2型糖尿病患者及非糖尿病人群的踝臂指数与高血压相关性研究

目的探讨2型糖尿病患者及非糖尿病人群中高血压与踝臂指数(ABI)的相关性。方法选取124例2型糖尿病患者作为糖尿病组,本院体检的122例非2型糖尿病体检人群作为对照组。比较两组人群高血压及非高血压人群的踝臂指数,同时分析两组人群ABI与收缩压、舒张压的简单线性相关性。最后运用Logistic回归研究两组人群高血压与ABI的相关性。结果两组人群ABI存在显著差异(P<0.05)。在糖尿病组,ABI在高血压人群与非高血压人群存在显著差异,而且,ABI与收缩压及舒张压均存在简单相关性(P<0.05)。在非校正模式及校正年龄、性别、总胆固醇、HDL、LDL、甘油三酯、BMI、腰围等影响因素后,高血压是ABI的独立危险因素(P<0.05)。但在非糖尿病人群中,均未发现上述相关性。结论 2型糖尿病患者中,高血压与反映外周动脉硬化的踝臂指数独立相关。     

踝/臂血压指数与传统心血管疾病危险因素聚集关系

目的 探讨踝/臂血压指数(ABI)与传统心血管疾病危险因素间聚集关系.方法 选取广西地区2 005人作为研究人群.采用t检验比较高血压、高TC、高血糖、低HDL-C、超重和肥胖、吸烟者与相应正常人群ABI值的差异.采用Logistic回归(后剔除法,进入P值0.05,移出P值0.10)分析ABI与年龄、性别、血压、总胆固醇(TC)、高密度脂蛋白胆同醇(HDL-C)、体质指数(BMI)、空腹血糖(FPG)、吸烟等因素间的关系.结果 该组人群中超重和肥胖、低HDL-C及吸烟者与相应正常人群间ABI值差别有统计学意义(P<0.05),高血压、高TC、高血糖者与相应正常人群间ABI值差别无统计学意义(P>0.05).Logistic回归分析表明性别(OR=3.874,95%CI:1.920～7.814)、高血压(OR=1.550,95%CI:1.013～2.372)、吸烟(OR=2.018,95%CI:0.930～4.376)为低ABI(ABI<0.9)的主要危险因素;男性以年龄(OR=2.125,95%CI:0.951～4.752)、吸烟(OR=2.332,95%CI:0.981～5.545)为低ABI的主要危险因素;女性以高血压(OR=1.595,95%CI:0.962～2.643)为其危险因素.60岁以上组人群的性别(OR=4.625,95%C/:1.803～11.867)、高血压(OR=2.085,95%CI:1.205～3.608)、吸烟(OR=3.617,95%CI:1.362～9.607)为其危险因素;其中,男性以吸烟(OR=6.817,95%CI:1.558～29.829)为主要危险因素,女性以高血压(OR=2.681,95%CI:1.345～5.342)为主要危险因素.60岁以下组人群的性别(OR=3.636,95%CI:1.721～7.681)为其主要危险因素,其中男女性均无独立危险因素.结论 ABI与传统心血管疾病危险因素间存在聚集关系.女性、高血压、吸烟增加低ABI的危险.     

同型半胱氨酸与低踝臂指数老年高血压的关系

目的:研究同型半胱氨酸(Hcy)与低踝臂指数(ABI)老年高血压的关系。方法:选取215例老年高血压患者,根据ABI检测值分为正常ABI组(0.90-1.39)108例和低ABI组(<0.90)107例,分别检测体重指数(BMI)、血压(BP)、总胆固醇(TC)、低密度脂蛋白(LDL-C)、Hcy、C反应蛋白(CRP)。结果:2组的年龄、性别、BMI、BP、TC、LDL-C差别无统计学意义(P>0.05);低ABI组的ABI值较正常ABI组明显降低,差别有统计学意义(P<0.05);低ABI组Hcy、CRP值较正常ABI组明显升高,差别有统计学意义(P<0.05);Hcy、CRP与ABI呈负相关(P<0.05)。结论:Hcy与低踝臂指数老年高血压密切相关,高Hcy血症是心血管疾病的重要危险因素,可能参与了老年高血压患者动脉粥样硬化的发生发展,具有重要的临床意义。     

踝-臂血压指数与传统心血管病危险因素关系的探讨

目的探讨踝臂血压指数ABI作为新的危险因素预测指标与传统心血管病危险因素间的关系。方法病例对照研究方法。结果Logistic回归分析表明年龄、高血压、糖尿病、吸烟为低ABI(ABI<0.9)的主要影响因素。其中男性ABI异常的相关危险因素有年龄、血糖值、血压值、吸烟率;女性ABI异常的相关危险因素有年龄、血糖值、吸烟率。结论ABI与其他心血管病危险因素间存在聚集关系。ABI与年龄、高血压、糖尿病、吸烟等相关;ABI值降低增加心血管病的发病危险。     

正常高值血压对动脉硬化影响的研究

目的探讨血压正常高值对早期动脉硬化亚临床病变的影响,从而更好的在早期识别高危人群并采取积极有效的防治措施。方法纳入480例受试者,分别为正常血压组(n=124)、正常高值血压组(n=186)、高血压组(n=170),诊断标准依据《中国高血压防治指南(2009年基层版)》,测定并比较3组代表早期动脉硬化的参数:脉搏传导速度(ba PWV)、踝臂指数(ABI)、颈动脉内膜中层厚度(IMT)等指标。结果 (1)与正常血压组比较,正常高值血压人群的ba PWV、IMT增加,ABI减少,分别为(1 696.15±304.11)cm/s、(0.95±0.07)mm、(1.09±0.15)与(1 333.08±233.33)cm/s、(0.85±0.12)mm、(1.18±0.15),P值均小于0.001,差异有统计学意义,但ba PWV、IMT低于高血压组,ABI高于高血压组,分别为(1 696.15±304.11)cm/s、(0.95±0.07)mm、(1.09±0.15)与(2 080.93±472.47)cm/s、(0.98±0.07)mm、(1.04±0.13),P值均小于0.001)差异有统计学意义。(2)血脂水平随着血压的升高而升高,组间及两两比较均有统计学差异(P0.001)。结论血压正常高值人群较血压正常人群动脉硬度增加,动脉顺应性降低,已存在早期动脉硬化改变。     

高血压病患者靶器官损害与踝臂指数异常的关系研究

目的分析高危高血压患者靶器官损害(target organ damage,TOD)与踝臂指数(ankle-brachial index,ABI)异常的关联性。方法选择2010年1月至2012年6月原发性高血压踝臂指数(ABI)异常者120例和原发性高血压踝臂指数正常者80例,并收集病史、体检和实验室检查资料,比较观察两者靶器官损害(TOD)情况。结果 ABI异常组左心室肥厚、动脉壁增厚和血肌酐轻度升高的发生率均高于ABI正常组(P<0.05);与正常组相比,ABI异常组血肌酐平均值较大(P<0.01)。校正一定因素(研究中心、人口学因素、心血管病危险度和心血管病危险因素)后,拟合靶器官损害与ABI异常关系的非条件Logistic回归模型表明,动脉壁增厚(OR:2.416,95%CI:1.395～4.183,P=0.0016)和血肌酐轻度升高(OR:3.377,95%CI:1.267～8.997,P=0.0149)与ABI异常之间有正相关关系,而左心室肥厚(OR:0.988,95%CI:0.576～1.695,P=0.9664)和微量白蛋白尿(OR:1.389;95%CI:0.685～2.817,P=0.3621)与ABI异常之间无明显相关关系。结论高危高血压患者动脉壁增厚和(或)血肌酐轻度升高与ABI异常的关系较为显著,而左心室肥厚和微量白蛋白尿与ABI异常的关系不明显,提示原发性高血压患者检测踝臂指数对动脉硬化和肾脏损害的防治具有指导性意义;同时,踝臂指数检测简单易行,操作简便,技术要求不高,不失为原发性高血压评估靶器官损害的一项指标,值得在基层医院进一步推广。     

围绝经期高血压患者心血管结构功能特点和疾病影响因素分析

目的分析围绝经期高血压患者心血管结构功能特点并研究围绝经期高血压的影响因素,为相关防治工作提供参考信息。方法选取2016年5月-2020年4月杭州市中医院诊治的围绝经期女性190例为研究对象,其中高血压患者56例为高血压组、正常血压女性134例为正常血压组,比较两组女性心脏结构、功能及血管功能指标,结构指标包括左心房前后径(LAd)、左心室舒张末前后径(LVEDd)、左心室收缩末期内径(LVESd)、右心室前后径(RVd)及左心室后壁厚度(LVPWT),功能指标包括左室射血分数(LVEF)、心排出量(CO)、心排血指数(CI)及二尖瓣环舒张早期与心房收缩期峰值速度比率(E/A),血管功能指标包括心踝血管指数(CAVI)、踝臂血压指数(ABI)。收集所有研究对象的一般资料,包括年龄、体质指数、腰臀比、学历、吸烟、饮酒、月经、基础疾病及高血压家族史,通过统计学分析判断以上各项是否为围绝经期女性高血压发病的影响因素。结果高血压组女性LAd、LVEDd、LVESd、RVd及LVPWT值均高于正常血压组,LVEF、CO及CI水平均显著低于正常血压组,差异均统计学意义(均P0.05);而E/A水平比较,差异无统计学意义(P0.05)。高血压组女性右侧和左侧CAVI及右侧ABI水平均显著高于正常血压组,差异均有统计学意义(均P0.05);而左侧ABI水平比较,差异无统计学意义(P0.05)。多因素Logistic分析结果显示,腰臀比、学历、月经、高血压家族史是围绝经期女性高血压发病的影响因素(均P0.05)。结论围绝经期女性高血压患者存在心血管结构功能异常,主要体现在左心室肥厚和扩大、右心室增大、左心室舒张功能及动脉硬化增加,应根据围绝经期女性高血压发病的影响因素采取防治措施,降低高血压对围绝经期女性的不良影响。     

踝臂指数在体检人群中的分布特征及其相关因素分析

目的研究踝臂指数(ABI)在沈阳地区健康体检人群中的分布特点及其影响因素。方法选择3208例体检者,应用全自动动脉硬化测量装置测量其ABI,并分为ABI正常组和ABI异常组。同时测量其身高、体重和血生化指标。运用多元线性回归模型分析各指标与ABI的相关性。结果体检人群中ABI均值为1.135±0.078,异常检出率为2.27%,男性高于女性。男性人群中,ABI异常组的收缩压(SBP)、舒张压(DBP)和ABI值均高于ABI正常组,差异有统计学意义(P0.05);女性人群中,各指标值在ABI正常组和ABI异常组之间差异均无统计学意义。多元线性回归分析显示SBP、性别、BMI和LDL-C与ABI之间呈现相关性。结论体检人群中ABI值的分布呈现年龄差异和性别差异。ABI可提示动脉硬化基本情况,在体检中具有重要的实用价值。     

老年高脂血症患者踝臂指数与颈动脉粥样硬化的相关性

目的 探讨老年高脂血症患者踝臂指数(ABI)与颈动脉内膜中层厚度(IMT)的关系.方法 选择268例老年高脂血症患者(高脂血症组)和84例健康体检者(正常对照组)作为研究对象,两组均行ABI及IMT测定,并进行比较.结果 高脂血症组ABI显著低于正常对照组(1.09±0.15比1.21±0.13,P=0.034),颈总动脉远端锁骨上0～15 mm处、16～ 30mm处、颈动脉分叉处和颈内动脉起始部IMT均显著高于正常对照组[(0.80±0.13) mm比(0.71±0.08) mm,(0.85±0.14)mm比(0.74±0.07) mm,(0.93 ±0.24) mm比(0.78±0.15) mm,(0.66±0.11) mm比(0.59±0.07)mm,P值分别为0.007、0.000、0.019、0.008].高脂血症组ABI与颈总动脉远端锁骨上0～15 mm处、16～ 30 mm处、颈动脉分叉处和颈内动脉起始部IMT均呈负相关(r值分别为-0.48、-0.53、-0.528、-0.245,P＜0.05或＜0.01).结论 老年高脂血症患者ABI降低与颈动脉粥样硬化有相关性,ABI可作为老年高脂血症患者颈动脉粥样硬化的指标.     

踝臂指数与新疆维吾尔族脑梗死患者疾病严重程度及预后的关系

目的探讨踝臂指数与新疆维吾尔族脑梗死患者疾病严重程度及预后的关系。方法收集患者临床资料,测量踝臂指数,对脑梗死严重程度进行分型,随访患者出院后6个月内再发脑梗死事件的情况。结果125例新疆维吾尔族脑梗死患者中,ABI异常者39例（占31．2％）;ABI正常组和异常组患者比较,年龄、高血压、糖尿病、高血脂的差异有统计学意义（P〈0．001）;ABI异常率在脑梗死轻、中、重型患者中比较,差异有统计学意义（P〈0．05）;随着脑梗死病情加重,ABI值逐渐降低（P〈0．01）,而中、重型患者ABI值间的差异无统计学意义（P〉0．05）;随访观察ABI异常患者出院后6个月内再发脑梗死事件增多（Х^2=71．667,P〈0．001）;年龄、糖尿病、高血压和ABI异常是脑梗死患者再发卒中事件的危险因素（年龄OR值5．850,P=0．024;糖尿病OR值9．651,P=0．026;高血压OR值9．766,P=O．014;ABI异常OR值8．836,P=0．023）。结论在新疆维吾尔族脑梗死患者中,随着病情加重,ABI异常者逐渐增多,ABI值逐渐降低;ABI异常患者容易卒中复发。     

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.