高胆红素血症与新生儿自发性眨眼的关系研究

目的评估高胆红素血症对新生儿自发性眨眼的影响。方法采用新生儿行为神经(NBNA)评分法、5分钟眨眼试验,检测评估53例高胆红素血症新生儿,按小时胆红素值分为高胆1组(小时胆红素第75百分位值)和高胆2组(小时胆红素第95百分位值),在黄疸消退后重复上述两项测评,并与38例同日龄正常新生儿对照。结果 (1)高胆红素血症新生儿NBNA评分明显低于正常同日龄新生儿,且自发性眨眼明显增多,差异有统计学意义(P0.05)。(2)高胆红素血症新生儿在黄疸消退后,NBNA评分和自发性眨眼频率较黄疸高峰期有所恢复,结果差异有统计学意义(P0.01)。(3)黄疸消退后高胆1组与同日龄的正常新生儿比较,NBNA评分和5分钟自发性眨眼频率差异无统计学意义(P值均0.05)。而高胆2组NBNA总分包括原始反射、一般评估仍明显低于正常同龄新生儿(P0.01);自发性眨眼频率仍较同日龄新生儿增多(P0.05)。(4)黄疸消退后高胆1组的NBNA评分、自发性眨眼恢复较好,与高胆2组比较差异有统计学意义(P0.05)。结论高胆红素血症可影响新生儿的行为表现和自发性眨眼频率,其影响程度与黄疸严重度有关。     

新生儿行为神经测定评分联合血清胆红素总量/白蛋白比值预测新生儿高胆红素血症并发急性胆红素脑病的临床价值

目的 探讨新生儿行为神经测定(NBNA)评分联合血清胆红素总量/白蛋白比值(B/A)预测新生儿高胆红素血症并发急性胆红素脑病的临床价值。方法 收集2020年5月—2021年6月杭州市妇产科医院收治的患儿62例为观察组,另选取在院进行健康体检的婴儿62例为对照组。检测两组NBNA评分、B/A水平,分析NBNA评分、B/A在高胆红素血症及其并发病情的表达水平以及对高胆红素血症以及并发症状的诊断价值。结果 观察组B/A表达水平高于对照组(8.51±2.03 vs. 5.69±1.35),NBNA评分表达水平低于对照组(26.88±4.23 vs. 35.33±5.61),差异有统计学意义(P<0.05)。logistic回归分析显示,B/A水平表达上升,NBNA评分表达水平下降是患有高胆红素血症以及并发不良病症患儿的重要影响机制。ROC曲线显示,两项联合对患有高胆红素血症及并发不良病症患儿的诊断价值高于NBNA评分、B/A单项诊断[AUC(95%CI):0.944(0.896~0.991)vs.0.823(0.749~0.897)vs.0.782(0.699~0.866)],差异有统计学意义(P<0.05)。结论 对于研究患有不良病症患儿情况变化,可检测出B/A水平表达上升,NBNA评分表达下降,能够有效地提前对患儿病情进行预测,减少不良反应的发生。     

高胆红素血症新生儿脑脊液胆红素检测的临床应用价值探讨

目的:探讨脑脊液中未结合胆红素检测在高胆红素血症新生儿中的临床应用价值。方法:对285例高胆红素血症新生儿的脑脊液和血液未结合胆红素水平进行检测,计算未结合胆红素/白蛋白比值(B/A),并进行新生儿行为神经评分(NBNA)。结果:警告期和痉挛期的胆红素脑病新生儿血中未结合胆红素(UCB)、脑脊液(CSF)中UCB和血B/A比值均明显高于单纯高胆红素血症的新生儿,差异有统计学意义(P<0.05),并且出现痉挛期的新生儿CSF中UCB高于警告期新生儿,差异有统计学意义(P<0.05),进一步研究发现血中UCB、CSF中UCB和B/A比值NBNA异常组患者均明显高于NBNA正常组新生儿,其中CSF中UCB与NBNA得分呈显著的负相关。结论:CSF中UCB检测不但能早期诊断胆红素脑病,并且能准确地反应高胆红素血症新生儿的脑功能情况。     

新生儿溶血性高胆红素血症与胆红素脑病的关系研究

目的研究新生儿溶血性高胆红素血症与胆红素脑病的关系,旨在为临床提供依据。方法选取东莞市妇幼保健院2015年1月-2016年12月期间收治的228例溶血性高胆红素血症患儿(高胆红素血症组)和同期收治的11例胆红素脑病患儿(胆红素脑病组)为研究对象。收集两组患儿的详细资料,包括体温、是否合并酸中毒、新生儿Apgar评分、血清总胆红素水平、间接胆红素水平、白蛋白水平、间接胆红素与白蛋白的比值(B/A比值)、开始治疗时间等,使用统计学软件对研究数据进行统计分析,明确新生儿溶血性高胆红素血症与胆红素脑病的关系。结果胆红素脑病组患儿的血清总胆红素水平明显高于高胆红素血症组(P0. 05),B/A比值1、开始治疗时间48 h的患儿所占比例大于高胆红素血症组(P0. 05)。两组患儿体温、生儿Apgar评分等指标比较差异无统计学意义(P0. 05)。结论溶血性高胆红素血症患儿血清总胆红素水平升高、B/A比值增大、开始治疗时间越晚发生胆红素脑病的风险越大。     

新生儿高胆红素血症对行为神经影响的观察

目的探讨新生儿高胆红素血症对行为神经的影响。方法将符合研究对象标准的病例分为2组,高胆组和正常对照组,正常对照组选择新生儿出生后3～7天进行NBNA测定,高胆组分别于高胆治疗前后以新生儿行为神经测定(NBNA)20项进行2次测定。结果随着高胆红素血症的治疗NBNA评分结果有所增加,且多数能达到正常,仅对咯咯声反应、月国窝角的2项评分与正常对照之间仍有显著差异P<0.05。结论高胆红素血症对新生儿行为方面的影响大部分为可逆的,对咯咯声反应的异常提示在对这些患儿进行随访时应注意听力方面的监测,及早发现听力异常,并对这部分患儿进行听力方面的早期干预,减少伤残率。     

行为测定在评价新生儿高胆红素血症脑损伤中的意义

【目的】　了解行为测定在新生儿高胆红素血症脑损伤中的临床意义。　【方法】　采用NBNA测定法对 3 5例新生儿高胆红素血症 (以后简称新生儿高胆 )患儿和 3 0例足月正常新生儿进行 3次行为测定 ,7个月时采用CDCC进行测定 1次。　【结果】　高胆组 3次NBNA测定均值都低于对照组 (P <0 .0 5 ) ,有 10例总分 <3 7分 ,而对照组无 1例 (P <0 .0 1)。高胆组黄疸高峰期NBNA均值明显低于生后 2 8d者 (P <0 .0 5 ) ,总分 <3 7分的例数在出生2 8天明显少于黄疸高峰期 (P <0 .0 1)。CDCC测定MDI和PDI得分结果高胆组均值明显低于对照组 (P <0 .0 5 ) .　【结论】　NBNA在评价新生儿高胆患儿早期轻微脑损伤中有重要的临床意义。     

新生儿高胆红素血症的病因及临床分析

新生儿黄疸是新生儿时期常见的症状,由于新生儿胆红素代谢的特点,早期新生儿可出现生理性黄疸,若同时伴有任何高危因素,黄疸程度超过生理性范围时,称为高胆红素血症(简称高胆),而其中高间接胆红素血症并发胆红素脑病,可造成神经系统的永久性损害,因此,对新生儿高胆红素血症及时查明病因,并进行早期干预以达到降低高胆的病死率和致残率是很重要的。1 资料和方法1.1 资料 我院1995年收治新生儿498例,其中高胆患儿105例,占21.08％;2001年收治新生儿545例,高胆患儿126例,占23.12％;总231例高胆患儿中男129例,女102例,男女比例为1.26:1;足月儿182例,早产儿41例,过期产儿8例;自然分娩138例,剖宫产82例,产钳等其他异常分娩方式11例;     

新生儿高胆红素血症总胆红素与白蛋白比值的临床意义

本文探讨总胆红素与白蛋白比值(B/A)与脑干听觉诱发电位(ABR)的关系及在预测胆红素神经毒性的价值。结果认为B/A比值是预测胆红素脑病的良好指标,对于足月高胆患儿B/A比值>5.0×10-3者,应采取积极的治疗措施。     

高胆红素血症新生儿听力筛查临床意义

[目的]探讨对高胆红素血症(简称高胆)新生儿进行听力筛查的临床意义,为早期干预治疗提供依据.[方法]对286例高胆患儿和5 525例正常新生儿所做的听力筛查结果进行分析.[结果]普通高胆组瞬态诱发耳声发射(TEOAE)初筛未通过37例(17.70%),42 d自动听性脑干反应(AABR)复筛未通过16例(7.66%);严重高胆组TEOAE初筛未通过23例(29.87%),42 d AABR复筛未通过15例(19.48%);对照组TEOAE初筛未通过496例(8.98%),42 d AABR复筛未通过68例(1.23%).高胆新生儿的听力筛查未通过率明显多于正常新生儿,而且血清胆红素越高,听力异常率越高.所有高胆新生儿最终确诊为听力障碍为3例. [结论] 高胆红素血症对新生儿听力有影响,因此对高胆新生儿进行听力筛查和随访是必要的,同时及时对高胆红素血症新生儿进行干预治疗可以减少听力障碍等后遗症的发生.     

重度高胆红素血症新生儿总胆红素/白蛋白比值与MRI成像异常的相关性探讨

目的 探讨重度高胆红素血症的新生儿总胆红素/白蛋白的比值(B/A)与颅脑核磁(MRI)异常的关系及其临床意义。方法 对象为2013年1月-2014年1月收治的足月重度高胆红素血症(血清总胆红素≥342.2 μmol/L)162例,按照颅脑核磁结果,分为核磁检查正常组(126例)及核磁检查异常组(36例)。回顾性分析B/A比值与颅脑核磁的关系。结果 分析结果显示:颅脑核磁异常组较颅脑核磁正常组具有更高的B/A比值,差异具有统计学意义(P<0.05)。结论 高B/A比值是重度高胆红素血症患儿发生颅脑核磁异常的危险因素,可能导致患儿遗留神经行为后遗症,对于无条件行磁共振检查的基层医院通过观察B/A值,对高B/A重度高胆红素血症新生儿积极退黄疸尽可能减少其遗留神经系统后遗症的机率,并加强高危患儿的随访工作。     

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.     

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.