MHD患者透析期间血压波动与其骨代谢指标的相关性

目的研究MHD患者透析期间血压波动与其骨代谢指标的相关性。方法选择2017年3月-2021年2月在广东省惠州市第六人民医院接受MHD治疗的透析患者355例作为观察对象。将患者分成观察组(即|△SBP|≥10mmHg)共107例,以及对照组(即|△SBP|<10mmHg)共248例。对比两组透析相关指标,分析MHD患者的骨代谢指标与其血压波动的相关性,利用Logistic回归分析法分析MHD患者自身血压波动的影响因素。结果观察组的血磷(1.98±0.24)mmol/L、iPTH水平(414.61±83.42)pg/mL均分别较对照组(1.79±0.36)mmol/L、(376.53±68.85)pg/mL明显更高(P<0.05)。根据Pearson法分析相关性显示,MHD患者透析期间血压波动|△SBP|值与其血磷及iPTH均呈正相关(P<0.05)。根据Logistic回归分析法发现,MHD患者自身血压波动的危险因素包含血磷,以及iPTH(OR>1)。结论MHD患者透析期间发生血压波动的状况与其骨代谢指标之间的相关性较好,且影响血压波动的因素包含血磷及iPTH,可采取适当的措施加以干预,从而更好地改善患者的预后,应予以重视。     

围绝经期血液透析女性透析参数和骨质疏松症发生的相关性分析

目的探讨围绝经期血液透析女性透析参数和骨质疏松症(OP)发生的关系。方法纳入该院2016年1月-2018年1月收治的围绝经期维持性血透(MHD)患者94例。收集患者的临床资料,包括年龄、围绝经状况及透析参数(透析时间、血清白蛋白、透析前舒张压、透析前收缩压、透析前心率、钙磷乘积、每周透析次数、平均动脉压及体质指数)。通过测定患者的骨密度,将患者分成骨量正常组15例、骨量减少组21例以及骨质疏松组58例。比较3组透析参数、全髋、股骨颈、腰椎及大转子骨密度。经Pearson线性相关分析透析参数与患者骨密度的相关性。经Logistic多因素模型分析围绝经期MHD患者骨质疏松发生的危险因素。结果骨质疏松组透析时间[(22.11±0.74)月]较骨量减少组、骨量正常组明显延长[(19.39±2.07)月、(16.72±2.43)月],且骨量减少组透析时间显著长于骨量正常组(P0.05)。骨质疏松组钙磷乘积[(5.35±0.71)mmol/L]较骨量减少组、骨量正常组明显增高[(4.53±0.46)mmol/L、(3.67±0.37)mmol/L],且骨量减少组钙磷乘积显著高于骨量正常组(P0.05)。骨质疏松组血清白蛋白[(30.61±1.56)g/L]显著低于骨量减少组、骨量正常组[(37.72±2.06)g/L、(38.95±2.13)g/L,P0.05]。骨质疏松组股骨颈、腰椎骨密度[(0.623±0.117)g/cm~2、(0.627±0.168)g/cm~2]显著低于骨量正常组及骨量减少组[(0.916±0.143)g/cm~2、(1.015±0.137)g/cm~2及(0.735±0.151)g/cm~2、(0.815±0.142)g/cm~2],且骨量减少组显著低于骨量正常组(P0.05)。股骨颈、腰椎骨密度与透析时间呈负相关(P0.05),与钙磷乘积呈正相关(P0.05)。透析时间≥18个月、钙磷乘积≥4 mmol/L是OP发生的危险因素(P0.05)。结论围绝经期MHD患者OP的发生可能与透析时间、钙磷乘积存在关联,且二者均为患者OP发生的危险因素。     

伴神经元特异性烯醇化酶增高的缺血性卒中患者相关危险因素分析

目的 采用Logistic回归分析伴神经元特异性烯醇化酶(NSE)增高的缺血性卒中(CIS)的相关危险因素,以期为CIS的防治提供更多的理论依据.方法 选择2007年5月至2011年12月住院的CIS患者210例.美国国立卫生研究院卒中量表(NIHSS)评估神经功能缺损程度,彩色多普勒超声检测颈动脉内膜-中层厚度(IMT),电化学发光法检测NSE表达水平.根据NSE水平将210例患者分为低NSE组(NSE≤12 μg/L)和高NSE组(NSE＞ 12μg/L).结果 低NSE组94例,高NSE组116例.单因素分析结果表明:低NSE组与高NSE组NIHSS评分、颈动脉IMT、高血压病史、冠心病病史、糖尿病病史、白细胞计数、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)比较差异均有统计学意义[(15.8±3.4)分比(21.6±4.7)分、(1.12 ±0.31) mm比(1.68±0.54) mm、29.8％ (28/94)比58.6％ (68/116)、17.0％ (16/94)比30.2％ (35/116)、13.8％(13/94)比27.6％ (32/116)、(6.68±3.45)×109/L比(10.08±4.27)×109/L、(4.67±1.22) mmol/L比(5.01±1.64) mmol/L、(1.26±0.44) mmol/L比(1.74±0.61) mmol/L、(3.42±1.14) mmol/L比(5.26±1.64) mmol/L、(1.32±0.22)mmol/L比(1.01±0.17) mmol/L](P＜ 0.05).进一步行多因素Logistic回归分析显示NIHSS评分、颈动脉IMT、白细胞计数、LDL-C、高血压病史、糖尿病病史是CIS患者NSE增高的独立危险因素.结论 NIHSS评分、颈动脉IMT、白细胞计数、LDL-C、高血压病史、糖尿病病史是CIS患者NSE增高的独立危险因素.对上述危险因素进行有效的干预有望降低CIS的发病率、缓解病情及改善患者的预后.     

不同透析方法治疗脑出血合并急性肾衰竭的疗效研究

目的 比较腹膜透析(PD)与间歇性血液透析(HD)治疗脑出血合并急性肾衰竭的疗效.方法 将46例脑出血合并急性肾衰竭患者按透析方法不同分为PD组(24例)和HD组(22例),比较两组的疗效.结果 PD组血尿素氮透析前(31.05±15.01)mmol/L,透析后第10天(13.23±3.86)mmol/L,HD组血尿素氮透析前(34.80±13.36)mmol/L,透析后第10天(14.65±4.02)mmol/L.PD组血肌酐透析前(465.55±135.31)μ mol/L,透析后第10天(176.25±91.31)μmol/L,HD组血肌酐透析前(495.33±107.25)μmol/L,透析后第10天(207.85±93.24)μmol/L.两组透析治疗前后比较差异均无统计学意义(P＞0.05).PD组发生并发症(低血压、心力衰竭、再次出血、严重感染)4例次,HD组为11例次,两组比较差异有统计学意义(P＜0.05).日平均住院费用PD组(863.25±153.78)元,HD组为(1054.45±237.26)元,两组比较差异有统计学意义(P＜0.05).结论 脑出血合并急性肾衰竭患者采用PD是一种安全、有效、经济的治疗方法.     

透析营养客观评分法评估血液透析患者的营养状况：75例观察

目的 应用透析营养客观评分法对维持性血液透析患者进行营养评估,了解营养不良的发生情况及严重程度,探讨引起患者营养不良的影响因素.方法 选择维持性血液透析患者75例,以透析营养客观评分作为营养不良的判断标准对患者进行营养评估,将患者分为营养正常、轻中度营养不良和重度营养不良3组.采用Logistic回归法分析引起患者营养不良的相关因素,和传统的主观综合营养评估进行比较,观察其对血液透析患者营养不良评估的价值.结果 75例患者中男女比例1.13∶1,平均年龄(54.90±12.10)岁,透析龄(85.37 ±54.17)个月.根据透析营养客观评分营养正常患者15例(20％)、轻中度营养不良者42例(56％)、重度营养不良者18例(24％).重度营养不良组与营养正常组相比,患者的体重指数[(19.81 ±2.22)比(23.90±2.44)kg/m2,P=0.030]、干体重[(50.85±7.60)比(59.94±10.89)kg,P=0.020]差异具有统计学意义,并且轻中度营养不良、重度营养不良组与营养正常组相比,患者的胆固醇[(4.60±0.84)、(3.73±0.68)mmol/L比(5.71±1.64)mmol/L,P =0.011,P=0.000]、标准蛋白质分解率[1.17、1.15g/(kg·d)比1.45 g/(kg·d),P=0.030,P=0.010]、肱三头肌皮下脂肪厚度[(1.44±0.77)、(1.00 ±0.41)cm比(1.80±0.63)cm,P=0.032,P=0.020]、上肢中臂周径[(24.85±1.48)、(21.66±1.48)cm 比(24.99 ±2.30)cm,P=0.046,P=0.037]差异具有统计学意义.多因素Logistic回归显示C反应蛋白[OR=12.482,95％ CI=0.190-130.928,P=0.035]和标准蛋白质分解率[OR =0.128,95％ CI=0.022-0.736,P=0.021]与营养不良存在相关性.结论 营养不良在维持性血液透析患者中的发生率较高,炎症和蛋白质摄入不足是引起血液透析患者营养不良的独立影响因素.     

脓毒症诱发急性肝功能障碍的危险因素及临床特征对比分析

目的 对比分析脓毒症诱发急性肝功能障碍的危险因素和临床特征.方法 将168例脓毒症患者按是否诱发急性肝功能障碍分为单纯脓毒症组(对照组,142例)和脓毒症诱发肝功能障碍组(观察组,26例).采用Logistic回归分析阐明脓毒症诱发急性肝功能障碍可能的危险因素；比较两组生化指标、血浆内皮素(ET)-1、脓毒症相关的序贯器官衰竭评分(SOFA).结果 168例脓毒症患者诱发急性肝功能障碍发生率为15.5％(26/168).多因素Logistic回归分析显示,长期饮酒(OR=4.213,95％ CI 1.399～13.174)、心功能不全(OR=4.210,95％ CI 1.463～12.504)以及低血压(OR =5.944,95％ CI 1.823～ 19.979)为脓毒症诱发急性肝功能障碍的独立危险因素；观察组患者的总胆红素、直接胆红素、肌酐、血糖波动范围、乳酸、ET-1、SOFA、病死率均明显高于对照组[(35.9±9.8)μmol/L比(27.8±6.7)μmol/L、(17.7±8.0)μ mol/L比(12.3±5.9)μmol/L、(219.6±156.4)μmol/L比(159.4±125.3) μmol/L、(7.6±4.9) mmol/L比(3.0±1.6) mmol/L、(3.8±1.3) mmol/L比(2.0±1.2) mmol/L、(79.6±25.7) μg/L比(60.8±12.6)μg/L、(8.8±2.6)分比(5.7±1.8)分、38.5％(10/26)比17.6％(25/142),P＜0.01或＜0.05].结论 长期饮酒、心功能不全以及低血压为脓毒症诱发急性肝功能障碍的危险因素；肝功能障碍患者具有较高的动脉乳酸、血浆ET-1和SOFA,预示预后不良.     

阿托伐他汀对腹膜透析患者微炎性反应状态的影响

目的 探讨阿托伐他汀对腹膜透析患者炎性反应因子水平的影响.方法 将51例稳定的腹膜透析患者随机分为阿托伐他汀组(26例)和非阿托伐他汀组(25例).治疗12周后检查总胆崮醇(TC)、高密度脂蛋白胆同醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、高敏c反应蛋白(hs-CRP)、白细胞介素(IL)-6和肿瘤坏死因子(TNF)-α.并设25例健康体检人员作为对照组.结果 阿托伐他汀组较治疗前血清TC、TG、LDL-C明显下降[分别为(4.98±1.22)mmol/L比(6.02±1.44)mmol/L、(1.27±0.66)mmol/L比(1.63±0.87)mmol/L、(2.11±0.49)mmol/L比(2.92±0.71)mmol/L],HDL-C明显上升[(1.31±0.34)mmol/L比(0.97±0.26)mmol/L];hs-CRP和IL-6、TNF-α显著降低[分别为(4.14±1.21)mg/L比(6.81±1.63)mg/L、(7.53±6.12)ng/L比(12.89±4.32)ng/L、(16.37±7.46)ng/L比(28.52±10.14)ng/L],且与非阿托伐他汀组治疗后比较差异均有统计学意义(P<0.05).结论 腹膜透析患者存在高血脂和微炎性反应状态,二者密切相关;阿托伐他汀对腹膜透析患者具有较好的凋脂作用,也可以使腹膜透析患者hs-CRP、IL-6、TNF-α水平下降.     

N末端脑钠肽前体水平对维持性血液透析患者容量负荷的预测价值

目的 探讨N末端脑钠肽前体(NT-proBNP)水平对维持性血液透析(MHD)患者容量负荷的预测价值.方法 选取120例MHD患者,根据血压水平分为血压控制不良组(72例)和血压控制良好组(48例).检测透析前后NT-proBNP水平,记录患者心胸比例、左心室质量指数(LVMI)、水肿指数、低血容量发生次数、超滤量并比较,分析NT-proBNP与上述指标的相关性.结果 血压控制不良组的收缩压、舒张压、透析前NT-prpBNP、心胸比例、LVMI、水肿指数、低血容量发生次数分别为( 159.7±18.2) mmHg(1mmHg=0.133 kPa)、(95.3±14.8) mmHg、(11 837.13±1374.26)ng/L、0.61±0.12、( 174.36±21.35) g/m2、2.93±1.72、12例次/周,血压控制良好组分别为(131.6±17.3) mm Hg、( 86.5±13.2) mm Hg、(7649.54±1106.18) ng/L、0.52±0.11、( 151.83±18.94) g/m2、1.02±1.48、26例次/周,两组比较差异有统计学意义(P＜0.01).相关分析显示,透析前后NT-proBNP的差值与超滤量呈显著正相关(P＜0.05);透析前NT-proBNP与收缩压、舒张压、心胸比例、LVMI、水肿指数均呈显著正相关(P＜0.05或＜0.01),而与低血容量发生次数呈显著负相关(P＜0.01).结论 MHD患者NT-proBNP水平与血压、心胸比例、水肿指数、低血容量发生次数、超滤量密切相关,通过检测NT-proBNP水平可更好地评估患者透析中血容量的变化,及时调整透析处方,保证透析的充分性,对提高MHD患者生存质量具有重要意义.     

维持性血液透析患者乙型肝炎病毒感染和疫苗接种情况及影响因素

目的调查维持性血液透析(MHD)患者乙型肝炎病毒(HBV)感染情况、疫苗接种现状,分析影响因素。方法选择2017年5月至2019年12月在本院行MHD3个月的患者360例。调查MHD患者HBV感染情况、疫苗接种现状,分析MHD患者HBV感染的影响因素。结果 360例患者中有43例出现HBV感染(感染组),感染率为11.94%(43/360),将其余317例未感染患者纳入未感染组。360例患者中有112例接种了乙型肝炎疫苗,接种率为31.11%(112/360)。两组年龄、透析龄、透析器重复使用史、输血次数、乙肝家族病史方面比较差异均有统计学意义(均P0.05)。多因素Logistic回归分析显示,年龄≥45岁、透析龄≥45个月、有透析器重复使用史、输血次数≥1、有乙肝家族病史是MHD患者HBV感染的危险因素(均P0.05)。结论本院MHD患者HBV感染率较高,年龄、透析龄、透析器重复使用史、输血次数、乙肝家族病史是影响因素,临床应针对影响因素采取防控措施。     

维持性血液透析患者钙磷代谢异常发生情况及其影响因素分析

目的 分析维持性血液透析(MHD)患者发生钙磷代谢异常的相关影响因素。方法 选取2019年5月至2022年5月我院收治的156例MHD患者作为研究对象,统计钙磷代谢异常发生情况,经单因素和多因素分析找出影响钙磷代谢异常的相关因素。结果 156例MHD患者的钙磷代谢异常发生率为37.18%。单因素和多因素Logistic回归分析显示,年龄≥60岁、透析时间≥2年、 GFR<60 mL/min、有糖尿病史为MHD患者发生钙磷代谢异常的危险因素(P<0.05)。结论 MHD患者钙磷代谢异常发生率较高,年龄≥60岁、透析时间≥2年、 GFR<60 mL/min、有糖尿病史为MHD患者发生钙磷代谢异常的危险因素,临床需对上述危险因素重点关注并予以针对性干预。     

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.     

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.     

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.     

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.     

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.     

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.