角蛋白19在Ⅲ度烧伤创面修复过程中的表达及意义

目的 通过对Ⅲ度烧伤创面原位再生修复过程中不同活组织角蛋白19(K19)表达特征的研究，探索Ⅲ度烧伤创面原位再生修复的可能机制。方法 选择有Ⅲ度烧伤创面的青年患者10例，在原位再生修复过程中的不同时期分别切取活组织，应用过氧化酶标记的链霉卵白素(SP)免疫组化法，以K19单抗检测表皮干细胞的分布和形态特征；同时取供皮区的正常皮肤以及慢性溃疡组织作对照。结果 (1)正常皮肤组织只有表皮基底细胞层和附属器的部分细胞表达K19；(2)伤后3—6d，10例患者的痴下活组织均未发现K19表达阳性细胞；(3)肉芽样组织有部分细胞表达K19；(4)早期再生组织检测结果示：在再生表皮的中部，即位于基底膜与颗粒层之间有大量的K19表达阳性细胞，且分布广泛而有规律；(5)晚期再生组织检测结果显示：与正常皮肤类似；(6)入院前慢性皮肤溃疡组织中无K19表达阳性细胞。结论 Ⅲ度烧伤创面经烧伤湿性医疗技术加rhEGF治疗后K19表达阳性细胞可以从无到有产生并不断增加，以实现Ⅲ度烧伤创面的原住再生修复。     

皮肤鳞癌组织角蛋白19表达特征的实验研究

目的 通过对皮肤鳞癌组织角蛋白19表达特征的研究，探讨表皮干细胞与皮肤鳞癌的关系。方法 选择皮肤鳞癌患者10例，旁开病变组织2cm作切口切除病变组织，取癌组织和皮肤鳞癌周边组织做检查，应用过氧化酶标记的链霉卵白素(SP)免疫组化法，以小鼠抗人角蛋白19型的单克隆抗体检测角蛋白19表达阳性细胞的分布特征。结果 正常皮肤只有表皮基底层和附属器有角蛋白19表达用性细胞，而癌组织内的角蛋白19表达阳性细胞不仅比正常皮肤多，且分布紊乱，其核大小不等，形态各异．皮肤鳞癌周边组织中的表皮有多层角蛋白19表达阳性细胞，但分布有规律，无异形件．结论 皮肤鳞癌与表皮干细胞可能存在某种关系，值得进一步探讨。     

负载VEGF DNA质粒人工真皮修复烧伤创面中对创面收缩与细胞凋亡的影响

目的 比较负载血管内皮生长因子(vascular endothelial growth factor,VEGF)DNA质粒胶原-磺化羧甲基壳聚糖真皮支架及胶原-磺化羧甲基壳聚糖真皮支架在修复Ⅲ度烧伤创面中对创面收缩与细胞凋亡的影响.方法 将两种不同真皮支架各移植于6头猪(共12头猪)Ⅲ度烧伤清创后创面,对植入支架1、2、3周后的创面及支架植入2周加植表皮2周的创面修复情况进行观察.同时,通过采用免疫组织化学方法,对不同时间的创面中表达α-SMA的成熟血管和肌成纤维细胞以及细胞凋亡发生情况进行检测和观察.以不植入支架的烧伤创面作为实验对照.结果 ①植入不同真皮支架的创面与无支架植人的肉芽创面不同,负载VEGF DNA质粒真皮支架修复创面效果好于无质粒负载真皮支架.②在两种不同支架植入后1～3周创面α-SMA表达阳性的血管数持续增加,支架植入2周加植表皮2周血管数比3周创面明显减少,不同时间点α - SMA表达阳性的血管以负载VEGF DNA质粒的胶原-磺化羧甲基壳聚糖人工真皮支架植入创面最多,无支架植入创面最少;③α-SMA表达阳性的肌成纤维细胞以负载VEGF DNA质粒的胶原-磺化羧甲基壳聚糖人工真皮支架植入创面最少,无支架植入创面最多,负载VEGF DNA质粒胶原-磺化羧甲基壳聚糖真皮支架及胶原-磺化羧甲基壳聚糖真皮支架创面中表达高峰为2周,无支架创面表达高峰为3周.④不同支架及无支架创面植入后2～4周,创面内细胞凋亡持续大幅增多,且无支架创面中发生细胞凋亡最少.结论 负载VEGF DNA质粒的胶原-磺化羧甲基壳聚糖人工真皮支架在烧伤创面愈合过程中可促进血管化,通过抑制创面收缩和促进细胞凋亡减少瘢痕的产生.     

烧伤疤痕形成因素与美比欧疤痕平疗法

疤痕组织是人体受到创伤后自身修复过程中产生的，对于浅表伤口，仅影响到表皮，它只需上皮细胞再生修复而使伤口愈合，修复后的皮肤结构完整，功能完全能够恢复正常。但创伤深达真皮和皮下组织时，就要通过疤痕组织的形成来修复。 一、疤痕形成因素 1．体外因素 (1) 烧伤 深Ⅱ度烧伤、浅Ⅱ度烧伤治疗不当等均可发生疤痕，如果烧伤创面发生感染，疤痕增生就会更加明显。……     

肢体移植排斥反应中细胞凋亡及致死基因表达

目的探讨同种异体肢体移植急性排斥反应时细胞凋亡及致死基因Fas、Fas配体(FasL)表达的作用及其意义。方法建立近交系SD大鼠与wistar大鼠间原位异体肢体移植模型。实验观察组为异基因组，SD大鼠为供体，Wistar大鼠为受体；对照组为同基因移植组，在Wistar大鼠之间移植。分别进行左腿原位移植术。术后第1，3，5，7d分别取移植肢体组织进行病理学检查及电镜扫描，采用原位末端标记法(TUNEL)检测移植肢体中的凋亡细胞，免疫组化方法检测移植肢体中Fas、FasL表达的变化。结果实验组大鼠在术后发生由轻到重的急性排斥反应，对照组无明显排斥现象。实验组的移植物细胞凋亡数均明显高于对照组，凋亡细胞主要分布在血管内皮细胞及皮肤基底层细胞；术后第7d因严重排斥使小血管广泛栓塞。异基因肢体移植组的移植物中Fas／FasL表达增高，并与病理学检查及细胞凋亡程度一致。结论Fas、FasL介导的血管内皮细胞凋亡在大鼠异基因肢体移植急性排斥反应中发挥重要作用，可作为判断移植肢体预后及监测排斥反应的重要指标。     

下调基质细胞衍生因子1对肛周脓毒创面感染模型大鼠的干预作用

目的探究下调基质细胞衍生因子1(SDF-1)对肛周脓毒创面感染模型大鼠的干预作用。方法选取40只SD健康雄性大鼠分为正常组(n=10)、模型组(n=10)、上调SDF-1组(n=10)、下调SDF-1组(n=10)。取正常组大鼠肛周组织及其他三组大鼠创面肉芽组织进行苏木精-伊红(HE)染色观察,于干预5、10、15 d后对各组大鼠创面进行观察,统计分析创面愈合率。蛋白质印迹法检测SDF-1、磷脂酰肌醇激酶(PI3K)、蛋白激酶(Akt)相对表达量,检测各组大鼠新生毛细血管数、成纤维细胞数量,酶联免疫吸附法检测血管内皮生长因子(VEGF)、促血管生成素-2(Ang-2)、超敏C-反应蛋白(hs-CRP)、白细胞介素-17(IL-17)、转化生长因子β1(TGF-β1)蛋白水平。结果与模型组、上调SDF-1组比较,下调SDF-1组大鼠PI3K、Akt表达较高(P0.05),创面愈合率较高(P0.05),大鼠新生毛细血管数、成纤维细胞数较高(P0.05),VEGF、Ang-2水平较高(P0.05),下调SDF-1组大鼠hs-CRP、IL-17、TGF-β1水平较低(P0.05)。结论下调肛周脓肿模型大鼠SDF-1表达,能够靶向调控PI3K、Akt表达,加速大鼠创面愈合,促进创面组织中新生毛细血管、成纤维细胞生成,抑制炎症反应。     

物理抗菌敷料对术后创面修复的实验研究

目的探讨物理抗菌敷料对大鼠创面的修复作用机制的研究。方法选取清洁级Wistar大鼠24只,随机数表法分为3组,分别为阴性对照组、药膏组和敷料组。建立大鼠背部皮肤损伤模型,在术后7和14 d分别对创面进行取材,比较各组皮肤溃疡形成的创面愈合程度、创面血管的变化及血管内皮生长因子(VEGF)的表达。结果术后7 d时,相对于阴性对照组来说,敷料组和药膏组炎性渗出层变薄,肉芽组织厚度增加,毛细血管增生活跃;在14 d时,敷料组和药膏组较阴性对照组相比,创面肉芽组织更趋于成熟现象,表现为血管数量减少,炎细胞减少,纤维细胞数目增多。免疫组化结果显示,在创面愈合的早期(7 d)时,VEGF的表达在药膏组和敷料组中较阴性对照组强;14 d时,VEGF的表达在药膏组和敷料组中较阴性对照组减弱。结论物理抗菌敷料可以和抗菌药物发挥类似的作用,促进肉芽组织的生长,加快创面的愈合。     

人类全厚皮片移植裸鼠模型烧伤后MMP-1、TIMP-1表达的动态变化

目的 研究NMP-1、TIMP-1在烧伤创面愈合至HS形成的过程中的表达、关系和作用。方法 将人类正常全厚皮肤移植于裸鼠，待其完全存活后造成深Ⅱ度烧伤创面；然后用免疫组织化学染色的方法，观察NMP-1、TIMP-1在烧伤创面愈合至瘢痕形成全过程中的表达变化。结果 NMP-1于烧伤后第2d出现，第3d～15d表达较强，第28d已下降到基底值。它在具有不同流动性组织的界面明显。TIMP-1于烧伤后第2d出现，很快就表现为类似于NMP-1的接触界面的表达模式，并且一直持续到烧伤后5月瘢痕的形成；它的表达模式没有NMP-1那么规则，但在血管周围有明显的分布。结论 在伤口愈合的炎症期和增生期，NMP-1和TIMP-1两种力量处于动态平衡；在重塑期，TIMP-1通过抑制MMP-1的表达，减少胶原降解，从而诱导HS形成；并且它们可能在具有不同流动性组织的界面起着特殊的作用。     

血竭负载人工真皮支架对猪Ⅲ°烧伤创面修复中VEGF表达及创面收缩的影响

目的探讨胶原-壳聚糖人工真皮支架负载不同浓度血竭对Ⅲ°烧伤创面修复中VEGF表达及创面收缩的影响。方法将负载两种不同浓度血竭（4 g/L和1 g/L）的真皮支架各移植于6头猪（分别为A组和B组）Ⅲ°烧伤清创后创面,对植入支架1、2、3周后的创面及植入支架2周创面加植表皮后2周的创面修复情况（4周创面）进行观察。同时通过采用免疫组织化学的方法,对不同时间的创面中细胞表达的VEGF及肌成纤维细胞表达的α-SMA进行检测和观察。实验以植入胶原-壳聚糖人工真皮支架及不植入支架的烧伤创面作为对照（分别为C组和D组）。结果①负载高浓度血竭的胶原-壳聚糖/硅橡胶双层人工真皮支架创面修复好于其他两种支架及不植入支架创面;②VEGF表达结果：四组1~3周VEGF阳性表达呈持续性升高,差异有显著性（P〈0.05）;A、B、C组支架植入2周并植表皮2周后（4周）创面,VEGF阳性表达明显降低,D组4周与3周相比无显著性差异;不同时间点,四组的阳性信号A组最多,D组最少;③创面α-SMA表达阳性的肌成纤维细胞数：A组表达高峰在2周,B、C、D组表达高峰在3周;各组不同时间点,D组表达最多,3~4周,A组表达最少。结论血竭能明显诱导胶原-壳聚糖人工真皮支架在修复Ⅲ°烧伤创面中的VEGF表达从而促进血管化速度,同时可抑制创面的收缩从而抑制瘢痕的增生,且血竭的这些作用与药物浓度有相关性,高浓度比低浓度的作用更为显著。     

HBV感染孕妇所产死胎脐带组织中HBV-DNA表达的观察

目的 观察死胎脐带组织中HBV-DNA表达，探讨死胎脐带组织中的HBV是否存在复制。方法 采集40例乙型肝炎产妇产下的死胎，常规尸检，取脐带组织，采用原位分子杂交法，检测其中的HBV-DNA。回访产妇产前静脉血HBVM检测结果。结果 死胎脐带组织中HBV-DNA的检出率为40%（16/40）例，HBV-DNA颗粒在死胎脐带血管内皮细胞浆，血管中呈点，灶状分布，但脐带血管内皮细胞核上无HBV-DNA存在。结论 死胎脐带组织中有HBV复制；死胎脐带组织中HBV-DNA表达与产妇血清中HBV复制状态无关。     

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.     

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.