不同血液净化方式对血液透析患者血β2-微球蛋白及甲状旁腺激素清除的影响

目的 观察普通血液透析(HD)、血液滤过(HF)、血液透析+血液灌流( HD+ HP)及高通量血液透析(HFHD)对尿毒症患者血β2-微球蛋白(β2-MG)、甲状旁腺激素(iPTH)清除的效果.方法 选择本院维持性血液透析患者60例,将患者分为HD、HF、HD+ HP、HFHD组,比较4组单次治疗对血β2-MG、iPTH的清除率.结果 (1)HD组治疗前后血β2-MG、iPTH均无显著下降(P＞0.05),HD+HP组治疗前后血iPTH显著下降(P＜0.01)、β2-MG无显著下降(p＞0.05),HF及HFHD组治疗前后血β2 -MG、iPTH均显著下降(P＜0.01);(2)HD组与HD+ HP组对血β2-MG的清除率比较差异无统计学意义(P＞0.05),此两组的清除率与HF及HFHD组比较差异有统计学意义(P＜0.01),HD+HP、HF及HFHD组对iPTH清除率比较差异无统计学意义(P＞0.05),而三组的清除率与HD组比较差异有统计学意义(P＜0.01).结论 HD不能有效清除β2-MG及iPTH; HD+ HP能有效清除iPTH,对β2-MG不能有效清除;HF及HFHD能有效清除β2-MG及iPTH.     

血液透析滤过对尿毒症患者疗效分析

目的:分析血液透析滤过对尿毒症患者的疗效。方法:对48例尿毒症患者随机分为血液透析滤过组(HDF)和常规血液透析组(HD),两组患者分别给予相应的基础治疗,检测尿素氮(BUN)、尿酸(UA)、肌酐(Scr)、甲状旁腺激素(iPTH)、β2-微球蛋白(β2-MG)清除情况。结果:BUN、UA、Scr三组比较治疗前后差异有统计学意义(P<0.05);HD治疗后不能有效清除iPTH和β2-MG,治疗前后比较差异无统计学意义(P>0.05),HDF能有效清除iPTH和β2-MG,治疗前后差异有统计学意义(P<0.05)。结论:HDF具有更稳定的血液动力学,增加中、小分子的清除,减少并发症,提高患者耐受性,降低不良反应的发生率。     

血液透析滤过串联血液灌流对维持性血液透析患者体内微炎症和营养不良状态的影响

目的探讨血液透析滤过(hemodiafiltration,HDF)联合血液灌流(hemoperfusion,HP)对维持性血液透析(maintaining hemodialysis,MHD)患者微炎症和营养不良状态的影响。方法选择2014年6月—2015年6月收治的MHD患者60例作为研究对象,随机分为血液透析(hemodialysis,HD)组和HDF+HP组各30例。HD组给予常规HD治疗,4 h/次,3次/周;HDF+HP组在HD组的基础上给予HDF串联HP治疗,1次/2周;两组均连续治疗24周。比较两组治疗前后IL-6、TNF-α、hs-CRP、Hcy水平,同时观察患者Hb、TP、Alb、TRF的变化情况。计量资料组间比较采用t检验,组内比较采用配对t检验,P0.05为差异有统计学意义。结果 HDF+HP组治疗后hs-CRP、IL-6、TNF-α、Hcy分别为(5.75±2.11)、(51.10±7.65)、(81.21±8.41)ng/L、(12.31±2.21)μmol/L,均明显低于治疗前的(14.11±2.20)、(102.22±20.32)、(197.83±24.47)ng/L、(39.96±9.43)μmol/L,差异均有统计学意义(均P0.05)。HDF+HP组治疗后Hb、TP、Alb、TRF分别为(105.65±22.21)、(63.10±22.65)、(39.21±6.41)g/L、(197.31±22.21)μg/L,均明显高于治疗前的(92.21±12.10)、(51.26±11.32)、(31.84±5.47)g/L、(162.96±15.42)μg/L,差异均有统计学意义(均P0.05)。治疗后,HDF+HP组hs-CRP、IL-6、TNF-α、Hcy、Hb、TP、Alb、TRF与HD组[(13.32±1.20)、(96.68±25.65)、(101.32±24.24)ng/L、(38.23±8.34)μmol/L、(93.22±13.10)、(52.32±12.32)、(33.87±4.54)g/L、(163.23±15.33)μg/L]比较差异均有统计学意义(均P0.05)。结论 HDF联合HP治疗MHD可明显改善患者体内微炎症及营养不良状态。     

不同血液净化方法对慢性肾衰竭维持性血液透析患者血清β2-微球蛋白的影响

目的 探讨不同血液净化方法对慢性肾衰竭维持性血液透析(MHD)患者血清β2-微球蛋白(β2-MG)的清除效果.方法 将40例慢性肾衰竭MHD患者随机分为四组:血液透析(HD)组,高通量血液透析(HFD)组,血液透析滤过(HDF)组,HD+血液吸附(AP)组,每组各10例.记录患者治疗前后血清β2-MG测得值并进行组内和组间统计学比较.结果 HD组第1次血液净化后β2-MG测得值[(53.49±1.15)mg/L]较第1次血液净化前(基线值)[(49.10±2.31)ms/L]上升但差异无统计学意义(P>0.05),6个月血液净化后β2-MG测得值[(55.63±1.30)mg/L]较基线值上升且差异有统计学意义(P<0.05).HFD组、HDF组和HD+AP组第1次血液净化后及6个月血液净化后β2-MG测得值较基线值均有明显下降趋势(P<0.05).并且HD+AP组6个月血液净化后β2-MG测得值较HFD组和HDF组下降趋势更为明显(P<0.05).结论 HD对β2-MG无清除效果,HFD、HDF和HD+AP能有效清除β2-MG,并且6个月后HD+AP清除β2-MG效果更佳.     

不同血液净化方式对维持性血液透析患者微炎症状况及生存质量的影响

目的：研究不同血液净化方式对维持性血液透析患者微炎症状况及生存质量的影响。方法：选取东莞市人民医院血液净化室维持性血液透析患者75例,将患者随机分为三组：低通量血液透析（HD）组、血液透析滤过（HDF）组和血液透析联合血液灌流（HD＋HP）组,连续治疗6个月后,检测治疗前后C反应蛋白（CRP）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、肿瘤坏死因子（TNF-α）及白蛋白（Ab）与血红蛋白（Hb）的含量,治疗前后进行两次SF-36问卷调查评估生存质量。结果：HDF组与HD＋HP组治疗后CRP、IL-6、IL-8、TNF-α的清除及Ab与Hb上升均优于HD组（P〈0.05）,HDF组与HD＋HP组两组间比较差异无统计学意义。治疗6个月前后三组患者行生存质量评分,在总体健康、躯体疼痛、躯体角色功能、社会功能、精力、心理健康方面,HDF组与HD＋HP组治疗均优于HD组（P〈0.05）,HDF组与HD＋HP组两组间比较差异无统计学意义,而情绪角色功能在治疗前后三组之间差异无统计学意义（P〉0.05）。结论：维持血液透析患者存在微炎症状态,HD＋HP及HDF能更好清除炎症因子,改善维持性血液透析患者微炎症状态,改善患者生存质量。     

不同血液净化方法对维持性血液透析患者高甲状旁腺素的清除效果观察

目的比较3种常用血液净化方法对维持性血液透析患者甲状旁腺素（PTH）清除效果。方法对进行维持性透析患者60例随机分为血液灌流串联血液透析组（HD＋HP）、血液透析滤过组（HDF）和血液透析组（HD）3组。记录单次透析前后的PTH值。结果（HD＋HP）组和HDF组治疗前后PTH比较差异有统计学意义（P〈0．05）。HD组患者治疗前后PTH比较差异无统计学意义（P〉0．05）。结论血液灌流联合血液透析和血液透析滤过能有效清除PTH，两者清除率差异无统计学意义，而血液透析不能有效清除PTH。     

烟酰胺对血液透析高磷血症的治疗观察

目的 观察烟酰胺对血液透析高磷血症的疗效及安全性.方法 28例维持性血液透析患者单盲法随机分为烟酰胺治疗组和安慰剂对照组,每组14例,安慰剂对照组给予安慰剂治疗；烟酰胺治疗组前4周每日口服烟酰胺500 mg,后4周每日口服烟酰胺750 mg,停用烟酰胺后再随访4周,检测血磷、血钙、免疫反应性甲状旁腺激素(iPTH)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇([DL-C)、三酰甘油(TG),并观察有无不良反应.结果 烟酰胺治疗组治疗第6、8周血磷水平分别下降至(1.55±0.55)、(1.32±0.65) mmol/L,与相应时间的安慰剂对照组的(1.91±0.52)、(1.91±0.58) mmol/L比较差异有统计学意义(P＜ 0.05)；烟酰胺治疗组治疗第8周钙磷乘积下降至(3.19±0.36) mmol2/L2、iPTH下降至(20.0±7.8) pmol/L,与安慰剂对照组的(4.09±0.37) mmol2/L2、(27.3±9.3) pmol/L比较差异有统计学意义(P＜0.05)；烟酰胺治疗组HDL-C在治疗第8周上升至(1.5±0.4) mmol/L,与安慰剂对照组的(1.1±0.3) mmo1/L比较差异有统计学意义；LDL-C在治疗第6、8周分别下降至(3.7±0.7)、(3.5±0.8) mmol/L,与相应时间的安慰剂对照组的(4.2±0.4)、(4.3±0.8) mmol/L比较差异有统计学意义(P＜0.05).烟酰胺治疗组停止治疗第4周,iPTH尚比安慰剂对照组低,其余指标均逐渐回复至治疗前水平.结论 烟酰胺对血液透析的高磷血症控制有效.     

三种血液净化方法治疗尿毒症皮肤瘙痒疗效比较

目的找到一种既有效又经济的血液净化方法治疗维持性血液透析病人的皮肤瘙痒。方法将长期进行维持性血液透析有皮肤瘙痒74例病人随机分为三组:血液透析加血液灌流组(HD+HP)25例,每周3次血液透析,其中每周第一次血液透析串连血液灌流;血液透析加血液滤过组(HD+HDF)24例,每周第一次为血液透析滤过其余两次为血液透析;血液透析加血液滤过间隔血液灌流组(HD+HDF/HP)25例,每周进行两次HD,另外单周加一次HD联合血液灌流治疗,而双周加1次HDF,三组疗程均为16w。治疗前后观察血清甲状膀腺(PTH)的数值变化及患者皮肤瘙痒缓解情况。结果 HD+HP组患者皮肤瘙痒缓解率为88%,HD+HP/HPF组缓解率84%,两者无统计学差异(p>0.05),而HD+HDF组缓解率67%,与前两组比较有明显统计学差异(p<0.05)。结论 HD+HP及HD+HP/HDF但均能有效治疗尿毒症患者皮肤瘙痒,而HD+HP/HDF更经济。     

血液灌流联合血液透析对患者血清中瘦素及营养状况的影响

目的探讨血液灌流联合血液透析对血液净化患者血清中瘦素及营养状况的影响。方法我院血透中心2009年1月～2009年12月采用血液透析联合灌流(HD+HF)、血液透析滤过(HDF)和单纯血液透析(HF)三种方法各对60名慢性肾衰患者行血液净化,比较血液净化6个月后患者血清中的瘦素(Leptin)水平和营养状况。结果 HP联合HD和HDF均能有效清除血液净化患者血清中的Leptin,改善患者的营养状况,差异有统计学意义(p<0.05)。结论 HP联合HD较HD和HDF在清除血液净化患者血清中的Leptin和改善患者营养状况方面更具优势,值得临床推广应用。     

常用血液净化方法对维持性血液透析患者血清甲状旁腺素的清除效果

目的通过比较两种不同的血液净化治疗方法对维持性血液透析患者的血清甲状旁腺素的清除效果,探讨如何提高慢性肾衰竭患者的生活质量。方法对于自2008年1月-2010年1月在我院治疗的280例慢性肾功能不全的患者中选择符合人选标准的60例慢性肾功能衰竭维持性血液透析患者,采取随机数表法随机分为血液透析滤过（HDF）组和血液透析滤过＋血液灌流（HDF＋HP）组分别进行治疗,治疗期为2个月,每组均为30例,每例在治疗前、后均抽血采用化学发光法进行血清甲状旁腺素（iPTH）的浓度检测。结果治疗后HDF＋HP组iPTH明显下降（P〈0．01）;HDF组iPTH浓度明显下降（P〈0．01）,治疗后iPTH浓度血液透析滤过＋血液灌流（HDF＋HP）组较血液透析滤过（HDF）组降低更显著（P〈0．01）。结论血液透析滤过（HDF）和血液透析滤过串联血液灌流（HDF＋HP）均能有效清除维持性血液透析患者的血清甲状旁腺素（iPTH）,但相比之下,前者对血清甲状旁腺素（iPTH）的清除效果更明显。     

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.