院外综合管理对支气管肺发育不良极早产儿近期预后的影响

目的 通过与非支气管肺发育不良(BPD)极早产儿进行对比,探讨院外综合管理对BPD极早产儿近期预后的影响。方法 选取2013年1月-2014年10月于中山大学附属第一医院出生并收住新生儿重症监护室(NICU)、存活时间≥28 d的极早产儿为研究对象,按有无合并BPD分为BPD组及非BPD组。对患儿出院后均进行规范随访及早期干预,比较两组患儿体格和神经系统发育情况、呼吸道症状发生率和再住院次数。结果 符合入选标准有76例极早产儿,其中BPD患儿39例,BPD发生率51.3%。两组均无死亡、失明及脑瘫患儿。BPD组纠正3、6月龄及12月龄时体重、身长完成追赶性生长比例与非BPD组相仿(P≥0.05),但头围的追赶性生长较非BPD组差(P<0.05)。BPD组合并肺炎次数、哮喘发作次数、再入院次数明显高于非BPD组(P<0.05)。结论 院外综合管理可改善BPD极早产儿预后,有助于促进其追赶性生长及减少神经系统不良预后,达到非BPD极早产儿水平,但未能降低其呼吸道症状发生率。     

解脲脲原体感染在早产儿支气管肺发育不良发生的相关性及其预后研究

目的探讨解脲脲原体感染(UU)在早产儿支气管肺发育不良发生的相关性及其预后。方法选取2013年6月-2014年6月间该院收治的早产儿585例,根据两组早产儿UU感染情况分为UU感染组180例、UU非感染组405例。比较两组患儿UU感染相关的临床特点,分析UU感染与支气管肺发育不良(BPD)发生之间的相关性,对中度、重度BPD患儿随访至出生后1年,观察其预后情况。结果 UU感染组中孕妇自然分娩率、胎膜早破率明显高于非UU感染组,新生儿呼吸窘迫综合征(NRDS)发生率、使用肺表面活性物质率明显低于非UU感染组,差异均有统计学意义(P0.01)。UU感染者BPD的发生率明显高于非UU感染者,差异有统计学意义(P0.01)。UU感染组BPD患儿中度和重度比例均明显高于非UU感染组,差异有统计学意义(P0.05)。重度BPD患儿出生1年内随访显示,两组喘息发作率、肺部感染率、再次入院情况、死亡率之间差异均无统计学意义(P0.05)。结论 UU感染者BPD的发生率及严重程度明显高于无UU感染者;但UU感染的BPD与非UU感染的BPD预后情况基本一致。     

西地那非预防早产儿支气管肺发育不良疗效观察

目的 探讨应用西地那非预防早产儿支气管肺发育不良(BPD)的临床价值. 方法 69例机械通气早产儿预防性口服西地那非治疗,69例未使用西地那非治疗,但其他治疗条件相同. 结果 肺动脉血流速度、心输出量、PaO2 、OI、PaO2/EO2,两组治疗12 h、24 h、7d和28 d后的与治疗前比较,差异均有统计学意义;两组各治疗时间点比较,差异均有统计学意义;心率和血压与治疗前比较,差异均无统计学意义;西地那非组各时间点的EO2、PaCO2与对照组相比,差异均无统计学意义.生后28 d患儿发生BPD,西地那非组和非西地那非分别为8.7％和21.7％,差异有统计学意义. 结论 预防性口服西地那非可降低早产儿BPD的发生率或改善BPD的严重程度,在推荐应用剂量范围内未发现明显不良反应,值得临床应用推广.     

不同时间吸入布地奈德对早产儿支气管肺发育不良转归的影响

目的探讨不同时间吸入布地奈德对早产儿支气管肺发育不良(BPD)转归的影响。方法选择2017年6月至2018年10月我院收治的50例BPD早产儿为研究对象,均给予布地奈德混悬液雾化吸入治疗。按照布地奈德用药时间的不同将患儿分为实验组(使用日龄<28 d, 26例)和对照组(使用日龄≥28 d, 24例),比较两组的用氧时间、住院时间、 BPD严重程度及不良反应。结果实验组的用氧时间、住院时间均短于对照组,差异有统计学意义(P <0.05)。实验组的BPD严重程度低于对照组,差异有统计学意义(P <0.05)。两组的不良反应发生率比较,差异无统计学意义(P>0.05)。结论早期吸入布地奈德能缩短BPD患儿的用氧时间与住院时间,减轻疾病严重程度,安全有效,值得临床推广。     

膳食指导联合铁剂治疗小儿缺铁性贫血的效果观察

目的观察膳食指导联合铁剂治疗小儿缺铁性贫血的临床效果。方法选择2012年3月-2015年2月在中心就诊的114例缺铁性贫血患儿作为观察对象,随机分为观察组和对照组,每组57例;对照组给予常规铁剂治疗,观察组在铁剂治疗的基础上给予膳食指导。以3个月为1个疗程,第1个疗程结束后随访半年,比较两组治疗前后RBC、Hb和Hct水平变化及贫血症状改善情况。结果治疗3个月后两组患儿RBC、Hb和Hct水平均有改善,但观察组患儿明显优于对照组。第1个疗程结束后观察组患儿缺铁性贫血症状的改善率(93.0%)明显优于对照组(78.9%),症状得到有效扭转的时间(3.0±0.9)d明显早于对照组的(5.5±1.4)d,平均住院时间(6.5±1.8)d明显少于对照组的(10.5±1.6)d;治疗期间观察组的药物不良反应发生率(5.3%)明显少于对照组(56.1%),随访期间观察组再次出现缺铁性贫血症状的复发率(3.5%)明显低于对照组(22.8%)。结论膳食指导联合铁剂治疗可有效改善缺铁性贫血患儿的贫血指标和症状,疗效显著,值得在临床推广应用。     

支气管肺发育不良患儿肺功能变化的动态随访研究

目的监测支气管肺发育不良(bronchopulmonary dysplasia,BPD)生后3年内潮气呼吸肺功能动态变化,以探讨BPD对患儿远期肺功能的影响。方法收集BPD患儿生后3年内临床资料及肺功能结果,与同龄非BPD患儿对比。结果 BPD患儿生后3年内均存在肺功能异常,肺功能参数如潮气量(VT)、吸气时间(TI)、达峰时间比(TPTEF/TE)、达峰容积比(VPTEF/VE)降低,呼吸频率(RR)、呼气时间(TE)升高,与非BPD患儿比较,差异有统计学意义(P0.05);身高及体重均较同龄非BPD儿童下降(P0.05)。结论 BPD导致婴儿肺功能异常,并影响生长发育。     

呼吸窘迫综合征早产儿发生支气管肺发育不良的危险因素及呼吸道疾病随访分析

目的 探讨罹患新生儿呼吸窘迫综合征(NRDS)的早产儿发生支气管肺发育不良(BPD)的危险因素及随访结局。方法 以2013年1月1日—2016年12月31日在首都医科大学附属北京友谊医院新生儿科住院并诊断为NRDS的早产儿为研究对象。根据是否诊断BPD分为BPD组和对照组(非BPD组),研究患NRDS的早产儿发生BPD的危险因素,并在出院后进行电话或门诊随访,观察其1岁内呼吸道感染及喘息的发生次数、再住院率及部分患儿2岁以后的肺功能情况。结果 共纳入79例患儿,其中BPD组32例,对照组47例。单因素分析显示,BPD组患儿胎龄及出生体重显著低于对照组,机械通气时间、应用肺表面活性物质人数及母亲患妊娠子痫比例明显高于对照组(P<0.01),而母亲年龄、是否有分娩前胎膜早破及妊娠期糖尿病两组间差异无统计学意义(P>0.05)。BPD组患儿生后1年内患呼吸道感染及喘息的次数明显高于对照组(P<0.01),而两组患儿1岁内再入院率、2岁后肺功能差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,患儿胎龄(≤28周OR=23.00,95%CI:6.767~78.172;>28~32周OR=4.518,95%CI:1.359~15.020),与机械通气>7 d(OR=4.380,95%CI:2.581~6.146)为发生BPD的危险因素。结论 胎龄及机械通气>7 d可能为NRDS早产儿发生BPD的危险因素。BPD可能导致患儿婴幼儿期的反复呼吸道感染及喘息发作,而是否会导致患儿远期肺功能的改变有待于进一步的研究。     

鼻塞持续气道正压通气联合不同时间应用肺表面活性物质对≤32周早产呼吸窘迫综合征患儿预后的影响

目的探讨鼻塞持续气道正压通气(n CPAP)联合不同时间应用肺表面活性物质(PS)对≤32周早产呼吸窘迫综合征(NRDS)患儿预后的影响。方法选取2014年9月-2015年12月厦门市妇幼保健院新生儿科接收的106例≤32周早产NRDS患儿,根据其PS治疗前n CPAP应用时间不同分为A组、B组和C组。A组患儿n CPAP应用时间<2 h,B组≥2 h且<4 h,C组为≥4 h。对比各组患儿治疗前后各血气指标,对比各组气管插管机械通气率、时间及住院时间,观察各组死亡率及并发症发生情况。结果各组治疗前p H、Pa CO_2、Pa O_2、Sa O_2指标水平比较,差异无统计学意义(P>0.05);用药治疗2 h后各组患儿各指标水平较治疗前相比均明显改善(P<0.05);治疗2 h后各组患儿血气指标组间比较,差异无统计学意义(P>0.05);治疗后24 h各组患儿p H值与治疗2 h相比,差异无统计学意义(P>0.05);A组患儿治疗后24 h Pa CO_2水平与治疗后2 h相比,差异无统计学意义(P>0.05),B组Pa CO_2水平较治疗后2 h相比下降(P<0.05);C组Pa CO_2水平较治疗后2 h相比升高(P<0.05);各组患儿治疗后24 h Pa O_2水平较治疗后2 h均降低,但差异无统计学意义(P>0.05);治疗24 h后,AB两组患儿Sa O_2水平与治疗后2 h相比,差异无统计学意义(P>0.05),但C组较治疗后2 h比较,差异有统计学意义(P<0.05)。各组治疗后3 d内气管插管机械通气率及通气时间比较,差异均无统计学意义(均P>0.05)。各组患儿住院时间比较,差异无统计学意(P>0.05)。各组患儿死亡率比较,差异无统计学意义(P>0.05);A组患儿BPD发病率高于B组(P<0.05);A组患儿BPD发病率与C组比较,差异无统计学意义(P>0.05);各组患儿BPD轻度、中度、中度发生率组间比较,差异无统计学意义(P>0.05);各组患儿NRC发生率组间比较,差异无统计学意义(P>0.05);各组患儿颅内出血发生率比较,差异无统计学意义(P>0.05)。结论≤32周NRDS患儿应用n CPAP时间为≥2 h且<4h时行PS治疗的效果最佳。     

支气管肺发育不良患儿肺泡灌洗液TGF-β1和IL-8水平变化及临床意义

目的探讨BPD患儿肺泡灌洗液TGF-β1和IL-8水平变化及临床意义。方法回顾性分析2012年3月-2015年3月新生儿科机械通气BPD组45例、机械通气非BPD组42例、早产非机械通气非BPD组39例、对照组36例,对肺泡灌洗液TGF-β1和IL-8水平进行检测,并进行相关性分析。结果机械通气BPD组患儿不同时间BALF中TGF-β1和IL-8水平比较,生后第1周差异有统计学意义,3组两两比较,BALF中TGF-β1水平差异无统计学意义(P0.05),而BALF中IL-8水平,机械通气BPD组机械通气非BPD组非机械通气非BPD组。机械通气BPD组患儿不同临床分度患儿BALF中TGF-β1和IL-8浓度比较,生后第1周、第2周、第3周BALF中TGF-β1和IL-8浓度比较,重度中度轻度。生后第2周BPD患儿BALF中TGF-β1与临床分度呈正相关(r=0.719,P0.01)。结论肺泡灌洗液TGF-β1和IL-8水平对BPD诊断有一定特异性,动态检测肺泡灌洗液TGF-β1和IL-8对BPD准确判断病情和预后具有重要意义。     

极早早产儿住院情况及结局

目的探讨极早早产儿(EPI)的住院情况及结局。方法选择2010年1月1日至2015年5月31日,在广西壮族自治区妇幼保健院新生儿重症监护病房(NICU)住院治疗的79例EPI为研究对象。回顾性分析其临床病历资料及随访资料,了解其孕母情况、新生儿期并发症发生情况、转归及出院后随访情况等。统计学比较出生体重1 000g与≥1 000~1 250g EPI呼吸治疗情况。结果 (1)本研究79例EPI孕母的前3位妊娠并发症依次为:胎膜早破占38.0%(30/79)、宫内感染和瘢痕子宫各为10.1%(8/79)。(2)新生儿期前5位临床表现依次为:呼吸困难100.0%(79/79)、反应差84.8%(67/79)、黄疸79.7%(63/79)、腹胀70.9%(56/79)及喂养不耐受62.0%(49/79)。(3)新生儿期前5位并发症依次为:早产儿贫血81.0%(64/79)、高胆红素血症77.2%(61/79)、喂养不耐受62.0%(49/79)、呼吸窘迫综合征(RDS)60.8%(48/79)及支气管肺发育不良(BPD)57.0%(45/79)。(4)在51例存活出院的EPI中,出生体重1 000g需呼吸机辅助通气时间较出生体重≥1 000~1 250g EPI长,并且差异有统计学意义(P0.05);但二者肺表面活性剂(PS)使用率、呼吸机辅助通气使用率、连续气道正压通气(CPAP)使用率及使用时间,以及高流量吸氧率比较,差异均无统计学意义(P0.05)。(5)这51例出院患儿中,66.7%(34/51)合并早产儿视网膜病(ROP),45.1%(23/51)听性脑干反应测听未通过。46例完成随访患儿中,语言发育落后为10.9%(5/46),运动发育落后、行为障碍及脑瘫均分别为4.3%(2/46)。结论 EPI发生的常见原因为胎膜早破,新生儿期并发症多,出院后应密切随访。     

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.