依据。方法测定40名肥胖青少年、37名超重青少年和42名体重正常青少年血清脂联素水平及颈动脉内中膜厚度,分析3组间的水平变化、分析两者间的相互关系。结果肥胖组血浆脂联素水平与超重组、正常对照组比较,明显低于对照组,差异有统计学意义(P0.05)。肥胖组颈动脉内中膜厚度与超重组、正常对照组比较,差异有统计学意义(P0.05)。颈动脉内-中膜厚度与脂联素水平呈负相关。结论肥胖青少年血清脂联素水平明显下降,颈动脉内膜厚度增厚,肥胖青少年存在着血管内皮功能障碍,动脉顺应性功能下降。     

单纯性肥胖青少年脂代谢紊乱和胰岛素抵抗对血管弹性的影响

目的 探讨单纯性肥胖青少年血脂紊乱、胰岛素抵抗与血管弹性的关系.方法 选取80例单纯肥胖青少年,按照血脂水平分为血脂正常组45例,血脂紊乱组35例.空腹抽取静脉血检测空腹血糖(FPG)、空腹胰岛素(FINS)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平,计算稳态模型胰岛素抵抗指数(HOMA-IR).彩色多普勒超声诊断仪测定颈动脉内膜中层厚度(IMT)、颈动脉血管硬化值(β)、血管弹性系数(Ep)、血管顺应性(AC)、增大指数(AI)、脉搏波传播速度(PWVβ),测量颈动脉收缩期血管内径(Ds)和颈动脉舒张期血管内径(Dd).结果 血脂紊乱组TG、TC、LDL-C和HOMA-IR均明显高于血脂正常组,HDL-C低于血脂正常组,差异均有统计学意义(P＜0.05);两组体质指数(BMI)、IMT、FPG、餐后2h血糖(2h PG)差异均无统计学意义(P＞0.05).两组颈动脉弹性参数β、Ep和AI差异均有统计学意义(P＜0.05).相关性分析显示,BMI、TG、LDL-C、HOMA-IR分别与β、Ep、AI、PWVβ呈正相关,与AC呈负相关,与Ds、Dd无明显相关性.TC、HDL-C、SBP、DBP与颈动脉各弹性参数无明显相关性(P＞0.05).结论 肥胖青少年存在血脂代谢紊乱、胰岛素抵抗和动脉内膜增厚等血管病变;血脂紊乱和胰岛素抵抗与动脉血管弹性密切相关,高甘油三酯血症和HOMA-IR是影响血管弹性的高危因素.     

2型糖尿病患者高同型半胱氨酸血症与颈动脉内膜-中层厚度关系

目的 探讨2型糖尿病(T2DM)患者血清同型半胱氨酸(Hcy)水平与颈动脉内膜-中层厚度(IMT)的关系和意义.方法 对T2DM患者组(51例)和健康对照组(21例)采用荧光偏振免疫分析法测定血清Hcy水平、彩色多普勒显像仪检查双侧颈总动脉,T2DM患者组根据血管内径狭窄程度依次分为IMT正常组、内膜厚组、斑块形成组,并同时测定血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白-胆固醇(LDL-C)及脂蛋白a.结果 随着IMT程度加重,血清Hcy水平逐渐升高,与健康对照组相比内膜增厚组及斑块形成组血清Ncy水平差异有统计学意义(P＜0.01),血清Hcy水平与IMT呈正相关(相关系数为0.716),多元线性回归提示血清Hcy水平与脂蛋白a有相关关系.结论 高Hcy血症作为独立的动脉粥样硬化危险因素对T2DM大血管病变的诊断及程度的判定有重要的临床意义.     

原发性高血压患者血管内皮功能和血管缓冲功能的临床研究

目的对比原发性高血压患者和血压正常者肱动脉血管内皮功能和动脉缓冲功能的损害程度及颈动脉粥样硬化和血流动力学指标。方法60例高血压患者分为脉压≤60mmHg(1mmHg=0.133kPa)组(39例)、脉压>60mmHg组(21例),分别测定静息、反应性充血、含服硝酸甘油后肱动脉内径(D)及内径变化,计算肱动脉横断面顺应性(CSC)和容积扩张性(VD)、动脉僵硬度(β值)。测定颈动脉内膜-中层厚度(IMT)、IMT/D、收缩期与舒张期内径之差(DS-DD)、峰值速度(Vmax)及最大剪切率(SR),并与30例血压正常者对照。结果高血压组与正常对照组相比,CSC、VD、DS-DD、(DS-DD)/DD、SR、Vmax减小,DS、DD、IMT增加,差异有统计学意义,P<0.05。结论高血压患者的动脉内皮功能、缓冲功能都有损害,随脉压增加损害更加明显。     

肥胖2型糖尿病患者血管内皮功能的影响因素及吡格列酮干预治疗

[目的] 研究肥胖2型糖尿病患者血管内皮功能的影响因素及吡格列酮的治疗作用.[方法] 新诊断肥胖2型糖尿病患者30例,正常对照组25例,治疗前后分别检测血清APN、HOMA-IR、TG、HDL、BMI,同时利用超声检测反应性充血肱动脉内径增加程度FMD. [结果] 肥胖2型糖尿病患者FMD及APN水平较正常对照明显降低,吡格列酮治疗后FMD显著改善(7.15±3.20 vs 10.36±4.55,P<0.01)、APN升高[(6.94±2.58)mg/L vs(9.77±3.16、mg/L,P<0.01.多元相关分析显示,FMD与APN、HDL呈显著正相关(r=0.592,r=0.306,P<0.01),与FBG、HOMA-IR呈负相关(r=-0.285,r=-0.291,P<0.01),与年龄、性别、:BMI、TG无关. [结论] 2型糖尿病患者存在明显的内皮功能紊乱及低脂联素血症,吡格列酮可通过多种途径起到改善血管内皮功能的作用.     

氧化应激在成年男性颈动脉粥样硬化中的作用

目的 探讨氧化应激在成年男性颈动脉粥样硬化中的作用.方法 采用彩色多普勒超声诊断仪对入选的56名研究对象行颈动脉彩色多普勒超声检查,将结果分为颈动脉内膜中层厚度(IMT)增厚组及非颈动脉内膜中层厚度(IMT)增厚组,再根据体质量指数(BMI)将非IMT增厚组分为肥胖组及对照组.评估各组病例的代谢指标、氧化应激指标.并对这些指标与颈动脉粥样硬化的关系进行相关性分析.结果 IMT增厚组空腹血糖、收缩压、平均动脉压、糖化血红蛋白、空腹胰岛素水平、HOMA-IR、脂质过氧化产物丙二醛总量显著高于肥胖组(P＜0.01),超氧化物歧化酶(SOD)活力低于肥胖组;IMT增厚组和肥胖组空腹血糖,收缩压,平均动脉压,糖化血红蛋白,空腹胰岛素水平、HOMA-IR、脂质过氧化产物丙二醛总量显著高于对照组,超氧化物歧化酶(SOD)活力低于对照组(P＜0.01).结论 氧化应激参与了颈动脉粥样硬化的发展,空腹血糖及收缩压与颈动脉粥样硬化程度线形相关.     

高频彩超对糖尿病颈总动脉血管病变的临床价值

目的：研究糖尿病（DM）与颈总动脉内膜-中膜厚度（IMT）、颈总动脉内径（CCAD）和阻力指数（RI）的关系。方法：选择30例DM患者作为观察组，30例年龄、性别、体重、身高相匹配的非DM病患者为对照组，观察2组病例颈总动脉IMT、CCAD和RI的差异。结果：DM组颈总动脉IMT、CCAD和RI均高于对照组，差异有统计学意义（P〈0.01）。结论：CCAD可作为DM动脉病变的超声观察窗口，高频彩色超声能直观动态地了解CCAD病变程度，对了解DM患者动脉硬化情况和预防脑梗死具有重要临床意义。     

2型糖尿病血清内脏脂肪素与肿瘤坏死因子-α及血管内皮功能的关系

目的 探讨2型糖尿病(T2DM)患者血清内脏脂肪素(visfatin)与糖脂代谢、肿瘤坏死因子-α(TNF-α)及血管内皮功能的关系.方法 选择59例T2DM患者作为T2DM组及23例健康体检者作为对照组,采用酶联免疫吸附法检测空腹血清visfatin和TNF-α水平,同时测定糖脂代谢指标,并测定部分T2DM患者(26例)及对照组(15例)内皮依赖性舒张功能(FMD),计算体质指数(BMI)、腰臀比(WHR)、稳态模型胰岛素抵抗指数(HOMA-IR)和胰岛β细胞功能指数(HOMA-β).结果 对照组visfatin和TNF-α水平分别为(18.99±8.19) μg/L和(21.80±6.86) ng/L,T2DM组分别为(34.80±9.37)μg/L和(33.57±10.15) ng/L.与对照组比较,T2DM组visfatin、TNF-α明显升高,FMD明显下降,差异均有统计学意义(P＜0.05),其血清visfatin水平与BMI、WHR、log10空腹胰岛素(FINS)、log10HOMA-IR、TNF-α呈正相关(r值分别为0.643、0.389、0.532、0.546、0.666,P＜0.01),与FMD呈负相关(r=-0.505,P＜0.01).结论 2型糖尿病患者血清visfatin水平升高,可能与肥胖、胰岛素抵抗、炎症反应、血管内皮功能受损有关.     

超重及肥胖儿童胰岛素敏感性及β细胞功能研究

【目的】研究超重及肥胖儿童胰岛素敏感性、胰岛素抵抗及β细胞功能。【方法】随机抽取新疆乌鲁木齐市天山区六所中小学10～15岁的在校学生527人,根据体重指数(bodymassindex,BMI)分为超重肥胖组和正常对照组,并进行体格检查和实验室生化检测。采用HOMA-IR,HOMA-B及胰岛素敏感指数(insulinsensitiveindex,ISI)评价。【结果】超重及肥胖组的ISI显著低于正常组(P<0.01),胰岛素抵抗指数(insulinresisindex,IR)、β细胞功能指数(β-cellfunctionindex,HBCI)显著高于正常组(P<0.01)。同时ISI与BMI负相关,IR与BMI、WHR呈正相关,HBCI与BMI呈正相关,与WHI呈负相关。【结论】超重肥胖儿童存在胰岛素的敏感降低、胰岛素抵抗及β细胞功能异常。     

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.