城乡地区新生儿维生素K营养状况的比较研究

新生儿、小婴儿发生出血的危险程度远远高于其他年龄阶段，维生素K是维持机体正常凝血功能的营养素，“机体的凝血功能状况”正逐渐被“机体的维生素K营养状况”所替代。凝血酶原前体蛋白（PIVKA－Ⅱ）是生化水平反映机维生素K营养状况指标，它能敏感地反映机体是否有亚临床维生素K缺乏。我们使用ELISA法对石家庄市及其周围县市的新生儿脐血进行了凝血酶原前体蛋白定量检测，以比较城乡新生儿出生时的维生素K营养状况。     

晚发型维生素K缺乏性出血患儿及其母亲维生素K营养状况的研究

【目的】以血清凝血酶原前体蛋白(PIVK-Ⅱ)来研究晚发型维生素K缺乏性出血(late vitamin K deficiencybleeding,LVKDB)患儿及其母亲维生素K营养状况,观察不同剂量维生素K对PIVKA-Ⅱ的影响。【方法】采用前瞻性研究方法,18例自2002年1月~2003年12月在沧州市中心医院住院的LVKDB患儿及其母亲组成观察组,患儿又分为5 mg和10 mg治疗组。20例同期住院的急性上呼吸道感染患儿及其母亲组成对照组。各组分别化验PIVKA-Ⅱ水平,观察组患儿在应用维生素K24 h3、d7、d三个时间检测。PIVKA-Ⅱ采用酶联免疫吸附试验方法。【结果】①应用维生素K24 h3、d、7 d观察组患儿PIVKA-Ⅱ水平高于对照组患儿(P<0.01);②观察组母亲PIVKA-Ⅱ水平与对照组母亲无差异(P>0.05);③观察组患儿维生素K 5 mg和10 mg治疗组血清PIVKA-Ⅱ水平无差异(P>0.05)。【结论】LVKDB患儿维生素K严重缺乏,而其母亲不存在维生素K不足,在LVKDB患儿治疗中没有必要应用大剂量维生素K。     

孕妇口服维生素K1改善新生儿维生素K营养状况

目的探索早期预防维生素K缺乏性出血的有效途径.方法通过孕妇口服维生素K1,观察能否改善其新生儿的维生素K营养状况.结果对照组新生儿骨钙蛋白未羧化率高于维生素K组(66.66%±18.20%和13.41%±11.96%,P＜0,001).对照组新生儿PIVKA-Ⅱ的阳性率为26.45%,而维生素K组PIVKA-Ⅱ阳性率降至0%(P＜0.001).结论让孕妇在分娩后期服用维生素K1可使其新生儿的维生素K营养状况得以改善,孕妇口服维生素K1是早期预防维生素K缺乏性出血的新途径.     

头孢菌素对儿童维生素K状况的影响及对策

【目的】通过血浆凝血酶原前体蛋白（PIVKA-Ⅱ）的测定,探讨第三代头孢菌素对儿童维生素K营养状况的影响。通过维生素K1预防性治疗,改善抗生素引起的维生素K缺乏状态。【方法】选择2005年10～12月间38例第三代头孢类抗生素治疗住院患儿,分为A组24例（抗生素治疗组）及B组14例（抗生素治疗＋维生素K1干预）。ELISA法测定血浆中PIVKA-Ⅱ。PIVKA-Ⅱ≥2μg/L为阳性（正常参考值〈2μg/L）。【结果】A组治疗前8例PIVKA-Ⅱ≥2μg/L,阳性率为33.33%,抗生素治疗后20例PIVKA-Ⅱ阳性,阳性率为83.33%（χ^2=12.343,P=0.001）。B组治疗前PIVKA-Ⅱ〉2μg/L者8例,阳性率为57.14%,使用维生素K1后全部转阴。【结论】第三代头孢菌素的应用引起小儿维生素K缺乏。抗生素治疗期间给予维生素K110 mg预防性治疗可改善维生素K缺乏状态。     

母亲口服维生素K_1预防婴儿维生素K缺乏出血症的研究

[目的 ]探讨乳母口服维生素K1 预防婴儿维生素K缺乏出血症 (VKDB)的效果。 [方法 ]干预组 9871名乳母自分娩后每 1 0天口服维生素K1 片 1 0mg直到满 3个月 ,未干预组 1 0 0 1 0人不服 ,均观察婴儿 6个月内的出血情况 ;同时小样本采集乳母初乳、1月乳、2月乳汁和婴儿的脐血、1个月、2个月静脉血分别测定维生素K1 和维生素K缺乏诱导蛋白 (PIVKA Ⅱ )含量。 [结果 ]干预组发生 1例VKDB ,未干预组发生 2 2例VKDB ;干预组母亲 1个月乳汁和 2个月乳汁中维生素K1 含量分别是未干预组的 3 5倍和 3倍 ,干预组婴儿 1个月外周血PIVKA Ⅱ阳性率和未干预组比较未表现出统计学差异。 [结论 ]母亲口服维生素K1 可明显提高母乳维生素K1 的含量 ,有效减少母乳喂养儿VKDB的发生     

孕妇使用Vit K1预防新生儿Vit K缺乏的研究

[目的] 探索预防早发性新生儿出血的有效方法. [方法] 将134例正常孕妇分为试验组和对照组,至分娩时,分别抽取母亲血和脐带血作血清Vit K1浓度测定及脐带血PIVKA-Ⅱ检测,并在新生儿出生后24小时内检测凝血像,进行统计学分析. [结果] 试验组孕妇血清Vit K1浓度明显高于对照组,试验组PIVKA-Ⅱ阳性较对照组显著降低. [结论] 正常妊娠晚期多次口服Vit K1可降低新生儿脐血PIVKA-Ⅱ阳性率,减少新生儿Vit K缺乏,对预防Vit K缺乏中的早发性新生儿出血有效.     

晚发性维生素K缺乏症20例临床分析

晚发性维生素K缺乏症是指新生儿晚期到婴儿期因维生素K摄入和吸收不足或因肝功能障碍，不能利用维生素K合成凝血酶原，导致维生素K依赖凝血因子活性低下，并能被维生素K所纠正的出血性疾病，以出生后1—3个月的母乳喂养儿多见。本文将我院儿科1994—2004年收治的20例晚发性维生素K缺乏症患儿20例分析如下。     

我国7省市新生儿维生素K缺乏诱导蛋白流行病学调查

目的：阐明我国7省市新生儿维生素K缺乏诱导蛋白水平以及维生素K缺乏流行病学状况。方法：采用ELISA法对我国7省市405例健康足月婴儿和142例早产婴儿脐血PIVK－Ⅱ进行测定。结果：（1）405例足月婴儿脐血PIVK－Ⅱ阳性率为44．7％（181／405），其中男婴为43．5％（93／214），女婴为46．1％（88／191）。142例早产婴儿脐血PIVK－Ⅱ为43．0％（61／142），其中男婴儿为45．3％（34／75），女婴为40．3％（27／40），二者性别无统计学意义。（2）城市和农村出生足月婴儿和早产婴儿脐血PIVK－Ⅱ阳性人群2－9mg/ml范围最多，亦占44．2％，但在＞200ng/ml极重度阳性亦占10．3％。（3）PIVK－Ⅱ阳性率随月龄增加而降低，但2月龄时其阳性率仍为14．3％。（4）城市新生儿PIVK－Ⅱ阳性率随出生体重增加和孕周增加而呈现下降趋势。结论：我国新生儿和婴儿存在较严重维生素K缺乏亚临床现象，应大规模实施维生素K预防干预的措施。     

极低出生体重儿低钙血症 维生素K缺乏症发生及预防投药量的探讨

目的:研究极低出生体重儿(verylowbirthweightinfantVLBWI)出生后低钙血症和维生素K缺乏症发生率、时间及预防方法。VLBWI出生后连续7日检测血钙及凝血酶原时间活动度(PA)。血清钙<7mg/dl者诊断为低钙血症,PA<30%者诊断为维生素K缺乏症。结果:VLBWI的62例中54例(87.1%)有低钙血症,43例(79.6%)的低钙血症发生在出生后第1天。葡萄糖酸钙30mg·kg·d连用5d后,49例(90.7%)血清钙恢复正常。62例维生素K缺乏症发生者中有38例(61.2%),其中出生时发生者为16例(42.1%),出生24h内发生者为20例(52.6%)。出生48h发生2例(5.3%)。38例维生素K缺乏症患儿均一次性肌注维生素K1(3mg)后,34例(89.5%)于注射后第1日PA恢复正常。结论:VLBWI易患低钙血症和维生素缺乏症。早期采取干预措施预防其发生发展。     

38例住院患儿维生素K营养状况分析

目的了解住院儿童维生素K的营养状况。方法EuSA法测定2005年10月至2005年12月在唐山市人民医院的38例儿科住院患儿的血浆凝血酶原前体蛋白（protein induced by vitamin K absence or antagonists-Ⅱ，PIVKA-Ⅱ）含量（正常值〈2ng／ml）。结果本组38例因感染性疾病住院的4个月至12岁患儿中，血浆凝血酶原前体蛋白含量≥2ng／ml为16例，阳性率为42．11％。本研究显示患儿年龄与血浆凝血酶原前体蛋白含量无相关性（r=-0．2369，P=0．1521）；病程（d）与血浆凝血酶原前体蛋白含量无相关性（r=-0．2676，P=0．1043）。结论本组大部分住院患儿存在亚临床维生素K缺乏，应引起高度重视。     

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.     

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.