肝乐宁联合拉米夫定治疗慢性乙型肝炎的临床研究

目的探讨肝乐宁联合拉米夫定治疗慢性乙肝的临床疗效.方法治疗组31例慢性乙肝病人每日静脉输入肝乐宁100 mg,对照组34例每日静脉输入甘草酸二铵150 mg,输液治疗30 d,两组均口服降酶保肝药和拉米夫定100 mg/d,疗程30 d.结果 30 d后,治疗组ALT复常率达90.3%,对照组只有52.9%,两者差异有显著性(P<0.01),治疗组白蛋白含量上升,1～2 g/L, HBeAg阴转率(7.8%)略高于对照组.结论肝乐宁联合拉米夫定即能明显改善肝脏功能,减少纤维化,又能有效地抑制HBVONA的复制,能使受损的肝脏得到尽快的恢复,我们认为此方案效果比较理想.     

甘草酸二铵与异甘草酸镁治疗慢性乙型肝炎疗效对比研究

目的：观察异甘草酸镁注射液治疗慢性乙型肝炎的临床疗效。方法：80例慢性乙型肝炎患者,随机分为治疗组和对照组。治疗组40例,应用异甘草酸镁注射液100mg,加入10％葡萄糖注射液250ml中静脉点滴,疗程30d。对照组40例,应用甘草酸二铵注射液150mg,加入10％葡萄糖注射液250ml中静脉点滴,疗程30d。结果：治疗组患者症状、体征的恢复以及丙氨酸氨基转移酶（ALT）、天门冬氨酸转氨酶（AST）、血清胆红素（SB）的恢复速度治疗组明显优于对照组（P〈0．05）。结论：异甘草酸镁治疗慢性乙型肝炎在改善临床症状和肝功能指标方面优于甘草酸二铵。     

甲氨喋呤（MTX）联合复方甘草酸铵治疗中重度银屑病

目的观察甲氨喋呤（MTX）联合复方甘草酸铵治疗中重度银屑病的临床疗效及安全性。方法65例患者随机分为2组。治疗组35例,每周MTX5～15mg静脉滴注1次,共12次,同时给予复方甘草酸铵注射液40ml,每日一次,静脉滴注;对照组30例,每周MTX5～15mg静脉滴注1次,共12次。结果治疗组有效率为77．1％,对照组为53．3％,两组差异有显著性（P〈0．05）。两组均未见严重不良反应。结论甲氨喋呤联合复方甘草酸铵治疗中重度银屑病安全有效。     

左卡尼汀联合甘草酸二铵治疗非酒精性脂肪肝46例疗效观察

目的：观察左卡尼汀联合甘草酸二铵治疗非酒精性脂肪肝的疗效。方法：选取非酒精性脂肪肝患者92例随机分为两组,试验组给予甘草酸二铵注射液150mg及左卡尼汀注射液2．0g静滴,对照组给予甘草酸二铵注射液150mg静滴,均1次／d,连用3周。结果：3周后两组病例ALT、AST均显著下降,但比较差异无统计学意义（P〉0．05）。试验组治疗3周后TG和TC较治疗前显著下降,比较差异无统计学意义（P〈0．01）。对照组治疗3周后TG和TC较治疗前无明显下降。结论：左卡尼汀联合甘草酸二铵治疗非酒精性脂肪肝,有保肝、降酶作用,达到治疗非酒精性脂肪肝的目的。     

甘草酸二铵预防HBV携带者抗结核治疗致肝损害的临床研究

目的 探讨甘草酸二铵预防HBV携带者服用抗结核药物致肝功能损害的临床疗效.方法 89例抗结核治疗的HBV携带者随机分为对照组41例和甘草酸二铵组48例,两组患者均给予2HRZE/4HR抗结核治疗,对照组加服维生素C片0.2 g,1日3次;甘草酸二铵组加服甘草酸二铵胶囊150 mg,1日3次;监测、比较两组患者的肝功能.结果 甘草酸二铵组肝功能损害的发生率为12.5%,而对照组为31.7%,两组差异有统计学意义（P〈0.05）;抗结核治疗后甘草酸二铵组的肝功能明显优于对照组（P〈0.05）.结论 甘草酸二铵能明显减少HBV携带者服用抗结核药物致肝功能损害的发生,而且具有良好的安全性.     

思美泰联合甘草酸二铵治疗非酒精性脂肪性肝炎

目的评价思美泰联合甘草酸二铵治疗非酒精性脂肪性肝炎（NASH）的疗效。方法80例NASH患者均分为2组。治疗组40例,予以思美泰（初始治疗：使用注射用丁二磺酸腺苷蛋氨酸,每天1000mg,静脉注射,共2周;维持治疗：使用丁二磺酸腺苷蛋氨酸肠溶片,每天1000mg口服,共22周）,同时给予甘草酸二铵肠溶片（天晴甘平）150mg,3次／d,共24周;对照组40例,予以甘草酸二铵肠溶片（天晴甘平）150mg,37欠／d,共24周。所有患者均禁酒,改善饮食结构,进行中等量的有氧运动,控制体重。结果治疗后两组临床症状、肝功能较治疗前均有明显改善（均P〈0．05）,B超提示脂肪肝程度减轻。其中乏力、纳差等症状改善情况和甘油三酯下降程度治疗组优于对照组（P均〈0．05）。治疗组无明显不良反应。结论在控制饮食及加强运动等基础上,联合思美泰和甘草酸二铵治疗,能有效改善NASH患者临床症状和肝功能情况,降低肝脂肪化,值得进一步推广。     

五酯胶囊联合复方甘草酸苷治疗非酒精性脂肪肝效果观察

目的观察五酯胶囊联合复方甘草酸苷治疗非酒精性脂肪肝的效果。方法 80例患者随机分为治疗组和对照组各40例,治疗组用五酯胶囊22.5mg口服,3次/d,联合注射用复方甘草酸苷120mg加入10%葡萄糖250mL静滴,1次/d;对照组注射用复方甘草酸苷120mg加入10%葡萄糖250mL静滴,1次/d,3周为1个疗程。观察治疗前及治疗后两组症状和肝功能指标(ALT、AST、GGT)变化,评价两组临床疗效,并比较不良反应发生情况。结果治疗组总有效率90.0%(36/40)高于对照组的70.0%(28/40);治疗组和对照组治疗后ALT、AST、GGT均低于治疗前,且治疗组治疗后ALT、AST、GGT改善情况均优于对照组;治疗组与对照组均未见明显不良反应,无血常规、尿常规方面改变,未见皮疹、过敏及心、肝、肾等脏器不良反应。结论五酯胶囊联合注射用复方甘草酸苷治疗非酒精性脂肪肝临床疗效明显,能显著改善肝功能,提高临床综合疗效。     

大剂量甘草酸二铵治疗顽固性转氨酶异常的慢性肝炎疗效观察

目的:观察大剂量甘草酸二铵治疗以顽固性转氨酶异常为主的慢性肝炎的疗效.方法:80例慢性肝炎病人随机分成二组,在基础治疗之上对照组应用甘草酸二铵250mg/d,治疗组应用甘草酸二铵500mg/d,疗程4周. 结果:治疗后对二组患者的谷丙转氨酶水平和复常率恢复情况进行比较,治疗组的谷丙转氨酶较对照组有明显下降,差异有显著意义(t＝7.98, P<0.001).复常率也显著高于对照组(X2 ＝16.97,P<0.001). 结论:大剂量甘草酸二铵对以顽固性转氨酶异常为主的慢性肝炎有较好的疗效.     

多烯磷脂酰胆碱联合甘草酸二铵在HIV/AIDS患者HAART肝损害治疗中的临床研究

目的探讨多烯磷脂酰胆碱联合甘草酸二铵治疗HAART肝损害的临床疗效。方法将62例药物性肝炎患者随机分为2组,每组各31例,对照组单用甘草酸二铵胶囊,实验组在对照组基础上加用多烯磷脂酰胆碱胶囊,比较两组临床治疗效果。结果 2组治疗后AST、ALT、TBIL、GGT水平均较治疗前降低,实验组降低更为明显,2组差异均有统计学意义(P值均0.05)。结论多烯磷脂酰胆碱胶囊联合甘草酸二铵胶囊治疗HAART肝损害疗效确切,可促进患者肝功能恢复,具有较好的临床应用价值。     

复方甘草酸铵联合西替利嗪和氯雷他定治疗慢性荨麻疹临床疗效观察

目的观察复方甘草酸铵联合氯雷他定片、西替利嗪治疗慢性荨麻疹的疗效。方法选择门诊慢性荨麻疹患者80例,随机分为两组,治疗组42人,治疗组早上饭前口服氯雷他定10 mg、晚上睡前口服西替利嗪10mg,复方甘草酸铵40 mL、10%氯化钾5 mL加入250 mL葡萄糖中静滴,每天一次;对照组38人,早上饭前口服氯雷他定10 mg、晚上睡前口服西替利嗪10 mg,3周后观察疗效。结果治疗组有效率83.33%,对照组有效率57.90%,有统计学差异(P<0.05)。结论复方甘草酸铵联合氯雷他定片、西替利嗪片治疗慢性荨麻疹疗效优于口服氯雷他定、西替利嗪,疗效好,复发率降低,且无明显不良反应。     

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.