铅中毒实验室检查指标的应用和探讨

对110例在我院同时进行血铅、尿铅、诊断性驱铅试验、尿d-氨基-γ-酮戊酸和锌原卟啉等检查的病例检查结果进行比较和分析。结果显示,观察对象筛查中血铅的灵敏度为7377%,尿铅为3770%,诊断性驱铅试验8033%;轻度铅中毒病人筛查中ZPP灵敏度最高(8182%),诊断性驱铅试验特异度、准确度和阳性预测值均最高(分别为100%、8818%和100%)。提示只采用单项检测指标筛查观察对象或诊断铅中毒,容易出现漏诊或误诊,应将几项指标联合应用。     

职业性慢性铅中毒诊断标准临床应用的探讨

对236例血铅（PhB）≥400μg/L和／或尿铅（Phu）≥70μg/L的某钢铁厂铅作业工人收住院，实施诊断性驱铅试验及驱铅治疗，依据《职业性慢性铅中毒诊断标准》（GBZ37-2002）进行诊断，发现依据PbB或PbU加ZPP诊断慢性轻度铅中毒的诊断率明显低于诊断性驱铅试验。强调铅作业工人应尽可能采用诊断性驱铅试验进行铅中毒的诊断，在驱铅试验受限时，适当降低ZPP诊断值对提高慢性轻度铅中毒的诊断率具有一定的意义。     

职业性慢性铅中毒诊断标准的临床应用及分析

对544名铅作业工人进行体检,有186人血铅（PbB）≥1．9umol／L或／和尿铅（PbU）≥0．34umol／L,依据《职业性慢性铅中毒诊断标准》（GBZ37-2002）进行诊断,发现PbB或PbU加ZPP诊断轻度铅中毒的诊断率明显低于诊断性驱铅试验。强调铅作业工人应尽可能采用驱铅试验进行铅中毒的诊断,提出了降低ZPP诊断值的建议。     

云南省某铅锌矿企业227例尿铅超标患者驱铅治疗疗效评价

目的评估云南省某铅锌矿作业工人尿铅超标者的临床诊断类型,探讨在治疗过程中血铅(PbB)、尿铅(PbU)、红细胞锌原卟啉(ZPP)浓度变化规律,评价驱铅治疗的效果。方法治疗结束后,依据《职业性慢性铅中毒诊断标准》(GBZ 37-2002)进行集体诊断。统计驱铅治疗过程中PbB、PbU、ZPP的值,对数据进行t检验和χ2检验,并对两变量相关性进行直线回归分析。结果 227例尿铅超标者诊断为铅中毒临床观察对象、轻度铅中毒、中度铅中毒的百分率分别为3.07%、2.71%、0.13%;驱铅治疗临床观察对象平均治疗1.92个疗程,轻度铅中毒平均治疗2.76个疗程,中度铅中毒平均治疗3.80个疗程后能达到较为满意的效果。结论该矿企尿铅超标的工人驱铅治疗效果良好。     

职业性慢性铅中毒早期诊断指标的研究

目的探讨驱铅试验和神经肌电图等指标在铅中毒诊断中的意义,为职业性慢性铅中毒早期诊断提供科学依据。方法对223例疑似职业性铅中毒病人,按照《职业性慢性铅中毒诊断标准》GBZ37-2002[1]进行诊断分级。结果 223例疑似职业性铅中毒病人经确诊有138例轻度铅中毒,85例中度铅中毒,驱铅试验+神经肌电图,诊断阳性率达100%,单纯血铅诊断阳性率80.3%(179/223)。结论血铅诊断职业性慢性铅中毒的诊断率明显低于诊断性驱铅试验+神经肌电图,为保护职业人群身体健康,建议尽快修订《标准》[1]。     

铅中毒诊断用四项检验指标的探讨

驱铅试验的尿铅值能反应机体铅负荷 ,代表血液与软组织中发挥毒作用的含铅量 ,临床上用诊断性驱铅试验的尿铅值来作为诊断铅中毒更有意义[1] ,是诊断铅中毒最灵敏可靠的病因指标[2 ] 。本文以临床驱铅试验尿铅值为诊断基准 ,探讨血铅、尿铅、红细胞锌卟啉 (ＺｎＰＰ)和尿δ 氨基酮戊酸 (尿δ ＡＬＡ)在铅中毒诊断上的合适度。1　对象与方法1.1　对象114例铅作业工人 ,男 93例 ,女 2 1例 ,年龄 19～ 60岁 ,平均(3 4 94± 9 18)岁 ,工龄 2月～ 2 7年 ,平均 (9 76± 6 87)年 ,主要来自本市某蓄电池厂。其中 1例系口服含铅药物所致急性铅中毒 ,…     

驱铅试验在慢性铅中毒诊断与治疗中的应用

总结及分析我院诊治的194例铅中毒及83例观察对象的病例资料。经相关分析认为,驱铅后尿铅值(CPb U)是慢性铅中毒、铅作业观察对象较好的诊断指标,其敏感度、特异性、正确度及阳性预测度、阴性预测度均明显优于血铅值(Pb B)、尿铅值(Pb U)、红细胞锌卟啉值(ZPP)。建议在诊断铅中毒和驱铅治疗时,尽可能以CPb U作重要参考指标。     

关于尿铅和血铅测定中几个问题的讨论

尿铅和血铅均是国家职业卫生标准GBZ3 7-2 0 0 2职业性慢性铅中毒的实验室检测指标。亦是铅作业人员的职业性健康检查的必查项目。然而作为预防铅对儿童健康的危害,是选择检测尿铅还是血铅,如何评定检测结果是值得讨论的。1　尿铅及血铅测定的意义1.1　尿铅是反映近期铅接触水平的敏感指标,取样方便,与血铅、尿δ-氨基-Γ-酮戊酸、血锌原卟啉显著相关,尿铅的测定积累了丰富的经验,研制出了性能良好,价格便宜的仪器,尿铅的测定准确可靠,尿铅结果与临床表现亦相关,驱铅试验认为是目前较好的反映体内铅负荷的检测方法,尤其对已脱离钳接触人员…     

有关尿铅和驱铅试验的文献综述

尿铅检测和驱铅试验是铅中毒诊断标准中的二项指标,但是多年来对尿铅正常值上限及异常值、驱铅试验方法和标准存在着不同看法,并有许多文献和专著报道,现就近年来所收集到的文献,作一综述。尿铅尿铅是反映近期铅接触水平的敏感指标之一,它与空气中铅浓度、血铅、FEP、ZPP均呈极为显著相关,与症状有一定的相关。是观察驱铅效果的最好指标,又是一项对机体无损性检查方法。所以,尿     

河南省儿童尿铅参考值

铅的职业危害已有不少学者报道 ,近年来铅对儿童的危害也引已起人们的关注 ,也有不少人研究成人尿铅正常参考值 ,不少人进行了儿童血铅的调查 ,血铅测定的标准方法是无火焰原子吸收法 ,所用原子吸收分光光度计价格昂贵 ,血铅测定成本较高 ,儿童血样采集难以接受 ,我国已有高灵敏度及高准确度的尿铅测定设备 ,尿铅测定成本较低 ,易于被儿童接受 ,且在国家颁布的职业性慢性铅中毒诊断标准中铅中毒观察对象的首选检验指标是尿铅。尿铅是衡量职业性铅危害的重要指标 ,衡量铅对儿童的危害也应将尿铅作为首选指标 ,故建立河南省儿童尿铅参考值十分…     

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.