高压氧早期干预对围产期缺氧缺血性脑病新生儿预后的影响

目的:观察高压氧早期干预对围产期缺氧缺血性脑病新生儿预后的影响,探讨新生儿缺氧缺血性脑病后遗症的有效防治方法。方法:将2002年1月～2005年10月湖北省中山医院新生儿科住院确诊的新生儿缺氧缺血性脑病患儿84例随机分为对照组和治疗组。两组早期均给予常规3项支持和3项对症治疗,并使用脑活素。治疗组在此基础上给予高压氧治疗2疗程。新生儿期采用中国新生儿20项行为神经评分法,对所有患儿分别于治疗前及治疗1疗程后各测1次行为神经评分(NB-NA);随访12个月期间复查颅CT、观察运动发育情况、测查Gesell智能发育商。结果:82例患儿坚持随访12个月。①治疗前两组NBNA评分无明显差别,治疗后治疗组评分明显高于对照组(38.8±2.3,34.6±2.2,P0.01);②治疗组脑发育不良发生率为7.14%(3/42),明显低于对照组25.0%(10/40),P0.05。③两组智能发育商得分:治疗组动作能评分较对照组明显提高(106.8±10.3,89.8±11.1,P0.01),应物能明显提高(102.3±11.6,87.7±11.9,P0.01),应人能明显提高(105.6±11.4,90.2±11.3,P0.01),言语能明显提高(98.8±11.9,91.6±10.3,P0.01)。结论:高压氧早期干预治疗能促进脑发育,提高新生儿行为神经评分和智能发育商,改善新生儿缺氧缺血性脑病的预后。     

高压氧联合神经节苷脂钠及中医康复治疗中重度缺氧缺血性脑病的临床效果观察

目的探讨高压氧联合神经节苷脂钠及中医康复治疗对中、重度缺氧缺血性脑病新生儿智能发育的影响。方法选择2014年9月—2015年9月在我院新生儿科住院治疗的中、重度缺氧缺血性脑病(HIE)新生儿120例为研究对象,将所选病例随机分为对照组60例,干预组60例。对照组在常规治疗基础上应用神经节苷脂钠治疗;干预组在对照组治疗的基础上给予高压氧治疗同时配合中医按摩康复干预。临床观察指标为神经行为评分(NBNA)测定,比较两组患儿头颅CT、精神运动发育商(DQ)。结果通过脑CT检查、NBNA测定及随访等各项指标观察,干预组患儿各项指标均明显优于对照组,两组比较有显著统计学意义(P0.01)。结论高压氧联合神经节苷脂钠及中医康复功能锻炼治疗中、重度缺氧缺血性脑病避免单纯药物治疗遗留的后遗症,促进了神经运动系统功能恢复,提高了患儿的生存质量,NBNA评分明显提高,值得临床推广应用。     

新生儿缺氧缺血性脑病中高氧液的应用研究

【目的】探讨高氧液对新生儿缺氧缺血性脑病的疗效,为减轻缺氧缺血对患儿脑损害提供临床依据。【方法】40例缺氧缺血性脑病新生儿,实验组20例使用高氧液,对照组20例未用高氧液。采用比色法和血气分析检测血浆超氧化物歧化敏(superoxidedismutase,SOD)、丙二醛(malondialialdehde,MDA)和血气变化,观察临床症状、体征、颅脑CT及新生儿神经评定(neonatalbehavioralneurologicalassessment,NBNA)评分。【结果】用高氧液组PaO_2、SaO_2明显升高(P<0.01),PaCO_2明显下降(P<0.01);血浆SOD升高、MDA下降(P<0.01);用高氧液组临床症状、体征迅速改善,颅脑CT及NBNA评分情况优于对照组(P<0.05)。【结论】高氧液对治疗新生儿缺氧缺血性脑病有明显疗效。     

新生儿缺氧缺血性脑病血清髓鞘碱性蛋白与头颅CT、行为神经的关系

【目的】探讨新生儿缺氧缺血性脑病(hypoxicischemicencephalopathyHIE)患儿血清髓鞘碱性蛋白(myehnbasicprotein,MBP)与头颅CT、行为神经(neonatalbehavioralneurologicalassessmentNBNA)的关系。【方法】选择足月HIE患儿43例为观察组,轻、中、重度分别为19、11、13例,选择无窒息史及神经系统疾病的新生儿10例为对照组。于出生后4d、10～14d分别取血清,用ELISA法测定血清MBP。生后1周内行头颅CT检查。并于生后4d、10～14d分别行20项NBNA评分。【结果】头颅CT分度为重度者,其血清MBP含量明显增高。生后第4dNBNA评分≤25分者,其血清MBP含量较>25分者明显增高。【结论】将头颅CT、NBNA和血清MBP结合分析,对更好地判断脑损伤程度、估计预后具有一定的意义。     

高压氧治疗新生儿缺氧缺血性脑病的临床疗效

目的研究高压氧对新生儿缺氧缺血性脑病的远期疗效。方法将98例符合新生儿缺氧缺血性脑病诊断标准的足月新生儿随机分为两组,治疗组50例,对照组48例,对照组仅给予常规治疗,治疗组在常规治疗的基础上加用高压氧。结果治疗组中,患儿在新生儿行为神经（NBNA）测试和发育商（DQ）值与对照组比较,显著高于对照组,差异有显著性意义（P〈0．05）。结论高压氧对足月新生儿缺氧缺血性脑病患儿智能、神经行为及生长发育有明显的促进作用,疗效肯定,值得推广。     

单唾液酸四己糖神经节苷脂对新生儿缺氧缺血性脑病血清基质金属蛋白酶-9水平的影响及疗效观察

【目的】 探讨单唾液酸四己糖神经节苷脂(monosialotetrahxosy1 ganglioside, GM1)治疗新生儿缺氧缺血性脑病的疗效及对血清金属蛋白酶-9(matrix metalloproteinases-9, MMP-9)水平的影响。 【方法】 60例新生儿缺氧缺血性脑病患儿,随机分为GM1治疗组(GM1组)30例和常规治疗组(常规组)30例,并选取正常新生儿20例作为对照组。比较治疗前后两组CT检测值与新生儿行为神经评分;并比较治疗组及正常对照组分别在生后24 h内及药物治疗7 d后抽血检测血清MMP-9水平。 【结果】 1)治疗后CT检查值,两组与治疗前比较,差异有统计学意义(t=3.11,P<0.05);治疗一疗程时两组间比较,差异无统计学意义(t=1.24,P>0.05 ),出生后28 d GM1组明显高于常规组(t=3.57, P<0.05)。两组患儿治疗后一疗程、出生后28d NBNA评分较前有明显改善,且GM1治疗组优于常规组(t=2.01,P<0.05);2)GM1组其临床症状和体征改善明显优于常规组(P<0.01);3)GM1组与常规治疗组后血清浓度MMP-9较前明显降低,其中GM1组降低幅度明显高于常规组(P<0.01)。 【结论】 GM1在HIE患儿早期应用可稳定神经元细胞膜,减少细胞凋亡,从而减少MMP-9的释放,发挥神经保护作用。     

高压氧治疗新生儿缺氧缺血性脑病临床效果观察

目的探讨高压氧治疗新生儿缺氧缺血性脑病的临床效果。方法选取在我院接受治疗符合缺氧缺血性脑病标准的患儿58例,随机分为对照组和治疗组,对照组采用常规的治疗方法进行治疗,治疗组在对照组的基础上采用高压氧进行治疗,比较两组患者的临床效果。结果治疗组的总有效率为86.21%,明显高于对照组的75.86%,两组患者相比具有显著性差异(P0.05);治疗组行为神经测定评分明显高于对照组,两组相比具有显著性差异(P0.05)。结论高压氧治疗新生儿缺氧缺血性脑病疗效确切,患者预后较好,后遗症的发生率较低,值得在临床上推广使用。     

高压氧早期干预对新生儿缺氧缺血性脑病预后影响的研究

目的:探讨高压氧(HBO)早期干预对新生儿缺氧缺血性脑病(HIE)预后的影响。方法:将102例符合HIE诊断的足月新生儿随机分为两组,治疗组56例,对照组46例。对照组仅常规治疗,治疗组在常规治疗的基础上早期加用HBO。结果:治疗1个月后治疗组患儿的脑电图异常率明显低于对照组(χ2=7.01,P<0.05);治疗3个月后治疗组头颅CT异常率明显低于对照组(χ2=7.36,P<0.05);治疗6个月后治疗组DQ明显优于对照组(χ2=8.05,P<0.05)。结论:高压氧早期干预对足月新生儿缺氧缺血性脑病的预后,疗效肯定。     

细胞生长肽加高压氧治疗新生儿缺氧缺血性脑病疗效观察

目的:观察应用细胞生长肽加高压氧治疗新生儿缺氧缺血性脑病的疗效。方法:将123例新生儿缺氧缺血性脑病患儿随机分为治疗组和对照组,两组均采用一般治疗(吸氧、止惊、降颅压等),治疗组加用细胞生长肽及高压氧,就其疗效进行回顾性分析。结果:应用细胞生长肽加高压氧治疗新生儿缺氧缺血性脑病,临床症状明显改善,脑电图明显好转,NBNA评分明显提高,与对照组相比差异有统计学意义。结论:使用细胞生长肽加高压氧治疗新生儿缺氧缺血性脑病临床疗效显著。     

高压氧及恢复期治疗对新生儿缺氧缺血性脑病预后的影响

【目的】　探讨应用高压氧及恢复期序贯治疗对新生儿缺氧缺血性脑病预后的影响。　【方法】　 12 9例缺氧缺血性脑病新生儿分两组 ,对照组只进行急性期的综合治疗。治疗组在急性期综合治疗的基础上 ,加高压氧治疗及恢复序贯足程的康复治疗。并通过随访对两组患儿神经系统后遗症发生率及 1岁时体格、智能的发育情况加以比较。　【结果】　两组比较 ,神经系统后遗症发生率及 1岁时智能发育情况差异均有非常显著性 (P <0 .0 1) ,而体格发育差异无显著性 (P >0 .0 5 )。　【结论】　对新生儿缺氧缺血性脑病的治疗 ,早期应用高压氧并积极进行恢复期序贯、足程的康复治疗 ,可减少神经系统后遗症的发生 ,对改善其预后起着非常重要的作用     

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.