短暂性脑缺血发作与后继脑梗死的相关因素分析

目的 探讨短暂性脑缺血发作(TIA)与后继脑梗死的相关因素.方法 对144例TIA 患者的临床资料进行分析.结果 144例患者中50例(34.7%)发生了脑梗死;其中累及后循环系统TIA 20例中11例(55.0%)发生脑梗死,累及颈内动脉系统TIA 118例中37例(31.4%)发生了脑梗死,两者比较差异有统计学意义(P＜0.05).54.0%(27/50)的脑梗死发生于TIA后1～7 d;TIA发作持续时间>30min、24h内TIA发作>5次以及首次发作后>24h开始治疗的患者发生脑梗死的危险性显著增高(P＜0.05),发生脑梗死的TIA患者平均动脉压、血糖、总胆固醇、三酰甘油显著高于未发生脑梗死者(P＜0.05).结论 TIA发作持续久、次数多、未及时治疗,尤其伴有高血压、高血糖、高胆固醇、高三酰甘油者后继脑梗死的危险性增高.     

前列地尔在糖尿病肾病治疗中的临床观察

目的 观察前列地尔对糖尿病肾病患者24h尿微量蛋白、肾功能及血脂的影响.方法 86例糖尿病肾病患者随机分为观察组和对照组,每组43例.两组均采用常规治疗控制血糖、血脂、血压等,均给予疏血通静脉治疗,在此基础上,观察组给予前列地尔(商品名保达新)20μg加0.9％氯化钠250 ml静脉滴注,每日1次,连续2周.结果 治疗后观察组总胆固醇、三酰甘油较治疗前明显降低,肌酐、尿素以也较治疗前明显降低,差异有统计学意义(P＜0.05);对照组总胆固醇、三酰甘油以及尿素尔、肌酐、24h尿微量白蛋白较治疗前无明显降低,差异无统计学意义(P＞0.05);两组治疗后血脂和肾功能各项指标比较差异均有统计学意义(P＜0.05).结论 糖尿病肾病患者在常规治疗控制血糖、血压、血脂的基础上,使用前列地尔可以减少尿蛋白,延缓肾功能的进一步恶化,有一定的疗效.     

螺内酯对糖尿病肾病患者尿8-异前列腺素F2α的影响

目的 了解螺内酯对糖尿病肾病患者尿8-异前列腺素F2α(8-iso-PGF2α)的影响.方法 将78例糖尿病肾病患者按随机数字表法分为试验组(40例)和对照组(38例),对照组采用常规治疗,试验组在常规治疗的基础上加用螺内酯20 mg/d,均治疗3个月.分别观察治疗前后收缩压、舒张压、空腹血糖、餐后2h血糖、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、糖化血红蛋白、尿白蛋白/尿肌酐、尿8-iso-PGF2.血钾、血钠等.结果 两组治疗前后空腹血糖、餐后2h血糖、收缩压、舒张压、糖化血红蛋白、三酰甘油、LDL-C、血钠比较差异无统计学意义(P＞0.05).对照组治疗前后ACR、8-iso-PGF2α比较差异无统计学意义(P＞0.05),试验组治疗后ACR、8-iso-PGF2α较治疗前和对照组治疗后均明显降低[(44.55±46.82) mg/g比(85.42±59.46) mg/g和(110.02±110.65) mg/g、(251.07±424.64) ng/L比(438.84±505.23) ng/L和(465.21±544.08)ng/L,P＜0.05].对照组和试验组治疗后TC均较治疗前明显降低[(4.63±0.87) mmol/L比(5.14±0.98) mmol/L和(4.56±0.80)mmol/L比(4.98±0.98) mmol/L,P＜0.05],但两组间比较差异无统计学意义(P＞0.05).试验组治疗后血钾较治疗前明显升高[(4.10±0.46) mmol/L比(3.82±0.46) mmol/L,P＜ 0.05].结论 螺内酯对糖尿病肾病具有独立的抗氧化和降低ACR的保肾作用.     

中青年原发性高血压患者静息心率与代谢综合征的关系

目的 探讨中青年原发性高血压患者静息心率(RHR)与代谢综合征之间的关系.方法 选择2012年1月至2013年5月门诊及住院中青年原发性高血压患者340例,按照RHR分为RHR1组(52例):RHR＜ 70次/min;RHR2组(168例):RHR 70～85次/min; RHR3组(120例):RHR＞ 85次/min.各组患者均行血压、空腹血糖、糖负荷后2h血糖、三酰甘油、高密度脂蛋白胆固醇、腰围测定,并进行比较.结果 三组空腹血糖、糖负荷后2h血糖、三酰甘油、腰围、收缩压、舒张压随RHR升高而升高,高密度脂蛋白胆固醇随RHR增高而下降[空腹血糖:(4.96±0.65),(5.66±0.77),(6.85±0.73) mmol/L;糖负荷后2h血糖:(6.85±0.51),(7.94 ± 0.66),(8.97±0.59) mmol/L;三酰甘油:(1.69±0.43),(2.58±0.75),(3.52±0.90) mmol/L;腰围:(78.3±6.5),(88.6±7.3),(95.8±9.2)cm;收缩压:(143.2±5.6),(156.7±6.1),(164.3±7.4)mmHg,1 mmHg =0.133 kPa;舒张压:(85.4±5.2),(93.6±4.7),(101.2±3.5) mmHg;高密度脂蛋白胆固醇:(1.08±0.64),(0.95±0.59),(0.78±0.33) mmol/L],各组间比较差异均有统计学意义(P＜0.05).相关性分析显示:RHR与空腹血糖、糖负荷后2h血糖、三酰甘油、腰围呈正相关(r值分别为0.52,0.45,0.50,0.36,P＜0.05),与高密度脂蛋白胆固醇呈负相关(r值为-0.39,P＜0.05).结论 RHR与中青年原发性高血压患者代谢紊乱密切相关,降压同时应注重心率控制.     

不同年龄段大动脉粥样硬化性脑梗死高危因素对比分析

目的 探讨不同年龄段大动脉粥样硬化性脑梗死高危因素的差别,以利于采取不同的预防方式,减少脑梗死的发生率及复发率.方法 回顾性分析192例大动脉粥样硬化性脑梗死患者的病历资料,按年龄分为青年组(46例)、中年组(57例)及老年组(89例).研究变量包括性别、既往病史(高血压、糖尿病)、长期吸烟、长期饮酒以及实验室检测指标(三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、同型半胱氨酸).结果 青年组三酰甘油升高率及长期吸烟率显著高于老年组[60.9％(28/46)比22.5％( 20/89)、65.2％( 30/46)比29.2％( 26/89),P＜0.05].中年组男性比例及长期吸烟、长期饮酒率显著高于老年组[ 80.7％ (46/57)比59.6％ (53/89)、57.9％(33/57)比29.2％(26/89)、47.4％(27/57)比15.7％(14/89),P＜0.05].中年组高血压、糖尿病及长期饮酒率显著高于青年组[ 84.2％ (48/57)比60.9％ (28/46)、54.4％ (31/57)比26.1％(12/46)、47.4％( 27/57)比23.9％(11/46),P＜ 0.05].青年组三酰甘油升高率高于中年组[60.9％(28/46)比29.8％(17/57),P＜0.05].老年组高血压率显著高于青年组[83.1％(74/89)比60.9％(28/46),P＜ 0.05].各组在低密度脂蛋白胆固醇升高、同型半胱氨酸升高及高密度脂蛋白胆固醇降低方面比较差异无统计学意义(P＞ 0.05).结论 不同年龄段大动脉粥样硬化性脑梗死预防侧重点不同,青年患者强调生活方式的改变,中年患者在生活方式改变基础上更强调血压、血糖的控制,老年患者则主要对血压进行控制.     

速效救心丸与复方丹参片治疗冠心病心绞痛的疗效观察

目的:探讨速效救心丸治疗冠心病心绞痛的临床效果.方法:选择冠心病心绞痛病例102例,随机分为治疗组和对照组,每组51例.治疗组给予速效救心丸治疗,对照组给予复方丹参片治疗.完成1疗程治疗后,比较两组的治疗效果.结果:治疗组治疗的显效率54.9％,显著高于对照组的显效率35.3％,差异显著,有统计学意义(P＜0.01);治疗组治疗的总有效率92.2％,明显高于对照组的总有效率82.4％,差异明显,有统计学意义(P＜0.05).治疗前,两组患者心绞痛发作频率和心绞痛持续时间比较均无明显差异,无统计学意义(P＞0.05);经过治疗,两组患者心绞痛发作频率和心绞痛持续时间比较均明显少于治疗前,差异明显,有统计学意义(P＜0.05);治疗后,治疗组患者心绞痛发作频率和心绞痛持续时间与对照组比较明显降低,差异明显,有统计学意义(P＜0.05).治疗前,两组患者硝酸甘油用量比较无明显差异,无统计学意义(P＞0.05);治疗后,两组患者硝酸甘油用量明显少于治疗前,差异明显,有统计学意义(P＜0.05),而组间比较,无统计学意义(P＞0.05).结论:速效救心丸治疗冠心病心绞痛的临床效果较复方丹参片好,且治疗有效率达92.2％,能很好改善患者的临床症状,值得临床应用.     

阿立哌唑与利培酮对精神分裂症患者糖脂代谢的影响

目的探讨阿立哌唑与利培酮对精神分裂症患者糖脂代谢的影响。方法将156例精神分裂症患者随机分为2组,每组78例,研究组口服阿立哌唑治疗,对照组口服利培酮治疗,观察8周。于治疗前及治疗8周末检测2组血糖、血脂、血清泌乳素水平及体重指数,对2组上述测评结果进行对比分析。结果研究组治疗前后血糖、血脂、血清泌乳素及体重指数各项指标检测结果均无显著变化(P0.05),对照组治疗8周末空腹血糖、餐后2 h血糖、三酰甘油、高密度脂蛋白胆固醇、血清泌乳素水平及体重指数均较治疗前有显著增高,差异有统计学意义(P0.01);治疗前2组各项检测指标差异均无统计学意义(P0.05),治疗8周末,研究组空腹血糖、餐后2 h血糖、三酰甘油、高密度脂蛋白胆固醇、血清泌乳素水平及体重指数水平均显著低于对照组,差异有统计学意义(P0.01)。结论利培酮对精神分裂症患者的血糖、血脂、血清泌乳素水平及体重指数均有显著影响,而阿立哌唑则无明显影响,值得临床推广使用。     

短暂性脑缺血发作持续时间与后继脑梗死关系的初步探讨

目的 探讨短暂性脑缺血发作(TIA)持续时间与后继脑梗死的关系.方法 选择首次入院的脑梗死患者547例,按患者脑梗死前是否发生同侧TIA,将其分为无TIA组(437例)和有TIA组(110例),有TIA组根据TIA持续时间分为<5 min组(17例)、5～20 min组(65例)、21～60min组(23例)和>60 min组(5例)4个亚组.采用神经功能缺损程度量表(CSS)和日常生活活动能力量表(ADL)进行评定,分析TIA的缺血预适应与TIA持续时间的关系.结果5～20 min组患者轻度神经功能缺损比率较高,为81.5%(53/65),与无TIA组(53.5%,234/437)较差异有统计学意义(P<0.05);同时5～20 min组Ⅰ级预后比率较高(78.5%,51/65),与无TIA组(54.0%,236/437)比较差异也有统计学意义(P<0.05).<5 min组、21～60 min组、>60 min组Ⅰ级预后比率分别为64.7%(11/17)、60.9%(14/23)、60.0%(3/5),与无TIA组比较差异均无统计学意义(P>0.05).结论 TIA的缺血预适应与TIA持续时间有一定关系.     

社区综合干预对代谢综合征高危人群心血管病危险因素的控制作用

目的 观察社区综合干预对代谢综合征高危人群心血管病危险因素的影响.方法 选取代谢综合征高危人群100例,按随机数字表法分为社区综合干预组(50例)与对照组(50例).社区综合干预组予以健康教育干预、健康生活习性干预、健康行为干预、药物干预等措施;对照组接受社会自然干预.两组均随访1年.评估两组人群干预前后的体质指数、腰围、血压、空腹血糖、血脂、血尿酸的变化.结果 社区综合干预组干预后进行体育锻炼、饮食控制、依从服药人数分别增加12％、16％、18％,吸烟、饮酒人数分别减少8％、6％;对照组进行体育锻炼、饮食控制、依从服药人数分别增加2％、0、4％,吸烟、饮酒人数分别减少4％、2％;社区综合干预组依从性明显高于对照组(P＜0.05).两组干预前腰围、体质指数、收缩压、舒张压、空腹血糖、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血尿酸水平比较差异无统计学意义(P＞0.05).干预后两组除高密度脂蛋白胆固醇指标外,其他各指标比较差异均有统计学意义(P＜ 0.05或＜0.01).结论 社区综合干预可改善代谢综合征高危人群的肥胖、血脂紊乱,降低血压、血糖、血尿酸水平.     

短暂性脑缺血发作进展为脑梗死危险因素分析

目的分析短暂性脑缺血发作(TIA)患者进展为脑梗死的主要危险因素,提高临床对TIA的诊治能力。方法回顾性分析2015年2月-2016年2月南京鼓楼医院收治的160例TIA患者的临床资料,记录发生脑梗死的病例。将其中发生脑梗死的45例TIA患者分为观察组,未发生脑梗死的115例TIA患者分为对照组,分析引起脑梗死的相关危险因素。结果 160例患者中颈内动脉系统TIA有90例,其中有19例发生脑梗死(21.11%);椎-基底动脉系统TIA有70例,其中有26例发生脑梗死(37.14%)。3个月内发作次数≥5次、TIA发作时间≥30 min、糖尿病、冠心病、高血压、治疗时间≥6 h是引起TIA发展为脑梗死的主要危险因素。结论发作时间长、发作频率高、合并有心血管疾病(糖尿病、冠心病、高血压)、未及时接受治疗的TIA患者容易发展为脑梗死。     

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.