不同剂量重组人粒细胞集落刺激因子对晚期卵巢癌化疗后骨髓抑制继发感染的预防

目的探讨临床推荐重组人粒细胞集落刺激因子(rhG-CSF)的低剂量和高剂量使用,对晚期卵巢癌化疗后防治骨髓抑制引起的白细胞和中性粒细胞减少的作用。方法将113例晚期卵巢癌肿瘤减灭术后行TP静脉化疗方案的患者分为rhG-CSF低剂量组45例,予50μg/d,共240个化疗疗程;rhG-CSF高剂量组43例,予150μg/d,共232个化疗疗程;对照组25例,未使用rhG-CSF,共135个化疗疗程;观察化疗后白细胞及中性粒细胞动态变化及不良反应。结果化疗后第11天,rhG-CSF低剂量组和rhG-CSF高剂量组均出现白细胞计数平均最低值,而对照组则在化疗后第9天出现白细胞计数平均最低值;rhG-CSF低剂量组、rhG-CSF高剂量组、对照组的白细胞计数平均最低值分别为1.07×109/L、0.93×109/L和1.70×109/L,使用rhG-CSF后未见严重的不良反应。结论无论是低剂量还是高剂量使用rhG-CSF,均可在短时间内有效恢复晚期卵巢癌化疗后白细胞和中性粒细胞的水平,减少感染的发生。     

丁胺卡那霉素引起一过性白细胞减少2例

1病历摘要 例1,刘某,女,55岁,因化脓性阑尾炎于2009年4月12日入院.实验室检查白细胞数16.8×109/L,中性粒细胞0.90,淋巴细胞0.11,给予青霉素1280万U/d,丁胺卡那霉素0.6g/d分别静滴,连用5日,发生全身瘙痒、皮疹,白细胞数3.0×109/L中性粒细胞0.78,淋巴细胞0.22,即停药.24h复查,白细胞数5.6×109/L,中性粒细胞0.66,淋巴细胞0.34,48h后白细胞数6.9×109,中性粒细胞0.76,淋巴细胞0.24,以后连续查多次均正常.     

慢性苯中毒与假性白细胞减少症的相关性研究

目的研究慢性轻度苯中毒(白细胞减少症)患者对肾上腺素试验、泼尼松试验反应及其血象变化特征。方法以43例骨髓象正常的慢性轻度苯中毒(白细胞减少症)患者作为苯中毒组,根据其性别、年龄匹配对照组。分别采集苯中毒组与对照组血样进行肾上腺素试验、泼尼松试验前后的血常规检查,并采用C2检验、t检验分析其试验阳性率、试验前后差值及增加率。结果肾上腺素试验:与对照组相比,苯中毒组肾上腺素试验阳性率(9.3%vs.80%,P0.001)及试验前后白细胞(1.18×109/L vs.2.39×109/L,P0.001)、中性粒细胞(0.43×109/L vs.1.25×109/L,P0.001)、淋巴细胞(0.34×109/L vs.1.02×109/L,P0.001)差值均低;而两组均有淋巴细胞增高现象。泼尼松试验:与对照组相比,苯中毒组泼尼松试验阳性率较低(47.05%vs.86.36%,P0.05),试验前后白细胞(2.04×109/L vs.3.22×109/L,P0.05)、中性粒细胞(2.80×109/L vs.3.66×109/L,P0.05)及淋巴细胞(-0.19×109/L vs.-0.42×109/L,P0.05)差值绝对值低;而两组细胞增加比率相似(57.2%vs.53.9%,P0.05),其中以中性粒细胞增高为主,淋巴细胞呈现负增长。结论苯中毒所致白细胞减少症可能与骨髓造血减少有关,而非白细胞分布异常及贮存池中成熟粒细胞释放障碍。     

临床执业医师资格考试试题(5)

1.男性,20岁,原发性肾病综合征患者,首次治疗,每日用泼尼松60 mg,3周后尿蛋白仍为( ),此时应A.改为地塞米松B.将泼尼松加量到80 mg/日C.改用环磷酰胺D.用原量继续观察E.减少泼尼松量到40 mg/日,加用免疫抑制剂2.男性,38岁,1月来乏力、食欲差,左上腹胀痛。查体:肝肋下3 cm,脾肋下10 cm,血红蛋白70g/L,白细胞260×109/L,血小板210×109/L,白细胞分类:中性粒及晚幼粒细胞为主,中性粒细胞碱性磷酸酶活性减低,首选治疗A.羟基尿B.三代头孢C.脾切除D.DA方案E.保肝治疗3.男性,16岁,3天来左膝关节肿胀。自幼于外伤后易出血不止。查体:皮肤粘…     

重组人粒细胞刺激因子对胃癌化疗患者化疗期感染及免疫功能的影响

目的探讨重组人粒细胞刺激因子对胃癌化疗患者化疗期感染及免疫功能的影响,为胃癌化疗患者化疗期感染的预防提供参考。方法选取2015年1月-2016年12月医院诊断为胃癌行化疗治疗的200例患者,将患者随机分为对照组与观察组,每组各100例,对照组在白细胞计数(WBC)<4×109/L时开始给予重组人粒细胞刺激因子皮下注射,观察组在化疗结束后24h时开始给予重组人粒细胞刺激因子皮下注射;观察患者化疗期感染发生情况,化疗期WBC最低值、粒细胞最低值、WBC低于正常值维持天数,化疗前后(2个化疗周期结束)CD_3~+、CD_4~+、CD_8~+、CD_4~+/CD_8~+、NK细胞水平。结果对照组化疗期发生感染者25例,感染率为25.00%,观察组化疗期发生感染者12例,感染率为12.00%,观察组感染率低于对照组,差异有统计学意义(P<0.05);观察组化疗期WBC最低值、粒细胞最低值分别为(3.48±0.64)×10~9/L、(2.69±0.60)×109/L,高于对照组(3.15±0.72)×10~9/L、(1.95±0.56)×109/L,WBC低于正常值维持天数为(3.12±1.08)d,短于对照组(3.69±1.12)d,两组比较差异有统计学意义(P<0.05);两组患者化疗前CD_3~+、CD_4~+、CD_8~+、CD_4~+/CD_8~+、NK细胞水平比较差异无统计学意义,化疗后低于化疗前(P<0.05),化疗后CD_3~+、CD_4~+、CD_4~+/CD_8~+、NK细胞水平观察组高于对照组,差异有统计学意义(P<0.05),CD_8~+低于观察组(P<0.05)。结论胃癌化疗患者在化疗后应用重组人粒细胞刺激因子能降低化疗期感染率,改善患者免疫功能,化疗后早期预防用药较WBC下降后再用药更为适宜。     

重组人粒细胞刺激因子对胃癌化疗感染和细胞免疫的影响

目的探讨重组人粒细胞刺激因子对胃癌化疗感染和细胞免疫的影响。方法随机选取2016年3月-2018年3月医院收治的80例诊断为胃癌行化疗治疗的患者。采用随机数字表法均分为两组,各40例。观察组40例在化疗结束后24h时开始重组人粒细胞刺激因子皮下注射。对照组40例患者在白细胞计数4×109/L时开始重组人粒细胞刺激因子皮下注射,统计80例患者化疗期感染率的控制情况。结果观察组40例患者化疗期感染率的控制情况明显优于对照组,对比差异有统计学意义(P<0.05)。两组80例患者免疫功能都得到了明显改善,其中观察组40例患者免疫功能改善程度明显优于对照组,对比差异有统计学意义(P<0.05)。观察组患者在治疗后白细胞最低值、中性粒细胞最低值等与对照组对比差异有统计学意义(P<0.05)。结论在胃癌患者皮下注射重组人粒细胞刺激因子对化疗期间感染率具有良好的控制作用,对改善白细胞最低值、粒细胞最低值、缩短白细胞低于正常值维持天数有一定的改善作用。     

重症监护病房患者中性粒细胞VCS参数检测的临床意义

目的研究重症监护病房患者感染后中性粒细胞细胞体积(V)、电导率(C)、激光散射(S)参数的变化。方法利用Beckman-Coulter LH750血球仪分别检测98例重症监护病房患者和40例对照组白细胞(WBC)、中性粒细胞(ANC)及其VCS参数:中性粒细胞平均体积(MNV)、中性粒细胞体积分布宽度(NDW)、中性粒细胞平均传导率(MNC)、中性粒细胞平均散射值(MNS),将98例患者根据微生物鉴定结果分为感染组和非感染组。结果感染组患者WBC(12.33±5.39)×109/L、ANC(10.04±5.17)×109/L及其VCS(MNV:157±18,NDW:24.38±4.18,MNC:136±12,MNS:137±11)参数与非感染组〔WBC:(8.71±4.22)×109/L,ANC:(6.79±4.50)×109/L,MNV:151±13,NDW:20.47±3.29,MNC:140±11,MNS:141±12〕、对照组〔WBC:(5.87±3.68)×109/L,ANC:(3.89±2.64)×109/L,MNV:144±8,NDW:18.61±1.39,MNC:144±8,MNS:145±9〕比较差异有统计学意义;非感染组患者WBC、ANC及其MNV、NDW参数与对照组比较差异有学意义;感染组患者经治疗后,细菌再培养阴性组VCS参数MNV(151±15,145±11)、NDW(22.48±3.65,19.31±3.29)与阳性组差异有统计学意义;MNV、NDW参数在感染诊断中要明显优于白细胞、中性粒细胞。结论中性粒细胞VCS参数是反应患者细菌感染的敏感指标。     

地塞米松足三里穴位注射治疗恶性肿瘤化疗后白细胞减少的疗效观察

目的 观察地塞米松足三里穴位注射治疗恶性肿瘤化疗后白细胞减少的疗效.方法 将60例中、晚恶性肿瘤化疗后发生白细胞减少的患者随机分为治疗组及对照组各30例,治疗组在对照组治疗基础上加用地塞米松足三里穴位注射.结果 治疗组治疗后第1、3、5、7天白细胞计数分别为(2.20±0.49)×109/L、(3.55±0.57)×109/L、(4.94 ±0.36)×109/L、(5.79±0.44)×109/L,而对照组分别为(1.97±0.26)×109/L、(2.30 ±0.46)×109/L、(3.02 ±0.37)×109/L、(3.68 ±0.25)×109/L;且治疗组治疗后第1、3、5、7天白细胞减少例数明显少于对照组;治疗组白细胞减少恢复正常的平均天数为4.13d,而对照组为6.04d.结论 地塞米松足三里穴位注射能有效恢复恶性肿瘤化疗后白细胞减少,且无明显不良反应,值得临床推广应用.     

重组人粒细胞刺激因子对胃癌化疗患者化疗期感染及免疫功能的影响北大核心CSCD

目的探讨重组人粒细胞刺激因子对胃癌化疗患者化疗期感染及免疫功能的影响,为胃癌化疗患者化疗期感染的预防提供参考。方法选取2015年1月-2016年12月医院诊断为胃癌行化疗治疗的200例患者,将患者随机分为对照组与观察组,每组各100例,对照组在白细胞计数(WBC)<4×109/L时开始给予重组人粒细胞刺激因子皮下注射,观察组在化疗结束后24h时开始给予重组人粒细胞刺激因子皮下注射;观察患者化疗期感染发生情况,化疗期WBC最低值、粒细胞最低值、WBC低于正常值维持天数,化疗前后(2个化疗周期结束)CD_3^+、CD_4^+、CD_8^+、CD_4^+/CD_8^+、NK细胞水平。结果对照组化疗期发生感染者25例,感染率为25.00%,观察组化疗期发生感染者12例,感染率为12.00%,观察组感染率低于对照组,差异有统计学意义(P<0.05);观察组化疗期WBC最低值、粒细胞最低值分别为(3.48±0.64)×10~9/L、(2.69±0.60)×109/L,高于对照组(3.15±0.72)×10~9/L、(1.95±0.56)×109/L,WBC低于正常值维持天数为(3.12±1.08)d,短于对照组(3.69±1.12)d,两组比较差异有统计学意义(P<0.05);两组患者化疗前CD_3^+、CD_4^+、CD_8^+、CD_4^+/CD_8^+、NK细胞水平比较差异无统计学意义,化疗后低于化疗前(P<0.05),化疗后CD_3^+、CD_4^+、CD_4^+/CD_8^+、NK细胞水平观察组高于对照组,差异有统计学意义(P<0.05),CD_8^+低于观察组(P<0.05)。结论胃癌化疗患者在化疗后应用重组人粒细胞刺激因子能降低化疗期感染率,改善患者免疫功能,化疗后早期预防用药较WBC下降后再用药更为适宜。     

重组人粒细胞集落刺激因子联合伊曲康唑治疗血液病患者侵袭性真菌感染的临床研究

目的观察分析重组人粒细胞集落刺激因子联合伊曲康唑胶囊治疗血液病中性粒细胞缺乏患者院内侵袭性真菌感染的临床治疗效果。方法选取从2012年3月-2013年3月收治的血液病中性粒细胞缺乏发生侵袭性真菌感染患者共52例,将其随机分为观察组和对照组各26例,观察组患者采用重组人粒细胞集落刺激因子联合伊曲康唑作为主要的治疗方案,对照组患者单纯采用伊曲康唑治疗侵袭性真菌感染。结果患者治疗有效率观察组为76.9%,明显要高于对照组的42.3%,两组患者比较差异有统计学意义(P<0.05);观察组患者的白细胞计数和中性粒细胞计数在治疗后均提高,分别为(2.92±0.30)×109/L和(1.52±0.21)×109/L,明显要高于对照组患者(2.27±0.28)×109/L和(1.09±0.29)×109/L;两组中性粒细胞100~500/mm3患者治疗有效率均明显高于<100/mm3患者,差异有统计学意义(P<0.05)。结论重组人粒细胞集落刺激因子联合伊曲康唑治疗血液病患者院内侵袭性真菌感染能取得满意的临床治疗效果,并有利于提高患者中性粒细胞和白细胞计数。     

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.     

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.     

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.