茶色素对肾损伤诱发高血压性心肌肥大的预防作用及其机制研究

目的研究茶色素对肾损伤诱发高血压性心肌肥大的预防作用及其涉及内皮素(ET)、血管紧张素Ⅱ(AngⅡ)和一氧化氮(NO)的机制。方法雄性SD大鼠通过部分肾切除造成高血压性心肌肥大模型,分别给予含0·10%和0·25%茶色素的水自由饮用,持续4周。同时设置模型对照组和假手术组。测定受试物给予前后大鼠的动脉收缩压和给予后大鼠心脏重量以及血清NO、一氧化氮合酶(NOS)、AngⅡ和ET浓度(RIA法)。结果4周后,模型对照组大鼠心脏重量(1·71±0·23)g,心脏系数(0·42±0·06),左心室重量(1·19±0·22)g,左心室系数(0·29±0·06),AngⅡ浓度(748·91±154·80)pg/ml,ET浓度(175·66±49·55)pg/ml,NO浓度(21·1±7·0)μmol/L。经0·10%和0·25%茶色素处理的大鼠心脏重量分别为(1·54±0·13)g和(1·54±0·14)g,心脏系数分别为(0·38±0·04)和(0·39±0·04),左心室重量分别为(1·07±0·11)g和(1·09±0·11)g,AngⅡ浓度分别为(466·18±111·44)pg/ml和(537·55±61·09)pg/ml,ET浓度(88·92±27·20)pg/ml和(97·11±26·74)pg/ml,NO浓度为(24·2±11·9)μmol/L和(33·0±22·5)μmol/L,与模型对照组比较均有显著性差异(P<0·05)。结论茶色素能预防部分肾切除所引起的心肌肥大,这种作用与茶色素对ET、AngⅡ以及NO的调节有关。     

福建省建筑材料天然放射性水平调查分析

[目的 ]分析福建省建材中天然放射性水平 ,并探讨建材辐射水平与人体的外照射有效剂量关系。 [方法 ]采集全省建材 2 6类2 75个样品 ,按规定方法分析测定样品中天然放射性核素含量。 [结果 ] 1建材原料中各种核素均值 2 2 6 Ra为 (79.0± 87.3) Bq· kg- 1 ,2 32 Th为 (40 .2± 38.3) Bq· kg- 1 ,4 0 K为 (383.2± 371 .6) Bq· kg- 1 ,Ra当量浓度均值为 (1 61 .4± 1 32 .8) Bq· kg- 1 ,空气吸收剂量率均值为(1 7.9± 1 3.7)· 1 0 - 8Gyh- 1 ,建材原料对人体的外照射有效剂量均值为 (52 0 .6± 41 9.7)μSv/ a。 2成品建材中 2 2 6 Ra含量为 (69.1± 37.7)Bq· kg- 1 ,2 32 Th为 (96.6± 66.7) Bq· kg- 1 ,4 0 K为 (459.3± 41 7.8) Bq· kg- 1 ,Ra当量浓度为 (2 1 3.7± 1 0 9.5) Bq· kg- 1 ,空气吸收剂量率为 (2 3.4± 1 0 .9)· 1 0 - 8Gyh- 1 ,成品建材对人体的外照射有效剂量为 (683.9± 350 .8)μSv/ a。 3装璜材料中 2 2 6 Ra含量为 (63.0± 2 8.1 )Bq· kg- 1 ,2 32 Th为 (44.9± 46.0 ) Bq· kg- 1 ,4 0 K为 (479.9± 355.2 ) Bq· kg- 1 ,Ra当量浓度为 (51 4 .6± 359.3) Bq· kg- 1 ,空气吸收剂量率为 (2 0 .5± 1 5.2 )· 1 0 - 8Gyh- 1 ,装璜材料对人体的外照射有效剂量为 (51 4 .6     

扶正化瘀胶囊联合拉米夫定治疗慢性乙型肝炎抗纤维化效果观察

目的观察扶正化瘀胶囊联合拉米夫定治疗慢性乙型肝炎抗纤维化的临床效果。方法选择2011年1—12月收治的慢性乙型肝炎患者54例,随机分成对照组26例和治疗组28例,对照组单用拉米夫定治疗,治疗组在对照组基础上给予扶正化瘀胶囊治疗,两组疗程均为24周。观察两组患者治疗前后肝功能(ALT、AST)、肝纤维化指标[血清透明质酸(hyaluronic acid,HA)、层粘连蛋白(laminin,LN)、Ⅲ型前胶原(procollagenⅢ,PC-Ⅲ)、Ⅳ型胶原(collagen typeⅣ,C-Ⅳ)]及炎症纤维化相关细胞因子———肿瘤坏死因子-α(tumor necrosis factorα,TNF-α)的变化情况。结果治疗24周后HA、LN、PC-III、C-Ⅳ、TNF-α的含量对照组分别为(195.4±22.5)ng/ml、(203.7±20.9)ng/ml、(173.9±32.0)μg/ml、(89.0±22.3)μg/ml、(112.2±10.5)ng/ml,治疗组分别为(120.4±34.5)ng/ml、(156.6±19.2)ng/ml、(100.3±31.3)μg/ml、(48.9±7.6)μg/ml、(85.1±12.7)ng/ml,两组比较差异均有统计学意义(均P<0.05)。两组ALT、AST复常率比较差异均无统计学意义(均P>0.05)。结论对于慢性乙型肝炎的抗纤维化治疗,扶正化瘀胶囊与拉米夫定的联合作用效果明显优于单用拉米夫定。     

中链脂肪酸对营养性肥胖大鼠体重及脂质代谢的作用

目的研究中链脂肪酸(MCFA)对营养性肥胖大鼠体重、体脂和血脂水平的影响。方法采用预防肥胖模型法,每天给予SD大鼠高脂营养饲料,并灌胃含不同剂量MCFA的食用油脂,饲养38天,观察体重、摄食量、体脂重量、血脂、胰岛素水平在不同剂量组动物间的差异。结果高、中、低三个剂量组大鼠分别摄入0·975、0·325和0·163g/kg bw MCFA38天,高剂量组与模型对照组相比,体重明显较低[分别(295·2±29·7)g和(324·6±9·1)g](P<0·05),脂肪垫重量明显较轻[分别(5·30±1·57)g和(7·20±1·74)g](P<0·05),脂肪细胞明显较小;各剂量组总的摄食量不显著低于模型对照组;血清甘油三酯(TG)、总胆固醇(TC)、胰岛素水平与模型对照组比较差异无显著性,中、高剂量组高密度脂蛋白胆固醇(HDL-C)水平高于模型对照组[分别(0·71±0·11)mmol/L、(0·73±0·12)mmol/L、(0·60±0·06)mmol/L](P<0·05),高剂量组大鼠的瘦素水平显著低于模型对照组[分别(1·61±0·39)ng/ml和(2·04±0·46)ng/ml](P<0·05)。结论在饲料摄入量没有差别的前提下,摄入0·975g/kg bw MCFA对营养性肥胖大鼠的体重增长有一定抑制作用,对血脂水平没有不良影响。     

电焊作业对工人血液中必需元素的影响

目的:探讨电焊作业对工人血液中必需元素的影响。方法:以某金属结构厂82名电焊作业工人为接触组,另以不接触毒物的61名非电焊工人为对照组,血锰含量测定采用石墨炉原子吸收法,血中铜、铁、锌、镁、钙含量则采用火焰原子吸收法测定。同时对电焊作业环境空气中的锰浓度、对照组作业场所空气中锰浓度进行采样测定。结果:血锰,接触组为42173±21163μg/L,明显高于对照组(29197±17162μg/L,P<0101);血锌,接触组和对照组分别为9102±3147mg/L和12172±3189mg/L,两者差异有显著性(P<0105);血镁,接触组和对照组分别为47199±9186mg/L和35182±15108mg/L,两者差异有显著性(P<0105);两组间血铜、血铁和血钙含量差异均无显著性(P>0105)。结论:电焊作业可能导致工人血锰含量增加,同时还可引起血锌含量下降,血镁含量升高。     

寻呼作业女工血清5-羟色胺水平的探讨

目的研究寻呼台作业人员血清5-羟色胺(5-HT)的变化规律。方法采用荧光分光光度测定法对76名寻呼台作业女工进行了血清5-HT含量测定。结果观察组工前血清5-HT含量为(72.7±12.8)μg/L,工后为(79.4±16.3)μg/L,对照组为(68.5±10.8)μg/L,三组间差异有显著性(P＜0.01);经q检验发现观察组工后高于工前(P＜0.05),且明显高于对照组(P＜0.01)。结论寻呼台作业人员血清5-HT含量可在一定程度上反映其职业应激状态。     

高血压患者血清锌、铜、钙、钴、镉、镁、镍、铬、钛的测定

本文应用直流等离子体原子发射光电直读光谱仪测定了60例正常人,45例高血压患者血清锌、铜、钙、钴、镉、镁、镍、铬、钛含量。结果表明,正常人血清锌19.70±3.75μmol/L(1.2876±0.2457μg/ml),铜17.23±3.48μmol/L(1.0945±0.2213μg/ml),钙2211.09±430.72μmol/L(104.6523±17.2634μg/ml),钴2.87±1.05μmol/L(0.3694±0.0616μg/ml),锅0.44±0.27μmol/L(0.0491±0.0300μg/ml),镁783.71±294.29μmol/L(19.0520±7.1543μg/ml),镍0.42±0.27μmol/L(0.0252±0.0156μg/ml),铬0.28±0.24μmol/L(0.0148±0.0123μg/ml),钛0.82±0.50μmol/L(0.0391±0.0243μg/ml),与文献报道值类似。高血压患者血清锌16.45±2.85μmol/L(1.0754±0.1863μg/ml),钙2308.32±276.29μmol/L(92.5175±11.0738μg/ml),钴2.23±0.62μmol/L(0.1316±0.0368μg/ml)和钛0.61±0.31μmol/L(0.0292±0.0147μg/ml),均低于正常对照组(分别为p<0.001,p<0.05)。镉0.85±0.40μmol/L(0.0951±0.0452μg/ml),镁1022.20±399.91μmol/L (24.8497±9.721 8μg/ml)和镉/锌比值高于正常对照组(P<0.001)。而铜17.58±3.11μmol/L(1.1169±0.1973μg/ml),镍0.39±0.01μmol/L(0.0231±0.0045μg/ml),铬0.31±0.12μmol/L(0.0163±0.0     

血清孕酮、肌酸激酶、甲胎蛋白在异位妊娠诊断中的意义

目的探讨血清孕酮、肌酸激酶及甲胎蛋白对异位妊娠早期诊断的意义。方法随机选择住院的异位妊娠患者56例,同期门诊的正常宫内妊娠者50例。检测比较两组血清孕酮、肌酸激酶及甲胎蛋白值。结果异位妊娠组的血清孕酮值(3·82±2·98ng/ml)显著低于正常早孕组(18·74±6·74ng/ml)(P(0·05);两组血清肌酸激酶值存在着明显的交叉;血清AFP值异位妊娠组(1·92±1·31ng/ml)与正常妊娠组(2·35±2·90ng/ml)无统计学显著性差异(P>0·05)。结论血清孕酮的测定可以协助异位妊娠与正常宫内妊娠的鉴别诊断。     

华北地区二十三种中药材中重金属及有害元素基线调查及参考限量标准建立

目的了解中国华北地区中药材重金属及有害元素的基线水平,制定适合国情并与国际接轨的参考限量标准。方法采用本实验室建立的植物药材中重金属及有害元素检测方法,完成了华北地区23种254份植物性中药材中铅、镉、汞和砷的测定。结果各类植物药材中铅、镉、汞和砷的含量分别为(1·78±1·98)、(0·17±0·24)、(0·04±0·06)和(0·72±0·69)mg/kg。在制定植物性中药材中重金属铅、镉、汞和砷的限量标准的过程中要充分考虑到人体经口摄入的各种食物、饮料及水等可食的物质中这些有害物质的摄入量。目前,中国人每人每日重金属和有害元素经口摄入总量(膳食和中药材相加)分别为铅102·9μg;镉21·4μg;汞5·7μg;无机砷81·0μg。分别占各自的每天允许摄入量值为铅45·7%;镉34·0%;汞5·7%;砷60·5%。建议植物性中药材铅、镉、汞和砷限量标准为铅5·0mg/kg;镉0·3mg/kg;汞0·2mg/kg;砷2·0mg/kg。结论中药材铅、镉、汞和砷基线水平的调查是成功的,在此摄入水平,这些有害元素对人体是安全的。     

冷冻浓缩腹水回输治疗顽固性肝硬化腹水的临床研究

目的 :探讨冷冻浓缩腹水回输治疗顽固性肝硬化腹水的疗效。方法 :采用血液透析机对 32例顽固性肝硬化腹水患者的腹水进行超滤浓缩 ,置 - 18℃环境中冷冻 2～ 3d,37℃温浴溶解后静脉回输。结果 :冷冻浓缩腹水回输前后 ,血清总蛋白分别为 (5 9.1± 5 .6 ) g/ L 和 (6 6 .3± 4 .7) g/ L,白 /球比值为 0 .8± 0 .3和 1.1± 0 .5 ,腹水总蛋白分别为 (15 .2±6 .8) g/ L 和 (5 5 .6± 8.4 ) g/ L,内生肌酐清除率分别为 (47.6± 6 .4 ) ml/ m in和 (71.2± 7.3) ml/ min,肾素分别为 (6 .3±1.5 ) ng.m l/ h和 (3.4± 1.4 ) ng.ml/ h,血管紧张素分别为 (30 2 .4± 4 6 .5 ) ng/ ml和 (137.7± 4 3.2 ) ng/ ml,醛固酮分别为 (6 2 7.8± 94 .3) μg/ m l和 (32 4 .5± 89.7) μg/ m l,治疗前后相比 ,差异均有高度显著性 (P<0 .0 1)。冷冻浓缩腹水回输后 ,未发生低血压、肝昏迷、消化道出血现象 ,未出现蛋白凝集 ,堵塞管腔。结论 :冷冻浓缩腹水回输可降低肾素 -血管紧张素 -醛固酮活性 ,克服了以往浓缩腹水静脉回输出现蛋白凝集、堵塞管腔的缺陷 ,是治疗顽固性肝硬化腹水的首选方法之一 ,具有临床推广价值     

The Impact of Medical Home on Selected Children's Health Outcome

Medical Home practice has been shown to deliver effective health care to children. This practice model calls for providing patient-centered care that is compassionate, culturally effective, coordinated, integrated, safe, of high quality, and accessible. This study shows that children in the states with a higher amount of Medical Home received childhood vaccinations at a higher rate than others. However, Medical Home had a limited effect on the rate of children receiving dental/medical services, mental health services, or number of overweight children.     

The Communication Infrastructure as a Social Determinant of Health: Implications for Health Policymaking and Practice

Policy Points

• Persistent communication inequalities limit racial/ethnic minority access to life‐saving health information and make them more vulnerable to the effects of misinformation.
•  Establishing data collection systems that detect and track acute gaps in the supply and/or access of racial/ethnic minority groups to credible health information is long overdue.
• Public investments and support for minority‐serving media and community outlets are needed to close persistent gaps in access to credible health information.

     

我国卫生支出经费来源的结构分析

本文着重从卫生经济学角度对我国九十年代的卫生总费用来源变化情况进行实证分析,提出：随着市场经济的发展,我国的卫生经费来源结构也发生了相应的变化,已经由过去的单一国家投入变成了现在的多元化投入相结合的涛资模式。出现了政府预算卫生支出的规模和力度相对减弱,公共卫生服务经费的增长速度低于政府预算卫生支出增长速度,企业效益持续滑坡,无力支付日益膨胀的劳保医疗费用,居民个人卫生支出的负担比例增长过快等新情况     

瑞安市不同人群健康教育效果调查分析

目的了解瑞安市现阶段的健康教育与健康促进的总体情况,探索适宜的健康教育工作模式。方法采用分层随机抽样的方法以问卷的形式进行调查。分别对瑞安市小学生、中学生和国家工作人员等6大类2 800人的健康知识、健康行为、健康状况及健康信息需求4大方面的内容做调查研究。结果健康知识知晓率和健康行为形成率:最高的是国家工作人员,分别为82.77%和81.11%。健康状况:53.60%的企业员工感觉睡眠质量好或很好,22.00%的老年人睡眠质量差或很差;46.47%的小学生感觉心情好或很好;24.05%的中学生表示不能应付压力;60.00%的国家工作人员体重正常;38.57%的育龄妇女超重或肥胖。健康信息需求方面:71.96%的人通过电视获取卫生保健信息;小学生最想拥有食品安全与传染病防治知识;中学生最想拥有心理卫生与青春期保健知识;企业员工最想拥有急救与预防意外伤害知识;老年人最想拥有慢性病防治知识。讨论被调查人群的健康知识知晓率与健康行为形成率都低于国家卫生部《疾病预防控制工作绩效考核》的指标要求。调查人群健康状况总体良好,但仍有很多问题值得关注。电视、报刊仍是各类人群获取健康信息的主要途径。6类人群对健康信息内容的需求各不相同,食品安全、传染病防治、急救预防、意外伤害及心理健康等内容普遍受关注。     

Policy Commercializing Nonprofits in Health: The History of a Paradox From the 19th Century to the ACA

Policy Points:

• Health policy in the United States has, for more than a century, simultaneously and paradoxically incentivized the growth as well as the commercialization of nonprofit organizations in the health sector.
• This policy paradox persists during the implementation of the Affordable Care Act of 2010.

Context

For more than a century, policy in the United States has incentivized both expansion in the number and size of tax-exempt nonprofit organizations in the health sector and their commercialization. The implementation of the Affordable Care Act of 2010 (ACA) began yet another chapter in the history of this policy paradox.

Methods

This article explores the origin and persistence of the paradox using what many scholars call “interpretive social science.” This methodology prioritizes history and contingency over formal theory and methods in order to present coherent and plausible narratives of events and explanations for them. These narratives are grounded in documents generated by participants in particular events, as well as conversations with them, observing them in action, and analysis of pertinent secondary sources. The methodology achieves validity and reliability by gathering information from multiple sources and making disciplined judgments about its coherence and correspondence with reality.

Findings

A paradox with deep historical roots persists as a result of consensus about its value for both population health and the revenue of individuals and organizations in the health sector. Participants in this consensus include leaders of governance who have disagreed about many other issues. The paradox persists because of assumptions about the burden of disease and how to address it, as well as about the effects of biomedical science that is translated into professional education, practice, and the organization of services for the prevention, diagnosis, treatment, and management of illness.

Conclusions

The policy paradox that has incentivized the growth and commercialization of nonprofits in the health sector since the late 19th century remains influential in health policy, especially for the allocation of resources. However, aspects of the implementation of the ACA may constrain some of the effects of the paradox.     

社区健康小屋对部队卫生服务建设启示

健康小屋作为一种系统、全面的健康自测体系,对社区卫生服务建设发挥着重要作用。一定程度上,部队相当于一个封闭的社区,基层部队卫生机构相当于营区里的社区卫生服务站点,在部队中进行健康小屋的建设,可以更好地发展和完善部队卫生服务。     

SCHIP Directors' Perception of Schools Assisting Students in Obtaining Public Health Insurance

Background:  Health insurance coverage increases access to health care. There has been an erosion of employer-based health insurance and a concomitant rise in children covered by public health insurance programs, yet more than 8 million children are still without health insurance coverage.
Methods:  This study was a national survey to assess the perceptions of State Child Health Insurance Program (SCHIP) directors (N = 51) regarding schools assisting students in obtaining public health insurance. This study examined the perceived benefits of and barriers to working with school systems and the perceived benefits to schools in assisting students to enroll in SCHIPs and what SCHIP activities were actually being conducted with school systems.
Results:  The majority (78%) of SCHIPs had been working with school systems for more than a year. Perceived benefits of working with schools were greater access to SCHIP-eligible children (75%), assistance with meeting mandates to cover all SCHIP-eligible children (65%), and greater ability of state agencies to identify SCHIP-eligible children (58%). A majority of the directors did not identify any of the potential barrier items. The directors cited the following benefits to schools in helping enroll students in public health insurance programs: reduces the number of students with untreated health problems (80%), reduces student absenteeism rates (68%), improves student attention and concentration during school (58%), and reduces the number of students being held back in school because of health problems (53%).
Discussion:  The perceived benefits derived from schools assisting in enrolling eligible students into SCHIPs are congruent with the mission of schools. Schools need to become proactive in helping to establish a healthy student body, which is more likely to be an academically successful body.