血清抗链球菌溶血素O效价与强直性脊柱炎病情及不同药物治疗影响的关联性研究

目的 探讨血清抗链球菌溶血素O（anti-streptolysin O，ASO）效价与强直性脊柱炎（ankylosing spondylitis，AS）疾病活动关联性，分析不同药物治疗对ASO效价的影响。方法 采取回顾性队列研究，收集AS患者治疗前后血清ASO、血沉（erythrocyte sedimentation rate，ESR）、C反应蛋白（c-reactive protein，CRP）、血白细胞（white blood cell，WBC）、血小板（platelet，PLT）、免疫球蛋白（immunoglobulin，Ig）以及治疗用药资料。分析AS不同时期血清ASO效价与ESR、CRP、WBC、PLT、Ig关联性，评估病情活动、不同药物对ASO效价的影响。结果 1 946例入选AS患者中，926例检测了血清ASO，效价升高者244例，ASO阳性率为26.35%。其中43例患者治疗后定期复查了2次ASO及相关指标。治疗前血清ASO效价与ESR、CRP均有正相关，差异具有统计学意义（均有P<0.05）；治疗后ASO效价降低，差异有统计学意义（χ2=51.907，P<0.001）；其中未用长效青霉者和使用长效青霉者治疗后ASO效价均显著降低，治疗前后三组间差异均有统计学意义（χ2=11.711，P=0.003；χ2=7.042，P=0.030），且使用长效青霉素者比未用者ASO效价降低更明显，两组间差异有统计学意义（F=3.404，P=0.049）。结论 AS治疗前血清ASO效价与病情活动有关，治疗后效价降低，抗感染治疗降低程度更明显。     

超敏C反应蛋白检测在强直性脊柱炎与类风湿性关节炎病情监测中的应用

目的探讨全定量免疫荧光超敏C反应蛋白（HS—CRP）检测在强直性脊柱炎（AS）和类风湿关节炎（RA）病情监测中的应用价值。方法采用全定量免疫荧光HS—CRP检测方法，对43例As患者和62例RA患者及30例健康体检者进行血清HS—CRP检测。结果该方法的批内重复性CV％为4．98％～3．68％；批间稳定性CV％为4．57％-5.42％：与美国德灵DadeBehring（BNP）特定蛋白分析仪测定结果的相关性良好（棚．997）；AS患者与RA患者在活动期HS—CRP水平与阳性率均高于对照组；AS与RA患者活动期HS—CRP水平及阳性率均高于非活动期（P〈0．01）；AS活动期与RA活动期、AS非活动期与RA非活动期之间HS—CRP水平及阳性率差别均无统计学意义（P〉0.05）。结论HS—CRP与AS及RA的病情活动程度有关，可作为监控病情进展的有效参考指标。HS—CRP在AS与RA的鉴别诊断中应用意义不大。     

儿童强直性脊柱炎HLA-B27抗原表达与骨损害关系的临床研究

目的探讨HLA—B27表达与儿童强直性脊柱炎骨代谢功能损伤的关系。方法检测HIA—B27不同型别的儿童强直性脊柱炎患者和对照群体骨代谢功能指标。结果分析显示各实验组间各项指标存在有不同程度的差异（FCT=87．3，P〈0．01；FBGP=197．1，P〈0．01），具体表现为：（可检测水平B27＋AS〉B27-AS〉B27＋对照和B27-对照（q12=7．48，q13=16．33，q14=20．87，q23=9．01，q24=12．47，P均〈0．01），而B27＋和B27-对照之间差异无显著意义（q34=2．33，P〉0．05）；BGP检测水平B27＋AS〉B27-AS〉B27＋对照和B27-对照（q12=11．6，q13=25．8，q14=30．7，q23=14．3，q24=17．7，P均〈0．01），而B27＋和B27-对照之间差异亦无显著意义（q34=1．69，P〉0．05）。结论儿童强直性脊柱炎HLA—B27的表达与骨质损害具有一定的关联性，为临床深入研究提供了有益的线索。     

单核细胞趋化蛋白-1与糖尿病心血管并发症的相关分析

目的探讨单核细胞趋化蛋白-1（MCP-1）与糖尿病及其大血管并发症的关系。方法在社区常住人口中筛查出糖尿病患者65例，糖耐量受损患者64例，正常对照组60例，对上述人群经颈动脉超声检查颈内中膜厚度（IMT），根据其厚度判断是否合并动脉粥样硬化（AS），同时用夹心酶联免疫法检测单核细胞趋化蛋白-1（MCP-1），比较IGT合并AS，IGT无AS，DM合并AS，DM元，AS和正常对照组间MCP-1的关系。结果MCP-1正常对照组（12．00±9．33）pg／mL，IGT（20．47±18．23）pg／ml和DM（36．33±13．14）pg／ml，P=0．000；IGT合并AS（32．1±8．2）pg／ml高于IGT无AS[（15．7±8．7）pg／ml，P=0．007]，DM合并AS（43．5±8，8）pg／ml高于DM无AS[（28．3±12．8）pg／ml，P=0．014]。MCP-1与IMT呈正相关（r=0．307，P=0．001）。二分类logistic回归分析入选的变量为年龄，MCP-1，性别。结论单核细胞趋化蛋白-1与糖代谢异常和动脉粥样硬化关系密切，有可能成为未来治疗糖尿病和大血管并发症的靶点。     

湖南汉族强直性脊柱炎患者肿瘤坏死因子-α-308位点基因多态性分析

目的探讨肿瘤坏死因子-α（TNF-α）-308位点基因多态性与强直性脊柱炎（AS）之间的相关性。方法应用多聚酶链反应-限制性片段长度多态性（PCR-RFLP）方法分析150例湖南汉族As患者和100例正常人TNF-α-308位点基因多态性,按不同基因型分类整理AS患者的临床资料（血沉,C-反应蛋白,脊柱炎症评分和骶髂关节放射学分级等）,运用活性酶联免疫吸附法检测血清TNF-α水平。结果AS患者与正常对照组的TNF-α-308G／G、G／A和A／A基因型频率分别为82％vs87％、14％vs14％和4％vs0％（P〉0．05）,AS患者TNF-α-308位点G／G基因型血清TNF-α水平显著低于G／A基因型（t=13．325,P〈0．01）和A／A基因型患者（t=9．756,P〈0．01）。结论TNF-α-308位点基因多态性和湖南汉族AS患者的发病无关,但能影响AS患者的病变部位及程度;TNF-α-308位点基因多态性与血清TNF-α水平有关。     

血液光量子治疗对强直性脊柱炎患者免疫学指标的影响

目的观察血液光量子治疗(UBIO)对强直性脊柱炎(AS)患者免疫学指标的影响,为临床治疗强直性脊柱炎提供参考依据。方法将首次诊断强直性脊柱炎患者45例随机分为单纯服药组(n=22)和服药+UBIO治疗组(n=23),即2个组均常规服用柳氮磺胺嘧啶片,其中1个组在服药基础上给予血液光量子治疗。检测2个组患者的白细胞(WBC)、抗链球菌O(ASO)、C-反应蛋白(CRP)及血沉(ESR),一些相关急病学免疫球蛋白(IgG、IgA、IgM)、补体成分(C3、C4)。结果 2个组患者在治疗1个月后,白细胞升高,ASO、CRP水平及血沉下降,治疗前后组间比较差异均有显著性(P<0.05),组间比较差异无显著性(P>0.05)。治疗2个月和3个月后,服药+UBIO治疗组的WBC计数高于单纯服药组,ASO、CRP、ESR水平低于单纯服药组,差异有显著性(P<0.05)。治疗2个月后,服药+UBIO组IgG为(8.68±1.10)g/L,IgA为(3.10±0.58)g/L,明显低于单纯服药组〔IgG(9.08±1.11)g/L,IgA(3.78±0.58)g/L〕,差异有显著性(P<0.05);IgM、C3、C4水平组间差异无显著性(P>0.05)。治疗3个月后,服药+UBIO组IgG、IgA、IgM、C3、C4水平明显低于单纯服药组,差异均有显著性(P<0.05)。结论血液光量子治疗方法对改善AS患者的免疫功能有一定作用。     

血清铁蛋白在强直性脊柱炎诊治中的价值

目的 探究血清铁蛋白在强直性脊柱炎(AS)中诊治和监测病情活动度的价值。方法 收集本院85例AS患者为疾病组,另外同期收集在本院体检的82例健康者为对照组,依据Bath强直性脊柱炎病情活动指标(BASDAI)分为缓解期和活动期期,检测所有入选人员的血清铁蛋白(SFe)、人类白细胞抗原(HLA)-B27(HLA-B27)、C-反应蛋白(CRP)和红细胞沉降率(ESR)水平,并统计分析。结果 AS组患者血清铁蛋白水平显著高于对照组(P 0. 05),活动期的血清铁蛋白显著高于缓解期(P 0. 05)。血清铁蛋白的灵敏度和特异度分别为82. 1%和73. 4%,SFe与BASDAI、CRP和ESR均呈正相关(r值分别为0. 84、0. 76、0. 68,P 0. 05)。结论 血清铁蛋白不但是AS诊断指标之一,而且也是监测AS患者疾病活动的重要指标。     

感染性疾病患儿 CRP、PA和 WBC的测定及临床意义

目的：探讨C－反应蛋白（ CRP）、前清蛋白（ PA）及白细胞计数（ WBC）水平测定在感染性疾病患儿诊断治疗中的临床意义。方法选择2011年9月至2013年9月于瑞安市人民医院进行治疗的72例感染性疾病患儿作为研究对象，其中36例细菌性感染患儿（细菌组），36例病毒性感染患儿（病毒组），所有患者均给予对症治疗，比较两组患儿在治疗前后血清CRP、PA及WBC水平，选取36例健康体检儿童作为对照。结果治疗前细菌组血清CRP、WBC水平明显高于病毒组及对照组，血清PA水平显著低于病毒组及对照组（与病毒组相比，tCRP ＝10．68，tWBC ＝4．96，tPA ＝11．32；与对照组相比，tCRP ＝11．75，tWBC ＝5．37，tPA ＝12．08；均P＜0．05），治疗后3组均无统计学差异（FCRP ＝1．75，FWBC ＝2．07，FPA ＝2．04；均P＞0．05）；治疗后细菌组血清CRP、PA及WBC水平与治疗前比较均有统计学差异（tCRP ＝9．478，tWBC ＝5．11，tPA ＝12．34；均P＜0．05）；以CRP≥8mg／L，WBC≥10×109／L，PA≤165mg／L为阳性，感染性疾病患儿中CRP、WBC、PA细菌组阳性率与病毒组和对照组比较，差异均有统计学意义（与病毒组比较χ2CRP ＝10．90，χ2WBC ＝4．13，χ2PA ＝20．63；与对照组比较χ2CRP ＝22．86，χ2WBC ＝7．60，χ2PA ＝28．68；均P＜0．05），病毒组与对照组比较，差异均无统计学意义（χ2CRP ＝1．35，χ2WBC ＝0．73，χ2PA ＝0．63；均P＞0．05）。各组指标经相关性分析发现，CRP与WBC之间呈现直线正相关（r＝0．56，P＜0．01），PA与CRP以及PA与WBC之间均呈现负相关（r值分别为－0．51，0．23，均P＜0．01）。结论 CRP、PA及WBC联合检测对感染性疾病患儿诊断治疗具有重要临床意义，CRP、PA水平变化可作为反映儿童细菌感染敏感指标。     

CD36基因多态性与急性冠脉综合征关联性的研究

目的　探讨新疆地区汉族、维吾尔（维）族人群CD36基因多态性与急性冠脉综合征（ACS）的关联性。方法　采用聚合酶链反应一限制性片段长度多态性（PCR-RFLP）方法,对522例ACS患者和1215名健康体检者CD36基因单核苷酸多态性（SNP）进行基因型鉴定。结果　在汉族和维族人群中,ACS组和对照组rs1722505的基因型及等位基因分布差异均有统计学意义（P值均<0．05）。在汉族人群ACS组中rs17154181的A等位基因频率明显低于对照组（P=0．034）。logistic回归分析在调整混杂因素后,在汉族和维族人群中rs1722505的AA+AG基因型者患ACS风险明显高于GG基因型者,汉族（DR=1．436,95％CI：1．047～1．970,P=0．025）,维族（OR=1．589,95％CI：1．009～2．473,P=0．046）。汉族人群rs17154181的AA+AG基因型者患ACS风险明显低于GG基因型者（OR=O．667,95％CI：0．494。0．900,P=0．008）。结论　CD36基因多态性在新疆地区汉族和维族人群闻存在差异,且CD36基因可能与两族人群ACS的发生相关,rs1722505的AA+AG基因型可能是汉族和维族人群ACS的危险因素,rs18154181的AA+AG基因型可能是汉族人群ACS的保护因素。     

结节性红斑患者白细胞计数、C-反应蛋白、血沉及抗链球菌溶血素O的测定及临床意义

目的探讨白细胞计数(WBC)、C-反应蛋白(CRP)、血沉(ESR)及抗链球菌溶血素O(ASO)在结节性红斑患者中的变化及临床诊断意义。方法收集2017年1月-2018年5月门诊56例结节性红斑患者作为观察组,选取同期50例健康体检者作为对照组。检测结节性红斑患者与对照组中WBC、CRP、ESR、ASO水平并进行对比分析,比较组间差异。结果结节性红斑患者的WBC、CRP、ESR、ASO水平均显著高于对照组,结节性红斑患者中WBC、CRP、ESR、ASO阳性率均高于对照组,差异均有统计学意义(P 0. 05)。结论综合检测WBC、CRP、ESR及ASO对鉴别结节性红斑病因,治疗及预后评估均有辅助作用。     

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.