急性脑出血合并全身炎症反应综合征患者血清TNF—α、IL-6动态变化的临床意义

目的探讨急性脑出血并发全身炎症反应综合征（SIRS）患者血清肿瘤坏死因子-α（TNF—α）和白细胞介素6（IL-6）含量的动态变化及其意义。方法127例急性脑出血患者分为SIRS组60例、非SIRS组67例,分别于发病内24h及3、7、14d晨起空腹抽取静脉血,采用双抗体夹心（ELISA）法测定血清TNF—α、IL-6水平,并观察两组患者的多器官功能障碍综合征（MODS）发生率及死亡率。结果在不同时间点,SIRS组患者的TNF-α含量差异有统计学意义（P〈0．01）,SIRS组的各时间点TNF—α含量均显著高于非SIRS组（P〈0．01）;在不同时间点,两组患者的IL-6含量差异有统计学意义（P〈0．01）,SIRS组的各时间点IL-6含量均显著高于非SIRS组（P〈0．01）;SIRS组患者的死亡率高达55％（33／60）,而非SIRS患者死亡率仅7．46％（5／67）,两者比较差异有统计学意义（Χ^2=11．39,P〈0．01）;SIRS组患者中有36％（22／60）出现MODS,非SIRS组中有4．48％（3／67）出现MODS,两者比较差异有统计学意义（Χ^2=9．87,P〈0．01）。结论TNF—α及IL-6参与了脑出血后的发生、发展病理生理过程,并具有很高的预警价值。     

血清和前列腺液中四种细胞因子水平与慢性非细菌性前列腺炎的关系

目的 探讨血清和前列腺液中细胞因子与慢性非细菌性前列腺炎（CAP）的关系。方法用ELISA法对68例CAP患者血清和前列腺液进行IL-2、IL-4、IL-8、TNF-α检测，同时，以20例健康男性作正常对照，并对所取得的数据进行统计学处理。结果CAP患者血清和前列腺液中的IL-2、IL-8、TNF-α，以及患者血清IL-4均有不同程度的升高，与正常对照组相比差异显著（P〈0．05或P〈0．01），患者前列腺液中的IL-4水平与正常对照组比较无显著性差异（P〉0．05）。结论IL-2、IL-8、TNF-仅水平可能在CAP发生发展过程中起重要作用，对CAP辅助性诊断有较大应用价值；前列腺液中的IL-4水平与CAP症状问无相关关系（r=0．28，P〉0．05），说明CAP的局部免疫反应可能不是以体液免疫为主，IL-4在其发病过程中不起主导作用；而患者血清中的IL-4水平与CAP间存在相关性（r=0．48，P〈0．05），可能是细胞因子间网络样调节作用的结果。     

丹参注射液对过敏性紫癜患儿TNF-α、IL-6、IL-8的影响

目的观察丹参注射液对过敏性紫癜（AP）患儿血清肿瘤坏死因子-α（TNF—α）,白细胞介素（IL-6,IL-8）等细胞因子的调节作用。方法选择AP患儿62例,随机分为观察纽和治疗组各31例,选择30例健康儿童作为正常对照组。观察组和治疗组在治疗前和治疗10天后,以ELISA双抗体夹心法检测TNF—α,IL-6,IL-8的血清水平。对照组儿童则抽血一次查TNF-α,IL-6．IL-8的水平备对照。结果观察组和治疗组治疗前后TNF—α,IL-6,IL-8的水平比较差异显著（P〈0．05或P〈0．01）．观察纽与治疗组治疗前TNF-α,IL-6,IL-8水平比较差异无显著性（P〉0．05）,治疗后两组间比较差异有显著性（P〈0．01）。结论丹参注射液可调节AP患儿的TNF—α,IL-6,IL-8的表达水平。     

血清CA-125、TNF-α、IL-8在先兆流产中的变化及意义

目的探讨血清CA-125、TNF-α、IL-8在先兆流产中的变化及意义。方法检测正常非孕妇女、正常早孕妇女和先兆流产妇女血清CA-125、TNF-α、IL-8水平。结果先兆流产组血清CA-125、TNF-α、IL-8水平明显高于正常非孕组及正常早孕组,差异有统计学意义（P〈0．05）。正常非孕组血清CA-125、TNF-α、IL-8水平与正常早孕组比较,差异无统计学意义（P〉0．05）。治疗后血清CA-125、TNF-α、IL-8水平明显下降,与治疗前比较差异有统计学意义（P〈0．05）。结论血清CA-125、TNF-α、IL-8可作为判断先兆流产预后的参考指标。     

糖尿病肾病患者血清IL-18、TNF-α、sICAM-1水平的变化及意义

目的探讨血清白细胞介素-18（IL-18）、肿瘤坏死因子-α（TNF-α）、可溶性细胞间黏附分子-1（sICAM-1）在糖尿病肾病（DN）中的变化及意义。方法78例2型糖尿病患者根据尿白蛋白排泄率（UAER）分为正常白蛋白尿组（28例）、微量白蛋白尿组（29例）和临床白蛋白尿组（21例）。30例健康者为健康对照组。所有受试者均采用双抗体夹心酶联免疫吸附法检测血清IL-18、TNF-α、sICAM-1水平。结果（1）糖尿病各组血清IL-18、TNF-α、sICAM-1水平均较健康对照组明显升高（P〈0．01）,且血清IL-18、TNF-α、sICAM-1水平在正常白蛋白尿组、微量白蛋白尿组和临床白蛋白尿组呈逐渐升高,组间比较差异有统计学意义（P〈0．01）。（2）相关分析显示DN患者血清IL-18、TNF-α、sICAM-1水平与UAER呈显著正相关（P〈0．01）;血清IL-18水平与血清TNF-α、sICAM-1水平呈显著正相关（P〈0．01）,血清TNF-α水平与血清sICAM-1水平亦呈显著正相关（P〈0．01）。结论DN患者血清IL-18、TNF-α、sICAM-1水平与DN的程度相关;血清IL-18、TNF-α、sICAM-1在监测DN的发生和发展方面有一定的临床意义。     

不同时期多发性硬化患者高敏C反应蛋白、白细胞介素-10和肿瘤坏死因子水平变化的临床意义

目的研究多发性硬化（MS）患者活动期和缓解期血清和高敏c反应蛋白（hs—CRP）、白细胞介素-10（IL-10）和肿瘤坏死因子（TNF-α）水平变化的临床意义。方法36例活动期Ms患者，并经治疗进入缓解期，选择同期健康人10例作为对照。hs—CRP采用免疫比浊法测定，IL—10和TNF-α采用酶联免疫吸附测定法测定。结果不同分期MS患者血清和CSF中hs-CRP、TNF-α和IL-10水平不同，发作期Ms患者血清和CSFhs—CRP、TNF-α和CSFIL-10水平较缓解期MS患者明显或显著增高（P〈0．05、P〈0．01或P〈0．001），缓解期血清IL-10水平则高于CSF（P〈0．05），缓解期血清和CSFTNF-α、IL-10较健康者增高（P〈0．05或P〈0．01）。结论血清和CSFhs—CRP、TNF-α和CSFIL-10水平明显增高提示MS处于发作期，缓解期血清和CSFTNF-α、CSFIL-10较健康者增高，提示MS缓解期病情仍存在一定的进展。周围血清hs—CRP水平增高可作为MS活动期诊断依据之一。     

T辅助细胞极化群体在儿童慢性特发性血小板减少性紫癜发病机制中的作用研究

目的 探讨儿童慢性特发性血小板减少性紫癜（CITP）发病中，T辅助细胞（Th）亚群细胞因子的变化。方法 采用定量夹心酶联免疫测定技术检测30例CITP患儿疾病活动期及治疗达完全缓解后，血清中Th1细胞因子白细胞介素（IL）-2、干扰素（IFN）-γ，Th2细胞因子IL-4，IL-5，IL-10和Th3细胞因子转化生长因子（TGF）-β1的变化。结果①在疾病活动期，Th1型细胞因子IL-2和IFN-γ浓度较正常对照组儿童显著升高，差异有显著意义（P〈0．01）；Th2型细胞因子IL-4，IL-5和IL-10浓度较正常对照组儿童降低，其中IL-4和IL-10显著低于对照组（P〈0．01）；Th1／Th2，（IL-2＋IFN-γ）／（IL-4＋IL-5）明显高于对照组（P〈0．01），并且与患儿外周血小板计数呈负相关（RR=0．2515，P=0．0174）；血清TGF-β1较对照组减少（P〈0．01）。②治疗缓解期，血清中Th2型细胞因子较疾病活动期明显升高，Th1／Th2明显下降，差异有显著意义（P〈0.01），血清TGF-β1明显增加，显著高于疾病活动期（P〈0．01）。结论CITP患儿存在异常的淋巴细胞极化状态，是一种Th1类优势疾病。疾病活动期，患儿具有Th1细胞因子活动模式，在疾病缓解期，Th1向Th2模式迁移，血清TGF-β1明显增加，Th3与Th2细胞协同发挥负性免疫调节作用，血小板逐渐上升。控制CITP中细胞因子反应，可能是免疫治疗的一种有效方式。     

异丙酚和异氟烷对肺癌根治术患者围术期血浆细胞因子的影响

目的探讨异丙酚和异氟烷麻醉对肺叶切除术肺癌患者围术期血浆细胞因子的影响。方法选择择期行肺叶切除术肺癌患者38例,随机分为异丙酚组和异氟烷组,每组19例。两组均于麻醉前（T0）、麻醉后切皮时（T1）、单肺通气60 min（T2）、膨肺后60 min（T3）、术后1 h（T4）、4 h（T5）2、4 h（T6）采用酶联免疫吸附法（ELISA）测定血清肿瘤坏死因子（TNF-α）、IL-6、IL-8、IL-10的浓度。结果两组TNF-α、IL-6、IL-8、IL-10浓度在单肺通气60 min时均明显上升,TNF-α、IL-6和IL-8浓度于术后1 h达到高峰,IL-10浓度于术后4 h达到高峰。A组术后1、4、24 h时间点IL-10的水平均明显高于B组（P〈0.05）;B组单肺通气60 min至术后4 h各时点的TNF-α、IL-6和IL-8浓度增加幅度均明显高于A组（P〈0.05）。结论异丙酚和异氟烷均能促进肺癌根治术患者产生致炎性和抗炎性细胞因子,且异丙酚较异氟烷有明显的抑制炎症作用。     

卡巴胆碱对烧伤延迟复苏大鼠免疫功能的影响

目的探讨卡巴胆碱对烧伤延迟复苏大鼠单核细胞Ia抗原、外周血淋巴细胞凋亡率及促炎细胞因子肿瘤坏死因子（TNF）-α、白介素（IL）-6的影响。方法104只成年雄性Wistar大鼠制作30％m度烧伤,延迟复苏模型。大鼠随机分为正常对照组、单纯烫伤组和卡巴胆碱治疗组,分别于6h、1、2、3、7、14d时间点处死动物并取血,流式细胞仪检测单核细胞la抗原表达率和淋巴细胞凋亡率,Elisa法检测TNFα、IL-6水平。结果大鼠烧伤延迟复苏后单核细胞Ia抗原表达率降低。其中6h、和1d时间点Ia抗原表达率严重降低,2d开始有所恢复,但仍明显低于正常大鼠（P〈0．01）。卡巴胆碱治疗组6h、1、2和3d时间点单核细胞Ia抗原表达率与单纯烫伤组比较明显提高（P〈0．01）。大鼠烫伤延迟复苏后淋巴细胞凋亡率在整个观察期与对照组比较均增高（P〈0．01）。给予卡巴胆碱后在6h、1、2和3d时间点与单纯烫伤组比较可见凋亡明显下降（P〈0．05）。烧伤延迟复苏后大鼠血浆TNF-α和IL-6与正常对照组比较明显升高（P〈0．01）,应用卡巴胆碱后可见6h、1、2和3d时间点TNFα和IL-6含量与单纯烧伤组比较明显降低（P〈0．01）。结论烧伤延迟复苏后,单核细胞Ia抗原表达率降低,淋巴细胞凋亡率增加,促炎细胞因子增加,免疫功能障碍。卡巴胆碱可提高烫伤延迟复苏大鼠的免疫功能。     

白细胞介素-13对成年人支气管哮喘的影响

目的通过检测白细胞介素（IL）-13浓度及其变化，探讨它在成人支气管哮喘（哮喘）发病机制中的意义，同时检测IL-10、肿瘤坏死因子（TNF）-α浓度，探讨它们与IL-13的相互关系。方法以31例哮喘患者（哮喘组）及9例健康者（对照组）作为研究对象。采集诱导痰及外周血标本，制作成涂片进行细胞学分析；用酶联免疫吸附法测定IL-13、TNF-α及IL-10浓度。结果哮喘组血清IL-13浓度高于对照组[分别为（89．88±36．75）ng／L和（27．03±12．19）ng／L，P〈0．01]，诱导痰中浓度也高于对照组[分别为（69．14±24．48）ng／L和（18．74±8．87）ng／L，P〈0．01]，且血清中的浓度高于诱导痰中的浓度（P〈0．05）；激素使用患者诱导痰中浓度比非激素使用患者低（P〈0．05），诱导痰中IL-13浓度与嗜酸粒细胞百分比呈显著正相关（r=0．54，P〈0．05）。哮喘组诱导痰中TNF-α及IL-10浓度均较对照组高[TNF-α分别为（66．32±18．74）ng／L和（5．36±6．86）ng／L，P〈0．01；IL-10分别为（118．08±55．17）ng／L和（5．66±8．03）ng／L，P〈0．05]。哮喘组中，发作期诱导痰中IL-10浓度高于稳定期浓度（P〈0．05）。轻度哮喘患者诱导痰中TNF-α浓度与重度哮喘患者比较差异有统计学意义（P〈0．05）。结论IL-13是与哮喘发病病理过程相关的细胞因子，与嗜酸粒细胞的活动关系密切，参与哮喘气道炎性反应及气道高反应性的发生，哮喘患者在激素治疗后其浓度降低。     

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.