儿童 IM 淋巴细胞亚群的变化及意义

目的：通过对儿童传染性单核细胞增多症（ IM）外周血淋巴细胞亚群的检测,探讨患儿细胞免疫功能变化与疾病的关系。方法采用流式细胞仪对40例观察组IM患儿外周血T、B和自然杀伤淋巴细胞亚群进行检测,以30例健康儿童作为对照组;同时对观察组患儿中的10例进行治疗2周后T细胞亚群的测定以观察动态变化情况。结果 IM患儿CD3、CD8 T淋巴细胞水平明显升高（t值分别为10．52、13．48,均P＜0．05）;CD19、CD4和CD4/CD8值水平明显降低,分别与正常对照组比较差异均有统计学意义（t值分别为-11．05、-15．16、-13．02,均P＜0．05）;自然杀伤细胞无明显变化（t＝-0．37,P＞0．05）。10例IM患儿治疗2周后,CD4、CD4/CD8值均高于治疗前,差异均有统计学意义（t值分别为-2．39、-2．21,均P＜0．05）;CD8值低于治疗前,差异有统计学意义（t＝4．57,P＜0．05）;治疗前CD3、CD19和自然杀伤细胞值与治疗后比较差异均无统计学意义（t值分别为1．43、-1．25、-0．53,均P＞0．05）。结论检测淋巴细胞亚群对评估IM患儿的细胞免疫状况、辅助诊断和指导治疗具有重要的临床价值。     

传染性单核细胞增多症并发肝损害的相关因素分析

目的 探讨传染性单核细胞增多症(IM)并发肝损害的相关因素,为IM并发肝损害发生的防治提供参考.方法 共纳入175例IM儿童患者,按照其是否发生肝损害分为两组,其中85例并发肝损害为病例组,90例未并发肝损害为对照组,应用非条件Logistic回归进行单因素及多因素分析.结果 单因素分析结果表明:两组间年龄≥6岁、男性、病程、病情(累及器官≥2个)、发热时间、最高体温、白细胞(WBC)、C反应蛋白(CRP)、CD4+、CD8+、CD4+/CD8+、EB病毒-衣壳抗原EBV-CA-IgM抗体阳性及红细胞沉降率增快比较差异有统计学意义(P＜0.05),其中年龄≥6岁、男性、病程、病情(累及器官≥2个)、发热时间、最高体温、WBC、CRP、CD8+、抗EBV-CA-IgM抗体阳性及红细胞沉降率增快与IM并发肝损害呈正相关,而CD4+、CD4+/CD8+与IM并发肝损害呈负相关.进一步行多因素分析结果表明:病情(累及器官≥2个)、CD8+高为IM并发肝损害的独立危险因素,而CD4+高、CD4+/CD8+高为IM并发肝损害的保护因素(P＜0.05).结论 病情(累及器官≥2个)、CD8+高为IM并发肝损害的独立危险因素,而CD4+高、CD4+/CD8+高为IM并发肝损害的保护因素,因此在临床工作中,积极抗病毒治疗的同时,可以使用免疫调节剂等对上述因素进行必要的干预.     

探究CD4＋T细胞及淋巴细胞亚群在小儿哮喘中的临床意义

目的：探究CD4＋T细胞四大亚群及淋巴细胞亚群在小儿哮喘中的临床意义。方法以2011年9月至2014年9月在广饶县中医院儿科进行治疗的哮喘患儿100例作为研究组,选取同期进行健康体检的儿童100例作为对照组。两组儿童均在早晨空腹情况下抽取静脉血5mL于3小时内进行标本处理,利用流式细胞仪器测量外周血中Th1、Th2、Th17、外周血Treg及淋巴细胞亚群。结果研究组患儿外周血Treg占CD4＋T细胞的比率明显高于对照组,差异具有统计学意义（t＝4．01,P＜0．05）;Th1占CD4＋T细胞的比率在两组间无明显统计学差异（t＝1．03,P＞0．05）;Th2占CD4＋T细胞的比率明显高于对照组（t＝5．32,P＜0．05）;Th17占CD4＋T细胞的比率明显高于对照组（t＝6．94,P＜0．05）。研究组CD3＋所占百分率明显低于对照组（t＝4．56,P＜0．05）;研究组CD4＋所占百分率的水平均明显低于对照组（t＝5．61,P＜0．05）;研究组CD8＋所占百分率明显低于对照组（ t＝5．04,P＜0．05）;研究组CD16＋56＋的水平均明显低于对照组（ t＝6．77,P＜0．05）。两组间的白细胞及中性粒细胞百分比差异无统计学意义（P＞0．05）;研究组淋巴细胞百分比较对照组低（t＝7．99,P＜0．05）;嗜酸性粒细胞百分比明显高于对照组（t＝12．58,P＜0．05）;单核细胞百分比的水平均明显高于对照组（t＝12．06,P＜0．05）。结论 CD4＋T淋巴细胞内细胞因子（Th1／Th2／Th17）、Treg及淋巴细胞亚群可作为判断哮喘免疫反应的标准,对疾病的诊断、预防、治疗以及疗效的评价都具有重要临床意义。     

r儿童传染性单核细胞增多症的免疫功能改变

目的探讨传染性单核细胞增多症（IM）患儿细胞免疫功能的变化及与疾病的关系。方法用流式细胞仪分别对22例正常儿童及24例IM患儿进行外周血淋巴细胞亚群检测。结果与健康对照组相比较。IM组CD3^＋CD19^-（总T淋巴细胞）及CD3^＋CD8^＋（抑制性T淋巴细胞）表达明显升高,差异具有统计学意义（t值分别为5．223,14．982,P〈0．01）,而CD3^-CD19^＋（总B淋巴细胞）、CD3^＋CD4^＋（辅助性T淋巴细胞）、CD3^＋CD4^＋／CD3^＋CD8^＋（辅助／抑制性T淋巴细胞比值）及CD3^-／CD16^＋cD56^＋（NK细胞）的表达则明显下降,差异均具有统计学意义（t值分别为-10．090、-9．355、-14．973、-6．652．均P〈0．01）。结论IM患儿外周血淋巴细胞亚群明显变化,存在免疫功能紊乱。检测外周血淋巴细胞亚群的表达可能对评估IM患儿的免疫功能情况、疾病的辅助诊断、治疗药物的指导以及预后的评估具有重要意义。     

用改良的APAAP法检测精神分裂症病人外周血T淋巴细胞亚群

用改良的APAAP法检测41例精神分裂症患者T淋巴细胞亚群，结果I型精神分裂症组外周血CD3^ 、CD4^ 明显减少（分别为P＜0．01，P＜0．05），CD8^ 虽有增高但无显著性差异（P＞0．05），CD4^ ／CD8^ 比值明显下降（P＜0．01）。Ⅱ型精神分裂症组外周血CD3^ 、CD4^ 无明显降低（P＞0．05），CD8^ 明显升高（P＜0．01），CD4^ ／CD8^ 比值明显下降（P＜0．01）。提示精神分裂症患者存在细胞免疫功能障碍，而这种免疫功能障碍与精神分裂症分型有关。     

湖南省苗族健康人群外周血CD3+、CD4+、CD8+T淋巴细胞正常参考值研究

目的了解并建立湖南省苗族健康人群外周血CD3＋、CD4＋、CD8＋T淋巴细胞正常参考值。方法应用FACSCalibur流式细胞仪检测10-19岁、20-29岁、30-39岁、40-49岁、50-59岁5个年龄组共360名健康苗族人的CD3＋、CD4＋、CD8＋T淋巴细胞数值。结果10-59岁组苗族人群外周血CD3＋、CD4＋、CD8＋T淋巴细胞绝对数和CD4＋／CD8＋比值分别为（1426．71±462．92）个／μL、（787．54±258．36）个／μL、（589．86±242．91）个／μL和1．46±0．50;10～19岁年龄组的CD3＋、CD8＋T淋巴细胞计数均明显高于30岁以上年龄组（F分别为10．80、8．51,均P〈0．05）,CD4＋T淋巴细胞计数明显高于50-59岁组（F=7．03,P（0．05）;不同性别间上述指标无差异（t分别为0．98、0．80、0．88、0．16,均P〉0．05）。结论建立不同民族的CD3＋、CD4＋、CD8＋T淋巴细胞正常参考值有助于临床诊断。     

胎盘早剥并发子宫胎盘卒中危险因素及母婴结局分析

目的：探讨并分析胎盘早剥并发子宫胎盘卒中的危险因素以及母婴结局。方法回顾性分析2011年6月至2015年6月沭阳县中医院收治的50例胎盘早剥孕产妇,依据术中检查其有无并发子宫胎盘卒中将之划分为观察组（并发有子宫胎盘卒中）21例和对照组（未并发子宫胎盘卒中）29例,对两组的临床资料及母婴结局进行比较,分析引起子宫胎盘卒中的危险因素。结果经统计学分析,两组患者的临床资料（年龄、孕周、孕产次及早产率）相比差异无显著性意义,在外伤、脐带原因及羊水过量上两组间也无显著性意义（χ2值分别为0．07、0．05、0．00,均P＞0．05）,但观察组子痫前期者要显著多于对照组,差异有显著性意义（χ2＝4．47,P＜0．05）;两组胎盘早剥所致母婴结局相比,观察组孕产妇宫腔积血、子宫压痛和DIC的发病率显著高于对照组（χ2值分别为18．64、22．58、3．74,均P＜0．01或＜0．05）;对照组胎儿Apgar评分显著高于对照组,死亡率低于对照组,差异具有显著性意义（χ2值分别为8．64、6．90,均P＜0．01）;两组的胎盘附着部及剥离面积差异也有显著性意义（χ2值分别为9．43、19．29,均P＜0．01）。结论子痫前期是预测胎盘早剥的重要因素,子宫胎盘卒中更易并发于胎盘附着于子宫底／角部者,其并发会导致母婴结局不良。     

亚临床甲状腺功能减退及其抗体阳性对妊娠结局的影响

目的：明确亚临床甲状腺功能减退（ SCH）及其过氧化物酶抗体（ TPOAb）阳性对妊娠结局的影响。方法收集2014年1月至2015年8月在首都医科大学附属北京友谊医院妇产科产检的2750例孕早期单活胎产妇病历资料,分为SCH＋TPOAb阳性组,SCH＋TPOAb阴性组,单纯TPOAb阳性组和对照组,比较分析4组孕妇妊娠结局和新生儿状况。结果与对照组相比,SCH＋TPOAb阳性组妊娠期糖尿病（ GDM）、妊娠期高血压及临床甲状腺功能减退症、早产、自发性流产及足月低体重儿发生率均明显增加（χ2值分别为12．07、4．17、433．89、9．95、8．28、5．78,均P＜0．05或P＜0．01）;SCH＋TPOAb阴性组临床甲状腺功能减退症,自发性流产发生率均明显增加（χ2值分别为152．35、5．80,均P＜0．05或P＜0．01）;单纯TPOAb阳性组妊娠期高血压、SCH、临床甲状腺功能减退症、早产发生率均明显增加（χ2值分别为7．23、38．55、39．73、8．96,均P＜0．01）;SCH＋TPOAb阳性组临床甲状腺功能减退症及早产发生率明显高于SCH＋TPOAb阴性组（χ2值分别为10．23、5．16、均P＜0．05或P＜0．01）。四组非瘢痕子宫剖宫产、未足月胎膜早破（ PPROM）、产后出血、子痫前期、胎儿窘迫、巨大儿、1分钟Apgar评分＜7分的发生率均无统计学差异（χ2值分别为4．33、1．33、3．79,均P＞0．05）。结论甲状腺功能正常孕妇孕早期促甲状腺激素（TSH）水平升高和（或） TPOAb阳性可明显增加产妇妊娠并发症及新生儿不良结局的发生率,应定期筛查,及早干预。     

传染性单核细胞增多症患儿CD3^＋CD4^-CD8^-T细胞与T淋巴细胞亚群变化情况及临床意义

目的 研究传染性单核细胞增多症（IM）患儿外周血CD3^＋CD4^-CD8^-T细胞（DNT细胞）及T淋巴细胞亚群变化及其临床意义.方法 采用免疫荧光流式细胞技术检测了48例IM患儿及40例正常儿童外周血DNT细胞与T淋巴细胞亚群CD3^＋T细胞、CD3^＋CD4^＋T细胞及CD3＋CD8＋T细胞水平.结果 IM患儿DNT细胞百分比（9.39±4.89）%高于正常对照组（4.26±1.68）%（P＜0.01）,CD3^＋CD4^＋T细胞百分比（21.45±9.87）%明显低于对照组（32.43±5.07）%（P＜0.01）;而CD3＋T细胞及CD3＋CD8＋T细胞百分比均明显高于对照组（P＜0.01）.结论 IM患儿DNT细胞升高及T淋巴细胞亚群比例改变,提示IM患儿存在免疫功能异常,为IM患儿临床免疫治疗提供理论依据.     

124例心肌损害病因回顾性分析

目的：探讨引起心肌损害的相关因素，为临床合理检查及治疗提供思路。方法对2012年1至12月住院的124例心肌损害患儿进行回顾性分析。了解心肌损害与病原体种类、年龄、病情轻重、病程长短及发热的关系。结果手足口病共658例，心肌损害57例（占8．66％）；支原体肺炎64例，心肌损害5例（占7．81％）；疱疹性咽峡炎共55例，心肌损害3例（占5．45％）；呼吸道病毒感染共1001例，心肌损害32例（占3．20％）；其它肠道病毒感染350例，心肌损害18例占（5．14％）。呼吸道细菌感染共321例，心肌损害7例占（2．18％）；肠道细菌感染共52例，心肌损害2例占（3．85％）。低于1岁婴儿心肌损害高于其它组（χ2值分别为5．17、33．09，均P＜0．01）；病程＞6天心肌损害检出率高，占（9．60％）；心肌损害与病情轻重无显著性差异（χ2＝0．08，P＞0．05）；发热患儿心肌损害发病率（占6．76％）较未发热患儿心肌损害发病率（3．62％）高，经比较有显著性差异（χ2＝12．54，P＜0．01）。结论手足口病、支原体感染的心肌损害发病率较高，年幼儿、病程长、发热患儿易合并心肌损害，应进行心肌酶谱检查以便及时治疗，病情轻重与心肌损害发病率无明显差异。     

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.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

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.