HBV父婴垂直传播水平与HBV-DNA载量的相关研究

目的 探讨HBsAg阳性父亲血HBV-DNA的不同载量水平对其新生儿发生HBV父婴垂直传播的影响.方法 对161例HBsAg阳性的父亲及其新生儿(母亲血清HBVM全阴性或仅HBsAb阳性及HBV-DNA均为阴性)HBV感染状况进行调查分析.采用ELISA检测HBVM,FQ-PCR法检测血清HBV DNA载量水平.结果 (1)父亲血HBV-DNA载量水平与新生儿脐带血HBV DNA阳性存在剂量反应关系趋势(χ~2=64.117,P=0.000).父亲血HBV-DNA≥1.0×107 copies/ml组新生儿的HBV父婴垂直传播水平显著高于＜1.0×107 copies/ml组(χ~2=71.539,P=0.000);(2)HBeAg阳性组与HBeAg阴性组父亲其新生儿的HBV-DNA阳性率差异有统计学意义(χ~2=6.892,P=0.009).结论 父亲血清HBV-DNA载量水平与是否发生HBV父婴垂直传播密切相关,随血清HBV-DNA载量增加而上升,并存在影响传播的浓度界面;父亲血清HBV-DNA 1.0×107 copies/ml及HBeAg阳性是HBV父婴垂直传播的危险因素.     

孕晚期注射HBIG及新生儿HBIG联合乙肝疫苗阻断HBV母婴传播的临床观察

目的:探讨乙型肝炎表面抗原(HBsAg)阳性孕妇孕晚期注射乙肝免疫球蛋白(HBIG)及其婴儿HBIG联合乙型肝炎疫苗阻断母婴传播的效果。方法:将108例HBsAg阳性孕妇分为两组,研究组58例,分别于孕28、32、36周时肌注HBIG 200国际单位(IU)。对照组50例,不注射HBIG。两组新生儿出生后6h内及第2周注射HBIG 200 IU,并按0-1-6方案全程接种乙肝疫苗,每次10μg。采集两组婴儿出生时、1岁时静脉血,采用酶联免疫法(ELISA)检测乙肝HBsAg、HBsAb;采用核酸扩增(PCR)荧光定量法检测HBV-DNA水平。结果:①研究组新生儿出生当天外周血HBsAg、HBV-DNA阳性率分别为5.17%和3.45%,显著低于对照组(18%和10%),两组比较差异有统计学意义;研究组新生儿血清抗-HBs阳性率25%,明显高于对照组(χ2=7.53,P<0.05)。②研究组婴儿1岁时外周血HBsAb阳转率为91.67%,显著高于对照组(24%,P<0.01)。结论:对HBsAg阳性孕妇孕晚期应用HBIG,新生儿出生时应用HBIG和乙型肝炎疫苗联合免疫,可以有效减少宫内感染的发生,并可显著提高婴儿HBsAb阳性率,可以有效阻断乙肝病毒的母婴传播。     

联合免疫措施阻断HBV母婴传播对新生儿血清中HBsAg水平影响

目的研究联合免疫措施阻断乙型肝炎病毒(HBV)母婴传播对新生儿血清中HBsAg水平影响。方法选取2016年8月-2017年2月医院HBsAg阳性孕妇468例为研究对象,根据随机数字表法,按照1∶1比例将研究对象随机分为试验组和对照组,每组234例。对照组采用乙肝疫苗接种,试验组采用联合免疫措施(乙肝免疫球蛋白联合乙肝疫苗接种)。观察和比较两组研究对象乙肝血清标志物(HBVM)、血清丙氨酸氨基转移酶(ALT)、HBV-DNA等指标水平和阻断效果及宫内感染率。结果试验组新生儿脐血检测HBsAg(+)率、HBsAg(+)/HBeAg(+)率、HBeAg(+)率、HBV-DNA(+)率、宫内感染率均低于对照组(P0.05),抗-HBs检出率90.17%高于对照组68.38%(P0.05);试验组新生儿6个月静脉血HBsAg(+)率、HBsAg(+)/HBeAg(+)、HBeAg(+)率、HBV-DNA(+)率、HBV感染率均低于对照组(P0.05),抗-HBs检出率85.04%、抗-HBs检出(10mIU/mL)率72.65%高于对照组的68.38%、50.00%(P0.05);试验组新生儿12个月静脉血HBsAg(+)率、HBsAg(+)/HBeAg(+)率、HBV-DNA(+)率、HBV感染率均低于对照组(P0.05);抗-HBs检出率94.87%、抗-HBs检出(10mIU/mL)率90.17%高于对照组的79.06%、70.94%(P0.05)。结论乙肝免疫球蛋白联合乙肝疫苗接种阻断HBV母婴传播效果较好,能有效提高抗-HBs检出率(10mIU/mL)、降低新生儿血清中HBsAg(+)率,因此在孕检期间出现血清HBVM抗原阳性者,应采用联合免疫措施阻断HBV母婴传播。     

乙型肝炎病毒感染免疫预防母婴传播的效果研究

目的:研究乙型肝炎病毒感染免疫预防母婴传播的效果。方法:选择2015-01~2017-02期间某医院收治的820例HBsAg阳性孕妇和婴儿作为研究对象,经过阻断HBV母婴传播,对乙型肝炎病毒感染免疫预防母婴传播效果进行分析对比。结果:经过治疗,观察组新生儿乙肝宫内感染率5.85%明显低于对照组18.29%,观察组免疫阻断率明显高于对照组,2组对比有显著差异(P0.05);观察组HBsAb阳性率21.71%和随访1a后HBsAb阴性转阳率96.34%,均高于对照组的5.12%、80%,2组对比有显著差异(P0.05)。结论:乙型肝炎病毒感染免疫预防母婴传播效果理想,值得推广应用。     

预防免疫对阻断乙型肝炎父婴传播的临床研究

[目的]探讨阻断乙型肝炎病毒父婴传播的方法。[方法]选取2003年1月～2006年1月,100例孕妇丈夫血清HBV DNA( ),孕前抗-HBs( )孕妇的病例为研究对象(观察组),并根据孕期是否肌注乙肝免疫球蛋白分2组:Ⅰ组孕期自孕24周产检起,每4周肌注乙肝免疫球蛋白200IU至分娩,Ⅱ组孕期不肌注乙肝免疫球蛋白。另筛选出孕妇无各种肝炎病毒感染,而丈夫血清HBV DNA( )的病例为对照组(Ⅲ组)。3组病例新生儿出生时均抽脐带血检测HBV DNA及抗-HBs。[结果]观察组Ⅰ组新生儿抗-HBs( ),阳性率为56.00%(28/50),观察组Ⅱ组新生儿抗-HBs( )阳性率为52.00%(26/50);对照组新生儿抗-HBs( )为O(0/45)无一例阳性。观察组抗-HBs( )率显著高于对照组(P﹤0.05)。Ⅰ组脐血HBV-DNA( )16.00%(8/50),Ⅱ组有18.22%(9/50),Ⅲ组有42.22%(19/45)。观察组新生儿感染率明显低于对照组。[结论]孕前成功获得抗-HBs( ),可有效阻断父婴传播;孕期加用HBIG未能进一步阻断父婴传播。     

乙肝母婴联合免疫与常规免疫效果的比较

目的 探讨乙型肝炎病毒感染孕妇其母婴联合免疫与婴儿单纯免疫两种方法的免疫效果.方法 时112例乙型肝炎病毒标志物阳性孕妇于妊娠后期3个月(即妊娠28周后)给予乙型肝炎免疫球蛋白200U免疫阻断母婴传播作为治疗组,73例乙型肝炎病毒标志物阳性孕妇生产前不做任何免疫治疗作为对照组,两组新生儿均常规接受乙肝疫苗接种和乙型肝炎免疫球蛋白注射,12月龄时采集外周血检测乙型肝炎病毒标志物、乙型肝炎病毒DNA及肝功能.结果 治疗组和对照组新生儿12个月龄时抗-HBs阳性率分别为95.5%和82.4%,两组间比较具有统计学意义(X2=4.09,P<0.05);治疗组孕妇HBV DNA高滴度者明显高于低滴度者所娩新生儿的感染率(X2=6.88,P<0.05);剖宫产与自然分娩之间感染HBsAg比较无显著性差异(X2=1.98,P>0.05).结论 对乙型肝炎病毒感染孕妇采用乙型肝炎免疫球蛋白进行免疫阻断可降低宫内感染及母婴传播的发生率,提高新生儿免疫保护率,减少慢性乙型肝炎病毒感染.     

乙型肝炎病毒与母婴传播的研究

目的 研究乙型肝炎高价免疫球蛋白(HBIg)阻断乙型肝炎病毒母婴传播的效果以及乙型肝炎病毒的母婴传播与病毒数量的关系.方法 将320例HBsAg阳性孕妇随机分成治疗组(163例)和对照组(157例),均在妊娠28周时检测HBV-DNA数量和HBsAg,治疗组自28周开始每4周肌肉注射1次HBIg200U直至分娩,对照组不给予上述药物,新生儿出生后检测HBsAg.结果 治疗组新生儿HBsAg阳性率(6.75%)明显低于对照组(34.39%),HBV-DNA含量高的孕妇所生新生儿HBsAg阳性率明显高于HBV-DNA含量低者.结论 HBIg能有效降低HBsAg阳性孕妇的宫内感染率,HBV-DNA含量直接影响HBsAg阳性孕妇的宫内感染率.     

乙肝免疫球蛋白联合乙肝疫苗阻断乙型肝炎病毒母婴传播的效果研究

目的研究乙肝免疫球蛋白(HBIG)联合乙肝疫苗阻断乙型肝炎病毒(HBV)母婴传播的效果,探讨阻断乙肝母婴传播的方法。方法按自愿原则将随州市曾都区HBsAg阳性孕妇319例分为实验组、对照组。实验组156例孕妇,于妊娠第28,32,36周肌肉注射HBIG 200IU及10μg基因乙肝疫苗,新生儿出生12h内、1月、6月龄各注射HBIG 100IU及5μg乙肝疫苗。对照组HBsAg阳性孕妇163例,不用药,仅新生儿出生后12h内、1月、6月龄接种乙肝疫苗每次5μg。所有新生儿均随访至3岁。乙肝标志物检测采用酶联免疫法,HBV-DNA病毒载量采用核酸扩增(PCR)荧光定量方法。结果实验组新生儿宫内感染率(6.41%)低于对照组(16.57%),新生儿HBsAb阳性率(22.44%)高于对照组(4.91%),1年后实验组幼儿HBV感染率(1.28%)低于对照组(13.50%),HBsAb阳性率(95.87%)高于对照组(88.39%),以上差异均有统计学意义(P均<0.01)。3年后实验组幼儿HBV感染率为1.90%,低于对照组(14.70%),差异有统计学意义(χ2=36.10,P<0.001);但实验组、对照组幼儿HBsAb阳性率差异无统计学意义。结论应用乙肝免疫球蛋白联合乙肝疫苗,能有效地阻断乙肝母婴宫内及生长过程中的感染,提高婴儿乙肝表面抗体应答率,有效地保护儿童健康。     

小剂量人乙型肝炎免疫球蛋白结合恩替卡韦对肝移植术后乙型肝炎病毒再感染的防治效果

目的探究小剂量人乙型肝炎免疫球蛋白(HBIG)结合恩替卡韦(ETV)对肝移植术后乙型肝炎病毒(HBV)再感染的防治作用。方法将2012年1月-2015年6月于宁波市医疗中心李惠利医院东部院区行肝移植且使用ETV预防HBV再感染的41例患者作为对照组,2015年7月-2019年1月使用ETV联合小剂量HBIG预防HBV再感染的115例肝移植患者作为联合组,均至少随访18个月,定期复查乙型肝炎表面抗原(HBsAg)、乙型肝炎表面抗体(HBsAb)、乙型肝炎e抗原(HBeAg)、乙型肝炎e抗体(HBeAb)及乙型肝炎核心抗体(HBcAb)及HBV DNA,统计HBV再感染情况;术后再感染者均行络氨酸-蛋氨酸-天门冬氨酸-天门冬氨酸(YMDD)基因变异筛查,观察YMDD变异情况,并记录治疗不良反应发生情况。结果联合组移植术后HBV再感染率为0.87%低于对照组(P0.05);联合组术后不同时间HBsAb抗体滴度均高于对照组(P0.05);对照组YMDD变异率为11.11%高于联合组,但差异无统计学意义(P=0.159);术前HBeAg(+)、术前HBV-DNA(+)患者HBV再感染率(13.33%、10.98%)均高于术前HBeAg(-)、术前HBV-DNA(-)患者(P0.05)。结论小剂量HBIG联合ETV防治肝移植术后HBV再感染效果优于单独应用ETV,安全有效,可减少HBV再感染率,提高HBsAb抗体滴度。     

妊娠合并乙型肝炎对产妇和新生儿的影响

目的 探讨妊娠合并乙型肝炎病毒感染对产妇和新生儿的影响.方法 回顾性分析对比120例妊娠合并乙型肝炎病毒感染患者的妊娠结局,并与同期120例正常妊娠者的妊娠结局比较.结果 ①并发症(胎膜早破、产后出血、妊娠期高血压疾病)的发生率以肝功能异常组发病率最高,无症状乙型肝炎病毒感染组次之,正常妊娠组最低,其差异有统计学意义(均P<0.05);②新生儿异常发生率(早产、低体重儿、新生儿窒息等)肝功能异常组与其他两组之间比较差异有统计学意义(均P<0.05),而无症状乙型肝炎病毒感染组与正常妊娠组比较差异无统计学意义(均P>0.05);③脐血经聚合酶链反应扩增(HBV-DNA阳性)有4.17%母婴垂直传播,且HBV-DNA阳性孕妇垂直传播率高.结论 妊娠合并乙肝病毒感染易发生各种并发症,肝功能异常对这些妊娠并发生症的发生有显著影响.母亲HBV-DNA阳性是乙型肝炎病毒宫内感染的主要危险因素.     

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.