胰岛素抵抗与急性脑梗死神经功能缺损严重程度的相关性研究

目的 探讨胰岛素抵抗(Insulin Resistance,IR)与急性脑梗死患者神经功能缺损的严重程度是否相关.方法 选取急性脑梗死患者75例,按神经功能缺损评分标准将其分为神经功能缺损轻型组和中重型组,其中轻型组37例,中重型组38例.两组分别检测空腹血糖(FPG)、空腹血清胰岛素(FINS)、纤维蛋白原(FIB)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL)、高密度脂蛋白胆固醇(HDL)、载脂蛋白A蛋白(ApoA)、载脂蛋白B蛋白(ApoB)、尿酸(UA),计算体重指数(BMI)、胰岛素敏感指数(ISI)、胰岛素抵抗指数(HOMA-IR).结果 急性脑梗死神经功能缺损中重型组中FPG、FINS、HOMA-IR为(5.41±0.46) mmol/l、(13.30±1.61) μ/IU/L、0.50±0.26高于轻型组(5.07±0.57) mmol/l、(9.38±2.79) μ/IU/L、0.28±0.11,比较差异有统计学意义(P＜0.05).ISI中重型组(-1.85±0.26)低于轻型组(-1.63±0.10),比较差异有统计学意义(P＜0.05).急性脑梗死患者神经功能缺损程度与ISI呈显著负相关(r=-0.651,P＜0.05).结论 急性脑梗死神经功能缺损中重型组较轻型组存在更严重的IR,并且IR程度与神经功能缺损的严重程度呈正相关.FINS、ISI、FPG是急性脑梗死神经功能缺损中重型发生的危险因素.     

鼠神经生长因子治疗急性脑梗死的临床对照研究

目的 观察鼠神经生长因子治疗急性脑梗死的临床疗效.方法 将140例急性脑梗死患者按人院日期分为治疗组和对照组各70例.对照组给予常规脑梗死治疗方案;治疗组在此基础上加用鼠神经生长因子,30 μg/次/d,共4周.记录治疗前后两组患者的神经功能缺损评分及治疗效果.结果 治疗组总有效率为85.7％,对照组为50.0％,差异具有统计学意义(x2=5.26,P＜0.05).治疗组治疗前后神经功能缺损评分差值高于对照组[(4.87±3.15)分vs (2.98 ±2.83)分,t=2.27,P＜0.05].结论 鼠神经生长因子能有效减少急性脑梗死患者的神经功能缺损,不良反应少,是一种安全有效的治疗急性脑梗死的药物.     

丁苯酞联合依达拉奉治疗急性脑梗死的临床疗效观察

目的 探讨丁苯酞联合依达拉奉治疗急性脑梗死的临床疗效.方法 选取60例急性脑梗死患者按随机数字表法分为治疗组和对照组,每组30例.两组在改善微循环及抗血小板聚集等常规治疗的基础上,治疗组予以丁苯酞联合依达拉奉治疗,对照组单纯应用依达拉奉治疗,疗程14d.两组在治疗前后分别进行神经功能缺损程度评分、日常生活活动能力评分(改良Barthel指数)及血液流变学检测,并进行比较.结果 治疗前两组神经功能缺损程度评分、日常生活活动能力评分比较差异无统计学意义(P＞0.05).治疗后治疗组和对照组神经功能缺损程度评分均显著下降、日常生活活动能力评分均显著升高(P＜0.01),且治疗后治疗组神经功能缺损程度评分显著低于对照组[(14.13±1.15)分比(17.16±1.08)分](P＜0.01),日常生活活动能力评分显著高于对照组[(62.83±10.14)分比(58.02±9.99)分](P＜0.01).治疗组治疗后的全血黏度、血浆黏度、红细胞压积均较治疗前显著降低(P＜0.01或＜0.05);对照组上述指标治疗前后比较差异无统计学意义(P＞0.05).结论 丁苯酞联合依达拉奉治疗急性脑梗死对神经功能、日常生活活动能力及血液流变学改善效果显著.     

依达拉奉联合低分子量肝素钙治疗急性脑梗死的疗效观察及对血清C反应蛋白的影响

目的 观察依达拉奉联合低分子量肝素钙治疗急性脑梗死的疗效及对血清C反应蛋白(CRP)的影响.方法 82例急性脑梗死患者按随机数字表法分为两组,每组41例,观察组采用依达拉奉联合低分子量肝素钙治疗;对照组仅采用低分子量肝素钙治疗,比较两组的临床疗效及治疗前后神经功能缺损程度评分及血清CRP的变化.结果 观察组的总有效率为90.2％(37/41),明显高于对照组的70.7％(29/41),差异有统计学意义(P＜0.05).两组治疗后神经功能缺损程度评分均明显下降(P＜0.05).并且,观察组治疗后神经功能缺损程度评分明显低于同期对照组[(9.86±3.41)分比( 13.62±4.23)分](P＜0.05).观察组治疗后血清CRP水平明显下降(P＜0.05),并且明显低于同期对照组[(14.79±3.02) mg/L比(17.38±3.89) mg/L](P＜ 0.05),而对照组治疗前后血清CRP水平比较差异无统计学意义(P＞ 0.05).结论 依达拉奉联合低分子量肝素钙治疗急性脑梗死能够明显提高临床疗效,改善神经功能,减少炎性反应的发生,值得临床推广应用.     

依达拉奉治疗急性脑梗死的临床疗效观察

目的 探讨依达拉奉治疗急性脑梗死的临床疗效.方法 回顾性分析了我院收治的64例急性脑梗死的临床资料,随机将患者分成观察组和对照组,两组患者均给予常规综合治疗,观察组在此基础上给予依达拉奉治疗,比较两组治疗效果及神经功能缺损.结果 治疗14d后观察组神经功能缺损评分下降比对照组下降明显,差异有统计学意义(P＜0.05),观察组显效率和总有效率均高于对照组,差异有统计学意义(P＜0.05).结论 依达拉奉能有效改善急性脑梗死患者的神经功能缺损程度,是一种有效、安全的神经保护剂.     

依达拉奉在治疗糖尿病合并急性脑梗死中的临床研究

目的 观察依达拉奉在糖尿病合并急性脑梗死治疗中的疗效和安全性.方法 80例糖尿病合并急性脑梗死病人随机分为治疗组A40例和对照组40例.2组病例于治疗前,治疗后进行神经功能缺损评分.结果 治疗14d后,治疗组和对照组均较治疗前下降(均P＜0.05),但治疗组下降水平显著低于对照组,差异具有显著性(均P＜0.05).结论 依达拉奉治疗糖尿病急性脑梗死能明显提高显效率,改善神经功能,是治疗急性脑梗死的有效措施之一.     

苦碟子注射液治疗急性脑梗死64例临床观察

目的 观察苦碟子注射液治疗急性脑梗死的疗效.方法 132例急性脑梗死患者按随机数字表法分为两组,治疗组64例,用苦碟子注射液30ml加于0.9％氯化钠注射液250ml中静脉滴注,每日1次;对照组68例,用川芎嗪注射液120 mg加于0.9％氯化钠注射液250 ml中静脉滴注,每日1次.两组均酌情使用脱水剂、降血压药物及对其他伴发疾病进行治疗,但均不用其他扩张血管、抗凝以及活血化瘀药物,两组均治疗14d,比较两组的治疗效果.结果 治疗组总有效率为89.1％(57/64),对照组总有效率为77.9％(53/68),治疗组总有效率显著高于对照组(P＜ 0.05).两组治疗后神经功能缺损程度评分较治疗前均显著降低(P＜0.01),且治疗组治疗后神经功能缺损程度评分显著低于同期对照组(P＜0.05).治疗组治疗后高切黏度、低切黏度、血浆黏度及红细胞压积较治疗前显著降低,差异有统计学意义(P＜0.05).两组治疗后均未发生严重不良反应.结论 苦碟子注射液治疗急性脑梗死疗效显著,且无明显不良反应,是一种治疗急性脑梗死的良药.     

盐酸法舒地尔治疗急性脑梗死的临床疗效分析

目的 探索新型扩血管药盐酸法舒地尔治疗急性脑梗死的临床疗效.方法 选择急性脑梗死患者160例,按随机数字表法分为治疗组和对照组,每组80例.治疗组给予盐酸法舒地尔30mg+0.9%氯化钠100 ml静脉滴注,2次/d,对照组给予川芎嗪120mg+0.9%氯化钠250ml静脉滴注,2次/d,分别在入院时及治疗后2周对患者进行神经功能缺损程度评分,进行临床疗效判定.结果 两组治疗后神经功能缺损程度评分均较治疗前显著改善(P＜0.05或＜0.01),但是治疗组改善明显优于对照组(P＜0.01).对照组总有效率83.75%(67/80),治疗组总有效率91.25%(73/80),两组总有效率比较差异有统计学意义(P＜0.05).结论 盐酸法舒地尔可以有效改善脑梗死患者的临床预后,是治疗急性脑梗死安全有效的药物.     

盐酸法舒地尔治疗急性脑梗死的临床疗效分析

目的 探索新型扩血管药盐酸法舒地尔治疗急性脑梗死的临床疗效.方法 选择急性脑梗死患者160例,按随机数字表法分为治疗组和对照组,每组80例.治疗组给予盐酸法舒地尔30mg+0.9%氯化钠100 ml静脉滴注,2次/d,对照组给予川芎嗪120mg+0.9%氯化钠250ml静脉滴注,2次/d,分别在入院时及治疗后2周对患者进行神经功能缺损程度评分,进行临床疗效判定.结果 两组治疗后神经功能缺损程度评分均较治疗前显著改善(P＜0.05或＜0.01),但是治疗组改善明显优于对照组(P＜0.01).对照组总有效率83.75%(67/80),治疗组总有效率91.25%(73/80),两组总有效率比较差异有统计学意义(P＜0.05).结论 盐酸法舒地尔可以有效改善脑梗死患者的临床预后,是治疗急性脑梗死安全有效的药物.     

高压氧联合药物治疗脑梗死的效果观察

目的:探讨高压氧联合药物治疗脑梗死的效果.方法:将本院在2016年7月至2017年3月收治的66脑梗死患者随机分为治疗组和对照组,每组各33例,对照组均采取常规药物治疗,治疗组采取高压氧联合药物治疗,比较两组患者的临床疗效、神经功能缺损评分.结果:治疗组患者的临床治疗有效率(93.9%)要明显高于对照组(P<0.05),在治疗20天后,治疗组患者的神经功能缺损评分要明显低于对照组,差异显著(P<0.05).结论:对脑梗死患者采用高压氧联合药物治疗能明显降低脑卒中患者神经功能缺损程度,促进运动功能恢复,提高患者生活质量.     

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.