槲皮素对慢性混合反流性食管炎大鼠食管黏膜的保护作用及对核转录因子-κB/白细胞介素-6信号通路的影响

目的　观察槲皮素对慢性混合反流性食管炎大鼠食管黏膜损伤的保护作用及对核转录因子κB(NF-κB)/白细胞介素（IL）-6信号通路的影响。方法　　采用贲门结扎术＋食管十二指肠吻合术建立慢性混合反流性食管炎大鼠模型。48只健康清洁级SD雄性大鼠采用随机数字表法分为正常对照组、假手术组、模型对照组、奥美拉唑组、低剂量槲皮素组和高剂量槲皮素组,每组8只,分别腹腔注射生理盐水2 ml（正常对照组、假手术组和模型对照组）、奥美拉唑20 mg/kg（奥美拉唑组）、槲皮素100 mg/kg（低剂量槲皮素组）和槲皮素200 mg/kg（高剂量槲皮素组）,每日1次。6周后处死,光镜下观察食管组织的形态学改变并评分,分别采用免疫组织化学染色及酶联免疫吸附试验检测NF-κB p65、IL-6蛋白在大鼠食管黏膜及血清中的表达,各组进行比较。结果　　正常对照组、假手术组、模型对照组、奥美拉唑组、低剂量槲皮素组、高剂量槲皮素组大鼠的食管黏膜病理评分分别为0.250±0.463、0.250±0.463、2.625±0.518、1.500±0.535、1.250±0.463、1.375±0.518;食管黏膜NF-κB p65蛋白评分分别为0.500±0.535、0.625±0.518、3.500±0.535、1.875±0.649、1.750±0.707、2.000±0.535;食管黏膜IL-6蛋白评分分别为1.125±0.641、1.125±0.835、5.375±0.518、2.375±0.518、2.000±0.535、2.250±0.463;血清NF-κB p65蛋白含量分别为（68.618±18.500）、（77.824±22.228）、（184.882±49.165）、（106.693±45.312）、（76.215±16.588）、（108.207±42.107） pg/ml;血清IL-6蛋白含量分别为（24.826±4.008）、（23.599±4.351）、（51.378±9.697）、（32.370±11.657）、（23.085±4.660）、（26.243±4.955）pg/ml。假手术组与正常对照组比较,以上5项指标差异均无统计学意义（P=1.000、P=0.642、P=1.000、P=0.518、P=0.673）;正常对照组、假手术组、奥美拉唑组、低剂量槲皮素组和高剂量槲皮素组与模型对照组比较,差异均有统计学意义（P＜0.001、P＜0.001、P＜0.001、P=0.002、P=0.001;P＜0.001、P＜0.001、P＜0.001、P=0.004、P=0.002;P=0.001、P＜0.001、P＜0.001、P=0.025、P=0.023;P均＜0.001; P＜0.001、P＜0.001、P＜0.001、P=0.023、P＜0.001）;低剂量槲皮素组、高剂量槲皮素组与奥美拉唑组比较,差异均无统计学意义（P=0.334、P=0.717、P=0.176、P=0.121、P=0.074;P=0.642、P=0.678、P=0.619、P=0.949、P=0.225）;低剂量槲皮素组与高剂量槲皮素组比较,差异均无统计学意义（P=0.619、P=0.438、P=0.334、P=0.086、P=0.243）。大鼠食管黏膜病理评分与黏膜NF-κB p65、IL-6蛋白含量呈明显正相关（r=0.803,P＜0.001;r=0.758,P＜0.001）,与血清NF-κB p65、IL-6蛋白含量亦呈明显正相关（r=0.486,P=0.004;r=0.544,P=0.001）。结论　　大鼠食管黏膜损伤程度越大,黏膜及血清NF-κB p65、IL-6蛋白含量越高。槲皮素能降低反流性食管炎大鼠食管黏膜的损伤程度,其作用机制可能与下调反流性食管炎大鼠NF-κB、IL-6水平,减轻食管炎症有关。     

糖尿病患者的营养评价及其少肌症发生的影响因素

目的　了解糖尿病患者的营养状况及其少肌症的影响因素。方法　对2013年1月至2014年12月北京医院营养科门诊297例糖尿病患者进行回顾性分析,比较非超重组［体质量指数（BMI）≤23.9 kg/m2］与超重组(BMI≥24.0 kg/m2)人体测量指标、身体成分、实验室检查指标、膳食摄入的差别,并分析糖尿病患者少肌症发生的影响因素。结果　超重组183例、非超重组114例,非超重组左手握力、右手握力、腰臀比及臂肌围均低于超重组［（24.14±7.76）kg比（27.78±9.31）kg,P=0.00;（25.55±7.86）kg比（28.62±9.55）kg, P=0.01;0.85±0.06比0.92±0.07,P=0.00;（21.45±3.73）cm比（25.18±4.36）cm,P=0.00］;非超重组的肌肉量、体脂百分比、内脏脂肪面积及骨骼肌指数均低于超重组［（37.64±6.58）kg比（45.66±8.92）kg;（27.25±8.15）%比（35.52±6.56）%;（71.56±25.28）cm2比（118.84±28.18）cm2;（6.22±1.17）kg/m2比（7.41±1.25）kg/m2］(P均=0.00）;非超重组血红蛋白水平低于超重组［（136.29±14.81）g/L比（141.01±13.47）g/L, P=0.03］;两组总蛋白及白蛋白水平差异无统计学意义（P=0.15,P=0.52）;非超重组血糖水平低于超重组［（7.08±2.28）mmol/L比（7.76±2.57）mmol/L,P=0.03］;非超重组与超重组的能量及蛋白质摄入差异无统计学意义（P=0.17,P=0.35）。糖尿病患者少肌症的检出率为10.4%（31/297）,非超重患者的少肌症检出率高于超重患者（22.8%比2.7%,P=0.00）。回归分析结果显示,女性（B=-1.371,95% CI=-1.595～-1.146)、增龄(B=-0.018,95% CI=-0.027～-0.009)、低BMI(B=-0.115,95% CI=0.092～0.138)、能量摄入的减少(B=0.014,95% CI=0.000～-0.029）是骨骼肌指数降低的主要危险因素。结论　糖尿病患者BMI在适度超重的范围内有更好的营养状态,有利于预防少肌症的发生。     

Lin28A过表达对胃癌细胞糖酵解的抑制作用及其机制

目的　探讨Lin28A基因对胃癌细胞糖酵解的作用及其分子机制。方法　利用慢病毒载体建立Lin28过表达胃癌BGC-823细胞株,以生物化学法检测细胞培养液乳酸含量,酶联免疫吸附试验（ELISA）法检测细胞内磷酸果糖（PFK）含量,蛋白质印迹法检测Lin28A、缺氧诱导因子1α（.HIF-1α）、葡萄糖转运蛋白1（GLUT-1）、丙酮酸激酶M2（PKM2）蛋白水平表达,反转录（RT）-PCR法检测let-7a RNA水平,膜联蛋白(Annexin)Ⅴ-别藻蓝蛋白（APC）单染法检测细胞凋亡。.结果　Lin28A蛋白在转染组的表达水平明显高于对照组和空载组（均P＜0.001）。转染组let-7a RNA表达水平（0.602±0.017）明显低于空载组（1.001±0.063）（P=0.005 2）。转染组HIF-1α、GLUT-1、PKM2蛋白的表达水平明显低于其他两组（均P＜0.001）。对照组、空载组、转染组细胞培养液乳酸含量分别为（1.71±0.13）、（1.53±0.11）、（1.24±0.04）mmol/L,转染组明显低于对照组和空载组（.P=0.017 0、0.031 0）;细胞内PFK含量分别为（3.71±0.13）、（3.49±0.14）、（1.79±0.05）mmol/L,转染组明显低于对照组和空载组（P=0.014 0、0.036 0）;凋亡率分别为5.02 %±0.14 %、7.16 %±0.21 %、10.39 %±0.37 %,转染组凋亡率明显高于对照组和空载组（P=0.000 5、0.000 7）。 结论　Lin28A过表达可以抑制let-7a表达,并通过抑制细胞的糖酵解促进人胃癌细胞凋亡。     

肠内联合肠外营养支持用于老年晚期消化道恶性肿瘤化疗患者的观察

目的 探讨肠内联合肠外营养支持对老年晚期消化道恶性肿瘤化疗的影响。方法 将2006年至2011年本院肿瘤内科收治的79例老年晚期消化道恶性肿瘤患者采用随机数字表法分为两组,治疗组（n=42）采用营养支持联合化疗,对照组（n=37）采用单纯化疗,入院后行营养风险筛查,2个化疗周期后比较营养状态、Karnofsky功能状态评分、毒性反应、院内感染率的变化。结果 两个周期化疗后,治疗组的体重指数 ［（19.00±3.31）kg/m2比（18.24±1.98）kg/m2,P=0.04］、白蛋白［（33.90±1.50） g/L比（29.90±2.38）g/L,P=0.02］、前白蛋白［（28.19±1.50)g/L比（25.51±8.38）g/L,P=0.01］、血红蛋白［（107.0±6.90)g/L 比（104.20±9.70）g/L,P=0.02］、淋巴细胞［（2.99±0.55)×109/L比（2.63±0.20）×109/L,P=0.03］均显著升高。化疗不良反应方面,治疗组骨髓抑制发生率明显低于对照组（28.57%比83.78%,P=0.00）;治疗组中有营养风险者的骨髓抑制发生率为31.03%,显著低于对照组的95.45%（P=0.00）,其他毒性反应差异无统计学意义。治疗组两次化疗后的院内感染发生率均显著低于对照组（0比10.81%,P=0.03;2.38% 比27.03%,P=0.02）。结论 老年晚期消化道恶性肿瘤患者化疗期间联合应用肠内加肠外营养支持有利于机体营养状况及体能的改善,减轻毒性反应,是院内感染发生的保护性因素。营养支持符合化疗患者的需求,具有安全、有效、合理的特点。     

吞咽障碍患者神经肌肉电刺激治疗效果评价

目的吞咽障碍可引发严重并发症,影响患者康复效果和生存质量。神经肌肉电刺激可以锻炼和加强肌肉的力量,增强神经反馈及时序性,恢复运动控制,改善患者预后。本研究探讨神经内科吞咽障碍患者行神经肌肉电刺激治疗的效果。方法选择2016-05-15-2017-05-15聊城市东昌府人民医院收治的90例神经内科吞咽障碍患者作为研究对象,根据患者临床资料进行配对设计,将患者分为研究组和对照组各45例。对照组采用常规吞咽康复训练,研究组在对照组基础上实施神经肌肉电刺激治疗。比较两组治疗前后洼田氏饮水试验分级、临床效果、Rosenbek渗漏-误吸量表(penetration-aspiration scale,PAS)评分、放射线透视下吞咽功能检查(videofluoroscopy swallowing study,VFSS)评分及舌骨喉复合体上移、前移运动速度。结果治疗后研究组Ⅰ、Ⅱ、Ⅲ、Ⅳ洼田饮水试验分级改善程度明显优于对照组,χ2=20.801,P0.001;研究组临床有效率为95.6%,显著高于对照组的80.0%,χ2=5.075,P=0.024;研究组VFSS评分为(7.41±2.51)分,高于对照组的(4.42±1.37)分,t=7.540,P0.001;PAS评分为(2.16±0.76)分,低于对照组的(3.87±0.85)分,t=10.815,P0.001;研究组舌骨上移速度为(27.37±8.06)mm/s,高于对照组的(21.83±9.04)mm/s,t=3.068,P=0.001;舌骨前移速度为(32.52±7.48)mm/s,高于对照组的(19.27±7.26)mm/s,t=8.527,P0.001;甲状软骨上移速度为(33.82±9.04)mm/s,高于对照组的(25.61±9.39)mm/s,t=4.225,P0.001;甲状软骨前移速度为(25.15±9.38)mm/s,高于对照组的(19.39±9.26)mm/s,t=2.931,P=0.002。结论吞咽障碍患者行神经肌肉电刺激治疗可提高临床效果,改善患者吞咽功能,提高生存质量。     

社区综合健康管理对老年高血压患者生活质量的影响

目的 探索江苏省南京市老年高血压患者在社区综合健康管理下的血压和生命质量变化情况。方法 2013年3~12月,按照整群随机抽样的原则,抽取南京市某社区医院管辖内老年高血压患者520例,再利用随机数字表产生随机数字将其分为对照组和管理组,对管理组老年高血压患者实施专项的社区健康管理,对照组老年高血压患者实施常规管理、不增加干预措施。对两组患者在基线、中期（6个月）和终期（18个月）共进行三次问卷调查,并用多水平模型分析生命质量变化情况。结果 管理组和对照组的基线情况差异均无统计学意义（均有P>0.05）。为期18个月的干预后,管理组对比对照组,收缩压平均降低（4.74±1.69） mm Hg（t=2.801,P=0.006）,舒张压平均降低（3.67±1.17） mm Hg（t=3.158,P=0.002）,差异具有统计学意义;在生命质量方面,两组的视力状况（Z=-3.142,P=0.002）、牙齿情况（Z=-2.130,P=0.034）、睡眠状况（Z=-3.471,P<0.001）、心理状况（Z=-2.051,P=0.040）和总体健康情况（Z=-2.653,P=0.008）的差异有统计学意义,管理组均优于对照组;生命质量得分变化情况也优于对照组。结论 社区健康管理可以改善老年高血压患者的血压状况,提高生活质量。     

腹膜透析患者四肢肌肉量变化与膳食摄入的关系

目的　探讨腹膜透析患者四肢肌肉量变化情况,分析四肢肌肉量变化与膳食摄入的关系。方法　采用便利抽样方法选择北京大学第三医院肾内科腹膜透析患者114例,在基线、透析后6及12个月采用多频体成分测量仪测评患者的体质量、总肌肉量、四肢肌肉量情况,用3天饮食记录法测评其膳食摄入情况,同时收集患者基线时人口社会学资料及临床资料。结果　透析后12个月的四肢肌肉量比基线时明显减少,差异有统计学意义［（19.27±5.59）kg比 （25.65±6.09）kg,P=0.000］;蛋白质摄入显著减少,差异有统计学意义［（0.85±0.21）g/(kg·d)比 （0.90±0.27）g/(kg·d),P=0.038］;能量摄入显著减少,差异有统计学意义［（128.37±26.67）kJ/(kg·d)比 （137.27±29.23）kJ/(kg·d),P=0.001］。将四肢肌肉量变化量进行3等分,肌肉减少量前1/3组患者的平均蛋白质摄入量（0.82±0.18）g/(kg·d)显著低于肌肉减少量后1/3组的患者（0.91±0.20）g/(kg·d)(P=0.021）。结论　随着腹透治疗的进行,患者四肢肌肉量减少,主要与其蛋白质、能量摄入不足有关,应加强透析患者的膳食管理,以缓解患者四肢肌肉量的衰减。     

营养咨询联合口服营养补充对食管癌放疗患者临床结局的影响

目的　评价营养咨询联合口服补充高脂肪、高蛋白肿瘤全营养配方食品（倍康素）对食管癌放疗患者营养状况和临床结局的影响。方法　选取80例能够经口进食且营养风险筛查2002（NRS2002）≥3分的食管癌放疗患者,随机数字表方法分为研究组（n=41,营养咨询+口服补充肿瘤全营养配方食品）和对照组（n=39,营养咨询）,比较放疗前后两组患者的能量摄入、营养状况、放疗不良反应发生率等。结果　放疗过程中,与对照组比较,研究组患者每天口服营养补充能量显著增加［（2 445±686） kJ比（1 747±456）kJ, P=0.003］;放疗前后对比,研究组患者前白蛋白和转铁蛋白水平显著升高［（17.35±5.83）mg/L比（20.15±6.02）mg/L, P=0.008;（213.74±52.66）mg/L比（264.19±43.78）mg/L,P=0.002］。此外,与对照组比较,研究组患者Ⅲ级放射性食管炎和Ⅲ级放射性皮肤损伤的发生率显著降低（24%比38%,P=0.000;27%比41%,P=0.000）。结论　营养咨询联合口服营养补充可改善食管癌放疗患者的营养状况,降低放疗相关毒副反应发生率,有助于改善临床结局。     

家属参与式护理模式对慢性肾衰竭透析患者 自护能力、心理状态、预后效果的影响

摘 要：目的：研究家属参与式护理模式对慢性肾衰竭透析患者自护能力、心理状态及预后效果的影响。方法：选择 2020年 2月—2023年 2月漯河市第一人民医院肾内科收治的 98例慢性肾衰竭透析患者，按双盲法分组标准将其分成对照组 （n=49） 和研究组 （n=49）。对照组予常规护理，研究组予家属参与式护理。对两组患者自护能力、心理状态和预后效果进行 对比分析。结果：护理后，研究组患者自我护理能力测定量表评分为 （129.02±5.27） 分，高于对照组患者的 （104.96±5.98） 分，差异有统计学意义 （t=21.130，P＜0.05）；研究组患者焦虑自评量表评分为 （42.52±3.65） 分、抑郁自评量表评分为 （41.70±4.28） 分，对照组患者两项评分分别为 （57.60±4.02） 分和 （58.34±4.15） 分，两组比较，差异均有统计学意义 （t值 分别为19.538和19.441，P值均＜0.05）；研究组患者并发症总发生率为4.08%，低于对照组患者的20.41%，差异有统计学意 义 （χ2 =19.441，P＜0.05）。结论：慢性肾衰竭透析患者行家属参与式护理模式，效果确切，值得推广。     

生物电阻抗分析法指导透析超滤对残余肾功能的保护作用

目的 观察生物电阻抗分析法指导新进入血液透析患者对残余肾功能（residual renal function,RRF）的保护作用。方法 选取2015年1月~2016年6月新进入血液透析的终末期肾病患者,随机分为试验组及对照组,随访3个月。试验组应用生物电阻抗分析法指导透析超滤,对照组依据有无水肿、透析过程中有无低血压症状及透析间期体重增加量来确定透析超滤量。比较两组前后的RRF、24 h尿量、透析不良事件发生率。结果 随访3月后,试验组24 h尿量（932.58±230.16）ml与对照组24 h尿量（584.45±137.76）ml比较差异有统计学意义（t=7.226,P<0.001）。试验组RRF（4.55±0.90）ml/min与对照组RRF（3.08±0.68）ml/min比较差异有统计学意义（t=7.300,P<0.001）。试验组RRF下降值（3.14±2.05）ml/min与对照组RRF下降值（4.40±2.09）ml/min比较差异有统计学意义（t=-2.384,P=0.020）。试验组24 h尿量下降值（452.58±456.96）ml与对照组24 h尿量下降值（877.45±452.45）ml比较差异有统计学意义（t=-3.679,P=0.001）。试验组发生不良事件次数共2次,对照组发生不良事件次数共8次,两组比较差异无意义（t=2.081,P=0.084）。结论 应用生物电阻抗分析法指导新入血液透析患者超滤,有助于延缓RRF的下降。     

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.     

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.