男性迟发性性腺功能减退症与性功能障碍

男性迟发性性腺功能减退症(LOH)是一种与年龄相关的、具有典型临床症状和血清睾酮水平低下(低于健康年轻成年男性推荐范围)的综合征,性功能障碍是LOH患者最常见症状之一.中老年男性性功能障碍的致病因素复杂,而睾酮缺乏是其中的重要因素.血清睾酮水平低下在LOH的发病机制中具有重要意义,睾酮补充治疗(TST)可在一定程度上改...     

TRT在ED合并LOH患者中应用的研究进展

男性迟发性性腺功能减退症(LOH)是一种与年龄相关的、具有典型临床症状和血清睾酮水平低下的综合征,勃起功能障碍(ED)是LOH患者最常见症状之一.中老年男性ED的致病因素复杂,而睾酮缺乏是其中的重要因素.睾酮在阴茎勃起的生理生化方面起着重要的作用.睾酮替代治疗(TRT)联合磷酸二酯酶5型抑制剂能提高磷酸二酯酶5型抑制剂单一治疗ED合并LOH失败患者的性功能.     

男性迟发性性腺功能减退的检测与治疗

男性迟发性性腺功能减退,多见于中老年人,是与年龄相关的睾酮缺乏综合征。其特点为血清睾酮水平降低,对性功能以及机体多器官、多系统都可产生不利影响。我国由于传统文化观念,许多老年男性不认为性功能障碍是一种疾病,甚至主动放弃性活动。上海市社区男性(平均年龄61.9岁)抽样调查发现,37.6%男性因传统观念的影响。     

我国中老年男性血清生殖激素水平相关研究

目前中国已经进入老龄化社会,中老年男性生殖健康问题日益引起广泛关注.中老年男性的雄激素水平低下往往因多种机制影响睾酮(T)的正常分泌和生物活性,是多种因素同时存在和共同作用的结果[1,2].欧洲一项在8个中心对3 369例中老年男性进行的横断面研究中,将迟发型性腺功能低下(LOH)分为3种类型,即原发性、继发性和代偿性.     

老年男性冠心病患者性激素水平与心室重构相关性研究

目的探讨老年男性冠心病患者性激素水平与心室重构相关性。方法选择老年男性冠心病患者145例,分为迟发性性腺功能减退(LOH)组及非LOH组,分别有72、73例;选择健康老年男性60例为对照组。对各组性激素水平、心肌重构相关指标进行监测并比较。结果 LOH组T及T/E2较对照组及非LOH组均有显著性下降(P0.05),非LOH组T及T/E2较对照组均有显著性下降(P0.05)。LOH组基质金属蛋白酶2(MMP-2)、金属蛋白酶2组织抑制剂(TIMP-2)、MMP-2/TIMP-2较对照组及非LOH组均有显著性差异(P0.05),非LOH组MMP-2、TIMP-2、MMP-2/TIMP-2较对照组均有显著性差异(P0.05)。T及T/E2与MMP-2、TIMP-2、MMP-2/TIMP-2显著相关(P0.05)。结论老年男性睾酮水平下降是导致冠心病心肌重构重要因素。     

男性迟发性性腺功能减退症的雄激素补充治疗

迟发性性腺功能减退症(late-onsethypogonadism,LOH)主要依据临床表现和血清生物睾酮水平进行诊断。由于靶器官敏感性不同造成血清睾酮水平存在很大的个体差异。2009年,中国雄激素治疗委员会参照国内外LOH指南,讨论后推荐睾酮补充治疗(TST)标准如下。TST原则     

雄激素足，才能“雄起”

有部分中老年男性的性功能障碍,是由体内睾酮雄激素水平偏低导致的。专家建议,在医生指导下适量补充雄激素,可明显改善症状。     

胰岛素样因子3应用于男性迟发性性腺功能减退诊断的可行性研究

目的分析胰岛素样因子3(insulin like factor 3,INSL 3)应用于男性迟发性性腺功能减退(late onset hypogonadism,LOH)诊断的可行性。方法选取中老年男性,间隔1个月抽取空腹晨血2次,分析INSL 3在血清中的平均浓度及其稳定性;依据男性LOH的诊断标准,分析患者组与正常对照组之间血清中INSL 3的浓度是否存在差异。结果接受重复抽血的中老年男性44人,血清INSL 3的浓度均值为(1.86±0.64)ng/m L,经过1个月的间隔期血清中INSL 3的浓度变化差异无统计学意义(P0.05)。在患者组与正常对照组之间血清中INSL 3的浓度差异有统计学意义(P0.05)。进一步研究发现血清INSL 3浓度与促黄体生成素(luteotropic hormone,LH)、总睾酮、游离睾酮之间存在相关性(P0.05),而与绝育术、烟酒、糖尿病、高血压、冠心病、体质量指数和中老年男性症状量表(aging males’symptoms scale,AMS)评分之间无相关性(P0.05)。结论初步研究提示血清INSL 3与男性性腺功能状态紧密相关且表达稳定,有望用于LOH的诊断。     

上海某社区男性迟发性性腺功能减退症的调查和研究

目的调查上海某社区男性迟发性性腺功能减退症(LOH)的流行病学情况。方法 2014年6月—2015年5月在上海某社区采用年龄分层抽样选取1 138例40~80岁的中老年男性进行中老年男子雄激素缺乏(ADAM)、老年男子症状(AMS)和国际勃起功能问卷-5(IIEF-5)调查,同时测定血清中总睾酮(TT)水平。结果研究对象年龄(58.91±8.76)岁,ADAM及AMS筛查LOH的患病率分别为64.85%和22.67%;ED阳性率为70.04%。TT水平各年龄组之间比较,差异无统计学意义(P0.05)。血压、空腹血糖、血脂在TT正常值分界组别之间差异有统计学意义(P0.05)。结论该社区中老年男性LOH筛查率较国内其他报告(特别是大中城市)LOH筛查率、ED患病率接近。     

双酚A日常生活暴露与生殖中心就诊男性性功能关系的研究

目的 探讨双酚A（BPA）日常生活暴露与男性性功能的关系。方法 选取2014年9月至2015年4月在山西省妇幼保健院生殖中心门诊部因不孕不育就诊的男性作为研究对象,收集其一般人口学特征、性功能状况资料和空腹静脉血标本。应用德尔菲专家评分法计算性功能总得分,采用高效液相色谱法测定研究对象血清BPA水平。采用Spearman秩相关、秩和检验,多因素logistic回归分析进行BPA水平、影响因素、性功能指标之间的关联性及趋势分析。结果 共纳入353名研究对象,总体性功能异常率为45.0%,性欲低下（47.3%）为性功能异常的主要类型。研究对象血清BPA浓度范围为0.38~21.93 ng/ml,中位数5.79 ng/ml。血清BPA水平与总体性功能、性欲、勃起能力、射精力度均呈负相关,与早泄呈正相关。按BPA水平的四分位数分组,以低浓度组（0.38~3.79 ng/ml）为参照进行关联性分析,发现BPA水平增高可增加性功能障碍的发生风险。结论 性欲低下是男性性功能障碍的主要类型,日常暴露于较高水平的BPA可能增加男性性功能障碍。     

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.