单纯性肥胖儿童血脂、血清铁蛋白与脂肪肝的关系

[目的]探讨3～6岁中重度单纯性肥胖儿童血脂、血清铁蛋白与脂肪肝的关系.[方法]选取大连市托幼园所的在园儿童111例,中重度单纯性肥胖儿童69例,正常对照组42例.两组均进行血脂、血清铁蛋白及肝脏B超检查.[结果]①肥胖组血清总胆固醇、甘油三酯、低密度脂蛋白胆固醇、血清铁蛋白均高于正常对照组（P＜0.01）.②肥胖组血清铁蛋白与甘油三酯具有相关性（r=0.324,P＜0.05）.③B超检查显示肥胖组儿童有13例并发脂肪肝,发病率为18.84%;正常对照组无1例脂肪肝发生（P＜0.01）.④肥胖脂肪肝组血清铁蛋白高于肥胖无脂肪肝组（P＜0.05）.[结论]中重度单纯性肥胖儿童已发生明显的脂代谢紊乱;中重度单纯性肥胖儿童并发脂肪肝较为常见,发病率为18.84%;血清铁蛋白对中重度单纯性肥胖儿童脂肪肝的早期诊断可能具有重要意义.     

儿童腹型肥胖与体内炎性因子水平及代谢综合征的关系研究

目的分析腹型肥胖与体内炎性因子水平及代谢综合征（MS）之间的关系,探讨儿童腹型肥胖的科学治疗方法。方法以该院儿科门诊2014年1月-2015年12月接诊的128例单纯性肥胖儿童为研究对象,根据腰围数据进行划分,设腹型组与非腹型组两组。同时对研究对象的体重、身高、臀围（H）、腰围（W）进行测量。采集各研究对象的空腹血并检测其血糖、血脂、超敏C反应蛋白（Hs-CRP）和内脂素水平。结果腹型组体质指数（BMI）、W、腰臀比（WHR）均明显高于非腹型组差异有统计学意义（t=4．85、3．82、3．08,均P〈0．05）;腹型组MS检出率明显高于非腹型组,差异有统计学意义（x^2=12．119,P〈0．05）;腹型组Hs—CRP及内脂素水平明显高于非腹型组,差异有统计学意义（t=4．612、4．121,均P〈0．05）;两组高血压、高血糖、高甘油三酯（TG）血症、低高密度脂蛋白胆固醇（HDL—C）血症的人数比较差异均有统计学意义（x^2=8．82、9．15、14．71、7．41,均P〈0．05）。结论在肥胖儿童中,较之非腹型肥胖儿童,腹型肥胖儿童MS患病几率更高;儿童腹部脂肪分布与体内炎症因子及TG的增高有着密切关系。因此,应对腹型肥胖进行积极防治。     

NAFLD儿童瘦素与脂联素检测的临床意义研究

目的：探讨肥胖儿童非酒精性脂肪性肝病（ NAFLD）患者瘦素（ LEP）、脂联素（ ADPN）的临床意义。方法对符合非酒精性脂肪性肝炎（ NASH）诊断的50例患儿、单纯性脂肪肝（ SFL）的50例患儿及50例正常儿童分别检测血谷丙转氨酶（ALT）、甘油三酯（TG）、总胆固醇（TC）、游离脂肪酸（FFA）、LEP、ADPN、身体质量指数（BMI）,比较其水平并分析ALT与各指标的关系。结果 NASH组和SFL组的BMI、TG、TC、FFA、LEP明显高于正常对照组（NASH组与正常组比较：t值分别为2．424、2．636、3．212、3．280、2．535,均P＜0．05;SFL组与正常组比较：t值分别为2．353、2．487、3．545、3．185、2．870,均P＜0．05）;NASH组和SFL组的ADPN明显低于正常对照组（t值分别为-0．294、-0．342,均P＜0．05）。 NASH组BMI、TG、FFA、LEP较SFL组升高（t值分别为2．132、2．488、2．590、3．759,均P＜0．05）,NASH组ADPN较SFL组降低（t＝-0．291,P＜0．05）。相关分析显示NAFLD患儿ALT与BMI、TG、TC、FFA、LEP呈正相关（r值分别为0．428、0．317、0．366、0．402、0．338,均P＜0．05）,与ADPN呈负相关（r＝-0．223,P＜0．05）。结论 NAFLD患儿存在高脂血症、高瘦素血症和低脂联素血症,随着NAFLD程度的加重,LEP升高和ADPN降低更明显。     

不同喂养方式对婴儿体格发育的影响

目的探讨不同喂养方式对婴儿期身高、体重发育的影响,比较不同喂养方式婴儿超重和肥胖的发生率。方法选择2011年6月至2012年12月在我院儿保门诊定期体检的0～1岁健康婴儿为研究对象,以生后6个月内的喂养方式分为纯母乳喂养组、混合喂养组和人工喂养组。比较3组婴儿3月龄、6月龄和1周岁时身高、体重发育情况和超重、肥胖的发生率。结果纯母乳喂养组、混合喂养组和人工喂养组儿童分别为103、152和34例。男婴在3、6月龄时,不同喂养组儿童的身长和体重均值无统计学差别,在12月龄时母乳喂养组儿童身长明显低于人工喂养组（t＝3．22,P＜0．05）,体重明显低于混合喂养组（t＝1．97,P＜0．05）和人工喂养组（t＝3．01,P＜0．05）。女婴在3、6月龄时,不同喂养组儿童的身长和体重均值无统计学差别,在12月龄时母乳喂养组女婴体重明显低于人工喂养组（t＝1．96,P＜0．05）。在3月龄时超重的发生率以混合喂养组最高,6、12月龄时均以人工喂养组发生率最高,且在12月龄时人工喂养组明显高于母乳喂养组（χ2＝4．29,P＜0．05）。肥胖的总体发生率在3、6、12月龄均以人工喂养组最高,且在6月龄时人工喂养组明显高于母乳喂养组（χ2＝3．88,P＜0．05）。结论人工喂养的婴儿超重和肥胖发生率均高于母乳喂养儿,母乳喂养对预防超重和肥胖的发生有一定作用。     

单纯性肥胖儿童血脂、脂蛋白、载脂蛋白的研究

目的：通过对单纯性肥胖儿童的血脂、脂蛋白、载脂蛋白进行研究，探讨其发生动脉粥样硬化（AS）的危险性。方法：对54名肥胖儿童和60名正常体重儿童分别测定其血清脂质、脂蛋白、载脂蛋白，同时测定腰围、臀围、皮褶厚度，计算腰臀围比（WHR）、体脂百分比（％BF）、脂肪组织（FM）。结果：肥胖组儿童血清甘油三酯（TG）、低密度脂蛋白胆固醇（LDL－C）、极低密度脂蛋白胆固醇（VLDL－C）和载脂蛋白B100(apoB100)的浓度高于非肥胖组（P＜0．05），而高密度脂蛋白胆固醇（HDL－C）、载脂蛋白AI（apoAI)的浓度却低于非肥胖组，差异有显著性（P＜0．05），肥胖组与非肥胖组儿童总胆固醇（TC）浓度差异没有显著性（P＞0．05）。结论：单纯性肥胖儿童脂质代谢出现紊乱，肥胖儿童发生AS的危险性增加。     

青少年空腹血糖受损与体脂分布的关系

目的探讨青少年空腹血糖受损（IFG）与体脂分布的关系。方法通过分层整群随机抽样，测定3874例13～18岁青少年身高、体重、腰围、臀围和空腹血糖（FPG）水平，通过问卷调查了解其父母糖尿病患病情况。根据FPG水平，分为空腹血糖正常组（FPG〈5．6mmol／L，n=3738）和空腹血糖受损组（5．6mmol／L≤〈FPG〈7．0mmol／L，n=136）。结果两组间各体脂指标比较，应用协方差分析校正性别、年龄后，空腹血糖受损组体重指数、腰围、腰围／身高比和腰臀比均高于空腹血糖正常组，组间比较差异有统计学意义（P〈0．05）。应用偏相关分析校正年龄、性别后，BMI、腰围、腰臀比及腰围／身高比均与FPG呈正相关（P〈0．05），其中腰围／身高比的r’值最大（r’=0．0925）。对FPG的多元线性回归分析，最佳模型引入年龄（β=-0．102，P〈0．05）、糖尿病家族史（β=0．186，P〈0．05）和腰围／身高比（β=0．842，P〈0．05）。结论中心性肥胖与青少年空腹血糖受损关系密切，腰围／身高比是描述青少年中心性肥胖的有效指标，是青少年空腹血糖受损的独立危险因素。     

单纯性肥胖儿童脂肪肝相关危险因素分析

目的 探讨导致单纯性肥胖儿童出现脂肪肝的相关危险因素,为单纯性肥胖儿童脂肪肝的预防及治疗提供一定的指导.方法 选择2011年7月至2012年11月在西安交通大学第二附属医院小儿内分泌专科门诊确诊的121例单纯性肥胖儿童为研究对象.将121例单纯性肥胖儿童根据腹部B超影像学检查结果分为脂肪肝组和非脂肪肝组,测量所有儿童的身高、体重,计算体质量指数(BMI)值;空腹8～ 12小时后,行肝脏B超检查.对所有肥胖儿童进行问卷调查,调查内容包括基本情况登记、儿童的一般情况、家庭情况、体格检查4部分.结果 脂肪肝总检出率为53.72％,其中男性患儿脂肪肝检出率(60.23％)显著高于女性患儿(36.36％),差异有统计学意义(t=5.497,P＜0.05).脂肪肝组患儿进食快餐频率以及吃零食、饮料频率高于非脂肪肝组患儿,经比较差异具有统计学意义(x2值分别为3.54、4.61,均P＜0.05).两组患儿的父母饮食习惯以及家族中糖尿病、高血压、高血脂、冠心病的发病率比较,差异均无统计学意义(均P＞ 0.05).结论 肥胖儿童脂肪肝的检出率较高,超过半数以上的肥胖儿童为脂肪肝患者,儿童个人的饮食习惯在脂肪肝的发生中起到重要作用,应引起重视.     

学龄期多动障碍合并双相障碍的行为研究

目的：讨论学龄期注意缺陷多动障碍（ ADHD）和双相障碍（ BD）共病患儿的临床行为特点。方法对浙江省湖州市第三人民医院门诊及院部收治的68例ADHD患者资料进行随访观察,其中有17例患者合并BPD,对单纯组和合并组的行为特点采用Achenbach儿童行为量表CBCL统计分析,记录各行为参数评分,并对两组各评分进行比较分析。结果两组患者在社交问题（t＝-3．552,P＜0．05）,注意问题（t＝-4．228,P＜0．05）,违纪行为（t＝-5．618,P＜0．05）,攻击行为（t＝-6．910,P＜0．05）,外化问题（t＝-6．998,P＜0．05）,行为总分（t＝-7．991,P＜0．05）几个方面比较具有显著统计学意义;在焦虑抑郁（t＝-2．511,P＜0．05）,思维问题（t＝-1．981,P＜0．05）两方面比较也具有显著统计学意义。结论精神科医生在对患者进行诊断时,针对行为问题居多的ADHD患儿,要进行详细的诊断分析,避免对BD造成误诊与漏诊。     

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。     

高血压合并非酒精性脂肪肝患者糖代谢及其危险因素的临床研究

摘要:目的　研究高血压合并非酒精性脂肪肝患者糖代谢情况,并探讨脂肪肝可能的危险因素。方法　收集2 010例高血压患者一般临床资料,测量血压,身高,体重,腰围,臀围,测定空腹血糖,OGTT2h血糖,糖化血红蛋白,血脂,肌酐等指标,并行肝脏的腹部超声检查,从而将高血压病患者分为合并非酒精性脂肪肝组（647例）和单纯高血压组（1 463例）。结果　647例高血压合并非酒精性脂肪肝患者血糖调节异常的有218例,占33.38%,糖尿病有280例,占43.28%,单因素分析显示:年龄、高脂病史、肌酐、腰围、甘油三酯、HDL-C、2h餐后血糖、糖化血红蛋白在高血压合并非酒精性脂肪肝组与单纯高血压组之间差异有统计学意义（P＜0.05或P＜0.01）,经多因素Logistic回归分析显示:OGTT2h血糖、高血脂病史、腰围、甘油三酯是高血压病患者发生脂肪肝的危险因素（OR值分别是1.10,5.81,1.03,1.16,P＜0.05）,HDL-C是其保护因素（OR值是0.51,P＜0.05）。结论　高血压合并非酒精性脂肪肝与肥胖,糖、脂质代谢异常等密切相关,相应患者我们应高度关注,采取综合措施进行早期干预和治疗。     

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.